1
|
Takahashi S, Kishino A, Miyai K, Takishima S, Omori T, Furuno H, Iemura R, Ono M, Ogasawara K, Sutani A, Nagasawa M. Impact of the COVID-19 Pandemic on Epidemiological Trends in Pediatric Cervical Abscess-Forming Infections. Microorganisms 2025; 13:190. [PMID: 39858958 PMCID: PMC11767812 DOI: 10.3390/microorganisms13010190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 01/07/2025] [Accepted: 01/15/2025] [Indexed: 01/27/2025] Open
Abstract
Abscess-forming cervical bacterial infections are rare and serious infections. Methods: We retrospectively examined the trends in abscess-forming cervical bacterial infections in children who required inpatient treatment in three periods before (January 2016 to June 2020), during (July 2020 to December 2022) and after the COVID-19 pandemic (January 2023 to June 2024). Results: The study included 96 patients with superficial cervical abscesses and 111 patients with deep cervical abscesses (34 with retropharyngeal abscesses, 51 with peritonsillar abscesses, and 26 with deep neck abscesses). Both decreased during the COVID-19 pandemic and increased significantly after the COVID-19 pandemic compared to before the COVID-19 pandemic (0.94 ± 0.92 vs. 0.50 ± 0.72 vs. 1.67 ± 1.11/month, 0.93 ± 0.96 vs. 0.60 ± 0.84 vs. 2.39 ± 1.70/month), which was related with the trends of respiratory viral infections. Bacteria were identified in 79 of the 97 cases in which punctures were performed; however, there were no significant differences between the three periods. No significant changes were found in the pharyngeal streptococcal antigen positivity rate, rate of oral antibiotic use before hospitalization, length of hospital stay, or duration of antibiotic administration before and after the COVID-19 pandemic. Conclusions: The COVID-19 pandemic has affected the epidemiology of cervical abscess-forming bacterial infections in children. Although the reemergence of respiratory viral infections after the COVID-19 pandemic may be a factor, the cause of the doubling in the number of neck abscesses after the COVID-19 pandemic remains unclear and requires further investigation.
Collapse
Affiliation(s)
- Shuhei Takahashi
- Department of Pediatrics, Musashino Red Cross Hospital, 1-26-1, Kyonan-cho, Musashino-City, Tokyo 180-8610, Japan;
- Department of Pediatrics and Developmental Biology, Institute of Science Tokyo, 1-5-45 Bunkyo-ku, Tokyo 113-8519, Japan
| | - Ai Kishino
- Department of Pediatrics, Tokyo Bay Urayasu-Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu-City, Chiba 279-0001, Japan;
| | - Kentaro Miyai
- Department of Pediatrics, Tokyo Kita Medical Center, 4-17-56 Akabanedai, Kita-ku, Tokyo 115-0053, Japan;
| | - Shigeru Takishima
- Department of Pediatrics, Soka Municipal Hospital, 2-21-1 Soka, Soka-City, Saitama 340-8560, Japan;
| | - Tae Omori
- Department of Pediatrics, Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan;
| | - Hidehiro Furuno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital, 3-31-1 Isobe, Mihama-ku, Chiba-City, Chiba 261-0012, Japan; (H.F.); (R.I.); (M.O.)
| | - Ryosei Iemura
- Department of Pediatrics, Chiba Kaihin Municipal Hospital, 3-31-1 Isobe, Mihama-ku, Chiba-City, Chiba 261-0012, Japan; (H.F.); (R.I.); (M.O.)
| | - Makoto Ono
- Department of Pediatrics, Chiba Kaihin Municipal Hospital, 3-31-1 Isobe, Mihama-ku, Chiba-City, Chiba 261-0012, Japan; (H.F.); (R.I.); (M.O.)
| | - Keisuke Ogasawara
- Department of Pediatrics, Tuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura-City, Ibaraki 300-0028, Japan;
| | - Akito Sutani
- Department of Pediatrics, Kawaguchi Municipal Medical Center, 180 Nishiaraijuku, Kawaguchi-City, Saitama 333-0833, Japan;
| | - Masayuki Nagasawa
- Department of Pediatrics, Musashino Red Cross Hospital, 1-26-1, Kyonan-cho, Musashino-City, Tokyo 180-8610, Japan;
- Department of Pediatrics and Developmental Biology, Institute of Science Tokyo, 1-5-45 Bunkyo-ku, Tokyo 113-8519, Japan
| |
Collapse
|
2
|
van Zandvoort K, Hassan AI, Bobe MO, Pell CL, Ahmed MS, Ortika BD, Ibrahim S, Abdi MI, Karim MA, Eggo RM, Ali SY, Hinds J, Soleman SM, Cummings R, McGowan CR, Mulholland EK, Hergeye MA, Satzke C, Checchi F, Flasche S. Pre-vaccination carriage prevalence of Streptococcus pneumoniae serotypes among internally displaced people in Somaliland: a cross-sectional study. Pneumonia (Nathan) 2024; 16:25. [PMID: 39633426 PMCID: PMC11619265 DOI: 10.1186/s41479-024-00148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 09/23/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Populations affected by humanitarian crises likely experience high burdens of pneumococcal disease. Streptococcus pneumoniae carriage estimates are essential to understand pneumococcal transmission dynamics and the potential impact of pneumococcal conjugate vaccines (PCV). Over 100 million people are forcibly displaced worldwide, yet here we present only the second pneumococcal carriage estimates for a displaced population. METHODS In October 2019, we conducted a cross-sectional survey among internally displaced people (IDP) living in Digaale, a permanent IDP camp in Somaliland where PCV has not been implemented. We collected nasopharyngeal swab samples from 453 residents which were assessed for presence of pneumococci and serotyped using DNA microarray. RESULTS We found that pneumococcal carriage prevalence was 36% (95%CI 31-40) in all ages, and 70% (95%CI 64-76) in children under 5. The three most common serotypes were vaccine serotypes 6B, 19F, and 23F. We estimated that the serotypes included in the 10-valent PNEUMOSIL vaccine were carried by 41% (95%CI 33-49) of all pneumococcal carriers and extrapolated that they caused 52% (95%CI 35-70) of invasive pneumococcal disease. We found some evidence that pneumococcal carriage was associated with recent respiratory symptoms, the total number of physical contacts made, and with malnutrition in children under 5. Through linking with a nested contact survey we projected that pneumococcal exposure of children under 2 was predominantly due to contact with children aged 2-5 (39%; 95%CI 31-48) and 6-14 (25%; 95%CI 17-34). CONCLUSIONS These findings suggest considerable potential for direct and indirect protection against pneumococcal disease in Digaale through PCV use in children and potentially adolescents.
Collapse
Affiliation(s)
- Kevin van Zandvoort
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Casey L Pell
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Belinda D Ortika
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Saed Ibrahim
- Save the Children International Somaliland, Hargeisa, Somaliland
| | | | - Mustapha A Karim
- Republic of Somaliland Ministry of Health Development, Hargeisa, Somaliland
| | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Saleban Yousuf Ali
- Republic of Somaliland Ministry of Health Development, Hargeisa, Somaliland
| | - Jason Hinds
- Institute for Infection and Immunity, St. George's, University of London, London, UK
- London Bioscience Innovation Centre, BUGS Bioscience, London, UK
| | | | | | - Catherine R McGowan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Save the Children UK, London, UK
| | - E Kim Mulholland
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Catherine Satzke
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
3
|
Mitsi E, Nikolaou E, Goncalves A, Blizard A, Hill H, Farrar M, Hyder-Wright A, Akeju O, Hamilton J, Howard A, Elterish F, Solorzano C, Robinson R, Reiné J, Collins AM, Gordon SB, Moxon RE, Weiser JN, Bogaert D, Ferreira DM. RSV and rhinovirus increase pneumococcal carriage acquisition and density, whereas nasal inflammation is associated with bacterial shedding. Cell Host Microbe 2024; 32:1608-1620.e4. [PMID: 39181126 DOI: 10.1016/j.chom.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/14/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024]
Abstract
Epidemiological studies report the impact of co-infection with pneumococcus and respiratory viruses upon disease rates and outcomes, but their effect on pneumococcal carriage acquisition and bacterial load is scarcely described. Here, we assess this by combining natural viral infection with controlled human pneumococcal infection in 581 healthy adults screened for upper respiratory tract viral infection before intranasal pneumococcal challenge. Across all adults, respiratory syncytial virus (RSV) and rhinovirus asymptomatic infection confer a substantial increase in secondary infection with pneumococcus. RSV also has a major impact on pneumococcal density up to 9 days post challenge. We also study rates and kinetics of bacterial shedding through the nose and oral route in a subset. High levels of pneumococcal colonization density and nasal inflammation are strongly correlated with increased odds of nasal shedding as opposed to cough shedding. Protection against respiratory viral infections and control of pneumococcal density may contribute to preventing pneumococcal disease and reducing bacterial spread.
Collapse
Affiliation(s)
- Elena Mitsi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, UK; Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Elissavet Nikolaou
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Andre Goncalves
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, UK; Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Annie Blizard
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Helen Hill
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Madlen Farrar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Angela Hyder-Wright
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Oluwasefunmi Akeju
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, UK
| | - Josh Hamilton
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Ashleigh Howard
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Filora Elterish
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, UK
| | - Carla Solorzano
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, UK; Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Ryan Robinson
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Jesus Reiné
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, UK; Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Andrea M Collins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Stephen B Gordon
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Malawi Liverpool Wellcome-Trust Programme, Queen Elizabeth Central Hospital Campus, P.O. Box 30096, Blantyre, Malawi
| | - Richard E Moxon
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, UK
| | - Jeffrey N Weiser
- Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA
| | - Debby Bogaert
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3584 EA Utrecht, the Netherlands
| | - Daniela M Ferreira
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, UK; Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| |
Collapse
|
4
|
Watkins TA, Green AB, Amat JA, Cheemarla NR, Hänsel K, Lozano R, Dudgeon SN, Germain G, Landry ML, Schulz WL, Foxman EF. High burden of viruses and bacterial pathobionts drives heightened nasal innate immunity in children. J Exp Med 2024; 221:e20230911. [PMID: 38949638 PMCID: PMC11215523 DOI: 10.1084/jem.20230911] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 04/17/2024] [Accepted: 06/12/2024] [Indexed: 07/02/2024] Open
Abstract
Studies during the COVID-19 pandemic showed that children had heightened nasal innate immune responses compared with adults. To evaluate the role of nasal viruses and bacteria in driving these responses, we performed cytokine profiling and comprehensive, symptom-agnostic testing for respiratory viruses and bacterial pathobionts in nasopharyngeal samples from children tested for SARS-CoV-2 in 2021-22 (n = 467). Respiratory viruses and/or pathobionts were highly prevalent (82% of symptomatic and 30% asymptomatic children; 90 and 49% for children <5 years). Virus detection and load correlated with the nasal interferon response biomarker CXCL10, and the previously reported discrepancy between SARS-CoV-2 viral load and nasal interferon response was explained by viral coinfections. Bacterial pathobionts correlated with a distinct proinflammatory response with elevated IL-1β and TNF but not CXCL10. Furthermore, paired samples from healthy 1-year-olds collected 1-2 wk apart revealed frequent respiratory virus acquisition or clearance, with mucosal immunophenotype changing in parallel. These findings reveal that frequent, dynamic host-pathogen interactions drive nasal innate immune activation in children.
Collapse
Affiliation(s)
- Timothy A. Watkins
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Alex B. Green
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Julien A.R. Amat
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Nagarjuna R. Cheemarla
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Katrin Hänsel
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Richard Lozano
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sarah N. Dudgeon
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Gregory Germain
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Marie L. Landry
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Wade L. Schulz
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ellen F. Foxman
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
5
|
Mushunje PK, Dube FS, Olwagen C, Madhi S, Odland JØ, Ferrand RA, Nicol MP, Abotsi RE. Characterization of bacterial and viral pathogens in the respiratory tract of children with HIV-associated chronic lung disease: a case-control study. BMC Infect Dis 2024; 24:637. [PMID: 38926682 PMCID: PMC11201860 DOI: 10.1186/s12879-024-09540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Chronic lung disease is a major cause of morbidity in African children with HIV infection; however, the microbial determinants of HIV-associated chronic lung disease (HCLD) remain poorly understood. We conducted a case-control study to investigate the prevalence and densities of respiratory microbes among pneumococcal conjugate vaccine (PCV)-naive children with (HCLD +) and without HCLD (HCLD-) established on antiretroviral treatment (ART). METHODS Nasopharyngeal swabs collected from HCLD + (defined as forced-expiratory-volume/second < -1.0 without reversibility postbronchodilation) and age-, site-, and duration-of-ART-matched HCLD- participants aged between 6-19 years enrolled in Zimbabwe and Malawi (BREATHE trial-NCT02426112) were tested for 94 pneumococcal serotypes together with twelve bacteria, including Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), Moraxella catarrhalis (MC), and eight viruses, including human rhinovirus (HRV), respiratory syncytial virus A or B, and human metapneumovirus, using nanofluidic qPCR (Standard BioTools formerly known as Fluidigm). Fisher's exact test and logistic regression analysis were used for between-group comparisons and risk factors associated with common respiratory microbes, respectively. RESULTS A total of 345 participants (287 HCLD + , 58 HCLD-; median age, 15.5 years [IQR = 12.8-18], females, 52%) were included in the final analysis. The prevalence of SP (40%[116/287] vs. 21%[12/58], p = 0.005) and HRV (7%[21/287] vs. 0%[0/58], p = 0.032) were higher in HCLD + participants compared to HCLD- participants. Of the participants positive for SP (116 HCLD + & 12 HCLD-), 66% [85/128] had non-PCV-13 serotypes detected. Overall, PCV-13 serotypes (4, 19A, 19F: 16% [7/43] each) and NVT 13 and 21 (9% [8/85] each) predominated. The densities of HI (2 × 104 genomic equivalents [GE/ml] vs. 3 × 102 GE/ml, p = 0.006) and MC (1 × 104 GE/ml vs. 1 × 103 GE/ml, p = 0.031) were higher in HCLD + compared to HCLD-. Bacterial codetection (≥ any 2 bacteria) was higher in the HCLD + group (36% [114/287] vs. (19% [11/58]), (p = 0.014), with SP and HI codetection (HCLD + : 30% [86/287] vs. HCLD-: 12% [7/58], p = 0.005) predominating. Viruses (predominantly HRV) were detected only in HCLD + participants. Lastly, participants with a history of previous tuberculosis treatment were more likely to carry SP (adjusted odds ratio (aOR): 1.9 [1.1 -3.2], p = 0.021) or HI (aOR: 2.0 [1.2 - 3.3], p = 0.011), while those who used ART for ≥ 2 years were less likely to carry HI (aOR: 0.3 [0.1 - 0.8], p = 0.005) and MC (aOR: 0.4 [0.1 - 0.9], p = 0.039). CONCLUSION Children with HCLD + were more likely to be colonized by SP and HRV and had higher HI and MC bacterial loads in their nasopharynx. The role of SP, HI, and HRV in the pathogenesis of CLD, including how they influence the risk of acute exacerbations, should be studied further. TRIAL REGISTRATION The BREATHE trial (ClinicalTrials.gov Identifier: NCT02426112 , registered date: 24 April 2015).
Collapse
Affiliation(s)
- Prince K Mushunje
- Department of Molecular and Cell Biology & Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| | - Felix S Dube
- Department of Molecular and Cell Biology & Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- School of Medicine, University of Lusaka, Lusaka, Zambia
| | - Courtney Olwagen
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir Madhi
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jon Ø Odland
- Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
- International Research Laboratory for Reproductive Ecotoxicology (IL RET), The National Research University Higher School of Economics, Moscow, Russia
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark P Nicol
- Marshall Centre, Division of Infection and Immunity, School of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Regina E Abotsi
- Department of Molecular and Cell Biology & Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pharmaceutical Microbiology, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| |
Collapse
|
6
|
Howard LM, Grijalva CG. Impact of respiratory viral infections on nasopharyngeal pneumococcal colonization dynamics in children. Curr Opin Infect Dis 2024; 37:170-175. [PMID: 38437245 DOI: 10.1097/qco.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE OF REVIEW Prevention of acute respiratory illnesses (ARI) in children is a global health priority, as these remain a leading cause of pediatric morbidity and mortality throughout the world. As new products and strategies to prevent respiratory infections caused by important pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza, respiratory syncytial virus and pneumococcus are advancing, increasing evidence suggests that these and other respiratory viruses and pneumococci may exhibit interactions that are associated with altered colonization and disease dynamics. We aim to review recent data evaluating interactions between respiratory viruses and pneumococci in the upper respiratory tract and their potential impact on pneumococcal colonization patterns and disease outcomes. RECENT FINDINGS While interactions between influenza infection and subsequent increased susceptibility and transmissibility of colonizing pneumococci have been widely reported in the literature, emerging evidence suggests that human rhinovirus, SARS-CoV-2, and other viruses may also exhibit interactions with pneumococci and alter pneumococcal colonization patterns. Additionally, colonizing pneumococci may play a role in modifying outcomes associated with respiratory viral infections. Recent evidence suggests that vaccination with pneumococcal conjugate vaccines, and prevention of colonization with pneumococcal serotypes included in these vaccines, may be associated with reducing the risk of subsequent viral infection and the severity of the associated illnesses. SUMMARY Understanding the direction and dynamics of viral-pneumococcal interactions may elucidate the potential effects of existing and emerging viral and bacterial vaccines and other preventive strategies on the health impact of these important respiratory pathogens.
Collapse
Affiliation(s)
- Leigh M Howard
- Department of Pediatrics, Division of Infectious Diseases
| | - Carlos G Grijalva
- Departments of Health Policy and Biomedical Informatics, Division of Pharmacoepidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
7
|
Wang L, Lu S, Guo Y, Liu J, Wu P, Yang S. Comparative study of diagnostic efficacy of sputum and bronchoalveolar lavage fluid specimens in community-acquired pneumonia children treated with fiberoptic bronchoscopy. BMC Infect Dis 2023; 23:565. [PMID: 37644391 PMCID: PMC10466683 DOI: 10.1186/s12879-023-08522-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is usually diagnosed in children, and the type of respiratory specimen is critical. Differences in pathogens detection between induced sputum (IS) and bronchoalveolar lavage fluid (BALF) have not been evaluated. METHODS In 2018, paired sputum and BALF samples from CAP hospitalised children with indications for bronchoalveolar lavage (BAL) were subjected to multiplex PCR for the detection of 11 common respiratory pathogens. RESULTS A total of 142 children with paired sputum and BALF were tested. The overall positivity rate was 85.9% (122/142) for sputum and 80.3% (114/142) for BALF. The two specimens presented almost perfect agreement between the detection on M. pneumoniae, influenza A, influenza B, bocavirus and RSV. In contrast, adenovirus had the lowest kappa value of 0.156, and a false negative rate (FNR) of 66.7%. Rhinovirus had the highest false positive rate (FPR) as 18.5%. The consistent rate was significantly higher in school-age children than those under 1 year old (p = .005). Bacterial co-infection in BALF specimens were observed in 14.8% (21/142). Of the 11 discordant pairs of specimens, 9 cases were sputum(+)/BALF(-) with adenovirus predominating. CONCLUSION Our findings suggest that the consistency of results between sputum and BALF is pathogen specific. Careful consideration needs to be given to whether sputum can be used as a substitute for BALF when children are young or co-infections with bacteria are suspected.
Collapse
Affiliation(s)
- Le Wang
- Institute of Pediatric Research, Children's Hospital of Hebei Province, 133 Zhonghua South Street, Shijiazhuang, 050031, Hebei Province, China
| | - Sukun Lu
- Institute of Pediatric Research, Children's Hospital of Hebei Province, 133 Zhonghua South Street, Shijiazhuang, 050031, Hebei Province, China
| | - Yinghui Guo
- Institute of Pediatric Research, Children's Hospital of Hebei Province, 133 Zhonghua South Street, Shijiazhuang, 050031, Hebei Province, China
| | - Jianhua Liu
- Institute of Pediatric Research, Children's Hospital of Hebei Province, 133 Zhonghua South Street, Shijiazhuang, 050031, Hebei Province, China
| | - Peng Wu
- Institute of Pediatric Research, Children's Hospital of Hebei Province, 133 Zhonghua South Street, Shijiazhuang, 050031, Hebei Province, China
| | - Shuo Yang
- Institute of Pediatric Research, Children's Hospital of Hebei Province, 133 Zhonghua South Street, Shijiazhuang, 050031, Hebei Province, China.
| |
Collapse
|
8
|
Robinson RE, Myerscough C, He N, Hill H, Shepherd WA, Gonzalez-Dias P, Liatsikos K, Latham S, Fyles F, Doherty K, Hazenberg P, Shiham F, Mclenghan D, Adler H, Randles V, Zaidi S, Hyder-Wright A, Mitsi E, Burhan H, Morton B, Rylance J, Lesosky M, Gordon SB, Collins AM, Ferreira DM. Comprehensive review of safety in Experimental Human Pneumococcal Challenge. PLoS One 2023; 18:e0284399. [PMID: 37141259 PMCID: PMC10159102 DOI: 10.1371/journal.pone.0284399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Experimental Human Pneumococcal Challenge (EHPC) involves the controlled exposure of adults to a specific antibiotic-sensitive Streptococcus pneumoniae serotype, to induce nasopharyngeal colonisation for the purpose of vaccine research. The aims are to review comprehensively the safety profile of EHPC, explore the association between pneumococcal colonisation and frequency of safety review and describe the medical intervention required to undertake such studies. METHODS A single-centre review of all EHPC studies performed 2011-2021. All recorded serious adverse events (SAE) in eligible studies are reported. An unblinded meta-analysis of collated anonymised individual patient data from eligible EHPC studies was undertaken to assess the association between experimental pneumococcal colonisation and the frequency of safety events following inoculation. RESULTS In 1416 individuals (median age 21, IQR 20-25), 1663 experimental pneumococcal inoculations were performed. No pneumococcal-related SAE have occurred. 214 safety review events were identified with 182 (12.85%) participants presenting with symptoms potentially in keeping with pneumococcal infection, predominantly in pneumococcal colonised individuals (colonised = 96/658, non-colonised = 86/1005, OR 1.81 (95% CI 1.28-2.56, P = <0.001). The majority were mild (pneumococcal group = 72.7% [120/165 reported symptoms], non-pneumococcal = 86.7% [124/143 reported symptoms]). 1.6% (23/1416) required antibiotics for safety. DISCUSSION No SAEs were identified directly relating to pneumococcal inoculation. Safety review for symptoms was infrequent but occurred more in experimentally colonised participants. Most symptoms were mild and resolved with conservative management. A small minority required antibiotics, notably those serotype 3 inoculated. CONCLUSION Outpatient human pneumococcal challenge can be conducted safely with appropriate levels of safety monitoring procedures in place.
Collapse
Affiliation(s)
- Ryan E Robinson
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Christopher Myerscough
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nengjie He
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen Hill
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Wendi A Shepherd
- North West Health Protection Team, UK Health Security Agency, Liverpool, United Kingdom
| | - Patricia Gonzalez-Dias
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Konstantinos Liatsikos
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Samuel Latham
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Fred Fyles
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Klara Doherty
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - Phoebe Hazenberg
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Fathimath Shiham
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniella Mclenghan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hugh Adler
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Vicki Randles
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Seher Zaidi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Angela Hyder-Wright
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Clinical Research Network, Liverpool, United Kingdom
| | - Elena Mitsi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hassan Burhan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Ben Morton
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jamie Rylance
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Maia Lesosky
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Stephen B Gordon
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Andrea M Collins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Daniela M Ferreira
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
9
|
Beentjes D, Shears RK, French N, Neill DR, Kadioglu A. Mechanistic Insights into the Impact of Air Pollution on Pneumococcal Pathogenesis and Transmission. Am J Respir Crit Care Med 2022; 206:1070-1080. [PMID: 35649181 PMCID: PMC9704843 DOI: 10.1164/rccm.202112-2668tr] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Streptococcus pneumoniae (the pneumococcus) is the leading cause of pneumonia and bacterial meningitis. A number of recent studies indicate an association between the incidence of pneumococcal disease and exposure to air pollution. Although the epidemiological evidence is substantial, the underlying mechanisms by which the various components of air pollution (particulate matter and gases such as NO2 and SO2) can increase susceptibility to pneumococcal infection are less well understood. In this review, we summarize the various effects air pollution components have on pneumococcal pathogenesis and transmission; exposure to air pollution can enhance host susceptibility to pneumococcal colonization by impairing the mucociliary activity of the airway mucosa, reducing the function and production of key antimicrobial peptides, and upregulating an important pneumococcal adherence factor on respiratory epithelial cells. Air pollutant exposure can also impair the phagocytic killing ability of macrophages, permitting increased replication of S. pneumoniae. In addition, particulate matter has been shown to activate various extra- and intracellular receptors of airway epithelial cells, which may lead to increased proinflammatory cytokine production. This increases recruitment of innate immune cells, including macrophages and neutrophils. The inflammatory response that ensues may result in significant tissue damage, thereby increasing susceptibility to invasive disease, because it allows S. pneumoniae access to the underlying tissues and blood. This review provides an in-depth understanding of the interaction between air pollution and the pneumococcus, which has the potential to aid the development of novel treatments or alternative strategies to prevent disease, especially in areas with high concentrations of air pollution.
Collapse
Affiliation(s)
- Daan Beentjes
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Rebecca K Shears
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Neil French
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Daniel R Neill
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Aras Kadioglu
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
10
|
Castro ALL, Camacho-Moreno G, Montañez-Ayala A, Varón-Vega F, Alvarez-Rodríguez JC, Valderrama-Beltrán S, Ariza BE, Pancha O, Santana AY, Flórez NS, Reyes P, Ruiz J, Beltran C, Prieto E, Rojas M, Urrego-Reyes J, Parellada CI. Invasive Pneumococcal Disease Characterization in Adults and Subgroups aged < 60 years and ≥ 60 years in Bogota, Colombia. IJID REGIONS 2022; 3:293-299. [PMID: 35774639 PMCID: PMC9231666 DOI: 10.1016/j.ijregi.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 11/02/2022]
Abstract
The clinical burden of IPD is high in the elderly and adults with comorbidities IPD placed a high burden on healthcare resources in the adult population The most common types causing IPD in adults were similar to those found in children Policy makers should consider pneumococcal vaccination for populations at risk
Background Methods Results Conclusions
Collapse
|
11
|
Rohde R, Friedland DR. Clinical perspectives on nasopharyngeal morphology in humans. Anat Rec (Hoboken) 2022; 305:2065-2074. [PMID: 35388627 DOI: 10.1002/ar.24926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/12/2022] [Indexed: 12/11/2022]
Abstract
The nasopharynx is an integral component of the upper aerodigestive tract, whose morphologic features share an intimate relationship with a vast array of clinical, functional, and quality of life conditions related to contemporary humans. Its composite architecture and central location amidst the nasal cavity, pharyngotympanic tube, palate, and skull base bears implications for basic physiologic functions including breathing, vocalization, and alimentation. Over the course of evolution, morphological modifications of nasopharyngeal anatomy have occurred in genus Homo which serve to distinguish the human upper aerodigestive tract from that of other mammals. Understanding of these adaptive changes from both a comparative anatomy and clinical perspective offers insight into the unique blueprint which underpins many clinical pathologies currently encountered by anthropologists, scientists, and otorhinolaryngologists alike. This discussion intends to familiarize readers with the fundamental role that nasopharyngeal morphology plays in upper aerodigestive tract conditions, with consideration of its newfound clinical relevance in the era of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Rebecca Rohde
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David R Friedland
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
12
|
Morimura A, Hamaguchi S, Akeda Y, Tomono K. Mechanisms Underlying Pneumococcal Transmission and Factors Influencing Host-Pneumococcus Interaction: A Review. Front Cell Infect Microbiol 2021; 11:639450. [PMID: 33996623 PMCID: PMC8113816 DOI: 10.3389/fcimb.2021.639450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/06/2021] [Indexed: 01/21/2023] Open
Abstract
Streptococcus pneumoniae (also called pneumococcus) is not only a commensal that frequently colonizes the human upper respiratory tract but also a pathogen that causes pneumonia, sepsis, and meningitis. The mechanism of pneumococcal infection has been extensively studied, but the process of transmission has not been fully elucidated because of the lack of tractable animal models. Novel animal models of transmission have enabled further progress in investigating pneumococcal transmission mechanisms including the processes such as pneumococcal shedding, survival in the external environment, and adherence to the nasopharynx of a new host. Herein, we present a review on these animal models, recent research findings about pneumococcal transmission, and factors influencing the host-pneumococcus interaction.
Collapse
Affiliation(s)
- Ayumi Morimura
- Department of Infection Control and Prevention, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeto Hamaguchi
- Department of Infection Control and Prevention, Osaka University Graduate School of Medicine, Osaka, Japan.,Division of Infection Control and Prevention, Osaka University Hospital, Osaka, Japan
| | - Yukihiro Akeda
- Department of Infection Control and Prevention, Osaka University Graduate School of Medicine, Osaka, Japan.,Division of Infection Control and Prevention, Osaka University Hospital, Osaka, Japan.,Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Kazunori Tomono
- Department of Infection Control and Prevention, Osaka University Graduate School of Medicine, Osaka, Japan.,Division of Infection Control and Prevention, Osaka University Hospital, Osaka, Japan
| |
Collapse
|
13
|
Hammond AJ, Binsker U, Aggarwal SD, Ortigoza MB, Loomis C, Weiser JN. Neuraminidase B controls neuraminidase A-dependent mucus production and evasion. PLoS Pathog 2021; 17:e1009158. [PMID: 33819312 PMCID: PMC8049478 DOI: 10.1371/journal.ppat.1009158] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/15/2021] [Accepted: 03/01/2021] [Indexed: 11/20/2022] Open
Abstract
Binding of Streptococcus pneumoniae (Spn) to nasal mucus leads to entrapment and clearance via mucociliary activity during colonization. To identify Spn factors allowing for evasion of mucus binding, we used a solid-phase adherence assay with immobilized mucus of human and murine origin. Spn bound large mucus particles through interactions with carbohydrate moieties. Mutants lacking neuraminidase A (nanA) or neuraminidase B (nanB) showed increased mucus binding that correlated with diminished removal of terminal sialic acid residues on bound mucus. The non-additive activity of the two enzymes raised the question why Spn expresses two neuraminidases and suggested they function in the same pathway. Transcriptional analysis demonstrated expression of nanA depends on the enzymatic function of NanB. As transcription of nanA is increased in the presence of sialic acid, our findings suggest that sialic acid liberated from host glycoconjugates by the secreted enzyme NanB induces the expression of the cell-associated enzyme NanA. The absence of detectable mucus desialylation in the nanA mutant, in which NanB is still expressed, suggests that NanA is responsible for the bulk of the modification of host glycoconjugates. Thus, our studies describe a functional role for NanB in sialic acid sensing in the host. The contribution of the neuraminidases in vivo was then assessed in a murine model of colonization. Although mucus-binding mutants showed an early advantage, this was only observed in a competitive infection, suggesting a complex role of neuraminidases. Histologic examination of the upper respiratory tract demonstrated that Spn stimulates mucus production in a neuraminidase-dependent manner. Thus, an increase production of mucus containing secretions appears to be balanced, in vivo, by decreased mucus binding. We postulate that through the combined activity of its neuraminidases, Spn evades mucus binding and mucociliary clearance, which is needed to counter neuraminidase-mediated stimulation of mucus secretions.
Collapse
Affiliation(s)
- Alexandria J. Hammond
- Department of Microbiology, New York University School of Medicine, New York, New York, United States of America
| | - Ulrike Binsker
- Department of Microbiology, New York University School of Medicine, New York, New York, United States of America
| | - Surya D. Aggarwal
- Department of Microbiology, New York University School of Medicine, New York, New York, United States of America
| | - Mila Brum Ortigoza
- Department of Microbiology, New York University School of Medicine, New York, New York, United States of America
- Department of Medicine, Division of Infectious Diseases, New York University School of Medicine, New York, New York, United States of America
| | - Cynthia Loomis
- Department of Pathology, New York University School of Medicine, New York, New York, United States of America
| | - Jeffrey N. Weiser
- Department of Microbiology, New York University School of Medicine, New York, New York, United States of America
| |
Collapse
|
14
|
Zangari T, Ortigoza MB, Lokken-Toyli KL, Weiser JN. Type I Interferon Signaling Is a Common Factor Driving Streptococcus pneumoniae and Influenza A Virus Shedding and Transmission. mBio 2021; 12:e03589-20. [PMID: 33593970 PMCID: PMC8545127 DOI: 10.1128/mbio.03589-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 01/27/2023] Open
Abstract
The dynamics underlying respiratory contagion (the transmission of infectious agents from the airways) are poorly understood. We investigated host factors involved in the transmission of the leading respiratory pathogen Streptococcus pneumoniae Using an infant mouse model, we examined whether S. pneumoniae triggers inflammatory pathways shared by influenza A virus (IAV) to promote nasal secretions and shedding from the upper respiratory tract to facilitate transit to new hosts. Here, we show that amplification of the type I interferon (IFN-I) response is a critical host factor in this process, as shedding and transmission by both IAV and S. pneumoniae were decreased in pups lacking the common IFN-I receptor (Ifnar1-/- mice). Additionally, providing exogenous recombinant IFN-I to S. pneumoniae-infected pups was sufficient to increase bacterial shedding. The expression of IFN-stimulated genes (ISGs) was upregulated in S. pneumoniae-infected wild-type (WT) but not Ifnar1-/- mice, including genes involved in mucin type O-glycan biosynthesis; this correlated with an increase in secretions in S. pneumoniae- and IAV-infected WT compared to Ifnar1-/- pups. S. pneumoniae stimulation of ISGs was largely dependent on its pore-forming toxin, pneumolysin, and coinfection with IAV and S. pneumoniae resulted in synergistic increases in ISG expression. We conclude that the induction of IFN-I signaling appears to be a common factor driving viral and bacterial respiratory contagion.IMPORTANCE Respiratory tract infections are a leading cause of childhood mortality and, globally, Streptococcus pneumoniae is the leading cause of mortality due to pneumonia. Transmission of S. pneumoniae primarily occurs through direct contact with respiratory secretions, although the host and bacterial factors underlying transmission are poorly understood. We examined transmission dynamics of S. pneumoniae in an infant mouse model and here show that S. pneumoniae colonization of the upper respiratory tract stimulates host inflammatory pathways commonly associated with viral infections. Amplification of this response was shown to be a critical host factor driving shedding and transmission of both S. pneumoniae and influenza A virus, with infection stimulating expression of a wide variety of genes, including those involved in the biosynthesis of mucin, a major component of respiratory secretions. Our findings suggest a mechanism facilitating S. pneumoniae contagion that is shared by viral infection.
Collapse
Affiliation(s)
- Tonia Zangari
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Mila B Ortigoza
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, Division of Infectious Diseases, New York University Grossman School of Medicine, New York, New York, USA
| | - Kristen L Lokken-Toyli
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Jeffrey N Weiser
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
15
|
Tay CJX, Ta LDH, Ow Yeong YX, Yap GC, Chu JJH, Lee BW, Tham EH. Role of Upper Respiratory Microbiota and Virome in Childhood Rhinitis and Wheeze: Collegium Internationale Allergologicum Update 2021. Int Arch Allergy Immunol 2021; 182:265-276. [PMID: 33588407 DOI: 10.1159/000513325] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022] Open
Abstract
There is emerging evidence that the respiratory microbiota influences airway health, and there has been intense research interest in its role in respiratory infections and allergic airway disorders. This review aims to summarize current knowledge of nasal microbiome and virome and their associations with childhood rhinitis and wheeze. The healthy infant nasal microbiome is dominated by Corynebacteriaceae and Staphylococcaceae. In contrast, infants who subsequently develop respiratory disorders are depleted of these microbes and are instead enriched with Proteobacteria spp. Although human rhinovirus and human respiratory syncytial virus are well-documented major viral pathogens that trigger rhinitis and wheezing disorders in infants, recent limited data indicate that bacteriophages may have a role in respiratory health. Future work investigating the interplay between commensal microbiota, virome, and host immunological responses is an important step toward understanding the dynamics of the nasal community in order to develop a strategical approach to combat these common childhood respiratory disorders.
Collapse
Affiliation(s)
- Carina Jing Xuan Tay
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Le Duc Huy Ta
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yu Xiang Ow Yeong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gaik Chin Yap
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Justin Jang Hann Chu
- Department of Microbiology and Immunology, Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, Singapore.,Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, .,Khoo Teck Puat- National University Children's Medical Institute, National University Health System, Singapore, Singapore, .,Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,
| |
Collapse
|
16
|
Experimental Human Challenge Defines Distinct Pneumococcal Kinetic Profiles and Mucosal Responses between Colonized and Non-Colonized Adults. mBio 2021; 12:mBio.02020-20. [PMID: 33436429 PMCID: PMC7844534 DOI: 10.1128/mbio.02020-20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Colonization of the upper respiratory tract with Streptococcus pneumoniae is the precursor of pneumococcal pneumonia and invasive disease. Following exposure, however, it is unclear which human immune mechanisms determine whether a pathogen will colonize. We used a human challenge model to investigate host-pathogen interactions in the first hours and days following intranasal exposure to Streptococcus pneumoniae Using a novel home sampling method, we measured early immune responses and bacterial density dynamics in the nose and saliva after volunteers were experimentally exposed to pneumococcus. Here, we show that nasal colonization can take up to 24 h to become established. Also, the following two distinct bacterial clearance profiles were associated with protection: nasal clearers with immediate clearance of bacteria in the nose by the activity of pre-existent mucosal neutrophils and saliva clearers with detectable pneumococcus in saliva at 1 h post challenge and delayed clearance mediated by an inflammatory response and increased neutrophil activity 24 h post bacterial encounter. This study describes, for the first time, how colonization with a bacterium is established in humans, signifying that the correlates of protection against pneumococcal colonization, which can be used to inform design and testing of novel vaccine candidates, could be valid for subsets of protected individuals.IMPORTANCE Occurrence of lower respiratory tract infections requires prior colonization of the upper respiratory tract with a pathogen. Most bacterial infection and colonization studies have been performed in murine and in vitro models due to the current invasive sampling methodology of the upper respiratory tract, both of which poorly reflect the complexity of host-pathogen interactions in the human nose. Self-collecting saliva and nasal lining fluid at home is a fast, low-cost, noninvasive, high-frequency sampling platform for continuous monitoring of bacterial encounter at defined time points relative to exposure. Our study demonstrates for the first time that, in humans, there are distinct profiles of pneumococcal colonization kinetics, distinguished by speed of appearance in saliva, local phagocytic function, and acute mucosal inflammatory responses, which may either recruit or activate neutrophils. These data are important for the design and testing of novel vaccine candidates.
Collapse
|
17
|
Nisar MI, Ahmed S, Jehan F, Shahid S, Shakoor S, Kabir F, Hotwani A, Munir S, Muhammad S, Khalid F, Althouse B, Hu H, Whitney C, Ali A, Zaidi AKM, Omer SB, Iqbal N. Direct and indirect effect of 10 valent pneumococcal vaccine on nasopharyngeal carriage in children under 2 years of age in Matiari, Pakistan. Vaccine 2021; 39:1319-1327. [PMID: 33422379 PMCID: PMC7910277 DOI: 10.1016/j.vaccine.2020.12.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/26/2022]
Abstract
Background Pakistan introduced Ten-valent pneumococcal-conjugate-vaccine PCV10 in 2012 as a 3 + 0 schedule without catch-up. Methods Children <2 years old in Matiari, Sindh provided nasopharyngeal swabs between 2014 and 2018, which were cultured for pneumococcus and serotyped through multiplex PCR at the Aga Khan University Hospital. Carriage rates over time for Vaccine-Type (VT) and Non-VT (NVT) serotypes were used to estimate direct, indirect, total and overall effects of vaccination. Regression analysis was used to determine factors associated with VT carriage. Results Pneumococcus was detected in 2370/3140 (75%). VT carriage decreased overall, 16.1–9.6% (p-trend <0.001); vaccinated (all 3 doses of PCV10 received) 11.3–8.1% (p-trend 0.031) and unvaccinated (no PCV10 dose received) 17.4–10.3% (p-trend 0.003) with a decline in serotypes 6B, 9V/9A and 19F. Immunization increased from 41.0% to 68.4% (p-trend 0.001). Direct effect of vaccine was 32.8% (95% CI 14.7–47.0%) and indirect effect 44.6%(95% CI 40.6–48.6%). Factors associated with decreased VT colonization were education 1–5 years (aOR 0.7, 95%CI 0.6–1.0), history of difficulty breathing (aOR 0.7, 95%CI 0.5–1.0), exposure to smoke (aOR 0.8, 95% CI 0.6–1.0), child fully immunized (aOR 0.7, 95%CI 0.5–1.0) and enrolled in 3rd (aOR 0.6, 95%CI 0.4–0.8) and 4th (aOR 0.6, 95%CI 0.5–0.9) year of the study whereas history of runny nose (aOR 1.5, 95% CI 1.2–1.9) was positively associated. Conclusions Decrease in VT pneumococcal carriage in vaccinated and unvaccinated children indicates herd immunity. Sustained increase in vaccine coverage and close long-term surveillance is warranted.
Collapse
Affiliation(s)
- Muhammad Imran Nisar
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Sheraz Ahmed
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahira Shahid
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Furqan Kabir
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sahrish Munir
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Muhammad
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
| | - Farah Khalid
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Hao Hu
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - Asad Ali
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anita K M Zaidi
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan; Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Saad B Omer
- Yale Institute for Global Health, New Haven, CT, USA
| | - Najeeha Iqbal
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
18
|
Brealey JC, Sly PD, Young PR, Chappell KJ. Analysis of phylogenetic diversity and in vitro adherence characteristics of respiratory syncytial virus and Streptococcus pneumoniae clinical isolates obtained during pediatric respiratory co-infections. MICROBIOLOGY-SGM 2020; 166:63-72. [PMID: 31714201 DOI: 10.1099/mic.0.000870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Respiratory syncytial virus (RSV) and Streptococcus pneumoniae are frequently co-associated during acute respiratory infections, particularly amongst infants and young children. In this study, we aimed to identify strains of RSV and serotypes/sequence types of S. pneumoniae associated with co-infections within a cohort of paediatric patients, and to assess RSV-mediated adhesion of pneumococcal isolates. The RSV glycoprotein sequence was determined for 58 RSV-positive samples and molecular serotyping and MLST was used to analyse 26 pneumococcal isolates. We also compared 23 pneumococcal isolates for their adherence to RSV-infected or mock-infected airway epithelia cells using immunofluorescence microscopy and automated particle counting. The tight association between RSV and S. pneumoniae was also visualized using scanning electron microscopy. This study did not identify any statistically significant trend in the strains of RSV and S. pneumoniae associated with co-infections. Furthermore, almost all isolates (22 of 23) showed significantly increased adherence to RSV-infected cells. The level of adherence did not appear to correlate with pneumococcal strain or sequence type, and isolates obtained from RSV-infected patients displayed a similar level of adherence as those from RSV-negative patients. The absence of particular S. pneumoniae or RSV strains associated with co-infection, together with the near ubiquitous presence of RSV-mediated adhesion throughout the pneumococcal clinical isolates, may indicate that the mechanisms governing the association with RSV are of sufficient importance to be maintained across much of the species.
Collapse
Affiliation(s)
- Jaelle C Brealey
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Qld 4072, Australia
| | - Peter D Sly
- Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Qld 4072, Australia.,Child Health Research Centre, The University of Queensland, South Brisbane, Qld 4101, Australia
| | - Paul R Young
- Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Qld 4072, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Qld 4072, Australia
| | - Keith J Chappell
- Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Qld 4072, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Qld 4072, Australia
| |
Collapse
|
19
|
Douros K, Everard ML. Time to Say Goodbye to Bronchiolitis, Viral Wheeze, Reactive Airways Disease, Wheeze Bronchitis and All That. Front Pediatr 2020; 8:218. [PMID: 32432064 PMCID: PMC7214804 DOI: 10.3389/fped.2020.00218] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022] Open
Abstract
The diagnosis and management of infants and children with a significant viral lower respiratory tract illness remains the subject of much debate and little progress. Over the decades various terms for such illnesses have been in and fallen out of fashion or have evolved to mean different things to different clinicians. Terms such as "bronchiolitis," "reactive airways disease," "viral wheeze," and many more are used to describe the same condition and the same term is frequently used to describe illnesses caused by completely different dominant pathologies. This lack of clarity is due, in large part, to a failure to understand the basic underlying inflammatory and associated processes and, in part, due to the lack of a simple test to identify a condition such as asthma. Moreover, there is a lack of insight into the fact that the same pathology can produce different clinical signs at different ages. The consequence is that terminology and fashions in treatment have tended to go around in circles. As was noted almost 60 years ago, amongst pre-school children with a viral LRTI and airways obstruction there are those with a "viral bronchitis" and those with asthma. In the former group, a neutrophil dominated inflammation response is responsible for the airways' obstruction whilst amongst asthmatics much of the obstruction is attributable to bronchoconstriction. The airways obstruction in the former group is predominantly caused by airways secretions and to some extent mucosal oedema (a "snotty lung"). These patients benefit from good supportive care including supplemental oxygen if required (though those with a pre-existing bacterial bronchitis will also benefit from antibiotics). For those with a viral exacerbation of asthma, characterized by bronchoconstriction combined with impaired b-agonist responsiveness, standard management of an exacerbation of asthma (including the use of steroids to re-establish bronchodilator responsiveness) represents optimal treatment. The difficulty is identifying which group a particular patient falls into. A proposed simplified approach to the nomenclature used to categorize virus associated LRTIs is presented based on an understanding of the underlying pathological processes and how these contribute to the physical signs.
Collapse
Affiliation(s)
- Konstantinos Douros
- Third Department of Paediatrics, Attikon Hospital, University of Athens School of Medicine, Athens, Greece
| | - Mark L. Everard
- Division of Paediatrics and Child Health, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
| |
Collapse
|
20
|
Shapiro DJ, Barak-Corren Y, Neuman MI, Mandl KD, Harper MB, Fine AM. Identifying Patients at Lowest Risk for Streptococcal Pharyngitis: A National Validation Study. J Pediatr 2020; 220:132-138.e2. [PMID: 32067779 DOI: 10.1016/j.jpeds.2020.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/08/2019] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the prevalence of features of viral illness in a national sample of visits involving children tested for group A Streptococcus pharyngitis. Additionally, we sought to derive a decision rule to identify patients with features of viral illness who were at low risk of having group A Streptococcus and for whom laboratory testing might be avoided. STUDY DESIGN Retrospective validation study using data from electronic health records of patients 3-21 years old evaluated for sore throat in a national network of retail health clinics (n = 67 127). We determined the prevalence of features of viral illness in patients tested for group A Streptococcus and developed a decision tree algorithm to identify patients with features of viral illness at low risk (<15%) of having group A Streptococcus. RESULTS Overall, 54% of patients had features of viral illness. Among patients with features of viral illness, those without tonsillar exudates who were 11 years or older and either lacked cervical adenopathy or had cervical adenopathy and lacked fever were identified as at low risk for group A Streptococcus according to the decision rule. This group comprised 34% of patients with features of viral illness, or 19% of all patients tested for group A Streptococcus infection. CONCLUSIONS Our findings provide an objective way to identify patients with features of viral illness who are at low risk of having group A Streptococcus. Improved identification such patients at low risk of group A Streptococcus could improve appropriate testing and antibiotic prescribing for pharyngitis.
Collapse
Affiliation(s)
- Daniel J Shapiro
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
| | - Yuval Barak-Corren
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Computational Health Informatics Program, Boston Children's Hospital, Boston, MA
| | - Mark I Neuman
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Kenneth D Mandl
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Computational Health Informatics Program, Boston Children's Hospital, Boston, MA
| | - Marvin B Harper
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Andrew M Fine
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| |
Collapse
|
21
|
Neal EFG, Nguyen CD, Ratu FT, Dunne EM, Kama M, Ortika BD, Boelsen LK, Kado J, Tikoduadua L, Devi R, Tuivaga E, Reyburn RC, Satzke C, Rafai E, Mulholland EK, Russell FM. Factors associated with pneumococcal carriage and density in children and adults in Fiji, using four cross-sectional surveys. PLoS One 2020; 15:e0231041. [PMID: 32236150 PMCID: PMC7112956 DOI: 10.1371/journal.pone.0231041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/13/2020] [Indexed: 01/26/2023] Open
Abstract
This study describes predictors of pneumococcal nasopharyngeal carriage and density in Fiji. We used data from four annual (2012-2015) cross-sectional surveys, pre- and post-introduction of ten-valent pneumococcal conjugate vaccine (PCV10) in October 2012. Infants (5-8 weeks), toddlers (12-23 months), children (2-6 years), and their caregivers participated. Pneumococci were detected and quantified using lytA qPCR, with molecular serotyping by microarray. Logistic and quantile regression were used to determine predictors of pneumococcal carriage and density, respectively. There were 8,109 participants. Pneumococcal carriage was negatively associated with years post-PCV10 introduction (global P<0.001), and positively associated with indigenous iTaukei ethnicity (aOR 2.74 [95% CI 2.17-3.45] P<0.001); young age (infant, toddler, and child compared with caregiver participant groups) (global P<0.001); urban residence (aOR 1.45 [95% CI 1.30-2.57] P<0.001); living with ≥2 children <5 years of age (aOR 1.42 [95% CI 1.27-1.59] P<0.001); low family income (aOR 1.44 [95% CI 1.28-1.62] P<0.001); and upper respiratory tract infection (URTI) symptoms (aOR 1.77 [95% CI 1.57-2.01] P<0.001). Predictors were similar for PCV10 and non-PCV10 carriage, except PCV10 carriage was negatively associated with PCV10 vaccination (0.58 [95% CI 0.41-0.82] P = 0.002) and positively associated with exposure to household cigarette smoke (aOR 1.21 [95% CI 1.02-1.43] P = 0.031), while there was no association between years post-PCV10 introduction and non-PCV10 carriage. Pneumococcal density was positively associated with URTI symptoms (adjusted median difference 0.28 [95% CI 0.16, 0.40] P<0.001) and toddler and child, compared with caregiver, participant groups (global P = 0.008). Predictors were similar for PCV10 and non-PCV10 density, except infant, toddler, and child participant groups were not associated with PCV10 density. PCV10 introduction was associated with reduced the odds of overall and PCV10 pneumococcal carriage in Fiji. However, after adjustment iTaukei ethnicity was positively associated with pneumococcal carriage compared with Fijians of Indian Descent, despite similar PCV10 coverage rates.
Collapse
Affiliation(s)
- Eleanor F. G. Neal
- Infection & Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- * E-mail:
| | - Cattram D. Nguyen
- Infection & Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | | | - Eileen M. Dunne
- Infection & Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | - Belinda D. Ortika
- Infection & Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
| | - Laura K. Boelsen
- Infection & Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
| | - Joseph Kado
- Telethon Kids Institute, University of Western Australia, Western Australia, Australia
- College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | | | - Rachel Devi
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - Rita C. Reyburn
- Infection & Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
| | - Catherine Satzke
- Infection & Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | - E. Kim Mulholland
- Infection & Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fiona M. Russell
- Infection & Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| |
Collapse
|
22
|
Symptoms associated with influenza vaccination and experimental human pneumococcal colonisation of the nasopharynx. Vaccine 2020; 38:2298-2306. [PMID: 32035708 PMCID: PMC7045083 DOI: 10.1016/j.vaccine.2020.01.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 12/14/2022]
Abstract
The timing and route of influenza vaccines effect symptom reporting in healthy adults. Symptoms experienced by healthy adults were further affected by the presence of S. pneumoniae. LAIV vaccination prior to S. pneumoniae exposure/colonisation led to reduced symptoms. TIV vaccination prior to S. pneumoniae exposure/colonisation led to increased nasal symptoms compared to LAIV.
Background Nasopharyngeal colonisation by S. pneumoniae is a prerequisite for invasive pneumococcal infections. Influenza co-infection leads to increased susceptibility to secondary pneumonia and mortality during influenza epidemics. Increased bacterial load and impaired immune responses to pneumococcus caused by influenza play a role in this increased susceptibility. Using an Experimental Human Challenge Model and influenza vaccines, we examined symptoms experienced by healthy adults during nasal co-infection with S. pneumoniae and live attenuated influenza virus. Methods Randomised, blinded administration of Live Attenuated Influenza Vaccine (LAIV) or Tetravalent Inactivated Influenza Vaccine (TIV) either preceded bacterial inoculation or followed it, separated by a 3-day interval. The presence and density of S. pneumoniae was determined from nasal washes. Participants completed a symptom questionnaire from the first intervention until 6 days post second intervention. Results The timing and type of influenza vaccination and presence of S. pneumoniae in the nasopharynx significantly affected symptom reporting. In the study where influenza vaccination preceded bacterial inoculation: nasal symptoms were less common in the LAIV group than the TIV group (OR 0.57, p < 0.01); with colonisation status only affecting the TIV group where more symptoms were reported by colonised participants compared to non-colonised participants following inoculation (n = 12/23 [52.17%] vs n = 13/38 [34.21%], respectively; p < 0.05). In the study where influenza vaccination followed bacterial inoculation: no difference was seen in the symptoms reported between the LAIV and TIV groups following inoculation and subsequent vaccination; and symptoms were unaffected by colonisation status. Conclusion Symptoms experienced during live viral vaccination and bacterial co-infection in the nasopharynx are directly affected by the precedence of the pathogen acquisition. Symptoms were directly affected by nasal pneumococcal colonisation but only when TIV was given prior to bacterial exposure.
Collapse
|
23
|
Trimble A, Connor V, Robinson RE, McLenaghan D, Hancock CA, Wang D, Gordon SB, Ferreira DM, Wright AD, Collins AM. Pneumococcal colonisation is an asymptomatic event in healthy adults using an experimental human colonisation model. PLoS One 2020; 15:e0229558. [PMID: 32155176 PMCID: PMC7064211 DOI: 10.1371/journal.pone.0229558] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/03/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Pneumococcal colonisation is regarded as a pre-requisite for developing pneumococcal disease. In children previous studies have reported pneumococcal colonisation to be a symptomatic event and described a relationship between symptom severity/frequency and colonisation density. The evidence for this in adults is lacking in the literature. This study uses the experimental human pneumococcal challenge (EHPC) model to explore whether pneumococcal colonisation is a symptomatic event in healthy adults. METHODS Healthy participants aged 18-50 were recruited and inoculated intra-nasally with either Streptococcus pneumoniae (serotypes 6B, 23F) or saline as a control. Respiratory viral swabs were obtained prior to inoculation. Nasal and non-nasal symptoms were then assessed using a modified Likert score between 1 (no symptoms) to 7 (cannot function). The rate of symptoms reported between the two groups was compared and a correlation analysis performed. RESULTS Data from 54 participants were analysed. 46 were inoculated with S. pneumoniae (29 with serotype 6B, 17 with serotype 23F) and 8 received saline (control). In total, 14 became experimentally colonised (30.4%), all of which were inoculated with serotype 6B. There was no statistically significant difference in nasal (p = 0.45) or non-nasal symptoms (p = 0.28) between the inoculation group and the control group. In those who were colonised there was no direct correlation between colonisation density and symptom severity. In the 22% (12/52) who were co-colonised, with pneumococcus and respiratory viruses, there was no statistical difference in either nasal or non-nasal symptoms (virus positive p = 0.74 and virus negative p = 1.0). CONCLUSION Pneumococcal colonisation using the EHPC model is asymptomatic in healthy adults, regardless of pneumococcal density or viral co-colonisation.
Collapse
Affiliation(s)
- Ashleigh Trimble
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
| | - Victoria Connor
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Respiratory Research Group at the Royal, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England, United Kingdom
| | - Ryan E. Robinson
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Respiratory Research Group at the Royal, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England, United Kingdom
| | - Daniella McLenaghan
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Respiratory Research Group at the Royal, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England, United Kingdom
| | - Carole A. Hancock
- Respiratory Research Group at the Royal, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England, United Kingdom
| | - Duolao Wang
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
| | - Stephen B. Gordon
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Comprehensive Local Research Network, Northwest Coast, Liverpool, England, United Kingdom
| | - Daniela M. Ferreira
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
| | - Angela D. Wright
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Comprehensive Local Research Network, Northwest Coast, Liverpool, England, United Kingdom
| | - Andrea M. Collins
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Respiratory Research Group at the Royal, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England, United Kingdom
- * E-mail:
| |
Collapse
|
24
|
Sidorenko S, Rennert W, Lobzin Y, Briko N, Kozlov R, Namazova-Baranova L, Tsvetkova I, Ageevets V, Nikitina E, Ardysheva A, Bikmieva A, Bolgarova E, Volkova M, Verentsova I, Girina A, Gordeeva N, Demko I, Dushchenko A, Evseeva G, Zharkova L, Yelistratova T, Zakharova J, Ivakhnishina N, Zubova E, Kalinogorskaya O, Klimashina A, Kozeeva T, Kraposhina A, Krechikova O, Mamaeva M, Nagovitsyna E, Protasova I, Semerikov V, Sokolova N, Soloveva I, Strelnikova N, Telepneva R, Feldblium I, Kholodok G, Chagaryan A, Sheglinkova N. Multicenter study of serotype distribution of Streptococcus pneumoniae nasopharyngeal isolates from healthy children in the Russian Federation after introduction of PCV13 into the National Vaccination Calendar. Diagn Microbiol Infect Dis 2019; 96:114914. [PMID: 31704066 DOI: 10.1016/j.diagmicrobio.2019.114914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/13/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
Russia introduced PCV13 in 2014. We studied the serotype composition of S. pneumoniae isolated from the nasopharynx of healthy children younger than 6 years in St. Petersburg, Smolensk, Perm, Krasnoyarsk, Khanty-Mansiysk and Khabarovsk, between 2016 and 2018. 2.4% of children had completed a 3-dose course of PCV13, while 25.6% had received 1 or 2 doses. Pneumococcal DNA detection by PCR demonstrated S. pneumoniae in 37.2% of samples with regional variation between sites (27.3 to 56.9%). There was little difference between vaccinated, partially vaccinated and un-vaccinated children. Children who had received at least 1 dose of PCV13 had lower carriage rates of vaccine serotypes than their unvaccinated peers (49.9 vs. 61.4%; p < 0.001). Children who had received at least 1 dose of PCV13 showed increased carriage rates of non-vaccine serotypes (50 vs 38.6%; P < 0.001). Especially serogroup 15AF was more prevalent among fully immunized children than among their peers (12.5 vs 2.7%; P < 0.05).
Collapse
Affiliation(s)
- Sergey Sidorenko
- Pediatric Research and Clinical Center for Infectious Diseases, Popov Str.9, Saint Petersburg, Russia, 197022 and North Western State Medical University named after I.I. Mechnikov, Kirochnaya Str. 41, St Petersburg, Russia, 191015.
| | - Wolfgang Rennert
- Rostropovich Vishnevskaya Foundation and Georgetown University Hospital Department of Pediatrics, 4200 Wisconsin Ave. # 200, Washington, DC, 20016, USA.
| | - Yuri Lobzin
- Pediatric Research and Clinical Center for Infectious Diseases, Popov Str.9, Saint Petersburg, Russia, 197022 and North Western State Medical University named after I.I. Mechnikov, Kirochnaya Str. 41, St Petersburg, Russia, 191015.
| | - Nikolay Briko
- I.M. Sechenov First Moscow State Medical University, Trubetskaya Str. 8-2, Moscow, Russia, 119991.
| | - Roman Kozlov
- Smolensk State Medical University, Krupskoy Str. 28, Smolensk, Russia 214019.
| | - Leila Namazova-Baranova
- Pirogov Russian National Research Medical University, Ostrovityanova Str. 1, Moskva, Russia, 11799.
| | - Irina Tsvetkova
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str.9, Saint Petersburg, Russia, 197022.
| | - Vladimir Ageevets
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str.9, Saint Petersburg, Russia, 197022.
| | - Ekaterina Nikitina
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str.9, Saint Petersburg, Russia, 198022.
| | - Anastasia Ardysheva
- Perm Clinical Center of the Federal Medical and Biological Agency, Tselinnaya Str., 27, Perm, Russia, 614056.
| | - Alina Bikmieva
- E.A.Vagner Perm State Medical University, 26 Petropavlovskaya Str, Perm, Russia 614990.
| | - Ekaterina Bolgarova
- Yekaterinburg Research Institute of Viral Infections, Letnyaya Str 23, Yekaterinburg, Russia 620030.
| | - Marina Volkova
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str.9, Saint Petersburg, Russia, 197022.
| | - Irina Verentsova
- Regional Clinical Hospital, Kalinina Str. 40, Khanty-Mansiysk, Russia 628012.
| | - Asiya Girina
- Khanty-Mansiysk State Medical Academy, Mira Str. 40. Khanty-Mansyisk, Russia 628011.
| | - Natalia Gordeeva
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Irina Demko
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Anna Dushchenko
- Far Eastern State Medical University, Karl Marx Str. 35, Khabarovsk, Russia 680000.
| | - Galina Evseeva
- Khabarovsk Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, - Research Institute of Maternity and Childhood Protection, Voronezhskaya Str. 49, Khabarovsk, Russia 680022.
| | - Ludmila Zharkova
- Smolensk State Medical University, Krupskoy Str. 28, Smolensk, Russia 214019.
| | - Tatyana Yelistratova
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Julia Zakharova
- Yekaterinburg Research Institute of Viral Infections, Letnyaya Str 23, Yekaterinburg, Russia 620030.
| | - Natalia Ivakhnishina
- Khabarovsk Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, - Research Institute of Maternity and Childhood Protection, Voronezhskaya Str. 49, Khabarovsk, Russia 680022.
| | - Elena Zubova
- Regional Pediatric Hospital, Baumana Str 22, Perm, Russia 614066.
| | - Olga Kalinogorskaya
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str. 9, Saint Petersburg, Russia, 194100.
| | - Alla Klimashina
- Perm Clinical Center of the Federal Medical and Biological Agency, Tselinnaya Str., 27, Perm, Russia, 614056.
| | - Tatiana Kozeeva
- Perm Clinical Center of the Federal Medical and Biological Agency, Tselinnaya Str., 27, Perm, Russia, 614056.
| | - Angelina Kraposhina
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Olga Krechikova
- Smolensk State Medical University, Krupskoy Str. 28, Smolensk, Russia 214019.
| | - Marina Mamaeva
- Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Elena Nagovitsyna
- Khabarovsk Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, - Research Institute of Maternity and Childhood Protection, Voronezhskaya Str. 49, Khabarovsk, Russia 680022.
| | - Irina Protasova
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | | | - Natalia Sokolova
- Perm Clinical Center of the Federal Medical and Biological Agency, Tselinnaya Str., 27, Perm, Russia, 614056.
| | - Irina Soloveva
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Natalia Strelnikova
- Far Eastern State Medical University, Karl Marx Str. 35, Khabarovsk, Russia 680000.
| | - Regina Telepneva
- Khabarovsk Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, - Research Institute of Maternity and Childhood Protection, Voronezhskaya Str. 49, Khabarovsk, Russia 680022.
| | - Irina Feldblium
- E.A.Vagner Perm State Medical University, Petropavlovskaya Str. 26, Perm, Russia 614990.
| | - Galina Kholodok
- Khabarovsk Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, - Research Institute of Maternity and Childhood Protection, Voronezhskaya Str. 49, Khabarovsk, Russia 680022.
| | - Aida Chagaryan
- Smolensk State Medical University, Krupskoy Str. 28, Smolensk, Russia 214019.
| | | |
Collapse
|
25
|
Dunne EM, Choummanivong M, Neal EFG, Stanhope K, Nguyen CD, Xeuatvongsa A, Satzke C, Sychareun V, Russell FM. Factors associated with pneumococcal carriage and density in infants and young children in Laos PDR. PLoS One 2019; 14:e0224392. [PMID: 31661527 PMCID: PMC6818791 DOI: 10.1371/journal.pone.0224392] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/13/2019] [Indexed: 02/04/2023] Open
Abstract
Nasopharyngeal carriage of Streptococcus pneumoniae (the pneumococcus) is a precursor to pneumococcal disease. Several host and environmental factors have been associated with pneumococcal carriage, however few studies have examined the relationship between host factors and pneumococcal carriage density. We sought to identify risk factors for pneumococcal carriage and density using data from cross-sectional pneumococcal carriage surveys conducted in the Lao People's Democratic Republic before and after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). Nasopharyngeal swabs were collected infants from aged 5–8 weeks old (n = 999) and children aged 12–23 months (n = 1,010), pneumococci detected by quantitative PCR, and a risk factor questionnaire completed. Logistic and linear regression models were used to evaluate associations between participant characteristics and pneumococcal carriage and density. In infants aged 5–8 weeks, living in a household with two or more children under the age of five years (aOR 1.97; 95% CI 1.39–2.79) and low family income (aOR 1.64; 95% CI 0.99–2.72) were positively associated with pneumococcal carriage. For children aged 12–23 months, upper respiratory tract infection (URTI) symptoms (aOR 2.64; 95% CI 1.97–3.53), two or more children under five in the household (aOR 2.40; 95% CI 1.80–3.20), and rural residence (aOR 1.84, 95% CI 1.35–2.50) were positively associated with pneumococcal carriage. PCV13 vaccination was negatively associated with carriage of PCV13 serotypes (aOR 0.60; 95% CI 0.44–0.83). URTI symptoms (p < 0.001), current breastfeeding (p = 0.005), rural residence (p = 0.012), and delivery by Caesarean section (p = 0.035) were associated with higher mean pneumococcal density in pneumococcal carriers (both age groups combined). This study provides new data on pneumococcal carriage and density in a high disease burden setting in southeast Asia.
Collapse
Affiliation(s)
- Eileen M. Dunne
- Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Eleanor F. G. Neal
- Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Kathryn Stanhope
- Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Cattram D. Nguyen
- Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Catherine Satzke
- Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Australia
| | | | - Fiona M. Russell
- Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
| |
Collapse
|
26
|
Thomas AC, Bailey M, Lee MRF, Mead A, Morales-Aza B, Reynolds R, Vipond B, Finn A, Eisler MC. Insights into Pasteurellaceae carriage dynamics in the nasal passages of healthy beef calves. Sci Rep 2019; 9:11943. [PMID: 31420565 PMCID: PMC6697682 DOI: 10.1038/s41598-019-48007-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/16/2019] [Indexed: 12/22/2022] Open
Abstract
We investigated three bovine respiratory pathobionts in healthy cattle using qPCR optimised and validated to quantify Histophilus somni, Mannheimia haemolytica and Pasteurella multocida over a wide dynamic range. A longitudinal study was conducted to investigate the carriage and density of these bacteria in the nasal passages of healthy beef calves (N = 60) housed over winter in an experimental farm setting. The three pathobiont species exhibited remarkably different carriage rates and density profiles. At housing, high carriage rates were observed for P. multocida (95%), and H. somni (75%), while fewer calves were positive for M. haemolytica (13%). Carriage rates for all three bacterial species declined over the 75-day study, but not all individuals became colonised despite sharing of environment and airspace. Colonisation patterns ranged from continuous to intermittent and were different among pathobiont species. Interval-censored exponential survival models estimated the median duration of H. somni and P. multocida carriage at 14.8 (CI95%: 10.6–20.9) and 55.5 (CI95%: 43.3–71.3) days respectively, and found higher density P. multocida carriage was associated with slower clearance (p = 0.036). This work offers insights into the dynamics of pathobiont carriage and provides a potential platform for further data collection and modelling studies.
Collapse
Affiliation(s)
- A C Thomas
- Bristol Veterinary School, University of Bristol, Langford, UK. .,Rothamsted Research, North Wyke, Devon, UK. .,Bristol Children's Vaccine Centre, University of Bristol, Bristol, UK.
| | - M Bailey
- Bristol Veterinary School, University of Bristol, Langford, UK
| | - M R F Lee
- Bristol Veterinary School, University of Bristol, Langford, UK.,Rothamsted Research, North Wyke, Devon, UK
| | - A Mead
- Rothamsted Research, Harpenden, UK
| | - B Morales-Aza
- Bristol Children's Vaccine Centre, University of Bristol, Bristol, UK.,School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - R Reynolds
- School of Population Health Sciences, University of Bristol, Bristol, UK
| | - B Vipond
- Public Health Laboratory Bristol, Public Health England, Bristol, UK
| | - A Finn
- Bristol Children's Vaccine Centre, University of Bristol, Bristol, UK.,School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.,School of Population Health Sciences, University of Bristol, Bristol, UK
| | - M C Eisler
- Bristol Veterinary School, University of Bristol, Langford, UK.
| |
Collapse
|
27
|
Thors V, Christensen H, Morales-Aza B, Oliver E, Sikora P, Vipond I, Muir P, Finn A. High-density Bacterial Nasal Carriage in Children Is Transient and Associated With Respiratory Viral Infections-Implications for Transmission Dynamics. Pediatr Infect Dis J 2019; 38:533-538. [PMID: 30985547 DOI: 10.1097/inf.0000000000002256] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND This longitudinal study describes the associations between respiratory viral infections, rhinitis and the prevalence and density of the common nasopharyngeal bacterial colonizers, Streptococcus pneumoniae (Sp), Moraxella catarrhalis (Mc), Haemophilus influenzae (Hi) and Staphylococcus aureus. METHODS In an observational cohort study, 161 children attending day care centers in Bristol, United Kingdom, were recruited. Monthly nasopharyngeal swabs were taken and stored frozen in Skim-milk, tryptone, glucose and glycerin broth (STGG) broth. Quantitative polymerase chain reaction was used for detection of respiratory viruses and 4 bacterial species. t tests and logistic regression models were used for analysis. RESULTS The frequent colonisers, Sp, Mc and Hi were more frequently found at high density in contrast to Staphylococcus aureus although temporally, high-density carriage was short lived. Respiratory viral infections and symptoms of rhinitis were both independently and consistently associated with higher bacterial density with an observed 2-fold increase in density for Sp, Mc and Hi (P = 0.004-0.017). CONCLUSIONS For Sp and Hi, the association between young age and higher bacterial DNA density was explained by more frequent viral infection and increased nasal discharge, while the associations between some viral specie's and some bacterial species' density appear to be stronger than others. Increased colonization density and rhinitis may promote transmission of these commonly carried organisms.
Collapse
Affiliation(s)
- Valtyr Thors
- From the School of Cellular and Molecular Medicine, University of Bristol, Education Centre, Bristol, United Kingdom
- Children's Hospital, Landspitali University Hospital Iceland, Reykjavik, Iceland
| | | | - Begonia Morales-Aza
- From the School of Cellular and Molecular Medicine, University of Bristol, Education Centre, Bristol, United Kingdom
| | - Elizabeth Oliver
- From the School of Cellular and Molecular Medicine, University of Bristol, Education Centre, Bristol, United Kingdom
| | - Paulina Sikora
- From the School of Cellular and Molecular Medicine, University of Bristol, Education Centre, Bristol, United Kingdom
| | - Ian Vipond
- Public Health Laboratory Bristol, Public Health England, Southmead Hospital, Bristol, United Kingdom
| | - Peter Muir
- Public Health Laboratory Bristol, Public Health England, Southmead Hospital, Bristol, United Kingdom
| | - Adam Finn
- From the School of Cellular and Molecular Medicine, University of Bristol, Education Centre, Bristol, United Kingdom
- School of Population Health Sciences, University of Bristol
| |
Collapse
|
28
|
Palmu AA, Ware RS, Lambert SB, Sarna M, Bialasiewicz S, Seib KL, Atack JM, Nissen MD, Grimwood K. Nasal swab bacteriology by PCR during the first 24-months of life: A prospective birth cohort study. Pediatr Pulmonol 2019; 54:289-296. [PMID: 30609299 PMCID: PMC7167656 DOI: 10.1002/ppul.24231] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/08/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Most respiratory bacterial carriage studies in children are based on cross-sectional samples or longitudinal studies with infrequent sampling points. The prospective Observational Research in Childhood Infectious Diseases birth cohort study intensively evaluated the community-based epidemiology of respiratory viruses and bacteria during the first 2-years of life. Here we report the bacteriologic findings. METHODS Pregnant women in Brisbane, Australia were recruited between September 2010 and October 2012, and their healthy newborn children were followed for the first 2-years of life. Parents kept a daily symptom diary for the study child, collected a weekly anterior nose swab and completed an illness burden diary when their child met pre-defined illness criteria. Specimens were tested for respiratory bacteria by real-time polymerase chain reaction (PCR) assays and those containing human genomic DNA, deemed as high-quality, were analyzed. RESULTS Altogether 8100 high-quality nasal swab specimens from 158 enrolled children were analyzed. Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae were detected in 42.4%, 38.9%, and 14.8% of these samples, respectively. Concomitant detection of bacteria was common. In contrast, Bordetella pertussis, B. parapertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Simkania negevensis were rarely identified. The prevalence of the three major bacteria was higher with increasing age and in the winter and spring months. Siblings and childcare attendance were the other risk factors identified. CONCLUSIONS We confirmed the feasibility of frequent nasal swabbing by parents for studying bacterial colonization. PCR detected the major respiratory tract bacteria with expected high frequencies, but atypical bacteria were found rarely in this cohort.
Collapse
Affiliation(s)
- Arto A Palmu
- National Institute for Health and Welfare, Department of Public Health Solutions, Tampere, Finland
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Stephen B Lambert
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Children's Health Research, Children's Health Queensland, Brisbane, Australia
| | - Mohinder Sarna
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Seweryn Bialasiewicz
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Children's Health Research, Children's Health Queensland, Brisbane, Australia
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - John M Atack
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Michael D Nissen
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Children's Health Research, Children's Health Queensland, Brisbane, Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
| |
Collapse
|
29
|
Zoch-Lesniak B, Ware RS, Grimwood K, Lambert SB. The Respiratory Specimen Collection Trial (ReSpeCT): A Randomized Controlled Trial to Compare Quality and Timeliness of Respiratory Sample Collection in the Home by Parents and Healthcare Workers From Children Aged <2 Years. J Pediatric Infect Dis Soc 2019; 9:134-141. [PMID: 30657971 PMCID: PMC7358654 DOI: 10.1093/jpids/piy136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/15/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Most acute respiratory infection (ARI) research focuses on severe disease and overlooks the burden of community-managed illness. For community-based studies, home-based specimen collection by parents could be a resource-saving alternative to collection by healthcare workers (HCWs). In this study, we compared parent and HCW groups for their likelihood to collect specimens and the timeliness and quality of such collection. METHODS In this unblinded randomized controlled trial, parents from Brisbane, Australia, were taught to identify new ARI episodes in their children aged <2 years. When their child had a new ARI, parents either collected a nasal swab from the child (P group) or contacted an HCW who visited to obtain a nasopharyngeal swab (HCW group). We compared the likelihood and timeliness of specimen collection and respiratory pathogen detection. A nested diagnostic study compared paired specimen collections from children in the HCW group. RESULTS Included were 76 incident ARI episodes from 31 children and 102 episodes from 33 children in the P and HCW groups, respectively. The proportions of ARIs for which a specimen was collected were similar (P group, 69.7%; HCW group, 72.5%; P = .77), and pathogens were detected in 93.8% and 77.5% of the specimens, respectively (P = .03). The period between ARI onset and specimen collection was shorter in the P group than in the HCW group (mean difference, 1.9 days [95% confidence interval, 0.7-3.0 days]; P < .001). For the 69 paired specimens, viral loads were lower in the parent-collected swabs (mean cycle threshold difference, 4.5 [95% confidence interval, 3.1-5.9]; P < .001). CONCLUSIONS Parents and HCWs obtained samples in similar proportions of ARI episodes, but the parents collected the samples fewer days after ARI onset and with a resulting higher likelihood of pathogen identification. This method can be used in population-based epidemiological studies of ARI as a resource-saving alternative. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00966069.
Collapse
Affiliation(s)
- Beate Zoch-Lesniak
- Centre of Rehabilitation Research, University of Potsdam, Germany,PhD Programme, Epidemiology, Braunschweig-Hannover, Germany
| | - Robert S Ware
- Menzies Health Institute Queensland, Queensland, Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland, Queensland, Australia,School of Medicine, Griffith University, Gold Coast, Queensland, Australia,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Queensland, Australia
| | - Stephen B Lambert
- Child Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia,Correspondence: S. B. Lambert, PhD, Child Health Research Centre, Faculty of Medicine, University of Queensland, 62 Graham Street, South Brisbane, Queensland, 4101, Australia ()
| |
Collapse
|
30
|
Caputo M, Zoch-Lesniak B, Karch A, Vital M, Meyer F, Klawonn F, Baillot A, Pieper DH, Mikolajczyk RT. Bacterial community structure and effects of picornavirus infection on the anterior nares microbiome in early childhood. BMC Microbiol 2019; 19:1. [PMID: 30616583 PMCID: PMC6322332 DOI: 10.1186/s12866-018-1372-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 12/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background Little is known regarding the nasal microbiome in early childhood and the impact of respiratory infection on the infants’ nasal microbial composition. Here we investigated the temporal dynamics and diversity of the bacterial composition in the anterior nares in children attending daycare centers. Results For our investigation, we considered 76 parental-taken nasal swabs of 26 children (aged 13 to 36 months) collected over a study period of 3 months. Overall, there was no significant age-specific effect or seasonal shift in the nasal bacterial community structure. In a sub-sample of 14 healthy children the relative abundance of individual taxa as well as the overall diversity did not reveal relevant changes, indicating a stable community structure over the entire study period. Moreover, the nasal bacterial profiles clustered subject-specific with Bray-Curtis similarities being elevated in intra-subject calculations compared to between-subject calculations. The remaining subset of 12 children provided samples taken during picornavirus infection (PVI) and either before or after a PVI. We detected an association between the relative abundance of members of the genus Streptococcus and PV when comparing both (i) samples taken during PVI with samples out of 14 healthy children and (ii) samples taken during PVI with samples taken after PVI within the same individual. In addition, the diversity was higher during PVI than after infection. Conclusions Our findings suggest that a personalized structure of the nasal bacterial community is established already in early childhood and could be detected over a timeframe of 3 months. Studies following infants over a longer time with frequent swab sampling would allow investigating whether certain parameter of the bacterial community, such as the temporal variability, could be related to viral infection. Electronic supplementary material The online version of this article (10.1186/s12866-018-1372-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mahrrouz Caputo
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig, Germany.,PhD Programme "Epidemiology", Hannover, Germany
| | - Beate Zoch-Lesniak
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig, Germany.,PhD Programme "Epidemiology", Hannover, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany.,German Centre for Infection Research (DZIF), Hannover-Braunschweig site, Inhoffenstraße 7, 38124, Braunschweig, Germany.,Institute for Epidemiology and Social Medicine, University of Münster, Domagkstraße 3, 48149, Münster, Germany
| | - Marius Vital
- Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany
| | - Frederic Meyer
- Microbial Communication Research Group, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany
| | - Frank Klawonn
- Biostatistics Research Group, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany.,Institute of Information Engineering, Ostfalia University, Salzdahlumer Str. 46/48, 38302, Wolfenbüttel, Germany
| | - Armin Baillot
- Governmental Institute of Public Health of Lower Saxony, Roesebeckstraße 4-6, 30449, Hannover, Germany
| | - Dietmar H Pieper
- Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany
| | - Rafael T Mikolajczyk
- German Centre for Infection Research (DZIF), Hannover-Braunschweig site, Inhoffenstraße 7, 38124, Braunschweig, Germany. .,Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06110, Halle (Saale), Germany.
| |
Collapse
|
31
|
Fadlyana E, Dunne EM, Rusmil K, Tarigan R, Sudigdoadi S, Murad C, Watts E, Nguyen C, Satzke C, Dewi NE, Indriyani SAK, Yani FF, Mulholland K, Kartasasmita C. Risk factors associated with nasopharyngeal carriage and density of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in young children living in Indonesia. Pneumonia (Nathan) 2018; 10:14. [PMID: 30603377 PMCID: PMC6305570 DOI: 10.1186/s41479-018-0058-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/29/2018] [Indexed: 01/05/2023] Open
Abstract
Background Potentially pathogenic bacteria Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus are commonly carried in the nasopharynx of young children. Host and environmental factors have been linked with pathogen carriage, and in many studies rural children have higher carriage rates than their urban counterparts. There are few published data on what factors contribute to increased pathogen density. The objectives of this study were to identify risk factors for nasopharyngeal carriage and density of S. pneumoniae, H. influenzae, M. catarrhalis, and S. aureus in young children in Indonesia. Methods Risk factor analysis was done using data on bacterial carriage and participant characteristics from a cross-sectional study that enrolled 302 children aged 12–24 months living in urban or semi-rural areas of Indonesia. Associations between host factors and odds of pathogen carriage were explored using logistic regression. Characteristics identified to be independent predictors of carriage by univariable analysis, as well as those that differed between urban and semi-rural participants, were included in multivariable models. Risk factors for increased pathogen density were identified using linear regression analysis. Results No differences in carriage prevalence between urban and semi-rural children were observed. Multiple children under the age of 5 years in the household (< 5y) and upper respiratory tract infection (URTI) symptoms were associated with S. pneumoniae carriage, with adjusted odds ratios (aOR) of 2.17 (95% CI 1.13, 4.12) and 2.28 (95% CI 1.15, 4.50), respectively. There was some evidence that URTI symptoms (aOR 1.94 [95% CI 1.00, 3.75]) were associated with carriage of M. catarrhalis. Children with URTI symptoms (p = 0.002), and low parental income (p = 0.011) had higher S. pneumoniae density, whereas older age was associated with lower S. pneumoniae density (p = 0.009). URTI symptoms were also associated with higher M. catarrahlis density (p = 0.035). Low maternal education (p = 0.039) and multiple children < 5y (p = 0.021) were positively associated with H. influenzae density, and semi-rural residence was associated with higher S. aureus density (p < 0.001). Conclusions This study provides a detailed assessment of risk factors associated with carriage of clinically-relevant bacteria in Indonesian children, and new data on host factors associated with pathogen density. Electronic supplementary material The online version of this article (10.1186/s41479-018-0058-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eddy Fadlyana
- 1Department of Child Health, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java Indonesia
| | - Eileen M Dunne
- 2Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC Australia.,3Department of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Kusnandi Rusmil
- 1Department of Child Health, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java Indonesia
| | - Rodman Tarigan
- 1Department of Child Health, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java Indonesia
| | - Sunaryati Sudigdoadi
- 4Department of Biomedical Sciences, Division of Microbiology, Universitas Padjadjaran, Bandung, West Java Indonesia
| | - Chrysanti Murad
- 4Department of Biomedical Sciences, Division of Microbiology, Universitas Padjadjaran, Bandung, West Java Indonesia
| | - Emma Watts
- 2Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC Australia
| | - Cattram Nguyen
- 2Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC Australia.,3Department of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Catherine Satzke
- 2Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC Australia.,3Department of Paediatrics, The University of Melbourne, Parkville, VIC Australia.,5Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC Australia
| | - Nurhandini Eka Dewi
- District Health Office of Central Lombok, Praya, West Nusa Tenggara Indonesia
| | | | - Finny Fitry Yani
- 8Department of Child Health, Universitas Andalas, Padang, West Sumatra Indonesia
| | - Kim Mulholland
- 2Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC Australia.,9London School of Hygiene and Tropical Medicine, London, UK
| | - Cissy Kartasasmita
- 1Department of Child Health, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java Indonesia
| |
Collapse
|
32
|
Weiser JN, Ferreira DM, Paton JC. Streptococcus pneumoniae: transmission, colonization and invasion. Nat Rev Microbiol 2018; 16:355-367. [PMID: 29599457 PMCID: PMC5949087 DOI: 10.1038/s41579-018-0001-8] [Citation(s) in RCA: 655] [Impact Index Per Article: 93.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Streptococcus pneumoniae has a complex relationship with its obligate human host. On the one hand, the pneumococci are highly adapted commensals, and their main reservoir on the mucosal surface of the upper airways of carriers enables transmission. On the other hand, they can cause severe disease when bacterial and host factors allow them to invade essentially sterile sites, such as the middle ear spaces, lungs, bloodstream and meninges. Transmission, colonization and invasion depend on the remarkable ability of S. pneumoniae to evade or take advantage of the host inflammatory and immune responses. The different stages of pneumococcal carriage and disease have been investigated in detail in animal models and, more recently, in experimental human infection. Furthermore, widespread vaccination and the resulting immune pressure have shed light on pneumococcal population dynamics and pathogenesis. Here, we review the mechanistic insights provided by these studies on the multiple and varied interactions of the pneumococcus and its host.
Collapse
|
33
|
Abstract
Colonization of the human nasopharynx by pneumococcus is extremely common and is both the primary reservoir for transmission and a prerequisite for disease. Current vaccines targeting the polysaccharide capsule effectively prevent colonization, conferring herd protection within vaccinated communities. However, these vaccines cover only a subset of all circulating pneumococcal strains, and serotype replacement has been observed. Given the success of pneumococcal conjugate vaccine (PCV) in preventing colonization in unvaccinated adults within vaccinated communities, reducing nasopharyngeal colonization has become an outcome of interest for novel vaccines. Here, we discuss the immunological mechanisms that control nasopharyngeal colonization, with an emphasis on findings from human studies. Increased understanding of these immunological mechanisms is required to identify correlates of protection against colonization that will facilitate the early testing and design of novel vaccines.
Collapse
Affiliation(s)
- Simon P. Jochems
- Department of Clinicial Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (SPJ); (DMF)
| | - Jeffrey N. Weiser
- Department of Microbiology, New York University School of Medicine, New York, New York, United States of America
| | - Richard Malley
- Division of Infectious Diseases, Boston Children′s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniela M. Ferreira
- Department of Clinicial Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (SPJ); (DMF)
| |
Collapse
|
34
|
Zafar MA, Wang Y, Hamaguchi S, Weiser JN. Host-to-Host Transmission of Streptococcus pneumoniae Is Driven by Its Inflammatory Toxin, Pneumolysin. Cell Host Microbe 2017; 21:73-83. [PMID: 28081446 DOI: 10.1016/j.chom.2016.12.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/28/2016] [Accepted: 12/06/2016] [Indexed: 01/05/2023]
Abstract
Host-to-host transmission is a critical step for infection. Here we studied transmission of the opportunistic pathogen Streptococcus pneumoniae in an infant mouse model. Transmission from nasally colonized pups required high levels of bacterial shedding in nasal secretions and was temporally correlated with, and dependent upon, the acute inflammatory response. Pneumolysin, a pore-forming cytotoxin and major virulence determinant, was both necessary and sufficient to promote inflammation, which increased shedding and allowed for intralitter transmission. Direct contact between pups was not required for transmission indicating the importance of an environmental reservoir. An additional in vivo effect of pneumolysin was to enhance bacterial survival outside of the host. Our findings provide experimental evidence of a microbial strategy for transit to new hosts and explain why an organism expresses a toxin that damages the host upon which it depends.
Collapse
Affiliation(s)
- M Ammar Zafar
- Department of Microbiology, New York University, New York, NY 10016, USA
| | - Yang Wang
- School of Medicine, Tsinghua University, 100084 Beijing, China; Department of Microbiology, New York University, New York, NY 10016, USA
| | - Shigeto Hamaguchi
- Department of Microbiology, New York University, New York, NY 10016, USA
| | - Jeffrey N Weiser
- Department of Microbiology, New York University, New York, NY 10016, USA.
| |
Collapse
|
35
|
Chonmaitree T, Jennings K, Golovko G, Khanipov K, Pimenova M, Patel JA, McCormick DP, Loeffelholz MJ, Fofanov Y. Nasopharyngeal microbiota in infants and changes during viral upper respiratory tract infection and acute otitis media. PLoS One 2017; 12:e0180630. [PMID: 28708872 PMCID: PMC5510840 DOI: 10.1371/journal.pone.0180630] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/18/2017] [Indexed: 01/21/2023] Open
Abstract
Background Interferences between pathogenic bacteria and specific commensals are known. We determined the interactions between nasopharyngeal microbial pathogens and commensals during viral upper respiratory tract infection (URI) and acute otitis media (AOM) in infants. Methods We analyzed 971 specimens collected monthly and during URI and AOM episodes from 139 infants. The 16S rRNA V4 gene regions were sequenced on the Illumina MiSeq platform. Results Among the high abundant genus-level nasopharyngeal microbiota were Moraxella, Haemophilus, and Streptococcus (3 otopathogen genera), Corynebacterium, Dolosigranulum, Staphylococcus, Acinetobacter, Pseudomonas, and Bifidobacterium. Bacterial diversity was lower in culture-positive samples for Streptococcus pneumoniae, and Haemophilus influenzae, compared to cultured-negative samples. URI frequencies were positively associated with increasing trend in otopathogen colonization. AOM frequencies were associated with decreasing trend in Micrococcus colonization. During URI and AOM, there were increases in abundance of otopathogen genera and decreases in Pseudomonas, Myroides, Yersinia, and Sphingomonas. Otopathogen abundance was increased during symptomatic viral infection, but not during asymptomatic infection. The risk for AOM complicating URI was reduced by increased abundance of Staphylococcus and Sphingobium. Conclusion Otopathogen genera played the key roles in URI and AOM occurrences. Staphylococcus counteracts otopathogens thus Staphylococcal colonization may be beneficial, rather than harmful. While Sphingobium may play a role in preventing AOM complicating URI, the commonly used probiotic Bifidobacterium did not play a significant role during URI or AOM. The role of less common commensals in counteracting the deleterious effects of otopathogens requires further studies.
Collapse
Affiliation(s)
- Tasnee Chonmaitree
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States of America
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States of America
- * E-mail:
| | - Kristofer Jennings
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Georgiy Golovko
- Sealy Center for Structural Biology, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Kamil Khanipov
- Sealy Center for Structural Biology, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Maria Pimenova
- Sealy Center for Structural Biology, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Janak A. Patel
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States of America
| | - David P. McCormick
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Michael J. Loeffelholz
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Yuriy Fofanov
- Sealy Center for Structural Biology, University of Texas Medical Branch, Galveston, TX, United States of America
| |
Collapse
|
36
|
Thors V, Christensen H, Morales-Aza B, Vipond I, Muir P, Finn A. The Effects of Live Attenuated Influenza Vaccine on Nasopharyngeal Bacteria in Healthy 2 to 4 Year Olds. A Randomized Controlled Trial. Am J Respir Crit Care Med 2017; 193:1401-9. [PMID: 26742001 DOI: 10.1164/rccm.201510-2000oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
RATIONALE Viral infections of the upper respiratory tract may influence the commensal nasopharyngeal bacteria. Changes in the bacterial niche could affect transmission dynamics. Attenuated vaccine viruses can be used to investigate this empirically in humans. OBJECTIVES To study the effects of mild viral upper respiratory infections on nasopharyngeal bacterial colonization using live attenuated influenza vaccine (LAIV) as a surrogate. METHODS We used trivalent LAIV to evaluate the effects of viral infection on bacterial carriage and density of Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, and Staphylococcus aureus. A total of 151 healthy children were randomized 1:1 to receive the vaccine starting either at recruitment (n = 74) or 28 days later (n = 77) in a stepped wedge fashion, allowing comparisons between recipients and nonrecipients as well as whole-group comparisons pre- and postvaccination. Bacterial carriage and density were determined using quantitative polymerase chain reaction assays. MEASUREMENTS AND MAIN RESULTS A total of 151 children were recruited, 77 in the LAIV group and 74 in the control group. LAIV recipients (n = 63 analyzed) showed an apparent transient increase in H. influenzae carriage but no further significant differences in carriage prevalence of the four bacterial species compared with controls (n = 72 analyzed). S. pneumoniae density was substantially higher in vaccine recipients (16,687 vs. 1935 gene copies per milliliter) 28 days after the first dose (P < 0.001). Whole-group multivariable analysis (prevaccine, after one dose, and after two doses) also showed increases in density of other species and H. influenzae carriage prevalence. CONCLUSIONS In the absence of any safety signals despite widespread use of the vaccine, these findings suggest that bacterial density, and thus transmission rates among children and to people in other age groups, may rise following attenuated influenza infections without associated clinical disease. LAIV could therefore be used as an experimental tool to elucidate the dynamics of transmission of nasopharyngeal bacteria.
Collapse
Affiliation(s)
| | - Hannah Christensen
- 2 School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; and
| | | | - Ian Vipond
- 3 Public Health Laboratory Bristol, Public Health England, Bristol, United Kingdom
| | - Peter Muir
- 3 Public Health Laboratory Bristol, Public Health England, Bristol, United Kingdom
| | - Adam Finn
- 1 School of Cellular and Molecular Medicine and
| |
Collapse
|
37
|
Thors V, Morales-Aza B, Pidwill G, Vipond I, Muir P, Finn A. Population density profiles of nasopharyngeal carriage of 5 bacterial species in pre-school children measured using quantitative PCR offer potential insights into the dynamics of transmission. Hum Vaccin Immunother 2016; 12:375-82. [PMID: 26367344 DOI: 10.1080/21645515.2015.1090069] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Bacterial vaccines can reduce carriage rates. Colonization is usually a binary endpoint. Real time quantitative PCR (qPCR) can quantify bacterial DNA in mucosal samples over a wide range. Using culture and single-gene species-specific qPCRs for Streptococcus pneumoniae (lytA), Streptococcus pyogenes (ntpC), Moraxella catarrhalis (ompJ), Haemophilus influenzae (hdp) and Staphylococcus aureus (nuc) and standard curves against log-phase reference strain broth cultures we described frequency and peak density distributions of carriage in nasopharyngeal swabs from 161 healthy 2-4 y old children collected into STGG broth. In general, detection by qPCR and culture was consistent. Discordance mostly occurred at lower detection thresholds of both methods, although PCR assays for S. pyogenes and S. aureus were less sensitive. Density varied across 5-7 orders of magnitude for the 5 species with the abundant species skewed toward high values (modes: S. pneumoniae log3-4, M. catarrhalis & H. influenzae log4-5 CFU/ml broth). Wide ranges of bacterial DNA concentrations in healthy children carrying these bacteria could mean that different individuals at different times vary greatly in infectiousness. Understanding the host, microbial and environmental determinants of colonization density will permit more accurate prediction of vaccine effectiveness.
Collapse
Affiliation(s)
- Valtyr Thors
- a University of Bristol; School of Cellular and Molecular Medicine ; Bristol , UK
| | - Begonia Morales-Aza
- a University of Bristol; School of Cellular and Molecular Medicine ; Bristol , UK
| | - Grace Pidwill
- a University of Bristol; School of Cellular and Molecular Medicine ; Bristol , UK
| | - Ian Vipond
- b Public Health Laboratory Bristol; Public Health England ; Bristol , UK
| | - Peter Muir
- b Public Health Laboratory Bristol; Public Health England ; Bristol , UK
| | - Adam Finn
- a University of Bristol; School of Cellular and Molecular Medicine ; Bristol , UK
| |
Collapse
|
38
|
Abstract
Pulmonary infections remain a major cause of infant and child mortality worldwide and are responsible for a substantial burden of morbidity. During the 2015 European Respiratory Society International Congress in Amsterdam, some of the main findings from peer-reviewed articles addressing this topic that were published in the preceding 12 months were reviewed in a Paediatric Clinical Year in Review session. The following article highlights some of the insights provided by these articles into the complex interactions of the human host with the extensive and dynamic populations of microorganisms that call an individual "home".
Collapse
Affiliation(s)
- Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Subiaco, Australia
| |
Collapse
|
39
|
Viral-bacterial co-infections in the respiratory tract. Curr Opin Microbiol 2016; 35:30-35. [PMID: 27940028 PMCID: PMC7108227 DOI: 10.1016/j.mib.2016.11.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/16/2016] [Accepted: 11/22/2016] [Indexed: 01/02/2023]
Abstract
Viruses predispose to secondary bacterial infection throughout the respiratory tract. Viral damage to airway epithelium and aberrant inflammatory responses play key roles. Dysregulation of both innate and acquired immune effectors contribute to co-infection. Viral co-infection promotes bacterial invasion of sterile sites within the airway. Optimal treatment likely requires control of both bacterial growth and host responses.
Preceding or concurrent viral respiratory tract infection can predispose to secondary bacterial co-infection throughout the airway. The mechanisms by which viruses promote these superinfections are diverse and replete. Whereas we understand much as to how viruses damage the airway and dysregulate both innate and acquired immune responses which, in turn, supports bacterial growth, adherence and invasion into normally sterile sites within the respiratory tract, new information regarding these co-infections is being gained from recent advances in microbiome research and our enhanced appreciation of the contribution of bacterial biofilms, among others. The advanced understanding obtained by continued research efforts in all aspects of viral–bacterial co-infections of the respiratory tract will allow us to devise novel approaches for disease prevention as well as to develop more effective therapeutics.
Collapse
|
40
|
DE LASTOURS V, MALOSH R, RAMADUGU K, SRINIVASAN U, DAWID S, OHMIT S, FOXMAN B. Co-colonization by Streptococcus pneumoniae and Staphylococcus aureus in the throat during acute respiratory illnesses. Epidemiol Infect 2016; 144:3507-3519. [PMID: 27535335 PMCID: PMC9150196 DOI: 10.1017/s0950268816001473] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 12/16/2022] Open
Abstract
Pneumonia due to either Streptococcus pneumoniae (Sp) or Staphylococcus aureus (Sa) accounts for most mortality after influenza and acute respiratory illness (ARI). Because carriage precedes infection, we estimated Sp and Sa carriage to examine the co-colonization dynamics between Sp, Sa and respiratory viruses in the presence of ARI in the oropharynx. We tested oropharyngeal specimens of community subjects (aged ⩾2 years) with ARI for the presence of influenza A and B, 11 other common respiratory viruses, Sp and Sa, using real-time PCR. A total of 338 participants reported 519 ARI episodes of which 119 (35%) carried Sp, 52 (13%) carried Sa and 25 (7%) carried both. Thirty-five subjects tested positive for influenza, of which 14 (40%) carried Sp and six (17%) carried Sa, significantly more than in the influenza-negative group (P = 0·03 and P = 0·04, respectively). In subjects infected by any virus compared to those with no virus, Sp carriage (39·2% vs. 27·9%, P = 0·03) but not Sa carriage (11·6% vs. 14%, P = 0·6) was more frequent. For children, when Sa was present, Sp carriage tended to be less frequent than expected given the presence of viral infection, but not significantly [observed relative risk 1·14, 95% confidence interval (CI) 0·4-3·1; with a relative excess risk due to interaction of -0·11]. Independent of age, Sp carriers were more likely to return that season with subsequent ARI (odds ratio 2·14, 95% CI 1·1-4·3, P = 0·03). Both Sp and Sa carriage rates in the oropharynx increase during influenza infection in children. However, no negative interaction between Sp and Sa was observed. Sp carriers are more likely to suffer subsequent ARI episodes than non-carriers.
Collapse
Affiliation(s)
- V. DE LASTOURS
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - R. MALOSH
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - K. RAMADUGU
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - U. SRINIVASAN
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - S. DAWID
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - S. OHMIT
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - B. FOXMAN
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
41
|
Zafar MA, Kono M, Wang Y, Zangari T, Weiser JN. Infant Mouse Model for the Study of Shedding and Transmission during Streptococcus pneumoniae Monoinfection. Infect Immun 2016; 84:2714-22. [PMID: 27400721 PMCID: PMC4995895 DOI: 10.1128/iai.00416-16] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/05/2016] [Indexed: 12/21/2022] Open
Abstract
One of the least understood aspects of the bacterium Streptococcus pneumoniae (pneumococcus) is its transmission from host to host, the critical first step in both the carrier state and the disease state. To date, transmission models have depended on influenza A virus coinfection, which greatly enhances pneumococcal shedding to levels that allow acquisition by a new host. Here, we describe an infant mouse model that can be utilized to study pneumococcal colonization, shedding, and transmission during bacterial monoinfection. Using this model, we demonstrated that the level of bacterial shedding is highest in pups infected intranasally at age 4 days and peaks over the first 4 days postchallenge. Shedding results differed among isolates of five different pneumococcal types. Colonization density was found to be a major factor in the level of pneumococcal shedding and required expression of capsule. Transmission within a litter occurred when there was a high ratio of colonized "index" pups to uncolonized "contact" pups. Transmission was observed for each of the well-colonizing pneumococcal isolates, with the rate of transmission proportional to the level of shedding. This model can be used to examine bacterial and host factors that contribute to pneumococcal transmission without the effects of viral coinfection.
Collapse
Affiliation(s)
- M Ammar Zafar
- Department of Microbiology, New York University, New York, New York, USA
| | - Masamitsu Kono
- Department of Microbiology, New York University, New York, New York, USA Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yang Wang
- Department of Microbiology, New York University, New York, New York, USA School of Medicine, Tsing Hua University, Beijing, China
| | - Tonia Zangari
- Department of Microbiology, New York University, New York, New York, USA
| | - Jeffrey N Weiser
- Department of Microbiology, New York University, New York, New York, USA
| |
Collapse
|
42
|
Chonmaitree T, Trujillo R, Jennings K, Alvarez-Fernandez P, Patel JA, Loeffelholz MJ, Nokso-Koivisto J, Matalon R, Pyles RB, Miller AL, McCormick DP. Acute Otitis Media and Other Complications of Viral Respiratory Infection. Pediatrics 2016; 137:peds.2015-3555. [PMID: 27020793 PMCID: PMC4811317 DOI: 10.1542/peds.2015-3555] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Viral upper and lower respiratory tract infections (URI, LRI) are common in infants. We determined the prevalence of viral URI and its complications, including acute otitis media (AOM) and LRI, and assessed the effect of bacterial-viral interactions, and genetic and environmental risks on AOM development. METHODS Healthy infants were enrolled from near birth and followed to the first episode of AOM up to 12 months of age. Nasopharyngeal specimens were collected at monthly intervals (months 1-6, 9) and during viral URI episodes for bacterial culture and viral polymerase chain reaction studies. Subjects were followed closely for AOM development. RESULTS A total of 367 infants were followed for 286 child-years; 887 URI (305 infants) and 180 AOM episodes (143 infants) were documented. Prevalence of URI, LRI, and AOM in the first year was 3.2, 0.25, and 0.67 per child-year, respectively. Cumulative AOM incidence by ages 3, 6, and 12 months was 6%, 23%, and 46%. Infants with and without AOM had 4.7 and 2.3 URI episodes per child-year, respectively (P < .002). Pathogenic bacterial colonization rates by month were significantly higher in infants with AOM (P < .005). Breastfeeding reduced both URI and AOM risks (P < .05). Significant bacterial-viral interactions occurred with Moraxella catarrhalis and a variety of respiratory viruses and altered URI and AOM risks. CONCLUSIONS Almost half of infants experienced AOM by age 1. Important AOM risk factors included frequent viral URI, pathogenic bacterial colonization, and lack of breastfeeding. Bacterial-viral interactions may play a significant role in AOM pathogenesis and deserve further investigation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Richard B. Pyles
- Departments of Pediatrics, ,Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas
| | | | | |
Collapse
|
43
|
Aiello AE, Simanek AM, Eisenberg MC, Walsh AR, Davis B, Volz E, Cheng C, Rainey JJ, Uzicanin A, Gao H, Osgood N, Knowles D, Stanley K, Tarter K, Monto AS. Design and methods of a social network isolation study for reducing respiratory infection transmission: The eX-FLU cluster randomized trial. Epidemics 2016; 15:38-55. [PMID: 27266848 PMCID: PMC4903923 DOI: 10.1016/j.epidem.2016.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 01/09/2016] [Accepted: 01/19/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Social networks are increasingly recognized as important points of intervention, yet relatively few intervention studies of respiratory infection transmission have utilized a network design. Here we describe the design, methods, and social network structure of a randomized intervention for isolating respiratory infection cases in a university setting over a 10-week period. METHODOLOGY/PRINCIPAL FINDINGS 590 students in six residence halls enrolled in the eX-FLU study during a chain-referral recruitment process from September 2012-January 2013. Of these, 262 joined as "seed" participants, who nominated their social contacts to join the study, of which 328 "nominees" enrolled. Participants were cluster-randomized by 117 residence halls. Participants were asked to respond to weekly surveys on health behaviors, social interactions, and influenza-like illness (ILI) symptoms. Participants were randomized to either a 3-Day dorm room isolation intervention or a control group (no isolation) upon illness onset. ILI cases reported on their isolation behavior during illness and provided throat and nasal swab specimens at onset, day-three, and day-six of illness. A subsample of individuals (N=103) participated in a sub-study using a novel smartphone application, iEpi, which collected sensor and contextually-dependent survey data on social interactions. Within the social network, participants were significantly positively assortative by intervention group, enrollment type, residence hall, iEpi participation, age, gender, race, and alcohol use (all P<0.002). CONCLUSIONS/SIGNIFICANCE We identified a feasible study design for testing the impact of isolation from social networks in a university setting. These data provide an unparalleled opportunity to address questions about isolation and infection transmission, as well as insights into social networks and behaviors among college-aged students. Several important lessons were learned over the course of this project, including feasible isolation durations, the need for extensive organizational efforts, as well as the need for specialized programmers and server space for managing survey and smartphone data.
Collapse
Affiliation(s)
- Allison E Aiello
- University of North Carolina-Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, United States.
| | - Amanda M Simanek
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Marisa C Eisenberg
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor, MI, United States
| | - Alison R Walsh
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor, MI, United States
| | - Brian Davis
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor, MI, United States
| | | | - Caroline Cheng
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor, MI, United States
| | - Jeanette J Rainey
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amra Uzicanin
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hongjiang Gao
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Nathaniel Osgood
- University of Saskatchewan, Department of Computer Science, Saskatoon, SK, Canada
| | - Dylan Knowles
- University of Saskatchewan, Department of Computer Science, Saskatoon, SK, Canada
| | - Kevin Stanley
- University of Saskatchewan, Department of Computer Science, Saskatoon, SK, Canada
| | - Kara Tarter
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor, MI, United States
| | - Arnold S Monto
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor, MI, United States
| |
Collapse
|
44
|
Usuf E, Bojang A, Hill PC, Bottomley C, Greenwood B, Roca A. Nasopharyngeal colonization of Gambian infants by Staphylococcus aureus and Streptococcus pneumoniae before the introduction of pneumococcal conjugate vaccines. New Microbes New Infect 2015; 10:13-8. [PMID: 26909154 PMCID: PMC4733216 DOI: 10.1016/j.nmni.2015.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 11/29/2022] Open
Abstract
Staphylococcus aureus and Streptococcus pneumoniae commonly colonize the upper respiratory tract and can cause invasive disease. Several studies suggest an inverse relationship between these two bacteria in the nasopharynx. This association is of particular concern as the introduction of pneumococcal conjugate vaccines (PCVs) that affect pneumococcal nasopharyngeal carriage become widespread. A cohort of children in rural Gambia were recruited at birth and followed for 1 year, before the introduction of PCV into the routine immunization program. Nasopharyngeal swabs were taken immediately after birth, every 2 weeks for the first 6 months and then every other month. The presence of S. aureus and S. pneumoniae was determined using conventional microbiologic methods. Prevalence of S. aureus carriage was 71.6% at birth, decreasing with age to reach a plateau at approximately 20% between 10 to 20 weeks of age. Carriage with any S. pneumoniae increased during the first 10 weeks of life to peak at approximately 90%, mostly of PCV13 serotypes. Although in the crude analysis S. aureus carriage was inversely associated with carriage of any S. pneumoniae and PCV13 serotypes, after adjusting by age and season, there was a positive association with any carriage (odds ratio 1.32; 95% confidence interval 1.07-1.64; p 0.009) and no association with carriage of PCV13 serotypes (odds ratio 0.99; 95% confidence interval 0.70-1.41; p 0.973). Among Gambian infants, S. aureus and S. pneumoniae are not inversely associated in nasopharyngeal carriage after adjustment for age. Further carriage studies following the introduction of PCV are needed to better understand the relationship between the two bacteria.
Collapse
Affiliation(s)
- E Usuf
- Disease Control and Elimination, MRC Unit The Gambia, Fajara, Gambia
| | - A Bojang
- Disease Control and Elimination, MRC Unit The Gambia, Fajara, Gambia
| | - P C Hill
- Centre for International Health, University of Otago, New Zealand
| | - C Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - B Greenwood
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - A Roca
- Disease Control and Elimination, MRC Unit The Gambia, Fajara, Gambia; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
45
|
Associations Between Viral and Bacterial Potential Pathogens in the Nasopharynx of Children With and Without Respiratory Symptoms. Pediatr Infect Dis J 2015; 34:1296-301. [PMID: 26262821 DOI: 10.1097/inf.0000000000000872] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nasopharyngeal (NP) bacterial colonization is necessary for subsequent respiratory and/or invasive infection. Our study aimed at comparing NP bacterial colonization rates between children with and without symptoms of an acute viral respiratory tract infection and examining associations between identified microorganisms. METHODS Children 3 months to 6 years of age with and without an acute viral respiratory tract infection were recruited, and a questionnaire was filled. NP samples were examined for Streptococcus pneumoniae (SP), Haemophilus influenzae (HI), Moraxella catarrhalis (MC), Staphylococcus aureus and Streptococcus pyogenes by culture. Viruses were detected with polymerase chain reaction. RESULTS Median age of the 386 recruited children was 23.4 months, and 127 had no respiratory symptoms. More asymptomatic subjects were found negative for all bacteria tested (P < 0.01). SP (P < 0.01), MC (P = 0.001) and mixed bacterial colonization patterns were more frequent among symptomatic children (P < 0.05). Colonization of symptomatic, virus-positive children with MC was higher than in asymptomatic and/or virus-negative children (P = 0.005). The highest HI and MC colonization rates were recorded in association with influenza virus. A strongly negative association between SP and S. aureus, a higher rate of HI detection among SP colonized children and an increased likelihood of MC detection in the presence of HI were observed. HI colonization was more likely in the presence of respiratory syncytial virus and MC colonization was associated with rhinovirus detection. CONCLUSIONS Viruses are associated with different NP bacterial colonization patterns. Observed pathogens' associations may play a role in disease, and continuous surveillance is required to follow possible effects of interventions such as vaccines.
Collapse
|
46
|
Decline in Pneumococcal Nasopharyngeal Carriage of Vaccine Serotypes After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Children in Atlanta, Georgia. Pediatr Infect Dis J 2015; 34:1168-74. [PMID: 26226445 DOI: 10.1097/inf.0000000000000849] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Streptococcus pneumoniae (SP) serotype distribution among nasopharyngeal (NP) carriage isolates changed significantly after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). We evaluated the impact on NP carriage and invasive disease of SP after the introduction of the 13-valent PCV (PCV13) in March 2010. METHODS NP swabs were collected from children 6-59 months of age in an emergency department from July 2010 to June 2013. After broth enrichment, samples were cultured for SP and isolates were serotyped. Clinical and immunization records were reviewed. Findings during 6 sequential 6-month study periods were compared. Surveillance isolates of invasive disease isolates were reviewed. RESULTS A total of 2048 children were enrolled, and 656 (32%) were SP carriers. Mean age of carriers was 27 months, 54% were males. Carriage was higher among day-care attendees (P < 0.01) and children with respiratory tract illnesses (P < 0.5) and otitis media (P < 0.01). Commonly carried serotypes included 35B (15.2%), 15B/C (14.2%), 19A (9.6%), 11A (8%), 23B (5.6%), 6C (5.3%), 21 (5%), and 15A (5%); 13.9% were PCV13 serotypes. The proportion of children with SP carriage remained stable but the serotype distribution changed during the study period. Among carriers, PCV13 serotypes declined from 29% (36/124) to 3% (3/99; P < 0.0001), predominantly because of decline of serotype 19A from 25.8% (32/124) to 3% (3/99; P < 0.0001); non-PCV13 serotypes (excluding 6C) increased from 68.4% (78/114) to 97% (95/98; P < 0.0001); serotype 35B significantly increased from 8.9% (11/124) to 25.3% (25/99; P < 0.05). Nonsusceptibility to ceftriaxone declined from 22.6% (28/124) to 0% (0/99; P < 0.0001), with a similar decline in penicillin nonsusceptibility. CONCLUSIONS Introduction of PCV13 for universal infant use was associated with significant reductions in nasopharyngeal carriage of PCV13 serotypes and resistant strains. Carriage of non-PCV13 serotypes increased modestly, particularly serotype 35B. Further investigation is warranted to determine whether nonvaccine pneumococcal serotypes carried in the nasopharynx are associated with significant replacement disease.
Collapse
|
47
|
Abstract
BACKGROUND The spectrum of acute symptoms in young outpatient children with respiratory tract infection (RTI) is variable, and it cannot be explained by the diagnosis of acute otitis media (AOM) versus uncomplicated RTI. We studied that the variation of symptoms is explained by the nasopharyngeal bacteria and/or respiratory viruses. METHODS Children aged 6-35 months with acute symptoms with AOM (n = 201) or without AOM (n = 225) were eligible in this cross-sectional study. We analyzed their nasopharyngeal samples for pathogenic bacteria by culture and for respiratory viruses by polymerase chain reaction. We surveyed 17 symptoms (fever, respiratory, ear related, nonspecific, gastrointestinal) with a structured questionnaire. RESULTS Fever had a positive association with influenza viruses [odds ratio (OR): 6.61; 95% confidence interval (CI): 1.66-26.27], human metapneumovirus (OR: 3.84; 95% CI: 1.25-11.77), coronaviruses (OR: 3.45; 95% CI: 1.53-7.75) and parainfluenza viruses (OR: 2.18; 95% CI: 1.07-4.47). Rhinitis (OR: 5.07; 95% CI: 1.93-13.36), nasal congestion (OR: 2.03; 95% CI: 1.25-3.31) and cough (OR: 1.91; 95% CI: 1.15-3.17) had positive associations with Moraxella catarrhalis. Furthermore, cough had a positive association with respiratory syncytial virus (OR: 7.20; 95% CI: 1.59-32.71) and parainfluenza viruses (OR: 2.79; 95% CI: 1.02-7.69). CONCLUSIONS The variation of acute symptoms in young children may be influenced by both nasopharyngeal bacteria and respiratory viruses. Our results showed a strong association between fever and respiratory viruses; rhinitis, nasal congestion and cough were associated with M. catarrhalis in the presence of viruses. Further studies are required to determine the possible synergistic role of M. catarrhalis in symptoms of RTI.
Collapse
|
48
|
Finn A. A Milestone in the Investigation of Population-Wide Effects of Vaccines. Am J Respir Crit Care Med 2015; 192:776-7. [DOI: 10.1164/rccm.201507-1417ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Adam Finn
- Bristol Children's Vaccine CentreUniversity of BristolBristol, United Kingdom
| |
Collapse
|
49
|
Siegel SJ, Roche AM, Weiser JN. Influenza promotes pneumococcal growth during coinfection by providing host sialylated substrates as a nutrient source. Cell Host Microbe 2015; 16:55-67. [PMID: 25011108 DOI: 10.1016/j.chom.2014.06.005] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 02/07/2014] [Accepted: 05/01/2014] [Indexed: 11/15/2022]
Abstract
Much of the mortality attributed to influenza virus is due to secondary bacterial pneumonia, particularly from Streptococcus pneumoniae. However, mechanisms underlying this coinfection are incompletely understood. We find that prior influenza infection enhances pneumococcal colonization of the murine nasopharynx, which in turn promotes bacterial spread to the lungs. Influenza accelerates bacterial replication in vivo, and sialic acid, a major component of airway glycoconjugates, is identified as the host-derived metabolite that stimulates pneumococcal proliferation. Influenza infection increases sialic acid and sialylated mucin availability and enhances desialylation of host glycoconjugates. Pneumococcal genes for sialic acid catabolism are required for influenza to promote bacterial growth. Decreasing sialic acid availability in vivo by genetic deletion of the major airway mucin Muc5ac or mucolytic treatment limits influenza-induced pneumococcal replication. Our findings suggest that higher rates of disease during coinfection could stem from influenza-provided sialic acid, which increases pneumococcal proliferation, colonization, and aspiration.
Collapse
Affiliation(s)
- Steven J Siegel
- Department of Microbiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aoife M Roche
- Department of Microbiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey N Weiser
- Department of Microbiology, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Pediatrics, University of Pennsylvania, Philadelphia, PA 19104, USA.
| |
Collapse
|
50
|
Abstract
BACKGROUND Staphylococcal aureus (SA) colonization in early infancy is common, but the pattern and factors affecting its acquisition and persistence in the first few months of life are not well studied. The aim is to study the rate of SA nasopharyngeal (NP) colonization at monthly intervals in the first 6 months of life and its association with environmental and host factors and other pathogenic NP bacteria. METHODS Data from a prospective study were analyzed on bacterial cultures of 1765 NP swabs from 367 infants who were followed from birth to 6 months of age. Demographic, breastfeeding, cigarette smoke exposure and day care attendance data were collected at each monthly visit. RESULTS The rate of infants colonized with SA was highest at age 1 month (25%) and declined to lowest rate by age 6 months (12%). The proportion of SA strains that was methicillin-resistant SA was also highest at age 1 month and declined rapidly by age 4 months (18% vs. 6%, P = 0.05). Colonization with Streptococcus pneumoniae (SP), nontypeable Haemophilus influenzae (NTHI) and Moraxella catarrhalis (MC) increased at different rates up to age 6 months. Univariate analysis showed that SA colonization rate was significantly lower with increasing age, black race, day care attendance, and colonization with NTHI, MC and SP (P < 0.05). Multivariate analysis showed that this effect was independently associated only with increasing age and MC colonization (P < 0.05). Furthermore, the time to first acquisition of SA from one month of age onwards was significantly associated with day care attendance, and NTHI and MC colonization. None of the infants colonized with SA developed SA infections through age 6 months. CONCLUSIONS SA colonization of NP begins very early in life and declines quickly. Methicillin-resistant SA has lower ability to maintain prolonged colonization status than methicillin-susceptible strains in the first 6 months of life. As the NP is colonized with other respiratory bacterial pathogens, the colonization with SA declines; however, this effect is stronger with Gram-negative bacteria, such as NTHI and MC.
Collapse
|