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Vasey B, Shankar AH, Herrera BB, Becerra A, Xhaja K, Echenagucia M, Machado SR, Caicedo D, Miller J, Amedeo P, Naumova EN, Bosch I. Multivariate time-series analysis of biomarkers from a dengue cohort offers new approaches for diagnosis and prognosis. PLoS Negl Trop Dis 2020; 14:e0008199. [PMID: 32544159 PMCID: PMC7380649 DOI: 10.1371/journal.pntd.0008199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 07/24/2020] [Accepted: 03/05/2020] [Indexed: 11/18/2022] Open
Abstract
Dengue is a major public health problem worldwide with distinct clinical manifestations: an acute presentation (dengue fever, DF) similar to other febrile illnesses (OFI) and a more severe, life-threatening form (severe dengue, SD). Due to nonspecific clinical presentation during the early phase of dengue infection, differentiating DF from OFI has remained a challenge, and current methods to determine severity of dengue remain poor early predictors. We present a prospective clinical cohort study conducted in Caracas, Venezuela from 2001-2005, designed to determine whether clinical and hematological parameters could distinguish DF from OFI, and identify early prognostic biomarkers of SD. From 204 enrolled suspected dengue patients, there were 111 confirmed dengue cases. Piecewise mixed effects regression and nonparametric statistics were used to analyze longitudinal records. Decreased serum albumin and fibrinogen along with increased D-dimer, thrombin-antithrombin complex, activated partial thromboplastin time and thrombin time were prognostic of SD on the day of defervescence. In the febrile phase, the day-to-day rates of change in serum albumin and fibrinogen concentration, along with platelet counts, were significantly decreased in dengue patients compared to OFI, while the day-to-day rates of change of lymphocytes (%) and thrombin time were increased. In dengue patients, the absolute lymphocytes to neutrophils ratio showed specific temporal increase, enabling classification of dengue patients entering the critical phase with an area under the ROC curve of 0.79. Secondary dengue patients had elongation of Thrombin time compared to primary cases while the D-dimer formation (fibrinolysis marker) remained always lower for secondary compared to primary cases. Based on partial analysis of 31 viral complete genomes, a high frequency of C-to-T transitions located at the third codon position was observed, suggesting deamination events with five major hot spots of amino acid polymorphic sites outside in non-structural proteins. No association of severe outcome was statistically significant for any of the five major polymorphic sites found. This study offers an improved understanding of dengue hemostasis and a novel way of approaching dengue diagnosis and disease prognosis using piecewise mixed effect regression modeling. It also suggests that a better discrimination of the day of disease can improve the diagnostic and prognostic classification power of clinical variables using ROC curve analysis. The piecewise mixed effect regression model corroborated key early clinical determinants of disease, and offers a time-series approach for future vaccine and pathogenesis clinical studies.
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Affiliation(s)
- Baptiste Vasey
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Anuraj H. Shankar
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Bobby Brooke Herrera
- E25Bio Inc., Cambridge, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aniuska Becerra
- Center for Infectious Diseases and Vaccine Research, University of Massachusetts, Worcester, Massachusetts, United States of America
| | - Kris Xhaja
- Center for Infectious Diseases and Vaccine Research, University of Massachusetts, Worcester, Massachusetts, United States of America
| | - Marion Echenagucia
- Centro Nacional de Hemofilia at Banco Municipal de Sangre, Universidad Central de Venezuela, Caracas, Venezuela
| | - Sara R. Machado
- Department of Health Policy, London School of Economics, London, United Kingdom
| | | | - John Miller
- J. Craig Venter Institute, La Jolla, California, United States of America
| | - Paolo Amedeo
- J. Craig Venter Institute, La Jolla, California, United States of America
| | - Elena N. Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Irene Bosch
- E25Bio Inc., Cambridge, Massachusetts, United States of America
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, United States of America
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Norma Blumenfeld deBosch
- Center for Infectious Diseases and Vaccine Research, University of Massachusetts, Worcester, Massachusetts, United States of America
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Pybus V, Onderdonk AB. The Effect of pH on Growth and Succinate Production byPrevotella bivia. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.3109/08910609609167725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- V. Pybus
- Charming Laboratory, Harvard Medical School, Boston, USA
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Lee MLT, Ross RA, Delaney ML, Onderdonk AB. Predicting Abnormal Microbial Population Levels in the Vaginal Ecosystem. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.3109/08910609409141360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M. L. T. Lee
- Charming Laboratory, Harvard Medical School and Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - R. A. Ross
- Charming Laboratory, Harvard Medical School and Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - M. L. Delaney
- Charming Laboratory, Harvard Medical School and Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - A. B. Onderdonk
- Charming Laboratory, Harvard Medical School and Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, 02115, USA
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Schellenberg J, Blake Ball T, Lane M, Cheang M, Plummer F. Flow cytometric quantification of bacteria in vaginal swab samples self-collected by adolescents attending a gynecology clinic. J Microbiol Methods 2008; 73:216-26. [PMID: 18423913 DOI: 10.1016/j.mimet.2008.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/12/2008] [Accepted: 03/04/2008] [Indexed: 01/19/2023]
Abstract
Bacterial vaginosis (BV) is an important risk factor in reproductive health outcomes, such as pre-term birth and sexually transmitted infections including HIV. However, its etiology, diagnosis and treatment remain poorly defined. We evaluated flow cytometry as a tool to quantify total bacterial cells in vaginal specimens self-collected longitudinally by adolescents. BV was diagnosed by Gram-stain (criteria of Hay and Ison). Average flow cytometric counts of bacterial cell-units (BCU) was log(10) 8.04 per gram sample and was found to correlate with sample weight (p<0.0001). BV was frequently observed in this group, with 22 of 32 participants (69%) diagnosed with BV for at least one timepoint. Surprisingly, increased BCU was associated with normal Hay-Ison score (p=0.0003), even when adjusting for sample weight (p=0.02). Since presence and quantity of Lactobacillus defines normal vaginal microbiology (ie. absence of BV), this result indicates a possible bias towards dominance of Lactobacillus cells in measurements of "total" BCU. Increased BCU per gram was associated in multivariate analysis with longer self-reported time since last menstruation (p=0.004) and last sexual intercourse (p=0.007). Sperm was detected in 3 samples provided by those reporting sexual intercourse in the previous 24 h. Light-scattering profiles of bacteria and vaginal cells in samples collected over time from an individual were often identical and distinct from other individuals. To our knowledge, this is the first description of flow cytometry for analysis of commensal bacteria in vaginal specimens. Further development may help to illuminate the complex dynamics of vaginal microbial communities underlying BV.
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Affiliation(s)
- John Schellenberg
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
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Abstract
GOALS The goals of this research were 2-fold: (1) to determine whether a commercially available probiotic mixture (VSL-3) could survive and grow in a continuous culture system simulating the vaginal environment and (2) to determine whether the probiotic mixture was capable of suppressing the growth of a known vaginal vault pathogen, Gardnerella vaginalis. BACKGROUND An abnormal vaginal microflora, such as that associated with bacterial vaginosis (BV) is an important health issue for women. In addition, the association of this condition with preterm labor and delivery suggests that control of BV may impact the number of preterm births. Interventional trials with antibiotics have received mixed reviews and other interventional options, including the use of probiotics, are being considered. STUDY A well-documented continuous culture system has been used to determine whether VSL-3 can survive and grow in conditions simulating a vaginal environment. In addition, the ability of VSL-3 to inhibit the growth of a known vaginal vault pathogen, G. vaginalis, has been determined. RESULTS The probiotic mixture was shown to survive and maintain itself within the fermentation vessel of the continuous culture system over an extended period of time. This mixture, when challenged with a known pathogen, was also shown to suppress the growth of G. vaginalis. CONCLUSIONS It may be feasible to use probiotics as interventional therapy to suppress the growth of pathogens within the vaginal vault associated with BV.
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Affiliation(s)
- Andrew B Onderdonk
- Department of Pathology Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Onderdonk AB, Lee ML, Lieberman E, Delaney ML, Tuomala RE. Quantitative microbiologic models for preterm delivery. J Clin Microbiol 2003; 41:1073-9. [PMID: 12624032 PMCID: PMC150298 DOI: 10.1128/jcm.41.3.1073-1079.2003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Preterm delivery (PTD) is the leading cause of infant morbidity and mortality in the United States. An epidemiological association between PTD and various bacteria that are part of the vaginal microflora has been reported. No single bacterial species has been identified as being causally associated with PTD, suggesting a multifactorial etiology. Quantitative microbiologic cultures have been used previously to define normal vaginal microflora in a predictive model. These techniques have been applied to vaginal swab cultures from pregnant women in an effort to develop predictive microbiologic models for PTD. Logistic regression analysis with microbiologic information was performed for various risk groups, and the probability of a PTD was calculated for each subject. Four predictive models were generated by using the quantitative microbiologic data. The area under the curve (AUC) for the receiver operating curves ranged from 0.74 to 0.94, with confidence intervals (CI) ranging from 0.62 to 1. The model for the previous PTD risk group with the highest percentage of PTDs had an AUC of 0.91 (CI, 0.79 to 1). It may be possible to predict PTD by using microbiologic risk factors measured once the gestation period has reached the 20-week time point.
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Affiliation(s)
- Andrew B Onderdonk
- Channing Laboratory, Departments of Pathology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Statistical models for vaginal microflora: identifying women at risk for group B streptococcus colonization as a test of concept. Infect Dis Obstet Gynecol 1997; 5:336-40. [PMID: 18476181 PMCID: PMC2364583 DOI: 10.1155/s1064744997000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/1997] [Accepted: 10/31/1997] [Indexed: 11/18/2022] Open
Abstract
Objective: The purpose of this study was to formulate a statistical model that relates human microflora to probabilities for vaginal colonization by group B Streptococcus (GBS). Methods: Longitudinal observations of total bacterial concentrations at various times during the menstrual cycle were obtained from overtly healthy, non-pregnant, menarcheal women. During each menstrual period and at appropriate intermenstrual times, the duplicate swab technique was used to sample the vaginal vault to obtain microbiologic samples. Women were identified as being colonized with GBS if their samples contained faculative gram-positive cocci. The method of generalized estimating equation (GEE) was used to model the longitudinal data set. Results: Concentrations of Corynebacterium sp., Streptococcus spp., and total anaerobic bacteria were found to be risk factors for GBS colonization. The sensitivity of the predictive model is 84% and the specificity is 79%. Conclusions: Although vaginal cultures for GBS are routinely performed to detect colonization, the statistical model described identifies associated risk factors which may be important determinants for GBS colonization.
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Lee MLT, Ross RA, Onderdonk AB. Demonstration of Microbial Subgroups among Normal Vaginal Microbiota Data. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 1995. [DOI: 10.3109/08910609509140087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M. -L. T. Lee
- Charming Laboratory, Brigham and Women's Hospital and Harvard Medical School, 180 Lonewood Avenue, Boston, MA, 02115, USA
| | - R. A. Ross
- Charming Laboratory, Brigham and Women's Hospital and Harvard Medical School, 180 Lonewood Avenue, Boston, MA, 02115, USA
| | - A. B. Onderdonk
- Charming Laboratory, Brigham and Women's Hospital and Harvard Medical School, 180 Lonewood Avenue, Boston, MA, 02115, USA
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