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Nieuwenburg SA, Jongen VW, Schim van der Loeff M, de Vries H, van Dam A. Seroconversion in syphilis screening without positive confirmatory tests points at early infection. Sex Transm Infect 2024; 100:138-142. [PMID: 38253515 DOI: 10.1136/sextrans-2023-055973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/02/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The chemiluminescence immunoassay (CLIA) is a widely used screening test for syphilis. A CLIA seroconversion in the absence of a positive line immunoassay (LIA) or rapid plasma reagin (RPR) could indicate either an early incubating syphilis or a false positive result. We aimed to evaluate the diagnostic value of such seroconversions. METHODS We retrospectively analysed data of clients visiting the Centre for Sexual Health Amsterdam between July 2013 and August 2021 with a positive CLIA and a negative RPR and negative or indeterminate LIA (at time To), and a preceding visit (T-1) with a negative CLIA <6 months of To ('unconfirmed CLIA seroconversion'). If available, data of follow-up visits (T1) <2 months of To were also included. A syphilis diagnosis was confirmed if darkfield microscopy or PCR for Treponema pallidum was positive at T0 or T1, or if RPR and/or LIA were positive at T1. RESULTS We included data of 107 clients with unconfirmed CLIA seroconversion. The value of CLIA seroconversion could not be established in 13 (12.1%) clients. In the remaining 94 clients, the unconfirmed CLIA seroconversion was confirmed as early syphilis in 72 (76.6%) clients and probable syphilis in 6 (6.4%) clients. In 16 (17.0%) clients, the unconfirmed CLIA seroconversion was regarded as a false positive reaction of whom 4 (5.3%) clients had a seroreversion of the CLIA at T1. CONCLUSION The majority of unconfirmed CLIA seroconversions represented early syphilis infections. Therefore, additional T. pallidum PCR, a follow-up consultation or early treatment is recommended.
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Affiliation(s)
- Silvia Achia Nieuwenburg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Amsterdam Institute for Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - Vita Willemijn Jongen
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Amsterdam Institute for Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Henry de Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Amsterdam Institute for Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Dermatology, Meibergdreef 9, Amsterdam, Amsterdam UMC location University of Amsterdam, Department of Dermatology, the Netherlands
| | - Alje van Dam
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Medical Microbiology, Amsterdam Health Service, Mebergdreef 9, Amsterdam, the Netherlands
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Teker B, Schim van der Loeff M, Hoornenborg E, Boyd A, Reedijk S, van Dam A, Jongen VW, de Vries H. Minimum inhibitory concentrations of Neisseria gonorrhoeae strains in clients of the Amsterdam sexual health clinic with a Dutch versus an international sexual network. Sex Transm Infect 2024; 100:173-180. [PMID: 38575313 DOI: 10.1136/sextrans-2023-055988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/13/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES International travel combined with sex may contribute to dissemination of antimicrobial-resistant (AMR) Neisseria gonorrhoeae (Ng). To assess the role of travel in Ng strain susceptibility, we compared minimum inhibitory concentrations (MICs) for five antibiotics (ie, azithromycin, ceftriaxone, cefotaxime, cefixime and ciprofloxacin) in strains from clients with an exclusively Dutch sexual network and clients with an additional international sexual network. METHODS From 2013 to 2019, we recorded recent residence of sexual partners of clients (and of their partners) with Ng at the Center for Sexual Health of Amsterdam. We categorised clients as having: (1) exclusively sexual partners residing in the Netherlands ('Dutch only') or (2) at least one partner residing outside the Netherlands. We categorised the country of residence of sexual partners by World Bank/EuroVoc regions. We analysed the difference of log-transformed MIC of Ng strains between categories using linear or hurdle regression for each antibiotic. RESULTS We included 3367 gay and bisexual men who had sex with men (GBMSM), 516 women and 525 men who exclusively had sex with women (MSW) with Ng. Compared with GBMSM with a 'Dutch only' network, GBMSM with: (1) a Western European network had higher MICs for ceftriaxone (β=0.19, 95% CI=0.08 to 0.29), cefotaxime (β=0.19, 95% CI=0.08 to 0.31) and cefixime (β=0.06, 95% CI=0.001 to 0.11); (2) a Southern European network had a higher MIC for cefixime (β=0.10, 95% CI=0.02 to 0.17); and (3) a sub-Saharan African network had a lower MIC for ciprofloxacin (β=-1.79, 95% CI=-2.84 to -0.74). In women and MSW, higher MICs were found for ceftriaxone in clients with a Latin American and Caribbean network (β=0.26, 95% CI=0.02 to 0.51). CONCLUSIONS For three cephalosporin antibiotics, we found Ng strains with slightly higher MICs in clients with partner(s) from Europe or Latin America and the Caribbean. International travel might contribute to the spread of Ng with lower susceptibility. More understanding of the emergence of AMR Ng is needed.
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Affiliation(s)
- Buhari Teker
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Dermatology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Maarten Schim van der Loeff
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands
| | - Elske Hoornenborg
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands
| | - Anders Boyd
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Sophia Reedijk
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Alje van Dam
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Medical Microbiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Vita Willemijn Jongen
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Henry de Vries
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Dermatology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands
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3
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Broertjes J, Jansen R, Verly I, van der Zwaluw K, van Dam A. Typhoid fever due to laboratory-acquired Salmonella Typhi, confirmed by core genome multi-locus sequence typing. Diagn Microbiol Infect Dis 2023; 107:116016. [PMID: 37481800 DOI: 10.1016/j.diagmicrobio.2023.116016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023]
Abstract
We present a case of laboratory-acquired Salmonella Typhi, resulting in hospitalization of a technician. Blood and stool cultures revealed a S. Typhi strain, identical to the strain with which the employee had recently worked, confirmed using core-genome multilocus sequence typing. The incident occurred despite working in a biosafety cabinet.
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Affiliation(s)
- Jorrit Broertjes
- Department of Medical Microbiology and Infection Prevention, University Medical Centers, Amsterdam, Netherlands.
| | - Rogier Jansen
- Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Iedan Verly
- Department of Medical Microbiology and Infection Prevention, University Medical Centers, Amsterdam, Netherlands
| | - Kim van der Zwaluw
- Centre for Infectious Disease Control, Diagnostics and Laboratory Surveillance (IDS), National Institute for Public Health and Environment, Bilthoven, Netherlands
| | - Alje van Dam
- Department of Medical Microbiology and Infection Prevention, University Medical Centers, Amsterdam, Netherlands; Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
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Edridge AWD, Abd-Elfarag G, Deijs M, Broeks MH, Cristella C, Sie B, Vaz FM, Jans JJM, Calis J, Verhoef H, Demir A, Poppert S, Nickel B, van Dam A, Sebit B, Titulaer MJ, Verweij JJ, de Jong MD, van Gool T, Faragher B, Verhoeven-Duif NM, Elledge SJ, van der Hoek L, Boele van Hensbroek M. Parasitic, bacterial, viral, immune-mediated, metabolic and nutritional factors associated with nodding syndrome. Brain Commun 2023; 5:fcad223. [PMID: 37731906 PMCID: PMC10507744 DOI: 10.1093/braincomms/fcad223] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/25/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Nodding syndrome is a neglected, disabling and potentially fatal epileptic disorder of unknown aetiology affecting thousands of individuals mostly confined to Eastern sub-Saharan Africa. Previous studies have identified multiple associations-including Onchocerca volvulus, antileiomodin-1 antibodies, vitamin B6 deficiency and measles virus infection-yet, none is proven causal. We conducted a case-control study of children with early-stage nodding syndrome (symptom onset <1 year). Cases and controls were identified through a household survey in the Greater Mundri area in South Sudan. A wide range of parasitic, bacterial, viral, immune-mediated, metabolic and nutritional risk factors was investigated using conventional and state-of-the-art untargeted assays. Associations were examined by multiple logistic regression analysis, and a hypothetical causal model was constructed using structural equation modelling. Of 607 children with nodding syndrome, 72 with early-stage disease were included as cases and matched to 65 household- and 44 community controls. Mansonella perstans infection (odds ratio 7.04, 95% confidence interval 2.28-21.7), Necator americanus infection (odds ratio 2.33, 95% confidence interval 1.02-5.3), higher antimalarial seroreactivity (odds ratio 1.75, 95% confidence interval 1.20-2.57), higher vitamin E concentration (odds ratio 1.53 per standard deviation increase, 95% confidence interval 1.07-2.19) and lower vitamin B12 concentration (odds ratio 0.56 per standard deviation increase, 95% confidence interval 0.36-0.87) were associated with higher odds of nodding syndrome. In a structural equation model, we hypothesized that Mansonella perstans infection, higher vitamin E concentration and fewer viral exposures increased the risk of nodding syndrome while lower vitamin B12 concentration, Necator americanus and malaria infections resulted from having nodding syndrome. We found no evidence that Onchocerca volvulus, antileiomodin-1 antibodies, vitamin B6 and other factors were associated with nodding syndrome. Our results argue against several previous causal hypotheses including Onchocerca volvulus. Instead, nodding syndrome may be caused by a complex interplay between multiple pathogens and nutrient levels. Further studies need to confirm these associations and determine the direction of effect.
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Affiliation(s)
- Arthur W D Edridge
- Amsterdam Centre for Global Child Health, Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Gasim Abd-Elfarag
- Amsterdam Centre for Global Child Health, Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Neurology & Psychiatry, College of Medicine, University of Juba, P.O. Box 82, Juba, South Sudan
| | - Martin Deijs
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Melissa H Broeks
- Department of Genetics, Section Metabolic Diagnostics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Cosimo Cristella
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Brandon Sie
- Division of Genetics, Brigham and Women’s Hospital, Howard Hughes Medical Institute, Boston, MA 02115, USA
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Frédéric M Vaz
- Department of Clinical Chemistry, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Judith J M Jans
- Department of Genetics, Section Metabolic Diagnostics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Job Calis
- Amsterdam Centre for Global Child Health, Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, P.O. Box 95, Blantyre, Malawi
| | - Hans Verhoef
- Division of Human Nutrition and Health, Wageningen University, 6701 AR Wageningen, The Netherlands
| | - Ayse Demir
- Laboratory for Clinical Chemistry and Hematology, Meander Medical Centre, 3813 TZ Amersfoort, The Netherlands
| | - Sven Poppert
- Diagnostic Centre, Swiss Tropical and Public Health Institute, University of Basel, 4123 Allschwil, Switzerland
- University of Basel, 4056 Basel, Switzerland
| | - Beatrice Nickel
- Diagnostic Centre, Swiss Tropical and Public Health Institute, University of Basel, 4123 Allschwil, Switzerland
- University of Basel, 4056 Basel, Switzerland
| | - Alje van Dam
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Boy Sebit
- Department of Neurology & Psychiatry, College of Medicine, University of Juba, P.O. Box 82, Juba, South Sudan
| | - Maarten J Titulaer
- Department of Neurology, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Jaco J Verweij
- Microvida Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Tom van Gool
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Brian Faragher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Nanda M Verhoeven-Duif
- Department of Genetics, Section Metabolic Diagnostics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Stephen J Elledge
- Division of Genetics, Brigham and Women’s Hospital, Howard Hughes Medical Institute, Boston, MA 02115, USA
| | - Lia van der Hoek
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Michael Boele van Hensbroek
- Amsterdam Centre for Global Child Health, Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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van den Beld M, Pijnacker R, van Dam A, Bovée L, Kwa D, Linde I, Wolthuis R, Notermans D, Bosch T, Franz E. Whole-genome sequencing of Shigella for surveillance purposes shows (inter)national relatedness and multidrug resistance in isolates from men who have sex with men. Microb Genom 2023; 9. [PMID: 37022322 DOI: 10.1099/mgen.0.000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
In the Netherlands, more than half of domestic shigellosis cases are among men who have sex with men (MSM), particularly in the Amsterdam region. However, there is limited insight into which Shigella strains circulate in the Netherlands. Our objective was to assess the added value of whole-genome sequencing (WGS)-based surveillance for Shigella. To this end, we determined the relatedness among Shigella spp. isolates from patients in the Amsterdam region, as well as in an international context, including antimicrobial resistance markers, using WGS. The following criteria were used: it should provide insight into (1) clustering of shigellosis cases and the affected population, (2) the extent of admixture of MSM-associated isolates with those from the broader population and (3) the presence of antimicrobial resistance. It should then lead to more opportunities for targeted control measures. For this study, Shigella isolates from three laboratories in the Amsterdam region obtained between February 2019 and October 2021 were subjected to Illumina WGS at the National Institute for Public Health and the Environment (RIVM). Raw data were quality-checked and assembled, the Shigella serotype was determined with ShigaTyper, and antimicrobial resistance markers were detected using ResFinder and PointFinder. For Shigella sonnei, subclades were determined using Mykrobe. Relatedness of isolates, including 21 international reference genomes, was assessed with core genome multilocus sequence typing. In total, 109 isolates were included, of which 27 were from females (25 %) and 66 were from males (61 %), with which the majority (n=48, 73 %) being from MSM. No information on sex was available for the remaining 16 cases. The WGS data for all isolates, comprising 55 S. sonnei, 52 Shigella flexneri, 1 Shigella boydii and 1 Shigella dysenteriae, met the quality criteria. In total, 14 clusters containing 51 isolates (49 %) were identified, with a median cluster size of 2.5 cases (range: 2-15). Nine out of 14 clusters were MSM-associated, and 8 clusters (57 %) were travel-related. Six of the MSM clusters were related to international reference genomes. The prevalence of antimicrobial resistance markers was higher among isolates from MSM than non-MSM patients, particularly for ciprofloxacin (89 vs 33 %) and azithromycin (58 vs 17 %). In conclusion, about half of Shigella spp. patients were part of a cluster, of which a substantial part were related to international reference genomes, particularly among MSM, and a high prevalence of antimicrobial resistance markers was found. These findings indicate widespread international circulation of Shigella spp., particularly among MSM, with multidrug resistance that hampers treatment of patients. Moreover, the results of this study led to the implementation of a national WGS-based laboratory surveillance programme for Shigella spp. that started in April 2022.
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Affiliation(s)
- Maaike van den Beld
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Roan Pijnacker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Alje van Dam
- Department of Infectious Diseases, GGD Amsterdam, Amsterdam, Netherlands
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam, Netherlands
| | - Lian Bovée
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Department of Infectious Diseases, GGD Amsterdam, Amsterdam, Netherlands
| | - David Kwa
- Department of Medial Microbiology, OLVG Laboratories, Amsterdam, Netherlands
| | - Ineke Linde
- Department of Infectious Diseases, GGD Amsterdam, Amsterdam, Netherlands
| | - Roxanne Wolthuis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Daan Notermans
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam, Netherlands
| | - Thijs Bosch
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Eelco Franz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
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Teker B, de Vries H, Heijman T, van Dam A, Schim van der Loeff M, Jongen VW. Spontaneous clearance of asymptomatic anogenital and pharyngeal Neisseria gonorrhoeae: a secondary analysis from the NABOGO trial. Sex Transm Infect 2022; 99:219-225. [PMID: 35820778 DOI: 10.1136/sextrans-2022-055488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/25/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Spontaneous clearance of asymptomatic Neisseria gonorrhoeae (NG) does occur, but data are scarce. We aimed to assess spontaneous clearance among patients with asymptomatic anal, pharyngeal, vaginal and urethral NG infections who participated in the New AntiBiotic treatment Options for uncomplicated GOnorrhoea (NABOGO) trial. In addition, we assessed the determinants associated with spontaneous clearance. METHODS The NABOGO trial (Trial registration number: NCT03294395) was a randomised controlled, double-blind, single-centre trial assessing non-inferiority of ertapenem, gentamicin and fosfomycin to ceftriaxone for treatment of uncomplicated gonorrhoea. For asymptomatic NABOGO participants, we collected pre-enrolment and enrolment visit samples before trial medication was given. Spontaneous clearance was defined as a positive pre-enrolment nucleic acid amplification test (NAAT) result, followed by a negative NAAT at enrolment. We compared the median time between pre-enrolment and enrolment visits for patients who cleared spontaneously and for those who did not. Determinants of spontaneous clearance were assessed using logistic regression. RESULTS Thirty-two of 221 (14.5%) anal NG infections cleared spontaneously, 17 of 91 (18.7%) pharyngeal, 3 of 13 (23.1%) vaginal and 9 of 28 (32.1%) urethral NG infections. The median time between the pre-enrolment and enrolment visit was longer for patients who cleared their pharyngeal infection spontaneously compared with those who did not (median 8 days (IQR=7-11) vs 6 days (IQR=4-8), p=0.012); no determinants of clearance at other sites were identified. Overall, patients with more days between the pre-enrolment and enrolment visit were more likely to clear spontaneously (adjusted OR=1.06 per additional day, 95% CI 1.01 to 1.12). No association between location of NG infection and spontaneous clearance was found. CONCLUSIONS A significant proportion of asymptomatic patients cleared their NG infections spontaneously. Given these results, treatment of all NG infections after a one-time NAAT may be excessive, and more research on the natural history of NG is needed to improve antibiotic stewardship.
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Affiliation(s)
- Buhari Teker
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Henry de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam institute for Infection and Immunity (AII), location Academic Medical Center, Amsterdam, the Netherlands
| | - Titia Heijman
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Alje van Dam
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam Institute for Infection Immunity (AII), Amsterdam, The Netherlands
| | - Vita Willemijn Jongen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
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van Dam A, Dekker M, Morales-Castilla I, Rodríguez MÁ, Wichmann D, Baudena M. Correspondence analysis, spectral clustering and graph embedding: applications to ecology and economic complexity. Sci Rep 2021; 11:8926. [PMID: 33903623 PMCID: PMC8076183 DOI: 10.1038/s41598-021-87971-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/05/2021] [Indexed: 11/09/2022] Open
Abstract
Identifying structure underlying high-dimensional data is a common challenge across scientific disciplines. We revisit correspondence analysis (CA), a classical method revealing such structures, from a network perspective. We present the poorly-known equivalence of CA to spectral clustering and graph-embedding techniques. We point out a number of complementary interpretations of CA results, other than its traditional interpretation as an ordination technique. These interpretations relate to the structure of the underlying networks. We then discuss an empirical example drawn from ecology, where we apply CA to the global distribution of Carnivora species to show how both the clustering and ordination interpretation can be used to find gradients in clustered data. In the second empirical example, we revisit the economic complexity index as an application of correspondence analysis, and use the different interpretations of the method to shed new light on the empirical results within this literature.
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Affiliation(s)
- Alje van Dam
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands. .,Centre for Complex Systems Studies, Utrecht University, Utrecht, The Netherlands.
| | - Mark Dekker
- Centre for Complex Systems Studies, Utrecht University, Utrecht, The Netherlands.,Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ignacio Morales-Castilla
- GloCEE-Global Change Ecology and Evolution Group, Department of Life Sciences, University of Alcalá, Alcalá, Spain
| | - Miguel Á Rodríguez
- GloCEE-Global Change Ecology and Evolution Group, Department of Life Sciences, University of Alcalá, Alcalá, Spain
| | - David Wichmann
- Centre for Complex Systems Studies, Utrecht University, Utrecht, The Netherlands.,Institute for Marine and Atmospheric Research Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mara Baudena
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands. .,Centre for Complex Systems Studies, Utrecht University, Utrecht, The Netherlands. .,GloCEE-Global Change Ecology and Evolution Group, Department of Life Sciences, University of Alcalá, Alcalá, Spain. .,National Research Council of Italy, Institute of Atmospheric Sciences and Climate (CNR-ISAC), Turin, Italy.
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9
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Abstract
Diversity is a central concept in many fields. Despite its importance, there is no unified methodological framework to measure diversity and its three components of variety, balance and disparity. Current approaches take into account disparity of the types by considering their pairwise similarities. Pairwise similarities between types may not adequately capture total disparity, since they do not take into account in which way pairs are similar. Hence, pairwise similarities do not discriminate between similarities of types in terms of the same feature and similarities in which all pairs share different features. This paper presents an alternative approach which is based on the overlap of features over the whole set of types. This results in a measure of diversity that takes into account the aspects of variety, balance and disparity. Based on this measure, the 'ABC decomposition' is introduced, which provides separate measures for the variety, balance and disparity, allowing them to enter analysis separately. The method is illustrated by analysing the industrial diversity from 1850 to present while taking into account the overlap in occupations they employ. Finally, the framework is extended to take into account disparity considering multiple features, providing a helpful tool in analysis of high-dimensional data.
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10
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van der Veer C, van Houdt R, van Dam A, de Vries H, Bruisten S. Accuracy of a commercial multiplex PCR for the diagnosis of bacterial vaginosis. J Med Microbiol 2018; 67:1265-1270. [PMID: 29985123 PMCID: PMC6230723 DOI: 10.1099/jmm.0.000792] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Bacterial vaginosis (BV) is a common clinical condition characterized by odorous vaginal discharge, vaginal itching and/or burning. BV can occur when vaginal lactobacilli are depleted and replaced by diverse anaerobic bacteria. We evaluated a commercial multiplex PCR (ATRiDA) for the diagnosis of BV. METHODS Cervicovaginal samples were included from women reporting urogenital symptoms and from women notified for sexually transmitted infections (STI) - who were not (necessarily) symptomatic. Clinical BV diagnoses were obtained from electronic patient files. The ATRiDA test measures the loads of Gardnerella vaginalis, Atopobium vaginae and Lactobacillus species in relation to overall bacterial load. The ATRiDA test outcome was compared to the clinical BV diagnosis and to vaginal microbiota composition, determined by 16SrRNA gene sequencing. RESULTS We included samples from 185 women reporting urogenital symptoms, of whom 81 had BV and 93 women who were notified for an STI, of whom 16 had BV. Overall, compared to the clinical BV diagnosis, the ATRiDA test demonstrated high sensitivity (96.9 %) and moderate specificity (70.2 %). The negative predictive value was high (>97.3). The positive predictive value differed by study group and was highest in women reporting urogenital symptoms (78.2 %). Sequencing showed that 54 % of women who had an ATRiDA BV-positive test outcome, but who were not clinically diagnosed with BV, had diverse anaerobic vaginal microbiota (asymptomatic vaginal dysbiosis). CONCLUSION The ATRiDA test is a sensitive method for the detection of BV but, given the high occurrence of asymptomatic vaginal dysbiosis, a positive test outcome should be interpreted together with clinical symptoms.
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Affiliation(s)
- Charlotte van der Veer
- 1Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Robin van Houdt
- 2Department of Medical Microbiology and Infection Prevention, VU University Medical Center, Amsterdam, the Netherlands
| | - Alje van Dam
- 1Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.,3Department of Medical Microbiology, OLVG General Hospital, Amsterdam, the Netherlands
| | - Henry de Vries
- 1Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.,4Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,5Amsterdam Infection and Immunity Institute, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sylvia Bruisten
- 5Amsterdam Infection and Immunity Institute, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,1Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
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Unemo M, Ringlander J, Wiggins C, Fredlund H, Jacobsson S, Cole M, Balla E, Barbara C, Borrego MJ, Brilene T, Chisholm S, Crucitti T, Dam AV, Hoffmann S, Jeverica S, Kohl P, Maikanti P, Mlynarczyk-Bonikowska B, Pakarna G, Pavlik P, Stary A, Stefanelli P, Svanborg G, Syversen G, Tzelepi E, Vazquez J. 006.2 High in vitro susceptibility to the novel spiropyrimidinetrione azd0914 among 873 contemporary clinical neisseria gonorrhoeae isolates in 21 european countries during 2012–2014. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052270.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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van Ierland-van Leeuwen M, Peringa J, Blaauwgeers H, van Dam A. Cat scratch disease, a rare cause of hypodense liver lesions, lymphadenopathy and a protruding duodenal lesion, caused by Bartonella henselae. BMJ Case Rep 2014; 2014:bcr-2014-203626. [PMID: 25355744 DOI: 10.1136/bcr-2014-203626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 46-year-old woman presented with right upper abdominal pain and fever. At imaging, enlarged peripancreatic and hilar lymph nodes, as well as hypodense liver lesions, were detected, suggestive of malignant disease. At endoscopy, the mass adjacent to the duodenum was seen as a protruding lesion through the duodenal wall. A biopsy of this lesion, taken through the duodenal wall, showed a histiocytic granulomatous inflammation with necrosis. Serology for Bartonella henselae IgM was highly elevated a few weeks after presentation, consistent with the diagnosis of cat scratch disease. Clinical symptoms subsided spontaneously and, after treatment with azithromycin, the lymphatic masses, liver lesions and duodenal ulceration disappeared completely.
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Affiliation(s)
| | - Jan Peringa
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Hans Blaauwgeers
- Department of Pathology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Alje van Dam
- Department of Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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13
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Joore IKCW, van Rooijen MS, Schim van der Loeff MF, de Neeling AJ, van Dam A, de Vries HJC. Low prevalence of methicillin-resistant Staphylococcus aureus among men who have sex with men attending an STI clinic in Amsterdam: a cross-sectional study. BMJ Open 2013; 3:bmjopen-2012-002505. [PMID: 23468471 PMCID: PMC3612809 DOI: 10.1136/bmjopen-2012-002505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is common among men who have sex with men (MSM) in the USA. It is unknown whether this is also the case in Amsterdam, the Netherlands. DESIGN Cross-sectional study. SETTING Sexually transmitted infection outpatient low-threshold clinic, Amsterdam, the Netherlands. PARTICIPANTS Between October 2008 and April 2010, a total of 211 men were included, in two groups: (1) 74 MSM with clinical signs of a skin or soft tissue infection (symptomatic group) and (2) 137 MSM without clinical signs of such infections (asymptomatic group). PRIMARY OUTCOME MEASURES S aureus and MRSA infection and/or colonisation. Swabs were collected from the anterior nasal cavity, throat, perineum, penile glans and, if present, from infected skin lesions. Culture for S aureus was carried out on blood agar plates and for MRSA on selective chromagar plates after enrichment in broth. If MRSA was found, the spa-gene was sequenced. SECONDARY OUTCOME MEASURES Associated demographic characteristics, medical history, risk factors for colonisation with S aureus and high-risk sexual behaviour were collected through a self-completed questionnaire. RESULTS The prevalence of S aureus colonisation in the nares was 37%, the pharynx 11%, the perianal region 12%, the glans penis 10% and in skin lesions 40%. In multivariable analysis adjusting for age, anogenital S aureus colonisation was significantly associated with the symptomatic group (p=0.01) and marginally with HIV (p=0.06). MRSA was diagnosed in two cases: prevalence 0.9% (95% CI 0.1% to 3.4%)). Neither had CA-MRSA strains. CONCLUSIONS CA-MRSA among MSM in Amsterdam is rare. Genital colonisation of S aureus is not associated with high-risk sexual behaviour.
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Affiliation(s)
- I K C W Joore
- Cluster of Infectious Diseases, STI Outpatient Clinic, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
| | - Martijn Sebastiaan van Rooijen
- Cluster of Infectious Diseases, STI Outpatient Clinic, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
- Department of Research, Cluster of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
- Department of Internal Medicine, Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Franciscus Schim van der Loeff
- Department of Research, Cluster of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
- Department of Internal Medicine, Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A J de Neeling
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (CIb/RIVM), Bilthoven, The Netherlands
| | - Alje van Dam
- Cluster of Infectious Diseases, Public Health Laboratory, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
- Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis General Hospital, Amsterdam, The Netherlands
| | - Henry J C de Vries
- Cluster of Infectious Diseases, STI Outpatient Clinic, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (CIb/RIVM), Bilthoven, The Netherlands
- Department of Dermatology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
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Herzberger P, Siegel C, Skerka C, Fingerle V, Schulte-Spechtel U, van Dam A, Wilske B, Brade V, Zipfel PF, Wallich R, Kraiczy P. Human pathogenic Borrelia spielmanii sp. nov. resists complement-mediated killing by direct binding of immune regulators factor H and factor H-like protein 1. Infect Immun 2007; 75:4817-25. [PMID: 17635869 PMCID: PMC2044541 DOI: 10.1128/iai.00532-07] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Borrelia spielmanii sp. nov. has recently been shown to be a novel human pathogenic genospecies that causes Lyme disease in Europe. In order to elucidate the immune evasion mechanisms of B. spielmanii, we compared the abilities of isolates obtained from Lyme disease patients and tick isolate PC-Eq17 to escape from complement-mediated bacteriolysis. Using a growth inhibition assay, we show that four B. spielmanii isolates, including PC-Eq17, are serum resistant, whereas a single isolate, PMew, was more sensitive to complement-mediated lysis. All isolates activated complement in vitro, as demonstrated by covalent attachment of C3 fragments; however, deposition of the later activation products C6 and C5b-9 was restricted to the moderately serum-resistant isolate PMew and the serum-sensitive B. garinii isolate G1. Furthermore, serum adsorption experiments revealed that all B. spielmanii isolates acquired the host alternative pathway regulators factor H and factor H-like protein (FHL-1) from human serum. Both complement regulators retained their factor I-mediated C3b inactivation activities when bound to spirochetes. In addition, two distinct factor H and FHL-1 binding proteins, BsCRASP-1 and BsCRASP-2, were identified, which we estimated to be approximately 23 to 25 kDa in mass. A further factor H binding protein, BsCRASP-3, was found exclusively in the tick isolate, PC-Eq17. This is the first report describing an immune evasion mechanism utilized by B. spielmanii sp. nov., and it demonstrates the capture of human immune regulators to resist complement-mediated killing.
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Affiliation(s)
- Pia Herzberger
- Institute of Medical Microbiology and Infection Control, University Hospital of Frankfurt, Paul-Ehrlich-Str. 40, D-60596 Frankfurt, Germany
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