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Millares L, Pascual S, Montón C, García-Núñez M, Lalmolda C, Faner R, Casadevall C, Setó L, Capilla S, Moreno A, Castro-Acosta AA, Alvarez-Martinez CJ, Sibila O, Peces-Barba G, Cosio BG, Agustí A, Gea J, Monsó E. Relationship between the respiratory microbiome and the severity of airflow limitation, history of exacerbations and circulating eosinophils in COPD patients. BMC Pulm Med 2019; 19:112. [PMID: 31234826 PMCID: PMC6591812 DOI: 10.1186/s12890-019-0867-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Received: 02/14/2019] [Accepted: 05/30/2019] [Indexed: 01/03/2023] Open
Abstract
Background The respiratory microbiome is altered in COPD patients but its relationship with core components of the disease, such as the severity of airflow limitation, the frequency of exacerbations or the circulating levels of eosinophils, is unclear. Methods Cross-sectional study comprising 72 clinically stable COPD patients (mean age 68 [SD 7.9] years; FEV1 48.7 [SD 20.1]% of reference) who provided spontaneous sputum samples for 16S rRNA gene amplification and sequencing. The microbiome composition was analysed with QIIME. Results We observed that: (1) more severe airflow limitation was associated with reduced relative abundance (RA) of Treponema and an increase in Pseudomonas; (2) patients with ≥2 exacerbations the previous year showed a significantly different bacterial community with respect to non-exacerbators (p = 0.014), with changes in 13 genera, including an increase of Pseudomonas, and finally, (3) peripheral eosinophils levels ≥2% were associated with more diverse microbiome [Chao1 224.51 (74.88) vs 277.39 (78.92) p = 0.006; Shannon 3.94 (1.05) vs 4.54 (1.06) p = 0.020], and a significant increase in the RAs of 20 genera. Conclusion The respiratory microbiome in clinically stable COPD patients varies significantly according to the severity of airflow limitation, previous history of exacerbations and circulating eosinophils levels. Electronic supplementary material The online version of this article (10.1186/s12890-019-0867-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Millares
- Fundació Parc Taulí- Institut d' Investigació i Innovació Parc Taulí (I3PT), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
| | - Sergi Pascual
- Respiratory Medicine Department, Hospital del Mar - IMIM, Barcelona, Spain
| | - Concepción Montón
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain.,Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.,Health Services Research on Chronic Diseases Network- REDISSEC, Galdakao, Spain.,Barcelona Respiratory Network, Barcelona, Spain
| | - Marian García-Núñez
- Fundació Parc Taulí- Institut d' Investigació i Innovació Parc Taulí (I3PT), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
| | - Cristina Lalmolda
- Fundació Parc Taulí- Institut d' Investigació i Innovació Parc Taulí (I3PT), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Rosa Faner
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Barcelona Respiratory Network, Barcelona, Spain
| | - Carme Casadevall
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Respiratory Medicine Department, Hospital del Mar - IMIM, Barcelona, Spain.,DCEXS, Universitat Pompeu Fabra, Barcelona, Spain
| | - Laia Setó
- Fundació Parc Taulí- Institut d' Investigació i Innovació Parc Taulí (I3PT), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Silvia Capilla
- Department of Microbiology, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Amàlia Moreno
- Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - Ady Angélica Castro-Acosta
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Respiratory Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos José Alvarez-Martinez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Respiratory Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Oriol Sibila
- Barcelona Respiratory Network, Barcelona, Spain.,Respiratory Department, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Germán Peces-Barba
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Respiratory Medicine, Fundación Jiménez Díaz, Madrid, Spain
| | - Borja G Cosio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Respiratory Medicine, Hospital Universitari Son Espases-IdISBa, Mallorca, Spain
| | - Alvar Agustí
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Barcelona Respiratory Network, Barcelona, Spain.,Institut Respiratori, Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Joaquim Gea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Respiratory Medicine Department, Hospital del Mar - IMIM, Barcelona, Spain.,Barcelona Respiratory Network, Barcelona, Spain.,DCEXS, Universitat Pompeu Fabra, Barcelona, Spain
| | - Eduard Monsó
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. .,Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain. .,Barcelona Respiratory Network, Barcelona, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Quero S, García-Núñez M, Párraga-Niño N, Barrabeig I, Pedro-Botet ML, de Simon M, Sopena N, Sabrià M. Discriminatory usefulness of pulsed-field gel electrophoresis and sequence-based typing in Legionella outbreaks. Future Microbiol 2016; 11:757-65. [DOI: 10.2217/fmb-2015-0030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: To compare the discriminatory power of pulsed-field gel electrophoresis (PFGE) and sequence-based typing (SBT) in Legionella outbreaks for determining the infection source. Materials & methods: Twenty-five investigations of Legionnaires’ disease were analyzed by PFGE, SBT and Dresden monoclonal antibody. Results: The results suggested that monoclonal antibody could reduce the number of Legionella isolates to be characterized by molecular methods. The epidemiological concordance PFGE–SBT was 100%, while the molecular concordance was 64%. Adjusted Wallace index (AW) showed that PFGE has better discriminatory power than SBT (AWSBT→PFGE = 0.767; AWPFGE→SBT = 1). The discrepancies appeared mostly in sequence type (ST) 1, a worldwide distributed ST for which PFGE discriminated different profiles. Conclusion: SBT discriminatory power was not sufficient verifying the infection source, especially in worldwide distributed STs, which were classified into different PFGE patterns.
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Affiliation(s)
- Sara Quero
- Unitat de Malalties Infeccioses, Fundació Institut d'Investigació Germans Trias I Pujol, Badalona, Spain E-08916
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
| | - Marian García-Núñez
- Unitat de Malalties Infeccioses, Fundació Institut d'Investigació Germans Trias I Pujol, Badalona, Spain E-08916
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
- CIBER de Enfermedades Respiratorias, Madrid, Spain E-28029
| | - Noemí Párraga-Niño
- Unitat de Malalties Infeccioses, Fundació Institut d'Investigació Germans Trias I Pujol, Badalona, Spain E-08916
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
- CIBER de Enfermedades Respiratorias, Madrid, Spain E-28029
| | - Irene Barrabeig
- Vigilancia Epidemiologica, Agencia de Salut Publica de Catalunya, Barcelona, Spain E-08005
| | - Maria L Pedro-Botet
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
- CIBER de Enfermedades Respiratorias, Madrid, Spain E-28029
- Unitat de Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Spain E-08916
| | - Mercè de Simon
- Laboratori de l'Agència de Salut Pública de Barcelona, Barcelona, Spain E-08001
| | - Nieves Sopena
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
- CIBER de Enfermedades Respiratorias, Madrid, Spain E-28029
- Unitat de Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Spain E-08916
| | - Miquel Sabrià
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
- CIBER de Enfermedades Respiratorias, Madrid, Spain E-28029
- Unitat de Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Spain E-08916
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Quero S, Párraga-Niño N, García-Núñez M, Sabrià M. [Proteomics in infectious diseases]. Enferm Infecc Microbiol Clin 2015; 34:253-60. [PMID: 25583331 DOI: 10.1016/j.eimc.2014.07.015] [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: 03/25/2014] [Revised: 07/22/2014] [Accepted: 07/30/2014] [Indexed: 11/27/2022]
Abstract
Infectious diseases have a high incidence in the population, causing a major impact on global health. In vitro culture of microorganisms is the first technique applied for infection diagnosis which is laborious and time consuming. In recent decades, efforts have been focused on the applicability of "Omics" sciences, highlighting the progress provided by proteomic techniques in the field of infectious diseases. This review describes the management, processing and analysis of biological samples for proteomic research.
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Affiliation(s)
- Sara Quero
- Unitat de Malalties Infeccioses, Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Cerdanyola, Barcelona, España
| | - Noemí Párraga-Niño
- Unitat de Malalties Infeccioses, Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Marian García-Núñez
- Unitat de Malalties Infeccioses, Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Barcelona, España; CIBER de Enfermedades Respiratorias, Bunyola, Illes Balears, España
| | - Miquel Sabrià
- Universitat Autònoma de Barcelona, Cerdanyola, Barcelona, España; CIBER de Enfermedades Respiratorias, Bunyola, Illes Balears, España; Unitat de Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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4
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Millares L, Pérez-Brocal V, Ferrari R, Gallego M, Pomares X, García-Núñez M, Montón C, Capilla S, Monsó E, Moya A. Functional Metagenomics of the Bronchial Microbiome in COPD. PLoS One 2015; 10:e0144448. [PMID: 26632844 PMCID: PMC4669145 DOI: 10.1371/journal.pone.0144448] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/18/2015] [Indexed: 02/07/2023] Open
Abstract
The course of chronic obstructive pulmonary disease (COPD) is frequently aggravated by exacerbations, and changes in the composition and activity of the microbiome may be implicated in their appearance. The aim of this study was to analyse the composition and the gene content of the microbial community in bronchial secretions of COPD patients in both stability and exacerbation. Taxonomic data were obtained by 16S rRNA gene amplification and pyrosequencing, and metabolic information through shotgun metagenomics, using the Metagenomics RAST server (MG-RAST), and the PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) programme, which predict metagenomes from 16S data. Eight severe COPD patients provided good quality sputum samples, and no significant differences in the relative abundance of any phyla and genera were found between stability and exacerbation. Bacterial biodiversity (Chao1 and Shannon indexes) did not show statistical differences and beta-diversity analysis (Bray-Curtis dissimilarity index) showed a similar microbial composition in the two clinical situations. Four functional categories showed statistically significant differences with MG-RAST at KEGG level 2: in exacerbation, Cell growth and Death and Transport and Catabolism decreased in abundance [1.6 (0.2-2.3) vs 3.6 (3.3-6.9), p = 0.012; and 1.8 (0-3.3) vs 3.6 (1.8-5.1), p = 0.025 respectively], while Cancer and Carbohydrate Metabolism increased [0.8 (0-1.5) vs 0 (0-0.5), p = 0.043; and 7 (6.4-9) vs 5.9 (6.3-6.1), p = 0.012 respectively]. In conclusion, the bronchial microbiome as a whole is not significantly modified when exacerbation symptoms appear in severe COPD patients, but its functional metabolic capabilities show significant changes in several pathways.
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Affiliation(s)
- Laura Millares
- Fundació Parc Taulí, Sabadell, Spain
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
- Fundació Insitut d’Investigació Germans Trias i Pujol, Badalona, Spain
- * E-mail:
| | - Vicente Pérez-Brocal
- Genomics and Health Area, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO-Public Health), Valencia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Evolutionary Genetics Unit, Institut Cavanilles de Biodiversitat i Biologia Evolutiva (ICBiBE), Universitat de València, Valencia, Spain
| | - Rafaela Ferrari
- Genomics and Health Area, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO-Public Health), Valencia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Evolutionary Genetics Unit, Institut Cavanilles de Biodiversitat i Biologia Evolutiva (ICBiBE), Universitat de València, Valencia, Spain
| | - Miguel Gallego
- Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Xavier Pomares
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain
- Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Marian García-Núñez
- Fundació Parc Taulí, Sabadell, Spain
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
- Fundació Insitut d’Investigació Germans Trias i Pujol, Badalona, Spain
| | - Concepción Montón
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain
- Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Silvia Capilla
- Department of Microbiology, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Eduard Monsó
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
- Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Andrés Moya
- Genomics and Health Area, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO-Public Health), Valencia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Evolutionary Genetics Unit, Institut Cavanilles de Biodiversitat i Biologia Evolutiva (ICBiBE), Universitat de València, Valencia, Spain
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Marin A, Garcia-Aymerich J, Sauleda J, Belda J, Millares L, García-Núñez M, Serra I, Benet M, Agustí A, Antó JM, Monsó E. Effect of bronchial colonisation on airway and systemic inflammation in stable COPD. COPD 2013; 9:121-30. [PMID: 22458940 DOI: 10.3109/15412555.2011.636407] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The recovery of potentially pathogenic microorganisms (PPMs) from bronchial secretions is associated with a local inflammatory response in COPD patients. The objective of this study was to determine the relationships between bronchial colonisation and both bronchial and systemic inflammation in stable COPD. In COPD patients recruited on first admission for an exacerbation, bacterial sputum cultures, interleukin (IL)-1β, IL-6 and IL-8 levels, and blood C-reactive protein (CRP) were measured in stable condition. Bronchial colonisation was found in 39 of the 133 (29%) patients and was significantly related to higher sputum IL-1β (median [percentile 25-75]; 462 [121-993] vs. 154 [41-477] pg/ml, p = 0.002), IL-6 (147 [71-424] vs. 109 [50-197] pg/ml, p = 0.047) and IL-8 values (15 [9-19] vs. 8 [3-15] (×10³) pg/ml, p = 0.002). Patients with positive cultures also showed significantly elevated levels of serum CRP (6.5 [2.5-8.5] vs. 3.5 [1.7-5.4] mg/l, p = 0.016). Bronchial colonisation by Haemophilus influenzae was associated with higher levels of IL-1β and IL-8 and clinically significant worse scores on the activity and impact domains of the St. George's Respiratory Questionnaire. In conclusion, bronchial colonisation is associated with bronchial inflammation and high blood CRP levels in stable COPD patients, being Haemophilus influenzae related to a more severe inflammatory response and impairment in health-related quality of life.
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Affiliation(s)
- Alicia Marin
- Department of Respiratory Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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Marin A, Garcia-Aymerich J, Sauleda J, Belda J, Millares L, García-Núñez M, Serra I, Benet M, Agustí A, Antó JM, Monsó E, on behalf of the PAC-COPD Study Gro. Effect of Bronchial Colonisation on Airway and Systemic Inflammation in Stable COPD. COPD 2012. [DOI: 10.3109/15412555.2012.636407] [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: 11/13/2022]
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Gómez J, Mòdol J, García-Núñez M, Baños V, Lorenzo M, Pedro-Botet ML, Hernández T, Herrero JA, Ruiz J, Sabrià M. [Low mortality rate in an outbreak of Legionnaires' disease: correlation with the cytopathogenity study]. Med Clin (Barc) 2009; 133:325-9. [PMID: 19595380 DOI: 10.1016/j.medcli.2009.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 05/06/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND In 2001 an outbreak of Legionnaires' diseases occurred in Murcia, Spain, with one of the lowest known rates of associated mortality. We describe the clinical data of a subgroup of patients, and present the results from molecular and virulence studies to correlate the lower mortality of the overall series with the strain virulence. PATIENTS AND METHODS A subgroup of 86 patients from the outbreak of Legionnaires'disease was prospectively included. Demographic, risk factors and clinical evolution data were obtained. Moreover, we performed a pulsed field gel electrophoresis and cytopathogenicity assay of the Murcia outbreak that were compared with other unrelated Legionella isolates. RESULTS Sixty-nine (77.9%) patients were males. The mean age of the patients was 58.2 years (range: 32-87). Smoking was the most frequent risk factor in 62 patients (71.7%) and 61 patients (70.2%) had underlying diseases. Clinical, laboratory and radiological manifestations were compatible with the atypical pneumonia syndrome. The mortality rate was 3.2%. All the clinical L. pneumophila isolates analyzed by PFGE showed the same subtype. When analyzing theses strains together with other Legionella strains, they were included in the group with lower virulence in the cytopathogenicity study. CONCLUSIONS The most outstanding data in this subgroup of patients were: male-sex, smoking, atypical clinical manifestations and low mortality. The low virulence of this molecular genotype of L. pneumophila may be responsible, in part, for the low mortality observed in the outbreak in Murcia.
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Affiliation(s)
- Joaquín Gómez
- Servicio de Enfermedades Infecciosas, Hospital Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
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Pedro-Botet ML, Sanchez I, Sabria M, Sopena N, Mateu L, García-Núñez M, Rey-Joly C. Impact of Copper and Silver Ionization on Fungal Colonization of the Water Supply in Health Care Centers: Implications for Immunocompromised Patients. Clin Infect Dis 2007; 45:84-6. [PMID: 17554706 DOI: 10.1086/518584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Accepted: 03/12/2007] [Indexed: 01/09/2023] Open
Abstract
Copper and silver ionization is a well-recognized disinfection method to control Legionella species in water distribution systems in hospitals. These systems may also serve as a potential indoor reservoir for fungi. The prevalence of fungi was significantly lower in ionized than in nonionized water samples from health care facilities. The clinical consequences of this finding require further investigation.
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Affiliation(s)
- Maria Luisa Pedro-Botet
- Infectious Diseases Unit, Hospital Germans Trias i Pujol of Badalona, Autonomous University of Barcelona, Barcelona, Spain.
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Pedro-Botet ML, Sopena N, García-Cruz A, Mateu L, García-Núñez M, Rey-Joly C, Sabrià M. Streptococcus pneumoniae and Legionella pneumophila pneumonia in HIV-infected patients. ACTA ACUST UNITED AC 2007; 39:122-8. [PMID: 17366028 DOI: 10.1080/00365540600951275] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 10/23/2022]
Abstract
We compared the epidemiological data, clinical features and mortality of community-acquired pneumonia (CAP) by Streptococcus pneumoniae and Legionella in HIV-infected patients and determined discriminative features. An observational, comparative study was performed (January 1994 to December 2004) in 15 HIV patients with CAP by Legionella and 46 by S. pneumoniae. No significant differences were observed in delay until initiation of appropriate antibiotic therapy. Smoking, cancer and chemotherapy were more frequent in patients with Legionella pneumonia (p=0.03, p=0.00009 and p=0.01). Patients with Legionella pneumonia had a higher mean CD4 count (p=0.04), undetectable viral load (p=0.01) and received highly active antiretroviral therapy more frequently (p=0.004). AIDS was more frequent in patients with S. pneumoniae pneumonia (p=0.03). Legionella pneumonia was more severe (p=0.007). Extrarespiratory symptoms, hyponatraemia and increased creatine phosphokinase were more frequent in Legionella pneumonia (p=0.02, p=0.002 and p=0.006). Respiratory failure, need for ventilation and bilateral chest X-ray involvement were of note in the Legionella group (p=0.003, p=0.002 and p=0.002). Mortality tended to be higher in the Legionella group (6.7 vs 2.2%). In conclusion, CAP by Legionella has a higher morbimortality than CAP by S. pneumoniae in HIV-infected patients. Detailed analysis of CAP presentation features allows suspicion of Legionnaires' disease in this subset.
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Sopena N, Force L, Pedro-Botet ML, Barrufet P, Sauca G, García-Núñez M, Tolchinsky G, Capdevila JA, Sabrià M. Sporadic and epidemic community legionellosis: two faces of the same illness. Eur Respir J 2006; 29:138-42. [PMID: 17005576 DOI: 10.1183/09031936.00077206] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [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: 11/05/2022]
Abstract
The present study compares the risk factors, presentation and outcome of community-acquired Legionella pneumophila pneumonia in 138 sporadic-case patients (1994-2004) and 113 outbreak-case patients (2002) treated in two hospitals in Catalonia (Spain) since urinary antigen assays were adopted. Univariate and multivariate analysis were performed to compare epidemiological and clinical features, blood chemistry values, radiological findings and outcome of sporadic and epidemic legionnaires' disease. Univariate analysis showed that male sex, chronic lung disease, HIV infection and immunosuppressive therapy prevailed in sporadic cases. Presentation with respiratory symptoms, confusion and blood chemistry alterations, such as hyponatraemia, aspartate aminotransferase and blood urea nitrogen elevation, and partial pressure of oxygen P(O)(2) <7.98 KPa (60 mmHg) were also more frequent in sporadic cases, while headache prevailed in outbreak cases. Sporadic cases had a greater delay in treatment, were more severe and had a worse outcome than epidemic cases. Multivariate analysis showed significant differences in sex, chronic lung disease, HIV infection and headache. The clinical and outcome differences between the two groups may be explained by the detection of milder forms of legionnaires' disease, the earlier treatment and the lower severity of underlying disease in the outbreak cases.
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Affiliation(s)
- N Sopena
- Infectious Diseases Unit, Germans Trias i Pujol University Hospital, Badalona, Spain.
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Ragull S, Luisa Pedro-Botet M, García-Núñez M, Esteve M, Sopena N, Rey Joly C, Sabrià M. Choque térmico como medida de control de un brote de legionelosis hospitalaria. Med Clin (Barc) 2006; 127:211-3. [PMID: 16938241 DOI: 10.1157/13091014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Superheat-and-flush is one of the methods of disinfection used against Legionella in hospital water distribution systems. An outbreak of nosocomial legionellosis (NL) was detected in the hospital Germans Trias i Pujol in January 1996. The aim of this study was to evaluate the impact of this disinfection technique at an environmental and clinical level. MATERIAL AND METHOD Water samples were collected daily from central and tap water points 3 days prior to 15 days after superheating and flushing. Clinical surveillance of NL was performed 30 consecutive days following disinfection. RESULTS After superheat-and-flush, the inoculum of Legionella pneumophila decreased in the central points but increased after day 11, achieving maximum values at 15 days. On the other hand, L. pneumophila was not detected in tap water points after 4 days but recolonization was observed after day 7, achieving 66% at day 9. No clinical cases of NL were detected during the study period. CONCLUSIONS Superheat-and-flush is an effective albeit transitory method of rapid disinfection in outbreaks of NL.
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Affiliation(s)
- Sonia Ragull
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
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Abstract
STUDY OBJECTIVES To compare the outcome of Legionnaires disease (LD) in patients with and without HIV infection. DESIGN Retrospective review of clinical charts. SETTING Six hundred-bed university hospital. PATIENTS We studied the clinical findings of 64 patients without HIV and 15 patients with HIV. Patients with a serologic diagnosis only were not included. Patients with previous immunosuppressive therapy or transplant recipients were excluded from the former group. In the HIV group, the mean CD4 cell count was 347.5/ microL, plasma viral load was undetectable in 50% of the patients, and only one patient (7%) was receiving cotrimoxazole as prophylaxis against Pneumocystis carinii at the time of pneumonia. No differences were observed in the two groups with respect to community or nosocomial acquisition, delay in the initiation of appropriate treatment, the use of macrolides or fluoroquinolones, and Fine score in cases of community-acquired LD. RESULTS Univariate analysis showed that time to apyrexia was longer, and respiratory symptoms, bilateral infiltrates in chest radiograph, hyponatremia, increase in aspartate aminotransferase and creatine phosphokinase (CK), and respiratory failure were more frequent in the HIV group. Mortality was greater in patients with HIV, achieving a statistically significant value of 20%; however, multivariate analysis only confirmed these differences with respect to the increase in CK. CONCLUSIONS LD has a more severe clinical presentation and worse evolution in patients with HIV.
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Affiliation(s)
- Maria Luisa Pedro-Botet
- Infectious Disease Unit, University Hospital Germans Trias i Pujol, Universitat Autònoma, Badalona, Spain.
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Sopena N, Sabrià M, Pedro-Botet ML, Reynaga E, García-Núñez M, Domínguez J, Matas L. Factors related to persistence of Legionella urinary antigen excretion in patients with legionnaires' disease. Eur J Clin Microbiol Infect Dis 2002; 21:845-8. [PMID: 12525918 DOI: 10.1007/s10096-002-0839-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [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: 12/01/2022]
Abstract
The aim of this prospective study was to compare patient characteristics, clinical data, and evolution of Legionella pneumophila pneumonia according to the duration of Legionella urinary antigen excretion. Urine samples from 61 patients with Legionella pneumonia diagnosed by detection of urinary antigen were obtained periodically until urinary antigen could no longer be detected. Cases were divided into two groups based on the duration of urinary antigen excretion: group I (46 patients, <60 days) and group II (15 patients, >or=60 days). Groups were compared for patient characteristics, clinical data, and evolution of pneumonia. Antigen excretion >or=60 days was observed significantly more frequently in immunosuppressed patients ( P=0.001) in whom the time to apyrexia was >72 h ( P=0.002), although only the time to apyrexia remained significant on multivariate analysis ( P=0.006). In conclusion, the duration of Legionella urinary antigen excretion was <60 days in most patients but was longer in immunosuppressed patients with a longer time to defervescence of fever.
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Affiliation(s)
- N Sopena
- Department of Internal Medicine, University Hospital Germans Trias i Pujol, C/Canyet s/n, Badalona (Barcelona) CP 08916, Spain
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