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Wolff BJ, Waller JL, Benitez AJ, Gaines A, Conley AB, Rishishwar L, Chande AT, Morrison SS, Jordan IK, Diaz MH, Winchell JM. Genomic analysis of Chlamydia psittaci from a multistate zoonotic outbreak in two chicken processing plants. J Genomics 2023; 11:40-44. [PMID: 37670735 PMCID: PMC10475345 DOI: 10.7150/jgen.86558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/27/2023] [Indexed: 09/07/2023] Open
Abstract
Four Chlamydia psittaci isolates were recovered from clinical specimens from ill workers during a multistate outbreak at two chicken processing plants. Whole genome sequencing analyses revealed high similarity to C. psittaci genotype D. The isolates differed from each other by only two single nucleotide polymorphisms, indicating a common source.
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Affiliation(s)
- Bernard J. Wolff
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica L. Waller
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alvaro J. Benitez
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anna Gaines
- Applied Bioinformatics Laboratory, Atlanta, GA, USA
| | | | - Lavanya Rishishwar
- Applied Bioinformatics Laboratory, Atlanta, GA, USA
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Aroon T. Chande
- Applied Bioinformatics Laboratory, Atlanta, GA, USA
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Shatavia S. Morrison
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - I. King Jordan
- Applied Bioinformatics Laboratory, Atlanta, GA, USA
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Maureen H. Diaz
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonas M. Winchell
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Wolff BJ, Gaines A, Conley AB, Norris E, Rishishwar L, Chande AT, Yang E, Diaz MH, Winchell JM. Multiplex Real-time PCR Assay for the Detection of all Chlamydia Species and Simultaneous Differentiation of C. psittaci and C. pneumoniae in Human Clinical Specimens. Ann Lab Med 2023; 43:375-380. [PMID: 36843406 PMCID: PMC9989537 DOI: 10.3343/alm.2023.43.4.375] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/04/2022] [Accepted: 01/10/2023] [Indexed: 02/28/2023] Open
Abstract
We developed and assessed the performance of a new multiplex real-time PCR assay for the detection of all Chlamydia species and simultaneous differentiation of Chlamydia psittaci and Chlamydia pneumoniae-two important human respiratory pathogens-in human clinical specimens. Next-generation sequencing was used to identify unique targets to design real-time PCR assays targeting all Chlamydia species, C. psittaci, and C. pneumoniae. To validate the assay, we used a panel of 49 culture isolates comprising seven C. psittaci genotypes, eight C. pneumoniae isolates, seven other Chlamydia species, and 22 near-neighbor bacterial and viral isolates, along with 22 specimens from external quality assessment (EQA) panels and 34 nasopharyngeal and oropharyngeal swabs and cerebrospinal fluid, stool, and sputum specimens previously identified as positive or negative for C. psittaci or C. pneumoniae. The assays were 100% specific, with limits of detection of 7.64- 9.02 fg/μL. The assay results matched with historical assay results for all specimens, except for one owing to the increased sensitivity of the new C. psittaci assay; the results of the EQA specimens were 100% accurate. This assay may improve the timely and accurate clinical diagnosis of Chlamydia infections and provide a greater understanding of the burden of disease caused by these agents.
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Affiliation(s)
- Bernard J Wolff
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anna Gaines
- Applied Bioinformatics Laboratory, Atlanta, GA, USA
| | | | - Emily Norris
- Applied Bioinformatics Laboratory, Atlanta, GA, USA
| | - Lavanya Rishishwar
- Applied Bioinformatics Laboratory, Atlanta, GA, USA.,School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Aroon T Chande
- Applied Bioinformatics Laboratory, Atlanta, GA, USA.,School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Eungi Yang
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maureen H Diaz
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonas M Winchell
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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3
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Mahtab S, Madhi SA, Baillie VL, Els T, Thwala BN, Onyango D, Tippet-Barr BA, Akelo V, Igunza KA, Omore R, Arifeen SE, Gurley ES, Alam M, Chowdhury AI, Rahman A, Bassat Q, Mandomando I, Ajanovic S, Sitoe A, Varo R, Sow SO, Kotloff KL, Badji H, Tapia MD, Traore CB, Ogbuanu IU, Bunn J, Luke R, Sannoh S, Swarray-Deen A, Assefa N, Scott JAG, Madrid L, Marami D, Fentaw S, Diaz MH, Martines RB, Breiman RF, Madewell ZJ, Blau DM, Whitney CG. Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016 -December 2021. PLOS Glob Public Health 2023; 3:e0001612. [PMID: 36963040 PMCID: PMC10027211 DOI: 10.1371/journal.pgph.0001612] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/27/2023] [Indexed: 03/26/2023]
Abstract
Each year, 2.4 million children die within their first month of life. Child Health and Mortality Prevention Surveillance (CHAMPS) established in 7 countries aims to generate accurate data on why such deaths occur and inform prevention strategies. Neonatal deaths that occurred between December 2016 and December 2021 were investigated with MITS within 24-72 hours of death. Testing included blood, cerebrospinal fluid and lung cultures, multi-pathogen PCR on blood, CSF, nasopharyngeal swabs and lung tissue, and histopathology examination of lung, liver and brain. Data collection included clinical record review and family interview using standardized verbal autopsy. The full set of data was reviewed by local experts using a standardized process (Determination of Cause of Death) to identify all relevant conditions leading to death (causal chain), per WHO recommendations. For analysis we stratified neonatal death into 24-hours of birth, early (1-<7 days) and late (7-<28 days) neonatal deaths. We analyzed 1458 deaths, 41% occurring within 24-hours, 41% early and 18% late neonatal deaths. Leading underlying causes of death were complications of intrapartum events (31%), complications of prematurity (28%), infections (17%), respiratory disorders (11%), and congenital malformations (8%). In addition to the underlying cause, 62% of deaths had additional conditions and 14% had ≥3 other conditions in the causal chain. The most common causes considering the whole causal chain were infection (40%), prematurity (32%) and respiratory distress syndrome (28%). Common maternal conditions linked to neonatal death were maternal hypertension (10%), labour and delivery complications (8%), multiple gestation (7%), placental complications (6%) obstructed labour and chorioamnionitis (5%, each). CHAMPS' findings showing the full causal chain of events that lead to death, in addition to maternal factors, highlights the complexities involved in each death along with the multiple opportunities for prevention. Highlighting improvements to prenatal and obstetric care and infection prevention are urgently needed in high-mortality settings.
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Affiliation(s)
- Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Toyah Els
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Bukiwe Nana Thwala
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Victor Akelo
- Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Kitiezo Aggrey Igunza
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Quique Bassat
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- Institutó Catalana de Recerca I Estudis Avançats [ICREA], Barcelona, Spain
- Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública [CIBERESP], Madrid, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- Instituto Nacional de Saúde [INS], Maputo, Mozambique
| | - Sara Ajanovic
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Rosauro Varo
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Henry Badji
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Cheick B Traore
- Department of Pathological Anatomy and Cytology, University Hospital of Point G, Bamako, Mali
| | | | - James Bunn
- World Health Organization-Sierra Leone, Freetown, Sierra Leone
| | - Ronita Luke
- Ola During Children's Hospital, Freetown, Sierra Leone
| | - Sulaiman Sannoh
- St. Luke's University Health Network, Easton, Pennsylvania, United States of America
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - J Anthony G Scott
- Department of Infectious Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lola Madrid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Dadi Marami
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Surafel Fentaw
- Bacterial and Mycology Unit, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Maureen H Diaz
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Roosecelis B Martines
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert F Breiman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Zachary J Madewell
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dianna M Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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Adhikari B, Harrison CJ, Lee BR, Schuster JE, Moffatt ME, Avadhanula V, Sahni LC, Englund JA, Klein EJ, Staat MA, McNeal M, Kobayashi M, Diaz MH, Perez A, Curns AT, Lu X, Selvarangan R. 880. Molecular Subtyping and Macrolide-Resistance Determination of Mycoplasma pneumoniae from Children Enrolled in New Vaccine Surveillance Network in the United States during 2015 to 2020. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Mycoplasma pneumoniae (MP), a common pediatric pneumonia pathogen, has 2 subtypes based on P1 adhesin gene variation. Macrolide-resistant MP (MRMP), seen since 2000 in many countries, has been subtype associated. Limited U.S. pediatric data exist on MP subtype or MRMP frequency and their clinical importance.
Methods
During 2015–2020, mid-turbinate nasal swab (MTNS) specimens and/or throat swabs were collected from children with acute respiratory illness (ARI) enrolled in emergency department (ED) or outpatient and inpatient settings at 4 CDC-funded New Vaccine Surveillance Network sites (Cincinnati, Seattle, Houston, and Kansas City). Specimens were tested for MP and common respiratory viruses by singleplex or multiplex polymerase chain reaction assay (PCR). P1-subtyping for MP positive specimens used multiplex TaqMan real-time PCR while MR was assessed by real time PCR with melt curve analysis (Lightmix®, TIBMolbiol). Select demographic/clinical data were analyzed by P1 subtype (P1–1 vs. P1–2).
Results
Of 208 MTNS specimens from 208 children (median age 5.5 years), 110 (53%) were P1–1, 89 (43%) P1–2, and 9 (4%) untypeable. Of 199 typeable specimens, 111 (56%) came from inpatients while 88 (44%) came from ED/outpatients.Overall MRMP prevalence during 2015–2020 was low (3/208,1.4%); all MRMP (Houston: 1 each in 2016–2017 and 2019–2020, Seattle: 1 in 2018–2019) were P1–1. Differences in P1–2 vs. P1–1 proportions were significant in 2 years: P1–2 dominated in 2015–2016; P1-1 in 2019–2020 (Figure 1). Common clinical symptoms for 199 MP-positive patients were fever (84%, mean 102.5±1.5oF), shortness of breath (82%), wheezing (67%), and cough (60%). Clinical manifestations, hospitalization, and antibiotic use did not differ in P1-1 vs. P1-2 patients. Antibiotics were used in 59/199 (30%) patients overall; amoxicillin was most frequent (48/199, 24%), followed by cefdinir (9/199, 5%) and azithromycin (5/199, 3%).
Conclusion
MP subtypes co-circulated during 2015–2020; P1-2 dominated in 2015–2016, P1-1 in 2018–2019. Signs/symptoms were similar for P1-1 and P1-2. MRMP detection was uncommon among our pediatric subjects. Ongoing surveillance is important to assess potential changes in MR prevalence and temporal subtype variation.
Disclosures
Christopher J Harrison, MD, Astellas: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Pediatric news: Honoraria|Pfizer: Grant/Research Support Brian R. Lee, PhD, MPH, CDC: Grant/Research Support|Merck: Grant/Research Support Mary E. Moffatt, M.D., Becton and Dickinson and Company: Stocks/Bonds|Biogen: Stocks/Bonds|Coloplast B: Stocks/Bonds|Express Scripts: Stocks/Bonds|Novo Nordisk A/S Spons ADR: Stocks/Bonds|Novo Nordisk A/S-B: Stocks/Bonds|Steris PLC: Stocks/Bonds|Stryker Corp: Stocks/Bonds|Thermo Fisher Scientific: Stocks/Bonds Janet A. Englund, MD, Astra Zeneca: Advisor/Consultant|Astra Zeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccine: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|SanofiPasteur: Advisor/Consultant.
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Affiliation(s)
| | | | - Brian R Lee
- Children's Mercy Kansas City , Kansas City, Missouri
| | | | - Mary E Moffatt
- Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine , Kansas City, Missouri
| | | | - Leila C Sahni
- Baylor College of Medicine, Texas Children’s Hospital , Houston, Texas
| | - Janet A Englund
- Seattle Children's Hospital/ Univ. Washington , Seattle, Washington
| | - Eileen J Klein
- University of Washington/Seattle Children's Hospital , Seattle, Washington
| | | | - Monica McNeal
- Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | | | - Maureen H Diaz
- US Centers for Disease Control and Prevention , Atlanta , Georgia
| | | | - Aaron T Curns
- Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Xiaoyan Lu
- Centers for Disease Control and Prevention , Atlanta , Georgia
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5
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Connor NE, Islam MS, Mullany LC, Shang N, Bhutta ZA, Zaidi AKM, Soofi S, Nisar I, Panigrahi P, Panigrahi K, Satpathy R, Bose A, Isaac R, Baqui AH, Mitra DK, Sadeq-ur Rahman Q, Hossain T, Schrag SJ, Winchell JM, Arvay ML, Diaz MH, Waller JL, Weber MW, Hamer DH, Hibberd P, Nawshad Uddin Ahmed ASM, Islam M, Hossain MB, Qazi SA, El Arifeen S, Darmstadt GL, Saha SK. Risk factors for community-acquired bacterial infection among young infants in South Asia: a longitudinal cohort study with nested case-control analysis. BMJ Glob Health 2022; 7:bmjgh-2022-009706. [PMID: 36319031 PMCID: PMC9628539 DOI: 10.1136/bmjgh-2022-009706] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Risk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship. METHODS Five sites in Bangladesh, India and Pakistan enrolled mother-child pairs via population-based pregnancy surveillance by community health workers. Medical, sociodemographic and epidemiological risk factor data were collected. Young infants aged 0-59 days with signs of possible serious bacterial infection (pSBI) and age-matched controls provided blood and respiratory specimens that were analysed by blood culture and real-time PCR. These tests were used to build a Bayesian partial latent class model (PLCM) capable of attributing the probable cause of each infant's infection in the ANISA study. The collected risk factors from all mother-child pairs were classified and analysed against the PLCM using bivariate and stepwise logistic multivariable regression modelling to determine risk factors of probable bacterial infection. RESULTS Among 63 114 infants born, 14 655 were assessed and 6022 had signs of pSBI; of these, 81% (4859) provided blood samples for culture, 71% (4216) provided blood samples for quantitative PCR (qPCR) and 86% (5209) provided respiratory qPCR samples. Risk factors associated with bacterial-attributed infections included: low (relative risk (RR) 1.73, 95% credible interval (CrI) 1.42 to 2.11) and very low birth weight (RR 5.77, 95% CrI 3.73 to 8.94), male sex (RR 1.27, 95% CrI 1.07 to 1.52), breathing problems at birth (RR 2.50, 95% CrI 1.96 to 3.18), premature rupture of membranes (PROMs) (RR 1.27, 95% CrI 1.03 to 1.58) and being in the lowest three socioeconomic status quintiles (first RR 1.52, 95% CrI 1.07 to 2.16; second RR 1.41, 95% CrI 1.00 to 1.97; third RR 1.42, 95% CrI 1.01 to 1.99). CONCLUSION Distinct risk factors: birth weight, male sex, breathing problems at birth and PROM were significantly associated with the development of bacterial sepsis across South Asian community settings, supporting refined clinical discernment and targeted use of antimicrobials.
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Affiliation(s)
- Nicholas E Connor
- Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nong Shang
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
| | - Anita K M Zaidi
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Sajid Soofi
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Imran Nisar
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Pinaki Panigrahi
- Department of Pediatrics, Georgetown University Medical Center, Washington, DC, USA
| | | | | | | | - Rita Isaac
- Christian Medical College, Vellore, India
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dipak K Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tanvir Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Stephanie J Schrag
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa L Arvay
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maureen H Diaz
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica L Waller
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martin W Weber
- Child and Adolescent Health and Development Division, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Patricia Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Maksuda Islam
- Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh
| | | | - Shamim A Qazi
- Consultant and Researcher, (Retired WHO staff), Geneva, Switzerland
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Samir K Saha
- Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh
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6
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Dawa J, Walong E, Onyango C, Mathaiya J, Muturi P, Bunei M, Ochieng W, Barake W, Seixas JN, Mayieka L, Ochieng M, Omballa V, Lidechi S, Hunsperger E, Otieno NA, Ritter JM, Widdowson MA, Diaz MH, Winchell JM, Martines RB, Zaki SR, Chaves SS. Effect of Time Since Death on Multipathogen Molecular Test Results of Postmortem Specimens Collected Using Minimally Invasive Tissue Sampling Techniques. Clin Infect Dis 2021; 73:S360-S367. [PMID: 34910183 PMCID: PMC8672767 DOI: 10.1093/cid/ciab810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/11/2022] Open
Abstract
Background We used postmortem minimally invasive tissue sampling (MITS) to assess the effect of time since death on molecular detection of pathogens among respiratory illness–associated deaths. Methods Samples were collected from 20 deceased children (aged 1–59 months) hospitalized with respiratory illness from May 2018 through February 2019. Serial lung and/or liver and blood samples were collected using MITS starting soon after death and every 6 hours thereafter for up to 72 hours. Bodies were stored in the mortuary refrigerator for the duration of the study. All specimens were analyzed using customized multipathogen TaqMan® array cards (TACs). Results We identified a median of 3 pathogens in each child’s lung tissue (range, 1–8; n = 20), 3 pathogens in each child’s liver tissue (range, 1–4; n = 5), and 2 pathogens in each child’s blood specimen (range, 0–4; n = 5). Pathogens were not consistently detected across all collection time points; there was no association between postmortem interval and the number of pathogens detected (P = .43) and no change in TAC cycle threshold value over time for pathogens detected in lung tissue. Human ribonucleoprotein values indicated that specimens collected were suitable for testing throughout the study period. Conclusions Results suggest that lung, liver, and blood specimens can be collected using MITS procedures up to 4 days after death in adequately preserved bodies. However, inconsistent pathogen detection in samples needs careful consideration before drawing definitive conclusions on the etiologic causes of death.
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Affiliation(s)
- Jeanette Dawa
- Washington State University, Global Health Programs (Kenya Office), Nairobi, Kenya.,College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Edwin Walong
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Clayton Onyango
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - John Mathaiya
- Department of Pathology, Thika Level 5 Hospital, Kiambu County, Kenya
| | - Peter Muturi
- Washington State University, Global Health Programs (Kenya Office), Nairobi, Kenya
| | - Milka Bunei
- Washington State University, Global Health Programs (Kenya Office), Nairobi, Kenya
| | | | - Walter Barake
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Josilene N Seixas
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lillian Mayieka
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Melvin Ochieng
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Victor Omballa
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Shirley Lidechi
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth Hunsperger
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Nancy A Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jana M Ritter
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Maureen H Diaz
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Roosecelis B Martines
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra S Chaves
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
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7
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McGovern OL, Stenger M, Oliver SE, Anderson TC, Isenhour C, Mauldin MR, Williams N, Griggs E, Bogere T, Edens C, Curns AT, Lively JY, Zhou Y, Xu S, Diaz MH, Waller JL, Clarke KR, Evans ME, Hesse EM, Morris SB, McClung RP, Cooley LA, Logan N, Boyd AT, Taylor AW, Bajema KL, Lindstrom S, Elkins CA, Jones C, Hall AJ, Graitcer S, Oster AM, Fry AM, Fischer M, Conklin L, Gokhale RH. Demographic, clinical, and epidemiologic characteristics of persons under investigation for Coronavirus Disease 2019-United States, January 17-February 29, 2020. PLoS One 2021; 16:e0249901. [PMID: 33857209 PMCID: PMC8049245 DOI: 10.1371/journal.pone.0249901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/16/2020] [Accepted: 03/28/2021] [Indexed: 01/04/2023] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), evolved rapidly in the United States. This report describes the demographic, clinical, and epidemiologic characteristics of 544 U.S. persons under investigation (PUI) for COVID-19 with complete SARS-CoV-2 testing in the beginning stages of the pandemic from January 17 through February 29, 2020. Methods In this surveillance cohort, the U.S. Centers for Disease Control and Prevention (CDC) provided consultation to public health and healthcare professionals to identify PUI for SARS-CoV-2 testing by quantitative real-time reverse-transcription PCR. Demographic, clinical, and epidemiologic characteristics of PUI were reported by public health and healthcare professionals during consultation with on-call CDC clinicians and subsequent submission of a CDC PUI Report Form. Characteristics of laboratory-negative and laboratory-positive persons were summarized as proportions for the period of January 17−February 29, and characteristics of all PUI were compared before and after February 12 using prevalence ratios. Results A total of 36 PUI tested positive for SARS-CoV-2 and were classified as confirmed cases. Confirmed cases and PUI testing negative for SARS-CoV-2 had similar demographic, clinical, and epidemiologic characteristics. Consistent with changes in PUI evaluation criteria, 88% (13/15) of confirmed cases detected before February 12, 2020, reported travel from China. After February 12, 57% (12/21) of confirmed cases reported no known travel- or contact-related exposures. Conclusions These findings can inform preparedness for future pandemics, including capacity for rapid expansion of novel diagnostic tests to accommodate broad surveillance strategies to assess community transmission, including potential contributions from asymptomatic and presymptomatic infections.
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Affiliation(s)
- Olivia L. McGovern
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Mark Stenger
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sara E. Oliver
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tara C. Anderson
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cheryl Isenhour
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew R. Mauldin
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nia Williams
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eric Griggs
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tonny Bogere
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Chris Edens
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aaron T. Curns
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joana Y. Lively
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- IHRC Inc., Contracting Agency to the Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yingtao Zhou
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Maximus Federal, Contracting Agency to the Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Songli Xu
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Maureen H. Diaz
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica L. Waller
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin R. Clarke
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mary E. Evans
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elisabeth M. Hesse
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sapna Bamrah Morris
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert P. McClung
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura A. Cooley
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Naeemah Logan
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrew T. Boyd
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Allan W. Taylor
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kristina L. Bajema
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephen Lindstrom
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher A. Elkins
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher Jones
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aron J. Hall
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Samuel Graitcer
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alexandra M. Oster
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alicia M. Fry
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marc Fischer
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura Conklin
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Runa H. Gokhale
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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8
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McGovern OL, Kobayashi M, Shaw KA, Szablewski C, Gabel J, Holsinger C, Drenzek C, Brennan S, Milucky J, Farrar JL, Wolff BJ, Benitez AJ, Thurman KA, Diaz MH, Winchell JM, Schrag S. Use of Real-Time PCR for Chlamydia psittaci Detection in Human Specimens During an Outbreak of Psittacosis - Georgia and Virginia, 2018. MMWR Morb Mortal Wkly Rep 2021; 70:505-509. [PMID: 33830980 PMCID: PMC8030988 DOI: 10.15585/mmwr.mm7014a1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Psittacosis is typically a mild febrile respiratory illness caused by infection with the bacterium Chlamydia psittaci and usually transmitted to humans by infected birds (1). On average, 11 psittacosis cases per year were reported in the United States during 2000-2017. During August-October 2018, the largest U.S. psittacosis outbreak in 30 years (82 cases identified*) occurred in two poultry slaughter plants, one each in Virginia and Georgia, that shared source farms (2). CDC used C. psittaci real-time polymerase chain reaction (PCR) to test 54 human specimens from this outbreak. This was the largest number of human specimens from a single outbreak ever tested for C. psittaci using real-time PCR, which is faster and more sensitive than commercially available serologic tests. This represented a rare opportunity to assess the utility of multiple specimen types for real-time PCR detection of C. psittaci. C. psittaci was detected more frequently in lower respiratory specimens (59% [10 of 17]) and stool (four of five) than in upper respiratory specimens (7% [two of 28]). Among six patients with sputum and nasopharyngeal swabs tested, C. psittaci was detected only in sputum in five patients. Cycle threshold (Ct) values suggested bacterial load was higher in lower respiratory specimens than in nasopharyngeal swabs. These findings support prioritizing lower respiratory specimens for real-time PCR detection of C. psittaci. Stool specimens might also have utility for diagnosis of psittacosis.
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9
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Althaus T, Thaipadungpanit J, Greer RC, Swe MMM, Dittrich S, Peerawaranun P, Smit PW, Wangrangsimakul T, Blacksell S, Winchell JM, Diaz MH, Day NPJ, Smithuis F, Turner P, Lubell Y. Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens. Int J Infect Dis 2020; 96:334-342. [PMID: 32437937 PMCID: PMC7211754 DOI: 10.1016/j.ijid.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/25/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES This study investigated causes of fever in the primary levels of care in Southeast Asia, and evaluated whether C-reactive protein (CRP) could distinguish bacterial from viral pathogens. METHODS Blood and nasopharyngeal swab specimens were taken from children and adults with fever (>37.5 °C) or history of fever (<14 days) in Thailand and Myanmar. RESULTS Of 773 patients with at least one blood or nasopharyngeal swab specimen collected, 227 (29.4%) had a target organism detected. Influenza virus type A was detected in 85/227 cases (37.5%), followed by dengue virus (30 cases, 13.2%), respiratory syncytial virus (24 cases, 10.6%) and Leptospira spp. (nine cases, 4.0%). Clinical outcomes were similar between patients with a bacterial or a viral organism, regardless of antibiotic prescription. CRP was higher among patients with a bacterial organism compared with those with a viral organism (median 18 mg/L, interquartile range [10-49] versus 10 mg/L [≤8-22], p = 0.003), with an area under the curve of 0.65 (95% CI 0.55-0.75). CONCLUSIONS Serious bacterial infections requiring antibiotics are an exception rather than the rule in the first line of care. CRP testing could assist in ruling out such cases in settings where diagnostic uncertainty is high and routine antibiotic prescription is common. The original CRP randomised controlled trial was registered with ClinicalTrials.gov, number NCT02758821.
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Affiliation(s)
- Thomas Althaus
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
| | - Janjira Thaipadungpanit
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rachel C Greer
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Myo Maung Maung Swe
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Myanmar-Oxford Clinical Research Unit (MOCRU), Medical Action Myanmar (MAM), Yangon, Myanmar
| | - Sabine Dittrich
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Pimnara Peerawaranun
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pieter W Smit
- Maasstad Ziekenhuis Hospital, Department of Medical Microbiology, Rotterdam, The Netherlands; Public Health Laboratory (GGD), Amsterdam, The Netherlands
| | - Tri Wangrangsimakul
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Stuart Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Jonas M Winchell
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maureen H Diaz
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Frank Smithuis
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Myanmar-Oxford Clinical Research Unit (MOCRU), Medical Action Myanmar (MAM), Yangon, Myanmar
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Cambodia-Oxford Medical Research Unit (COMRU), Angkor Hospital for Children, Siem Reap, Cambodia
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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10
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Kutty PK, Jain S, Taylor TH, Bramley AM, Diaz MH, Ampofo K, Arnold SR, Williams DJ, Edwards KM, McCullers JA, Pavia AT, Winchell JM, Schrag SJ, Hicks LA. Mycoplasma pneumoniae Among Children Hospitalized With Community-acquired Pneumonia. Clin Infect Dis 2020; 68:5-12. [PMID: 29788037 DOI: 10.1093/cid/ciy419] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/14/2018] [Indexed: 12/22/2022] Open
Abstract
Background The epidemiology of Mycoplasma pneumoniae (Mp) among US children (<18 years) hospitalized with community-acquired pneumonia (CAP) is poorly understood. Methods In the Etiology of Pneumonia in the Community study, we prospectively enrolled 2254 children hospitalized with radiographically confirmed pneumonia from January 2010-June 2012 and tested nasopharyngeal/oropharyngeal swabs for Mp using real-time polymerase chain reaction (PCR). Clinical and epidemiological features of Mp PCR-positive and -negative children were compared using logistic regression. Macrolide susceptibility was assessed by genotyping isolates. Results One hundred and eighty two (8%) children were Mp PCR-positive (median age, 7 years); 12% required intensive care and 26% had pleural effusion. No in-hospital deaths occurred. Macrolide resistance was found in 4% (6/169) isolates. Of 178 (98%) Mp PCR-positive children tested for copathogens, 50 (28%) had ≥1 copathogen detected. Variables significantly associated with higher odds of Mp detection included age (10-17 years: adjusted odds ratio [aOR], 10.7 [95% confidence interval {CI}, 5.4-21.1] and 5-9 years: aOR, 6.4 [95% CI, 3.4-12.1] vs 2-4 years), outpatient antibiotics ≤5 days preadmission (aOR, 2.3 [95% CI, 1.5-3.5]), and copathogen detection (aOR, 2.1 [95% CI, 1.3-3.3]). Clinical characteristics were non-specific. Conclusions Usually considered as a mild respiratory infection, Mp was the most commonly detected bacteria among children aged ≥5 years hospitalized with CAP, one-quarter of whom had codetections. Although associated with clinically nonspecific symptoms, there was a need for intensive care in some cases. Mycoplasma pneumoniae should be included in the differential diagnosis for school-aged children hospitalized with CAP.
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Affiliation(s)
- Preeta K Kutty
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas H Taylor
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna M Bramley
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen H Diaz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krow Ampofo
- University of Utah Health Sciences Center, Salt Lake City
| | - Sandra R Arnold
- Le Bonheur Children's Hospital, Memphis.,University of Tennessee Health Science Center, Memphis
| | - Derek J Williams
- Vanderbilt University Medical Center, Nashville.,Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville
| | - Kathryn M Edwards
- Vanderbilt University Medical Center, Nashville.,Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville
| | - Jonathan A McCullers
- Le Bonheur Children's Hospital, Memphis.,University of Tennessee Health Science Center, Memphis.,St Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew T Pavia
- University of Utah Health Sciences Center, Salt Lake City
| | | | | | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Diaz MH, Waller JL, Theodore MJ, Patel N, Wolff BJ, Benitez AJ, Morris T, Raghunathan PL, Breiman RF, Whitney CG, Blau DM, Winchell JM. Development and Implementation of Multiplex TaqMan Array Cards for Specimen Testing at Child Health and Mortality Prevention Surveillance Site Laboratories. Clin Infect Dis 2019; 69:S311-S321. [PMID: 31598666 PMCID: PMC7108207 DOI: 10.1093/cid/ciz571] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Child Health and Mortality Prevention Surveillance (CHAMPS) laboratories are employing a variety of laboratory methods to identify infectious agents contributing to deaths of children <5 years old and stillbirths in sub-Saharan Africa and South Asia. In support of this long-term objective, our team developed TaqMan Array Cards (TACs) for testing postmortem specimens (blood, cerebrospinal fluid, lung tissue, respiratory tract swabs, and rectal swabs) for >100 real-time polymerase chain reaction (PCR) targets in total (30-45 per card depending on configuration). Multipathogen panels were configured by syndrome and customized to include pathogens of significance in young children within the regions where CHAMPS is conducted, including bacteria (57 targets covering 30 genera), viruses (48 targets covering 40 viruses), parasites (8 targets covering 8 organisms), and fungi (3 targets covering 3 organisms). The development and application of multiplex real-time PCR reactions to the TAC microfluidic platform increased the number of targets in each panel while maintaining assay efficiency and replicates for heightened sensitivity. These advances represent a substantial improvement in the utility of this technology for infectious disease diagnostics and surveillance. We optimized all aspects of the CHAMPS molecular laboratory testing workflow including nucleic acid extraction, quality assurance, and data management to ensure comprehensive molecular testing of specimens and high-quality data. Here we describe the development and implementation of multiplex TACs and associated laboratory protocols for specimen processing, testing, and data management at CHAMPS site laboratories.
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Affiliation(s)
- Maureen H Diaz
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica L Waller
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Bernard J Wolff
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alvaro J Benitez
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Timothy Morris
- Public Health Informatics Institute, The Task Force for Global Health, Atlanta, Georgia, USA
| | - Pratima L Raghunathan
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Cynthia G Whitney
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Beall SG, Cantera J, Diaz MH, Winchell JM, Lillis L, White H, Kalnoky M, Gallarda J, Boyle DS. Performance and workflow assessment of six nucleic acid extraction technologies for use in resource limited settings. PLoS One 2019; 14:e0215753. [PMID: 30998749 PMCID: PMC6472818 DOI: 10.1371/journal.pone.0215753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/16/2019] [Indexed: 01/20/2023] Open
Abstract
Infectious disease nucleic acid amplification technologies (NAAT) have superior sensitivity, specificity, and rapid time to result compared to traditional microbiological methods. Recovery of concentrated, high quality pathogen nucleic acid (NA) from complex specimen matrices is required for optimal performance of several NA amplification/detection technologies such as polymerase chain reaction (PCR). Fully integrated NAAT platforms that enable rapid sample-to-result workflows with minimal user input are generally restricted to larger reference lab settings, and their complexity and cost are prohibitive to widespread implementation in resource limited settings (RLS). Identification of component technologies for incorporation of reliable and affordable sample preparation with pathogen NA amplification/detection into an integrated platform suitable for RLS, is a necessary first step toward achieving the overarching goal of reducing infectious disease-associated morbidity and mortality globally. In the current study, we evaluate the performance of six novel NA extraction technologies from different developers using blinded panels of stool, sputum and blood spiked with variable amounts of quality-controlled DNA- and/or RNA-based microbes. The extraction efficiencies were semi-quantitatively assessed using validated real-time reverse transcription (RT)-PCR assays specific for each microbe and comparing target-specific RT-PCR results to those obtained with reference NA extraction methods. The technologies were ranked based on overall diagnostic accuracy (analytical sensitivity and specificity). Sample input and output volumes, total processing time, user-required manual steps and cost estimates were also examined for suitability in RLS. Together with the performance analysis, these metrics were used to select the more suitable candidate technologies for further optimization of integrated NA amplification and detection technologies for RLS.
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Affiliation(s)
- Shivani G. Beall
- Centers for Disease Control and Prevention, Division of Bacterial Diseases, Respiratory Diseases Branch, Atlanta, Georgia, United States of America
| | | | - Maureen H. Diaz
- Centers for Disease Control and Prevention, Division of Bacterial Diseases, Respiratory Diseases Branch, Atlanta, Georgia, United States of America
| | - Jonas M. Winchell
- Centers for Disease Control and Prevention, Division of Bacterial Diseases, Respiratory Diseases Branch, Atlanta, Georgia, United States of America
| | | | | | | | - James Gallarda
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
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13
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Velaphi SC, Westercamp M, Moleleki M, Pondo T, Dangor Z, Wolter N, von Gottberg A, Shang N, Demirjian A, Winchell JM, Diaz MH, Nakwa F, Okudo G, Wadula J, Cutland C, Schrag SJ, Madhi SA. Surveillance for incidence and etiology of early-onset neonatal sepsis in Soweto, South Africa. PLoS One 2019; 14:e0214077. [PMID: 30970036 PMCID: PMC6457488 DOI: 10.1371/journal.pone.0214077] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/06/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Globally, over 400,000 neonatal deaths in 2015 were attributed to sepsis, however, the incidence and etiologies of these infections are largely unknown in low-middle income countries. We aimed to determine incidence and etiology of community-acquired early-onset (<72 hours age) sepsis (EOS) using culture and molecular diagnostics. METHODS This was a prospective observational study, in which we conducted a surveillance for pathogens using a combination of blood culture and a polymerase chain reaction (PCR)-based test. Blood culture was performed on all neonates with suspected EOS. Among the subset fulfilling criteria for protocol-defined EOS, blood and nasopharyngeal (NP) respiratory swabs were tested by quantitative real-time reverse-transcriptase PCR using a Taqman Array Card (TAC) with 15 bacterial and 12 viral targets. Blood and NP samples from 312 healthy newborns were also tested by TAC to estimate background positivity rates. We used variant latent-class methods to attribute etiologies and calculate pathogen-specific proportions and incidence rates. RESULTS We enrolled 2,624 neonates with suspected EOS and from these 1,231 newborns met criteria for protocol-defined EOS (incidence- 39.3/1,000 live-births). Using the partially latent-class modelling, only 26.7% cases with protocol-defined EOS had attributable etiology, and the largest pathogen proportion were Ureaplasma spp. (5.4%; 95%CI: 3.6-8.0) and group B Streptococcus (GBS) (4.8%; 95%CI: 4.1-5.8), and no etiology was attributable for 73.3% of cases. Blood cultures were positive in 99/1,231 (8.0%) with protocol-defined EOS (incidence- 3.2/1,000 live-births). Leading pathogens on blood culture included GBS (35%) and viridans streptococci (24%). Ureaplasma spp. was the most common organism identified on TAC among cases with protocol-defined EOS. CONCLUSION Using a combination of blood culture and a PCR-based test the common pathogens isolated in neonates with sepsis were Ureaplasma spp. and GBS. Despite documenting higher rates of protocol-defined EOS and using a combination of tests, the etiology for EOS remains elusive.
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Affiliation(s)
- Sithembiso C. Velaphi
- Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew Westercamp
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Malefu Moleleki
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service (NHLS), and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tracy Pondo
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Ziyaad Dangor
- Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service (NHLS), and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service (NHLS), and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nong Shang
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Alicia Demirjian
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Jonas M. Winchell
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Maureen H. Diaz
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Firdose Nakwa
- Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace Okudo
- Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeannette Wadula
- Department of Clinical Microbiology and Infectious Diseases, NHLS, South Africa and School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie J. Schrag
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Shabir A. Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Carrim M, Wolter N, Benitez AJ, Tempia S, du Plessis M, Walaza S, Moosa F, Diaz MH, Wolff BJ, Treurnicht FK, Hellferscee O, Dawood H, Variava E, Cohen C, Winchell JM, von Gottberg A. Epidemiology and Molecular Identification and Characterization of Mycoplasma pneumoniae, South Africa, 2012-2015. Emerg Infect Dis 2019; 24:506-513. [PMID: 29460736 PMCID: PMC5823326 DOI: 10.3201/eid2403.162052] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During 2012-2015, we tested respiratory specimens from patients with severe respiratory illness (SRI), patients with influenza-like illness (ILI), and controls in South Africa by real-time PCR for Mycoplasma pneumoniae, followed by culture and molecular characterization of positive samples. M. pneumoniae prevalence was 1.6% among SRI patients, 0.7% among ILI patients, and 0.2% among controls (p<0.001). Age <5 years (adjusted odd ratio 7.1; 95% CI 1.7-28.7) and HIV infection (adjusted odds ratio 23.8; 95% CI 4.1-138.2) among M. pneumonia-positive persons were associated with severe disease. The detection rate attributable to illness was 93.9% (95% CI 74.4%-98.5%) in SRI patients and 80.7% (95% CI 16.7%-95.6%) in ILI patients. The hospitalization rate was 28 cases/100,000 population. We observed the macrolide-susceptible M. pneumoniae genotype in all cases and found P1 types 1, 2, and a type 2 variant with multilocus variable number tandem repeat types 3/6/6/2, 3/5/6/2, and 4/5/7/2.
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15
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Saha SK, Schrag SJ, El Arifeen S, Mullany LC, Shahidul Islam M, Shang N, Qazi SA, Zaidi AKM, Bhutta ZA, Bose A, Panigrahi P, Soofi SB, Connor NE, Mitra DK, Isaac R, Winchell JM, Arvay ML, Islam M, Shafiq Y, Nisar I, Baloch B, Kabir F, Ali M, Diaz MH, Satpathy R, Nanda P, Padhi BK, Parida S, Hotwani A, Hasanuzzaman M, Ahmed S, Belal Hossain M, Ariff S, Ahmed I, Ibne Moin SM, Mahmud A, Waller JL, Rafiqullah I, Quaiyum MA, Begum N, Balaji V, Halen J, Nawshad Uddin Ahmed ASM, Weber MW, Hamer DH, Hibberd PL, Sadeq-Ur Rahman Q, Mogan VR, Hossain T, McGee L, Anandan S, Liu A, Panigrahi K, Abraham AM, Baqui AH. Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study. Lancet 2018; 392:145-159. [PMID: 30025808 PMCID: PMC6053599 DOI: 10.1016/s0140-6736(18)31127-9] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/08/2018] [Accepted: 05/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. METHODS From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples. FINDINGS 6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28% of episodes (16% bacterial and 12% viral). Mean incidence of bacterial infections was 13·2 (95% credible interval [CrI] 11·2-15·6) per 1000 livebirths and of viral infections was 10·1 (9·4-11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95% CrI 4·8-6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6-3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46% of pSBI episodes, among which 92% were bacterial. 85 (83%) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs. INTERPRETATION Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Samir K Saha
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh.
| | - Stephanie J Schrag
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Shams El Arifeen
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Luke C Mullany
- Johns Hopkins Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mohammad Shahidul Islam
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Nong Shang
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Shamim A Qazi
- Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland
| | - Anita K M Zaidi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Pinaki Panigrahi
- Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sajid B Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Nicholas E Connor
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Dipak K Mitra
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Rita Isaac
- Christian Medical College, Bagayam, Vellore, India
| | - Jonas M Winchell
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Melissa L Arvay
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Maksuda Islam
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Yasir Shafiq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Nisar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Benazir Baloch
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Furqan Kabir
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Murtaza Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Maureen H Diaz
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | | | - Pritish Nanda
- Asian Institute of Public Health, Bhubaneswar, India
| | | | | | - Aneeta Hotwani
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - M Hasanuzzaman
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Sheraz Ahmed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mohammad Belal Hossain
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Shabina Ariff
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Imran Ahmed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syed Mamun Ibne Moin
- Johns Hopkins Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Arif Mahmud
- Johns Hopkins Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica L Waller
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Iftekhar Rafiqullah
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | | | - Nazma Begum
- Johns Hopkins Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jasmin Halen
- Christian Medical College, Bagayam, Vellore, India
| | - A S M Nawshad Uddin Ahmed
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Martin W Weber
- Child and Adolescent Health and Development Division, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Davidson H Hamer
- Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Patricia L Hibberd
- Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Tanvir Hossain
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Lesley McGee
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | | | - Anran Liu
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Kalpana Panigrahi
- Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Abdullah H Baqui
- Johns Hopkins Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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16
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Patel JC, George J, Vuong J, Potts CC, Bozio C, Clark TA, Thomas J, Schier J, Chang A, Waller JL, Diaz MH, Whaley M, Jenkins LT, Fuller S, Williams DE, Redd JT, Arthur RR, Taweh F, Vera Walker Y, Hardy P, Freeman M, Katawera V, Gwesa G, Gbanya MZ, Clement P, Kohar H, Stone M, Fallah M, Nyenswah T, Winchell JM, Wang X, McNamara LA, Dokubo EK, Fox LM. Rapid Laboratory Identification of Neisseria meningitidis Serogroup C as the Cause of an Outbreak - Liberia, 2017. MMWR Morb Mortal Wkly Rep 2017; 66:1144-1147. [PMID: 29073124 PMCID: PMC5689101 DOI: 10.15585/mmwr.mm6642a5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Diaz MH, Desai HP, Morrison SS, Benitez AJ, Wolff BJ, Caravas J, Read TD, Dean D, Winchell JM. Correction: Comprehensive bioinformatics analysis of Mycoplasma pneumoniae genomes to investigate underlying population structure and type-specific determinants. PLoS One 2017; 12:e0186030. [PMID: 28977025 PMCID: PMC5627953 DOI: 10.1371/journal.pone.0186030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Diaz MH, Desai HP, Morrison SS, Benitez AJ, Wolff BJ, Caravas J, Read TD, Dean D, Winchell JM. Comprehensive bioinformatics analysis of Mycoplasma pneumoniae genomes to investigate underlying population structure and type-specific determinants. PLoS One 2017; 12:e0174701. [PMID: 28410368 PMCID: PMC5391922 DOI: 10.1371/journal.pone.0174701] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/13/2017] [Indexed: 11/28/2022] Open
Abstract
Mycoplasma pneumoniae is a significant cause of respiratory illness worldwide. Despite a minimal and highly conserved genome, genetic diversity within the species may impact disease. We performed whole genome sequencing (WGS) analysis of 107 M. pneumoniae isolates, including 67 newly sequenced using the Pacific BioSciences RS II and/or Illumina MiSeq sequencing platforms. Comparative genomic analysis of 107 genomes revealed >3,000 single nucleotide polymorphisms (SNPs) in total, including 520 type-specific SNPs. Population structure analysis supported the existence of six distinct subgroups, three within each type. We developed a predictive model to classify an isolate based on whole genome SNPs called against the reference genome into the identified subtypes, obviating the need for genome assembly. This study is the most comprehensive WGS analysis for M. pneumoniae to date, underscoring the power of combining complementary sequencing technologies to overcome difficult-to-sequence regions and highlighting potential differential genomic signatures in M. pneumoniae.
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Affiliation(s)
- Maureen H. Diaz
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heta P. Desai
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shatavia S. Morrison
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alvaro J. Benitez
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bernard J. Wolff
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jason Caravas
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Timothy D. Read
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Deborah Dean
- Center for Immunobiology and Vaccine Research, University of California San Francisco Benioff Children’s Hospital Oakland Research Institute, Oakland, California, United States of America
- Joint Graduate Program in Bioengineering, University of California San Francisco and University of California Berkeley, Oakland, California, United States of America
| | - Jonas M. Winchell
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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19
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Mesquita LP, Diaz MH, Howerth EW, Stallknecht DE, Noblet R, Gray EW, Mead DG. Pathogenesis of Vesicular Stomatitis New Jersey Virus Infection in Deer Mice ( Peromyscus maniculatus) Transmitted by Black Flies ( Simulium vittatum). Vet Pathol 2016; 54:74-81. [PMID: 27312365 DOI: 10.1177/0300985816653172] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The natural transmission of vesicular stomatitis New Jersey virus (VSNJV), an arthropod-borne virus, is not completely understood. Rodents may have a role as reservoir or amplifying hosts. In this study, juvenile and nestling deer mice ( Peromyscus maniculatus) were exposed to VSNJV-infected black fly ( Simulium vittatum) bites followed by a second exposure to naive black flies on the nestling mice. Severe neurological signs were observed in some juvenile mice by 6 to 8 days postinoculation (DPI); viremia was not detected in 25 juvenile deer mice following exposure to VSNJV-infected fly bites. Both juvenile and nestling mice had lesions and viral antigen in the central nervous system (CNS); in juveniles, their distribution suggested that the sensory pathway was the most likely route to the CNS. In contrast, a hematogenous route was probably involved in nestling mice, since all of these mice developed viremia and had widespread antigen distribution in the CNS and other tissues on 2 DPI. VSNJV was recovered from naive flies that fed on viremic nestling mice. This is the first report of viremia in a potential natural host following infection with VSNJV via insect bite and conversely of an insect becoming infected with VSNJV by feeding on a viremic host. These results, along with histopathology and immunohistochemistry, show that nestling mice have widespread dissemination of VSNJV following VSNJV-infected black fly bite and are a potential reservoir or amplifying host for VSNJV.
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Affiliation(s)
- L P Mesquita
- 1 Department of Pathology, University of Georgia, Athens, GA, USA.,2 Department of Pathology, University of São Paulo, São Paulo, Brazil
| | - M H Diaz
- 3 Southeastern Cooperative Wildlife Disease Study, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.,4 Centers for Disease Control and Prevention, Division of Bacterial Diseases, Respiratory Diseases Branch, Atlanta, GA, USA
| | - E W Howerth
- 1 Department of Pathology, University of Georgia, Athens, GA, USA
| | - D E Stallknecht
- 3 Southeastern Cooperative Wildlife Disease Study, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - R Noblet
- 5 Department of Entomology, University of Georgia, Athens, GA, USA
| | - E W Gray
- 5 Department of Entomology, University of Georgia, Athens, GA, USA
| | - D G Mead
- 3 Southeastern Cooperative Wildlife Disease Study, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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20
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Cross KE, Mercante JW, Benitez AJ, Brown EW, Diaz MH, Winchell JM. Simultaneous detection of Legionella species and L. anisa, L. bozemanii, L. longbeachae and L. micdadei using conserved primers and multiple probes in a multiplex real-time PCR assay. Diagn Microbiol Infect Dis 2016; 85:295-301. [PMID: 27107536 PMCID: PMC5505572 DOI: 10.1016/j.diagmicrobio.2016.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/03/2016] [Accepted: 03/29/2016] [Indexed: 10/27/2022]
Abstract
Legionnaires' disease is a severe respiratory disease that is estimated to cause between 8,000 and 18,000 hospitalizations each year, though the exact burden is unknown due to under-utilization of diagnostic testing. Although Legionella pneumophila is the most common species detected in clinical cases (80-90%), other species have also been reported to cause disease. However, little is known about Legionnaires' disease caused by these non-pneumophila species. We designed a multiplex real-time PCR assay for detection of all Legionella spp. and simultaneous specific identification of four clinically-relevant Legionella species, L. anisa, L. bozemanii, L. longbeachae, and L. micdadei, using 5'-hydrolysis probe real-time PCR. The analytical sensitivity for detection of nucleic acid from each target species was ≤50fg per reaction. We demonstrated the utility of this assay in spiked human sputum specimens. This assay could serve as a tool for understanding the scope and impact of non-pneumophila Legionella species in human disease.
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Affiliation(s)
- Kristen E Cross
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Jeffrey W Mercante
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Alvaro J Benitez
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Ellen W Brown
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Maureen H Diaz
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Jonas M Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA.
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21
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Diaz MH, Cross KE, Benitez AJ, Hicks LA, Kutty P, Bramley AM, Chappell JD, Hymas W, Patel A, Qi C, Williams DJ, Arnold SR, Ampofo K, Self WH, Grijalva CG, Anderson EJ, McCullers JA, Pavia AT, Wunderink RG, Edwards KM, Jain S, Winchell JM. Identification of Bacterial and Viral Codetections With Mycoplasma pneumoniae Using the TaqMan Array Card in Patients Hospitalized With Community-Acquired Pneumonia. Open Forum Infect Dis 2016; 3:ofw071. [PMID: 27191004 PMCID: PMC4867659 DOI: 10.1093/ofid/ofw071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 01/25/2016] [Accepted: 03/28/2016] [Indexed: 12/13/2022] Open
Abstract
Mycoplasma pneumoniae was detected in a number of patients with community-acquired pneumonia in a recent prospective study. To assess whether other pathogens were also detected in these patients, TaqMan Array Cards were used to test 216 M pneumoniae-positive respiratory specimens for 25 additional viral and bacterial respiratory pathogens. It is interesting to note that 1 or more codetections, predominantly bacterial, were identified in approximately 60% of specimens, with codetections being more common in children.
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Affiliation(s)
| | | | | | | | | | - Anna M Bramley
- Influenza Division , Centers for Disease Control, and Prevention , Atlanta, Georgia
| | | | - Weston Hymas
- University of Utah Health Sciences Center , Salt Lake City
| | - Anami Patel
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis
| | - Chao Qi
- Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Derek J Williams
- Vanderbilt University School of Medicine, Nashville, Tennessee; Vanderbilt Vaccine Research Program, Nashville, Tennessee
| | - Sandra R Arnold
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis
| | - Krow Ampofo
- University of Utah Health Sciences Center , Salt Lake City
| | - Wesley H Self
- Vanderbilt University School of Medicine , Nashville, Tennessee
| | | | | | - Jonathan A McCullers
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis; St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew T Pavia
- University of Utah Health Sciences Center , Salt Lake City
| | | | - Kathryn M Edwards
- Vanderbilt University School of Medicine, Nashville, Tennessee; Vanderbilt Vaccine Research Program, Nashville, Tennessee
| | - Seema Jain
- Influenza Division , Centers for Disease Control, and Prevention , Atlanta, Georgia
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22
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Tomczyk S, Arriola CS, Beall B, Benitez A, Benoit SR, Berman L, Bresee J, da Gloria Carvalho M, Cohn A, Cross K, Diaz MH, Francois Watkins LK, Gierke R, Hagan JE, Harris AM, Jain S, Kim L, Kobayashi M, Lindstrom S, McGee L, McMorrow M, Metcalf BL, Moore MR, Moura I, Nix WA, Nyangoma E, Oberste MS, Olsen SJ, Pimenta F, Socias C, Thurman K, Waller J, Waterman SH, Westercamp M, Wharton M, Whitney CG, Winchell JM, Wolff B, Kim C. Multistate Outbreak of Respiratory Infections Among Unaccompanied Children, June 2014-July 2014. Clin Infect Dis 2016; 63:48-56. [PMID: 27001799 DOI: 10.1093/cid/ciw147] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/07/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND From January 2014-July 2014, more than 46 000 unaccompanied children (UC) from Central America crossed the US-Mexico border. In June-July, UC aged 9-17 years in 4 shelters and 1 processing center in 4 states were hospitalized with acute respiratory illness. We conducted a multistate investigation to interrupt disease transmission. METHODS Medical charts were abstracted for hospitalized UC. Nonhospitalized UC with influenza-like illness were interviewed, and nasopharyngeal and oropharyngeal swabs were collected to detect respiratory pathogens. Nasopharyngeal swabs were used to assess pneumococcal colonization in symptomatic and asymptomatic UC. Pneumococcal blood isolates from hospitalized UC and nasopharyngeal isolates were characterized by serotyping and whole-genome sequencing. RESULTS Among 15 hospitalized UC, 4 (44%) of 9 tested positive for influenza viruses, and 6 (43%) of 14 with blood cultures grew pneumococcus, all serotype 5. Among 48 nonhospitalized children with influenza-like illness, 1 or more respiratory pathogens were identified in 46 (96%). Among 774 nonhospitalized UC, 185 (24%) yielded pneumococcus, and 70 (38%) were serotype 5. UC transferring through the processing center were more likely to be colonized with serotype 5 (odds ratio, 3.8; 95% confidence interval, 2.1-6.9). Analysis of core pneumococcal genomes detected 2 related, yet independent, clusters. No pneumococcus cases were reported after pneumococcal and influenza immunization campaigns. CONCLUSIONS This respiratory disease outbreak was due to multiple pathogens, including Streptococcus pneumoniae serotype 5 and influenza viruses. Pneumococcal and influenza vaccinations prevented further transmission. Future efforts to prevent similar outbreaks will benefit from use of both vaccines.
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Affiliation(s)
- Sara Tomczyk
- Epidemic Intelligence Service Respiratory Diseases Branch
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jose E Hagan
- Epidemic Intelligence Service Global Immunizations Division, Centers for Disease Control and Prevention, Atlanta, Georgia US Public Health Service, Rockville, Maryland
| | - Aaron M Harris
- Respiratory Diseases Branch US Public Health Service, Rockville, Maryland
| | | | - Lindsay Kim
- Respiratory Diseases Branch US Public Health Service, Rockville, Maryland
| | | | | | | | | | | | - Matthew R Moore
- Respiratory Diseases Branch US Public Health Service, Rockville, Maryland
| | | | - W Allan Nix
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Edith Nyangoma
- Epidemic Intelligence Service Division of Global Migration and Quarantine
| | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Christina Socias
- Epidemic Intelligence Service National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | | | | | | | | | | | - Cynthia G Whitney
- Respiratory Diseases Branch US Public Health Service, Rockville, Maryland
| | | | | | - Curi Kim
- US Public Health Service, Rockville, Maryland Office of Refugee Resettlement, Administration for Children and Families, Washington D.C
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Diaz MH, Winchell JM. The Evolution of Advanced Molecular Diagnostics for the Detection and Characterization of Mycoplasma pneumoniae. Front Microbiol 2016; 7:232. [PMID: 27014191 PMCID: PMC4781879 DOI: 10.3389/fmicb.2016.00232] [Citation(s) in RCA: 29] [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: 01/15/2016] [Accepted: 02/15/2016] [Indexed: 12/12/2022] Open
Abstract
Over the past decade there have been significant advancements in the methods used for detecting and characterizing Mycoplasma pneumoniae, a common cause of respiratory illness and community-acquired pneumonia worldwide. The repertoire of available molecular diagnostics has greatly expanded from nucleic acid amplification techniques (NAATs) that encompass a variety of chemistries used for detection, to more sophisticated characterizing methods such as multi-locus variable-number tandem-repeat analysis (MLVA), Multi-locus sequence typing (MLST), matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), single nucleotide polymorphism typing, and numerous macrolide susceptibility profiling methods, among others. These many molecular-based approaches have been developed and employed to continually increase the level of discrimination and characterization in order to better understand the epidemiology and biology of M. pneumoniae. This review will summarize recent molecular techniques and procedures and lend perspective to how each has enhanced the current understanding of this organism and will emphasize how Next Generation Sequencing may serve as a resource for researchers to gain a more comprehensive understanding of the genomic complexities of this insidious pathogen.
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Affiliation(s)
| | - Jonas M. Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, AtlantaGA, USA
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Olson D, Watkins LKF, Demirjian A, Lin X, Robinson CC, Pretty K, Benitez AJ, Winchell JM, Diaz MH, Miller LA, Foo TA, Mason MD, Lauper UL, Kupfer O, Kennedy J, Glodé MP, Kutty PK, Dominguez SR. Outbreak of Mycoplasma pneumoniae-Associated Stevens-Johnson Syndrome. Pediatrics 2015; 136. [PMID: 26216320 PMCID: PMC4516944 DOI: 10.1542/peds.2015-0278] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) is an uncommon, sporadic disease and outbreaks are rare. In November 2013, an outbreak of SJS was identified at Children's Hospital Colorado. METHODS Outbreak cases were children aged 5-21 with a discharge diagnosis of SJS admitted from September 1 to November 30, 2013. Medical charts were reviewed using standardized data collection forms. Respiratory specimens were tested for viruses and Mycoplasma pneumoniae (Mp) by polymerase chain reaction (PCR). We conducted a separate 4-year retrospective case-control study comparing hospitalized SJS cases with and without evidence of Mp infection. RESULTS During the outbreak, 8 children met SJS criteria. Median age was 11.5 years (range 8-16 years); 5 (63%) were boys and 5 (63%) were Mp-PCR-positive. Of the 5 PCR-positive children, none had preceding medication exposure, and all had radiographic pneumonia. All outbreak Mp isolates were macrolide susceptible. The retrospective case-control analysis showed that Mp-associated SJS episodes (n = 17) were more likely to have pneumonia (odds ratio [OR] 7.5, confidence interval [CI] 1.6–35.1), preceding respiratory symptoms (OR 30.0, CI 3.3–269.4) [corrected] an erythrocyte sedimentation rate ≥35 mg/dL (OR 22.8, CI 2.1-244.9), and ≤3 affected skin sites (OR 4.5, CI 1.2-17.4) than non-Mp-associated SJS episodes (n = 23). CONCLUSIONS We report the largest outbreak of SJS in children, which was also predominately associated with Mp infection. Mp-associated SJS was associated with a distinct clinical presentation that included less extensive skin disease, an elevated erythrocyte sedimentation rate, and evidence of a preceding respiratory infection.
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Affiliation(s)
| | - Louise K. Francois Watkins
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia Demirjian
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xia Lin
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christine C. Robinson
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Kristin Pretty
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado
| | | | | | - Maureen H. Diaz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa A. Miller
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Teresa A. Foo
- University of Colorado School of Medicine, Aurora, Colorado
| | | | | | | | | | | | - Preeta K. Kutty
- Centers for Disease Control and Prevention, Atlanta, Georgia
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25
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Diaz MH, Benitez AJ, Cross KE, Hicks LA, Kutty P, Bramley AM, Chappell JD, Hymas W, Patel A, Qi C, Williams DJ, Arnold SR, Ampofo K, Self WH, Grijalva CG, Anderson EJ, McCullers JA, Pavia AT, Wunderink RG, Edwards KM, Jain S, Winchell JM. Molecular Detection and Characterization of Mycoplasma pneumoniae Among Patients Hospitalized With Community-Acquired Pneumonia in the United States. Open Forum Infect Dis 2015; 2:ofv106. [PMID: 26284257 PMCID: PMC4536330 DOI: 10.1093/ofid/ofv106] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 04/16/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022] Open
Abstract
We report molecular characteristics of M. pneumoniae in respiratory specimens from children and adults hospitalized with CAP. The P1 type 1 genotype and MLVA type 4/5/7/2 predominated, but proportions of types differed between children and adults. Macrolide resistance was rare. Background. Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP). The molecular characteristics of M pneumoniae detected in patients hospitalized with CAP in the United States are poorly described. Methods. We performed molecular characterization of M pneumoniae in nasopharyngeal/oropharyngeal swabs from children and adults hospitalized with CAP in the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, including P1 typing, multilocus variable-number tandem-repeat analysis (MLVA), and macrolide susceptibility genotyping. Results. Of 216 M pneumoniae polymerase chain reaction-positive specimens, 40 (18.5%) were obtained from adults and 176 (81.5%) from children. P1 type distribution differed between adults (64% type 1 and 36% type 2) and children (84% type 1, 13% type 2, and 3% variant) (P < .05) and among sites (P < .01). Significant differences in the proportions of MLVA types 4/5/7/2 and 3/5/6/2 were also observed by age group (P < .01) and site (P < .01). A macrolide-resistant genotype was identified in 7 (3.5%) specimens, 5 of which were from patients who had recently received macrolide therapy. No significant differences in clinical characteristics were identified among patients with various strain types or between macrolide-resistant and -sensitive M pneumoniae infections. Conclusions. The P1 type 1 genotype and MLVA type 4/5/7/2 predominated, but there were differences between children and adults and among sites. Macrolide resistance was rare. Differences in strain types did not appear to be associated with differences in clinical outcomes. Whole genome sequencing of M pneumoniae may help identify better ways to characterize strains.
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Affiliation(s)
| | | | | | | | | | - Anna M Bramley
- Influenza Division , Centers for Disease Control and Prevention , Atlanta, Georgia
| | | | - Weston Hymas
- University of Utah Health Sciences Center , Salt Lake City
| | - Anami Patel
- Le Bonheur Children's Hospital ; University of Tennessee Health Science Center
| | - Chao Qi
- Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Derek J Williams
- Vanderbilt University School of Medicine , Nashville, Tennessee ; Vanderbilt Vaccine Research Program , Nashville
| | - Sandra R Arnold
- Le Bonheur Children's Hospital ; University of Tennessee Health Science Center
| | - Krow Ampofo
- University of Utah Health Sciences Center , Salt Lake City
| | - Wesley H Self
- Vanderbilt University School of Medicine , Nashville, Tennessee
| | | | | | - Jonathan A McCullers
- Le Bonheur Children's Hospital ; University of Tennessee Health Science Center ; St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Andrew T Pavia
- University of Utah Health Sciences Center , Salt Lake City
| | | | - Kathryn M Edwards
- Vanderbilt University School of Medicine , Nashville, Tennessee ; Vanderbilt Vaccine Research Program , Nashville
| | - Seema Jain
- Influenza Division , Centers for Disease Control and Prevention , Atlanta, Georgia
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26
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Hastings DL, Harrington KJ, Kutty PK, Rayman RJ, Spindola D, Diaz MH, Thurman KA, Winchell JM, Safranek TJ. Mycoplasma pneumoniae outbreak in a long-term care facility--Nebraska, 2014. MMWR Morb Mortal Wkly Rep 2015; 64:296-9. [PMID: 25811678 PMCID: PMC4584882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
On June 20, 2014, a Nebraska long-term care facility notified the East Central District Health Department (ECDHD) and Nebraska Department of Health and Human Services (NDHHS) of an outbreak of respiratory illness characterized by cough and fever in 22 residents and resulting in four deaths during the preceding 2 weeks. To determine the etiologic agent, identify additional cases, and implement control measures, Nebraska and CDC investigators evaluated the facility's infection prevention measures and collected nasopharyngeal (NP) and oropharyngeal (OP) swabs or autopsy specimens from patients for real-time polymerase chain reaction (PCR) testing at CDC. The facility was closed to new admissions until 1 month after the last case, droplet precautions were implemented, ill residents were isolated, and group activities were canceled. During the outbreak, a total of 55 persons experienced illnesses that met the case definition; 12 were hospitalized, and seven died. PCR detected Mycoplasma pneumoniae DNA in 40% of specimens. M. pneumoniae should be considered a possible cause of respiratory illness outbreaks in long-term care facilities. Morbidity and mortality from respiratory disease outbreaks at long-term care facilities might be minimized if facilities monitor for respiratory disease clusters, report outbreaks promptly, prioritize diagnostic testing in outbreak situations, and implement timely and strict infection control measures to halt transmission.
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Affiliation(s)
- Deborah L. Hastings
- Epidemic Intelligence Service, CDC
- Nebraska Department of Health and Human Services
| | | | - Preeta K. Kutty
- National Center for Immunization and Respiratory Diseases, CDC
| | | | | | - Maureen H. Diaz
- National Center for Immunization and Respiratory Diseases, CDC
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27
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Diaz MH, Silkaitis C, Malczynski M, Noskin GA, Warren JR, Zembower T. Contamination of Examination Gloves in patient Rooms and Implications for Transmission of Antimicrobial-Resistant Microorganisms. Infect Control Hosp Epidemiol 2015; 29:63-5. [DOI: 10.1086/524338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An assessment of bacterial contamination on examination gloves indicated that contaminated gloves may be a mechanism of indirect bacterial transmission from the hands of healthcare workers to patients. This mechanism is indicated by the recovery of identical Acinetobacter baumannii isolates from gloves and from the clinical cultures of a patient with invasive infection.
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28
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Diaz MH, Benitez AJ, Winchell JM. Investigations of Mycoplasma pneumoniae infections in the United States: trends in molecular typing and macrolide resistance from 2006 to 2013. J Clin Microbiol 2015; 53:124-30. [PMID: 25355769 PMCID: PMC4290910 DOI: 10.1128/jcm.02597-14] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [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: 09/09/2014] [Accepted: 10/22/2014] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma pneumoniae is a leading cause of respiratory infections, including community-acquired pneumonia (CAP). Currently, pathogen-specific testing is not routinely performed in the primary care setting, and the United States lacks a systematic surveillance program for M. pneumoniae. Documentation of individual cases and clusters typically occurs only when severe illness and/or failure to improve with empirical antibiotic therapy is observed. Outbreaks, some lasting for extended periods and involving a large number of cases, occur regularly. However, many more likely go unrecognized due to the lack of diagnostic testing and structured reporting. We reviewed data from 17 investigations of cases, small clusters, and outbreaks of M. pneumoniae infections that were supported by the Centers for Disease Control and Prevention (CDC) between 2006 and 2013. We examined 199 M. pneumoniae-positive specimens collected during this time period in order to identify trends in antimicrobial resistance and circulating types. Overall, macrolide resistance was identified in approximately 10% of M. pneumoniae infections occurring during this time period. Typing of strains revealed cocirculation of multiple multilocus variable-number tandem-repeat analysis (MLVA) and P1 types throughout this period, including diversity in types detected within individual outbreaks. Three MLVA types (4572, 3562, and 3662) accounted for 97% of the infections during the study period. A systematic surveillance program is necessary to understand the burden of M. pneumoniae disease in the United States, facilitate case and outbreak identification, and inform appropriate therapeutic and infection control strategies.
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Affiliation(s)
- Maureen H Diaz
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alvaro J Benitez
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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29
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Waller JL, Diaz MH, Petrone BL, Benitez AJ, Wolff BJ, Edison L, Tobin-D'Angelo M, Moore A, Martyn A, Dishman H, Drenzek CL, Turner K, Hicks LA, Winchell JM. Detection and characterization of Mycoplasma pneumoniae during an outbreak of respiratory illness at a university. J Clin Microbiol 2014; 52:849-53. [PMID: 24371236 PMCID: PMC3957776 DOI: 10.1128/jcm.02810-13] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/20/2013] [Indexed: 01/14/2023] Open
Abstract
An outbreak at a university in Georgia was identified after 83 cases of probable pneumonia were reported among students. Respiratory specimens were obtained from 21 students for the outbreak investigation. The TaqMan array card (TAC), a quantitative PCR (qPCR)-based multipathogen detection technology, was used to initially identify Mycoplasma pneumoniae as the causative agent in this outbreak. TAC demonstrated 100% diagnostic specificity and sensitivity compared to those of the multiplex qPCR assay for this agent. All M. pneumoniae specimens (n=12) and isolates (n=10) were found through genetic analysis to be susceptible to macrolide antibiotics. The strain diversity of M. pneumoniae associated with this outbreak setting was identified using a variety of molecular typing procedures, resulting in two P1 genotypes (types 1 [60%] and 2 [40%]) and seven different multilocus variable-number tandem-repeat analysis (MLVA) profiles. Continued molecular typing of this organism, particularly during outbreaks, may enhance the current understanding of the epidemiology of M. pneumoniae and may ultimately lead to a more effective public health response.
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Affiliation(s)
- Jessica L. Waller
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maureen H. Diaz
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brianna L. Petrone
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alvaro J. Benitez
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernard J. Wolff
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Edison
- Georgia Department of Public Health, Atlanta, Georgia, USA
- Epidemiology Workforce Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ashley Moore
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Audrey Martyn
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Hope Dishman
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | | | - Kim Turner
- Fulton County Department of Health and Wellness, Atlanta, Georgia, USA
| | - Lauri A. Hicks
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M. Winchell
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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30
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Diaz MH, Waller JL, Napoliello RA, Islam MS, Wolff BJ, Burken DJ, Holden RL, Srinivasan V, Arvay M, McGee L, Oberste MS, Whitney CG, Schrag SJ, Winchell JM, Saha SK. Optimization of Multiple Pathogen Detection Using the TaqMan Array Card: Application for a Population-Based Study of Neonatal Infection. PLoS One 2013; 8:e66183. [PMID: 23805203 PMCID: PMC3689704 DOI: 10.1371/journal.pone.0066183] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [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: 03/29/2013] [Accepted: 05/02/2013] [Indexed: 12/01/2022] Open
Abstract
Identification of etiology remains a significant challenge in the diagnosis of infectious diseases, particularly in resource-poor settings. Viral, bacterial, and fungal pathogens, as well as parasites, play a role for many syndromes, and optimizing a single diagnostic system to detect a range of pathogens is challenging. The TaqMan Array Card (TAC) is a multiple-pathogen detection method that has previously been identified as a valuable technique for determining etiology of infections and holds promise for expanded use in clinical microbiology laboratories and surveillance studies. We selected TAC for use in the Aetiology of Neonatal Infection in South Asia (ANISA) study for identifying etiologies of severe disease in neonates in Bangladesh, India, and Pakistan. Here we report optimization of TAC to improve pathogen detection and overcome technical challenges associated with use of this technology in a large-scale surveillance study. Specifically, we increased the number of assay replicates, implemented a more robust RT-qPCR enzyme formulation, and adopted a more efficient method for extraction of total nucleic acid from blood specimens. We also report the development and analytical validation of ten new assays for use in the ANISA study. Based on these data, we revised the study-specific TACs for detection of 22 pathogens in NP/OP swabs and 12 pathogens in blood specimens as well as two control reactions (internal positive control and human nucleic acid control) for each specimen type. The cumulative improvements realized through these optimization studies will benefit ANISA and perhaps other studies utilizing multiple-pathogen detection approaches. These lessons may also contribute to the expansion of TAC technology to the clinical setting.
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Affiliation(s)
- Maureen H. Diaz
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica L. Waller
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca A. Napoliello
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Md. Shahidul Islam
- Department of Microbiology, Bangladesh Institute of Child Health, Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Bernard J. Wolff
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel J. Burken
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rhiannon L. Holden
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Velusamy Srinivasan
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melissa Arvay
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lesley McGee
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - M. Steven Oberste
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cynthia G. Whitney
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephanie J. Schrag
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonas M. Winchell
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Samir K. Saha
- Department of Microbiology, Bangladesh Institute of Child Health, Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh
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31
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Conklin L, Adjemian J, Loo J, Mandal S, Davis C, Parks S, Parsons T, McDonough B, Partida J, Thurman K, Diaz MH, Benitez A, Pondo T, Whitney CG, Winchell JM, Kendig N, Van Beneden C. Investigation of a Chlamydia pneumoniae outbreak in a Federal correctional facility in Texas. Clin Infect Dis 2013; 57:639-47. [PMID: 23723194 DOI: 10.1093/cid/cit357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chlamydia pneumoniae illness is poorly characterized, particularly as a sole causative pathogen. We investigated a C. pneumoniae outbreak at a federal correctional facility. METHODS We identified inmates with acute respiratory illness (ARI) from 1 November 2009 to 24 February 2010 through clinic self-referral and active case finding. We tested oropharyngeal and/or nasopharyngeal swabs for C. pneumoniae by real-time polymerase chain reaction (qPCR) and serum samples by microimmunofluorescence. Cases were inmates with ARI and radiologically confirmed pneumonia, positive qPCR, or serological evidence of recent infection. Swabs from 7 acutely ill inmates were tested for 18 respiratory pathogens using qPCR TaqMan Array Cards (TACs). Follow-up swabs from case patients were collected for up to 8 weeks. RESULTS Among 33 self-referred and 226 randomly selected inmates, 52 (20.1%) met the case definition; pneumonia was confirmed in 4 by radiology only, in 9 by qPCR only, in 17 by serology only, and in 22 by both qPCR and serology. The prison attack rate was 10.4% (95% confidence interval, 7.0%-13.8%). White inmates and residents of housing unit Y were at highest risk. TAC testing detected C. pneumoniae in 4 (57%) inmates; no other causative pathogens were identified. Among 40 inmates followed prospectively, C. pneumoniae was detected for up to 8 weeks. Thirteen (52%) of 25 inmates treated with azithromycin continued to be qPCR positive >2 weeks after treatment. CONCLUSIONS Chlamydia pneumoniae was the causative pathogen of this outbreak. Higher risk among certain groups suggests that social interaction contributed to transmission. Persistence of C. pneumoniae in the oropharynx creates challenges for outbreak control measures.
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Affiliation(s)
- Laura Conklin
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Bai Y, Kosoy MY, Diaz MH, Winchell J, Baggett H, Maloney SA, Boonmar S, Bhengsri S, Sawatwong P, Peruski LF. Bartonella vinsonii subsp. arupensis in humans, Thailand. Emerg Infect Dis 2012; 18:989-91. [PMID: 22607728 PMCID: PMC3358162 DOI: 10.3201/eid1806.111750] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We identified Bartonella vinsonii subsp. arupensis in pre-enriched blood of 4 patients from Thailand. Nucleotide sequences for transfer-messenger RNA gene, citrate synthase gene, and the 16S-23S rRNA internal transcribed spacer were identical or closely related to those for the strain that has been considered pathogenic since initially isolated from a human in Wyoming, USA.
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Affiliation(s)
- Ying Bai
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.
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Diaz MH, Winchell JM. Detection of Mycoplasma pneumoniae and Chlamydophila pneumoniae directly from respiratory clinical specimens using a rapid real-time polymerase chain reaction assay. Diagn Microbiol Infect Dis 2012; 73:278-80. [PMID: 22541789 DOI: 10.1016/j.diagmicrobio.2012.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 02/27/2012] [Accepted: 03/19/2012] [Indexed: 11/28/2022]
Abstract
We developed a rapid real-time polymerase chain reaction assay for detecting Mycoplasma pneumoniae and Chlamydophila pneumoniae directly from respiratory specimens. This procedure provides over 5 times faster results compared to existing methods while maintaining equivalent detection rates for specimens containing limited target organisms.
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Affiliation(s)
- Maureen H Diaz
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Shaver CM, Diaz MH, King JD, Musunuri S, Kazzaz JA, Hauser AR. PSEUDOMONAS AERUGINOSA INDUCES LOCALIZED IMMUNOSUPPRESSION DURING PNEUMONIA. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.637a] [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: 11/01/2022] Open
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Ottmann C, Yasmin L, Weyand M, Veesenmeyer JL, Diaz MH, Palmer RH, Francis MS, Hauser AR, Wittinghofer A, Hallberg B. Phosphorylation-independent interaction between 14-3-3 and exoenzyme S: from structure to pathogenesis. EMBO J 2007; 26:902-13. [PMID: 17235285 PMCID: PMC1794388 DOI: 10.1038/sj.emboj.7601530] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 12/04/2006] [Indexed: 01/04/2023] Open
Abstract
14-3-3 proteins are phosphoserine/phosphothreonine-recognizing adapter proteins that regulate the activity of a vast array of targets. There are also examples of 14-3-3 proteins binding their targets via unphosphorylated motifs. Here we present a structural and biological investigation of the phosphorylation-independent interaction between 14-3-3 and exoenzyme S (ExoS), an ADP-ribosyltransferase toxin of Pseudomonas aeruginosa. ExoS binds to 14-3-3 in a novel binding mode mostly relying on hydrophobic contacts. The 1.5 A crystal structure is supported by cytotoxicity analysis, which reveals that substitution of the corresponding hydrophobic residues significantly weakens the ability of ExoS to modify the endogenous targets RAS/RAP1 and to induce cell death. Furthermore, mutation of key residues within the ExoS binding site for 14-3-3 impairs virulence in a mouse pneumonia model. In conclusion, we show that ExoS binds 14-3-3 in a novel reversed orientation that is primarily dependent on hydrophobic residues. This interaction is phosphorylation independent and is required for the function of ExoS.
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Affiliation(s)
- Christian Ottmann
- Department of Structural Biology, Max-Planck-Institute for Molecular Physiology, Dortmund, Germany
- Chemical Genomics Centre, Dortmund, Germany
| | - Lubna Yasmin
- Department of Medical Biosciences/Pathology, Umeå University, Umeå, Sweden
| | - Michael Weyand
- Department of Structural Biology, Max-Planck-Institute for Molecular Physiology, Dortmund, Germany
| | - Jeffrey L Veesenmeyer
- Departments of Microbiology/Immunology and Medicine, Northwestern University, Chicago, IL, USA
| | - Maureen H Diaz
- Departments of Microbiology/Immunology and Medicine, Northwestern University, Chicago, IL, USA
| | - Ruth H Palmer
- Umeå Center for Molecular Pathogenesis, Umeå University, Umeå, Sweden
| | | | - Alan R Hauser
- Departments of Microbiology/Immunology and Medicine, Northwestern University, Chicago, IL, USA
| | - Alfred Wittinghofer
- Department of Structural Biology, Max-Planck-Institute for Molecular Physiology, Dortmund, Germany
| | - Bengt Hallberg
- Department of Medical Biosciences/Pathology, Umeå University, Umeå, Sweden
- Department of Medical Biosciences/Pathology, Buil. 6M, Umeå University, Umeå 90187, Sweden. Tel.: +46 907 852 523; Fax: +46 907 852 829; E-mail:
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Currier CB, Montalbert C, Dholakia SV, Diaz MH, Helfrich GB, Sulkin MD. Surgical management of infected Thomas shunts. Surgery 1981; 89:375-7. [PMID: 7466628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Infected Thomas shunts pose a problem for the surgeon treating end-stage renal failure patients. Complete removal of the prosthesis with ligation of the femoral vessels may jeopardize the limb. Removal of the shunt without the Dacron patch usually will not eradicate the infection. The present article describes a two-stage approach in six patients with arterial bypass of the infected area and complete removal of the prosthesis. There were no postoperative complications. Arterial circulation was maintained, and all operative sites healed completely.
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Currier CB, Papadopoulou Z, Helfrich GB, Diaz MH, Sulkin MD. Successful renal transplantation in focal segmental glomerulosclerosis. Transplant Proc 1979; 11:49-54. [PMID: 377682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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38
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Smyth NP, Magovern GJ, Ramirez RG, Diaz MH, Dixon CM, Fecht DC, Johnson A. In vivo study of a new radioisotope-powered cardiac pacer. J Thorac Cardiovasc Surg 1975; 70:2-8. [PMID: 1152502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A new radioisotopic pulse generator has been developed. It is 6 cm. long, 4.7 cm. high, 1.92 cm. wide, and weighs 61 Gm. (2 oz.). It is the smallest pulse generator made and has a life expectancy of over 20 years. The circuit is a conventional ventricular-inhibited (V.V.I.) type. In vitro testing has passed all Atomic Energy Commission requirements. The present study is concerned with in vivo testing of the complete pacemaker system, by means of both myocardial and endocranial electrodes, in 20 dogs with and without induced heart block. Extensive testing for electromagnetic compatability was carried out on 1 animal with induced heart block and a special, fast-rate pulse generator. Based on studies to date, the Atomic Energy Commission has issued a license for limited clinical trial which has already begun at the collaborating institutions.
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Mispireta LA, Doromal NM, Diaz MH. Primary hyperparathyroidism. Med Ann Dist Columbia 1974; 43:285-93. [PMID: 4526337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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40
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Mispireta LA, Marsh HB, Bacos JA, Diaz MH, Absolon KB. Tumors of the heart. Med Ann Dist Columbia 1974; 43:245-9. [PMID: 4526568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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