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Bull TJ, Munshi T, Lopez-Perez PM, Tran AC, Cosgrove C, Bartolf A, Menichini M, Rindi L, Parigger L, Malanovic N, Lohner K, Wang CJH, Fatima A, Martin LL, Esin S, Batoni G, Hilpert K. Specific Cationic Antimicrobial Peptides Enhance the Recovery of Low-Load Quiescent Mycobacterium tuberculosis in Routine Diagnostics. Int J Mol Sci 2023; 24:17555. [PMID: 38139385 PMCID: PMC10743970 DOI: 10.3390/ijms242417555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
The culture confirmation of Mycobacterium tuberculosis (MTB) remains the gold standard for the diagnosis of Tuberculosis (TB) with culture conversion representing proof of cure. However, over 40% of TB samples fail to isolate MTB even though many patients remain infectious due to the presence of viable non-culturable forms. Previously, we have shown that two short cationic peptides, T14D and TB08L, induce a hormetic response at low concentrations, leading to a stimulation of growth in MTB and the related animal pathogen Mycobacterium bovis (bTB). Here, we examine these peptides showing they can influence the mycobacterial membrane integrity and function through membrane potential reduction. We also show this disruption is associated with an abnormal reduction in transcriptomic signalling from specific mycobacterial membrane sensors that normally monitor the immediate cellular environment and maintain the non-growing phenotype. We observe that exposing MTB or bTB to these peptides at optimal concentrations rapidly represses signalling mechanisms maintaining dormancy phenotypes, which leads to the promotion of aerobic metabolism and conversion into a replicative phenotype. We further show a practical application of these peptides as reagents able to enhance conventional routine culture methods by stimulating mycobacterial growth. We evaluated the ability of a peptide-supplemented sample preparation and culture protocol to isolate the MTB against a gold standard routine method tested in parallel on 255 samples from 155 patients with suspected TB. The peptide enhancement increased the sample positivity rate by 46% and decreased the average time to sample positivity of respiratory/faecal sampling by seven days. The most significant improvements in isolation rates were from sputum smear-negative low-load samples and faeces. The peptide enhancement increased sampling test sensitivity by 19%, recovery in samples from patients with a previously culture-confirmed TB by 20%, and those empirically treated for TB by 21%. We conclude that sample decontamination and culture enhancement with D-enantiomer peptides offer good potential for the much-needed improvement of the culture confirmation of TB.
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Affiliation(s)
- Tim J. Bull
- Institute of Infection and Immunity, St. George’s, University of London, Cranmer Terrace, London SW17 0RE, UK (K.H.)
| | - Tulika Munshi
- Institute of Infection and Immunity, St. George’s, University of London, Cranmer Terrace, London SW17 0RE, UK (K.H.)
| | | | - Andy C. Tran
- Institute of Infection and Immunity, St. George’s, University of London, Cranmer Terrace, London SW17 0RE, UK (K.H.)
| | - Catherine Cosgrove
- St. George’s Hospital NHS Trust, Cranmer Terrace, London SW17 0RE, UK; (C.C.)
| | - Angela Bartolf
- St. George’s Hospital NHS Trust, Cranmer Terrace, London SW17 0RE, UK; (C.C.)
| | - Melissa Menichini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy (L.R.); (S.E.); (G.B.)
| | - Laura Rindi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy (L.R.); (S.E.); (G.B.)
| | - Lena Parigger
- Institute of Molecular Biosciences, Biophysics Division, University of Graz, Humboldstrasse 50/III, 800 Graz, Austria; (L.P.); (K.L.)
| | - Nermina Malanovic
- Institute of Molecular Biosciences, Biophysics Division, University of Graz, Humboldstrasse 50/III, 800 Graz, Austria; (L.P.); (K.L.)
| | - Karl Lohner
- Institute of Molecular Biosciences, Biophysics Division, University of Graz, Humboldstrasse 50/III, 800 Graz, Austria; (L.P.); (K.L.)
| | - Carl J. H. Wang
- School of Chemistry, Monash University, Clayton, VIC 3800, Australia (A.F.); (L.L.M.)
| | - Anam Fatima
- School of Chemistry, Monash University, Clayton, VIC 3800, Australia (A.F.); (L.L.M.)
| | - Lisandra L. Martin
- School of Chemistry, Monash University, Clayton, VIC 3800, Australia (A.F.); (L.L.M.)
| | - Semih Esin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy (L.R.); (S.E.); (G.B.)
| | - Giovanna Batoni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy (L.R.); (S.E.); (G.B.)
| | - Kai Hilpert
- Institute of Infection and Immunity, St. George’s, University of London, Cranmer Terrace, London SW17 0RE, UK (K.H.)
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Falcone M, Tiseo G, Giordano C, Leonildi A, Menichini M, Vecchione A, Pistello M, Guarracino F, Ghiadoni L, Forfori F, Barnini S, Menichetti F. Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study. J Antimicrob Chemother 2021; 76:1078-1084. [PMID: 33374002 PMCID: PMC7799007 DOI: 10.1093/jac/dkaa530] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19. Objectives To identify predictors of superinfections in COVID-19. Methods Prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. Clinical data and outcomes were registered. Superinfection was defined as a bacterial or fungal infection that occurred ≥48 h after hospital admission. A multivariate analysis was performed to identify factors independently associated with superinfections. Results Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19 days (range 11–29.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were: intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5–39.5, P < 0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4–13.1, P < 0.001); immunomodulatory agents (tocilizumab/baricitinib) (OR 5.09, 95% CI 2.2–11.8, P < 0.001); C-reactive protein on admission >7 mg/dl (OR 3.59, 95% CI 1.7–7.7, P = 0.001); and previous treatment with piperacillin/tazobactam (OR 2.85, 95% CI 1.1–7.2, P = 0.028). Length of hospital stay was longer in patients who developed superinfections ompared with those who did not (30 versus 11 days, P < 0.001), while mortality rates were similar (18.8% versus 23.2%, P = 0.445). Conclusions The risk of bacterial and fungal superinfections in COVID-19 is consistent. Patients who need empiric broad-spectrum antibiotics and immunomodulant drugs should be carefully selected. Infection control rules must be reinforced.
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Affiliation(s)
- Marco Falcone
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Tiseo
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cesira Giordano
- Microbiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alessandro Leonildi
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Melissa Menichini
- Microbiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Mauro Pistello
- Virology Unit, Department of Laboratory Medicine Pisa University Hospital and Retrovirus Center, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Lorenzo Ghiadoni
- Emergency Medicine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Simona Barnini
- Microbiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesco Menichetti
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Menichini M, Lari N, Lupetti A, Rindi L. Evaluation of Xpert MTB/RIF Ultra assay for rapid diagnosis of pulmonary and extra-pulmonary tuberculosis in an Italian center. Eur J Clin Microbiol Infect Dis 2020; 39:1597-1600. [PMID: 32232690 DOI: 10.1007/s10096-020-03867-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Nicoletta Lari
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Via San Zeno, 35/39, 56127, Pisa, Italy
| | - Antonella Lupetti
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Via San Zeno, 35/39, 56127, Pisa, Italy
| | - Laura Rindi
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Via San Zeno, 35/39, 56127, Pisa, Italy.
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Giordano C, Vecchione A, Menichini M, Lupetti A, Barnini S. Rapid detection of carbapenem resistant Klebsiella pneumoniae directly from positive blood cultures during an outbreak in the Tuscany region in Italy. ACTA ACUST UNITED AC 2020. [DOI: 10.15761/cmid.1000167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Genua F, Menichini M, Lari N, Rindi L. Genotyping and clarithromycin susceptibility testing of Mycobacterium avium subsp. hominissuis isolated in Tuscany, Italy. Infect Genet Evol 2018; 65:144-149. [PMID: 30055327 DOI: 10.1016/j.meegid.2018.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 11/24/2022]
Abstract
Mycobacterium avium subsp. hominissuis (MAH) is a major cause of nontuberculous mycobacteria infection and the incidence of MAH infections is increasing in many countries. This study aimed at determining the VNTR-based genetic diversity and the susceptibility to clarithromycin of a collection of 71 MAH human strains isolated in the last seven years. The VNTR analysis, revealing 16 unique patterns and 8 clusters including a total of 55 isolates, showed that most MAH isolates displayed a close genetic relationship, indicating that the MAH genotypes are quite homogeneous in our geographical area. Clarithromycin showed strong antimicrobial activity against MAH isolates, as indicated by the high proportion (94.4%) of susceptible strains. No association between specific VNTR patterns and the clinical features or the MIC of clarithromycin was found.
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Affiliation(s)
- Flavia Genua
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie, in Medicina e Chirurgia, Università di Pisa, I-56127 Pisa, Italy
| | - Melissa Menichini
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie, in Medicina e Chirurgia, Università di Pisa, I-56127 Pisa, Italy
| | - Nicoletta Lari
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie, in Medicina e Chirurgia, Università di Pisa, I-56127 Pisa, Italy
| | - Laura Rindi
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie, in Medicina e Chirurgia, Università di Pisa, I-56127 Pisa, Italy.
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Di Luca M, Navari E, Esin S, Menichini M, Barnini S, Trampuz A, Casani A, Batoni G. Detection of Biofilms in Biopsies from Chronic Rhinosinusitis Patients: In Vitro Biofilm Forming Ability and Antimicrobial Susceptibility Testing in Biofilm Mode of Growth of Isolated Bacteria. Adv Exp Med Biol 2017; 1057:1-27. [PMID: 28389992 DOI: 10.1007/5584_2017_34] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic rhinosinusitis (CRS) is the most common illness among chronic disorders that remains poorly understood from a pathogenic standpoint and has a significant impact on patient quality of life, as well as healthcare costs. Despite being widespread, little is known about the etiology of the CRS. Recent evidence, showing the presence of biofilms within the paranasal sinuses, suggests a role for biofilm in the pathogenesis. To elucidate the role of biofilm in the pathogenesis of CRS, we assessed the presence of biofilm at the infection site and the ability of the aerobic flora isolated from CRS patients to form biofilm in vitro. For selected bacterial strains the susceptibility profiles to antibiotics in biofilm condition was also evaluated.Staphylococci represented the majority of the isolates obtained from the infection site, with S. epidermidis being the most frequently isolated species. Other isolates were represented by Enterobacteriaceae or by species present in the oral flora. Confocal laser scanning microscopy (CLSM) of the mucosal biopsies taken from patients with CRS revealed the presence of biofilm in the majority of the samples. Strains isolated from the specific infection site of the CRS patients were able to form biofilm in vitro at moderate or high levels, when tested in optimized conditions. No biofilm was observed by CLSM in the biopsies from control patients, although the same biopsies were positive for staphylococci in microbiological culture analysis. Drug-susceptibility tests demonstrated that the susceptibility profile of planktonic bacteria differs from that of sessile bacteria in biofilms.
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Affiliation(s)
- Mariagrazia Di Luca
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy. .,NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Pisa, Italy. .,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin, Berlin, Germany.
| | - Elena Navari
- Department of Medical and Surgical Pathology, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy
| | - Semih Esin
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy.,Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Melissa Menichini
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy.,Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Simona Barnini
- Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Andrej Trampuz
- Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin, Berlin, Germany.,Center for Musculoskeletal Surgery, Septic Unit Charité-Universitätsmedizin, Berlin, Germany
| | - Augusto Casani
- Department of Medical and Surgical Pathology, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy
| | - Giovanna Batoni
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy.,Microbiology Unit, Pisa University Hospital, Pisa, Italy
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Carmassi C, Stratta P, Calderani E, Bertelloni CA, Menichini M, Massimetti E, Rossi A, Dell'Osso L. Impact of Mood Spectrum Spirituality and Mysticism Symptoms on Suicidality in Earthquake Survivors with PTSD. J Relig Health 2016; 55:641-649. [PMID: 26112609 DOI: 10.1007/s10943-015-0072-z] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the present study was to explore the correlations between Spirituality/Mysticism/Psychoticism symptoms and suicidality in young adult survivors of the L'Aquila earthquake. The sample included 475 subjects recruited among high school seniors who had experienced the April 6, 2009, earthquake. Assessments included: Trauma and Loss Spectrum-Self Report and Mood Spectrum-Self Report (MOODS-SR). Mysticism/Spirituality dimension and suicidality were evaluated by means of some specific items of the MOOD-SR. The Spirituality/Mysticism/Psychoticism MOODS-SR factor score was significantly higher among subjects with PTSD diagnosis with respect to those without. Similarly, subjects with suicidal ideation, as well as those who committed a suicide attempt, reported significantly higher scores than those without.
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Affiliation(s)
- Claudia Carmassi
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
| | - P Stratta
- Section of Psychiatry, Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - E Calderani
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - C A Bertelloni
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - M Menichini
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - E Massimetti
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - A Rossi
- Section of Psychiatry, Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - L Dell'Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy
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Carmassi C, Gemignani S, Bertelloni C, Calderani E, Pocai B, Manni C, Menichini M, Dell’Osso L. EPA-1337 – Validation of the italian version inventory of complicated grief (ICG): a study on complicated grief symptom profile. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78554-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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