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Kelly GC, Rachmat A, Hontz RD, Sklar MJ, Tran LK, Supaprom C, Luy M, Lina S, Gregory MJ, Sopheab H, Brooks JS, Sutherland IW, Corson KS, Letizia AG. Etiology and risk factors for diarrheal disease amongst rural and peri-urban populations in Cambodia, 2012-2018. PLoS One 2023; 18:e0283871. [PMID: 37000848 PMCID: PMC10065300 DOI: 10.1371/journal.pone.0283871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
Diarrheal diseases are a leading cause of mortality and morbidity, disproportionally affecting persons residing in low and middle-income countries. Accessing high-resolution surveillance data to understand community-level etiology and risk remains challenging, particularly in remote and resource limited populations. A multi-year prospective cohort study was conducted in two rural and two peri-urban villages in Cambodia from 2012 to 2018 to describe the epidemiology and etiology of acute diarrheal diseases within the population. Suspected diarrheal episodes among participants were self-reported or detected via routine weekly household visits. Fresh stool and fecal swabs were tested, and acute-illness and follow-up participant questionnaires collected. Of 5027 enrolled participants, 1450 (28.8%) reported at least one diarrheal incident. A total of 4266 individual diarrhea case events were recorded. Diarrhea incidence rate was calculated to be 281.5 persons per 1000 population per year, with an event rate of 664.3 individual diarrhea events occurring per 1000 population per year. Pathogenic Escherichia coli, Aeromonas spp., and Plesiomonas shigelloides were the most prevalent bacterial infections identified. Hookworm and Strongyloides stercoralis were the predominant helminth species, while Blastocystis hominis and Giardia lamblia were the predominant protozoan species found. Norovirus genotype 2 was the predominant virus identified. Mixed infections of two or more pathogens were detected in 36.2% of positive cases. Risk analyses identified unemployed status increased diarrhea risk by 63% (HR = 1.63 [95% CI 1.46, 1.83]). Individuals without access to protected water sources or sanitation facilities were 59% (HR = 1.59 [95% CI 1.49, 1.69]) and 19% (HR = 1.19 [95% CI 1.12, 1.28]) greater risk of contracting diarrhea, respectively. Patient-level surveillance data captured in this long-term study has generated a unique spatiotemporal profile of diarrheal disease in Cambodia. Understanding etiologies, together with associated epidemiological and community-level risk, provides valuable public health insight to support effective planning and delivery of appropriate local population-targeted interventions.
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Affiliation(s)
- Gerard C. Kelly
- Vysnova Partners, Inc., Landover, Maryland, United States of America
- * E-mail:
| | - Agus Rachmat
- AC Investment Co, Contractor for NAMRU-2 Phnom Penh, Phnom Penh, Cambodia
| | | | | | - Long Khanh Tran
- Vysnova Partners, Inc., Landover, Maryland, United States of America
| | - Chonthida Supaprom
- AC Investment Co, Contractor for NAMRU-2 Phnom Penh, Phnom Penh, Cambodia
| | - Malen Luy
- AC Investment Co, Contractor for NAMRU-2 Phnom Penh, Phnom Penh, Cambodia
| | - Sin Lina
- AC Investment Co, Contractor for NAMRU-2 Phnom Penh, Phnom Penh, Cambodia
| | | | - Heng Sopheab
- National Institute of Public Health, Ministry of Health, Cambodia
| | - John S. Brooks
- U.S. Naval Medical Research Unit TWO, Phnom Penh, Cambodia
| | | | - Karen S. Corson
- U.S. Naval Medical Research Unit TWO, Singapore, Singapore
- U.S. Naval Medical Research Unit TWO, Phnom Penh, Cambodia
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Hii KC, Robie ER, Saihidi I, Berita A, Alarja NA, Xiu L, Merchant JA, Binder RA, Goh JKT, Guernier-Cambert V, Galán D, Gregory MJ, Gray GC. Leptospirosis infections among hospital patients, Sarawak, Malaysia. Trop Dis Travel Med Vaccines 2021; 7:32. [PMID: 34719397 PMCID: PMC8559352 DOI: 10.1186/s40794-021-00154-2] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022]
Abstract
Background Leptospirosis diagnoses have increased in Sarawak, Malaysia in recent years. Methods To better understand the burden of disease and associated risk factors, we evaluated 147 patients presenting with clinical leptospirosis to local hospitals in Sarawak, Malaysia for the presence of Leptospira and associated antibodies. Sera and urine specimens collected during the acute illness phase were assessed via a commercially available rapid diagnostic test (Leptorapide, Linnodee Ltd., Antrim, Northern Ireland), an ELISA IgM assay (Leptospira IgM ELISA, PanBio, Queensland, Australia) and a pan-Leptospira real-time PCR (qPCR) assay to estimate disease prevalence and diagnostic accuracy of each method. Microagglutination testing was performed on a subset of samples. Results Overall, 45 out of 147 patients (30.6%) showed evidence of leptospires through qPCR in either one or both sera (20 patients) or urine (33 patients), and an additional ten (6.8%) were considered positive through serological testing, for an overall prevalence of 37.4% within the study population. However, each diagnostic method individually yielded disparate prevalence estimates: rapid test 42.2% for sera and 30.5% for urine, ELISA 15.0% for sera, qPCR 13.8% for sera and 23.4% for urine. Molecular characterization of a subset of positive samples by conventional PCR identified the bacterial species as Leptospira interrogans in 4 specimens. A multivariate risk factor analysis for the outcome of leptospirosis identified having completed primary school (OR = 2.5; 95 CI% 1.0–6.4) and weekly clothes-washing in local rivers (OR = 10.6; 95 CI% 1.4–214.8) with increased likelihood of leptospirosis when compared with those who had not. Conclusion Overall, the data suggest a relatively high prevalence of leptospirosis in the study population. The low sensitivities of the rapid diagnostic test and ELISA assay against qPCR highlight a need for better screening tools. Supplementary Information The online version contains supplementary material available at 10.1186/s40794-021-00154-2.
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Affiliation(s)
- King-Ching Hii
- Department of Pediatrics, Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Emily R Robie
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Division of Infectious Diseases, Duke University School of Medicine, DUMC Box 102359, Durham, NC, 27710, USA
| | - Izreena Saihidi
- Department of Pediatrics, Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Antoinette Berita
- Department of Pediatrics, Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Natalie A Alarja
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Division of Infectious Diseases, Duke University School of Medicine, DUMC Box 102359, Durham, NC, 27710, USA
| | - Leshan Xiu
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Division of Infectious Diseases, Duke University School of Medicine, DUMC Box 102359, Durham, NC, 27710, USA.,National Health Commission Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - James A Merchant
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Raquel A Binder
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Division of Infectious Diseases, Duke University School of Medicine, DUMC Box 102359, Durham, NC, 27710, USA
| | - Johnny Keh-Tun Goh
- Department of Pediatrics, Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Vanina Guernier-Cambert
- Present address: Agricultural Research Service, National Animal Disease Center, United States Department of Agriculture, Ames, IA, USA
| | - Diego Galán
- Division of Infectious Diseases, Duke University School of Medicine, DUMC Box 102359, Durham, NC, 27710, USA
| | - Michael J Gregory
- United States Naval Medical Research Center- Asia, Singapore, Singapore
| | - Gregory C Gray
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,Division of Infectious Diseases, Duke University School of Medicine, DUMC Box 102359, Durham, NC, 27710, USA. .,Emerging Infectious Disease Program, Duke-NUS Medical School, Singapore, Singapore. .,Global Health Center, Duke Kunshan University, Kunshan, China.
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3
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Ngoi ST, Chong CW, Ponnampalavanar SSLS, Tang SN, Idris N, Abdul Jabar K, Gregory MJ, Husain T, Teh CSJ. Genetic mechanisms and correlated risk factors of antimicrobial-resistant ESKAPEE pathogens isolated in a tertiary hospital in Malaysia. Antimicrob Resist Infect Control 2021; 10:70. [PMID: 33892804 PMCID: PMC8062948 DOI: 10.1186/s13756-021-00936-5] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Knowledge on the epidemiology, genotypic and phenotypic features of antimicrobial-resistant (AMR) ESKAPEE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli) and their association with hospital-acquired infections (HAIs) are limited in Malaysia. Therefore, we evaluated the AMR features and resistance mechanisms of the ESKAPEE pathogens collected in a tertiary hospital located in the capital of Malaysia. METHODS A total of 378 AMR-ESKAPEE strains were obtained based on convenience sampling over a nine-month study period (2019-2020). All strains were subjected to disk diffusion and broth microdilution assays to determine the antimicrobial susceptibility profiles. Polymerase chain reaction (PCR) and DNA sequence analyses were performed to determine the AMR genes profiles of the non-susceptible strains. Chi-square test and logistic regression analyses were used to correlate the AMR profiles and clinical data to determine the risk factors associated with HAIs. RESULTS High rates of multidrug resistance (MDR) were observed in A. baumannii, K. pneumoniae, E. coli, and S. aureus (69-89%). All organisms except E. coli were frequently associated with HAIs (61-94%). Non-susceptibility to the last-resort drugs vancomycin (in Enterococcus spp. and S. aureus), carbapenems (in A. baumannii, P. aeruginosa, and Enterobacteriaceae), and colistin (in Enterobacteriaceae) were observed. Both A. baumannii and K. pneumoniae harbored a wide array of extended-spectrum β-lactamase genes (blaTEM, blaSHV, blaCTX-M, blaOXA). Metallo-β-lactamase genes (blaVEB, blaVIM, blaNDM) were detected in carbapenem-resistant strains, at a higher frequency compared to other local reports. We detected two novel mutations in the quinolone-resistant determining region of the gyrA in fluoroquinolone-resistant E. coli (Leu-102-Ala; Gly-105-Val). Microbial resistance to ampicillin, methicillin, and cephalosporins was identified as important risk factors associated with HAIs in the hospital. CONCLUSION Overall, our findings may provide valuable insight into the microbial resistance pattern and the risk factors of ESKAPEE-associated HAIs in a tertiary hospital located in central Peninsular Malaysia. The data obtained in this study may contribute to informing better hospital infection control in this region.
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Affiliation(s)
- Soo Tein Ngoi
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, 47500, Bandar Sunway, Selangor, Malaysia
| | | | - Soo Nee Tang
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nuryana Idris
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Kartini Abdul Jabar
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Michael J Gregory
- United States Naval Medical Research Unit Two (NAMRU-2), Phnom Penh, Cambodia
| | - Tupur Husain
- United States Naval Medical Research Unit Two (NAMRU-2), Phnom Penh, Cambodia
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Taitt CR, Leski TA, Prouty MG, Ford GW, Heang V, House BL, Levin SY, Curry JA, Mansour A, Mohammady HE, Wasfy M, Tilley DH, Gregory MJ, Kasper MR, Regeimbal J, Rios P, Pimentel G, Danboise BA, Hulseberg CE, Odundo EA, Ombogo AN, Cheruiyot EK, Philip CO, Vora GJ. Tracking Antimicrobial Resistance Determinants in Diarrheal Pathogens: A Cross-Institutional Pilot Study. Int J Mol Sci 2020; 21:ijms21165928. [PMID: 32824772 PMCID: PMC7460656 DOI: 10.3390/ijms21165928] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022] Open
Abstract
Infectious diarrhea affects over four billion individuals annually and causes over a million deaths each year. Though not typically prescribed for treatment of uncomplicated diarrheal disease, antimicrobials serve as a critical part of the armamentarium used to treat severe or persistent cases. Due to widespread over- and misuse of antimicrobials, there has been an alarming increase in global resistance, for which a standardized methodology for geographic surveillance would be highly beneficial. To demonstrate that a standardized methodology could be used to provide molecular surveillance of antimicrobial resistance (AMR) genes, we initiated a pilot study to test 130 diarrheal pathogens (Campylobacter spp., Escherichia coli, Salmonella, and Shigella spp.) from the USA, Peru, Egypt, Cambodia, and Kenya for the presence/absence of over 200 AMR determinants. We detected a total of 55 different determinants conferring resistance to ten different categories of antimicrobials: genes detected in ≥ 25 samples included blaTEM, tet(A), tet(B), mac(A), mac(B), aadA1/A2, strA, strB, sul1, sul2, qacEΔ1, cmr, and dfrA1. The number of determinants per strain ranged from none (several Campylobacter spp. strains) to sixteen, with isolates from Egypt harboring a wider variety and greater number of genes per isolate than other sites. Two samples harbored carbapenemase genes, blaOXA-48 or blaNDM. Genes conferring resistance to azithromycin (ere(A), mph(A)/mph(K), erm(B)), a first-line therapeutic for severe diarrhea, were detected in over 10% of all Enterobacteriaceae tested: these included >25% of the Enterobacteriaceae from Egypt and Kenya. Forty-six percent of the Egyptian Enterobacteriaceae harbored genes encoding CTX-M-1 or CTX-M-9 families of extended-spectrum β-lactamases. Overall, the data provide cross-comparable resistome information to establish regional trends in support of international surveillance activities and potentially guide geospatially informed medical care.
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Affiliation(s)
- Chris R. Taitt
- US Naval Research Laboratory, Center for Biomolecular Science & Engineering, Washington, DC 20375, USA; (T.A.L.); (G.J.V.)
- Correspondence: ; Tel.: +1-011-202-404-4208
| | - Tomasz A. Leski
- US Naval Research Laboratory, Center for Biomolecular Science & Engineering, Washington, DC 20375, USA; (T.A.L.); (G.J.V.)
| | - Michael G. Prouty
- US Naval Medical Research Unit No. 2-Phnom Penh, Blvd Kim Il Sung, Khan Toul Kork, Phnom Penh, Cambodia; (M.G.P.); (G.W.F.); (V.H.)
| | - Gavin W. Ford
- US Naval Medical Research Unit No. 2-Phnom Penh, Blvd Kim Il Sung, Khan Toul Kork, Phnom Penh, Cambodia; (M.G.P.); (G.W.F.); (V.H.)
| | - Vireak Heang
- US Naval Medical Research Unit No. 2-Phnom Penh, Blvd Kim Il Sung, Khan Toul Kork, Phnom Penh, Cambodia; (M.G.P.); (G.W.F.); (V.H.)
| | - Brent L. House
- US Naval Medical Research Unit No. 3, Naval Air Station Sigonella, 95030 Sigonella, Italy; (B.L.H.); (S.Y.L.); (J.A.C.); (A.M.); (H.E.M.); (M.W.)
| | - Samuel Y. Levin
- US Naval Medical Research Unit No. 3, Naval Air Station Sigonella, 95030 Sigonella, Italy; (B.L.H.); (S.Y.L.); (J.A.C.); (A.M.); (H.E.M.); (M.W.)
| | - Jennifer A. Curry
- US Naval Medical Research Unit No. 3, Naval Air Station Sigonella, 95030 Sigonella, Italy; (B.L.H.); (S.Y.L.); (J.A.C.); (A.M.); (H.E.M.); (M.W.)
| | - Adel Mansour
- US Naval Medical Research Unit No. 3, Naval Air Station Sigonella, 95030 Sigonella, Italy; (B.L.H.); (S.Y.L.); (J.A.C.); (A.M.); (H.E.M.); (M.W.)
| | - Hanan El Mohammady
- US Naval Medical Research Unit No. 3, Naval Air Station Sigonella, 95030 Sigonella, Italy; (B.L.H.); (S.Y.L.); (J.A.C.); (A.M.); (H.E.M.); (M.W.)
| | - Momtaz Wasfy
- US Naval Medical Research Unit No. 3, Naval Air Station Sigonella, 95030 Sigonella, Italy; (B.L.H.); (S.Y.L.); (J.A.C.); (A.M.); (H.E.M.); (M.W.)
| | - Drake Hamilton Tilley
- US Naval Medical Research Unit No. 6 Peru, Lima 07001, Peru; (D.H.T.); (M.J.G.); (M.R.K.); (J.R.); (P.R.); (G.P.)
| | - Michael J. Gregory
- US Naval Medical Research Unit No. 6 Peru, Lima 07001, Peru; (D.H.T.); (M.J.G.); (M.R.K.); (J.R.); (P.R.); (G.P.)
| | - Matthew R. Kasper
- US Naval Medical Research Unit No. 6 Peru, Lima 07001, Peru; (D.H.T.); (M.J.G.); (M.R.K.); (J.R.); (P.R.); (G.P.)
| | - James Regeimbal
- US Naval Medical Research Unit No. 6 Peru, Lima 07001, Peru; (D.H.T.); (M.J.G.); (M.R.K.); (J.R.); (P.R.); (G.P.)
| | - Paul Rios
- US Naval Medical Research Unit No. 6 Peru, Lima 07001, Peru; (D.H.T.); (M.J.G.); (M.R.K.); (J.R.); (P.R.); (G.P.)
| | - Guillermo Pimentel
- US Naval Medical Research Unit No. 6 Peru, Lima 07001, Peru; (D.H.T.); (M.J.G.); (M.R.K.); (J.R.); (P.R.); (G.P.)
| | - Brook A. Danboise
- US Army Medical Research Directorate-Africa/Kenya, Kericho 20200, Kenya; (B.A.D.); (C.E.H.); (E.A.O.); (A.N.O.); (E.K.C.); (C.O.P.)
| | - Christine E. Hulseberg
- US Army Medical Research Directorate-Africa/Kenya, Kericho 20200, Kenya; (B.A.D.); (C.E.H.); (E.A.O.); (A.N.O.); (E.K.C.); (C.O.P.)
| | - Elizabeth A. Odundo
- US Army Medical Research Directorate-Africa/Kenya, Kericho 20200, Kenya; (B.A.D.); (C.E.H.); (E.A.O.); (A.N.O.); (E.K.C.); (C.O.P.)
| | - Abigael N. Ombogo
- US Army Medical Research Directorate-Africa/Kenya, Kericho 20200, Kenya; (B.A.D.); (C.E.H.); (E.A.O.); (A.N.O.); (E.K.C.); (C.O.P.)
| | - Erick K. Cheruiyot
- US Army Medical Research Directorate-Africa/Kenya, Kericho 20200, Kenya; (B.A.D.); (C.E.H.); (E.A.O.); (A.N.O.); (E.K.C.); (C.O.P.)
| | - Cliff O. Philip
- US Army Medical Research Directorate-Africa/Kenya, Kericho 20200, Kenya; (B.A.D.); (C.E.H.); (E.A.O.); (A.N.O.); (E.K.C.); (C.O.P.)
| | - Gary J. Vora
- US Naval Research Laboratory, Center for Biomolecular Science & Engineering, Washington, DC 20375, USA; (T.A.L.); (G.J.V.)
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Rozo M, Schully KL, Philipson C, Fitkariwala A, Nhim D, Som T, Sieng D, Huot B, Dul S, Gregory MJ, Heang V, Vaughn A, Vantha T, Prouty AM, Chao CC, Zhang Z, Belinskaya T, Voegtly LJ, Cer RZ, Bishop-Lilly KA, Duplessis C, Lawler JV, Clark DV. An Observational Study of Sepsis in Takeo Province Cambodia: An in-depth examination of pathogens causing severe infections. PLoS Negl Trop Dis 2020; 14:e0008381. [PMID: 32804954 PMCID: PMC7430706 DOI: 10.1371/journal.pntd.0008381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/16/2019] [Accepted: 05/11/2020] [Indexed: 01/20/2023] Open
Abstract
The world's most consequential pathogens occur in regions with the fewest diagnostic resources, leaving the true burden of these diseases largely under-represented. During a prospective observational study of sepsis in Takeo Province Cambodia, we enrolled 200 patients over an 18-month period. By coupling traditional diagnostic methods such as culture, serology, and PCR to Next Generation Sequencing (NGS) and advanced statistical analyses, we successfully identified a pathogenic cause in 46.5% of our cohort. In all, we detected 25 infectious agents in 93 patients, including severe threat pathogens such as Burkholderia pseudomallei and viral pathogens such as Dengue virus. Approximately half of our cohort remained undiagnosed; however, an independent panel of clinical adjudicators determined that 81% of those patients had infectious causes of their hospitalization, further underscoring the difficulty of diagnosing severe infections in resource-limited settings. We garnered greater insight as to the clinical features of severe infection in Cambodia through analysis of a robust set of clinical data.
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Affiliation(s)
- Michelle Rozo
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, Maryland, United States of America
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Kevin L. Schully
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, Maryland, United States of America
| | - Casandra Philipson
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Fort Detrick, Maryland, United States of America
- Defense Threat Reduction Agency, Fort Belvoir, Virginia, United States of America
| | | | | | - Tin Som
- Chenda Polyclinic, Phnom Penh, Cambodia
| | - Darith Sieng
- Lucerent Clinical Solutions, Phnom Penh, Cambodia
| | - Bora Huot
- Chenda Polyclinic, Phnom Penh, Cambodia
| | - Sokha Dul
- Chenda Polyclinic, Phnom Penh, Cambodia
| | | | - Vireak Heang
- U.S. Naval Medical Research Unit TWO (NAMRU-2), Phnom Penh, Cambodia
| | - Andrew Vaughn
- U.S. Naval Medical Research Unit TWO (NAMRU-2), Phnom Penh, Cambodia
| | - Te Vantha
- Takeo Provincial Referral Hospital, Takeo, Cambodia
| | - Angela M. Prouty
- U.S. Naval Medical Research Unit TWO (NAMRU-2), Phnom Penh, Cambodia
| | - Chien-Chung Chao
- Viral and Rickettsial Diseases Department, Naval Medical Research Center-Silver Spring, Silver Spring, Maryland, United States of America
| | - Zhiwen Zhang
- Viral and Rickettsial Diseases Department, Naval Medical Research Center-Silver Spring, Silver Spring, Maryland, United States of America
| | - Tatyana Belinskaya
- Viral and Rickettsial Diseases Department, Naval Medical Research Center-Silver Spring, Silver Spring, Maryland, United States of America
| | - Logan J. Voegtly
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Fort Detrick, Maryland, United States of America
- Leidos, Reston, Virginia, United States of America
| | - Regina Z. Cer
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Fort Detrick, Maryland, United States of America
- Leidos, Reston, Virginia, United States of America
| | - Kimberly A. Bishop-Lilly
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Fort Detrick, Maryland, United States of America
| | - Chris Duplessis
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, Maryland, United States of America
| | - James V. Lawler
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, Maryland, United States of America
- Global Center for Health Security at Nebraska and Division of Infectious Disease, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Danielle V. Clark
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, Maryland, United States of America
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
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Rojas JD, Reynolds ND, Pike BL, Espinoza NM, Kuroiwa J, Jani V, Ríos PA, Nunez RG, Yori PP, Bernal M, Meza RA, Kosek MN, McCoy AJ, Simons MP, Gregory MJ, Guerry P, Poly FM. Distribution of Capsular Types of Campylobacter jejuni Isolates from Symptomatic and Asymptomatic Children in Peru. Am J Trop Med Hyg 2020; 101:541-548. [PMID: 31392944 PMCID: PMC6726929 DOI: 10.4269/ajtmh.18-0994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 01/01/2023] Open
Abstract
Campylobacter jejuni is the leading bacterial cause of diarrhea worldwide. A capsular polysaccharide (CPS) conjugate vaccine is under development and requires determination of the valency. However, distribution of CPS types circulating globally is presently poorly described. We aimed to determine whether CPS type distribution in Peru differs from that in other endemic regions. We used a multiplex polymerase chain reaction (PCR) assay for the detection of CPS encoding genes capable of distinguishing all 35 CPS types on Campylobacter isolates in two prospective communities based studies conducted in cohorts of children less than 59 months of age in Peru. Results showed that CPS type HS4 complex was the most prevalent, followed by HS3 complex and HS15. Differences in CPS type for symptomatology were not statistically significant. Most subjects demonstrated repeated infections over time with different CPS types, suggesting that CPS types may confer of a level of homologous protective immunity. In this dataset, some differences in CPS type distribution were observed in comparison to other low-middle income countries. Further studies need to be conducted in endemic areas to increase our knowledge of CPS type distribution and guide vaccine development.
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Affiliation(s)
- Jesús D Rojas
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru.,Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Brian L Pike
- U.S. National Medical Research Center, Singapore
| | - Nereyda M Espinoza
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Janelle Kuroiwa
- Enteric Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, Maryland
| | - Vihasi Jani
- Enteric Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, Maryland
| | - Paul A Ríos
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Rosa G Nunez
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Pablo P Yori
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Manuela Bernal
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Rina A Meza
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Margaret N Kosek
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Andrea J McCoy
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Mark P Simons
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Michael J Gregory
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Patricia Guerry
- Enteric Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, Maryland
| | - Frédéric M Poly
- Enteric Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, Maryland
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7
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François R, Yori PP, Rouhani S, Siguas Salas M, Paredes Olortegui M, Rengifo Trigoso D, Pisanic N, Burga R, Meza R, Meza Sanchez G, Gregory MJ, Houpt ER, Platts-Mills JA, Kosek MN. The other Campylobacters: Not innocent bystanders in endemic diarrhea and dysentery in children in low-income settings. PLoS Negl Trop Dis 2018; 12:e0006200. [PMID: 29415075 PMCID: PMC5819825 DOI: 10.1371/journal.pntd.0006200] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 09/22/2017] [Revised: 02/20/2018] [Accepted: 12/31/2017] [Indexed: 12/13/2022] Open
Abstract
Background Campylobacter is one of the main causes of gastroenteritis worldwide. Most of the current knowledge about the epidemiology of this food-borne infection concerns two species, C. coli and C. jejuni. Recent studies conducted in developing countries and using novel diagnostic techniques have generated evidence of the increasing burden and importance of other Campylobacter species, i.e. non-C. coli/jejuni. We performed a nested case-control study to compare the prevalence of C. coli/jejuni and other Campylobacter in children with clinical dysentery and severe diarrhea as well as without diarrhea to better understand the clinical importance of infections with Campylobacter species other than C. coli/jejuni. Methodology/Principal findings Our nested case-control study of 439 stool samples included dysenteric stools, stools collected during severe diarrhea episodes, and asymptomatic stools which were systematically selected to be representative of clinical phenotypes from 9,160 stools collected during a birth cohort study of 201 children followed until two years of age. Other Campylobacter accounted for 76.4% of the 216 Campylobacter detections by qPCR and were more prevalent than C. coli/jejuni across all clinical groups. Other Campylobacter were also more prevalent than C. coli/jejuni across all age groups, with older children bearing a higher burden of other Campylobacter. Biomarkers of intestinal inflammation and injury (methylene blue, fecal occult test, myeloperoxidase or MPO) showed a strong association with dysentery, but mixed results with infection. MPO levels were generally higher among children infected with C. coli/jejuni, but Shigella-infected children suffering from dysentery recorded the highest levels (26,224 ng/mL); the lowest levels (10,625 ng/mL) were among asymptomatic children infected with other Campylobacter. Adjusting for age, sex, and Shigella infection, dysentery was significantly associated with C. coli/jejuni but not with other Campylobacter, whereas severe diarrhea was significantly associated with both C. coli/jejuni and other Campylobacter. Compared to asymptomatic children, children suffering from dysentery had a 14.6 odds of C. coli/jejuni infection (p-value < 0.001, 95% CI 5.5–38.7) but were equally likely to have other Campylobacter infections–odds ratio of 1.3 (0.434, 0.7–2.4). Children suffering from severe diarrhea were more likely than asymptomatic children to test positive for both C. coli/jejuni and other Campylobacter–OR of 2.8 (0.034, 1.1–7.1) and 1.9 (0.018, 1.1–3.1), respectively. Compared to the Campylobacter-free group, the odds of all diarrhea given C. coli/jejuni infection and other Campylobacter infection were 8.8 (<0.001, 3.0–25.7) and 2.4 (0.002, 1.4–4.2), respectively. Eliminating other Campylobacter in this population would eliminate 24.9% of the diarrhea cases, which is almost twice the population attributable fraction of 15.1% due to C. coli/jejuni. Conclusions/Significance Eighty-seven percent of the dysentery and 59.5% of the severe diarrhea samples were positive for Campylobacter, Shigella, or both, emphasizing the importance of targeting these pathogens to limit the impact of dysentery and severe diarrhea in children. Notably, the higher prevalence of other Campylobacter compared to C. coli/jejuni, their increasing burden during early childhood, and their association with severe diarrhea highlight the importance of these non-C. coli/jejuni Campylobacter species and suggest a need to clarify their importance in the etiology of clinical disease across different epidemiological contexts. Campylobacter is a major public health concern in developed and developing countries. C. coli and C. jejuni have long been considered to be the major disease-causing species, and clinical microbiologic approaches target these two species. However, less selective diagnostic approaches have shown the increasing importance of other Campylobacter species (i.e. non-C. coli/jejuni). Our case-control study investigated the association between diarrhea, C. coli/jejuni, and other Campylobacter among 439 stool samples from 201 children in peri-urban communities in Loreto, Peru. Three quarters of the 216 Campylobacter detections were associated with other Campylobacter, whose prevalence increased with age and was greater than that of C. coli/jejuni in all age and clinical groups (dysentery, severe diarrhea, and asymptomatic). Despite their lower prevalence, C. coli/jejuni were more strongly associated with higher levels of myeloperoxidase, clinical dysentery, and the presence of leukocytes and blood in the stool compared to other Campylobacter. Other Campylobacter were equally likely as C. coli/jejuni to be detected in severe diarrhea cases–odds ratio of 1.9 (p-value = 0.018, 95% CI 1.1–3.1) and 2.8 (0.034, 1.1–7.1), respectively. Removing C. coli/jejuni in this population would eliminate 15.1% of diarrhea compared to 24.9% if other Campylobacter were eliminated.
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Affiliation(s)
- Ruthly François
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Pablo Peñataro Yori
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
- Biomedical Research, Asociación Benéfica PRISMA, Iquitos, Peru
| | - Saba Rouhani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | | | | | | | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Rosa Burga
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Rina Meza
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Graciela Meza Sanchez
- Facultad de Medicina Humana, Universidad Nacional de la Amazonía Peruana, Iquitos, Peru
| | - Michael J. Gregory
- Bacteriology Department, Naval Medical Research Unit-6 (NAMRU-6), Lima, Peru
| | - Eric R. Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, United States of America
| | - James A. Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, United States of America
| | - Margaret N. Kosek
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
- Biomedical Research, Asociación Benéfica PRISMA, Iquitos, Peru
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, United States of America
- * E-mail:
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Schully KL, Berjohn CM, Prouty AM, Fitkariwala A, Som T, Sieng D, Gregory MJ, Vaughn A, Kheng S, Te V, Duplessis CA, Lawler JV, Clark DV. Melioidosis in lower provincial Cambodia: A case series from a prospective study of sepsis in Takeo Province. PLoS Negl Trop Dis 2017; 11:e0005923. [PMID: 28902844 PMCID: PMC5612750 DOI: 10.1371/journal.pntd.0005923] [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: 05/24/2017] [Revised: 09/25/2017] [Accepted: 09/01/2017] [Indexed: 12/31/2022] Open
Abstract
Melioidosis is a severe infectious disease caused by the gram-negative soil bacterium Burkholderia pseudomallei. Melioidosis is well known to be a major cause of morbidity and mortality in Southeast Asia, particularly in Thailand. However, melioidosis remains underreported in surrounding areas such as Cambodia. We report a case series of melioidosis in seven patients from Takeo Province, Cambodia. The patients, aged 24–65 years, were enrolled from May 2014 to May 2015 during a one year prospective study of sepsis at Takeo Provincial Hospital. They presented with fever, rigors, dyspnea, fatigue, diaphoresis, productive cough, and skin abscesses. Six of the seven patients were also hyponatremic. B. pseudomallei was cultured from the blood of six patients and the sputum of one patient. In this manuscript, we provide a detailed description of the clinical presentation, case management and laboratory confirmation of B. pseudomallei, as well as discuss the difficulties of identifying and treating melioidosis in low resource settings. In spite of the fact that Cambodia shares borders with well-known hyper-endemic areas for Burkholderia pseudomallei where thousands of melioidosis cases occur each year, only a handful of melioidosis cases have been described in Cambodia. This is due, in part, to the lack of appropriate diagnostic resources there and the fact that physicians are not familiar with the appropriate diagnostic and treatment algorithms. As a result, the true burden of melioidosis in Cambodia is drastically underestimated and confirmed cases are rarely treated properly. During a one year study of sepsis in Takeo Provincial Hospital in Takeo Province Cambodia, we enrolled 139 patients which included seven culture-confirmed cases of melioidosis. As part of our study, laboratory workups including blood gasses, blood chemistries and hematology are routinely performed as well as imaging and a detailed record of medications administered during treatment. As a result, our report describes one of the more well-characterized cohorts of adult B. pseudomallei infections from Cambodia, originating in a region that had relatively few documented cases previously. Additionally, our case series touches upon a number of challenges faced by resource-limited health systems addressing melioidosis in areas of high endemicity.
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Affiliation(s)
- Kevin L. Schully
- Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland, United States of America
- * E-mail:
| | | | | | | | - Tin Som
- Naval Medical Research Unit-2, Phnom Penh, Cambodia
| | - Darith Sieng
- Naval Medical Research Unit-2, Phnom Penh, Cambodia
| | - Michael J. Gregory
- Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland, United States of America
| | | | - Sim Kheng
- Cambodian Communicable Disease Control, Ministry of Health, Phnom Penh, Cambodia
| | - Vantha Te
- Takeo Provincial Referral Hospital, Takeo, Cambodia
| | - Christopher A. Duplessis
- Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland, United States of America
| | - James V. Lawler
- Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland, United States of America
| | - Danielle V. Clark
- Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland, United States of America
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9
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Gregory MJ, Anderson M, Causgrove TP. Measurement of energy barriers to conformational change in poly-l-glutamic acid by temperature-derivative spectroscopy. Chem Phys 2013. [DOI: 10.1016/j.chemphys.2013.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Abstract
Use of cyclosporine (CsA) in the management of children with steroid-resistant (SRNS) and steroid-dependent (SDNS) nephrotic syndrome has become increasingly popular in recent years. Although most children receive a renal biopsy prior to initiation of CsA, the relationship between initial renal histology and the subsequent clinical response to CsA is not known. We analyzed the correlation between pre-CsA segmental and global glomerular scarring and interstitial fibrosis and the subsequent response to CsA in 23 children (5.6+/-1.0 years, Mean+/-SEM) with SDNS (n=8) and SRNS (n=15) treated with CsA for 24.2+/-3.8 months and followed for 28.0+/-4.1 months. Complete remission was obtained in 78% of patients within 67.6+/-16 days, while 18% had a partial response and 4% no response. Quantitative histological analysis revealed a trend toward partial rather than complete response with increasing segmental glomerular (P=0.13), global glomerular (P=0.05), and interstitial (P=0.08) scarring, and among patients with minimal change nephrotic syndrome versus IgM nephropathy versus focal segmental glomerulosclerosis. Among complete responders, linear regression analyses revealed no correlation between time to response and pre-CsA glomerular or interstitial scarring. We conclude that increased glomerular or interstitial scarring on a pre-CsA renal biopsy tends to correlate with a partial, rather than complete, response to CsA in childhood nephrotic syndrome.
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Affiliation(s)
- W E Smoyer
- Department of Pediatrics, University of Michigan, Ann Arbor, USA
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11
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Gregory MJ, Schwartz GJ. Diagnosis and treatment of renal tubular disorders. Semin Nephrol 1998; 18:317-29. [PMID: 9613872] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is a wide variety of renal tubular disorders affecting children. Understanding the pathophysiology of each disease assists in the recognition and treatment of these diseases, which can have profound effects on a child's growth and development. We review some of the more common tubular disorders found in children, emphasizing those conditions in which recent advances have been made in understanding of the specific genetic or physiological defect responsible: Fanconi's syndrome, cystinuria, renal tubular acidosis, and the hypokalemic metabolic alkaloses. Current recommendations are presented for diagnosing and treating these conditions.
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Affiliation(s)
- M J Gregory
- Department of Pediatrics, University of Rochester, NY 14642, USA
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Abstract
This study examined the influence of mode of ventilation (spontaneous or controlled) on the target blood concentrations required to maintain anaesthesia with 'Diprifusor' (a target controlled infusion system for propofol) in 40 healthy, unpremedicated, adult patients undergoing knee arthroscopy. All patients were given alfentanil (10 micrograms.kg-1) and ketorolac (10 mg) immediately before induction and all received a 2:1 mixture of nitrous oxide:oxygen. An initial target blood concentration of propofol of 6.0 micrograms.ml-1 was used in most patients to induce anaesthesia. The blood target concentration required to produce acceptable anaesthetic conditions was not significantly influenced by the mode of ventilation. The mean maintenance target concentration for propofol was 3.9 (SD 0.83) micrograms.ml-1 in the ventilated group and 3.5 (SD 0.82) micrograms.ml-1 in the group of patients breathing spontaneously.
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Affiliation(s)
- A L Richards
- Anaesthetic Department, Royal Oldham Hospital, UK
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13
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Valentini RP, Smoyer WE, Sedman AB, Kershaw DB, Gregory MJ, Bunchman TE. Outcome of antineutrophil cytoplasmic autoantibodies-positive glomerulonephritis and vasculitis in children: a single-center experience. J Pediatr 1998; 132:325-8. [PMID: 9506649 DOI: 10.1016/s0022-3476(98)70453-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Vasculitis associated with antineutrophil cytoplasmic autoantibodies (ANCA) can be accompanied by a focal and necrotizing glomerulonephritis that carries a high morbidity. As many as 60% of reported children with ANCA-associated glomerulonephritis progress to end-stage renal disease. Seven children (13.0+/-0.89 years, mean age +/- SEM) with both a focal and necrotizing glomerulonephritis and a positive ANCA titer are described. Presenting symptoms were constitutional (100%) and sinopulmonary (71%); additional renal features included microscopic hematuria (100%), proteinuria (71%), and renal insufficiency (71%). Acute therapy (0 to 2 weeks from diagnosis) included intravenous corticosteroids and intravenous cyclophosphamide for all patients. Induction therapy (2 weeks to 6 months from diagnosis) consisted of cyclophosphamide (100%) and daily corticosteroids (86%) for a minimum of 6 months. Maintenance therapy that followed 6 months of induction therapy consisted of alternate day steroids (100%) combined with either oral azathioprine (50%) or oral cyclophosphamide (50%). Long-term follow-up for 48+/-12 months in all seven patients revealed that only one (14%) patient had end-stage renal disease, whereas the remaining patients had microscopic hematuria (100%), proteinuria (50%), and renal insufficiency (33%). These findings suggest that early recognition and aggressive treatment of children with ANCA-associated glomerulonephritis and vasculitis may result in an improved renal outcome compared with previous reports.
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Affiliation(s)
- R P Valentini
- Department of Pediatrics, University of Michigan, Ann Arbor, USA
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14
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Gregory MJ, Smoyer WE, Sedman A, Kershaw DB, Valentini RP, Johnson K, Bunchman TE. Long-term cyclosporine therapy for pediatric nephrotic syndrome: a clinical and histologic analysis. J Am Soc Nephrol 1996; 7:543-9. [PMID: 8724887 DOI: 10.1681/asn.v74543] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Cyclosporine (CsA) is effective in treating steroid-dependent (SDNS) and steroid-resistant (SRNS) nephrotic syndrome (NS) in children, but because of the potential for chronic nephrotoxicity, its long-term use is controversial. This study reports the results of long-term CsA treatment in 22 children with idiopathic NS. Indications for treatment included SDNS (N = 7) and SRNS (N = 15) children. Pre-CsA histology showed minimal change disease in three patients, immunoglobulin M nephropathy (IgM) in 14 patients, and focal segmental glomerulosclerosis (FSGS) in five patients. All patients had normal initial serum creatinine values. CsA was added to prednisone at 6.3 +/- 0.4 mg/kg per day (mean +/- SE) and adjusted to maintain whole blood trough HPLC levels of 70 to 120 ng/mL for a period of 6 to 53 months (mean, 22 months). Analysis by clinical course revealed that 13 of 15 patients with SRNS (87%) entered remission after a mean duration of CsA treatment of 58 days, whereas seven of seven patients with SDNS were able to be weaned off of daily prednisone therapy. Histologic analysis showed that all five patients with FSGS and 13 of 14 patients with IgM nephropathy either entered remission or were weaned off of daily steroids. Ten of the 22 patients (45%) with complete remission required CsA plus low-dose alternate-day prednisone to maintain remission. Hypertension was seen in eight of 22 patients (36%). No patient had a significant increase in serum creatinine concentration. Renal biopsies performed in 12 patients after 12 to 41 months (mean, 21 months) of CsA therapy showed no nephrotoxicity or disease progression in ten patients. Progression of the previous interstitial fibrosis and tubular atrophy was noted in two patients, suggesting a 17% incidence of CsA nephrotoxicity. This analysis of the long-term risks and benefits of CsA for childhood NS has identified two important findings: (1) combined CsA and alternate-day steroids can be highly effective in inducing complete remission in patients with SRNS and biopsy-proven IgM nephropathy, and (2) long-term use of CsA in moderate doses with closely monitored levels can result in a relatively low incidence of nephrotoxicity.
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Affiliation(s)
- M J Gregory
- Department of Pediatrics, University of Michigan, Ann Arbor, USA
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Lacki MJ, Gregory MJ, Williams PK. Spatial Response of an Eastern Chipmunk Population to Supplemented Food. American Midland Naturalist 1984. [DOI: 10.2307/2425338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Gregory MJ. Health care delivery by means of Health Maintenance Organisations. Aust Hosp 1978:5-7, 9. [PMID: 10308667] [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: 02/12/2023]
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Gregory MJ. Abortion laws. Eugen Rev 1939; 31:147. [PMID: 21260358 PMCID: PMC2962397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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