Bacterial findings in patients referred to hospital for the treatment of acute tonsillitis with or without peritonsillar phlegmon

BACKGROUND

The vast majority of patients with acute tonsillitis (AT) are managed in general practice. However, occasionally patients are referred to hospital for specialized management because of aggravated symptoms and/or findings suggestive of peritonsillar involvement. No prospective studies have been conducted aiming to investigate the prevalent and significant microorganisms in this highly selected group of patients. We aimed to describe the microbiological findings of acute tonsillitis with or without peritonsillar phlegmon (PP) in patients referred for hospital treatment and to point out potential pathogens using the following principles to suggest pathogenic significance: (1) higher prevalence in patients compared to healthy controls, (2) higher abundance in patients compared to controls, and (3) higher prevalence at time of infection compared to time of follow up.

METHODS

Meticulous and comprehensive cultures were performed on tonsillar swabs from 64 patients with AT with (n = 25) or without (n = 39) PP and 55 healthy controls, who were prospectively enrolled at two Danish Ear-Nose-Throat Departments between June 2016 and December 2019.

RESULTS

Streptococcus pyogenes was significantly more prevalent in patients (27%) compared to controls (4%) (p < 0.001). Higher abundance was found in patients compared to controls for Fusobacterium necrophorum (mean 2.4 vs. 1.4, p = 0.017) and S. pyogenes (mean 3.1 vs. 2.0, p = 0.045) in semi-quantitative cultures. S. pyogenes, Streptococcus dysgalactiae, and Prevotella species were significantly more prevalent at time of infection compared to follow up (p = 0.016, p = 0.016, and p = 0.039, respectively). A number of species were detected significantly less frequently in patients compared to controls and the mean number of species was significantly lower in patients compared to controls (6.5 vs. 8.3, p < 0.001).

CONCLUSIONS

Disregarding Prevotella spp. because of the prevalence in healthy controls (100%), our findings suggest that S. pyogenes, F. necrophorum, and S. dysgalactiae are significant pathogens in severe AT with or without PP. In addition, infections were associated with reduced diversity (dysbacteriosis).

TRIAL REGISTRATION

The study is registered in the ClinicalTrials.gov protocol database (# 52,683). The study was approved by the Ethical Committee at Aarhus County (# 1-10-72-71-16) and by the Danish Data Protection Agency (# 1-16-02-65-16).

[Research progress on the correlation between changes in gut microbiota and sarcopenia in patients with cirrhosis]

Sarcopenia is one of the common complications of cirrhosis. Studies have demonstrated that patients with cirrhosis combined with sarcopenia have a high mortality rate. The occurrence of sarcopenia may be associated with inflammatory states and metabolic abnormalities caused by changes in the gut microbiota environment, but such studies are currently relatively lacking. This article elaborates on the correlation between changes in the gut microbiota environment, as well as the diagnosis and treatment, in order to provide reference and assistance for the treatment of patients with cirrhosis and sarcopenia.

Emerging frontiers of antibiotics use and their impacts on the human gut microbiome

Antibiotics, the primary drugs used to cure bacterial diseases, are increasingly becoming ineffective due to the emergence of multiple drug resistance (MDR) leading to recurrence of previously sensitive pathogens. Human gut microbiome (GM), known to play an important role in various physiological processes, consists of pool of diverse microbes. Indiscriminate use of antibiotics during the life span of an individual may lead to development of resistant microbes e.g. Vibrio, Acinetobacter, Escherichia, Klebsiella, Clostridia, etc. in the human GM. Transmission of antibiotic resistant genes (ARGs) between pathogenic and commensal bacteria occurs more frequently in microbiome communities wherein bacteria communicate and exchange cellular constituents both among themselves and with the host. Additionally, co-factors like 'early vs. late' exposure, type of antibiotics and duration of treatment modulate the adverse effects of antibiotics on GM maturation. Furthermore, factors like mode of birth, ethnicity, malnutrition, demography, diet, lifestyle, etc., which influence GM composition, can also indirectly alter the host response to antibiotics. Currently, advanced 'omics' and culturomics approaches are revealing novel avenues to study the interplay between antibiotics and the microbiome and to identify resistant genes in these bacterial communities. Here, we discuss the recent developments that have given insights into the effects of antibiotics on the homeostatic balance of the gut microbiome and thus on human health.

Gut microbiota may contribute to the postnatal male reproductive abnormalities induced by prenatal dibutyl phthalate exposure

Phthalate is an environmental endocrine disruptor that causes direct and intergenerational male reproductive damage. However, its mechanisms require further investigation. The role of gut microbiota in male reproductive function has been gradually revealed in the past. To explore the intergenerational testicular injury and the influence on offspring gut microbiota of the widely used phthalate dibutyl phthalate (DBP), we conducted a prenatal DBP exposure experiment with microbiota sequencing. We finally explained the gestational DBP exposure-induced gut dysbacteriosis, which is one of the mechanisms of testicular injury in the offspring. The occurrence of seminiferous atrophy and spermatogenic cells apoptosis showed a slight increase. Our study partially supported the results of previous research works on the characteristics of gut dysbacteriosis, which featured the increased relative abundance of Bacteroidetes, Prevotella and P. copri. Focusing on the role of gut microbiota in reproductive function is important. Future studies need to investigate the relationship between environmental pollution and human health.

Analysis of the relationship between bile duct and duodenal microbiota reveals that potential dysbacteriosis is the main cause of primary common bile duct stones

Bacteria play an important role in the formation of primary Common Bile Duct (CBD) stones. However, the composition and function of the microbiota of bile duct in patients with primary CBD stones remained to be explored. We utilized the 16S rRNA gene high-throughput sequencing technology to analyze the microbial diversity and community composition of biliary and duodenal microbiota in 15 patients with primary CBD stones and 4 patients without biliary tract diseases. Alpha diversity analysis showed that the microbiota richness was similar in bile and intestinal fluid; Beta diversity analysis showed that there were differences in the composition between biliary microbiota and the duodenal microbiota, but the abundance of the main groups showed similarities. The composition of the biliary microbiota from gallstone patients was more complex, as was the duodenal microbiota. Proteobacteria and Firmicutes were the dominant bacteria at phylum level, accounting for at least 75% of the total reads in each subgroup. Pseudomonas and Escherichia-Shigella were the major genus among subgroups, but Escherichia-Shigella had increased abundance in duodenal microbiota with primary choledocholithiasis, which may play an important role in stone formation. It is noteworthy that Clostridiumsensu_stricto, Lachnospiraceae _UCG-008, Butyrivibrio and Roseburia which could produce short chain fatty acids (SCFAs), were significantly decreased in biliary microbiota with primary CBD stones (p < 0.05). Our study provided new insights into the compositional of normal biliary microbiota. The micro-ecology of biliary and duodenal in patients with stones is complex and closely related, and there is a potential for dysbacteriosis. The decrease in abundance of certain major acid-producing bacteria affects the health of the biliary tract and thus leads to the formation of stones.

[Correlative factors analysis and predictive model construction of intestinal flora imbalance during acute exacerbation of chronic obstructive pulmonary disease]

Objective: To explore correlative factors and construct predictive model of intestinal flora imbalance in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Methods: The patients in acute exacerbation stage of COPD (AECOPD) hospitalized in Yixing People's Hospital from January 1 to December 31, 2019 were included. According to the clinical symptoms and results of fecal examination, the subjects were divided into case group (n=45) and control group (n=83). Multivariate logistic regression was used to analyze the correlative factors of intestinal flora imbalance in AECOPD patients. The prediction model of intestinal flora imbalance in patients with AECOPD was constructed according to the results of factor logistic regression analysis, and the effectiveness of the prediction model was evaluated by receiver operating characteristic (ROC) curve analysis. Results: The ages of subjects in case group and control group were (76±9) and (74±8) years old, respectively, among which males accounted for 80.0% (36/45) and 69.9% (58/83), respectively. The multivariate logistic regression model analysis showed that serum albumin concentration, frequency of acute exacerbation ≥2 times/year, complicated with chronic cor pulmonale and diabetes mellitus were correlative factors of intestinal flora imbalance in patients with AECOPD. The OR (95%CI) were 0.98 (0.80-0.97), 3.70 (1.79-11.72), 2.62 (1.46-10.80) and 3.85 (1.17-8.58), respectively. The prediction model of intestinal flora imbalance was logit P=3.858-0.13×serum albumin consentration+1.52×acute exacerbation ≥2 times/year+1.379×chronic cor pulmonale+1.155×diabetes mellitus. The area under the ROC curve of this model was 0.847 and the sensitivity and specificity of the prediction model were 88.9% and 71.1%, respectively. Conclusions: Serum albumin, frequency of acute exacerbation ≥2 times/year, complicated with chronic cor pulmonale and diabetes mellitus are correlative factors of intestinal flora imbalance in patients with AECOPD. The predictive model shows high clinical value in predicting intestinal flora imbalance in patients with AECOPD.

Early-life gut dysbiosis linked to juvenile mortality in ostriches

BACKGROUND

Imbalances in the gut microbial community (dysbiosis) of vertebrates have been associated with several gastrointestinal and autoimmune diseases. However, it is unclear which taxa are associated with gut dysbiosis, and if particular gut regions or specific time periods during ontogeny are more susceptible. We also know very little of this process in non-model organisms, despite an increasing realization of the general importance of gut microbiota for health.

METHODS

Here, we examine the changes that occur in the microbiome during dysbiosis in different parts of the gastrointestinal tract in a long-lived bird with high juvenile mortality, the ostrich (Struthio camelus). We evaluated the 16S rRNA gene composition of the ileum, cecum, and colon of 68 individuals that died of suspected enterocolitis during the first 3 months of life (diseased individuals), and of 50 healthy individuals that were euthanized as age-matched controls. We combined these data with longitudinal environmental and fecal sampling to identify potential sources of pathogenic bacteria and to unravel at which stage of development dysbiosis-associated bacteria emerge.

RESULTS

Diseased individuals had drastically lower microbial alpha diversity and differed substantially in their microbial beta diversity from control individuals in all three regions of the gastrointestinal tract. The clear relationship between low diversity and disease was consistent across all ages in the ileum, but decreased with age in the cecum and colon. Several taxa were associated with mortality (Enterobacteriaceae, Peptostreptococcaceae, Porphyromonadaceae, Clostridium), while others were associated with health (Lachnospiraceae, Ruminococcaceae, Erysipelotrichaceae, Turicibacter, Roseburia). Environmental samples showed no evidence of dysbiosis-associated bacteria being present in either the food, water, or soil substrate. Instead, the repeated fecal sampling showed that pathobionts were already present shortly after hatching and proliferated in individuals with low microbial diversity, resulting in high mortality several weeks later.

CONCLUSIONS

Identifying the origins of pathobionts in neonates and the factors that subsequently influence the establishment of diverse gut microbiota may be key to understanding dysbiosis and host development. Video Abstract.

Clinical effects of probiotics in ordinary-type COVID-19 patients with diarrhea

BACKGROUND

Coronavirus disease-2019 (COVID-19) is a newly emerging infectious disease that has caused a global pandemic. A variety of drugs have been used to treat COVID-19, including probiotics. This study focused on the clinical significance of probiotics in COVID-19 patients with diarrhea.

AIM

To evaluate the role of probiotics in the treatment of COVID-19 patients with diarrhea.

METHODS

A total of 800 cases of ordinary-type COVID-19 were observed, the number of patients with diarrhea was counted, and the time to improvement of diarrhea was compared between two groups of patients with and without probiotics.

RESULTS

Of the 800 patients with ordinary-type COIVD-19, 90 had diarrhea, with an incidence of 11.25%. There was no significant difference in age, sex, or fecal pus cells between the two groups (P > 0.05). The duration of diarrhea in the 30-40, 45-5, 56-65, and 66-70 age groups in the study group and the control group was 4.27 ± 1.36 d, 5.54 ± 1.53 d, 7.82 ± 1.04 d, and 5.74 ± 1.48 d, and 5.24 ± 1.28 d, 6.58 ± 1.39 d, 8.65 ± 1.23 d, and 7.43 ± 0.91 d, respectively. In the same age group, the duration of disease in the study group was significantly shorter than that in the control group (P < 0.05). Probiotics had obvious effect in relieving patients' abdominal distension, nausea, vomiting, and other gastrointestinal symptoms.

CONCLUSION

After the destruction of intestinal mucosal barrier function, intestinal flora imbalance and diarrhea occurs. Probiotics can assist to maintain the integrity of intestinal barrier function, reduce the risk of intestinal infection, shorten the course of diarrhea, and reduce the risk of systemic infection aggravated by the translocation of intestinal flora, which is conducive to the relief of patients' gastrointestinal symptoms.

Airway Inflammation Biomarker for Precise Management of Neutrophil-Predominant COPD

Chronic obstructive pulmonary disease (COPD) course can be divided into stable stage and acute exacerbation. Deepen the understanding to the function and role of airway inflammatory cells in stable COPD is important for developing new therapies to restore airway dysfunction and preventing stable stage COPD progress to acute exacerbation COPD. Neutrophil is a feature of lower airways and lung inflammation in majority COPD patients at stable stage and increased neutrophils usually means COPD patients are in a more serious stage. Neutrophil-predominant COPD always accompanied by increased numbers of macrophages, lymphocytes, and dendritic cells. The composition proportion of different inflammatory cells are changed with disease severity. Recently, neutrophilic inflammation has been proved to be correlated with the disturbance of airway resident microbiota, which promote neutrophil influx and exacerbates inflammation. Consequently, understanding the details of increased neutrophils and dysbacteriosis in COPD is necessary for making precise management strategy against neutrophil-associated COPD.

Effects of ceftriaxone-induced intestinal dysbacteriosis on regulatory T cells validated by anaphylactic mice

Both probiotics and pathogens in the human gut express pathogen-associated molecular patterns (PAMPs) and die with the release of endotoxin and bacterial DNA, which can stimulate our immune system and cause immune reaction. However, it's interesting and fascinating to address why the normal intestinal flora will not generate immunological rejection like the pathogen does. By investigating the changes in cells and molecules relevant to immune tolerance in mice with ceftriaxone-induced dysbacteriosis, our study discovered that both the Evenness indexes and Shannon Wiener index of intestinal flora showed a decrease in dysbacteriosis mice. Moreover, the proportion of αβ⁺TCR⁺CD3⁺CD4^-CD8^- cells, CD3⁺γδTCR⁺ cells and CD4⁺CD25⁺FoxP3⁺ cells in the Peyer's patches (PPs), mesenteric lymph nodes (MLNs) and spleen (SP) and the level of TGF-β1, IL-2, IL-4 and IL-10 in the serum also changed. Intestinal dysbacteriosis in an asthma murine model resulted in enhancement of immunologic response to the allergen ovalbumin (OVA), which was an agent that aggravates asthma symptoms. In summary, it is integral to maintain a certain amount or variety of intestinal microflora for regulatory T cells to act in averting hypersensitivity.

[Bacterial vaginosis]

Bacterial vaginosis (BV) is the main cause of vaginal dysbacteriosis in the women during the reproductive age. It is an entity in which many studies have focused for years and which is still open for discussion topics. This is due to the diversity of microorganisms that cause it and therefore, its difficult treatment. Bacterial vaginosis is probably the result of vaginal colonization by complex bacterial communities, many of them non-cultivable and with interdependent metabolism where anaerobic populations most likely play an important role in its pathogenesis. The main symptoms are an increase of vaginal discharge and the unpleasant smell of it. It can lead to serious consequences for women, such as an increased risk of contracting sexually transmitted infections including human immunodeficiency virus and upper genital tract and pregnancy complications. Gram stain is the gold standard for microbiological diagnosis of BV, but can also be diagnosed using the Amsel clinical criteria. It should not be considered a sexually transmitted disease but it is highly related to sex. Recurrence is the main problem of medical treatment. Apart from BV, there are other dysbacteriosis less characterized like aerobic vaginitis of which further studies are coming slowly but are achieving more attention and consensus among specialists.

Haemorrhagic bowel syndrome in fattening pigs

Background

Haemorrhagic bowel syndrome (HBS) is a sporadically occurring disorder in fattening pigs, characterized by sudden death in combination with severe abdominal distension and intense red colouration of the intestine. Deep understanding of aetiology and pathogenesis of HBS are still lacking, although several risk factors are known.

Case presentation

In a continuously stocked fattening farm with 1500 pigs and liquid feeding based on whey, the mortality rate increased from 1.7% to 3.5% during summer time. Sporadic sudden death of growing pigs occurred along with severe abdominal distension as the main sign in these animals. All batches arriving at the farm received in-feed medication with Tiamulin hydrogen fumarate (2 mg/kg body weight/day; according to the license for use in Switzerland) due to detection of Brachyspira hyodysenteriae in the past, although a partial sanitation had been conducted thereafter. No changes of the origins, housing and the feeding procedure were reported. A herd examination was conducted revealing a hygiene problem in the feeding system. For further diagnostics a necropsy was performed, showing a pale carcass with a bloated abdomen due to a haemorrhagic infarction of part of the small intestine caused by a mesenteric torsion. Furthermore, a feed analysis was conducted, revealing a pH-value of 5 in the liquid feed, and a severe contamination with Enterobacteriaceae was detected. Based on these examinations, HBS was diagnosed. Subsequently, the farmer controlled the pH-value of the liquid feed with formic acid, improved the cleaning procedure of the liquid feeding system and stopped the in-feed medication. Following the implementation of these measures, key performance indicators improved significantly, but 4 months later the same clinical manifestation occurred again. This time huge variations in the pH-value of the liquid feed between different feeding times were recorded and were attributed to improper mixing of the formic acid in the whey tank. After implementation of a technical solution to control the pH-value, the health status improved again.

Conclusion

In the present case, it is likely that the cause of the clinical manifestation of HBS was a contamination of Enterobacteriaceae in the liquid feed facilitated by a hygiene problem in the feeding system, and a chronic dysbacteriosis of the intestinal tract due to the non-justified routine use of antimicrobials. Speculatively, the prophylactic antimicrobial treatment was unnecessary and might even have exacerbated the clinical problem.

Characteristics of fecal microbial communities in patients with non-anastomotic biliary strictures after liver transplantation

AIM

To explore the possible relationship between fecal microbial communities and non-anastomotic stricture (NAS) after liver transplantation (LT).

METHODS

A total of 30 subjects including 10 patients with NAS, 10 patients with no complications after LT, and 10 non-LT healthy individuals were enrolled. Fecal microbial communities were assessed by the 16S rRNA gene sequencing technology.

RESULTS

Different from the uncomplicated and healthy groups, unbalanced fecal bacterium ratio existed in patients with NAS after LT. The results showed that NAS patients were associated with a decrease of Firmicutes and Bacteroidetes and an increase of Proteobacteria at the phylum level, with the proportion-ratio imbalance between potential pathogenic families including Enterococcaceae, Streptococcaceae, Enterobacteriaceae, Pseudomonadaceae and dominant families including Bacteroidaceae.

CONCLUSION

The compositional shifts of the increase of potential pathogenic bacteria as well as the decrease of dominant bacteria might contribute to the incidence of NAS.

Application of heat-killed bifidobactera in treatment of enterogenic infection caused by dysbacteriosis in mice

AIM: To observe the curative effect of heat-killed bifi-dobactera on dysbacteriosis-induced enterogenic infe-ction in mice.

METHODS: A total of 40 mice were randomly divided into living bacterium group, heat-killed bacterium group, spontaneous recovery group, and normal control group (10 for each). After treatment with the corresponding methods, the serum indexes such as total protein (TP),

albumin (ALB), globulin (GLO), γ-Glutamyl transpepti-dase (GTT), blood urea nitrogen (BUN), lactic dehydro-genase (LDH), creatinine (CER), and tagged bacterium in the homogenate of the mice were detected.

RESULTS: The levels of TP and GLO in the heat-killed bacterium group were significantly increased (71.46±2.01 g/L vs 64.61±2.16 g/L; 35.63±1.57 g/L vs 330.73±1.03 g/L, P < 0.05), while the levels of GGT and BUN were significantly decreased (2.47±0.28 IU/L vs 7.13±1.19 IU/L; 8.32±0.71 mmol/L vs 12.05±0.64 mmol/L, P < 0.01) as compared with those in the spontaneous recovery group. The level of LDH in the heat-killed bac-terium group was significantly decreased as compared with that in the living bacterium group and the normal control group (2 561.23±61.40 vs 2 951.70±155.61, 2 895.27±104.38, P < 0.05). The numbers of the entero-bactera was markedly deceased in the renal, hepatic and pulmonary tissues of the heat-killed bacterium group in comparison with those in the spontaneous recovery group(1.19±0.37, 1.56±0.20, 1.62±0.15 vs 2.17±0.97, 2.42±0.14, 2.20±0.09, P < 0.05 or P < 0.01).

CONCLUSION: The heat-killed bifidobactera are effec-tive in the treatment of enterogenic infection caused by dysbacteriosis in mice, and the effect is the same as that of the living bifidobactera.