New Assay Can Distinguish Between Viral and Bacterial Infections in Kids

MedicalResearch.com Interview with:
Prof. Alain Gervaix
Head of the Emergency Division
Department of Children and Adolescents
University Hospitals of Geneva
Switzerland

MedicalResearch.com: What is the background for this study?

Response: Many are familiar with the following ‘seemingly’ simple clinical dilemma that occurs on a daily basis across the world. A patient visits the doctor with a fever. Commonly, assigning a diagnosis comes down to deciding whether the infection is bacterial or viral. Accordingly, the doctor decides if to treat or not to treat with antibiotics. The problem is that bacterial and viral infections often present with very similar symptoms, causing uncertainty that leads to antibiotics being used, in many instances, when they are not needed. This antibiotic misuse contributes to the rise of antimicrobial resistance, one of the biggest health threats of the 21st century.

Host biomarkers hold great promise as routine diagnostic tools that can assist doctors in making correct antibiotic treatment decisions, as they overcome key limitations of currently applied pathogen-based tests. Recently, a novel host-assay (ImmunoXpert™) for differentiating bacterial from viral infections was developed and validated to yield high sensitivity and specificity. The three-protein host-assay comprises tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), Interferon gamma-induced protein-10 (IP-10) and C-reactive protein (CRP).

Continue reading

Pubic Hair Grooming–Related Injuries Surprisingly Common

MedicalResearch.com Interview with:

Thomas W. Gaither, BS
Department of Urology
University of California, San Francisco
General Hospital, San Francisco

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We study genitourinary trauma and reconstruction. This study was motivated from a previous study showing that Emergency Room visits due to grooming were increasing over the past nine year. We sought to better characterize who was at most risk for grooming injuries. We found that grooming is extremely common in both men and women and minor injuries occur in about 25% of groomers. Surprisingly, a little over one percent sought medical care due to their injury. Participants at most risk our those who remove all of their pubic hair frequently ( as opposed to those who just trim). We did not find any instruments that were necessarily putting participants at risk for injury.

Continue reading

Outcomes of Hospital-Onset Multidrug Resistant Pseudomonas aeruginosa

MedicalResearch.com Interview with:

Sanjay Merchant, PhD Executive Director Center for Observational and Real-world Evidence (CORE) Merck

Dr. Merchant

Sanjay Merchant, PhD
Executive Director
Center for Observational and Real-world Evidence (CORE)
Merck

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In February, the World Health Organization (WHO) published its first ever list of antibiotic-resistant “priority pathogens” that pose the greatest threat to human health. The list highlights in particular the threat of gram-negative bacteria that are resistant to multiple antibiotics, referred to as multidrug-resistant (MDR) bacteria, which have built-in abilities to find new ways to resist treatment. MDR Pseudomonas aeruginosa (MDR PsA) is listed as one of the pathogens in the Critical category in terms of need for new therapies. It poses an urgent threat.

We set out to better understand the clinical and economic burden associated with hospital-onset MDR PsA so that appropriate treatment strategies can be employed to mitigate resistance. Our findings were presented at ASM Microbe 2017.

Mortality rates for hospital-onset MDR PsA patients (20.1%) were almost twice as high compared to patients who did not have MDR PsA (11.5%). The MDR PsA patient group had a significantly higher odds ratio for mortality even after controlling for various factors that may impact mortality.

Hospital-onset MDR PsA patients spent six additional days in the hospital when compared to patients who did not have MDR PsA infectionsThese findings highlight the public health threat of MDR PsA among hospitalized patients and the need for timely and effective therapy.

Continue reading

Outbreak of Severe Fungal Eye Infections Linked To IV Opioid Epidemic

MedicalResearch.com Interview with:
Aubrey Tirpack, PGY3

New England Eye Center
Tufts Medical Center 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Intravenous drug abuse is a known risk factor for the development of endogenous fungal endophthalmitis (EFE), a severe intraocular infection cause by the seeding of mycotic organisms to the eye.

Our institution noted a marked increase in cases of EFE beginning in May 2014, which correlates to increasing rates of opioid abuse throughout the New England region. Ten patients were found to have intravenous drug abuse related EFE over the two year time period studied. The most common presenting symptoms were floaters, decreased vision, and pain. All patients were treated with systemic antifungals and nine patients underwent intravitreal antifungal injection. All patients were ambulatory at presentation and the majority were without systemic signs of infection.

Continue reading

Aspirin Promotes Growth of Staph aureus in Nose

MedicalResearch.com Interview with:
Dr. Fernanda Buzzola

IMPaM, UBA-CONICET

MedicalResearch.com: What is the background for this study?

Response: Staphylococcus aureus represents a serious problem to public health due to methicillin-resistance and the bacterial persistence over a long period of time in the host. Approximately the 20% of the human population is at risk to acquire an endogenous infection by S. aureus as a consequence of its asymptomatic nasal colonization.

Aspirin, the main source of salicylic acid in the human host, is currently taken by millions of human beings worldwide without medical prescription and widely indicated for defined purposes, including prevention of coronary thrombosis. Salicylic acid is a plant hormone known too for its use as a key ingredient in anti-acne preparations and medications for skin conditions. We also consume mild doses of salicylic acid when we eat fruits and vegetables. Iron is an important trace element for the human body and plays an essential role in blood formation. The metabolism of many bacteria, including S. aureus, also depends on the availability of iron molecules. Salicylic acid forms complexes with iron ions in the blood and so deprives not only us but also the staphylococcal bacteria of this element. S. aureus modifies its metabolism if the iron content is insufficient. The microorganism reacts to the changed – from its perspective, negative – conditions through the intensified formation of a biofilm, a sort of layer of slime formed by the aggregation of individual bacteria. The enhanced biofilm production allows the bacteria to survive for an even longer period under unfavourable living conditions.

Continue reading

Inflammasomes Might Be Involved in Making You Sleep More When Sick or Sleep Deprived

MedicalResearch.com Interview with:
Mark Robert Zielinski, MD
Department of Psychiatry
Harvard Medical School and Veterans Affairs Boston Healthcare System
West Roxbury, MA 02132

MedicalResearch.com: What is the background for this study?

Response: Anecdotally, people have known that the immune system and sleep are related. In the last several decades this relationship has been systematically investigated. This work led to important findings that several molecules that enhance inflammation including interleukin-1 beta regulate sleep. Interleukin-1 beta is known to increase sleep and sleep intensity after sleep loss and in response to pathogens. However, it was unknown how these effects are connected. Interestingly, the NLRP3 inflammasome is a protein complex that senses changes in the local environment and subsequently activates pro-inflammatory molecules including interleukin-1 beta. Therefore, we wanted to see if the NLRP3 inflammasome is involved in sleep regulation. 

Continue reading

Sepsis Linked To High Rate of Hospital Readmissions

MedicalResearch.com Interview with:

Sachin Yende, M.D., M.S., Associate professor University of Pittsburgh School of Medicine’s departments of Critical Care Medicine and Clinical and Translational and Vice president of Critical Care at the VA Pittsburgh.

Dr. Yende

Sachin Yende, M.D., M.S., Associate professor
University of Pittsburgh School of Medicine’s departments of
Critical Care Medicine and Clinical and Translational and
Vice president of Critical Care at the VA Pittsburgh.

Florian B. Mayr, M.D., M.P.H. Faculty member in University of Pittsburgh Department of Critical Care Medicine and the Center for Health Equity Research and Promotion

Dr. Mayr

Florian B. Mayr, M.D., M.P.H.
Faculty member in University of Pittsburgh
Department of Critical Care Medicine and the
Center for Health Equity Research and Promotion

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Centers for Medicare and Medicaid Services and the Veteran Health Administration currently track readmission rates for pneumonia, acute heart attacks, heart failure and chronic obstructive lung disease for quality purposes and pay for performance. In our study, we were able to demonstrate that unplanned readmissions after sepsis (defined as life threatening organ failure due to the body’s response to an overwhelming infection) are more common than readmission for these other conditions stated above and associated with significant excess costs.

Continue reading

New Guidelines for Prevention, Detection and Management of Surgical Site Infections

MedicalResearch.com Interview with:

Kristen A. Ban, MD Loyola University American College Surgery Clinical Scholar

Dr. Kristen Ban

Kristen A. Ban, MD
Loyola University
American College Surgery Clinical Scholar

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The American College of Surgeons previously released surgical site infections (SSI) guidelines, and we wanted to update them with the most recent literature to give surgeons a concise, comprehensive document of recommended practices to reduce SSI. We were very fortunate to partner with our colleagues and content experts at the Surgical Infection Society for this update. There are a few areas where we had additional literature to support new or different guidelines.

Blood glucose control is now recommended for all patients regardless of diabetic status. SSI reduction bundles have become very popular, and we emphasize that compliance must be high with all parts of these bundles to obtain the maximum benefit.

Finally, we recommend cessation of prophylactic antibiotics at incision closure with some exceptions (mainly in regard to implanted material/hardware).

Continue reading

Genetic Cause of Subtle Immune Deficiency Identified

MedicalResearch.com Interview with:

Prof. Adrian Liston (VIB-KU Leuven)

Prof. Adrian Liston

Prof. Adrian Liston
(VIB-KU Leuven)

MedicalResearch.com: What is the background for this study?

Response: With vaccinations, sanitation, antibiotics and general improvements in living standards, infectious disease is no longer a major killer of children. Death or hospitalisation of children from infection is rare in countries with modern health care systems. Those rare events were once thought to be chance outcomes on the roulette of bad luck, but increasingly we are recognising that genetic mutations underlie severe pediatric infections.

In our study we are seeking to identify the mutations and immunological changes that occur in children, causing them to have severe reactions to infectious disease.

Continue reading

Whole Genome Sequencing Speeds Analysis of Shigella Outbreak in California

Dr-Varvara-Kozyreva.jpg

Dr. Varvara Kozyreva

MedicalResearch.com Interview with:
Varvara Kozyreva, PhD
Research Scientist Supervisor I
Genotyping Unit
Foodborne & Waterborne Diseases Section (FWDS)
Microbial Diseases Laboratory Program (MDL)
Division of Communicable Disease Control (DCDC)
Center for Infectious Diseases (CID)
California Department of Public Health (CDPH)
Richmond, CA 94804
California Department of Pubic Health

MedicalResearch.com: What is the background for this study?

CDPH Response: Two large shigellosis outbreaks occurred in San Diego and San Joaquin Counties of California in 2014-2015.

Shigellosis is caused by bacteria of Shigella genus and manifests itself as abdominal pain, diarrhea and other gastrointestinal symptoms. Each year, shigellosis causes around 500,000 infections, 6,000 hospitalizations and 70 deaths in the U.S. The shigellosis outbreaks in California were caused by a rare strain of Shiga-toxin producing Shigella sonnei bacteria. Shigella sonnei normally causes a relatively mild disease and is not known to produce Shiga-toxin. The emergence of this Shiga-toxin producing strain in California was unusual and concerning that shigellosis could become more severe in the future.

The California Department of Public Health Microbial Diseases Laboratory in collaboration with UC Davis tried to understand the origin of the Shigella sonnei strains circulating in California, how the bacteria acquired the Shiga-toxin gene and antibiotic resistance, as well as the relationships of California strains to other lineages around the world. This was the first major whole-genome study of Shigella sonnei bacteria in North America. In order to accomplish this we have sequenced and analyzed genomes of the recent outbreak strains as well as historical Shigella sonnei isolates from our archive going back as far as 1980. We also compared the genomes of California bacteria to other Shigella sonnei genomes from around the world. Among recent isolates we found two distinct outbreak populations: the Shiga-toxin producing strain primarily localized to San Diego and the San Joaquin Valley area, and the strain from the San Francisco Bay Area remarkable for its resistance to broad range of antibiotics.

MedicalResearch.com:  What are the main findings?

CDPH Response: Comprehensive analysis of genomes revealed a common origin of the toxin-producing strains of Shigella sonnei and their connection to earlier strains circulating in California. We learned that these microorganisms were not introduced to California but have originated locally.

It appeared that the toxin gene was introduced to Shigella sonnei with the Shiga-toxin encoding bacteriophage, the virus of bacteria, which interjected itself into Shigella sonnei genome. Most likely this happened via genetic exchange with Escherichia coli and other Shigella species. Furthermore, the bacteriophage in Shigella sonnei from California was very similar to a bacteriophage of Escherichia coli strain, which has caused a large outbreak in Europe in 2011.

 MedicalResearch.com: What should readers take away from this report?

CDPH Response: Whole Genome Sequencing (WGS) of Shigella sonnei allowed in-depth analysis of outbreak strains in California. The knowledge helped strengthen earlier epidemiological analysis of the outbreaks and understand the emerging trends in Shigella sonnei populations circulating in California.

The recent shigellosis outbreaks in California are characterized by two trends: 1) an acquisition of a new virulence factor (Shiga-toxin) by a local bacteria and 2) introduction of the antibiotic-resistant strain from abroad. It demonstrates two possible ways for the pathogens of high public health concern to emerge. This highlights the importance of monitoring the emergence and dissemination of the virulence and antibiotic resistance genetic determinants as well as shifts in local pathogen populations and flow of the bacterial strains between the countries and continents.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

CDPH Response:  Whole Genome Sequencing (WGS) of Shigella sonnei allowed in-depth analysis of outbreak strains in California. The knowledge helped strengthen earlier epidemiological analysis of the outbreaks and understand the emerging trends in Shigella sonnei populations circulating in California.

The recent shigellosis outbreaks in California are characterized by two trends: 1) an acquisition of a new virulence factor (Shiga-toxin) by a local bacteria and 2) introduction of the antibiotic-resistant strain from abroad. It demonstrates two possible ways for the pathogens of high public health concern to emerge. This highlights the importance of monitoring the emergence and dissemination of the virulence and antibiotic resistance genetic determinants as well as shifts in local pathogen populations and flow of the bacterial strains between the countries and continents.

MedicalResearch.com: Is there anything else you would like to add:
CDPH Response:
1. Additional genome analysis of Shigella sonnei is needed to find out if other bacterial traits influence their pathogenic properties.
2. Researchers should foster communications with the healthcare professionals to increase awareness about the potential for serious infectious due to Shigella sonnei.
3. More widespread use of Whole Genome Sequencing (WGS) in public health laboratories would help outbreak investigations, characterization of pathogenic properties of the bacteria and detection of antibiotic resistance genes. This would create a more complete picture of the bacterial world surrounding us, and in turn, help to protect public health

Citation:

Recent Outbreaks of Shigellosis in California Caused by Two Distinct Populations of Shigella sonnei with either Increased Virulence or Fluoroquinolone Resistance
Varvara K. Kozyreva, Guillaume Jospin, Alexander L. Greninger, James P. Watt, Jonathan A. Eisen, Vishnu Chaturvedi
Melanie Blokesch, Editor
DOI: 10.1128/mSphere.00344-16

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com