Air Pollution Linked To Increased Respiratory Infections in Kids

MedicalResearch.com Interview with:

Benjamin D. Horne, PhD Director of Cardiovascular and Genetic Epidemiology Intermountain Heart Institute Intermountain Medical Center Salt Lake City, Utah 

Dr. Horne

Benjamin D. Horne, PhD
Director of Cardiovascular and Genetic Epidemiology
Intermountain Heart Institute
Intermountain Medical Center
Salt Lake City, Utah 

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

Response: Evidence suggests that short-term elevations (even for just a few days) of fine particulate matter air pollution (PM2.5, which is particulate matter less than 2.5 um or about one-thirtieth the diameter of a human hair) is associated with various poor health outcomes among adults, including myocardial infarction, heart failure exacerbation, and worsening of chronic obstructive pulmonary disease symptoms. Studies of long-term exposure to moderately elevated levels of PM2.5 indicate that chronic daily air pollution exposure may contribute to death due to pneumonia and influenza.

Research regarding the association of short-term elevations in PM2.5 has provided some limited evidence of a possible association between short-term PM2.5 increases and infection with respiratory syncytial virus (RSV) or bronchiolitis in children, but scientifically these reports have been weak and unreliable, probably because they have only looked at a period of a few days to a week after short-term PM2.5 elevations. An evaluation of a very large population in a geographic location that provides a wide variation in PM2.5 levels from lowest to highest levels and that examines longer periods of time after the PM2.5 elevations is needed to determine whether a PM2.5 association with lower respiratory infection exists.

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Post Exposure Doxycycline in PReP Users May Reduce Risk of Syphilis and Chlamydiae

MedicalResearch.com Interview with:

Professor Jean-Michel Molina MD Head of Department of Infectious Diseases, Hôpital Saint-Louis Paris France 

Prof. Molina

Professor Jean-Michel Molina MD
Head of Department of Infectious Diseases, Hôpital Saint-Louis
Paris France 

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

Response: There is a high rate of sexually transmitted infections (STIs) among Pre-exposure prophylaxis users and we wished to assess whether post-exposure prophylaxis (PEP) with doxycycline could reduce the incidence of sexually transmitted infections in this population.

We have found indeed a high rate of STIs most of them (71%) being asymptomatic and warranting therefore systematic testing. Also PEP reduced the incidence of syphilis and chlamydiae infection by 70%, not for gonorrhea due to the high rate of detection in throat swabs without any impact of PEP.

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Unusual Microorganisms and Antimicrobial Resistances in a Group of Syrian Migrants

MedicalResearch.com Interview with:
Prof. Ciccozzi Massimo Clinical Pathology and Microbiology Laboratory University Hospital Campus Bio-Medico of Rome, Italy; Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, Rome, Italy.
Prof. Ciccozzi Massimo
Clinical Pathology and Microbiology Laboratory
University Hospital Campus Bio-Medico of Rome, Italy; Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, Rome, Italy.  

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

Prof. Massimo: In the spring 2011 civil war becoming in Syria providing condition for diseases outbreaks In the Syrian Arab Republic before the crisis, the access to health services increased since the 1980s, with better equity between the rural populations and the middle class. the capacity of the health system, so as the quality of care, were not sufficient to improve the decrease the inequity. As normally happens the onset of civil war can led to the complete deterioration of the health infrastructure through the destruction of facilities.

We describe a group of 48 Syrian migrants arrived in the second week of October 2015 in the asylum seekers centre (ASC) in Rome (Italy) where they receive social, legal and health assistance. An internal healthcare facility (IHF) is operative where specialized personnel (e.g. infectivologist, nurses and psychologist) was prompt to receive the Syrian people making them all the tests for microbial agents presence (bacterial and virus agents).

This group is of importance not only because refugee from the tremendous civil war but also because stopped in this Centre for only twenty days. Our aim was the knowledge of their health status, this is important for people that have to travel in north Europe facing many kilometers again.

Rectal, nasal and pharyngeal swabs were collected from all refugees, whereas serum samples were available from 30/48 subjects. Eighteen refugees refused phlebotomy for blood collection for religious reasons.

All refugees resulted negative for HBV, HBC and HIV infections. Bacterial microorganism and fungi isolated from surveillance swabs were found with Gram-negative bacteria representing by a larger number of species than Gram-positive and fungi microorganisms.

These reports enforce the hypothesis that circulation of new emerging pathogens found, can be source of infection in susceptible patients or nosocomial settings.

Interestingly, in some subjects, polymicrobial colonization was found and in some cases until to six different microorganisms, potentially pathogens, were isolated in the same individual. The microbiological surveillance performed in this group of Syrian migrants upon their arrival in Italy evidenced the carriage of unusual microorganism, potentially pathogens and carriers of antimicrobial resistance in some cases, that could be introduced in the country giving asylum. These migrants moving from a country to another could promote the diffusion of these microorganisms within different settings during their traveling around the world.

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Genes Identified That May Predispose Some Individuals to Getting Sick

Dr. Ephraim Tsalik assesses Charles Watts for a respiratory infection in the ER at the Durham VA Medical Center on Wednesday, January 13, 2016.

Dr. Ephraim Tsalik
Duke Health

MedicalResearch.com Interview with:
Ephraim L. Tsalik, MD MHS PhD

Assistant Professor of Medicine
Division of Infectious Diseases
Center for Applied Genomics & Precision Medicine
Duke University Medical Center
Emergency Department Service Line
Durham VA Medical Center 

Medical Research: What is the background for this study? What are the main findings?

Dr. Tsalik: This study was motivated by the convergence of two research interests.  The first was spearheaded by Dr. Sack, leading our collaboration at Johns Hopkins.  Dr. Sack and his colleagues have a long history and expertise in studying enteric infections such as E. coli.  The second is our group here at Duke’s Center for Applied Genomics & Precision Medicine as well as the Durham VA Medical Center.  Specifically, we have an interest in studying the host response to infectious disease.  One of the ways we’ve done that historically is through challenge studies where healthy volunteers are exposed to a pathogen in a controlled setting.  Despite everyone getting the same exposure, not everyone gets sick.  That observation gives us a unique opportunity to study the host biology of symptomatic individuals, asymptomatic individuals, and what distinguishes the two from each other.  That is precisely what we did here.

Volunteers ingested Enterotoxigenic E. coli (ETEC), which is a common cause of traveler’s diarrhea.  Some subjects became ill with diarrhea while others remained well.  In this study, we focused on gene expression patterns, which is a snapshot of how genes in the body are being used in response to this infection.  Some genes are more active, some are less.  The pattern of those changes that occur in response to infection is what we call a “signature”.

This approach allowed us to generate some key findings.  First of all, we were able to define the genes involved in the body’s response to this type of E. coli infection.  Second, we discovered genes that were differentially expressed at baseline that could distinguish people who would go on to become ill from those that would remain healthy.  Although this study was not designed to identify the mechanism for that resilience to infection, it does focus our attention on where to look.  We suspect the genes we identified are likely to play a role in infectious disease resilience and susceptibility based on their known immune function roles.  We also have data, which wasn’t published in this study, that implicates some of these genes in the resilience to other infections such as influenza.

The last major finding was something called Drug Repositioning Analysis.  This is a tool that allowed us to identify drugs and drug classes that could be used to mitigate infections caused by ETEC.  That analysis highlighted some compounds already known to be effective such as Zinc.  But it also identified several other drug classes that have not previously been investigated and could be important tools to combat such infections especially as antibiotic resistance looms.

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Complex Bacterial Biofilms Can Rapidly Obstruct Catheters

Dr Sandra A. Wilks PhD Senior Research Fellow IfLS Knowledge Mobilisation Fellow in Healthcare Technologies Faculty of Natural and Environmental Science & Faculty of Health Sciences Centre for Biological Sciences, University of Southampton, Southampton, UK

Dr. Sandra Wilks

MedicalResearch.com Interview with:
Dr Sandra A. Wilks PhD

Senior Research Fellow
IfLS Knowledge Mobilisation Fellow in Healthcare Technologies
Faculty of Natural and Environmental Science & Faculty of Health Sciences
Centre for Biological Sciences,
University of Southampton,
Southampton, UK 

Medical Research: What is the background for this study? What are the main findings?
Dr. Wilks: The use of indwelling Foley urinary catheters for extended periods of time results in high risks of urinary tract infections (UTI) and catheter blockages. Blockages are often caused by the presence of Proteus mirabilis, a urease-producing bacterium which results in an increase of the urine pH and the development of crystalline biofilms. Biofilms develop when bacteria attach to a surface, forming a community structure, held together by extracellular polymeric substances (EPS). Once in a biofilm, bacteria exhibit high resistance to the action of antibiotics and are protected by other stress factors. The crystalline biofilms resulting from the presence of Proteus are highly complex environments and cause complete blockage of the catheter within days. Such blockages cause pain and trauma for patients, and result in high demands on healthcare resources.

In this study, we have used an advanced microscopy technique (episcopic differential interference contrast, EDIC microscopy developed by Best Scientific) to track the development of these crystalline encrustations on two commonly used catheter materials; silicone and hydrogel latex. We have identified four distinct stages to crystalline biofilm formation;

  • (1) an initial foundation layer (conditioning film) formed by individual ‘colonising’ P. mirabilis cells, which occurred in less than 1 hour;
  • (2) this was rapidly followed by a sheet-like microcrystalline material (after 24 hours) that covers this conditioning film;
  • (3) after 4 days exposure, large amounts of crystalline material was seen to extend out from the surface with;
  • (4) defined struvite crystals embedded within the structure and P. mirabilis visible throughout. This pattern was the same on both materials.

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Medical Societies Discuss Dramatic Increase In Prices For Older Medications For Infectious Diseases

Carlos del Rio, MD Chair, HIV Medicine Association Department of Medicine Hubert Professor and Chair of the Department of Global Health at the Rollins School of Public Health Professor of Medicine in the Division of Infectious Diseases Emory University School of Medicine

Dr. Carlos del Rio

MedicalResearch.com Interview Questions
Carlos del Rio, MD

Chair, HIV Medicine Association
Department of Medicine
Hubert Professor and Chair of the Department of Global Health at the Rollins School of Public Health Professor of Medicine in the Division of Infectious Diseases
Emory University School of Medicine

MedicalResearch.com Editor’s note:  Dr. Carlos del Rio discusses the statement from the Infectious Diseases Society of America (IDSA), HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society (PIDS) regarding the news that Express Scripts is taking steps to improve access to obtaining pyrimethamine for patients with toxoplasmosis.

Medical Research: What is the background for this Express Scripts announcement?

Dr. del Rio: The HIV Medicine Association (HIVMA) and the Infectious Diseases Society of America initially heard from our members (ID and HIV clinicians) in August about the 5000% price increase in Daraprim® (from $13.50 to $750 per tablet) following Turing Pharmaceuticals’ acquisition of the rights to distribute Daraprim® from Impax Laboratories, Inc.[1] ID and HIV clinicians told us they had been having difficulties obtaining pyrimethamine since earlier in the summer when Impax implemented a controlled distribution system making the drug available only through Walgreen’s Specialty Pharmacy.

Despite HIVMA, IDSA and others urging Turing to reverse the price hike, no action was taken and providers continued to report the scarcity of the drug due to the cost and issues with the distribution system. [2] Due to these ongoing challenges, HIVMA and IDSA thought it was important to provide information to our members and other providers regarding the new lower cost option so they could evaluate this option in consultation with their patients. Initially Turing agreed to reconsider the price increase and to lower it; however, on Nov. 24th Turing announced that they would not lower the list price of Daraprim but instead planned to offer discounts of up to 50% to some hospitals. [3] The announcement reinforced the urgent need for affordable treatment options and failed to address that a majority of the eight to twelve month treatment course occurs on an outpatient basis.

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Clinical Trial of Ultraviolet Blood Irradiation For Resistant Infectious Disease

MedicalResearch.com Interview with:
Dr. J. Todd Kuenstner MD
Clinical Laboratories
Charleston Area Medical Center, Charleston, Virginia
West Virginia School of Medicine, Charleston, West Virginia

Medical Research: What is the background for this study? What are the main findings?

Dr. Kuenstner: Prior to the advent of recent antiviral therapies with sustained virologic response rates (SVR) of 94%, ultraviolet blood irradiation (UVBI) was proposed as a method to improve the outcome of treatment with interferon and ribavirin which had an virologic response rates of 50%. This therapy was invented by Dr. Emmett Knott in 1928 and used to treat viral and bacterial infectious disease in the 1930s through the 1950s and an estimated 60,000 treatments were conducted in the United States by 1948. The AVIcure hemo-irradiator is a modification of the Knott Hemo-irradiator and meets contemporary safety standards.

This study describes the FDA phase II controlled clinical trial that was conducted before the advent of sofosbuvir and ledipasvir with the AVIcure hemo-irradiator using ultraviolet blood irradiation (UVBI) for the treatment of 10 patients infected with the hepatitis C virus (HCV). This study is significant because of the potential of this device for treating other infectious diseases with few treatment options. This therapy was safe and beneficial in the 10 patients that were studied. At the nadir of the viral load, the mean reduction of hepatitis C viral load was 45% (p=0.0048) or 0.35 log viral load (p=0.015). Three of the patients in the group achieved a greater than 0.5 log viral load reduction at some point in the trial. The phase I controlled clinical trial of UVBI in patients with HCV infection on 10 patients (submitted for publication) showed that 7 of 10 patients had a greater than 0.5 log reduction in viral load and a mean viral load reduction of 56% and a mean log viral load reduction of 0.60 (p=0.039).

In the phase II clinical trial, 8 of 10 patients also showed a concurrent reduction in their serum transaminase levels, mean reduction in AST of 15% (p=0.0069) and mean reduction in ALT of 19% (p=0.0031). The above phase II trial results were achieved in spite of two therapeutic “holidays” of 7 weeks duration during the trial and during these therapeutic “holidays” the patients did not receive any treatments.

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New Borrelia Tick-Borne Disease Confirmed in Series of 51 Patients

MedicalResearch.com Interview with:
Dr. Philip Molloy, MD

Imugen Medical Director

Medical Research: What is the background for this study? What are the main findings?

Response: There is a newly described tick-borne infection in the US, first case published in NEJM Man 2013 (from Imugen researchers).  We then developed and validated both PCR and serologic blood tests.  Physicians  started ordering these tests, and many additional cases were uncovered, 51 of which are described in this paper.

Medical Research: What should clinicians and patients take away from your report?

Response: Be aware of yet another pathogen transmitted to humans from ticks, and don’t assume it’s Lyme.  Tests are available to help sort it out.  Imugen has been offering these tests commercially since 2013.

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The Infectious Diseases Society of America Comments on the 21st Century Cures Bill Including Antibiotic Development

Ms. Amanda Jezek Director of Government Relations Infectious Diseases Society Of AmericaMedicalResearch.com Interview with:
Ms. Amanda Jezek
Director of Government Relations
Infectious Diseases Society Of America

Editor’s Note: The Infectious Diseases Society of America Comments on the 21st Century Cures bill,  a bill desigend  “to help modernize and personalize health care, encourage greater innovation, support research” including important issues surrounding antimicrobial resistance and antibiotic development.

Ms. Amanda Jezek has been Director of Government Relations at Infectious Diseases Society of America (ISDA) since July 2011. Ms. Jezek is “is responsible for policy development and advocacy on IDSA priority issues including antimicrobial resistance, antimicrobial and diagnositcs development, preparedness and federal funding’.

MedicalResearch: What are the main objectives of the 21st Century Cures bill? 

Ms. Jezek: This question goes far beyond IDSA’s work on the bill, so I would not be comfortable being quoted on this. The Energy and Commerce Committee’s website has more information.  Very generally, the bill seeks to advance the research and development of new cures for patients with a wide variety of diseases and conditions.

MedicalResearch: What health care needs and problems does it address? 

Ms. Jezek: I can only answer from IDSA’s perspective, keeping in mind that many sections of this bill go well beyond the field of ID.  IDSA is very pleased that the bill prioritizes the research and development of some of the most urgently needed new antibiotics to treat serious or life threatening infections with few or no current treatment options.  IDSA is also very pleased that the bill takes important steps to increase funding for NIH, which is urgently needed to ensure adequate investment in biomedical research and support for young people entering or thinking of pursuing research careers.

MedicalResearch: Does the proposed legislation address hospital-based infections, antibiotic resistance, pandemic detection and management, vaccine issues such as mandatory vaccination of school age children, or antibiotics in food sources? 

Ms. Jezek: The bill’s focus is really biomedical research and development and as these issues fall more into the public health sphere, they are not the specific focus of the bill.  However, the provisions aimed at antibiotic R&D also include language aimed at making sure the antibiotics are used appropriately and that their use is monitored, both of which are critical for addressing antibiotic resistance.

MedicalResearch: Does the legislation enable simplified access to clinical medical research trials or expedited review of new pharmaceuticals and medications

Ms. Jezek: I’m only answering from IDSA’s perspective, understanding that we are not involved in every provision in the bill and other provisions may address these issues.  One of the antibiotics provisions, which IDSA has been championing, would allow antibiotics to treat serious or life threatening infections with few or no current treatment options to be studied in smaller, more rapid clinical trials and approved only for the limited population of patients who need them.  This approach is needed because some of the most deadly, difficult to treat infections currently occur in small numbers of critically ill patients who are difficult to enroll in clinical trials, making it very difficult and sometimes impossible to populate traditional, large clinical trials.

MedicalResearch: How will patients benefit from bill?

Ms. Jezek: The bill will help enable the development of new safe and effective antibiotics to treat infections that could otherwise be lethal.  Such antibiotics could literally mean the difference between life or death for patients with these infections.

MedicalResearch: What should health care providers be aware of if the legislation passes?

Ms. Jezek: I think all of the components that IDSA is pursuing—specifically regarding antibiotic development and NIH funding—would be of great interest to providers given their potential impact on new treatment options for patients.

MedicalResearch: Is funding for implementation of the bill included in the legislation?

Ms. Jezek: As I understand it, the Committee is still working on some of this, so I can only provide a partial answer.  For the NIH funding-the bill would authorize new money for NIH for the next 3 years, but the Appropriations Committee in Congress would still need to actually appropriate that money.  However, the NIH Innovation Fund in the bill would provide mandatory funding for NIH for the next 5 years, and this would not have to be approved by the Appropriations Committee.  Some parts of the bill (such as the limited population antibiotic development provision discussed above) are not expected to require additional funding, as it is merely addressing a regulatory barrier.  Lastly, some funding items are still being worked out.

Citation:

(See a two-page Fact Sheet of H.R. 6 HERE. )

 

Ms. Amanda Jezek, Director of Government Relations, & Infectious Diseases Society Of America (2015). The Infectious Diseases Society of America Comments on the 21st Century Cures Bill Including Antibiotic Development 

MRSA Persistence Linked With Household Members and Pets

MedicalResearch.com Interview with:
Valerie Cluzet, MD
Hospital of the University of Pennsylvania
Division of Infectious Diseases
Philadelphia, PA 19104

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

Dr. Cluzet: MRSA is a major cause of skin and soft tissue infection (SSTI) in the community and we know that colonization is an important risk factor for subsequent infection. Past studies have calculated duration of colonization based on colonization at hospital admission or focused on populations not representative of the typical community-dwelling patient. We wanted to identify the factors associated with duration of colonization in a typical patient that clinicians would see (i.e. adults and children presenting to ambulatory setting with a MRSA SSTI), so that the findings would be generalizable and relevant to their practice. In addition, there has been an increasing focus on the role of the household in transmission of MRSA, so wanted to specifically examine that in a longitudinal, systematic way.

There are a few major points that emerged from our study.

1) The first is that the duration of colonization after treatment for a methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) is relatively short, but there is a significant subset of patients (approximately 20%) who will have persistent colonization.

2) We also found that treatment of the MRSA SSTI with clindamycin was associated with shorter duration of colonization, an association we did not see with other MRSA-active agents.

3) Finally, this study highlights the potential role of MRSA colonization among household members as a contributing factor in duration of colonization in patients.
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