Pneumococcal serotypes in children with acute and chronic inflammatory diseases of the lungs and in healthy children

The serotyping of 350 Streptococcus pneumoniae strains isolated from patients with acute and chronic diseases of the respiratory organs and from healthy children was carried out with the use of the agglutination test. 145 pleural fluid samples were tested for the presence of the pneumococcal antigen and its K-type. The prevailing pneumococcal serotypes were 6, 1, 19, 12 and 9 in acute pneumonia and 6, 19, 42, 3 and 12 in chronic pneumonia, including, respectively, 64.8% and 62% of all typed strains. Cases of pneumonia with complications in the form of pleuritis were mostly induced by serotypes 3, 1, 12 and 14, while in the destructive forms of pneumonia K-types 3, 14, 9 and 12 were isolated. Examinations of healthy pre-school children have shown 16.1% of them to be transitory pneumococcus carriers. Multiple biological examinations carried out during 1.5 years revealed that in this period 42.4% of the children were pneumococcus carriers.     

Pneumococcal zinc metalloproteinase ZmpC cleaves human matrix metalloproteinase 9 and is a virulence factor in experimental pneumonia

The ZmpC zinc metalloproteinase of Streptococcus pneumoniae, annotated in the type 4 genome as SP0071, was found to cleave human matrix metalloproteinase 9 (MMP-9). The previously described IgA protease activity was confirmed to be specifically linked to the IgA1-protease/SP1154 zinc metalloproteinase. MMP-9 is a protease cleaving extracellular matrix gelatin and collagen and is activated by proteolytic cleavage like most proteases. MMP-9 is a human protease and is involved in a variety of physiological and pathological matrix degrading processes, including tissue invasion of metastases and opening of the blood-brain barrier. While TIGR4 (serotype 4) and G54 (serotype 19) pneumococcal genome strains have a highly conserved copy of zmpC, the genome of R6 (a derivative of serotype 2 D39 strain) lacks zmpC. Both the analysis for zmpC presence and MMP-9 cleavage activity in various pneumococcal strains showed correlation of ZmpC with MMP-9 cleavage activity. When assaying clinical isolates of S. pneumoniae, the zmpC gene was not found in any of the nasal and conjunctival swab isolates, but it was present in 1 out of 13 meningitis isolates and in 6 out of 11 pneumonia isolates. In a murine pneumonia model, infection with a zmpC-mutant reduced mortality at 3-4 days post-infection by 75%, when compared with infection with wild-type strains. These data indicate that the ZmpC pneumococcal protease may play a role in pneumococcal virulence and pathogenicity in the lung.     

Virulence of Streptococcus pneumoniae strains belonging to different serovars

The study of the virulence of 352 S. pneumoniae strains isolated from patients with inflammatory lung diseases revealed that their virulence depended, to a certain extent, on the state of the polysaccharide capsule of streptococci, as among 299 typed cultures 38.1% were virulent, while out of 53 nontypable strains of these bacteria only 8 strains (15.1%) proved to be highly pathogenic for white mice and all S. pneumoniae R-forms proved to be avirulent. All 11 S. pneumoniae strains under study belonging to serovars 1 and 2 and 87% of the cultures belonging to serovar 3, isolated from patients with inflammatory lung diseases in Leningrad, were highly virulent. The characteristic feature of S. pneumoniae cultures of other serotypes was their wide spectrum of pathogenicity. S. pneumoniae cultures isolated from the spinal fluid of patients with pneumococcal meningitis also differed in their pathogenicity levels but strains highly pathogenic for mice prevailed.     

Streptococcus pneumoniae serotype-2 childhood meningitis in Bangladesh: a newly recognized pneumococcal infection threat

Background

Streptococcus pneumoniae is a leading cause of meningitis in countries where pneumococcal conjugate vaccines (PCV) targeting commonly occurring serotypes are not routinely used. However, effectiveness of PCV would be jeopardized by emergence of invasive pneumococcal diseases (IPD) caused by serotypes which are not included in PCV. Systematic hospital based surveillance in Bangladesh was established and progressively improved to determine the pathogens causing childhood sepsis and meningitis. This also provided the foundation for determining the spectrum of serotypes causing IPD. This article reports an unprecedented upsurge of serotype 2, an uncommon pneumococcal serotype, without any known intervention.

Methods and Findings

Cases with suspected IPD had blood or cerebrospinal fluid (CSF) collected from the beginning of 2001 till 2009. Pneumococcal serotypes were determined by capsular swelling of isolates or PCR of culture-negative CSF specimens. Multicenter national surveillance, expanded from 2004, identified 45,437 patients with suspected bacteremia who were blood cultured and 10,618 suspected meningitis cases who had a lumber puncture. Pneumococcus accounted for 230 culture positive cases of meningitis in children <5 years. Serotype-2 was the leading cause of pneumococcal meningitis, accounting for 20.4% (45/221; 95% CI 15%–26%) of cases. Ninety eight percent (45/46) of these serotype-2 strains were isolated from meningitis cases, yielding the highest serotype-specific odds ratio for meningitis (29.6; 95% CI 3.4–256.3). The serotype-2 strains had three closely related pulsed field gel electrophoresis types.

Conclusions

S. pneumoniae serotype-2 was found to possess an unusually high potential for causing meningitis and was the leading serotype-specific cause of childhood meningitis in Bangladesh over the past decade. Persisting disease occurrence or progressive spread would represent a major potential infection threat since serotype-2 is not included in PCVs currently licensed or under development.     

Multilocus sequence-typing for characterization of Moscow strains of Haemophilus influenzae type b

Haemophilius influenzae, type b (Hib) bacteria, were genotyped by multilocus sequence typing (MLST) using 5 loci (adk, fucK, mdh, pgi, recA). 42 Moscow Hib strains (including 38 isolates form cerebrospinal fluid of children, who had purulent meningitis in 1999-2001, and 4 strains isolated from healthy carriers of Hib), as well as 2 strains from Yekaterinburg were studied. In MLST a strain is characterized, by alleles and their combinations (an allele profile) referred to also as sequence-type (ST). 9 Sts were identified within the Russian Hib bacteria: ST-1 was found in 25 strains (57%), ST-12 was found in 8 strains (18%), ST-11 was found in 4 strains (9%) and ST-15 was found in 2 strains (4.5%); all other STs strains (13, 14, 16, 17, 51) were found in isolated cases (2.3%). A comparison of allelic profiles and of nucleotide sequences showed that 93% of Russian isolates, i.e. strain with ST-1, 11, 12, 13, 15 and 17, belong to one and the same clonal complex. 2 isolates from Norway and Sweden from among 7 foreign Hib strains studied up to now can be described as belonging to the same clonal complex; 5 Hib strains were different from the Russian ones.     

The characteristics of suppurative meningitis morbidity caused by Streptococcus pneumoniae and Haemophilus influenza type B

Of the 1,018 patients with purulent bacterial meningitis, hospitalized at the 2nd Clinical Infectious Hospital in Moscow during the period of 1980-1987, the diagnosis was confirmed in 54.7%; of these, meningitis of pneumococcal etiology was established in 44.8% and meningitis caused by H. influenzae, type b, in 23.8% of the patients. In meningitis of pneumococcal etiology high risk groups included mainly adults, especially those over 50 years, and children under 3 years of age. In meningitis of H. influenzae etiology high risk groups included mainly young children under 2 years of age. Meningitis of pneumococcal etiology was characterized by considerable death rate (on the average, 20%), while in meningitis of H. influenzae etiology death rate was 3 times lower. Pneumococci of serotypes 1, 3, 6, and 19 were found to be of the highest etiological importance for adults and pneumococci of serotypes 19, 6, 12, and 1, for children. In recent years greater etiological role of serotype 42 in adults was noted. The study of the spread of meningitides of different etiology is a high-priority task for this country.     

IL-1 receptor type 1 gene-deficient mice demonstrate an impaired host defense against pneumococcal meningitis

The fatality rate associated with Streptococcus pneumoniae meningitis remains high despite adequate antibiotic treatment. IL-1 is an important proinflammatory cytokine, which is up-regulated in brain tissue after the induction of meningitis. To determine the role of IL-1 in pneumococcal meningitis we induced meningitis by intranasal inoculation with 8 x 10(4) CFU of S. pneumoniae and 180 U of hyaluronidase in IL-1R type I gene-deficient (IL-1R(-/-)) mice and wild-type mice. Meningitis resulted in elevated IL-1alpha and IL-1beta mRNA and protein levels in the brain. The absence of an intact IL-1 signal was associated with a higher susceptibility to develop meningitis. Furthermore, the lack of IL-1 impaired bacterial clearance, as reflected by an increased number of CFU in cerebrospinal fluid of IL-1R(-/-) mice. The characteristic pleocytosis of meningitis was not significantly altered in IL-1R(-/-) mice, but meningitis was associated with lower brain levels of cytokines. The mortality was significantly higher and earlier in the course of the disease in IL-1R(-/-) mice. These results demonstrate that endogenous IL-1 is required for an adequate host defense in pneumococcal meningitis.     

Capsular serotype and antibiotic resistance of Streptococcus pneumoniae isolates in Malaysia

Background

Streptococcus pneumoniae is a major causative agent of severe infections, including sepsis, pneumonia, meningitis, and otitis media, that has since become a major public health concern. In this study, the serotypes distribution of pneumococcal isolates was investigated to predict the efficacy of the 7-valent pneumococcal conjugate vaccine (PCV7) among the Malaysian populations.

Methodology/Principal Findings

A total of 151 clinical isolates were serotyped using multiplex PCR assays. Out of them, there were 21.2% penicillin-resistant, 29.1% penicillin-intermediate, and 49.7% penicillin-susceptible S.pneumoniae strains. Serotypes detected among the Malaysian isolates were 1, 3, 10A, 11A/11D, 12F/12A, 14, 15A, 15B/15C, 16F, 18C/18B/18A/18F, 19A, 19F, 23F, 35B, 35F/47F, 6A/6B, 7C/7B/40, 7F/7A, 9V/9A, and 34. Serotype 19F and 23F were the two most prevalent serotypes detected. Serotypes are highly associated with invasiveness of isolates (p = 0.001) and penicillin susceptibility (p<0.001). Serotype 19F was observed to have increased resistance against penicillin while serotype 19A has high invasive tendency. Age of patients was an important factor underlying the pneumococcal serotypes (p = 0.03) and clinical sites of infections (p<0.001). High prevalence of pneumococcal isolates were detected among children <5 years old at nasopharyngeal sites while elderly adults ≥60 years old were at increased risk for pneumococcal bacteremia.

Conclusion/Significance

Current study revealed that a number of serotypes, especially those associated with high penicillin resistance, have been formulated in the PCV7. Therefore, the protections expected from the routine use of PCV7 would be encouraging for the Malaysian. However, it is not possible to predict serotypes that might become predominant in the future and hence continued surveillance of circulating serotypes will be needed.     

A comparative analysis of the Salmonella typhi strains isolated from patients and bacterial carriers

The comparative analysis of 133 S. typhi clinical strains isolated from patients and carriers in Dnepropetrovsk Province in 1978-1987 was carried out. As shown by this analysis, 10 Vi phage types were represented in the set of strains under study, phage types A and F1 being the most numerous ones. Phage type F1 occurred less frequently among the strains isolated from carriers. 31.1% of the strains were found to contain plasmids with different molecular weight ranging from 96 to 0.5 MD. The occurrence of plasmid-containing strains remained at the same level during the whole period under study. Low-molecular plasmids occurred more frequently in the strains isolated from carriers. The minimal suppressive concentrations of a number of antibiotics, such as penicillin, ampicillin, monomycin, chloramphenicol, tetracycline, rifampicin and streptomycin, were determined. 7% of the strains were resistant to penicillin, 9% to monomycin, 15%--to tetracycline and 2.6% to chloramphenicol. The correlation between penicillin and monomycin resistance of the strains and the presence of the plasmid with a molecular weight of 60 MD in these strains was established. All strains were shown to be highly variable in the degree of their virulence: from 10(2) to 10(8). The strains isolated from patients possessed greater virulence.     

Allelic variation of the streptokinase gene in β-hemolytic streptococci group C and G isolates of human origin

Abstract Genetic diversity of the streptokinase gene ( sk ) from 36 strains of S. equisimilis and 54 strains of group G streptococci was examined. The strains were isolated from patients with various streptococcal disease manifestations and healthy carriers. The region of the gene that corresponds to amino acid residues 174–244, was PCR amplified. The amplified product was subjected to Mlu I, Pvu II, Dra I and Dde I digestion. Based on the restriction enzyme digestion patterns nine sk alleles were recognized. There was no correlation between the various sk gene alleles and streptococcal disease manifestations. Three of the nine sk gene alleles, sk 4, sk 7, and sk 8, were detected earlier among group A streptococci. The other six alleles were unique to S. equisimilis and group G streptococci. The most common alleles were sk 5, found in 21/90 (23%) and sk 10 detected in 43/90 (47%) of the strains. Alleles sk 1 and sk 2, the most frequent among group A streptococci, were not found among the strains in the present investigation. Thus, it appears that the sk gene has been evolving in line with other species distinguishing features of the streptococci.     

Seasonal and daily activity patterns of striped skunks (Mephitis mephitis) in the Canadian prairies

We investigated the hypothesis that the daily and seasonal activity patterns of female and male striped skunks ( Mephitis mephitis ) vary with reproductive constraints. Four biological periods were identified: pre-parturition (1 April–14 May), parturition and rearing (15 May–30 June), pre-dispersal (1–31 July), and dispersal (1–31 August). Tracking data (1873h) indicated that activity (percentage time active) of female skunks varied among seasons, being lowest during the pre-parturition period (34 ± 10%), and highest during the pre-dispersal period (66 ± 4%). Male activity did not vary among seasons (55 ± 3%). Animals of both sexes were mostly nocturnal, and had similar patterns of daily activity. Onset and cessation of activity were highly variable, but were not affected by season or sex. Daily activity typically started 13 ± 10 min before sunset, and was terminated 35 ± 8min before sunrise. Night-time activity periods of both sexes were often (57%, n = 108) interrupted by at least one resting period (median = 1, range = 0–4). However, females rarely (5%, n = 89) returned to the maternal den to rest. We hypothesize that the nocturnal activity of adults is linked to prey activity and reduced predation risk, whereas apparent diurnal activity of juveniles represents an adaptation to daily fasting periods caused by the nocturnal foraging trips of females.     

Pneumococci in the African Meningitis Belt: Meningitis Incidence and Carriage Prevalence in Children and Adults

Background

The development of optimal vaccination strategies for pneumococcal conjugate vaccines requires serotype-specific data on disease incidence and carriage prevalence. This information is lacking for the African meningitis belt.

Methods

We conducted hospital-based surveillance of acute bacterial meningitis in an urban and rural population of Burkina Faso during 2007–09. Cerebrospinal fluid was evaluated by polymerase chain reaction for species and serotype. In 2008, nasopharyngeal swabs were obtained from a representative population sample (1 month to 39 years; N = 519) and additional oropharyngeal swabs from 145 participants. Swabs were evaluated by culture.

Results

Annual pneumococcal meningitis incidence rates were highest among <6-month-old (58/100,000) and 15- to 19-year-old persons (15/100,000). Annual serotype 1 incidence was around 5/100,000 in all age groups. Pneumococcal carriage prevalence in nasopharyngeal swabs was 63% among <5-year-old children and 22% among ≥5-year-old persons, but adding oropharyngeal to nasopharyngeal swabs increased the estimated carriage prevalence by 60%. Serotype 1 showed high propensity for invasive disease, particularly among persons aged ≥5 years.

Conclusions

Serotype 1 causes the majority of cases with a relatively constant age-specific incidence. Pneumococcal carriage is common in all age groups including adults. Vaccination programs in this region may need to include older target age groups for optimal impact on disease burden.     

Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae Isolates Causing Invasive Diseases from Shenzhen Children’s Hospital

Objective

To provide guidance for clinical disease prevention and treatment, this study examined the epidemiology, antibiotic susceptibility, and serotype distribution of Streptococcus pneumoniae (S. pneumoniae) associated with invasive pneumococcal diseases (IPDs) among children less than 14 years of age in Shenzhen, China.

Materials and Methods

All the clinical strains were isolated from children less than 14 years old from January 2009 to August 2012. The serotypes and antibiotic resistance of strains of S. pneumoniae were determined using the capsular swelling method and the E-test.

Results

A total of 89 strains were isolated and 87 isolates were included. The five prevailing serotypes were 19F (28.7%), 14 (16.1%), 23F (11.5%), 19A (9.2%) and 6B (6.9%). The most common sequence types (ST) were ST271 (21.8%), ST876 (18.4%), ST320 (8.0%) and ST81 (6.9%) which were mainly related to 19F, 14, 19A and 23F, respectively. The potential coverage by 7-, 10-, and 13-valent pneumococcal conjugate vaccine were 77.0%, 77.0%, and 89.7%, respectively. Among the 87 isolates investigated, 11.5% were resistant to penicillin, and for meningitis isolates, the resistance rate was 100%. Multi-drug resistance (MDR) was exhibited by 49 (56.3%) isolates. Eighty-four isolates were resistance to erythromycin, among which, 56 (66.7%) carried the ermB gene alone and 28 (33.3%) expressed both the ermB and mefA/E genes.

Conclusions

The potential coverage of PCV13 is higher than PCV7 and PCV10 because high rates of serotypes 19A and 6A in Shenzhen. The clinical treatment of IPD needs a higher drug concentration of antibiotics. Continued surveillance of the antimicrobial susceptibility and serotypes distribution of IPD isolates may be necessary.     

Burden of pneumonia and meningitis caused by Streptococcus pneumoniae in China among children under 5 years of age: a systematic literature review

BACKGROUND AND METHODS: To understand the burden and epidemiology of Streptococcus pneumoniae disease among children between 1 and 59 months of age in China, we conducted a review of literature published between 1980 and 2008 applying standardized algorithms. Because of the absence of population-based surveillance for pneumococcal disease (PD), we identified all-cause pneumonia, bacteremia and meningitis burden, syndromes most commonly associated with S. pneumoniae, and applied the proportion of disease attributable to S. pneumoniae from studies that determined the etiology of these three syndromes to calculate PD burden. Because of the microbiologic difficulties in identifying S. pneumoniae-attributable pneumonia which likely underestimates the pneumonia burden, we also used the proportion obtained from vaccine efficacy trials. RESULTS: Between 1980 and 2008, there were 12,815 cases/100,000/year of all-cause pneumonia among children between 1 month and 59 months, with 526 deaths/100,000 annually. There were 14 meningitis cases/100,000/year. We estimate that as of 2000, there were 260,768 (113,000 to 582,382) and 902 (114-4,463) cases of pneumococcal pneumonia and meningitis, respectively with 10,703 (4,638-23,904) and 75 (9-370) pneumococcal pneumonia and meningitis deaths, respectively. Pneumococcal pneumonia cases and deaths were more than two-fold higher, 695,382 (173,845-1,216,918) and 28,542 (7,136-49,949), respectively, when parameters from efficacy trials were used. Serotypes 19F, 19A and 14 were the most common serotypes obtained from pneumonia/meningitis patients. Currently available vaccines are expected to cover 79.5% to 88.4% of the prevalent serotypes. With high antibiotic resistance, introducing pneumococcal vaccines to the routine immunization program should be considered in China. Population-based studies are warranted.     

Enzymatic profile of Cryptococcus neoformans strains by using the API-ZYM system

Determination of the enzymatic profile of 41 Cryptococcus neoformans strains, 20 isolated from AIDS patients and 21 from bird droppings, was performed by using the API-ZYM commercial kit system (Bio-Mérieux, France), which tests 19 different kinds of enzymes. All the strains showed positive enzymatic activity to the esterase (C4) (n. 3). On the contrary, alkaline phosphatase (n. 2), cystine arylamidase (n. 8), trypsin (n. 9), chymotripsin (n. 10), alpha-galactosidase (n. 13), beta-glucuronidase (n. 15), alpha-mannosidase (n. 19), alpha-fucosidase (n. 20) were negative in all the strains. The other 10 enzymes (n. 4,5,6,7,11,12,14,16,17,18) were distributed among the strains in different positive percentages. From the results of each enzymatic profile obtained, the 20 AIDS strains were grouped into 15 types, while the 21 bird dropping strains were grouped into 14 types. Interestingly, only one enzyme profile type occurred in the strains isolated from the AIDS patients and from the bird droppings. These results suggest that the API ZYM system is useful in discriminating between the AIDS strains and the bird dropping strains.     

Pneumococcal serotypes in various diseases of children

The serotyping of pneumococci isolated from different material obtained from children aged 0 to 11 years was carried out. Out of 156 patients with different diseases, hospitalized in two clinics in Moscow during February-May 1983, pneumococci were isolated from 67 patients (43%). The isolated pneumococcal strains belonged to 11 serotypes. Pneumococci of serotypes 3, 6, 9 and 19 were shown to occur most frequently in different diseases and constituted 50% of the isolated strains. The inoculation of the material by the quantitative method permitted the authors to find out the role of pneumococci as the etiological factor in the pathogenesis of some diseases. A certain dependence of diversity in the types of isolated pneumococci on the age of sick children was noted. Almost all isolated strains were found to be sensitive to penicillin, ampicillin and benzylpenicillin. But a few individual strains were sensitive only to one of these antibiotics. The data on some biological properties of pneumococci cultivated on solid culture media are presented.     

Effects of temperature on developmental performance, survival and growth of sea lamprey embryos

This study assesses the influence of thermal regime on the development, survival rates and early growth of embryos of sea lamprey Petromyzon marinus incubated at five constant temperatures (7, 11, 15, 19 and 23° C). The time from fertilization to 50% hatching and from hatching to 50% burrowing were inversely related to incubation temperature. All the embryos incubated at 7° C died at very early stages, while those maintained at 11° C did not attain the burrowing stage. Survival from fertilization to hatching was 61, 89, 91 and 89% at 11, 15, 19 and 23° C, decreasing to 58, 70 and 70% from hatching to burrowing at 15, 19 and 23° C, respectively. Larvae reared during the first 3 months of exogenous feeding in a common environment at constant 21° C, revealed maximum survival for an incubation temperature of 15° C (43% of burrowed larvae) decreasing strongly at 19° C (16%) and 23° C (one suvivor among 240 larvae). Body length at the burrowing stage was maximum for embryos incubated at 19° C, but body mass increased in the interval 15–23° C. Mean incubation temperatures experienced by 117 broods during the embryonic development in the source river were estimated in 15·3±2·30° C and 16·7±1·76° C (mean±1 s.d .) for the periods fertilization-to-hatching and hatching-to burrowing, respectively.     

Leukocyte Attraction by CCL20 and Its Receptor CCR6 in Humans and Mice with Pneumococcal Meningitis

We previously identified CCL20 as an early chemokine in the cerebrospinal fluid (CSF) of patients with pneumococcal meningitis but its functional relevance was unknown. Here we studied the role of CCL20 and its receptor CCR6 in pneumococcal meningitis. In a prospective nationwide study, CCL20 levels were significantly elevated in the CSF of patients with pneumococcal meningitis and correlated with CSF leukocyte counts. CCR6-deficient mice with pneumococcal meningitis and WT mice with pneumococcal meningitis treated with anti-CCL20 antibodies both had reduced CSF white blood cell counts. The reduction in CSF pleocytosis was also accompanied by an increase in brain bacterial titers. Additional in vitro experiments showed direct chemoattractant activity of CCL20 for granulocytes. In summary, our results identify the CCL20-CCR6 axis as an essential component of the innate immune defense against pneumococcal meningitis, controlling granulocyte recruitment.     

Genetic differences in physiology, growth hormone levels and migratory behaviour of Atlantic salmon smolts

Out of five strains of Atlantic salmon Salmo salar of 1+ years released upstream of a fyke net in the River Gudenaa in 1996, three, Lagan, Ätran and Corrib, migrated immediately, 50% of the recaptured fish reaching the net in 3–6 days. Burrishoole and Conon fish migrated with a 15–19 day delay. Smolt development in 1997 at the hatchery showed a spring surge in gill Na⁺, K⁺-ATPase activity in all strains which was correlated with increased seawater tolerance. Differences in the timing of gill enzyme development matched the observed migration pattern well. Lagan, Ätran and Corrib strains reached high enzyme activity earlier than the Burrishoole and Conon strains, and strains with delayed enzyme development and migration showed a delayed regression of seawater tolerance compared with the early strains. Inter-strain differences in plasma growth hormone profiles could not be related to the observed patterns of Na⁺, K⁺-ATPase and seawater tolerance development. The study gives evidence of genetic influence on the timing and intensity of smolting and subsequent migration in Atlantic salmon.