Secondary infection withStreptococcus pneumoniaehas contributed significantly to morbidity and mortality during multiple influenza virus pandemics and remains a common threat today. During a concurrent infection, both pathogens can influence the transmission of each other, but the mechanisms behind this are unclear. In this study, condensation air sampling and cyclone bioaerosol sampling were performed using ferrets first infected with the 2009 H1N1 pandemic influenza virus (H1N1pdm09) and secondarily infected withS. pneumoniaestrain D39 (Spn). We detected viable pathogens and microbial nucleic acid in expelled aerosols from co-infected ferrets, suggesting that these microbes could be present in the same respiratory expulsions. To assess whether microbial communities impact pathogen stability within an expelled droplet, we performed experiments measuring viral and bacterial persistence in 1 μL droplets. We observed that H1N1pdm09 stability was unchanged in the presence of Spn. Further, Spn stability was moderately increased in the presence of H1N1pdm09, although the degree of stabilization differed between airways surface liquid collected from individual patient cultures. These findings are the first to collect both pathogens from the air and in doing so, they provide insight into the interplay between these pathogens and their hosts.
This article addresses the scientific literature on contributing factors and preventive strategies for anterior cruciate ligament (ACL) injuries, and it offers suggestions home health care professionals may find useful in the prevention and rehabilitation of this injury. More specifically, this two-part article summarizes contemporary research on the functional anatomy of the knee, precipitating factors to ACL injuries, and current strategies in the rehabilitation of these injuries. Part 1-covered here-addresses the knee's functional anatomy and precipitating factors to ACL injuries noted in the scientific literature. Part 2-covered in a subsequent issue of Home Health Care Management & Practice (HHCMP)-addresses contemporary trends evident in the peer-reviewed literature on the topic of the rehabilitation of ACL injuries.
This article is the second in a two-part series that addresses the scientific literature on the contributing factors and preventive strategies for anterior cruciate ligament (ACL) injuries. Part 1, which was presented in a previous edition of Home Health Care Management & Practice ( HHCMP), covered contemporary research on the functional anatomy of the knee and precipitating factors to ACL injuries. Part 2, presented here, addresses contemporary trends evident in the peer-reviewed literature on the topic of the rehabilitation of ACL injuries, and it offers suggestions home health care professionals may find useful in the prevention and rehabilitation of this injury.
Secondary infection with Streptococcus pneumoniae has contributed significantly to morbidity and mortality during multiple influenza virus pandemics and remains a common threat today. During a concurrent infection, both pathogens can influence the transmission of each other, but the mechanisms behind this are unclear. In this study, condensation air sampling and cyclone bioaerosol sampling were performed using ferrets first infected with the 2009 H1N1 pandemic influenza virus (H1N1pdm09) and secondarily infected with S. pneumoniae strain D39 (Spn). We detected viable pathogens and microbial nucleic acid in expelled aerosols from co-infected ferrets, suggesting that these microbes could be present in the same respiratory expulsions. To assess whether microbial communities impact pathogen stability within an expelled droplet, we performed experiments measuring viral and bacterial persistence in 1 µL droplets. We observed that H1N1pdm09 stability was unchanged in the presence of Spn. Further, Spn stability was moderately increased in the presence of H1N1pdm09, although the degree of stabilization differed between airway surface liquid collected from individual patient cultures. These findings are the first to collect both pathogens from the air and in doing so, they provide insight into the interplay between these pathogens and their hosts. IMPORTANCE The impact of microbial communities on transmission fitness and environmental persistence is under-studied. Environmental stability of microbes is crucial to identifying transmission risks and mitigation strategies, such as removal of contaminated aerosols and decontamination of surfaces. Co-infection with S. pneumoniae is very common during influenza virus infection, but little work has been done to understand whether S. pneumoniae alters stability of influenza virus, or vice versa, in a relevant system. Here, we demonstrate that influenza virus and S. pneumoniae are expelled by co-infected hosts. Our stability assays did not reveal any impact of S. pneumoniae on influenza virus stability, but did show a trend towards increased stability of S. pneumoniae in the presence of influenza viruses. Future work characterizing environmental persistence of viruses and bacteria should include microbially complex solutions to better mimic physiologically relevant conditions.
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