The abnormal oropharyngeal carrier state: symptom or disease?

Saene, H. K. F. van; Stoutenbeek, C. P.; Torres, Antoni

doi:10.1016/s0954-6111(06)80052-1

Cited by 18 publications

(8 citation statements)

References 26 publications

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“…All those patients with positive bacteriology in their endotracheal secretions had the same organisms isolated on admission surveillance swabs, indicating primary endogenous infection. 37 This reinforces the view that potential pathogens are carried first in the nasopharynx and then there is migration down the trachea into the lower airways. 37 38 The organisms isolated on admission were generally normal community organisms because most of the patients were in good health before RSV infection and PICU admission.…”

Section: Discussionsupporting

confidence: 75%

High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis

Thorburn

2006

Thorax

303

282

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Background: Respiratory syncytial virus (RSV) is the most common cause of viral lower respiratory tract infections (LRTI). Viral LRTI is a risk factor for bacterial superinfection, having an escalating incidence with increasing severity of respiratory illness. A study was undertaken to determine the incidence of pulmonary bacterial co-infection in infants and children with severe RSV bronchiolitis, using paediatric intensive care unit (PICU) admission as a surrogate marker of severity, and to study the impact of the co-infection on morbidity and mortality. Methods: A prospective microbiological analysis was made of lower airways secretions on all RSV positive bronchiolitis patients on admission to the PICU during three consecutive RSV seasons. Results: One hundred and sixty five children (median age 1.6 months, IQR 0.5-4.6) admitted to the PICU with RSV bronchiolitis were enrolled in the study. Seventy (42.4%) had lower airway secretions positive for bacteria: 36 (21.8%) were co-infected and 34 (20.6%) had low bacterial growth/possible co-infection. All were mechanically ventilated (median 5.0 days, IQR 3.0-7.3). Those with bacterial co-infection required ventilatory support for longer than those with only RSV (p,0.01). White cell count, neutrophil count, and C-reactive protein did not differentiate between the groups. Seventy four children (45%) received antibiotics prior to intubation. Sex, co-morbidity, origin, prior antibiotics, time on preceding antibiotics, admission oxygen, and ventilation index were not predictive of positive bacterial cultures. There were 12 deaths (6.6%), five of which were related to RSV. Conclusions: Up to 40% of children with severe RSV bronchiolitis requiring admission to the PICU were infected with bacteria in their lower airways and were at increased risk for bacterial pneumonia.

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Section: Discussionsupporting

confidence: 75%

High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis

Thorburn

2006

Thorax

303

282

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“…Similarly, P. acnes phage PA6 was the most abundant phage in the filtered sample, yet appeared in extremely low abundance (<0.01%) in the chloroformed sample. P. acnes is ubiquitous in the healthy oral cavity, whereas Gramnegative bacteria such as E. coli are generally present in low abundance or not at all because they are rapidly cleared in healthy people (4,33,34). Abedon (35) demonstrated that phage with more abundant hosts tend to have shorter latent periods, i.e., a smaller lag time between adsorption and host lysis.…”

Section: Resultsmentioning

confidence: 99%

Metagenomic detection of phage-encoded platelet-binding factors in the human oral cavity

Willner¹,

Furlan²,

Schmieder³

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

128

118

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The human oropharynx is a reservoir for many potential pathogens, including streptococcal species that cause endocarditis. Although oropharyngeal microbes have been well described, viral communities are essentially uncharacterized. We conducted a metagenomic study to determine the composition of oropharyngeal DNA viral communities (both phage and eukaryotic viruses) in healthy individuals and to evaluate oropharyngeal swabs as a rapid method for viral detection. Viral DNA was extracted from 19 pooled oropharyngeal swabs and sequenced. Viral communities consisted almost exclusively of phage, and complete genomes of several phage were recovered, including Escherichia coli phage T3, Propionibacterium acnes phage PA6, and Streptococcus mitis phage SM1. Phage relative abundances changed dramatically depending on whether samples were chloroform treated or filtered to remove microbial contamination. pblA and pblB genes of phage SM1 were detected in the metagenomes. pblA and pblB mediate the attachment of S. mitis to platelets and play a significant role in S. mitis virulence in the endocardium, but have never previously been detected in the oral cavity. These genes were also identified in salivary metagenomes from three individuals at three time points and in individual saliva samples by PCR. Additionally, we demonstrate that phage SM1 can be induced by commonly ingested substances. Our results indicate that the oral cavity is a reservoir for pblA and pblB genes and for phage SM1 itself. Further studies will determine the association between pblA and pblB genes in the oral cavity and the risk of endocarditis.endocarditis | metagenomics | oropharyngeal viruses | phage-encoded virulence | streptococcal phage

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“…Discrepancies between pharyngeal and distal airway cultures were even higher for H. influenzae in pati-ents with bronchiectasis. The lack of concordance between pharyngeal swabs and PSB or BAL cultures could be explained as follows: 1) pharyngeal swabs may not be the best samples since they can miss bacteriological information; some authors recommend pharyngeal gargles [40]; 2) pharyngeal colonization may, perhaps, be a transient feature, whilst distal airway colonization is a constant one; 3) other oropharyngeal-related reservoirs for distal airway colonization that were not evaluated in the present study could play a role, e.g., sinuses [41] and dental plaque [42]; and, finally, 4) some microorganisms, such as P. aeruginosa and H. influenzae have special affinity due to their ability of adhere to tracheal cells without previous oropharyngeal colonization, particularly in specific populations, such as patients with COPD or bronchiectasis [31,34].…”

Section: Discussionmentioning

confidence: 99%

Bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study

Cabello

Torres²,

Celis³

et al. 1997

Eur Respir J

262

216

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In contrast to the healthy population, distal airway bacterial colonization may occur in patients with chronic lung diseases, who often have altered pulmonary defences. However, the information dealing with this issue is insufficient and is based mainly on nonspecific samples, such as sputum cultures.Using quantitative cultures of bronchoscopic protected specimen brush (PSB) and bronchoalveolar lavage (BAL) samples, we studied the bacterial colonization of distal airways in 16 healthy subjects, 33 patients with bronchogenic carcinoma, 18 with chronic obstructive pulmonary disease (COPD), 17 with bronchiectasis, and 32 with a long-term tracheostomy due to laryngeal carcinoma. All patients were without exacerbation, and free from antibiotic treatment at least 1 month before the study protocol. Thresholds for quantitative cultures to define colonization were ≥10 2 colony-forming units (cfu)·mL -1 for PSB and ≥10 3 cfu·mL -1 for BAL.Only one healthy subject was colonized by a potential pathogenic microorganism (PPM) (Staphylococcus aureus 4×10 2 cfu·mL -1 in a PSB culture). Colonization was observed in 14 (42%) bronchogenic carcinoma patients (19 non-PPMs, and 10 PPMs); in 15 (83%) COPD patients (22 non-PPMs and 7 PPMs); in 15 (88%) bronchiectasis patients (20 non-PPMs and 13 PPMs); and in 15 (47%) long-term tracheostomy patients (5 non-PPMs and 13 PPMs). The two most frequent nonPPMs isolated in all groups studied were Streptococcus viridans and Neisseria spp. Haemophilus spp., Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were the most frequent PPMs isolated in bronchogenic carcinoma, COPD, bronchiectasis and long-term tracheostomized patients, respectively. Pseudomonas aeruginosa colonization was infrequent in all the groups.Our results show that distal airway bacterial colonization is a frequent feature in stable patients with chronic lung diseases and also in patients with long-term tracheostomy. However, the pattern of colonization differs among groups studied. The knowledge of different colonization patterns may be important for future antibiotic prophylactic strategies and for the empirical antibiotic regimens when exacerbations occur in these patients.

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The abnormal oropharyngeal carrier state: symptom or disease?

Cited by 18 publications

References 26 publications

High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis

High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis

Metagenomic detection of phage-encoded platelet-binding factors in the human oral cavity

Bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study

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