Cranberries and lower urinary tract infection prevention

Lower urinary tract infections are very common diseases. Recurrent urinary tract infections remain challenging to treat because the main treatment option is long-term antibiotic prophylaxis; however, this poses a risk for the emergence of bacterial resistance. Some options to avoid this risk are available, including the use of cranberry products. This article reviews the key methods in using cranberries as a preventive measure for lower urinary tract infections, including in vitro studies and clinical trials.

Community-acquired urinary tract infection: age and gender-dependent etiology

LO, Denise Swei et al. Community-acquired urinary tract infection: age and gender-dependent etiology. J. Bras. Nefrol. [online]. 2013, vol.35, n.2, pp. 93-98. ISSN 0101-2800. http://dx.doi.org/10.5935/0101-2800.20130016. INTRODUCTION: Choosing the antimicrobial agent for initial therapy of urinary tract infection (UTI) is usually empirical and should consider the prevalence of uropathogens in different age groups and gender. OBJECTIVE: To establish prevalence rates of uropathogens in community-acquired UTI in relation to age and gender. METHODS: Crosssectional study conducted in the emergency department (ED) of a general hospital, from January to December, 2010, in patients younger than 15 years old who had clinical suspicion of UTI and collected quantitative urine culture. UTI was defined as urine culture with growth of a single agent > 100.000 colony forming units (cfu)/mL in a midstream collection or > 50.000 cfu/mL in urethral catheterization. RESULTS: There were 63.464 visits to ED. 2577 urine cultures were obtained, of whom 291 were positive for UTI (prevalence = 11.3% of clinical suspicion and 0.46% of visits), 212 cases (72.8%) in females, median age = 2.6 years. The predominant uropathogen was E. coli (76.6%), followed by Proteus mirabilis (10.3%) and Staphylococcus saprophyticus (4.1%). Among infants < 3 months, prevalence rates of E. coli were significantly lower (50% vs 78.4%; OR = 0.276; p = 0.006). Higher prevalences of Staphylococcus saprophyticus occurred among patients > 10 years (24.4% vs 0.4%; OR = 79.265; p < 0.0001). Proteus mirabilis was significantly more prevalent in boys than girls (24.0% vs 5.2%; OR = 5.786; p < 0.001). CONCLUSIONS: E. coli was the most prevalent community-acquired uropathogen. Nevertheless, initial empiric antimicrobial treatment of UTI should consider the significant prevalence of other agents different from E. coli in infants < 3 months, the high prevalence of Staphylococcus saprophyticus in patients > 10 years and Proteus mirabilis in males.

Interactions of inhaled nanoparticles with the alveolar-capillary barrier of the human respiratory tract

In dieser Arbeit wurden zytotoxische Effekte sowie die inflammatorische Reaktionen des distalen respiratorischen Traktes nach Nanopartikelexposition untersucht. Besondere Aufmerksamkeit lag auch auf der Untersuchung unterschiedlicher zellulärer Aufnahmewege von Nanopartikeln wie z.B. Clathrin- oder Caveolae-vermittelte Endozytose oder auch Clathrin- und Caveolae-unabhängige Endozytose (mit möglicher Beteiligung von Flotillinen). Drei unterschiedliche Nanopartikel wurden hierbei gewählt: amorphes Silica (aSNP), Organosiloxan (AmorSil) und Poly(ethyleneimin) (PEI). Alle unterschiedlichen Materialien gewinnen zunehmend an Interesse für biomedizinische Forschungsrichtungen (drug and gene delivery). Insbesondere finden aSNPs auch in der Industrie vermehrt Anwendung, und stellen somit ein ernstzunehmendes Gesundheitsrisiko dar. Dieser wird dadurch zu einem begehrten Angriffsziel für pharmazeutische Verabreichungen von Medikamenten über Nanopartikel als Vehikel aber bietet zugleich auch eine Angriffsfläche für gesundheitsschädliche Nanomaterialien. Aus diesem Grund sollten die gesundheitsschädigenden Risiken, sowie das Schicksal von zellulär aufgenommenen NPs sorgfältig untersucht werden. In vivo Studien an der alveolaren-kapillaren Barriere sind recht umständlich. Aus diesem Grund wurde in dieser Arbeit ein Kokulturmodel benutzt, dass die Alveolar-Kapillare Barrier in vivo nachstellt. Das Model besteht aus dem humanen Lungenepithelzelltyp (z.B. NCI H441) und einem humanen microvasculären Endothelzelltyp (z.B. ISO-HAS-1), die auf entgegengesetzten Seiten eines Transwell-Filters ausgesät werden und eine dichte Barriere ausbilden. Die NP Interaktion mit Zellen in Kokultur wurde mit denen in konventioneller Monokultur verglichen, in der Zellen 24h vor dem Experiment ausgesät werden. Diese Studie zeigt, dass nicht nur die polarisierte Eigenschaft der Zellen in Kokultur sondern auch die unmittelbare Nähe von Epithel und Endothelzelle ausschlaggebend für durch aSNPs verursachte Effekte ist. Im Hinblick auf inflammatorische Marker (sICAM, IL-6, IL8-Ausschüttung), reagiert die Kokultur auf aSNPs empfindlicher als die konventionelle Monokultur, wohingegen die Epithelzellen in der Kokultur auf zytotoxikologischer Ebene (LDH-Ausschüttung) unempfindlicher auf aSNPs reagierten als die Zellen in Monokultur. Aufnahmestudien haben gezeigt, dass die Epithelzellen in Kokultur entschieden weniger NPs aufnehmen. Somit zeigen die H441 in der Kokultur ähnliche epitheliale Eigenschaften einer schützenden Barriere, wie sie auch in vivo zu finden sind. Obwohl eine ausreichende Aufnahme von NPs in H441 in Kokultur erreicht werden konnte, konnte ein Transport von NPs durch die epitheliale Schicht und eine Aufnahme in die endotheliale Schicht mit den gewählten Inkubationszeiten nicht gezeigt werden. Eine Clathrin- oder Caveolae-vermittelte Endozytose von NPs konnte mittels Immunfluoreszenz weder in der Mono- noch in der Kokultur nachgewiesen werden. Jedoch zeigte sich eine Akkumulation von NPs in Flotillin-1 und-2 enthaltende Vesikel in Epithelzellen aus beiden Kultursystemen. Ergebnisse mit Flotillin-inhibierten (siRNA) Epithelzellen, zeigten eine deutlich geringere Aufnahme von aSNPs. Zudem zeigte sich eine eine reduzierte Viabilität (MTS) von aSNP-behandelten Zellen. Dies deutet auf eine Beteiligung von Flotillinen an unbekannten (Clathrin oder Caveolae -unabhängig) Endozytosemechanismen und (oder) endosomaler Speicherung. Zusammenfassend waren die Aufnahmemechanismen für alle untesuchten NPs in konventioneller Monokultur und Kokultur vergleichbar, obwohl sich die Barriereeigenschaften deutlich unterscheiden. Diese Arbeit zeigt deutlich, dass sich die Zellen in Kokultur anders verhalten. Die Zellen erreichen hierbei einen höheren Differenzierungsgrad und eine Zellkommunikation mit anderen relevanten Zelltypen wird ermöglicht. Durch das Einbringen eines dritten relevanten Zelltyps in die Kokultur, des Alveolarmakrophagen (Zelllinie THP-1), welcher die erste Verteidigungsfront im Alveolus bildet, wird diese Aussage weiter bekräftigt. Erste Versuche haben gezeigt, dass die Triplekultur bezüglich ihrer Barriereeigenschaften und IL-8-Ausschüttung sensitiver auf z.B. TNF- oder LPS-Stimulation reagiert als die Kokultur. Verglichen mit konventionellen Monokulturen imitieren gut ausgebildete, multizelluräre Kokulturmodelle viel präziser das zelluläre Zusammenspiel im Körper. Darum liefern Nanopartikelinteraktionen mit dem in vitro-Triplekulturmodel aufschlussreichere Ergebnisse bezüglich umweltbedingter oder pharmazeutischer NP-Exposition in der distalen Lung als es uns bisher möglich war.

Type IV delayed-type hypersensitivity of the respiratory tract due to budesonide use: report of two cases and a literature review

Respiratory type-IV hypersensitivity reactions due to corticosteroids is a rare phenomenon. We describe two such cases. The first is a 37- year-old atopic woman who developed labial angioedema and nasal itching after the use of budesonide nasal spray. A month later, after the first puffs of a formoterol/budesonide spray prescribed for asthma, she noticed symptoms of tongue and oropharyngeal itching and redness with subsequent dysphagia, labial and tongue angioedema, and facial oedema. The second is a 15-year-old non-atopic woman who reported pruritic eruptions around the nostrils after using a budesonide nasal spray. A year later she presented with nasal pruritus with intense congestion and labial and facial oedema after using the same spray. Both patients were evaluated with patch-tests using the commercial T.R.U.E. test, a budesonide solution, and corticosteroid creams. Test evaluation was performed at 48 and 96 hours. In both patients, patch tests were positive to budesonide (++) on the second day. The first patient also had a positive (+) reaction to tixocortol-21-pivalate. All the other patch tests were negative. Clinicians should be aware that hypersensitivity reactions may occur during the use of nasal or inhaled corticosteroids.

Rapid qualitative urinary tract infection pathogen identification by SeptiFast real-time PCR

Background Urinary tract infections (UTI) are frequent in outpatients. Fast pathogen identification is mandatory for shortening the time of discomfort and preventing serious complications. Urine culture needs up to 48 hours until pathogen identification. Consequently, the initial antibiotic regimen is empirical. Aim To evaluate the feasibility of qualitative urine pathogen identification by a commercially available real-time PCR blood pathogen test (SeptiFast®) and to compare the results with dipslide and microbiological culture. Design of study Pilot study with prospectively collected urine samples. Setting University hospital. Methods 82 prospectively collected urine samples from 81 patients with suspected UTI were included. Dipslide urine culture was followed by microbiological pathogen identification in dipslide positive samples. In parallel, qualitative DNA based pathogen identification (SeptiFast®) was performed in all samples. Results 61 samples were SeptiFast® positive, whereas 67 samples were dipslide culture positive. The inter-methodological concordance of positive and negative findings in the gram+, gram- and fungi sector was 371/410 (90%), 477/492 (97%) and 238/246 (97%), respectively. Sensitivity and specificity of the SeptiFast® test for the detection of an infection was 0.82 and 0.60, respectively. SeptiFast® pathogen identifications were available at least 43 hours prior to culture results. Conclusion The SeptiFast® platform identified bacterial DNA in urine specimens considerably faster compared to conventional culture. For UTI diagnosis sensitivity and specificity is limited by its present qualitative setup which does not allow pathogen quantification. Future quantitative assays may hold promise for PCR based UTI pathogen identification as a supplementation of conventional culture methods.

An optimized in vitro model of the respiratory tract wall to study particle cell interactions

As a part of the respiratory tissue barrier, lung epithelial cells play an important role against the penetration of the body by inhaled particulate foreign materials. In most cell culture models, which are designed to study particle-cell interactions, the cells are immersed in medium. This does not reflect the physiological condition of lung epithelial cells which are exposed to air, separated from it only by a very thin liquid lining layer with a surfactant film at the air-liquid interface. In this study, A549 epithelial cells were grown on microporous membranes in a two chamber system. After the formation of a confluent monolayer the cells were exposed to air. The morphology of the cells and the expression of tight junction proteins were studied with confocal laser scanning and transmission electron microscopy. Air-exposed cells maintained monolayer structure for 2 days, expressed tight junctions and developed transepithelial electrical resistance. Surfactant was produced and released at the apical side of the air-exposed epithelial cells. In order to study particle-cell interactions fluorescent 1 microm polystyrene particles were sprayed over the epithelial surface. After 4 h, 8.8% of particles were found inside the epithelium. This fraction increased to 38% after 24 h. During all observations, particles were always found in the cells but never between them. In this study, we present an in vitro model of the respiratory tract wall consisting of air-exposed lung epithelial cells covered by a liquid lining layer with a surfactant film to study particle-cell interactions.

Oral purified bacterial extracts in acute respiratory tract infections in childhood: a systematic quantitative review

BACKGROUND: Recurrent acute respiratory tract infections (ARTI) are a common problem in childhood. Some evidence suggests a benefit regarding the prevention of ARTI in children treated with the immunomodulator OM-85 BV (Bronchovaxom). METHODS: We summarised the evidence on the effectiveness of the immunomodulator OM-85 BV in the prevention of ARTI in children. We searched randomised comparisons of oral purified bacterial extracts against inactive controls in children with respiratory tract diseases in nine electronic databases and reference lists of included studies. We extracted salient features of each study, calculated relative risks (RR) or weighted mean differences (WMD) and performed meta-analyses using random-effects models. RESULTS: Thirteen studies (2,721 patients) of low to moderate quality tested OM-85 BV. Patients and outcomes differed substantially, which impeded pooling results of more than two trials. Two studies (240 patients) reporting on the number of patients with less than three infections over 6 month of follow-up in children not in day care showed a trend for benefit RR 0.82 (95% CI, 0.65-1.02). One out of two studies examining the number of children not in day care without infections over 4-6 month reported a significant RR of 0.42 (95% CI, 0.21-0.82) whereas the smaller, second study did not [RR 0.92 (95% CI, 0.58-1.46)]. Two studies reporting the number of antibiotic courses indicated a benefit for the intervention arm [WMD 2.0 (95% CI, 1.7-2.3)]. Two out of the three studies showed a reduction of length of episodes of 4-6 days whereas a third study showed no difference between the two groups. CONCLUSION: Evidence in favour of OM-85 BV in the prevention of ARTI in children is weak. There is a trend for fewer and shorter infections and a reduction of antibiotic use.

Visualization and quantitative analysis of nanoparticles in the respiratory tract by transmission electron microscopy

ABSTRACT: Nanotechnology in its widest sense seeks to exploit the special biophysical and chemical properties of materials at the nanoscale. While the potential technological, diagnostic or therapeutic applications are promising there is a growing body of evidence that the special technological features of nanoparticulate material are associated with biological effects formerly not attributed to the same materials at a larger particle scale. Therefore, studies that address the potential hazards of nanoparticles on biological systems including human health are required. Due to its large surface area the lung is one of the major sites of interaction with inhaled nanoparticles. One of the great challenges of studying particle-lung interactions is the microscopic visualization of nanoparticles within tissues or single cells both in vivo and in vitro. Once a certain type of nanoparticle can be identified unambiguously using microscopic methods it is desirable to quantify the particle distribution within a cell, an organ or the whole organism. Transmission electron microscopy provides an ideal tool to perform qualitative and quantitative analyses of particle-related structural changes of the respiratory tract, to reveal the localization of nanoparticles within tissues and cells and to investigate the 3D nature of nanoparticle-lung interactions.This article provides information on the applicability, advantages and disadvantages of electron microscopic preparation techniques and several advanced transmission electron microscopic methods including conventional, immuno and energy-filtered electron microscopy as well as electron tomography for the visualization of both model nanoparticles (e.g. polystyrene) and technologically relevant nanoparticles (e.g. titanium dioxide). Furthermore, we highlight possibilities to combine light and electron microscopic techniques in a correlative approach. Finally, we demonstrate a formal quantitative, i.e. stereological approach to analyze the distributions of nanoparticles in tissues and cells.This comprehensive article aims to provide a basis for scientists in nanoparticle research to integrate electron microscopic analyses into their study design and to select the appropriate microscopic strategy.