Efficacy and Long-Term Outcomes of Palivizumab Prophylaxis to Prevent Respiratory Syncytial Virus Infection in Infants with Cystic Fibrosis in Northern Ireland

BACKGROUND: RSV causes considerable morbidity and mortality in children. In cystic fibrosis (CF) viral infections are associated with worsening respiratory symptoms and bacterial colonization. Palivizumab is effective in reducing RSV hospitalization in high risk patient groups. Evidence regarding its effectiveness and safety in CF is inconclusive. CF screening in N. Ireland enabled timely palivizumab prophylaxis, becoming routine in 2002.

OBJECTIVES: To determine the effect of palivizumab on RSV-related hospitalization and compare lung function and bacterial colonization at age 6 years for those born pre- and post-introduction of palivizumab prophylaxis.

METHODS: A retrospective audit was conducted for all patients diagnosed with CF during the period from 1997 to 2007 inclusive. RSV-related hospitalization, time to Pseudomonas aeruginosa (PA) 1st isolate, lung function and growth parameters were recorded. Comparisons were made for outcomes pre- and post-introduction of routine palivizumab administration in 2002. A cost evaluation was also performed.

RESULTS: Ninety-two children were included; 47 pre- and 45 post-palivizumab introduction. The overall RSV-positive hospitalization rate was 13%. The relative risk of RSV infection in palivizumab non-recipients versus recipients was 4.78 (95%CI: 1.1-20.7), P = 0.027. Notably, PA 1st isolate was significantly earlier in the palivizumab recipient cohort versus non-recipient cohort (median 57 vs. 96 months, P < 0.025) with a relative risk of 2.5. Chronic PA infection at 6 years remained low in both groups, with similar lung function and growth parameters. Total costs were calculated at £96,127 ($151,880) for the non-recipient cohort versus £137,954 ($217,967) for the recipient cohort.

CONCLUSION: Palivizumab was effective in reducing RSV-related hospitalization infection in CF patients. Surprisingly, we found a significantly earlier time to 1st isolate of PA in palivizumab recipients which we could not explain by altered or improved diagnostic tests. 

Production of extended-spectrum β-lactamases and the potential indirect pathogenic role of Prevotella isolates from the cystic fibrosis respiratory microbiota

Extended-spectrum β-lactamase (ESBL) production and the prevalence of the β-lactamase-encoding gene blaTEM were determined in Prevotella isolates (n=50) cultured from the respiratory tract of adults and young people with cystic fibrosis (CF). Time-kill studies were used to investigate the concept of passive antibiotic resistance and to ascertain whether a β-lactamase-positive Prevotella isolate can protect a recognised CF pathogen from the action of ceftazidime in vitro. The results indicated that approximately three-quarters (38/50; 76%) of Prevotella isolates produced ESBLs. Isolates positive for ESBL production had higher minimum inhibitory concentrations (MICs) of β-lactam antibiotics compared with isolates negative for production of ESBLs (P<0.001). The blaTEM gene was detected more frequently in CF Prevotella isolates from paediatric patients compared with isolates from adults (P=0.002), with sequence analysis demonstrating that 21/22 (95%) partial blaTEM genes detected were identical to blaTEM-116. Furthermore, a β-lactamase-positive Prevotella isolate protected Pseudomonas aeruginosa from the antimicrobial effects of ceftazidime (P=0.03). Prevotella isolated from the CF respiratory microbiota produce ESBLs and may influence the pathogenesis of chronic lung infection via indirect methods, including shielding recognised pathogens from the action of ceftazidime.

Lipopolysaccharide modification in Gram-negative bacteria during chronic infection

The Gram-negative bacterial lipopolysaccharide (LPS) is a major component of the outer membrane that plays a key role in host-pathogen interactions with the innate immune system. During infection, bacteria are exposed to a host environment that is typically dominated by inflammatory cells and soluble factors, including antibiotics, which provide cues about regulation of gene expression. Bacterial adaptive changes including modulation of LPS synthesis and structure are a conserved theme in infections, irrespective of the type or bacteria or the site of infection. In general, these changes result in immune system evasion, persisting inflammation, and increased antimicrobial resistance. Here, we review the modifications of LPS structure and biosynthetic pathways that occur upon adaptation of model opportunistic pathogens (Pseudomonas aeruginosa, Burkholderia cepacia complex bacteria, Helicobacter pylori and Salmonella enterica) to chronic infection in respiratory and gastrointestinal sites. We also discuss the molecular mechanisms of these variations and their role in the host-pathogen interaction.

Inhibition of protease-ENaC signaling improves mucociliary function in cystic fibrosis airways

Rationale: In cystic fibrosis (CF) a reduction in airway surface liquid (ASL) height
compromises mucociliary clearance, favoring mucus plugging and chronic bacterial infection. Inhibitors of ENaC have therapeutic potential in CF airways to reduce the hyperstimulated sodium and fluid absorption to levels which can restore airways hydration.

Objectives: To determine whether a novel compound (QUB-TL1) designed to inhibit protease/ENaC signaling in CF airways restores ASL volume and mucociliary function.

Methods: Protease activity was measured using fluorogenic activity assays. Differentiated primary airway epithelial cell cultures (F508del homozygotes) were used to determined ENaC activity (Ussing chamber recordings), ASL height (confocal microscopy) and mucociliary function (by tracking the surface flow of apically applied microbeads). Cell toxicity was measured by LDH assay.

Measurements and Results: QUB-TL1 inhibits extracellularly-located CAPs, including prostasin, matriptase and furin, the activities of which are observed at excessive levels at the apical surface of CF airway epithelial cells (AECs). QUB-TL1-mediated CAPs inhibition results in diminished ENaC-mediated Na+ absorption in CF AECs due to internalization of a prominent pool of cleaved (active) ENaCγ from the cell surface. Importantly, diminished ENaC activity correlates with improved airway hydration status and mucociliary clearance. We further demonstrate QUB-TL1-mediated furin inhibition, which is in contrast to other serine protease inhibitors (camostat mesylate and aprotinin), affords protection against neutrophil elastase-mediated ENaC activation and Pseudomonas aeruginosa exotoxin A induced cell death.

Conclusions: QUB-TL1 corrects aberrant CAP activities providing a mechanism to delay or prevent the development of CF lung disease in a manner independent of CFTR mutation.

Caracterização molecular de cianobactérias de sistemas aquáticos portugueses

As alterações climáticas favorecem a ocorrência global de episódios de precipitação e seca extremas, colocando em risco a qualidade da água em sistemas aquáticos usados consumo humano ou recreação. O fenómeno de seca, em particular, será mais frequente e severo, alterando toda a hidrodinâmica dos sistemas aquáticos e, consequentemente, a ecologia das comunidades aquáticas. A ocorrência de blooms de cianobactérias intensificarse- á sob este novo cenário climático. Em Portugal, estudos parcelares em rios e barragens têm sido realizados com enfoque em cianobactérias tóxicas e outras bactérias patogénicas, mas não há trabalhos publicados acerca da composição da comunidade bacteriana (CCB). O presente trabalho pretende colmatar esta falha, com particular atenção para a ocorrência de blooms cianobacterianos, em vários sistemas aquáticos portugueses lóticos e lênticos. Este objectivo foi alcançado utilizando metodologias moleculares, como a técnica rDNA 16S-DGGE (Denaturing Gradient Gel Electrophoresis), independente do cultivo, e a sequenciação. Dados ambientais foram também determinados para correlacionar com as variações sazonais ou espaciais da diversidade da CCB. O impacto da seca na distribuição espacial da CCB foi também investigado. A lagoa da Vela é um caso de estudo especial, devido à vasta documentação sobre a ocorrência de blooms de cianobactérias durante os últimos anos, e várias estirpes isoladas de blooms foram estudadas em mais detalhe. Os resultados mostraram, em geral, perfis de DGGE típicos de verão vs. inverno nos sistemas aquáticos estudados. Nos sistemas lênticos, os filótipos dominantes afiliaram com Cyanobacteria (formas unicelulares, coloniais e filamentosas), eucariotas fototróficos e Actinobacteria, enquanto nos rios, Bacteroidetes e Betaproteobacteria foram dominantes. Nos sistemas lênticos, os factores mais significativos para a sazonalidade da CCB incluíram a temperatura da água, a condutividade e a clorofila a, apesar da variação extrema dos níveis de precipitação, sugerindo que a BCC poderá resistir a mudanças severas causadas pela seca. Nos rios, a sazonalidade da CCB foi principalmente definida pela temperatura e os níveis de amónia. No verão seco de 2005, as barragens do Alentejo (Sul de Portugal) mostraram similaridade na CCB, com filótipos comuns de Cyanobacteria, Actinobacteria e Alphaproteobacteria. No entanto, os perfis de DGGE sugerem filótipos ubíquos em sistemas portugueses geograficamente distantes. Na Lagoa da Vela, a seca conduziu à redução drástica do nível da água e à variação na diversidade espacial da CCB (e cianobactérias dominantes) e potencial tóxico, o que pode ter impacto directo nos utilizadores da lagoa. Os resultados também mostraram a presença de estirpes tóxicas de Microcystis na lagoa e um bloom não clonal de estirpes de Aphanizomenon aphanizomenoides, com diferentes morfótipos, genótipos e ecótipos.

Potential health benefits of Artemisia gorgonum extracts

Relevância etnofarmacológica: Artemisia gorgonum (Asteraceae), conhecida como “losna ou lorna”, é usada em Cabo Verde na medicina tradicional para o tratamento de inflamações, febre e gastroenterites. Estudos recentes sugerem que artimetina, isolada a partir de Artemisa gorgonum, poderia ser usada para o tratamento da malária devido à sua atividade antiplasmodial. Objetivo do estudo: Avaliação in vitro da atividade anti-microbiana e sinergética dos extratos hidroetanol (70%) e metanol de A. gorgonum (EHAG e EMAG) em bactérias do trato urinário e uma espécie de fungo. A atividade antioxidante dos extratos de hidroetanol (70%), metanol, clorofórmio e clorofórmio-metanol (1:2), e o efeito protetor de EHAG contra lesões hepáticas em ratos induzidos com CCl4 também foram analisados. Material e métodos: A atividade antimicrobiana dos extratos de A. gorgonum foi testada in vitro contra sete estirpes de microrganismos, incluindo bactérias Gram-positivas, Gram-negativas e uma espécie de fungo. O método DAA (Decimal assay for additivity) foi determinado para atividade antibacteriana do EHAG contra Pseudomonas aeruginosa. O efeito antioxidante in vitro de vários extratos de A. gorgonum foi analisado pelo método DPPH. A lesão hepática foi induzida por injeção intrapeitoral do CCl4. Seguidamente, os ratos foram administrados oralmente com EHAG, diariamente, por um período de 7 dias. Resultados e Discussão: Foi observada atividade antibacteriana dos extratos de EHAG e EMAG contra todos os microrganismos usados neste estudo. O crescimento das estirpes de Escherichia coli e Pseudomonas aeruginosa foi o mais inibido por ambos os extratos, apresentando valores significativos, enquanto o crescimento das estirpes S. aureus e Klebsiella spp. foi o menos afetado. Candida albicans foi inibida fortemente pelo EMAG. As combinações de extrato hidroetanólico com antibióticos demonstraram atividade antibacteriana sinergética contra todos os patogénicos testados. Em contrapartida, a combinação de extrato metanólico com antibióticos permitiu observar efeitos antagónicos contra todas as bactérias, exceto Klebsiella spp. que apresentou atividade sinérgica. O EHAG e EMAG mostraram efeito significativo na eliminação do radical DPPH. A atividade hepatoprotetora foi observada em ratos previamente administrados com CCl4. Estes estudos evidenciam os potenciais benefícios de A. gorgonum.

Brazilian savanna forest : conservation, medicinal reservoir and bioprospecting

This study aimed to analyse the Brazilian savanna forest from a Legal Reserve (LR) area from a perspective of conservation, reservoir of organic carbon and medicinal biomass for a prospective use of native medicinal plants. An ethnobotanical and ethnopharmacological survey was carried out close to a community settled in the rural area in the south of Tocantins, being selected 9 of the most cited species (cajuí- Anacardium othonianum; inharé-Brosimum gaudichaudii; jatobá-Hymenaeae courbaril; jenipapo-Genipa americana, aroeira-Myracrodruon urundeuva; negramina-Siparuna guianensis; barbatimão- Stryphnodendron obovatum; assa peixe-Vernonia brasiliana, embaúba-Cecropia pachystachya). Crude foliar extracts were subjected to a preliminary phytochemical prospection and triage of secondary metabolites with antimicrobial activity of potential interest in health and familiar agriculture. Phenolic compounds, terpenes and flavonoids were detected in the extracts of most species, which suggests the presence of antimicrobial, antioxidant and anti-insect activities. It was evident the need to better know the LR as a reservoir of medicinal biomass in an area under ecological tension where 35% (610ha) of the property is LR and should be protected by law. Therefore, a forest inventory of live woody species was performed using the allometric or indirect method. This identified a rare remnant of Semidecidual Seasonal Forest amidst the largest world savannah, the Cerrado biome. An analysis of the forest average productivity per basal area (m².ha), aerial live biomass (ton.ha-1) and carbon stock was carried out. The forest fragment was considered relatively rich in species and diversity, although showing signs of disturbance and dominance by a few species. Its horizontal structure suggests biotic regeneration conditions. It is an important reservoir of medicinal plants. Of the families (57.5%) presenting medicinal species, 19 from a total of 33 are represented in the area and contain 44% (27) of the total species (61) and 63% (432) of the total individuals catalogued. Medicinal species have ecological importance for the equilibrium of the local flora and represent 80% of the 10 species with higher Importance Value Index (IVI): Tetragastris altissima, Chrysophyllum marginatum, Oenocarpus distichus, Sclerolobium paniculatum, Simarouba versicolor, Alibertia macrophylla, Siparuna guianensis, Maprounea guianensis, Licania parvifolia e Physocalymma scaberrimum. Medicinal productivity was high for this type of phytophysionomy: 183,2 ton. ha-1 of biomass and 91,51 ton. ha-1 of carbon representing 66% of the total biomass and carbon of this Cerrado forest. From this stage S. guianensis (Siparunaceae) was selected for performing bioassays in order to verify its biological activity against microorganisms of health and agricultural relevance. This is a native aromatic medicinal plant recommended as priority for conservation, with local popular medicinal validation and availability of medicinal feedstock (3300 Kg.ha-1), with the foliar fraction giving 38Kg/ha of crude extract and 5L/ha of essential oil. Foliar crude extracts and essential oil were obtained and tested in vitro using a disk diffusion bioassay. Different concentrations of these natural products were tested against gram-positive bacteria (Staphylococcus aureus ATCC 29213), gram-negative bacteria (Escherichia coli ATCC 25922 and ATCC 35218; Pseudomonas aeruginosa ATCC 10145) and fungi (Candida albicans ATCC 6258 e Fusarium oxysporum). The essential oil inhibited the growth of S. aureus in its crude concentration (380μg.mL-1), as well as diluted to half (190μg.mL-1) and a quarter strength (95μg.mL-1). It’s likely that such action is due to sesquiterpenes major components, such as bisabolol and bisabolene (10.35%), measured by gas chromatography (GC-MS, GC-FID). Extracts did not exhibit any antimicrobial activity against the microorganisms tested. The native medicinal plants prospective market is an alternative that favours the conservation of biodiversity while generating benefits for the development of sustainable family productive activities within local ecosystems instead of the current inappropriate uses. This strengthens conservation policies of Legal Reserve in rural settlements and is in agreement with public policy on global warming and climate changes.

Removal of cyanobacteria and cyanotoxins from drinking water by powdered activated carbon adsorption/ultrafiltration

Tese dout., Ciências e Tecnologias do Ambiente, Universidade do Algarve, 2009

Desempenho da flotação por ar dissolvido na remoção de cianobactérias de diferentes morfologias

A presença de cianobactérias em reservatórios utilizados para produção de água para consumo humano representa um elevado risco para a saúde pública. Estes organismos contribuem para a redução da qualidade da água e têm a capacidade de produzir cianotoxinas que podem afectar a saúde humana e animal. Existem casos em todo o mundo de intoxicação letal de diversos animais por consumo de água de lagos contaminados com cianobactérias, e mesmo casos de morte de humanos, atribuídas à exposição de cianotoxinas. De modo a fazer face a este crescente problema é necessário desenvolver e implementar tecnologias de tratamento de água nas ETA que permitam fazer face a uma florescência de cianobactérias num reservatório de água destinado ao abastecimento humano. Neste trabalho avaliou-se a capacidade do processo C/F/DAF na remoção cianobactérias de diferentes morfologias, células e colónias de M. aeruginosa e filamentos de P. rubescens, em águas sintéticas hidrofóbicas e hidrofílicas, com concentração de DOC moderada e moderada/elevada. Assim como da sequência C/F/DAF→NF na remoção de células e de toxinas de cianobactérias. A remoção de NOM e o seu efeito na remoção de cianobactérias foram também avaliados. Concluiu-se que o processo C/F/DAF é eficiente na remoção de cianobactérias de diferentes morfologias, com remoções entre 78 e 100% de MC intra. No entanto, a morfologia que apresentou remoções mais elevadas foram os filamentos, enquanto as colónias apresentaram valores mais baixos. Globalmente, verificou-se que o aumento da concentração de NOM facilita a remoção de cianobactérias, sendo que as águas hidrofóbicas apresentaram-se mais fáceis de tratar por C/F/DAF. Por sua vez, o tratamento C/F/DAF→NF, é uma opção eficiente para fazer face a um eventual bloom de cianobactérias em ETA, uma vez que a remoção de cianobactérias (em MC intra e chl_a) foi de 100% e a remoção de microcistina extracelular de 95%, aproximadamente.

Development of chitosan packaging films with carvacrol and grape seed extract as antimicrobial and antioxidant agents

In order to produce packaging films with a broad spectrum of action on microorganisms, the effect of two antimicrobial (AM) to be included in the films, carvacrol and GSE were studied separately on different microorganisms. Carvacrol was more effective against the grampositive bacteria than against the gram-negative bacterium. GSE was not effective against yeast. Subsequently, a search for optimal combinations of carvacrol, GSE and the addition of chitosan (as a third component with film forming properties) was carried out. Response surface analysis showed several synergetic effects and three optimal AM combinations (OAMC) were obtained for each microorganism. The experimental validation confirmed that the optimal solutions found can successfully predict the response for each microorganism. The optimization of mixtures of the three components, but this time, using the same concentration for all microorganisms, was also studied to obtain an OAMC with wide spectrum of activity. The results of the response surface analysis showed several synergistic effects for all microorganisms. Three OAMC, OAMC-1, OAMC-2, OAMC-3, were found to be the optimal mixtures for all microorganisms. The radical scavenging activity (RSA) of the different agents was then compared with a standard antioxidant (AOX) BHT, at different concentrations; as also at the OAMC. The RSA increased in the following order: chitosanaeruginosa was the more sensitive and S. aureus was the most resistant to the action of OAMC-3. The physico-mechanical properties of 3 films, film-1 with OAMC-1, film-2 with OAMC-2 and film-3 with OAMC-3 were studied. Film-3 presented the lowest WVP, CO2P and TS values and the highest O2P whereas film-1 presented the highest WVP and the lowest crystallinity, CO2P, TS and luminosity. Being one of the components of GSE, gallic acid (GA) release in water from film-1, film-2 and film-3 was next studied over a 30 day period. The mathematical model for the release of GA based on Fick’s law successfully fitted the experimental data and GA diffusion coefficients, assumed to be Arrhenius temperature dependent were obtained for each film. This work will contribute to the development of environmentally friendly packaging films, resulting in improved food preservation and shelf-life extension.

Topical bacteriophage therapy of the infected diabetic foot

Tese de doutoramento, Medicina (Medicina Interna), Universidade de Lisboa, Faculdade de Medicina, 2014

In-situ development of self-defensive antibacterial biomaterials: phenol-g-keratin-EC based bio-composites with characteristics for biomedical applications

Recently, the development of highly inspired biomaterials with multi-functional characteristics has gained considerable attention, especially in biomedical, and other health-related areas of the modern world. It is well-known that the lack of antibacterial potential has significantly limited biomaterials for many challenging applications such as infection free wound healing and/or tissue engineering etc. In this perspective, herein, a series of novel bio-composites with natural phenols as functional entities and keratin-EC as a base material were synthesised by laccase-assisted grafting. Subsequently, the resulting composites were removed from their respective casting surfaces, critically evaluated for their antibacterial and biocompatibility features and information is also given on their soil burial degradation profile. In-situ synthesised phenol-g-keratin-EC bio-composites possess strong anti-bacterial activity against Gram-positive and Gram-negative bacterial strains i.e., B. subtilis NCTC 3610, P. aeruginosa NCTC 10662, E. coli NTCT 10418 and S. aureus NCTC 6571. More specifically, 10HBA-g-keratin-EC and 20T-g-keratin-EC composites were 100% resistant to colonisation against all of the aforementioned bacterial strains, whereas, 15CA-g-keratin-EC and 15GA-g-keratin-EC showed almost negligible colonisation up to a variable extent. Moreover, at various phenolic concentrations used, the newly synthesised composites remained cytocompatible with human keratinocyte-like HaCaT, as an obvious cell ingrowth tendency was observed and indicated by the neutral red dye uptake assay. From the degradation point of view, an increase in the degradation rate was recorded during their soil burial analyses. Our investigations could encourage greater utilisation of natural materials to develop bio-composites with novel and sophisticated characteristics for potential applications.

Accessing Planktothrix species diversity and associated toxins using quantitative real-time PCR in natural waters

Tese de Doutoramento em Biologia apresentada à Faculdade de Ciências da Universidade do Porto, 2015.

Post-surgical wound infections involving Enterobacteriaceae with reduced susceptibility to ß-lactams in two Portuguese hospitals

The post-surgical period is often critical for infection acquisition. The combination of patient injury and environmental exposure through breached skin add risk to pre-existing conditions such as drug or depressed immunity. Several factors such as the period of hospital staying after surgery, base disease, age, immune system condition, hygiene policies, careless prophylactic drug administration and physical conditions of the healthcare centre may contribute to the acquisition of a nosocomial infection. A purulent wound can become complicated whenever antimicrobial therapy becomes compromised. In this pilot study, we analysed Enterobacteriaceae strains, the most significant gram-negative rods that may occur in post-surgical skin and soft tissue infections (SSTI) presenting reduced β-lactam susceptibility and those presenting extended-spectrum β-lactamases (ESBL). There is little information in our country regarding the relationship between β-lactam susceptibility, ESBL and development of resistant strains of microorganisms in SSTI. Our main results indicate Escherichia coli and Klebsiella spp. are among the most frequent enterobacteria (46% and 30% respectively) with ESBL production in 72% of Enterobacteriaceae isolates from SSTI. Moreover, coinfection occurred extensively, mainly with Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (18% and 13%, respectively). These results suggest future research to explore if and how these associations are involved in the development of antibiotic resistance.

Brazilian fruit pulps as functional foods and additives: Evaluation of bioactive compounds

Eight tropical fruit pulps from Brazil were simultaneously characterised in terms of their antioxidant and antimicrobial properties. Antioxidant activity was screened by DPPH radical scavenging activity (126–3987 mg TE/100 g DW) and ferric reduction activity power (368–20819 mg AAE/100 g DW), and complemented with total phenolic content (329–12466 mg GAE/100 g DW) and total flavonoid content measurements (46–672 mg EE /100 g DW), whereas antimicrobial activity was tested against the most frequently found food pathogens. Acerola and açaí presented the highest values for the antioxidant-related measurements. Direct correlations between these measurements could be observed for some of the fruits. Tamarind exhibited the broadest antimicrobial potential, having revealed growth inhibition of Pseudomonas aeruginosa. Escherichia coli, Listeria monocytogenes, Salmonella sp. and Staphylococcus aureus. Açaí and tamarind extracts presented an inverse relationship between antibacterial and antioxidant activities, and therefore, the antibacterial activity cannot be attributed (only) to phenolic compounds.