Effective control of Staphylococcus aureus lung infection despite tertiary lymphoid structure disorganisation.

BACKGROUND: Tertiary lymphoid structures (TLS) are triggered by persistent bronchopulmonary infection with Staphylococcus aureus, but their roles remain elusive. The present study sought to examine the effects of B- and/or T-cell depletion on S. aureus infection and TLS development (lymphoid neogenesis) in mice. METHODS: C57Bl/6 mice were pre-treated with 1) an anti-CD20 monoclonal antibody (mAb) (B-cell depletion) or 2) an anti-CD4 and/or an anti-CD8 mAb (T-cell depletion) or 3) a combination of anti-CD20, anti-CD4 and anti-CD8 mAbs (combined B- and T-cell depletion) or 4) isotype control mAbs. After lymphocyte depletion, mice were infected by intratracheal instillation of agarose beads containing S. aureus (106 CFU per mouse). 14 days later, bacterial load and lung inflammatory cell infiltration were assessed by cultures and immunohistochemistry, respectively. RESULTS: 14 days after S. aureus-bead instillation, lung bacterial load was comparable between control and lymphocyte-depleted mice. While TLS were observed in the lungs of infected mice pre-treated with control mAbs, these structures were disorganised or abolished in the lungs of lymphocyte-depleted mice. The absence of CD20+ B-lymphocytes had no effect on CD3+ T-lymphocyte infiltration, whereas CD4+/CD8+ T-cell depletion markedly reduced CD20+ B-cell infiltration. Depletion of CD4+ or CD8+ T-cells separately had limited effect on B-cell infiltration, but led to the absence of germinal centres. CONCLUSION: TLS disorganisation is not associated with loss of infection control in mice persistently infected with S. aureus.

A Telemedicine Intervention to Ensure the Correct Usage of Inhaler Devices.

Background: Chronic obstructive pulmonary disease and asthma patients' use of inhalers is error prone. Introduction: This study evaluated telemedicine to improve the use of inhalers. Materials and Methods: Prospective, single-center pilot study in 50 patients with long-term prescription of inhaled medicine and ongoing home health care visits. In an initial telemedicine intervention, tablet devices were used by the patient to record inhaler use at home in the real-time remote presence of a physician. Errors were identified, explained to the patient, and corrected remotely. When necessary, further telemedicine interventions were scheduled at 24-48 h intervals. Follow-up interventions were performed during routine outpatient visits. Patient satisfaction was evaluated on a scale of 0 (completely unsatisfied) to 10 (completely satisfied). Results: An initial telemedicine intervention was conducted for 42 of the 50 patients included. In these patients, 96 initial inhaler medicine administration telemedicine interventions were performed, of which 94 were usable. In the initial interventions, 71 errors were identified, of which 22 (31%) were considered critical. In 81 follow-up interventions in 39 patients (median delay 256 days), 32 errors were identified (p < 0.001 vs. initial 71 errors), of which 7 were critical (p = 0.0017 vs. initial 22 errors). Discussion: This paves the way for future studies testing putative benefits of telemedicine regarding inhaled drug delivery, treatment adherence, disease control, quality of life, and health care burden and costs. Conclusions: A telemedicine intervention aimed at improving the administration of inhaled medication by adult patients at home is feasible, highly appreciated by patients, and effective at correcting medicine administration errors.