ABSTRACT
Autologous vaccines (short: autovaccines) have been used since the beginning of the 20th century to treat chronic staphylococcal infections, but their mechanisms of action are still obscure. This prospective pilot study involved four patients with furunculosis who were vaccinated with autologous formalin-killed Staphylococcus aureus cells. Vaccines were individually prepared from the infecting S. aureus strain and repeatedly injected subcutaneously in increasing doses over several months. We characterized the virulence gene repertoire and spa genotype of the infecting and colonising S. aureus strains. Serum antibody responses to secreted and surface-bound bacterial antigens were determined by two-dimensional immunoblotting and flow-cytometry based assays (Luminex). All patients reported clinical improvement. Molecular characterization showed that all strains isolated from one patient over time belonged to the same S. aureus clone. Already before treatment, there was robust antibody binding to a broad range of staphylococcal antigens. Autovaccination moderately boosted the IgG response to extracellular antigens in two patients, while the antibody response of the other two patients was not affected. Similarly, vaccination moderately enhanced the antibody response against some staphylococcal surface proteins, e.g. ClfA, ClfB, SdrD and SdrE. In summary, autovaccination only slightly boosted the pre-existing serum antibody response, predominantly to bacterial surface antigens.
Subject(s)
Antibodies, Bacterial/blood , Autovaccines/immunology , Furunculosis/immunology , Furunculosis/microbiology , Staphylococcal Infections/immunology , Staphylococcal Vaccines/immunology , Staphylococcus aureus/immunology , Adult , Autovaccines/administration & dosage , Electrophoresis, Gel, Two-Dimensional , Female , Formaldehyde , Humans , Immunoblotting , Immunoglobulin G/blood , Male , Middle Aged , Prospective Studies , Serum/chemistry , Staphylococcal Infections/microbiology , Staphylococcal Vaccines/administration & dosage , Staphylococcus aureus/isolation & purification , Vaccines, Inactivated/administration & dosage , Vaccines, Inactivated/immunology , Young AdultABSTRACT
The aim of this work was to investigate HLA phenotype predisposition to posttransplantation diabetes mellitus (PTDM) in kidney transplant recipients stratified according to kidney failure etiology. Ninety-eight transplant recipient pairs with kidney grafts from the same cadaveric donor were qualified for the study. In each pair, 1 kidney was grafted to an individual with autosomal dominant polycystic kidney disease (ADPKD group) and 1 to recipient with a different cause of kidney failure (non-ADPKD group). All class II HLA antigens were determined with the PCR-SSP molecular method. To identify class I HLA molecules we used both molecular and serologic methods. Diabetes was diagnosed according to the American Diabetes Association criteria. The posttransplantation observation period was 12 months. In the ADPKD group, HLA-B27 was more common in PTDM than non-PTDM patients; 31.6% versus 11.4% (P = .069). The difference achieved significance when comparing insulin-treated with non-insulin-treated patients (44.4% vs 12.4%; P = .029). In the non-ADPKD group, HLA-A28 and HLA-B13 were observed more frequently in patients with PTDM than in recipients without diabetes (22.2% vs 2.5% [P = .0099] and 22.2% vs 3.8% [P = .020]). All of these associations were significant upon multivariate analysis. HLA-B27 allele is a factor predisposing ADPKD patients to insulin-dependent PTDM. Antigens predisposing to PTDM among kidney graft recipients without ADPKD include HLA-A28 and B13.
Subject(s)
Diabetes Mellitus/etiology , HLA-B27 Antigen/immunology , Kidney Transplantation/adverse effects , Polycystic Kidney, Autosomal Dominant/surgery , Adult , Diabetes Mellitus/diagnosis , Diabetes Mellitus/genetics , Diabetes Mellitus/immunology , Female , Gene Frequency , Genotype , HLA-B27 Antigen/genetics , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Phenotype , Poland , Polycystic Kidney, Autosomal Dominant/immunology , Polymerase Chain Reaction , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
The aim of this study was to analyse the resistance patterns, serotypes and genetic diversity of Streptococcus pneumoniae-resistant strains isolated in the West Pomerania region of Poland. They were clinical isolates obtained during a 5-year study (2001-2005) mainly from ambulatory patients with upper respiratory tract infections. The strains showed resistance to 8 out of 9 tested antibiotics (except vancomycin) and 53.8% of the strains were multidrug-resistant (MDR). The increase over time in the number of MDR strains and in resistance degrees was not statistically significant. Resistance to cotrimoxazole was the most frequent (86.7%). Penicillin nonsusceptibility was shown in 38% of the strains and resistance to macrolides in 36.7% of the strains, mainly of MLS(B) phenotype (94.1%). A significant resistance increase was only observed for beta-lactam antibiotic. The population of S. pneumoniae-resistant strains in our region presented 31 resistance patterns, 13 serotypes and a high genetic diversity-70 pulse field gel electrophoresis (PFGE) profiles have been described: 44 of them were unique and 26 clusters consisted of 2 to 30 strains similar by more than 87%. Cluster I, grouping 30 strains of similar resistant patterns (TSH: 70%, SH, TH, T, H, S) and mainly serotype 19F, isolated over the 5 years of the study, could represent a new national clone. The polysaccharide 23-valent vaccine covers 83.5%, while the conjugated 7-, 9- and 11-valent vaccines cover 79.1-79.7% of the resistant strains collected in our region. A statistically significant decrease of vaccine coverage in time has been noted.
