A comparison of the NIRUDAK models and WHO algorithm for dehydration assessment in older children and adults with acute diarrhoea: a prospective, observational study

Levine, Adam C; Gainey, Monique; Qu, Kexin; Nasrin, Sabiha; Sharif, Mohsena Bint-E; Noor, Syada S; Barry, Meagan A; Garbern, Stephanie C; Schmid, Christopher H; Rosen, Rochelle K; Nelson, Eric J; Alam, Nur H

doi:10.1016/s2214-109x(23)00403-5

Cited by 8 publications

(2 citation statements)

References 25 publications

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“…This allowed us to capture both intracellular and cell-bound phages, along with free phage particles, but sequencing each fraction separately could yield further insights into distinct phage populations. (v) From a clinical perspective, the measurement of dehydration status was categorical and could be improved in future studies by incorporating digital tools to quantify the degree of dehydration (44)(45)(46). (vi) Lastly, our study lacked information about host genetics or immunity, which also influence disease severity (8,47).…”

Section: Discussionmentioning

confidence: 99%

Phage predation, disease severity, and pathogen genetic diversity in cholera patients

Madi,

Cato,

Abu Sayeed

et al. 2024

Science

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Despite an increasingly detailed picture of the molecular mechanisms of bacteriophage (phage)–bacterial interactions, we lack an understanding of how these interactions evolve and impact disease within patients. In this work, we report a year-long, nationwide study of diarrheal disease patients in Bangladesh. Among cholera patients, we quantified Vibrio cholerae (prey) and its virulent phages (predators) using metagenomics and quantitative polymerase chain reaction while accounting for antibiotic exposure using quantitative mass spectrometry. Virulent phage (ICP1) and antibiotics suppressed V. cholerae to varying degrees and were inversely associated with severe dehydration depending on resistance mechanisms. In the absence of antiphage defenses, predation was “effective,” with a high predator:prey ratio that correlated with increased genetic diversity among the prey. In the presence of antiphage defenses, predation was “ineffective,” with a lower predator:prey ratio that correlated with increased genetic diversity among the predators. Phage-bacteria coevolution within patients should therefore be considered in the deployment of phage-based therapies and diagnostics.

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Section: Discussionmentioning

confidence: 99%

Phage predation, disease severity, and pathogen genetic diversity in cholera patients

Madi,

Cato,

Abu Sayeed

et al. 2024

Science

View full text Add to dashboard Cite

show abstract

“…This allowed us to capture both intracellular and cell-bound phages, along with free phage particles, but sequencing each fraction separately could yield further insights into distinct phage populations. From a clinical perspective, the measurement of dehydration status was categorical and could be improved in future studies by incorporating digital tools to quantify the degree of dehydration (44)(45)(46). Finally, our study lacked information about host genetics or immunity, which also influence disease severity (8,47).…”

Section: Phages Not Antibiotics Are Associated With Vc Within-host Di...mentioning

confidence: 99%

Phage predation, disease severity and pathogen genetic diversity in cholera patients

Madi,

Cato,

Sayeed

et al. 2023

Preprint

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Nearly a century has passed since d'Herelle and colleagues discovered phages that infectVibrio choleraeand mitigate cholera epidemics. Despite an increasingly detailed picture of the molecular mechanisms of resistance and counter-resistance that shape phage and bacterial interactions, we lack an understanding of how these interactions play out during natural infection, how they are affected by antibiotic exposure, and how they relate to clinical outcomes. To fill these gaps, we conducted a year-long, nation-wide study of diarrheal patients in the cholera-endemic setting of Bangladesh. A total of 2574 stool samples were collected from enrolled patients at hospital admission and screened forV. choleraeand virulent phages (ICP1, 2, or 3). All 282 culture positive samples, and an additional 107 culture negative but PCR positive samples, were analyzed by shotgun metagenomic sequencing. From these metagenomes, we estimated the relative abundances ofV. cholerae, phages, and members of the gut microbiome, while accounting for antibiotic exposure determined by quantitative mass spectrometry. Consistent with d'Herelle's thesis, we observed higher phage toV. choleraeratios in patients with mild dehydration, demonstrating in the modern era that phages are indicative of disease severity. Antibiotics were associated with lessV. choleraeand with mild disease; ciprofloxacin in particular was associated with several known antibiotic resistance genes. Phage resistance genes in theV. choleraeintegrative conjugative element (ICE) were associated with lower phage toV. choleraeratios. In the absence of detectable ICEs, phages shaped genetic diversity, selecting for nonsynonymous point mutations in theV. choleraegenome. Together, our results point to both antibiotics and phages as inverse correlates of disease severity, while also selecting for resistance genes or mutations within cholera patients.

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Point of care lactate for differentiating septic shock from hypovolemic shock in non-ICU settings: a prospective observational study

Shahrin,

Sarmin,

Parvin

et al. 2024

The Lancet Regional Health - Southeast Asia

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A comparison of the NIRUDAK models and WHO algorithm for dehydration assessment in older children and adults with acute diarrhoea: a prospective, observational study

Cited by 8 publications

References 25 publications

Phage predation, disease severity, and pathogen genetic diversity in cholera patients

Phage predation, disease severity, and pathogen genetic diversity in cholera patients

Phage predation, disease severity and pathogen genetic diversity in cholera patients

Point of care lactate for differentiating septic shock from hypovolemic shock in non-ICU settings: a prospective observational study

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