Background: Community acquired pneumonia (CAP) is a high incidence disease resulting in about 260,000 hospital admissions per year in Germany, more than myocardial infarction or stroke. Worldwide, CAP is the most frequent infectious disease with high lethality ranging from 1.2 % in those 20–29 years old to over 10 % in patients older than 70 years, even in industrial nations. CAP poses numerous medical challenges, which the PROGRESS (Pneumonia Research Network on Genetic Resistance and Susceptibility for the Evolution of Severe Sepsis) network aims to tackle: Operationalization of disease severity throughout the course of disease, outcome prediction for hospitalized patients and prediction of transitions from uncomplicated CAP to severe CAP, and finally, to CAP with sepsis and organ failure as a life-threatening condition. It is a major aim of PROGRESS to understand and predict patient heterogeneity regarding outcome in the hospital and to develop novel treatment concepts. Methods: PROGRESS was designed as a clinical, observational, multi-center study of patients with CAP requiring hospitalization. More than 1600 patients selected for low burden of co-morbidities have been enrolled, aiming at a total of 3000. Course of disease, along with therapy, was closely monitored by daily assessments and long-term follow-up. Daily blood samples allow in depth molecular-genetic characterization of patients. We established a well-organized workflow for sample logistics and a comprehensive data management system to collect and manage data from more than 50 study centers in Germany and Austria. Samples are stored in a central biobank and clinical data are stored in a central data base which also integrates all data from molecular assessments. Discussion: With the PROGRESS study, we established a comprehensive data base of high quality clinical and molecular data allowing investigation of pressing research questions regarding CAP. In-depth molecular characterization will contribute to the discovery of disease mechanisms and establishment of diagnostic and predictive biomarkers. A strength of PROGRESS is the focus on younger patients with low burden of co-morbidities, allowing a more direct look at host biology with less confounding. As a resulting limitation, insights from PROGRESS will require validation in representative patient cohorts to assess clinical utility. Trial registration: The PROGRESS study was retrospectively registered on May 24th, 2016 with ClinicalTrials.gov: NCT02782013

S. aureus est un pathogène humain qui produit une grande variété de facteurs de virulence, dont la leucocidine de Panton Valentine. Cette toxine est à l’origine de symptomatologies potentiellement sévères telles que la pneumonie nécrosante et l’ostéomyélite compliquée récidivante. Malgré la faible prévalence des gènes de la PVL au sein de souches de S. aureus, nous assistons à une émergence et à une diffusion de souches S. aureus résistantes à la méticilline d’origine communautaire (SARM-C) produisant la PVL. Bien que hautement conservée au sein de différents génomes, la PVL produite par les souches SARM-C américaines USA300 porte une substitution His176Arg avec un impact potentiel sur la fonctionnalité de la PVL. Nous avons étudié la distribution de ce polymorphisme au sein d’une sélection de souches SARM-C isolées de divers continents et nous avons confirmé le rôle leucotoxique de la PVL envers les neutrophiles humains quel que soit le fond génétique de la souche d’origine. Nous avons mis au point un modèle expérimental de lapin afin d’étudier le rôle de la PVL secrétée par la souche USA300 dans la pathogenèse de l’ostéomyélite. La PVL s’est révélée être un déterminant de la gravité de la maladie en termes de persistance et extension de l’infection, ainsi que d’amplitude de la réaction inflammatoire. Dès lors que nous avons conforté le rôle pathogène de la PVL, nous avons exploré l’effet des antibiotiques sur l’expression de la leucocidine. Nous avons observé après traitement avec l’oxacilline et l’imipénème une augmentation de la production de PVL. Cette augmentation est le résultat d’une activation transcriptionnelle des gènes de la PVL, activation médiée par les protéines liant la pénicilline et des régulateurs de la virulence staphylococcique, sarA et rot. D’autres antibiotiques la clindamycine, le linézolide et la rifampicine exercent un effet inhibiteur sur la production de PVL et bloquent l’induction de toxine par les bêta-lactamines. Sur la base de ces observations, nous recommandons pour le traitement des infections sévères à S. aureus producteur de PVL l’utilisation de l’oxacilline en association avec la clindamycine ou la rifampicine pour S. aureus sensible à la méticilline et du linézolide pour le SARM. / S. aureus is a human pathogen producing a large variety of virulence factors such as the Panton Valentine leukocidin (PVL). This toxin has been epidemiologically related to severe diseases such as necrotising pneumonia and recurrent osteomyelitis. The world wide spreading of PVL producing community acquired methicillin resistant S. aureus (CA-MRSA) has been reported. Although highly preserved within various genomes, the sequence of PVL produced by the american CA-MRSA strain USA300 carries a His176Arg substitution with a potential impact on the functionality of the leukocidin. We studied the distribution of this polymorphism within a selection of CA-MRSA strains isolated from various continents and we confirmed PVL toxicity towards human neutrophiles regardless to the genetic background of the harboring strain. We used an experimental rabbit model in order to study the relevancy of USA300 secreted PVL in the pathogenesis of osteomyelitis. We showed that PVL is a determinant of disease severity in terms of persistence and extension of the infection, as well as amplitude of the inflammatory reaction. We investigated the effect of antibiotics on the expression of the leukocidin. We observed increase PVL production after oxacilline and imipenem treatment. This was the consequence of trascriptional activation of PVL genes, mediated by penicillin binding proteins and S. aureus virulence regulators sarA and rot. Other antibiotics such as clindamycin, linezolid and rifampicin decreased PVL production and suppressed the inductor effect of beta-lactams. Based on these observations, we recommend for the treatment of the severe PVL induced diseases the use of oxacillin associated with either clindamycin or rifampicin for methicillin susceptible S. aureus or linezolid for MRSA.

Les pneumopathies acquises sous ventilation mécanique (PAVM) sont responsables d'une mortalité élevée. La nébulisation d'antibiotiques permet d'améliorer l'efficacité de leur traitement. Pour autant, aucune donnée pharmacocinétique portant sur la colistine et la gentamicine ne permet de recommander un schéma posologique particulier.Nous avons comparé les propriétés pharmacocinétiques plasmatique et intra-pulmonaire de la colistine (administrée sous forme de prodrogue, le colistiméthate sodique ou CMS) et de la gentamicine selon le mode d'administration (nébulisation ou perfusion intraveineuse) chez des patients de réanimation présentant une PAVM.Les concentrations intra-pulmonaires de colistine et de gentamicine étaient, respectivement, de 10 à 40 et 50 à 70 fois supérieures, après nébulisation, à celles retrouvées après administration d'une même dose par voie intraveineuse. La nébulisation permettrait également de limiter le risque de toxicité systémique avec une biodisponibilité inférieure à 10%.En assurant de fortes concentrations intra-pulmonaires et un faible passage systémique, la nébulisation de CMS et de gentamicine pourrait être une bonne alternative à leur administration intraveineuse dans le traitement des PAVM. / Ventilator-associated pneumonia (VAP) is associated with high mortality. Nebulization of antibiotics improves outcome of patient with VAP. However, pharmacokinetic data concerning colistin and gentamicin allowing for optimal dosing regimen recommendation are lacking.We compared systemic and pulmonary concentrations of colistin (administered as an inactive prodrug, colistin methanesulfonate or CMS) and gentamicin according to the route of administration (nebulization and intravenous infusion) in critically ill patients with VAP.Intra-pulmonary concentrations of colistin and gentamicin were 10 to 40-fold and 50 to 70-fold much higher after nebulization than after the same dose by intravenous route, respectively. Nebulization has also the theoretical potential advantage to improve patients' safety in relation to the colistin biodisponibility lower than 10%.With high intra-pulmonary concentrations and very low systemic absorption, CMS and gentamicin nebulization may be good alternatives to intravenous infusion for VAP treatment.

Streptococcus pneumoniae é o principal causador da pneumonia bacteriana. As vacinas atualmente disponíveis contêm polissacarídeo capsular conjugado ou não com proteínas carreadoras. No entanto, elas apresentam elevado custo ou proteção reduzida nos grupos de risco (crianças abaixo de 5 anos de idade e idosos). Proteínas de superfície de S. pneumoniae, como a PsaA e PspA, são consideradas fortes candidatas vacinais. Com o objetivo de se desenvolver uma vacina de ampla cobertura e baixo custo contra pneumococos, os genes psaA e pspA foram clonados em vetores de expressão em E. coli, pAE e pET e as proteínas expressas foram purificadas por cromatografias de afinidade e de troca aniônica. O rendimento de proteína recombinante obtido com a construção baseada em pET foi 3 vezes maior que o obtido com pAE. Condições de cultivo foram estabelecidas utilizando meio definido com indução por IPTG e/ou por lactose. As cepas recombinantes estão adequadas para serem usadas em estudos para escalonamento da produção em biorreatores. / Streptococcus pneumoniae is the main causative agent of bacterial pneumonia. The current vaccines available contain capsular polysaccharide conjugated or not with carrier proteins. However these are either too expensive or do not protect the high-risk groups. Surface proteins of S. pneumoniae, such as PsaA and PspA, are considered strong vaccine candidates. With the aim of developing a broad-coverage and low-cost vaccine against pneumococcus, the psaA and pspA genes were cloned in E. coli expression vectors, pAE and pET and the expressed proteins were purified through affinity and anion exchange chromatography. The yield of the recombinant protein obtained with the construction based in pET was 3-fold higher than that obtained with pAE. Culture conditions were established using defined media with IPTG and/or lactose induction. The recombinant strains are now ready to undergo studies for scale-up of production in bioreactors.

Le paludisme et la pneumonie constituent encore des problèmes de santé publique dans les pays à faible revenu, dont Madagascar. Toutefois, si le paludisme a reçu plus d’attention et vu ses programmes de lutte renforcés depuis la création du Fonds mondial en 2002, la pneumonie quant à elle est souvent négligée. Cependant, depuis peu, l’Unicef, s’appuyant sur les résultats encourageants obtenus au niveau communautaire dans la lutte contre le paludisme, pousse à l’intégration du dépistage et de la prise en charge de la pneumonie au niveau communautaire. Pour appuyer ce plaidoyer, des études d’impact et de type coût-efficacité sont nécessaires pour vérifier que cette stratégie est bien efficace et efficiente. C’est l’objet du chapitre 4 de cette thèse qui étudie l’expérience pilote menée par l’Unicef dans le district d’Antalaha. Nous montrons que ce programme a eu un impact notable sur la prise en charge du paludisme et de la pneumonie. Toutefois, la qualité de cette prise en charge est encore remise en question. Cela indique que, avant de décider d’une mise à l’échelle, ce programme mérite d’être révisé pour l’améliorer. Outre la perte de bien-être, le paludisme et la pneumonie ont un coût financier d’abord, économique, ensuite. Un des arguments de plaidoyer est alors de montrer, s’il y en a, les effets économiques des deux maladies. C’est l’objet des chapitres 2 et 3 avec une application à Madagascar. Auparavant, le sous-bassement théorique du lien entre santé et revenu ou développement économique est présenté dans le premier chapitre. / Malaria and pneumonia remain a public health problem in low-income countries, including Madagascar. However, while malaria has received more attention and its control programs have been strengthened since the creation of the Global Fund in 2002, pneumonia is often neglected. Face on the encouraging results of malaria community case management, UNICEF wants to integrate pneumonia management at community level. To support this advocacy, the impact and the cost-effectiveness of this strategy must be known to verify that it is effective and efficient. This is the purpose of Chapter 4 of this thesis which studies the pilot experiment conducted by Unicef in the district of Antalaha. It is shown that this program has had a significant impact on the management of malaria and pneumonia. However, the quality of this care is questioned. This situation indicates that, before scaling up, this program should be revised to improve it. Besides the loss of well-being, malaria and pneumonia have a financial and economic cost. Therefore, the economic effects of the two diseases are shown in the chapters 2 and 3 concerning the case of Madagascar. Previously, the theoretical under-base of the link between health and economic development is presented in the first chapter.

A suinocultura brasileira representa uma importante atividade econômica para o país, o qual ocupa lugar de destaque na produção e exportação de carne suína no mundo. O destaque do país na produção de suínos, deve-se a melhorias na sanidade, manejo, produção integrada e, principalmente, no aprimoramento gerencial dos produtores. O primeiro artigo consistiu em determinar a frequência e a distribuição das doenças infecciosas (DI) diagnosticadas através de exame de necropsia e histopatologia em suínos nas fases de crescimento e terminação ao longo de 12 anos (2005-2016) no sul do Brasil. Foram avaliados 1906 laudos anatomopatológicos de suínos nas fases de crescimento/terminação, dos quais as DI corresponderam a 75,6% (1441 casos) do total. As infecções por circovírus suíno tipo 2 (PCV2) foram as mais frequentes, contabilizando 51,3% (739/1441) dos casos, seguidas por DI que afetam o sistema respiratório (30,1% dos casos). Dentre essas, destacam-se a influenza suína A (15,1%; 218/1441) e pneumonias bacterianas (15%; 216/1441). O diagnóstico de influenza exibiu uma frequência elevada entre os anos de 2010 a 2013, totalizando 43,1% (167/387) dos casos. Após este período, ambas DI respiratórias exibiram caráter endêmico. As DI que afetam o sistema digestório totalizaram 10,5% (151/1441) dos diagnósticos, com as seguintes condições: enterocolite por Salmonella spp. (43,7%; 66/151), enteropatia proliferativa por Lawsonia spp. (41,7%; 63/151) e colite por Brachyspira spp. (14,6%; 22/151). Além dessas, as polisserosites e meningites bacterianas representaram 5,8% (84/1441) e 2,3% (33/1441) dos casos diagnosticados, respectivamente. O segundo artigo descreve três surtos de doença por circovírus suíno tipo-2 (PCVD) com lesões envolvendo musculatura esquelética. Em um curso clínico de 7 a 10 dias, 92 suínos apresentaram apatia, emagrecimento e diarreia. Ainda, cerca de 30 dos suínos afetados, apresentavam dificuldade de locomoção, fraqueza muscular, paresia de membros pélvicos e decúbito permanente. Quatro suínos exibiram palidez em músculos esqueléticos dos membros pélvicos, torácicos e dorso-lombares. As lesões microscópicas observadas consistiam de miosite necrótica granulomatosa, predominantemente, em membros pélvicos e torácicos, e em menor intensidade nos músculos dorso-lombares. No exame imuno-histoquímico para PCV2 observou-se marcação multifocal acentuada, predominantemente, no citoplasma e núcleos de macrófagos, linfócitos e células gigantes multinucleadas, além de marcação discreta no citoplasma no citoplasma de fibras necróticas da musculatura esquelética. As amostras de músculo esquelético foram positivas na reação em cadeia de polimerase para PCV2 e a ampliação exibiu 99% de identidade com sequências pertencentes ao genótipo PCV2b. / Brazilian pig farms represent an important economic activity for the country, which occupies a prominent place in the production and export of pork in the world. The country's prominence in pork production is due to improvements in sanitation, management, integrated production and, mainly, in the managerial improvement of the producers. The first study aimed to determine the frequency and distribution of infectious diseases (ID) diagnosed through necropsy and histopathology examination in growing-finishing swine along 12 years (2005-2016) in Southern Brazil. A total of 1906 anatomopathological exams performed in growing-finishing swine were evaluated, of which ID accounted for 75.6% (1441 cases) of the total. Porcine circovirus type 2 (PCV2) infections were the most frequent, accounting for 51.3% of the cases (739/1441), followed by respiratory system ID (30.1% of the cases). Among these, the main conditions were swine influenza (15.1%; 218/1441) and bacterial pneumonia (15%; 216/1441). Influenza diagnosis had a higher frequency between 2010 and 2013, accounting for 43,1% (167/387) of the cases. After this period, both respiratory ID had an endemic occurrence. Digestive system ID accounted for 10.5% (151/1441) of the diagnosis, with the main conditions diagnosed: Salmonella spp. enterocolitis (43.7%; 66/151), Lawsonia spp. proliferative enteropathy (41.7%; 63/151) and Brachyspira spp. colitis (14.6%; 22/151). Besides these, polyserositis and bacterial meningitis represented, respectively, 5.8% (84/1441) and 2.3% (33/1441) of the cases diagnosed. The second study describes three outbreak of porcine circovirus disease (PCVD) with the involvement of skeletal muscle. In a clinical course of 7 to 10 days, 92 pigs had apathy, weight loss and diarrhea. Approximately 30 of these 92 pigs had stiff gait, muscle weakness, hind limb paresis, and recumbency. 4 pigs necropsied presented pale discoloration from hind and thoracic limbs, as well from dorsal lumbar skeletal muscles. The microscopical lesions consisted of granulomatous necrotizing myositis mainly of hind and thoracic limbs, and mildly from dorsal lumbar muscles. Immunohistochemistry exam for PCV2 revealed marked multifocal intracytoplasmic and intranuclear staining predominantly in macrophages, lymphocytes and multinucleated giant cells, with a lower amount in the cytoplasm of necrotic fibers of the skeletal muscle. Affected muscle samples were polymerase chain reaction– positive for PCV2 and the amplicon exhibited 99% identity with sequences belonging to the PCV2b genotype.

Chemoattractant agents play a crucial role in the initiation of immune responses, by regulating the traffic and function of leucocyte populations. Their receptors are therefore considered as potential targets for the development of new therapies in the fields of cancer and inflammatory diseases. ChemR23, a previously orphan receptor discovered in the laboratory, is structurally related to receptors for chemoattractant agents. It is expressed on immature myeloid and plasmacytoid dendritic cells (mDCs and pDCs respectively), as well as on adipocytes, macrophages, NK and endothelial cells. Chemerin, the endogenous ligand of ChemR23, is abundant in various human samples originating from inflammatory diseases, including pleural effusions. Chemerin is secreted as an inactive precursor, prochemerin, and is activated by the removal of six or seven amino-acids from its carboxy-terminus by serine proteases, such as as cathepsin G and elastase. Chemerin acts as a chemoattractant agent of low nanomolar potency for macrophages, immature mDCs and pDCs. It is however more active on pDCs, in line with the higher expression of ChemR23 on these cells. pDCs possess important immunoregulatory properties in lung diseases, and their ability to secrete large amounts of type I interferon (IFN) upon viral infection makes them crucial players in anti-viral immunity.<p>According to these elements, and to the role of neutrophils in the physiopathology of many inflammatory lung diseases and in the generation of active chemerin, we began in 2007 to study the role of chemerin and its receptor ChemR23 in inflammatory lung diseases. We first characterized the mouse chemerin/ChemR23 system, and described that this system was very similar to the human one, in terms of distribution, pharmacology and functional properties. We then used wild type mice (WT) and mice invalidated for the receptor (ChemR23-/-) in various models of inflammatory lung diseases, including asthma, lung fibrosis, viral pneumonia, and acute lung injury. <p>Whereas the asthma and lung fibrosis models did not allow to demonstrate a significant role of the chemerin/ChemR23 system (possibly as a result of the lack of production of active chemerin in these models), infection by either the Pneumonia Virus of Mice (PVM), the mouse counterpart of human RSV, or by a murinized H1N1 influenza strain resulted in a significantly higher mortality rate in ChemR23-/- mice as compared to their WT counterparts. Using the PVM-induced pneumonia model, we observed that the excessive mortality of knock-out mice is caused by an inadequate and excessive innate immune response characterized by a massive recruitment of neutrophils to the lungs, associated with a delayed viral clearance and lower type I IFN synthesis. This latter observation suggested an impairment of pDC recruitment, according to the important contribution of pDCs to the production of type I IFNs in viral diseases, and the role of chemerin in the recruitment of these cells. We indeed confirmed a lower recruitment of pDCs in the lung of infected ChemR23-/- mice, as compared to WT mice. However, experiments of adoptive transfert and depletion of pDCs failed to proof a link between impaired pDC recruitment and the excessive morbidity and mortality observed in ChemR23-invalidated mice. <p>In parallel, we studied the role of the chemerin/ChemR23 system in the control of innate immune responses, by using a model of acute lung injury caused by the intra-tracheal instillation of bacterial lipopolysaccharide (LPS). In this model, administration of recombinant chemerin together with LPS in WT mice resulted in a significant (about 50%) reduction of neutrophil recruitment to both lung parenchyma and airways. Assessment of pro-inflammatory cytokines and chemokines in broncho-alveolar lavage fluids confirmed this anti-inflammatory effect of chemerin, which was ChemR23-dependent, as the inflammatory response of ChemR23-/- mice was unaffected by chemerin. In our hands, chemerin does not modulate macrophage functions, in contrast to data recently published by other groups, attributing anti-inflammatory effects of chemerin or chemerin-derived peptide to the modulation of macrophage activation and phagocytosis. Other hypotheses that could take our observations into account are presently investigated, including an immunomodulatory role of chemerin on lung epithelial or endothelial cells, and/or the ChemR23-dependent recruitment of subtypes of macrophages or other myeloid cells endowed with immunosuppressive properties. <p>In conclusion, our studies characterized the mouse chemerin/ChemR23 system and highlighted the role of this system in the physiopathology of some inflammatory lung diseases. Our results suggest that the chemerin/ChemR23 system might be considered as a potential therapeutic target for the development of future anti-infectious and anti-inflammatory therapies, particularly for viral pneumonia, which represent a major public health problem, as well as for acute respiratory distress syndrome (ARDS) following severe acute lung injuries.<p> <p><p>Les agents chimioattractants jouent un rôle fondamental dans l’initiation des réponses immunes en régulant le trafic et la fonction des populations leucocytaires. Leurs récepteurs constituent dès lors des cibles d’intérêt pour le développement de traitements contre les maladies inflammatoires et le cancer. Le laboratoire d’accueil a identifié le récepteur ChemR23, exprimé à la surface des cellules dendritiques myéloïdes (mDCs) et plasmacytoïdes (pDCs) immatures, des macrophages, des cellules NK, des adipocytes, et des cellules endothéliales. Le ligand endogène du récepteur ChemR23, la chémérine, est présent en abondance dans divers échantillons pathologiques d’origine inflammatoire. La chémérine est produite sous la forme d'un précurseur inactif, la prochémérine, qui nécessite pour devenir active le clivage protéolytique de six ou sept acides aminés à son extrémité carboxy-terminale. La chémérine induit le chimiotactisme des macrophages et des DCs immatures, et en particulier des pDCs immatures en accord avec l’expression plus importante de ChemR23 par les pDCs. Les pDCs jouent un rôle immunorégulateur important en pathologie pulmonaire, en particulier dans la physiopathologie des pneumonies virales, par leur capacité à produire d’importantes quantités d’interféron (IFN) de type I.<p>Compte tenu de ces éléments et du rôle des polynucléaires neutrophiles dans de nombreuses pathologies pulmonaires, ainsi que dans la génération de chémérine active à partir de son précurseur, nous avons débuté en octobre 2007, l’étude du rôle de la chémérine et de son récepteur ChemR23 dans le contrôle des pathologies pulmonaires inflammatoires. Nous avons tout d’abord caractérisé le système chémérine/ChemR23 chez la souris et avons montré que ce système présentait des caractéristiques similaires à celles décrites chez l’homme, en termes de distribution, de pharmacologie et de propriétés fonctionnelles. <p>Ensuite, nous avons comparé des souris sauvages et invalidées pour le récepteur ChemR23 (ChemR23-/-) dans divers modèles de pathologies pulmonaires. Les modèles d’asthme et de fibrose pulmonaire induite par instillation de bléomycine ou de silice n’ont pas permis de mettre en évidence un rôle important du couple chémérine/ChemR23, peut-être en raison de l’absence de génération de forme active de chémérine dans ces modèles. En revanche, l’administration de deux agents viraux différents, le PVM (Pneumonia Virus of Mice), l’équivalent murin du RSV humain, et un virus de l’influenza H1N1 murinisé, a résulté en un taux de mortalité 40% plus élevé pour les souris ChemR23-/- par rapport à leurs homologues sauvages. En utilisant le modèle de pneumonie induite par le PVM, nous avons montré que cette différence de mortalité est causée par une réponse immune inappropriée et excessive, associée à une réduction de l’élimination du virus, ainsi qu’à un déficit de synthèse d’IFN de type I. Les pDCs, dans un contexte d’infection virale, sont capables de synthétiser d’importantes quantités d’IFN de type I, et nous avons mis en évidence un déficit relatif de recrutement en pDCs chez les souris ChemR23-/- infectées. Néanmoins, les expériences de transfert adoptif et de déplétion de pDCs n’ont pas permis de lier ce défaut de recrutement à l’excès de morbidité et de mortalité observé chez les souris ChemR23-/- infectées. <p>En parallèle, le rôle de ce couple ligand-récepteur dans le contrôle des réponses immunitaires innées a été étudié dans un modèle de pneumopathie aiguë induite par instillation intra-trachéale de lipopolysaccharide (LPS). Dans ce modèle, l’administration simultanée de chémérine recombinante avec le LPS entraîne chez les souris sauvages une diminution significative (environ 50%) du nombre de polynucléaires neutrophiles recrutés dans les voies aériennes et dans le parenchyme pulmonaire, ainsi qu’une importante diminution de synthèse de cytokines pro-inflammatoires. Cet effet anti-inflammatoire de la chémérine est dépendant de ChemR23, et ne semble pas être secondaire à un effet de la chémérine sur l’activation des macrophages, contrairement à certaines données publiées récemment par d’autres groupes. D’autres hypothèses permettraient cependant de prendre en compte ces observations, notamment un effet de la chémérine sur les cellules épithéliales et/ou endothéliales pulmonaires, ainsi que sur le recrutement de sous-populations de macrophages ou d’autres cellules myéloïdes possédant des propriétés immunosuppressives. Des expériences complémentaires ont été initiées afin de tester ces hypothèses. <p>En conclusion, après avoir caractérisé le système chémérine/ChemR23 chez la souris, nos études ont permis de mettre en évidence le rôle de ce couple ligand/récepteur dans la physiopathologie de certaines pneumopathies inflammatoires, ouvrant ainsi de nouvelles perspectives thérapeutiques, en particulier pour le traitement des pneumopathies virales, qui constituent un problème de santé publique majeur, ainsi que des syndromes de détresse respiratoire aiguë (ARDS). / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-10-17T13:18:52Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_IncidenciaInfeccaoHospitalar.pdf: 1290455 bytes, checksum: b987e2dd281d83e5bd2516f53119f227 (MD5) / Approved for entry into archive by Irvana Coutinho (irvana@ufpa.br) on 2017-10-17T14:09:11Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_IncidenciaInfeccaoHospitalar.pdf: 1290455 bytes, checksum: b987e2dd281d83e5bd2516f53119f227 (MD5) / Made available in DSpace on 2017-10-17T14:09:11Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_IncidenciaInfeccaoHospitalar.pdf: 1290455 bytes, checksum: b987e2dd281d83e5bd2516f53119f227 (MD5) Previous issue date: 2008 / Pacientes portadores do HIV/AIDS podem ser expostos aos mesmos riscos para aquisição de Infecção Hospitalar (IH) que os não infectados. Contudo, fatores relacionados à imunodepressão desses pacientes, representam papel importante na patogênese relacionada ao desenvolvimento da infecção nosocomial. O estudo investigou e comparou a incidência de infecções entre pacientes portadores do HIV e pacientes admitidos com outras doenças que não HIV/AIDS, internados na Clínica de Doenças Infecciosas e Parasitárias do Hospital Universitário João de Barros Barreto, e relacionou-o aos procedimentos invasivos (ventilador mecânico, sonda vesical de demora e cateter vascular central). A metodologia utilizada baseou-se em estudo analítico, observacional, prospectivo, realizado no período de fevereiro a dezembro de 2007, mediante visitas diárias aos pacientes desde a sua internação até a alta, na busca de infecções. Dentre as 1.130 saídas e 20.276 pacientes-dia, 40 pacientes evoluíram com IH, sendo 17 (42,5%) pacientes não-HIV e 23 (57,5%) pacientes HIV positivos, na qual desenvolveram 19 (39,6%) e 29 (60,4%) infecções hospitalares, respectivamente. 11 (55%) pacientes HIV positivos apresentaram contagem de células TCD4<100cél/mm3 e 15 (65,22%) evoluíram a óbito associado à IH. A incidência de infecção hospitalar foi maior para os pacientes HIV positivos, com 3,09 episódios por 1000 pacientes-dia, que para os pacientes não-HIV (1,74 episódios por 1000 pacientes-dia), assim como a pneumonia, topografia mais freqüente, a qual teve uma incidência de 1,6 episódios por 1000 pacientes-dia. Quanto à influência do procedimento invasivo, a infecção do trato urinário (ITU) foi maior nos pacientes não-HIV com 12,11 episódios de ITU relacionada à sonda vesical de demora (SVD) por 1000 SVD-dia. Os resultados deste estudo sugerem que os pacientes HIV positivos são mais predispostos a evoluir com IH, provavelmente pelo seu estado imunológico associado aos procedimentos invasivos, o que justifica a necessidade de medidas preventivas direcionadas para esta população. / HIV/AIDS patients may be exposed to the same risks for acquisition of nosocomial infections than non-HIV/AIDS patients, however, factors related to the immune suppression of former patients represent important paper in the pathogenesis for the development of nosocomial infections. This study investigated and compared the incidence of infections between HIV infected inpatients and non-infected inpatients in the Infectious Diseases Service of Hospital Universitário João de Barros Barreto. Nosocomial infections were related to invasive procedures (mechanical ventilation, urinary and central vascular catheter). It was an analytical, observational and prospective study, accomplished from February to December, 2007. Daily visits were performed by infection control team and the researcher from the first day in the Hospital to his discharge. There were reported 1.130 exits and 20.276 patients-day; 40 patients developed nosocomial infections and 17 (42,5%) non-HIV patients had 19 (39,6%) infections and 23 (57,5%) HIV patients developed 29 (60,4%) infections; eleven (55%) of these 23 patients had T4 cells counts less than 100cells/mm3 and 15 (65,22%) deaths were related to nosocomial infections. Hospital infections rates in HIV patients were higher than in non-HIV patients (3.09 versus 1.74 infections by 1000 patients-day). Pneumonia was the most frequent infection site an its incidence was 1,6 episodes for 1000 patients-day. Urinary tract infection in non-HIV patients was 12,11 episodes by 1000 urinary catheters-day compared to 4,41 episodes by 1000 urinary catheters-day in HIV positive patients. In conclusion, HIV patients are more susceptible to acquire nosocomial infections probably because of immune suppression related to HIV infection and invasive procedures and preventive and control measures should be directed to this patient population.

Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-10-18T15:55:51Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PrevalenciaPneumoniaUnidade.pdf: 2308365 bytes, checksum: 00d2b3ad3bcd519d7d2de9783c94ebc6 (MD5) / Approved for entry into archive by Irvana Coutinho (irvana@ufpa.br) on 2017-11-14T15:30:13Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PrevalenciaPneumoniaUnidade.pdf: 2308365 bytes, checksum: 00d2b3ad3bcd519d7d2de9783c94ebc6 (MD5) / Made available in DSpace on 2017-11-14T15:30:13Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PrevalenciaPneumoniaUnidade.pdf: 2308365 bytes, checksum: 00d2b3ad3bcd519d7d2de9783c94ebc6 (MD5) Previous issue date: 2012-09-12 / A pneumonia constitui um importante problema de saúde pública contribuindo com altas taxas de morbidade e mortalidade no mundo principalmente nos países em desenvolvimento. Este estudo tem como objetivo avaliar a prevalência de pneumonia em crianças hospitalizadas em Unidade de Terapia Intensiva pediátrica, bem como estimar a incidência destas crianças, com diagnostico de pneumonia e quais variáveis estão associadas com o desenvolvimento da pneumonia, determinar qual a incidência da mortalidade infantil nesta Unidade de Terapia Intensiva por pneumonia. Trata-se de um estudo de caráter descritivo com delineamento transversal e abordagem retrospectiva a partir de revisão de prontuários de crianças que estiveram hospitalizadas em uma Unidade de Terapia Intensiva pediátrica de um hospital público municipal de Imperatriz no Maranhão, durante o período de janeiro a dezembro de 2011. Os dados foram obtidos inicialmente através dos registros contidos em livro de admissão das crianças na Unidade de Terapia Intensiva Pediátrica, onde se constatou 230 admissões. Em um segundo momento, foram selecionados e incluídos na pesquisa prontuários de crianças de ambos os sexos na faixa etária de um mês a 12 anos de idade, internados Unidade de Terapia Intensiva pediátrica com diagnóstico de pneumonia hospitalar, perfazendo uma amostra de 60 prontuários, dos quais realizou-se coleta dos dados contidos nos mesmos utilizando-se formulário previamente estruturado. Dos 230 pacientes internados na Unidade de Terapia Intensiva do referido hospital, no período de janeiro a dezembro de 2011 26%(n=60) desenvolveram pneumonia nosocomial, faixa etária que compreende entre 1 a 12 meses 63% (n=38), seguidos das idades entre 13 e 36 meses com 36%(n= 13 ), o diagnóstico de pneumonia foi de 26%. Observou-se que a pneumonia relacionada a assistência à saúde no Hospital Infantil de Imperatriz representou uma complicação frequente em pacientes pediátricos sob cuidados intensivos, sendo um fator agravante para ocorrência de óbitos, com importante relação a procedimentos invasivos em especial ventilação mecânica invasiva, bem como a terapêutica utilizada. / Pneumonia is an important public health problem contributing to high rates of morbidity and mortality in the world especially in developing countries. This study aims to evaluate the prevalence of pneumonia in children hospitalized in the pediatric intensive care unit, as well as to estimate the incidence of these children, with diagnosis of pneumonia and identify variables associated with the development of pneumonia, which determine the incidence of infant mortality this ICU for pneumonia. This is a descriptive study with cross-sectional and retrospective approach from a review of medical records of children who were hospitalized in a pediatric intensive care unit of a Municipal Hospital in Imperatriz Maranhão, during the period January to December 2011. data were initially obtained through the records contained in the admission book of children in the Pediatric Intensive Care Unit, where they found 230 admissions. In a second stage, were selected and included in the records of children of both sexes aged one month to 12 years of age, hospitalized pediatric intensive care unit with a diagnosis of nosocomial pneumonia research, making a sample of 60 medical records of which held the collection of the data contained therein using previously structured form. Of the 230 patients admitted to the Intensive Care Unit of the hospital, in the period January-December 2011 26% (n = 60) developed nosocomial pneumonia, age between 1 to 12 months 63% (n = 38), followed ages between 13 and 36 months with 36% (n = 13), the diagnosis of pneumonia was 26%. It was observed that pneumonia related to health care at the Children's Hospital the Imperatriz represented a common complication in pediatric patients under intensive care, being an aggravating factor for the occurrence of deaths, with important relationship to invasive procedures particularly invasive mechanical ventilation as well as therapy used.

Pseudomonas aeruginosa est un pathogène opportuniste responsable de pneumonies. Il est particulièrement impliqué dans la mortalité des patients sous ventilation mécanique et des patients atteints de la mucoviscidose. Ces infections sont difficiles à traiter en raison de l’existence de nombreuses résistances aux antibiotiques chez cette bactérie et des alternatives thérapeutiques s’avèrent donc nécessaires. Nous avons ainsi émis l’hypothèse qu’une application oropharyngée de lactobacilles pourrait permettre de limiter les infections à P. aeruginosa et leurs effets chez les patients concernés. L’objectif principal de ce travail était d’évaluer les effets d’un mélange de lactobacilles dans un modèle murin de pneumonie à P. aeruginosa. Les effets de lactobacilles isolés dans les cavités orales de volontaires sains sur la formation de biofilm et l’activité élastolytique de P. aeruginosa PAO1 ont été mesurés in vitro. Les effets des lactobacilles sélectionnés ont ensuite été évalués dans un modèle d’infection de cellules épithéliales respiratoires(A549) par P. aeruginosa PAO1 puis dans un modèle murin de pneumonie à P. aeruginosa PAO1. Les effets de 87 lactobacilles sur la formation de biofilm et l’activité élastolytique de P. aeruginosa PAO1 ont été déterminés in vitro,aboutissant à la sélection de 3 et 5 souches ayant respectivement inhibé la formation de biofilm et l’activité élastolytique de P. aeruginosa PAO1. Parmi ces souches, L. fermentum K.C6.3.1E, L. paracasei ES.D.88 et L. zeae Od.76,qui étaient les souches les plus actives contre la formation de biofilm ou l’activité élastolytique et les plus acidifiantes lors de croissances dans une salive artificielle, ont été associées dans un mélange testé dans un modèle cellulaire d’infection à P. aeruginosa PAO1. Ce mélange n’a pas eu d’effet cytotoxique et a démontré un effet cytoprotecteur vis-à-vis de l’infection à P. aeruginosa PAO1. In vivo, l’administration intratrachéale de ces mêmes bactéries de façon prophylactique a permis d’une part de réduire les charges pulmonaires en P. aeruginosa PAO1 et d’autre part de réduire ses effets pro-inflammatoires au niveau pulmonaire (IL-6, TNF-α). Ces résultats prometteurs laissent entrevoir la possibilité de nouvelles applications thérapeutiques pour les probiotiques. / Pseudomonas aeruginosa is an opportunistic pathogen that causes pneumonia and which is involved in themortality of mechanically-ventilated or cystic fibrosis patients.These infections are difficult to treat because of the existence of many antibiotic resistances in P. aeruginosa and therapeutic alternatives are needed. Our hypothesis was that the use of probiotics could be an alternative to antibiotic therapy in order to reduce P. aeruginosa infections and its injurious and pro-inflammatory effects in lungs.The main goal of this work was to evaluate the effects of lactobacilli in a murine model of P. aeruginosa pneumonia.The first step of this work was to screen lactobacilli isolated from oral cavities of healthy volunteers against biofilmformation and elastolytic activity of P. aeruginosa PAO1. The effects of selected lactobacilli were then evaluated in amodel of infection of lung epithelial cells by P. aeruginosa PAO1 and in a murine model of P. aeruginosa PAO1pneumonia. Eighty-seven lactobacilli were tested in vitro, leading to the selection of 3 and 5 strains respectively active against biofilm formation and elastolytic activity. The most active strains (L. fermentum K.C6.3.1E, L. paracasei ES.D.88and L. zeae Od.76) toward biofilm formation and elastolytic activity were chosen to be tested in vitro, in a cell model of P. aeruginosa PAO1 infection. This mix showed cytoprotective effect against P. aeruginosa PAO1. Finally, the prophylactic intratracheal administration of the mix of lactobacilli in mice allowed to reduce the pulmonary loads in P.aeruginosa PAO1. In the same time, the pro-inflammatory effects(IL-6 and TNF- α) of the infection were reduced. These promising results suggest the possibility of new therapeutic applications for probiotics.