In the Biopneumo study we investigate if patients with pneumococcal invasive disease, i.e. patients with bacteria infecting the blood stream, have defects in their immune responses. We further determine bacterial factors associated with the disease, and how pneumococcal bacteria modulate immune responses.
Adult patients with invasive pneumococcal disease are identified at microbiological laboratories in the Region Västra Götaland, and prospectively included at the clinic. The patients are sampled during disease for assessment of immunoglobulin levels, and for analysis of polymorphisms in genes involved in immune responses. After two months the patients return and donate blood for assessments of phagocyte function, lymphocyte populations and immunoglobulins. Clinical data including risk factors, manifestations and outcome are collected. Virulence traits in the pneumococcal strains are determined by genome sequencing methods. In vitro experiments analyze microRNA and surface protein expression in monocytes stimulated by pneumococcal bacteria.
We expect to identify new risk groups in need of immunological investigations and/or preventions, such as vaccination or immunoglobulin substitution. We further expect to find many patients with undiscovered immune deficiencies or underlying conditions that need special care.
In Tanzania, DR Congo and Ethiopia we identify risk factors for carriage of pneumococcal bacteria, including exposure to indoor air pollution due to cooking on open fires. We assess the circulating types of pneumococci in children after introduction of pneumococcal conjugate vaccines in the child immunization programs. We also determine antimicrobial resistance rates in bacterial pathogens present in children. There is a high misuse of antibiotics in Sub-Saharan Africa leading to high rates of antimicrobial resistance in bacteria causing common infections in the child population. In Tanzania we qualitatively explore behavior patterns among mothers to young children and among health care professionals in the primary health care level on the use of antibiotics in children. The project will guide implementations aiming to improve the rational use of antibiotics in Tanzania and hence reduce the level of antimicrobial resistance in the community.