Wald/DeMuri Research Group

Our research is mainly focused on upper respiratory infections (URI) in children such as sinusitis, otitis media and pharyngitis.

Probiotics as a preventive for upper respiratory infections

Upper respiratory tract infections (URI) are one of the most common infectious diseases of childhood and lead to complications such as acute bacterial sinusitis and otitis media. Yet, there are very few interventions that patients can use to prevent URI. Our group is interested in the use of probiotics to prevent or modify URI and its complications. We are studying the mechanism of probiotics in altering the immune response in children and how this may affect the duration and severity of URI. In addition, we are interested in the safety profile of probiotics in children.

Nasal cytokine responses in children with viral upper respiratory infection

Acute bacterial sinusitis is one of the most common complications of upper respiratory tract infection and results in millions of antibiotic prescriptions per year. Distinguishing URI from sinusitis can be challenging in the early stages of illness. In this NIH-funded study we are analyzing the cytokine profiles in the nasopharynx during episodes of upper respiratory infection and during episodes of sinusitis. We will compare the cytokine signature in URIs that are uncomplicated with those that develop into sinusitis, with the goal of identifying a marker(s) that aid in the recognition of sinusitis and the reduction of unnecessary antibiotic use.

Transcriptomic and genetic differences of group A streptococcus in humans: Acute infection versus carriage

Acute pharyngitis is the most common illness for which children and adults seek acute medical care. Group A streptococcus (GAS) is the most frequent bacterial cause of pharyngitis in children and causes both suppurative (acute otitis media, acute sinusitis, mastoiditis) and non-suppurative (post-streptococcal glomerulonephritis and acute rheumatic fever) sequelae. The carrier state of GAS is of particular significance to public health as carriers serve as a reservoir for spread of the pathogen to others in the population. This study is being performed in collaboration with Dr. Laura Cook at the State University of New York-Binghamtom and Dr. Michael Federle at the University of Illinois-Chicago. Children with acute GAS pharyngitis will be recruited and enrolled in the study. The specific goals of this study are to 1) demonstrate the transcriptomic profiles and genetic differences in GAS recovered from individuals with acute pharyngitis compared to GAS recovered from carriers and 2) employ in vitro and tissue culture models of carriage to determine how differentially expressed genes or genetic mutations affect the colonization potential of GAS. This study will offer the first data on the transcriptomics of GAS carrier state in a human host, providing invaluable information on the genetic and transcriptional changes GAS undergoes when switching from a pathogenic to colonization state in the only natural host.

Use of anterior mouth (“lollipop”) swabs in the diagnosis of group A streptococcal (GAS) pharyngitis

Streptococcal pharyngitis is the most common bacterial cause of sore throat and accounts for 20-30% of sore throats in children and 10-15% of episodes of pharyngitis in adults. The diagnosis of streptococcal pharyngitis is made by swabbing the posterior pharynx. Although pharyngeal swabs are not painful, they do result in mild discomfort and often are dreaded by young children. This may lead to children being uncooperative and struggling against the procedure (resulting in a negative experience for patient, parent and provider) as well as decreased sample quality which may result in a missed diagnosis. We are seeking to determine if streptococcal pharyngeal infections can be detected in saliva, specifically in swabs inoculated by children sucking on them in the anterior portion of the mouth as they would a lollipop. Recently, highly sensitive PCR based methods have been FDA cleared for the diagnosis of GAS on pharyngeal swabs. This study will address the performance of PCR from anterior mouth swabs compared with traditional throat swabs.

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Wald – https://www.ncbi.nlm.nih.gov/myncbi/ellen.wald.1/bibliography/public/

DeMuri – https://www.ncbi.nlm.nih.gov/myncbi/gregory.demuri.1/bibliography/public/