Severe Intestinal Infections Research Articles

Evaluation of the Incidence of Rotavirus Infection and the Effectiveness of Vaccination in the Khanty-Mansi Autonomous Ugra District in 2014–2018

Relevance. Rotavirus infection (RVI) is recognized as the main cause of severe gastroenteritis in children worldwide and leads to 527 000 deaths annually.Aim. Present study was intended to evaluate the effectiveness of anti-epidemic measures and vaccination against RVI in children in Pyt-Yakh, Khanty-Mansiysk Autonomous Okrug-Ugra in 2016–2017.Materials and methods. An analysis of the incidence of intestinal infection and RVI was carried out within 2 years prior (2014–2015) to and 2 years after (2016–2017) the implementation of anti-epidemic measures.A separate study was conducted to evaluate the safety and efficacy of a live oral pentavalent vaccine in 593 children including 433 who received three doses of the vaccine in 2016–2017.Results. It was shown that anti-epidemic measures including vaccination decreased the chances of RVI in children aged 0–17 years 1.68 fold in 2017–2018 compared to 2015–2016 (odds ratio (OR) 0.59, 95% confidence interval (CI) 0.49–0.71, p < 0.001). The same data were obtained for children 12 months and younger (OR 0.57, 95% CI 0.35–0.95, р = 0.037) and children aged 1–2 years old (OR 0.62, 95% CI 0.45–0.84, р = 0.002). There were no cases of moderate or severe intestinal infections or hospitalizations in vaccinated population as well as postvaccinal complications.Conclusion. The incidence of intestinal and rotavirus infections in all population in 2018 compared to 2016decreased by 53% and 72% respectively.

Total Synthesis of Tiacumicin B: Implementing Hydrogen Bond Directed Acceptor Delivery for Highly Selective β‐Glycosylations

AbstractA total synthesis of tiacumicin B, a natural macrolide whose remarkable antibiotic properties are used to treat severe intestinal infections, is reported. The strategy is in part based on the prior synthesis of the tiacumicin B aglycone, and on the decisive use of sulfoxides as anomeric leaving groups in hydrogen‐bond‐mediated aglycone delivery (HAD). This new HAD variant permitted highly β‐selective rhamnosylation and noviosylation. To increase convergence, the rhamnosylated C1–C3 fragment thus obtained was anchored to the C4–C19 aglycone fragment by adapting the Suzuki–Miyaura cross‐coupling used for the aglycone synthesis. Ring‐size‐selective macrolactonization provided a compound engaged directly in the noviolysation step with virtually total β selectivity. The final efficient removal of all the protecting groups provided synthetic tiacumicin B.

Total Synthesis of Tiacumicin B: Implementing Hydrogen Bond Directed Acceptor Delivery for Highly Selective β-Glycosylations.

A total synthesis of tiacumicin B, a natural macrolide whose remarkable antibiotic properties are used to treat severe intestinal infections, is reported. The strategy is in part based on the prior synthesis of the tiacumicin B aglycone, and on the decisive use of sulfoxides as anomeric leaving groups in hydrogen-bond-mediated aglycone delivery (HAD). This new HAD variant permitted highly β-selective rhamnosylation and noviosylation. To increase convergence, the rhamnosylated C1-C3 fragment thus obtained was anchored to the C4-C19 aglycone fragment by adapting the Suzuki-Miyaura cross-coupling used for the aglycone synthesis. Ring-size-selective macrolactonization provided a compound engaged directly in the noviolysation step with virtually total β selectivity. The final efficient removal of all the protecting groups provided synthetic tiacumicin B.

Schistosoma mansoni infection and risk factors among the fishermen of Lake Hawassa, southern Ethiopia.

Schistosomiasis is a neglected tropical parasitic disease caused by different species of genus Schistosoma. Schistosoma mansoni causes a severe intestinal parasitic infection of high public and medical importance in Ethiopia. This study aimed to determine the prevalence of, and risk factors for, S. mansoni infection among the fishermen of Lake Hawassa, southern Ethiopia, using a cross-sectional study design. A total of 243 fishermen were selected from the Hawassa Town Fishermen Association's list in 2013. Data on socio-demographic characteristics and risk factors were collected from the fishermen using semi-structured questionnaires. Stool samples were collected and processed using the Kato-Katz thick smear technique. The overall prevalence of S. mansoni among the fishermen was 29.21% and the mean intensity of infection was 158.88 eggs per gram (EPG). The overall prevalence of intestinal helminths, including S. mansoni, was 69.54%. Similar prevalences of S. mansoni were recorded in age groups 15-19, 20-24 and 25-29 years: 31.82%, 31.75% and 31.94%, respectively. Fishermen who swam a minimum of once a week in Lake Hawassa were 2.92 times (95% CI: 1.554, 5.502) more likely to have acquired S. mansoni infection than those who swam in the lake less than once a week. The results indicate moderate endemicity of S. mansoni infection among the fishermen of Lake Hawassa. These fishermen could be a potentially high-risk group for S. mansoni infection and might be responsible for the transmission of infection to other segments of the community visiting the lake for recreation. Moreover, a high prevalence of soil-transmitted helminths (STHs) was recorded among the fishermen. Integrated prevention and control strategies for schistosomiasis and STHs by different sectors are needed to tackle this problem.

Disease dynamics in a coupled cholera model linking within-host and between-host interactions

ABSTRACTA new modelling framework is proposed to study the within-host and between-host dynamics of cholera, a severe intestinal infection caused by the bacterium Vibrio cholerae. The within-host dynamics are characterized by the growth of highly infectious vibrios inside the human body. These vibrios shed from humans contribute to the environmental bacterial growth and the transmission of the disease among humans, providing a link from the within-host dynamics at the individual level to the between-host dynamics at the population and environmental level. A fast-slow analysis is conducted based on the two different time scales in our model. In particular, a bifurcation study is performed, and sufficient and necessary conditions are derived that lead to a backward bifurcation in cholera epidemics. Our result regarding the backward bifurcation highlights the challenges in the prevention and control of cholera.

Synergistic approach for treatment of chicken coccidiosis using berberine – A plant natural product

Despite the advent of anticoccidial drugs and vaccines, coccidiosis continues to result in substantial economic losses to the poultry industry. Berberine, a natural alkaloid is well known in studies involving synergistic approaches, thereby reducing the dosage of principal drugs. Therefore, a study was designed to see whether a synergistic anticoccidial effect could be obtained between amprolium and berberine, in vivo using broiler chicken. Anticoccidial activity was measured in comparison to the reference drug amprolium on the basis of oocyst output reduction, mean weight gain and feed conversion ratio. Oocyst output was measured using Mc-Masters counting technique. Different combinations of berberine and amprolium were tested and out of which 1:1 ratio was the most effective for controlling these parasites. Oral gavaging of 100(50 + 50) mg/kg body weight of 1:1 ratio of amprolium and berberine caused the equivalent reduction in number of oocysts (38.85 ± 9.61) one day prior to that of standard drug amprolium (49.95 ± 16.65) as well as pure berberine (44.4 ± 9.61) used in the study. Weight gain of birds was also highest in the synergistic group (1547.43 ± 12.86) among all the infected groups. Besides feed conversion ratio in the synergistic group was also better (1.387 ± 0.026). The results of this study proved the effectiveness of both amprolium and berberine and revealed synergism between amprolium and berberine against coccidian oocysts, confirmed by significant reduction in the number of coccidian oocysts shed in the feces, leading to better weight gain and improved feed conversion ratio. The study deep-rooted the synergistic potential of berberine, a natural bioactive compound for controlling a protozoan parasite and the results of this study corroborate with its use for treatment of severe diarrhoea, amoebiasis and intestinal infections.

The Clostridium difficile cell wall protein CwpV confers phase-variable phage resistance.

SummaryBacteriophages are present in virtually all ecosystems, and bacteria have developed multiple antiphage strategies to counter their attacks. C lostridium difficile is an important pathogen causing severe intestinal infections in humans and animals. Here we show that the conserved cell‐surface protein CwpV provides antiphage protection in C . difficile. This protein, for which the expression is phase‐variable, is classified into five types, each differing in their repeat‐containing C‐terminal domain. When expressed constitutively from a plasmid or the chromosome of locked ‘ON’ cells of C . difficile R20291, CwpV conferred antiphage protection. Differences in the level of phage protection were observed depending on the phage morphological group, siphophages being the most sensitive with efficiency of plaquing (EOP) values of < 5 × 10−7 for phages ϕCD38‐2, ϕCD111 and ϕCD146. Protection against the myophages ϕMMP01 and ϕCD52 was weaker, with EOP values between 9.0 × 10−3 and 1.1 × 10−1. The C‐terminal domain of CwpV carries the antiphage activity and its deletion, or part of it, significantly reduced the antiphage protection. CwpV does not affect phage adsorption, but phage DNA replication is prevented, suggesting a mechanism reminiscent of superinfection exclusion systems normally encoded on prophages. CwpV thus represents a novel ubiquitous host‐encoded and phase‐variable antiphage system in C . difficile.

A new bioinformatics analysis can reveal intestinal infection as a cause of graft rejection in islet xenotransplantation in non-human primate. (TRAN1P.940)

Abstract Pancreatic islet transplantation is one of the most attractive treatment modality for select type 1 diabetes patients suffering from frequent hypoglycemia unawareness. However, because of the shortage of human donor organs, xenotransplantation is becoming more highlighted. Under this circumstance, we have recently achieved reproducible and consistent survivals of adult porcine islet for more than 180 days in the liver of five diabetic monkeys under immunosuppression regimen base on anti-CD154. Interestingly, among five monkeys, one has exhibited graft failure after having experienced severe intestinal infections. Because the porcine islets were exposed to direct blood flow from the intestine, intestinal infection would exert detrimental effect on porcine islets. To test this hypothesis, we performed RNA-seq with peripheral blood from graft maintaining monkey or rejecting monkey after intestinal infections. By using novel bioinformatics tool called Time-series RNA-seq analysis package, we demonstrated highly relevant activated immunologic pathway in graft rejecting monkey, but not in well maintaining monkey. Consistent with this notion, we further confirmed that porcine islets were indeed rejected by CD8+ T cells by immunohistochemistry. Taken together, we for the first time showed that a new bioinformatics analysis using peripheral blood RNA-seq data can pinpoint intestinal infection as a cause of graft rejection in intraportal islet xenotransplantation.

Draft Genome Sequences of Four Closely Linked Vibrio vulnificus Isolates from the Biotype 1 Environmental Genotype.

Biotype 1 of Vibrio vulnificus, which causes severe invasive intestinal and wound infections, is split into two genotypes with all previously sequenced clinical isolates from the C genotypes. We report here the whole-genome sequencing of two clinical isolates and two closely linked oyster isolates from the E genotype for comparative studies.

Cladribine for 13 cases refractory high-risk children Langerhans cell histiocytosis

To observe the efficacy and adverse reaction of the improvement program of cladribine combined with cytarabine (2-CdA+Ara-C) in treatment of children with refractory high-risk Langerhans cell histiocytosis (LCH). 13 patients with refractory high-risk LCH or recurrent LCH were treated by combined 2-CdA+Ara-C chemotherapy. The treatment efficacy and the disease state in the process were evaluated according to the Histiocyte Society Evaluation and Treatment Guidelines (2009). The drug toxicity was evaluated according to the Common Terminology Criteria Adverse Events Version 4.0 (CTCAE v4.0, 2009). Of 13 patients, 10 cases achieved non active disease (NAD); 2 patients with liver cirrhosis before the improvement program with CIP-LCH-2012 gave up the treatment after 1 course of therapy; 1 patient died of infectious shock after chemotherapy with severe pulmonary infection and intestinal infection. All 13 patients had grade 3 of blood and lymphatic system toxicity; 10 patients had grade 1 of hepatobiliary and gastrointestinal side effects; 3 patients with liver cirrhosis before the improvement program had grade 2 or grade 3 of hepatobiliary system and gastrointestinal system side effects, including 1 patient of death. The improvement program of CIP-LCH-2012 had significant efficacy for children with refractory high-risk and relapsed LCH. The cladribine-associated toxicity was of significant myelosuppression, which may be tolerated in the most children patients. The program could be considered as a recommended salvage therapy for multi-system LCH (MS-LCH) after failure of first-line therapy, and as a first-line therapy for MS-LCH with risk organ injury. The program should be used with caution or dose-adjustment consideration for pre-treatment of severe organ damage exist, especially cirrhosis.

Effective concentration and detection of cryptosporidium, giardia, and the microsporidia from environmental matrices.

Cryptosporidium spp., Giardia spp., and members of Microsporidia are enteropathogenic parasites of humans and animals, producing asymptomatic to severe intestinal infections. To circumvent various impediments associated with current detection methods, we tested a method providing multistage purification and separation in a single, confined step. Standard real-time PCR was used as a detection method. Samples spiked with C. parvum and G. intestinalis were split for comparison to standard Method 1623. Results were equivalent to immunomagnetic procedures for Cryptosporidium, and Giardia. Overall percent recovery for Cryptosporidium with Method 1623 averaged 26.89% (std 21.44%; min = 0%; max = 73%) and was similar but less variable for qPCR method at an estimated average of 27.67 (std 17.65%; min = 5%; max = 63%). For Giardia, Method 1623 had an overall average recovery of 27.11% (std 17.98%; min = 1%; max = 58%), while multistage purification and qPCR had an estimated lower overall recovery at 18.58% (std 13.95%; min = 0%; max = 35%). Microsporidia were also readily detected with an estimated recovery of 46.81% overall (std 17.66%; min = 18%; max = 70%) for E. intestinalis and 38.90% (std 14.36%; min = 13%; max = 62%) for E. bieneusi.

Draft Genome Sequence of Israeli Outbreak-Associated Vibrio vulnificus Biotype 3 Clinical Isolate BAA87

Vibrio vulnificus is a seafood-associated pathogen that causes severe wound and intestinal infections. Biotype 3 of V. vulnificus emerged in 1996 as the cause of an Israeli outbreak associated with the handling of infected tilapia. Here, we describe the whole-genome sequence of the ATCC biotype 3 clinical isolate BAA87 (CDC9530-96).

Thiophenone and furanone in control ofEscherichia coliO103:H2 virulence

Escherichia coli are a mutual and foodborne pathogen, causing severe intestinal infections typically characterized by diarrhoea and vomiting. Biofilms are often a common source of pathogenic and nonpathogenic bacteria. Quorum sensing is a phenomenon where bacteria communicate and initiate the regulation of several virulence factors and biofilm formation. Thus, quorum sensing has been a new target in the fight against bacterial biofilms. In this study, we investigated the effect of two quorum-sensing inhibitors for preventing in vitro biofilm formation in wild-type E. coli O103:H2. Furanone F202 originates from the red algae Delisea pulchra, and thiophenone TF101 is a sulphur analogue of furanone. We also investigated the effect of thiophenone and furanone on virulence factors controlled by quorum sensing. Both TF101 and F202 interfered with biofilm formation, although TF101 was more effective. TF101 reduced motility presumably by interfering with flagella production, visualized by microscopic techniques. The expressions of flhd, which are involved in flagella synthesis, were affected by thiophenone. This is the first study exploring the effect of thiophenone on E. coli biofilm formation and virulence factors.

In vivo anticoccidial activity of berberine [18, 5,6-dihydro-9,10-dimethoxybenzo(g)-1,3-benzodioxolo(5,6-a) quinolizinium] – An isoquinoline alkaloid present in the root bark of Berberis lycium

Coccidiosis, caused by various Eimeria species, is a major parasitic disease in chicken. However the increasing resistance of these parasites to currently used anticoccidial drugs has stimulated the search for new methods of control. As part of this effort we investigated the root bark of Berberis lycium (barberry) as a potential source of compounds with anticoccidial activity. In the present study anticoccidial activity of different solvent extracts of the root bark of B. lycium and berberine was evaluated in vivo using broiler chicken. Results of the study demonstrated equipotent efficacy of pure berberine in comparison to that of standard drug amprolium on the basis of reduction in coccidian oocyst output, body weight gain of chicken and feed conversion ratio. Among the extracts crude methanolic extract showed highest anticoccidial activity tested at 300mg/kg body weight which could be due to the presence of alcohol-soluble active ingredients in root bark of B. lycium. Toxicological studies revealed that B. lycium extracts as well as berberine were not lethal up to dosage of 2000mg/kg body weight. LD50 was not determined as mortalities were not recorded in any of the five groups of chicken. From the present study it can be concluded that root bark of B. lycium has the immense potential to contribute to the control of coccidian parasites of chicken. Our results corroborate the use of berberine for treatment of severe diarrhoea, amoebiasis and intestinal infections and could justify its use in folk medicine for treatment of haemorrhagic dysentery.

Splenectomy prior to antiviral therapy in patients with hepatitis C virus related decompensated cirrhosis

Patients with hepatitis C virus-related decompensated cirrhosis can benefit from interferon-based antiviral therapy, but the common complication of cytopenia is a contraindication for this treatment. Splenectomy prior to interferon therapy may alleviate this problem. To investigate whether splenectomy improves the efficacy of antiviral therapy, 13 interferon-naïve hepatitis C virus decompensated cirrhotic patients underwent splenectomy between January 2008 and January 2011, followed 1–3 months later by an interferon-based therapeutic regimen (pegylated/standard interferon-α combined with ribavirin for 48 weeks). Ten (76.9%) of the patients developed postoperative complications, which included minor portal vein thrombosis (2/13, 15.4%) and transient ascites (8/13, 61.5%). At one-month post-splenectomy, the patients showed significantly increased platelet (pre-surgery: 48.2±15.9 vs. 186.0±70.6×103μL−1, p<0.001) and leukocyte (2.1±0.5 vs. 5.7±1.4×103μL−1, p<0.001) counts. Eight (61.5%) of the patients achieved sustained virological response, including all HCV genotype 2a-infected patients (4/4, 100%) and some of the genotype 1b-infected patients (4/9, 44.4%). Temporary interferon-α suspension was required for one patient to address severe intestinal infection. These results indicate that splenectomy prior to interferon-based therapy was safe and may facilitate adherence to subsequent antiviral therapy in selected HCV cirrhotic patients with portal hypertension and hypersplenism.

Proteomic View of Interactions of Shiga Toxin-Producing Escherichia coli with the Intestinal Environment in Gnotobiotic Piglets

BackgroundShiga toxin (Stx)-producing Escherichia coli cause severe intestinal infections involving colonization of epithelial Peyer’s patches and formation of attachment/effacement (A/E) lesions. These lesions trigger leukocyte infiltration followed by inflammation and intestinal hemorrhage. Systems biology, which explores the crosstalk of Stx-producing Escherichia coli with the in vivo host environment, may elucidate novel molecular pathogenesis aspects.Methodology/Principal FindingsEnterohemorrhagic E. coli strain 86–24 produces Shiga toxin-2 and belongs to the serotype O157:H7. Bacterial cells were scrapped from stationary phase cultures (the in vitro condition) and used to infect gnotobiotic piglets via intestinal lavage. Bacterial cells isolated from the piglets’ guts constituted the in vivo condition. Cell lysates were subjected to quantitative 2D gel and shotgun proteomic analyses, revealing metabolic shifts towards anaerobic energy generation, changes in carbon utilization, phosphate and ammonia starvation, and high activity of a glutamate decarboxylase acid resistance system in vivo. Increased abundance of pyridine nucleotide transhydrogenase (PntA and PntB) suggested in vivo shortage of intracellular NADPH. Abundance changes of proteins implicated in lipopolysaccharide biosynthesis (LpxC, ArnA, the predicted acyltransferase L7029) and outer membrane (OM) assembly (LptD, MlaA, MlaC) suggested bacterial cell surface modulation in response to activated host defenses. Indeed, there was evidence for interactions of innate immunity-associated proteins secreted into the intestines (GP340, REG3-γ, resistin, lithostathine, and trefoil factor 3) with the bacterial cell envelope.SignificanceProteomic analysis afforded insights into system-wide adaptations of strain 86–24 to a hostile intestinal milieu, including responses to limited nutrients and cofactor supplies, intracellular acidification, and reactive nitrogen and oxygen species-mediated stress. Protein and lipopolysaccharide compositions of the OM were altered. Enhanced expression of type III secretion system effectors correlated with a metabolic shift back to a more aerobic milieu in vivo. Apparent pathogen pattern recognition molecules from piglet intestinal secretions adhered strongly to the bacterial cell surface.

Bacillus cereus and severe intestinal infections in preterm neonates: Putative role of pooled breast milk

Bacillus cereus is an environmental pathogen whose spores resist the usual cleaning procedure applied by the food industry and hospitals. We reported a cluster of severe intestinal infections due to Bcereus in 2 very low birth weight neonates from a neonatal intensive care unit. Environmental sampling and bacteriological analysis of pooled breast milk (PBM) were performed. Practices for preparation and administration of milk were observed and additional laboratory experiments performed. Strains were typed using M13-polymerase chain reaction and their virulence tested using cellular and insect models. Bcereus strains were exclusively isolated from intestinal tracts and PBM. No environmental culture yielded any viable Bcereus. Although genotypically diverse, both clinical and food strains exhibited high virulence potency. These findings pointed out the pathogenic potency of Bcereus in neonates; the putative role of PBM as a reservoir for pathogenic Bcereus and the triggered effect ofadefective care procedure, which allowed the growth of bacteria in pasteurized PBM. Well described from dried formula, the presence of pathogenic Bcereus strains in PBM was not previously reported. Careful monitoring of conditions during collection, conservation, and administration of PBM should be implemented in high-risk populations such as premature neonates.

Protective effect of glucose–insulin–potassium (GIK) on intestinal tissues after severe burn in experimental rats

Intestinal barrier damage after scald and burns, other trauma or major operations result in severe intestinal infections that cause serious consequences. Therefore, it is important to develop methods to protect intestinal barrier after severe burns. This study used rats that had full-thickness burn of approximately 30% of the total body surface area to investigate the effect and mechanism of glucose–insulin–potassium (GIK) and provide experimental evidence for application of GIK in protecting the intestine after burns or other trauma and major surgeries. The results show that the degree of intestinal damage and plasma diamine oxidase (DAO) levels in GIK (the concentrations of glucose, insulin, sodium chloride and potassium chloride were 100gl−1, 70Ul−1, 9gl−1 and 5gl−1, respectively) and insulin (30IUl−1) treatment groups were significantly lower than that in control group; the status of anti-inflammatory and pro-inflammatory cytokines and the ratio between them in GIK and insulin groups also significantly improved compared to those in control group; intestinal tumour necrosis factor-alpha (TNFα), nuclear factor-kappaB (NF-κB) and interleukin-10 (IL-10) messenger RNA (mRNA) expression and IL10/TNFα in GIK and insulin groups 2 days after the injury were also improved significantly compared to those in control group. All the indices including body weight detected in GIK group were improved to those in insulin group. Taken together, these results show that GIK and insulin show protective effect on intestine after severe burn, which may relate to controlling hyperglycaemia and regulating intestinal expression of NFκB and pro-inflammatory and anti-inflammatory cytokine genes by GIK and insulin; the protective effect of GIK on intestinal tissue after severe burn is superior to that of using insulin alone, which may attribute to improving the nutritional status by glucose supplement and the relatively higher dose of insulin in the GIK group.

GM-CSF: a role in immune and inflammatory reactions in the intestine

Granulocyte macrophage colony-stimulating factor (GM-CSF) is a cytokine that promotes myeloid cell development and maturation, and dendritic cell differentiation and survival in vitro. Growing evidence supports the notion that GM-CSF has a major role in some inflammatory and autoimmune reactions and in the host’s response to pulmonary infection, but few studies have addressed its functions and importance in the GI tract. Recent studies demonstrated that administration of GM-CSF can result in clinical improvement in patients with Crohn’s disease. Mice deficient in GM-CSF (GM-CSF-/-) developed more severe intestinal and systemic infection after an enteric infection, and more severe colitis in response to enteric exposure to dextran sodium sulfate. Both the severity of infection and colitis were largely prevented by GM-CSF administration. Such studies indicate that GM-CSF has an important role in the regulation of intestinal immune and inflammatory responses.

Selective Growth Inhibitory Effect of Biochanin A Against Intestinal Tract Colonizing Bacteria

Both bifidobacteria and clostridia are part of the natural gut microflora and while clostridia may be responsible for severe intestinal infections, bifidobacteria are probiotic microorganisms belonging to the most important prospective bacteria in the bowel. The antimicrobial activity of biochanin A was tested in vitro against six Bifidobacterium spp., and eight Clostridium spp. using the broth microdilution method. Biochanin A showed an inhibition against all clostridia in the range of minimum inhibitory concentrations (MIC) from 64 μg/mL (for Cl. clostridioforme, strains DSM 933 and I3) to 1,024 μg/mL (for Cl. perfringens, DSM 11778). No bifidobacteria were suppressed at four-fold higher concentration (MICs > 4,096) than MIC of Cl. perfringens. These results indicate selective growth inhibition of biochanin A and its potential use in antimicrobial prevention and/or protection.