High serum endostatin levels in Down syndrome: implications for improved treatment and prevention of solid tumours

We report here a comparison of serum endostatin levels in Down syndrome patients to normal control subjects. We analysed serum samples from 35 patients with Down syndrome and 54 normal control subjects and found that although serum levels of endostatin vary widely in a normal human population, serum endostatin levels are significantly elevated in patients with Down syndrome. This result may explain the relative decrease in incidence of various solid tissue tumours observed in Down syndrome, given the role of endostatin as a potent inhibitor of tumour-induced angiogenesis in both human and animal models. Based upon these data, we propose that an increase of about one-third of normal endostatin serum levels may represent an effective therapeutic dose to significantly inhibit many solid tumours.

Cloning, overexpression, purification, and immunobiology of an 85-kilodalton outer membrane protein from Haemophilus ducreyi

We have identified an 85-kDa outer membrane protein that is expressed by all tested strains of Haemophilus ducreyi. Studies of related proteins from other pathogenic bacteria, including Haemophilus influenzae, Pasteurella multocida, Neisseria gonorrhoeae, Neisseria meningitidis, and Shigella dysenteriae, suggested a role for these proteins in pathogenesis and immunity. In keeping with the first such described protein from Haemophilus influenzae type B, we termed the H. ducreyi protein D15. The gene encoding the H. ducreyi D15 protein was cloned and sequenced, and the deduced amino acid sequence was found to be most similar to sequences of the D15-related proteins from other Pasteurella spp. The arrangement of the flanking genes was similar to that of H. influenzae Rd and suggested that D15 was part of a multigene operon. Attempts to make a null mutation of the D15 gene were unsuccessful, paralleling results in other D15 gene studies. Overexpression of H. ducreyi D15 in Escherichia coli resulted in a source of recombinant D15 (rD15) from which it was readily purified. rD15 was immunogenic, and it was found that immunization of rabbits with an rD15 vaccine preparation conferred partial protection against a virulent challenge infection. Antisera to an N-terminal peptide recognized all tested strains of H. ducreyi.

Brain abscess caused by methicillin-resistant Staphylococcus aureus

A Swedish tourist was admitted to a Cuban hospital due to epileptic seizures caused by brain tumors. Upon return to Sweden and admission to our hospital, methicillin-resistant Staphylococcus aureus (MRSA) was isolated. He was later considered to be free of MRSA but then developed a brain abscess from which MRSA was isolated.

Prevalence of sindbis virus neutralizing antibodies among Swedish passerines indicates that thrushes are the main amplifying hosts

The Sindbis virus uses birds as vertebrate hosts in the summer amplification cycle, and the virus is transmitted by ornithophilic Culex species. Previous field and experimental studies have shown that mainly passerine birds are involved in the amplification. To delineate the pattern of Sindbis virus infections among passerines, we collected and sampled birds for blood at five study sites located in northern, central, and southern Sweden. All study sites were lowland forested wetlands and humid forests. The blood samples were assayed for Sindbis neutralizing antibodies, and we tested if the prevalence of Sindbis antibodies varied in relation to bird characteristics (i.e., species, body-mass, sex, and age), and environmental factors (i.e., year, month, and location). We found that Sindbis virus infections occurred in almost all passerine species sampled, but that the infection prevalence was unequally distributed among species. The fieldfare, the redwing, and the songthrush each had significantly higher prevalence than the average for all species. Large passerine species had higher infection prevalence than small species. The infection was less prevalent in hatching-year birds than in older birds during June and July, but not in August. Males and females had the same infection prevalence. The prevalence of Sindbis antibodies was higher in central than in southern Sweden, which coincided with a higher proportion of fieldfare-redwing-songthrush samples in the central region of the country. Thus, it is possible that regional and annual variations in the prevalence of Sindbis antibodies in Swedish passerine species depend on the number of fieldfares, redwings, and songthrushes available for feeding by vector mosquitoes.

Ehrlichia-infected ticks on migrating birds

During the spring of 1996, an estimated 581,395 Ehrlichia-infected ticks were imported into Sweden by migrating birds. Ehrlichia gene sequences found in ticks collected from these migrating birds were identical to those of granulocytic ehrlichiosis found in domestic animals and humans in Sweden. These findings support the idea that birds may play a role in dispersing Ehrlichia.

Salmonella in sub-Antarctica: low heterogeneity in Salmonella serotypes in South Georgian seals and birds

The number of human visitors to Antarctica is increasing rapidly, and with it a risk of introducing infectious organisms to native animals. To study the occurrence of salmonella serotypes in sub-Antarctic wildlife, faecal samples were collected from gentoo penguins, macaroni penguins, gray-headed albatrosses, black-browed albatrosses and Antarctic fur seals on Bird Island in the South Georgian archipelago during the austral summer of 1996 and 1998. In 1996, S. havana, S. typhimurium and S. enteritidis were isolated from 7% of gentoo penguins and 4% of fur seals. In 1998, however, 22% of fur seals were found to be infected with S. havana, S. enteritidis and S. newport. All isolates, except one, showed identical pulsed-field gel electrophoresis-patterns within each serotype, irrespective of sampling year and animal reservoir. No significant antibiotic resistance was found. The very low heterogeneity in the salmonella isolates found could either indicate a high genetic adaptation of the bacteria to the environment or a recent introduction of salmonella into the area.

Chlamydophila abortus in a Brown skua (Catharacta antarctica lonnbergi) from a subantarctic island

On Bird Island, South Georgia, a new strain of Chlamydophila abortus was detected in one Brown skua out of 37 specimens from six different seabird species. Phylogenetic analysis of the rnpB and omp1 genes indicated the strain to be more closely related to C. abortus than to 6BC, the type strain of Chlamydophila psittaci.

Transglutaminase-mediated fibronectin multimerization in lung endothelial matrix in response to TNF-alpha

Exposure of lung endothelial monolayers to tumor necrosis factor (TNF)-alpha causes a rearrangement of the fibrillar fibronectin (FN) extracellular matrix and an increase in protein permeability. Using calf pulmonary artery endothelial cell layers, we determined whether these changes were mediated by FN multimerization due to enhanced transglutaminase activity after TNF-alpha (200 U/ml) for 18 h. Western blot analysis indicated that TNF-alpha decreased the amount of monomeric FN detected under reducing conditions. Analysis of (125)I-FN incorporation into the extracellular matrix confirmed a twofold increase in high molecular mass (HMW) FN multimers stable under reducing conditions (P < 0.05). Enhanced formation of such HMW FN multimers was associated with increased cell surface transglutaminase activity (P < 0.05). Calf pulmonary artery endothelial cells pretreated with TNF-alpha also formed nonreducible HMW multimers of FN when layered on surfaces precoated with FN. Inhibitors of transglutaminase blocked the TNF-alpha-induced formation of nonreducible HMW multimers of FN but did not prevent either disruption of the FN matrix or the increase in monolayer permeability. Thus increased cell surface transglutaminase after TNF-alpha exposure initiates the enhanced formation of nonreducible HMW FN multimers but did not cause either the disruption of the FN matrix or the increase in endothelial monolayer permeability.

Development of a serological test for Haemophilus ducreyi for seroprevalence studies

We developed a new enzyme immunoassay (rpEIA) for use in determining the seroprevalence of chancroid. Three highly conserved outer membrane proteins from Haemophilus ducreyi strain 35000 were cloned, overexpressed, and purified from Escherichia coli for use as antigens in the rpEIA. Serum specimens from patients with and without chancroid were assayed to determine optimum sensitivity and specificity and to establish cutoff values. On the basis of these data, rpEIA was found to be both sensitive and specific when used to test a variety of serum specimens from patients with genital ulcers and urethritis and from healthy blood donors.

Serum resistance in Haemophilus ducreyi requires outer membrane protein DsrA

Haemophilus ducreyi is resistant to killing by normal serum antibody and complement. We discovered an H. ducreyi outer membrane protein required for expression of serum resistance and termed it DsrA (for "ducreyi serum resistance A"). The dsrA locus was cloned, sequenced, and mutagenized. An isogenic mutant (FX517) of parent strain 35000 was constructed and characterized, and it was found to no longer express dsrA. FX517 was at least 10-fold more serum susceptible than 35000. DsrA was expressed by all strains of H. ducreyi tested, except three naturally occurring, avirulent, serum-sensitive strains. FX517 and the three naturally occurring dsrA-nonexpressing strains were complemented in trans with a plasmid expressing dsrA. All four strains were converted to a serum-resistant phenotype, including two that contained truncated lipooligosaccharide (LOS). Therefore, serum resistance in H. ducreyi does not require expression of full-length LOS but does require expression of dsrA. The dsrA locus from eight additional H. ducreyi strains was sequenced, and the deduced amino acid sequences were more than 85% identical. The major difference between the DsrA proteins was due to the presence of one, two, or three copies of the heptameric amino acid repeat NTHNINK. These repeats account for the variability in apparent molecular mass of the monomeric form of DsrA (28 to 35 kDa) observed in sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Since DsrA is present in virulent strains, is highly conserved, and is required for serum resistance, we speculate that it may be a virulence factor and a potential vaccine candidate.

Isolation and characterization of Campylobacter jejuni subsp. jejuni from macaroni penguins (Eudyptes chrysolophus) in the subantarctic region

On Bird Island, South Georgia, albatrosses (n = 140), penguins (n = 100), and fur seals (n = 206) were sampled for Campylobacter jejuni. C. jejuni subsp. jejuni was recovered from three macaroni penguins (Eudyptes chrysolophus). These isolates, the first reported for the subantarctic region, showed low genetic diversity and high similarity to Northern Hemisphere C. jejuni isolates, possibly suggesting recent introduction to the area.

Feral pigeons as carriers of Cryptococcus laurentii, Cryptococcus uniguttulatus and Debaryomyces hansenii

We collected fresh droppings and cloaca samples from feral pigeons Columba livia in the southern Swedish city of Malmö, and isolated the following fungi: Debaryomyces hansenii var. hansenii, Cryptococcus laurentii and Cryptococcus uniguttulatus. The first two species are known to be pathogenic to humans. No strains of Cryptococcus neoformans var. neoformans were found. Our results indicate that feral pigeons can be carriers of medically significant fungi other than Cryptococcus neoformans var. neoformans.

Increased mortality of black-browed albatross chicks at a colony heavily-infested with the tick Ixodes uriae

At Bird Island, South Georgia, we studied the effects of the tick Ixodes uriae on survival of chicks at two colonies of the black-browed albatross Diomedea melanophrys, one where most chicks were infested with ticks, the other where most chicks were tick-free. When the two colonies were compared, it was found that the colony heavily-infested with ticks had significantly greater chick mortality than the colony lightly-infested with ticks. However, within each of the two colonies, there was no significant difference in survival between chicks with ticks and those without ticks.

Isolation of Lyme disease Borrelia from puffins (Fratercula arctica) and seabird ticks (Ixodes uriae) on the Faeroe Islands

This is the first report on the isolation of Lyme disease Borrelia from seabirds on the Faeroe Islands and the characteristics of its enzootic cycle. The major components of the Borrelia cycle include the puffin (Fratercula arctica) as the reservoir and Ixodes uriae as the vector. The importance of this cycle and its impact on the spread of human Lyme borreliosis have not yet been established. Borrelia spirochetes isolated from 2 of 102 sampled puffins were compared to the borreliae previously obtained from seabird ticks, I. uriae. The rrf-rrl intergenic spacer and the rrs and the ospC genes were sequenced and a series of phylogenetic trees were constructed. Sequence data and restriction fragment length polymorphism analysis grouped the strains together with Borrelia garinii. In a seroepidemiological survey performed with residents involved in puffin hunting on the Faeroe Islands, 3 of 81 serum samples were found to be positive by two commonly used clinical tests: a flagellin-based enzyme-linked immunosorbent assay (ELISA) and Western blotting. These three positive serum samples also had high optical density values in a whole-cell ELISA. The finding of seropositive Faeroe Islanders who are regularly exposed to I. uriae indicate that there may be a transfer of B. garinii by this tick species to humans.

Distribution and abundance of the tick Ixodes uriae in a diverse subantarctic seabird community

At Bird Island, South Georgia, we surveyed the distribution and abundance of ticks on the vertebrate fauna and found only 1 species Ixodes uriae. We classified all seabird species into 3 groups: (1) seabirds nesting on the surface of the ground solitarily, in dispersed groups of a few nests, or in colonies with well-spaced nests; (2) seabirds nesting on the surface of the ground in dense colonies; and (3) seabirds nesting in dense colonies in burrows or rock crevices. We detected I. uriae only on 3 species of the second group that nested in large, dense, persistent colonies, i.e., black-browed albatross (Diomedea melanophrys), gray-headed albatross (Diomedea chrysostoma), and macaroni penguin (Eudyptes chrysolophus). Ticks were found on the undersides of the feet on albatrosses but not on the undersides of the feet on penguins. We hypothesize that the coarse pebble nests of penguins, combined with the fact that their young walk around more than albatross young, make the environment on the underside of penguin feet more harsh and hostile for ticks than the underside of albatross feet. Despite the great abundance of Antarctic fur seals (Arctocephalus gazella) on the island, we found no ticks on them.

[Jevgenij Botkin--personal physician of the tzar--an obituary 80 years after his death]

On 17 July 1998 the remains of Tsar Nicholas II and his family were buried, a historic event extensively covered by the media. The remains of four servants liquidated with the royal family were buried with them. Among the servants was the Tsar's personal physician, Jevgenij Botkin. Not often does a doctor follow his patients not only onto death, but into death--the Hippocratic oath leading to liquidation, so to speak. Who was Dr. Botkin? Did he know what to expect, or was he just a chance victim?

PCR detection of Chlamydia psittaci in faecal samples from passerine birds in Sweden

To investigate to what extent wild passerine birds are carriers of Chlamydia psittaci, 312 faecal samples from 18 bird species were collected. Using the PCR technique and subsequent DNA sequencing, C. psittaci DNA was demonstrated in faecal samples from 9 (2.9%) birds of 6 different species. Sera from 65 bird-ringers, highly exposed to wild birds, were tested by microimmunofluorescence assay for the occurrence of IgG and IgM antibodies to C. psittaci. No such antibodies were found. This results indicate that a significant proportion of wild passerine birds are carriers of C. psittaci, but rarely infectious to humans.

[Refugee or immigrant children in hospital]

The aim of the study was to gain knowledge of the diagnosis, length of hospital stay, and ethnic background of refugee and immigrant children admitted to the Paediatric Ward at Aker University Hospital in Oslo, and to find out how well the staff and families of the children communicated. 347 children, admitted from ten districts in the immediate vicinity of the hospital, were included in the study. 133 (38%) children had parents who were both born in a non-western country. 44 of the children came from a refugee background and 89 from an immigrant background. The median stay on the Paediatric Ward was three days for the immigrant children and two days for the refugee children and children from Western countries. None of the groups was admitted more frequently than the others. Refugee and immigrant children were most often admitted because of respiratory diseases or obscure symptoms. Communication between the staff and more than 40% of the families with refugee or immigrant backgrounds was not satisfactory. Three out of four mothers and one out of two fathers were unable to communicate well in Norwegian. One third of the mothers had less than six years of school education and one quarter of the immigrant mothers had never attended school.

Cloning and characterization of tdhA, a locus encoding a TonB-dependent heme receptor from Haemophilus ducreyi

Haemophilus ducreyi is unable to synthesize heme and must acquire it from its only known host, humans. We cloned and sequenced a gene encoding an outer membrane receptor for heme. It was designated tdhA (for TonB-dependent heme receptor A) since it was related by sequence homology to the family of TonB-dependent receptors. TdhA was strikingly similar to open reading frame HI0113 from the genome of Haemophilus influenzae Rd and also shared homology with five other heme receptors, including HxuC, HemR, HmuR, ChuA, and ShuA, from gram-negative bacteria. An Escherichia coli hemA tonB mutant strongly expressing H. ducreyi tdhA grew on low levels of heme as a source of heme only when an intact H. ducreyi Ton system plasmid was present, formally demonstrating functional TonB dependence. tdhA was expressed poorly in vitro by H. ducreyi and only under conditions of heme limitation. A survey of H. ducreyi revealed that all tested strains but one synthesized small amounts of TdhA in vitro under heme-limiting conditions. Surprisingly, an isogenic mutant of tdhA as well as its parent, 35000, both required the same high levels of heme for growth (50 microgram/ml [77 microM] on agar medium). This result, together with previous findings, suggests that in vitro, the uptake of heme by H. ducreyi is mediated by a TonB- and TdhA-independent mechanism, possibly diffusion.

Enteropathogenic bacteria in migrating birds arriving in Sweden

Birds have been thought to play a role in transmitting infectious agents like influenza, Borrelia and Salmonella. To investigate the role of migrating birds in the dispersal of enteropathogenic bacteria, stool samples from 151 wild birds (50 gulls and 101 passerines) just entering Sweden from their winter grounds were analysed for Salmonella spp., Campylobacter spp. and EHEC O157:H7. The thermophilic isolated enteropathogens found were further analysed by antibiograms. Among the 50 gulls examined, we found 2 isolates of Salmonella typhimurium with multiple antibiotic resistance. Three isolates of C. jejuni were found in the 101 stool samples from passerines. We did not isolate EHEC O157:H7 in any of the bird stools examined.