Waterborne Campylobacter jejuni epidemic in a Finnish hospital for rheumatic diseases

A waterborne Campylobacter jejuni outbreak in the Rheumatism Foundation Hospital in Heinola, Finland, in November-December 1986 is described. 32 patients and 62 members of the staff developed gastrointestinal symptoms. C. jejuni heat-stable serotype 45 was isolated from the faeces of 32 enteritis patients and from none of the controls. No other enteropathogens were found. Positive serological responses to C. jejuni acid extract antigen were detected by enzyme immunoassay in 34% of the symptomatic hospital patients, in 40% of the symptomatic staff members, and in 10% of the controls. The clinical course of the illness was mostly mild and self-limited. No striking progress in the arthritis symptoms of the patients was found after the outbreak. The hospital has its own water supply. C. jejuni of the same serotype as the epidemic strain was isolated from the water of the pipeline system. After a careful examination some aged components of the waterworks were found to be responsible for leaks that resulted in the contamination of the water.

Properties of Escherichia coli isolates from urinary tract infections in boys

Fifty-five isolates of Escherichia coli from urine of boys younger than three years of age with urinary tract infection (UTI) were compared with strains from girls of the same age range who had UTI. The frequency of P fimbriae, hemolysin, and type 1C fimbriae, previously described as associated with pyelonephritis (PN) in girls, was also high (76%, 60%, and 31%, respectively) in UTI-associated strains from boys. However, in contrast to isolates from girls, strains from lower UTI in boys did not differ from PN-associated strains regarding these three characteristics. In contrast, aerobactin production was significantly associated with PN compared with lower UTI in both sexes. Serotypes O4 and O6 were overrepresented among all UTI-associated strains from boys and PN-associated strains from girls. This overrepresentation was largely accounted for by three clones, one of which was a new clone identified among the UTI-associated strains from boys.

Detection of gram-negative bacteria in urine by the chromogenic limulus assay

The value of the chromogenic limulus assay for detection of gram-negative bacteria in urine was determined. The assay was performed in microtiter plates at room temperature. In 311 consecutively collected urine samples from patients with suspected urinary tract infection, the assay was positive in all 35 samples containing greater than or equal to 10(5) bacteria/ml. No false positive or false negative results were obtained. Four of six urine specimens from patients with gonococcal infection were positive in the assay, whereas samples from patients with chlamydial infection did not yield a positive result. The assay is a rapid and reliable method for detection of urinary tract infection caused by gram-negative bacteria when greater than or equal to 10(5) bacteria/ml are present.

Bacterial flora of the cervix in women using an intrauterine device

The cervical bacterial flora of 18 healthy, parous, sexually active women was analysed before, and 3-5 months after insertion of a copper-releasing intrauterine device (IUD) and after long-term use of an IUD for 3-5.5 years in another nine women. No significant differences were found in the number of aerobic bacteria isolated before or after IUD insertion or after long-term use of an IUD. In contrast to aerobic bacteria, significantly more anaerobes were isolated in the cervix of women having used an IUD for several years when compared to those using barrier contraception with a condom. None of the women had clinical signs of pelvic infection and a cervical bacterial flora rich in anaerobes can be regarded as a normal finding in healthy sexually active women using an IUD for contraception.

Expression of P, type-1, and type-1C fimbriae of Escherichia coli in the urine of patients with acute urinary tract infection

In vivo expression, in human urine, of P, type-1, and type-1C fimbriae by Escherichia coli was analyzed by indirect immunofluorescence. Urine samples from 20 patients with acute urinary tract infection, as well as cultures of the corresponding E. coli isolates, were immunostained with three polyclonal antisera to P fimbriae, antiserum to type-1 fimbriae, monoclonal antibody specific for type-1C fimbriae, and fluorochrome-conjugated second antibodies. P fimbriae were found in 17 urine samples and in 18 of the isolated strains. Type-1-fimbriate bacteria were detected in only nine urine samples, although 18 of the isolated strains expressed type-1 fimbriae after growth in vitro. Four strains possessed type-1C fimbriae; only two expressed type-1C fimbriae in urine. The bacterial populations in urine were heterogeneous, and in each positive staining, only a fraction of the bacterial cells were reactive. The results show that E. coli P fimbriae are expressed and are subject to phase variation in vivo during acute urinary tract infection.

Growth of Escherichia coli in a pulp and cardboard mill

The coliform flora of a pulp and cardboard mill that uses birch as the raw material and ammonium sulphate as the process chemical was studied. Escherichia coli was observed to multiply in the mill. It persisted as the dominant thermotolerant coliform in the effluent. Klebsiellae were encountered among total coliforms only. The E. coli strains isolated had the biochemical characteristics and maximum growth temperatures typical to the species. However, serotyping and hemolysin test differentiated these strains from pathogenic and fecal E. coli.

Characterisation of Escherichia coli strains associated with canine urinary tract infections

Of 33 Escherichia coli strains isolated from canine urinary tract infections, 22 were haemolytic and 27 were classified into O serogroups, the most common being O4, O6, O2 and O83. P-fimbriated strains were haemolytic and belonged mainly to serogroups O4 and O6. Twenty-nine strains possessed type-1 fimbriae but only small numbers possessed S fimbriae, type-1C fimbriae, X adhesins or the aerobactin system. It is postulated that P fimbriae and haemolysin production contribute to bacterial virulence in canine pyelonephritis and cystitis.

Bacterial flora of the cervix in women using different methods of contraception

Bacteriologic culture samples were taken from the cervix in three groups of 10 healthy, sexually active women using barrier contraception, oral contraceptives, or a levonorgestrel-releasing intrauterine contraceptive device. Culture samples for Candida albicans and Trichomonas vaginalis were taken, a cytologic vaginal smear was obtained, and an amine sniff test was performed; these were in addition to a routine gynecologic examination. Multiple bacteria were isolated from the cervix in women using oral contraceptives or an intrauterine contraceptive device, whereas lactobacilli alone dominated the flora of women using barrier contraception. Significantly more anaerobic bacteria were isolated from the cervix in oral contraceptive and intrauterine contraceptive device users when compared with the barrier method users. Symptoms and findings evident of anaerobic vaginosis were associated with the occurrence of anaerobic bacteria in the cervix of three patients using the intrauterine contraceptive device. The results showed that the cervical bacterial flora in sexually active healthy women is rich in anaerobes that can be regarded as a normal finding in women using oral contraceptives or intrauterine contraceptive devices. Barrier contraception with a condom prevents this anaerobic shift and maintains a lactobacilli-dominated flora in the cervix.

P-fimbriated clones among uropathogenic Escherichia coli strains

A total of 237 Escherichia coli strains isolated from the urine of patients with various forms of urinary tract infection or from feces of healthy children were analyzed for O group, possession of K1 capsule, type 1 fimbriae, P fimbriae, X adhesin, and production of hemolysin. Some of the strains were also analyzed for K and H antigens, outer membrane protein pattern, and plasmid content. P fimbriation, hemolysin production, and certain O groups were found to be significantly correlated with pyelonephritogenicity. Possession of type 1 fimbriae or of K1 capsule or plasmid content did not significantly correlate with virulence. Outer membrane protein patterns in 139 strains of the more common O groups were analyzed. Only one to three patterns, which varied between serotypes, were usually found within any one O group. Distinctive groups (clones) were found when the strains were grouped according to complete serotype, fimbriation, hemolysin production, and outer membrane protein pattern; also, the mean number of plasmids was typical of the strains in a given clone. Seven clones associated with pyelonephritis were found; together they accounted for 57% of the O serotypable strains from the pyelonephritis patients. The seven clones were P fimbriated but differed in their serotypes as follows: O1:K1:H7, O4:K12:H1, O4:K12:H5, O6:K2:H1, O16:K1:H6, or O18ac:K5:H7. All O1:K1:H7 strains observed fell into two clones according to the presence or absence of type 1 fimbriae and hemolysin production. One clone associated with cystitis was also found; this consisted of O6:K13:H1 strains lacking P fimbriae. Not a single representative of these eight clones was found among the fecal strains from the healthy children. They are proposed to represent virulent clones with special ability to cause human urinary tract infection.

Mannose-resistant haemagglutination and P antigen recognition are characteristic of Escherichia coli causing primary pyelonephritis

Thirty-two Escherichia coli strains from 30 children with pyelonephritis were examined for their haemagglutination patterns and O and K serotypes. 29 (91%) of the strains showed mannose-resistant haemagglutination (MRHA). By use of well-defined target cells, these MRHA+ strains could be shown to recognise human cells either in a P-specific manner (recognising a specific galactosyl-galactose structure which is part of P blood groups antigens) or in a separate, X-specific manner. Both recognition mechanisms could occur separately or together on the same bacteria, the frequencies of P and X specificity being 81 and 19%, respectively. Both MRHA and P specificity were significantly associated with the O antigens 01, 04, 06, 016, and 018, and the capsular antigen K1, which have previously been associated with pyelonephritis. However, the association of MRHA and P specificity with upper urinary tract infection in children is greater than that of any other laboratory-defined bacterial characteristic.