Inactivation of Clostridium difficile spores by microwave irradiation

Rapid, Point-of-Care Microwave Lysis and Electrochemical Detection of Clostridioides difficile Directly from Stool Samples

The rapid detection of the spore form of Clostridioides difficile has remained a challenge for clinicians. To address this, we have developed a novel, precise, microwave-enhanced approach for near-spontaneous release of DNA from C. difficile spores via a bespoke microwave lysis platform. C. difficile spores were microwave-irradiated for 5 s in a pulsed microwave electric field at 2.45 GHz to lyse the spore and bacteria in each sample, which was then added to a screen-printed electrode and electrochemical DNA biosensor assay system to identify presence of the pathogen's two toxin genes. The microwave lysis method released both single-stranded and double-stranded genome DNA from the bacterium at quantifiable concentrations between 0.02 μg/mL to 250 μg/mL allowing for subsequent downstream detection in the biosensor. The electrochemical bench-top system comprises of oligonucleotide probes specific to conserved regions within tcdA and tcdB toxin genes of C. difficile and was able to detect 800 spores of C. difficile within 300 µL of unprocessed human stool samples in under 10 min. These results demonstrate the feasibility of using a solid-state power generated, pulsed microwave electric field to lyse and release DNA from human stool infected with C. difficile spores. This rapid microwave lysis method enhanced the rapidity of subsequent electrochemical detection in the development of a rapid point-of-care biosensor platform for C. difficile.

Microscopy methods for Clostridioides difficile

Microscopic technologies including light and fluorescent, transmission electron microscopy (TEM), scanning electron microscopy (SEM), and cryo-electron microscopy have been widely utilized to visualize Clostridioides difficile at the molecular, cellular, community, and structural biology level. This comprehensive review summarizes the microscopy tools (fluorescent and reporter system) in their use to study different aspects of C. difficile life cycle and virulence (sporulation, germination) or applications (detection of C. difficile or use of antimicrobials). With these developing techniques, microscopy tools will be able to find broader applications and address more challenging questions to study C. difficile and C. difficile infection.

New Thoughts on an Old Topic: Secrets of Bacterial Spore Resistance Slowly Being Revealed

The quest for bacterial survival is exemplified by spores formed by some Firmicutes members. They turn up everywhere one looks, and their ubiquity reflects adaptations to the stresses bacteria face. Spores are impactful in public health, food safety, and biowarfare. Heat resistance is the hallmark of spores and is countered principally by a mineralized gel-like protoplast, termed the spore core, with reduced water which minimizes macromolecular movement/denaturation/aggregation. Dry heat, however, introduces mutations into spore DNA. Spores have countermeasures to extreme conditions that are multifactorial, but the fact that spore DNA is in a crystalline-like nucleoid in the spore core, likely due to DNA saturation with small acid-soluble spore proteins (SASPs), suggests that reduced macromolecular motion is also critical in spore dry heat resistance. SASPs are also central in the radiation resistance characteristic of spores, where the contributions of four spore features-SASP; Ca2+, with pyridine-2,6-dicarboxylic acid (CaDPA); photoproduct lyase; and low water content-minimize DNA damage. Notably, the spore environment steers UV photochemistry toward a product that germinated spores can repair without significant mutagenesis. This resistance extends to chemicals and macromolecules that could damage spores. Macromolecules are excluded by the spore coat which impedes the passage of moieties of ≥10 kDa. Additionally, damaging chemicals may be degraded or neutralized by coat enzymes/proteins. However, the principal protective mechanism here is the inner membrane, a compressed structure lacking lipid fluidity and presenting a barrier to the diffusion of chemicals into the spore core; SASP saturation of DNA also protects against genotoxic chemicals. Spores are also resistant to other stresses, including high pressure and abrasion. Regardless, overarching mechanisms associated with resistance seem to revolve around reduced molecular motion, a fine balance between rigidity and flexibility, and perhaps efficient repair.

The effect of cold storage and cooking on the viability of Clostridioides difficile spores in consumer foods

The increased detection of clinical cases of Clostridioides difficile coupled with the persistence of clostridial spores at various stages along the food chain suggest that this pathogen may be foodborne. This study examined C. difficile (ribotypes 078 and 126) spore viability in chicken breast, beef steak, spinach leaves and cottage cheese during refrigerated (4 °C) and frozen (-20 °C) storage with and without a subsequent sous vide mild cooking (60 °C, 1 h). Spore inactivation at 80 °C in phosphate buffer solution, beef and chicken were also investigated to provide D_80°C values and determine if PBS was a suitable model system for real food matrices. There was no decrease in spore concentration after chilled or frozen storage and/or sous vide cooking at 60 °C. Non-log-linear thermal inactivation was observed for both C. difficile ribotypes at 80 °C in phosphate buffer solution (PBS), beef and chicken. The predicted PBS D_80°C values of 5.72±[2.90, 8.55] min and 7.50±[6.61, 8.39] min for RT078 and RT126, respectively, were in agreement with the food matrices D_80°C values of 5.65 min (95% CI range from 4.29 to 8.89 min) for RT078 and 7.35 min (95% CI range from 6.81 to 7.01 min) for RT126. It was concluded that C. difficile spores survive chilled and frozen storage and mild cooking at 60 °C but may be inactivated at 80 °C. Moreover thermal inactivation in PBS was representative of that observed in real food matrices (beef and chicken).

The Environment, Farm Animals and Foods as Sources of Clostridioides difficile Infection in Humans

The recent discovery of the same Clostridioides difficile ribotypes associated with human infection in a broad range of environments, animals and foods, coupled with an ever-increasing rate of community-acquired infections, suggests this pathogen may be foodborne. The objective of this review was to examine the evidence supporting this hypothesis. A review of the literature found that forty-three different ribotypes, including six hypervirulent strains, have been detected in meat and vegetable food products, all of which carry the genes encoding pathogenesis. Of these, nine ribotypes (002, 003, 012, 014, 027, 029, 070, 078 and 126) have been isolated from patients with confirmed community-associated C. difficile infection (CDI). A meta-analysis of this data suggested there is a higher risk of exposure to all ribotypes when consuming shellfish or pork, with the latter being the main foodborne route for ribotypes 027 and 078, the hypervirulent strains that cause most human illnesses. Managing the risk of foodborne CDI is difficult as there are multiple routes of transmission from the farming and processing environment to humans. Moreover, the endospores are resistant to most physical and chemical treatments. The most effective current strategy is, therefore, to limit the use of broad-spectrum antibiotics while advising potentially vulnerable patients to avoid high-risk foods such as shellfish and pork.

A Review and Perspective of Environmental Disinfection Technology Based on Microwave Irradiation

PURPOSE OF REVIEW

In the context of COVID-19 sweeping the world, the development of microbial disinfection methods in gas, liquid, and solid media has received widespread attention from researchers. As a disinfection technology that can adapt to different environmental media, microwave-assisted disinfection has the advantages of strong permeability, no secondary pollution, etc. The purpose of this review is to put forward new development requirements for future microwave disinfection strategies by summarizing current microwave disinfection methods and effects. From the perspective of the interaction mechanism of microwave and microorganisms, this review provides a development direction for more accurate and microscopic disinfection mechanism research.

RECENT FINDINGS

Compared to other traditional environmental disinfection techniques, microwave-assisted disinfection means have the advantages of being more destructive, free of secondary contamination, and thorough. Currently, researchers generally agree that the efficiency of microwave disinfection is the result of a combination of thermal and non-thermal effects. However, the performance of microwave disinfection shows the differences in the face of different environmental media as well as different types of microorganisms.

SUMMARY

This review highlights the inactivation mechanism of microwave-assisted disinfection techniques used in different scenarios. Suggestions for promoting the efficiency and overcoming the limitations of low energy utilization, complex reactor design, and inaccurate monitoring methods are proposed.

Microwaves, a potential treatment for bacteria: A review

Bacteria have brought great harm to the public, especially after the emergence of multidrug-resistant bacteria. This has rendered traditional antibiotic therapy ineffective. In recent years, hyperthermia has offered new treatments to remove bacteria. Microwaves (MW) are a component of the electromagnetic spectrum and can rapidly heat materials. Taking advantage of this characteristic of MW, related studies have shown that both thermal and non-thermal effects of MW can inactivate various bacteria. Even though the understanding of MW in the field of bacteria is not sufficient for widespread use at present, MW has performed well in dealing with microorganisms and controlling infection. This review will focus on the application of MW in bacteria and discuss the advantages, prospects and challenges of using MW in the bacterial field.

Teicoplanin Suppresses Vegetative Clostridioides difficile and Spore Outgrowth

In recent decades, the incidence of Clostridioides difficile infection (CDI) has remained high in both community and health-care settings. With the increasing rate of treatment failures and its ability to form spores, an alternative treatment for CDI has become a global priority. We used the microdilution assay to determine minimal inhibitory concentrations (MICs) of vancomycin and teicoplanin against 30 distinct C. difficile strains isolated from various host origins. We also examined the effect of drugs on spore germination and outgrowth by following the development of OD₆₀₀. Finally, we confirmed the spore germination and cell stages by microscopy. We showed that teicoplanin exhibited lower MICs compared to vancomycin in all tested isolates. MICs of teicoplanin ranged from 0.03-0.25 µg/mL, while vancomycin ranged from 0.5-4 µg/mL. Exposure of C. difficile spores to broth supplemented with various concentrations of antimicrobial agents did not affect the initiation of germination, but the outgrowth to vegetative cells was inhibited by all test compounds. This finding was concordant with aberrant vegetative cells after antibiotic treatment observed by light microscopy. This work highlights the efficiency of teicoplanin for treatment of C. difficile through prevention of vegetative cell outgrowth.

Disposal of the large volume of sputum positive for Mycobacterium tuberculosis by using microwave sterilisation technology as an alternative to traditional autoclaving in a tertiary respiratory care hospital in Delhi, India

Background

Everyday, tuberculosis hospitals collect enormous amount of sputum containing viable Mycobacterium tuberculosis bacilli, the disposal of which is a challenging task. Chemical (5% phenol) and physical (autoclaving) disinfection methods involve cost, space and cause further environmental degradation. Over the years, use of microwave for sterilisation of biomedical waste has become widespread. However, its efficacy to sterilise large volume of M. tuberculosis positive sputum has never been investigated.

Aim

To evaluate the effectiveness of microwave in sterilising large volumes of M. tuberculosis positive sputum samples.

Methods

226 sputum samples positive for M. tuberculosis were checked by Ziehl-Neelsen staining and liquid culture (MGIT ™) both before and after microwaving. χ² test was performed, and p-value <0.05 was considered significant.

Findings

Before microwaving, samples containing acid fast bacilli (AFB) and live M. tuberculosis bacilli were 93.8% and 95% (≈94.7%) respectively; which came down to 14.2% (32) and <1% (≈0.9%) in post microwave. In the 32 post-microwave AFB positive samples, bacilli appeared apoptotic, decreased in size, fragmented, loosely arranged and were easily missed as stain artefacts. Their beaded appearance was not appreciable. Background pus cells were of smaller size, did not take up methylene blue stain properly, and multilobed nuclear material was missing.

Conclusion

The study shows efficacy of microwave as an alternative sterilisation method for large volume sputum samples containing M. tuberculosis bacilli. Microwave can become an effective sterilisation method, especially for isolated tuberculosis care centres in countries which struggle for disposal of sputum, the biomedical waste.

Antimicrobial Effect of Asiatic Acid Against Clostridium difficile Is Associated With Disruption of Membrane Permeability

Antibiotic resistance is a major concern in Clostridium difficile, the causative agent of antibiotic-associated diarrhea. Reduced susceptibility to first- and second-line agents is widespread, therefore various attempts have been made to seek alternative preventive and therapeutic strategies against this pathogen. In this work, the antimicrobial properties of asiatic acid were evaluated against C. difficile. Asiatic acid displayed substantial inhibitory effects on 19 C. difficile isolates collected from different sources with minimal inhibitory concentrations ranging from 10 to 20 μg/ml. Time kill analysis and minimal bactericidal concentration revealed potential bactericidal activity of this compound. Asiatic acid induced membrane damages and alterations in morphological ultrastructure in C. difficile, thereby causing the leakage of intracellular substances. Moreover, asiatic acid also displayed an inhibitory effect on cell motility, but did not interfere with biofilm formation and spore germination. Analysis of drug combination showed no synergistic effect between asiatic acid and vancomycin/metronidazole. Altogether, asiatic acid exhibited strong antimicrobial activity against vegetative cells and could serve as an alternative resource for tackling C. difficile.

Microwave Technologies: An Emerging Tool for Inactivation of Biohazardous Material in Developing Countries

Inappropriate treatment and disposal of waste containing biohazardous materials occurs especially in developing countries and can lead to adverse effects on public and occupational health and safety, as well as on the environment. For the treatment of biohazardous waste, microwave irradiation is an emerging tool. It is a misbelief that microwave devices cannot be used for inactivation of solid biohazardous waste; however, the inactivation process, and especially the moisture content, has to be strictly controlled, particularly if water is required to be added to the process. Appropriate control allows also inactivation of waste containing inhomogeneous compositions of material with low fluid/moisture content. Where appropriate, especially where control of transport of waste cannot be guaranteed, the waste should be inactivated directly at the place of generation, preferably with a closed waste collection system. In waste containing sufficient moisture, there are direct useful applications, for example the treatment of sewage sludge or human feces. A number of examples of microwave applications with impacts for developing countries are presented in this review. In respect to energy costs and environmental aspects, microwave devices have clear advantages in comparison to autoclaves.

Efficacy Evaluation of Control Measures on the Reduction of Staphylococcus aureus in Salad and Bacillus cereus in Fried Rice Served at Restaurants

The objective of this study was to assess the effect of washing on Staphylococcus aureus reduction in salads and the effect of reheating on Bacillus cereus vegetative cells and spores reduction in fried rice at restaurants using the stochastic food safety objective (FSO) tool. The leaf vegetable was inoculated with S. aureus and washed with tap water, 100 ppm of NaClO, or 30 ppm of slightly acidic electrolyzed water (SAEW) for either 60 s or 5 min. The washing effect of 30 ppm SAEW was greater than that of 100 ppm NaClO. Based on the FSO concept, washing leaf vegetables with 30 ppm SAEW for 5 min was the most efficient control measure for S. aureus in salads. In addition, the salad should be consumed within 4 h at 25°C and 2 h at 35°C after 5 min of washing with 100 ppm NaClO or 30 ppm SAEW. The fried rice was first inoculated with B. cereus vegetative cells or spores and was then reheated in a frying pan at medium (internal temperature of fried rice: 69.2°C-78.8°C) or high heat (internal temperature of fried rice:103.8°C-121.4°C) or in a microwave oven (internal temperature of fried rice:86.3°C-90.6°C) for 3 or 4 min. Based on the FSO, reheating rice in a microwave oven was the most efficient control measure for B. cereus vegetative cells and spores in fried rice. The holding time for fried rice can be extended up to 6 h at 25°C, 3 h at 35°C, and 2 h at 45°C with reheating. Microbiological hazards in salads and fried rice can be controlled by washing with a sanitizer and reheating, respectively and then by controlling of holding temperature before being served at restaurants.

Structural Characterization of Clostridium sordellii Spores of Diverse Human, Animal, and Environmental Origin and Comparison to Clostridium difficile Spores

Clostridium sordellii is a significant pathogen with mortality rates approaching 100%. It is the bacterial spore that is critical in initiating infection and disease. An understanding of spore structures as well as spore morphology across a range of strains may lead to a better understanding of C. sordellii infection and disease. However, the structural characteristics of the C. sordellii spores are limited. In this work, we have addressed this lack of detail and characterized the C. sordellii spore morphology. The use of traditional and advanced microscopy techniques has provided detailed new observations of C. sordellii spore structural features, which serve as a reference point for structural studies of spores from other bacterial species.

Clostridium sordellii is an often-lethal bacterium causing human and animal disease. Crucial to the infectious cycle of C. sordellii is its ability to produce spores, which can germinate into toxin-producing vegetative bacteria under favorable conditions. However, structural details of the C. sordellii spore are lacking. Here, we used a range of electron microscopy techniques together with superresolution optical microscopy to characterize the C. sordellii spore morphology with an emphasis on the exosporium. The C. sordellii spore is made up of multiple layers with the exosporium presenting as a smooth balloon-like structure that is open at the spore poles. Focusing on the outer spore layers, we compared the morphologies of C. sordellii spores derived from different strains and determined that there is some variation between the spores, most notably with spores of some strains having tubular appendages. Since Clostridium difficile is a close relative of C. sordellii, their spores were compared by electron microscopy and their exosporia were found to be distinctly different from each other. This study therefore provides new structural details of the C. sordellii spore and offers insights into the physical structure of the exosporium across clostridial species.

IMPORTANCEClostridium sordellii is a significant pathogen with mortality rates approaching 100%. It is the bacterial spore that is critical in initiating infection and disease. An understanding of spore structures as well as spore morphology across a range of strains may lead to a better understanding of C. sordellii infection and disease. However, the structural characteristics of the C. sordellii spores are limited. In this work, we have addressed this lack of detail and characterized the C. sordellii spore morphology. The use of traditional and advanced microscopy techniques has provided detailed new observations of C. sordellii spore structural features, which serve as a reference point for structural studies of spores from other bacterial species.

Microwave as an emerging technology for the treatment of biohazardous waste: A mini-review

Microwave is an emerging technology to treat biohazardous waste, including material from healthcare facilities. A screen of the peer-reviewed literature shows that only limited information may be found in this area of work and, furthermore, analysis of the references reveals that sometimes not all necessary aspects for the appropriate use of the technology are considered. Very often conventional microwave technology is applied for the inactivation of pathogens, which might make sense for certain applications but, on the other hand, may lead to the misbelief that microwave systems cannot be used for the inactivation of a solid "dry" waste. However, conventional microwave units have no means to control the inactivation process, and especially moisture content. But there are a few sophisticated microwave technologies with appropriate measurements allowing a validated inactivation of biohazardous materials. These technologies are an effective tool for inactivation and some of them are commercially available. It must also be considered that the waste should be preferably inactivated either directly at the place where it is generated or biohazardous waste should be transported only in closed systems. Moreover, microwave technology presents a possibility to save energy costs in comparison to the more widely used autoclaves. This mini-review will discuss important aspects for the use of microwave technology for the treatment of biohazardous waste.