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Fodor CC, Fouhse J, Drouin D, Ma T, Willing BP, Guan LL, Cobo ER. Colonic innate immune defenses and microbiota alterations in acute swine dysentery. Microb Pathog 2022; 173:105873. [DOI: 10.1016/j.micpath.2022.105873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
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Yeh JC, Lo DY, Chang SK, Kuo HC. Antimicrobial Susceptibility Patterns of Brachyspira Species Isolated in Taiwan. Microb Drug Resist 2018; 24:685-692. [PMID: 29653474 DOI: 10.1089/mdr.2017.0188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Some members of the Brachyspira genus cause diseases such as swine dysentery (SD) and porcine intestinal (or colonic) spirochetosis. Severe economic losses are caused by decreased feed intake and increased feed conversion ratio, as well as costs associated with treatment and death. A loss of clinical efficacy of some antimicrobial agents authorized for treating SD has been observed in many countries. The aim of this study was to analyze the antimicrobial susceptibility of Brachyspira isolated from Taiwan and to investigate the mechanism of decreased susceptibility to macrolides. A total of 55 Brachyspira isolates obtained from the grower-finisher period were evaluated in this study. These isolates included B. hyodysenteriae (n = 37), B. murdochii (n = 11), B. pilosicoli (n = 5), B. intermedia (n = 1), and B. innocens (n = 1). Antimicrobial susceptibility testing was performed to examine 12 selected antimicrobial agents. The results showed that the 50% and 90% minimum inhibitory concentration (MIC) values of the tested macrolides were all >256 μg/ml. The MIC50 of lincomycin, tiamulin, carbadox, olaquindox, ampicillin, amoxicillin, doxycycline, oxytetracycline, and gentamicin were 32, 1, ≤0.125, ≤0.125, 0.5, 0.25, 2, 2, and 2 μg/ml. The genetic basis of the decreased susceptibility to tylosin and lincomycin in Brachyspira spp. was investigated and the results showed a possible connection to the mutations at position A2058 and G2032 of the 23S rRNA gene. These findings demonstrated that, in Taiwan, there may be a decrease in susceptibility of Brachyspira spp. to antimicrobials commonly used for the treatment of SD.
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Affiliation(s)
- Jih-Ching Yeh
- 1 Department of Veterinary Medicine, College of Veterinary Medicine, National Chiayi University , Chiayi, Taiwan , ROC
| | - Dan-Yuan Lo
- 1 Department of Veterinary Medicine, College of Veterinary Medicine, National Chiayi University , Chiayi, Taiwan , ROC
| | - Shao-Kuang Chang
- 2 Graduate Institute of Veterinary Medicine, National Taiwan University , Taipei, Taiwan , ROC
| | - Hung-Chih Kuo
- 1 Department of Veterinary Medicine, College of Veterinary Medicine, National Chiayi University , Chiayi, Taiwan , ROC
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Vadillo S, San-Juan C, Calderón M, Risco D, Fernández-Llario P, Pérez-Sancho M, Redondo E, Hurtado MA, Igeño MI. Isolation of Brachyspira species from farmed wild boar in Spain. Vet Rec 2017; 181:vetrec-2017-104348. [PMID: 28765497 DOI: 10.1136/vr.104348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/06/2017] [Accepted: 06/04/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Santiago Vadillo
- Facultad de Veterinaria, Universidad de Extremadura, Cáceres, Spain
| | - Carlos San-Juan
- Facultad de Veterinaria, Universidad de Extremadura, Cáceres, Spain
| | - Marta Calderón
- Facultad de Veterinaria, Universidad de Extremadura, Cáceres, Spain
| | - David Risco
- Facultad de Veterinaria, Universidad de Extremadura, Cáceres, Spain
| | | | | | - Eloy Redondo
- Facultad de Veterinaria, Universidad de Extremadura, Cáceres, Spain
| | - Miguel A Hurtado
- Facultad de Veterinaria, Universidad de Extremadura, Cáceres, Spain
| | - M Isabel Igeño
- Departamento de Bioquímica y Biología Molecular y Genética, IPROCAR, Universidad de Extremadura, Cáceres, Spain
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Casas V, Rodríguez-Asiain A, Pinto-Llorente R, Vadillo S, Carrascal M, Abian J. Brachyspira hyodysenteriae and B. pilosicoli Proteins Recognized by Sera of Challenged Pigs. Front Microbiol 2017; 8:723. [PMID: 28522991 PMCID: PMC5415613 DOI: 10.3389/fmicb.2017.00723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/07/2017] [Indexed: 11/13/2022] Open
Abstract
The spirochetes Brachyspira hyodysenteriae and B. pilosicoli are pig intestinal pathogens that are the causative agents of swine dysentery (SD) and porcine intestinal spirochaetosis (PIS), respectively. Although some inactivated bacterin and recombinant vaccines have been explored as prophylactic treatments against these species, no effective vaccine is yet available. Immunoproteomics approaches hold the potential for the identification of new, suitable candidates for subunit vaccines against SD and PIS. These strategies take into account the gene products actually expressed and present in the cells, and thus susceptible of being targets of immune recognition. In this context, we have analyzed the immunogenic pattern of two B. pilosicoli porcine isolates (the Spanish farm isolate OLA9 and the commercial P43/6/78 strain) and one B. hyodysenteriae isolate (the Spanish farm V1). The proteins from the Brachyspira lysates were fractionated by preparative isoelectric focusing, and the fractions were analyzed by Western blot with hyperimmune sera from challenged pigs. Of the 28 challenge-specific immunoreactive bands detected, 21 were identified as single proteins by MS, while the other 7 were shown to contain several major proteins. None of these proteins were detected in the control immunoreactive bands. The proteins identified included 11 from B. hyodysenteriae and 28 from the two B. pilosicoli strains. Eight proteins were common to the B. pilosicoli strains (i.e., elongation factor G, aspartyl-tRNA synthase, biotin lipoyl, TmpB outer membrane protein, flagellar protein FlaA, enolase, PEPCK, and VspD), and enolase and PEPCK were common to both species. Many of the identified proteins were flagellar proteins or predicted to be located on the cell surface and some of them had been previously described as antigenic or as bacterial virulence factors. Here we report on the identification and semiquantitative data of these immunoreactive proteins which constitute a unique antigen collection from these bacteria.
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Affiliation(s)
- Vanessa Casas
- CSIC/UAB Proteomics Laboratory, IIBB-CSIC, IDIBAPSBarcelona, Spain.,Faculty of Medicine, Autonomous University of BarcelonaBarcelona, Spain
| | | | | | - Santiago Vadillo
- Departamento Sanidad Animal, Facultad de Veterinaria, Universidad de ExtremaduraCáceres, Spain
| | | | - Joaquin Abian
- CSIC/UAB Proteomics Laboratory, IIBB-CSIC, IDIBAPSBarcelona, Spain.,Faculty of Medicine, Autonomous University of BarcelonaBarcelona, Spain
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Casas V, Vadillo S, San Juan C, Carrascal M, Abian J. The Exposed Proteomes of Brachyspira hyodysenteriae and B. pilosicoli. Front Microbiol 2016; 7:1103. [PMID: 27493641 PMCID: PMC4955376 DOI: 10.3389/fmicb.2016.01103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/01/2016] [Indexed: 11/13/2022] Open
Abstract
Brachyspira hyodysenteriae and Brachyspira pilosicoli are well-known intestinal pathogens in pigs. B. hyodysenteriae is the causative agent of swine dysentery, a disease with an important impact on pig production while B. pilosicoli is responsible of a milder diarrheal disease in these animals, porcine intestinal spirochetosis. Recent sequencing projects have provided information for the genome of these species facilitating the search of vaccine candidates using reverse vaccinology approaches. However, practically no experimental evidence exists of the actual gene products being expressed and of those proteins exposed on the cell surface or released to the cell media. Using a cell-shaving strategy and a shotgun proteomic approach we carried out a large-scale characterization of the exposed proteins on the bacterial surface in these species as well as of peptides and proteins in the extracellular medium. The study included three strains of B. hyodysenteriae and two strains of B. pilosicoli and involved 148 LC-MS/MS runs on a high resolution Orbitrap instrument. Overall, we provided evidence for more than 29,000 different peptides pointing to 1625 and 1338 different proteins in B. hyodysenteriae and B. pilosicoli, respectively. Many of the most abundant proteins detected corresponded to described virulence factors and vaccine candidates. The level of expression of these proteins, however, was different among species and strains, stressing the value of determining actual gene product levels as a complement of genomic-based approaches for vaccine design.
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Affiliation(s)
- Vanessa Casas
- Consejo Superior de Investigaciones Científicas/UAB Proteomics Laboratory, Instituto de Investigaciones Biomedicas de Barcelona-Consejo Superior de Investigaciones Científicas, Institut d'investigacions Biomèdiques August Pi i Sunyer Barcelona, Spain
| | - Santiago Vadillo
- Departamento Sanidad Animal, Facultad de Veterinaria, Universidad de Extremadura Cáceres, Spain
| | - Carlos San Juan
- Departamento Sanidad Animal, Facultad de Veterinaria, Universidad de Extremadura Cáceres, Spain
| | - Montserrat Carrascal
- Consejo Superior de Investigaciones Científicas/UAB Proteomics Laboratory, Instituto de Investigaciones Biomedicas de Barcelona-Consejo Superior de Investigaciones Científicas, Institut d'investigacions Biomèdiques August Pi i Sunyer Barcelona, Spain
| | - Joaquin Abian
- Consejo Superior de Investigaciones Científicas/UAB Proteomics Laboratory, Instituto de Investigaciones Biomedicas de Barcelona-Consejo Superior de Investigaciones Científicas, Institut d'investigacions Biomèdiques August Pi i Sunyer Barcelona, Spain
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Alavi L, Jamshidian M, Seifi-Abadshapuri MR, Mayahi M, Alavi SM. Isolation of Brachyspira pilocicoli from Gastrointestinal Tract of Commercial Chickens in Khuzestan, South West Iran. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2013. [DOI: 10.17795/ijep15062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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MALDI-TOF MS analysis of human and animal Brachyspira species and benefits of database extension. J Proteomics 2012; 78:273-80. [PMID: 23036724 DOI: 10.1016/j.jprot.2012.09.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/06/2012] [Accepted: 09/23/2012] [Indexed: 11/22/2022]
Abstract
Spirochaetes belonging to the genus Brachyspira are anaerobic bacteria that colonize the large intestine of humans and animals, mainly pigs. The main species are namely, B. hyodysenteriae, the etiological agent of swine dysentery, B. pilosicoli, a zoonotic agent causing colonic spirochaetosis both in humans and different animal species, B. aalborgi, exclusively infecting humans causing colonic spirochaetosis, B. intermedia, a potential animal pathogen, B. innocens and B. murdochii, generally commensal of pigs, and B. alvinipulli, found in egg laying hens with diarrhea. In this study, for the first time, MALDI-TOF MS was applied on Brachyspira strains of human and animal origins, supplementing the existing database, limited to the species B. murdochii only, with spirochaetal protein profiles and demonstrating its usefulness in the rapid, cheap and reliable identification of Brachyspira strains at the species level, overcoming the problems previously encountered in the identification of these spirochaetes when using biochemical and genetic-based methods. Moreover, a dendrogram based on protein profiles of the different spirochaetal species was generated reflecting their host spectrum, showing in the same branch the only two species able to infect humans (B. aalborgi and B. pilosicoli) and in the other branch the spirochaetes infecting exclusively animals.
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Antimicrobial susceptibility testing of bovine digital dermatitis treponemes identifies macrolides for in vivo efficacy testing. Vet Microbiol 2012; 160:496-500. [PMID: 22749760 DOI: 10.1016/j.vetmic.2012.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 06/02/2012] [Accepted: 06/04/2012] [Indexed: 11/24/2022]
Abstract
Digital dermatitis (DD) is a major infectious lameness of dairy cattle and sheep considered to be caused by treponemes. The aim of this study was to identify antibiotics effective against DD treponemes that might be useful in the treatment of ruminant DD in the future or to identify antibiotics useful in isolation studies. Here, a microdilution method was used to identify in vitro antimicrobial susceptibility of treponemes cultured from DD lesions to eight relevant antibiotics. DD treponemes exhibited highest susceptibility to amoxicillin, azithromycin and gamithromycin. Unfortunately, amoxicillin whilst having potential for DD treatment in other animals (e.g. sheep) would require milk withhold periods in dairy cattle. DD treponemes were not particularly susceptible to two cephalosporins: cefalexin and ceftiofur, which do not require milk withhold. The bacteria demonstrated low susceptibility to trimethoprim and especially colistin suggesting these antimicrobials may be particularly useful in isolation of DD treponemes. The most promising high susceptibility results for macrolides indicate a rationale to consider veterinary licensed macrolides as DD treatments. Furthermore, given the DD treponeme antibiotic susceptibility similarities to established treatments for human treponematoses, identification of treponemacidal, long acting β-lactam analogues not requiring milk withhold may allow for development of a successful treatment for dairy cattle DD.
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Lugsomya K, Tummaruk P, Hampson D, Prapasarakul N. Development of a modified selective medium to enhance the recovery rate of Brachyspira hyodysenteriae and other porcine intestinal spirochaetes from faeces. Lett Appl Microbiol 2012; 54:330-5. [DOI: 10.1111/j.1472-765x.2012.03213.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clothier KA, Kinyon JM, Frana TS, Naberhaus N, Bower L, Strait EL, Schwartz K. Species characterization and minimum inhibitory concentration patterns of Brachyspira species isolates from swine with clinical disease. J Vet Diagn Invest 2011; 23:1140-5. [DOI: 10.1177/1040638711425580] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Typhlocolitis and dysentery due to Brachyspira hyodysenteriae infection represent an economically important disease syndrome in growing pigs. Largely disappearing from U.S. swine herds in the late 1990s and early 2000s, Brachyspira-associated disease and bacterial isolation from swine with clinical disease has increased in the last several years, and non– B. hyodysenteriae isolates are commonly identified. Antimicrobial resistance has been demonstrated in Brachyspira spp. isolates from Europe and Asia, and may be the reason for the resurgence in U.S. herds. Seventy-nine clinical isolates identified at the Iowa State University Veterinary Diagnostic Lab were tested with multiple polymerase chain reaction assays to establish species identity, and evaluated for minimum inhibitory concentrations (MICs) using an agar dilution method against lincomycin, gentamicin, valnemulin, tiamulin, salinomycin, and carbadox. Only 38.0% of isolates could be confirmed as the known pathogens B. hyodysenteriae (30.4%) or Brachyspira pilosicoli (7.6%). Twenty of the 79 isolates (25.3%) were identified as Brachyspira murdochii, and 13.9% could not be identified to species. The MIC values were consistently high against lincomycin and moderately high against gentamicin. The remaining antimicrobials had MICs that were at the low end of the test ranges. Brachyspira murdochii and Brachyspira spp. had significantly greater MIC values against several of these drugs than other Brachyspira spp. examined. The increased incidence of these less definitively characterized Brachyspira species with increased MIC values to commonly prescribed antimicrobials may, at least in part, explain the increased prevalence and severity of this disease complex in recent years. Further research is necessary to understand these changes.
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Affiliation(s)
- Kristin A. Clothier
- Iowa State University Veterinary Diagnostic Laboratory, Department of Veterinary and Production Animal Medicine, Iowa State University, College of Veterinary Medicine, Ames, IA
| | - Joann M. Kinyon
- Iowa State University Veterinary Diagnostic Laboratory, Department of Veterinary and Production Animal Medicine, Iowa State University, College of Veterinary Medicine, Ames, IA
| | - Timothy S. Frana
- Iowa State University Veterinary Diagnostic Laboratory, Department of Veterinary and Production Animal Medicine, Iowa State University, College of Veterinary Medicine, Ames, IA
| | - Nadine Naberhaus
- Iowa State University Veterinary Diagnostic Laboratory, Department of Veterinary and Production Animal Medicine, Iowa State University, College of Veterinary Medicine, Ames, IA
| | - Leslie Bower
- Iowa State University Veterinary Diagnostic Laboratory, Department of Veterinary and Production Animal Medicine, Iowa State University, College of Veterinary Medicine, Ames, IA
| | - Erin L. Strait
- Iowa State University Veterinary Diagnostic Laboratory, Department of Veterinary and Production Animal Medicine, Iowa State University, College of Veterinary Medicine, Ames, IA
| | - Kent Schwartz
- Iowa State University Veterinary Diagnostic Laboratory, Department of Veterinary and Production Animal Medicine, Iowa State University, College of Veterinary Medicine, Ames, IA
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Evans NJ, Brown JM, Demirkan I, Birtles R, Hart CA, Carter SD. In vitro susceptibility of bovine digital dermatitis associated spirochaetes to antimicrobial agents. Vet Microbiol 2008; 136:115-20. [PMID: 19081208 DOI: 10.1016/j.vetmic.2008.10.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 10/13/2008] [Accepted: 10/20/2008] [Indexed: 12/18/2022]
Abstract
Bovine digital dermatitis (BDD) is an infectious lameness in cattle, which has a large global impact in terms of animal welfare and cost. The majority of evidence suggests that spirochaetes are the aetiological agent of this disease. The aim of this study was to identify the susceptibility of BDD associated spirochaetes to a range of antimicrobial agents with a view to potential usage in vivo to treat this widespread cattle disease. A microdilution method was adapted to determine the in vitro susceptibilities of 19 UK digital dermatitis spirochaetes (6 Treponema medium/Treponema vincentii-like, 8 Treponema phagedenis-like and 5 Treponema denticola/Treponema putidum-like) to eight relevant antimicrobials. The BDD spirochaetes exhibited the highest susceptibility to penicillin and erythromycin and this information may now be used to aid development of efficacious treatments. This study has also identified that BDD spirochaete T167 is spectinomycin resistant and that the likely biological basis is a point mutation in the 16S rRNA gene. Interestingly, nearly all Brachyspira isolate 16S rRNA gene sequences in Genbank have this substitution, suggesting it may be responsible for the characteristic spectinomycin resistance reported for the Brachyspira genus.
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Affiliation(s)
- Nicholas J Evans
- Department of Veterinary Pathology, University of Liverpool, Liverpool L69 CBX, UK.
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Calderaro A, Bommezzadri S, Gorrini C, Piccolo G, Peruzzi S, Dettori G, Chezzi C. Comparative evaluation of molecular assays for the identification of intestinal spirochaetes from diseased pigs. Vet Microbiol 2006; 118:91-100. [PMID: 16879935 DOI: 10.1016/j.vetmic.2006.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Revised: 06/20/2006] [Accepted: 06/26/2006] [Indexed: 11/18/2022]
Abstract
Rapid identification of porcine Brachyspira species is required in order to differentiate pathogenic from non-pathogenic species. The aim of our study was to compare a recently described genetic method based on polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP), nox RFLP-PCR assay, and three species-specific PCRs described previously in the literature with a 16S rRNA gene RFLP-PCR discriminatory reference assay (16S RFLP-PCR) for the identification of Brachyspira spp. of swine origin. In this study, 20 porcine spirochaetal strains were identified and compared to 33 reference strains by 16S RFLP-PCR and nox RFLP-PCR and three species-specific PCRs. RFLP-PCR methods showed concordant results for 47 strains and discordances for 6 strains (2 differently identified and 4 not revealed by nox RFLP-PCR). In our hands species-specific PCRs showed concordant results with 16S and nox RFLP-PCR for 43 strains and discordances for 10 strains (2 differently identified and 8 not amplified). The same results observed testing the 20 field-isolated spirochaetes were obtained for the corresponding porcine faecal samples. The detection limit was 10(2) -10(3) cells/g of faeces for 16S rRNA gene PCR and 10(4) cells/g of faeces for nox PCR. In our experience nox RFLP-PCR appeared successful for the speciation of B. hyodysenteriae reserving 16S RFLP-PCR for all other pathogenic and non-pathogenic Brachyspira species. Among the species-specific PCR assays tested only that for B. pilosicoli was useful in our hands.
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Affiliation(s)
- A Calderaro
- Department of Pathology and Laboratory Medicine, Section of Microbiology, Faculty of Medicine and Surgery, University of Parma, Viale A. Gramsci, 14-43100 Parma, Italy.
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Råsbäck T, Fellström C, Gunnarsson A, Aspán A. Comparison of culture and biochemical tests with PCR for detection of Brachyspira hyodysenteriae and Brachyspira pilosicoli. J Microbiol Methods 2006; 66:347-53. [PMID: 16457900 DOI: 10.1016/j.mimet.2005.12.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 12/19/2005] [Accepted: 12/21/2005] [Indexed: 10/25/2022]
Abstract
Traditional culture and biochemical tests (CBT) were compared with PCR for sensitivity and detection of Brachyspira hyodysenteriae and Brachyspira pilosicoli in seeded faeces and clinical samples from diarrhoeic pigs. A duplex PCR system was developed based on primers detecting the tlyA-gene of B. hyodysenteriae and the 16S rRNA-gene of B. pilosicoli. Sensitivities for the PCR system were determined on seeded faeces, using DNA that had been recovered from primary cultures or extracted directly from faeces. Compared to CBT, PCR applied to DNA extracted directly from faeces lowered the sensitivity by a factor of 1000 to 10,000. B. hyodysenteriae and B. pilosicoli detection was compared for CBT and PCR using 200 clinical samples. CBT detected more B. hyodysenteriae isolates in the clinical samples than PCR, but fewer B. pilosicoli positive samples. An atypical strongly haemolytic isolate was detected only by CBT.
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Affiliation(s)
- T Råsbäck
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7018, SE-750 07 Uppsala, Sweden.
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