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Blanco-Picazo P, Gómez-Gómez C, Aguiló-Castillo S, Fernández-Orth D, Cerdà-Cuéllar M, Muniesa M, Rodríguez-Rubio L. Chicken liver is a potential reservoir of bacteriophages and phage-derived particles containing antibiotic resistance genes. Microb Biotechnol 2022; 15:2464-2475. [PMID: 35485188 PMCID: PMC9437878 DOI: 10.1111/1751-7915.14056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Abstract
Poultry meat production is one of the most important agri‐food industries in the world. The selective pressure exerted by widespread prophylactic or therapeutic use of antibiotics in intensive chicken farming favours the development of drug resistance in bacterial populations. Chicken liver, closely connected with the intestinal tract, has been directly involved in food‐borne infections and found to be contaminated with pathogenic bacteria, including Campylobacter and Salmonella. In this study, 74 chicken livers, divided into sterile and non‐sterile groups, were analysed, not only for microbial indicators but also for the presence of phages and phage particles containing antibiotic resistance genes (ARGs). Both bacteria and phages were detected in liver tissues, including those dissected under sterile conditions. The phages were able to infect Escherichia coli and showed a Siphovirus morphology. The chicken livers contained from 103 to 106 phage particles per g, which carried a range of ARGs (blaTEM, blaCTx‐M‐1, sul1, qnrA, armA and tetW) detected by qPCR. The presence of phages in chicken liver, mostly infecting E. coli, was confirmed by metagenomic analysis, although this technique was not sufficiently sensitive to identify ARGs. In addition, ARG‐carrying phages were detected in chicken faeces by qPCR in a previous study of the group. Comparison of the viromes of faeces and liver showed a strong coincidence of species, which suggests that the phages found in the liver originate in faeces. These findings suggests that phages, like bacteria, can translocate from the gut to the liver, which may therefore constitute a potential reservoir of antibiotic resistance genes.
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Affiliation(s)
- Pedro Blanco-Picazo
- Department de Genètica, Microbiologia i Estadística, Universitat de Barcelona, Diagonal 643, Planta 0, Barcelona, 08028, Spain
| | - Clara Gómez-Gómez
- Department de Genètica, Microbiologia i Estadística, Universitat de Barcelona, Diagonal 643, Planta 0, Barcelona, 08028, Spain
| | - Sergi Aguiló-Castillo
- Spanish National Bioinformatics Institute (INB)/ELIXIR-ES, Barcelona Supercomputing Center, Barcelona, Spain
| | - Dietmar Fernández-Orth
- Department of Bioinformatics and Molecular Biology, Cerba Internacional Pl. Ramon Llull, 7-10, Sabadell, Barcelona, 08203, Spain
| | - Marta Cerdà-Cuéllar
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la Universitat Autònoma de Barcelona, Bellaterra, Barcelona, 08193, Spain
| | - Maite Muniesa
- Department de Genètica, Microbiologia i Estadística, Universitat de Barcelona, Diagonal 643, Planta 0, Barcelona, 08028, Spain
| | - Lorena Rodríguez-Rubio
- Department de Genètica, Microbiologia i Estadística, Universitat de Barcelona, Diagonal 643, Planta 0, Barcelona, 08028, Spain
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Blanco-Picazo P, Gómez-Gómez C, Morales-Cortes S, Muniesa M, Rodríguez-Rubio L. Antibiotic resistance in the viral fraction of dairy products and a nut-based milk. Int J Food Microbiol 2022; 367:109590. [PMID: 35220008 DOI: 10.1016/j.ijfoodmicro.2022.109590] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
Phages, the most abundant biological entities in the biosphere, can carry different bacterial genes, including those conferring antibiotic resistance. In this study, dairy products were analyzed by qPCR for the presence of phages and phage particles containing antibiotic resistance genes (ARGs). Eleven ARGs were identified in 50 samples of kefir, yogurt, milk, fresh cheese and nut-based milk (horchata), purchased from local retailers in Barcelona. Propagation experiments showed that at least some of the phages isolated from these samples infected Escherichia coli WG5, which was selected as the host strain because it does not contain prophages or ARGs in its genome. Electron microscopy revealed that the phage particles showed morphologies compatible with the Myoviridae and Siphoviridae families. Our results show that dairy products contain ARGs within infectious phage particles and may therefore serve as a reservoir of ARGs that can be mobilized to susceptible hosts, both in the food matrix and in the intestinal tract after ingestion.
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Affiliation(s)
- Pedro Blanco-Picazo
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain
| | - Clara Gómez-Gómez
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain
| | - Sara Morales-Cortes
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain
| | - Maite Muniesa
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain
| | - Lorena Rodríguez-Rubio
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain.
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3
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Bacteriophages as Fecal Pollution Indicators. Viruses 2021; 13:v13061089. [PMID: 34200458 PMCID: PMC8229503 DOI: 10.3390/v13061089] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/28/2021] [Accepted: 06/05/2021] [Indexed: 12/12/2022] Open
Abstract
Bacteriophages are promising tools for the detection of fecal pollution in different environments, and particularly for viral pathogen risk assessment. Having similar morphological and biological characteristics, bacteriophages mimic the fate and transport of enteric viruses. Enteric bacteriophages, especially phages infecting Escherichia coli (coliphages), have been proposed as alternatives or complements to fecal indicator bacteria. Here, we provide a general overview of the potential use of enteric bacteriophages as fecal and viral indicators in different environments, as well as the available methods for their detection and enumeration, and the regulations for their application.
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Toribio-Avedillo D, Martín-Díaz J, Blanco-Picazo P, Blanch AR, Muniesa M. F-specific coliphage detection by the Bluephage method. WATER RESEARCH 2020; 184:116215. [PMID: 32726738 DOI: 10.1016/j.watres.2020.116215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
F-specific coliphages have been proposed as viral indicators of fecal pollution. These intestinal phages infect cells through the F-pili of the host strains used for their detection, Escherichia. coli HS/FAmp in the US-EPA standard method and Salmonella enterica WG49 in the ISO method. The recently designed Bluephage protocol allows the rapid detection of as low as one somatic coliphage in a working day. The current study describes a new Bluephage method designed to exclusively detect F-specific phages. It employs two new host strains, CB14 and CB16, which detect the same number of F-specific phages as their respective parental strains HS and WG49. In the Bluephage method, when the strain is lysed by bacteriophage infection, the yellow medium turns blue. As low as one F-specific phage was detected in 3 to 5 h by this approach and when the sample contained high phage concentrations, results were obtained in less than 3 h. The F-specific Bluephage method can be used with different sample volumes and allows phage quantification by the most probable number technique. Strain CB14 performed more consistently than CB16, with comparable detection efficiency after increasing the incubation time to 50 min without shaking.
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Affiliation(s)
- Daniel Toribio-Avedillo
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Barcelona E-08028, Spain
| | - Julia Martín-Díaz
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Barcelona E-08028, Spain
| | - Pedro Blanco-Picazo
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Barcelona E-08028, Spain
| | - Anicet R Blanch
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Barcelona E-08028, Spain
| | - Maite Muniesa
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Barcelona E-08028, Spain.
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Blanco-Picazo P, Roscales G, Toribio-Avedillo D, Gómez-Gómez C, Avila C, Ballesté E, Muniesa M, Rodríguez-Rubio L. Antibiotic Resistance Genes in Phage Particles from Antarctic and Mediterranean Seawater Ecosystems. Microorganisms 2020; 8:microorganisms8091293. [PMID: 32847015 PMCID: PMC7565065 DOI: 10.3390/microorganisms8091293] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 01/17/2023] Open
Abstract
Anthropogenic activities are a key factor in the development of antibiotic resistance in bacteria, a growing problem worldwide. Nevertheless, antibiotics and resistances were being generated by bacterial communities long before their discovery by humankind, and might occur in areas without human influence. Bacteriophages are known to play a relevant role in the dissemination of antibiotic resistance genes (ARGs) in aquatic environments. In this study, five ARGs (blaTEM, blaCTX-M-1, blaCTX-M-9, sul1 and tetW) were monitored in phage particles isolated from seawater of two different locations: (i) the Mediterranean coast, subjected to high anthropogenic pressure, and (ii) the Antarctic coast, where the anthropogenic impact is low. Although found in lower quantities, ARG-containing phage particles were more prevalent among the Antarctic than the Mediterranean seawater samples and Antarctic bacterial communities were confirmed as their source. In the Mediterranean area, ARG-containing phages from anthropogenic fecal pollution might allow ARG transmission through the food chain. ARGs were detected in phage particles isolated from fish (Mediterranean, Atlantic, farmed, and frozen), the most abundant being β-lactamases. Some of these particles were infectious in cultures of the fecal bacteria Escherichia coli. By serving as ARG reservoirs in marine environments, including those with low human activity, such as the Antarctic, phages could contribute to ARG transmission between bacterial communities.
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Affiliation(s)
- Pedro Blanco-Picazo
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain; (P.B.-P.); (G.R.); (D.T.-A.); (C.G.-G.); (E.B.)
| | - Gabriel Roscales
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain; (P.B.-P.); (G.R.); (D.T.-A.); (C.G.-G.); (E.B.)
| | - Daniel Toribio-Avedillo
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain; (P.B.-P.); (G.R.); (D.T.-A.); (C.G.-G.); (E.B.)
| | - Clara Gómez-Gómez
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain; (P.B.-P.); (G.R.); (D.T.-A.); (C.G.-G.); (E.B.)
| | - Conxita Avila
- Department of Evolutionary Biology, Ecology and Environmental Sciences (BEECA), Faculty of Biology, and Biodiversity Research Institute (IrBIO), University of Barcelona, Diagonal 643, 08028 Barcelona, Spain;
| | - Elisenda Ballesté
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain; (P.B.-P.); (G.R.); (D.T.-A.); (C.G.-G.); (E.B.)
| | - Maite Muniesa
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain; (P.B.-P.); (G.R.); (D.T.-A.); (C.G.-G.); (E.B.)
- Correspondence: (M.M.); (L.R.-R.)
| | - Lorena Rodríguez-Rubio
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Diagonal 643, Annex, Floor 0, 08028 Barcelona, Spain; (P.B.-P.); (G.R.); (D.T.-A.); (C.G.-G.); (E.B.)
- Correspondence: (M.M.); (L.R.-R.)
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Toribio-Avedillo D, Méndez J, Muniesa M, Blanch AR. Evaluation of New Components in Modified Scholten's Medium for the Detection of Somatic Coliphages. FOOD AND ENVIRONMENTAL VIROLOGY 2020; 12:148-157. [PMID: 32006190 DOI: 10.1007/s12560-020-09419-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/24/2020] [Indexed: 06/10/2023]
Abstract
Enteric bacteriophages (somatic coliphages, F-specific coliphages or both together) are now recognized as useful viral indicators in water, shellfish, and biosolids and are being progressively included in national and international sanitary regulations. Among them, somatic coliphages have an advantage in that they usually outnumber F-RNA coliphages in water environments. Their enumeration using Modified Scholten's (MS) media, following the ISO 10705-2 standard for the growth of Escherichia coli host strain WG5, is highly efficient and a common practice worldwide. These media contain a high concentration of nutrients, which may be modified to save costs without loss of bacterial growth host efficiency. This study explored reducing the concentration of nutrients in the current formulation and/or incorporating new components to improve the host bacterial growth and/or the enumeration of somatic coliphages at an affordable analytical cost. A twofold dilution of the original MS media was found not to affect the bacterial growth rate. The addition of combinations of assayed compounds to twofold diluted MS media slightly enhanced its analytical performance without altering bacterial growth. By generating savings in both cost and time while maintaining optimal results, media dilution could be applied to design new simple applications for coliphage enumeration.
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Affiliation(s)
- Daniel Toribio-Avedillo
- Microbiology Section, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, 643 Diagonal Ave., 08028, Barcelona, Spain
| | - Javier Méndez
- Microbiology Section, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, 643 Diagonal Ave., 08028, Barcelona, Spain
| | - Maite Muniesa
- Microbiology Section, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, 643 Diagonal Ave., 08028, Barcelona, Spain
| | - Anicet R Blanch
- Microbiology Section, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, 643 Diagonal Ave., 08028, Barcelona, Spain.
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Weaver AA, Hasan NA, Klaassen M, Karathia H, Colwell RR, Shrout JD. Prosthetic joint infections present diverse and unique microbial communities using combined whole-genome shotgun sequencing and culturing methods. J Med Microbiol 2019; 68:1507-1516. [PMID: 31460858 DOI: 10.1099/jmm.0.001068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introduction. Prosthetic joint infections (PJIs) are challenging to treat therapeutically because the infectious agents often are resistant to antibiotics and capable of abundant growth in surface-attached biofilms. Though infection rates are low, ca. 1-2 %, the overall increase in the sheer number of joint replacement surgeries results in an increase in patients at risk.Aims. This study investigates the consensus of microbial species comprising PJI ecology, which is currently lacking.Methodology. In this study, PJI populations from seven patients were analysed using combined culturing and whole-genome shotgun sequencing (WGSS) to establish population profiles and compare WGSS and culture methods for detection and identification of the PJI microbiome.Results. WGSS detected strains when culture did not, notably dormant, culture-resistant and rare microbes. The CosmosID algorithm was used to predict micro-organisms present in the PJI and discriminate contaminants. However, culturing indicated the presence of microbes falling below the WGSS algorithm threshold. In these instances, microbes cultured are believed to be minor species. The two strategies were combined to build a population profile.Conclusions. Variability between and among PJIs showed that most infections were distinct and unique. Comparative analysis of populations revealed PJIs to form clusters that were related to, but separate from, vaginal, skin and gut microbiomes. Fungi and protists were detected by WGSS, but the role of fungi is just beginning to be understood and for protists it is unknown. These micro-organisms and their novel and strain-specific microbial interactions remain to be determined in current clinical tests.
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Affiliation(s)
| | - Nur A Hasan
- Center for Bioinformatics and Computational Biology, University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD, 20742, USA.,CosmosID Inc, Rockville, MD, 20850, USA
| | | | | | - Rita R Colwell
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, 21205, USA.,CosmosID Inc, Rockville, MD, 20850, USA.,Center for Bioinformatics and Computational Biology, University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD, 20742, USA
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8
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Infectious phage particles packaging antibiotic resistance genes found in meat products and chicken feces. Sci Rep 2019; 9:13281. [PMID: 31527758 PMCID: PMC6746790 DOI: 10.1038/s41598-019-49898-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/29/2019] [Indexed: 11/08/2022] Open
Abstract
Bacteriophages can package part of their host's genetic material, including antibiotic resistance genes (ARGs), contributing to a rapid dissemination of resistances among bacteria. Phage particles containing ARGs were evaluated in meat, pork, beef and chicken minced meat, and ham and mortadella, purchased in local retailer. Ten ARGs (blaTEM, blaCTX-M-1, blaCTX-M-9, blaOXA-48, blaVIM, qnrA, qnrS, mecA, armA and sul1) were analyzed by qPCR in the phage DNA fraction. The genes were quantified, before and after propagation experiments in Escherichia coli, to evaluate the ability of ARG-carrying phage particles to infect and propagate in a bacterial host. According to microbiological parameters, all samples were acceptable for consumption. ARGs were detected in most of the samples after particle propagation indicating that at least part of the isolated phage particles were infectious, being sul1the most abundant ARG in all the matrices followed by β-lactamase genes. ARGs were also found in the phage DNA fraction of thirty-seven archive chicken cecal samples, confirming chicken fecal microbiota as an important ARG reservoir and the plausible origin of the particles found in meat. Phages are vehicles for gene transmission in meat that should not be underestimated as a risk factor in the global crisis of antibiotic resistance.
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Toribio-Avedillo D, Martín-Díaz J, Jofre J, Blanch AR, Muniesa M. New approach for the simultaneous detection of somatic coliphages and F-specific RNA coliphages as indicators of fecal pollution. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 655:263-272. [PMID: 30471594 DOI: 10.1016/j.scitotenv.2018.11.198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 05/04/2023]
Abstract
Two groups of coliphages have been recently included in different water management policies as indicators of viral fecal pollution in water and food: somatic coliphages, which infect E. coli through cell wall receptors, and F-specific RNA coliphages, which infect through the F-pili. Somatic coliphages are more abundant in fecally contaminated waters, except reclaimed waters, those disinfected by UV irradiation, and some groundwater samples that show a higher level of F-specific coliphages. Somatic coliphages are morphologically similar to DNA enteric viruses while F-specific coliphages are similar to RNA viruses such as norovirus and hepatitis A viruses, which are the viral pathogens of concern in sewage. The use of strains sensitive to both types of phages has been proposed for total coliphage enumeration, thereby avoiding double analysis. The standardized methods available for coliphage detection are robust and cost-effective, but the introduction of ready-to-use methods would facilitate routine implementation in laboratories. The fastest available tool for somatic coliphage enumeration is the recently developed Bluephage, which uses a modified β-glucuronide-overexpressing E. coli strain unable to take up the glucuronide substrate. The overexpressed enzyme accumulates inside the bacterial cells until released by phage-induced cell lysis, whereupon it encounters its substrate and the medium changes from yellow to blue. The present method uses E. coli strain CB12, sensitive to somatic coliphages and F-specific coliphages due to the expression of the F-pili. The Bluephage approach incorporating CB12 detects both types of coliphages in a time range of 1:30 to 4:00 h, as assayed with coliphages from raw sewage, river water, sludge and mussels. This strategy can be applied to obtain qualitative and quantitative results and is applicable to microplates as well as to large sample volumes (100 ml). Moreover it can provide monitoring of water bodies at real time, as for example for ambient recreational beach monitoring.
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Affiliation(s)
- Daniel Toribio-Avedillo
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028 Barcelona, Spain
| | - Julia Martín-Díaz
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028 Barcelona, Spain
| | - Juan Jofre
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028 Barcelona, Spain
| | - Anicet R Blanch
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028 Barcelona, Spain
| | - Maite Muniesa
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028 Barcelona, Spain.
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10
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Cho K, Lee C, Park S, Kim JH, Choi YS, Kim MS, Koo ES, Yoon HJ, Kang JH, Jeong YS, Choi JD, Ko G. Use of coliphages to investigate norovirus contamination in a shellfish growing area in Republic of Korea. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:30044-30055. [PMID: 30076551 DOI: 10.1007/s11356-018-2857-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/26/2018] [Indexed: 06/08/2023]
Abstract
A number of severe norovirus outbreaks due to the consumption of contaminated shellfish have been reported recently. In this study, we evaluated the distribution of coliphage densities to determine their efficacy as fecal indicators of enteric viruses, including noroviruses, in water samples collected from a shellfish growing area in Republic of Korea over a period of approximately 1 year. Male-specific and somatic coliphages in water samples were analyzed using the single agar layer method, and norovirus genogroups I and II, which infect mainly humans, were analyzed using duplex reverse transcription quantitative PCR. Male-specific and somatic coliphages were detected widely throughout the study area. Several environmental parameters, including salinity, precipitation, temperature, and wind speed were significantly correlated with coliphage concentrations (P < 0.05). Moreover, the concentrations of male-specific coliphages were positively correlated with the presence of human noroviruses (r = 0.443; P < 0.01). The geospatial analysis with coliphage concentrations using a geographic information system revealed that densely populated residential areas were the major source of fecal contamination. Our results indicate that coliphage monitoring in water could be a useful approach to prevent norovirus contamination in shellfish.
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Affiliation(s)
- Kyuseon Cho
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Cheonghoon Lee
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - SungJun Park
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
- N-Bio, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Jin Hwi Kim
- Department of Civil and Environmental Engineering, Dongguk University, 1 Pildong-ro, Jung-gu, Seoul, Republic of Korea
| | - Yong Seon Choi
- Department of Biology, College of Sciences, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Man Su Kim
- Department of Biology, College of Sciences, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Eung Seo Koo
- Department of Biology, College of Sciences, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Hyun Jin Yoon
- Department of Seafood Science and Technology, Gyeongsang National University, 38 Cheondaegukchi-gil, Tongyeong-si, Gyeongsangnam-do, Republic of Korea
| | - Joo-Hyon Kang
- Department of Civil and Environmental Engineering, Dongguk University, 1 Pildong-ro, Jung-gu, Seoul, Republic of Korea
| | - Yong Seok Jeong
- Department of Biology, College of Sciences, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Jong Duck Choi
- Department of Seafood Science and Technology, Gyeongsang National University, 38 Cheondaegukchi-gil, Tongyeong-si, Gyeongsangnam-do, Republic of Korea
| | - GwangPyo Ko
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea.
- N-Bio, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea.
- Center for Human and Environmental Microbiome, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea.
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11
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Muniesa M, Ballesté E, Imamovic L, Pascual-Benito M, Toribio-Avedillo D, Lucena F, Blanch AR, Jofre J. Bluephage: A rapid method for the detection of somatic coliphages used as indicators of fecal pollution in water. WATER RESEARCH 2018; 128:10-19. [PMID: 29078067 DOI: 10.1016/j.watres.2017.10.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 10/09/2017] [Accepted: 10/14/2017] [Indexed: 05/04/2023]
Abstract
The use of somatic coliphages as indicators of fecal and viral pollution in water and food has great potential due to the reliability, reproducibility, speed and cost effectiveness of methods for their detection. Indeed, several countries already use this approach in their water management policies. Although standardized protocols for somatic coliphage detection are available, user-friendly commercial kits would facilitate their routine implementation in laboratories. The new method presented here allows detection of up to 1 somatic coliphage in under 3.5 h, well within one working day. The method is based on a modified Escherichia coli strain with knocked-out uidB and uidC genes, which encode the transport of glucuronic acid inside cells, and overexpressing uidA, which encodes the enzyme β-glucuronidase. The enzyme accumulated in the bacterial cells only has contact with its substrate after cell lysis, such as that caused by phages, since the strain cannot internalize the substrate. When the enzyme is released into the medium, which contains a chromogen analogous to glucuronic acid, it produces a change of color from yellow to dark blue. This microbiological method for the determination of fecal pollution via the detection of culturable microorganisms can be applied to diverse sample types and volumes for qualitative (presence/absence) and quantitative analysis and is the fastest reported to date.
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Affiliation(s)
- M Muniesa
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028, Barcelona, Spain.
| | - E Ballesté
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028, Barcelona, Spain
| | - L Imamovic
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028, Barcelona, Spain
| | - M Pascual-Benito
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028, Barcelona, Spain
| | - D Toribio-Avedillo
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028, Barcelona, Spain
| | - F Lucena
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028, Barcelona, Spain
| | - A R Blanch
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028, Barcelona, Spain
| | - J Jofre
- Department of Genetics, Microbiology and Statistics, Microbiology Section, Faculty of Biology, University of Barcelona, Diagonal 643, E-08028, Barcelona, Spain
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12
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Hodgson KR, Torok VA, Turnbull AR. Bacteriophages as enteric viral indicators in bivalve mollusc management. Food Microbiol 2017; 65:284-293. [DOI: 10.1016/j.fm.2017.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/20/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
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13
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Agulló-Barceló M, Galofré B, Sala L, García-Aljaro C, Lucena F, Jofre J. Simultaneous detection of somatic and F-specific coliphages in different settings by Escherichia coli strain CB390. FEMS Microbiol Lett 2016; 363:fnw180. [PMID: 27481701 DOI: 10.1093/femsle/fnw180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 12/29/2022] Open
Abstract
Bacteriophages are increasingly being used as water quality indicators. Two groups of phages infecting Escherichia coli, somatic and F-specific coliphages, are being considered as indicators of fecal and viral contamination for several types of water around the world. However, some uncertainties remain regarding which coliphages to assess. Recently, E. coli strain CB390 has been reported to be suitable for simultaneous detection of both groups, which seems to be more informative than determining only one of the groups. Here, a significant number of samples from different settings, mostly those where F-specific phages have been reported to outnumber somatic coliphages, are analyzed for somatic coliphages, F-specific RNA phages by standardized methods and coliphages detected by host strain CB390. The results presented here confirm that the numbers of phages counted using CB390 are equivalent to the sum of the somatic and F-specific coliphages counted independently in all settings. Hence the usefulness of this strain for simultaneous detection of somatic and F-specific coliphages is confirmed. Also, sets of data on the presence of coliphages in reclaimed and groundwater are reported.
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Affiliation(s)
- Miriam Agulló-Barceló
- Department of Microbiology, Faculty of Biology, University of Barcelona, Av. Diagonal 643, 08028 Barcelona, Spain
| | - Belén Galofré
- Aigües de Barcelona, EMGCIA, C/General Batet 1-7, 08028 Barcelona, Spain
| | - Lluís Sala
- Consorci de la Costa Brava, Plaça Josep Pla I Casadevall, 4, 17001 Girona, Spain
| | - Cristina García-Aljaro
- Department of Microbiology, Faculty of Biology, University of Barcelona, Av. Diagonal 643, 08028 Barcelona, Spain
| | - Francisco Lucena
- Department of Microbiology, Faculty of Biology, University of Barcelona, Av. Diagonal 643, 08028 Barcelona, Spain
| | - Juan Jofre
- Department of Microbiology, Faculty of Biology, University of Barcelona, Av. Diagonal 643, 08028 Barcelona, Spain
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14
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Fauvel B, Cauchie HM, Gantzer C, Ogorzaly L. Contribution of hydrological data to the understanding of the spatio-temporal dynamics of F-specific RNA bacteriophages in river water during rainfall-runoff events. WATER RESEARCH 2016; 94:328-340. [PMID: 26971808 DOI: 10.1016/j.watres.2016.02.057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/16/2016] [Accepted: 02/28/2016] [Indexed: 05/04/2023]
Abstract
Heavy rainfall events were previously reported to bring large amounts of microorganisms in surface water, including viruses. However, little information is available on the origin and transport of viral particles in water during such rain events. In this study, an integrative approach combining microbiological and hydrological measurements was investigated to appreciate the dynamics and origins of F-specific RNA bacteriophage fluxes during two distinct rainfall-runoff events. A high frequency sampling (automatic sampler) was set up to monitor the F-specific RNA bacteriophages fluxes at a fine temporal scale during the whole course of the rainfall-runoff events. A total of 276 rainfall-runoff samples were collected and analysed using both infectivity and RT-qPCR assays. The results highlight an increase of 2.5 log10 and 1.8 log10 of infectious F-specific RNA bacteriophage fluxes in parallel of an increase of the water flow levels for both events. Faecal pollution was characterised as being mainly from anthropic origin with a significant flux of phage particles belonging to the genogroup II. At the temporal scale, two successive distinct waves of phage pollution were established and identified through the hydrological measurements. The first arrival of phages in the water column was likely to be linked to the resuspension of riverbed sediments that was responsible for a high input of genogroup II. Surface runoff contributed further to the second input of phages, and more particularly of genogroup I. In addition, an important contribution of infectious phage particles has been highlighted. These findings imply the existence of a close relationship between the risk for human health and the viral contamination of flood water.
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Affiliation(s)
- Blandine Fauvel
- Luxembourg Institute of Science and Technology (LIST), Department of Environmental Research and Innovation (ERIN), 41, rue du Brill, L-4422 Belvaux, Luxembourg; Université de Lorraine, Laboratoire de Chimie, Physique et Microbiologie pour l'Environnement (LCPME), UMR 7564, Faculté de Pharmacie, Nancy F-54000, France; CNRS, LCPME, UMR 7564, Nancy F-54000, France
| | - Henry-Michel Cauchie
- Luxembourg Institute of Science and Technology (LIST), Department of Environmental Research and Innovation (ERIN), 41, rue du Brill, L-4422 Belvaux, Luxembourg
| | - Christophe Gantzer
- Université de Lorraine, Laboratoire de Chimie, Physique et Microbiologie pour l'Environnement (LCPME), UMR 7564, Faculté de Pharmacie, Nancy F-54000, France; CNRS, LCPME, UMR 7564, Nancy F-54000, France
| | - Leslie Ogorzaly
- Luxembourg Institute of Science and Technology (LIST), Department of Environmental Research and Innovation (ERIN), 41, rue du Brill, L-4422 Belvaux, Luxembourg.
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15
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Ferrer O, Casas S, Galvañ C, Lucena F, Bosch A, Galofré B, Mesa J, Jofre J, Bernat X. Direct ultrafiltration performance and membrane integrity monitoring by microbiological analysis. WATER RESEARCH 2015; 83:121-31. [PMID: 26141428 DOI: 10.1016/j.watres.2015.06.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 05/09/2023]
Abstract
The feasibility of substituting a conventional pre-treatment, consisting of dioxi-chlorination, coagulation/flocculation, settling and sand filtration, of a drinking water treatment plant (DWTP) by direct ultrafiltration (UF) has been assessed from a microbiological standpoint. Bacterial indicators, viral indicators and human viruses have been monitored in raw river, ultrafiltered and conventionally pre-treated water samples during two years. Direct UF has proven to remove bacterial indicators quite efficiently and to a greater extent than the conventional process does. Nevertheless, the removal of small viruses such as some small bacteriophages and human viruses (e.g. enteroviruses and noroviruses) is lower than the current conventional pre-treatment. Membrane integrity has been assessed during two years by means of tailored tests based on bacteriophages with different properties (MS-2, GA and PDR-1) and bacterial spores (Bacillus spores). Membrane integrity has not been compromised despite the challenging conditions faced by directly treating raw river water. Bacteriophage PDR-1 appears as a suitable microbe to test membrane integrity, as its size is slightly larger than the considered membrane pore size. However, its implementation at full scale plant is still challenging due to difficulties in obtaining enough phages for its seeding.
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Affiliation(s)
- O Ferrer
- CETaqua, Water Technology Center, Carretera d'Esplugues 75, 08940, Cornellà de Llobregat, Spain.
| | - S Casas
- CETaqua, Water Technology Center, Carretera d'Esplugues 75, 08940, Cornellà de Llobregat, Spain
| | - C Galvañ
- CETaqua, Water Technology Center, Carretera d'Esplugues 75, 08940, Cornellà de Llobregat, Spain
| | - F Lucena
- Departament de Microbiologia, UB, Universitat de Barcelona, Av. Diagonal, 643, Barcelona, Spain
| | - A Bosch
- Departament de Microbiologia, UB, Universitat de Barcelona, Av. Diagonal, 643, Barcelona, Spain
| | - B Galofré
- AB, Aigües de Barcelona, Av. Diagonal 211, 08018, Barcelona, Spain
| | - J Mesa
- AB, Aigües de Barcelona, Av. Diagonal 211, 08018, Barcelona, Spain
| | - J Jofre
- Departament de Microbiologia, UB, Universitat de Barcelona, Av. Diagonal, 643, Barcelona, Spain
| | - X Bernat
- CETaqua, Water Technology Center, Carretera d'Esplugues 75, 08940, Cornellà de Llobregat, Spain
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16
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Rezaeinejad S, Vergara GGRV, Woo CH, Lim TT, Sobsey MD, Gin KYH. Surveillance of enteric viruses and coliphages in a tropical urban catchment. WATER RESEARCH 2014; 58:122-31. [PMID: 24747143 DOI: 10.1016/j.watres.2014.03.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/28/2014] [Accepted: 03/18/2014] [Indexed: 05/13/2023]
Abstract
An assessment of the occurrence and concentration of enteric viruses and coliphages was carried out in highly urbanized catchment waters in the tropical city-state of Singapore. Target enteric viruses in this study were noroviruses, adenoviruses, astroviruses and rotaviruses. In total, 65 water samples were collected from canals and the reservoir of the Marina catchment on a monthly basis over a period of a year. Quantitative PCR (qPCR) and single agar layer plaque assay (SAL) were used to enumerate target enteric viruses and coliphages in water samples, respectively. The most prevalent pathogen were noroviruses, detected in 37 samples (57%), particularly norovirus genogroup II (48%), with a mean concentration of 3.7 × 10(2) gene copies per liter. Rotavirus was the second most prevalent virus (40%) with a mean concentration of 2.5 × 10(2) GC/L. The mean concentrations of somatic and male-specific coliphages were 2.2 × 10(2) and 1.1 × 10(2) PFU/100 ml, respectively. The occurrence and concentration of each target virus and the ratio of somatic to male-specific coliphages varied at different sampling sites in the catchment. For sampling sites with higher frequency of occurrence and concentration of viruses, the ratio of somatic to male-specific coliphages was generally much lower than other sampling sites with lower incidences of enteric viruses. Overall, higher statistical correlation was observed between target enteric viruses than between enteric viruses and coliphages. However, male-specific coliphages were positively correlated with norovirus concentrations. A multi-level integrated surveillance system, which comprises the monitoring of bacterial indicators, coliphages and selected enteric viruses, could help to meet recreational and surface water quality criteria in a complex urbanized catchment.
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Affiliation(s)
- S Rezaeinejad
- Department of Civil and Environmental Engineering, Faculty of Engineering, National University of Singapore, Blk E1A-07-03, 1 Engineering Drive 2, Singapore 117576, Singapore
| | - G G R V Vergara
- Department of Civil and Environmental Engineering, Faculty of Engineering, National University of Singapore, Blk E1A-07-03, 1 Engineering Drive 2, Singapore 117576, Singapore
| | - C H Woo
- Technology and Water Quality Office, Public Utilities Board, Singapore
| | - T T Lim
- Technology and Water Quality Office, Public Utilities Board, Singapore
| | - M D Sobsey
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K Y H Gin
- Department of Civil and Environmental Engineering, Faculty of Engineering, National University of Singapore, Blk E1A-07-03, 1 Engineering Drive 2, Singapore 117576, Singapore.
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17
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Muniesa M, Colomer-Lluch M, Jofre J. Could bacteriophages transfer antibiotic resistance genes from environmental bacteria to human-body associated bacterial populations? Mob Genet Elements 2013; 3:e25847. [PMID: 24195016 PMCID: PMC3812792 DOI: 10.4161/mge.25847] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/16/2013] [Accepted: 07/22/2013] [Indexed: 01/17/2023] Open
Abstract
Environments without any contact with anthropogenic antibiotics show a great abundance of antibiotic resistance genes that use to be chromosomal and are part of the core genes of the species that harbor them. Some of these genes are shared with human pathogens where they appear in mobile genetic elements. Diversity of antibiotic resistance genes in non-contaminated environments is much greater than in human and animal pathogens, and in environments contaminated with antibiotic from anthropogenic activities. This suggests the existence of some bottleneck effect for the mobilization of antibiotic resistance genes among different biomes. Bacteriophages have characteristics that make them suitable vectors between different biomes, and as well for transferring genes from biome to biome. Recent metagenomic studies and detection of bacterial genes by genomic techniques in the bacteriophage fraction of different microbiota provide indirect evidences that the mobilization of genes mediated by phages, including antibiotic resistance genes, is far more relevant than previously thought. Our hypothesis is that bacteriophages might be of critical importance for evading one of the bottlenecks, the lack of ecological connectivity that modulates the pass of antibiotic resistance genes from natural environments such as waters and soils, to animal and human microbiomes. This commentary concentrates on the potential importance of bacteriophages in transferring resistance genes from the environment to human and animal body microbiomes, but there is no doubt that transduction occurs also in body microbiomes.
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Affiliation(s)
- Maite Muniesa
- Department of Microbiology; University of Barcelona; Barcelona, Spain
| | | | - Juan Jofre
- Department of Microbiology; University of Barcelona; Barcelona, Spain
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18
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Biosensors for the detection of waterborne pathogens. Anal Bioanal Chem 2011; 402:117-27. [DOI: 10.1007/s00216-011-5407-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 08/30/2011] [Accepted: 09/08/2011] [Indexed: 11/26/2022]
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Connelly JT, Kondapalli S, Skoupi M, Parker JSL, Kirby BJ, Baeumner AJ. Micro-total analysis system for virus detection: microfluidic pre-concentration coupled to liposome-based detection. Anal Bioanal Chem 2011; 402:315-23. [DOI: 10.1007/s00216-011-5381-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/15/2011] [Accepted: 08/30/2011] [Indexed: 11/29/2022]
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20
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Gómez-Doñate M, Payán A, Cortés I, Blanch AR, Lucena F, Jofre J, Muniesa M. Isolation of bacteriophage host strains of Bacteroides species suitable for tracking sources of animal faecal pollution in water. Environ Microbiol 2011; 13:1622-31. [PMID: 21443742 DOI: 10.1111/j.1462-2920.2011.02474.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Microbial source tracking (MST) methods allow the identification of specific faecal sources. The aim is to detect the sources of faecal pollution in a water body to allow targeted, efficient and cost-effective remediation efforts in the catchment. Bacteriophages infecting selected host strains of Bacteroides species are used as markers to track faecal contaminants in water. By using a suitable Bacteroides host from a given faecal origin, it is possible to specifically detect bacteriophages of this faecal origin. It can thus be used to detect specific phages of Bacteroides for MST. With this objective, we isolated several Bacteroides strains from pig, cow and poultry faeces by applying a previously optimized methodology used to isolate the host strains from humans. The isolated strains belonged to Bacteroides fragilis and Bacteroides thetaiotaomicron. These strains, like most Bacteroides species, detected phages of the Siphoviridae morphology. Using the newly isolated host strains for phage enumeration in a range of samples, we showed that these detect phages in faecal sources that coincide with their own origin (70-100% of the samples), and show no detection or very low percentages of detection of phages from other animal origins (from 0 to 20% of the samples). Only strains isolated from pig wastewater detected phages in 50% of human sewage samples. Nevertheless, those strains detecting phages from faecal origins other than their own detected fewer phages (2-3 log₁₀ pfu·100 ml⁻¹) than the phages detected by the specific strain of the same origin. On the basis of our results, we propose that faecal source tracking with phages infecting specific Bacteroides host strains is a useful method for MST. In addition, the method presented here is feasible in laboratories equipped with only basic microbiological equipment, it is more rapid and cost-effective than other procedures and it does not require highly qualified staff.
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Affiliation(s)
- Marta Gómez-Doñate
- Department of Microbiology, University of Barcelona-Institut de l'aigua, Diagonal 645, E-08028, Barcelona, Spain
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21
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Jofre J. Is the replication of somatic coliphages in water environments significant? J Appl Microbiol 2009; 106:1059-69. [DOI: 10.1111/j.1365-2672.2008.03957.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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