Restriction fragment length polymorphisms among the flagellar genes of the Lior heat-labile serogroup reference strains and field strains of Campylobacter jejuni and C. coli

flaA-SVR Based Genetic Diversity of Multiresistant Campylobacter jejuni Isolated From Chickens and Humans

Campylobacter jejuni is one of the most common causes of human foodborne bacterial infections worldwide. The objective of this study was to assess the molecular diversity, using flaA sequencing, of 602 C. jejuni isolated from chicken food chain, i.e., chicken feces (n = 151), chicken carcasses (n = 150), chicken meat (n = 150), and from humans (n = 151) and to determine antimicrobial multiresistant profiles of the isolates as well as to analyze the relationship of the isolate genotypes with their antimicrobial resistance profiles and source of isolation. Multidrug resistant patterns were identified in 110 (18.3%) C. jejuni isolates recovered from all sources and most isolates were resistant to ciprofloxacin (CIP), nalidixic acid (NAL), streptomycin (STR), and tetracycline (TET) (92; 15.3%) or ciprofloxacin, streptomycin, and tetracycline (13; 2.2%). Only a few isolates were multiresistant to ciprofloxacin, nalidixic acid, tetracycline, and erythromycin (3; 0.5%) or ciprofloxacin, nalidixic acid, streptomycin, tetracycline, and erythromycin (2; 0.3%). A total of 79 flaA-SVR subtypes were identified, including 40 (50.6%) unique to the isolates' origins, with the most common sequence types 16, 54, 36, 34, and 287 which covered 56 (9.3%), 50 (8.3%), 48 (8.0%), 35 (5.8%), and 32 (5.3%) of C. jejuni isolates, respectively. It was found that 13 isolates had the novel flaA-SVR subtypes which were not present in the pubMLST database. These isolates were recovered from chicken feces (6 isolates), carcasses (2 isolates), meat (one isolate) and from humans (4 isolates). Multiresistant C. jejuni were classified into 26 different sequence subtypes. Among the most numerous multidrug resistant profile CIP+NAL+STR+TET 21 different flaA-SVR subtypes, with total of 92 isolates, were identified. Most of them were classified to 287 (18; 19.6% isolates), 100 (13; 14.1%), 34 (9; 9.8%), 208 (8; 8.7%), and 781 (8; 8.7%) molecular variants. Isolates resistant to CIP, STR and TET (13 isolates) were mainly from chicken feces (12 isolates) and classified into 5 flaA-SVR sequence types, with the most common 36 (8 isolates). The obtained results show a broad molecular diversity of multiresistant C. jejuni isolates and suggest chickens as a possible source of human Campylobacter infections in Poland.

Development of a strain-specific molecular method for quantitating individual campylobacter strains in mixed populations

The identification of sites resulting in cross-contamination of poultry flocks in the abattoir and determination of the survival and persistence of campylobacters at these sites are essential for the development of intervention strategies aimed at reducing the microbial burden on poultry at retail. A novel molecule-based method, using strain- and genus-specific oligonucleotide probes, was developed to detect and enumerate specific campylobacter strains in mixed populations. Strain-specific oligonucleotide probes were designed for the short variable regions (SVR) of the flaA gene in individual Campylobacter jejuni strains. A 16S rRNA Campylobacter genus-specific probe was also used. Both types of probes were used to investigate populations of campylobacters by colony lift hybridization. The specificity and proof of principle of the method were tested using strains with closely related SVR sequences and mixtures of these strains. Colony lifts of campylobacters were hybridized sequentially with up to two labeled strain-specific probes, followed by the generic 16S rRNA probe. SVR probes were highly specific, differentiating down to 1 nucleotide in the target sequence, and were sufficiently sensitive to detect colonies of a single strain in a mixed population. The 16S rRNA probe detected all Campylobacter spp. tested but not closely related species, such as Arcobacter skirrowi and Helicobacter pullorum. Preliminary field studies demonstrated the application of this technique to target strains isolated from poultry transport crate wash tank water. This method is quantitative, sensitive, and highly specific and allows the identification and enumeration of selected strains among all of the campylobacters in environmental samples.

Risk factors for infection with Campylobacter jejuni flaA genotypes

We aimed to explore Campylobacter genotype-specific risk factors in Australia. Isolates collected prospectively from cases recruited into a case-control study were genotyped using flaA restriction fragment-length polymorphism typing (flaA genotyping). Exposure information for cases and controls was collected by telephone interview. Risk factors were examined for major flaA genotypes using logistic and multinomial regression. Five flaA genotypes accounted for 325 of 590 (55%) cases - flaA-6b (n=129), flaA-6 (n=70), flaA-10 (n=48), flaA-2 (n=43), flaA-131 (n=35). In Australia, infections due to flaA-10 and flaA-2 were found to be significantly associated with eating non-poultry meat (beef and ham, respectively) in both case-control and inter-genotype comparisons. All major genotypes apart from flaA-10 were associated with chicken consumption in the case-control comparisons. Based on several clinical criteria, infections due to flaA-2 were more severe than those due to other genotypes. Thus genotype analysis may reveal genotype-specific niches and differences in virulence and transmission routes.

Tracing flock-related Campylobacter clones from broiler farms through slaughter to retail products by pulsed-field gel electrophoresis

A total of 237 Campylobacter isolates from broiler flocks at farm (45 isolates) and slaughter (192 isolates) were typed by pulsed-field gel electrophoresis (PFGE) for epidemiological tracing studies. For PFGE, a modification of the Campynet method was used, which was standardized in a European Union project. The goal of the study was to trace flock-related Campylobacter clones through the whole production chain, from farm through slaughter to retail products, to investigate the introduction of thermophilic Campylobacter spp. on incoming contaminated carcasses during processing to the final products. The results of this study showed that identical clones of this pathogen, which had previously been found within the flocks during primary production, were also detected at individual stages of processing, including final products, which were packed and ready for sale. Most of the detected clones dominated during primary production and at slaughter. This study found PFGE to be suitable for examining epidemiological field data in the same region and time contexts. The discriminatory power of SmaI restriction enzyme digestion was sufficient. Relationships of the isolated Campylobacter strains could be confirmed by use of a second restriction enzyme, KpnI.

Clonal complexes of Campylobacter jejuni identified by multilocus sequence typing are reliably predicted by restriction fragment length polymorphism analyses of the flaA gene

Multilocus sequence typing (MLST) has provided important new insights into the population structure of Campylobacter jejuni and is rapidly becoming the gold standard for typing this species. However, the methodology is comparatively costly and slow to perform for the routine surveillance testing of large numbers of isolates required by public health laboratories. Restriction fragment length polymorphism analysis of the flaA gene (RFLP-flaA) and sequencing of the variable region in the fla locus (SVR-fla) were compared to MLST to determine if a low cost alternative could be found that reliably predicts clonal lineage (as determined by MLST). An isolate of C. jejuni from each of 153 patients from New South Wales, Australia, collected sequentially over a period of 30 months from 1999 to 2001 and comprising 40 sequence types (ST) from 15 clonal complexes (CC) was examined. Of 15 CC, 12 were represented by more than one isolate and a predominant RFLP-flaA type was found for 10 (83%). Of these, seven (70%) correctly predicted the predominant MLST CC with a probability of >0.8. Of 40 STs detected, 19 were reported for the first time, 9 of which were represented by more than one isolate. Eight of these were represented by a single RFLP-flaA type. Only two of eight major SVR-fla types were able to predict CC with a probability of >0.8, indicating that flaA-RFLP is a more reliable predictor of CC than SVR-fla and thus offers an alternative to MLST for use in routine surveillance.

Use of the oxford multilocus sequence typing protocol and sequencing of the flagellin short variable region to characterize isolates from a large outbreak of waterborne Campylobacter sp. strains in Walkerton, Ontario, Canada

The Walkerton (Ontario, Canada) outbreak of waterborne Escherichia coli O157:H7 and Campylobacter jejuni was quite limited in both space and time, making it a good model for exploring the utility of different typing and subtyping methods for the characterization of relationships among isolates of these organisms. We have extended previous work with these organisms through analysis by the Oxford multilocus sequence typing (MLST) and the flagellin short variable region (fla-SVR) sequencing methods. Additional isolates not epidemiologically related to the Walkerton outbreak have also been included. Both sequencing methods identified and differentiated between Walkerton outbreak strains 1 and 2. When these strains were compared with isolates that were not part of the outbreak, the information produced by the fla-SVR method more often correlated with epidemiological findings than that produced by MLST, though both methods were required for optimal discrimination. The MLST data were more relevant in terms of the overall population structure of the organisms. Both mutation and recombination appeared to be responsible for generating diversity among the isolates tested.

Detection of heat-stable antigens of Campylobacter jejuni and C. coli by direct agglutination and passive hemagglutination

The two serotyping schemes for the detection of heat-stable antigens of Campylobacter jejuni and Campylobacter coli use the same strains for antiserum production but differ in the detection systems used for identifying agglutination. The Penner method uses passive hemagglutination (PHA) while the Laboratory of Enteric Pathogens method uses the same antisera but in a whole-bacterial-cell direct agglutination (DA) protocol. C. jejuni produces a polysaccharide capsule, which is antigenic, and is the main component detected by the PHA method. The DA method will detect both capsule antigens and lipopolysaccharide (LPS) or lipooligosaccharide (LOS) surface antigens. Comparison of both methods by using a selection of isolates from human infection has shown a range of variation in agglutination specificity, reflecting the differences in antigens detected by the two methods. While 27.4% of the 416 C. jejuni isolates reacted with the antisera raised against the same type strains by either method, the majority showed a range of more complex relationships. None of the 37 C. coli isolates reacted with the same antiserum by both methods. Together the two schemes gave a total of 102 distinct combined serogroups for C. jejuni and 16 for C. coli. Thus, while some clonally related isolates share the same capsule and LOS or LPS antigens, other strains appear to have a common capsule antigen but differ in their LPS or LOS structures or vice versa.

Use of pulsed-field gel electrophoresis and flagellin gene typing in identifying clonal groups of Campylobacter jejuni and Campylobacter coli in farm and clinical environments

Although campylobacters have been isolated from a wide range of animal hosts, the association between campylobacters isolated from humans and animals in the farm environment is unclear. We used flagellin gene typing and pulsed-field gel electrophoresis (PFGE) to investigate the genetic diversity among isolates from animals (cattle, sheep, and turkey) in farm environments and sporadic cases of campylobacteriosis in the same geographical area. Forty-eight combined fla types were seen among the 315 Campylobacter isolates studied. Six were found in isolates from all four hosts and represented 50% of the total number of isolates. Seventy-one different SmaI PFGE macrorestriction profiles (mrps) were observed, with 86% of isolates assigned to one of 29 different mrps. Fifty-seven isolates from diverse hosts, times, and sources had an identical SmaI mrp and combined fla type. Conversely, a number of genotypes were unique to a particular host. We provide molecular evidence which suggests a link between campylobacters in the farm environment with those causing disease in the community.

Pathophysiology of Campylobacter jejuni infections of humans

Campylobacter jejuni and closely related organisms are major causes of human bacterial enteritis. These infections can lead to extraintestinal disease and severe long-term complications. Of these, neurological damage, apparently due to the immune response of the host, is the most striking. This review examines current knowledge of the pathophysiology of the organism. Diversity of C. jejuni isolates in genotypic and phenotypic characteristics now is recognized and clinically relevant examples are presented. Expected future directions are outlined.

Restriction fragment length polymorphism analysis of the flaA gene of Campylobacter jejuni for subtyping human, animal and poultry isolates

233 strains of Campylobacter jejuni were subtyped by PCR-RFLP analysis of the flagellin (flaA) gene by double digestion with EcoRI and PstI (EP flaA-profiling). The strains represented a variety of common Penner heat stable (HS) serotypes and comprised isolates of human, bovine, ovine, chicken and canine origin. FlaA amplicons were obtained directly from DNA in cell lysates of most strains. RFLP analysis showed considerable allelic variation and nine EP flaA-types were identified of which the most common were type 2 (32%), type 3 (20%), type 4 (12%) and type 6 (12%). Other flaA-profiles each represented less than 10% of strains. C. jejuni strains of each serotype generally had one or two specifically associated flaA-types although some were features of several serotypes. Strains with the same flaA-type were found in different hosts. EP flaA-profiles were reproducible, clear and simple to record, and laboratory protocols were rapid and low cost with high throughput capacity. The EP flaA-profiling scheme provided an excellent molecular subtyping method to supplement HS serotyping, and reference strains are recommended to facilitate its use in future epidemiological investigations.

Rapid identification of thermotolerant Campylobacter jejuni, Campylobacter coli, Campylobacter lari, and Campylobacter upsaliensis from various geographic locations by a GTPase-based PCR-reverse hybridization assay

Recently, a gene from Campylobacter jejuni encoding a putative GTPase was identified. Based on two semiconserved GTP-binding sites encoded within this gene, PCR primers were selected that allow amplification of a 153-bp fragment from C. jejuni, C. coli, C. lari, and C. upsaliensis. Sequence analysis of these PCR products revealed consistent interspecies variation, which allowed the definition of species-specific probes for each of the four thermotolerant Campylobacter species. Multiple probes were used to develop a line probe assay (LiPA) that permits analysis of PCR products by a single reverse hybridization step. A total of 320 reference strains and clinical isolates from various geographic origins were tested by the GTP-based PCR-LiPA. The PCR-LiPA is highly specific in comparison with conventional identification methods, including biochemical and whole-cell protein analyses. In conclusion, a simple method has been developed for rapid and highly specific identification of thermotolerant Campylobacter species.

Stability of related human and chicken Campylobacter jejuni genotypes after passage through chick intestine studied by pulsed-field gel electrophoresis

The genomic stability of 12 Campylobacter jejuni strains consisting of two groups of human and chicken isolates was studied by analysis of their PFGE (pulsed-field gel electrophoresis) patterns after passage through newly hatched chicks' intestines. The patterns of SmaI, SalI, and SacII digests remained stable after intestinal passage, except for those of two strains. One originally human strain, FB 6371, changed its genotype from II/A (SmaI/SacII) to I/B. Another strain, BTI, originally isolated from a chicken, changed its genotype from I/B to a new genotype. The genomic instability of the strains was further confirmed by SalI digestion and ribotyping of the HaeIII digests. In addition, heat-stable serotype 57 of strain FB 6371 changed to serotype 27 in all isolates with new genotypes but remained unchanged in an isolate with the original genotype. Serotype 27 of strain BTI remained stable. Our study suggests that during intestinal colonization, genomic rearrangement, as demonstrated by changed PFGE and ribopatterns, may occur.

Associations between heat-stable (O) and heat-labile (HL) serogroup antigens of Campylobacter jejuni: evidence for interstrain relationships within three O/HL serovars

A comparative examination of the heat-stable (O) and heat-labile (HL) serogrouping results for 9,024 sporadic human isolates of Campylobacter jejuni revealed conserved associations between specific O and HL antigens (O/HL serovars). Forty-nine percent of the isolates which grouped for both O and HL antigens belonged to one of three serovars: O 4 complex/HL 1 (17.9%), O 1/HL 2 (16.8%), or O 50/HL 7 (14.5%). Other common serovars were O 2/HL 4 (8.3%), O 6/HL 6 (8.1%), O 53/HL 11 (4.5%), O 19/HL 17 (3.3%), O 5/HL 9 (3.3%), O 9/HL 9 (3.2%), and O 23/HL 5 (3.1%). These 10 serovars accounted for 83.1% of the serogroupable isolates. A large number of strains (41.3%) could be typed by only one of the two methods or could not be serogrouped (11%). Strains belonging to three serovars, O 2/HL 4, O 50/HL 7, and O 23/HL 5, were further characterized by combining data from expressed features (O/HL serogroups, phage groups, and biotypes) with restriction fragment length polymorphism genotypes. These polyphasic data demonstrated that within each serovar, individual isolates showed substantial conservation of both genomic and phenotypic characteristics. The essentially clonal nature of the three serovars confirmed the potential of combined O and HL serogrouping as a practical and phylogenetically valid method for investigating the epidemiology of sporadic C. jejuni infection.

The application of genotyping techniques to the epidemiological analysis of Campylobacter jejuni

Campylobacter jejuni serogroup reference strains and collections of sporadic and outbreak-associated isolates were examined for restriction fragment length polymorphisms (RFLPs), using C. jejuni random chromosomal and 16S rRNA gene probes. A collection of 48 Penner (HS) and 14 Lior (HL) serogroup reference strains, plus 10 clinical isolates, generated 35 RFLP and 26 ribotype patterns. In combination the two loci generated 48 distinct genotypes. Both probes were able to differentiate between certain random isolates of the same HS/HL serogroups but greater discrimination was obtained with RFLP than with ribotyping. Genotyping distinguished accurately between related and unrelated strains when applied to several outbreaks. Genotypic analysis of C. jejuni by restriction fragment length polymorphisms is a valuable technique for epidemiological typing. Chromosomal variation detected by the two unlinked probe loci provides some information about the genetic relationship between isolates.

Flagellin gene profiling of Campylobacter jejuni heat-stable serotype 1 and 4 complex

Flagellin gene (flaA) sequence polymorphisms were used to discriminate amongst 167 strains of Campylobacter jejuni serotype HS1 and the HS4 complex. Direct PCR of cell suspensions provided a rapid method for analysing DNase-negative strains, whereas purified DNA was necessary for the DNase-positive strains. Nine different PCR-RFLP patterns (genotypes) were identified by analysis with Hinfl and 12 with Ddel, giving a total of 19 combined flaA profile types. The most common combined fla types were H1D1 (35%) and H1D2 (20%) for serotype HS1, and H1D2 (23%) and H4D7 (43%) for serotype HS4. Comparison of flaA typing with other key subtyping methods for C. jejuni showed it to be less discriminatory than pulsed field gel electrophoretic (PFGE) profiling, but more so than ribotyping. Fla types provided a useful indication of strain diversity, but as some were conserved across different serotypes, ribotypes and PFGE types, the same fla type could not be used as the sole basis for grouping strains. We provide evidence for several distinct subgroups based on conserved multiple genomic criteria within the HS1 and HS4 strains, and conclude that monitoring of such subgroups could provide a novel basis for future epidemiological surveillance of C. jejuni.

Sequential development of resistance to fluoroquinolones and erythromycin in an isolate of Campylobacter jejuni

A severe episode of Campylobacter jejuni gastroenteritis in a patient with HIV infection was treated with ciprofloxacin and, because of therapeutic failure, subsequently with roxithromycin. After treatment, C. jejuni was again isolated from feces and shown to be resistant to both drugs. We present molecular evidence of the sequential development of both types of resistance in the patient isolate. To our knowledge, this is the first case with documented evidence showing sequential emergence of resistance to fluoroquinolones and erythromycin in a strain of C. jejuni during treatment.