Cefotaxime/sulbactam plus gentamicin as a potential carbapenem- and amikacin-sparing first-line combination for neonatal sepsis in high ESBL prevalence settings

BACKGROUND

Infection with ESBL-producing Enterobacteriaceae infection is ubiquitous in some neonatal ICUs and increasing levels of antibiotic resistance are a cause for urgent concern. Delineation of bacterial and viral sepsis can be challenging, often leading to patients receiving empirical antibiotics without or whilst waiting for a definitive causal diagnosis. Empirical therapy is often dependent on broad-spectrum 'Watch' antibiotics, contributing to further resistance.

METHODS

ESBL-producing Enterobacteriaceae clinical isolates found to have caused neonatal sepsis and meningitis underwent a detailed in vitro screening including susceptibility testing, chequerboard combination analysis and hollow-fibre infection model dynamic analyses using combinations of cefotaxime, ampicillin and gentamicin in combination with β-lactamase inhibitors.

RESULTS

Additivity or synergy was found for all antibiotic combinations against seven Escherichia coli and three Klebsiella pneumoniae clinical isolates. Cefotaxime or ampicillin plus sulbactam combined with gentamicin was able to consistently inhibit the growth of ESBL-producing isolates at typical neonatal doses, and the combination cleared the hollow-fibre infection model system of organisms resistant to each agent alone. The combination of cefotaxime/sulbactam and gentamicin was consistently bactericidal at clinically achievable concentrations (Cmax of 180, 60 and 20 mg/L for cefotaxime, sulbactam and gentamicin, respectively).

CONCLUSIONS

The addition of sulbactam to cefotaxime or ampicillin to the typical first-line empirical therapy could obviate the need for carbapenems and amikacin in settings with high ESBL-infection prevalence.

Implications of identifying the recently defined members of the Staphylococcus aureus complex S. argenteus and S. schweitzeri: a position paper of members of the ESCMID Study Group for Staphylococci and Staphylococcal Diseases (ESGS)

BACKGROUND

Staphylococcus argenteus and Staphylococcus schweitzeri, previously known as divergent Staphylococcus aureus clonal lineages, have been recently established as novel, difficult-to-delimit, coagulase-positive species within the S. aureus complex. Methicillin-resistant strains of S. argenteus are known from Australia and the UK. Knowledge of their epidemiology, medical significance and transmission risk is limited and partly contradictory, hampering definitive recommendations. There is mounting evidence that the pathogenicity of S. argenteus is similar to that of 'classical' S. aureus, while as yet no S. schweitzeri infections have been reported.

AIM

To provide decision support on whether and how to distinguish and report both species.

SOURCES

PubMed, searched for S. argenteus and S. schweitzeri.

CONTENT

This position paper reviews the main characteristics of both species and draws conclusions for microbiological diagnostics and surveillance as well as infection prevention and control measures.

IMPLICATIONS

We propose not distinguishing within the S. aureus complex for routine reporting purposes until there is evidence that pathogenicity or clinical outcome differ markedly between the different species. Primarily for research purposes, suitably equipped laboratories are encouraged to differentiate between S. argenteus and S. schweitzeri. Caution is urged if these novel species are explicitly reported. In such cases, a specific comment should be added (i.e. 'member of the S.aureus complex') to prevent confusion with less- or non-pathogenic staphylococci. Prioritizing aspects of patient safety, methicillin-resistant isolates should be handled as recommended for methicillin-resistant Staphylococcus aureus (MRSA). In these cases, the clinician responsible should be directly contacted and informed by the diagnosing microbiological laboratory, as they would be for MRSA. Research is warranted to clarify the epidemiology, clinical impact and implications for infection control of such isolates.

The alpha-1 adrenergic antagonist doxazosin for treatment of cocaine dependence: A pilot study

BACKGROUND

Medications decreasing central noradrenergic activity have been associated with attenuation of cocaine effects.

AIMS

This pilot study examined the efficacy of doxazosin versus placebo for reducing cocaine use in treatment-seeking cocaine dependent persons.

METHODS

We screened 108 cocaine dependent subjects and assigned 35 participants to receive either doxazosin (8mg/day) or placebo for 13 weeks. Participants were titrated on the study medication according to two different schedules. During the initial phase of the study, patients were titrated onto the study medication over an 8-week period (DOX-slow). After reviewing data from our human laboratory study, a second phase was initiated, wherein titration was accelerated to a 4-week period (DOX-fast). All participants received weekly cognitive behavioral therapy. Urine toxicology was performed thrice weekly.

RESULTS

Baseline subject characteristics were comparable. Thirty subjects entered the study: 8 subjects in DOX-slow, 9 subjects in DOX-fast, and 13 subjects in placebo. Total number of cocaine-negative urines was significantly increased in the DOX-fast group; and percentage of total cocaine-negative urines by group were 10% for DOX-slow group, 35% for DOX-fast group, and 14% for placebo (χ(2)=36.3, df=2, p<0.0001). The percentage of participants achieving two or more consecutive weeks of abstinence by group was 0% for DOX-slow group, 44% for DOX-fast group, and 7% for placebo (χ(2)=7.35, df=2, p<0.023).

CONCLUSIONS

This pilot study suggests the potential efficacy of doxazosin when rapidly titrated in reducing cocaine use.

Meticillin-resistant Staphylococcus aureus carriage in UK veterinary staff and owners of infected pets: new risk groups

Meticillin-resistant Staphylococcus aureus (MRSA) nasal carriage on admission to hospital remains one of the most important risk factors for subsequent infection. Identification of high risk groups for MRSA carriage is vital for the success of infection control programmes. Veterinary staff may be one such risk group but little is known about pet owners and the role of contact with infected pets. As part of a UK-wide case-control study investigating risk factors for MRSA infection in dogs and cats between 2005 and 2008, 608 veterinary staff and pet owners in contact with 106 MRSA and 91 meticillin-susceptible S. aureus (MSSA)-infected pets were screened for S. aureus nasal carriage. Laboratory isolation and characterisation included salt broth enrichment, standard and automated microbiological tests, demonstration of the S. aureus-specific thermonuclease gene (nuc) and of mecA, and polymerase chain reaction-based lineage characterisation. MRSA carriage was 12.3% in veterinarians attending MRSA-infected animals and 7.5% in their owners. In the MSSA control group, MRSA carriage was 4.8% in veterinary staff and 0% in owners. Veterinary staff carried MRSA more frequently than owners (odds ratio: 2.33; 95% confidence interval: 1.10-4.93). All MRSA from humans and all but one animal MRSA were CC22 or CC30, typical for hospital MRSA in the UK. This study indicates for the first time an occupational risk for MRSA carriage in small animal general practitioners. Veterinary staff and owners of MRSA-infected pets are high risk groups for MRSA carriage despite not having direct hospital links. Strategies to break the cycle of MRSA infection must take these potential new reservoirs into account.

Lack of transmission of methicillin-resistant Staphylococcus aureus (MRSA) between apparently healthy dogs in a rescue kennel

Although it is widely accepted that methicillin-resistant Staphylococcus aureus (MRSA) can be transmitted between humans and animals in both directions, little is known about the dynamics of animal-to-animal transfer. This study aimed to investigate aspects of dog-to-dog MRSA transfer in a rescue facility in the South-East of England during an MRSA outbreak. One hundred and twenty-nine apparently healthy dogs, mostly housed in pairs, were swabbed at nasal, oral, axillary and perianal sites. Swabs were enriched in selective broth and staphylococci identified using standard biological methods. MRSA isolates were confirmed by demonstration of the thermonuclease gene (nuc) and mecA. After initial swabbing, a dog excluded from the study design but housed at the same facility was discovered to have a wound infection due to MRSA. MRSA carriage was identified in 10/129 dogs (7.8%) and all isolates were of the same lineage as the one isolated from the infected dog. All carrier dogs lived in shared kennels and their 16 kennel partners sampled negative on two occasions. Concurrently with successful antimicrobial treatment of the infected patient, MRSA carriage resolved spontaneously in all dogs within two weeks. In conclusion, MRSA did not transmit readily between apparently healthy dogs, MRSA carriage was not supported for long periods in a regularly cleaned environment and exposure alone may not lead to MRSA acquisition by dogs without the presence of additional risk factors.

Genetic diversity in CC398 methicillin-resistant Staphylococcus aureus isolates of different geographical origin

Staphylococcus aureus of sequence type 398 has emerged in Europe, North America and Asia, and has typically been associated with livestock and their human contacts. We analysed two Panton-Valentine leukocidin (PVL)-negative t034-ST398 isolates from humans in contact with pigs and two t034-ST398 PVL-positive isolates from two unrelated, adopted Chinese children, using multistrain microarrays to determine genomic variability between the two sets of isolates. The ST398 isolates clearly belong to the same lineage when compared to other clonal lineages. However, the four isolates cluster into two distinct groups corresponding to differences in epidemiology based on mobile genetic elements and resistance patterns, suggesting that the two groups are epidemiologically distinct.

Molecular characterisation of the dominant UK methicillin-resistant Staphylococcus aureus strains, EMRSA-15 and EMRSA-16

Epidemic methicillin-resistant Staphylococcus aureus types 15 and 16 (EMRSA-15 and EMRSA-16) are the dominant types of MRSA found in UK hospitals, but accurate designation of strains has been difficult. Restriction fragment length polymorphism (RFLP) profiles of seven core virulence genes were used to classify unambiguously isolates of MRSA from St George's Hospital into two groups corresponding to EMRSA-15 and EMRSA-16. Variants of both EMRSA-15 and EMRSA-16 isolates occurred that had lost virulence genes encoded on mobile genetic elements. EMRSA-16 isolates had core gene profiles identical to a cluster of previously characterised MSSA (methicillin-sensitive S. aureus) isolates from St George's Hospital, suggesting that they have arisen from this source, or that loss of the accessory genetic element encoding methicillin resistance is frequent. EMRSA-15 and EMRSA-16 strains were distinct from other MRSA strains previously identified in UK hospitals, and always carried a mobile genetic element encoding multiple superantigens. These results contribute to the understanding of the types of MRSA found in UK hospitals, how they vary and how they arose.

Genetic variation among hospital isolates of methicillin-sensitive Staphylococcus aureus: evidence for horizontal transfer of virulence genes

Staphylococcus aureus strains often carry in their genomes virulence genes that are not found in all strains and that may be carried on discrete genetic elements. Strains also differ in that they carry one of four classes of an accessory gene regulator (agr) locus, an operon that regulates virulence factor expression and that has been proposed to be a therapeutic target. To look at their distribution among hospital strains, we investigated 38 methicillin-sensitive S. aureus isolates, classifying the isolates by agr class and screening them for the presence and restriction fragment length polymorphisms (RFLPs) of 12 core and 14 accessory virulence genes. Twenty-three (61%) were agr class I, 10 (26%) were agr class II, and 5 (13%) were agr class III. None were agr class IV. The S. aureus strains had distinguishable RFLP profiles, although clusters of isolates with clearly related core gene profiles were found among our strains, including all five agr class III strains, two sets of six strains within agr class I, and six strains within agr class II. Within these clusters there was evidence of horizontal acquisition and/or loss of multiple accessory virulence genes. Furthermore, two isolates from the same patient were identical except for the presence of the sea gene, indicating that movement of mobile elements may occur in vivo. Several strong correlations with the carriage of virulence genes between strains were seen, including a positive correlation between tst and agr class III and negative correlations between tst and lukE-splB and between lukE-splB and seg-sei. This suggests that the core genome or the presence of accessory genetic elements within a strain may influence acquisition and loss of other elements encoding virulence genes.

Interactive regulatory pathways control virulence determinant production and stability in response to environmental conditions in Staphylococcus aureus

The accessory gene regulator (agr) and staphylococcal accessory regulator (sar) loci are important regulators of toxin production in Staphylococcus aureus. In this study we examined how environmental conditions degree of aeration and salt concentration - affect the transcription and translation of mRNAs for alpha-haemolysin (Hla) and serine protease (Ssp) via these pathways and influence the stability of these proteins. Using Northern analysis, we have confirmed earlier observations that sarA is involved in the upregulation of RNAIII, the effector molecule encoded by the agr locus. However, this effect was abolished in highly aerated cultures. While sarA does appear to have an up-regulatory effect on hla transcription that is independent of agr, we propose that the PC1839 (sarA) mutant produces less alpha-haemolysin activity mainly as a result of post-translational inactivation by proteases. The most obvious phenotypic feature of PC1839 (sarA) is the upregulation of proteases. In this study we show that ssp is repressed by SarA at the transcriptional level. Western analysis using an anti-alpha-haemolysin antibody identified a major breakdown product that is only present in the supernatant of strains that are overexpressing serine protease. We have also confirmed that agr exerts a significant regulatory influence on hla at the level of translation, as well as transcription. Finally, the addition of salt upregulates ssp transcription and dramatically downregulates transcription of hla, and is an example of an environmental parameter that affects toxin production independently of agr and sarA. How environmental signals are transduced to control alpha-haemolysin and serine protease production, activity and stability at multiple levels are discussed.

Evidence for Clostridium perfringens enterotoxin (CPE) inducing a mitogenic and cytokine response in vitro and a cytokine response in vivo

We investigated some immunogenic properties of Clostridium perfringens enterotoxin (CPE) in vitro using murine J774A macrophages (MPhi) and in vivo using Swiss Webster (SW) mice. CPE was a potent mitogen in vitro, where cell proliferation increased with CPE concentration. CPE was nonmitogenic when MPhi were concurrently incubated with CPE and interferon gamma (IFN-gamma). MPhi incubated in the presence of CPE induced the synthesis of interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and interferon-gamma (IFN-gamma), but not interleukin-2 (IL-2). In vivo, CPE induced a pro-inflammatory cytokine response with striking production of IFN-gamma, IL-1, and IL-6. Regardless of route of CPE entry, serum cytokine levels generally peaked within 1 h of administration and were maintained for 4-8 h. Although CPE engenders an intense immune response during toxicosis, the toxin does not appear to be a superantigen. Death from CPE-induced shock appears to result from various interrelating immunological mechanisms.

The gene for toxic shock toxin is carried by a family of mobile pathogenicity islands in Staphylococcus aureus

Tst, the gene for toxic shock syndrome toxin-1 (TSST-1), is part of a 15.2 kb genetic element in Staphylococcus aureus that is absent in TSST-1-negative strains. The prototype, in RN4282, is flanked by a 17 nucleotide direct repeat and contains genes for a second possible superantigen toxin, a Dichelobacter nodosus VapE homologue and a putative integrase. It is readily transferred to a recA recipient, and it always inserts into a unique chromosomal copy of the 17 nucleotide sequence in the same orientation. It is excised and circularized by staphylococcal phages phi13 and 80alpha and replicates during the growth of the latter, which transduces it at very high frequency. Because of its site and orientation specificity and because it lacks other identifiable phage-like genes, we consider it to be a pathogenicity island (PI) rather than a transposon or a defective phage. The tst element in RN4282, near tyrB, is designated SaPI1. That in RN3984 in the trp region is only partially homologous to SaPI1 and is excised by phage 80 but not by 80alpha. It is designated SaPI2. These PIs are the first in any gram-positive species and the first for which mobility has been demonstrated. Their mobility may be responsible for the spread of TSST-1 production among S. aureus strains.

Rumen bacterial and protozoal populations in cattle being relocated in tropical Queensland

Rumen microbial populations were measured in Brahman-cross steers that were relocated from spear grass (Heteropogon contortus) dominant pastures in northern Queensland to buffel grass (Cenchrus ciliasis) dominant pastures in central Queensland, to assess whether aspects of rumen function may contribute to the sometimes reported depressed growth rates following relocation. Nine genera of ciliate protozoa (Isotricha, Dasytricha, Entodinia, Epidinium, Diplodinium, Ostracodinium, Metadinium, Elytroplastron, and Eudiplodinium) were recorded in the rumen fluid of the steers. In most steers all genera were present at any time and the generic mix persisted throughout the 10 months over which the study was conducted. Protozoal population composition fluctuated only slightly over the sampling period. Entodinia were predominant, occupying 50-70% of the population. Population density varied according to season, with the highest density (4-8×105 /mL rumen fluid) occurring in the wet season. Bacterial and protozoal populations were remarkably stable and little affected by relocation. Again, the major impact on population density was the season, with all carbohydrate (soluble sugar, starch, xylan, and cellulose) utilising bacterial subpopulations reaching the greatest density with the onset of the wet season.

Chronic health effects of microbial foodborne disease

The acute effects of foodborne disease are sometimes not the end of the illness. Several significant foodborne pathogens are capable of triggering chronic disease, and even permanent tissue or organ destruction, probably via immune mechanisms. Arthritis, septic and reactive, inflammatory bowel disease, haemolytic uraemic syndrome, Guillain-Barré syndrome, and possible several autoimmune disorders can be triggered by foodborne pathogens or their toxins. Research is needed to more fully understand the mechanisms by which the immune system is inappropriately activated by these common foodborne disease-causing agents.

Chronic sequelae of foodborne disease

In the past decade the complexity of foodborne pathogens, as well as their adaptability and ability to cause acute illness, and in some cases chronic (secondary) complications, have been newly appreciated. This overview examines long-term consequences of foodborne infections and intoxications to emphasize the need for more research and education.

Clostridium perfringens type A enterotoxin (CPE): more than just explosive diarrhea

The bacterial pathogen Clostridium perfringens is the most prolific toxin-producing species within the clostridial group. The toxins are responsible for a wide variety of human and veterinary diseases, many of which are lethal. C. perfringens type A strains are also associated with one of the most common forms of food-borne illness (FBI). The toxicosis results from the production and gastrointestinal absorption of a protein-enterotoxin known as CPE. The regulation, expression, and mechanism of action of CPE has been of considerable interest as the protein is unique. CPE expression is sporulation associated, although the mechanism of cpe-gene regulation is not fully elucidated. Cloning studies suggest the involvement of global regulators, but these have not been identified. Although very few type A strains are naturally enterotoxigenic, the cpe gene appears highly conserved. In FBI strains, cpe is chromosomally encoded; whereas in veterinary strains, cpe may be plasmid-encoded. Variation in cpe location suggests the involvement of transposable genetic element(s). CPE-like proteins are produced by some C. perfringens types C and D; and silent remnants of the cpe gene can be found in C. perfringens type E strains associated with the iota toxin gene. CPE has received attention for its biomedical importance. The toxin has been implicated in sudden infant death syndrome (SIDS) because of its superantigenic nature. CPE can destroy a wide variety of cell types both in vitro and in vivo, suggesting that it could have potential in the construction of immunotoxins to neoplastic cells. It is obvious that CPE is an interesting protein that deserves continued attention.

Staphylococcus aureus but not Staphylococcus epidermidis can acquire iron from transferrin

Staphylococci grow and cause infection under the iron-restricted conditions found in vivo. They therefore must possess mechanisms to obtain iron for metabolism from this environment. To determine if staphylococci can extract iron bound to human transferrin, we labelled transferrin with 55Fe and performed uptake assays on cells grown in iron-restricted and iron-plentiful conditions. Growing cultures of Staphylococcus aureus NCTC 8532 could take up radioactive iron during mid- to late-exponential phase of growth. This process was iron-regulated and did not require direct contact between the cell and the labelled transferrin. Siderophore production was detected during this phase, but reductase or protease activity was not. S. epidermidis ATCC 14990 could not access 55Fe bound to transferrin, nor did this isolate produce siderophore, reductase or protease. This difference in the ability to acquire iron bound to transferrin may contribute to the increased virulence of S. aureus when compared to S. epidermidis.

Is thermophily a transferrable property in bacteria?

Bacteria exhibit unique diversity in their ability to grow at different temperatures. Indeed, eubacteria and archaebacteria are the only organisms able to grow above 65 degrees C. The temperature range for a species is generally considered to be a stable character; however, mutants may be isolated that have a Tmin or Tmax below or above the parent organism. Some bacteria may also be coaxed to grow at different temperature by training cultures, through an incremental increase or decrease of temperature. Genetic approaches, for example, the transformation of mesophilic Bacillus to thermophily using DNA from closely related thermophiles, has been very controversial. A major problem has been the lack of stability of the high-temperature phenotype upon subculture, which has not allowed extensive genetic and biochemical characterization of the transformants. The mechanism whereby the thermophilic phenotype is carried is unknown, although it is possible that the adapter genes are plasmid encoded. Studies using phenotypically stable transformants indicated that the thermostability of some cellular components was significantly increased, both in the vegetative cell and spore state. Enzyme thermostability, for example, appeared to be associated with an increased use of hydrophobic amino acids; however, the biochemical mechanisms for these alterations remain unknown. Thermophily is still a challenging problem with some interesting molecular biology.

Production of siderophore by coagulase-negative staphylococci and its relation to virulence

The ability to produce siderophore is considered to be a virulence factor for many pathogenic bacteria. To determine if siderophore production by coagulase-negative staphylococci (CNS) was related to virulence, 40 clinical isolates of CNS cultured from peritoneal dialysis fluid were compared with 38 commensal skin isolates. Siderophore activity was detected using the chrome azurol S liquid assay. Using precursor studies, Staphylococcus epidermidis isolates were shown to be more likely to produce the siderophore staphyloferrin A. Production of staphyloferrin B amongst non-Staphylococcus epidermidis species was associated with clinical isolates rather than commensal isolates, and therefore may play a role in pathogenicity.

Can superantigens trigger sudden infant death?

A majority of sudden infant death syndrome (SIDS) victims have respiratory or gastrointestinal infections prior to death. This has led to an investigation of the role of pathogenic bacteria and the potentially lethal toxins they produce as triggers for sudden infant death. A small group of bacteria have been consistently identified in SIDS victims as compared to controls, and remarkably, three of these produce superantigenic toxins. Superantigens exert a powerful effect on the immune system, stimulating T-cells, which subsequently induces the formation of large amounts of cytokines. Generation of an overwhelming inflammatory response may lead to death by shock, or other, as yet unrecognized effects of the toxin on the respiratory or cardiac systems. A SIDS/superantigen model is proposed which may explain many of the pathological characteristics of SIDS and establish quantifiable markers for SIDS.

Staphylococcal iron requirements, siderophore production, and iron-regulated protein expression

Despite the ability of staphylococci to grow in iron-restricted conditions in vivo, their iron requirements and the mechanisms possessed by them for the uptake of iron are poorly understood. Many bacteria are known to produce siderophores. By using the chrome azurol S universal method for the detection of siderophores, all 14 isolates of Staphylococcus aureus tested grew well under conditions of iron restriction and produced iron-regulated siderophore in large quantities, while all 19 isolates of coagulase-negative staphylococci (CoNS) grew poorly under conditions of iron restriction and produced low levels of iron chelator. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis profiles of S. aureus isolates revealed altered protein patterns due to iron restriction, while altered profiles were not seen in the CoNS group. The ability to grow in iron-restricted conditions, possibly with the assistance of siderophore-mediated iron uptake, may contribute to the increased pathogenicity of S. aureus when compared with that of the CoNS.

Sudden infant death syndrome (SIDS): are common bacterial toxins responsible, and do they have a vaccine potential?

Despite extensive research, no unifying concept has satisfactorily explained the cause of the sudden infant death syndrome (SIDS). The details are briefly outlined of some of the evidence supporting the hypothesis that common bacterial toxins are important in the aetiology of SIDS. These bacterial toxins act as triggers to initiate a biochemical cascade resulting in death. Data from four research groups, each working independently, indicated that the bacteria Clostridium perfringens, Escherichia coli, Staphylococcus aureus, Streptococcus spp. and Enterococcus spp. were present in higher numbers in infants who had suffered SIDS than in control infants. Certainly more detailed studies need to be performed on the role of bacterial infections in infants. There are many implications arising from this work, particularly the use of vaccination as a means of reducing infections, and consequently the number of SIDS deaths.

Success and failure rates of cylinder implants in type IV bone

It is well documented that implant success rates are much lower in Type IV bone than in Types I, II, and III. However, all of these studies have reported on the use of screw type implants. The present study demonstrates the efficacy of cylinder implant use in Type IV bone. A total of 513 cylinders were placed in Type IV bone and were followed for 0 to 60+ months in function. The absolute success rate was 95.7%. Of the 22 fixture failures encountered, 8 were discovered at the time of second stage surgery, 3 during the first year following uncovering, and 11 occurred after 24 to 36 months in function. A possible rationale for the higher success rate of cylinders as compared to that reported for screw type implants in Type IV bone is presented. Further well-controlled studies directly comparing various implant designs in a range of bony sites are needed to better understand and to fully document the differences suggested by the present study.

Cloning of the cyclomaltodextrinase gene from Bacillus subtilis high-temperature growth transformant H-17

The cyclomaltodextrinase gene from Bacillus subtilis high-temperature growth transformant H-17 was cloned on separate PstI, BamHI, and EcoRI fragments into the plasmid vector pUC18, but was expressed in an inactive form in the host, Escherichia coli DH5 alpha. High level constitutive expression of the gene product was also detrimental to the E. coli host, which led to structural instability of the recombinant plasmid. The cyclomaltodextrinase gene was cloned on a 3-kb EcoRI fragment into the plasmid vector pPL708, and the fragment was structurally maintained in the host B. subtilis YB886. The cloned gene product was synthesized in an enzymatically active form in the B. subtilis host; however, expression was at a low level. Subcloning of the 3-kb EcoRI fragment into pUC18 and transformation into E. coli XL1-Blue (F' lacIq) indicated that the cyclomaltodextrinase gene was cloned with its own promoter, since expression of the gene occurred in the absence of IPTG. Subcloning of the cyclomaltodextrinase gene downstream from the Bacillus temperature phage SPO2 promoter of pPL708 may increase expression of this gene.

Identification of Staphylococcus epidermidis and Staphylococcus hominis from blood cultures by testing susceptibility to desferrioxamine

Testing susceptibility to desferrioxamine has recently been described as a method for the identification of Staphylococcus epidermidis. This method was compared to a commercial test and the tube coagulase test for the identification of staphylococci from blood cultures and other fluid specimens. A total of 216 isolates was tested over a 13-month period. Sensitivity of the desferrioxamine test in identifying isolates of Staphylococcus epidermidis and Staphylococcus hominis was 97.3%, while specificity was 91.8%. When isolates displaying discrepant desferrioxamine results were characterized using recently described interpretive criteria, sensitivity and specificity of the desferrioxamine test improved to 100%. The desferrioxamine test was reliable, inexpensive and simple to perform, and should prove useful in the diagnostic laboratory.

Post-translational modification of the tegument proteins (VP13 and VP14) of herpes simplex virus type 1 by glycosylation and phosphorylation

VP13 and VP14, major tegument proteins of herpes simplex virus type 1 (HSV-1) and the products of the UL47 gene, have been shown by partial proteolytic mapping to have closely related protein sequences. These proteins are phosphorylated in virus-infected cells, but not in preparations of purified virus. They also contain O-linked oligosaccharide units which include beta-1,4-N-acetyl galactosamine residues, as demonstrated by the binding of Dolichos biflorus lectin. This modification was detected only in purified virus and appears to be restricted to VP13/14 and VP22, another HSV-1 tegument protein.

Susceptibility to desferrioxamine: a new test for the identification of Staphylococcus epidermidis

The ability to identify Staphylococcus epidermidis quickly and accurately has become increasingly important in clinical microbiology. Susceptibility to desferrioxamine, an iron-chelating agent, was investigated as a new test for the identification of S. epidermidis. All strains of S. epidermidis and S. hominis tested were susceptible to a 1000-micrograms disk of desferrioxamine when grown on brain heart infusion agar. All other strains of coagulase-negative staphylococci, S. aureus and micrococci were resistant. As a single test, susceptibility to desferrioxamine was 96.4% efficient in identifying S. epidermidis; when combined with additional tests such as alkaline phosphatase production and fermentation of trehalose, the efficiency improved to 100%. Desferrioxamine disks were easy to prepare, stable and inexpensive. The test was simple to perform and interpret and should readily find application in clinical microbiology laboratories.

Evaluation of a Visual DNA Probe for Enterotoxigenic E. coli Detection in Foods and Wastewater by Colony Hybridization

A visual DNA probe for the detection of enterotoxigenic E. coli (LT EEC) by colony hybridization was evaluated to determine its efficacy as a more restrictive, routine indicator method for foods and wastewater. The E. coli heat labile enterotoxin (LT) gene was used as the DNA probe to detect LT EEC. In control experiments the reliability of the probe was demonstrated with food spiked with LT EEC. Raw oysters and wastewater examined for naturally occurring LT EEC showed significant levels of probe positive isolates. Despite some problems, for example background noise associated with food type, the DNA probe proved satisfactory as a method for indicating the presence of enterotoxigenic Enterobacteriaceae .

The effect of a Clostridium perfringens 8-6 enterotoxin on viability and macromolecular synthesis in Vero cells

Clostridium perfringens type A 8-6 enterotoxin causes gross morphological damage to Vero cells grown in tissue culture. Damage was observed to occur after only 30 minutes exposure at concentrations as low as 20 ng/ml, and within 60 minutes 95% of the cells had detached. Concentrations as low as 0.01 ng were able to cause detectable inhibition of plating efficiency. The enterotoxin inhibited DNA, RNA and protein synthesis and caused the reversal of glucose transport. Heat inactivated enterotoxin had no effect on cell function or morphology.

A scanning electron microscope study of the effect of an enterotoxin from Clostridium perfringens 8-6 on mice of different ages

Intestinal damage to mice caused by an enterotoxin from a coatless spore mutant of Clostridium perfringens type A (8-6) was examined by scanning electron microscopy. Two distinct types of damage were observed, both of which could be correlated with animal age. Damage appeared to occur in a specific sequence similar to that found in previous studies in rabbits. We conclude that the type of ileal tissue damage reflects the mode of toxin incorporation from the gut, which is a function of animal age.

Protoplast water content of bacterial spores determined by buoyant density sedimentation

Protoplast wet densities (1.315 to 1.400 g/ml), determined by buoyant density sedimentation in Metrizamide gradients, were correlated inversely with the protoplast water contents (26.4 to 55.0 g of water/100 g of wet protoplast) of nine diverse types of pure lysozyme-sensitive dormant bacterial spores. The correlation equation provided a precise method for obtaining the protoplast water contents of other spore types with small impure samples and indicated that the average protoplast dry density was 1.460 g/ml.

Purification and properties of an enterotoxin from a coatless spore mutant of Clostridium perfringens type A

A method is described for isolating an enterotoxin from a coatless spore mutant (8-6) of Clostridium perfringens type A. The characteristics of this enterotoxin only slightly resembled those of previously isolated enterotoxins of C. perfringens. The type A (8-6) enterotoxin was found to be composed of two subunits of Mr 18 000 with isoelectric points of 3.8 and 4.3. The LD50 for mice was 39 micrograms/kg with 0.10 micrograms corresponding to one erythemal unit. The type A (8-6) enterotoxin was inactivated by heating for 10 min at 60 degrees C. The amino acid composition data of type A (8-6) and delta toxins was similar, but type A (8-6) and type A enterotoxins showed less similarity. This lack of similarity between type A and type A (8-6) enterotoxins was confirmed by the failure of anti-sera to type A enterotoxin to neutralize the type A (8-6) enterotoxin, in both the mouse and erythemal tests.

A comparison of UV induced DNA photoproducts from isolated and non-isolated developing bacterial forespores

UV-induced photoproduct formation has been compared in non-isolated and isolated developing forespores. We have found that levels of spore type photoproducts are greatly affected by mother cell DNA. We have also observed the presence of the photoproduct 6-4'-(pyrimidin-2'-one)-thymine in developing forespores. We conclude from these and other data in the literature that the degree of hydration around the forespore DNA is reduced by the presence of dipicolinic acid which influences photoproduct formation without causing a change in conformational state.

A method for the isolation of intact, viable forespores from Bacillus species using high pressure

Large-scale preparation of Bacillus forespores was performed using nitrogen gas under high pressure to force an osmotically stable spheroplast suspension through a micrometer needle valve. Ninety-nine percent recovery of intact viable forespores at various stages of sporulation was achieved with a variety of Bacillus species. The isolated forespores are stable for up to 7 days when kept under nongerminating conditions.

Scanning electron probe x-ray microanalysis of elemental distributions in freeze-dried cryosections of Bacillus coagulans spores

High-resolution scanning electron probe X-ray microanalysis had been employed to examine elemental distributions in freeze-dried cryosections of Bacillus coagulans spores. Calcium, manganese, and phosphorus were concentrated in the protoplast and the coat. Iron was found in the coat but not in the protoplast, whereas the silicon seen on the coat of other spore species was absent. Sulfur was present in the coat, but was distributed over a broader area than the other elements, which suggested that phosphorus and the metal ions were located in the outer coat layer.

Effects of activated carbon and bacteriostatic filters on microbiological quality of drinking water

Three activated carbon filters for point-of-use water treatment were tested in laboratory and field studies for chemical removal and microbiological effects on water. All removed free available chlorine in municipally treated water to below the limit of detection, but removed only about 50 to 70% of the total available chlorine and 4 to 33% of the total organic carbon. Standard plate count bacteria in the effluent increased steadily with time for 3 weeks and remained elevated over the 8-week period of the study. Total coliform bacteria were found to persist and proliferate on the filters for several days after transient contamination of the influent water. Silver-containing activated carbon filters suppressed total coliform but not total bacterial growth. Pseudomonas aeruginosa was recovered from the effluents of all filters at some time during the tests.

Distribution of calcium and other elements in cryosectioned Bacillus cereus T spores, determined by high-resolution scanning electron probe x-ray microanalysis

The distribution of a number of key elements in Bacillus cereus T spores was determined by high-resolution scanning electron probe X-ray microanalysis. To circumvent the redistribution of soluble or weakly bound elements, freeze-dried cryosections of spores, which had been rapidly frozen in 50% aqueous polyvinyl pyrrolidone, were employed. The sections were examined by using a modified Philips EM400 electron microscope fitted with a field emission gun, scanning transmission electron microscopy attachment, and a computer-linked energy-dispersive X-ray microanalysis system. X-ray maps for selected elements and the corresponding electron image were produced simultaneously by scanning the cryosections with a fine electron beam in a raster pattern, using the scanning transmission electron microscopy attachment. The results indicated that almost all of the calcium, magnesium, and manganese, together with most of the phosphorus, was located in the core region. An unexpectedly high concentration of silicon was found in the cortex/coat layer. Granules containing high concentrations of calcium, manganese, and phosphorus were demonstrated in spores containing reduced levels of dipicolinic acid. Spot mode analyses, in which a stationary beam was located over the region of interest in the spore cryosection, confirmed the results obtained with the scanning mode and also provided a more accurate quantitation of the elemental concentrations on a dry weight bases.

Image intensifier as an aid to insertion of the Zickel nail apparatus for proximal femoral fractures

Technical problems have been encountered when using the usual method of implanting the Zickel nail. We have attempted to overcome them by placing the patient on an orthopaedic table and screening the femur using an image intensifier. The results, and the particular ways in which this technique has helped, are described.

Purification and properties of histidinol dehydrogenases from psychrophilic, mesophilic and thermophilic bacilli

As a first step in elucidating one molecular mechanism of adaptation to life at extreme temperatures, we purified and characterized the enzyme histidinol dehydrogenase (EC 1.1.1.23) from a number of bacilli whose growth temperatures range from 5 degrees t to 90 degrees C. The enzymes were purified by (NH4)2SO4 precipitation, ion-exchange chromatography on Sephadex, affinity chromatography on histamine- or histidine-Sepharose and preparative gradient gel electrophoresis. All had similar mol.wts. (29200), sedimentation coefficients (S20,w 2.56S), affinities for histidinol and NAD+ (Km = 48 micron and 0.2 mM respectively) and all had pH optima at 9.6. Marked differences were observed in stability with respect to temperature and the temperature at which the initial velocity for histidinol dehydrogenation was optimal. These optima range from 25 degrees C for the enzyme from the psychrophilic species through to 41 degrees C for the mesophiles to 85-92 degrees C for the extreme thermophiles. It is concluded that the ability of the enzymes to operate at their various optimum temperatures is an intrinsic property of their amino acid sequences.