Salmonella Paratyphi B; Public Health and Parental Choice: When to Treat Asymptomatic Carriers of Infection?

BACKGROUND

Salmonella Paratyphi B (Paratyphoid B) is a rare infection and a notifiable disease in England. Disease is typically mild, and chronic carriage in children has been described in endemic countries. Almost all cases in England are imported, with very few cases of community transmission reported.

METHODS

The aim of this work was to describe an unusual cluster of Paratyphoid B cases transmitted within England, examining clinical, epidemiologic and microbiologic data. Detailed phylogenetic analysis is presented to corroborate public health epidemiologic links between cases.

RESULTS

One child had recently returned from an endemic area and had mild gastrointestinal symptoms. One year later, 2 other children with no travel history developed invasive disease requiring hospitalization. Epidemiologic links confirmed person-to-person spread between these three cases. All isolates of S. Paratyphi B (n = 93) received by the Gastrointestinal Bacteria Reference Unit between 2014 and 2019 were typed using whole genome sequencing. Three cases of Paratyphoid B were identified in the same geographical location over a 2-year period. S. Paratyphi B strains isolated from the stool and blood of the three cases were closely linked (0-5 single-nucleotide polymorphisms) using whole genome sequencing.

CONCLUSIONS

This case series highlights the potential public health risks of paratyphoid B and the range of pediatric complications associated with this illness, especially in younger children. Although rare, chronic carriage of Paratyphoid B can lead to transmission in nonendemic areas and should be considered in all children presenting with signs of enteric fever even where there is no history of foreign travel.

Development of a real-time PCR method for the genoserotyping of Salmonella Paratyphi B variant Java

Discriminating between D-tartrate fermenting and non-fermenting strains of Salmonella enterica subsp. enterica serotype Paratyphi B is of major importance as these two variants have different pathogenic profiles. While D-tartrate non-fermenting S. Paratyphi B isolates are the causative agent of typhoid-like fever, D-tartrate fermenting isolates (also called variant Java) of the same serotype trigger the less dangerous gastroenteritis. The determination of S. Paratyphi B variants requires a time-consuming process and complex biochemical tests. Therefore, a quadruplex real-time PCR method, based on the allelic discrimination of molecular markers selected from the scientific literature and from whole genome sequencing data produced in-house, was developed in this study, to be applied to Salmonella isolates. This method was validated with the analysis of 178 S. Paratyphi B (D-tartrate fermenting and non-fermenting) and other serotypes reaching an accuracy, compared with the classical methods, of 98% for serotyping by slide agglutination and 100% for replacement of the biochemical test. The developed real-time PCR permits to save time and to obtain an accurate identification of a S. Paratyphi B serotype and its D-tartrate fermenting profile, which is needed in routine laboratories for fast and efficient diagnostics.

Infection Dynamics and Antimicrobial Resistance Profile of Salmonella Paratyphi B d-tartrate Positive (Java) in a Persistently Infected Broiler Barn

The infection dynamics of S. Java were examined in three consecutive rearing periods on a broiler farm in Northwestern Germany which had been persistently infected with S. Java for more than five years. The barn was investigated for Salmonella occurrence after cleaning and disinfection to verify the persistent contamination of the broiler house with S. Java before the start of the first rearing cycle. Confirmation of Salmonella absence in day-old chicks (time-point 1) as well as early establishment of infection between days 5-7 (time-point 2) were confirmed by caecal swabs prepared for qPCR and classical microbiological methods. At three time-periods (between days 11-15 (time-point 3), days 25-28 (time-point 4), and days 38-40 (time-point 5)) caecal content was examined for colony forming units (CFU) Salmonella/g. In general, there was an increase in Salmonella Java load at time-point 4 compared to time-points 3 and 5. Therefore, we observed a bell-shaped course of infection resulting in higher rates of Salmonella CFU/g prior to prethinning than at final slaughter. The antimicrobial susceptibility testing revealed resistance to tetracycline, fluorquinolones, trimethoprim, and cefoxitin.

Genotypic and phenotypic differentiation of Salmonella enterica serovar Paratyphi B in Malaysia

Abstract. Salmonella enterica serovar Paratyphi B is known to cause either paratyphoid fever or gastroenteritis. Differentiation of Salmonella ser. Paratyphi B into biotype Java (d-tartrate fermenting, dT+) and biotype Paratyphi B (d-tartrate non-fermenting, dT) is important for Salmonella epidemiology. This study applied a PCR approach to differentiate the two biotypes to augment the conventional biochemical method and to determine the antibiograms and genomic diversity of Malaysian S. Paratyphi B. Among 100 strains tested (clinical, 86; non-humans, 14), only two clinical strains were confirmed as biotype Paratyphi B as indicated by both lead acetate test and PCR. Antibiotic resistance rates were as follows: streptomycin 18%, sulphonamides 13%, ampicillin 10%, chloramphenicol 4%, tetracycline 3%, cefotaxime 2%, cefpodoxime 2%, ceftazidime 2%, gentamicin 1% and trimethoprim 1%. None showed resistance towards amoxicillin-clavulanic acid, ceftiofur, ciprofloxacin, nalidixic acid and trimethoprim-sulphamethoxazole. Seven strains showed multidrug resistance towards 3 or more classes of antimicrobial agents. REP-PCR and PFGE generated 32 and 76 different profiles, respectively. PFGE (D = 0.99) was more discriminative than REP-PCR (D = 0.93) and antimicrobial susceptibility test (D = 0.48) in subtyping the strains. Strains isolated 18 years apart (1982 - 2008) from different localities in Malaysia were clonally related as demonstrated by REP-PCR and PFGE, indicating that these strains were stable and widely distributed. In some clusters, strains isolated from different sources (clinical, food and animal) were grouped together. Thus, biotype Java was the most common biotype of Salmonella ser. Paratyphi B in Malaysia. The PCR approach is highly recommended due to its simplicity, specificity and ease of operation. The level of antimicrobial resistance among Salmonella ser. Paratyphi B remained relatively low in Malaysia but the emergence of resistance to cephalosporins is a cause for concern.

Antibacterial activities of Emblica officinalis and Coriandrum sativum against Gram negative urinary pathogens

Present investigation is focused on antibacterial potential of aqueous infusions and aqueous decoctions of Emblica officinalis (amla) and Coriandrum sativum (coriander) against 345 bacterial isolates belonging to 6 different genera of Gram negative bacterial population isolated from urine specimens by employing well diffusion technique. Aqueous infusion and decoction of Emblica officinalis exhibited potent antibacterial activity against Escherichia coli (270), Klebsiella pneumoniae (51), K. ozaenae (3), Proteus mirabilis (5), Pseudomonas aeruginosa (10), Salmonella typhi (1), S. paratyphi A (2), S. paratyphi B (1) and Serratia marcescens (2) but did not show any antibacterial activity against Gram negative urinary pathogens.

Isolation of Salmonella enterica subspecies enterica serovar Paratyphi B dT+, or Salmonella Java, from Indonesia and alteration of the d-tartrate fermentation phenotype by disrupting the ORF STM 3356

Salmonella enterica subspecies enterica serovar Paratyphi B [O1,4,(5),12 : Hb : 1,2] can cause either an enteric fever (paratyphoid fever) or self-limiting gastroenteritis in humans. The d-tartrate non-fermenting variant S. enterica subsp. enterica serovar Paratyphi B dT- (S. Paratyphi B) is the causative agent of paratyphoid fever, and the d-tartrate fermenting variant S. enterica subsp. enterica serovar Paratyphi B dT+ (S. Paratyphi B dT+; formerly called Salmonella Java) causes gastroenteritis. S. Java is currently recognized as an emerging problem worldwide. Twelve dT+ S. Java isolates were collected in Indonesia between 2000 and 2002. One-third of them contained Salmonella genomic island 1 (SGI1), which gives the multidrug-resistant phenotype to the bacteria. In this study, a PCR-based method to detect a single nucleotide difference responsible for the inability to ferment d-tartrate, reported elsewhere, was validated. The d-tartrate fermenting phenotype of S. Java was converted to the non-fermenting phenotype by the disruption of the ORF STM 3356, and the d-tartrate non-fermenting phenotype of the ORF STM 3356-disrupted strain and the dT- reference strain was changed to the dT+ phenotype by complementing ORF STM 3356 in trans. The results show that the dT+ phenotype requires a functional product encoded by STM 3356, and support the use of the PCR-based discrimination method for S. Paratyphi B and S. Java as the standard differentiation method.

Aquariums as reservoirs for multidrug-resistant Salmonella Paratyphi B

Multidrug-resistant Salmonella enterica serovar Paratyphi B dT+ isolates from patients with gastroenteritis were identical with isolates from their home aquariums. Matched isolates had identical phage types, XbaI and IS200 profiles, and Salmonella genomic island 1 (SGI1). Ornamental fish tanks are reservoirs for SGI1-containing S. Paratyphi B dT+.

Multiple-antibiotic resistance in Salmonella enterica serotype Paratyphi B isolates collected in France between 2000 and 2003 is due mainly to strains harboring Salmonella genomic islands 1, 1-B, and 1-C

This study was conducted to investigate the occurrence of multiple-antibiotic resistance among 261 clinical isolates of Salmonella enterica serotype Paratyphi B strains collected between 2000 and 2003 through the network of the French National Reference Center for Salmonella. The 47 multidrug-resistant (MDR) isolates identified (18%), were characterized on the basis of the presence of several resistance genes (bla(TEM), bla(PSE-1), bla(CTX-M), floR, aadA2, qacEdelta1, and sul1), the presence of Salmonella genomic island 1 (SGI1) by PCR mapping and hybridization, and the clonality of these isolates by several molecular (ribotyping, IS200 profiling, and pulsed-field gel electrophoresis [PFGE]) and phage typing methods. The results of PCR and Southern blot experiments indicated that 39 (83%) of the 47 S. enterica serotype Paratyphi B biotype Java MDR isolates possessed the SGI1 cluster (MDR/SGI1). Among these 39 MDR/SGI1 isolates, only 3 contained variations in SGI1, SGI1-B (n = 1) and SGI1-C (n = 2). The 39 MDR/SGI1 isolates showed the same specific PstI-IS200 profile 1, which contained seven copies from 2.6 to 18 kb. Two PstI ribotypes were found in MDR/SGI1 isolates, RP1 (n = 38) and RP6 (n = 1). Ribotype RP1 was also found in two susceptible strains. Analysis by PFGE using XbaI revealed that all the MDR/SGI1 isolates were grouped in two related clusters, with a similarity percentage of 82%. Isolation of MDR/SGI1 isolates in France was observed mainly between the second quarter of 2001 and the end of 2002. The source of the contamination has not been identified to date. A single isolate possessing the extended-spectrum beta-lactamase bla(CTX-M-15) gene was also identified during the study.

Multiple antimicrobial resistant Salmonella enterica serovar Paratyphi B variant Java in cattle: a case report

An epidemiological investigation of a calf rearing premises and a closely associated dairy herd was carried out after the isolation of Salmonella enterica serovar Paratyphi B variant Java phage type 3b variant 2 from clinically diseased calves on the premises. The isolate was resistant to ampicillin, chloramphenicol, streptomycin, sulphonamides, tetracyclines, trimethoprim and cefoperazone. The organism was widespread on the calf unit and was also recovered from the dairy premises, mainly from groups of weaned calves. The investigation was extended to 10 epidemiologically linked farms but no S Java was isolated from any of the 40 to 60 samples collected from each premises. Molecular studies showed that the S Java isolates were genetically most similar to isolates from cases of human disease associated with ornamental fish tanks or feed. Long PCR and resistance gene profiling identified a resistance island which was indistinguishable from the human 'fish tank' strain of S Java and animal and human epidemic strains of S Typhimurium DT104. The isolates were clearly distinguished from multi-resistant S Java strains commonly associated with continental poultry. This is the first report of S Java with this resistance pattern in Great Britain.

Emergence of multidrug-resistant Salmonella Paratyphi B dT+, Canada

We document an increase in the number of multidrug-resistant Salmonella enterica serovar Paratyphi B dT+ identified in Canada. Most of these strains harbor Salmonella genomic island 1 (SGI1). Further studies are needed to determine factors contributing to the observed emergence of this multidrug-resistant strain.

Multiple-drug resistance in D-tartrate-positive Salmonella enterica serovar paratyphi B isolates from poultry is mediated by class 2 integrons inserted into the bacterial chromosome

The presence of integrons in 85 multiresistant German isolates of the predominating Salmonella enterica subsp. enterica serovar Paratyphi B dT(+) clone was investigated. All isolates possessed a chromosomally located Tn7-like class 2 integron carrying the same dfrA1-sat1-aadA1 array of gene cassettes. Only four isolates (4.7%) revealed an additional class 1 integron with two strains each containing the aadA1 or dfrA1-aadA1 gene cassettes.

DNA fingerprinting of human isolates of Salmonella enterica serotype Paratyphi B in Malaysia

AIMS

DNA fingerprinting of Salmonella enterica serotype Paratyphi B isolated in Malaysia during 1982-83, 1992 and 1996-2002 was carried out by pulsed-field gel electrophoresis (PFGE), antimicrobial susceptibility tests and D-tartrate utilization tests to assess the extent of genetic diversity of these isolates in Malaysia.

METHODS AND RESULTS

Eighty-six human isolates and one food isolate of Salm. Paratyphi B were analysed by PFGE, antimicrobial susceptibility tests and D-tartrate utilization tests. Sixty-five strains were D-tartrate-negative (dT-) while 22 strains were D-tartrate-positive (dT+). Thirty-seven per cent of the Salm. Paratyphi B strains were resistant to one or more antimicrobial agents. PFGE analysis clearly distinguished the dT- and dT+ strains into two clusters based on the unweighted pair group average method (UPGMA). Twenty-two XbaI-pulsotypes were observed among the 65 dT- strains while 17 XbaI-pulsotypes were observed among the 22 isolates of Salm. Paratyphi B dT+.

CONCLUSIONS

The present study showed that PFGE was very discriminative with 33.7% of the strains yielding distinct fingerprints. Paratyphoid fever in Malaysia is probably caused by one predominant, endemic clone of Salm. Paratyphi B dT- with various subtypes. There was no association between the pulsotypes and the severity of the disease indicating that the severity of the disease is probably multifactorial.

SIGNIFICANCE AND IMPACT OF THE STUDY

The findings of the present study verify the usefulness of PFGE in characterizing strains of Salm. Paratyphi B. This is the first report on the application of PFGE on a large collection of Salm. Paratyphi B in Malaysia.

Explosive increase of Salmonella Java in poultry in the Netherlands: consequences for public health

In the Netherlands Salmonella Paratyphi B variant Java increased in poultry from less than 2% of all isolates before 1996 to 60% in 2002. Despite exposure to contaminated meat is high, human patients with Java infection are rare (0.3% of all isolates). However, 50% of the human isolates showed PFGE profiles identical to the poultry clone. Resistance to flumequin in S. Java increased from 3% between 1996-2000 to 19% in 2001, and 39% in 2002, while that of other serotypes in poultry remained at about 7%. S. Java is also fast becoming less sensitive to ciprofloxacin.

Investigation of human infections with Salmonella enterica serovar Java in Scotland and possible association with imported poultry

PFGE analysis of S. Java strains (29 from humans, 30 from poultry meat) showed two major clusters. All isolates from poultry imported from the Netherlands belonged to Cluster A, which also comprised 10 human isolates. Thirty-one of the 37 isolates in this cluster had an identical JavX1 pattern, similar to the X8 profile of a particular S. Java clone predominant in poultry production in several European countries. Cluster B comprised 19 human isolates and two poultry isolates of unknown origin. These results combined with epidemiological data and information on the origins of poultry meat strongly suggested that imported poultry meat is an important source of Java infections in humans in Scotland.

[Explosive increase in Salmonella java in poultry. Consequences for public health]

In the Netherlands S. Paratyphi B variation Java increased in poultry from less than 2% of all isolates before 1996 up to 40% in 2001. This development in poultry runs in parallel with that in Germany and appears not to occur in other European countries. A German study shows that in the late nineties it concerns isolates of only one multi-resistant clone of Java (in Holland as well) whilst isolates before the middle nineties were genetically much more heterogeneous and sensitive to antibiotics. Although the exposition of humans to contaminated poultry meat is relatively high, human patients with a Java infection are rare. Treatment of poultry flocks with quinolones was about 13% in 2000-2001. Resistance to flumequin of Java increased from 3% between 1996-1999 to 20% between 2000-2002 whilst that of other serotypes in poultry remained about 7%. Java is also fast becoming less sensitive to ciprofloxacin which is the antibiotic of first choice in serious cases of salmonellosis. The ministries of public health, agriculture and the production boards, with their research institutes, together with the poultry meat production chain integrations have recently decided to work together in order to determine the public health importance of the Java epidemic in poultry and finding measures for effective control in the poultry industry.

Typhoid fevers: treatment with lomefloxacin

Typhoid group of fevers pose a major threat and are a cause of high morbidity and mortality in the tropical countries. Over the last decade there has been a steady increase in the development of multiresistant strains of Salmonellae all over the world. Multiresistance ranges between 5% to 86%. In a recent study in Pakistan multidrug resistance in Salmonellae has increased to over 39%. Hence alternative therapy is needed. Fluroquinolones are an effective alternative requiring a shorter course of treatment than conventional antimicrobial agents. Lomefloxacin because of its longer half life and convenient BD dose was used in a multicentre study to treat cases of typhoid group of fevers including cases due to multiresistant isolates. In order to overcome the challenge presented by the multiresistant salmoneallae, a dual purpose multicentre study was conducted in two stages. The first stage included a vitro study and the second in vivo study. Two hundred local salmonellae isolates were collected and their sensitivity and minimum inhibitory concentrations were determined by standard methods. Two hundred and fourteen patients clinically suspected of suffering from typhoid groups of fevers were given Lomefloxacin 200 mg. BD for 14 days. Forty percent of Salmonellae isolates were found to be multiresistant while only 2% were found to be resistant to Fluroqunilones. The mean MIC 90 was found to be 0.06 mg/L Lomefloxacin was found to be effective in over 97% cases for treating typhoid group fevers including the ones due to multiresistant isolates. The side effects were found to be minimal and transient.

Quinolone-resistant Salmonella paratyphi B meningitis in a newborn: a case report

While there are concerns about the consequences of widespread use of quinolones, there are few reports of quinolone-resistant strains of Salmonella typhi or Salmonella paratyphi from the Indian subcontinent. We present a case report of a newborn with meningitis due to a quinolone-resistant strain of S. paratyphi B presenting to the Aga Khan University Hospital (AKUH).

[Survival of Salmonella paratyphi B and Pseudomonas aeruginosa in seawater after incubation or washing in the presence of osmolytes]

The authors have compared the survival in seawater of Salmonella paratyphi B and Pseudomonas aeruginosa cells grown at low or high osmolarity, in the presence of organic osmolytes: glycine betaine, choline, proline, and glutamate. The four substrates enhanced the survival potential of S. paratyphi B while only glycine betaine protected P. aeruginosa. In addition only S. paratyphi B cells were more resistant after a preliminary growth at high osmolarity. Both bacteria were sensitive to osmotic down-shock, sensitization of S. paratyphi B being inversely proportional (p greater than or equal to 0.01) to the osmolarity of the medium used to wash cells. The transit in wastewater, at low osmolarity, can therefore modify the behavior of these pathogens in the marine environment.

Antimicrobial susceptibilities and beta-lactamase production of Hong Kong isolates of gastroenteric salmonellae and Salmonella typhi

We examined the in-vitro antibiotic susceptibility of 760 gastroenteric salmonellae and 36 strains of Salmonella typhi isolated in Hong Kong between 1985 and 1988. S. typhi remained susceptible to all the antibiotics tested except for one isolate resistant to chloramphenicol, another to kanamycin and co-trimoxazole, and a third to nalidixic acid. In contrast, resistance and multiple resistance has increased significantly in gastroenteric salmonellae over the last ten years. Seventeen percent were resistant to ampicillin, 61% to tetracycline, 23% to chloramphenicol and 8% to gentamicin. Many ampicillin-resistant strains remained resistant to ampicillin even in the presence of sulbactam (69%) or clavulanic acid (25%). More than 50% of isolates were resistant to two or more antibiotics and one isolate was resistant to eleven. Ampicillin-resistance was usually due to the production of TEM-1 or OXA-1 beta-lactamases but a few isolates produced AER-1, PSE-1 or PSE-2. Genetic determinants for these enzymes were usually borne on plasmids ranging in size from 2 to 143.7 Md but half of the OXA-1 genes were chromosomally located.

[Antibiotics used for paratyphi B infections resistant to classical treatment and the results of their use]

Salmonella paratyphi B is a pathogenic agent causing outbreaks and keeping epidemiologic importance. The classical treatment of this disease is made by ampicillin, chloramphenicol, and co-trimoxazole in resistant strain. The resistant strains tends to cause a treatment problem. We report treatment and antibiogram results of 48 patients exactly diagnosed as paratyphi B infection by clinic and laboratory evaluation. These patients came to pediatric clinic of Erzincan state Hospital from Erzincan town and its backgrounds and had ages between 3 months and 5 years. All isolates were resistant to ampicillin, chloramphenicol and cotrimoxazole but usually sensitive to 3. generation cephalosporins (Cefotaxime had greatest sensitivity ratio with 79.1%) and amikacin.

Prospective randomized comparative trial of pefloxacin versus cotrimoxazole in the treatment of typhoid fever in adults

Pefloxacin, which has been shown to have a high in vitro activity against Salmonella spp., was compared to cotrimoxazole in the treatment of typhoid fever in adults. In a prospective, randomized trial, 42 patients with bacteriologically documented typhoid fever received either 400 mg pefloxacin b.i.d. or 160/800 mg cotrimoxazole b.i.d. Duration of treatment was 14 days in both groups. All patients were cured without experiencing a relapse or becoming a salmonella carrier. Apyrexia and resolution of digestive and neurological symptoms were obtained in a significantly shorter time with pefloxacin than with cotrimoxazole. Pefloxacin was well tolerated and more effective than cotrimoxazole in the treatment of typhoid fever.

Distribution of Salmonella typhi and Salmonella paratyphi B phage types in Italy from 1974 through 1985

The temporal changes in occurrence and distribution in Salmonella typhi and paratyphi B phage types in Italy during a twelve year period are considered. From 1974 to 1985, 2.075 isolates of Salmonella typhi and 830 isolates of Salmonella paratyphi B were phage typed at the National Centre for Enterobacteria in Rome and the three Regional Centres for Enterobacteria in Milan, Palermo and Pisa. The most prevalent types of Salmonella typhi were A, C1, D1, Vi degraded strains E1, I+IV and C4. Types A, C1 and D1 accounted for 59.1% of the total. The distribution of the phage types as A, B2, C1, D1, D4, D9, E1, F1, N, 28 and I+IV, Vi degraded and Vi negative strains in the three time periods (1974-77; 1978-81 and 1982-85) was quite similar; some types such as D8, E2, 0 and 43 were found sporadically and others like C9, D6, F4, H and 45 which were present in the first period, disappeared in the last. The most prevalent types of Salmonella paratyphi B were Tauton, Dundee, 1, and 3a. Type 2, frequently found in the 1974-77 period was however not seen during 1981-85.

In vitro activity of ofloxacin against 210 clinical isolates of typhoid salmonellae

210 clinical isolates of typhoid salmonellae, cultivated from blood of patients with typhoid fever (108 strains of Salmonella typhi, 99 strains of Salmonella paratyphi A and three strains of Salmonella paratyphi B) as well as 266 random clinical isolates of Escherichia coli (n = 152), Klebsiella spp. (n = 51) and Proteus spp. (n = 63) were tested for susceptibility to ofloxacin, using an agar dilution method. All the typhoid salmonellae were found to be highly sensitive to ofloxacin with MICs ranging from 0.03 mg/l to 0.12 mg/l. The sensitivity pattern of enterobacteriaceae was comparable to data published internationally.

Cloning and molecular epidemiology of plasmid-determined fosfomycin resistance

The plasmid determinant of resistance to fosfomycin (For) was cloned into pBR322 and located in a 0.7-kilobase segment of DNA by transposon mutagenesis and in vitro deletion analysis. It encodes an 18-kilodalton protein located in the cytoplasm of resistant cells. Its synthesis is constitutive. The For genetic determinant is common to all plasmids isolated since 1975 in an hospital environment as determined by DNA-DNA hybridization. However, plasmids which carry For can be divided into two groups on the basis of size, pattern of antibiotic resistances, incompatibility specificity, and restriction and hybridization properties.

[Transfer of kanamycin resistance among familial strains of Enterobacteriaceae isolated from a chronic bacterial carrier of Salmonella schottmuelleri]

Escherichia coli, Enterobacter aerogenes and S. schottmuelleri were isolated from the large intestine of a bacteriocarrier. E. coli and E. aerogenes strains proved to be resistant to a number of antibiotics. Plasmids were detected in DNA preparations obtained from E. coli strains. After the hybridization of these E. coli strains with E. coli C600 5K and S. schottmuelleri at 28 degrees C the transfer of resistance to kanamycin was found to occur. From some of the transconjugates thus obtained resistance to kanamycin was transferred to E. aerogenes. This resistance was found to be controlled by the plasmid with a molecular weight exceeding 2 Md. The fact that S. schottmuelleri in the carrier's body retained their sensitivity to antibiotics can be explained by the absence of the transfer of plasmid Kmr at a temperature exceeding 28 degrees C and by the existence of the infective agent in an ecological niche other than that of E. coli.

[Conjugative R-plasmid resistance of Salmonella]

A total of 4801 Salmonella strains of 67 serovars isolated from various sources in 1968-1982 were studied for their sensitivity to 12 drugs. The Salmonella strains of groups A, B, C, D and E amounted to 0.8, 84.6, 6.4, 5.8 and 2.0 per cent, respectively. The Salmonella strains of the other groups amounted to 0.4 per cent. During the 5-year periods, the number of the antibiotic resistant Salmonella strains increased from 57.7 to 93.4 per cent. The conjugative drug resistance was detected in 16 out of the 67 serovars. The Salmonella strains usually resistant to 4-10 drugs were the donors of this conjugative drug resistance. The strains of S. typhimurium responsible for the hospital infections were characterized by the highest levels of the antibiotic polyresistance and the greatest variety of the conjugative R plasmids. The structure of the multiple and conjugative drug resistance of the organisms causing salmonellosis was more frequently defined by the conjugative plasmids of the antibiotic resistance of the S. typhimurium serovar. The Salmonella R plasmids determined various levels of the antibiotic resistance. The highest resistance levels were observed to benzylpenicillin, chloramphenicol and erythromycin and the lowest resistance levels to tetracycline.

Effect of human leukocyte interferon on invasiveness of Salmonella species in HEp-2 cell cultures

The effect of human leukocyte interferon on the invasiveness of Salmonella and Shigella species in HEp-2 cell cultures was examined. The intracellular and extracellular bacteria were identified by a combination of Nomarski differential interference contrast microscopy and UV incident light microscopy applied on the same microscope. Pretreatment of HEp-2 cells with human leukocyte interferon reduced the number of Salmonella typhimurium and Salmonella paratyphi-B bacteria per cell and the proportion of cells containing bacteria in a dose-dependent manner. Maximum inhibitory effect was observed with ca. 100 U of interferon per ml. The inhibitory effect was neutralized with anti-human interferon globulin. Murine fibroblast interferon did not influence the invasiveness of Salmonella species. Invasiveness of Shigella flexneri was not influenced by treatment of cells with human interferon.

[Effect of conjugative R plasmids on the virulence of antibiotic-sensitive Salmonella strains and their streptomycin-resistant mutants]

The pathogenicity level of antibiotic sensitive and streptomycin resistant strains of S. typhimurium, S. paratyphi B and S. kottbus changed under the effect of identical R plasmids more frequently in contrary directions. The conjugative plasmids of antibiotic resistance widened the ranges of the virulence changes in the Salmonella serovars for albino mice. It was found that 7 out of 8 plasmids studied significantly decreased and increased the virulence of the antibiotic sensitive Salmonella strains. As a rule, R plasmids of various origin decreased the virulence of all the tested streptomycin chromosome resistant causative agents of salmonellosis.

[Compatibility groups of resistance plasmids from Gram negative bacteria isolated in Algeria ]

The plasmids characterized in Algeria generally belong to the C and F1 me compatibility groups. With the exception of Vibrio cholerae el for the two groups are found in many bacterial species. Plasmids belonging to group C are the only stable in Vibrio cholerae el tor. The possibility that epidemics of Vibrio cholerae el tor carrying C plasmids might be observed, should not be excluded. On the other hand, it is presently impossible to guess what will be the future epidemic plasmid in Salmonella typhi and paratyphi B.

[A fi- tetracyclin resistance plasmid with specific restriction of phages on salmonella typhi, S. paratyphi B and S. typhi-murium (author's transl)]

Among 262 strains of Salmonella typhi from an epidemic outbreak of typhoid fever in Baden-Württemberg in 1974 2 strains were isolated which were tetracyclin resistant and showed no reactions with the Vi testphages T, D6 and VII whilst all other strains belonged to lysotype A, subtype Tananarive. It turned out that the Tc resistance in both strains was caused by a fi- R plasmid which could be transfered to other S. typhi strains, to E. coli K12, S. paratyphi B, S. java and S. typhi-murium as well as from Tc resistant E. coli K12 back to S. typhi. The Tc R plasmid introduced in S. typhi, lysotype A, caused specific restrictions of typing phages T, D6 and VII. Also, the transfer of the plasmids to strains of S. paratyphi B and S. typhi-murium resulted in restrictions of a number of typing phages. Both plasmids had identical patterns of restriction. In this pattern the Tc R plasmid differed from those described in the literature.

Observations on morphological, cultural and biochemical changes concomitant with chloramphenicol resistance in Salmonella paratyphi B

It is possible to induce chloramphenicol-resistance in Salmonella paratyphi B in vitro and to isolate mutants with different levels of resistance by different techniques. The resistance is invariably accompanied by definite changes in the morphological, cultural and biochemical properties. The degree of resistance and the conditions of isolation seem to influence the biological properties of the mutants. The higher the level of resistance, the greater will be the diversion from the normal.

Antimicrobial resistance and incidence of R factor among Salmonella isolated from patients with enteric fever and other clinical conditions in Madras, India (1975-1976)

The incidence of transmissible drug resistance among Salmonella isolated from patients with enteric fever and other clinical conditions is reported. All of the Salmonella isolated were studied for antimicrobial resistance. Of the 336 strains, five were multiply resistant to drugs including chloramphenicol, and four of these strains transmitted resistance to Escherichia coli F-Lac+. Multiply drug resistant E. coli were isolated from 12 patients receiving chloramphenicol, and in seven cases the E. coli transmitted drug resistance to sensitive Salmonella isolated from the same patients. The occurrence of multiple drug resistance among Salmonella was not found to be restricted to a single serogroup, and multiple drug resistance in Salmonella paratyphi A in India is reported for the first time. Although the incidence of Salmonella carring R factor is negligible, the unpredictability of its occurrence poses a potential threat in a country where typhoid is endemic.

Genetics of sensitivity of Salmonella species to colicin M and bacteriophages T5, T1, and ES18

Nearly all of 62 strains of Salmonella paratyphi B were sensitive to colicin M and phage T5 but resistant to phages T1 and ES18 and to colicin B. All tested S. typhimurium strains were resistant to colicin M and phage T5, and many were sensitive to phage ES18. A rough S. typhimurium LT2 strain given the tonA region of Escherichia coli or S. paratyphi B became sensitive to colicin M and phage T5. We infer that the tonA allele of S. paratyphi B, like that of E. coli, determines an outer membrane protein that adsorbs T5 and colicin M but not phage ES18, whereas the S. typhimurium allele determines a protein able to adsorb only ES18. The partial T1 sensitivity of a rough LT2 strain with a tonA allele from E. coli or S. paratyphi B and also the tonB(+) phentotype of an E. coli B trp-tonB Delta mutant carrying an F' trp of LT2 origin showed that S. typhimurium LT2 has a tonB allele like that of E. coli with respect to determination of sensitivity to colicins and phage T1. Rough S. paratyphi B, although T5 sensitive, remained resistant to T1 even when given F' tonB(+) of E. coli origin. Classes of Salmonella mutants selected as resistant to colicin M included: T5-resistant mutants, probably tonA(-); mutants unchanged except for M resistance, perhaps tolerant; and Exb(+) mutants, producing a colicin inhibitor (presumably enterochelin). Some Exb(+) mutants were resistant to a bacteriocin inactive on E. coli but active on all tested S. paratyphi B and S. typhimurium strains (and on nearly all other tested Salmonella). A survey showed sensitivity to colicin M in several other species of Salmonella.

[Sensitivity to chemoantibiotic therapy of new isolated Salmonellae strains (author's transl)]

The results of chemoantibiotic sensitivity tests carried out on 626 Salmonellae strains, isolated in 1973, 1974 and 1975 at the Bacteriol. Laboratory of S. Maria Nuova Hospital, Florence (Italy), are here related. The lowest percentages of antibiotic resistance have been noted to gentamycin and colimycin. Significant differences of antibiotic resistances were observed in single tested strains: the Salmonella wien strains were polyresistant, while the Salmonella panama strains showed a very high sensitivity to all the antibiotics. The conclusion is that in order to conduct a correct and useful antibiotic therapy, the microbic sensitivity test on isolated Salmonellae strains should be always performed.

Treatment of chronic salmonella carriers. Study with 40 cases of S. typhi, 19 cases of S. paratyphi b and 28 cases of S. enteritidis strains

The present stage of our studies suggests that, provided a highly effective combined therapy is, and can be, carried out correctly, all excreters can be cured of their chronic carrier state by chemotherapy within 8-12 weeks. Although we cannot recommend a universal therapeutic regimen for all patients, a highly effective 'basic therapy' (RMP+TSP) is available for the majority of the cases, needing occasional modification, depending on the specific requirements of the individual patient as shown by the result of the serum activity determination. This method saves the patient from toxic inconveniences caused by inadequate treatment, it shortens the treatment time and makes cholecystectomy superfluous - unless it is considered necessary out of a different indication in which case it should certainly be done. We cannot share the often expressed view that Salmonella enteritidis excreters cannot be cured, a view which is found even in the most recent manuals. The same applies to the view that therapy is not necessary because it would delay cure. It is indispensable to establish a close cooperation between the public health authorities and the private physician, and we therefore wish to sincerely thank all colleagues and Public Health Officers for their collaboration.

Beta-lactam antibiotics with N-oxide side chains. 1. Quinoxaline N-oxides

A series of penicillin derivatives of quinoxaline di-N-oxide carboxylic acids was prepared. These compounds were prepared from the acid chlorides and mixed anhydrides of the quinoxaline di-N-oxides. The compounds prepared exhibited minimal antibacterial activity against gram-negative organisms.