Isolation of Cyclospora oocysts from fruits and vegetables using lectin-coated paramagnetic beads.

Published techniques for recovering parasites from fruit and vegetables are generally inadequate, with low and variable recovery efficiencies. Herein, we describe an improved method for analyzing fruit and vegetables for Cyclospora oocysts. The technique includes washing procedures, sonication, and separation using lectin-coated paramagnetic beads. Identification is by microscopy (differential interference contrast and fluorescence). Oocyst recovery efficiencies from mushrooms, lettuce, and raspberries were approximately 12%. Recovery efficiencies from bean sprouts were approximately 4%. Although no significant difference in recovery efficiency could be detected between samples processed using the lectin-coated beads and samples processed without this procedure, distinct advantages were apparent when the lectin-coated beads were used. A considerably smaller, cleaner final volume remained for microscopy, which increases the sensitivity of the technique and reduces operator time.

Well-planned due diligence can protect buyers of healthcare entities.

Conducting a thorough due diligence is essential for any buyer that plans to acquire a healthcare entity, including a hospital or a group practice, because it provides an opportunity for the buyer to uncover billing or other fraud-and-abuse problems within the selling organization. These problems can be significant, because the buyer can be held liable for undiscovered billing problems that result in investigation, prosecution, and penalties. It is important for the buyer to ascertain who bears the liability of fraud-and-abuse violations and attempt to protect itself from assuming such liability.

Effects of Preservatives on Viability of Cryptosporidium parvum Oocysts.

Potassium dichromate and formalin reduced the viability of Cryptosporidium parvum oocysts as assessed by inclusion or exclusion of 4',6-diamidino-2-phenylindole (DAPI) and propidium iodide (PI) and excystation. Some formalin-treated oocysts containing dead sporozoites excluded PI; that this fluorogenic assay relies not solely upon exclusion of PI but also upon highlighting of sporozoite nuclei by DAPI is reiterated.

Induction of folds or sutures on the walls of Cryptosporidium parvum oocysts and their importance as a diagnostic feature.

The proportion of oocysts of Cryptosporidium parvum showing a fold on oocyst walls when incubated with either fluorescent monoclonal antibody or a surface-reactive fluorescent dye was increased by incubating suspensions of oocysts with dimethyl sulfoxide, sucrose, or Hanks' balanced salt solution. Further incubation of sucrose-incubated oocysts with water showed this to be a reversible phenomenon. Oocysts demonstrating this fold after incubation in dimethyl sulfoxide were of the same viability as control oocysts and followed the same excystation dynamics. Despite this fold having been previously described as a suture, we were unable to find any evidence that this pattern of fluorescence highlighted the same suture that has been described in ultrastructural studies. Furthermore, oocysts were observed in which this fold was not always continuous with the gape in the oocyst wall through which the sporozoites had emerged. We propose that this fluorescently highlighted region or fold should no longer be described as a suture and question its validity as a diagnostic feature. When environmental and other samples are being examined for the presence of C. parvum oocysts, objects of appropriate size, shape, and fluorescence which do not demonstrate a surface fold should not necessarily be excluded.

In vitro excystation of Cryptosporidium parvum.

Protocols for in vitro excystation of oocysts of Cryptosporidium parvum, including different chemical pre-incubation steps, were compared to examine some of the biochemical triggers involved in excystation and to define an in vitro excystation protocol of a reproducibly high efficiency. Pre-incubation steps which increased the permeability of the oocysts were found to enhance excystation dynamics and pre-treatment of oocysts with saliva was found to decrease the permeability and reduce excystation. Although excystation was maximal after incubation for 4 h, sporozoites tended to lyse over this period, and maximum sporozoite recovery occurred after 30 min. The results obtained are discussed in relation to excystation protocols adopted by different research groups and a number of recommendations are given for in vitro excystation of C. parvum oocysts.

Survival of Cryptosporidium parvum oocysts under various environmental pressures.

The survival of various isolates of Cryptosporidium parvum oocysts under a range of environmental pressures including freezing, desiccation, and water treatment processes and in physical environments commonly associated with oocysts such as feces and various water types was monitored. Oocyst viability was assessed by in vitro excystation and by a viability assay based on the exclusion or inclusion of two fluorogenic vital dyes. Although desiccation was found to be lethal, a small proportion of oocysts were able to withstand exposure to temperatures as low as -22 degrees C. The water treatment processes investigated did not affect the survival of oocysts when pH was corrected. However, contact with lime, ferric sulfate, or alum had a significant impact on oocyst survival if the pH was not corrected. Oocysts demonstrated longevity in all water types investigated, including seawater, and when in contact with feces were considered to develop an enhanced impermeability to small molecules which might increase the robustness of the oocysts when exposed to environmental pressures.

Viability of Cryptosporidium parvum oocysts: correlation of in vitro excystation with inclusion or exclusion of fluorogenic vital dyes.

A viability assay for oocysts of Cryptosporidium parvum based on the inclusion or exclusion of two fluorogenic vital dyes, 4',6-diamidino-2-phenylindole (DAPI) and propidium iodide, was developed by using several different isolates of oocysts. Correlation of this assay with viability measured by in vitro excystation was highly statistically significant, with a calculated correlation coefficient of 0.997. In this research, two similar excystation protocols were utilized, and no significant difference between excystation protocols was detected. Percent excystation of oocyst suspensions could be increased or reduced by inclusion of a preincubation treatment in either excystation protocol, and this alteration was also demonstrated in the viability assay. Oocysts which excluded both dyes would not excyst in vitro unless a further trigger was provided and were more resistant to acid or alkali treatment. The results of this research provide a reproducible, user-friendly assay which is applicable to individual oocysts and also provides a useful adjunct for identification of oocysts in water and environmental samples.

Rubella: immunity and vaccination in schoolgirls.

Of 191 schoolgirls, 128 volunteered to take part in a feasibility study of serotesting before and after rubella vaccination, and all responded to RA 27/3 vaccine. Had the serum samples been taken by a fingerprick method the number of volunteers would probably have increased considerably. A change in policy for rubella vaccination to testing both before and after vaccination would cost no more than the existing policy, would ensure primary response, and would differentiate those women who were protected by the vaccine from those with antibody to wild virus.