Cryptosporidium meleagridis from humans: molecular analysis and description of affected patients.

OBJECTIVES: To genetically characterize an unusual genotype of Cryptosporidium from the stools of humans with diarrhoea and to identify risk factors in the affected patients. METHODS: DNA was extracted from human faeces where Cryptosporidium oocysts were detected by light microscopy. Cryptosporidial gene fragments from six different loci were analysed by PCR alone, PCR/RFLP and by DNA sequencing. Oocysts were characterized by light and immunofluorescence microscopy and epidemiological data was collected from the affected patients. RESULTS: Analysis of the Cryptosporidium oocyst wall protein (COWP) gene amplified from > 2000 human faecal samples identified 19 patients all of which produced an unusual RFLP profile. Subsequent DNA sequence analysis of this and an additional four genetic loci (including 18S rRNA sequences) confirmed these as a homogeneous group which was genetically distinct from Cryptosporidium parvum. The isolates were identified as Cryptosporidium meleagridis since the gene sequences were identical to those from this species recovered from birds. Conventional microscopy showed oocysts indistinguishable from C. parvum and reacted strongly with two different commercially available anti-oocyst monoclonal antibodies. None of the patients showed risk factors unusual for cryptosporidiosis; however, ten of the cases occurred during the summer/autumn, six had a history of foreign travel, four were co-infected with Giardia, two were HIV positive, and six were without identifiable immunocompromising factors. CONCLUSIONS: This study further confirms that C. meleagridis, in addition to C. parvum, is involved in human disease. The study also highlights the lack of basic information on the host range of this genus of parasites, the complexity of the transmission routes involved in human cryptosporidiosis, and the value of molecular techniques in identify hitherto unrecognised differences in Cryptosporidium from human faeces.

Legionnaires' disease and the sick-building syndrome.

In October 1985, six cases of legionnaires' disease were associated with a police headquarters building. Four were amongst staff who worked in or visited the communications wing of the headquarters and two cases occurred in the local community. A case-control study implicated the operations room of the communications wing as the main area associated with infection. This wing was air-conditioned and smoke tracer studies showed that drift from the exhaust as well as from the base of the cooling tower entered the main air-intake which serviced the air-conditioning system. Legionella pneumophila serogroup 1 subgroup pontiac was isolated from water and sludge in the cooling tower pond. Contaminated drift from the top of the cooling tower was probably responsible for the two community cases. An additional discovery was that symptoms suggestive of the sick-building syndrome were associated with working in this wing.

Clinical and pathological variability of infection by enterohaemorrhagic (Vero cytotoxin producing) Escherichia coli.

The clinical and pathological features of five sporadic cases of enteric infection caused by Escherichia coli O157 (enterohaemorrhagic or Vero cytotoxin-producing E coli showed a range of features. These included one case with pseudomembranous colitis, one with an acute exacerbation of ulcerative colitis, and three with enterocolitis. Diagnostic difficulties encountered initially in four of the five cases were finally resolved by correlating the results of microbiological with histopathological investigations. In view of the heterogeneity of clinical and histological signs and symptoms, it is concluded that all patients with abdominal pain and diarrhoea or rectal bleeding should have early microbiological investigation.

Control of an outbreak of group C meningococcal meningitis with a polysaccharide vaccine.

An outbreak of meningitis in Royal Air Force recruits due to Neisseria meningitidis Group C type PI, 2 gave the first opportunity for polysaccharide vaccine to be used for controlling such an outbreak in the U.K. The effect of the vaccine on an epidemic in a large recruit training centre was studied after chemoprophylaxis had failed. With the possible exception of one vaccinee, further cases did not arise among camp personnel. Vaccination was continued until the carriage rate of the epidemic strain among recruits leaving the camp had fallen from greater than 19 to less than 1%. Two persons who had only indirect contact with the camp developed the disease. Vaccination early in the course of such an outbreak appears to be a useful and practical method of limiting symptomatic infection but not acquisition of the epidemic strain.

Campylobacter enteritis and bloody stools in the neonate.

Within 72 hours of birth three babies had loose stools containing fresh blood, mucus, and Campylobacter jejuni/coli. Campylobacter enteritis should be considered in newborn babies passing blood per rectum.

Dissemination of Bacillus cereus in a maternity unit.

During a period of 4 months, 54 of 1059 (5%) specimens received for bacterial culture from neonates in a maternity unit yielded Bacillus cereus. Of the strains isolated, 48 originated from 259 umbilical cord swabs examined. Furthermore, 88% of the isolates belonged to a single, previously undescribed serotype. Strains of the same serotype were also found to be widely distributed in the environment throughout the maternity unit. The primary source of the organism, however, could not be established.