Evaluation of two Salmonella typhi strains with reduced virulence for use in teaching and proficiency testing.

A total of 21 cases of laboratory-acquired typhoid fever associated with teaching and proficiency tests occurred in the United States during a 33-month period, prompting a search for less virulent strains of S. typhi which would be suitable for teaching purposes. Two strains were evaluated which are reported to have reduced virulence for mice. Strain Ty21a is a genetically constructed mutant that lacks the enzyme UDP-glucose-4-epimerase. This strain has reduced virulence for humans if grown under special laboratory conditions (in the presence of 0.1% d-galactose) and has been evaluated as a candidate for use as a live, oral vaccine. Strain H901 was originally isolated in Russia in 1918. It has not been tested in humans, but its nonmotile variant, O901, has been found to be somewhat less virulent for humans; however, it can cause infection with doses of 10(7) organisms. In teaching exercises, all strains should be treated as though they are fully virulent. Ty21a and H901 were satisfactory, but not ideal, for teaching purposes. Biochemically, they could be identified by conventional tests and by commercially available diagnostic systems, although Ty21a was H(2)S negative. Serologically, both strains posed problems. Both Ty21a and H901 were Vi antigen negative, and Ty21a was rough and grew poorly. Both strains were susceptible to antibiotics, including chloramphenicol, ampicillin, and trimethoprim-sulfameth-oxazole. When Ty21a and H901 were mixed with Escherichia coli and plated, Hektoen and salmonella-shigella agars were most useful for their recovery. The appearance of Ty21a and H901 on differential plating media was typical, although Ty21a had smaller colonies. The plating efficiency on MacConkey agar for Ty21a was 0.6 compared with 1 for H901. Neither strain can be recommended unequivocally for teaching purposes; instead, the advantages and disadvantages of each must be considered. Both strains have been deposited in the American Type Culture Collection (Ty21a = ATCC 33459 = CDC 2861-79; H901 = ATCC 33458 = CDC 2862-79).

Identification of Proteus penneri sp. nov., formerly known as Proteus vulgaris indole negative or as Proteus vulgaris biogroup 1.

The name Proteus penneri sp. nov. is proposed for a group of organisms previously called Proteus vulgaris indole negative or P. vulgaris biogroup 1. All of these strains were salicin negative, esculin negative, and chloramphenicol resistant (zone size, less than 14 mm). DNA relatedness studies indicated that when DNA from P. penneri strain 1808-73 was labeled and tested against unlabeled DNA from 13 other P penneri strains, a highly related group was formed (88 to 99% relatedness at 60 degrees C and 67 to 99% relatedness at 75 degrees C). Strain 1808-73 (ATCC 33519) is proposed as the type strain of P. penneri. In this study, two distinct groups of indole-positive P. vulgaris strains were also apparent. The first group (defined as P. vulgaris biogroup 2) was indole positive, salicin positive, and esculin positive, and the second group (defined as P. vulgaris biogroup 3) was indole positive, salicin negative, and esculin negative. The current type strain of P. vulgaris (ATCC 13315) belongs to biogroup 3. The DNA from P. penneri strains was not highly related to labeled DNA from the type strain of P. vulgaris (14 to 30% relatedness at 75 degrees C) or from P. vulgaris strain PR 1 (ATCC 29905), which belongs to biogroup 2 (27 to 33% relatedness at 75 degrees C). Strains of biogroup 2 were sensitive to chloramphenicol (zone size, greater than 19mm), and 10 of these strains formed a highly related group by DNA hybridization when DNA from PR 1 was labeled (64 to 100% relatedness at 60 degrees C and 70 to 100% relatedness at 75 degrees C), but they were not highly relatedness to the type strain of P. vulgaris (51 to 68% relatedness at 60 degrees C and 14 to 44% relatedness at 75 degrees C). Further DNA relatedness studies are needed on strains of biogroup 3 before a definitive taxonomic proposal can be made for these two indole-positive biogroups.

Illness caused by Vibrio damsela and Vibrio hollisae.

Vibrio damsela was isolated from six wound infections in otherwise healthy persons. In five of the six cases the wounds were known to have been exposed to salt or brackish water at the time of the injury. Vibrio hollisae was isolated from an index stool culture in nine cases in which no other enteric pathogen was identified. All nine patients had diarrhoea and abdominal pain; one patient had bloody diarrhoea. Six of the nine patients were known to have eaten raw seafood in the five days before they became ill. These data suggest that both V. damsela and V. hollisae can produce diseases with distinct clinical and epidemiological characteristics.

Identification of Vibrio hollisae sp. nov. from patients with diarrhea.

The name Vibrio hollisae (synonym = Special Bacteriology group EF-13) is proposed for a new group of 16 strains that occurred in stool cultures of patients with diarrhea. V. hollisae is a small gram-negative rod, which is motile with a single polar flagellum. No lateral or peritrichous flagella were observed, even when it was grown on a solid medium. Sodium chloride is required for growth, so V. hollisae is a halophilic vibrio. Strains were positive (36 degrees C, 24 or 48 h) for oxidase (Kovacs), indole production, nitrate reduction to nitrite, and fermentation of D-glucose (acid, no gas), L-arabinose, D-galactose, and D-mannose. Strains were negative for the following tests often used in enteric bacteriology: lipase (corn oil); deoxyribonuclease; gelatinase; methyl red; Voges-Proskauer; utilization of citrate, acetate, and malonate; L-lysine decarboxylase (Møllers); L-ornithine decarboxylase (Møllers); L-arginine dihydrolase (Møllers); growth in KCN medium; and acid production from D-adonitol, D-arabitol, cellobiose, dulcitol, erythritol, glycerol (25% delayed positive at 7 days), i-(myo)-inositol, lactose, maltose, D-mannitol, melibiose, alpha-methyl-D-glucoside, mucate, raffinose, L-rhamnose, salicin, D-sorbitol, sucrose, trehalose, and D-xylose. None of the strains was motile (semisolid medium) at 36 degrees C at 48 h, but by 7 days 88% were motile. The strains did not grow within 2 days when plated on thiosulfate-citrate-bile salts-sucrose (TCBS) agar or MacConkey agar, but they grew on sheep blood agar and marine agar. By DNA-DNA hybridization (75 degrees C, hydroxyapatite with (32)P), V. hollisae was only 0 to 4% related to 21 named species in Vibrio and Photobacterium. The type strain is designated ATCC 33564, which has a mean guanineplus-cytosine content in DNA of 50 mol%. With the disk diffusion method V. hollisae had relatively large zones of inhibition around penicillin, ampicillin, carbenicillin, cephalothin, colistin, polymyxin B, streptomycin, kanamycin, gentamicin, tetracycline, chloramphenicol, and sulfadiazine. Future studies should focus on the isolation of this new vibrio and its ecology and relationship to human diseases.

Vibrio damsela, a Marine Bacterium, Causes Skin Ulcers on the Damselfish Chromis punctipinnis.

A previously undescribed marine bacterium, Vibrio damsela, was isolated from naturally occurring skin ulcers on a species of temperate-water damselfish, the blacksmith (Chromis punctipinnis). Laboratory infection of the blacksmith with Vibrio damsela produced similar ulcers. Vibrio damsela was pathogenic for four other species of damselfish but not for members of other families of fish. The bacterium has also been isolated from water and from two human wounds and may be a cause of human disease.

Vibrio metschnikovii bacteremia in a patient with cholecystitis.

Vibrio metschnikovii was isolated from the blood of an 82-year-old patient with peritonitis and an inflamed gallbladder. This is probably the first clinically significant isolate of this new vibrio.

Tatumella ptyseos gen. nov., sp. nov., a member of the family Enterobacteriaceae found in clinical specimens.

The name Tatumella ptyseos gen. nov., sp. nov., is proposed for a group of organisms (previously called group EF-9) isolated from clinical sources in the United States, Canada, and Puerto Rico. A total of 68% of these isolates were from sputum specimens. T. ptyseos strains are gram-negative, oxidase-negative, fermentative rods that grow on MacConkey agar. The distinctive biochemical characteristics of 44 T. ptyseos isolates were as follows: acid but no gas from D-glucose, sucrose, and, usually (71%), D-xylose (62% delayed); no acid from lactose, maltose, or D-mannitol; negative tests for indole, urea, methyl red, gelatin, L-lysine decarboxylase, and L-ornithine decarboxylase; L-arginine dihydrolase variable; phenylalanine deaminase positive; Voges-Proskauer positive by the Coblentz method but negative by the O'Meara method; nonmotile at 36 degrees C but 66% weakly motile (30% delayed) at 25 degrees C; Simmons citrate positive at 25 degrees C (89%) but Simmons citrate negative at 36 degrees C. Deoxyribonucleic acid-deoxyribonucleic acid relatedness studies on 26 T. ptyseos strains showed that they were 80 to 100% related at 60 degrees C, which indicated that they comprise a single species. The deoxyribonucleic acid relatedness to other species within the Enterobacteriaceae was 7 to 38%. This is evidence that this species belongs in this family, is distinct from all described species and is best placed in a new genus. The T. ptyseos isolates studied were susceptible to all of the antimicrobial agents tested by broth dilution; these antimicrobial agents were amikacin, ampicillin, cephalothin, chloramphenicol, gentamicin, kanamycin, tetracycline, and tobramycin. Three striking differences between T. ptyseos and other members of the Enterobacteriaceae were its large zone of inhibition around penicillin (mean diameter 24 mm), its tendency to die on some laboratory media (such as blood agar) within 7 days, and its small number (usually one) of flagella. Strain H36 (=ATCC 33301, =CDC D6168, =CDC 9591-78) is the type strain of this new species. T. ptyseos is the type species for the genus Tatumella.

Kluyvera, a new (redefined) genus in the family Enterobacteriaceae: identification of Kluyvera ascorbata sp. nov. and Kluyvera cryocrescens sp. nov. in clinical specimens.

Kluyvera is proposed as a new genus for the group of organisms formerly known as Enteric Group 8 (synonym = API group 1). Strains of Kluyvera share the properties of most members of the family Enterobacteriaceae: they are gram-negative rods, motile with peritrichous flagella, catalase positive, and oxidase negative; they grow on MacConkey agar, ferment D-glucose with the production of acid and gas, and are susceptible to many antibiotics. Strains are usually indole positive, methyl red positive, Voges-Proskauer negative, citrate positive, H2S (triple sugar iron) negative, urea negative, phenylalanine deaminase negative, lysine decarboxylase positive, arginine dihydrolase negative, and ornithine decarboxylase positive. Kluyvera strains ferment many of the sugars and polyhydroxyl alcohols used in identification. By deoxyribonucleic acid-deoxyribonucleic acid hybridization, strains of Kluyvera were divided into three groups. Kluyvera ascorbata is proposed as the type species for the genus. Most strains of K. ascorbata have been isolated from clinical specimens. K. cryocrescens is proposed as the second species. It was occasionally isolated from clinical specimens, but it was isolated more commonly from the environment. Kluyvera species group 3 was heterogeneous, but was distinct from the two named species by deoxyribonucleic acid hybridization. This group was rare, so no species name will be proposed at this time. K. ascorbata can be differentiated from K. cryocrescens by its positive ascorbate test, inability to grow at 5 degrees C in a refrigerator, and smaller zones of inhibition around carbenicillin and cephalothin disks. The test normally used for identification does not clearly differentiate these two species. Kluyvera species are probably infrequent opportunistic pathogens. The most common source is sputum, where they are probably not clinically significant. Five strains have been from blood cultures. More information is needed about the incidence and clinical significance of the genus Kluyvera.

Salmonella typhi: the laboratory as a reservoir of infection.

As a part of educational and proficiency exercises thousands of students and laboratory personnel have been exposed to Salmonella typhi. In a retrospective study 24 cases of laboratory-acquired typhoid fever in the United states during a 33-month period were identified; laboratory-acquired cases represented only 2.4% of all typhoid cases but 11.2% of the sporadic cases. Twenty-one of the 24 cases occurred when S. typhi was voluntarily introduced into the laboratory for educational proficiency testing or research purposes. Twelve patients were exposed to S. typhi when working with it as an unknown organism; another five were merely present in the laboratory. Obvious breaks in technique were found to be the cause of infection for only seven of the 24 patients, although infection of the others implies that breaks in technique occurred. Laboratory-acquired typhoid fever may severe as a marker for other less severe laboratory-acquired infections; these data suggest that such infections could be common.

Unusual groups of Morganella ("Proteus") morganii isolated from clinical specimens: lysine-positive and ornithine-negative biogroups.

Morganella ("Proteus") morganii is the only species in the recently proposed genus Morganella, but we suspect there are yet undescribed species in the genus. Two candidates for new species were recently investigated. Nineteen strains isolated from clinical specimens resembled M. morganii but were lysine positive and nonmotile and fermented glycerol within 24 h. Typical M. morganii are lysine negative and motile and ferment glycerol slowly or not at all. The three-test variance from typical M. morganii suggested that this new group might be a new Morganella species; however, strains of the group were closely related to typical M. morganii by deoxyribonucleic acid (DNA)-DNA hybridization. A second group of 14 strains isolated from clinical specimens was ornithine negative but was otherwise very similar to M. morganii. This group was also closely related to M. morganii by DNA hybridization. Both sets of strains clearly belong in the species Morganella morganii as distinct biogroups; they are not separate species as originally suspected. Initially both biogroups posed a problem in identification until their true relationship to M. morganii was determined.

Unusual Enterobacteriaceae. "Proteus rettgeri" that "change" into Providencia stuartii.

A blood culture bottle from a patient with bacteremia contained both Proteus rettgeri biogroup 5 and Providencia stuartii (described in Bergey's Manual of Determinative Bactiology [8th ed., 1974] as Proteus inconstans), which had the same unusual antibiotic resistance pattern. Single colonies of this P. rettgeri biogroup 5 isolate were shown to produce urea- clones. If current taxonomy is used, the strain changed from P. rettgeri to P. stuartii in the laboratory and probably also in the patient. Urea- clones were also found in three of six other strains of P. rettgeri biogroup 5. No urea-negative clones were found in two isolates each of P. rettgeri biogroups 1 and 3. Previous data from deoxyribonucleic acid-deoxyribonucleic acid hybridization, biochemical reactions, and serological cross-reactions all have indicated that the taxon now called P. rettgeri biogroup 5 should be classified as P. stuartii urea+. We propose that this taxonomic change be made. Urease production is probably plasmid mediated in P. stuartii urea+ and can easily be lost, as shown in our case report and in three stock cultures. Urea hydrolysis will no longer be the key test for differentiating P. rettgeri from P. stuartii. Rather, acid production from trehalose, D-arabitol, adonitol, and D-mannitol will be the key tests. Whereas P. rettgeri is usually trehalose-, D-arabitol+, adonitol+, and D-mannitol+, P. stuartii has the opposite reactions.

Detection of Serratia outbreaks in hospital.

Infections due to Serratia marcescens were studied in 23 different hospitals. A retrospective study was done in 4 hospitals; all isolates were compared by serological typing, antibiograms, bacteriocin production, and bacteriocin sensitivity. 2 of the hospitals were having cross-infection problems due to antibiotic-resistant strains, but the other 2 had little or no cross-infection. Outbreaks were studied in 19 other hospitals. 9 of these outbreaks were classified as "common source" since contaminated "sterile solutions" were incriminated as the cause in each. One hospital had a "pseudo-outbreak," in which Serratia from E.D.T.A. blood-collecting tubes contaminated blood-cultures as they were collected. All 10 of these strains from common-source outbreaks were generally sensitive to antibiotics. Outbreaks in 9 other hospitals resulted from cross-infection and were caused by strains which were very resistant to antibiotics. Guidelines for detecting outbreaks are given and control measures are suggested.

Differentiation of Proteus mirabilis by bacteriophage typing and the Dienes reaction.

A provisional typing schema based on sensitivity to 23 bacteriophages has been established for Proteus mirabilis. Seventy-three bacteriophages were isolated on strains of P. mirabilis (64), P. vulgaris (1), P. morganii (7), and P. rettgeri (1), but those isolated on P. mirabilis were the most useful in differentiating other strains of . mirabilis. From the 73 phages studied, the best 23 were chosen by computer analysis for the provisional system, which was then used to study P. mirabilis infections in a 500-bed general hospital. All patient isolates for 19 months were saved and then compared by bacteriophage typing and the Dienes reaction in a retrospective study. There was evidence for only three instances of cross-infection or -colonization during this time. Bacteriophage typing was very sensitive in differentiating strains, since 200 strains were differentiated into 113 different lysis patterns and 94% were typable. The Dienes reaction was useful at times but often gave reactions that were difficult to read or that changed when the tests were repeated. The bacteriophages described by Schmidt and Jeffries were also evaluated and proved useful in combination with ours. The value of bacteriophage typing was clearly established, and work toward a standardized schema for P. mirabilis should continue.

Automation of Salmonella typhi phage typing.

Two steps in the procedure for bacteriophage typing of Salmonella typhi have been automated. The culture inoculum was applied by flooding the surface of phage agar in a 150x20 mm petri dish and removing the excess liquid with a safety pipettor. This step replaced the older method of manually preparing up to 100 individual areas for inoculation. The number of bacteria per unit area was the same with both methods, so the automated method involved no change in the technique. The second automated step involved use of a bacteriophage applicator which simultaneously dispensed 59 uniform drops of bacteriophages onto the inoculated plate. The automated procedure has reduced personnel time by about 90% with no less in sensitivity or accuracy.

Unusual Enterobacteriaceae: lactose-positive Salmonella typhimurium which is endemic in São Paulo, Brazil.

Since 1971 a lactose-positive (lac+) Salmonella typhimurium variety Copenhagen has been endemic in the city of Sao Paulo. The strain is a strong lactose fermenter and resembles Escherichia coli on primary plating media and in triple sugar iron agar. Although most isolates of the strain have uniform properties, some have slightly different antigens, antibiograms, phage types, or fermentation patterns. Most isolates have come from stools of infants under 1 year of age and are probably hospital acquired; however, other isolates are probably community acquired. Eighteen other lac+ Salmonella isolated in the United States were also studied. Most of these strains resembled E. coli on primary plates and triple sugar iron agar; thus their identification would pose a problem for most clinical laboratories. A simple procedure for detecting lac+ Salmonella mixed with lac+ E. coli consists of touching 12 colonies in succession with a straight wire and then inoculating a peptone iron agar tube. H2S production is apparent from lac+ Salmonella even if 11 E. coli and one Salmonella colony are picked. If a positive peptone iron agar tube is observed, then individual colonies are tested to rule out other strong H2S producers. The true incidence of lac+ Salmonella is unknown because they are not isolated and identified in most laboratories.