Long-term survival of Escherichia coli O157 on pasture following an outbreak associated with sheep at a scout camp.

AIMS: To monitor the decay of E. coli O157 in soil (loamy sand) on a scout campsite following an outbreak in humans. METHODS AND RESULTS: Samples of soil and sheep faeces were collected from the campsite and tested for the presence of E. coli O157 by immunomagnetic separation (IMS) after enrichment in buffered peptone water + vancomycin at 42 degrees C for 6 h. Enumeration of target was carried out by direct plating onto sorbitol MacConkey agar plates supplemented with cefixime and tellurite (CTSMAC) incubated at 37 degrees C for 24 h. Low numbers (< 100 g(-1)) were estimated by the most probable number (3-tube MPN) technique. CONCLUSIONS: Survival was observed for 15 weeks. SIGNIFICANCE AND IMPACT OF THE STUDY: A number of laboratory studies have followed the decay of E. coli O157 in soil, animal faeces and water. This study follows (for the first time) the decay of the organism in soil after an outbreak associated with sheep. It demonstrates the long-term persistence of the organism in the environment and the results will be potentially important in performing risk assessments for both human and animal infection.

Intergenic spacer (IGS) polymorphism: a new genetic marker for differentiation of Toxoplasma gondii strains and Neospora caninum.

The region between the 28S and 18S rRNA genes, including the intergenic spacer (IGS) region and the 5S rRNA gene, from 32 strains of Toxoplasma gondii and the NC1 strain of Neospora caninum was amplified and used for DNA sequencing and/or restriction fragment length polymorphism (RFLP) analysis. The 5S rDNA sequences from 20 strains of T. gondii were identical. The IGS region between the 5S and 18S rRNA genes (nontranscribed spacer 2 or NTS 2) showed 10 nucleotide variations. Six of the 10 variant positions correlated with the murine virulence of the strains. Intraspecific polymorphisms distinguished the virulent strains of zymodemes 5, 6, and 8 from other virulent strains (in zymodeme 1). RFLP methods (IGS-RFLP) were developed and used to characterize the virulent and avirulent patterns among 29 T. gondii strains. Sequence diversity of 19.8% was found between T. gondii and N. caninum when comparing a region of 919 bp at the 3' end of NTS 2. The sequence variation in ribosomal IGS could therefore be a useful marker for Toxoplasma strain identification and for distinguishing N. caninum from T. gondii.

VTEC: lessons learned from British outbreaks.

Important Escherichia coli O157 outbreaks in England and Scotland since 1982-83 are reviewed. The scientific lessons learned from them are described and their legal consequences outlined. The light shed by them on relationships between law and science is discussed, and questions of blame are analysed in the context of Reason's 'resident pathogen' metaphor and Vaughan's study of the 1986 Challenger Space Shuttle disaster.

Molecular typing of Toxoplasma gondii strains by GRA6 gene sequence analysis.

The utility of sequence polymorphisms in the dense granule antigen GRA6 gene as typing markers for Toxoplasma gondii was investigated. The coding region of GRA6 was amplified, sequenced and compared for 30 Toxoplasma strains from eight different zymodemes (Z1-Z8). Sequence alignment identified nucleotide polymorphisms at 24 positions out of 690 bp, which correlated with murine-virulence. Types I, II, and III could be distinguished from each other on the basis of three, 10, and six variable positions, respectively. Two deletions of 15 bp and 3 bp existed in the avirulent (type II) strains. With one exception, all polymorphic positions resulted in amino acid substitutions, and the two gaps of 15 bp and 3 bp caused the deletion of six amino acids in type II strains. Intra-specific polymorphisms were also found in the virulent group. A high degree of sequence polymorphism correlating with the phenotypes of T. gondii strains points to the GRA6 gene being a good marker for strain characterisation and typing of the isolates of this apicomplexan. The large variety of amino acid changes supports the view that the GRA6 protein plays an important role in the antigenicity and pathogenicity of T. gondii. The existence of polymorphic restriction sites for endonuclease MseI was used to develop a PCR-RFLP method which could simply differentiate the three different groups (types I, II, III) of T. gondii.

In vitro activities of meropenem and other antimicrobial agents against British meningococcal isolates.

The in vitro activity of meropenem was compared with those of penicillin, ampicillin, cefuroxime, cetriaxone, cefotaxime, rifampicin, chloramphenicol, sulphadiazine and ciprofloxacin against 121 British meningococcal isolates by a microdilution method in Mueller-Hinton broth and by the E test. All meningococcal strains were susceptible to the agents except for ampicillin (88.4%), penicillin (88.4%), sulphadiazine (57.9%) and rifampicin (95%). The emergence of resistance problems among meningococcal isolates stresses the need for their constant monitoring and of the development of new agents. In this study we have shown that meropenem is highly active in vitro against Neisseria meningitidis. Recent studies have indicated that meropenem is highly active clinically and bacteriologically in the treatment of bacterial meningitis. Thus, the potentials of meropenem as meningococcal prophylactic and therapeutic agent needs to be fully evaluated.

Usefulness of rat-derived antigen in the serodiagnosis of Pneumocystis carinii infection.

Sera from patients with likely and possible Pneumocystis carinii pneumonia (PCP) on the basis of clinical information and laboratory investigations were tested by immunoblotting to assess the usefulness of trophozoites in the serodiagnosis of PCP. IgG antibodies to 50-60- kDa proteins were demonstrated with cyst antigen, but antibodies to additional proteins of 61, 70, 82, 95, 99 and 116 kDa were found with trophozoite antigen. These bands were not demonstrated with control sera. IgG antibody to the 116-kDa protein was found in 18 (46%) of 39 sera from patients with possible PCP compared with 5 (17%) of 30 sera from patients with likely PCP. There was no other significant difference between the two patient groups in detection of these proteins. Sera with higher indirect immunofluorescence assay (IFA) IgG titres were more likely to be immunoblot positive. Only 4 of 16 patients with likely PCP were IgG negative in the IFA; three of these were IgG immunoblot positive. In 4 of 10 patients with likely PCP and 6 of 15 patients with possible PCP, demonstration of IgM or IgA, or both, by IFA or immunoblotting provided evidence suggestive of current infection. This study confirms the usefulness of rat-derived antigen, especially trophozoite antigen, in PCP serology. The IgG IFA remains the most useful test, but IgM and IgA testing and immunoblotting can support the diagnosis.

Absorption of IgG does not enhance toxoplasma IgM and IgA immunoblotting.

Total IgG, IgM and IgA levels and toxoplasma IgG, IgM and IgA immunoblotting patterns were assayed in 10 sera before and after IgG absorption with Protein G-Sepharose 4. Removal of IgG (mean reduction 96%) was accompanied by a significant reduction in the level of IgM (mean reduction 56%) and IgA (mean reduction 53%) in nine of the 10 sera. The absorbed supernates showed fewer and weaker IgM bands in five sera, but IgA immunoblotting patterns were unaffected by absorption. There was no benefit in removing IgG in toxoplasma IgM and IgA immunoblotting.

The detection of penicillin insensitivity in Neisseria meningitidis by polymerase chain reaction.

Strains of penicillin-sensitive and -insensitive Neisseria meningitidis were examined using a range of polymerase chain reaction (PCR) primers directed at the meningococcal penicillin-binding protein 2 gene. DNA from isolates whose penicillin MIC was <0.2 mg/L yielded a product of the expected size with all the primers, but many amplification patterns were seen with DNA from isolates whose MIC was above this level. All strains whose MIC was >0.25 mg/L failed to produce a product of the expected size with at least one of the primers used. The changes seen in penicillin-insensitive strains were consistent with horizontal gene transfer from Neisseria flavescens in some isolates, although the source for others remains unknown. PCR-based methods for the detection of antibiotic resistance are becoming increasingly important with the expanding use of molecular techniques for bacteriological diagnosis.

Improved diagnosis of reactivated toxoplasmosis.

AIMS: To identify antigens detected by western blotting in primary Toxoplasma gondii infection and determine their role in diagnosis of reactivated toxoplasmosis. METHODS: Twenty three immunocompromised patients were tested by IgG western blotting. Patients were grouped retrospectively. Group 1 comprised 15 human immunodeficiency (HIV)/AIDS patients and included: group 1A (six patients with clinical and/or serological evidence of reactivation), group 1B (five patients with clinical evidence only), and group 1C (four asymptomatic patients). Group 2 comprised eight non-HIV/AIDS immunocompromised patients with clinical and/or serological evidence of reactivation. Immunocompetent patients (n = 23) with primary toxoplasmosis were a control group used to determine the progression of the antigens detected. RESULTS: In primary toxoplasmosis, antibodies against 6, 20, 22, 23, 25, 28, 29, and 36 kDa antigens predominated. Detection of four or more of the 6, 20, 22, 23, 25, and 36 kDa antigens was considered to be western blot positive. In two group 1A patients, western blotting indicated past infection. During reactivation, this reverted to being western blot positive. Three other group 1A patients were western blot positive. In three of five group 1B patients, western blot positive results improved serological diagnosis of reactivated toxoplasmosis (p < 0.05). In two of five group 1B patients and all four group 1C patients, western blot indicated past infection. In group 2, two of eight patients reverted from a pattern of past infection to western blot positive. Five other patients from group 2 were western blot positive. CONCLUSIONS: Detection of some low molecular weight antigens is diagnostic of reactivated toxoplasmosis. These antigens can be detected even with normal dye test titres and their detection improves the diagnosis of reactivated toxoplasmosis. They might be the result of the release of bradyzoites from ruptured tissue cysts.

Do IgA, IgE, and IgG avidity tests have any value in the diagnosis of toxoplasma infection in pregnancy?

AIM: To determine the value of tests for specific IgA, IgE, and IgG avidity in diagnosing Toxoplasma gondii infection during pregnancy. METHODS: In a retrospective study, current serological tests (dye test and three IgM assays with different sensitivities) were compared with immunosorbent agglutination assays (ISAGA) for specific IgA and IgE and an IgG avidity enzyme linked immunosorbent assay (ELISA). Patient group 1 comprised six women with definite or probable infection during pregnancy determined by congenital toxoplasmosis or laboratory results. Group 2 comprised seven women infected during or before 11 pregnancies (two consecutive pregnancies in two patients and three in a third). RESULTS: One patient in group 1 seroconverted during pregnancy. IgA ISAGA and avidity confirmed acute infection when confirmatory IgM ELISA remained negative. In five of six patients from group 1, IgA and IgE ISAGA and avidity confirmed acute infection. In group 2, the dye test titre was raised in seven of 11 pregnancies (six of seven patients). Specific IgM and IgA were positive during all 11 pregnancies. IgE ISAGA was positive in only four of 11 pregnancies (three of seven patients), but negative results in the remainder may exclude acute infection. High avidity antibodies indicative of past infection were found in four of 11 pregnancies (two of seven patients). CONCLUSIONS: Each test improved diagnosis or timing of infection but no single test was ideal. The IgA ISAGA was sensitive and detected seroconversion. Positive IgE ISAGA and low avidity both confirmed infection, whereas negative IgE may exclude acute infection. High avidity diagnosed past infection but persistence of low avidity reduced its value to differentiate acute and past infection. Further studies with larger patient groups are needed to determine the optimum diagnostic strategy. These techniques are valuable in complementing existing tests.

Progression of Pneumocystis carinii infection in an animal model.

The development of Pneumocystis carinii infection in immunosuppressed rats is important not only in understanding the infection, but also as a source of P. carinii antigen for use in diagnostic serological tests. The aims of this study were to monitor the progression of P. carinii infection in the Sprague Dawley rat model and then determine parameters that indicate the maximum production of P. carinii antigen. Seventeen Sprague Dawley rats were killed at intervals up to 9 weeks after the start of immunosuppressive therapy. The progression of P. carinii lung infection was observed by Giemsa staining of lung imprints and by a hemi-nested polymerase chain reaction (PCR). Body weight, food and water intake and the appearance and activity of the rats were measured daily. Seven control rats were kept under the same conditions. P. carinii infection was detected in the lung 2 weeks after immunosuppression by hemi-nested PCR and after 3 weeks by Giemsa staining. No P. carinii DNA was detected in any of the blood samples. Rats with moderate or severe lung infection had been immunosuppressed for > or = 6 weeks. Body weight was significantly greater in control rats than in the immunosuppressed rats. Six weeks of immunosuppression was used as a cut-off to determine measurements to identify those rats with moderate or severe infections in their lungs. A combination of > 34% body weight loss at 6 weeks after immunosuppression and the condition of the animals with scores < or = 9 used in conjunction with duration of immunosuppression may be useful to maximise the yield of P. carinii infection from individual rats.

Methicillin susceptibility testing of staphylococci by Etest and comparison with agar dilution and mecA detection.

The susceptibility to methicillin of 44 Staphylococcus aureus and 120 coagulase-negative staphylococci (CNS) was determined by Etest, agar dilution and presence of the mecA gene. There was agreement between the results of all methods when testing S. aureus. However, discrepancies occurred with CNS when cultural methods were compared with presence of the mecA gene. mecA-positive isolates tested as resistant more often with agar dilution on Columbia agar plus 5% NaCl than by Etest.

Molecular epidemiology of Escherichia coli O157:H7 by pulsed-field gel electrophoresis and comparison with that by bacteriophage typing.

One hundred twenty-four Escherichia coli O157:H7 isolates were characterized by pulse-field gel electrophoresis, bacteriophage typing, and PCR of verotoxin genes. Diversity indices obtained--0.786 for phage types and 0.987 for pulsed-field gel electrophoresis types--demonstrated that phage typing falls below the critical value (0.9) required for confident interpretation of results.