bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of including broth cultures as part of a routine culture protocol
Authors: Derby P , Davies R , Oliver S
Published: January 2020

Three hundred seventeen clinical specimens from both superficially and deeply infected sites were prospectively examined to assess the true value of including liquid media as part of the routine culture procedure. All broth cultures were subcultured after overnight incubation onto plate media. The isolates obtained from the broth cultures were then compared with the isolates obtained on primary solid media. The isolates obtained from the broth cultures only were evaluated for clinical relevance by review of the patients' records. Twenty-two clinically relevant isolates were obtained from the broth cultures only, but the isolation of these additional organisms altered patient management for only two patients. It would appear from these results that the additional expense and time involved in culturing clinical specimens in fluid media is unwarranted.
An improved colorimetric PCR-based method for detection and differentiation of Entamoeba histolytica and Entamoeba dispar in feces
Authors: Britten D , Wilson S M , McNerney R , Moody A H , Chiodini P L , Ackers J P
Published: January 2020

The epidemiological implications of the recent separation of "Entamoeba histolytica" into two separate species, pathogenic E. histolytica sensu stricto and commensal E. dispar, will not become apparent without methods of distinguishing between them which are applicable to large numbers of specimens. We have modified a PCR-based method to produce such a technique which may be completed in 1 day while still identifying 10(-1) E. histolytica and 1 to 10 E. dispar trophozoites per g of feces when present separately and 10 E. histolytica and 100 E. dispar trophozoites per g in the presence of 10(6) trophozoites per g of the other species. Applied to fecal specimens from 18 patients from which E. histolytica or E. dispar had been grown and identified to the species level by hexokinase isoenzyme analysis, the method in every case yielded the correct result. Positive and negative results are easily distinguished by eye, and we are now applying this technique to a large-scale epidemiological study of amebiasis in the eastern Mediterranean region.
Development of a reverse transcriptase PCR-enzyme-linked immunosorbent assay for quantification of human immunodeficiency virus type 1 RNA in plasma: comparison with commercial quantitative assays
Authors: Trabaud M A , Audoly G , Leriche K , Cotte L , Ritter J , Sepetjan M , Trepo C
Published: January 2020

A quantitative reverse transcriptase PCR assay with automated detection by nonradioactive hybridization was developed for the determination of human immunodeficiency virus (HIV) type 1 RNA levels. This assay is based on the use of an external standard curve with an internal standard. The accuracy of quantification was verified by comparison with reference commercial tests, the Chiron branched-DNA and Roche AMPLICOR HIV MONITOR assays. This assay was able to quantify viremia in patients with CD4 cell numbers below and above 500/mm3 and to quantify some HIV strains which could not be titrated by the MONITOR assay.
Use of cycloserine-cefoxitin-fructose agar and L-proline-aminopeptidase (PRO Discs) in the rapid identification of Clostridium difficile
Authors: Fedorko D P , Williams E C
Published: January 2020

The PRO Disc (Carr-Scarborough Microbiologicals, Inc., Decatur, Ga.) can be used to screen for L-proline-aminopeptidase produced by Clostridium difficile grown on cycloserine-cefoxitin-fructose agar (CCFA). Fifty stored isolates of C. difficile (48 toxin-positive and 2 toxin-negative isolates) and 47 fresh C. difficile isolates (39 toxin-positive and 8 toxin-negative isolates) were all PRO Disc positive. Other Clostridium species that were PRO Disc positive could be differentiated from C. difficile by failure to grow on CCFA, different colonial morphology on CCFA, or morphology upon Gram staining.
Congenital toxoplasmosis due to maternal reinfection during pregnancy
Authors: Gavinet M F , Robert F , Firtion G , Delouvrier E , Hennequin C , Maurin J R , Tourte-Schaefer C , Dupouy-Camet J
Published: January 2020

A case of congenital toxoplasmic chorioretinitis was diagnosed (specific-immunoglobulin G [IgG] and -IgM comparative Western blot analysis) in a baby whose mother was immune during pregnancy. Maternal sera showed an increase in specific IgG and emergence of both IgM and IgA during pregnancy. The mother was probably reinfected through contact with kittens.
Comparative analysis of genetic variability among Candida albicans isolates from different geographic locales by three genotypic methods
Authors: Clemons K V , Feroze F , Holmberg K , Stevens D A
Published: January 2020

The objective of the present study was to conduct a comparative genotypic analysis of Candida albicans isolates from the United States, Europe, and Southeast Asia to determine whether differences between isolates might be associated with geographic locations. The genotypes of 86 unrelated isolates of C. albicans (from the United States and Europe) and 26 isolates from Singapore were examined by three DNA typing methods. Computer-assisted methods were used to analyze the gel patterns for all isolates. A dendrogram based on the overall similarity of the patterns obtained by restriction endonuclease analysis (REA) with EcoRI clustered the U.S. and European isolates into two major groups (groups A and B). The Singaporean isolates demonstrated unique REA profiles, with nine isolates having both or neither of the REA-characteristic 3.7- and 4.2-kb bands present in groups A and B. By REA profiles, the Singaporean isolates were related to each other with similarity values (S(AB)s) of > 0.80, but only one isolate mixed with the U.S. and European isolates at this S(AB) (an arbitrary threshold for genetic similarity). Randomly amplified polymorphic DNA (RAPD) analysis generated DNA profiles that clustered the C. albicans isolates into approximately the same number of distinct typing groups as REA. However, isolates identical to each other by REA were generally different from each other by RAPD analysis. In a composite dendrogram prepared from the results obtained by RAPD analysis, the isolates from the United States and Europe clustered in major groups with S(AB)s of > 0.85, while Singaporean isolates connected to these clusters at S(AB)s of > or = 0.75. Pulsed-field gel electrophoresis was less discriminatory, discerning about one-third as many distinct subtypes as REA or RAPD analysis; the Singaporean isolates were distributed randomly with the U.S. and European isolates. These results suggest that a high degree of genetic diversity exists between C. albicans isolates from Southeast Asia and those from the United States and Europe.
Equally high prevalences of infection with cagA-positive Helicobacter pylori in Chinese patients with peptic ulcer disease and those with chronic gastritis-associated dyspepsia
Authors: Pan Z J , van der Hulst R W , Feller M , Xiao S D , Tytgat G N , Dankert J , van der Ende A
Published: January 2020

Approximately 60% of Helicobacter pylori isolates in the Western world possess the cytotoxin-associated gene A (cagA). cagA-positive H. pylori is found to be associated with peptic ulcer disease (PUD) and gastric adenocarcinoma. To investigate the cagA status of H. pylori isolates from Chinese patients with PUD and chronic gastritis (CG), H. pylori populations from 83 patients, 48 with PUD and 35 with CG, were assessed by two different cagA-specific PCRs, Southern blotting, and colony hybridization. The combined results from PCR, Southern blotting, and colony hybridization indicate a prevalence of cagA-positive H. pylori isolates of 98% (47 of 48) among Chinese PUD patients and 100% (35 of 35) among Chinese CG patients. Amplification with primer sets 1 and 2 yielded 52 and 95% of the 82 cagA-positive Chinese H. pylori, respectively. In contrast, the sensitivity of cagA-specific PCR for cagA-positive H. pylori isolates from Dutch patients with primer set 1 was 92% (112 of 122) and that with primer set 2 was 91% (50 of 55). The prevalence of cagA-positive H. pylori populations in Chinese patients with PUD and CG is almost universally high. Therefore, cagA cannot be used as a marker for the presence of PUD in Chinese patients. Our data further suggest that allelic variation in cagA may exist and that distinct H. pylori genotypes may circulate in China and Western Europe.
Comparison of two automated DNA amplification systems with a manual one-tube nested PCR assay for diagnosis of pulmonary tuberculosis
Authors: Yuen K Y , Yam W C , Wong L P , Seto W H
Published: January 2020

Eighty-four specimens of respiratory secretions culture positive for mycobacteria (70 positive for Mycobacterium tuberculosis and 14 positive for nontuberculous mycobacteria) and 120 culture-negative specimens were evaluated by three DNA amplification techniques: a manual in-house single-tube nested PCR (nPCR) and two commercial automated assays (the Cobas Amplicor System [aPCR-h] from Roche Diagnostic Systems and the Abbott LCx Probe System [aLCx-p] from Abbott Laboratories). The overall diagnostic sensitivities of the nPCR, aPCR-h, and aLCx-p were 77.1, 84.3, and 77.1%, respectively, and the sensitivities were 57.9, 57.9, and 36.8%, respectively, for smear-negative specimens. Specimens culture positive for nontuberculous mycobacteria were negative by all three assays. Eight culture-negative specimens which were positive by one or more assays had previously been documented by culture to be positive for M. tuberculosis and were taken from patients who were treated with antituberculosis agents. Retesting of specimens negative by one assay by the other two assays revealed that each test had its unique group of negative specimens. When considering the DNA extraction and amplification steps of these assays separately, it was found that extracts from aPCR-h and aLCx-p were compatible with nPCR amplication, while the two automated assays could only amplify extracts processed with their own reagents. Limiting dilution analysis revealed that the order of analytical sensitivity was nPCR, followed by aLCx-p and then aPCR-h. Comparison of the work flow of each assay revealed that although the aPCR-h demands the least specimen handling, the turnaround time of aLCx-p is the most favorable.
Comparison of biotyping, ribotyping, and pulsed-field gel electrophoresis for investigation of a common-source outbreak of Burkholderia pickettii bacteremia
Authors: Chetoui H , Melin P , Struelens M J , Delhalle E , Nigo M M , De Ryck R , De Mol P
Published: January 2020

Over a 3-month period, six immunocompromised patients developed one or more episodes of Burkholderia pickettii bacteremia and/or catheter infection. Vials of a commercially available, "sterile" saline for injection which had been used for flushing the patients' indwelling intravenous devices were implicated as the common source of the organisms. No further cases were diagnosed once the use of this saline was discontinued. Twenty-six isolates, including 9 outbreak-related strains from case patients and contaminated saline as well as 17 control strains, were tested comparatively by biotyping, ribotyping with EcoRI and HindIII, and pulsed-field gel electrophoresis (PFGE) with SpeI. Macrorestriction analysis revealed nine PFGE groups and was more discriminating than ribotyping (seven ribotypes) and biotyping (two biovars). Among the outbreak-related isolates, one B. pickettii type was found by the three typing methods. Furthermore, PFGE was useful for subdividing ribotypes and for distinguishing isolates involved in the outbreak from all epidemiologically unrelated strains.
Analysis of incidence of infection with enterotoxigenic Escherichia coli in a prospective cohort study of infant diarrhea in Nicaragua
Authors: Paniagua M , Espinoza F , Ringman M , Reizenstein E , Svennerholm A M , Hallander H
Published: January 2020

Diarrheal episodes with enterotoxigenic Escherichia coli (ETEC) were prospectively monitored during the first 2 years of life in a cohort of 235 infants from Leon, Nicaragua. ETEC was an etiological finding in 38% (310 of 808) of diarrheal episodes and in 19% (277 of 1,472) of samples taken as asymptomatic controls at defined age intervals (P = <0.0001). The majority of diarrheal episodes (80%) occurred before 12 months of age. The major ETEC type was characterized by colonization factor CFA I and elaboration of both heat-labile enterotoxin and heat-stable enterotoxin (ST). The proportion of E. coli strains with CFA I was significantly higher in cases with diarrhea (P = 0.002). The second most prevalent type showed putative colonization factor PCFO166 and production of ST. The prevalence of PCFO166 was approximately 20%, higher than reported before. Children with a first CFA I episode contracted a second ETEC CFA I infection 24% of the time, compared with 46% for ETEC strains of any subtype. Most of the ETEC episodes were of moderate severity, and only 5% (15 of 310) were characterized as severe. In conclusion, our results give valuable information for the planning of intervention studies using ETEC vaccines.
Interpretation criteria for standardized Western blots for three European species of Borrelia burgdorferi sensu lato
Authors: Hauser U , Lehnert G , Lobentanzer R , Wilske B
Published: January 2020

Western blots (WBs; immunoblots) are a widely used tool for the serodiagnosis of Lyme borreliosis, but so far, no defined criteria for performance, analysis, and interpretation have been established in Europe. For the current study WBs were produced with strains PKa2 (Borrelia burgdorferi sensu stricto), PKo (Borrelia afzelii), and PBi (Borrelia garinii). To improve resolution we used gels of 17 cm in length. In a first step, 13 immunodominant proteins were identified with monoclonal antibodies. Then, the apparent molecular masses of all visually distinguishable bands were determined densitometrically. Approximately 40 bands of between 14 and 100 kDa were differentiated for each strain. From a study with 330 serum samples (from 189 patients with Lyme borreliosis and 141 controls), all observed bands were documented. To establish criteria for a positive WB result, the discriminating ability of a series of band combinations (interpretation rules) were evaluated separately for each strain (for immunoglobulin G [IgG] WB, > 40 combinations; for IgM WB, > 15 combinations). The following interpretation criteria resulting in specificities of greater than 96% were recommended: for IgG WB, at least one band of p83/100, p58, p56, OspC, p21, and p17a for PKa2; at least two bands of p83/100, p58, p43, p39, p30, OspC, p21, p17, and p14 for PKo; and at least one band of p83/100, p39, OspC, p21, and p17b for PBi; for IgM WB, at least one band of p39, OspC, and p17a or a strong p41 band for PKa2; at least one band of p39, OspC, and p17 or a strong p41 band for PKo; and at least one band of p39 and OspC or a strong p41 band for PBi. The overall sensitivity was the highest for PKo WB, followed by PBi and PKa2 WB, in decreasing order. Standardization of WB assays is necessary for comparison of results from different laboratories.
Serological diagnosis of bovine, caprine, and ovine mastitis caused by Listeria monocytogenes by using an enzyme-linked immunosorbent assay
Authors: Bourry A , Cochard T , Poutrel B
Published: January 2020

An enzyme-linked immunosorbent assay for detecting Listeria monocytogenes antibodies in bovine (n = 35), caprine (n = 27), and ovine (n = 30) milk samples was evaluated by comparison with bacteriological examination. Microtiter plates were coated with proteins obtained from culture supernatant, and antibodies were revealed with a monoclonal antibody able to react with the immunoglobulins belonging to the three animal species. The arithmetic mean optical density (OD) of milk samples infected with L. monocytogenes was above that of uninfected milk samples or milk samples infected with pathogens others than L. monocytogenes. With an OD threshold of 0.2 for goat and ewe milk samples, the sensitivity and specificity of the test were 100 and 88%, respectively. The choice of a different OD threshold (0.5) for cows allowed the discrimination of all of the infected cows and yielded no false positives, and both sensitivity and specificity were 100%.
Development of a direct PCR assay for detection of the diphtheria toxin gene
Authors: Nakao H , Popovic T
Published: January 2020

PCR has proved to be a reliable tool for the detection of the diphtheria toxin gene, tox, and its use has allowed for the rapid differentiation between toxigenic and nontoxigenic strains. In this study, this PCR was further developed, evaluated, and standardized to detect this gene directly from clinical specimens. Optimal conditions for collection, transport, and storage of the clinical specimens and isolation and purification of DNA from the clinical specimens were defined. With two sets of primers that detect the A and B subunits of the diphtheria toxin gene, sensitivity levels of 50 and 500 CFU/PCR mixture, respectively, were achieved. This PCR was evaluated with 162 clinical samples collected from patients with diphtheria and other upper respiratory tract infections, as well as from healthy individuals.
Study of internal transcribed spacer and mitochondrial large-subunit genes of Pneumocystis carinii hominis isolated by repeated bronchoalveolar lavage from human immunodeficiency virus-infected patients during one or several episodes of pneumonia
Authors: Latouche S , Poirot J L , Bernard C , Roux P
Published: January 2020

The objective of this study was to type, analyze, and compare Pneumocystis carinii hominis strains obtained from different samples during a given or recurrent episodes of P. carinii pneumonia (PCP) for epidemiologic purposes. We studied 36 bronchoalveolar lavage (BAL) or induced sputum (IS) samples from 16 human immunodeficiency virus-infected patients with one or several episodes of PCP. PCR amplification and direct sequencing were performed on the two internal transcribed spacers (ITS1 and ITS2) of P. carinii hominis rRNA genes by using DNA extracted from BAL or IS samples, and the sequences were compared to the mitochondrial large-subunit (mt LSU) gene sequence determined in a previous study in our laboratory. The studies of the mt LSU and ITS sequences showed that some patients (n = 10) were infected with the same strains of P. carinii hominis during a given episode of PCP. In one patient infected with strains with identical sequences in several episodes, the recurrence could have been due to reactivation of organisms not eliminated by treatment during the first episode or to de novo infection by an identical strain. In five patients infected with strains with different sequences in each episode, recurrence was due to de novo infection. Sequence analysis of these two P. carinii hominis gene regions showed that de novo infection can occur in AIDS patients with recurrent PCP.
Detection of Neospora from tissues of experimentally infected rhesus macaques by PCR and specific DNA probe hybridization
Authors: Ho M S , Barr B C , Tarantal A F , Lai L T , Hendrickx A G , Marsh A E , Sverlow K W , Packham A E , Conrad P A
Published: January 2020

Neospora is a newly recognized Toxoplasma-like cyst-forming coccidian parasite that causes abortion or congenital infections in naturally or experimentally infected animals. In this study, pregnant rhesus macaques were inoculated with culture-derived tachyzoites of a bovine Neospora isolate, and tissue samples from various major organs were collected from dams and fetuses for the detection of parasite DNA by using oligonucleotide primers COC-1 and COC-2 for PCR amplification of a conserved coccidial nuclear small-subunit rRNA gene sequence, and amplification products were confirmed by hybridization with a Neospora-specific DNA probe. PCR products were amplified from DNAs of different fetal monkey tissues, including brain, heart, lung, liver, spleen, skeletal muscle, skin, and placenta. In addition, Neospora DNA was amplified from the brain, heart, and lung tissues of infected rhesus macaque dams. The PCR and probe hybridization system may provide an effective method for the detection of Neospora infection in fetuses and dams from nonhuman primates and may be useful in determining the zoonotic potential of Neospora.
Application of DNA typing methods and genetic analysis to epidemiology and taxonomy of Saccharomyces isolates
Authors: Clemons K V , Park P , McCusker J H , McCullough M J , Davis R W , Stevens D A
Published: January 2020

We have previously described differences in phenotype and virulence among clinical and nonclinical isolates of Saccharomyces. To further characterize these isolates, a comparison of restriction fragment length polymorphism (RFLP) patterns and genetic analysis were done. The cellular DNA of each of 49 clinical and 11 nonclinical isolates of Saccharomyces was digested with the endonuclease EcoRI, and the resultant fragments were separated by electrophoresis. Sixty isolates were grouped on the basis of the presence (group B) or absence (group A) of a 3-kb band. Group A contained 43 isolates (35 clinical and 8 nonclinical isolates) in 31 discernible subgroups, and group B had 17 isolates (14 clinical and 3 nonclinical isolates) in 10 subgroups. Interestingly, six of eight known vaginal isolates were group B, with four of those six being identical. Virulence of isolates was associated with membership in group A (P = 0.03). Comparison of known members of sibling species within the genus Saccharomyces, which cannot be distinguished by standard biochemical tests, showed that S. paradoxus, S. bayanus, and S. cerevisiae could be differentiated by RFLP analysis. Genetic analysis of the isolates forming viable spores showed that most group A isolates were diploid and members of the species S. cerevisiae. Those group A and B isolates unable to form viable spores may be diploid hybrids between Saccharomyces species. The group B isolates that formed viable spores were tetraploid and may also be interspecific hybrids. Overall, clinical isolates of Saccharomyces were very heterogeneous and exhibited little clonality. RFLP pattern analysis could be a useful method of demonstrating transmission in patients with infection or between environmental sources and patients.
Descriptive profile of tuberculin skin testing programs and laboratory-acquired tuberculosis infections in public health laboratories
Authors: Kao A S , Ashford D A , McNeil M M , Warren N G , Good R C
Published: January 2020

The increase in numbers of cases of tuberculosis in the United States has placed greater demands on mycobacteriology laboratory workers to produce rapid and accurate results. The greater number of specimens generated by the increased emphasis on detecting the disease has placed these workers at greater risk of laboratory-acquired infection. We surveyed 56 state and territorial public health laboratories to determine the status of existing tuberculin skin testing (TST) programs and to evaluate the frequency of probable laboratory-acquired tuberculosis for each responding mycobacteriology laboratory. Probable laboratory-acquired infections were determined by each laboratory's evaluation of occupational positions, duties, and employee histories and review of medical records. Two-step TST for new employees was routinely practiced in only 33% of responding laboratories, and mycobacteriology laboratorians were found to be most frequently screened when they were compared to employees of other departments. Of 49 (88%) responding laboratories, 13 reported that 21 employees were TST converters from 1990 to 1994. Seven of these 21 employees were documented to have laboratory-acquired infections based on evaluations by their respective laboratories. Based on Centers for Disease Control and Prevention guidelines, converters are categorized on the basis of both a change in the size of the zone of induration and the age of the person being tested. By the definitions in the guidelines, 14 mycobacteriologists were identified as recent converters, 7 of whom were > or = 35 years of age and 4 of whom were exposed in the laboratory within a 2-year period. Inadequate isolation procedures, the high volume of specimen handling, and faulty ventilation accounted for these laboratory-associated infections. These results suggest that more frequent periodic evaluations based on documented TST conversions for workers in mycobacterial laboratories should be performed, since this population is at increased risk of becoming infected with Mycobacterium tuberculosis. Although general assessments are necessary to accurately and effectively evaluate the risk of tuberculosis transmission, they are especially important for those working in high-risk areas within a public health laboratory.
Comparison of direct-plating and enrichment methods for isolation of Vibrio cholerae from diarrhea patients
Authors: Lesmana M , Richie E , Subekti D , Simanjuntak C , Walz S E
Published: January 2020

A direct-plating method on thiosulfate citrate bile salts sucrose agar (DIR-TCBS) in conjunction with enrichment in alkaline peptone water (APW) incubated for both 6 h and 24 h followed by subculture onto TCBS (APW6h-TCBS and APW24h-TCBS, respectively) was performed on 16,034 rectal swab samples for isolating Vibrio cholerae. A total of 2,932 (18.3%) rectal swab samples were positive for V. cholerae O1 biotype El Tor, with the Ogawa serotype constituting 99.2% of the isolates. There were no significant differences in V. cholerae O1 isolation rates between the three culture systems nor between the combinations of any two systems. However, direct plating plus enrichment demonstrated a significantly higher V. cholerae O1 isolation rate than DIR-TCBS alone (P < 0.02). Conversely, enrichment procedure, alone or in combination with DIR-TCBS, yielded significantly more (P < 0.0001) V. cholerae non-O1 isolates than DIR-TCBS alone. The length of incubation time of the enrichment broth, 6 h, offers no significant advantages over 24 h for the isolation of V. cholerae O1 and non-O1. A 24-h enrichment broth incubation period has the practical advantage of being easy to integrate into a normal laboratory workday, whereas 6-h broth enrichment, although more commonly recommended, requires that arrangements be made for after-hours subculture.
Determination of genotypes of hepatitis C virus in Venezuela by restriction fragment length polymorphism
Authors: Pujol F H , Loureiro C L , Devesa M , Blitz L , Parra K , Beker S , Liprandi F
Published: January 2020

Hepatitis C virus genotypes in Venezuela were analyzed by restriction fragment length polymorphism in the 5' noncoding region. The absence of BstUI digestion was found to be a useful marker for genotype 2 specimens. From 122 serum samples, 66, 20, and 2.5% were classified as genotypes 1, 2, and 3, respectively; 0.8% were classified as genotype 4; and 10% appeared to be mixed infections.
Increased prevalence of genotype F hepatitis B virus isolates in Buenos Aires, Argentina
Authors: Telenta P F , Poggio G P , López J L , Gonzalez J , Lemberg A , Campos R H
Published: January 2020

The genomic coding region of the hepatitis B surface antigen (HBsAg) was partially sequenced from 12 HBsAg-positive sera of carriers residing in Buenos Aires, Argentina. A phylogenetic analysis groups the 12 isolates into genotypes A (n = 4), B (n = 1), D (n = 2), and F (n = 5). The occurrence of genotypes A and D is not unexpected, considering the mainly European origin of the studied population. The high prevalence of genotype F and its genetic composition support the suggestion that F strains originated in native populations of the New World.
Improvement of growth of Chlamydia pneumoniae on HEp-2 cells by pretreatment with polyethylene glycol in combination with additional centrifugation and extension of culture time
Authors: Tjhie J H , Roosendaal R , MacLaren D M , Vandenbroucke-Grauls C M
Published: January 2020

The following adaptations led to improved growth of Chlamydia pneumoniae on HEp-2 cells compared to that by the standard method: monolayer preincubation with 7% polyethylene glycol (PEG), extension of incubation time to 7 days, and extension of incubation to 7 days in combination with centrifugation on days 3, 4, and 5. These adaptations resulted in approximate increases in numbers of inclusion-forming units (IFU) of 2-, 5-, and 69-fold, respectively. A combination of preincubation with PEG, prolonged incubation, and centrifugation on days 3, 4, and 5 increased the numbers of IFU >300-fold. This is therefore recommended as the optimal method for culturing C. pneumoniae.
Evaluation of a commercial enzyme-linked immunosorbent assay for detection of immunoglobulin M antibody in diagnosis of human leptospiral infection
Authors: Winslow W E , Merry D J , Pirc M L , Devine P L
Published: January 2020

The PanBio Leptospira immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) is a commercially available screening test for the diagnosis of acute leptospiral infection. The ability of the test to diagnose early or recent Leptospira interrogans infection was assessed by testing sera with known microagglutination test (MAT) titers to serovars pomona, hardjo, copenhageni, and australis. The IgM ELISA detected all 41 cases of early or recent leptospiral infection (sensitivity, 100%), with a positive ELISA result seen in many cases before MAT antibody titers reached 1:50. Thirty-eight of 41 patients showed seroconversion (fourfold or greater increase in titer by MAT, 2 of 41 patients had a single sample with elevated titer, and 1 patient from whom leptospires were isolated from a blood sample failed to show MAT titers, despite a seroconversion (negative to positive result) in the ELISA. Follow-up sera obtained from 8 of 12 patients (67%) for 3 to 48 months after the acute stage of illness showed persisting IgM antibody. However, the range of levels detected in these samples (maximum ELISA ratio, 2.0) was lower than the range seen when infection was recent. Reactivity in the IgM ELISA was observed for only 1 of 59 serum samples from asymptomatic donors (specificity, 98%) and 16 of 233 serum samples from patients with Ross River virus, brucella, Epstein-Barr virus, cytomegalovirus, mycoplasma, Q-fever, toxoplasma, hepatitis A virus, Treponema pallidum, or Borrelia burgdorferi infection (specificity, 93%), with the majority of these patients showing lower levels of IgM in comparison to those in patients with leptospiral infection. We conclude that this ELISA is sufficiently sensitive for use as an initial screen for leptospiral infections, with subsequent confirmation of positive test results by MAT.
HEp-2 cell adherence patterns, serotyping, and DNA analysis of Escherichia coli isolates from eight patients with AIDS and chronic diarrhea
Authors: Polotsky Y , Nataro J P , Kotler D , Barrett T J , Orenstein J M
Published: January 2020

Three morphologic patterns of interaction between bacteria and enterocytes have been observed in colonic biopsy specimens from AIDS patients with chronic diarrhea in the United States. The DNA encoding virulence factors and the HEp-2 cell adherence patterns of Escherichia coli strains isolated from the stools of eight symptomatic AIDS patients were compared with those of five control strains with known adherence patterns. One clinical isolate from a patient with attaching-and-effacing enteropathy displayed the localized adherence attaching-and-effacing pattern typical of enteropathogenic E. coli on HEp-2 cells, five isolates displayed the "stacked-brick" aggregative adherence pattern typical of enteroaggregative E. coli strains, and one isolate showed the pattern characteristic of diffusely adherent E. coli. One patient's isolate displayed features of all three patterns. No clinical isolate hybridized with standard probes for enteropathogenic, enteroaggregative, diffusely adherent, enterotoxigenic, and enteroinvasive E. coli strains. Thus, isolates from symptomatic AIDS patients in the United States can display the same interactive patterns with HEp-2 cells as the agents of pediatric or traveler's diarrhea, but lack their typical virulence factors.
Genotypic analysis of Burkholderia cepacia isolates from 13 French cystic fibrosis centers
Authors: Segonds C , Bingen E , Couetdic G , Mathy S , Brahimi N , Marty N , Plesiat P , Michel-Briand Y , Chabanon G
Published: January 2020

Burkholderia cepacia has been involved in outbreaks of pulmonary infection among patients with cystic fibrosis (CF), and the spread of a highly transmissible clone has been reported throughout the United Kingdom and Canada. These data prompted a DNA-based typing study of the strains recovered in French CF centers. Ninety-five isolates recovered from 71 patients attending 13 CF centers in 9 regions of France were characterized by randomly amplified polymorphic DNA (RAPD) analysis and pulsed-field gel electrophoresis (PFGE). Twenty-one genotypes were identified among the 95 isolates, and the results of RAPD and PFGE were concordant for 89 isolates (94%). Cross-colonization was demonstrated in 7 of the 13 CF centers. The investigation of serial isolates showed that most chronically colonized patients harbored a single B. cepacia strain. A geographically clustered distribution of B. cepacia genotypes was observed, except for one genotype, which was detected in four regions but was proven to be different from the genotype of the British-Canadian highly transmissible strain. The present study confirms the ability of B. cepacia to spread among CF communities in France and the importance of epidemiological surveys in the institution of prevention policies.
Evaluation of a nonradiometric system (BACTEC 9000 MB) for detection of mycobacteria in human clinical samples
Authors: Zanetti S , Ardito F , Sechi L , Sanguinetti M , Molicotti P , Delogu G , Pinna M P , Nacci A , Fadda G
Published: January 2020

This study was carried out to evaluate the rate of recovery and time required for detection of mycobacteria from pulmonary and extrapulmonary human clinical samples, by using a fluorescence-quenching-based oxygen sensor (BACTEC 9000 MB; Becton Dickinson Microbiology Systems, Sparks, Md.). The results were compared with those obtained by microscopy, conventional culture in Lowenstein-Jensen (LJ) medium, and a BACTEC radiometric system (BACTEC 460 TB; Becton Dickinson). Of the 779 clinical samples processed, 364 from pulmonary sites and 415 from extrapulmonary sites, 62 (7.9%) were positive for mycobacterial isolates; of the positive samples, 59 (95.1%) were detected with the fluorescent BACTEC 9000 MB system, 57 (91.9%) were detected with the radiometric system (BACTEC 460 TB), and 43 (69.3%) were detected with LJ conventional culture. The mean times to detection of all mycobacteria with BACTEC 9000 MB and BACTEC 460 TB were similar (10.3 and 10.0 days, respectively). The results obtained indicate that the nonradiometric BACTEC (BACTEC 9000 MB) system is as efficient as Bactec 460 TB and significantly more efficient than LJ for the rapid recovery of mycobacteria from both pulmonary and extrapulmonary clinical specimens. Though the BACTEC 9000 MB system is recommended for respiratory specimens, we demonstrated that it can be successfully used also for recovery of mycobacteria from clinical specimens from various extrapulmonary sites.
Development of an antimicrobial susceptibility testing method suitable for performance during space flight
Authors: Jorgensen J H , Skweres J A , Mishra S K , McElmeel M L , Maher L A , Mulder R , Lancaster M V , Pierson D L
Published: January 2020

Very little is known regarding the effects of the microgravity environment of space flight upon the action of antimicrobial agents on bacterial pathogens. This study was undertaken to develop a simple method for conducting antibacterial susceptibility tests during a space shuttle mission. Specially prepared susceptibility test research cards (bioMérieux Vitek, Hazelwood, Mo.) were designed to include 6 to 11 serial twofold dilutions of 14 antimicrobial agents, including penicillins, cephalosporins, a beta-lactamase inhibitor, vancomycin, erythromycin, tetracycline, gentamicin, ciprofloxacin, and trimethoprim-sulfamethoxazole. MICs of the drugs were determined by visual reading of color end points in the Vitek research cards made possible by incorporation of a colorimetric growth indicator (alamarBlue; Accumed International, Westlake, Ohio). This study has demonstrated reproducible susceptibility results in the testing of isolates of Staphylococcus aureus, group A Streptococcus species, Enterococcus faecalis, Escherichia coli (beta-lactamase-positive and -negative strains), Klebsiella pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa. In some instances, the MICs were comparable to those determined by a standard broth microdilution method, while in some cases the unique test media and format yielded slightly different values that were themselves reproducible. The proposed in-flight experiment will include inoculation of the Vitek cards on the ground prior to launch of the space shuttle, storage of inoculated cards at refrigeration temperature aboard the space shuttle until experiment initiation, and then incubation of the cards for 18 to 48 h prior to visual interpretation of MICs by the mission's astronauts. Ground-based studies have shown reproducible MICs following storage of inoculated cards for 7 days at 4 to 8 degrees C to accommodate the mission's time schedule and the astronaut's activities. For comparison, ground-based control (normal gravity) MIC values will be generated by simultaneous inoculation and incubation of a second set of test cards in a laboratory at the launch site. This procedure can provide for a safe and compact experiment that should yield new information on the effects of microgravity on the biological activities of various classes of antibiotics.
Evidence that mortality from Vibrio vulnificus infection results from single strains among heterogeneous populations in shellfish
Authors: Jackson J K , Murphree R L , Tamplin M L
Published: January 2020

Vibrio vulnificus is the leading cause of food-related mortality reported in the state of Florida. It is normal microflora in marine environments, where seawater and molluscan shellfish are the primary vectors of V. vulnificus disease. Risk correlates with seasonally high numbers of V. vulnificus bacteria during the summer months. Currently, the infectious dose for humans, as well as whether the disease is caused by single or multiple strains found in molluscan shellfish, is unknown. In this work, we studied pulsed-field gel electrophoresis profiles of V. vulnificus strains isolated from blood and oysters associated with V. vulnificus disease. Results showed that ca. 10(3) V. vulnificus bacteria/gram of oyster and higher concentrations were associated with human infections and that a single V. vulnificus strain, evidenced by pulsed-field gel electrophoresis profiles, was isolated from human tissues.
Molecular epidemiology of Streptococcus pyogenes in an area where acute pharyngotonsillitis is endemic
Authors: Nguyen L , Levy D , Ferroni A , Gehanno P , Berche P
Published: January 2020

During an open clinical trial in an area where streptococcal infections are hyperendemic, we studied the genetic polymorphism of Streptococcus pyogenes isolates collected from patients and from healthy carriers living in close contact with them. The clonal diversity of isolates was analyzed by pulsed-field gel electrophoresis with three restriction enzymes (SmaI, ApaI, and SacII). The pharynx of each patient and healthy carrier was colonized by a single clone, suggesting the clonal nature of streptococcal colonization in individuals. Among 52 isolates obtained from patients with acute pharyngotonsillitis, we found 14 genetically unrelated clones, showing the genetic diversity of S. pyogenes. However, two clones belonging to the M1 and M12 serotypes represented about 70% of isolates in carriers and patients. Pharyngeal colonization in cured patients was monitored for 3 to 4 months. After the initial elimination of S. pyogenes following antibiotic therapy, the rate of recolonization was high by day 30 (about 20%) and was also at that level between days 90 and 120; this was similar to the carriage rate in family contacts. Thus, cured patients can be recontaminated by unrelated clones, suggesting that colonization of healthy carriers might be a potential source of spread and redistribution of S. pyogenes isolates.
Emergence of Clostridium botulinum type B-like nontoxigenic organisms in a patient with type B infant botulism
Authors: Yamakawa K , Karasawa T , Kakinuma H , Maruyama H , Takahashi H , Nakamura S
Published: January 2020

We encountered a patient with infant botulism caused by a single clone of Clostridium botulinum type B. In the early convalescent phase, a C. botulinum type B-like nontoxigenic organism emerged in the feces instead. Growth inhibition of toxigenic strains by nontoxigenic strains was examined.
Invasive amoebiasis in two patients with AIDS and cytomegalovirus colitis
Authors: Fätkenheuer G , Arnold G , Steffen H M , Franzen C , Schrappe M , Diehl V , Salzberger B
Published: January 2020

Homosexual persons or human immunodeficiency virus (HIV)-infected patients frequently excrete cysts of nonpathogenic strains of Entamoeba histolytica ("Entamoeba dispar"). However, invasive amoebiasis is rare. We report two patients with AIDS and cytomegalovirus colitis in whom invasive amoebiasis was histologically diagnosed. It is concluded that E. histolytica has to be considered in HIV-infected patients with colitis.
Immunoreactivity of a 38-kilodalton Penicillium marneffei antigen with human immunodeficiency virus-positive sera
Authors: Chongtrakool P , Chaiyaroj S C , Vithayasai V , Trawatcharegon S , Teanpaisan R , Kalnawakul S , Sirisinha S
Published: January 2020

Penicillium marneffei produced and secreted a 38-kDa antigen that appeared to be specific for this dimorphic fungus. This component could not be detected in antigenic extracts of Histoplasma capsulatum, Cryptococcus neoformans, Aspergillus niger, Aspergillus fumigatus, Aspergillus flavus, Aspergillus terreus, Candida albicans, and two other species of Penicillium by immunoblot analysis against the sera from patients with culture-confirmed penicilliosis marneffei. Antibody reactive with this antigen was found in a large proportion of human immunodeficiency virus (HIV)-positive patients, indicating a presumptive diagnosis of P. marneffei infection. A small number of asymptomatic HIV-seropositive patients and HIV-seropositive patients with other fungal infections were also found to be positive by this analysis, suggesting that subclinical or mixed fungal infections involving P. marneffei are not uncommon.
Recognition of a Nocardia transvalensis complex by resistance to aminoglycosides, including amikacin, and PCR-restriction fragment length polymorphism analysis
Authors: Wilson R W , Steingrube V A , Brown B A , Blacklock Z , Jost K C , McNabb A , Colby W D , Biehle J R , Gibson J L , Wallace R J
Published: January 2020

Amikacin resistance, rare among nocardiae, was observed in 58 clinical isolates of nocardiae. All of these isolates hydrolyzed hypoxanthine, and 75 to 100% utilized citrate, D-galactose, and D-trehalose as sole carbon sources. Based on utilization of I-erythritol, D-glucitol, i-myo-inositol, D-mannitol, and ribitol and susceptibility to amoxicillin-clavulanic acid, the 58 isolates were separable into four groups. One group was negative for I-erythritol and ribitol and included all the isolates belonging to Nocardia asteroides complex antibiogram type IV. The remaining three groups were positive for I-erythritol and ribitol and were grouped within Nocardia transvalensis. The group that included the type strain was designated N. transvalensis sensu stricto, and the other two groups were designated new taxons 1 and 2. PCR-restriction fragment length polymorphism (RFLP) analysis of a 439-bp segment of the 65-kDa heat shock protein gene with XhoI and HinfI produced identical patterns for 53 (91%) and 58 (100%) isolates, respectively, and differentiated them from all other Nocardia taxa. NarI- and HaeIII-derived RFLP patterns clearly differentiated each of the four biochemically defined taxa. These four groups were also distinguishable by using the chromogenic substrates in Dade MicroScan test panels. By high-performance liquid chromatography, these isolates exhibited the same unique mycolic acid-ester elution patterns that differed from those of all other clinically significant nocardiae. Gas-liquid chromatographic analysis of fatty acids also produced similar patterns for all isolates that distinguished them from all other Nocardia taxa, but did not differentiate the four taxa within the complex. We propose the designation N. transvalensis complex for these four groups of nocardiae, pending further genetic evaluation.
Comparison of radioimmunoassay and enzyme-linked immunoassay methods for detection of Histoplasma capsulatum var. capsulatum antigen
Authors: Durkin M M , Connolly P A , Wheat L J
Published: January 2020

The purpose of this study was to compare the conventional radioimmunoassay (RIA) to an enzyme-linked immunoassay (EIA) for the measurement of Histoplasma antigen in banked urine specimens. A correlation between the two methods would allow the EIA to be used as a nonradioactive alternative to the established 125I RIA. The study used stored urine from patients diagnosed with histoplasmosis during an outbreak in Indianapolis which began in 1988. Control specimens from healthy adults, patients with other fungal infections, urinary tract infections, or nonfungal pneumonia were also tested. Both the RIA and EIA were run concurrently. The RIA system measured antigen levels of 0.4 to 27.0 RIA units, while the EIA measured antigen levels of 0.6 to 20.1 units. Both the EIA and RIA detected measurable antigen levels in urine from 50 of 56 patients (89%) with disseminated disease and 11 of 30 patients (37%) with self-limiting disease. One of 96 control specimens, from a patient with paracoccidioidomycosis, was positive with both systems. Antigen levels measured by EIA correlated well with those measured by the established RIA method (correlation coefficient, 0.974). The EIA is an acceptable alternative to the RIA for measuring Histoplasma antigen levels in urine specimens.
Comparison of the hybrid capture tube test and PCR for detection of human papillomavirus DNA in cervical specimens
Authors: Cope J U , Hildesheim A , Schiffman M H , Manos M M , Lörincz A T , Burk R D , Glass A G , Greer C , Buckland J , Helgesen K , Scott D R , Sherman M E , Kurman R J , Liaw K L
Published: January 2020

The strong association of human papillomavirus (HPV) and cervical cancer makes it important to study HPV detection methods that may play a role in cervical cancer screening. We compared two DNA methods that are commonly used for HPV research in the United States: the MY09/MY11 L1 consensus primer PCR-based test and the first-generation Hybrid Capture tube method (HCT). Laboratory assays by each method were performed with 596 cervicovaginal specimens collected from participants in a large cohort study conducted in Portland, Oreg. Included were 499 specimens from women whose cytology was normal and 97 specimens from women with squamous intraepithelial lesions (SILs). The overall HPV DNA positivity for known types was 22.5% by PCR compared to 13.6% by HCT. When the analysis was restricted to the 14 HPV types detectable by both methods, the sensitivity of HCT, with PCR used as the standard for HPV status, was higher for specimens from women with concurrent SILs (81.0%) than for specimens from women with normal cytology (46.7%). Among specimens testing positive by both methods, 97.2% of the time the two methods agreed on whether specimens were positive for cancer-associated HPV types. Both of these HPV test methods provide information that supplements the information provided by the Pap smear. The PCR method has higher analytic sensitivity than HCT in detecting HPV, but HCT may be helpful in identifying women with concurrent SILs.