Potential sources of enterotoxigenic Escherichia coli in homes of children with diarrhoea in Thailand.
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Adolescent↗
Biomedical subjects
B Rowe
Publications and source records attributed to B Rowe.
Haemolytic-uraemic syndrome: clinical experience of an outbreak in the West Midlands.
In 1982-3, 35 children from the West Midlands developed the haemolytic-uraemic syndrome. This was a higher incidence than expected and included an epidemic localised to the Wolverhampton area in July 1983 which comprised 11 cases in two weeks. Twenty three children were treated with dialysis, of whom three died. Six patients developed chronic renal failure, four of them from Wolverhampton. Extrarenal manifestations included neurological sequelae in four, two of whom also developed insulin dependent diabetes mellitus and chronic renal failure. Cardiomyopathy occurred in one child, who also had chronic renal failure. The outcome of these 35 patients was not predictable from prognostic criteria derived from previous experience in Britain. This, together with the high prevalence of extrarenal disease and the geographical localisation of the 1983 outbreak, suggested an aetiological agent new to the region. Faeces from 10 patients were examined for verotoxin producing Escherichia coli, and positive strains of serotype O157.H7 were found in three patients during the Wolverhampton outbreak.
Child↗
Identification of enteric pathogens in the small and large intestine of children with diarrhea.
Enteric pathogens were identified in children with diarrhea from duodenal specimens obtained with a string capsule and from fecal specimens. Rotavirus was identified in stools of 43 of 100 children, and was recovered from the small intestine from nine (21%) children who were excreting this virus. Shigella was isolated from stools from 22, Salmonella from 17, enterotoxigenic Escherichia coli from eight, and Aeromonas hydrophila from one of 100 children with diarrhea. In contrast to rotavirus, Salmonella, Shigella, enterotoxigenic Escherichia coli, and A. hydrophila were not isolated from the small intestine. Nonenterotoxigenic Aeromonas species were recovered from the small intestine, but not the stool of five children. These children were also infected with Shigella or with rotavirus; this suggests that Aeromonas was not the cause of their diarrhea. None of 51 Escherichia coli isolated with the string capsules, or 67 isolated from stool that agglutinated in commercial enteropathogenic Escherichia coli antisera were of classical enteropathogenic Escherichia coli serotypes. One hundred and five of these 118 Escherichia coli did not hybridize with a deoxyribonucleic acid probe for plasmid mediated factors conferring adherence to HeLa cells. Examination of specimens collected with a string capsule from children with diarrhea did not identify any more enteric pathogens than examining stools. Furthermore testing Escherichia coli for agglutination in commercial enteropathogenic Escherichia coli antisera did not identify Escherichia coli of enteropathogenic serotypes.
Aeromonas↗
Characterization of plasmids conferring resistance to gentamicin and apramycin in strains of Salmonella typhimurium phage type 204c isolated in Britain.
In Salmonella typhimurium phage type 204c isolated in Britain, gentamicin resistance is specified by plasmids of the I1 compatibility group which also confer resistance to apramycin. These plasmids have been subdivided into three types within the I1 group on the basis of their antibiotic resistance specificity, their ability to produce colicin Ib and their restriction enzyme digest fragmentation patterns. All three have been identified in strains from cattle, but as yet only two types have been found in strains from humans. It is suggested that the use of apramycin in animal husbandry is responsible for the appearance of gentamicin resistance in multiresistant strains of phage type 204c, a phage type already epidemic in bovine animals and with an increasing incidence in humans.
Acetyltransferases↗
Salmonella gold-coast from outbreaks of food-poisoning in the British Isles can be differentiated by plasmid profiles.
Four distinctive plasmid profile types have been identified in strains of Salmonella gold-coast isolated in Britain. Strains of one type, designated plasmid profile type 4, caused an extensive outbreak of food-poisoning in 1984, and it has been confirmed that the vehicle of infection was imported French pâté.
Animals↗
An outbreak of gastroenteritis on a passenger cruise ship.
In an outbreak of gastroenteritis on board a cruise ship 251 passengers and 51 crew were affected and consulted the ship's surgeon during a 14-day period. There was a significant association between consumption of cabin tap water and reported illness in passengers. Enterotoxigenic Escherichia coli were isolated from passengers and crew and coliforms were found in the main water storage tank. Contamination of inadequately chlorinated water by sewage was the most likely source of infection. A low level of reported illness and late recognition of the outbreak delayed investigation of what was probably the latest in a series of outbreaks of gastrointestinal illness on board this ship. There is a need for a national surveillance programme which would monitor the extent of illness on board passenger cruise ships as well as a standard approach to the action taken when levels of reported illness rise above a defined level.
Disease Outbreaks↗
The role of Shigella spp., enteroinvasive Escherichia coli, and other enteropathogens as causes of childhood dysentery in Thailand.
Shigella spp. were isolated from 44%, Pleisomonas shigelloides from 22%, Campylobacter spp. from 16%, and Salmonella spp. from 10% of 200 Thai children with mucoid or bloody diarrhea. Enteroinvasive Escherichia coli (EIEC) was identified by examining isolates of E. coli for plasmids larger than 120 megadaltons (MDa), by identifying E. coli with a virulence marker antigen in an ELISA, and by performing DNA hybridization with a 17-kilobase (kb) EcoRI digestion fragment of plasmid pWR100 (a 140-MDa plasmid of Shigella flexneri 5). Sixty-four isolates of EIEC from 10 (5%) of the children were identified by these methods and confirmed by the Sereny test. All isolates of EIEC fermented lactose, and isolates of EIEC from seven children belonged to recognized serotypes of EIEC (O28ac:H- and O29:H-), whereas isolates of EIEC from three children were untypable. Examination of DNA from the total fecal growth with the 17-kb probe identified 9 of 10 children from whom EIEC were isolated and 2 of 102 children from whom EIEC or Shigella spp. were not isolated. Detection of EIEC by ELISA and DNA hybridization are important advances in defining the etiology of dysentery.
Campylobacter↗
Molecular epidemiology of neonatal meningitis due to Citrobacter diversus: a study of isolates from hospitals in Maryland.
Six cases of neonatal meningitis due to Citrobacter diversus were diagnosed in three Baltimore (Maryland) hospitals between 1983 and 1985. Using plasmid profiles, biotypes, serotypes, and chromosomal restriction endonuclease digests as epidemiological markers, we studied 63 isolates of C. diversus (including four isolates from cerebrospinal fluid) from these and seven other hospitals in Maryland. Within two of the three hospitals with meningitis cases, the same strain of C. diversus was isolated from case infant(s), healthy neonates, and nursery personnel. In all three hospitals, C. diversus strains different from those implicated as a cause of meningitis were also isolated. Other than the meningitis-associated strains, 15 different strains of C. diversus were isolated from infants in the hospitals studied, with several distinct clusters of asymptomatic, colonized infants identified.
Citrobacter↗
R plasmids in Salmonella typhimurium in the United Kingdom.
In the United Kingdom, R plasmids are common in bovine-associated phage types of Salmonella typhimurium and in particular in strains of phage type 204c (DT204c); all strains of this type carry at least three R plasmids. Gentamicin resistance appeared in DT204c in 1983 and plasmids conferring resistance to gentamicin also code for resistance to apramycin. Three types of apramycin-gentamicin resistance plasmid have been identified.
Humans↗
Plasmids coding for colonization factor antigens I and II, heat-labile enterotoxin, and heat-stable enterotoxin A2 in Escherichia coli.
Colonization factor antigens I and II (CFA/I and CFA/II) are important in the pathogenesis of diarrhea in humans caused by some enterotoxigenic Escherichia coli (ETEC). Plasmid DNA from 16 CFA/I+ and five CFA/II+ ETEC were examined by Southern blot analysis with enterotoxin gene probes and were compared with plasmid DNA from derivatives of the same ETEC that had lost the ability to produce these colonization factors. Among the 16 CFA/I+ ETEC strains, the loss of CFA/I was accompanied by the loss of a plasmid of between 34 and 68 megadaltons (MDa) coding for heat-stable enterotoxin A2 (ST-A2) in 12 strains, by the loss of a 60-MDa plasmid coding for heat-labile enterotoxin (LT) and ST-A2 in one strain, or by deletions of a segment of DNA encoding for ST-A2 in three strains. Among five CFA/II+ ETEC strains, the loss of CFA/II was associated with the loss of a plasmid of 75 MDa coding for LT and ST-A2 in three strains, with the loss of genes coding for LT and ST-A2 from a 68-MDa plasmid in one strain, or with no discernible loss of a plasmid or DNA sequences coding for enterotoxins in the remaining strain. The loss of CFA/I and CFA/II production was associated with the loss of DNA sequences encoding for ST-A2 in 20 of 21 ETEC examined.
Antigens, Bacterial↗
Molecular techniques in the study of Salmonella typhi in epidemiologic studies in endemic areas: comparison with Vi phage typing.
We examined 141 Salmonella typhi strains of known phage type isolated during ongoing epidemiologic studies in Santiago, Chile, and Lima, Peru. Plasmids were present in 12 (17%) of 70 S. typhi isolates from Santiago and 5 (7%) of 71 isolates from Lima; these plasmids were not associated with antimicrobial resistance. Identical 21 kilobase (kb) plasmids (as defined by restriction endonuclease digest pattern) were present in 13 of the 17 plasmid-containing isolates. Virtually identical digest patterns were identified when chromosomal DNA of selected strains from Santiago, Lima, and the United States was extracted and then digested with restriction endonucleases. The similarities among plasmids and chromosomal digest patterns emphasize the homogeneity and possible clonal origin of S. typhi isolates; these data also suggest that there is only a limited role for plasmid and chromosomal analysis as a substitute for phage typing in epidemiologic studies.
Bacteriophage Typing↗
Two distinct toxins active on Vero cells from Escherichia coli O157.
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Bacterial Toxins↗
Increasing incidence of resistance to gentamicin and related aminoglycosides in Salmonella typhimurium phage type 204c in England, Wales and Scotland.
Phage type 204c of Salmonella typhimurium (DT 204c) appeared in bovine animals in 1979. It is now the predominant type in cattle in England, Wales and Scotland and ranks in the 10 most common phage types in humans. All strains of DT 204c have been resistant to at least four antimicrobial drugs. In 1979 and 1980 the most common resistance pattern was that of chloramphenicol, streptomycin, sulphonamides, tetracyclines and trimethoprim (CSSuTTm) but since 1981 strains with additional resistance to ampicillin and neomycin-kanamycin (AK) have predominated. Strains resistant to furazolidone (Fu) have caused sporadic outbreaks. Gentamicin resistance (G) appeared in DT 204c in 1983 and gentamicin-resistant strains are increasing in incidence. With the exception of resistance to furazolidone, drug resistance in DT 204c has been plasmid-mediated. Characterisation of gentamicin resistance plasmids in DT 204c of R-type ACGKSSuTTm has demonstrated the existence of three distinct lines, two of which have been found exclusively in cattle and one in cattle and humans. The misguided and often inappropriate use of antimicrobial drugs in calves has contributed to the appearance of multiresistant strains of DT 204c and positive measures to limit range and levels of antimicrobials available to feed manufacturers may be necessary.
Aminoglycosides↗
Expression of cloned plasmid regions encoding colonization factor antigen I (CFA/I) in Escherichia coli.
Molecular cloning from a plasmid encoding colonization factor antigen I (CFA/I) and heat-stable enterotoxin isolated two regions, 1 and 2, that are required for the production of CFA/I fimbriae. The level of CFA/I synthesis measured by ELISA was similar in an Escherichia coli K12 strain carrying regions 1 and 2 cloned separately on compatible plasmid vectors to that in the same strain containing the parental plasmid. The structural gene for the CFA/I fimbrial subunit was within region 1. This region directed production in E. coli minicells of at least six independent polypeptides, of which the fimbrial subunit and at least three others appeared to be synthesized as precursor molecules that underwent processing. Cloned DNA containing CFA/I region 2 specified three polypeptides in minicells. Attempts to reduce the size of the cloned region 1 resulted in a derivative plasmid that carried the CFA/I structural gene but did not complement a region-2 recombinant plasmid to restore production of CFA/I fimbriae.
Antigens, Bacterial↗
An outbreak of food-borne enterotoxigenic Escherichia coli diarrhoea in England.
An outbreak of diarrhoea with abdominal pain occurred among members of the staff of a school and their guests after a social function at which a cold buffet was served. Sixty people attended the function and 43 subsequently completed questionnaires. Of these, 27 had diarrhoea. The median incubation period was 36 h and the range 12-66 h. Food history analysis showed an association between diarrhoea and eating curried turkey mayonnaise. Stool specimens from 13 of those who developed diarrhoea were examined: Escherichia coli 06.H16 (producing heat-stable and heat-labile enterotoxins) was found in nine specimens and E. coli 027.H20 (producing heat-stable enterotoxin) in 11 specimens. Eight patients had both strains and only one was negative for enterotoxigenic E. coli. Food samples were not available for examination. Enterotoxigenic E. coli should be considered as a possible cause in well-defined outbreaks of food-borne diarrhoea with abdominal pain.
Abdomen↗
Escherichia coli diarrhoea.
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Adhesiveness↗
Plasmid characterization of drug-resistant Shigella dysenteriae 1 from an epidemic in Central Africa.
A widespread epidemic of severe dysentery in Zaire and neighbouring Central African countries was caused by a multiply drug-resistant strain of Shigella dysenteriae 1. Early isolations were resistant to ampicillin, chloramphenicol, streptomycin, sulphonamides and tetracyclines (R-type = ACSSuT). Later in the epidemic strains resistant to trimethoprim (Tm) became prevalent and a few strains resistant to kanamycin (K) or nalidixic acid were also isolated. All resistances except nalidixic acid were encoded by plasmids of incompatibility groups X (ACT) or I1 (ACSSuTTm) and the epidemic strain also carried an SSu plasmid and a number of cryptic plasmids. The Inc X plasmid from this epidemic is the same as that in Sh. dysenteriae 1 strains isolated in Somalia in 1976 whereas the epidemic strains from the Shiga outbreaks in Central America, 1969 to 1971, and Sri Lanka, 1979, carried plasmids of group B. This epidemic demonstrates that when a multiresistant strain includes resistance to trimethoprim, nalidixic acid is a suitable alternative therapeutic agent.
Africa, Central↗
Escherichia coli 0142.H6; a drug-resistant enteropathogenic clone?
For many years strains of Escherichia coli belonging to particular serotypes (EPEC) were a common cause of outbreaks of infantile enteritis in Europe and North America. E. coli 0142.H6 was first isolated from infants with diarrhoea in Indonesia in 1960 and a further outbreak occurred in Mexico in 1965. Between 1967 and 1972 outbreaks of infantile enteritis caused by E. coli 0142 were reported in hospitals in Scotland, England, Northern Ireland and Eire. Sporadic cases occurred in Canada in 1972 and a further outbreak occurred in Arizona, U.S.A. in 1975. Strains from all these incidents were examined by biochemical and serological methods. Their resistance to antimicrobial drugs was determined and their resistance plasmids characterized; their plasmid profiles were visualized by agarose gel electrophoresis. The cumulative evidence suggests that strains isolated in the British Isles all belonged to a single clone and were related to those isolated in Indonesia, the U.S.A. and Canada. However, the strains from Mexico appeared to be unrelated. This study demonstrates that single clones of enteropathogenic E. coli may spread throughout the world, causing outbreaks of diarrhoeal disease and acquiring resistance to antimicrobial drugs.
Anti-Bacterial Agents↗