Enterotoxigenic Escherichia coli causing infantile enteritis in Britain.
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Biomedical subjects
Publications and source records attributed to B Rowe.
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The ability of certain Escherichia coli strains to produce enterotoxin is determined by transmissible plasmids. It is therefore possible that any E. coli strain might be able to acquire such a plasmid and that the correlation between enterotoxigenicity and serotype might be random. However, recent studies show that the enterotoxigenic strains so far describe belong to a restricted range of serotypes. Enterotoxigenic strains of E. coli O6.H16 and E. coli O148.H28 have been associated with outbreaks of diarrhoea in several countries, therefor strains of E. coli belonging to these serotypes were selected for further study. Twenty-three strains of E. coli O6.H16 and 14 strains of E. coli O148.H28 were examined; 20 strains of E. coli O6.H16 and all 14 strains of E. coli O148.H28 were enterotoxigenic but strains of E. coli O6 wit flagellar antigens other than H16 and strains of E. coli O148 wit flagellar antigens other than H28 were not enterotoxigenic. The examination of single colony subcultures derived from the E. coli O6.H16 strains showed that in some strains loss of enterotoxigenicity had occurred in a proportional of colonies.
Five bacteriophage stocks were prepared after enrichment of a sewage sample using Escherichia coli 02:K1:H4 (strain U9/41). The bacteriophages were tested for their ability to lyse 224 strains of E. coli that had been tested for the presence of the K1 antigen by means of an antiserum-agar diffusion technique, using a meningococcus group B antiserum known to detect the E. coli K1 antigen. The standard test strains for E. coli K antigens 2 to 99 were used as control strains. Of the 101 strains found to possess the K1 antigen using the antiserum-agar technique, 93 were lysed by at least one of the bacteriophages, whereas 8 of the 123 strains apparently lacking K1 were lysed by one or more of the bacteriophages. None of the standard test strains for K antigens 2 to 99 was lysed by any of the bacteriophages. The eight strains thought to lack K1 but that were lysed by bacteriophage were re-examined by immunoelectrophoresis, using meningococcus group B antiserum; five of the eight strains gave a precipitin line corresponding to K1. The use of K1-specific bacteriophages offers an inexpensive and easy method for the identification of the K1 antigen.
Altogether 411 cultures of Escherichia coli isolated from blood and 60 from cerebrospinal fluid (CSF) of patients in the United Kingdom were identified biochemically and serologically. They were tested for the presence of K1 antigen by an antiserum-agar method using horse meningococcus group B antiserum and by slide agglutination using E. coli 07.K1.H-antiserum. In total 71 cultures from blood (17%) and 29 from CSF (48%) gave positive results by both methods and were considered to possess the K1 antigen. Among the cultures from patients less than 3 years of age the K1 antigen was found significantly more often in those isolated from CSF (53%) than in those from blood (29%). The K1 antigen was found significantly more frequently in cultures isolated from the blood of patients less than 3 years old (29%) than in those from the blood of older patients (13%). Cultures which gave negative results in the slide agglutination test also gave negative results by the antiserum-agar method but positive results obtained by slide agglutination were not always confirmed using the antiserum-agar technique. Slide agglutination was considered to be valuable for the elimination of K1 negative cultures, but positive results required confirmation using the antiserum-agar method.
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Three test systems were used to study enterotoxin production by epidemic strains of Escherichia coli from cases of infantile enteritis in well-documented outbreaks in the U.K. The tests used were the Y1-mouse-adrenal-cell test and the Chinese-hamster-ovary-cell (C.H.O.) test for the detection of heat-labile enterotoxin and the infant-mouse test for the detection of heat-stable enterotoxin. All 6 outbreaks had been studied using full serotyping techniques and the results had been published. In each outbreak the epidemiological studies clearly implicated a particular serotype of E. Coli as the epidemic strain and cultures of that serotype were tested for enterotoxin production. Although a control strain validated by other workers was positive in all three systems, the epidemic strains from infantile enteritis were negative. It seems that the three enterotoxin tests used in this study are of little value in recognising strains of E. coli causing epidemics of infantile enteritis in the U.K.
A new salmonella subgenus I serotype is described. Strein C.S. 1608/73, serotype 67:R:1, 2, was isolated from activated sewage sludge and was assigned the name S. crossness. The serotype is biochemically atypical in its ability to utilize sucrose and this ability appears to be controlled by a transferable plasmid.
Escherichia coli O 27 H 7 was found in 16 stool samples submitted during a Caribbean cruise (Cruise Z) by 29 patients reporting with diarrhoea. A retrospective search revealed E. coli O 27 H 7 in 11 of 20 and 2 of 14 stool cultures from patients on two previous cruises (Y and X respectively) and in a culture from fresh cream (Cruise Y). The repeated occurrence of E. coli O 27 H 7 in the absence of any other apparent cause suggested that this serotype may have been responsible for the diarrhoea. The results of pathogenicity tests suggested that this strain elaborated heat-stable (ST) enterotoxin. The possibility that food may have been the vector is discussed.
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An outbreak of enteritis occurred amongst babies in a nursery unit. 25 babies were affected and 5 required intravenous therapy; there were not fatalities. From 24 of the 25 babies affected, an Escherichia coli with a previously undescribed O-antigen was isolated. An outbreak of diarrhoea had taken place in the same hospital a year before and re-examiniation of cultures of E. coli isolated at that time showed that 5 of the 15 babies affected had been excreting E. coli with the same O-antigen. Isolates from 10 of the babies were tested for enterotoxin production in the infant mouse model and 4 gave a positive response. The new O-antigen has been accepted into the international serotyping scheme and has been designated E. coli O159.
In that supplement are given the characters of new Salmonella serotypes recognized in 1975 by WHO collaborating Centre for reference and research on Salmonella. Twenty-six belong to the sub-genus I, 10 to the sub-genus II, 9 to the sub-genus III and 1 to the sub-genus IV. A new H antigen phase 1(g,Z62) has been approved. Biochemical and antigenic variants of already known serotypes are described.
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The names Citrobacter koseri, Levinea malonatica and Citrobacter diversus are synonymous. As a result of the study of representative strains of these organisms an antigenic scheme comprising seven O antigens has been proposed. The examination of a further 165 strains from clinical sources suggests that an additional seven antigens should be included in the scheme. The serological and biochemical reactions of the test strains for all 14 O antigens are described.
165 strains of Citrobacter koseri isolated from clinical specimens were studied and their biochemical reactions determined. They were examined serologically by means of a scheme consisting of 14 O antigens. The sources of the clinical specimens were tabulated and the epidemiological information was summarized. The clinical significance of these findings is discussed.
Four Escherichia coli strains were established as antigenic test strains for four new o groups, o158, o159, o160 and o161. The strains of o158 and o159 were isolated from cases of infantile diarrhoea in Great Britain, while the o160 and o161 strains were isolated from faecal specimens in Arabia. The o161 strain was at the same time designated as test strain of a new H antigen, H54, while a strain belonging to o group 148 was established as antigenic test strain for H53; this strain was also isolated from human faeces in Arabia.