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Biomedical subjects

J G Wells

Publications and source records attributed to J G Wells.

At least 109 records · Page 6Linked to original sources

Plasmid-mediated tissue invasiveness in Yersinia enterocolitica.

Plasmids have an important role in the pathogenicity of certain bacterial species, and Escherichia coli provides the most complete example of the relationship involved. Enterotoxigenic strains of E. coli, in addition to producing heat-stable and/or heat-labile enterotoxins, may also produce a haemolysin and fimbriate cell surface antigens which facilitate the adherence of the bacterial cell to the mucosa of the small bowel. Numerous studies have shown that these properties are plasmid-mediated and that the plasmids act in concert to confer on the host bacterium the ability to produce enteric disease in man and in animals. Moreover, studies with invasive strains of E. coli have shown that the Col V plasmid, which codes for the synthesis of colicin V, significantly enhances the pathogenicity of its host bacterium. Although the relationship between Col V plasmids and virulence is unclear, reports indicate that Col V-containing strains of E. coli are better able to survive in the alimentary tract and that colicine V itself inhibits macrophage function. It is probable that bacterial virulence is a complex phenomenon involving both chromosomal and plasmid genes. We describe here a virulence plasmid which mediates tissue invasiveness in human pathogenic strains of Yersinia enterocolitica.

Bacterial Toxins↗

Heat-labile enterotoxigenic Escherichia coli induced diarrhea aboard a Miami-based cruise ship.

Beginning in late December, 1975, almost one-third of the passengers on two successive cruises of a Miami-based cruise ship noted the onset of diarrheal illness while on board. A single serotype of Escherichia coli that produced heat-labile enterotoxin without producing heat-stable enterotoxin was recovered from the stool of most ill passengers cultured. Epidemiological investigation could not specifically define the mode of spread. The clinical picture presented was similar to the illness caused by enterotoxigenic E. coli that produce only heat-stable enterotoxin or that produce heat-stable and heat-labile enterotoxins.

Diarrhea↗

Norwalk virus gastroenteritis aboard a cruise ship: an outbreak on five consecutive cruises.

An explosive outbreak of gastroenteritis caused by a parvovirus-like (PVL) agent (Norwalk agent) affected 521 (64%) cruise ship passengers in 1977. The illness was characterized as mild-to-moderate and lasted one to two days. Principal symptoms experienced by ill passengers were nausea, vomiting, and diarrhea; fever was reported for approximately 25% of the patients. The outbreak was compatible with a common-source exposure, but no such exposure was identified. On the next four cruises, passengers experienced a similar gastrointestinal illness, but the outbreaks were less explosive, affected fewer persons, and symptoms appeared milder, on each subsequent cruise. No common source was identified, and person-to-person transmission may have occurred. The etiology of these outbreaks would have remained unknown were it not for the recent development of a specific radioimmunoassay (RIA) for the serologic identification of Norwalk virus and the measurement of antibody titers to the virus. A fourfold or greater rise in serum antibody titers to Norwalk antigen in serum from seven of eight ill passengers and the identification of Norwalk antigen in stool specimens from two ill passengers on the first cruise demonstrated that Norwalk virus caused this outbreak. The symptoms experienced by passengers on the four subsequent cruises suggest that a Norwalk agent probably also caused these outbreaks. In addition, a stool specimen from an ill passenger on cruise 3 contained Norwalk antigen.

Disease Outbreaks↗

Use of Moore swabs for isolating Vibrio cholerae from sewage.

The Moore swab method was shown to be a practical and sensitive technique for the isolation of Vibrio cholerae from sewage. In each of three instances in which cholera patients lived in homes connected to municipal sewers, V. cholerae was isolated from the community sewage plant intake at the time of the patients illness. Sewer systems became negative within 1 day after patients were treated with tetracycline. Sewer surveillance using the Moore swab also found evidence of infections occurring in areas where surveillance of diarrheal illness failed to detect cholera. Culturing community sewage by the Moore swab method proved to be an economical and effective way of determining areas where V. cholerae infections were occurring.

Bacteriological Techniques↗

Diarrhea in a non-hospitalized rural Salvadoran population: the role of enterotoxigenic Escherichia coli and rotavirus.

To determine the role of rotavirus, enterotoxigenic Escherichia coli and enteropathogenic E. coli in diarrheal disease of non-hospitalized children and adults living in rural El Salvador, stool specimens were collected from 156 persons with diarrhea and 134 age- and sex-matched controls over a 1-year period. Enterotoxigenic Escherichia coli (ETEC) were isolated as frequently from controls (13.4%) as from diarrhea cases (12.2%). Enteropathogenic E. coli were isolated from 13 cases (8.3%) and 10 (7.7%) controls. Rotavirus was demonstrated in only five of the 129 specimens from cases examined; the five persons infected were less than or equal to 3 years of age. No invasive E. coli were found. Serotyping of ETEC revealed serogroups of ETEC previously associated with enterotoxigenicity but was not helpful in separating infection from disease. The etiology of diarrhea in this rural, non-hospitalized population was complex. Isolation of a known pathogen did not prove etiology. The rotaviruses, which have been isolated frequently from hospitalized persons, were rare. Further laboratory and epidemiologic studies in such populations are needed to identify those factors that determine pathogenicity.

Adolescent↗

Evidence for enterotoxin production by a classic enteropathogenic serotype of Escherichia coli.

Isolates of classic enteropathogenic Escherichia coli O:128 that had been implicated in an outbreak of diarrhea in a hospital nursery were found to produce heat-stable enterotoxin after storage for six years. This finding indicated that enteropathogenicity and the ability to produce enterotoxin may coincide in E. coli, and further study of enteropathogenic strains that produce enterotoxin may help in elucidation of the relationship between enteropathogenic and enterotoxigenic E. coli.

Diarrhea, Infantile↗

Vibrio parahaemolyticus gastroenteritis outbreaks aboard two cruise ships.

Outbreaks of Vibrio parahaemolyticus gastrointestinal illness occurred on two Caribbean cruise ships in late 1974 and early 1975. In all, 697 passengers and 27 crew were affected. Epidemiologic evidence incriminated seafoods served on the ships as the vehicles of transmission. The seafoods were probably contaminated by V. parahaemolyticus after cooking in seawater from the ships' internal seawater distribution systems. Use of seawater in foodhandling areas was discontinued, and no further outbreaks occurred.

Disease Outbreaks↗

Comparison of assay of coliform enterotoxins by conventional techniques versus in vivo intestinal perfusion.

Thirty-six strains of coliform bacteria were tested for enterotoxigenicity both by conventional assays, including the Y-1 adrenal and Chinese hamster ovary cell assays for heat-labile toxin and the suckling mouse assay for heat-stable toxin, and by determining the ability of graded concentrations of ultrafiltrate high- or low-molecular-weight toxin preparations to induce water secretion during in vivo perfusion in the rat jejunum. The ultrafiltrates of all 18 strains isolated from persons with infectious diarrheal disease, including seven of Escherichia coli, seven of Klebsiella pneumoniae, and four of Enterobacter cloacae, contained one (nine strains) or two (nine strains) potent toxin fractions (resembling either heat-labile or heat-stable toxin in terms of apparent molecular weight and heat lability characteristics) that induced water secretion at perfusion concentrations of 10 ng/ml or less. Unconcentrated broth filtrates of five of the E. coli strains and two of Klebsiella reacted positively in one or more of the conventional assay systems. Concentrated ultrafiltrates from two strains that were negative in the in vitro assays for heat-labile toxin were tested and also proved to be inactive in these test systems. None of 18 strains isolated from control sources produced, in the ultrafiltrates, enterotoxins capable of inducing water secretion at low concentrations, and none reacted positively in the conventional assays. These results indicate that some strains of coliform bacteria elaborate potent toxin materials that are capable of inducing water secretion and can be detected by perfusion of concentrated ultrafiltrates but not by conventional assay systems for enterotoxigenicity. Whether this represents quantitative or qualitative differences between the toxin materials that stimulate these different test systems remains to be established.

Animals↗

Exotoxin activity associated with the Legionnaires disease bacterium.

Hemolysis occurred around growth of the Legionnaires disease bacterium on supplemented Mueller-Hinton agar containing sterile defibrinated blood from each of five mammalian species. Hemolysis was most pronounced with guinea pig or rabbit blood, was less intense with horse or sheep blood, and was slight with blood from a human donor. Sterile filtrates of allantoic fluid from embryonated hen's eggs that had been infected with this organism displayed hemolytic activity in a radial hemolysis assay with guinea pig cells in agar. Growth of the Legionnaires disease bacterium on F-G agar with 5% hen's egg yolk was surrounded by a zone of clearing and more circumscribed zones of iridescence and increased opacity on and in the medium. Attempts to detect activity analogous to that of Escherichia coli heat-labile or heat-stable enterotoxin in allantoic fluid from infected eggs or in cultures of the Legionnaires disease bacterium were not successful.

Agar↗

Detection of enterotoxigenic and invasive strains of Yersinia enterocolitica.

Membrane filtrates and heavy cell suspensions of 11 strains of Yersinia enterocolitica isolated from a recent epidemic were examined respectively for enterotoxin activity and tissue invasiveness. Although no heat-labile enterotoxins were detected, some strains were found to possess heat-stable enterotoxins and to have the ability to penetrate the conjunctival epithelia of guinea pig eyes. These activites were detected only in cultures grown at 25 degrees C and not at 36 degrees C.

Adrenal Glands↗

Vibrio parahaemolyticus enterocolitis in Bangladesh: report of an outbreak.

In March 1974 eight men in Chandpur, Bangladesh, experienced an illness characterized by severe abdominal cramps, nausea, vomiting and bloody diarrhea with onset 20 min to 9 h (median 2.5 h) after eating one of two fish dishes at a restaurant. Rectal cultures from all eight grew Kanagawa-positive strains of Vibrio parahaemolyticus (serotype O3K5) that were negative in the Sereny test for invasiveness and the Y-1 adrenal cell and infant mouse assays for enterotoxin production. The short incubation, severity of abdominal cramps and grossly bloody stools distinguish this illness from that usually associated with V. parahaemolyticus infection in the United States.

Adolescent↗

Side effects of immersion-type cleansers on the metal components of dentures.

Three metals were immersed in eight denture cleansing solutions for a period of 240 hours to determine the relative side effects of these cleansers upon various metal components of complete and removable partial dentures. Conclusions drawn from this study are: 1. Commercial bleaches and unbuffered hypochlorite solutions should not be used on dentures with metal components. 2. Routine use of buffered hypochlorite solutions may cause surface damage to aluminum-base material. 3. Stainless steel (orthodontic wire) will tarnish after continued exposure to buffered and unbuffered hypochlorite solutions. 4. Further research is necessary to delineate the effects of existing denture cleansers and to improve on their effectiveness and safety.

Alkalies↗

Isolation of Yersinia enterocolitica from well water and growth in distilled water.

Yersinia enterocolitica was recovered from well water during a large water-borne outbreak of gastrointestinal illness. Isolates were predominantly Nilehn biotype 1, of which 57% were serologically nontypable. Isolation and enumeration of these Y. enterocolitica strains were made on M-Endo broth. Laboratory studies were conducted on selected isolates to establish the growth of Y. enterocolitica in distilled water and the competitive growth of this organism in various enteric media. Growth was obtained in sterile distilled water without added nutrients at 4, 25, and 37 degrees C. M-Endo medium gave equal or better recovery of Y. enterocolitica in competitive growth studies than did other commonly used enteric media using the membrane filter technique and incubating at 35 degrees C. All well water isolates were confirmed biochemically at 25 and 35 degrees C and serotyped, and antibiotic susceptibility tests were performed.

Culture Media↗

Escherichia coli heat-labile enterotoxin: comparison of antitoxin assays and serum antitoxin levels.

The mouse adrenal tumor cells (Y-1 strain) and the Chinese hamster ovary cells, two routinely used tissue culture assays for Escherichia coli heat-labile enterotoxin (LT), were used to detect serum antitoxin responses in culture-positive patients from several well-defined sources. There was no correlation between a significant antitoxin response and isolation of LT-producing E. coli in two "domestic" diarrheal outbreaks. Serum samples from a third group of individuals in a rural cholera-endemic area consistently demonstrated significant rises in neutralizing antibody to LT.

Antibodies, Bacterial↗

Epidemic diarrhea at Crater Lake from enterotoxigenic Escherichia coli. A large waterborne outbreak.

In June and July 1975, Gastrointestinal illness occurred in more than 200 staff members and 2000 visitors to an American national park. In was characterized by prolonged diarrhea, cramps, nausea, and vomiting, lasted a median duration of 8 days, and was significantly associated with consumption of park water (P less than 0.001), which had been contaminated by raw sewage. Enterotoxigenic Escherichia coli serotype 06:K15:H16 was isolated from 20 of 49 ill park residents and from the park's water supply, but not from 71 residents who had never been ill or had been well for at least 4 days. No other bacterial, viral, or parasitic pathogens were isolated from ill or well persons. This outbreak is the first waterborne epidemic of diarrheal illness shown to be due to enterotoxigenic. E. coli, and this study documents one mode of transmission of this pathogen. This investigation also suggests the relative insensitivity of current methods for identifying persons infected with this organism, either by the culturing of randomly selected isolates or by measuring serologic responses.

Diarrhea↗

Giardiasis in day-care centers: evidence of person-to-person transmission.

In August and September 1975, an outbreak of diarrhea occurred in children 1 to 3 1/2 years old attending a day-care center. An investigation revealed overlapping epidemics of shigellosis and giardiasis, with 54% of the children infected with Giardia lamblia. At two other centers 29% and 38% of the children had G. lamblia infection, but none had Shigella. The prevalence of G. lamblia in the day-care children was significantly higher than the 2% prevalence in age-matched children not in day-care centers. Epidemiologic data suggested fecal-oral transmission of the parasite from child to child in the centers and from infected children to other family members.

Adult↗

Shigellosis from swimming.

In Augsut 1974, 31 of 45 cases of Shigella sonnei infection in Dubuque, Iowa, were traced to swimming in an 8-km stretch of the Mississippi River. Comparison of the first case in each affected family with neighborhood controls showed a significant correlation between swimming and illness (P less than .0001). A significant association between diarrheal illness and swimming (P less than .0001) was also demonstrated by a retrospective survey of 60 families who had camped at a park beside the river; the attack rate for swimmers who got water in their mouths while swimming was 18%. They had been swimming in water where the mean fecal coliform count was 17,500 organisms per 100 ml; the federal recommended upper limit for swimming water is 200 per 100 ml. A water sample obtained at the park swimming area one month after authorities had banned swimming in the area yielded S sonnei with the same antibiogram, colicin type, and phage type as the isolates from six swimmers.¿

Child↗

Travelers' diarrhea in Mexico. A prospective study of physicians and family members attending a congress.

We conducted a prospective study of travelers' diarrhea on 73 physicians and 48 family members attending a medical congress in Mexico City, in October, 1974. Fecal and blood specimens were collected before, during and after their visit and examined for enteric bacterial pathogens, viruses and parasites. In 59 (49 per cent) participants travelers' diarrhea developed. Median duration of illness was five days. Onset occurred a median of six days after arrival. An etiologic agent was found in 63 per cent of ill participants. Enterotoxigenic Escherichia coli of different, non-"enteropathogenic" serotypes was the most common cause; other responsible pathogens included salmonellae, invasive Esch. coli., shigellae, Vibrio parahaemolyticus, Giardia lamblia and the human reovirus-like agent. Consumption of salads containing raw vegetables was associated with enterotoxigenic Esch. coli infection (P = 0.014). Travelers' diarrhea in Mexico is a syndrome caused by a variety of pathogens, the most common of which is enterotoxigenic Esch. col.

Diarrhea↗