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Biomedical subjects

J S Brazier

Publications and source records attributed to J S Brazier.

At least 19 recordsLinked to original sources
PubMed2002

Fusobacterium necrophorum infections in England and Wales 1990-2000.

In response to a marked increase in both the number of Fusobacterium necrophorum bacteraemia reports to the PHLS Communicable Disease Surveillance Centre and the number of F. necrophorum isolates referred to the PHLS Anaerobe Reference Unit in 1999, the data from both sources on F. necrophorum infections were reviewed for the decade 1990-2000. There were 208 reports of F. necrophorum bacteraemia (average 19/year; range 14-34/year) with a peak in incidence in the late winter months; 68% were from male patients and the peak age range was 16-23 years. Of 205 referred isolates of F. necrophorum, 122 (59%) were from blood cultures and these represented 58% of the bacteraemia reports; the others were from brain and soft tissue abscesses, pleural and joint fluids, eyes, ears and lymphatic tissue. The average number of referrals was 19/year (range 9-37/year). The peak year for bacteraemia reports (34) and isolate referrals (37) was 1999; this increase was not sustained in 2000. All isolates were susceptible to metronidazole, but 2% were resistant to penicillin and 15% to erythromycin. F. necrophorum continues to be a regular but uncommon cause of bacteraemia and metastatic abscesses following an acute sore throat, especially in young, otherwise healthy adults.

Abscess↗
PubMed2001

Typing of Clostridium difficile.

Clostridium difficile is primarily recognised as a nosocomially acquired pathogen manifesting in gastrointestinal disease subsequent to the patient receiving broad-spectrum antibiotics. Infection can be sporadic, but outbreaks commonly occur within a ward or hospital as a result of cross-infection. Since the 1980s, the epidemiology of C. difficile disease has been studied by the application of many different typing or fingerprinting methods; these, and the lessons learned, are reviewed herein.

Clostridioides difficile↗
PubMed2000

PCR-restriction fragment length polymorphism analysis for identification of Bacteroides spp. and characterization of nitroimidazole resistance genes.

Bacteroides spp. are opportunist pathogens that cause blood and soft tissue infections and are often resistant to antimicrobial agents. We have developed a combined PCR-restriction fragment length polymorphism (RFLP) technique to characterize the 16S rRNA gene for identification purposes and the nitroimidazole resistance (nim) gene for detection of resistance to the major antimicrobial agent used to treat Bacteroides infections: metronidazole (MTZ). PCR-RFLP analysis of 16S ribosomal (rDNA) with HpaII and TaqI produced profiles that enabled discrimination of type strains and identification of 70 test strains to the species level. The 16S rDNA PCR-RFLP identification results agreed with routine phenotypic testing for 62 of the strains. The discrepancies between phenotypic and PCR-RFLP methods for eight strains were resolved by 16S rDNA sequencing in three cases, but five strains remain unidentified. The presence of nim genes was indicated by PCR in 25 of 28 strains that exhibited reduced sensitivity to MTZ. PCR-RFLP of the nim gene products identified the four reported genes (nimA, -B, -C, and -D) and indicated the presence of a previously unreported nim gene in 5 strains. This novel nim gene exhibited 75% DNA sequence similarity with nimB. These rapid, accurate, and inexpensive methods should enable improved identification of Bacteroides spp. and the detection of MTZ resistance determinants.

Anti-Bacterial Agents↗
PubMed1999

Clostridium difficile: an update on its epidemiology and role in hospital outbreaks in England and Wales.

Data from the surveillance system of general outbreaks of infectious intestinal disease and from laboratory reports collated by the Communicable Disease Surveillance Centre (CDSC) and requests for outbreak investigation by the PHLS Anaerobe Reference Unit were used to evaluate the current epidemiology of Clostridium difficile infection in England and Wales. Between January 1992 and December 1996, CDSC received 10,220 laboratory reports of C difficile isolation from patient's faeces and 26,873 of toxin in faeces. Over 75% of all reports were of people aged 64 years and over. The surveillance system captured a minimum data set on 694 hospital outbreaks of infectious intestinal disease. C. difficile was responsible for 109 (15%) outbreaks affecting 1625 people, of whom 1152 were found to have a C. difficile toxin producing strain. The median duration of outbreaks was 11 days. Fingerprinting by Pyrolysis Mass Spectrometry (PMS) was performed by the PHLS Anaerobe Reference Unit in 60 outbreaks, and typing by Polymerase Chain Reaction ribotyping (PCR) in 14.

Adolescent↗
PubMed1999

PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes.

A reference library of types of Clostridium difficile has been constructed by PCR ribotyping isolates (n = 2,030) from environmental (n = 89), hospital (n = 1,386), community practitioner (n = 395), veterinary (n = 27), and reference (n = 133) sources. The library consists of 116 distinct types identified on the basis of differences in profiles generated with PCR primers designed to amplify the 16S-23S rRNA gene intergenic spacer region. Isolates from 55% of infections in hospitals in the United Kingdom belonged to one ribotype (type 1), but this type was responsible for only 7. 5% of community infections.

Animals↗
PubMed1999

A study of infectious intestinal disease in England: microbiological findings in cases and controls.

A study was undertaken to identify the microorganisms and toxins in stool specimens associated with infectious intestinal disease (IID) among cases in the community and presenting to general practitioners (GPs) and in asymptomatic controls. Population based cohorts were recruited from practice lists in 70 practices and followed for 26 weeks (cohort component). Seven hundred and sixty-one cases of IID identified from the cohorts, 2893 cases who presented to GPs in 34 of the practices (GP component), and age/sex matched control subjects (555 and 2264, respectively) submitted stool specimens by post for comprehensive microbiological examination. Campylobacter spp (12.2% of stools tested), rotavirus group A (7.7%), and small round structured virus (SRSV) (6.5%) were the organisms most commonly detected in the GP component. SRSV was identified in 7.0% of cases in the community cohort. No target microorganisms or toxins were identified in 45.1% and 63.1% of cases in the two components. Aeromonas spp, Yersinia spp, and some enterovirulent groups of Escherichia coli were detected as frequently in controls as in cases. The higher frequency of detection of campylobacter, salmonella, and rotavirus among cases who presented to GPs than among those in the community suggests that those pathogens cause more severe illness. No enteropathogens were detected from a large proportion of cases although comprehensive standard methods were used to seek them.

Case-Control Studies↗
PubMed1998

The diagnosis of Clostridium difficile-associated disease.

There are well-documented risk factors associated with the development of antibiotic-associated diarrhoea; knowledge of these and of the typical signs and symptoms should alert the clinician to the possibility of Clostridium difficile-associated diarrhoea (CDAD). It is therefore common practice in large general hospitals for clinicians to request, and for laboratories to include, investigations for C. difficile on in-patient stool specimens to confirm a diagnosis of CDAD. The laboratory methods used to investigate for CDAD are divided into two main categories: those that are aimed at detecting the presence of C. difficile or its products, and those that detect either of its two major toxins, A (enterotoxin) and B (cytotoxin). Within each of these broad strategies there are various rationales which are reviewed here.

Animals↗
PubMed1998

The epidemiology and typing of Clostridium difficile.

Clostridium difficile is normally a harmless environmental bacterium but, under certain circumstances, it can cause hospital outbreaks of disease. To understand the disease epidemiology, outbreaks have been investigated by many different methods. The phenotypic and genotypic approaches to typing are reviewed here and the epidemiology of C. difficile-associated disease is elucidated in light of recent information.

Clostridioides difficile↗
PubMed1998

PCR-ribotyping and pyrolysis mass spectrometry fingerprinting of environmental and hospital isolates of Clostridium difficile.

The relationships between environmental isolates of Clostridium difficile were examined by two typing methods, PCR ribotyping and pyrolysis mass spectrometry (PyMS). The 184 isolates were divided into 23 different PCR ribotypes, 13 of which were producers of toxins A and B; the remaining 10 types did not produce either toxin A or B. PyMS analysis resolved 31 groups with 60 (32.5%) isolates in one group (group 9). In both methods most of the isolates showed similar clustering. PCR ribotypes of the environmental isolates were compared with those of clinical isolates that had been typed previously. Seventeen PCR types (13 toxigenic PCR types and four non-toxigenic types) were found in both sets of isolates.

Animals↗
PubMed1998

Guidelines for optimal surveillance of Clostridium difficile infection in hospitals.

The availability of surveillance data on C. difficile infection in hospitals in England and Wales is being jeopardised by the trend not to culture the organism for diagnostic purposes. NHS trust laboratories that no longer have the ability to isolate C. difficile cannot investigate putative outbreaks or monitor antimicrobial susceptibilities. These laboratories may now need to rely on their local public health laboratory for such investigations. Recent recommendations from the Department of Health(DH)/PHLS have highlighted the need for culture in outbreak investigations, for surveillance purposes, and for monitoring antimicrobial susceptibilities. It is important, therefore, that NHS diagnostic laboratories and public health laboratories, in particular, retain the ability to isolate C. difficile. A cost-effective approach is described that will facilitate surveillance by typing of strains and also enable their antimicrobial susceptibilities to be monitored.

Bacterial Typing Techniques↗
PubMed1997

Preliminary findings of the international typing study on Clostridium difficile. International Clostridium Difficile Study Group.

Preliminary results of the International Typing Study on Clostridium difficile indicate that there is excellent correlation between the phenotypic methods reliant on cell surface antigens for typing strains and that a larger number of phenotypes and genotypes of C. difficile exists than was previously appreciated by each group of investigators acting independently. Evidence has also emerged that some of the types described by each method are common to all typing methods, indicating that strains of the same type are found in hospitals in the United Kingdom, Belgium, the United States, and Australia.

Bacterial Typing Techniques↗