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PubMed1999

Molecular diagnostics for existing and emerging infections. Complementary tools for a new era of clinical microbiology.

Diagnostic molecular methods have had a large effect on diagnosis and management of infectious diseases. These tools have been developed in response to diagnostic methods that lack sensitivity, specificity, or rapid turnaround time, to assist with identification of agents that are difficult to cultivate or classify or as methods for assessing the effects of antiviral or antimicrobial agents in chronic infection. Molecular methods have also enabled microbiologists to define disease by the presence of virulence, toxin, or antimicrobial resistance genes and to identify potentially important clones of organisms responsible for outbreaks of infection. Early outcome-based studies suggest that molecular methods may provide substantial reductions in per patient costs. Nucleic acid diagnostic methods will continue to be used in infectious disease and microbiology, and increasingly appear to be complementary tools with important diagnostic, patient management, and health care cost benefits for the laboratory and health care systems.

Communicable Diseases↗
PubMed2001

The panmictic nature of Neisseria meningitidis serogroup B during a period of endemic disease in Canada.

Three hundred and one (301) strains of Neisseria meningitidis serogroup B, isolated from patients with meningococcal disease during the years 1994-1996, were subjected to multilocus enzyme electrophoresis, serotyping, and serosubtyping. Based on the analyses of 14 enzyme loci, 177 electrophoretic types (ETs) were identified. Of these, 136 were represented by single isolates and 41 were represented by multiple isolates (range 2-31). The mean genetic diversity for isolates was 0.444 and for ETs was 0.440. The index of association (I(A)) between loci was 0.530 +/- 0.08 for isolates and 0.256 +/- 0.10 for ETs. Cluster analysis revealed the presence of 39 lineages each represented by a single ET or clusters of ETs. The most common serotypes were 4, 15, and 14 and accounted for 84 (28.0%), 53 (17.6%), and 32 (10.6%) of the isolates, respectively, and were dispersed amongst 46 ETs (1-122), 35 ETs (3-165), and 26 ETs (18-76), respectively. The 109 (36.6%) nontypable (NT) isolates were amongst 74 ETs (6-177). The mean genetic diversity for serotypes 4, 15, and 14 and NT isolates was 0.368, 0.371, 0.343, and 0.442, respectively, and for ETs was 0.363, 0.354, 0.397, and 0.440, respectively. Combinations of serotypes and serosubtypes (number of isolates) that occurred most frequently were 4:P1.14 (17), 14:P1.16 (16), NT:P1.16 (16), 15:P1.16 (13), and NT:P1.13 (13). The majority of group B disease in Canada during 1994-1996 was caused by meningococci of considerable genetic diversity, and reflects a situation of endemic disease. However, the results also indicate that organisms belonging to the ET-5 complex, which has been responsible for outbreaks of group B disease globally for several decades, have been introduced into the country.

Alleles↗
PubMed2002

[Acinetobacter, a nosocomial pathogen. Contribution of experimental models].

EPIDEMIOLOGY: The increasing importance of Acinetobacter as a nosocomial pathogen responsible for outbreaks in intensive care units has been pointed out for twenty years. Today Acinetobacter infections are essentially pneumonia in patients under mechanical ventilation. EXPERIMENTAL MODELS: Most clinical isolates are resistant to b-lactam antibiotics as well as to other drugs. Animal models represent an essential step between in vivo testing an<d clinical studies, necessary to understand physiopathology, pharmacology and efficacy of therapy. The virulence of clinical isolates of Acinetobacter spp has been studied in a mouse model of systemic infection. Pharmacological studies and efficacy of antibiotics have been studied in a mouse model of Acinetobacter pneumonia. HUMAN THERAPEUTICS: The majority of strains are multi-resistant to antibiotics and the infections they cause are difficult to treat. Isolated or combined Sulbactam has often been used with success.

Acinetobacter↗
PubMed2002

[Clinical and epidemiological characteristics of botulism in France].

Botulism is still found in France. Botulism is life-threatening and may have epidemic occurrences, which justifies an epidemiological watch with systematic notification of cases. In order to complete these recent epidemiological data, older cases since 1940 have been reviewed through a survey sent to the French Ministry of Health and the Pasteur Institute (National Reference Center). A Medline search has also been completed. In France, foodborne botulism is the main source of contamination. Type B is nearly always involved but type E botulism has been regularly reported. Fatal outcome due to botulism-induced respiratory muscle weakness can now be avoided by mechanical ventilation, leading to better prognosis. Microbiological diagnosis has been confirmed in two-thirds of the cases by isolation of toxin in the patient's serum. It is important to identify the foodstuff incriminated to prevent the development of a botulism outbreak. Foodstuffs responsible for foodborne botulism are the same since 1940. However, the increased consumption of vacuum-packed foodstuffs might facilitate the persistence of botulism. In conclusion, this review points out the significance of epidemiological screening of foodstuffs in the alimentary chain as well as the systematic notification of botulism. The regular educational information for young physicians regarding botulism should be continued.

Adult↗
PubMed2004

[Spread of viruses through the food chain].

Food associated viruses are responsible for a high number of infectious diseases in man, mainly gastroenteritis and hepatitis. The three most important viral agents are noroviruses (NV) (formerly known as Norwalk-like viruses), Rotavirus (RV) and Hepatitis A-Virus (HAV). The numbers of infections in man were in 2002 according to the Robert Koch-Institut for NV and RV 50,000, respectively, and for HAV 1,500, slightly decreasing in 2003. The rate of foodborne infections caused by viruses can only be estimated (appr. 20% of total cases). On the other hand only a very small part of viral gastroenteritis can be diagnosed and notified. Besides the direct infection through contaminated food the human to human infection is the most important source, also responsible for outbreaks. There is at the moment no routine diagnostic tool available for the detection of viruses in food because of the lack of standardized methods. For NV, one of the most important foodborne (live bivalve molluscs) viral pathogens, indicator organisms are in use. There is a scientific evaluation in different member states concerning the value of bacterial indicators vs. bacteriophages. In addition to foodborne viruses (via faecal contamination present in the food chain) there are emerging zoonotic viral agents. Food may be a vector for this agents depending on the production structures (e.g. SARS or influenca).

Animals↗
PubMed2005

Human exposure to mosquito-control pesticides--Mississippi, North Carolina, and Virginia, 2002 and 2003.

Public health officials weigh the risk for mosquito-borne diseases against the risk for human exposure to pesticides sprayed to control mosquitoes. Response to outbreaks of mosquito-borne diseases has focused on vector control through habitat reduction and application of pesticides that kill mosquito larvae. However, in certain situations, public health officials control adult mosquito populations by spraying ultra-low volume (ULV) (<3 fluid ounces per acre [oz/acre]) mosquito-control (MC) pesticides, such as naled, permethrin, and d-phenothrin. These ULV applications generate aerosols of fine droplets of pesticides that stay aloft and kill mosquitoes on contact while minimizing the risk for exposure to persons, wildlife, and the environment. This report summarizes the results of studies in Mississippi, North Carolina, and Virginia that assessed human exposure to ULV naled, permethrin, and d-phenothrin used in emergency, large-scale MC activities. The findings indicated ULV application in MC activities did not result in substantial pesticide exposure to humans; however, public health interventions should focus on the reduction of home and workplace exposure to pesticides.

Environmental Exposure↗
PubMed2005

Progress in improving state and local disease surveillance--United States, 2000-2005.

In September 2000, states began receiving federal funding to plan and implement integrated electronic systems for disease surveillance. CDC and state and local health departments had recognized the importance of such systems and of uniform standards to improve the usefulness of public health surveillance and the timeliness of response to outbreaks of disease. Previously, state health departments received most case-report forms by mail and then entered the data into computer systems, sometimes weeks after the cases of notifiable disease had occurred, including cases that warranted immediate public health investigation or intervention. In addition, depending on the disease, only 10%-85% of cases were reported, and more than 100 different systems were used to transmit these reports from the states to CDC (CDC, unpublished data, 2005). This report summarizes progress since the initial funding in 2000 in improving state and local disease surveillance through secure, Internet-based data entry and automated electronic laboratory results (ELR) reporting. Both are components of the National Electronic Disease Surveillance System (NEDSS), the surveillance and monitoring component of the broader Public Health Information Network (PHIN) initiative. Local, state, and national public health officials should continue to improve the timeliness and completeness of disease surveillance.

Humans↗
PubMed2006

Rapid diagnosis of avian influenza (AI) and assessment of pathogenicity of avian H5 and H7 subtypes by molecular methods.

Avian influenza (AI) is a highly contagious viral disease of poultry that is found worldwide. There are two forms of AI: a mild form called low pathogenicity avian influenza (LPAI), and a severe form called highly pathogenic avian influenza (HPAI). HPAI is associated with the H5 and H7 subtypes of AI virus (AIV) and is subject to Federal control and International reporting. A real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay has been developed and validated that can help in the early detection of AI outbreaks. The rRT-PCR assay can also be used to identify infections caused by H5 and H7 subtypes of AIV New isolates of AIV must be characterized as LPAI or HPAI for reporting and control purposes. The criteria for classification of an AI virus as HPAI are defined by the World Organization for Animal Health (OIE); the definition includes a virulence and a molecular criterion. The virulence requirement for HPAI is defined as an AIV killing 75% or more of eight inoculated chickens within 10 days. The molecular criterion is the presence of multiple dibasic amino acids at the proteolytic cleavage site of the haemagglutinin (H) protein. All HPAI viruses isolated before 2002 fulfilled both the virulence and molecular criteria. Consequently, nucleotide sequencing of the H gene and deduction of the amino acid motif at the H cleavage site has been successfully used to assess the virulence of H5 and H7 AIVs rapidly. Since 2002, however, there have been three outbreaks of HPAI where the viruses responsible for the outbreaks have either fulfilled the virulence criterion or the molecular criterion, but not both.

Amino Acid Sequence↗
PubMed1985

[Arnozán-Dubreuilh depilating folliculitis].

Male patient, aged twenty-six years. Having an eight-and-a-half-year- old dermatosis of localized evolution on scalp, under arms, thighs, pubis and legs, characterized by inflammatory papules and follicular and extra-adnexial pustules, tiny scars and lack of hair in the affected areas. The authors present a representative case of "depilating folliculitis" of (Arnozán and Dubreuilh) stressing the following: Uncommon frequency in our country but frequent in warmer climates where it is observed mainly among peasants and sugar-cane workers. Wide-depilated areas principally in folds. Seasonal outbreak. Good response to treatment. A revision of the theme is made emphasizing the histopathologic pathogenesis.

Adult↗
PubMed1986

The virtual elimination of rubella and mumps from the United States and the use of combined measles, mumps and rubella vaccines (MMR) to eliminate measles.

The measles elimination effort, which began in 1978, has made dramatic contributions to the virtual elimination of rubella and congenital rubella syndrome (CRS) and the control of mumps in the USA. The use of combined MMR vaccine has resulted in immunization levels at school entry in excess of 95% against each of these diseases. As a result, record low levels of rubella, CRS, and mumps were reported in 1984. Continued use of MMR, along with improved surveillance and aggressive response to outbreaks, can be expected to eliminate rubella and mumps as well as measles.

Cost-Benefit Analysis↗
PubMed1985

Water supply as a source of Pseudomonas aeruginosa in a hospital for hematological malignancies.

This report details of an investigation on a significant increase in nosocomial bacteremias due to multiply-resistant Pseudomonas aeruginosa strains which occurred in a hematological ward. Serotyping according to Habs method showed a high frequence of the serotype 12. Control cultures identified in the hospital building water reservoirs the presence of the organism. After disinfection of these water reservoirs, the frequence of nosocomial septicemias caused by serotype 12 Pseudomonas aeruginosa strains on the overall bacteremic episodes declined immediately and showed a declining trend in the following 13 months period. To conclude serotyping of Pseudomonas aeruginosa is a useful epidemiological marker and allows to discover from where the diffusion of the organism responsible of outbreaks starts.

Cancer Care Facilities↗
PubMed1974

Epidemiological evaluation of influenza in Italy.

A statistical study of the mortality from all causes and from respiratory diseases was carried out in an evaluation of the influenza epidemics in Italy from 1956 to 1973. Type A influenzaviruses were responsible for outbreaks every 2-3 years. Type B influenzavirus appeared every 4 years and accounted for a single noteworthy epidemic in 1962-63. From the analysis of data on both general mortality and respiratory mortality a better evaluation of the extent of the influenza outbreaks could be made.

Disease Outbreaks↗
PubMed1994

Poliomyelitis in Oman: acute flaccid paralysis surveillance leading to early detection and rapid response to a type 3 outbreak.

Countries are increasingly requesting guidance on carrying out acute flaccid paralysis (AFP) surveillance, aimed at detecting and confirming all cases of acute paralytic poliomyelitis. The experience of Oman provides many lessons in this respect. AFP surveillance in Oman was established systematically. First, an epidemiologist was assigned to coordinate surveillance, and a laboratory for performing polio-virus isolation was identified. Next, operational guidelines for AFP surveillance were developed and widely promoted among health staff. The quality of the system has been monitored for more than 3 years with selected performance indicators. From January 1990 to April 1993, 49 AFP cases were reported, corresponding to an average annual rate of 2.1 AFP cases per 100,000 children aged less than 15 years. A total of 98% of the AFP cases were investigated within 48 hours of being reported; two stool samples were obtained from 94% of the cases. Following complete investigation, nearly a third of the reported AFP cases were classified as being clinically compatible with Guillain-Barré syndrome. Four AFP cases, all reported in 1991, were confirmed to be due to wild type 3 poliovirus. Because AFP surveillance detected these cases rapidly, Oman was able to carry out outbreak control measures promptly and more than 350,000 extra doses of oral poliovirus vaccine were delivered to children under 6 years of age.

Adolescent↗
PubMed1997

Antibody responses of cows during an outbreak of neosporosis evaluated by indirect fluorescent antibody test and different enzyme-linked immunosorbent assays.

Serum samples from 70 (33 aborting and 37 non-aborting) dairy cows from a herd in California were analyzed for Neospora caninum antibodies in different laboratories by various serologic assays including enzyme-linked immunosorbent assay (ELISA) with recombinant antigens (Nc4.1 and Nc14.1), kinetic ELISA, whole tachyzoite lysate ELISA, immunostimulating complex (iscom) ELISA, antigen capture competitive inhibition ELISA, and by the indirect fluorescent antibody test. Eighteen percent of pregnant cows in this herd had aborted within 2 mo of the index case. All 70 cows had antibodies to N. caninum by at least 1 of the tests. Antibody levels to N. caninum in aborting cows as a group were higher than in nonaborting cows. However, it was concluded that no serological test could be used to establish definitively that N. caninum caused the abortion in an individual cow.

Abortion, Veterinary↗
PubMed1998

The molecular epidemiology of tuberculosis in Zaragoza, Spain: a retrospective epidemiological study in 1993.

SETTING: The incidence of tuberculosis (TB) in Spain is one of the highest in Europe. In Zaragoza region the incidence rate of tuberculosis and the acquired immune deficiency syndrome (AIDS) are close to the national average. OBJECTIVE: To better define the molecular epidemiology of tuberculosis in an area of Europe where this has not been previously studied. DESIGN: A retrospective epidemiological study on tuberculosis was conducted in Zaragoza, a region of Spain, in 1993. The study population consisted of 226 patients from whom positive culture and complete clinical and demographic data were available. Mycobacterium tuberculosis strains were typed by standard restriction fragment length polymorphism (RFLP). A cluster was defined as two or more isolates with identical RFLP patterns when five or more copies of IS6110 are present. The 137 non-clustered patients were compared with the 89 clustered patients and studied by using univariate analysis. RESULTS: Thirty-nine percent of the patients were clustered, suggesting possible recent transmission. Infection with drug-resistant M. tuberculosis was associated with a decreased risk of being in a cluster. The strains isolated from human immunodeficiency virus (HIV)-positive patients were not associated with clustering. We found that immigration was not a major determinant in the total number of TB cases. CONCLUSION: Immigration, HIV and drug resistance were not associated with recent transmission. More than 50% of the clusters contained two or three patients, indicating that small outbreaks were responsible for most of the tuberculosis cases. Our RFLP typing results indicate that a TB control programme should be implemented in Spain in order to lower transmission of TB.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Epidemiologic markers of Salmonella].

Salmonellae are enterobacteria responsible for outbreaks of human and animal clinical diseases, with important hygienic and economic consequences. Accurate epidemiological studies require the use of efficient markers, which make it possible to trace the establishment and diffusion of different bacterial strains and also to evaluate the similarities between different isolates. Numerous phenotypic and genotypic markers applicable to Salmonella are available for these epidemiological studies. Nevertheless, the relative interest of those markers depends on the serotypes, and a different hierarchy can be achieved for the Typhimurium and Enteritidis serotypes.

Animals↗
PubMed1998

Genomic and antigenic variations of porcine reproductive and respiratory syndrome virus major envelope GP5 glycoprotein.

The objective of the present study was to evaluate the importance of genomic and antigenic variations which may have affected the major envelope glycoprotein GP5 of porcine reproductive and respiratory syndrome virus (PRRSV) isolates responsible for outbreaks in Quebec and Ontario, in comparison with the modified-live U.S. vaccine strain (MLV) and the European prototype strain from Lelystad (LV). Nucleotide sequence analyses of the open reading frame (ORF)5 genes showed that all of the isolates studied were heterogenous, amino acid (aa) identities varied from 88 to 99% with the MLV strain, and between 51 and 54% with the LV strain. The aa substitutions were randomly scattered across the protein, although one region between residues 26 and 39 was found to correspond to a hypervariable region which involved 0 to 3 potential N-glycosylation sites. The ORF5 encoded products of 5 of these isolates, including the MLV and LV strains, were expressed in E. coli as recombinant proteins fused to the glutathione S-transferase (GST) protein and used to raise hyperimmune anti-ORF5 sera in rabbits. The reactivity patterns of strain-specific hyperimmune anti-ORF5 sera and a panel of 4 monoclonal antibodies directed against the ORF5 gene product of the Quebec IAF-Klop strain of PRRSV, indicated that GP5 of field isolates also underwent antigenic variations. The data suggest that neutralizing epitopes, independent of conformation and glycosylation, are also associated with antigenic variability of the GP5 of PRRSV.

Amino Acid Sequence↗