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Sensitive and specific detection of Salmonid alphavirus using real-time PCR (TaqMan).

Pancreas disease is responsible for major economic losses in the European salmonid farming industry. It was previously believed that a single subtype (salmon pancreas disease virus) of the virus species Salmonid alphavirus (SAV) was responsible for all outbreaks of pancreas disease in the UK and Norway. However, the recent discovery that pancreas disease in Norway is caused by a new and distinct subtype of salmonid alphavirus, exclusively found in Norway, has advocated the need for better diagnostic tools. In the present paper, three real-time PCR assays for all known subtypes of salmonid alphavirus have been developed; the Q_nsP1 assay is a broad-spectrum one that detects RNA from all subtypes, the Q_SPDV assay specifically detects the salmon pancreas disease virus subtype, and the Q_NSAV assay only detects the new Norwegian salmonid alphavirus subtype. The results demonstrated the assays to be highly sensitive and specific, detecting <0.1TCID50 of virus stocks. Regression analysis and standard curves calculated from the Ct-values from 10-fold serial dilutions of virus stocks showed that the assays were highly reproducible over a wide range of RNA input. Thirty-nine field samples were tested in triplicate and compared with traditional RT-PCR. Overall, the real-time assays detected 35 positive compared to 29 positives in standard RT-PCR, and were thus shown to be more sensitive for detecting salmonid alphaviruses in field samples.

Alphavirus↗

Emergence of a novel subgroup within the widely circulating lineage of foot-and-mouth disease virus serotype Asia 1 in India.

The complete VP1 encoding (1D) gene of 54 foot-and-mouth disease (FMD) virus serotype Asia1 field isolates, most of which were isolated during 2000 and 2001, was sequenced. The phylogenetic analysis identified a novel subgroup (>10% nucleotide divergence) within the widely circulating lineage of this serotype. The newly emerged viruses were responsible for disease outbreaks in both cattle and buffaloes and were present in six different states in the country. Amino acid sequence comparison of these isolates revealed significant sequence divergence at many of the amino acid positions in comparison to those of lineage VI-A and C. Emergence of such viruses may affect the efficacy of vaccine strain currently used for protection against FMD in India.

Amino Acid Sequence↗

Leptospirosis in trout farmers.

A worker on a trout farm died from serologically confirmed leptospirosis. Four other workers at the trout farm had recently had an influenza-like illness; one had had jaundice. The man with jaundice had high leptospiral antibody titres, and two others had titres of 1/30. The remaining serum sample was negative. Family members and neighbours not associated with the farm had no detectable leptospiral antibodies. There was evidence of rat infestation around the ponds and in a shed used for storing trout food. Pond water or trout food contaminated with rat urine is believed to have been responsible for the outbreak. Another case occurred in a fish farmer elsewhere and it is thought he was infected through wading in rat polluted water with defective rubber boots. A survey to determine the incidence of leptospirosis in fish farm workers is under way.

Animal Feed↗

Foodborne viral illness--status in Australia.

Norwalk-like virus contamination of oysters and orange juice, and hepatitis A virus contamination of oysters have been responsible for large outbreaks of foodborne viral disease in Australia. Rotavirus, adenovirus, astrovirus, parvovirus and other enteroviruses also contribute to the incidence of gastroenteritis in this country but the role of foods and waters in transmitting these viruses is unclear. Protocols for the investigation, surveillance and reporting of foodborne viral illness require further development to enable a more accurate description of the problem. Few laboratories have the capability to analyse foods for viruses and specific training in this technology is needed. Management of food safety in Australia largely relies on the implementation of HACCP principles, but these need to be adapted to address the specific risks from viruses.

Adenoviridae↗

A seven-year survey of Klebsiella pneumoniae producing TEM-24 extended-spectrum beta-lactamase in Nice University Hospital (1994-2000).

The aim of this study was to investigate TEM-24-producing isolates of Klebsiella pneumoniae, and their clonal dissemination in Nice University Hospital. During the 1994-2000 period, a total of 263 non-repetitive isolates of ESBL-producing K. pneumoniae were collected. Most of these isolates were highly resistant in vitro to ceftazidime, cefotaxime and aztreonam, but susceptible to cefoxitin and imipenem. Resistance profile analysis revealed seven predominant antibiotypes (P1 to P7). Isoelectric focusing evidenced beta-lactamase activity, with a chromosomal penicillinase (pl 7.7), and one or two additional enzymes with pls ranging from 5.4 to 8.2 identified as presumed TEM-1 pl 5.4, TEM-3 pl 6.3, TEM-24 pl 6.5, SHV-3 pl 7.0, SHV-4 pl 7.8, SHV-5 pl 8.2, or other unidentified beta-lactamases. Among these K. pneumoniae, 130 isolates produced TEM-24, and 115 of them were highly resistant in vitro to quinolones (antibiotype P1). This phenotype was responsible for an outbreak in a medical intensive care unit from March to September 2000. Four isolates submitted were genetical sequenced, and shared 99.9% homology with tem-24 (GenBank no. X 65253). Pulsed-field gel electrophoresis and enterobacterial repetitive intergenic consensus polymerase chain reaction (PCR) (ERIC2-PCR) applied to 28 non-epidemic and six epidemic isolates yielded concordant results. Molecular typing revealed the persistence and dissemination of a single clone of TEM-24 producing K. pneumoniae in Nice Hospital during the seven-year study period.

Anti-Bacterial Agents↗

Mycobacterium avium complex endocarditis: spurious diagnosis resulting from laboratory cross contamination.

Contamination between specimens within clinical microbiology laboratories may be responsible for spurious outbreaks of mycobacterial infections. We report the case of a patient who had culture-negative endocarditis and whose cardiac tissue obtained at surgery yielded Mycobacterium avium complex (MAC). Epidemiologic investigation suggested cross contamination probably occurred during processing of the sputum specimens of a patient with pulmonary MAC disease and the cardiac samples from our patient; molecular strain typing showed the isolates from both patients to be identical. When mycobacterial infection rates increase or an unexpected case of mycobacterial infection occurs, the clinician should be alert to the possibility of cross contamination in the laboratory as a possible explanation.

Diagnostic Errors↗

Epidemiological typing of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates by pulsed-field gel electrophoresis and antibiotic susceptibility patterns.

Over a 16-month period, Klebsiella pneumoniae isolates from 102 patients admitted to a university hospital in Liege (Belgium) produced extended-spectrum beta-lactamases. Pulsed-field gel electrophoresis of genome macrorestriction patterns with XbaI and antibiotic susceptibility patterns subdivided 39 isolates into eight clonally related groups. Two of them were implicated in the course of this outbreak. They were responsible for successive waves of infection or colonization in different wards of the hospital while the others were encountered sporadically. A beta-lactamase with an isoelectric point of 7.6 and consistent with type SHV-2 characterized all nine isolates chosen among both major groups.

DNA, Bacterial↗

-Prevention of respiratory syncytial virus infection-.

Respiratory syncytial virus (RSV) is responsible for annual outbreaks of severe respiratory disease among infants. Its prevention has been considered for many years but the first vaccination trials resulted in diseases of increased severity. New vaccines are in progress with promising results, although their efficacy in the presence of maternal antibodies, and their tolerance in very young babies, remain to be demonstrated. Concerning passive immunization, intravenous anti-RSV immunoglobulins have been successfully tested in children at risk of severe bronchiolitis; however this prophylaxis is not applicable to healthy children. The use of local immunization with intranasal monoclonal antibodies is under study. While waiting for a safe and efficient immunization against RSV, prevention of nosocomial infections by cohorting and handwashing is recommended.

Administration, Intranasal↗

Occupational contact sensitization to the stabilized chlorinated paraffin fraction in neat cutting oil.

Twelve men developed contact sensitization to a neat cutting oil to which they were occupationally exposed in the same factory. Serial patch testing ultimately showed strong positive reactions to the chlorinated paraffin fraction of the oil in all 12 patients, whereas negative results were obtained in all 25 controls. Patch testing to pure chlorinated paraffin, on the other hand, gave negative results. Unexplained positive patch test reactions to epoxy resin from the standard series were elicited in half of the cases, suggesting that an epoxy stabilizer within the chlorinated paraffin fraction was the most likely sensitizer responsible for the outbreak of dermatitis. Because of insufficient manufacturer cooperation, we were not able to specifically identify the sensitizer. A number of deficiencies in the work practice, which accounted for the relatively large size of the sensitized group, were identified.

Adult↗

Risk factors for mortality associated with respiratory disease among Menz and Horro sheep in Ethiopia.

A retrospective case-control study was conducted on 6718 sheep of two breeds (2772 Horro and 3946 Menz) on risk factors for mortality associated with respiratory disease (MARD) in Ethiopia, based on data collected between October 1993 and December 1997. Potential risk factors examined were breed, gender, age, month, and air temperatures.Fifty-four per cent of total deaths in the flock could be attributed to respiratory disease and the annual MARD rate ranged between 6.3 and 19.0%. There was significant breed (P<0.0001) and gender (P<0.0001) difference in MARD. The Horro breed had a higher (P<0.0001) annual MARD than the Menz breed (16.5+/-0.18 vs. 12.4+/-0.15%). A higher (P<0.0001) proportion of males suffered than females (15.1+/-0.23% vs. 13.8+/-0.13%). Age was also an important risk factor for MARD: there was a strong polynomial relationship (R(2)=0.91, P<0.0001) between MARD and age; the risk of being young if a sheep was a MARD case was high. MARD was high between October and March but relatively low between the months of April and September. There was a significant (P<0.05) negative cubic relationship (R(2)=0.49) between monthly MARD and monthly average minimum air temperatures. There was also a significant (P<0.01) positive exponential relationship (R(2)=0.61) between monthly MARD and average monthly daily deviation between maximum and minimum air temperatures. Timely health and management interventions focusing on these factors are necessary to alleviate losses from MARD. Understanding variations in MARD risk within a population can enhance early response to potential outbreaks, reducing losses.

Animals↗

Vibrio cholerae O139 Bengal: odyssey of a fortuitous variant.

Vibrio cholerae O139, the new serogroup associated with epidemic cholera, came into being in the second half of the year 1992 in an explosive fashion and was responsible for several outbreaks in India and other neighbouring countries. This was an unprecedented event in the history of cholera and the genesis of the O139 serogroup was, at that time, thought to be the beginning of the next or the eighth pandemic of cholera. However, with the passage of time, the O1 serogroup of the El Tor biotype again reappeared and displaced the O139 serogroup on the Indian subcontinent, and there was a feeling among cholera workers that the appearance of this new serogroup may have been a one-time event. The resurgence of the O139 serogroup in September 1996 in Calcutta and the coexistence of both the O1 and O139 serogroups in much of the cholera endemic areas in India and elsewhere, suggested that the O139 serogroup has come to stay and is a permanent entity to contend with in the coming years. During the past 10 years, intensive work on all aspects of the O139 serogroup was carried out by cholera researchers around the world. The salient findings on this serogroup over the past 10 years pertinent to its prevalence, clinico-epidemiological features, virulence-associated genes, rapid screening and identification, molecular epidemiology, and vaccine developments have been highlighted.

Antigens, Bacterial↗

Development of a novel hand-held immunoassay for the detection of enterohemorrhagic Escherichia coli O157:H7.

Escherichia coli O157:H7 is an important human pathogen responsible for numerous outbreaks of hemorrhagic colitis and hemolytic uremic syndrome world-wide. A portable detection device is needed for field testing and point-of-care testing. Poly(dimethylsiloxane) (PDMS) is a solid substrate well suited for adsorption of macromolecules. The purpose of this study was to develop a hand-held enzyme-linked immunosorbent assay (ELISA) for the detection of E. coli O157:H7 antigens. The prototype consisted of three modules: one for loading reagents, a second for immunosensor detection, and a third for discharge of wastes. Reagent delivery was achieved by using 1-ml syringes embedded within the loading module. The detection module was based on a PDMS layer on which varying concentrations of E. coli O157:H7 antigens, and negative controls (Lactobacillus rhamnosus R011 and phosphate-buffered saline) were passively adsorbed. Commercially available goat anti-E. coli O157:H7 antibody was used as a primary antibody, a donkey anti-goat IgG conjugated with horseradish peroxidase was used as a secondary antibody, and a precipitating substrate was employed for colorimetric detection. Results obtained with the prototype were compared to those obtained using a conventional nitrocellulose membrane-based immunoassay. Using the prototype, E. coli O157:H7 antigens, in quantities from 4 to 400 ng, were accurately detected. This detection limit was comparable to that observed using conventional dot-blot assays. The PDMS layer could be re-used without loss of sensitivity. Colorimetric detection could be visualized readily without the need for sophisticated equipment. Furthermore, this device can be adapted to perform diagnostics for other microbial pathogens currently detected using immunoassay methodology.

Colorimetry↗

Epidemiology of Clostridium difficile-associated infections.

Clostridium difficile is responsible for 15-25% of cases of antibiotic-associated diarrhea (AAD) and for virtually all cases of antibiotic-associated pseudomembranous colitis (PMC). This anaerobic bacterium has been identified as the leading cause of nosocomial infectious diarrhea in adults and can be responsible for large outbreaks. Nosocomial C. difficile infection results in an increased length of stay in hospital ranging from 8 to 21 days. Risk factors for C. difficile-associated diarrhea include antimicrobial therapy, older age (>65 years), antineoplastic chemotherapy and length of hospital stay. Other interventions with high risk associations are enemas, nasogastric tubes, gastrointestinal surgery and antiperistaltic drugs. Prospective studies have shown that nosocomial transmission of C. difficile is frequent but often remains asymptomatic. Patients can be contaminated from environmental surfaces, shared instrumentation, hospital personnel hands and infected roommates. Once an outbreak starts, C. difficile may be spread rapidly throughout the hospital environment where spores may persist for months. Measures that are effective in reducing incidence of C. difficile infections and cross-infection include: (i) an accurate and rapid diagnosis, (ii) appropriate treatment, (iii) implementation of enteric precautions for symptomatic patients, (iv) reinforcement of hand-washing, (v) daily environmental disinfection, and (vi) a restrictive antibiotic policy. C. difficile is a common cause of infectious diarrhea and should be therefore systematically investigated in patients with nosocomial diarrhea.

Anti-Bacterial Agents↗

Foot-and-mouth disease in the UK: what should we do next time?

Mathematical models were used to guide the UK foot-and-mouth disease (FMD) control policy during the 2001 epidemic. Based on data collected during the epidemic, prospective modelling using a variety of approaches gave the same conclusions: (i) that the epidemic had not been brought under control by 'traditional' methods, and (ii) that neighbourhood control measures (the contiguous cull) could bring the epidemic under control and result in a net saving of livestock. Retrospective analyses suggest that the subsequent course of the epidemic was consistent with a beneficial impact of the contiguous cull and that it would have been difficult to achieve a better outcome using reactive vaccination, which would have required very large-scale vaccination programmes to have been implemented quickly. Perhaps the most important lesson to be learned is the vital importance of rapid and decisive intervention in response to an outbreak, including the earliest possible implementation of a national ban on the movement of livestock once the presence of disease is confirmed.

Animals↗

A phylogenetic-tree analysis elucidating nosocomial transmission of hepatitis C virus in a haemodialysis unit.

Nosocomial transmission of hepatitis C virus (HCV) subtype 1b involving 11 haemodialysis patients occurred in a haemodialysis unit in Japan in March 2000. Sequencing of the HCV-E1 region (411-bp) and phylogenetic-tree analysis showed near identity between HCV isolates derived from these patients and a haemodialysis patient who was known to be HCV-positive. The mode of transmission could not be conclusively established, but retrospective analysis suggested that the sharing of contaminated multidose vials of heparin-saline solutions, which were prepared in the Haemodialysis Center using accidentally contaminated instruments such as needles, may have been responsible for the outbreak. To prevent transmission of HCV in a haemodialysis unit, it may be important to observe strictly standard precautions and to prepare all medications in the Pharmacy. After these measures were taken, no new seroconversions and no new nosocomial transmissions of HCV have been observed in our haemodialysis unit.

Adult↗

SARS: epidemiology.

Severe acute respiratory syndrome (SARS) originated in Southern China in November 2002, and was brought to Hong Kong in February 2003. From Hong Kong, the disease spread rapidly worldwide but mostly to Asian countries. At the end of the epidemic in June, the global cumulative total was 8422 cases with 916 deaths (case fatality rate of 11%). People of all ages were affected, but predominantly females. Health care workers were at high risk and accounted for one-fifth of all cases. Risk factors for death included old age and comorbid illnesses, especially diabetes. The disease is caused by a novel coronavirus and is transmitted by droplets or direct inoculation from contact with infected surfaces. Contaminated sewage was found to be responsible for the outbreak in a housing estate in Hong Kong affecting over 300 residents. The mean incubation period was 6.4 days (range 2-10). The duration between onset of symptoms and hospitalisation was from 3 to 5 days. The relatively prolonged incubation period allowed asymptomatic air travellers to spread the disease globally. The number of individuals infected by each case has been estimated to be 2.7. Effective control of nosocomial transmission included early detection of disease, strict isolation of patients, practice of droplet and contact precautions and compliance with the use of personal protective equipment. Effective control of disease spread in the community included tracing and quarantine of contacts. Development of a validated diagnostic test and an effective vaccine as well as elimination of possible animal reservoirs are measures needed to prevent another epidemic.

Adolescent↗

The crystal structures of severe acute respiratory syndrome virus main protease and its complex with an inhibitor.

A newly identified severe acute respiratory syndrome coronavirus (SARS-CoV), is the etiological agent responsible for the outbreak of SARS. The SARS-CoV main protease, which is a 33.8-kDa protease (also called the 3C-like protease), plays a pivotal role in mediating viral replication and transcription functions through extensive proteolytic processing of two replicase polyproteins, pp1a (486 kDa) and pp1ab (790 kDa). Here, we report the crystal structures of the SARS-CoV main protease at different pH values and in complex with a specific inhibitor. The protease structure has a fold that can be described as an augmented serine-protease, but with a Cys-His at the active site. This series of crystal structures, which is the first, to our knowledge, of any protein from the SARS virus, reveal substantial pH-dependent conformational changes, and an unexpected mode of inhibitor binding, providing a structural basis for rational drug design.

Amino Acid Chloromethyl Ketones↗

Malaria-attributable morbidity in Assam, north-eastern India.

Malaria is endemic in the Indian state of Assam and transmission of the causative parasites is perennial and persistent. The available data on malaria-related morbidity and mortality in the state for the years 1991-1999 have been reviewed. Over this period, Plasmodium falciparum was the predominant parasite, causing 58%-68% of the malaria cases; all other cases were attributed to P. vivax. All malaria-related deaths were attributed to P. falciparum infection, and the numbers of such deaths were correlated with the numbers of cases of P. falciparum malaria. The deaths occurred mostly in the rainy season (April-September) and among all age-groups of both sexes. The factors responsible for focal outbreaks of malaria across the state are discussed in relation to the existing health infrastructure.

Adolescent↗