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PubMed2006

Frequent emergence of resistance in Clostridium difficile during treatment of C. difficile-associated diarrhea with fusidic acid.

Samples from patients with Clostridium difficile-associated diarrhea (CDAD) that were randomized to fusidic acid (n = 59) or metronidazole (n = 55) therapy for 7 days were cultured for Clostridium difficile in feces on days 1, 8 to 13, and 35 to 40. Of the patients who were culture positive only before treatment, 77% (36/47) were permanently cured (no treatment failure and no clinical recurrence), compared to 54% (22/41) of those with persistence of C. difficile at one or both follow-ups (P = 0.03). A similar association between bacterial persistence and a worse outcome of therapy was seen in both treatment groups. Resistance to fusidic acid was found in 1 of 88 pretherapy isolates available, plus in at least 1 subsequent isolate from 55% (11/20) of patients who remained culture-positive after fusidic acid therapy. In 10 of these 11 patients, the resistant follow-up isolate(s) belonged to the same PCR ribotype as the susceptible day 1 isolate, confirming frequent emergence of resistance to fusidic acid during treatment. Despite this, 5 of these 11 patients were permanently cured with fusidic acid, relative to 5 of 9 patients with susceptible C. difficile at follow-up (P = 1.0). None of the 36 PCR ribotypes of C. difficile identified was associated with any particular clinical outcome or emergence of fusidic acid resistance. In conclusion, culture positivity for C. difficile was common after both fusidic acid and metronidazole therapy and was associated with treatment failure or recurrence of CDAD. Development of resistance in C. difficile was frequent in patients given fusidic acid, but it was without apparent negative impact on therapeutic efficacy in the actual CDAD episode.

Anti-Bacterial Agents↗

PubMed2000

Use of moxidectin treatment in the investigation of abomasal nematodiasis in wild reindeer (Rangifer tarandus platyrhynchus).

An experiment was conducted to evaluate moxidectin as a tool for understanding the impact of parasitism on wild Svalbard reindeer (Rangifer tarandus platyrhynchus). Adult females were injected subcutaneously with moxidectin at a dose rate of 0-4 mg/kg bodyweight, and groups of animals were culled within its expected period of efficacy (around 14 days) or around 12 or 24 weeks after treatment. Moxidectin was effective in eliminating the reindeers' abomasal worm burdens, and although they became reinfected, worm burdens were significantly lower in the treated animals compared to the untreated controls for up to 24 weeks after treatment. Nematode eggs did not reappear in faeces until five weeks after treatment, a similar period to that claimed by the manufacturer for sheep and cattle. Animals culled 12 and 24 weeks after treatment had been reinfected and harboured a wide range of abomasal worm burdens which contributed to the understanding of the seasonal variation in the relationship between faecal egg count and worm burden.

Animals↗

PubMed1976

Synthesis of 11, 12-2H2- and 11, 12-3H2-labeled chenodeoxycholic and lithocholic acids.

Deuterium- and tritium-labeled chenodeoxycholic acid and lithocholic were prepared by catalytic reduction of their respective delta11 derivatives. Structures of the intermediates and their isotopic purity were verified by chemical ionization and electron impact mass spectrometry and by nuclear magnetic resonance spectroscopy. Experimental conditions for reductive deuteration were defined which gave complete reduction of the olefin and a product of high isotopic purity. Conditions for optimal tritiation were developed with which little exchange of protons with the solvent occurred; the product had high specific activity. To test biological stability of the label, the 3H-labeled chenodeoxycholic acid was administered simultaneously with 14C-labeled chenodeoxycholic acid to two healthy subjects and the 3H/14C ratio in bile was determined daily for several days. The ratio remained identical to that administered, suggesting that the 11,12-3Hlabel in chenodeoxycholic acid is stable during enterohepatic cycling and can be used for valid estimates fo bile acid kinetics in many by the isotope dilution technique.

Chenodeoxycholic Acid↗

PubMed1994

PCBs and organochlorine pesticide residues in otters (Lutra lutra) and in otter spraints from SW England and their likely impact on populations.

PCB and organochlorine pesticide residues were determined in otter (Lutra lutra) spraints (faeces) from nine catchment regions in SW England over the period 1989-1991. Results of analyses of tissues from 22 otters are also presented. Dieldrin occurred in the majority of spraint samples and p,p-DDE and total PCBs in all. Lindane occurred mainly in samples collected in spring. Lindane was not found in otter tissues collected after 1991, but dieldrin, p,p-DDE and PCBs were found in all tissues. Dieldrin and p,p-DDE concentrations were strongly correlated in otter tissues, but there were no correlations with lindane or PCBs. Mean concentrations of contaminants varied widely between catchments. It was considered that PCBs were the compounds of most concern in influencing otter populations and that levels in spraints from one catchment were likely to be sufficiently high to exert a negative effect on populations. While levels of PCBs were elevated above background level in several other catchments and some individual otters had high levels of PCBs, it was considered that they were not sufficient to significantly hinder further population consolidation of otters in SW England.

Animals↗

PubMed2005

Seasonal and spatial variation in the monitoring parameters of Gaza Beach during 2002-2003.

Seawater pollution problems are gaining interest worldwide because of their public health impact and other issues. Levels of pollutants at Gaza Beach determined the only recreational area for the inhabitants of Gaza were recently determined and shown to be high. Five bathing sites in the Middle Camps area along the Gaza Strip coastal area were monitored for 1 year (fortnightly). Seawater samples were subjected to microbiological analysis (fecal coliforms and fecal streptococci) and physiochemical analysis (water temperature, pH, electroconductivity, dissolved oxygen (DO), biochemical oxygen demand, total, Kjeldahlnitrogen, and ammonia). Results revealed seasonal and locational variation in all of the parameters studied. The highest levels of pollution were detected during winter, especially after a rainfall or after a discharge from Wadi Gaza. Locations associated with sewage discharge had the highest fecal indicator levels. Statistical analysis of the data demonstrated significant linear correlations between several parameters (e.g., DO and biochemical oxygen demand, biochemical oxygen demand and fecal coliforms, biochemical oxygen demand and fecal streptococci).

Ammonia↗

PubMed2005

The impact of bird populations on the microbiological quality of bathing waters.

To ensure optimum quality at Bathing Waters, the control of diffuse sources of bacterial contamination is receiving increasing attention. As part of an initiative to improve the quality of the EU designated bathing waters on the Fylde Coast (North West England), a project was undertaken to quantify the faecal indicator load from birds and assess the significance on water quality. High bird counts are encountered on the Fylde Coast with gulls, feral pigeons and starlings being prominent. The piers at Blackpool make an attractive roost for starlings with numbers peaking at over 30,000 in late summer. Systematic recording of bird numbers and locations was undertaken during 2001/2. Estimates were also made of the daily faecal organism production by the different species. The spatial distribution of faecal organisms from the bird population was statistically linked to synoptic water quality data. This allowed estimates to be made of the contribution from birds to the faecal pollution load at the bathing waters. The work confirmed a statistically significant link between bird populations and water quality with a marked seasonal bias.

Animals↗

PubMed2002

Characterization of Norwalk-like virus associated with gastroenteritis in Indonesia.

Norwalk Virus and Norwalk-like viruses (NLVs) are reportedly responsible for 2.5-4.0% of nonbacterial acute gastroenteritis (NBAG) worldwide. To help clarify the impact of NLVs on NBAG in Indonesia, stool specimens from 102 patients, 74 with NBAG and 28 with BAG, were screened for the presence of NLVs, using a reverse transcription-polymerase chain reaction (RT-PCR) assay. The specimens were subtyped using prototype-specific oligonucleotide probes and were sequenced and compared with published NLV sequences. Of the 102 specimens examined, 31 (30%) were found to be positive for NLVs. Type-specific probe analysis of the RT-PCR products indicated that 31 isolates hybridized to UK1 (Taunton agent) and UK3/4 (Hawaii agent/Snow Mountain agent) prototype strains. The results of this study indicate that prototype strains of NV or NLVs co-circulate in Indonesia and contribute to the overall level of acute gastroenteritis throughout the region.

Acute Disease↗

PubMed2006

Influence of cholesterol and fat in food on indirect parameters of exocrine pancreatic function.

Fecal elastase 1, chymotrypsin activity, and fat content in stool are clinical parameters of exocrine pancreatic function. The aim of this study was to clarify the possible impact of extreme changes in diet on fecal enzyme concentration/activity, since extreme diets may lead to wrong conclusions in the diagnosis of pancreatic insufficiency. Twelve healthy test persons followed 4 diet phases, each with a duration of 6 days. The 4 diet phases were (1) nearly fat-free with a low-cholesterol content; (2) high in fat and low in cholesterol; (3) high in cholesterol deriving from meat, and (4) high in cholesterol deriving from eggs. At the end of each diet phase, a 72-hour stool collection was carried out to measure fecal elastase 1, chymotrypsin and fecal fat content. The results showed no significant changes after each of the 4 diet phases. The clinical parameters of fecal elastase 1 and chymotrypsin activity in stool do not seem to be significantly influenced by fat and cholesterol deriving from food.

Adult↗

PubMed1996

The impact of rufloxacin given as prophylaxis to patients with cancer on their oral and faecal microflora.

A single dose of 200 mg/day rufloxacin was investigated for preventing infection and for its impact on the commensal flora in a pilot study of 62 patients undergoing cytotoxic treatment for cancer. No infection caused by Gram-negative bacilli occurred among 54 assessable patients but prophylaxis was replaced by empirical treatment for fever in 19 cases and because of an adverse event, in a further three cases. The remaining 32 patients completed prophylaxis. The number of oral Branhamella spp., faecal Enterobacteriaceae and Bacteriodes spp. were significantly reduced whereas there was little effect of rufloxacin on the numbers of the other oral and faecal microflora. However, resistance to rufloxacin increased among both oral viridans streptococci, coagulase negative staphylococci and the faecal enterococci. These preliminary data suggest that selective oral antimicrobial prophylaxis for patients with cancer might be achieved with once-daily rufloxacin.

Administration, Oral↗

PubMed1987

Bowel flora changes in humans receiving cefixime (CL 284,635) or cefaclor.

Twelve healthy young male subjects received either cefixime, a new oral cephalosporin (CL 284,635), or cefaclor (six subjects on each drug) orally for 2 weeks. In the case of cefixime, single daily doses of 400 mg were taken; with cefaclor, the dosage was 250 mg three times daily. Modest changes in the fecal flora were noted in both drug groups, but the changes were of different types. In the case of cefixime, there was more of an impact on the indigenous flora, and in the case of cefaclor, there was more ingrowth of new flora. With cefixime, Enterobacteriaceae were usually decreased (the decrease in Escherichia coli count was statistically significant), as were counts of clostridia and sometimes Bifidobacterium spp.; the Bacteroides fragilis group was eliminated in one subject. Coincident with these decreases, four subjects had increases in counts of group D streptococci of 3 logs or more. There was new appearance of Clostridium difficile in four subjects and of Staphylococcus aureus in one; four new strains of Enterobacteriaceae appeared. With cefaclor, there was no decrease of E. coli counts; two subjects had elimination of Bifidobacterium spp. There was little change in counts of group D streptococci. On the other hand, there were 13 new strains of Enterobacteriaceae, two of S. aureus, and three of C. difficile.

Bacteria↗

PubMedDate not supplied

Impact of rufloxacin and ciprofloxacin on the intestinal microflora in a germ-free mice model.

The impact of rufloxacin and ciprofloxacin on faecal microflora was investigated in an experimental germ-free mice model into which human gastrointestinal flora was introduced and stabilized. Animals received oral doses of 10, 40 or 80 mg rufloxacin/kg, 30 or 60 mg ciprofloxacin/kg once daily for 10 days, or no treatment. Microflora was studied before, during and 1 week after treatment. No significant effect ( < 2 log reduction, p > 0.05) on aerobic microflora was observed after rufloxacin as compared to controls, except for a marked decrease in enterobacteria and a slight decrease in enterococci, staphylococci and anaerobes at the highest dose. Both doses of ciprofloxacin significantly reduced enterobacteria and clostridia, while the lower dose slightly reduced peptococci, bifidobacteria and eubacteria. The depression of the intestinal ecosystem was reversible, except for enterobacteria at the higher ciprofloxacin dose. No bacterial resistance was detected after either treatment.

Administration, Oral↗

PubMed2005

Estimation of diffuse and point source microbial pollution in the ribble catchment discharging to bathing waters in the north west of England.

Achieving compliance with the mandatory standards of the 1976 Bathing Water Directive (76/160/EEC) is required at all U.K. identified bathing waters. In recent years, the Fylde coast has been an area of significant investments in 'point source' control, which have not proven, in isolation, to satisfactorily achieve compliance with the mandatory, let alone the guide, levels of water quality in the Directive. The potential impact of riverine sources of pollution was first confirmed after a study in 1997. The completion of sewerage system enhancements offered the potential for the study of faecal indicator delivery from upstream sources comprising both point sources and diffuse agricultural sources. A research project to define these elements commenced in 2001. Initially, a desk study reported here, estimated the principal infrastructure contributions within the Ribble catchment. A second phase of this investigation has involved acquisition of empirical water quality and hydrological data from the catchment during the 2002 bathing season. These data have been used further to calibrate the 'budgets' and 'delivery' modelling and these data are still being analysed. This paper reports the initial desk study approach to faecal indicator budget estimation using available data from the sewerage infrastructure and catchment sources of faecal indicators.

Bathing Beaches↗

PubMed1975

Diarrhoea in general practice: a sixteen-year report of investigations in a microbiology laboratory, with epidemiological assessment.

Results are presented of the laboratory examination of faeces specimens from 20,273 patients with acute diarrhoea. These were household index cases seen in general practice in a London borough during the years 1953-68. An annual average of about 2 per cent of households in the area were affected, but there was considerable fluctuation with year and season. Half the patients were children although only one-fifth of the population at risk was under 15 years of age. The greatest incidence of diarrhoea was among children under 5 years old. Male children, but female adults predominated. Specimens were sent for laboratory diagnosis at the discretion of the general practitioner. The laboratory found some abnormality in nearly a third and there were indications that transmissible infection was involved in about one-fifth of patients. The most common diagnosis was Sonne dysentery (9 per cent) which came in epidemic waves and made its greatest impact among young school children. Microscopy was useful, and giardiasis was diagnosed in 1-4 per cent of index patients. Other parasites were less commonly found. Fatty globules characteristic of an infectious condition we have called 'fatty diarrhoea' were frequently observed by microscopy in stools from young children and occasionally from older persons. Blood or pus cells were seen in less than half the shigella and salmonella infections and in a much smaller proportion of the remainder. A test for occult blood performed on specimens from all patients of 40 years or older was positive, in the absence of visible red cells, in a tenth of these cases. Other studies on the bacteriology of diarrhoea in general practice are referred to and some epidemiological comparisons made. The possible place of unidentified infective agents in the aetiology of undiagnosed diarrhoeas and of 'fatty diarrhoea' is discussed.

Adolescent↗

PubMed1996

[Protozoan infections and intestinal helminthiasis among the population of a village in the northern Sudan savannah area of Mali (West Africa)].

A cross sectional survey was carried out on intestinal parasites in a rural village located in a Sudan savannah area of Mali in September 1994. This survey was aimed to describe the prevalence of intestinal protozoa and helminths, and to evaluate the possible epidemiological impact of some sociobehavioural factors. A total of 209 stool specimens were examined with 3 methods: fresh stool examination, Kato thick smear technique and a formalin-ether concentration technique in a closed system. Cryptosporidium was also searched following the Ziehl-Neelsen staining and the immunofluorescence method using monoclonal antibody. Microsporidia were investigated by Trichrome staining technique. The concentration technique, as expected, was the more sensitive method: the protozoan cyst rate and the helminth egg rate were 70.3% and 11%, respectively. The low prevalence of intestinal nematodes, unexpected for this area, could be attributed to the improvement in sanitation (traditional WC present in 73.9% of the families), but also to the repeated treatments of the population against onchocercosis with ivermectin since 1992. We found no cases of isosporosis, cryptosporidiosis and microsporidiosis in our study population, neither significant association between socio-behavioural factors and parasitic infections.

Cross-Sectional Studies↗

PubMed1982

Stercoral ulceration.

Stercoral ulceration is the loss of bowel integrity from the pressure effects of inspissated feces. The lesion usually occurs in constipated, bedridden patients and presents as an isolated lesion in the rectosigmoid area. Because of associated diseases in the population at risk, perforation and hemorrhage, the principal complications, result in a mortality exceeding 50 per cent. The diagnosis of perforated stercoral ulceration should be considered in any patient with a long-standing history of constipation who presents with acute abdominal pain and clinical findings consistent with perforation of a hollow viscus. Early celiotomy with vigorous debridement and irrigation of the peritoneal cavity and either exteriorization or resection with proximal colostomy is the treatment of choice. Since constipation and colonic dysfunction are more common in the older patient, as the mean age of the population increases, the surgeon may encounter this problem more often. Four patients with stercoral ulceration managed at the Medical College of Virginia Hospitals are added to the 53 patients previously reported in the literature.

Adult↗

PubMed2025

Novel Bacteroides bacteriophage-like quantitative real-time PCR assays for human sewage pollution measurement.

A recent study reports the genome sequence of ΦB124-14, a bacteriophage capable of infecting a narrow subset of Bacteroides spp. closely associated with the human gut. To investigate the use of ΦB124-14 for fecal source identification applications, the genome was interrogated for human-associated genetic regions using bioinformatic and laboratory approaches. Fifty-three primer sets were tested using 100 fecal samples from ten animal sources, primary influent sewage from 36 geographical locations across the United States, and environmental surface waters with known human sewage impact. Based on candidate primer set end-point PCR analyses and next generation amplicon sequencing, two novel quantitative real-time PCR assays (qPCR), PS28 and PS30, were designed and evaluated. Both qPCR assays exhibited a sensitivity of 86.1 %, a specificity of 100 %, and successfully detected ΦB124-14-like genetic markers in sewage impacted environmental water samples. PS28 and PS30 performance was then compared to established DNA-based viral (CPQ_056 and CPQ_064) and bacterial (HF183/BacR287 and HumM2) human-associated qPCR assays. Findings indicated ΦB124-14 bacteriophage-like qPCR assays exhibited superior specificity, but markers consistently occurred at lower concentrations in United States primary influent sewage. Reduced sensitivity may be insufficient for application in U.S. environmental waters, especially when trace levels of sewage are present. Furthermore, paired measurements of ΦB124-14 and crAssphage bacteriophage-like sequences in high volume (10 L) primary influent sewage samples (n = 38) indicated significant correlations ranging from r = 0.593 (p < 0.0001; PS30 versus CPQ_056) to r = 0.938 (p < 0.0001; PS28 versus PS30). A comparison of bacteriophage-like marker concentrations with cultured GB-124 in sewage samples showed no significant correlations (r ≤ 0.215, p ≥ 0.183).

Sewage↗

PubMed2006

Efficacy of monensin sodium for the reduction of fecal shedding of Mycobacterium avium subsp. paratuberculosis in infected dairy cattle.

Reducing the quantity of Mycobacterium avium subsp. paratuberculosis (MAP) being shed by cows with Johne's disease should decrease the risk of spread of this disease to young stock. Previous work has suggested that monensin sodium decreases the pathologic lesions associated with Johne's disease, but the impact on shedding of viable MAP remains unknown. After serologic screening of 32 dairy herds in southwestern Ontario, 228 cows from 13 of these herds were enrolled into a randomized clinical trial. Fecal culture and PCR were used to identify 114 cows as potential fecal shedders, while another 114 cows were enrolled as ELISA negative, herd and parity matched controls. All cows were randomized to receive either a monensin controlled release capsule (CRC) or a placebo capsule. Serial fecal and blood samples were collected for fecal culture and serum ELISA testing over a 98-day period. On day 98 of the study, treatments were switched for all cows continuing in the trial. These remaining cows were followed for another 98 days with a similar sampling protocol. Mixed effect models were used to measure the impact of treatment on the number of colony forming units identified on fecal cultures over time. During the first 98 days of the study, cows treated with a monensin CRC were found to shed 3.4cfu per tube less than placebo treated cows (P=0.05). The serum ELISA S/P ratio was reduced by 1.39 units in cows given monensin (P=0.06). However, treatment with monensin did not reduce the odds of testing positive on serology. Only the cows shedding MAP on day 0 were found to have a reduced odds of testing positive on fecal culture when treated with monensin (OR=0.27; P=0.03). Monensin sodium administered to infected animals at 335mg/day marginally reduced fecal shedding of MAP in mature dairy cattle, but the biological significance of this reduction is unknown.

Animals↗

PubMed1992

Ecological effects of short-term ciprofloxacin treatment of travellers' diarrhoea.

Forty-two subjects travelling to Mexico for 11 days were enrolled in a randomized, double-blind, placebo-controlled trial comparing ciprofloxacin 250 mg twice daily for three days or placebo for treatment of travellers' diarrhoea. Seventeen (41%) subjects were randomized to treatment. By the last treatment day, all seven evaluable subjects in the ciprofloxacin group, and three of eight evaluable subjects in the placebo group were cured (P = 0.04). The mean time to cure was 26 h for ciprofloxacin and 60 h for placebo-treated patients (P = 0.03). Faecal specimen were collected pre-travel, after four days in Mexico, 48 h post-travel and four weeks post-travel. Potentially pathogenic Escherichia coli strains carrying diarrhoeagenic virulence genes were detected by DNA hybridization tests, during or after travel, in 41% of treated and 31% of asymptomatic travellers. Travel, irrespective of diarrhoea and type of treatment, had a minor impact on the aerobic and anaerobic microflora. In travellers with ongoing diarrhoea, a suppression of the numbers of anaerobic bacteria was found, but the microflora was otherwise virtually unaffected. Significantly increased frequencies of E. coli resistant to ampicillin, doxycycline, chloramphenicol and co-trimoxazole were found during and after travel in all categories of travellers, though more frequently in subjects who experienced diarrhoea. The susceptibility of Bacteroides spp. remained unchanged. The sensitivity of E. coli to ciprofloxacin was not affected by travel, except in four ciprofloxacin-treated subjects who acquired multiresistant E. coli with ciprofloxacin MICs of > or = 0.125 mg/L post-travel. Bacteroides strains with MICs of > or = 64 mg/L were isolated post-travel from four ciprofloxacin-treated patients, and from one of the other 34 travellers not treated with ciprofloxacin.

Administration, Oral↗