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Targeted protein degradation by Salmonella under phagosome-mimicking culture conditions investigated using comparative peptidomics.

The pathogen Salmonella enterica is known to cause both food poisoning and typhoid fever. Because of the emergence of antibiotic-resistant isolates and the threat of bioterrorism (e.g. contamination of the food supply), there is a growing need to study this bacterium. In this investigation, comparative peptidomics was used to study S. enterica serovar Typhimurium cultured in either a rich medium or in an acidic, low magnesium, and minimal nutrient medium designed to roughly mimic the macrophage phagosomal environment (within which Salmonella are known to survive). Native peptides from cleared cell lysates were enriched by using isopropanol extraction and analyzed by using both LC-MS/MS and LC-FTICR-MS. We identified and quantified 5,163 peptides originating from 682 proteins, and the data clearly indicated that compared with Salmonella cultured in the rich medium, cells cultured in the phagosome-mimicking medium had dramatically higher abundances of a wide variety of protein degradation products, especially from ribosomal proteins. Salmonella from the same cultures were also analyzed using traditional, bottom-up proteomic methods, and when the peptidomics and proteomics data were analyzed together, two clusters of proteins targeted for proteolysis were tentatively identified. Possible roles of targeted proteolysis by phagocytosed Salmonella are discussed.

Bacterial Proteins↗

Turning up the heat on infection control--APIC's 31st Annual Educational Conference and International Meeting 2004.

Infection prevention and control is facing new challenges worldwide: emerging and reemerging infectious diseases, increasing resistance of bacterial pathogens, virtually unlimited possibilities of germ transmission due to travel activities, and the necessity to improve emergency and bioterrorism response capabilities. In a way it is designative that the Association of Professionals in Infection Control (APIC) met in Phoenix, the name of which is symbolic of rebirth. Accordingly the conference covered a wide spectrum of infection control-related topics and new aspects thereof. Recognized speakers provided an insight into basic principles and latest updates on several infectious diseases, detection and prevention strategies, patient safety as well as professional development, to name just a few. Networking was the magic word of the event, and all participants were successfully encouraged to start right away with it.

Communication↗

In vitro susceptibility to quinolones of Francisella tularensis subspecies tularensis.

Francisella tularensis is a potent pathogen and a possible bioterrorism agent, for which quinolones offer promising new therapeutic options. There are, however, no data on the susceptibility to quinolones of natural isolates of F. tularensis tularensis, the highly virulent North American subspecies. In the present study, 8 isolates of F. tularensis tularensis, originating from 8 different states of the USA, and 16 US isolates of F. tularensis holarctica were tested. All 24 isolates showed MIC values < or = 0.125 mg/l to 6 different quinolones. Against ciprofloxacin, the predominant quinolone used to date in therapy against subspecies holarctica, MIC values were consistently < or = 0.064 mg/l. Thus quinolones seem to be promising options for the treatment of tularemia, including cases caused by the highly virulent subspecies F. tularensis tularensis.

Animals↗

Export controls and biological weapons: new roles, new challenges.

This article considers the value of export controls in reducing the threat of biological weapons. It concludes that export control through export licensing is an essential element in the overall strategy to limit the spread of biological weapons. Modifications to existing export control systems can maximize the usefulness of export controls for limiting the threat of biological warfare and bioterrorism. Export controls are useful only within a broader strategy that includes both an arms control dimension and military defensive preparedness.

Australia↗

The medical threat of biological weapons.

There is a heightened threat of biological weapons being used for biological warfare or bioterrorism. Many of the microorganisms and toxins that may be used as such biological weapons can easily be acquired and mass produced. Dissemination of aerosols of these biological agents can produce mass casualties. If used by a terrorist they may overwhelm our current public health system. Some biological agents, such as Bacillus anthracis (anthrax) and botulinum toxin, are considered far more likely than others to be used as biological weapons; smallpox virus was apparently produced in mass quantities by the former Soviet Union and may also be a serious threat. The release of such agents could go undetected for several hours or days and would be followed by mass illnesses and a first line of response by the public health community. Rapid epidemiological investigation to identify the nature of the disease outbreak would be critical for limiting casualties. For many, but not all, biological agents there are medical treatments that can greatly lower the mortality rate. There currently are, however, insufficient supplies of medicinals and trained personnel to cope with a massive bioterrorist or biological warfare use of biological weapons. Increasing our preparedness is critical.

Bacterial Infections↗

Will emergency health care providers respond to mass casualty incidents?

INTRODUCTION: Emergency response plans often call on health care providers to respond to the workplace outside of their normal working pattern. HYPOTHESIS: Providers will report to work during a mass casualty emergency regardless of family duties, type of incident, or availability of treatment. METHODS: Survey of emergency personnel needed to respond to a mass casualty incident. Two scenarios were presented: one involving the release of a nontransmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. At critical time points, participants were asked whether they would report to work. Additional questions considered the effect of commonly used treatment dissemination methods. RESULTS: A total of 186 surveys were issued and returned. (45 physicians, 29 nurses, 86 EMS personnel, and 20 support staff); 6 were incomplete and excluded. Initial commitment rates were 78%. The highest commitment rate identified was 84% and the lowest was 18%. Any treatment dissemination method excluding providers' family members led to decreases in commitment rate, as did agents identified to be transmissible. CONCLUSIONS: As an event develops, fewer health care providers will report to work and at no time will all providers report when asked. This conclusion may be generalizable to several types of incidents ranging from pandemic influenza to bioterrorism. Identification of the causative agent is a major decision point for providers to return to or stay away from work. Offering on-site treatment of providers' family increases commitment to work. These factors should be considered in emergency planning.

Cross-Sectional Studies↗

Issues with the integration of technical information in planning for and responding to nontraditional disasters.

In the post-9/11 environment, it has become recognized that the response to man-made disasters (such as chemical spills, bioterrorism, and radiation dispersal) requires a much broader range of tools and technical knowledge than needed for natural disasters (i.e., hurricanes, earthquakes, or drought). This need also requires that those who develop technical information for disaster planning maintain a broader perspective of how the information will be used and what the priorities are for developing new information. In addition, the ability to communicate information within a context understandable to the "end user" has become more critical. The intent of this article is to present issues to help those who traditionally collect and interpret technical information (toxicology, risk assessment, mitigation planners, etc.) to better understand how their information is used in planning for and responding to incidents. These issues are similar to those experienced when trying to provide the users of information provided on material safety data sheets (MSDS) with an understanding of the value and limits of such information in decision making. Confounding the problem are the many sources that provide exposure limits and the limited amount of time the user has to understand the limits of the data during an emergency. While the Federal Response Plan integrates the efforts of multiple agencies, the "on-scene" responders are faced with trying to respond to contradictory strategies and applications of information. Sources of response technical information need to better communicate the limits of application/interpretation of that information in emergency situations.

Communication↗

T cell immunity to brucellosis.

Brucellosis is an ancient disease of animals and man that still threatens the health and prosperity of many, primarily in the third world, who depend on animal agriculture for their livelihood. Further, its pathogenicity and the facts that it is zoonotic is effectively eradicated from many Western nations make it a dangerous bioterrorism threat. Targeted human vaccination may reduce the various threats brucellosis poses. Significant effort has been expended toward this goal and many candidate vaccines exist. However, the ideal vaccine would be a subunit vaccine that specifically targets only the critical aspects of the immune response necessary to induce immunity. Much about the immune response, in particular the T cell response, remains to be discovered in order to accomplish that goal. In this review we focus on T cell responses to brucellosis with particular attention to the specific roles of T cell subtypes. We also point out areas of research on T cell responses that may allow exploitation of cutting edge vaccine technologies for the next generation vaccine for brucellosis.

Animals↗

Role of clinical microbiology laboratories in the management and control of infectious diseases and the delivery of health care.

Modern medicine has led to dramatic changes in infectious diseases practice. Vaccination and antibiotic therapy have benefited millions of persons. However, constrained resources now threaten our ability to adequately manage threats of infectious diseases by placing clinical microbiology services and expertise distant from the patient and their infectious diseases physician. Continuing in such a direction threatens quality of laboratory results, timeliness of diagnosis, appropriateness of treatment, effective communication, reduction of health care-associated infections, advances in infectious diseases practice, and training of future practitioners. Microbiology laboratories are the first lines of defense for detection of new antibiotic resistance, outbreaks of foodborne infection, and a possible bioterrorism event. Maintaining high-quality clinical microbiology laboratories on the site of the institution that they serve is the current best approach for managing today's problems of emerging infectious diseases and antimicrobial agent resistance by providing good patient care outcomes that actually save money.

Communicable Disease Control↗

Primary induction of human CD8+ cytotoxic T lymphocytes and interferon-gamma-producing T cells after smallpox vaccination.

This study measured the ability of a standard smallpox vaccine, given by scarification (by bifurcated needle), to induce primary human vaccinia virus-specific cytotoxic and interferon (IFN)-gamma-producing T lymphocyte responses. Because protection against smallpox may be mediated in part by T cell memory responses induced by vaccination, an analysis of the induction of primary human cytotoxic T lymphocytes (CTL) and IFN-gamma-producing T cell responses was performed. Although smallpox is no longer an epidemic threat under natural conditions, vaccination is still recommended for persons working with vaccinia viruses in the laboratory and for those who may be at risk from the potential use of smallpox virus as a bioterrorism agent. The results demonstrate that smallpox vaccine given by bifurcated needle induces strong vaccinia virus-specific CD8(+) CTL and IFN-gamma-producing T cell responses and provide baseline information useful for planning the immunologic assessment of future smallpox vaccines.

Adult↗

Future savings from measles eradication in industrialized countries.

Estimates are made of monetary savings associated with measles eradication in seven industrialized countries. Three scenarios were studied: First, changing from the present two-dose measles-mumps-rubella (MMR) immunization schedule to one-dose of MMR; second, the use of an MMR and mumps-rubella schedule; or third, continuing the present schedule. Results show that the largest savings (US $623 million) would be achieved by changing to a one-dose MMR schedule with an assumption of a 3% discount rate and measles eradication in 2010. The smallest overall savings would result from option 3, by use of a 5% discount rate and the assumption that measles eradication occurs in 2020 ($10 million). These savings are less than previously estimated for the United States, partly because of the assumption that measles vaccines will continue to be delivered in response to possible bioterrorism threats.

Canada↗

Smallpox vaccination and patients with human immunodeficiency virus infection or acquired immunodeficiency syndrome.

Smallpox vaccination strategies are evolving rapidly and have important implications for human immunodeficiency virus (HIV)-infected persons. Cell-mediated immunity is important for controlling both smallpox and vaccinia. For smallpox, the concern is a substantial increase in the associated mortality rate, which is 30% among healthy persons. For smallpox vaccination, the concern is progressive vaccinia, which is usually lethal but relatively uncommon. The risks associated with both smallpox and vaccinia viruses probably correlate with CD4 cell count, and, as a corollary, the best protection against infection with each is presumably immune reconstitution. It appears that all vaccinations will be voluntary, with 2 recommendations: (1) HIV-infected persons will be advised to decline preemptive vaccination, and (2) in the event of a bioterrorism attack involving smallpox, HIV-infected patients with exposures will be advised to receive vaccine.

Acquired Immunodeficiency Syndrome↗

Effect of sex on Coxiella burnetii infection: protective role of 17beta-estradiol.

Q fever is a zoonosis caused by Coxiella burnetii and recently has been recognized as a potential agent of bioterrorism. In Q fever, men are symptomatic more often than women, despite equal seroprevalence. We hypothesized that sex hormones play a role in the pathogenesis of C. burnetii infection. When C57/BL6 mice were injected with C. burnetii, bacteria load and granuloma numbers were lower in females than in males. Ovarectomized mice showed increased bacteria load in the spleen and the liver, similar to that found in males. The granuloma number was also increased in ovarectomized mice and reached the levels found in males. Tissue infection and granulomatous response are largely under the control of estrogens: treatment of ovarectomized mice with 17beta-estradiol reduced both bacteria loads and granuloma numbers. These results show that sex hormones control host response to C. burnetii infection and may account for host-dependent clinical presentation of Q fever.

Animals↗

Gentamicin and tetracyclines for the treatment of human plague: review of 75 cases in new Mexico, 1985-1999.

Streptomycin, an antimicrobial with limited availability, is the treatment of choice for plague, a fulminating and potentially epidemic disease that poses a bioterrorism concern. We evaluated the efficacy of gentamicin and tetracyclines for treating human plague. A medical record review was conducted on all 75 patients with plague who were reported in New Mexico during 1985-1999. Fifty patients were included in an analysis that compared streptomycin-treated patients (n=14) with those treated with gentamicin and/or a tetracycline (n=36). The mean numbers of fever days, hospital days, and complications and the number of deaths did not differ between patients treated with streptomycin and those treated with gentamicin. One patient who received tetracycline alone experienced a serious complication. Gentamicin alone or in combination with a tetracycline was as efficacious as streptomycin for treating human plague. The efficacy of a tetracycline alone could not be determined from the study.

Adult↗

Modified vaccinia Ankara: potential as an alternative smallpox vaccine.

Despite the declaration of smallpox eradication in 1980, the existence of variola stockpiles and the threat of bioterrorism demand that immunity to smallpox through vaccination be maintained. Although the currently available vaccine was used for the most successful medical intervention ever accomplished, it also is associated with side effects that are difficult to accept in a vaccine for a disease that has not been present for >25 years. Herein, we review alternative approaches to maintaining immunity to smallpox through vaccination with attenuated poxviruses, and we suggest modified vaccinia Ankara (MVA) as a leading candidate for an alternative smallpox vaccine.

Humans↗

Signs and symptoms predictive of death in patients with foodborne botulism--Republic of Georgia, 1980-2002.

Foodborne botulism is a severe, potentially fatal disease characterized by cranial nerve palsies and descending paralysis. Little is known about signs and symptoms predictive of death from botulism. We studied patients with botulism in the Republic of Georgia, which has the highest reported rate of foodborne botulism in the world. After abstracting medical records of patients with botulism who were hospitalized during 1980-2002, we performed classification-and-regression-tree analysis to identify clinical syndromes predictive of survival and death. We identified records for 706 patients hospitalized for foodborne botulism from 1980-2002. Trivalent antitoxin was administered to 623 patients (88%). Fifty-four (8%) died. Patients with shortness of breath and impaired gag reflex and without diarrhea were 23 times more likely to die than were patients without this syndrome. Validating this clinical prediction rule may help reduce mortality from botulism in Georgia. Validation in other settings could help public health preparations for large outbreaks of naturally occurring or bioterrorism-related botulism.

Adolescent↗

Development and experience with an algorithm to evaluate suspected smallpox cases in the United States, 2002-2004.

Concerns that smallpox, an eradicated disease, might reappear because of a bioterror attack and limited experience with smallpox diagnosis in the United States prompted us to design a clinical algorithm. We used clinical features of classic smallpox to classify persons presenting with suspected smallpox rashes into 3 categories: those with high, those with moderate, and those with low risk of having smallpox. The classification guides subsequent diagnostic strategies, limiting smallpox laboratory testing to high-risk persons to minimize the number of false-positive test results. From January 2002 through June 2004, the Centers for Disease Control and Prevention (CDC) received 43 consultations regarding suspected smallpox cases. No patient was at high risk for having smallpox. One patient was tested for the presence of variola virus. Varicella was the diagnosis for 23 cases (53%). The algorithm worked well to guide clinical and public health responses to suspected smallpox cases. The poster is available from CDC, and an interactive version and laboratory protocol are available at http://www.bt.cdc.gov/agent/smallpox/diagnosis/riskalgorithm/index.asp. We recommend use of the algorithm in the United States and elsewhere.

Adolescent↗