Prevalence of vancomycin-resistant enterococci in hospitalized patients and those living in the community in the Czech Republic

Between July 1, 2002 and December 31, 2003, rectal swabs from both hospitalized patients and community subjects in the Czech Republic were taken to ascertain the prevalence of vancomycin-resistant enterococci (VRE). The swabs were used for isolating and identifying enterococci and their susceptibility to antibiotics. Vancomycin resistance phenotypes were verified by PCR detection of vanA, vanB, vanC1 and vanC2 genes. A molecular biology analysis was performed in Enterococcus faecium VanA strains. During the observed period, 2691 rectal swabs from the hospitalized patients and 6529 rectal swabs from the subjects in community setting were examined. In total, 31 VRE of hospital origin and 13 community-population strains were isolated. The prevalence of VRE in the gastrointestinal tract was 1.9% in the hospitalized patients and 0.4% in the community subjects. The prevailing strains were Enterococcus faecium VanA (61.3%) in the VRE of hospital origin and Enterococcus gallinarum VanC (46.2%) in the community VRE. Mutual comparison between the hospital and community Enterococcus faecium VanA strains showed no similarity.     

The incidence and PCR detection of Campylobacter upsaliensis in dogs and cats

A study was made of the incidence of Campylobacter upsaliensis among dogs and cats suffering from acute or chronic diarrhoea; 225 dogs and cats were examined and 51 strains were identified, 16 (7%) of which were Camp. upsaliensis. When rectal swabs were taken from a control group of 126 dogs and cats without clinical symptoms, 19 Campylobacter spp. and four Camp. upsaliensis were identified. All the Camp. upsaliensis strains were isolated in dogs. The Campylobacter strains were identified on the basis of their biochemical characteristics and by PCR (polymerase chain reaction).     

in Vitro Activity of Antimycotic Agents Determined by e-Test Method Against Vaginal Shape Candida Species

Vaginal candidiasis continues to be a common cause of vaginal discharge, pruritus and other local complaints in women worldwide. Although numerous antimycotic agents are available for the treatment of yeast vaginitis there is little comparative data on the in vitro activity of these drugs. The objectives of this study were to isolate and identify the Candida species in the vagina and anus of patients treated in a gynaecology clinic, as well as determine the susceptibility to azolic compounds measured by the E-test method. Vaginal and rectal swabs were collected from 80 adult non-pregnant patients, seen at a gynaecological clinic, aged 18–59 years, with sexual activity, with and without vaginitis. The swabs were processed by methods routinely used for the detection of pathogenic yeasts. The susceptibility of the isolates to fluconazole, ketoconazole and itraconazole, was measured by the agar diffusion method (E-test), using RPMI 1640 medium with 2% glucose and phosphate buffer. Candida species (33) strains were isolated from 17 patients at similar proportions from both anatomical sites, and 12 patients harboured 24 strains of C. albicans in the vaginal and rectal tracts. Twenty one percent of the strains of C. albicans were resistant to ketoconazole, 54% were resistant to itraconazole and 0% were resistant to fluconazole. The sensitivity of strains isolated from the two sites were similar, indicating that these are strains of the same phenotype. This revised version was published online in August 2006 with corrections to the Cover Date.     

2005～2008年广东省诺如病毒胃肠炎暴发的分子流行病学特征

为研究广东省诺如病毒胃肠炎暴发疫情的分子流行病学特点,我们采集了2005～2008年期间24起急性暴发性胃肠炎患者的粪便和肛拭子标本,使用诺如病毒特异性引物,通过逆转录-聚合酶链反应(RT-PCR)技术进行检测,再经核苷酸序列测定以分析诺如病毒的基因型,同时收集急性暴发性胃肠炎患者的相关流行病学资料。结果显示:24起急性暴发性胃肠炎中19起由诺如病毒引起,时间主要集中在每年的10月至次年2月,2005年病毒胃肠炎暴发疫情是由GⅡ-3基因型病毒引起,主要为幼儿园和小学,发生地主要在内陆山区,2006年秋季疫情以后则均为GⅡ-4型的变异株2006b引起,主要为大学和社区,2007年疫情数比其他年份高1倍,发生地遍及广东全省。广东省诺如病毒变异株2006b在个别特殊的基因位点呈现出高度的地域一致性。随着诺如病毒流行株的基因型由GⅡ-3变为GⅡ-4型,广东省诺如病毒流行的强度大大增加,新出现诺如病毒变异株2006b引起的暴发波及地方多,涉及人群从低幼儿童为主扩展到全年龄组,表明GⅡ-4新变异株比其它毒株具有更高的侵袭力。     

雁门关地区羊致病性大肠杆菌的分离及生物特性分析

为了有效防控羊致病性大肠杆菌病,以雁门关地区养羊企业和规模专业户为研究对象,对临床健康羊和腹泻症状羊进行致病性大肠杆菌的分离、培养、生化试验、血清型鉴定、致病性试验以及耐药性研究.结果显示,从180头份(临床健康羊的小肠150头份,腹泻病羊的肛门棉拭子30头份)材料中分离培养出符合羊大肠杆菌生化特性的72株,其中25株...     

Year-round prevalence of norovirus in the environment of catering companies without a recently reported outbreak of gastroenteritis

Food handlers play an important role in the transmission of norovirus (NoV) in food-borne outbreaks of gastroenteritis (GE). In a year-round prevalence study, the prevalence of NoV in catering companies without recently reported outbreaks of GE was investigated and compared to the observed prevalence in catering companies with recently reported outbreaks. Swab samples were collected from surfaces in the kitchens and (staff) bathrooms in 832 randomly chosen companies and analyzed for the presence of NoV RNA. In total, 42 (1.7%) out of 2,496 environmental swabs from 35 (4.2%) catering companies tested positive. In contrast, NoV was detected in 147 (39.7%) of the 370 samples for 44 (61.1%) of the 72 establishments associated with outbreaks of gastroenteritis. NoV-positive swabs were more frequently found in winter, in specific types of companies (elderly homes and lunchrooms), and in establishments with separate bathrooms for staff. We found a borderline association with population density but no relation to the number of employees. Sequence analysis showed that environmental strains were interspersed with strains found in outbreaks of illness in humans. Thus, the presence of NoV in catering companies seemed to mirror the presence in the population but was strongly increased when associated with food-borne GE. Swabs may therefore serve as a valuable tool in outbreak investigations for the identification of the causative agent, although results should be interpreted with care, taking into account all other epidemiological data.     

Prevalence and distribution of Arcobacter species in various sources in Turkey and molecular analysis of isolated strains by ERIC-PCR

AIMS: To determine the prevalence of Arcobacter in various food, animal and water sources in Turkey and to subtype the isolated strains using enterobacterial repetitive intergenic consensus (ERIC)-PCR. METHODS AND RESULTS: A total of 806 samples consisting of chicken (100) and turkey meat (100); minced beef (27); rectal swabs from cattle (173), sheep (68) and dogs (62); cloacal swabs of broilers (100) and layers (100); gall bladders of cattle (50) and drinking water samples (26) were examined. A previously described membrane filtration method was used for the isolation. Isolates were identified at species level using multiplex-PCR and discriminated by ERIC-PCR for subtyping. Ninety-eight (12.1%) of the samples examined were found positive for arcobacters. Arcobacter spp. were isolated from 68%, 4%, 6.9%, 8% and 37% of chicken and turkey meats, rectal swabs and gall bladders of cattle and minced beef, respectively. No arcobacters were obtained from the rectal swabs of sheep and dogs, cloacal swabs of broilers and layers, and water samples examined. In total, 99 Arcobacter isolates were obtained. Of these isolates, 92 were identified as Arcobacter butzleri, five were Arcobacter skirrowii and two were Arcobacter cryaerophilus. Thirteen distinct DNA profiles among A. butzleri isolates were obtained by the ERIC-PCR. Of these profiles, eight were from chicken carcass, three from cattle rectal swab and two from minced beef meat isolates. Some of the isolates originated from different sources gave the same DNA profiles. All isolates of A. skirrowii and A. cryaerophilus gave different DNA profiles. CONCLUSIONS: Poultry carcasses, minced beef meat, rectal swabs and gall bladders of cattle were found to be positive for Arcobacter spp. A. butzleri was the predominant species isolated. In addition, large heterogeneity among the Arcobacter isolates was determined. SIGNIFICANCE AND IMPACT OF THE STUDY: Contamination of the poultry carcasses and minced beef meat, rectal and gall bladder samples of cattle with arcobacters poses a risk for both human and animal infections. Detection of several different Arcobacter strains may suggest multiple sources for contamination and infection.     

Viral infections of the Kenya baboon (Papio cynocephalus) in its natural habitat

Stools, rectal swabs, throat swabs, and tissues were collected from 508 baboons (Papio cynocephalus) in 17 areas of Kenya and Tanzania during 5 field trips between 1961 and 1968. A total of 11 isolations were made: nine agents were recovered from 508 fecal samples and 2 from 468 throat swabs. These isolates were identified as adenovirus serotypes AA153, SA7, SV15 and SV23. SV23 was found only in throat swabs and never from fecal material while AA153, SA7 and SV15 were recovered only from fecal material. One rectal specimen produced 2 serotypes, SV15 and SA7. No isolates were recovered from necropsy samples from 19 animals.     

A novel multiplex PCR assay for the detection of Salmonella enterica serovar Enteritidis in human faeces

AIMS: To develop a multiplex PCR assay for the detection of Salmonella enterica serovar Enteritidis in human faeces. METHODS AND RESULTS: A total of 54 Salmonella strains representing 19 serovars and non-Salmonella strains representing 11 different genera were used. Five primer pairs were employed in the assay. Three of them targeted to the genes hilA, spvA and invA that encode virulence-associated factors. A fourth primer pair amplified a fragment of a unique sequence within S. enterica serovar Enteritidis genomes. An internal amplification control (a fragment of a conservative sequence within the 16S rRNA genes) was targeted by a fifth primer pair. The assay produced two or three amplicons from the invA, hilA and 16S rRNA genes for 19 Salmonella serovars. All Salmonella and non-Salmonella strains yielded a band of an internal amplification control. For S. enterica serovar Typhimurium, four products (the fourth from the spvA gene), and for S. enterica serovar Enteritidis five amplicons (the fifth from the sdf gene) were observed. S. enterica serovar Enteritidis was cultured from three of 71 rectal swabs from diarrhoeal patients. Five specific amplicons were generated with the multiplex PCR assay only from culture-positive faecal samples. CONCLUSION: The multiplex PCR assay specifically detects S. enterica serovar Enteritidis. SIGNIFICANCE AND IMPACT OF THE STUDY: This is a novel multiplex PCR assay, which contains an internal amplification control and enables concurrent survey for Salmonella virulence genes.     

Rectal Swabs for Analysis of the Intestinal Microbiota

The composition of the gut microbiota is associated with various disease states, most notably inflammatory bowel disease, obesity and malnutrition. This underlines that analysis of intestinal microbiota is potentially an interesting target for clinical diagnostics. Currently, the most commonly used sample types are feces and mucosal biopsy specimens. Because sampling method, storage and processing of samples impact microbiota analysis, each sample type has its own limitations. An ideal sample type for use in routine diagnostics should be easy to obtain in a standardized fashion without perturbation of the microbiota. Rectal swabs may satisfy these criteria, but little is known about microbiota analysis on these sample types. In this study we investigated the characteristics and applicability of rectal swabs for gut microbiota profiling in a clinical routine setting in patients presenting with various gastro-intestinal disorders. We found that rectal swabs appeared to be a convenient means of sampling the human gut microbiota. Swabs can be performed on demand, whenever a patient presents; swab-derived microbiota profiles are reproducible, whether they are gathered at home by patients or by medical professionals in an outpatient setting and may be ideally suited for clinical diagnostics and large-scale studies.     

Detection of enterotoxic strains of Escherichia coli in children with diarrhea treated at the Child Health Center 1986-1988

Studies on detection of enterotoxigenic strains of E. coli were carried in 1986-1988. During this time 2324 rectal swabs from children with diarrhoea symptoms were tested. On the whole 701 E. coli were selected. The ability to produce thermolabile enterotoxin by E. coli strains was evaluated by three methods: Elek test, passive immunohemolysis and ELISA. Among selected E. coli strains enterotoxigenic strains accounted for 21.8% in 1986, 16.3% in 1987 and 28.2% in 1988.     

Isolation of varicella-zoster virus from pharyngeal and nasal swabs in varicella patients

Thirteen children aged 5 months to 4 years were observed during a varicella epidemic in an Infants' Hospital; except for two normal individuals, the children had various forms of congenital defects. Eleven of the children developed varicella. During the first 3 days of exanthem, a total of 17 VZ virus strains were isolated: 12 from vesicular fluid, 3 from 23 nasal and 2 from 22 pharyngeal swabs. No strain was isolated during the incubation period despite 57 and 56 swabs having been collected from the throat and nose, respectively; nor was VZ virus isolated from 6 pharyngeal and 7 nasal swabs taken on the first day of exanthem. Isolation attempts performed from vesicular fluid to control quality of the isolation conditions gave a positivity rate of 100%. Under these optimal isolation conditions VZ virus was found in the nose or throat alongside skin vesicles in four of the 11 ill children. Besides VZ virus, the pharyngeal and nasal swabs yielded, respectively, four and four cytomegalovirus strains. The cytomegalovirus infections were inapparent.     

Diagnostic differences in psychogeriatric patients in Toronto,New York and London,England.

National statistics on psychiatric illness in the elderly patient from Canada, the United States and the United Kingdom suggest great differences in morbidity in these three centres. The present study shows that these differences stem mainly from different diagnostic habits in the three countries, but also there were more alcoholics in the Canadian sample. In particular, the diagnostic bias of the New York psychiatrists towards diagnosing most elderly patients as senile was not shared by their Toronto colleagues. Some patients were psychiatrically well, in spite of receiving a psychiatric diagnosis, and could have been helped without hospitalization. In addition, some depressed patients were labelled senile. Recommendations include improvement of catchment and treatment facilities for the elderly alcoholic and the provision of psychogeriatric diagnostic centres.     

Factors affecting the increase of R plasmids during hospitalization

The incidence of the TEM -lactamases among 3,010 Gram-negative rods isolated from 670 anorectal swabs was determined by immunological tests. The results from 44 persons without hospital contact were compared with results from 242 hospitalized patients and 30 nurses working in the hospital. The TEM -lactamase has been found in 10% of the strains isolated from the control group and from patients on day 0 and in 20% of the strains isolated from nurses. On day 10, the number of TEM strains had risen to 15% in hospitalized patients but remained stable in the control group. The increase of TEM-producing strains is significantly favored in patients receiving antimicrobial agents, but also occurred in patients without antibiotic therapy. Patients in surgery acquired TEM-producing strain as much as patients in internal medicine. Older patients (35 years) acquired more TEM-producing strains even if they did not receive antibiotics. The factors influencing the prevalence of TEM-type -lactamase were the duration of hospitalization and the age of the patient.     

Incidence of lysogeny, colicinogeny, and drug resistance in enterobacteria isolated from sewage and from rectum of humans and some domesticated species.

Enterobacteria were isolated by streaking swabs of sewage and rectal swabs from human volunteers from domesticated animals. Thirty strains of human origin were identified as Escherichia coli. Out of 1,367 rectal isolates of animal origin, 21% were lysogenic (phi+), 29% were colicinogenic (col+), and 7% were col+ phi+. Out of 85 rectal samples more than 60% harbored variable numbers of col+ or phi+ bacteria. Lysogens harboring homoimmune prophages were detectable in six out of eight human subjects in sequential samples taken at weekly intervals. Chickens in Hong Kong are fed on antibiotic-containing feeds; the avian isolates contained the highest frequency (98%) of drug-resistant bacteria, whereas only 39% of the bovine and 61% of the human isolates were drug resistant. Transmissible drug resistance was demonstrable in sewage isolates and those from animal sources; the highest frequency (58%) of resistance donors was shown by the avian isolates, and the lowest (9%) was shown by the bovine isolates. Unselected marker analysis has shown that a vast majority of multiply resistant donors of diverse origins are able to transmit multiple resistance.     

2007年北京地区儿童手足口病病原的初步筛查

2007年4～6月儿童手足口病流行期间,对北京地区51例皮损症状典型、伴/不伴发热、无重症合并症的手足口病患儿采样,建立RT-PCR方法,以5'非编码区(5'UTR)肠道病毒通用引物、CA16和EV71 VP1区特异性引物直接对82份临床标本进行了初步筛查,肠道病毒阳性率达70.6%。检测病例中CA16阳性25例(25/51)、EV71阳性4例(4/51)、非CA16和EV71的肠道病毒阳性病例7例(7/51),三者比例约为6:1:2。2007年北京地区儿童轻症手足口病主要病原包括CA16和EV71,同时还存在一定比例其它肠道病毒。部分EV71毒株经测序验证及系统进化分析显示为C4基因亚型。     

Prevalence and significance of hepatitis B surface antigen in a general hospital.

Over a 6-month period 2025 patients admitted to New Mount Sinai Hospital, Toronto were screened for hepatitis B surface antigen (HBsAg) by counter-immunoelectrophoresis (CIEP) and radioimmunoassay (RIA). CIEP detected 12 HBsAg-positive patients and RIA 16. RIA is therefore the more sensitive test for HBsAg. Of the 16 patients 2 had liver disease previously diagnosed, 3 had malignant disease and 11 were asymptomatic carriers. Of the 11 carriers all were born in countries where the carrier rate is known to be high. Routine screening of hospital patients on admission is of no value in detecting unsuspected liver disease but is of value in detecting asymptomatic carriers, which is of importance for the patient and his family. Routine screening tests for HBsAg in Canadian hospitals that treat many patients born in countries with a known high HBsAg prevalence is recommended. Routine screening is also recommended in all hospitals in Mediterranean and Asian countries.     

Patient Delay in Colorectal Cancer Patients: Associations with Rectal Bleeding and Thoughts about Cancer

Rectal bleeding is considered to be an alarm symptom of colorectal cancer. However, the symptom is seldom reported to the general practitioner and it is often assumed that patients assign the rectal bleeding to benign conditions. The aims of this questionnaire study were to examine whether rectal bleeding was associated with longer patient delays in colorectal cancer patients and whether rectal bleeding was associated with cancer worries. All incident colorectal cancer patients during a 1-year period in the County of Aarhus, Denmark, received a questionnaire. 136 colorectal cancer patients returned the questionnaire (response rate: 42%). Patient delay was assessed as the interval from first symptom to help-seeking and was reported by the patient. Patients with rectal bleeding (N = 81) reported longer patient intervals than patients without rectal bleeding when adjusting for confounders including other symptoms such as pain and changes in bowel habits (HR = 0.43; p = 0.004). Thoughts about cancer were not associated with the patient interval (HR = 1.05; p = 0.887), but more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding (chi² = 15.29; p<0.001). Conclusively, rectal bleeding was associated with long patient delays in colorectal cancer patients although more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding. This suggests that assignment of symptoms to benign conditions is not the only explanation of long patient delays in this patient group and that barriers for timely help-seeking should be examined.     

Serotypes of Vibrio parahaemolyticus from clinical and environmental sources in Togo (West Africa).

Serological analysis of O and K antigens was performed on 343 strains of Vibro parahaemolyticus isolated from clinical and environmental sources in Togo. Only two strains were not typable by the available O antisera. K untypable strains were found in 4.8% of isolates from gastroenteritis patients, in 11% from healthy carriers, and in 47% and 46% of isolates, respectively, from water and fish samples. Thirteen serotypes identified in Togo are not considered in the Japanese antigenic scheme. The suitability of the Japanese typing scheme for geographic areas outside of Japan is discussed and its extension is suggested.     

Vibrio parahaemolyticus infectious for both humans and edible mollusk abalone

The aims of this study are to report evidence of the first laboratory-acquired infection of Vibrio parahaemolyticus associated with handling experimentally infected abalones and to describe the virulence of the two bacterial strains tested in these animals. Two strains of V. parahaemolyticus, one from the stool of a patient with acute gastroenteritis (strain 880713) and the other from the hemolymph of a diseased small abalone Haliotis diversicolor supertexta (strain 880915), were identified and characterized. Both strains were lethal to small abalone, with similar LD(50) values (8.36-8.41 x 10(4) colony-forming units/g abalone). Laboratory-acquired infection resulted in one individual experiencing two episodes of acute gastroenteritis due to handling virulence tests during a 1-week interval. Our present results suggest that a V. parahaemolyticus strain isolated from the stool of a patient with gastroenteritis was infectious for small abalone, a major species of edible mollusk abalone cultured in Taiwan, while a similar strain isolated from hemolymph of a diseased small abalone was infectious for humans. This is the first report of V. parahaemolyticus virulent to small abalone as a zoonotic pathogen.