Improved 18-Hour Methyl Red Test

Standard methods for the methyl red (MR) test are not practical for routine use in clinical laboratories because of the necessarily prolonged incubation period. When read after overnight incubation, the usual MR test is often equivocal or falsely positive. The present study demonstrates the importance of standardizing the total volume of broth, the size of the vessel in which the cultures are incubated, and the density of the inoculum. In very small volumes of broth, cultures are better exposed to atmospheric oxygen, and thus MR-negative organisms tend to revert the initial acidic pH much more quickly than in deeper, large-volume broth cultures. In the proposed technique, a single colony was inoculated into a 0.5-ml amount of MR-Voges Proskauer (VP) broth (13- by 100-mm tube), and, after 18 to 24 hr at 37 C, one drop of MR was added. With this technique, the broth cultures produced either a definite red (positive) or yellow (negative) color, whereas various shades of orange were frequently observed when larger volumes of broth were tested after only 1 to 2 days of incubation. With 6.0-ml broth cultures, 18-hr MR tests were totally unreliable, but 18-hr tests in 0.5 ml of broth were comparable to the standard MR test performed after 5 days of incubation and superior to those performed after 48 hr in 6.0-ml broth cultures. With the proposed technique, the MR test can be incorporated readily into the routine scheme for identification of Enterobacteriaceae.     

Usefulness of the latex test for rapid detection of Salmonella O antigen in bacterial culture fluids and clinical specimens. III. Diagnostic field studies]

The aim of this study was to evaluate a latex reagent prepared in our laboratory for a routine diagnosis of Salmonellosis in humans. Liquid cultures in selenite broth (SF) (18-24 hr), previously inoculated with faeces samples of individuals suspected of being infected with Salmonella were subjected to the study. In these cultures, after 15 min. of heating at boiling temperatures, group antigens of Salmonella with an aid of polyvalent latex reagent A-E and monovalent reagents B, C1, C2, D, and E were searched. The results of latex test were compared to the results obtained by routine bacteriological examination. Studies performed in 13 laboratories of Sanitary Epidemiological Stations included 5246 faeces samples. Out of these samples 1835 (35%) reacted with monovalent latex reagent and 1897 (36.2%) samples were positive, for Salmonella by culture technique and belonged to 14 genera of group B, C1, D, and E. S. enteritidis was the most frequently isolated and encountered for 98.6% of all isolated strains. Latex test with A-E reagent was positive in 2246 (42.8%) of culture samples in SF medium, of which 1736 were positive by culture and 510 samples were negative for Salmonella in routine bacteriological examination. The samples positive in culture and with A-E latex reagent reacted in 97.2% with one monovalent reagent. Out of bacteriologically negative samples and reacting with A-E latex reagent 28.8% were positive with monovalent latex reagents. In summary, we can conclude that latex test used in a survey studies can be an usefull test in addition to routine bacteriological examination, since after 18-24 hr it allows with high credibility of 95% to confirm or exclude Salmonella in a tested sample. Such a procedure due to a shortening of routine diagnostic course brings significant savings. Moreover, latex test makes possible rapid detection of mixed infections with Salmonella of different serological groups. The use of extremely carefully, properly prepared selenite broth constitutes a basic condition for agreement between results of latex test and routine bacteriological investigation.     

Selection of methods of detecting lactose-fermenting Salmonella strains and evaluating their usefulness for diagnostic studies

Salmonella rods of subspecies I, lactose-fermenting were first isolated in Poland in 1980. They were isolated from a plus sample taken from a brain abscess of a child. Next strains were isolated from faeces of newborn and hospitalized children. Growth characteristic of colonies of lactose-fermenting Salmonella strains on selective-differentiating media (Mac Conkey's Levine, SS, So?tys) recommended for inoculation of clinical material resembled Escherichia coli. So far these type of colonies were omitted in diagnostic examinations. Lactose-fermenting variants showed on Bismuth sulfate agar "Difco" (WB) typical for Salmonella growth pattern. They grew on this medium after 48 hr of incubation in a form of black, medium sized colonies, with some metallic brilliance and characteristic blackening of the medium undercolonies. Precise knowledge of biochemical properties of lactose-fermenting Salmonella allows to supplement so far used diagnostic scheme with additional tests permitting differentiation of lactose-fermenting variants of Salmonella from the other members of Enterobacteriaceae family. Taking into consideration biochemical variants in diagnostic procedure i.e. lactose-fermenting Salmonella, allowedns to isolate in the years 1983-1985 lactose-positive strains in 1305 out of 2773 (47%) individuals positive for S. agona. In 1987, 246 persons (28.3%) out of 869 with lactose-fermenting Salmonella of various serotypes were simultaneously infected with lactose-negative variant. Lactose-fermenting strains of Salmonella belonged most frequently to the following genera: S. agona, S. enteritidis, S. oranienburg, S. typhimurium, and S. goldcoast. It was found that the modified diagnostic procedure makes possible the isolation and the identification of lactose-positive varians of Salmonella.     

Efficiency of different enrichment and isolation procedures for the detection of Salmonella serotypes in edible offal

Rapid detection systems for Salmonella in foodstuffs are currently being developed. However, existing standards still call for application of traditional methods employing pre-enrichment followed by selective enrichment and isolation. The efficacy of various methods was tested using 264 chicken and lamb organ meats. Pre-enrichment was carried out in Tryptone Soy Broth (TSB) and enrichment in Tetrathionate Brilliant Green Broth (TTB) at 37°C, Selenite Broth with Brilliant Green and Sulphapyridine at 37°C and 43°C, and Rappaport-Vassiliadis Broth (RV 10) at 42°C. The isolation media were Brilliant Green Agar (BGA), Deoxycholate Citrate Agar, Hektoen Enteric Agar (HEA) and Salmonella-Shigella Agar.
Enrichment in RV/42°C followed by isolation on BGA as recommended by ISO standard no. 6579 and enrichment in TTB/37°C followed by isolation in HEA, no longer recommended by that standard, produced the best results. Low percentages of positive samples and difficulties in detecting Salmonella are the result of interference by competing organisms (Enterobacteriaceae) and the number of salmonellas present after enrichment.
A total of 528 samples (TSB, eggs, lamb liver and chicken liver) were inoculated with Salm. enteritidis, Salm. kapemba and Salm. virchow , and the preceding experiment was repeated. All the TSB and egg samples tested positive, but the percentage of positive samples from the lamb and chicken liver was only 81–92%. Recovery of the salmonellas did not depend upon the method employed or the serotype inoculated but instead on interference by competing flora and the numbers of Salmonella present in the samples.     

Proficiency testing of water microbiology laboratories in The Netherlands

In a 3-year period, four series of simulated water samples containing selected test strains were distributed to more than 50 laboratories in The Netherlands for bacteriological testing. Participating laboratories examined the samples by enrichment or membrane filtration methods, or both, for total coliform organisms, thermotol-erant coliform organisms, faecal streptococci and standard plate counts (37˙ and 22˙C) according to Dutch standard methods. The results were quantitatively satisfactory: the distribution of positive and negative results with subsamples conformed to stochastic variation; the standard deviation of membrane or plate counts was usually in the range which may be expected from a Poisson distribution, and there was good correspondence between average counts in participating laboratories and those expected from controls in the organizing laboratory. Problems of a qualitative nature were frequently encountered, however. Among them were a false positive response with a strain of Enterobacter cloacae in the thermotolerant coliform test; a false positive result with Clostridium perfringens in enrichment tests for total or thermotolerant coliform organisms and false positive results with Micrococcus varians in the faecal streptococcus test by membrane filtration. It is concluded that quality assessment should be a consistent activity in water microbiology laboratories. For this purpose, stable and well characterized reference materials are needed.     

Modified Agglutination Test for Pasteurella tularensis

Several modifications in technique were incorporated into the standard agglutination test for Pasteurella tularensis. Reciprocal shaking of all tubes in a Kahn shaker was introduced to increase the rate of agglutination and quantity of agglutinated cell mass, making it possible to report preliminary results within 4 hr. Increased incubation time at a higher temperature was used to favor the rate of agglutination. A serum control for each serum tested was necessary to detect false positive tests. Finally, a verification procedure with 5% NaCl used as the diluent was instituted to prevent these false positive reactions.     

A Rapid, Presumptive Procedure for the Detection of Salmonella in Foods and Food Ingredients

A rapid detection procedure was developed in which a lysine-iron-cystine-neutral red (LICNR) broth medium, originally described by Hargrove et al. in 1971, was modified and used to detect the presence of viable Salmonella organisms in a variety of foods, food ingredients, and feed materials by using a two-step enrichment technique. Tetrathionate broth was used to enrich samples with incubation at 41 C for 20 hr, followed by transfer to LICNR broth and incubation at 37 C for 24 hr for further enrichment and for the detection of Salmonella organisms by color change. One hundred ten samples representing 18 different sample types were evaluated for the presence of viable Salmonella. Ninety-four percent of the samples found to be presumptive positive by this method were confirmed as positive by a culture method. Fluorescent-antibody results also compared closely. A second study was conducted under quality-control laboratory conditions by using procedures currently employed for Salmonella detection. One hundred forty-three samples representing 19 different sample types were evaluated for the presence of viable Salmonella. No false negatives were observed with the rapid-detection method. The usefulness of the LICNR broth procedure as a screening technique to eliminate negative samples rapidly and to identify presumptive positive samples for the presence of viable Salmonella organisms was established in this laboratory.     

Staphylococcal Footpad Infection in Mice

Local footpad infection in mouse was investigated with 55 clinically isolated strains of Staphylococcus aureus. When 10⁷ viable cells were inoculated into the footpad, local swelling and bacterial growth resulted after 24 hr. With a dose of 10⁶ cells, moderate swelling was observed after a few hours but the reaction had almost disappeared after 24 hr. About 75% of the staphylococcal strains tested caused footpad edema in mice at doses of 10⁷ cells. A statistical comparison of the virulence of the organisms on intravenous and intraperitoneal injection with that in inducing footpad swelling is also reported.     

Liquid Nitrogen Preservation of Saccharomyces carlsbergensis and its Use in a Rapid Biological Assay of Vitamin B6 (Pyridoxine)

Growth medium as well as freezing menstruum greatly influenced the recovery of Saccharomyces carlsbergensis when it was quickly frozen in liquid nitrogen at - 196 C and quickly thawed at 40 C. Nearly 90% recovery in viability was obtained when S. carlsbergensis was grown in Trypticase Soy Broth and frozen in vitamin B(6) basal assay medium. The growth phase of S. carlsbergensis also influenced recovery after freezing. When S. carlsbergensis was grown in Trypticase Soy Broth and frozen in the broth at the logarithmic-growth phase, only 7% viability was retained; the recovery rate increased to 81% when the culture was frozen in the maximal stationary phase. To have the least possible lag period of growth after thawing, a technique called growth-phase conditioning was introduced. After 1 hr of growth-phase conditioning, S. carlsbergensis was clearly out of lag phase, and budding was observed. A vitamin B(6) microbiological assay with a 6-hr incubation period and with the use of liquid nitrogen-frozen S. carlsbergensis is described.     

A monoclonal antibody to a subset of human monocytes found only in the peripheral blood and inflammatory tissues

A monoclonal antibody is described that was generated by immunizing mice with cultured human blood monocytes. The antibody (27E10) belongs to the IgG1 subclass and detects a surface antigen at Mr 17,000 that is found on 20% of peripheral blood monocytes. The antigen is increasingly expressed upon culture of monocytes, reaching a maximum between days 2 and 3. Stimulation of monocytes with interferon-gamma (IFN-gamma), 12-O-tetradecanoyl-phorbol-13-acetate (TPA), and lipopolysaccharide (LPS) but not with N-formyl-L-methionyl-L-leucyl-L-phenylalanine (fMLP) increased the 27E10 antigen density. The amount of 27E10-positive cells is not or is only weakly affected. The antigen is absent from platelets, lymphocytes, and all tested human cell lines, yet it cross-reacts with 15% of freshly isolated granulocytes. By using the indirect immunoperoxidase technique, the antibody is found to be negative on cryostat sections of normal human tissue (skin, lung, and colon) and positive on only a few monocyte-like cells in liver and on part of the cells of the splenic red pulp. In inflammatory tissue, however, the antibody is positive on monocytes/macrophages and sometimes on endothelial cells and epidermal cells, depending on the stage and type of inflammation, e.g., BCG granulomas are negative, whereas psoriasis vulgaris, atopic dermatitis, erythrodermia, pressure urticaria, and periodontitis contain positively staining cells. In contact eczemas at different times after elicitation (6 hr, 24 hr, and 72 hr), the 27E10 antigen is seen first after 24 hr on a few infiltrating monocytes/macrophages, which increase in numbers after 72 hr. From this it is concluded that the antibody 27E10 detects an antigen expressed by a subset of peripheral blood monocytes. In situ the antigen is found only in inflammatory tissues and is absent from normal resident mononuclear phagocytes.     

平板运动试验对冠心病的诊断意义

目的:探讨平板运动试验(TET)对诊断冠状动脉粥样硬化性心脏病(冠心病)的临床意义。方法:对比分析217例疑诊或临床诊断冠心病患者的平板运动试验和选择性冠状动脉造影(CAG)结果。结果:以选择性冠状动脉造影为标准,平板运动试验敏感性为68.4%,特异性为88.4%,阳性预测值为77.1%,阴性预测值为82.9%。结论:简便、易行及无创的平板运动试验是诊断冠心病的重要手段。     

Serological identification of group D streptococci using commercial antisera

Three commercial group D streptococcal antisera were tested for the serological identification of 100 group D enterococci; 20 Streptococcus bovis; 5 isolated from each of the following streptococcal groups: A, B, C and G; and 3 isolates from serological group F. Antisera from Difco Laboratories, BBL, and Wellcome Reagents Limited were used in the classic capillary tube precipitin test on extracts prepared using the Rantz and Randall procedure. No false positive precipitin reactions were observed. Of the enterococcal isolates, all 100 reacted with the Wellcome, 99 reacted with the BBL, and 96 reacted with the Difco group D antisera. However, of the 20 S. bovis isolates, only 2 reacted with the BBL, and 1 reacted with both the Difco and the Wellcome antisera. Each antiserum was then used to prepare staphylococcal coagglutination (CoA) reagents and each isolate was subsequently tested. A simple extraction procedure was performed by suspending colonies of an isolate in a loopful of salin on a microscope slide and gently heating the slide directly in the flame of a Bunsen burner. All 100 enterococci and all 20 S. bovis gave positive results with the BBL and the Wellcome CoA reagents. Using the Difco reagent, 2 S. bovis isolates failed to produce postitive results. No false positive results were observed with the non-Group D isolates. Our results indicate that the CoA technique using commercial group D antisera may provide faster and sometimes more sensitive serological identification than the classic capillary tube precipitin test.     

全基因组外显子测序及其应用

近年来,众多研究小组开展了大量的全基因组关联研究(Genome-wide association studies,GWAS),发现并鉴定了许多与复杂疾病/性状相关联的遗传变异,为复杂疾病发病机制的研究提供了重要线索。由于GWAS的结果存在假阳性、假阴性、检测到的单核苷酸多态性很少位于功能区以及对稀有变异和结构变异不敏感等问题,导致了其应用的局限性。而新一代测序技术的进步,促进了全基因组测序和全基因组外显子测序的快速发展,为解决上述问题提供了契机。全基因组外显子测序是利用序列捕获技术将全基因组外显子区域DNA捕捉并富集后进行高通量测序的基因组分析方法。由于其具有对常见和罕见变异高灵敏度,能发现外显子区绝大部分疾病相关变异以及仅需要对约1%的基因组进行测序等优点,促使全基因组外显子测序成为鉴定孟德尔疾病的致病基因最有效的策略,也被运用于复杂疾病易感基因的研究和临床诊断中。     

Microtiter Solid-Phase Radioimmunoassay for Hepatitis B Antigen

A micro-solid-phase radioimmunoassay (micro-SPRIA) for hepatitis B antigen (HB Ag) was developed for use with microtiter serological equipment. Radiolabeled immunoglobulin G was prepared from human and animal sera containing hepatitis B antibody (HB Ab); it was not necessary to isolate specific HB Ab by immunochemical means. A micro-SPRIA prepared with guinea pig reagents was approximately as sensitive as the AusRIA radioimmunoassay, but, like the AusRIA test, yielded false positive results. A micro-SPRIA prepared with human reagents was slightly less sensitive but did not yield false positive results. These micro-SPRIA tests offer several advantages, including conservation of reagents, adaptability to other antigen-antibody systems, ease of performance (especially when testing large numbers of specimens), and economy.     

False "false-positive" results in diagnostic cytology

With the introduction of transbronchial brushings and fine needle aspiration biopsy, which enable us to obtain samples directly from lesions, the diagnostic potential of cytology for the detection of malignancy, including early cancer, has been greatly enhanced. From 1976 to 1982, five positive cytology reports were initially considered to be "false positives" on the basis of negative gross findings, benign operative biopsies or negative histologic findings in the resected surgical specimens. However, these proved to be false "false positives," based upon the clinical follow-up or further examination of the surgical specimens. Presentation is made of three of these cases with positive cytologic findings and initially negative histologic diagnoses, with an analysis of the causes of the latter. From our experience, four types of cancerous lesions seem prone to being missed during gross examination, namely: any small cancer with a consistency similar to that of the parenchyma of the organ in which the tumor is located, superficially invasive carcinoma, scar cancer and a radiologically occult lung cancer in the presence of a coexisting radiologically demonstrable lesion. With more clinical application of these cytologic methods, false "false positives" are expected to occur more often.     

Comparison of acetate differential agar with sellers citrate-mannitol-agar

A total of 245 isolates of Escherichia coli (paracolons) were employed in comparing the use of acetate differential agar (ADA) with the simple test described by Sellers to eliminate these organisms from consideration as enteric pathogens. At 18 hr after the media were inoculated, 83% of the isolates produced a positive citrate reaction on Sellers citrate-mannitol-agar (SCM) and 7% gave a positive reaction on ADA. At 24 hr, 92% of the cultures were positive on SCM versus 42% on ADA. At 48 hr, 244 (99.6%) of the isolates were positive on SCM, whereas a 72-hr incubation period was required for equal results with ADA. One isolate failed to grow on either medium.     

Frequency of False Positive Rapid HIV Serologic Tests in African Men and Women Receiving PrEP for HIV Prevention: Implications for Programmatic Roll-Out of Biomedical Interventions

Background

Rapid HIV assays are the mainstay of HIV testing globally. Delivery of effective biomedical HIV prevention strategies such as antiretroviral pre-exposure prophylaxis (PrEP) requires periodic HIV testing. Because rapid tests have high (>95%) but imperfect specificity, they are expected to generate some false positive results.

Methods

We assessed the frequency of true and false positive rapid results in the Partners PrEP Study, a randomized, placebo-controlled trial of PrEP. HIV testing was performed monthly using 2 rapid tests done in parallel with HIV enzyme immunoassay (EIA) confirmation following all positive rapid tests.

Results

A total of 99,009 monthly HIV tests were performed; 98,743 (99.7%) were dual-rapid HIV negative. Of the 266 visits with ≥1 positive rapid result, 99 (37.2%) had confirmatory positive EIA results (true positives), 155 (58.3%) had negative EIA results (false positives), and 12 (4.5%) had discordant EIA results. In the active PrEP arms, over two-thirds of visits with positive rapid test results were false positive results (69.2%, 110 of 159), although false positive results occurred at <1% (110/65,945) of total visits.

Conclusions

When HIV prevalence or incidence is low due to effective HIV prevention interventions, rapid HIV tests result in a high number of false relative to true positive results, although the absolute number of false results will be low. Program roll-out for effective interventions should plan for quality assurance of HIV testing, mechanisms for confirmatory HIV testing, and counseling strategies for persons with positive rapid test results.     

The mouse spot test. Evaluation of its performance in identifying chemical mutagens and carcinogens

The published results on 60 chemicals and X-rays investigated in the mouse spot test were compared with data on the same chemicals tested in the bacterial mutation assay (Ames test) and lifetime rodent bioassays. The performance of the spot test as an in vivo complementary assay to the in vitro bacterial mutagenesis test reveals that of 60 agents, 38 were positive in both systems, 6 were positive only in the spot test, 10 were positive only in the bacterial test and 6 were negative in both assays. The spot test was also considered as a predictor of carcinogenesis; 45 chemicals were carcinogenic of which 35 were detected as positive by the spot test and 3 out of 6 non-carcinogens were correctly identified as negative. If the results are regarded in sequence, i.e. that a positive result in a bacterial mutagenicity test reveals potential that may or may not be realized in vivo, then 48 chemicals were mutagenic in the bacterial mutation assay of which 38 were active in the spot test and 31 were confirmed as carcinogens in bioassays. 12 chemicals were non-mutagenic to bacteria of which 6 gave positive responses in the spot test and 5 were confirmed as carcinogens. These results provide strong evidence that the mouse coat spot test is an effective complementary test to the bacterial mutagenesis assay for the detection of genotoxic chemicals and as a confirmatory test for the identification of carcinogens. The main deficiency at present is the paucity of data from the testing of non-carcinogens. With further development and improvement of the test it is probable that the predictive performance of the assay in identifying carcinogens should improve, since many of the false negative responses may be due to inadequate testing.     

Laboratory-based evaluation of TOX A/B QUIK CHEK "NISSUI" to detect toxins A and B of clostridium difficile]

The TOX A/B QUIK CHEK "NISSUI" which detects both toxin A (TcdA) and toxin B (TcdB) of Clostridium difficile in stool specimens through immunochromatography was first approved to be released in Japan, and we evaluated its accuracy. In the evaluation, the TOX A/B QUIK CHEK "NISSUI" could correctly detect TcdA and TcdB in solution and in stool specimens spiked with culture broth of TcdA and/or TcdB-producing isolates of C. difficile. The minimum detectable concentrations for TcdA and TcdB were determined to be < or =0.32 ng/ml and < or =0.63 ng/ml, respectively. The TOX A/B QUIK CHEK "NISSUI" gave the consistent results with the colon-endoscopic diagnosis, that is, all the 10 stool specimens from the patients with pseudomembranous colitis were read as being positive, but negative for five patients without any C. difficile-associated disease (CDAD). Of 10 positive stool specimens, one was read as being negative by the commercially available test reagents that can detect only TcdA. In clinical evaluation, a total of 240 stool specimens were tested. Of these, the TOX A/B QUIK CHEK "NISSUI" gave 19 positive results, and TcdA and/or TcdB-producing strains of C. difficile were successfully isolated from all the positive stool specimens, except one. Whereas, of 221 negative stool specimens, 28 isolates of C. difficile were recovered and 11 isolates were identified as TcdA and/or TcdB-producing strains. With these results, it can be concluded that the TOX A/B QUIK CHEK "NISSUI" can correctly detect both TcdA and TcdB of C. difficile, and should be promptly applied to clinical microbiology laboratory to make a definite diagnosis of CDAD, particularly for the CDAD caused by the TcdA-negative but TcdB-positive mutant strains.     

Evaluation of false ultrasonographic pregnancy diagnoses in sows by measuring the concentration of unconjugated estrogens in feces

On Days 26, 28, and 30 after AI, ultrasonographic pregnancy diagnoses were performed on 207 gilts and sows by using a 3.5 MHz linear-array transducer. Fecal samples were taken from the rectum after each ultrasonographic examination, and the concentrations of unconjugated estrogens in selected samples (n = 73) were measured by RIA. Fecal unconjugated estrogen concentration of 11.7 ng/g feces or higher was indicative of pregnancy. The overall sensitivity and specificity of the ultrasonographic test was 99% for farrowing sows and 73.1% for nonfarrowing sows. With one exception, sows with a false negative diagnosis by ultrasonography on Day 26 were correctly diagnosed pregnant by elevated fecal unconjugated estrogens or repeated ultrasonographic examinations on Days 28 or 30. Return to estrus around the sampling period may cause false positive results in the unconjugated estrogen assay, while early embryonic mortality can result in false positive diagnoses in both the ultrasonographic test and estrogen assay. Although there was a positive correlation between the concentrations of unconjugated estrogens in the feces and litter size at farrowing in the selected sows, it seems very unlikely that fecal estrogens can provide an accurate tool for predicting litter size.