Pathogenic enteric Escherichia coli in children with and without diarrhea in Maputo, Mozambique

A study was conducted on the circulation of potentially diarrheagenic Escherichia coli in two groups of children, both under the age of seven. The first group (548 children) suffered from mild diarrhea and attended the Xipamanine Health Center of Maputo, in Mozambique. The second group (380 children) included randomly chosen, asymptomatic, children from the same population. A total of 503 E. coli strains were isolated from the two groups of children (n=375 and 128, respectively). All E. coli strains were genotypically and phenotypically screened. The presence of virulence-associated genes was assessed by a set of multiplex PCR specific for st and lt genes of enterotoxic Escherichia coli (ETEC), eae and bfpA genes of enteropathogenic E. coli (EPEC), stx(1) and stx(2) of enterohemorrhagic E. coli (EHEC), ial of enteroinvasive E. coli (EIEC) and the species-specific gene uidA. Adhesion and citotoxicity of isolated E. coli were evaluated in vitro on different cell cultures. A total of 37 isolates harbored virulence-associated genes: 18 were classified as ETEC, (15 from symptomatic, and three from asymptomatic children), 16 as EPEC (respectively, 13 and 3) and three EIEC in the symptomatic group. No stx(1) or stx(2) genes, associated with enterohemorrhagic E. coli were found. On the basis of the adhesion pattern on HeLa cells, 167 E. coli were classified as diffusely adhering, (125 in patients and 42 in controls) and 67 as enteroaggregative, (50 and 17, respectively). To the best of our knowledge, this is the first report in the literature on the circulation of potentially diarrheagenic E. coli in Mozambique.     

急性腹泻患者致泻性大肠埃希菌流行情况及耐药性分析

目的 了解致泻性大肠埃希菌（DEC）在急性腹泻患者中的分布及对常用抗菌药物的敏感性,为疾病的防控和治疗提供依据。方法 收集2014年1月至2015年12月期间就诊于浙江大学医学院附属第一医院急性腹泻患者粪便标本,采用常规病原菌检验流程对常见肠道致病菌进行分离培养鉴定,分离到的疑似大肠埃希菌采用多重PCR和单重PCR进行鉴定、分型,采用纸片扩散法（K-B法）对各型DEC进行18种常用药物敏感试验。结果 从1 019例急性腹泻患者标本中分离到396株病原菌,其中DEC 230株,分离率为22.6%,占所有分离菌株的58.1%,居病原菌首位。230株DEC中,ETEC占56.5%,EAEC占30.4%,EPEC占8.7%,STEC占0.4%,混合型DEC占0.9%,未发现EIEC。各型DEC全年均有检出,其中夏季（6~8月）分离率最高,达24.0%,患者主要分布在19~45岁,男女检出率分别为21.8%和23.2%,差异无统计学意义。DEC对氨苄西林的耐药率最高,达49.3%,对头孢唑林、复方新诺明、氨苄西林/舒巴坦的耐药率分别为46.4%、35.7%、30.9%,其余抗菌药物耐药率均低于15.0%,未出现亚胺培南耐药株。207株DEC中,产ESBLs菌株占41.1%,多重耐药菌株占44.9%。结论 DEC是本地区急性腹泻最常见的细菌性病原,是临床肠道感染中不可忽视的病原之一,尤其是同时携带多型别毒力基因菌株及产ESBLs菌株和多重耐药菌。长期持续监测其分布及耐药趋势,对疾病的预防、治疗具有重要意义。     

Cell-detaching Escherichia coli (CDEC) strains from children with diarrhea: Identification of a protein with toxigenic activity

Twenty-four strains of cell-detaching Escherichia coli (CDEC) isolated from stool specimens in different cities in Brazil were examined for virulence properties. Aerobactin production and multiple antibiotic resistance were observed in most of the isolates. In hybridization studies, the alphahly, pap, and cnf sequences, common properties of this category of E. coli, were found in a minority of isolates. Half of the CDEC isolates had enteroaggregative DNA sequences (pet, astA, aggA), six strains carried the shet1 gene, nine strains carried the daaC sequence, and one strain carried the stp gene. Thirteen strains induced fluid accumulation in the rabbit intestinal loop assay. Supernatant filtrate of one of those strains, which did not hybridize with any of the toxin probes tested, induced destructive lesions in the rabbit ileal loop and enterotoxic activity in the Ussing chamber. A 12-kDa protein purified by 60% ammonium sulfate precipitation of the supernatant filtrate demonstrated a toxigenic effect that was inhibited by the anti-12-kDa protein antiserum.     

婴幼儿腹泻轮状病毒和腺病毒检测结果分析

目的了解本地区婴幼儿腹泻患者中轮状病毒和腺病毒的感染情况,为临床治疗提供依据。方法收集2013年1月-12月门诊和住院腹泻患儿的粪便,进行轮状病毒和腺病毒抗原检测,并对结果进行统计学分析。结果在检测的2 579例婴幼儿腹泻中轮状病毒阳性为616例,阳性率为23.89%,高发季节为1月、11月和12月,高发年龄组为13-24月婴幼儿,腺病毒阳性共102例,阳性率为3.96%,程散发状况,高发年龄组为7-12月的婴幼儿。结论轮状病毒和腺病毒都能引起婴幼儿腹泻,但是轮状病毒为最主要的病原体,及时检测轮状病毒抗原,为临床治疗和疾病监测提供参考。     

腹泻仔猪源致病性大肠杆菌生物膜与耐药性及毒力的相关性

【目的】探讨腹泻仔猪源致病性大肠杆菌生物膜形成能力及其与耐药性、毒力之间的相关性。【方法】收集临床分离鉴定的129株致病性大肠杆菌,采用96孔微量板法、K-B法、微量稀释法、寇氏改良法分别测定体外生物膜形成能力、耐药表型、生物膜菌与浮游菌的最小抑菌浓度(MIC)、对小鼠的半数致死量(LD_(50))。【结果】129株致病性大肠杆菌生物膜阳性率为96.1%,以弱阳性(1+)为主;分离株对四环素、氨苄青霉素、阿莫西林的耐药率分别为92.2%、92.2%、93%,对亚胺培南的耐药率最低为1.6%,共呈现94种多重耐药谱,其中以阿莫西林-氨苄青霉素-四环素-强力霉素-复方新诺明-甲氧苄啶构成比最大,为86.0%,且其与环丙沙星、氟苯尼考、左氧氟沙星、诺氧沙星、头孢拉定及头孢哌酮的耐药性有相关性(P0.05),环丙沙星和氟苯尼考对生物膜形成菌的MIC较对应浮游菌分别提高2-16倍和8-16倍;生物膜形成能力3+的菌株LD_(50)最大。【结论】腹泻仔猪源致病性大肠杆菌普遍具有生物膜形成能力,呈现多重耐药,生物膜形成菌对环丙沙星及氟苯尼考的耐药性与生物膜形成能力呈正相关,但随着生物膜形成能力的增强,LD_(50)值则相应增大。     

Isolation of enteric pathogens from patients with travelers' diarrhea using fecal transport media

Abstract We investigated the effectiveness of a two-vial fecal transport system: glycerol-buffered saline (GBS) and modified Cary-Blair with antibiotics (CBA) to transport stool samples to an enteric disease reference laboratory. In a blind study we compared the results of culturing 41 specimens promptly in the field laboratory to subculturing GBS and CBA in the reference laboratory. A pathogen was isolated from 72% of the cases in each laboratory. In addition, a pathogen was isolated from 32 of 45 samples inoculated into GBS and CBA and transported to the reference laboratory for subculture. These results demonstrate that GBS and CBA are effective means of transporting specimens to a reference laboratory when studying the etiology of diarrhea in remote parts of the world.     

Prevalence and characteristics of cytolethal distending toxin-producing Escherichia coli from children with diarrhea in Japan

In the present study, we examined the prevalence and characteristics of CTEC among diarrheal children in Japan during a year-long surveillance study. A PCR-RFLP assay for the detection and differentiation of five types of E. coli cdtB gene (types I through V) was developed, and 362 stool specimens collected from patients reporting to pediatric departments in two hospitals were analyzed. Of the 35 samples (9.7%) that were positive for the cdtB gene, 21 were positive for cdt-I , three for cdt-II , four for cdt-III , three for cdt-IV and four samples were positive for cdt-V , as determined by different molecular techniques. The recovery of CTEC having cdt alleles was a little less, which included 19 with cdt-I , one cdt-II , three cdt-III, three cdt-IV and four with cdt-V . Among 30 CTEC strains isolated, the majority of them (43%) belonged to serogroup O2. The other virulence genes such as astA , cnf1 , eaeA , cnf2 and bfpA genes were detected in 14 (47%), 11 (37%), four (13%), three (10%) and one (3.3%) strains of CTEC, respectively. However, the other common virulence-associated genes specific for DEC were not detected in these strains. Interestingly, an untypable cdt gene was detected by PCR-RFLP in Providencia alcalifaciens . Our data indicate that CTEC may be associated with diarrheal children in Japan and most of them do not belong to a conventional enteropathogenic pathovar and thus differ from strains isolated in developing countries.     

重庆地区成人感染性腹泻病原学分析

目的 研究重庆地区成人感染性腹泻患者的病原学特点.方法 采用MICROSCAN系统进行粪便细菌培养,用ELISA和多重PCR方法进行病毒检测.结果 130例腹泻标本中,检出细菌阳性17例,包括沙门菌属7例,志贺菌属5例,副溶血弧菌3例和嗜水气单胞菌2例.病毒检测中,单重感染30例,双重感染10例,三重感染1例.A组轮状病毒检出率为3.85％ (5/130),B轮状病毒检出率为3.85％ (5/130),C组轮状病毒检出率为15.4％ (20/130),诺如病毒检出率为9.23％ (12/130),星状病毒检出率为4.62％(6/130),札如病毒检出率为3.08％ (4/130),腺病毒检出率为0.77％(1/130).结论 重庆地区成人腹泻患者中,沙门菌和志贺菌为细菌感染的主要菌种,轮状病毒和诺如病毒为病毒感染的主要病原体.     

Enteropathogens associated with acute diarrhea in community and hospital patients in Jakarta,Indonesia

The prevalence of bacteria, parasite and viral pathogens in 3875 patients with diarrhea in community and hospital settings from March 1997 through August 1999 in Jakarta, Indonesia was determined using routine bacteriology and molecular assay techniques. Bacterial pathogens isolated from hospital patients were, in decreasing frequency, Vibrio cholerae O1, Shigella flexneri, Salmonella spp. and Campylobacter jejuni, while S. flexneri, V. cholerae O1, Salmonella spp. and C. jejuni were isolated from the community patients. V. cholerae O1 was isolated more frequently (P<0.005) from the hospital patients than the community patients. Overall, bacterial pathogens were isolated from 538 of 3875 (14%) enrolled cases of diarrhea. Enterotoxigenic Escherichia coli were detected in 218 (18%) of 1244 rectal swabs. A small percentage of enterohemorrhagic E. coli (1%) and of Clostridium difficile (1.3%) was detected. Parasitic examination of 389 samples resulted in 43 (11%) positives comprising Ascaris lumbricoides (1.5%), Blastocystis hominis (5.7%), Giardia lamblia (0.8%), Trichuris trichiura (2.1%) and Endolimax nana (0.5%). Rotavirus (37.5%), adenovirus (3.3%) and Norwalk-like virus (17.6%) were also detected. Antimicrobial resistance was observed among some isolates. Bacterial isolates were susceptible to quinolones, with the exception of some isolates of C. jejuni which were resistant to ciprofloxacin, nalidixic acid and norfloxacin. Data obtained from this community- and hospital-based study will enable the Indonesian Ministry of Health to plan relevant studies on diarrheal diseases in the archipelago.     

Single multiplex assay to identify simultaneously enteropathogenic, enteroaggregative, enterotoxigenic, enteroinvasive and Shiga toxin-producing Escherichia coli strains in Brazilian children

A multiplex PCR to differentiate typical and atypical enteropathogenic Escherichia coli (EPEC), enteroaggregative E. coli (EAEC), enterotoxigenic (ETEC), enteroinvasive E. coli (EIEC) and Shiga toxin-producing E. coli (STEC) strains was developed and evaluated. The targets selected for each group were eae and bfpA for EPEC, aggR for EAEC, elt and est for ETEC, ipaH for EIEC and stx for STEC isolates. This PCR was specific and sensitive for rapid detection of target isolates in stools. Among 79 children with acute diarrhea, this technique identified 13 (16.4%) with atypical EPEC, four (5%) with EAEC, three (3.8%) with typical EPEC, one (1.3%) with ETEC and one (1.3%) with EIEC.     

Cytotoxicity and antimicrobial susceptibility of Clostridium difficile isolated from hospitalized children with acute diarrhea

Clostridium difficile is an important pathogen associated with outbreaks of pseudomembranous colitis and other intestinal disorders such as diarrhea. In this study, 181 stool samples from children with and without acute diarrhea were analysed. Eighteen children with acute diarrhea were positive to C. ramosum, C. difficile, C. limosum, C. clostridioforme, C. septicum, C. butyricum, C. innocuum and Clostridium sp. Nineteen children without diarrhea harbored C. ramosum, C. septicum, C. barattii, C. butyricum, C. innocuum, C. sphenoides, C. bifermentans, C. clostridioforme and C. paraputrificum. No patient with diarrhea harbored C. barattii, C. bifermentans, C. paraputrificum and C. sphenoides. In addition, ten C. difficile strains were detected in 5 (5.5%) of the children with diarrhea. Also, no children from control group harbored C. difficile, C. limosum and Clostridium sp. Most of the tested strains were resistant to all the used antimicrobial. Nine C. difficile were toxigenic on VERO cells and by multiplex PCR, six strains showed both toxin A and B genes and three strains showed only toxin B gene. In this study, the presence of C. difficile was not significant, and it is suggested the need of more studies to evaluate the role of clostridia or C. difficile play in the childhood diarrhea and these organisms must be looked for routinely and a periodic evaluation of antimicrobial susceptibility should be performed.     

Exoproducts of the Escherichia coli strain H22 inhibiting some enteric pathogens both in vitro and in vivo

AIMS: The antagonistic activity of the Escherichia coli strain H22 against enteric bacteria was studied both in vitro and in vivo. METHODS AND RESULTS: In vitro, bacterial strains belonging to seven of nine genera of the family Enterobacteriaceae (Enterobacter, Escherichia, Klebsiella, Morganella, Salmonella, Shigella and Yersinia) were inhibited by the strain H22. Six days after simultaneous oral inoculation in germ-free mice, E. coli strain H22 reduced the faecal population of Shigella flexneri 4 to undetectable levels (P < 0.05). In ex vivo assay, inhibitory zones against Sh. flexneri 4 were observed around faecal samples from mice inoculated with E. coli strain H22. The in vitro inhibition of Sh. flexneri 4 was shown to be mediated by microcin C7. In addition to microcin C7, strain H22 was shown to produce aerobactin, new variants of colicins E1 and Ib, and bacteriophage particles with morphology similar to the phages of the family Myoviridae. CONCLUSIONS: Altogether, the properties of E. coli H22, observed both under in vitro and in vivo conditions, suggest its potential use as a probiotic strain for livestock and humans. SIGNIFICANCE AND IMPACT OF THE STUDY: The strain H22 was shown to produce several antimicrobial compounds with inhibitory capabilities against pathogenic or potentially pathogenic enterobacteria.     

荧光定量PCR检测大剂量甲氨喋呤化疗急性淋巴细胞白血病患儿肠道乳酸杆菌和大肠埃希菌量的变化

目的研究大剂量甲氨喋呤（HDMTX）化疗急性淋巴细胞白血病（ALL）患儿肠道菌群的变化,并和健康儿童进行比较。从微生态的角度分析HDMTX化疗与肠道菌群变化的相互关系,为微生态制剂用于HDMTX化疗副作用的预防和治疗提供依据。并探讨荧光定量PCR技术在该领域应用的实用性和可行性,以便推广应用。方法收集36例HDMTX化疗前后ALL患儿及36例健康对照组儿童的粪便标本,并提取目标细菌DNA,用分子生物学专用分光光度仪进行DNA的A值测量。用细菌的16S rRNA/DNA序列设计乳酸杆菌和大肠埃希菌的引物,行常规PCR完成细菌的定性,然后取准确定量的两种细菌DNA,经系列稀释后做荧光定量PCR,制作出标准曲线,待测样品同时进行荧光定量PCR反应,并和标准曲线进行比较,获得各样品中两种细菌的量。结果HDMTX化疗ALL患儿的肠道菌群与健康儿童比较发生了明显的变化,患儿化疗前1天、化疗后第3天、化疗后第7天和对照组儿童的粪便标本中细菌的A260值分别为（2436.3±768.6）、（1496.5±577.1）、（1966.6±598.3）和（3479.3±870.5）ng/μl;患儿化疗前1天、化疗后第3天、化疗后第7天和对照组的肠道乳酸杆菌数量的对数值分别为（8.10±0.43）、（6.73±0.45）、（7.45±0.43）和（9.12±0.50）ng/μl,而大肠埃希菌数量的对数值分别是（6.62±0.4）、（5.96±0.42）、（7.02±0.42）和（7.52±0.43）ng/μl。对照组和ALL组,ALL组化疗前和后,大便标本中乳酸杆菌和大肠埃希菌数量的对数值差异均有非常显著性（P〈0.01）。结论HDMTX化疗ALL患儿肠道中乳酸杆菌和大肠埃希菌的数量较正常对照组明显减少。在HDMTX化疗治疗过程中,采用微生态制剂,调整细菌比例,使肠道内益生菌的数量尽快恢复正常是必要的。16S rRNA/DNA荧光定量PCR技术在临床细菌定量分析中切实可行。     

Viral and bacterial infections associated with camel (Camelus dromedarius) calf diarrhea in North Province,Saudi Arabia

Diarrhea and deaths in new-born camel calves were noticed by veterinary investigators and pastoralist in Saudi Arabia to be very high. Hence, it is thought to be necessary to investigate this problem from the virological and bacteriological point of view. The role of pathogenic bacteria and viruses in six different towns of North Province (Al-Assafia, Arar, Domat Aljandal, Hail, Skaka and Khoa) in Saudi Arabia was studied. Survey was conducted in diarrheic camel calves aged 12 months or younger. In our study calf diarrhea was reported in 184 out of 2308 camels examined clinically during one year, the prevalence of diarrhea was found to be 8.0% in calves ranging from one month to one year. In the present study group A rotavirus and Brucella abortus were detected in 14.7% and 8.98%, respectively, using ELISA technique. Escherichia coli was isolated from diarrheic calf camel (58.2%) 99/170 samples during dry and wet season. Salmonella spp. and Enterococcus spp. were detected in 12% and 8.8% of the specimens, respectively. In this study enterotoxogenic E. coli (ET E. coli) was isolated from 7% of diarrheic camel, which indicates the strong correlation between the camel calf diarrhea and the detection of enterotoxogenic E. coli. This study represented the first report for the detection of group A rotavirus and B. abortus antigen and antibodies in calf camels in Saudi Arabia. It is recommended that the disease should be controlled by vaccination in calf camels.     

杭州地区腹泻儿童轮状病毒与腺病毒感染调查

目的 分析不同季节及不同年龄段腹泻患儿感染轮状病毒（RV）与腺病毒（Eads）情况,为临床提供早期、快速、准确、可靠的依据,以便及时采取相应的治疗使患儿早日康复。方法 采用杭州艾博医药有限公司提供的轮状病毒（A组）/腺病毒检测试剂盒（乳胶法）,对2012年1月至2015年12月浙江省人民医院门诊和住院就诊的3 368例腹泻儿童粪便标本进行轮状病毒和腺病毒抗原检测。结果 3 368例腹泻儿童粪便中,RV阳性578例占17.16%,Eads阳性106例占3.15%。11月至次年1月为轮状病毒感染的高发月份,1～3岁为儿童感染的高发年龄;腺病毒感染阳性率低,呈散发性。结论 杭州地区近年1～3岁婴幼儿的腹泻主要是由轮状病毒和腺病毒引起,其中轮状病毒感染率明显高于腺病毒,且有明显的季节性;而腺病毒感染呈散发流行,未表现出明显的季节性及年龄分布。     

阿泰宁治疗冷凉、喝酒性腹泻35例疗效观察

目的观察和评价阿泰宁（酪酸梭菌CGMCC0313．1制剂）治疗冷凉、喝酒性腹泻的临床疗效。方法选择受凉、吃凉食和喝酒后就腹泻的患者,口服阿泰宁胶囊,一次3粒,一天2～3次,疗程14～60d。治疗期间观察患者的临床症状、服药情况,治疗结束后评价药物的疗效。结果35例冷凉、喝酒性腹泻患者治疗后腹泻、腹痛和腹部不适等症状有显著的改善（P〈0．01或P〈0．001）;治愈率为97．14％（34／35）,总有效率为100％（35／35）,治疗中未见不良反应或副作用。结论阿泰宁治疗冷凉、喝酒性腹泻疗效显著。     

儿童细菌性腹泻病原菌分布及耐药性分析

目的 了解小儿细菌性腹泻的病原菌分布及耐药情况。方法 对773例临床上疑为细菌性腹泻病的患儿的粪便标本进行培养、鉴定及药物敏感试验、超广谱β-内酰胺酶（ESBLs）检测。结果 773例标本中分离出阳性菌株671株,总检出率为86．6％。其中埃希菌属、志贺菌属及耶尔森菌3种致病性细菌占阳性菌株的54．5％,肠杆菌属、非发酵菌群、酵母样真菌、肠球菌属、变形杆菌属、克雷伯菌属和枸橼酸杆菌属等条件致病菌占阳性菌株的45．5％。埃希菌属及志贺菌属对头孢他啶及氨曲南耐药率低（16．4％以下）,而肠杆菌属等条件致病菌对常用抗生素耐药率均较高。G^-杆菌中ESBLs的检出率为38．3％,其中大肠埃希菌占66．7％。结论 埃希菌属是儿童细菌性腹泻病的主要致病菌（50．2％）,且耐药率及ESBLs产生率高,但肠杆菌属等条件致病菌检出率也较高（45．5％）,且耐药率高,可能与抗生素广泛使用,肠杆菌群失调有关,应引起高度重视。     

Molecular identification of Salmonella isolates from poultry and meat productsin Irbid City,Jordan

The sensitivity and accuracy of molecular diagnosis of Salmonella from meat and poultry products using polymerase chain reaction (PCR) was compared with conventional microbiological methods. A total of 212 samples representing the most frequently used fresh and frozen meat and poultry products (whole, cut, ground, and processed) were collected from different locations within the city of Irbid. DNA was extracted directly from each food sample and amplified using Salmonella-specific primers. Samples were also analysed using conventional microbiological methods for the presence of Salmonella spp. Results showed that Salmonella was detected in 185 samples out of 212 (87%) by PCR technique, while 172 (81%) samples were detected Salmonella positive by conventional microbiological methods. On the other hand, 27 (12.7%) samples were negative by PCR and 40 (18.8%) samples were negative by conventional microbiological methods. PCR assay proved to be an effective method for Salmonella detection in meat and poultry products with high specificity and sensitivity and more importantly a less time-consuming procedure. Using PCR, Salmonella spp. detection could be achieved within 24–36 h compared to 3–8 days for the conventional microbiological methods.