Symptoms and Clinical Course of EHEC O104 Infection in Hospitalized Patients: A Prospective Single Center Study

Objectives

Shiga-toxin producing O157:H7 Entero Haemorrhagic E. coli (STEC/EHEC) is one of the most common causes of Haemolytic Uraemic Syndrome (HUS) related to infectious haemorrhagic colitis. Nearly all recommendations on clinical management of EHEC infections refer to this strain. The 2011 outbreak in Northern Europe was the first to be caused by the serotype O104:H4. This EHEC strain was found to carry genetic features of Entero Aggregative E. coli (EAEC) and extended spectrum β lactamase (ESBL). We report symptoms and complications in patients at one of the most affected centres of the 2011 EHEC O104 outbreak in Northern Germany.

Methods

The courses of patients admitted to our hospital due to bloody diarrhoea with suspected EHEC O104 infection were recorded prospectively. These data include the patients’ histories, clinical findings, and complications.

Results

EHEC O104 infection was confirmed in 61 patients (female = 37; mean age: 44±2 years). The frequency of HUS was 59% (36/61) in our cohort. An enteric colonisation with co-pathogens was found in 57%. Thirty-one (51%) patients were treated with plasma-separation/plasmapheresis, 16 (26%) with haemodialysis, and 7 (11%) with Eculizumab. Patients receiving antibiotic treatment (n = 37; 61%) experienced no apparent change in their clinical course. Twenty-six (43%) patients suffered from neurological symptoms. One 83-year-old patient died due to comorbidities after HUS was successfully treated.

Conclusions

EHEC O104:H4 infections differ markedly from earlier reports on O157:H7 induced enterocolitis in regard to epidemiology, symptomatology, and frequency of complications. We recommend a standard of practice for clinical monitoring and support the renaming of EHEC O104:H4 syndrome as “EAHEC disease”.     

Food Insecurity,Food Based Coping Strategies and Suboptimal Dietary Practices of Adolescents in Jimma Zone Southwest Ethiopia

Despite the high prevalence of adolescent food insecurity in Ethiopia, there is no study which documented its association with suboptimal dietary practices. The objective of this study is to determine the association between adolescent food insecurity and dietary practices. We used data on 2084 adolescents in the age group of 13–17 years involved in the first round survey of the five year longitudinal family study in Southwest Ethiopia. Adolescents were selected using residence stratified random sampling methods. Food insecurity was measured using scales validated in developing countries. Dietary practices were measured using dietary diversity score, food variety score and frequency of consuming animal source food. Multivariable regression models were used to compare dietary behaviors by food security status after controlling for socio-demographic and economic covariates.Food insecure adolescents had low dietary diversity score (P<0.001), low mean food variety score (P<0.001) and low frequency of consuming animal source foods (P<0.001). After adjusting for other variables in a multivariable logistic regression model, adolescent food insecurity (P<0.001) and rural residence (P<0.001) were negatively associated with the likelihood of having a diversified diet (P<0.001) and frequency of consuming animal source foods, while a high household income tertile was positively associated. Similarly, multivariable linear regression model showed that adolescent food insecurity was negatively associated with food variety score, while residence in semi-urban areas (P<0.001), in urban areas (P<0.001) and high household income tertile (P = 0.013) were positively associated. Girls were less likely to have diversified diet (P = 0.001) compared with boys.Our findings suggest that food insecurity has negative consequence on optimal dietary intake of adolescents. Food security interventions should look into ways of targeting adolescents to mitigate these dietary consequences and provide alternative strategies to improve dietary quality of adolescents in Southwest Ethiopia.     

Experiment-specific estimation of peptide identification probabilities using a randomized database

Determining the error rate for peptide and protein identification accurately and reliably is necessary to enable evaluation and crosscomparisons of high throughput proteomics experiments. Currently, peptide identification is based either on preset scoring thresholds or on probabilistic models trained on datasets that are often dissimilar to experimental results. The false discovery rates (FDR) and peptide identification probabilities for these preset thresholds or models often vary greatly across different experimental treatments, organisms, or instruments used in specific experiments. To overcome these difficulties, randomized databases have been used to estimate the FDR. However, the cumulative FDR may include low probability identifications when there are a large number of peptide identifications and exclude high probability identifications when there are few. To overcome this logical inconsistency, this study expands the use of randomized databases to generate experiment-specific estimates of peptide identification probabilities. These experiment-specific probabilities are generated by logistic and Loess regression models of the peptide scores obtained from original and reshuffled database matches. These experiment-specific probabilities are shown to very well approximate "true" probabilities based on known standard protein mixtures across different experiments. Probabilities generated by the earlier Peptide_Prophet and more recent LIPS models are shown to differ significantly from this study's experiment-specific probabilities, especially for unknown samples. The experiment-specific probabilities reliably estimate the accuracy of peptide identifications and overcome potential logical inconsistencies of the cumulative FDR. This estimation method is demonstrated using a Sequest database search, LIPS model, and a reshuffled database. However, this approach is generally applicable to any search algorithm, peptide scoring, and statistical model when using a randomized database.     

Body temperature regulation in a desert lizard, Sauromalus obesus, under undisturbed field conditions

1. Mean selected body temperatures (MSBTs), measured by radiotelemetry, are presented for 15 chuckwallas on 26 animal days. 2. MSBT, during the period of activity, ranged from 37.3 to 39.8 degrees C (means = 38.8 +/- 0.2 SE degrees C) while MSBTs, from the time lizards attained their first high set point to the time that solar radiation ceased, ranged from 36.1 to 39.6 degrees C (means = 38.3 +/- 0.2 SE degrees C). 3. On cloudy, cool days, animals could not maintain high Tbs because of the absence of solar radiation. 4. On sunny March and April days, animals were active for 5-6 hr but Tb then fell rapidly to low levels. 5. From late April to mid May, animals were active for 7-8 hr and Tbs did not fall as drastically because of higher Tas after sunset. 6. August was the time of year (for this study) when chuckwallas had the highest effective 24 hr Tb but it was also the time when they had the shortest activity interval.     

Interaction of gamma 1-syntrophin with diacylglycerol kinase-zeta. Regulation of nuclear localization by PDZ interactions

Syntrophins are modular adapter proteins that link ion channels and signaling proteins to dystrophin and its homologues. A yeast two-hybrid screen of a human brain cDNA library using the PDZ domain of gamma 1- syntrophin, a recently identified brain-specific isoform, yielded overlapping clones encoding the C terminus of diacylglycerol kinase-zeta (DGK-zeta), an enzyme that converts diacylglycerol into phosphatidic acid. In biochemical assays, the C terminus of DGK-zeta, which contains a consensus PDZ-binding motif, was found to be necessary and sufficient for association with gamma 1-syntrophin. When coexpressed in HeLa cells, DGK-zeta and gamma 1-syntrophin formed a stable complex that partitioned between the cytoplasm and nucleus. DGK-zeta translocates from the cytosol to the nucleus, a process negatively regulated by protein kinase C phosphorylation. We found that DGK-zeta recruits gamma 1-syntrophin into the nucleus and that the PDZ-binding motif is required. Disrupting the interaction altered the intracellular localization of both proteins; DGK-zeta accumulated in the nucleus, whereas gamma 1-syntrophin remained in the cytoplasm. The level of endogenous syntrophins in the nucleus of HeLa cells also reflected the amount of nuclear DGK-zeta. In the brain, DGK-zeta and gamma 1-syntrophin were colocalized in cell bodies and dendrites of cerebellar Purkinjie neurons and other neuronal cell types, suggesting that their interaction is physiologically relevant. Moreover, coimmunoprecipitation and pull-down experiments from brain extracts and cells suggest that DGK-zeta, gamma 1-syntrophin, and dystrophin form a ternary complex. Collectively, our results suggest that gamma 1-syntrophin participates in regulating the subcellular localization of DGK-zeta to ensure correct termination of diacylglycerol signaling.