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- Yersiniosis in poland in 2012. [Journal Article]
- Przegl Epidemiol 2014; 68(2):235-8.
The aim of this study is to assess the epidemiology of yersiniosis in Poland in 2012 compared to previous years.We reviewed surveillance data published in the annual bulletin "Infectious diseases and poisonings in Poland" from 2007 to 2012 (MP Czarkowski et al., NIH and GIS) and individual yersiniosis case reports from 2012 sent by the Sanitary-Epidemiological Stations. Additionally, we used data from the Department of Demographic Surveys in Central Statistical Office.In Poland in 2012 a total of 231 yersiniosis cases were reported including 201 cases of intestinal and 30 cases of extraintestinal yersiniosis; 61.9% of patients were hospitalized. The incidence rate was 0.6 per 100 000 inhabitants. No deaths related to the disease were reported. Intestinal yersiniosis was manifested mostly by following symptoms: diarrhoea (87%), fever (76%), abdominal pain (47%) and vomiting (31%). The most affected group in intestinal infections were children younger than 4 years - 145 cases (72% of all cases). Extraintestinal form of infection was more common than in 2011 (19 cases) and usually involved symptoms from the osteoarticular system, noted in 90% of patients. Similarly to the previous year (2011) most cases of yersiniosis were reported from Mazowieckie province (103), no case has been reported from Świętokrzyskie province. Serological types of Yersinia enterocolitica were identified in 120 cases (52%): serotype O3 (96.7%), O8 (2.5%) and O9 (<1%). There were two household outbreaks. In comparison to previous years the total number of cases caused by serotype O8 has significantly decreased - from 55 cases in 2011 to 3 cases in 2012.A large percentage (48%) of unknown Yersinia serotypes is a consequence, that physicians do not always request serotyping in routine diagnostics. Reporting cases of extraintestinal yersiniosis from only few provinces may suggest that the real number of infections remains underreported.
- Whole-animal chemical screen identifies colistin as a new immunomodulator that targets conserved pathways. [Journal Article]
- MBio 2014; 5(4)
The purpose of this study was to take advantage of the nematode Caenorhabditis elegans to perform a whole-animal chemical screen to identify potential immune activators that may confer protection against bacterial infections. We identified 45 marketed drugs, out of 1,120 studied compounds, that are capable of activating a conserved p38/PMK-1 mitogen-activated protein kinase pathway required for innate immunity. One of these drugs, the last-resort antibiotic colistin, protected against infections by the Gram-negative pathogens Yersinia pestis and Pseudomonas aeruginosa but not by the Gram-positive pathogens Enterococcus faecalis and Staphylococcus aureus. Protection was independent of the antibacterial activity of colistin, since the drug was administered prophylactically prior to the infections and it was also effective against antibiotic-resistant bacteria. Immune activation by colistin is mediated not only by the p38/PMK-1 pathway but also by the conserved FOXO transcription factor DAF-16 and the transcription factor SKN-1. Furthermore, p38/PMK-1 was found to be required in the intestine for immune activation by colistin. Enhanced p38/PMK-1-mediated immune responses by colistin did not reduce the bacterial burden, indicating that the pathway plays a role in the development of host tolerance to infections by Gram-negative bacteria.The innate immune system represents the front line of our defenses against invading microorganisms. Given the ever-increasing resistance to antibiotics developed by bacterial pathogens, the possibility of boosting immune defenses represents an interesting, complementary approach to conventional antibiotic treatments. Here we report that the antibiotic colistin can protect against infections by a mechanism that is independent of its microbicidal activity. Prophylactic treatment with colistin activates a conserved p38/PMK-1 pathway in the intestine that helps the host better tolerate a bacterial infection. Since p38/PMK-1-mediated immune responses appear to be conserved from plants to mammals, colistin may also activate immunity in higher organisms, including humans. Antibiotics with immunomodulatory properties have the potential of improving the long-term outcome of patients with chronic infectious diseases.
- The first imported human case of Yersinia pseudotuberculosis serotype O1 septicemia presents with acute appendicitis-like syndrome in Taiwan. [Journal Article]
- J Formos Med Assoc 2014 Sep; 113(9):656-9.
Human nonplague yersiniosis occurs more commonly in temperate regions than in tropical or subtropical regions. In Taiwan, which is located in a subtropical region of Southeast Asia, only environmental isolates and human infection of Yersinia enterocolitica were reported, but a human case of Y. pseudotuberculosis infection had not been identified. We report the first person with Y. pseudotuberculosis serotype O1 septicemia who presented with acute appendicitis-like syndrome and who was probably contracted the infection via ingestion of raw foods in a barbecue restaurant in Japan.
- Multiplex Detection of Gastrointestinal Pathogens: A Comparative Evaluation of Two Commercial Panels Using Clinical Stool Specimens. [JOURNAL ARTICLE]
- J Clin Microbiol 2014 Aug 6.
The detection of pathogens associated with gastrointestinal disease may be important in certain patient populations, such as immunocompromised hosts, the critically ill, or individuals with prolonged disease that is refractory to treatment. In this study, we evaluated two commercially-available multiplex panels (FilmArray™ Gastrointestinal [GI] Panel [BioFire Diagnostics, Salt Lake City, UT] and the Luminex xTag® gastrointestinal pathogen panel [GPP] [Luminex Corporation, Toronto, Canada]) using Cary-Blair stool samples (n=500) submitted to our laboratory for routine GI testing (e.g., culture, antigen testing, microscopy, individual real-time PCR). At the time of this study, the prototype (non-FDA cleared) FilmArray GI panel targeted 23 pathogens (14 bacterial, 5 viral, 4 parasitic) and testing of 200 μL of Cary-Blair stool was recommended. In contrast, the Luminex GPP assay was FDA-cleared for the detection of 11 pathogens (7 bacterial, 2 viral, 2 parasitic), but had the capacity to identify 4 additional pathogens using a research-use-only protocol. Importantly, the Luminex assay was FDA-cleared for 100 μL raw stool; however, 100 μL Cary-Blair stool was tested by the Luminex assay in this study. Among 230 prospectively collected samples, routine testing was positive for one or more GI pathogens in 19 (8.3%) samples, compared to 76 (33.0%) by the FilmArray and 69 (30.3%) by the Luminex assay. Clostridium difficile (12.6-13.9% prevalence) and norovirus GI/GII (5.7-13.9% prevalence) were two of the most commonly detected pathogens among prospective samples by both assays. Sapovirus was also commonly detected (5.7% positive rate) by the FilmArray assay. Among 270 additional, previously characterized samples, both multiplex panels demonstrated high sensitivity (>90%) for the majority of targets, with the exception of several pathogens, notably Aeromonas sp. (23.8%) by FilmArray and Yersinia enterocolitica (48.1%) by the Luminex assay. Interestingly, the FilmArray and Luminex panels identified mixed infections in 21.1% and 13.0% of positive prospective samples, respectively, compared to only 8.3% by routine methods.
- Influence of PhoP and Intra-Species Variations on Virulence of Yersinia pseudotuberculosis during the Natural Oral Infection Route. [Journal Article]
- PLoS One 2014; 9(7):e103541.
The two-component regulatory system PhoP/PhoQ has been shown to (i) control expression of virulence-associated traits, (ii) confer survival and growth within macrophages and (iii) play a role in Yersinia infections. However, the influence of PhoP on virulence varied greatly between different murine models of infection and its role in natural oral infections with frequently used representative isolates of Y. pseudotuberculosis was unknown. To address this issue, we constructed an isogenic set of phoP+ and phoP- variants of strain IP32953 and YPIII and analyzed the impact of PhoP using in vitro functionality experiments and a murine oral infection model, whereby we tested for bacterial dissemination and influence on the host immune response. Our results revealed that PhoP has a low impact on virulence, lymphatic and systemic organ colonization, and on immune response modulation by IP32953 and YPIII, indicating that PhoP is not absolutely essential for oral infections but may be involved in fine-tuning the outcome. Our work further revealed certain strain-specific differences in virulence properties, which do not strongly rely on the function of PhoP, but affect tissue colonization, dissemination and/or persistence of the bacteria. Highlighted intra-species variations may provide a potential means to rapidly adjust to environmental changes inside and outside of the host.
- Improving the Th1 cellular efficacy of the lead Yersinia pestis rF1-V subunit vaccine using SA-4-1BBL as a novel adjuvant. [JOURNAL ARTICLE]
- Vaccine 2014 Jul 18.
The lead candidate plague subunit vaccine is the recombinant fusion protein rF1-V adjuvanted with alum. While alum generates Th2 regulated robust humoral responses, immune protection against Yersinia pestis has been shown to also involve Th1 driven cellular responses. Therefore, the rF1-V-based subunit vaccine may benefit from an adjuvant system that generates a mixed Th1 and humoral immune response. We herein assessed the efficacy of a novel SA-4-1BBL costimulatory molecule as a Th1 adjuvant to improve cellular responses generated by the rF1-V vaccine. SA-4-1BBL as a single adjuvant had better efficacy than alum in generating CD4(+) and CD8(+) T cells producing TNFα and IFNγ, signature cytokines for Th1 responses. The combination of SA-4-1BBL with alum further increased this Th1 response as compared with the individual adjuvants. Analysis of the humoral response revealed that SA-4-1BBL as a single adjuvant did not generate a significant Ab response against rF1-V, and SA-4-1BBL in combination with alum did not improve Ab titers. However, the combined adjuvants significantly increased the ratio of Th1 regulated IgG2c in C57BL/6 mice to the Th2 regulated IgG1. Finally, a single vaccination with rF1-V adjuvanted with SA-4-1BBL+alum had better protective efficacy than vaccines containing individual adjuvants. Taken together, these results demonstrate that SA-4-1BBL improves the protective efficacy of the alum adjuvanted lead rF1-V subunit vaccine by generating a more balanced Th1 cellular and humoral immune response. As such, this adjuvant platform may prove efficacious not only for the rF1-V vaccine but also against other infections that require both cellular and humoral immune responses for protection.
- [Does the Hospital Cost of Care Differ for Inflammatory Bowel Disease Patients with or without Gastrointestinal Infections? - A Case-Control Study]. [English Abstract, Journal Article]
- Z Gastroenterol 2014 Jul; 52(7):643-8.
Objective:Gastrointestinal Infections have been implicated as possible causes of exacerbation of inflammatory bowel disease (IBD) or risk factors for severe flares in general. The introduction of the G-DRG reimbursement system has greatly increased the pressure to provide cost effective treatment in German hospitals. Few studies have compared the costs of treating IBD patients with or without gastrointestinal infections and none of them have specifically considered the German reimbursement situation.
Methods:We performed a single center case-control retrospective chart review from 2002 to 2011 of inpatients with IBD (Department of Internal Medicine IV, University Hospital Jena) with an exacerbation of their disease. The presence of gastrointestinal infections (Salmonella, Shigella, Campylobacter, Yersinia, adeno-, rota-, norovirus and Clostridium difficile) was assessed in all inpatients with Cohn's disease (CD) and ulcerative colitis (UC). IBD patients with gastrointestinal infections (n = 79) were matched for age to IBD patients who were negative for gastrointestinal pathogens (n = 158). Patient level costing (PLC) was used to express the total cost of hospital care for each patient; PLC comprised a weighted daily bed cost plus cost of all medical services provided (e. g., endoscopy, microbiology, pathology) calculated according to an activity-based costing approach. All costs were discounted to 2012 values.
Results:Gastrointestinal infections in IBD patients were not associated with an increase in mortality (0 %); however, they were associated with 2.3-fold higher total hospital charges (6499.10 € vs. 2817.00 €; p = 0.001) and increased length of stay in hospital (14.5 vs. 9.4 days; p < 0.0001). Despite increased reimbursement by DRG for IBD patients with gastrointestinal infections compared to patients without infections (3833.90 € vs. 2553.50 €; p = 0.005), hospital care in these patients was substantially underfunded (deficit - 2496.80 € vs. - 433.10 €) because of increased length of stay with personnel costs, especially in UC.
Conclusion:Inpatient hospital costs differ significantly for IBD patients with and without gastrointestinal infections, especially in ulcerative colitis, when care was provided in a single university hospital.
- Bacterial foodborne infections after hematopoietic cell transplantation. [JOURNAL ARTICLE]
- Biol Blood Marrow Transplant 2014 Jul 11.
Diarrhea, abdominal pain and fever are common among patients undergoing hematopoietic cell transplant (HCT), but such symptoms are also typical with foodborne infections. The burden of disease caused by foodborne infections in patients undergoing HCT is unknown. We sought to describe bacterial foodborne infection incidence post-transplant within a single-center population of HCT recipients.All HCT recipients transplanted from 2001 through 2011 at the Fred Hutchinson Cancer Research Center in Seattle, WA were followed for one year post-transplant. Data were collected retrospectively using center databases, which include information from transplant, on-site examinations, outside records, and collected laboratory data. Patients were considered to have a bacterial foodborne infection if Campylobacter jejuni/coli, Listeria monocytogenes, E. coli 0157:H7, Salmonella species, Shigella species, Vibrio species or Yersinia species were isolated in culture within one-year post-transplant. Non-foodborne infections with these agents and patients with preexisting bacterial foodborne infection (within 30 days of transplant) were excluded from analyses.A total of 12/4069 (0.3%) patients developed a bacterial foodborne infection within one year post-transplant. Patients with infections had a median age at transplant of 50.5 years (interquartile range [IQR]: 35-57), and the majority were adults ≥18 years of age (9/12 [75%]), male gender (8/12 [67%]) and post-allogeneic transplant (8/12 [67%]). Infectious episodes occurred at an incidence rate of 1.0 per 100,000 patient-days (95% CI: 0.5-1.7) and at a median of 50.5 days after transplant (IQR: 26-58.5). The most frequent pathogen detected was Campylobacter jejuni/coli (5/12 [42%]) followed by Yersinia (3/12 [25%]), while Salmonella (2/12 [17%]) and Listeria (2/12 [17%]) showed equal frequencies; no cases of Shigella, Vibrio, or E. coli 0157:H7 were detected. Most patients were diagnosed via stool (8/12 [67%]), fewer through blood (2/12 [17%]), one via both stool and blood simultaneously, and one through urine. Mortality due to bacterial foodborne infection was not observed during follow-up.Our large single-center study indicates that common bacterial foodborne infections were a rare complication following HCT, and the few cases that did occur resolved without complications. These data provide important baseline incidence for future studies evaluating dietary interventions for HCT patients.
- Yersinia ruckeri Biotypes 1 and 2 in France: presence and antibiotic susceptibility. [Journal Article]
- Dis Aquat Organ 2014 May 13; 109(2):117-26.
Yersinia ruckeri is the causative agent of yersiniosis, a disease reported in a number of fish species, especially rainbow trout. This study was undertaken to describe the phenotypes of Y. ruckeri on French rainbow trout farms. More than 100 isolates, collected during recent outbreaks on trout farms, were characterized by phenotypic tests, namely using biochemical tests of the API 20E system, serotyping, biotyping (tests for motility and lipase activity) and by describing the pattern of susceptibility to several antibiotics. The isolates showed a low phenotypic diversity with a prevalent serotype (O1) and API 20E profile 5 1(3)07 100. As in other European countries, Biotype 2 (BT2), which lacks both motility and secreted lipase activity, was found to be present in France. The emergence of 'French' BT2 was different than that observed for other European countries (Finland, Spain, Denmark and the UK). The antibiotic pattern was uniform for all isolates, regardless of the geographical area studied. The results indicate that no resistance has yet emerged, and the efficacy of the antibiotic generally used against yersiniosis in France, trimethoprim/sulfamethoxasol, is not compromised (minimum inhibitory concentrations [MIC] of between 0.016 and 0.128 µg ml-1). Enrofloxacin and doxycycline, not used as a first-line treatment in fish diseases, have reasonably good efficacies (with MICs ≤0.128 and 0.256, respectively).
- Bioserotypes and virulence markers of Y. enterocolitica strains isolated from roe deer (Capreolus capreolus) and red deer (Cervus elaphus). [Journal Article, Research Support, Non-U.S. Gov't]
- Pol J Vet Sci 2014; 17(2):315-9.
Free-living animals are an important environmental reservoir of pathogens dangerous for other animal species and humans. One of those is Yersinia (Y.) enterocolitica, the causative agent of yersiniosis--foodborne, enzootic disease, significant for public health. The purpose of the study was to identify bioserotypes and virulence markers of Y enterocolitica strains isolated from roe deer (Capreolus capreolus) and red deer (Cervus elaphus) obtained during the 2010/2011 hunting season in north-eastern Poland. From among 48 rectal swabs obtained from 24 roe deer, two strains of Y enterocolitica from one animal were isolated. Although both belonged to biotype 1A they were identified as different serotypes. The strain obtained from cold culture (PSB) belonged to serotype 0:5, while the strain isolated from warm culture (ITC) was regarded as nonidentified (NI), what may suggest mixed infection in that animal. The presence of ystB gene, coding for YstB enterotoxin, directly related to Y enterocolitica pathogenicity was detected in both strains using triplex PCR. The effect of the examination of 32 swabs obtained from 16 red deer was the isolation of two Y enterocolitica strains from two different animals. Both belonged to biotype 1A with NI serotype, but were originated from different types of culture. They gave positive results in case of products of a size corresponding to the ystB gene. No amplicons corresponding to ail and ystA genes were found. Roe deer and red deer may carry and shed Y. enterocolitica, what seems to be important in aspect of an environmental reservoir of this pathogen. The Y enterocolitica strains isolated from wild ruminants had the amplicons of the ystB gene, what suggest they can be potential source of Y enterocolitica infection for humans.