In Ontario, numbers for August show there were 319 cases of C.difficile, a deadly form of infectious diarrhea, found among the 228 hospital sites in Ontario. The provincial C.diff rate was 0.39 per 1,000 patient days.
Information from patientsafetyontario.net.
Monday, October 6, 2008
Disinfectants Can Make Bacteria Resistant To Treatment
Chemicals used in the environment to kill bacteria could be making them stronger, according to a paper published in the October issue of the journal Microbiology. Low levels of these chemicals, called biocides, can make the potentially lethal bacterium Staphylococcus aureus remove toxic chemicals from the cell even more efficiently, potentially making it resistant to being killed by some antibiotics.
Biocides are used in disinfectants and antiseptics to kill microbes. They are commonly used in cleaning hospitals and home environments, sterilizing medical equipment and decontaminating skin before surgery. At the correct strength, biocides kill bacteria and other microbes. However, if lower levels are used the bacteria can survive and become resistant to treatment.
"Bacteria like Staphylococcus aureus make proteins that pump many different toxic chemicals out of the cell to interfere with their antibacterial effects," said Dr Glenn Kaatz from the Department of Veterans Affairs Medical Center in Detroit, USA. "These efflux pumps can remove antibiotics from the cell and have been shown to make bacteria resistant to those drugs. We wanted to find out if exposure to biocides could also make bacteria resistant to being killed by the action of efflux pumps."
The researchers exposed S. aureus taken from the blood of patients to low concentrations of several biocides and dyes, which are also used frequently in hospitals. They looked at the effect of exposure on the bacteria and found that mutants that make more efflux pumps than normal were produced.
"We found that exposure to low concentrations of a variety of biocides and dyes resulted in the appearance of resistant mutants," said Dr Kaatz. "The number of efflux pumps in the bacteria increased. Because the efflux pumps can also rid the cell of some antibiotics, pathogenic bacteria with more pumps are a threat to patients as they could be more resistant to treatment."
If bacteria that live in protected environments are exposed to biocides repeatedly, for example during cleaning, they can build up resistance to disinfectants and antibiotics. Such bacteria have been shown to contribute to hospital-acquired infections.
"Scientists are trying to develop inhibitors of efflux pumps. Effective inhibitors would reduce the likelihood of additional resistance mechanisms emerging in bacteria," said Dr Kaatz. "Unfortunately, inhibitors evaluated to date do not work on a wide range of pathogens so they are not ideal to prevent resistance."
"Careful use of antibiotics and the use of biocides that are not known to be recognised by efflux pumps may reduce the frequency at which resistant strains are found," said Dr Kaatz. "Alternatively, the combination of a pump inhibitor with an antimicrobial agent or biocide will reduce the emergence of such strains and their clinical impact."
--------------------------------------------------------------------------------
Adapted from materials provided by Society for General Microbiology, via EurekAlert!, a service of AAAS.
Source - Science Daily
Biocides are used in disinfectants and antiseptics to kill microbes. They are commonly used in cleaning hospitals and home environments, sterilizing medical equipment and decontaminating skin before surgery. At the correct strength, biocides kill bacteria and other microbes. However, if lower levels are used the bacteria can survive and become resistant to treatment.
"Bacteria like Staphylococcus aureus make proteins that pump many different toxic chemicals out of the cell to interfere with their antibacterial effects," said Dr Glenn Kaatz from the Department of Veterans Affairs Medical Center in Detroit, USA. "These efflux pumps can remove antibiotics from the cell and have been shown to make bacteria resistant to those drugs. We wanted to find out if exposure to biocides could also make bacteria resistant to being killed by the action of efflux pumps."
The researchers exposed S. aureus taken from the blood of patients to low concentrations of several biocides and dyes, which are also used frequently in hospitals. They looked at the effect of exposure on the bacteria and found that mutants that make more efflux pumps than normal were produced.
"We found that exposure to low concentrations of a variety of biocides and dyes resulted in the appearance of resistant mutants," said Dr Kaatz. "The number of efflux pumps in the bacteria increased. Because the efflux pumps can also rid the cell of some antibiotics, pathogenic bacteria with more pumps are a threat to patients as they could be more resistant to treatment."
If bacteria that live in protected environments are exposed to biocides repeatedly, for example during cleaning, they can build up resistance to disinfectants and antibiotics. Such bacteria have been shown to contribute to hospital-acquired infections.
"Scientists are trying to develop inhibitors of efflux pumps. Effective inhibitors would reduce the likelihood of additional resistance mechanisms emerging in bacteria," said Dr Kaatz. "Unfortunately, inhibitors evaluated to date do not work on a wide range of pathogens so they are not ideal to prevent resistance."
"Careful use of antibiotics and the use of biocides that are not known to be recognised by efflux pumps may reduce the frequency at which resistant strains are found," said Dr Kaatz. "Alternatively, the combination of a pump inhibitor with an antimicrobial agent or biocide will reduce the emergence of such strains and their clinical impact."
--------------------------------------------------------------------------------
Adapted from materials provided by Society for General Microbiology, via EurekAlert!, a service of AAAS.
Source - Science Daily
HIV/AIDS Emerged as Early as 1880s
October 1, 2008
The AIDS pandemic in humans originated at least three decades earlier than previously thought, and it may have been triggered by rapid urbanization in west-central Africa during the early 20th century, according to an international team of researchers.
A better understanding of the conditions that helped fuel the pandemic could be key in controlling the disease and preventing future outbreaks of other emerging viruses.
"Rapid urbanization was the turning point that allowed the pandemic to start," said Michael Worobey, an evolutionary biologist at the University of Arizona, Tucson, and lead author of the study.
"We as human beings made some changes that took a virus that could not exist on its own and turned it into a successful epidemic," he added.
Birth of AIDS
Until now it was thought that HIV-1 Group M, the strain of HIV that causes the most infections worldwide, originated in 1930 in Cameroon.
Epidemic levels of AIDS and HIV-1 infections started appearing in Leopoldville, Belgian Congo (now Kinshasa, Democratic Republic of the Congo), around 1960.
Findings from the new study, however, suggest that the virus most likely started circulating among humans in sub-Saharan Africa sometime between 1884 and 1924.
Worobey and his colleagues made the discovery while analyzing tissue samples collected between 1958 and 1960 from Kinshasa. One of them, acquired in 1960, contained bits of HIV-1 RNA, the virus's genetic material.
The researchers compared the 1960 virus with the oldest known HIV-1 strain, which was obtained in 1959 and evolved independently of the 1960 variant. They found that the 1960 version was significantly different.
Next the researchers constructed an evolutionary family tree of the HIV-1 virus, made up of both the 1959 and 1960 strains along with more than a hundred modern viral sequences.
Using a mathematical model, Worobey and his colleagues discovered that the 1960 strain must have been evolving for at least 40 years to account for the number of differences from the 1959 strain.
The model also traced the most recent common ancestor of both strains to 1908.
The team's findings appear today in the journal Nature.
Lurking Danger
"This confirms that this was a virus that was lurking around for many decades before it exploded into the human population to become a noticeable pandemic, as opposed to something that started in the '70s or '80s," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), in Maryland.
NIAID funded the study along with the National Institutes of Health.
"It solidifies our understanding of the timetable of how this virus emerged from the chimpanzees to establish itself as a human infection," Fauci added.
"[HIV-1] flew below the radar level for decades until social conditions such as the end of colonization, migration of people to cities, increase in prostitution, and promiscuous sexual activity made it much easier for the disease to explode into a pandemic," Fauci explained.
More Mutations
Robert Garry is a microbiologist at New Orleans's Tulane University who was not involved with the study.
In the late 1980s, Garry was the first scientist to examine tissues samples taken from the U.S.'s first confirmed AIDS patient, who died in 1969.
"This study is very important, and what they are finding here is when the human virus started circulating in people," he said. "We still don't know when exactly the virus jumped from chimpanzees to humans, but it may be pushed back even further with this study.
"There will be other emerging viruses in the future, and what we learn about the conditions that help viruses spread, be it social changes or changes within the virus itself, will make us better prepared for other epidemics," he said.
Garry also argues that, though the rapid growth of cities in west-central Africa may have sparked the spread of infections, the virus itself underwent some sort of genetic change to facilitate transmission.
"We have to figure out what that change was," he cautioned.
Source:Amitabh Avasthi - National Geographic News
The AIDS pandemic in humans originated at least three decades earlier than previously thought, and it may have been triggered by rapid urbanization in west-central Africa during the early 20th century, according to an international team of researchers.
A better understanding of the conditions that helped fuel the pandemic could be key in controlling the disease and preventing future outbreaks of other emerging viruses.
"Rapid urbanization was the turning point that allowed the pandemic to start," said Michael Worobey, an evolutionary biologist at the University of Arizona, Tucson, and lead author of the study.
"We as human beings made some changes that took a virus that could not exist on its own and turned it into a successful epidemic," he added.
Birth of AIDS
Until now it was thought that HIV-1 Group M, the strain of HIV that causes the most infections worldwide, originated in 1930 in Cameroon.
Epidemic levels of AIDS and HIV-1 infections started appearing in Leopoldville, Belgian Congo (now Kinshasa, Democratic Republic of the Congo), around 1960.
Findings from the new study, however, suggest that the virus most likely started circulating among humans in sub-Saharan Africa sometime between 1884 and 1924.
Worobey and his colleagues made the discovery while analyzing tissue samples collected between 1958 and 1960 from Kinshasa. One of them, acquired in 1960, contained bits of HIV-1 RNA, the virus's genetic material.
The researchers compared the 1960 virus with the oldest known HIV-1 strain, which was obtained in 1959 and evolved independently of the 1960 variant. They found that the 1960 version was significantly different.
Next the researchers constructed an evolutionary family tree of the HIV-1 virus, made up of both the 1959 and 1960 strains along with more than a hundred modern viral sequences.
Using a mathematical model, Worobey and his colleagues discovered that the 1960 strain must have been evolving for at least 40 years to account for the number of differences from the 1959 strain.
The model also traced the most recent common ancestor of both strains to 1908.
The team's findings appear today in the journal Nature.
Lurking Danger
"This confirms that this was a virus that was lurking around for many decades before it exploded into the human population to become a noticeable pandemic, as opposed to something that started in the '70s or '80s," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), in Maryland.
NIAID funded the study along with the National Institutes of Health.
"It solidifies our understanding of the timetable of how this virus emerged from the chimpanzees to establish itself as a human infection," Fauci added.
"[HIV-1] flew below the radar level for decades until social conditions such as the end of colonization, migration of people to cities, increase in prostitution, and promiscuous sexual activity made it much easier for the disease to explode into a pandemic," Fauci explained.
More Mutations
Robert Garry is a microbiologist at New Orleans's Tulane University who was not involved with the study.
In the late 1980s, Garry was the first scientist to examine tissues samples taken from the U.S.'s first confirmed AIDS patient, who died in 1969.
"This study is very important, and what they are finding here is when the human virus started circulating in people," he said. "We still don't know when exactly the virus jumped from chimpanzees to humans, but it may be pushed back even further with this study.
"There will be other emerging viruses in the future, and what we learn about the conditions that help viruses spread, be it social changes or changes within the virus itself, will make us better prepared for other epidemics," he said.
Garry also argues that, though the rapid growth of cities in west-central Africa may have sparked the spread of infections, the virus itself underwent some sort of genetic change to facilitate transmission.
"We have to figure out what that change was," he cautioned.
Source:Amitabh Avasthi - National Geographic News
Saturday, September 27, 2008
Australia in biosecurity 'hotspot'
Australia is "encased by a ring of fire" with modelling by international experts showing Asia to be the most likely source of the next global infectious disease outbreak.
The panel of biosecurity and infectious disease experts also warn that a "fortress Australia" approach is not enough to stop bio-threats entering the country.
Instead Australia must also help develop the region's capacity to deal with and prevent infectious disease outbreaks, they say.
The presentation came ahead of today's launch, by the Australian Biosecurity Cooperative Research Centre, of the Biosecurity Risk Intelligence Scanning Committee.
Committee chair Professor John Edwards, Dean of the School of Veterinary and Biomedical Sciences at Murdoch University, says the group aims to predict emerging threats and inform research priorities.
"Australia has some of the best biosecurity systems in the world," Edwards says.
"But biosecurity is something you can never do well enough."
Edwards says greater attention needs to be given to animal viruses as up to 70% have zoonotic potential - can be passed to humans.
Priority assessments
He says the new committee will as a priority assess the risk of bat-borne viruses such as the Hendra-like Nipah virus, the dengue-like Chikungunya virus and Bluetongue virus. The later is spread by a biting midge and causes serious disease in livestock, particularly sheep.
Dr Peter Daszak, executive director of the Consortium for Conservation Medicine, says modelling of the likely areas where new viruses will emerge shows the region to the north of Australia to be most at risk.
"Australia is surrounded by the hotspot for emerging diseases and they are areas with incredibly low surveillance effort," he says.
"To understand the risk of new viruses we have to know what viruses wildlife carry, and of course we don't.
"We need to understand what makes them emerge and deal with that before they emerge."
'Hottest of hotspots'
Daszak says more than half of all emerging disease come from wildlife, yet estimates suggest 99.8% of viral diversity is unknown.
While it is hard to predict what the next pandemic will be, Daszak says "we can get a handle on where the next one will come from".
"The countries that border Australia are becoming the hottest of the hot spots," he says, adding we are "encased" by a biosecurity "ring of fire".
"The networks of trade and travel mean we are extremely connected to areas where diseases are emerging and therefore [Australia is] at high risk," Daszak says.
His view is supported by World Health Organization deputy regional advisor for communicable disease surveillance and response Dr Julie Hall.
Hall says the Asia-Pacific region has all the "drivers that enhance or create an environment" where new disease can emerge.
This includes high population density, significant poultry populations, and natural disasters and climate change causing large migrations of population.
'One new disease a year'
Hall says 70% of new emerging diseases are expected to come from animals and globally during the past 30 years on average one new disease a year has emerged.
She says the emerging threats in the region at present come from vector-borne disease, spread by mosquitoes.
This includes Dengue fever and Chikungunya virus.
However, Hall warns the most serious threat to the nation's biosecurity is "influenza fatigue" where interest wanes in the field because the threatened pandemic does not arrive.
This would mean a cut in funding to safeguards and the erosion of systems that prevent the pandemics from occurring.
Source: ABC
The panel of biosecurity and infectious disease experts also warn that a "fortress Australia" approach is not enough to stop bio-threats entering the country.
Instead Australia must also help develop the region's capacity to deal with and prevent infectious disease outbreaks, they say.
The presentation came ahead of today's launch, by the Australian Biosecurity Cooperative Research Centre, of the Biosecurity Risk Intelligence Scanning Committee.
Committee chair Professor John Edwards, Dean of the School of Veterinary and Biomedical Sciences at Murdoch University, says the group aims to predict emerging threats and inform research priorities.
"Australia has some of the best biosecurity systems in the world," Edwards says.
"But biosecurity is something you can never do well enough."
Edwards says greater attention needs to be given to animal viruses as up to 70% have zoonotic potential - can be passed to humans.
Priority assessments
He says the new committee will as a priority assess the risk of bat-borne viruses such as the Hendra-like Nipah virus, the dengue-like Chikungunya virus and Bluetongue virus. The later is spread by a biting midge and causes serious disease in livestock, particularly sheep.
Dr Peter Daszak, executive director of the Consortium for Conservation Medicine, says modelling of the likely areas where new viruses will emerge shows the region to the north of Australia to be most at risk.
"Australia is surrounded by the hotspot for emerging diseases and they are areas with incredibly low surveillance effort," he says.
"To understand the risk of new viruses we have to know what viruses wildlife carry, and of course we don't.
"We need to understand what makes them emerge and deal with that before they emerge."
'Hottest of hotspots'
Daszak says more than half of all emerging disease come from wildlife, yet estimates suggest 99.8% of viral diversity is unknown.
While it is hard to predict what the next pandemic will be, Daszak says "we can get a handle on where the next one will come from".
"The countries that border Australia are becoming the hottest of the hot spots," he says, adding we are "encased" by a biosecurity "ring of fire".
"The networks of trade and travel mean we are extremely connected to areas where diseases are emerging and therefore [Australia is] at high risk," Daszak says.
His view is supported by World Health Organization deputy regional advisor for communicable disease surveillance and response Dr Julie Hall.
Hall says the Asia-Pacific region has all the "drivers that enhance or create an environment" where new disease can emerge.
This includes high population density, significant poultry populations, and natural disasters and climate change causing large migrations of population.
'One new disease a year'
Hall says 70% of new emerging diseases are expected to come from animals and globally during the past 30 years on average one new disease a year has emerged.
She says the emerging threats in the region at present come from vector-borne disease, spread by mosquitoes.
This includes Dengue fever and Chikungunya virus.
However, Hall warns the most serious threat to the nation's biosecurity is "influenza fatigue" where interest wanes in the field because the threatened pandemic does not arrive.
This would mean a cut in funding to safeguards and the erosion of systems that prevent the pandemics from occurring.
Source: ABC
World Faces Global Pandemic Of Antibiotic Resistance, Experts Warn
Sep. 18, 2008) — Vital components of modern medicine such as major surgery, organ transplantation, and cancer chemotherapy will be threatened if antibiotic resistance is not tackled urgently, warn experts on bmj.com.
A concerted global response is needed to address rising rates of bacterial resistance caused by the use and abuse of antibiotics or "we will return to the pre-antibiotic era", write Professor Otto Cars and colleagues in an editorial.
All antibiotic use "uses up" some of the effectiveness of that antibiotic, diminishing the ability to use it in the future, write the authors, and antibiotics can no longer be considered as a renewable source.
They point out that existing antibiotics are losing their effect at an alarming pace, while the development of new antibiotics is declining. More than a dozen new classes of antibiotics were developed between 1930 and 1970, but only two new classes have been developed since then.
According to the European Centre for Disease Prevention and Control, the most important disease threat in Europe is from micro-organisms that have become resistant to antibiotics. As far back as 2000, the World Health Organisation was calling for a massive effort to address the problem of antimicrobial resistance to prevent the "health catastrophe of tomorrow".
So why has so little been done to address the problem of resistance, ask the authors?
Antibiotics are over prescribed, still illegally sold over the counter in some EU countries, and self medication with leftover medicines is commonplace.
There are alarming reports about serious consequences of antibiotic resistance from all around the world. However, there is still a dearth of data on the magnitude and burden of antibiotic resistance, or its economic impact on individuals, health care, and society. This, they suggest, may explain why there has been little response to this public health threat from politicians, public health workers, and consumers.
In addition, there are significant scientific challenges but few incentives to developing new antibiotics, state the authors.
The authors believe that priority must be given to the most urgently needed antibiotics and incentives given for developing antibacterials with new mechanisms of action. In addition, "the use of new antibiotics must be safeguarded by regulations and practices that ensure rational use, to avoid repeating the mistakes we have made by overusing the old ones", they say.
They point out that reducing consumer demand could be the strongest force to driving change—individuals must be educated to understand that their choice to use an antibiotic will affect the possibility of effectively treating bacterial infections in other people.
But, they claim, the ultimate responsibility for coordination and resources rests with national governments, WHO and other international stakeholders.
Not only is there an urgent need for up-to-date information on the level of antibiotic resistance, but also for evidence of effective interventions for the prevention and control of antibiotic resistance at national and local levels, while more focus is needed on infectious diseases, they conclude.
--------------------------------------------------------------------------------
Adapted from materials provided by BMJ-British Medical Journal, via EurekAlert!, a service of AAAS.
Source: ScienceDaily
A concerted global response is needed to address rising rates of bacterial resistance caused by the use and abuse of antibiotics or "we will return to the pre-antibiotic era", write Professor Otto Cars and colleagues in an editorial.
All antibiotic use "uses up" some of the effectiveness of that antibiotic, diminishing the ability to use it in the future, write the authors, and antibiotics can no longer be considered as a renewable source.
They point out that existing antibiotics are losing their effect at an alarming pace, while the development of new antibiotics is declining. More than a dozen new classes of antibiotics were developed between 1930 and 1970, but only two new classes have been developed since then.
According to the European Centre for Disease Prevention and Control, the most important disease threat in Europe is from micro-organisms that have become resistant to antibiotics. As far back as 2000, the World Health Organisation was calling for a massive effort to address the problem of antimicrobial resistance to prevent the "health catastrophe of tomorrow".
So why has so little been done to address the problem of resistance, ask the authors?
Antibiotics are over prescribed, still illegally sold over the counter in some EU countries, and self medication with leftover medicines is commonplace.
There are alarming reports about serious consequences of antibiotic resistance from all around the world. However, there is still a dearth of data on the magnitude and burden of antibiotic resistance, or its economic impact on individuals, health care, and society. This, they suggest, may explain why there has been little response to this public health threat from politicians, public health workers, and consumers.
In addition, there are significant scientific challenges but few incentives to developing new antibiotics, state the authors.
The authors believe that priority must be given to the most urgently needed antibiotics and incentives given for developing antibacterials with new mechanisms of action. In addition, "the use of new antibiotics must be safeguarded by regulations and practices that ensure rational use, to avoid repeating the mistakes we have made by overusing the old ones", they say.
They point out that reducing consumer demand could be the strongest force to driving change—individuals must be educated to understand that their choice to use an antibiotic will affect the possibility of effectively treating bacterial infections in other people.
But, they claim, the ultimate responsibility for coordination and resources rests with national governments, WHO and other international stakeholders.
Not only is there an urgent need for up-to-date information on the level of antibiotic resistance, but also for evidence of effective interventions for the prevention and control of antibiotic resistance at national and local levels, while more focus is needed on infectious diseases, they conclude.
--------------------------------------------------------------------------------
Adapted from materials provided by BMJ-British Medical Journal, via EurekAlert!, a service of AAAS.
Source: ScienceDaily
QualSec's eNose Detects Emerging Global Health Threats
NanoNose Detector Turns Epidemic Intelligence into a Predictive Science
CHAPEL HILL, N.C.--(BUSINESS WIRE)--QualSec (OTCBB: QLSCB):
In 1918, a strain of influenza, popularly known as the Spanish flu, ravaged the globe, killing an estimated 2.5% of the world's population. Now, concerns about new pandemics have led the global public health community to seek early warning systems to identify disease "hot spots" and enable rapid responses to prevent epidemics. The technological breakthrough that epidemiologists are looking for exists with QualSec’s NanoNose.
As environmental changes worldwide bring people in greater contact with animals, zoonoses - diseases that can transfer between humans and animals – are increasingly emerging as threats, including diseases like avian influenza, hantavirus, Ebola and West Nile viruses. QualSec’s NanoNose uses patented breakthroughs in nanotechnology for rapid data collection, allowing health officials better disease surveillance and vulnerability mapping.
This electronic nose technology developed by QualSec will be able to rapidly identify "hot spots" that could become epidemic nodes. Rapid detection is crucial for effective epidemic intelligence.
QualSec’s NanoNose is highly portable and rugged, and can be easily deployed to remote areas and used by operators with minimal training to detect epidemics before they spread. Though the sensor is designed to process data individually, it can be linked into a wireless network and transmit findings of disease to a central response center, where global health organizations can react to disease outbreaks.
For further details on the company and its products please visit the company's website at www.qualsensors.com.
QualSec believes that this press release contains forward-looking statements as that term is defined by the Private Securities Litigation Reform Act of 1995. Such forward-looking statements are subject to risks and uncertainties. Such statements are based on management's current expectations and are subject to facts that could cause results to differ materially from the forward-looking statements. For further information you are encouraged to view QualSec's filings with the Securities and Exchange Commission, including its annual report on Form 10K for the period ending December 31, 2007. The Company assumes no obligation to update the information contained in this press release.
CHAPEL HILL, N.C.--(BUSINESS WIRE)--QualSec (OTCBB: QLSCB):
In 1918, a strain of influenza, popularly known as the Spanish flu, ravaged the globe, killing an estimated 2.5% of the world's population. Now, concerns about new pandemics have led the global public health community to seek early warning systems to identify disease "hot spots" and enable rapid responses to prevent epidemics. The technological breakthrough that epidemiologists are looking for exists with QualSec’s NanoNose.
As environmental changes worldwide bring people in greater contact with animals, zoonoses - diseases that can transfer between humans and animals – are increasingly emerging as threats, including diseases like avian influenza, hantavirus, Ebola and West Nile viruses. QualSec’s NanoNose uses patented breakthroughs in nanotechnology for rapid data collection, allowing health officials better disease surveillance and vulnerability mapping.
This electronic nose technology developed by QualSec will be able to rapidly identify "hot spots" that could become epidemic nodes. Rapid detection is crucial for effective epidemic intelligence.
QualSec’s NanoNose is highly portable and rugged, and can be easily deployed to remote areas and used by operators with minimal training to detect epidemics before they spread. Though the sensor is designed to process data individually, it can be linked into a wireless network and transmit findings of disease to a central response center, where global health organizations can react to disease outbreaks.
For further details on the company and its products please visit the company's website at www.qualsensors.com.
QualSec believes that this press release contains forward-looking statements as that term is defined by the Private Securities Litigation Reform Act of 1995. Such forward-looking statements are subject to risks and uncertainties. Such statements are based on management's current expectations and are subject to facts that could cause results to differ materially from the forward-looking statements. For further information you are encouraged to view QualSec's filings with the Securities and Exchange Commission, including its annual report on Form 10K for the period ending December 31, 2007. The Company assumes no obligation to update the information contained in this press release.
Tuesday, August 26, 2008
Changing Pattern of Clostridium Difficile Associated Diarrhoea in a Tertiary Care Hospital: A 5 Year Retrospective Study
Changing Pattern of Clostridium Difficile Associated Diarrhoea in a Tertiary Care Hospital: A 5 Year Retrospective Study
Posted on: Tuesday, 26 August 2008, 03:00 CDT
By Chaudhry, Rama Joshy, Lovely; Kumar, Lalit; Dhawan, Benu
Background & objectives: Frequent use of broad spectrum antibiotics in hospitalized patients has increased the incidence of Clostridium difficile diarrhoea in recent years. In our tertiary care hospital in north India, C. difficile was responsible for 15 per cent of cases of nosocomial diarrhoea in 1999. A retrospective study was carried out to determine the frequency of C. difficile associated diarrhoea (CdAD) in our hospital, and to assess the effect of awareness among the hospital personnel and control measures taken to present C. difficile infection following the previous report. Methods: A retrospective chart review of all suspected cases of CdAD diagnosed at the hospital from January 2001 to December 2005 was done. Clinical specimens comprised 524 stool samples. All the samples were analyzed for C. difficile using culture and ELISA for toxin A and B. Attempts were made to type isolates using antibiogram, SDS-PAGE, gas liquid chromatography (GLC), PCR for toxin A and B gene fragments and restriction fragment length polymorphism (RFLP).
Results: A total of 37 (7.1%) specimens were positive for C. difficile toxin (11.2% in 2001, 9.4% in 2002, 8.6% in 2003, 5% in 2004 and 4% in 2005). The highest number of C. difficile toxin positive cases were from stool samples of patients hospitalized in the haematology/oncology ward (67.5% of all positive cases) followed by gastrointestinal surgery, neurology and nephrology wards. Of the C. difficile toxin positive samples, 15 (41%) were also positive for C. difficile culture. The isolates were grouped in to one, 3 and 5 groups using antibiogram, SDS-PAGE and PCR RFLP respectively. We observed an increase in the number of stool specimens tested for C. difficile infection but a decrease in C. difficile positives.
Interpretation & conclusions: A decrease in the number of C. difficile positive cases were noted during the 5 year study period though number of samples tested was increased. This may be due to stringent surveillance and an improved antibiotic policy followed in the hospital.
Diarrhoea is one of the most frequent side effects of antibiotic treatment. The symptoms may vary from slight abdominal discomfort to severe diarrhoea to colitis1. The aetiology of antibiotic associated diarrhoea (AAD) varies. The disruption of normal enteric flora caused by antibiotics may lead to overgrowth of pathogens and functional disturbances of the intestinal carbohydrate and bile acid metabolism, resulting in osmotic diarrhoea1. Allergic, toxic and pharmacological effects of antibiotics may also affect the intestinal mucosa and motility2. Cytotoxin producing Clostridium difficile has been reported to be the causative agent of approximately 20 per cent of AAD and of nearly all cases of pseudomembraneous colitis, the most severe manifestation of AAD1. Because of the frequent use of broad spectrum antibiotics, the incidence of C. difficile diarrhoea has risen dramatically in recent years3,4. Established guidelines should be followed to minimize exposure to the pathogen which include judicious use of antibiotics, rapid detection of C. difficile by immunoassays for toxin A and B, isolation of patients who had C. difficile associated diarrhoea (CdAD), proper disinfection of objects and education of staff members5. In our hospital which is a tertiary care hospital in north India, C. difficile was responsible for 15 per cent of cases of nosocomial diarrhoea in 1999(6). Standard control measures were implemented in our hospital to minimize the spread of this nosocomial pathogen after this report. This retrospective analysis was carried out in continuation of our earlier study6 to determine the effect of awareness and control measures taken to contain C. difficile infection in our hospital during the subsequent years.
Material & Methods
The study comprised retrospective analysis of faecal specimens from 524 patients suspected on clinical grounds to have CdAD2. The patients were hospitalized in All India Institute of Medical Sciences, New Delhi, India, over a period of 5 yr (January 1, 2001 - December 31, 2005). These included 80 patients in 2001, 96 in 2002, 92 in 2003, 106 in 2004 and 150 patients in 2005 respectively. Of these, 53 per cent were males and 82.4 per cent were in all age group > 12-60 yr (Table I).
Clinical information about the cause of diarrhoea underlying disease and antimicrobial therapy was obtained by reviewing the patient charts. A patient was considered to have CdAD if AAD was present and a stool specimen was positive in a toxin dependent C. difficile assay.
Sample collection and isolation of C. difficile: All the stool specimens were processed immediately for culture of C. difficile and stool aliquots were stored at -20[degrees]C for <72 h till they were tested for C. difficile toxin A and B. Spore selection was performed using 95 per cent ethanol and culture for C. difficile was done on cycloserine cefoxitin fructose agar (CCFA) and brain heart infusion agar (BHIA) as described elsewhere6. Concurrently, a loopful of stool specimen was inoculated into Robertsons cooked meat broth and incubated at 37[degrees]C for 48 h.
The plates were incubated anaerobically at 37[degrees]C in an anaerobic jar for 48 h. After incubation, the plates were examined and colonies which resembled C. difficile were Gram stained and identified by biochemical reactions using standard methods7.
When culture plate were negative for C. difficile, subcultures were made from cooked meat broth onto CCFA and BHIA and incubated anaerobically at 37[degrees]C up to 5 days before being discarded as negative.
Enzyme immunoassay for toxin A and B: Detection of enterotoxin and cytotoxin (toxin A and toxin B) of C. difficile was performed on the stool specimens by a double sandwich enzyme-linked immunosorbent assay technique using a commercial kit (Premier toxins A & B; Meridian Diagnostics, Inc., Cincinnati, Ohio, USA). The assay was performed according to the manufacturer's instructions.
Characterization of C. difficile isolates: All the C. difficile isolates were characterized phenotypically using antibiogram, SDS- PAGE6, gas liquid chromatography (GLC)7, and genotypically using PCR for toxin A gene and RFLP8,9.
Antibiogram typing - Antibiogram patterns were determined by disc diffusion method10. The antibiotics tested were chloramphenicol (30 [mu]g), penicillin G (10 units), clindamycin (2 [mu]g), vancomycin (5 [mu]g); metronidazole (5 [mu]g), tetracycline (30 [mu]g) and erythromycin (10 [mu]g). The results were expressed as susceptible or resistant.
Analysis of volatile fatty acids by gas liquid chromatography (GLC): All isolates were inoculated to cooked meat broth and incubated anaerobically for 48 h or more for GLC analysis to detect volatile fatty acids produced as metabolic end products. 1 ml of RCM broth was acidified with 0.2 ml of 50 per cent sulphuric acid and extracted with 1 ml of diethyl ether. The mixture was shaken vigorously and centrifuged at 176 g for 3 min; 1.5 [mu]l of the extracted ether layer was injected to the injection port of preconditioned GLC column with a 10 [mu]l Hamilton syringe. Chromatography was performed on a Nucon Series 5700, fitted with a flame ionization detector (FID)7. Operating conditions were as follows: carrier gas (oxygen free nitrogen): 60 ml/min oven temperature: detector 240[degrees]C, column 175[degrees]C, injector 240[degrees]C, attenuation 4X, sensitivity of the detector was set at 1000X. Fatty acids were identified by comparing the retention times of peaks in the test samples with those of known standard solutions which were examined each day7.
PCR assay for toxin gene fragments: The presence of toxin A gene in all isolates of C. difficile was determined by specific PCR using published primers8. PCR to detect the toxin B gene was performed in the C. difficile isolates using primers that had been developed and validated by Gumerlock et at9 to yield a 399-bp fragment for toxin B gene. PCR was performed in a 25 [mu]l reaction volume. Each reaction tube contained 1 X buffer (10 mm Tris HCl, pH 8.3, 50 mm KCl, 2.5 mm MgCl^sub 2^, 0.001% gelatin), each deoxynuclotide at a concentration of 100 mm (MBI, Fermentas, USA), each primer at a concentration of 20 pmol, 1.25 U Taq polymerase (MBI, Fermantas, USA) and 10 [mu]l of DNA. PCR was performed for 2 min at 95[degrees]C followed by 30 cycles of 1 min of denaturation at 95[degrees]C, 1 min of annealing at 52[degrees]C and 1 min of extension at 72[degrees]C. After the 30th cycle, extension was continued for an additional 10 min. 10 [mu]l of the amplified product was analyzed in 1 per cent agarose gel stained with ethidium bromide.
PCR-restriction fragment length polymorphism (RFLP) analysis: The amplified toxin A gene fragment was then digested with Alu I(10 units) restriction enzyme, under conditions recommended by the supplier (MBI-Fermentas). These digests were then subjected to electrophoresis on 2.5 per cent agarose gel at 60 V, along side a PCR size marker (100 bps, Sigma, USA).
Comparisons of patterns were performed visually. Strains with patterns differing alteast by one band were assigned to different types.
Results
A total of 524 stool specimens were analyzed for C. difficile from suspected cases of CdAD. The maximum number of C. difficile suspected cases were from oncology ward (378 cases, 72%), followed by other wards such as gastrointestinal surgery, neurology, nephrology and other medical wards. A total of 95 per cent of the analyzed group were on multiple antibiotics which included, 65 per cent on cephalosporins, 35 per cent on quinolones, 43 per cent on aminoglycosides, 12 per cent on macrolides, 69 per cent in vancomycin and metronidazole. Of the analyzed group, 37 (7.1%) patients were positive for C. difficile infection by the toxin dependent assay. Of these, 9 samples (11.2%) were positive in 2001, 9 (9.4%) in 2002, 8 (8.6%) in 2003, 5 (5%) in 2004 and 6 patients (4%) in 2005 (Fig. 1). Fifteen (41%) of the 37 toxin positive stool samples were also positive for C. difficile by culture. Eight of the 37 toxin positive cases expired, the cause of death was not directly related to C. difficile diarrhoea, although this might have been a contributory factor. Other pathogenic clostridia isolated from the patient group included C. perfringens (2.5%).
The highest number of C. difficile toxin positive cases were from stool samples of patients hospitalized in the haematology/oncology ward (25 samples, 67.5% of all positive cases), followed by gastrointestinal surgery, neurology and nephrology wards. Recovery rates of C. difficile in patient populations surveyed and summarized in Table II.
Of the 37 positive cases, 19 (51%) were males; 32 patients (86%) experienced diarrhoea during antibiotic treatment or within 15 days after the start of antibiotic treatment. The median time of occurrence of symptoms was 7 days (ranges 0-16 days) after start of antibiotic treatment and 8 days after admittance to hospital. All the patients were on multiple drugs and 50 per cent of the positive cases were on 3rd generation cephalosporins. None of the positive cases was on clindamycin. C. difficile positive cases were treated with metronidazole or vancomycin.
Antibiogram grouped all 15 isolates together as all were sensitive to erythromycin, chloramphenicol, penicillin, tetracyclin, clindamycin, vancomycin and metronidazole.
The identical fatty acid producers were grouped into 2 groups based on the production of isocaproic acid. Except one, all the isolates were producing isocaproic acid.
Based on the protein profiles observed on SDSPAGE, the isolates were placed into 3 groups; 12 isolates in group A, 2 in group B and 1 in group C.
PCR and RFLP analysis: All the ...lates were positive for toxin A (1.2 kb fragment) ... (399 bp) gene by PCR. Five different restriction profiles were obtained using Alu I endonucleases. The isolates were classified into five RFLP groups. The most frequent RFLP type was group I (6 isolates) group II, III, IV and V had 5, 2, 1 and 1 isolates respectively.
Discussion
C. difficile is considered as the most frequent aetiological agent of nosocomial diarrhoea occurring in hospitalized patients, spreading easily to the environment, the hands of health care workers and subsequently to other patients, particularly in large hospitals12. A trend of increasing prevalence of C. difficile has been reported in Europe and USA during the past 10 years13.
In our hospital C. difficile was found to be responsible for 15 per cent of the cases of nosocomial diarrhoea in our earlier study6. In this study, C. difficile was isolated mainly from patients in the haematology/ oncology wards. This points to the high risk areas for nosocomial spread of C. difficile isolates14. However, the percentage of infection showed a gradual decrease during the recent years.
Standard laboratory methods for diagnosing these infections include stool culture and identification of bacterial isolate, faecal toxin detection and C. difficile antigen detection. The culture lacks specificity due to the possible faecal carriage of non- toxigenic isolates, therefore many laboratories rely on toxin detection rather than culure for diagnosis of C. difficile infection15. A European survey of diagnostic methods for C. difficile, showed that culture of the organism is performed only in few countries. Mostly C. difficile toxin EIAs were used for diagnosis of CdAD16. In this study we used ELISA for toxin A, B and culture for diagnosing C. difficile infection. However, to the previous study6 we used C. difficile toxin A dependent ELISA for the analysis.
There was a gradual decrease in the percentage of ... infection during 2001 and 2005. The fact ... the 22 culture negative cases were on ... or vancomycin at the time of sample ... might be responsible for the decrease in isolation of organism as compared with the ELISA.
Older age, female gender and a prolonged hospital stay have been identified as risk factors in hospitalized CdAD patients17. In the current study, there was no gender prevalence among the positive cases and the median age of positive cases were 39 yr. However, highest percentage of culture positives was seen among patients >60 yr of age. Prolonged courses of antibiotic treatment have been related to an increased risk of AAD18,19. The median time for occurrence of symptoms was 7 days after the start of treatment in the present study, which was in accordance with other studies1,20. This suggests that disturbance of the normal colonic flora, eventually resulting in diarrhoea, takes place within about one week of antibiotic treatment. Prolonged duration of hospital stay has also been reported to be associated with AAD and CdAD19,21. In the present study, the median time of hospital stay was 8 days.
AAD was found to be frequently associated with cephalosporins, clindamycin and broad spectrum penicillins and quinolones22-25. In this study, about 50 per cent of our CdAD cases were on cephalosporins. However, since all the patients were on multiple antibiotics, the association with a particular group was not identified.
Discontinuation of antibiotic therapy withdraws the offending agents but is often not appropriate if the indication for such therapy was correct. An alternative is to change to antibiotics that do not belong to the high risk groups for induction of CdAD, such as quinolones, sulphonamides, parenteral aminoglycosides, cotrimoxazole, etc26. Metronidazole is suggested as the first line drug for the treatment of C. difficile infection2, and therefore the policy of the use of metronidazole in the treatment of suspected CdAD in our hospital is justified.
No nosocomial outbreak of C. difficile was reported during the study period. In this study we found antibiogram was least discriminatory of the typing strategies evaluated. The detection of short chain fatty acids by GLC is commonly utilized in bacteriological laboratories to identify anaerobes27. As all the isolates were positive for toxin A gene, we looked forward to analyze the variability of toxin A gene among C. difficile isolates by RFLP analysis. As the sequence analysis of the amplified 1.2 kbp toxin A gene fragment does not show any restriction sites for the previously reported restriction enzymes like Hinc II, Hind III, Ace I, EcoR I28, we decided to examine the amplified gene structure using restriction enzyme AIu I (5' AG[arrow down]CT 3', 3'TC[arrow up]GA 5'), which showed multiple restriction sites (8 sites) in the amplicon.
Although PCR-RFLP types 1 and II clustered some patient isolates, there was no epidemiological association between them. The locations where these patients were housed were different, and were admitted at different time periods. Better discriminatory methods such as pulsed field gel electrophoresis (PFGE) or ribotyping may be used to analyze the epidemiology of the pathogen.
In our recent prospective study, all the C. perfringens isolates were analyzed for the presence of enterotoxin by reverse passive later agglutination (RPLA), ELISA and by PCR assay for the presence of enterotoxin gene29. Of these, two were positive by PCR, RPLA and ELISA for C. perfringens enterotoxin. None of these samples had a co- infection with C. difficile.
Prevention of C. difficile infection is challenging. A change in antibiotic policy and implementation of standard infection control measures reduce the incidence of C. difficile symptomatic infections30,31. Combined approach, involving effective control measures, the use of rapid and sensitive techniques for laboratory diagnosis as well as prudent use of antibiotics, is necessary to reduce morbidity and mortality due to C. difficile associated infections in hospitalized patients.
In conclusion, we observed a decrease in the number of C. difficile toxin positive cases during the 5 yr of the study though there was an increase in the number of stool specimens tested per year for C. difficile. This possibly could be a result of stringent surveillance and antibiotic policy followed in our hospital especially in high risk areas such as haematology/oncology wards. Secondly, the use of clindamycin has been minimized in the hospital. Thirdly, antibiotics effective against C. difficile such as metronidazole have been included as the first line drugs in suspected CdAD cases. Isolation of the patients having C. difficile infection and regular awareness programmes conducted in the hospital might also have contributed.
Acknowledgment
Authors thank Ms. Sonam, Ms. Poornima and Shri Madho Prasad for technical assistance and acknowledge the Indian Council of Medical Research (ICMR), New Delhi, for financial suppport.
References
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2. Hogenauer C, Hammer HF, Krejs GJ, Reisinger EC. Mechanisms and management of antibiotic-associated diarrhea. Clin Infect Dis 1998; 27 : 702-10.
3. Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002; 235 : 363-72. 4. Kyne L, Hamel MB, Polavaram R, Kelly CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002; 34 : 346-53.
5. Schroeder MS. Clostridium difficile-associated diarrhea. Am Fam Physician 2005; 71 : 921-8.
6. Dhawan B, Chaudhry R, Sharma N Incidence of Clostridium difficile infection: a prospective study in an Indian hospital. J Hosp Infect 1999; 43 : 275-80.
7. Sutter VL, Citron DM, Edelstein MAC, Finegold SM. Wadsworth Anaerobic Manual. Belmont, California: Star Publishers, 1985. p. 71- 5.
8. Kato N, Ou CY, Kato H, Bartley SL, Brown VK, Dowell VR Jr, et al. Identification of toxigenic Clostridium difficile by the polymerase chain reaction. J Clin Microbiol 1991; 29 : 33-7.
9. Gumerlock PH, Tang YJ, Weiss JB, Silva J Jr. Specific detection of toxigenic strains of Clostridium difficile in stool specimens. J Clin Microbiol 1993; 3 : 507-11.
10. Lambe DW Jr., Laslie WW. A standard disc diffusion method for antibiotic susceptability testing for anaerobes; four years antibiotic data. In: Lambe DW Jr, Gena RJ, Carson KJM, editors. Anaerobic bacteria-selected topics. New York: Plenum Press, 1980.
11. Laemmli UK. Cleavage of structural proteins during the assembly of the head of bacteriophage. Nature 1970; 227 : 680-5.
12. Wroblewska MM, Swoboda-Kopec E, Rokosz A, Nurzynska G, Bednarska A, Luczak M. Detection of Clostridium difficile and its toxin A (TcdA) in stool specimens from hospitalised patients. Pol J Microbiol 2005; 54 : 111-5.
13. Wongwanich S, Pongpech P, Dhiraputra C, Huttayananont S, Sawanpanyalert P. Characteristics of Clostridium difficile strains isolated from asymptomatic individuals and from diarrheal patients. Clin Microbiol Infect 2001; 7: 438-41.
14. Blot E, Escande MC, Besson D, Barbut F, Granpeix C, Asselain B, et al. Outbreak of C. difficile related diarrhea in an adult oncology unit: risk factors and microbiological characteristics. J Hosp Infect 1993; 53: 187-92.
15. Wilcox MH, Fawley WN, Settle CD, Davidson A. Recurrence of symptoms in Clostridium difficile infection-relapse or reinfection? J Hosp Infect 1998; 38 : 93-100.
16. Barbut F, Delmee M, Brazier JS, Petit JC, Poxton IR, Rupnik M, et al. ESCMID Study Group on Clostridium difficile (ESGCD). A European survey of diagnostic methods and testing protocols for Clostridium difficile. Clin Microbiol Infect 2003; 9 : 989-96.
17. Al-Eidan FA, McElnay JC, Scott MG, Kearney MP. Clostridium difficile-associated diarrhoea in hospitalised patients. J Clin Pharm Ther 2000; 25 : 101-9.
18. Spencer R. The role of antimicrobial agents in the aetiology of Clostridium difficile-associated disease. J Antimicrob Chemother 1998; 41 : 21-7.
19. Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect 1998; 40 : 1-15.
20. Thamilikitkul V, Danpakdi K, Chokloikaew S. Incidence of diarrhea and Clostridium difficile toxin in stools from hospitalized patients receiving Clindamycin, beta lactams, and nonantibiotic medications. J Clin Gastroenterol 1996; 22 : 161-3.
21. Clabots CR, Johnson S, Olson MM, Peterson LR, Gerding DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992; 166 : 561-7.
22. Impallomeni M, Galletly NP, Wort SU, Starr JM, Rogers TR. Increased risk of diarrhea caused by Clostridium difficile in elderly patients receiving cefotaxime. BMJ 1995; 311 : 1345-6.
23. Pear SM, Williamson TH, Bettin KM, Gerding DN, Galgiani JN. Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann Intern Med 1994; 720 : 272-7.
24. Pepin J, Saheb N, Coulombe MA, Alary ME, Carrivean MP, Authier S, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005; 41 : 1254- 60.
25. Muto CA, Pokrywka M, Shutt K, Mendelsohn AS, Nouri K, Posey K, et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005; 26 : 273-80
26. Bartlett JG. Antibiotic associated diarrhea. Clin Infect Dis 1992; 15 : 573-81.
27. Pepersack F, Labbe M, Nonhoff C, Schoutens E. Use of gas- liquid chromatography as a screening test for toxigenic Clostridium difficile in diarrhoeal stools. J Clin Pathol 1983; 36 : 1233-6.
28. McFarland LV, Surawicz CM, Rubin M, Fekety R, Elmer GW, Greenberg RN. Recurrent Clostridium difficile disease: Epidemiology and clinical characteristics. Infect Control Hosp Epidemiol 1999; 20 : 43-50.
29. Joshy L, Chaudhry R, Dhawan B, Kumar L, Das BK. Incidence and characterization of Clostridium perfringens isolated from antibiotic- associated diarrhoeal patients: a prospective study in an Indian hospital. J Hosp Infect 2006; 63 : 323-9.
30. Khan R, Cheesbrough J. Impact of changes in antibiotic policy on Clostridium difficile-associated diarrhoea (CDAD) over a five- year period in a district general hospital. J Hosp infect 2003; 54 : 104-8.
31. Riley TV. Nosocomial diarrhoea due to Clostridium difficile. Curr Opin Infect Dis 2004; 17 : 323-7.
Rama Chaudhry, Lovely Joshy, Lalit Kumar* & Benu Dhawan
Departments of Microbiology, * Medical Oncology, Institute- Rotary Cancer Hospital
All India Institute of Medical Sciences, New Delhi, India
Received December 7, 2006
Reprint requests: Dr Rama Chaudhry, Professor, Department of Microbiology, All India Institute of Medical Sciences
New Delhi 110029, India
e-mail: drramach@rediffmail.com, ramach003@yahoo.com
Copyright Indian Council of Medical Research Apr 2008
(c) 2008 Indian Journal of Medical Research. Provided by ProQuest LLC. All rights Reserved.
Source: Indian Journal of Medical Research
Posted on: Tuesday, 26 August 2008, 03:00 CDT
By Chaudhry, Rama Joshy, Lovely; Kumar, Lalit; Dhawan, Benu
Background & objectives: Frequent use of broad spectrum antibiotics in hospitalized patients has increased the incidence of Clostridium difficile diarrhoea in recent years. In our tertiary care hospital in north India, C. difficile was responsible for 15 per cent of cases of nosocomial diarrhoea in 1999. A retrospective study was carried out to determine the frequency of C. difficile associated diarrhoea (CdAD) in our hospital, and to assess the effect of awareness among the hospital personnel and control measures taken to present C. difficile infection following the previous report. Methods: A retrospective chart review of all suspected cases of CdAD diagnosed at the hospital from January 2001 to December 2005 was done. Clinical specimens comprised 524 stool samples. All the samples were analyzed for C. difficile using culture and ELISA for toxin A and B. Attempts were made to type isolates using antibiogram, SDS-PAGE, gas liquid chromatography (GLC), PCR for toxin A and B gene fragments and restriction fragment length polymorphism (RFLP).
Results: A total of 37 (7.1%) specimens were positive for C. difficile toxin (11.2% in 2001, 9.4% in 2002, 8.6% in 2003, 5% in 2004 and 4% in 2005). The highest number of C. difficile toxin positive cases were from stool samples of patients hospitalized in the haematology/oncology ward (67.5% of all positive cases) followed by gastrointestinal surgery, neurology and nephrology wards. Of the C. difficile toxin positive samples, 15 (41%) were also positive for C. difficile culture. The isolates were grouped in to one, 3 and 5 groups using antibiogram, SDS-PAGE and PCR RFLP respectively. We observed an increase in the number of stool specimens tested for C. difficile infection but a decrease in C. difficile positives.
Interpretation & conclusions: A decrease in the number of C. difficile positive cases were noted during the 5 year study period though number of samples tested was increased. This may be due to stringent surveillance and an improved antibiotic policy followed in the hospital.
Diarrhoea is one of the most frequent side effects of antibiotic treatment. The symptoms may vary from slight abdominal discomfort to severe diarrhoea to colitis1. The aetiology of antibiotic associated diarrhoea (AAD) varies. The disruption of normal enteric flora caused by antibiotics may lead to overgrowth of pathogens and functional disturbances of the intestinal carbohydrate and bile acid metabolism, resulting in osmotic diarrhoea1. Allergic, toxic and pharmacological effects of antibiotics may also affect the intestinal mucosa and motility2. Cytotoxin producing Clostridium difficile has been reported to be the causative agent of approximately 20 per cent of AAD and of nearly all cases of pseudomembraneous colitis, the most severe manifestation of AAD1. Because of the frequent use of broad spectrum antibiotics, the incidence of C. difficile diarrhoea has risen dramatically in recent years3,4. Established guidelines should be followed to minimize exposure to the pathogen which include judicious use of antibiotics, rapid detection of C. difficile by immunoassays for toxin A and B, isolation of patients who had C. difficile associated diarrhoea (CdAD), proper disinfection of objects and education of staff members5. In our hospital which is a tertiary care hospital in north India, C. difficile was responsible for 15 per cent of cases of nosocomial diarrhoea in 1999(6). Standard control measures were implemented in our hospital to minimize the spread of this nosocomial pathogen after this report. This retrospective analysis was carried out in continuation of our earlier study6 to determine the effect of awareness and control measures taken to contain C. difficile infection in our hospital during the subsequent years.
Material & Methods
The study comprised retrospective analysis of faecal specimens from 524 patients suspected on clinical grounds to have CdAD2. The patients were hospitalized in All India Institute of Medical Sciences, New Delhi, India, over a period of 5 yr (January 1, 2001 - December 31, 2005). These included 80 patients in 2001, 96 in 2002, 92 in 2003, 106 in 2004 and 150 patients in 2005 respectively. Of these, 53 per cent were males and 82.4 per cent were in all age group > 12-60 yr (Table I).
Clinical information about the cause of diarrhoea underlying disease and antimicrobial therapy was obtained by reviewing the patient charts. A patient was considered to have CdAD if AAD was present and a stool specimen was positive in a toxin dependent C. difficile assay.
Sample collection and isolation of C. difficile: All the stool specimens were processed immediately for culture of C. difficile and stool aliquots were stored at -20[degrees]C for <72 h till they were tested for C. difficile toxin A and B. Spore selection was performed using 95 per cent ethanol and culture for C. difficile was done on cycloserine cefoxitin fructose agar (CCFA) and brain heart infusion agar (BHIA) as described elsewhere6. Concurrently, a loopful of stool specimen was inoculated into Robertsons cooked meat broth and incubated at 37[degrees]C for 48 h.
The plates were incubated anaerobically at 37[degrees]C in an anaerobic jar for 48 h. After incubation, the plates were examined and colonies which resembled C. difficile were Gram stained and identified by biochemical reactions using standard methods7.
When culture plate were negative for C. difficile, subcultures were made from cooked meat broth onto CCFA and BHIA and incubated anaerobically at 37[degrees]C up to 5 days before being discarded as negative.
Enzyme immunoassay for toxin A and B: Detection of enterotoxin and cytotoxin (toxin A and toxin B) of C. difficile was performed on the stool specimens by a double sandwich enzyme-linked immunosorbent assay technique using a commercial kit (Premier toxins A & B; Meridian Diagnostics, Inc., Cincinnati, Ohio, USA). The assay was performed according to the manufacturer's instructions.
Characterization of C. difficile isolates: All the C. difficile isolates were characterized phenotypically using antibiogram, SDS- PAGE6, gas liquid chromatography (GLC)7, and genotypically using PCR for toxin A gene and RFLP8,9.
Antibiogram typing - Antibiogram patterns were determined by disc diffusion method10. The antibiotics tested were chloramphenicol (30 [mu]g), penicillin G (10 units), clindamycin (2 [mu]g), vancomycin (5 [mu]g); metronidazole (5 [mu]g), tetracycline (30 [mu]g) and erythromycin (10 [mu]g). The results were expressed as susceptible or resistant.
Analysis of volatile fatty acids by gas liquid chromatography (GLC): All isolates were inoculated to cooked meat broth and incubated anaerobically for 48 h or more for GLC analysis to detect volatile fatty acids produced as metabolic end products. 1 ml of RCM broth was acidified with 0.2 ml of 50 per cent sulphuric acid and extracted with 1 ml of diethyl ether. The mixture was shaken vigorously and centrifuged at 176 g for 3 min; 1.5 [mu]l of the extracted ether layer was injected to the injection port of preconditioned GLC column with a 10 [mu]l Hamilton syringe. Chromatography was performed on a Nucon Series 5700, fitted with a flame ionization detector (FID)7. Operating conditions were as follows: carrier gas (oxygen free nitrogen): 60 ml/min oven temperature: detector 240[degrees]C, column 175[degrees]C, injector 240[degrees]C, attenuation 4X, sensitivity of the detector was set at 1000X. Fatty acids were identified by comparing the retention times of peaks in the test samples with those of known standard solutions which were examined each day7.
PCR assay for toxin gene fragments: The presence of toxin A gene in all isolates of C. difficile was determined by specific PCR using published primers8. PCR to detect the toxin B gene was performed in the C. difficile isolates using primers that had been developed and validated by Gumerlock et at9 to yield a 399-bp fragment for toxin B gene. PCR was performed in a 25 [mu]l reaction volume. Each reaction tube contained 1 X buffer (10 mm Tris HCl, pH 8.3, 50 mm KCl, 2.5 mm MgCl^sub 2^, 0.001% gelatin), each deoxynuclotide at a concentration of 100 mm (MBI, Fermentas, USA), each primer at a concentration of 20 pmol, 1.25 U Taq polymerase (MBI, Fermantas, USA) and 10 [mu]l of DNA. PCR was performed for 2 min at 95[degrees]C followed by 30 cycles of 1 min of denaturation at 95[degrees]C, 1 min of annealing at 52[degrees]C and 1 min of extension at 72[degrees]C. After the 30th cycle, extension was continued for an additional 10 min. 10 [mu]l of the amplified product was analyzed in 1 per cent agarose gel stained with ethidium bromide.
PCR-restriction fragment length polymorphism (RFLP) analysis: The amplified toxin A gene fragment was then digested with Alu I(10 units) restriction enzyme, under conditions recommended by the supplier (MBI-Fermentas). These digests were then subjected to electrophoresis on 2.5 per cent agarose gel at 60 V, along side a PCR size marker (100 bps, Sigma, USA).
Comparisons of patterns were performed visually. Strains with patterns differing alteast by one band were assigned to different types.
Results
A total of 524 stool specimens were analyzed for C. difficile from suspected cases of CdAD. The maximum number of C. difficile suspected cases were from oncology ward (378 cases, 72%), followed by other wards such as gastrointestinal surgery, neurology, nephrology and other medical wards. A total of 95 per cent of the analyzed group were on multiple antibiotics which included, 65 per cent on cephalosporins, 35 per cent on quinolones, 43 per cent on aminoglycosides, 12 per cent on macrolides, 69 per cent in vancomycin and metronidazole. Of the analyzed group, 37 (7.1%) patients were positive for C. difficile infection by the toxin dependent assay. Of these, 9 samples (11.2%) were positive in 2001, 9 (9.4%) in 2002, 8 (8.6%) in 2003, 5 (5%) in 2004 and 6 patients (4%) in 2005 (Fig. 1). Fifteen (41%) of the 37 toxin positive stool samples were also positive for C. difficile by culture. Eight of the 37 toxin positive cases expired, the cause of death was not directly related to C. difficile diarrhoea, although this might have been a contributory factor. Other pathogenic clostridia isolated from the patient group included C. perfringens (2.5%).
The highest number of C. difficile toxin positive cases were from stool samples of patients hospitalized in the haematology/oncology ward (25 samples, 67.5% of all positive cases), followed by gastrointestinal surgery, neurology and nephrology wards. Recovery rates of C. difficile in patient populations surveyed and summarized in Table II.
Of the 37 positive cases, 19 (51%) were males; 32 patients (86%) experienced diarrhoea during antibiotic treatment or within 15 days after the start of antibiotic treatment. The median time of occurrence of symptoms was 7 days (ranges 0-16 days) after start of antibiotic treatment and 8 days after admittance to hospital. All the patients were on multiple drugs and 50 per cent of the positive cases were on 3rd generation cephalosporins. None of the positive cases was on clindamycin. C. difficile positive cases were treated with metronidazole or vancomycin.
Antibiogram grouped all 15 isolates together as all were sensitive to erythromycin, chloramphenicol, penicillin, tetracyclin, clindamycin, vancomycin and metronidazole.
The identical fatty acid producers were grouped into 2 groups based on the production of isocaproic acid. Except one, all the isolates were producing isocaproic acid.
Based on the protein profiles observed on SDSPAGE, the isolates were placed into 3 groups; 12 isolates in group A, 2 in group B and 1 in group C.
PCR and RFLP analysis: All the ...lates were positive for toxin A (1.2 kb fragment) ... (399 bp) gene by PCR. Five different restriction profiles were obtained using Alu I endonucleases. The isolates were classified into five RFLP groups. The most frequent RFLP type was group I (6 isolates) group II, III, IV and V had 5, 2, 1 and 1 isolates respectively.
Discussion
C. difficile is considered as the most frequent aetiological agent of nosocomial diarrhoea occurring in hospitalized patients, spreading easily to the environment, the hands of health care workers and subsequently to other patients, particularly in large hospitals12. A trend of increasing prevalence of C. difficile has been reported in Europe and USA during the past 10 years13.
In our hospital C. difficile was found to be responsible for 15 per cent of the cases of nosocomial diarrhoea in our earlier study6. In this study, C. difficile was isolated mainly from patients in the haematology/ oncology wards. This points to the high risk areas for nosocomial spread of C. difficile isolates14. However, the percentage of infection showed a gradual decrease during the recent years.
Standard laboratory methods for diagnosing these infections include stool culture and identification of bacterial isolate, faecal toxin detection and C. difficile antigen detection. The culture lacks specificity due to the possible faecal carriage of non- toxigenic isolates, therefore many laboratories rely on toxin detection rather than culure for diagnosis of C. difficile infection15. A European survey of diagnostic methods for C. difficile, showed that culture of the organism is performed only in few countries. Mostly C. difficile toxin EIAs were used for diagnosis of CdAD16. In this study we used ELISA for toxin A, B and culture for diagnosing C. difficile infection. However, to the previous study6 we used C. difficile toxin A dependent ELISA for the analysis.
There was a gradual decrease in the percentage of ... infection during 2001 and 2005. The fact ... the 22 culture negative cases were on ... or vancomycin at the time of sample ... might be responsible for the decrease in isolation of organism as compared with the ELISA.
Older age, female gender and a prolonged hospital stay have been identified as risk factors in hospitalized CdAD patients17. In the current study, there was no gender prevalence among the positive cases and the median age of positive cases were 39 yr. However, highest percentage of culture positives was seen among patients >60 yr of age. Prolonged courses of antibiotic treatment have been related to an increased risk of AAD18,19. The median time for occurrence of symptoms was 7 days after the start of treatment in the present study, which was in accordance with other studies1,20. This suggests that disturbance of the normal colonic flora, eventually resulting in diarrhoea, takes place within about one week of antibiotic treatment. Prolonged duration of hospital stay has also been reported to be associated with AAD and CdAD19,21. In the present study, the median time of hospital stay was 8 days.
AAD was found to be frequently associated with cephalosporins, clindamycin and broad spectrum penicillins and quinolones22-25. In this study, about 50 per cent of our CdAD cases were on cephalosporins. However, since all the patients were on multiple antibiotics, the association with a particular group was not identified.
Discontinuation of antibiotic therapy withdraws the offending agents but is often not appropriate if the indication for such therapy was correct. An alternative is to change to antibiotics that do not belong to the high risk groups for induction of CdAD, such as quinolones, sulphonamides, parenteral aminoglycosides, cotrimoxazole, etc26. Metronidazole is suggested as the first line drug for the treatment of C. difficile infection2, and therefore the policy of the use of metronidazole in the treatment of suspected CdAD in our hospital is justified.
No nosocomial outbreak of C. difficile was reported during the study period. In this study we found antibiogram was least discriminatory of the typing strategies evaluated. The detection of short chain fatty acids by GLC is commonly utilized in bacteriological laboratories to identify anaerobes27. As all the isolates were positive for toxin A gene, we looked forward to analyze the variability of toxin A gene among C. difficile isolates by RFLP analysis. As the sequence analysis of the amplified 1.2 kbp toxin A gene fragment does not show any restriction sites for the previously reported restriction enzymes like Hinc II, Hind III, Ace I, EcoR I28, we decided to examine the amplified gene structure using restriction enzyme AIu I (5' AG[arrow down]CT 3', 3'TC[arrow up]GA 5'), which showed multiple restriction sites (8 sites) in the amplicon.
Although PCR-RFLP types 1 and II clustered some patient isolates, there was no epidemiological association between them. The locations where these patients were housed were different, and were admitted at different time periods. Better discriminatory methods such as pulsed field gel electrophoresis (PFGE) or ribotyping may be used to analyze the epidemiology of the pathogen.
In our recent prospective study, all the C. perfringens isolates were analyzed for the presence of enterotoxin by reverse passive later agglutination (RPLA), ELISA and by PCR assay for the presence of enterotoxin gene29. Of these, two were positive by PCR, RPLA and ELISA for C. perfringens enterotoxin. None of these samples had a co- infection with C. difficile.
Prevention of C. difficile infection is challenging. A change in antibiotic policy and implementation of standard infection control measures reduce the incidence of C. difficile symptomatic infections30,31. Combined approach, involving effective control measures, the use of rapid and sensitive techniques for laboratory diagnosis as well as prudent use of antibiotics, is necessary to reduce morbidity and mortality due to C. difficile associated infections in hospitalized patients.
In conclusion, we observed a decrease in the number of C. difficile toxin positive cases during the 5 yr of the study though there was an increase in the number of stool specimens tested per year for C. difficile. This possibly could be a result of stringent surveillance and antibiotic policy followed in our hospital especially in high risk areas such as haematology/oncology wards. Secondly, the use of clindamycin has been minimized in the hospital. Thirdly, antibiotics effective against C. difficile such as metronidazole have been included as the first line drugs in suspected CdAD cases. Isolation of the patients having C. difficile infection and regular awareness programmes conducted in the hospital might also have contributed.
Acknowledgment
Authors thank Ms. Sonam, Ms. Poornima and Shri Madho Prasad for technical assistance and acknowledge the Indian Council of Medical Research (ICMR), New Delhi, for financial suppport.
References
1. Wistrom J, Norrby SR, Myhre EB, Eriksson S, Granstron G, Legergrea, et al. Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother 2001; 47 : 43-50.
2. Hogenauer C, Hammer HF, Krejs GJ, Reisinger EC. Mechanisms and management of antibiotic-associated diarrhea. Clin Infect Dis 1998; 27 : 702-10.
3. Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002; 235 : 363-72. 4. Kyne L, Hamel MB, Polavaram R, Kelly CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002; 34 : 346-53.
5. Schroeder MS. Clostridium difficile-associated diarrhea. Am Fam Physician 2005; 71 : 921-8.
6. Dhawan B, Chaudhry R, Sharma N Incidence of Clostridium difficile infection: a prospective study in an Indian hospital. J Hosp Infect 1999; 43 : 275-80.
7. Sutter VL, Citron DM, Edelstein MAC, Finegold SM. Wadsworth Anaerobic Manual. Belmont, California: Star Publishers, 1985. p. 71- 5.
8. Kato N, Ou CY, Kato H, Bartley SL, Brown VK, Dowell VR Jr, et al. Identification of toxigenic Clostridium difficile by the polymerase chain reaction. J Clin Microbiol 1991; 29 : 33-7.
9. Gumerlock PH, Tang YJ, Weiss JB, Silva J Jr. Specific detection of toxigenic strains of Clostridium difficile in stool specimens. J Clin Microbiol 1993; 3 : 507-11.
10. Lambe DW Jr., Laslie WW. A standard disc diffusion method for antibiotic susceptability testing for anaerobes; four years antibiotic data. In: Lambe DW Jr, Gena RJ, Carson KJM, editors. Anaerobic bacteria-selected topics. New York: Plenum Press, 1980.
11. Laemmli UK. Cleavage of structural proteins during the assembly of the head of bacteriophage. Nature 1970; 227 : 680-5.
12. Wroblewska MM, Swoboda-Kopec E, Rokosz A, Nurzynska G, Bednarska A, Luczak M. Detection of Clostridium difficile and its toxin A (TcdA) in stool specimens from hospitalised patients. Pol J Microbiol 2005; 54 : 111-5.
13. Wongwanich S, Pongpech P, Dhiraputra C, Huttayananont S, Sawanpanyalert P. Characteristics of Clostridium difficile strains isolated from asymptomatic individuals and from diarrheal patients. Clin Microbiol Infect 2001; 7: 438-41.
14. Blot E, Escande MC, Besson D, Barbut F, Granpeix C, Asselain B, et al. Outbreak of C. difficile related diarrhea in an adult oncology unit: risk factors and microbiological characteristics. J Hosp Infect 1993; 53: 187-92.
15. Wilcox MH, Fawley WN, Settle CD, Davidson A. Recurrence of symptoms in Clostridium difficile infection-relapse or reinfection? J Hosp Infect 1998; 38 : 93-100.
16. Barbut F, Delmee M, Brazier JS, Petit JC, Poxton IR, Rupnik M, et al. ESCMID Study Group on Clostridium difficile (ESGCD). A European survey of diagnostic methods and testing protocols for Clostridium difficile. Clin Microbiol Infect 2003; 9 : 989-96.
17. Al-Eidan FA, McElnay JC, Scott MG, Kearney MP. Clostridium difficile-associated diarrhoea in hospitalised patients. J Clin Pharm Ther 2000; 25 : 101-9.
18. Spencer R. The role of antimicrobial agents in the aetiology of Clostridium difficile-associated disease. J Antimicrob Chemother 1998; 41 : 21-7.
19. Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect 1998; 40 : 1-15.
20. Thamilikitkul V, Danpakdi K, Chokloikaew S. Incidence of diarrhea and Clostridium difficile toxin in stools from hospitalized patients receiving Clindamycin, beta lactams, and nonantibiotic medications. J Clin Gastroenterol 1996; 22 : 161-3.
21. Clabots CR, Johnson S, Olson MM, Peterson LR, Gerding DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992; 166 : 561-7.
22. Impallomeni M, Galletly NP, Wort SU, Starr JM, Rogers TR. Increased risk of diarrhea caused by Clostridium difficile in elderly patients receiving cefotaxime. BMJ 1995; 311 : 1345-6.
23. Pear SM, Williamson TH, Bettin KM, Gerding DN, Galgiani JN. Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann Intern Med 1994; 720 : 272-7.
24. Pepin J, Saheb N, Coulombe MA, Alary ME, Carrivean MP, Authier S, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005; 41 : 1254- 60.
25. Muto CA, Pokrywka M, Shutt K, Mendelsohn AS, Nouri K, Posey K, et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005; 26 : 273-80
26. Bartlett JG. Antibiotic associated diarrhea. Clin Infect Dis 1992; 15 : 573-81.
27. Pepersack F, Labbe M, Nonhoff C, Schoutens E. Use of gas- liquid chromatography as a screening test for toxigenic Clostridium difficile in diarrhoeal stools. J Clin Pathol 1983; 36 : 1233-6.
28. McFarland LV, Surawicz CM, Rubin M, Fekety R, Elmer GW, Greenberg RN. Recurrent Clostridium difficile disease: Epidemiology and clinical characteristics. Infect Control Hosp Epidemiol 1999; 20 : 43-50.
29. Joshy L, Chaudhry R, Dhawan B, Kumar L, Das BK. Incidence and characterization of Clostridium perfringens isolated from antibiotic- associated diarrhoeal patients: a prospective study in an Indian hospital. J Hosp Infect 2006; 63 : 323-9.
30. Khan R, Cheesbrough J. Impact of changes in antibiotic policy on Clostridium difficile-associated diarrhoea (CDAD) over a five- year period in a district general hospital. J Hosp infect 2003; 54 : 104-8.
31. Riley TV. Nosocomial diarrhoea due to Clostridium difficile. Curr Opin Infect Dis 2004; 17 : 323-7.
Rama Chaudhry, Lovely Joshy, Lalit Kumar* & Benu Dhawan
Departments of Microbiology, * Medical Oncology, Institute- Rotary Cancer Hospital
All India Institute of Medical Sciences, New Delhi, India
Received December 7, 2006
Reprint requests: Dr Rama Chaudhry, Professor, Department of Microbiology, All India Institute of Medical Sciences
New Delhi 110029, India
e-mail: drramach@rediffmail.com, ramach003@yahoo.com
Copyright Indian Council of Medical Research Apr 2008
(c) 2008 Indian Journal of Medical Research. Provided by ProQuest LLC. All rights Reserved.
Source: Indian Journal of Medical Research
Sunday, August 24, 2008
Nanotubes could help study retrovirus transmission between human cells
Recent findings by medical researchers indicate that naturally occurring nanotubes may serve as tunnels that protect retroviruses and bacteria in transit from diseased to healthy cells — a fact that may explain why vaccines fare poorly against some invaders.
To better study the missions of these intercellular nanotubes, scientists have sought the means to form them quickly and easily in test tubes.
Sandia National Laboratories researchers have now learned serendipitously to form nanotubes with surprising ease.
"Our work is the first to show that the formation of nanotubes is not complicated, but can be a general effect of protein-membrane interactions alone," says Darryl Sasaki of Sandia's Bioscience and Energy Center.
Sandia is a National Nuclear Security Administration laboratory.
The tunnel-like structures have been recognized only recently as tiny but important bodily channels for the good, the bad, and the informational.
In addition to providing protected transport to certain diseases, the nanotubes also seem to help trundle bacteria to their doom in the tentacles of microphages. Lastly, the nanotubes may provide avenues to send and receive information (in the form of chemical molecules) from cell to cell far faster than their random dispersal into the bloodstream would permit.
Given the discovery of this radically different transportation system operating within human tissues, it was natural for researchers to attempt to duplicate the formation of the nanotubes. In their labs, they experimented with giant lipid vesicles that appeared to mimic key aspects of the cellular membrane.
Giant lipid vesicles resemble micron-sized spherical soap bubbles that exist in water. They are composed of a lipid bilayer membrane only five nanometers thick.
The object for experimenters was to create conditions in which the spheres would morph into cylinders of nanometer radii.
But researchers had difficulties, says Sasaki, perhaps because they used a composite lipid called egg PC that requires unnecessarily high energies to bend into a tubular shape.
Egg PC is inexpensive, readily available, and offers good, stable membrane properties. It is the usual lipid of choice in forming nanocylinders via mechanical stretching techniques.
But Sandia postdoctoral researcher Haiqing Lui instead used POPC — a single pure lipid requiring half the bending energy of egg PC.
She was trying to generate nanotubes by a completely different approach that involved the use of motor proteins to stretch naturally occurring membranes into tubes.
Working with Sandia researcher George Bachand, she serendipitously found that interaction of the POPC membrane with a high affinity protein called streptavidin alone was enough to form the nanotubes.
"Perhaps this information — linking membrane bending energy with nanotube formation — may provide some clue about the membrane structure and the cell's ability to form such intercellular connections," Sasaki says.
The formation was confirmed by Sandia researcher Carl Hayden, who characterized the nanotube formation through a confocal imaging microscope. The custom instrument allows pixel-by-pixel examination of the protein interaction with the membranes comprising the nanotubes by detecting the spectrum and lifetimes of fluorescent labels on the proteins.
Nanotube formation had been noticed previously by cell biologists, but they had dismissed the tiny outgrowths as "junk — an aberration of cells growing in culture," says Sasaki. "The reason they were only noticed recently as trafficking routes is because of labeling studies that marked organelles and proteins. This allowed a focused look at what these nanostructures might be used for."
It became clear, says Sasaki, that the organelles were being transported with "specific directionality" on the backs of motor proteins within the tubes, rather than randomly.
Three-dimensional networks of nanotubes also are found to be created by macrophages — part of the police force of the body — grown in culture, says George. The tubes in appearance and function resemble a kind of spider web, capturing bacterium and transporting them to the macrophages, which eat them.
Source : DOE/Sandia National Laboratories
To better study the missions of these intercellular nanotubes, scientists have sought the means to form them quickly and easily in test tubes.
Sandia National Laboratories researchers have now learned serendipitously to form nanotubes with surprising ease.
"Our work is the first to show that the formation of nanotubes is not complicated, but can be a general effect of protein-membrane interactions alone," says Darryl Sasaki of Sandia's Bioscience and Energy Center.
Sandia is a National Nuclear Security Administration laboratory.
The tunnel-like structures have been recognized only recently as tiny but important bodily channels for the good, the bad, and the informational.
In addition to providing protected transport to certain diseases, the nanotubes also seem to help trundle bacteria to their doom in the tentacles of microphages. Lastly, the nanotubes may provide avenues to send and receive information (in the form of chemical molecules) from cell to cell far faster than their random dispersal into the bloodstream would permit.
Given the discovery of this radically different transportation system operating within human tissues, it was natural for researchers to attempt to duplicate the formation of the nanotubes. In their labs, they experimented with giant lipid vesicles that appeared to mimic key aspects of the cellular membrane.
Giant lipid vesicles resemble micron-sized spherical soap bubbles that exist in water. They are composed of a lipid bilayer membrane only five nanometers thick.
The object for experimenters was to create conditions in which the spheres would morph into cylinders of nanometer radii.
But researchers had difficulties, says Sasaki, perhaps because they used a composite lipid called egg PC that requires unnecessarily high energies to bend into a tubular shape.
Egg PC is inexpensive, readily available, and offers good, stable membrane properties. It is the usual lipid of choice in forming nanocylinders via mechanical stretching techniques.
But Sandia postdoctoral researcher Haiqing Lui instead used POPC — a single pure lipid requiring half the bending energy of egg PC.
She was trying to generate nanotubes by a completely different approach that involved the use of motor proteins to stretch naturally occurring membranes into tubes.
Working with Sandia researcher George Bachand, she serendipitously found that interaction of the POPC membrane with a high affinity protein called streptavidin alone was enough to form the nanotubes.
"Perhaps this information — linking membrane bending energy with nanotube formation — may provide some clue about the membrane structure and the cell's ability to form such intercellular connections," Sasaki says.
The formation was confirmed by Sandia researcher Carl Hayden, who characterized the nanotube formation through a confocal imaging microscope. The custom instrument allows pixel-by-pixel examination of the protein interaction with the membranes comprising the nanotubes by detecting the spectrum and lifetimes of fluorescent labels on the proteins.
Nanotube formation had been noticed previously by cell biologists, but they had dismissed the tiny outgrowths as "junk — an aberration of cells growing in culture," says Sasaki. "The reason they were only noticed recently as trafficking routes is because of labeling studies that marked organelles and proteins. This allowed a focused look at what these nanostructures might be used for."
It became clear, says Sasaki, that the organelles were being transported with "specific directionality" on the backs of motor proteins within the tubes, rather than randomly.
Three-dimensional networks of nanotubes also are found to be created by macrophages — part of the police force of the body — grown in culture, says George. The tubes in appearance and function resemble a kind of spider web, capturing bacterium and transporting them to the macrophages, which eat them.
Source : DOE/Sandia National Laboratories
Worms do calculus to find meals or avoid unpleasantness
Thanks to salt and hot chili peppers, researchers have found a calculus-computing center that tells a roundworm to go forward toward dinner or turn to broaden the search. It's a computational mechanism, they say, that is similar to what drives hungry college students to a pizza.
These behavior-driving calculations, according to a paper published in the July 3 issue of the journal Nature, are done "in a tiny, specialized computer inside a primitive roundworm," says principal investigator Shawn Lockery, a University of Oregon biologist and member of the UO Institute of Neuroscience.
In their paper, the researchers documented how two related, closely located chemosensory neurons, acting in tandem, regulate behavior. The left neuron controls an on switch, while the opposing right one an off switch. These sister neurons are situated much like the two nostrils or two eyes of mammals. Together these neurons are known as ASE for antagonistic sensory cues.
It's possible, Lockery said, that the discovery someday could help research aimed at treating at least some of the 200,000 people in the United States who annually seek medical treatment, according to records of the National Institutes of Health, for problems involving taste and smell.
"This computer does some nice calculus, differentiating the rate of change of the strength of various tastes," Lockery said. "The worm uses this information to find food and to avoid poisons."
Lockery and colleagues predicted the existence of a derivative-crunching mechanism in the Journal of Neuroscience in 1999 based on findings that nematodes change directions based on taste and smell.
"In effect, they have two nostrils or two tongues but they are so close together that it is really like having one nostril or one tongue, and yet they find their way around quite effectively," Lockery said. "We knew from behavioral experiments that nematodes were doing the same thing that humans were doing, but only from the view of behavioral responses. We didn't know what was going on in the brain."
To get there, Lockery and colleagues used new imaging and molecular tools, along with some genetic engineering of their worms.
In one experiment, these chemosensory neurons carried a fluorescent protein that changed color based on neuronal activity. In another experiment, the neurons carried receptor proteins that recognize capsaicin, the active component in chili peppers.
Researchers found that when concentrations of salt were high, fluorescent proteins change from blue to yellow, showing that the left neuron (ASEL) was active as the worms continued forward movement. When salt levels were reduced, the right neuron (ASER) activated but generated a different behavior; the worms began a turning, or searching, motion.
"At this point, we wanted to know if these neurons really are controlling behavior. If ASEL really signals that things are getting better, then, if you could artificially activate ASEL the animals ought to go straight like a human going directly toward the pizza," Lockery said. "Conversely, if you activate the ASER the animals ought to turn to find their goal."
Such was the case, according to the capsaicin-receptor experiment. When the pepper ingredient was spread on turning worms with receptor proteins in the left neuron, they straightened their motion. Likewise, capsaicin applied to worms with the receptors in their right neurons caused them to change from turning motion to forward crawling.
"We have discovered a tiny, specialized computer inside a primitive round worm," Lockery said. "The computer calculates the rate of change of the strengths, or concentrations, of various tastes. The worm uses this information to find food and to avoid poisons."
Evidence for such on and off switching cells in other chemosensory networks of mammals, he added, "There are strong indications that a similar device exists in the human nervous system."
Source : University of Oregon
These behavior-driving calculations, according to a paper published in the July 3 issue of the journal Nature, are done "in a tiny, specialized computer inside a primitive roundworm," says principal investigator Shawn Lockery, a University of Oregon biologist and member of the UO Institute of Neuroscience.
In their paper, the researchers documented how two related, closely located chemosensory neurons, acting in tandem, regulate behavior. The left neuron controls an on switch, while the opposing right one an off switch. These sister neurons are situated much like the two nostrils or two eyes of mammals. Together these neurons are known as ASE for antagonistic sensory cues.
It's possible, Lockery said, that the discovery someday could help research aimed at treating at least some of the 200,000 people in the United States who annually seek medical treatment, according to records of the National Institutes of Health, for problems involving taste and smell.
"This computer does some nice calculus, differentiating the rate of change of the strength of various tastes," Lockery said. "The worm uses this information to find food and to avoid poisons."
Lockery and colleagues predicted the existence of a derivative-crunching mechanism in the Journal of Neuroscience in 1999 based on findings that nematodes change directions based on taste and smell.
"In effect, they have two nostrils or two tongues but they are so close together that it is really like having one nostril or one tongue, and yet they find their way around quite effectively," Lockery said. "We knew from behavioral experiments that nematodes were doing the same thing that humans were doing, but only from the view of behavioral responses. We didn't know what was going on in the brain."
To get there, Lockery and colleagues used new imaging and molecular tools, along with some genetic engineering of their worms.
In one experiment, these chemosensory neurons carried a fluorescent protein that changed color based on neuronal activity. In another experiment, the neurons carried receptor proteins that recognize capsaicin, the active component in chili peppers.
Researchers found that when concentrations of salt were high, fluorescent proteins change from blue to yellow, showing that the left neuron (ASEL) was active as the worms continued forward movement. When salt levels were reduced, the right neuron (ASER) activated but generated a different behavior; the worms began a turning, or searching, motion.
"At this point, we wanted to know if these neurons really are controlling behavior. If ASEL really signals that things are getting better, then, if you could artificially activate ASEL the animals ought to go straight like a human going directly toward the pizza," Lockery said. "Conversely, if you activate the ASER the animals ought to turn to find their goal."
Such was the case, according to the capsaicin-receptor experiment. When the pepper ingredient was spread on turning worms with receptor proteins in the left neuron, they straightened their motion. Likewise, capsaicin applied to worms with the receptors in their right neurons caused them to change from turning motion to forward crawling.
"We have discovered a tiny, specialized computer inside a primitive round worm," Lockery said. "The computer calculates the rate of change of the strengths, or concentrations, of various tastes. The worm uses this information to find food and to avoid poisons."
Evidence for such on and off switching cells in other chemosensory networks of mammals, he added, "There are strong indications that a similar device exists in the human nervous system."
Source : University of Oregon
New antibiotic beats superbugs at their own game
The problem with antibiotics is that, eventually, bacteria outsmart them and become resistant. But by targeting the gene that confers such resistance, a new drug may be able to finally outwit them. Rockefeller University scientists tested the new drug, called Ceftobiprole, against some of the deadliest strains of multidrug-resistant Staphylococcus aureus (MRSA) bacteria, which are responsible for the great majority of staphylococcal infections worldwide, both in hospitals and in the community.
The research, to be published in the August 2008 issue of the journal Antimicrobial Agents and Chemotherapy and available online now, looked at how well Ceftobiprole worked against bacterial clones that had already developed resistance to other drugs. In every case, Ceftobiprole won. "It just knocked out the cells 100 percent," says the study's lead investigator, Alexander Tomasz, head of the Laboratory of Microbiology at Rockefeller.
Previous research had already shown that -- in general -- Ceftobiprole was highly effective against most clinical isolates of S. aureus. "Instead, we looked more carefully at the highly resistant cells that already occur in such clinical isolates at very low frequency -- maybe in one bacterium in every 1,000," says Tomasz. Ceftobiprole was able to kill these resistant cells.
Never before has an antibiotic been tested this way. "In the history of antibiotic development, an antibiotic arrives on the scene, and sooner or later resistant bacteria emerge," Tomasz says. "We sought to test in advance which would win this particular chess game: the new drug, or the bacteria that now cause human deaths."
In an ominous new "move" in this chess game, S. aureus strains with resistance to vancomycin (VRSA), a different class of antibiotics, also began to appear in hospitals in the United States. Ceftobiprole was also able to kill these new resistant VRSA strains.
The drug is effective because the chemists who developed Ceftobiprole managed to outwit the bacteria at their own game, Tomasz says. The broad-spectrum antibiotic was discovered by Basilea Pharmaceuticals, based in Basel, Switzerland, and is being developed in the U.S. and worldwide by Johnson & Johnson. The research was supported by Johnson & Johnson along with a grant from the U.S. Public Health Service.
Source : Rockefeller University
The research, to be published in the August 2008 issue of the journal Antimicrobial Agents and Chemotherapy and available online now, looked at how well Ceftobiprole worked against bacterial clones that had already developed resistance to other drugs. In every case, Ceftobiprole won. "It just knocked out the cells 100 percent," says the study's lead investigator, Alexander Tomasz, head of the Laboratory of Microbiology at Rockefeller.
Previous research had already shown that -- in general -- Ceftobiprole was highly effective against most clinical isolates of S. aureus. "Instead, we looked more carefully at the highly resistant cells that already occur in such clinical isolates at very low frequency -- maybe in one bacterium in every 1,000," says Tomasz. Ceftobiprole was able to kill these resistant cells.
Never before has an antibiotic been tested this way. "In the history of antibiotic development, an antibiotic arrives on the scene, and sooner or later resistant bacteria emerge," Tomasz says. "We sought to test in advance which would win this particular chess game: the new drug, or the bacteria that now cause human deaths."
In an ominous new "move" in this chess game, S. aureus strains with resistance to vancomycin (VRSA), a different class of antibiotics, also began to appear in hospitals in the United States. Ceftobiprole was also able to kill these new resistant VRSA strains.
The drug is effective because the chemists who developed Ceftobiprole managed to outwit the bacteria at their own game, Tomasz says. The broad-spectrum antibiotic was discovered by Basilea Pharmaceuticals, based in Basel, Switzerland, and is being developed in the U.S. and worldwide by Johnson & Johnson. The research was supported by Johnson & Johnson along with a grant from the U.S. Public Health Service.
Source : Rockefeller University
Pandemic mutations in bird flu revealed
Scientists have discovered how bird flu adapts in patients, offering a new way to monitor the disease and prevent a pandemic, according to research published in the August issue of the Journal of General Virology. Highly pathogenic H5N1 avian influenza virus has spread through at least 45 countries in 3 continents. Despite its ability to spread, it cannot be transmitted efficiently from human to human. This indicates it is not fully adapted to its new host species, the human. However, this new research reveals mutations in the virus that may result in a pandemic.
"The mutations needed for the emergence of a potential pandemic virus are likely to originate and be selected within infected human tissues," said Professor Dr Prasert Auewarakul from Mahidol University, Thailand. "We analyzed specific molecules called haemagglutinin on viruses derived from fatal human cases. Our results suggest new candidate mutations that may allow bird flu to adapt to humans."
Viruses with a high mutation rate such as influenza virus usually exist as a swarm of variants, each slightly different from the others. These are called H5N1 bird flu quasispecies. Professor Dr Auewarakul and his colleagues found that some mutations in the quasispecies were more frequent than others, which indicates they may be adaptive changes that make the virus more efficient at infecting humans. Most of these mutations were found in the area required for the virus to bind to the host cell.
"This study shows that the H5N1 virus is adapting each time it infects a human," said Professor Dr Auewarakul. "Such adaptations may lead to the emergence of a virus that can cause a pandemic. Our research highlights the need to control infection and transmission to humans to prevent further adaptations."
The research has provided genetic markers to help scientists monitor bird flu viruses with pandemic potential. This means they will be able to detect potentially dangerous strains and prevent a pandemic. The research also gives new insights into the mechanism of the genesis of a pandemic strain.
"Our approach could be used to screen for mutations with significant functional impact," said Professor Dr Auewarakul. "It is a new method of searching for changes in H5N1 viruses that are required for the emergence of a pandemic virus. We hope it will help us to prevent a pandemic in the future."
Source : Society for General Microbiology
"The mutations needed for the emergence of a potential pandemic virus are likely to originate and be selected within infected human tissues," said Professor Dr Prasert Auewarakul from Mahidol University, Thailand. "We analyzed specific molecules called haemagglutinin on viruses derived from fatal human cases. Our results suggest new candidate mutations that may allow bird flu to adapt to humans."
Viruses with a high mutation rate such as influenza virus usually exist as a swarm of variants, each slightly different from the others. These are called H5N1 bird flu quasispecies. Professor Dr Auewarakul and his colleagues found that some mutations in the quasispecies were more frequent than others, which indicates they may be adaptive changes that make the virus more efficient at infecting humans. Most of these mutations were found in the area required for the virus to bind to the host cell.
"This study shows that the H5N1 virus is adapting each time it infects a human," said Professor Dr Auewarakul. "Such adaptations may lead to the emergence of a virus that can cause a pandemic. Our research highlights the need to control infection and transmission to humans to prevent further adaptations."
The research has provided genetic markers to help scientists monitor bird flu viruses with pandemic potential. This means they will be able to detect potentially dangerous strains and prevent a pandemic. The research also gives new insights into the mechanism of the genesis of a pandemic strain.
"Our approach could be used to screen for mutations with significant functional impact," said Professor Dr Auewarakul. "It is a new method of searching for changes in H5N1 viruses that are required for the emergence of a pandemic virus. We hope it will help us to prevent a pandemic in the future."
Source : Society for General Microbiology
New study sheds light on how intracellular pathogens trigger the immune system
Disease-causing microbes like the food-borne bacterium Listeria monocytogenes specialize in invading and replicating inside their animal hosts' own cells, making them particularly tricky to defeat. Now, a new study led by biologists at the University of California, Berkeley, has identified a molecular alarm system in which the intracellular pathogen sends out signals that kick the immune response into gear.
The findings, to be reported the week of July 14 in the journal Proceedings of the National Academy of Sciences, shed light on how the cells recognize and destroy the pathogenic bugs living within their walls, and may even provide new targets for the research and development of new vaccines and drugs.
The pathogens' signals come from multidrug resistance transporters (MDRs), membrane proteins used by a wide variety of organisms to pump out a broad range of molecules from their systems. Similar transporters have been linked in other studies to the development of resistance to multiple drugs that are toxic to the pathogen. This study is the first to connect multidrug resistance transporters directly to stimulation of the immune system, although the nature of the molecules that the bacteria are spitting out remains unclear.
"For the MDRs to work, the pathogen needs to be alive, so this study actually shows how the immune system can tell the difference between a living, harmful microbe and one that is dead," said the study's principal investigator, Daniel Portnoy, a UC Berkeley professor with joint appointments in the Department of Molecular and Cell Biology and the School of Public Health, and associate director of the Berkeley Center for Emerging and Neglected Diseases. "This is important because you don't want the immune system to overreact to non-threats, which is what happens in autoimmune disorders such as inflammatory bowel disease, asthma and multiple sclerosis."
The Listeria bacterium makes headlines when it contaminates deli meats, raw cheeses, cole slaw and other foods. According to the Centers for Disease Control and Prevention, Listeria causes some 2,500 infections and 500 deaths each year, and at greatest risk are people who have weakened immune systems or are pregnant.
The bacteria first trick immune cells into swallowing them, where they become encased in bubbles called vacuoles. The bacteria become dangerous when they break out of these bubbles into the cells' internal fluid, or cytosol, to multiply and spread the infection. The role of MDRs is not clearly known, but the results of this study plainly show that one particular MDR transporter is necessary for the host to respond to the infection, the authors said. In addition, overexpression of this or other related MDRs leads to an enhanced host immune response.
"The only way the bug molecule enters into the cytosol is if the bacterium is virulent," said Portnoy, who is also a member of UC Berkeley's Health Sciences Initiative. "We know that there are different immune system receptors in different compartments of a cell, but until this paper, it was not understood exactly how the cytosolic surveillance system was triggered. Our findings suggest that the molecules pumped out by the pathogen while it's in the cellular fluid help the immune system gauge whether a bacterium is a threat based upon its location inside the cell."
The researchers isolated the role of multidrug resistance transporters by manipulating specific genes in the bacteria that controlled their expression and then measuring how increased or decreased activity by the transporter proteins impacted levels of interferon beta, a protein produced by the immune system that rally more disease-fighting cells when infections are detected.
They found that greater MDR expression led to greater stimulation of the immune system, as measured by interferon beta levels.
Strains of Listeria with higher levels of MDR expression increased interferon beta levels up to 20-fold compared with unmodified, wild-type Listeria in cell cultures, the study found. Tests in mice infected with those same mutant strains of Listeria had bacterial loads that were 20 times lower in their livers, although the researchers could not attribute the decreased levels solely to the higher levels of interferon beta.
"This paper raises the classic issue of the tug-of-war in the evolution of the host and the pathogen; it's a never-ending arms race," said Gregory Crimmins, UC Berkeley graduate student in molecular and cell biology who, along with former UC Berkeley post-doctoral researcher Anat Herskovits, was the study's co-lead author.
The study results could provide clues to the actions of other intracellular pathogens, such as the bacteria responsible for tuberculosis and Legionnaires' disease, since they also activate similar immune mechanisms, the researchers said.
Crimmins noted that better understanding of how the class of interferons in this study is triggered could have implications for a variety of diseases. "Type I interferons have wide-ranging effects on the immune system, and are used to treat multiple sclerosis, hepatitis C and some types of cancer," he said. "The strains generated in this study may provide novel insight into the role of Type I interferons in coordinating the host immune response."
"By understanding the pathways of innate immunity, we can better understand acquired immunity, and that is important for vaccine development," added Portnoy. "The concept of making safe but fully effective vaccines is still a challenge, especially for intracellular pathogens."
Portnoy pointed out that weakened Listeria is already being used to develop cancer vaccines by Anza Pharmaceuticals, a Concord-based biopharmaceutical company with which he consults.
Source : University of California - Berkeley
The findings, to be reported the week of July 14 in the journal Proceedings of the National Academy of Sciences, shed light on how the cells recognize and destroy the pathogenic bugs living within their walls, and may even provide new targets for the research and development of new vaccines and drugs.
The pathogens' signals come from multidrug resistance transporters (MDRs), membrane proteins used by a wide variety of organisms to pump out a broad range of molecules from their systems. Similar transporters have been linked in other studies to the development of resistance to multiple drugs that are toxic to the pathogen. This study is the first to connect multidrug resistance transporters directly to stimulation of the immune system, although the nature of the molecules that the bacteria are spitting out remains unclear.
"For the MDRs to work, the pathogen needs to be alive, so this study actually shows how the immune system can tell the difference between a living, harmful microbe and one that is dead," said the study's principal investigator, Daniel Portnoy, a UC Berkeley professor with joint appointments in the Department of Molecular and Cell Biology and the School of Public Health, and associate director of the Berkeley Center for Emerging and Neglected Diseases. "This is important because you don't want the immune system to overreact to non-threats, which is what happens in autoimmune disorders such as inflammatory bowel disease, asthma and multiple sclerosis."
The Listeria bacterium makes headlines when it contaminates deli meats, raw cheeses, cole slaw and other foods. According to the Centers for Disease Control and Prevention, Listeria causes some 2,500 infections and 500 deaths each year, and at greatest risk are people who have weakened immune systems or are pregnant.
The bacteria first trick immune cells into swallowing them, where they become encased in bubbles called vacuoles. The bacteria become dangerous when they break out of these bubbles into the cells' internal fluid, or cytosol, to multiply and spread the infection. The role of MDRs is not clearly known, but the results of this study plainly show that one particular MDR transporter is necessary for the host to respond to the infection, the authors said. In addition, overexpression of this or other related MDRs leads to an enhanced host immune response.
"The only way the bug molecule enters into the cytosol is if the bacterium is virulent," said Portnoy, who is also a member of UC Berkeley's Health Sciences Initiative. "We know that there are different immune system receptors in different compartments of a cell, but until this paper, it was not understood exactly how the cytosolic surveillance system was triggered. Our findings suggest that the molecules pumped out by the pathogen while it's in the cellular fluid help the immune system gauge whether a bacterium is a threat based upon its location inside the cell."
The researchers isolated the role of multidrug resistance transporters by manipulating specific genes in the bacteria that controlled their expression and then measuring how increased or decreased activity by the transporter proteins impacted levels of interferon beta, a protein produced by the immune system that rally more disease-fighting cells when infections are detected.
They found that greater MDR expression led to greater stimulation of the immune system, as measured by interferon beta levels.
Strains of Listeria with higher levels of MDR expression increased interferon beta levels up to 20-fold compared with unmodified, wild-type Listeria in cell cultures, the study found. Tests in mice infected with those same mutant strains of Listeria had bacterial loads that were 20 times lower in their livers, although the researchers could not attribute the decreased levels solely to the higher levels of interferon beta.
"This paper raises the classic issue of the tug-of-war in the evolution of the host and the pathogen; it's a never-ending arms race," said Gregory Crimmins, UC Berkeley graduate student in molecular and cell biology who, along with former UC Berkeley post-doctoral researcher Anat Herskovits, was the study's co-lead author.
The study results could provide clues to the actions of other intracellular pathogens, such as the bacteria responsible for tuberculosis and Legionnaires' disease, since they also activate similar immune mechanisms, the researchers said.
Crimmins noted that better understanding of how the class of interferons in this study is triggered could have implications for a variety of diseases. "Type I interferons have wide-ranging effects on the immune system, and are used to treat multiple sclerosis, hepatitis C and some types of cancer," he said. "The strains generated in this study may provide novel insight into the role of Type I interferons in coordinating the host immune response."
"By understanding the pathways of innate immunity, we can better understand acquired immunity, and that is important for vaccine development," added Portnoy. "The concept of making safe but fully effective vaccines is still a challenge, especially for intracellular pathogens."
Portnoy pointed out that weakened Listeria is already being used to develop cancer vaccines by Anza Pharmaceuticals, a Concord-based biopharmaceutical company with which he consults.
Source : University of California - Berkeley
A viral cloaking device
Viruses achieve their definition of success when they can thrive without killing their host. Now, biologists Pamela Bjorkman and Zhiru Yang of the California Institute of Technology have uncovered how one such virus, prevalent in humans, evolved over time to hide from the immune system.
The human immune system and the viruses hosted by our bodies are in a continual dance for survival--viruses ever seek new ways to evade detection, and our immune system devises new methods to hunt them down. Human Cytomegalovirus (HCMV), says Bjorkman, Caltech's Delbrück Professor of Biology and a Howard Hughes Medical Institute (HHMI) Investigator, "is the definition of a successful virus--it thrives but it doesn't affect the host."
HCMV is carried by eight in 10 people. Although it generally harms only those who are immunocompromised, it has also been linked with brain tumors like the one for which Ted Kennedy recently had surgery. Understanding how HCMV survives may help in the development of a vaccine, as well as in the fight against other viruses with similar evasive tactics.
"We are interested in mechanisms taken by viruses to escape our immune system," says Caltech biology postdoc and HHMI associate Zhiru Yang. She and Bjorkman published their findings on HCMV survival mechanisms in the July 15 edition of Proceedings of the National Academy of Sciences. They describe the underpinnings of a viral cloaking device, partly made of stolen goods from healthy cells, that helps HCMV to move undetected through the body.
For 20 years, Bjorkman's lab has been dedicated to understanding class 1 major histocompatibility complex (MHC) proteins and the immune response, most recently related to AIDS research. MHC proteins carry peptides, small pieces that are chopped up from the cell's internal proteins, to the cell's surface. If a cell has been infected, MHC presents viral peptides to signal T cells to kill it. So some viruses evolved to evade T cells by keeping MHC from reaching the cell surface. In turn, the immune system recruited other hunters to search for cells that don't show MHC proteins.
Sometime along its treacherous evolutionary path, HCMV stole a class 1 MHC molecule from its host and modified it for supreme stealth. "This is a decoy," Bjorkman says. She and Yang analyzed the structure of the mimic, called UL18, to compare how similar it is to the real thing. They found that despite a mere 23 percent match in genetic sequences, UL18 looks almost exactly the same as a true class 1 MHC.
The same immune cells that search for missing MHC proteins are designed to bind to them when they find them, thereby inhibiting an immune response. Yang and Bjorkman found that UL18 happens to bind 1,000 times tighter to these inhibitory receptors than real MHC molecules do. "This is exactly what the virus wants--to avoid being recognized by T cells, but to engage inhibitory receptors to turn off immune cells," Yang notes. "Only a small number of UL18 molecules are required to have the same inhibitory effect as a large number of MHC class I molecules."
"What I find astounding is that the virus stole this gene and kept it almost identical but improved upon its binding," Bjorkman says.
UL18 didn't stop there. "It also binds peptides--that's unique to this MHC mimic. We don't know why," Bjorkman adds. The peptide is obscured from killer cells by yet another shield, Yang says. In a trait it shares with HIV proteins, HCMV's UL18 covers itself with carbohydrates, which are unrecognizable to the immune system. A real class 1 MHC molecule has one site for adding carbohydrates; the fake has 13, Bjorkman notes. The only place where it's not covered is where it binds to the inhibitory receptor.
All its efforts have made UL18 virtually undetectable. "It's a good example of a viral protein that evolved from its host ancestor to block unwanted interactions," Yang says. "The more we understand that, the more effectively we can fight viruses that hide out," Bjorkman adds.
Source : California Institute of Technology
The human immune system and the viruses hosted by our bodies are in a continual dance for survival--viruses ever seek new ways to evade detection, and our immune system devises new methods to hunt them down. Human Cytomegalovirus (HCMV), says Bjorkman, Caltech's Delbrück Professor of Biology and a Howard Hughes Medical Institute (HHMI) Investigator, "is the definition of a successful virus--it thrives but it doesn't affect the host."
HCMV is carried by eight in 10 people. Although it generally harms only those who are immunocompromised, it has also been linked with brain tumors like the one for which Ted Kennedy recently had surgery. Understanding how HCMV survives may help in the development of a vaccine, as well as in the fight against other viruses with similar evasive tactics.
"We are interested in mechanisms taken by viruses to escape our immune system," says Caltech biology postdoc and HHMI associate Zhiru Yang. She and Bjorkman published their findings on HCMV survival mechanisms in the July 15 edition of Proceedings of the National Academy of Sciences. They describe the underpinnings of a viral cloaking device, partly made of stolen goods from healthy cells, that helps HCMV to move undetected through the body.
For 20 years, Bjorkman's lab has been dedicated to understanding class 1 major histocompatibility complex (MHC) proteins and the immune response, most recently related to AIDS research. MHC proteins carry peptides, small pieces that are chopped up from the cell's internal proteins, to the cell's surface. If a cell has been infected, MHC presents viral peptides to signal T cells to kill it. So some viruses evolved to evade T cells by keeping MHC from reaching the cell surface. In turn, the immune system recruited other hunters to search for cells that don't show MHC proteins.
Sometime along its treacherous evolutionary path, HCMV stole a class 1 MHC molecule from its host and modified it for supreme stealth. "This is a decoy," Bjorkman says. She and Yang analyzed the structure of the mimic, called UL18, to compare how similar it is to the real thing. They found that despite a mere 23 percent match in genetic sequences, UL18 looks almost exactly the same as a true class 1 MHC.
The same immune cells that search for missing MHC proteins are designed to bind to them when they find them, thereby inhibiting an immune response. Yang and Bjorkman found that UL18 happens to bind 1,000 times tighter to these inhibitory receptors than real MHC molecules do. "This is exactly what the virus wants--to avoid being recognized by T cells, but to engage inhibitory receptors to turn off immune cells," Yang notes. "Only a small number of UL18 molecules are required to have the same inhibitory effect as a large number of MHC class I molecules."
"What I find astounding is that the virus stole this gene and kept it almost identical but improved upon its binding," Bjorkman says.
UL18 didn't stop there. "It also binds peptides--that's unique to this MHC mimic. We don't know why," Bjorkman adds. The peptide is obscured from killer cells by yet another shield, Yang says. In a trait it shares with HIV proteins, HCMV's UL18 covers itself with carbohydrates, which are unrecognizable to the immune system. A real class 1 MHC molecule has one site for adding carbohydrates; the fake has 13, Bjorkman notes. The only place where it's not covered is where it binds to the inhibitory receptor.
All its efforts have made UL18 virtually undetectable. "It's a good example of a viral protein that evolved from its host ancestor to block unwanted interactions," Yang says. "The more we understand that, the more effectively we can fight viruses that hide out," Bjorkman adds.
Source : California Institute of Technology
New evidence of battle between humans and ancient virus
For millennia, humans and viruses have been locked in an evolutionary back-and-forth -- one changes to outsmart the other, prompting the second to change and outsmart the first. With retroviruses, which work by inserting themselves into their host's DNA, the evidence remains in our genes. Last year, researchers at Rockefeller University and the Aaron Diamond AIDS Research Center brought an ancient retrovirus back to life and showed it could reproduce and infect human cells. Now, the same scientists have looked at the human side of the story and found evidence that our ancestors fought back against that virus with a defense mechanism our bodies still use today.
"This is the first time that we've been able to take an ancient retrovirus and analyze how it interacts with host defense mechanisms in the laboratory in the present day," says Paul Bieniasz, who is an associate professor and head of the Laboratory of Retrovirology at Rockefeller and a scientist at the Aaron Diamond AIDS Research Center. Bieniasz and graduate student Youngnam Lee took their resurrected virus, called HERV-K, tested its strength against molecules involved in human antiviral defense and published their results in the Journal of Virology (online ahead of print, June 18).
Bieniasz, who also is an investigator at the Howard Hughes Medical Institute, and Lee found that, at least in the laboratory, human cells infected with HERV-K fought back with several antiviral proteins. One of those proteins, called APOBEC3G, leaves a tell-tale signature behind: It mutates virus DNA in a recognizable pattern and is one our cells use to attack modern retroviruses. "But this is the first time it's been shown for this ancient retrovirus," Bieniasz says.
Once the scientists found that modern human cells attacked HERV-K with this molecule, they went back to look at the "fossil evidence," remnants of the virus that still remain in our genes and that the researchers had previously used to reconstruct it. What emerged were two copies of HERV-K that had clearly been mutated, and thus inactivated, by the APOBEC3G protein. "We're looking at things that happened millions and millions of years ago," says Lee. "But these sorts of ancient interactions may have influenced how humans are able to combat these retroviruses today. These proteins help protect us against current retroviruses." Indeed, HERV-K may well have helped to shape the modern APOBEC3G defense.
The earlier study and this one provide two sides of the evolutionary coin: the infectious agent, and the host defense. "Retroviruses are able to infect us and leave remnants in our DNA, and our DNA also holds evidence of what we've done to them in return," Lee says. "It's an illustration of the fight between host and virus."
Source : Rockefeller University
"This is the first time that we've been able to take an ancient retrovirus and analyze how it interacts with host defense mechanisms in the laboratory in the present day," says Paul Bieniasz, who is an associate professor and head of the Laboratory of Retrovirology at Rockefeller and a scientist at the Aaron Diamond AIDS Research Center. Bieniasz and graduate student Youngnam Lee took their resurrected virus, called HERV-K, tested its strength against molecules involved in human antiviral defense and published their results in the Journal of Virology (online ahead of print, June 18).
Bieniasz, who also is an investigator at the Howard Hughes Medical Institute, and Lee found that, at least in the laboratory, human cells infected with HERV-K fought back with several antiviral proteins. One of those proteins, called APOBEC3G, leaves a tell-tale signature behind: It mutates virus DNA in a recognizable pattern and is one our cells use to attack modern retroviruses. "But this is the first time it's been shown for this ancient retrovirus," Bieniasz says.
Once the scientists found that modern human cells attacked HERV-K with this molecule, they went back to look at the "fossil evidence," remnants of the virus that still remain in our genes and that the researchers had previously used to reconstruct it. What emerged were two copies of HERV-K that had clearly been mutated, and thus inactivated, by the APOBEC3G protein. "We're looking at things that happened millions and millions of years ago," says Lee. "But these sorts of ancient interactions may have influenced how humans are able to combat these retroviruses today. These proteins help protect us against current retroviruses." Indeed, HERV-K may well have helped to shape the modern APOBEC3G defense.
The earlier study and this one provide two sides of the evolutionary coin: the infectious agent, and the host defense. "Retroviruses are able to infect us and leave remnants in our DNA, and our DNA also holds evidence of what we've done to them in return," Lee says. "It's an illustration of the fight between host and virus."
Source : Rockefeller University
Yale researchers uncover West Nile's targets
Screening the entire human genome, a team headed by Yale University scientists have identified several hundred genes that impact West Nile virus infection. The findings reported Wednesday online in the journal Nature may give scientists valuable new clues about ways to intervene in a host of deadly viral infections.
"Diseases like West Nile affect millions of people," said Erol Fikrig, professor of medicine and microbial pathogenesis at Yale, an investigator with the Howard Hughes Medical Institute, and senior author of the paper. "We have found a dictionary of genes critical to a viral infection. Using these techniques, this can be done with any virus."
West Nile is transmitted by mosquitoes and has become a significant health threat in many parts of the United States since being introduced into North America in 1999. Symptoms range from mild flu-like symptoms to potentially fatal inflammation of the brain and central nervous system. West Nile is part of the flavivirus family, which includes dengue, yellow fever and tick- borne encephalitis viruses, among others, and causes thousands of deaths annually.
West Nile virus consists of only 10 proteins so it must hijack dozens of cellular processes of the host in order to infect individuals and replicate. To find out exactly which of those processes were involved in an infection, the team from Yale and three other research instituitions used a technique called global RNA interference targeting strategy.
Using tiny snippets of small interfering RNA, scientists are now able to disable individual genes and thereby assess their function. Testing the entire human genome, the team was able to identify 305 individual proteins that can alter viral infection. Many of those proteins appear crucial to the ability of the virus to infect people and reproduce. About 30 percent of the genes involved in West Nile infection also appear to play a role in Dengue fever, the researchers report.
Theoretically, if scientists can find a way to interfere in the virus' ability to use those proteins it might be possible to treat or prevent a variety of different infections. "It might be possible to find a 'pan flavivirus' target," Fikrig said.
Source : Yale University
"Diseases like West Nile affect millions of people," said Erol Fikrig, professor of medicine and microbial pathogenesis at Yale, an investigator with the Howard Hughes Medical Institute, and senior author of the paper. "We have found a dictionary of genes critical to a viral infection. Using these techniques, this can be done with any virus."
West Nile is transmitted by mosquitoes and has become a significant health threat in many parts of the United States since being introduced into North America in 1999. Symptoms range from mild flu-like symptoms to potentially fatal inflammation of the brain and central nervous system. West Nile is part of the flavivirus family, which includes dengue, yellow fever and tick- borne encephalitis viruses, among others, and causes thousands of deaths annually.
West Nile virus consists of only 10 proteins so it must hijack dozens of cellular processes of the host in order to infect individuals and replicate. To find out exactly which of those processes were involved in an infection, the team from Yale and three other research instituitions used a technique called global RNA interference targeting strategy.
Using tiny snippets of small interfering RNA, scientists are now able to disable individual genes and thereby assess their function. Testing the entire human genome, the team was able to identify 305 individual proteins that can alter viral infection. Many of those proteins appear crucial to the ability of the virus to infect people and reproduce. About 30 percent of the genes involved in West Nile infection also appear to play a role in Dengue fever, the researchers report.
Theoretically, if scientists can find a way to interfere in the virus' ability to use those proteins it might be possible to treat or prevent a variety of different infections. "It might be possible to find a 'pan flavivirus' target," Fikrig said.
Source : Yale University
Early treatment is key to combating hepatitis C virus
Canadian researchers have shown that patients who receive early treatment for Hepatitis C virus (HCV) within the first months following an infection, develop a rapid poly-functional immune response against HCV similar to when infection is erradicted spontaneously, according to a new study published in the Journal of Virology. Therefore, early treatment can restore immune response against HCV and help eliminate the virus rapidly. This new discovery of the mechanisms of viral eradication could contribute to the development of new treatments.
About a quarter of infected individuals eradicate the infection spontaneously, without treatment. Led by Dr. Naglaa Shoukry and Dr. Julie Bruneau, affiliated to both the Research Centre of the Université de Montréal Hospital Centre and the Université de Montréal, as well as with researchers from the Institut national de la santé et de la recherché scientifique (Montréal branch), the study found that early treatment restores a rapid poly-functional immune response, characterized by the simultaneous production of multiple antiviral mediators.
HCV is transmitted through infected blood. Although a quarter of infected patients can eradicate the infection spontaneously, the majority develop persistent infection, a major cause of cirrhosis and cancer of the liver. The only approved treatment for HCV is an anti-viral drug known as pegylated interferon alpha. This drug is successful in only half of cases when administered during chronic infection. Success rates among those treated early after infection are significantly higher or around 90%.
In North America alone, most new HCV infections occur among intravenous drug users (IDUs), a vulnerable population that is often undiagnosed and untreated. In the study, researchers followed a group of IDUs at high risk of HCV infection before and immediately after exposure to HCV. Their findings clearly show the importance of early diagnosis and treatment of HCV – particularly in marginalized populations such as IDUs and aboriginal populations.
Source : University of Montreal Hospital Centre
About a quarter of infected individuals eradicate the infection spontaneously, without treatment. Led by Dr. Naglaa Shoukry and Dr. Julie Bruneau, affiliated to both the Research Centre of the Université de Montréal Hospital Centre and the Université de Montréal, as well as with researchers from the Institut national de la santé et de la recherché scientifique (Montréal branch), the study found that early treatment restores a rapid poly-functional immune response, characterized by the simultaneous production of multiple antiviral mediators.
HCV is transmitted through infected blood. Although a quarter of infected patients can eradicate the infection spontaneously, the majority develop persistent infection, a major cause of cirrhosis and cancer of the liver. The only approved treatment for HCV is an anti-viral drug known as pegylated interferon alpha. This drug is successful in only half of cases when administered during chronic infection. Success rates among those treated early after infection are significantly higher or around 90%.
In North America alone, most new HCV infections occur among intravenous drug users (IDUs), a vulnerable population that is often undiagnosed and untreated. In the study, researchers followed a group of IDUs at high risk of HCV infection before and immediately after exposure to HCV. Their findings clearly show the importance of early diagnosis and treatment of HCV – particularly in marginalized populations such as IDUs and aboriginal populations.
Source : University of Montreal Hospital Centre
Thursday, August 21, 2008
'We may never get rid of our hospital superbugs'
Thursday August 21 2008
HOSPITAL bugs like MRSA and C Diff -- linked to dozens of deaths in Ireland -- may always be with us, a top consultant has warned.
C Diff infection contributed to 10 deaths at St Colmcille's Hospital, Loughlinstown last year, and to 13 deaths at Ennis General Hospital.
A new virulent strain of C Diff, called 027, has emerged recently and it has more toxins in it than in other types of C Diff, making it a more serious strain, consultant microbiologist with the Health Protection Surveillance Centre, Dr Fidelma Fitzpatrick said.
The priority was to minimise the incidence of Healthcare-Associated Infections (HCAIs) as much as possible and she believed hospitals have procedures in place to prevent them.
But eventually eliminating MRSA, C Diff and other infections in hospitals or the community is problematic because "as long as there is healthcare, there will be HCAIs," she said.
High risk patients include those who are older, have a damaged immune system due to cancer or other diseases, patients on antibiotics or those with breaks in their skin from insertion of drips, from wounds or burns or after surgery.
C Diff is a bug found in the bowel of about one in 20 healthy patients and is kept in check by the "good" bacteria in the bowel.
"If a patient takes an antibiotic, sometimes this can kill off the good bacteria in the bowel and that allows bugs such as C Diff to multiply and in some patients this can also lead to C Diff infection," Dr Fitzpatrick said.
The most common symptom of C Diff is diarrhoea, although some people complain of nausea, reduced appetite and crampy abdominal pain.
"It's important to remember that most patients recover completely from C Diff," she said.
"However, in a small percentage of patients, the infection causes an inflammation of the bowel (colitis) and that can be very serious. But again, it is more serious in the high risk groups of patients."
The most recent comprehensive study, in 2006, showed that approximately one in 20 Irish patients had a HCAI at the time of the study. The incidence was less than in England, where around one in 12 patients had a HCAI at the time.
- Source: - Harold.ie
HOSPITAL bugs like MRSA and C Diff -- linked to dozens of deaths in Ireland -- may always be with us, a top consultant has warned.
C Diff infection contributed to 10 deaths at St Colmcille's Hospital, Loughlinstown last year, and to 13 deaths at Ennis General Hospital.
A new virulent strain of C Diff, called 027, has emerged recently and it has more toxins in it than in other types of C Diff, making it a more serious strain, consultant microbiologist with the Health Protection Surveillance Centre, Dr Fidelma Fitzpatrick said.
The priority was to minimise the incidence of Healthcare-Associated Infections (HCAIs) as much as possible and she believed hospitals have procedures in place to prevent them.
But eventually eliminating MRSA, C Diff and other infections in hospitals or the community is problematic because "as long as there is healthcare, there will be HCAIs," she said.
High risk patients include those who are older, have a damaged immune system due to cancer or other diseases, patients on antibiotics or those with breaks in their skin from insertion of drips, from wounds or burns or after surgery.
C Diff is a bug found in the bowel of about one in 20 healthy patients and is kept in check by the "good" bacteria in the bowel.
"If a patient takes an antibiotic, sometimes this can kill off the good bacteria in the bowel and that allows bugs such as C Diff to multiply and in some patients this can also lead to C Diff infection," Dr Fitzpatrick said.
The most common symptom of C Diff is diarrhoea, although some people complain of nausea, reduced appetite and crampy abdominal pain.
"It's important to remember that most patients recover completely from C Diff," she said.
"However, in a small percentage of patients, the infection causes an inflammation of the bowel (colitis) and that can be very serious. But again, it is more serious in the high risk groups of patients."
The most recent comprehensive study, in 2006, showed that approximately one in 20 Irish patients had a HCAI at the time of the study. The incidence was less than in England, where around one in 12 patients had a HCAI at the time.
- Source: - Harold.ie
MicuRx Pharmaceuticals Selects Next-Generation Antibiotic Candidate Targeting MRSA and Expands Operation in China
MicuRx Pharmaceuticals, Inc., a privately-held biopharmaceutical company developing next-generation antibiotics, today announced the nomination of MRX- I as its first preclinical development candidate. MRX-I is an antibacterial molecule targeting multi-drug resistant gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Simultaneously, the company expanded its operations in China to increase MicuRx' capacity in antibacterial drug discovery and development.
"Only 12 months after initial funding, we have discovered multiple drug leads and selected our first development candidate MRX-I, a promising antibacterial compound that we expect to be superior to many of the top- selling antibiotics available today," said Zhengyu Yuan, Ph.D., president and chief executive officer of MicuRx Pharmaceuticals, Inc. "This enhanced productivity is owed in part to our hybrid business model that leverages the drug discovery capacity readily available in China and the superior management expertise in the United States."
"MRX-I and additional MicuRx pipeline leads have been identified using our proprietary drug discovery platform," commented Mike F. Gordeev, Ph.D., executive vice president and chief scientific officer of MicuRx. "We will continue to leverage this novel platform to further enhance the pharmacological properties and safety profile of clinically validated antibiotic classes, creating best-in-class antibiotics capable of addressing the growing problem of the bacterial multi-drug resistance."
MicuRx raised $10 million in 2007 with Morningside Group as the sole investor. To facilitate the development of its lead compounds and expand the research capacity, MicuRx recently moved its research and development operations in China to a new 10,000 square-foot facility in ZhangJian HighTech Park in Shanghai, China. The company intends to use this integrated state-of- art chemistry and biology facility for drug discovery and development activities to advance its next-generation antimicrobial products.
About Multi-Drug Resistance and MRSA
Modern antimicrobials (antibiotics and related pharmaceuticals) have substantially reduced the threat posed by infectious diseases and contributed to a dramatic drop in mortality rates over the past 30 years. However, due to widespread use of existing drugs in the community and hospital environment, pathogenic bacteria resistant to current antimicrobial therapies have evolved and become ubiquitous, presenting a global health threat. The World Health Organization has set forth a mandate to combat this growing problem and encouraged an urgent action of the member countries. MicuRx is addressing this need directly by developing best-in-class antimicrobials targeting multi- drug resistant bacteria.
About MicuRx Pharmaceuticals, Inc.
MicuRx is discovering and developing next-generation antibacterial and antifungal products. By applying designer modifications to validated antibiotics, MicuRx intends to improve overall pharmacological properties of antimicrobial drugs in order to overcome antibiotic resistance, increase the antibacterial spectrum, improve the dosing regimen, or reduce adverse side effects. The company has research and development facilities in San Francisco Bay Area and ZhangJiang High-Tech Park in Shanghai, China.
CONTACT: Zhengyu Yuan, Ph.D., President and CEO of MicuRx Pharmaceuticals,Inc., +1-510-324-8662, ; or Angela Bitting,+1-925-202-6211, , for MicuRx Pharmaceuticals, Inc. zyuan@micurx.com a.bitting@comcast.net
"Only 12 months after initial funding, we have discovered multiple drug leads and selected our first development candidate MRX-I, a promising antibacterial compound that we expect to be superior to many of the top- selling antibiotics available today," said Zhengyu Yuan, Ph.D., president and chief executive officer of MicuRx Pharmaceuticals, Inc. "This enhanced productivity is owed in part to our hybrid business model that leverages the drug discovery capacity readily available in China and the superior management expertise in the United States."
"MRX-I and additional MicuRx pipeline leads have been identified using our proprietary drug discovery platform," commented Mike F. Gordeev, Ph.D., executive vice president and chief scientific officer of MicuRx. "We will continue to leverage this novel platform to further enhance the pharmacological properties and safety profile of clinically validated antibiotic classes, creating best-in-class antibiotics capable of addressing the growing problem of the bacterial multi-drug resistance."
MicuRx raised $10 million in 2007 with Morningside Group as the sole investor. To facilitate the development of its lead compounds and expand the research capacity, MicuRx recently moved its research and development operations in China to a new 10,000 square-foot facility in ZhangJian HighTech Park in Shanghai, China. The company intends to use this integrated state-of- art chemistry and biology facility for drug discovery and development activities to advance its next-generation antimicrobial products.
About Multi-Drug Resistance and MRSA
Modern antimicrobials (antibiotics and related pharmaceuticals) have substantially reduced the threat posed by infectious diseases and contributed to a dramatic drop in mortality rates over the past 30 years. However, due to widespread use of existing drugs in the community and hospital environment, pathogenic bacteria resistant to current antimicrobial therapies have evolved and become ubiquitous, presenting a global health threat. The World Health Organization has set forth a mandate to combat this growing problem and encouraged an urgent action of the member countries. MicuRx is addressing this need directly by developing best-in-class antimicrobials targeting multi- drug resistant bacteria.
About MicuRx Pharmaceuticals, Inc.
MicuRx is discovering and developing next-generation antibacterial and antifungal products. By applying designer modifications to validated antibiotics, MicuRx intends to improve overall pharmacological properties of antimicrobial drugs in order to overcome antibiotic resistance, increase the antibacterial spectrum, improve the dosing regimen, or reduce adverse side effects. The company has research and development facilities in San Francisco Bay Area and ZhangJiang High-Tech Park in Shanghai, China.
CONTACT: Zhengyu Yuan, Ph.D., President and CEO of MicuRx Pharmaceuticals,Inc., +1-510-324-8662, ; or Angela Bitting,+1-925-202-6211, , for MicuRx Pharmaceuticals, Inc. zyuan@micurx.com a.bitting@comcast.net
Wednesday, August 20, 2008
Wednesday, February 6, 2008
E. Coli on the Rise, Aided by Factory Farms, Antibiotic Overuse
E. coli is not going away anytime soon. As a matter-of-fact, U.S. food safety officials say the potential for dangerous E. coli bacteria is on the rise again with the potential greatest in spinach and other fresh foods. Since 2006, when an E. coli outbreak in spinach swept the nation, outbreaks of the bacteria have become more varied, likely because of the growing trend in raw fruits and vegetable consumption, which can harbor dangerous bacteria, HealthDay, reported in a syndicated story appearing in USA Today.
In the last two years, a variety of pathogens in food have killed at least three people, sickened more than 1,300 others, and touched nearly every state in the country as well as Canada, HealthDay reported. The problem is difficult to police because the food-surveillance system is outdated, under-funded, and overwhelmed by the emergence of mega-farms, mega-distribution centers, and mega-transporters, HealthDay said. “Before, it was just bad produce coming from one farm,” said Michael Hansen, a senior scientist with Consumers Union.
Couple this with the overarching problem with infectious diseases which are now becoming more resistant to bacteria because of antibiotic overuse and abuse. We overuse or misuse antibiotics; bacteria mutate, changing just enough to ensure antibiotics have no effect on them and giving them a wide berth to spread with ever more power. Although tempting, preventative antibiotic regimes only worsen the epidemic and strengthen the bacteria. And while new drugs are emerging, it’s just a matter of time before super bugs will become resistant to them, too. In many cases, they have.
Antibiotic resistance is so pervasive that scientists now report having found evidence of drug-repelling E. coli in Arctic birds as remote as the polar ice cap. It seems migratory fowl that circumnavigate the globe along centuries-old flyways passed the bacteria. Scientists in Sweden traveled to vast regions of the frigid ice cap in search of species they hoped had been spared exposure to drug-resistant strains and were surprised to discover widespread antibiotic-resistant E. coli in Arctic-dwelling birds never previously exposed to the drugs. This study added credence to the notion that antibiotic resistance is global and no region is unscathed.
In addition to the spread of E. coli and the growing resistance of the infection to traditional medications, it seems that there is emerging data that the negative health effects of E. coli can remain for months and years later. It was believed that once we recover from a food-related contamination that we are healed and the illness is gone. Not so. According to recent research, these illnesses can have long-term, lasting effects that can either linger for months or years or can show up months or years after the original illness. As part of their studies, researchers found that some children who suffered severe cases of E. coli developed health problems later in life, such as kidney problems, high blood pressure, and kidney failure; the health problems appeared as late as 10 to 20 years later. The research also found people who suffered salmonella or shigella can find themselves suffering with arthritis later in life and, for those who exhibited mild campylobacter, a type of paralysis can strike following the initial complaints.
In the last two years, a variety of pathogens in food have killed at least three people, sickened more than 1,300 others, and touched nearly every state in the country as well as Canada, HealthDay reported. The problem is difficult to police because the food-surveillance system is outdated, under-funded, and overwhelmed by the emergence of mega-farms, mega-distribution centers, and mega-transporters, HealthDay said. “Before, it was just bad produce coming from one farm,” said Michael Hansen, a senior scientist with Consumers Union.
Couple this with the overarching problem with infectious diseases which are now becoming more resistant to bacteria because of antibiotic overuse and abuse. We overuse or misuse antibiotics; bacteria mutate, changing just enough to ensure antibiotics have no effect on them and giving them a wide berth to spread with ever more power. Although tempting, preventative antibiotic regimes only worsen the epidemic and strengthen the bacteria. And while new drugs are emerging, it’s just a matter of time before super bugs will become resistant to them, too. In many cases, they have.
Antibiotic resistance is so pervasive that scientists now report having found evidence of drug-repelling E. coli in Arctic birds as remote as the polar ice cap. It seems migratory fowl that circumnavigate the globe along centuries-old flyways passed the bacteria. Scientists in Sweden traveled to vast regions of the frigid ice cap in search of species they hoped had been spared exposure to drug-resistant strains and were surprised to discover widespread antibiotic-resistant E. coli in Arctic-dwelling birds never previously exposed to the drugs. This study added credence to the notion that antibiotic resistance is global and no region is unscathed.
In addition to the spread of E. coli and the growing resistance of the infection to traditional medications, it seems that there is emerging data that the negative health effects of E. coli can remain for months and years later. It was believed that once we recover from a food-related contamination that we are healed and the illness is gone. Not so. According to recent research, these illnesses can have long-term, lasting effects that can either linger for months or years or can show up months or years after the original illness. As part of their studies, researchers found that some children who suffered severe cases of E. coli developed health problems later in life, such as kidney problems, high blood pressure, and kidney failure; the health problems appeared as late as 10 to 20 years later. The research also found people who suffered salmonella or shigella can find themselves suffering with arthritis later in life and, for those who exhibited mild campylobacter, a type of paralysis can strike following the initial complaints.
Antibiotic resistance: A global phenomenon
Scientists have discovered antibiotic-resistant bacteria in the Arctic, suggesting that drug-resistance has spread into the farthest reaches of nature - an alarming prospect for future healthcare.
The researchers from Sweden studied antimicrobial drug resistance in Escherichia coli isolated from Arctic birds to 17 antimicrobial drugs, detecting resistance to 14 of them.
“We were extremely surprised,” said Björn Olsen, Professor of Infectious Diseases at Uppsala University and at the Laboratory for Zoonosis Research at the University of Kalmar.
“We took samples from birds living far out on the tundra and had no contact with people. This further confirms that resistance to antibiotics has become a global phenomenon and that virtually no region of the earth, with the possible exception of the Antarctic, is unaffected.”
The team took samples from 97 birds in north-eastern Siberia, northern Alaska, and northern Greenland and cultivated them directly in laboratories the researchers had installed onboard the icebreaking ship they used to reach the Arctic. Samples were further analysed at the microbiological laboratory at the Central Hospital in Växjö, Sweden.
The researchers suggest the reason for the resistance is that immigrating birds have passed through regions in Southeast Asia, for example, where there is a great deal of antibiotic pressure and carried with them the resistant bacteria to the tundra.
Professor Olsen told Laboratory News: “The fact that an isolate from a juvenile Western sandpiper sampled far from human settlements on the tundra had resistance to cefadroxil, cefuroxime, and cefpodoxime, a resistance pattern commonly seen in clinical isolates, supports the theory of introduction by migration and transfer of bacteria between birds.”
In a paper published in the journal Emerging Infectious Diseases, the team goes further to suggest that migrating birds carrying antibiotic-resistant bacteria can then infect isolated human communities, using the Bolivian community of 130 Guaraní Indians as an example. This community is located at an altitude of 1,700m and can only be reached by a 3-hour steep climb. Nevertheless, high rates of drug-resistant E. coli were found in this community, although exposure to antimicrobial drugs in the area had been limited.
“A possible explanation for the unexpectedly high carriage rate of drug-resistant E. coli in the Indian community in Bolivia is the importation of drug-resistant isolates by migratory birds,” said Jonas Bonnedahl, a physician specialising in infectious diseases in Kalmar and one of those participating in the expedition.
He added: “Our findings show that resistance to antibiotics is not limited to society and hospitals but is now spreading into the wild. Escalating resistance to antibiotics over the last few years has crystallised into one of the greatest threats to well-functioning health care in the future.”
The researchers from Sweden studied antimicrobial drug resistance in Escherichia coli isolated from Arctic birds to 17 antimicrobial drugs, detecting resistance to 14 of them.
“We were extremely surprised,” said Björn Olsen, Professor of Infectious Diseases at Uppsala University and at the Laboratory for Zoonosis Research at the University of Kalmar.
“We took samples from birds living far out on the tundra and had no contact with people. This further confirms that resistance to antibiotics has become a global phenomenon and that virtually no region of the earth, with the possible exception of the Antarctic, is unaffected.”
The team took samples from 97 birds in north-eastern Siberia, northern Alaska, and northern Greenland and cultivated them directly in laboratories the researchers had installed onboard the icebreaking ship they used to reach the Arctic. Samples were further analysed at the microbiological laboratory at the Central Hospital in Växjö, Sweden.
The researchers suggest the reason for the resistance is that immigrating birds have passed through regions in Southeast Asia, for example, where there is a great deal of antibiotic pressure and carried with them the resistant bacteria to the tundra.
Professor Olsen told Laboratory News: “The fact that an isolate from a juvenile Western sandpiper sampled far from human settlements on the tundra had resistance to cefadroxil, cefuroxime, and cefpodoxime, a resistance pattern commonly seen in clinical isolates, supports the theory of introduction by migration and transfer of bacteria between birds.”
In a paper published in the journal Emerging Infectious Diseases, the team goes further to suggest that migrating birds carrying antibiotic-resistant bacteria can then infect isolated human communities, using the Bolivian community of 130 Guaraní Indians as an example. This community is located at an altitude of 1,700m and can only be reached by a 3-hour steep climb. Nevertheless, high rates of drug-resistant E. coli were found in this community, although exposure to antimicrobial drugs in the area had been limited.
“A possible explanation for the unexpectedly high carriage rate of drug-resistant E. coli in the Indian community in Bolivia is the importation of drug-resistant isolates by migratory birds,” said Jonas Bonnedahl, a physician specialising in infectious diseases in Kalmar and one of those participating in the expedition.
He added: “Our findings show that resistance to antibiotics is not limited to society and hospitals but is now spreading into the wild. Escalating resistance to antibiotics over the last few years has crystallised into one of the greatest threats to well-functioning health care in the future.”
Streptomyces in Nature and Medicine
Streptomyces in Nature and Medicine is an Account of 50 Years of Genetic Studies of the Soil Inhabiting Microbes That Produce Most of the Antibiotics Used to Treat Infections
DUBLIN, Ireland--(BUSINESS WIRE)--Research and Markets (http://www.researchandmarkets.com/reports/c81742) has announced the addition of “Streptomyces in Nature and Medicine: The Antibiotic Makers” to their offering.
This is an insiders account of 50 years of genetic studies of the soil-inhabiting microbes that produce most of the antibiotics used to treat infections, as well as anti-cancer, anti-parasitic and immunosuppressant drugs. The book begins by describing how these microbes the actinomycetes were discovered in the latter part of the nineteenth century, but remained a Cinderella group until, in the 1940s, they shot to prominence with the discovery of streptomycin, the first effective treatment for tuberculosis and only the second antibiotic, after penicillin, to become a medical marvel.
There followed a massive effort over several decades to find further treatments for infectious diseases and cancer, tempered by the rise of antibiotic resistance consequent on antibiotic misuse and over-use. The book goes on to describe the discovery of gene exchange in the actinomycetes in the context of the rise of microbial genetics in the mid-20th century, leading to determination of the complete DNA sequence of a model member of the group at the turn of the millennium. There follow chapters in which the intricate molecular machinery that adapts the organisms metabolism and development to life in the soil, including antibiotic production, is illuminated by the DNA blueprint.
Then came an up-to-the minute account of the use of genetic engineering to make novel, hybrid, antibiotics, and a topical description of techniques to learn the roles of the thousands of genes in a genome sequence, throwing a powerful light on the biology of the organisms and their harnessing for increasing antibiotic productivity. In the final chapter we return to the mycobacteria that cause tuberculosis and leprosy, the first actinomycetes to be discovered, and how methodology, in part derived from the study of the streptomycetes, is being applied to understand and control these still deadly pathogens.
About the Author
David A. Hopwood, Professor of Genetics, University of East Anglia (Emeritus)
Contents:
Preface.
Introduction.
1. Actinomycetes and Antibiotics
2. Antiobiotic Discovery and Resistance
3. Microbial Sex
4. Towards Gene Cloning
5. From Chromosome Map to DNA Sequence
6. Bacteria That Develop
7. The Switch to Antibiotic Production
8. Unnatural Natural Products
9. Functional Genomics
10. Genomics Against TB and Leprosy
Conclusion.
Notes and references.
Glossary.
Index.
For more information visit http://www.researchandmarkets.com/reports/c81742
Source: Oxford University Press
DUBLIN, Ireland--(BUSINESS WIRE)--Research and Markets (http://www.researchandmarkets.com/reports/c81742) has announced the addition of “Streptomyces in Nature and Medicine: The Antibiotic Makers” to their offering.
This is an insiders account of 50 years of genetic studies of the soil-inhabiting microbes that produce most of the antibiotics used to treat infections, as well as anti-cancer, anti-parasitic and immunosuppressant drugs. The book begins by describing how these microbes the actinomycetes were discovered in the latter part of the nineteenth century, but remained a Cinderella group until, in the 1940s, they shot to prominence with the discovery of streptomycin, the first effective treatment for tuberculosis and only the second antibiotic, after penicillin, to become a medical marvel.
There followed a massive effort over several decades to find further treatments for infectious diseases and cancer, tempered by the rise of antibiotic resistance consequent on antibiotic misuse and over-use. The book goes on to describe the discovery of gene exchange in the actinomycetes in the context of the rise of microbial genetics in the mid-20th century, leading to determination of the complete DNA sequence of a model member of the group at the turn of the millennium. There follow chapters in which the intricate molecular machinery that adapts the organisms metabolism and development to life in the soil, including antibiotic production, is illuminated by the DNA blueprint.
Then came an up-to-the minute account of the use of genetic engineering to make novel, hybrid, antibiotics, and a topical description of techniques to learn the roles of the thousands of genes in a genome sequence, throwing a powerful light on the biology of the organisms and their harnessing for increasing antibiotic productivity. In the final chapter we return to the mycobacteria that cause tuberculosis and leprosy, the first actinomycetes to be discovered, and how methodology, in part derived from the study of the streptomycetes, is being applied to understand and control these still deadly pathogens.
About the Author
David A. Hopwood, Professor of Genetics, University of East Anglia (Emeritus)
Contents:
Preface.
Introduction.
1. Actinomycetes and Antibiotics
2. Antiobiotic Discovery and Resistance
3. Microbial Sex
4. Towards Gene Cloning
5. From Chromosome Map to DNA Sequence
6. Bacteria That Develop
7. The Switch to Antibiotic Production
8. Unnatural Natural Products
9. Functional Genomics
10. Genomics Against TB and Leprosy
Conclusion.
Notes and references.
Glossary.
Index.
For more information visit http://www.researchandmarkets.com/reports/c81742
Source: Oxford University Press
DUBLIN, Ireland--(BUSINESS WIRE)--Research and Markets (http://www.researchandmarkets.com/reports/c81742) has announced the addition of “Streptomyces in Nature and Medicine: The Antibiotic Makers” to their offering.
This is an insiders account of 50 years of genetic studies of the soil-inhabiting microbes that produce most of the antibiotics used to treat infections, as well as anti-cancer, anti-parasitic and immunosuppressant drugs. The book begins by describing how these microbes the actinomycetes were discovered in the latter part of the nineteenth century, but remained a Cinderella group until, in the 1940s, they shot to prominence with the discovery of streptomycin, the first effective treatment for tuberculosis and only the second antibiotic, after penicillin, to become a medical marvel.
There followed a massive effort over several decades to find further treatments for infectious diseases and cancer, tempered by the rise of antibiotic resistance consequent on antibiotic misuse and over-use. The book goes on to describe the discovery of gene exchange in the actinomycetes in the context of the rise of microbial genetics in the mid-20th century, leading to determination of the complete DNA sequence of a model member of the group at the turn of the millennium. There follow chapters in which the intricate molecular machinery that adapts the organisms metabolism and development to life in the soil, including antibiotic production, is illuminated by the DNA blueprint.
Then came an up-to-the minute account of the use of genetic engineering to make novel, hybrid, antibiotics, and a topical description of techniques to learn the roles of the thousands of genes in a genome sequence, throwing a powerful light on the biology of the organisms and their harnessing for increasing antibiotic productivity. In the final chapter we return to the mycobacteria that cause tuberculosis and leprosy, the first actinomycetes to be discovered, and how methodology, in part derived from the study of the streptomycetes, is being applied to understand and control these still deadly pathogens.
About the Author
David A. Hopwood, Professor of Genetics, University of East Anglia (Emeritus)
Contents:
Preface.
Introduction.
1. Actinomycetes and Antibiotics
2. Antiobiotic Discovery and Resistance
3. Microbial Sex
4. Towards Gene Cloning
5. From Chromosome Map to DNA Sequence
6. Bacteria That Develop
7. The Switch to Antibiotic Production
8. Unnatural Natural Products
9. Functional Genomics
10. Genomics Against TB and Leprosy
Conclusion.
Notes and references.
Glossary.
Index.
For more information visit http://www.researchandmarkets.com/reports/c81742
Source: Oxford University Press
DUBLIN, Ireland--(BUSINESS WIRE)--Research and Markets (http://www.researchandmarkets.com/reports/c81742) has announced the addition of “Streptomyces in Nature and Medicine: The Antibiotic Makers” to their offering.
This is an insiders account of 50 years of genetic studies of the soil-inhabiting microbes that produce most of the antibiotics used to treat infections, as well as anti-cancer, anti-parasitic and immunosuppressant drugs. The book begins by describing how these microbes the actinomycetes were discovered in the latter part of the nineteenth century, but remained a Cinderella group until, in the 1940s, they shot to prominence with the discovery of streptomycin, the first effective treatment for tuberculosis and only the second antibiotic, after penicillin, to become a medical marvel.
There followed a massive effort over several decades to find further treatments for infectious diseases and cancer, tempered by the rise of antibiotic resistance consequent on antibiotic misuse and over-use. The book goes on to describe the discovery of gene exchange in the actinomycetes in the context of the rise of microbial genetics in the mid-20th century, leading to determination of the complete DNA sequence of a model member of the group at the turn of the millennium. There follow chapters in which the intricate molecular machinery that adapts the organisms metabolism and development to life in the soil, including antibiotic production, is illuminated by the DNA blueprint.
Then came an up-to-the minute account of the use of genetic engineering to make novel, hybrid, antibiotics, and a topical description of techniques to learn the roles of the thousands of genes in a genome sequence, throwing a powerful light on the biology of the organisms and their harnessing for increasing antibiotic productivity. In the final chapter we return to the mycobacteria that cause tuberculosis and leprosy, the first actinomycetes to be discovered, and how methodology, in part derived from the study of the streptomycetes, is being applied to understand and control these still deadly pathogens.
About the Author
David A. Hopwood, Professor of Genetics, University of East Anglia (Emeritus)
Contents:
Preface.
Introduction.
1. Actinomycetes and Antibiotics
2. Antiobiotic Discovery and Resistance
3. Microbial Sex
4. Towards Gene Cloning
5. From Chromosome Map to DNA Sequence
6. Bacteria That Develop
7. The Switch to Antibiotic Production
8. Unnatural Natural Products
9. Functional Genomics
10. Genomics Against TB and Leprosy
Conclusion.
Notes and references.
Glossary.
Index.
For more information visit http://www.researchandmarkets.com/reports/c81742
Source: Oxford University Press
ADLS: Management Addresses Concerns re FDA Workshop and Meetings
The Management of Advanced Life Sciences Holdings, Inc. (ADLS) held a conference call today to address concerns regarding a FDA workshop last week and an upcoming meeting of the Anti-Infective Drugs Advisory Committee to discuss product development and clinical trial design for community acquired pneumonia (CAP).
Dr. Michael Flavin, Chairman and CEO of Advanced Life Sciences, said, As part of a mandated review process, the FDA is reviewing CAP trials through workshops. The Company anticipates that upcoming meetings will continue the discussions conducted last week, but an agenda is unknown at this time."
"We view the workshop as an idea generation event. Participants are focused on appropriate margins for the trials and scientific justification for those margins, because of the serious nature of the disease. The spotlight on antiobiotic resistance continues to grow. If approved our Cethromycin is well positioned to address these issues."
"The workshop discussions were not worrisome. We have confirmed suitability of our trial design. We have captured extensive important data to support development. We believe that our plans are on track for a strong NDA submission, and no meetings or conversations with the FDA have changed that. We feel certain that changes will not be placed on our trials."
"Be assured that nothing clinical is on hold."
Dr Flavin added, "We have also made progress with prospective partnerships and feel that developments regarding these could be likely in 2008."
KNOBIAS DISCLAIMER: All statements made in this article were made by the Company and do not in any way reflect the opinions of Knobias. Knobias is not a registered broker-dealer, nor investment advisor, and does not endorse or recommend any securities mentioned. This story is provided for informational purposes only and is not intended for trading purposes. Knobias shall not be liable for any actions taken in reliance of any information provided herein. Republication or redistribution of Knobias content is expressly prohibited without prior written consent of Knobias.com, LLC.
ABOUT KNOBIAS: Knobias is a premier financial information provider of trading and investing data covering all U.S. equities for investors and security professionals. Knobias is best described by its three major components: Real-time desktop applications providing quotes, charts, level 2, analysis etc.; Knobias RAiDAR providing thousands of real-time news stories, alerts and documents daily; Knobias fundamentals providing a comprehensive database of fundamental research information.
If your company wishes to participate in the EventX newswire, please contact Knobias: http://www.knobias.com
Knobias.com, LLC 601-978-3399 601-978-3675 info@knobias.com www.knobias.com/cmtx
Dr. Michael Flavin, Chairman and CEO of Advanced Life Sciences, said, As part of a mandated review process, the FDA is reviewing CAP trials through workshops. The Company anticipates that upcoming meetings will continue the discussions conducted last week, but an agenda is unknown at this time."
"We view the workshop as an idea generation event. Participants are focused on appropriate margins for the trials and scientific justification for those margins, because of the serious nature of the disease. The spotlight on antiobiotic resistance continues to grow. If approved our Cethromycin is well positioned to address these issues."
"The workshop discussions were not worrisome. We have confirmed suitability of our trial design. We have captured extensive important data to support development. We believe that our plans are on track for a strong NDA submission, and no meetings or conversations with the FDA have changed that. We feel certain that changes will not be placed on our trials."
"Be assured that nothing clinical is on hold."
Dr Flavin added, "We have also made progress with prospective partnerships and feel that developments regarding these could be likely in 2008."
KNOBIAS DISCLAIMER: All statements made in this article were made by the Company and do not in any way reflect the opinions of Knobias. Knobias is not a registered broker-dealer, nor investment advisor, and does not endorse or recommend any securities mentioned. This story is provided for informational purposes only and is not intended for trading purposes. Knobias shall not be liable for any actions taken in reliance of any information provided herein. Republication or redistribution of Knobias content is expressly prohibited without prior written consent of Knobias.com, LLC.
ABOUT KNOBIAS: Knobias is a premier financial information provider of trading and investing data covering all U.S. equities for investors and security professionals. Knobias is best described by its three major components: Real-time desktop applications providing quotes, charts, level 2, analysis etc.; Knobias RAiDAR providing thousands of real-time news stories, alerts and documents daily; Knobias fundamentals providing a comprehensive database of fundamental research information.
If your company wishes to participate in the EventX newswire, please contact Knobias: http://www.knobias.com
Knobias.com, LLC 601-978-3399 601-978-3675 info@knobias.com www.knobias.com/cmtx
Dead cats have authorities puzzled at Belfield
LAUREN DONOVAN
Bismarck Tribune
Belfield Police Commissioner Sharon Dorval hung a poster at the local post office with pictures of a dozen dead cats, alleging they were removed from Belfield and killed, possibly shot.
She and others are looking for more information. The cats were in various stages of decomposition, which might mean they were killed over time.
Stark County Sheriff Clarence Tuhy confirmed that one of his officers found several killed cats dumped at an oil field site northwest of town.
Tuhy said it wasn’t clear how long the animals had been there. Some were found in pieces.
“Where do you start investigating?” he asked.
One possibility is that all the cats belonged to the same person, who decided to dispose of them.
Authorities say if the cats were killed in city limits, someone could be in trouble for illegally discharging a weapon in town. Animal cruelty charges also could apply.
— Billings County Pioneer
Infection alert
A confirmed staph infection had Beulah school officials moving quickly to protect students and staff.
When a staff member-coach was diagnosed with the kind of staph bacteria that’s resistant to antibiotics on Jan. 18, it didn’t take school officials long to have students remove all their belongings from gym and weight room lockers, and disinfect the lockers and showers with a chemical spray.
The gym, locker rooms and weight rooms were temporarily quarantined from public use.
A week later, the infection was confirmed as MRSA staph, which can lead to skin infections, pneumonia and bloodstream infections, all dangerous conditions because of their resistance to common antiobiotic remedies.
It also was learned that the only means of contagion was through open wounds, and the teacher-coach was allowed to return to school so long as the affected area was covered.
In the meantime, students have been asked to follow basic safety hygiene and not share shower towels and remove gym clothing from lockers for regular washing.
In addition, the school weight room now has spray bottles of disinfectant on hand, and student athletes are asked to use them after they are done with their workouts.
— Beulah Beacon
Bismarck Tribune
Belfield Police Commissioner Sharon Dorval hung a poster at the local post office with pictures of a dozen dead cats, alleging they were removed from Belfield and killed, possibly shot.
She and others are looking for more information. The cats were in various stages of decomposition, which might mean they were killed over time.
Stark County Sheriff Clarence Tuhy confirmed that one of his officers found several killed cats dumped at an oil field site northwest of town.
Tuhy said it wasn’t clear how long the animals had been there. Some were found in pieces.
“Where do you start investigating?” he asked.
One possibility is that all the cats belonged to the same person, who decided to dispose of them.
Authorities say if the cats were killed in city limits, someone could be in trouble for illegally discharging a weapon in town. Animal cruelty charges also could apply.
— Billings County Pioneer
Infection alert
A confirmed staph infection had Beulah school officials moving quickly to protect students and staff.
When a staff member-coach was diagnosed with the kind of staph bacteria that’s resistant to antibiotics on Jan. 18, it didn’t take school officials long to have students remove all their belongings from gym and weight room lockers, and disinfect the lockers and showers with a chemical spray.
The gym, locker rooms and weight rooms were temporarily quarantined from public use.
A week later, the infection was confirmed as MRSA staph, which can lead to skin infections, pneumonia and bloodstream infections, all dangerous conditions because of their resistance to common antiobiotic remedies.
It also was learned that the only means of contagion was through open wounds, and the teacher-coach was allowed to return to school so long as the affected area was covered.
In the meantime, students have been asked to follow basic safety hygiene and not share shower towels and remove gym clothing from lockers for regular washing.
In addition, the school weight room now has spray bottles of disinfectant on hand, and student athletes are asked to use them after they are done with their workouts.
— Beulah Beacon
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