Plasmid content and protein I serovar of non-penicillinase-producing gonococci isolated in Munich

One hundred and twenty-four strains of non-penicillinase-producing gonococci isolated in Munich in 1986 were characterized in terms of their plasmid content and protein I serovar. Eighty-two per cent of the strains belonged to serogroup 1-B with over half belonging to either serovar 1B-2 or 1B-3. Half of the 22 serogroup 1A strains belonged to serovar 1A-2. Nineteen strains (15.3%) were found to lack the 2.6 Md cryptic plasmid although seven of these strains contained the 24.4 Md conjugative plasmid. Nine of the 105 strains which harboured the cryptic plasmid also contained the conjugative plasmid. The 19 strains which lacked the cryptic plasmid comprised 10 different serovars, indicating the heterogeneous nature of this group of organisms.     

Concordance of auxotype/serovar classes of Neisseria gonorrhoeae between sexual contacts.

One hundred and three known sexual-contact pairs of patients with culture-proven gonorrhoea who attended St Mary's Hospital, London between May 1989 and February 1991 were identified. All isolates from these patients were serotyped and auxotyped and compared for type concordance within sexual-contact pairs. Serotype was concordant in 80 (78%) of 103 sexual-contact pairs, auxotype in 88 (85%) and auxotype/serovar (A/S) class in 66 (64%) on the first screening. All pairs of isolates showed concordance in both serotype and auxotype when typing was repeated using a single set of serotyping reagents and of auxotyping media. Seventeen serovars, 9 auxotypes and 36 A/S classes were found in this population. Our results suggest that both serotyping and auxotyping may be used as markers to allow tracing of sexual-contact pairs, but that a single set of reagents should be used to ensure maximum reliability.     

Plasmid content,serotypes, and antimicrobial susceptibility of Neisseria gonorrhoeae strains isolated in Munich in 1987–88

Eighty-four strains of Neisseria gonorrhoeae isolated in Munich between January 1987 and June 1988 were characterized in terms of their plasmid content, protein I serovar and susceptibility or resistance to four antimicrobial agents. Eighty two percent of the strains belonged to serogroup 1B, the three most prevalent serovars being 1B-1, 1B-2 and 1B-6. Among the serogroup 1A strains, 1A-2 was the commonest serovar. Fourteen strains (16.7%) lacked the 2.6 Md cryptic plasmid, although two of these strains contained the conjugative gonococcal plasmid. Although some degree of resistance to penicillin and tetracycline was noted, all the strains were sensitive to spectinomycin and cefotiam.     

Antimicrobial susceptibility of gonococci isolated in the Central African Republic

Using agar dilution techniques, we determined the minimum inhibitory concentrations (MIC) of 11 antimicrobials for 70 isolates of Neisseria gonorrhoeae obtained in Bangui, Central African Republic. These gonococci were found to be fairly susceptible to commonly used antibiotics: only 3 isolates (4%) had a penicillin MIC ≥ 1.0 μg/ml and 6 (9%) had a tetracycline MIC ≥ 2.0 μg/ml. With regard to other antibiotics, 54 isolates (77%) had an erythromycin MIC ≥ 0.25 μg/ml, all had a spectinomycin MIC ≤ 16 μg/ml, and 32 (46%) had a sulfamethoxazole/trimethoprim MIC ≥ 9.5/0.5 μg/ml. None of these isolates produced penicillinase.     

Characteristics of gonococci isolated from men with urethritis in Dubai.

Neisseria gonorrhoeae were collected from men attending out-patient clinics in Dubai. The susceptibility to a range of therapeutic antibiotics and their auxotype and serotype was determined. The plasmid content of all penicillinase-producing strains was also analysed. Thirty-six strains of N. gonorrhoeae were isolated from specimens collected from 79 patients over a 24-day period. Of the 36 isolates, 9(25%) were penicillinase-producing N. gonorrhoeae (PPNG) and 15 (42%) were chromosomally resistant N. gonorrhoeae (CMRNG). CMRNG exhibited higher levels of resistance to cefuroxime, chloramphenicol, tetracycline and erythromycin than PPNG. All isolates were susceptible to ceftriaxone and spectinomycin. Three (8%) isolates showed reduced susceptibility (MIC, > or = 0.25 mg/l) to ciprofloxacin. Six isolates of PPNG carried the 4.4 MD and three the 3.2 MD penicillinase encoding plasmid. The total gonococcal population was phenotypically diverse, with 12 serovars, 6 auxotypes and 21 A/S classes. Gonorrhoea was found to be a major cause of urethritis in Dubai and the strains exhibited high levels of resistance to penicillin.     

A new leptospiral serovar in the Pyrogenes serogroup isolated in Nigeria

Five leptospiral strains were isolated from bovine kidneys during a cultural survey for pathogenic leptospires in Nigeria. Preliminary test results indicated that the five strains were identical and serologically heterologous to the other members of the Pyrogenes serogroup. Further examination of the strains by the cross-agglutinin absorption test, factor analysis and restriction endonuclease analysis confirmed that the strains constitute a new serovar. It is therefore proposed that this strain be recognised and designated as serovar nigeria, type strain Vom.     

Altodouro,a new Leptospira serovar of the Pomona serogroup isolated from rodents in northern Portugal

A Leptospira strain (designated RIM 139) was isolated from the kidney of a house-mouse, Mus musculus, in Trás-os-Montes e Alto Douro region of northern Portugal. The isolate showed typical leptospiral motility and morphology under dark-field microscopy and was pathogenic for hamsters.Species determination was carried out on basis of PCR products generated by species-specific primers and by sequencing of the secY gene. Putative serogroup typing was performed using the microscopic agglutination test (MAT) with a panel of rabbit anti-Leptospira sera representative of the major pathogenic serogroups. Serovar identification was carried out by a combination of monoclonal antibodies and cross-agglutinin absorption test (CAAT). The novel nature of the strain was confirmed by restriction endonuclease analysis (REA). Results showed that RIM 139 represents a new serovar. The name Altodouro is proposed for this new serovar. Speciation findings – PCR analysis of the ompL1 gene and sequencing of the secY gene – indicated that it belonged to Leptospira kirschneri as did amplification with G1/G2 and B64-I/B64-II the primer sets.     

Plasmid profiles of legionella pneumophila strains isolated in Spain

An assay for plasmid DNA content was carried out in 100 strains of Legionella pneumophila of distinct serogroups and isolated from various sources (clinical, environment). The strains were isolated from different geographic regions in our country. The presence of plasmids was proved in one of the 11 clinical isolates and in 68 of the 89 isolated of environmental origin studied. In the strains belonging to serogroup 1 and isolated in our region (Cantabria), three plasmid profiles were observed, whereas in strains of the same serogroup from other geographic regions, two profiles were shown which exhibited differences compared to the former ones. Analysis by means of restriction endonucleases suggested that plasmids of similar size in serogroup 1 strains of different source, were related. The results obtained do not appear to reveal any correlation between plasmid profile and source of isolation or serogroup.Corresponding author.     

Emergency, anaesthetic and essential surgical capacity in the Gambia

Objective

To assess the resources for essential and emergency surgical care in the Gambia.

Methods

The World Health Organization’s Tool for Situation Analysis to Assess Emergency and Essential Surgical Care was distributed to health-care managers in facilities throughout the country. The survey was completed by 65 health facilities – one tertiary referral hospital, 7 district/general hospitals, 46 health centres and 11 private health facilities – and included 110 questions divided into four sections: (i) infrastructure, type of facility, population served and material resources; (ii) human resources; (iii) management of emergency and other surgical interventions; (iv) emergency equipment and supplies for resuscitation. Questionnaire data were complemented by interviews with health facility staff, Ministry of Health officials and representatives of nongovernmental organizations.

Findings

Important deficits were identified in infrastructure, human resources, availability of essential supplies and ability to perform trauma, obstetric and general surgical procedures. Of the 18 facilities expected to perform surgical procedures, 50.0% had interruptions in water supply and 55.6% in electricity. Only 38.9% of facilities had a surgeon and only 16.7% had a physician anaesthetist. All facilities had limited ability to perform basic trauma and general surgical procedures. Of public facilities, 54.5% could not perform laparotomy and 58.3% could not repair a hernia. Only 25.0% of them could manage an open fracture and 41.7% could perform an emergency procedure for an obstructed airway.

Conclusion

The present survey of health-care facilities in the Gambia suggests that major gaps exist in the physical and human resources needed to carry out basic life-saving surgical interventions.     

Arenal, a new Leptospira serovar of serogroup Javanica, isolated from a patient in Costa Rica.

Leptospirosis is a worldwide distributed zoonotic disease caused by pathogenic spirochetes of the genus Leptospira. The basic taxon of Leptospira is the serovar. Currently, nearly 300 serovars have been identified. Leptospirosis is particularly prevalent in warm and humid tropical regions where conditions for transmission and survival of pathogenic leptospires in the environment are optimal. Leptospirosis probably constitutes a serious veterinary and public health problem in Central America but solid figures are missing. To determine distribution of leptospirosis in Costa Rica and to identify locally circulating pathogenic serovars, we performed a sentinel-based study, isolating and characterizing leptospires from patients attending hospitals. Strain MAVJ 401 was isolated from a hospitalized patient in the Alajuela province. The isolate produced agglutination titers notably with reference rabbit antisera against serovars of serogroup Javanica but appeared serologically unique in the standard Cross Agglutinin Absorption Test. Therefore, MAVJ 401 was considered to represent a new serovar, designated Arenal, of the serogroup Javanica. Genotypic analysis revealed that strain MAVJ 401 belongs to Leptospira santarosai, a species that almost exclusively occurs in Latin America. This is not a unique finding of an exotic serovar. Recent isolates from severely ill patients in the same region appeared to be identical to Arenal. We have identified a novel highly virulent serovar from a patient in Costa Rica that is common in this area, thus posing a threat for the local public and veterinary health.     

Characterization of multidrug-resistant Salmonella enterica serovar Heidelberg isolated from humans and animals

Salmonella enterica serovar Heidelberg has been recognized as one of the most common serovar associated with foodborne infections in the United States. It is also frequently isolated from nonhuman sources and has increasingly shown resistance to various antimicrobial agents. The present study was undertaken to identify the predominant antimicrobial resistance phenotypes and genotypes of Salmonella Heidelberg (n = 95) isolates of human, swine, and turkey origin. Antimicrobial susceptibility was done using Kirby-Bauer disk diffusion method with a panel of 12 antimicrobials. Pulsed-field gel electrophoresis genotyping was used to determine the diversity of the isolates. The antimicrobial resistance genes and carriage of Class 1 and 2 integrons were determined by polymerase chain reaction. All Salmonella Heidelberg isolates from swine were resistant to one or more of the antimicrobials tested and the majority (73.3%) showed multidrug resistance to streptomycin, tetracycline, and kanamycin (R-type: StTeKm). About 80% of the Salmonella Heidelberg isolates of human origin were pan-susceptible, however, one isolate showed multidrug resistance to 10 of 12 antimicrobials tested. Among the multidrug-resistant (MDR) Salmonella Heidelberg isolates, Class 1 integrons with variable sizes of 1.2 to 1.5 kb were detected in six isolates (three each) from humans and swine. DNA sequencing revealed that Class 1 integrons of both human and swine origin carried a gene encoding aminoglycoside adenyltransferase (aadA). Resistance genes identified in other loci include aphA1-Iab, strA, bla(TEM), and tetA (B). Both human and swine MDR strains of Salmonella Heidelberg carried the resistance phenotypes on self-transferable plasmids. Dendrogram analysis of pulsotypes indicated possible clonality of Salmonella Heidelberg between isolates of human and swine origin. The findings in this study indicate the increasing significance of swine as reservoirs of emerging MDR serovars, such as MDR Salmonella Heidelberg, is of public health significance.     

Characterization of extended-spectrum cephalosporin-resistant Salmonella enterica serovar Heidelberg isolated from food animals, retail meat, and humans in the United States 2009

Salmonella enterica is one of the most common causes of foodborne illness in the United States. Although salmonellosis is usually self-limiting, severe infections typically require antimicrobial treatment, and ceftriaxone, an extended-spectrum cephalosporin (ESC), is commonly used in both adults and children. Surveillance conducted by the National Antimicrobial Resistance Monitoring System (NARMS) has shown a recent increase in ESC resistance among Salmonella Heidelberg isolated from food animals at slaughter, retail meat, and humans. ESC resistance among Salmonella in the United States is usually mediated by a plasmid-encoded bla(CMY) β-lactamase. In 2009, we identified 47 ESC-resistant bla(CMY)-positive Heidelberg isolates from humans (n=18), food animals at slaughter (n=16), and retail meats (n=13) associated with a spike in the prevalence of this serovar. Almost 90% (26/29) of the animal and meat isolates were isolated from chicken carcasses or retail chicken meat. We screened NARMS isolates for the presence of bla(CMY), determined whether the gene was plasmid-encoded, examined pulsed-field gel electrophoresis patterns to assess the genetic diversities of the isolates, and categorized the bla(CMY) plasmids by plasmid incompatibility groups and plasmid multi-locus sequence typing (pMLST). All 47 bla(CMY) genes were found to be plasmid encoded. Incompatibility/replicon typing demonstrated that 41 were IncI1 plasmids, 40 of which only conferred bla(CMY)-associated resistance. Six were IncA/C plasmids that carried additional resistance genes. pMLST of the IncI1-bla(CMY) plasmids showed that 27 (65.8%) were sequence type (ST) 12, the most common ST among bla(CMY)-IncI1 plasmids from Heidelberg isolated from humans. Ten plasmids had a new ST profile, ST66, a type very similar to ST12. This work showed that the 2009 increase in ESC resistance among Salmonella Heidelberg was caused mainly by the dissemination of bla(CMY) on IncI1 and IncA/C plasmids in a variety of genetic backgrounds, and is likely not the result of clonal expansion.     

Characteristics of strains of Salmonella enterica serovar Typhimurium DT104 isolated in the Slovak Republic

From 1997 to 2000 in the Slovak Republic 8 strains of Salmonella enterica serovar Typhimurium DT104 were isolated from sporadic cases of human salmonellosis. Four strains were multiresistant and three strains were sensitive to antibiotics. We investigated the influence of the cultivation medium (complete Müeller-Hinton, synthetic-Staples) on growth, surface hydrophobicity and motility of the mentioned isolates. The hydrophobicity was evaluated by methods of adherence to the hydrocarbon xylene (BATH) in a salt-aggregation test with ammonium sulphate (SAT) and adherence to a plast. The growth of tested strains in 24 hours was greater after cultivation in the complete medium, but the salmonellae grew considerably also in the synthetic medium where the only source of C and N was asparagine. Of the investigated characteristics the cultivation medium influenced most the adherence of isolates to xylene as after cultivation in a synthetic medium all isolates with the exception of two were hydrophobic. The motility of strains was also greater after growth in this medium. Conversely cultivation in complete medium suppressed these properties of isolates. The cultivation medium did not influence the adherence of isolates to plasts and only a slight influence was observed on the salt aggregating properties of the investigated strains.     

Therapeutic landscapes of the Jola, The Gambia, West Africa

This paper contributes to the 'new' medical geography through its analysis of the therapeutic landscapes of the Jola of The Gambia. The paper advances the debate surrounding the conceptualization of medicine and health through a review of literature on African medicinal systems; it examines in detail the health care system of the Jola of The Gambia, documenting indigenous human and ethnoveterinary medical beliefs and practices and focusing in particular on the role of herbal medicine; and it discusses the interactions and links between indigenous medicine and biomedicine, thus demonstrating the importance of placing an understanding of health care systems in different places within an awareness of global power relations. The paper therefore links cultural perspectives with a political economy analysis, to highlight the importance of place and specificity of cultural context when investigating health care beliefs and practices. The intention of the paper is to present a theoretically informed empirical case study which reinforces the practical value of a 'new' medical geography.     

Virulotyping of Salmonella enterica serovar Napoli strains isolated in Italy from human and nonhuman sources

Salmonella enterica serovar Napoli is an emerging serovar in Italy, France, and Switzerland, but little is known about its pathogenicity to humans. A collection of 112 strains of Salmonella Napoli isolated in Italy from human cases, foods of animal origin, and the environment have been characterized by the detection of a set of virulence genes, pulsed-field gel electrophoresis (PFGE), and antibiotic susceptibility. All the strains examined were susceptible to all the antimicrobials tested. The Salmonella pathogenicity islands genes ssaQ, mgtC spi_4D, and sopB were present from 75.0% to 100% of the tested strains. Only one human and four environmental strains showed the avrA gene. The phage-related sopE1 gene was present in 93% of the strains, whereas sodC1 and gipA genes were only in four and two environmental strains, respectively. The bcfC fimbrial gene was present in all the animal/food strains, in the 71.4% of environmental strains, and in 46.8% of the human strains, respectively. Overall, we observed 10 distinct virulence profiles (VP), but VP1-2-3 included 99 out of 112 strains. PFGE showed that 103 out of 111 isolates were grouped in four major clusters and three minor clusters, whereas two strains were totally unrelated. The most represented PFGE clusters mainly correlated with the virulotypes are VP1, VP2, and VP3. Salmonella Napoli shows an array of virulence genes similar to other serovars considered of public health importance and confirming its capability to cause infection in human. Concerning possible source of infection or reservoirs, the results did not point out any, but our hypothesis is that the environment can act as the main reservoir for Salmonella Napoli, and from there it can spill over to animals and humans. Further studies are needed to increase the knowledge on the ecology of Salmonella Napoli serovar and on the main risk factors for human infection.     

Multidrug resistance in Salmonella enterica serovar typhi isolated from patients with typhoid fever complications in Lagos, Nigeria

OBJECTIVE: The aim of this study was to determine the prevalence of Salmonella enterica serovar typhi in patients with pyrexia of unknown origin (PUO), and antimicrobial resistance in strains isolated from patients with S. typhi in Lagos, Nigeria. STUDY DESIGN: In total, 103 patients were included in this study, subdivided into two categories. Category A comprised 74 patients presenting with PUO, and Category B comprised 29 patients harbouring S. typhi who did not respond to initial treatment. METHODS: Blood samples were cultured for bacterial isolates and identified by standard procedures. Susceptibility testing was performed according to the National Committee for Clinical Laboratory Standards. Plasmid DNA extraction was performed using the alkaline lysis method with Escherichia coli v517 used as the standard. Conjugation and transformation experiments were performed using standard methods. For the latter, E. coli K12 HB 101 (ara-14, galK2, hsd 520, lacyl, leu, mtl-1, Pro A2, rec A13, rps L20, sup E44, thii xyl-5) was used as the recipient and plasmid PBR 322 was used as the positive control. RESULTS: The prevalence of S. typhi in PUO was 16.2% (12/74). In all, 25 of 41 (61.0%) cases were multidrug resistant (MDR) with phenotypic-resistant patterns: ACoCT, ACTCeS, ACTCoCe and ACTS were commonly encountered among the strains. Interestingly, four of the strains harbouring similar plasmid DNA were isolated from patients with hepatosplenomegaly, and a strain harbouring a large transferable plasmid of 81.2MDa was isolated from a psychosis patient. CONCLUSIONS: Our study confirmed the circulation of MDR S. typhi in Lagos, Nigeria. Periodic review of antibiotics used in hospitals is essential as the efficacies of chloramphenicol, ampicillin and cotrimoxazole are now doubtful. Ciprofloxacin and ofloxacin are effective drugs for treatment of typhoid fever, but with current trends of drug abuse in Nigeria, resistance is likely to develop. These results, therefore, provide an early warning signal for the prudent use of fluoroquinolone antimicrobials to preserve their usefulness.