The Rho-Independent Transcription Terminator for the porA Gene Enhances Expression of the Major Outer Membrane Protein and Campylobacter jejuni Virulence in Abortion Induction.

Campylobacter jejuni is a leading cause of foodborne illnesses worldwide. Its porA gene encodes the major outer membrane protein (MOMP) that is abundantly expressed and has important physiological functions, including a key role in systemic infection and abortion induction in pregnant animals. Despite the importance of porA in C. jejuni pathogenesis, mechanisms modulating its expression levels remain elusive. At the 3' end of the porA transcript, there is a Rho-independent transcription terminator (named T porA in this study). Whether T porA affects the expression and function of MOMP remains unknown and is investigated in this study. Green fluorescent protein (GFP) fusion constructs with the porA promoter at the 5' end and an intact T porA or no T porA at the 3' end of the gfp coding sequence revealed that both the transcript level of gfp and its fluorescence signals were more than 2-fold higher in the construct with T porA than in the one without T porA Real-time quantitative PCR (qRT-PCR) analysis of the porA mRNA and immunoblot detection of MOMP in C. jejuni showed that disruption of T porA significantly reduced the porA transcript level and the expression of MOMP. An mRNA decay assay demonstrated that disruption of T porA resulted in a shortened transcript half-life of the upstream gfp or porA gene, indicating that T porA enhances mRNA stability. In the guinea pig model, the C. jejuni construct with an interrupted T porA was significantly attenuated in abortion induction. Together, these results indicate that T porA enhances the expression level of MOMP by stabilizing its mRNA and influences the virulence of C. jejuni.

High Prevalence of Fluoroquinolone-Resistant Campylobacter Bacteria in Sheep and Increased Campylobacter Counts in the Bile and Gallbladders of Sheep Medicated with Tetracycline in Feed.

Campylobacter is a major foodborne pathogen in humans and a significant cause of abortion in sheep. Although ruminants are increasingly recognized as important reservoirs for Campylobacter species, limited information is available about the molecular epidemiology and antimicrobial resistance (AMR) profiles of sheep Campylobacter Here, we describe a two-trial study that examined Campylobacter profiles in sheep and determined whether in-feed tetracycline (TET) influenced the distribution and AMR profiles of Campylobacter Each trial involved 80 commercial sheep naturally infected with Campylobacter: 40 of these sheep were medicated with tetracycline in feed, while the other 40 received feed without antibiotics. Fecal and bile samples were collected for the isolation of Campylobacter The bacterial isolates were analyzed for antimicrobial susceptibility and genotypes. The results revealed that 87.0% and 61.3% of the fecal and bile samples were positive for Campylobacter (Campylobacter jejuni and Campylobacter coli), with no significant differences between the medicated and nonmedicated groups. All but one of the tested Campylobacter isolates were resistant to tetracycline. Although fluoroquinolone (FQ) resistance remained low in C. jejuni (1.7%), 95.0% of the C. coli isolates were resistant to FQ. Genotyping revealed that C. jejuni sequence type 2862 (ST2862) and C. coli ST902 were the predominant genotypes in the sheep. Feed medication with tetracycline did not affect the overall prevalence, species distribution, and AMR profiles of Campylobacter, but it did increase the total Campylobacter counts in bile and gallbladder. These findings identify predominant Campylobacter clones, reveal the high prevalence of FQ-resistant C. coli, and provide new insights into the epidemiology of Campylobacter in sheep.IMPORTANCECampylobacter is a major cause of foodborne illness in humans, and antibiotic-resistant Campylobacter is considered a serious threat to public health in the United States and worldwide. As a foodborne pathogen, Campylobacter commonly exists in the intestinal tract of ruminant animals, such as sheep and cattle. Results from this study reveal the predominant genotypes and high prevalence of tetracycline (TET) and fluoroquinolone (FQ) resistance in sheep Campylobacter The finding on fluoroquinolone resistance in sheep Campylobacter is unexpected, as this class of antibiotics is not used for sheep in the United States, and it may suggest the transmission of fluoroquinolone-resistant Campylobacter from cattle to sheep. Additionally, the results demonstrate that in-feed medication with tetracycline increases Campylobacter counts in gallbladders, suggesting that the antibiotic promotes Campylobacter colonization of the gallbladder. These findings provide new information on Campylobacter epidemiology in sheep, which may be useful for curbing the spread of antibiotic-resistant Campylobacter in animal reservoirs.

Muscular damage in a patient with hepatitis B induced by beta-l-2'-deoxythymidine and detected by 18F-FDG PET/CT.

A 58 years old man under 2'-Deoxy-L-thymidine treatment for his hepatitis B was admitted to our hospital complaining for the last 2 months of recurrent upper abdomen discomfort, fatigue and weight loss of 10 kilograms and general muscular soreness, for 2 weeks. He had elevated creatine kinase (CK), myoglobin, CK-MB and other related or common laboratory findings. Fluorine-18- fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) showed a diffuse, homogenous, moderately elevated glucose uptake in all muscle groups. Muscular damage induced by 2'-Deoxy-L-thymidine was suspected and the drug was discontinued. Muscle soreness and the biomarkers for muscular tissue damage improved. Fluorine-18-FDG PET/CT is useful to rule out malignancy and identify muscular tissue damage.

A pediatric hypophosphatemic rickets on MRI, 99mTc-MDP bone scan and 18F-FDG PET/CT.

We present a case of a 13 years old boy who was hospitalized with a 10 months history of progressive pain and weakness in his lower extremities. The laboratory tests revealed slightly decreased phosphate and 25-hydroxyvitamin D3, high alkaline phosphatase, normal calcium and parathyroid hormone (PTH). Magnetic resonance imaging (MRI) showed multiple patchy lesions indicating bone destruction in the metaphyses and epiphyses of the left knee. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed a generalized decrease of bone density in axial bones with slightly increased 18F-FDG metabolism. Whole body technetium-99m methylene diphosphonate (99mTc-MDP) scintigraphy revealed multiple areas of increased uptake at costochondral junctions of the ribs bilaterally suggesting a rachitic rosary and at the metaphyses of the bones of the limbs. Based on these findings we suggested the diagnosis of hypophosphatemic rickets (HPR). Phosphate and vitamin D substitution resulted in clinical improvement of the symptoms after 3 months.

Inactivation of Clostridium difficile in sewage sludge by anaerobic thermophilic digestion.

There has been an increase in community-associated Clostridium difficile infections with biosolids derived from wastewater treatment being identified as one potential source. The current study evaluated the efficacy of thermophilic digestion in decreasing levels of C. difficile ribotype 078 associated with sewage sludge. Five isolates of C. difficile 078 were introduced (final density of 5 log CFU/g) into digested sludge and subjected to anaerobic digestion at mesophilic (36 or 42 °C) or thermophilic (55 °C) temperatures for up to 60 days. It was found that mesophilic digestion at 36 °C did not result in a significant reduction in C. difficile spore levels. In contrast, thermophilic sludge digestion reduced endospore levels at a rate of 0.19-2.68 log CFU/day, depending on the strain tested. The mechanism of lethality was indirect - by stimulating germination then inactivating the resultant vegetative cells. Acidification of sludge by adding acetic acid (6 g/L) inhibited the germination of spores regardless of the sludge digestion temperature. In conclusion, thermophilic digestion can be applied to reduce C. difficile in biosolids, thereby reducing the environmental burden of the enteric pathogen.

(18)F-FDG PET/CT imaging in systemic lupus erythematosus related autoimmune haemolytic anaemia and lymphadenopathy.

OBJECTIVE: We present a case of systemic lupus erythematosus (SLE) related autoimmune haemolytic anaemia (AIHA) and lymphadenopathy. AIHA as a serious complication of SLE, requiring urgent appropriate management. The timely differential diagnosis between SLE with lymphadenopathy and lymphoma, primary and SLE-related AIHA often looms as practical challenge under clinical scenario. Fluorine-18 fluorodeoxyglucose position emission tomography/computed tomography ((18)F-FDG PET/CT) performed for fever of a known origin and for possible malignancy, showed increased (18)F-FDG uptake in lymph nodes, as well as increased spleen uptake, which was probably due to lymphoma. CONCLUSIONS: A symmetrically increased (18)F-FDG uptake in small lymph nodes with multiple serous cavity effusion helped the differential diagnosis between SLE related AIHA and lymphoma. In addition, PET/CT can visualize not only the degree of disease activity or the "burden of inflammation" but also the distribution of the disease in the entire body.

A pediatric malignant paraganglioma and brief review of the literature.

A 10 years old boy presented to our hospital complaining of belly pain. He had a retroperitoneal mass diagnosed by ultrasound 3 days before. During that time he was found to have slight hypertension. Computed tomography (CT) showed a left retroperitoneal mass with edge enhancement and central necrosis indicating pheochromocytoma (PCC). Vanillymandelic acid (VMA) in the 24 hours urine sample was not elevated. Pheochromocytoma was suspected given his hypertension and the ultrasound and CT findings. Fluorine-18- fluorodeoxy glucose positron emission tomography (18F-FDG PET) showed intense uptake in the left adrenal area (SUVmax 32.9) with a central 18F-FDG uptake defect. Subsequently, left adrenalectomy was successfully performed. Histological examination showed that the tumor was a paraganglioma (PGL) with low-grade malignancy. CONCLUSION: Fluorine-18-FDG PET is a highly sensitive method to detect PGL, but could not make a differential diagnosis between PGL and PCC although high uptake of 18F-FDG may indicate malignancy. As our case clearly demonstrates, rare cases of PCC or PGL should be considered in the setting of secondary hypertension.

Sanitary status and incidence of methicillin-resistant Staphylococcus aureus and Clostridium difficile within Canadian hotel rooms.

The study described in this article aimed at establishing a baseline assessment of the sanitary status of ice and guest rooms within Canadian hotels. Collectively, 54 hotel rooms belonging to six different national chains were sampled. High-contact surfaces (comforter, alarm clock, bedside lamp, TV remote, bathroom countertop, faucet, and toilet seat) were sampled using adenosine triphosphate (ATP) swabs and replicate organism detection and counting plates. ATP swab readings ranged from 2.12 to 4.42 log relative light units. Coliforms were recovered from 36% of surfaces with high prevalence being recovered from the comforter, TV remote, bathroom countertop, faucet, and toilet seat. Oxacillin-resistant bacteria were recovered from 19% of surfaces with 46% of isolates confirmed as methicillin-resistant Staphylococcus aureus. Two toxigenic Clostridium difficile isolates were recovered in the course of the study. Collectively, 24% of the ice samples harbored coliforms with a single sample testing positive for E. coli. The authors' study demonstrates that hotel rooms represent a potential source of community-acquired infections and the need for enhanced sanitation practices.

Effect of Danofloxacin Treatment on the Development of Fluoroquinolone Resistance in Campylobacter jejuni in Calves.

Campylobacter is a leading cause of foodborne gastroenteritis. Recent studies have indicated a rise in fluoroquinolone-resistant (FQ-R) Campylobacter in cattle, where FQ is used to control bovine respiratory disease (BRD). To assess the effect of danofloxacin treatment on the development of FQ-resistance in C. jejuni, 30 commercial calves were divided into Group 1, Group 2, and Group 3 (n = 10), and were all inoculated orally with FQ-susceptible (FQ-S) C. jejuni; seven days later, Group 3 was challenged with transtracheal Mannheimia haemolytica, and one week later, Group 2 and Group 3 were injected subcutaneously with danofloxacin. Rectal feces were collected to determine relative percentages of FQ-R Campylobacter via culture. Before oral inoculation with C. jejuni, 87% of calves were naturally colonized by FQ-R C. jejuni. Two days after the inoculation, FQ-R C. jejuni decreased substantially in the majority of calves. Within 24 h of danofloxacin injection, almost all C. jejuni populations shifted to an FQ-R phenotype in both FQ-treated groups, which was only transitory, as FQ-S strains became predominant during later periods. Genotyping indicated that the spike seen in FQ-R C. jejuni populations following the injection was due mainly to enrichment of preexisting FQ-R C. jejuni, rather than development of de novo FQ resistance in susceptible strains. These results provide important insights into the dynamic changes of FQ-resistant Campylobacter in cattle in response to FQ treatment.

Influence of Single Dose Enrofloxacin Injection on Development of Fluoroquinolone Resistance in Campylobacter jejuni in Calves.

Fluoroquinolone (FQ) resistance in a major foodborne bacterial pathogen, Campylobacter jejuni, derived from cattle has recently become prevalent and poses a significant public health concern. However, the underlying factors for this increase are not entirely clear. To evaluate the effect of enrofloxacin treatment on FQ-resistance development in C. jejuni, 35 commercial calves were equally divided into five groups (Groups 1-5) and were orally inoculated with FQ-susceptible (FQ-S) C. jejuni. Eight days later, Groups 4 and 5 were challenged with Mannheimia haemolytica via a transtracheal route to induce a respiratory disease; after 8 days, Groups 2, 3, 4, and 5 were injected subcutaneously with enrofloxacin (7.5 mg/kg for Groups 2 and 4, and 12.5 mg/kg for Groups 3 and 5). Colonization levels by FQ-resistant (FQ-R) and FQ-S Campylobacter in rectal feces were determined via differential culture throughout the experiment. Before oral inoculation with C. jejuni, only five calves were naturally colonized by Campylobacter, four of which were also colonized by FQ-R C. jejuni (three in Group 1 and one in Group 3). Soon after the oral inoculation, almost all calves in the groups became stably colonized by FQ-S C. jejuni (~3-6 log10 CFU/g), except that the four calves that were pre-colonized before inoculation remained positive with both FQ-R and FQ-S C. jejuni. Following enrofloxacin administration, C. jejuni colonization declined sharply and rapidly in all treated groups to undetectable levels; however, the vast majority of the animals were recolonized by C. jejuni at comparable levels 72 h after the treatment. Notably, no FQ-R C. jejuni was detected in any of the calves that received enrofloxacin, regardless of the drug dose used or disease status of the animals. The lack of detection of FQ-R C. jejuni was likely due to the localized high concentration of the antibiotic in the intestine, which may have prevented the emergence of the FQ-R mutant. These findings indicate that single-dose enrofloxacin use in cattle poses a low risk for selection of de novo FQ-R mutants in C. jejuni.

Pharmacokinetics of tulathromycin in pregnant ewes (Ovis aries) challenged with Campylobacter jejuni.

The purpose of this study was to evaluate the pharmacokinetics of tulathromycin in the plasma and maternal and fetal tissues of pregnant ewes when administered within 24 hours of a single, IV Campylobacter jejuni (C. jejuni) challenge. Twelve, pregnant ewes between 72-92 days of gestation were challenged IV with C. jejuni IA3902 and then treated with 1.1 ml/45.36 kg of tulathromycin subcutaneously 18 hours post-challenge. Ewes were bled at predetermined time points and euthanized either at a predetermined time point or following the observation of vaginal bleeding or abortion. Following euthanasia, tissues were collected for bacterial culture, pharmacokinetics and histologic examination. The maximum (geometric) mean tulathromycin plasma concentration was estimated at 0.302 µg/mL, with a peak level observed at around 1.2 hours. The apparent systemic clearance of tulathromycin was estimated at 16.6 L/h (or 0.28 L/kg/h) with an elimination half-life estimated at approximately 22 hours. The mean tissue concentrations were highest in the uterus (2.464 µg/g) and placentome (0.484 µg/g), and were lowest in fetal liver (0.11 µg/g) and fetal lung (0.03 µg/g). Compared to previous reports, results of this study demonstrate that prior IV administration of C. jejuni appeared to substantially alter the pharmacokinetics of tulathromycin, reducing both the peak plasma concentrations and elimination half-life. However, additional controlled trials are required to confirm those observations.

Modulation of Campylobacter jejuni Motility, Adhesion to Polystyrene Surfaces, and Invasion of INT407 Cells by Quorum-Sensing Inhibition.

Campylobacter jejuni is a major foodborne pathogen, and the LuxS-mediated quorum-sensing (QS) system influences its motility, biofilm formation, invasion, host colonization, and virulence. QS therefore represents a target for the control of C. jejuni. The aim of this study was to investigate the correlation of QS inhibition with changes in C. jejuni motility, adhesion to polystyrene surfaces, and adhesion to and invasion of INT407 cells. This was achieved by studying (i) the luxS-deficient mutant and (ii) treatment of C. jejuni with 20 natural extracts as six essential oils, 11 ethanolic extracts, and three pure compounds. Compared to the wild-type, the ΔluxS mutant showed decreased motility, adhesion to polystyrene surfaces, and invasion of INT407 cells. The anti-QS effects of the treatments (n = 15/20) were assayed using Vibrio harveyi BB170 bioluminescence. Moderate positive correlation was shown between C. jejuni QS reduction and reduced motility (τ = 0.492, p = 0.024), adhesion to polystyrene surfaces (τ = 0.419, p = 0.008), and invasion (r = 0.394, p = 0.068). The best overall effect was achieved with a Sedum rosea (roseroot) extract, with 96% QS reduction, a 1.41 log (96%) decrease in adhesion to polystyrene surfaces, and an 82% decrease in invasion. We show that natural extracts can reduce motility, adhesion to polystyrene surfaces, and invasion of INT407 cells by C. jejuni through modulation of the LuxS (QS) system.

A Homologous Bacterin Protects Sheep against Abortion Induced by a Hypervirulent Campylobacter jejuni Clone.

Campylobacter jejuni clone SA has emerged as the predominant cause of ovine abortion outbreaks in the United States (US). Despite the fact that commercial Campylobacter vaccines are available, their efficacy in protecting abortion induced by C. jejuni clone SA is uncertain, and a protective vaccine is needed to control the disease. In this study, an experimental homologous bacterin (made of a clone SA isolate) and two commercial Campylobacter vaccines were evaluated for their protection against C. jejuni clone SA-induced sheep abortion. All vaccines induced high levels of antibodies against C. jejuni clone SA in pregnant ewes, but only the experimental homologous bacterin produced significant protection (80%). Immunoblotting showed that the experimental vaccine elicited more specific antibodies against C. jejuni clone SA. These findings strongly suggest the necessity of developing a homologous vaccine for the control C. jejuni clone SA induced abortion on sheep farms.

Experimental evaluation of tulathromycin as a treatment for Campylobacter jejuni abortion in pregnant ewes.

OBJECTIVE: To evaluate the efficacy of tulathromycin for prevention of abortion in pregnant ewes when administered within 24 hours after experimental inoculation with Campylobacter jejuni. ANIMALS: 20 pregnant ewes between 72 and 92 days of gestation. PROCEDURES: All ewes were inoculated with a field strain of C jejuni (8.5 × 108 to 10.6 × 108 CFUs, IV). Eighteen hours later, ewes received either tulathromycin (1.1 mL/45 kg [2.4 mg/kg], SC; n = 10) or sterile saline (0.9% NaCl) solution (1.1 mL/45 kg, SC; sham; 10). Ewes were euthanized immediately after observation of vaginal bleeding, abortion, or completion of a 21-day observation period. Necropsy was performed on all ewes, and tissue specimens were obtained for bacterial culture and histologic examination. RESULTS: 1 sham-treated ewe and 1 tulathromycin-treated ewe developed signs of severe endotoxemia and were euthanized within 24 hours after C jejuni inoculation. Seven sham-treated and 2 tulathromycin-treated ewes developed vaginal bleeding or aborted and were euthanized between 4 and 21 days after C jejuni inoculation. The proportion of tulathromycin-treated ewes that developed vaginal bleeding or aborted during the 21 days after C jejuni inoculation (2/9) was significantly less than that for the sham-treated ewes (7/9). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that administration of tulathromycin to pregnant ewes following exposure to C jejuni was effective in decreasing the number of C jejuni-induced abortions. Because of concerns regarding the development of macrolide resistance among Campylobacter strains, prophylactic use of tulathromycin in sheep is not recommended.

Antibiotic resistance trends and mechanisms in the foodborne pathogen, Campylobacter.

Campylobacter is a major foodborne pathogen and is commonly present in food producing animals. This pathogenic organism is highly adaptable and has become increasingly resistant to various antibiotics. Recently, both the Centers for Disease Control and Prevention and the World Health Organization have designated antibiotic-resistant Campylobacter as a serious threat to public health. For the past decade, multiple mechanisms conferring resistance to clinically important antibiotics have been described in Campylobacter, and new resistance mechanisms constantly emerge in the pathogen. Some of the recent examples include the erm(B) gene conferring macrolide resistance, the cfr(C) genes mediating resistance to florfenicol and other antimicrobials, and a functionally enhanced variant of the multidrug resistance efflux pump, CmeABC. The continued emergence of new resistance mechanisms illustrates the extraordinary adaptability of Campylobacter to antibiotic selection pressure and demonstrate the need for innovative strategies to control antibiotic-resistant Campylobacter. In this review, we will briefly summarize the trends of antibiotic resistance in Campylobacter and discuss the mechanisms of resistance to antibiotics used for animal production and important for clinical therapy in humans. A special emphasis will be given to the newly discovered antibiotic resistance.

[Long-term effects and complications of intravascular brachytherapy].

Since the introduction of percutaneous transluminal coronary angioplasty, restenosis has remained the most challenging problem facing interventional cardiologist. Intravascular radiation is a feasible and promising adjunctive therapy in restenosis treatment by suppressing both neointimal proliferation and constrictive remodeling, while there are growing concerns about its long-term effects and complications in clinical perspectives as well as dosing and paradoxical stimulation. Current comments on them may well favor the choice of comprehensive treatment protocol for clinicians.