Evidence of delays in transferring patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus to long-term-care facilities.

This retrospective case-control study examined whether there was a difference in length of time awaiting long-term-care placement for patients identified as having methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus compared to controls. Thirty-nine patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus waited for placement an average of 61 days longer than controls (P<.0002). The average number of requests for placement was 2.5 compared to 1.7 for controls (P=.015).

Corynebacterium diphtheriae septicemia.

This report describes the case of a patient with chronic lymphocytic leukemia in whom septicemia caused by a nontoxigenic strain of Corynebacterium diphtheriae developed. Numerous abscesses were present in sections of liver and spleen taken at autopsy. The case is discussed, and the literature on infections caused by organisms of the genus Corynebacterium is briefly reviewed.

Microscopic evaluation of sputum specimens submitted for Mycobacterium tuberculosis culture.

Using microscopic screening criteria employed in the study of sputum in acute bacterial pneumonia, the authors evaluated 644 sputum samples from 347 patients submitted for mycobacterial bacterial culture. After microscopic examination, these specimens were processed using standard mycobacterial laboratory technics. Salivary specimens accounted for 67.1% of the samples evaluated, and yielded 13 of the total 42 Mycobacterium tuberculosis isolates, as well as 4 of the 21 smear-positive culture-positive specimens. Although specimens from the lower respiratory tract are preferred, specimens of a salivary nature should not be discarded by the Mycobacteriology Laboratory.

Isoenzyme analysis of human and animal isolates of Giardia duodenalis from British Columbia, Canada.

Isoenzyme patterns of 32 isolates of Giardia duodenalis, obtained from 6 beavers and 11 humans from British Columbia, plus 15 other isolates were evaluated using thin-layer starch-gel electrophoresis. We attempted to use 12 enzymes; 9 gave reproducible and interpretable results. The isoenzyme patterns of the isolates were classified into 12 groups with 17 (53%) of the 32 isolates confined to 1 group. The other 11 groups each comprised only 1 or 2 isolates. There was no obvious correlation between clinical symptoms and isoenzyme patterns. Our findings suggest that beavers, like humans and gerbils are receptive to organisms with many different isoenzyme patterns.

Molecular epidemiology of cryptosporidiosis outbreaks and transmission in British Columbia, Canada.

Isolates from 25 (13 sporadic and 12 outbreak) cryptosporidiosis cases, 24 of which were from British Columbia, Canada, were characterized using nested polymerase chain reaction amplification of the polymorphic internal transcribed spacer 1 locus. Two predominant Cryptosporidium parvum genotypes were found. Twelve (8 sporadic and 4 outbreak) isolates amplified with the cry7/cry21 primer pair and 12 (5 sporadic and 7 outbreak) isolates amplified with the cry7/cryITS1 primer pair. Multi-locus gene analysis using sequence polymorphisms on 3 other loci, i.e., the thrombospondin-related adhesion protein gene, the dihydrofolate reductase gene, and the 18S rRNA gene on 8 (4 outbreak and 4 sporadic) isolates showed non-random association among the human and animal alleles of the 4 different C. parvum gene loci. Associations between these 2 parasite genotypes and different routes of cryptosporidiosis transmission such as zoonotic, anthroponotic, and waterborne transmission were studied using municipal population and agricultural information, as well as detection of C. parvum oocysts in municipal drinking water specimens of the residential communities of sporadic and outbreak cases.

The toilet as a transmission vector of vancomycin-resistant enterococci.

An elderly woman, admitted to the intensive care unit of a large university teaching hospital, was found to be colonized with vancomycin-resistant enterococci leading to the temporary closure of the unit. She had acquired the organism nosocomially, most likely from an environmental source, which had been contaminated when the toilet of a former patient, also colonized with vancomycin-resistant enterococci, had become blocked and overflowed throughout his and the adjoining room. This is the first report of a hospital toilet as the transmission vector for vancomycin-resistant enterococci.

Giardia duodenalis: enhanced growth in cell culture.

Growth of Giardia duodenalis in broth and in animals has been studied in considerable detail. In contrast, the kinetics of growth in cell culture have been little evaluated. In this study, in vitro growth of G. duodenalis was evaluated in cell culture, primarily using mouse McCoy cells in vials. The media used were Giardia broth (TYI-G), Trichomonas vaginalis broth (TYI-T), and standard cell culture media (CMGA) alone and in combination (2 parts by volume CMGA to one part of TYI broth). Addition of cell culture enhanced the sensitivity of the systems in detecting low numbers of G. duodenalis. Growth was identified consistently with inocula less than or equal to 10/ml, and often with a calculated 10-1/ml inoculum with CMGA/TYI-T and CMGA/TYI-G with cells, and with TYI-G with and without cells. The 2 preferred systems for sensitivity and growth were CMGA/TYI-G with cells and TYI-G with cells. The pH fell minimally in the growth systems and, if CMGA was in the media, cell monolayers remained intact and viable throughout the experiment. In preliminary experiments, cell cultures did not allow growth of one strain of G. muris. These cell culture systems may be useful for detection of low numbers of non-laboratory adapted trophozoites, and should be useful in evaluating the interaction of G. dudodenalis with cells in culture.

A second community outbreak of waterborne giardiasis in Canada and serological investigation of patients.

A waterborne outbreak of giardiasis which occurred 5 years after another in the same town in Canada was investigated. Sera from residents defined as cases or non-cases were tested by enzyme-linked immunosorbent assay (ELISA) and compared with sera from symptomatic and asymptomatic control groups. The outbreak-associated Giardia isolate was retrieved from contaminated drinking water and antigen from this strain was used in the serological investigation. Up to 84% of cases were identified by ELISA. More cases were identified by elevated immunoglobulin (Ig) G than by either elevated anti-Giardia IgA or IgM levels. Residents of the community infected during the first outbreak were significantly less likely to have been reinfected during the second outbreak. This is the first report of a second waterborne outbreak occurring in a community and results of the investigations are consistent with an acquired, protective immunity lasting at least 5 years.

Laboratory diagnosis of giardiasis.

The epidemiology, clinical presentations, and recent developments in understanding Giardia are reviewed. Diagnosis is discussed in light of recent studies that challenge the clinician's approach to the diagnosis of enteric parasites, including giardiasis, and that demonstrate the need for further evaluation on the basis of cost-effectiveness, as well as reliability and clinical practicality. The overall effectiveness and difficulties associated with present standard diagnostic methods and the more recently developed immunologic approaches to diagnosis in giardiasis are reviewed.

Immunological methods of diagnosis in giardiasis: an overview.

The epidemiology and clinical presentations of giardiasis are reviewed to provide a basis of understanding the laboratory aspects of this parasitic infection. Diagnosis is then discussed in light of recent studies that challenge our overall approach to the diagnosis of enteric parasites and demonstrate the need for further evaluation on the basis of cost-effectiveness as well as reliability and clinical practicality. Overall effectiveness as well as the difficulties with present standard diagnostic methods in giardiasis are reviewed. This is followed by a discussion of the more recently developed immunological approaches to diagnosis. The role of these tests in the parasitology laboratory is also discussed.

Isoelectric focusing of ten strains of Giardia duodenalis.

Ten strains of human- and animal-source Giardia duodenalis were evaluated using an isoelectric focusing technique. Banding patterns obtained from total cell proteins of trophozoites demonstrated both similarities and differences between strains. This confirms the heterogeneity of this morphological group of Giardia sp. demonstrated by others. Heterogeneity was demonstrated among the strains retrieved from human and animal hosts and from hosts within the same geographical region.

Evaluation of molecular techniques to biotype Giardia duodenalis collected during an outbreak.

Twenty-seven Giardia duodenalis cyst-positive specimens (human, animal, or drinking water) were obtained from a waterborne outbreak in a community in British Columbia, western Canada. Parasite isolates were characterized using molecular techniques at 4 different steps of organism retrieval. None of the drinking water samples (n = 20) infected gerbils and none was successfully amplified using polymerase chain reaction (PCR). We were able to genotype 4 of 7 (human and animal) isolates by amplification of DNA from original specimens at the triosephosphate isomerase (tpi) gene locus using PCR followed by restriction fragment length polymorphism (RFLP) analysis. Five of the original specimens inoculated into Mongolian gerbils (Meriones unguiculatus) were infective and genotyped at the tpi locus using parasite material collected from the gerbil (cysts and trophozoites). Pulsed field gel electrophoresis (PFGE) was used to biotype trophozoites collected from the gerbils as well as trophozoites from the 4 isolates that adapted to culture. Four of these 5 isolates displayed the same (designated outbreak) biotype at all parasite retrieval steps with all molecular techniques including the originally amplified isolates. PCR-RFLP identified an additional biotype group. The 4 isolates that adapted to in vitro culture were also characterized by isoenzyme electrophoresis (IE). Biotype groups identified in these axenized isolates were all the same with each molecular technique (PCR-RFLP, PFGE, IE) tested. Results of this study demonstrate a need for more sensitive molecular methods to detect and characterize Giardia in original host and environmental samples. Results are also consistent with evidence of biotype changes that occur during the presently used process of isolate retrieval.

Factors associated with acquiring giardiasis in British Columbia residents.

Giardia is the most frequently reported intestinal parasite in Canada. More than 2,000 cases are reported annually in British Columbia which exceeds the number of cases of either campylobacteriosis or salmonellosis. Since the different ways this parasite is spread in British Columbia have not been determined, our purpose was to investigate certain factors that might be associated with acquiring giardiasis in this province. Telephone interviews provided information from a group of infected persons and from a group of non-infected control subjects. Information obtained from these interviews was used to identify associated risk factors in this group of cases. If results of the study are generalized to the population-at-risk, they indicate that water (drinking and recreational) is an important vector for transmission of Giardia in British Columbia.

Inhibitory and lethal activities of rosaramicin, erythromycin, and clindamycin against Campylobacter fetus subsp jejuni and intestinalis.

In a comparative study of the inhibitory and lethal effects of rosaramicin, erythromycin, and clindamycin on strains of Campylobacter fetus subsp jejuni and C intestinalis, C jejuni was more readily killed by rosaramicin and clindamycin than was C intestinalis. Erythromycin exhibited an equally lethal effect against both subspecies. However, it was the least active of the macrolides tested against both C jejuni and C intestinalis.

Evaluation of a tangential-flow multiple-filter technique for detection of Giardia lamblia cysts in water.

A system of tangential-flow filtration was evaluated for use in the detection of Giardia cysts in drinking water. This method was more sensitive in recovering cysts than a frequently used wound-orlon system of through-filtration.

Comparison of an in vitro method and an in vivo method of Giardia excystation.

An in vitro method and an in vivo method of excystation were compared to determine the most useful method for the retrieval of Giardia duodenalis isolates. Cysts from 11 Giardia strains were used. In vitro excystation produced motile trophozoites in 16 sets, while in vivo excystation produced trophozoites in all of the 21 comparative sets of excystations. Few cultures were lost because of contamination by either method (17% of in vitro-derived trophozoites versus 23% of in vivo-derived trophozoites; P greater than 0.05). Both methods demonstrated comparable isolate retrieval rates (15% of in vitro-derived trophozoites adapting to culture compared with 29% of in vivo-derived trophozoites; P greater than 0.05), although analysis of the strains retrieved showed that two isolates were retrieved from in vitro excystation alone, compared with four from in vivo excystation. Analysis that included results of extra in vivo cultures showed that a total of nine isolates were retrieved by using this type of excystation. Despite the disadvantages of cost and labor, in vivo excystation appears to be more useful than in vitro excystation for isolate retrieval at the present time.

Characterization of Giardia duodenalis isolates from a waterborne outbreak.

Isolates were retrieved from drinking water and from animal and human sources associated with a waterborne outbreak of giardiasis. This is the first report of water-source and epidemic-associated Giardia isolates being adapted to in vitro propagation. Outbreak-associated, non-out-break-associated, and reference isolates were characterized using isoenzyme electrophoresis and pulsed-field gel electrophoresis (PFGE). All outbreak-associated and 2 other isolates were in one of eight zymodemes. The chromosomal complement of the outbreak-associated isolates was relatively homogeneous; this PFGE karyotype was distinguishable from other karyotypes. Overall results of both characterization methods were similar, although PFGE appears to be a more discriminating biotyping technique. Banding patterns of the outbreak-associated Giardia isolates remained the same even though the parasite passed through different hosts during the outbreak. Heterogeneity of isolates was also demonstrated for the first time within a single community not associated with the outbreak.

Comparison of in vitro antimicrobial susceptibilities of Mycobacterium avium-M. intracellulare strains from patients with acquired immunodeficiency syndrome (AIDS), patients without AIDS, and animal sources.

Difloxacin, A-56620, cefazolin, cefotaxime, ceftizoxime, cephapirin, SK&F 88070, and spectinomycin were used to compare the in vitro susceptibilities of Mycobacterium avium-M. intracellular isolates from patients with acquired immunodeficiency syndrome (AIDS), patients without AIDS, and diseased animals. Against the isolates from humans without AIDS, the quinolone compounds difloxacin and A-56620 were found to be the most effective, each inhibiting 50% of strains at a concentration of 2 micrograms/ml. The remaining antimicrobial agents had MICs for 50% of strains tested of at least 32 micrograms/ml. Statistically significant differences were observed in the antibiogram patterns among the M. avium-M. intracellulare strains from each of the three sources.