Clinical manifestations of Campylobacter jejuni infection in adolescents and adults, and change in antibiotic resistance of the pathogen over the past 16 years.

BACKGROUND: Campylobacter jejuni infection, traditionally a paediatric illness, is now seen more frequently in adolescents and adults in northern China. Published surveillance reports on C. jejuni infection in these patients are rare. We aimed to characterize (1) the clinical manifestations of this infection in adolescents and adults, and (2) changes in antibiotic resistance of the pathogen. METHODS: We retrospectively examined 492 cases of C. jejuni infection in patients aged ≥ 14 y treated at the Peking University First Hospital, Beijing, China, for the period January 1994 to December 2010. RESULTS: The disease was more common in patients aged 14-24 y and in men (57.9%; p < 0.0001 vs women). The peak incidence was seen between May and October. The infection manifested with acute diarrhoea (< 10 bowel movements per day, loose or mucous stool), fever (mostly low grade), and abdominal cramps and pain. Faecal leukocytes and erythrocytes were demonstrated in, respectively, 90.9% and 79.3% of stool specimens, while leukocytes > 10 per high-power field were detected in 70.3%. In 1994-1998, 44.5% of C. jejuni strains were resistant to fluoroquinolone, 0% to gentamicin, and 0% to cefuroxime; in 2005-2010, resistance increased significantly to 97.9%, 16.7%, and 93.0%, respectively (p < 0.0001). The resistance to erythromycin did not change significantly (3% vs 6.4%, p = 0.4). CONCLUSIONS: Manifestations of C. jejuni infection in adolescent and adult patients are similar to those in children. Over the 16-y study period, resistance of C. jejuni to fluoroquinolones, gentamicin, and cefuroxime significantly increased.

[Construction of HLA-A2-peptide tetramer and application in HBV/HCV infection].

OBJECTIVE: To construct HBV and HCV-specific HLA-A2-peptide tetramers, and to direct clinical therapy. METHODS: Recombinant class I HLA-A2 heavy chains and beta-2 M were produced in Escherichia coli cells transformed with pBV220 vectors. Only the extracellular domain of class I heavy chain was expressed, following modification by replacement of the C-terminal domain with a substrate sequence for BirA biotinylation. HLA-A2-BSP was folded in the presence of beta-2 microglobulin and a specific peptide to form a peptide-MHC complex. The MHC complexes were biotinylated using purified BirA enzyme. Biotinylated MHC-peptide complexes were purified. Tetramers were generated by mixing biotinylated protein complex with streptavidin-PE at a molar ratio of 4:1. Then analysis of stained PBMCs was performed using FACScan and CellQuest software. RESULTS: The expression levels of pBV220-HLA-A2-BSP and beta-2M were 46% and 48% of total bacterial proteins estimated from SDS - PAGE, respectively. And they were mainly located in the insoluble fraction of the cell as inclusion bodies and the proportion were about 85% and 90%, respectively. The purity of pBV220-HLA-A2-BSP and beta-2M was above 95% analyzed by SDS-PAGE, and the concentration of pBV220-HLA-A2-BSP and beta-2M was about 1.5 g/L and 1.2 g/L, respectively. Using the constructed HLA-A2-peptide tetramer to detect the HBV/HCV-specific CTL, the HBV-specific CD8(+) frequencies were 1.84% and 0.02% - 0.68% of the total CD8(+) T cells in acute and chronic HBV hepatitis, respectively. As an additional control, an HLA-A2/HCV tetramer was tested in the acute and chronic HBV hepatitis. The frequencies never exceeded 0.02% of the total CD8(+) T cell number. Similar low levels of background staining were also detected in the HLA-A2(+) or A2(-) healthy control. The HCV-specific CD8(+) frequency was 0.02 - 0.72% of the total CD8(+) T cells in chronic HCV hepatitis. The same frequencies of control were detected. CONCLUSION: High-efficient expressions of HLA-A0201-BSP and beta-2m proteins lay a good foundation for further expression and purification in prokaryotic system and constructing MHC class I-peptide tetramer complexes to study the function of CTLs. Especially, using these two HBV and HCV-specific tetramer can detect the frequencies of the HBV/HCV-specific CD8(+) T cells directly in vitro.

[Effects of needle retaining at Zusanli (ST 36) on hemodynamic change of anterior tibial artery].

OBJECTIVE: To observe the effects of needle retaining on hemodynamic change and investigate the significance of retaining needle. METHODS: Manual acupuncture was performed at the left Zusanli (ST 36) of 26 healthy adult volunteers who have not receiued acupuncture. 26 cases were randomly divided into a needle retaining group and a quick needling group, 13 cases in each group. Hemodynamic parameters of the anterior tibial artery were observed with color Doppler ultrasound before needling and 0, 1, 2, 3, 4 and 5 minutes after needle manipulation. Hemodynamic parameters were also compared between the two groups 0, 1, 2, 3, 4 and 5 minutes after needle manipulation. RESULTS: There were no significant difference in V(max) and Vm between 0, 1, 2, 3, 4 and 5 minutes after needling manipulation (all P > 0.05). CONCLUSION: Needle retaining can not change regional hemodynamic.

Campylobacter enteritis in adult patients with acute diarrhea from 2005 to 2009 in Beijing, China.

BACKGROUND: There has been a marked global increase in the incidence of human Campylobacter enteritis in recent years. This study investigated the epidemiological and clinical features of Campylobacter enteritis in adult patients suffering from acute diarrhea. METHODS: This was a retrospective review of Campylobacter enteritis in adult patients with acute diarrhea presenting at Beijing University First Hospital, Beijing, China, in the summer and autumn (April to October) of 2005 to 2009. The data collected included the species of campylobacter identified, and the age, gender, clinical manifestations and results of laboratory test on stool samples collected from the patients. Campylobacter sensitivity tests to various antimicrobial agents were conducted on 80 specimens. Chi-square tests were applied using SPSS13.0 software and a two-sided P value of < 0.05 was considered statistically significant. RESULTS: Campylobacter spp. isolated from the stool specimens of 142 patients with diarrhea represented 14.9% of all the cases examined. C. jejuni was identified in 127 patients (89.4%) and C. coli in 15 others (10.6%). The infection incidence was highest in the age range of 21 - 30 years which comprised 21.7% of the total cases examined. Most cases of diarrhea (46 patients) occurred in June. Watery diarrhea (97.2%), abdominal pain (72.5%) and fever (64.8%) were the most common manifestations of enteric campylobacteriosis. Only four patients (2.8%) had bloody diarrhea. The antimicrobial resistance rates were: cefoperazone (100%), levofloxacin (61.3%), gentamicin (12.5%), erythromycin (6.3%), and azithromycin (2.5%). CONCLUSIONS: Campylobacter was prevalent among adults with acute diarrhea from 2005 to 2009 in Beijing, China. The large number of those afflicted by the disease warrants the commission of a large multicenter study to determine the extent of enteric campylobacteriosis in this region.