Identification and functional analysis of the cytolethal distending toxin gene from Avibacterium paragallinarum.

Avibacterium paragallinarum is the causative agent of infectious coryza, an important respiratory disease of chickens. Cytolethal distending toxins (CDTs) are a family of protein cytotoxins that cause cell cycle arrest and apoptosis in eukaryotic cells. Whole-genome sequencing analysis showed that Av. paragallinarum contains cdtABC genes. Filter-sterilized lysates prepared from Av. paragallinarum or from recombinant Escherichia coli expressing cdtABC genes exhibited CDT activity on HeLa cells and chicken embryo fibroblast (DF-1) cells. In vitro DNase assays showed that purified recombinant CdtB has DNase activity. Polymerase chain reaction and sequencing analysis revealed that the cdtABC genes are present in all strains of Av. paragallinarum examined in this study. This is the first report of the identification and functional analysis of cdtABC genes from Av. paragallinarum. The gene products of cdtABC genes may be involved in the pathogenesis of the disease caused by Av. paragallinarum.

Identification of the lic1ABCD operon that controls the phase-variable expression of phosphorylcholine on lipopolysaccharide from Avibacterium paragallinarum.

Phosphorylcholine (ChoP) is an important virulence factor found on the surface of many mucosal pathogens and its expression enhances bacterial colonization on mucous membranes and reduces susceptibility to antimicrobial peptides. Whole-genome sequencing analyses showed that Avibacterium paragallinarum contained an operon with strong sequence similarity to the lic1ABCD operon from Haemophilus influenzae and the pcgDABC operon from Pasteurella multocida; both operons are involved in metabolism and addition of ChoP on bacterial lipopolysaccharide (LPS). Western immunoblot analysis with ChoP-specific monoclonal antibody showed that ChoP is present on LPS of Av. paragallinarum and the expression of ChoP is controlled by phase variation mediated by the number of 5'-CAAT-3' tetranucleotide tandem repeats within the coding region of the lic1A gene. The number of tetranucleotide repeats varied widely among strains, and variation in the number of repeats was observed following in vivo passage but not in vitro passage. Antimicrobial susceptibility assays showed that ChoP expression decreased susceptibility of Av. paragallinarum to chicken antimicrobial peptide fowlicidin-1. This is the first report showing that ChoP is present on LPS from Av. paragallinarum and that Av. paragallinarum contains a phase-variable gene. These results could be valuable for understanding the mechanism of pathogenicity of Av. paragallinarum.

Regions Important for Hemagglutination Activity and Serotypes of Avibacterium paragallinarum HMTp210 Protein.

Avibacterium paragallinarum is an important respiratory pathogen of domestic chickens. Avibacterium paragallinarum has been subtyped into three serogroups and nine serovars according to the Page and revised Kume schemes. The major hemagglutinin antigen of A. paragallinarum is HMTp210, which is a large protein of about 2000 amino acids (aa), including a 70-aa signal peptide at its N-terminal end. However, the regions important for the hemagglutination (HA) activity and serotypes of HMTp210 remain unclear. In this study we constructed a series of A. paragallinarum strains expressing HMTp210 in-frame deletion mutants and determined their HA titers to identify the regions important for the HA activity and serotypes of HMTp210. Two distinct types of HA activities were found in HMTp210. The type 1 HA activity resided in the region spanning the full-length HA (aa 71-2084), whereas the type 2 resided in the region spanning aa 1003-2084. The putative ligand binding of the type 1 HA activity was located at aa 176-360, which had a structure similar to YadA of Yersinia enterocolitica. The putative ligand binding site of the type 2 HA activity was located at aa 1003-1125, which had a structure similar to UspA1 from Moraxella catarrhalis. The type 1 HA activity appeared to be Page serogroup specific, whereas type 2 appeared to be Kume serovar specific. Finally, sequence analyses of the regions spanning aa 1-400 and aa 1100-1600 of HMTp210 could be useful for the molecular serotyping (the Page and revised Kume schemes) of A. paragallinarum isolates.

Regiones importantes para la actividad de hemaglutinación y serotipos de la proteína HMTp210 de Avibacterium paragallinarum. La bacteria Avibacterium paragallinarum es un patógeno respiratorio importante de los pollos domésticos. Avibacterium paragallinarum se subtipificó en tres serogrupos y nueve serovares de acuerdo con los esquemas revisados de Page y Kume. El principal antígeno de la hemaglutinina de A. paragallinarum es la proteína HMTp210, que es una proteína grande de unos 2000 aminoácidos (aa), que incluye un péptido señal de 70 aminoácidos en su extremo N-terminal. Sin embargo, las regiones importantes para la actividad de hemaglutinación (HA) y de los serotipos de la proteína HMTp210 siguen sin estar determinados. En este estudio, se construyó una serie de cepas de A. paragallinarum que expresaban mutantes de deleción en marco de lectura de HMTp210 y se determinaron sus títulos de hemaglutinación para identificar las regiones importantes para la actividad de hemaglutinación y de los serotipos de HMTp210. Se encontraron dos tipos distintos de actividades hemaglutinación en la proteína HMTp210. La actividad de hemaglutinación de tipo 1 residía en la región que abarcaba la longitud completa (aminoácidos 71­2084), mientras que la de tipo 2 residía en la región que abarcaba entre los aminoácidos 1003­2084. El sitio supuesto de unión al ligando de la actividad de hemaglutinación tipo 1 se ubicó entre los aminoácidos 176­360, que tenía una estructura similar a la proteína YadA de Yersinia enterocolitica. El supuesto sitio de unión del ligando de la actividad de hemaglutinación tipo 2 se ubicó entre los aminoácidos 1003­1125, que tenía una estructura similar a la proteína UspA1 de Moraxella catarrhalis. La actividad de hemaglutinación tipo 1 parecía ser específica del serogrupo Page, mientras que la hemaglutinación tipo 2 parecía ser específica del serovar Kume. Finalmente, los análisis de secuencias de las regiones que abarcan los aminácidos 1­400 y aminoácidos 1100­1600 de HMTp210 podrían ser útiles para la serotipificación molecular (por el esquema revisado de Page y Kume revisado) de aislamientos de A. paragallinarum.

Relationship Between the Serotypes and Hemagglutinin Gene Sequences of Avibacterium paragallinarum.

Avibacterium paragallinarum has been subtyped into three serogroups (A, B, and C) and nine serovars (A-1, A-2, A-3, A-4, B-1, C-1, C-2, C-3, and C-4) according to the Page and Kume schemes. Both schemes use the hemagglutination inhibition test for serotyping. However, the relationship between the hemagglutinin gene (HMTp210) sequences and serotypes of A. paragallinarum is still unclear. This problem is partly due to the lack of information on the complete HMTp210 sequence from the formal reference strain of Page serogroup B (strain 0222 or Spross). In this study, we determined the complete HMTp210 sequence of strain Spross. The sequence of Spross and those of other HMTp210 sequences retrieved from GenBank were used to conduct phylogenetic analyses to investigate the relationship between the serotypes and HMTp210 sequences of A. paragallinarum. Four phylogenetic clusters, designated clusters A-1, A-2, B, and C, were identified. Clustering based on complete HMTp210 sequences correlates with serotyping based on hemagglutination inhibition tests. Serovar A-2 was found to contain a chimeric HMTp210 gene that might have resulted from recombination between serovar A-1 and serovar C-1. In addition, phylogenetic analysis based on partial sequences (approximately nucleotides 1-1200) of HMTp210 was sufficient to discriminate between serogroups A, B, and C. These findings could be valuable for developing a molecular method for serotyping of A. paragallinarum.

Relación entre los serotipos y las secuencias génicas de hemaglutinina de Avibacterium paragallinarum. Avibacterium paragallinarum se ha subtipificado en tres serogrupos (A, B y C) y nueve serovares (A-1, A-2, A-3, A-4, B-1, C-1, C-2, C- 3 y C-4) de acuerdo con los esquemas Page y Kume. Ambos esquemas utilizan la prueba de inhibición de la hemaglutinación para la serotipificación. Sin embargo, la relación entre las secuencias del gene de la hemaglutinina (HMTp210) y los serotipos de A. paragallinarum aún no está clara. Este problema se debe en parte a la falta de información sobre la secuencia completa del gene HMTp210 de la cepa de referencia formal del serogrupo B de Page (cepa 0222 o Spross). En este estudio, se determinó la secuencia completa de HMTp210 de la cepa Spross. La secuencia de Spross y las de otras secuencias del gene HMTp210 obtenidas de GenBank se utilizaron para realizar análisis filogenéticos para investigar la relación entre los serotipos y las secuencias de HMTp210 de A. paragallinarum. Se identificaron cuatro agrupaciones filogenéticas, denominadas grupos A-1, A-2, B y C. La agrupación basada en las secuencias completas del gene HMTp210 se correlaciona con la serotipificación basada en pruebas de inhibición de la hemaglutinación. Se encontró que el serovar A-2 contenía un gene HMTp210 quimérico que podría haber resultado de la recombinación entre el serovar A-1 y el serovar C-1. Además, el análisis filogenético basado en secuencias parciales (aproximadamente nucleótidos 1-1200) del gene HMTp210 fue suficiente para discriminar entre los serogrupos A, B y C. Estos hallazgos podrían ser valiosos para desarrollar un método molecular para la serotipificación de A. paragallinarum.

Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay, bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019.

INTRODUCTION: In 2015/2016, Canada's largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization. METHODS: Engage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator. RESULTS: Across the three cities, 26-35% and 14-21% of men ≤ 26 years and 7-26% and 2-9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06-4.36; ≥27: PR = 2.73, 95%CI 1.14-6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64-5.05; ≥27: PR = 2.03, 95%CI 1.07-3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance. CONCLUSIONS: Sixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.

Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada's three largest cities.

BACKGROUND: Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. METHODS: Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. RESULTS: Across the cities, 26-40%, 7-14%, 33-39%, and 13-28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06-7.62; Stage 2: aOR = 3.09, 95%CI = 1.19-8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07-2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05-1.48; Stage 2: aOR = 1.24, 95%CI = 1.05-1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13-0.71; Stage 2: aOR = 0.27, 95%CI = 0.12-0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15-0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09-0.30; Stage 2: aOR = 0.18, 95%CI = 0.09-0.35; Stage 3: aOR = 0.38, 95%CI = 0.21-0.61). DISCUSSION: Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.

Serotypes and Hemagglutinin Gene Sequences of Avibacterium paragallinarum Isolated in Taiwan.

Despite routine vaccine use, sporadic outbreaks of infectious coryza in poultry continue to occur in Taiwan. This study was designed to determine the serotypes and the complete nucleotide sequences of a hemagglutinin gene (HMTp210) of Avibacterium paragallinarum isolated in Taiwan between 1994 and 2017. Hemagglutination inhibition tests showed that these isolates belong to serogroups B and C. Sequence analyses of the HMTp210 gene showed that Taiwanese serogroup B isolates are most similar (94.7%-98.2% identity) to strain FARPER-174 isolated in Peru in 2015. In contrast, Taiwanese serogroup C isolates are most similar (96.3%-99.8% identity) to strain H-18 isolated in Japan in 1976. This is the first report showing the presence of A. paragallinarum of serogroup B in Taiwan. In addition, one Taiwanese isolate showed cross-reactivity with serogroup B and C antisera. This isolate contains a chimeric HMTp210 gene that might result from recombination between serogroups B and C. These findings could be valuable for the epidemiologic study and molecular serotyping of A. paragallinarum.

Serotipos y secuencias de genes de hemaglutinina de Avibacterium paragallinarum aislados en Taiwán. A pesar del uso rutinario de vacunas, en Taiwán continúan ocurriendo brotes esporádicos de coriza infecciosa en avicultura. Este estudio fue diseñado para determinar los serotipos y las secuencias de nucleótidos completas de un gene de hemaglutinina (HMTp210) de Avibacterium paragallinarum aislado en Taiwán entre 1994 y 2017. Las pruebas de inhibición de la hemaglutinación mostraron que estos aislamientos pertenecen a los serogrupos B y C. El análisis de secuencias del gene HMTp210 mostró que los aislamientos del serogrupo B taiwaneses son más similares (94.7% ­98.2% de identidad) a la cepa FARPER-174 aislada en Perú en el año 2015. En contraste, los aislamientos del serogrupo C taiwaneses son más similares (96.3% ­99.8% de identidad) a la cepa H -18 aislada en Japón en 1976. Este es el primer reporte que muestra la presencia de A. paragallinarum del serogrupo B en Taiwán. Además, un aislado taiwanés mostró reactividad cruzada con los antisueros del serogrupo B y C. Este aislado contiene un gene HMTp210 quimérico que podría resultar de la recombinación entre los serogrupos B y C. Estos hallazgos podrían ser valiosos para el estudio epidemiológico y la serotipificación molecular de A. paragallinarum.

[Study on treatment of chronic tinnitus by tetanus stimulation and evaluation methods of tinnitus].

Objective:The purpose of this study was to explore the efficacy of tetanus stimulation in tinnitus treatment and the correlation between the mainstream questionnaires of tinnitus and tinnitus-matching in order to find a more convenient and accurate method for tinnitus evaluation. Method:Ten patients with chronic tinnitus and normal or mild hearing impairment were enrolled in this study, totaling 13 ears. Their age ranged from 23 to 53 years old. The stimulus sound（white noise, frequency modulation 14.1 Hz, repetitive amplitude modulation, duty cycle 0.5） was selected and the sound intensity was 50 dB SL. Experimental procedure: （4 minutes sound stimulation+4 minutes rest） ×4 times, totaling 32 minutes. The patients were treated three times a week for 5 weeks. The loudness of tinnitus was matched before and after each treatment, and tinnitus handicap inventory（THI）, tinnitus handicap questionnaire（THQ） and visual analog scales（VAS） were also used for assessment before the first treatment each week. The loudness matching and the above scales were performed once more at follow-up for one week after end-of-treatment. Result:①Single treatment: the matched loudness value decreased by 1.000（0.000, 3.000） dB（Z=7.553, P<0.01） after each single treatment. ②After five weeks' treatment: the matched loudness value decreased（9.692±8.038） dB（t=4.348, P<0.01）; VAS value decreased by 2.000（1.000, 3.000）（Z=2.890, P<0.01）; total score of THQ decreased（7.389%±8.847%）（t=2.641, P<0.05）. ③Correlation analysis: there was positive correlation between total scores of THI and THQ（r=0.747, P<0.01）; the matched loudness values have positive correlation with VAS value（r=0.593, P<0.01）, THI-F（r=0.346, P<0.01） and THQ-factor 3 score（r=0.294, P<0.05）; there was positive correlation between the VAS value and THI-F（r=0.326, P<0.05）, the total score of THI（r=0.466, P<0.01）, THQ-factor 3 score（r=0.291, P<0.05）, the total score of THQ（r=0.497, P<0.01）. Conclusion:The loudness of tinnitus declined with significant fluctuation during tetanus sound therapy. THQ scale is recommended as a sensitive indicator for evaluating the efficacy of tinnitus treatment; VAS is recommended for rapid assessment of tinnitus. Tetanus stimulation is expected to become an important direction in tinnitus sound therapy.

The Fimbrial Protein is a Virulence Factor and Potential Vaccine Antigen of Avibacterium paragallinarum.

Fimbriae are recognized as virulence factors and potential vaccine antigens of several pathogenic bacteria, but the function of the fimbriae from Avibacterium paragallinarum is not well known. In this study, a gene encoding the fimbrial protein FlfA was identified in A. paragallinarum . Sequencing analysis of the putative promoter region of flfA suggests that flfA expression in A. paragallinarum might be controlled by phase variation. The flfA gene from A. paragallinarum was expressed as a recombinant protein (r-FlfA) in Escherichia coli . Immunization with r-FlfA conferred chickens protection against challenge infection with A. paragallinarum . Virulence assays showed that the flfA-deficient mutants of A. paragallinarum were less virulent than their parental wild-type strains. These results indicated that the fimbrial protein FlfA is a virulence factor and potential vaccine antigen from A. paragallinarum .

Non-occupational post-exposure prophylaxis for HIV at St Michael's Hospital, Toronto: a retrospective review of patient eligibility and clinical outcomes.

Stringent eligibility criteria, drug costs and antiretroviral toxicities are challenges in delivering HIV non-occupational post-exposure prophylaxis (nPEP). We reviewed patients' nPEP eligibility and clinical outcomes at St Michael's Hospital, Toronto, Canada to identify opportunities for improvement. Of 241 patients, 59%, 36% and 6% presented for high- (receptive anal/vaginal, blood), medium- (insertive anal/vaginal) and low-risk (oral) sexual exposures, respectively, and nearly all (93%) presented within 72 hours. Of 205 patients given nPEP, 20 were known to have discontinued nPEP prematurely: three due to costs but none due to toxicities. Two HIV seroconversions occurred in patients with suspected ongoing potential exposures. Five asymptomatic syphilis diagnoses were made among 71 tested. Only 39% and 19% of nPEP patients returned to our institution for follow-up at 3-4 and six months, respectively. Our findings underscore the feasibility and importance of nPEP programmes to HIV and sexually transmitted infection control, while identifying opportunities for improvement.

Awareness of, usage of and willingness to use HIV pre-exposure prophylaxis among men in downtown Toronto, Canada.

Pre-exposure prophylaxis (PrEP) is a promising strategy whereby HIV-uninfected people could take antiretroviral (ARV) medications to reduce their risk of HIV acquisition. Reports suggest that unsupervised PrEP use has been occurring in gay communities of USA cities before human safety and efficacy data became available. We administered a 20-item questionnaire to men undergoing HIV testing at Hassle Free Clinic, a sexual health clinic in the gay village of Toronto. Questionnaire items enquired about demographics, sexual partners, substance use and awareness of, usage of and willingness to use PrEP. Logistic regression was used to identify characteristics associated with PrEP-related outcomes. Of 256 participants, 11.7% were aware of PrEP, with more men who have sex with men (MSM) aware (14.1%) than non-MSM (4.9%). No participants reported PrEP usage. Willingness to consider PrEP use was high and associated with high-risk activities, suggesting opportunities for PrEP use in the future.

Respiratory syncytial virus vaccine: a systematic overview with emphasis on respiratory syncytial virus subunit vaccines.

OBJECTIVE: To explore whether RSV vaccines are efficacious in preventing respiratory syncytial virus (RSV) lower respiratory infection (LRI). METHODS: Randomized clinical trials were sought through Medline using the following search terms: "RSV" or "RSV infection" and "viral vaccine". Randomized controlled trials in adults or children that provided data on clinical outcomes (RSV LRIs, all LRI, all RSV infections) were included. Control groups could receive placebo or another vaccine. Qualitative assessment and summary data were obtained independently by three authors and summarized on a pre-printed form. Where disagreements occurred, the studies were reviewed by all investigators. These disagreements were mainly clerical, such as misinterpretations of the table or text or transcription errors. Consensus was obtained for all studies. Summary statistics consists of relative risk (RR) and number needed to vaccinate to prevent the above outcomes. RESULTS: Because of the outcomes examined, only studies of a purified F protein subunit (PFP) vaccine were included in the meta-analysis. These clinical trials were phase I studies to determine vaccine safety rather than efficacy. Efficacy of PFP-1 or PFP-2 vaccine were analyzed together. A statistically significant RR in overall number of RSV infections was observed RR 0.55 (95%CI, 0.35, 0.88), but the test of heterogeneity was significant raising doubts about the validity of this conclusion. The effect of vaccination on RSV LRI did not reach statistical significance. CONCLUSIONS: RSV subunit vaccines were found to reduce the overall incidence of all RSV infections. However, RSV subunit vaccines must be tested in large field trials because of concerns about the appropriateness of pooling, the risk of publication bias and the fact that the clinically important outcome of RSV LRI was not reduced.

Antibiotic prescribing by pediatricians for respiratory tract infection in children.

To examine antimicrobial prescribing rates for viral respiratory tract infections by primary care pediatricians in the greater Toronto area, charts were reviewed for the week of 17-21 February 1997 at 61 pediatricians' offices. Antibiotics were considered appropriate if the diagnosis was compatible with bacterial infection. A total of 3,585 patient visits were reviewed. The common cold was the most common respiratory tract syndrome leading to an office visit (1,317 visits). The overall rate of appropriate antibiotic prescribing was 89.5%. There was no significant difference in prescribing when physicians were compared by year of graduation from medical school, sex, or location of training. Diagnostic codes (ICD-9 [International Classification of Diseases, 9th edition] codes) did not match the chart diagnosis in 41% of cases. Toronto primary care pediatricians appear to have a lower rate of inappropriate antibiotic prescribing than do primary care physicians in other regions of Canada and the United States.