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Biomedical subjects

C H Pai

Publications and source records attributed to C H Pai.

At least 55 records · Page 3Linked to original sources

Experimental infection of infant rabbits with verotoxin-producing Escherichia coli.

To study the pathogenesis of diarrheal disease due to verotoxin (VT)-producing Escherichia coli, 3-day-old rabbits were inoculated intragastrically with live E. coli O157:H7 (high VT producer), E. coli O113:K75:H21 (low VT producer), or O157:H45 (VT negative) and were examined for clinical symptoms, bacterial colonization, presence of detectable free VT in the intestines, and histological changes. Diarrhea developed consistently with 10(8) bacteria of E. coli O157:H7 but was observed only infrequently with even a higher dose of E. coli O113:K75:H21. VT-negative strains failed to cause diarrhea under the same experimental conditions. E. coli O157:H7 was recovered from the colon of infected animals in a significantly higher concentration than from the small intestine, and the clinical symptoms correlated with the presence of detectable free VT in the colon. Histological changes were seen mainly in the mid- and distal colon; these changes were characterized by a vast increase in apoptosis in the surface epithelium, increased mitotic activity in the crypts, mucin depletion, and a mild to moderate infiltration of neutrophils in the lamina propria and epithelium. Multiple foci of attached bacteria were seen on the surface epithelium of the gut-associated lymphoid tissue, cecum, and colon. Bacteria were never seen in epithelial cells or the lamina propria. These mucosal abnormalities as well as clinical symptoms were reproduced in infant rabbits by the intragastric administration of VT alone. These results are consistent with the hypothesis that VT plays a major role in the pathogenesis of diarrhea caused by E. coli O157:H7 and other VT-producing E. coli.

Age Factors↗

Inhibition of human neutrophil chemiluminescence by plasmid-mediated outer membrane proteins of Yersinia enterocolitica.

Recent studies have shown that the cell surface properties of Yersinia enterocolitica are altered by the presence of the virulence plasmid, which mediates temperature-inducible outer membrane proteins (OMP). We investigated the interaction of Y. enterocolitica with human polymorphonuclear leukocytes by monitoring luminol-enhanced chemiluminescence (CL) responses. A plasmid-bearing strain grown at 37 degrees C induced four- to sixfold less CL than did the same strain grown at 25 degrees C or a plasmidless, isogenic strain grown at either temperature. Inhibition of CL responses by whole cells was related to plasmid-mediated expression of OMP. The OMP alone could inhibit the CL response of polymorphonuclear leukocytes stimulated by either opsonized zymosan or whole cells of Y. enterocolitica. Pronase treatment of whole cells, which removed the plasmid-mediated OMP, resulted in partial but significant elimination of CL inhibition by whole cells and by OMP derived from them. Incubation with Y. enterocolitica for 60 min did not affect the viability of polymorphonuclear leukocytes. Our results suggest that the interaction of Y. enterocolitica with human polymorphonuclear leukocytes is directly affected by the plasmid-mediated OMP.

Bacterial Outer Membrane Proteins↗

Rapid diagnosis of rotavirus gastroenteritis by a commercial latex agglutination test.

The Rotalex test, a commercial latex agglutination test for rotavirus, was compared with direct electron microscopy (EM) and the Rotazyme test I, a commercial enzyme immunoassay, for detection of rotavirus in stools of children and neonates. For initial stool specimens from 265 children (less than 3 years old) with diarrhea, the Rotalex test had a sensitivity of 81.7% and specificity of 99.5% compared with EM results. Positive and negative predictive values were 98 and 94.9%, respectively. The Rotalex test was slightly more sensitive and specific than the Rotazyme test. When daily stool specimens from patients with rotavirus gastroenteritis were examined, the sensitivity of the Rotalex test varied depending on the time of stool collection relative to the onset of symptoms. Sensitivity was 100 (20/20), 96 (23/24), and 54% (7/13) during 1 to 4, 5 to 7, and 8 to 18 days, respectively, after the onset of symptoms. The sensitivity of the Rotazyme test varied similarly with days from onset. We also examined 214 EM-negative stool specimens from asymptomatic newborns. False positivity by the Rotalex test was only 3.3% (7/214) compared with 4.2% (9/215) for the Rotazyme test. The Rotalex test was as sensitive and specific as EM for detection of rotavirus during the acute stage of illness and much faster and cheaper than EM or the Rotazyme test. The test appears to be suitable for routine use in small hospitals, emergency wards, or even the physician's office for rapid diagnosis of rotavirus gastroenteritis.

Child, Preschool↗

Simple screening method for beta-lactamase-positive and -negative ampicillin-resistant Haemophilus influenzae isolates.

A simple, inexpensive method for screening for beta-lactamase-positive and beta-lactamase-negative ampicillin-resistant Haemophilus influenzae isolates was developed. Disks containing 10 micrograms of cloxacillin yielded no zone of inhibition when placed on chocolate agar plates inoculated with beta-lactamase-positive (16 strains) or ampicillin-resistant (greater than or equal to 1 microgram/ml) beta-lactamase-negative (10 strains) H. influenzae, whereas ampicillin-susceptible (less than or equal to 0.5 microgram/ml; 36 strains) H. influenzae almost always (92%) showed a zone of inhibition.

Ampicillin↗

Latex agglutination test for detection of Clostridium difficile toxin in stool samples.

A total of 163 stool specimens were tested for detection of Clostridium difficile and its toxin by cytotoxicity assay with tissue culture, latex agglutination test, and isolation of the organism. From 33 specimens which were positive for toxin by cytotoxicity, 30 were positive by the latex agglutination test; the organism was isolated from 21. The total number of samples which were positive with the latex agglutination test was 44. The predictive value of a positive latex agglutination result relative to the cytotoxicity test was 68%, and the predictive value of a negative result was 97.5%. The specificity and sensitivity of the latex agglutination test relative to the cytotoxicity assay and the low cost and simple facilities required indicate that the latex agglutination test is a useful procedure for screening for C. difficile toxins, provided that positive latex results are confirmed by cytotoxicity assay.

Antitoxins↗

Sporadic cases of hemorrhagic colitis associated with Escherichia coli O157:H7. Clinical, epidemiologic, and bacteriologic features.

During a 6-month period in 1983, Escherichia coli O157:H7 was isolated from 19 (15%) of 125 patients with grossly bloody diarrhea and 1 sibling with non-bloody diarrhea in the Calgary area. There was no clustering of the cases geographically or in time. All but 1 had clinical manifestations typical of hemorrhagic colitis associated with E. coli O157:H7. The illness appeared to be associated with consumption of hamburgers by 15 patients. The diarrheal illness was usually self-limited, but 3 children developed the hemolytic-uremic syndrome shortly after onset of illness. The organism was excreted in the stools very briefly in adults, although bacterial shedding continued for a longer period in children. All isolates produced verotoxin, and cytotoxic activities were present in stool filtrates. The results suggest that the incidence of sporadic cases of hemorrhagic colitis due to E. coli O157:H7 may be higher than has been suspected, and that patients with grossly bloody diarrhea should be studied promptly for E. coli O157:H7 infection. Specific techniques for identifying this serotype must be applied to the stool cultures. Detection of free cytotoxin in stool filtrates may be an effective diagnostic procedure.

Adolescent↗

Erythromycin in treatment of Campylobacter enteritis in children.

Erythromycin ethylsuccinate therapy was compared with no treatment in a randomized, prospective trial of treatment of Campylobacter enteritis in infants and children. Patients received either erythromycin ethylsuccinate (N = 15), 40 mg/kg/day every six hours, for seven days or no treatment (N = 12). The mean age (5.5 v 3.7 years), sex ratio, and mean duration of illness before admission to study (5.5 v 6.4 days) of the two groups were similar. No difference was noted in the mean days to resolution of diarrhea (3.2 v 3.8 days). However, the mean duration of bacterial shedding was shorter in the treatment group (2.0 days) compared with the group without treatment (16.8 days). Bacteriologic relapse occurred in one patient in the treatment group, and three relapses occurred in the group without treatment. Two secondary cases occurred among household contacts, one in each group.

Campylobacter Infections↗

Serum resistance associated with virulence in Yersinia enterocolitica.

Yersinia enterocolitica strains that exhibited a calcium requirement for growth and autoagglutination at 37 degrees C were invariably virulent in rabbits, causing diarrhea and a high degree of lethality, and were capable of colonizing the intestinal lumen and establishing foci of infection on the Peyer's patches of mice. Strains that had lost the properties of calcium dependency and autoagglutinability were totally avirulent in rabbits and were quickly eliminated from the intestinal lumen and tissues of mice. Virulent and avirulent strains were shown to be equally invasive to HeLa cells. However, the virulent strains were resistant to the bactericidal action of normal serum, and this serum resistance was lost with the loss of virulence. Furthermore, the serum resistance of virulent strains was expressed, as were other properties, when strains were grown at 37 degrees C, but not at 27 degrees C. These results suggest that a virulence factor associated with serum resistance plays an essential role in the pathogenicity of Y. enterocolitica.

Agglutination↗

Enhancement of recovery of Neisseria meningitidis by gelatin in blood culture media.

The efficacy of gelatin for the recovery of Neisseria meningitidis from blood cultures was evaluated in a clinical setting. The organism was isolated from seven patients with meningococcal infections in blood culture media containing 1% gelatin. In contrast, only two blood cultures from these patients were positive in media without gelatin (P less than 0.05). Gelatin did not influence the recovery of other organisms isolated during this study. Conventional blood culture media may be supplemented with gelatin when meningococcemia is suspected.

Blood↗

Yersinia enterocolitica gastroenteritis: a prospective study of clinical, bacteriologic, and epidemiologic features.

A prospective study was performed to estimate the frequency of gastroenteritis due to Yersinia enterocolitica in Montreal children and their families. Evidence of bacterial infection was correlated with clinical features and serologic responses. YE was isolated from the stools of 181 (index cases) of 6,364 children with gastroenteritis over a 15-month period; Salmonella was isolated from 280 and Shigella from 68. Median ages were 24, 30, and 41 months, respectively. All but 18 YE isolates were biotype 4, serotype 0:3. YE was not found in the stools of 545 children without gastrointestinal symptoms. Clinical manifestations of the index cases with YE biotype 4, serotype 0:3 (n = 57) included diarrhea (98%), fever (88%), abdominal pain (64.5%), and vomiting (38.5%) with mean durations of 14, 3.9, 7.7, and 2.4 days, respectively. The duration of excretion of YE in the stool ranged from 14 to 97 days (mean 42). Spread of YE occurred in 27 of 57 families studied, involving 15 of 41 children and 19 of 117 adult contacts; approximately one-third of infected contacts developed diarrhea. Agglutination titers of greater than or equal to 200 were demonstrated in all index cases infected with serotype 0:3, with the exception of two very young infants. YE is a frequent cause of bacterial gastroenteritis in Montreal children. The illness is characterized by persistent diarrhea and abdominal pain, prolonged YE excretion in the stools, and moderate communicability.

Adolescent↗

Model of neonatal meningitis caused by Escherichia coli K1 in guinea pigs.

A total of 88 neonatal guinea pigs was inoculated intranasally with a clinical isolate of Escherichia coli K1 that had been passaged once in the peritoneum of an adult guinea pig; 74 animals became bacteremic, of which 54 had meningitis, 12 hr after inoculation. Bacteremia and/or meningitis occurred consistently in repeated experiments. It was possible to obtain serial specimens of cerebrospinal fluid by cisternal puncture without killing the animals. The induction of meningitis in a predictable fashion without disrupting the blood-brain barrier and the ability to study the cerebrospinal fluid without killing the animal make this a useful model of human neonatal meningitis caused by E. coli K1.

Aminoglycosides↗

Experimental Yersinia enterocolitica enteritis in rabbits.

Young rabbits weighing 500 to 800 g were inoculated orogastrically with clinical isolates of Yersinia enterocolitica (serotype O:3; enterotoxigenic; HeLa cell invasive) at a dose of 1.4 X 10(10) bacteria suspended in 10% sodium bicarbonate solution. Diarrhea developed in 41 (87%) of 47 rabbits, with a mean +/- standard deviation onset at 5.4 +/- 2.4 days. The attack rate and onset of diarrhea were correlated with inoculum size. The 50% infectious dose was 2.9 X 10(8) bacteria. Bacterial colonization occurred in almost all rabbits, regardless of inoculum size. Seroconversion was demonstrated in 30 (71%) of 42 rabbits with or without diarrhea. Histopathological alterations were present in the jejuna, ilea, and colons of rabbits with diarrhea; the most pronounced changes were generally noted in the ilea. Crypt abscesses localized at the depth of the intestinal glands were observed consistently and were composed of a bacterial nidus admixed with and enveloped by inflammatory cells comprised of eosinophils, neutrophils, and mononuclear cells. Rabbits inoculated with a raw fish isolate of Y. enterocolitica (serotype O:6,30; non-enterotoxigenic; HeLa cell noninvasive) did not exhibit infection clinically, bacteriologically, or pathologically.

Animals↗

Pathogenic properties of Yersinia enterocolitica.

A total of 88 isolates of Yersinia enterocolitica was examined for heat-stable enterotoxin production and ability to penetrate HeLa cells and evoke keratoconjunctivitis in guinea pigs (Séreny test) as potential pathogenic properties. All 49 isolates belonging to serotypes O:3, O:8, O:9, and O:5,27 and only 5 of 39 strains of other serotypes were HeLa positive. Séreny-positive strains were found only in serotype O:8. Heat-stable enterotoxin production was almost ubiquitous in all serotypes. Y. enterocolitica strains were classified into five groups with regard to their potential pathogenic properties.

Animals↗