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Blood cultures: principles and techniques.

Detecting the presence of microorganisms in blood is an important function of the clinical microbiology laboratory. With prompt isolation, identification, and antimicrobial susceptibility testing of bacterial isolates, the clinician can modify the selection and dosage of the antimicrobics used initially to treat a suspected septicemia. Principles and techniques for blood collection, culture, examination, and reporting are reviewed.

Anti-Bacterial Agents↗

[Seroepidemiologic investigations in the Alpine ibex (Capra i. ibex) of Piz Albris in the canton of Grigioni (Switzerland)].

Sero-epidemiological investigations in wild animals may allow to assess distribution of selected pathogens that sometimes seem to be involved in sanitary interrelationships between wild and domestic ungulates sharing the same areas. Serological studies were carried out to investigate the prevalence of antibody against 8 pathogens in Alpine ibex of Albris colony (Grisons, Switzerland). Investigated sera came from 89 animals shot by gamekeepers in 1990-1991. Antibody against smooth Brucella, Coxiella burnetti, Leptospira interrogans, Borrelia Burgdorferi, Mycobacterium paratuberculosis, BHV-1 and ovine-caprine lentiviruses were not detected in the tested sera. However, 31% of sera analysed were found to be positive for Chlamydia psittaci. Three sera showed high antibody titres ( > or = 1/128) suggestive of active infection in the animals. Any influence of Chlamydia psittaci in reproductive performance of free-ranging alpine ibex should be investigated through isolation of the agent. Results are discussed with reference to methods used and with epidemiological picture in Switzerland and were compared with results of serological investigations carried out in ibex in Italy and France.

Animals↗

Surfaceome of Leptospira spp.

The identification of the subset of outer membrane proteins exposed on the surface of a bacterial cell (the surfaceome) is critical to understanding the interactions of bacteria with their environments and greatly narrows the search for protective antigens of extracellular pathogens. The surfaceome of Leptospira was investigated by biotin labeling of viable leptospires, affinity capture of the biotinylated proteins, two-dimensional gel electrophoresis, and mass spectrometry (MS). The leptospiral surfaceome was found to be predominantly made up of a small number of already characterized proteins, being in order of relative abundance on the cell surface: LipL32 > LipL21 > LipL41. Of these proteins, only LipL32 had not been previously identified as surface exposed. LipL32 surface exposure was subsequently verified by three independent approaches: surface immunofluorescence, whole-cell enzyme-linked immunosorbent assay (ELISA), and immunoelectron microscopy. Three other proteins, Q8F8Q0 (a putative transmembrane outer membrane protein) and two proteins of 20 kDa and 55 kDa that could not be identified by MS, one of which demonstrated a high degree of labeling potentially representing an additional, as-yet-uncharacterized, surface-exposed protein. Minor labeling of p31(LipL45), GroEL, and FlaB1 was also observed. Expression of the surfaceome constituents remained unchanged under a range of conditions investigated, including temperature and the presence of serum or urine. Immunization of mice with affinity-captured surface components stimulated the production of antibodies that bound surface proteins from heterologous leptospiral strains. The surfaceomics approach is particularly amenable to protein expression profiling using small amounts of sample (<10(7) cells) offering the potential to analyze bacterial surface expression during infection.

Animals↗

Monoclonal antibodies suitable for incorporation into a competitive enzyme-linked immunosorbent assay (ELISA) for detection of specific antibodies to Leptospira interrogans serovar pomona.

Monoclonal antibodies (mAb) were produced by fusing Sp2/0-Ag14 myeloma cells with spleen cells from BALB/c and ND4 mice that were immunized with killed Leptospira interrogans serovar pomona whole cells. Thirty hybridomas which produced antibodies (of the IgG1, IgG2a, IgG2b, or IgG3 isotype) that bound to epitopes on the serovar pomona whole cell antigen were identified by an indirect enzyme-linked immunosorbent assay (ELISA). Twenty-eight of these 30 mAbs cross-reacted in the indirect ELISA with at least one whole cell antigen prepared from 12 other pathogenic Leptospira serovars, and/or with whole cell antigen from the non-pathogenic Leptospira biflexa serovar patoc. The two serovar pomona-specific mAbs, which were designated M897 and M898, were obtained from the ND4 mouse and were both of the IgG1 isotype. In competitive ELISAs, M897 and M898 were inhibited from binding to the pomona antigen by bovine sera with anti-serovar pomona microscopic agglutination test (MAT) titres ranging from 100 to 6400. No significant inhibition was observed with pomona MAT-negative sera or with sera from animals experimentally infected with serovars canicola, copenhageni, grippotyphosa, hardjo type hardjobovis or sejroe. The epitopes recognized by M897 and M898 were both highly susceptible to sodium meta-periodate oxidation, indicating a carbohydrate composition. Neither of these mAbs reacted in immunoblots with the separated components of the serovar pomona whole cell antigen.

Animals↗

Retention of leptospiral agglutinins and long-term response to administration of monoclonal antibodies in vervet monkeys (Cercopithecus aethiops) on Barbados.

In a study of 21 wild-caught Barbadian vervet monkeys (Cercopithecus aethiops sabaeus), naturally-acquired leptospiral agglutinins were found to persist for over five years. Groups of seropositive as well as seronegative vervets were given a placebo, or full-strength monoclonal antibodies MCA F12C3 (Icterohaemorrhagiae copenhageni), or diluted F12C3 MCAs. They were challenged 24 hours later with a suspension of highly virulent leptospires (copenhageni) administered intraperitoneally. Immunoprotection was evident in animals receiving full strength MCAs as measured by their failure to develop any substantial antibody response and by their lower geometric mean titres over a period of 142 weeks (maximum GMT of 113 compared with a maximum of 1280 in the placebo group). Diluted MCAs had little or no protective value. The serological response of the monkeys which were seropositive at capture to challenge with virulent copenhageni antigen was strongly anamnestic both in those given MCAs and those given placebo. None of the naturally or experimentally infected vervets showed clinical signs of leptospiral illness.

Agglutinins↗

Detection of leptospires in tissue using an immunoperoxidase staining procedure.

An immunoperoxidase technique for the localisation of leptospires in sections of formalin fixed paraffin embedded kidney tissue is described. The procedure utilises a two-layered antibody sandwich with rabbit anti-leptospiral immunoglobin. Using antiserum to specific leptospiral serovars the presence and distribution of specific serovar in the tissue could be determined. The technique was also used to detect leptospires of given serovars in smears made from infected tissues and fluids. There was good correlation between culture results and results of the immunoperoxidase staining method on kidneys infected with leptospires. The diagnostic possibilities of the technique on formalin fixed tissue specimens are discussed.

Animals↗

Leptospirosis presenting as a haemorrhagic fever in a traveller from Africa.

Leptospirosis is usually a mild illness, although the severity of clinical manifestations may vary between the serovars of leptospires. In May 1993, a 48-year-old man from Ghana presented with severe icteric leptospirosis, initially managed as viral haemorrhagic fever. The causative serovar, bataviae, had not been previously diagnosed in human infection in Australia.

Diagnostic Errors↗

[Cluster and multiple regression analysis of leptospirosis epidemic factors].

Ten-year surveillance of Rice-field-typed leptospirosis was carried out in high-infected foci. Twenty two parameters of epidemic data were divided into 3 categories and cluster-analyzed. 5 typical variables were selected for multiple regression equation. The equation contained four factors, i.e. rodents density, carriage rates of main animal hosts, GMT of population antibody against leptospira and quantity of rainfall in August. The expected morbidity of leptospirosis calculated by the equation were roughly identical to the real morbidity.

Animals↗

Influence of the mechanism of transmission of the infective agent on the aetiological structure of leptospiral foci.

It has been demonstrated that the differences observed in the aetiological structure of the individual foci of leptospirosis can be explained not only by the affinity of leptospiral serogroups to certain animal species, but also by different mechanisms of transmission of the causative agent of leptospiral infection which can be transferred both by sexual and alimentary routes (in water). It has been demonstrated that mostly one serotype of leptospires predominates in natural foci of leptospirosis, but several in anthropurgic ones. In the author's opinion, leptospiral infection in natural foci is mainly spread by the sexual route through the background species of animals--carriers of leptospirosis, and by the alimentary route in the anthropurgic foci. It is presumed that leptospires of the serogroups Javanica, Australis, Icterohaemorrhagiae, transmitted by the shrew-mice, hedgehogs and rats by the sexual route, are by their origin "ancient" serogroups of leptospires while the serogroups of leptospires isolated from domestic animals, showing predominantly the alimentary route of transmission of infection in the focus, are representatives of the "younger" forms of the evolutional development of leptospires.

Animals↗

Acute renal failure due to leptospirosis: clinical features and outcome in six cases.

Six cases of severe leptospiral infection with renal failure are described. Five of the six patients had acute oliguric renal failure requiring dialysis. Renal function recovered over three weeks and by two months all patients had plasma creatinine levels less than 200 mumol/litre. The initial diagnosis of leptospirosis depended on clinical and epidemiological features because serological confirmation was not possible during the first week of the illness. All the patients had either high risk occupations or a history of exposure to external sources of infection. All had fever, myalgia, jaundice and muscle tenderness. Although bilirubin levels were high (greater than 350 mumol/litre in five) the elevations of aspartate transaminase and alkaline phosphatase levels, and prolongations of prothrombin times were relatively slight. Thrombocytopenia occurred in five of the six cases. Leptospira complement fixation tests were weakly positive or negative on admission in five cases but rose to significant levels subsequently. Penicillin treatment resulted in Jarisch-Herxheimer reactions in three cases. The important complications were: upper gastro-intestinal haemorrhage (five cases), thrombocytopenia less than 30 000 platelets/mm3 (four cases), atrial fibrillation (three cases), drowsiness with asterixis (four cases). All six patients were seriously ill and required intensive supportive therapy. All survived.

Acute Kidney Injury↗

Small terrestrial mammals as reservoirs of leptospires in the Sava Valley (Croatia).

Small mammals trapped in seven sites along the river Sava in Croatia were examined for leptospiral infection by renoculture and serological methods. Of the 1749 animals caught 702 were examined by renoculture method and 626 were tested by microagglutination-lysis. The dominant animals species caught were Microtus arvalis (672 animals) and Apodemus agrarius (552 animals). Of the 115 strains of leptospires isolated the dominant serotypes were L. grippotyphosa (40) and L. pomona (35). Five strains of L. sejroe, 9 strains of L. australis, 1 strain of L. bataviae and 25 undetermined strains were isolated, the infection rate ranging from 3 to 32%. Serologic evidence of infection was demonstrated in 91 animals, the prevalence ranging from 0 to 43% of animals depending on the trapping site. Specific agglutinins most frequently encountered were those against L. pomona (50) and L. grippotyphosa (26), though agglutinins against L. jalna (5), L. bataviae (4), L. bratislava (3) etc., were also found. A high degree if association between L. grippotyphosa and the common vole as well as between L. pomona and the field mouse was found indicating that as far as these two types of leptospires are concerned the Sava valley may be considered as their vast natural focus. It was also concluded that wild small mammals in this region of Croatia may be a source of leptospiral infection for the local population as well as for outdoor-reared domestic animals (swine, bovine).

Animals↗

Expression and comparative analysis of genes encoding outer membrane proteins LipL21, LipL32 and OmpL1 in epidemic leptospires.

Leptospiral outer membrane proteins (OMPs) are highly conserved in different species, and play an essential role in the development of new immunoprotection and serodiagnosis strategies. The genes encoding LipL21, LipL32 and OmpL1 were cloned from the complete genome sequence of Leptospira interrogans serovar lai strain Lai and expressed in vitro. Sequence comparison analysis revealed that the three genes were highly conserved among distinct epidemic leptospires, including three major epidemic species Leptospira interrogans, Leptospira borgpetersenii and Leptospira weilii, in China. Immunoblot analysis was further performed to scrutinize 15 epidemic Leptospira reference strains using the antisera of the recombinant OMPs. Both immunoblot assay and reverse transcription-polymerase chain reaction demonstrated that these three OMPs were conservatively expressed in pathogenic L. interrogans strains and other pathogenic leptospires. Additionally, the use of these recombinant OMPs as antigens in enzyme-linked immunosorbent assay (ELISA) for serodiagnosis of leptospirosis was evaluated. The recombinant LipL32 and OmpL1 proteins showed a high degree of ELISA reactivity with sera from patients infected with L. interrogans strain Lai and other pathogenic leptospires. These results may contribute to the identification of candidates for broad-range vaccines and immunodiagnostic antigens in further research.

Antigens, Bacterial↗

Molecular characterization of Leptospira spp. strains isolated from small rodents in Croatia.

We report the isolation and characterization of 16 Leptospira spp. strains isolated from small rodents captured in 11 different regions of inland Croatia. Large NotI and SgrAI restriction fragment allowed us to assign 10 isolates to the serovar istrica, 5 isolates to the serovar tsaratsovo and 1 isolate to the serovar lora. The phylogenetic analysis conducted from the sequences of the first 330 bp from the 16S rDNA gene revealed that the strains belonged to three different species, L. borgpetersenii, L. kirschneri and L. interrogans. Carrier rates in eight rodent species varied from 0 to 71.4%. Mus musculus showed the highest infection level and confirmed its role as a major reservoir of the serogroup Sejroë. For the first time we reported the occurrence of serovars tsaratsovo and lora in Croatia.

Animals↗

Risk factors for Neospora caninum-associated abortion storms in dairy herds in The Netherlands (1995 to 1997).

A 2 to 1 matched case control study design was used to analyze herd level risk factors for Neospora caninum-associated abortion storms in 47 dairy herds. Data were obtained using a questionnaire regarding the state of affairs at the farms over the 2 years prior to the abortion storm. The questionnaire included 120 variables considered to be potential risk factors for either introduction of infection or recrudescence of chronic infection. The relationship between risk factors and case control pairs was analyzed by conditional logistic regression using a three-steps procedure. In addition, cross sectional serology was used to assess the possible role of concomitant infections. The main factors that were significant in the analysis and that were considered to have potential biological relevance were the presence of dogs, the presence of poultry, and the feeding of moldy maize-silage during summer. For both the presence of dogs and the presence of poultry on the farms, a linear relationship was found between the number of animals and the assessed risk for an abortion storm. These findings suggest a possible role of these species in the transmission of N. caninum. Further evidence for such a role of dogs was the significant association between the presence of dogs and the presence of seropositive cattle in the control herds. The feeding of moldy fodder is considered to be a factor which may induce recrudescence of a latent N. caninum-infection by mycotoxins causing immune suppression. We also found some evidence for a possible influence of management practices around calving and a high prevalence of retained afterbirths. No significant association was found for herd level prevalence of antibodies to bovine viral diarrhea virus, bovine herpesvirus 1, Leptospira hardjo or Salmonella dublin.

Abortion, Veterinary↗

An outbreak of leptospirosis on a single farm in east Otago.

AIMS: To present an outbreak of leptospirosis on a dairy farm which had an unvaccinated herd. METHODS: Nine people working or living on the farm were tested for the presence of leptospira antibody by the microscopic agglutination test. Nineteen cows randomly selected, were also tested. RESULTS: Three human cases and one suspected case were detected over a one month period (December 1992-January 1993). Seventy-nine percent of the dairy herd tested had serological evidence of infection with L hardjo. CONCLUSIONS: Leptospirosis continues to be a major occupational problem in New Zealand. The importance of herd vaccination and the use of protective clothing during milking is emphasised.

Adolescent↗

Canine viral vaccines at a turning point--a personal perspective.

The most important canine viral infections are distemper and CPV-2. Problems of variable CD vaccine safety and efficacy persist, but CD vaccines have greatly reduced the prevalence of disease and cases in vaccinated dogs are now rare. Canine hepatitis (ICH, CAV-1 infection) also has been controlled well by vaccines for more than 35 years and it is now rare; the sporadic cases seen in the 1990s have usually occurred in unvaccinated dogs. CAV-2 vaccines should, therefore, continue to be given since they have proved to be safe and effective, and prevent hepatitis as well as adenoviral tracheobronchitis. Failure to vaccinate would likely result in increase in cases of ICH, a serious disease, but never as significant as distemper and CPV infection. "Are we vaccinating too often?" The question is complex, but the dominant opinion is "yes" (Smith, 1995). The question cannot be responded to unequivocally, however, since manufacturers employ different strains that vary in their immunizing capacity and, probably, duration of immunity. This question was frequent with distemper in the 1960s. At that time, many veterinarians tested batches of the vaccine they used by providing pre- and postvaccinal sera to competent diagnostic laboratories. That practice appeared to benefit veterinarians and dogs, as well as the quality of vaccines. Unfortunately, many owners and some veterinarians seem to hold the view that infectious diseases such as parvovirus infection can be controlled by frequent vaccination alone. The common practice of dog breeders of vaccinating their animals several times each year is senseless. Revaccination for distemper and parvovirus infection is suggested at 1 year of age, but recommendations regarding the frequency of most vaccinations given after that time are unclear. Since most distemper and CPV-2 vaccines probably provide immunity that endures several years, vaccination at 3- to 5-year intervals, after the first year, seems a reasonable practice until more data on duration of immunity become available. "Are too many kinds of vaccines being promoted for dogs?" Distemper and parvovirus vaccines are essential; canine adenovirus vaccines are recommended since the few cases brought to our attention in recent years have been in unvaccinated dogs. Vaccination against respiratory infections is recommended for most dogs, especially those in kennels, or if they are to be boarded. Need has not been clearly established for coronavirus vaccines; Lyme disease vaccines (see below) are useful in preventing illness in areas where the disease exists, but are unnecessary elsewhere since dogs respond rapidly to appropriate antibiotics; current Leptospira bacterins are without benefit since they contain serovars that fail to protect in most areas (noted below). Lyme disease (LD) was not considered here, but newer recombinant (OspA) vaccines are now available that appear to be safe and effective for at least 1 year and they have not caused vaccine-induced postvaccinal lameness, which has been documented with certain whole-cell Lyme disease bacterins. Lyme disease vaccines should be restricted to dogs in, or entering, endemic areas where infested ticks reside. More than 85% of LD cases occur in the mid-Atlantic and Northeastern States, about 10% in six Midwestern states (Michigan, Minnesota, and Wisconsin), and a smaller percentage in restricted areas of northern California and the Pacific Northwest. Leptospirosis also was not discussed here, but vaccines are commonly reported as a cause of anaphylaxis and current vaccines do not contain the serovars prevalent in most regions. The vast majority of cases diagnosed at the New York State Diagnostic Lab at Cornell are grippotyphosa and pomona serovars and there have been no recent cases caused by canicola or icterohemorrhagiae serovars. Because leptospirosis is an important disease of dogs, there is an urgent need for more research and the development of safer vaccines that contain the prevalent

Animals↗