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Tetracycline resistance of Corynebacterium diphtheriae isolated from diphtheria patients in Jakarta, Indonesia.

Of 133 Corynebacterium diphtheriae isolates from diphtheria patients in Jakarta, Indonesia, 86% were resistant to greater than or equal to 32 micrograms of tetracycline per ml. All isolates were sensitive to ampicillin, cephalothin, chloramphenicol, clindamycin, penicillin, erythromycin, and kanamycin. The general resistance of C. diphtheriae to tetracycline in this part of Indonesia appears to be unique compared with resistance reported in studies done in other parts of the world.

Corynebacterium diphtheriae↗

Identification and characterization of three new promoter/operators from Corynebacterium diphtheriae that are regulated by the diphtheria toxin repressor (DtxR) and iron.

DtxR is a dimeric, sequence-specific, DNA-binding protein that functions as an iron-dependent, negative global regulator in Corynebacterium diphtheriae. Under high-iron conditions, DtxR represses the synthesis of diphtheria toxin, corynebacterial siderophore, and other components of the high-affinity iron uptake system. Three DtxR-regulated promoter/operators designated tox, IRP1, and IRP2 were reported previously. In this study, we identified and characterized three additional DtxR-regulated promoter/operators from C. diphtheriae designated IRP3, IRP4, and IRP5. When beta-galactosidase was expressed from these three new promoter/ operators in Escherichia coli containing dtxR+ on pDSK29, enzyme levels were 5- to 30-fold lower during high-iron growth than during low-iron growth. In gel shift assays, the mobility of DNA fragments containing each promoter/operator decreased in the presence of purified DtxR and Co2+. In footprinting assays, DtxR protected 36-, 35-, and 30-bp regions of IRP3, IRP4, and IRP5, respectively, from cleavage by DNase I. In the 19-bp core of each promoter/operator, 12 or 13 bp matched the consensus for the DtxR-binding site. The putative polypeptides encoded by the open reading frames (ORFs) downstream from IRP3 and IRP4 were homologous, respectively, to several bacterial transcriptional regulators and to the deduced polypeptide encoded by an ORF located between the E. coli genes for primosomal replication protein N and adenine phosphoribosyltransferase. The putative polypeptide encoded by the ORF downstream from IRP5 was not homologous to any sequence in the protein database at the National Center for Biotechnology Information. When the ORFs downstream from IRP3 and IRP4 were expressed under the control of the phage T7 promoter in E. coli, polypeptide products of the predicted sizes were detected in small amounts by sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

Amino Acid Sequence↗

Characterization of the diphtheria tox transcript in Corynebacterium diphtheriae and Escherichia coli.

Transcription of the tox gene in lysogenic Corynebacterium diphtheriae strains C7(beta tox+), C7 (gamma tox) and the hypertoxigenic PW8 (omega tox+) was analyzed and compared with transcription of the C. diphtheriae tox gene in the recombinant strain Escherichia coli (pDT201). In all cases S1 nuclease mapping localized the 5' terminus of the tox mRNA to a site 8 or 9 base pairs (bp) downstream of a region similar to the -10 consensus sequence of E. coli promoters. In C. diphtheriae the tox transcript was observed only in strains that were grown under iron-limiting conditions; in the presence of excess iron, transcription beyond bp 38 of the tox coding region was not observed. In contrast, in E. coli(pDT201) tox was expressed at equivalent levels in both iron-depleted and iron-supplemented media. The DNA insertion in the tox gene of the nontoxigenic corynephage gamma was found to occur at bp 54 of the tox coding region. The insertion event resulted in the duplication of a 7-bp target sequence, and the ends of the insert were found to constitute an imperfect inverted repeat of approximately 26 bp. Transcription from the tox promoter in C7(gamma tox) was found to initiate at the same nucleotides as in C7(beta tox+), PW8, and E. coli(pDT201) and remained sensitive to iron inhibition. These observations are discussed in relation to the mechanism of iron-mediated regulation of the tox gene.

Base Sequence↗

Cloning, sequence, and footprint analysis of two promoter/operators from Corynebacterium diphtheriae that are regulated by the diphtheria toxin repressor (DtxR) and iron.

DtxR is an iron-dependent sequence-specific DNA-binding protein that binds to the tox operator, an inverted-repeat nucleotide sequence located upstream from the diphtheria toxin gene. In this study, two additional iron-regulated promoter/operator sequences (IRP1 and IRP2) that are controlled by DtxR were cloned from the chromosome of Corynebacterium diphtheriae and characterized. Operon fusions to lacZ were used to analyze expression from IRP1 and IRP2 in Escherichia coli. Transcription from both promoters was strongly repressed in high-iron medium in the presence of the cloned dtxR gene; however, transcription in the absence of dtxR was 50- to 100-fold greater, regardless of the iron concentration. Purified DtxR altered the electrophoretic mobility of DNA fragments carrying IRP1 or IRP2, and the nucleotide sequences of the two promoter/operator regions indicated that they are both homologous with the tox operator. DtxR protected an approximately 30-bp region on both IRP1 and IRP2 from DNase I digestion. A 19-bp consensus DtxR-binding site was derived from a comparison of the various DtxR-regulated operator/promoter sequences. Footprinting experiments using hydroxyl radicals and dimethyl sulfate demonstrated that DtxR interacted with these operators in a symmetrical manner, probably as a dimer or multimer. The deduced amino acid sequence of an open reading frame (ORF1) located downstream from IRP1 was homologous with a family of periplasmic proteins involved in iron transport in gram-negative bacteria and with the ferrichrome receptor, FhuD, from Bacillus subtilis. These findings suggest that ORF1 encodes a membrane-associated lipoprotein that may serve as the receptor for a ferric-siderophore complex in C. diphtheriae.

Amino Acid Sequence↗

Identification of Corynebacterium diphtheriae by immunofluorescence during a diphtheria epidemic.

During a large epidemic of diphtheria, the technique of immunofluorescence was applied to specimens obtained from 310 patients, 77 of whom were diagnosed clinically as having the disease. The technique made use of commerical fluorescent antisera prepared against the somatic antigens of Corynebacterium diphtheriae. The results obtained by immunofluorescence of slides prepared directly from swabs were found to be unsatisfactory but when the swabs were subjected to prior incubation in a growth medium the results of immunofluorescence and bacterial culture agreed in 95% of specimens. Immunofluorescence applied to bacterial colonies obtained on primary isolation agreed completely with definitive bacterial identification. These two methods for the rapid identification of C. diphtheriae appeared to be as reliable as formal cultural and biochemical methods and could be usefully and economically applied to the examination of large numbers of clinical specimens during an epidemic.

Bacteriological Techniques↗

Genetic relationships of Corynebacterium diphtheriae strains isolated from a diphtheria case and carriers by restriction fragment length polymorphism of rRNA genes.

In the present study we report the results of an analysis, based on ribotyping of Corynebacterium diphtheriae intermedius strains isolated from a 9 years old child with clinical diphtheria and his 5 contacts. Quantitative analysis of RFLPs of rRNA was used to determine relatedness of these 7 C.diphtheriae strains providing support data in the diphtheria epidemiology. We have also tested those strains for toxigenicity in vitro by using the Elek's gel diffusion method and in vivo by using cell culture method on cultured monkey kidney cell (VERO cells). The hybridization results revealed that the 5 C.diphtheriae strains isolated from contacts and one isolated from the clinical case (nose case strain) had identical RFLP patterns with all 4 restriction endonucleases used, ribotype B. The genetic distance from this ribotype and ribotype A (throat case strain), that we initially assumed to be responsible for the illness of the patient, was of 0.450 showing poor genetic correlation among these two ribotypes. We found no significant differences concerned to the toxin production by using the cell culture method. In conclusion, the use of RFLPs of rRNA gene was successful in detecting minor differences in closely related toxigenic C.diphtheriae intermedius strains and providing information about genetic relationships among them.

Adult↗

[The estimation of the amount of diphtheria toxin and its activity by various tests in the dynamic cultivation of Corynebacterium diphtheriae PW8].

Direct correlation between the results of tests for the biological activity of diphtheria toxin, carried out in vivo guinea pigs and in vitro in the microcytotoxicity test in CHO cell culture, has been established, which makes it possible to use the latter as one of the methods for the rapid, reproducible and economic evaluation of diphtheria toxin. The qualitative and quantitative evaluation of diphtheria toxin in the enzyme immunoassay with the use of monoclonal antibodies and in the microcytotoxicity test demonstrates that these two tests, when used for controlling cultivation processes, have essential advantages over the flocculation test as regards their specificity and information content.

Animals↗

[Booster vaccination with a diphtheria-tetanus vaccine for dermo-jet with low diphtheria toxoid content].

Indications are provided on how the organization of polyvaccinations against tuberculosis, poliomyelitis and diphtheria-tetanus in school collectivities can be rationalized. 19 persons aged 19-20 years were vaccinated intradermally with 1.5 Lf diphtheria toxoid and 15 Lf tetanus toxoid (contained in 0.1 ml) by means of a single injection with a jet injector (Dermo-Jet). In cases which had not previously been immunized, vaccination with the toxoid doses employed did not induce detectable antitoxin titers. In all cases which had previously been immunized the antitoxin titers after the booster injection were at least 400 times higher than the protection threshold for diphtheria and 1700 times higher than the protection threshold for tetanus. This was also the case in preimmunized cases which had no detectable antitoxin titer before the vaccination. The increase in antitoxin titer was inversely proportional to the prevaccinal titer in the manner of a logarithmic exponential function. It may be concluded from these results that the benefit of a booster vaccination is particularly high in poorly immunized persons whereas it is clearly limited in cases showing a high prevaccinal titer. The well tolerated intradermal vaccination with the jet injector (Dermo-Jet) can be considered as equivalent to the subcutaneous technic. From the point of view of organization (time consumption, problems of sterilization) this method is much preferable to intramuscular or subcutaneous vaccination.

Adult↗

Crystallization and preliminary X-ray studies of the diphtheria Tox repressor from Corynebacterium diphtheriae.

Crystals of the diphtheria tox repressor (DtxR) from Corynebacterium diphtheriae suitable for structure determination have been obtained. DtxR activated with transition metal ions represses the expression of the structural gene for the diphtheria toxin, tox, which is encoded on the genome of a family of closely related corynebacteriophages. The space group of the obtained crystals is trigonal P3(1)21 or its enantiomorph P3(2)21 with a = b = 64.2 A, c = 220.5 A, alpha = beta = 90 degrees, gamma = 120 degrees. Two monomers comprise the asymmetric unit. The crystals diffract to a resolution of better than 3 A.

Bacterial Proteins↗

Diphtheria toxin receptor binding domain substitution with interleukin-2: genetic construction and properties of a diphtheria toxin-related interleukin-2 fusion protein.

We have genetically replaced the diphtheria toxin receptor binding domain with a synthetic gene encoding interleukin-2 (IL-2) and a translational stop signal. The diphtheria toxin-related T-cell growth factor fusion gene encodes a 70 586-d polypeptide, pro-IL-2-toxin. The mature form of IL-2-toxin has a deduced mol. wt of 68,086 and is shown to be exported to the periplasmic compartment of Escherichia coli (pABI508), and contain immunologic determinants intrinsic to both its diphtheria toxin and IL-2 components. IL-2-toxin has been purified from periplasmic extracts of recombinant strains of E. coli (pABI508) by immunoaffinity chromatography using immobilized anti-IL-2. The purified chimeric toxin is shown to selectively inhibit protein synthesis in IL-2 receptor bearing targeted cells, whereas cell lines which do not express the IL-2 receptor are resistant to IL-2-toxin action.

Bacterial Proteins↗

Simultaneous administration of diphtheria-tetanus-pertussis-polio and hepatitis B vaccines in a simplified immunization program: immune response to diphtheria toxoid, tetanus toxoid, pertussis, and hepatitis B surface antigen.

We studied the interactions of hepatitis B vaccine with other vaccines used in the World Health Organization expanded programs of immunization. Three groups of Senegalese children were vaccinated with hepatitis B vaccine (HB) alone, diphtheria-tetanus-pertussis (DTP)-polio vaccine alone, or a combination of hepatitis B vaccine and DTP-polio vaccines simultaneously. The immune responses to HBsAg, tetanus toxoid, diphtheria toxoid, and pertussis were measured after one and two vaccinations at 6-month intervals. The immune responses to the combination of HB vaccine and DTP-polio vaccines were similar to the immune responses observed after administration of each vaccine alone. In addition, no adverse reactions were noted. These experimental trials also demonstrated that with a DTP-polio vaccine containing 30Lf of tetanus and diphtheria toxoids, two doses given at 6-month intervals are sufficient to provide a satisfactory immune response. In the case of pertussis and HB vaccines; however, a third dose is necessary.

Antibodies, Bacterial↗

Response of cultured mammalian cells to diphtheria toxin. V. Concurrent resistance to ribonucleic acid viruses in diphtheria toxin-resistant KB cell strains.

It was determined that KB-R cell strains, isolated from the KB cell line and resistant to diphtheria toxin, also resist infection by poliovirus, Mengo virus, vesicular stomatitis virus, and Newcastle disease virus. This resistance manifests itself by reduction in yields of progeny virus (a reduction of more than 2 logs in some cases), reduced production of viral-specific ribonucleic acid (RNA), and delayed cytopathic effect. In three KB-R strains tested, resistance was related to a step which falls between adsorption of virus and uncoating or release of viral messenger RNA. In two of these three strains, a second resistance mechanism was also active, causing a reduced production of viral-specific RNA. A relationship between the resistance to diphtheria toxin and the resistance to viral infection of the KB-R strains is considered. It has been postulated that the native diphtheria toxin molecule must be "activated" at the surface of a susceptible cell by a proteolytic process before it can enter the cell and inhibit protein synthesis. It is also known that the eclipse of some viruses occurs at or near the cell membrane and involves proteolytic activity. Resistance to viruses and toxin in the KB-R strains may result from the loss or modification of related labilizing or activating principles associated with the surface receptors for these agents.

Carbon Isotopes↗

Interactions between diphtheria toxin entry and anion transport in Vero cells. IV. Evidence that entry of diphtheria toxin is dependent on efficient anion transport.

Entry of prebound diphtheria toxin at low pH occurred rapidly in the presence of isotonic NaCl, NaBr, NaSCN, NaI, and NaNO3, but not in the presence of Na2SO4, 2-(N-morpholino)ethanesulfonic acid neutralized with Tris, or in buffer osmotically balanced with mannitol. SCN- was the most efficient anion to facilitate entry. Uptake studies with radioactively labeled anions showed that SCN- was transported into cells 3 times faster than Cl-, while the entry of SO2-4 occurred much more slowly. The anion transport inhibitors 4-acetamido-4'-isothiocyanostilbene-2,2'-disulfonic acid and piretanide inhibited entry at low pH even in the presence of permeant anions. When cells with bound toxin were exposed to low pH in the absence of permeant anions, then briefly exposed to neutral pH and subsequently exposed to pH 4.5 in the presence of isotonic NaCl, toxin entry was induced. The data indicate that efficient anion transport at the time of exposure to low pH is required for entry of surface-bound diphtheria toxin into the cytosol. Since insertion of diphtheria toxin into the membrane occurs even in the absence of permeant anions, the results indicate that low pH is required not only for insertion of fragment B into the membrane, but also for the subsequent entry of fragment A into the cytosol.

Animals↗

Immunochemical studies of antitoxin produced in normal and allergic individuals hyperimmunized with diphtheria toxoid. I. Relationship of skin sensitivity to purified diphtheria toxoid to the presence of circulating, non-precipitating antitoxin.

Among a group of 131 young adults tested, there was a high degree of correlation between the occurrence of immediate skin reactions of the wheal and erythema type produced by purified diphtheria toxoid and personal or familial history of allergy of the hay-fever type. Of 39 Schick-negative subjects who received a "booster" dose of purified diphtheria toxoid, 19 showed no immediate skin reactions before immunization. The development of skin sensitivity in these subjects was associated with the production of non-precipitating circulating antitoxin. Three subjects produced 20 units or more antitoxin per cc. serum following immunization, without demonstrable precipitins. Despite the fact that none showed immediate skin reactions to Schick toxoid prior to immunization, all 3 possessed a high degree of skin sensitivity to toxoid following immunization.

Adult↗

Immunochemical studies of antitoxin produced in normal and allergic individuals hyperimmunized with diphtheria toxoid. III. Studies of the passive Arthus reaction in guinea pigs using human precipitating and nonprecipitating diphtheria antitoxin.

The Arthus reaction was studied in guinea pigs passively immunized with human diphtheria antitoxin. Diphtheria toxoid was given intradermally 24 hours following the intravenous administration of antitoxin and the subsequent reactions were graded and measured. The intensity of Arthus reactions was dependent upon the relative amounts of precipitating antitoxin and toxoid used. Severe lesions were caused by intravenous sensitization with 0.48 mg. precipitating antitoxin N and intradermal challenge with 0.05 or 0.17 toxoid N. Reactions of lesser intensity were caused by smaller amounts of antitoxin and toxoid. The nature of the antibody used for sensitization was of importance in the severity of Arthus reactions. In contrast to the behavior of precipitating antitoxin, amounts of non-precipitating antitoxin equivalent to 0.48 mg. N did not cause severe Arthus reactions when 0.05 or 0.17 mg. toxoid N was given intradermally. Precipitating antitoxic whole serum is altered by heating at 56 degrees C. for 5 hours so that its precipitability is lost without any appreciable loss of antitoxic strength. This modified antitoxin produced Arthus reactions of only intermediate severity in guinea pigs sensitized with 0.48 mg. antitoxin N. When fractions of precipitating antitoxic serum were obtained using a cold ethanol technique described by Deutsch (16), a mixture of the purified gamma(2)-globulin and the crude albumin fraction heated together at 56 degrees C. for 5 hours behaved similarly to whole serum. However, gamma(2)-globulin alone was not affected by the heating procedure, remained precipitable by toxoid, and was able to cause a severe Arthus reaction following sensitization with 0.48 mg. antitoxin N.

Administration, Intravenous↗

How soon after a prior tetanus-diphtheria vaccination can one give adult formulation tetanus-diphtheria-acellular pertussis vaccine?

BACKGROUND: Adult formulation tetanus and diphtheria toxoids and acellular pertussis vaccines (Tdap) have been developed to prevent pertussis in adolescents and adults. There are concerns that unacceptable rates of severe injection site reactions, including Arthus-type reactions might occur if Tdap is administered too soon after a previous tetanus and diphtheria toxoid-containing vaccine formulated for infants and younger children (TD) or older children and adults (Td). METHODS: To evaluate whether adverse reactions after Tdap might be related to time since last receipt of TD/Td, we performed an open label, province-wide, clinical trial comparing the reactogenicity of Tdap given 18 months-9 years versus > or = 10 years after a previous TD/Td. RESULTS: Seven thousand one hundred fifty-six children and adolescents were enrolled in the study (464-963 subjects per cohort), and 7001 had documented dates of the previous immunization within the specified intervals; adverse event data were provided by 5931 (84.7%). No whole limb swelling, Arthus-like reactions or serious adverse events related to vaccination were reported. No differences in reports of fever were found by interval since last immunization. Injection site erythema and swelling were slightly and statistically significantly increased among those participants with most recent prior TD/Td. Compared with the 10-year interval group, the maximum increase for any other group was < or = 8.6% for any erythema, < or = 6% for erythema > 10 mm, < or = 10.3% for any swelling, < or = 6.9% for swelling > 10 mm, < or = 5.2% for any pain and < or = 3.7% for moderate/severe pain. CONCLUSION: Although there is a slight increase in injection site events with decreasing interval since a previous immunization, Tdap can be safely administered at intervals of > or = 18 months since a previous TD/Td vaccine.

Adult↗

Application of PCR for detection of toxigenic Corynebacterium diphtheriae strains isolated during the Russian diphtheria epidemic, 1990 through 1994.

A total of 250 Corynebacterium diphtheriae isolates from clinical cases and carriers in Russia were assayed by PCR directed at the A subunit of the diphtheria toxin gene to distinguish toxigenic from nontoxigenic strains; 170 strains were positive as indicated by the presence of the 248-bp amplicon. The results of this PCR assay were in complete concordance with those of the standard immunoprecipitation assay (Elek), and the PCR assay is a useful tool for rapid identification in clinical laboratories.

Carrier State↗

Comparison of a diphtheria and tetanus toxoids and bicomponent acellular pertussis vaccine with diphtheria and tetanus toxoids and whole-cell pertussis vaccine in infants.

OBJECTIVE: To compare the reactogenicity and immunogenicity of a diphtheria and tetanus toxoids and two-component acellular pertussis (ADTP) vaccine with a US-licensed whole-cell (WDTP) vaccine. SETTING: General pediatric practice in suburban Rochester, NY. DESIGN: Prospective, double-blind, randomized study. PARTICIPANTS: One hundred ten infants were studied; 88 (80%) received ADTP and 22 (20%) received WDTP at ages 2, 4, and 6 months. INTERVENTION: Vaccination. MEASUREMENTS/MAIN RESULTS: Temperature of 38.3 degrees C or higher (P = .03) and moderate or severe injection-site pain (P = .02) occurred less frequently in infants receiving ADTP than those receiving WDTP for the combined three doses. Following the third dose, ADTP vaccination produced higher antibody responses than WDTP to pertussis toxin (geometric mean enzyme-linked immunosorbent assay IgG was 52.2 vs 12.5; P < .001) and to filamentous hemagglutinin (geometric mean IgG was 182.8 vs 3.5; P < .001). No interference in the diphtheria or tetanus antibody responses was observed in recipients of the ADTP vaccine. CONCLUSIONS: This two-component ADTP vaccine, when given as a primary infant series, produces fewer adverse effects and greater immunogenicity to the two pertussis components that it contains than US-licensed WDTP vaccine.

Antibody Formation↗