Controlled multiplex PCR of enterotoxigenic Clostridium perfringens strains in food samples

Developing rats between 5 and 44 days of age as well as rats about 2 months old were anesthetized with urethane. Spontaneous activities and muscle potentials to sciatic stimuli were recorded from their exposed medial gastrocnemius muscles using concentric electrodes. Neostigmine of 0.12-0.40 mg/kg was injected into the contralateral muscles. Regardless of age, spontaneous activities were not observed and muscle potentials were evoked by single stimuli primarily in a biphasic wave (main component) before the drug treatment. Developmental differences were revealed in the presence of the drug. 1) Spontaneous activities were detected only in single spikes around postnatal 10 days. Single or double spikes were often found in rats of about two weeks. Burst discharges such as seen in adult rats were observed immediately before weaning. 2) In rats of 2 weeks or so, one or more components were observed obscurely following the main component of muscle potentials, which appeared definitely at the preweaning period. 3) When double shocks with the interval of 2 sec were delivered in the presence of the drug, the second potential was greatly depressed in rats older than two weeks as well as in adult rats. The potential was only slightly reduced in rats around 10 days. Thus, an adult pattern as to impulse transmission was observed immediately before weaning. These alterations would, at least in part, reflect the maturation of acetylcholine receptors at neuromuscular junctions.     

Detection of enterotoxigenic Clostridium perfringens in food and fecal samples with a duplex PCR and the slide latex agglutination test

A duplex PCR procedure was evaluated for the detection of Clostridium perfringens in food and biological samples and for the identification of enterotoxigenic strains. This method uses two sets of primers which amplify in the same reaction two different DNA fragments simultaneously: the 283-bp C. perfringens phospholipase C gene fragment and the 426-bp enterotoxin gene fragment. Internal primers within the two primer sets confirmed the specificity of the method by DNA-DNA hybridization with the PCR products. No cross-reaction was observed with other Clostridium species or with other bacteria routinely found in food. The detection level was approximately 10(5) C. perfringens cells per g of stool or food sample. When overnight enrichment culture was used, 10 C. perfringens cells per g was detected in 57 artificially contaminated food samples. The duplex PCR is a rapid, sensitive, and reliable method for the detection and identification of enterotoxigenic C. perfringens strains in food samples. A slide latex agglutination test was also evaluated as a rapid, simple technique for the detection of C. perfringens enterotoxin in stool samples.     

Infection due to Clostridium difficile among elderly residents of a long-term-care facility

In a study of the epidemiology of infection due to Clostridium difficile at long-term-care facilities, we conducted point-prevalence surveys and obtained stool samples from residents receiving antibiotics and from those developing diarrhea during 1 year at a 350-bed nursing home and an adjoining 280-bed chronic-care hospital. C. difficile and/or its cytotoxin was detected in 236 specimens from 94 residents. Only 16 (17%) of these 94 individuals had diarrhea at the time C. difficile was detected. The prevalence of C. difficile infection ranged from 2.1% to 8.1% in the nursing home and from 7.1% to 14.7% in the hospital. The organism was recovered from six (8.8%) of 68 residents receiving antibiotics, and four of the six developed antibiotic-associated diarrhea. The receipt of antibiotic treatment within the previous 8 weeks (odds ratio [OR], 7.9), the presence of a nasogastric or gastrostomy feeding tube (OR, 6.5), urinary and fecal incontinence (OR, 2.5), and the presence of more than three underlying diseases (OR, 2.0) were statistically significant independent variables associated with C. difficile infection. Typing of isolates by restriction-endonuclease analysis indicated that most C. difficile infections at this long-term-care facility were associated with endogenous enteric carriage of the organism, with little evidence of cross-infection.     

Deletion analysis of the Clostridium perfringens enterotoxin

To further our knowledge of the structure-function relationship and mechanism of action of the Clostridium perfringens enterotoxin (CPE), a series of recombinant CPE (rCPE) species containing N- and C-terminal CPE deletion fragments was constructed by recombinant DNA approaches. Each rCPE species was characterized for its ability to complete the first four early steps in the action of CPE, putatively ordered as specific binding, a postbinding physical change to bound CPE, large-complex formation, and induction of alterations in small-molecule membrane permeability. These studies demonstrated that (i) at least 44 amino acids can be removed from the N terminus of CPE without loss of cytotoxicity, (ii) removal of the first 53 amino acids from the N terminus of CPE produces a fragment that appears to be noncytotoxic because it cannot undergo the post-binding physical change step in CPE action, (iii) removal of as few as five amino acids from the C terminus of CPE produces a noncytotoxic fragment lacking receptor binding activity, and (iv) a fragment lacking the first 44 N-terminal amino acids of native CPE formed twice as much large complex and was twice as cytotoxic as native CPE. From these structure-function results, it appears that the minimum-size cytotoxic CPE fragment comprises approximately residues 45 to 319 of native CPE. Results from these deletion fragment studies have also contributed to our understanding of CPE action by (i) independently supporting previous suggestions that binding, the postbinding physical change step, and large-complex formation represent important steps in CPE cytotoxicity and (ii) providing independent evidence confirming the putative sequential order of these early events in CPE action.     

Prospective study of the risk of Clostridium difficile diarrhoea in elderly patients following treatment with cefotaxime or piperacillin-tazobactam

BACKGROUND: Rates of Clostridium difficile diarrhoea have recently been rising, with the elderly being at highest risk. AIM: To compare the incidence of C. difficile colonization and diarrhoea in elderly patients treated for presumed infection with either empirical cefotaxime (CTX) or piperacillin-tazobactam (PT). METHODS: A prospective, ward-based, crossover study was carried out on two well-matched care of the elderly wards at a UK tertiary care hospital, in patients requiring empirical broad-spectrum antibiotic treatment. RESULTS: There was a highly significant increased incidence of C. difficile colonization (26/34 vs. 3/14, P=0.001) and diarrhoea (18/34 vs. 1/14, P=0.006) in patients who received CTX as opposed to PT. DNA fingerprinting suggested that most infections arose from strains acquired from the hospital environment. CONCLUSIONS: Elderly patients are significantly less likely to develop C. difficile diarrhoea after treatment with PT than after CTX. The source of C. difficile appears to be predominantly from the ward environment.     

Relative importance of enterotoxigenic and invasive enteropathogenic bacteria in infantile diarrhoea

Swedish children and adults (648 patients) with acute diarrhoea were investigated for enterotoxigenic strains in stool cultures. A total number 74 strains were isolated from 28 patients and assayed in the rabbit intestinal loop test and the adrenal cell test. Only three of the enterotoxigenic E. coli (ETEC) isolates belonged to classical enteropathogenic serotypes of E. coli (EPEC). Two enterotoxigenic strains of Proteus morganii, two of Enterobacter hafniae and one of Citrobacter freundii were isolated. None of 67 EPEC strains were found to produce a heat-labile enterotoxin (LT) in either of the two test systems. A number of Yersinia enterocolitica and Pseudomonas aeruginosa strains from stool cultures often produced toxic effects in the cell test but no enterotoxin activity was detected for any of the strains investigated either in the adrenal cell test for heat-labile enterotoxin (LT) or the suckling mouse test for heat-stable enterotoxin (ST). All EPEC isolates were also tested for ST and for invasive properties in the Sereny test; each isolate was negative in both test systems. It is concluded that production of LT and ST enterotoxin were common in stool isolates from Ethiopian children but a rare phenomenon among Swedish children with acute infantile diarrhoea. Isolation of aerobic stool bacteria with invasive properties seems to be uncommon both in Ethiopian and Swedish children. However, since both LT and ST as well as invasive properties seem to be very unstable genetic properties in many of these stool isolates improved sensitive methods for the last two properties will probably change this picture in the future.     

Pancreaticoduodenectomy due to cancer in the elderly

The elderly have traditionally been excluded from pancreaticoduodenectomy due to the high morbimortality of this procedure. Six cases of pancreaticoduodenectomy) 5 cephalic and 1 total) for periampullary tumors in patients over 70 are reported. There was no mortality. We conclude that, in selected cases, pancreaticoduodenectomy can be performed safely in the elderly.     

UDP-glucose deficiency causes hypersensitivity to the cytotoxic effect of Clostridium perfringens phospholipase C

A Chinese hamster cell line with a mutation in the UDP-glucose pyrophosphorylase (UDPG:PP) gene leading to UDP-glucose deficiency as well as a revertant cell were previously isolated. We now show that the mutant cell is 10(5) times more sensitive to the cytotoxic effect of Clostridium perfringens phospholipase C (PLC) than the revertant cell. To clarify whether there is a connection between the UDP-glucose deficiency and the hypersensitivity to C. perfringens PLC, stable transfectant cells were prepared using a wild type UDPG:PP cDNA. Clones of the mutant transfected with a construct having the insert in the sense orientation had increased their UDP-glucose level, whereas those of the revertant transfected with a UDPG:PP antisense had reduced their level of UDP-glucose compared with control clones transfected with the vector. Exposure of these two types of transfectant clones to C. perfringens PLC demonstrated that a cellular UDP-glucose deficiency causes hypersensitivity to the cytotoxic effect of this phospholipase. Further experiments with genetically engineered C. perfringens PLC variants showed that the sphingomyelinase activity and the C-domain are required for its cytotoxic effect in UDP-glucose-deficient cells.     

Risk factors for Clostridium difficile-associated diarrhoea in HIV-infected patients

OBJECTIVE: To identify risk factors associated with a first episode of Clostridium difficile-associated diarrhoea (CDAD) in patients with HIV infection. DESIGN: A case-control study. SETTING: University teaching hospital HIV inpatient unit. PATIENTS AND METHODS: Nineteen HIV-infected patients with CDAD, defined as diarrhoea with positive stool culture for Clostridium difficile (CD) and positive stool cytotoxin B assay, were compared with 38 randomly selected controls (HIV-infected patients hospitalized on the ward on the day the matched case was diagnosed). CD isolates were phenotyped by electrophoretic protein patterns. RESULTS: The incidence of CDAD among HIV-infected patients was 4.1/100 of patient-admissions. On univariate analysis, cases were more likely to have used clindamycin [11 out of 19 compared with four out of 38; odds ratio (OR) 19; 95% confidence interval (CI), 2-160; P = 0.0007], and pyrimethamine (14 out of 19 compared with 13 out of 38; OR, 4.8; 95% CI, 1.4-16, P = 0.02) in the month before diagnosis, and to have had cerebral toxoplasmosis (12 out of 19 compared with 13 out of 38; OR, 2.8; 95% CI, 0.9-8.6; P = 0.09). There was also a significant increase of the risk of CDAD as duration of hospitalization in the ward increased (chi 2 for trend, P = 0.007). Multivariate models associated two risk factors with CDAD: clindamycin use (OR, 42; 95% CI, 2-813; P = 0.01), and prolonged hospitalization in the ward (OR, 3.6 per week in the ward; 95% CI, 1-13, P = 0.048). Of 18 available CD isolates, 15 (83%) had identical electrophoretic protein pattern. CONCLUSIONS: Clindamycin use and prolonged hospitalization in the ward were the main risk factors associated with CDAD in this study. These observations, together with the occurrence of one major phenotype of CD, suggest nosocomial transmission of CD in the ward.     

Enterotoxigenic Clostridium perfringens type A necrotic enteritis in a foal

A Thoroughbred-Quarter Horse crossbred foal developed hemorrhagic enteritis and died < 48 hours after birth. Gross and histologic findings were suggestive of Clostridium perfringens type C infection, and large numbers of C perfringens were isolated from intestinal contents. However, genotyping of isolates indicated that they were enterotoxigenic C perfringens type A, and isolates were found to produce C perfringens enterotoxin in vitro. This case suggests that enterotoxigenic C perfringens type A may cause enteric disease in horses.     

Genetic organization and distribution of tetracycline resistance determinants in Clostridium perfringens

The Tet P determinant from the conjugative Clostridium perfringens R plasmid pCW3 two functional overlapping tetracycline resistance genes, tetA(P) and tetB(P). The tetA(P) gene encodes a putative 46-kDa transmembrane protein which mediates active efflux of tetracycline from the cell, while tetB(P) encodes a putative 72.6-kDa protein which has significant similarity to Tet M-like tetracycline resistance proteins (J. Sloan, L.M. McMurry, D. Lyras, S. B. Levy, and J. I. Rood, Mol. Microbiol. 11:403-415, 1994). In the present study, hybridization and PCR analysis of 81 tetracycline-resistant isolates of C. perfringens showed that they all carried the tetA(P) gene. Most of these isolates (93%) carried a second tetracycline resistance gene, with 53% carrying tetB(P) and 40% carrying a tet(M)-like gene. Despite the wide distribution of the tetB(P) and tet(M) genes, no isolate which carried both of these determinants was detected. In isolates that carried both tetA(P) and tetB(P) these genes overlapped, as in pCW3. Isolates carrying this combination of genes originated from diverse geographical locations and environmental sources. The single Clostridium paraputrificum isolate examined carried tetA(P), indicating that this gene is not confined to C.perfringens. However, neither tetA(P) nor tetB(P) was detected in the nine Clostridium difficile isolates tested. Nucleotide sequence analysis of isolates lacking tetB(P) revealed that they contained the tetA408(P) gene, which lacked the codons for the 12 carboxy-terminal amino acids of the TetA(P) protein.     

Nosocomial pseudobacteremia. Positive blood cultures due to contaminated benzalkonium antiseptic

Pseudomonas cepacia or Enterobacter species or both were isolated from blood cultures of 79 patients in a community hospital between April 1971 and March 1972. No common exposures other than venipuncture correlated with positive blood cultures. Pseudomonas cepacia, Enterobacter, and other Gram-negative enteric bacteria were cultured from aqueous benzalkonium chloride used for skin antisepsis prior to ordinary and blood culture venipuncture. Contamination of blood cultures by organisms from the antiseptic most likely accounted for positive cultures in 35 to 38 patients (92%) with P cepacia. The remaining three patients had repeated blood cultures positive for P cepacia and circumstantial clinical evidence of bacteremia; they may have contracted disease through exposure to the contaminated antiseptic. Substitution of an iodine-alcohol antiseptic abruptly reduced the isolation of P cepacia and Enterobacter.     

Effect of cysteine modifications on the activity of the 'small' Clostridium perfringens sialidase

The 'small' (43 kDa) sialidase of Clostridium perfringens is inhibited by low concentrations of mercury ions. For the investigation of possible functional roles of the enzyme's four cysteine residues at the amino acid positions 2, 282, 333 and 349, they were separately altered to serine by site-directed mutagenesis. The four mutant sialidases expressed in E. coli and purified by metal chelate chromatography were markedly reduced in specific activity when compared to the wild-type enzyme but with the exception of C282S exhibited similar K(M)-values indicating an unchanged mode of substrate binding. The substrate specificity was also conserved for C2S, C282S, and C333S. Only the C349S sialidase exhibited a higher relative activity with colominic acid and the alpha2,6-linked sialic acid of sialyllactose compared to the alpha2,3-linked isomer than the other mutants. Chemical modifications with the thiol-blocking reagents N-ethylmaleimide (NEM), p-chloromercuribenzoate (pCMB) and HgCl2 had little effect on the C282S sialidase, e.g., 6% inhibition by 5 mM NEM compared to reductions in activity between 65 and 90% for the wild-type and other mutant enzymes, supporting the idea that among the enzyme's cysteines, Cys-282 has the highest structural or functional significance. The results also explain the higher mercury tolerance of Salmonella typhimurium and Clostridium tertium sialidases, which have the positions equivalent to Cys-282 altered to Val and Thr, respectively, indicating that the thiol group of Cys-282, despite being situated near the active site, is not involved in catalysis.     

Genome mapping of Clostridium perfringens strains with I-CeuI shows many virulence genes to be plasmid-borne

The intron-encoded endonuclease I-CeuI from Chlamydomonas eugametos was shown to cleave the circular chromosomes of all Clostridium perfringens strains examined at single sites in the rRNA operons, thereby generating ten fragments suitable for the rapid mapping of virulence genes by pulsed-field gel electrophoresis (PFGE). This method easily distinguishes between plasmid and chromosomal localisations, as I-CeuI only cuts chromosomal DNA. Using this approach, the genes for three of the four typing toxins, beta, epsilon, and tau, in addition to the enterotoxin and lambda-toxin genes, were shown to be plasmid-borne. In a minority of strains, associated with food poisoning, where the enterotoxin toxin gene was located on the chromosome, genes for two of the minor toxins, theta and mu, were missing.     

Efficacy of octreotide in diarrhoea due to Vibrio cholerae: a randomized, controlled trial

The ultrastructure of autonomic nerve fibers and terminal varicosities is described in relation to the lamina propria of the human seminiferous tubules during childhood (age 3 to 10 years). Autonomic nerve varicosities are classified as: Type I with numerous small (30-60 nm) agranular vesicles and variable numbers of large (100 nm) granular vesicles, and Type II with numerous small (30-60 nm) granular vesicles and sporadic large granular vesicles. These two varicosity types are consistent in morphology with cholinergic and adrenergic nerve terminals, respectively. Nerve varicosities are found, associated with Schwann cells, in proximity to the cells of the lamina propria. Although not found in direct "synaptic' contact, these autonomic endings are often within a few hundred nanometers of the cellularity of the lamina propria. The Schwannian sheath is interrupted over the varicosities at these sites and occasionally the terminal varicosities are totally lacking a Schwann sheath. These findings are consistent with the structural relationship of autonomic nerve "terminals' and effector in other endocrine and non-endocrine systems. This is the first evidence of adrenergic nerve varicosities in proximity to the lamina propria in humans (at any age). Evidence is also presented which suggests a locational difference in the distribution of cholinergic (Type I) and adrenergic (Type II) nerve varicosities in this region, with only cholinergic endings observed directly adjacent to the basal lamina of the seminiferous tubules.     

Multicentre evaluation of a commercial test for the rapid diagnosis of Clostridium difficile-mediated antibiotic-associated diarrhoea

Although histologic studies of mucin distribution in the peribiliary glands have been conducted, a quantitative study of mucin content in intrahepatic bile ducts has yet to be reported. In an attempt to evaluate the mucin content in stone-containing intrahepatic bile ducts, we conducted a study on 25 surgically resected livers with hepatolithiasis. Specimens from 10 livers without stones served as controls. All specimens were fixed in 10% formalin and sectioned for periodic acid Schiffalcian blue double-stain (PAS-AB; pH 2.5) to evaluate the epithelial mucin content of the intrahepatic bile ducts. The PAS-AB positive area and the total epithelial area were measured with a computerized image analyzer and the PAS-AB index was calculated as the proportion of the PAS-AB positive to the total epithelial area. The histochemical study showed that epithelial cells in both the intramural glands and extramural glands of stone-containing intrahepatic bile ducts stained heavily and homogeneously with PAS-AB, while those of controls stained weakly. The PAS-AB indexes in stone-containing intrahepatic bile ducts were 51.8 +/- 15.88% for mucous cells of intramural glands, 52.86 +/- 9.85% for mucous cells of extramural glands, and 77.29 +/- 21.59% for serous cells of extramural glands. These values were all significantly higher than those of control specimens. However, the PAS-AB index of the epithelial lining in both hepatolithiasis and control specimens were similarly low, indicating the epithelial lining does not secrete much mucous glycoprotein. The results of this study led us to conclude that stone-containing intrahepatic bile ducts contain an abundant amount of mucous glycoprotein, and mucin is secreted from the peribiliary glands, not from the epithelial lining of the bile ducts.     

Cloning, sequencing and expression of the acylneuraminate lyase gene from Clostridium perfringens A99

The acylneuraminate lyase gene from Clostridium perfringens A99 was cloned on a 3.3 kb HindIII DNA fragment identified by screening the chromosomal DNA of this species by hybridization with an oligonucleotide probe that had been deduced from the N-terminal amino acid sequence of the purified protein, and another probe directed against a region that is conserved in the acylneuraminate lyase gene of Escherichia coli and in the putative gene of Clostridium tertium. After cloning, three of the recombinant clones expressed lyase activity above the background of the endogenous enzyme of the E. coli host. The sequenced part of the cloned fragment contains the complete acylneuraminate lyase gene (ORF2) of 864 bp that encodes 288 amino acids with a calculated molecular weight of 32.3 kDa. The lyase structural gene follows a noncoding region with an inverted repeat and a ribosome binding site. Upstream from this regulatory region another open reading frame (ORF1) was detected. The 3'-terminus of the lyase structural gene is followed by a further ORF (ORF3). A high homology was found between the amino acid sequences of the sialate lyases from Clostridium perfringens and Haemophilus influenzae (75% identical amino acids) or Trichomonas vaginalis (69% identical amino acids), respectively, whereas the similarity to the gene from E. coli is low (38% identical amino acids). Based on our new sequence data, the 'large' sialidase gene and the lyase gene of C. perfringens are not arranged next to each other on the chromosome of this species.