Demonstration that Australian Pasteurella multocida isolates from sporadic outbreaks of porcine pneumonia are non-toxigenic (toxA-) and display heterogeneous DNA restriction endonuclease profiles compared with toxigenic isolates from herds with progressive atrophic rhinitis

Capsular types A and D of Pasteurella multocida cause economic losses in swine because of their association with progressive atrophic rhinitis (PAR) and enzootic pneumonia. There have been no studies comparing whole-cell DNA profiles of isolates associated with these two porcine respiratory diseases. Twenty-two isolates of P. multocida from diseased pigs in different geographic localities within Australia were characterised genotypically by restriction endonuclease analysis (REA) with the enzyme CfoI. Seven of 12 P. multocida isolates from nasal swabs from pigs in herds where PAR was either present or suspected displayed a capsular type D phenotype. These were shown to possess the toxA gene by polymerase chain reaction (PCR) and Southern hybridisation, and further substantiated by production of cytotoxin in vitro. The CfoI profile of one of these seven isolates, which was from the initial outbreak of PAR in Australia (in Western Australia, WA), was identical with profiles of all six other toxigenic isolates from sporadic episodes in New South Wales (NSW). The evidence suggests that the strain involved in the initial outbreak was responsible for the spread of PAR to the eastern states of Australia. Another 10 isolates, representing both capsular types A and D, were isolated exclusively from porcine lung lesions after sporadic outbreaks of enzootic pneumonia in NSW and WA. CfoI restriction endonuclease profiles of these isolates revealed considerable genomic heterogeneity. Furthermore, none of these possessed the toxA gene. This suggests that P. multocida strains with the toxA gene do not have a competitive survival advantage in the lower respiratory tract or that toxin production does not play a role in the pathology of pneumonic lesions, or both. REA with polyacrylamide gel electrophoresis and silver staining was found to be a practical and discriminatory tool for epidemiological tracing of P. multocida outbreaks associated with PAR or pneumonia in pigs.     

Interaction of Mycoplasma hyopneumoniae and Pasteurella multocida infections in swine

To investigate the interaction between Mycoplasma hyopneumoniae and Pasteurella multocida infection, 32 pigs were randomly assigned by litter, sex, and weight to 4 treatment groups. Group-1 pigs were inoculated with M hyopneumoniae and allowed to recover from M hyopneumoniae infection. Group-2 pigs were vaccinated against M hyopneumoniae and then inoculated with M hyopneumoniae. Group-3 pigs were inoculated with M hyopneumoniae and developed clinical signs of mycoplasmosis. Group-4 pigs had never been exposed to M hyopneumoniae. All pigs were initially seronegative for M hyopneumoniae. All pigs were subsequently inoculated with P multocida and euthanatized 2 weeks later. Pasteurella multocida was isolated only from the lungs of group-3 pigs, and these pigs had a significantly higher median percentage of lung surface area affected by pneumonia than did pigs in the other groups. For group-3 pigs, percentage of lung surface area affected by pneumonia was positively correlated with the number of P multocida colonies isolated. We concluded that P multocida is not a primary respiratory pathogen in pigs, but that M hyopneumoniae infection can render the lungs susceptible to P multocida colonization and infection. Pigs recovered from or vaccinated against infection with M hyopneumoniae were resistant to P multocida infection.     

Fatal flecainide intoxication

OBJECTIVE: The objective of this work was to examine the diversity within Australian isolates of Actinobacillus equuli and related organisms by the genotypic method of ribotyping. DESIGN: Ribotyping, performed using the enzyme HaeIII, was used to examine the diversity in 12 field isolates of A equuli (five being capable of fermenting L-arabinose), one field isolate of Pasteurella caballi and two unclassifiable field isolates. Isolates were obtained from Australian horses, except for three isolates of A equuli (one L-arabinose positive and two L-arabinose negative) which were obtained from horses and a pig in Africa. In addition, the type strains for A equuli and P caballi and a reference strain for Bisgaard Taxon 9 were included in the study. RESULTS: The ribotype patterns were analysed by computerised cluster analysis, yielding five clusters (A to E). All five of the L-arabinose positive A equuli were assigned to cluster A, with all the other seven A equuli isolates (all L-arabinose negative) and the type strain being assigned to cluster B. One of the two unclassified isolates formed cluster C along with the reference strain for Bisgaard Taxon 9. The remaining unclassified isolate formed cluster D. Cluster E consisted of the field isolate and reference strain of P caballi. CONCLUSION: The results of this study indicate that A equuli is a diverse species, with L-arabinose positive isolates of A equuli being quite distinct from typical L-arabinose negative isolates. Ribotyping appears to be a useful tool in confirming the identity of A equuli-like organisms from horses.     

Genotypic analysis of Toxoplasma gondii isolates from pigs

To determine the prevalence of the 3 primary clonal lineages of Toxoplasma gondii (strain types I, II, and III) in a potential food source of infection for humans, we analyzed 43 isolates of T. gondii that had been collected from pigs at an abattoir in Iowa. Parasites were harvested as in vitro-grown tachyzoites, and their genotypes were determined at the SAG1 and SAG2 loci. On the basis of the allele identified at the SAG2 locus, isolates were grouped into 1 of the 3 primary lineages. Type II strains were by far the most prevalent, accounting for 83.7% of the isolates. The type III genotype was identified in only 16.3% of the isolates. These prevalences differ significantly from a previous sampling of isolates from animals but are similar to the frequencies with which they occur in human disease cases. Similar to the previously characterized strain P89, strains P62 and P105 appeared to have recombinant genotypes. The type I genotype was not identified in the isolates from pigs although these strains have previously been shown to account for approximately 10-25% of toxoplasmosis cases in humans.     

A case report of extensive vitiligo

Minimum inhibitory concentrations of doxycycline and oxytetracycline were determined against 55 Pasteurella multocida strains, 59 Actinobacillus pleuropneumoniae strains and 26 Mycoplasma hyopneumoniae strains isolated from the respiratory tract of pigs. An additional set of 76 P multocida strains isolated from pneumonic pigs was tested for their minimum inhibitory concentrations of doxycycline. The P multocida and A pleuropneumoniae strains were isolated in France and the minimum inhibitory concentrations were determined by an agar dilution method. The M hyopneumoniae strains were isolated in the United Kingdom and minimum inhibitory concentrations were determined by a serial broth dilution method. All the strains tested were susceptible to doxycycline whereas 15 per cent of the P multocida strains and 22 per cent of the A pleuropneumoniae strains were resistant to oxytetracycline. Doxycycline concentrations inhibiting 90 per cent of strains were 1 microgram/ml for P multocida and 2 micrograms/ml for A pleuropneumoniae. The ratio of the minimum inhibitory concentrations of doxycycline and oxytetracycline ranged between 1/1 and 1/4 for the oxytetracycline-susceptible strains and between 1/16 and 1/64 for the oxytetracycline-resistant strains. All the M hyopneumoniae strains were susceptible to doxycycline and oxytetracycline, the concentrations inhibiting 90 per cent of strains being 1 microgram/ml and 2 micrograms/ml, respectively. These data confirm that doxycycline has a higher in vitro activity against pig respiratory pathogens than oxytetracycline.     

The goat as a model for studies of pneumonic pasteurellosis caused by Pasteurella multocida

A model of pneumonic pasteurellosis has been established in goats using Pasteurella multocida harvested from pneumonic lungs of goats (types A and D), rabbits (type A) and sheep (type D). The resultant infections were acute, subacute or chronic. The gross and histological lesions of the subacute and chronic infections were typical of pneumonic pasteurellosis. P. multocida type D produced significantly (P < 0.01) more severe lesions when compared with other isolates. There were strong correlations between the clinical signs and the severity of lesions.     

Molecular typing of Borrelia burgdorferi from Lyme disease patients by PCR-restriction fragment length polymorphism analysis

Ninety-three Borrelia burgdorferi isolates obtained from erythema migrans lesions or blood of Lyme disease patients in Westchester County, N.Y., between 1991 and 1994 were characterized by PCR-restriction fragment length polymorphism (PCR-RFLP) analysis of the 16S-23S rRNA gene spacer. All isolates could be classified into three distinct RFLP types. Among the 82 skin biopsy isolates studied, 21 (25.6%) were type 1, 37 (45.1%) were type 2, and 21 (25.6%) were type 3. Three (3.7%) cultures contained a mixture of two isolates with distinct RFLP types. The 11 isolates cultured from blood showed a similar predominance of RFLP type 2 (6 of 11; 54.5%) relative to types 1 (2 of 11; 18.2%) and 3 (3 of 11; 27.3%). For one patient both skin and blood isolates were cultured, and RFLP analysis revealed that these isolates differed from one another. This study demonstrates that there is genotypic heterogeneity in B. burgdorferi strains infecting Lyme disease patients, and this typing approach may allow differentiation of isolates with various degrees of pathogenic potential.     

Differentiation of Pasteurella multocida subspecies multocida isolates from the respiratory system of pigs by using polymerase chain reaction fingerprinting technique

PCR fingerprinting technique was applied to subtype 44 Pasteurella multocida subspecies multocida (P.m.sp.m.) isolates from the respiratory system of pigs. Two single primers were tested for their abilities to generate individual fingerprints by using PCR. Primer 1 (core sequence of the M13 phage) grouped the 44 P.m.sp.m. strains into five distinct fingerprinting profiles, while primer 2 ((GACA)4) grouped them into seven profiles. The results suggest that PCR fingerprinting is an efficient technique to detect DNA polymorphism in the species P.m.sp.m. This technique could be used to differentiate P.m.sp.m. strains of the same capsular serotype.     

Efficacy of doxycycline in feed for the control of pneumonia caused by Pasteurella multocida and Mycoplasma hyopneumoniae in fattening pigs

A multicentre, controlled, randomised and blinded study was carried out in three French pig herds to assess the efficacy of doxycycline administered in the feed for the control of pneumonia. About 20 per cent of 363 pigs from the three fattening units were diseased at the start of the study. Pneumonic lesions were found on pigs examined postmortem and Pasteurella multocida was isolated from the lungs of pigs in all the herds. Mycoplasma hyopneumoniae infection was confirmed either by detection in pneumonic lungs or by seroconversion in pigs sampled three weeks apart. P multocida, Bordetella bronchiseptica and Actinobacillus pleuropneumoniae were isolated from 64 per cent, 50 per cent and 2 per cent, respectively, of 148 nasal swabs. The following variables were significantly different between the treated and untreated groups (P < or = 0.001): the incidence of diseased pigs during the three weeks from the start of treatment (8.1 per cent in treated group v 35.4 per cent in control group), mean daily weight gain over the same period (934 g/day in the treated group v 834 g/day in the control group) and the cure rate of pigs which were diseased at the start of treatment (73.5 per cent in treated group v 35.3 per cent in control group). These data demonstrate that an average dose of 11 mg doxycycline/kg bodyweight per day in feed for eight days was effective in controlling pneumonia due to P multocida and M hyopneumoniae in these fattening pigs.     

Are nasal swabs for swine appropriate for the diagnosis of bacterial pneumonia agents?

Nasal swabs and lungs of 150 pigs with pneumonia were tested by culture at post mortem examination. The isolated agents were Pasteurella multocida (P.m.), P. haemolytica, Bordetella bronchiseptica, Actinobacillus pleuropneumoniae, Staphylococcus aureus, Streptococcus spp. and Escherichia coli. P.m. was most frequently found, and this agent only showed a significant correlation between lungs and nasal swabs. In 80.6% of pigs with P.m. in the lung the agent was detected in the nose, too. Drug resistance patterns of P.m. isolates from lungs and noses of the single animals were identical or similar, also in case of different capsular types. The examination of porcine nasal swabs for bacteria capable of causing pneumonia should be limited to P. multocida. Demonstration of agents in lung material is generally more certain.     

Identification of the replication region of the Lactobacillus acidophilus plasmid pLA106

Several naturally occurring antibiotic resistance plasmids were isolated from Pasteurella multocida type D strains. One plasmid, pPM1, was used to study transfer of DNA among P. multocida strains, and could be transferred into Escherichia coli and some P. multocida isolates. However, pPM1 could only be transferred into the toxigenic P. multocida LFB3 at very low frequency. Plasmid recovered from the electrotransformants could be transferred to LFB3 at high frequency. These plasmid DNAs were resistant to PstI, and sensitive to DpnI digestion. Sensitivity to DpnI was common to all the P. multocida DNAs, but resistance to PstI was confined to LFB3. Plasmid pPM1 treated with PstI methylase was able to transform LFB3 at an increased frequency compared to unmethylated DNA, suggesting that LFB3 has a restriction system which cleaves at or near PstI sites.     

Dysphagia in patients with inclusion body myositis

OBJECTIVE: To determine whether ampicillin- and tetracycline-resistant strains of Pasteurella multocida and P haemolytica isolated from California cattle with pneumonia were spatially and temporally clustered and to compare overall estimates of percentages of these isolates resistant to these antimicrobials with estimates obtained on the basis of regional and temporal information. DESIGN: Epidemiologic study. SAMPLE POPULATION: Records of P multocida and P haemolytica isolates obtained from lung or tracheal wash samples collected from California cattle with pneumonia between July 1, 1991 and July 31, 1996. Only isolates obtained from samples submitted by dairies and calf ranches were used. PROCEDURE: Spatial clustering of ampicillin- and tetracycline-resistant isolates was assessed by use of nearest-neighbor and Cuzick and Edwards' analyses. Linear clustering along a north-south line was assessed by use of runs and maximum length of runs tests. Temporal clustering was assessed by use of scan tests. Spatial-temporal clustering was assessed by use of Barton's method. Regional estimates of percentages of P multocida and P haemolytica resistant to ampicillin or tetracycline were calculated. RESULTS: There was significant spatial clustering of resistant isolates and significant linear clustering along a north-south line. Significant differences in regional estimates of percentages of antimicrobial-resistant isolates were found. CLINICAL IMPLICATIONS: Results support the hypothesis that antimicrobial-resistant organisms can be clustered at the local level and reinforce the need to establish regional estimates of percentages of bacterial isolates that will be susceptible to commonly used antimicrobials.     

Genetic diversity of Borrelia burgdorferi in lyme disease patients as determined by culture versus direct PCR with clinical specimens

Two hundred seventeen isolates of Borrelia burgdorferi originally cultured from skin biopsy samples or blood of early Lyme disease patients were genetically characterized by PCR-restriction fragment length polymorphism (RFLP) typing of the 16S-23S ribosomal DNA intergenic spacer. Three major RFLP types were observed. Of the cultured isolates, 63 of 217 (29.0%) were type 1, 85 of 217 (39.2%) were type 2, and 58 of 217 (26.7%) were type 3; mixtures of two RFLP types were obtained in 6.0% (13 of 217) of the cultures. Comparison of typing of B. burgdorferi performed directly on 51 patient skin specimens with typing of cultures originally isolated from the same tissue revealed that a much larger proportion of direct tissue samples had mixtures of RFLP types (43.1% by direct typing versus 5.9% by culture [P < 0.001). In addition, identical RFLP types were observed in only 35.5% (11 of 31) of the paired samples. RFLP type 3 organisms were recovered from blood at a significantly lower rate than were either type 1 or type 2 strains. These studies demonstrate that the genetic diversity of B. burgdorferi patient isolates as determined by cultivation differs from that assessed by PCR performed directly on patient tissue.     

Antibody responses of cattle to outer membrane proteins of Pasteurella multocida A:3

OBJECTIVE: To quantify the serum antibody responses to Pasteurella multocida A:3 outer membrane proteins (OMP) for cattle vaccinated with the homologous serogroup and to correlate those responses with the extent of experimentally induced pneumonia. ANIMALS: 29, 5- to 8-month-old beef-type calves. PROCEDURE: Calves were vaccinated SC or by aerosal exposure on days 0 and 7 with live or killed P multocida or phosphate-buffered saline solution (control) and subsequently challenge exposed with virulent P multocida. Antibody responses to P multocida A:3 outer membranes were quantified, using an ELISA. Antibody responses to individual OMP were detected by immunoblot analysis (western blot) and were quantified by densitometry. Antibody responses were compared among groups of calves and for various times after vaccination. Regression analyses were used to determine whether significant correlations existed between lesion scores and antibody responses to either whole outer membranes or to individual OMP. RESULTS: By ELISA, antibody responses to outer membranes for calves aerosol vaccinated with live P multocida were significantly (P < 0.05) greater than those for control calves or for killed P multocida vaccinates. There was a significant (P < 0.05) correlation between lesion score and antibody responses to outer membranes. By western blotting and densitometry, antibodies to 11 prominent OMP (100, 97, 90, 85, 74, 53, 46, 35, 32, 21, and 16 kd) were identified and quantified. In experiment 1, SC vaccination with live P multocida increased antibody binding to all protein bands except 85-, 74-, and 35-kd bands. Aerosol vaccination with live P multocida stimulated increases in antibody binding to all bands except 100 and 16 kd. Antibody responses to the 97-, 90-, 74-, and 35- kd bands were significantly (P < 0.05; greater for live aerosol vaccinates than for control calves. In experiment 2, antibody responses were not different between the killed P multocida vaccinates or control calves Antibody responses for live P multocida aerosol vaccinates were significantly (P < 0.05) greater than those for control calves for the 100-, 90-, 85-, 74-, 53-, 35-, and 16-kd bands. Regression analyses indicated significant correlations (P < 0.05) between lesion score and antibody responses to the 100-, 90-, 53-, 46-, 35-, and 32-kd OMP. CONCLUSIONS: Several OMP of P multocida type A:3 may be important for stimulating immunity to the organism in cattle.     

Characterization of axenic isolates of Giardia intestinalis established from humans and animals in Germany

A total of 15 isolates of Giardia intestinalis, the first axenic cultures of this organism to be described from Germany, were established in Bonn from faecal cysts obtained from human and animal stool specimens. Measurement of in vitro growth kinetics for 12 of the isolates revealed 3 phenotypes ('rapid', 'medium-rate' and 'slow' growers) characterized by generation times of 9-11 h (5 isolates), 12-15 h (5 isolates) and > or = 18-20 h (2 isolates), respectively. Cloned sublines exhibited growth rates similar to those of the parent isolates. Genetic analyses involving use of the polymerase chain reaction to amplify segments of genes encoding variant-specific surface proteins or the enzyme glutamate dehydrogenase, coupled with the detection of restriction-fragment-length polymorphisms, identified genotypes belonging to three previously described genetic groups. Seven isolates (from humans, a calf and a chinchilla) were typed to genetic group I--a potentially zoonotic genotype belonging to assemblage A, one of two major genetic lineages defined by analysis of G. intestinalis from humans and animals. Six isolates (all from humans) showed identity with the group II genotype--recovered thus far only from humans and also belonging to assemblage A. Two isolates (one from a human, the other from a monkey housed at the Cologne zoo) were classified as assemblage B genotypes. The in vitro growth rates correlated strongly with genotype, group I or group II (assemblage A) genotypes accounting for all of the 'rapid' and 'medium-rate' cultures and both assemblage B isolates being 'slow growers'. The data indicate that genetically based metabolic differences may determine how rapidly G. intestinalis isolates can grow in axenic culture.     

Molecular markers for differentiation of multiresistant Klebsiella pneumoniae isolates in a pediatric hospital

OBJECTIVE: To study the spread of extended-spectrum beta-lactamase-producing, but aminoglycoside-susceptible, Klebsiella pneumoniae strains in our hospital over an 8-month period, by using two genotypic markers. DESIGN: Ribotyping (using two endonucleases) and randomly amplified polymorphic DNA analysis (RAPD; using two different 10-mer primers) were applied to the epidemiological typing of clinical K pneumoniae isolates from stools, ileal fluid, or urine of hospitalized children. SETTING AND PATIENTS: The surgical intensive-care ward (S1: 9 patients, 17 isolates), surgical unit (S2: 2 patients, 2 isolates), and gastroenterology ward (GE: 1 patient, 1 isolate) of the Robert Debré Hospital of Paris, France. RESULTS: Ribotyping of the 20 clinical isolates, the type strain of the species, and two epidemiologically unrelated isolates with EcoRI and HindIII revealed 6 and 5 different patterns, respectively. Six ribotypes were identified by using these two enzymes. RAPD generated 6 distinct patterns, in complete agreement with ribotyping. Our genotypic results showed that 11 patients from wards S1, S2, and GE harbored genotypically related strains, suggesting nosocomial transmission and cross-colonization between and within the three wards. CONCLUSIONS: Ribotyping and RAPD appear to be reliable methods for distinguishing K pneumoniae strains. The spread of one strain of K pneumoniae in different units of our hospital was demonstrated by both methods. However, RAPD has the advantage of simplicity and rapidity conferred by polymerase chain reaction.     

Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group

BACKGROUND AND METHODS: To define better the bacteria responsible for infections of dog and cat bites, we conducted a prospective study at 18 emergency departments. To be eligible for enrollment, patients had to meet one of three major criteria for infection of a bite wound (fever, abscess, and lymphangitis) or four of five minor criteria (wound-associated erythema, tenderness at the wound site, swelling at the site, purulent drainage, and leukocytosis). Wound specimens were cultured for aerobic and anaerobic bacteria at a research microbiology laboratory and, in some cases, at local hospital laboratories. RESULTS: The infected wounds of 50 patients with dog bites and 57 patients with cat bites yielded a median of 5 bacterial isolates per culture (range, 0 to 16) at the reference laboratory. Significantly more isolates grew at the reference laboratory than at the local laboratories (median, 1; range, 0 to 5; P<0.001). Aerobes and anaerobes were isolated from 56 percent of the wounds, aerobes alone from 36 percent, and anaerobes alone from 1 percent; 7 percent of cultures had no growth. Pasteurella species were the most frequent isolates from both dog bites (50 percent) and cat bites (75 percent). Pasteurella canis was the most common isolate of dog bites, and Past. multocida subspecies multocida and septica were the most common isolates of cat bites. Other common aerobes included streptococci, staphylococci, moraxella, and neisseria. Common anaerobes included fusobacterium, bacteroides, porphyromonas, and prevotella. Isolates not previously identified as human pathogens included Reimerella anatipestifer from two cat bites and Bacteroides tectum, Prevotella heparinolytica, and several porphyromonas species from dog and cat bites. Erysipelothrix rhusiopathiae was isolated from two cat bites. Patients were most often treated with a combination of a beta-lactam antibiotic and a beta-lactamase inhibitor, which, on the basis of the microbiologic findings, was appropriate therapy. CONCLUSIONS: Infected dog and cat bites have a complex microbiologic mix that usually includes pasteurella species but may also include many other organisms not routinely identified by clinical microbiology laboratories and not previously recognized as bite-wound pathogens.     

Virulence of capsulated and noncapsulated isolates of Pasteurella multocida and their adherence to porcine respiratory tract cells and mucus

The virulence and the adherence to porcine respiratory tract cells and mucus of three toxigenic, capsular type D Pasteurella multocida isolates and their noncapsulated variants were evaluated in the present study. Loss of capsule by P. multocida, verified by transmission electron microscopy after polycationic ferritin labeling, was associated with a massive reduction in virulence of the organisms in mice. Specific-pathogen-free piglets inoculated intranasally with one of the capsulated isolates or its noncapsulated variant developed turbinate lesions characterized by bone resorption and by an inflammation of the mucosa associated with hyperplasia and squamous metaplasia of the epithelium. Infection with the capsulated isolate led to more severe lesions and atrophy of turbinates. The interactions of these P. multocida isolates with porcine respiratory tract cells and mucus were studied in vitro. The presence of capsule resulted in a decrease in binding of respiratory tract mucus were studied in vitro. The presence of capsule resulted in a decrease in binding of respiratory tract mucus to P. multocida isolates as determined by a dot blot assay. The presence of capsule also resulted in a significant decrease in adherence to porcine tracheal rings maintained in culture. The capsule seemed to mask outer membrane components which are involved in adherence. One of these components might be lipopolysaccharide since purified lipopolysaccharide bound respiratory tract mucus and blocked adherence of this microorganism to porcine tracheal rings. Our data indicate that capsular material does not seem to be involved in adherence of P. multocida to respiratory tract cells and mucus, but capsulated isolates are more virulent in mice and also in piglets.     

Haemorrhagic septicaemia vaccines

Haemorrhagic septicaemia (HS), an economically important disease of cattle and buffaloes, is caused by Pasteurella multocida (6:B). Vaccination against this disease is widely practised. Plain broth bacterins, or alum precipitated and aluminium hydroxide gel vaccines are administered twice a year since these vaccines offer an immunity of 4-6 months. Many countries use oil adjuvant vaccine (OAV), which gives both a higher degree and a longer duration of immunity up to 1 year. A double emulsion and multiple emulsion vaccine consisting of a thin viscosity have also been experimentally developed that gave an immunity parallel to OAV. Recently, a live vaccine developed from a fallow deer strain (B:3,4) has been used in Myanmar that offers an immunity for more than a year but is not free from constraints. The present review provides information on HS vaccines developed from time to time using whole bacteria or their components. The kinetics and isotype of antibody and cell-mediated immune responses have also been poorly understood so far, and hence information on their role in protection against HS is reviewed.     

Diagnosis and management of asthma: occupational health nurses'' awareness and use of national consensus practice guidelines

In 7 patients who received liver transplants, 12 plasma proteins were subjected to phenotype analysis in donor and recipient before and after transplantation. The plasma proteins analyzed were haptoglobin, transferrin, glycoprotein GC, alpha-1-antitrypsin, complement factor 3 (C3), orosomucoid 1, properdin factor B, complement factor 6, alpha-2-HS-glycoprotein (A2HS), plasminogen, factor B of coagulation factor XIII, and interalpha-trypsin-inhibitor (ITI). Classification was done with isoelectric focusing or agarose gel electrophoresis (C3). A change from recipient to donor type was observed for all systems with the exception of C3. This is the first time such data have been obtained for the A2HS and ITI systems. The time is indicated at which the recipient type disappeared and the donor type appeared. In addition to the expected phenotype changes from recipient to donor type, unexpected results were found in some systems. For instance, in 2 patients a mixed type was synthesized, or new phenotypes appeared. Possible explanations include blood transfusions, immunosuppressive therapy, extrahepatic sites of synthesis and disturbed transplant function. The usefulness of phenotype determination as a diagnostic criterion for transplant function is discussed.