An analysis of staining methods for the detection of Cryptosporidium spp. oocysts in water-related samples

The ability of five staining techniques, originally developed for the rapid identification of Cryptosporidium spp. oocysts in faecal samples, to detect oocysts in water and water-related samples was assessed. All the stains used (modified Ziehl Neelsen, auramine-phenol (Lempert), Wright-Giemsa, safranin-methylene blue and FITC-labelled monoclonal antibody) stained oocysts after storage in water for 2 months at 4 degrees C (71-89% of control values). Storage of oocysts below 0 degrees C greatly reduced the staining ability of auramine-phenol. With the exception of oocysts stored in raw and final waters, the histochemical stains proved less useful in detecting oocysts than the monoclonal antibody. Organisms of similar size and shape took up these stains, causing confusion in interpretation. Cold Ziehl Neelsen and the FITC-labelled monoclonal antibody were best at identifying oocysts from a waterborne outbreak. Screening with a fluorescent antibody, followed by confirmation with cold Ziehl Neelsen, where possible, are the currently recommended procedures for the detection of oocysts in water-related samples.

A comparison of fluorescein diacetate and propidium iodide staining and in vitro excystation for determining Giardia intestinalis cyst viability

The viability of 4 human isolates of Giardia intestinalis cysts using either the fluorogenic vital dyes fluorescein diacetate (FDA) and propidium iodide (PI) or in vitro excystation was assessed. Whereas viable cysts, as defined by in vitro excystation were present in each of the 4 isolates, cysts from only 3 of the 4 isolates took up the vital dyes. FDA consistently over-estimated cyst viability whilst PI under-estimated non-viable cysts when compared with in vitro excystation. Following in vitro excystation, both FDA and PI stained a proportion of unexcysted cysts indicating that FDA stained cysts which were incapable of excystation, whereas PI did not stain all cysts which were incapable of excystation. One human cyst isolate, which underwent in vitro excystation, could not be stained with either FDA or PI. In the absence of currently more specific fluorescent indicators of viability, PI alone could be used to determine the lower limit of nonviability in positive water-related samples, where small numbers of cysts are to be expected.

Genetic relatedness of antibiotic resistance determinants in multiply resistant Hemophilus influenzae

Antimicrobial resistance determinants and plasmids present in 10 multiply antibiotic-resistant strains of Hemophilus influenzae isolated from patients in different geographic regions of Spain were characterized. Conjugative plasmids with molecular sizes of 38-50 MDa encoded resistance to ampicillin, chloramphenicol, kanamycin, streptomycin, sulfamethoxazole, and tetracycline. Trimethoprim resistance was not linked to the other antibiotic resistance determinants and trimethoprim-resistant transconjugants and transformants lacked detectable plasmid DNA, suggesting that this determinant is chromosomal. Restriction endonuclease analysis revealed similarities among the plasmids, but several restriction patterns could be distinguished. Three hybridization patterns were found with DNA probes coding for H. parainfluenzae beta-lactamase and chloramphenicol-acetyltransferase. Resistance to kanamycin was due to drug modification by aminoglycoside-phosphotransferase (3')I. In Spain, it appears that multiple antibiotic resistance phenotypes in H. influenzae did not arise from acquisition of a single R plasmid; rather, both plasmid and chromosomal resistance evolved independently from several sources.

Psychiatric disorders in the first-degree relatives of probands with bulimia nervosa

Data from a family study of psychiatric disorders showed higher rates of major affective disorders, eating disorders, and alcoholism in first-degree relatives of 40 bulimic probands than in first-degree relatives of 24 control subjects. More importantly, the data showed higher rates of major affective disorders in relatives of bulimic probands who themselves had no history of major affective disorders than in relatives of control subjects. This significant finding indicates a familial relationship between bulimia nervosa and major affective disorders, which suggests the possibility of a common diathesis.

Endobronchial infection in cystic fibrosis

In symptomatic patients with cystic fibrosis, the recovery of bacteria in an inflammatory exudate from the lower respiratory tract is strong evidence of endobronchitis. It is not known when this chronic infection begins, the etiologic agents during infancy or the mechanism of evolution from Haemophilus influenzae and Staphylococcus aureus to Pseudomonas aeruginosa. Antibiotic administration to "suppress" the infection in relatively well patients is an unproven benefit. During an exacerbation of bronchitis, administration of appropriate antibiotics decreases sputum bacterial density and is accompanied by decreased amounts of indicators of inflammation in sputum: pulmonary function improves, particularly that reflecting medium to small airway status. In the future aggressive diagnostic procedures will be followed by therapeutic and prophylactic antibiotic administration conducted in a manner to minimize emergence of antibiotic-resistant bacteria. Adjunctive therapy, to minimize those aspects of the host response which inflict lung damage, will become standard.

In vitro activities and targets of three cephem antibiotics against Haemophilus influenzae

The antimicrobial activities of cefixime, cefpodoxime, and ceftibuten were determined with 18 ampicillin-susceptible (Amps), 13 ampicillin-resistant beta-lactamase-producing (AmprBLP), and 7 ampicillin-resistant non-beta-lactamase-producing (AmprNBLP) strains of Haemophilus influenzae. An effect of inoculum density on apparent MIC, the bactericidal activity of these agents, and the targets of the three cephems were determined. The MICs of cefixime, cefpodoxime, and ceftibuten for 90% of the Amps and AmprBLP isolates were 0.04, 0.08, and 0.08 microgram/ml, respectively. In contrast, the MICs for 90% of the AmprNBLP strains were 0.96, 1.92, and 7.68 micrograms/ml. No significant inoculum effect was observed for any group of strains comparing inocula of 10(3) and 10(5) CFU, whereas only the AmprNBLP isolates showed a marked effect at an inoculum of 10(6) CFU. Although bactericidal levels were achieved for the Amps and AmprBLP strains, tolerance to cefixime and ceftibuten was observed. The bactericidal activity for the AmprNBLP strains was limited, with cefixime showing the highest activity of the three cephems. Penicillin-binding proteins 2, 4, and 5 revealed high affinity, with 50% inhibitory concentration levels below the MIC for all three cephems, suggesting that these are important targets of these agents in H. influenzae. We conclude that the cephems are highly active in vitro against Amps and AmprBLP strains of H. influenzae, but less so against AmprNBLP isolates.

Persistence of rat parvovirus in athymic rats

Euthymic (SD or outbred rnu/+) and athymic (rnu/rnu) rats were inoculated oronasally or intraperitoneally with the RV-Y strain of rat virus when they were 2 days or 4 weeks old. Clinical signs of infection in athymic infants were similar to those in euthymic infants, but significantly more athymic infants died. Some infants developed anemia and thrombocytopenia. After inoculation of infants. RV-Y was detected in surviving euthymic rats for 7 weeks and in surviving athymic rats for at least 10 weeks. After oronasal inoculation of 4 week-old rats no clinical illness was observed. RV-Y persisted less than 6 weeks in juvenile euthymic rats but at least 12 weeks in athymic juvenile rats. Intraperitoneal inoculation of juveniles resulted in infection for at least 6 weeks. The antibody response of athymic rats to RV-Y was significantly reduced compared to that of euthymic rats. These studies indicate that T cell deficiency increases the severity and duration of RV infection and imply that T cells are required for the full expression of resistance to RV infection. They also suggest that RV-Y induced anemia could serve as a model for human parvovirus-induced anemia.

The impact of Haemophilus influenzae type b meningitis on nutritional status

We investigated the immediate impact and long-term effects of Haemophilus influenzae type b meningitis on nutritional status and growth in 111 children. Mean weight change during 10 d of hospitalization was a loss of less than 1%. Follow-up median weight-for-height percentiles increased after admission (p less than 0.01). Percentile values were as follows: admission, 45th; 1 mo, 60th; 3 mo, 60th; and 6 mo, 68th. Forty-three percent of the cases were greater than 75th percentile of weight-for-height at 6 mo after disease. An additional follow-up assessment of weight-for-height indicated that 43% of a representative sample subset of 49 were still obese 1.17-5.5 y after disease. Significant differences in median concentrations of serum prealbumin were found between days 1 (128 mg/L) and 5 (199 mg/L, p less than 0.0001) and days 5 and 10 (214 mg/L, p less than 0.02). Median erythrocyte glutathione reductase activity coefficients increased between days 1 (1.16) and 5 (1.20, p less than 0.01). The mean free erythrocyte protoporphyrin-heme ratio increased between days 5 (10.78 X 10(-6)) and 10 (14.22 X 10(-6), p less than 0.01). We conclude that there were transient adverse changes in nutritional status. Obesity appears to occur after disease.

In vitro evaluation of the determinants of bactericidal activity of ampicillin dosing regimens against Escherichia coli

An in vitro flow model was used to examine the influence of peak concentration (Cmax), the area under the antibiotic concentration-time curve (AUC), the magnitude of AUC above the MIC, and the aggregate time the antibiotic concentration exceeds the MIC (TMIC) on the bactericidal effect of ampicillin against Escherichia coli ATCC 12407. Bacteria in the log phase were exposed to therapeutically realistic drug regimens. Ampicillin concentration and bacterial density (CFU per milliliter) were measured over time. Four parameters reflecting bactericidal activity were quantitated: difference between initial and minimum and initial and final bacterial densities, area under the bacterial density-time curve, and a fourth parameter, sigma, which is a function of these three. Multiple regression analysis confirmed AUC as the major factor in predicting bactericidal activity. An AUC of greater than 70 micrograms.h/ml correlated with the lack of emergence of resistance.

The effect of respiratory viral infections on patients with cystic fibrosis

We examined, in a 2-year prospective study, the frequency of respiratory viral infections in 19 school-age patients with cystic fibrosis and their unaffected siblings. At 2-month intervals throughout the study period, pulmonary function tests, oropharyngeal cultures, and serologic tests for respiratory viruses were performed in all subjects. Quantitative sputum cultures for bacteria were performed in subjects with cystic fibrosis. The same laboratory specimens were also collected at the time of all acute respiratory illnesses. Over the 2-year period, 398 viral cultures and serum samples were collected, 210 from patients with cystic fibrosis and 188 from their siblings. The frequency of culture-documented and seropositive viral infections was not significantly different between patients with cystic fibrosis and their siblings. The patients with the highest frequency of viral infection were younger and had the lowest rate of decline in lung function and severity score. We conclude that school-age patients with cystic fibrosis are no more susceptible to viral infections than their unaffected siblings. We were unable to demonstrate any significant adverse effect of respiratory viral infections on pulmonary function in 19 patients with cystic fibrosis aged 5 to 21 years.

The in vitro unscheduled DNA synthesis (UDS) assay in rat primary hepatocytes: evaluation of 2-furoic acid and 7 drug candidates

The in vitro unscheduled DNA synthesis assay (UDS) is part of the routine genetic toxicology screening at The Upjohn Company. The purpose of this paper is to report results for 8 compounds which were tested in the in-house genetic toxicology program. These compounds represent diverse chemical structure and most of them entered the screening program because they are biologically active in efficacy screens. All tests were carried out under Good Laboratory Practices Regulations of the U.S. Food and Drug Administration. None of the materials reported here produced an increase in UDS and therefore the UDS results with these compounds do not suggest potential for genotoxicity.

Gallstone disease. The clinical manifestations of infectious stones

Gallstones from 82 patients were examined under a scanning electron microscope for evidence of bacteria, and the findings were compared with the clinical manifestations of the disease. Bacteria were present in 68% of pigment stones and the pigment portions of 80% of composite stones. These gallstones were referred to as infectious stones. No bacteria were found in cholesterol gallstones. Acute cholangitis was diagnosed in 52% of patients with infectious stones and in 18% of patients with noninfectious stones. Over half of the patients with noninfectious stones presented with mild symptoms. Infectious stones were more often associated with a previous common duct exploration, an urgent operation, infected bile, a common duct procedure, and complications. These data show that gallstone disease is more virulent in patients whose gallstones contain bacteria.

Interannual variation of the incidence of Haemophilus influenzae type b meningitis

We conducted a population-based retrospective cohort study to define the annual age-specific incidence of Haemophilus influenzae type b meningitis for birth to 5-year-old residents of King County, Washington, from January 1977 through December 1986. We found naturally occurring wide interannual variations in incidence. The standard deviations of the age-specific incidence during the eight years before the introduction of H influenzae vaccine varied from 26% to 115% of the mean. If short-term changes in incidence were used to assess the efficacy of an H influenzae vaccine (which is less than 100% efficacious and not administered to all susceptible children), the conclusions could be erroneous. To avoid this bias, long-term cohort studies, case/control studies using concurrent controls, or large clinical trials are better choices. We found no significant change in overall incidence during the ten-year study period.

The in vitro unscheduled DNA synthesis (UDS) assay in rat primary hepatocytes. Validation of improved methods for primary culture including data on the lack of effect of ionizing radiation

The in vitro unscheduled DNA synthesis (UDS) assay was evaluated for inclusion in a battery of assays used at The Upjohn Company for evaluation of lead compounds in the development of new and existing drug entities. This evaluation process encompassed aspects of the isolation of hepatocytes and tests of reference mutagens and genotoxins. The flow rate of perfusion solutions and their temperatures were critical in the isolation of high viability hepatocytes in good yield. The attachment of freshly isolated hepatocytes to coverslips was greatly enhanced by coating the coverslips with type III collagen. Results of testing 12 known genotoxic agents (UV light, cyclophosphamide, 7,12-dimethylbenzanthracene, dimethylnitrosamine, diethylnitrosamine, 2-acetylaminofluorene, benzo[a]pyrene, methyl methanesulfonate, ethyl methanesulfonate, N-propyl-N'-nitro-N-nitrosoguanidine, benzidine and 4-aminobiphenyl) were in agreement with the literature. The use of X-ray did not induce unscheduled DNA synthesis in hepatocytes. This latter finding draws attention to the inability of this assay to detect agents which result in 'short-patch' repair of damage.

Comparison of isolation in cell culture with conventional and modified mouse antibody production tests for detection of murine viruses

The sensitivity of the mouse antibody production test with intraperitoneal or intrasplenic inoculation of mice with reovirus type 3, minute virus of mice, lymphocytic choriomeningitis virus, or mouse hepatitis virus was compared with that of direct isolation in cultured cells. The mouse antibody production test for detection of mouse hepatitis virus was significantly more sensitive than virus isolation in permissive cells, but differences in sensitivity were less marked for the other three viruses. The intrasplenic route of inoculation did not yield seroconversion that occurred earlier or more consistently than that detected after intraperitoneal inoculation.

Duration of challenge immunity to coronavirus JHM in mice

The duration of challenge resistance in mice immunized with mouse hepatitis virus (MHV) strain JHM was examined as a model of immunity to corona-virus infection. Genetically susceptible BALB/cByJ mice were immunized by intranasal (i.n.) or per os (p.o.) inoculation with MHV-JHM or sterile tissue culture fluid (sham) then challenged i.n. with MHV-JHM or sterile tissue culture fluid 1, 6, or 12 months later. Four days after challenge, virus in nasal turbinates and liver was quantified, and prevalence of microscopic lesions in liver and gut-associated lymphoid tissue was tabulated as indices of challenge resistance. MHV-immunized and challenged groups were compared to sham-immunized and challenged groups. Mice immunized by i.n. inoculation were strongly resistant to challenge at 1, 6, and 12 months. Mice immunized by p.o. inoculation were resistant at 1 month, but became partially susceptible to reinfection at 6 and 12 months, based upon all indices. These data indicate that, depending upon route of immunization, mice can become susceptible to reinfection with the same coronavirus strain over time.

High compared with standard dose lipase pancreatic supplement

Cotazym-S-Forte, a new pancreatic supplement containing 10,000 BP units of lipase activity per capsule, was compared with a standard dose pancreatin supplement (Pancrease) with 5000 BP units lipase activity in a randomised crossover trial. The number of capsules of Cotazym-S-Forte administered was half the usual number of Pancrease capsules and was associated with the same degree of fat absorption as Pancrease.

Safety of aerosol tobramycin administration for 3 months to patients with cystic fibrosis

To determine the potential toxicity of prolonged aerosol tobramycin administration, 22 patients with cystic fibrosis were monitored while receiving inhaled tobramycin three times a day for 12 weeks. Prior to, four times during administration and approximately 6 weeks after discontinuation of treatment, we assessed pulmonary function, weight, height, body temperature, eighth cranial nerve function, serum creatinine, blood urea nitrogen, urinary creatinine clearance, plasma iothalamate clearance, urinary beta-2 microglobulin concentration, and Pseudomonas aeruginosa density in sputum. There was no detectable laboratory evidence of nephrotoxicity. Neither a decrease in auditory acuity (range 250-20,000 Hz) nor vestibular dysfunction was detected. Pulmonary function tests significantly improved during the first month in all subjects (P less than 0.05) but returned to enrollment values by the end of the 12th week of administration of tobramycin aerosol. Sputum P. aeruginosa density initially decreased from a mean of 10(7) cfu/gm to a mean of 10(4) cfu/gm after 2 weeks of aerosol tobramycin administration and remained significantly below the enrollment value throughout. Coincident with the reduced bacterial density, a reduction in cough frequency and sputum production, as well as a weight gain was observed. Seventy-three percent of the patients with sputum P. aeruginosa isolates susceptible to tobramycin on enrollment yielded resistant organisms during aerosol administration. However, 1 year later all sputum P. aeruginosa isolates obtained from patients were susceptible to tobramycin. We conclude that thrice daily aerosol tobramycin administration for 3 months is not associated with detectable eighth cranial nerve or renal toxicity. Transient emergence of tobramycin resistant P. aeruginosa may occur.

Virus strain specificity of challenge immunity to coronavirus

The resistance of immunized mice to challenge with the same or a different strain of mouse hepatitis virus (MHV) was examined as a model of challenge immunity to coronavirus infection. Genetically susceptible BALB/cByJ mice were given an intranasal immunizing infection of respiratory-type MHV-JHM, MHV-S, or enterotropic MHV-Y. Control mice were sham-immunized with sterile tissue culture fluid. Recovered mice were challenged intranasally with MHV-JHM, MHV-S or sterile tissue culture fluid at 30 days after immunization. Resistance to challenge inoculation was evaluated in groups of mice at 4 and 30 days after challenge. At 4 days, the prevalence of MHV lesions in nose and liver was tabulated and MHV titers in liver were determined. At 30 days, the prevalence of residual brainstem spongiform lesions was tabulated and serum antibody to MHV-JHM and MVH-S was quantified by enzyme immunoassay. Mice immunized with MHV-JHM or MHV-S resisted challenge with the MHV homotype, but MHV-S-immunized mice were fully susceptible to challenge with MVH-JHM. Mice immunized with enterotropic MHV-Y were only partially protected against challenge with antigenically related, but biologically different MHV-S. Serum antibody responses to MHV supported these observations. These data indicate that challenge immunity to coronaviruses is strong, but highly virus strain-specific.

Randomized treatment of patients with typhoid fever by using ceftriaxone or chloramphenicol

Sixty-three patients with Salmonella typhi infections were randomly assigned to receive either ceftriaxone iv in single daily doses of 75 mg/kg for children and 3-4 g for adults for seven days or to receive 60 mg of chloramphenicol/kg a day orally or iv in four divided doses until defervescence and then 40 mg/kg a day to complete 14 d. In the ceftriaxone group, one death occurred, and two of seven patients still febrile 11 d after starting treatment were given chloramphenicol. In the chloramphenicol group, one death and one gastrointestinal perforation occurred. The probability of remaining febrile was similar for both groups during the first seven days but was significantly greater for patients receiving ceftriaxone during the 14-d period. Patients in the chloramphenicol group were more likely to be bacteremic on day 3. These results suggest that a seven-day course of once-daily ceftriaxone shows promise as an alternative to 14 d of chloramphenicol for treating typhoid fever.

Reference interval for prealbumin for children two to 36 months old

To define a reference value for serum prealbumin (transthyretin) concentration, we used a rate immunonephelometric microassay to quantify it in 76 healthy children, ranging in age from two to 36 months. Age-specific ranges (+/- 2 SD from the mean) are: 2-5.9 months, 142-330 mg/L; 6-11.9 months, 120-274 mg/L; 12-17.9 months, 115-259 mg/L; 18-23.9 months, 143-243 mg/L; 24-36 months, 108-258 mg/L. When the data were grouped into those for subjects younger and older than 12 months of age, the mean for the 2-11.9 month age group (210 mg/L) significantly (P less than 0.01) exceeded that of the 12-36 month age group (187 mg/L). We propose that in spite of a decrease in prealbumin concentration with increasing age, it is acceptable to use the reference interval 116-281 mg/L (+/- 2 SD from the mean) for children from two to 36 months old. We also compared concentrations of prealbumin in serum and plasma of 41 individuals, finding the mean difference to be +11.7 mg/L; concentrations in plasma averaged 6.7% greater than those in serum.