Predicting future occlusion or stenosis of lower extremity bypass grafts using artificial intelligence to simultaneously analyze all flow velocities collected in current and previous ultrasound examinations

Objective

Routine surveillance with duplex ultrasound (DUS) examination is recommended after femoral-popliteal and femoral-tibial-pedal vein bypass grafts with various intervals postoperatively. The presently used methodology to analyze bypass graft DUS examination does not use all the available data and has been shown to have a significant rate for missing impending bypass graft failure. The objective of this research is to investigate recurrent neural networks (RNNs) to predict future bypass graft occlusion or stenosis.

Methods

This study includes DUS examinations of 663 patients who had bypass graft operations done between January 2009 and June 2022. Only examinations without missing values were included. We developed two RNNs (a bidirectional long short-term memory unit and a bidirectional gated recurrent unit) to predict bypass graft occlusion and stenosis based on peak systolic velocities collected in the 2 to 5 previous DUS examinations. We excluded the examinations with missing values and split our data into training and test sets. Then, we applied 10-fold cross-validation on training to optimize the hyperparameters and compared models using the test data.

Results

The bidirectional long short-term memory unit model can gain an overall sensitivity of 0.939, specificity of 0.963, and area under the curve of 0.950 on the prediction of bypass graft occlusion, and an overall sensitivity of 0.915, specificity of 0.909, and area under the curve of 0.912 predicting the development of a future critical stenosis. The results on different bypass types show that the system performs differently on different types. The results on subcohorts based on gender, smoking status, and comorbidities show that the performance on current smokers is lower than the never smoker.

Conclusions

We found that RNNs can gain good sensitivity, specificity, and accuracy for the detection of impending bypass graft occlusion or the future development of a critical bypass graft stenosis using all the available peak systolic velocity data in the present and previous bypass graft DUS examinations. Integrating clinical data, including demographics, social determinants, medication, and other risk factors, together with the DUS examination may result in further improvements.

Clinical Relevance

Detecting bypass graft failure before it occurs is important clinically to prevent amputations, salvage limbs, and save lives. Current methods evaluating screening duplex ultrasound examinations have a significant failure rate for detecting a bypass graft at risk for failure. Artificial intelligence using recurrent neural networks has the potential to improve the detection of at-risk bypass graft before they fail. Additionally, artificial intelligence is in the news and is being applied to many fields. Vascular surgeons need to know its potential to improve vascular outcomes.

A new noninvasive and patient-specific hemodynamic index for the severity of renal stenosis and outcome of interventional treatment

Renal arterial stenosis (RAS) often causes renovascular hypertension, which may result in kidney failure and life-threatening consequences. Direct assessment of the hemodynamic severity of RAS has yet to be addressed. In this work, we present a computational concept to derive a new, noninvasive, and patient-specific index to assess the hemodynamic severity of RAS and predict the potential benefit to the patient from a stenting therapy. The hemodynamic index is derived from a functional relation between the translesional pressure indicator (TPI) and lumen volume reduction (S) through a parametric deterioration of the RAS. Our in-house computational platform, InVascular, for image-based computational hemodynamics is used to compute the TPI at given S. InVascular integrates unified computational modeling for both image processing and computational hemodynamics with graphic processing unit parallel computing technology. The TPI-S curve reveals a pair of thresholds of S indicating mild or severe RAS. The TPI at S = 0 represents the pressure improvement following a successful stenting therapy. Six patient cases with a total of 6 aortic and 12 renal arteries are studied. The computed blood pressure waveforms have good agreements with the in vivo measured ones and the systolic pressure is statistical equivalence to the in-vivo measurements with p < .001. Uncertainty quantification provides the reliability of the computed pressure through the corresponding 95% confidence interval. The severity assessments of RAS in four cases are consistent with the medical practice. The preliminary results inspire a more sophisticated investigation for real medical insights of the new index. This computational concept can be applied to other arterial stenoses such as iliac stenosis. Such a noninvasive and patient-specific hemodynamic index has the potential to aid in the clinical decision-making of interventional treatment with reduced medical cost and patient risks.

Phylogenetic diversity and position of the genus Campylobacter

RNA sequence analysis has been used to examine the phylogenetic position and structure of the genus Campylobacter. A complete 5S rRNA sequence was determined for two strains of Campylobacter jejuni and extensive partial sequences of the 16S rRNA were obtained for several strains of C. jejuni and Wolinella succinogenes. In addition limited partial sequence data were obtained from the 16S rRNAs of isolates of C. coli, C. laridis, C. fetus, C. fecalis, and C. pyloridis. It was found that W. succinogenes is specifically related to, but not included, in the genus Campylobacter as presently constituted. Within the genus significant diversity was noted. C. jejuni, C. coli and C. laridis are very closely related but the other species are distinctly different from one another. C. pyloridis is without question the most divergent of the Campylobacter isolates examined here and is sufficiently distinct to warrant inclusion in a separate genus. In terms of overall position in bacterial phylogeny, the Campylobacter/Wolinella cluster represents a deep branching most probably located within an expanded version of the Division containing the purple photosynthetic bacteria and their relatives. The Campylobacter/Wolinella cluster is not specifically includable in either the alpha, beta or gamma subdivisions of the purple bacteria.

A colony lift immunoassay for the specific identification and quantification of Listeria monocytogenes

A colony lift immunoassay (CLI) has been developed to detect Listeria monocytogenes after the organisms have been cultured on filter membranes or agar plates. Polyvinylidene fluoride membranes (PVDF) (Millipore, Bedford, MA), used in the CLI, were prewet with methanol and used to imprint colonies that were grown on the filter or agar plates. A positive control was applied to the edge of each membrane. The imprinted membranes were subsequently air dried, peroxidase neutralized, blocked, and reacted for 20 min with a 2-microg/ml unconjugated Mab EM-7G1 solution. The membranes were washed briefly and reacted for 30 min with a 1:2000 dilution of a commercially prepared peroxidase-labeled goat anti-mouse secondary antibody (Kirkegaard and Perry Laboratories (KPL), Gaithersburg, MD). After a second wash step, the membranes were exposed to a 3,3',5, 5'-tetramethylbenzidine membrane substrate (KPL), rinsed in deionized water, and allowed to dry. Colonies of L. monocytogenes were identified by a blue color reaction on the membrane, which could be used to reference the colonies either on the filter membranes or agar plates. The CLI was tested against a wide range of Listeria species as well as several non-Listeria species and was shown to have a high degree of sensitivity (96%) and specificity (90%). We have shown that it is useful as a simple and rapid method to detect and identify L. monocytogenes.

Development and evaluation of a 24-hour method for the detection and quantification of Listeria monocytogenes in meat products

A 24-h filter monitor-based test, Listeria-SELeCT, has been developed to quantify Listeria monocytogenes organisms in meat samples with a sensitivity of < or = 1.0 CFU/g. The technique comprises a filter monitor-based system and a colony lift immunoassay to identify and enumerate the target organism. Meat homogenates were centrifuged and the eluate was filtered to trap and immobilize the microorganisms on the filter. Fraser broth was then added to the filter apparatus to allow the organisms to become established overnight and to inhibit contaminants, after which the filters were transferred onto Modified Oxford medium agar, a selective medium for L. monocytogenes. After 10 to 12 h, a colony lift immunoassay was used to confirm and enumerate suspect colonies on the filter. A correlation study between the Listeria-SELeCT method and the most probable number technique showed the Listeria-SELeCT to be considerably more accurate than the most probable number for quantitatively determining the number of viable organisms in meat samples. Because of ease and speed of testing, the Listeria-SELeCT system also provided major advantages over the most probable number technology.

Development of a colony lift immunoassay to facilitate rapid detection and quantification of Escherichia coli O157:H7 from agar plates and filter monitor membranes

E. coli O157:H7 is a food-borne adulterant that can cause hemorrhagic ulcerative colitis and hemolytic uremic syndrome. Faced with an increasing risk of foods contaminated with E. coli O157:H7, food safety officials are seeking improved methods to detect and isolate E. coli O157:H7 in hazard analysis and critical control point systems in meat- and poultry-processing plants. A colony lift immunoassay was developed to facilitate the positive identification and quantification of E. coli O157:H7 by incorporating a simple colony lift enzyme-linked immunosorbent assay with filter monitors and traditional culture methods. Polyvinylidene difluoride (PVDF) membranes (Millipore, Bedford, Mass.) were prewet with methanol and were used to make replicates of every bacterial colony on agar plates or filter monitor membranes that were then reincubated for 15 to 18 h at 36 +/- 1 degree C, during which the colonies not only remained viable but were reestablished. The membranes were dried, blocked with blocking buffer (Kirkegaard and Perry Laboratories [KPL], Gaithersburg, Md.), and exposed for 7 min to an affinity-purified horseradish peroxidase-labeled goat anti-E. coli O157 antibody (KPL). The membranes were washed, exposed to a 3,3',5,5'-tetramethylbenzidine membrane substrate (TMB; KPL) or aminoethyl carbazole (AEC; Sigma Chemical Co., St. Louis, Mo.), rinsed in deionized water, and air dried. Colonies of E. coli O157:H7 were identified by either a blue (via TMB) or a red (via AEC) color reaction. The colored spots on the PVDF lift membrane were then matched to their respective parent colonies on the agar plates or filter monitor membranes. The colony lift immunoassay was tested with a wide range of genera in the family Enterobacteriaceae as well as different serotypes within the E. coli genus. The colony lift immunoassay provided a simple, rapid, and accurate method for confirming the presence of E. coli O157:H7 colonies isolated on filter monitors or spread plates by traditional culture methods. An advantage of using the colony lift immunoassay is the ability to test every colony serologically on an agar plate or filter monitor membrane simultaneously for the presence of the E. coli O157 antigen. This colony lift immunoassay has recently been successfully incorporated into a rapid-detection, isolation, and quantification system for E. coli O157:H7, developed in our laboratories for retail meat sampling.

Campylobacter jejuni in broiler chickens: colonization and humoral immunity following oral vaccination and experimental infection

A formalin inactivated, Campylobacter jejuni whole cell vaccine, either with or without Escherichia coli heat labile toxin (LT) as a mucosal adjuvant, was administered orally to broiler chickens. Three vaccine trials were performed, differing in the number of vaccinations, and time of administration, as well as the inclusion and dose of LT. The overall reductions of C. jejuni colonization in the vaccinated chickens ranged from 16 to 93% compared with non-vaccinated controls. Enhanced levels of anti-C. jejuni secretory IgA antibodies were demonstrated in vaccinated chickens. Vaccination also appeared to induce an anamnestic response to C. jejuni antigens in the 14-33 kDa range, as demonstrated by Western immunoblots. Interestingly, the inclusion of LT in the vaccine regimen did not appear to boost the immunogenicity of the vaccine. These results are encouraging and suggest that future development of successful oral vaccines for the control of enteropathogenic Campylobacter in poultry is feasible.

Development of a rapid and specific colony-lift immunoassay for detection and enumeration of Campylobacter jejuni, C. coli, and C. lari

Contamination of retail poultry by Campylobacter spp. is a significant source of human diarrheal disease. We have developed a colony-lift immunoassay (CLI) for the detection of Campylobacter jejuni, C. coli, and C. lari isolated from such sources and grown on selective agar medium or on filter membranes. This technique has been successfully utilized to quantify Campylobacter colonies within 18 to 28 h after sampling. Hydrophobic, high-protein-binding membranes were prewet with methanol and used to imprint bacterial cells from the agar or filter membrane, while leaving colonies intact and viable. The membranes were air dried, peroxidase neutralized, blocked with bovine serum albumin in phosphate-buffered saline, and hybridized for 5 min with an affinity-purified, horseradish peroxidase-labeled goat anti-Campylobacter antibody preparation (Kirkegaard and Perry Laboratories). The membranes were washed briefly, exposed to a 3,'5,5'-tetramethylbenzidine membrane substrate, rinsed in deionized water, and allowed to dry. Lifted colonies of Campylobacter were identified by a blue color reaction on the membrane. Replicas of the membranes were made by marking the location of the Campylobacter colonies on clear transparencies, which were subsequently utilized to locate the original colony on the filter membrane or agar plate. The specificity of this antibody preparation has been evaluated against a wide range of Campylobacter spp., including American Type Culture Collection type and references strains, retail poultry isolates, and isolates obtained from cloacal swabs of live commercial broiler chickens. Specificity against numerous non-Campylobacter spp. obtained from the same sources was also evaluated. The CLI provided a rapid and simple means for detection and enumeration of enteropathogenic Campylobacter organisms. We have successfully combined this CLI procedure with methods recently developed in our laboratories for retail meat and poultry sampling. Potentially, broader applications for use of this technique include detection and enumeration of campylobacters from clinical, veterinary, and environmental samples.

Safety and immunogenicity of a prototype oral whole-cell killed Campylobacter vaccine administered with a mucosal adjuvant in non-human primates

The safety and immunogenicity of two prototype oral Campylobacter killed whole-cell (CWC) vaccines were tested in rhesus monkeys. Animals were immunized with a primary two-dose series (days 0 and 14) of vaccine consisting of CWC (10(10) particles/dose) given alone or in combination with 0.5-1000 micrograms of the heat-labile enterotoxin of Escherichia coli as an oral adjuvant (OA). A booster vaccination, 4 weeks after primary immunization, was given to animals receiving CWC alone or supplemented with 0.5, 5 or 50 micrograms of OA. Both CWC and CWC-OA were well tolerated, with no adverse side-effects noted. Campylobacter-specific as well as adjuvant-specific antibody-secreting cells (ASCs) were determined in peripheral blood collected 7 days after each vaccine dose. Campylobacter-specific IgA ASC responses were enhanced by OA in a dose-dependent manner (p = 0.025), while IgG ASC responses were not. Seroconversions (both IgA and IgG) to Campylobacter antigens were also enhanced in monkeys receiving adjuvanted vaccine. No significant booster vaccination effect was observed in circulating ASCs in any of the immunization groups. In vitro T-cell proliferative responses to Campylobacter jejuni antigens were somewhat enhanced in both the CWC and CWC-OA immunization groups. These results demonstrate that CWC-OA is safe and superior to CWC alone in its ability to stimulate both local and systemic Campylobacter-specific IgA and IgG responses in primates and they support its further evaluation in human clinical studies.

Heat shock- and alkaline pH-induced proteins of Campylobacter jejuni: characterization and immunological properties

The protein response to physiological stress was characterized in Campylobacter jejuni 81176 after exposure to heat and pH shock and following periods of recovery. Immunoreactivities of major stress-related proteins were determined with anti-Campylobacter immune rabbit serum and intestinal lavage fluid. Distinct proteins with molecular masses ranging from 10 to 120 kDa were induced and/or released by selective heat or pH treatments. The most notable responses were those of two proteins with apparent molecular masses of 45 and 64 kDa that were induced and two other proteins of 10 and 12 kDa that were released by selective heat shock, alkaline pH treatment, or both. On the basis of N-terminal sequence analysis and immunological cross-reactivity data, the 64- and 10-kDa proteins were the C. jejuni homologs of Escherichia coli GroEL and GroES proteins, respectively. Enhanced chemiluminescence Western blotting (immunoblotting) revealed that all four proteins were among the major protein antigens recognized by anti-Campylobacter rabbit serum immunoglobulin G (IgG) and immune rabbit intestinal lavage IgA (secretory IgA). The results of this investigation suggest that the C. jejuni 10-, 12-, 45-, and 64-kDa proteins and a number of minor stress-related proteins deserve further evaluation of their respective roles in Campylobacter pathogenesis and immunity.

Efficacy of filter types for detecting Campylobacter jejuni and Campylobacter coli in environmental water samples by polymerase chain reaction

A previously developed polymerase chain reaction (PCR) amplification of a target region in the flaA Campylobacter flagellin gene was evaluated and adapted for use with environmental water samples. The ability to detect Campylobacter jejuni or Campylobacter coli in seeded water samples was tested with various filters after concentration and freeze-thaw lysis of the bacterial cells. A nonradioactive probe for the amplified flagellin gene fragment detected as little as 1 to 10 fg of genomic DNA and as few as 10 to 100 viable C. jejuni cells per 100 ml of water filtered onto Fluoropore (Millipore Corp.) filters. No amplification was obtained with cellulose acetate filters, most likely because of binding of the DNA to the filter. Concentration and lysis of target cells on Fluoropore and Durapore (Millipore Corp.) filters allowed PCR to be performed in the same reaction tube without removing the filters. This methodology was then adapted for use with environmental water samples. The water supply to a broiler chicken production farm was suspected as the source of C. jejuni known to be endemic in grow-out flocks at the farm, despite the inability to culture the organisms by standard methods. The filtration-PCR method detected Campylobacter DNA in more than half of the farm water samples examined. Amplified campylobacter DNA was not detected in small volumes of regional surface water samples collected on a single occasion in February. The filtration-PCR amplification method provided a basis for detection of C. jejuni and C. coli in environmental waters with a high degree of specificity and sensitivity.

Killed Campylobacter elicits immune response and protection when administered with an oral adjuvant

The heat-labile toxin (HLT) of enterotoxigenic Escherichia coli (ETEC) is a potent oral adjuvant. We determined whether the ETEC HLT could be mixed with killed campylobacter to induce an immune response protective upon subsequent challenge with live pathogens. Mice were immunized orally three times with 10(9) sonicated campylobacter with or without 25 micrograms of ETEC HLT, and humoral immune responses in intestinal lavage fluids measured by ELISA. Whereas 10(9) live bacteria induced strong intestinal IgA responses, killed bacteria did not unless ETEC HLT was also added. The magnitude of the antibody response was dependent on the amount of antigen given. The ETEC HLT given with bacteria also induced a potent cross-reaction with cholera toxin. The latter had an adjuvant effect in mice similar to that of ETEC HLT. Protection against colonization was studied in mice and rabbits. In contrast to non-immune animals, those given live organisms or sonicated cells mixed with ETEC HLT quickly cleared homologous, but not heterologous, Lior serotypes of Campylobacter upon challenge. These data show for the first time that ETEC HLT can potentiate an immune response to killed campylobacter that promotes a rapid clearance of live pathogens from the intestine.

Significance of flagella in colonization resistance of rabbits immunized with Campylobacter spp

Cross-protection among different Lior and Penner serogroups of Campylobacter spp. was studied. Rabbits were orally immunized by gastric feeding with Campylobacter spp., and 27 to 30 days later, they were challenged with matched or unmatched serogroups by the removable intestinal tie adult rabbit diarrhea (RITARD) procedure. When immunized animals were challenged with different Lior serotypes, no protection against colonization was seen; however, when challenged with homologous Lior serogroups, protection was demonstrated. Immune animals were colonized for an average of 1 day or less versus at least 6 days for nonimmune animals. Rabbits challenged with matched Penner-unmatched Lior strains showed only marginal protection. Our study also demonstrated that flagella are important in initiating colonization and eliciting protective immunity. Campylobacter coli VC167B3, an isogenic, nonflagellated mutant, did not colonize rabbits regardless of the route of administration. Single feeding of the mutant strain did not protect the host, whereas three feedings, 48 h apart, resulted in complete protection against the flagellated parent strain. When mutant strain immunized rabbits were challenged with other strains of the same Lior serotype, marginal protection was obtained. Immunogold labeling indicated that there is one or more antigens on the cell surface of the nonflagellated mutant which reacts with a polyclonal antiserum from organisms of the same Lior serogroup. These data implicated the flagellum as the cross-strain protective component of the Lior antigen complex.

In vivo antigenic variation of Campylobacter flagellin

Campylobacter coli VC167 cells producing either antigenic phase 1 (P1) or phase 2 (P2) flagellins (as determined by characteristic protein and DNA patterns) were used to infect rabbits by the removable intestinal tie-adult rabbit diarrhea (RITARD) procedure. Rabbits infected with P2 cells shed predominantly P2 cells throughout the infection; in rabbits infected with P1 cells, a transition of fecal isolates from P1 to P2 was observed.

The fate of enteric pathogenic bacteria in estuarine and marine environments

Sufficient laboratory and field data are now available to hypothesize that enteric pathogens survive for very long periods of time in sea-water. In fact, these Gram-negative bacteria probably enter into dormancy, during which they remain viable and potentially virulent, yet are non-culturable when traditional bacteriological methods are employed. Increasing use of the world's oceans-for discharge of domestic wastes may result in public health problems in the future from the allochthonous human pathogens accumulating in the marine environment at disposal sites.

Substrate utilization by Campylobacter jejuni and Campylobacter coli

An attempt was made to elucidate in Campylobacter spp. some of the physiologic characteristics that are reflected in the kinetics of CO2 formation from four 14C-labeled substrates. Campylobacter jejuni and C. coli were grown in a biphasic medium, and highly motile spiral cells were harvested at 12 h. Of the media evaluated for use in the metabolic tests, minimal essential medium without glutamine, diluted with an equal volume of potassium sodium phosphate buffer (pH 7.2), provided the greatest stability and least competition with the substrates to be tested. The cells were incubated with 0.02 M glutamate, glutamine, alpha-ketoglutarate, or formate, or with concentrations of these substrates ranging from 0.0032 to 0.125 M. All four substrates were metabolized very rapidly by both species. A feature of many of these reactions, particularly obvious with alpha-ketoglutarate, was an immediate burst of CO2 production followed by CO2 evolution at a more moderate rate. These diphasic kinetics of substrate utilization were not seen in comparable experiments with Escherichia coli grown and tested under identical conditions. With C. jejuni, CO2 production from formate proceeded rapidly for the entire period of incubation. The rate of metabolism of glutamate, glutamine, and alpha-ketoglutarate by both species was greatly enhanced by increased substrate concentration. The approach to the study of the metabolism of campylobacters here described may be useful in detecting subtle changes in the physiology of cells as they are maintained past their logarithmic growth phase.

Viable but nonculturable stage of Campylobacter jejuni and its role in survival in the natural aquatic environment

Conditions influencing the survival of Campylobacter jejuni in the natural aquatic environment have been determined. Release of Campylobacter spp. into natural waters by animal hosts is postulated to play a key role in the maintenance of viability and transmission of the organism in the environment. Laboratory flask microcosms containing filter-sterilized stream water were used to test C. jejuni for the ability to remain viable in simulated natural systems. The microcosms were compared with the biphasic and shaking broth procedures used routinely for growth of Campylobacter spp. in the research laboratory. The stream-water microcosms were analyzed to determine effects of temperature and aeration on the survival of a well-characterized C. jejuni strain isolated originally from a human campylobacteriosis patient. Morphological characteristics were evaluated by phase-contrast microscopy and scanning or transmission electron microscopy. Survival curves were quantified on the basis of plate counts, epifluorescent microscopy, optical density measurements, and direct viable counts associated with protein synthesis in the absence of DNA replication. A significant difference was observed between results of direct enumeration, i.e., direct viable counts or acridine orange direct counts, and those from spread plate cultures. In all cases, increasing temperature of cultivation resulted in decreased recoverability on laboratory media, due possibly to an increased metabolic rate, as analyzed by CO2 evolution in the presence of radiolabeled glutamate. Stream water held at low temperature (4 degrees C) sustained significant numbers of campylobacters for greater than 4 months. Microcosms, aerated with shaking, exhibited logarithmic decline in recoverable C. jejuni, while stationary systems underwent a more moderate rate of decrease to the nonculturable state.(ABSTRACT TRUNCATED AT 250 WORDS)

Pathogenicity of aeromonas

The ability of 15 Aeromonas sobria and 9 Aeromonas hydrophila isolates to cause subcutaneous lesions was tested. An inoculum of 10(11) colony forming units/l was injected subcutaneously into mice. Surviving animals developed a subcutaneous abscess and/or localised skin sloughing and loss of hair (alopecia). An abscess was induced by all nine A. hydrophila isolates and by three of the 15 A. sobria isolates. The induction of local epidermal sloughing and loss of hair followed challenge with either A. hydrophila or A. sobria and correlated with the organisms' lethality for mice and their cytotoxicity in the Y-I adrenal cell assay. Local epidermal sloughing was not induced by the media used for growing the organisms or by sonicated cells of the isolates. The ability to cause epidermal sloughing was lost by incubating viable cells at 45 degrees C for 35 minutes. These yet unreported in vivo features of Aeromonas sp. may be useful in studies of the pathogenicity of the species as well as for rapid assay of toxicity of strains.

Vibrio factors cause rapid fluid accumulation in suckling mice

Non-O-1 and O-1 Vibrio cholerae and Vibrio fluvialis isolated from clinical and environmental sources were examined for virulence factor production in 3-day-old suckling mice and in Y-1 tissue culture. The responses of the suckling mice to intragastrically administered bacterial cultures were measured by intestinal fluid accumulation (FA), diarrhea, and mortality. Regardless of the O-serovar, source of isolation, or ability to produce cholera toxin, all strains of V. cholerae stimulated increased FA, which was measurable in the mice at 4 h post-inoculation. The factor(s) causing these symptoms was found to be distinct from cholera toxin by the kinetics of FA and serological difference from cholera toxin based on in vivo neutralization tests. In most instances, FA was followed by high rates of mortality. Y-1 mouse adrenal tumor cell assays also showed that many V. cholerae produced extracellular heat-labile cytotoxic factor(s), and many cholera toxin-negative strains also caused a cytotonic-like morphological response. The majority of V. fluvialis strains produced smaller amounts of cytotoxic factor(s) but no cytotoxic reactions. The factor which stimulates rapid FA in suckling mice could be one of several virulence-associated factors contributing to diarrheal disease by nontoxigenic vibrios, but this is not verified at present.

Biphasic culture system for rapid Campylobacter cultivation

We developed a biphasic culture system consisting of 4 ml of brucella agar (BA) and 6 ml of brucella broth (BB) in 25-cm2 tissue culture flasks, which were incubated in air (BB/BAa) or in a gas mixture of 5% O2, 10% CO2, and 85% N2 (BB/BAg). These media were also used with a supplement consisting of ferrous sulfate, sodium metabisulfite, and sodium pyruvate and incubated as above (FB/FAa and FB/FAg, respectively). Highly satisfactory growth of Campylobacter jejuni 301 was obtained with all medium-gas phase combinations provided that the number of viable cells in the inoculum was large (greater than or equal to 10(6)/ml). The use of FB/FAa permitted the inoculum to be reduced to 100 cells per ml. With an adjusted gas phase (BB/BAg and FB/FAg), near-optimal growth was obtained from an inoculum of 1 to 10 cells per ml. Under most of these conditions the generation time was approximately 90 min. During the logarithmic growth phase, the cells retained their typical spiral morphology and high motility. These media also proved to be highly satisfactory for the cultivation of fresh isolates as well as other stock strains of Campylobacter. When the broth phase of the cultures, after addition of 15% glycerol, was quickly frozen and maintained at -70 degrees C, all strains thus far examined were readily recoverable and satisfactorily cultivated without additional passage.

Aeromonas sobria in chlorinated drinking water supplies

Aeromonas species were recovered from over 27% of 183 chlorinated drinking water samples collected during an 18-month period. Sixteen of 20 isolates tested elicited a cytotoxic response by Y-1 mouse adrenal cells. None of the strains was either enterotoxigenic by the rabbit ligated ileal loop assay, exhibited piliation, or showed significant mannose resistant adherence to human buccal cells. TheAeromonas isolates were further identified to beA. sobria and were resistant to ampicillin and susceptible to chloramphenicol, kanamycin, streptomycin, and tetracycline. Total coliform levels did not correlate withAeromonas densities in distribution water. With 85% of the samplings,Aeromonas occurred in distribution water when no coliforms were detectable by either the membrane filter or most-probable-number techniques. A significant correlation (P<.001) existed between standard plate count levels andAeromonas.

Association of Aeromonas sobria with human infection

Fifteen Aeromonas isolates from various human infections and nine isolates from polluted water were identified as either Aeromonas hydrophila or Aeromonas sobria and examined for cytotoxigenicity, enterotoxigenicity, adherence to epithelial cells, and other virulence-associated factors, including proteases, lipases, elastases, and hemolysins. Two groups of organisms (I and II) were distinguishable based on differences in median lethal doses in mice and cytotoxicity for Y-1 adrenal cells. Group I clinical and environmental strains had median lethal doses of less than 10(7) colony-forming units, were cytotoxic, frequently possessed several virulence-associated factors, and had lysine decarboxylase-positive or Voges-Proskauer-positive phenotypes or both. Piliation of Aeromonas was associated strongly with ability to adhere to human buccal cells, and these characteristics were associated with group I strains. Group II clinical and environmental strains had median lethal doses of greater than or equal to 10(7) colony-forming units, were not cytotoxic, and usually were lysine decarboxylase negative or Voges-Proskauer negative or both. Clinical strains in group II exhibited enterotoxigenicity, which was not detected in group II environmental strains. A sobria was more frequently associated with human infections; 13 of the 15 clinical strains were A. sobria, and 2 were A. hydrophila. On the other hand, the majority of the environmental strains (seven of nine) were A. hydrophila.