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Mohanna M, Roberts E, Whitty L, Gritzfeld JF, Pain CE, Girschick HJ, Preston J, Hadjittofi M, Anderson C, Ferguson PJ, Theos A, Hedrich CM. Priorities in Chronic nonbacterial osteomyelitis (CNO) - results from an international survey and roundtable discussions. Pediatr Rheumatol Online J 2023; 21:65. [PMID: 37391782 DOI: 10.1186/s12969-023-00851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disorder that predominantly affects children and young people. The pathophysiology and molecular mechanisms of CNO remain poorly understood, and diagnostic criteria and biomarkers are lacking. As a result, treatment is empiric and follows personal experience, case series and expert consensus plans. METHODS A survey was designed to gain insight on clinician and patient experiences of diagnosing and treating CNO and to collate opinions on research priorities. A version containing 24 questions was circulated among international expert clinicians and clinical academics (27 contacted, 21 responses). An equivalent questionnaire containing 20 questions was shared to explore the experience and priorities of CNO patients and family members (93 responses). RESULTS Responses were used to select topics for four moderated roundtable discussions at the "International Conference on CNO and autoinflammatory bone disease" (Liverpool, United Kingdom, May 25-26th, 2022). The group identified deciphering the pathophysiology of CNO to be the highest priority, followed by clinical trials, necessary outcome measures and classification criteria. Surprisingly, mental wellbeing scored behind these items. CONCLUSIONS Agreement exists among clinicians, academics, patients and families that deciphering the pathophysiology of CNO is of highest priority to inform clinical trials that will allow for the approval of medications for the treatment of CNO by regulatory agencies.
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Affiliation(s)
- M Mohanna
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Roberts
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - L Whitty
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J F Gritzfeld
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - C E Pain
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - H J Girschick
- Klinik Für Kinder- Und Jugendmedizin, Vivantes Netzwerk Für Gesundheit GmbH, Klinikum Im Friedrichshain, Berlin, Germany
| | - J Preston
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - M Hadjittofi
- Clinical Health Psychology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - C Anderson
- Royal Hospital for Children and Young People, Edinburgh, UK
| | - P J Ferguson
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - A Theos
- Department of Human Science, CRMO Patient/Parent Partner, Georgetown University, Washington, DC, USA
| | - C M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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German EL, Solórzano C, Sunny S, Dunne F, Gritzfeld JF, Mitsi E, Nikolaou E, Hyder-Wright AD, Collins AM, Gordon SB, Ferreira DM. Protective effect of PCV vaccine against experimental pneumococcal challenge in adults is primarily mediated by controlling colonisation density. Vaccine 2019; 37:3953-3956. [PMID: 31176540 PMCID: PMC6611220 DOI: 10.1016/j.vaccine.2019.05.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 11/03/2022]
Abstract
Widespread use of Pneumococcal Conjugate Vaccines (PCV) has reduced vaccine-type nasopharyngeal colonisation and invasive pneumococcal disease. In a double-blind, randomised controlled trial using the Experimental Human Pneumococcal Challenge (EHPC) model, PCV-13 (Prevenar-13) conferred 78% protection against colonisation acquisition and reduced bacterial intensity (AUC) as measured by classical culture. We used a multiplex qPCR assay targeting lytA and pneumococcal serotype 6A/B cpsA genes to re-assess the colonisation status of the same volunteers. Increase in detection of low-density colonisation resulted in reduced PCV efficacy against colonisation acquisition (29%), compared to classical culture (83%). For experimentally colonised volunteers, PCV had a pronounced effect on decreasing colonisation density. These results obtained in adults suggest that the success of PCV vaccination could primarily be mediated by the control of colonisation density. Studies assessing the impact of pneumococcal vaccines should allow for density measurements in their design.
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Affiliation(s)
- E L German
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - C Solórzano
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - S Sunny
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - F Dunne
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - J F Gritzfeld
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - E Mitsi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - E Nikolaou
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | | | - A M Collins
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - S B Gordon
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - D M Ferreira
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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Mitsi E, Roche AM, Reiné J, Zangari T, Owugha JT, Pennington SH, Gritzfeld JF, Wright AD, Collins AM, van Selm S, de Jonge MI, Gordon SB, Weiser JN, Ferreira DM. Agglutination by anti-capsular polysaccharide antibody is associated with protection against experimental human pneumococcal carriage. Mucosal Immunol 2017; 10:385-394. [PMID: 27579859 PMCID: PMC5332540 DOI: 10.1038/mi.2016.71] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/12/2016] [Indexed: 02/04/2023]
Abstract
The ability of pneumococcal conjugate vaccine (PCV) to decrease transmission by blocking the acquisition of colonization has been attributed to herd immunity. We describe the role of mucosal immunoglobulin G (IgG) to capsular polysaccharide (CPS) in mediating protection from carriage, translating our findings from a murine model to humans. We used a flow cytometric assay to quantify antibody-mediated agglutination demonstrating that hyperimmune sera generated against an unencapsulated mutant was poorly agglutinating. Passive immunization with this antiserum was ineffective to block acquisition of colonization compared to agglutinating antisera raised against the encapsulated parent strain. In the human challenge model, samples were collected from PCV and control-vaccinated adults. In PCV-vaccinated subjects, IgG levels to CPS were increased in serum and nasal wash (NW). IgG to the inoculated strain CPS dropped in NW samples after inoculation suggesting its sequestration by colonizing pneumococci. In post-vaccination NW samples pneumococci were heavily agglutinated compared with pre-vaccination samples in subjects protected against carriage. Our results indicate that pneumococcal agglutination mediated by CPS-specific antibodies is a key mechanism of protection against acquisition of carriage. Capsule may be the only vaccine target that can elicit strong agglutinating antibody responses, leading to protection against carriage acquisition and generation of herd immunity.
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Affiliation(s)
- E Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - AM Roche
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J Reiné
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Zangari
- Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA
| | - JT Owugha
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - SH Pennington
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - JF Gritzfeld
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - AD Wright
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - AM Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S van Selm
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - MI de Jonge
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - SB Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK,The Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - JN Weiser
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA
| | - DM Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Corresponding Author: Daniela M. Ferreira, , Department of Clinical Sciences, Liverpool School of Tropical Medicine, UK, phone 0151 705 3711
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Glennie S, Gritzfeld JF, Pennington SH, Garner-Jones M, Coombes N, Hopkins MJ, Vadesilho CF, Miyaji EN, Wang D, Wright AD, Collins AM, Gordon SB, Ferreira DM. Modulation of nasopharyngeal innate defenses by viral coinfection predisposes individuals to experimental pneumococcal carriage. Mucosal Immunol 2016; 9:56-67. [PMID: 25921341 PMCID: PMC4703943 DOI: 10.1038/mi.2015.35] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/13/2015] [Indexed: 02/04/2023]
Abstract
Increased nasopharyngeal colonization density has been associated with pneumonia. We used experimental human pneumococcal carriage to investigate whether upper respiratory tract viral infection predisposes individuals to carriage. A total of 101 healthy subjects were screened for respiratory virus before pneumococcal intranasal challenge. Virus was associated with increased odds of colonization (75% virus positive became colonized vs. 46% virus-negative subjects; P=0.02). Nasal Factor H (FH) levels were increased in virus-positive subjects and were associated with increased colonization density. Using an in vitro epithelial model we explored the impact of increased mucosal FH in the context of coinfection. Epithelial inflammation and FH binding resulted in increased pneumococcal adherence to the epithelium. Binding was partially blocked by antibodies targeting the FH-binding protein Pneumococcal surface protein C (PspC). PspC epitope mapping revealed individuals lacked antibodies against the FH binding region. We propose that FH binding to PspC in vivo masks this binding site, enabling FH to facilitate pneumococcal/epithelial attachment during viral infection despite the presence of anti-PspC antibodies. We propose that a PspC-based vaccine lacking binding to FH could reduce pneumococcal colonization, and may have enhanced protection in those with underlying viral infection.
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Affiliation(s)
- S Glennie
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK ,grid.5337.20000 0004 1936 7603Present Address: 7Present address: School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK., ,
| | - J F Gritzfeld
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S H Pennington
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Garner-Jones
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - N Coombes
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M J Hopkins
- grid.269741.f0000 0004 0421 1585Liverpool Specialist Virology Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| | - C F Vadesilho
- grid.418514.d0000 0001 1702 8585Centro de Biotecnologia, Instituto Butantan, Sao Paulo, Brazil
| | - E N Miyaji
- grid.418514.d0000 0001 1702 8585Centro de Biotecnologia, Instituto Butantan, Sao Paulo, Brazil
| | - D Wang
- grid.48004.380000 0004 1936 9764Tropical Clinical Trial Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A D Wright
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK ,grid.269741.f0000 0004 0421 1585NIHR Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - A M Collins
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK ,grid.269741.f0000 0004 0421 1585NIHR Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - S B Gordon
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - D M Ferreira
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
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Gladstone RA, Gritzfeld JF, Coupland P, Gordon SB, Bentley SD. Genetic stability of pneumococcal isolates during 35 days of human experimental carriage. Vaccine 2015; 33:3342-5. [PMID: 26006086 PMCID: PMC4503797 DOI: 10.1016/j.vaccine.2015.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/31/2015] [Accepted: 05/11/2015] [Indexed: 12/30/2022]
Abstract
The experimental human carriage (EHPC) inoculum is genetically stable over 35 days. Documentation of stability further addresses concerns of validity and safety of EHPC. Confidence in EHPC to safely and reproducibly measure VEcol is key to aiding vaccine licensure.
Background Pneumococcal carriage is a reservoir for transmission and a precursor to pneumococcal disease. The experimental human pneumococcal carriage model provides a useful tool to aid vaccine licensure through the measurement of vaccine efficacy against carriage (VEcol). Documentation of the genetic stability of the experimental human pneumococcal carriage model is important to further strengthen confidence in its safety and conclusions, enabling it to further facilitate vaccine licensure through providing evidence of VEcol. Methods 229 isolates were sequenced from 10 volunteers in whom experimental human pneumococcal carriage was established, sampled over a period of 35 days. Multiple isolates from within a single volunteer at a single time provided a deep resolution for detecting variation. HiSeq data from the isolates were mapped against a PacBio reference of the inoculum to call variable sites. Results The observed variation between experimental carriage isolates was minimal with the maximum SNP distance between any isolate and the reference being 3 SNPs. Conclusion The low-level variation described provides evidence for the stability of the experimental human pneumococcal carriage model over 35 days, which can be reliably and confidently used to measure VEcol and aid future progression of pneumococcal vaccination.
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Affiliation(s)
- R A Gladstone
- Pathogen Genomics, Wellcome Trust Sanger Institute, Cambridge, UK
| | - J F Gritzfeld
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - P Coupland
- Sequencing R&D Group, Wellcome Trust Sanger Institute, Cambridge, UK
| | - S B Gordon
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S D Bentley
- Pathogen Genomics, Wellcome Trust Sanger Institute, Cambridge, UK.
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Collins A, Wright A, Mitsi E, Gritzfeld J, Hancock C, Shaw D, Pennington S, Morton B, Ferreira D, Gordon S. T4 Pneumococcal Conjugate Vaccine Reduces Rate, Density And Duration Of Experimental Human Pneumococcal Colonisation: First Human Challenge Testing Of A Pneumococcal Vaccine. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gritzfeld JF, Cremers AJH, Ferwerda G, Ferreira DM, Kadioglu A, Hermans PWM, Gordon SB. Density and duration of experimental human pneumococcal carriage. Clin Microbiol Infect 2014; 20:O1145-51. [PMID: 24995531 PMCID: PMC4313687 DOI: 10.1111/1469-0691.12752] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/01/2014] [Accepted: 07/01/2014] [Indexed: 02/03/2023]
Abstract
The density and duration of pneumococcal carriage are considered to affect the likelihood of transmission and invasive disease. Because of its importance in both spreading and causing disease, carriage has been suggested as an endpoint in future vaccine studies. Culture is the current gold standard for detection, but may not be sensitive enough to detect changes at low density. Healthy adult volunteers received an intranasal inoculation of Streptococcus pneumoniae serotype 6B. Pneumococcal density in nasal washes collected at six time-points post-inoculation was determined by culture and quantitative PCR (qPCR). Natural pneumococcal carriers detected at initial screening were followed in parallel. In 331 nasal washes from 79 volunteers, the sensitivity and specificity of pneumococcal detection by qPCR, as compared with culture, were 92.3% and 75.9%. The estimation of pneumococcal density by culture and qPCR was highly correlated (rs = 0.73, p <0.0001), although qPCR had a lower detection limit. Pneumococcal density fluctuated within a carriage episode, and occasionally fell below the detection limit of both methods. The duration of carriage episodes was underestimated when only one method was used. Similar fluctuations in density were observed in natural carriers. Pneumococcal carriage is a dynamic event. Culture and qPCR are complementary for surveying the density and duration of pneumococcal carriage episodes.
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Affiliation(s)
- J F Gritzfeld
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
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Fremaux B, Gritzfeld J, Boa T, Yost CK. Evaluation of host-specific Bacteroidales 16S rRNA gene markers as a complementary tool for detecting fecal pollution in a prairie watershed. Water Res 2009; 43:4838-4849. [PMID: 19604534 DOI: 10.1016/j.watres.2009.06.045] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 06/12/2009] [Accepted: 06/22/2009] [Indexed: 05/28/2023]
Abstract
Our ability to identify and eliminate fecal contamination of water, now and in the future, is essential to reduce incidences of waterborne disease. Bacterial source tracking is a recently developed approach for identifying sources of fecal pollution. PCR primers designed by Bernhard and Field [Bernhard, A.E., Field, K.G., 2000a. A PCR assay to discriminate human and ruminant feces on the basis of host differences in Bacteroides-Prevotella genes encoding 16S rRNA. Appl. Environ. Microbiol. 66(10), 4571-4574] and Dick et al. [Dick, L.K., Bernhard, A.E., Brodeur, T.J., Santo Domingo, J.W., Simpson, J.M., Walters, S.P., Field, K.G., 2005. Host distributions of uncultivated fecal Bacteroidales bacteria reveal genetic markers for fecal source identification. Appl. Environ. Microbiol. 71(6), 3184-3191] for the detection of human (HF183), pig (PF163) and ruminant (CF128) specific Bacteroidales 16s rRNA genetic markers were tested for their suitability in detecting fecal pollution in Saskatchewan, Canada. The sensitivity and specificity of these primers were assessed by testing eight raw human sewage samples and 265 feces from 12 different species in Saskatchewan. The specificity of each primer set was > or =94%. The accuracy of HF183 and PF163 to distinguish between the different species was 100%, whereas CF128 cross-reacted with 22% of the pig feces. Occurrence of the host-specific Bacteroidales markers and the conventional indicator Escherichia coli in relation to several enteropathogens was investigated in 70 water samples collected from different sites along the Qu'Appelle River (Saskatchewan, Canada). Human and ruminant fecal markers were identified in 41 and 14% of the water samples, respectively, whereas the pig marker was never detected in the river water. The largest concentrations in E. coli counts were concomitant to the simultaneous detection of HF183 and CF128. Thermotolerant Campylobacter spp., Salmonella spp. and Shiga toxin genes (stx1 and stx2)-positive E. coli (STEC) were detected in 6, 7 and 63% of the water samples, respectively. However, none of the stx positive water samples were positive for the E. coli O157:H7 gene marker (uidA). Odds ratios analysis suggests that CF128 may be predictive for the presence of Salmonella spp. in the river investigated. None of the fecal indicators were able to confidently predict the presence of thermotolerant Campylobacter spp. and STEC.
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Affiliation(s)
- B Fremaux
- Laboratory for Irrigation Water Protection, Biology Department, University of Regina, 3737 Wascana Parkway, Regina, SK S4S0A2, Canada
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Fremaux B, Boa T, Chaykowski A, Kasichayanula S, Gritzfeld J, Braul L, Yost C. Assessment of the microbial quality of irrigation water in a prairie watershed. J Appl Microbiol 2009; 106:442-54. [DOI: 10.1111/j.1365-2672.2008.04012.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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