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Schaudinn C, Rydzewski K, Meister B, Grunow R, Heuner K. Francisella tularensis subsp. holarctica wild-type is able to colonize natural aquatic ex vivo biofilms. Front Microbiol 2023; 14:1113412. [PMID: 36860486 PMCID: PMC9969146 DOI: 10.3389/fmicb.2023.1113412] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/16/2023] [Indexed: 02/15/2023] Open
Abstract
Biofilms are a matrix-associated lifestyle of microbial communities, often enabling survivability and persistence of such bacteria. The objective of this study was to investigate the survival of the wild-type strain A-271 of Francisella tularensis subsp. holarctica (Fth) in a natural aquatic ex vivo biofilm. To that purpose, we allowed Fth A-271 to produce its own biofilm on solid surfaces but also to colonize naturally formed biofilms from aquatic habitats, which were infected with Francisella in the laboratory. The survival rates of the bacteria in biofilms were compared to those of planktonic bacteria as a function of the employed culture condition. It could be shown by light- and electron microscopy that Fth is able to form a complex, matrix-associated biofilm. The biofilm form of Francisella showed longer cultivability on agar plates in natural water when compared to planktonic (free-living) bacteria. Be it as a part of the existing ex vivo biofilm or free-floating above as planktonic bacteria, more than 80% of Francisella were not only able to survive under these conditions for 28 days, but even managed to establish microcolonies and areas with their own exclusive biofilm architecture within the ex vivo biofilm. Here, we can demonstrate for the first time that a Francisella tularensis wild-type strain (Type B) is able to successfully colonize an aquatic multi-species ex vivo biofilm. It is worthwhile to speculate that Fth might become more persistent in the environment when it forms its own biofilm or integrates in an existing one. Multi-species biofilms have been shown to be more resistant against stress compared to single-species biofilms. This may have an important impact on the long-term survival of Francisella in aquatic habitats and infection cycles in nature.
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Affiliation(s)
- Christoph Schaudinn
- Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4), Robert Koch Institute, Berlin, Germany
| | - Kerstin Rydzewski
- Working Group: Cellular Interactions of Bacterial Pathogens, Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2), Robert Koch Institute, Berlin, Germany,Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2), Robert Koch Institute, Berlin, Germany
| | - Beate Meister
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2), Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2), Robert Koch Institute, Berlin, Germany
| | - Klaus Heuner
- Working Group: Cellular Interactions of Bacterial Pathogens, Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2), Robert Koch Institute, Berlin, Germany,Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2), Robert Koch Institute, Berlin, Germany,*Correspondence: Klaus Heuner, ✉
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Böhm S, Vom Berge K, Hierhammer D, Jacob D, Grunow R, Riehm JM, Konrad R, Dauer M, Bouschery B, Hossain H, Schichtl E, Böhmer MM. Epidemiological investigation of a tularaemia outbreak after a hare hunt in Bavaria, Germany, 2018. Zoonoses Public Health 2021; 69:106-116. [PMID: 34780120 DOI: 10.1111/zph.12899] [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] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/10/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
In November 2018, a tularaemia outbreak occurred in Bavaria, Germany, among participants of a hare hunt and butchery employees handling the hares. We conducted an epidemiological outbreak investigation, including a retrospective cohort study among hunting participants, to identify likely transmission routes and activities associated with infection. Twelve of 41 participants were antibody-positive for Francisella (F.) tularensis (attack rate: 29%). Cases reported influenza-like symptoms (n = 11), lymphadenopathy (n = 1) and conjunctivitis (n = 1). Infection only occurred in those hunting participants present while hares were processed, while risk of infection was highest when directly involved (RR = 10.0; 95%CI: 2.6-392). F. tularensis was isolated from 1/4 hares. Only two individuals reported using some of the recommended personal protective equipment (PPE). Occurrence of mainly non-specific symptoms, likely due to early treatment, was not indicative of a specific transmission route. Transmissions via direct (skin/mucosa) contact and by inhalation of contaminated aerosols seem plausible. Promoting and increasing appropriate use of PPE among people processing hares is crucial to prevent future outbreaks.
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Affiliation(s)
- Stefanie Böhm
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany.,Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | | | - Daniela Jacob
- Consiliary Laboratory for Tularemia, Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Consiliary Laboratory for Tularemia, Robert Koch Institute, Berlin, Germany
| | - Julia M Riehm
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Regina Konrad
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Marc Dauer
- Klinikum St. Marien, Amberg, Germany.,Department of Internal Medicine II, University Hospital, Saarland University, Saarbrücken, Germany
| | | | - Hamid Hossain
- Institute of Laboratory Medicine and Microbiology, Klinikum St. Marien, Amberg, Germany.,Institute of Laboratory Medicine and Microbiology, Kliniken Nordoberpfalz AG, Weiden, Germany
| | | | - Merle M Böhmer
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany.,Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University, Magdeburg, Germany
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Appelt S, Rohleder AM, Invernizzi C, Mikulak R, Brinkmann A, Nitsche A, Krüger M, Dorner MB, Dorner BG, Scholz HC, Grunow R. Strengthening the United Nations Secretary-General's Mechanism to an alleged use of bioweapons through a quality-assured laboratory response. Nat Commun 2021; 12:3078. [PMID: 34035242 PMCID: PMC8149868 DOI: 10.1038/s41467-021-23296-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/11/2021] [Accepted: 04/23/2021] [Indexed: 12/01/2022] Open
Abstract
The cascade of innovations in biotechnology opens new pathways for biological warfare. The international laboratory network being developed under the UN Secretary-General’s Mechanism could provide vital evidence in case of an alleged biological attack.
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Affiliation(s)
- Sandra Appelt
- Centre for Biological Threats and Special Pathogens (ZBS 1, ZBS 2 and ZBS 3), Robert Koch Institute, Berlin, Germany
| | - Anna-Maria Rohleder
- Centre for Biological Threats and Special Pathogens (ZBS 1, ZBS 2 and ZBS 3), Robert Koch Institute, Berlin, Germany
| | | | - Robert Mikulak
- Biological Policy Staff, Bureau of International Security and Nonproliferation, U.S. Department of State, Washington, USA
| | - Annika Brinkmann
- Centre for Biological Threats and Special Pathogens (ZBS 1, ZBS 2 and ZBS 3), Robert Koch Institute, Berlin, Germany
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens (ZBS 1, ZBS 2 and ZBS 3), Robert Koch Institute, Berlin, Germany
| | - Maren Krüger
- Centre for Biological Threats and Special Pathogens (ZBS 1, ZBS 2 and ZBS 3), Robert Koch Institute, Berlin, Germany
| | - Martin B Dorner
- Centre for Biological Threats and Special Pathogens (ZBS 1, ZBS 2 and ZBS 3), Robert Koch Institute, Berlin, Germany
| | - Brigitte G Dorner
- Centre for Biological Threats and Special Pathogens (ZBS 1, ZBS 2 and ZBS 3), Robert Koch Institute, Berlin, Germany
| | - Holger C Scholz
- Centre for Biological Threats and Special Pathogens (ZBS 1, ZBS 2 and ZBS 3), Robert Koch Institute, Berlin, Germany.
| | - Roland Grunow
- Centre for Biological Threats and Special Pathogens (ZBS 1, ZBS 2 and ZBS 3), Robert Koch Institute, Berlin, Germany.
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Appelt S, Jacob D, Rohleder AM, Bråve A, Szekely Björndal Å, Di Caro A, Grunow R. Assessment of biorisk management systems in high containment laboratories, 18 countries in Europe, 2016 and 2017. ACTA ACUST UNITED AC 2021; 25. [PMID: 32914748 PMCID: PMC7502897 DOI: 10.2807/1560-7917.es.2020.25.36.2000089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Europe-wide activities to improve biosafety and biosecurity performed within the frameworks of the European Union (EU)-funded Joint Actions EMERGE and QUANDHIP led to the development of an Integrated European Checklist for Laboratory Biorisk Management (ECL). To better understand different approaches shaping biorisk management (BRM) systems on an operational level in high containment laboratories, the ECL was used to map the implementation of BRM in 32 high containment laboratories in 18 countries in Europe. The results suggest that the BRM elements referring to standard microbiological working practices and the handling of infectious material were fulfilled particularly well. The elements safety exercises involving internal and external emergency responders, and appropriate decommissioning plans were not fulfilled particularly well. BRM in Biosafety Level (BSL) 4 laboratories handling Risk Group (RG) 4 viruses appear to vary among each other less than BSL3 laboratories handling RG 3 bacteria. It is important to agree on comparable regulations in Europe as high containment laboratories are indispensable for a safe, quick and effective response to public health threats. As high containment laboratories may also present a public health risk it is crucial to have robust BRM on organisational and operational levels.
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Affiliation(s)
- Sandra Appelt
- Centre for Biological Threats and Special Pathogens (ZBS2), Robert Koch Institute, Berlin, Germany
| | - Daniela Jacob
- Centre for Biological Threats and Special Pathogens (ZBS2), Robert Koch Institute, Berlin, Germany
| | - Anna-Maria Rohleder
- Centre for Biological Threats and Special Pathogens (ZBS2), Robert Koch Institute, Berlin, Germany
| | - Andreas Bråve
- Office of Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | - Åsa Szekely Björndal
- Office of Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | - Antonino Di Caro
- Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Roland Grunow
- Centre for Biological Threats and Special Pathogens (ZBS2), Robert Koch Institute, Berlin, Germany
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- The EMERGE partners are acknowledged at the end of the article
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Papp S, Kimmerl K, Gatz J, Laue M, Grunow R, Kaspari O. Evaluation of Sporicidal Disinfectants for the Disinfection of Personal Protective Equipment During Biological Hazards. Health Secur 2020; 18:36-48. [PMID: 32078425 PMCID: PMC7047094 DOI: 10.1089/hs.2019.0128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 02/03/2023] Open
Abstract
A fast, effective, and safe disinfection of personal protective equipment (PPE) is vitally important for emergency forces involved in biological hazards. This study aimed to investigate a broad range of disinfectants to improve the established disinfection procedure. We analyzed the efficacy of chlorine-, peracetic acid–, and oxygen-based disinfectants against Bacillus spores on PPE. Therefore, spores of different Bacillus species were exposed to disinfectants on PPE material by using a standardized procedure covering the dried spores with disinfectants and applying mechanical distribution. Efficacy of disinfectants was quantified by determining the reduction factor (log10 levels) and number of viable spores left afterward. The chlorine-based granulate Hypochlorit CA G (2% chlorine) sufficiently inactivated Bacillus spores of risk groups 1 and 2, even with temperatures ranging from −20 to 35°C. Wofasteril® SC super (1.75% peracetic acid) achieved a reliable reduction of risk groups 1 and 2 and even fully virulent Bacillus spores by ≥5 log10 levels on PPE. With this, Hypochlorit-CA G and Wofasteril® SC super proved to be promising alternatives to the previously proven and widely used peracetic acid compound Wofasteril® (2% peracetic acid) for the disinfection of PPE when bacterial spores are known to be the contaminating agent. These results will help to improve the disinfection of PPE during biological hazards by providing new data on promising alternative compounds. A fast, effective, and safe disinfection of personal protective equipment (PPE) is vitally important for emergency forces involved in biological hazards. This study aimed to investigate a broad range of disinfectants to improve the established disinfection procedure. The authors analyzed the efficacy of chlorine-, peracetic acid-, and oxygen-based disinfectants against Bacillus spores on PPE.
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Affiliation(s)
- Stefanie Papp
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
| | - Katharina Kimmerl
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
| | - Jacob Gatz
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
| | - Michael Laue
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
| | - Oliver Kaspari
- Dr. Stefanie Papp, Katharina Kimmerl, Jacob Gatz, Prof. Dr. Roland Grunow, and Dr. Oliver Kaspari are with the Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2); Dr. Michael Laue is with the Centre for Biological Threats and Special Pathogens, Advanced Light and Electron Microscopy (ZBS 4); all are with the Robert Koch Institute, Berlin, Germany
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Jacob D, Barduhn A, Tappe D, Rauch J, Heuner K, Hierhammer D, vom Berge K, Riehm JM, Hanczaruk M, Böhm S, Böhmer MM, Konrad R, Bouschery B, Dauer M, Schichtl E, Hossain H, Grunow R. Outbreak of Tularemia in a Group of Hunters in Germany in 2018-Kinetics of Antibody and Cytokine Responses. Microorganisms 2020; 8:microorganisms8111645. [PMID: 33114188 PMCID: PMC7690809 DOI: 10.3390/microorganisms8111645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/28/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 02/01/2023] Open
Abstract
In November 2018, an outbreak of tularemia occurred among hare hunters in Bavaria, Germany. At least one infected hare was confirmed as the source of infection. A number of hunting dogs showed elevated antibody titers to Francisella tularensis, but the absence of titer increases in subsequent samples did not point to acute infections in dogs. Altogether, 12 persons associated with this hare hunt could be diagnosed with acute tularemia by detection of specific antibodies. In nine patients, the antibody and cytokine responses could be monitored over time. Eight out of these nine patients had developed detectable antibodies three weeks after exposure; in one individual the antibody response was delayed. All patients showed an increase in various cytokines and chemokines with a peak for most mediators in the first week after exposure. Cytokine levels showed individual variations, with high and low responders. The kinetics of seroconversion has implications on serological diagnoses of tularemia.
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Affiliation(s)
- Daniela Jacob
- Robert Koch Institute, 13353 Berlin, Germany; (D.J.); (A.B.); (K.H.)
| | - Anne Barduhn
- Robert Koch Institute, 13353 Berlin, Germany; (D.J.); (A.B.); (K.H.)
| | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany; (D.T.); (J.R.)
| | - Jessica Rauch
- Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany; (D.T.); (J.R.)
| | - Klaus Heuner
- Robert Koch Institute, 13353 Berlin, Germany; (D.J.); (A.B.); (K.H.)
| | - Daniela Hierhammer
- Local Health Authority, 92421 Schwandorf, Bavaria, Germany; (D.H.); (K.v.B.)
| | - Katharina vom Berge
- Local Health Authority, 92421 Schwandorf, Bavaria, Germany; (D.H.); (K.v.B.)
| | - Julia M. Riehm
- Bavarian Health and Food Safety Authority, 85764 Oberschleißheim, Germany; (J.M.R.); (M.H.); (S.B.); (M.M.B.); (R.K.)
| | - Matthias Hanczaruk
- Bavarian Health and Food Safety Authority, 85764 Oberschleißheim, Germany; (J.M.R.); (M.H.); (S.B.); (M.M.B.); (R.K.)
| | - Stefanie Böhm
- Bavarian Health and Food Safety Authority, 85764 Oberschleißheim, Germany; (J.M.R.); (M.H.); (S.B.); (M.M.B.); (R.K.)
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, 13353 Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, 169 73 Solna, Sweden
| | - Merle M. Böhmer
- Bavarian Health and Food Safety Authority, 85764 Oberschleißheim, Germany; (J.M.R.); (M.H.); (S.B.); (M.M.B.); (R.K.)
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University, 39106 Magdeburg, Germany
| | - Regina Konrad
- Bavarian Health and Food Safety Authority, 85764 Oberschleißheim, Germany; (J.M.R.); (M.H.); (S.B.); (M.M.B.); (R.K.)
| | - Berit Bouschery
- Department of Medicine II, Klinikum St. Marien, 92224 Amberg, Germany; (B.B.); (M.D.)
| | - Marc Dauer
- Department of Medicine II, Klinikum St. Marien, 92224 Amberg, Germany; (B.B.); (M.D.)
- Department of Medicine II, Saarland University, 66421 Homburg, Germany
| | | | - Hamid Hossain
- Institute of Laboratory Medicine and Microbiology, Klinikum St. Marien, 92224 Amberg, Germany;
- Institute of Laboratory Medicine and Microbiology, Kliniken Nordoberpfalz AG, 92637 Weiden, Germany
| | - Roland Grunow
- Robert Koch Institute, 13353 Berlin, Germany; (D.J.); (A.B.); (K.H.)
- Correspondence:
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Katz A, Karvonen O, Di Caro A, Vairo F, Ippolito G, Grunow R, Jacob D, Salminen M. SHARP Joint Action – Strengthening International Health Regulations and preparedness in the EU. Eur J Public Health 2020. [PMCID: PMC7543434 DOI: 10.1093/eurpub/ckaa166.606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although the preparedness to health emergencies of biological, chemical, environmental and unknown origin across the Europe is at high level, gaps do exist across the EU Member States and European countries. The previous coronavirus epidemic, SARS in 2002, showed that countries responded largely individually to this emerging threat. EU wide, joint responses were not taken. SARS epidemic showed that strengthening of the common EU efforts was needed. Many actions were taken, and since 2013 the European Commission Decision 1082/2013/EU on serious cross-border threats to health has provided a framework to improve preparedness and to strengthen the response capacities in Europe to health threats. SHARP Joint Action is a 3-year collaborative action of 26 countries and 61 partners, co-funded by the EC and coordinated by the Finnish Institute for Health and Welfare, Finland, and co-coordinated by Robert Koch Institute, Germany and National Institute of Infectious Diseases Lazzaro Spallanzani, Italy. SHARP started it's actions in June 2019, and it aims to strengthen implementation of the International Health Regulations (IHR) and the Decision 1082/2013/EU. SHARP consists of ten work packages covering core public health capacities, including: IHR core capacity strengthening and assessment, preparedness and response planning, training, laboratory preparedness and responsiveness, chemical safety and threats, and case management, infection prevention and control preparedness. Through this cross-sectoral approach, SHARP supports the Member States and partner countries in strengthening their capacities. In response to the COVID-19 outbreak, SHARP has also supported the EC and the Member States, and especially work packages for laboratory preparedness and responsiveness (WP7) and for case management and infection prevention and control preparedness (WP10) were activated. The activities regarding laboratory preparedness and response have been coordinated with the ECDC.
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Affiliation(s)
- A Katz
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - O Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - A Di Caro
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - F Vairo
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - G Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - R Grunow
- Robert Koch Institute, Berlin, Germany
| | - D Jacob
- Robert Koch Institute, Berlin, Germany
| | - M Salminen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
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Appelt S, Faber M, Köppen K, Jacob D, Grunow R, Heuner K. Francisella tularensis Subspecies holarctica and Tularemia in Germany. Microorganisms 2020; 8:microorganisms8091448. [PMID: 32971773 PMCID: PMC7564102 DOI: 10.3390/microorganisms8091448] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/27/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022] Open
Abstract
Tularemia is a zoonotic disease caused by Francisella tularensis a small, pleomorphic, facultative intracellular bacterium. In Europe, infections in animals and humans are caused mainly by Francisella tularensis subspecies holarctica. Humans can be exposed to the pathogen directly and indirectly through contact with sick animals, carcasses, mosquitoes and ticks, environmental sources such as contaminated water or soil, and food. So far, F. tularensis subsp. holarctica is the only Francisella species known to cause tularemia in Germany. On the basis of surveillance data, outbreak investigations, and literature, we review herein the epidemiological situation-noteworthy clinical cases next to genetic diversity of F. tularensis subsp. holarctica strains isolated from patients. In the last 15 years, the yearly number of notified cases of tularemia has increased steadily in Germany, suggesting that the disease is re-emerging. By sequencing F. tularensis subsp. holarctica genomes, knowledge has been added to recent findings, completing the picture of genotypic diversity and geographical segregation of Francisella clades in Germany. Here, we also shortly summarize the current knowledge about a new Francisella species (Francisella sp. strain W12-1067) that has been recently identified in Germany. This species is the second Francisella species discovered in Germany.
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Affiliation(s)
- Sandra Appelt
- Centre for Biological Threats and Special Pathogens (ZBS 2), Robert Koch Institute, 13353 Berlin, Germany; (S.A.); (D.J.); (R.G.)
| | - Mirko Faber
- Gastrointestinal Infections, Zoonoses and Tropical Infections (Division 35), Department for Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany;
| | - Kristin Köppen
- Cellular Interactions of Bacterial Pathogens, ZBS 2, Robert Koch Institute, 13353 Berlin, Germany;
| | - Daniela Jacob
- Centre for Biological Threats and Special Pathogens (ZBS 2), Robert Koch Institute, 13353 Berlin, Germany; (S.A.); (D.J.); (R.G.)
| | - Roland Grunow
- Centre for Biological Threats and Special Pathogens (ZBS 2), Robert Koch Institute, 13353 Berlin, Germany; (S.A.); (D.J.); (R.G.)
| | - Klaus Heuner
- Cellular Interactions of Bacterial Pathogens, ZBS 2, Robert Koch Institute, 13353 Berlin, Germany;
- Correspondence: ; Tel.: +49-301-8754-2226
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9
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Karatuna O, Dance DAB, Matuschek E, Åhman J, Turner P, Hopkins J, Amornchai P, Wuthiekanun V, Cusack TP, Baird R, Hennessy J, Norton R, Armstrong M, Zange S, Zoeller L, Wahab T, Jacob D, Grunow R, Kahlmeter G. Burkholderia pseudomallei multi-centre study to establish EUCAST MIC and zone diameter distributions and epidemiological cut-off values. Clin Microbiol Infect 2020; 27:S1198-743X(20)30384-0. [PMID: 32653660 DOI: 10.1016/j.cmi.2020.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Melioidosis, caused by Burkholderia pseudomallei, requires intensive antimicrobial treatment. However, standardized antimicrobial susceptibility testing (AST) methodology based on modern principles for determining breakpoints and ascertaining performance of methods are lacking for B. pseudomallei. This study aimed to establish MIC and zone diameter distributions on which to set epidemiological cut-off (ECOFF) values for B. pseudomallei using standard EUCAST methodology for non-fastidious organisms. METHODS Non-consecutive, non-duplicate clinical B. pseudomallei isolates (9-70 per centre) were tested at eight study centres against eight antimicrobials by broth microdilution (BMD) and the EUCAST disc diffusion method. Isolates without and with suspected resistance mechanisms were deliberately selected. The EUCAST Development Laboratory ensured the quality of study materials, and provided guidance on performance of the tests and interpretation of results. Aggregated results were analysed according to EUCAST recommendations to determine ECOFFs. RESULTS MIC and zone diameter distributions were generated using BMD and disc diffusion results obtained for 361 B. pseudomallei isolates. MIC and zone diameter ECOFFs (mg/L; mm) were determined for amoxicillin-clavulanic acid (8; 22), ceftazidime (8; 22), imipenem (2; 29), meropenem (2; 26), doxycycline (2; none), tetracycline (8; 23), chloramphenicol (8; 22) and trimethoprim-sulfamethoxazole (4; 28). CONCLUSIONS We have validated the use of standard BMD and disc diffusion methodology for AST of B. pseudomallei. The MIC and zone diameter distributions generated in this study allowed us to establish MIC and zone diameter ECOFFs for the antimicrobials studied. These ECOFFs served as background data for EUCAST to set clinical MIC and zone diameter breakpoints for B. pseudomallei.
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Affiliation(s)
- O Karatuna
- EUCAST Development Laboratory, Växjö, Sweden.
| | - D A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - E Matuschek
- EUCAST Development Laboratory, Växjö, Sweden
| | - J Åhman
- EUCAST Development Laboratory, Växjö, Sweden
| | - P Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - J Hopkins
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - P Amornchai
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - V Wuthiekanun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - T-P Cusack
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic; National Infection Service, Public Health England, London, UK
| | - R Baird
- Royal Darwin Hospital, Darwin, NT, Australia
| | - J Hennessy
- Royal Darwin Hospital, Darwin, NT, Australia
| | - R Norton
- Townsville Hospital, Townsville, QLD, Australia
| | - M Armstrong
- Townsville Hospital, Townsville, QLD, Australia
| | - S Zange
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - L Zoeller
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - T Wahab
- Public Health Agency of Sweden, Stockholm, Sweden
| | - D Jacob
- Robert Koch Institute, Berlin, Germany
| | - R Grunow
- Robert Koch Institute, Berlin, Germany
| | - G Kahlmeter
- EUCAST Development Laboratory, Växjö, Sweden
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10
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Abstract
Background In 2016, an uncommon outbreak of oropharyngeal tularaemia involving six human cases occurred in Germany, caused by drinking contaminated fresh must after a grape harvest. Aim We describe the details of laboratory investigations leading to identification of the outbreak strain, its characterisation by next generation sequencing (NGS) and the finding of the possible source of contamination. Methods We incubated wine samples in different media and on agar plates. NGS was performed on DNA isolated from young wine, sweet reserve and an outbreak case’s lymph node. A draft genome of the outbreak strain was generated. Vertebrate-specific PCRs using primers targeting the mitochondrial cytochrome b gene and product analyses by blast search were used to identify the putative source of must contamination. Results No bacterial isolate could be obtained. Analysis of the draft genome sequence obtained from the sweet reserve attributed this sequence to Francisella tularensis subsp. holarctica, belonging to the B.12/B.34 phylogenetic clade (erythromycin-resistant biovar II). In addition, the DNA sequence obtained from the case’s isolate supported our hypothesis that infection was caused by drinking contaminated must. The vertebrate-specific cytochrome b sequence derived from the young wine and the sweet reserve could be assigned to Apodemus sylvaticus (wood mouse), suggesting that a wood mouse infected with F. tularensis may have contaminated the must. Conclusion The discovered source of infection and the transmission scenario of F. tularensis in this outbreak have not been observed previously and suggest the need for additional hygienic precautionary measures when processing and consuming freshly pressed must.
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Affiliation(s)
- Daniela Jacob
- These authors contributed equally to this work.,Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Kristin Köppen
- Cellular Interactions of Bacterial Pathogens, ZBS 2, Robert Koch Institute, Berlin, Germany.,These authors contributed equally to this work
| | - Aleksandar Radonić
- Genome Sequencing (MF 2), Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Berit Haldemann
- Bioinformatics (MF 1), Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Philipp Zanger
- Heidelberg Institute of Global Health, Unit of Epidemiology and Biostatistics, University Hospitals, Heidelberg, Germany.,Department of Infectious Diseases, Medical Microbiology and Hygiene, University Hospitals, Heidelberg, Germany.,Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
| | - Klaus Heuner
- Cellular Interactions of Bacterial Pathogens, ZBS 2, Robert Koch Institute, Berlin, Germany.,These authors contributed equally to this work
| | - Roland Grunow
- Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
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11
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Bartolini B, Gruber CE, Koopmans M, Avšič T, Bino S, Christova I, Grunow R, Hewson R, Korukluoglu G, Lemos CM, Mirazimi A, Papa A, Sanchez-Seco MP, Sauer AV, Zeller H, Nisii C, Capobianchi MR, Ippolito G, Reusken CB, Di Caro A. Laboratory management of Crimean-Congo haemorrhagic fever virus infections: perspectives from two European networks. ACTA ACUST UNITED AC 2020; 24. [PMID: 30722811 PMCID: PMC6386216 DOI: 10.2807/1560-7917.es.2019.24.5.1800093] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Indexed: 11/30/2022]
Abstract
Background Crimean-Congo haemorrhagic fever virus (CCHFV) is considered an emerging infectious disease threat in the European Union. Since 2000, the incidence and geographic range of confirmed CCHF cases have markedly increased, following changes in the distribution of its main vector, Hyalomma ticks. Aims To review scientific literature and collect experts’ opinion to analyse relevant aspects of the laboratory management of human CCHF cases and any exposed contacts, as well as identify areas for advancement of international collaborative preparedness and laboratory response plans. Methods We conducted a literature review on CCHF molecular diagnostics through an online search. Further, we obtained expert opinions on the key laboratory aspects of CCHF diagnosis. Consulted experts were members of two European projects, EMERGE (Efficient response to highly dangerous and emerging pathogens at EU level) and EVD-LabNet (Emerging Viral Diseases-Expert Laboratory Network). Results Consensus was reached on relevant and controversial aspects of CCHF disease with implications for laboratory management of human CCHF cases, including biosafety, diagnostic algorithm and advice to improve lab capabilities. Knowledge on the diffusion of CCHF can be obtained by promoting syndromic approach to infectious diseases diagnosis and by including CCHFV infection in the diagnostic algorithm of severe fevers of unknown origin. Conclusion No effective vaccine and/or therapeutics are available at present so outbreak response relies on rapid identification and appropriate infection control measures. Frontline hospitals and reference laboratories have a crucial role in the response to a CCHF outbreak, which should integrate laboratory, clinical and public health responses.
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Affiliation(s)
- Barbara Bartolini
- 'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
| | - Cesare Em Gruber
- 'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
| | - Marion Koopmans
- Erasmus MC, Department of Viroscience, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, The Netherlands
| | - Tatjana Avšič
- Institute of Microbiology and Immunology, Faculty of Medicine, Ljubljana, Slovenia
| | - Sylvia Bino
- Control of Infectious Diseases Department Institute of Public Health, Tirana, Albania
| | - Iva Christova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Roger Hewson
- Public Health England, National Infection Service WHO Collaborating Centre for Virus Reference and Research (Special Pathogens), Porton Down, Salisbury, United Kingdom
| | | | - Cinthia Menel Lemos
- Consumers, Health, Agriculture and Food Executive Agency (CHAFEA), Luxembourg, Luxembourg
| | - Ali Mirazimi
- Department of Laboratory Medicine, Clinical Microbiology, Karolinska Institute and Karolinska University Hospital, Solna, Sweden.,National Veterinary Institute, Uppsala, Sweden.,Public Health agency of Sweden, Solna, Sweden
| | - Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Aisha V Sauer
- European Commission, Directorate General for Health and Food Safety, Unit for Crisis Management and Preparedness in Health, Luxembourg, Luxembourg
| | - Hervè Zeller
- European Center for Disease Prevention and Control, Office of the Chief Scientist, Stockholm, Sweden
| | - Carla Nisii
- 'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
| | - Maria Rosaria Capobianchi
- 'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
| | - Giuseppe Ippolito
- 'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
| | - Chantal B Reusken
- Authors contributed equally to the work and share last authorship.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Erasmus MC, Department of Viroscience, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, The Netherlands
| | - Antonino Di Caro
- Authors contributed equally to the work and share last authorship.,'L. Spallanzani' National Institute for Infectious Diseases IRCCS (INMI), WHO Collaborating Center for Clinical Care, Diagnosis, Response and Training on Highly Infectious Diseases, Rome, Italy
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12
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Dupke S, Schubert G, Beudjé F, Barduhn A, Pauly M, Couacy-Hymann E, Grunow R, Akoua-Koffi C, Leendertz FH, Klee SR. Serological evidence for human exposure to Bacillus cereus biovar anthracis in the villages around Taï National Park, Côte d'Ivoire. PLoS Negl Trop Dis 2020; 14:e0008292. [PMID: 32407387 PMCID: PMC7224451 DOI: 10.1371/journal.pntd.0008292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Bacillus cereus biovar anthracis (Bcbva) is an untypical anthrax-causing pathogen responsible for high wildlife mortality in Taï National Park (TNP), Côte d’Ivoire. However, nothing is known about its effect on the rural population living in the region bordering TNP. Contact to bushmeat is a known risk factor for exposure to a variety of zoonotic pathogens, but no human infections with Bcbva were noted so far. Therefore, we performed a retrospective seroprevalence analysis with sera from 1,386 study volunteers. We used assays which detect antibodies against the protective antigen PA, which is synthesized by both Bcbva and classic B. anthracis, and against the recently described antigen pXO2-60, a 35-kDa protein only produced by Bcbva. We found a high seroprevalence (22.37%) of antibodies against PA, and approximately half of those sera (10.46%) were also positive for the Bcbva-specific antigen pXO2-60. All sera negative for PA were also negative for antibodies against pXO2-60, confirming specificity and suitability of the PA/pXO2-60 combined serological assay. The fact that a large fraction of sera was positive for PA but negative for pXO2-60 can most likely be explained by lower immunogenicity of pXO2-60, but exposure to classic B. anthracis cannot be excluded. As only Bcbva has been detected in the TNP area so far, exposure to Bcbva can be suspected from the presence of antibodies against PA alone. In a questionnaire, most study participants reported contact to bushmeat and livestock carcasses. Unfortunately, risk factor analysis indicated that neither animal contacts, sex, age, nor country of origin were significant predictors of Bcbva seroprevalence. Nevertheless, our study added to an assessment of the distribution of Bcbva and its impact on the human population, and our data can serve to raise awareness of anthrax in the affected regions. Anthrax is a zoonotic disease transmitted from animals to humans and normally caused by B. anthracis mainly in savanna regions. However, untypical bacteria named Bacillus cereus biovar anthracis (Bcbva) were detected in a variety of wild animals in the rain forest region of the Taï National Park (TNP) in Côte d’Ivoire. No anthrax infections in humans living in the region around TNP were reported until now. Therefore, we assessed exposure to the pathogen by analysis of sera from human volunteers for the presence of antibodies against the protective antigen (PA), which is produced by B. anthracis and Bcbva, and against the Bcbva-specific protein pXO2-60. We found antibodies against PA in more than 20% of sera from humans living in the TNP region, and around 10% possessed also antibodies against pXO2-60, confirming exposure to Bcbva. As only Bcbva, but not classic B. anthracis was found in TNP, we assume that the majority of humans had contact with Bcbva and that pXO2-60 is less immunogenic than PA. Although most people reported animal contacts, there was no statistically significant correlation with the presence of antibodies against Bcbva. Nevertheless, our study confirmed that Bcbva represents a danger for humans living in the affected area.
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Affiliation(s)
- Susann Dupke
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, ZBS 2: Highly Pathogenic Microorganisms, Berlin, Germany
| | - Grit Schubert
- Robert Koch Institute, P3: Epidemiology of Highly Pathogenic Microorganisms, Berlin, Germany
| | - Félicité Beudjé
- Laboratoire National d’Appui au Développement Agricole/Laboratoire central de Pathologie Animale, Bingerville, Côte d’Ivoire
| | - Anne Barduhn
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, ZBS 2: Highly Pathogenic Microorganisms, Berlin, Germany
| | - Maude Pauly
- Robert Koch Institute, P3: Epidemiology of Highly Pathogenic Microorganisms, Berlin, Germany
| | - Emmanuel Couacy-Hymann
- Laboratoire National d’Appui au Développement Agricole/Laboratoire central de Pathologie Animale, Bingerville, Côte d’Ivoire
| | - Roland Grunow
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, ZBS 2: Highly Pathogenic Microorganisms, Berlin, Germany
| | - Chantal Akoua-Koffi
- Centre de Recherche pour le Développement, Université Alassane Ouattara, Bouaké, Côte d’Ivoire
| | - Fabian H. Leendertz
- Robert Koch Institute, P3: Epidemiology of Highly Pathogenic Microorganisms, Berlin, Germany
- * E-mail:
| | - Silke R. Klee
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, ZBS 2: Highly Pathogenic Microorganisms, Berlin, Germany
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13
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Rohde A, Papp S, Feige P, Grunow R, Kaspari O. Development of a novel selective agar for the isolation and detection of Bacillus anthracis. J Appl Microbiol 2020; 129:311-318. [PMID: 32052540 DOI: 10.1111/jam.14615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this study was to develop a novel selective agar for the specific isolation and detection of Bacillus anthracis. METHODS AND RESULTS Based on published data on antibiotic resistance and susceptibility of B. anthracis and other closely related species of the Bacillus cereus sensu lato group, a new selective agar formulation termed CEFOMA (Bacillus CEreus sensu lato group-specific antibiotics, FOsfomycin, MAcrolides) was developed and evaluated. All tested strains of B. anthracis were able to grow on CEFOMA with the same colony number as on non-selective media, whereas CEFOMA inhibited the growth of the other species within the B. cereus sensu lato group. In comparison to other selective agars, CEFOMA had a superior performance and considerably reduced the total amount of accompanying flora in soil. Furthermore, B. anthracis was successfully isolated from deliberately spiked soil samples. CONCLUSIONS CEFOMA is a highly promising selective agar for the efficient isolation of B. anthracis from environmental samples with a large bacterial background flora. SIGNIFICANCE AND IMPACT OF THE STUDY The isolation of B. anthracis from environmental samples is severely impaired by the lack of adequate selective agars which suppress the growth of other bacteria. CEFOMA agar represents an important improvement and suitable alternative to currently used selective agars.
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Affiliation(s)
- A Rohde
- Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - S Papp
- Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - P Feige
- Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - R Grunow
- Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - O Kaspari
- Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
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14
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Appelt S, Köppen K, Radonić A, Drechsel O, Jacob D, Grunow R, Heuner K. Genetic Diversity and Spatial Segregation of Francisella tularensis Subspecies holarctica in Germany. Front Cell Infect Microbiol 2019; 9:376. [PMID: 31781515 PMCID: PMC6851236 DOI: 10.3389/fcimb.2019.00376] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/22/2019] [Accepted: 10/17/2019] [Indexed: 01/28/2023] Open
Abstract
Francisella tularensis is an intracellular pleomorphic bacterium and the causative agent of tularemia, a zoonotic disease with a wide host range. Among the F. tularensis subspecies, especially F. tularensis subsp. holarctica is of clinical relevance for European countries. The study presented herein focuses namely on genetic diversity and spatial segregation of F. tularensis subsp. holarctica in Germany, as still limited information is available. The investigation is based on the analysis of 34 F. tularensis subsp. holarctica isolates and one draft genome from an outbreak strain. The isolates were cultured from sample material being that of primarily human patients (n = 25) and free-living animals (n = 9). For six of 25 human isolates, epidemiological links between disease onset and tick bites could be established, confirming the importance of arthropod linked transmission of tularemia in Germany. The strains were assigned to three of four major F. tularensis subsp. holarctica clades: B.4, B.6, and B.12. Thereby, B.6 and B.12 clade members were predominantly found; only one human isolate was assigned to clade B.4. Also, it turned out that eight isolates which caused pneumonia in patients clustered into the B.6 clade. Altogether, eight different final subclades were assigned to clade B.6 (biovar I, erythromycin sensitive) and six to B.12 (biovar II, erythromycin resistant) in addition to one new final B.12 subclade. Moreover, for 13 human and 3 animal isolates, final subclade subdivisions were not assigned (B.12 subdivisions B.33 and B.34, and B.6 subdivision B.45) because official nomenclatures are not available yet. This gives credit to the genetic variability of F. tularensis subsp. holarctica strains in Germany. The results clearly point out that the given genetic diversity in Germany seems to be comparably high to that found in other European countries including Scandinavian regions. A spatial segregation of B.6 and B.12 strains was found and statistically confirmed, and B.12 clade members were predominantly found in eastern parts and B.6 members more in western to southern parts of Germany. The portion of B.12 clade members in northeastern parts of Germany was 78.5% and in southwestern parts 1.9%.
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Affiliation(s)
- Sandra Appelt
- Centre for Biological Threats and Special Pathogens (ZBS2), Robert Koch Institute, Berlin, Germany
| | - Kristin Köppen
- Working Group Cellular Interactions of Bacterial Pathogens, ZBS2, Robert Koch Institute, Berlin, Germany
| | - Aleksandar Radonić
- Methodology and Research Infrastructure Genome Sequencing (MF2), Robert Koch Institute, Berlin, Germany
| | - Oliver Drechsel
- Bioinformatics (MF1), Robert Koch Institute, Berlin, Germany
| | - Daniela Jacob
- Centre for Biological Threats and Special Pathogens (ZBS2), Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Centre for Biological Threats and Special Pathogens (ZBS2), Robert Koch Institute, Berlin, Germany
| | - Klaus Heuner
- Working Group Cellular Interactions of Bacterial Pathogens, ZBS2, Robert Koch Institute, Berlin, Germany
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15
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Gruber CEM, Bartolini B, Castilletti C, Mirazimi A, Hewson R, Christova I, Avšič T, Grunow R, Papa A, Sánchez-Seco MP, Kopmans M, Ippolito G, Capobianchi MR, Reusken CBEM, Di Caro A. Geographical Variability Affects CCHFV Detection by RT-PCR: A Tool for In-Silico Evaluation of Molecular Assays. Viruses 2019; 11:E953. [PMID: 31623214 PMCID: PMC6833031 DOI: 10.3390/v11100953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 01/21/2023] Open
Abstract
The Crimean-Congo hemorrhagic fever virus (CCHFV) is considered to be a major emerging infectious threat, according to the WHO R&D blueprint. A wide range of CCHFV molecular assays have been developed, employing varied primer/probe combinations. The high genetic variability of CCHFV often hampers the efficacy of available molecular tests and can affect their diagnostic potential. Recently, increasing numbers of complete CCHFV genomic sequences have become available, allowing a better appreciation of the genomic evolution of this virus. We summarized the current knowledge on molecular methods and developed a new bioinformatics tool to evaluate the existing assays for CCHFV detection, with a special focus on strains circulating in different geographical areas. Twenty-two molecular methods and 181 sequences of CCHFV were collected, respectively, from PubMed and GenBank databases. Up to 28 mismatches between primers and probes of each assay and CCHFV strains were detected through in-silico PCR analysis. Combinations of up to three molecular methods markedly decreased the number of mismatches within most geographic areas. These results supported the good practice of CCHFV detection of performing more than one assay, aimed for different sequence targets. The choice of the most appropriate tests must take into account patient's travel history and geographic distribution of the different CCHFV strains.
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Affiliation(s)
- Cesare E M Gruber
- National Institute for Infectious Diseases (INMI) "L. Spallanzani" IRCCS, WHO Collaborating Center for clinical care, diagnosis, response and training on Highly Infectious Diseases, 00149 Rome, Italy.
| | - Barbara Bartolini
- National Institute for Infectious Diseases (INMI) "L. Spallanzani" IRCCS, WHO Collaborating Center for clinical care, diagnosis, response and training on Highly Infectious Diseases, 00149 Rome, Italy.
| | - Concetta Castilletti
- National Institute for Infectious Diseases (INMI) "L. Spallanzani" IRCCS, WHO Collaborating Center for clinical care, diagnosis, response and training on Highly Infectious Diseases, 00149 Rome, Italy.
| | - Ali Mirazimi
- Public Health agency of Sweden, 17182 Solna, Sweden.
- National veterinary Institute, 75189 Uppsala, Sweden.
- Department of laboratory Medicine, Clinical Microbiology, Karolinska Institute and Karolinska, 17177 Stockholm, Sweden.
| | - Roger Hewson
- Public Health England, National Infection Service WHO Collaborating Centre for Virus Reference and Research (Special Pathogens) Porton Down, Salisbury SP40JG, UK.
| | - Iva Christova
- National Reference Laboratory on Vector-Borne Pathogens, Leptospira and Listeria, Microbiology Department, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria.
| | - Tatjana Avšič
- Faculty of Medicine, Institute of Microbiology and Immunology, 1000 Ljubljana, Slovenia.
| | - Roland Grunow
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms (ZBS 2), Robert Koch Institute, 13353 Berlin, Germany.
| | - Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
| | - María P Sánchez-Seco
- National Centre of Microbiology, Institute of Health "Carlos III", Majadahonda, 28220 Madrid, Spain.
| | - Marion Kopmans
- Erasmus MC, Department of Viroscience, WHO Collaborating Centre for arbovirus and viral hemorrhagic fever reference and research, 3015 CN Rotterdam, The Netherlands.
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases (INMI) "L. Spallanzani" IRCCS, WHO Collaborating Center for clinical care, diagnosis, response and training on Highly Infectious Diseases, 00149 Rome, Italy.
| | - Maria R Capobianchi
- National Institute for Infectious Diseases (INMI) "L. Spallanzani" IRCCS, WHO Collaborating Center for clinical care, diagnosis, response and training on Highly Infectious Diseases, 00149 Rome, Italy.
| | - Chantal B E M Reusken
- Erasmus MC, Department of Viroscience, WHO Collaborating Centre for arbovirus and viral hemorrhagic fever reference and research, 3015 CN Rotterdam, The Netherlands.
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands.
| | - Antonino Di Caro
- National Institute for Infectious Diseases (INMI) "L. Spallanzani" IRCCS, WHO Collaborating Center for clinical care, diagnosis, response and training on Highly Infectious Diseases, 00149 Rome, Italy.
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16
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Reusken CB, Mögling R, Smit PW, Grunow R, Ippolito G, Di Caro A, Koopmans M. Status, quality and specific needs of Ebola virus diagnostic capacity and capability in laboratories of the two European preparedness laboratory networks EMERGE and EVD-LabNet. ACTA ACUST UNITED AC 2019; 23. [PMID: 29766839 PMCID: PMC5954606 DOI: 10.2807/1560-7917.es.2018.23.19.17-00404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 01/19/2023]
Abstract
From December 2013 to March 2016, West Africa experienced the largest Ebola virus (EBOV) outbreak to date, leading to a European-wide activation of laboratory preparedness and response. At the end of the outbreak, laboratories associated with the two European preparedness networks of expert laboratories EMERGE JA and EVD-LabNet were invited to participate in an assessment of the response of European laboratories to the EBOV outbreak, to identify learning points and training needs to strengthen future outbreak responses. Response aspects assessed included diagnostics, biorisk management and quality assurance. The overall coverage of EBOV diagnostics in the European Union/European Economic Area (EU/EEA) was found to be adequate although some points for quality improvement were identified. These included the need for relevant International Organization for Standardization (ISO) accreditation, the provision of EBOV external quality assessments (EQA) in periods where there is no emergency, facilitating access to controls and knowledge, biorisk management without compromising biosafety and a rapid public health response, and the need for both sustained and contingency funding for preparedness and response activities.
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Affiliation(s)
- Chantal B Reusken
- Department of Viroscience, World Health Organization Collaborating Centre for Arbovirus and Viral Haemorrhagic Fever Reference and Research, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Ramona Mögling
- Department of Viroscience, World Health Organization Collaborating Centre for Arbovirus and Viral Haemorrhagic Fever Reference and Research, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Pieter W Smit
- Department of Viroscience, World Health Organization Collaborating Centre for Arbovirus and Viral Haemorrhagic Fever Reference and Research, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Giuseppe Ippolito
- National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani, Rome, Italy
| | - Antonino Di Caro
- National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani, Rome, Italy
| | - Marion Koopmans
- Department of Viroscience, World Health Organization Collaborating Centre for Arbovirus and Viral Haemorrhagic Fever Reference and Research, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Hunger I, Becker S, Frank C, Grunow R, Herzog C, Kurth A, Monazahian M, Nitsche A, Sasse J, Schulz-Weidhaas C, Wollin KM, Schaade L. [Four years after the Ebola crisis : Challenges, experiences, and implications in the German public health context]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1041-1051. [PMID: 31428830 DOI: 10.1007/s00103-019-02995-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Ebola virus disease outbreak in West Africa in 2014/2015 was by far the biggest, most prolonged, and geographically most widespread outbreak of this disease since the discovery of the Ebola virus in 1976. Although no cases of Ebola virus disease were confirmed in Germany, a number of crisis management activities were initiated.Based on a combination of local, national, and international lessons learned, literature research, and a large number of discussions among German colleagues as well as German and foreign colleagues, the experiences of selected German public health actors as well as implications for health protection activities in Germany are presented.On the one hand, preparedness for managing unusual high consequence health events-caused by rare, highly pathogenic biological agents-including the provision of adequate material and personnel resources remains important in Germany. On the other hand, more German engagement in global health is necessary, because the dividing line between global health and local health is increasingly disappearing.
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Affiliation(s)
- Iris Hunger
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
| | - Stephan Becker
- Institut für Virologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Christina Frank
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Roland Grunow
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Christian Herzog
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Andreas Kurth
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Masyar Monazahian
- Zentrum für Gesundheits- und Infektionsschutz, Niedersächsisches Landesgesundheitsamt, Hannover, Deutschland
| | - Andreas Nitsche
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Julia Sasse
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Claudia Schulz-Weidhaas
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Klaus-Michael Wollin
- Zentrum für Gesundheits- und Infektionsschutz, Niedersächsisches Landesgesundheitsamt, Hannover, Deutschland
| | - Lars Schaade
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
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18
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Abstract
Exploratory field analyses of the inactivation capacity of disinfectants on contaminated personal protective equipment (PPE) are required to select a suitable surrogate for biohazardous agents like spores of Bacillus anthracis. The objectives of our study were (1) the determination of an appropriate surrogate for the inactivation of spores of B. anthracis with peracetic acid (PAA), and (2) application of optimized inactivation conditions for an effective decontamination of PPE with PAA under field conditions. For inactivation studies, B. anthracis spores from different strains and B. thuringiensis spores were fixed by air drying on carriers prepared from PPE fabric. Time and concentration studies with PAA-based disinfectants revealed that the spores of the B. thuringiensis strain DSM 350 showed an inactivation profile comparable to that of the spores of the B. anthracis strain with the highest stability, implying that B. thuringiensis can serve as an appropriate surrogate. Rapid (3 to 5 minutes) and effective surface decontamination was achieved with 2% PAA/0.2% surfactant. In field studies, PPE contaminated with spores of B. thuringiensis was treated with the disinfectant. Optimizing the decontamination technique revealed that spraying in combination with brushing was effective within 5 minutes of exposure.
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Affiliation(s)
- Karin Lemmer
- Dr. Karin Lemmer is a scientist in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Professor Georg Pauli is the former Head of the Centre for Biological Threats and Special Pathogens; Sabine Howaldt is a medical technical assistant in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Dr. Ingeborg Schwebke is Deputy Head of the Unit Hospital Hygiene, Infection Prevention and Control, Department of Infectious Diseases; Professor Martin Mielke is Head of the Department of Infectious Diseases; and Professor Roland Grunow is Head of the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; all at the Robert Koch Institute, Berlin, Germany
| | - Georg Pauli
- Dr. Karin Lemmer is a scientist in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Professor Georg Pauli is the former Head of the Centre for Biological Threats and Special Pathogens; Sabine Howaldt is a medical technical assistant in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Dr. Ingeborg Schwebke is Deputy Head of the Unit Hospital Hygiene, Infection Prevention and Control, Department of Infectious Diseases; Professor Martin Mielke is Head of the Department of Infectious Diseases; and Professor Roland Grunow is Head of the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; all at the Robert Koch Institute, Berlin, Germany
| | - Sabine Howaldt
- Dr. Karin Lemmer is a scientist in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Professor Georg Pauli is the former Head of the Centre for Biological Threats and Special Pathogens; Sabine Howaldt is a medical technical assistant in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Dr. Ingeborg Schwebke is Deputy Head of the Unit Hospital Hygiene, Infection Prevention and Control, Department of Infectious Diseases; Professor Martin Mielke is Head of the Department of Infectious Diseases; and Professor Roland Grunow is Head of the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; all at the Robert Koch Institute, Berlin, Germany
| | - Ingeborg Schwebke
- Dr. Karin Lemmer is a scientist in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Professor Georg Pauli is the former Head of the Centre for Biological Threats and Special Pathogens; Sabine Howaldt is a medical technical assistant in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Dr. Ingeborg Schwebke is Deputy Head of the Unit Hospital Hygiene, Infection Prevention and Control, Department of Infectious Diseases; Professor Martin Mielke is Head of the Department of Infectious Diseases; and Professor Roland Grunow is Head of the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; all at the Robert Koch Institute, Berlin, Germany
| | - Martin Mielke
- Dr. Karin Lemmer is a scientist in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Professor Georg Pauli is the former Head of the Centre for Biological Threats and Special Pathogens; Sabine Howaldt is a medical technical assistant in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Dr. Ingeborg Schwebke is Deputy Head of the Unit Hospital Hygiene, Infection Prevention and Control, Department of Infectious Diseases; Professor Martin Mielke is Head of the Department of Infectious Diseases; and Professor Roland Grunow is Head of the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; all at the Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Dr. Karin Lemmer is a scientist in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Professor Georg Pauli is the former Head of the Centre for Biological Threats and Special Pathogens; Sabine Howaldt is a medical technical assistant in the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; Dr. Ingeborg Schwebke is Deputy Head of the Unit Hospital Hygiene, Infection Prevention and Control, Department of Infectious Diseases; Professor Martin Mielke is Head of the Department of Infectious Diseases; and Professor Roland Grunow is Head of the Unit Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens; all at the Robert Koch Institute, Berlin, Germany
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19
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Krause C, Schawitzke A, Grunow R, Jacob D, Röcken C, Egberts JH. Seltene Differenzialdiagnose PET-positiver pulmonaler Raumforderungen. Chirurg 2019; 90:493-495. [DOI: 10.1007/s00104-019-0803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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20
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Dupke S, Barduhn A, Franz T, Leendertz FH, Couacy-Hymann E, Grunow R, Klee SR. Analysis of a newly discovered antigen of Bacillus cereus biovar anthracis for its suitability in specific serological antibody testing. J Appl Microbiol 2018; 126:311-323. [PMID: 30253024 DOI: 10.1111/jam.14114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/31/2018] [Accepted: 09/12/2018] [Indexed: 12/21/2022]
Abstract
AIMS The aim of this work was to identify a protein which can be used for specific detection of antibodies against Bacillus cereus biovar anthracis (Bcbva), an anthrax-causing pathogen that so far has been described in African rainforest areas. METHODS AND RESULTS Culture supernatants of Bcbva and classic Bacillus anthracis (Ba) were analysed by gel electrophoresis, and a 35-kDa protein secreted only by Bcbva and not Ba was detected. The protein was identified as pXO2-60 by mass spectrometry. Sequence analysis showed that Ba is unable to secrete this protein due to a premature stop codon in the sequence for the signal peptide. Immunization of five outbred mice with sterile bacterial culture supernatants of Bcbva revealed an immune response in ELISA against pXO2-60 (three mice positive, one borderline) and the protective antigen (PA; four mice). When supernatants of classic Ba were injected into mice or human sera from anthrax patients were analysed, only antibodies against PA were detected. CONCLUSIONS In combination with PA, the pXO2-60 protein can be used for the detection of antibodies specific against Bcbva and discriminating from Ba. SIGNIFICANCE AND IMPACT OF THE STUDY After further validation, serological assays based on pXO2-60 can be used to perform seroprevalence studies to determine the epidemiology of B. cereus bv anthracis in affected countries and assess its impact on the human population.
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Affiliation(s)
- S Dupke
- Robert Koch-Institute, Centre for Biological Threats and Special Pathogens (ZBS2), Berlin, Germany
| | - A Barduhn
- Robert Koch-Institute, Centre for Biological Threats and Special Pathogens (ZBS2), Berlin, Germany
| | - T Franz
- Robert Koch-Institute, Centre for Biological Threats and Special Pathogens (ZBS2), Berlin, Germany
| | - F H Leendertz
- Robert Koch-Institute, Epidemiology of Highly Pathogenic Microorganisms (P3), Berlin, Germany
| | - E Couacy-Hymann
- Laboratoire National d'Appui au Développement Agricole (LANADA), Laboratoire Central Vétérinaire de Bingerville (LCVB), Bingerville, Côte d'Ivoire
| | - R Grunow
- Robert Koch-Institute, Centre for Biological Threats and Special Pathogens (ZBS2), Berlin, Germany
| | - S R Klee
- Robert Koch-Institute, Centre for Biological Threats and Special Pathogens (ZBS2), Berlin, Germany
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21
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Affiliation(s)
- Florian Burckhardt
- Federal State Agency for Consumer and Health Protection, Rhineland-Palatinate, Koblenz, Germany
| | | | - Klaus Jahn
- Federal State Ministry for Social Affairs, Employment, Health, and Demographics, Rhineland-Palatinate, Mainz, Germany
| | | | | | - Manfred Vogt
- Federal State Agency for Consumer and Health Protection, Rhineland-Palatinate, Koblenz, Germany
| | - Stefan Bent
- Federal State Agency for Consumer and Health Protection, Rhineland-Palatinate, Koblenz, Germany
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22
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Girault G, Wattiau P, Saqib M, Martin B, Vorimore F, Singha H, Engelsma M, Roest HJ, Spicic S, Grunow R, Vicari N, De Keersmaecker SCJ, Roosens NHC, Fabbi M, Tripathi BN, Zientara S, Madani N, Laroucau K. High-resolution melting PCR analysis for rapid genotyping of Burkholderia mallei. Infect Genet Evol 2018; 63:1-4. [PMID: 29751195 DOI: 10.1016/j.meegid.2018.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/24/2022]
Abstract
Burkholderia (B.) mallei is the causative agent of glanders. A previous work conducted on single-nucleotide polymorphisms (SNP) extracted from the whole genome sequences of 45 B. mallei isolates identified 3 lineages for this species. In this study, we designed a high-resolution melting (HRM) method for the screening of 15 phylogenetically informative SNPs within the genome of B. mallei that subtype the species into 3 lineages and 12 branches/sub-branches/groups. The present results demonstrate that SNP-based genotyping represent an interesting approach for the molecular epidemiology analysis of B. mallei.
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Affiliation(s)
- G Girault
- Paris-Est University, ANSES, Laboratory for Animal Health, Bacterial Zoonosis Unit, European Union Reference Laboratory for Equine Diseases/Glanders, Maisons-Alfort, France
| | - P Wattiau
- Department of Bacterial Diseases, CODA-CERVA (Veterinary and Agrochemical Research Centre), Brussels, Belgium
| | - M Saqib
- University of agriculture, Faisalabad, Pakistan
| | - B Martin
- Paris-Est University, ANSES, Laboratory for Animal Health, Bacterial Zoonosis Unit, European Union Reference Laboratory for Equine Diseases/Glanders, Maisons-Alfort, France
| | - F Vorimore
- Paris-Est University, ANSES, Laboratory for Animal Health, Bacterial Zoonosis Unit, European Union Reference Laboratory for Equine Diseases/Glanders, Maisons-Alfort, France
| | - H Singha
- ICAR-National Research Centre on Equines, Hisar, India
| | - M Engelsma
- WageningenBioveterinary Research, Lelystad, The Netherlands
| | - H J Roest
- WageningenBioveterinary Research, Lelystad, The Netherlands
| | - S Spicic
- Croatian Veterinary Institute, Department for Bacteriology and Parasitology, Laboratory for Bacterial Zoonoses and Molecular Diagnosis of Bacterial Diseases, Zagreb, Croatia
| | - R Grunow
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - N Vicari
- IstitutoZooprofilatticoSperimentaledellaLombardia e dell'EmiliaRomagna "Bruno Ubertini", Pavia, Italy
| | - S C J De Keersmaecker
- Platform Biotechnology and Molecular Biology, Scientific Institute of Public Health, Brussels, Belgium
| | - N H C Roosens
- Platform Biotechnology and Molecular Biology, Scientific Institute of Public Health, Brussels, Belgium
| | - M Fabbi
- IstitutoZooprofilatticoSperimentaledellaLombardia e dell'EmiliaRomagna "Bruno Ubertini", Pavia, Italy
| | - B N Tripathi
- ICAR-National Research Centre on Equines, Hisar, India
| | - S Zientara
- Paris-Est University, ANSES, Laboratory for Animal Health, Bacterial Zoonosis Unit, European Union Reference Laboratory for Equine Diseases/Glanders, Maisons-Alfort, France
| | - N Madani
- Paris-Est University, ANSES, Laboratory for Animal Health, Bacterial Zoonosis Unit, European Union Reference Laboratory for Equine Diseases/Glanders, Maisons-Alfort, France
| | - K Laroucau
- Paris-Est University, ANSES, Laboratory for Animal Health, Bacterial Zoonosis Unit, European Union Reference Laboratory for Equine Diseases/Glanders, Maisons-Alfort, France.
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23
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Wittwer M, Altpeter E, Pilo P, Gygli SM, Beuret C, Foucault F, Ackermann-Gäumann R, Karrer U, Jacob D, Grunow R, Schürch N. Population Genomics of Francisella tularensis subsp. holarctica and its Implication on the Eco-Epidemiology of Tularemia in Switzerland. Front Cell Infect Microbiol 2018; 8:89. [PMID: 29623260 PMCID: PMC5875085 DOI: 10.3389/fcimb.2018.00089] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 12/21/2017] [Accepted: 03/07/2018] [Indexed: 12/30/2022] Open
Abstract
Whole genome sequencing (WGS) methods provide new possibilities in the field of molecular epidemiology. This is particularly true for monomorphic organisms where the discriminatory power of traditional methods (e.g., restriction enzyme length polymorphism typing, multi locus sequence typing etc.) is inadequate to elucidate complex disease transmission patterns, as well as resolving the phylogeny at high resolution on a micro-geographic scale. In this study, we present insights into the population structure of Francisella tularensis subsp. holarctica, the causative agent of tularemia in Switzerland. A total of 59 Fth isolates were obtained from castor bean ticks (Ixodes ricinus), animals and humans and a high resolution phylogeny was inferred using WGS methods. The majority of the Fth population in Switzerland belongs to the west European B.11 clade and shows an extraordinary genetic diversity underlining the old evolutionary history of the pathogen in the alpine region. Moreover, a new B.11 subclade was identified which was not described so far. The combined analysis of the epidemiological data of human tularemia cases with the whole genome sequences of the 59 isolates provide evidence that ticks play a pivotal role in transmitting Fth to humans and other vertebrates in Switzerland. This is further underlined by the correlation of disease risk estimates with climatic and ecological factors influencing the survival of ticks.
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Affiliation(s)
- Matthias Wittwer
- Spiez Laboratory, Federal Office for Civil Protection, Spiez, Switzerland.,Swiss National Reference Center for Francisella tularensis (NANT), Spiez, Switzerland
| | | | - Paola Pilo
- Department of Infectious Diseases and Pathobiology, Institute of Veterinary Bacteriology, University of Berne, Berne, Switzerland
| | - Sebastian M Gygli
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Christian Beuret
- Spiez Laboratory, Federal Office for Civil Protection, Spiez, Switzerland
| | | | - Rahel Ackermann-Gäumann
- Spiez Laboratory, Federal Office for Civil Protection, Spiez, Switzerland.,Swiss National Reference Centre for Tick-Transmitted Diseases (NRZK), Spiez, Switzerland
| | - Urs Karrer
- University of Basel, Basel, Switzerland.,Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Daniela Jacob
- ZBS 2, Center for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- ZBS 2, Center for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Nadia Schürch
- Spiez Laboratory, Federal Office for Civil Protection, Spiez, Switzerland.,Swiss National Reference Center for Francisella tularensis (NANT), Spiez, Switzerland
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24
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Tlapák H, Köppen K, Rydzewski K, Grunow R, Heuner K. Construction of a New Phage Integration Vector pFIV-Val for Use in Different Francisella Species. Front Cell Infect Microbiol 2018; 8:75. [PMID: 29594068 PMCID: PMC5861138 DOI: 10.3389/fcimb.2018.00075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/27/2017] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Abstract
We recently identified and described a putative prophage on the genomic island FhaGI-1 located within the genome of Francisella hispaniensis AS02-814 (F. tularensis subsp. novicida-like 3523). In this study, we constructed two variants of a Francisella phage integration vector, called pFIV1-Val and pFIV2-Val (Francisella Integration Vector-tRNAVal-specific), using the attL/R-sites and the site-specific integrase (FN3523_1033) of FhaGI-1, a chloramphenicol resistance cassette and a sacB gene for counter selection of transformants against the vector backbone. We inserted the respective sites and genes into vector pUC57-Kana to allow for propagation in Escherichia coli. The constructs generated a circular episomal form in E. coli which could be used to transform Francisella spp. where FIV-Val stably integrated site specifically into the tRNAVal gene of the genome, whereas pUC57-Kana is lost due to counter selection. Functionality of the new vector was demonstrated by the successfully complementation of a Francisella mutant strain. The vectors were stable in vitro and during host-cell infection without selective pressure. Thus, the vectors can be applied as a further genetic tool in Francisella research, expanding the present genetic tools by an integrative element. This new element is suitable to perform long-term experiments with different Francisella species.
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Affiliation(s)
- Hana Tlapák
- Division 2 (ZBS 2), Cellular Interactions of Bacterial Pathogens, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Kristin Köppen
- Division 2 (ZBS 2), Cellular Interactions of Bacterial Pathogens, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Kerstin Rydzewski
- Division 2 (ZBS 2), Cellular Interactions of Bacterial Pathogens, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Division 2 (ZBS 2), Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Klaus Heuner
- Division 2 (ZBS 2), Cellular Interactions of Bacterial Pathogens, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
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25
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Abstract
Tularemia, also known as “rabbit fever,” is a zoonosis caused by the facultative intracellular, gram-negative bacterium Francisella tularensis. Infection occurs through contact with infected animals (often hares), arthropod vectors (such as ticks or deer flies), inhalation of contaminated dust or through contaminated food and water. In this review, we would like to provide an overview of the current epidemiological situation in Germany using published studies and case reports, an analysis of recent surveillance data and our own experience from the laboratory diagnostics, and investigation of cases. While in Germany tularemia is a rarely reported disease, there is evidence of recent re-emergence. We also describe some peculiarities that were observed in Germany, such as a broad genetic diversity, and a recently discovered new genus of Francisella and protracted or severe clinical courses of infections with the subspecies holarctica. Because tularemia is a zoonosis, we also touch upon the situation in the animal reservoir and one-health aspects of this disease. Apparently, many pieces of the puzzle need to be found and put into place before the complex interaction between wildlife, the environment and humans are fully understood. Funding for investigations into rare diseases is scarce. Therefore, combining efforts in several countries in the framework of international projects may be necessary to advance further our understanding of this serious but also scientifically interesting disease.
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Affiliation(s)
- Mirko Faber
- Gastrointestinal Infections, Zoonoses and Tropical Infections (Division 35), Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Klaus Heuner
- Working Group, Cellular Interactions of Bacterial Pathogens, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany.,Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany
| | - Daniela Jacob
- Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany
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26
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Weill FX, Domman D, Njamkepo E, Tarr C, Rauzier J, Fawal N, Keddy KH, Salje H, Moore S, Mukhopadhyay AK, Bercion R, Luquero FJ, Ngandjio A, Dosso M, Monakhova E, Garin B, Bouchier C, Pazzani C, Mutreja A, Grunow R, Sidikou F, Bonte L, Breurec S, Damian M, Njanpop-Lafourcade BM, Sapriel G, Page AL, Hamze M, Henkens M, Chowdhury G, Mengel M, Koeck JL, Fournier JM, Dougan G, Grimont PAD, Parkhill J, Holt KE, Piarroux R, Ramamurthy T, Quilici ML, Thomson NR. Genomic history of the seventh pandemic of cholera in Africa. Science 2017; 358:785-789. [DOI: 10.1126/science.aad5901] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/10/2017] [Indexed: 11/02/2022]
Abstract
The seventh cholera pandemic has heavily affected Africa, although the origin and continental spread of the disease remain undefined. We used genomic data from 1070 Vibrio cholerae O1 isolates, across 45 African countries and over a 49-year period, to show that past epidemics were attributable to a single expanded lineage. This lineage was introduced at least 11 times since 1970, into two main regions, West Africa and East/Southern Africa, causing epidemics that lasted up to 28 years. The last five introductions into Africa, all from Asia, involved multidrug-resistant sublineages that replaced antibiotic-susceptible sublineages after 2000. This phylogenetic framework describes the periodicity of lineage introduction and the stable routes of cholera spread, which should inform the rational design of control measures for cholera in Africa.
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Affiliation(s)
- François-Xavier Weill
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Paris, 75015, France
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK
| | - Daryl Domman
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK
| | - Elisabeth Njamkepo
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Paris, 75015, France
| | - Cheryl Tarr
- Centers for Disease Control and Prevention, Escherichia and Shigella Reference Unit, Atlanta, GA 30333, USA
| | - Jean Rauzier
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Paris, 75015, France
| | - Nizar Fawal
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Paris, 75015, France
| | - Karen H. Keddy
- Centre for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg 2131, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Henrik Salje
- Institut Pasteur, Mathematical Modelling of Infectious Diseases, Paris, 75015, France
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Sandra Moore
- Laboratoire de Parasitologie-Mycologie, CHU Timone, Université de la Méditerranée, Marseille, 13385, France
| | - Asish K. Mukhopadhyay
- National Institute of Cholera and Enteric Diseases (NICED), Kolkata, West Bengal 700010, India
| | - Raymond Bercion
- Institut Pasteur de Bangui, BP 923, Bangui, Central African Republic
- Institut Pasteur de Dakar, BP 220, Dakar, Senegal
| | | | | | - Mireille Dosso
- Bacteriology and Virology Department, Institut Pasteur, Abidjan, Côte d'Ivoire
| | - Elena Monakhova
- Rostov-on-Don Research Institute for Plague Control, Rostov-on-Don, 344022, Russia
| | - Benoit Garin
- Institut Pasteur de Dakar, BP 220, Dakar, Senegal
| | | | - Carlo Pazzani
- University of Bari “A. Moro”, Department of Biology, Bari, 70126, Italy
| | - Ankur Mutreja
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0SP, UK
- Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India
| | | | - Fati Sidikou
- Centre de Recherche Medicale et Sanitaire (CERMES), BP 10887, Niamey, Niger
| | | | - Sébastien Breurec
- Institut Pasteur de Bangui, BP 923, Bangui, Central African Republic
| | - Maria Damian
- Cantacuzino National Institute of Research-Development for Microbiology and Immunology, Bucharest, Romania
| | | | - Guillaume Sapriel
- Université de Versailles Saint-Quentin-en-Yvelines, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, 78180, France
- Atelier de Bioinformatique, ISYEB, UMR 7205, Paris, 75005, France
| | | | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), EDST-FSP, Université Libanaise, Tripoli, Lebanon
| | | | - Goutam Chowdhury
- National Institute of Cholera and Enteric Diseases (NICED), Kolkata, West Bengal 700010, India
| | - Martin Mengel
- Agence de Médecine Préventive (AMP), Paris, 75015, France
| | - Jean-Louis Koeck
- Centre Hospitalier des Armées Bouffard, Djibouti, Republic of Djibouti
| | | | - Gordon Dougan
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0SP, UK
| | - Patrick A. D. Grimont
- Institut Pasteur, Unité Biodiversité des Bactéries Pathogènes Emergentes, Paris, 75015, France
| | - Julian Parkhill
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK
| | - Kathryn E. Holt
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Renaud Piarroux
- Laboratoire de Parasitologie-Mycologie, CHU Timone, Université de la Méditerranée, Marseille, 13385, France
| | | | - Marie-Laure Quilici
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Paris, 75015, France
- Institut Pasteur, Unité du Choléra et des Vibrions, Paris, 75015, France
| | - Nicholas R. Thomson
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Lemmer K, Howaldt S, Heinrich R, Roder A, Pauli G, Dorner B, Pauly D, Mielke M, Schwebke I, Grunow R. Test methods for estimating the efficacy of the fast-acting disinfectant peracetic acid on surfaces of personal protective equipment. J Appl Microbiol 2017; 123:1168-1183. [DOI: 10.1111/jam.13575] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 11/27/2022]
Affiliation(s)
- K. Lemmer
- Centre for Biological Threats and Special Pathogens; Robert Koch Institute; Berlin Germany
| | - S. Howaldt
- Centre for Biological Threats and Special Pathogens; Robert Koch Institute; Berlin Germany
| | - R. Heinrich
- Centre for Biological Threats and Special Pathogens; Robert Koch Institute; Berlin Germany
| | - A. Roder
- Centre for Biological Threats and Special Pathogens; Robert Koch Institute; Berlin Germany
| | - G. Pauli
- Centre for Biological Threats and Special Pathogens; Robert Koch Institute; Berlin Germany
| | - B.G. Dorner
- Centre for Biological Threats and Special Pathogens; Robert Koch Institute; Berlin Germany
| | - D. Pauly
- Centre for Biological Threats and Special Pathogens; Robert Koch Institute; Berlin Germany
| | - M. Mielke
- Applied Infection Control and Hospital Hygiene; Robert Koch Institute; Berlin Germany
| | - I. Schwebke
- Applied Infection Control and Hospital Hygiene; Robert Koch Institute; Berlin Germany
| | - R. Grunow
- Centre for Biological Threats and Special Pathogens; Robert Koch Institute; Berlin Germany
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Zimmermann F, Köhler SM, Nowak K, Dupke S, Barduhn A, Düx A, Lang A, De Nys HM, Gogarten JF, Grunow R, Couacy-Hymann E, Wittig RM, Klee SR, Leendertz FH. Low antibody prevalence against Bacillus cereus biovar anthracis in Taï National Park, Côte d'Ivoire, indicates high rate of lethal infections in wildlife. PLoS Negl Trop Dis 2017; 11:e0005960. [PMID: 28934219 PMCID: PMC5626515 DOI: 10.1371/journal.pntd.0005960] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/03/2017] [Accepted: 09/12/2017] [Indexed: 11/18/2022] Open
Abstract
Bacillus cereus biovar anthracis (Bcbva) is a member of the B. cereus group which carries both B. anthracis virulence plasmids, causes anthrax-like disease in various wildlife species and was described in several sub-Saharan African rainforests. Long-term monitoring of carcasses in Taï National Park, Côte d'Ivoire, revealed continuous wildlife mortality due to Bcbva in a broad range of mammalian species. While non-lethal anthrax infections in wildlife have been described for B. anthracis, nothing is known about the odds of survival following an anthrax infection caused by Bcbva. To address this gap, we present the results of a serological study of anthrax in five wildlife species known to succumb to Bcbva in this ecosystem. Specific antibodies were only detected in two out of 15 wild red colobus monkeys (Procolobus badius) and one out of 10 black-and-white colobus monkeys (Colobus polykomos), but in none of 16 sooty mangabeys (Cercocebus atys), 9 chimpanzees (Pan troglodytes verus) and 9 Maxwell's duikers (Cephalophus maxwellii). The combination of high mortality and low antibody detection rates indicates high virulence of this disease across these different mammalian species.
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Affiliation(s)
- Fee Zimmermann
- Robert Koch Institute, P3: “Epidemiology of Highly Pathogenic Microorganisms", Seestraße 10, Berlin, Germany
- Robert Koch Institute, ZBS 2: Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms, Seestraße 10, Berlin, Germany
| | - Susanne M. Köhler
- Robert Koch Institute, P3: “Epidemiology of Highly Pathogenic Microorganisms", Seestraße 10, Berlin, Germany
| | - Kathrin Nowak
- Robert Koch Institute, P3: “Epidemiology of Highly Pathogenic Microorganisms", Seestraße 10, Berlin, Germany
| | - Susann Dupke
- Robert Koch Institute, ZBS 2: Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms, Seestraße 10, Berlin, Germany
| | - Anne Barduhn
- Robert Koch Institute, ZBS 2: Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms, Seestraße 10, Berlin, Germany
| | - Ariane Düx
- Robert Koch Institute, P3: “Epidemiology of Highly Pathogenic Microorganisms", Seestraße 10, Berlin, Germany
| | - Alexander Lang
- Robert Koch Institute, P3: “Epidemiology of Highly Pathogenic Microorganisms", Seestraße 10, Berlin, Germany
| | - Hélène M. De Nys
- Robert Koch Institute, P3: “Epidemiology of Highly Pathogenic Microorganisms", Seestraße 10, Berlin, Germany
| | - Jan F. Gogarten
- Robert Koch Institute, P3: “Epidemiology of Highly Pathogenic Microorganisms", Seestraße 10, Berlin, Germany
- Department of Biology, McGill University, Montreal, QC, Canada
- Primatology Department, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, Leipzig, Germany
| | - Roland Grunow
- Robert Koch Institute, ZBS 2: Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms, Seestraße 10, Berlin, Germany
| | | | - Roman M. Wittig
- Primatology Department, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, Leipzig, Germany
- Taï Chimpanzee Project, Centre Suisse de Recherches Scientifiques, Abidjan 01, Côte d’Ivoire
| | - Silke R. Klee
- Robert Koch Institute, ZBS 2: Centre for Biological Threats and Special Pathogens, Highly Pathogenic Microorganisms, Seestraße 10, Berlin, Germany
| | - Fabian H. Leendertz
- Robert Koch Institute, P3: “Epidemiology of Highly Pathogenic Microorganisms", Seestraße 10, Berlin, Germany
- * E-mail:
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Chen F, Rydzewski K, Kutzner E, Häuslein I, Schunder E, Wang X, Meighen-Berger K, Grunow R, Eisenreich W, Heuner K. Differential Substrate Usage and Metabolic Fluxes in Francisella tularensis Subspecies holarctica and Francisella novicida. Front Cell Infect Microbiol 2017; 7:275. [PMID: 28680859 PMCID: PMC5478678 DOI: 10.3389/fcimb.2017.00275] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 04/14/2017] [Accepted: 06/06/2017] [Indexed: 12/14/2022] Open
Abstract
Francisella tularensis is an intracellular pathogen for many animals causing the infectious disease, tularemia. Whereas F. tularensis subsp. holarctica is highly pathogenic for humans, F. novicida is almost avirulent for humans, but virulent for mice. In order to compare metabolic fluxes between these strains, we performed 13C-labeling experiments with F. tularensis subsp. holarctica wild type (beaver isolate), F. tularensis subsp. holarctica strain LVS, or F. novicida strain U112 in complex media containing either [U-13C6]glucose, [1,2-13C2]glucose, [U-13C3]serine, or [U-13C3]glycerol. GC/MS-based isotopolog profiling of amino acids, polysaccharide-derived glucose, free fructose, amino sugars derived from the cell wall, fatty acids, 3-hydroxybutyrate, lactate, succinate and malate revealed uptake and metabolic usage of all tracers under the experimental conditions with glucose being the major carbon source for all strains under study. The labeling patterns of the F. tularensis subsp. holarctica wild type were highly similar to those of the LVS strain, but showed remarkable differences to the labeling profiles of the metabolites from the F. novicida strain. Glucose was directly used for polysaccharide and cell wall biosynthesis with higher rates in F. tularensis subsp. holarctica or metabolized, with higher rates in F. novicida, via glycolysis and the non-oxidative pentose phosphate pathway (PPP). Catabolic turnover of glucose via gluconeogenesis was also observed. In all strains, Ala was mainly synthesized from pyruvate, although no pathway from pyruvate to Ala is annotated in the genomes of F. tularensis and F. novicida. Glycerol efficiently served as a gluconeogenetic substrate in F. novicida, but only less in the F. tularensis subsp. holarctica strains. In any of the studied strains, serine did not serve as a major substrate and was not significantly used for gluconeogenesis under the experimental conditions. Rather, it was only utilized, at low rates, in downstream metabolic processes, e.g., via acetyl-CoA in the citrate cycle and for fatty acid biosynthesis, especially in the F. tularensis subsp. holarctica strains. In summary, the data reflect differential metabolite fluxes in F. tularensis subsp. holarctica and F. novicida suggesting that the different utilization of substrates could be related to host specificity and virulence of Francisella.
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Affiliation(s)
- Fan Chen
- Department of Chemistry, Chair of Biochemistry, Technische Universität MünchenGarching, Germany
| | - Kerstin Rydzewski
- Working Group "Cellular Interactions of Bacterial Pathogens", ZBS 2, Robert Koch InstituteBerlin, Germany
| | - Erika Kutzner
- Department of Chemistry, Chair of Biochemistry, Technische Universität MünchenGarching, Germany
| | - Ina Häuslein
- Department of Chemistry, Chair of Biochemistry, Technische Universität MünchenGarching, Germany
| | - Eva Schunder
- Working Group "Cellular Interactions of Bacterial Pathogens", ZBS 2, Robert Koch InstituteBerlin, Germany
| | - Xinzhe Wang
- Department of Chemistry, Chair of Biochemistry, Technische Universität MünchenGarching, Germany
| | - Kevin Meighen-Berger
- Department of Chemistry, Chair of Biochemistry, Technische Universität MünchenGarching, Germany
| | - Roland Grunow
- Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Highly Pathogenic Microorganisms, Robert Koch InstituteBerlin, Germany
| | - Wolfgang Eisenreich
- Department of Chemistry, Chair of Biochemistry, Technische Universität MünchenGarching, Germany
| | - Klaus Heuner
- Working Group "Cellular Interactions of Bacterial Pathogens", ZBS 2, Robert Koch InstituteBerlin, Germany
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Grunow R, Jacob D, Klee S, Schlembach D, Jackowski-Dohrmann S, Loenning-Baucke V, Eberspächer B, Swidsinski S. Brucellosis in a refugee who migrated from Syria to Germany and lessons learnt, 2016. ACTA ACUST UNITED AC 2017; 21:30311. [PMID: 27525454 PMCID: PMC4998511 DOI: 10.2807/1560-7917.es.2016.21.31.30311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 07/21/2016] [Accepted: 08/03/2016] [Indexed: 11/20/2022]
Abstract
A teenage woman migrating from Syria arrived in May 2015 in Germany. She gave birth to a healthy child in early 2016, but became febrile shortly after delivery. Blood cultures revealed Brucella melitensis. In retrospect, she reported contact with sheep in Syria and recurrent pain in the hip joints over about five months before diagnosis of brucellosis. We discuss consequences for adequate treatment of mother and child as well as for clinical and laboratory management.
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Lasch P, Grunow R, Antonation K, Weller SA, Jacob D. Inactivation techniques for MALDI-TOF MS analysis of highly pathogenic bacteria – A critical review. Trends Analyt Chem 2016. [DOI: 10.1016/j.trac.2016.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Slesak G, Fleck R, Jacob D, Grunow R, Schäfer J. Imported cholera with acute renal failure after a short business-trip to the Philippines, Germany, October 2015. ACTA ACUST UNITED AC 2016; 21:30099. [PMID: 26767388 DOI: 10.2807/1560-7917.es.2016.21.1.30099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/07/2016] [Indexed: 11/20/2022]
Abstract
A German businessman developed acute watery diarrhoea after a three-day trip to the Philippines. He was admitted with severe hypotension and acute renal failure, but recovered with rapid rehydration. Vibrio cholerae O1 serotype Ogawa was isolated. Physicians need to be aware of endemic cholera in Asia including the Philippines and consider this in their pre-travel advice.
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Becker S, Lochau P, Jacob D, Heuner K, Grunow R. Successful re-evaluation of broth medium T for growth of Francisella tularensis ssp. and other highly pathogenic bacteria. J Microbiol Methods 2016; 121:5-7. [DOI: 10.1016/j.mimet.2015.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 11/16/2022]
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Keim P, Grunow R, Vipond R, Grass G, Hoffmaster A, Birdsell DN, Klee SR, Pullan S, Antwerpen M, Bayer BN, Latham J, Wiggins K, Hepp C, Pearson T, Brooks T, Sahl J, Wagner DM. Whole Genome Analysis of Injectional Anthrax Identifies Two Disease Clusters Spanning More Than 13 Years. EBioMedicine 2015; 2:1613-8. [PMID: 26870786 PMCID: PMC4740342 DOI: 10.1016/j.ebiom.2015.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 07/16/2015] [Revised: 09/24/2015] [Accepted: 10/02/2015] [Indexed: 12/30/2022] Open
Abstract
Background Anthrax is a rare disease in humans but elicits great public fear because of its past use as an agent of bioterrorism. Injectional anthrax has been occurring sporadically for more than ten years in heroin consumers across multiple European countries and this outbreak has been difficult to trace back to a source. Methods We took a molecular epidemiological approach in understanding this disease outbreak, including whole genome sequencing of Bacillus anthracis isolates from the anthrax victims. We also screened two large strain repositories for closely related strains to provide context to the outbreak. Findings Analyzing 60 Bacillus anthracis isolates associated with injectional anthrax cases and closely related reference strains, we identified 1071 Single Nucleotide Polymorphisms (SNPs). The synapomorphic SNPs (350) were used to reconstruct phylogenetic relationships, infer likely epidemiological sources and explore the dynamics of evolving pathogen populations. Injectional anthrax genomes separated into two tight clusters: one group was exclusively associated with the 2009–10 outbreak and located primarily in Scotland, whereas the second comprised more recent (2012–13) cases but also a single Norwegian case from 2000. Interpretation Genome-based differentiation of injectional anthrax isolates argues for at least two separate disease events spanning > 12 years. The genomic similarity of the two clusters makes it likely that they are caused by separate contamination events originating from the same geographic region and perhaps the same site of drug manufacturing or processing. Pathogen diversity within single patients challenges assumptions concerning population dynamics of infecting B. anthracis and host defensive barriers for injectional anthrax. Funding This work was supported by the United States Department of Homeland Security grant no. HSHQDC-10-C-00,139 and via a binational cooperative agreement between the United States Government and the Government of Germany. This work was supported by funds from the German Ministry of Defense (Sonderforschungsprojekt 25Z1-S-431,214). Support for sequencing was also obtained from Illumina, Inc. These sources had no role in the data generation or interpretation, and had not role in the manuscript preparation. Panel 1: Research in Context Systematic Review We searched PubMed for any article published before Jun. 17, 2015, with the terms “Bacillus anthracis” and “heroin”, or “injectional anthrax”. Other than our previously published work (Price et al., 2012), we found no other relevant studies on elucidating the global phylogenetic relationships of B. anthracis strains associated with injectional anthrax caused by recreational heroin consumption of spore-contaminated drug. There were, however, publically available genome sequences of two strains involved (Price et al., 2012, Grunow et al., 2013) and the draft genome sequence of Bacillus anthracis UR-1, isolated from a German heroin user (Ruckert et al., 2012) with only limited information on the genotyping of closely related strains (Price et al., 2012, Grunow et al., 2013). Lay Person Interpretation Injectional anthrax has been plaguing heroin drug users across Europe for more than 10 years. In order to better understand this outbreak, we assessed genomic relationships of all available injectional anthrax strains from four countries spanning a > 12 year period. Very few differences were identified using genome-based analysis, but these differentiated the isolates into two distinct clusters. This strongly supports a hypothesis of at least two separate anthrax spore contamination events perhaps during the drug production processes. Identification of two events would not have been possible from standard epidemiological analysis. These comprehensive data will be invaluable for classifying future injectional anthrax isolates and for future geographic attribution. Whole genome sequences of injectional anthrax B. anthracis isolates fall in two tight but distinct genomic clusters. The distinct genomic clusters are consistent with two or more disease events that overlap in time and space. Defining pathogen clusters will lead to better public health responses to difficult to track disease outbreaks.
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Affiliation(s)
- Paul Keim
- The Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ 86011-4073, USA; The Pathogen Genomics Division, The Translational Genomics Research Institute, 3051 W. Shamrell Blvd, Suite 106, Flagstaff, AZ 86001 USA
| | | | - Richard Vipond
- Public Health England, Porton Down, Wiltshire SP4 0JG, United Kingdom; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool L69 7BE, United Kingdom
| | - Gregor Grass
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - Alex Hoffmaster
- The Center for Disease Control and Prevention, Atlanta, GA, USA
| | - Dawn N Birdsell
- The Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ 86011-4073, USA
| | | | - Steven Pullan
- Public Health England, Porton Down, Wiltshire SP4 0JG, United Kingdom; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool L69 7BE, United Kingdom
| | - Markus Antwerpen
- Public Health England, Porton Down, Wiltshire SP4 0JG, United Kingdom
| | - Brittany N Bayer
- The Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ 86011-4073, USA
| | - Jennie Latham
- Public Health England, Porton Down, Wiltshire SP4 0JG, United Kingdom
| | - Kristin Wiggins
- The Pathogen Genomics Division, The Translational Genomics Research Institute, 3051 W. Shamrell Blvd, Suite 106, Flagstaff, AZ 86001 USA
| | - Crystal Hepp
- The Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ 86011-4073, USA
| | - Talima Pearson
- The Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ 86011-4073, USA
| | - Tim Brooks
- Public Health England, Porton Down, Wiltshire SP4 0JG, United Kingdom; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool L69 7BE, United Kingdom
| | - Jason Sahl
- The Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ 86011-4073, USA; The Pathogen Genomics Division, The Translational Genomics Research Institute, 3051 W. Shamrell Blvd, Suite 106, Flagstaff, AZ 86001 USA
| | - David M Wagner
- The Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ 86011-4073, USA
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Brézillon C, Haustant M, Dupke S, Corre JP, Lander A, Franz T, Monot M, Couture-Tosi E, Jouvion G, Leendertz FH, Grunow R, Mock ME, Klee SR, Goossens PL. Capsules, toxins and AtxA as virulence factors of emerging Bacillus cereus biovar anthracis. PLoS Negl Trop Dis 2015; 9:e0003455. [PMID: 25830379 PMCID: PMC4382292 DOI: 10.1371/journal.pntd.0003455] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/04/2014] [Indexed: 11/18/2022] Open
Abstract
Emerging B. cereus strains that cause anthrax-like disease have been isolated in Cameroon (CA strain) and Côte d’Ivoire (CI strain). These strains are unusual, because their genomic characterisation shows that they belong to the B. cereus species, although they harbour two plasmids, pBCXO1 and pBCXO2, that are highly similar to the pXO1 and pXO2 plasmids of B. anthracis that encode the toxins and the polyglutamate capsule respectively. The virulence factors implicated in the pathogenicity of these B. cereus bv anthracis strains remain to be characterised. We tested their virulence by cutaneous and intranasal delivery in mice and guinea pigs; they were as virulent as wild-type B. anthracis. Unlike as described for pXO2-cured B. anthracis, the CA strain cured of the pBCXO2 plasmid was still highly virulent, showing the existence of other virulence factors. Indeed, these strains concomitantly expressed a hyaluronic acid (HA) capsule and the B. anthracis polyglutamate (PDGA) capsule. The HA capsule was encoded by the hasACB operon on pBCXO1, and its expression was regulated by the global transcription regulator AtxA, which controls anthrax toxins and PDGA capsule in B. anthracis. Thus, the HA and PDGA capsules and toxins were co-regulated by AtxA. We explored the respective effect of the virulence factors on colonisation and dissemination of CA within its host by constructing bioluminescent mutants. Expression of the HA capsule by itself led to local multiplication and, during intranasal infection, to local dissemination to the adjacent brain tissue. Co-expression of either toxins or PDGA capsule with HA capsule enabled systemic dissemination, thus providing a clear evolutionary advantage. Protection against infection by B. cereus bv anthracis required the same vaccination formulation as that used against B. anthracis. Thus, these strains, at the frontier between B. anthracis and B. cereus, provide insight into how the monomorphic B. anthracis may have emerged. Anthrax is caused by the bacterium Bacillus anthracis that affects all mammals worldwide. It emerged more than 10,000 years ago from a Bacillus cereus precursor. In the past decade, B. cereus bacteria were isolated in the USA from anthrax-like pneumonia cases. They harbour one virulence plasmid very similar to the toxin–encoding plasmid of B. anthracis. Recently, an anthrax-like disease in great apes in Africa was caused by emerging B. cereus strains, named B. cereus biovar anthracis. These strains are atypical as they possess both plasmids coding for toxin and capsule similar to those so far found only in B. anthracis. These unusual pathogenic B. cereus are currently neglected. We explored the virulence of these pathogens and their colonisation and dissemination capacity within the murine host. We found that these toxinogenic strains harbour two capsules, the classical B. anthracis capsule and an additional polysaccharidic capsule. This latter capsule confers virulence alone or in combination with toxins. Both capsules are concomitantly expressed, under the control of a common global regulator and host signals. Our results show that acquisition of new genetic information by these B. cereus clearly gives them a selective advantage, favouring their dissemination within infected hosts and the environment.
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Affiliation(s)
| | - Michel Haustant
- Institut Pasteur, Pathogénie des Toxi-Infections Bactériennes, Paris, France
| | - Susann Dupke
- Robert Koch-Institut, Centre for Biological Threats and Special Pathogens (ZBS 2), Berlin, Germany
| | - Jean-Philippe Corre
- Institut Pasteur, Pathogénie des Toxi-Infections Bactériennes, Paris, France
| | - Angelika Lander
- Robert Koch-Institut, Centre for Biological Threats and Special Pathogens (ZBS 2), Berlin, Germany
| | - Tatjana Franz
- Robert Koch-Institut, Centre for Biological Threats and Special Pathogens (ZBS 2), Berlin, Germany
| | - Marc Monot
- Institut Pasteur, Pathogenèse des bactéries anaérobies, Paris, France
| | | | - Gregory Jouvion
- Institut Pasteur, Unité Histopathologie Humaine et Modèles Animaux, Paris, France
| | - Fabian H. Leendertz
- Robert Koch-Institut, Epidemiology of Highly Pathogenic Microorganisms (P 3), Berlin, Germany
| | - Roland Grunow
- Robert Koch-Institut, Centre for Biological Threats and Special Pathogens (ZBS 2), Berlin, Germany
| | - Michèle E. Mock
- Institut Pasteur, Pathogénie des Toxi-Infections Bactériennes, Paris, France
| | - Silke R. Klee
- Robert Koch-Institut, Centre for Biological Threats and Special Pathogens (ZBS 2), Berlin, Germany
- * E-mail: (SRK); (PLG)
| | - Pierre L. Goossens
- Institut Pasteur, Pathogénie des Toxi-Infections Bactériennes, Paris, France
- * E-mail: (SRK); (PLG)
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Zasada AA, Formińska K, Zacharczuk K, Jacob D, Grunow R. Comparison of eleven commercially available rapid tests for detection of Bacillus anthracis, Francisella tularensis and Yersinia pestis. Lett Appl Microbiol 2015; 60:409-13. [PMID: 25598285 DOI: 10.1111/lam.12392] [Citation(s) in RCA: 31] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED Yersinia pestis, Bacillus anthracis and Francisella tularensis cause serious zoonotic diseases and have the potential to cause high morbidity and mortality in humans. In case of natural outbreaks and deliberate or accidental release of these pathogens rapid detection of the bacteria is crucial for limitation of negative effects of the release. In the present study, we evaluated 11 commercially available rapid test kits for the detection of Y. pestis, B. anthracis and F. tularensis in terms of sensitivity, specificity and simplicity of the procedure. The results revealed that rapid and easy-to-perform lateral flow assays for detection of highly pathogenic bacteria have very limited sensitivity. In contrast, the immunofiltration assays showed high sensitivity but limited specificity and required a too complicated procedure to be applied in the field by nonlaboratory workers (e.g. First Responders like fire, police and emergency medical personnel). Each sample - whether tested negative or positive by the rapid tests - should be retested in a reference laboratory using validated methods. SIGNIFICANCE AND IMPACT OF THE STUDY Rapid detection of highly pathogenic bacteria causing anthrax, plague and tularemia is crucial for the limitation of negative effects of a potential release (natural, accidental or deliberate). In the study, commercially available rapid tests for detection of Bacillus anthracis, Yersinia pestis and Francisella tularensis were investigated in terms of sensitivity, specificity and ease-to-perform. The study showed problems which could be faced during testing and results interpretation. Conclusions from this study should be helpful not only in selection of the most appropriate test for particular group of First Responders but also in undertaking decisions in situation of a contamination suspicion which have high social and economical impacts.
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Affiliation(s)
- A A Zasada
- Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
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Grunow R, Ippolito G, Jacob D, Sauer U, Rohleder A, Di Caro A, Iacovino R. Benefits of a European project on diagnostics of highly pathogenic agents and assessment of potential "dual use" issues. Front Public Health 2014; 2:199. [PMID: 25426479 PMCID: PMC4227464 DOI: 10.3389/fpubh.2014.00199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 05/28/2014] [Accepted: 10/03/2014] [Indexed: 11/13/2022] Open
Abstract
Quality assurance exercises and networking on the detection of highly infectious pathogens (QUANDHIP) is a joint action initiative set up in 2011 that has successfully unified the primary objectives of the European Network on Highly Pathogenic Bacteria (ENHPB) and of P4-laboratories (ENP4-Lab) both of which aimed to improve the efficiency, effectiveness, and response capabilities of laboratories directed at protecting the health of European citizens against high consequence bacteria and viruses of significant public health concern. Both networks have established a common collaborative consortium of 37 nationally and internationally recognized institutions with laboratory facilities from 22 European countries. The specific objectives and achievements include the initiation and establishment of a recognized and acceptable quality assurance scheme, including practical external quality assurance exercises, comprising living agents, that aims to improve laboratory performance, accuracy, and detection capabilities in support of patient management and public health responses; recognized training schemes for diagnostics and handling of highly pathogenic agents; international repositories comprising highly pathogenic bacteria and viruses for the development of standardized reference material; a standardized and transparent Biosafety and Biosecurity strategy protecting healthcare personnel and the community in dealing with high consequence pathogens; the design and organization of response capabilities dealing with cross-border events with highly infectious pathogens including the consideration of diagnostic capabilities of individual European laboratories. The project tackled several sensitive issues regarding Biosafety, Biosecurity and "dual use" concerns. The article will give an overview of the project outcomes and discuss the assessment of potential "dual use" issues.
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Affiliation(s)
| | - G. Ippolito
- Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - D. Jacob
- Robert Koch Institute, Berlin, Germany
| | - U. Sauer
- Robert Koch Institute, Berlin, Germany
| | | | - A. Di Caro
- Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - R. Iacovino
- Spallanzani National Institute for Infectious Diseases, Rome, Italy
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Kaspari O, Lemmer K, Becker S, Lochau P, Howaldt S, Nattermann H, Grunow R. Decontamination of a BSL3 laboratory by hydrogen peroxide fumigation using three different surrogates for Bacillus anthracis spores. J Appl Microbiol 2014; 117:1095-103. [PMID: 25040253 DOI: 10.1111/jam.12601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/08/2014] [Accepted: 07/15/2014] [Indexed: 11/29/2022]
Abstract
AIMS Two independent trials investigated the decontamination of a BSL3 laboratory using vaporous hydrogen peroxide and compared the effect on spores of Bacillus cereus, Bacillus subtilis and Bacillus thuringiensis as surrogates for Bacillus anthracis spores, while spores of Geobacillus stearothermophilus served as control. METHODS AND RESULTS Carriers containing 1·0 × 10(6) spores were placed at various locations within the laboratory before fumigation with hydrogen peroxide following a previously validated protocol. Afterwards, carriers were monitored by plating out samples on agar and observing enrichment in nutrient medium for up to 14 days. Three months later, the experiment was repeated and results were compared. On 98 of 102 carriers, no viable spores could be detected after decontamination, while the remaining four carriers exhibited growth of CFU only after enrichment for several days. Reduction factors between 4·0 and 6·0 log levels could be reached. CONCLUSIONS A validated decontamination of a laboratory with hydrogen peroxide represents an effective alternative to fumigation with formaldehyde. Spores of B. cereus seem to be more resistant than those of G. stearothermophilus. SIGNIFICANCE AND IMPACT OF THE STUDY The results of this study provide important results in the field of hydrogen peroxide decontamination when analysing the effect on spores other than those of G. stearothermophilus.
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Affiliation(s)
- O Kaspari
- Division Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Robert Koch-Institute, Berlin, Germany
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Burian R, Protheroe D, Grunow R, Diefenbacher A. Establishing a nurse-based psychiatric CL service in the accident and emergency department of a general hospital in Germany. Nervenarzt 2014; 85:1217-24. [PMID: 24969951 DOI: 10.1007/s00115-014-4069-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R Burian
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus "Königin Elisabeth" Herzberge, Herzbergstr. 79, 10365, Berlin, Germany,
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Abstract
Trichlorphone is bacteriocidal for Escherichia coli K-12. The bacterial inactivation depends on the concentration and the reaction time of trichlorphone and on the growth phase of the bacteria. DDVP formed by hydrolysis of trichlorphone had a higher bacteriocidal effect than trichlorphone itself; pH-changes may modify the effectiveness. The processes that take place in the bacterial cultures containing trichlorphone are discussed.
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Affiliation(s)
- R. Grunow
- Institut für Biophysik der Deutschen Akademie der Wissenschaften, Berlin-Buch und Institut für Mikrobengenetik der Universität Rostock
| | - Kh. Lohs
- Institut für Biophysik der Deutschen Akademie der Wissenschaften, Berlin-Buch und Institut für Mikrobengenetik der Universität Rostock
| | - E. Geissler
- Institut für Biophysik der Deutschen Akademie der Wissenschaften, Berlin-Buch und Institut für Mikrobengenetik der Universität Rostock
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Balabanova Y, Klar S, Deleré Y, Wilking H, Faber MS, Lassen SG, Gilsdorf A, Dupke S, Nitschke M, Sayk F, Grunow R, Krause G. Serological evidence of asymptomatic infections during Escherichia coli O104:H4 outbreak in Germany in 2011. PLoS One 2013; 8:e73052. [PMID: 24039858 PMCID: PMC3767767 DOI: 10.1371/journal.pone.0073052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/17/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction The largest known outbreak caused by a rare hybrid strain of Shiga toxin-producing E.coli (STEC) and enteroaggregative E. coli (EAEC) (E.coli O104:H4) of serotype O104:H4 occurred in Germany in 2011. Fenugreek sprouts acted as a transmission vehicle and were widely consumed in the outbreak area at the time of the epidemic. In total 3,842 people developed a clinical illness caused by this strain; however the rates of asymptomatic infections remain unclear. We aimed to develop a serological assay for detection of E.coli O104 LPS specific antibodies and to establish the post-outbreak levels of seropositivity among people with documented exposure to contaminated sprouts. Results and Discussion Developed serological assays (ELISA with 84% sensitivity, 63% specificity and Western Blot with 100% sensitivity, 82.5% specificity) identified 33% (16/49) level of asymptomatic infection. Relatively small sample size and a significant time- lapse between the onset of symptoms and serum samples collection (appr. 8 weeks) might explain the assay variability. No association was found between clinical or demographic characteristics and assay positivity. Larger studies are needed to understand the complexity of human immune response and factors influencing development of clinical symptoms. Development of intra-outbreak research plans will substantially aid the conduct of more thorough scientific investigation during an outbreak period.
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Affiliation(s)
| | | | | | | | | | - Sofie Gillesberg Lassen
- Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training, Stockholm, Sweden
| | | | | | | | | | | | - Gérard Krause
- Robert Koch Institute, Berlin, Germany
- Helmholtz Centre for Infection Research, Braunschweig, Germany
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Grunow R, Klee SR, Beyer W, George M, Grunow D, Barduhn A, Klar S, Jacob D, Elschner M, Sandven P, Kjerulf A, Jensen JS, Cai W, Zimmermann R, Schaade L. Anthrax among heroin users in Europe possibly caused by same Bacillus anthracis strain since 2000. Euro Surveill 2013. [DOI: 10.2807/ese.18.13.20437-en] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Injection anthrax was described first in 2000 in a heroin-injecting drug user in Norway. New anthrax cases among heroin consumers were detected in the United Kingdom (52 cases) and Germany (3 cases) in 2009-10. In June 2012, a fatal case occurred in Regensburg, Bavaria. As of December 2012, 13 cases had been reported in this new outbreak from Germany, Denmark, France and the United Kingdom. We analysed isolates from 2009-10 and 2012 as well as from the first injection anthrax case in Norway in 2000 by comparative molecular typing using a high resolution 31 marker multilocus variable-number tandem repeat analysis (MLVA) and a broad single nucleotide polymorphism (SNP) analysis. Our results show that all cases may be traced back to the same outbreak strain. They also indicate the probability of a single source contaminating heroin and that the outbreak could have lasted for at least a decade. However, an additional serological pilot study in two German regions conducted in 2011 failed to discover additional anthrax cases among 288 heroin users.
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Affiliation(s)
- R Grunow
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany
| | - S R Klee
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany
| | - W Beyer
- University of Hohenheim, Institute of Environmental and Animal Hygiene, Stuttgart, Germany
| | - M George
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany
| | - D Grunow
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany
| | - A Barduhn
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany
| | - S Klar
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany
| | - D Jacob
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany
| | - M Elschner
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - P Sandven
- Norwegian Institute of Public Health, Department of Bacteriology and Immunology, Oslo, Norway
| | - A Kjerulf
- Statens Serum Institut, National Institute for Health Data and Disease Control, Copenhagen, Denmark
| | - J S Jensen
- Statens Serum Institut, National Institute for Health Data and Disease Control, Copenhagen, Denmark
| | - W Cai
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - R Zimmermann
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - L Schaade
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany
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Grunow R, Klee SR, Beyer W, George M, Grunow D, Barduhn A, Klar S, Jacob D, Elschner M, Sandven P, Kjerulf A, Jensen JS, Cai W, Zimmermann R, Schaade L. Anthrax among heroin users in Europe possibly caused by same Bacillus anthracis strain since 2000. Euro Surveill 2013; 18:20437. [PMID: 23557972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Injection anthrax was described first in 2000 in a heroin-injecting drug user in Norway. New anthrax cases among heroin consumers were detected in the United Kingdom (52 cases) and Germany (3 cases) in 2009-10. In June 2012, a fatal case occurred in Regensburg, Bavaria. As of December 2012, 13 cases had been reported in this new outbreak from Germany, Denmark, France and the United Kingdom. We analysed isolates from 2009-10 and 2012 as well as from the first injection anthrax case in Norway in 2000 by comparative molecular typing using a high resolution 31 marker multilocus variable-number tandem repeat analysis (MLVA) and a broad single nucleotide polymorphism (SNP) analysis. Our results show that all cases may be traced back to the same outbreak strain. They also indicate the probability of a single source contaminating heroin and that the outbreak could have lasted for at least a decade. However, an additional serological pilot study in two German regions conducted in 2011 failed to discover additional anthrax cases among 288 heroin users.
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Affiliation(s)
- R Grunow
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany.
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Schunder E, Rydzewski K, Grunow R, Heuner K. First indication for a functional CRISPR/Cas system in Francisella tularensis. Int J Med Microbiol 2013; 303:51-60. [PMID: 23333731 DOI: 10.1016/j.ijmm.2012.11.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/21/2012] [Accepted: 11/25/2012] [Indexed: 11/26/2022] Open
Abstract
Francisella tularensis is a zoonotic agent and the subspecies novicida is proposed to be a water-associated bacterium. The intracellular pathogen F. tularensis causes tularemia in humans and is known for its potential to be used as a biological threat. We analyzed the genome sequence of F. tularensis subsp. novicida U112 in silico for the presence of a putative functional CRISPR/Cas (clustered regularly interspaced short palindromic repeats/CRISPR-associated) system. CRISPR/Cas systems are known to encode an RNA-guided adaptive immunity-like system to protect bacteria against invading genetic elements like bacteriophages and plasmids. In this work, we present a first indication that F. tularensis subsp. novicida encodes a functional CRISPR/Cas defence system. Additionally, we identified various spacer DNAs homologous to a putative phage present within the genome of F. tularensis subsp. novicida-like strain 3523. CRISPR/Cas is also present in F. tularensis subsp. tularensis, holarctica, and mediasiatica, but these systems seem to be non-functional.
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Affiliation(s)
- Eva Schunder
- Cellular Interactions of Bacterial Pathogens, Centre for Biological Security, Division 2 (ZBS2), Robert Koch-Institute, Berlin, Germany
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Grunow R, Verbeek L, Jacob D, Holzmann T, Birkenfeld G, Wiens D, von Eichel-Streiber L, Grass G, Reischl U. Injection anthrax--a new outbreak in heroin users. Dtsch Arztebl Int 2012; 109:843-8. [PMID: 23267409 DOI: 10.3238/arztebl.2012.0843] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/24/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Injection anthrax is a rare disease that affects heroin users and is caused by Bacillus anthracis. In 2012, there were four cases in Germany, one of which was fatal, as well as a small number of cases in other European countries, including Denmark, France, and the United Kingdom. Three cases among drug users occurred in Germany in 2009/2010, in the setting of a larger outbreak centered on Scotland, where there were 119 cases. CASE PRESENTATION AND CLINICAL COURSE: We present three cases of injection anthrax, two of which were treated in Regensburg and one in Berlin. One patient died of multi-organ-system failure on the day of admission to the hospital. The others were treated with antibiotics, one of them also with surgical wound debridement. The laboratory diagnosis of injection anthrax is based on the demonstration of the pathogen, generally by culture and/or by polymerase chain reaction, in material removed directly from the patient's wound. The diagnosis is additionally supported by the detection of specific antibodies. CONCLUSION Injection anthrax may be viewed either as an independent disease entity or as a special type of cutaneous anthrax with massive edema, necrotizing fasciitis in many cases, and about 30% mortality. It has appeared in recent years among heroin users in various European countries. In patients with suggestive clinical presentation and a history of heroin use, anthrax infection must be suspected early, so that the appropriate diagnostic tests can be performed without delay. Timely treatment can be life-saving. It is therefore important that physicians--and the individuals at risk--should be well-informed about this disease.
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Abstract
Tularaemia, caused by Francisella tularensis, had not been registered in Kosovo before an outbreak in 1999 and 2000. A national surveillance system has been implemented in Kosovo since 2000 to monitor a number of diseases, including tularaemia. Antibody detection in human sera was used for laboratory diagnosis of tularaemia and F. tularensis lipopolysaccharide antigen was used as a marker of infection. The purpose of this study is to describe the incidence of tularaemia in Kosovo after the 1999-00 outbreak. In 2001 and 2002, a second outbreak occurred, with 327 serologically confirmed cases. From 2001 to 2010, 25-327 cases were registered per year, giving a mean annual incidence of 5.2 per 100,000 population. The most likely sources of infection were contaminated drinking water and food. The dominant clinical manifestations were the glandular (79%) and ulcero-glandular (21%) forms. By 2010, the disease had spread throughout Kosovo. Presumably as a result of war and subsequent environmental disruption, mass population displacement and breakdown of sanitation and hygiene, the two major outbreaks of tularaemia resulted in the establishment of an active endemic area of tularaemia in Kosovo.
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Affiliation(s)
- R Grunow
- Robert Koch Institute, Centre for Biological Security (ZBS 2), Berlin, Germany.
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Jacob D, Sauer U, Housley R, Washington C, Sannes-Lowery K, Ecker DJ, Sampath R, Grunow R. Rapid and high-throughput detection of highly pathogenic bacteria by Ibis PLEX-ID technology. PLoS One 2012; 7:e39928. [PMID: 22768173 PMCID: PMC3386907 DOI: 10.1371/journal.pone.0039928] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 06/04/2012] [Indexed: 11/18/2022] Open
Abstract
In this manuscript, we describe the identification of highly pathogenic bacteria using an assay coupling biothreat group-specific PCR with electrospray ionization mass spectrometry (PCR/ESI-MS) run on an Ibis PLEX-ID high-throughput platform. The biothreat cluster assay identifies most of the potential bioterrorism-relevant microorganisms including Bacillus anthracis, Francisella tularensis, Yersinia pestis, Burkholderia mallei and pseudomallei, Brucella species, and Coxiella burnetii. DNA from 45 different reference materials with different formulations and different concentrations were chosen and sent to a service screening laboratory that uses the PCR/ESI-MS platform to provide a microbial identification service. The standard reference materials were produced out of a repository built up in the framework of the EU funded project "Establishment of Quality Assurances for Detection of Highly Pathogenic Bacteria of Potential Bioterrorism Risk" (EQADeBa). All samples were correctly identified at least to the genus level.
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Affiliation(s)
| | | | - Roberta Housley
- Ibis Biosciences, Inc., an Abbott Company, Carlsbad, California, United States of America
| | | | | | - David J. Ecker
- Ibis Biosciences, Inc., an Abbott Company, Carlsbad, California, United States of America
| | - Rangarajan Sampath
- Ibis Biosciences, Inc., an Abbott Company, Carlsbad, California, United States of America
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Holzmann T, Frangoulidis D, Simon M, Noll P, Schmoldt S, Hanczaruk M, Grass G, Pregler M, Sing A, Hörmansdorfer S, Bernard H, Grunow R, Zimmermann R, Schneider-Brachert W, Gessner A, Reischl U. Fatal anthrax infection in a heroin user from southern Germany, June 2012. Euro Surveill 2012; 17:20204. [PMID: 22790532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Blood cultures from a heroin user who died in June 2012, a few hours after hospital admission, due to acute septic disease, revealed the presence of Bacillus anthracis. This report describes the extended diagnosis by MALDI-TOF and real-time PCR and rapid confirmation of the anthrax infection through reference laboratories. Physicians and diagnostic laboratories were informed and alerted efficiently through the reporting channels of German public health institutions, which is essential for the prevention of further cases.
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Affiliation(s)
- T Holzmann
- Institute of Medical Microbiology and Hygiene, University Hospital of Regensburg, Germany.
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Holzmann T, Frangoulidis D, Simon M, Noll P, Schmoldt S, Hanczaruk M, Grass G, Pregler M, Sing A, Hörmansdorfer S, Bernard H, Grunow R, Zimmermann R, Schneider-Brachert W, Gessner A, Reischl U. Fatal anthrax infection in a heroin user from southern Germany, June 2012. Euro Surveill 2012. [DOI: 10.2807/ese.17.26.20204-en] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Blood cultures from a heroin user who died in June 2012, a few hours after hospital admission, due to acute septic disease, revealed the presence of Bacillus anthracis. This report describes the extended diagnosis by MALDI-TOF and real-time PCR and rapid confirmation of the anthrax infection through reference laboratories. Physicians and diagnostic laboratories were informed and alerted efficiently through the reporting channels of German public health institutions, which is essential for the prevention of further cases.
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Affiliation(s)
- T Holzmann
- Institute of Medical Microbiology and Hygiene, University Hospital of Regensburg, Regensburg, Germany
| | | | - M Simon
- Institute of Medical Microbiology and Hygiene, University Hospital of Regensburg, Regensburg, Germany
| | - P Noll
- Krankenhaus der Barmherzigen Brüder, Regensburg, Germany
| | - S Schmoldt
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - M Hanczaruk
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - G Grass
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - M Pregler
- District Health Office, Regensburg, Germany
| | - A Sing
- Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - S Hörmansdorfer
- Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - H Bernard
- Robert-Koch Institute, Berlin, Germany
| | - R Grunow
- Robert-Koch Institute, Berlin, Germany
| | | | - W Schneider-Brachert
- Institute of Medical Microbiology and Hygiene, University Hospital of Regensburg, Regensburg, Germany
| | - A Gessner
- Institute of Medical Microbiology and Hygiene, University Hospital of Regensburg, Regensburg, Germany
| | - U Reischl
- Institute of Medical Microbiology and Hygiene, University Hospital of Regensburg, Regensburg, Germany
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Kleo K, Schäfer D, Klar S, Jacob D, Grunow R, Lisdat F. Immunodetection of inactivated Francisella tularensis bacteria by using a quartz crystal microbalance with dissipation monitoring. Anal Bioanal Chem 2012; 404:843-51. [DOI: 10.1007/s00216-012-6172-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 05/10/2012] [Accepted: 05/30/2012] [Indexed: 11/29/2022]
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