Biospectroscopy to metabolically profile biomolecular structure: a multistage approach linking computational analysis with biomarkers

Biospectroscopy is employed to derive absorbance spectra representative of biomolecules present in biological samples. The mid-infrared region (λ = 2.5 μm-25 μm) is absorbed to give a biochemical-cell fingerprint (v = 1800-900 cm(-1)). Cellular material produces complex spectra due to the variety of chemical bonds present. The complexity and size of spectral data sets warrant multivariate analysis for data reduction, interpretation, and classification. Various multivariate analyses are available including principal component analysis (PCA), partial least-squares (PLS), linear discriminant analysis (LDA), and evolving fuzzy rule-based classifier (eClass). Interpretation of both visual and numerical results facilitates biomarker identification, cell-type discrimination, and predictive and mechanistic understanding of cellular behavior. Biospectroscopy is a high-throughput nondestructive technology. A comparison of biomarkers/mechanistic knowledge determined from conventional approaches to biospectroscopy coupled with multivariate analysis often provides complementary answers and a novel approach for diagnosis of disease and cell biology.

FTIR Microspectroscopy Coupled with Two-Class Discrimination Segregates Markers Responsible for Inter- and Intra-Category Variance in Exfoliative Cervical Cytology

Infrared (IR) absorbance of cellular biomolecules generates a vibrational spectrum, which can be exploited as a “biochemical fingerprint” of a particular cell type. Biomolecules absorb in the mid-IR (2–20 μm) and Fourier-transform infrared (FTIR) microspectroscopy applied to discriminate different cell types (exfoliative cervical cytology collected into buffered fixative solution) was evaluated. This consisted of cervical cytology free of atypia (i.e. normal; n = 60), specimens categorised as containing low-grade changes (i.e. CIN1 or LSIL; n = 60) and a further cohort designated as high-grade (CIN2/3 or HSIL; n = 60). IR spectral analysis was coupled with principal component analysis (PCA), with or without subsequent linear discriminant analysis (LDA), to determine if normal versus low-grade versus high-grade exfoliative cytology could be segregated. With increasing severity of atypia, decreases in absorbance intensity were observable throughout the 1,500 cm⁻¹ to 1,100 cm⁻¹ spectral region; this included proteins (1,460 cm⁻¹), glycoproteins (1,380 cm⁻¹), amide III (1,260 cm⁻¹), asymmetric (ν_as) PO₂⁻ (1,225 cm⁻¹) and carbohydrates (1,155 cm⁻¹). In contrast, symmetric (ν_s) PO₂⁻ (1,080 cm⁻¹) appeared to have an elevated intensity in high-grade cytology. Inter-category variance was associated with protein and DNA conformational changes whereas glycogen status strongly influenced intra-category. Multivariate data reduction of IR spectra using PCA with LDA maximises inter-category variance whilst reducing the influence of intra-class variation towards an objective approach to class cervical cytology based on a biochemical profile.

Fourier transform infrared microspectroscopy identifies symmetric PO(2)(-) modifications as a marker of the putative stem cell region of human intestinal crypts

Complex biomolecules absorb in the mid-infrared (lambda = 2-20 microm), giving vibrational spectra associated with structure and function. We used Fourier transform infrared (FTIR) microspectroscopy to "fingerprint" locations along the length of human small and large intestinal crypts. Paraffin-embedded slices of normal human gut were sectioned (10 microm thick) and mounted to facilitate infrared (IR) spectral analyses. IR spectra were collected using globar (15 microm x 15 microm aperture) FTIR microspectroscopy in reflection mode, synchrotron (<or=10 microm x 10 microm aperture) FTIR microspectroscopy in transmission mode or near-field photothermal microspectroscopy. Dependent on the location of crypt interrogation, clear differences in spectral characteristics were noted. Epithelial-cell IR spectra were subjected to principal component analysis to determine whether wavenumber-absorbance relationships expressed as single points in "hyperspace" might on the basis of multivariate distance reveal biophysical differences along the length of gut crypts. Following spectroscopic analysis, plotted clusters and their loadings plots pointed toward symmetric (nu(s))PO(2)(-) (1,080 cm(-1)) vibrations as a discriminating factor for the putative stem cell region; this proved to be a more robust marker than other phenotypic markers, such as beta-catenin or CD133. This pattern was subsequently confirmed by image mapping and points to a novel approach of nondestructively identifying a tissue's stem cell location. nu(s)PO(2)(-), probably associated with DNA conformational alterations, might facilitate a means of identifying stem cells, which may have utility in other tissues where the location of stem cells is unclear.

Preliminary work on the development of a novel detection method for osteoporosis

Osteoporosis affects both the organic and mineral phases of bone resulting in a decrease in resistance to fracture. Dual x-ray absorptiometry (DEXA) scans are used for diagnosing osteoporosis, which is conventionally characterised by a decrease in mineral density. Unfortunately, some patients who suffer osteoporotic fractures have normal bone density, because both the organic and the mineral phase are affected. However, there are currently no methods of evaluating the health of the organic phase. Patients undergoing treatment for osteoporosis have reported hardening of their fingernails. As the properties of nail and bone may be linked in a comparable, measurable way, this work used both mechanical (nano-indentation) and chemical (Raman spectroscopy) methods to evaluate differences between fingernails sourced from osteoporotic and non-osteoporotic patients. The difference in mean modulus between the nails sourced from the groups was 1.1 GPa. The disulphide bond content of fingernail samples from each group was measured by Raman spectroscopy and disulphide bond content of fingernail was found to be significantly lower in the osteoporotic group. It can be concluded that a relationship between the mechanical and chemical properties of nail and bone may exist in a measurable way. This work has suggested that changes in the organic phase of bone are reflected in similar proteins, such as keratin, from which fingernails are composed. Collagen and keratin are two distinct structural proteins, but they share the need for protein sulphation and disulphide bond formation, via cysteine, for their structural integrity. A disorder of either process should lead to disordered collagen and keratin synthesis.

Characterization of human corneal stem cells by synchrotron infrared micro-spectroscopy

PURPOSE

The purpose of this study was to use high resolution synchrotron radiation-based Fourier Transform Infrared (FTIR) micro-spectroscopy coupled with multivariate analysis to investigate the characteristics of adult stem cell (SC) and transit amplifying (TA) cell populations of the human corneal epithelium.

METHODS

Spectra of individual SC and TA cells in situ from cryosections of human cornea were collected using a synchrotron micro-spectroscopy facility at Daresbury laboratory, UK. Multivariate analysis and Mann Whitney U tests were used to analyse the spectral data from the SC and TA cell populations.

RESULTS

There were marked differences between the median spectra of the two cell populations. This correlated with their level of differentiation and functional specialization. Multivariate (principal component) analysis revealed that the cell populations could be segregated into distinct clusters, with only slight overlap between the two cell types. Significant (p<0.05) spectral differences were found in the spectral regions associated with nucleic acid, protein and lipids.

CONCLUSIONS

Synchrotron FTIR micro-spectroscopy together with principal component analysis is able to discriminate between SC and TA cell populations. Our results also suggest a small sub-population of corneal epithelial cells in the SC niche have TA cell-like characteristics. Many of the spectral differences between the SC and TA cell populations relate to differences in nucleic acid conformation.

IR microspectroscopy: potential applications in cervical cancer screening

Screening exfoliative cytology for early dysplastic cells reduces incidence and mortality from squamous carcinoma of the cervix. In the developed world, screening programmes have adopted a 3-5 years recall system. In its absence, cervical cancer would be the second most common female cancer in these regions; instead, it is currently eleventh. However, there exist a number of limitations to the smear test even given the removal of contaminants using liquid-based cytology. It is prohibitively expensive, labour-intensive and subject to inaccuracies that give rise to significant numbers of false negatives. There remains a need for novel approaches to allow efficient and objective interrogation of exfoliative cytology. Methods that variously exploit infrared (IR) microspectroscopy are one possibility. Using IR microspectroscopy, an integrated 'biochemical-cell fingerprint' of the lipid, protein and carbohydrate composition of a biomolecular entity may be derived in the form of a spectrum via vibrational transitions of individual chemical bonds. Powerful statistical approaches (e.g. principal component analysis) now facilitate the interrogation of large amounts of spectroscopic data to allow the extraction of what may be small but extremely significant biomarker differences between disease-free and pre-malignant or malignant samples. An increasing wealth of literature points to the ability of IR microspectroscopy to allow the segregation of cells based on their disease status. We review the current evidence supporting its diagnostic potential in cancer biology.

Non-contact micro-cantilevers detect photothermally induced vibrations that can segregate different categories of exfoliative cervical cytology

We implemented a non-contact photo-thermo-mechanical recording method whereby a silicon nitride atomic force microscopy cantilever is placed several micrometer above the surface of samples. Samples were illuminated with infrared (IR) radiation after which, cantilever mechanical vibrations were optically sensed. Following spectrometric acquisition and Fourier transformation, true IR absorption spectra were obtained. With multivariate analysis, segregation between different categories of exfoliative cervical cytology was obtained. This approach points towards the implementation of a novel near-field system that allows IR spectral analysis without probe contamination.

ATR microspectroscopy with multivariate analysis segregates grades of exfoliative cervical cytology

Although cervical cancer screening in the UK has led to reductions in the incidence of invasive disease, this programme remains flawed. We set out to examine the potential of infrared (IR) microspectroscopy to allow the profiling of cellular biochemical constituents associated with disease progression. Attenuated total reflection-Fourier Transform IR (ATR) microspectroscopy was employed to interrogate spectral differences between samples of exfoliative cervical cytology collected into liquid based cytology (LBC). These were histologically characterised as normal (n = 5), low-grade (n = 5), high-grade (n = 5) or severe dyskaryosis (? carcinoma) (n = 5). Examination of resultant spectra was coupled with principal component analysis (PCA) and subsequent linear discriminant analysis (LDA). The interrogation of LBC samples using ATR microspectroscopy with PCA-LDA facilitated the discrimination of different categories of exfoliative cytology and allowed the identification of potential biomarkers of abnormality; these occurred prominently in the IR spectral region 1200 cm(-1) - 950 cm(-1) consisting of carbohydrates, phosphate, and glycogen. Shifts in the centroids of amide I (approximately 1650 cm(-1)) and II (approximately 1530 cm(-1)) absorbance bands, indicating conformational changes to the secondary structure of intracellular proteins and associated with increasing disease progression, were also noted. This work demonstrates the potential of ATR microspectroscopy coupled with multivariate analysis to be an objective alternative to routine cytology.

Characterization of putative stem cell populations in the cornea using synchrotron infrared microspectroscopy

PURPOSE

High-resolution synchrotron radiation-based Fourier transform infrared (SR-FTIR) microspectroscopy coupled with multivariate analysis was used to investigate the characteristics of putative adult stem cell (SC), transiently amplified (TA) cell, and terminally differentiated (TD) cell populations of the corneal epithelium.

METHODS

Spectra of individual cells in situ in cryosections of bovine cornea were collected by using a synchrotron microspectroscopy facility at Daresbury Laboratory (United Kingdom). The resultant spectra were analyzed by multivariate analysis.

RESULTS

The median spectra of the three different cell populations showed marked differences, which correlated with their degree of differentiation and proliferative capacity. Multivariate (principal component) analysis (PCA) showed that the three cell populations could be segregated into discrete clusters, with only a slight overlap between the SC and TA cell populations. Further analysis (Mann-Whitney test) indicated that the most significant (P<0.001) spectral differences between the SC and TA cell populations were chiefly associated with changes in nucleic acid conformation.

CONCLUSIONS

SR-FTIR microspectroscopy coupled with PCA appears to enable the identification of SC, TA cell, and TD cell populations. The results also suggest that a small subpopulation of cells in the corneal epithelial SC niche possess TA cell-like characteristics. The most significant spectral characteristics associated with the SCs appear to relate to differences in nucleic acid conformation. This finding is consistent with recent theories suggesting that the control of differentiation is related to major changes in chromatin structure.

Infrared spectroscopy with multivariate analysis potentially facilitates the segregation of different types of prostate cell

The prostate gland is conventionally divided into zones or regions. This morphology is of clinical significance as prostate cancer (CaP) occurs mainly in the peripheral zone (PZ). We obtained tissue sets consisting of paraffin-embedded blocks of cancer-free transition zone (TZ) and PZ and adjacent CaP from patients (n = 6) who had undergone radical retropubic prostatectomy; a seventh tissue set of snap-frozen PZ and TZ was obtained from a CaP-free gland removed after radical cystoprostatectomy. Paraffin-embedded tissue slices were sectioned (10-mum thick) and mounted on suitable windows to facilitate infrared (IR) spectra acquisition before being dewaxed and air dried; cryosections were dessicated on BaF(2) windows. Spectra were collected employing synchrotron Fourier-transform infrared (FTIR) microspectroscopy in transmission mode or attenuated total reflection-FTIR (ATR) spectroscopy. Epithelial cell and stromal IR spectra were subjected to principal component analysis to determine whether wavenumber-absorbance relationships expressed as single points in "hyperspace" might on the basis of multivariate distance reveal biophysical differences between cells in situ in different tissue regions. After spectroscopic analysis, plotted clusters and their loadings curves highlighted marked variation in the spectral region containing DNA/RNA bands ( approximately 1490-1000 cm(-1)). By interrogating the intrinsic dimensionality of IR spectra in this small cohort sample, we found that TZ epithelial cells appeared to align more closely with those of CaP while exhibiting marked structural differences compared to PZ epithelium. IR spectra of PZ stroma also suggested that these cells are structurally more different to CaP than those located in the TZ. Because the PZ exhibits a higher occurrence of CaP, other factors (e.g., hormone exposure) may modulate the growth kinetics of initiated epithelial cells in this region. The results of this pilot study surprisingly indicate that TZ epithelial cells are more likely to exhibit what may be a susceptibility-to-adenocarcinoma spectral signature. Thus, IR spectroscopy on its own may not be sufficient to identify premalignant prostate epithelial cells most likely to progress to CaP.

The use of fingernails as a means of assessing bone health: a pilot study

BACKGROUND

Anecdotally, patients volunteer reports of increasing hardness of their fingernails within months of starting diverse treatments for osteoporosis. The properties of both nail and bone may be linked in a comparable, measurable way.

METHODS

We examined the fingernails of two groups of patients, with (n = 9) and without (n = 13) osteoporosis at either the hip or lumbosacral spine. We performed nanoindentation to assess the degree of nail brittleness and Raman spectroscopy to assess the disulfide bond content of nail.

RESULTS

The mean moduli of fingernails of patients with low bone mineral density (BMD) are lower than those of patients with normal BMD. The mean difference in mean modulus between the groups was found to be 0.996 (p = 0.15 between groups). The spectroscopy data also showed differences between the two sets of nails. The disulfide bond content of the nails sourced from osteoporotic patients was lower than that from healthy patients (p = 0.06 between groups).

CONCLUSIONS

Bone collagen and nail keratin are two distinct structural proteins, and both require protein sulfation and disulfide bond formation, via cysteine, for structural integrity. A disorder of either process may lead to disordered collagen and keratin synthesis. This is reflected in the structural abnormalities seen in clinical syndromes in which there is either protein deficiency, disorders of sulfur metabolism, or cystathione beta-synthase deficiency. The relationship between nail and bone may exist in a measurable way. This pilot study should lead to further work to explore this relationship. Could nail prove to be a valuable adjunct to diagnosis or provide a means of more rapid follow-up after commencement of therapy?

Monitoring cell cycle distributions in MCF-7 cells using near-field photothermal microspectroscopy

Microspectroscopic techniques such as Fourier transform infrared (FTIR) have played an important role in "fingerprinting" the biochemical composition of cellular components. Based on structure and function, complex biomolecules absorb energy in the mid-infrared (lambda = 2-20 microm) yielding characteristic vibrational infrared (IR) spectra. However, optical detection FTIR microspectroscopy may not be suitable for IR-absorbing sample materials. Photothermal microspectroscopy (PTMS) permits the direct measurement of heat generated as a result of sample material absorbing radiation. This approach generates true absorption spectra and is implemented by interfacing a scanning probe microscope and an FTIR spectrometer. Detection is performed using a near-field ultra-miniaturized temperature sensor. Employing PTMS, IR spectra of MCF-7 cells were examined in spectral regions (900-2000 cm(-1)) corresponding to proteins, DNA, RNA, glycoproteins, carbohydrates, lipids, and levels of protein phosphorylation. As a cell passes through the cell cycle, its nuclear material decondenses and condenses and this has led to ambiguity as to whether the intensity of such spectral regions may be associated with the G(1)-, S- or G(2)-phases of the cell cycle. Cultured cells were tracked over a time course known to correspond to marked alterations in cell-cycle distributions, as determined using flow cytometry. Experiments were carried out in the absence or presence of lindane, a pesticide known to induce G(1)-arrest in MCF-7 cells. Significant (P < 0.05) elevations in spectral intensities were associated with exponentially growing cell populations, predominantly in S-phase or G(2)-phase, compared to more quiescent populations predominantly in G(1)-phase. Increases in the absorption band at 970 cm(-1), associated with elevated protein phosphorylation, were observed in vibrational spectra of exponentially growing cell populations compared to those exhibiting a slowing in their growth kinetics. These results seem to suggest that intracellular bulk changes, associated with transit through the cell cycle, can be tracked using PTMS.

Frictional forces between cohesive powder particles studied by AFM

A range of commercially important powders (hydrated alumina, limestone, titania and zeolite) and glass ballotini were attached to atomic force microscope cantilevers, and inter-particle friction forces studied in air using lateral force microscopy (LFM). The in situ calibration procedure for friction forces is described. LF images, line profiles, LF histograms, surface roughness, pull-off forces, and the load dependence of friction in the range 0-25 nN were studied for both particle-particle and particle-wall (steel) contacts. The single-particle friction results are discussed in terms of contact mechanics theory. Particle-particle contacts showed load-dependent friction, involving single asperity contacts (non-linear behaviour) or multi-asperity contacts (linear behaviour). Particle-wall contacts usually showed little load dependence and were more adhesive. The results are also related to shear stress-normal stress data (yield loci) for the same materials from bulk shear testers.

Progress in near-field photothermal infra-red microspectroscopy

Near-field photothermal Fourier transform infra-red microspectroscopy, which utilizes atomic force microscopy (AFM)-type temperature sensors, is being developed with the aim of achieving a spatial resolution higher than the diffraction limit. Here we report on a new implementation of the technique. Sensitivity of the technique is assessed by recording infra-red spectra from small quantities of analytes and thin films. A photothermomechanical approach, which utilizes conventional AFM probes as temperature sensors, is also discussed based on preliminary results. Early indication suggests that the photothermal approach is more sensitive than the thermomechanical one.

Micro-thermal analysis: scanning thermal microscopy and localised thermal analysis

Micro-thermal analysis combines the imaging capabilities of atomic force microscopy with the ability to characterise, with high spatial resolution, the thermal behaviour of materials. The conventional AFM tip is replaced by a miniature heater/thermometer which enables a surface to be visualised according to its response to the input of heat (in addition to measuring its topography). Areas of interest may then be selected and localised thermal analysis (modulated temperature calorimetry and thermomechanical analysis) carried out. Localised dynamic mechanical measurements are also possible. Spatially resolved chemical analysis can be performed using the same basic apparatus by means of pyrolysis gas chromatography-mass spectrometry or high-resolution photothermal infrared spectrometry.

Atomic force microscopy of the cornea and sclera

We report the first investigation of the extracellular matrix of cornea and sclera using an atomic force microscope (AFM), and evaluate the potential of this new technique. We were able to obtain 2-3 nanometre resolution of both tissues in a condition close to their native state. The AFM was able to resolve surface features on the collagen fibrils, as well as providing unique images of crossbridge structures between collagen fibrils in both cornea and sclera.

Evaluation of [3H]thymidine uptake method for studying growth of spiroplasmas under various conditions

[3H]thymidine uptake and colony counts are quantitative and inexpensive methods for studying Spiroplasma growth. Using these techniques, we demonstrated subtle effects on the growth of suckling mouse cataract agent of medium alterations, inoculum size, and freezing of cultures. In addition, suckling mouse cataract agent multiplied more actively under aerobic than under anaerobic conditions. These techniques have wide application for the study of Spiroplasma growth and will be useful for the development of a defined medium.

Selection of a reference lot of Mueller-Hinton agar

A collaborative study was undertaken to evaluate the performance of currently marketed Mueller-Hinton agars from seven manufacturers by replicate disk diffusion tests with standard quality control strains. Identification of the manufacturers was concealed, and the resulting data were evaluated for the selection of a physical reagent standard against which the performance of future production lots would be tested and made to conform. A medium was selected which was sufficiently close to existing National Committee for Clinical Laboratory Standards quality control limits that current interpretive criteria would require minimum modification. Two of the seven lots were eliminated from further consideration because the final pHs were outside acceptable limits. The remaining four lots had 96% of mean zone diameters less than or equal to 2 mm from those of the chosen lot and 65% of the means were less than or equal to 1 mm from those of the chosen lot for all 28 antimicrobial agent-organism combinations. Manufacturers then attempted to produce new lots of Mueller-Hinton agar which performed within the prescribed limits of the chosen lot. One lot performed in close conformity with the selected standard, but the overall performance of the media was essentially the same as that of the randomly chosen lots in the initial study. It was concluded that one of the original seven lots demonstrated properties which made it a tentative candidate for a physical reagent standard and that the use of a physical reagent standard in evaluating production lots might aid in stabilizing the performance of Mueller-Hinton agar.

Spectrum of Vibrio infections in a Gulf Coast community

Infection with Vibrio species was diagnosed in 23 patients over a 10-year period in a Gulf Coast community. Species isolated were Vibrio vulnificus, V. cholerae, V. parahaemolyticus, and V. alginolyticus. Clinical presentations included diarrhea, wound infection, and bacteremia. Gastrointestinal tract infection was infrequently diagnosed, despite the routine use of stool culture media appropriate for vibrio isolation. Bacteremic infections were severe and occurred only in patients with underlying diseases. Wound infections were complicated by tissue necrosis and required surgical debridement. In patients with underlying diseases, soft tissue infections often progressed to fatal septicemias.

Laboratory techniques for detection of urinary tract infection and assessment of value

Manual methods for diagnosing urinary tract infection have long been under review, modification, and evaluation; thus, methods of collection and interpretation have been found to require more scrutiny. Various screening procedures include chemical, microscopic, and cultural methods, the latter two being highly reliable. In addition, examples of infections due to anaerobic bacteria and Mycoplasma have been documented, with the accompanying need to consider their role in particular situations. There has also been a need for localizing the infection, which has been accomplished with some useful methods. From the literature it is apparent that the tests all have a portion of patients' results that do not fit the true picture. These must be considered carefully in light of other information.

Use of a bronchoscopic protected catheter technique in the clinical evaluation of a new antibiotic

We prospectively compared the usefulness of a bronchoscopic protected catheter technique with the results from sputum cultures in the evaluation of moxalactam, a new beta-lactam antibiotic. The significance of a given isolate on protected catheter culture was determined by quantitative bacteriology. 32 patients with community-acquired pneumonia were enrolled in the study and 31 grew common lower respiratory tract pathogens from their protected catheter specimen. The most common single pathogens recovered were Streptococcus pneumoniae (11 patients) and Haemophilus influenzae (2). Mixed flora, predominantly anaerobes, were isolated from 15 patients, and 3 patients had mixed aerobic infections. All seven bacteremic cases had the identical organism isolated from the protected catheter specimen, confirming the accuracy of the technique. Comparisons with sputum cultures showed that the predominant organism on sputum culture was the same as that obtained from the protected catheter culture in only 13% of the cases. Sputum cultures revealed either no pathogen or a different pathogen in 23 cases, and no sputum could be obtained in 4. Compared to cultures of expectorated sputum, we found the protected catheter bronchoscopic culture technique to have the following advantages in the bacteriologic evaluation of moxalactam: 1) greater accuracy and sensitivity in bacteremic patients; 2) accurate delineation of the bacteriology of infections; and 3) a higher percentage of patients with evaluable bacteriology leading to greater efficiency during the investigation.

Comparison of susceptibilities of anaerobic bacteria to cefmenoxime, ceftriaxone, and other antimicrobial compounds

The minimal inhibitory concentrations of cefmenoxime, cefotaxime, cefoxitin, ceftriaxone, chloramphenicol, clindamycin, and moxalactam were determined by agar dilution for 202 clinical isolates of anaerobic bacteria. Cefoxitin and moxalactam were the most active among the cephalosporin-like compounds.

Diagnosis of bacterial pulmonary infections with quantitative protected catheter cultures obtained during bronchoscopy

Quantitative bacteriology was performed on specimens collected by protected catheter fiberoptic bronchoscopy from 172 patients. Of the patients who had pneumonia, 75 of 78 (96%) had one or more species present at greater than or equal to 10(3) CFU/ml, whereas 2 of 35 (6%) control patients had organisms present in that quantity. In addition, 66% of the control specimens yielded no isolates by this technique. All of the 11 patients with bronchitis had greater than or equal to 10(3) CFU/ml. Quantitative bacteriology revealed high levels of colonization in patients without infection and endobronchial structural disease. The data suggest that bacterial counts of greater than or equal to 10(3) CFU/ml in suspended secretions collected with a protected catheter brush were diagnostic of the bacteriological etiology of lower respiratory tract infections in patients without endobronchial structural abnormalities.

Use of a bronchoscopic protected catheter brush for the diagnosis of pulmonary infections

Fiberoptic bronchoscopy using a protected brush catheter was done in 65 patients with suspected pulmonary infections to obtain uncontaminated specimens for culture. Quantitative aerobic and anaerobic cultures were done on each specimen. Forty-one patients had pneumonia. Ten bacteremic patients had the same organisms recovered from the catheter and blood cultures. Seven patients had received antibiotics before the procedure, and cultures grew no organisms in high concentration. In 23 of 24 remaining patients probable pathogens were recovered in high concentrations, and specific therapy resulted in clinical improvement in all of these patients. Five patients with lung abscesses and seven with necrotizing pneumonia had mixed aerobic and anaerobic organisms recovered. Twelve patients had final diagnoses of nonbacterial lung disease, and cultures were negative or revealed low concentrations of organisms. Quantitative cultures were necessary in distinguishing pathogens from nonpathogens. There were no complications. The results of this study indicate that fiberoptic bronchoscopy using a special protected catheter is an accurate and safe technique for identification of etiologic agents in lower respiratory tract infections.

Cation components of Mueller-Hinton agar affecting testing of Pseudomonas aeruginosa susceptibility to gentamicin

Seven lots of Mueller-Hinton agar were examined for calcium and magnesium contents and their distribution in pools or compartments. Gel disruption and centrifugation yielded the soluble cations, which varied from 9 to 113% of the total calcium and from 76 to 102% of the total magnesium. Throughout the experiments, a standardized disk diffusion test, using Pseudomonas aeruginosa (ATCC 27852) and a 10-mug gentamicin disk, served as an indicator for medium performance. Zone diameters correlated well with the sums of the soluble calcium and magnesium values in the different lots (r = -0.85). Ionized calcium, presumably the biologically active ion, was measured with a calcium-specific electrode. It represented only a fraction of the soluble calcium pool in three lots. Autoclaving resulted in shifts of the cations between the different pools. Addition of magnesium to one medium lot resulted in shifts of soluble and ionized calcium, indicating an interdependence of calcium and magnesium, and zone diameters correlated with soluble magnesium (r = -0.98), soluble calcium (r = -0.96), and ionized calcium (r = -0.96) in this experiment. Manipulation of one medium to match the performance of another showed that excess amounts of both ions were required to obtain similar performance. Satisfactory performance of an individual medium can be obtained by cation supplementation, but simple adjustment will not suffice for all media. The interaction of the other cation pool components must also be evaluated.

An intracavitary fungus ball composed of syncephalastrum

A case of a pulmonary intracavitary fungus ball composed of Syncephalastrum sp., a member of the class Zygomycetes not previously reported in association with human disease, is presented. The fungus was cultured preoperatively from bronchial secretions as well as from the fungal mass from the resected lung. This fungus appeared to behave in a saprophytic manner similar to that of the more common Aspergillus fungus ball.

The prevalence of actinomycetes-like organisms found in cervicovaginal smears of 300 IUD wearers

The association of Actinomyces with IUD wearers has been widely documented and the possibility of the recognition of actinomycetes-like organisms in routine Papanicolaou-stained cervicovaginal smears has been reported. We conducted a retrospective study of IUD wearers to determine the prevalence and significance of actinomycetes-like organisms found in such smears. Three hundred smears from current IUD wearers were rescreened for actinomycetes-like organisms. Of this group, 200 patients were from a public health family planning clinic, and 100 were private patients. The incidence for the public health group was 25.5% and for the private patient group, 8%. A case history of actinomycosis is included. Findings such as other infectious agents, abnormal cytology and symptoms are also discussed. Although the presence of Actinomyces probably represents an opportunistic infection, the threat of pelvic actinomycosis with serious complications poses a management problem to the clinician when Actinomyces is reported in a routine Papanicolaou smear. Our findings lead us to question the practicality of the earlier recommendations of IUD removal and antibiotic therapy.

Effect of different lots of Mueller-Hinton agar on the interpretation of the gentamicin susceptibility of Pseudomonas aeruginosa

Population distributions and quality control data for strains of Pseudomonas aeruginosa tested for gentamicin susceptibility on six lots of Mueller-Hinton agar were analyzed. The lots of agar were used in three University of Washington hospitals from April 1975 through October 1977. The analyses indicated that the performance of members of the P. aeruginosa populations in each hospital closely followed the performance of the quality control strain, P. aeruginosa ATCC 27853, when tested on each lot of Mueller-Hinton medium. The variability of zone diameters with the P. aeruginosa populations and the quality control strain indicated that a fixed indeterminate range (13 to 16 mm) of gentamicin susceptibility was not applicable to these organisms as it was with the Enterobacteriaceae. Variability in gentamicin susceptibility results was demonstrated in both minimal inhibitory concentration and disk diffusion tests when eight selected P. aeruginosa strains and the quality control strain were tested on each lot of medium. This variation in susceptibility to gentamicin was not related to the total Ca(2+), Mg(2+), or Zn(2+) content of each lot of medium. The data demonstrated that a moving indeterminate range of gentamicin susceptibility, 3 to 6 mm below the mean zone diameter of the quality control strain, was a suitable criterion for strains tested on a single medium lot. These results illustrate the importance of defining stringent performance standards for media used in the susceptibility testing of P. aeruginosa with gentamicin and other aminoglycoside antibiotics.

Nonspecific vaginitis: role of Haemophilus vaginalis and treatment with metronidazole

To assess the cause of nonspecific vaginitis, we performed a prospective case-control study of vaginal flora and a randomized unblinded trial of different therapies. Haemophilus vaginalis was isolated from 17 to 18 women with signs of vaginitis but only one of 18 normal matched controls (P less than 0.002). The concentration of anaerobic bacteria in vaginal washings also was increased in patients. Clinical improvement and eradication of H. vaginalis occurred in one of seven patients given sulfonamide vaginal cream, two of 15 given oral doxycycline, nine of 27 given oral ampicillin, and 80 of 81 given oral metronidazole. On the seventh day of therapy signs of nonspecific vaginitis persisted in 31 of 31 with, and in two of 92 without, persistent H. vaginalis infection (P less than 0.001). These data suggest the causal role of H. vaginalis in nonspecific vaginitis, possibly in concert with vaginal anaerobes. The widespread use of sulfonamide creams is inappropriate. Metronidazole is effective, but its efficacy must be weighed against its possible toxicity.

Effects of two blood culture anticoagulants on growth of Neisseria meningitidis

Tests of 25 strains of Neisseria meningitidis for sensitivity to sodium polyanethol sulfonate (SPS) showed that the sensitivity of strains varied with both inoculum size and SPS concentration. In Trypticase soy broth (TSB), 2 out of 13 strains were sensitive to 0.05% SPS, whereas 8 out of 13 strains were sensitive to the same concentration of SPS in brain heart infusion (BHI). In artificial blood cultures with six strains of meningococci, the addition of 10% defibrinated blood was found to eliminate the sensitivity of all six strains to SPS in BHI, but not of the two strains in TSB. Addition of 1.2% gelatin to artificial blood cultures eliminated the inhibitory effect of 0.05% SPS, whereas the addition of 1% yeast extract to blood cultures containing 0.025% or 0.05% SPS enhanced the inhibitory effect of this anticoagulant. None of the 13 strains tested was inhibited by 0.05% sodium amylosulfate in TSB or BHI alone or in artificial blood cultures with these media.

Emergence in a burn center of populations of bacteria resistant to gentamicin, tobramycin, and amikacin: evidence for the need for changes in zone diameter interpretative standards

From July 1974 through June 1976, a number of isolates of Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa from the Burn Center exhibited a shift to smaller zone diameters with gentamicin than did isolates from the general hospital population. Although many had zone diameters >/=13 mm and would have been considered susceptible by this breakpoint, they were found to have minimal inhibitory concentrations (MICs) of >/=8 mug of gentamicin per ml by agar dilution testing. Zone diameters and MICs of gentamicin, tobramycin, and amikacin were subsequently compared for 168 isolates from both the Burn Center and general hospital. The results revealed many isolates that fell into presently used gentamicin- and tobramycin-"susceptible" categories by disk diffusion tests but were resistant by MIC. The data indicated that criteria for gentamicin disk diffusion testing should include an intermediate or indeterminate category, and that the limits of the intermediate category for tobramycin and amikacin should be expanded.

Unusual coiled gram-positive anaerobe isolated from a gutter wall abscess

A gram-positive, nonsporing coiled rod was visible on Gram stain and isolated in pure culture from 20 ml of pus. This organism differs from previously described species in that it produces only acetic acid from glucose metabolism, hydrolyzes esculin, and has less fermentative activity in carbohydrates.

Bacteriology of the urethra in normal men and men with nongonococcal urethritis

Sixty-nine Caucasian males without a previous history of urethritis and who developed nongonococcal urethritis (NGU) and 39 similar men without urethritis (NU) were cultured from the urethra for Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, aerobes, and anaerobes. C. trachomatis infection was proven by culture of serology in 26 (38%) of the NGU group and 1 (3%) of the NU group; the C. trachomatis-negative NGU group had significantly more U. urealyticum (81%) than the C. trachomatis-positive NGU group (42%) or the NU group (59%). Aerobes were isolated from significantly more NU men (91%) than from men with NGU (66%). The aerobic and anaerobic flora of the two NGU groups were similar. The NU group had significantly more aerobic lactobacilli. Haemophilus vaginalis, alpha-hemolytic streptococci (not Streptococcus faecalis), and anaerobes, predominantly Bacteroides species. This study has provided information about the prevalence and the variety of the aerobic and anaerobic microbiological flora of the anterior urethra of sexually active males. It does not implicate any bacteria other than C. trachomatis and U. urealyticum as potential causes of NGU.

The Fuchs' spot: an ophthalmoscopic and fluorescein angiographic study

A correlation of funduscopic and fluorescein angiographic findings in the Fuchs' spot of high myopia is presented. A variety of ophthalmoscopic changes indicate that both serous and hemorrhagic detachments of the retinal pigment epithelium and neurosensory retina are associated with this lesion. Fluorescein angiography, however, reveals subretinal reovascularization from the choroid as the basic underlying disease in most cases reviewed. Wide variations in the ophthalmoscopic appearance of the pigmented maculopathy of high myopia necessitate a more descriptive approach than that indicated by the term "Fuchs' spot." Fluorescein angiography becomes a necessity to delineate neovascular lesions as paracentral tufts may possibly be treated with laser photocoagulation to reduce progression.

Etiology of nongonococcal urethritis. Evidence for Chlamydia trachomatis and Ureaplasma urealyticum

Chlamydia trachomatis, Ureaplasma urealyticum (T-mycoplasma), and Hemophilus vaginalis have previously been considered possible etiological agents in nongonococcal urethritis (NGU). In this study, current C. trachomatis infection was confirmed by culture and (or) micro-immunofluorescence serology in 26 of 69 men experiencing afirst episode of NGU, and 1 of 39 with no urethritis. Serum IgM immunofluorescent antibody to chlamydia was demonstrated in 16 of 20 men with chlamydia culture positive NGU, and 3 of 39 with chlamydia culture negative NG, and none of 34 with no urethritis. 9 of 10 culture positive men with less than or equal to 10 days symptoms developed immunofluorescent antibody seroconversion in paired sera. U. realyticum was isolated significantly more often and in significantly higher concentration from first voided urine from chlamydia-negative cases of NGU than from chlamydia-positive NGU. Ureaplasmacidal antibody titers increased fourfold in six men, four of whom had negative cultures for for unreaplasma. H. vaginalis was isolated from c9 of 33 men with no urethritis and 2 of 69 with NGU. C. trachomatis is susceptible, and U. urealyticum is resistant to sulfonamides. A 10-day course of sulfisoxazole therapy produced improvement in 13 of 13 chlamydia-positive, unreaplasma-negative, and only 14 of 29 chlamydia-negative, unreaplasma-positive NGU cases (P less than 0.002). Thus, culture, serology, and response to therapy support the etiologic role of chlamydia in NGU. Quantitative culture and response to therapy suggest U. unrealyticum may cause many cases of chlamydia-netative NGU.

Smear results in the diagnosis of mycobacterioses using blue light fluorescence microscopy

Examination of 6,880 sputum specimens from untreated patients disclosed that 3.1% were positive for mycobacteria by fluorescence microscopy, and 92.5% of these has positive cultures. There was a positive correlation between the number of organisms seen on smear and growth on culture. All specimens with positive smears and negative cultures contained rare or few acid-fast bacilli on the smear. Eighty-two percent of the specimens with positive cultures and negative smears yielded less than 25 colonies, whereas there were greater than 25 colonies from 93% of the specimens with positive smears and cultures. In a low prevalence, general hospital population, the primary acid-fast smear continued to be a reliable diagnostic tool.

Evaluation of methods for the rapid identification of Neisseria gonorrhoeae in a routine clinical laboratory

Of 78 isolates of Neisseria gonorrhoeae, 21 failed to grow and produce acid in unsupplemented cystine-Trypticase agar (CTA); whereas positive reactions were obtained by using serum-supplemented CTA and fluorescent antibody (FA). An additional 290 strains of Neisseria were evaluated by FA and by a rapid carbohydrate degradation technique (RF). There was agreement between the two methods 92% of the time on the initial trial and 99% of the time with repeats on discrepancies. The RF and FA tests provided rapid and reliable identification of N. gonorrhoeae, alleviating the problems of CTA due to lack of growth and need for overnight incubation.

Polymicrobial etiology of acute pelvic inflammatory disease

We studied 204 women with acute pelvic inflammatory disease to delineate further the causes of that illness. Gonococci were recovered from 91. Gonococcal pili antibody rose or fell significantly in 12 of 18 patients with positive cultures and only two of 19 who had negative cultures and smears for Neisseria gonorrhaoea(P smaller than 0.005). N. gonorrhoeae was found in peritoneal exudate from eight of 21 patients with, and none of 33 without, cervical gonococcal infection. Among patients with severe disease, other bacteria were recovered from peritoneal exudates from five of 16 with, and 19 of 22 without, cervical gonococcal infection (P smaller than 0.025). Mixed anaerobic and aerobic bacterial peritoneal infection was common in nongonococcal pelvic disease. The most common species recovered were Bacteroides fragilis, peptostreptococci, and peptococci. Tuboperitoneal gonococcal infection probably causes pelvic inflammatory disease in most patients with cervical gonococcal infection, whereas polymicrobial tuboperitoneal infection probably causes most nongonococcal cases.

Distribution of streptococcal groups in clinical specimens with evaluation of bacitracin screening

During a 2-year period, 4,968 strains of beta-hemolytic streptococci were examined for the clinical source distribution and bacitracin sensitivity of each group. In the upper respiratory tract, groups A (51.7%) and C (20.4%) accounted for most of the isolates, and in wounds and exudates group A (79.1%) made up most of the isolates. Group B (71.2%) was the major component of isolates from the genitorinary tract and, while composing 29.3% of the lower respiratory tract isolates, competed with group A (18.8%) and the nongroupables (22.8%) for supremacy. Bacitracin screening showed that 0.5% of group A streptococci were resistant, and sensitive non-group A isolates were group B (2.6%), group C (6.0%), group G (8.0%), and the nongroupables (2.2%). It was found that those groups which were most predominant in wounds and the upper respiratory tract gave the highest rate of false positives with bacitracin, whereas the predominant group of the genitourinary tract gave the lowest rate of false positives.

Clinical evaluation of enteric media in the primary isolation of Salmonella and Shigella

Over a 1-year period, media for the isolation of enteric pathogens were compared on 455 stool specimens. Fifty-three pathogens were isolated, of which 56% were Shigella sonnei and 13% were Sh. flexneri. Of these isolates, 90% were found on xylose-lysine-desoxycholate agar, 87% on Hekton enteric agar, and 80% on MacConkey without crystal violet with 2% agar and 0.007% neutral red, but only 28% were recovered on Salmonella-Shigella agar. Less than one-half of the shigellae were recovered after Selenite-F enrichment. On the other hand, enrichment was the most helpful method for isolating salmonellae. Studies on cultures from which mixed isolates were obtained indicated that numbers and chance distribution have an effect on the results obtained. The performance of Salmonella-Shigella agar in the isolation of enteric pathogens was inferior, and the effort involved to obtain those isolates was greater than for Hekton enteric and xylose-lysine-desoxycholate agars.