Genomic Insights Into the Mechanism of Carbapenem Resistance Dissemination in Enterobacterales From a Tertiary Public Heath Setting in South Asia

SUMMARY

10.6% patients were CRE positive. Only 27% patients were prescribed at least 1 antibiotic to which infecting pathogen was susceptible. Burn and ICU admission and antibiotics exposures facilitate CRE acquisition. Escherichia coli ST167 was the dominant CRE clone.

BACKGROUND

Given the high prevalence of multidrug resistance (MDR) across South Asian (SA) hospitals, we documented the epidemiology of carbapenem-resistant Enterobacterales (CRE) infections at Dhaka Medical College Hospital between October 2016 and September 2017.

METHODS

We enrolled patients and collected epidemiology and outcome data. All Enterobacterales were characterized phenotypically and by whole-genome sequencing. Risk assessment for the patients with CRE was performed compared with patients with carbapenem-susceptible Enterobacterales (CSE).

RESULTS

10.6% of all 1831 patients with a clinical specimen collected had CRE. In-hospital 30-day mortality was significantly higher with CRE [50/180 (27.8%)] than CSE [42/312 (13.5%)] (P = .001); however, for bloodstream infections, this was nonsignificant. Of 643 Enterobacterales isolated, 210 were CRE; blaNDM was present in 180 isolates, blaOXA-232 in 26, blaOXA-181 in 24, and blaKPC-2 in 5. Despite this, ceftriaxone was the most commonly prescribed empirical antibiotic and only 27% of patients were prescribed at least 1 antibiotic to which their infecting pathogen was susceptible. Significant risk factors for CRE isolation included burns unit and intensive care unit admission, and prior exposure to levofloxacin, amikacin, clindamycin, and meropenem. Escherichia coli ST167 was the dominant CRE clone. Clustering suggested clonal transmission of Klebsiella pneumoniae ST15 and the MDR hypervirulent clone, ST23. The major trajectories involved in horizontal gene transfer were IncFII and IncX3, IS26, and Tn3.

CONCLUSIONS

This is the largest study from an SA public hospital combining outcome, microbiology, and genomics. The findings indicate the urgent implementation of targeted diagnostics, appropriate antibiotic use, and infection-control interventions in SA public institutions.

Beneficial Effects of Epigallocatechin-3-O-Gallate, Chlorogenic Acid, Resveratrol, and Curcumin on Neurodegenerative Diseases

Many observational and clinical studies have shown that consumption of diets rich in plant polyphenols have beneficial effects on various diseases such as cancer, obesity, diabetes, cardiovascular diseases, and neurodegenerative diseases (NDDs). Animal and cellular studies have indicated that these polyphenolic compounds contribute to such effects. The representative polyphenols are epigallocatechin-3-O-gallate in tea, chlorogenic acids in coffee, resveratrol in wine, and curcumin in curry. The results of human studies have suggested the beneficial effects of consumption of these foods on NDDs including Alzheimer's and Parkinson's diseases, and cellular animal experiments have provided molecular basis to indicate contribution of these representative polyphenols to these effects. This article provides updated information on the effects of these foods and their polyphenols on NDDs with discussions on mechanistic aspects of their actions mainly based on the findings derived from basic experiments.

L-Arginine Exerts Excellent Anti-Stress Effects on Stress-Induced Shortened Lifespan, Cognitive Decline and Depression

The anti-stress potential of dietary L-arginine (Arg) was assessed in psychosocially stress-loaded senescence-accelerated (SAMP10) mice. Although this strain of mouse is sensitive to stress, daily administration of Arg at 3 mg/kg significantly suppressed aging-related cognitive decline and behavioral depression at nine months of age and counteracted stress-induced shortened lifespan. To investigate the mechanism of the anti-stress effect of Arg in the brain, early changes in oxidative damage and gene expression levels were measured using SAMP10 mice that were stress-loaded for three days. Increased lipid peroxidation in the brains of stressed mice was significantly lowered by Arg intake. Several genes associated with oxidative stress response and neuronal excitotoxic cell death, including Nr4a1, Arc, and Cyr61, remarkably increased in response to psychosocial stress; however, their expression was significantly suppressed in mice that ingested Arg even under stress conditions. In contrast, the genes that maintain mitochondrial functions and neuronal survival, including Hba-a2 and Hbb-b2, were significantly increased in mice that ingested Arg. These results indicate that Arg reduces oxidative damage and enhances mitochondrial functions in the brain. We suggest that the daily intake of Arg plays important roles in reducing stress-induced brain damage and slowing aging.

Mutation in Sodium-Glucose Cotransporter 2 Results in Down-Regulation of Amyloid Beta (A4) Precursor-Like Protein 1 in Young Age, Which May Lead to Poor Memory Retention in Old Age

Senescence-accelerated mouse prone 10 (SAMP10) exhibits cerebral atrophy and depression-like behavior. A line of SAMP10 with spontaneous mutation in the Slc5a2 gene encoding the sodium-glucose cotransporter (SGLT) 2 was named SAMP10/TaSlc-Slc5a2^slc (SAMP10-ΔSglt2) and was identified as a renal diabetes model. In contrast, a line of SAMP10 with no mutation in SGLT2 (SAMP10/TaIdrSlc, SAMP10(+)) was recently established under a specific pathogen-free condition. Here, we examined the mutation effect in SGLT2 on brain function and longevity. No differences were found in the survival curve, depression-like behavior, and age-related brain atrophy between SAMP10-ΔSglt2 and SAMP10(+). However, memory retention was lower in SAMP10-ΔSglt2 mice than SAMP10(+). Amyloid beta (A4) precursor-like protein 1 (Aplp1) expression was significantly lower in the hippocampus of SAMP10-ΔSGLT2 than in SAMP10(+) at 2 months of age, but was similar at 12 months of age. CaM kinase-like vesicle association (Camkv) expression was remarkably lower in SAMP10(+). These genes have been reported to be involved in dendrite function. Amyloid precursor proteins have been reported to involve in maintaining homeostasis of glucose and insulin. These results suggest that mutation in SGLT2 results in down-regulation of Aplp1 in young age, which can lead to poor memory retention in old age.

Green Tea Catechins Trigger Immediate-Early Genes in the Hippocampus and Prevent Cognitive Decline and Lifespan Shortening

Senescence-accelerated mouse prone 10 (SAMP10) mice, after ingesting green tea catechins (GT-catechin, 60 mg/kg), were found to have suppressed aging-related decline in brain function. The dose dependence of brain function on GT-catechin indicated that intake of 1 mg/kg or more suppressed cognitive decline and a shortened lifespan. Mice that ingested 1 mg/kg GT-catechin had the longest median survival, but the dose was less effective at suppressing cognitive decline. The optimal dose for improving memory acquisition was 60 mg/kg, and memory retention was higher in mice that ingested 30 mg/kg or more. To elucidate the mechanism by which cognitive decline is suppressed by GT-catechin, changes in gene expression in the hippocampus of SAMP10 mice one month after ingesting GT-catechin were analyzed. The results show that the expression of immediate-early genes such as nuclear receptor subfamily 4 (Nr4a), FBJ osteosarcoma oncogene (Fos), early growth response 1 (Egr1), neuronal PAS domain protein 4 (Npas4), and cysteine-rich protein 61 (Cyr61) was significantly increased. These results suggest that GT-catechin suppresses age-related cognitive decline via increased expression of immediate-early genes that are involved in long-term changes in plasticity of synapses and neuronal circuits.

Function of Green Tea Catechins in the Brain: Epigallocatechin Gallate and its Metabolites

Over the last three decades, green tea has been studied for its beneficial effects, including anti-cancer, anti-obesity, anti-diabetes, anti-inflammatory, and neuroprotective effects. At present, a number of studies that have employed animal, human and cell cultures support the potential neuroprotective effects of green tea catechins against neurological disorders. However, the concentration of (−)-epigallocatechin gallate (EGCG) in systemic circulation is very low and EGCG disappears within several hours. EGCG undergoes microbial degradation in the small intestine and later in the large intestine, resulting in the formation of various microbial ring-fission metabolites which are detectable in the plasma and urine as free and conjugated forms. Recently, in vitro experiments suggested that EGCG and its metabolites could reach the brain parenchyma through the blood–brain barrier and induce neuritogenesis. These results suggest that metabolites of EGCG may play an important role, alongside the beneficial activities of EGCG, in reducing neurodegenerative diseases. In this review, we discuss the function of EGCG and its microbial ring-fission metabolites in the brain in suppressing brain dysfunction. Other possible actions of EGCG metabolites will also be discussed.

Stress-reducing effect of cookies containing matcha green tea: essential ratio among theanine, arginine, caffeine and epigallocatechin gallate

The stress-reducing effect of matcha, a high-quality fine-powdered green tea, has recently been clarified by animal experiments and clinical trials. However, the effect of matcha added to confectioneries is not clear. One aim of this study was to evaluate the relationship between matcha components and their stress-reducing effect in mice that were loaded with territorially-based stress. Adrenal hypertrophy, a marker of stress, was significantly suppressed in stress-loaded mice that had ingested matcha components, displaying a caffeine and epigallocatechin gallate to theanine and arginine (CE/TA) ratio of 2 or less. Another aim was to evaluate, in humans, the stress-reducing effect of matcha in cookies using test-matcha (CE/TA = 1.79) or placebo-matcha (CE/TA = 10.64). Participants, who were fifth year pharmacy college students, consumed 4.5 g of matcha in three pieces of cookie daily for 15 days. Salivary α-amylase activity, a stress marker, was significantly lower in the test-matcha group than in the placebo group. These results indicate that the CE/TA ratio of tea components is a key indicator for the suppression of stress. Moreover, matcha with a CE/TA ratio of 2 or less displays a stress-reducing effect, even if it is included in confectionery products. Such products may also benefit individuals who have no habit of drinking matcha as a beverage.

Green Tea Extracts Attenuate Brain Dysfunction in High-Fat-Diet-Fed SAMP8 Mice

Unhealthy diet promotes progression of metabolic disorders and brain dysfunction with aging. Green tea extracts (GTEs) have various beneficial effects and alleviate metabolic disorders. GTEs have neuroprotective effects in rodent models, but their effects against brain dysfunction in models of aging fed unhealthy diets are still unclear. Here, we showed that GTEs attenuate high-fat (HF) diet-induced brain dysfunction in senescence-accelerated mouse prone-8 (SAMP8), a murine model of senescence. SAMP8 mice were fed a control diet, HF diet, or HF diet with 0.5% GTEs (HFGT) for four months. The HF diet reduced memory retention and induced amyloid β_1–42 accumulation, whereas GTEs attenuated these changes. In HF diet-fed mice, lipid oxidative stress, assessed by malondialdehyde levels, was increased. The levels of proteins that promote synaptic plasticity, such as brain-derived neurotrophic factor (BDNF) and postsynaptic density protein 95 (PSD95), were reduced. These alterations related to brain dysfunction were not observed in HFGT diet-fed mice. Overall, our data suggest that GTEs intake might attenuate brain dysfunction in HF diet-fed SAMP8 mice by protecting synaptic plasticity as well as via anti-oxidative effects. In conclusion, GTEs might ameliorate unhealthy diet-induced brain dysfunction that develops with aging.

Beneficial Effects of Green Tea Catechins on Neurodegenerative Diseases

Tea is one of the most consumed beverages in the world. Green tea, black tea, and oolong tea are made from the same plant Camellia sinensis (L.) O. Kuntze. Among them, green tea has been the most extensively studied for beneficial effects on diseases including cancer, obesity, diabetes, and inflammatory and neurodegenerative diseases. Several human observational and intervention studies have found beneficial effects of tea consumption on neurodegenerative impairment, such as cognitive dysfunction and memory loss. These studies supported the basis of tea's preventive effects of Parkinson's disease, but few studies have revealed such effects on Alzheimer's disease. In contrast, several human studies have not reported these favorable effects with regard to tea. This discrepancy may be due to incomplete adjustment of confounding factors, including the method of quantifying consumption, beverage temperature, cigarette smoking, alcohol consumption, and differences in genetic and environmental factors, such as race, sex, age, and lifestyle. Thus, more rigorous human studies are required to understand the neuroprotective effect of tea. A number of laboratory experiments demonstrated the benefits of green tea and green tea catechins (GTCs), such as epigallocatechin gallate (EGCG), and proposed action mechanisms. The targets of GTCs include the abnormal accumulation of fibrous proteins, such as Aβ and α-synuclein, inflammation, elevated expression of pro-apoptotic proteins, and oxidative stress, which are associated with neuronal cell dysfunction and death in the cerebral cortex. Computational molecular docking analysis revealed how EGCG can prevent the accumulation of fibrous proteins. These findings suggest that GTCs have the potential to be used in the prevention and treatment of neurodegenerative diseases and could be useful for the development of new drugs.

Participation of Tumor-Associated Myeloid Cells in Progression of Amelanotic Melanoma (RMM Tumor Line) in F344 Rats, with Particular Reference to MHC Class II- and CD163-Expressing Cells

Tumor progression is often influenced by infiltration of myeloid cells; depending on the M1- or M2-like activation status, these cells may have either inhibitory or promoting effects on tumor growth. We investigated the properties of tumor-associated myeloid cells in a previously established homotransplantable amelanotic melanoma (RMM tumor line) in F344 rats. RMM tumor nodules were allowed to reach the sizes of 0.5, 1, 2 and 3 cm, respectively. Immunohistochemistry and flow cytometry was performed for macrophage markers CD68 and CD163, and for the antigen-presenting cell marker, MHC class II. Although no significant change was observed in the number of CD68⁺ and CD163⁺ macrophages during RMM progression, the number of MHC class II⁺ antigen-presenting cells was reduced in 3 cm nodules. Real-time RT-PCR of laser microdissection samples obtained from RMM regions rich in MHC class II⁺ cells demonstrated high expressions of M1-like factors: IFN-γ, GM-CSF and IL-12a. Furthermore, fluorescence-activated cell sorting, followed by real-time RT-PCR for CD11b⁺ MHC class II⁺ (myeloid antigen-presenting cells), CD11b⁺ CD163⁺ (M2 type myeloid cells), CD11b⁺ CD80⁺ (M1 type myeloid cells) and CD11b⁺ CD11c⁺ (dendritic cells) cells was performed. Based on the levels of inflammation- and tumor progression-related factors, MHC class II⁺ antigen-presenting cells showed polarization towards M1, while CD163⁺ macrophages, towards M2. CD80⁺ and CD11c⁺ myeloid cells did not show clear functional polarization. Our results provide novel information on tumor-associated myeloid cells in amelanotic melanoma, and may become useful in further research on melanoma immunity.

Cutaneous Histiocytic Sarcoma with Regional Lymph Node Metastasis in a Netherland Dwarf Rabbit (Oryctolagus cuniculus)

A 10-year-old male Netherland dwarf rabbit (Oryctolagus cuniculus) was presented with a red nodular mass (1 cm in diameter) with ulceration and hair loss in the skin of the left upper lip. Cytological examination revealed atypical round cells. The mass was excised surgically. Histologically, the mass was composed of large round to polyhedral neoplastic cells with marked cytological atypia. The neoplastic cells were often binucleated or multinucleated. Immunohistochemically, the neoplastic cells were intensely positive for Iba1 and vimentin, but fewer neoplastic cells expressed E-cadherin. Nuclear immunoreactivity for Ki67 was detected in approximately 41% of the neoplastic cells. Metastasis to the left cervical lymph nodes was detected 6 months after the surgical excision. Based on clinical, histopathological and immunohistochemical findings, the present case was diagnosed as cutaneous histiocytic sarcoma. To the authors' knowledge cutaneous histiocytic disease has not been reported previously in lagomorphs.

VISCERAL LEISHMANIASIS IS ENDEMIC IN GOLDEN JACKALS OF BANGLADESH AGRICULTURAL UNIVERSITY CAMPUS, A THREAT FOR EXPANDING FUTURE ZOONOTIC VISCERAL LEISHMANIASIS

Visceral leishmaniasis (VL), now a day, is an endemic protozoal disease of human in Bangladesh. The disease is transmissible to canids and endemic in canids in many parts of the world including western China and India. In Bangladesh, the occurrence of VL in canids is unknown. Golden jackals, a common wild canid of Bangladesh Agricultural University (BAU) Campus, living with street dogs, cats and often get closure to human shelter. It is not surprising to find VL in golden Jackals of BAU campus, Mymensingh and this study was, therefore, aimed to identify the occurrence of leishmanial infection in their visceral organs. Venous blood, liver, kidney, spleen and bone marrow from the jackals (N=5) were collected, impression smears from these organs were made onto clean slides and stained with Giemsa’s stain. Leishmanial pro - and amastigote stages of the parasite were detected in the impression smears made from liver, spleen, kidney and bone marrow in all jackals. Leishmanial amastigote stage of the parasite was seen in the macrophages of blood, spleen and liver. Part of liver, kidney, spleen and bone marrow from the jackal were fixed in 10% buffered neutral formalin and stained with hematoxylin and eosin (H&E). Histopathological study revealed scatteredly distributed microgranuloma in the hepatic parenchyma, consisting of closely packed collection of macrophages and lymphocytes with fibrous tissue encapsulation. In kidney, chronic glomerulonephritis was seen; the inflamed areas were infiltrated with lymphocytes and macrophages. Specific pathology in spleen and bone marrow was not observed. Genomic DNA was extracted from the liver, kidney, spleen and bone marrow of jackals. Polymerase chain reaction (PCR) with species specific primers were used to identify the species of leishmanial protozoa involved. Results of PCR showed 145bp amplicon, specific for Leishmania donovani infection in all five jackals. This is the first report in Bangladesh describing the occurrence of VL in golden jackals. This result reinforce the assumption that golden jackals of BAU campus harbour leishmanial protozoa, could serve as a symptomless carrier and transmit the infection to other canids and human, require further investigation.DOI: http://dx.doi.org/10.3329/bjvm.v10i1-2.15655

EFFECTS OF CHRONIC ARSENIC TOXICITY ON THE HAEMATOLOGY AND HISTOARCHITECTURE OF FEMALE REPRODUCTIVE SYSTEM OF BLACK BENGAL GOAT

This study was aimed to observe the effects of chronic arsenic toxicity on the haematology and histoarchitecture of female reproductive system of black Bengal goat. Adult She goats (N=4) were orally administered with sodium arsenite (4 mg/kg body weight) for first seven weeks followed by 5 mg/kg body weight for next eight weeks. Blood was collected from the treated goat at day0, 20, 40, 60, 80 and 100. There was significant difference of TEC, Hb concentration and TLC in goats which are chronically exposed with arsenic. Lymphocyte was decreased with the treatment of sodium arsenite but neutrophil, eosinophil and monocyte were increased. At the end of study the goats were euthanasized. The ovary, uterine tube, uterus, cervix and vagina were collected for gross and histopathological examinations. In histopathological examination the ovarian follicles appeared degenerated and there was much stromal thickening around the follicle. Thickened myometrial layer and shortened mucosal folds in the uterine tube were observed. There was reduction in the number and size of endometrial glands. The mucosal cell lines appeared degenerated. Thin vaginal mucosa and proliferation of connective tissue; shortened cervical crypts and thickened glandular epithelium of cervix were also observed. It may be concluded that chronic arsenic exposure might have adverse effects on the female reproductive system.DOI = http://dx.doi.org/10.3329/bjvm.v9i1.11214 Bangl. J. Vet. Med. (2011). 9(1): 59-66 

Effects of Lens culinaris agglutinin on gene expression of gluconeogenic enzymes in the mouse intestine

BACKGROUND

Lectins are proteins that bind specifically to the carbohydrate moiety of glyco-conjugates. Japanese mistletoe lectin given intragastrically affected cytokine gene expression in the mouse intestine. This study examines the actions of Lens culinaris agglutinin (LCA) on the gene expression of gluconeogenic enzymes in the intestine.

RESULTS

The results of quantitative real-time reverse transcription-polymerase chain reaction indicated that LCA caused an up-regulation of the gene expression of glucose-6-phosphatase (G6Pase) and phosphoenolpyruvate carboxykinase (PEPCK). This change was correlated with an increase in the expression of two transcription factors, HNF1α and HNF4α. Experiments using human colonic cancer Caco-2 cells demonstrated that LCA up-regulated the gene expression of G6Pase and PEPCK whereas insulin had the opposite effect. In addition, the observed up-regulation of HNF4α gene expression in the duodenum raises the possibility that the lectin promotes the colorectal cancer.

CONCLUSION

Lentil beans should be cooked well to avoid unfavourable effects of LCA.

Isolation and serotyping of dengue viruses by mosquito inoculation technique from clinically suspected cases of dengue fever

Dengue virus was isolated from 44 clinically suspected cases of dengue fever by mosquito inoculation technique using Aedes aegypti mosquito in the department of virology, BSMMU in the year 2000. Identification of dengue virus was done by direct fluorescent antibody technique using FITC conjugated anti-dengue monoclonal antibody and serotyping was carried out by indirect fluorescent antibody technique using serotype specific monoclonal anti-dengue antibody. The dengue virus isolation rate was 41.9%. The result of serotyping revealed circulation of all four serotypes of dengue viruses in Dhaka, Bangladesh and DEN-3 was the predominant (70.5%) serotype during the outbreak in 2000. The rate of isolation was higher in patient's serum at an early stage of fever (p<0.01) and with higher body temperature (p<0.01). The rate of isolation was 77.77% in patient's serum collected on the 1st day of fever, and then the rate gradually declined and lowest (16.6%) on the 5th day of fever. The mosquito inoculation technique is an easy, economical and sensitive method for dengue virus isolation and is recommended for routine virological surveillance in laboratories of Bangladesh where sophisticated facilities are limited.