Early Diagnosis of Tularemia by Flow Cytometry, Czech Republic, 2003-20151

We retrospectively assessed the utility of a flow cytometry–based test quantifying the percentage of CD3+ T cells with the CD4–/CD8– phenotype for predicting tularemia diagnoses in 64 probable and confirmed tularemia patients treated during 2003–2015 and 342 controls with tularemia-like illnesses treated during 2012–2015 in the Czech Republic. The median percentage of CD3+/CD4–/CD8– T cells in peripheral blood was higher in tularemia patients (19%, 95% CI 17%–22%) than in controls (3%, 95% CI 2%–3%). When we used 8% as the cutoff, this test’s sensitivity was 0.953 and specificity 0.895 for distinguishing cases from controls. The CD3+/CD4–/CD8– T cells increased a median of 7 days before tularemia serologic test results became positive. This test supports early presumptive diagnosis of tularemia for clinically suspected cases 7–14 days before diagnosis can be confirmed by serologic testing in regions with low prevalences of tularemia-like illnesses.

Aerosol prime-boost vaccination provides strong protection in outbred rabbits against virulent type A Francisella tularensis

Tularemia, also known as rabbit fever, is a severe zoonotic disease in humans caused by the gram-negative bacterium Francisella tularensis (Ft). While there have been a number of attempts to develop a vaccine for Ft, few candidates have advanced beyond experiments in inbred mice. We report here that a prime-boost strategy with aerosol delivery of recombinant live attenuated candidate Ft S4ΔaroD offers significant protection (83% survival) in an outbred animal model, New Zealand White rabbits, against aerosol challenge with 248 cfu (11 LD₅₀) of virulent type A Ft SCHU S4. Surviving rabbits given two doses of the attenuated strains by aerosol did not exhibit substantial post-challenge fevers, changes in erythrocyte sedimentation rate or in complete blood counts. At a higher challenge dose (3,186 cfu; 139 LD₅₀), protection was still good with 66% of S4ΔaroD-vaccinated rabbits surviving while 50% of S4ΔguaBA vaccinated rabbits also survived challenge. Pre-challenge plasma IgG titers against Ft SCHU S4 corresponded with survival time after challenge. Western blot analysis found that plasma antibody shifted from predominantly targeting Ft O-antigen after the prime vaccination to other antigens after the boost. These results demonstrate the superior protection conferred by a live attenuated derivative of virulent F. tularensis, particularly when given in an aerosol prime-boost regimen.

[REAL TIME POLYMERASE CHAIN REACTION IN TULAREMIA LABORATORY DIAGNOSTICS]

AIM

Enhancement of tularemia laboratory diagnostics by F. tularensis DNA determination in blood sera of patients using real time polymerase chain reaction (RT-PCR).

MATERIALS AND METHODS

39 blood sera of patients obtained during transmissive epidemic outbreak of tularemia in Khanty-Mansiysk in 2013 were studied in agglutination reaction, passive hemagglutination, RT-PCR. Specific primers and fluorescent probes were used: ISFTu2F/R+ISFTu2P, Tu14GF/R+tul4-PR2.

RESULTS

Advantages of using RT-PCR for early diagnostics of tularemia, when specific antibodies are not detected using traditional immunologic methods, were established. Use of a combination of primers and ISFTu2F/R+ISFTu2P probe allowed to detect F. tularensis DNA in 100% of sera, whereas Tul4G F/R+tul4-PR2 combination--92% of sera. The data were obtained when DNA was isolated from sera using "Proba Rapid" express method. Clinical-epidemiologic diagnosis oftularemia was confirmed by both immune-serologic and RT-PCR methods when sera were studied 3-4 weeks after the onset of the disease.

CONCLUSION

RT-PCR with ISFTu2F/R primers and fluorescent probe ISFTu2P, having high sensitivity and specificity, allows to determine F. tularensis DNA in blood sera of patients at both the early stage and 3-4 weeks after the onset of the disease.

Prospective investigation of the hypothalamo-pituitary-adrenal axis in patients with tularemia

BACKGROUND/AIM

To investigate prospectively the hypothalamo-pituitary-adrenal (HPA) axis by adrenocorticotropic hormone (ACTH) stimulation test.

MATERIALS AND METHODS

Tularemia was diagnosed according to guidelines. An ACTH stimulation test (1 µg) and a dexamethasone suppression test (DST; 1 mg) were performed in patients in the acute phase of tularemia before antibiotic treatment and in the chronic phase.

RESULTS

Nineteen patients (mean age: 41.0 ± 13.2 years; 57.9% female) with tularemia were enrolled in the study in 2011 and 2012. Cortisol response to ACTH stimulation test was sufficient in all patients during the acute phase. After the DST, the cortisol was not suppressed during the acute phase in only one patient. The median control time of 11 patients after acute tularemia was 13 months. During the chronic phase, cortisol response to ACTH stimulation was normal in all patients, and after DST cortisol was suppressed in all patients. The peak cortisol level after the ACTH stimulation test in the acute phase was higher than that in the chronic phase, but the difference was not statistically significant.

CONCLUSION

The HPA axis of patients with tularemia was not significantly affected in the acute and chronic phases.

[Serum immunoglobulin IgG subclass distribution of antibody responses to Francisella tularensis in patients with tularemia]

INTRODUCTION

The present study was aimed at determining the IgG subclass distribution against F. tularensis in patients with tularemia.

METHODS

The total number of 56 serum samples obtained from patients with serologically confirmed tularemia were tested by in-house ELISA with bacterial sonicate as the antigen for the presence of IgG1, IgG2, IgG3 and IgG4 antibodies to F. tularensis. Based on the results of determining the level of antibodies in the sera of 30 blood donors, the cut-off limit of serum antibodies for each subclass was set at arithmetic mean plus three standard deviations.

RESULTS

Antibodies of subclass IgG1 to F. tularensis were diagnosed in 41 (73.2%), IgG2 in 52 (92.9%) and IgG3 in 13 (23.2%) serum samples. The arithmetic mean of OD450 of antibodies IgG2 was over three-times higher than antibodies IgG1 and IgG3 measured in all of tested serum samples. The concentration of IgG4 was below the detection level.

CONCLUSION

In conclusion, IgG2 antibodies to F. tularensis are predominating IgG subclass in tularemia. This study showed also that subclasses of IgG1 and IgG3 but not IgG4 antibodies to F. tularensis are produced during natural infection in humans.

[Comparison of usefulness of commercial ELISA Virion/Serion, homemade ELISA and tube agglutination test in serodiagnosis of tularemia]

INTRODUCTION

Tularemia is a highly infectious zoonotic disease caused by Gram-negative bacterium Francisella tularensis. The microbiological diagnosis of tularemia is based on bacteriological, molecular and serological investigations. In the present study we compared of usefulness of commercial ELISA Virion/Serion, home-made ELISA and tube agglutination test in serodiagnosis of tularemia.

METHODS

Serum samples from 57 patients with clinical symptoms of tularemia, 13 patients with yersiniosis and 20 blood donors were tested. The cut-off limit of IgA, IgG and IgM serum antibodies in home-made ELISA was set at mean antibody titer determined in sera of healthy blood donors exceeded by the three standard deviations. The cut-off for positivity in tube agglutination test was titers 25. The IgG and IgM antibodies to lipopolysaccharides of F. tularensis in Virion/Serion ELISA were measured and results interpreted according to the instructions by the manufacturer.

RESULTS

The results of the study showed that 39 (68.4%) serum samples obtained from the patients suspected for tularemia were positive by tube agglutination test and Virion/Serion ELISA assay for IgG and IgM antibodies. Home-made ELISA was slightly more sensitive and detected the IgA/IgG antibodies in 42 (73.7%) and IgM antibodies in 39 (68.4%) of serum samples. The positive reactions were not detected by the tube agglutination test and home-made ELISA in serum samples from patients with yersiniosis and blood donors. The Virion/Serion ELISA detected IgG antibodies in diagnostically significant level only in one blood donor.

CONCLUSIONS

In conclusion, all three serological tests can be successfully used in routine serodiagnosis of tularemia.

[Morphometric characteristics of tularemia infectious process in the organism of immunized guinea pigs]

AIM

Morphometric characteristic of organ and system state of guinea pigs immunized with live tularemia vaccine during infection with virulent culture of tularemia.

MATERIALS AND METHODS

Morphometric study of histological material from immunized guinea pigs infected subcutaneously at day 30 with a culture of virulent tularemia strain was performed. A standard scheme of sampling and preparation of morphological material and staining of final semifine section with hematoxylin and eosin, impregnation with silver by Masson in Gamperl and Grimelius modificationwas used. Morphometric study was performed by using "Densitomorphometry" program.

RESULTS

Morphometric parameters that characterize functional state of organs and systems in immunized, immunized with consequent infection and infected guinea pigs were established. Reactive processes that take place in the infected animal organism against the background of prior immunization fit into the range of adaptation-compensation reactions.

CONCLUSION

The morphometric study carried out allowed to adequately evaluate the state of functionally important systems of the organism of experimental animals, this allows to consider perspective the wider use of morphometric analysis in experimental morphology.

Pneumonic tularemia in rabbits resembles the human disease as illustrated by radiographic and hematological changes after infection

Background

Pneumonic tularemia is caused by inhalation of the gram negative bacterium, Francisella tularensis. Because of concerns that tularemia could be used as a bioterrorism agent, vaccines and therapeutics are urgently needed. Animal models of pneumonic tularemia with a pathophysiology similar to the human disease are needed to evaluate the efficacy of these potential medical countermeasures.

Principal Findings

Rabbits exposed to aerosols containing Francisella tularensis strain SCHU S4 developed a rapidly progressive fatal pneumonic disease. Clinical signs became evident on the third day after exposure with development of a fever (>40.5°C) and a sharp decline in both food and water intake. Blood samples collected on day 4 found lymphopenia and a decrease in platelet counts coupled with elevations in erythrocyte sedimentation rate, alanine aminotransferase, cholesterol, granulocytes and monocytes. Radiographs demonstrated the development of pneumonia and abnormalities of intestinal gas consistent with ileus. On average, rabbits were moribund 5.1 days after exposure; no rabbits survived exposure at any dose (190–54,000 cfu). Gross evaluation of tissues taken at necropsy showed evidence of pathology in the lungs, spleen, liver, kidney and intestines. Bacterial counts confirmed bacterial dissemination from the lungs to the liver and spleen.

Conclusions/Significance

The pathophysiology of pneumonic tularemia in rabbits resembles what has been reported for humans. Rabbits therefore are a relevant model of the human disease caused by type A strains of F. tularensis.

Effects of sublethal exposure of European brown hares to paraoxon on the course of tularemia

OBJECTIVES

The causative agent of tularemia Francisella tularensis is highly infectious and lagomorphs are important reservoirs and a source of human disease. The aim of the present study was to test the hypothesis that sublethal exposure to pesticides increases the susceptibility of hares to F. tularensis and modulates the course of the infection.

METHODS

Experimental hares were allocated to a) control, b) paraoxon-treated, c) F. tularensis-treated, and d) paraoxon-and-F. tularensis-treated groups of five specimens on a random basis and subcutaneously inoculated with a wild F. tularensis subsp. holarctica strain (a single dose of 9 × 108 CFU pro toto) and/or injected a sublethal dose of paraoxon (100 μg/kg). Group differences were evaluated using survival curves, oxidative stress responses as well as caspase-3 and acetylcholinesterase activities in whole blood samples collected on day 2 post exposure.

RESULTS

The paraoxon-and-F. tularensis-treated group showed a rapid onset of clinical signs and all deaths occurred on days 2 and 3 post exposure. F. tularensis-inoculated hares survived from 3 to 10 days, while only one hare died on day 12 in the paraoxon-treated group. Survival curves in the three exposed groups were significantly different from the control and median survival in F. tularensis-inoculated and paraoxon-and-F. tularensis-treated hares amounted to 7 and 2 days, respectively. Compared with controls, significant responses included an eight- and seven-fold activation of caspase-3 in F. tularensis-inoculated and paraoxon-and-F. tularensis-treated hares, respectively, and a 1.5-fold decrease of blood acetylcholinesterase activities in the paraoxon-treated and paraoxon-and-F. tularensis-treated groups. There was a 1.3- to 1.4-fold decrease of the ferric reducing antioxidant power in blood of F. tularensis-inoculated hares and the paraoxon-and-F. tularensis-treated group, respectively. The blood lipid peroxidation levels were of no differences among the four experimental groups.

CONCLUSIONS

Results of this study can help understand the pathogenesis of tularemia and mortality of hares in agricultural habitats. Use of anticholinesterase agents in agriculture can pose a threat of infectious disease outbreaks and higher mortality in wildlife populations.

Molecular immunology of experimental primary tularemia in mice infected by respiratory or intradermal routes with type A Francisella tularensis

The type A subspecies of Francisella tularensis is a highly virulent facultative intracellular bacterial pathogen, and a potential biological weapon. Recently, there has been renewed interest in developing new vaccines and therapeutics against this bacterium. Natural cases of disease, tularemia, caused by the type A subspecies are very rare. Therefore, the United States Food and Drug Administration will rely on the so-called Animal Rule for efficacy testing of anti-Francisella medicines. This requires the human disease to be modeled in one or more animal species in which the pathogenicity of the agent is reasonably well understood. Mice are natural hosts for F. tularensis, and might be able to satisfy this requirement. Tularemia pathogenesis appears to be primarily due to the host inflammatory response which is poorly understood at the molecular level. Additionally, the extent to which this response varies depending on host and pathogen genetic background, or by pathogen challenge route or dose is unknown. Therefore, the present study examined sera and infected tissues from C57BL/6 and BALB/c mice challenged by natural intradermal (ID) and respiratory routes with one of two distinct type A strains of the pathogen for cytokine and chemokine responses that might help to explain the morbidity associated with tularemia. The results show that the molecular immune response was mostly similar regardless of the variables examined. For instance, mRNA for the proinflammatory cytokine IL-6, and chemokines KC, and IP-10 was consistently upregulated at all sites of infection. Upregulation of mRNA for several other cytokines and chemokines occurred in a more tissue restricted manner. For instance, IFN-gamma was highly upregulated in the skin of BALB/c, but not C57BL/6 mice after ID inoculation of the pathogen, whilst IL-10 mRNA upregulation was only consistently seen in the skin and lungs.

An immunoaffinity tandem mass spectrometry (iMALDI) assay for detection of Francisella tularensis

Francisella tularensis (F. tularensis) has been designated by the CDC as 1 of the 10 organisms most likely to be engineered for bioterrorism. Symptoms of tularemia in humans are non-specific, thus making the disease difficult to diagnose. If not quickly diagnosed and treated, the disease has a high mortality rate--thus methods for early and specific diagnosis are of critical importance. This immunoaffinity MALDI MS/MS (iMALDI) assay provides unambiguous detection of F. tularensis peptides at attomole levels from peptide solutions, and at low CFU levels from bacteria. The addition of stable-labeled versions of the peptide as internal standards allows absolute quantitation of F. tularensis peptides with a linear dynamic range spanning two orders of magnitude. The ability of mass spectrometry to obtain amino acid sequence data on affinity-captured peptides provides absolute specificity and avoids "false positives" from the non-specific binding. The F. tularensis iMALDI assay has been applied to different samples, such as nasal swabs. This novel quantitative diagnostic F. tularensis iMALDI assay allows the safe, sensitive, and specific detection of F. tularensis. The assay can be easily adapted to other target peptides and therefore has broad application potential in clinical diagnosis of other pathogens and diseases.

Proteomic analysis of antibody response in a case of laboratory-acquired infection with Francisella tularensis subsp. tularensis

Immunoproteomic analysis was applied to study the immunoreactivity of serum samples collected at different time points from a laboratory assistant accidentally infected with highly virulent strain of Francisella tularensis subsp. tularensis. Immunoblotting showed that the spectrum of F. tularensis antigens recognized specifically by immune sera remained with the exception for 1 antigen stable for up to 16 years after infection. Using immunoproteomics approach 10 immunoreactive antigens were successfully identified. Several new immunogenic F. tularensis proteins were described for the first time.

[Evaluation of immunobiological activity of Francisella tularensis C-complex preparations as promising component of subunit vaccines]

Data on influence of Francisella tularensis C-complex preparations on formation of immunity against tularemia are presented. Study of cellular immunity characteristics as well as dynamics of antibody response was carried out on white mice and guinea pigs models. Absence of toxicity, pyrogenicity, and negative effects on immunocompetent cells in combination with protective activity points to possibility of use the C-complex as a component of a subunit vaccine.

Detection of antibodies to Francisella tularensis in cats

Blood samples were obtained from privately owned cats in Connecticut and New York State, USA in 1985-1990, and analyzed for evidence of Francisella tularensis, the etiologic agent of tularemia. Of the 91 sera tested by microagglutination (MA) methods, 11 (12%) contained antibodies to F. tularensis. Analyses of the same sera by indirect fluorescent antibody (IFA) staining methods revealed 22 (24%) positives. There was good agreement in results of both tests (73% concordance). However, we measured higher titers (1:80 to 1:640) with IFA analysis than by MA methods (1:80 to 1:160). Both tests were suitable for general screening purposes. The DNA of F.tularensis was not detected in the 24 antibody-positive sera tested. Cats living in Connecticut and New York State were naturally exposed to F.tularensis or a closely related organism. With exposure to ticks, other biting arthropods, mice, and rabbits, cats are at risk for acquiring F.tularensis infections and can be an important source of information on the presence of this agent in nature.

Raccoons and skunks as sentinels for enzootic tularemia

We analyzed sera from diverse mammals of Martha's Vineyard, Massachusetts, for evidence of Francisella tularensis exposure. Skunks and raccoons were frequently seroreactive, whereas white-footed mice, cottontail rabbits, deer, rats, and dogs were not. Tularemia surveillance may be facilitated by focusing on skunks and raccoons.

Transcriptional profiling of the peripheral blood response during tularemia

Tularemia is a febrile disease caused by the highly contagious bacterium Francisella tularensis. We undertook an analysis of the transcriptional response in peripheral blood during the course of ulceroglandular tularemia by use of Affymetrix microarrays comprising 14,500 genes. Samples were obtained from seven individuals at five occasions during 2 weeks after the first hospital visit and convalescent samples 3 months later. In total, 265 genes were differentially expressed, 95 of which at more than one time point. The differential expression was verified with real-time quantitative polymerase chain reaction for 36 genes (R(2)=0.590). The most prominent changes were noted in samples drawn on days 2-3 and a considerable proportion of the upregulated genes appeared to represent an interferon-gamma-induced response and also a proapoptotic response. Genes involved in the generation of innate and acquired immune responses were found to be downregulated, presumably a pathogen-induced event. A logistic regression analysis revealed that seven genes were good predictors of the early phase of tularemia. This is the first description of the transcriptional host response to ulceroglandular tularemia and the study has identified gene subsets relevant to the pathogenesis of the disease and subsets that may serve as early diagnostic biomarkers.

[Immunization with cellulose-immobilized antigens. The development of A. E. Gurvitch concept]

A highly purified TUL4-CBD chimeric protein was obtained by one stage purification method. TUL4-CBD protein consists of TUL4 Francisella tularensis mature peptide sequence, Gly-Ser spacer and cellulose binding domain (CBD) of Anaerocellum thermophilum. The TUL4-CBD protein was shown to induce production of specific antibodies to TUL4 protein in laboratory animals.

Seroprevalence of brucellosis, tularemia, and yersiniosis in wild boars (Sus scrofa) from north-eastern Germany

Brucellosis and tularemia are classical zoonotic diseases transmitted from an animal reservoir to humans. Both, wildlife and domestic animals, contribute to the spreading of these zoonoses. The surveillance of the animal health status is strictly regulated for domestic animals, whereas systematic disease monitoring in wildlife does not exist. The aim of the present study was to provide data on the prevalence of anti-Brucella, anti-Francisella and anti-Yersinia antibodies in wild boars from North-Eastern Germany to assess public health risks. A total of 763 sera of wild boars from Mecklenburg-Western Pomerania hunted in 1995/1996 were tested using a commercially available Brucella suis ELISA, an in-house lipopolysaccharide (LPS)-based Francisella ELISA, and commercially available Western blot kits for the detection of anti-Francisella and anti-Yersinia antibodies. The Yersinia enterocolitica O:9 LPS is able to induce serological cross-reactions indistinguishable from brucellosis due to a similar immunodominant epitope in the Brucella O-polysaccharide. The Yersinia Western blot assay was, therefore, based on five recombinant Yersinia outer proteins which have been proved to be specific for the serodiagnosis of yersiniosis. Anti-Brucella, anti-Francisella and anti-Yersinia antibodies were detected in 22.0%, 3.1%, and 62.6% of the wild boars, respectively. The high seroprevalence of tularemia and brucellosis in wild boars indicates that natural foci of these zoonoses are present in wildlife in Germany. However, the impact of transmission of zoonotic pathogens from wildlife to livestock is unknown. Only careful and systematic monitoring will help to prevent the (re)emergence of these zoonotic diseases in domestic animals and consequently human infection.

[Rodents as the vectors of infective agents in the natural foci of infections in the Moscow megapolis]

This work deals with the results of 40-year observations on the circulation of infective agents in the natural foci of infections (tularemia, leptospirosis, hemorrhagic fever with renal syndrome) among rodents and other small mammals in the territory of the Moscow. The monitoring of their frequency and the infection rates remains the main effective measure for the prophylaxis of dangerous infections among the population of the megapolis.

A novel screening ELISA and a confirmatory Western blot useful for diagnosis and epidemiological studies of tularemia

A novel enzyme-linked immunosorbent assay (ELISA) and a confirmatory Western blot (WB) to detect human antibodies against Francisella tularensis were evaluated. The ELISA was based on partially purified lipopolysaccharide (LPS), the WB on whole antigen of F. tularensis. Positive WB showed a typical LPS ladder. Sensitivity and specificity of the ELISA, as assessed in 104 positive sera and 1149 'normal' sera from healthy young adults, were 99.0% and 97.1% respectively. Sensitivity of the WB was close to 100%, whereas specificity was 99.6%. Antibodies against the LPS of F. tularensis were detected in four of the 'normal' sera in both ELISA and WB. The assays were further evaluated using sera of individuals from Norway, Sweden and Kosovo suspected to be infected in tularemia outbreaks. Results revealed that the combination of ELISA and WB is suitable for laboratory confirmation of tularemia as well as for large-scale epidemiological studies.

Comparison of enzyme-linked immunosorbent assay, Western blotting, microagglutination, indirect immunofluorescence assay, and flow cytometry for serological diagnosis of tularemia

The serodiagnostic efficiencies of five different approaches to detecting antibodies (immunoglobulins G, A, and M) developed in clinically proven infections with Francisella tularensis have been assessed. Fifty serum samples from patients suffering from tularemia during an outbreak in Sweden were compared with samples from 50 healthy blood donors (controls) by using an enzyme-linked immunosorbent assay (ELISA), microagglutination (MA), Western blotting (WB), an indirect immunofluorescence assay (IIFA), and flow cytometry (FC). ELISA, WB, and FC were based on the use of preparations of lipopolysaccharides (LPS) of the live vaccine strain of Francisella tularensis subsp. holarctica (ATCC 29684) as a capture antigen. Whole methanol-fixed bacteria were used for IIFA and MA. Optimized protocols yielded a diagnostic sensitivity and specificity of 100% for WB, MA, and FC, 98% for ELISA, and 93% for IIFA. A total of 6,632 serum samples from individuals between the ages of 18 and 79 years, representatively recruited from all regions of Germany, were screened to estimate and confirm the positive predictive value (PVpos) of the ELISA. Serum samples from 15 (0.226%) individuals tested positive for F. tularensis-specific antibodies by ELISA and confirmatory WB. The resulting prevalence-dependent PVpos of 10.2% and specificity of 98.1% were consistent with our findings for tularemia patients and controls. We conclude that the combined usage of a screening ELISA and a confirmatory WB based on LPS as a common antigen, as well as the MA, is a suitable serodiagnostic tool, while the quality of the IIFA is hampered by subjective variations of the results. FC is a promising new approach that might be improved further in terms of multiplex analyses or high-throughput applications.

[Evolution of serological characteristics in 26 patients with tularemia three years after the outbreak]

INTRODUCTION

Tularemia was an unknown zoonosis in our region until the first quarter of 1998. The outbreak that took place on those dates has made possible to study some scantly known characteristics of the disease, as are the determinants for the persistence of a high antibody titer.

MATERIAL AND METHODS

Between March and May, 2001, a clinical-analytical control was carried out in 26 patients who showed tularemia in the first quarter of 1998.

RESULTS

The clinical forms during the acute phase were: ulceroglandular (46.2% of patients), nodal (26.9%), typhoid (15.4%) and pharyngeal (11.5%). Antibiotics most prescribed were streptomycin and doxycycline. Nine patients showed sequelae three years later. The arithmetical mean of antibody titer declined from 1/1011 in 1998 to 1/187 in 2001. 76.92% of the patients maintained an antibody titer equal or higher than 1/160 three years after the acute phase. A significant relation between the initial antibody titer and the antibody titer registered in the late phase was observed. A relationship between final antibody titer and prescribed antibiotic, presence of sequelae, gender, or age was not demonstrated.

CONCLUSIONS

The antibody titer in the presence of Francisella tularensis is high in an important percentage of the patients along years. We should reconsider the standard diagnostic criteria to our community, accepting as a certainty diagnosis exclusively the presence of a demonstrative culture or the existence of seroconversion.

Serologic Survey for Canine Infectious Diseases among Sympatric Swift Foxes (Vulpes velox) and Coyotes (Canis latrans) in Southeastern Colorado

Swift foxes (Vulpes velox) and coyotes (Canis latrans) are sympatric canids distributed throughout many regions of the Great Plains of North America. The prevalence of canid diseases among these two species where they occur sympatrically is presently unknown. From January 1997 to January 2001, we collected blood samples from 89 swift foxes and 122 coyotes on the US Army Piñon Canyon Maneuver Site, Las Animas County, SE Colorado (USA). Seroprevalence of antibodies against canine parvovirus (CPV) was 71% for adult (> 9 mo old) and 38% for juvenile (< or = 9 mo old) swift foxes. Adult (<1 yr old) and juvenile (<1 yr old) coyotes had a seroprevalence for CPV of 96% and 78%, respectively. Presence of antibodies against canine distemper virus (CDV) was 5% for adult foxes and 0% for juvenile foxes. Seroprevalence of CDV was 46% for adult coyotes and 18% for juvenile coyotes. No swift foxes had canine adenovirus (CAV) antibodies, whereas 81% and 63% of adult and juvenile coyotes, respectively, had antibodies for CAV. Seroprevalence of antibodies against Yersinia pestis was 68% among adult foxes and 34% among juvenile swift foxes. Seroprevalence of Y. pestis antibodies was 90% and 70% for adult and juvenile coyotes, respectively. No swift foxes had antibodies against Francisella tularensis, whereas seroprevalence was 4% among both adult and juvenile coyotes. Antibodies against CPV and plague were common in both species, whereas antibodies against CDV and CAV were more prevalent in coyotes compared to swift foxes.

[Rapid laboratory detection of antigens of infective agents of infections and technical means for their realization]

A system of new accelerated and rapid methods for the detection of the antigens of the infective agents of plague, cholera, tularemia and brucellosis were developed on the basis of solid phase immunosuspension tests: the passive hemagglutination (PHA) test and the latex agglutination (LA) test. The immunological and physico-chemical properties of suspensions in the PHA and LA tests made it possible to use extraneous sources of energy (centrifugal acceleration and the electric field) to accelerate these tests. The results of the PHA and LA tests were registered with the use of a densitometer, model Ultrascan 2202, and a tester, model C 34014.2. To apply centrifugal acceleration and the electric field, a laboratory centrifuge and an electrophoretic microchamber were designed. Densitometry was carried out on modified plates and conductometry, with the use of modified electrodes. The time of obtaining the results of the PHA and LA tests was 15-30 minutes with the use of centrifugation and 2-5 minutes in the electric field, which made it possible to regard these tests as rapid.

The proportion of circulating gammadelta T cells increases after the first week of onset of tularaemia and remains elevated for more than a year

In various human intracellular bacterial diseases, an increase of the proportion of circulating Vgamma9Vdelta2 T cells has been observed. The prevalence of the finding among infected subjects and the time course of the elevation remain to be investigated. In the present study, comprising blood samples from a large number of cases of ulceroglandular tularaemia, the percentage of Vgamma9Vdelta2 T cells within the first week of onset of disease (5.3 +/- 0.7% (mean +/- s.e.m.)) did not differ from that of control subjects (5.3 +/- 0. 8%). Thereafter, percentages increased rapidly and within the interval of 8-40 days mean levels were > 20% (P < 0.001). Of 45 individuals sampled within 3 months of onset, 42 showed a percentage of Vgamma9Vdelta2 T cells of > 10%. Significantly increased levels were still recorded at 18 months (13.8 +/- 2.4%; P < 0.05) but not at 24 months (10.2 +/- 2.1%; P > 0.10). Thus, a consistent increase of circulating Vgamma9Vdelta2 T cells was demonstrated in tularaemia. The initial delay and the prolonged course of elevation may suggest a role in immunoregulation and/or immunological memory. Furthermore, the percentage of gammadelta T cells expressing tumour necrosis factor-alpha in response to phorbol myristate acetate was decreased during the first week and up to 40 days after onset, possibly reflecting the modulation of an inflammatory response.

[Laboratory diagnosis and serologic course in patients with tularemia]

BACKGROUND

Tularemia was practically unknown in Spain until the end of 1997, when an epidemic outbreak was declared. This paper presents the data on microbiological diagnosis of 55 patients who suffered from tularemia.

PATIENTS AND METHODS

Thirty-two samples from 19 patients and 151 serum samples from 55 patients were obtained for culture. Serologic diagnosis was performed by tube sero-agglutination and microagglutination. Three types of tests were performed on all sera: Wright sero-agglutination (WSA), Coombs test against Brucella spp. and sero-agglutination against Yersinia enterocolitica O:3, Yersinia enterocolitica O:3, and Proteus OX 19.

RESULTS

F. tularensis was found in two samples (6.25%) of the 32 received. Titers > or = 1/160 were obtained in 78.2% and 74.5% of the initial sera by tube sero-agglutination and microagglutination, respectively. Correlation between the two tests was 0.80 (p < 0.001). Prozone phenomenon was observed in 59.9% of the sera, while crossed reactivity to Brucella spp. and Proteus spp. was found in 9.3% and 22.8%, respectively. No crossed reactivity was observed with Yersinia spp.

CONCLUSIONS

Culture of F. tularensis has low sensitivity. The correlation obtained between tube sero-agglutination and microagglutination is good. Both techniques are useful in routine diagnosis of tularemia, although microagglutination has some advantages over tube agglutination.

Peripheral blood leukocyte counts, erythrocyte sedimentation rate and C-reactive protein in tularemia caused by the type B strain of Francisella tularensis

The behavior of leukocytes, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in tularemia caused by Type B of Francisella tularensis was analyzed in different clinical forms and severities of disease in 101 adult tularemia patients. The mean leukocyte count was 8.3 X 10(9)/l and the leukocyte differential count was also usually normal. The behavior of leukocytes was similar in different clinical forms and severities of tularemia. The changes in differential counts were milder than reported earlier. Both CRP and ESR were higher in severe than in milder forms of tularemia (p less than 0.05 and p less than 0.01, respectively), and CRP was higher in pulmonary than in ulceroglandular tularemia during the second week (p less than 0.05). There were high individual CRP concentrations of up to 225 mg/l in acute tularemia but there were also low CRP values (10-40 mg/l). Thus the behavior of CRP in tularemia resembled that seen in tuberculosis, and CRP did not always allow differentiation of tularemia from viral diseases.

A probable endocrine basis for the depression of ketone bodies during infectious or inflammatory state in rats

The effects of infection with Streptococcus pneumoniae, Francisella tularensis, and Venezuelan equine encephalitis virus as well as inflammatory stress induced by the administration of turpentine and endotoxin on plasma ketone bodies and insulin were studied in white rats. All of the infectious/inflammatory stresses caused a significant decrease in the ketonemia of fasting and an elevation of plasma insulin. When a pneumococcal infection was initiated in a diabetic rat, inhibition of fasting ketonemia did not occur. Similarly, pneumococcal infection in the hypophysectomized rat did not result in a noticeable depression of either fasting ketonemia or plasma FFA. The increase in circulating insulin appears to be closely correlated with the inhibition of fasting ketonemia noted in the infectious/inflammatory stress.

Changes in whole blood and serum components of grivet monkeys with experimental respiratory Francisella tularensis infection

Grivet monkeys infected with virulent Francisella tularensis Strain Schu S4 showed significant early changes in serum levels of trace metals, triglycerides and activities of alkaline phosphatase, lactate dehydrogenase and alpha-hydroxybutyrate dehydrogenase. Free amino acid levels decreased slightly and there was a marked increase in the phenylalanine: tyrosine ratio. Serum lysozyme activity and seromucoid levels also increased. Kanamycin therapy produced remission of overt signs but the changes in blood constituents were less readily affected. Immunization with the live vaccine strain of F. tularensis induced transient responses similar to those resulting from Schut S4 infection. Immunized monkeys subsequently challenged with the virulent Schu S4 strain showed no clinical signs or marked changes in blood constituents.

Changes in whole blood and serum components during Francisella tularensis and rabbit pox infections of rabbits

Rabbits infected with virulent Francisella tularensis strain Schu S4 or rabbit pox virus (Utrecht strain) showed significant early changes in serum levels of trace metals, neutral fat and alkaline phosphatase activity. With F. tularensis infections a marked early leukopenia and a decrease in serum amino acids were also observed; the effect on amino acid levels was less pronounced in rabbit pox infections. In both diseases these changes preceded the appearance of acute phase globulins in the serum. Vaccination with the live vaccine strain of F. tularensis slightly increased survival times but did not delay the onset of metabolic changes in rabbits subsequently infected with the virulent Schu S4 strain.

The significance and mechanism of an increased serum phenylalanine-tyrosine ratio during infection

Infections or inflammatory states often cause significant increases in serum phenylalanine and the phenylalanine-tyrosine ratio. More than 95% of samples obtained during inflammatory diseases in man showed phenylalanine-tyrosine ratio increases greater than the maximum normal values. An increase in this ratio also occurred in monkeys with induced Rocky Mountain spotted fever, viral encephalitis, yellow fever, or pneumococcal and Salmonella infections, as well as in rats with pneumococcal and Salmonella infections, as well as in rats with pneumococcal, Salmonella or tularemia infections. A similar ratio increase occurred in rats inoculated with unpurified mediator substances (released by activated leukocytes) that appear to initiate many of the secondary metabolic phenomena associated with infection and/or inflammation. To identify responsible mechanisms, rats were given lethal doses of Streptococcus pneumoniae; serum phenylalanine and phenylalanine-tyrosine ratios increased significantly. Hepatic phenylalanine hydroxylase activities were slightly decreased when compared to noninfected controls. Infected and noninfected rats showed comparable oxidation rates for 14C-phenylalanine given with an oral phenylalanine load, as a pulse-oral dose, or as an intraperitoneal injection. After 8 hr, both infected and control rats had similar amounts of radioactivity in total body protein, but tissue distributions were markedly altered during pneumococcal sepsis. Serum proteins of infected rats contained almost twice as much total radioactivity as that found in controls, while the amount of labeled phenylalanine in skeletal muscle protein was significantly reduced in the infected group. Isolated muscles from infected rats released more phenylalanine and less tyrosine than control muscles. Infection-related increases in serum phenlalanine could not be explained by decreased hydroxylation or oxidation. Rather, the data were consistent with an increased flux of phenylalanine into serum, most likely as the result of increased skeletal muscle catabolism. Elevations in the serum phenylalanine-tyrosine ratio have potential value for estimating the presence of an inflammatory fisease and the catabolic state of a patient.

Pathogenesis of tularemia in monkeys aerogenically exposed to Francisella tularensis 425

The pathogenesis of tularemia was studied in groups of rhesus monkeys (Macaca mulatta) that inhaled graded 10-fold doses ranging from 10 through 10(6) organisms of Francisella tularensis 425, a strain highly virulent for the white mouse but of reduced virulence for the domestic rabbit. Mean incubation periods ranged from 3 to 6 days followed by acute illness lasting 5 to 11 days with subsequent recovery of most animals. The higher inhaled doses resulted in shorter incubation periods, longer and more severe acute illnesses, and 18% mortality at the highest dose. Strain 425 multiplied in the lungs, disseminated to the regional lymph nodes, and became systemic. Maximal bacterial populations in tissues were reached by the 7th day after exposure of the animals regardless of the number of organisms inhaled. F. tularensis was no longer recoverable from any of six tissues examined 2 months after exposure. The most significant tissue changes occurred in the lungs; these consisted of foci of liquefaction necrosis, lobular consolidation, and pleural effusion and adhesions. The data indicate that the inhaled dose of strain 425 determined the maximal growth of the organism in the lungs which in turn influenced the severity of the usually self-limiting pneumonia and systemic infection. Although the monkey is less resistant to tularemia than is man, this laboratory animal when infected with F. tularensis 425 provides a useful model for the self-limiting type of human pulmonary tularemia usually observed in Europe and Asia but to a lesser extent in North America.

Effects of three bacterial infections on serum lipids of rabbits

Alteration of the rabbit serum lipids as a result of three bacterial infections was studied by quantitative thin-layer and gas-liquid chromatography. Anthrax infection slightly changed the serum lipid. Cholesterol did not change, though free fatty acids, triglycerides, and cholesteryl esters doubled, and lecithin increased threefold. Tularemia infection produced drastic changes in the serum lipid content of rabbits, increasing levels of cholesterol over 4-fold, free fatty acids 17-fold, triglycerides 11-fold, cholesteryl esters 2.5-fold, and lecithin almost 3-fold. Pneumococcus infection increased cholesterol 2.5 times, free fatty acids were more than doubled, triglycerides were increased 9.5 times, and lecithin was increased almost 4 times. Gas-liquid chromatographic analysis of the methyl esters of free fatty acids showed only quantitative changes in these acids due to infection. Some possible mechanisms of alteration of serum lipid content are discussed.

Insulin response during tularemia in man

Serum insulin concentrations were measured serially in seven nondiabetic subjects following a rapid intravenous glucose load during a preinfection control period, during early clinical respiratory tularemia, and again in convalescence following therapy. Within twenty-four hours of onset of clinical illness the rate of glucose disappearance from the blood had diminished significantly (p&lt;0.05). At the same time there was a brisk rise in insulin levels reaching higher peak concentrations and falling more slowly than the response observed during the preinfection control period. The pattern during clinical illness was different from that described after intravenous glucose loading in maturity onset diabetes or obesity and may have been influenced by glucocorticoid excess. Increased whole blood pyruvate concentrations following glucose loading during clinical illness were compatible with heightened glucocorticoid ction. The magnitude of insulin clinical illness was significantly increased (p&lt;0.02) and was directly related to height of fever In contrast, the rate of glucose disappearance was inversely related to fever. The inverse relationship of the magnitude of insulin output to the rate of glucose reappearance suggested a peripheral inhibition of insulin action during infection. Although fever may have played a role during acute illness, the persistence of an abnormal insulin response in one patient during convalescence suggested that this change was not dependent upon fever alone. Other factors that may have contributed to the peripheral inhibition of insulin action during clinical illness are briefly discussed.