REGULATION OF TOXIN SYNTHESIS BY CLOSTRIDIUM DIFFICILE

Clostridium difficile is the leading definable cause of nosocomial diarrhea worldwide due to its virulence, multi-drug resistance, spore-forming ability, and environmental persistence. The incidence of C. difficile infection (CDI) has been increasing exponentially in the last decade. Virulent strains of C. difficile produce either toxin A and/or toxin B, which are essential for the pathogenesis of this bacterium. Current methods for diagnosing CDI are mostly qualitative tests that detect the bacterium, the toxins, or the toxin genes. These methods do not differentiate virulent C. difficile strains that produce active toxins from non-virulent strains that do not produce toxins or produce inactive toxins. Based on the knowledge that C. difficile toxins A and B cleave a substrate that is stereochemically similar to the native substrate of the toxins, uridine diphosphoglucose, a quantitative, cost-efficient assay, the Cdifftox activity assay, was developed to measure C. difficile toxin activity. The concept behind the activity assay was modified to develop a novel, rapid, sensitive, and specific assay for C. difficile toxins in the form of a selective and differential agar plate culture medium, the Cdifftox Plate assay (CDPA). This assay combines in a single step the specific identification of C. difficile strains and the detection of active toxin(s). The CDPA was determined to be extremely accurate (99.8% effective) at detecting toxin-producing strains based on the analysis of 528 C. difficile isolates selected from 50 tissue culture cytotoxicity assay-positive clinical stool samples. This new assay advances and improves the culture methodology in that only C. difficile strains will grow on this medium and virulent strains producing active toxins can be differentiated from non-virulent strains. This new method reduces the time and effort required to isolate and confirm toxin-producing C. difficile strains and provides a clinical isolate for antibiotic susceptibility testing and strain typing. The Cdifftox activity assay was used to screen for inhibitors of toxin activity. Physiological levels of the common human conjugated bile salt, taurocholate, was found to inhibit toxin A and B in vitro activities. When co-incubated ex vivo with purified toxin B, taurocholate protected Caco-2 colonic epithelial cells from the damaging effects of the toxin. Furthermore, using a caspase-3 detection assay, taurocholate reduced the extent of toxin B-induced Caco-2 cell apoptosis. These results suggest that bile salts can be effective in protecting the gut epithelium from C. difficile toxin damage, thus, the delivery of physiologic amounts of taurocholate to the colon, where it is normally in low concentration, could be useful in CDI treatment. These findings may help to explain why bile rich small intestine is spared damage in CDI, while the bile salt poor colon is vulnerable in CDI. Toxin synthesis in C. difficile occurs during the stationary phase, but little is known about the regulation of these toxins. It was hypothesized that C. difficile toxin synthesis is regulated by a quorum sensing mechanism. Two lines of evidence supported this hypothesis. First, a small (KDa), diffusible, heat-stable toxin-inducing activity accumulates in the medium of high-density C. difficile cells. This conditioned medium when incubated with low-density log-phase cells causes them to produce toxin early (2-4 hrs instead of 12-16 hrs) and at elevated levels when compared with cells grown in fresh medium. These data suggested that C. difficile cells extracellularly release an inducing molecule during growth that is able to activate toxin synthesis prematurely and demonstrates for the first time that toxin synthesis in C. difficile is regulated by quorum signaling. Second, this toxin-inducing activity was partially purified from high-density stationary-phase culture supernatant fluid by HPLC and confirmed to induce early toxin synthesis, even in C. difficile virulent strains that over-produce the toxins. Mass spectrometry analysis of the purified toxin-inducing fraction from HPLC revealed a cyclic compound with a mass of 655.8 Da. It is anticipated that identification of this toxin-inducing compound will advance our understanding of the mechanism involved in the quorum-dependent regulation of C. difficile toxin synthesis. This finding should lead to the development of even more sensitive tests to diagnose CDI and may lead to the discovery of promising novel therapeutic targets that could be harnessed for the treatment C. difficile infections.

Importance of antibiotic class to the development of Clostridium difficile infection (CDI) in adults: A systematic review

C. difficile causes gastrointestinal infections in humans, including severe diarrhea. It is implicated in 20%-30% of cases of antibiotic-associated diarrhea, in 50%-70% of cases of antibiotic-associated colitis, and in >90% of cases of antibiotic-associated pseudomembranous colitis. Exposure to antimicrobial agent, hospitalization and age are some of the risk factors that predispose to CDI. Virtually all hospitalized patients with nosocomially-acquired CDI have a history of treatment with antimicrobials or neoplastic agent within the previous 2 months. The development of CDI usually occurs during treatment with antibiotics or some weeks after completing the course of the antibiotics. ^ After exposure to the organism (often in a hospital), the median incubation period is less than 1 week, with a median time of onset of 2days. The difference in the time between the use of antibiotic and the development of the disease relate to the timing of exogenous acquisition of C. difficile. ^ This paper reviewed the literature for studies on different classes of antibiotics in association with the rates of primary CDI and RCDI from the year 1984 to 2012. The databases searched in this systematic review were: PubMed (National Library of Medicine) and Medline (R) (Ovid). RefWorks was used to store bibliographic data. ^ The search strategy yielded 733 studies, 692 articles from Ovid Medline (R) and 41 articles from PubMed after removing all duplicates. Only 11 studies were included as high quality studies. Out of the 11 studies reviewed, 6 studies described the development of CDI in non-CDI patients taking antibiotics for other purposes and 5 studies identified the risk factors associated with the development of recurrent CDI after exposure to antibiotics. ^ The risk of developing CDI in non-CDI patients receiving beta lactam antibiotics was 2.35%, while fluoroquinolones, clindamycin/macrolides and other antibiotics were associated with 2.64%, 2.54% and 2.35% respectively. Of those who received beta lactam antibiotic, 26.7% developed RCDI, while 36.8% of those who received any fluoroquinolone developed RCDI, 26.5% of those who received either clindamycin or macrolides developed RCDI and 29.1% of those who received other antibiotics developed RCDI. Continued use of non-C. difficile antibiotics especially fluoroquinolones was identified as an important risk factor for primary CDI and recurrent CDI. ^

The epidemiology of dengue among children less than 18 months of age in Puerto Rico, 1999--2011

Between 1999 and 2011, 4,178 suspected dengue cases in children less than 18 months of age were reported to the Centers for Disease Control and Prevention Dengue Branch in Puerto Rico. Of the 4,178, 813 were determined to be laboratory-positive and 737 laboratory-negative. Those remaining were either laboratory-indeterminate, not processed or positive for Leptospira . On average, 63 laboratory-positive cases were reported per year. Laboratory-positive cases had a median age of 8.5 months. Among these cases, the median age for those with dengue fever was 8.7 months and 7.9 months for dengue hemorrhagic fever. Clinical signs and symptoms indicative of dengue were greatest among laboratory-positive cases and included fever, rash, thrombocytopenia, bleeding manifestations, and petechiae. The most common symptoms among patients who were laboratory-negative were fever, nasal congestion, cough, diarrhea, and vomiting. Using the 1997 WHO guidelines, nearly 50% of the laboratory-positive cases met the case definition for dengue fever, and 61 of these were further determined to meet the case definition for dengue hemorrhagic fever. In comparison, 15% of laboratory-negative cases met the case definition for dengue fever and less than 1% for dengue hemorrhagic fever. None of the laboratory-positive or laboratory-negative cases met the criteria for dengue shock syndrome.^

Rifaximin-mediated changes to the epithelial cell proteome: 2-D gel analysis

Diarrhea remains a significant cause of worldwide morbidity and mortality. Over 4 million children die of diarrhea annually. Although antibiotics can be used as prophylaxis or for treatment of diarrhea, concern remains over antibiotic resistance. Rifaximin is a semi-synthetic rifamycin derivative that can be used to treat symptoms of infectious diarrhea, inflammatory bowel syndrome, bacterial overgrowth of the small bowel, pouchitis, and fulminant ulcerative colitis. Rifaximin is of particular interest because it is poorly adsorbed in the intestines, shows no indication of inducing bacterial resistance, and has minimal effect on intestinal flora. In order to better understand how rifaximin functions, we sought to compare the protein expression profile of cells pretreated with rifaximin, as compared to cells treated with acetone, rifamycin (control antibiotic), or media (untreated). 2-D gel electrophoresis identified 38 protein spots that were up- or down-regulated by over 2-fold in rifaximin treated cells compared to controls. 16 of these spots were down-regulated, including keratin, annexin A5, intestinal-type alkaline phosphatase, histone h4, and histone-binding protein RbbP4. 22 spots were up-regulated, including heat shock protein HSP 90 alpha, alkaline phosphatase, and fascin. Many of the identified proteins are associated with cell structure and cytoskeleton, transcription and translation, and cellular metabolism. A better understanding of the functionality of rifaximin will identify additional potential uses for rifaximin and determine for whom the drug is best suited. ^

Clostridium difficile infection (CDI): Clinical outcomes associated with concomitant non-CDI antibiotic use

This research examined the relationship between concomitant non-CDI antibiotic use and complications arising due to Clostridium difficile infection. To observe the hypothesized association, 160 total CDI patients between the ages of 50-90 were selected, 80 exposed to concomitant antibiotics and 80 unexposed. Samples were matched based upon their age and Horn's index, a severity score for underlying illness. Patients were de-identified by a third party, and analyzed retrospectively for differences between the two groups. In addition, patients exposed to broad spectrum antibiotics at the time of CDI treatment were further studied to demonstrate whether antibiotics had any effect on CDI complications. Between the two groups, the outcomes of interest (recurrent CDI, refractory CDI, mortality, ICU stay, and length of hospitalization) were not associated with concomitant antibiotic use at the time of CDI therapy. However, within the exposed population, certain classes of antibiotics such as cephalosporin, antifungals, and tetracyclines were more common in patients compared to other types of therapy. In addition, days of therapy provided evidence that sustained use of antibiotics affected CDI (p = 0.08), although a more robust sample size and additional study would be needed. Finally, refractory CDI was found to be potentially overestimated within the exposed population due to the possibility of antibiotic-associated diarrhea.^

Complications of misoprostol and other abortion induction methods in the developing world: A systematic review

OBJECTIVE: To systematically review published literature to examine the complications associated with the use of misoprostol and compare these complications to those associated with other forms of abortion induction. ^ DATA SOURCES: Studies were identified through searches of medical literature databases including Medline (Ovid), PubMed (NLM), LILACS, sciELO, and AIM (AFRO), and review of references of relevant articles. ^ STUDY SELECTION AND METHODS: A descriptive systematic review that included studies reported in English and published before December 2012. Eligibility criteria included: misoprostol (with or without other methods) and any other method of abortion in a developing country, as well as quantitative data on the complication of each method. The following is information extracted from each study: author/year, country/city, study design/study sample, age range, setting of data collection, sample size, the method of abortion induction, the number of cases for each method, and the percentage of complications with each method. RESULTS: A total of 4 studies were identified (all in Latin America) describing post-abortion complications of misoprostol and other methods in countries where abortion is generally considered unsafe and/or illegal. The four studies reported on a range of complications including: bleeding, infection, incomplete abortion, intense pelvic pain, uterine perforation, headache, diarrhea, nausea, mechanical lesions, and systemic collapse. The most prevalent complications of misoprostol-induced abortion reported were: bleeding (7-82%), incomplete abortion (33-70%), and infection (0.8-67%). The prevalence of these complications reported from other abortion methods include: bleeding (16-25%), incomplete abortion (15-82%), and infection (13-50%). ^ CONCLUSION: The literature identified by this systematic review is inadequate for determining the complications of misoprostol used in unsafe settings. Abortion is considered an illicit behavior in these countries, therefore making it difficult to investigate the details needed to conduct a study on abortion complications. Given the differences between the reviewed studies as well as a variety of study limitations, it is not possible to draw firm conclusions about the rates of specific-abortion related complications.^

Proceedings of the Fifteenth Annual biochemical Engineering Symposium

This work represents the proceedings of the fifteenth symposium which convened at Colorado State University on May 24, 1985. The two day meeting was scheduled one month later than usual, i.e., after the spring semester, so that travelers from the Midwest (Iowa State University, Kansas State University and University of Missouri) could enjoy the unique mountain setting provided at Pingree Park. The background of the photograph on the cover depicts the beauty of the area. ContentsGreg Sinton and S.M. Leo, KSU. Models for the Biodegration of 2.4-D and Related Xenobiotic Compounds. V. Bringi, CSU. Intrinsic Kinetics from a Novel Immobilized Cell CSTR. Steve Birdsell, CU. Novel Microbial Separation Techniques. Mark Smith, MU. Kinetic Characterization of Growth of E. coli on Glucose. Michael M. Meagher, ISU. Kinetic Parameters of Di- and Trisaccharaide Hydrolysis by Glucoamylase II. G.T. Jones and A.K. Ghosh Hajra, KSU. Modeling and Simulation of Legume Modules with Reactive Cores and Inert Shells. S.A. Patel and C.H. Lee, KSU. Energetic Analysis and Liquid Circulation in an Airlift Fermenter. Rod R. Fisher, ISU. The Effects of Mixing during Acid Addition of Fractionally Precipitated Protein. Mark M. Paige, CSU. Fed-batch Fermentations of Clostridium acetobutylicum. Michael K. Dowd, ISU. A Nonequilibirium Thermodynamic Description of the Variation of Contractile Velocity and Energy Use in Muscle. David D. Drury, CSU. Analysis of Hollow Fiber Bioreactor Performance for MAmmalian Cells by On-Line MMR. H.Y. Lee, KSU. Process Analysis of Photosynthetic Continuous Culture Systems. C.J. Wang, MU. Kinetic Consideration in Fermentation of Cheese Whey to Ethanol.

Characterizing Overall Response to Two-shot Vaccination for BVDV Type 2 in Angus Weanling Calves

Vaccination is a management strategy utilized to help reduce prevalence of bovine respiratory disease in feedlots. However, not all animals respond similarly to vaccinations. It is believed that an animal’s genetics control part of the ability to respond to a vaccination protocol. In order to evaluate the genetic control of a new trait such as response to vaccination, it is important to understand the non-genetic factors that affect an animal’s response to vaccination. The objective of this study was to characterize the non-genetic factors affecting overall response to a two-shot vaccination for bovine viral diarrhea virus type 2 (BVDV2) in Angus weanling calves.

Relatos y recuerdos sobre las ciudades de Mendoza y Santiago en la memoria de los viajeros del siglo XIX

El presente trabajo tiene como objetivo realizar un estudio histórico comparativo, basado en las descripciones de los relatos de cuatro viajeros extranjeros Samuel Haigh, Peter Schmidtmeyer, Francis Bond Head y Campbell Scarlett, que llegaron entre los años 1817 y 1835 a la provincia de Mendoza para luego cruzar la cordillera de los Andes rumbo a Santiago de Chile. El trabajo se divide en dos partes; la primera se refiere a los relatos y testimonios del viaje por la provincia de Mendoza y la segunda parte destaca las descripciones sobre la ciudad de Santiago de Chile. Cada una de las partes ha sido seleccionada y analizada en sus diferentes observaciones por los relatos de cada uno de los cuatro viajeros. Destacando aquellos aspectos distintivos y originales sobre algunos temas en particular, como así también las consideraciones que hacen respecto a la sociedad, sus creencias y su cultura.

Prescripción de medicamentos en las farmacias : una realidad preocupante

Se presume que la prescripción de medicamentos sin receta médica en las farmacias es una práctica frecuente. El objetivo fue conocer la conducta del personal de las farmacias ante una consulta realizada por estudiantes de medicina entrenados para actuar como pacientes simulados de las siguientes situaciones: 1: Infección respiratoria alta, 2: Diarrea aguda; 3: Disuria, 4: Ulcera genital, 5: Hipertensión arterial, 6: Cefalea aguda, 7: Artralgia de tobillo. Se efectuaron 100 entrevistas y cada una de las situaciones se realizó al menos 12 veces. En solo el 28% de los casos no se indicó tratamiento y las 72 prescripciones fueron realizadas por 38 farmacéuticos y 34 no profesionales. La medicación se consideró inadecuada en 58.3%, iatrogénica en 51.4% y la posología incorrecta en 50%. Los fármacos más indicados fueron antibióticos (23.6%), AINES (20.8%), antidiarreicos (11.8%) y antigripales (9.7%). Las situaciones 7 (100%), 1 (93.3%) y 2 (84.6%) tuvieron la mayor frecuencia de indicación de tratamiento y fue significativa la negativa a medicar en las situaciones 4 (OR, 0.16) y 5 (OR, 0.22) (p<0.05). La prescripción fue incorrecta en el 100% de las situaciones 2 y 4 y iatrogénica en el 100% de las situaciones 2, 4 y 5. En 48 casos se sugirió consulta médica y la situación 5 tuvo 4.27 veces más posibilidades de ser derivada (p= 0.01). Este estudio demuestra que en las farmacias del gran Mendoza es común la venta de medicamentos sin prescripción médica lo que compromete la seguridad y salud de las personas.

Por qué escribí La pasión de los nómades (1994) : un libro y muchos viajes

Se trata de una reflexión solicitada a la autora sobre su novela La pasión de los nómades (1994), que propone el retorno del Lucio V. Mansilla de Una excursión a los indios ranqueles (1879) a la Argentina de la década del '90 en el siglo XX. Novela de cruces (de géneros sexuales y ontológicos, de géneros literarios, de lenguas y culturas, de textos y discursos, del mito y la parodia ), Supone también un cruce de viajeros y merodeadores incansables: sobrenaturales peregrinos del mundo celta (Merlín y Rosaura), vulgares y menesterosos inmigrantes, fantasmas de cristianos y de ranqueles. La novela, cuya génesis se cuenta en estas páginas supuso también un viaje geográfico real sobre el que la autora se detiene especialmente.

El viajero posmoderno : un aporte a la tipología de viajeros

El trabajo tiene por objetivo identificar las características que distinguen al viajero de la segunda mitad del siglo XX de sus antepasados: el peregrino medieval, el colonizador, el viajero moderno. El marco teórico lo brindan las reflexiones sobre postmodernismo (Hutcheon, Lyotard, Nogerol, Vattimo) y las tipologías clásicas de viajeros según el comparatismo (Pageaux, Wolfzettel).Es la hipótesis que el escritor viajero de la segunda mitad del siglo XX, lejos de ser simplemente un turista masificado, viaja en soledad, bajo las demandas de su individualismo. Su texto sin compromisos ideológicos fracciona la realidad, la deconstruye usando la fina ironía, la contradicción y la ambigüedad. No se interesa por la originalidad de su escrito, sino que lo arma como un collage inter- y paratextual, y es leído ampliamente, porque pertenece a la sociedad postmoderna con sus marcas de Individualismo, valores materialistas, multiplicidad espacio-temporal, mediatización de la realidad, masificación de la cultura y consumismo. Así, el relato de viajes que tradicionalmente ha sido siempre un texto subjetivo, con estilo aditivo y que ha servido de intermediario entre culturas resulta una tipología textual apropiada para la expresión de las experiencias del viajero postmoderno.

Abordaje interdisciplinario a Viaje por los estados del Plata de Hermann Burmeister : parte II : abordaje desde la historia

El presente artículo forma parte del proyecto interdisciplinario sobre iterología mendocina que tiene como principal objetivo analizar los relatos de viajeros extranjeros a Mendoza desde una perspectiva histórica, literaria y geográfica. Desde hace tiempo, estos relatos constituyen una fuente indispensable para el estudio de nuestro pasado y el texto de Hermann Burmeister reviste especial importancia para los historiadores debido a que el científico alemán permaneció en la provincia por algo más de un año. Por esta razón sus descripciones son detalladas y minuciosas; además, estuvo en Mendoza antes de que el terremoto de 1861 la destruyera, con lo cual, su relato ayuda a recrear aquella ciudad desaparecida, El objetivo de este trabajo es ejemplificar la metodología de trabajo utilizada por la Historia para analizar el texto de viaje. Para ello, se ha escogido el tema de la presencia de las mujeres en el relato del viajero alemán.

Destellos de un nuevo sujeto : Los conflictos obreros en los saladeros y el nacimiento de la clase obrera entrerriana (1854-1868)

El objetivo del trabajo es demostrar la existencia de conflictos obreros en Entre Ríos, a partir de las luchas salariales en los saladeros entre 1854 y 1868. Colateralmente, cuestionamos las fechas de génesis del movimiento obrero argentino. La reconstrucción de las luchas se realizó con una gran variedad de fuentes: crónicas de viajeros, documentación oficial y, principalmente, el análisis epistolar de los establecimientos saladeriles de Justo José de Urquiza. A partir de la evidencia empírica, que muestra los enfrentamientos entre los trabajadores y patrones, sostenemos la existencia de un proletariado en formación. Se analizarán las estrategias de luchas y los mecanismos patronales para superar las situaciones planteadas

Santa Cruz vista por exploradores y primeros habitantes

Durante la primera mitad del siglo XIX la Patagonia austral argentina permaneció aislada y despoblada; recién en la segunda mitad, autoridades, científicos y pioneros empezaron a ocuparse de ella. A través de este trabajo iremos viendo distintas visiones y experiencias de algunos exploradores y pioneros, tomando como hilo conductor la isla Pavón -negocio de Luis Piedra Buena- y la zona cercana del río Santa Cruz. Esta región era, en esos momentos, la única parte del territorio con algunos habitantes. La factoría de la isla Pavón adquiere no sólo importancia económica, sino particularmente política, frente al desarrollo que va cobrando Punta Arenas y a los deseos del expansionismo chileno. Por esta razón nos detendremos, en un primer momento, en el nacimiento y los años iniciales de este enclave chileno, para comprender la trascendencia que se le debe dar al establecimiento de Piedra Buena, punto hacia donde se dirigía todo explorador y barco argentino y única barrera que existió durante mucho tiempo para defensa de nuestra soberanía.