Jorge Olarte

Salmonella typhi resistant to Chloramphenicol, Ampicillin, and Other Antimicrobial Agents: Strains Isolated During an Extensive Typhoid Fever Epidemic in Mexico

During 1972 a large epidemic, in excess of 10,000 cases, of typhoid fever occurred in Mexico City, Pachuca, and other communities of Mexico. The main characteristic of the epidemic, in addition to the large number of persons affected, was the prevalence of a strain of Salmonella typhi which was highly resistant to chloramphenicol both in vivo and in vitro, and which belonged to a single phage type, Vi degraded approaching type A. Of 493 strains of S. typhi studied during the outbreak, 452 (91.7%) were resistant to chloramphenicol (CM), tetracycline (TC), streptomycin (SM), and sulfonamides (SU). The epidemic strain owes its resistance to an R factor which is easily transferable to Escherichia coli K-12 and which appears to be stable. In the third month of the outbreak, a strain of S. typhi resistant to CM, TC, SM, SU, ampicillin (AM), and kanamycin (KM) was isolated from a patient with severe typhoid fever. During the following 9 months, six additional strains of S. typhi resistant to AM, CM, TC, SM, and SU were also isolated. Transfer experiments to E. coli K-12 indicate that these strains are infected with two different R factors, one causing CM, TC, SM, and SU resistance and the other causing AM or AM and KM resistance. The frequency of transfer of the resistance in overnight crosses was in the order of 10−4 for CM, TC, SM, and SU and 10−6 for AM or AM, and KM. The appearance of these strains resistant both to chloramphenicol and ampicillin was a cause for concern for the clinicians; fortunately, they have remained an infrequent cause of disease.

Prospective study of enteropathogens in children with diarrhea in Houston and Mexico

During a 22-month period, 595 children with diarrhea and 210 age-matched controls attending clinics in Houston (367 children) and Mexico (438) were prospectively evaluated for enteric pathogens. Enteropathogens associated with disease were Shigella (18%), rotavirus (14%), Salmonella (9%), toxigenic Escherichia coli (6%), and others (12%), including 14 Proteus isolates that caused rounding of adrenal cells. Enteropathogens were isolated from a greater (P less than 0.001) number of children with diarrhea (59%) than from asymptomatic controls (6%). Paired sera tested for antibody to heat-labile toxin of E. coli rarely demonstrated a fourfold rise during episodes of diarrhea. This study demonstrates: (1) more striking illness in children from Mexico; (2) more common occurrence of Shigella in Houston, and of rotavirus and Salmonella in Mexico; (3) lack of seasonal occurrence of rotavirus isolation in either population and a summertime occurrence of Shigella in Houston; (4) lack of toxigenic E. coli isolation in endemic diarrhea of either population; and (5) a significant (P less than 0.001) age-related acquisition of E. coli LT antibodies.

Enteropathogens associated with pediatric diarrhea in Mexico City

Enteropathogens were investigated as possible agents in pediatric diarrhea occurring in Mexico City during the summer of 1975. Pathogens were identified in 47 (76%) of 62 cases. Rotavirus particles were detected in 16 cases. Enterotoxigenic Escherichia coli was detected in 29 cases; 11 were positive for heat-labile enterotoxin and 18 were positive for only the heat-stable form of enterotoxin. Multiple pathogens were found simultaneously in 15 (24%) of the study population. This study indicates that the etiology of pediatric summertime diarrhea in Mexico City is diverse. ETEC and RV were the most frequently encountered pathogens, yet they frequently occurred together and with other pathogens. ST-only strains of toxigenic E. coli were as frequently recovered as LT-E. coli suggesting that both forms of ETEC must be sought in future field studies.

Characterization of an R-Plasmid Associated with Ampicillin Resistance in Shigella dysenteriae Type 1 Isolated from Epidemics

Ampicillin-resistant strains of Shigella dysenteriae type 1 isolated in epidemics in Mexico, Central America, and Bangla Desh were examined for the presence of plasmid deoxyribonucleic acid (DNA) by gel electrophoresis. All strains contained a heterogeneous population of plasmids. Transfer experiments to Escherichia coli K-12 indicated that the ampicillin resistance determinant (Apr) was located on a 5.5-megadalton (Mdal) plasmid identical in all Shiga strains examined, as judged by DNA hybridization and by its molecular properties. This 5.5-Mdal plasmid contained the ampicillin transposon (TnA) sequences. There was not a high degree of homology between the Shiga Apr plasmid DNA and DNA obtained from AprSalmonella typhi strains isolated from typhoid epidemics in Mexico, previous to the dysentery outbreaks. Although low, the degree of reassociation observed indicated that probably part of the TnA sequence was present in S. typhi DNA. The DNA hybridization experiments showed, in addition, that there was a high degree of homology among Apr plasmids isolated from different enterobacteria, and this identity was confirmed by restriction endonuclease activity. These results together with their similarities in molecular and replicative properties indicate that the Apr plasmids, as was suggested for the Smr Sur plasmids, possibly evolved once and then epidemiologically spread in the Enterobacteriaceae. Images

Efficacy of Bicozamycin in Treatment of Acute Diarrhea Caused by Enterotoxigenic Escherichia Coli

Bicozamycin is a new antibiotic first reported by Miyoshi, et al., in 1972.(1) Bicozamycin is poorly absorbed from the gastrointestinal tract. Its spectrum of activity includes many enteropathogens including Escherichia coli in which bicozamycin appears to interfer with biosynthesis of lipoprotein and its incorporation into peptidoglycan in the cell wall.(2) Bicozamycin has no apparent activity against gram-positive, anaerobic organisms, Proteus or Pseudomonas. Finally, plasmid-mediated resistance has been looked for, but only chromosomal resistance to bicozamycin has so far been demonstrated. In view of these features of bicozamycin, a prospective, randomized, double-blind, placebo controlled study of bicozamycin in the empiric treatment of acute diarrhea in a population of U.S. adults newly arrived in Guadalajara, Mexico, was conducted.