Paul D. Brown

Evaluation of the polymerase chain reaction for early diagnosis of leptospirosis

Early diagnosis of leptospirosis is important because severe leptospiral infection can run a fulminant course. The polymerase chain reaction (PCR) was evaluated for the detection of leptospires in clinical samples from patients with acute leptospiral infection. Blood and urine samples from 71 patients with leptospirosis were examined by PCR, culture or serology. Samples from 44 (62%) patients with the diagnosis of leptospirosis were positive by PCR as compared to 34 (48%) by culture. The presence of leptospires was demonstrated by PCR in 13 patients before the development of antibodies, as well as in two patients who were seronegative during their illness and at autopsy. Samples from 16 patients without leptospirosis were seronegative and culture negative, and also negative by PCR. We conclude that PCR is a rapid, sensitive and specific means of diagnosing leptospiral infection, especially during the first few days of the disease.

Antimicrobial resistance of Escherichia coli isolates from broiler chickens and humans

BackgroundAntimicrobial usage is considered the most important factor promoting the emergence, selection and dissemination of antimicrobial-resistant microorganisms in both veterinary and human medicine. The aim of this study was to investigate the prevalence and genetic basis of tetracycline resistance in faecal Escherichia coli isolates from healthy broiler chickens and compare these data with isolates obtained from hospitalized patients in Jamaica.ResultsEighty-two E. coli strains isolated from faecal samples of broiler chickens and urine and wound specimens of hospitalized patients were analyzed by agar disc diffusion to determine their susceptibility patterns to 11 antimicrobial agents. Tetracycline resistance determinants were investigated by plasmid profiling, transformations, and amplification of plasmid-borne resistance genes. Tetracycline resistance occurred at a frequency of 82.4% in avian isolates compared to 43.8% in human isolates. In addition, among avian isolates there was a trend towards higher resistance frequencies to kanamycin and nalidixic acid (p < 0.05), while a greater percentage of human isolates were resistant to chloramphenicol and gentamicin (p < 0.05). Multiple drug resistance was found in isolates from both sources and was usually associated with tetracycline resistance. Tetracycline-resistant isolates from both avian and human sources contained one or several plasmids, which were transmissible by transformation of chemically-competent E. coli. Tetracycline resistance was mediated by efflux genes tetB and/or tetD.ConclusionThe present study highlights the prevalence of multiple drug resistant E. coli among healthy broiler chickens in Jamaica, possibly associated with expression of tetracycline resistance. While there did not appear to be a common source for multiple drug resistance in the strains from avian or human origin, the genes encoding resistance are similar. These results suggest that genes are disseminated in the environment and warrant further investigation of the possibility for avian sources acting as reservoirs for tetracycline resistance.

Differentiation of Leptospira species and serovars by PCR-restriction endonuclease analysis, arbitrarily primed PCR and low-stringency PCR

Reference strains from 30 serovars representing seven species of Leptospira and 48 recent isolates from human patients, dogs and rats, were characterised by polymerase chain reaction-restriction endonuclease analysis (PCR-REA), arbitrarily primed PCR (AP-PCR) and low stringency PCR (LS-PCR). PCR-REA analysis yielded seven groups among 29 serovars of pathogenic Leptospira; the non-pathogenic L. biflexa serovar patoc was not amplified with the primer pairs studied. AP-PCR and LS-PCR fingerprinting resulted in 25 and 21 distinct profiles, respectively, among the 30 reference strains. The results of the three PCR-based techniques were highly concordant and were in general agreement with those from previous DNA studies, confirming the high level of polymorphism among Leptospira species and serovars, and supported the concept of the serovar as the basic taxonomic unit of leptospiral classification. Results of the PCR-based typing methods for 11 randomised leptospiral strains, 36 clinical isolates from human patients and dogs and 12 survey isolates from trapped rats agreed with those from serological identification. With one exception, isolates of the same serovar gave identical profiles irrespective of the source. AP-PCR and LS-PCR are simple to perform and interpret, and appear to be useful for characterising isolates of Leptospira spp. for diagnostic and epidemiological purposes.

Antibiotic resistance in clinical isolates of Pseudomonas aeruginosa in Jamaica

OBJECTIVEnTo assess antibiotic resistance in clinical isolates of Pseudomonas aeruginosa in Jamaica, and to obtain baseline information on the presence of this important pathogen.nnnMETHODSnA total of 51 isolates of Pseudomonas aeruginosa, obtained from 162 clinical specimens from major hospitals and laboratories in seven parishes in Jamaica, were analyzed between May and August 2002. Isolates were tested against 18 different antibiotics by a disk diffusion method.nnnRESULTSnOrganisms were cultured from wound swabs (56%), high vaginal swabs (10.5%) and ear swabs (42.5%). Overall, the highest percentage rates of resistance were found for cefaclor (100% of all isolates), nalidixic acid (82.4%), kanamycin (76.5%), and trimethoprim/sulfamethoxazole (56.9%). Resistance rates were 25.5% or lower for tobramycin, gentamicin and polymyxin B, cefotaxime, ciprofloxacin and norfloxacin, piperacillin, carbapenems and amikacin. Forty-one isolates showed intermediate sensitivity to most of the antipseudomonal antibiotics, and the remaining 10 isolates were resistant to eight or more antibiotics. The multiresistant isolates, most of which were hospital isolates, were all resistant to tetracycline, nalidixic acid and trimethoprim/sulfamethoxazole, and highly (80%-90%) resistant to kanamycin, ciprofloxacin and norfloxacin.nnnCONCLUSIONSnThis study confirms that antibiotic resistance in this clinical pathogen is emerging in Jamaica, and suggests that due care must be taken in hospital settings to adequately diagnose pseudomonal infections and prescribe the antibiotic treatment most effective in preventing the increase in multidrug resistant organisms.

Direct detection of leptospiral material in human postmortem samples

Leptospiral culture, direct immunofluorescence, and the polymerase chain reaction (PCR) were used to detect leptospiral material in postmortem specimens collected from eight patients who died of leptospirosis. Diagnosis of leptospiral infection was based on clinical summary (premortem) and confirmed by serological analysis and/or culture of leptospires. Leptospiral culture was the least sensitive technique, yielding two isolates (3%) from 65 samples. Both isolates were from the aqueous humour and cerebrospinal fluid of the same patient. Direct immunofluorescence was of intermediate sensitivity for detection of leptospires, confirming the presence of leptospires in 11% (2 of 18) of tissue samples from three patients. PCR analysis was the most sensitive technique for detection of leptospiral material in tissue samples, being positive in 20% (11 of 56) of samples from eight patients. Both samples (cerebellum and liver) positive by immunofluorescence were also positive by PCR. The sensitivity of the PCR assay was 1-10 leptospires ml(-1) sample, and the assay was specific for Leptospira pathogenic species. Multi-system involvement was indicated based on successful amplification of leptospiral DNA from more than one tissue sample, which corroborated with the clinical and pathologic findings. The results suggest that in acute and/or fatal leptospirosis, the pathogenesis of the pathologic features are related to the presence of the organisms in the tissues. In conclusion, PCR combined with serology appears to be a useful tool for diagnosis of leptospirosis and may be invaluable in epidemiological studies.

Modulation of glucose uptake in adipose tissue by nitric oxide-generating compounds.

There is increasing evidence that endogenous nitric oxide (NO) influences adipogenesis, lipolysis and insulin-stimulated glucose uptake. We investigated the effect of NO released from S-nitrosoglutathione (GSNO) and S-nitroso N-acetylpenicillamine (SNAP) on basal and insulin-stimulated glucose uptake in adipocytes of normoglycaemic and streptozotocin (STZ)-induced diabetic rats. GSNO and SNAP at 0.2, 0.5, and 1 mM brought about a concentration-dependent increase in basal and insulin-stimulated 2-deoxyglucose uptake in adipocytes of normoglycaemic and STZ-induced diabetic rats. SNAP at 1.0 mM significantly elevated basal 2-deoxyglucose uptake (115.8 ± 10.4%) compared with GSNO at the same concentration (116.1 ± 9.4%;P 0.05) in STZ-induced diabetic rats. Conversely, SNAP at concentrations of 10 mM and 20 mM significantly decreased basal 2-deoxyglucose uptake by 50.0 ± 4.5% and 61.5 ± 7.2% respectively in adipocytes of STZ-induced diabetic rats (P 0.05). GSNO at concentrations of 10 mM and 20 mM also significantly decreased basal 2-deoxyglucose uptake by 50.8 ± 6.4% and 55.2 ± 7.8% respectively in adipocytes of STZ-induced diabetic rats (P 0.05). These observations indicate that NO released from GSNO and SNAP at 1 mM or less stimulates basal and insulin-stimulated glucose uptake, and at concentrations of 10 mM and 20 mM inhibits basal glucose uptake. The additive effect of GSNO or SNAP, and insulin observed in this study could be due to different mechanisms and warrants further investigation.

Apocynin Ameliorates Cadmium-Induced Hypertension Through Elevation of Endothelium Nitric Oxide Synthase

Apocynin is reported to have antioxidant and NADPH oxidase inhibitor activities. Cadmium toxicity is reported to causes oxidative damage, resulting in vascular dysfunction, reduced bioavailability of nitric oxide (NO) and hypertension. The study aimed to investigate the protective effects of apocynin in cadmium-induced hypertension. Thirty-six (36) adult male Sprague–Dawley rats were randomly divided into 6 groups. Group 1 served as control, Groups 2 and 3 received 50 and 100xa0mg/Kg (b.w) apocynin, respectively, Group 4 received 100xa0ppm CdCl2 in their drinking water, while Group 5 and 6 received 100xa0ppm CdCl2 in their drinking and 50 and 100xa0mg/Kg (b.w) apocynin, respectively, for 8xa0weeks. Blood pressure readings were taken weekly using the tail-cuff method. cGMP, endothelial nitric oxide synthase (eNOS), NO and hematological parameters were analyzed at the end of 8xa0weeks. Apocynin, although a poor antioxidant, caused a significant reduction (pxa0<xa00.05) in systolic and mean arterial pressures in the cadmium-induced elevations in blood pressure and amelioration of altered hematological parameters. However, while cadmium exposures did not alter the cGMP, eNOS and nitrate concentrations in serum, apocynin reduced the cGMP and nitrite values while significantly elevating (pxa0<xa00.05) the eNOS concentrations and also improved the cadmium-induced anemia. Apocynin was effective in reducing cadmium-induced elevated blood pressures through elevation of eNOS. Inhibition of NADPH oxidase activity may be a useful strategy for prevention and treatment of cadmium-induced hypertension.

Acute impairment of insulin signalling by dexamethasone in primary cultured rat skeletal myocytes

In this study, we examined the cellular content of the insulin receptor substrate (IRS)-1, the levels of phosphorylated tyrosine (pY) and serine (pS) residues in IRS-1, and the glucose transporters GLUT-1 and GLUT-4 in primary cultured rat skeletal myocytes treated with the glucocorticoid, dexamethasone. Dexamethasone markedly increased basal and insulin-stimulated IRS-1 content 4 to 5-fold (pu200a<u200a0.01). A similar level of increase was observed for IRS-1 pY content. However, dexamethasone treatment had no effect on IRS-1 pS content. Further, dexamethasone reduced the cellular content of GLUT-1 when insulin and glucose were absent (p < 0.05), but did not significantly affect the expression of GLUT-4 in the presence of insulin (p > 0.05). We conclude that dexamethasone treatment impairs insulin signalling by a mechanism independent of serine-phosphorylation-mediated IRS-1 depletion, or of impairment of GLUT-1 expression. Instead, dexamethasone-induced insulin resistance may be mediated via reduced cellular content of IRS-1 accompanied by parallel reduction in tyrosine phosphorylation in IRS-1.

Nitric oxide agents impair insulin-mediated signal transduction in rat skeletal muscle

BackgroundEvidence demonstrates that exogenously administered nitric oxide (NO) can induce insulin resistance in skeletal muscle. We have investigated the modulatory effects of two NO donors, S-nitroso-N-acetyl-D, L-penicillamine (SNAP) and S-nitrosoglutathione (GSNO) on the early events in insulin signaling in rat skeletal myocytes.ResultsSkeletal muscle cells from 6–8 week old Sprague-Dawley rats were treated with SNAP or GSNO (25 ng/ml) in the presence or absence of glucose (25 mM) and insulin (100 nM). Cellular insulin receptor-β levels and tyrosine phosphorylation in IRS-1 were significantly reduced, while serine phosphorylation in IRS-1 was significantly increased in these cells, when compared to the insulin-stimulated control. Reversal to near normal levels was achieved using the NO scavenger, 2-(4-carboxyphenyl)-4, 4, 5, 5-tetramethylimidazoline-1-oxyl 3-oxide (carboxy-PTIO).ConclusionThese data suggest that NO is a potent modulator of insulin-mediated signal transduction and may play a significant role in the pathogenesis of type 2 diabetes mellitus.

Multiple antibiotic resistance index, fitness and virulence potential in respiratory Pseudomonas aeruginosa from Jamaica

Respiratory infections are common causes of morbidity and mortality worldwide. We sought to assess the multiple antibiotic resistance (MAR) index, fitness and virulence potential in Pseudomonas aeruginosa from patients with lower respiratory tract infections. Isolates were assessed for antimicrobial susceptibility, in vitro competitive fitness, and pigment, elastase and rhamnolipid production. Oxidative stress tolerance was determined on both planktonic and biofilm cells, and virulence potential was tested in a plant model. Mean MAR index for isolates was 0.34 (range 0.17-0.50). Whilst isolates exhibited good biofilm formation in the presence of ciprofloxacin, there was no significant difference in biofilm production over the concentration range assessed. Several drug-resistant strains were out-competed by a susceptible strain even in the presence of antibiotic. H2O2 exerted a greater oxidative stress than tert-butyl-hydroperoxide and, as expected, biofilms were more resistant than planktonic cells. Whilst most (81u2009%) isolates were pigmented there was no significant difference between pigmented and non-pigmented isolates when elastolytic activity was compared (P>0.05). More than half of the isolates produced the quorum sensing mediator rhamnolipid and infection of the plant model by bacteria occurred whether elastase or rhamnolipid was present or absent. These data suggest that non-pigmented strains of P. aeruginosa might pose an equally significant microbiological threat as pigmented strains even though pigment production appeared to be strongly associated with elastase expression. Whilst dual expression of elastase and rhamnolipid by these bacteria would cause severe tissue damage (as seen in the plant model), non-production of either does not prevent bacteria from causing serious infection.