Vijay Aswani

Contribution of Polymorphisms in ankA, gltA, and groESL in Defining Genetic Variants of Anaplasma phagocytophilum

ABSTRACT Analysis of several nucleotide polymorphisms in polymorphic genes (ankA, gltA, and groESL) from 16S rRNA gene-based genetic variants of Anaplasma phagocytophilum from dogs in the western United States defined at least two sets of multigene polymorphisms to further characterize these variants. The multigene polymorphism approach holds promise for development of a genotyping scheme for this important pathogen.

Prevalence of Staphylococcus aureus and lack of its lytic bacteriophages in the anterior nares of patients and healthcare workers at a rural clinic.

Background: Nearly 30% of people in the United States are colonized with Staphylococcus aureus and 1% to 2% with methicillin-resistant Staphylococcus aureus (MRSA) in the anterior nares. However, it is not known if lytic bacteriophages against S. aureus are present in the anterior nares, and if they are, what the prevalence rate is, or if they interfere with S. aureus colonization. The aim of this study was to determine the prevalence of nasal carriage of S. aureus and MRSA and to screen for S. aureus lytic bacteriophages in healthcare environment workers and ambulatory patients. Methods: We enrolled 202 individuals into this study. The anterior nares were swabbed to isolate S. aureus, MRSA, and any lytic S. aureus bacteriophages that may be present. Putative S. aureus colonies on blood agar plates were identified using gram stain, catalase and coagulase tests, and confirmed by S. aureus-specific PCR. Presence of staphylococcal lytic bacteriophages were screened by a plaque assay technique using a methicillin-sensitive reference S. aureus strain ATCC 29213. Results: Of the 49 (24%) individuals who screened positive for S. aureus, two (1%) were positive for MRSA. None of the samples were positive for lytic bacteriophages against S. aureus. Subgroup analysis found no significant difference in the prevalence of S. aureus in the house staff compared to other healthcare environment workers or ambulatory patients of the clinic. Similarly, no significant difference in colonization was noted across the population with respect to age, sex, body mass index, or presence of diabetes mellitus. Conclusion: The prevalence of nasal carriage of S. aureus and MRSA in the studied population was 24% and 1%, respectively, similar to the rate of prevalence in the United States. The study also showed that the anterior nares do not seem to harbor lytic bacteriophages against S. aureus.

Staphylococcus epidermidis Bacteriophages from the Anterior Nares of Humans

ABSTRACT The role of virulent bacteriophages in staphylococcal colonization of the human anterior nares is not known. This report of lytic bacteriophages against Staphylococcus epidermidis in the anterior nares of 5.5% of human subjects (n = 202) suggests their potential role in modulating staphylococcal colonization in this ecological niche.

Complete Genome Sequence of Staphylococcus aureus MCRF184, a Necrotizing Fasciitis-Causing Methicillin-Sensitive Sequence Type 45 Staphylococcus Strain

ABSTRACT We report here the complete genome sequence of a highly virulent methicillin-sensitive Staphylococcus aureus strain, MCRF184, belonging to sequence type 45. This staphylococcal strain was isolated from a surgical biopsy specimen from a patient with necrotizing fasciitis.

Fifty-Three Years after a Pencil Puncture Wound.

A pencil core with an intact pencil tip was excised from the thigh of a 60-year-old male 53 years after a puncture wound. Histologic examination of the excised pencil core and the surrounding tissue revealed a foreign body reaction with abundant entrapped dark black pigment and chronic reparative changes, including dense sclerosis and focal granulation tissue formation.

Complete Genome Sequence of a Staphylococcus epidermidis Bacteriophage Isolated from the Anterior Nares of Humans

ABSTRACT We report here the complete genome sequence of a virulent Staphylococcus epidermidis siphophage, phage 6ec, isolated from the anterior nares of a human. This viral genome is 93,794 bp in length, with a 3′ overhang cos site of 10 nucleotides, and it codes for 142 putative open reading frames.

A Novel Case of Diabetic Muscle Necrosis in a Patient with Cystic Fibrosis-Related Diabetes

Cystic fibrosis is a recessive autosomal disease caused by mutations in the cystic fibrosis transmembrane conductance regulator gene. Cystic fibrosis-related diabetes (CFRD) is a common comorbidity of cystic fibrosis. Diabetic myonecrosis is a rare self-limited complication of poorly controlled diabetes mellitus that commonly presents with acute, intense pain and swelling of lower extremities and responds well to conservative management. We report the first case of diabetic myonecrosis in a patient with CFRD.

Phylogenetic distribution and expression of a penicillin-binding protein homologue, Ear and its significance in virulence of Staphylococcus aureus

PURPOSE Staphylococcus aureus is an opportunistic human pathogen that can cause serious infections in humans. A plethora of known and putative virulence factors are produced by staphylococci that collectively orchestrate pathogenesis. Ear protein (Escherichia coli ampicillin resistance) in S. aureus is an exoprotein in COL strain, predicted to be a superantigen, and speculated to play roles in antibiotic resistance and virulence. The goal of this study was to determine if expression of ear is modulated by single nucleotide polymorphisms in its promoter and coding sequences and whether this gene plays roles in antibiotic resistance and virulence. METHODOLOGY Promoter, coding sequences and expression of the ear gene in clinical and carriage S. aureus strains with distinct genetic backgrounds were analysed. The JE2 strain and its isogenic ear mutant were used in a systemic infection mouse model to determine the competiveness of the ear mutant.Results/Key findings. The ear gene showed a variable expression, with USA300FPR3757 showing a high-level expression compared to many of the other strains tested including some showing negligible expression. Higher expression was associated with agr type 1 but not correlated with phylogenetic relatedness of the ear gene based upon single nucleotide polymorphisms in the promoter or coding regions suggesting a complex regulation. An isogenic JE2 (USA300 background) ear mutant showed no significant difference in its growth, antibiotic susceptibility or virulence in a mouse model. CONCLUSION Our data suggests that despite being highly expressed in a USA300 genetic background, Ear is not a significant contributor to virulence in that strain.

A Case Study of Mental Illness and Psychiatric Services on the Caribbean Island of Nevis

Objective: This case study describes the burden of psychiatric disease and mental health services available on the Caribbean island of Nevis. Methods: Hospital and clinic records and government reports were retrospectively collated and analyzed. Previously unpublished information pertaining to psychiatric cases on the island from 2003 to 2005 was collated and analyzed. The personal experience of the authors as primary care providers participating in mental health care is integrated into the analysis. Results: Mental health services on the island of Nevis are provided free of cost as part of community health services. A psychiatrist visits the island twice a week from the adjoining island of Saint Kitts and is aided by two resident psychiatric nurses. Local primary care providers at the islands only hospital are providers of emergency, urgent, and hospital psychiatric care. The most common psychiatric diagnoses are depression, schizophrenia, and drug-induced psychosis. Conclusions: Psychiatric disease and provision of care on the island is compared with other Caribbean islands and isolated settings. The provision of psychiatric care by primary care physicians and nurses on the island highlights the importance of training primary care providers in basic psychiatric care.

Two Unusual Pediatric Cases of Fungal Infections in Farming Families

ABSTRACT It is not known whether farming families have more cases of uncommon fungal infections than the general population because of their interdependence on farming environments, including farm animals and other pets. The authors describe here two cases of fungal infections with interesting epidemiology that suggest associations that have been insufficiently described and explored in the literature. The first is a case of otomycosis in a 17-year-old female and is suspected to be linked to hay baling. The second is a case of tinea capitis in a 25-month-old female toddler living on a farm and illustrates that rural farming families with closer association with animals are infected with different species of fungi than are seen in urban areas.