scholarly journals Characterization ofClostridium difficileStrains in British Columbia, Canada: A Shift from NAP1 Majority (2008) to Novel Strain Types (2013) in One Region

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Agatha N. Jassem ◽  
Natalie Prystajecky ◽  
Fawziah Marra ◽  
Pamela Kibsey ◽  
Kennard Tan ◽  
...  
Keyword(s):  
British Columbia ◽  
Gel Electrophoresis ◽  
Older Patients ◽  
Pfge Pattern ◽  
Pulsed Field Gel Electrophoresis ◽  
Binary Toxin ◽  
Younger Patients ◽  
Pcr Ribotyping ◽  
Health Hospital

Background.Clostridium difficileis a major cause of gastrointestinal illness. Epidemic NAP1 strains contain toxins A and B, a deletion in repressortcdC, and a binary toxin.Objectives. To determine the molecular epidemiology ofC. difficilein British Columbia and compare between two time points in one region.Methods.C. difficileisolates from hospital and community laboratories (2008) and one Island Health hospital laboratory (2013) were characterized by pulsed-field gel electrophoresis, PCR-ribotyping, toxin possession,tcdCgenotype, and antimicrobial susceptibility.Results. In 2008, 42.7% of isolates had NAP1 designation. Hospital-collected isolates were associated with older patients and more NAP1 types. Unlike other isolates, most NAP1 isolates possessed binary toxin and a 19 bp loss intcdC. All isolates were susceptible to metronidazole and vancomycin. A 2013 follow-up revealed a 28.9% decrease in NAP1 isolates and 20.0% increase in isolates without NAP designation in one region. Then, community-associated cases were seen in younger patients, while NAP types were evenly distributed. Isolates without NAP designation did not cluster with a PFGE pattern or ribotype.Conclusions. Evaluation ofC. difficileinfections within British Columbia revealed demographic associations, epidemiological shifts, and characteristics of strain types. Continuous surveillance ofC. difficilewill enable detection of emerging strains.

scholarly journals Application of pulsed-field gel electrophoresis to the epidemiological characterization ofStaphylococcus intermediusimplicated in a food-related outbreak

1994 ◽  
Vol 113 (1) ◽  
pp. 75-81 ◽  
Author(s):  
F. M. Khambaty ◽  
R. W. Bennett ◽  
D. B. Shah
Keyword(s):  
Gel Electrophoresis ◽  
Pfge Pattern ◽  
Pulsed Field Gel Electrophoresis ◽  
Western United States ◽  
Single Strain ◽  
Pulsed Field ◽  
Definitive Evidence ◽  
Staphylococcus Intermedius ◽  
Epidemiological Characterization

SUMMARYAn outbreak of food intoxication involving over 265 cases in western United States occurred in October 1991.Staphylococcus intermediuswas implicated as the aetiologic agent. Representative outbreak isolates (five clinical and ten from foods) produced type A enterotoxin. DNA fragments generated by four restriction endonucleases and analysed by pulsed-field gel electrophoresis (PFGE) provided definitive evidence that all isolates from nine different counties in California and Nevada were derived from a single strain. The PFGE pattern of these outbreak isolates was distinct from those of a heterogeneous collection of sevenS. intermediusstrains of veterinary origin and five unrelatedS. aureuslaboratory strains. The data show a significant PFGE pattern heterogeneity not only among members of differentStaphylococcusspecies but also within members of the same species and even the same enterotoxin type. The results indicate that PFGE is a valuable strain-specific discriminator for the epidemiological characterization ofS. intermedius. To our knowledge, this represents the first documented foodborne outbreak caused byS. intermedius. These findings suggest that the presence ofS. intermediusand other species such asS. hyicusin food should be reason for concern.

scholarly journals Functional Capacity Past Age 40 in Patients With Congenital Ventricular Septal Defects

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Marie Maagaard ◽  
Filip Eckerström ◽  
Nicolai Boutrup ◽  
Vibeke E. Hjortdal
Keyword(s):  
Oxygen Uptake ◽  
Exercise Capacity ◽  
Functional Capacity ◽  
Older Patients ◽  
Ventricular Septal Defects ◽  
Younger Patients ◽  
Septal Defects ◽  
Lower Oxygen ◽  
And Control

Background Ventricular septal defects (VSD), when treated correctly in childhood, are considered to have great prognoses, and the majority of patients are discharged from follow‐up when entering their teens. Young adults were previously found to have poorer functional capacity than healthy peers, but the question remains whether functional capacity degenerates further with age. Methods and Results A group of 30 patients with surgically closed VSDs (51±8 years) with 30 matched, healthy control participants (52±9 years) and a group of 30 patients with small unrepaired VSDs (55±12 years) and 30 matched control participants (55±10 years) underwent cardiopulmonary exercise testing using an incremental workload protocol and noninvasive gas measurement. Peak oxygen uptake was lower in participants with closed VSDs than matched controls (24±7 versus 34±9 mL/min per kg, P <0.01) and with unrepaired VSDs than matched controls (26±5 versus 32±8 mL/min per kg, P <0.01). Patients demonstrated lower oxygen uptake from exercise levels at 20% of maximal workload compared with respective control groups ( P <0.01). Peak ventilation was lower in patients with surgically closed VSDs than control participants (1.0±0.3 versus 1.4±0.4 L/min per kg, P <0.01) but similar in patients with unrepaired VSDs and control participants ( P =0.14). Exercise capacity was 29% lower in older patients with surgically closed VSDs than healthy peers, whereas younger patients with surgically closed VSDs previously demonstrated 18% lower capacity compared with peers. Older patients with unrepaired VSDs reached 21% lower exercise capacity, whereas younger patients with unrepaired VSDs previously demonstrated 17% lower oxygen uptake than healthy peers. Conclusions Patients with VSDs demonstrate poorer exercise capacity than healthy peers. The difference between patients and control participants increased with advancing age—and increased most in patients with operated VSDs—compared with previous findings in younger patients. Results warrant continuous follow‐up for these simple defects.

Results after Laparoscopic Fundoplication: Does Age Matter?

2006 ◽  
Vol 72 (9) ◽  
pp. 778-784 ◽  
Author(s):  
Sarah M. Cowgill ◽  
Dean Arnaoutakis ◽  
Desiree Villadolid ◽  
Sam Al-Saadi ◽  
Demetri Arnaoutakis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Older Patients ◽  
Laparoscopic Fundoplication ◽  
Nissen Fundoplication ◽  
Younger Patients ◽  
Before And After ◽  
Laparoscopic Nissen ◽  
Age Range

Antireflux fundoplications are undertaken with hesitation in older patients because of presumed higher morbidity and poorer outcomes. This study was undertaken to determine if symptoms of gastroesophageal reflux disease (GERD) could be safely abrogated in a high-risk/reward population of older patients. One hundred eight patients more than 70 years of age (range, 70–90 years) underwent laparoscopic Nissen fundoplications undertaken between 1992 and 2005 and were compared with 108 concurrent patients less than 60 years of age (range, 18–59 years) to determine relative outcomes. Before and after fundoplication, patients scored the severity of reflux and dysphagia on a Likert Scale (0 = minor, 10 = severe). Before fundoplication, older patients had lower reflux scores ( P < 0.01), but not lower dysphagia scores or DeMeester scores. One patient (86 years old) died from myocardial infarction; otherwise, complications occurred infrequently, inconsequentially, and regardless of age. At similar durations of follow-up, reflux and dysphagia scores significantly improved ( P < 0.01) for older and younger patients. After fundoplication, older patients had lower dysphagia scores ( P < 0.01) and lower reflux scores ( P < 0.01). At the most recent follow-up, 82 per cent of older patients rated their relief of symptoms as good or excellent. Similarly, 81 per cent of the younger patients reported good or excellent results. Ninety-one per cent of patients 70 years of age or more versus 85 per cent of patients less than 60 years would undergo laparoscopic Nissen fundoplication again, if necessary. With fundoplication, symptoms of GERD improve for older and younger patients, with less symptomatic dysphagia and reflux in older patients after fundoplication. Laparoscopic fundoplication safely ameliorates symptoms of GERD in elderly patients with symptomatic outcomes superior to those seen in younger patients.

scholarly journals Phenotypic and Genotypic Characteristics and Epidemiological Significance of ctx+ Strains of Vibrio cholerae Isolated from Seafood in Malaysia

2004 ◽  
Vol 70 (4) ◽  
pp. 1964-1972 ◽  
Author(s):  
Chien-Hsien Chen ◽  
Toshio Shimada ◽  
Nasreldin Elhadi ◽  
Son Radu ◽  
Mitsuaki Nishibuchi
Keyword(s):  
Cholera Toxin ◽  
Vibrio Cholerae ◽  
Gel Electrophoresis ◽  
Pulsed Field Gel Electrophoresis ◽  
Pulsed Field ◽  
Pcr Ribotyping ◽  
Electrophoresis Method ◽  
Toxigenic Strains ◽  
Arbitrarily Primed Pcr ◽  
Genotypic Characteristics

ABSTRACT Of 97 strains of Vibrio cholerae isolated from various seafoods in Malaysia in 1998 and 1999, 20 strains carried the ctx gene and produced cholera toxin. Fourteen, one, and five of these toxigenic strains belonged to the O139, O1 Ogawa, and rough serotypes, respectively. The rough strains had the rfb gene of the O1 serotype. The toxigenic strains varied in their biochemical characteristics, the amount of cholera toxin produced, their antibiograms, and the presence or absence of the pTLC plasmid sequence. DNA fingerprinting analysis by arbitrarily primed PCR, ribotyping, and a pulsed-field gel electrophoresis method classified the toxigenic strains into 3, 7, and 10 types, respectively. The relatedness of these toxigenic strains to clinical strains isolated in other countries and from international travelers was examined by using a dendrogram constructed from the pulsed-field gel electrophoresis profiles. The results of the examination of the antibiogram and the possession of the toxin-linked cryptic plasmid were consistent with the dendrogram-based relatedness: the O139 strains isolated from Malaysian seafoods could be separated into two groups that appear to have been introduced from the Bengal area independently. The rough strains of Malaysian seafood origin formed one group and belonged to a cluster unique to the Thailand-Malaysia-Laos region, and this group may have persisted in this area for a long period. The single O1 Ogawa strain detected in Malaysian seafood appears to have an origin and route of introduction different from those of the O139 and the rough strains.

Acute Promyelocytic Leukemia In Canada: Poor Outcomes In Older Patients Remain

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1714-1714
Author(s):  
Matthew D. Seftel ◽  
Anna Serebrin ◽  
Pascal Lambert ◽  
Julie Bergeron ◽  
Janeve Everett ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Acute Promyelocytic Leukemia ◽  
Older Patients ◽  
Early Death ◽  
Promyelocytic Leukemia ◽  
Survival Outcomes ◽  
Younger Patients ◽  
One Year

Abstract Introduction Despite widespread use of all-trans retinoic acid (ATRA) in treatment of Acute Promyelocytic Leukemia (APL), recent studies in the US1 and Sweden2 have reported continuing high rates of early death. Patient age has appeared to be an important factor affecting outcomes. We studied the incidence and outcomes in the Canadian APL patients to determine which patients may be at higher risk, and to analyze the success of current management. Methods We used data from the Canadian Cancer Registry, which included all patients diagnosed between 1993-2007. We obtained incidence, Early Death (ED) (death within 30 days of diagnosis), and 1 and 5-year overall survival (OS). This was stratified by age, sex, and time period of diagnosis. Detailed information was obtained on a subset of patients managed at five Canadian leukemia referral centres from 1999 to 2010. Results There were 399 cases of APL diagnosed in Canada between 1993-2007.This accounted for 3.01% of Acute Myeloid Leukemia cases. Incidence (age-standardized to the 1991 Canadian census population) was 0.083/100000. The incidence was greater in the population aged 50 and over, with an incidence rate ratio (IRR) of 2.192 (95% C.I.1.80 - 2.67, p<0.001). ED was 21.8% overall, with a rate over three times higher in older patients as compared to younger patients. The ED rate was 10.6% in younger (<50 years) patients and 35.5% in older (≥50 years) patients. One-year overall survival was 84.1% in younger patients as compared to 52.3% in older adults. The rate of death at one year is nearly three times higher in the older patients. Five-year survival was 54.6%; this was 73.3% in the younger patients (<50), and 29.1% in the older group (≥50 years). There were 131 patients in the leukemia referral centre cohort, who predominantly received tretinoin (ATRA) based therapy. In this population, ED was 14.6%. Two-year OS was 76.5% (95% C.I. 68%-83%). Age over 60 predicted an inferior outcome at 2-years with a hazard ratio of 4.051 (95% CI 1.17-7.57). Conclusions To our knowledge, this is the largest nationwide epidemiologic study of APL. Despite widespread use of ATRA in Canada and low rates of ED reported in clinical trials (often 3-8%), we found that the real survival outcomes of APL were worse than anticipated. However they were similar to those reported recently from other developed counties1,2. The outcomes were much poorer for the older patients with APL. This included a higher rate of early death as well as poorer rates of survival at one, two and five year follow-up times. The ED rates of patients <50 more closely matched rates reported in clinical trials. We compared the survival outcomes of the entire population with APL to a sample of only patients treated at specialized referral centres. Despite receiving care in a specialized tertiary centre, the survival of older patients remained significantly poorer than the younger patients. The incidence of APL was also double in the older population as compared to the younger population. Overall the age-standardized incidence was lower in Canada than has been reported in other countries1,2. This emphasizes that, although APL is a type of AML that does affect younger patients, there is a large and important impact of this disease on older patients. Recent studies in the US and Sweden have also reported higher rates of APL in older populations and poorer rates of survival at various follow up times. Overall the patients with high-risk Sanz scores had the worst survival outcomes. The survival at most time points was slightly higher for patients scored as intermediate-risk compared to those who were in the low-risk category. When arsenic becomes widely available as a first line therapy it will be important to continue population-based analysis to see how this affects outcomes and whether the outcomes are difference in difference age groups or populations. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Usefulness of Pulsed-Field Gel Electrophoresis in Tracking Two Outbreaks of Invasive Meningococcal Disease Serogroup C in British Columbia

2007 ◽  
Vol 18 (6) ◽  
pp. 363-367 ◽  
Author(s):  
Grahame Quan ◽  
Mark Gilbert ◽  
Samara T David ◽  
Tazim Rahim ◽  
Kathy Adie ◽  
...  
Keyword(s):  
British Columbia ◽  
Meningococcal Disease ◽  
Gel Electrophoresis ◽  
Outer Membrane Proteins ◽  
Case Fatality ◽  
Pulsed Field Gel Electrophoresis ◽  
Invasive Meningococcal Disease ◽  
Sequencing Data ◽  
Outbreak Strain ◽  
Pulsed Field

Two major outbreaks of invasive meningococcal disease serogroup C (IMD-C) were identified in British Columbia between 2000 and 2004. Pulsed-field gel electrophoresis (PFGE) andporAgene sequencing of all retained IMD-C isolates were used to assess correlations between genotypes and epidemiological patterns. PFGE patterns of IMD-C genotypes correlated with epidemiological patterns between 2000 and 2004 in British Columbia, and demonstrated that PFGE can identify outbreak-related cases. Both IMD-C outbreaks correlated with a respective PFGE pattern. PFGE analysis demonstrated that the 2004 British Columbia outbreak strain in men who have sex with men was closely related to the 2001 Abbotsford outbreak strain.PorAsequencing data indicated low diversity of class 1 outer membrane proteins in British Columbia, and did not correlate with epidemiological trends. There was a trend for outbreak-associated PFGE types to demonstrate higher case fatality rates.

scholarly journals Molecular Epidemiology of Penicillin-ResistantStreptococcus pneumoniae Isolates Recovered in Italy from 1993 to 1996

1998 ◽  
Vol 36 (10) ◽  
pp. 2944-2949 ◽  
Author(s):  
Anna Marchese ◽  
Mario Ramirez ◽  
Gian Carlo Schito ◽  
Alexander Tomasz
Keyword(s):  
Gel Electrophoresis ◽  
Fragment Length Polymorphism ◽  
Antibiotic Resistance Genes ◽  
Northern Italy ◽  
Pfge Pattern ◽  
Pulsed Field Gel Electrophoresis ◽  
Pfge Type ◽  
Penicillin Binding Protein ◽  
Additional Resistance ◽  
Restriction Fragment Length

Thirty-nine penicillin-resistant Streptococcus pneumoniae isolates recovered among the approximately 700 pneumococcal strains collected from 1993 to 1996 in central and northern Italy were analyzed for several characteristics, including serotype, antibiotic susceptibility profile, chromosomal relatedness (by using pulsed-field gel electrophoresis [PFGE]), restriction fragment length polymorphism (RFLP) of the penicillin-binding protein (PBP) genes 1A, 2X, and 2B, and the presence of a variety of antibiotic resistance genes (determined by hybridization with appropriate DNA probes). The MICs of penicillin for most of the isolates (30 of 39) were high, in the range of 1 μg/ml or higher, and these 30 isolates carried additional resistance traits to two or more drugs (erythromycin, chloramphenicol, co-trimoxazole, and tetracycline) and expressed serotypes 9, 19, and 23 and three distinct PFGE patterns. More than half (22 of 30) of the isolates for which MICs were high were identified as representatives of two widespread international epidemic clones of S. pneumoniae. The first one of these clones (seven isolates) expressed serotype 23F and possessed all properties characteristic of the widespread Spanish/USA international clone. Seven additional strains with serotype 19 also had the same PFGE pattern, PBP gene, and RFLP polymorphisms, and other properties typical of the serotype 23 Spanish/USA clone, suggesting that these strains were the products of a capsular transformation event (from serotype 23F to serotype 19) in which the Spanish/USA clone was the recipient. The second international clone was represented by eight serotype 9 isolates which were resistant to penicillin and trimethoprim-sulfamethoxazole and had the molecular properties of the French/Spanish epidemic clone. The remaining eight isolates for which penicillin MICs were high appeared to represent a hitherto-undescribed “Italian” clone; they had a novel PFGE type, unique RFLPs for the PBP genes, and resistance to tetracycline, trimethoprim-sulfamethoxazole, and erythromycin, and the penicillin MICs for these isolates were 2 to 4 μg/ml.

Monitoring of Chicken Houses and an Attached Egg-Processing Facility in a Laying Farm for Salmonella Contamination between 1994 and 1998

2001 ◽  
Vol 64 (12) ◽  
pp. 1912-1916 ◽  
Author(s):  
TOSHIYUKI MURASE ◽  
KAZUKO SENJYU ◽  
TAKESHI MAEDA ◽  
MASAYUKI TANAKA ◽  
HIROSHI SAKAE ◽  
...  
Keyword(s):  
Gel Electrophoresis ◽  
Salmonella Enterica ◽  
Environmental Samples ◽  
Pfge Pattern ◽  
Pulsed Field Gel Electrophoresis ◽  
Drain Water ◽  
Pulsed Field ◽  
Processing Facility ◽  
Single Clone

Two chicken houses and an attached egg-processing facility in a laying farm were sampled between 1994 and 1998 to investigate Salmonella contamination. Each of the houses was environmentally controlled and fitted with egg belts that transported eggs from the houses to the egg-processing facility. Four hundred twenty-eight Salmonella isolates were obtained from 904 environmental samples collected from the houses. Two hundred fifty-two of the 428 (58.9%) isolates yielded five serotypes as follows: Salmonella enterica subsp. enterica serovar Livingstone, Salmonella serovar Cerro, Salmonella serovar Montevideo, Salmonella serovar Mbandaka, and Salmonella serovar Corvallis. The remaining (41.1%, 176 of 428) isolates included four other serotypes and isolates that were untypeable. Salmonella isolates obtained from the drain water collected after the washing of the eggs in the egg-processing facility yielded the same serotypes as those found in the chicken houses. Strains having an identical pulsed-field gel electrophoresis (PFGE) pattern were continually recovered from a house for more than 1 year. Several strains of Salmonella Cerro, Salmonella Mbandaka, and Salmonella Montevideo obtained from both the houses and from the egg-processing facility were indistinguishable by PFGE, respectively. These results suggest that Salmonella organisms originating from a single clone colonized the chicken houses and that the egg belts are likely to be one of the means by which Salmonella organisms are spread from one house to the others.

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