Attaching and effacing (A/E) rabbit enteropathogenic Escherichia coli (REPEC) strains belonging to serogroup O103 are an important cause of diarrhea in weaned rabbits. Like human EPEC strains, they possess the locus of enterocyte effacement clustering the genes involved in the formation of the A/E lesions. In addition, pathogenic REPEC O103 strains produce an Esp-dependent but Eae (intimin)-independent alteration of the host cell cytoskeleton characterized by the formation of focal adhesion complexes and the reorganization of the actin cytoskeleton into bundles of stress fibers. To investigate the role of intimin and its translocated coreceptor (Tir) in the pathogenicity of REPEC, we have used a newly constructed isogenic tir null mutant together with a previously described eae null mutant. When human HeLa epithelial cells were infected, the tir mutant was still able to induce the formation of stress fibers as previously reported for the eae null mutant. When the rabbit epithelial cell line RK13 was used, REPEC O103 produced a classical fluorescent actin staining (FAS) effect, whereas both the eae and tir mutants were FAS negative. In a rabbit ligated ileal loop model, neither mutant was able to induce A/E lesions. In contrast to the parental strain, which intimately adhered to the enterocytes and destroyed the brush border microvilli, bacteria of both mutants were clustered in the mucus without reaching and damaging the microvilli. The role of intimin and Tir was then analyzed in vivo by oral inoculation of weaned rabbits. Although both mutants were still present in the intestinal flora of the rabbits 3 weeks after oral inoculation, neither mutant strain induced any clinical signs or significant weight loss in the inoculated rabbits whereas the parental strain caused the death of 90% of the inoculated rabbits. Nevertheless, an inflammatory infiltrate was present in the lamina propria of the rabbits infected with both mutants, with an inflammatory response greater for the eae null mutant. In conclusion, we have confirmed the role of intimin in virulence, and we have shown, for the first time, that Tir is also a key factor in vivo for pathogenicity.Although Escherichia coli belongs to the normal microflora present in the gastrointestinal tracts of most mammals and birds, certain E. coli strains have been associated with intestinal or extraintestinal infections. Among these pathogenic E. coli strains, enteropathogenic E. coli (EPEC) is a major cause of infant diarrhea in developing countries (for a recent review, see reference 51) and is a significant category of diarrheagenic E. coli in different animal species. In addition, EPEC is an important cause of morbidity and mortality in weaned rabbits (5,54,56). EPEC is also pathogenic in neonatal calves (20,53) and seems to be isolated more frequently in farms with recurrent diarrhea (7). In swine, EPEC is involved in cases of postweaning diarrhea (67). There is also increasing evidence for a diarrheagenic role of EPEC in dogs (16,64). Finally, EPEC has been isolated ...

Sleep disturbances are frequently reported in victims following burn injuries. This prospective study was designed to assess sleep quality and to examine its daily relationship to pain intensity within the first week of hospitalization. Twenty-eight non-ventilated patients were interviewed during 5 consecutive mornings (number of observations=140) to collect information about perceived quality of sleep (visual analogue scale, number of hours, number of awakenings, presence of nightmares). Pain intensity was assessed at rest (nighttime, morning, during the day) and following therapeutic procedures using a 0-10 numeric scale. Seventy-five percent of patients reported sleep disturbances at some point during the study although, in most patients, sleep quality was not consistently poor. Pooled cross-section regression analyses showed significant temporal relationships between quality of sleep and pain intensity such that a night of poor sleep was followed by a significantly more painful day. Pain during the day was not found to be a significant predictor of poor sleep on the following night. These results support previous findings that perceived quality of sleep following burn injury is poor. Moreover, they show a daily relationship between quality of sleep and acute burn pain in which poor sleep is linked to higher pain intensity during the day.

These results obtained with objective measures support previous findings that subjective sleep quality following burn injuries is poor, and strengthen the evidence of a relationship between sleep and sensitivity to pain. Nonetheless, further analyses are necessary to determine and dissociate the effects of pain intensity and analgesic medication on sleep.