Rhodococcus equi is a facultative pathogen of foals. Infection causes an often fatal pulmonary pneumonia. The organism has also been isolated from pigs, cattle, humans and the environment. Equine virulence has a high positive correlation with the expression of a 17.4 kD polypeptide of unknown function, VapA, the product of the plasmid-encoded vapA gene. More recently an isogene of vapA, referred to as vapB and encoding an 18.2 kDa polypeptide, has been identified among pig and human isolates. The two genes share > 80% sequence identity, yet their host strains apparently exhibit different pathogenicity profiles (for example by reference to virulence in mouse model system and host specificity). In this study, a polymerase chain reaction (PCR) technique was developed that permits the selective amplification of vapA and vapB. Using this technique the distribution of the two genes among 35 randomly selected isolates of Rhodococcus equi from various animal and environmental sources was determined. Using this technique the genotype of each isolate could be unambiguously assigned as vapA+, vapB+ or vap- (i.e., scoring negative for both vapA and vapB). No isolate scored positive for both vapA and vapB. 100% of equine isolates scored vapA+, confirming the status of vapA as a reliable marker of equine virulence. All three genotypes were found among human isolates; porcine isolates scored either vapB+ or vap- and no vapA+ isolates were present in this sample. Rigorous statistical analysis using the Fisher Exact test confirmed that the high frequency of vapA+ among equine isolates is significant; however the sample size was too small to draw statistically significant conclusions regarding the distribution of genotypes among within other animal groups.
Meticillin-resistant Staphylococcus aureus (MRSA) is a major pathogen responsible for significant numbers of healthcare-associated infections and isolates containing Panton-Valentine leukocidin (PVL) that cause severe skin infections are emerging as a serious problem. The rapid detection of MRSA would be an invaluable tool in a diagnostic laboratory. The aim of this study is to develop real-time polymerase chain reaction (PCR) assays for the detection of MRSA and PVL directly from clinical samples, and then combining these assays. Individual assays for MRSA (SCCmec) and PVL (lukF and lukS) were optimised and evaluated with screening and wound swabs, respectively. MRSA- and PVL-positive isolates were detected by the assays with an analytical sensitivity of 100 cfu per reaction. No other bacterial species were amplified. Fifty of 402 (12.4%) nasal swabs were positive by culture and PCR. Four of the 402 (1.0%) swabs were PCR-positive/culture-negative. Three of the 402 (0.7%) swabs were PCR-negative/culture-positive. The sensitivity of the MRSA assay is 95% and the specificity is 99% using conventional culture as the gold standard. Five of 240 wound swabs (2.1%) were positive for PVL. Three of the PVL-positive swabs were meticillin-sensitive Staphylococcus aureus (MSSA) and two were MRSA. The MRSA assay is a powerful and sensitive diagnostic tool, giving rapid results and could allow more timely treatment and infection control decisions to be taken. It can also, when combined with the PVL assay, provide valuable epidemiological information.
The findings appeared to have face validity, and it was felt these could be used as the basis for developing a "Scottish Trainer Framework" for doctors and others involved in teaching and training in Scotland.
The control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) is a major challenge for healthcare establishments, especially as this pathogen continues to evolve. The emergence and spread of community associated MRSA producing Panton-Valentine leukocidin (PVL) causing severe, sometimes fatal, infections in otherwise healthy people is a significant cause of concern. Patient screening to detect MRSA is now widely used as part of an effective control program to limit the spread of this pathogen. Real-time PCR targeting specific MRSA markers offers a rapid alternative to conventional methods enabling earlier intervention, such as patient isolation and decolonization treatment. Herein we describe a multiplex real-time assay that combines primers and probes to detect MRSA and the genes for PVL to provide a rapid and informative assay.
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