A collection of 63 isolates of Pseudomonas aeruginosa associated with ulcerative keratitis, collected from six centres in England, were typed using serotyping and random amplified polymorphic DNA-PCR, and screened for several variable virulence-related genotypes and phenotypes. Sixty-one percent of the isolates were of either serotype O1 or serotype O11, but there was no evidence for a common clone. The majority of isolates (59 %) were PCR-positive for exoU rather than for exoS (38 %), and carried a-type fliC genes (76 %) rather than b-type (24 %). Isolates were PCR-positive for pyoverdine-receptor types at a prevalence of 38 % for type I, 46 % for type II and 8 % for type III. All but one of the isolates exhibited twitching activity. There was a correlation between the presence of exoS and twitching activity (P ¼ 0 . 04), suggesting that a combination of exoS genotype and good twitching activity may have a role to play in ExoU-independent corneal virulence.
INTRODUCTIONPseudomonas aeruginosa, a major opportunistic pathogen, is a common cause of bacterial keratitis, especially in contact lens wearers. Infection with P. aeruginosa leads to a rapid destructive keratitis and potential perforation within 2-4 days (Fleiszig & Evans, 2002). Generally P. aeruginosa-related keratitis tends to have a poor outcome in terms of corneal scarring and response to treatment. The pathogenesis of P. aeruginosa keratitis consists of colonization of the cornea, induction of proinflammatory cytokines (TNF-AE, IL-1) (Kernacki et al., 1998;Rudner et al., 2000), the migration of neutrophils into the cornea to kill and remove the pathogen (Pillar & Hobden, 2002), and subsequent corneal damage due to the neutrophil response and bacterial factors.Flagella and pili play potential roles in the pathogenicity of P. aeruginosa as adhesins (Feldman et al., 1998; Comolli et al., 1999). Type IV pili are surface appendages with a role in adherence (Hahn, 1997) or non-flagellar 'twitching' motility that are produced by many bacterial pathogens. It has been demonstrated that mutants of P. aeruginosa defective in twitching motility show reduced ability to colonize the cornea in a mouse model (Zolfaghar et al., 2003). Thus, twitching motility appears to contribute to the role of pili in corneal infection. In addition, it has been shown that flagellum assembly mutants are attenuated in their ability to invade corneal epithelial cells (Fleiszig et al., 2001). The flagella of P. aeruginosa also contribute to the inflammatory responses of corneal epithelial cells in a TLR5-NF-kB signalling pathway-dependent manner (Zhang et al., 2003). P. aeruginosa is capable of secreting a number of proteins with potential roles in pathogenicity. These include proteases (alkaline protease, staphylolytic protease, elastase, protease IV), heat-labile and heat-stable haemolysins, phospholipase C and exotoxins A, S, T, U and Y (Kawaharajo et al., 1974;Kessler et al., 1977;Ohman et al., 1980;Pillar & Hobden, 2002;Sato et al., 2003;Schulert et al., 2003). Clinical isolates o...