Faculty Bibliography

Using a commercially available enzyme-linked immunosorbent assay (ELISA) and an immunoblot assay (IB), we tested sera from 100 patients with erythema migrans (EM) seen in 1991 a the Westchester County Medical Center Lyme Disease Diagnostic Center. Convalescent-phase sera were available from 59 patients. Fifty-five patients had EM of < 7 days' duration, 31 had EM of 7 to 14 days' duration, and 14 had EM of > 14 days' duration. During the acute phase of infection, 35 patients had a positive ELISA result and 43 had a positive IB result by the recently published criteria of Dressler et al. (F. Dressler, J. A. Whalen, B. N. Reinhardt, and A. C. Steere, J. Infect. Dis. 167:392-400, 1993) for interpretation of IB in patients with Lyme disease. A greater sensitivity of IB was observed in patients with EM of < 7 days' duration, as follows: 14 of 55 (25%) for IB versus 7 of 55 (13%) for ELISA (P = 0.144). Sera of all 14 patients with EM of > 14 days' duration were reactive by both tests, as follows: 13 positive and 1 equivocal by ELISA and 12 positive and 2 indeterminate by the IB. The band reactivity most frequently observed in the IB was to the 41- and 25-kDa antigens, the latter being the most frequent band observed in immunoglobulin M blots. Seroconversion was observed in 74 and 64% of evaluable patients by ELISA and IB, respectively, despite the use of antibiotic therapy

Two variants of Campylobacter jejuni IN1 differing in the expression of flagella, IN1 (Fla+ Mot+, wild type) and IN1-NM (Fla- Mot-), were tested for their ability to establish infection in adult hamsters. Animals were challenged intracecally with 2 X 10(9) to 5 X 10(10) CFU and monitored for evidence of infection. None of the challenged animals developed illness. There was a significant difference, however, in the ability of IN1 to infect hamsters (35 of 43) compared with that of IN1-NM (1 of 42) (P less than 0.01). Additionally, eight animals challenged with IN1-NM excreted only the campylobacters of Fla+ phenotype, which were shown to be identical with the parental Fla+ Mot+ type. Both groups of animals developed serum immunoglobulin G antibodies to outer membrane proteins of IN1 as measured by an enzyme-linked immunosorbent assay; however, only animals that excreted Fla+ organisms developed antiflagellin antibodies. In vitro reversibility from Fla+ to Fla- occurred with a frequency of 9.2 X 10(-6) per cell per generation; however, reversion from Fla- to Fla+ could not be detected in vitro. Further characterization of IN1-NM showed that it produced a cytoplasmic 62K flagellin subunit protein, but this protein lacked six epitopes detected in IN1 and also differed in its two-dimensional gel electrophoresis pattern. The results of these studies support the concept that an intact flagellum is necessary for intestinal infection with C. jejuni and that this model may be useful for studying the immune response to C. jejuni

We used the Du Pont radioimmunoassay kit for soluble Legionella pneumophila serogroup 1 antigenuria (Du Pont Co., Wilmington, Del.) to test 422 urine samples from patients with and without Legionnaires disease (LD). The urine specimens were collected from 23 patients with culture-proven LD and from 346 patients without LD. L. pneumophila serogroup 1 was isolated from 14 patients with culture-proven LD, and other L. pneumophila serogroups or other Legionella species were isolated from 9 patients; 58 urine specimens were tested from these 23 patients. The non-LD group was composed of 75 bacteremic patients (35 gram-negative and 40 gram-positive bacteremias), 7 patients with candidemia, 48 patients with non-LD pneumonia, 90 patients with gram-negative bacteriuria (greater than 10(5) CFU/ml), 23 patients with gram-positive bacteriuria (greater than 10(5) CFU/ml), 14 patients with candiduria (greater than 10(5) CFU/ml), and 89 outpatients with negative urine cultures. All tests were performed in duplicate, including positive and negative controls. Sample results with values greater than or equal to 3.0 times those of the negative controls were considered positive for L. pneumophila serogroup 1 antigenuria. The average sample-to-negative ratios were 19.1 for the L. pneumophila serogroup 1 specimens, and 1.0 for both the non-serogroup 1 legionella group and the non-LD specimens. All but one of the patients who were culture positive for L. pneumophila serogroup 1 had at least one specimen positive for serogroup 1 antigenuria; none of the non-L. pneumophila serogroup 1 patients had a positive urine test. The test was highly specific (100%) and sensitive (93%) for the detection of L. pneumophila serogroup 1 antigenuria. Concentrations of urine by vacuum evaporation increased test sensitivity without apparently affecting specificity