THE OFFICIAL PATIENT’S SOURCEBOOK
on
SCHERICHIA OLI
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Escherichia Coli: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83318-4 1. Escherichia Coli-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of Escherichia coli.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to Escherichia coli. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to Escherichia coli, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Anthrax
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The Official Patient's Sourcebook on Aspergillosis
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The Official Patient's Sourcebook on Bacterial Waterborne Diseases
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The Official Patient's Sourcebook on Blastomycosis
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The Official Patient's Sourcebook on Botulism
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The Official Patient's Sourcebook on Brainerd Diarrhea
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The Official Patient's Sourcebook on Brucellosis
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The Official Patient's Sourcebook on Campylobacteriosis
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The Official Patient's Sourcebook on Chlamydia Pneumonia
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The Official Patient's Sourcebook on Cholera
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The Official Patient's Sourcebook on Coccidioidomycosis
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The Official Patient's Sourcebook on Cryptococcosis
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The Official Patient's Sourcebook on Diarrheagenic Escherichia Coli
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The Official Patient's Sourcebook on Diphtheria
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The Official Patient's Sourcebook on Drug-resistant Streptococcus Pneumoniae
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The Official Patient's Sourcebook on Enterotoxigenic E. Coli
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The Official Patient's Sourcebook on Food Irradiation
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The Official Patient's Sourcebook on Foodborne Disease
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The Official Patient's Sourcebook on Genital Candidiasis
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The Official Patient's Sourcebook on Glanders
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The Official Patient's Sourcebook on Group A Streptococcus
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The Official Patient's Sourcebook on Group B Streptococcus
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The Official Patient's Sourcebook on Haemophilus Influenzae Serotype B
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The Official Patient's Sourcebook on Hansen's Disease
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The Official Patient's Sourcebook on Helicobacter Pylori Infections
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The Official Patient's Sourcebook on Histoplasmosis
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The Official Patient's Sourcebook on Invasive Candidiasis
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The Official Patient's Sourcebook on Legionellosis
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The Official Patient's Sourcebook on Leptospirosis
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The Official Patient's Sourcebook on Leptospirosis Infection in Pets
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The Official Patient's Sourcebook on Listeriosis
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The Official Patient's Sourcebook on Melioidosis
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The Official Patient's Sourcebook on Meningitis
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The Official Patient's Sourcebook on Mycobacterium Avium Complex
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The Official Patient's Sourcebook on Mycoplasma Pneumoniae
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·
The Official Patient's Sourcebook on Nocardiosis
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The Official Patient's Sourcebook on Oropharyngeal Candidiasis
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The Official Patient's Sourcebook on Other Mycobacterium Species
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The Official Patient's Sourcebook on Pertussis
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The Official Patient's Sourcebook on Pneumonia among Children in Developing Countries
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The Official Patient's Sourcebook on Psittacosis
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The Official Patient's Sourcebook on Salmonella Enteritidis Infection
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The Official Patient's Sourcebook on Salmonellosis
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The Official Patient's Sourcebook on Shigellosis
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The Official Patient's Sourcebook on Sporotrichosis
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The Official Patient's Sourcebook on Streptococcus Pneumoniae Disease
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The Official Patient's Sourcebook on Toxic Shock Syndrome
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The Official Patient's Sourcebook on Trachoma
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The Official Patient's Sourcebook on Travelers Diarrhea
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The Official Patient's Sourcebook on Typhoid Fever
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The Official Patient's Sourcebook on Unexplained Deaths & Critical Illnesses
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The Official Patient's Sourcebook on Urinary Tract Infections
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The Official Patient's Sourcebook on Vibrio Parahaemolyticus
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The Official Patient's Sourcebook on Vibrio Vulnificus
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The Official Patient's Sourcebook on Yersiniosis
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents
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Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON ESCHERICHIA COLI: GUIDELINES ... 9
Overview............................................................................................................... 9 What Is Escherichia Coli O157:H7? .................................................................. 10 How Is E. Coli O157:H7 Spread? ...................................................................... 11 What Illness Does E. coli O157:H7 Cause? ....................................................... 12 How Is E. coli O157:H7 Infection Diagnosed? .................................................. 12 How Is the Illness Treated? ................................................................................ 13 What Are the Long-Term Consequences of Infection?....................................... 13 What Can Be Done to Prevent the Infection? .................................................... 13 What Can You Do to Prevent E. coli O157:H7 Infection? ................................ 13 Escherichia Coli: Technical Notes....................................................................... 14 Additional Information....................................................................................... 17 More Guideline Sources ..................................................................................... 20 Vocabulary Builder............................................................................................. 28
CHAPTER 2. SEEKING GUIDANCE ....................................................... 35
Overview............................................................................................................. 35 Associations and Escherichia Coli ...................................................................... 35 Finding More Associations................................................................................. 37 Finding Doctors.................................................................................................. 39 Selecting Your Doctor ........................................................................................ 40 Working with Your Doctor ................................................................................ 41 Broader Health-Related Resources ..................................................................... 42 Vocabulary Builder............................................................................................. 42
CHAPTER 3. CLINICAL TRIALS AND ESCHERICHIA COLI ................... 43
Overview............................................................................................................. 43 Recent Trials on Escherichia Coli....................................................................... 46 Benefits and Risks............................................................................................... 47 Keeping Current on Clinical Trials.................................................................... 50 General References.............................................................................................. 51 Vocabulary Builder............................................................................................. 52
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 53 CHAPTER 4. STUDIES ON ESCHERICHIA COLI ..................................... 55
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Contents
Overview............................................................................................................. 55 The Combined Health Information Database ..................................................... 55 Federally-Funded Research on Escherichia Coli................................................. 61 E-Journals: PubMed Central .............................................................................. 74 The National Library of Medicine: PubMed ...................................................... 77 Vocabulary Builder............................................................................................. 85
CHAPTER 5. PATENTS ON ESCHERICHIA COLI ................................... 95
Overview............................................................................................................. 95 Patents on Escherichia Coli ................................................................................ 96 Patent Applications on Escherichia Coli .......................................................... 111 Keeping Current ............................................................................................... 115 Vocabulary Builder........................................................................................... 115
CHAPTER 6. BOOKS ON ESCHERICHIA COLI ..................................... 119
Overview........................................................................................................... 119 Book Summaries: Federal Agencies .................................................................. 119 Book Summaries: Online Booksellers ............................................................... 121 The National Library of Medicine Book Index ................................................. 122 Chapters on Escherichia Coli ............................................................................ 125 General Home References ................................................................................. 130 Vocabulary Builder........................................................................................... 130
CHAPTER 7. MULTIMEDIA ON ESCHERICHIA COLI .......................... 137
Overview........................................................................................................... 137 Video Recordings .............................................................................................. 137 Bibliography: Multimedia on Escherichia Coli................................................. 140 Vocabulary Builder........................................................................................... 141
CHAPTER 8. PERIODICALS AND NEWS ON ESCHERICHIA COLI ....... 143
Overview........................................................................................................... 143 News Services & Press Releases ....................................................................... 143 Newsletters on Escherichia Coli ....................................................................... 146 Newsletter Articles ........................................................................................... 146 Academic Periodicals covering Escherichia Coli .............................................. 147 Vocabulary Builder........................................................................................... 148
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 151
Overview........................................................................................................... 151 NIH Guidelines................................................................................................. 151 NIH Databases.................................................................................................. 152 Other Commercial Databases ........................................................................... 156 The Genome Project and Escherichia Coli........................................................ 157 Specialized References....................................................................................... 162
CHAPTER 10. DISSERTATIONS ON ESCHERICHIA COLI ..................... 165
Overview........................................................................................................... 165 Dissertations on Escherichia Coli..................................................................... 165 Keeping Current ............................................................................................... 167
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PART III. APPENDICES .................................................. 169 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 171
Overview........................................................................................................... 171 Your Medications: The Basics .......................................................................... 172 Learning More about Your Medications .......................................................... 173 Commercial Databases...................................................................................... 174 Contraindications and Interactions (Hidden Dangers) ................................... 176 A Final Warning .............................................................................................. 176 General References............................................................................................ 177
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 179
Overview........................................................................................................... 179 What Is CAM? ................................................................................................. 179 What Are the Domains of Alternative Medicine?............................................ 180 Can Alternatives Affect My Treatment? ......................................................... 183 Finding CAM References on Escherichia Coli ................................................. 184 Additional Web Resources................................................................................ 195 General References............................................................................................ 201 Vocabulary Builder........................................................................................... 202
APPENDIX C. RESEARCHING NUTRITION ......................................... 205
Overview........................................................................................................... 205 Food and Nutrition: General Principles........................................................... 206 Finding Studies on Escherichia Coli ................................................................ 210 Federal Resources on Nutrition........................................................................ 211 Additional Web Resources................................................................................ 212 Vocabulary Builder........................................................................................... 212
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 215
Overview........................................................................................................... 215 Preparation ....................................................................................................... 215 Finding a Local Medical Library ...................................................................... 216 Medical Libraries Open to the Public............................................................... 216
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 223
Overview........................................................................................................... 223 Your Rights as a Patient................................................................................... 223 Patient Responsibilities .................................................................................... 227 Choosing an Insurance Plan............................................................................. 228 Medicare and Medicaid .................................................................................... 230 NORD’s Medication Assistance Programs ..................................................... 233 Additional Resources ........................................................................................ 234
APPENDIX F. MORE ON FOOD IRRADIATION .................................... 235
Overview........................................................................................................... 235 Which Foodborne Diseases Could Be Prevented with Irradiation? ................. 236 Irradiation Process............................................................................................ 236 How Does Irradiation Affect Foods? ................................................................ 237
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How Do You Measure the Amount of Irradiation Used?................................ 238 How Does Irradiation Affect Disease-Causing Microbes?............................... 239 Which Foods Can Be Irradiated?...................................................................... 239 Which Foods Have Been Approved for Irradiation in the United States? ....... 240 Which Foods Are Being Irradiated in the U.S.?............................................... 241 How Can I Tell If the Food Has Been Irradiated? ............................................ 241 Are Consumers Ready to Buy Irradiated Foods? ............................................. 242 Would Irradiation Replace Other Foodborne Disease Prevention Efforts? ..... 242 Is Irradiation of Food Just Like Pasteurization of Milk? .................................. 242 Who Makes Sure That the Irradiation Facilities Are Operated Safely?........... 243 Have There Been Any Accidents Involving Irradiation Facilities? ................. 243 What Radioactive Waste Is Generated? ........................................................... 244 What about the Effect of Irradiation on Food Packaging Materials? ............... 244 Do Other Countries Irradiate Their Food? ...................................................... 245 What Is the CDC’s Position on Food Irradiation? ........................................... 245 How Can I Find Out More about Food Irradiation? ....................................... 245 Vocabulary Builder........................................................................................... 246
ONLINE GLOSSARIES.................................................... 249 Online Dictionary Directories.......................................................................... 250
ESCHERICHIA COLI GLOSSARY................................ 251 General Dictionaries and Glossaries ................................................................ 275
INDEX................................................................................... 277
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
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Escherichia Coli
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Escherichia Coli has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to Escherichia coli, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on Escherichia coli. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on Escherichia coli should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
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options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching Escherichia coli (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to Escherichia coli. It also gives you sources of information that can help you find a doctor in your local area specializing in treating Escherichia coli. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with Escherichia coli. Part II moves on to advanced research dedicated to Escherichia coli. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on Escherichia coli. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with Escherichia coli or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with Escherichia coli. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with Escherichia coli.
Scope While this sourcebook covers Escherichia coli, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that Escherichia coli is often considered a synonym or a condition closely related to the following: ·
Traveler's Diarrhea - Giardiasis
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Escherichia Coli
In addition to synonyms and related conditions, physicians may refer to Escherichia coli using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for Escherichia coli:4 ·
008.0 escherichia coli [e. coli]
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008.0 escherichia coli intestinal infection
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008.00 e. coli, unspecified
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008.02 enterotoxigenic e. coli
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008.03 enteroinvasive e. coli
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008.04 enterohemorrhagic e. coli
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008.09 other intestinal e. coli infections
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to Escherichia coli. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
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Why “Internet age”? All too often, patients diagnosed with Escherichia coli will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with Escherichia coli is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of Escherichia coli, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on Escherichia coli. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of Escherichia coli to you or even given you a pamphlet or brochure describing Escherichia coli. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON ESCHERICHIA COLI: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on Escherichia coli. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on Escherichia coli can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on Escherichia coli. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with Escherichia coli and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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Centers for Disease Control and Prevention: various fact sheets on infectious diseases at http://www.cdc.gov/health/diseases.htm
Among the above, the National Institute of Allergy and Infectious Diseases (NIAID) is particularly noteworthy. The mission of the NIAID is to provide support for scientists conducting research aimed at developing better ways to diagnose, treat, and prevent the many infectious, immunologic and allergic diseases that afflict people worldwide.6 The NIAID is composed of four extramural divisions: the Division of AIDS; the Division of Allergy, Immunology and Transplantation; the Division of Microbiology and Infectious Diseases; and the Division of Extramural Activities. In addition, NIAID scientists conduct intramural research in laboratories located in Bethesda, Rockville and Frederick, Maryland, and in Hamilton, Montana. The following patient guideline was recently published by the NIAID on Escherichia coli.
What Is Escherichia Coli O157:H7?7 Escherichia coli O157:H7 is an emerging cause of foodborne illness. An estimated 73,000 cases of infection and 61 deaths occur in the United States each year. Infection often leads to bloody diarrhea, and occasionally to This paragraph has been adapted from the NIAID: http://www.niaid.nih.gov/facts/overview.htm. “Adapted” signifies that a passage has been reproduced exactly or slightly edited for this book. 7 Adapted from The Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/ncidod/dbmd/diseaseinfo/escherichiacoli_g.htm. 6
Guidelines 11
kidney failure. Most illness has been associated with eating undercooked, contaminated ground beef. Person-to-person contact in families and child care centers is also an important mode of transmission. Infection can also occur after drinking raw milk and after swimming in or drinking sewagecontaminated water. Consumers can prevent E. coli O157:H7 infection by thoroughly cooking ground beef, avoiding unpasteurized milk, and washing hands carefully.Because the organism lives in the intestines of healthy cattle, preventive measures on cattle farms and during meat processing are beinginvestigated. E. coli O157:H7 is one of hundreds of strains of the bacterium Escherichia coli. Although most strains are harmless and live in the intestines of healthy humans and animals, this strain produces a powerful toxin and can cause severe illness. E. coli O157:H7 was first recognized as a cause of illness in 1982 during an outbreak of severe bloody diarrhea; the outbreak was traced to contaminated hamburgers. Since then, most infections have come from eating undercooked ground beef. The combination of letters and numbers in the name of the bacterium refers to the specific markers found on its surface and distinguishes it from other types of E. coli.
How Is E. Coli O157:H7 Spread? The organism can be found on a small number of cattle farms and can live in the intestines of healthy cattle. Meat can become contaminated during slaughter, and organisms can be thoroughly mixed into beef when it is ground. Bacteria present on the cow’s udders or on equipment may get into raw milk. Eating meat, especially ground beef, which has not been cooked sufficiently to kill E. coli O157:H7 can cause infection. Contaminated meat looks and smells normal. Although the number of organisms required to cause disease is not known, it is suspected to be very small.
12 Escherichia Coli
Among other known sources of infection are consumption of sprouts, lettuce, salami, unpasteurized milk and juice, and swimming in or drinking sewage-contaminated water. Bacteria in diarrheal stools of infected persons can be passed from one person to another if hygiene or hand washing habits are inadequate. This is particularly likely among toddlers who are not toilet trained. Family members and playmates of these children are at high risk of becoming infected. Young children typically shed the organism in their feces for a week or two after their illness resolves. Older children rarely carry the organism without symptoms.
What Illness Does E. coli O157:H7 Cause? E. coli O157:H7 infection often causes severe bloody diarrhea and abdominal cramps; sometimes the infection causes non-bloody diarrhea or no symptoms. Usually little or no fever is present, and the illness resolves in 5 to 10 days. In some persons, particularly children under 5 years of age and the elderly, the infection can also cause a complication called hemolytic uremic syndrome, in which the red blood cells are destroyed and the kidneys fail. About 2%-7% of infections lead to this complication. In the United States, hemolytic uremic syndrome is the principal cause of acute kidney failure in children, and most cases of hemolytic uremic syndrome are caused by E. coli O157:H7.
How Is E. coli O157:H7 Infection Diagnosed? Infection with E. coli O157:H7 is diagnosed by detecting the bacterium in the stool. Most laboratories that culture stool do not test for E. coli O157:H7, so it is important to request that the stool specimen be tested on sorbitolMacConkey (SMAC) agar for this organism. All persons who suddenly have diarrhea with blood should get their stool tested for E. coli O157:H7.
Guidelines 13
How Is the Illness Treated? Most persons recover without antibiotics or other specific treatment in 5-10 days. There is no evidence that antibiotics improve the course of disease, and it is thought that treatment with some antibiotics may precipitate kidney complications. Antidiarrheal agents, such as loperamide (Imodium), should also be avoided. Hemolytic uremic syndrome is a life-threatening condition usually treated in an intensive care unit. Blood transfusions and kidney dialysis are often required. With intensive care, the death rate for hemolytic uremic syndrome is 3%-5%.
What Are the Long-Term Consequences of Infection? Persons who only have diarrhea usually recover completely. About one-third of persons with hemolytic uremic syndrome have abnormal kidney function many years later, and a few require long-term dialysis. Another 8% of persons with hemolytic uremic syndrome have other lifelong complications, such as high blood pressure, seizures, blindness, paralysis, and the effects of having part of their bowel removed.
What Can Be Done to Prevent the Infection? E. coli O157:H7 will continue to be an important public health concern as long as it contaminates meat. Preventive measures may reduce the number of cattle that carry it and the contamination of meat during slaughter and grinding. Research into such prevention measures is just beginning.
What Can You Do to Prevent E. coli O157:H7 Infection? ·
Cook all ground beef and hamburger thoroughly. Because ground beef can turn brown before disease-causing bacteria are killed, use a digital instant-read meat thermometer to ensure thorough cooking. Ground beef should be cooked until a thermometer inserted into several parts of the patty, including the thickest part, reads at least 160º F. Persons who cook ground beef without using a thermometer can decrease their risk of illness by not eating ground beef patties that are still pink in the middle.
14 Escherichia Coli
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If you are served an undercooked hamburger or other ground beef product in a restaurant, send it back for further cooking. You may want to ask for a new bun and a clean plate, too.
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Avoid spreading harmful bacteria in your kitchen. Keep raw meat separate from ready-to-eat foods. Wash hands, counters, and utensils with hot soapy water after they touch raw meat. Never place cooked hamburgers or ground beef on the unwashed plate that held raw patties. Wash meat thermometers in between tests of patties that require further cooking.
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Drink only pasteurized milk, juice, or cider. Commercial juice with an extended shelf life that is sold at room temperature (e.g. juice in cardboard boxes, vacuum sealed juice in glass containers) has been pasteurized, although this is generally not indicated on the label. Juice concentrates are also heated sufficiently to kill pathogens.
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Wash fruits and vegetables thoroughly, especially those that will not be cooked. Children under 5 years of age, immunocompromised persons, and the elderly should avoid eating alfalfa sprouts until their safety can be assured. Methods to decontaminate alfalfa seeds and sprouts are being investigated.
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Drink municipal water that has been treated with chlorine or other effective disinfectants.
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Avoid swallowing lake or pool water while swimming
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Make sure that persons with diarrhea, especially children, wash their hands carefully with soap after bowel movements to reduce the risk of spreading infection, and that persons wash hands after changing soiled diapers. Anyone with a diarrheal illness should avoid swimming in public pools or lakes, sharing baths with others, and preparing food for others.
For more information about reducing your risk of foodborne illness, visit the U.S. Department of Agriculture’s Food Safety and Inspection Service website at http://www.fsis.usda.gov. For more advice on cooking ground beef, visit http://www.fsis.usda.gov/OA/topics/gb.htm.
Escherichia Coli: Technical Notes The Division of Bacterial and Mycotic Diseases of the CDC publishes summary information on Escherichia coli for use by healthcare professionals and physicians. The information is presented in the form of notes. The notes
Guidelines 15
are written in a rather technical language. A few medical expressions are particularly noteworthy. “Clinical features” generally cover the signs and symptoms of Escherichia coli that can help the doctor with diagnosis. It may also include a discussion of the cause or “etiology” of Escherichia coli. “Etiologic agent” signifies the particular organism, typically written in Latin, which causes or is associated with Escherichia coli. “Reservoir” indicates the habitat or living environment of the organism. “Incidence” describes the number of people that are diagnosed with Escherichia coli within a given population. “Sequelae” includes any related health consequences or secondary pathological conditions and diseases that may result from Escherichia coli. “Transmission” describes how a disease spreads. “Risk Groups” are people who are most likely to be diagnosed with Escherichia coli. “Surveillance” describes how Escherichia coli is monitored by government officials across the population. “Challenges” and “Opportunities” are issues or areas where officials think progress might be made in understanding or combating Escherichia coli in the future. The notes that follow were recently published by the CDC.8
Clinical Features Acute bloody diarrhea and abdominal cramps with little or no fever; usually lasts 1 week.
Etiologic Agent Escherichia coli serotype O157:H7. Gram-negative rod-shaped bacterium producing Shiga toxin(s).
Incidence An estimated 73,000 cases occur annually in the United States. Uncommonly reported in patients in less industrialized countries.
Sequelae Hemolytic uremic syndrome (HUS): Persons with this illness have kidney failure and often require dialysis and transfusions. Some develop chronic Adapted from The Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/ncidod/dbmd/diseaseinfo/escherichiacoli_t.htm. 8
16 Escherichia Coli
kidney failure or neurologic impairment (e.g., seizures or stroke). Some have surgery to remove part of the bowel. Estimated 61 fatal cases annually; 3-5% with HUS die. Costs Estimated 2,100 hospitalizations annually in the United States. The illness is often misdiagnosed; therefore, expensive and invasive diagnostic procedures may be performed. Patients who develop HUS often require prolonged hospitalization, dialysis, and long-term follow-up.
Transmission Major source is ground beef; other sources include consumption of unpasteurized milk and juice, sprouts, lettuce, and salami, and contact with cattle. Waterborne transmission occurs through swimming in contaminated lakes, pools, or drinking inadequately chlorinated water. Organism is easily transmitted from person to person and has been difficult to control in child day-care centers.
Risk Groups All persons. Children <5 years old and the elderly are more likely to develop serious complications.
Surveillance E. coli O157:H7 infection is nationally reportable and is reportable in most U.S. states. HUS is also reportable in most states. Trends Since the first description of this illness in 1982, infections have been reported from >30 countries on six continents. The use of subtyping by pulsed-field gel electrophoresis and comparison of patterns by PulseNet has increased the ability to identify outbreaks.
Guidelines 17
Challenges Developing farm and slaughterhouse-based methods to decrease contamination of meat; encouraging use of irradiation to increase the safety of ground beef; identifying ways to prevent contamination of foods eaten raw (e.g., produce); educating the U.S. public to cook ground beef thoroughly, preferably using a digital instant-read thermometer; convincing clinical laboratories to screen for E. coli O157:H7 in stools from persons with bloody diarrhea; conducting population-based surveillance for HUS and determining which serotype of Shiga toxin-producing E. coli was responsible for illness; identifying other vehicles of transmission; developing an international network for subtyping and communicating about outbreaks.
Opportunities Learning more about the ecology of this organism in cattle and other ruminants may help in devising methods to decrease its prevalence in food animals. Learning how this pathogen contaminates produce items could lead to measures that would increase their safety. Decreasing the incidence of these infections would decrease HUS, the major cause of kidney failure in children in the United States. Transmission in day-care centers highlights need for better infection-control practices.
Additional Information Surveillance CDC currently has six surveillance systems for obtaining information about E. coli O157:H7. They serve different purposes and provide information on various features of the organism’s epidemiology. ·
Public Health Laboratory Information System (PHLIS): PHLIS is a passive, laboratory-based surveillance system that collects data about many infections, including E. coli O157:H7. Reporting is limited to illnesses that are confirmed by culture and verified at the state public health laboratory. After verification, information about the infection is reported electronically to CDC by the state. More information on PHLIS can be found at http://www.cdc.gov/ncidod/dbmd/phlisdata.
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National Electronic Telecommunications System for Surveillance (NETSS): NETSS is a passive, physician-based surveillance system that captures both laboratory-confirmed and clinically suspected cases of all
18 Escherichia Coli
nationally notifiable diseases, including E. coli O157:H7. The number of illnesses reported through NETSS tends to be higher than the number reported through PHLIS because NETSS does not require confirmation by the state public health laboratory. More information on NETSS can be found at http://www.cdc.gov/epo/dphsi/netss.htm. E. coli O157:H7 infections and other surveillance data collected by NETSS is published weekly in the CDC Morbidity and Mortality Report (MMWR) and can be found at http://www2.cdc.gov/mmwr. The Morbidity and Mortality Weekly Report (MMWR) also publishes an annual summary of the NETSS E. coli O157:H7 surveillance data; this information can be found at http://www2.cdc.gov/mmwr/summary.html. ·
FoodNet: The Foodborne Diseases Active Surveillance Network (FoodNet) is an active surveillance system for identifying and characterizing culture-confirmed infections that may be foodborne, including E. coli O157:H7. FoodNet workers regularly contact more than 300 laboratories for confirmed cases of foodborne infections in several states encompassing a population of more than 25 million persons. In addition to monitoring the number of E. coli O157:H7 infections, investigators monitor laboratory techniques for isolation of bacteria, perform case-control studies of ill persons to determine foods associated with illness, and administer questionnaires to people living in FoodNet sites to better understand trends in the eating habits of Americans. Annual FoodNet reports that include data about E. coli O157:H7 can be found at http://www.cdc.gov/foodnet/annuals.htm. More information on FoodNet can be found at http://www.cdc.gov/foodnet.
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National Molecular Subtyping Network for Foodborne Diseases Surveillance (PulseNet): PulseNet is a national network of public health laboratories that perform pulsed-field gel electrophoresis (PFGE), a type of DNA “fingerprinting”, on certain foodborne bacteria, including E. coli O157:H7. PFGE “fingerprint” patterns are submitted electronically to CDC and can be compared rapidly with others in a large database. This system can help determine if individual infections are related or if an outbreak is occurring. PulseNet is not a surveillance system itself but a laboratory subtyping method used in surveillance. More information on PulseNet can be found at http://www.cdc.gov/pulsenet.
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National Antimicrobial Resistance Monitoring System (NARMS): NARMS is a passive surveillance system that monitors antimicrobial resistance of E. coli O157:H7 and selected other bacteria that cause human illness. NARMS is a collaboration between CDC, 16 state and local health departments, the Food and Drug Administration (FDA), and the United States Agricultural Department (USDA). More information on NARMS can be found at http://www.cdc.gov/narms.
Guidelines 19
·
Foodborne Outbreak Detection Unit: CDC monitors outbreaks of foodborne disease, including outbreaks caused by Shigella. Each year, state and territorial epidemiologists voluntarily (passively) report the results of outbreak investigations to CDC. While outbreaks account for a small percentage of the total number of illnesses that occur each year, these investigations provide valuable information about sources of foodborne infection and often highlight important prevention opportunities. The latest summaries can be found at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/ss4901a1.htm. The Council of State and Territorial Epidemiologists
Annual summaries of E. coli O157:H7 outbreaks are reported to the Council of State and Territorial Epidemiologists. The most recent annual reports can be found at the following links: ·
Surveillance for Outbreaks of Escherichia coli O157:H7 Infection; Summary of 1999 Data: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/files/ecoli_99summary.p df
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Surveillance for Outbreaks of Escherichia coli O157:H7 Infection; Summary of 1998 Data: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/csteec98.pdf MMWR Articles
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Outbreaks of Escherichia coli O157:H7 Infections Among Children Associated With Farm Visits --- Pennsylvania and Washington, 2000; MMWR April 20, 2001 / Vol. 50 / No. 15: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5015a5.htm
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Outbreak of Escherichia coli O157:H7and Campylobacter Among Attendees of the Washington County Fair --- New York, 1999; MMWR September 17, 1999/ Vol. 48 / No. 36: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4836a4.htm
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Outbreaks of Escherichia coli O157:H7 Infection and Cryptosporidiosis Associated with Drinking Unpasteurized Apple Cider - Connecticut and New York, October 1996; MMWR January 10, 1997 / Vol. 46 / No. 1: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00045558.htm
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Outbreak of E. coli O157:H7 Infections Associated with Drinking Unpasteurized Commercial Apple Juice - October 1996; MMWR
20 Escherichia Coli
November 9, 1996 / Vol. 45 / No. 44: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00044358.htm ·
Outbreak of Acute Gastroenteritis Attributable to Escherichia coli Serotype O104:H21 - Helena, Montana, 1994; MMWR July 14, 1995 / Vol. 44 / No. 27: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00038146.htm
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Enhanced Detection of Sporadic Escherichia coli O157:H7 Infections New Jersey, July 1994; MMWR June 9, 1995 / Vol. 44 / No. 22: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00037182.htm
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Escherichia coli O157:H7 Outbreak at a Summer Camp - Virginia, 1994; MMWR June 9, 1995 / Vol. 44 / No. 22: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00037189.htm Links
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FoodNet: http://www.cdc.gov/ncidod/dbmd/foodnet
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PulseNet: http://www.cdc.gov/ncidod/dbmd/pulsenet/pulsenet.htm
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E. Coli Index: http://sun1.bham.ac.uk/bcm4ght6/res.html
More Guideline Sources The guideline above on Escherichia coli is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to Escherichia coli. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with Escherichia coli. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this
Guidelines 21
Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on Escherichia coli and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Safe Eating: A Guide to Preventing Foodborne Illness Source: Chicago, IL: American Dietetic Association. 1997. 12 p. Contact: Available from American Dietetic Association. 216 West Jackson Boulevard, Chicago, IL 60606-6995. (312) 899-0040. Fax (312) 899-4899. Price: $5.00 for members, $6.25 for nonmembers for pack of 25. Summary: Foodborne illness, sometimes called food poisoning, results from eating contaminated foods. When food is not handled properly during shopping, storage, preparation, or serving, microorganisms that cause foodborne illness can contaminate it. These microorganisms include bacteria, viruses, parasites, and molds. This brochure summarizes food safety and storage advice to help consumers maintain the freshness and quality of foods that they purchase. Topics include bacteria that cause foodborne illness, including salmonella, escherichia coli, listeria monocytogenes, and clostridium botulinum; tips for safe
22 Escherichia Coli
shopping; refrigerator, freezer, and pantry storage; safe food preparation; recommendations for how long to keep various foods; strategies for safe cooking and serving of meat, poultry, seafood, eggs, and hot foods; when to consult a health care provider regarding a foodborne illness; and the role of registered dietitians in preventing foodborne illness and supporting food safety. One chart illustrates the safe and dangerous temperatures for handling food. 1 figure. 2 tables. (AA-M). ·
About Keeping Safe from Waterborne Pathogens Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1997. 15 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Price: $1.72 each for 1-24 copies; $1.47 each for 25-99 copies. Summary: This brochure educates readers about waterborne pathogens, disease-causing organisms that can affect water safety and can also be spread in food or through poor personal hygiene. The brochure emphasizes that most water in the U.S. is safe, but that untreated water is a concern for everyone. People with certain health problems may need to use care even with treated water. The brochure describes three kinds of waterborne pathogens, with common examples of each: bacteria (Escherichia coli, shigella, salmonella, campylobacter), viruses (hepatitis A, Norwalk virus), and protozoa (giardia lamblia, cryptosporidium). Other topics covered include how pathogens get into the water, the use of chlorine to disinfect water, how government agencies and water suppliers work to keep the water supply safe, what consumers can do to help, risk factors for being affected by waterborne pathogens (including people with immune system disease), water hazards during an emergency (major storms or disasters), the signs of waterborne illness, when to contact a health care provider, diagnosis and treatment of waterborne illness, and prevention strategies, including being careful during recreational activities, following advisories during a water emergency, and observing good hygiene. The brochure concludes with a section of questions and answers about having water tested for pathogens, what to do if tap water looks funny, and where to get more information. The brochure includes the toll free Safe Drinking Water Hotline (800-426-4791). The brochure is illustrated with attractive, cartoon-like line drawings.
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Questions and Answers on Urinary Tract Infections Source: Alexandria, VA: American Medical Women's Association. 1997. 4 p.
Guidelines 23
Contact: Available from American Medical Women's Association. 801 North Fairfax Street, Alexandria, VA 22314. (781) 585-8220. Price: Single copy free. Summary: This brochure outlines symptoms, diagnosis, and treatment of urinary tract infections (UTIs). An infection of the urinary tract commonly has the following symptoms: frequent and urgent need to urinate, painful urination, cloudy urine, lower back or abdominal pain, blood in the urine. About 80 to 90 percent of UTIs are caused by Escherichia coli bacteria, which are normally present in the rectum. Factors that may contribute to UTIs are sexual intercourse, some birth control methods, low water intake, and anatomic problems. The first step a health care provider will take to confirm a bacterial UTI is to review the symptoms and test the patient's urine. The infection should be diagnosed by a urine culture, since several other conditions, including vaginal infections, gonorrhea, chlamydia, irritable bladder, and bladder cancer, can have similar symptoms. When pain is the predominant symptom, the diagnosis may be interstitial cystitis. If the urine culture shows bacteria, the health care provider will prescribe a course of antibiotics. The brochure outlines other steps to take to treat a UTI, including drinking large amounts of water; avoiding caffeine, acid foods, spices, citrus fruits, tomatoes, alcohol, and chocolate; drinking cranberry juice cocktail; and trying hot water bottles or heating pads to ease cramps and soothe the pain. The brochure concludes with a section of suggestions for preventing UTIs, including drinking plenty of fluids, wiping from 'front to back' (vagina to anus) after urinating to avoid spreading bacteria, scheduling frequent bathroom breaks, drinking water before and after sex in order to ensure a good volume of urination afterward, checking the fit of a diaphragm or using another method of birth control, avoiding tight clothing and pantyhose, and wearing cotton underwear. ·
Urinary Tract Infections Source: Montreal, Quebec: Kidney Foundation of Canada. 199x. [4 p.]. Contact: Available from Kidney Foundation of Canada. 300-5165, rue Sherbrooke Ouest, Montreal, QC H4A 1T6. (514) 369-4806. Fax (514) 3692472. Website: www.kidney.ca. Price: Single copy free. Summary: This brochure answers common questions about urinary tract infections (UTIs). The brochure first reviews the urinary system and how it works. A UTI is an inflammation usually caused by bacteria attacking the kidneys, ureters, bladder, or urethra. A UTI most often occurs when bacteria enter the urethra; the bacteria that usually cause UTIs come from the intestines and are called Escherichia coli. People with low resistance, a poor diet, or stress are more inclined to get a UTI. Other risk factors
24 Escherichia Coli
include urethral damage from childbirth, surgery, or the use of a catheter. Women are more prone to UTIs than men. Bladder infection (cystitis) symptoms can include urinary urgency, burning during urination, cloudy or foul smelling urine, and pain in the lower abdomen. In some cases, mild symptoms may be present without a UTI. Smoking, anxiety, drinking a lot of coffee, food allergies, or premenstrual syndrome may cause mild symptoms. The brochure lists self care prevention strategies, including recommendations to drink plenty of water, urinate frequently, urinate after having sex, wipe from front to back after defecating, change sanitary napkins often, cut down on alcohol and caffeine, wear cotton underwear, and avoid bubble baths, perfumed soaps, and vaginal douches. The brochure concludes with a brief description of the Kidney Foundation of Canada, including patient services and public education programs. 2 figures. ·
[Lois Joy Galler Foundation for Hemolytic-Uremic Syndrome, Inc. Information Packet] Source: Melville, NY: Lois Joy Galler Foundation for Hemolytic-Uremic Syndrome, Inc. 1995. (information packet). Contact: Available from Lois Joy Galler Foundation for HemolyticUremic Syndrome, Inc. 734 Walt Whitman Road, Melville, NY 11747. (516) 673-3017. Fax (516) 673-3025. Price: Single copy free. Summary: This information packet presents a basic introduction to hemolytic-uremic syndrome (HUS), a rare, but important cause of severe kidney disease in children. The packet includes information about the Lois Joy Galler Foundation, an organization established to raise public awareness about HUS, to provide a supportive community for the families of affected children, and to acquire the funds needed to enable doctors and scientists to conduct research and develop methods of preventing or curing HUS. The packet includes a basic brochure about the Foundation and about HUS; a fact sheet on HUS; a postcard reminding readers of the importance of safe food handling, particularly of ground meat products; copies of newspaper articles about HUS; a report from the CDC on preventing foodborne illness caused by Escherichia coli; a resume on Dr. Bernard Sidney Kaplan; a press release from the Foundation on HUS and E. coli; and letters from the U.S. Secretary of Agriculture, the American Meat Institute, and the U.S. President.
Guidelines 25
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “Escherichia coli” or synonyms. The following was recently posted: ·
Diagnosis and management of foodborne illnesses: a primer for physicians. Source: Centers for Disease Control and Prevention/American Medical Association/Food Safety and Inspection Service/Center for Food Safety and Applied Nutrition.; Reprint released 2001 January; 88 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1933&sSearch_string=escherichia+coli
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Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Source: Infectious Diseases Society of America.; 1999 October; 14 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1897&sSearch_string=escherichia+coli
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Guidelines for preventing opportunistic hematopoietic stem cell transplant recipients.
infections
among
Source: Centers for Disease Control and Prevention/Infectious Diseases Society of America/American Society for Blood and Marrow Transplantation.; 2000 October 20; 126 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1799&sSearch_string=escherichia+coli ·
Guidelines for prevention of nosocomial pneumonia. Source: Centers for Disease Control and Prevention.; 1994 January (updated 1997); 63 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0841&sSearch_string=escherichia+coli
26 Escherichia Coli
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Parameters for the diagnosis and management of sinusitis. Source: American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology/Joint Council of Allergy, Asthma and Immunology.; 1998 December; 37 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1103&sSearch_string=escherichia+coli
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Practice guideline for evaluation of fever and infection in long-term care facilities. Source: Infectious Diseases Society of America.; 2000 September; 14 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1890&sSearch_string=escherichia+coli
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Practice guidelines for the management of community-acquired pneumonia in adults. Source: Infectious Diseases Society of America.; 2000 February; 36 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1891&sSearch_string=escherichia+coli
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Practice guidelines for the management of infectious diarrhea. Source: Infectious Diseases Society of America.; 2001 February; 21 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2017&sSearch_string=escherichia+coli
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Recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. Source: American Society of Clinical Oncology.; 1994 November (updated 2000); 37 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0044&sSearch_string=escherichia+coli
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that
Guidelines 27
contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Foodborne Diseases Summary: This online fact sheet provides a description of the more common and serious foodborne illnesses -- Escherichia coli (E. coli), Salmonellosis, Campylobacteriosis, and Shigellosis. Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2381
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to Escherichia coli. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
28 Escherichia Coli
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Pertaining to the abdomen. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess
Guidelines 29
rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Chlamydia: A genus of the family CHLAMYDIACEAE whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is CHLAMYDIA TRACHOMATIS. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Chronic: Persisting over a long period of time. [EU] Citrus: Any tree or shrub of the rue family or the fruit of these plants. [NIH] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family BACILLACEAE. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, CRYPTOSPORIDIUM. It occurs in both animals and humans. [NIH] Cryptosporidium: A genus of coccidian parasites of the family CRYPTOSPORIDIIDAE, found in the intestinal epithelium of many vertebrates including humans. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the
30 Escherichia Coli
volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Giardia: A genus of flagellate intestinal protozoa parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, NEISSERIA GONORRHOEAE, was isolated by Neisser in 1879. [NIH] Hepatitis: Inflammation of the liver. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestines: The section of the alimentary canal from the STOMACH to the ANUS. It includes the LARGE INTESTINE and SMALL INTESTINE. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the
Guidelines 31
body; said of diagnostic techniques. [EU] Listeria: A genus of bacteria which may be found in the feces of animals and man, on vegetation, and in silage. Its species are parasitic on cold-blooded and warm-blooded animals, including man. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Mycotic: Pertaining to a mycosis; caused by fungi. [EU] Neurologic: Pertaining to neurology or to the nervous system. [EU] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Pathogen: Any disease-producing microorganism. [EU] Pneumonia: Inflammation of the lungs with consolidation. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Premenstrual: Occurring before menstruation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: SARCOMASTIGOPHORA, Labyrinthomorpha, APICOMPLEXA, MICROSPORA, Ascetospora, Myxozoa, and CILIOPHORA. [NIH] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU]
32 Escherichia Coli
Ruminants: A suborder of the order ARTIODACTYLA whose members have the distinguishing feature of a four-chambered stomach. Horns or antlers are usually present, at least in males. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as EPILEPSY or "seizure disorder." [NIH] Sinusitis: Inflammation of a sinus. The condition may be purulent or nonpurulent, acute or chronic. Depending on the site of involvement it is known as ethmoid, frontal, maxillary, or sphenoid sinusitis. [EU] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Telecommunications: electronic means. [NIH]
Transmission of information over distances via
Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transfusion: The introduction of whole blood or blood component directly
Guidelines 33
into the blood stream. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Ureter: One of a pair of thick-walled tubes that transports urine from the KIDNEY PELVIS to the BLADDER. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
Seeking Guidance 35
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with Escherichia coli. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.9 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with Escherichia coli. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Escherichia Coli As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.10 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 10 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 9
36 Escherichia Coli
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
Lois Joy Galler Foundation for Hemolytic Uremic Syndrome, Inc Address: Lois Joy Galler Foundation for Hemolytic Uremic Syndrome, Inc. 734 Walt Whitman Road, Melville, NY 11747 Telephone: (516) 673-3017 Fax: (516) 673-3025 Email:
[email protected] Web Site: http://www.loisjoygaller.org Background: The Lois Joy Galler Foundation strives to acquire the funds needed to enable doctors and scientists to conduct research and develop methods of preventing or curing Hemolytic Uremic Syndrome, raise public awareness, and provide a supportive community for the families of affected children. Hemolytic-Uremic Syndrome (HUS), a rare disorder that primarily affects young children, is often preceded by a flu-like illness (gastroenteritis) characterized by vomiting, abdominal pain, fever, and diarrhea, which, in some cases, may be bloody. Symptoms of Hemolytic- Uremic Syndrome usually become apparent three to 10 days after the development of gastroenteritis and may include sudden paleness, irritability, weakness, lack of energy, and/or excretion of abnormally diminished amounts of urine. The disease typically progresses to include inability of the kidneys to process waste products from the blood and excrete them into the urine (acute renal failure); a decrease in circulating red blood cells (microangiopathic hemolytic anemia); a decrease in circulating blood platelets (thrombocytopenia); and the abnormal accumulation of platelets within certain blood vessels (microthrombi), reducing the blood flow to several organs (e.g., kidneys, pancreas, brain) potentially leading to multiple organ dysfunction or failure. The onset of Hemolytic-Uremic Syndrome is most frequently associated with infection by a particular strain (O157:H7) of Escherichia coli (E. coli) bacterium. The Lois Joy Galler Foundation for Hemolytic Uremic Syndrome, Inc. was founded by Mr. and Mrs. Robert C. Galler in
Seeking Guidance 37
memory of their daughter, Lois Joy. In addition to offering support to affected families and promoting research, the Foundation provides information concerning HUS in easy-to-understand lay terminology. The Foundation also has a web site on the Internet at http://www.comed.com/galler/ that discusses the organization's goals, has a listing of its Board of Directors and Medical Research Council (MRC), and provides understandable information on HUS.
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about Escherichia coli. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “Escherichia coli” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and
38 Escherichia Coli
“Escherichia coli”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “Escherichia coli” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with Escherichia coli. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “Escherichia coli” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Seeking Guidance 39
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with Escherichia coli must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:11 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at http://www.abms.org/newsearch.asp.12 You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 11 12
40 Escherichia Coli
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about Escherichia coli?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for Escherichia coli?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
13 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 41
Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
14
42 Escherichia Coli
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
15
Clinical Trials 43
CHAPTER 3. CLINICAL TRIALS AND ESCHERICHIA COLI Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning Escherichia coli.
What Is a Clinical Trial?16 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for Escherichia coli is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
16
44 Escherichia Coli
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on Escherichia coli.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for Escherichia coli compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on Escherichia coli carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on Escherichia coli. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.”
Clinical Trials 45
This treatment, like a placebo, has no effect on Escherichia coli and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how Escherichia coli develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for Escherichia coli. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
46 Escherichia Coli
surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Escherichia Coli The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to Escherichia coli.17 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
UTI Prophylaxis Using Bacterial Interference Following SCI Condition(s): Urinary Tract Infections Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Rehabilitation Research and Development Service Purpose - Excerpt: Urinary tract infection (UTI) is the most common infection in patients with SCI and is a major cause of morbidity and mortality in this population. The bladder of patients with SCI, especially those who have indwelling catheters, is often colonized by bacteria that may or may not cause symptoms of UTI. Bacteria that do not cause symptoms are usually considered benign colonizers and are often left untreated because they may afford some protection against symptomatic infection with more harmful bacteria. We applied the concept of using benign bacteria to prevent symptomatic infection, so-called bacterial interference, by deliberately colonizing the bladder of patients with SCI with a non-pathogenic prototype of Escherichia coli (strain 83972). The
17
These are listed at www.ClinicalTrials.gov.
Clinical Trials 47
preliminary results of our VA-funded study that compared the rates of symptomatic UTI in patients with SCI while colonized with E. coli 83972 vs. historical rates of symptomatic UTI prior to study enrollment indicated that deliberate colonization of the bladder of patients with SCI with E. coli 83972 is safe and very promising as to its ability to prevent symptomatic UTI. However, before this innovative approach of bacterial interference can be successfully applied in the population of patients with SCI, it is essential to: (A) confirm the ultimate efficacy of bacterial interference by conducting a prospective, randomized, placebocontrolled clinical trial (objective #1); and (B) enhance the practicality of applying this innovative approach in SCI patients by delineating the bacterial and host factors that can promote successful colonization with E. coli 83972 (objectives #2-3). Phase(s): Phase II Study Type: Interventional Contact(s): Rabih Darouiche, M.D. 713-794-7117
[email protected]; Texas; VAMC, Houston, Texas, United States; Recruiting; Rabih Darouiche, M.D., Principal Investigator. Study chairs or principal investigators: David Wolff, Ph.D. Special Assistant to the Director; Program Analysis and Review Section (PARS) VA Rehabilitation Research & Development Service; Danielle M Kerkovitch, Ph.D.; Program Analysis and Review Section (PARS), VA Rehabilitation Resaearch and Development Service Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00037921;jsessionid=D18295 1613506147C46212E375237251
Benefits and Risks18 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for Escherichia coli. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 18
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who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over. ·
If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with Escherichia coli. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient. What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention.
How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
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What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care.
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What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for Escherichia coli? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with
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most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “Escherichia coli” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Benign: Not malignant; not recurrent; favourable for recovery. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on Escherichia coli. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on Escherichia coli. In Part II, as in Part I, our objective is not to interpret the latest advances on Escherichia coli or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with Escherichia coli is suggested.
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CHAPTER 4. STUDIES ON ESCHERICHIA COLI Overview Every year, academic studies are published on Escherichia coli or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on Escherichia coli. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on Escherichia coli and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Escherichia coli, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “Escherichia coli” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Escherichia Coli O157: H7 Infection in Humans Source: Annals of Internal Medicine. 123(9): 698-714. November 1, 1995. Summary: In this article, the authors review the clinical relevance of Escherichia coli 0157: H7 infection, including the epidemiology of the infection and its clinical presentations, pathogenesis, microbiology, diagnosis, treatment, and prevention. All articles and case reports in MEDLINE or the bibliographies of relevant articles describing E. coli 0157: H7 were selected. The data synthesis showed that infection with E. coli 0157: H7 presents with a wide spectrum of clinical manifestations, including the hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura. Patients at extremes of age have an increased risk for infection and associated complications. Transmission of E. coli 0157: H7 is primarily foodborne, with undercooked meat the most common culprit. Treatment is primarily supportive and includes the management of complications as necessary. The authors conclude that development of the hemolytic-uremic syndrome or thrombotic thrombocytopenia purpura should raise strong suspicion of E. coli 0157: H7 infection and should lead to prompt evaluation. 3 figures. 217 references. (AA-M).
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Intestinal Epithelial Cell Protein Phosphorylation in Enteropathogenic Escherichia Coli Diarrhoea Source: Lancet. Volume 339. February 29, 1992. p. 521-523. Summary: The ability of enteropathogenic Escherichia coli (EPEC) to cause diarrhea in man is associated with the formation of characteristic histopathological lesions in small-intestine enterocytes, with gross cytoskeletal damage and loss of brush-border microvilli. This article reports on research into enterocyte protein phosphorylation in response to EPEC infection. Results showed that the major protein is myoxin lightchain, an important cytoskeletal protein known to affect actin organization in non-muscle cells. The authors hypothesize about the role
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of EPEC-induced phosphorylation of other cell proteins in the mechanism of secretory EPEC diarrhea. 10 references. (AA-M). ·
Epidemiology of Infections Caused by Escherichia coli O157: H7, Other Enterohemorrhagic E. coli, and the Associated Hemolytic Uremic Syndrome Source: Epidemiologic Reviews. Volume 13: 60-98. 1991. Summary: In 1982, investigation of two outbreaks of a distinctive bloody diarrheal syndrome led to the identification of a new bacterial pathogen, Escherichia coli O157: H7. This review summarizes the epidemiologic data on E. coli O157: H7 and similar E. coli that have accumulated in the first decade of research. After a brief discussion of nomenclature, the authors cover the microbiology, clinical manifestations, outbreak investigations and studies of transmission, and incidence of the infection; hemolytic uremic syndrome; thrombotic thrombocytopenic purpura; and animal reservoirs and food vehicles. 3 figures. 6 tables. 226 references.
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Widespread Distribution of Urinary Tract Infections Caused by A Multidrug-Resistant Escherichia Coli Clonal Group Source: New England Journal of Medicine. 345(14): 1007-1013. October 4, 2001. Summary: The management of urinary tract infections (UTIs) is complicated by the increasing prevalence of antibiotic-resistant strains of Escherichia coli. This article reports on a study of the clonal composition of E. coli isolates that were resistant to trimethoprim-sulfamethoxazole from women with community-acquired UTIs. Of the 255 E. coli isolates, 55 (22 percent) from a California university cohort were resistant to trimethoprim-sulfamethoxazole as well as to other antibiotics. There was a common pattern of DNA fingerprinting, suggesting that the isolates belonged to the same clonal group (clonal group A), in 28 of 55 isolates with trimethoprim-sulfamethoxazole resistance (51 percent) and in 2 of randomly selected isolates that were susceptible to trimethoprimsulfamethoxazole. In addition, 11 of 29 resistant isolates (38 percent) from a Michigan cohort and 7 of 18 (39 percent) from a Minnesota cohort belonged to clonal group A. The authors conclude that in three geographically diverse communities, a single clonal group accounted for nearly half of community-acquired UTIs in women that were caused by E. coli strains with resistance to trimethoprim-sulfamethoxazole. The widespread distribution and high prevalence of E. coli clonal group A have major public health implications. 2 figures. 3 tables. 37 references.
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Dynamic Interactions Between Host and Pathogen During Acute Urinary Tract Infections Source: Urology. 57(6A Supplement): 56-61. June 2001. Contact: Available from Urology. P.O. Box 2126, Marion, OH 43306-8226. (800) 215-4692. Fax (740) 382-5866. Summary: Urinary tract infections (UTIs) have traditionally been viewed as acute and often self-limiting infections caused predominantly by noninvasive Escherichia coli. However, this concept has been challenged by recent findings demonstrating that an acute bladder infection results from a complex series of host-pathogen interactions that can lead to bacterial invasion and persistence and that ultimately can determine the course of the infectious disease. This article reviews the dynamic interactions between host and pathogen during acute UTIs. The ability of E. coli to gain a foothold in the bladder is greatly facilitated by type 1 pilus-mediated attachment to and invasion of bladder epithelial cells. Invasion allows uropathogenic strains of E. coli to exploit the intracellular environment by replicating within these epithelial cells while evading a multitude of host defenses. An intracellular location also provides them a safe haven from many common antibiotic therapies. However, attachment and invasion also activates a cascade of innate host defenses, leading to the death and exfoliation of bladder cells and the production of inflammatory mediators. The ability of uropathogenic E. coli to flux out of cells and colonize surrounding cells provides them a mechanism to subvert these defense mechanisms and persist in the bladder epithelium for weeks following the acute infection. The authors conclude that the persistence of E. coli in bladder tissue may be relevant to more chronic diseases of the urinary tract such as recurrent UTIs and interstitial cystitis (IC). 1 figure. 29 references.
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When to Consider TMP-SMX Resistance in Treating Acute Urinary Tract Infections? (commentary) Source: Consultant. 40(1): 18-20. January 2000. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: This commentary, in the form of a letter, offers advice on when to consider TMP SMX resistance in treating acute urinary tract infections (UTIs). The authors note that they recently reported on antibiotic resistance among urinary pathogens that caused acute, uncomplicated cystitis. Resistance of Escherichia coli to TMP and TMP SMX (trimethoprim sulfamethoxazole) rose from 9 percent in 1992 to 18 percent in 1996. The authors also briefly report additional clinical data on
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the outcomes of patients who receive TMP SMX for UTIs. The authors conclude that, collectively, these data suggest that TMP SMX may no longer be the optimal empiric therapy for women with acute, uncomplicated UTIs, at least in areas where the prevalence of resistance is high. Alternative therapies, such as fluoroquinolone that is primarily excreted through the urine, should be considered for the empiric treatment of UTIs. The letter is published with a further commentary in which Dr. S. G. Mulholland suggests that using the alternative drugs for empiric therapy may be unnecessary because there are many communities where the resistance to TMP SMX is not high. 8 references. ·
Escherichia Coli O157:H7 Infection Source: American Family Physician. 56(3): 859-861. September 1, 1997. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This three page fact sheet reviews basic information about Escherichia coli O157:H7 infection and how to prevent it. E. coli is the name of a strain of bacteria that causes severe gastroenteritis (cramps and diarrhea). E. coli is one of the leading causes of bloody diarrhea. The symptoms are worse in children and older people, and especially in people who have another illness. Written in a question and answer format, the fact sheet covers how E. coli infection is transmitted, the symptoms of E. coli infection, complications arising from E. coli infection, diagnostic strategies for establishing E. coli infection, treatment options, and ways to prevent infection with E. coli. The most common way to get this infection is by eating rare (undercooked) hamburgers. The germ can also be passed from person to person in day care centers and nursing homes. The most common complication of E. coli infection is hemolytic uremic syndrome (HUS), which consists of hemolytic anemia (low red blood cell count), thrombocytopenia (low platelet count), and renal (kidney) failure. A stool culture is required to confirm E. coli infection. There is no special treatment for E. coli infection, except hydration (drinking a lot of water) and watching for complications. The fact sheet lists rules to follow to prevent contracting foodborne infections such as E. coli. These rules cover handwashing techniques, cooking meat thoroughly, defrosting meats safely, and handling leftovers properly. The fact sheet is also available online.
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Association Between Use of Spermicide-Coated Condoms and Escherichia Coli Urinary Tract Infection in Young Women Source: American Journal of Epidemiology. 144(5): 512-520. September 1, 1996. Summary: The use of a diaphragm with spermicide increases the risk of urinary tract infection (UTI) in women. To determine whether spermicide-coated condoms are also associated with an increased risk of UTI, the authors of this article conducted a case-control study at a large health maintenance organization in Seattle, Washington. Cases were sexually active young women with acute UTI caused by Escherichia coli, identified from computerized laboratory files from 1990 to 1993. Agematched controls were randomly selected from the enrollment files of the plan. Of 1,904 eligible women, 604 cases and 629 controls (65 percent) were interviewed. During the previous year, 40 percent of the cases and 31 percent of the controls had been exposed to any type of condom. Exposure to spermicide-coated condoms conferred a higher risk of UTI. In multivariate analyses, intercourse frequency, history of UTI, and frequency of spermicide-coated condom exposure were independent predictors of UTI. Spermicide-coated condoms were responsible for 42 percent of the UTIs among women who were exposed to these products. 1 figure. 5 tables. 20 references. (AA-M).
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Escherichia Coli O157: H7 and the Hemolytic-Uremic Syndrome Source: New England Journal of Medicine. 333(6): 364-368. August 10, 1995. Summary: In this article, the authors consider the relationship between Escherichia coli O157: H7 and the hemolytic-uremic syndrome (HUS). Topics include the epidemiology of E. coli O157: H7, including incidence, geographic and seasonal factors, and transmission; pathophysiology and immunity; clinical manifestations; diagnosis; treatment; and recognition of and response to outbreaks. The authors note that several studies have shown that infection with E. coli O157: H7 is responsible for most cases of HUS, a major cause of acute renal failure in children. 2 figures. 1 table. 60 references.
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Urinary Tract Infections in Women Source: American Family Physician. 41(2): 565-571. February 1990. Summary: This article discusses urinary tract infections in women and notes that the clinical conditions that cause dysuria in women can usually be differentiated by the history and selected physical and laboratory examinations. Cystitis can be treated with short-course therapy in
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uncomplicated cases. Pretreatment cultures are usually not necessary, since most infections are caused by 'Escherichia coli.' Outpatient treatment of pyelonephritis is appropriate in selected patients. Follow-up culture after treatment of either cystitis or pyelonephritis is indicated to identify those patients requiring longer treatment or urologic evaluation. The article recounts research that suggests that recurrent urinary tract infections can be managed with postcoital antibiotics, long-term prophylaxis or patient self-administration of short-course therapy. The article stresses that bacteriuria and pyelonephritis in pregnancy must be aggressively diagnosed and treated. 26 references. 5 tables (AA-M). ·
Urinary Tract Infections in Obstetrics and Gynecology Source: Journal of Reproductive Medicine. 35(3): 339-342. March 1990. Summary: Escherichia coli is still the most common bacterial pathogen associated with urinary tract infections in women. Because of increasing resistance, ampicillin or a sulfonamide alone is no longer recommended for the empiric treatment of these infections. Antimicrobial therapy that contains a beta-lactamase inhibitor or that is resistant to the action of beta-lactamase is preferred. For the treatment of acute, uncomplicated lower urinary tract infection in a young woman, a short course of therapy (single dose) may be adequate. For an upper tract or complicated infection, a longer course of therapy is advised. Asymptomatic bacteriuria in pregnancy should be treated; a short course of therapy with a beta-lactam antibiotic may be tried only if posttherapy follow-up cultures are planned. When bacteriuria persists or recurs, a longer course of therapy should follow, with consideration given to a urologic workup after delivery. 3 tables, 12 references. (AA).
Federally-Funded Research on Escherichia Coli The U.S. Government supports a variety of research studies relating to Escherichia coli and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.19 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at 19 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to Escherichia coli and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore Escherichia coli and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for Escherichia coli: ·
Project Title: Biosynthesis of the Escherichia Coli Lipopolysaccharide Principal Investigator & Institution: Gatti, Domenico L.; Biochemistry; Wayne State University Detroit, Mi 48202 Timing: Fiscal Year 2000; Project Start 1-MAY-1998; Project End 0-APR2003 Summary: The lipopolysaccharide (LPS), also known as endotoxin, is a unique constituent of the outer cell membrane of Gram negative bacteria and is responsible for the pathophysiological phenomena of the shock syndrome associated with Gram negative sepsis. Since LPS is essential for bacterial growth, the enzymes that catalyze its synthesis are important drug targets for antimicrobial chemotherapy. One of the principal components of LPS is 3-deoxy-D-manno-octulosonate (KD0). This 8carbon sugar is first synthesized as a phosphorylated precursor (KDO8P) by a specific bacterial synthase. The reaction, with involves the condensation of phosphoenolpyruvate (PEP) with arabinose 5-(A5P) to yield KDO8P and Pi, is poorly understood at present. This fact has limited the suitability of KDO8P synthase as therapeutic target. The current project will employ structural analysis of KDO8P synthase from Escherichia coli to determine the details of the enzyme catalytic mechanism. The three-dimensional structure of the wild type enzyme will be solved first in the absence of bound ligands. Subsequent structure determinations will be done in the presence of the enzyme substrates (PEP+ a5P), its products (KDO8P, Pi) and analogs of these ligands, and will provide initial information on the amino acids in the active site of KDO8P synthase that are important for catalysis. The catalytic role of chemical groups of KDO8P synthase will be examined further in structures obtained at different pH values, and by employing mutant forms of the enzyme. Notably, E. coli KDO8P synthase exhibits sequence
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similarity to two other enzymes that recognize a pyruvyl moiety, the bifunctional 3-deoxy-D-arabino-heptulosonate 7-phosphate synthase/chorismate mutase from Bacillus subtilis and the chorismate mutase from Staphylococcus xylosus, for which no structural information is available. Thus, studies of KDO8P synthase will provide a mechanism model for a new class of enzymes that catalyze the transfer of threecarbon units. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Copper Homeostasis in Escherichia Coli Principal Investigator & Institution: Chen-Ho, Kui; Northwestern University 633 Clark St Evanston, Il 60208
Chemistry;
Timing: Fiscal Year 2002; Project Start 1-MAY-2002 Summary: (provided by applicant) As an essential element to all living cells, copper can be highly toxic when allowed to accumulate in excess of cellular needs. The intracellular free copper concentration is controlled below the toxic level by both copper efflux ATPases whose gene expressions are regulated by metal-sensitive transcription factors, and metallochaperones that guide copper into the target proteins and protect this highly active element from adventious actions. However, little is known about the molecular and mechanistic principles of these processes. Simple organisms such as Escherichia coli provides an excellent model system to study copper homeostasis in cells. Recent studies have shown that in E. coli a copper-responsive transcription regulator, namely CueR, is responsible for gene expression of the principal copper-exporter, CopA. This proposal focuses on the mechanistic details of the CueR-mediated transcription regulation of the CopA gene and the molecular and structural bases of CueR in metal recognition. By calibrating the copper sensitivity of the CueR/CopA gene interaction in vitro, this proposal provides a convenient probe to determine the intracellular free copper concentration in E. coli. These results may provide experimental evidence for the importance of metallochaperones in prokaryotic cells, and may lead to the discovery of the first copper chaperone in E. coli. These studies lay the groundwork for delineating the fundamental principles of metal homeostasis in both prokaryotic and eukaryotic cells. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Enteropathogenic Escherichia Coli Bundle Forming Pili Principal Investigator & Institution: Schoolnik, Gary K.; Professor; Medicine; Stanford University Stanford, Ca 94305
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Timing: Fiscal Year 2000; Project Start 1-MAY-1997; Project End 0-APR2002 Summary: (Adapted from applicant's abstract): Enteropathogenic Escherichia coli (EPEC) are a significant cause of childhood diarrhea. EPEC infection of the small intestine involves adherence of the organism to the epithelial surface, reorganization of the underlying cytoskeleton, and in human volunteer studies, has been shown to require the enteroadherent factor (EAF) plasmid locus that codes for the expression of the bundle-forming pilus (BFP). BFP is a filamentous colonizing factor that belongs to the Type IV family of pilus proteins. The proposed work will focus on this critical virulence determinant by addressing the following questions: How is the BFP assembled on the bacterial surface? How is its expression regulated in vivo? How does it function to confer virulence? BFP biogenesis will be studied using genetic, biochemical and ultrastructural methods. Knockout mutations of each of 12 bfp gene cluster cistrons will be prepared to elucidate their role in biogenesis and pilus function. Antisera to each BFP biogenic protein will be used to determine its subcellular location, and immunoprecipitation, chemical cross-linking and thin-layer immunogold electron microscopy experiments will be conducted to co-localize biogenic proteins to the hypothesized "assembly complex". Small bowel biopsies and aspirates from EPEC-infected volunteers will be studied by reverse PCR to determine if, when and where in vivo transcriptional expression of bfpA occurs and the identification of the responsible environment cues. bfpT, a separate EAF plasmid locus that transcriptionally activates bfpA expression, will be similarly studied, including experiments to determine if a bfpT knockout mutant is virulent in human volunteers. Genes that regulate bfpT expression will be sought using a bfpT-CAT fusion reporter plasmid and an EPEC expression library. To learn more about the pathogenic function of BFP, bfp gene cluster mutants will be sought that: (a) produce morphologically normal pili, but do not adhere; or (b) do not produce pili, but retain adherence function. These mutants will be biochemically characterized and studied for virulence in human volunteers. Morphological evidence for BFP adherence function will also be sought using BFP-specific antisera for immunogold scanning electron microscopic studies of EPEC-infected tissue culture cells and small bowel biopsies. These studies seek to provide new information about the biogenesis and pathogenic function of Type IV pili in general and of BFP in particular. Because BFP is a proven virulence determinant, these studies might also lead to new strategies for the prevention of EPEC infections in children. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Escherichia Coli Elimination in Cattle Principal Investigator & Institution: Bohach, Carolyn; Microbiol/Molec Biol & Biotech; University of Idaho Moscow, Id 83843 Timing: Fiscal Year 2000; Project Start 1-MAY-2000; Project End 0-APR2002 Summary: There is no text on file for this abstract. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Virul Factors of Uropath Escherichia Coli Principal Investigator & Institution: Redford, Peter; Medical Microbiol & Immunology; University of Wisconsin Madison 500 Lincoln Dr Madison, Wi 53706 Timing: Fiscal Year 2000; Project Start 1-APR-1999; Project End 1-MAR2004 Summary: Escherichia coli is the most common cause of communityacquired urinary tract infections, resulting in an estimated eight million physician visits a year in the United States. It is also a leading cause of nosocomial infections. Pathogenic E. coli strains carry groupings of genes which are absent in strains that do not cause infection of the urinary tract. These clusters of extra genes have been termed "pathogenicity islands (PAI's)", and the hypothesis to be tested is that they code for the factors necessary in the development of cystitis, pyelonephritis and sepsis. The basis for this hypothesis is the homology of some PAI sequences to virulence genes recognized in other pathogens such as Salmonella, Shigella, Yersinia, Serratia, Vibrio, Bordetella and Streptococcus. Putative virulence genes will be identified on the basis of homologies to sequences of known virulence genes. They also will be found by signature-tagged mutagenesis of a wild-type uropathogenic strain and negative selection of avirulent mutants in a murine model of ascending urinary tract infection. The mouse model will be used to confirm the loss of virulence of signature- tagged mutants as well as test specific allelic knock-outs of candidate virulence genes identified by sequence homologies. New virulence genes will be further examined at the molecular level with analysis of expression conditions and characterization of translation products. The goal of this project is to further the understanding of the mechanisms that underlie the ability of these uropathogenic E. coli to cause disease. The information will promote the development of new chemotherapies and vaccines. The performance of this research plan requires an investigator with a background in basic research. The candidate for this award has worked a year at the NIH and a year so far in the laboratory of the sponsor. The sponsor has more than two decades
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of research experience in this field and has trained eight Ph.D.'s and six postdoctoral fellows. He heads a fully-equipped and expertly- staffed laboratory at a large university with a distinguished record of research success. The combination of the experience gained in this research, the mentorship given by the sponsor and the educational opportunities offered by the university will accomplish the second goal of this project and meet the ambition of the award candidate: to launch a career as an independent academic investigator. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Aggregative E Coli Molecular and Clinical Studies Principal Investigator & Institution: Wanke, Christine A.; Associate Professor; Family Medicine & Cmty Health; Tufts University Boston 136 Harrison Ave Boston, Ma 02111 Timing: Fiscal Year 2000; Project Start 0-SEP-1998; Project End 8-FEB-2002 Summary: The Enteroaggregative Escherichia coli (EAggEc) are a complex group of bacterial organisms which have a distinctive phenotype and a strong association with persistent diarrheal disease in children in the developing world and in patients infected with the Human Immunodeficiency Virus (HIV). To date, however, there are very few hard data about EAggEc that permit speculation about the molecular basis for pathogenesis or development of additional diagnostic methodologies. While very elegant work has been done to describe the genes which are responsible for encoding the AAF/1 fimbriae in some EAggEc strains, it is not possible at present to implicate AAF/1 as the fimbrial adhesin which is present in all or even the majority of EAggEc strains. None of the other work that has been done to date on serogroups of EAggEc strains, entero or cytotoxins, invasive ability, clump formation or hemagglutinins can explain the pathogenesis of diarrhea associated with these organisms or serve as a definitive means of identifying clinically important EAggEc strains as these factors have not been identified in the majority of EAggEc strains from various geographic locations. Not all patients colonized with Enteroaggregative Escherichia coli are symptomatic. This may be due to differences in the host or differences in the colonizing bacteria or a combination of the two. The purpose of this pilot proposal is to address the question of whether the EAggEc function as an opportunistic pathogen, able to cause diarrheal disease in very selected circumstances, such as young or malnourished children in the developing world or patients with immune compromise, such as HIV. This issue will be addressed by undertaking molecular characterization of EAggEc isolates from patients in whom "host factors" which may be related to EAggEc pathogenesis can be measured. A
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longitudinal clinical study will be performed which will compare patients who are symptomatic when infected with EAggEc and those who are not. Strains from these two groups of patients will be compared, using molecular techniques. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: DR Adhesins in E Coli Renal Vs Bladder Tropism Principal Investigator & Institution: Das, Margaret; Obstetrics and Gynecology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2001; Project Start 1-AUG-2001 Summary: Escherichia coli expressing Dr adhesin cause pyelonephritis and related AFA-III cause cystitis. This study seeks to identify the receptor-binding site of DraE and provide insights into the mechanism of renal vs bladder tropism. Aim 1. To identify and characterize domains of Dr fimbriae that interact with DAF. We propose that N-terminal surface exposed residues of DraE form an assembled epitope that bind DAF. The hydrophilic domain Val30 to Pro42 will be mutated by alanine-scanning mutagenesis and mutants analyzed for binding and invasion of DAF+ CHO cells. Aim 2. To investigate the pathogenic mechanism that determines kidney vs bladder tropism of Dr+ E. coli. DraE and AWE differ in three amino acids (D54N, T90M, I113T). Dr+E. coli infect the kidneys while AFA-III+ E. coli infect the bladder. Amino acids of DraE will be replaced with those of Afa3E and renal tropism analysed using isogenic mutants of E. coli HI 11128 in mice. Aim 3. To study attachment and cell invasion by DraE and Afa3E adhesins. DraE is more invasive than Afa3E. We will study invasion using polystyrene beads coated with purified DraE mutants, immunogold staining and electron microscopy. Resolving the binding domain will enable design of peptide inhibitors against the common receptor preventing bacterial dispersion and cell invasion. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: EAE Gene Cluster of Enteropathogenic E Coli Principal Investigator & Institution: Donnenberg, Michael S.; Medicine; University of Maryland Balt Prof School Professional Schools Baltimore, Md 21201 Timing: Fiscal Year 2000; Project Start 1-FEB-1992; Project End 1-JAN2002 Summary: (Adapted from the applicants abstract): Enteropathogenic Escherichia coli (EPEC), a leading cause of infant diarrhea worldwide,
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can attach intimately to host cells, efface microvilli and disrupt the cytoskeleton in a process known as attaching and effacing. A complete characterization of the attaching and effacing effect would greatly advance our understanding of pathogen-host interactions and is the long term goal of this project. The eae gene cluster is required for attaching and effacing. Within this cluster are genes encoding at least two proteins that are secreted by EPEC, EspA and EspB. When expressed in host cells, EspB causes dramatic changes in cellular morphology. In the studies described in this proposal, the proteins encoded by the eae gene cluster will be used as tools to dissect the molecular and cellular events that occur during attaching and effacing. Each of the remaining genes of the cluster will be mutated to assign a role for each locus in attaching and effacing. Experiments to elucidate functional roles as chaperones, components of the secretion apparatus, and signaling proteins are described. Detailed studies of the precise role of EspB in pathogenesis will be performed to test the primary hypothesis that EspB acts inside the host cell to directly alter signaling proteins involved in cytoskeletal dynamics. The functions of different domains of the EspB protein will be explored in carefully planned structure-function studies. Finally, the role of the EspA protein in pathogenesis will be studied, exploring the hypothesis that EspA is required for EspB translocation to the cell cytoplasm. A detailed understanding of the molecular events that result in the attaching and effacing effect is likely to emerge from these studies. Knowledge of the precise events involved in attaching and effacing will lead to a better understanding of EPEC infection, of enterohemorrhagic E. coli infection, of interactions between bacteria and host cells, and of regulation of the host cell cytoskeleton. This information may result in new strategies for preventing and ameliorating infections. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Effects of E. Coli On Intestinal Function Principal Investigator & Institution: Hecht, Gail A.; Chief; Medicine; University of Illinois at Chicago at Chicago Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 1-JUN-1997; Project End 0-JUN2006 Summary: Enteropathogenic Escherichia coli (EPEC) is a major cause of diarrhea worldwide and is associated with high rates of morbidity and mortality. The mechanisms underlying EPEC pathogenesis are not understood. EPEC has direct effects on host intestinal epithelial functions including tight junction (TJ) permeability which is believed to contribute to diarrhea. The objective of this proposal is to elucidate the cellular and molecular basis for the EPEC-induced alterations in host intestinal
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epithelial tight junction barrier function. In part, the changes in intestinal TJ permeability are related to contraction of the perijunctional cytoskeletal ring. EPEC also alters TJ-associated proteins, including occludin, ZO-1, and claudin-1. Several TJ proteins directly interact with the cytoskeleton thus reconciling the observation that EPEC may exploit both mechanisms by which the TJ barrier is regulated. Experiments for Specific Aim 1 will characterize the effects of EPEC on individual TJ proteins and their interactions with each other. The focus of Specific Aim 2 will be to investigate the relationship between the two mechanisms by which EPEC perturbs the TJ barrier i.e., cytoskeletal contraction and alterations in TJ proteins. The proteins that transmit signals initiated by EPEC attachment to the host cell are not defined. Ezrin, a membranecytoskeleton linker molecule capable of mediating signal transduction events, may be involved in the cross-talk between microbe and host. Specific Aim 3 will define the role of the membrane-cytoskeleton linker protein ezrin in EPEC-induced alterations in tight junctions. EPEC virulence genes are likely involved in the perturbation of TJ barrier function since non- pathogenic E. coli do not elicit the same effect. The pathogenicity island of EPEC, called the locus of enterocyte effacement, has been sequenced and cloned and contains genes encoding type III secretory machinery, through which bacteria directly deliver proteins into host cells. Studies outlined in Specific Aim 4 will determine the specific EPEC proteins involved in the alteration of host intestinal epithelial TJ proteins and identify the signaling pathways responsible. These Specific Aims will address the overall hypothesis of this proposal which is that EPEC disrupts the tight junction barrier by stimulating contraction of the perijunctional cytoskeletal ring and by altering tight junction-associated proteins via signaling pathways transduced by the membrane-cytoskeletal linker protein ezrin. We further hypothesize that specific EPEC attachment factors and/or injection of proteins into host intestinal epithelial cells by type III secretion are responsible for this physiological alteration. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Functional Genomic/Proteomic Analysis of E Coli 0157:H7 Principal Investigator & Institution: Conway, Tyrrell; Associate Professor; University of Oklahoma Hlth Sciences Ctr Health Sciences Center Oklahoma City, Ok 73190 Timing: Fiscal Year 2000; Project Start 5-SEP-2000; Project End 1-AUG2005 Summary: The CDC estimates that over 73,000 cases of E. coli O157:H7 infections occur annually in the US, but the pathogenesis of E. coli
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O157:H7 is poorly understood. The first step in gastro-intestinal disease is colonization, yet despite extensive research next to nothing is known about this process. To colonize the intestinal tract, E. coli O157:H7 must survive the hostile acidic pH of the gastric contents, pass through the small intestine, adhere to the colonic intestinal epithelium, adapt to the colonic environment, and acquire essential nutrients for growth. The same is true for the 400-500 commensal species that inhabit the mammalian large intestine and again, next to nothing is known about this process. For the last few years, we have used colonization by commensal E. coli strains as a model and are beginning to understand the process better. Mucus provides the nutrients necessary for commensal E. coli strains to colonize. Our results substantiate the essential role of mucus-derived sugar acids-hexonic and neuronic acids-for intestinal colonization by E. coli and stand in contrast to widely held, yet unchallenged assumption that glucose is the major carbon source available to microbial invaders- but there is essentially no free glucose in the colon. Our improved understanding of colonization came as we began to use functional genomics tools for examining E. coli metabolism during in vitro growth and intestinal colonization by commensal strains to include a pathogen. We will develop functional genomic tools to understand the in situ physiology of E. coli O157:H7, and thus illuminate the process by which intestinal pathogens first colonize a host. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: New Animal Model for EHEC Pathogenesis and Prevention Principal Investigator & Institution: Butterton, Joan R.; Assistant Professor; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 1-JUL-2005 Summary: (adapted from the application) Investigation of the gastrointestinal disease and renal injury caused by enterohemorrhagic Escherichia coli (EHEC) and the development and testing of interventions to prevent disease following infection have been hampered by the lack of a convenient animal model that effectively reproduces the typical human colonic disease that progresses to HUS. The Principal Investigator proposes to develop the use of a new mouse model of EHEC infection with the long term goal of increasing the ability to study disease pathogenesis and prevention. The new animal model will be compared with prior models in the evaluation of vaccine strategies against EHEC. This will be accomplished through the following two Specific Aims: 1. Evaluation of the use of Citrobacter rodentium expressing Stx in a mouse model of Shiga toxin-producing E. Coli (STEC) infection. C. rodentium, a
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naturally occurring pathogen of laboratory mice which causes transmissible murine colonic hyperplasia, binds to the mouse enterocyte by a specific attachment and effacement lesion similar to that of EHEC. Strategies have been developed to lysogenize C. rodentium with antibiotic-marked Stx1- and Stx2-expressing bacteriophages as well as to express toxin components from plasmid vectors. Toxin production, phage induction, and lysogen stability will be evaluated in vitro. Mice will be challenged with toxin-producing C. rodentium and evaluated for clinical and pathologic signs of disease. This model has the potential of reproducing both the gastrointestinal and renal injury seen in EHEC infection, allows the use of adult animals and the development of normal immune responses, utilizes the power of mouse genetics to investigate genetic factors in determining gastrointestinal (GI) and systemic disease expression, and provides a significant increase in the ease of identifying and testing new interventions compared to many other animal models. 2. Expression of nontoxic Stx1 and Stx2 antigens using a balanced lethal plasmid system in Vibrio cholerae vaccine strains. Vibrio cholerae will be used as a live oral attenuated vaccine vector to deliver immunogenic antigens of EHEC to stimulate a common mucosal immune response. A balanced lethal plasmid system will be used to provide stable expression of the heterologous antigens from the vaccine strains. The germfree mouse model of V. cholerae colonization will be used to examine mucosal and systemic immune responses to the toxin components expressed by the vector strains. The new mouse challenge model will be compared to prior mouse models in evaluating protection from disease in response to immunization with V. cholerae strains expressing the EHEC antigens. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Pathophysiology of Childhood Hemolytic Uremic Syndrome Principal Investigator & Institution: Tarr, Phillip I.; Associate Professor; Children's Hospital and Reg Medical Ctr Box 5371, 4800 Sand Pt Way Ne Seattle, Wa 98105 Timing: Fiscal Year 2000; Project Start 0-SEP-1996; Project End 1-AUG2001 Summary: Approximately 10% of children with Escherichia coli 0157:H7 infection develop the hemolytic uremic syndrome (HUS). The pathophysiologic cascade leading from gastrointestinal infection with this Shiga-toxigenic organism to systemic vascular injury is incompletely understood. There are no suitable animal models in which glomerular thrombotic lesions result from enteral or parenteral challenge with Shiga-
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toxin, or enteral challenge with E. coli 0157:H7 or other Shiga-toxigenic E. Coli. Escherichia coli 0157:H7 infection remains frequently diagnosed in western Washington children before HUS ensues, thereby identifying a population of children at high risk of developing microangiopathic sequelae within a week. This study will examine such children, and assay a selected variety of circulating, urinary and fecal inflammatory, prothrombotic, vasoactive, genetic, and microbial factors which could plausibly play, initiate and/or perpetuate microangiopathic abnormalities leading to HUS. These include cytokines, thrombogenic factors, fibrinolytic factors, markers of endothelial cell injury/activation, arachidonic acid metabolites, circulating endotoxin levels, platelet activating factor concentrations, expression of host cell antigens, concentrations of E. coli 0157:H7 and of fecal free toxin, and toxin genotype. In addition to defining the elements of the cascade leading to kidney failure in children with E. coli 0157:H7 infection, this research could also identify the group at highest risk of developing HUS following enteric infection E. coli 0157:H7, thereby suggesting children most likely to benefit from novel therapeutic strategies. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Phage Encoded Functions in Enterohemorrhagic E.Coli Principal Investigator & Institution: Christie, Gail E.; Microbiology and Immunology; Virginia Commonwealth University 901 W Franklin St Richmond, Va 23284 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 9-SEP-2002 Summary: (adapted from the application) The long-term goal of this research is to understand the role of temperate phages in, and the contribution of phage-encoded gene products to, the virulence of enterohemorrhagic Escherichia coli (EHEC). EHEC are emerging foodborne pathogens that have caused large-scale outbreaks of gastrointestinal illness in developed countries during the past two decades. Intestinal infection can lead to diarrhea, hemorrhagic colitis or more severe systemic complications, such as hemolytic uremic syndrome. The production of Shiga toxins by EHEC strains plays an important role in the development of serious complications following EHEC infection. Two immunologically distinct Shiga toxins, designated Stx1 and Stx2, have been identified among clinical E. coli isolates of many serotypes. Genes for both Shiga toxin types in E. coli have been shown to be encoded on lysogenic lambdoid bacteriophages. These Shiga toxinencoding phages have played an important role in transmitting the stx genes during the evolution of Stx-producing enteric pathogens, and continue to be involved in ongoing dissemination of Shiga toxin genes to
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new hosts. In addition, recent studies have shown that the toxin genes appear to be integrated into the lytic circuitry of these phages in such a way that prophage induction leads to increased toxin gene expression and concomitant release of toxin by host cell lysis. One aim of the experiments outlined in this application is to define more clearly the roles of phage-encoded functions in toxin gene expression and toxin release. A second aim of the application is to investigate other phage-encoded genes that are postulated to play roles in lysogenic conversion. The products of these genes may affect processes, such as colonization or immune evasion, that could contribute to the virulence of lysogenic bacteria. Using the Stx2-encoding phage 933W, which has been sequenced in its entirety, directed mutations in individual genes will be constructed. The effects of these mutations on Shiga toxin production or other interactions with host cells will be assessed in vitro, and effects on virulence using a mouse model system will be determined. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: RNA Polymerase Sigma Subunit--Structure and Function Principal Investigator & Institution: Burgess, Richard R.; Professor; Oncology; University of Wisconsin Madison 500 Lincoln Dr Madison, Wi 53706 Timing: Fiscal Year 2000; Project Start 1-DEC-1980; Project End 1-MAR2001 Summary: We propose to study in detail the structure of the Escherichia coli RNA polymerase major sigma subunit(sigma70),the interaction of sigma70 with core polymerase subunits, and the additional members of the sigma family and how they compete for binding to core. In this way we hope to understand how sigma70 functions to determine the selectivity of RNA polymerase binding and RNA chain initiation, and how the cell can alter its pattern of transcription by using other sigmalike factors. Specifically, our aims are: A. To Study the Structure and Function of Sigma-70. We will test our hypothesis that sigma70 forms a "hairpin" structure and must open or partially unfold to function. We will crystallize sigma70, determine its 3-D crystal structure, and compare its structure to other sigmas. We will use mutations and protein fragments to probe functional domains utilizing a rapid method for producing proteins and protein fragments in Escherichia coli S-30 extract systems. We will determine what step in the transcription process each MAb to sigma70 is inhibiting. We will more precisely epitope map and study several particularly interesting MAbs. B. To Identify Regions of Core Polymerase Subunits Involved in Sigma Interaction. We will use chemical crosslinking and specific MAbs to determine the site of binding of
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sigma70 and a short 25 amino acid region of sigma70 to core. We will also determine the regions on core involved in interactions with other sigmas. C. To Study Competition of Sigma-Family Members for Core. We will measure the in vivo levels of known sigmas as a function of growth conditions. We will study the competition of these various sigmas for core polymerase both in vivo and in purified in vitro systems. We will examine the role of anti-sigmas in affecting sigma competition. D. To Study Sigma-S and Sigma-70 Holoenzyme Interaction with the bolAp1 Promoter. We will determine the interactions of holoenzyme containing sigma70 or sigmaS with the bolAp1 promoter and determine why both holoenzymes function in vitro but only E-sigma-S functions in vivo at this promoter. We propose to continue to study sigma structure and function by a concerted use of biochemistry, protein and physical chemistry, MAb. technology, and molecular genetics. Our long experience studying sigma and our recent progress place us in a unique position to carry out the proposed experiments and to answer many important remaining questions about the structure and function of Escherichia coli sigmas. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central20 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).21 Access to this growing archive of e-journals is free and unrestricted.22 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “Escherichia coli” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for Escherichia coli in the PubMed Central database:
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 21 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 22 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 20
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A model combining cell physiology and population genetics to explain Escherichia coli laboratory evolution by Martin Grana and Luis Acerenza; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64492
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A second NAD +-dependent DNA ligase (LigB) in Escherichia coli by Verl Sriskanda and Stewart Shuman; 2001 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=97608&ren dertype=external
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An architectural role of the Escherichia coli chromatin protein FIS in organising DNA by Robert Schneider, Rudolf Lurz, Gerhild Luder, Carolin Tolksdorf, Andrew Travers, and Georgi Muskhelishvili; 2001 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=97572&ren dertype=external
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Association of the Urease Gene with Enterohemorrhagic Escherichia coli Strains Irrespective of Their Serogroups by Masayuki Nakano, Tetsuya Iida, Makoto Ohnishi, Ken Kurokawa, Akira Takahashi, Teizo Tsukamoto, Teruo Yasunaga, Tetsuya Hayashi, and Takeshi Honda; 2001 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88583&ren dertype=external
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Automated Ribotyping Provides Rapid Phylogenetic Subgroup Affiliation of Clinical Extraintestinal Pathogenic Escherichia coli Strains by Olivier Clermont, Christophe Cordevant, Stephane Bonacorsi, Armelle Marecat, Marc Lange, and Edouard Bingen; 2001 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88585&ren dertype=external
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Beyond Serotypes and Virulence-Associated Factors: Detection of Genetic Diversity among O153:H45 CFA/I Heat-Stable Enterotoxigenic Escherichia coli Strains by A. B. F. Pacheco, L. C. S. Ferreira, M. G. Pichel, D. F. Almeida, N. Binsztein, and G. I. Viboud; 2001 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88573&ren dertype=external
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Binding specificity of Escherichia coli trigger factor by Holger Patzelt, Stefan Rudiger, Dirk Brehmer, Gunter Kramer, Sonja Vorderwulbecke, Elke Schaffitzel, Andreas Waitz, Thomas Hesterkamp, Liying Dong, Jens Schneider-Mergener, Bernd Bukau, and Elke Deuerling; 2001 December 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64667
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Evaluation of thresholds for the detection of binding sites for regulatory proteins in Escherichia coli K12 DNA by Esperanza BenitezBellon, Gabriel Moreno-Hagelsieb, and Julio Collado-Vides; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88811
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First isolation of the enterohaemorrhagic Escherichia coli O145:H- from cattle in feedlot in Argentina by Nora L. Padola, Marcelo E. Sanz, Paula M. A. Lucchesi, Jesus E. Blanco, Jorge Blanco, Miguel Blanco, Analia I. Etcheverria, Guillermo H. Arroyo, and Alberto E. Parma; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=102760
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From the Cover:IscR, an Fe-S cluster-containing transcription factor, represses expression of Escherichia coli genes encoding Fe-S cluster assembly proteins by Christopher J. Schwartz, Jennifer L. Giel, Thomas Patschkowski, Christopher Luther, Frank J. Ruzicka, Helmut Beinert, and Patricia J. Kiley; 2001 December 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64955
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Genetic control of manno(fructo)kinase activity in Escherichia coli by Andrew A. Sproul, Linda T. M. Lambourne, Jims Jean-Jacques D, and Hans L. Kornberg; 2001 December 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=65016
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Long term adaptation of a microbial population to a permanent metabolic constraint: overcoming thymineless death by experimental evolution of Escherichia coli by Valerie A. de Crecy-Lagard, Jacques Bellalou, Rupert Mutzel, and Philippe Marliere; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=60676
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Mode of DNA --protein interaction between the C-terminal domain of Escherichia coli RNA polymerase [alpha] subunit and T7D promoter UP element by Olga N. Ozoline, Nobuyuki Fujita, and Akira Ishihama; 2001 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=97620&ren dertype=external
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Occurrence of leu+ revertants under starvation cultures in Escherichia coli is growth-dependent by Jianling Jin, Peiji Gao, and Yumin Mao; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=115868
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Oxygen and nitrate-dependent regulation of dmsABC operon expression in Escherichia coli: sites for Fnr and NarL protein interactions by Shawn M. D. Bearson, Jeffrey A. Albrecht, and Robert P. Gunsalus; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=116602
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Pattern formation in Escherichia coli: A model for the pole-to-pole oscillations of Min proteins and the localization of the division site by Hans Meinhardt and Piet A. J. de Boer; 2001 December 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64659
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Selective Permeation and Organic Extraction of Recombinant Green Fluorescent Protein (gfpuv) from Escherichia coli by Thereza Christina Vessoni Penna and Marina Ishii; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=115201
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.23 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with Escherichia coli, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “Escherichia coli” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “Escherichia coli” (hyperlinks lead to article summaries): ·
Methods for the detection and isolation of Shiga toxin-producing Escherichia coli. Author(s): De Boer E, Heuvelink AE. Source: Symp Ser Soc Appl Microbiol. 2000; (29): 133S-143S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10880188&dopt=Abstract
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Molecular Cloning and Expression in Escherichia coli of an ExoLevanase Gene from the Endophytic Bacterium Gluconacetobacter
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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diazotrophicus SRT4. Author(s): Menendez C, Hernandez L, Selman G, Mendoza MF, Hevia P, Sotolongo M, Arrieta JG. Source: Current Microbiology. 2002 July; 45(1): 5-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12029520&dopt=Abstract ·
Molecular cloning of a 10-deacetylbaccatin III-10-O-acetyl transferase cDNA from Taxus and functional expression in Escherichia coli. Author(s): Walker K, Croteau R. Source: Proceedings of the National Academy of Sciences of the United States of America. 2000 January 18; 97(2): 583-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10639122&dopt=Abstract
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Molecular cloning of a taxa-4(20),11(12)-dien-5alpha-ol-O-acetyl transferase cDNA from Taxus and functional expression in Escherichia coli. Author(s): Walker K, Schoendorf A, Croteau R. Source: Archives of Biochemistry and Biophysics. 2000 February 15; 374(2): 371-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10666320&dopt=Abstract
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Molecular cloning, sequencing, and expression in Escherichia coli of the gene encoding a novel 5-oxoprolinase without ATP-hydrolyzing activity from Alcaligenes faecalis N-38A. Author(s): Nishimura A, Oyama H, Hamada T, Nobuoka K, Shin T, Murao S, Oda K. Source: Applied and Environmental Microbiology. 2000 August; 66(8): 3201-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10919770&dopt=Abstract
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Molecular sieve mechanism of selective release of cytoplasmic proteins by osmotically shocked Escherichia coli. Author(s): Vazquez-Laslop N, Lee H, Hu R, Neyfakh AA. Source: Journal of Bacteriology. 2001 April; 183(8): 2399-404. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11274096&dopt=Abstract
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Mucosal immunization of mice using CpG DNA and/or mutants of the heat-labile enterotoxin of Escherichia coli as adjuvants. Author(s): McCluskie MJ, Weeratna RD, Clements JD, Davis HL. Source: Vaccine. 2001 June 14; 19(27): 3759-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11395211&dopt=Abstract
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Mutational scanning and affinity cleavage analysis of UhpA-binding sites in the Escherichia coli uhpT promoter. Author(s): Olekhnovich IN, Kadner RJ. Source: Journal of Bacteriology. 2002 May; 184(10): 2682-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11976297&dopt=Abstract
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NADP-dependent isocitrate dehydrogenase from the halophilic archaeon Haloferax volcanii: cloning, sequence determination and overexpression in Escherichia coli. Author(s): Camacho M, Rodriguez-Arnedo A, Bonete MJ. Source: Fems Microbiology Letters. 2002 April 9; 209(2): 155-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12007799&dopt=Abstract
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Novel substrates of Escherichia coli nth protein and its kinetics for excision of modified bases from DNA damaged by free radicals. Author(s): Dizdaroglu M, Bauche C, Rodriguez H, Laval J. Source: Biochemistry. 2000 May 9; 39(18): 5586-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10820032&dopt=Abstract
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Oriented channels reveal asymmetric energy barriers for sugar translocation through maltoporin of Escherichia coli. Author(s): Van Gelder P, Dumas F, Rosenbusch JP, Winterhalter M. Source: European Journal of Biochemistry / Febs. 2000 January; 267(1): 79-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10601853&dopt=Abstract
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Overproduction in Escherichia coli, purification and characterization of a family I.3 lipase from Pseudomonas sp. MIS38. Author(s): Amada K, Haruki M, Imanaka T, Morikawa M, Kanaya S.
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Source: Biochimica Et Biophysica Acta. 2000 May 23; 1478(2): 201-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10825531&dopt=Abstract ·
Polymerase chain reaction assay for detection of Escherichia coli O157: H7 and Escherichia coli O157: H-. Author(s): Miyamoto T, Ichioka N, Sasaki C, Kobayashi H, Honjoh K, Iio M, Hatano S. Source: Journal of Food Protection. 2002 January; 65(1): 5-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11808805&dopt=Abstract
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Positioning of sigma(S), the stationary phase sigma factor, in Escherichia coli RNA polymerase-promoter open complexes. Author(s): Colland F, Fujita N, Kotlarz D, Bown JA, Meares CF, Ishihama A, Kolb A. Source: The Embo Journal. 1999 July 15; 18(14): 4049-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10406809&dopt=Abstract
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Prevalence of Escherichia coli O157:H7 from cull dairy cows in New York state and comparison of culture methods used during preharvest food safety investigations. Author(s): McDonough PL, Rossiter CA, Rebhun RB, Stehman SM, Lein DH, Shin SJ. Source: Journal of Clinical Microbiology. 2000 January; 38(1): 318-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10618108&dopt=Abstract
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Purification and characterization of a beta-lactamase from Haemophilus ducreyi in Escherichia coli. Author(s): Lawung R, Prachayasittikul V, Bulow L. Source: Protein Expression and Purification. 2001 October; 23(1): 151-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11570857&dopt=Abstract
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Purification and characterization of a mammalian homolog of Escherichia coli MutY mismatch repair protein from calf liver mitochondria. Author(s): Parker A, Gu Y, Lu AL.
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Source: Nucleic Acids Research. 2000 September 1; 28(17): 3206-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10954587&dopt=Abstract ·
Purification and characterization of aminopeptidase B from Escherichia coli K-12. Author(s): Suzuki H, Kamatani S, Kumagai H. Source: Biosci Biotechnol Biochem. 2001 July; 65(7): 1549-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11515538&dopt=Abstract
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Purification and characterization of recombinant Plasmodium falciparum adenylosuccinate synthetase expressed in Escherichia coli. Author(s): Jayalakshmi R, Sumathy K, Balaram H. Source: Protein Expression and Purification. 2002 June; 25(1): 65-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12071700&dopt=Abstract
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Purification and properties of Aquifex aeolicus DNA polymerase expressed in Escherichia coli. Author(s): Chang JR, Choi JJ, Kim HK, Kwon ST. Source: Fems Microbiology Letters. 2001 July 10; 201(1): 73-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11445170&dopt=Abstract
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Purification and properties of Thermus filiformis DNA polymerase expressed in Escherichia coli. Author(s): Choi JJ, Jung SE, Kim HK, Kwon ST. Source: Biotechnology and Applied Biochemistry. 1999 August; 30 ( Pt 1): 19-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10467114&dopt=Abstract
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Purification of bovine S100A12 from recombinant Escherichia coli. Author(s): Yamashita K, Oyama Y, Shishibori T, Matsushita O, Okabe A, Kobayashi R. Source: Protein Expression and Purification. 1999 June; 16(1): 47-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10336859&dopt=Abstract
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Purification of the Ca2+-binding protein S100A1 from myocardium and recombinant Escherichia coli.
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Author(s): Ehlerman P, Remppis A, Most P, Bernotat J, Heizmann CW, Katus HA. Source: J Chromatogr B Biomed Sci Appl. 2000 January 14; 737(1-2): 3945. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10681039&dopt=Abstract ·
Purification, characterization, and immunogenicity of the refolded ectodomain of the Plasmodium falciparum apical membrane antigen 1 expressed in Escherichia coli. Author(s): Dutta S, Lalitha PV, Ware LA, Barbosa A, Moch JK, Vassell MA, Fileta BB, Kitov S, Kolodny N, Heppner DG, Haynes JD, Lanar DE. Source: Infection and Immunity. 2002 June; 70(6): 3101-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12011004&dopt=Abstract
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Reduction of Listeria monocytogenes and Escherichia coli O157:H7 numbers on vacuum-packaged fresh beef treated with nisin or nisin combined with EDTA. Author(s): Zhang S, Mustapha A. Source: Journal of Food Protection. 1999 October; 62(10): 1123-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10528714&dopt=Abstract
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Refolding and purification of yeast carboxypeptidase Y expressed as inclusion bodies in Escherichia coli. Author(s): Hahm MS, Chung BH. Source: Protein Expression and Purification. 2001 June; 22(1): 101-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11388806&dopt=Abstract
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Response surface modeling for the inactivation of Escherichia coli O157:H7 on green peppers (Capsicum annuum L.) by chlorine dioxide gas treatments. Author(s): Han Y, Floros JD, Linton RH, Nielsen SS, Nelson PE. Source: Journal of Food Protection. 2001 August; 64(8): 1128-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11510647&dopt=Abstract
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Selective Permeation and Organic Extraction of Recombinant Green Fluorescent Protein (gfpuv) from Escherichia coli. Author(s): Christina Vessoni Penna T, Ishii M.
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Source: Bmc Biotechnology [electronic Resource]. 2002 April 24; 2(1): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11972900&dopt=Abstract ·
Short term treatment with Escherichia coli recombinant human granulocyte-macrophage-colony stimulating factor prior to chemotherapy for Hodgkin disease. Author(s): Aglietta M, Montemurro F, Fagioli F, Volta C, Botto B, Cantonetti M, Racanelli V, Teofili L, Ferrara R, Amadori S, Castoldi GL, Dammacco F, Levis A. Source: Cancer. 2000 January 15; 88(2): 454-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10640980&dopt=Abstract
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Spinach holo-acyl carrier protein: overproduction and phosphopantetheinylation in Escherichia coli BL21(DE3), in vitro acylation, and enzymatic desaturation of histidine-tagged isoform I. Author(s): Broadwater JA, Fox BG. Source: Protein Expression and Purification. 1999 April; 15(3): 314-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10092491&dopt=Abstract
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Substrate recognition by Escherichia coli MutY using substrate analogs. Author(s): Chepanoske CL, Porello SL, Fujiwara T, Sugiyama H, David SS. Source: Nucleic Acids Research. 1999 August 1; 27(15): 3197-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10454618&dopt=Abstract
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Survival of enterohemorrhagic Escherichia coli O157:H7 in retail mustard. Author(s): Mayerhauser CM. Source: Journal of Food Protection. 2001 June; 64(6): 783-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11403126&dopt=Abstract
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Taxol biosynthesis: molecular cloning of a benzoyl-CoA:taxane 2alphaO-benzoyltransferase cDNA from taxus and functional expression in Escherichia coli. Author(s): Walker K, Croteau R.
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Source: Proceedings of the National Academy of Sciences of the United States of America. 2000 December 5; 97(25): 13591-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11095755&dopt=Abstract ·
The comparison of aluminium effects and its uptake by Escherichia coli in different media. Author(s): Bojic A, Purenovic M, Kocic B, Mihailovic D, Bojic D. Source: Cent Eur J Public Health. 2002 June; 10(1-2): 66-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12096687&dopt=Abstract
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The effect of EDTA and fulvic acid on Cd, Zn, and Cu toxicity to a bioluminescent construct (pUCD607) of Escherichia coli. Author(s): Campbell CD, Hird M, Lumsdon DG, Meeussen JC. Source: Chemosphere. 2000 February; 40(3): 319-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10665423&dopt=Abstract
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The impact of infant feeding patterns on infection and diarrheal disease due to enterotoxigenic Escherichia coli. Author(s): Long K, Vasquez-Garibay E, Mathewson J, de la Cabada J, DuPont H. Source: Salud Publica Mex. 1999 July-August; 41(4): 263-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10624137&dopt=Abstract
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The mechanism of carbonate killing of Escherichia coli. Author(s): Jarvis GN, Fields MW, Adamovich DA, Arthurs CE, Russell JB. Source: Letters in Applied Microbiology. 2001 September; 33(3): 196-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11555203&dopt=Abstract
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The NRAMP proteins of Salmonella typhimurium and Escherichia coli are selective manganese transporters involved in the response to reactive oxygen. Author(s): Kehres DG, Zaharik ML, Finlay BB, Maguire ME. Source: Molecular Microbiology. 2000 June; 36(5): 1085-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10844693&dopt=Abstract
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UDP-3-O-(R-3-hydroxymyristoyl)-N-acetylglucosamine deacetylase of Escherichia coli is a zinc metalloenzyme. Author(s): Jackman JE, Raetz CR, Fierke CA. Source: Biochemistry. 1999 February 9; 38(6): 1902-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10026271&dopt=Abstract
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Verocytotoxin-producing Escherichia coli O157: public health and microbiological significance. Author(s): Bolton FJ, Aird H. Source: Br J Biomed Sci. 1998 June; 55(2): 127-35. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10198471&dopt=Abstract
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ZupT is a Zn(II) uptake system in Escherichia coli. Author(s): Grass G, Wong MD, Rosen BP, Smith RL, Rensing C. Source: Journal of Bacteriology. 2002 February; 184(3): 864-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11790762&dopt=Abstract
Vocabulary Builder Aberrant: Wandering or deviating from the usual or normal course. [EU] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Acylation: The addition of an organic acid radical into a molecule. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Alcaligenes: A genus of gram-negative, aerobic, motile bacteria that occur in water and soil. Some are common inhabitants of the intestinal tract of vertebrates. These bacteria occasionally cause opportunistic infections in humans. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broad-spectrum antibiotic. [NIH]
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Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Azoxymethane: A potent carcinogen and neurotoxic compound. It is particularly effective in inducing colon carcinomas. [NIH] Bacteriophages: Viruses whose host is a bacterial cell. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biogenesis: The origin of life. It includes studies of the potential basis for life in organic compounds but excludes studies of the development of altered forms of life through mutation and natural selection, which is evolution. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Bordetella: A genus of gram-negative, aerobic bacteria whose cells are minute coccobacilli. It consists of both parasitic and pathogenic species. [NIH] Bronchoconstriction: The act or process of decreasing the calibre of a bronchus; bronchostenosis. [EU] Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Catechin: Extracted from Uncaria gambier, Acacia catechu and other plants;
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it stabilizes collagen and is therefore used in tanning and dyeing; it prevents capillary fragility and abnormal permeability, but was formerly used as an antidiarrheal. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Citrobacter: A genus of gram-negative, rod-shaped enterobacteria that can use citrate as the sole source of carbon. [NIH] Colitis: Inflammation of the colon. [EU] Commensal: 1. living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. an organism living on or within another, but not causing injury to the host. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxins: Substances elaborated by microorganisms, plants or animals that are specifically toxic to individual cells; they may be involved in immunity or may be contained in venoms. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Digitalis: A genus of toxic herbaceous Eurasian plants of the Scrophulaceae which yield cardiotonic glycosides. The most useful are Digitalis lanata and D. purpurea. [NIH] Dysuria: Painful or difficult urination. [EU] Empiric:
Empirical; depending upon experience or observation alone,
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without using scientific method or theory. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Erythrina: A genus of leguminous shrubs or trees, mainly tropical, yielding certain alkaloids, lectins, and other useful compounds. [NIH] Erythritol: A four-carbon sugar that is found in algae, fungi, and lichens. It is twice as sweet as sucrose and can be used as a coronary vasodilator. [NIH] Exfoliation: A falling off in scales or layers. [EU] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU]
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Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Handwashing: The act of cleansing the hands with water or other liquid, with or without the inclusion of soap or other detergent, for the purpose of removing soil or microorganisms. [NIH] Hemagglutinins: Agents that cause agglutination of red blood cells. They include antibodies, blood group antigens, lectins, autoimmune factors, bacterial, viral, or parasitic blood agglutinins, etc. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunization: The induction of immunity. [EU] Immunogenic: Producing immunity; evoking an immune response. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals,
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including humans. Pathogenicity from this genus is rare. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lethal: Deadly, fatal. [EU] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microvilli: Minute projections of cell membranes which greatly increase the surface area of the cell. [NIH] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Myocardium: The muscle tissue of the HEART composed of striated, involuntary muscle known as cardiac muscle. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents
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the passage of solute molecules, but is permeable to the solvent). [EU] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Periplasm: The space between the inner and outer membranes of a cell that is shared with the cell wall. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Pseudomonas: A genus of gram-negative, aerobic, rod-shaped bacteria widely distributed in nature. Some species are pathogenic for humans, animals, and plants. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid
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hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Ribotyping: Restriction fragment length polymorphism analysis of rRNA genes that is used for differentiating between species or strains. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spermicide: An agent that is destructive to spermatozoa. [EU] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]
Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Technetium: The first artificially produced element and a radioactive fission product of uranium. The stablest isotope has a mass number 99 and is used diagnostically as a radioactive imaging agent. Technetium has the atomic symbol Tc, atomic number 43, and atomic weight 98.91. [NIH] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin.
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2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Toxic: Pertaining to, due to, or of the nature of a poison or toxin; manifesting the symptoms of severe infection. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vibrio: A genus of vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
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CHAPTER 5. PATENTS ON ESCHERICHIA COLI Overview You can learn about innovations relating to Escherichia coli by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.24 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with Escherichia coli within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with Escherichia coli. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
24Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Escherichia Coli By performing a patent search focusing on Escherichia coli, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on Escherichia coli: ·
Expression vectors encoding Escherichia coli OmpC as a cell surface anchoring motif Inventor(s): Lee; Sang Yup (Teajon, KR), Xu; Zhaohui (Taejon, KR), Choi; Jong Hyun (Seoul, KR) Assignee(s): Korea Advanced Institute of Science and Technology (Teajon, KR) Patent Number: 6,274,345 Date filed: February 18, 2000 Abstract: The present invention relates to expression vectors containing a gene encoding outer membrane protein C(OmpC) from Escherichia coli as a cell surface anchoring motif, more specifically, to expression vectors comprising a gene encoding OmpC which is designed to express a gene of foreign protein in fused form with OmpC on the cell surface of Escherichia coli, and a method for displaying the desired protein on the surface of the bacteria employing the OmpC as a cell surface anchoring motif. In accordance with the present invention, the desired protein can be expressed efficiently on the cell surface of bacteria so that the expressed protein can be applied to a variety of applications such as live vaccine development, peptide libraries screening, antibody production, environmental bioadsorbent, whole cell catalysis, and biosensor development. Excerpt(s): The present invention relates to expression vectors comprising a gene encoding outer membrane protein C("OmpC") from Escherichia coli (("E. coli") as a cell surface anchoring motif, more specifically, to expression vectors comprising a gene encoding OmpC which is designed to express a gene of foreign protein in fused form with OmpC on the cell
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surface of E. coli, and a method for displaying the desired protein on the surface of E. coli employing the OmpC as a cell surface anchoring motif. Web site: http://www.delphion.com/details?pn=US06274345__ ·
Bacterial strain of Escherichia coli BKIIM B-3996 as the producer of Lthreonine Inventor(s): Debabov; Vladimir Georgievich (Moscow, RU), Kozlov; Jury Ivanovich (Moscow, RU), Khurges; Evgeny Moiseevich (Moscow, RU), Livshits; Vitaly Arkadievich (Moscow, RU), Zhdanova; Nelli Isaakovna (Moscow, RU), Gusyatiner; Mikhail Markovich (Moscow, RU), Sokolov; Alexandr Konstantinovich (Moscow, RU), Bachina; Tatyana Alexandrovna (Moscow, RU), Yankovsky; Nikolai Kazimirovich (Moscow, RU), Tsygankov; Jury Dmitrievich (Moscow, RU), Chistoserdov; Andrei Jurievich (Moscow, RU), Plotnikova; Tatyana Grigorievna (Moscow, RU), Shakalis; Irina Clegovna (Moscow, RU), Belareva; Alla Valentinovna (Moscow, RU), Arsatiants; Raisa Alexandrovna (Moscow, RU), Sholin; Albert Fedorovich (Moscow, RU), Pozdnyakova; Tamara Mikhailovna (Moscow, RU) Assignee(s): Ajinomoto Co., Inc. (Tokyo, JP) Patent Number: 6,165,756 Date filed: September 7, 1999 Abstract: A bacterial strain of Escherichia coli BKIIM B-3996, a producer of L-threonine, containing a recombinant plasmid pVIC40 and deposited on Nov. 19, 1987 in the collection of microorganism cultures at the USSR Antiobiotics Research Institute under Reg. No. 1867. Excerpt(s): The present invention relates generally to micro-biological industry and more specifically it concerns a novel bacterial strain of Escherichia coli BKIIM B-3996 as the producer of L-threonine. ... Known in the present state of the art are the L-threonine producing strains of microorganisms of a variety of species (e.g., Brevibacterium flavum, Serratia marcescens, Escherichia coli, and others). It is the mutating strains of E. coli whose cells contain hybrid plasmids carrying the genes of the threonine operon (U.S. Pat. Nos. 4,278,785; 4,321,325) that prove to be the most officacious L-threonine producers, of which the most productive is Escherichia coli strain VNIIgenetika M-1 (U.S. Pat. No. 4,321,325), which contains multicopy plasmid pYN7 obtained on the base of vector pBR322 and incorporating the threonine operon of E. coli strain K12 resistant to alpha-amino-beta-hydroxyvaleric acid, an analogue of threonine. The genes of the threonine operon of plasmid pYN7 code a bifunctional enzyme, viz., aspartate-kinase-homoserinedehydrogenase,
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which is insensitive to inhibition with L-threonine. Said strain M-1 is capable of accumulating L-threonine till a concentration of 30 g/l for a 40-hour fermentation period in laboratory fermenters when cultivated under conditions of feeding a sugar-ammonia additive to the nutrient medium in response to a signal sent by the pH sensor. ... The aforesaid object is accomplished due to the fact that, according to the invention, proposed herein is a novel bacterial strain of Escherichia coli BKIIM B3996 as the L-threonine producer, said strain containing recombinant plasmid pVIC40 and deposited on Nov. 19, 1987 in the collection of microorganism cultures at the USSR Antibiotics Research Institute under Reg. No. 1867. Web site: http://www.delphion.com/details?pn=US06165756__ ·
Pathogenicity and protective attributes of major clones of Escherichia coli recovered from chickens during processing Inventor(s): Wilson; Richard A. (Boalsburg, PA), Whittam; Thomas (State College, PA), Kapur; Vivek (St. Anthony, MN) Assignee(s): The Penn State Research Foundation (University Park, PA) Patent Number: 6,096,322 Date filed: June 23, 1997 Abstract: New methods and compositions suitable for the vaccination of poultry against pathogenic Escherichia coli are presented. The invention uses the clonal structure of bacterial populations in order to successfully vaccinate against such poultry pathogens by selecting out closely related non-pathogenic organisms. Live E. coli are used to effect immunization. Excerpt(s): The present invention relates to the field of veterinary medicine, specifically to materials and methods for the immunization of poultry against Escherichia coli infections. ... By way of background, Escherichia coli infections in poultry represent a variety of clinical conditions including airsacculitis, pericarditis, and perihepatitis. Collectively, these conditions are a major cause of economic loss to the poultry industry [Gross, W. B., Colibacillosis in Diseases of Poultry, 9th ed., Calnek, B. W. et al., eds., Iowa State University Press, P. 138, 1991]. The extent of the economic loss due to diseases caused by E. coli in poultry, however, is often underestimated because a substantial number of birds are condemned at processing plants. For instance, more than 42 million young chickens were condemned due to airsacculitis or septicemia in 1988 [Anonymous, Federal meat and poultry inspection FY89 Statistical summary annual. July 1990 (P). Congressional Information Service, Washington D.C.]. In 1989, the number of young
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chickens condemned was nearly 40 million accounting for approximately 70% of all condemnations. ... Both airsacculitis and septicemia are conditions that can be caused by E. coli infections, and not surprisingly, E. coli can be readily isolated from tissues of a large percentage of birds that are condemned in processing plants [Kapur, V. et al. Characterization and Clonal Analysis of Escherichia coli Isolated from Poultry During Processing, Manuscript in preparation]. These isolates fell into several previously described genetic clusters of organisms isolated from clinical cases of avian colibacillosis, swollen head syndrome, and from apparently healthy birds [Whittam, T. S., et al. Infect. Immun. 56:2458-2466, 1988; White, D. G., et al. Infect. Immun. 58:3613-3620, 1990], as well as into some clonal groups not previously described. Significantly, none of the isolates recovered from processing plants belonged to clone cluster A1, a majority of whose isolates were recovered from the heart, air sac, or liver, and is thought to be a specialized avian cluster containing pathogenic E. coli. In addition, nearly a third of the isolates recovered from birds condemned at processing plants were previously discovered to belong to a clonal group (cluster C) that contains mostly low virulence strains. These results, along with serotypic analysis of E. coli isolates from processing plants have indicated that the bacterial strains associated with condemnation at processing plants do not necessarily represent the same population of isolates associated with clinical disease. Web site: http://www.delphion.com/details?pn=US06096322__ ·
Method for isolation and identification of Escherichia coli 0157:H7 and plating media for said process Inventor(s): Restaino; Lawrence (Elburn, IL) Assignee(s): R&F Laboratories, Inc. (West Chicago, IL) Patent Number: 6,087,156 Date filed: October 23, 1998 Abstract: A solid plating medium for the presumptive detection of Escherichia coli 0157:H7 which comprises (1) an ingredient which promotes growth of Escherichia coli cells under incubation, (2) an ingredient which inhibits growth of gram positive microorganisms under incubation, (3) an ingredient that inhibits growth of Proteus sp. under incubation, (4) an ingredient which inhibits the growth of strains of Escherichia coli other than Escherichia coli 0157:H7 under incubation, (5) a carbohydrate medium that under incubation is not fermented by Escherichia coli 0157:H7 but which is fermented by other microorganisms
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including other strains of Escherichia coli, (6) a pH indicator dye which changes the plating media to a first color when the pH of the medium changes, (7) a chromogenic beta-galactosidase substrate that produces precipitate of a second color responsive to beta-galactosidase, the first color contrasting with the second color and the first and second colors blending to produce a third color which contrasts with the first and second colors, and (8) a mass of agar sufficient to solidify the mixture. Also, the method of detecting the presence of Escherichia coli 0157:H7 comprising inoculating the solid plating medium set forth above with a test sample containing Escherichia coli including Escherichia coli 0157:H7, then incubating said plating medium for a period sufficient to obtain colonies of microorganisms and generating one or more of the colors produced by the plating medium, and then examining the surface of the medium for the presence of colonies of the second color. Excerpt(s): Escherichia coli 0157:H7 has been recognized as an important human pathogen. Studies have shown that it is principally transmitted through food, Escherichia coli 0157:H7: Epidemiology, Pathogenesis, and Methods for Detection in Food, Nisha V. Padhye and Michael P. Doyle-Journal of Food Protection, Vol. 55, No. 7, Pages 555-565 (July 1992). There is thus a need for a rapid diagnostic test for the presence of Escherichia coli 0157:H7 in food in order to prevent the spread of Escherichia coli 0157:H7 through the food supply. ... Pradhye and Doyle, supra, survey methods of detection of Escherichia coli 0157:H7. A stable characteristic of Escherichia coli 0157:H7 is that it will not ferment sorbitol within 24 hours whereas other strains of Escherichia coli will produce fermentation in sorbitol under incubation temperatures within 24 hours, and this characteristic has been used in processes for the isolation of Escherichia coli 0157:H7 from other enterics. Since there are microorganisms other than Escherichia coli 0157:H7 that do not ferment sorbitol, including some strains of Escherichia coli, this characteristic is not sufficiently specific to serve as an identifying test for Escherichia coli 0157:H7. ... Anita J. Okrend, Bonnie E. Rose and Charles P. Lattuada describe an improved plating medium in Use of 5-Bromo-4-Chloro-3Indoxyl-Beta-D-Glucuronide in MacConkey Sorbitol Agar in the Isolation of Escherichia coli 0157:H7 from Ground Beef, Journal of Food Protection, Vol. 53, No.11, Pages 941-943 (November 1990). This article describes a plating medium in which 5-bromo-4-chloro-3-indoxyl-beta-Dglucuronide acid cyclohexylammonium salt was dissolved in ethanol and the solution added to MacConkey Sorbitol Agar. Since approximately 97% of all Escherichia coli are beta-glucuronidase positive, but Escherichia coli 0157:H7 is beta-glucuronidase negative, this medium responds to the presence of Escherichia coli 0157:H7 by isolating white
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colonies rather than isolating blue colonies resulting from betaglucuronidase positive microorganisms. Web site: http://www.delphion.com/details?pn=US06087156__ ·
Amplification and detection of shigella spp. and enteroinvasive strains of Escherichia coli Inventor(s): Hellyer; Tobin J. (Owings Mills, MD), McMillian; Ray A. (Timonium, MD) Assignee(s): Becton Dickinson and Company (Franklin Lakes, NJ) Patent Number: 6,060,252 Date filed: April 12, 1999 Abstract: Amplification primers and methods for specific amplification and detection of a Shigella spp. and enteroinvasive strains of Escherichia coli (EIEC) target are disclosed. The primer-target binding sequences are useful for amplification and detection of Shigella and EIEC target in a variety of amplification and detection reactions. Excerpt(s): The present invention relates to methods for determining the presence or absence of Shigella spp. and enteroinvasive strains of Escherichia coli (EIEC) in patients, food or water. The method involves using nucleic acid primers to amplify specifically a Shigella and EIEC ipaH target, preferably using one of the techniques of Strand Displacement Amplification (SDA), thermophilic Strand Displacement Amplification (tSDA) or fluorescent real time tSDA, and optionally using a microelectronic array. Web site: http://www.delphion.com/details?pn=US06060252__
·
Strains of Escherichia coli, methods of preparing the same and use thereof in fermentation processes for l-threonine production Inventor(s): Wang; Ming-Der (San Diego, CA), Bradshaw; Jill S. (Decatur, IL), Swisher; Stacia L. (Decatur, IL), Liaw; Hungming James (Champaign, IL), Hanke; Paul D. (Urbana, IL), Binder; Thomas P. (Decatur, IL) Assignee(s): The Archer-Daniels-Midland Company (Decatur, IL) Patent Number: 5,939,307 Date filed: July 29, 1997 Abstract: The present invention relates to novel strains of Escherichia coli and fermentation processes involving these microorganisms. More specifically, the present invention relates to genetically-modified
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Escherichia coli strains and the use thereof for the production of the amino acids, particularly members of the aspartate family of amino acids such as threonine. The present invention also relates to methods of preparing E. coli strains for use in the fermentative production of amino acids. Excerpt(s): The present invention relates to novel strains of Escherichia coli and fermentation processes involving these microorganisms. More specifically, the present invention relates to genetically-modified Escherichia coli strains and the use thereof for the production of the amino acids, particularly members of the aspartate family of amino acids such as threonine. The present invention also relates to methods of preparing E. coli strains for use in the fermentative production of amino acids. ... Because of the problems associated with obtaining high levels of amino acid production via natural biosynthesis (e.g. repression of the thr operon by the desired product), bacterial strains have been produced having plasmids containing a thr operon with a thrA gene that encodes a feedback-resistant enzyme. With such plasmids, L-threonine has been produced on an industrial scale by fermentation processes employing a wide variety of microorganisms, such as Brevibacterium flavum, Serratia marcescens, and Escherichia coli. ... Preferably, the inventive bacterial strains are strains of Escherichia coli. More preferably, the inventive bacterial strains are strains of E. coli that exhibit resistance to the macrolide anitbiotic borrelidin. A particularly preferred example of the inventive bacterial strains is E. coli strain kat-13, which was deposited at the Agricultural Research Service Culture Collection (NRRL), 1815 North University Street, Peoria, Ill. 61604, USA, on Jun. 28, 1996 and assigned accession number NRRL B-21593. Web site: http://www.delphion.com/details?pn=US05939307__ ·
Escherichia coli K-12 strains for production of recombinant proteins Inventor(s): Bogosian; Gregg (Ballwin, MO) Assignee(s): Monsanto Comapny (St. Louis, MO) Patent Number: 5,932,439 Date filed: November 13, 1996 Abstract: Novel Escherichia coli K-12 strains comprising diminished catechol production and/or orotate phosphoribosyltransferase activity levels of at least about 30 units, and methods for the use of such novel Escherichia coli K-12 strains in increasing the production of heterologous proteins therein are disclosed.
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Excerpt(s): The present invention relates to improved Escherichia coli K12 strains and methods for their use in the production of heterologous proteins. In one aspect, the invention relates to the manipulation of E. coli K-12 strain genomic DNA such that said genomic DNA comprise novel combinations of specific wild type genes and heterologous genes. In another aspect, the invention relates to novel E. coli K-12 strains in which specific wild-type genes are reintroduced into the genomes of E. coli K-12 strains lacking said genes. In a further aspect, the invention relates to genetic manipulations of a novel E. coli K-12 strain phenotype, which manipulations provide for increased production of heterologous protein therein. In a further aspect, the invention relates to methods for improving the amount of heterologous protein produced in E. coli K-12 strains, improving the ability to retrieve said proteins, and for improving the yield of heterologous proteins produced in E. coli K-12 strains. ... With the advent of recombinant DNA technology, the use of microorganisms as mini-factories for the production of many useful proteins, enzymes, and other substances has become a routine occurrence. One broad group of microorganisms of choice for use as mini-factories has included organisms from the genus Escherichia and species coli commonly referred to as E. coli. Within this group is a widely used subgroup of organisms which are members of a strain referred to as the E. coli K-12 strain ›see "Escherichia coli and Salmonella typhimurium: Cellular and Molecular Biology", (1987) Neidhardt, F. C. et al. (eds.), American Society for Microbiology, volume 2, chapter 72!. ... Although the E. coli K-12 strain is uniquely different from other E. coli strains, it is, in fact, not a single entity. Rather, it is a family of related bacterial clones, all derived by genetic mutation from an original isolate ›see "Escherichia coli and Salmonella typhimurium: Cellular and Molecular Biology" (1987)!. The E. coli K-12 strains used for both research and commercial purposes today are derivatives of mutant clones which were created and isolated in the first studies of this strain, using irradiation with X-rays, and later with UV and other chemical treatments to induce random mutations. Some of the genetic mutants or derivatives have evolved through purposeful selection and, thus, have well characterized mutations. It is, however, also recognized that many of the present day derivatives contain undetected and/or, as yet, uncharacterized allelic differences. Thus, present day members of the E. coli K-12 strain differ from one another by mutations, both spontaneous and induced, in one or many genes. Web site: http://www.delphion.com/details?pn=US05932439__
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·
Shuttle vectors for Escherichia coli and cyanobateria Inventor(s): Hagiwara; Hideaki (Takarazuka, JP), Takeshima; Yasunobu (Kasai, JP) Assignee(s): Yoshihide Hagiwara (Takarazuka, JP) Patent Number: 5,821,119 Date filed: May 13, 1997 Abstract: A vector plasmid containing(a) the OriA region of plasmid pBA1 derived from Anacystis nidulans,(b) the multicloning region and(c) the region of colicin E1 plasmid, which contains the OriE region thereof and wherein the gene defined by the rop region thereof is removed.This plasmid is replicable in the cells of both Escherichia coli and cyanobacteria and thus useful as a shuttle vector. Excerpt(s): This invention relates to a novel plasmid, and relates in particular to a shuttle vector plasmid replicable in the cells of both Escherichia coli and cyanobacteria, which contains a DNA fragment containing the OriA region of plasmid pBA1 derived from Anacystis nidulans, a cyanobacterium. ... As examples of heterogenous proteins expressed using the strain R2 and known human carbonic anhydrase and the lac IQ repressor protein of Escherichia coli ›G. D. Price and M. R. Badger, Plant Physiol. 91:505-513 (1989)!, .alpha.-amylase of Bacillus amyloliquefaciens A50 ›I. V. Elanskaya and I. B. Morzunoba, Mol. Genet. Microbiol. Virusol. 0(9):7-1 (1989)!, an insecticidal protein of B. sphaericus 1593M ›N. Tandeau de Marsac et al., Mol. Gen. Genet. 209:396-398 (1987)!, .beta.-galactosidase of Escherichia coli ›D. J. Scanlan et al., Gene. 90:43-49 (1990), M. R. Schaefer and S. S. Golden, J. Bacteriol. 171(7):39733981 (1989)!, Mn-superoxide dismutase of Escherichia coli ›M. Y. Gruber et al., Proc. Natl. Acad. Sci. USA 87:2608-2612 the (cI.sup.ts repressor protein of .lambda. phage ›D. Friedberg and J. Seiiffers, Mol. Gen. Genet. 203:505-510 (1986)!, disaturase of a cyanobacterium Synechosystis PCC 6803 strain (des A) ›H. Wada et al., Nature 347:200-203 (1990!, etc. ... On the other hand, A. nidulans 6301 has been developed using its endogenous plasmid (pBA1) vectors (shuttle vectors with Escherichia coli) such as pBAS 18 ›12 kb, K. Shinozaki et al., Gene. 19:221-225 (1982)! and pBAS 5 ›14 kb, Kazuo Shinozaki, "Shokubutsu Idenshi Sosa Gijutsu" (Plant Gene Manipulation Techniques), supervised by Hikoyuki Yamaguchi, pages 98 to 110, published by CMC!. A. Nidulans 6301 was deposited on Feb. 24, 1998, under deposit number FERM BP-6267, with the National Institute of Bioscience and Human-Technology (formerly the Fermentation Research Institute), Agency of Industrial Science and Technology. However, any of the vectors has difficult problems in gene manipulation, for example that the size of a gene capable of being
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inserted into any of the vectors is restricted because it has a length of 10 kb or more and each vector has only a small number of restriction endonuclease recognition sites usable for cloning. Further, the strain 6301 has a disadvantage that it does not easily take a gene DNA into its cell, compared with the strain R2, and as a result to transformation frequency is lower than that of the strain R2. As a method of enhancing the transformation frequency of the strain 6301, H. Daniell, et al. ›Proc. Natl. Acad. Sci. USA 83:2546-2550 (1986)! propose that cells of the strain 6301 are treated with EDTA-lysozyme to convert them to permeaplasts, whereby they more easily take up DNAs. In fact, they succeeded in enhancing the transformation frequency of the strain 6301 using this method, but it has problems, for example, that the manipulation takes much time and is complicated and further the cells are easily damaged by the EDTA-lysozyme treatment. Web site: http://www.delphion.com/details?pn=US05821119__ ·
Probe for diagnosing Escherichia coli, Klebsiella pneumonieae or Enterobacter cloacae Inventor(s): Ohno; Tsuneya (Tokyo, JP), Matsuhisa; Akio (Nara, JP), Uehara; Hirotsugu (Kobe, JP), Eda; Soji (Higashi-Osaka, JP) Assignee(s): Tsuneya Ohno (Tokyo, JP), Fuso Pharmaceutical Industries, Ltd. (Osaka, JP) Patent Number: 5,763,188 Date filed: August 29, 1997 Abstract: DNA probes for diagnosing infectious diseases involving Escherichia coli, Klebsielkli pneunmoniae or Enterobacter cloacae and methods of using such probes are provided. Excerpt(s): Examples on probes prepared from Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae (J. Infection, vol. 26, pp. 159-170 (1993), J. Clin. Microbiol., vol. 31., pp. 552-557 (1993)) respectively listed as relatively popular causative bacteria of the infectious diseases, especially bacteremia were described as follows. ... (3) Selection of Probe having Specificity to Species of Origin Bacteria Escherichia coli containing each clone prepared according to Manual of Maniatis (T. Maniatis, et al., "Molecular Cloning (A Laboratory Manual)", Cold Spring Harbour Laboratory (1982)) was cultivated with small scale culture, and obtained plasmids containing each clone. ... With regard to probes prepared from Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, since these bacteria are belonged to the same group
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(enteric bacteria; Gram negative aerobic bacillus) as a causative bacteria of bacteremia (See, J. Infection, vol. 26, pp. 159-170 (1993), J. Clin. Microbiol., vol. 31., pp. 552-557 (1993), supra), and the cross-reaction had been confirmed among said three bacteria in the foregoing series experiments on the specificity, each probe prepared from one of said three bacteria was designated as a probe for detecting all these bacteria as a relevant bacteria. Web site: http://www.delphion.com/details?pn=US05763188__ ·
Production of tryptophan by the bacterium Escherichia coli Inventor(s): Camakaris; Helen (Eaglemont, AU), Cowan; Peter (Brighton, AU), Pittard; James (Research, AU) Assignee(s): Degussa Aktiengesellschaft (Frankfurt, DE) Patent Number: 5,756,345 Date filed: September 5, 1996 Abstract: This invention is concerned with the production of Ltryptophan by strains of Escherichia coli.The invention provides a host and method for growing that host such that plasmids can be stably maintained in the absence of antibiotics, leading to high productivity of tryptophan in fermentation. It offers significant improvements over previous methods and produces tryptophan free from any contamination by tyrosine an phenylalanine thus simplifying downstream processing.The E. coli strains having productivity for L-tryptophan comprise in their genome a mutant gene encoding a partially defective tryptophanyl-tRNA synthetase introducing a temperature-conditional tryptophan auxotrophy in the host and further mutations on the chromosome which disable the transport systems encoded by aroP, mtr and tnaB and being transformed with a plasmid containing a tryptophan operon encoding anthranilate synthase freed from feedback-inhibition by tryptophan. Excerpt(s): This invention is concerned with the production of tryptophan by the bacterium Escherichia coli. ... Anthranilate synthase activity in wild-type strains of Escherichia coli is extremely sensitive to feedback-inhibition by tryptophan, showing about 50% inhibition at concentrations of tryptophan as low as 0.02 mM. Feedback-resistant mutants have been reported in various publications, for example. Aiba et al., Canadian Patent Application No. 1182409, Tribe and Pittard. (1979). Applied and Environmental Microbiol. 38: 1811-190, Aiba et al. (1982). Applied and Environmental Microbiol. 43: 289-297. In each case, isolation of such mutants involved selection for resistance to growth inhibition by
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tryptophan analogues. ... A strain of Escherichia coli K-12, KA56 (galE.sup.-, thi.sup.-) (Russell, R. R. B. and A. J. Pittard. (1971). J. Bacteriol. 108: 790-798) was treated with the mutagen N-methyl-N'-nitroN-nitrosoguanidine by the method of Adelberg, Mandel and Chen (Biochem Biophys Res Commun. (1965). 18: 788-795). After treatment with mutagen, cells were washed and resuspended in minimal medium supplemented with casamino acids and with glycerol as carbon source, to utilize an enrichment procedure developed in this laboratory (Russell, R. R. B. and A. J. Pittard. (1971). J. Bacteriol. 108: 790-798). After several hours growth at 32.degree. C., the culture was shifted to 42.degree. C. and one hour later galactose was added to give a fmal concentration of 2%. Cells which lack uridine diphosphate galactose-4-epimerase (i.e. galE.sup.-) but are able to synthesize the enzymes galactokinase and galactose-1-phosphate uridyl transferase in response to the addition of galactose, accumulate UDP galactose which is toxic to the cell and causes cell lysis (Fukasawa, T., and H. Nikaido. (1959). Nature (London). 184: 1168-1169). Cells which are unable to synthesize new enzymes in glycerol galactose casamino acids medium at 42.degree. C. do not form this compound and are not killed. Amongst such survivors one can find temperature-sensitive auxotrophs with mutations in the trpS gene. (Casamino acids contains very low levels of tryptophan). After 5 hours at 42.degree. C. in the presence of galactose, cells are recovered, washed and either (1) added to nutrient broth at 32.degree. C. and cultured to midexponential phase or (2) spread onto nutrient agar plates to give about 200 colonies per plate and incubated for 48 hours at 32.degree. C. The colonies on each nutrient agar plate are replicated to two plates of MM and MM supplemented with L-tryptophan at 10.sup.-3 M (MM+Trp). (MM represents half-strength Medium 56 (Monod, Cohen-Bazire and Cohen. (1951). Web site: http://www.delphion.com/details?pn=US05756345__ ·
Detection of shiga-like toxins of enterohemoragic Escherichia coli Inventor(s): O'Brien; Alison (Bethesda, MD), Lindgren; Susanne Ward (Portland, OR), Perera; Liyanage Parakrama (Rockville, MD), Strockbine; Nancy A. (Lithonia, GA), Melton-Celsa; Angela Ruth (Sterling, VA) Assignee(s): Henry M. Jackson Foundation for the Advancement of Military Medicine (Rockville, MD) Patent Number: 5,747,272 Date filed: March 10, 1995
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Abstract: A rapid, sensitive, non-radioactive diagnostic kit for the direct detection of both Shiga-like toxin, type I, and Shiga-like toxin, type II, produced by enterohemorrhagic Escherichia Coli in food and clinical samples. This diagnostic kit is comprised of a monoclonal antibody capable of detecting Shiga-like toxin, type I, and a monoclonal antibody capable of detecting Shiga-like toxin, type II, together with a chemiluminescing detection reagent with a sensitivity enhancer. Excerpt(s): Infection with Enterohemorrhagic Escherichia coli (EHEC) is associated with food-borne outbreaks of diarrhea, hemorrhagic colitis and the hemolytic uremic syndrome. Hemorrhagic colitis is characterized by severe abdominal pain with watery diarrhea. This is followed by grossly bloody diarrhea without fever (Riley, L. W., 1987, The epidemiologic, clinical, and microbiological features of hemorrhagic colitis, Ann. Rev. of Microbiology 41:383-407). The symptoms typically last from four to eight days. The illness is usually self-limiting. Hemolytic uremic syndrome associated with EHEC is characterized by a thrombocytopenia, microangiopathic hemolytic anemia and acute renal failure (Levin, et al., 1989, Hemolytic uremic syndrome, Adv. Pediatric Infectious Disease 4:51-82). The illness occurs predominantly in children under four years of age. ... One assay is specific for detecting SLT-II produced by E. Coli 0157:H7 (Doyle, et al., 1987, "Isolation of Escherichia Coli 0157:H7 from Retail Fresh Meats and Poultry," Applied and Environmental Microbiology, 53:2394-2396). This method requires incubating a sample in an enrichment medium overnight. The sample is then filtered through hydrophobic grid membrane paper. The filter paper is then placed on a nitrocellulose paper and the nitrocellulose paper is again incubated overnight with an enrichment medium. The toxins are then detected using an antibody to the toxin and standard immunoblot procedures. The procedure is time consuming and complex. Furthermore, the procedure does not detect all SLTs. ... A monoclonal antibody-producing hybridoma was generated in this manner by Strockbine, et al., from the fusion of SP2/0-Ag14 myeloma cells and BALB/c mice immunized with purified, biologically active SLT from E. coli H30. This hybridoma was designated 13C4 (Strockbine, N. A., Marques, L. R. M., Holmes, R. K, and O'Brien, A. D., 1985, Characterization of Monoclonal Antibodies against Shiga-Like Toxin from Escherichia coli, Infection and Immunity, 50:695-700). This antibody is generally characterized as being of the G1 heavy and kappa light chain classes. This hybridoma was deposited at the American Type Culture Collection, 12301 Parklawn Drive, Rockville, Md. 20852, USA and was assigned catalogue number CRL 1794. This hybridoma is hereinafter referenced as ATCC CRL 1794.
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Web site: http://www.delphion.com/details?pn=US05747272__ ·
Genetic markers and methods for the detection of escherichia coli serotype-0157:H7 Inventor(s): Jensen; Mark Anton (West Chester, PA) Assignee(s): E. I. du Pont de Nemours and Company (Wilmington, DE) Patent Number: 5,747,257 Date filed: February 29, 1996 Abstract: A method, diagnostic sequences and primers are provided that are useful in the identification of the Escherichia coli 0157:H7 serotype. The method first involves the identification of a RAPD-amplified DNA fragment common to 0157:H7 Escherichia coli, the identification of the most conserved regions of that fragment, and the preparation of specific primers useful for detecting the presence of a marker within the fragment whereby that set of primers is then useful in the identification of all 0157:H7 Escherichia coli. Excerpt(s): A detection methodology using PCR/RAPD specific to Escherichia coli 0157:H7 serotypes would be of high utility in the food industry. Detection methods not dependent on sequences derived from a known gene or associated with a known phenotypic characteristic of E. coli 0157:H7 serotype have not previously been disclosed. ... A set of eight 12-base primers (Table I) was used in a Random Amplified Polymorphic DNA (RAPD) analysis of 48 strains of Escherichia coli, including 7 strains representing serotype 0157:H7. The results of these amplifications were examined for a 0157:H7 specific amplification product that could be easily separated from other RAPD products. Five RAPD primers that showed the promising results were subsequently used in the analysis of 64 additional strains of E. coli, including 5 strains of 0157:H7. Web site: http://www.delphion.com/details?pn=US05747257__
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Assay for enterohemorrhagic Escherichia coli 0157:H7 by the polymerase chain reaction Inventor(s): Fratamico; Pina M. (Elkins Park, PA), Sackitey; Solomon K. (Norristown, PA), Wiedmann; Martin (Ithaca, NY) Assignee(s): The United States of America as represented by the Secretary of (Washington, DC) Patent Number: 5,652,102 Date filed: December 5, 1994 Abstract: Primers specific for enterohemorrhagic Escherichia coli (EHEC) 0157:H7 bacteria have been designed which are useful for detecting the bacteria by polymerase chain reaction methods. The primers were derived from DNA sequences contained within a 60-MDa plasmid which is present in most EHEC. The primers may also be used in combination with primers derived from other sequences of significance, the conserved sequences of Shiga-like toxins I and II and the eaeA gene, in a single simultaneous amplification reaction to specifically identify EHEC serotype 0157. Excerpt(s): Escherichia coli 0157:H7, also known as enterohemorrhagic E. coli (EHEC), has been associated with recent outbreaks of foodborne diseases. Sporadic cases of hemorrhagic colitis and hemolytic uremic syndrome have occurred worldwide. These outbreaks have been attributed to the presence of the pathogenic microorganism in ground beef since beef and dairy cattle are known to carry the organism in their intestinal tracts and carcasses are frequently contaminated during the slaughter process. The most visible outbreak in the United States occurred in the Western states and involved over 500 cases and several deaths of young children. Investigations by the Centers for Disease Control indicate that EHEC is the third most important cause of foodborne illness in the U.S., and the incidence of the disease is increasing. There is thus a strong incentive to develop a quick and sensitive assay method for the detection of the microorganism in beef products such as ground beef, on beef carcasses during inspection and in cattle fecal specimens. This invention relates to novel primers which can be used to detect pathogenic E. coli by specifically amplifying a fragment of a plasmid found in all strains tested by polymerase chain reaction (PCR). Web site: http://www.delphion.com/details?pn=US05652102__
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Patent Applications on Escherichia Coli As of December 2000, U.S. patent applications are open to public viewing.25 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to Escherichia coli: ·
Nucleotide sequence of Escherichia coli pathogenicity islands Inventor(s): Dillon, Patrick J. ; (Carlsbad, CA), Choi, Gil H. ; (Rockville, MD), Welch, Rodney A. ; (Madison, WI) Correspondence: Human Genome Sciences Inc; 9410 Key West Avenue; Rockville; MD; 20850 Patent Application Number: 20020072595 Date filed: September 20, 2001 Abstract: The present invention relates to novel genes located in two chromosomal regions within uropathogenic E. coli that are associated with virulence. These chromosomal regions are known as pathogenicity islands (PAIs). In particular, the present application discloses 142 sequenced fragments (contigs) of DNA from two pools of cosmids covering pathogenicity islands PAI IV and PAI V located on the chromosome of the uropathogenic Escherichia coli J96. Further disclosed are 351 predicted protein-coding open reading frames within the sequenced fragments. Excerpt(s): Escherichia coli (E. coli) is a normal inhabitant of the intestine of humans and various animals. Pathogenic E. coli strains are able to cause infections of the intestine (intestinal E. coli strains) and of other organs such as the urinary tract (uropathogenic E. coli) or the brain (extraintestinal E. coli). Intestinal pathogenic E. coli are a well established and leading cause of severe infantile diarrhea in the developing world. Additionally, cases of newborn meningitis and sepsis have been attributed to E. coli pathogens. ... Chromosomal PAIs in bacterial cells have been described in increasing detail over recent years. For example, J. Hacker and co-workers described two large, unstable regions in the chromosome of uropathogenic Escherichia coli strain 536 as PAI-I and PAI-II (Hacker J., et al., Microbiol. Pathog. 8:213-25 1990). Hacker found that PAI-I and PAI-II containing virulence regions can be lost by spontaneous deletion due to recombination events. Both of these PAIs were found to encode multiple virulence genes, and their loss resulted in reduced hemolytic activity, serum resistance, mannose-resistant
25
This has been a common practice outside the United States prior to December 2000.
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hemagglutination, uroepithelial cell binding, and mouse virulence of the E. coli. (Knapp, S et al., J. Bacteriol. 168:22-30 1986). Therefore, pathogenicity islands are characterized by their ability to confer complex virulence phenotypes to bacterial cells. ... The present invention is based on the high through-put, random sequencing of cosmid clones covering two pathogenic islands (PAIs) of uropathogenic Escherichia coli strain J96 (04:K6; E. coli J96). PAIs are large fragments of DNA which comprise pathogenicity determinants. PAI IV is located approximately at 64 min (nearphe V) on the E. coli chromosome and is greater than 170 kilobases in size. PAI V is located at approximately 94 min (atpheR) on the E. coli chromosome and is approximately 106 kb in size. These PAIs differ in location to the PAIs described by Hacker and colleagues for uropathogenic strain 536 (PAII, 82 minutes {selC} and PAI II, 97 minutes {leuX}). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
L-arginine producing escherichia coli and method of producing Larginine Inventor(s): Gusyatiner, Mikhail Markovich ; (Moscow, RU), Leonova, Tatyana Viktorovna ; (Moscow, RU), Ptitsyn, Leonid Romanovich ; (Moscow, RU), Yampolskaya, Tatyana Abramovna ; (Moscow, RU) Correspondence: Oblon Spivak Mcclelland Maier & Neustadt PC; Fourth Floor; 1755 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20020034793 Date filed: June 22, 2001 Abstract: Arginine can be efficiently produced by cultivating Escherichia coli which has an ability to produce arginine and an ability to utilize acetate in a culture medium to produce and accumulate arginine in the medium, and collecting arginine from the medium. Excerpt(s): The present invention relates to L-arginine producing Escherichia coli and a method of producing L-arginine by fermentation using Escherichia coli. L-arginine is an industrially useful amino acid as ingredients of liver function promoting agents, amino acid transfusions, comprehensive amino acid preparations and the like. ... It is known that some mutants of Escherichia coli resistant to analogs of arginine and pyrimidines produce arginine (Pierard A. and Glansdorf N., Mol. Gen. Genet., 118, 235, 1972. and Glansdorf N., Biosynthesis of arginine and polyamines. In "E. coli and Salm. thyphimurium, 1996). Additionally, the methods for producing arginine using mutants of E. coli resistant to some other drugs or recombinant strain of E. coli into which a gene encoding
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an enzyme of arginine biosynthetic pathway is introduced are known. ... That is, the present invention provides Escherichia coli which has an ability to produce arginine and an ability to utilize acetate. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Anti-idiotypic antibody against FimH adhesion of uropathogenic type I-fimbriated escherichia coli, compositions containing same and method for using same Inventor(s): Wu, Xue-Ru ; (Staten Island, NY) Correspondence: Browdy and Neimark, P.L.L.C.; 624 Ninth Street, NW; Suite 300; Washington; DC; 20001-5303; US Patent Application Number: 20020028200 Date filed: May 10, 2001 Abstract: The present invention relates to an anti-idiotypic antibody or antigen-binding fragment against FimH adhesin of uropathogenic Type Ifimbriated Escherichia coli and an immunizing composition containing such an anti-idiotypic antibody or antigen-binding fragment thereof as an active immunizing component. The present invention also relates to a method for stimulating and enhancing the production of antibodies which recognize and bind to FimH of uropathogenic Type-I-fimbriated Escherichia coli, but not to FimH of non-uropathogenic Type I-fimbriated Escherichia coli. Excerpt(s): Over 85% of all UTIs are caused by the enterobacteria Escherichia coli, and an overwhelming majority of these E. coli bacteria express surface filamentous organelles called Type I fimbriae. Experimental and epidemiological studies have established that Type I fimbriae are the major virulence factor of uropathogenic E. coli, where these fimbriae function as an adhesive apparatus that allows E. coli to bind to the epithelial lining, urothelium, of the urinary tract. Such a binding between the invading E. coli and the host urothelial surface is a pivotal step in the establishment of E. coli colonization within the urinary tract. ... The present invention provides an anti-idiotypic antibody or an antigen binding fragment thereof which mimics FimH adhesin and serves as a surrogate for FimH in generating a humoral immune response as well as possibly a cellular immune response. Thus, the present invention also provides an immunizing composition and a method for stimulating and enhancing the production of antibodies which recognize and bind to FimH adhesin of uropathogenic Type I-fimbriated Escherichia coli but not to FimH adhesin of non-uropathogenic Type I-
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fimbriated Escherichia composition to a subject.
coli
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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Bacterial strain of escherichia coli BKIIM B-3996 as the producer of Lthreonine Inventor(s): Debabov, Vladimir Georgievich ; (Moscow, RU), Kozlov, Jury Ivanovich ; (Moscow, RU), Khurges, Evgeny Moiseevich ; (Moscow, RU), Livshits, Vitaly Arkadievich ; (Moscow, RU), Zhdanova, Nelli Isaakovna ; (Moscow, RU), Gusyatiner, Mikhail Markovich ; (Moscow, RU), Sokolov, Alexandr Konstantinovich ; (Moscow, RU), Bachina, Tatyana Alexandrovna ; (Moscow, RU), Yankovsky, Nikolai Kazimirovich ; (Moscow, RU), Tsygankov, Jury Dmitrievich ; (Moscow, RU), Chistoserdov, Andrei Jurievich ; (Moskovskaya oblast, RU), Plotnikova, Tatyana Grigorievna ; (Moscow, RU), Shakalis, Irina Olegovna ; (Moscow, RU), Belareva, Alla Valentinovna ; (Moscow, RU), Arsatiants, Raisa Alexandrovna ; (Moscow, RU), Sholin, Albert Fedorovich ; (Moscow, RU), Pozdnyakova, Tamara Mikhailovna ; (Moscow, RU) Correspondence: Oblon Spivak Mcclelland Maier & Neustadt Pc; Fourth Floor; 1755 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20010049129 Date filed: July 13, 2001 Abstract: A bacterial strain of Escherichia coli BKIIM B-3996, a producer of L-threonine, containing a recombinant plasmid pVIC40 and deposited on Nov. 19, 1987 in the collection of microorganism cultures at the USSR Antibiotics Research Institute under Reg. No. 1867. Excerpt(s): The present invention relates generally to microbiological industry and more specifically it concerns a novel bacterial strain of Escherichia coli BKIIM. B-3996 as the producer of L-threonine. ... Known in the present state of the art as the L-threonine producing strains of microorganisms of a variety of species (e.g., Brevibacterium flavum, Serratia marcescens, Escherichia coli, and others). It is the mutating strains of E. coli whose cells contain hybrid plasmids caryying the genes of the threonine operon (U.S. Pat. Nos. 4,278,785; 4,321,325) that prove to be the most efficacious L-threonine producers, of which the most productive is Escherichia coli strain VNIIgenetika M-1 (U.S. Pat. No. 4,321,325), which contains multicopy plasmid pYN7 obtained in the base of vector pBR322 and incorporating the threonine operon of E. coli strain K12 resistant to alpha-amino-beta-hydroxyvaleric acid, an analogue of
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threonine. The genes of the threonine operon of plasmid pYN7 code a bifunctional enzyme, viz., aspartate-kinase-homoserinedehydrogenase, which is insensitive to inhibition with L-threonine. Said strain M-1 is capable of accumulating L-threonine till a concentration of 30 g/l for a 40-hour fermentation period in laboratory fermenters when cultivated under conditions of feeding a sugar-ammonia additive to the nutrient medium in response to a signal sent by the pH sensor. ... The aforesaid object is accomplished due to the fact that, according to the invention, proposed herein is a novel bacterial strain of Escherichia coli BKIIM B3996 as the L-threonine producer, said strain containing recombinant plasmid pVIC40 and deposited on Nov. 19, 1987 in the collection of microorganism cultures at the USSR Antibiotics Research Institute under Reg. No. 1867. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with Escherichia coli, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “Escherichia coli” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on Escherichia coli. You can also use this procedure to view pending patent applications concerning Escherichia coli. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Aerobic: 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. [EU] Ammonia: Ammonia. A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of
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metabolically important reactions. [NIH] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Brevibacterium: A gram-positive organism found in dairy products, fresh and salt water, marine organisms, insects, and decaying organic matter. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Chromosomal: Pertaining to chromosomes. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Enterobacter: Gram-negative gas-producing rods found in feces of man and other animals, sewage, soil, water, and dairy products. [NIH] Enterococcus: A genus of gram-positive, coccoid bacteria consisting of organisms causing variable hemolysis that are normal flora of the intestinal tract. Previously thought to be a member of the genus streptococcus, it is now recognized as a separate genus. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Galactokinase: An enzyme that catalyzes reversibly the formation of galactose 1-phosphate and ADP from ATP and D-galactose. Galactosamine can also act as the acceptor. A deficiency of this enzyme results in galactosemia. EC 2.7.1.6. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour -
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now often used of endocrine factors as opposed to neural or somatic. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Klebsiella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms arrange singly, in pairs, or short chains. This genus is commonly found in the intestinal tract and is an opportunistic pathogen that can give rise to bacteremia, pneumonia, urinary tract and several other types of human infection. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Myeloma: A tumour composed of cells of the type normally found in the bone marrow. [EU] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Plasmids: Any extrachromosomal hereditary determinant. Plasmids are self-replicating circular molecules of DNA that are found in a variety of bacterial, archaeal, fungal, algal, and plant species. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Proteus: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that occurs in the intestines of humans and a wide variety of animals, as well as in manure, soil, and polluted waters. Its species are pathogenic, causing urinary tract infections and are also considered secondary invaders, causing septic lesions at other sites of the body. [NIH] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and
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niacin. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Urothelium: The epithelial lining of the urinary tract. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU]
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CHAPTER 6. BOOKS ON ESCHERICHIA COLI Overview This chapter provides bibliographic book references relating to Escherichia coli. You have many options to locate books on Escherichia coli. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on Escherichia coli include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “Escherichia coli” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on Escherichia coli:
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1997 Red Book: Report of the Committee on Infectious Diseases. 24th ed Source: Elk Grove Village, IL: American Academy of Pediatrics. 1997. 764 p. Contact: Available from American Academy of Pediatrics. Publications, P.O. Box 747, Elk Grove Village, IL 60009-0747. (800) 433-9016 or (847) 228-5005. Fax (847) 228-1281. E-mail:
[email protected]. Price: Single copy free to members, with additional copies $74.95 each; $79.95 for nonmembers. ISBN: 091076185x. Publication number MA0001. Summary: This monograph contains the 24th edition of the report of the Committee on Infectious Diseases, the group responsible for formulating and revising guidelines of the American Academy of Pediatrics for the control of infectious diseases in children. Five sections present guidelines in the areas of active and passive immunization; recommendations for the care of children in special circumstances, including children in day care, infection control for hospitalized children, and medical evaluation of internationally adopted children; summaries of infectious diseases; antimicrobial prophylaxis; and antimicrobials and related therapy. Infectious diseases that can affect the digestive system include amebiasis, campylobacter infections, cholera, Escherichia coli, diarrhea, giardia lamblia, helicobacter pylori, hepatitis, HIV, malaria, parasitic diseases, salmonellosis, schistosomiasis, shigellosis, vibrio infections, and yersinia infections. A summary of major changes in the 1997 edition is provided; changes include the addition of recent information on Escherichia coli diarrhea (E coli 0157:H7 infection) and its complication of hemolyticuremic syndrome, and expanded information about Hepatitis A, B, and C. A subject index concludes the volume. 9 appendices.
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Escherichia Coli 0157:H7: Diarrheal Illness and Hemolytic-Uremic Syndrome Source: Research Triangle Park, NC: Glaxo Wellcome Inc. 1995. 24 p. Contact: Available from Glaxo Wellcome Educational Resource Center. 5 Moore Drive, Research Triangle Park, NC 27709. (800) 824-2896. Price: Single copy free; available to health care professionals only. Order Number GVL231. Summary: This monograph familiarizes readers with diarrheal illness and hemolytic-uremic syndrome (HUS), associated with Escherichia coli 0157:H7. Topics include the epidemiology of illness caused by enterohemorrhagic E. coli, including HUS; methods for isolating and identifying this pathogen and establishing the diagnosis of HUS; treatment for individuals with enterohemorrhagic E. coli-induced illness;
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and methods for preventing this illness. One section provides information for patients about E. coli 0157:H7. The monograph concludes with a multiple-choice self-test, with which readers can qualify for continuing medical education (CME) credits. 2 figures. 3 tables. 32 references. (AA-M).
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to Escherichia coli (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Escherichia Coli 0157: Bibliography. January 1993-December 1993 by Ellen K. Miller (1995); ISBN: 0788121790; http://www.amazon.com/exec/obidos/ASIN/0788121790/icongroupin terna
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Escherichia Coli in Domestic Animals and Humans by C.L. Gyles (Editor) (1996); ISBN: 0851989217; http://www.amazon.com/exec/obidos/ASIN/0851989217/icongroupin terna
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Escherichia Coli: Mechanisms of Virulence by Max Sussman (Editor) (1997); ISBN: 0521453615; http://www.amazon.com/exec/obidos/ASIN/0521453615/icongroupin terna
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E. Coli: A Practical Approach to the Organism and Its Control in Foods (Practical Food Microbiology Series) by Alec Kyriakides, et al (1998); ISBN: 0751404624; http://www.amazon.com/exec/obidos/ASIN/0751404624/icongroupin terna
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Escherichia Coli and Salmonella: Cellular and Molecular by Frederick C. Neidhardt (Editor) (1999); ISBN: 1555811647; http://www.amazon.com/exec/obidos/ASIN/1555811647/icongroupin terna
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The Mechanism of Translation Termination in Escherichia Coli (Comprehensive Summaries of Uppsala Dissertations, 493) by David V.
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Freistroffer (1999); ISBN: 9155445969; http://www.amazon.com/exec/obidos/ASIN/9155445969/icongroupin terna ·
From Replication Initiation to Condensation and Partition of Chromosome and Plasmid in Escherichia Coli (Comprehensive Summaries of Uppsala dissertati by Tao Weitao (1999); ISBN: 9155446132; http://www.amazon.com/exec/obidos/ASIN/9155446132/icongroupin terna
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Escherichia Coli 0157 in Farm Animals by C. S. Stewart (Editor), H. J. Flint (Editor) (1999); ISBN: 085199332X; http://www.amazon.com/exec/obidos/ASIN/085199332X/icongroupi nterna
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On the Cell Cycle of Escherichia Coli and Cell Division in Haloferax Mediterranei (Comprehensive Summaries of Uppsala Dissertations from the Faculty o by Bjorn Gullbrand (2001); ISBN: 9155450563; http://www.amazon.com/exec/obidos/ASIN/9155450563/icongroupin terna
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Structural Studies on the Integral Membrane Protein, Ubiquinol Oxidase from Escherichia Coli (Comprehensive Summaries of Uppsala Dissertations from th by Jeff Abramson (2001); ISBN: 9155449352; http://www.amazon.com/exec/obidos/ASIN/9155449352/icongroupin terna
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E. Coli: Shiga Toxin Methods and Protocols (Methods in Molecular Medicine, 73) by Dana Philpott (Editor), et al (2003); ISBN: 0896039390; http://www.amazon.com/exec/obidos/ASIN/0896039390/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “Escherichia coli” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:26 In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or
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Bacterial genetic systems. Author: edited by Jeffrey H. Miller; Year: 1991; San Diego: Academic Press, c1991; ISBN: 0121821056 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0121821056/icongroupin terna
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E. coli: a practical approach to the organism and its control in foods. Author: Chris Bell and Alex Kyriakides; Year: 1998; London; New York: Blackie Academic & Professional, 1998; ISBN: 0751404616 (pbk.)
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E. coli: Shiga toxin methods and protocols. Author: edited by Dana Philpott and Frank Ebel; Year: 2003; Totowa, N.J.: Humana Press, 2003; ISBN: 0896039390 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0896039390/icongroupin terna
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Escherichia coli: mechanisms of virulence. Author: edited by Max Sussman; Year: 1997; Cambridge; New York: Cambridge University Press, 1997; ISBN: 0521453615 (hardback) http://www.amazon.com/exec/obidos/ASIN/0521453615/icongroupin terna
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Escherichia coli 0157: January 1994-July 1995. Author: Ellen Kay Miller; Year: 1995; Beltsville, Md.: National Agricultural Library, [1995]
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Escherichia coli 0157 in farm animals. Author: edited by C.S. Stewart and H.J. Flint; Year: 1999; Wallingford, Oxon, UK; New York: CABI, c1999; ISBN: 085199332X http://www.amazon.com/exec/obidos/ASIN/085199332X/icongroupi nterna
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Escherichia coli in domestic animals and humans. Author: edited by C.L. Gyles; Year: 1994; Wallingford, Oxon, UK: CAB International, c1994; ISBN: 0851989217 http://www.amazon.com/exec/obidos/ASIN/0851989217/icongroupin terna
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Escherichia coli O157:H7 and other shiga toxin-producing E. coli strains. Author: editors, James B. Kaper, Alison D. O'Brien; Year: 1998; Washington, DC: ASM Press, c1998; ISBN: 1555811299 (hardcover) http://www.amazon.com/exec/obidos/ASIN/1555811299/icongroupin terna
phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Escherichia coli O157:H7 and other verotoxigenic E. coli in foods: proceedings of a Workshop on Methods to Isolate Escherichia coli O157:H7 and Other Verotoxigenic E. coli from Foods held on March 1819, 1991 in Ottawa, Canada. Author: editors, E.C.D. Todd and; Year: 1993; [Ottawa?]: Polyscience Publications Inc., c1993; ISBN: 0921317395 http://www.amazon.com/exec/obidos/ASIN/0921317395/icongroupin terna
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Factors involved in deoxyribonucleic acid ligation in Escherichia coli cells. Author: Juhani Syväoja; Year: 1987; Oulu: University of Oulu, 1987; ISBN: 9514223608 http://www.amazon.com/exec/obidos/ASIN/9514223608/icongroupin terna
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Genetic elements in Escherichia coli. Author: P.F. Smith-Keary; Year: 1988; Houndmills, Basingstoke, Hampshire: Macmillan Education, 1988; ISBN: 0333442679
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Investigation of space flight effects on Escherichia coli growth. Author: David M. Klaus, Marvin W. Luttges, and Louis S. Stodieck; Year: 1994; Warrendale, PA: SAE International, 1994
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Piezoelectric crystal immunosensor for E. coli. Author: Chandra S. Theegala, Beniam T. Berhane, and Ahmad A. Suleiman; Year: 1997; Warrendale, PA: SAE International, 1997
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Recent advances in verocytotoxin-producing Escherichia coli infections: proceedings of the 2nd International Symposium and Workshop on Verocytotoxin (Shiga-like toxin)-procuding Escherichia coli Infections, Bergamo, Italy, 27-30 June 1994. Author: editors, Moha; Year: 1994; Amsterdam; New York: Elsevier, 1994; ISBN: 0444818405 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0444818405/icongroupin terna
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Regulation of gene expression in Escherichia coli. Author: [edited by] E.C.C. Lin, A. Simon Lynch; Year: 1996; New York: Chapman Hall; Austin: R.G. Landes Co., c1996; ISBN: 0412102919 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0412102919/icongroupin terna
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Report of WHO working group meeting on shiga-like toxin producing Escherichia coli (SLTEC), with emphasis on zoonotic aspects: Bergamo, Italy, 1 July 1994. Author: Howe, C. J; Year: 1995; [Geneva]: World Health Organization, Veterinary Public Health Unit, c1995
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Short course in bacterial genetics: a laboratory manual and handbook for Escherichia coli and related bacteria. Author: Jeffrey H. Miller; Year:
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1992; Plainview, N.Y.: Cold Spring Harbor Laboratory Press, 1992; ISBN: 0879693495 http://www.amazon.com/exec/obidos/ASIN/0879693495/icongroupin terna ·
Third International E. Coli Genome Meeting [microform]: November 48, 1994, Marine Biological Laboratory, Woods Hole, Massachusetts: [abstracts of talks]. Author: International E. Coli Genome Meeting (3rd: 1994: Woods Hole, Mass.); Year: 1994; [Woods Hole, Mass.?: The Laboratory?, 1994?]
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Trimethoprim resistance: dissemination and molecular mechanisms in Escherichia coli and Shigella spp. Author: by Elina Heikkilä; Year: 1991; Turku: Turun yliopisto, 1991; ISBN: 9518806535
Chapters on Escherichia Coli Frequently, Escherichia coli will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with Escherichia coli, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Escherichia coli using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “Escherichia coli” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on Escherichia coli: ·
Food-Related Illnesses and Allergies Source: in Townsend, C.E. and Roth, R.A. Nutrition and Diet Therapy. 7th ed. Albany, NY: Delmar Publishers. 1999. 171-187 p. Contact: Available from Delmar Publishers. 3 Columbia Circle, Albany, NY 12212. (800) 865-5840. E-mail:
[email protected]. Price: $44.95 plus shipping and handling. ISBN: 0766802965. Summary: This chapter on food related illnesses and allergies is from an undergraduate textbook on nutrition and diet therapy. The chapter identifies the diseases caused by contaminated food, along with their signs and the means by which they are spread; lists the signs of food contamination; reviews precautions for protecting food from contamination; and covers allergies and elimination diets and their uses.
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Foodborne illnesses covered include Campylobacter jejuni, Clostridium botulinum, Clostridium perfringens, Cyclospora, Escherichia coli (O157:H7), Listeria monocytogenes, Salmonella, Shigella, and Staphylococcus aureas. The authors stress that infection or poisoning traced to food is usually caused by human ignorance or carelessness. Food should not be prepared by anyone who has or carries a contagious disease. All fresh fruits and vegetables should be washed before being eaten. Meats, poultry, fish, eggs, and dairy products should be refrigerated. Food should be covered to prevent contamination by dust, insects, or animals. Food allergies can cause many different and unpleasant symptoms, and elimination diets are used to determine their causes. Some of the most common food allergens are milk, chocolate, eggs, tomatoes, fish, citrus fruit, legumes, strawberries, and wheat. The chapter includes lists of key terms to learn, recommended discussion topics, and suggested supplemental activities, and a section of review questions so readers can test their comprehension of the material. Two illustrative case studies are appended. 1 figure. 4 tables. ·
Food-Borne Illness Source: in Hagan, P.T., ed. Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems. New York, NY: Kensington Publishers. 1999. p. 26-27. Contact: Available from Mayo Clinic. 200 First Street, S.W., Rochester, MN 55905. (800) 291-1128 or (507) 284-2511. Fax (507) 284-0161. Website: www.mayo.edu. Price: $16.95 plus shipping and handling. ISBN: 0962786578. Summary: Foodborne illness is a growing problem in the U.S. This chapter on foodborne illness is from a self care handbook on everyday health problems published by the Mayo Clinic. The handbook offers readers a guide to symptoms, diagnosis, and treatment for common problems (particularly self care strategies and tips for handling these problems in children). All foods naturally contain small amounts of bacteria. When food is poorly handled, improperly cooked, or inadequately stored, bacteria can multiply in great enough numbers to cause illness. Parasites, viruses, and chemicals can also contaminate food, but foodborne illness from these sources is less common. Eating contaminated food can result in illness, depending on the organism, the amount of exposure, one's age, and health status. As people age, their immune cells may not respond as quickly and effectively to infectious organisms. Young children are at increased risk of illness because their immune systems haven't developed fully. Conditions such as diabetes, AIDS, and cancer treatment also reduce the immune response, making
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one more susceptible to foodborne illness. The chapter briefly lists self care strategies, particularly for handling short lived (less than 12 hours) food poisoning. One section cautions readers about botulism, a potentially fatal food poisoning. A side bar reviews how to handle food safely. The chapter concludes with a chart of common troublesome bacteria, how each is spread, the symptoms caused by infection, and prevention strategies. Bacteria included are Campylobacter jejuni, Clostridium perfringens, Escherichia coli 0157:H7, Salmonella, Staphylococcus aureus, and Vibrio vulnificus. The book is focused on how to prevent illness, how to detect illness before it becomes a serious and costly problem, and how to avoid unnecessary trips to the clinic or emergency room. 1 table. ·
Approach to Patients with Gastrointestinal Tract Infections and Food Poisoning Source: in Feigin, R.D. and Cherry, J.D., eds. Textbook of Pediatric Infectious Diseases. 4th ed. Volume 1. Philadelphia, PA: W.B. Saunders Company. 1998. p. 567-601. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Price: $315.00. ISBN: 0721664482. Summary: This chapter on managing young patients with gastrointestinal (GI) tract infections and food poisoning is from a textbook on pediatric infectious diseases. The authors stress that the approach to patients must begin with a thorough medical history, including information about epidemiologic factors, a physical examination, and knowledge of the pathophysiology of various enteropathogens. GI tract infections can include a wide range of symptoms and can be caused by a variety of agents and organisms. However, most infectious diarrhea illness can be classified into a category based on its cause, its pathophysiology, and the clinical response. This information can then be used to determine the appropriate diagnostic and monitoring tests and to decide which therapy to use. All patients with diarrhea require some degree of fluid and electrolyte therapy, a few need other nonspecific support, and for some, specific antimicrobial therapy is indicated to shorten the illness. The authors consider epidemiology and etiology, including outbreaks in child care centers and hospitals, foodborne or waterborne diarrhea, antimicrobial-associated diarrhea, travelers' diarrhea, and diarrhea in immunocompromised patients, including those with AIDS; bacterial organisms that cause gastroenteritis, including Aeromanas hydrophila, Bacillus cereus, Campylobacter, Clostridium difficile, Clostridium perfringens,
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Escherichia coli, Plesiomonas shigelloides, Salmonella, Shigella, Staphylococcus aureus, Vibrio cholerae, Vibrio parahaemolyticus, and Yersinia enterocolitica; viral agents, including rotaviruses, astroviruses, calciviruses, and enteric adenoviruses; and parasites, including Cryptosporidium, Entamoeba histolytica, Giardia lamblia, Strongyloides stercoralis, Isospora belli, microsporidia, and Cyclospora. Diagnostic considerations, including laboratory testing, are reviewed. The authors also discuss treatment options, including fluid and electrolyte therapy, dietary manipulation, nonspecific therapy with antidiarrheal compounds, and specific therapy with antimicrobial agents. 5 figures. 18 tables. 392 references. (AA-M). ·
Gastrointestinal Disease and Hepatitis Source: in Andersen, R.D., et al. Infections in Children: A Sourcebook for Educators and Child Care Providers. Aspen Publishers, Inc. 1994. p. 137146. Contact: Available from Aspen Publishers, Inc. 7201 McKinney Circle, Frederick, MD 21701. (800) 638-8437 or (301) 417-7500. Price: $36. ISBN: 0834203871. Summary: This chapter, from a handbook for educators and child care providers on infections in children, addresses gastrointestinal disease and hepatitis. The chapter covers vomiting; diarrhea; common causes of infectious diarrhea, including rotavirus, Escherichia coli, campylobacter species, salmonella, and shigella; hepatitis A; hepatitis B; and hepatitis C. In each section, the authors review the illness and its symptoms, consider etiology, review transmission and its prevention, and remind readers of the situations in which consultation of a health care provider is indicated. 3 references.
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Routes of Transmission of Pathogenic Microorganisms Source: in Joneja, J.M. and Bielory, L. Understanding Allergy, Sensitivity, and Immunity: A Comprehensive Guide. New Brunswick, NJ: Rutgers University Press. 1990. p. 20-25. Contact: Available from Rutgers University Press. 109 Church Street, New Brunswick, NJ 08901. (201) 932-7037. Price: $35 (cloth) or $13.95 (paperback). ISBN: 0813515203 (cloth) or 0813515211 (paperback). Summary: This chapter, from a comprehensive guide to understanding allergy, sensitivity, and immunity, discusses the routes of transmission of pathogenic microorganisms, notably the digestive route. Microorganisms in food, water, and other beverages are introduced into the digestive tract during eating and drinking. They may cause infections of the alimentary
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system alone or in other organ systems after dissemination from the initial infection site. Cholera, typhoid fever, and shigellosis are intestinal infections caused by bacteria that can be transmitted in contaminated water supplies. Hepatitis A virus can be transmitted in the same manner. Escherichia coli, a normal inhabitant of the healthy intestinal tract, but which can cause gastroenteritis, is commonly present in water contaminated with feces. The authors also discuss the variety of ways that food can be contaminated. ·
Escherichia Coli O157:H7 Gastroenteritis and the Hemolytic Uremic Syndrome: An Emerging Infectious Disease Source: in Coggins, C.H., ed. Annual Review of Medicine: Selected Topics in the Clinical Sciences, Volume 50. Palo Alto, CA: Annual Reviews. 1999. p. 355-367. Contact: Available from Annual Reviews. 4139 El Camino Way, P.O. Box 10139, Palo Alto, CA 94303-0139. (650) 493-4400. E-mail:
[email protected]. Website: www.AnnualReviews.org. Price: $60.00 plus shipping and handling. ISBN: 0824305507. Summary: Escherichia coli O157:H7 is an increasingly common cause of a variety of illnesses, including blood diarrhea and the hemolytic uremic syndrome (HUS). This emerging infectious agent was first identified in 1982 and has been isolated with increasing frequency since then. This article reviews the epidemiology, clinical spectrum, diagnosis, treatment, and prevention of infections with E. coli O157:H7. Infection with E. coli O157:H7 can be entirely asymptomatic or can present with a wide variety of clinical findings, including watery diarrhea, bloody diarrhea, HUS, thrombotic thrombocytopenic purpura (TTP), and death. The illness usually resolves after 1 week with no obvious sequelae; however, 5 to 10 percent of children with E. coli O157:H7 infection will develop HUS. HUS consists of the triad of microangiopathic hemolytic anemia, thrombocytopenia, and oliguric renal failure. Antimicrobial agents have no proven value in the treatment of E. coli O157:H7 infections. Antimotility agents should not be given to patients with bloody diarrhea or suspected E. coli O157:H7 infection, as these drugs may increase the risk of HUS in these patients. Treatment of HUS is supportive, with particular attention to the management of fluids and electrolytes. With meticulous care, the mortality rate for HUS is approximately 4 percent. 1 figure. 62 references. (AA-M).
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General Home References In addition to references for Escherichia coli, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Bacteria Menace: Todays Emerging Infections and How to Protect Yourself by Skye Weintraub; Paperback - 350 pages (May 2002), Woodland Publishing; ISBN: 1580543529; http://www.amazon.com/exec/obidos/ASIN/1580543529/icongroupinterna · Bacterial Infections by Axel Dalhoff (Editor); Paperback (April 1999), S. Karger Publishing; ISBN: 380556841X; http://www.amazon.com/exec/obidos/ASIN/380556841X/icongroupinterna · Encyclopedia of Infectious Diseases (Encyclopedia of Infectious Diseases, 1998) by Carol Turkington, Bonnie Ashby; Library Binding - 384 pages (September 1998), Facts on File, Inc.; ISBN: 0816035121; http://www.amazon.com/exec/obidos/ASIN/0816035121/icongroupinterna · Epidemic! The World of Infectious Disease by Rob Desalle (Editor), American Museum of Natural History; Paperback - 246 pages, 1st edition (September 1999), New Press; ISBN: 1565845463; http://www.amazon.com/exec/obidos/ASIN/1565845463/icongroupinterna · I Know How We Fight Germs (Sam’s Science) by Kate Rowan, et al; School & Library Binding - 32 pages (January 1999), Candlewick Press; ISBN: 0763605034; http://www.amazon.com/exec/obidos/ASIN/0763605034/icongroupinterna · Outbreak Alert: Responding to the Increasing Threat of Infectious Diseases by Jason Eberhart-Phillips, M.D.; Paperback - 292 pages (July 2000), New Harbinger Publications; ISBN: 1572242019; http://www.amazon.com/exec/obidos/ASIN/1572242019/icongroupinterna
Vocabulary Builder Actinomycosis: Infections with bacteria of the genus actinomyces. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Allergen: A antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Amebiasis: Infection with any of various amebae. It is an asymptomatic
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carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Aqueous: Watery; prepared with water. [EU] Arthralgia: Pain in a joint. [EU] Aspergillus: A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family Trichocomaceae. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cellulitis: An acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions. [NIH] Cyclospora: A genus of coccidian parasites in the family eimeriidae. Cyclospora cayetanensis is pathogenic in humans, probably transmitted via the fecal-oral route, and causes nausea and diarrhea. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH]
Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU]
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Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Entamoeba: A genus of ameboid protozoa characterized by the presence of beaded chromatin on the inner surface of the nuclear membrane. Its organisms are parasitic in invertebrates and vertebrates, including humans. [NIH]
Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Erysipelas: An acute superficial form of cellulitis involving the dermal lymphatics, usually caused by infection with group A streptococci, and chiefly characterized by a peripherally spreading hot, bright red, edematous, brawny, infiltrated, and sharply circumscribed plaque with a raised indurated border. Formerly called St. Anthony's fire. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Gangrene: Death of tissue, usually in considerable mass and generally associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Geotrichosis: Infection due to the fungus Geotrichum. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU]
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Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Isospora: A genus of protozoan parasites found in the intestines of birds, amphibians, reptiles, and mammals, including man. The oocysts produce two sporocysts, each with four sporozoites. Many species are parasitic in wild and domestic animals. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Megacolon: An abnormally large or dilated colon; the condition may be congenital or acquired, acute or chronic. [EU] Membranes: Thin layers of tissue which cover parts of the body, separate adjacent cavities, or connect adjacent structures. [NIH] Mycobacterium: An organism of the genus Mycobacterium. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neisseria: A genus of gram-negative, aerobic, coccoid bacteria whose organisms are part of the normal flora of the oropharynx, nasopharynx, and genitourinary tract. Some species are primary pathogens for humans. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to
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involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Papillomavirus: A genus of papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH]
Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Perianal: Located around the anus. [EU] Plesiomonas: A genus of gram-negative, facultatively anaerobic, rodshaped bacteria that occurs in fish and other aquatic animals and in a variety of mammals, including man. Its organisms probably do not belong to the normal intestinal flora of man and can cause diarrhea. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Protozoan: 1. any individual of the protozoa; protozoon. 2. of or pertaining to the protozoa; protozoal. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Refractory: Not readily yielding to treatment. [EU] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Squamous: Scaly, or platelike. [EU] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Strongyloides: A genus of parasitic nematodes widely distributed as intestinal parasites of mammals. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU]
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Varicella: Chicken pox. [EU] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]
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CHAPTER 7. MULTIMEDIA ON ESCHERICHIA COLI Overview Information on Escherichia coli can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on Escherichia coli. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on Escherichia coli is the Combined Health Information Database. You will need to limit your search to “video recording” and “Escherichia coli” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “Escherichia coli” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on Escherichia coli:
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·
Kitchens Alive with Germs Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1999. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. Price: $19.95 plus shipping and handling; bulk copies available. Order number 062099A. Summary: This videotape on foodborne illness and food handling is one in a series of health promotion programs called 'Picture of Health,' produced by the University of Wisconsin. In this program, moderated by Carol Koby and featuring dietitian Donna Weihofen and biotechnology educator Thomas Zinnen, the risk factors associated with the common kitchen sink and errors in food handling are explored. Topics include the evolution of bacteria into new strains, the rules of food safety, improvements in the detection of pathogens, beneficial bacteria, germs (a simple term for things that are small and can grow, including bacteria, viruses, fungi, proteus), harmful bacteria (including specific strains of Escherichia coli, salmonella, and listeria), the symptoms of food poisoning, specific foods at high risk of contamination (raw meats and vegetables), food handling, cooked versus uncooked foods, the problems associated with unprocessed apple cider, dishwashers and the use of heat to reduce bacteria levels, and food recalls. The program features a segment in which Dr. Zinnen works with a group of preschoolers to demonstrate proper handwashing techniques. The program concludes by referring viewers to the informational website of the American Dietetic Association (www.eatright.org).
·
E. Coli: Case of the Mysterious Microbe Source: Princeton, NJ: Films for the Humanities and Sciences. 1998. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126 or (609) 275-1400. Fax (609) 275-3767. E-mail:
[email protected]. Website: www.films.com. Price: $129.00 to purchase; $75.00 for rental; plus shipping and handling. Order number BXA7945. Summary: In this factual case study, revelers at a Burns Day celebration in Scotland become ill. When Escherichia coli is suspected, health officials try to discover its source. They and researchers move cautiously from one possible cause to the next: the food served, the water drunk, the improper handling of the food. When none of the investigations prove conclusive,
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suspicions mount that the microbe was probably passed on by someone sitting at the table where people became ill. During the program, researchers working on the case trace the evolution of the deadly 0157 E. coli strain from animals to ancient humans and make connections between E. coli and diseases such as flu and tuberculosis. The program is presented in a documentary style, with all involved parties contributing to solving the mystery. The viewer is taken back to the scene and follows along each trail of inquiry. The program covers the symptoms of E. coli poisoning, the most striking of which is severe abdominal pain and diarrhea. For children, the infection can result in kidney failure, and for older people it can be fatal. Although the mystery of this particular outbreak was never solved, the program packs a powerful message about the toxicity of E. coli: 0157 and the importance of appropriate food handling techniques. ·
Raw Terror: E. Coli Bacteria Source: Princeton, NJ: Films for the Humanities and Sciences. 1997. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126 or (609) 275-1400. Fax (609) 275-3767. E-mail:
[email protected]. Website: www.films.com. Price: $129.00 to purchase; $75.00 for rental; plus shipping and handling. Order number BXA6998. Summary: Eleven year old Damion Heersink nearly died after eating meat tainted with Escherichia coli:0157. This program details his battle to survive and documents the procedures that saved him. Doctors explain how E. coli bacteria produce hemolytic uremic syndrome, a condition that releases toxins into the bloodstream and can cause kidney failure. The program shows how kidney dialysis and a risky plasma exchange remove toxins from his system and reports on the use of two emergency surgeries to extract fluids from around his heart and to repair a hole in his intestine through which bacteria are escaping. Permanent lung and kidney damage are shown as two possible results of exposure to E. coli. (AA-M).
·
Food Borne Illnesses and Their Prevention Source: Charleston, WV: Cambridge Educational. 1995. (videocassette). Contact: Available from Cambridge Educational. P.O. Box 2153, Dept. D23, Charleston, WV 25328-2153. (800) 468-4227. Fax (800) FAX ON US. Website: www.cambridgeeducational.com. Price: $79.00 plus shipping and handling.
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Summary: This videotape program takes an indepth look at the recommended practices for food handlers (at home or commercially) to follow in order to prevent the spread of bacteria and other pathogens that can cause foodborne illness. The program investigates the causes, symptoms, and treatment of foodborne illnesses, with emphasis placed on their prevention. The program discusses the more common and severe illnesses in some detail. These include Salmonella, Campylobacter jejuni, Escherichia coli, Botulism, and Listeriosis. For each infectious organism, the narrator describes why the pathogen causes illness, how long the illness should be expected to last, safe and proper treatments, and when to contact a health care provider. The program then reviews shopping, food preparation, and hygiene issues that can help prevent foodborne illness. The final section of the videotape reviews the recommended internal cooking temperatures for a variety of foods. The program stresses that almost all foodborne illnesses can be avoided if people who handled food are educated about causes and the proper procedures to avoid contamination. The USDA Food Hotline number (800-535-4555) is provided for viewers who would like to obtain additional information.
Bibliography: Multimedia on Escherichia Coli The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in Escherichia coli (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on Escherichia coli. For more information, follow the hyperlink indicated: ·
Core evidence. Source: a presentation of Films for the Humanities & Sciences; produced by MEDSTAR; TLC; Year: 1999; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c1999
·
E. coli : case of the mysterious microbe. Source: a presentation of Films for the Humanities & Sciences; a Border Television co-production with the EBS Trust; Year: 1998; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1998
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·
E. coli 0157 : H7: where's the beef?: recorded at DDW 1995 in San Diego. Source: AGA; Year: 1995; Format: Sound recording; [United States]: American Gastroenterological Association, [1995?]
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E. coli O157:H7 : what the clinical microbiologist should know. Source: Centers for Disease Control and Prevention; produced by Television Services, Training and Media Development Branch, Division of Media and Training Services, Public Health P; Year: 1994; Format: Videorecording; Alanta, GA: The Centers, [1994]
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E. coli omega protein : an enzyme which breaks and rejoins the DNA backbone. Source: University of Texas Cancer Center M. D. Anderson Hospital and Tumor Institute: [produced by] MDA-TV; Year: 1977; Format: Videorecording; Houston: The Center, 1977
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F. A. detection of enteropathogenic Escherichia coli. Source: National Communicable Disease Center, Laboratory Program; [made by] National Medical Audiovisual Center; Year: 1967; Format: Motion picture; [Atlanta]: The Center: [for loan by National Medical Audiovisual Center; Washington: for sale by National Audiovisual Center], 1967
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Food safety : a challenge for everyone in public health. Source: Centers for Disease Control and Prevention, UNC School of Public Health; Year: 2001; Format: Videorecording; [Atlanta, Ga.]: Public Health Training Network, [2001]
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Of mice and men and E. coli. Source: Great Atlantic Radio Conspiracy; Year: 1977; Format: Sound recording; [Baltimore]: Great Atlantic Radio Conspiracy, [1977]
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Peptide binding to HLA class I molecules isolated from E. coli : what peptides bind and how do they fit?. Year: 1992; Format: Videorecording; [Bethesda, Md.: NIAID, 1992]
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Sequences in human, bovine, and E. coli tryptophanyl tRNA synthetases. Source: University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Institute; Year: 1976; Format: Videorecording; Houston: The Institute, 1976
Vocabulary Builder Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Anastomosis: An opening created by surgical, traumatic or pathological means between two normally separate spaces or organs. [EU]
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Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH]
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CHAPTER 8. PERIODICALS AND NEWS ON ESCHERICHIA COLI Overview Keeping up on the news relating to Escherichia coli can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on Escherichia coli. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover Escherichia coli beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on Escherichia coli is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “Escherichia coli” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to Escherichia coli. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “Escherichia coli” (or synonyms). The following was recently listed in this archive for Escherichia coli: ·
Enteroaggregative Escherichia coli linked with diarrhea in HIVpositive individuals Source: Reuters Medical News Date: October 27, 2000 http://www.reuters.gov/archive/2000/10/27/professional/links/20001 027clin015.html
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Nontoxic polymyxin B nonapeptide enhances killing of resistant Escherichia coli Source: Reuters Medical News Date: August 16, 2000 http://www.reuters.gov/archive/2000/08/16/professional/links/20000 816scie001.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news
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items are indexed by MEDLINEplus within their search engine. The following was recently indexed as relating to Escherichia coli: ·
Better E. Coli Technology Planned http://www.nlm.nih.gov/medlineplus/news/fullstory_8312.html
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “Escherichia coli” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “Escherichia coli” (or synonyms). If you know the name of a company that is relevant to Escherichia coli, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “Escherichia coli” (or synonyms).
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Newsletters on Escherichia Coli Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “Escherichia coli.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “Escherichia coli” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·
Overused Antibiotics Lead to Resistant UTIs: Assessing Resistance Risk, Testing Fluoroquinolone Alternatives Key Source: Urology Times. 22(3): 2. March 1994. Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This brief news article, from a professional newsletter, warns that physicians' overuse of fluoroquinolones to treat urinary tract infections (UTIs) has led to a significant increase in ciprofloxacin-resistant Escherichia coli. Topics include problems with recurrence of urinary tract infections; recent increases in the use of fluoroquinolones; risk factors for ciprofloxacin-resistant E coli UTIs; experience with 54 patients with resistant UTIs; and the course of ciprofloxacin-resistant E coli-induced UTIs. The article concludes with a brief discussion of alternative treatments, including the combination of amoxicillin and potassium clavulanate.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html.
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Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “Escherichia coli” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months.
Academic Periodicals covering Escherichia Coli Academic periodicals can be a highly technical yet valuable source of information on Escherichia coli. We have compiled the following list of periodicals known to publish articles relating to Escherichia coli and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on Escherichia coli published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on Escherichia coli: ·
Applied Microbiology and Biotechnology. (Appl Microbiol Biotechnol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A pplied+Microbiology+and+Biotechnology&dispmax=20&dispstart=0
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Bioorganic & Medicinal Chemistry. (Bioorg Med Chem) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi oorganic+&+Medicinal+Chemistry&dispmax=20&dispstart=0
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Biotechnology and Bioengineering. (Biotechnol Bioeng) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi otechnology+and+Bioengineering&dispmax=20&dispstart=0
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Intensive Care Medicine. (Intensive Care Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Int ensive+Care+Medicine&dispmax=20&dispstart=0
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Journal of Applied Microbiology. (J Appl Microbiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Applied+Microbiology&dispmax=20&dispstart=0
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Journal of Bacteriology. (J Bacteriol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Bacteriology&dispmax=20&dispstart=0
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Journal of Biochemistry. (J Biochem (Tokyo)) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Biochemistry&dispmax=20&dispstart=0
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Journal of Clinical Microbiology. (J Clin Microbiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Clinical+Microbiology&dispmax=20&dispstart=0
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Molecular Microbiology. (Mol Microbiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=M olecular+Microbiology&dispmax=20&dispstart=0
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Nucleic Acids Research. (Nucleic Acids Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=N ucleic+Acids+Research&dispmax=20&dispstart=0
·
Plant & Cell Physiology. (Plant Cell Physiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Pl ant+&+Cell+Physiology&dispmax=20&dispstart=0
Vocabulary Builder Amoxicillin:
A broad-spectrum semisynthetic antibiotic similar to
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ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Polymyxin: Basic polypeptide antibiotic group obtained from Bacillus polymyxa. They affect the cell membrane by detergent action and may cause neuromuscular and kidney damage. At least eleven different members of the polymyxin group have been identified, each designated by a letter. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/health/diseases.htm
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.27 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:28 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 28 See http://www.nlm.nih.gov/databases/databases.html. 27
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
·
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
·
MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
·
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
·
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat Escherichia coli, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and Escherichia coli using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “Escherichia coli” (or synonyms) into
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the “For these words:” box above, you will only receive results on fact sheets dealing with Escherichia coli. The following is a sample result: ·
Waterborne-Disease Outbreaks, 1989-1990 Source: MMWR. Morbidity and Mortality Weekly Report. 40(SS-3): 1-21. 1991. Summary: This report presents statistics for waterborne-disease outbreaks (WBDO) for 1989-1990. Sixteen states reported 26 outbreaks due to water intended for drinking and an estimated total of 4,288 persons became ill in these outbreaks. In addition to WBDOs associated with water intended for drinking, the surveillance summaries include data about outbreaks associated with water used for recreational purposes and outbreaks of gastroenteritis (waterborne or foodborne) on ocean-going passenger vessels that call on ports in the United States. The report includes a list of data sources, definitions, interpretation of data, the results of the reports, and previously unreported outbreaks. The authors discuss the agents implicated in the outbreaks, notably Giardia lamblia and Escherichia coli. They conclude that the national surveillance of WBDOs, which has proceeded for two decades, continues to be a useful means for characterizing the epidemiology of waterborne diseases. 5 figures. 6 tables. 39 references. (AA-M).
The NLM Gateway29 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.30 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.31 To use the NLM Gateway, simply go to the search site at Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 31 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while 29 30
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http://gateway.nlm.nih.gov/gw/Cmd. Type “Escherichia coli” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 344613 Books / Periodicals / Audio Visual 2563 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 350661
HSTAT32 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.33 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.34 Simply search by “Escherichia coli” (or synonyms) at the following Web site: http://text.nlm.nih.gov. also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 32 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 33 The HSTAT URL is http://hstat.nlm.nih.gov/. 34 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
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Coffee Break: Tutorials for Biologists35 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.36 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.37 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical
35 Adapted
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 37 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
36
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literature, and to explore relevant Web http://www.med.virginia.edu/~wmd4n/medweaver.html. ·
sites;
see
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.
The Genome Project and Escherichia Coli With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to Escherichia coli. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).38 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “Escherichia coli” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for Escherichia coli: Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
38
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·
3-prime @repair Exonuclease 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?606605
·
3-prime @repair Exonuclease 2 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?300370
·
5-prime,3-prime-@nucleotidase, Cytosolic Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?191720
·
Acetylserotonin Methyltransferase-like Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?300162
·
Adp-ribosyltransferase Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?173870
·
Aldehyde Dehydrogenase 1 Family, Member A2 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?603687
·
Aldehyde Dehydrogenase, Family 3, Subfamily A, Member 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?100660
·
Alkb, E. Coli, Homolog of Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?605345
·
Alpha-methylacyl-coa Racemase Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?604489
·
Angiotensin I Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?106150 Genes and Disease (NCBI - Map)
The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this
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site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
·
Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich’s ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
160 Escherichia Coli
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “Escherichia coli” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database39 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form.
Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.
39
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At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database40 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “Escherichia coli” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.
40
162 Escherichia Coli
Specialized References The following books are specialized references written for professionals interested in Escherichia coli (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · 2002 Pocket Book of Infectious Disease Therapy by John G. Bartlett; Paperback - 348 pages, 11th edition (November 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781734320; http://www.amazon.com/exec/obidos/ASIN/0781734320/icongroupinterna · Bacterial Infections of Humans: Epidemiology and Control by Alfred S. Evans (Editor), et al; Hardcover - 887 pages, 3rd edition (July 15, 1998), Plenum Publishing Corporation; ISBN: 0306453207; http://www.amazon.com/exec/obidos/ASIN/0306453207/icongroupinterna · Cellular Microbiology : Bacteria-Host Interactions in Health and Disease by Brian Henderson, et al; Hardcover - 478 pages (May 28, 1999), John Wiley & Sons; ISBN: 047198678X; http://www.amazon.com/exec/obidos/ASIN/047198678X/icongroupinterna
· The Comprehensive Sourcebook of Bacterial Protein Toxins by Joseph E. Alouf (Editor), John H. Freer (Editor); Hardcover - 718 pages, 2nd edition (August 15, 1999), Academic Press; ISBN: 0120530759; http://www.amazon.com/exec/obidos/ASIN/0120530759/icongroupinterna · Current Diagnosis & Treatment in Infectious Diseases by Walter R. Wilson (Editor), et al; Paperback - 985 pages, 1st edition (June 22, 2001), McGraw-Hill Professional Publishing; ISBN: 0838514944; http://www.amazon.com/exec/obidos/ASIN/0838514944/icongroupinterna · Hunter’s Tropical Medicine and Emerging Infectious Diseases by George W. Hunter (Editor), et al; Hardcover - 1192 pages, 8th edition (January 15, 2000), W B Saunders Co; ISBN: 0721662234; http://www.amazon.com/exec/obidos/ASIN/0721662234/icongroupinterna · Infectious Disease by Barbara Bannister, et al; Paperback - 506 pages, 2nd edition (August 15, 2000), Blackwell Science Inc.; ISBN: 0632053194; http://www.amazon.com/exec/obidos/ASIN/0632053194/icongroupinterna · Infectious Disease Epidemiology: Theory and Practice by Kenrad E. Nelson, et al; Hardcover - 600 pages (May 2000), Aspen Publishers, Inc.; ISBN: 083421766X; http://www.amazon.com/exec/obidos/ASIN/083421766X/icongroupinterna
· Laboratory Diagnosis of Bacterial Infections (Infectious Disease and Therapy, Vol 26) by Nevio Cimolai (Editor); Hardcover (August 2001),
Physician Guidelines and Databases 163
Marcel Dekker; ISBN: 0824705890; http://www.amazon.com/exec/obidos/ASIN/0824705890/icongroupinterna · Mandell, Douglas, and Bennett’s Principles & Practice of Infectious Diseases (2 Vol. Set) by Gerald L. Mandell (Editor), et al; Hardcover - 3263 pages, 5th edition (June 15, 2000), Churchill Livingstone; ISBN: 044307593X; http://www.amazon.com/exec/obidos/ASIN/044307593X/icongroupinterna
· Molecular Bacteriology: Protocols and Clinical Applications by Neil Woodford (Editor), Alan Johnson (Editor); Hardcover - 682 pages, 1st edition (June 15, 1998), Humana Press; ISBN: 0896034984; http://www.amazon.com/exec/obidos/ASIN/0896034984/icongroupinterna · Molecular Epidemiology of Infectious Diseases by R. C. Andrew Thompson; Hardcover - 326 pages, 1st edition (October 15, 2000), Edward Arnold; ISBN: 0340759097; http://www.amazon.com/exec/obidos/ASIN/0340759097/icongroupinterna · Persistent Bacterial Infections by James P. Nataro (Editor), et al; Hardcover (June 2000), American Society for Microbiology; ISBN: 1555811590; http://www.amazon.com/exec/obidos/ASIN/1555811590/icongroupinterna
Dissertations 165
CHAPTER 10. DISSERTATIONS ON ESCHERICHIA COLI Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to Escherichia coli. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Escherichia Coli ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to Escherichia coli. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with Escherichia coli: ·
A Comparison of Porcine Class 2 and Bovine Enterotoxigenic Strains of Escherichia Coli by Harnett, Norma M; Phd from University of Guelph (canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK52499
166 Escherichia Coli
·
A Conformational Study of 5-fluoroucacil Labeled Escherichia Coli 5srrna by Smith, James Lewis; Phd from The University of British Columbia (canada), 1980 http://wwwlib.umi.com/dissertations/fullcit/NK50059
·
A Genetic Analysis of the To1a,b Locus of Escherichia Coli K-12 by Bernstein, Alan; Phd from University of Toronto (canada), 1972 http://wwwlib.umi.com/dissertations/fullcit/NK14664
·
A Genetic Study of Membrane Protein Insertion and Disulfide Bond Formation in Escherichia Coli K-12 by Tian, Hongping; Phd from Harvard University, 2001, 136 pages http://wwwlib.umi.com/dissertations/fullcit/3011500
·
A Major Cell Envelope Protein of Escherichia Coli K12 Purification and Properties by Kuntz, Douglas Arthur; Phd from The University of Western Ontario (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL36084
·
A Study of the Transcriptional Control Region Identification of a Putative Regulatory Sequence in Escherichia Coli Rna Polymerase Binding Sites by Roy, Rabindra Nath; Phd from The University of New Brunswick (canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK58642
·
A Study of Trna Biosynthesis in Escherichia Coli by Chase, Randal; Phd from The University of British Columbia (canada), 1974 http://wwwlib.umi.com/dissertations/fullcit/NK22048
·
Acid Tolerance in Escherichia Coli O157:h7 Following Cold Shock Treatment by Cho, Chia-hui; Msc from The University of Manitoba (canada), 2001, 167 pages http://wwwlib.umi.com/dissertations/fullcit/MQ57527
·
Activation of Expression of the Escherichia Coli Hya Operon Encoding Uptake-hydrogenase Hyd1 by King, Paul Wayne; Phd from University of Georgia, 2001, 101 pages http://wwwlib.umi.com/dissertations/fullcit/3025327
·
An Analysis of the Function of Region 1.2 of the Primary Sigma Factor, Sigma 70, from Escherichia Coli by Baldwin, Nicole Elizabeth; Phd from The Univ. of Texas H.s.c. at Houston Grad. Sch. of Biomed. Sci., 2001, 160 pages http://wwwlib.umi.com/dissertations/fullcit/3028786
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Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to Escherichia coli is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with Escherichia coli and related conditions.
Researching Your Medications 171
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with Escherichia coli. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for Escherichia coli. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of Escherichia coli. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
172 Escherichia Coli
Your Medications: The Basics41 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of Escherichia coli. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with Escherichia coli take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for Escherichia coli. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
41
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 173
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for Escherichia coli). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the
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medications your doctor has recommended for Escherichia coli. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.42 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided.
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office. Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
42
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medications are listed in the Reuters’ database as associated with Escherichia coli (including those with contraindications):43 ·
Filgrastim http://www.reutershealth.com/atoz/html/Filgrastim.htm
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Filgrastim (G-CSF) http://www.reutershealth.com/atoz/html/Filgrastim_(G-CSF).htm
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Loperamide HCl http://www.reutershealth.com/atoz/html/Loperamide_HCl.htm
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Ticarcillin http://www.reutershealth.com/atoz/html/Ticarcillin.htm Mosby’s GenRx
Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
43
Adapted from A to Z Drug Facts by Facts and Comparisons.
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Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with Escherichia coli--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat Escherichia coli or potentially create deleterious side effects in patients with Escherichia coli. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with Escherichia coli. Exercise caution--some of these drugs may have fraudulent claims, and
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others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with Escherichia coli. The FDA warns patients to watch out for44: ·
Secret formulas (real scientists share what they know)
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Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
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If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Interactions in Infectious Diseases (Infectious Disease) by Stephen C. Piscitelli (Editor), et al; Hardcover - 372 pages (September 2000), Humana Press; ISBN: 0896037509; http://www.amazon.com/exec/obidos/ASIN/0896037509/icongroupinterna · Management of Antimicrobials in Infectious Diseases: Impact of Antibiotic Resistance by Arch G. Mainous, Ph.D. (Editor), et al; Hardcover - 350 pages, 1st edition (January 15, 2001), Humana Press; ISBN: 0896038211; http://www.amazon.com/exec/obidos/ASIN/0896038211/icongroupinterna · Manual of Antibiotics and Infectious Diseases: Treatment and Prevention by John E. Conte; Paperback - 755 pages, 9th edition (December 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781723167; http://www.amazon.com/exec/obidos/ASIN/0781723167/icongroupinterna 44
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to Escherichia coli. Finally, at the conclusion of this chapter, we will provide a list of readings on Escherichia coli from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?45 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?46 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
46
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.47
47
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Escherichia Coli Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for Escherichia coli. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “Escherichia coli” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options.
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National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to Escherichia coli and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “Escherichia coli” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to Escherichia coli: ·
Airway administration of Escherichia coli endotoxin to mice induces glucocorticosteroid-resistant bronchoconstriction and vasopermeation. Author(s): Lefort J, Motreff L, Vargaftig BB. Source: American Journal of Respiratory Cell and Molecular Biology. 2001 March; 24(3): 345-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11245635&dopt=Abstract
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Alteration of the repressor activity of MarR, the negative regulator of the Escherichia coli marRAB locus, by multiple chemicals in vitro. Author(s): Alekshun MN, Levy SB. Source: Journal of Bacteriology. 1999 August; 181(15): 4669-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10419969&dopt=Abstract
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Antibacterial activity of garlic powder against Escherichia coli O-157. Author(s): Sasaki J, Kita T, Ishita K, Uchisawa H, Matsue H. Source: J Nutr Sci Vitaminol (Tokyo). 1999 December; 45(6): 785-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10737231&dopt=Abstract
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Antibacterial activity of green tea polyphenols against Escherichia coli K 12. Author(s): Amarowicz R, Pegg RB, Bautista DA. Source: Die Nahrung. 2000 February; 44(1): 60-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10703004&dopt=Abstract
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Antibacterial activity of S-methyl methanethiosulfinate and S-methyl 2-propene-1-thiosulfinate from Chinese chive toward Escherichia coli
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O157:H7. Author(s): Seo KI, Moon YH, Choi SU, Park KH. Source: Biosci Biotechnol Biochem. 2001 April; 65(4): 966-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11388483&dopt=Abstract ·
Autophosphorylation of phosphoglucosamine mutase from Escherichia coli. Author(s): Jolly L, Pompeo F, van Heijenoort J, Fassy F, Mengin-Lecreulx D. Source: Journal of Bacteriology. 2000 March; 182(5): 1280-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10671448&dopt=Abstract
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Avian air sac and plasma proteins that bind surface polysaccharides of Escherichia coli O2. Author(s): Weebadda WK, Hoover GJ, Hunter DB, Hayes MA. Source: Comparative Biochemistry and Physiology. Part B, Biochemistry & Molecular Biology. 2001 October; 130(3): 299-312. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11567892&dopt=Abstract
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Bioaccumulation of mercury from wastewater by genetically engineered Escherichia coli. Author(s): Deng X, Wilson DB. Source: Applied Microbiology and Biotechnology. 2001 July; 56(1-2): 2769. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11499944&dopt=Abstract
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Biosynthesis of terpenoids: YchB protein of Escherichia coli phosphorylates the 2-hydroxy group of 4-diphosphocytidyl-2C-methylD-erythritol. Author(s): Luttgen H, Rohdich F, Herz S, Wungsintaweekul J, Hecht S, Schuhr CA, Fellermeier M, Sagner S, Zenk MH, Bacher A, Eisenreich W. Source: Proceedings of the National Academy of Sciences of the United States of America. 2000 February 1; 97(3): 1062-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10655484&dopt=Abstract
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Characterization of recombinant human chymase expressed in Escherichia coli.
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Author(s): Takai S, Sumi S, Aoike M, Sakaguchi M, Itoh Y, Jin D, Matsumura E, Miyazaki M. Source: Jpn J Pharmacol. 2000 February; 82(2): 144-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10877533&dopt=Abstract ·
Characterization of up-regulated proteases in an industrial recombinant Escherichia coli fermentation. Author(s): Jordan GL, Harcum SW. Source: Journal of Industrial Microbiology & Biotechnology. 2002 February; 28(2): 74-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12074055&dopt=Abstract
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Chemical treatment of Escherichia coli. II. Direct extraction of recombinant protein from cytoplasmic inclusion bodies in intact cells. Author(s): Falconer RJ, O'Neill BK, Middelberg AP. Source: Biotechnology and Bioengineering. 1998 February 20; 57(4): 381-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10099214&dopt=Abstract
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Cloning and functional expression in Escherichia coli of a cDNA encoding cardenolide 16'-O-glucohydrolase from Digitalis lanata Ehrh. Author(s): Framm JJ, Peterson A, Thoeringer C, Pangert A, Hornung E, Feussner I, Luckner M, Lindemann P. Source: Plant & Cell Physiology. 2000 November; 41(11): 1293-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11092916&dopt=Abstract
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Common architecture of the primary galactose binding sites of Erythrina corallodendron lectin and heat-labile enterotoxin from Escherichia coli in relation to the binding of branched neolactohexaosylceramide. Author(s): Teneberg S, Berntsson A, Angstrom J. Source: Journal of Biochemistry. 2000 September; 128(3): 481-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10965049&dopt=Abstract
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Cost-effective whole-cell assay for laboratory evolution hydroxylases in Escherichia coli. Author(s): Schwaneberg U, Otey C, Cirino PC, Farinas E, Arnold FH.
of
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Source: Journal of Biomolecular Screening : the Official Journal of the Society for Biomolecular Screening. 2001 April; 6(2): 111-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11689105&dopt=Abstract ·
Cytidine 5'-triphosphate-dependent biosynthesis of isoprenoids: YgbP protein of Escherichia coli catalyzes the formation of 4diphosphocytidyl-2-C-methylerythritol. Author(s): Rohdich F, Wungsintaweekul J, Fellermeier M, Sagner S, Herz S, Kis K, Eisenreich W, Bacher A, Zenk MH. Source: Proceedings of the National Academy of Sciences of the United States of America. 1999 October 12; 96(21): 11758-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10518523&dopt=Abstract
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Cytotoxicity of derivatives from dehydrocrotonin on V79 cells and Escherichia coli. Author(s): da Silva Melo P, Duran N, Haun M. Source: Toxicology. 2001 February 28; 159(3): 135-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11223169&dopt=Abstract
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Damage to the cytoplasmic membrane of Escherichia coli by catechincopper (II) complexes. Author(s): Hoshino N, Kimura T, Yamaji A, Ando T. Source: Free Radical Biology & Medicine. 1999 December; 27(11-12): 124550. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10641717&dopt=Abstract
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Detection of immunomagnetically captured Escherichia coli O157:H7 by antibody-conjugated alkaline phosphatase. Author(s): Tu SI, Patterson D, Briggs C, Irwin P, Yu L. Source: Journal of Industrial Microbiology & Biotechnology. 2001 June; 26(6): 345-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11571617&dopt=Abstract
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Effect of an extract of cauliflower (leaf) on the labeling of blood elements with technetium-99m and on the survival of Escherichia coli AB1157 submitted to the treatment with stannous chloride.
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Author(s): Lima EA, Dire G, Mattos DM, Freitas RS, Gomes ML, de Oliveira MB, Faria MV, Jales RL, Bernardo-Filho M. Source: Food and Chemical Toxicology : an International Journal Published for the British Industrial Biological Research Association. 2002 July; 40(7): 919-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12065213&dopt=Abstract ·
Effect of single mutations on the specificity of Escherichia coli FPG protein for excision of purine lesions from DNA damaged by free radicals. Author(s): Sidorkina O, Dizdaroglu M, Laval J. Source: Free Radical Biology & Medicine. 2001 September 15; 31(6): 81623. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11557320&dopt=Abstract
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Effect of the Cymbopogon citratus, Maytenus ilicifolia and Baccharis genistelloides extracts against the stannous chloride oxidative damage in Escherichia coli. Author(s): Melo SF, Soares SF, da Costa RF, da Silva CR, de Oliveira MB, Bezerra RJ, Caldeira-de-Araujo A, Bernardo-Filho M. Source: Mutation Research. 2001 September 20; 496(1-2): 33-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11551478&dopt=Abstract
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Effects of beta-glucuronidase-deficient and lycopene-producing Escherichia coli strains on formation of azoxymethane-induced aberrant crypt foci in the rat colon. Author(s): Arimochi H, Kataoka K, Kuwahara T, Nakayama H, Misawa N, Ohnishi Y. Source: Biochemical and Biophysical Research Communications. 1999 August 27; 262(2): 322-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10462473&dopt=Abstract
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Effects of heat stress on the antimicrobial drug resistance of Escherichia coli of the intestinal flora of swine. Author(s): Moro MH, Beran GW, Griffith RW, Hoffman LJ.
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Source: Journal of Applied Microbiology. 2000 May; 88(5): 836-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10792544&dopt=Abstract ·
Elongation factor Tu and DnaK are transferred from the cytoplasm to the periplasm of Escherichia coli during osmotic downshock presumably via the mechanosensitive channel mscL. Author(s): Berrier C, Garrigues A, Richarme G, Ghazi A. Source: Journal of Bacteriology. 2000 January; 182(1): 248-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10613892&dopt=Abstract
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Engineering Escherichia coli for the synthesis of taxadiene, a key intermediate in the biosynthesis of taxol. Author(s): Huang Q, Roessner CA, Croteau R, Scott AI. Source: Bioorganic & Medicinal Chemistry. 2001 September; 9(9): 2237-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11553461&dopt=Abstract
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Epigallocatechin gallate and gallocatechin gallate in green tea catechins inhibit extracellular release of Vero toxin from enterohemorrhagic Escherichia coli O157:H7. Author(s): Sugita-Konishi Y, Hara-Kudo Y, Amano F, Okubo T, Aoi N, Iwaki M, Kumagai S. Source: Biochimica Et Biophysica Acta. 1999 October 18; 1472(1-2): 42-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10572924&dopt=Abstract
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Escherichia coli 6-pyruvoyltetrahydropterin synthase ortholog encoded by ygcM has a new catalytic activity for conversion of sepiapterin to 7,8-dihydropterin. Author(s): Woo HJ, Hwang YK, Kim YJ, Kang JY, Choi YK, Kim CG, Park YS. Source: Febs Letters. 2002 July 17; 523(1-3): 234-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12123838&dopt=Abstract
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Escherichia coli double-strand uracil-DNA glycosylase: involvement in uracil-mediated DNA base excision repair and stimulation of activity by endonuclease IV. Author(s): Sung JS, Mosbaugh DW.
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Source: Biochemistry. 2000 August 22; 39(33): 10224-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10956012&dopt=Abstract ·
Escherichia coli strains blocked in Tat-dependent protein export exhibit pleiotropic defects in the cell envelope. Author(s): Stanley NR, Findlay K, Berks BC, Palmer T. Source: Journal of Bacteriology. 2001 January; 183(1): 139-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11114910&dopt=Abstract
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Export and folding of signal-sequenceless Bacillus licheniformis betalactamase in Escherichia coli. Author(s): Frate MC, Lietz EJ, Santos J, Rossi JP, Fink AL, Ermacora MR. Source: European Journal of Biochemistry / Febs. 2000 June; 267(12): 3836-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10849003&dopt=Abstract
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Expression and characterization of the prtV gene encoding a collagenase from Vibrio parahaemolyticus in Escherichia coli. Author(s): Yu MS, Lee CY. Source: Microbiology (Reading, England). 1999 January; 145 ( Pt 1): 14350. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10206692&dopt=Abstract
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Extracellular sensing components and extracellular induction component alarmones give early warning against stress in Escherichia coli. Author(s): Rowbury RJ. Source: Adv Microb Physiol. 2001; 44: 215-57. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11407114&dopt=Abstract
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Fructose-6-phosphate aldolase is a novel class I aldolase from Escherichia coli and is related to a novel group of bacterial transaldolases. Author(s): Schurmann M, Sprenger GA.
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Source: The Journal of Biological Chemistry. 2001 April 6; 276(14): 1105561. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11120740&dopt=Abstract ·
Hyperbaric oxygen delivery in treatment of a child with KlippelTrenaunay syndrome complicated with a limb threatening Escherichia coli infection. Author(s): Gionis D, Kalabalikis P, Zachariadis B, Moustaki M, Ourani E, Papazoglou K, Papadatos J. Source: Intensive Care Medicine. 2000 March; 26(3): 355. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10823397&dopt=Abstract
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Identification of an RNA-binding Site in the ATP binding domain of Escherichia coli Rho by H2O2/Fe-EDTA cleavage protection studies. Author(s): Wei RR, Richardson JP. Source: The Journal of Biological Chemistry. 2001 July 27; 276(30): 283807. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11369775&dopt=Abstract
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Identification of the two zinc-bound cysteines in the ferric uptake regulation protein from Escherichia coli: chemical modification and mass spectrometry analysis. Author(s): Gonzalez de Peredo A, Saint-Pierre C, Adrait A, Jacquamet L, Latour JM, Michaud-Soret I, Forest E. Source: Biochemistry. 1999 June 29; 38(26): 8582-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10387106&dopt=Abstract
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In vivo synergy between green tea extract and levofloxacin against enterohemorrhagic Escherichia coli O157 infection. Author(s): Isogai E, Isogai H, Hirose K, Hayashi S, Oguma K. Source: Current Microbiology. 2001 April; 42(4): 248-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11178724&dopt=Abstract
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Influence of cranberry juice on attachment of Escherichia coli to glass. Author(s): Allison DG, Cronin MA, Hawker J, Freeman S.
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Source: Journal of Basic Microbiology. 2000; 40(1): 3-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10746194&dopt=Abstract ·
Inhibitory effects of gynostemma pentaphyllum on the UV induction of bacteriophage lambda in lysogenic Escherichia coli. Author(s): Zhu S, Fang C, Zhu S, Peng F, Zhang L, Fan C. Source: Current Microbiology. 2001 October; 43(4): 299-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11683367&dopt=Abstract
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Interaction of omega-conotoxin and the membrane calcium transport system of Escherichia coli. Author(s): Tisa LS. Source: Fems Microbiology Letters. 2000 July 1; 188(1): 97-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10867241&dopt=Abstract
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Isolation of the Escherichia coli nucleoid. Author(s): Cunha S, Odijk T, Suleymanoglu E, Woldringh CL. Source: Biochimie. 2001 February; 83(2): 149-54. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11278063&dopt=Abstract
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Kinetics and thermodynamics of activation of quinoprotein glucose dehydrogenase apoenzyme in vivo and catalytic activity of the activated enzyme in Escherichia coli cells. Author(s): Iswantini D, Kano K, Ikeda T. Source: The Biochemical Journal. 2000 September 15; 350 Pt 3: 917-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10970809&dopt=Abstract
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Lectins in fruits having gastrointestinal activity: their participation in the hemagglutinating property of Escherichia coli O157:H7. Author(s): Coutino-Rodriguez R, Hernandez-Cruz P, Giles-Rios H. Source: Archives of Medical Research. 2001 July-August; 32(4): 251-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11440778&dopt=Abstract
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Manganese is essential for catalytic activity of Escherichia coli agmatinase. Author(s): Carvajal N, Lopez V, Salas M, Uribe E, Herrera P, Cerpa J.
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Source: Biochemical and Biophysical Research Communications. 1999 May 19; 258(3): 808-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10329468&dopt=Abstract ·
Manganese supplementation relieves the phenotypic deficits seen in superoxide-dismutase-null Escherichia coli. Author(s): Al-Maghrebi M, Fridovich I, Benov L. Source: Archives of Biochemistry and Biophysics. 2002 June 1; 402(1): 1049. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12051688&dopt=Abstract
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Mapping of the Rsd contact site on the sigma 70 subunit of Escherichia coli RNA polymerase. Author(s): Jishage M, Dasgupta D, Ishihama A. Source: Journal of Bacteriology. 2001 May; 183(9): 2952-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11292818&dopt=Abstract
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Mapping protein-protein interactions with a library of tethered cutting reagents: the binding site of sigma 70 on Escherichia coli RNA polymerase. Author(s): Traviglia SL, Datwyler SA, Meares CF. Source: Biochemistry. 1999 April 6; 38(14): 4259-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10194343&dopt=Abstract
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Mapping RNA-protein interactions in ribonuclease P from Escherichia coli using disulfide-linked EDTA-Fe. Author(s): Biswas R, Ledman DW, Fox RO, Altman S, Gopalan V. Source: Journal of Molecular Biology. 2000 February 11; 296(1): 19-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10656815&dopt=Abstract
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Metal-catalyzed oxidation of phenylalanine-sensitive 3-deoxy-Darabino-heptulosonate-7-phosphate synthase from Escherichia coli: inactivation and destabilization by oxidation of active-site cysteines. Author(s): Park OK, Bauerle R.
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Source: Journal of Bacteriology. 1999 March; 181(5): 1636-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10049398&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to escherichia coli; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation:
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·
General Overview Bladder Infection Alternative names: Urinary Tract Infection [UTI] Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000269.html Brain Inflammation, Meningitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Me ningitiscc.html Diarrhea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Food Poisoning Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Foo dPoisoningcc.html Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulc erativeColitiscc.html Meningitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Me ningitiscc.html
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Shock Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Sho ckcc.html Ulcerative Colitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Ulcerative_Colitis. htm Ulcerative Colitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulc erativeColitiscc.html Urinary Tract Infection Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/UTI.htm Urinary Tract Infection in Women Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Uri naryTractInfectioninWomencc.html UTI Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Uri naryTractInfectioninWomencc.html
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Herbs and Supplements Barberry Alternative names: Berberis vulgaris Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Barberry.htm Bovine Colostrum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Bovine_Colostrum.htm Cranberry Alternative names: Vaccinium macrocarpon Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cranberry.htm Cranberry Alternative names: Vaccinium macrocarpon Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cranberr ych.html Cranberry Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000139.html Cranberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10019,00.html Curcuma Alternative names: Turmeric; Curcuma longa L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/
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Doxycycline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Doxycycline.htm Goldenseal Alternative names: Hydrastis canadensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Goldense alch.html Goldenseal Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 791,00.html Hibiscus Alternative names: Hibiscus, Roselle; Hibiscus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Humulus Alternative names: Hops; Humulus lupulus L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Hydrastis canadensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Goldense alch.html Melaleuca Alternative names: Tea Tree Oil; Melaleuca alternifolia Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/
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Momordica Alternative names: Bitter Gourd, Karela; Momordica charantia Linn. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Ocimum Alternative names: Basil, Albahaca; Ocimum basilicum Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Oregano/Wild Marjoram Alternative names: Origanum vulgare Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Oregano.htm Oregon Grape Alternative names: Berberis aquifolium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Oregon_Grape.htm Piper nigrum Alternative names: Black Pepper Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Tetracycline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Tetracycline.htm Vaccinium macrocarpon Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cranberr ych.html
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Herbal Antibiotics : Natural Alternatives for Treating Drug-Resistant Bacteria (Storey Medicinal Herb Guide) by Stephen Harrod Buhner; Paperback - 128 pages (September 1999), Storey Books; ISBN: 1580171486; http://www.amazon.com/exec/obidos/ASIN/1580171486/icongroupinterna · Natural Alternatives to Antibiotics by John McKenna; Paperback - 176 pages (November 1998), Avery Penguin Putnam; ISBN: 0895298392; http://www.amazon.com/exec/obidos/ASIN/0895298392/icongroupinterna · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·
Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·
Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001),
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Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna ·
New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Colostrum: The thin, yellow, serous fluid secreted by the mammary glands during pregnancy and immediately postpartum before lactation begins. It consists of immunologically active substances, white blood cells, water, protein, fat, and carbohydrates. [NIH] Diffusion: The process of becoming diffused, or widely spread; the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent, a process requiring no addition of energy to the system. [EU] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Microgram: A unit of mass (weight) of the metric system, being onemillionth of a gram (10-6 gm.) or one one-thousandth of a milligram (10-3 mg.). [EU] Postmenopausal: Occurring after the menopause. [EU] Tetracycline:
An
antibiotic
originally
produced
by
Streptomyces
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viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with Escherichia coli. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with Escherichia coli may be given different recommendations. Some recommendations may be directly related to Escherichia coli, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of Escherichia coli. We will then show you how to find studies dedicated specifically to nutrition and Escherichia coli.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:48 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
48
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?49
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”50 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.51 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 50 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 51 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 49
210 Escherichia Coli
the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected]
Finding Studies on Escherichia Coli The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.52 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
52
Researching Nutrition 211
periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “Escherichia coli” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on Escherichia coli: ·
E. coli, Salmonella, Listeria, bacteria become unwelcome house guests. Source: Welland, D. Environmental-nutrition (USA). (October 1997). volume 20(10) page 1, 6. salmonella listeria escherichia coli foods contamination foodborne diseases 0893-4452 Summary: salmonella listeria escherichia coli produit alimentaire contamination maladie transmissible par aliment
Additional consumer oriented references include: ·
A study into the antibiotic effect of garlic Allium sativum on Escherichia coli and Staphylococcus albus. Source: Maidment, D.C.J. Dembny, Z. Harding, C. Nutr-food-sci. Bradford, West Yorkshire, England : MCB University Press. 1999. (4/5) page 170-172. 0034-6659
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
·
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
·
The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
212 Escherichia Coli
·
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
·
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
·
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
·
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
·
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
·
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
·
Google: http://directory.google.com/Top/Health/Nutrition/
·
Healthnotes: http://www.thedacare.org/healthnotes/
·
Open Directory Project: http://dmoz.org/Health/Nutrition/
·
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
·
WebMDÒHealth: http://my.webmd.com/nutrition
·
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH]
Researching Nutrition 213
Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 215
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.53
53
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
216 Escherichia Coli
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):54 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
·
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
·
California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
54
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 217
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
·
California: San José PlaneTree Health Library, http://planetreesanjose.org/
·
California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
·
California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
·
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
·
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
·
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
·
Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
·
Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
·
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
218 Escherichia Coli
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
·
Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
·
Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
·
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
·
Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
·
Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
·
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
·
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
·
Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
·
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 219
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
·
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
·
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
·
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
·
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
·
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
·
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
·
Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
·
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
·
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
·
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
·
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
·
Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
·
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
·
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
·
New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
·
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
·
New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
·
New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
·
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
·
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
·
Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 221
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
·
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
·
Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
·
Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
·
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
·
Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
·
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 223
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with Escherichia coli faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.55 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
55Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
224 Escherichia Coli
·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 225
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
226 Escherichia Coli
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 227
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.56
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”57 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 57 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 56
228 Escherichia Coli
·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.58 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.59 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 59 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 58
Your Rights and Insurance 229
3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
230 Escherichia Coli
7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
Your Rights and Insurance 231
contact information on how to find more in-depth information about Medicaid.60
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
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232 Escherichia Coli
Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
Your Rights and Insurance 233
phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.61 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:62 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
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More on Food Irradiation 235
APPENDIX F. MORE ON FOOD IRRADIATION Overview63 Food irradiation is a promising new food safety technology that can eliminate disease-causing germs from foods. Like pasteurization of milk, and pressure cooking of canned foods, treating food with ionizing radiation can kill bacteria and parasites that would otherwise cause foodborne disease. Similar technology is used to sterilize medical devices so they can be used in surgery or implanted without risk of infection. The food that NASA astronauts eat has been sterilized by irradiation to avoid getting foodborne illness in space. The effects of irradiation on the food and on animals and people eating irradiated food have been studied extensively. These studies show clearly that when irradiation is used as approved on foods: ·
Disease-causing germs are reduced or eliminated
·
Food does not become radioactive
·
Dangerous substances do not appear in the foods
·
Nutritional value of the food is essentially unchanged
Irradiation is a safe and effective technology that can prevent many foodborne diseases.
Adapted from the Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodirradiation.htm.
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Which Foodborne Irradiation?
Diseases
Could
Be
Prevented
with
Treating raw meat and poultry with irradiation at the slaughter plant could eliminate bacteria commonly found on raw meat and raw poultry, such as E. coli O157:H7, Salmonella, and Campylobacter. These organisms currently cause millions of infections and thousands of hospitalizations in the United States every year. Irradiating prepared ready-to-eat meats like hot dogs and deli meats, could eliminate the risk of Listeria from such foods. Irradiation could also eliminate parasites like Cyclospora and bacteria like Shigella and Salmonella from fresh produce. The potential benefit is also great for those dry foods that might be stored for long times and transported over great distances, such as spices and grains. Animal feeds are often contaminated with bacteria like Salmonella. Irradiation of animal feeds could prevent the spread of Salmonella and other pathogens to livestock through feeds.
Irradiation Process Three different irradiation technologies exist, that use three different kinds of rays: gamma rays, electron beams and x-rays. The first technology uses the radiation given off by a radioactive substance. This can be either a radioactive form of the element cobalt (Cobalt 60) or of the element cesium (Cesium 137). These substances give off high energy photons, called gamma rays, which can penetrate foods to a depth of several feet. These particular substances do not give off neutrons, which means they do not make anything around them radioactive. This technology has been used routinely for more than thirty years to sterilize medical, dental and household products, and it is also used for radiation treatment of cancer. Radioactive substances emit gamma rays all the time. When not in use, the radioactive “source” is stored down in a pool of water which absorbs the radiation harmlessly and completely. To irradiate food or some other product, the source is pulled up out of the water into a chamber with massive concrete walls that keep any rays from escaping. Medical products or foods to be irradiated are brought into the chamber, and are exposed to the rays for a defined period of time. After it is used, the source is returned to the water tank. Electron beams, or e-beams, are produced in a different way. The e-beam is a stream of high energy electrons, propelled out of an electron gun. This electron gun apparatus is a larger version of the device in the back of a TV
More on Food Irradiation 237
tube that propels electrons into the TV screen at the front of the tube, making it light up. This electron beam generator can be simply switched on or off. No radioactivity is involved. Some shielding is necessary to protect workers from the electron beam, but not the massive concrete walls required to stop gamma rays. The electrons can penetrate food only to a depth of three centimeters, or a little over an inch, so the food to be treated must be no thicker than that to be treated all the way through. Two opposing beams can treat food that is twice as thick. E-beam medical sterilizers have been in use for at least fifteen years. The newest technology is X-ray irradiation. This is an outgrowth of e-beam technology, and is still being developed. The X-ray machine is a more powerful version of the machines used in many hospitals and dental offices to take X-ray pictures. To produce the X-rays, a beam of electrons is directed at a thin plate of gold or other metal, producing a stream of X-rays coming out the other side. Like cobalt gamma rays, X-rays can pass through thick foods, and require heavy shielding for safety. However, like e-beams, the machine can be switched on and off, and no radioactive substances are involved. Four commercial X-ray irradiation units have been built in the world since 1996.
How Does Irradiation Affect Foods? The foods are not changed in nutritional value and they are not made dangerous as a result of the irradiation. The high energy ray is absorbed as it passes through food, and gives up its energy. The food is slightly warmed. Some treated foods may taste slightly different, just as pasteurized milk tastes slightly different from unpasteurized milk. If the food still has living cells, (such as seeds, or shellfish, or potatoes) they will be damaged or killed just as microbes are. This can be a useful effect. For example, it can be used to prolong the shelf life of potatoes by keeping them from sprouting. The energy can induce a few other changes. At levels approved for use on foods, levels of the vitamin thiamine are slightly reduced. This reduction is not enough to result in vitamin deficiency. There are no other significant changes in the amino acid, fatty acid, or vitamin content of food. In fact, the changes induced by irradiation are so minimal that it is not easy to determine whether or not a food has been irradiated. Irradiated foods need to be stored, handled and cooked in the same way as unirradiated foods. They could still become contaminated with germs during processing after irradiation, if the rules of basic food safety are not
238 Escherichia Coli
followed. Because the irradiated foods have fewer microbes of all sorts, including those that cause spoilage, they may have a longer shelf life before spoiling. The safety of irradiated foods has been studied by feeding them to animals and to people. These extensive studies include animal feeding studies lasting for several generations in several different species, including mice, rats, and dogs. There is no evidence of adverse health effects in these well-controlled trials. In addition, NASA astronauts eat foods that have been irradiated to the point of sterilization (substantially higher levels of treatment than that approved for general use) when they fly in space. The safety of irradiated foods has been endorsed by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and by the Assistant Secretary of Health, as well as by the U.S. Department of Agriculture (USDA)and the Food and Drug Administration (FDA).
How Do You Measure the Amount of Irradiation Used? The dose of irradiation is usually measured in a unit called the Gray, abbreviated Gy.. This is a measure of the amount of energy transferred to food, microbe or other substance being irradiated. 10 kiloGrays, or 10,000 Grays, is the same as an older measure, the megaRad. A single chest X-ray has a dose of roughly a half of a milliGray (a thousandth of a Gray). To kill Salmonella., fresh chicken can be irradiated at up to 4.5 kiloGrays, which is about 7 million times more irradiation than a single chest X-ray. To measure the amount of irradiation something is exposed to, photographic film is exposed to the irradiation at the same time. The film fogs at a rate that is proportional to the irradiation level. The killing effect of irradiation on microbes is measured in D-values. One Dvalue is the amount of irradiation needed to kill 90% of that organism. For example, it takes 0.3 kiloGrays to kill 90% of E. coli O157, so the D-value of E. coli is 0.3 kGy. These numbers can be added exponentially. It takes two D (or 0.6 kGy in the case of E. coli) to kill 99% of the organisms present, 3 D (or 0.9 kGy) to kill 99.9% and so on. Thus, once you know the D-value for an organism, and how many organisms might possibly be present in a food, the technician can estimate how much irradiation it will take to kill all of them. For example, if you think that a thousand E. coli O157 could be present in a food, then you want to be able to treat with at least 4 D, or 4 x 0.3 kGy, or 1.2 kGy. The D-values are different for each organism, and need to be measured
More on Food Irradiation 239
for each organism. They can even vary by temperature, and by the specific food. The energy of e-beams and of x-rays is measured in the amount of energy developed by the electron gun, and is measured in electron volts (eV). The usual apparatus runs at 5 to 10 million electron volts (MeV).
How Does Irradiation Affect Disease-Causing Microbes? When microbes present in the food are irradiated, the energy from the rays is transferred to the water and other molecules in the microbe. The energy creates transient reactive chemicals that damage the DNA in the microbe, causing defects in the genetic instructions. Unless it can repair this damage, the microbe will die when it grows and tries to duplicate itself. Diseasecausing organisms differ in their sensitivity to irradiation, depending on the size of their DNA, the rate at which they can repair damaged DNA, and other factors. It matters if the food is frozen or fresh, as it takes a higher dose to kill microbes in frozen foods. The size of the DNA “target” in the organism is a major factor. Parasites and insect pests, which have large amounts of DNA, are rapidly killed by extremely low doses of irradiation, with D-values of 0.1 kiloGray or less. It takes more irradiation to kill bacteria, because they have a somewhat smaller DNA, with D-values in the range of 0.3 to 0.7 kiloGray. Some bacteria can form dense hardy spores, which means they enter a compact and inert hibernation state. It takes more irradiation to kill a bacterial spore, with Dvalues on the order of 2.8 kiloGray. Viruses are the smallest pathogens with that have nucleic acid, and they are in general resistant to irradiation at doses approved for foods. This means that they may have D-values of 10 kG or higher. The prion particles associated with bovine spongiform encephalopathy (BSE, also known as mad cow disease) do not have nucleic acid at all, and so they are not inactivated by irradiation, except at extremely high doses. This means that irradiation will work very well to eliminate parasites and bacteria from food, but will not work to eliminate viruses or prions from food.
Which Foods Can Be Irradiated? At low doses, irradiation could be used on a wide variety of foods to eliminate insect pests, as a replacement for fumigation with toxic chemicals
240 Escherichia Coli
that is routine for many foods now. It can also inhibit the growth of molds, inhibit sprouting, and prolong the shelf life. At higher doses, irradiation could be used on a variety of different foods to eliminate parasites and bacteria that cause foodborne disease. Many foods can be irradiated effectively, including meat, poultry, grains, and many seafoods, fruits and vegetables. It is likely to have greatest application for raw foods of animal origin that are made by mixing materials from many animals together, such as ground meat or sausage. However, not all foods are suitable for irradiation. For example, oysters and other raw shellfish can be irradiated, but the shelf life and quality decreases markedly because the live oyster inside the shell is also damaged or killed by the irradiation. Shell eggs can sometimes be contaminated on the insides with Salmonella. However, irradiation causes the egg whites to become milky and more liquid, which means it looks like an older egg, and may not serve as well in some recipes. Alfalfa seeds used in making alfalfa sprouts can sometimes be contaminated with Salmonella. Using irradiation to eliminate Salmonella from the seeds may require a dose of irradiation that also interferes with the viability of the seeds themselves. Combining irradiation with other strategies to reduce contamination with germs may overcome these limitations.
Which Foods Have Been Approved for Irradiation in the United States? A variety of foods have been approved for irradiation in the United States, for several different purposes. For meats, separate approval is required both from the FDA and the USDA.
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Approval Year
Food
Dose
Purpose
1963
Wheat flour
0.2-0.5 kGy
Control of mold
1964
White potatoes
0.05-0.15 kGy
Inhibit sprouting
1986
Pork
0.3-1.0 kGy
Kill Trichina parasites
1986
Fruit and vegetables
1.0 kGy
Insect control, increase shelf life
1986
Herbs and spices
30 kGy
Sterilization
1990 – FDA
Poultry
3 kGy
Bacterial pathogen reduction
1992 – USDA
Poultry
1.5-3.0 kGy
Bacterial pathogen reduction
1997 – FDA
Meat
4.5 kGy
Bacterial pathogen reduction
1999 - USDA (pending) Meat
4.5 kGy
Bacterial pathogen reduction
Which Foods Are Being Irradiated in the U.S.? A facility in Florida has been irradiating strawberries and other fruits on a limited basis, to prolong shelf life. On a trial basis, fresh tropical fruits from Hawaii have been irradiated before shipping them to the mainland, instead of fumigating them to eliminate the fruit fly pests that could spread to the mainland. Some spices for commercial use have been irradiated. In addition irradiation is widely used to sterilize a variety of medical and household products, from hip joint implants to bandaids and baby pacifiers. Other technologies used to sterilize fruits, spices and medical devices use toxic chemicals, such as ethylene oxide. Use of irradiation can reduce the use of these other hazardous substances.
How Can I Tell If the Food Has Been Irradiated? A distinctive logo has been developed for use on food packaging, in order to identify the product as irradiated. This symbol is called the “radura” and is used internationally to mean that the food in the package has been irradiated. A written description may also be present, such as “Irradiated to destroy harmful microbes”. It is not required to label a food if a minor ingredient of the food, such as a spice, has been irradiated itself.
242 Escherichia Coli
Are Consumers Ready to Buy Irradiated Foods? Many consumers are quite willing to buy irradiated foods. This is particularly true if the purpose of the irradiation is clearly indicated. Consumers are interested in a process that eliminates harmful microbes from the food and reduce the risk of foodborne disease. In test marketing of specific irradiated foods, consumers have shown that they are willing to buy them. Typically at least half will buy the irradiated food, if given a choice between irradiated product and the same product non-irradiated. If consumers are first educated about what irradiation is and why it is done, approximately 80% will buy the product in these marketing tests.
Would Irradiation Prevention Efforts?
Replace
Other
Foodborne
Disease
Irradiation is not a short cut that means food hygiene efforts can be relaxed. Many steps need to be taken from farm to table to make sure that our food supply is clean and safe. Irradiation is a major step forward, but it does not replace other important efforts, including efforts to improve sanitation on the farm and in the food processing plant. For irradiation to be effective, the food that is to be irradiated already needs to be clean. The more initial contamination there is, the higher dose of irradiation it would take to eliminate possible pathogens, and the greater the change in the taste and quality of the food. The protection of irradiation will be overcome if the contamination levels are too high. The same is true for pasteurized milk. To be pasteurized, milk must be produced in regulated dairy farms, and must be of Grade A quality. Milk that is less than Grade A is not pasteurized for direct sale as milk. Thus, irradiation of food is an important additional step for added safety in the whole farm-to-table continuum of food safety measures.
Is Irradiation of Food Just Like Pasteurization of Milk? Irradiation has the potential to be used like milk pasteurization in the future. We have confidence in the safety of pasteurized milk for several reasons. The milk is graded and tested to make sure that the milk is clean enough to pasteurize in the first place. Careful industry standards and regulations monitor the effectiveness of the pasteurization process. The pasteurization
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occurs just before the milk goes into the carton, so the chance of recontamination after pasteurization is nearly zero. Similar strategies and designs can make food irradiation as effective as milk pasteurization. Currently, pasteurization is applied to foods (like milk) that already meet a defined cleanliness standard, and is applied at a dose that gives a standard defined effect. As the irradiation of food becomes commercialized for various foods, similar standardization will be required.
Who Makes Sure That the Irradiation Facilities Are Operated Safely? The effectiveness of the treatment in eliminating pathogens will be regulated as a food safety process, by either the USDA or the FDA, often in concert with State authorities, just as is the case now for milk pasteurization or retort canning. The safety of operations of irradiation facilities is regulated separately. This requires extensive worker training, supervision, and regulatory oversight. Facilities using radioactive sources are regulated by the Nuclear Regulatory Commission (NRC). To be licensed, the facility must have been designed with multiple fail-safe measures, and must establish extensive and well documented safety procedures, and worker training. The safe transport of the radioactive sources is regulated by the Department of Transportation. E-beam and X-ray sources are not monitored by the NRC, but rather by the part of the FDA that regulates medical X-ray devices, and by the same State authorities that regulate other medical, dental and industrial uses of these technologies.
Have There Been Any Accidents Involving Irradiation Facilities? Medical sterilization facilities have been operated in this country for more than 30 years, without a fatal accident. Over 100 such facilities are currently licensed, along with at least that many medical radiation treatment centers, and bone marrow transplant centers (which also use Cobalt 60 to irradiate patients). No events have been documented in this country that led to exposure of the population at large to radioactivity. In other countries, a small number of fatal incidents have been documented in which a worker
244 Escherichia Coli
by-passed multiple safety steps to enter the chamber while the source was exposed, resulting in a severe or even lethal radiation injury to themselves.
What Radioactive Waste Is Generated? Is waste storage or transport a problem? Cobalt 60 is manufactured in a commercial nuclear reactor, by exposing non-radioactive cobalt to intense radiation in the reactor core. Cesium 137 is a by-product of the manufacture of weapons-grade radioactive substances. Thus the supply of these two substances, like that of other radioactive materials used in medicine, science and industry, is dependent on the nuclear industry. The food irradiation facilities themselves do not become radioactive, and do not create radioactive waste. The cobalt sources used in irradiation facilities decay by 50% in five years, and therefore require periodic replacement. The small radioactive cobalt “pencils” are shipped back to the original nuclear reactor, where they can be recharged for further use. The shipment occurs in special hardened steel canisters that have been designed and tested to survive crashes without breaking. Cobalt is a solid metal, and even if somehow something should break, it will not spread through the environment. Cobalt 60 may also be disposed of as a radioactive waste. Given its relatively short half life(5 years) and its stable metallic form, the material is not considered to be a problematic waste. In contrast to metallic cobalt, cesium is a salt, which means it can dissolve in water. Cesium 137 sources decay by 50% in 31 years, and therefore are not often replaced. When they are replaced, the old cesium sources will be sent to a storage site in the same special transport canisters. If a leak should occur, there is the possibility that the cesium salts could dissolve in water and thus spread into the environment. This happened at a medical sterilizer facility in Decatur, Georgia in 1992, when a steel container holding the cesium cracked, and some cesium leaked into the shielding water tank. E-beams and X-ray facilities do not involve radioactive substances.
What about the Effect of Irradiation on Food Packaging Materials? The food to be irradiated will often already be in its final package. This raises the question about whether the irradiation has any effect on the packaging
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that might be transferred to the foods. The effect of irradiation on plastics and other packaging was investigated in the 1960s and early 1970s, in order to identify safe packaging materials for use in the space program. A limited number of materials have been approved for use in packaging food that is to be irradiated. This limited number reflects the limited needs of NASA, not the difficulty of identifying safe products. Many modern packaging materials have simply not been tested. Testing and approving a wider array of packaging materials is critical to the successful commercialization of irradiated foods.
Do Other Countries Irradiate Their Food? Many other countries have begun to irradiate food, including France, the Netherlands, Portugal, Israel, Thailand, Russia, China and South Africa.
What Is the CDC’s Position on Food Irradiation? CDC has stated that food irradiation is a promising new application of an established technology. It holds great potential for preventing many important foodborne diseases that are transmitted through meat, poultry, fresh produce and other foods. An overwhelming body of scientific evidence demonstrates that irradiation does not harm the nutritional value of food, nor does it make the food unsafe to eat. Just as for the pasteurization of milk, it will be most effective when irradiation is coupled to careful sanitation programs. Consumer confidence will depend on making food clean first, and then using irradiation or pasteurization to make it safe. Food irradiation is a logical next step to reducing the burden of foodborne disease in the United States.
How Can I Find Out More about Food Irradiation? Basic documents on the safety and efficacy of food irradiation include: ·
Lee, Philip R. Assistant Secretary for Health. Irradiation to prevent foodborne illness (Editorial). JAMA 272, p 261, 1994
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Radomyski T, Murano EA, Olson DG, Murano PS. Elimination of pathogens of significance in food by low-dose irradiation: A review. J Food Protection 57:pp73-86, 1994
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·
Thayer DW, Josephson ES, Brynjolfsson A, Giddings GG. Radiation pasteurization of food Ames (IA). Council for Agricultural Science and Technology; 1996 Issue paper No 7.
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Mussman HC. Potentials of cold pasteurization for the safety of foods of animal origin. J Am Vet Med Assoc, 209, pp 2057-2058, 1996.
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Osterholm, M.T. and M. E. Potter, Irradiation pasteurization of solid foods; taking food safety to the next level. Emerging Infectious Disease, 3:575-577; 1997.
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Joint FAO/IAEA/WHO study group on High-Dose Irradiation. Highdose irradiation: wholesomeness of food irradiated with doses above 10kGy. WHO technical report series 890. World Health Organization, Geneva, 1999.
Web Sites with Information on Food Irradiation ·
For general information about food irradiation, see the Web site of the Foundation for Food Irradiation Education: http://www.foodirradiation.com/
·
For a list of countries using irradiation, see http://www.iaea.org/icgfi
Vocabulary Builder Cesium: A member of the alkali metals. It has an atomic symbol Cs, atomic number 50, and atomic weight 132.91. Cesium has many industrial applications, including the construction of atomic clocks based on its atomic vibrational frequency. [NIH] Cobalt: A trace element that is a component of vitamin B12. It has the atomic symbol Co, atomic number 27, and atomic weight 58.93. It is used in nuclear weapons, alloys, and pigments. Deficiency in animals leads to anemia; its excess in humans can lead to erythrocytosis. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU]
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Fumigation: The application of smoke, vapor, or gas for the purpose of disinfecting or destroying pests or microorganisms. [NIH] Hibernation: The dormant state in which some animal species pass the winter. It is characterized by narcosis and by sharp reduction in body temperature and metabolic activity and by a depression of vital signs. It is a natural physiological process in many warm-blooded animals. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Radioactivity: The quality of emitting or the emission of corpuscular or electromagnetic radiations consequent to nuclear disintegration, a natural property of all chemical elements of atomic number above 83, and possible of induction in all other known elements. [EU] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Sterilization: 1. the complete destruction or elimination of all living microorganisms, accomplished by physical methods (dry or moist heat), chemical agents (ethylene oxide, formaldehyde, alcohol), radiation (ultraviolet, cathode), or mechanical methods (filtration). 2. any procedure by which an individual is made incapable of reproduction, as by castration, vasectomy, or salpingectomy. [EU]
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
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Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to Escherichia coli and keep them on file.
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Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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ESCHERICHIA COLI GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Actinomycosis: Infections with bacteria of the genus actinomyces. [NIH] Acylation: The addition of an organic acid radical into a molecule. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Aerobic: 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH] Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Alcaligenes: A genus of gram-negative, aerobic, motile bacteria that occur in water and soil. Some are common inhabitants of the intestinal tract of vertebrates. These bacteria occasionally cause opportunistic infections in humans. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU]
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Allergen: A antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Ammonia: Ammonia. A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broad-spectrum antibiotic. [NIH] Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anastomosis: An opening created by surgical, traumatic or pathological means between two normally separate spaces or organs. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU]
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Anus: The distal or terminal orifice of the alimentary canal. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Aqueous: Watery; prepared with water. [EU] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Arthralgia: Pain in a joint. [EU] Aspergillus: A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family Trichocomaceae. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Azoxymethane: A potent carcinogen and neurotoxic compound. It is particularly effective in inducing colon carcinomas. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriophages: Viruses whose host is a bacterial cell. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biogenesis: The origin of life. It includes studies of the potential basis for
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life in organic compounds but excludes studies of the development of altered forms of life through mutation and natural selection, which is evolution. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Bordetella: A genus of gram-negative, aerobic bacteria whose cells are minute coccobacilli. It consists of both parasitic and pathogenic species. [NIH] Brevibacterium: A gram-positive organism found in dairy products, fresh and salt water, marine organisms, insects, and decaying organic matter. [NIH] Bronchoconstriction: The act or process of decreasing the calibre of a bronchus; bronchostenosis. [EU] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Catechin: Extracted from Uncaria gambier, Acacia catechu and other plants; it stabilizes collagen and is therefore used in tanning and dyeing; it prevents capillary fragility and abnormal permeability, but was formerly used as an antidiarrheal. [NIH]
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Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Cellulitis: An acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions. [NIH] Cesium: A member of the alkali metals. It has an atomic symbol Cs, atomic number 50, and atomic weight 132.91. Cesium has many industrial applications, including the construction of atomic clocks based on its atomic vibrational frequency. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: Persisting over a long period of time. [EU] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Citrobacter: A genus of gram-negative, rod-shaped enterobacteria that can use citrate as the sole source of carbon. [NIH] Citrus: Any tree or shrub of the rue family or the fruit of these plants. [NIH] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH]
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Cobalt: A trace element that is a component of vitamin B12. It has the atomic symbol Co, atomic number 27, and atomic weight 58.93. It is used in nuclear weapons, alloys, and pigments. Deficiency in animals leads to anemia; its excess in humans can lead to erythrocytosis. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Colitis: Inflammation of the colon. [EU] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Colostrum: The thin, yellow, serous fluid secreted by the mammary glands during pregnancy and immediately postpartum before lactation begins. It consists of immunologically active substances, white blood cells, water, protein, fat, and carbohydrates. [NIH] Commensal: 1. living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. an organism living on or within another, but not causing injury to the host. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraception: The prevention of conception or impregnation. [EU] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, cryptosporidium. It occurs in both animals and humans. [NIH] Cryptosporidium: A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Cyclospora: A genus of coccidian parasites in the family eimeriidae. Cyclospora cayetanensis is pathogenic in humans, probably transmitted via the fecal-oral route, and causes nausea and diarrhea. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystitis: Inflammation of the urinary bladder. [EU]
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Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxins: Substances elaborated by microorganisms, plants or animals that are specifically toxic to individual cells; they may be involved in immunity or may be contained in venoms. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH]
Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diffusion: The process of becoming diffused, or widely spread; the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent, a process requiring no addition of energy to the system. [EU] Digitalis: A genus of toxic herbaceous Eurasian plants of the Scrophulaceae which yield cardiotonic glycosides. The most useful are Digitalis lanata and
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D. purpurea. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Dysuria: Painful or difficult urination. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Encephalopathy: Any degenerative disease of the brain. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Entamoeba: A genus of ameboid protozoa characterized by the presence of beaded chromatin on the inner surface of the nuclear membrane. Its organisms are parasitic in invertebrates and vertebrates, including humans. [NIH]
Enterobacter: Gram-negative gas-producing rods found in feces of man and other animals, sewage, soil, water, and dairy products. [NIH] Enterococcus: A genus of gram-positive, coccoid bacteria consisting of organisms causing variable hemolysis that are normal flora of the intestinal tract. Previously thought to be a member of the genus streptococcus, it is now recognized as a separate genus. [NIH]
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Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Erysipelas: An acute superficial form of cellulitis involving the dermal lymphatics, usually caused by infection with group A streptococci, and chiefly characterized by a peripherally spreading hot, bright red, edematous, brawny, infiltrated, and sharply circumscribed plaque with a raised indurated border. Formerly called St. Anthony's fire. [EU] Erythrina: A genus of leguminous shrubs or trees, mainly tropical, yielding certain alkaloids, lectins, and other useful compounds. [NIH] Erythritol: A four-carbon sugar that is found in algae, fungi, and lichens. It is twice as sweet as sucrose and can be used as a coronary vasodilator. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Exfoliation: A falling off in scales or layers. [EU] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate,
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is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Facial: Of or pertaining to the face. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Folklore: The common orally transmitted traditions, myths, festivals, songs, superstitions, and stories of all peoples. [NIH] Fumigation: The application of smoke, vapor, or gas for the purpose of disinfecting or destroying pests or microorganisms. [NIH] Galactokinase: An enzyme that catalyzes reversibly the formation of galactose 1-phosphate and ADP from ATP and D-galactose. Galactosamine can also act as the acceptor. A deficiency of this enzyme results in galactosemia. EC 2.7.1.6. [NIH] Gangrene: Death of tissue, usually in considerable mass and generally associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geotrichosis: Infection due to the fungus Geotrichum. [NIH] Giardia: A genus of flagellate intestinal protozoa parasitic in various vertebrates, including humans. Characteristics include the presence of four
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pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Handwashing: The act of cleansing the hands with water or other liquid, with or without the inclusion of soap or other detergent, for the purpose of removing soil or microorganisms. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hemagglutinins: Agents that cause agglutination of red blood cells. They include antibodies, blood group antigens, lectins, autoimmune factors, bacterial, viral, or parasitic blood agglutinins, etc. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hepatitis: Inflammation of the liver. [EU]
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Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hibernation: The dormant state in which some animal species pass the winter. It is characterized by narcosis and by sharp reduction in body temperature and metabolic activity and by a depression of vital signs. It is a natural physiological process in many warm-blooded animals. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Humoral: Of, relating to, proceeding from, or involving a bodily humour now often used of endocrine factors as opposed to neural or somatic. [EU] Hydration: The condition of being combined with water. [EU] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU]
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Immunization: The induction of immunity. [EU] Immunogenic: Producing immunity; evoking an immune response. [EU] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infantile: Pertaining to an infant or to infancy. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Pertaining to the intestine. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Isospora: A genus of protozoan parasites found in the intestines of birds, amphibians, reptiles, and mammals, including man. The oocysts produce two sporocysts, each with four sporozoites. Many species are parasitic in wild and domestic animals. [NIH] Klebsiella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms arrange singly, in pairs, or short chains. This genus is commonly found in the intestinal tract and is an opportunistic pathogen that can give rise to bacteremia, pneumonia, urinary tract and several other types of human infection. [NIH] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals,
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including humans. Pathogenicity from this genus is rare. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lethal: Deadly, fatal. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Listeria: A genus of bacteria which may be found in the feces of animals and man, on vegetation, and in silage. Its species are parasitic on cold-blooded and warm-blooded animals, including man. [NIH] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Megacolon: An abnormally large or dilated colon; the condition may be congenital or acquired, acute or chronic. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microgram: A unit of mass (weight) of the metric system, being onemillionth of a gram (10-6 gm.) or one one-thousandth of a milligram (10-3 mg.). [EU] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU]
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Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microvilli: Minute projections of cell membranes which greatly increase the surface area of the cell. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mycobacterium: An organism of the genus Mycobacterium. [EU] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH]
Mycotic: Pertaining to a mycosis; caused by fungi. [EU] Myeloma: A tumour composed of cells of the type normally found in the bone marrow. [EU] Myocardium: The muscle tissue of the HEART composed of striated, involuntary muscle known as cardiac muscle. [NIH] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neisseria: A genus of gram-negative, aerobic, coccoid bacteria whose organisms are part of the normal flora of the oropharynx, nasopharynx, and genitourinary tract. Some species are primary pathogens for humans. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Pertaining to neurology or to the nervous system. [EU] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used
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to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
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Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papillomavirus: A genus of papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH]
Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Particle: A tiny mass of material. [EU] Pathogen: Any disease-producing microorganism. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Perianal: Located around the anus. [EU] Pericarditis: Inflammation of the pericardium. [EU] Periplasm: The space between the inner and outer membranes of a cell that is shared with the cell wall. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Plasmids:
Any extrachromosomal hereditary determinant. Plasmids are
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self-replicating circular molecules of DNA that are found in a variety of bacterial, archaeal, fungal, algal, and plant species. [NIH] Plesiomonas: A genus of gram-negative, facultatively anaerobic, rodshaped bacteria that occurs in fish and other aquatic animals and in a variety of mammals, including man. Its organisms probably do not belong to the normal intestinal flora of man and can cause diarrhea. [NIH] Pneumonia: Inflammation of the lungs with consolidation. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polymyxin: Basic polypeptide antibiotic group obtained from Bacillus polymyxa. They affect the cell membrane by detergent action and may cause neuromuscular and kidney damage. At least eleven different members of the polymyxin group have been identified, each designated by a letter. [NIH] Postmenopausal: Occurring after the menopause. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premenstrual: Occurring before menstruation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
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Proteus: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that occurs in the intestines of humans and a wide variety of animals, as well as in manure, soil, and polluted waters. Its species are pathogenic, causing urinary tract infections and are also considered secondary invaders, causing septic lesions at other sites of the body. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: sarcomastigophora, Labyrinthomorpha, apicomplexa, microspora, Ascetospora, Myxozoa, and ciliophora. [NIH] Protozoan: 1. any individual of the protozoa; protozoon. 2. of or pertaining to the protozoa; protozoal. [EU] Pseudomonas: A genus of gram-negative, aerobic, rod-shaped bacteria widely distributed in nature. Some species are pathogenic for humans, animals, and plants. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Radioactivity: The quality of emitting or the emission of corpuscular or electromagnetic radiations consequent to nuclear disintegration, a natural property of all chemical elements of atomic number above 83, and possible of induction in all other known elements. [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refractory: Not readily yielding to treatment. [EU] Remission: A diminution or abatement of the symptoms of a disease; also
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the period during which such diminution occurs. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Ribotyping: Restriction fragment length polymorphism analysis of rRNA genes that is used for differentiating between species or strains. [NIH] Ruminants: A suborder of the order artiodactyla whose members have the distinguishing feature of a four-chambered stomach. Horns or antlers are usually present, at least in males. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood
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on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sinusitis: Inflammation of a sinus. The condition may be purulent or nonpurulent, acute or chronic. Depending on the site of involvement it is known as ethmoid, frontal, maxillary, or sphenoid sinusitis. [EU] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spermicide: An agent that is destructive to spermatozoa. [EU] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Squamous: Scaly, or platelike. [EU] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]
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Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Sterilization: 1. the complete destruction or elimination of all living microorganisms, accomplished by physical methods (dry or moist heat), chemical agents (ethylene oxide, formaldehyde, alcohol), radiation (ultraviolet, cathode), or mechanical methods (filtration). 2. any procedure by which an individual is made incapable of reproduction, as by castration, vasectomy, or salpingectomy. [EU] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Strongyloides: A genus of parasitic nematodes widely distributed as intestinal parasites of mammals. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Systemic: Pertaining to or affecting the body as a whole. [EU] Technetium: The first artificially produced element and a radioactive fission product of uranium. The stablest isotope has a mass number 99 and is used diagnostically as a radioactive imaging agent. Technetium has the atomic symbol Tc, atomic number 43, and atomic weight 98.91. [NIH] Telecommunications: electronic means. [NIH]
Transmission of information over distances via
Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Threonine:
An essential amino acid occurring naturally in the L-form,
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which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Thrombocytopenia: Decrease in the number of blood platelets. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Ticarcillin: An antibiotic derived from penicillin similar to carbenicillin in action. [NIH] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Toxic: Pertaining to, due to, or of the nature of a poison or toxin; manifesting the symptoms of severe infection. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the
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kidney pelvis to the bladder. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Urothelium: The epithelial lining of the urinary tract. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Varicella: Chicken pox. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vibrio: A genus of vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
Glossary 275
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
276 Escherichia Coli
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
·
Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
Index 277
INDEX A Abdomen .........................................24, 28 Abdominal....... 12, 15, 23, 29, 30, 36, 42, 108, 139, 257, 260, 267 Aberrant...............................................189 Abscess .......................................132, 258 Acetylglucosamine.................................85 Acylation ................................................83 Aerobic .....85, 86, 91, 106, 133, 251, 254, 265, 269 Agar .......................................12, 100, 107 Alanine...................................................67 Alimentary..28, 30, 91, 128, 253, 263, 267 Alkaline ................................115, 188, 252 Amebiasis ............................................120 Ammonia .........................93, 98, 115, 273 Amoxicillin............................................146 Ampicillin ...............................................61 Anaerobic .....30, 32, 89, 92, 93, 117, 134, 142, 259, 261, 263, 265, 268, 269, 270, 271, 274 Anemia ....36, 59, 108, 129, 159, 246, 256 Antibiotic ....... 57, 58, 61, 71, 85, 92, 148, 149, 202, 211, 252, 268, 271, 272, 273 Antibody......86, 87, 90, 96, 108, 113, 188, 252, 257, 264 Antigen ..............82, 86, 90, 113, 252, 264 Antimicrobial .....18, 25, 62, 120, 127, 149, 189, 202, 255, 258 Anus ......................................23, 134, 267 Anxiety...................................................24 Aqueous ........................................87, 257 Arginine ...............................................112 Assay.......................72, 80, 108, 110, 187 Asymptomatic ......................129, 130, 252 Azoxymethane.....................................189 B Bacteremia ...32, 105, 116, 117, 253, 263, 270 Bacteriophages................................71, 72 Bacteriuria ...............................61, 93, 274 Baths ...............................................14, 24 Benign ...................................46, 133, 265 Biochemical ...........................................64 Biogenesis .............................................64 Biosynthesis ..................83, 102, 188, 190 Bronchoconstriction .............................185 C Campylobacter ......................22, 120, 128 Capsules..............................................209 Carbohydrate...........88, 99, 116, 208, 261
Catechin.............................................. 188 Catheter ................................................ 24 Cellulitis....................................... 132, 259 Cesium........................................ 236, 244 Chemotherapy ................................ 62, 83 Chlamydia ............................................. 23 Chlorine..................................... 14, 22, 82 Cholesterol.................................. 206, 208 Chromosomal ..................................... 111 Chronic..... 15, 32, 58, 131, 133, 224, 252, 264, 271 Ciprofloxacin ....................................... 146 Citrus............................................. 23, 126 Clostridium ............................................ 21 Cobalt.................................. 236, 237, 244 Colitis .................................... 72, 108, 110 Commensal........................................... 70 Concomitant.......................................... 73 Condoms............................................... 60 Conjugated.......................................... 188 Contamination....... 13, 17, 106, 125, 138, 140, 211, 240, 242, 243 Cryptosporidium.................................... 22 Cues...................................................... 64 Cysteine ...................................... 213, 272 Cystitis .............. 23, 24, 25, 58, 61, 65, 67 Cytokines .............................................. 72 Cytoplasm ....................... 68, 87, 190, 257 Cytoskeleton ............................. 64, 68, 69 Cytotoxins ............................................. 66 D Degenerative ...................... 207, 246, 258 Dermis......................................... 131, 257 Diaphragm ........................ 23, 29, 60, 257 Diarrhoea ...................................... 30, 260 Disinfectant ................................. 116, 259 Distal ............................. 28, 134, 253, 269 Dysuria.................................................. 60 E Electrolyte ........................... 127, 149, 268 Electrons ....... 91, 236, 237, 246, 258, 266 Electrophoresis ............................... 16, 18 Empiric ............................................ 59, 61 Endogenous........................................ 104 Enterotoxins ................................ 132, 259 Enzyme .. 62, 88, 91, 92, 93, 97, 102, 113, 115, 116, 141, 193, 213, 256, 259, 260, 268, 272, 273 Epidemiological................................... 113 Epithelium ......... 29, 58, 70, 134, 256, 267 Erythritol.............................................. 186
278 Escherichia Coli
Escherichia ...4, 21, 25, 26, 109, 112, 113, 114, 195, 211 Ethanol ................................................100 Exfoliation ..............................................58 Extracellular...................89, 190, 191, 262 Extraction.............................................187 Exudate .......................................132, 259 F Feces ...............12, 31, 116, 129, 258, 264 Fermentation ..32, 98, 100, 101, 102, 106, 112, 115, 187, 270 Fibrinolytic .............................................72 Fumigation...........................................239 G Galactokinase......................................107 Gastroenteritis ..32, 36, 59, 127, 129, 154, 270 Gastrointestinal.....70, 71, 72, 88, 93, 116, 127, 128, 149, 193, 255, 259, 260, 274 Genitourinary ...............................133, 265 Genotype .................................72, 91, 267 Giardia ...........................................22, 120 Glomerular.............................................71 Glucose .............32, 70, 88, 193, 261, 271 Gonorrhea .............................................23 H Handwashing.................................59, 138 Helicobacter.........................................120 Hemagglutinins......................................66 Hepatitis.................................22, 120, 128 Herpes .........................................132, 262 Hibernation ..........................................239 Histidine.................................................83 Homeostasis..........................................63 Humoral ...............................................113 Hydration ...............................................59 Hydrophilic.............................................67 Hydrophobic ........................108, 117, 262 Hyperplasia............................................71 I Idiopathic .....................................133, 262 Immunity ...60, 87, 89, 118, 128, 257, 263, 274 Immunization ......71, 79, 89, 98, 117, 120, 262, 271 Immunogenic .........................................71 Incubation ......................................99, 100 Induction ...71, 73, 89, 191, 193, 247, 263, 269 Infantile ................................................111 Inflammation ...23, 30, 131, 132, 255, 258, 259, 260 Intestines ..11, 23, 30, 117, 133, 260, 263, 269 Invasive .....................................16, 66, 67
L Lesion ....................... 31, 71, 90, 264, 267 Lethal ............................................ 71, 244 Ligation ............................................... 124 Listeria .................................. 21, 138, 211 Localization ........................................... 77 Lymphoma .................................. 133, 264 M Membrane.... 62, 69, 82, 90, 96, 108, 117, 132, 142, 149, 188, 193, 258, 265, 266, 268 Meningitis............................ 111, 117, 264 Metabolite ........................................... 209 Microbiological ...................... 85, 108, 114 Microbiology........ 56, 57, 86, 90, 253, 264 Microorganism ... 28, 31, 97, 98, 110, 114, 115, 252, 267 Microscopy...................................... 64, 67 Microvilli .......................................... 56, 68 Molecular ... 32, 63, 65, 66, 68, 74, 83, 91, 115, 125, 131, 152, 156, 157, 251, 252, 269, 273 Mucus ................................................... 70 Mutagenesis ................................... 65, 67 Myeloma ............................................. 108 Myocardium .......................................... 81 N Neoplasms .................................. 133, 265 Neural ................... 31, 117, 207, 262, 267 Neurologic............................................. 16 Neutrons ............................. 236, 247, 266 Nosocomial ....................... 25, 31, 65, 266 O Operon .................... 76, 97, 102, 106, 114 Organelles............................. 87, 113, 257 Osmotic............................................... 190 Overdose ............................................ 207 Oxidation............................................. 194 P Palpation ..................................... 134, 267 Pancreas............................................... 36 Paralysis ................................. 13, 31, 267 Parasitic ..... 30, 31, 86, 89, 120, 132, 133, 134, 254, 258, 260, 261, 263, 264, 272 Parenteral ............................................. 71 Pathogen.... 17, 57, 58, 61, 66, 68, 70, 71, 100, 117, 120, 140, 241, 263 Pericarditis ............................................ 98 Periplasm ............................................ 190 Phenotype....................... 66, 91, 103, 267 Phenylalanine ............................. 106, 194 Phosphorylation .................................... 56 Plasmids ............... 97, 102, 105, 106, 114 Pneumonia...................... 25, 26, 117, 263 Poisoning . 21, 30, 32, 117, 126, 127, 138, 139, 260, 270
Index 279
Polymyxin ............................144, 149, 268 Potassium......................32, 146, 208, 271 Precursor .........62, 91, 117, 118, 267, 273 Premenstrual .........................................24 Prevalence.................................17, 57, 59 Progressive..................................133, 265 Proportional .........................................238 Proteins .....57, 63, 64, 68, 69, 73, 76, 77, 78, 84, 86, 87, 102, 103, 104, 117, 186, 206, 208, 252, 257, 273 Proteus ................................................138 Protozoa .....22, 30, 31, 90, 132, 134, 247, 258, 260, 264, 269, 271 Protozoan ......................29, 133, 256, 263 Purpura ....................................56, 57, 129 Pyelonephritis ......................25, 61, 65, 67 R Radioactivity ................................237, 243 Reagent .................................29, 108, 255 Receptor ..................................67, 86, 252 Recombinant ......81, 83, 97, 98, 102, 103, 112, 114, 115, 186, 187 Recurrence ..........................................146 Remission......................................92, 269 Riboflavin.............................................206 Ruminants .............................................17 S Salmonella...............21, 22, 128, 138, 211 Sanitation.....................................242, 245 Secretion .............68, 69, 90, 92, 265, 270 Seizures.............................13, 16, 32, 270 Selenium..............................................208 Septicemia.............................................98 Serum ..................111, 117, 149, 252, 270 Sinusitis ...................................26, 32, 271 Soaps ......................................24, 32, 271 Sorbitol ..........................................12, 100 Spectrum ...56, 85, 93, 129, 148, 252, 274 Spermicide.............................................60 Spices ......................23, 86, 236, 241, 254 Spores .................................................239
Steel.................................................... 244 Sterilization ................................. 238, 243 Substrate....................................... 83, 100 Symptomatic ..................... 46, 52, 66, 272 Systemic ......... 71, 72, 131, 134, 254, 272 T Technetium ......................................... 188 Tetracycline................................. 202, 258 Thermoregulation................................ 206 Threonine...................... 97, 101, 102, 114 Thrombocytopenia .... 36, 56, 59, 108, 129 Thyroxine ............................................ 208 Tolerance ...................................... 93, 273 Toxic .... 31, 32, 63, 87, 93, 107, 132, 207, 213, 239, 241, 255, 257, 259, 267, 270, 273 Toxicology........................................... 153 Toxin .. 11, 15, 17, 70, 72, 77, 92, 93, 108, 123, 124, 190, 273 Tryptophan.......................................... 106 Tuberculosis........................................ 139 Tyrosine .............................................. 106 U Ulcer.................................... 131, 255, 273 Urinalysis ...................................... 93, 274 Urothelium........................................... 113 V Vaccination ........................................... 98 Vaccine ............. 70, 85, 96, 118, 251, 274 Vaginal ............................................ 23, 24 Vascular ................ 71, 131, 132, 257, 260 Vasoactive ............................................ 72 Vibrio................................................... 120 Viral....................................... 89, 128, 261 Virulence ..... 64, 65, 69, 72, 99, 111, 113, 123 Viruses . 21, 22, 31, 90, 93, 126, 138, 239, 264, 274 Y Yersinia ............................................... 120
