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Journal of Clinical Microbiology, January 2003, p. 27-33, Vol. 41, No. 1
0095-1137/03/$08.00+0 DOI: 10.1128/JCM.41.1.27-33.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.
National Laboratory for Enteric Pathogens, National Microbiology Laboratory/CSCHAH, Winnipeg, Manitoba,1 Canadian Research Institute for Food Safety, Food Science Department, University of Guelph, Guelph, Ontario, Canada2
Received 18 July 2002/ Returned for modification 29 August 2002/ Accepted 18 October 2002
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Pulsed-field gel electrophoresis (PFGE) has been used to define a limited diversity within several established PTs of S. enterica serotype Enteritidis (14, 21); however, use of this technique has often resulted in failure to distinguish epidemiologically unrelated strains. In the absence of phage typing data, PFGE has not been effective for distinguishing S. enterica serotype Enteritidis PT 1 isolates from serotype Enteritidis PT 4 isolates due to pattern similarities (16). Randomly amplified polymorphic DNA (RAPD) analysis, PCR ribotyping, and typing by PCR for repetitive elements (M13 and the enterobacterial repetitive intergenic consensus sequence [ERIC]) have low indices of discrimination (9, 11, 12, 15). This can create problems when clusters of similar isolates are detected within a short period of time and can result in extensive and costly epidemiologic investigations that are ultimately unproductive. Most ribotyping methods do not discriminate well among S. enterica serotype Enteritidis strains (21); and those developed to date have proved too cumbersome, too expensive, too difficult to standardize, or too time-consuming to be effective when used with the large numbers of isolates that form the basis of molecular typing networks such as PulseNet (22) in the United States and PulseNet Canada (24).
Initial investigations on the application of ribotyping used SphI as the digestion enzyme. The data thus generated by this procedure suggested that use of this enzyme may serve to discriminate among many S. enterica serotype Enteritidis PT 8 strains. However, some strains remain untypeable because their DNA was not restricted (7). Recently, Landeras and colleagues (10, 12, 13) developed a method for ribotyping of S. enterica serotype Enteritidis isolates using a mixture of restriction enzymes, PstI and SphI (PS; PS ribotyping), and this appeared to be more discriminatory than other methods (10, 11, 14). However, the efficacy of the PS ribotyping method for the differentiation of S. enterica serotype Enteritidis PT 8 strains has been tested with only a relatively few isolates.
The aim of the present work was to determine the utility of the method for the differentiation of S. enterica serotype Enteritidis isolates and, in particular, PT 8 isolates that, by PFGE or other fingerprinting methods, appear to be identical or very similar. A further goal was to adapt the method for automated ribotyping, thereby making it suitable for use with a large number of specimens and hence applicable for use in the PulseNet and PulseNet Canada identification schemes. PS ribotyping was found to be very effective for the subtyping of S. enterica serotype Enteritidis PT 8 strains with identical PTs and PFGE patterns and can be adapted for use in automated ribotyping with the RiboPrinter (RP).
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Preparation of riboprobe. The riboprobe, which contained the entire 7.5-kb Escherichia coli rrnB rRNA operon (16S, 23S, and 5S rRNA genes), was amplified from recombinant plasmid pKK3535 (2) with primers rrnB F2 (5'-TGG ATC CGC CTA CCT TTC ACG AGT-3') and rrnB R3 (5'-CTT TTG GCA GAC GCA GAC CTA CG-3'). PCR amplification was done with the Expand High Fidelity PCR system (Roche Molecular Biochemicals, Laval, Quebec, Canada) according to the instructions of the manufacturer. The protocol consisted of 30 cycles of the following steps: denaturation at 94°C for 1 min, annealing at 64°C for 1.5 min, and extension at 68°C for 6 min.
Manual ribotyping. Ribotyping was performed with bacteria embedded in agarose plugs ("bugs in plugs" method). Bacterial cultures were grown overnight at 37°C on nutrient agar containing 1.5% NaCl. High-molecular-weight genomic DNA was prepared in 1.2% Seakem Gold agarose (Mandel Scientific Co. Inc., Guelph, Ontario, Canada) plugs by the standardized protocol of the Centers for Disease Control and Prevention (3). Digestion of the bacteria embedded in agarose plugs was done by the method of Nair et al. (17) with the enzyme system developed by Landeras and colleagues (10, 11, 12). After the plugs were cut out of the agarose, three-quarters of each original plug was equilibrated for 1 h with 1x buffer H (Roche Molecular Biochemicals). Digestion of DNA was accomplished by adding 40 U of PstI, 40 U of SphI, and 1.0 µl of a 0.5-mg/ml RNase solution (Roche Molecular Biochemicals) in a total volume of 100 µl, followed by incubation for 4 h at 37°C. Finally, the intact plugs containing the digested DNA were equilibrated with 0.5 ml of 0.5x TBE (Tris-borate-EDTA; 10x TBE was obtained from Sigma-Aldrich Canada Ltd., Oakville, Ontario, Canada) for 15 min at room temperature and placed into a 1% agarose gel. The samples were electrophoresed for 18 h at 60 V in 0.5x TBE. The molecular size marker used was a 1-kb DNA extension ladder (Gibco Life Technologies, Burlington, Ontario, Canada). The gels were stained with ethidium bromide, photographed, and blotted with a Vacugene XL blotting apparatus (Amersham Pharmacia Biotech Ltd., Baie d'Urfé, Quebec, Canada). Blotting was performed by protocol 1 of the manufacturer's instructions. Blots were cross-linked with UV irradiation and probed with 500 ng of labeled riboprobe and 100 ng of labeled DNA ladder.
All subsequent procedures were done by the protocol for hybridization in tubes supplied with the Enhanced Chemiluminescent (ECL) Direct Nucleic Acid Labeling and Detection kit (Amersham Life Science Inc., Oakville, Ontario, Canada). The rrnB rRNA operon of E. coli originally from plasmid pKK3535 (2) was used as a probe for the rRNA genes, and the labeled size standard was used to visualize standard lanes. Developed blots were exposed to Hyperfilm-MP photographic film (Amersham Life Science Inc.).
Automated ribotyping. Ribotyping was performed with the RP microbial characterization system (Qualicon, Inc., DuPont, Wilmington, Del.). The software included with the system compared single patterns of the strains or composite patterns in RiboGroups (21). Briefly, colonies were picked from individual culture plates, placed in tubes containing lysis buffer, and loaded into the RP unit. Within the unit, bacterial DNA digestion was accomplished with 27 µl of PstI at 40 U/µl (Qualicon) and 27 µl of SphI at 40 U/µl (Roche Molecular Biochemicals). The substitute restriction enzyme protocol in which digestion takes place at 37°C for 2 h was used. The RiboPrint pattern for each isolate was then compared to the patterns generated for the other isolates. As no database was available for comparison of isolates in assays with the restriction enzymes combined, characterization was critical. Automated ribotyping and manual ribotyping were performed with distinct, but overlapping, groups of isolates in order to facilitate comparison of the two methods and to gather more extensive data on isolates of interest.
PFGE. PFGE was done by previously described protocols (3). Electrophoresis was performed with a CHEF DR III unit (Bio-Rad Ltd., Mississauga, Ontario, Canada) in 1% PFGE agarose at 14°C. Initial and final switch times were 2.2 and 63.8 s, respectively, and the total run time was 22 h. Following electrophoresis the gels were stained with ethidium bromide (0.5 µg/ml) and imaged with an Alpha Imager 2000 (Canberra Packard Canada, Mississauga, Ontario, Canada).
PCR. ERIC PCR was performed as described by López-Molina et al. (15) with primers ERIC 1R (5'-ATG TAA GCT CCT GGG GAT TCA C-3') and ERIC 2 (5'-AAG TAA GTG ACT GGG GTG AGC G-3'), synthesized at the University of Manitoba DNA Laboratory (Winnipeg, Manitoba, Canada). Amplifications were done in a Perkin-Elmer 9600 thermal cycler. Ten microliters of each of the amplified products was run on 1% DNA typing-grade agarose gels (Gibco BRL Life Technologies) in 0.5x TBE for 105 min at 120 V. A 100-bp ladder (Gibco BRL Life Technologies) was used as a marker. After electrophoresis the gels were stained in a solution of 0.5 µg of ethidium bromide (Gibco BRL Life Technologies) per ml and photographed under UV irradiation.
Analysis of data. Interpretation of the PFGE and ribotype patterns was aided by use of Bionumerics (version 1.50) software (Applied Maths, Kortrijk, Belgium). All associations obtained with this software package were checked visually by at least two laboratorians. For the isolates analyzed in this study, each unique pattern was given a separate number. Similarity coefficients were obtained by calculating Dice coefficients. Automated cluster analysis was performed by using the unweighted pair group method with arithmetic averages within Bionumerics software. Dendrograms were constructed with Bionumerics software. Band position tolerances and optimization values of 1% were used for all analyses.
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FIG. 1. Results from ribotyping of S. enterica serotype Enteritidis strains by two methods. (a) Dendrogram of PS ribotype patterns obtained by manual ribotyping. (b) Dendrogram of ribotype patterns obtained by automated ribotyping with the RP unit. The ribotype designations are given at the right in both panels.
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TABLE 1. Manual ribotyping of S. enterica serotype Enteritidis strains associated with an outbreak in 1998 and a pseudo-outbreak in 1999a
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TABLE 2. Results of automated and manual ribotyping for selected S. enterica serotype Enteritidis strainsa
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An increase in travel-related S. enterica serotype Enteritidis cases was noticed from January through April 2000 (5). Phage typing, PFGE with two enzymes, and PS ribotyping grouped many of these PT 4 strains into a single group that included strains from patients who had traveled to Thailand and the Dominican Republic (Table 3). Two strains isolated from patients who had traveled to the Dominican Republic differed only by their PFGE patterns, while another two differed only by their PS ribotype patterns. The single characteristic that differentiated the pattern for an isolate from a sporadic case in Ontario in 1998 from the predominant pattern for isolates from patients with travel-associated disease was the PS ribotype, with the sporadic isolate being PS 6 and the travel-associated isolates being PS 1 and PS 3. In contrast, S. enterica serotype Enteritidis isolates from patients who had traveled to Jamaica and Cuba had different PTs, PFGE patterns, and PS ribotypes (Table 3).
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TABLE 3. Manual ribotyping of S. enterica serotype Enteritidis isolates for comparison of isolates from sporadic cases with strains associated with travel in 1999
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S. enterica serotype Enteritidis isolates from sporadic cases of human disease could generally be distinguished from each other and from outbreak strains by phage typing and/or ribotyping (Table 2). Two isolates of PT 4, PS 1, and RP 6 were detected in Prince Edward Island in 1999 and in British Columbia in 2000, respectively, and were therefore considered epidemiologically unrelated. In other cases more than one isolate with a unique combination of types was isolated during the same year within the same province. Although no epidemiologic evidence was available to link the individuals from whom the isolates were obtained, there was also little evidence to prove that no link existed.
ERIC PCR was capable of differentiating isolates not distinguished by other methods (Table 1). REP and RAPD PCRs did not differentiate PT 4, PT 5a, and PT 8 strains (data not shown), confirming the very low discriminatory powers of these assays for S. enterica serotype Enteritidis.
Although PS ribotyping and automated ribotyping were capable of differentiating among the different PTs, there was not a direct relationship between ribotype and PT (Table 4). PS 6 was detected among three PTs types, while PS 1, PS 8, PS 9, and PS 10 were each found to be associated with two PTs. Five PTs had more than one PS type, with PT 8 producing six PS types. In a different group of isolates, RP 1 was found to be distributed among three PTs and RP 6 was found to be distributed into two PTs, with PT 8 divided among 12 RP types.
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TABLE 4. Ribotypes associated with specific PTs
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FIG. 2. Comparison of ribotype patterns obtained by manual ribotyping with DNA restricted in plugs and automated ribotyping with the RPunit. (a) Variation among patterns within each method. Lanes 1 to 3 were generated by manual ribotyping, lanes 4 to 6 were produced with the RP unit. Lanes 1 and 4, strain 99-2048, PS 3, RP 11; lanes 2 and 5, strain 99-3761, PS 14, RP 17; lanes 3 and 6, strain 99-2472, PS 8, RP 10. Approximate DNA fragment sizes (in kilobases) are shown at the left of each set of three lanes. (b) Comparison of manual and automated ribotype patterns for each strain. The strains in each lane were the same as those in panel a. Lanes 1, 3, and 5 were generated by manual ribotyping, while lanes 2, 4, and 6 were generated by automated ribotyping. Approximate DNA fragment sizes (in kilobases) are shown for each lane.
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The patterns obtained by both manual and automated ribotyping were reproducible when the analysis was repeated with freshly prepared bacteria. The only difference in the banding pattern was seen with isolate EN5472, in which doublets at approximately 6.5 and 17 kb were not seen in the initial analysis but were seen in subsequent analyses (data not shown). Differences in pattern intensities suggest that slight differences in the cell concentration used for the analysis may be responsible for the pattern differences seen, making band designation more difficult. Similar pattern intensity differences were seen in the RP patterns for strains EN5580 and 99-3761. While these differences did not appear to interfere with the appropriate band designation for isolate EN5580, they may have led to the introduction of a separate RP designation for isolate 99-3761, which shared a common PT and similar RP pattern with isolate 99-3763. In contrast, the intensities of the PS patterns obtained by manual ribotyping with the bugs in plugs method were remarkably reproducible within and between blots.
The isolates were characterized and assigned to a specific RiboGroup that defined their genetic relatedness by using the software provided with the RP system. Visual examination of the patterns was obtained, and a degree of similarity equal to or higher than 0.95 allowed the samples in the RiboGroups to be merged. The 46 isolates analyzed were clustered into eight RiboGroups, S-1 to S-8 (Table 5). A few of these groups, for example, S-3 and S-6, incorporated a number of different RP types.
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TABLE 5. Comparison of RP types with RiboGroups created with RP system software
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The diversity of patterns associated with each PT is not known and may be different for different PTs. There appeared to be a relatively high degree of diversity of ribotypes for PT 4 and PT 8. In contrast, all isolates of S. enterica serotype Enteritidis PT 30 from patients and from almonds associated with an international outbreak of enteric disease due to contaminated almonds had a single unique pattern by PFGE with XbaI (data not shown) and PS 5 by ribotyping. In the absence of epidemiologic evidence, it would be difficult to determine whether new patient isolates were associated with the outbreak. With further data collection, the predictive power of the ribotyping method(s) would improve as the sizes of the databases increase. Some ribotypes were found among multiple PTs, suggesting that the two methods measured independent characteristics.
The results of manual and automated ribotyping were not easily subject to direct comparison, although the two methods did appear to provide comparable strain discrimination. Both methods were reproducible. Previous work reported a 96% overall reproducibility for automated ribotyping (18). The minor differences between the two methods appear to be related to the fact that each procedure exhibits differences in resolution for different ranges of DNA fragment sizes. During the development of the automated ribotyping method, it was noted that differences in the intensities of RP patterns that affect pattern interpretation could arise quite readily if the input bacterial cell concentrations were not precisely standardized. While the stability of the ribotype patterns was not probed extensively here, repeat analysis of each isolate gave identical results in all but one instance. Similarly, Landeras and Mendoza (12) found that only a single band of about 7 kb, similar to the weak band that migrated at about 6.6 kb in this study, was not always reproducible and, hence, did not include that band in pattern analysis.
Use of the RP program to merge groups resulted in a loss of discriminatory power for automated ribotyping compared with that obtained by use of Bionumerics software to score every band. Comparison of the data from Table 5 and Fig. 1b indicated that in some cases the pattern differences were subtle (e.g., RP 2 versus RP 7 in S-8), although in other cases clear multiple band differences were seen (e.g., RP 4 and RP 12 in S-3). The interpretive criteria used for manual ribotyping generally assume that a single band difference is significant, allowing greater differentiation among related strains. Since this was the purpose for developing this assay, we propose that the same criteria be adopted for the interpretation of automated ribotyping of S. enterica serotype Enteritidis isolates by using PstI and SphI. A practical consequence of this recommendation is that pattern analysis would have to be carried out with a software package such as Bionumerics to allow scoring of individual bands, database construction, and information exchange. This would increase the time to completion for the testing of isolates.
Since both manual and automated ribotyping can subtype S. enterica serotype Enteritidis strains well, the choice of method to be used may depend on considerations other than the discriminatory power of the assay. Automated ribotyping has a much higher throughput and a shorter turnaround time than manual ribotyping and could be readily standardized among different laboratories. Standardization of the cell concentration used appears to be critical for the reproducible designation of RP band patterns produced by automated ribotyping. Manual ribotyping has proved successful for the subtyping of strains in ways that are epidemiologically meaningful, but it may be more difficult to standardize among different laboratories and also requires greater preparation time. Relatively few laboratories have access to RPs, which are relatively expensive, although some laboratories are now beginning to offer automated ribotyping on a fee-for-service basis. It is anticipated that the public health benefits resulting from adoption and use of either method will justify further development and use of ribotyping with a combination of the restriction enzymes PstI and SphI, especially for investigations of outbreaks of enteric disease due to S. enterica serotype Enteritidis.
Present address: Department of Microbiology, University of New Hampshire, Durham, NH 03824-2617. ![]()
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