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A Systematic Review of the Association between GBS and C.jejuni and the Isolation and Genotyping of

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Tutor: LiZhenZhong
School: Hebei Medical University
Course: Neurology
Keywords: Guillain-Barré syndrome,C.jejuni,Isolation,Serumantibody,Meta-analysisGuillain-B
CLC: R745
Type: Master's thesis
Year:  2014
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Abstract:
Part1A Systematic Review and Meta-analysis of the Association betweenGBS and C.jejuniObjective: To quantify the association between GBS and C.jejuni.Methods: The literatures were searched from Pubmed database(1966-2013.11) and checked from reference lists. The incidence of GBSoccurring after infection with C.jejuni, the isolation rate of C.jejuni fromstools and seropositivity in GBS cases were extracted. Meta-analyses ofrandom effects models were conducted using R software3.0.2to pool theresults of the studies included. Potential sources of heterogeneity weredetected by meta-regression.Results: A total of25articles were in accordance with the criteria,2reported the incidence of GBS occurring after infection with C.jejuni, both ofthe articles showed the risk of developing GBS after C.jejuni infection washigher than the risk in the general population.13reported the isolation rate ofC.jejuni from stools in GBS cases, the pooled isolation rate was10.24%,(95%CI:6.7%,15.4%)with high statistical heterogeneity(Qdf=55.77, P <0.001,I2=78.5%). Although meta-regression coefficients were not statisticallysignificant for the country(developed/developing)(P=0.89)and enrichmentculture method(P=0.89),as well as multi methods(P=0.77) and multi specim-ens(P=0.27), that for the mean age of patients (P=0.007)and the researchtime(P=0.03) were significantly negative, which would indicate that as age ofpatients increase and over time, the isolation rate decreases apparently.16reported C.jejuni seropositivity in GBS cases, the C.jejuni seropositiveityamong GBS cases range from17.24%to81.25%(median36.97%), among thecontrols range from0to58.33%(median7.83%). The pooled RD was33.64% (95%CI:23.33%,43.94%)with high statistical heterogeneity(Qdf=135.1, P<0.001,I2=91.34%). In meta-regression, the mean age (P=0.99), thecountry(developed/developing)(P=0.53), the research time(P=0.23), antib-ody(P=0.48), or source of control (P=0.93) were not significant study-levelcovariates.Conclusions:1The risk of developing GBS after C.jejuni infection was higher thanthe risk in the general population.2The estimated isolation rate of C.jejuni from stools in GBS cases was10.24%,as the age increases and over time, the isolation rate decreases.3The C.jejuni seropositivity among GBS cases range from17.24%to81.25%(median36.97%), among the controls range from0to58.33%(median7.83%). The pooled RD was33.64%.4The results was limited by high statistical heterogeneity, there is aneed for exchange and cooperation among laboratory in the world and morelarge-scale and multicenter studies to compliment mandatory notification data. Part2The Isolation and Genotyping of the C.jejuni from Patients withGBSObjective: To isolate C.jejuni strains from GBS patients many times in arow and evaluate the genetic polymorphism of the isolates.Methods: We choose Columbia blood plate medium for isolation ofC.jejuni strains from fecal samples, the isolated were confirmed by Gramstaining, hippurate hydrolysis, multiplex PCR and VITEC-2Compact. We alsoevaluate the genetic polymorphism of the isolates by RAPD and MLST.Results: Among the23included patients with GBS, one patient hadpositive stool specimens for C.jejuni.5C.jejuni strains were isolated from thepatient, which were identified3different genotypes by RAPD and all found belonging to ST508by MLST.Conclusion:1Co-infection with multiple RAPD genotyping C.jejuni strains occurin GBS patients.2The C.jejuni strains isolated from patients with GBS may not bepathogennic bacteria, there is still a need for further animal experiment toprove it. Part3The Multiocus Sequence Typing of the C.jejuni from Patients withGBSObjective:To obtain the genotype profiles of the eight GBS-assosiatedC.jejuni isolated from north China by multiocus sequence typing(MLST);Toget a comprehensive profile of the genetic character of the GBS-associatedstrains and the strains isolated in China.Method: DNA were extracted from samples and confirmed by multiplexPCR. Each of the seven housekeeping gene fragments was amplified by PCRand sequenced by company. The sequence were edited and corrected bysoftware, then the sequence data for each of the seven MLST loci werecompared with sequences in the MLST database to determine the allelenumber and the sequence type(ST) of each strain was assigned from theprofiles of the seven alleles. Get a comprehensive profile of the geneticcharacter of the GBS-associated strains and the strains isolated in China byeBURST and UPMA cluster analysis, and spiltdecomposition networkanalysis。Results: The ST of the eight GBS-assosiated C.jejuni isolated from northChina were ST51, ST45, ST3907, ST22, ST2240, ST22, ST22, no new STwere found in this study. We got45GBS-assosiated C.jejuni from the MLSTdatabase, which were assigned to34STs that belonged to14clonal complexes.The most commonly identified clonal complex was ST22(28.89%). Phylogen- etic tree and spiltdecomposition network were established. We got151C.jejuni in China from the MLST database, which were assigned to141STsthat belonged to23clonal complexes. The most commonly identified clonalcomplex was ST353(8%). Phylogenetic tree and spiltdecomposition networkwere established.Conclusion: The C.jejuni from patients with GBS are related to the ST22complex.
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