Septic arthritis has the potential to be a highly destructive joint disease. Although numerous bacterial species are capable of inducing septic arthritis, Staphylococcus aureus is most commonly implicated, accounting for up to 65% of cases. Whilst this organism is known to produce a diverse array of potential virulence factors, studies investigating a variety of S. aureus-related infections have implicated alpha(Hla)-, beta(Hlb)- and gamma(Hlg)-haemolysins as key damaging toxins, with the ‘pore-forming’ Hla considered to be the most potent. The work presented in this study focused on gaining further insight into the interaction between S. aureus toxins and in situ chondrocytes during an episode of septic arthritis. An in vitro bovine osteochondral explant model of S. aureus-induced septic arthritis was developed in this study. Utilising fluorescence-mode confocal laser scanning microscopy (CLSM), the model, which avoided the complexities of a host immune response, permitted an assessment of the following: (1) the spatial and temporal quantification of in situ chondrocyte viability following exposure to both a laboratory ‘wild-type’ (S. aureus 8325-4) and clinical strains of S. aureus; (2) the influence of Hla, Hlb and Hlg on in situ chondrocyte viability through the use of specific ‘haemolysin-knockout’ mutant strains; (3) the influence of altered culture medium osmolarity and extracellular Ca2+ on Hla-induced in situ chondrocyte death; and (4) dynamic changes in intracellular Ca2+ within in situ chondrocytes following Hla exposure. S. aureus 8325-4 and S. aureus clinical strains rapidly reduced in situ chondrocyte viability ( > 45% chondrocyte death at 40hrs). The increased acidity, observed during bacterial culture, had a minimal effect on chondrocyte viability. Chondrocyte death commenced within the superficial zone (SZ) of cartilage and rapidly progressed to the deep zone (DZ). Simultaneous exposure of SZ and DZ chondrocytes to S. aureus 8325-4 toxins (achieved with the use of subchondral bone-free explants) demonstrated that SZ chondrocytes were more susceptible to the toxins than DZ chondrocytes. When explants were cultured in the presence of a selection of isogenic S. aureus mutants, with varying Hla, Hlb and Hlg production capabilities (all originating from S. aureus 8325-4), Hla-producing mutants induced significant in situ chondrocyte death compared to toxin deficient controls (Hla-Hlb-Hlg-). In contrast, mutants producing Hlb and Hlg in the absence of Hla were unable to induce significant chondrocyte death. Hla alone was therefore identified as the key damaging toxin to in situ chondrocyte viability. Raised culture medium osmolarity had no influence on Hla-induced in situ chondrocyte death. In the absence of Hla, a high extracellular Ca2+ concentration (20mM) had no influence on chondrocyte viability during the experimental period. Hla-induced chondrocyte death increased in the presence of raised extracellular Ca2+ concentrations thereby confirming a role of Ca2+ in the chondrocyte death pathway. There was no significant difference between S. aureus growth in high and low Ca2+ culture media. Finally, when live osteochondral explants stained with the Ca2+-sensitive fluorophore Fluo-4 were cultured with an Hla-containing S. aureus supernatant (S. aureus 8325-4 (Hla+Hlb+Hlg+)) there was a significant rise in intracellular Ca2+ in comparison to those explants exposed to a non-Hla-containing supernatant (S. aureus DU5938 (Hla- Hlb-Hlg-)). The Hla-induced Ca2+ transients were always followed by chondrocyte death. Thus, it is likely that Hla-induced chondrocyte death was associated with a rise in intracellular Ca2+. These findings are of translational relevance. Firstly, toxins released by S. aureus have a rapid and fatal action on in situ chondrocytes, thereby advocating the prompt and thorough removal of bacteria and their toxins during the treatment of septic arthritis. Secondly, the identification of Hla alone as the key damaging toxin to in situ chondrocyte viability, with its destructive action being associated with a rise in intracellular Ca2+, may enable the development of future targeted therapeutic strategies in order to reduce the extent of cartilage destruction during and after an episode of septic arthritis.

Toxic shock syndrome toxin-1 (TSST-1), an exoprotein produced by some strains of Staphylococcus aureus, is implicated in the pathogenesis of menstrual TSS. However, its role in nonmenstrual TSS is less certain. In order to study the pathogenetic role of TSST-1 in TSS, three approaches were taken: a) to develop an ELISA for detection of TSST-1 in biologic fluids in order to verify TSST-1 production in vivo in TSS patients, b) to quantitate TSST-1 specific antibodies in the serum of TSS patients and controls to determine whether such antibodies are protective, and c) to attempt to identify other staphylococcal products which may be implicated in some forms of TSS. A sensitive and specific noncompetitive enzyme-linked immunosorbent assay (ELISA) capable of detecting TSST-1 at concentrations from 0.5 to 16 ng/ml was developed. This assay did not detect other staphylococcal enterotoxins including A, B, C₁, C₂, C₃, D and E. Possible interference by protein A was readily eliminated by pretreatment of test samples with 10% nonimmune rabbit serum. The assay was adapted for rapid screening of TSST-1 production by S. aureus isolates in culture supernatants in vitro, and for the detection of TSST-1 in vaginal washings and urine of TSS patients and healthy controls in vivo. All 35 S. aureus isolates confirmed to be TSST-1 positive by Ouchterlony immunodiffusion, and 59 of 60 isolates confirmed to be TSST-1 negative, gave concordant results by ELISA. Interestingly, toxigenic S. aureus strains isolated from TSS patients quantitatively produced significantly more toxin in vitro compared to toxigenic control strains (p<0.05, Mann-Whitney rank sum test). TSST-1 could be detected by ELISA in 3 of 4 vaginal washings collected within 3 days of hospitalization from 3 women with acute menstrual TSS, compared to 0 of 17 washings from 9 TSS women collected greater than 3 days after hospitalization (p=0.003, Fisher's exact test) and 1 of 15 washings from 14 healthy control women (p=0.016). TSST-1 was not detected in the urine of 4 acute TSS patients, 2 convalescent TSS patients or in 3 control urine tested. A sensitive and reproducible ELISA was also developed for the quantitation of TSST-1 specific IgG in serum. Anti-TSST-1 was assessed in acute and convalescent sera from 16 nonmenstrual (9 female, 7 male) and 14 menstrual TSS patients, and from 87 healthy women and 66 healthy men as controls. Quantitative levels of anti-TSST-1 in the study groups were calculated as the percent of standard activity (POSA) relative to a medium titre reference serum standard. ELISA titers in acute sera from menstrual TSS (26.2 ± 5.2, mean POSA ± S.E.M.), but not nonmenstrual TSS women (71.8 ± 18.6), were significantly lower than in healthy controls (78.9 ± 7.3) (p<0.01, Mam-Whitney test). Titers from menstrual TSS patients remained low (25.2 ± 10.7) even during late convalescence (mean duration 20 months after illness onset), compared to healthy female controls (p<0.05). Acute titers in males with TSS (37.0 ± 15.6) were also significantly lower than those in control men (114.6 + 11.0) (p<0.05). An inverse relationship of recovery of toxigenic S. aureus and anti-TSST-1 titers in acute sera of TSS patients was observed. Interestingly, antibody titers in control men were significantly higher than in control women (p<0.001). No age-dependent effects or interactive effects of age and sex on ELISA titers were observed. To enable immunoblot analyses, TSST-1 was produced and partially purified using column chromatography techniques. Percent recovery of TSST-1 from culture supernatant through to the final procedure was approximately 15.5%. The relative purity of TSST-1 (TSST-l/total protein, w/w) was increased from 0.21% in culture supernatants to 94.4% in the final product. Ouchterlony immunoprecipitation against reference rabbit antitoxin demonstrated identity with reference TSST-1 as well as with TSST-1 prepared in other laboratories. Physical characterization demonstrated a molecular weight of 24 kd and a pi of 7.0. Using pooled normal human serum as a first antibody probe, several bands in addition to the 24 kd TSST-1 band were visualized by immunoblot against our partially purified toxin as well as similar preparations obtained from other investigators. To determine whether any of the additional bands might be implicated in TSS, acute and convalescent sera from TSS patients were used to probe for immunoreactive bands in our partially purified TSST-1 as well as a commercially obtained preparation. Seroconversion was demonstrated to the 24 kd TSST-1 protein in 7 of 10 TSS patients from whom toxigenic S. aureus was isolated. In addition, seroconversion was noted to a 49 kd band in 4 patients, to a 21 kd band in 3 patients, to a 28 kd band in 1 patient and to a 32 kd band in 2 patients. In conclusion: 1) the ability to measure TSST-1 in biologic fluids lends stronger support for the role of TSST-1 in menstrual TSS patients; 2) the serologic data support the etiologic role of TSST-1 in menstrual TSS and in nonmenstrual TSS patients from whom toxigenic S. aureus could be cultured, but not for nonmenstrual TSS women from whom toxigenic S. aureus was not isolated; 3) immunoblotting results with acute and convalescent sera from TSS and control patients, not only add further support to the role of TSST-1 in patients from whom toxigenic S. aureus could be isolated, but also indicate that there may be several other staphylococcal products implicated in TSS, particularly in whom antibody to TSST-1 pre-existed in acute sera. The nonresponsiveness or lack of seroconversion to TSST-1 in some patients could suggest either: a) TSST-1 was not the etiologic agent for such patients; b) TSST-1 was the etiologic agent, but the exposure was sufficient for an immune response (similar to tetanus), or; c) some immunologic defect may be present. Future studies are required to clarify these possibilities. / Science, Faculty of / Microbiology and Immunology, Department of / Graduate

The advancement in synthetic chemicals commonly referred to as contaminants of emerging concern (CECs) and their application has led to an increase in environmental pollution. The use of septic tanks otherwise referred to as onsite water treatment systems (OWTS), promotes the introduction of CECs into the environment while allowing little in the way of remediation. In order to study the impacts of CECs from OWTS as they infiltrate the environment and the aquifer system, water, sediment, and vegetation samples were collected around a sinkhole lake surrounded by residential housing using OWTSs. The main question of this research project is what is the fate of CECs from OWTSs effluent within the catchment of a sinkhole lake? Liquid chromatograph mass spectrometry was used to analyze the samples for the presence of CECs. It was found that the relative quantity of CECs in the individual constituents is dependent upon 1) the hydrophobicity and polarity of the individual compound, 2) the specific sampling site, 3) the topography gradient, and 4) for vegetation the connectedness of the sample type to the sediment. The implications derived from this study can be applied in environmental engineering, urban and suburban planning, environmental monitoring, and should be considered when residents use well water as their source of potable water.

In this study the mouse tumor necrosis factor-alpha (TNF-α) was prepared by stimulating macrophage cell line RAW 264.7 with lipopoly-saccharide (LPS) obtained from Escheria coli strain 055:B5.

<p> Recirculating Sand Filters (RSFs) provide a compact method of secondary treatment to septic systems and lagoons, are relatively easy to operate and require little maintenance. Together, these characteristics render RSFs particularly appropriate for small communities and municipalities, as they offer a number of economic and operational advantages over conventional technologies. A preliminary study investigating RSF effluent quality, conducted jointly by McMaster University, the Great Lakes Sustainability Fund (GLSF) and the Ontario Ministry of the Environment (MOE) in 1999-2001, conducted pilot-scale experiments and demonstrated that municipal sewage can be successfully treated year-round by RSFs. The results of the preliminary study recommended that further work be conducted to investigate the selection of media size, dosing frequency, recycle ratio, and hydraulic loading rate. </p> <p> The primary objective of this study was to develop design and operating conditions under Ontario climatic conditions with respect to media size, dosing frequency, recycle ratio and hydraulic loading rate by conducting further pilot-scale studies. Three pilot-scale RSFs, operating in parallel, were loaded intermittently with septic tank effluent to evaluate the above mentioned operating parameters on the removal of total suspended solids (TSS), 5-day carbonaceous biochemical oxygen demand (cBOD5), total ammonia-nitrogen (TAN) and total nitrogen (TN). The addition of alum was also implemented to evaluate the removal of total phosphorus (TP). The effluent objectives for this study were based on the MOE general secondary treatment level requirements of monthly averages based on a minimum of four weekly samples. The four-phase experimental program began in April, 2004 and ended in June, 2005. Three media sizes were investigated, with d10 of 2.6, 5 and 7.7 ·mm. The applied hydraulic loading rates were 0.2 and 0.4 rnlday. Dosing frequencies of 24 and 48 times/day were observed. Recycle ratios of 300% and 500% were also evaluated. </p> <p> It was found that the RSF operating with 2.6 mm media, 500% recycle ratio and 24 times/day dosing frequency under a hydraulic loading rate of 0.2 rnlday produced the best quality effluent, and achieved the effluent objectives required by the MOE. These operating criteria, however, must still be investigated under cold weather conditions to ensure acceptable year-round performance in Ontario. With proper addition of alum, the TP effluent objective was achieved under the optimum operating conditions. </p> / Thesis / Master of Applied Science (MASc)

The compatibility of home water softeners and septic tanks is of concern for the on-site wastewater treatment community. Research has shown that high sodium levels in activated sludge plants can lead to deflocculation and poor effluent quality. Therefore, it is logical to assume that high sodium levels that result from the exchange of calcium and magnesium for sodium in home softeners could give rise to poor effluent quality from septic tanks, leading to shortened lives of drain fields. Additionally, the release of regeneration discharges to the septic tank might further damage performance. This study was undertaken to investigate the effect home ion-exchange softeners have on septic tank performance. A column study was set up and varying levels of sodium were added to wastewater influent and these were fed to columns that contained solids collected from operating septic tanks. In addition, slug influent solutions, which mimic regeneration flow, with varying amounts of excess sodium were investigated. To reinforce the lab column experiments, data were obtained from private septic tanks to determine the effluent quality from septic tanks both diverting and receiving the regeneration flow. Also utilized were graduated cylinder experiments, where the effect of sodium on grease flocculation was determined, and batch anaerobic digestion studies, which determined the effect sodium has on the production of gases and the degradation of solids. The study showed that the addition of sodium to septic tanks is likely to impact the effluent quality of sewage discharged from a septic tank to a drain field. The common way of measuring ion concentrations for comparison in this study was to obtain the monovalent to divalent ratio (M/D Ratio). This is simply the concentration of the sodium ions in solution divided by the concentrations of magnesium and calcium, on an equivalent weight basis (all other monovalent and divalent ions were negligible). Slug solutions of high levels of salts (Septic Tank Effluent M/D = 11), mimicking regeneration wastes from water softeners with an inefficient regeneration cycle, increased the effluent solids, COD and BOD. However, if the regeneration wastes contained the same amount of calcium and magnesium, but a smaller amount of sodium (Septic Tank Effluent M/D = 5), the negative effect on these effluent characteristics was greatly lessened. In an optimum case with a regeneration solution containing a minimal amount of excess sodium (Septic Tank Effluent M/D = 3), the effluent characteristics were often actually more favorable than in similar situations where the regeneration wastes were diverted (Septic Tank Effluent M/D = 2). The case studies reinforced these data, showing that sodium concentrations correlated with an increased discharge of solids to the drain field. The studies on grease flocculation as well as anaerobic digestion suggest that these processes are not affected by the sodium level. Overall, it appears that the use of home softeners with septic tanks may have an effect on solids discharge to the drain field and the level of impact will depend on the level of hardness in the water, whether the regeneration waste is discharged to the septic tank, and the amount of excess sodium present in regeneration wastes. / Master of Science

This research evaluated serum amyloid A (SAA) concentration in synovial fluid of healthy horses as a potential marker for use in the diagnosis and monitoring of horses with septic arthritis. The first study evaluated the effect of arthroscopic lavage of healthy joints on concentrations of systemic and synovial SAA; as well as total protein concentration, nucleated cell count and percentage of neutrophils in synovial fluid. The second study, evaluated the effect of repeated through-and-through joint lavage on SAA in systemic blood and SAA, total protein, nucleated cell count and percentage of neutrophils in synovial fluid from healthy joints. In the first study, middle carpal joints of 6 horses were randomly assigned to one of the following treatments 1) arthrocentesis (controls) or 2) arthroscopic lavage. A washout period of 30 days was allowed in between treatments. Synovial fluid and blood samples were collected at 0, 24, 48, 72, 96 and 120 h. Measurements included SAA in blood and synovial fluid, and total protein, nucleated cell count and percentages of neutrophils in synovial fluid. In the second study, one tarsocrural joint was randomly assigned to receive repeated through-and-through joint lavage at 0, 48 and 96 h in 6 horses. Synovial fluid and blood samples were collected at 0, 24, 48, 72, 96 and 120 h. Measurements included SAA in blood and synovial fluid, and total protein, nucleated cell count and percentages of neutrophils in synovial fluid. For this study, synovial fluid samples collected at time 0 were considered as control values. After arthroscopic lavage and repeated through-and-through joint lavage, systemic and synovial SAA did not increase from baseline values (except for systemic SAA at 24h after arthroscopic lavage and in controls). Total protein values were significantly increased at all time points after arthroscopic and through-and-through joint lavages (except at 96h on both lavage procedures) but not in controls. With both lavage procedures, nucleated cell count significantly increased from baseline values at all time points (except at 96h after through-and-through joint lavage). Percentage of neutrophils was significantly increased after arthroscopic lavage at all time points and only at 24h in controls; however, the percentages of neutrophils were not significantly increased after repeated through-and-through joint lavage. Synovial SAA was not affected by arthroscopic or repeated through-and-through joint lavage; however, synovial total protein and nucleated cell counts were significantly increased. Synovial SAA may be a valuable inflammatory marker that is not affected by procedures as arthroscopic or repeated through-and-through joint lavage in horses. Further validation of synovial SAA as a marker for evaluating the progression of septic joints while treatment is installed is warranted.

2 pp. / Originally published: 2001 / An onsite sewage treatment system or "septic system" is effective way to safely recycle household wastewater back into the natural environment. The key to effective treatment is proper design, system installation, responsible operation, and periodic maintenance. This article provides information about how to improve septic system performance by taking simple steps at home.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.