Expert daily consultation between HIV and ICU physicians is essential in the management of critically-ill HIV-seropositive patients admitted to the ICU. Additionally, the advice of a pharmacist with expertise of treatment of HIV-associated infection should be sought. In some cases this expertise will be obtained by transfer of the patient to a tertiary centre (category IV recommendation). “
“Yersinia pestis PsaA is an adhesin important for the establishment of bacterial infection. PsaA synthesis requires the products of the psaEFABC genes. Here, by prediction

analysis, we identified a PsaA signal sequence with two signal peptidase (SPase) cleavage sites, type-I and type-II (SPase-I and SPase-II). By Edman degradation and site-directed mutagenesis, the precise site for one of these Spase-I PsaA cleavage

sites was located between alanine and serine at BMS-777607 in vitro positions 31 and 32, respectively. Yersinia pestis psaA expression and the role of the PsaB and PsaC proteins were evaluated in recombinant attenuated Salmonella Typhimurium vaccine strains. PsaA was detected in total extracts as a major 15-kDa (mature) and 18-kDa (unprocessed) protein bands. PsaA synthesis was not altered by a ΔA31–ΔS32 double-deletion mutation. In contrast, the synthesis of PsaA (ΔA31–ΔS32) in Y. pestis and delivery to the supernatant was decreased. Otherwise, substitution of the amino acid cysteine at position 26 by valine involved in the SPase-II cleavage site did not show any effect PD0332991 concentration on the secretion of PsaA in Salmonella and Yersinia. These results help clarify the secretion pathway of PsaA

for the possible development of vaccines against Y. pestis. The Yersinia are Gram-negative bacteria with 11 species including the gastrointestinal pathogens Yersinia pseudotuberculosis and Yersinia enterocolitica, and the systemic pathogen Yersinia pestis, which is typically fatal without treatment. Genetic and whole-genome studies indicate that Y. pestis is closely related to Y. pseudotuberculosis. In contrast, Y. enterocolitica is only distantly related to Y. pestis and Y. pseudotuberculosis, displaying a more variable genomic arrangement (Achtman et al., 1999). Yersinia pestis is the etiological agent of plague in humans (Perry & Fetherston, 1997) and a recently recognized re-emerging disease. Aldol condensation The widespread aerosol dissemination combined with high mortality rates make Y. pestis a deadly pathogen (Inglesby et al., 2000). PsaA fimbrillar protein serves as an important adhesin in the establishment of Y. pestis infections in the three known clinical forms: bubonic, septicemic or pneumonic development (Cathelyn et al., 2006; Chauvaux et al., 2007; Liu et al., 2009). PsaA forms fimbria-like structures on the bacterial surface when grown in acidic culture medium at 35–41 °C (Ben-Efraim et al., 1961; Lindler et al., 1990).