Numerous studies have unsuccessfully tried to unravel the definitive host of the coccidian parasite Besnoitia besnoiti. Cattle infections by B. besnoiti cause a chronic and debilitating condition called bovine besnoitiosis that has emerged in Europe during the last two decades, mainly due to limitations in its control associated to the absence of vaccines and therapeutical tools. Although the exact transmission pathway of B. besnoiti is currently unknown, it is assumed that the parasite might have an indirect life cycle with a carnivore as definitive host. Current lack of studies in wildlife might underestimate the importance of free-living species in the epidemiology of B. besnoiti. Thus, the aim of the present study is to assess the presence of Besnoitia spp. in free-ranging mesocarnivores in Spain. DNA was searched by PCR on faeces collected from wild carnivores as a first approach to determine which species could be considered as potential definitive host candidates in further research. For this purpose, a total of 352 faecal samples from 12 free-living wild carnivore species belonging to the Canidae, Felidae, Herpestidae, Mustelidae, Procyonidae, and Viverridae families were collected in seven Spanish regions. PCR testing showed that Besnoitia spp. DNA was present in four faecal samples from red foxes collected in western Spain, an area with the greatest density of extensively reared cattle and associated to high incidence of bovine besnoitiosis in the country. To date, this is the first report of a Besnoitia besnoiti-like sequence (99.57% homology) from carnivore faeces in a worldwide context. Red foxes might contribute to the epidemiology of B. besnoiti, although further studies, mostly based on bioassay, would be needed to elucidate the accuracy and extent of these interesting findings.
Tailgut cysts are rare diseases but require a particular management. We present two cases report of a tailgut cyst two females. treated with transabdominal surgical approach. We review the relevant information present in the medical literature about the incidence, methods of diagnosis, treatment options and management plans.
T-cell large granular lymphocytic leukemia (T-LGL) is a chronic malignancy characterized by clonal expansion of cytotoxic T-cells possibly complicated by cytopenias of one or more myeloid lineages. By describing a multiply-refractory T-LGL case, this report highlights the importance of molecular-targeted and non-cytotoxic therapies in the context of frail elderly patients.
It is an elegant albeit limited study reporting effects of pre op LVEF on long term results in patients with RHD undergoing DVR. Study includes146 pqtients out of 201 who underwent DVR in the study period. Although all had some improvement immediate post op, those with preserved EF and smaller left ventricles regardless of type of prostheses used, surgical techniques ( partial or full Sub-valvular Apparatus Preservation), had more sustained improvement after 3-4 years than those with lower EF and more dilation . It can be partially explained by more prevalence of aortic insufficiency in patients with pre op lower EF <50 and dilation ( average LVESD 49 mm vs 32 mm in EF >50). There are myocardial factors which also play a part , those with abnormal LV function have more extensive loss of myofibrils either due to disproportion of mitochondria-to-myofibril ratio or myofibrillar degeneration exhibiting the extent RHD involves myocardium. Structural adaptation may not all be just a result of hemodynamic abnormalities in these patients (1). The recommendation that surgical intervention should occur before the LV starts to dilate or EF drops is well founded and would be impactful in the developing world, an estimated 250,000 deaths occur annually worldwide and 10.5 million disability adjusted life years due to RHD, mostly in young people.
The surgical treatment of pulmonary hypertension (PH), with or without pulmonary artery aneurysm, has evolved during the last 40 years from heart-lung transplants to bilateral lung transplants as the treatment of choice for PH patients with preserved right and left ventricular function and without complex cardiac abnomalies.
Fishbone perforation, a severe complication causing damage to nearby organs, is difficult to diagnose because the patient and family cannot remember the history of fishbone ingestion exactly. A detailed history of eating, as well as a thorough physical examination and diagnostic imaging, are needed to make an accurate diagnosis.
Disease activity and treatment-related toxicity are the most important contributors to poor prognosis in patients with ANCA-associated vasculitis (AAV). Sometimes, it is difficult to distinguish them. We present a case to highlight the challenges in the management of AAV and the complications with immunosuppression.
Background: In children and adolescents, isolated cholestasis rarely is a first clinical sign of severe sepsis. Case: A previously healthy 14-year-old adolescent had severe S. aureus sepsis. Delayed diagnosis required a prolonged antimicrobial treatment. Conclusion: This unique case illustrates the importance of considering jaundice as an early sign of sepsis.
Actinomycosis is a rare, indolent and invasive infection caused by Actinomyces species. Pulmonary actinomycosis is very rarely seen in the paediatric population. The classic radiological presentation of thoracic involvement of actinomycosis includes lower lobe consolidation, empyema and periostitis of the ribs. We report a case of endobronchial pulmonary actinomycosis in a child diagnosed on endobronchial biopsy and broncho-alveolar lavage taken during bronchoscopy. Bronchoscopy can be dangerous when performed on these cases, as there is a risk of severe bleeding and large airway obstruction, as was the case with this patient.
African swine fever (ASF), is a serious global concern from an ecological and economic point of view. While it is well established that its main transmission routes comprise contact between infected and susceptible animals and transmission through contaminated carcasses, the specific mechanism leading to its long-term persistence is still not clear. Among others, a proposed mechanism involves the potential role of convalescent individuals, which would be able to shed the virus after the end of the acute infection. Using a spatially explicit, stochastic, individual-based model, we tested: 1) if ASF can persist when transmission occurs only through infected wild boars and infected carcasses; 2) if the animals that survive ASF can play a relevant role in increasing ASF persistence chances; 3) how hunting pressure can affect the ASF probability to persist. The scenario in which only direct and carcass-mediated transmission were contemplated had 52% probability of virus persistence 10 years after the initial outbreak. The inclusion of survivor-mediated transmission corresponded to slightly higher persistence probabilities (57%). ASF prevalence during the endemic phase was generally low, ranging 0.1-0.2%. The proportion of seropositive individuals gradually decreased with time and ranged 4.5 – 6.6%. Our results indicate that direct and carcass-mediated infection routes are sufficient to explain and justify the long-term persistence of ASF at low wild boar density and the ongoing geographic expansion of the disease front in the European continent. During the initial years of an ASF outbreak, hunting should be carefully evaluated as a management tool, in terms of potential benefits and negative side-effects, and combined with an intensive effort for the detection and removal of wild boar carcasses. During the endemic phase, further increasing hunting effort should not be considered as an effective strategy. Additional effort should be dedicated to finding and removing as many wild boar carcasses as possible.
Methods: Twenty-two French nursing homes were included. COVID-19 had been diagnosed with real-time reverse-transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2. Blood S-protein IgG and nucleocapsid (N) IgG protein (N-protein IgG) were measured 21-24 days after the first jab (1,004 residents) and 6 weeks after the second (820 residents). Results: Among the 735 residents without prior COVID-19, 41.7% remained seronegative for S-protein IgG after the first jab vs 2.1% of the 270 residents with a previous positive RT-PCR (p<0.001). After the second jab, only 3% of the 586 residents without prior COVID-19 remained seronegative. However, 26.5% of them had low S-protein IgG levels (50-1050 UA/mL) vs 6.4% of the 222 residents with prior COVID-19. Residents with old infection (first wave), or seropositive for N-protein IgG at the time of vaccination, had the highest S-protein IgG levels. Residents with a prior COVID-19 infection had higher S-protein IgG levels after one dose than those without two jabs. Interpretation: A single vaccine jab is sufficient to reach immunity in residents with prior COVID-19. Most residents without prior COVID-19 are seropositive for S-protein IgG after the second jab, but around 30% have low levels of S-protein IgG. Whether residents with no or low post-vaccine immunity are at higher risk of symptomatic COVID-19 requires further analysis.
Cardiac ochronosis is a rare disease, estimated to affect 1 in 250,000 persons. While there is extensive evidence of the musculoskeletal alterations of the disease, cardiac involvement has not been widely studied and most information we currently have derives from case reports and case series. We report the case of a 64-year old patient with a known history of alkaptonuria who presented with dyspnea and weight loss. On evaluation, he was found to have severe aortic stenosis, coronary artery disease, and interventricular septal hypertrophy. Surgery revealed extensive ochronotic pigment deposition affecting the cardiac septum, both internal thoracic arteries, the native coronary arteries, and the aortic valve. Ochronotic heart disease is an often disregarded presentation of alkaptonuria. More information is needed on the course of the disease, as well as long-term outcomes after valve replacement surgery and/or CABG in patients with alkaptonuria.
As apex predators, pinnipeds are considered to be useful bioindicators of marine and coastal environments. Endemic to a small archipelago in the South Pacific, the Juan Fernandez fur seal (JFFS) is one of the less-studied members of the pinniped family Otariidae. This study aimed to characterize the fecal microbiome of the JFFS for the first time, in order to establish a baseline for future studies of host-microbial-environment interactions and monitoring programs. During two consecutive reproductive seasons, 57 fecal samples were collected from 7 different JFFS colonies within the Juan Fernandez Archipelago, Chile. Bacterial composition and abundance were characterized by sequencing the V4 region of the 16S rRNA gene. The overall microbiome composition was dominated by five phyla: Firmicutes (40 %), Fusobacteria (30 %), Bacteroidetes (22 %), Proteobacteria (6 %) and Actinobacteria (2 %). Alpha diversity was higher in Tierras Blancas. However, location was not found to be a dominant driver of microbial composition. Interestingly, the strongest signal in the data was a negative association between the genera Peptoclostridium and Fusobacterium, which explained 29.7 % of the total microbial composition variability between samples. The genus Peptoclostridium has not been reported in other pinniped studies and its role here is unclear, with interpretation challenging due to a lack of information regarding microbiome functionality in marine mammals. As a first insight into the JFFS fecal microbiome, these results contribute towards our understanding of the natural microbial diversity and composition in free-ranging pinnipeds.
Understanding and preserving intra-specific diversity (ISD) is important for species conservation. However, ISD units do not have taxonomic standards and are not universally recognized. The terminology used to describe ISD is varied and often used ambiguously. We compared classical and authoritative definitions of terms used to describe ISD with terms used in recent studies of three fish taxa: sticklebacks (Gasterosteidae), Pacific salmon and trout (Oncorhynchus spp., “PST”), and lampreys (Petromyzontiformes). Our review revealed the terminological ambiguity of “races” and “subspecies”, found similar definitions of “subspecies” and “ecotype”, and of “ecotype” and “reaction norms”. “Species pairs” describes two phenotypes; however, in some situations more than one phenotype may occur. “Ecotype” was originally used to describe patterns in genes and ecology, and recent studies employing this term tend to report a genetic basis in ISD. Ecotype is used most frequently in genetic- and evolution-based journals. By contrast, “life history” includes biological parameters that affect population growth and decline, and this term tends to be used in organismal- and ecology-based journals. When the genetic or demographic components of ISD are not well understood, a conservative approach would be to refer to expressions of this diversity as “phenotypes”. The nature of human interests in particular taxa could influence how these organisms are studied, and hence the ways in which their ISD is understood, described, and conserved.
Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection with clinical features of Kawasaki-like disease was reported in various pediatric centers in late April 2020. Currently, cases have increased throughout the world with a range of manifestations from less to greater severity. However, hemophagocytosis has not been described in patients with MIS-C. We describe two infants diagnosed with MIS-C who presented Macrophage Activation Syndrome (MAS) with hemophagocytosis documented in the bone marrow. MIS-C can be complicated with MAS, the key features for diagnosis are splenomegaly, hypofibrinogenemia, hypertriglyceridemia and bone marrow hemophagocytosis. Cytokine storm and MAS in MIS-C may represent part of the spectrum of the disease and HScore could be of value in order to give timely and aggressive treatment.
Summary: This study evaluates through modeling the possible individual and combined effect of three populational parameters of pathogens (reproduction rate; rate of novelty emergence; and propagule size) on the colonization of new host species – putatively the most fundamental process leading to the emergence of new infectious diseases. The results are analyzed under the theoretical framework of the Stockholm Paradigm using IBM simulations to better understand the evolutionary dynamics of the pathogen population and the possible role of Ecological Fitting. The simulations suggest that all three parameters positively influence the success of colonization of new hosts by a novel parasite population but contrary to the prevailing belief, the rate of novelty emergence (e.g. mutations) is the least important factor. Maximization of all parameters result in a synergetic facilitation of the colonization and emulates the expected scenario for pathogenic microorganisms. The simulations also provide theoretical support for the retention of the capacity of fast-evolving lineages to retro-colonize their previous host species/lineage by ecological fitting. Capacity is, thus, much larger than we can anticipate. Hence, the results support the empirical observations that opportunity of encounter (i.e. the breakdown in mechanisms for ecological isolation) is a fundamental determinant to the emergence of new associations – especially Emergent Infectious Diseases - and the dynamics of host exploration, as observed in SARS-CoV-2. Insights on the dynamics of Emergent Infectious Diseases derived from the simulations and from the Stockholm Paradigm are discussed.