[Risk factors for infectious foot -disorders on two Swiss cattle -mountain pastures]. / Risikofaktoren für infektiöse Zehen­erkrankungen auf zwei Schweizer ­Rinderalpen.

INTRODUCTION: In the present study, risk groups for infectious foot disorders were identified on two large Swiss cattle mountain pastures by analyzing animal and treatment data of a total of 3256 animals of the bovine species. Both mountain pastures were part of the Federal Office for Agriculture (FOAG) consultancy project «Healthy animals, attractive herdsmen positions and less medication on large cattle mountain pastures¼. The project was launched in 2020 following the increased incidence of lameness on these mountain pastures. Bacteriological and histological analyses were to provide information as to whether the most common foot disorder was interdigital phlegmon (IP) or whether digital dermatitis also occurred. Further, the temporal distribution of cases over the mountain pasture season and the influence of mountain pasture and year were investigated and interpreted for the project years 2020 to 2022, and treatment incidences were compared between years. Multiple treatment cycles in the same individual were classified into persistent infections and new infections. Nineteen of 394 first-treated cattle were clinically examined, 12 of them were additionally sampled for bacteriological and histological analyses. All cases examined showed, both clinically and following laboratory analyses, typical characteristics for IP. In contrast, there was no specific evidence for the presence of digital dermatitis. No persistent infections occurred during treatment with benzylpenicillin. Multivariate logistic regression analyses identified > 365-730-day-old cattle (odds ratio OR 8,29), as well as inseminated (OR 5,30) and non-inseminated (OR 7,85) heifers as risk groups for the disease studied (p < 0,05). Association with the oestrus activity of non-inseminated heifers and a generally higher locomotor activity in heifers compared to cows - with a correspondingly increased risk of injury - is conceivable. Meat breeds had a reduced risk compared to dairy breeds (OR 0,29). Breed differences in behavior and/or the effectiveness of the local immune response might have an impact. Knowing about these risk groups can be put to use in the future when selecting animals to be taken to the mountain pastures and/or when planning pasture management in order to reduce the prevalence of infectious foot disorders and thereby the use of antibiotics.

INTRODUCTION: Dans la présente étude, nous avons identifié, grâce à l'analyse des données concernant les animaux et les traitements d'un total de 3256 animaux de l'espèce bovine, des groupes à risque pour les maladies infectieuses des onglons sur deux grands alpages bovins en Suisse. Les deux alpages faisaient partie du BLW-projet de conseil «Animaux sains, postes de bergers attractifs et moins de médicaments sur les grands alpages bovins¼. Le projet a débuté en 2020 suite à l'accumulation de problèmes de boiteries sur ces alpages. Des analyses bactériologiques et histologiques devaient fournir des indications afin de savoir si la maladie des onglons majoritaire était le phlegmon interdigité (PI) ou si la dermatite digitale était également présente. La répartition temporelle des cas de maladies durant la saison d'estivage et l'influence de l'alpage et de l'année pour les années de projet 2020 à 2022 ont été évaluées et interprétées, et les incidences des traitements comparées entre les années. Les cycles de traitement multiples chez le même individu ont été répartis en deux groupes: les infections persistantes et les nouvelles infections. Dix-neuf des 394 bovins primo-traités ont été évalués cliniquement. Douze de ces 19 animaux ont également été soumis à un échantillonnage bactériologique et histologique. Tous les cas étudiés présentaient, aussi bien cliniquement que suite à l'analyse technique en laboratoire, les caractéristiques typiques d'un PI. Par contre, il n'y a pas eu d'indication quant à la présence de dermatite digitale. Aucune infection persistante n'a été constatée après traitement avec de la Benzylpénicilline. Les bovins âgés > 365­730 jours (OR 8.29), ainsi que les génisses inséminées (odds ratio OR 5.30) et non inséminées (OR 7.85) ont été identifiés, suite à une analyse de régression logistique multivariée, comme faisant partie de groupes à risque pour la maladie étudiée (p < 0.05). Un lien avec l'activité en période de chaleurs des génisses non inséminées et une activité locomotrice généralement plus intensive des génisses par rapport aux vaches ­ avec par conséquent un risque accru de blessures ­ est concevable. Le risque était réduit pour les races à viande par rapport aux races laitières (OR 0.29). Des différences de comportement et/ou d'efficacité de l'immunité locale entre les races pourraient avoir une influence. Le fait de connaître ces groupes à risque pourrait être mis à profit à l'avenir lors de la sélection des animaux à monter à l'alpage et/ou lors de la planification de la gestion des prairies, afin de diminuer la prévalence des maladies infectieuses des onglons et ainsi l'utilisation d'antibiotiques.

[Non-antibiotic treatment of interdigital hyperplasia secondary infected with digital dermatitis treponemes in dairy cows]. / Nicht-antibiotische Behandlung von Dermatitis digitalis infizierter Hyperplasia interdigitalis beim Milchvieh.

INTRODUCTION: Since the spread of classical digital dermatitis (DD) lesions within the cattle population, frequency of infections of interdigital hyperplasia (IH) lesions with DD-associated Treponema spp. (IH+DD) increased. The aim of the present case series is to describe an alternative treatment technique to surgical lesion removal or local treatment of HI+DD lesions with antibiotics. In this report, the effect of repeated local administration of salicylic acid paste, protected by a water repellent bandage was described and assessed for the treatment of four dairy cows with IH+DD lesions. Milker's fat Eutra was applied to the unaffected skin adjacent to the lesion to protect healthy skin from the keratolytic properties of salicylic acid paste. Treatment was repeated at weekly intervals in all four cases until the IH+DD lesions had completely clinically healed. Two cows additionally showed classical DD lesions between the heels. Clinical healing was defined as remission of IH and complete healing of the DD lesions located on IH lesions and between the heels. Complete healing was evident at three weeks of treatment in all four cases. Weekly repeated topical application of salicylic acid paste under bandage may be recommended as an alternative to surgical or antibiotic treatment of IH+DD lesions.

INTRODUCTION: Depuis la propagation des lésions classiques de dermatite digitale (DD) dans la population bovine, on constate une multiplication des hyperplasies interdigitées infectées par des Treponema spp. associés à la DD (IH+DD). Le but de cette étude de cas est de décrire une méthode alternative de traitement des lésions IH+DD en remplacement de l'excision chirurgicale resp. du traitement local avec des antibiotiques. L'effet d'une application locale répétée sous pansement d'une pâte à base d'acide salicylique pour le traitement de quatre vaches présentant des lésions IH+DD est décrit et évalué dans ce rapport. De la graisse à traire a été appliquée sur la peau saine adjacente, afin de la protéger des effets kératolytiques de la pâte à base d'acide salicylique. Le traitement a été répété à intervalles d'une semaine jusqu'à guérison clinique complète des lésions IH+DD pour les quatre cas. Deux vaches présentaient en plus des lésions classiques de DD dans la région des talons. La guérison clinique a été définie comme l'involution de l'hyperplasie interdigitée et la guérison complète des lésions de DD situées en surface et entre les talons. La durée jusqu'à la guérison clinique complète était dans les quatre cas de trois semaines. Une application topique répétée de pâte à bas d'acide salicylique sous pansement peut être recommandée comme alternative au traitement chirurgical et antibiotique de lésions IH+DD.

Short communication: Claw block application improves locomotion and weight-bearing characteristics in cattle with foot diseases.

In cattle with foot diseases, application of a block on the healthy partner claw is a common method of pain relief. The aim of this study was to evaluate the effect of wooden claw blocks on locomotion characteristics and weight distribution in healthy (group C; n = 17) versus lame (group L; n = 17) cattle. Group L was further subdivided into group L1 (lameness score ≤3; n = 7) and group L2 (lameness score >3; n = 10). We performed lameness scoring using a numeric rating system and measured locomotion characteristics using 2 accelerometers (400 Hz; kinematic outcome = stance phase duration; kinetic outcomes = foot load and toe-off) and a 4-scale weighing platform (difference of mean weight distribution across the limbs; ∆weight) before and after application of a claw block. We applied claw blocks to a randomly assigned lateral or medial claw of the fore or hindlimb in group C cows, and on the healthy partner claw in group L cows. Variables were expressed as differences across limbs. We used 1-way ANOVA to determine the differences between groups C and L and between groups L1 and L2 for ∆weight after application of the claw block. We performed paired t tests to compare variables before and after application of the claw block in groups C and L. Group L scored higher on the numeric rating system than group C (mean ± SD, 3.40 ± 0.62 vs. 1.87 ± 0.28) and showed greater differences in relative stance phase duration (16.34 ± 10.78% vs. 2.13 ± 1.94%), foot load (9.68 ± 8.06 g vs. 3.26 ± 3.69 g), toe-off (3.91 ± 3.14 g vs. 0.78 ± 0.66 g), and ∆weight (53.62 ± 28.85% vs. 8.52 ± 6.19%). In group C, we observed an increase of 12.17 percentage points in ∆weight after block application, from 8.52 ± 6.19% to 20.69 ± 17.01%. Compared with the baseline, group L showed a decrease in numeric rating system score (2.88 ± 0.49 vs. 3.40 ± 0.62) and a decrease in differences between the limbs in relative stance phase duration (7.66 ± 9.96% vs. 16.34 ± 10.78%) and foot load (4.26 ± 4.14 g vs. 9.68 ± 8.06 g) after application of a claw block. Group L2 showed smaller ∆weight after application of a claw block than group L1 (-7.8 ± 8.7% vs. 10.4 ± 7.6%). After block application in group L, we observed smaller differences across the limbs in variables measured to describe gait-cycle characteristics while walking, but no significant improvement while standing. We concluded that application of a claw block must be combined with other methods of pain relief, such as analgesic medication.

Chronic necrotizing pulmonary aspergillosis: pathologic outcome after itraconazole therapy.

OBJECTIVE: To characterize chronic necrotizing pulmonary aspergillosis (CNPA) clinically, radio-graphically, and pathologically and to describe its response to treatment. MATERIAL AND METHODS: We present three cases of well-documented CNPA and detail the long-term clinical and pathologic responses to the new antifungal triazole, itraconazole. RESULTS: Although all three patients had an appreciable clinical response to itraconazole therapy, tissue obtained at the time of operation or autopsy revealed residual CNPA despite 5 to 12 months of treatment. Even though pathologic resolution of the CNPA did not occur, patient prognosis was determined solely by comorbid illness. CONCLUSION: Itraconazole seems to be effective in CNPA when used in a suppressive (rather than curative) role in patients with limited life expectancy.

Asymptomatic extralobar sequestration in a 43-year-old woman.

A 43-year-old white woman had an asymptomatic left lower lobe density on a chest roentgenogram. She had a past history of biopsy-proven sarcoidosis in 1984 that resolved without corticosteroids. A midsystolic click was heard on cardiac examination. Computed tomography (CT) revealed an extralobar pulmonary sequestration in the left base. Rapid sequence CT scanning revealed an arterial supply from the thoracic aorta and venous return to the inferior vena cava. A pleural lining and cystic parenchymal changes were also seen. After a discussion of the risks and benefits of surgical resection, the patient elected only clinical follow-up.

Cavitary coccidioidomycosis with fungus ball formation. Diagnosis by fiberoptic bronchoscopy with coexistence of hyphae and spherules.

Pulmonary cavitary coccidioidomycosis with fungus ball formation was observed in two individuals with hemoptysis. The first patient had no overt compromise; the second was an insulin-dependent diabetic. In both, fiberoptic bronchoscopy was performed and cultures yielded Coccidioides immitis. The coexistence of spherules and hyphae of C immitis was seen histologically on bronchoscopic biopsy specimen of one cavitary lesion. Specific antifungal therapy and surgical excision were withheld and each patient has done well. This report provides for the first time nonsurgical confirmation that C immitis can produce an intracavitary fungus ball.

Systemic sporotrichosis treated with itraconazole.

Amphotericin B is recommended for the treatment of systemic infection caused by Sporothrix schenckii. However, this agent is toxic, its use is frequently followed by relapse, and some isolates of S. schenckii are resistant. Recent studies suggest that newer azole compounds, such as itraconazole, are effective in cutaneous and lymphocutaneous sporotrichosis, but data on their efficacy in systemic infections are scarce. We used itraconazole in the sequential treatment of six patients with systemic sporotrichosis: three with bone and joint disease and three with disseminated infection manifested by subcutaneous nodules. In all six cases, symptoms and signs of infection improved, with resolution of subcutaneous nodules, normalization of imaging studies, cessation of wound drainage, and return of joint mobility and function. No toxicity was noted. One patient with disseminated infection had a relapse while receiving 100 mg of itraconazole daily. The average duration of follow-up was 18 months. Thus itraconazole appears promising for the treatment of systemic sporotrichosis. A dose of at least 200 mg/d appears to be needed to prevent relapse.

Noncardiogenic pulmonary edema following upper airway obstruction. 7 cases and a review of the literature.

Pulmonary edema is a relatively common problem facing most physicians. Its separation into cardiogenic and noncardiogenic or high-permeability variants is crucial to its proper early management. Our understanding of the disease processes producing noncardiogenic pulmonary edema has greatly expanded in the last 2 decades. Upper airway obstruction (UAO) is one of many recently recognized mechanisms which can produce noncardiogenic pulmonary edema. The UAO may be subtle in some patients, making its association with the subsequent pulmonary edema difficult especially for the physician unaware of this entity and the potential risk factors contributing to it. A high index of suspicion for this diagnosis is required in the right clinical settings. Our clinical results support a noncardiogenic basis for pulmonary edema occurring after UAO. Five of our 7 patients had at least 1 identifiable risk factor for the development of peri-intubation UAO and pulmonary edema. Additionally, the onset of pulmonary edema following UAO and the duration of the pulmonary edema varied considerably in our patients. Individuals with additional risk factors for the development of noncardiogenic pulmonary edema developed a more severe form of pulmonary edema associated with other organ-system disease. However, in most individuals, UAO-associated pulmonary edema appears to be a self-limited reversible process once it is recognized and properly treated.

Pulmonary sporotrichosis: review of treatment and outcome.

Four culture-documented cases of pulmonary sporotrichosis, three primary infections and one with multisystem involvement, are presented. Two of these patients are the first reported cases of primary lung disease treated with ketoconazole. This antifungal agent appears to be ineffective in eradicating this infection. The four cases, as well as a review of the literature, illustrate several important aspects of this rare disease. Pulmonary sporotrichosis is most commonly found in males with a history of alcohol abuse who are between the ages of 30 and 60. The infection is usually confined to the parenchyma of the lung but can involve hilar and mediastinal lymph nodes, pleura, skin, subcutaneous tissue, and joints. All but two cases have been reported in the United States, and the majority reside within states bordering the Missouri or Mississippi rivers. Direct occupational or environmental exposure appears to be an important predisposing risk factor. The onset of the disease is insidious, presenting in a manner similar to many other granulomatous or neoplastic diseases. Tuberculosis is the most common suspected diagnosis before confirmation of sporotrichosis. The chest radiograph most commonly demonstrates upperlobe cavitary disease with surrounding parenchymal infiltrates. The diagnosis can be suspected with high serologic titers or skin-test positivity, but needs to be confirmed by culture. The organism can usually be grown from sputum, as well as routine bronchoscopic procedures, open-lung biopsy specimens or pleural fluid. Histologic examination shows granulomas of both the caseating and noncaseating varieties. Frequently, organisms can be seen in necrotic areas of the lung tissue by diastase-modified GMS or PAS staining. Staining by direct fluorescent antibody technique can also be done and appears to be highly specific. Treatment is controversial, but total surgical resection of diseased lung as well as a perioperative regimen of SSKI or amphotericin B appears to be the most efficacious therapy. Medical therapy alone with SSKI or amphotericin B may be useful in selected cases but has been disappointing in the majority of reports. The imidazoles are usually ineffective, and the search for more effective medical therapy continues.

Incidence of fever and bacteremia following transbronchial needle aspiration.

Fiberoptic bronchoscopy and transbronchial needle aspiration were performed on 50 occasions in 47 afebrile patients. The aspirations were followed by endobronchial or transbronchial biopsies in 22 patients, as well as bronchial brushings and washings where appropriate. Blood for cultures was drawn at 5 and 30 minutes following needle aspiration, as well as at the time of any temperature above 38 degrees C during the 24 hours following the procedure. In five (10 percent) of the 50 cases, there was temperature greater than 38 degrees C (100.4 degrees F) in the 24 hours following the bronchoscopy; in no patient were cultures of blood positive, whether done early after the procedure or at the time of fever. We conclude that transbronchial needle aspiration, a new procedure gaining widespread popularity in diagnostic thoracic medicine, is not associated with clinically detectable bacteremia. This procedure should not require antimicrobial prophylaxis in patients susceptible to endocarditis.

Hemostasis by premedication with estrogen in hair-transplant surgery.

Premedication with water-soluble conjugated estrogens administered the previous day and a half-hour before operation diminished bleeding and allows for a drier field, better vision and quicker work. Post-operative bleeding is negligible. Their short-term use has not led to feminization nor presented cardiovascular problems.