Theileria orientalis Ikeda genotype infection associated with anaemia, abortion and death in beef cattle in Western Australia.

BACKGROUND: Theileria orientalis infection causes a clinical syndrome in cattle characterised by weakness, reluctance to walk, anaemia, jaundice and death in peri-parturient cows and young calves, referred to as bovine anaemia caused by Theileria orientalis group (BATOG). Abortions in pregnant cows are also reported. Pallor, pyrexia and elevated heart and respiratory rates are typical findings on physical examination. CASE REPORT: A syndrome of abortions, lethargy, inappetence, jaundice and deaths in beef cattle on two separate properties and a separate cluster of three properties within 15 km west of the town of Denmark in Western Australia was associated with the presence of severe regenerative anaemia and the presence of Theileria orientalis Ikeda genotype in blood samples taken from affected cattle and their cohorts. A diagnosis of bovine anaemia caused by the T. orientalis group was based on consistent clinical, haematological, biochemical and PCR findings. Conventional PCR testing detected only the T. orientalis Ikeda type. On the two properties where it was investigated, quantitative PCR testing for parasite load was suggestive of recent infections. Sequencing of T. orientalis major piroplasm surface protein gene PCR products demonstrated that they were identical to those from similar bovine cases in New South Wales. CONCLUSION: The clinical history of affected cattle and the biochemical, haematological and PCR findings were consistent with bovine anaemia caused by the T. orientalis Ikeda genotype. This clinical syndrome had not been recognised in Western Australia before this series of cases.

Hyperoxaluria, hyperglycoluria and renal oxalosis in Gilbert's potoroos (Potorous gilbertii).

CASE REPORT: Six Gilbert's potoroos (Potorous gilbertii) in a captive colony, five of which were closely related, died or were euthanased with severe renal disease. Clinical signs were mostly non-specific. Renal calculi were seen on ultrasound of two affected potoroos and oxalate crystalluria was seen in two of three affected potoroos that had urine samples examined. Necropsies revealed extensive severe renal oxalosis in all affected potoroos. These findings and markedly increased concentrations of glycolate in the urine of the four affected potoroos for which it was measured, confirmed a disorder of oxalate metabolism and suggested a condition similar to primary hyperoxaluria type 1 in humans. Liver alanine : glyoxylate aminotransferase activity and intracellular location were assessed as normal in one affected potoroo, which is inconsistent with human primary hyperoxaluria type 1. Although a condition similar to human primary hyperoxaluria type 2 or 3 was not ruled out, other clinicopathological findings were not consistent with those seen in humans with these conditions. A lack of faecal oxalate-degrading activity was observed in two affected potoroos in which it was measured, whereas oxalate-degrading activity was variably present in healthy captive and wild potoroos. CONCLUSION: Although the pathogenesis of renal oxalosis in these cases was not clear, the biochemical findings of elevated urinary oxalate and glycolate excretion indicate an abnormality of oxalate metabolism. The familial pattern of disease suggests it could be an inherited condition.

Evaluation of a copro-antigen ELISA to detect Fasciola hepatica infection in sheep, cattle and horses.

OBJECTIVE: To determine the specificity and sensitivity of a commercial copro-antigen ELISA for the detection of Fasciola hepatica infection in cattle and sheep and to assess the suitability of the test for use in horses. METHODS: Testing was done on more than 100 negative faecal samples from each of sheep, cattle and horses and on at least 40 positive faecal samples from each species. Positive samples were selected based on a positive sedimentation test for liver fluke eggs. Faecal samples of animals from Western Australia, which is free of liver fluke infection, served as negative controls. Specificity and sensitivity were assessed for each species using the recommended kit cut-off and also custom cut-offs specific for each species based on the mean plus 3-fold standard deviation of the mean of the negative samples for each species. RESULTS: Using the cut-off recommended by the kit manufacturer, the specificity was 100% for all species and the sensitivity was 88%, 80% and 9% for sheep, cattle and horses, respectively. Using the lower custom cut-offs for each species improved the sensitivity to 100% for sheep, 87% for cattle and 28% for horses, while maintaining the specificity above 99% for all species. CONCLUSIONS: The sensitivity of the commercial copro-antigen ELISA can be improved by using custom cut-off values for each species. With this modification, it is a suitable alternative screening test to the currently used sedimentation test for border control of sheep and cattle movement. The test is not suitable for use in horses.

Evaluating a systematic voiding programme for patients with urinary incontinence after stroke in secondary care using soft systems analysis and Normalisation Process Theory: findings from the ICONS case study phase.

BACKGROUND: Urinary incontinence (UI) affects between 40 and 60% of people in hospital after stroke, but is often poorly managed in stroke units. OBJECTIVES: To inform an exploratory trial by three methods: identifying the organisational context for embedding the SVP; exploring health professionals' views around embedding the SVP and measuring presence/absence of UI and frequency of UI episodes at baseline and six weeks post-stroke. DESIGN: A mixed methods single case study included analysis of organisational context using interviews with clinical leaders analysed with soft systems methodology, a process evaluation using interviews with staff delivering the intervention and analysed with Normalisation Process Theory, and outcome evaluation using data from patients receiving the SVP and analysed using descriptive statistics. SETTING: An 18 bed acute stroke unit in a large Foundation Trust (a 'not for profit' privately controlled entity not accountable to the UK Department of Health) serving a population of 370,000. PARTICIPANTS: Health professionals and clinical leaders with a role in either delivering the SVP or linking with it in any capacity were recruited following informed consent. Patients were recruited meeting the following inclusion criteria: aged 18 or over with a diagnosis of stroke; urinary incontinence (UI) as defined by the International Continence Society; conscious; medically stable as judged by the clinical team and with incontinence classified as stress, urge, mixed or 'functional'. All patients admitted to the unit during the intervention period were screened for eligibility; informed consent to collect baseline and outcome data was sought from all eligible patients. RESULTS: Organisational context: 18 health professionals took part in four group interviews. Findings suggest an environment not conducive to therapeutic continence management and a focus on containment of UI. Embedding the SVP into practice: 21 nursing staff took part in six group interviews. Initial confusion gave way to embedding of processes facilitated by new routines and procedures. Patient outcome: 43 patients were recruited; 28 of these commenced the SVP. Of these, 6/28 (21%) were continent at six weeks post-stroke or discharge. CONCLUSION: It was possible to embed the SVP into practice despite an organisational context not conducive to therapeutic continence care. Recommendations are made for introducing the SVP in a trial context.

Cryptococcosis in Gilbert's and long-nosed potoroo.

Two cases of fatal cryptococcosis are described, one of Cryptococcus neoformans infection in a Gilbert's potoroo (Potorous gilbertii) and one of Cryptococcus gattii infection in a long-nosed potoroo (Potorous tridactylus). The diagnoses were confirmed by culture and specific immunohistochemistry, respectively. The long-nosed potoroo tested positive using the latex cryptococcal antigen test (LCAT), whereas the Gilbert's potoroo had a negative LCAT result despite having advanced disease of some duration. In both cases, the clinical presentation was a progressive neurologic disease associated with a central nervous system infection. Pulmonary infection was also observed in the long-nosed potoroo. Specific treatment with antifungal agents was unsuccessful in the long-nosed potoroo.

Avian cryptococcosis.

Clinical and laboratory findings in 15 unreported cases of avian cryptococcosis from Australia were collated and contrasted with 11 cases recorded in the literature. Cryptococcus species produced localized invasive disease of the upper respiratory tract of captive parrots living in Australia. This resulted in signs referable to mycotic rhinitis or to involvement of structures contiguous with the nasal cavity, such as the beak, sinuses, choana, retrobulbar space and palate. Parrots of widely differing ages were affected and of the seven birds for which sex was determinable, six were male. Cryptococcus bacillisporus (formerly C. neoformans var. gattii) accounted for four of five infections in which the species or variety was determinable, suggesting that exposure to eucalyptus material may be a predisposing factor. In these cases, Cryptococcus appeared to behave as a primary pathogen of immunocompetent hosts. One tissue specimen was available from an Australian racing pigeon with minimally invasive subcutaneous disease; immunohistology demonstrated a C. neoformans var. grubii (formerly C. neoformans var. neoformans serotype A) infection, presumably subsequent to traumatic inoculation of yeast cells into the subcutis. Two similar cases had been reported previously in pigeons domiciled in America. Data for parrots, one pigeon and other birds studied principally in America and Europe (and likely infected with C. neoformans) suggested a different pattern of disease, more suggestive of opportunistic infection of immunodeficient hosts. In this cohort of patients, the organism was not restricted to cool superficial sites such as the upper respiratory tract or subcutis. Instead, infections typically penetrated the lower respiratory tract or disseminated widely to a variety of internal organs. Finally, three captive North Island brown kiwis, one residing in Australia, the other two in New Zealand, died as a result of severe diffuse cryptococcal pneumonia (two cases) or widely disseminated disease (one case). C. bacillisporus strains were isolated from all three cases, as reported previously for another kiwi with disseminated disease in New Zealand.

Disseminated Mycobacterium avium infection in a dog with chronic diarrhoea.

A 3-year-old Maltese-cross dog presented with a 4-month history of chronic diarrhoea and inappetence. Poorly regenerative anaemia, leukocytosis and hypoproteinaemia were evident on several occasions. Biopsies of stomach, duodenum and colon revealed marked infiltration of mucosae by macrophages containing many acid-fast bacilli. Similar organisms were numerous in a faecal smear. Melaena, hematochezia and severe abdominal pain developed and were unresponsive to therapy. Following euthanasia and necropsy, histiocytic cells containing acid-fast bacilli were found throughout the gastrointestinal tract, mesenteric and peripheral lymph nodes, spleen, liver, kidney and lungs. The organism was identified as Mycobacterium avium by bacterial culture and polymerase chain reaction testing.

Retracted confessions: through opiate withdrawal to a new conceptual framework.

We note growing concern by defence councils over the reliability of confessions obtained from suspects withdrawing from opiate dependence. We focus on a case report and highlight the conceptual weaknesses of current thinking about confessions. A philosophical model is adapted to clarify the theoretical aspects and thereby provide a conceptual framework to help the doctor confronted with the practical issue of how to assess a suspect's fitness for interrogation or the reliability of an individual's confession. We argue that the practice of not treating withdrawal in custody is unjust and inhumane. The model presented is of value in dealing with the issues raised by retracted confessions generally and not just in the specific instances where the suspect is a drug user.

Tuberculosis in wild seals and characterisation of the seal bacillus.

Tuberculosis was diagnosed in 3 otariid seals found dead on beaches at 3 locations on the south coast of Western Australian between May 1990 and March 1991. This confirms that tuberculosis is present in the 2 native seals (Neophoca cinerea and Arctocephalus forsteri) in Western Australian waters. Mycobacterium sp isolated from the lungs of 2 of the seals were studied to determine the similarity of the strains to each other, to the strains isolated during 1986 from Australian sea lions and New Zealand fur seals kept in captivity at a marine park near Perth, Western Australia, and to a strain isolated in 1988 from a seal trainer who worked with the infected captive seals for 3 years. After restriction endonuclease analysis (REA) with the endonucleases Bst EII, Bcl I and Pvu II, one of the wild seal strains appeared to have identical DNA fragment patterns to the strains from the captive seals and the seal trainer. The other wild seal isolate had identical REA profiles using Bst EII and Bcl I, but a minor difference was detected using Pvu II. Differences in these isolates were more clearly seen in restriction fragment length polymorphisms after hybridisation with two DNA probes. The secretory protein MPB70, present in M bovis, was not detected in wild seal isolates using sodium dodecyl sulphate polyacrylamide gel electrophoresis and Western blotting techniques. Analysis of protein and DNA fragment profiles indicated that seal tuberculosis isolates form a unique cluster within the M tuberculosis complex.

Obsessive slowness revisited.

Of 665 patients referred between 1969 and 1984 for behavioural treatment of obsessive-compulsive disorder, 22 had marked slowness not due to washing, which was secondary to mental or overt rituals or ruminations. Over 90% of the slowness cases were male, and over a quarter had pre-natal or delivery problems.

Tuberculosis in a captive colony of pinnipeds.

Tuberculosis was diagnosed in 10 of 16 otariid seals upon post mortem examination. The species involved were New Zealand fur seals (Arctocephalus forsteri), Australian sea lions (Neophoca cinerea) and an Australian fur seal (Arctocephalus pusillus doriferus). Five seals died, four as a direct result of mycobacterial infection. One seal died of unrelated disease. The remaining 10 animals were subsequently tuberculin tested and then killed and necropsied. Tuberculous lesions were seen in five. Gross pathological changes were most commonly seen in the respiratory system. However, a generalized infection, a case with lesions confined to the liver and draining lymph nodes, and a case with tuberculous meningitis also were seen. Histological lesions were characterized by spindle cell proliferation and necrosis without mineralization or giant cell formation. The mycobacteria isolated was identified as belonging to the Mycobacterium tuberculosis complex but it appeared to be unique. Intradermal tuberculin testing showed promise as a diagnostic aid; however, the results were not statistically significant. Circumstances suggest that the initial infection was present when the seals were captured from the wild.

Four-year retrospective survey of fire incidents in a psychiatric hospital.

This paper describes a four-year retrospective survey of fire incidents in a psychiatric hospital. The results suggest that there were sufficient similarities between a fire incident and a violent incident for the former to be included in a hospital register of violent incidents. The authors recommend that fire incidents should be studied prospectively, and that hospital fire officers should be an integral part of the multidisciplinary team auditing such incidents.

The Geriatric Mental State (GMS) used in the community: replication studies of the computerized diagnosis AGECAT.

Three studies are reported using the Geriatric Mental State in one of its community forms on a total of 647 subjects aged over 65 and living in their own homes. The concordance between the computer diagnosis AGECAT and psychiatrists' diagnosis is at least as good in these replication samples as in the original studies (Copeland et al. 1986). AGECAT has been shown to be useful for epidemiological surveys and as a diagnostic guide for non-medical interviewers.