Case report: Urbanized non-human primates as sentinels for human zoonotic diseases: a case of acute fatal toxoplasmosis in a free-ranging marmoset in coinfection with yellow fever virus.

Free-ranging non-human primates (NHP) can live in anthropized areas or urban environments in close contact with human populations. This condition can enable the emergence and transmission of high-impact zoonotic pathogens. For the first time, we detected a coinfection of the yellow fever (YF) virus with Toxoplasma gondii in a free-ranging NHP in a highly urbanized area of a metropolis in Brazil. Specifically, we observed this coinfection in a black-tufted marmoset found dead and taken for a necropsy by the local health surveillance service. After conducting an epidemiological investigation, characterizing the pathological features, and performing molecular assays, we confirmed that the marmoset developed an acute fatal infection caused by T. gondii in coinfection with a new YF virus South American-1 sub-lineage. As a result, we have raised concerns about the public health implications of these findings and discussed the importance of diagnosis and surveillance of zoonotic agents in urbanized NHPs. As competent hosts of zoonotic diseases such as YF and environmental sentinels for toxoplasmosis, NHPs play a crucial role in the One Health framework to predict and prevent the emergence of dangerous human pathogens.

Neurological and gastrointestinal manifestations of spontaneous poisoning by Ricinus communis in goats.

An outbreak of Ricinus communis poisoning in goats with neurological and digestive changes was related to the ingestion of different vegetative parts of the plant. Two poisoned animals died within 5 h of the plant intake showing necrotic gastroenteritis and hepatocytes degeneration and necrosis. Toxicological analysis by HPLC-DAD assay demonstrated 21.1-25.1 µg/g of ricinine in samples of ruminal fluids and 10.1-10.9 µg/g in the liver of poisoned goats.

Hepato-pathological hallmarks for the surveillance of Yellow Fever in South American non-human primates.

The early detection and diagnosis of deaths in free-ranging non-human primates (NHPs) are key points for the surveillance of Yellow Fever (YF) in Brazil. The histopathological identification of infectious diseases remains very useful and reliable in the screening and detection of emerging zoonotic diseases such as YF. We surveyed data records and liver slides stained with hematoxylin and eosin from the Epizootics Surveillance Network to control YF, Ministry of Health of Brazil, to evaluate histopathological hallmarks for the diagnosis of the YF virus infection. We selected natural fatal cases in NHPs from the genera Alouatta spp., Callithrix spp., and Sapajus spp. with a positive immunohistochemical assay for YF in liver samples. Our findings showed the full-spectrum YF-associated hepatic lesions in all NHPs, but some histopathological findings differed in the distribution and intensity between the three genera. In our study, South American NHPs showed significant differences in the YF-associated hepatic histopathological features compared to fatal cases reported in humans.

Fatal Human Alphaherpesvirus 1 Infection in Free-Ranging Black-Tufted Marmosets in Anthropized Environments, Brazil, 2012-2019.

Human alphaherpesvirus 1 (HuAHV1) causes fatal neurologic infections in captive New World primates. To determine risks for interspecies transmission, we examined data for 13 free-ranging, black-tufted marmosets (Callithrix penicillata) that died of HuAHV1 infection and had been in close contact with humans in anthropized areas in Brazil during 2012-2019. We evaluated pathologic changes in the marmosets, localized virus and antigen, and assessed epidemiologic features. The main clinical findings were neurologic signs, necrotizing meningoencephalitis, and ulcerative glossitis; 1 animal had necrotizing hepatitis. Transmission electron microscopy revealed intranuclear herpetic inclusions, and immunostaining revealed HuAHV1 and herpesvirus particles in neurons, glial cells, tongue mucosal epithelium, and hepatocytes. PCR confirmed HuAHV1 infection. These findings illustrate how disruption of the One Health equilibrium in anthropized environments poses risks for interspecies virus transmission with potential spillover not only from animals to humans but also from humans to free-ranging nonhuman primates or other animals.

Pathology in Practice.

In collaboration with the American College of Veterinary Pathologists.

Endemic Xanthium strumarium poisoning in cattle in flooded areas of the Araguari River, Minas Gerais, Brazil.

In this paper, we describe poisoning outbreaks of Xanthium strumarium in cattle on the borders of the Araguari River, Southeastern Brazil. In this region, several hydroelectric plants promote transient flooding, which creates a favorable environment for the invasion of X. strumarium in extensive areas, often as the predominant species in those areas. The outbreaks occurred between July and September (dry season). Bovines of all ages were affected, including suckling animals. Mortality varied from 2% to 5.5%. The animals exhibited ataxia, weakness, loss of balance, recumbency, and the majority were found dead. Laboratory results showed a marked increase in the serum activities of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase. Histological and ultrastructural changes in the liver consisted of centrilobular necrosis and hemorrhage. On toxicological evaluation, the dicotyledons contained 0.30 µg/mg of atractyloside and 0.37 µg/mg of carboxyatractyloside. Considerable economic loss has occurred in this region due to the lack of knowledge regarding X. strumarium as a toxic plant and its adaptation to the environmental and climatic conditions of the region, which have made the condition endemic.

Uraemic Encephalopathy in a Persian Cat with Chronic Kidney Disease.

Uraemic encephalopathy (UE) is rarely associated with acute kidney injury or chronic kidney disease in domestic animals, and we now report the first case in a cat. The animal presented with hypothermia, apathy, lethargy, depression, severe dehydration, uraemic breath, elevated serum urea nitrogen and creatine concentrations, and eventual seizures and coma prior to death. Gross necropsy findings included severe bilateral renal scarring, ulcerative stomatitis and glossitis, and uraemic gastropathy. Microscopic lesions of diffuse interstitial fibrosis, multifocal mineralization and lymphoplasmacytic interstitial nephritis were seen in the kidneys. There was symmetrical, bilateral spongy vacuolation of the white matter of the basal nuclei and cerebellum and Alzheimer type II astrocytes in the cerebral cortex and hippocampus. Glial fibrillary acid protein immunolabelling was absent or faint in astrocytes of the cerebral grey matter. UE should be included in the differential diagnosis in animals with chronic kidney disease and neurological signs.

Pulmonary actinomycosis in a free-living black-tufted marmoset (Callithrix penicillata).

Actinomycosis is a very rare infection in wild animals with a few reports in captive non-human primates. Herein we report a case of pulmonary actinomycosis in a free-living black-tufted marmoset in the urban area of the Federal District, Brazil. The animal presented severe dyspnea and died in the garden of a residence. At necropsy, the left-pulmonary lobes showed multiple nodules filled with purulent content. A myriad of beaded, branching, filamentous Gram-positive and modified Ziehl-Neelsen-negative bacilli arranged in aggregates or star-like colonies, surrounded by macrophages, neutrophils, and Splendori-Hoepli phenomenon were observed in histological sections of the lungs. According to the pathological findings and characteristic morphotintorial pattern of the infectious agent, pulmonary actinomycosis was diagnosed. Until now, fatal pulmonary actinomycosis had never been reported in free-living Simiiformes. Knowledge about the diseases that affect commensal free-range simians in urban areas forms the basis for actions aimed at conservation of the species.

Methodological aspects of minimal residual disease assessment by flow cytometry in acute lymphoblastic leukemia: A French multicenter study.

Background: Minimal residual disease (MRD) assessment provides a powerful prognostic factor for therapeutic stratification in acute lymphoblastic leukemia (ALL). Multiparameter flow cytometry (MFC) has the potential for a rapid and sensitive identification of high risk patients. Our group has previously published that MRD levels analyzed by clone specific Ig/TcR-QPCR and MFC were concordant at a sensitivity of 10-4 . Here we report the MFC methodological aspects from this multi-center experience. Methods: MRD was assessed by MFC in 1030 follow-up samples from 265 pediatric and adult patients with de novo ALL treated in the FRALLE, EORTC or GRALL clinical trials. MRD assessment as applied by the eight participating MFC laboratories is described in detail regarding cell preparation, leukemia-associated immunophenotype (LAIP) markers and data analysis. Samples were obtained from bone marrow (BM) and peripheral blood (PB). Immunostaining was performed after erythrocyte lysis or Ficoll enrichment. Results: This study confirms the applicability of MFC-based MRD assessment in 97% of patients with ALL at the 10-4 cut-off. MRD values after Ficoll enrichment and erythrocyte lysis were found comparable. Higher MRD values were obtained in BM than in PB, especially for B-lineage ALL. Conclusions: Measurement of MRD by MFC at the 10-4 cut-off is applicable within a few hours for almost all patients and using a comparable analytical strategy allows for multicenter collaborative studies. The method can be introduced in a strategy aimed at defining the risk of failure of patients with childhood or adult ALL. © 2014 Clinical Cytometry Society.

Duplicação da vesícula biliar / Double gallbladder

A duplicação da vesícula biliar é uma anomalia congênita rara, com prevalência, em autópsias, de aproximadamente 1:4.000 (1). A ultra-sonografia é atualmente o método de diagnóstico por imagem de escolha para a investigação de alterações da vesícula. Várias alterações podem simular a duplicação da vesícula biliar durante uma investigação pela ultra-sonografia, incluindo cisto de colédoco, vesícula em barrete frígio, divertículo de vesícula, adenomiomatose focal, septações, vasos aberrantes, má rotação intestinal associada a bridas de Ladd e coleções líquidas perivesiculares (2-4). Apresentamos mais um caso e uma revisão da literatura

Pubic bone anchoring devices for the surgical treatment of urinary stress incontinence in patients with severe genital prolapse.

The aim of this study was to test a surgical technique for the treatment of stress urinary incontinence associated with genital prolapse through a transvaginal suspension anchored to the pubic bone. Thirty-seven patients with severe genital prolapse and urodynamically proven stress incontinence were operated on with this procedure from February 1998 to May 2000. Preoperatively a detailed history, pelvic examination and urodynamic studies were carried out. The degree of prolapse was assessed pre- and postoperatively in the lithotomy position in accordance with the classification proposed by Baden and Walker [8]. Two titanium bone screws with no. 1 polypropylene sutures attached to them and a battery-operated screw inserter are used to fix the vaginal sutures to the pubic bone bilaterally. The procedure is performed transvaginally with no abdominal or suprapubic incisions. Objective outcomes were assessed by symptom assessment, clinical examination and a full urodynamic evaluation at 6 months postoperatively, and annually by clinical evaluation. Subjective outcomes were assessed by directly interviewing the patients about their postoperative urinary symptoms and asking them to classify their level of satisfaction. An objective cure rate (no objective loss of urine during coughing in the absence of a simultaneous detrusor contraction) at the 6-month postoperative urodynamic evaluation was observed in 23 of 37 patients (62%). Recurrent anterior vaginal wall prolapse (grade 2) had developed in 7 of 37 patients (27%). Subjectively, 73% of the patients expressed satisfaction with the procedure. Early results using two bone screws into the pubis to fix the periurethral and perivesical tissues and vagina to the posterior surface of the pubic bone were disappointing. Based on our results we have abandoned the use of this procedure to correct stress incontinence associated with severe genital prolapse.

Cisto simples de testículo: relato de caso e revisão da literatura / Simple testicular cyst: case report and review of the literature

O autor relata um achado de cisto simples no testículo de um paciente adulto durante estudo ultra-sonográfico. Faz uma revisão da literatura, sugere acompanhamento e conduta conservadora

The author reports a case of an adult patient with a simple testicular cyst diagnosed by ultrasound. A review of the literature is presented and a conservative treatment approach and follow-up is recommended.

Ainhum - relato de um caso e revisäo da literatura / Ainhum - a case report and review of the literature

Resumo: Neste artigo é apresentado um novo caso de ainhum (daciliólise espontânea). Os aspectos clínicos e radiológicos säo discutidos, juntamente com uma revisäo da literatura.

Pé madura - relato de um caso e revisäo da literatura / Madura foot - a case report and review of the literature

Resumo: Neste trabalho é apresentado um caso de pé Madura. Os aspectos clínicos e imagenológicos säo discutidos, juntamente com uma revisäo da literatura.

Duplicaçäo de uretra: relato de dois caso / Urethra duplication: report of two cases

Os autores apresentam dois novos casos de duplicaçäo de uretra em crianças do sexo masculino, demonstram a importância dos métodos de imagem para elucidaçäo da anormalidade e fazem revisäo da literatura

[Analysis of the validity of vaginal-cervical cytologic examination in 162 pre- and post-menopausal patients]. / Analisi della validità dell'esame citologico cervico-vaginale relativo a 162 pazienti in età pre- e post-menopausale.

The authors examine 162 cervico-vaginal smears of women in peri-menopause presenting cellular alterations (ASCUS). These patients were treated with a local topic therapy as the persistence of these alterations in 23 cases (14.2%) second level analyses were performed: gynecological visit, colposcopy and biopsy. In addition to inflammatory aspects 2 in situ carcinomas and 2 moderate dysplasias were recorded. We believe therefore that cytology could be a valid aid also in pre-menopausal women in the cervico-vaginal pathology.

Diagnóstico ultra-sonográfico de hidrohematometrocolpos: relato de caso / Ultrasonographic diagnosis of hidro-hematometrocolpos: case report

Após revisäo da literatura, os autores relatam um caso e os achados ultra-sonográficos de hidrohematometrocolpos. Relatam os diagnósticos diferenciais e discutem os critérios diagnósticos.

Endolymphatic chemotherapy in gynecologic cancer.

Bleomycin oil suspension was infused preoperatively into the bilateral pedal lymphatic vessels of 18 patients with cancer of the vulva, uterine cervix, and endometrium. The object of this technique was to reduce the number of local recurrences in pelvic and abdominal lymph nodes. Except in the case of two patients, it was possible to infuse both extremities. Side effects of the treatment were generally mild. In a postoperative study of the surgical specimens, metastases were found in 18 lymph nodes. All of these showed selective necrosis of existing metastases and conservation of the morphology of healthy nodes. Necrosis of the primary tumor was occasionally produced.

Intraarterial infusion chemotherapy as a primary treatment in cancer of uterine cervix limited to the pelvis.

Percutaneous intraarterial infusion chemotherapy via the internal iliac arteries was performed as a primary treatment in 14 patients with invasive cancer of the uterine cervix. The drugs used were Mitomycin-C, Bleomycin and Cis-Platinum in cycles of 52 hours which were repeated, in some cases, 21 days apart. Complete responses were observed in two patients. Partial responses were seen in 10 patients and no response in two patients. 5 patients were treated surgically and 8 patients received radiotherapy after the infusion. The effect of chemotherapy was more evident in exophytic tumors with less effect on the parametria. Tumor masses can be reduced and patients can then be treated by surgery or radiotherapy. 6 patients died from sepsis.