An atypical Bacillus anthracis infection in a bull-A potential occupational health hazard.

Bacillus anthracis infecting cattle is usually identified based on the typical symptom: sudden death. Bacillus anthracis causing atypical symptoms may remain undiagnosed and represent a potential occupational health hazard for, that is veterinarians and producers, butchers and tanners. In the year 2004, one case of sudden death in a dairy farm in southern Finland was diagnosed as bovine anthrax. Four years later 2008, an atypical case of anthrax was diagnosed in the same holding. The bull was taken to the Production Animal Hospital of the Faculty of Veterinary Medicine, University of Helsinki because of fever, loss of appetite and a symmetrically swollen scrotal sac. Penicillin treatment cured the fever but not the swollen scrotum. Before the intended therapeutic castration, a punctuate consisting of 10 ml fluid collected into a syringe from the scrotal sac was cultivated on blood agar at 37°C. After 24 hr, an almost pure culture of a completely non-hemolytic Bacillus cereus-like bacteria was obtained. The strain was identified as B. anthracis using Ba-specific primers by the Finnish Food Safety Authority (RUOKAVIRASTO). After the diagnosis, the bull was euthanized and destroyed, the personnel were treated with prophylactic antibiotics and the clinic was disinfected. In this particular case, treatment with water, Virkon S and lime seemed to be effective to eliminate endospores and vegetative cells since no relapses of anthrax have occurred in 10 years. This case is the last reported anthrax case in Finland.

T-CELL LYMPHOCYTIC LEUKEMIA IN A FALLOW DEER (DAMA DAMA).

A 17-yr-old female fallow deer presented with ataxia, inappetence, decreased fecal output, and decreased mentation. A complete blood count demonstrated leukocytosis (24.1×10(3)/µl, n=1.16-7.38×10(3)/µl), characterized by lymphocytosis (22.89×10(3)/µl, n=0.18-3.65×10(3)/µl), anemia (packed cell volume 20%, n=29.0-55.8%), decreased red blood cell count (4.1×10(3)/µl, n=6.86-14.72×10(3)/µl), and decreased hemoglobin (7.5 g/dl, n=9.4-19.2 g/dl). Numerous mature, well-differentiated lymphocytes were noted on the blood film. Despite treatment and clinical improvement, the decision was made to euthanize the deer. Histopathology identified a monomorphic population of CD3 positive, CD79a negative small lymphocytes replacing most of the hematopoietic tissue in the bone marrow without evidence of tissue invasion. Results of viral screening were negative.

Comminuted fracture of the accessory carpal bone removed via an arthroscopic-assisted arthrotomy.

A 16-year-old American paint horse gelding was presented for evaluation of a left forelimb lameness grade III/V. Radiographs and computed tomography revealed a comminuted fracture of the accessory carpal bone involving the entire articulation with the distal radius and the proximal aspect of the articulation with the ulnar carpal bone. Multiple fragments were present in the palmar pouch of the antebrachiocarpal joint. An arthroscopic-assisted open approach was necessary to remove all fractured fragments. Subsequently the horse was re-admitted for lameness and was treated successfully with antibiotics and long-term supportive bandaging.

Fracture comminutive de l'os du carpe accessoire enlevé à l'aide d'une arthrotomie assistée par arthroscopie. Un cheval American Paint Horse âgé de 16 ans a été présenté pour l'évaluation d'une boiterie de la jambe avant gauche de grade III/V. Les radiographies et la tomodensitométrie ont révélé une fracture comminutive de l'os du carpe accessoire touchant toute l'articulation avec le radius distal et l'aspect proximal de l'articulation avec l'os du carpe cubital. Des fragments multiples étaient présents dans la poche palmaire de l'articulation antébrachio-carpienne. Une approche ouverte assistée par arthroscopie a été nécessaire pour retirer tous les fragments fracturés. Le cheval a ensuite été réadmis pour boiterie et a été traité avec succès à l'aide d'antibiotiques et de pansements de soutien à long terme.(Traduit par Isabelle Vallières).

Administration of perioperative penicillin reduces postoperative serum amyloid A response in horses being castrated standing.

OBJECTIVES: To compare postoperative inflammatory responses in horses administered perioperative procaine penicillin and those not administered penicillin using acute phase protein serum amyloid A (SAA) as a marker of inflammation. STUDY DESIGN: Randomized clinical trial. ANIMALS: Stallions (n=50) castrated under field conditions. METHODS: SAA concentrations were determined on days 0, 3, and 8. Six horses were subsequently excluded because of elevated SAA concentrations on day 0. Of the remaining 50 horses, 26 were administered nonsteroidal anti-inflammatory drug (NSAID) therapy and 24 were administered NSAID and 25,000 U/kg procaine penicillin on day 0, 1, and 2. RESULTS: SAA concentrations increased significantly from preoperative levels in both groups, and on day 8 concentrations were significantly (P<.02) higher in horses administered only NSAID than in those administered procaine penicillin and NSAID. Infectious complications occurred more frequently (P<.01) in horses with preoperatively elevated SAA concentrations (the excluded horses) than in horses with normal preoperative SAA concentrations (the included horses). CONCLUSIONS: Perioperative antimicrobial therapy reduced the postoperative SAA response, suggesting that bacteria were present in the surgical wound and contributed to inflammation after castration. Horses with elevated preoperative SAA concentrations developed infectious complications more often than horses with normal preoperative SAA concentrations. CLINICAL RELEVANCE: Administration of antimicrobials may be important in horses being castrated standing under field conditions. Increased SAA concentrations seem to be an indicator of increased surgical risk in horses and may be useful before elective surgery for planning.

Audit of the management of early syphilis at North Manchester General Hospital.

The city of Manchester has seen a sustained increase in reported cases of early (infectious) syphilis since the late 1990s. We audited the management of patients presenting with early syphilis to North Manchester General Hospital, with reference to the UK national guidelines. Between January 1999 and December 2001 72 cases of early syphilis were identified. Most (90%) occurred in men who have sex with men, 50% of whom were HIV-positive. Serology and polymerase chain reaction testing of lesions were useful diagnostic tests. Treatment regimens followed the national guidelines in 63% of cases, with adherence to the guidelines improving as the outbreak continued. The majority of patients were treated with intramuscular penicillin (78%), with only three discontinuing this treatment due to side effects. Only 4% of sexual contacts identified were traced and screened, an indication of high levels of both anonymous sex and partner change in this group.

A multi-district audit of the management of syphilis in genitourinary medicine clinics in Yorkshire.

An audit against standards and guidelines of a representative sample of syphilis cases managed in genitourinary medicine clinics in Yorkshire was carried out. Satisfactory serological endpoints could be determined for about two-thirds of treated early and less than one-third of treated late syphilis cases. HIV antibody testing was obtained for less than half of all cases. Recently available national guidelines suggest inadequacy of both the dose and duration of treatments with procaine penicillin of asymptomatic late syphilis cases where lumbar puncture was not carried out. The diagnosis and management of syphilis is complex, and this audit demonstrates the importance of the systematic approach developed by genitourinary medicine clinic and laboratory services.

Cutaneous manifestations of anthrax in Eastern Anatolia: a review of 39 cases.

Anthrax is essentially a disease of grazing herbivorous animals. The most common form of the disease is cutaneous anthrax, which accounts for 95% of all cases. We report here 39 cutaneous anthrax cases in humans that were seen in Eastern Anatolia over a six-year period. The clinical presentation was malignant edema in 16 of the cases (41%) and malignant pustule in 23 (59%). A secondary bacterial infection was present in 13 patients (33.3%) in the vicinity of the lesions. The agent was observed using Gram-stained smears in 25 patients (64%), and Bacillus anthracis was isolated from 15 patients (38.5%). All of the patients were treated with penicillin G or penicillin procaine, except one patient who had a penicillin allergy. One patient with cervical edema (2.5%) died as a result of laryngeal edema and sepsis syndrome. In conclusion, we found that the appearance of the skin lesion of cutaneous anthrax may vary, and this fact, combined with the rarity of this disease, which contributes to a general lack of experience among medical personnel, may make diagnosis difficult in nonagricultural settings

Antimicrobial therapy for bacillus anthracis-induced polymicrobial infection in (60)Co gamma-irradiated mice.

Challenge with both nonlethal ionizing radiation and toxigenic Bacillus anthracis spores increases the rate of mortality from a mixed bacterial infection. If biological weapons, such as B. anthracis spores, and nuclear weapons were used together, casualties could be more severe than they would be from the use of either weapon alone. We previously discovered that a polymicrobial infection developed in B6D2F(1)/J mice after nonlethal (7-Gy) (60)Co gamma irradiation and intratracheal challenge with B. anthracis Sterne spores 4 days after irradiation. In this present study, we investigated the survival of mice and the response of the polymicrobial infection during the course of antimicrobial therapy with penicillin G procaine, ofloxacin, trovafloxacin, or gatifloxacin. Survival was prolonged, but not ensured, when the mice were treated with either broad-spectrum ofloxacin or narrow-spectrum penicillin G for 7 days beginning 6 or 24 h after challenge. Survival was not prolonged when therapy was delayed more than 24 h after challenge. When these two antimicrobial agents were given for 21 days, the survival rate was increased from 0% for the controls to 38 to 63% after therapy. Therapy with trovafloxacin or gatifloxacin reduced the incidence of mixed infection and improved the rate of survival to 95% (trovafloxacin) or 79% (gatifloxacin), whereas the rate of survival for the controls was 5%. We conclude that the mixed infection induced by B. anthracis in irradiated mice complicates effective therapy with a single antimicrobial agent. To limit mortality following nonlethal irradiation and challenge with B. anthracis spores, antimicrobial therapy needs to be initiated within a few hours after challenge and continued for up to 21 days.

[Effect of naproxen sodium on serum concentrations of IL-1, IL-6, and TNF in patients with acute, purulent pharyngo-tonsillitis]. / Efecto del naproxeno sódico en las concentraciones séricas de IL-1, IL-6 y TFN en pacientes con faringoamigdalitis aguda purulenta.

BACKGROUND: Cytokines produced by macrophages and neutrophils participate in the host's defense mechanism; in infectious processes. Interleukins such as LI-1, IL-6, and tumor necrosis factor (TNF) also have a role in these acute phase mechanisms. OBJECTIVE: Assess the effect of sodium naproxen on the serum concentration of IL-1, IL-6 and TNF in acute infectious process. MATERIAL A METHODS: Eighteen patients with clinical diagnosis of acute purulent pharyngitis and/or tonsillitis were randomly assigned to one of two groups of 9 patients each. RESULTS: The patients in the first group received sodium naproxen and those in the other group received placebo. Patients of both groups received procaine G penicillin. Patients in the group receiving sodium naproxen showed improvement of the infectious and febrile syndromes within 72 hours. Patients receiving placebo showed signs and symptoms; of the infections and febrile syndromes for more than three days. DISCUSSION: Patients receiving treatment with sodium naproxen had a statistically significant reduction of the serum concentration of IL-1b as compared to basal and 72 h measurements; there were also statistically significant differences with respect to patients receiving placebo. IL-6 and TNF did not change in any of the groups. These results show that serum IL-1b levels dropped in both groups with a more striking reduction in the group receiving sodium naproxen , that also showed a faster improvement of the symptoms.

Faringoamigdalitis aguda. Su tratamiento / Treatment for acute pharungotonsillitis

Con el objeto de evaluar la utilidad de tres distintos esquemas terapéuticos en la faringoamigdalitis aguda (FAA) no purulenta, se realizó un ensayo clínico controlado que comparó tres grupos de 30 pacientes cada uno: grupo A con tratamiento sintomático, grupo B tratado con penicilina procaínica por siete días más medicamentos sintomáticos, grupo C tratado con penicilina procaínica por dos días y con penicilina benzatínica por dos días y con penicilina benzatínica al tercer día, y sintomáticos. Este estudio nos permitió observar que no existieron diferencias estadísticamente significativas cuando comparamos los tres grupos, p> 0.6, p> 0.6 y p> 1, respectivamente. Se propone el tratamiento sintomático en la FAA para brindar mayor beneficio terapéutico y evitar el uso indiscriminado de antibióticos en la consulta de medicina familiar

A comparison of procaine penicillin with sulbactam-ampicillin in the treatment of peritonsillar abscesses.

The clinical efficacy of procaine penicillin and sulbactam-ampicillin was compared in patients with peritonsillar abscesses after peroral abscess drainage. Forty-two patients were randomly assigned to receive either procaine penicillin or sulbactam-ampicillin intramuscularly on an outpatient basis. The mean time required for clinical symptoms (throat pain, dysphagia and fever) to resolve was compared. No statistically significant difference was found between the clinical recoveries of patients using either antibiotic (P > 0.05). The authors conclude that intramuscular procaine penicillin can be safely prescribed on an outpatient basis to most patients with peritonsillar abscess after incision and drainage. In contrast, a broader spectrum and more expensive antibiotic, such as sulbactam-ampicillin, should be reserved for non-responders.

Clinical disease associated with simian agent 8 infection in the baboon.

Simian agent 8 (SA8) is an alphaherpesvirus that was first reported as a spontaneous natural infection in a captive baboon colony in 1988. It was first isolated from an African vervet monkey in 1958 and was classified as a simian agent. Simian agent 8 was later isolated from a baboon rectal swab specimen in 1969 and from an oral lesion in a vervet monkey in 1972. Restriction endonuclease analysis was used to identify the virus as SA8. In a 1-year period, 70 baboons housed in two outside 6-acre breeding corrals developed lesions principally on the genitalia and oral cavity. The incidence was the same for males and females, with recurrence rate, severity of the lesions, and duration for the lesions to resolve being greater in the female baboons. Lesions involving the mouth, tongue, and lips were most commonly observed in the juvenile population. The lesions tended to start as small multiple papules or vesicles, which advanced to large pustular or ulcerative areas. Using an every-other-day treatment regimen consisting of Nolvasan cleaning and procaine penicillin G injections, it took an average of 14 to 21 days for the lesions to resolve totally. Thirty-seven percent of the baboons with herpetic lesions experienced another episode of SA8 infection, usually within 1 year of development of the primary lesion. Several complications have been documented to be associated with SA8 infections. Partial or total vaginal obstruction is most common, leading to impaired breeding performance and pyelonephritis. A vaginal corrective surgical procedure has been developed to allow these females to return to productive breeding status within the colony. Penile urethral obstruction, also causing pyelonephritis, was observed in the male baboons. A case of sciatic neuritis was reported in a baboon that presented with self mutilation of the foot; viral isolation revealed the etiologic agent to be SA8. Four female baboons with chronic SA8 infections went on to develop perineal neoplasms. This is an economically important disease entity in captive baboons because it causes severe morbidity, decreased reproductive performance, and ultimately death in 1% of the baboon colony each year. The baboon is a promising animal model in which to study genital herpes as it relates to disease in human beings.

Possible value of nasal smear in acute maxillary sinusitis: an experimental study.

The aim of this study is to determine the role of nasal smear in evaluating diagnosis and response to the treatment by the patient of acute maxillary sinusitis. We compared nasal smear and histopathological findings obtained from rabbits experimentally induced acute maxillary sinusitis. The animals were divided into two groups; one with blocked ostium and treated with antibiotic and the other applied natural ostiotomy, during a 4-week period. There was no statistically significant difference between the two groups in respect of recovery period. This conclusion was derived from nasal smear and biopsy findings. It was observed that nasal smear and biopsy findings were consistent with each other and with clinical findings. The results of this study revealed that nasal smear may be used in the diagnosis and treatment follow-up of acute maxillary sinusitis.