Effect of bovine apo-lactoferrin on the growth and virulence of Actinobacillus pleuropneumoniae.

Actinobacillus pleuropneumoniae (App) is a Gram-negative bacterium that causes porcine pleuropneumonia, leading to economic losses in the swine industry. Due to bacterial resistance to antibiotics, new treatments for this disease are currently being sought. Lactoferrin (Lf) is an innate immune system glycoprotein of mammals that is microbiostatic and microbicidal and affects several bacterial virulence factors. The aim of this study was to investigate whether bovine iron-free Lf (BapoLf) has an effect on the growth and virulence of App. Two serotype 1 strains (reference strain S4074 and the isolate BC52) and a serotype 7 reference strain (WF83) were analyzed. First, the ability of App to grow in iron-charged BLf was discarded because in vivo, BapoLf sequesters iron and could be a potential source of this element favoring the infection. The minimum inhibitory concentration of BapoLf was 14.62, 11.78 and 10.56 µM for the strain BC52, S4074 and WF83, respectively. A subinhibitory concentration (0.8 µM) was tested by assessing App adhesion to porcine buccal epithelial cells, biofilm production, and the secretion and function of toxins and proteases. Decrease in adhesion (24-42 %) was found in the serotype 1 strains. Biofilm production decreased (27 %) for only the strain 4074 of serotype 1. Interestingly, biofilm was decreased (60-70 %) in the three strains by BholoLf. Hemolysis of erythrocytes and toxicity towards HeLa cells were not affected by BapoLf. In contrast, proteolytic activity in all strains was suppressed in the presence of BapoLf. Finally, oxytetracycline produced synergistic effect with BapoLf against App. Our results suggest that BapoLf affects the growth and several of the virulence factors in App.

[Iatrogenic pleuropneumonia complicating central venous cannulation in a very low birth weight infant]. / Jatrogenna pleuropneumonia jako powilkanie cewnikowania zyl centralnych u noworodka.

BACKGROUND: Central venous cannulation is necessary for long-term parenteral nutrition in premature infants. Peripherally inserted long catheters are commonly used in these patients but even this relatively simple technique can end in serious complications. We present a case in which perforation of the vena cava and migration of the catheter to the intrapleural space resulted in multiple organ failure and death. CASE REPORT: A 700 g bw. infant, born at 28 weeks of gestation, was referred to our centre because of suspected bowel perforation. In the referring hospital, the infant had a central venous catheter inserted peripherally. The catheter migrated to the right intrapleural space, and parenteral formula was delivered over several hours to the right pleura, resulting in hydrothorax with serious compression of the lung and atelectasis. Emergency laparotomy did not reveal any pathology and a chest tube was inserted into the right pleura; the effusion fluid contained a large number fat particles. The child's condition worsened and he died 16 days after surgery because of multiple organ failure and sepsis. CONCLUSION: Accidental migrations of central venous catheters to the pleural space have been described by many authors. It can result in severe pneumonia, cardiac tamponade or sepsis and is often fatal. We conclude that central venous catheters in premature infants should be inserted under ultrasonography or fluoroscopy. Catheters should never be forced along vessels; their size ought to be adjusted to age, and a free outflow of blood should be obtained before they are used.

Listeria monocytogenes-associated respiratory infections: a study of 38 consecutive cases.

OBJECTIVES: Listeria monocytogenes (Lm) is a foodborne human pathogen responsible for severe infections, including septicaemia, neurolisteriosis, and maternal-foetal and focal infections. Little is known about Lm-associated respiratory tract or lung infections. METHODS: We conducted a retrospective study of culture-proven cases of Lm pleural infections and pneumonia reported to the French National Reference Centre for Listeria from January 1993 to August 2016. RESULTS: Thirty-eight consecutive patients with pleural infection (n = 32), pneumonia (n = 5), or both (n = 1) were studied; 71% of these were men. Median age was 72 (range 29-90). Two patients presented with concomitant neurolisteriosis. All patients but one reported at least one immunosuppressive condition (97%), with a median number of 2 (range 0-5), including 29% (8/28) with current exposure to immunosuppressive therapy and 50% (17/34) with ongoing neoplasia; 75% (21/28) reported previous pleural or pulmonary disease. Antibiotic therapy mostly consisted in amoxicillin (72%) associated with aminoglycoside in 32%. Chest-tube drainage was performed in 7/19 patients with empyema (37%); 25% of the patients (7/30) required intensive care management. In-hospital mortality reached 35% and occurred after a median time interval of 4 days (range 1-33 days). Three patients had recurrence of empyema (time interval of 1 week to 4 months after treatment completion). Altogether, only 13/31 patients (42%) diagnosed with Lm respiratory infection experienced an uneventful outcome at 2-year follow-up. CONCLUSION: Lm is a rare but severe cause of pneumonia and pleural infection in older immunocompromised patients, requiring prompt diagnosis and adequate management and follow-up.

Pleuropneumonia as a sequela of myelography and general anaesthesia in a Thoroughbred colt.

A 3-year-old Thoroughbred colt was presented to the University Veterinary Centre Camden for evaluation of ataxia. The horse was anaesthetised to facilitate cervical radiography and myelographic examination of the spinal cord. Recovery from anaesthesia was uneventful. Five days after general anaesthesia the horse re-presented with pleuropneumonia. It was euthanased 24 hours after presentation on humane grounds. Necropsy revealed severe tracheal erosion over the middle third of the ventral surface of the trachea, pleuropneumonia and narrowing of the cervical cord between C4 and C6. It is postulated that extension and flexion of the neck during myelography resulted in movement of the endotracheal tube cuff, causing the tracheal lesion and predisposing the colt to pleuropneumonia. Severe tracheal lesions and pleuropneumonia have not been reported as sequela of equine myelography, and should be considered as possible complications following repeated cervical manipulation during myelography in the horse.

[Varicella: previously healthy children sometimes develop complications]. / Waterpokken: soms complicaties bij voorheen gezonde kinderen.

Three healthy boys, 3.5, 5 and 1.5 years of age, were admitted to hospital with a severe bacterial skin infection, cerebellar ataxia, and pneumonia, respectively, one week after the onset of varicella. They recovered completely after treatment. Studies in Europe report complications from varicella in 2.5% of healthy children. Most of these are neurological complications and secondary bacterial infections of skin and soft tissue. Last year, a European consensus was published that recommended that all healthy children be vaccinated against chickenpox. In The Netherlands, routine varicella zoster virus (VZV) vaccination has not (yet) been implemented. We propose a new discussion on the possible inclusion of VZV vaccination in the national vaccination programme.

Nonsurgical resolution of caudal mediastinal paraesophageal abscess in a cat.

A one-year-old, castrated male domestic short hair cat was admitted with a history of anorexia, regurgitation and pyrexia for two days. Fever and leukocytosis were identified. There were a large soft tissue density oval mass in the caudal mediastinum on thoracic radiographs, a fluid-filled oval mass in the caudal mediastinum on ultrasonography, and left-sided and ventrally displaced and compressed esophagus on esophagram. On esophageal endoscopy, there were no esophageal abnormalities. CT findings with a fluid filled mass with rim enhancement indicated a caudal mediastinal paraesophageal abscess. The patient was treated with oral antibiotics, because the owner declined percutaneous drainage and surgery. The patient was admitted on emergency with severe respiratory distress; and ruptured abscess and deteriorated pleuropneumonia were suspected. With intensive hospitalization care and additional antibiotic therapy, the patient had full recovery.

Clinical observations of children with pleuropneumonia due to Mycoplasma pneumoniae.

A comparative study on the clinical presentation of Mycoplasma pneumoniae infection was performed in 56 patients with pleuropneumonia and those who had pneumonia without pleural effusion. The latter consisted of 773 cases; their age distribution reached a peak at 3-5 years of age in males and at 4-6 years in females. The 56 cases with pleuropneumonia were distributed among children of all ages. Pneumococcal infection was demonstrated by blood culture in one of 56 cases. Serological tests revealed a higher prevalence of mixed viral infections among children with pleuropneumonia (18/44) than with pneumonia but no effusion (69/419). There was a tendency toward a severe and prolonged course of illness with strong indications of infection among pleuropneumonia cases. Complications such as exanthema or liver dysfunction were observed more frequently among pleuropneumonia cases than among simple pneumonia cases. These results suggest that other pathogenic agents or unknown host reactions to these agents may modify the clinical picture of pleuropneumonia caused by M. pneumoniae.

Sequential study of lesion development in experimental haemophilus pleuropneumonia.

Recently weaned pigs were infected aerogenically with Haemophilus (Actinobacillus) pleuropneumoniae, serotype 5. At three, six, 12, and 18 hours and one, two, four and seven days after exposure to haemophili a pair of animals were killed and necropsied. Pulmonary oedema with multifocal petechial haemorrhages and a diffuse neutrophilic bronchiolitis and alveolitis were observed at three and six hours after infection. Focal areas of coagulative necrosis developed in areas of intense suppuration at 12 and 18 hours after infection. At one and two days after infection, necrotic areas were surrounded by dense bands of degenerating leucocytes and contained unidentifiable round and elongated cells characteristic of this disease. In subacute lesions a thick layer of granulation tissue formed around the outer margin of developing abscesses. Most of the round and elongated cells in alveolar exudates could not be identified by enzyme histochemistry or electron microscopic examination. Neutrophils in various stages of degeneration and deterioration provided strong evidence that some of the cells were of this type. These findings suggest that neutrophils may play an early and significant role in development of lesions.

Role of haemophilus pleuropneumoniae lipopolysaccharide endotoxin in the pathogenesis of porcine Haemophilus pleuropneumonia.

Intact Haemophilus pleuropneumoniae cells (strain Shope 1, serotype 1), highly purified lipopolysaccharide (LPS) obtained from this strain of H pleuropneumoniae, as well as from Escherichia coli O111:B4, filter-sterilized H pleuropneumoniae cell-free culture supernatant fluid, and heat-inactivated supernatant fluid were given intranasally to CF1 mice and intratracheally to pigs. Pulmonary lesions induced by H pleuropneumoniae in mice were similar to those induced by H pleuropneumoniae in pigs. Histologically, lungs of mice and pigs killed 1 or 2 days after inoculation with 200 micrograms of highly purified H pleuropneumoniae LPS had lesions similar to one another and were similar to those in mice and pigs given intact H pleuropneumoniae, except that little or no necrosis or hemorrhage was observed. In mice killed 1 or 2 days after inoculation of 200 micrograms of E coli O111:B4 LPS, pulmonary lesions were similar to those in mice given H pleuropneumoniae LPS. Pulmonary lesions in mice given cell-free culture supernatant fluid obtained from a midlog-phase growth culture of H pleuropneumoniae cultivated in a chemically defined medium were severe and consisted of neutrophil infiltration and extensive necrosis. In mice, the heat-inactivated supernatant fluid produced mild lesions that consisted of foci of neutrophil aggregation and no necrosis. Extensive necrosis observed in lesions caused by cell-free culture supernatant fluid could be attributed to the action of a heat-labile component, perhaps by the extracellular heat-labile hemolysin produced by H pleuropneumoniae cultivated in chemically defined medium. A LPS endotoxin and a heat-labile factor may be involved in the pulmonary lesion development in the acute phase of porcine Haemophilus pleuropneumonia.

Case-control study of risk factors for development of pleuropneumonia in horses.

Risk factors for development of pleuropneumonia were determined by reviewing medical records of 45 horses with pleuropneumonia and 180 control horses examined between Jan 1, 1980 and Jan 1, 1990. Factors considered included age, breed, sex, occupation, transport farther than 500 miles within the previous week, racing within the previous 48 hours, viral respiratory tract infection or exposure to horses with viral respiratory tract disease within the previous 2 weeks, and vaccination against influenza or rhinopneumonitis within the previous 6 months. Results indicated that Thoroughbreds were at a greater risk of developing pleuropneumonia than were other horses, and Standardbreds were at a reduced risk. Transport farther than 500 miles and viral respiratory tract disease or exposure to horses with respiratory tract disease were determined to be risk factors for the development of pleuropneumonia.

Pleural effusion associated with acute and chronic pleuropneumonia and pleuritis secondary to thoracic wounds in horses: 43 cases (1982-1992).

Case records of 43 horses with pleural effusion associated with acute pleuropneumonia, chronic pleuropneumonia, or pleuritis secondary to a penetrating thoracic wound were reviewed to determine the predisposing factors, diagnosis, and treatment of this condition. Acute pleuropneumonia was diagnosed in 36 horses, the majority of which were Thoroughbreds (89%). Of 22 (61%) horses that were in race training at the onset of illness, 11 (31%) had been recently transported a long distance and 4 (11%) had evidence of exercise-induced pulmonary hemorrhage. Physical examination findings and hematologic data were nonspecific. The most consistent abnormality was hyperfibrino-genemia. Affected horses were treated with antibiotics, thoracic drainage, nonsteroidal anti-inflammatory drugs, and supportive care. Twenty-two (61%) horses were discharged from the hospital, with the mean duration of hospitalization for those discharged being 23 days. Nine (25%) horses were euthanatized and 5 (14%) died. Bacterial culturing of thoracic fluid resulted in growth in 30 of the 36 (83%) horses. The finding of anaerobic bacteria in thoracic fluid was not associated with a lower survival rate (62%) than the overall survival rate (61%). Four horses with chronic pleuropneumonia had a history of lethargy and inappetence for > 2 weeks. Actinobacillus equuli was isolated, either alone or in combination with other bacteria, from thoracic fluid of these 4 horses. Each horse was treated with broad spectrum antibiotics and made a rapid recovery. Three horses with acute pleuritis secondary to penetrating thoracic wounds also had nonspecific clinical signs, apart from the wound and a large volume of pleural effusion. Bacteriologic isolates from these horses differed slightly from those of horses with acute pleuropneumonia.

Feedlot cattle pneumonia.

The etiology, epidemiology, clinical signs, and pathology of feedlot cattle pneumonias are discussed. This information enables a clinician with a feedlot cattle pneumonia problem to give prompt, useful advice on cause, prevention, and treatment based on findings of the feedlot visit.

Congenital afibrinogenemia in Hasan Sadikin Hospital.

A case of a 24-year-old male with congenital afibrinogenemia has been discussed. The diagnosis was made based upon history, physical examination, umbilical cord bleeding, bleeding history and similar cases were found being the patient's grandfather and brother. Laboratory tests supported the diagnosis with a prolonged bleeding time, prothrombin time (PT), undetected partial thromboplastin time (PTT), flat line on thromboelastogram, and undetected fibrinogen (less than 78 mg/dl), with substitution test which showed fibrinogen deficiency.

Towards an understanding of equine pleuropneumonia: factors relevant for control.

OBJECTIVE: To review relevant literature on factors associated with the development of equine pleuropneumonia. DESIGN: A review of the literature using a range of databases including Current Contents, Medline, ChemAbstracts, Biological Abstracts and CAB and a comprehensive search strategy which involved use of keywords, author and subject category searches. Additional sources included review of articles cited by key accumulated references. RESULTS: Since the early years of this century, many of the "gaps" in our knowledge of the pathogenesis of this disease have been filled. We now know that equine pleuropneumonia results from contamination of the lower respiratory tract with bacteria similar to the normal oropharyngeal microbiota of the horse and that transportation of any mode, especially over long distances (and consequently with no or short rest periods), is the single most important predisposing factor for this disease. This is associated with restraint of horses such that they are unable to lower their heads, which leads to increased opportunity for lower respiratory tract contamination and a reduced opportunity for clearance. Strenuous exercise also results in lower respiratory tract contamination and exercise subsequent to transportation exerts additive detrimental effects on the defenses of the lower respiratory tract. CLINICAL IMPLICATIONS: While modern veterinary medicine and surgery have significantly reduced the death rate from pleuropneumonia, horses that develop the disease have a high probability of not returning to their prior use. This underscores the importance of developing the most effective strategies for its prevention.

Inflammation and increased numbers of bacteria in the lower respiratory tract of horses within 6 to 12 hours of confinement with the head elevated.

Confinement of horses with their heads elevated for periods up to 24 hours was used to evaluate the extent and the effects of bacterial contamination of the equine lower respiratory tract. Significant (P < 0.05) increases in bacterial numbers (up to 10(9) colony forming units/mL in transtracheal aspirate derived samples) occurred within 6 or 12 hours in most horses. Pasteurella/Actinobacillus spp and Streptococcus spp were most commonly isolated. Lowering of the head for 30 minutes every 6 hours to facilitate postural drainage did not prevent multiplication of organisms to levels equivalent to those achieved by horses where the head was elevated for 24 hours. When horses were released from confinement and heads were no longer maintained in an elevated position, clearance of accumulated secretions and bacteria occurred within 8 to 12 hours. Thus, confinement with the head elevated resulted in significant bacterial contamination and multiplication within the lower respiratory tract during a period often encountered in routine management procedures, such as transportation. The clearance of accumulated secretions occurred over a prolonged period after release from such confinement.

[Acute pleuro-pneumonitis resulting from leptospirosis]. / Une pleuro-pneumopathie sévère révélant une leptospirose.

We report a case of acute pneumonitis with pleural effusion and respiratory distress syndrome that was the inaugural sign of leptospirosis in a 37-year-old patient exposed to rat dejections at home. The patient was given penicillin and oxygen therapy with evacuation of the pleural effusion. Lung manifestations in leptospirosis usually occur as non-specific cough and hemoptysis. Pleural effusion is uncommon. Adult respiratory distress syndrome and profuse hemoptysis can also occur, requiring special care.

[Etiology of acute and chronic bronchopulmonary diseases in children. I. The results of a bacteriological and immunological study]. / Etiologiia ostrykh i khronicheskikh bronkholegochnykh zabolevanii u detei. Soobshchenie I. Rezul'taty bakteriologicheskogo i immunologicheskogo issledovaniia.

The bacteriological study of tracheal aspirate, sputum and bronchial washings obtained from 130 children with acute pneumonia and pleuritis and from 186 children with chronic pneumonia was carried out. In the samples of pleural exudate, urine and blood serum from the patients with acute pneumonia and pleuritis the presence of Streptococcus pneumoniae and Haemophilus influenzae antigens was determined by the method of countercurrent immunoelectrophoresis (CIE). S. pneumoniae and H. influenzae were found to be of different importance in the pathogenesis of acute and chronic bronchopulmonary diseases in children. In acute pneumonia and pleuritis in children who had not been treated with antibiotics pneumococci were isolated in 65.9% of cases and H. influenzae, in 20.4% of cases. In children with chronic pneumonia at the period of exacerbation H. influenzae dominated in the microflora (79%), while pneumococci were isolated 31.9% of cases. The use of CIE permitted the detection of pneumococcal antigen in 21.8% of those exudate samples which had shown no bacterial growth after inoculation. H. influenzae antigen was detected in pleural exudate in 5.4% of cases. In concentrated urine obtained from the children with acute pneumonia and pleuritis pneumococcal antigen was detected in samples from 29.6% of patients, and in nonconcentrated urine the occurrence of this antigen was reduced by half.

[Clinical and pathological features of Haemophilus pleuropneumoniae infection in pigs (author's transl)]. / Klinische en pathologische kenmerken van Haemophilus pleuropneumoniae-infectie bij het varken.

The incidence of Haemophilus pleuropneumoniae (= H. parahaemolyticus or HPP) infection in fattening pigs showed a marked increase in the Netherlands during the past five years. The clinical picture on pig-breeding farms has been known for an even longer period. A peracute, acute and subacute chronic form, i.e. stages marked by exudation, proliferation and desquamation, and sequestration respectively can be differentiated. Clinical features of the (sub)acute stage of HPP infection consist in severe dyspnoea, high temperature and bloody foam from the nose and/or at the mouth. When the infection runs a chronic course, the clinical symptoms are less specific. The bacteriological diagnosis, treatment and prevention are discussed, attention also being paid to the possibility of vaccination.

[THe etiology of pleuropneumopathies in infants and small children]. / Etiologia pleuropneumopatiilor la sugar si copilul mic.

In a follow-up study during 20 years (1975-1994) we observed, beside clinical aspects, the evolution of pleuropneumopathies in infants and small children (1-3 years of age), and the etiology of these infections. The casuistry includes 456 children-237 infants (51,97%) and 219 small children, between 1-3 years of age (48,02%), which were admitted in Clinical Children's Hospital from Oradea (Clinical Hospital for Children) with pleuropneumopathies. 4 intervals of time were analyzed comparatively, each of 5 years, starting with a number of 235 cases in the first one and reaching only 45 observations in the last one. The etiology was dominated by coagulase-negative and coagulase-positive Staph, aureus (34,20-60,40%), Strept. pneumoniae (14,10-40,00%). From the Gram negative bacteria, there were identified Kl. pneumoniae (2,20-9,80%), Pseudomonas sp. (2,20-5,19%), E. coli and Proteus sp. (1,70-2,20%). There were 2,90-9,85% of cases with a potential of pathogenicity, in various associations. In the last 10 years, the number of cases with unprecised etiology is growing (22,50-33,30%) probably because of the implication of anaerobe and coagulase-negative staphylococci, no tests of isolation and identification being made for them.