[Infections Associated with Treatment with Hirudo medicinalis - Report of Two Cases and Review of the Literature]. / Infektionen im Zusammenhang mit der Anwendung von Hirudo medicinalis - Zwei Fallberichte und Literaturübersicht.

Medicinal leeches are well-established for promoting venous drainage in transplants/flaps and analgesia in osteoarthritis. Although medicinal leeches are bred and kept under controlled conditions, they are colonised by a genuine species-specific bacterial flora. Therapeutic application of leeches implies skin penetration carrying an a priori risk of infection. We report 2 cases with different indications for medicinal leech therapy. In both cases wound infection occurred in close temporal and spatial correlation or with evidence of a leech-associated germ that could be treated successfully. An unclarified complication rate warrants strict indications for the application of medicinal leeches. Preventive measures are currently tested.

In vitro sensitivity of poultry Brachyspira intermedia isolates to essential oil components and in vivo reduction of Brachyspira intermedia in rearing pullets with cinnamaldehyde feed supplementation.

Cecal enteritis due to Brachyspira infections tends to be chronic in laying hens. Limited availability of antimicrobial drugs for use in laying hens emphasizes the need for alternative control measures. A broth microdilution method was used to determine the antimicrobial susceptibility of 20 Brachyspira intermedia field isolates from laying hen flocks to components of essential oils (EO). Minimal inhibitory concentration (MIC) distributions, obtained for 8 EO components, were all monomodal. Cinnamaldehyde had the lowest MIC values (40 to 80 mg/L), followed by nerolidol, capsaicin, carvacrol, and thymol (80 to 320 mg/L), eugenol (160 to 640 mg/L), and linalool (320 to 1,280 mg/L). The MIC ranges of piperine were mostly above the test range of 1,280 mg/L. In an in vivo experiment, coated trans-cinnamaldehyde was supplemented to the feed of rearing pullets. A completely randomized experimental design with 4 treatments and 3 replicates each (replicate = group of seven 1-d-old laying hen chickens) was applied. The negative and positive controls received a conventional feed during the whole trial. The positive controls were orally inoculated on 3 consecutive days (d 22, 23, and 24) with 1 mL of 1.0 × 10(8) cfu/mL of a B. intermedia field isolate. Two treatment groups (preventive and curative), identically inoculated, received the coated trans-cinnamaldehyde-supplemented feed (500 mg/kg of trans-cinnamaldehyde), the preventive group from d 1, the curative from d 25. On d 32, ceca were collected for bacteriologic Brachyspira enumeration. The mean enumeration of Brachyspira cells was decreased (P < 0.05) in the curative treated group versus the positive control group. The in vitro results of the present study demonstrate the potential of EO components as antimicrobials against poultry Brachyspira isolates, including isolates with acquired resistance for classic antimicrobial drugs. Reduction of Brachyspira colonization in young pullets was obtained, in a curative way, in an in vivo study using feed supplemented with coated trans-cinnamaldehyde. Further studies are necessary to investigate the mode of action of the coated trans-cinnamaldehyde in reducing Brachyspira colonization of the ceca.

Association of Stenotrophomonas maltophilia infection with lower airway disease in the horse: a retrospective case series.

Stenotrophomonas maltophilia is being reported with increasing frequency as a human nosocomial pathogen, especially among immuno-compromised patients. To the authors' knowledge, this pathogen has not previously been associated with lower airway disease in the horse. In this paper the clinical findings, laboratory diagnosis and response to treatment of seven cases of respiratory infection with S. maltophilia in horses, presented at three equine referral hospitals in Denmark in 2007, are described. In all cases there was a clinical history of chronic coughing and abundant mucopurulent exudate was observed in the lower trachea on endoscopy. On culture of tracheal aspirate, grey, slow-growing colonies, identified as S. maltophilia by both API 20NE identification and 16s ribosomal DNA sequencing, were identified. All isolates had a similar antibiotic susceptibility pattern characterised by resistance to all penicillins and cephalosporins, and to imipenem, gentamicin, amikacin and rifampicin. Ribotyping and pulsed-field gel electrophoresis of the S. maltophilia isolates from different patients indicated that they were either indistinguishable or closely related. This study indicates that S. maltophilia can be associated with chronic lower airway disease in the horse and provides useful initial insights into the diagnosis, therapy and epidemiology of this novel condition.

Antimicrobial therapy for water-associated wound infections in a disaster setting: gram-negative bacilli in an aquatic environment and lessons from Banda Aceh.

INTRODUCTION: As members of the Japan Disaster Relief (JDR) team in Banda Aceh, three of the authors treated 1,891 patients following the tsunami of 2004. Of the 367 cases with traumatic injuries, 216 cases required antimicrobial therapy. The medical services were continued by the Japan Self-Defense (JSD) Medical Team until mid-March 2005. Of the 216 cases initially treated by JDR, 54 required prolonged antimicrobial therapy for persistent symptoms despite repeated debridement. The aim of this study is to recommend an appropriate antimicrobial therapy for water-associated wound infections in the absence of laboratory services in disaster settings following tsunami. METHODS: The JDR and JSD treatment records were analyzed retrospectively. In August 2006, 19 months after the tsunami, the authors investigated pathogens in natural aquatic habitats in the affected area in Banda Aceh. At the same time, interviews with tsunami survivors were performed to determine the influential factors that facilitated wound infections after the tsunami. RESULTS: From the 49 water samples tested, Aeromonas sp., Vibrio sp., Klebsiella sp., and Proteus sp. were isolated from 24, 16, 15, and six samples, respectively. Regardless of the genus, almost all of the isolated gram-negative bacilli were sensitive to ciprofloxacin and gentamicin. CONCLUSIONS: From the microbiological test results and analyses of the medical records and interviews, the researchers recommend the following regimen when clinical microbiological tests are not available: initial treatment with beta"lactam penicillins for three days, followed, if the first antimicrobial is not effective, by ciprofloxacin or any other relevant new quinolones, with the addition of gentamicin if necessary.

Delayed leech-borne infection with Aeromonas hydrophilia in escharotic flap wound.

Medicinal leeches (Hirudo medicinalis) are commonly used in plastic surgery for the salvage of congested flaps and replanted parts compromised by venous congestion. Infection associated with leech therapy is a documented complication of leech application, with reported incidences ranging from 2.4 to 20% [De Chalain TM. Exploring the use of the medicinal leech: a clinical risk-benefit analysis. J Reconstr Microsurg 1996;12(3):165-72.1]. We describe a case of delayed leech-borne infection, from the escharotic portion of a latissimus dorsi flap, which developed several days after stopping leech therapy for venous congestion in a reconstructed breast.

Potential routes of acquisition of Arcobacter species by piglets.

The aim of this study was to determine the prevalence and the transmission routes of Arcobacter spp. in sows and their offspring on a breeding farm. Twelve Arcobacter-positive sows and their litters were studied for this purpose. Analysis of rectal samples showed a high prevalence of Arcobacter spp. among the sows (approximately 42% of the sows carried one or more Arcobacter species). Intermittent excretion of one particular species and shifts in excretion from one species to another were observed in individual animals over time. The detection of Arcobacter spp. in amniotic fluid of the sows and in rectal samples from newborn piglets (ranging from 38.5-83.3% per litter), as well as the high similarity between PFGE profiles of Arcobacter isolates from sows and their respective newborns indicated the existence of an intra-uterine transmission route for Arcobacter spp. Specific antibodies against Arcobacter spp. were detected in colostrum by Western blot. At 2 weeks of age, only a few piglets were positive for Arcobacter. The reappearance of Arcobacter in these piglets at Week 3 and the shift in the Arcobacter species detected (from a prominent presence of A. cryaerophilus at birth to the presence of A. skirrowii and A. butzleri at 3 weeks after birth) showed that a post-natal infection route from their mothers, newcomers or the environment to the piglets existed. Thus, in this manuscript the transmission of Arcobacter spp. (both vertical and horizontal) from carrying sows to their offspring is demonstrated.

Mechanisms of severe transfusion reactions.

Serious adverse effects of transfusion may be immunologically or non-immunologically mediated. Currently, bacterial contamination of blood products, particularly platelets, is one of the most significant causes of transfusion-related morbidity and mortality. Septic transfusion reactions can present with clinical symptoms similar to immune-mediated hemolytic transfusion reactions and transfusion-related acute lung injury. Extremely high fever and/or gastrointestinal symptoms, in a transfusion recipient, may be indicative of sepsis. The diagnosis is based upon culturing the same organism from both the patient and the transfused blood component. Numerous organisms have been implicated as the cause of septic transfusion reactions. Due to different storage conditions, gram negative organisms are more often isolated from red blood cell components; gram positive organisms are more often isolated from platelets. Prevention of septic transfusion reactions is primarily dependent on an adequate donor history and meticulous preparation of the donor phlebotomy site. Visual inspection of blood components prior to transfusion is also vital to preventing these reactions. Several methods of detection of bacterial contamination and inactivation of pathogens are currently under active investigation.

Aeromonas hydrophila infections following clinical use of medicinal leeches: a review of published cases.

Ten Aeromonas hydrophila infections following postsurgical leech applications have been reported. These cases indicate that postsurgical wounds and damaged tissue can provide entry for either acute or delayed A. hydrophila infection. These infections can range from localized cellulitis to progressive myonecrosis and sepsis. These infections may occur with measurable frequency in groups of patients exposed to leeches. Based on this review, it is recommended that leeches be applied only to tissue with a reasonably certain arterial supply; that patients receive antibiotics against A. hydrophila prior to leech administration; and that consideration be given to prolonged antibiotic administration to patients discharged home with open wounds or questionably viable tissue after leech administration.