Diagnosis and treatment of spontaneous group A streptococcal peritonitis.

BACKGROUND: Primary group A streptococcal peritonitis (PSAP) is a rare, fulminant and often fatal infection. The clinical manifestations include diffuse peritoneal signs with toxic shock syndrome and sometimes fasciitis. METHODS: Patients with PSAP diagnosed between December 2002 and December 2006 were studied retrospectively, focusing on the initial presentation, diagnosis, treatment and outcome. RESULTS: Six patients were identified (five women and one man). The clinical presentation was heterogeneous. All six patients had diffuse peritonitis, four had toxic shock syndrome on hospital admission and two patients also had fasciitis. All patients were treated surgically, and the final diagnosis was confirmed after operation. There were no deaths, but two patients had aesthetic sequelae owing to necrotizing fasciitis. CONCLUSION: PSAP is a rare condition, often requiring aggressive surgical treatment. Group A streptococcal peritonitis should be suspected in patients with no radiological evidence of a peritoneal portal of entry and no history of ascites.

Pain as the only consistent sign of acute appendicitis: lack of inflammatory signs does not exclude the diagnosis.

BACKGROUND: The clinical diagnosis of acute appendicitis in adults remains tricky, but radiological examinations are very helpful to determine the diagnosis even when the adult patient presents atypically. This study was designed to quantify the proportion of patients with a preoperative diagnosis of acute appendicitis that had isolated right lower quadrant pain without biological inflammatory signs and then to determine which imaging examination led to the determination of the diagnosis. METHODS: In this monocentric study based on retrospectively collected data, we analyzed a series of 326 patients with a preoperative diagnosis of acute appendicitis and isolated those who were afebrile and had isolated right lower quadrant pain and normal white blood cell counts and C-reactive protein levels. We determined whether the systematic ultrasonography examination was informative enough or a complementary intravenous contrast media computed tomography scan was necessary to determine the diagnosis, and whether the final pathological diagnosis fit the preoperative one. RESULTS: A total of 15.6% of the patients with a preoperative diagnosis of acute appendicitis had isolated rebound tenderness in the right lower quadrant, i.e., they were afebrile and their white blood cell counts and C-reactive protein levels were normal. In 96.1% of the cases, the ultrasonography examination, sometimes complemented by an intravenous contrasted computed tomography scan if the ultrasonography result was equivocal, fit the histopathological diagnosis of acute appendicitis. CONCLUSIONS: The diagnosis of acute appendicitis cannot be excluded when an adult patient presents with isolated rebound tenderness in the right lower quadrant even without fever and biological inflammatory signs. In our study, ultrasonography and computed tomography were very helpful when making the final diagnosis.

Influence of gastrointestinal trichostrongylidosis on ram fertility.

A study on the influence of gastrointestinal trichostrongyles on ram fertility was performed. Two groups of semen donor rams (Sarda breed) were utilized; one was experimentally infected with Haemonchus contortus, Trichostrongylus colubriformis and Teladorsagia circumcincta and the other was used as a control group. In all animals, coprological, haematological and reproductive parameters were studied. The results suggest that the parasites had a limited effect with some changes in phosphorus, cholesterol and chlorine levels. In our experience the parasitic burden produced no significant change on ram fertility.

Priority trends and prospects of blackberry breeding in conditions of Central Russia.

This overview substantiates the possibility and expediency of blackberry breeding in Central Russia, where it is in demand, but not widespread in horticulture. Significant achievements of world breeding, which gave modern cultivars a large set of economically important qualities and growing interest in it all over the world, including Russian gardeners, make it relevant to work with blackberries as an object of selection, and as a promising garden plant. However, insufficient frost and winter hardiness of the bulk of the cultivars of this culture cause certain difficulties when growing it in the areas with cold winters to which the Central zone of Russia belongs. The expansion of the market of berry products also imposes increasingly high requirements on the complex of economic indicators of new cultivars, primarily the quality of blackberry fruit. In this regard, improving the existing range of varieties of the culture, increasing its adaptive properties and commodity qualities of berries are urgent tasks for breeders when creating new cultivars. The relevance of blackberry breeding is also dictated by the fact that in Russia its domestic range of varieties is represented by only one modern cultivar obtained in the southern region and adapted, first of all, to it. For the Central zone of the country, the cultivars of this plant have not been developed (except for the limited experiments of I.V. Michurin conducted almost 100 years ago). Therefore, the breeding of adapted cultivars of the culture in the climatic conditions of this region may be promising. It is also possible to grow here (with shelter for the winter) the cultivars already created abroad that can give with the right agricultural technology a good industrial harvest, which is confirmed by the practice of amateur and farm gardening, as well as scientific research. The purpose of this work is to designate the leading directions of blackberry breeding, the most important in the conditions of Central Russia and to show prospects of the development of new cultivars of this valuable culture in the specified climatic zone. The analysis of world trends and experience in the blackberry breeding and variety study, as well as the results of our own research of the culture conducted in the Orel region, allow us to consider it promising and relevant to work on improving the range of varieties of this plant in Central Russia. All priority areas of blackberry breeding, indicated in foreign and domestic breeding programs (winter hardiness, high quality of fresh and processed fruit, the correct shape of berries, their large size, the necessary values of biochemical composition, high productivity of plants, thornless shoots and high resistance to diseases and pests), are relevant for this region of our country, while high winter hardiness is currently the most important of them.

[Gas gangrene of the abdominal wall due to underlying GI pathology: seven cases]. / Gangrène gazeuse extensive révélant une pathologie digestive: 7 observations.

OBJECTIVE: Gas gangrene of the abdominal wall is a rare clinical occurrence with high rates of morbidity and mortality. The primary source of the infection is often unknown. To analyze the primary underlying intestinal etiologies and diagnostic approaches of gas gangrene of the abdominal wall, and to highlight specific treatment problems, particularly that of constructing a colostomy exteriorized through a massively infected abdominal wall. PATIENTS AND METHODS: Seven cases of abdominal wall gas gangrene due to a gastrointestinal etiology were identified. (Cases arising from proctologic sources or related to recent abdominal surgery were excluded.) During the same period, 39 other patients presenting with abdominal wall gangrene from non-intestinal sources were treated. RESULTS: The etiologies were: perforated sigmoid diverticulitis (n=2), perforated appendicitis (n=1), acute pancreatitis with associated cecal perforation (n=1), and perforated colorectal cancer (n=3). Four of the seven patients died despite treatment (mortality of 57%). CONCLUSION: The clinical presentations of these seven cases demonstrate that a GI source must be suspected whenever a patient presents with abdominal wall gas gangrene, even when there are no specific GI symptoms. Imaging, particularly with CT scan, is essential both to visualize the extent of tissue necrosis and to reveal underlying primary GI pathology. This optimizes the surgical approach both by allowing for complete debridement and drainage of infected tissue, and by focussing the intervention on correction of the underlying primary GI source of infection.

The establishment rate of a sheep nematode: revisiting classics using a meta-analysis of 87 experiments.

Strongyle nematode establishment rate in their host is a highly variable life history trait, which makes it difficult to estimate. A meta-analysis was applied to the nematode Teladorsagia circumcincta of sheep in order to acquire a general framework of the factors modulating this life trait. A linear model was built with individual data on 540 infected lambs extracted from 13 articles. Lambs breed and age, time lag between last infection and the interaction between infection mode, infective dose and the number of repeated infective doses were significantly related with the establishment rate. The influence of infection mode on nematode establishment rate was also evaluated by comparing nematode establishment rate distributions within lamb populations infected under different conditions. Natural and repeated experimental infections lead to similar distribution of establishment rate. Conversely, these infection conditions resulted in different parasite establishment rates in average (12.7 and 23.4%, respectively). Three hypotheses are discussed to explain this result: immune protective response, host avoidance behaviour and parasite virulence.

Population evolution of the free-living stage of goat gastrointestinal nematodes on herbage under tropical conditions in Guadeloupe (French West Indies).

In Guadeloupe (French West Indies), paddocks were contaminated with gastrointestinal helminth eggs by young goats during the rainy season and the dry season. The evolution of L3 population size on herbage was followed over a period of 56 days. The major genera were Haemonchus and Trichostrongylus. It was shown that the L3 appeared on herbage 7-14 days after the beginning of contamination (DAC), and the L3 population sizes were maximal between the 14th and the 21st DAC. The maximum duration of larval survival ranged between 49 and 56 days. There was a marked depressive effect by the dry season on eggs hatching and L3 development with some arrested egg hatching in Trichostrongylus. The climatic events and the amount of dry matter on pastures during the grazing period appeared as the main important factors which could interfere with the overall evolution of the L3 population size and there was no preferential direction of L3 migration from faeces to herbage.

Morphological polymorphism in the nematode Teladorsagia circumcincta in relation to age of larvae, infection mode and lamb characteristics in experimental conditions.

Variations in the proportion of the less-frequent morph of Teladorsagia circumcincta, T. c. trifurcata, were studied under experimental conditions. Infections with older larvae (over 7 months of age at 4 degrees C) yield a lower proportion of T. c. trifurcata compared with those obtained from fresh larvae (15 days). This phenomenon could account for the reduction in the proportion of the morph trifurcata in two isolates that were acclimated to laboratory rearing for several generations. The infection mode (single or trickle infections did not significantly modify the proportions of both morphs. The morph trifurcata was found in higher proportions (> 5.5%) in more susceptible male and/or Romanov lambs, and in lower proportions (< 2.5%) in less susceptible female and/or Mérinos d'Arles lambs.

Effects of irrigation on appearance and survival of infective larvae of goat gastro-intestinal nematodes in Guadeloupe (French West Indies).

In Guadeloupe (French West Indies), faeces from naturally infected goats were deposited during the dry season on three plots, irrigated with long (plot A) or short herbage (B) and non-irrigated with long herbage (C). Microclimatic data and the evolution of L3 population size in faeces, on soil surface and on herbage were followed over a period of 26 days. The initial nematode egg population was comprised of 58% Haemonchus contortus (HC), 25% Trichostrongylus colubriformis (TC) and 17% Oesophagostomum columbianum (OC). Temperature and water content varied in time and space (soil, faeces, herbage) from homogeneous in A to very heterogeneous in C. In A and B, population dynamics were similar with higher values of maxima in A. Larval peaks occurred on day 9 after deposition in faeces in plot A: 23.1, 39.1 and 17.2 L3/100 eggs, respectively for HC, TC and OC; the same day in soil: 1.9, 0.6 and 3.1 L3/100 eggs. On day 26 it remained less than 1 L3/100 eggs in both soil and herbage for the three species. In C, only TC larvae were observed coming, after rain, from eggs in which hatching had been delayed. It was difficult to separate the respective effects of temperature and water content on the development of the eggs, but irrigation gave favourable conditions for all eggs to develop into larvae. Pasture rotation with 28-35 days of regrowth should minimize the increased risk of infection for the goats due to irrigation.

Pasture populations of cattle nematode larvae in Guadeloupe (French West Indies).

The development of numbers of third-stage (L3) larvae of gastrointestinal nematodes after pat (faeces) deposition by heifers is described, using a mathematical model, for seven experiments carried out in Guadeloupe (French West Indies). A dramatic rise in L3 population size occurred on herbage near pats, 17-25 days after pat deposition. There was no clear relationship between climatic data and L3 population dynamics. However, 5 successive days of rainfall induced the resumption of larval migration in two experiments. Changing the unit of expression of L3 population size (100 L3 m-2 vs 1000 L3 per kg DM) did not alter estimates of the model parameters. The evolution of L3 population of Haemonchus and Cooperia were similar.

Effect of genetic type, lactation and management on helminth infection of ewes in an intensive grazing system on irrigated pasture.

A survey of helminth infection was conducted in a flock of 290 ewes distributed into Romanov (R), Merinos d'Arles (M) and Romanov x Merinos (R x M) genetic types, grazing irrigated pasture in the south of France. Faecal egg and larval counts were done seven times per year from 1981 to 1984 on homogeneous groups of ewes and then individually once to four times every autumn from 1985 to 1988. Helminth fauna was diverse and more abundant during autumn. High levels of strongyle infection occurred in the ewes that remained on the same irrigated pastures during summer. Moving to Alpian pastures during the summer lowered autumnal infection. Significant differences between genotypes in intensity of infection were observed in the order R > R x M > M for strongyles (Teladorsagia circumcincta and/or Trichostrongylus vitrinus, Chabertia ovina and/or Oesophagostomum venulosum, Nematodirus spp.), Moniezia spp. and Dictyocaulus filaria. The hierarchy was reversed for Fasciola hepatica infection and not consistent from one year to another for protostrongylid infections. The effect of lactation intensity on the postparturient rise was studied by equilibrating number of ewes according to reproductive status (zero, one or two lambs in lactation). Merino ewes with two lambs in lactation, as well as primiparous Romanov ewes, had significantly higher strongyle infections than the others. The repeatabilities of the larval and egg counts between the four trial years were 0.24, 0.23 and 0.16, respectively, for protostrongyles, Nematodirus and strongyles, with higher intra-annual values for protostrongyles and inconsistently significant results for strongyles due to the presence of several species.

Worm population characteristics and pathological changes in lambs after a single or trickle infection with Teladorsagia circumcincta.

The regulation of the worm population and of its pathological effects was studied after a single or trickle infection with T. circumcincta. One hundred and twenty lambs, 60 Romanov and 60 Mérinos d'Arles, 3 months old, were distributed in four balanced groups: non-infected (G0), infected with 7000 L3 per animal once and slaughtered after 4 weeks (G14) or 8 weeks (G18), and infected 8 times and slaughtered after 8 weeks (G88). Parasitological, histological, haematological parameters and weight gains were recorded on each animal. Female and artificially nursed lambs had lower worm burdens and egg counts (epg) than males and naturally suckled lambs. No difference in parasitological parameters was seen between the two breeds, but Mérinos lambs infected once, had a higher increase in pepsinogen concentrations than Romanov lambs. In the infected animals, a significant proliferation of mast and eosinophil cells was observed in the abomasum wall. Serum pepsinogen concentrations were significantly higher 3 weeks p.i. and the weight gain was depressed during the first month p.i. The worm population was more numerous and younger in group G14 compared with G18 in which 24% of the worms had been expelled during the second month p.i. The female worms in G18 were longer and had more eggs in utero and higher egg output. After the trickle infection (G88) the take was reduced, female worms were longer with more eggs in vagina (pars ejectrix) and there was a higher variability in the number of eggs (compared with G18 data). The pepsinogen rise was smaller but no specific effect was seen on histological and haematological parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Genetic resistance to gastrointestinal nematode parasites in Polish long-wool sheep.

A study was undertaken from 1991 to 1994 on a farm in southern Poland to evaluate the genetic parameters of resistance to gastrointestinal nematodes. The predominant species were Teladorsagia circumcincta and Haemonchus contortus. A total of 32 sires were evaluated, around 15 per year. Faecal egg counts were measured twice during the 4-month grazing season for lambs (total 659 lambs) and three times for their mothers (total 327 ewes). Infection levels were high during the first 2 years and low during the last 2 years. Using an animal model, the heritability of log10(epg+25) increased from 0.20 in August to 0.33 in September for lambs, and from 0.18 in May to 0.25 in September for ewes. The repeatability of ewe faecal egg count between years was 0.25. A genetic correlation of 0.58 was found between faecal egg count in ewes and in 6-7-month-old lambs. A negative genetic correlation (-0.61) was estimated between faecal egg count in September and daily weight gain of lambs from 70 days of age to the end of grazing season (7 months of age). The results confirm the feasibility of genetic selection of sheep for resistance to nematode parasites in an environment where T. circumcincta and H. contortus are the dominant species.

Genetic variability in resistance of Creole goats to natural infection with trichostrongylids in Guadeloupe.

The objective of this study was to show the existence of genetic variability in resistance of Creole goats to natural infection with intestinal nematodes. Four successive cohorts of male and female kids were reared from weaning during 9 months in intensive pangola pastures (stocking rate 1.4 t/ha, regrowth of 21 days, 300 kg N/ ha/year of fertilization). All cohorts considered, 203 offsprings from 13 bucks and 149 goats were used in the experiment. Animals were treated with an oral dose of ivermectin every seven weeks, from 3 to 11 months of age. They were sampled for fecal egg counts (FEC) and packed cell volume (PCV), 6 weeks after drenching, when 6 and 10 months old. Haemonchus contortus and Trichostrongylus colubriformis were the predominant species. Data of one cohort when 6 months of age and another one when 10 months old were not included in calculations because a self-cure occurred during a rainy season. Estimated means of FEC after square-root transformation were 1054 and 711 respectively for 6-month-old and 10-month-old kids. Phenotypic correlations between FEC and PCV were -0.46 (p < 0.001) and -0.29 (p < 0.01) when 6 and 10 months old, respectively. FEC repeatabilities estimated as variance ratio were 0.47 and 0.06 for within-age measures (data recorded at one week interval) and between age measures (6 vs. 10 months) respectively. No sire effect was significant for PCV. Sire effect on FEC was more significant when 6 months old (p < 0.03) than when 10 months old (p < 0.15). Further studies are now being carried out to confirm this genetic determinism of resistance to natural infection with strongyles in Creole goats.

The distribution of trichostrongyle infective larvae on pasture and grazing behaviour in calves.

The distribution of trichostrongyle infective larvae was investigated at three different times during the grazing season on a calf pasture in a district in the west of France. The grass was collected around the dated pats in several successive rings measured every 10 cm, and the larvae were extracted. The larval population was higher on August 20 than on June 10 or October 7. The main species were Ostertagia in June and October, Cooperia in August. Migrations were correlated with pat ageing for the two species; Ostertagia larvae migrated further than Cooperia ones. The distance of the calves' grazing location from the nearest refusal was observed at the same time. In August and October, one third of the observed grazing locations were upon the refusals, where larval density was maximum. Pat density and stocking rate increased during the grazing season, grass availability decreased, refusal area decreased after the August maximum. The observations give a better understanding of animal infection and are of great help for the interpretation of numbers of larvae near to and away from the pats.

Relative effect of temperature and moisture on the development of strongyle eggs to infective larvae in bovine pats in Argentina.

To determine the most efficient microclimatic factors in bovine faeces that could explain the rate of development of parasitic nematode species, experimental pats were deposited in three locations (sun, shade and laboratory) in central-west Argentina during summer, autumn and winter seasons. Faecal water content (FWC) and temperature inside the pats were recorded during the duration of the experimental periods. The mean temperature and minimal values of FWC explained 54% of the variability of the rate of development of Haemonchus (third-stage larvae per 100 eggs) and mean maximal temperature and minimal FWC values were the two main factors regulating Cooperia development (R2 = 0.42). Rainfall was the third factor. No microclimatic component explained the development of Ostertagia in our experiments.

Accuracy of two methods for counting eggs of sheep nematode parasites.

A comparative study was carried out on eight species of sheep gastrointestinal nematodes in order to compare the value of two techniques for egg counting: the classical McMaster technique with saturated magnesium sulfate solution and a technique of egg extraction from faeces and counting by total collection after three centrifugations. Efficiency of extraction from 10 g of faeces was 95.9 to 99.5% according to the species of parasite, whereas the number of eggs counted by the McMaster technique represented only 16.5% of the total eggs present in the faeces. Advantages inherent in the use of these techniques are discussed.

Estimation of uptake of digestive tract strongyle larvae from pasture, using oesophagus fistulated sheep.

Three Merino of Arles ewes fistulated at the oesophagus were used in autumn and spring in order to assess their larval uptake on infected irrigated pasture. The rate of transmission (ingested/available larvae of digestive tract strongyle) was low when the pasture was heavily infected; it was not otherwise modified by environmental factors.

Comparison of the resistance to sympatric and allopatric isolates of Haemonchus contortus of Black Belly sheep in Guadeloupe (FWI) and of INRA 401 sheep in France.

The resistance of a tropical breed of sheep towards the nematode parasite Haemonchus contortus (Hc) was compared to that of a European breed after artificial infection with the parasite following a 2 x 2 x 2 experimental design: two isolates (Hc Gua from Guadeloupe versus Hc Fra from France), two breeds each reared in their native habitats (Black Belly (BB) in Guadeloupe, FWI, INRA 401 reared in France), and two groups of lambs with differing infection status (one naive, i.e. infected for the first time during the experiment, and one primed, i.e. which had previously received doses of 5000 L3 on Days -35 and -32 before the infection during this experiment). Both groups were composed of 10 male lambs, which were 20 weeks of age when they were given a dose of 10,000 L3 of the relevant isolate on Day 0. Resistance was assessed by regular fecal egg counts (FECs) and blood samples, and worm counts were processed on Day 35 p.i. The FEC was lower in the BB than in INRA 401 lambs, lower in the primed than naive groups, and lower in Hc Fra than in Hc Gua. The eosinophil count remained unchanged in the naive INRA 401 groups, but increased in all the other groups. The hematocrit fell after infection, but the live weight was not affected by the infection. Worm burdens were 1868 and 5237 in the naive BB and INRA 401 groups, respectively, and 596 and 4835 in the primed BB and INRA 401 groups. The daily production of eggs per Hc Gua female worm was 1.5-fold that of Hc Fra. The number of worms had no effect on worm length or Hc in utero egg count in the BB sheep, but a positive and significant correlation between these two traits was seen in the INRA 401 lambs. These findings are indicative of innate resistance, and confirmed the high acquired resistance of the BB sheep to both sympatric and allopatric isolates of Hc. The regulation of worm population and fecundity differed in the BB and INRA 401 sheep.

Feasibility of herbage sampling in large extensive pastures and availability of cattle nematode infective larvae in mountain pastures.

Herbage sampling has been used to ascertain the contamination and epidemiology of cattle nematode infective larvae in large extensive pastures situated in the centre of France, where heifers graze for four months on a total area of one ha/heifer in mountains virtual "hectares", tufts of grass being picked both close to faecal pats or "refusals", and far from these pats. Ostertagia was the predominant parasite and the occurrence of Dictyocaulus resulted from silent-carrier heifers. Just after the thawing of the snow, when the heifers arrived in the mountains, the contamination was very high: 8000-9000 L3 and 45.00 to 63.00 L3 kg-1 dry herbage, respectively, far from and close to faecal pats, but this contamination decreases regularly during the season. The sampling of four areas (four "hectares") in each paddock was found to be a very valuable method. The variation of the mean was low and found mainly when the number of larvae was high (6-19% only for the spring sampling). This technique could have some merit in parallel or concurrently with tracer calves which are always difficult and expensive to use.