Tip of the iceberg: extracardiac CT findings in infective endocarditis.

Infective endocarditis (IE) is a disease with high morbidity and mortality rate, but diagnosis is confounded by diverse clinical presentations, which mimic other pathologies. A history of illicit intravenous drug use, previous cardiac valve surgery, and indwelling intracardiac devices increases the risk for developing infective endocarditis. The modified Duke criteria serve as the standard diagnostic tool, though its accuracy is reduced in certain cases. Radiologists in the Emergency Room setting reading body CT may be the first to identify the secondary extra-cardiac complications and facilitate expeditious management by considering otherwise unsuspected infective endocarditis. This review highlights common extracardiac complications of IE and their corresponding CT findings in the chest, abdomen, pelvis, and brain. If IE is suspected radiologists should suggest further investigation with echocardiography.

Consumption of trematode parasite infectious stages: from conceptual synthesis to future research agenda.

Given their sheer cumulative biomass and ubiquitous presence, parasites are increasingly recognized as essential components of most food webs. Beyond their influence as consumers of host tissue, many parasites also have free-living infectious stages that may be ingested by non-host organisms, with implications for energy and nutrient transfer, as well as for pathogen transmission and infectious disease dynamics. This has been particularly well-documented for the cercaria free-living stage of digenean trematode parasites within the Phylum Platyhelminthes. Here, we aim to synthesize the current state of knowledge regarding cercariae consumption by examining: (a) approaches for studying cercariae consumption; (b) the range of consumers and trematode prey documented thus far; (c) factors influencing the likelihood of cercariae consumption; (d) consequences of cercariae consumption for individual predators (e.g. their viability as a food source); and (e) implications of cercariae consumption for entire communities and ecosystems (e.g. transmission, nutrient cycling and influences on other prey). We detected 121 unique consumer-by-cercaria combinations that spanned 60 species of consumer and 35 trematode species. Meaningful reductions in transmission were seen for 31 of 36 combinations that considered this; however, separate studies with the same cercaria and consumer sometimes showed different results. Along with addressing knowledge gaps and suggesting future research directions, we highlight how the conceptual and empirical approaches discussed here for consumption of cercariae are relevant for the infectious stages of other parasites and pathogens, illustrating the use of cercariae as a model system to help advance our knowledge regarding the general importance of parasite consumption.

Patterns of Clinostomum marginatum infection in fishes and amphibians: integration of field, genetic, and experimental approaches.

Digenetic trematodes of the genus Clinostomum are cosmopolitan parasites infecting fishes, amphibians, reptiles, and snails as intermediate hosts. Despite the broad geographical distribution of this genus, debate about the number of species and how they vary in host use has persisted. To better understand patterns of infection among host species and across life stages, we used large-scale field surveys and molecular tools to examine five species of amphibians and seven species of fishes from 125 California ponds. Among the 12,360 examined hosts, infection was rare, with an overall prevalence of 1.7% in amphibians and 9.2% in fishes. Molecular evidence indicated that both groups were infected with Clinostomum marginatum. Using generalized linear mixed effects models, host species identity and host life stage had a strong influence on infection status, such that Lepomis cyanellus (green sunfish) (49.3%) and Taricha granulosa (rough skinned newt) (9.2%) supported the highest overall prevalence values, whereas adult amphibians tended to have a higher prevalence of infection relative to juveniles (13.3% and 2.5%, respectively). Experimentally, we tested the susceptibility of two amphibian hosts (Pseudacris regilla [Pacific chorus frog] and Anaxyrus boreas [western toad]) to varying levels of cercariae exposure and measured metacercariae growth over time. Pseudacris regilla was 1.3× more susceptible to infection, while infection success increased with cercariae exposure dose for both species. On average, metacarcariae size increased by 650% over 20 days. Our study highlights the importance of integrating field surveys, genetic tools, and experimental approaches to better understand the ecology of host-parasite interactions.

Development and application of an eDNA method to detect and quantify a pathogenic parasite in aquatic ecosystems.

Approaches based on organismal DNA found in the environment (eDNA) have become increasingly utilized for ecological studies and biodiversity inventories as an alternative to traditional field survey methods. Such DNA-based techniques have largely been used to establish the presence of free-living organisms, but have much potential for detecting and quantifying infectious agents in the environment, which is necessary to evaluate disease risk. We developed an eDNA method to examine the distribution and abundance of the trematode Ribeiroia ondatrae, a pathogenic parasite known to cause malformations in North American amphibians. In addition to comparing this eDNA approach to classical host necropsy, we examined the detectability of R. ondatrae in water samples subject to different degradation conditions (time and temperature). Our test exhibited high specificity and sensitivity to R. ondatrae, capable of detecting as little as 14 fg (femtograms) of this parasite's DNA (1/2500th of a single infectious stage) from field water samples. Compared to our results from amphibian host necropsy, quantitative PCR was -90% concordant with respect to R. ondatrae detection from 15 field sites and was also a significant predictor of host infection abundance. DNA was still detectable in lab samples after 21 days at 25°C, indicating that our method is robust to field conditions. By comparing the advantages and disadvantages of eDNA vs. traditional survey methods for determining pathogen presence and abundance in the field, we found that the lower cost and effort associated with eDNA approaches provide many advantages. The development of alternative tools is critical for disease ecology, as wildlife management and conservation efforts require reliable establishment and monitoring of pathogens.

Diversity, decoys and the dilution effect: how ecological communities affect disease risk.

Growing interest in ecology has recently focused on the hypothesis that community diversity can mediate infection levels and disease ('dilution effect'). In turn, biodiversity loss--a widespread consequence of environmental change--can indirectly promote increases in disease, including those of medical and veterinary importance. While this work has focused primarily on correlational studies involving vector-borne microparasite diseases (e.g. Lyme disease, West Nile virus), we argue that parasites with complex life cycles (e.g. helminths, protists, myxosporeans and many fungi) offer an excellent additional model in which to experimentally address mechanistic questions underlying the dilution effect. Here, we unite recent ecological research on the dilution effect in microparasites with decades of parasitological research on the decoy effect in macroparasites to explore key questions surrounding the relationship between community structure and disease. We find consistent evidence that community diversity significantly alters parasite transmission and pathology under laboratory as well as natural conditions. Empirical examples and simple transmission models highlight the diversity of mechanisms through which such changes occur, typically involving predators, parasite decoys, low competency hosts or other parasites. However, the degree of transmission reduction varies among diluting species, parasite stage, and across spatial scales, challenging efforts to make quantitative, taxon-specific predictions about disease. Taken together, this synthesis highlights the broad link between community structure and disease while underscoring the importance of mitigating ongoing changes in biological communities owing to species introductions and extirpations.

The effect of trematode infection on amphibian limb development and survivorship.

The causes of amphibian deformities and their role in widespread amphibian declines remain conjectural. Severe limb abnormalities were induced at high frequencies in Pacific treefrogs (Hyla regilla) exposed to cercariae of a trematode parasite (Ribeiroia sp.). The abnormalities closely matched those observed at field sites, and an increase in parasite density caused an increase in abnormality frequency and a decline in tadpole survivorship. These findings call for further investigation of parasite infection as a cause of amphibian deformities in other sites and species.

Maturational gradients in the retina of the ferret.

In the present set of studies, we have examined the site for the initiation of retinal maturation in the ferret. A variety of maturational features across the developing inner and outer retina were examined by using standard immunohistochemical, carbocyanine dye labelling, and Nissl-staining techniques, including 1) two indices of early differentiation of the first-born retinal ganglion cells, the presence of beta-tubulin and of neuron-specific enolase; 2) the receding distribution of chondroitin sulfate proteoglycans within the inner retina; 3) the distribution of the first ganglion cells to grow axons along the optic nerve; 4) the emergence of the inner plexiform layer; 5) the emergence of the outer plexiform layer and 6) the onset of synaptophysin immunoreactivity within it; 7) the differentiation of calbindin-immunoreactive horizontal cells; and 8) the cessation of proliferative activity at the ventricular surface. Although we were able to define distinct maturational gradients that are associated with many of these features of inner and outer retinal development (each considered in detail in this report), with dorsal retina maturing before ventral retina, and with peripheral retina maturing last, none showed a clear initiation in the region of the developing area centralis. Rather, maturation began in the peripapillary retina dorsal to the optic nerve head, which is consistent with previous studies on the topography of ganglion cell genesis in the ferret. These results make clear that the order of retinal maturation and the formation of the area centralis are not linked, at least not in the ferret.

Rods and cones project to the inner plexiform layer during development.

Mature rod and cone photoreceptor cells extend terminals to the outer plexiform layer (OPL), where they form characteristic spherules or pedicles, synapsing with the second-order neurons of the inner nuclear layer (INL). The present study demonstrates that, prior to the formation of this connectivity, immature rods and cones in the ferret extend processes beyond the level of the horizontal cells and future OPL, reaching the inner plexiform layer (IPL). The number of processes extending to the IPL increases steadily as the population of photoreceptor cells expands postnatally, reaching a maximum 2 weeks after birth. These processes are immunopositive for synaptophysin, and they terminate in two strata occupied by the dendrites of amacrine cells and ganglion cells. The frequency of these processes declines rapidly during the third postnatal week, and they are no longer detectable by the fourth postnatal week. Their loss is neither a consequence of photoreceptor cell death nor is it due to selective protein trafficking mechanisms that render them immunonegative. Rather, these processes retract to the level of the OPL during this period, coincident with the maturation of bipolar and horizontal cell processes. These results demonstrate that, despite the clear presence of environmental signals presaging the formation of the OPL, photoreceptor terminals initially ignore them to grow beyond this level of the retina. Rather, they detect and respond to signals within the IPL during this period, terminating in proximity to the processes of other cells in the inner retina, where they may contribute to transient retinal circuitry during early development.

Chronotopic fiber reordering and the distribution of cell adhesion and extracellular matrix molecules in the optic pathway of fetal ferrets.

We have examined the age-related reordering of optic axons as they pass through the chiasmatic region in fetal ferrets. Proportions of young and old optic axons were determined from electron micrographs taken sequentially through the prechiasmatic nerve, chiasm, and tract. This "chronotopic" reordering of axons was shown to emerge gradually, beginning rostral to the fusion of the two optic nerves, but continuing to develop caudal to the chiasmatic midline. Segregation of young from old optic axons was most pronounced within the optic tract. We then compared the emergence of this fiber reorganization to the distribution of cell adhesion and extracellular matrix molecules and to the glial architecture within the pathway. Using immunohistochemistry, the distributions of the cell adhesion molecules L1, NCAM, and TAG-1 and the extracellular matrix molecules laminin-1 and chondroitin sulfate proteoglycans (CSPGs) were determined. Among these, only the distribution of CSPGs was observed to change in a manner that complemented the segregation of young from old optic axons. CSPGs were densest in the deeper parts of the optic tract, coincident with radial glial fibers that turn to course within the region of the oldest optic axons. Both the glial architecture and the CSPG distribution form as a consequence of the invasion of the first optic axons, shown by the developmental sequence of each, and by the fact that these glial and molecular features fail to form in the absence of optic axons. The data suggest a model in which the gradient of CSPGs across the depth of the tract contributes to the formation of the chronotopic fiber reordering by providing a relatively unfavorable environment for subsequent axonal growth. The CSPGs may do so by interfering with adhesion molecules on optic axons that normally promote elongation.

A review of fixed phagocytic and pinocytotic cells of decapod crustaceans, with remarks on hemocytes.

Clearance of foreign materials from the hemocoel of decapod crustaceans involves several distinct kinds of cells. Proteins, and possibly viruses below 30 nm diameter, are known to be removed by the branchial podocytes, which are specialized pinocytotic nephrocytes located in the gills. These cells, and podocytes of the antennal gland (excretory organ) which may also be of importance in clearance, are similar to podocytes of Bowman's capsule of the vertebrate kidney. Phagocytic clearance of particulate material (with possible exception of the small viruses) is accomplished by three kinds of cells, one free and the other two fixed to tissues facing hemal spaces. The hemocytes, free cells suspended in the hemolymph, are the most abundant and generalized of these phagocytic cells. Phagocytic reserve cells are applied to myofibers in the heart of penaeid and palaemonid shrimp, and probably the same as reserve cells found throughout the hemocoel of all decapods. They are minimally involved in clearance of injected carbon and carmine, but are not known to phagocytize naturally occurring particles such as bacteria or viruses. The fixed phagocytes are very important in the clearance of some substances. They are located on the exterior surfaces of arterioles in hemal spaces of the hepatopancreas. They are highly specialized cells designed to sequester large amounts of various types of particulate matter, not only through phagocytosis but by trapping and retaining vast numbers of particles within a net- or sievelike layer of granular material which surrounds the free surface of the fixed phagocyte. Derivation, morphology, development, and function of the above cell types are described and discussed.

Angioarchitecture of the ciliary artery circulation of the posterior pole.

Morphologic findings on scanning electron microscopy of vascular cast of the posterior pole in primates are presented. The prelaminar region of the optic disc received the majority of its blood supply from the short posterior ciliary arteries, mainly from direct branches arising from peripapillary arterioles surrounding the optic nerve but also from indirect branches from the peripapillary choroid. The capillaries from this prelaminar region drained directly into the central retinal vein. The peripapillary choriocapillaris was a single layer of anastomosing capillaries supplied by precapillary choroidal arterioles. The peripapillary choriocapillaris was not seen to contribute to the vascular supply of the optic disc. Our results are in general agreement with those of previous scanning electron microscopy studies of the vascular supply of the distal part of the optic nerve.

Cytotoxic activity in broth-culture filtrates of Campylobacter pylori.

Broth-culture filtrates of Campylobacter pylori induced non-lethal cytopathic effects in vitro in 7 of 9 mammalian cell lines tested. Transmission electronmicroscopy revealed that the response consisted of intracellular vacuolisation. Intestine 407 cells were among the most responsive and were used for routine assay. About 55% of isolates of C. pylori tested, originating from four geographic regions worldwide, produced cytotoxic activity. The activity was neutralisable by specific antisera to broth-culture filtrates or to sonicated bacteria but not by antisera to other bacterial preparations. Cytotoxic activity was heat-labile (70 degrees C for 30 min), was protease-sensitive and ammonium-sulphate precipitable. It did not pass through an ultrafiltration membrane with a nominal mol.-wt limit of 100 X 10(3). It was concluded that C. pylori can produce a factor that alters cultured cells in vitro. The relevance of this factor to the pathogenesis of gastritis associated with C. pylori remains to be determined.

Vasovasostomy and vas occlusion: preliminary observations using artificial devices in guinea pigs.

Intravas devices designed to reverse a vasectomy or to occlude the vasa instead of transecting them were evaluated in guinea pigs. Absorbable intravas devices (AID) were inserted into the vasa at the time of vasovasostomy and produced a return of normal semen quality in 73% of the experimental animals as compared with only 40% in the control group. Seventy per cent of the AID group sired litters. In a second group of guinea pigs, vasectomy was replaced by the bilateral insertion of reversible intravas plugs (RIP) which occluded the lumina. After a period of azoospermia, the central, occlusive pins were removed from the devices. Sperm-positive animals were bred and three of five sired normal offspring. Histologic examination of the vasa revealed morphologic changes in some AID animals, these being attributed to the vasectomy procedure. A similar evaluation of the functional RIP insertion site revealed the desired occlusive tissue-device interfaces.

Schwann cell proliferations mimicking medullated retinal nerve fibers.

Ophthalmoscopically visible white patches in the optic nerve head and adjacent retina in a rhesus monkey histologically represented peripheral rather than central nervous myelin. This case of Schwann cell proliferations appearing as medullated retinal nerve fibers raises questions concerning the relationship of this phenomenon to developmental and acquired lesions of the optic nerve head in man.

Three-dimensional CT angiography of the thorax: clinical applications.

Spiral CT with three-dimensional (3D) display can provide a rapid noninvasive examination of the vascular system and has been shown to have a wide range of clinical applications in the thorax, including imaging of the aorta, pulmonary vasculature, and venous abnormalities. Three-dimensional images can provide views of the imaging volume from innumerable viewing angles for both the radiologist and referring clinician, and potentially obviate invasive procedures such as angiography. In this article, we will review many of these applications of spiral CT angiography with 3D displays. Emphasis is placed on study design, protocol selection, and display of pathology.

Clinical ocular findings in a colony of chinchillas (Chinchilla laniger).

Examination of 14 aged chinchillas revealed a shallow orbit, a rudimentary nictitating membrane, a large cornea, a densely pigmented iris with a vertical slit pupil, and an anangiotic fundus with variable vascularization of the optic disc. Mean intraocular pressure was 18.5 /+- 5.75 standard deviation mmHg. Bilateral posterior cortical cataracts and asteroid hyalosis were observed in 2 animals.

How I turned a critical public into useful consultants.

When Peter Johnson was an executive in the private sector, he viewed conflict with company outsiders as, at best, an annoyance. But when Johnson became the administrator of Bonneville Power Administration in Portland, Oregon, he realized that outsiders had the power to bring the organization down. To survive, BPA had to listen to the people affected by the agency's decisions-BPA's harshest critics. BPA had long been respected, but by the time Johnson arrived in 1981, the agency was reviled. People were put off by BPA's father-knows-best approach to decision making, whereby the agency first made decisions and then explained them. So Johnson took what many thought was an unimaginable risk. Despite the warnings of attorneys and his own deep apprehensions, he opened up BPA's decision making to the public. The first attempts to involve BPA's critics were full of fireworks, but thanks to BPA's rock-solid commitment to public involvement, success soon followed. Experiences early on proved to Johnson that involving the public in BPA's decision making was a practical alternative to litigation. Moreover, BPA's stakeholders--once the agency's adversaries--became BPA's partners in making better decisions, and the agency gained authority and legitimacy.

Biomphalaria straminea (Mollusca: Planorbidae) as an intermediate host of Ribeiroia sp. (Trematoda: Psilostomidae) in Brazil.

Species of Ribeiroia are trematode parasites of birds and mammals that have acquired notoriety since Ribeiroia ondatrae was identified as a cause of mortality and malformations in North American amphibians. Although species of Ribeiroia have been reported in vertebrate hosts in South America, the snails involved in its transmission remain unknown in Brazil. During malacological studies conducted at Pampulha Reservoir, Belo Horizonte, Minas Gerais, Brazil, between January 2009 and February 2012, in total 14,264 specimens of Biomphalaria straminea were collected, of which 192 (1.35%) were infected with gymnocephalous cercariae. The larvae were used for experimental infection of laboratory-reared guppies ( Poecilia reticulata ); metacercariae obtained in these fishes were orally administered to domestic ducks (Cairina moschata); and adult parasites were obtained from the proventriculus 10 days after infection. Based on morphological and molecular analyses, the parasite was identified as Ribeiroia sp., a species morphologically similar to R. ondatrae , but distinctly different at the molecular level. This is the first report of larvae of Ribeiroia in Brazil and B. straminea as a new intermediate host for this genus.