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1.
Article in English | MEDLINE | ID: mdl-37510599

ABSTRACT

Young migrant women workers frequently experience disparities in accessing health services, including sexual and reproductive health (SRH) services, especially in urban settings. This study assesses the barriers and utilization of SRH services and explores factors associated with the utilization of these services among young female migrant workers working in the industrial zone (IZ) in Vietnam. A cross-sectional survey was conducted among 1061 young women migrant workers working in an IZ in Hanoi, Vietnam. Multivariable logistic regression analysis was used to identify factors associated with utilization of SRH services. Nearly 35% of the participants reported using SRH services at least once since working in the IZ. Additionally, around 78% of the participants reported using a contraceptive method during their last sexual encounter. The study also found that older participants (25-29 years old) were nearly two times more likely to use SRH services than younger participants (18-24 years old) (OR = 1.91, 95% CI: 1.19-3.06). Married participants had nearly six times higher odds of using SRH services compared to single participants (OR = 5.98, 95% CI: 3.71-9.63), and participants with higher incomes were more likely to use SRH services (OR = 1.02, 95% CI: 1.01-1.04). The most commonly reported barriers to access SRH services were inconvenient hours of service operation (26.2%), followed by long distance from the service location (9.2%) and high service cost (5.2%). This study found a low level of SRH service utilization and identified several barriers to accessing these services among the study participants. The study findings provide important evidence insights for policymakers and program managers to develop and implement policies that help reduce barriers and enhance the provision of SRH services tailored to the needs of IZ married and unmarried women migrant workers in the IZ in rapidly developing and urbanizing countries like Vietnam and other low- and middle-income countries with similar contexts.


Subject(s)
Reproductive Health Services , Transients and Migrants , Female , Humans , Adult , Adolescent , Young Adult , Vietnam , Cross-Sectional Studies , Reproductive Health , Sexual Behavior
2.
Exp Dermatol ; 32(4): 479-490, 2023 04.
Article in English | MEDLINE | ID: mdl-36562556

ABSTRACT

Due to its high metastatic potential, malignant melanoma is one of the deadliest skin cancers. In melanoma as well as in other cancers, acidification of the tumor microenvironment (=TME, inverse pH-gradient) is a well-known driver of tumor progression and metastasis. Membrane-bound receptors, such as the proton-sensitive GPCR (pH-GPCR) GPR4, are considered as potential initiators of the signalling cascades relevant to malignant transformation. In this study, we investigated the pH-dependent migration of GPR4 wildtype/overexpressing SK-Mel-28 cells using an impedance-based electrical wounding and migration assay and classical Boyden chamber experiments. Migration of GPR4 overexpressing SK-Mel-28 cells was enhanced in a range of pH 6.5-7.5 as compared to controls in the impedance-based electrical wounding and migration assay. In Boyden chamber experiments, GPR4 overexpression only increased migration at pH 7.5 in a Matrigel-free setup, but not at pH 6.5. Results indicate that GPR4 is involved in the migration of melanoma cells, especially in the tumor periphery, and that this process is affected by pH in the TME.


Subject(s)
Melanoma , Receptors, G-Protein-Coupled , Skin Neoplasms , Humans , Hydrogen-Ion Concentration , Melanoma/pathology , Receptors, G-Protein-Coupled/metabolism , Skin Neoplasms/pathology , Tumor Microenvironment , Cell Line, Tumor
3.
Vet Dermatol ; 33(6): 572-575, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36000585

ABSTRACT

BACKGROUND: Demodex gatoi is a contagious ectoparasite that causes pruritic dermatitis in otherwise healthy cats. The diagnosis of this mite can be difficult, and its prevalence is unknown. OBJECTIVES: The goal of this study was to identify the prevalence of D. gatoi in a population of cats with no known previous exposure to treatments using real-time PCR and superficial skin scrapings. ANIMALS: Fifty cats from shelters and 50 cats from feral populations of eastern Tennessee were included in this study. MATERIALS AND METHODS: To identify the presence of D. gatoi, superficial skin scrapings and plucked hairs were collected from multiple sites for microscopic and PCR evaluation, respectively. RESULTS: Ten of 100 cats were positive for D. gatoi. Nine cats had a positive PCR for D. gatoi with negative skin scrapings. One mite was identified on superficial skin scrapings from one cat, which was negative on PCR. Four of 50 feral cats (8%) were positive for D. gatoi. Of the shelter cats, four of 20 stray cats (20%) and two of 30 owner-surrendered cats (6.67%) were positive. Only one of 10 positive cats had skin lesions. CONCLUSIONS AND CLINICAL RELEVANCE: These findings demonstrate that asymptomatic cats represent a source of infection for D. gatoi to healthy cats. This mite should be considered a differential diagnosis in pruritic cats with a history of potential exposure. Additionally, skin scrapings appear to be insensitive; thus, multiple diagnostic tests, including PCR, should be performed to identify the presence of D. gatoi.


Subject(s)
Cat Diseases , Mite Infestations , Mites , Cats , Animals , United States , Mite Infestations/epidemiology , Mite Infestations/veterinary , Mite Infestations/diagnosis , Prevalence , Pruritus/veterinary , Real-Time Polymerase Chain Reaction/veterinary , Cat Diseases/diagnosis , Cat Diseases/epidemiology
4.
Vet Dermatol ; 33(3): 192-e54, 2022 Jun.
Article in English | MEDLINE | ID: mdl-34904763

ABSTRACT

BACKGROUND: Testing for hyperadrenocorticism is commonly pursued in adult dogs with dermatological disease, and adrenocortical suppression has been well-documented following the use of topical corticosteroids in otic preparations. An otic suspension that contains florfenicol, terbinafine and mometasone furoate, and lasts for 30 days after a single application, frequently is used to treat canine otitis externa (OE). This medication was shown to cause adrenocortical suppression on Day (D)2 postadministration and two weeks after two applications two weeks apart. HYPOTHESIS/OBJECTIVES: The objective of this study was to determine if topical florfenicol/terbinafine/mometasone furoate causes adrenocortical suppression in healthy, small-breed dogs with bilateral OE at D28 postapplication. ANIMAL: Seven client-owned dogs weighing <10 kg diagnosed with non-Pseudomonas bilateral OE. MATERIALS AND METHODS: Cortisol was measured pre- and post-adrenocorticotropic (ACTH) stimulation on D0. Topical florfenicol/terbinafine/mometasone furoate was applied in both ears. Dogs were reassessed on D28, and cortisol was measured pre- and post-ACTH stimulation. RESULTS: The median pre- and post-ACTH cortisol concentrations on D28 were 2.5 µg/dL (range 2.0-5.0 µg/dL) and 14.3 µg/dL (range 11.5-23.1 µg/dL), respectively. There was no significant difference (P = 0.85) between post-ACTH cortisol concentrations from D0 to D28. CONCLUSIONS AND CLINICAL RELEVANCE: Results demonstrated no evidence of adrenocortical suppression, suggesting that there is no need to delay adrenocortical function testing in dogs treated with topical florfenicol/terbinafine/mometasone furoate when applied as per the manufacturer's recommendations.


Subject(s)
Dog Diseases , Otitis Externa , Adrenocorticotropic Hormone , Animals , Dog Diseases/drug therapy , Dogs , Hydrocortisone , Mometasone Furoate/therapeutic use , Otitis Externa/drug therapy , Otitis Externa/veterinary , Terbinafine/therapeutic use , Thiamphenicol/analogs & derivatives
5.
Infect Control Hosp Epidemiol ; 43(8): 1058-1062, 2022 08.
Article in English | MEDLINE | ID: mdl-34075869

ABSTRACT

Healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection were interviewed to describe activities and practices in and outside the workplace. Among 2,625 healthcare personnel, workplace-related factors that may increase infection risk were more common among nursing-home personnel than hospital personnel, whereas selected factors outside the workplace were more common among hospital personnel.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Delivery of Health Care , Health Personnel , Humans , Personnel, Hospital , Skilled Nursing Facilities
6.
JAMA ; 325(13): 1286-1295, 2021 04 06.
Article in English | MEDLINE | ID: mdl-33821897

ABSTRACT

Importance: Controlling antimicrobial resistance in health care is a public health priority, although data describing antimicrobial use in US nursing homes are limited. Objective: To measure the prevalence of antimicrobial use and describe antimicrobial classes and common indications among nursing home residents. Design, Setting, and Participants: Cross-sectional, 1-day point-prevalence surveys of antimicrobial use performed between April 2017 and October 2017, last survey date October 31, 2017, and including 15 276 residents present on the survey date in 161 randomly selected nursing homes from selected counties of 10 Emerging Infections Program (EIP) states. EIP staff reviewed nursing home records to collect data on characteristics of residents and antimicrobials administered at the time of the survey. Nursing home characteristics were obtained from nursing home staff and the Nursing Home Compare website. Exposures: Residence in one of the participating nursing homes at the time of the survey. Main Outcomes and Measures: Prevalence of antimicrobial use per 100 residents, defined as the number of residents receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed residents. Multivariable logistic regression modeling of antimicrobial use and percentages of drugs within various classifications. Results: Among 15 276 nursing home residents included in the study (mean [SD] age, 77.6 [13.7] years; 9475 [62%] women), complete prevalence data were available for 96.8%. The overall antimicrobial use prevalence was 8.2 per 100 residents (95% CI, 7.8-8.8). Antimicrobial use was more prevalent in residents admitted to the nursing home within 30 days before the survey date (18.8 per 100 residents; 95% CI, 17.4-20.3), with central venous catheters (62.8 per 100 residents; 95% CI, 56.9-68.3) or with indwelling urinary catheters (19.1 per 100 residents; 95% CI, 16.4-22.0). Antimicrobials were most often used to treat active infections (77% [95% CI, 74.8%-79.2%]) and primarily for urinary tract infections (28.1% [95% CI, 15.5%-30.7%]). While 18.2% (95% CI, 16.1%-20.1%) were for medical prophylaxis, most often use was for the urinary tract (40.8% [95% CI, 34.8%-47.1%]). Fluoroquinolones were the most common antimicrobial class (12.9% [95% CI, 11.3%-14.8%]), and 33.1% (95% CI, 30.7%-35.6%) of antimicrobials used were broad-spectrum antibiotics. Conclusions and Relevance: In this cross-sectional survey of a cohort of US nursing homes in 2017, prevalence of antimicrobial use was 8.2 per 100 residents. This study provides information on the patterns of antimicrobial use among these nursing home residents.


Subject(s)
Anti-Infective Agents/therapeutic use , Antimicrobial Stewardship , Drug Utilization/statistics & numerical data , Nursing Homes/statistics & numerical data , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Cross-Sectional Studies , Female , Fluoroquinolones/therapeutic use , Humans , Logistic Models , Male , Middle Aged , Prescription Drug Overuse/statistics & numerical data , United States , Urinary Tract Infections/drug therapy
7.
Vet Dermatol ; 32(4): 371-e104, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33720445

ABSTRACT

BACKGROUND: In dogs with pituitary-dependent hypercortisolaemia, retinoic acid was shown to lower cortisol, reduce pituitary tumour size and decrease clinical signs when administered for six months. Oral vitamin A (retinol) has been used to treat various canine dermatoses in which retinoic acid has been efficacious. OBJECTIVES: To determine if orally administered vitamin A lowers cortisol and reduces clinical signs in dogs with pituitary-dependent hypercortisolaemia over a five month period. METHODS AND MATERIALS: Five dogs were enrolled in this study. Diagnosis of hypercortisolaemia was based on the presence of at least three clinical signs and one abnormal screening test. Diagnosis of pituitary-dependent disease was based on low dose dexamethasone suppression (LDDS) test results and symmetrical adrenal glands on ultrasound. Adrenocorticotropic hormone (ACTH) stimulation testing and adrenal ultrasound were performed at each visit. Plasma was collected at each visit and stored at -80°C for batch analysis of endogenous ACTH at conclusion of the study. RESULTS: Four dogs completed the study. A fifth dog died from complications of hypercortisolaemia before the third month. One dog showed improvement in clinical signs, yet there was no significant decrease in adrenal gland size or cortisol concentrations. Endogenous ACTH concentrations at the fifth month were decreased from baseline in two dogs and increased from baseline in one dog. The treatment had no adverse effects. CONCLUSIONS AND CLINICAL IMPORTANCE: Results from this study failed to show an improvement in clinical signs or cortisol concentration after five months of oral daily vitamin A in dogs with hypercortisolaemia.


Subject(s)
Adrenocortical Hyperfunction , Dog Diseases , Pituitary Diseases , Adrenocortical Hyperfunction/veterinary , Adrenocorticotropic Hormone , Animals , Dog Diseases/drug therapy , Dogs , Pituitary Diseases/veterinary , Vitamin A/therapeutic use
8.
Vet Dermatol ; 31(5): 385-e102, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32794342

ABSTRACT

BACKGROUND: Feline inflammatory aural polyps (IP) have been reported as solitary growths, yet bilateral polyps may occur more commonly than described previously. OBJECTIVES: To identify the prevalence and risk factors associated with bilateral feline IP within a population of cats evaluated at a veterinary teaching hospital over a 10 year period. ANIMALS: Twenty-five cats with histologically confirmed IP. METHODS AND MATERIALS: A retrospective study was performed by searching computerized medical records of cats seen at The University of Tennessee Veterinary Teaching Hospital from 2005 to 2015. Keywords used for the search included "feline polyp", "ventral bulla osteotomy", "inflammatory polyp ear canal" and "nasopharyngeal polyp". RESULTS: Cats were separated into groups with unilateral or bilateral disease. Six of 25 (24%) cats had bilateral IP. Twelve cats had computed tomography performed (four of six with bilateral IP; eight of 19 with unilateral IP). Clinical signs, history of upper respiratory infection, post-treatment complications, and IP recurrence with and without local and systemic steroid administration were studied between groups and no differences were identified. In four of six cats with bilateral disease, the second polyp was identified with advanced imaging performed at the time of referral. CONCLUSIONS AND CLINICAL IMPORTANCE: These findings demonstrate that bilateral IP occur more frequently than reported previously and establish a prevalence for bilateral IP. These findings also highlight the value of advanced imaging techniques in diagnosing bilateral IP.


Subject(s)
Cat Diseases , Polyps , Animals , Cat Diseases/diagnosis , Cat Diseases/epidemiology , Cats , Hospitals, Animal , Hospitals, Teaching , Inflammation/veterinary , Polyps/veterinary , Retrospective Studies
9.
Vet Microbiol ; 246: 108720, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32605759

ABSTRACT

Staphylococcus pseudintermedius is a major opportunistic bacterial pathogen and the leading cause of pyoderma in dogs. In canines it is also often associated with infections of the urinary system and wounds and occasionally infects people. Widespread antimicrobial resistance has made the development of alternative treatments a high priority. The development of a staphylococcal vaccine, however, has proven challenging. Identification of virulence factors that inhibit phagocytosis and avoid innate immunity may play a significant role in preventing or treating infection with S. pseudintermedius. In this study, we identified a putative 5'-nucleotidase provisionally named SpAdsA, a S. pseudintermedius cell- wall protein encoded by SpAdsA. SpAdsA shares approximately 52% identity with the orthologous protein of Staphylococcus aureus and 14.8% identity with that of Streptococcus suis type2. It catalyzes the dephosphorylation of adenosine triphosphate and attenuation of this enzyme with critical amino acid substitutions nearly eliminated its hydrolytic activity. Exogenous adenosine inhibited phagocytosis of S. pseudintermedius by canine neutrophils and monocytes. Conversely, the addition of SpAdsA inhibitor or A2A adenosine receptor antagonist impaired the capacity of S. pseudintermedius to escape from killing by phagocytic cells. The neutralizing ability of canine antibody produced against SpAdsA-M was determined. Taken together, these results suggest that SpAdsA likely plays an important role in S. pseudintermedius virulence and that attenuated SpAdsA may be a good candidate for inclusion in a vaccine against S. pseudintermedius.


Subject(s)
5'-Nucleotidase/immunology , Phagocytes/microbiology , Phagocytosis , Staphylococcus/enzymology , 5'-Nucleotidase/genetics , Adenosine/pharmacology , Adenosine Triphosphate/metabolism , Animals , Bacterial Proteins/genetics , Bacterial Proteins/immunology , Cell Wall/chemistry , Dogs , Phagocytes/immunology , Phosphorylation , Staphylococcus/genetics , Virulence Factors
10.
JAMA Netw Open ; 3(7): e206004, 2020 07 01.
Article in English | MEDLINE | ID: mdl-32633762

ABSTRACT

Importance: Current information on the characteristics of patients who develop sepsis may help in identifying opportunities to improve outcomes. Most recent studies of sepsis epidemiology have focused on changes in incidence or have used administrative data sets that provided limited patient-level data. Objective: To describe sepsis epidemiology in adults. Design, Setting, and Participants: This retrospective cohort study reviewed the medical records, death certificates, and hospital discharge data of adult patients with sepsis or septic shock who were discharged from the hospital between October 1, 2014, and September 30, 2015. The convenience sample was obtained from hospitals in the Centers for Disease Control and Prevention Emerging Infections Program in 10 states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee). Patients 18 years and older with discharge diagnosis codes for severe sepsis or septic shock were randomly selected. Data were analyzed between May 1, 2018, and January 31, 2019. Main Outcomes and Measures: The population's demographic characteristics, health care exposures, and sepsis-associated infections and pathogens were described, and risk factors for death within 30 days after sepsis diagnosis were assessed. Results: Among 1078 adult patients with sepsis (569 men [52.8%]; median age, 64 years [interquartile range, 53-75 years]), 973 patients (90.3%) were classified as having community-onset sepsis (ie, sepsis diagnosed within 3 days of hospital admission). In total, 654 patients (60.7%) had health care exposures before their hospital admission for sepsis; 260 patients (24.1%) had outpatient encounters in the 7 days before admission, and 447 patients (41.5%) received medical treatment, including antimicrobial drugs, chemotherapy, wound care, dialysis, or surgery, in the 30 days before admission. A pathogen associated with sepsis was found in 613 patients (56.9%); the most common pathogens identified were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and Clostridioides difficile. After controlling for other factors, an association was found between underlying comorbidities, such as cirrhosis (odds ratio, 3.59; 95% CI, 2.03-6.32), immunosuppression (odds ratio, 2.52; 95% CI, 1.81-3.52), vascular disease (odds ratio, 1.54; 95% CI, 1.10-2.15), and 30-day mortality. Conclusions and Relevance: Most adults experienced sepsis onset outside of the hospital and had recent encounters with the health care system. A sepsis-associated pathogen was identified in more than half of patients. Future efforts to improve sepsis outcomes may benefit from examination of health maintenance practices and recent health care exposures as potential opportunities among high-risk patients.


Subject(s)
Cross Infection , Hospitalization/statistics & numerical data , Sepsis , Shock, Septic , Causality , Cohort Studies , Cross Infection/epidemiology , Cross Infection/therapy , Environmental Exposure/analysis , Environmental Exposure/statistics & numerical data , Female , Hospital Mortality , Humans , Incidence , Male , Middle Aged , Outcome and Process Assessment, Health Care , Risk Factors , Sepsis/mortality , Sepsis/therapy , Shock, Septic/mortality , Shock, Septic/therapy , United States/epidemiology
11.
Infect Control Hosp Epidemiol ; 41(7): 848-850, 2020 07.
Article in English | MEDLINE | ID: mdl-32340639

ABSTRACT

Acute change in mental status (ACMS), defined by the Confusion Assessment Method, is used to identify infections in nursing home residents. A medical record review revealed that none of 15,276 residents had an ACMS documented. Using the revised McGeer criteria with a possible ACMS definition, we identified 296 residents and 21 additional infections. The use of a possible ACMS definition should be considered for retrospective nursing home infection surveillance.


Subject(s)
Infections/diagnosis , Mental Disorders/diagnosis , Nursing Care , Nursing Homes , Documentation , Humans , Infections/complications , Mental Disorders/etiology , Retrospective Studies
13.
J Am Med Dir Assoc ; 21(1): 91-96, 2020 01.
Article in English | MEDLINE | ID: mdl-31822391

ABSTRACT

OBJECTIVES: Describe antibiotic use for urinary tract infection (UTI) among a large cohort of US nursing home residents. DESIGN: Analysis of data from a multistate, 1-day point prevalence survey of antimicrobial use performed between April and October 2017. SETTING AND PARTICIPANTS: Residents of 161 nursing homes in 10 US states of the Emerging Infections Program (EIP). METHODS: EIP staff reviewed nursing home medical records to collect data on systemic antimicrobial drugs received by residents, including therapeutic site, rationale for use, and planned duration. For drugs with the therapeutic site documented as urinary tract, pooled mean and nursing home-specific prevalence rates were calculated per 100 nursing home residents, and proportion of drugs by selected characteristics were reported. Data were analyzed in SAS, version 9.4. RESULTS: Among 15,276 residents, 407 received 424 antibiotics for UTI. The pooled mean prevalence rate of antibiotic use for UTI was 2.66 per 100 residents; nursing home-specific rates ranged from 0 to 13.6. One-quarter of antibiotics were prescribed for UTI prophylaxis, with a median planned duration of 111 days compared with 7 days when prescribed for UTI treatment (P < .001). Fluoroquinolones were the most common (18%) drug class used. CONCLUSIONS AND IMPLICATIONS: One in 38 residents was receiving an antibiotic for UTI on a given day, and nursing home-specific prevalence rates varied by more than 10-fold. UTI prophylaxis was common with a long planned duration, despite limited evidence to support this practice among older persons in nursing homes. The planned duration was ≥7 days for half of antibiotics prescribed for treatment of a UTI. Fluoroquinolones were the most commonly used antibiotics, despite their association with significant adverse events, particularly in a frail and older adult population. These findings help to identify priority practices for nursing home antibiotic stewardship.


Subject(s)
Antimicrobial Stewardship , Urinary Tract Infections , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Homes for the Aged , Humans , Nursing Homes , Urinary Tract Infections/drug therapy , Urinary Tract Infections/epidemiology
14.
PLoS One ; 14(7): e0220301, 2019.
Article in English | MEDLINE | ID: mdl-31356636

ABSTRACT

Staphylococci have evolved numerous strategies to evade their hosts' immune systems. Some staphylococcal toxins target essential components of host innate immunity, one of the two main branches of the immune system. Analysis of the Staphylococcus pseudintermedius secretome using liquid chromatography mass spectrometry guided by genomic data, was used to identify an S. pseudintermedius exotoxin provisionally named SpEX. This exoprotein has low overall amino acid identity with the Staphylococcus aureus group of proteins named staphylococcal superantigen like proteins (SSLs) and staphylococcal enterotoxin- like toxin X (SEIX), but predictive modeling showed that it shares similar folds and domain architecture to these important virulence factors. In this study, we found SpEX binds to complement component C5, prevents complement mediated lysis of sensitized bovine red blood cells, kills polymorphonuclear leukocytes and monocytes and inhibits neutrophil migration at sub-lethal concentrations. A mutant version of SpEX, produced through amino acid substitution at selected positions, had diminished cytotoxicity. Anti-SpEX produced in dogs reduced the inhibitory effect of native SpEX on canine neutrophil migration and protected immune cells from the toxic effects of the native recombinant protein. These results suggest that SpEX likely plays an important role in S. pseudintermedius virulence and that attenuated SpEX may be an important candidate for inclusion in a vaccine against S. pseudintermedius infections.


Subject(s)
Cloning, Molecular/methods , Exotoxins/genetics , Exotoxins/metabolism , Staphylococcus/pathogenicity , Amino Acid Substitution , Animals , Bacterial Toxins/genetics , Bacterial Toxins/metabolism , Cattle , Chromatography, Liquid , Complement C5/metabolism , Dogs , Exotoxins/chemistry , Exotoxins/toxicity , Mass Spectrometry , Models, Molecular , Protein Domains , Staphylococcus/genetics , Staphylococcus/metabolism
15.
Am J Infect Control ; 47(7): 780-785, 2019 07.
Article in English | MEDLINE | ID: mdl-30723028

ABSTRACT

BACKGROUND: Clostridium difficile infection (CDI) is a leading cause of hospital-associated infections. Antibiotic stewardship, environmental disinfection, and reduction of transmission via health care workers are the major modes of CDI prevention within hospitals. METHODS: The aim of this study was to evaluate the role of the environment in the spread of CDI within hospital rooms. Bed tracing of positive-CDI inpatients was performed to detect the strength of association to specific rooms. Environmental cultures were conducted to identify adequacy of environmental C difficile (CD) spores. Whole-genome sequencing was performed to evaluate the degree of CD relatedness. RESULTS: Bed tracing performed for 211 CDI patients showed a limited list of high-burden rooms. Environmental cultures for surfaces disinfected with a sporicidal agent were almost entirely negative, whereas the floors were positive for CDI in 15% of the studied patient rooms. Whole-genome sequencing did not detect any close genetic relatedness. CONCLUSIONS: Unlike in an outbreak setting, bed tracing did not yield conclusive results of room reservoirs. The C diff Banana Broth culture was inexpensive, sensitive, and easy to incubate under aerobic conditions. Sporicidal disinfectants were effective in eliminating CD from the environment. CD spores were found on floors and hard-to-clean surfaces.


Subject(s)
Antimicrobial Stewardship/methods , Clostridioides difficile/isolation & purification , Clostridium Infections/epidemiology , Cross Infection/epidemiology , Disease Reservoirs/microbiology , Aged , Bacterial Typing Techniques , Clostridioides difficile/classification , Clostridioides difficile/drug effects , Clostridioides difficile/genetics , Clostridium Infections/ethnology , Clostridium Infections/microbiology , Community-Acquired Infections , Contact Tracing/statistics & numerical data , Cross Infection/ethnology , Cross Infection/microbiology , Disinfectants/pharmacology , Female , Genome, Bacterial , Hospitals , Humans , Male , Middle Aged , Patients' Rooms , Pennsylvania/epidemiology , Spores, Bacterial/drug effects , Spores, Bacterial/isolation & purification , Whole Genome Sequencing
16.
Vet Dermatol ; 30(1): 36-e10, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30556622

ABSTRACT

BACKGROUND: Schipperkes develop bilaterally symmetrical alopecia preceded by lightening of the hair coat not associated with systemic clinical signs. The alopecia is presumptively diagnosed as Alopecia X but has never been investigated. HYPOTHESIS/OBJECTIVES: The purpose of this study was to describe clinical features, histopathological and laboratory abnormalities associated with symmetrical, noninflammatory alopecia in schipperkes. ANIMALS: Three healthy and eight affected schipperkes. METHODS AND MATERIALS: Complete blood count (CBC), serum chemistry panel, urinalysis (UA), urine cortisol: creatinine ratio (UCCR), total thyroxine (T4 ), free thyroxine by equilibrium dialysis (fT4 ed), thyroid stimulating hormone (TSH) and pre- and post-stimulation cortisol with sex hormone analyses were performed for all dogs. A minimum of two skin biopsy sites were sampled for histopathological evaluation. RESULTS: The CBC, serum chemistry panel, UA, T4 , fT4 ed, TSH and post-ACTH cortisol concentrations were normal for all dogs. Androstenedione concentrations were increased for all dogs; two of three healthy and five of eight affected dogs had increased post-ACTH androstenedione concentrations. Estradiol concentrations were increased for all healthy and four of eight affected dogs, with post-ACTH estradiol concentrations increased for all healthy and five of eight affected dogs. Progesterone concentrations were increased for two of three healthy and four of eight affected dogs. Post-ACTH progesterone concentrations were increased for one of three healthy and four of eight affected dogs. For one of three healthy and two of eight affected dogs, 17-hydroxyprogesterone concentrations were increased; post-ACTH 17-hydroxyprogesterone concentrations were increased in three of eight affected dogs only. Histopathology results from affected dogs were consistent with hair cycle arrest. CONCLUSIONS AND CLINICAL IMPORTANCE: This disorder resembles Alopecia X clinically and histologically.


Subject(s)
Animal Fur/pathology , Dog Diseases/pathology , Hair Diseases/veterinary , Adrenocorticotropic Hormone/blood , Alopecia/pathology , Alopecia/veterinary , Animals , Creatinine/urine , Dogs , Female , Hair Diseases/pathology , Hydrocortisone/urine , Male , Skin/pathology , Thyroid Hormones/blood
17.
PLoS One ; 13(9): e0204450, 2018.
Article in English | MEDLINE | ID: mdl-30261001

ABSTRACT

Bacterial infections from Staphylococcus pseudintermedius are the most common cause of skin infections (pyoderma) affecting dogs. Two component pore-forming leukocidins are a family of potent toxins secreted by staphylococci and consist of S (slow) and F (fast) components. They impair the innate immune system, the first line of defense against these pathogens. Seven different leukocidins have been characterized in Staphylococcus aureus, some of which are host and cell specific. Through genome sequencing and analysis of the S. pseudintermedius secretome using liquid chromatography mass spectrometry we identified two proteins, named "LukS-I" and "LukF-I", encoded on a degenerate prophage contained in the genome of S. pseudintermedius isolates. Phylogenetic analysis of LukS-I components in comparison to the rest of the leukocidin family showed that LukS-I was most closely related to S. intermedius LukS-I, S. aureus LukE and LukP, whereas LukF-I was most similar to S. intermedius LukF-I S. aureus gamma hemolysin subunit B. The killing effect of recombinant S. pseudintermedius LukS-I and LukF-I on canine polymorphonuclear leukocytes was determined using a flow cytometry cell permeability assay. The cytotoxic effect occurred only when the two recombinant proteins were combined. Engineered mutant versions of the two-component pore-forming leukocidins, produced through amino acids substitutions at selected points, were not cytotoxic. Anti-Luk-I produced in dogs against attenuated proteins reduced the cytotoxic effect of native canine leukotoxin which highlights the importance of Luk-I as a promising component in a vaccine against canine S. pseudintermedius infections.


Subject(s)
Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Leukocidins , Staphylococcus/genetics , Staphylococcus/metabolism , Amino Acid Sequence , Animals , Antibodies, Bacterial/immunology , Antibodies, Bacterial/metabolism , Bacterial Proteins/chemistry , Cell Death , Dog Diseases/immunology , Dogs , Escherichia coli , Exotoxins/genetics , Exotoxins/metabolism , Genome, Bacterial , Leukocidins/chemistry , Leukocidins/genetics , Leukocidins/immunology , Leukocidins/metabolism , Leukocytes/metabolism , Leukocytes/microbiology , Mutation , Phylogeny , Recombinant Proteins/metabolism , Staphylococcal Infections/immunology , Staphylococcal Infections/veterinary , Staphylococcus/immunology
18.
Vet Dermatol ; 29(5): 435-e144, 2018 Oct.
Article in English | MEDLINE | ID: mdl-29926986

ABSTRACT

BACKGROUND: Dermatophilus congolensis is a facultative anaerobic actinomycete that causes papular to exudative dermatitis with crusting in horses. This organism is frequently implicated as a cause of pastern dermatitis, but few data are available validating the organism's association with this disease. HYPOTHESIS/OBJECTIVES: The aim of this study was to evaluate if D. congolensis is associated with pastern dermatitis in horses utilizing RT-qPCR. ANIMALS: Fifteen client-owned horses diagnosed with pastern dermatitis and eight client-owned unaffected control horses were utilized for this study. METHODS: A cross-sectional study was performed. History and physical examination findings were recorded, and samples were collected and tested for D. congolensis utilizing cytological evaluation and RT-qPCR. Dermatophyte culture and superficial skin scrapings were also performed. RESULTS: Ten of 15 horses with pastern dermatitis had feathered pasterns. Dermatophilus congolensis was identified by RT-qPCR from one nonfeathered horse but none with feathered pasterns. Cytological evaluation identified bacteria in all horses but failed to identify organisms resembling D. congolensis in any horse. Four of 15 horses, all feathered, were positive for Chorioptes mites. Fungal culture was negative for dermatophytes in all horses. All test results were negative for the eight control horses. CONCLUSIONS AND CLINICAL IMPORTANCE: Dermatophilus congolensis was uncommonly associated with pastern dermatitis in horses in this population. However, chorioptic mange was commonly associated with pastern dermatitis in feathered horses and represented an important differential diagnosis for this clinical presentation.


Subject(s)
Actinobacteria , Dermatitis/veterinary , Gram-Positive Bacterial Infections/veterinary , Horse Diseases/epidemiology , Real-Time Polymerase Chain Reaction/veterinary , Animals , Dermatitis/diagnosis , Dermatitis/epidemiology , Dermatitis/microbiology , Female , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Horse Diseases/diagnosis , Horse Diseases/microbiology , Horses , Male , Prevalence , Real-Time Polymerase Chain Reaction/methods , Skin/microbiology , Skin/pathology , Tennessee/epidemiology
19.
Vet Dermatol ; 2018 Apr 24.
Article in English | MEDLINE | ID: mdl-29691933

ABSTRACT

BACKGROUND: Cutaneous adverse food reaction (CAFR) is diagnosed by performing an elimination diet trial utilizing prescription or home-cooked diets followed by provocative challenge. OBJECTIVES: To report findings of PCR analysis of a prescription vegetarian diet (RCV) for undeclared proteins of animal origin, as well as to describe its utilization for diagnosis and management of dogs suspected of having CAFR. ANIMALS: Three client-owned dogs. METHODS: PCR analysis of RCV for 11 mammalian species and poultry. In three dogs, clinical examination, cytology, aerobic culture (if indicated) and at least one elimination diet trial with RCV. RESULTS: In our case series, all dogs had a history of pruritus and recurrent pyoderma that resolved with infection control and an elimination diet trial. In cases 1 and 2, a diagnosis of CAFR was made following an elimination trial with RCV and provocative challenge. Case 3 had a previously confirmed diagnosis of CAFR and RCV was successfully used to maintain remission of CAFR-related signs. PCR testing of RCV was negative for 11 mammalian species and poultry. CONCLUSIONS AND CLINICAL IMPORTANCE: The RCV diet was found not to contain any undeclared mammalian or avian proteins. In this case series, the RCV was successfully used to diagnose and maintain three dogs with CAFR.

20.
Vet Pathol ; 55(5): 731-735, 2018 09.
Article in English | MEDLINE | ID: mdl-29661122

ABSTRACT

A striking form of lymphocytic mural folliculitis is described in 6 tigers ( Panthera tigris). Clinically, all tigers exhibited regionally extensive chronic, variably waxing and waning alopecia with minimal scaling and crusting most pronounced over the head, neck, and shoulders. More severely affected tigers exhibited marked hyperpigmentation and lichenification. Pruritus was not a feature. Tigers generally lacked signs of systemic illness and clinical pathology findings were unremarkable. Histologic examination of skin biopsies revealed infiltrative lymphocytic mural folliculitis extending the length of the hair follicle. Mild epidermal lymphocytic infiltrates were frequent. The surrounding dermis was histologically unremarkable in 4 of 6 tigers or associated with mild perifollicular and periadnexal mixed inflammation in 2 of 6 tigers. The cause of the mural folliculitis was not identified, and tigers responded poorly to immunomodulatory therapy. Lymphocytic mural folliculitis might be a nonspecific hypersensitivity reaction pattern in tigers, and care should be taken to differentiate this reaction pattern from epitheliotropic T-cell lymphoma.


Subject(s)
Folliculitis/veterinary , Lymphoma/veterinary , Tigers , Animals , Diagnosis, Differential , Folliculitis/diagnosis , Folliculitis/pathology , Lymphocytes/pathology , Lymphoma/diagnosis , Lymphoma/pathology , Skin/pathology
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