Central sensitization, chronic pain, and other symptoms: Better understanding, better management.

Central sensitization, a pathophysiologic process in which the central nervous system undergoes changes that alter its processing of pain and other sensory stimuli, may be the mechanism underlying various conditions in which patients have unexplained pain and fatigue. Patients frequently misunderstand the cause of their symptoms and pursue unnecessary evaluations and treatments. Clinicians have a pivotal role in decreasing this misunderstanding by providing patient education, which can affect perception, management, functional status, and quality of life.

Multi-host dispersal of known and novel carnivore amdoparvoviruses.

Amdoparvoviruses (family Parvoviridae) are ssDNA viruses that cause an immune complex-mediated wasting syndrome in carnivores. They are multi-host pathogens and cross-species infection is facilitated by the fact that viral entry is mediated by cellular Fc receptors recognizing antibody-coated viruses. We developed a pan-amdoparvovirus PCR and screened tissue samples from 666 wild carnivores (families Felidae, Canidae, and Mustelidae) from Newfoundland or Labrador (Canada) and molecularly characterized the identified strains. Fifty-four out of 666 (8.1%) animals were amdoparvovirus-positive. Infection rate was the highest in American mink (34/47, 72.3%), followed by foxes (Arctic and red foxes, 13/311, 4.2%), lynx (2/58, 3.5%), and American martens (5/156, 3.4%). No virus was detected in samples from 87 coyotes and 17 ermines. Viruses from Newfoundland were classified as Aleutian mink disease virus (AMDV). Mink harvested near AMDV-affected fur farms had higher prevalence (24/24, 100%) than other mink (10/23, 43.5%; P < 0.001) and their viruses were phylogenetically closely related to those from farms, while most viruses from other mink were in other clades. Strains from three foxes and two lynx were highly related to mink strains. This proves that farms disperse AMDV that subsequently spreads among wild mink (maintenance host) and transmits to other spillover carnivore hosts. In Labrador two novel viruses were identified, Labrador amdoparvovirus 1 (LaAV-1) found in foxes (9/261, 3.5%) and martens (5/156, 3.4%), and LaAV-2 found in one fox (0.4%). LaAV-1 fulfills all requirements to be classified as a novel species. LaAV-1 was most similar to viruses of mink and skunks (AMDV and skunk amdoparvovirus (SKAV)) while LaAV-2 was more closely related to other viruses infecting canids. LaAV-1 capsid proteins were almost indistinguishable from those of AMDV in some regions, suggesting that LaAV-1 could be a virus of mustelids that can infect foxes. While intensive farming practices provide occasions for inter-species transmission in farms, niche overlap or predation could explain cross-species transmission in the wild, but competition among sympatric species reduces the chances of direct contacts, making this an infrequent event. Pan-amdoparvovirus detection methods in wide epidemiological investigations can play a crucial role in defining amdoparvoviral ecology and evolution and discovering novel viruses.

Epidemiology and molecular characterization of protoparvoviruses infecting wild raccoons (Procyon lotor) in British Columbia, Canada.

Feline panleukopenia virus (FPV) and canine parvovirus 2 (CPV-2) belong to the species Carnivore protoparvovirus 1. While FPV has been endemic in cats for many years, CPV-2 emerged at the end of the 1970s and 3 antigenic variants (CPV-2a, b and c) are currently circulating in domestic and wild animals. Although raccoons played a fundamental role in the emergence of CPV-2a in dogs, knowledge about protoparvoviruses in these animals is still limited. We investigated 72 raccoons found dead or injured in southern British Columbia (BC), Canada, between 2009 and 2017. Among the 49 protoparvovirus-positive (66%) animals, 39 (80%) exhibited enteritis. Approximately 21% were FPV-positive and these were from Vancouver Island, while 79% were CPV-positive and found on the BC mainland, suggesting geographic separation of strains. Notably, one CPV-positive individual was FPV-vaccinated. The co-circulation of multiple FPV strains was observed, while the CPV-2 strain were all classified as CPV-2a, located in one unique clade, and likely originated from a single introduction. All BC CPV-2 sequences possessed a VP2-305His and therefore could represent one of the intermediate viruses that facilitated the emergence of CPV-2a in dogs. Like other raccoon viruses, all BC CPV-2 sequences possessed a VP2-300Asp but, differently, possessed a VP2-301Ala. Finally, two unique amino acid substitutions were identified in the NS1 of FPV (His554Gln and Gly573Cys). To our knowledge, this is the first molecular characterization of protoparvoviruses in wildlife from this region of North America and more studies are needed to elucidate the distribution of these viruses in wildlife outside the USA.