ABSTRACT
Nocardiosis, a rare infectious disease in dogs and cats, is caused by Gram-positive aerobic actinomycetes of the genus Nocardia. A one-year-old castrated male Great Dane was presented with clinical signs of an ulcerated nodule on the right ear, which was observed after two weeks of treatment with cyclosporine and prednisolone due to idiopathic hepatitis. Cytological examination revealed pyogranulomatous inflammatory cells and blanched filamentous rods. To detect infectious agents, serosanguinous discharge of the nodule was subjected to bacterial and fungal cultures. For phenotyping of the infectious agents, colonies on blood agar culture plates were further analyzed by matrix-assisted laser desorption ionization (MALDI)-time-of-flight (TOF) mass spectrometry (VITEK MS). The MALDI-TOF spectra were identified as N. africana. Thus, the present case was diagnosed as cutaneous nocardiosis. The skin lesions of ulcerated nodules with fistulous tracts were gradually resolved by the administration of meropenem (8 mg/kg TID, IV) and doxycycline (5 mg/kg BID, PO). Although complete resolution of the skin lesions was observed on day 91 after the initial presentation, single administration of doxycycline was continued until day 198 after the initial presentation to prevent recurrence. To the best of our knowledge, this is the first report of Nocardia africana infection in a dog. In addition, our results show that MALDI-TOF mass spectrometry analysis could be a useful tool for the detection of Nocardia. spps.
ABSTRACT
BACKGROUND: Continuous veno-venous hemodiafiltration (CVVHDF) is a preferred treatment modality in hemodynamically unstable acute kidney injury (AKI) patients, because it has advantages over intermittent dialysis in terms of hemodynamic stability. However, this patient group still shows a significantly high mortality rate. To aid in the management of these high-risk patients, we evaluated the risk factors for mortality in CVVHDF-treated hypotensive AKI patients. METHODS: We studied 67 patients with AKI and hypotension who were treated with CVVHDF from February 2008 to August 2010. We reviewed patient characteristics and laboratory parameters to evaluate the risk factors for 90-day mortality. RESULTS: Of the 67 enrolled patients (male:female=42:25; mean age=69±14 years), 18 (27%) survived until 90 days after the initiation of CVVHDF. There was no significant difference in survival rates according to the etiology of AKI [hypovolemic shock 2/10 (20%), cardiogenic shock 4/20 (20%), septic shock 12/37 (32%)]. Univariate analysis did show significant differences between survivors and non-survivors in the frequency of ventilator use (44% vs. 76%, respectively; P=0.02), APACHE II score (29±7 vs. 34±7, respectively; P=0.01), SOFA score (11±4 vs. 13±4, respectively; P=0.03), blood pH (7.3±0.1 vs. 7.2±0.1, respectively; P=0.03), and rate of urine output <500 mL for 12 hours (50% vs. 80%, respectively; P=0.03). A multivariate Cox proportional hazards model showed that a urine output<500 mL for 12 hours was the only significant risk factor for 90-day mortality following CVVHDF treatment (odds ratio=2.1, confidence interval=1.01-4.4, P=0.048). CONCLUSION: A urine output<500 mL for 12 hours before the initiation of CVVHDF is an independent risk factor for 90-day mortality in hypotensive AKI patients treated with CVVHDF.
ABSTRACT
A total of 74 Staphylococcus pseudintermedius strains were isolated from the 99 clinical cases of canine pyoderma or chronic otitis in our veterinary teaching hospital during May 2006-February 2008. In this study, we examined the genetic distribution of staphylococcal pyogenic toxins such as staphylococcal enterotoxins A (sea), B (seb), C (sec), D (sed), E (see), and toxic shock syndrome toxin 1 (tst) as well as the previously characterized S. intermedius exfoliative toxin (siet) among those isolates. The polymerase chain reaction analyses with the toxin gene-specific primers revealed that 18 (24.3%) of 74 S. pseudintermedius isolates carried the sec genes, but none of the sea, seb, sed, see and tst genes. Further DNA sequencing analysis of the amplified sec genes revealed that they all belonged to the canine type C staphylococcal enterotoxin (SEC(canine) ) whose superantigenic activity has been demonstrated. In addition to the sec(canine) genes, our polymerase chain reaction results showed that all the 74 isolates carried the siet gene. Since both SEC(canine) and SIET toxins are known to be biologically active, it would be interesting to investigate how those toxins are involved in the pathogenesis of the canine diseases by S. pseudintermedius such as pyoderma or chronic otitis.
