PREVALENCE AND RISK FACTORS OF ANAPLASMA INFECTIONS IN EASTERN MOOSE (ALCES ALCES AMERICANA) AND WINTER TICKS (DERMACENTOR ALBIPICTUS) IN MAINE, USA.

Eastern moose (Alces alces americana) are heavily parasitized by winter ticks (Dermacentor albipictus), the dominant cause of increased calf mortality in the northeastern US. Although much work has focused on the direct negative effects of winter tick on moose, it remains unknown whether diseases transmitted by ticks may also affect moose health or pose a risk to other species. We explored the role that moose and winter ticks play in transmission of the tick-borne bacterial pathogens, Anaplasma spp., which cause mild to severe illness in humans and domestic animals. Our objectives were to 1) estimate the prevalence of Anaplasma spp. in moose and winter ticks; 2) determine the phylogenetic placement of these strains with respect to those found in other hosts and vectors; and 3) explore risk factors of Anaplasma infection in moose. A total of 157 moose (142 calves, 15 adults) were captured in western (n=83) and northern (n=74) Maine in 2017 and 2018. We screened for Anaplasma spp. in moose whole blood samples using a genus-specific PCR assay targeting the 16S rRNA gene. Over half (54%) of the moose were infected with Anaplasma bacteria, with a greater proportion of moose harboring Anaplasma-infections in the western (67%) versus northern study areas (38%). Male moose exhibited a higher prevalence than did females (63% vs. 47%). In contrast, Anaplasma spp. prevalence in winter ticks was low (<1%). Sequencing and phylogenetic analysis revealed that the single Anaplasma strain in moose was highly divergent from the strain in winter ticks and most closely related to an uncharacterized North American cervid strain. We conclude that winter ticks are unlikely to play a significant role in Anaplasma transmission to moose; however, high infection prevalence warrants further investigation into the impacts of Anaplasma spp. infection on moose health.

Statewide Passive Surveillance of Ixodes scapularis and Associated Pathogens in Maine.

The blacklegged tick, Ixodes scapularis, is the primary vector of multiple human pathogens, including the causative agents of Lyme disease, anaplasmosis, and babesiosis. Both I. scapularis and its associated pathogens have expanded their geographic range throughout the northeastern Unites States and into northern New England. Through this study, we present an updated distribution of I. scapularis in Maine and report the first statewide passive surveillance infection and coinfection prevalence of Borrelia burgdorferi, Anaplasma phagocytophilum, and Babesia microti within the state's I. scapularis population. In 2019, we collected 2016 ticks through a passive surveillance program, in which Maine residents submitted tick samples for identification and/or pathogen testing. We used a single multiplex quantitative PCR assay to detect tickborne pathogens in 1901 tick samples. At the state level, we found that Bo. burgdorferi and A. phagocytophilum infection rates of adults (42.4%, 11.1%) were nearly double that of nymphs (26.9%, 6.7%), whereas B. microti prevalence was similar for both adults (6.5%) and nymphs (5.2%). Spatially, we found an uneven distribution of both tick activity and pathogen prevalence, with both increasing on a north to south gradient. We also noted a potential association between the ratio of adult to nymphal ticks and the incidence of tickborne disease in human populations, with counties that exhibit high rates of human disease also maintaining low adult to nymph ratios.

Echinococcus in wild canids in Québec (Canada) and Maine (USA).

Zoonotic Echinococcus spp. cestodes (E. canadensis and E. multilocularis) infect domestic animals, wildlife, and people in regions of Canada and the USA. We recovered and quantified Echinococcus spp. cestodes from 22 of 307 intestinal tracts of wild canids (23 wolves, 100 coyotes, 184 red and arctic foxes) in the state of Maine and the province of Québec. We identified the species and genotypes of three Echinococcus spp. cestodes per infected animal by sequencing mitochondrial DNA at two loci. We further confirmed the absence of E. multilocularis by extracting DNA from pools of all cestodes from each animal and running a duplex PCR capable of distinguishing the two species. We detected E. canadensis (G8 and G10), but not E. multilocularis, which is emerging as an important human and animal health concern in adjacent regions. Prevalence and median intensity of E. canadensis was higher in wolves (35%, 460) than coyotes (14%, 358). This parasite has historically been absent in Atlantic regions of North America, where suitable intermediate hosts, but not wolves, are present. Our study suggests that coyotes are serving as sylvatic definitive hosts for E. canadensis in Atlantic regions, and this may facilitate eastward range expansion of E. canadensis in the USA and Canada. As well, compared to wolves, coyotes are more likely to contaminate urban green spaces and peri-urban environments with zoonotic parasites.

Defibulation to treat female genital cutting: effect on symptoms and sexual function.

OBJECTIVE: Women who have undergone type III female genital cutting may suffer long-term complications. Defibulation (reconstructive surgery of the infibulated scar) can alleviate some of these complications. We studied the physical and sexual outcomes after defibulation and evaluated both patient and husband satisfaction. METHODS: The medical records of 40 consecutive women with a history of type III female genital cutting who underwent defibulation between 1995 and 2003 were reviewed. Data collected included demographics, indications for the procedure, closure type, intraoperative and postoperative complications. Telephone surveys were conducted between 6 months and 2 years postprocedure to evaluate the long-term health and sexual satisfaction outcomes. RESULTS: Of 40 women identified as having undergone defibulation, 95% were Somali, 65% were married, and 73% were between the ages of 19 and 30. Primary indications for defibulation were being pregnant (30%), dysmenorrhea (30%), apareunia (20%), and dyspareunia (15%). Secondary indications were apareunia (20%), difficulty urinating (12.5%), and dyspareunia (10%). Sixty-five percent had a subcuticular repair. Forty-eight percent had an intact clitoris buried beneath the scar. None had intraoperative or postoperative complications. Of the 32 patients reached by telephone, 94% stated they would highly recommend it to others. One hundred percent of patients and their husbands were satisfied with the results, felt their appearance had improved, and were sexually satisfied. CONCLUSION: Defibulation is recommended for all infibulated women who suffer long-term complications. The complication rates are minimal, with high satisfaction rates among patients and their husbands. LEVEL OF EVIDENCE: II-3.

Pulmonary Kaposi's sarcoma in pregnancy.

Kaposi's sarcoma in human immunodeficiency virus (HIV) -infected women, often misdiagnosed, has an aggressive clinical course, with high rates of visceral involvement and decreased survival. We describe the first case of isolated pulmonary Kaposi's sarcoma in pregnancy. A nulliparous woman was diagnosed with AIDS after presenting at 25 weeks gestation with a cough and multiple pulmonary nodules. Extensive pulmonary evaluation was nondiagnostic until thorascopic lung biopsy revealed Kaposi's sarcoma. Despite combination antiretroviral therapy, her malignancy progressed. Labor was induced at 33.5 weeks gestation for nonreassuring fetal testing. She received chemotherapy postpartum and remains in remission. Pulmonary Kaposi's sarcoma should be considered in the differential diagnosis of HIV-infected obstetric patients with respiratory compromise. Definitive diagnosis is necessary given the aggressive clinical course that is potentially responsive to therapy.

Fetal ovarian cysts: incidence, diagnosis and management.

Greater numbers of fetal ovarian cysts are being diagnosed due to improved antenatal imaging. These numbers correspond to data from autopsy studies showing approximately 30% of neonates to have ovarian cysts. Fetal ovarian cysts pose a risk of acute and long-term complications. These risks must be weighed against the probability of cyst regression. The de- The decision to cision to intervene must be based on cyst based on cyst size, ultracharacteristic sound characteristics and clinical symptoms. Treatment options include conservative management, antenatal or neonatal cyst aspiration, laparoscopic cystectomy and laparotomy. Diagnosis is important, given the possible complications and the current management options. Criteria for management have been established at several centers; however, a controversy over conservative versus surgical therapy remains.

Surgical resection of a large recurrent pelvic arteriovenous malformation using deep hypothermic circulatory arrest.

Transcatheter embolization has emerged as the treatment of choice for pelvic arteriovenous malformations (AVMs), because surgical resection may be difficult and is associated with a high recurrence rate. We report a patient with a large recurrent pelvic AVM in whom transcatheter embolization was not feasible. This patient underwent surgical resection of the AVM, which was accomplished with deep hypothermic circulatory arrest. Early postoperative angiography demonstrated a small amount of residual AVM, which was successfully embolized with microcoils. Follow-up magnetic resonance angiography at 2 months showed no residual AVM. In cases where surgical resection of an extensive AVM is required, deep hypothermic circulatory arrest offers the distinct advantages of performing the resection in a bloodless field and enabling adequate visualization of important adjacent structures.