A Functional Return-to-Play Progression After Exertional Heat Stroke in a High School Football Player.

OBJECTIVE: To present a functional return-to-play (RTP) progression after exertional heat stroke (EHS) in a 17-year-old high school football defensive end (height = 185 cm, mass = 145.5 kg). BACKGROUND: The patient had no pertinent medical history but moved to a warm climate several days before the EHS occurred. After completing an off-season conditioning test (14- × 110-yd [12.6- × 99.0-m] sprints) on a warm afternoon (temperature = approximately 34°C [93°F], relative humidity = 53%), the patient collapsed. An athletic trainer (AT) was called to the field, where he found the patient conscious but exhibiting central nervous system dysfunction. Emergency medical services were summoned and immediately transported the patient to the hospital. DIFFERENTIAL DIAGNOSIS: Exertional heat stroke, heat exhaustion, exertional sickling, rhabdomyolysis, and cardiac arrhythmia. TREATMENT: The patient was immediately transported to a hospital, where his oral temperature was 39.6°C (103.3°F). He was transferred to a children's hospital and treated for rhabdomyolysis, transaminitis, and renal failure. He was hospitalized for 11 days. After a physician's clearance once the laboratory results normalized, an RTP progression was completed. The protocol began with light activity and progressed over 3 weeks to full football practice. During activity, an AT monitored the patient's gastrointestinal temperature, heart rate, rating of perceived exertion, fluid consumption, and sweat losses. UNIQUENESS: Documentation of RTP guidelines for young athletes is lacking. We used a protocol intended for the football setting to ensure the athlete was heat tolerant, had adequate physical fitness, and could safely RTP. Despite his EHS, he recovered fully, with no lasting effects, and successfully returned to compete in the final 5 games of the season. CONCLUSIONS: Using a gradual RTP progression and close monitoring, a high school defensive end successfully returned to football practice and games after EHS. This case demonstrates the feasibility of implementing a safe RTP protocol after EHS and may serve as a guide to ATs working in the high school setting. This case also highlights the need for more research in this area.

Humoral immunity and injection-site reactions in cattle vaccinated with a multivalent clostridial vaccine administered via subcutaneous injection or via transdermal needle-free injection.

OBJECTIVE: To evaluate injection-site reactions and serum antibody titers in cattle vaccinated with a clostridial vaccine administered SC or via needle-free transdermal injection. ANIMALS: Sixteen 11-to 12-month-old Herefords. PROCEDURES: Cattle in 2 groups were vaccinated on days 0 and 28 with a commercially available multivalent clostridial vaccine administered SC or transdermally Injection sites and serum antibody titers were evaluated at several time points after vaccination. Serum antibody titers against Clostridium perfringens beta toxin, Clostridium novyi alpha toxin, and Clostridium septicum alpha toxin were determined with an ELISA; Clostridium sordellii lethal toxin titers were determined with a toxin neutralization assay. RESULTS: Firm injection site swellings developed in cattle vaccinated via either route; however, at several observation times, swellings were significantly smaller in cattle vaccinated transdermally. Serum titers against C perfringens beta toxin and C septicum alpha toxin did not differ significantly between groups after vaccination; serum titers against C novyi alpha toxin were not significantly different between groups, except on days 10 and 56, when they were significantly higher in cattle vaccinated SC. Titers against C sordellii lethal toxin were significantly higher in cattle vaccinated SC on several days after vaccination, but titers were not significantly different after day 49. CONCLUSIONS AND CLINICAL RELEVANCE: Transdermal vaccination of cattle resulted in serum antibody titers that were similar to those induced via SC vaccination and caused injection-site reactions that were significantly smaller. Transdermal vaccination may be an effective technique for vaccinating cattle against clostridial diseases while minimizing local reactions that often develop after clostridial vaccination.

Occurrence of canine parvovirus type 2c in the United States.

Canine parvovirus (CPV) type 2 (CPV-2) emerged around 1978 as a major pathogen of dogs worldwide. In the mid-1980s, the original CPV-2 had evolved and was completely replaced by 2 variants, CPV-2a and CPV-2b. In 2000, a new variant of CPV (named CPV-2c) was detected in Italy and now cocirculates with types 2a and 2b in that country. The CPV-2c has also been reported from single outbreaks in Vietnam and Spain. This study was conducted to determine if CPV-2c occurs in the United States. Thirty-three fecal samples were collected from dogs in 16 states between April 2006 and April 2007 and were tested for CPV using real-time polymerase chain reaction (PCR). Positive samples were further tested using conventional PCR and minor-groove binding TaqMan PCR assays to determine the viral type and to differentiate vaccine strains from field strains. Twenty-seven samples were positive for CPV, 7 of which were CPV-2c from 5 states: Arizona, California, Georgia, Oklahoma, and Texas. Of the 7 isolates, 4 differed from European CPV-2c isolates by 2 additional single-nucleotide mutations at positions 4076 and 4104, the latter of which produces a ThrAla change at residue 440 located near a major antigenic site. The coast-to-coast geographic distribution of the states in which CPV-2c was detected strongly suggests that this new CPV variant is probably widespread in the United States. The continuous evolution of CPV requires that monoclonal antibody-based and nucleic acid-based diagnostic assays should be periodically checked for sensitivity on prevalent CPV strains.

Vaccination of puppies born to immune dams with a canine adenovirus-based vaccine protects against a canine distemper virus challenge.

None of the currently available distemper vaccines provides a satisfactory solution for the immunization of very young carnivores in the face of maternal-derived immunity. Since mucosal immunization with replication-competent adenovirus-based vaccines has been proven effective in the face of passive immunity against the vector, it has the potential to provide a solution for the vaccination of young puppies born to canine distemper virus (CDV)-immune dams. We report the engineering and the characterization of two replication-competent canine adenovirus type 2 (CAV2)-based vaccines expressing, respectively, the CDV hemagglutinin (HA) and fusion (F) antigens. We first demonstrated that the intranasal vaccination with a mixture of both recombinant CAV2s provides an excellent level of protection in seronegative puppies, confirming the value of replication-competent adenovirus-based vectors for mucosal vaccination. In contrast, intranasal immunization with the same vaccine of puppies born to CDV- and CAV2-immune dams, failed to activate specific and protective immune responses. We hypothesized that an active CAV2 infection occurred while puppies were in close contact with the vaccinated dams in the breeding units and that the resulting active mucosal immunity interfered with the intranasal administration of CAV2-based CDV vaccine. However, when puppies born to CDV- and CAV2-immune dams were vaccinated subcutaneously with the CAV2-based CDV vaccine, significant seroconversion and solid protective immunity were triggered despite pre-existing systemic immunity to the vector. This latter result is surprising and suggests that subcutaneous vaccination with a replication-competent recombinant CAV2 may be an efficient strategy to overcome both passive and active adenovirus specific immunity in the dog. From a practical point of view, this could pave the way for an original strategy to vaccinate young puppies in the face of maternal-derived immunity.