Successful treatment of a chronic oroantral fistula infected with extensively drug resistant bacteria using long-term oesophageal tube feeding and several non-conventional treatments in a horse.

BACKGROUND: Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses. CASE REPORT: An 8-year-old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5 days), followed by oral trimethoprim-sulphonamide (10 days) and then oral doxycycline (14 days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug-resistant (MDR) Escherichia coli was confirmed. Although susceptible to enrofloxacin in vitro, 30 days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug-resistant (XDR) gram-negative microorganisms. Whole-genome sequencing (WGS) revealed multiple sequence types of E. coli, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3 months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116. CONCLUSION: These non-conventional therapeutics, antimicrobials and long-term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified.

Evaluation of immuno-1 toxoplasma IgG assay in the prenatal screening of toxoplasmosis.

We evaluated the Immuno-1 (Bayer Diagnostics, Tarrytown, New York, USA) and IMx (Abbott Laboratories, Chicago, Illinois, USA) toxoplasma IgG assays in 298 (223 fresh in-house prenatal + 75 supplied by Bayer) specimens over 15 days. Discordant results were resolved by indirect fluorescence assay (Gull Laboratories, Salt Lake City, Utah, USA). The performance of Immuno-1 assay was found to be comparable to the IMx assay. Immuno-1, being a random access analyzer with minimum hands-on time requirements may have an advantage in the overall laboratory efficiency.

Effect of riboflavin supplementation on riboflavin nutriture of a secondary school population in Nigeria.

Riboflavin status was assessed in 42 secondary school students before and after supplementing the food intake with 5 mg riboflavin daily for 7 days. Energy, protein, and riboflavin intakes were determined on foods actually consumed by each student. Riboflavin nutriture was based on urinary riboflavin excretion and erythrocyte glutathione reductase activity coefficient. The energy and riboflavin intakes of the students were 68 to 82% and 80 to 88%, respectively, of the recommended allowance. The basal urinary riboflavin excretion was 0.335 mg/g creatinine and increased significantly to 3.51 mg/g creatinine after supplementation. The basal erythrocyte glutathione reductase activity coefficient values indicated an overall prevalence of 38% biochemical ariboflavinosis (erythrocyte glutathione reductase activity coefficient greater than 1.30) and dropped significantly (p less than 0.001) from 1.26 to 1.08. The results confirm that urinary riboflavin is of limited value in the assessment of riboflavin status while erythrocyte glutathione reductase activity coefficient more precisely assesses metabolic availability of riboflavin and more accurately detects biochemical ariboflavinosis.