Characterization of Avian Pox in a Ruffed Grouse (Bonasa umbellus) from Pennsylvania.

A free-ranging, adult male ruffed grouse (Bonasa umbellus) was harvested by a hunter during November 2019 in Forest County, PA. The bird was submitted for necropsy due to a skin mass on its left leg. Upon necropsy, two proliferative skin masses were grossly visible, one on the left leg and one on the cere. An additional mass was present on the oropharyngeal mucosa covering the hard palate. These masses were diagnosed as avian pox based on histopathologic and cytologic findings, including marked epithelial hypertrophy, hyperplasia, vacuolar degeneration with eosinophilic stippling, and intracytoplasmic inclusion bodies. An avipoxvirus was detected using PCR and was identified as fowlpox virus through sequencing of the 4b core gene segment. The avipoxvirus from this case showed genetic similarity to isolates from Eastern wild turkeys (Meleagris gallopavo silvestris).

Caracterización de la viruela aviar en un grévol engolado (Bonasa umbellus) en el estado de Pensilvania. Un cazador recolectó un grévol engolado macho adulto silvestre (Bonasa umbellus) durante noviembre del 2019 en el condado de Forest, Pensilvania. El ave fue sometida a necropsia debido a una masa cutánea en su pata izquierda. Durante la necropsia, dos masas cutáneas proliferativas fueron claramente visibles, una en la pierna izquierda y otra en la cera. Había una masa adicional en la mucosa orofaríngea que cubría el paladar duro. Estas masas se diagnosticaron como viruela aviar con base en los hallazgos histopatológicos y citológicos, que incluyeron hipertrofia epitelial marcada, hiperplasia, degeneración vacuolar con punteado eosinofílico y cuerpos de inclusión intracitoplasmáticos. Se detectó un avipoxvirus mediante PCR y se identificó como virus de la viruela aviar mediante la secuenciación del segmento del gene 4b del centro viral. El avipoxvirus de este caso mostró similitud genética con aislamientos de pavos salvajes del este (Meleagris gallopavo silvestris).

Ebbs and Flows of Desire: A Qualitative Exploration of Contextual Factors Affecting Sexual Desire in Bisexual, Lesbian, and Straight Women.

Previous research has found that sexual desire ebbs and flows over time within and across relationships, leading to instances of desire discrepancy. The purpose of the present study was to understand factors that may contribute to desire and desire discrepancy and examine differences and similarities across women from diverse sexual identity groups. The present qualitative study involved semi-structured interviews with 31 women (10 bisexual, 8 lesbian, and 13 straight). We identified six main themes (changes across lifespan, hormonal influences, mental and physical health, objective of desire, partner dynamics, external factors) with 21 subthemes. The findings showed more similarities between the women than differences.

Limited genetic variability of Cytauxzoon felis apical membrane antigen-1 (ama1) from domestic cats and bobcats.

BACKGROUND: Cytauxzoon felis is a tick-transmitted apicomplexan that causes cytauxzoonosis in domestic cats (Felis catus). Even with intensive care, the mortality rate of acute cytauxzoonosis approaches 40% in domestic cats, while bobcats (Lynx rufus), the natural intermediate host of C. felis, remain clinically asymptomatic. However, multiple reports of domestic cats surviving acute disease without any treatment exist. One hypothesis for survival of these cats is infection with unique C. felis genotypes of lower pathogenicity. Prior studies have identified genetically distinct C. felis isolates containing polymorphisms within internal transcribed spacer regions (ITS) of the rRNA operon. However, these polymorphisms do not correlate with the clinical outcome of cytauxzoonosis, and so additional genetic markers are needed to test this hypothesis. We selected C. felis apical membrane antigen-1 (ama1) as a potential genetic marker of differential pathogenicity. AMA1 is a vaccine candidate for relatives of C. felis within Plasmodium spp.; however its historically high level of genetic polymorphism has resulted in escape from vaccine-induced immunity. While such diversity has hindered vaccine development, the expected polymorphism within the ama1 gene may be useful to evaluate population genetics. RESULTS: A 677 bp sequence of the C. felis ama1 gene was PCR-amplified from 84 domestic cats and 9 bobcats and demonstrated 99.9% sequence identity across all samples. A single nucleotide polymorphism (SNP) was identified in domestic cats and bobcats with evidence for co-infection with both genotypes identified in two domestic cats. The prevalence of the two genotypes varied with geographical distribution in domestic cats. Nucleotide diversity (π) and haplotype diversity (H) were calculated for C. felis ama1 and ama1 of related apicomplexans to assess genetic diversity. Based on these values (π = 0.00067 and H = 0.457), the diversity of the C. felis ama1 gene region analyzed is considerably lower than what is documented in related apicomplexans. CONCLUSIONS: In surprising contrast to related apicomplexans, our results support that the sequence of the C. felis ama1 gene is highly conserved. While lack of genetic diversity limits utility of C. felis AMA1 as a genetic marker for clinical outcome, it supports further investigation as a vaccine candidate for cytauxzoonosis.

Patient feedback as a quality improvement strategy in an acute care, inpatient unit: An investigation of outcome and readmission rates.

High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as "patient centered." Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N = 2,247) that used a quality-improvement strategy called systematic patient feedback. Benchmarks were constructed using randomized clinical trials (RCTs) from inpatient treatment for depression, RCTs from patient feedback in outpatient settings, and national data on psychiatric hospital readmission rates. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d = 1.33 and d = 1.38 for patients diagnosed with a mood disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression. Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is "patient centered" may provide a path toward lower readmission rates in addition to other evidence-based strategies after discharge. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Lung cancer incidence and the strength of municipal smoke-free ordinances.

BACKGROUND: Smoke-free laws reduce disease prevalence. The impact of municipal smoke-free laws on lung cancer incidence in Kentucky was examined. The authors hypothesized that lung cancer incidence rates would be associated with the strength of smoke-free laws. METHODS: This was a secondary analysis of 83,727 Kentucky residents aged ≥ 50 years who were newly diagnosed with lung cancer from 1995 to 2014. In 2014, 33 municipalities had 1 or more smoke-free laws. County-level characteristics included adult smoking rate, sex, race/ethnicity, income, physician supply, observed radon values, and rurality. RESULTS: Individuals living in communities with comprehensive smoke-free laws were 7.9% less likely than those living in communities without smoke-free protections to be diagnosed with lung cancer. The difference in lung cancer incidence between counties with moderate/weak laws and those without laws was not significant. CONCLUSIONS: Comprehensive smoke-free laws were associated with fewer new cases of lung cancer, whereas weak or moderate smoke-free laws did not confer the same benefit. One hundred percent smoke-free laws, covering all workers and the public with few or no exceptions, may be key in reducing new cases of lung cancer. Cancer 2018;124:374-80. © 2017 American Cancer Society.

Systemic immune responses in Cytauxzoon felis-infected domestic cats.

OBJECTIVE: To characterize systemic immune responses in Cytauxzoon felis-infected cats. SAMPLE: Blood and lung samples obtained from 27 cats. PROCEDURES: Cats were allocated into 4 groups: cats that died of cytauxzoonosis, acutely ill C felis-infected cats, healthy survivors of C felis infection, and healthy uninfected cats. Serum concentrations of tumor necrosis factor-α and interleukin-1 ß were measured and serum proteins characterized. Blood smears were stained immunocytochemically and used to assess immunoglobulin deposition. Immunohistochemical expression of CD18 and tumor necrosis factor-α were compared in lung tissues obtained from cats that died and healthy uninfected cats. A real-time reverse-transcription PCR assay for CD18 expression was performed on selected blood samples from all groups. RESULTS: Concentrations of both cytokines were greater and serum albumin concentrations were significantly lower in cats that died of cytauxzoonosis, compared with results for all other groups. Erythrocytes from acutely ill cats and survivors of C felis infection had staining for plasmalemmal IgM, whereas erythrocytes from the other groups did not. Increased staining of C felis-infected monocytes and interstitial neutrophils for CD18 was detected. The real-time reverse-transcription PCR assay confirmed a relative increase in CD18 expression in cats that died of cytauxzoonosis and acutely ill cats, compared with expression in other groups. Immunostaining for TNF-α in lung samples confirmed a local proinflammatory response. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated immunopathologic responses were greater in cats that died of C felis infection than in cats that survived C felis infection.

Variation in the ITS-1 and ITS-2 rRNA genomic regions of Cytauxzoon felis from bobcats and pumas in the eastern United States and comparison with sequences from domestic cats.

Cytauxzoon felis, a tick-borne protozoan parasite, is the causative agent of cytauxzoonosis in domestic cats in the United States. The natural reservoir for this parasite is the bobcat (Lynx rufus), which typically does not develop clinical signs. Although not likely important reservoirs, C. felis has also been detected in pumas (Puma concolor) in Florida and Louisiana. Recent studies suggest that specific genotypes of C. felis that circulate in domestic cats may be associated with variable clinical outcomes and specific spatial locations. In the current study, we investigated the intraspecific variation of the C. felis internal transcribed spacer (ITS)-1 and ITS-2 rRNA regions from 145 wild felids (139 bobcats and six pumas) from 11 states (Florida, Georgia, Kansas, Kentucky, Louisiana, Missouri, North Carolina, North Dakota, South Carolina, Oklahoma, and Pennsylvania). Unambiguous ITS-1 and ITS-2 data were obtained for 144 and 112 samples, respectively, and both ITS-1 and ITS-2 sequences were obtained for 111 (77%) samples. For the ITS-1 region, sequences from 65 samples collected from wild felids were identical to those previously reported in domestic cats, while the other 79 sequences were unique. C. felis from 45 bobcats and one puma had ITS-1 sequences identical to the most common sequence reported from domestic cats. Within the ITS-2 region, sequences from 49 bobcats were identical to those previously reported in domestic cats and 63 sequences were unique (with some occurring in more than one bobcat). The most common ITS-2 sequence from domestic cats was also common in wild felids (31 bobcats and a puma). Samples from three pumas from Florida and two bobcats from Missouri had a 40- or 41-bp insert in the ITS-2 similar to one described previously in a domestic cat from Arkansas. Additionally, a previously undescribed 198- or 199-bp insert was detected in the ITS-2 sequence from four bobcats. Collectively, based on combined ITS-1 and ITS-2 sequences, five different genotypes were detected in the wild felids. Genotype ITSa was the most common genotype (11 bobcats and one puma) and fewer numbers of ITSb, ITSe, ITSg, and ITSi were detected in bobcats. These data indicate that, based on ITS-1 and ITS-2 sequences, numerous C. felis strains may circulate in wild felids.

Distribution and prevalence of Cytauxzoon felis in bobcats (Lynx rufus), the natural reservoir, and other wild felids in thirteen states.

Cytauxzoon felis, a protozoan parasite of wild and domestic felids, is the causative agent of cytauxzoonosis in domestic and some exotic felids in the United States. The bobcat (Lynx rufus) is the natural reservoir for this parasite, but other felids such as Florida panthers (Puma concolor coryii) and domestic cats may maintain long-term parasitemias and serve as reservoirs. Experimentally, two tick species, Dermacentor variabilis and Amblyomma americanum, have demonstrated the ability to transmit C. felis. These two tick species have overlapping distributions throughout much of the southeastern United States. The objective of the current study was to determine the distribution and prevalence of C. felis in free-ranging bobcat populations from 13 states including California, Colorado, Florida, Georgia, Kansas, Kentucky, Missouri, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, and West Virginia. These states were selected because of differential vector presence; D. variabilis is present in each of these states except for the region of Colorado sampled and A. americanum is currently known to be present only in a subset of these states. Blood or spleen samples from 696 bobcats were tested for C. felis infection by a polymerase chain reaction (PCR) assay which targeted the first ribosomal internal transcribed spacer region (ITS-1). Significantly higher prevalences of C. felis were detected from Missouri (79%, n=39), North Carolina (63%, n=8), Oklahoma (60%, n=20), South Carolina (57%, n=7), Kentucky (55%, n=74), Florida (44%, n=45), and Kansas (27%, n=41) compared with Georgia (9%, n=159), North Dakota (2.4%, n=124), Ohio (0%, n=19), West Virginia (0%, n=37), California (0%, n=26), and Colorado (0%, n=67). In addition to bobcats, seven cougars (Puma concolor) from Georgia, Louisiana, and North Dakota and one serval (Leptailurus serval) from Louisiana were tested for C. felis. Only one cougar from Louisiana was PCR positive, which represents the first report of an infected cougar outside of the Florida panther population. These data also indicate that C. felis is present in North Dakota where infection has not been reported in domestic cats. Based on a nonparametric analysis, prevalence rates were significantly higher in states where there are established populations of A. americanum, which supports recent data on the experimental transmission of C. felis by A. americanum and the fact that domestic cat clinical cases are temporally associated with A. americanum activity. Collectively, these data confirm that bobcats are a common reservoir for C. felis and that A. americanum is likely an epidemiologically important vector.

Identification and genetic characterization of Cytauxzoon felis in asymptomatic domestic cats and bobcats.

The objectives of the current study were to assess the prevalence of Cytauxzoon felis infection among a population of domestic cats that were clinically healthy but at higher risk for parasite exposure and to determine if the strains present in these asymptomatically infected cats were genetically unique as compared to those present both in domestic cats that were fatally infected and in the natural reservoir host, the bobcat. Using real-time PCR analysis targeting a portion of the parasite 18S rRNA gene specific for C. felis, 27/89 (30.3%) high-risk asymptomatic domestic cats from Arkansas and Georgia, and 34/133 (25.6%) bobcats from Arkansas, Georgia and Florida, were identified as positive for C. felis infection. Conventional PCR analysis was performed on all positive samples, targeting the C. felis ribosomal internal transcribed spacer regions 1 and 2 (ITS1, ITS2) in order to utilize the ITS sequences as markers to assess the genotype variability of the parasite population. Within the asymptomatically infected domestic cat samples, 3 genetically distinct parasite populations were identified. The C. felis ITS sequences from asymptomatic cats were identical to those previously reported from clinically ill infected cats, and 2 of the 3 sequence types were also present in infected bobcat samples. While sequence diversity exists, evaluation of the ITS region does not appear to be useful to verify pathogenicity of C. felis strains within host species. However, the presence of asymptomatic C. felis infections in clinical healthy domestic cats warrants further investigation to determine if these cats can serve as a new reservoir for C. felis transmission.

Genetic variability of archived Cytauxzoon felis histologic specimens from domestic cats in Georgia, 1995-2007.

Cytauxzoon felis infection in domestic cats has historically been nearly 100% fatal. However, increasing reports of domestic cats that survive cytauxzoonosis and reports of asymptomatic cats with C. felis infections suggest the existence of different parasite strains that vary in pathogenicity. The objective of the current study was to obtain epidemiologic information about cytauxzoonosis through genotypic characterization of archived histologic specimens from domestic cats with C. felis infections that were diagnosed in Georgia between 1995 and 2007. Such retrospective data on genetic variability will provide an historic context for current studies of C. felis genotype frequencies. Cytauxzoon felis DNA was obtained from formalin-fixed, paraffin-embedded tissues from infected cats diagnosed with cytauxzoonosis at necropsy. Genetic characterization of C. felis was performed using sequence analysis of the polymerase chain reaction-amplified ribosomal internal transcribed spacer regions 1 and 2 (ITS1, ITS2). Eleven different combined ITS1 and ITS2 sequences were identified, the majority of which were identical to those previously reported in fatally infected cats from Georgia. The findings of the current study document the existence of genetically distinct C. felis populations in historical samples and, together with data from contemporary samples, demonstrate a diverse population structure for C. felis.

Dermoid cysts presenting as enlarged thyroid glands in a cat.

A 5-year-old spayed female cat was evaluated for hyperthyroidism based on an elevated free thyroxine (T(4)) measurement and bilaterally enlarged symmetric subcutaneous masses in the area of the thyroid glands. Physical examination revealed bilateral subcutaneous masses on either side of the cervical trachea. Blood was obtained for serum biochemical profile and thyroid function analysis. Mild hyperalbuminemia, mild hypercalcemia, and mildly increased alanine aminotransferase activity were identified. Serum concentrations of total and free thyroxine were within the reference interval. Cytologic analysis of fine-needle aspirates from one of the masses was suspicious for neoplasia. Nuclear scintigraphy revealed no abnormalities. Surgically obtained excisional biopsies of both masses were submitted for histopathology and diagnosed as bilateral dermoid cysts. After excisional biopsy, the patient recovered without incident. The histopathologic diagnosis of completely excised bilateral dermoid cysts indicated that no further medical or surgical intervention was required. This is the first report of a cat presenting with bilateral dermoid cysts in the area of the thyroid glands. Histopathologic examination was necessary to make a definitive diagnosis. Practitioners should include cysts in their list of differential diagnoses for ventral neck masses in cats.

Squamous cell carcinoma.

Squamous cell carcinoma (SCC) is a relatively common, malignant neoplasm of dogs and cats that can arise in a variety of locations. The gross appearance of SCC can be variable and nonspecific, so definitive diagnosis requires microscopic examination of the tissue (cytology or histology). Several treatment modalities exist, but surgical excision, if possible, is regarded as the best treatment option. Early diagnosis and treatment of SCC are key because small, early-stage tumors are the most amenable to treatment and carry the best prognosis.

Genetic variability of Cytauxzoon felis from 88 infected domestic cats in Arkansas and Georgia.

Although cytauxzoonosis has historically been nearly 100% fatal in domestic cats, increasing number of reports of infected cats that demonstrate less-severe disease suggest the existence of different strains of Cytauxzoon felis. To test this hypothesis, the genetic variability of C. felis was examined in blood samples from naturally infected domestic cats from Arkansas and Georgia by using the first and second ribosomal internal transcribed spacer regions (ITS1, ITS2) as markers to assess genotypic variability. In addition, the clinical outcome of infection (survival vs. fatal disease) was analyzed. Within the C. felis ITS1 region, there were a total of 8 single nucleotide polymorphisms (SNP) and a single nucleotide insertion. Within the ITS2 region, there were a total of 4 SNPs and a single 40 base pair insertion. When taken together, the ITS1 and ITS2 sequence data defined a total of 11 different sequences and 3 unique genotypes. One unique ITS1-ITS2 genotype was detected in samples submitted exclusively from Arkansas, and a second unique genotype was submitted exclusively from Georgia. There was a significant association between infection with C. felis that contained particular ITS genotypes and survival of the infected domestic cat. The identification of unique C. felis genotypes obtained from different geographic areas and the association of particular ITS genotypes with the outcome of infection suggest the existence of parasite strains that may vary in pathogenicity to the domestic cat and offer an explanation for the survival of some infected cats in more recent case studies.

Detection of persistent Cytauxzoon felis infection by polymerase chain reaction in three asymptomatic domestic cats.

Repeated polymerase chain reaction (PCR) testing of 3 asymptomatic domestic cats were positive for Cytauxzoon felis DNA, suggesting persistent infection. Two cats initially presented with clinical signs consistent with acute cytauxzoonosis and, in both cases, signs of illness resolved after treatment. Parasitemia was detected in peripheral blood smears from these cats upon presentation with illness and, at subsequent follow-up appointments, in the absence of clinical illness. Polymerase chain reaction analysis was positive for C. felis from blood sampled at each time point. A third cat, a housemate of a cat fatally infected with C. felis, was preventatively treated for infection at the time of the housemate cat's death. This contact cat, having never shown signs of clinical illness consistent with cytauxzoonosis infection, had no detectable parasitemia but was positive for C. felis on repeated PCR testing. Detection of asymptomatically infected cats allows for the possibility of a yet unrecognized population of infected domestic cats that may have the capacity to serve as an additional reservoir host for C. felis, altering the currently accepted paradigm of C. felis transmission to domestic cats through bobcats as the reservoir host. In cases of very low parasitemia, more sensitive means of parasite detection, such as PCR testing, may be necessary to detect infected cats. Increased detection of asymptomatically infected cats will aid in understanding the epidemiology of C. felis infection and enhance the ability to prevent this highly fatal infectious disease of domestic cats.

A subcutaneous mass on the neck of a horse.

A 25-year-old Arabian gelding was presented for investigation of a subcutaneous neck mass. Fine-needle aspirates and impression smears revealed mast cells with widely varying degrees of cytoplasmic granulation and scattered eosinophils. Histopathology revealed a poorly circumscribed mass composed of sheets and bundles of mast cells with a large population of eosinophils. The mast cells were separated into numerous lobules by a heavy collagenous stroma, and multifocal collagen necrosis was present. Strong reactivity of the tumor cells for both Giemsa and toluidine blue stains confirmed the diagnosis of a mast cell tumor, and a Luna stain accentuated the eosinophilic infiltrates. Cutaneous mast cell tumors are found in many domestic animals but are uncommonly encountered in horses. Equine cutaneous mast cell tumors are usually benign, and there are no reports of visceral metastasis. Surgical excision is thought to be curative.