Linking animal and human health burden: challenges and opportunities.

Quantifying the impact of poor animal health outcomes on human health represents a complex challenge. Using the disability-adjusted life year (DALY) metric as an endpoint, this article discusses how animal health outcomes can impact humans through three key processes: directly through zoonotic disease, indirectly via changes in yields and their impacts on nutrition and wealth, and finally, through indirect features associated with the agricultural industry, such as pharmaceuticals and climate change. For each process, the current state of the art and feasibility of global DALY-associated estimates are discussed. Existing frameworks for zoonoses already consider some key pathogens; ensuring completeness in the pathogens considered and consistency in methodological decisions is an important next step. For diet, risk factor frameworks enable a calculation of attributable DALYs; however, significant economic methodological developments are needed to ensure that local production changes are appropriately mapped to both local and global changes in dietary habits. Concerning wealth-related impacts, much work needs to be done on method development. Industry-related impacts require a focus on key research topics, such as attribution studies for animal antimicrobial resistance contributing to human outcomes. For climate change, a critical next step is identifying to what extent associated industry emissions are amenable to change should animal health outcomes improve. Allocation of finite funds to improve animal health must also consider the downstream impact on humans. Leveraging DALYs enables comparisons with other human health-related decisions and would represent a transformative way of approaching animal health decision-making should the obstacles in this article be addressed and new methods be developed.

La quantification de l'impact des problèmes de santé animale sur la santé humaine constitue un défi d'une grande complexité. En se servant de l'indicateur des années de vie ajustées sur l'incapacité (DALY) comme critère d'évaluation, les auteurs examinent trois processus essentiels illustrant l'impact que la situation zoosanitaire peut avoir sur la santé humaine : impact direct résultant des maladies zoonotiques, impact indirect résultant des mauvaises performances des animaux et de leurs conséquences sur la nutrition et la création de richesses, et enfin, effets indirects résultant de facteurs en lien avec le secteur agricole, par exemple l'utilisation de produits pharmaceutiques et le changement climatique. Pour chacun de ces processus, les auteurs font le point sur l'état actuel des connaissances et sur l'applicabilité des évaluations mondiales basées sur l'indicateur DALY. Les cadres existants relatifs aux zoonoses recouvrent déjà certains agents pathogènes majeurs ; la prochaine étape importante consistera à assurer une couverture complète des agents pathogènes et à veiller à la cohérence des décisions méthodologiques. S'agissant de l'alimentation, les cadres basés sur l'analyse des facteurs de risque permettent de calculer les DALY imputables à l'alimentation ; toutefois, d'importantes avancées méthodologiques sur les aspects économiques de cette corrélation seront nécessaires pour s'assurer que tout changement intervenant localement en matière de production animale est correctement mis en correspondance avec les modifications des habitudes alimentaires dans ce même contexte local mais aussi à l'échelle mondiale. S'agissant des impacts liés à la création de richesses, il reste beaucoup à faire dans le domaine méthodologique. La détermination des impacts liés aux filières d'élevage requiert des travaux axés sur des sujets précis, par exemple des études visant à déceler les sources de la résistance aux agents antimicrobiens qui contribuent à l'apparition d'antibiorésistances chez l'être humain. Enfin, pour ce qui concerne le changement climatique, une étape cruciale consistera à déterminer dans quelle mesure les émissions associées à l'élevage sont susceptibles de changer en cas d'amélioration de la situation zoosanitaire. Dans un contexte de ressources limitées, l'affectation de fonds à l'amélioration de la santé animale doit également prendre en compte l'impact en aval sur la santé humaine. L'utilisation de l'indicateur DALY permet des comparaisons avec d'autres décisions de santé publique et représenterait une approche transformative de la prise de décision en santé animale, dès lors que les obstacles mentionnés dans cet article sont surmontés et que de nouvelles méthodes sont mises au point.

Cuantificar el impacto de una mala sanidad animal en la salud humana es un desafío complejo. Utilizando el parámetro de años de vida ajustados en función de la discapacidad (AVAD o DALY) como criterio de valoración, en este artículo se examina cómo la sanidad animal puede repercutir en los seres humanos a través de tres procesos clave: directamente, a través de las zoonosis; indirectamente, a través de cambios en los rendimientos y sus repercusiones en la nutrición y la riqueza; y, por último, a través de factores indirectos asociados a la industria agropecuaria, como los fármacos y el cambio climático. Para cada uno de estos procesos, se examinan el estado actual y la viabilidad de estimar AVAD a escala mundial. Los marcos existentes para la zoonosis ya tienen en cuenta algunos patógenos claves; garantizar la exhaustividad de los patógenos considerados y la coherencia en las decisiones metodológicas es un próximo paso importante. En lo que respecta a la alimentación, aunque los marcos de factores de riesgo permiten calcular los AVAD atribuibles, se necesitan importantes avances metodológicos en el ámbito económico para asegurar que los cambios en la producción local se correspondan adecuadamente con los cambios locales y mundiales en los hábitos alimentarios. En cuanto a las repercusiones en la riqueza, queda mucho trabajo por hacer en el desarrollo de métodos. Para abordar las repercusiones relacionadas con la industria, es necesario centrarse en temas clave de investigación, como los estudios de atribución relativos al impacto en la salud humana de la resistencia a los antimicrobianos en los animales. En lo que se refiere al cambio climático, un próximo paso crucial es determinar en qué medida las emisiones de la industria podrían cambiar, en función de la mejora de los resultados en materia de sanidad animal. Al asignar fondos limitados para la mejora de la sanidad animal también se deben tener en cuenta las repercusiones correspondientes en los seres humanos. Utilizar los AVAD permite hacer comparaciones con otras decisiones importantes relacionadas con la salud humana y representaría una forma transformadora de enfocar la toma de decisiones en materia de sanidad animal, en caso de que se aborden los obstáculos presentados en ese artículo y se desarrollen nuevos métodos.

Hazardous o-toluidine mineralization by photocatalytic bismuth doped ZnO slurries.

Photocatalytic mineralization of o-toluidine in aqueous media under UV/solar irradiation was achieved by bare and bismuth doped zinc oxide nanoparticles. By adopting different analytical approaches a reaction mechanism is proposed, explaining the differences in photodetoxification performances.

Emergence of macrolide-resistant strains during an outbreak of Mycoplasma pneumoniae infections in children.

OBJECTIVES: Mycoplasma pneumoniae is a frequent cause of human lower respiratory tract infections (LRTIs) for which macrolides are the treatment of choice. The aim of this study was to determine the rate of macrolide resistance and to subtype M. pneumoniae strains in Italy. PATIENTS AND METHODS: During an outbreak of M. pneumoniae infections in southern Italy in 2010, 48 clinical specimens from 43 paediatric patients hospitalized for LRTIs were analysed for macrolide resistance. The mutations associated with resistance (A2063G and A2064G) and M. pneumoniae subtypes were detected by sequencing the targeted domain V region of the 23S rRNA gene and a region in the MPN528a gene, respectively. RESULTS: Macrolide resistance genotypes were detected in 11 (26%) of the 43 M. pneumoniae-positive children. The A2063G mutation was identified in seven patients and the A2064G mutation was identified in the remaining four. Upon admission, the isolates from three patients showed a susceptible genotype but subsequently acquired the A2063G mutation. Genotyping revealed M. pneumoniae subtype 1 in 33 of 40 sequenced strains and subtype 2 in the remaining 7. There was no association between macrolide resistance or susceptibility and the M. pneumoniae subtypes. CONCLUSIONS: This is the first report of macrolide resistance among M. pneumoniae strains in Italy. Our findings indicate an unexpected high prevalence of macrolide resistance genotypes in children, and so macrolide resistance should be carefully considered in patients who do not respond appropriately to antibiotic treatment. The epidemiological monitoring of macrolide resistance has become necessary in Italy and in the rest of Europe.

Giardiasis in HIV: a possible role in patients with severe immune deficiency.

We report the epidemiological, clinical and therapeutic characteristics of giardiasis in a population of HIV-infected patients with diarrhoic syndrome. During the period between 1988 and 1995, 720 HIV-patients with diarrhoic syndrome were evaluated. Fecal specimens were submitted to parasitological examination according to the Ritchie formalin-ethil acetate centrifugal sedimentation method and stained with iodine. Samples also underwent modified Ziehl-Neelsen staining and standard bacteriologic testing. Cystis of G. intestinalis were identified in stool sample of 25 patients. Two patients were classified as in stage A2 and 23 in C3. Mean CD4 values of patients with giardiasis (26.9 cells/mmc) were compared with those of 65 patients from whom, during the study, was isolated Cryptosporidium parvum (63.12, cells/mmc): the difference resulted highly significant (p < 0.001). Among the patients with full-blown AIDS, giardiasis occurred following a single previous AIDS-defining event in 13 inividuals, in seven and in five subjects giardiasis was the 3rd and, respectively, the 4th relevant AIDS-defining condition. Death occurred within the following 2 months in nine patients and within 6, 12 and 24 months in seven, six and two patients, respectively; at present only three AIDS patients are still alive. In general, G. intestinalis in HIV+, is not considered a major cause of enteritis; nevertheless, in our experience enteritis due to G intestinalis is a frequent event among AIDS patients, especially in the most advanced stage of disease, irrespectively of the risk factor. The increase in mean survival of AIDS patients will probably lead to a progressive emergence of this pathogen which could determine a severe diarroic syndrome with hydro-electrolytic impairments.

Epidemiological research on trichinellosis in Apulia and Basilicata (southern Italy).

Trichinellosis is a zoonotic infection and has a worldwide distribution. In Italy numerous sporadic cases and outbreaks of human trichinellosis have been reported. The authors report an epidemiological survey of trichinellosis in Apulia and Basilicata, two regions of southern Italy, where two outbreaks of human trichinellosi (about one hundred cases) have recently occurred, due to ingestion of wild boar meat (sausages). Serological and/or parasitological research was carried out in the trichinellosis patients, in uninfected people (control group), and in wild and synantropic animals. The incidence of infection found in various animal species (sylvatic trichinellosis) in these two regions is high and can represent a serious health risk.

[Urinary schistosomiasis: description of a case. Clinico-therapeutic considerations and preventive measures]. / Schistosomiasi urinaria: descrizione di un caso. Considerazioni clinico-terapeutiche e misure di prevenzione.

In Italy, imported cases of urinary schistosomiasis may be frequently undiagnosed, because the symptoms are mild and the number of schistosome eggs in urine is low. The Authors report one case of S. haematobium infection in whom the diagnosis was suspected on the basis of the anamnestic and clinical data and confirmed by the presence of typical eggs in urine and histologically in biopsies taken at cystoscopy. Moreover preventive measures are suggested for the individuals who go to those Countries where schistosomiasis is endemic.

[An epidemic of familial toxoplasmosis (author's transl)]. / Episodio familiare di toxoplasmosi.

After observation of choroiditis of toxoplasmic nature in a member of a rural family, the authors have led a clinical and serological study on other five members of the household. Three of five had antibody titers and two of these demonstrated antibody titers consistent with recent toxoplasmic infection; one of these members manifested asymptomatic choroiditis. Therefore, it would be interesting to carry out a clinical and serological study on relatives of patient with toxoplasmosis.

[Studies on the physiopathology of cholera in Bari]. / Rilievi sulla fisiopatologia del colera a Bari

During a small epidemic of cholera in South Italy in summer of 1973, the infection showed some peculiarities and differences in comparison with cholera classic picture of Asiatic areas. In this paper epidemiological, pathogenetic, clinical and biochemical data of patients admitted to the Institute of Infectious Diseases of Bari are reported. The age of the majority of patients (over 50) is an important factor for understanding cause of infection; but also preexistent basal diseases are responsible of severe course of infection. In fact, in spite of low mortality (2/70), in many cases the course of disease has been complicated by metabolic disorders. Also cardio-vascular conditions have influenced course of infection. The Authors discuss the causes of this atypic behaviour of cholera in South Italy.

[Studies on the efficacy of cholera vaccination in a population sample of Bari]. / Indagini sull'efficacia della vaccinazione anticolerica in un campione di popolazione barese

To measure the efficacy of cholera vaccination during the epidemic of cholera occurred in August-September 1973 in Bari, agglutinating and vibriocidal antibody titers were determined in 151 subjects; of these, 65 were children between 6 months and 4 years of age and 86 adults past thirty years. Antibodies could be proved in 80% of the subjects, with relatively higher frequency in children (84,6%) than in adults (76,7%). No significant difference was seen against the serotypes Inaba and Ogawa. The vibriocidal antibody tests was uniformly more sensitive than the agglutination test. In 108 of these subjects (all of 65 children and 43 of the adults), it was possible to make the serological controls 3 and 6 months after vaccination. At 3 months, antibodies were determined in 50,7% of the children and in 44,2% of the adults; at 6 months, only 20% of the children and 18,6% of the adults showed agglutinating and vibriocidal antibodies. For the control, the research of V. cholerae-antibodies was maked also in sera of 300 healties subjects of all ages, by whom the bleedings were obtained prior to epidemic of cholera. Antibodies against the serotypes Inaba and Ogawa were determined in 23 subjects (7,6%); of these, 5 had vibriocidal titers of 1:2560-1:5120.

[Research on V. cholerae anti-antibodies (agglutinating and vibriocidal) in patients affected by cholera-like gastroenteritis. Studies performed during the cholera epidemic occurred in Apulia in August-September 1973]. / Ricerca degli anticorpi anti-"V. cholerae" (agglutinanti e vibriocidi) in soggetti affetti da gastroenterite coleriforme. Studi condotti durante l'epidemia di colera verificatasi in Puglia nell'Agosto-Settembre 1973

Agglutinating and vibriocidal antibody titers anti-V. cholerae of the serotypes Ogawa and Inaba, were determined in sera from 189 patients with cholera-like diarrheas during the epidemic of cholera occurred in August-September 1973, in Bari. Antibodies were determined in 74,2% of 70 patients, whose in the faeces and vomiting were isolated strains identified as V. cholerae, biotype El Tor, serotype Ogawa. This frequency was higher against the serotype Ogawa. The antibodies could be proved very early, 4-6 days from the beginning of symptomatology, but they disappeared as rapidly; really, at 2.3 months antibodies were determined in 7,7% only of the above mentioned subjects. As regards the other 119 patients with non-vibrio, cholera-like diarrheas, antibodies were determined in 28 subjects only; 27 of these has received cholera-vaccine some weeks before. One single case remained which was bacteriological negative, but showed signifcant agglutinating and vibriocidal antibody titers against the serotypes Ogawa and Inaba.

Gastric abnormalities in cholera: epidemiological and clinical considerations.

The anatomofunctional status of the stomach was studied in cholera patients during the outbreak in Bari, Italy, in 1973. Of a total of 70 patients examined, 24 were found to have undergone gastric resection for ulcer in the past. Stomach secretions induced by fasting and histamine stimulation were studied in 30 patients, the majority of whom showed achlorhydria and other disturbances of gastric secretion. These abnormalities not only predisposed the patients to cholera infection but shortened the incubation period. The clinical course and severity of the disease were also related to the degree of gastric damage, the most serious cases occurring in gastrectomized patients.