Probiotic intake unmasking a gastro-pleural fistula.

OBJECTIVE: Gastropleural fistula represents a rare clinical event often resulting in an iatrogenic complication of gastrointestinal surgery. Clinical presentation is insidious, patients complain of chronic and non-specific respiratory symptoms and may be conservatively treated for lung infections for several months until detailed tests finally reveal the correct diagnosis. PATIENTS AND METHODS: We describe a case of a healthy patient with an unexpected diagnosis of empyema due to a gastropleural fistula. RESULTS: A 51-year-old man with a past history of splenectomy for cyst was admitted because of high fever and cough. A chest radiography and CT-scan revealed a left-side pneumonia complicated with pleural empyema. Broad spectrum empirical antibiotics and pleural drainage did not significantly improve the clinical picture. While the need for a surgical complex thoracic approach becomes a collective awareness, questions about causes of empyema and its unfavorable evolution in our patient did not initially find a common satisfactory answer. It was only by the identification of probiotics bacteria in the pleural fluid that a gastropleural fistula was suspected, and then, it was confirmed by CT-scan and by digestive endoscopy. A combined thoraco-abdominal surgical treatment was therefore scheduled, leading to progressive improvement till total healing. CONCLUSIONS: Although gastropleural fistula is rare, it is necessary to include this pathological condition in the differential diagnosis of a persistent complicated pneumonia, because early diagnosis and, consequently, surgical management, may significantly impact on the prognosis of these patients. In our case, the detection of probiotics bacteria in the pleural fluid helped us to suspect and to look for the fistula.

Cucullanus carettae Baylis, 1923, in a loggerhead sea turtle (Caretta caretta) from the Adriatic sea: first detection and molecular characterization.

Cucullanus carettae Baylis, 1923 (Nematoda: Cucullanidae) is found worldwide in loggerhead turtles (Caretta caretta). Regarding the Mediterranean, C. carettae has been identified in the Tyrrhenian and the Ionian Sea and a unique description of a Cucullanus sp. specimen in loggerheads from the Adriatic Sea has been reported in the literature so far. In the framework of a bio-monitoring project of the Abruzzo and Molise coasts, a parasitological survey was performed on stranded and by-caught sea turtles, at the Istituto Zooprofilattico of Abruzzo and Molise "G. Caporale." During necropsy, the gastrointestinal system of 72 stranded loggerhead turtles was analyzed for the presence of endoparasites and fecal samples were collected for coprological examination. Adult C. carettae (n = 123) was found in the upper intestine of one loggerhead turtle, associated with chronic lymphoplasmocytic enteritis. Additionally, five stool samples (6.9%) were positive for Cucullanus sp. eggs. Molecular characterization of adult nematodes was carried out to study phylogenetic relationships among the Cucullanus species. To our knowledge, this is the first morphological and molecular identification of C. carettae in loggerhead turtles from the Adriatic Sea. Additional studies on the distribution of this parasite in the Mediterranean are encouraged.

Genetic diversity of Coxiella burnetii in domestic ruminants in central Italy.

BACKGROUND: As the epidemiology of human Q Fever generally reflects the spread of Coxiella burnetii in ruminant livestock, molecular characterization of strains is essential to prevent human outbreaks. In this study we report the genetic diversity of C. burnetii in central Italy accomplished by MST and MLVA-6 on biological samples from 20 goat, sheep and cow farms. RESULTS: Five MST and ten MLVA profiles emerged from the analysis establishing a part of C. burnetii strain world atlas. In particular, ST32 occurred on 12 farms (60%), prevalently in goat specimens, while ST12 (25%) was detected on 4 sheep and 1 goat samples. ST8 and a variant of this genotype were described on 2 different sheep farms, whereas ST55 was observed on a goat farm. Five complete MLVA profiles different from any other published genotypes were described in this study in addition to 15 MLVA incomplete panels. Despite this, polymorphic markers Ms23, Ms24 and Ms33 enabled the identification of samples sharing the same MST profile. CONCLUSIONS: Integration of such data in international databases can be of further help in the attempt of building a global phylogeny and epidemiology of Q fever in animals, with a "One Health" perspective.

The length of BTV-8 viraemia in cattle according to infection doses and diagnostic techniques.

Four groups of BTV free Frisian and cross bred calves were used to determine the length of viraemia following infection with different doses of BTV-8 Italian isolate. The first group of five animals was infected with 10 TCID(50) of BTV-8, the second group of four animals with 10(3) TCID(50) and the third group, which also included four animals, was infected with 10(6) TCID(50). A placebo containing uninfected tissue culture medium was given to the four animals of the fourth group. The viraemia was evaluated by real time RT-PCR and virus isolation. In all infected groups, virus isolation was able to detect infectious virus up to 39 days post infection (dpi) while RT-PCR was positive up to 151-157dpi. Infectious dose did influence neither the length nor the pattern of BTV-8 viraemia and confirmed that real time RT-PCR remains positive although no circulating virus is detectable in the peripheral circulation.

Risk factors associated with the occurrence of undesired effects in sheep and goats after field vaccination with modified-live vaccine against bluetongue virus serotypes 2, 4 and 16.

In the 2004, the Sardinian bluetongue (BT) vaccination campaign used the combination of monovalent BTV-2, BTV-4 and BTV-16 modified-live vaccines manufactured by the Onderstepoort Biological Products in South Africa. Following vaccination, some herds showed temperature, oedema, lameness, hyperaemia and decrease in milk production, and some others remained perfectly healthy. This study aimed to evaluate whether important factors present in the herd at the time of vaccination could be associated to the occurrence of undesired effects observed after immunisation with BTV modified-live vaccines. A sample of 17 sheep and 4 goat flocks, for a total of 670 animals, were included in the study and risk factors such as presence of most important parasitic, bacterial and viral diseases as well as anomalies of biochemical and haematological parameters were associated to the presence or absence of side effects. For each factor the relative risk and 95% confidence interval were calculated. Following vaccination, bluetongue-like symptoms were observed in 13 flocks. In these flocks, a higher (P<0.05) proportion of animals had viraemia and showed higher titers to BTV-16 after immunisation. Positive association (RR=2.50, 1.17-5.04) was also found between flocks in which undesired effect were observed and positive serology against Maedi-Visna virus. On the contrary, presence of BTV genome fractions in the blood of animals at the time of vaccination was found to be protective (RR=0.7, 0.58-0.84) to the occurrence of undesired effect subsequent to BTV vaccination.

First evidence of bluetongue virus serotype 16 in Croatia.

This study described the first report of BTV-16 in Croatia. Serological evidence occurred in cattle at the end of September and continued during October and November 2004. All positive animals were in the Dubrovnik-Neretva County, a region located in the southernmost part of Croatia. BTV-16 infection was also detected in goats and sheep. Apart from few cases reported in Greece between 1999 and 2000, BTV-16 has never been reported in the Balkanic peninsula before. The BTV strain was isolated from cattle blood samples and typed as BTV-16. When the S5 was sequenced, it showed 100% homology with the BTV-16 vaccine isolate produced by Ondersterpoort Biological Product (SA) and used in Italy during the 2004 BT vaccination campaign. On the other hand no complete homology was found when the same RNA segment sequence was compared with that of the homologous Italian field isolate. As no evidence of livestock movements from Italy was demonstrated, an eolic transmission of the infection through infected Culicoides was hypothesised. According to the local meteostations, in several occasions, during the 2004 summer months, the west-east breeze blew with a speed above 50 km/h from Italy towards the Dubrovnik County. It is concluded that the BTV-16 which infected Croatian livestock was similar to the homologous OBP vaccine isolate and it is likely that it was introduced from Italy into the Southern regions of Croatia through infected Culicoides carried by the wind.

Serological evidence of USUTU virus occurrence in north-eastern Italy.

In the recent years, USUTU virus (USUV), a flavivirus of the Japanese encephalitis virus complex, has been reported in Central Europe. As part of a systematic surveillance programme to monitor possible entrance and/or circulation of vector-borne viruses, since 2001, sentinel-chicken flocks were placed throughout the Italian territory nearby areas considered at risk of virus introduction. They have been periodically checked for the presence of antibodies against flaviviruses by indirect ELISA, plaque reduction neutralization test for USUTU, West Nile and tick-borne encephalitis viruses. In July 2007, a sentinel chicken in a flock of 20 animals located within the Ravenna province seroconverted to USUV reaching neutralizing titres up to 1:5120. A second chicken seroconverted to the same virus 2 months later. Although no virus was rescued from these animals and from wild or farm birds sampled in the area, these results still provided evidence of the circulation of USUV in north-eastern Italy.