Non-Invasive Wildlife Disease Surveillance Using Real Time PCR Assays: The Case of the Endangered Galemys pyrenaicus Populations from the Central System Mountains (Extremadura, Spain).

The Iberian desman (Galemys pyrenaicus) is a small semi-aquatic mammal that inhabits mountainous areas from the centre to the north of the Iberian Peninsula and the Pyrenees and is listed as endangered because it has suffered a serious decline. Since 1960, only three species of digeneans (Omphalometra flexuosa, Maritrema pyrenaica and Mathovius galemydis) and two nematodes (Aonchotheca galemydis and Paracuaria hispanica) have been reported from the desman, but no further information on health status and no data from Extremadura has been available. The aim of our study was to characterise the diversity and distribution of parasites and microbiomes of desmans in different areas of the Central System of Extremadura. Between 2019 and 2021 we collected 238 fecal samples and one tissue (intestine) sample that was obtained from a dead desman. DNA templates were processed by commercial or customised real-time PCR using TaqMan probes. Representative data were obtained for Cryptosporidium spp., Omphalometra spp., Eimeria spp., Salmonella spp., Staphylococcus spp. and Leptospira spp. Omphalometra spp. was studied using a newly developed PCR test. The screening of the dead desman allowed us to obtain, for the first time, a partial sequence of the 18SrDNA. This study is the most complete study of the desman, allowing us to identify parasites and the microbiome in populations of G. pyrenaicus using non-invasive sampling.

Ocular involvement in STEC-associated hemolytic uremic syndrome.

BACKGROUND: Hemolytic uremic syndrome (HUS) is a systemic thrombotic microangiopathy characterized by hemolytic anemia, thrombocytopenia, and variable kidney involvement. Extrarenal thrombotic microangiopathy occurs in central nervous system (CNS), colon, and other organ systems, but ocular involvement is rarely recognized. This study aimed to analyze frequency and severity of ocular involvement in STEC-HUS, and the relationship between ocular involvement and disease severity, with emphasis on CNS, kidney, and colonic disease. METHODS: Prospective, longitudinal, observational study. INCLUSION CRITERIA: STEC-HUS patients September 2014-January 2019. Funduscopic examination (FE) was performed within 48 h of admission. We evaluated severity of CNS disease, kidney involvement, and presence of hemorrhagic colitis (HC). RESULTS: Ninety-nine patients were included (female 52), mean age 39.4 months (DE: 29.8; range 9-132). Thirteen patients (13.1%) had abnormal FE, 10 showing variable degrees of hemorrhagic exudates and 2 with typical Purtscher-like retinopathy. Other findings included tortuous vascularity, cotton wool spots, and transient retinal edema. CNS involvement was present in 16/99 patients, severe in 12 (75%). Abnormal FE occurred in 5/12 (31%) patients with severe CNS involvement vs. 8/87 (9.2%) with mild, moderate, or no CNS disease (p = 0.0191). Abnormal FE was present in 2/33 (6%) patients without dialysis vs. 11/66 (16.6%) requiring dialysis (p = 0.20). Finally, there were FE abnormalities in 6/20 patients with HC vs. 7/79 without HC (p = 0.012). CONCLUSIONS: FE abnormalities were present in 13% of HUS patients. Abnormal FE significantly associated with more severe disease, including severe CNS involvement and HC. We suggest FE should be performed in severe HUS, especially in cases with severe CNS disease. A higher resolution version of the Graphical abstract is available as Supplementary information.

Hypoalbuminemia: a risk factor in patients with STEC-associated hemolytic uremic syndrome.

BACKGROUND: We aimed to determine the prevalence of hypoalbuminemia in STEC-HUS patients with hemorrhagic colitis (HC) and whether serum albumin level (SAL), leukocyte count, hematocrit and serum sodium level (SSL) are prognostic markers of HC, central nervous system disease (CNSd) and/or dialysis requirement and evaluate if hypoalbuminemia is associated with fecal protein losses. METHODS: We prospectively evaluated STEC-HUS patients treated at our institution from 9/2011 to 2/2019, analyzing the presence of HC, CNSd and dialysis requirement and SAL, SSL, leukocytes, hematocrit and α1-antitrypsin clearance. RESULTS: We evaluated 98 patients, with mean age of 33.3 months. SAL ≤ 29.5 g/l, > 24,600 leukocytes/mm3 and hematocrit > 30% behave as independent prognostic markers for HC. SAL ≤ 28 g/l, > 25,200 leukocytes/mm3 and hematocrit > 30% behave as prognostic markers for CNSd. SAL ≤ 31.6 g/l, > 13,800 leukocytes/mm3, hematocrit > 18.9% and hyponatremia (≤ 132 mEq/l) behave as prognostic markers for dialysis requirement. However, in multivariate logistic regression models, only hypoalbuminemia behaved as a risk factor for HC, CNSd and dialysis. α1-antitrypsin clearance was performed in 69 patients and was high in 9/69 (13%), only 4 with HC. No significant association was observed between α1-antitrypsin clearance and albuminemia (χ2 = 0.1076, p = 0.7429) as well as α1-antitrypsin clearance and HC (χ2 = 1.7892, p = 0.1810). CONCLUSIONS: Almost all patients with HC had hypoalbuminemia, which behaves as a risk factor for HC, CNSd and dialysis requirement. No significant association was observed between elevated α1-antitrypsin clearance and hypoalbuminemia nor between elevated α1-antitrypsin clearance and HC. These findings could be related to the small number of evaluated patients.

Relationship between red blood cell transfusion requirements and severity of renal disease during the acute stage of hemolytic uremic syndrome.

BACKGROUND: We performed a retrospective evaluation of patients with diarrhea-associated hemolytic uremic syndrome (D + HUS) with the aims of: (1) determining the rate of red blood cell (RBC) transfusions; (2) establishing the relationship between need for RBC transfusion and severity of renal involvement; (3) determining whether precise measurements of lactic dehydrogenase (LDH) levels can predict the rate of hemolysis and severity of renal disease. METHODS: A total of 288 patients with D + HUS were retrospectively divided into three groups based on dialysis treatment: group 1, no dialysis treatment (144 patients); group 2, dialysis for 1-10 days (67 patients); group 3, dialysis for ≥11 days (77 patients). RESULTS: Of the patients in groups 1, 2 and 3, 73.6, 86.5 and 83.1%, respectively, required at least one RBC transfusion. The number of RBC transfusions in groups 1, 2 and 3 was 163, 107 and 162, respectively. Comparison of the groups revealed that the number of RBC transfusions was significantly higher in patients in groups 2 and 3 than in those in group 1 (p = 0.0001). Most RBC transfusions (94.2%) occurred during the first 2 weeks of the disease. The median peak LDH level was 2091 U/l in 32 patients with no RBC transfusion (group A), 3900 U/l in 73 patients with one transfusion (group B) and 6378 U/l in 62 patients with two or more transfusions (group C). Patients who received two or more RBC transfusions had a significantly higher median peak LDH level than those who did not receive RBC transfusions or received only one transfusion. This difference was also observed between patients who received only one RBC transfusion and those who did not receive any transfusions (p < 0.00001). Comparison of LDH levels on admission and peak LDH levels among patients in groups A, B and C revealed that 28/32 patients in group A, 56/73 patients in group B and 33/62 patients in group C had a stable LDH level, suggesting that patients with a stable LDH level require fewer RBC transfusions (p ≤ 0.006). Finally, we evaluated the possibility of an association between peak LDH levels and the degree of renal disease. The median peak LDH level in patients of group 1, 2 and 3 was 3538 (range 756-9373), 5165 (451-9205) and 7510 (1,145-16,340) U/l, respectively. Patients with >10 days of dialysis (group 3) had the highest LDH levels, followed by patients with 1-10 days of dialysis (group 2) and then by patients with no dialysis requirements (group 1) (p < 0.00001). CONCLUSIONS: The rate of RBC transfusion was higher in patients with the most severe renal injury, and most were performed during the first 2 weeks of the disease. Patients with stable LDH levels seemed to require fewer RBC transfusions. Median peak LDH levels were significantly higher in the group of patients with the most severe renal disease.

Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children.

Hemorrhagic colitis (HC) is a severe manifestation of the hemolytic uremic syndrome (HUS). We performed a retrospective analysis of patients with HC with the following aims: (1) to characterize the clinicopathologic features; (2) to evaluate mortality rate; (3) to analyze severity of renal and central nervous system (CNS) disease. Patients with HC assisted between 1981-2009 were evaluated and compared with a control group of 137 patients without HC. Among 987 patients with diarrheal prodrome (D) + HUS, 54 (5.5%) presented HC. Clinical findings included abdominal pain (96%), distension (93%), hematochezia (44%), and abdominal mass (11%). Surgery was indicated in 35 patients (65%), and 17 (48.5%) required bowel resection. Transverse and ascending colon were most frequently affected. Macroscopic evaluation showed bowel necrosis (18) and perforation (12). Histologic evaluation (29) showed that 25 (86.2%) had necrosis of the affected segment (transmural in 21). A leukocyte count >20,000/mm(3) and hematocrit >30% were more common in HC patients than in controls (p < 0.001 and p < 0.0001, respectively). Mortality rate was higher in HC patients (33.3%) than in controls (1.4%; p < 0.0001). Dialysis >10 days, seizures, and coma were more frequent in HC patients than in controls (p < 0.0001). In summary, most patients had prominent abdominal findings, and almost 2/3 patients required surgery. Transverse/ascending colon was most affected, and the main histologic finding was transmural necrosis. Higher hematocrit and leukocytosis were frequent. Mortality rate was extremely high, and most had long-lasting anuria and severe neurologic involvement.

[Chronic renal failure, dialysis and transplant: multicentric study: 1996-2003]. / Enfermedad renal crónica, diálisis y trasplante: Estudio multicéntrico: 1996-2003.

OBJECTIVE: The multicentric study of chronic renal failure, dialysis and transplant started in 1996 by the Nephrology Committee of the Argentine Pediatrics Society with the aim of knowing the development characteristics of children with this pathology. POPULATION, MATERIAL AND METHODS: The study included children and adolescents on conservative treatment, dialysis or transplant who have registered any of the three modalities before being 19 year-old, since january 1996 to december 2003. The statistical analysis was made with the statistical software SAS; in order to calculate the survival curve, the method employed was Kaplan-Meier and the standardized height and weight z-scores were calculated. RESULTS: In this report, there is data related to 710 patients with chronic renal failure, under conservative treatment 34.2%, dialysis 57.6% and transplant 29.5%. The end-stage renal disease incidence was of 6.5/million inhabitants. The main etiologies were obstructive uropathy 18.3%, reflux nephropathy 15.1%, hemolytic uremic syndrome 14.4%, aplasia/dysplasia/hypoplasia 13.8%, and focal segmental glomerulosclerosis 8.9%. From the patients on dialysis treatment, 62.3% were under hemodialysis, and only 37.7% on peritoneal dialysis. Live-donor sources accounted for 46.2 % of the transplants, with a 1-year patient's survival of 98.7% and a 1-year graft survival of 96.4 %, similar with both donors. CONCLUSION: The results obtained, even though they do not correspond to the total population affected and the monitoring is still insufficient, allowed us to have a profile of the chronic renal failure in our country.

Síndorme nefrítico / Nephritic syndrome

El síndrome nefrítico se caracteriza por la combinación de hematuria y proteinuria como manifestación de injuria glomerular, generalmente asociadas a oliguria, hipertensión arterial y edema. La causa mas común del síndrome nefrítico es la glomérulo nefritis pos estreptocócica, secundaria a sepas nefritogenicas de estreptococo ß hemolítico del grupo A. Causas menos frecuentes son: otras infecciones, glomérulo nefritis membrano-proliferativa, LES, endocarditis bacteriana, enfermedad de Berger, Síndrome de Schonlein-Henoch, vasculitis, etc.

Síndorme Nefrítico / Nephritic Syndrome

El síndrome nefrítico se caracteriza por la combinación de hematuria y proteinuria como manifestación de injuria glomerular, generalmente asociadas a oliguria, hipertensión arterial y edema. La causa mas común del síndrome nefrítico es la glomérulo nefritis pos estreptocócica, secundaria a sepas nefritogenicas de estreptococo ß hemolítico del grupo A. Causas menos frecuentes son: otras infecciones, glomérulo nefritis membrano-proliferativa, LES, endocarditis bacteriana, enfermedad de Berger, Síndrome de Schonlein-Henoch, vasculitis, etc

The pharmacokinetic behaviour of marbofloxacin in Eurasian buzzards (Buteo buteo) after intraosseous administration.

This study reports on the administration of a single dose of marbofloxacin (2 mg/kg) to five adult Eurasian buzzards (Buteo buteo) by the intraosseous (IO) route, which has been proposed as a rapid and efficient means for the parenteral delivery of antimicrobial drugs. The drug was rapidly absorbed. Peak marbofloxacin concentration (C(max)) in plasma and area under the concentration-time curve (AUC) of 1.92+/-0.78 microg/mL and 8.53+/-2.73 microg h/mL, respectively. The time marbofloxacin remained in the plasma after IO administration was relatively short (elimination half-life, t(1/2beta)=4.91+/-0.65 h; mean residence time (MRT)=5.38+/-0.57 h). Single dose marbofloxacin gave values for C(max)/minimum inhibitory concentration (MIC) of 19.2 and an AUC/MIC value of 85.3h after IO administration. The IO route appears to be practical and effective for the rapid delivery of marbofloxacin to buzzards.

Complicaciones trombóticas en niños con síndrome nefrótico primario / Thrombotic complications in children with primary nephrotic syndrome

Introducción. Las complicaciones tromboembólicas, en niños con síndrome nefrótico, aunque infrecuentes, se cuentan entre las intercurrencias más graves. Objetivo. Descripción de nuestra experiencia en pacientes con síndrome nefrótico que han padecido episodios de complicaciones tromboembólicas, su incidencia, presentación clínica, anomalías de laboratorio, métodos auxiliares de diagnóstico empleados, tratamiento y evolución. Población, material y métodos. Se estudiaron en forma retrospectiva 610 niños con síndrome nefrótico primario asistidos en el Servicio de Nefrología del Hospital de Niños “Superiora Sor María Ludovica” de La Plata (Argentina), en un período de 32 años (1969-2001). Se analizaron 9 pacientes en los cuales se determinó la presencia de complicaciones tromboembólicas, su presentación clínica, localización, factores condicionantes, laboratorio, tratamiento y evolución. Resultados. En 9 de 610 pacientes con síndrome nefrótico (incidencia: 1,47 por ciento) se detectaron 11 episodiosde trombosis. Cinco de ellos presentaron un síndrome nefrótico corticosensible (2 corticodependientes) y 4 corticorresistentes. Se efectuaron biopsias renales percutáneas en 5 (3 cambios mínimos y 2 glomerulonefritis membrano proliferativa tipo II). Las localizaciones de las complicaciones tromboembólicas fueron variadas: cerebro (n igual 6 ), venas profundas de miembros inferiores (n igual 5), senos intracraneanos (n igual 2), venas ilíacas, venas renales, vena cava, un trombo intracardíaco y tromboembolismo pulmonar (estas 5 últimas como parte de un evento trombótico generalizado en un mismo paciente). Todos los episodios se desarrollaron durante una recaída del síndrome nefrótico, bajo tratamiento esteroideo. Según la localización, la complicación tromboembólica se confirmó mediante ecografía Doppler color, tomografía axial computada, angiografía radiológica y tomográfica o angiorresonancia magnética.

Complicaciones trombóticas en niños con síndrome nefrótico primario / Thrombotic complications in children with primary nephrotic syndrome

Introducción. Las complicaciones tromboembólicas, en niños con síndrome nefrótico, aunque infrecuentes, se cuentan entre las intercurrencias más graves. Objetivo. Descripción de nuestra experiencia en pacientes con síndrome nefrótico que han padecido episodios de complicaciones tromboembólicas, su incidencia, presentación clínica, anomalías de laboratorio, métodos auxiliares de diagnóstico empleados, tratamiento y evolución. Población, material y métodos. Se estudiaron en forma retrospectiva 610 niños con síndrome nefrótico primario asistidos en el Servicio de Nefrología del Hospital de Niños ¶Superiora Sor María Ludovica÷ de La Plata (Argentina), en un período de 32 años (1969-2001). Se analizaron 9 pacientes en los cuales se determinó la presencia de complicaciones tromboembólicas, su presentación clínica, localización, factores condicionantes, laboratorio, tratamiento y evolución. Resultados. En 9 de 610 pacientes con síndrome nefrótico (incidencia: 1,47 por ciento) se detectaron 11 episodiosde trombosis. Cinco de ellos presentaron un síndrome nefrótico corticosensible (2 corticodependientes) y 4 corticorresistentes. Se efectuaron biopsias renales percutáneas en 5 (3 cambios mínimos y 2 glomerulonefritis membrano proliferativa tipo II). Las localizaciones de las complicaciones tromboembólicas fueron variadas: cerebro (n igual 6 ), venas profundas de miembros inferiores (n igual 5), senos intracraneanos (n igual 2), venas ilíacas, venas renales, vena cava, un trombo intracardíaco y tromboembolismo pulmonar (estas 5 últimas como parte de un evento trombótico generalizado en un mismo paciente). Todos los episodios se desarrollaron durante una recaída del síndrome nefrótico, bajo tratamiento esteroideo. Según la localización, la complicación tromboembólica se confirmó mediante ecografía Doppler color, tomografía axial computada, angiografía radiológica y tomográfica o angiorresonancia magnética.(AU)