Effects of the microencapsulated feed additive of lactic acid bacteria on production parameters and post-vaccinal immune response in pigs.

The aim of the study was to determine the effects of feed addition of LAVIPAN PL5 probiotic preparation containing compositions of microencapsulated lactic acid bacteria (Leuconostoc mesenteroides, Lactobacillus casei, Lactobacillus plantarum, Pediococcus pentosaceus) on production parameters and post-vaccinal immune response in pigs under field condition. The study was performed on 400 pigs in total and 60 pigs from this group were used to evaluate the effect of the product tested on the post-vaccinal response. The animals were divided into two groups: control group, fed without additive of LAVIPAN PL5 and the study group, receiving LAVIPAN PL5 at doses recommended by manufacturer from weaning to the end of fattening. The following parameters were recorded: main production parameters, including weight gains, fattening time (slaughter age) and animal health status during the study (mortality), and specific humoral post-vaccinal response after vaccination against swine erysipelas. The results indicate that the application of LAVIPAN PL5 had positive influence on the animals` productivity and did not significantly affect the post-vaccinal antibody levels and the development and maintenance of the post-vaccinal response, albeit the levels of antibodies were slightly higher in the animal receiving the test preparation. The higher average daily weight gains (by over 3%) which resulted in a 2 kg higher average weight at slaughter and a reduction of the fattening period by 5 days, undoubtedly contributed to significant economic benefits.

[Non-Necrotizing Acute Dermo-Hypodermal Infections: Erysipela and Infectious Cellulitis]. / Dermo-Hipodermites Bacterianas Agudas Não Necrotizantes: Erisipela e Celulite Infeciosa.

Non-necrotizing acute dermo-hypodermal infections are infectious processes that include erysipela and infectious cellulitis, and are mainly caused by group A ß-haemolytic streptococcus. The lower limbs are affected in more than 80% of cases and the risk factors are disruption of cutaneous barrier, lymphoedema and obesity. Diagnosis is clinical and in a typical setting we observe an acute inflammatory plaque with fever, lymphangitis, adenopathy and leucocytosis. Bacteriology is usually not helpful because of low sensitivity or delayed positivity. In case of atypical presentations, erysipela must be distinguished from necrotizing fasciitis and acute vein thrombosis. Flucloxacillin and cefradine remain the first line of treatment. Recurrence is the main complication, so correct treatment of the risk factors is crucial.

As dermo-hipodermites bacterianas agudas não necrotizantes são processos infeciosos que incluem a erisipela e a celulite infeciosa, e são geralmente causadas por estreptococos ß­hemolíticos do grupo A. Em mais de 80% dos casos situam-se nos membros inferiores e são fatores predisponentes a existência de solução de continuidade na pele, o linfedema crónico e a obesidade. O seu diagnóstico é essencialmente clínico e o quadro típico baseia-se na presença de placa inflamatória associada a febre, linfangite, adenopatia e leucocitose. Os exames bacteriológicos têm baixa sensibilidade ou positividade tardia. Nos casos atípicos é importante o diagnóstico diferencial com a fasceíte necrotizante e a trombose venosa profunda. A flucloxacilina ou a cefradina são os fármacos de primeira linha. A recidiva constitui a complicação mais frequente, sendo fundamental o correto tratamento dos fatores de risco.

Interventions for the prevention of recurrent erysipelas and cellulitis.

BACKGROUND: Erysipelas and cellulitis (hereafter referred to as 'cellulitis') are common bacterial skin infections usually affecting the lower extremities. Despite their burden of morbidity, the evidence for different prevention strategies is unclear. OBJECTIVES: To assess the beneficial and adverse effects of antibiotic prophylaxis or other prophylactic interventions for the prevention of recurrent episodes of cellulitis in adults aged over 16. SEARCH METHODS: We searched the following databases up to June 2016: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and LILACS. We also searched five trials registry databases, and checked reference lists of included studies and reviews for further references to relevant randomised controlled trials (RCTs). We searched two sets of dermatology conference proceedings, and BIOSIS Previews. SELECTION CRITERIA: Randomised controlled trials evaluating any therapy for the prevention of recurrent cellulitis. DATA COLLECTION AND ANALYSIS: Two authors independently carried out study selection, data extraction, assessment of risks of bias, and analyses. Our primary prespecified outcome was recurrence of cellulitis when on treatment and after treatment. Our secondary outcomes included incidence rate, time to next episode, hospitalisation, quality of life, development of resistance to antibiotics, adverse reactions and mortality. MAIN RESULTS: We included six trials, with a total of 573 evaluable participants, who were aged on average between 50 and 70. There were few previous episodes of cellulitis in those recruited to the trials, ranging between one and four episodes per study.Five of the six included trials assessed prevention with antibiotics in participants with cellulitis of the legs, and one assessed selenium in participants with cellulitis of the arms. Among the studies assessing antibiotics, one study evaluated oral erythromycin (n = 32) and four studies assessed penicillin (n = 481). Treatment duration varied from six to 18 months, and two studies continued to follow up participants after discontinuation of prophylaxis, with a follow-up period of up to one and a half to two years. Four studies were single-centre, and two were multicentre; they were conducted in five countries: the UK, Sweden, Tunisia, Israel, and Austria.Based on five trials, antibiotic prophylaxis (at the end of the treatment phase ('on prophylaxis')) decreased the risk of cellulitis recurrence by 69%, compared to no treatment or placebo (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.13 to 0.72; n = 513; P = 0.007), number needed to treat for an additional beneficial outcome (NNTB) six, (95% CI 5 to 15), and we rated the certainty of evidence for this outcome as moderate.Under prophylactic treatment and compared to no treatment or placebo, antibiotic prophylaxis reduced the incidence rate of cellulitis by 56% (RR 0.44, 95% CI 0.22 to 0.89; four studies; n = 473; P value = 0.02; moderate-certainty evidence) and significantly decreased the rate until the next episode of cellulitis (hazard ratio (HR) 0.51, 95% CI 0.34 to 0.78; three studies; n = 437; P = 0.002; moderate-certainty evidence).The protective effects of antibiotic did not last after prophylaxis had been stopped ('post-prophylaxis') for risk of cellulitis recurrence (RR 0.88, 95% CI 0.59 to 1.31; two studies; n = 287; P = 0.52), incidence rate of cellulitis (RR 0.94, 95% CI 0.65 to 1.36; two studies; n = 287; P = 0.74), and rate until next episode of cellulitis (HR 0.78, 95% CI 0.39 to 1.56; two studies; n = 287). Evidence was of low certainty.Effects are relevant mainly for people after at least two episodes of leg cellulitis occurring within a period up to three years.We found no significant differences in adverse effects or hospitalisation between antibiotic and no treatment or placebo; for adverse effects: RR 0.87, 95% CI 0.58 to 1.30; four studies; n = 469; P = 0.48; for hospitalisation: RR 0.77, 95% CI 0.37 to 1.57; three studies; n = 429; P = 0.47, with certainty of evidence rated low for these outcomes. The existing data did not allow us to fully explore its impact on length of hospital stay.The common adverse reactions were gastrointestinal symptoms, mainly nausea and diarrhoea; rash (severe cutaneous adverse reactions were not reported); and thrush. Three studies reported adverse effects that led to discontinuation of the assigned therapy. In one study (erythromycin), three participants reported abdominal pain and nausea, so their treatment was changed to penicillin. In another study, two participants treated with penicillin withdrew from treatment due to diarrhoea or nausea. In one study, around 10% of participants stopped treatment due to pain at the injection site (the active treatment group was given intramuscular injections of benzathine penicillin).None of the included studies assessed the development of antimicrobial resistance or quality-of-life measures.With regard to the risks of bias, two included studies were at low risk of bias and we judged three others as being at high risk of bias, mainly due to lack of blinding. AUTHORS' CONCLUSIONS: In terms of recurrence, incidence, and time to next episode, antibiotic is probably an effective preventive treatment for recurrent cellulitis of the lower limbs in those under prophylactic treatment, compared with placebo or no treatment (moderate-certainty evidence). However, these preventive effects of antibiotics appear to diminish after they are discontinued (low-certainty evidence). Treatment with antibiotic does not trigger any serious adverse events, and those associated are minor, such as nausea and rash (low-certainty evidence). The evidence is limited to people with at least two past episodes of leg cellulitis within a time frame of up to three years, and none of the studies investigated other common interventions such as lymphoedema reduction methods or proper skin care. Larger, high-quality studies are warranted, including long-term follow-up and other prophylactic measures.

[Recurrent erysipelas and cellulitis: management]. / Erysipèle et dermohypodermite récidivants: prise en charge.

Erysipelas and infectious cellulitis are skin infections that develop following the entry of bacteria through gaps in the skin. The most common complication is recurrence. Control of predisposing factors remains essential to prevent it. Prophylactic antibiotics are sometimes prescribed, but this approach is based on small studies and expert opinion. This article reflects the current state of knowledge and the standard of care.

Prevalence of Met-203 type spaA variant in Erysipelothrix rhusiopathiae isolates and the efficacy of swine erysipelas vaccines in Japan.

Since 2009, erysipelas infection among pigs in Japan has been increasing. This study investigated the prevalence, and characteristics of Erysipelothrix rhusiopathiae isolates in Japan from 2008 to 2010 and assessed the efficacy of current commercial erysipelas vaccines. Based on polymorphisms in a 432-bp hypervariable region in the surface protective antigen A (spaA) gene, 34 isolates were classified into three groups: (i) Group 1 with methionine at position 203 (Met-203) and isoleucine at position 257 (Ile-257) (18 isolates of serotype 1a and one untypable isolate). (ii) Group 2 with Ile-257 (12 isolates of serotypes 1a, 1b, 2, 10 and 11), and (iii) Group 3 with alanine at position 195 (Ala-195) and Ile-257 (three isolates of serotype 1a). Isolates with Met-203 were highly pathogenic in mice and pigs, causing death in the pig and LD50 values of 0.45-1.45 CFU per mouse. One live and three inactivated commercial E. rhusiopathiae vaccines were evaluated for efficacy against a Met-203 isolate. Almost all mice and pigs that received vaccine survived, while non-vaccinated controls all died within 5 days of the challenge. This indicates that swine erysipelas vaccines might be still effective in protecting animals against the recently prevalent Met-203 isolates in Japan.

Erysipelas in laying hens is associated with housing system.

Following the change from conventional cages to non-cage housing systems and furnished cages, which in Sweden was finalised by 2005, problems caused by Erysipelothrix rhusiopathiae increased in laying hen flocks. This study aimed to investigate possible associations between housing systems for laying hens and outbreaks of erysipelas. Also, sera from 129 flocks in different housing systems, collected during 2005-2007, were analysed for the presence of antibodies to E rhusiopathiae using an indirect ELISA test. Antibodies were detected in all housing systems. The mean flock absorbance values from free-range flocks were significantly higher than corresponding values from other housing systems. Data on the Swedish laying hen population were compared with the recorded number of erysipelas outbreaks during 1998-2011. Outbreaks occurred on 15 farms with indoor litter-based systems (n=87 farms in 2011). No outbreak was diagnosed on farms with flocks in conventional or furnished cages. The results indicate that the risk for an outbreak was higher in free-range systems than in indoor litter-based systems, and lowest for flocks housed in cages. Absence of erysipelas in the majority of subsequent flocks on the affected farms suggested that proper measures, including vaccination, were undertaken.

[Treatment of limbs lymphedema]. / Traitement des lymphœdèmes des membres.

The treatment of lymphedema aims to reduce the volume and prevent infectious and joints mobility complications. This treatment rarely cure and is usually symptomatic; thus it should be continued throughout the life. The erysipelas and lymphangitis are common complications of lymphedema. Erysipela is always of streptococcal origin and requires systemic antibiotics. The risk of recurrent erysipelas on lymphedema is high. In case of large swelling associated with significant dermal sclerosis, it may lead to decrease joint mobility and functional impairment. The skin cares, manual lymph drainage, compression therapy with bandages and exercises are the four pillars of the complex decongestive therapy of limb lymphedema. Compression is the most important treatment. Lymphedema can be improved by only bandages, but a sustained improvement of lymphedema cannot be seen without bandages. The effectiveness of treatment must be evaluated by objective methods, measuring the perimeters of members or volumes. The management of lymphedema includes three phases: attack or initial treatment that aims to reduce volume of the lymphedema and maintenance phase to maintain the result and finally withdrawal phase. In the attack phase, we use complex decongestive therapy, mainly multilayer inelastic bandaging and manual lymphatic drainage (MLD). In the maintenance phase, we use elastic compression (stockings or sleeves) possibly associated with MLD. At all stages skin care and exercises are used. Adjuvant treatments may be useful (intermittent pneumatic compression, drug treatment). Surgery is rarely used except for genital lymphedema. The therapeutic management of lymphedema is difficult but has a variety of techniques. The complex decongestive therapy is very effective to restore a better quality of life even though it does not provide a cure for lymphedema.

[Optimization of prophylaxis of relapses of primary erysipelas with the use of cyclopheron].

The aim of the work was to evaluate efficiency of combined therapy of primary erysipelas with the use of immunomodulator cyclopheron (CP), its influence on the clinical picture of the disease, frequency of relapses, lipid peroxidation (LPO) and dynamics of anti-inflammatory cytokines (IL-1b, TNF-alpha). Some of the 87 patients with uncomplicated primary erysipelas of different localization were followed up for 2 years. Lipid peroxidation and dynamics of anti-inflammatory cytokines were studied in 65 patients. A group of 36 patients were given cyclopheron (Polisan, Russia) in addition to standard treatment including etiotropic, pathogenetic and symptomatic therapy. Cyclopheron was first administered by intramuscular injections and thereafter as tablets. Cyclopheron reduced duration of asthenovegetative syndrome, hyperemia, infiltration and regional lymphadenitis compared with controls, but did not significantly alter duration of fever and local oedema. The drug decreased the frequency of early complications as demonstrated by "absolute risk reduction" to 0.35 [0.19; 0.51]. Plasma levels of malonic dialdehyde, lipid hydroperoxides, and TNF-alpha in the reconvalescence period were lower than in control subjects suggesting optimization of homeostasis and correction of inflammatory processes. It is supposed that efficiency of cyclopheron in patients with primary erysipelas may be due to its immunomodulatory activity that prevents formation of chronic foci of Staphylococcal infections in derma and regional lymph nodes.

Recurrent erysipelas despite antibiotic prophylaxis: an analysis from case studies.

BACKGROUND: Erysipelas is a distinctive type of superficial cellulitis of the skin with prominent lymphatic involvement, generally caused by group A streptococci. A substantial proportion of patients experience recurrences of erysipelas, and this may be a reason to install prophylactic antibiotic treatment. Despite such prophylaxis, further recurrences are occasionally encountered. OBJECTIVES: To investigate recurrences of erysipelas during prophylactic antibiotic treatment and to delineate the reasons for such failure. METHODS: Retrospective chart review of 117 adult patients with episodes of erysipelas known in our institution between 1990 and 2004. RESULTS: Recurrent episodes of erysipelas, despite prophylactic treatment, were found in eight patients. Our analysis indicated noncompliance, incorrect selection and insufficient dosing of antibiotics, and causative pathogens other than streptococci as demonstrable causes of the recurrence of erysipelas. In three patients, a reason for failure could not be identified. CONCLUSIONS: In a minority of cases, erysipelas recurs despite antibiotic prophylaxis. Based on these cases, we first recommend that all efforts are made to (re)confirm the diagnosis of erysipelas and search for the causative microorganism. Based on this information, the right antibiotic with adequate dosing and timing can be selected. The issue of compliance with the prophylactic treatment should be addressed and finally, the clinician should be aware that prophylaxis does not prevent erysipelas in all cases.

Recurrence of lymphoedema-associated cellulitis (erysipelas) under prophylactic antibiotherapy: a retrospective cohort study.

OBJECTIVE: To identify the predictors of successful antibiotic prophylactic treatment using benzathin-penicillin G to prevent recurrence of erysipelas in patients with secondary upper limb lymphoedema. DESIGN: A retrospective cohort study. SETTING AND PATIENTS: Patients with secondary arm lymphoedema were recruited in a single lymphology unit between 1990 and 2003. All patients had had at least three recurrences of erysipelas. Patients were given 2.4 MU benzathin-penicillin G intramuscularly at 14-day intervals. For each patient, the following data were recorded: characteristics of breast cancer treatment (type of surgery, radiotherapy, hormone therapy), number of erysipelas recurrences before inclusion, patient characteristics including body mass index (BMI) and lymphoedema volume at inclusion. MAIN OUTCOME MEASURES: The outcome studied was the occurrence of erysipelas on the affected arm under antibiotic prophylactic treatment. RESULTS: With a 4.2-year median follow-up from the onset of antibiotic prophylactic treatment, 23 of 48 women experienced recurrence of erysipelas. The median duration of erysipelas recurrence-free period under this treatment was 2.7 years. The estimated rate of recurrence was 26%[95% confidence interval (CI) 13-38%] at 1 year and 36% (95% CI 22-50%) at 2 years. No patient stopped the treatment because of side-effects. No predictive factor of erysipelas recurrence under antibiotic prophylactic treatment was identified. CONCLUSIONS: Antibiotic prophylaxis using benzathin-penicillin is a well-tolerated treatment of erysipelas recurrence in patients with upper limb lymphoedema secondary to breast cancer. The rate of erysipelas recurrence was 26% at 1 year in patients who had a history of at least one erysipelas. We did not find any predictor of erysipelas recurrence.

Severe relapsing erysipelas associated with chronic Streptococcus agalactiae vaginal colonization.

We report a case of severe recurrent erysipelas of the breast due to infection with Streptococcus agalactiae and demonstrate that strains isolated from the skin were closely related to strains isolated from the vagina, which is consistent with the claim that the vagina acts as a reservoir for S. agalactiae isolates that are responsible for erysipelas relapse. Hypervirulence of strains and persistence of a bacterial reservoir may explain why 5 months of prophylaxis with penicillin V (1 million U daily) was necessary to achieve permanent eradication of vaginal carriage and to prevent recurrence of erysipelas caused by S. agalactiae infection.

Erysipelas in the critically endangered kakapo (Strigops habroptilus).

This paper describes the effect of a disease outbreak on the success of a translocation for conservation management in a critically endangered species. Three juvenile kakapo from a group of 19 translocated birds died within 72 h of transport between New Zealand offshore islands. Clinical findings, gross necropsy changes, cytology, histopathology and bacterial culture confirmed systemic disease caused by Erysipelothrix rhusiopathiae. On the island from which the kakapo were sourced, positive cultures of E. rhusiopathiae were obtained from the medulla of the ulna from 10 out of 15 seabird carcasses examined, suggesting that this could be the source of infection for the kakapo. Immediately after the diagnosis, all of the translocated birds were re-captured and treated with antibiotics. A vaccination programme has commenced using a commercial killed bacterin developed for turkeys. The disease outbreak has had costly implications for the population and conservation management of the species. This is the first report of erysipelas in wild parrots, and the first report of the management of erysipelas in a critically endangered wild population of birds.

[Erysipelas]. / Erisipela.

Erysipelas is an acute dermo-hypodermal infection (non necrotizing) of bacterial origin, mainly group A beta-haemolytic streptococcus. The lower limbs are affected in more than 80% of the cases and the identified risk factors are disruption of cutaneous barrier, lymphoedema and obesity. Diagnosis is clinical and based upon the association of an acute inflammatory plaque with fever, lymphangitis, adenopathy and leukocytosis. Bacteriology is usually not helpful because of low sensitivity or delayed positivity. In the atypical forms erysipelas must be distinguished from necrotizing fasciitis and acute vein thrombosis. Penicillin remains the gold standard treatment, although new drugs, given their pharmacodynamic profile, may be used. Recurrence is the main complication, being crucial the correct treatment of the risk factors.

[How I prevent erysipelas and its consequences and recurrences]. / Comment je préviens...un érysipèle, ses consequences et ses récidives.

Erysipelas is a serious infection of the skin. In case of delay in initiating adequate antibiotic treatment, complications, sometimes dismal, can supervene. In addition, erysipelas shows a tendancy to recurrences. The prevention of an episode of erysipelas calls for correct personal hygiene and adequate use of topical antiseptics in case of skin effraction, even when minimal. When erysipelas is established, a rapidly initiated antibiotic treatment for a prolonged period prevents streptococcal gangrene complications. Elastic contention of any leg edema from venous or lymphatic origin and prophylactic antisepsis of discrete wounds help in preventing erysipelas recurrences.