Changes of microbial and metabolome of the equine hindgut during oligofructose-induced laminitis.

BACKGROUND: Laminitis is a common and serve disease which caused by inflammation and pathological changes of the laminar junction. However, the pathologic mechanism remains unclear. In this study we aimed to investigate changes of the gut microbiota and metabolomics in oligofructose-induced laminitis of horses. RESULTS: Animals submitted to treatment with oligofructose had lower fecal pH but higher lactic acid, histamine, and Lipopolysaccharide (LPS) in serum. Meanwhile, oligofructose altered composition of the hindgut bacterial community, demonstrated by increasing relative abundance of Lactobacillus and Megasphaera. In addition, the metabolome analysis revealed that treatment with oligofructose decreased 84 metabolites while 53 metabolites increased, such as dihydrothymine, N3,N4-Dimethyl-L-arginine, 10E,12Z-Octadecadienoic acid, and asparagine. Pathway analysis revealed that aldosterone synthesis and secretion, regulation of lipolysis in adipocytes, steroid hormone biosynthesis, pyrimidine metabolism, biosynthesis of unsaturated fatty acids, and galactose metabolism were significantly different between healthy and laminitis horses. Furthermore, correlation analysis between gut microbiota and metabolites indicated that Lactobacillus and/or Megasphaera were positively associated with the dihydrothymine, N3,N4-Dimethyl-L-arginine, 10E,12Z-Octadecadienoic acid, and asparagine. CONCLUSIONS: These results revealed that disturbance of gut microbiota and changes of metabolites were occurred during the development of equine laminitis, and these results may provide novel insights to detect biomarkers for a better understanding of the potential mechanism and prevention strategies for laminitis in horses.

Impact of dedicated infectious disease teamwork on the treatment and prognosis of patients with diabetic foot infection.

OBJECTIVE: The aim was to develop and evaluate the impact of a new model in which the infectious disease (ID) physician and pharmacist work together to treat diabetic foot infections (DFIs). METHODS: A quasi-experimental before-after study was conducted. The medical charts of inpatients with DFI admitted between April 1, 2017 and March 31, 2018 were reviewed retrospectively (control group, n = 30). Inpatients diagnosed with DFI between April 1, 2018 and March 31, 2019 were enrolled prospectively as the intervention group and received treatment through dedicated ID teamwork (intervention group, n = 35). RESULTS: The distribution of infection severity and levels of metabolic criteria were similar in the two groups. Compared with the control group, the intervention group received adequate initial empirical treatment more frequently (96.8% vs 43.5%, p < 0.001) and had a shorter median duration of fever (1 day vs 7.5 days, p < 0.001). Rates of healing and relapse within 6 months were similar in the two groups, although the intervention group showed more sites of osteomyelitis (p = 0.036) and a higher percentage of polymicrobial infections (48.6% vs 10.0%, p = 0.001). CONCLUSION: The early and full participation of ID physicians and pharmacists in the treatment of DFI facilitated targeted antimicrobial treatment and improved patient outcomes.

Are mosque carpets' reservoirs for fungi causing superficial foot mycosis? A cross-sectional study in Riyadh, Saudi Arabia.

The possibility of superficial foot mycoses to spread through contaminated mosque carpets between worshipers imposes a great health burden and is never addressed in Riyadh, SA. We aimed to assess the prevalence of fungal infections, especially human dermatophytosis acquired from mosque carpets, in five different regions of Riyadh, Saudi Arabia and establish a means of contamination control. A cross-sectional study of 100 mosques in Riyadh, Saudi Arabia, was conducted, using a multistage random cluster sampling technique. The study included mosques that had an ablution area and regularly hosted five prayers a day. Sterile swabs were used for sampling, and the samples were transported to the laboratory for culture and analysis using a micro-scan system. A total of 199 (65%) samples contained several fungal species. Rhodotorula (74%), Cladosporium (47%), Bipolaris (46.6%), other yeasts (43.7%), Alternaria (40%), dematiaceous molds (34%), Curvularia (32.4%), and Candida (31%) were the most frequently isolated species. Species belonging to several other genera were also detected. This study revealed a relatively high prevalence of fungal organisms in mosque carpets in Riyadh, suggesting the need for implementing new strategies and laws to increase the level of hygiene awareness among worshipers and mosque caretakers to limit the spread of foot fungal infections.

Characterization of Foot Mycetoma Using Sonography and Color Doppler Imaging.

BACKGROUND AND OBJECTIVE: Mycetoma of the foot, commonly referred to as Madura foot, is a chronic granulomatous infection, which impacts vascularization of the affected region. This study aimed to evaluate foot mycetoma using Doppler and sonography techniques to identify the principle sonographic features and blood flow patterns associated with the condition. MATERIALS AND METHODS: This was a cross-sectional prospective single-center study conducted at the Mycetoma Research Center (MCR) in Khartoum State, Sudan. Sixty patients with Madura foot were examined using a Duplex ultrasound machine with a 7-10 MHZ linear probe. Data was analyzed using SPSS software. The distribution of demographic data was evaluated by simple descriptive statistics. Statistical tests was performed using Student's independent t-tests to compare different forms of mycetoma and Chi-square tests to examine differences in blood flow patterns between fungal (eumycetoma) and bacterial (actinomycetoma) forms of the infection. RESULTS: The presence of multiple cavities and aggregated grains were more common in eumycetoma than in actinomycetoma. The echotexture was significantly more heterogeneous in eumycetoma than in actinomycetoma (p = 0.03). Eumycetoma had higher vascularity than actinomycetoma. CONCLUSION: Mycetoma has characteristic sonographic features and patterns of vascularity, which are essential to differentiate between the fungal and bacterial forms of mycetoma.

Orthopedic Surgical Foot Management in Hansen Disease.

Hansen disease remains a common problem worldwide with 750,000 new cases diagnosed each year. Nerve injury is a central feature of the pathogenesis because of the unique tendency of Mycobacterium leprae to invade Schwann cells and the peripheral nervous system, that can be permanent and develop into disabilities. The orthopedic surgeon has an important role in the management of neuropathy, performing surgical release of the tibial and common peroneal nerves in potentially constricting areas, thus providing a better environment for nerve function. In cases of permanent loss of nerve function with drop foot, specific tendon transfers can be used.

Bayesian assessment of diagnostic accuracy of a commercial borescope and of trimming chute exams for diagnosing digital dermatitis in dairy cows.

Digital dermatitis (DD) is a worldwide infectious disease of cattle that causes lameness, discomfort, and economic losses. The reference standard test to diagnose DD is visual observation in a trimming chute, which cannot be practically performed daily on dairy farms. Moreover, some lesion misclassification may occur using this standard diagnostic method. The possibility of misclassification makes the use of a trimming chute debatable as a perfect reference standard test. The objective of this study was, therefore, to assess the diagnostic accuracy of a commercial borescope and trimming chute exam. The accuracy (sensitivity and specificity) of the tests and DD prevalence were investigated using Bayesian latent class analyses. Our hypothesis was that a commercial borescope can be routinely used to diagnose DD in a milking parlor without previous feet cleaning. A cross-sectional study was performed in a freestall facility. The lesions were scored (M0, M1, M2, M3, M4, M4.1) in the milking parlor with a borescope, followed by an examination in the trimming chute 48 to 72 h after the borescope exam. A total of 870 hind feet were scored during 2 sessions of trimming chute exams and borescope exams in the milking parlor. The data were analyzed in 2 ways. First, data were dichotomized into DD lesions (M1, M2, M3, M4, M4.1) and absence of DD lesions (M0). Second, data were dichotomized into active DD lesions (M1, M2, M4.1) and inactive lesions (M0, M3, M4). A Bayesian latent class model allowing for conditional dependence between tests was used to estimate tests' accuracy, likelihood ratio, and DD prevalence. When the data were dichotomized into DD lesions (M1-M4.1) versus absence of DD (M0) lesions, the sensitivity and specificity of the borescope was 55% [95% credible interval (CrI) 40-71%] and 81% (95% CrI 75-88%). The sensitivity of trimming chute exams was 79% (95% CrI 68-88%), and specificity was 80% (95% CrI 71-89%). When the data were dichotomized into active lesions (M1, M2, M4.1) versus inactive lesions or absence of lesions (M3, M4, M0), the sensitivity and specificity of the borescope were, respectively, 32% (95% CrI 13-58%) and 91% (95% CrI 88-95%). The sensitivity and specificity of trimming chute exams were 91% (95% CrI 81-97%) and 81% (95% CrI 75-89%), respectively. In conclusion, it is possible to use the borescope in the milking parlor without cleaning the feet to monitor prevalence of DD lesions. However, an isolated borescope examination, especially for diagnosing active DD lesions, has low sensitivity for use as a surveillance method. For such use, the sensitivity could be improved by repeating the borescope exam on a regular basis.

Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region.

BACKGROUND: Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues that can be caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). It is the prerogative of young men between the third and fourth decade and is transmitted through any trauma causing an inoculating point. The classic clinical triad associates a painless hard and swelling subcutaneous mass, multiple fistulas, and the pathognomonic discharge of grains. Although endemic in many tropical and subtropical countries, mycetoma can also be found in non-endemic areas as in Morocco, and causes then diagnosis problems leading to long lasting complications. Therefore, we should raise awareness of this neglected disease for an earlier management. Under medical treatment however, mycetoma has a slow healing and surgery is often needed, and relapses are possible. CASE PRESENTATION: Herein we report a case of a 64 years old patient, with a history of eumycetoma occurring ten years ago treated with oral terbinafine coupled with surgery. A complete remission was seen after 2 years. He presented a relapse on the previous scar 6 months ago. There wasn't any bone involvement in the magnetic resonance imaging (MRI). The patient was put under oral terbinafine with a slow but positive outcome. CONCLUSION: Through this case report, we perform a literature review and highlight the importance of increase awareness of mycetoma in clinical practice especially in non-endemic regions.

Acute phase response and clinical manifestation in outbreaks of interdigital phlegmon in dairy herds.

Several Finnish dairy herds have suffered from outbreaks of interdigital phlegmon (IP). In these new types of outbreaks, morbidity was high and clinical signs severe, resulting in substantial economic losses for affected farms. In our study, we visited 18 free stall dairy herds experiencing an outbreak of IP and 3 control herds without a similar outbreak. From a total of 203 sampled cows, 60 suffered from acute stage IP. We demonstrated that acute phase response of bovine IP was evident and therefore an appropriate analgesic should be administered in the treatment of affected animals. The response was most apparent in herds with high morbidity in IP and with a bacterial infection comprising Fusobacterium necrophorum and Dichelobacter nodosus, indicating that combination of these two bacterial species affect the severity of the disease.

[Plantar actinomycetoma in a patient without risk factors]. / Actinomicetoma plantar en un paciente sin factores de riesgo.

A case of plantar actinomycetoma without risk factors is presented, which was diagnosed by hystopatological analysis of a foot biopsy because of the suspicion of neoplasia. Since the patient did not fully respond to the first-line therapy antibiotics, a 24-weeks doxycycline regime was started, achieving a satisfactory response. Finally, a brief discussion on plantar mycetomas is presented.

The microbiome of the footrot lesion in Merino sheep is characterized by a persistent bacterial dysbiosis.

Footrot is prevalent in most sheep-producing countries; the disease compromises sheep health and welfare and has a considerable economic impact. The disease is the result of interactions between the essential causative agent, Dichelobacter nodosus, and the bacterial community of the foot, with the pasture environment and host resistance influencing disease expression. The Merino, which is the main wool sheep breed in Australia, is particularly susceptible to footrot. We characterised the bacterial communities on the feet of healthy and footrot-affected Merino sheep across a 10-month period via sequencing and analysis of the V3-V4 regions of the bacterial 16S ribosomal RNA gene. Distinct bacterial communities were associated with the feet of healthy and footrot-affected sheep. Infection with D. nodosus appeared to trigger a shift in the composition of the bacterial community from predominantly Gram-positive, aerobic taxa to predominantly Gram-negative, anaerobic taxa. A total of 15 bacterial genera were preferentially abundant on the feet of footrot-affected sheep, several of which have previously been implicated in footrot and other mixed bacterial diseases of the epidermis of ruminants. Some, including Porphyromonas, can trigger a shift in the composition of bacterial communities and may therefore be of significance to the expression of footrot. A comparison of the communities in footrot lesions of different scores and at different times revealed that this state of dysbiosis is persistent at the active margins of lesions, irrespective of their severity.

Different microbiomes are found in healthy breeder ducks and those with foot pad dermatitis.

Foot pad dermatitis (FPD) is a serious problem of the modern poultry industry, negatively affecting birds' welfare and health status, walking and feeding activity, growth performance, carcass quality, and economic performance of meat production. The gut microbiome in poultry with FPD has not been previously investigated. Therefore, we compared the cecal microbiomes of 8 breeding ducks with FPD to 8 control ducks (breeders with apparently healthy feet) by pyrosequencing the bacterial 16S ribosomal RNA gene. The results showed a significant ß-diversity (P < 0.05) of cecal microbiota presented between healthy and FPD-affected breeder ducks. The plasma endotoxins, interleukin 1ß (IL-1ß), IL-17, IL-6, IL-10, and tumor necrosis factor-α concentration, and the abundance of class Clostridia in FPD-affected ducks was markedly higher (P < 0.05), however, the abundance of genus Prevotella, Lactobacillus, Lachnospiraceae UCG-008, and the Firmicutes to Bacteroidetes ratio in FPD-affected ducks was significantly lower (P < 0.05) when compared to healthy ducks. These findings suggest when duck breeders are affected with FPD, ducks show an increased inflammatory response and a difference of structure and composition of the cecal microbiome.

Actinomicetoma plantar en un paciente sin factores de riesgo / Plantar actinomycetoma in a patient without risk factors

Resumen Se presenta un caso clínico de un actinomicetoma plantar en un paciente sin factores de riesgo, cuyo diagnóstico fue realizado mediante una biopsia de tejido plantar por sospecha de una neoplasia. Dado que el paciente no respondió satisfactoriamente a la terapia de primera línea, debió completar 24 semanas de tratamiento con doxiciclina, a lo cual evolucionó favorablemente. Finalmente, se desarrolla una breve discusión sobre los micetomas plantares.

A case of plantar actinomycetoma without risk factors is presented, which was diagnosed by hystopatological analysis of a foot biopsy because of the suspicion of neoplasia. Since the patient did not fully respond to the first-line therapy antibiotics, a 24-weeks doxycycline regime was started, achieving a satisfactory response. Finally, a brief discussion on plantar mycetomas is presented.

Innocuous "foot lump" in patient with diabetes mellitus: A manifestation of phaeohyphomycosis.

Invasive mycotic infection presenting as "foot lump" in an immunocompetent patient is extremely rare. The case highlights the difficulty in diagnosis of fungal infections of foot including attempts to isolate the fungus and non-response to anti-fungal agents. A 64-year-old lady with T2DM for four years presented with painless, gradually progressive swelling over plantar aspect of left mid-foot for six months. Foot examination revealed soft-to-firm lump over the plantar aspect of left mid-foot obscuring the lateral longitudinal arch. No signs of inflammation or bony deformities were noticed. X-ray foot revealed radio-dense shadow in soft tissue without bone changes, corroborated by MRI. A diagnosis of lipoma, ganglion cyst, tubercular abscess and a fungal infection were considered. Aspirate cytology suggested the presence of Aspergillus hyphae although repeated cultures were unsuccessful. Medical management in form of itraconazole initially, followed by voriconazole was tried. However, there was no response to anti fungal agents and the lesion was surgically excised. Histopathological examination confirmed the presence of pigmented fungus (phaehyphomycosis).

Treponeme-Associated Hoof Disease of Free-Ranging Elk ( Cervus elaphus) in Southwestern Washington State, USA.

A novel foot disease in free-ranging elk ( Cervus elaphus) in southwestern Washington State emerged in 2008 and spread throughout the region. Initial studies showed adult elk had chronic hoof overgrowth, sole ulcers, and sloughed hoof capsules, but no cause was determined. To identify possible causes and characterize the earliest lesions, 9-, 7-, and 3-month-old elk were collected. Nine-month-old elk had sole ulcers (3/9 elk) and sloughed/overgrown hoof capsules (4/9 elk) similar to adults. Histologically, lesions consisted of coronary, heel bulb, and interdigital ulcers with suppurative inflammation, epithelial hyperplasia, deeply invasive spirochetes, and underrunning of the hoof capsule and heel-sole junction. Spirochetes were identified as Treponema via immunohistochemistry and polymerase chain reaction (PCR). Seven-month-old elk had similar underrunning foot ulcers (6/8 elk) with Treponema identified in all lesions but no chronic overgrowth or sloughed hoof capsules. Three-month-old calves had superficial coronary erosions with no inflammation or identifiable spirochetes (3/5 elk) but were culture/PCR positive for Treponema, suggesting possible early lesions. Lesions from 9- and 7-month-old elk included aerobic and anaerobic bacteria, many of which are associated with infectious foot disease in livestock. Antibody enzyme-linked immunosorbent assay of 7- and 3-month-old elk from the enzootic region showed a trend toward increased Treponema antibody titers compared to normal control elk from outside the region, further supporting the significance of Treponema in the pathogenesis of foot disease. Treponeme-associated hoof disease (TAHD) in elk, a debilitating and progressive condition, shares similarities to bovine digital dermatitis and contagious ovine digital dermatitis.

Mechanical removal (epidermal scarification) of pododermatitis injuries reduces the presence of both inflammatory tissue and its associated microbiota in broiler feet.

Chicken feet have become an important commodity in the international market, representing a significant portion of poultry products exported by countries such as Brazil and the USA. However, the presence of pododermatitis in the footpad is an important barrier to exportation, since importing countries do not accept injured feet or allow the use of automatic equipments to remove the affected tissue. The objective of this research was to evaluate the impact of using an automatic equipment to remove injuries of pododermatitis on histological and microbiological traits of broiler feet processed according to commercial practices. A total of 240 broiler feet obtained from a commercial processing plant was visually classified according to the degree of pododermatitis and distributed in a 4 × 2 factorial arrangement, totalizing eight treatments with 30 replications. Factors were feet classification (1 to 4) and injury removal (yes or no). Feet were sampled for microbiological and histological analysis before and after the mechanical removal of pododermatitis injuries by an automatic machine that promoted footpad epidermal scarification. No significant interaction between feet classification and injury removal was detected for any of the analyzed variables. Also, no significant effect of feet classification was detected on aerobic plate counts, total coliforms and Escherichia coli. Feet inflammation score tended to increase (P = 0.06) according to the downgrading of feet classification, but the mechanical removal of pododermatitis injuries reduced feet inflammation score (P < 0.01), total coliform counts (P = 0.01), and E. coli (P = 0.01) independently of feet classification. Together, these results demonstrate the efficacy of the automatic equipment in removing both the inflammatory tissue and its associated microbiota in broiler feet affected by pododermatitis. Therefore, in addition to the already authorized use of blades, the use of automatic equipments for epidermal scarification in the processing of broiler feet deserves further consideration by the regulatory agencies.

The importance of diagnostic imaging of mycetoma in the foot.

BACKGROUND: Mycetoma is a chronic, localized infection caused by fungi and bacteria. It usually affects the skin, subcutaneous tissue, and bone of exposed areas with deformity of the affected limb, ulcers, and fistula; however, pain is not severe, therefore the patient comes late to hospital for care. OBJECTIVE: To establish the diagnosis of mycetoma in the foot by imaging and identify the principal radiological signs. MATERIALS AND METHODS: Six patients with foot mycetoma were evaluated with plain x-ray, ultrasound, and magnetic resonance (MR) after confirming the diagnosis by histopathology and culture. RESULTS: All patients presented the MR "dot-in-circle" sign; four presented "punched out" bone lesions on plain x-ray. The six patients had fistulas, ulceration, a seropurulent exudate, edema, and a foot deformity. Four patients had N. brasiliensis infection with positive anti-Nocardia IgG antibodies, and only half presented bone lesions. CONCLUSION: Characteristic findings were foot deformity, edema, bone lesions, ulcers, fistulas and the presence of the "dot-in-circle" sign. We recommend a comprehensive study of patients with plain x-ray and MR.