Development of diagnostic assays for differentiation of atypical Aeromonas salmonicida vapA type V and type VI in ballan wrasse (Labrus bergylta, Ascanius).

Aeromonas salmonicida (As) is a highly heterogeneous bacterial species, and strains' host specificity has been reported. Ballan wrasse (Labrus bergylta Ascanius, 1767) is susceptible to atypical As (aAs) vapA type V and type VI in Scotland and Norway. Identification of the bacterium is achieved by culture and molecular techniques; however, the available methods used to distinguish the As types are costly and time-consuming. This paper describes the development of a PCR and a restriction enzyme assay for the detection of aAs vapA type V and type VI in ballan wrasse, respectively. Type V-specific primers were designed on conserved regions of the vapA gene, and the restriction enzyme assay was performed on the PCR products of the hypervariable region of vapA gene for the detection of type VI isolates. Amplification product was produced for type V (254 bp) and restriction bands (368 and 254 bp) for type VI isolates only. In addition, the assays detected type V and type VI isolates in spiked water samples and type V in diagnostic tissue samples. The assays are fast, specific and cost-effective and can be used as specific diagnostic tools for cleaner fish, to detect infectious divergence strains, and to manage and mitigate aAs disease outbreaks through vaccine development.

Novel atypical Aeromonas salmonicida bath challenge model for juvenile ballan wrasse (Labrus bergylta, Ascanius).

Atypical Aeromonas salmonicida (aAs) is currently one of the most routinely recovered bacterial pathogens isolated during disease outbreaks in farmed cleaner fish, ballan wrasse (Labrus bergylta, Ascanius). Vibrionaceae family bacteria have also been isolated from ballan wrasse in Scotland. This study determined the infectivity, pathogenicity and virulence of aAs and Vibrionaceae isolates in juvenile farmed ballan wrasse (n = 50; approx. 2 g) using a bath challenge, and fish were monitored for a period of 16 days. Atypical As caused significant mortalities in contrast to Vibrionaceae isolates. Notably, differential virulence was observed between two aAs vapA type V strains at similar challenge doses. Diseased fish exhibited a systemic infection where aAs was detected in all analysed tissues (liver, spleen and kidney) by PCR and qPCR. Macroscopically, moribund and survivor fish exhibited hepatomegaly and splenomegaly. In moribund and surviving fish, histopathology showed granulomatous hepatitis with eosinophilic granular cells surrounding bacterial colonies and endocarditis along with splenic histiocytosis. This is the first report of a successful aAs bath challenge model for juvenile ballan wrasse which provides an important tool for future studies on vaccine efficacy and immunocompetence.

Prolonged Brackish Water Exposure: A Case Report.

Exposure to and consumption of brackish water are associated with an elevated risk of infection, hypernatremia, and hypothermia. Minimal data exist to support the diagnosis and treatment of patients with long-term brackish water exposure. We present a case of a patient who spent 5 to 10 d semisubmerged in the Elizabeth River in coastal Virginia. A 55-y-old male presented via ambulance after 5 to 10 d of being "stuck in the mud." He was hypernatremic, with a sodium of 176 mEq·L-1, hypothermic to 34.5°C (94.1°F), and hypotensive at 88/50 mm Hg, with a sodium concentration of 176 mEq·L-1 and an osmolality of 412 mosm·kg-1. He developed pneumonia, with respiratory cultures growing Vibrio parahemolyticus, Klebsiella oxytoca, and Shewanella algae. He had pustules, which grew Aeromonas hydrophilia and Aeromonas caviae. A nasogastric tube was placed. Using suction, 500 mL of coarse sand and gravel was removed from his stomach. Antibiotics and intravenous fluids were given. The patient fully recovered after 3 wk and was discharged to rehabilitation. Exposure to brackish water can present a unique set of infectious and metabolic complications. Initial care should include treatment of metabolic derangements, such as hypovolemia, hypernatremia, and hypothermia, and treatment of infections with antibiotics based on knowledge of the most likely causative organisms.

Rapidly fatal metastatic cutaneous angiosarcoma initially mimicking a furuncle in a middle-aged male.

Cutaneous angiosarcomas are rare but typically occur in three distinct clinical settings and are most commonly found on the scalp or face of elderly men. Positive prognostic factors include tumor size less than 5 cm, primary tumor location below the head, negative margins after excision, resectability, and younger age. Metastases drastically reduce survival and the most common metastatic site is lung. We present a 43-year-old man who had primary cutaneous angiosarcoma that initially mimicked a furuncle and eventuated in multiple metastases. The metastatic disease included brain involvement, which has rarely been reported, especially in a relatively young person without known predisposing conditions. This unique case also highlights the need for early diagnosis followed by advanced imaging, given the limitations of current therapies and high metastatic potential of angiosarcoma.

Development of a SYBR green I real-time PCR assay for specific identification of the fish pathogen Aeromonas salmonicida subspecies salmonicida.

A SYBR Green I real-time polymerase chain reaction protocol for specific detection of the fish pathogen Aeromonas salmonicida subsp. salmonicida was developed and validated for rapid diagnosis of typical furunculosis. The sequence of the aopO gene of A. salmonicida subsp. salmonicida, which encodes for a serine/threonine protein kinase linked to virulence, was chosen for primer design. The selected primers amplified a 119-bp internal fragment of the aopO gene. The specificity test proved that 100 % (40/40) of the A. salmonicida subsp. salmonicida strains tested showed a positive amplification with subspecies-specific melting temperatures (Tm) of 80.75 ± 0.35 °C. Atypical A. salmonicida subspecies and other non-related bacterial fish pathogens did not amplify or showed unspecific melting profiles, except for one strain of A. salmonicida subsp. achromogenes and one strain of A. salmonicida subsp. smithia. The detection sensitivity was 21 fg of purified bacterial DNA per reaction, corresponding to 1-2 bacterial cells and 6-60 bacteria per reaction for seeded kidney and blood. The assay was highly reproducible with low variation coefficient values for intra-run and inter-run assays. The assay also allowed the specific detection of A. salmonicida subsp. salmonicida in tissues of fish naturally and experimentally infected. No amplification was detected when tissues from healthy fish or fish affected by other diseases were tested. The SYBR Green real-time PCR and melt curve analysis developed in this study is a rapid and accurate method for the specific identification of A. salmonicida subsp. salmonicida isolates and its detection on tissues of fish affected by furunculosis.

O itinerário terapêutico do paciente em tratamento oncológico: implicações para a prática de enfermagem / El itinerario terapéutico del paciente en tratamiento oncológico: implicaciones para la práctica de enfermería / The therapeutic itinerary of patient in oncological treatment: implications for nursing practice

RESUMO A trajetória do cliente oncológico ainda é permeada por percalços que interferem em seu prognóstico e qualidade de vida. Assim, este estudo visa a mapear o itinerário do paciente oncológico desde o diagnóstico até o tratamento e analisar suas implicações nas ações de enfermagem para o controle do câncer. Estudo qualitativo, realizado através da técnica de história oral de dez clientes oncológicos atendidos em um hospital federal no município do Rio de Janeiro, Brasil. Os dados foram tratados de acordo com a técnica de análise temática, além da confecção de representações do itinerário terapêutico de cada entrevistado. Foram identificados três eixos temáticos: trajetória antes do diagnóstico, trajetória do diagnóstico ao início do tratamento, e trajetória no tratamento. Percebe-se que o acesso aos serviços apresenta-se como um problema que culmina no agravamento da doença, no aparecimento de metástases e a morte do paciente, além de criar condições para a falta de adesão ao tratamento.

RESUMEN La trayectoria del cliente oncológico todavía es permeada por inconvenientes que interfieren en su pronóstico y calidad de vida. Así, este estudio pretende identificar el itinerario del paciente oncológico desde el diagnóstico hasta el tratamiento y analizar sus implicaciones en las acciones de enfermería para el control del cáncer. Estudio cualitativo, realizado a través de la técnica de historia oral de diez clientes oncológicos atendidos en un hospital federal en el municipio de Rio de Janeiro, Brasil. Los datos fueron tratados de acuerdo con la técnica de análisis temático, además de la confección de representaciones del itinerario terapéutico de cada entrevistado. Fueron identificados tres ejes temáticos: trayectoria antes del diagnóstico; trayectoria del diagnóstico al inicio del tratamiento; y trayectoria en el tratamiento. Se nota que el acceso a los servicios se presenta como un problema que culmina en el agravamiento de la enfermedad, el en surgimiento de metástasis y la muerte del paciente, además de crear condiciones para la falta de adhesión al tratamiento.

ABSTRACT The course of oncology patients is still crossed by setbacks that interfere with their prognosis and quality of life. This study aims to map the itinerary of cancer patients from diagnosis to treatment and to analyze its implications in nursing healthcare practices for the control of cancer. This is a qualitative study, conducted using oral history technique with ten cancer patients treated in a federal hospital in the city of Rio de Janeiro, Brazil. The data were analyzed according to thematic analysis technique and with the making of representations of the therapeutic itinerary of each interviewee. Three main themes were identified: course before diagnosis, course from diagnosis to the beginning of treatment, and course during treatment. We observed that the access to medical services is presented as a problem that culminates in the worsening of the disease, appearing of metastases and death of the patient, in addition to creating conditions that hinder the adherence to treatment.

[Analysis of acute sinusitis or nasal furuncle derived orbitalcellulitis in children: review of 18 cases].

Objective:To analyze the diagnosis and treatment of acute sinusitis or nasal furuncle derived periorbital cellulitis in children.Method:The clinical data of 18 children with acute sinusitis or nasal furuncle derived orbital cellulitis was analyzed retrospectively.Result:Sixteen cases(88.89%) had acute sinusitis and 2(11.11%) had furuncle of nose.All cases were treated with antibiotics and steroids.And 16 cases were cured and the other two received surgery.The median length of hospitalization was 7.33 days(5-13 days).Conclusion:Sufficient antibiotics combined with steroids and local treatment is critical in treating pediatric orbital cellulitis.Timely and decisive surgical intervention can effectively control the progression of disease.

Aeromonas salmonicida infection levels in pre- and post-stocked cleaner fish assessed by culture and an amended qPCR assay.

Due to increasing resistance to chemical therapeutants, the use of 'cleaner fish' (primarily wrasse, Labridae, species) has become popular in European salmon farming for biocontrol of the salmon louse, Lepeophtheirus salmonis (Krøyer). While being efficient de-licers, cleaner fish mortality levels in salmon cages are commonly high, and systemic bacterial infections constitute a major problem. Atypical furunculosis, caused by Aeromonas salmonicida A-layer types V and VI, is among the most common diagnoses reached in clinical investigations. A previously described real-time PCR (qPCR), targeting the A. salmonicida A-layer gene (vapA), was modified and validated for specific and sensitive detection of all presently recognized A-layer types of this bacterium. Before stocking and during episodes of increased mortality in salmon cages, cleaner fish (primarily wild-caught wrasse) were sampled and screened for A. salmonicida by qPCR and culture. Culture indicated that systemic bacterial infections are mainly contracted after salmon farm stocking, and qPCR revealed A. salmonicida prevalences of approximately 4% and 68% in pre- and post-stocked cleaner fish, respectively. This underpins A. salmonicida's relevance as a contributing factor to cleaner fish mortality and emphasizes the need for implementation of preventive measures (e.g. vaccination) if current levels of cleaner fish use are to be continued or expanded.

Nasal Vestibular Furunculosis Presenting as the Rudolph Sign.

Nasal furunculosis is a deep infection of hair follicle within the nasal vestibule. In this report, the authors presented a 49-year-old woman with 4-day history of focal red area and tender swelling on the tip of her nose. On physical examination, together with a swelling at nasal vestibulum, erythema, and edema on the skin of nasal tip were observed, which is called the Rudolph Sign. The patient was treated with intranasal topical mupirocin and oral sodium fusidate. Because nasal furunculosis may lead to serious complications such as ophthalmic vein thrombosis and cavernous sinus thrombosis, early diagnosis and effective treatment is essential.

Furúnculo, furunculosis y ántrax: abordaje y tratamiento / Management of furuncle, furunculosis and anthrax

No disponible

Eruptive furunculosis following the soak and smear regimen.

The 'soak and smear' regimen is a highly effective method for localised topical therapy employed by dermatologists for widespread inflammatory skin conditions. The regimen involves application of topical medication under occlusion after soaking in water. Complications from this treatment method are rare. We present a case of multiple, generalised methicillin-resistant Staphylococcus aureus (MRSA)-positive furuncles arising in a patient as an unexpected consequence of therapy. The case highlights an unanticipated risk of a commonly employed treatment amid an epidemic of MRSA in the community.

Miasis furuncular por Dermatobia hominis / Foruncular myiasis due to Dermatobia hominis

No disponible