Q fever infection in dairy cattle herds: increased risk with high wind speed and low precipitation.

Ruminants are considered the main reservoir for transmission of Coxiella burnetii (Cb) to humans. The implementation of effective control measures against Cb in ruminants requires knowledge about potential risk factors. The objectives of this study were (i) to describe the spatial distribution of Q fever-infected dairy cattle herds in Sweden, (ii) to quantify the respective contributions of wind and animal movements on the risk of infection, while accounting for other sources of variation, and (iii) to investigate the possible protective effect of precipitation. A total of 1537 bulk milk samples were collected and tested for presence of Cb antibodies. The prevalence of test-positive herds was higher in the south of Sweden. For herds located in areas with high wind speed, open landscape, high animal densities and high temperature, the risk of being infected reached very high values. Because these factors are difficult to control, vaccination could be an appropriate control measure in these areas. Finally, the cumulated precipitation over 1 year was identified as a protective factor.

Assessment of control measures against livestock-associated methicillin-resistant Staphylococcus aureus in a farrow-to-finish pig herd using infectious disease modelling.

Pigs are considered to be the main reservoir for livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA), which is a zoonotic opportunistic pathogen. As LA-MRSA is an occupational hazard, there is an incentive to control its spread in pig herds. Currently, knowledge about effective control measures which do not require culling the whole herd are limited, and the control strategies against LA-MRSA vary between countries. This study uses a stochastic compartment model to simulate possible control measures for LA-MRSA in a farrow-to-finish pig herd. The aims of the study were to (1) extend a previously published disease spread model with additional management and control measures; (2) use the extended model to study the effect of the individual LA-MRSA control measures on the within-herd LA-MRSA prevalence; (3) evaluate the effect of control measures when they are implemented in combinations. From the individual control measures tested in the study, thorough cleaning was found to be most effective in reducing the LA-MRSA prevalence in the herd. When the different control measures were combined, cleaning together with disease surveillance had the largest impact on reducing the LA-MRSA and a higher chance of causing disease elimination. The results of the study showed that achieving disease elimination once LA-MRSA had been introduced in the herd was challenging but was more likely when control measures were introduced early during the outbreak. This emphasises the importance of early detection of the pathogen and subsequent rapid implementation of LA-MRSA control measures.

Investigations and actions taken during 2011 due to the first finding of Echinococcus multilocularis in Sweden.

Echinococcus multilocularis is a parasite that can cause alveolar echinococcosis disease. After the first positive finding of E. multilocularis in Sweden in 2011, a consulting group with representatives from relevant authorities was summoned. In this group, all relevant information was shared, strategies for information dissemination and any actions to be taken due to the finding of E. multilocularis were discussed and decided. The present paper describes the actions taken during 2011 and the results thereof, including surveillance in animals, risk assessment for humans to become infected and recommendations given to the public. Further discussion about whether the parasite was introduced, and if so, how, as well as possible future development of the infection in animals and humans in Sweden and future actions are included.

First detection of Echinococcus multilocularis in Sweden, February to March 2011.

Surveillance for the fox tapeworm, Echinococcus multilocularis, has been carried out in Sweden since 2000, with about 300 red foxes analysed annually. We report the first finding of E. multilocularis in Sweden, in a fox shot in December 2010 in the south-west of the country. A second infected fox shot in the same location was detected in March 2011. This paper describes the national monitoring programme and the ongoing work to estimate the prevalence and spread of the infection.

How mechanistic modelling supports decision making for the control of enzootic infectious diseases.

Controlling enzootic diseases, which generate a large cumulative burden and are often unregulated, is needed for sustainable farming, competitive agri-food chains, and veterinary public health. We discuss the benefits and challenges of mechanistic epidemiological modelling for livestock enzootics, with particular emphasis on the need for interdisciplinary approaches. We focus on issues arising when modelling pathogen spread at various scales (from farm to the region) to better assess disease control and propose targeted options. We discuss in particular the inclusion of farmers' strategic decision-making, the integration of within-host scale to refine intervention targeting, and the need to ground models on data.

Vetsyn: An R package for veterinary syndromic surveillance.

A recent inventory showed that several countries are exploring varied types of animal health sources for the development of veterinary syndromic surveillance (VSS), however, few systems have documented success after the phase of development or exploratory analysis of data. We suggest there are three main challenges in the current development of animal syndromic surveillance: (i) the lack of standards in disease recording and classification; (ii) the development of statistical methods appropriate to deal with animal data; and (iii) the creation of ready-to-use tools that employ these statistical methods. We address the latter two challenges and present an R package - vetsyn - which covers the steps of VSS implementation from classified data to interface. Detailed tutorials are included with the package. The goal is to provide ready-to-use codes to automatize the process of converting pre-classified animal health data into epidemiological information. The package functions are illustrated using real data and simulated outbreaks. Functions to monitor data daily and weekly are available. The main innovation offered by the package is ability to manage data streams, analyses, alarms and user interface in a continuous flow. We expect that this will facilitate the implementation of syndromic surveillance systems by veterinary epidemiologists and surveillance practitioners.

Tomographic imaging of the human thyroid using 124I.

After receiving between 100 and 300 mu Ci of the positron-emitting radioisotope 124I (half-life, 4.2 days), 64 patients with a variety of thyroid disorders were imaged with a high resolution positron camera. A 3-dimensional image of the distribution of radioiodine uptake within the thyroid was obtained from a single 10- to 15-min scan. This image may be viewed as a sequence of 2-mm thick transverse, sagittal, or frontal sections or as a 3-dimensional shaded surface. The functional volume of the thyroid may be estimated by counting the volume elements (voxels) inside the thyroid surface. The precision of the estimate varied from 6-15%, depending on the size and clinical status of the thyroid. The volume estimation procedure was validated with phantoms and with the thyroids of patients who subsequently underwent partial thyroidectomy. This 3-dimensional imaging technique may be useful for diagnosis and management of thyroid diseases.

Malignant immunoblastic lymphoma with filopodia (so-called anemone or porcupine cell tumour).

The ultrastructure of a lymph node showed cells with cytoplasmic projections described by other authors as anemone cell tumour or porcupine cells. Histology and immunohistochemistry have shown that this tumour is a malignant B cell lymphoma, immunoblastic, with Kappa light chains. Our findings thus confirm recent studies suggesting that some of these tumours were malignant lymphomas.

Collagenous colitis with protracted course and fatal evolution. Report of a case.

We report the case of a female patient who suffered from collagenous colitis for 13 years, the complications of which may have contributed to her death. The disease was associated with seropositive rheumatoid arthritis and Sjögren's syndrome. Cases of collagenous colitis with a course leading to death have not been reported in the literature, to the best of our knowledge.

Inflammatory fibroid polyp in a continent ileo-anal pouch after colectomy for ulcerative colitis--case report.

The most frequent complication occurring in continent ileo-anal pouches after colectomy for ulcerative colitis (UC) is pouchitis. Recurrences of adenomas or carcinomas in pouches of familial adenomatous polyposis (FAP) patients are exceptional, whereas in those with ulcerative colitis dysplasia it is a very rare occurrence. We describe the case of a young woman who developed a mass in a J pouch three years after its construction following colectomy for ulcerative colitis. Histological and immunohistochemical studies showed that this mass had the features of an inflammatory fibroid polyp. A review of the literature of lesions observed in continent ileo-anal pouches after colectomy for UC would suggest that this lesion is an exceedingly rare complication of those devices.

Acinic cell carcinoma of minor salivary gland origin.

The occurrence of acinic cell carcinoma in the minor salivary glands appears to be exceptional. A review of the English language literature revealed about 80 previously reported cases. In this paper, the clinical behaviour and pathological findings in three cases are reported. The tumours took their origin from the hard palate, soft palate and lower lip. The three cases presented with malignant clinical behaviour; all three recurred. In one case the local recurrence was multinodular with capsular infiltration. Two cases developed regional lymph node metastasis, and one metastasized to the lung and liver. In one the tumour infiltrated bony structures, and nerve in another. These cases tend to support the belief of some authors that acinic cell 'tumours' are clinically malignant and should be included in the carcinoma group.

[Perforated tubular duplication of the sigmoid colon in adults]. / Perforation d'une duplication tubulaire sigmoïdienne chez l'adulte.

Intestinal duplications are rare malformations and a diagnostic challenge. The case presented herein relates to a perforated tubular duplication of the sigmoid colon in a 23-year-old man with intermittent abdominal pain during 3 months and a bout of peritonitis which resolved spontaneously. This case is unusual since duplications generally spare adults, are seldom found in the colon, and do not perforate. The only cases of duplication which can be suspected preoperatively belong to the communicating type or those containing ectopic gastric mucosa. The intraoperative finding in this case of a malformative mesenteric cyst reminds us that duplications can be found in association with other intestinal, vertebral, or genitourinary tract malformations. In conclusion, intestinal duplications should be resected even when they are asymptomatic, as occasional cancerous transformation associated with a poor prognosis have been reported.

Dermoid cyst of the pancreas. Case report and review of the literature.

During an annual check-up in a 46 year-old man, a round mass was discovered in the left hypochondrium upon abdominal ultrasonography. Computed tomographic scan located the mass at the upper border of the body of the pancreas, suggesting an expansive process. Left pancreatectomy was performed, leading to the discovery of a dermoid cyst. This cyst was apparently part of the pancreatic parenchyma. Only 11 cases of dermoid cysts of the pancreas have been reported between 1918 and 1977. Elective enucleation of the cyst is thought to be adequate surgical treatment.

Inflammatory fibroid polyp of the gastrointestinal tract: possible origin in myofibroblasts? A study of twelve cases.

Inflammatory fibroid polyp (eosinophilic granuloma) is a rare benign condition found in the gastro-intestinal tract. Approximately 200 cases have been described in the literature. It is generally considered as a granulation tissue of a peculiar type; however its cellular composition remains controversial. Either macrophages, fibroblasts or myofibroblasts have been proposed as its main cellular constituents. A retrospective study of 12 cases (8 gastric and 4 intestinal locations) based on histology, immuno-histochemistry and electron microscopy, would suggest that this condition is truly a peculiar type of granulation tissue made up primarily of myofibroblasts.

[Malignant paraganglioma of the duodenum. Immunohistochemical and ultrastructural study of a case]. / Le paragangliome malin du duodénum. Etude immunohistochimique et ultrastructurale d'un cas.

Paragangliomas of the duodenum are rare. Only 40 cases, most of them corresponding to benign tumours, have been published. In this study, we report a malignant paraganglioma of the duodenum with lymph node metastasis occurring in a 73 year old woman. The essential clinical manifestations which brought the patient to surgery were abdominal pain, melaena and anemia. The surgical specimen was investigated histologically, immunohistochemically and ultrastructurally. The tumour was composed of three types of cells: epithelial, gangliocytic and spindle shaped mesenchymal cells. The first contained ultrastructurally intracytoplasmic granules bound with double membranes; they stained with monoclonal antibodies against chromogranin. Gangliocytic cells stained with monoclonal N.S.E. antibodies and the spindle cells stained with S 100 protein. The spindle cells displayed ultrastructurally glial cell characteristics, containing micro-filaments of glial type. These immunological and ultrastructural features argued in favor of the neuroendocrine cell origin of this paraganglioma.

[Digestive amyloidosis with ischemic ulcer of the colon in a chronic hemodialysis patient]. / Amyloïdose digestive avec ulcère ischémique du colon chez un hémodialysé chronique.

A 78 year old male patient who had been treated by haemodialysis for 17 years for renal failure, secondary to tuberculosis, is reported. Following severe rectal bleeding, an ischaemic ulcer of the ascending colon was noticed, which required right hemicolectomy. On the surgical specimen, the ulcer showed massive vascular involvement with amyloidosis of the type found in haemodialysed patients, and constituted of beta 2 micro-globulin deposits. These amyloid deposits have certainly played an important part in the development of this ischaemic lesion.

[Bone marrow involvement in Whipple's disease]. / Atteinte de la moelle osseuse en cas de maladie de Whipple.

The authors present the case of a 57 years old woman who had atypical Whipple's disease characterized solely by migratory arthralgia, weight loss and unexplained anemia which had lasted for 5 years. Once the diagnosis of Whipple's disease was established on abdominal lymph node biopsy, the retrospective study of a bone marrow biopsy revealed the presence of PAS-positive sickle-formed particles within medullary macrophages. Review of the literature attests the rarity of ante-mortem diagnosis of Whipple's disease in bone marrow preparations. We suggest that bone marrow biopsies stained with the PAS technique be employed in clinical settings of chronic migratory arthralgia and unexplained anemia.

[Segmental colonic lipomatosis. A case of isolated caecocolonic lipomatosis (author's transl)]. / La lipomatose colique segmentaire. A propos d'une observation de lipomatose caeco-colique isolée.

The authors report a case of isolated segmental caecocolonic lipomatosis complicated by infarts. The diagnosis was made from the urgent symptoms and treatment was by simple right colectomy and immediate reconstitution of continuity.