Acute Gastrointestinal Disease Research Articles

PPAR-gamma Signaling in Metabolic Homeostasis

BACKGROUND: Peroxisome proliferator-activated receptor (PPAR)-γ, or also known as nuclear receptor subfamily 1 group C member 3 (NR1C3), is a PPAR which serves as master regulator of adipocytes differentiation, and plays an important role in lipid metabolism or adipogenesis. Recent study showed that PPAR-γ is expressed in most tissue and also has critical impact in many metabolic homeostasis disorders.CONTENT: Dysregulation of PPAR-γ is correlated to the development of obesity, type 2 diabetes, atherosclerosis, cardiovascular disease, acute kidney injury, autoimmune disease, gastrointestinal disease and Alzheimer’s disease. Abundant number of new emerging compounds, with in vitro and in vivo effectiveness as natural and synthetic agonists of PPARs, are investigated, developed and used as the treatment of metabolic disorders of glucose and/or lipid and other diseases.SUMMARY: Based on all studies explanation, targeting PPAR-γ is proven to be a good therapeutic method for reducing negative effect of several metabolic homeostasis disorder. Now, many natural and synthetic agonists of PPARs are used as the treatment of metabolic disorders of glucose and/or lipid or another metabolic homeostasis disorder. Such agonists have different properties and specificities for individual PPARs receptors, different absorption and distribution, and distinctive gene expression profiles, which ultimately lead to different clinical outcomes.KEYWORDS: PPAR-γ, dysregulation, agonist, adipogenesis, metabolic disorder, homeostasis

ЕТІОЛОГІЧНА СТРУКТУРА ГОСТРИХ ШЛУНКОВО–КИШКОВИХ ЗАХВОРЮВАНЬ ТЕЛЯТ

The results of tests of samples of biological material from the calves with acute gastrointestinal diseases presents in the article. It was found that the occurrence and development of acute gastrointestinal diseases the leading role played by opportunistic bacteria association: S. aureus, S. saprophiticus, S. agalactiae, S. faecalis, S. pyogenes, E. coli, E. cloacae, C. jejuni, P. vulgaris, P. mirabilis, P. aeruginosa and K. Pneumoniae. Of the 632 examinations we studied 2,786 samples of biological material. Analysis of the results on our diagnostic work shows that acute gastrointestinal disease in calves caused by microbial associations. At acute gastrointestinal disease isolated pathogen E. coli – 21.0%. Coccoid microorganisms group also had significant representation. Thus, a biomaterial of 15.5% was allocated S. faecalis, at 11.6% was allocated pathogen S. aureus. Although to a lesser extent, but large office in the species spectrum of microorganisms by acute gastrointestinal diseases of calves occupied S. agalactiae – 4.8%, S. saprophiticus – 4.6%, S. pyogenes – 3.7%. Among the important place occupied microorganisms culture P. vulgaris – 8.5% of the total allocation of the samples. The average discharge frequency was characteristic for Campylobacter jejuni – 6.5% of cases.In analyzing the sensitivity of microorganisms isolated from calves with acute gastro–intestinal diseases to different groups of antibiotic drugs found that E. coli has a low sensitivity to antibiotics almost all studied groups. The largest number of selected crops susceptible to cephalosporins – 74.8%. Most of the isolated cultures weaklysensitive or insensitive to antibiotics studied by us. These data are an indication of the spread of antibiotic–resistant strains of microorganisms among newborn calves in the farms of Sumy and Chernihiv regions, which explains the low efficiency of antibiotic therapy. Highly active towards crop S. aureus, S. saprophiticus, S. agalactiae, S. faecalis, S. pyogenes, E. coli, E. cloacae, C. jejuni, P. vulgaris, P. mirabilis, P. aeruginosa, and K. pneumoniae were drug «Ceftioklin» and combined antibacterial agents.

Scoring System for Multiple Organ Dysfunction in Adult Horses with Acute Surgical Gastrointestinal Disease.

BackgroundThe prevalence of multiple organ dysfunction syndrome (MODS) in horses with acute surgical gastrointestinal (GI) disease is unknown. Currently, there are no validated criteria to confirm MODS in adult horses.ObjectivesTo develop criteria for a MODS score for horses with acute surgical colic (MODS SGI) and evaluate the association with 6‐month survival. To compare the MODS SGI score with a MODS score extrapolated from criteria used in people (MODS EQ).AnimalsAdult horses that required exploratory laparotomy (n = 62) for colic. Healthy adult horses undergoing elective surgical procedures (n = 12) established the reference range of some variables.MethodsProspectively, a MODS SGI score was developed based on organ‐specific criteria established from a literature review, data collection, and clinical judgment. Data for scoring each horse were collected on Days 1 and 2 postoperatively. Horses were scored retrospectively using both scoring criteria. The prognostic performance of the MODS SGI score and its overall performance compared with the MODS EQ score were assessed with receiver operating characteristic (ROC) curve analysis.ResultsThe MODS SGI score had excellent performance for predicting 6‐month survival with an area under the ROC curve (AUC) of 0.95 (95% CI: 0.87–0.99). The AUC for the MODS SGI score was significantly higher than the MODS EQ (AUC: 0.76; 0.63–0.86).Conclusions and Clinical ImportanceThe MODS SGI score predicts 6‐month survival from discharge in horses with acute surgical colic. The MODS SGI score performed better than a score extrapolated from human scoring systems.

Association between acute gastrointestinal injury grading system and disease severity and prognosis in critically ill patients: A multicenter, prospective, observational study in China

PurposeThis prospective study investigated the association between disease severity and acute gastrointestinal injury (AGI) grade and between prognosis and AGI. MethodsIn 12 teaching hospitals in China, patients in intensive care units who had received a diagnosis of AGI were enrolled (N = 196). Their demographics, body mass index, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score, mechanical ventilation, acute kidney injury, intensive care unit stay, and 7-day and 28-day mortality were recorded. ResultsOf the 196 AGI patients, 90, 64, 29, and 13 were classified as grades I, II, III, and IV, respectively. Acute Physiology and Chronic Health Evaluation II scores independently predicted grades III and IV; acute kidney injury independently predicted grade III. The 28-day mortality rates of grades I and II were similar, as were those of grades III and IV. The mortality rate of patients with grades I + II (gastrointestinal dysfunction) was significantly lower than that of patients with grades III + IV (gastrointestinal failure). ConclusionDifferentiating AGI as gastrointestinal dysfunction or gastrointestinal failure appears to be more valid for predicting prognosis than the AGI 4-grade system.

Heart rate variability in horses with acute gastrointestinal disease requiring exploratory laparotomy.

To describe heart rate variability (HRV) in horses with acute gastrointestinal disease that undergo exploratory laparotomy. We hypothesized that horses with ischemic gastrointestinal disease will have reduced HRV compared to horses with nonischemic lesions. We further hypothesized that a reduction in HRV will be associated with nonsurvival. Prospective, clinical, observational study. University veterinary teaching hospital. Horses presented for acute colic (n = 57) or elective surgical procedures (n = 10) were enrolled. Admission heart rate (HR) was recorded and within 2 hours of recovery from general anesthesia continuous telemetry was placed, monitored and recorded for 48-52 hours postoperatively. Stored electrocardiograms were manually inspected and R-to-R intervals were extracted and uploaded into HRV software for analysis. Time domain and frequency spectral analysis were investigated at Times 1 (2-10 h), 2 (16-24 h), 3 (30-38 h), and 4 (44-52 h) postoperatively. A two-way ANOVA for repeated measures was used for group comparisons. Logistic regression analysis was used to detect potential associations between admission HR, time and frequency domain variables, and nonsurvival. Horses diagnosed with an ischemic gastrointestinal lesion (n = 22) at the time of surgery had significantly higher postoperative heart rates and reduced time domain-derived measures of HRV than horses with nonischemic gastrointestinal lesions (n = 35) or control horses (n = 10). Horses that survived to discharge had significantly lower postoperative HRs, higher time domain, and lower low frequency spectral measures of HRV compared to nonsurvivors. The multivariable logistic regression model had a receiver operating characteristic area under the curve (AUC) of 0.95 and was significantly better at predicting nonsurvival than admission HR (P = 0.0124). Reduced HRV was strongly associated with ischemic gastrointestinal disease and nonsurvival. HRV analysis is a noninvasive technique that may provide diagnostic and prognostic information pertinent to the management of postoperative horses with severe gastrointestinal disease.

Detection of Dientamoeba fragilis in Portuguese children with acute gastroenteritis between 2011 and 2013.

Dientamoeba fragilis is an inhabitant of human gastrointestinal tract with a worldwide distribution. The first description considered this protozoan a rare and harmless commensal, since then it has struggled to gain recognition as a pathogen. Commercial multiplex real-time PCR was used to detect D. fragilis in fecal samples from hospitalized children (⩽18 years) with acute gastrointestinal disease, admitted to two hospitals of Lisbon area, with different demographic characteristics. A total of 176 children were studied, 103 (58·5%) male, 144 (81·8%) children between 0 and 5 years and 32 (18·2%) above 6 years old. The overall protozoa frequency considering the four tested microorganisms were 8·5% (15/176), and the most frequently found protozoan was D. fragilis, 6·3% (11/176). Dientamoeba fragilis frequency was higher among older children (21·9%), than younger children (2·8%), and greater in boys (6·8%) than in girls (5·5%). All positive children presented with diarrhoea associated with vomiting, fever and abdominal pain. Infection was associated with the age of children (P < 0·001), school attendance (P = 0·002) and consumption of certain foods (P = 0·014), e.g. cakes with crème and ham. The frequency of diantamoebiasis found in a cohort of hospitalized Portuguese children, with acute gastrointestinal disease, could be considered a very high value when compared with the protozoan frequency normally associated with this pathology.

Transcriptomic and proteomic analyses reveal key innate immune signatures in the host response to the gastrointestinal pathogen Campylobacter concisus.

Pathogenic species within the genus Campylobacter are responsible for a considerable burden on global health. Campylobacter concisus is an emergent pathogen that plays a role in acute and chronic gastrointestinal disease. Despite ongoing research on Campylobacter virulence mechanisms, little is known regarding the immunological profile of the host response to Campylobacter infection. In this study, we describe a comprehensive global profile of innate immune responses to C. concisus infection in differentiated THP-1 macrophages infected with an adherent and invasive strain of C. concisus. Using RNA sequencing (RNA-seq), quantitative PCR (qPCR), mass spectrometry, and confocal microscopy, we observed differential expression of pattern recognition receptors and robust upregulation of DNA- and RNA-sensing molecules. In particular, we observed IFI16 inflammasome assembly in C. concisus-infected macrophages. Global profiling of the transcriptome revealed the significant regulation of a total of 8,343 transcripts upon infection with C. concisus, which included the activation of key inflammatory pathways involving CREB1, NF-κB, STAT, and interferon regulatory factor signaling. Thirteen microRNAs and 333 noncoding RNAs were significantly regulated upon infection, including MIR221, which has been associated with colorectal carcinogenesis. This study represents a major advance in our understanding of host recognition and innate immune responses to infection by C. concisus.

Ileostomy As a Treatment Option in Patients with Refractory Acute Gastro-Intestinal Graft Versus Host Disease

Introduction: Treatment of refractory gastro-intestinal GVHD (rGI-GVHD) is still disappointing. Indeed, combination of or escalating dose of immunosuppressive treatments not only have no beneficial effects on disease progression but also are responsible for an increased risk of infections with short-term survival rate less than 20%. GI surgery has been for long time offered to patients with Crohn disease; this approach is usually restricted to patients with GVHD-related GI occlusion. Given the similarity between the two diseases, and the predominance of GI-GVHD damages in the distal part of the small bowel, we have considered surgery in 8 patients with rGI-GVHD. We performed an end ileostomy in order to circumvent the affected portion of the intestine and limit the use of immunosuppressive treatment. Here, we report our experience on patients with rGI-GVHD who underwent GI-surgery.Methods: Eight patients with acute grade 4 GVHD according to standard criteria were retrospectively analyzed. First line treatment consisted of steroids at the dose of 2 mg/kg/day for all patients. Second-line therapy consisted of anti-IL2R monoclonal antibodies (n=6) or anti-thymocyte globulin (n=2). Six patients had received 2 lines of therapy before surgery while 1 had received 4 lines and 1 after 5 lines. The diagnosis of acute GI-GVHD was confirmed by comprehensive GI examination including upper and lower endoscopies with biopsies, wireless video-capsule endoscopy and investigation for eliminate infection. In addition, barium small follow-through was performed to evaluate the extension of the GI damages before surgery in order to guide the intervention. After surgery, oral feeding was encouraged and patients received both enteral and parenteral nutrition until GI-lesions recovery and restoration of intestinal continuity with end-to-end anastomosis.Results: Table 1 summarizes patient’s characteristics and outcome. The median occurrence of aGVHD was 30 days (25-34) from transplant. Four patients are alive and GVHD free, 81, 71, 11 and 6 months after transplant. The first patient underwent an initial resection of 150cm of distal ileum with immediate intestinal continuity restoration for a progressive obstructive syndrome. The other patients had proximal ileostomy at 100 cm to 150cm after the post duodenal angle. For one patient, perendoscopic gastrostomy was also realized during surgery to simplify enteral nutrition. Two patients (#4 and #5) died of infections 6 and 13 days after surgery. They were in very bad condition at surgery. Patient #3 who improved his GVHD after surgery, died 225 days later of severe flu infection.Conclusion: Despite its limited size, this cohort of patients with severe rGI-GVHD treated with ileostomy appears promising. Whenever possible, this original and multidisciplinary approach should be considered in patients with grade IV rGI-GVHD after 2 lines of immunosuppressive treatment. A prospective study will start soon to evaluate the safety and efficacy of GI surgery in GI-GVHD after one line of therapy.Table 1:Patients and GVHD characteristics and outcome.#AgeGenderOnsetof aGVHDfrom transplant(Days)Number of Prior line of immunosuppressive therapy(Lines)Time of surgery from GVHD (Days)Outcome(Time from transplant)1411302185Alive, GVHD-free (81 months)246230493Alive, GVHD-free (71 months)3612302140Dead (13months)433126564Dead (3 months)527225249Dead (3 months)644234222Alive, GVHD-free (11 months)721130225Dead (4 months)8331352120Alive, GVHD free (6 months) DisclosuresNo relevant conflicts of interest to declare.

Bedside colonoscopy in intensive care units: indications, techniques, and outcomes

Colonoscopy performed in critically ill patients is poorly documented in the literature. The clinical setting is completely different from routine outpatient colonoscopy with different aims and techniques. We proposed to examine the role of urgent colonoscopy in critically ill patients. This was a retrospective review of patients in a prospectively recorded database. All patients undergoing colonoscopy in an intensive care unit were identified from a colonoscopy database. A chart review yielded indications, diagnoses, co-morbidities, depth of intubation, and outcome. Main outcome measures were indications for colonoscopy, type and dose of sedation, bowel preparation, completion rate, findings, treatment, and complications. Forty one patients underwent 49 bedside colonoscopies (31 men (79 percent), 10 women, mean age of 68.1years). The most common indications were to exclude ischemic colitis in 25 (confirmed in 19, operated in 14), decompression of colonic distension in 7 (all decompressed, 0 operated), and diagnosis of lower gastrointestinal hemorrhage in 7 (cause found in 7, 0 operated). All patients had major co-morbidities and 28 were being ventilated at the time of the colonoscopy. A minority of patients received sedation. 14 (36%) of the patients died. Colonoscopy reached the cecum in 16 patients (41%), the hepatic flexure in 25 (64%), and the splenic flexure in 36 (92%). Prep was poor in 15 patients and stool prevented completion in 13. In 30% of patients, colonoscopy was not pursued to the cecum. Bedside colonoscopy is helpful in the diagnosis and management of acute lower gastrointestinal disease in intensive care patients.

Emergence of the GII-4 Norovirus Sydney2012 Strain in England, Winter 2012–2013

Norovirus is the commonest cause of acute gastrointestinal disease and is the main aetiological agent of outbreaks of gastroenteritis, particularly in semi-closed environments. Norovirus infections in England typically peak between December and March each year. The most commonly detected norovirus strains belong to the genetically diverse genogroup-II genotype-4 (GII-4) genocluster and in the previous two norovirus winter seasons the majority of GII-4 strains in circulation worldwide have been genetically similar to the GII-4 strain New Orleans 1805/2009/USA. At the beginning of the 2012/13 season a genetically distinct GII-4 strain (Sydney 2012/NSW0514/2012/AU) was described which emerged worldwide during the winter of 2012/13. Here we describe the emergence of norovirus strains genetically related to Sydney2012 in England during the 2012/13 season to replace NewOrleans2009 strains as the most commonly detected variant of GII-4 norovirus in England. Furthermore, we demonstrate that whilst the emergence of Sydney2012 coincided with an early peak in the number of norovirus outbreaks, there was not an overall increase in norovirus activity compared to the previous season. Finally, we show that the Sydney2012 strain is associated with distinct genetic changes compared to the NewOrleans2009 strain, and these changes may have contributed to the emergence of the Sydney2012 strain.

Does intraoperative low arterial partial pressure of oxygen increase the risk of surgical site infection following emergency exploratory laparotomy in horses?

Decreased tissue oxygenation is a critical factor in the development of wound infection as neutrophil mediated oxidative killing is an essential mechanism against surgical pathogens. The objective of this prospective case series was to assess the impact of intraoperative arterial partial pressure of oxygen (PaO2) on surgical site infection (SSI) in horses undergoing emergency exploratory laparotomy for acute gastrointestinal disease. The anaesthetic and antibiotic protocol was standardised. Demographic data, surgical potential risk factors and PaO2, obtained 1h after induction of anaesthesia were recorded. Surgical wounds were assessed daily for infection during hospitalisation and follow up information was obtained after discharge.A total of 84 adult horses were included. SSI developed in 34 (40.4%) horses. Multivariate logistic regression showed that PaO2, anaesthetic time and subcutaneous suture material were predictors of SSI (AUC=0.76, sensitivity=71%, specificity=65%). The use of polyglycolic acid sutures increased the risk and horses with a PaO2 value <80mmHg [10.6kPa] and anaesthetic time >2h had the highest risk of developing SSI (OR=9.01; 95% CI 2.28–35.64). The results of this study confirm the hypothesis that low intraoperative PaO2 contributes to the development of SSI following colic surgery.

An update on transfusion-related necrotizing enterocolitis

Necrotizing enterocolitis is an acute gastrointestinal disease in infants.Recent studies have reported that approximately 25％ to 35％ infants receiving packed red blood cell transfusions develop transfusionrelated necrotizing enterocolitis.The pathogenesis of transfusion-related necrotizing enterocolitis is not clear.This article reviews previous researches and current theoretical perspectives of transfusion-related necrotizing enterocolitts. Key words: Red blood cell transfusion; Infants; Transfusion-related necrotizing enterocolitis

Thrombelastographic characterization of coagulation/fibrinolysis in horses

Carboxyheme and metheme states modulate hemostasis in humans and other species. Further, carbon monoxide and/or nitric oxide production increase in inflammatory disorders involving the gastrointestinal tract, with associated hypercoagulability or hypocoagulability. In particular, the horse suffers both thrombotic or coagulopathic complications during acute gastrointestinal disease. This investigation characterized the thrombelastographic response to carboxyheme (via CORM-2) or metheme (via phenylhydroxylamine, PHA) states without/with addition of tissue type plasminogen activator. Citrated plasma was obtained from 14 normal mares and three horses with enteritis. In normal horses, a carboxyheme state did not enhance the velocity of clot growth and minimally enhanced clot strength (9%). In contrast, a metheme state was associated with a decrease in the velocity of clot formation (54%) and clot strength (47%). During fibrinolysis, a carboxyheme state significantly decreased the onset (113%) and velocity (27%) of fibrinolysis; however, in contrast, a metheme state more markedly increased the onset (84%) and velocity (133%) of fibrinolysis. These data support a carbon monoxide-dominant modulation of hemostasis in normal horses. In contrast, an increase in the severity of acute gastrointestinal disease was associated with a likely nitric oxide-mediated, metheme state-induced hypocoagulable/hyperfibrinolytic state. Additional investigation is warranted to determine the role played by carbon monoxide and nitric oxide in equine thrombotic and coagulopathic disease.

Isolated idiopathic transient hyperphosphatasemia in an adult patient after renal transplantation: a case report

Transient hyperphosphatasemia (TH) is characterized by the isolated elevation of serum alkaline phosphatase (ALP) in children. There is no evidence of liver or bone disease and the ALP levels return to normal within 4 months. Few adult cases have been reported. Here, we report the case of TH in a 54-year-old woman, who for 4 years after receiving a renal transplant, was regularly followed up at a renal outpatient clinic. Her underlying disease was chronic glomerulonephritis, for which she was taking immunosuppressive drugs (cyclosporine and mycophenolate mofetil). Routine laboratory analyses revealed that her ALP level had risen to 909 IU/l, which is a seven-fold increase relative to the upper normal limit (35 - 130 IU/l). The levels of intact parathyroid hormone; the tumor markers CEA, α-FP, CA 19-9, and CA 125; and other serum parameters were normal. The patient lacked symptoms, relevant clinical signs, and evidence of acute infection or acute chronic gastrointestinal disease. Lymph node enlargement and malignancy were not detected on a physical examination and ultrasonographic analysis of the abdomen, respectively. A bone scan showed no evidence of bone pathology. ALP isoenzyme analysis by electrophoresis showed patterns similar to those seen in TH of infancy and childhood. The ALP levels of the patient returned spontaneously to 126 IU/l 5 months after diagnosis. While isolated hyperphosphatasemia in renal transplantation patients may be a benign condition, we recommend that such cases be differentially diagnosed from other diseases that can trigger hyperphosphatasemia, including malignancy, infection, bone and liver diseases.

Risk factors for sporadicYersinia enterocoliticainfections, Germany 2009–2010

Yersinia enterocolitica is an important cause of acute gastrointestinal disease and post-infectious complications. In Germany, incidence of reported yersiniosis is relatively high compared with other countries of the European Union. Children aged <5 years are most frequently affected. The aim of our study was to identify risk factors for sporadic yersiniosis in Germany. A population-based case-control study was conducted in five federal states of Germany from April 2009 to June 2010. Cases exhibiting gastrointestinal symptoms were notified to the local health department with a Yersinia enterocolitica infection culture-confirmed from stool. Controls were selected from population registries and frequency-matched on age group and state of residency. Cases and controls received a questionnaire on possible risk factors by mail. Multivariable logistic regression modelling was used to identify risk factors and to calculate adjusted odds ratios (aORs). Population attributable fractions (PAFs) were estimated for exposures associated with yersiniosis. We analysed data on 571 case patients and 1798 controls. Consumption of raw minced pork, a dish frequently consumed even by young children in Germany, was the main risk factor for disease (aOR 4·7, 95% confidence interval (CI) 3·5-6·3, PAF 30%). This association varied by age group and, unexpectedly, was strongest for children aged <2 years (aOR 17·5, 95% CI 6·0-51·2). Other independent risk factors included recent preparation of minced pork in the household (aOR 1·4, 95% CI 1·1-1·9, PAF 21%), playing in a sandbox (aOR 1·7, 95% CI 1·3-2·4, PAF 17%), and contact with birds (aOR 1·7, 95% CI 1·1-2·6, PAF 4%). Prevention efforts should specifically target parents and caregivers of young children and focus on the high infection risk associated with consumption of raw minced pork.

Using the E-PASS scoring system to estimate the risk of emergency abdominal surgery in patients with acute gastrointestinal disease

The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system, which quantifies a patient's reserve and surgical stress, is used to predict morbidity and mortality in patients before elective gastrointestinal surgery. We conducted this study to clarify whether the E-PASS scoring system is useful for assessing the risks of emergency abdominal surgery. The subjects of this retrospective study were 51 patients who underwent emergency gastrointestinal surgery at a public general hospital. The main outcomes were the E-PASS scores and the postoperative course, defined by mortality and morbidity. Postoperative complications developed in 15 of the 51 patients (29.4%). The E-PASS score was significantly higher in the patients with postoperative complications than in those without (0.61 ± 0.31 vs 0.20 ± 0.35, respectively; n = 36). The morbidity rates were significantly lower in the patients with a value less than 0.5 than in those with a value more than 0.5 (17.1% and 56.3%, respectively; P < 0.01). There were 7 operative deaths among the 16 patients with a high score, versus none among the 9 patients with a low score (P < 0.01). Three patients underwent laparoscopic-assisted bowel resection with a good postoperative course, with scores of less than 0.5. The E-PASS scoring system is useful for surgical decision making and evaluating whether patients will tolerate emergency gastrointestinal surgery. Minimally invasive therapy would assist in lowering the risk of complications.

Clusters of infectious diseases in German nursing homes – observations from a prospective infection surveillance study, October 2008 to August 2009

A prospective infection surveillance study was carried out among residents of seven nursing homes in and around Berlin, Germany, from October 2008 to August 2009. A considerable number of infections were found to occur in clusters. Active surveillance was carried out using pre-established case definitions of infections in nursing homes (McGeer criteria). Case finding was based on routine nursing files. Infection rates were calculated per 1,000 resident days. Clusters were identified using a pre-established definition. In total 511 residents were observed during 74,626 resident days (rd), and 393 infections occurred in 243 participants, giving an overall incidence of infection of 5.3 per 1,000 rd. The most common infections were gastrointestinal infections (n=122; 1.6/1,000 rd), acute respiratory disease (n=86; 1.2/1,000 rd) and urinary tract infections (n=71; 1.0/1,000 rd). Seven clusters involving 74 infections in 57 residents were observed: three of acute respiratory disease, three of acute gastrointestinal disease and one of conjunctivitis. Attack rates varied between 11% and 61%. Clusters occurred frequently in the observed nursing homes and could be detected by infection surveillance based on routine documentation.

Companion animals symposium: microbes and gastrointestinal health of dogs and cats.

ABSTRACTRecent molecular studies have revealed complex bacterial, fungal, archaeal, and viral communities in the gastrointestinal tract of dogs and cats. More than 10 bacterial phyla have been identified, with Firmicutes, Bacteroidetes, Proteobacteria, Fusobacteria, and Actinobacteria constituting more than 99% of all gut microbiota. Microbes act as a defending barrier against invading pathogens, aid in digestion, provide nutritional support for enterocytes, and play a crucial role in the development of the immune system. Of significance for gastrointestinal health is their ability to ferment dietary substrates into short-chain fatty acids, predominantly to acetate, propionate, and butyrate. However, microbes can have also a detrimental effect on host health. Specific pathogens (e.g., Salmonella, Campylobacter jejuni, and enterotoxigenic Clostridium perfringens) have been implicated in acute and chronic gastrointestinal disease. Compositional changes in the small intestinal microbiota, potentially leading to changes in intestinal permeability and digestive function, have been suggested in canine small intestinal dysbiosis or antibiotic-responsive diarrhea. There is mounting evidence that microbes play an important role in the pathogenesis of canine and feline inflammatory bowel disease (IBD). Current theories for the development of IBD favor a combination of environmental factors, the intestinal microbiota, and a genetic susceptibility of the host. Recent studies have revealed a genetic susceptibility for defective bacterial clearance in Boxer dogs with granulomatous colitis. Differential expression of pathogen recognition receptors (i.e., Toll-like receptors) were identified in dogs with chronic enteropathies. Similarly to humans, a microbial dysbiosis has been identified in feline and canine IBD. Commonly observed microbial changes are increased Proteobacteria (i.e., Escherichia coli) with concurrent decreases in Firmicutes, especially a reduced diversity in Clostridium clusters XIVa and IV (i.e., Lachnospiraceae, Ruminococcaceae, Faecalibacterium spp.). This would indicate that these bacterial groups, important short-chain fatty acid producers, may play an important role in promoting intestinal health.

Thrombelastography in Horses with Acute Gastrointestinal Disease

Coagulopathies in horses with gastrointestinal disease are frequently identified and associated with morbidity and fatality. Determine if thrombelastography (TEG) identifies abnormalities associated with lesion type, presence of systemic inflammatory response syndrome (SIRS), morbidity, and fatality more consistently than traditional coagulation testing. One-hundred and one horses examined for gastrointestinal disease and 20 healthy horses. TEG, tissue factor (TF)-TEG, and traditional coagulation panels parameters and percentages of horses with coagulopathies were compared for lesion type, presence of SIRS, complications, and survival. Changes in individual parameters and increased incidence of coagulopathies were associated with fatality (R, P= .007; k-value [K], P= .004; clot lysis [CL]30, P= .037; CL60, P= .050; angle [Ang], P= .0003; maximum amplitude [MA], P= .006; lysis [Ly]30, P= .042; Ly60, P= .027; CI, P= .0004; ≥ 2 TEG coagulopathies, P= .013; ≥ 3 TEG coagulopathies, P= .038; TF-R, P= .037; TF-K, P= .004; TF-CL30, P < .0001; TF-CL60, P < .0001; TF-Ang, P= .005; TF-Ly30, P= .0002; TF-Ly60, P < .0001; TF-CI, P= .043; ≥ 1 TF-TEG coagulopathies, P= .003; ≥ 2 TF-TEG coagulopathies, P= .0004; prothrombin tme [PT], P < .0001; activated partial throboplastin time [aPTT], P= .021), inflammatory lesions (MA, P= .013; TF-CL30, P= .033; TF-CL60, P= .010; TF-Ly60, P= .011; ≥ 1 TF-TEG coagulopathy, P= .036; ≥ 2 TF-TEG coagulopathy, P= .0007; PT, P= .0005; fibrinogen, P= .019), SIRS (MA, P= .004; TF-CL30, P= .019; TF-CL60, P= .013; TF-Ly30, P= .020; TF-Ly60, P= .010; PT, P < .0001; aPTT, P= .032; disseminated intravascular coagulation, P= .005), and complications (ileus: aPTT, P= .020; diarrhea: TF-CL30, P= .040; TF-Ly30, P= .041; thrombophlebitis: ≥ 1 TF-TEG coagulopathy, P= .018; laminitis: MA, P= .004; CL60, P= .045; CI, P= .036; TF-MA, P= .019; TF-TEG CI, P= .019). Abnormalities in TEG and TF-TEG parameters were indicative of hypocoagulation and hypofibrinolysis. TEG identifies changes in coagulation and fibrinolysis associated with lesion type, SIRS, morbidity, and fatality in horses with gastrointestinal disease.

Vibrio cholerae - A Review

Vibrio cholerae is a facultative anaerobic, Gram negative, non-spore forming curved rod, about 1.04-1.06 m long. It is a facultative human pathogen found in coastal waters that causes the acute gastrointestinal disease, cholera, a major health threat in poor nations. It is widely acknowledged as one of the most important water borne pathogen of worldwide economic significance. Sea foods and water is the most common vehicle for this infection in humans. It has been isolated from wide variety of samples such as seawater, sediments, plankton, finfish and shellfishes of coastal and estuarine environments. Cholera pathogenesis is a complex process and involves synergistic action of several genes. CT is considered the most important epidemic marker among various toxins produced by V.cholerae. Detection of V.cholerae from food stuffs is problematic, since they are present at low level together with large number of competing microflora and also they may be injured by different food processing methods. [Vet. World 2011; 4(9.000): 423-428]