History Of Animal Contact Research Articles

Streptococcus suis and an Incidentally Diagnosed Metastatic Colon Cancer

Background: Streptococcus suis is a zoonotic infection known to cause meningitis and sepsis, in addition to several other rare manifestations. Infection with this organism is rare in the absence of pork ingestion or a handling history. Case presentation: The authors report the case of a 62-year-old male with no animal contact history, who presented with symptoms of urinary tract infection. It was his second infection over the course of 2 years. His urine culture was positive for Escherichia coli but his blood culture was positive for S. suis. Ultrasound of the abdomen ruled out underlying predisposing urinary pathology. However, it did show several heterogeneous liver masses with abnormal vascularity. A follow-up abdominal CT revealed a malignant neoplastic process involving the sigmoid colon with metastatic liver lesions. Colonoscopy demonstrated a fungating mass at the sigmoid colon and biopsies revealed a moderately differentiated adenocarcinoma. Conclusion: This case suggests the possibility of associated colon cancer in patients presenting with S. suis with no explicit history of animal or pork contact. It also proposes the existence of an association between colon cancer with Streptococcus species other than bovis.

Clinical and epidemiological characteristics of tinea capitis in northern Taiwan during 2014-2019: An unusual bimodal distribution of patients and comparison of paediatric and adult cases.

Tinea capitis (TC) mainly occurs in children, and related studies in adults are rare. We aimed to investigate the current epidemiological, clinical and mycological characteristics of TC and to compare adult and paediatric patients in northern Taiwan. We conducted a retrospective study at Chang Gung Memorial Hospital, Linkou Branch, from 2014 to 2019. The dataset included age, sex, records of underlying diseases, animal contact history, frequent hair salon visits, clinical patterns, treatment and outcome via chart or phone call reviews. The average ages of 72 children and 104 adults recruited were 6.0 and 74.0years, respectively. A female predominance was noted in both groups, and the ratio of females was significantly higher in adults (94.2% vs 59.7%, P<.0001). Microsporum canis (76.4%) and Trichophyton mentagrophytes (11.1%) in children, and M.canis (49.0%) and T.violaceum (31.7%) in adults were the most common pathogens. Adults were more likely to be infected with T.violaceum (OR=10.14, 95% CI=2.04-50.26) than children. In contrast, adults were less likely to be infected with M.canis than children (OR=0.31, 95% CI=0.11-0.90). Furthermore, adults visited hair salons more, had less animal contact and were more immunosuppressed than children. TC is not unusual in the adult population. Dermatologists are advised to realise risk factors such as immunosuppression and regular hair salon visit in adult TC.

COMPLICATED PLEURAL EFFUSION CAUSED BY PASTEURELLA MULTOCIDA IN A PATIENT WITH RHABDOMYOLOYSIS: A CASE REPORT

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pasteurella multocida is present in the oral, nasopharyngeal and upper respiratory tract of cats, dogs, and other animals. This organism most commonly causes skin and soft tissue infections following animal bites and scratches; however, cases of respiratory illness have been reported. Here, we present an interesting case of P. multocida bacteremia and complicated pleural effusion discovered in a patient with rhabdomyolysis. CASE PRESENTATION: A 73-year-old female immunocompetent patient suffered a fall, spent two days on the ground, and was brought to the emergency department by EMS. There she was found to have rhabdomyolysis as well as bacteremia which grew Pasteurella multocida. Computed Tomography (CT) scans demonstrated loculated effusions in the bilateral lower lobes, initially more severe on the right side. The patient required a right-sided thoracentesis and left sided chest tube with administration of tPA-dornase and recovered with initiation of antimicrobial therapy. DISCUSSION: Pasteurella multocida is a gram-negative bacterium transmitted to humans by animal bite, though reports of transference through saliva alone have been reported. Our patient remembered being bitten by her cat when she initially fell, but a history of exposure cannot always be elicited. Indeed, many elderly patients cannot recall the events surrounding a fall but those exposed to secretions of pets through inhalation or bites can develop P. Multocida complications. In most immunocompetent persons, this bacteria causes cellulitis or localized wound infections. Our patient subsequently developed a complicated effusion. Pasteurella multocida infection of the respiratory tract is an unusual, but a known sequela of bacteremia among case reports. The development of pleural effusion secondary to P. multocida mostly occurred in the setting of chronic respiratory disease or immunocompromised state. We were unable to identify any reports of P.multocida pleural effusions occurring concurrently with or sequentially to rhabdomyolysis, as was seen in this patient. Rhabdomyolysis can develop after bacterial infections including legionella(1) and mycoplasma pneumonia(2), as well as after viral infections including influenza. However, rhabdomyolysis has not been directly linked as an inciting factor in the development of respiratory illness in humans. In rats, it was found that rhabdomyolysis induced ultrastructural impairment of the lung with Type II cell damage. This suggests that rhabdomyolysis can induce tissue injury associated with increased oxidative stress which can progress to acute lung injury.(3) CONCLUSIONS: In conclusion, we presented a case of complicated pleural effusion secondary to P. multocida infection in a patient with rhabdomyolysis. Obtaining patient history of animal contact is an important addition to fall questionnaires, as it may encourage the use of empiric treatment to cover for P.multocida. Reference #1: Sutarjono B, Alexis J, Sachidanandam JC. Legionella pneumonia complicated by rhabdomyolysis. BMJ Case Reports. 2019;12(6):10-12. doi:10.1136/bcr-2019-229243 Reference #2: Byrd RP, Roy TM. Rhabdomyolysis and bacterial pneumonia. Respiratory Medicine. 1998;92(2):359-362. doi:10.1016/S0954-6111(98)90123-8 Reference #3: Rodrigo R, Trujillo S, Bosco C. Biochemical and ultrastructural lung damage induced by rhabdomyolysis in the rat. Experimental Biology and Medicine. 2006;231(8):1430-1438. doi:10.1177/153537020623100817 DISCLOSURES: No relevant relationships by Katherine Polednik, source=Web Response No relevant relationships by Tejas Sangoi, source=Web Response No relevant relationships by Keniesha Thompson, source=Web Response

‘Characterisation of suspected Crimean-Congo Haemorrhagic Fever (CCHF) cases in a public sector hospital Islamabad’

ABSTRACT Pakistan has been experiencing a continuous rise in the incidence of Crimean Congo Haemorrhagic Fever (CCHF). Sporadic cases of CCHF are reported from rural areas of Punjab, Azad Jammu Kashmir and Khyber Pakhtunkhwa and neighbouring Afghanistan where cattle herding is common. The objective of this paper was to describe the epidemiology of CCHF. A descriptive study was carried out in the CCHF isolation ward in Islamabad in a tertiary care hospital from February to November 2018. Using a standardised case definition, all patients admitted in the isolation ward with clinical evidence of CCHF were included in the study. After taking the informed consent, data were collected on demographic factors, history of animal contact, tick-bite history, co-morbidity, laboratory results and treatment outcome. Data were analysed as per time, place and person. During the study period, 40 suspected CCHF patients were admitted in the isolation ward, 32 (80%) males were affected. Mean age of the cases was 33.5 years (range 13–70 years). Most affected 17 (42.5%) age group was 20–29 years. Animal contact history was found in Thirty-seven (92.5%) of cases and 28 (70%) with tick bites. Most of the cases, 26 (65%), were reported from July to August. Forty patients in this study were tested by Real Time Polymerase Chain Reaction (PCR), 20 (50%) were positive, out of which 6(30%) expired. Majority of the positive patients were animal handlers by occupation (37.5%). Proper personal protective equipment was available. The reference laboratory facility was not available for immediate investigations was sent to National Institute of Health for confirmation. The overall results show the important risk factors for CCHF a history of tick bites, high-risk occupations and having contact with livestock. Public health measures should focus on preventing tick bites, increasing awareness of CCHF signs and symptoms, timely investigation, and treatment to reduce mortality. Our analyses recommend the government to set up isolation units in all major hospitals, and proper surveillance system.

Unusual Presentation of Orf Disease on a Thermal Burn Scar

Introduction Orf disease is a viral disease of sheep and goats that can appear in humans too. The usual presentation is in sites that have direct contact. Clinical manifestation of Orf disease may be unusual in burn patients. Case Report In this case report, we described a rare presentation of Orf disease on a burn scar of a two-year girl. The patient had a history of animal contact and the presence of Orf virus was confirmed using pathologic studies and Polymerase Chain Reaction (PCR). Conclusion Few other reports of Orf disease on a burn scar are also available in scientific literature which propose the higher risk of these patients for development of Orf disease.

Clinical characteristics of acute Q fever patients in South Korea and time from symptom onset to serologic diagnosis

BackgroundAcute Q fever usually presents as a nonspecific febrile illness, and its occurrence is rapidly increasing in South Korea. This study investigated the clinical characteristics of acute Q fever patients in South Korea and the time from symptom onset to serologic diagnosis. The clinical courses were examined according to antibiotic treatment.MethodsData of patients diagnosed with acute Q fever at Chungbuk National University Hospital between January 2015 and February 2018 were retrospectively collected. Demographic and epidemiologic data were reviewed. The time from symptom onset to serologic diagnosis by an immunofluorescence assay (IFA) was analyzed. Clinical courses and the percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) were compared between patients administered antibiotics with anti-Coxiella burnetii activity and patients not administered such antibiotics.ResultsForty-eight patients (median age: 51.5 years) were included. Most were male (95.8%) and had no history of animal contact (91.7%). The median time from illness onset to serologic diagnosis was 21 days. Thirty-nine patients received antibiotics with anti-C. burnetii activity. The length of hospital stay and fever duration did not significantly differ between patients who received antibiotics with anti-C. burnetii activity (7 and 15 days) and those who did not (5 and 8 days) (P = 0.110 and P = 0.137, respectively). The percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) did not significantly differ between patients who received antibiotics with anti-C. burnetii activity and those who did not (P = 0.340).ConclusionsMost acute Q fever patients had a nonspecific febrile illness with mild elevation of transaminases and no history of animal contact or occupational risk. The time from symptom onset to a positive IFA test was longer than the fever duration in most acute Q fever patients. Consequently, it may be difficult for clinicians to serologically diagnose acute Q fever. However, inappropriate antibiotic treatment was not associated with prolongation of symptoms or progression to chronic Q fever.

Acute Febrile Illness Caused by Brucella abortus Infection in Humans in Pakistan.

Brucellosis is a zoonosis of great and worldwide public health concern that can cause a severe febrile illness in humans. In Pakistan, brucellosis is a critical problem in both animals and humans. This study aimed to gain insight into its prevalence and to analyze the potential risk factors of patients with acute febrile illness (AFI) of an unknown cause, at the hospitals of Rawalpindi and Islamabad in Pakistan. In total, 446 blood samples were collected from patients and screened for brucellosis using the Rose Bengal Plat Test (RBPT). All the serum samples were investigated for Brucella DNA using specific real-time PCR. Age, sex, occupation, urbanicity, socioeconomic status and history of animal contact were recorded and assessed as potential risk factors. The proportion of acute febrile illness patients for whom brucellosis could be suspected was 10.1% by the RBPT. Brucella DNA was detected in 26 (5.8%) cases and identified as B. abortus. Contact with infected animals, consumption of raw milk and socioeconomic status showed a highly significant (p < 0.05) correlation with seropositivity. Elderly patients (19.7% RBPT and 12.1% PCR) and females (13% RBPT and 9.3% PCR) were of high risk of brucellosis. Patients suffering from brucellosis-related manifestations should be screened for brucellosis, especially those in contact with animals or those consuming their unprocessed products, given the increased risk. The results of this study, which highlight that Brucella abortus as an important cause of acute febrile illnesses in humans, aid the development of effective control strategies for human brucellosis in Pakistan.

Leptospirosis: Seroprevalence, risk factors, and diagnostic view in a tertiary care center in North India

INTRODUCTION: Leptospirosis is a zoonotic disease with clinical manifestations, ranging from subclinical infection to fulminant disease. OBJECTIVE: To study the seroprevalence, various epidemiological risk factors, and diagnostic aspects of leptospirosis. MATERIALS AND METHODS: One hundred and seventy-one clinically suspected individuals were enrolled in the study at Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, during January 2013–May 2014. A detailed history of patients was taken on a predesigned pro forma. Blood sample was collected from the patients, and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR), and microscopic agglutination test (MAT) were done for diagnosis. The patients' details were also scored according to the modified Faine's criteria. RESULTS: Of 171 patients, 24 (14.1%) cases were diagnosed positive by IgM ELISA. Contact with dirty surroundings, fieldworkers, history of animal contact, and use of public bathing facilities/ponds were associated with 20 (83.3%), 20 (83.3%) 19 (79.2%), and 18 (75%) cases, respectively. Fifteen (62.5%) cases were diagnosed during July–September (P = 0.004). Fever, myalgia, and abdominal pain were the common symptoms. Calf tenderness was seen in 22 cases (P 25. CONCLUSIONS: Dirty surroundings, fieldworkers, animal contact, and heavy rainfall are the major epidemiological risk factors for leptospirosis. Modified Faine's criteria may play a useful role in diagnosis for a patient with low clinical score.

Pattern of childhood brucellosis in Najran, south Saudi Arabia in 2013-2017.

BackgroundWith more than 500,000 new cases annually, human brucellosis is the commonest zoonotic disease worldwide. In some endemic countries, its prevalence is more than 10 per 100,000 population.ObjectiveThe aim of this study was to determine the magnitude of the problem and the clinical features, laboratory findings, treatment given and complications seen in children with brucellosis in Najran City, Kingdom of Saudi Arabia.MethodsThis is a case-series study by analysis of data of children known or diagnosed to have brucellosis for the last 4 years in Najran City. Data was obtained by reviewing the hospital records of the Maternity and Children Hospital and Najran Armed Forces Hospital in Najran during the period from 2013 to 2017. The statistical analysis was carried out using SPSS version 16.0. Since it was the first report of brucellosis on the study population, we used descriptive statistics (frequency, proportion, mean, and standard deviation) for presenting the findings.ResultsWe studied 57 diagnosed cases of child brucellosis throughout the past 4 years in Najran, south Saudi Arabia with an average number of about 12 cases per year. Of the cases, 15.8% reported a history of ingestion of raw milk and dairy product and only 1.8% of them reported a history of animal contact while 82.4% confirmed unknown mode of transmission. Fever was the only finding in 36.8%, fever and arthralgia 21.1%, and fever and myalgia 19.3%. Two thirds of the cases were diagnosed by standard agglutination test (SAT). Hepatosplenomegaly was found in 10.5%. Rifampicin was the antibiotic of choice and 70.2% of cases have been cured but 3.5% relapsed and 1.8% died from complications.ConclusionsResults suggest brucellosis be considered in every child living in an endemic area, showing symptoms of fever and having a history of ingestion of raw milk and dairy product and/or animal contact.Prevention should rely on health education of the public about different issues of the disease including boiling raw milk.

An Overwiev of ORF Virus Infection in Humans and Animals.

Orf virus is a DNA virus that belongs to the Parapoxvirus genus. The virus is a causative agent of orf in humans or contagious ecthyma in animals which is mostly seen in sheep, goat and cattle. Orf is an emerging zoonosis with an increasing number of worldwide outbreaks that have been reported. It is a contagious disease that tends to spread very fast among livestock. The morbidity rate is very high, particularly among young unvaccinated animals. The fatality rate is low but can be seen due to secondary infections. The disease has a significant effect on livestock health and may lead to economical losses. Humans may become infected if they have a direct contact with animal lesions. The disease is seen as a cutaneous lesion with a mild clinical outcome. Human to human transmission exists but is very rare. Nosocomial transmission was reported with one outbreak in a burn unit. The diagnosis is mostly based on the history of animal contact and clinical findings. Molecular tests are used to confirm clinical diagnose. There is no specific treatment but a live vaccine is available for animals. Surveillance implementations and infection control measurements are very important for the prevention of infection. Currently, there are limited studies on orf or contagious ecthyma. It has been observed that there are few studies that have resulted in patents. The aim of this paper was to review the current relevant patents, epidemiological features, clinical presentations, the diagnosis and treatment of orf.

The epidemiological features and clinical analysis of 119 brucellosis cases

Objective To analyze the epidemiological characteristics, clinical manifestations, diagnosis and treatment effect of brucella in=nfection, and to provide practical foundation and valuable experience for clinical treatment and prevention of brucellosis. Methods One hundred and nineteen patients with brucella infection hospitalized at the First Hospital of Lanzhou University from January 1st 2011 to July 30th 2011 were enrolled. Clinical data including gender, age, contact history with bovine and clinical manifestations such as fever, sweating and joint and muscle pain were extracted. Diagnosis and treatment effect of these patients were all recorded. The epidemiological characteristics and clinical manifestations were analyzed. Results The majority of patients were middle-aged male, and the number of male cases were 2.5 times of female cases. The brucella infections were observed all seasons in Lanzhou, while most cases were observed between May and July. A total of 78 cases had clear animal contact history. Among them, 53 cases (44.54%) had contact history with bovine. Main clinical manifestations included fever (n=84, 70.59%), muscle and joint pain (n=93, 78.15%), sweating (n=52, 43.70%), fatigue (n=29, 24.37%), and the most common clinical symptoms was joint and muscle pain. Blood routine test showed neutropenia (n=25, 21.01%), increase in blood sedimentation (n=34, 28.57%) and blood coagulation dysfunction (n=30, 25.21%). Liver function examination showed increase in ALT (n=37, 31.09%) and AST (n=43, 36.13%). Other examination showed that splenomegaly (n=28, 23.52%) was the most common finding, and liver diffuse lesions (n=22, 18.49%) ranked second. The most common drugs were doxycycline (n=79, 66.39%), rifampin (n=60, 50.42%) and cephalosporins (n=50, 42.02%). Among them, 45 cases (37.82%) were treated with combination therapy of rifampin and doxycycline, and 31 cases were treated with combination therapy of doxycycline and rifapentine or cephalosporins. Totally 112 cases (94.12%) recovered. Conclusions The majority of patients with brucellosis are male. The clinical manifestations of brucellosis are varied. Clinicians should pay attention to identify and prevent misdiagnosis. The timely and effective treatment should be provided according to patients’ conditions. The relevant departments should also strengthen supervision and education of brucellosis. Key words: Brucellosis; Epidemiological characteristic; Clinical manifestations; Diagnosis; Treatment

Serologic evidence and risk factors for Helicobacter pylori infection in animals and humans.

Helicobacter pylori (H. pylori) is one of the most common bacterial infections among humans worldwide. Although many records imply its interfamilial acquisition, the role of animals remains poorly understood. This study was undertaken to investigate the seroprevalence of H. pylori in animals and their human contacts in Cairo and Giza governorates, Egypt. Commercial enzyme-linked immunosorbent assay (ELISA) kits were used to detect IgG antibodies to H. pylori in dogs, cattle, and humans. Seropositive dogs (35/94; 37.2%), cattle (24/80; 30%) and humans (40/90; 44.4%) were found. Seroprevalence in animals significantly varied in different areas of sample collection, but there was no association with sex or age. Human seropositivity rates were associated with increasing age; moreover, seropositive dog owners (51.7%; 15/29), had seropositive dogs. However, infection was not associated with subject's sex, occupation, or history of animal contact. Our findings indicate H. pylori is widely distributed in cattle and dogs and their human contacts in Cairo and Giza, Egypt. Further studies to determine infection in other occupational groups are needed. This study provides baseline information on the seroprevalence of H. pylori, which may be required to begin prevention control programs in our area.

A rare cardiac manifestation of Brucellosis (RCD code: VIII)

Brucellosis, a zoonosis caused by gram negative bacillus Brucella, is characterized by a systemic illness with vague symptoms. Though, cardiac involvement with Brucella is reported mostly as endocarditis, the occurrence of exclusive Brucella constrictive pericarditis without endocardium involvement is extremely rare. We report a case of a young villager who presented with symptoms of low grade fever, dypnea and malaise with signs of right heart failure. He was diagnosed to have constrictive pericarditis on 2-D echocardiogram and the diagnosis was confirmed by cardiac magnetic resonance(CMR) imaging. A pericardiectomy was performed for the relief of pericardial constriction. The patient, however, continued to have low grade fever and lethargy. A workup for chronic infections revealed strongly positive titres for Brucella, indicating that the patient was suffering from systemic Brucellosis. The patient was treated with combination of antibiotics for six weeks and responded well to treatment. The case highlights the fact that Brucellosis has a wide array of clinical presentations and may present as an isolated exclusive constrictive pericarditis. The diagnosis of Brucellosis should always be considered in patients presenting with chronic fever with history of animal contact.

The Epidemiology and Characteristics of Q fever and Co‐infections with Scrub Typhus, Murine Typhus or Leptospirosis in Taiwan: A Nationwide Database Study

Q fever (QF) is a worldwide zoonosis associated with outbreaks. Only a few nationwide studies regarding the surveillance and epidemiology of human QF have been reported. Although QF is endemic in Taiwan, a nationwide database investigation of the epidemiology and characteristics of QF and its associations with scrub typhus (ST), murine typhus (MT) and leptospirosis (LS) has never been reported. We analysed nationwide databases of suspected QF, ST, MT and LS cases from October 2007 to December 2014 obtained from the Centers for Disease Control, Taiwan. A total of 468 (4.2%) QF cases were identified among 11109 suspected QF cases. QF cases were mainly distributed in the southern and Kaohsiung-Pingtung regions but rarely in the eastern region. Compared to non-QF cases, QF cases had significantly higher percentages of males (88.7 versus 66.2%) and high-risk occupations (farming, animal husbandry or veterinary medicine) (16.2 versus 10.5%). But the percentages of specific animal contact, including cattle (0.6 versus 0.8%) and goats (0.9 versus 1.0%), were low in both. The majority of suspected QF cases (89.4%) were simultaneously suspected with ST, MT or LS, and the combinations of suspected diseases differed between regions. The number of suspected QF cases from the eastern region decreased since 2009, which was not observed in other regions. A total of 1420 (12.8%) cases had confirmed diseases, including QF (453, 4.1%), QF+ST (7, 0.06%), QF+MT (4, 0.04%), QF+LS (4, 0.04%), MT (186, 1.7%), ST (545, 4.9%), ST+LS (11, 0.1%) and LS (210, 1.9%). Compared to cases of unknown disease, QF cases had larger percentages of high-risk occupations (16.2 versus 9.6%) but similar histories of animal contact (29.8 versus 25.1%). QF is an endemic disease in southern Taiwan. It is difficult to differentiate QF from ST, MT or LS only by high-risk occupations and history of animal contact, and co-infection of QF with these diseases should be considered.

Investigation on Toxoplasma gondii infection in reproductive women in Shandong Province

To investigate the Toxoplasma gondii infection situation and relative factors in reproductive women in Shandong area, so as to provide the evidences for establishing strategies for reducing the birth defects and improving the quality of population. A total of 5 386 reproductive women who visited hospitals at county and city levels in Shandong region from January 2013 to December 2015 were treated as the research objects, and their venous blood samples were collected to detect the antibodies (IgG and IgM) against T. Gondii in serum. Meanwhile, the related risk factors of T. gondii infection were surveyed by questionnaires. Among the 5 386 reproductive women, 623 ones were positive for IgG antibody and the positive rate was 11.56%, and 328 ones were positive for IgM antibody and the positive rate was 6.21%. The single factor analysis showed that the pregnant status (χ2 = 13.12, P < 0.01), whether the residences were in downtowns or counties (χ2 = 6.27, P < 0.05), whether having animal contact history (χ2 = 10.46, P < 0.01), and whether eating half-baked foods (χ2 = 21.19, P < 0.01) were related to T. gondii infection. The T. gondii infection rate of reproductive women in Shandong Province is high; the related risk factors include pregnant status, residence, degree of intimate contact with animal, and whether eating half-baked foods. It suggests that the detection of T. gondii infection and health education in reproductive women should be strengthened.

Evaluation of cutaneous anthrax cases during an outbreak in the east region of Turkey.

Anthrax is a zoonotic infection caused by Bacillus anthracis. We aimed to retrospectively evaluate cutaneous anthrax cases that occurred during an outbreak in eastern Turkey (Hakkari-Yüksekova), where people mostly earn their living from animal husbandry. Forty-six cutaneous anthrax patients that were admitted to the hospital during a very short duration of 3 months (June-August 2011) were evaluated. Out of 46 patients, 27 (52%) were women and 19 (48%) were men. The mean age was 37 ± 13 years. The distribution of occupations was 1 butcher, 1 cook, 5 farmers, 27 housewives, 11 shepherds, and 1 teacher. Multiple lesions were seen in 7 patients (15%) and the rest of the patients had only 1 lesion. We observed significant clinical differences among the cases and noted which particular symptoms were associated with the various skin lesions. We treated our patients with intramuscular procaine penicillin or oral ciprofloxacin/doxycycline. Anthrax is an important health problem that can cause lethal outbreaks. Therefore, one should think about anthrax when faced with a patient with history of animal contact that has a painless ulcer with edema and/or vesicles, especially in endemic countries like Turkey.

Epidemiological characteristics of human brucellosis in Al-Qassim region, Saudi Arabia, between 2010 and 2014

Background: Brucellosis, a zoonotic infection having an important public health issue in endemic countries; Saudi Arabia is one of these countries. The incidence of brucellosis in AlQassim region is much higher than the national one. Evaluation of the epidemiological situation of brucellosis is the first step in prevention and control. The objective was to describe the epidemiological characteristics of brucellosis in Al-Qassim region during the period between 2010 and 2014. Methods: All epidemiological surveillance forms from 2010 to 2014 were analyzed for epidemiological characteristics. Results: There were 4283 notified cases of human brucellosis in AL-Qassim region between 2010 and 2014, the annual incidence decreased from 84.5 to 48.7 per 100,000 populations. The highest number of cases was reported from Uyoon Al-Jawa followed by Buraidah. The number of cases was highest from March to June. and lowest was in November; the male to female ratio was 3:1. Saudis represents 51.1% of cases. The mean age of the cases was 34±15 years; the most common age group was middle age. Shepherds and farmers represent 46.5% of cases. The most common presenting symptoms were fever (79.7%), joint pain (72.7%), and muscle pain (70.9%). The most common antibiotics used as treatment were doxycycline (80.9%) and streptomycin (63.2%). A history of animal contact was the most common risk factor (80.7%), followed by consumption of raw milk (55.6%). Conclusions: There was a marked decrease in the incidence of brucellosis from 2010 to 2014 in the Al-Qassim region. However, continued efforts are needed to eliminate the disease.

Prevalence and identification of Cryptosporidium species in paediatric patients with diarrhoea.

To determine the prevalence of Cryptosporidium infection in children with diarrhoea, identify associated factors and identify the parasite using Polymerase Chain Reaction (PCR). A total of 138 diarrhoeic faecal samples were collected between August 2011 and February 2013, from children under 12 years of age, admitted to paediatric units of Teaching Hospitals, Kandy and Peradeniya, Sirimawo Bandaranayake Childrens' Hospital, Peradeniya and District General Hospital, Matale. One hundred faecal samples collected from healthy children were used as controls. All control and test samples were screened for the presence of Cryptosporidium oocysts with Modified Ziehl-Neelsen (MZN) method and PCR. Prevalence of Cryptosporidium infection among children with diarrhoea was 5.7%. All the cases positive for Cryptosporidium were below 3 years of age. The majority (7 out of 8) of the positive cases had watery diarrhoea while none of the healthy children excreted Cryptosporidium oocysts in the faeces. Of the 8 positive cases, 6 had a history of animal contact. A large proportion of positive cases used pipe borne municipal water. The majority (66.6%) of positive cases did not consume boiled cooled water. We were able to identify C. parvum from one of the eight cases that had diarrhoea. The current study shows that Cryptosporidium is one of the aetiological agents responsible for childhood watery diarrhoea in Sri Lanka, thus stressing the importance of routine stool examination for Cryptosporidium oocysts. This study recommends boiling water as an important measure to prevent the transmission of Cryptosporidium oocysts. Further molecular studies are needed to determine the other species of Cryptosporidium responsible for cryptosporidiosis in children in Sri Lanka.

Injectional anthrax - new presentation of an old disease.

Bacillus anthracis infection (anthrax) has three distinct clinical presentations depending on the route of exposure: cutaneous, gastrointestinal and inhalational anthrax. Each of these can lead to secondary bacteraemia and anthrax meningitis. Since 2009,anthrax has emerged among heroin users in Europe,presenting a novel clinical manifestation, 'injectional anthrax', which has been attributed to contaminated heroin distributed throughout Europe; before 2009 only one case was reported. During 2012 and 2013,new cases of injectional anthrax were diagnosed in Denmark, France, Germany, and the United Kingdom.Here we present a comprehensive review of the literature and information derived from different reporting systems until 31 December 2013. Overall 70 confirmed cases were reported, with 26 fatalities (37% case fatality rate).The latest two confirmed cases occurred in March 2013. Thirteen case reports have been published,describing 18 confirmed cases. Sixteen of these presented as a severe soft tissue infection that differed clinically from cutaneous anthrax, lacked the characteristic epidemiological history of animal contact and ten cases required complimentary surgical debridement. These unfamiliar characteristics have led to delays of three to 12 days in diagnosis, inadequate treatment and a high fatality rate. Clinicians' awareness of this recently described clinical entity is key for early 'and successful management of patients.

Hematogenous pasteurella haemolytica brain abscess

ABSTRACT Pasteurella infections are common in domestic animals and very rare in human. We report a hematogenously acquired Pasteurella haemolytica brain abscess, mimicking brain tumor on magnetic resonance imaging, in an 18-year-old female patient known with cardiac interventricular communication, without recent history of animal contact. The outcome was good after abscess complete removal and antimicrobials therapy for 6 weeks. To the best of our knowledge, this is the first reported case of P. haemolytica brain abscess.