Internal Abscesses Research Articles

Treatment of severe atopic dermatitis and eosinophilic esophagitis with dupilumab in a 14-year-old boy with autosomal dominant hyper-IgE syndrome

Autosomal dominant hyper-IgE syndrome (AD-HIES), also known as Job syndrome and Buckley syndrome, is characterized by elevated IgE levels, eosinophilia, recurrent cutaneous and internal organ abscesses, pneumonia leading to pneumatoceles, mucocutaneous candidiasis, characteristic facies, delayed shedding of primary teeth, bone fractures due to minor trauma, joint hypermobility, and scoliosis.1 In addition, allergic disorders such as atopic dermatitis (AD), food allergy, and eosinophilic esophagitis (EoE)2 may be associated with AD-HIES.

Clinical characteristics and predictors of mortality in patients with melioidosis: the Kapit experience.

Melioidosis, caused by Burkholderia pseudomallei, is prevalent in rural areas of Malaysia. The aim of this study is to delineate the epidemiology and predictors of mortality from melioidosis in Kapit district, Sarawak. For this retrospective study of patients with culture-confirmed melioidosis admitted to Kapit Hospital, Sarawak, Malaysia, between July 2016 and July 2019, epidemiological, clinical and microbiological data were obtained. Univariate and multivariate logistic regression analyses were used to determine predictors of mortality. Seventy three patients met inclusion criteria. Diabetes mellitus (28.8%) and hypertension (27.4%) were primary co-morbidities. Clinical spectrum of melioidosis ranged from bacteraemia (64.4%), pneumonia (61.6%) and internal organ abscesses (49.3%) to localised soft tissue (21.9%) and joint abscesses (6.9%). Mortality rate was 12.3%. Bacteraemia and pneumonia were significantly associated with septic shock, whereas patients with soft tissue abscesses tended to present with a milder form of melioidosis without septic shock. Septic shock, mechanical ventilation, intensive care unit admission, serum urea, creatinine, bicarbonate, albumin and aspartate transaminase were all significantly associated with increased mortality on univariate analysis (all P<0.05). Multivariate analysis revealed that low serum bicarbonate (P=0.004, OR 0.64, 95% CI 0.48-0.87) and albumin (P=0.031, OR 0.73, 95% CI 0.54-0.97) could be associated with a higher mortality. Melioidosis remains a fatal infection and commonly presents with septic shock, in the form of bacteraemia and pneumonia. Two routine clinical parameters, serum bicarbonate and serum albumin, may have important prognostic implications in septicaemic melioidosis.

Predicting the mortality of melioidosis in the heart of Borneo

Background: Melioidosis, caused by Burkholderia pseudomallei, is prevalent in rural areas of Malaysia. This soil-dwelling pathogen is inherently resistant to many first-line antibiotics and carries a high mortality rate. Hence, it poses a significant burden of disease in terms of productivity losses among farmers and blue-collar workers in resource-poor environments. There are limited reports on the factors associated with mortality from melioidosis in Borneo. Methods and materials: This study delineates the epidemiological, clinical and microbiological characteristics of melioidosis, and the predictors of mortality. Seventy-three adults, with culture-confirmed melioidosis at Kapit Hospital, Sarawak, Malaysia, over a 3-year period were retrospectively identified. Results: Among 73 patients, diabetes mellitus (28.8%; n = 21) and hypertension (27.4%; n = 20) were reported as the primary risk factors. The clinical spectrum of melioidosis may vary from localised soft tissue (21.9%; n = 16) and joint abscesses (6.9%; n = 5), to a fulminant end of the spectrum, in the form of bacteraemia (64.4%; n = 47), pneumonia (61.6%; n = 45) and internal organ abscesses (49.3%; n = 36). The mortality rate was 12.3% (n = 9). The mean time from presentation to initiation of anti-melioidosis treatment was 2.6 ± 2.3 days. Positive cultures largely came from blood (58.9%, n = 43) and sputum (28.8%; n = 21). All isolates were sensitive to Ceftazidime and 92.7% were sensitive to Gentamicin, which is a unique occurrence in Sarawak. Using univariate analyses, we identified septic shock (p < 0.001), intensive care unit admission (p = 0.001), mechanical ventilation (p < 0.001), serum urea (p < 0.001), serum creatinine (p < 0.001), serum aspartate transaminase (p = 0.037), serum bicarbonate (p < 0.001) and serum albumin (p = 0.025), to be associated with increased risk of mortality. Multivariate logistic regression analyses identified serum bicarbonate (p = 0.004, OR 0.64, 95% CI 0.48–0.87) and serum albumin (p = 0.031, OR 0.73, 95% CI 0.54–0.97), to be the independent predictors of mortality from melioidosis. Conclusion: The identification of these two routine clinical parameters, namely serum bicarbonate and serum albumin, have important prognostic implications in septicaemic melioidosis, which could potentially allow prompt recognition of critically ill patients and timely initiation of anti-melioidosis treatment.

The challenges of a Lemierre’s syndrome in COVID-19 times

&lt;p&gt;Lemierre’s syndrome is a type of necrotizing fasciitis of the head and neck that is an uncommon rapidly spreading infection involving the skin, subcutaneous tissue and the fascia leading to life-threatening complications like septicaemia, bone marrow suppression, disseminated intravascular coagulation and multi-organ failure. The management of this disease, especially in COVID-19 pandemic is a challenge as it is associated with high morbidity. A 46-year-old male presented to us with complaints of swelling in the neck with discoloration of skin in the neck and chest. Computed tomography (CT) scan of the neck revealed thrombosis of the right internal jugular vein (IJV) and diffuse abscesses on both sides of the neck. A high index of suspicion is required for the diagnosis of Lemierre’s syndrome in the absence of typical clinical features. The rapid, unpredictable dissemination of infection and occult thrombus within the IJV make both diagnosis and management a challenge especially, during COVID-19 times.&lt;/p&gt;

First report of fatal tick pyaemia caused by heavy infestation with the red sheep tick, Haemaphysalis punctata and co-infection with Babesia and Theileria species

Tick pyaemia is a disease of sheep characterised by the development of internal abscesses caused by Staphylococcus aureus. The disease is normally triggered by infestation with Ixodes ricinus and can...

English

BACKGROUND Magnetic resonance imaging is known to demonstrate the perianal anatomy accurately. MR Fistulography with saline as contrast agent has been described to facilitate the detection of fistula tracks. We wanted to study the diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of magnetic resonance fistulography using saline as a contrast agent using surgical findings as a reference standard. METHODS Fifty-nine clinically diagnosed cases of perianal fistulae who were sent for preoperative MR imaging of the perianal fistulae were included in the study. MR imaging after instillation of saline was obtained in these patients through a cannula inserted into the external opening. T2 and STIR images in axial and coronal planes were studied. Diagnostic indices were calculated using surgical findings as reference standard. RESULTS MR imaging with saline instillation demonstrated a sensitivity of 97.92 % in the detection of primary tracks. The sensitivity in determination of internal opening, secondary tracks, abscesses and horseshoe tracks were 98.04 %, 95.24 %, 100 % and 100 % respectively. MRI had 100 % specificity in detection of primary tracks, internal opening, secondary tracks, abscesses and horseshoe tracks before and after instillation of saline. The sensitivity was found to be more in participants who did not have active perianal discharge at the time of MR examination. CONCLUSIONS MRI with instillation of saline into the fistulous track is highly accurate for the presurgical evaluation of perianal fistula with respect to accurate depiction of primary track, secondary track, abscess and horseshoe extensions. It can serve as a cheaper alternative to MR examination using I.V. Gadolinium based contrast agents or MR Fistulography using Gadolinium agents. KEYWORDS Magnetic Resonance Imaging (MRI), Perianal Fistula, Saline, Pre-Operative Assessment, Fistulography, Horseshoe, Internal Opening, Secondary Tracks

Deep Remission at 1 Year Prevents Progression of Early Crohn’s Disease

We investigated the effects of inducing deep remission in patients with early Crohn's disease (CD). We collected follow-up data from 122 patients (mean age, 31.2 ± 11.3 y) with early, moderate to severe CD (median duration, 0.2 years; interquartile range, 0.1-0.5) who participated in the Effect of Tight Control Management on CD (CALM) study, at 31 sites, representing 50% of the original CALM patient population. Fifty percent of patients (n= 61) were randomly assigned to a tight control strategy (increased therapy based on fecal level of calprotectin, serum level of C-reactive protein, and symptoms), and 50% were assigned to conventional management. We categorized patients as those who were vs were not in deep remission (CD endoscopic index of severity scores below 4, with no deep ulcerations or steroid treatment, for 8 or more weeks) at the end of the follow-up period (median, 3.02 years; range, 0.05-6.26 years). The primary outcome was a composite of major adverse outcomes that indicate CD progression during the follow-up period: new internal fistulas or abscesses, strictures, perianal fistulas or abscesses, or hospitalization or surgery for CD. Kaplan-Meier and penalized Cox regression with bootstrapping were used to compare composite rates between patients who achieved or did not achieve remission at the end of the follow-up period. Major adverse outcomes were reported for 34 patients (27.9%) during the follow-up period. Significantly fewer patients in deep remission at the end of the CALM study had major adverse outcomes during the follow-up period (P= .01). When we adjusted for potential confounders, deep remission (adjusted hazard ratio, 0.19; 95% confidence interval, 0.07-0.31) was significantly associated with a lower risk of major adverse outcome. In an analysis of follow-up data from the CALM study, we associated induction of deep remission in early, moderate to severe CD with decreased risk of disease progression over a median time of 3 years, regardless of tight control or conventional management strategy.

468. Epidemiologic Features of Invasive Methicillin-Resistant Staphylococcus aureus and Group A Streptococcus Infections among Adults Who Inject Drugs in the San Francisco Bay Area, 2008–2017

BackgroundInjection drug use has been associated with infection with invasive methicillin-resistant Staphylococcus aureus (iMRSA) and invasive group A Streptococcus (iGAS). In light of the ongoing opioid epidemic, we sought to describe the epidemiologic features of iGAS and iMRSA infections among persons who inject drugs (PWID) in the San Francisco Bay Area.MethodsActive, population-based surveillance for iMRSA and iGAS was conducted in three California counties during 2008–2017. We defined a case as recovery of MRSA or GAS from a normally sterile site in a surveillance area resident ≥18 years of age. We collected demographic and clinical information and history of injection drug use (IDU) in the past 12 months. Trends in the incidence of infection were assessed using the Cochran-Armitage test for trend. Odds ratios (OR) and 95% Confidence Intervals (CI) were calculated comparing PWID and non-PWID.ResultsOf the 6,705 iMRSA and 1,691 iGAS cases identified during 2008–2017, 764 (11%) and 241 (14%), respectively, were among PWID. The proportion of iMRSA cases reporting IDU increased from 9.6% in 2008 to 12.9% (P = 0.017) in 2017 (Figure 1); no significant trend was observed for iGAS cases (Figure 2). Among iMRSA and iGAS cases, PWID cases were younger than non-PWID cases (iMRSA median 46 vs. 63 years, P < 0.0001; iGAS 41 vs. 57 years, P < 0.0001) and were more likely to be homeless (iMRSA OR 8.3, CI 6.7–10.2; iGAS OR 5.4, CI 4.0–7.2), and diagnosed with endocarditis (iMRSA OR 5.9, CI 4.8–7.3; iGAS OR 2.8, CI 1.3–6.4) and internal abscesses (iMRSA OR 4.3, CI 3.5–5.3; iGAS OR 3.4, CI 2.1–5.5) (Table 1). For iMRSA, PWID cases were more likely than non-PWID cases to be community-associated, (OR 2.5, CI 2.1–2.9) and diagnosed with septic arthritis (OR 2.4, CI 1.9–3.0).ConclusionThe proportion of iMRSA cases reporting IDU significantly increased between 2008 and 2017, in the San Francisco Bay Area. iMRSA and iGAS cases among PWID are younger, more likely to be homeless, and diagnosed with endocarditis and internal abscesses. Prevention measures targeting this younger population who are experiencing homelessness and/or are injecting drugs, may limit severe manifestations of iMRSA and iGAS. These prevention measures should include support of safe injection practices. Disclosures All authors: No reported disclosures.

Fistula Following Laparoscopic Sleeve Gastrectomy: a Proposed Classification and Algorithm for Optimal Management.

Laparoscopic sleeve gastrectomy (LSG) is an accepted restrictive procedure with a hormonal component. There is no definitive course of treatment for post-LSG fistula; it remains a feared complication. We aimed to classify post-LSG fistulas and propose an algorithm to optimize their treatment. Following primary and revisional LSG in obese patients, a retrospective observational study of fistulas was undertaken. Radiological studies were performed to identify anatomically distinct types of fistulas. An algorithm was elaborated for the classification and evolving treatment of each type of fistula. Twenty post-LSG fistulas were studied (13 [2.5%] from our center, 7 referred) with a mean body mass index of 43.1±10.2kg/m2 (32.0-76.0) and mean age of 33.1±11.4years (20.0-56.0). In all cases, the clinically suspected diagnosis was radiologically confirmed by water-soluble upper gastrointestinal series and double-contrast abdomino-pelvic CT scan. Three anatomical fistula types were characterized: type I, a small leak with no collection; type II, a leak with associated intra-abdominal abscess; and type III, a leak with multiple internal or external abscesses, a complex fistula. In accord with our algorithm, patients without sepsis received conservative treatment initially; this was sufficient for type I leaks. Type II abscesses received internal or external percutaneous drainage, and in some cases, stenting or endoprosthesis. Surgery was reserved for failure of conservative options and type III fistula. In cases of sepsis, surgery was mandatory. A radiologically defined, anatomically based classification system and treatment algorithm proved effective in clinical management of post-LSG fistula.

Improved detection of Burkholderia pseudomallei from non-blood clinical specimens using enrichment culture and PCR: narrowing diagnostic gap in resource-constrained settings.

To evaluate the diagnostic utility of enrichment culture and PCR for improved case detection rates of non-bacteraemic form of melioidosis in limited resource settings. Clinical specimens (n = 525) obtained from patients presenting at a tertiary care hospital of South India with clinical symptoms suggestive of community-acquired pneumonia, lower respiratory tract infections, superficial or internal abscesses, chronic skin ulcers and bone or joint infections were tested for the presence of Burkholderia pseudomallei using conventional culture (CC), enrichment culture (EC) and PCR. Sensitivity, specificity, positive and negative predictive values of CC and PCR were initially deduced using EC as the gold standard method. Further, diagnostic accuracies of all the three methods were analysed using Bayesian latent class modelling (BLCM). Detection rates of B. pseudomallei using CC, EC and PCR were 3.8%, 5.3% and 6%, respectively. Diagnostic sensitivities and specificities of CC and PCR were 71.4, 98.4% and 100 and 99.4%, respectively in comparison with EC as the gold standard test. With Bayesian latent class modelling, EC and PCR demonstrated sensitivities of 98.7 and 99.3%, respectively, while CC showed a sensitivity of 70.3% for detection of B. pseudomallei. An increase of 1.6% (95% CI: 1.08-4.32%) in the case detection rate of melioidosis was observed in the study population when EC and/or PCR were used in adjunct to the conventional culture technique. Our study findings underscore the diagnostic superiority of enrichment culture and/or PCR over conventional microbiological culture for improved case detection of melioidosis from non-blood clinical specimens.

PATHOLOGICAL AND BACTERIOLOGICAL STUDIES ON SOME RECORDED INTERNAL ABSCESSES IN SLAUGHTERED CATTLE

Internal microbial infection may lead to abscesses formation in cattle. This study was conducted on 1500 slaughtered cattle from Mansoura abattoir and Damietta local dairy farms to screen out the presence of internal abscesses. Of 1500 slaughtered cattle, 160 animals (10.67%) were affected with lung abscesses (n=140) (87.5%), lung abscesses with tonsillar involvement (n=3) (1.87%), liver abscesses (n=15) (9.37%), bacterial endocarditis with systemic lodgment of bacterial emboli (n=1) (0.62%) and spinal epidural abscess (n=1) (0.62%). Younger animals less than 1 year were more susceptible. A variety of bacterial species including, Pasteurella multocida (P. multocida) 132 (70.58%), Arcanobacterium pyogenes (A. pyogenes) 30 (16.04%), Pseudomonas aeruginosa 12 (6.41%), Staphylococcus aureus 8 (4.27%) and Streptococcus spp. 5 (2.67%) were isolated. The histopathological changes associated with the internal abscesses formation were described in this study. In conclusion, the frequency of bovine abscesses was the highest in lungs. The most common isolate was P. multocida followed by A. pyogenes.

Molecular epidemiology of Corynebacterium pseudotuberculosis isolated from horses in California

Corynebacterium pseudotuberculosis biovar Equi is an important pathogen of horses. It is increasing in frequency in the United States, and is responsible for various clinical forms of infection, including external abscesses, internal abscesses of the abdominal or thoracic cavities, and ulcerative lymphangitis. The host/pathogen factors dictating the form or severity of infection are currently unknown. Our recent investigations have shown that genotyping C. pseudotuberculosis isolates using enterobacterial repetitive intergenic consensus (ERIC)-PCR is useful for understanding the evolutionary genetics of the species as well for molecular epidemiology studies. The aims of the present study were to assess (i) the genetic diversity of C. pseudotuberculosis strains isolated from horses in California, United States and (ii) the epidemiologic relationships among isolates. One hundred and seven C. pseudotuberculosis biovar Equi isolates from ninety-five horses, and two C. pseudotuberculosis biovar Ovis strains, C. pseudotuberculosis ATCC 19410T type strain and C. pseudotuberculosis 1002 vaccine strain, were fingerprinted using the ERIC 1+2-PCR. C. pseudotuberculosis isolated from horses showed a high genetic diversity, clustering in twenty-seven genotypes with a diversity index of 0.91. Minimal spanning tree showed four major clonal complexes with a pattern of temporal clustering. Strains isolated from the same horse showed identical ERIC 1+2-PCR genotype, with the exception of two strains isolated from the same animal that showed distinct genotypes, suggesting a co-infection. We found no strong genetic signals related to clinical form (including internal versus external infections). However, temporal clustering of genotypes was observed.

The epidemiology and clinical spectrum of melioidosis in a teaching hospital in a North-Eastern state of Malaysia: a fifteen-year review.

BackgroundOver the last two decades, many epidemiological studies were performed to describe risks and clinical presentations of melioidosis in endemic countries.MethodsWe performed a retrospective analysis of 158 confirmed cases of melioidosis collected from medical records from 2001 to 2015 in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia, in order to update the current status of melioidosis clinical epidemiology in this putatively high risk region of the country.ResultsPrincipal presentations in patients were lung infection in 65 (41.1 %), skin infection in 44 (27.8 %), septic arthritis/osteomyelitis in 20 (12.7 %) and liver infection in 19 (12.0 %). Bacteremic melioidosis was seen in most of patients (n = 121, 76.6 %). Focal melioidosis was seen in 124 (78.5 %) of patients and multi-focal melioidosis was reported in 45 (28.5 %) cases. Melioidosis with no evident focus was in 34 (21.5 %) patients. Fifty-four (34.2 %) patients developed septic shock. Internal organ abscesses and secondary foci in lungs and/or soft tissue were common. A total of 67 (41 %) cases presented during the monsoonal wet season. Death due to melioidosis was reported in 52 (32.9 %) patients, while relapses were occurred in 11 (7.0 %). Twelve fatal melioidosis cases seen in this study were directly attributed to the absence of prompt acute-phase treatment. Predisposing risk factors were reported in most of patients (n = 133, 84.2 %) and included diabetes (74.7 %), immune disturbances (9.5 %), cancer (4.4 %) and chronic kidney disease (11.4 %). On multivariate analysis, the only independent predictors of mortality were the presence of at least one co-morbid factor (OR 3.0; 95 % CI 1.1–8.4), the happening of septic shock (OR 16.5; 95 % CI 6.1–44.9) and age > 40 years (OR 6.47; 95 % CI 1.7–23.8).ConclusionsMelioidosis should be recognized as an opportunistic nonfatal infection for healthy person. Prompt early diagnosis and appropriate antibiotics administration and critical care help in improved management and minimizing risks for death.

Vernonanthura polyanthes leaves aqueous extract enhances doxorubicin genotoxicity in somatic cells of Drosophila melanogaster and presents no antifungal activity against Candida spp.

Vernonanthura polyanthes (Spreng.) A.J. Vega & Dematt. (Asteraceae), known as "assa-peixe", has been used in ethnomedicine for the treatment of various diseases such as bronchitis, pneumonia, hemoptysis, persistent cough, internal abscesses, gastric and kidney stone pain. Moreover, some studies demonstrated that species of Genus Vernonia present antifungal activity. Due to the biological relevance of this species, the aim of this study was to investigate the toxic, genotoxic, antigenotoxic and antifungal potential of V. polyanthes leaves aqueous extract in somatic cells of Drosophila melanogaster or against Candida spp. The aqueous extract of the plant showed no toxic, genotoxic and antigenotoxic activity in the experimental conditions tested using the wing somatic mutation and recombination test (SMART/wing). However, when the extract was associated with doxorubicin, used in this work as a positive control, the mutagenic potential of doxorubicin was enhanced, increasing the number of mutations in D. melanogaster somatic cells. In the other hand, no inhibitory activity against Candida spp. was observed for V. polyanthes leaves aqueous extract using agar-well diffusion assay. More studies are necessary to reveal the components present in the V. polyanthes leaves aqueous extract that could contribute to potentiate the doxorubicin genotoxicity.

Imported Melioidosis in South Korea: A Case Series with a Literature Review

ObjectivesMelioidosis is a potentially fatal infectious disease caused by the environmental anaerobic Gram-negative bacillus Burkholderia pseudomallei. Melioidosis is endemic to areas of northern Australia and Southeast Asia. With increasing international travel and migration, imported cases of melioidosis are being reported regularly. Here, we summarize the 11 cases of melioidosis reported in South Korea from 2003 to 2014. MethodsTracing epidemiological investigations were performed on every patient reported to the National Surveillance System since 2011. A systematic literature search was performed to identify melioidosis cases that occurred prior to 2011. ResultsThe overall fatality rate was 36.4%. All the patients had visited Southeast Asia where melioidosis is endemic. The stay in the endemic region ranged from 4 days to 20 years. Of the seven patients who developed initial symptoms after returning to South Korea, the time interval between returning to South Korea and symptom onset ranged from 1 day to 3 years. The remaining four patients developed symptoms during their stay in the endemic region and were diagnosed with melioidosis in South Korea. Seven (63.6%) patients possessed at least one risk factor, all of whom were diabetic. Pneumonia was the most frequent clinical manifestation, but the patients showed a wide spectrum of clinical features, including internal organ abscesses, a mycotic aneurysm of the aorta, and coinfection with tuberculosis. ConclusionAn early diagnosis and initiation of the appropriate antibiotics can reduce the mortality of melioidosis. Consequently, increased awareness of the risk factors and clinical features of melioidosis is required.

English

Lemierre Syndrome: A rare case of forgotten desease. Lemierre's syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein and metastatic abscesses following or pharyngeal infection. Though classically caused by Fuso bacterium necrophorum, a number of other causative organisms have been reported in literature. We report a case of lemierre’s syndrome following pharyngitis.

The relationship between Corynebacterium pseudotuberculosis biovar equi phenotype with location and extent of lesions in horses

Equine infection with Corynebacterium pseudotuberculosis can manifest in several forms, including external or internal abscesses. The objective of this study was to phenotype clinical isolates of C. pseudotuberculosis and to investigate the relationship between lesion location and extent of lesions in the animals from which they were collected. One hundred and seventy-one C. pseudotuberculosis biovar equi isolates were collected from horses presenting to the University of California Veterinary Medical Teaching Hospital and two other sources in the period between September 1996 and December 2011. Bacterial isolates were grouped on the bases of biochemical characteristics and growth on brain heart infusion agar. Six phenotypes were identified: (1) large colonies that metabolized sucrose (n = 81); (2) large sucrose-negative colonies (n = 47); (3) medium sucrose-positive (n = 20); (4) medium sucrose-negative (n = 11); (5) small sucrose-positive (n = 7), and (6) small sucrose-negative (n = 5). Medical records corresponding to each isolate were accessed from the University's administrative computer system or from the submitting source in order to determine the anatomical site from which the isolate was collected (n = 171), as well as the extent of lesions (n = 164) in the patient. The relationship between phenotype, lesion location and extent of lesions was then investigated statistically. No significant relationship between strain and lesion location or extent of lesions was found. This suggests that phenotypic differences during in vitro culture does not account for external versus internal disease in horses. Further work to characterize strains genotypically and to identify determinants for bacterial virulence should be performed. Importantly, host and environmental factors should also be further investigated.

Variable virulence factors in Burkholderia pseudomallei (melioidosis) associated with human disease.

Burkholderia pseudomallei is a Gram-negative environmental bacterium that causes melioidosis, a potentially life-threatening infectious disease affecting mammals, including humans. Melioidosis symptoms are both protean and diverse, ranging from mild, localized skin infections to more severe and often fatal presentations including pneumonia, septic shock with multiple internal abscesses and occasionally neurological involvement. Several ubiquitous virulence determinants in B. pseudomallei have already been discovered. However, the molecular basis for differential pathogenesis has, until now, remained elusive. Using clinical data from 556 Australian melioidosis cases spanning more than 20 years, we identified a Burkholderia mallei-like actin polymerization bimA Bm gene that is strongly associated with neurological disease. We also report that a filamentous hemagglutinin gene, fhaB3, is associated with positive blood cultures but is negatively correlated with localized skin lesions without sepsis. We show, for the first time, that variably present virulence factors play an important role in the pathogenesis of melioidosis. Collectively, our study provides a framework for assessing other non-ubiquitous bacterial virulence factors and their association with disease, such as candidate loci identified from large-scale microbial genome-wide association studies.

Keelpijn en zwelling van de hals: eerste symptomen van het syndroom van Lemierre

Lemierre's syndrome, a thrombophlebitis of the internal jugular vein, is a rare disorder, usually caused by the microorganism Fusobacterium necrophorum. Throat ache and swelling of the neck are often the first symptoms. Without adequate treatment, Lemierre's syndrome may result in thrombosis of the internal jugular vein and metastatic lung abscesses, with a mortality rate of 18%. On the basis of 2 cases, Lemierre's syndrome is described here. In cases where Lemierre's syndrome is suspected, hospitalization often follows, with the administration of intravenous antibiotics and drainage of the abscesses. One should be on the alert for Lemierre's syndrome when a patient is presented with swelling in the neck following an oropharyngeal infection.

Haematological, Biochemical And Serum Electrolyte Changes In Non-Pregnant Boer Does Inoculated With Corynebacterium Pseudotuberculosis Via Various Routes

Caseous lymphadenitis is a chronic disease characterized by internal and external abscesses and is caused by Corynebacterium pseudotuberculosis.Thisstudy is designed to measure the hematological, biochemicaland serum electrolyte changes in experimental non-pregnant doesinoculated with Corynebacterium pseudotuberculosis via variousroutes. Little is known about the changes in these parameters through different routes of infection.A total of 20 healthy does (n=20) were divided into 4 groups (intradermal, intranasal, oral and control) of 5 goats each. The three groups were inoculated with 107cfu/1ml of live Corynebacterium pseudotuberculosis, while control is kept unexposed. Following infection, blood samples were collected from the jugular vein for hematological, biochemical and serum electrolyteanalysis. A significantdecrease was observed in RBC count (p<0.05) in the intradermal group, whilenochangesobserved in PCV, Hb, MCV and MCHC parameters. Significant increasein WBC were observed in intradermal, intranasal and oral groups (p<0.05). Slight increase (p<0.05) in monocyte count was observed in intranasal group. A significant reduction (p<0.05) in lymphocytic count was observed for the intranasally inoculated group (p<0.05) and a slight increase (p<0.05) in neutrophil was observed in intranasal and intradermal groups. Biochemically,creatinine and albumin levels increases inintranasal group(p<0.05) and GGT levels were elevated in all the three infected groups (p<0.05).However,there were no significant changes in AST, T.Protein and APT. Serumelectrolyte, revealed a decrease in Calcium (Ca+) concentration in intradermal group with concentration of 2.22mmol/L,intranasal 2.23mmol/L group (p<0.05), and no changes were observed in potassium (K+) and sodium (Na+). The study, therefore, observed increase in WBCs, neutrophils, monocytes, creatinine, GGT, albumin levels and decrease in RBCs, lymphocytes and calcium concentrations on different route of infections.