Possible Routes Of Transmission Research Articles

Bovine leukemia virus discovered in human blood

BackgroundBovine leukemia virus (BLV) infection is widespread in cattle globally and is present in marketed beef and dairy products. Human infection with BLV has been reported in breast and lung cancer tissues and was significantly associated with breast cancer in 3 case-control studies. The purpose of this current research was to determine if BLV is present in human blood cells and if antibodies to BLV are related to blood cell infection.MethodsStandard liquid PCR and Sanger DNA sequencing were used to test for BLV in buffy coat cells (leukocytes and platelets) of blood specimens from 95 self-selected female subjects.Enzyme-linked immunosorbent assay (ELISA) for IgG, IgM, and IgA was used to detect antibodies to BLV in the plasma of the corresponding blood samples.ResultsBLV DNA was detected in the buffy coat cells of blood in 33/95 (38%) of the subjects by PCR and DNA sequencing. IgG antibodies were detected in 30/95(32%), IgM in 55/95(58%), and IgA in 30/95(32%) of the subjects. There was no significant correlation between presence of the antibodies and presence of BLV DNA.ConclusionsThis first report of BLV in human blood raises the question of whether infection of leukocytes could conceivably lead to leukemia as it does in infected cattle. Also, system wide circulation of infected blood cells could facilitate BLV transit to various internal tissues/organs with potential for their infection and subsequent development of cancer. The most likely route of BLV transmission to humans would be zoonotic, as a foodborne infection. Although eradicated from cattle in some countries, BLV still has a high rate of infection in the Americas, the Middle East, and parts of Europe and Asia. This report of BLV in the blood layer containing human leukocytes/platelets adds important information which could be useful to elucidate possible routes of transmission of BLV to humans and to prevent further human infection.

Dealing with leishmaniosis in dogs and cats

Canine leishmaniosis (CanL) is caused by the protozoan parasite Leishmania infantum. It is a zoonosis and is endemic in the Mediterranean basin, Portugal, Latin America and southern Asia. However, the...

BMP9 Action in the Hypothalamus Suppresses Hepatic Glucose Production Through a Central PI3K/Akt /mTOR Pathway

Background: Bone morphogenetic proteins (BMPs) are secreted ligands of the transforming growth factor-β (TGF-β) superfamily of proteins. BMP7 has been reported to traverse obesity and regulates appetite in the hypothalamus. However, whether central BMP9 regulates glucose metabolism and insulin sensitivity remains unclear. In this study, we focused on the impacts of central BMP-9 signaling and possible route of transmission. Methods: We performed intracerebroventricular (ICV) surgery and injected adenovirus expressing BMP9 (Ad-BMP9) or adenovirus encoding enhanced green fluorescence protein (Ad-GFP) into cerebral ventricle of mice. Then metabolic analyses, hyperinsulinemic-euglycemic clamp (HEC) and analysis of PIP3 formation were fulfilled. Real-time PCR and Western blot were performed to investigate potential pathway. Findings: We exhibited that hypothalamic BMP9 expression was downregulated in obese or insulin resistance (IR) mice. Overexpression of BMP9 in the hypothalamus reduced food intake, body weight, blood glucose, and elevated energy expenditure in high fat diet (HFD)-fed mice. Importantly, central treatment of BMP9 improved hepatic IR and inhibited hepatic glucose production (HGP) in mice fed with HFD. The increased hepatic insulin sensitivity and the related metabolic impacts by central BMP9 were blocked by ICV rapamycin injection (an inhibitor of the mTOR signaling). In addition, ICV BMP9 promoted the ability of insulin to activate the insulin receptor (InsR)/PI3K/Akt kinase pathway in hypothalamus. Interpretation: This study provided insight into the potential mechanism by which central BMP9 ameliorates glucose metabolism and IR by promoting the ability insulin to activate the mTOR/PI3K/Akt signaling in the hypothalamus. Funding Statement: This work was supported by grants from National Natural Science Foundation (No:81873658, 81670755), the Natural Science Foundation Project of CQ (No. cstc2015jcyjA10084 and cstc2013 jcyjA 10067) and the Science and Technology Key Program of Health Bureau of Chongqing (2015ZDXM038). Declaration of Interests: The authors have no conflict of interests to declare. Ethics Approval Statement: In the study, all kinds of treatments for mice were strictly carried out in accordance with the administrative animal management method of Chongqing Medical University, and at the same time, they met the relevant regulations of the Ethics Society of Chongqing Medical University.

Pathogen shifts in a honeybee predator following the arrival of the Varroa mite.

Emerging infectious diseases (EIDs) are a global threat to honeybees, and spillover from managed bees threaten wider insect populations. Deformed wing virus (DWV), a widespread virus that has become emergent in conjunction with the spread of the mite Varroa destructor, is thought to be partly responsible for global colony losses. The arrival of Varroa in honeybee populations causes a dramatic loss of viral genotypic diversity, favouring a few virulent strains. Here, we investigate DWV spillover in an invasive Hawaiian population of the wasp, Vespula pensylvanica, a honeybee predator and honey-raider. We show that Vespula underwent a parallel loss in DWV variant diversity upon the arrival of Varroa, despite the mite being a honeybee specialist. The observed shift in Vespula DWV and the variant-sharing between Vespula and Apis suggest that these wasps can acquire DWV directly or indirectly from honeybees. Apis prey items collected from Vespula foragers were positive for DWV, indicating predation is a possible route of transmission. We also sought cascading effects of DWV shifts in a broader Vespula pathogen community. We identified concurrent changes in a suite of additional pathogens, as well as shifts in the associations between these pathogens in Vespula. These findings reveal how hidden effects of the Varroa mite can, via spillover, transform the composition of pathogens in interacting species, with potential knock-on effects for entire pathogen communities.

Clinical correlates and profile of patients on antiretroviral therapy: A hospital-based cross-sectional study from a tertiary care institution of North India

Introduction: HIV/AIDS as a global pandemic has affected each and every region of the world. The HIV epidemic is dynamic in nature with relation to temporal changes, geographic distribution, and modes of transmission. India, though in the declining phase, is still confronting with the varied nature of the spread of the disease. Materials and Methods: This hospital-based cross-sectional study was conducted among four hundred people living with HIV/AIDS (PLHIV) attending the antiretroviral therapy (ART) center of a tertiary care institute of North India. Data were collected from the patients using a predesigned pretested questionnaire maintaining confidentiality. The data were analyzed using simple proportion and percentages. Results: The mean age of the study participants was 32.8 ± 7.4 years. The mean duration of ART intake was 24.5 ± 14.4 months. There was a significant improvement in clinical staging and CD4 count with ART intake among PLHIV. The most prevalent possible route of transmission was found to be heterosexual (85.5%) route. Conclusion: The spread among the population, particularly in the younger age group, reinforces the fact that preventive strategies need to be initiated within the target population at an early stage. Health education and social campaigns are the mainstays for “getting to zero” target.

Improvement of Multiple Routing Based on Fuzzy Clustering and PSO Algorithm In WSNs to Reduce Energy Consumption

One of the most important issues discussed in Wireless Sensor Networks (WSNs) is how to transfer information from nodes within the network to the base station and select the best possible route for transmission of this information, taking into account energy consumption for the network lifetime with maximum reliability and security. Hence, it would be useful to provide a suitable method that would have the features mentioned. This paper uses an Ad-hoc On-demand Multipath Distance Vector (AOMDV) as a routing protocol. This protocol has high energy consumption due to its multipath. However, it is a big challenge if it can reduce AOMDV energy consumption. Therefore, clustering operations for nodes are of high priority to determine the head of clusters which LEACH protocol and fuzzy logic and Particle Swarm Optimization (PSO) algorithm are used for this purpose. Simulation results represent 5% improvement in energy consumption in a WSN compared to AOMDV method.

Migratory abscess of the middle ear resulting from an odontogenic infection: an unusual case report

Infections of odontogenic origin are the commonly encountered diseases in their routine practice by head and neck specialists. Their spread to adjacent fascial spaces may follow as sequelae of untreated odontogenic infections, along a predictable route. Unusually, these infections may follow an uncommon path for the spread and may appear at a distant site in contrast to the site of infection, resulting in the formation of a ‘migratory abscess’. This case report is entitled to present an unusual and rare case of migratory abscess of the right middle ear in a 20-year old male patient, occurring as sequelae of an odontogenic infection in the right lower second molar and to explain a possible route of transmission of infection in this challenging case presentation.

Intrafamilial Transmission of Hepatitis C Virus Among Families of Infected Pediatric Oncology Patients

Background and Aims: Hepatitis C virus (HCV) is the most commonly encountered blood transmittable hepatitis among cancer patients. Several studies have reported clustering of HCV infections in families or household contacts of infected cases. Data about the epidemiological aspects of intrafamilial transmission from pediatric cancer patients are scarce and still debated. We aimed to figure-out the magnitude of horizontal intrafamilial transmission of HCV from infected pediatric oncology patients; its prevalence, risk factors and possible routes of transmission. Patients and Methods: 157 (86 HCV positive, 71 HCV negative) pediatric oncology patients and their household family contacts (751) were enrolled in this cross sectional case- control study. Blood samples were collected from 450 relatives of HCV infected cases (group-1) and 301 household contacts of HCV negative cases (group-2) for analysis of HCV antibodies and HCV RNA to confirm positivity. Family contacts of HCV infected cases were interviewed and close-ended questionnaire was filled for each participant to determine risk factors and possible routes of intrafamilial transmission. Results: Significantly higher HCV prevalence and chronicity rates were documented among relatives of HCV infected cases as compared with contacts of HCV negative cases (12.6% & 10.6% for group-1 Vs 7% & 5.3% for group-2 respectively). Risk factors of infection were calculated by univariate and logistic regression analysis among contacts of HCV infected cases. Female caregivers, particularly mother (OR 5.1, 95% CI 2-13.5), contact with index cases blood, either directly without using personal protective equipment (OR7.8, 95% CI2.9-23.8)or indirectly through common use of sharps (razors, scissors) (OR8.9, 95% CI3.5-20.5) and nail clippers (OR 2.1 95% CI 1.1-5.4) and giving care to infected cases (OR 2.9 95% CI 1.3-16.6) represented the real predictors of intrafamilial HCV infection. Conclusion: Intrafamilial transmission of HCV from infected children to their relatives does occur. Parenteral route is the only documented way of transmission either directly or indirectly. Funding: This research did not receive any grant from any funding agency. Declaration of Interest: Authors declare no conflicts of interest. Ethical Approval: The study protocol was approved by our hospital local research and ethical committee and written informed consent was taken from each participant or his/her legal guardian before enrollment.

Potential Animal Reservoir of Mycobacterium ulcerans: A Systematic Review.

Mycobacterium ulcerans is the causative agent of Buruli ulcer, also known in Australia as Daintree ulcer or Bairnsdale ulcer. This destructive skin disease is characterized by extensive and painless necrosis of the skin and soft tissue with the formation of large ulcers, commonly on the leg or arm. To date, 33 countries with tropical, subtropical and temperate climates in Africa, the Americas, Asia and the Western Pacific have reported cases of Buruli ulcer. The disease is rarely fatal, although it may lead to permanent disability and/or disfigurement if not treated appropriately or in time. It is the third most common mycobacterial infection in the world after tuberculosis and leprosy. The precise mode of transmission of M. ulcerans is yet to be elucidated. Nevertheless, it is possible that the mode of transmission varies with different geographical areas and epidemiological settings. The knowledge about the possible routes of transmission and potential animal reservoirs of M. ulcerans is poorly understood and still remains patchy. Infectious diseases arise from the interaction of agent, host and environment. The majority of emerging or remerging infectious disease in human populations is spread by animals: either wildlife, livestock or pets. Animals may act as hosts or reservoirs and subsequently spread the organism to the environment or directly to the human population. The reservoirs may or may not be the direct source of infection for the hosts; however, they play a major role in maintenance of the organism in the environment, and in the mode of transmission. This remains valid for M. ulcerans. Possums have been suggested as one of the reservoir of M. ulcerans in south-eastern Australia, where possums ingest M. ulcerans from the environment, amplify them and shed the organism through their faeces. We conducted a systematic review with selected key words on PubMed and INFORMIT databases to aggregate available published data on animal reservoirs of M. ulcerans around the world. After certain inclusion and exclusion criteria were implemented, a total of 17 studies was included in the review. A variety of animals around the world e.g., rodents, shrews, possums (ringtail and brushtail), horses, dogs, alpacas, koalas and Indian flap-shelled turtles have been recorded as being infected with M. ulcerans. The majority of studies included in this review identified animal reservoirs as predisposing to the emergence and reemergence of M. ulcerans infection. Taken together, from the selected studies in this systematic review, it is clear that exotic wildlife and native mammals play a significant role as reservoirs for M. ulcerans.

Modeling and optimal control analysis of Zika virus with media impact

Zika virus disease is a mosquito-borne disease which is mainly transmitted by the female Aedes mosquitoes. Initially, since the 1950, the Zika virus disease (or Zika fever) was known to occur only in a narrow equatorial belt from Africa to Asia but from 2007 to 2016, the virus spread eastward (i.e. across the Pacific Ocean to the Americas) and that led to the 2015–2016 Zika virus epidemic. Now, it is creating a viral threat to societies all over the World because it spreads very fast in a globally connected world. The Zika virus is a member of the virus family Flaviviridae and its dynamics is governed by the day time activities of Aedes mosquitoes (i.e. A. aegypti and A. albopictus, etc.). However, there also exist new evidences of its transmission dynamics being governed via sexual contact and that has been reported from different nations (i.e. Argentina, Canada, Chile, France, Italy, New Zealand, Peru, Portugal, and USA). This paper introduces a mathematical model to investigate the transmission dynamics of Zika virus disease through the inclusion of the impact of media. Our proposed model involves both the possible routes of transmission (i.e. mosquito borne and sexual transmission). The existence and stability of different equilibria of this model are presented and analyzed in detail. The basic reproduction number $$R_0$$ of the model is computed and it is found that for $$R_0<1$$ , the disease free equilibrium of the model is locally asymptotically stable. When $$R_0>1$$ , the endemic equilibrium point exists and is locally asymptotically stable under some restriction on parameters. For $$R_0<1$$ , backward bifurcation occurs, which suggests that lowering $$R_0$$ below one is not enough to eliminate the disease from the population. Finally, we extend our model to optimal control model by introducing two types of control parameters and compare the results of both the models using numerical simulation. Our presented results highlight the efficacy of the role of media and show that the proposed model is efficient in the analysis of transmission dynamics of the Zika virus disease. The sensitivity analysis of the parameters suggests that the key parameters are the mosquito biting rate and the rate of transmission due to the sexual contact between human to human. A small increase in any of these parameters can lead to great increase in the basic reproduction number $$R_0$$ and this causes a large outbreak of this disease. So, the control policies should aim for controlling both the routes of transmission of this disease.

Hepatitis A in Iceland

Hepatitis A virus (HAV) epidemics occurred repeatedly in Iceland in the early 20th century, but since then few cases have been reported and no epidemics since 1952. The latest Icelandic studies on HAV from around 1990 showed low incidence of infection and de-- creasing prevalence of antibodies. The objective of this study was to determine the incidence, clinical presentation and origin of HAV, abroad or in Iceland. A retrospective search was undertaken on all patients with positive anti-HAV IgM during the 11 years period of 2006-2016 in the virological database of the National University Hospital of Iceland. Clinical data was collected from medical records on symptoms at diagnosis, blood test results and possible route of transmission. A total of 12 individuals were diagnosed with acute hepatitis A during the period and 6691 HAV total andibody tests and 1984 HAV IgM antibody tests were performed. Nine (75%) had been abroad within 7 weeks from initial symptoms. The most common symptoms were jaundice (83%), fever (67%) and nausea and/or vomiting (58%). 50% were admitted to a hospital. 42% had elevated INR/PT. Everyone sur-vived without complications. Annually, approximately one case of acute hepatitis A was diagnosed in Iceland during the study period but a very high number of antibody tests were performed. The majority of cases occurred among individuals who had recently been abroad. If patients have jaundice, fever and nausea, testing for HAV infection should be undertaken. HAV is not endemic in Iceland.

Population structure and virulence gene profiles of Streptococcus agalactiae collected from different hosts worldwide.

Streptococcus agalactiae is a leading cause of morbidity and mortality among neonates and causes severe infections in pregnant women and nonpregnant predisposed adults, in addition to various animal species worldwide. Still, information on the population structure of S. agalactiae and the geographical distribution of different clones is limited. Further data are urgently needed to identify particularly successful clones and obtain insights into possible routes of transmission within one host species and across species borders. We aimed to determine the population structure and virulence gene profiles of S. agalactiae strains from a diverse set of sources and geographical origins. To this end, 373S. agalactiae isolates obtained from humans and animals from five different continents were typed by DNA microarray profiling. A total of 242 different S. agalactiae strains were identified and further analyzed. Particularly successful clonal lineages, hybridization patterns, and strains were identified that were spread across different continents and/or were present in more than one host species. In particular, several strains were detected in both humans and cattle, and several canine strains were also detected in samples from human, bovine, and porcine hosts. The findings of our study suggest that although S. agalactiae is well adapted to various hosts including humans, cattle, dogs, rodents, and fish, interspecies transmission is possible and occurs between humans and cows, dogs, and rabbits. The virulence and resistance gene profiles presented enable new insights into interspecies transmission and make a crucial contribution to the identification of suitable targets for therapeutic agents and vaccines.

Mother-to-infant transmission of hepatitis B virus: challenges and perspectives.

Chronic hepatitis B virus (HBV) infection due to perinatal mother-to-infant transmission (MTIT) remains a serious global health problem. Despite passive-active immunoprophylaxis using hepatitis B vaccination with or without hepatitis B immunoglobulin (HBIg), up to 8-10% of newborns still acquire HBV infection. Understanding the mechanisms of MTIT is essential for the interruption of HBV transmission. There are three possible routes of transmission: intrauterine transmission, transmission during delivery (intrapartum) and postnatal transmission through close contact or breast milk (postpartum). Overall, positivity for hepatitis B e antigen (HBeAg) and the high viral load of the mothers are the two most important risk factors related to MTIT of HBV. This article briefly reviews the viral factors related to MTIT of HBV and discusses the issues that warrant further investigation.

Transmission of Agregatibacter actimomycetemcomitans in families with chronic periodontitis: A literature review

SUMMARYThis literature review cross-contaminationevidence of periodontal pathogens, specificallyAggregatibacter actinomycetemcomitansbetween members of the same family,which includes spouses and children, aswell as to identify the more importanttransmission routes. Describing the possibleroutes of transmission of periodontalbacteria could lead to methods to preventor reduce microbial cross-contaminationbetween family members and possiblyreduce disease transmission.Key words: Periodontitis, microbiology,transmission, Aggregatibacter actinomycetemcomitans.

Use of multiple-locus variable-number of tandem repeats analysis (MLVA) to investigate genetic diversity of Salmonella enterica subsp. enterica serovar Typhimurium isolates from human, food, and veterinary sources.

Salmonella enterica subspecies enterica serovar Typhimurium is the most common zoonotic pathogen in Bulgaria. To allow efficient outbreak investigations and surveillance in the food chain, accurate and discriminatory methods for typing are needed. This study evaluated the use of multiple‐locus variable‐number of tandem repeats analysis (MLVA) and compared results with antimicrobial resistance (AMR) determinations for 100 S. Typhimurium strains isolated in Bulgaria during 2008–2012 (50 veterinary/food and 50 human isolates). Results showed that isolates were divided into 80 and 34 groups using MLVA and AMR, respectively. Simpson's index of diversity was determined to 0.994 ± 0.003 and 0.945 ± 0.012. The most frequently encountered MLVA profiles were 3‐11‐9‐NA‐211 (n = 5); 3‐12‐9‐NA‐211 (n = 3); 3‐12‐11‐21‐311 (n = 3); 3‐17‐10‐NA‐311 (n = 3); 2‐20‐9‐7‐212 (n = 3); and 2‐23‐NA‐NA‐111 (n = 3). No clustering of isolates related to susceptibility/resistance to antimicrobials, source of isolation, or year of isolation was observed. Some MLVA types were found in both human and veterinary/food isolates, indicating a possible route of transmission. A majority (83%) of the isolates were found to be resistant against at least one antimicrobial and 44% against ≥4 antimicrobials. Further studies are needed to verify MLVA usefulness over a longer period of time and with more isolates, including outbreak strains.

SOCIO-DEMOGRAPHIC AND CLINICAL PROFILE OF HIV POSITIVE PATIENTS ATTENDING INTEGRATED COUNSELING &amp; TESTING CENTRE OF A PRIMARY HEALTH CENTRE IN DELHI

Introduction: The Human Immunodeficiency Virus (HIV) infection is a global pandemic affecting principally the sexually active and economically productive population of any country. Additionally the dual epidemic of HIV and TB infection is of growing concern in Asia, where nearly two-third of TB-infected individuals live and where tuberculosis now accounts for 40 percent of HIV/AIDS deaths. Keeping this in mind, a study was conducted to understand the profile of HIV/AIDS patients attending Integrated Counseling and Testing Center (ICTC) located at Primary Health Centre, Palam in Delhi.Methodology: This was a descriptive record based study undertaken at ICTC, PHC PALAM, New Delhi. Records of all HIV seropositive patients identified in reference period (January 2010 to December 2014) were analyzed retrospectively to assess the socio-demographic and clinical profile including possible route of transmission, CD4 counts at the time of first reporting to the Anti Retroviral Treatment (ART) centre and the presence of co-infections including tuberculosis were recorded. Total 77 HIV seropositive patients were identified.Results: Mean Age of presentation of male was 31.18 ± 8.85 years (12-60 years) and female 30.30 ± 10.07 years (7-53 years). Majority of HIV+ persons were married (16% of males and 6% females were unmarried).24% of women were widows. Majority of HIV+ males and females had only primary schooling. 11% males and 21% females were illiterate. Main occupations of HIV+ males were daily wages labor and salaried service or other unspecified four out of 5 HIV+ women were housewives 70% of subjects were either referred from RNTCP or were self reporting. Heterosexual route was the most common route of transmission. Mean CD4 counts Males: 190.48 ± 180.52, Females: 286.21 ± 220.25 (t=2.09; p=0.039, significant).At the time of first reporting to ART centers, mean CD4 count was significantly higher in HIV+ females as compared to males. More than 50% of HIV+ males and 30% of females had co-infection of HIV &amp; TB. CD4 count was associated with gender and co-infection with TB. Significantly higher odds of HIV-TB co-infection among male as compared to females (chi-square=4.49, p=0.034) and odds Ratio=2.76(1.07 – 7.14)Conclusions: Low literacy and some occupations carry higher risk of HIV. CD4 count was associated with gender and co-infection with TB. Odds of co-infection with TB were higher in males. Analysis of information at ICTC &amp; ART centre should be used to monitor and plan HIV prevention and control in the area.SAARC J TUBER LUNG DIS HIV/AIDS, 2017; XIV(1), page: 22-26

Molecular typing of Clostridium difficile isolates cultured from patient stool samples and gastroenterological medical devices in a single Iranian hospital

This study aimed to characterize Clostridium difficile isolates cultured from stool samples of patients with C. difficile infection (CDI) and swabs from a medical environment in a gastroenterology center in Tehran, Iran. A total of 158 samples (105 stool samples from hospitalized patients and 53 swabs from medical devices and the environment) were collected from January 2011 to August 2011 and investigated for the presence of C. difficile by direct anaerobic culture on a selective media for C. difficile. C. difficile isolates were further characterized by capillary electrophoresis (CE) ribotyping and toxin gene multiplex PCR. Of 158 samples, C. difficile was cultured in 19 of 105 stool samples (18%) and in 4 of 53 swabs (7.5%). C. difficile PCR ribotype (RT) 126 was the most common RT in the study (21.7%). Further RTs were: 001, 003, 014, 017, 029, 039, 081, 103 and 150. RTs 126, 001, 150 were cultured from both the stool samples and swabs of medical devices and the hospital environment which suggest a possible route of transmission.

Survival of Toxoplasma gondii tachyzoites in simulated gastric fluid and cow’s milk

The protozoan parasite Toxoplasma gondii is one of the most important food-related pathogens worldwide. Besides contact to oocysts or ingestion of tissue cysts mainly by consumption of raw or undercooked meat from infected animals, raw milk is considered to be a risk factor and possible route of transmission for tachyzoites. This stage of the parasite is usually very sensitive to acidic pH and, therefore, considered unlikely to survive stomach passage. However, tachyzoites were shown to survive for several days in milk and there are also reports on transmission of toxoplasmosis via milk. Thus, the aim of the study was to examine retention of infectivity of tachyzoites in simulated gastric fluid (SGF) of different acidity and to elucidate whether addition of different shares of milk would affect survival of the parasites. Tachyzoites were exposed to SGF of pH 2.0 through 6.0 and their remaining infectivity was examined by cell culture. Furthermore, the impact on survival was investigated in different admixtures of milk to the SGF (25, 50, 75%) as well as in pure milk. Tachyzoites were shown to retain infectivity in SGF of pH 5.0 and 6.0 for at least 90min while they were more sensitive to lower pH values. Admixture of milk resulted in extension of survival. The results support the hypothesis of tachyzoites to survive stomach passage and their retention of infectivity.

Experimental Infection of Mink Enforces the Role of Arcanobacterium phocae as Causative Agent of Fur Animal Epidemic Necrotic Pyoderma (FENP).

Fur Animal Epidemic Necrotic Pyoderma (FENP) is a severe, often lethal infectious disease affecting all three fur animal species: mink (Neovision vision), foxes (Vulpes lagopus) and finnraccoons (Nyctereutes procyonoides). Previous studies showed an association between Arcanobacterium phocae and FENP. An experimental infection was conducted to confirm the ability of A. phocae to infect mink either alone or concurrently with a novel Streptococcus sp. found together with A. phocae in many cases of FENP. Different inoculation methods were tested to study possible routes of transmission. Typical signs, and gross- and histopathological findings for FENP were detected when naïve mink were infected with the tissue extract of mink with FENP, using a subcutaneous/ intradermal infection route. Edema, hemorrhage, necrosis and pus formation were detected in the infection site. A pure culture preparation of A. phocae alone or concurrently with the novel Streptococcus sp. caused severe acute signs of lethargy, apathy and anorexia and even mortality. The histopathological findings were similar to those found in naturally occurring cases of FENP. In contrast, the perorally infected mink presented no clinical signs nor any gross- or histopathological lesions. This study showed that A. phocae is able to cause FENP. The study also indicated that predisposing factors such as the environment, the general condition of the animals, temperature and skin trauma contribute to the development of the disease.

Prolonged outbreak of clonal MDR Pseudomonas aeruginosa on an intensive care unit: contaminated sinks and contamination of ultra-filtrate bags as possible route of transmission?

BackgroundWe report on an outbreak in a surgical, interdisciplinary intensive care unit (ICU) of a tertiary care hospital. We detected a cluster of ICU patients colonized or infected with multidrug-resistant Pseudomonas aeruginosa. We established an outbreak investigation team, performed an exploratory epidemiological analysis and initiated an epidemiology-based intervention.MethodsAs part of the outbreak investigation, we performed microbiological examinations of the sinks in the patient rooms and a retrospective case-control study. All patients admitted to the outbreak ICU between January 2012 and February 2014 were included. Cases were patients colonized with the outbreak strain. Controls were patients with a different Pseudomonas aeruginosa strain. Risk factors were evaluated using multivariable conditional logistic regression analysis. Strain typing was performed using the repetitive element-based polymerase chain reaction (rep-PCR) DiversiLab system.ResultsThe outbreak strain was found in the sinks of five (of 16) patient rooms. Altogether 21 cases and 21 (randomly selected) controls were included. In the univariate analysis, there was no significant difference in baseline data of the patients. In the multivariate analysis, stay in a room with a colonized sink (Odds Ratio[OR] 11.2, p = 0.007) and hemofiltration (OR 21.9, p = 0.020) were independently associated with an elevated risk for colonization or infection by the outbreak strain. In a subsequent evaluation of the work procedures associated with hemofiltration, we found that the ultra-filtrate bags had been on average five times per day emptied in the sinks of the patient rooms and were used multiple for the same patient. We exchanged the traps of the contaminated sinks and eliminated work procedures involving sinks in patient rooms by implementation of single use bags, which are emptied outside patient rooms to reduce splash water at the sinks. In the 20 month follow-up period, the outbreak strain was detected only once, which indicated that the outbreak had been ceased (incidence 0.75% vs. 0.04%, p < 0.001) Furthermore, the incidence of Pseudonomas aeruginosa overall was significantly decreased (2.5% vs. 1.5%, p < 0.001).ConclusionIn ICUs, limiting work processes involving sinks results in reduced multidrug-resistant Pseudomonas aeruginosa rates. ICUs with high rates of Pseudomonas aeruginosa should consider eliminating work processes that involve sinks and potentially splash water in close proximity to patients.Trial registrationAll data were surveillance based data which were obtained within the German Law on Protection against Infection (“Infektionsschutzgesetz”). Therefore a trial registration was not required.