Purulent Research Articles

The heart of the matter: a re-iteration of the role of the social determinants of health in addressing health inequity in Central Australia.

The persisting life-expectancy 'gap' between First Nations and non-First Nations Australians is fundamentally driven by the social determinants of health. These include income and social protection, access to adequate housing and food security, among others. These factors are particularly prominent in Central Australia. Inadequate housing has led to some of the highest rates of Streptococcus pyogenes infection in the world, which in turn drives an extremely high prevalence of rheumatic heart disease. Food insecurity and inadequate social protection manifesting as energy insecurity result in inadequate nutrition and have resulted in a huge burden of diabetes in Central Australia. These factors, combined with social exclusion, racism and the pervasive effect of colonisation, also drive a high rate of alcohol misuse. Only by prioritising equity in these 'social determinants' and emphasising the importance of First Nations leadership in formulating and implementing solutions will health inequity be addressed.

Microbiological and Haemato-biochemical Studies in Canine Pyometra

Background: Canine pyometra, is a pathological condition that results in the accumulation of purulent exudate in the uterus due to hormonal imbalance in female dogs. This is the most prevalent hormonally mediated reproductive disorder and life threatening disease of intact female dogs. The objective of the present study was to assess the physiological, haematological and biochemical changes and isolate the pathogenic microorganism present in the uterus of pyometra bitches. Methods: This study was carried out in ten bitches with a history of lethargy, depression, in appetence, polydipsia, occasional vomiting and vaginal discharge presented for treatment at the Veterinary Poly Clinic, Coimbatore, Tamil Nadu. The disease was diagnosed by history, clinical signs, physical examination, imaging techniques haematology and biochemical study. The involvement of the pathogenic organism was confirmed by microbial examination of the pus-filled uterus after the ovariohysterectomy. Result: The result showed that physiological parameters rectal temperature, heart rate and respiration rate were increased in pyometra affected dog than healthy one. The haematological parameters of red blood cell count, haemoglobin and packed cell volume were decreased in pyometra affected dogs than healthy dogs. Leukocytosis, neutrophilia, lymphocytosis, monocytosis and eosinophilia condition also observed in pyometra affected dogs. Biochemically, increased Blood urea nitrogen (BUN) creatinine and hyperprotenimia were observed in pyometra dogs. Increased activity of hepatic enzyme Alanine transaminase (ALT), Aspartate aminotransferase (AST) and Alkaline phosphatase (ALP) were also observed in pyometra dogs. The major pathogenic microorganisms involved in pyometra are Escherichia coli (40.25%), Staphylococcus (20.46%), Streptococcus (20.32%), Pseudomonas (6.41%), Proteus (6.32%) and Pasteurella (6.24%). Thus the dogs with pyometra show significant changes in physiological, haematological, biochemical parameters and growth of pathogenic microorganism in uterine fluid were the important indications of pyometra affected dogs.

TREATMENT OF EXPERIMENTAL GENERALIZED PURULENT PERITONITIS WITH SILVER NANOPARTICLES AND LOW-FREQUENCY ULTRASOUND

Summary. Generalized purulent peritonitis (GPP) remains one of the most serious complications in abdominal surgery and, in terms of its severity, occupies a leading place among urgent surgical diseases. Sanitation of the abdominal cavity (AC) is the most important stage in the complex treatment of GPP. Low-frequency ultrasound is one of the safe and promising methods of physical antisepsis with many advantages in the sanitation of purulent foci, and silver nanoparticles (AgNPs) have pronounced bactericidal properties against a wide range of multidrug-resistant microorganisms. This study aims to search for new pathogenetically substantiated methods and approaches to treating GPP that provide adequate sanitation of AC and effectively influence the AC microflora in the postoperative and/or interoperative period. Aim. To investigate the effectiveness of treatment of experimental GPP with the combined use of AgNPs and low-frequency US. Materials and methods. The study was performed on an experimental model of GPP in 60 laboratory rats. All test animals were divided into 3 groups: in the first group, planned sanitation of the AC was carried out with low-frequency ultrasound and saline solution, in the second group - with low-frequency ultrasound and SNP solution, in the third, control group – with a 0.05% aqueous solution of chlorhexidine. The number of necessary sanitation, the timing of laparostomy closure, the abdominal cavity index (ACI), the dynamics of systemic endotoxicosis (clinically), the number of complications, mortality, the volume and nature of effusion into the AC, the presence of necrotic tissue and limited purulent foci, changes of the parental and visceral peritoneum, fibrinous layers and intestinal condition was assessed during the treatment. Results and discussion. During the experiment, a significant decrease in the number of necessary sanitation was noted in the AgNPs/US (3.13±0.64) and US (4.63±0.92) groups compared to the control group (6.38±1.6), as well as the timing of laparostomy closure (5.33±1.51) days, (8.33±2.07) days and (11.33±2.94) days, respectively). The difference in ACI was observed starting from day 5: on day 5 in the AgNPs/US group ACI was 9±2.24 and was significantly different from the US group (15±1.58) and the control group (16±2.92); on the seventh day the HPI was, respectively, (5±1.0) in the AgNPs/US group, 12±2.92 in the US group and 15±1.58 in the control group. The use of low-frequency US made it possible to reduce the number of complications in the US and AgNPs/US groups (2 in the AgNPs/US group, 3 in the US group, 14 in the control group) and the mortality rate (35%, 45%, and 60%, respectively). The use of low-frequency US and AgNPs solution contributed to faster and better cleaning of the AC from the purulent peritoneal exudate and fibrin deposition, a reduction in inflammatory manifestations of the visceral and parietal peritoneum, and more rapid normalization of intestinal function. Conclusions. The combined use of AgNPs and low-frequency US leads to a more rapid elimination of purulent-inflammatory processes in the AC, a decrease in the ACI, a reduction in the number of necessary planned sanitation, and the timing of laparostomy closure. Planned sanitation of the AC using low-frequency US and an antiseptic solution of AgNPs helps to reduce the number of complications, the mortality rate and improves the results of treatment of experimental GPP, which allows us to consider the proposed treatment method as promising. Funding. This study was carried out with grant support from the National Research Foundation of Ukraine (project No. 2023.04/0109) and is part of the research work, funded by the Ministry of Education and Science of Ukraine No. 0124U000540.

Molecular Factors Involved in the Pathogenesis of Pyometra in Domestic Cats (Felis catus).

Pyometra is a major reproductive disorder affecting female cats. Characterized by the accumulation of purulent exudate in the uterus, it can lead to severe and potentially fatal complications. This pathology primarily occurs in adult cats during diestrus, but can also affect younger felines, often due to inappropriate administration of hormonal medications. While the etiopathogenesis of pyometra is better understood in bitches, few studies have addressed the molecular factors involved in feline pyometra. Therefore, this review aims to provide an up-to-date and comprehensive discussion of pyometra in cats, focusing on the regulation of molecular factors described in this species, including hormonal, redox, immunological, and growth factors. Understanding the regulation of these factors in pyometra is crucial for elucidating its pathogenesis in domestic cats and for improving diagnosis and identifying novel therapeutic approaches.

Guided bone regeneration improves defect fill and reconstructive outcomes in 3-wall peri-implantitis defects.

This multi-center, randomized clinical trial compared the long-term outcomes of guided bone regeneration (GBR) with open flap debridement (OFD) in treating peri-implantitis-related bony defects with ≥3 osseous walls over 36 months. The study aimed to evaluate the healing potential of GBR using a deproteinized bovine bone mineral (DBBM) graft and native bilayer collagen membrane (NBCM) compared to OFD without the use of graft materials. Sixty-six individuals diagnosed with peri-implantitis were randomly assigned to either GBR (34 patients) or OFD (32 patients). The OFD group served as the control, where inflamed tissue was removed and the implant surface decontaminated using 3% hydrogen peroxide, but no bone graft was placed. The GBR group received DBBM and NBCM for defect reconstruction. Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP), suppuration (SUP), mucosal recession (MREC), and patient-reported outcomes (PROs) were assessed over the study duration. Post-surgical care included azithromycin, ibuprofen, and chlorhexidine rinses. The study involved baseline assessments, surgical interventions, and follow-ups at 6, 12, and 36 months. Supportive peri-implant therapy was provided every 3 months during the additional 24-month follow-up. Primary outcome was RDF at 36 months. Secondary outcomes included PPD, BOP, SUP, MREC, and PROs. Descriptive statistics and ANCOVA models were used for analysis. At 36 months, GBR resulted in a mean RDF of 2.13 ± 1.26 mm, compared to 1.64 ± 1.54 mm with OFD (p = .18). No significant differences were found in PPD, BOP, SUP, REC, or PROs between the groups. Treatment success (defined as no additional bone loss, PPD ≤ 5 mm, no BOP, and no SUP) was achieved in 46.2% of GBR cases and 20% of OFD cases (p = 0.053). GBR provided improved short-term defect fill and higher treatment success compared to OFD, although the differences were not statistically significant. Both procedures maintained clinical parameters over 36 months, with similar patient satisfaction (PROs) observed for GBR and OFD. The adjunct use of DBBM and NBCM may offer clinical benefits for peri-implantitis cases with specific bony defect morphology.

MiniMizer Gastric Ring displacement at 31weeks of gestation as a life-threatening complication.

This case report describes a pregnant woman who underwent a laparoscopic MiniMizer Gastric Ring procedure for clinically severe obesity only one month before conception. At 31 weeks of gestation, the patient as admitted to the hospital with postprandial vomiting and persistent left-sided colicky abdominal pain. Maternal abdominal MRI revealed an intestinal obstruction and elective surgery was recommended. Due to the considerable risk to the fetus, antenatal corticosteroids were immediately administered to promote lung maturation and magnesium sulfate was started for fetal neuroprotection. During an exploratory laparoscopy, significantly enlarged and ischemic intestinal loops were found, leading to the decision to perform an atraumatic "en caul" cesarean delivery. After a successful "en caul" delivery, the MiniMizer ring, which had dislodged downwards and led to mesenteric ischemia, was visualized. Intraoperative esophagogastroduodenoscopy revealed a 1cm defect in the stomach wall related to gastric ring, covered with purulent exudate. Further exploration, showed a herniation of the distal alimentary loop through the Petersen foramen. Successful management included ring removal and intestinal loop reduction from the Petersen's space, without evidence of strangulation, as confirmed with indocyanine green (ICG) angiography. The postoperative course was uneventful. Women with obesity who have undergone bariatric surgery should to be informed of the increased likelihood of becoming pregnant after treatment. It is advised to notify the patient of the importance of maintaining a sufficient interval between bariatric surgery and conception. Additionally reports from the literature on various complications during pregnancy after bariatric surgery are presented.

6472 Methimazole Induced Agranulocytosis: Uncommon Complication of a Common Medication

Abstract Disclosure: R. Kaur: None. L. Kaur: None. A. Sridhar: None. T. Chaudhary: None. N. Patel: None. Methimazole (MMI) induced agranulocytosis is a rare and life threatening adverse effect that usually occurs within 3 months of drug initiation and can rapidly lead to overwhelming infection. It is reported in 0.1 to 0.5 % of patients on treatment with methimazole. MMI is a standard drug used in graves disease and toxic multinodular goiter. We report a case of MMI induced agranulocytosis in an elderly female with recently diagnosed toxic multinodular goiter. A 66 year old female with past medical history of recently diagnosed toxic multinodular goiter for which she was started on methimazole 80mg/day two months ago presented to the emergency department with chief complaint of severe sore throat associated with rapidly increasing pharyngeal pain and fever over the past 24 hours. She was lethargic, febrile with temperature of 102 F, tachycardic with heart rate of 115/minute and hypotensive with blood pressure of 108/64 mm Hg. Physical examination revealed diffuse pharyngeal and tonsillar erythema with bilateral purulent exudate with tender anterior cervical lymphadenopathy. Thyroid was enlarged, firm, irregular and nontender. Pulmonary, cardiac and abdominal exam was unremarkable. Lab work showed severe leukopenia with WBC count of 1,600/mm3, neutropenia with absolute neutrophil count of 0.0 x 1000/ul (normal range 1.8-7.3 x 1000/ul) and erythrocyte sedimentation rate and C reactive protein were both elevated. Blood cultures and fungal cultures showed no growth. Urinalysis and urine culture were both unremarkable. She had an extensive haematological, rheumatological and infectious disease workup for neutropenia, which was largely unrevealing. Rapid streptococcal testing was negative but throat cultures grew beta haemolytic streptococci. Treatment included suspending methimazole, administering antimicrobial therapy with piperacillin - tazobactam, acyclovir and fluconazole. She was also started on a granulocyte colony stimulating factor. Patient presented satisfactory evolution with progressive increase in leukocyte count and remission of symptoms by day 5 of treatment, rendering further bone marrow testing unnecessary. Antibiotics were changed to oral amoxicillin-clavulanic acid after throat culture results were available and the patient was discharged in stable condition. One month after discharge she underwent total thyroidectomy for definitive cure and is currently followed up as an outpatient by endocrinology. The objective of this case report is to present an uncommon case of agranulocytosis secondary to use of methimazole and to increase awareness among the physicians about the need to consider this diagnosis in patients on this medication. It is also advised that these patients be educated about the drugs side effects, a practice that may avert suffering and unnecessary costs. Presentation: 6/3/2024

The double-edged role of FASII regulator FabT in Streptococcus pyogenes infection.

In Streptococcus pyogenes, the type II fatty acid (FA) synthesis pathway FASII is feedback-controlled by the FabT repressor bound to an acyl-Acyl carrier protein. Although FabT defects confer reduced virulence in animal models, spontaneous fabT mutants arise in vivo. We resolved this paradox by characterizing the conditions and mechanisms requiring FabT activity, and those promoting fabT mutant emergence. The fabT defect leads to energy dissipation, limiting mutant growth on human tissue products, which explains the FabT requirement during infection. Conversely, emerging fabT mutants show superior growth in biotopes rich in saturated FAs, where continued FASII activity limits their incorporation. We propose that membrane alterations and continued FASII synthesis are the primary causes for increased fabT mutant mortality in nutrient-limited biotopes, by failing to stop metabolic consumption. Our findings elucidate the rationale for emerging fabT mutants that improve bacterial survival in lipid-rich biotopes, but lead to a genetic impasse for infection.

Inhibition of Streptococcus pyogenes biofilm by Lactiplantibacillus plantarum and Lacticaseibacillus rhamnosus.

The human pathobiont Streptococcus pyogenes forms biofilms and causes infections, such as pharyngotonsillitis and necrotizing fasciitis. Bacterial biofilms are more resilient to antibiotic treatment, and new therapeutic strategies are needed to control biofilm-associated infections, such as recurrent pharyngotonsillitis. Lactiplantibacillus plantarum and Lacticaseibacillus rhamnosus are two bacterial commensals used for their probiotic properties. This study aimed to elucidate the anti-biofilm properties of L. plantarum and L. rhamnosus cell-free supernatants (LPSN and LRSN, respectively) on S. pyogenes biofilms grown in vitro in supplemented minimal medium. When planktonic or biofilm S. pyogenes were exposed to LPSN or LRSN, S. pyogenes survival was reduced significantly in a concentration-dependent manner, and the effect was more pronounced on preformed biofilms. Enzymatic digestion of LPSN and LRSN suggested that glycolipid compounds might cause the antimicrobial effect. In conclusion, this study indicates that L. plantarum and L. rhamnosus produce glycolipid bioactive compounds that reduce the viability of S. pyogenes in planktonic and biofilm cultures.IMPORTANCEStreptococcus pyogenes infections are a significant concern for populations at risk, such as children and the elderly, as non-invasive conditions such as impetigo and strep throat can lead to severe invasive diseases such as necrotizing fasciitis. Despite its susceptibility to current antibiotics, the formation of biofilm by this pathogen decreases the efficacy of antibiotic treatment alone. The ability of commensal lactobacillus to kill S. pyogenes has been documented by previous studies using in vitro settings. The relevance of our study is in using a physiological setup and a more detailed understanding of the nature of the lactobacillus molecule affecting the viability of S. pyogenes. This additional knowledge will help for a better comprehension of the molecules' characteristics and kinetics, which in turn will facilitate new avenues of research for its translation to new therapies.

Streptococcus constellatus appendicitis in children: A case series

AbstractBackgroundStreptococcus constellatus (SC) is a pathogen well‐known for its involvement in pyogenic infections, with a notable preference for manifesting within the oral cavity, head and neck, and abdomen. This bacterium, belonging to the Streptococcus milleri group, has garnered attention for its propensity to incite inflammatory processes, especially in the abdominal region.ObjectivesThis study aims to present and characterise nine cases of paediatric patients with SC appendicitis.MethodsWe conducted a report on nine cases of SC appendicitis, all of whom presented to the emergency room with typical symptoms of appendicitis.ResultsPatients diagnosed with SC appendicitis exhibited a severe clinical course, necessitating appendectomy at presentation and requiring prolonged parenteral antimicrobial therapy. Furthermore, a higher readmission rate was observed among these patients, even several months after their initial discharge.ConclusionsSurgeons should be vigilant regarding SC appendicitis and its severe clinical course. Prolonged treatment with antimicrobial agents may be necessary for these patients to achieve better outcomes.

Trifolirhizin from Sophora flavescens as a Promising Medicinal Agent: An Update on Biological Significance, Pharmacological Activity, and Analytical Applications

Sophora flavescens is an important medicinal plant found in India and East Asia, primarily in China, Japan, Korea and Russia. Trifolirhizin is an active phytochemical of Sophora flavescens and other Chinese medications such as Zeng-Sheng-Ping, Xian-Lian-Ke-Li, ASHMI, Ling Zhi, Ku Shen, and Gan Cao, Ku Shen injection and Zeng Sheng Ping tablets. Sophora flavescens have numerous therapeutic benefits against hematochezia, jaundice, liver disorders, dysentery, oliguria, asthma, eczema, vulvar swelling, and inflammatory complications. The purpose of the present review is to summarize the scientific information on trifolirhizin for their biological potential, pharmacological activities, and analytical aspects of medicine. Scientific information on trifolirhizin has been collected from various scientific databases such as Scopus, Science Direct, PubMed, and Google Scholar. Further, the present review summarized the pharmacological activities of trifolirhizin and their different molecular mechanisms and analytical aspects. The scientific data on trifolirhizin signified the biological potential and therapeutic effectiveness of trifolirhizin in medicine. Present review signified the presence of trifolirhizin in the Sophora flavescens. Sophora flavescens has been shown to be effective against ulcers, chronic bronchitis, acne, atopic dermatitis, chronic hepatitis, enteritis, pyogenic infection and other inflammatory diseases. Furthermore, the present review also summarized the biological potential of trifolirhizin in gastric cancer, hepatocellular carcinoma, colorectal cancer, apoptosis, ulcerative colitis, and asthma. However, hepatoprotective effects, anti-inflammatory effects, wound healing potential, and efficiency of melanin synthesis were also revealed. In addition, this review also summarizes the molecular mechanisms of trifolirhizin and their pharmacokinetic and metabolic parameters. This review also describes the analytical aspects of trifolirhizin in medicine. This review will be useful to the entire research community exploring the biological potential of trifolirhizin in medicine. However, scientific studies require comprehensive and detailed data on trifolirhizin evaluation, quality control, toxicity, and clinical efficacy.

Computed tomographic findings of a medically managed canine renal cortical abscess

AbstractA 10‐year‐old, neutered, male labrador retriever was referred for acute history of abdominal pain and distention, pyrexia and pelvic limb ataxia. Peritoneal free fluid with intracellular bacteria was confirmed, and subsequent abdominal computed tomography revealed a hypoattenuating and rim‐enhancing focal lesion in the cortex of the left kidney, with associated regional inflammation. The dog underwent fine‐needle aspiration of the lesion with ultrasound guidance confirming the presence of a renal abscess with growth of Escherichia coli on culture of the acquired purulent intralesional fluid. Medical management was commenced, and on repeat clinical examination and computed tomography imaging, the clinical signs and renal lesion had resolved. To the authors’ best knowledge, this is the first report of confirmation of complete resolution of a cortical renal abscess, treated with only medical management, using computed tomography examination.

Alarming Prevalence of Nosocomial Pseudomonas aeruginosa among Patients with Infected Burn Wounds

Background: Recently, the prevalence of nosocomial Pseudomonas aeruginosa has become a concern due to its involvement in increased morbidity and mortality, especially those highly virulent strains associated with burn wounds in burn centers. Therefore, this cross-sectional study aimed to isolate and determine the prevalence of nosocomial Pseudomonas aeruginosa among burned inpatients. This study was carried out between September 2023 and March 2024. A total of 355 pus, purulent fluid and necrotic tissue swabs were obtained from burn victims with burns at the Burn Centers in Najaf City, Iraq. 85/355 (23.9%) of isolates under study were detected as Pseudomonas aeruginosa based on laboratory methods (microscopic, biochemical and culture). All test isolates appeared to grow optimally on cetrimide and chromium agar media, and colonies appeared green on these media when examined by the naked eye and greenish fluorescence under ultraviolet light. However, colonies on blood agar were bright and metallic, and the most common type of lysis was β-hemolysin followed by α-hemolysin. On Nutrient agar, most of the isolates were characterized by positive multi-pigment production 57/85 (67.1%), while 28/85 (32.9%) of the isolates were negative pigment production. Conclusion: The rate of virulent P. aeruginosa in the current study raises the degree of alarm, especially among burn patients because they do not have the means of defense that qualify them to resist this virulent pathogen. Also, the older age groups were more affected by it, which increases the levels of risk because elderly patients have weak immunity in addition to most of them being infected with other diseases such as diabetes, which increases the complications associated with burn infections. The impact of Pseudomonal infections on females in most age groups was one of the results of utmost importance and the real reasons behind it must be known. According to numerous studies and reports, the possession of this dangerous pathogen of multiple virulence factors such as its ability to form biofilms delays or prevents the patient's recovery and increases the likelihood of death in burn inpatients. Also, the possession of these virulent bacteria of a large genome makes them exceptionally adaptable and resistant to unfavorable environments.

A specific and ultrasensitive Cas12a/crRNA assay with recombinase polymerase amplification and lateral flow biosensor technology for the rapid detection of Streptococcus pyogenes.

Patients may experience a range of symptoms due to Streptococcus pyogenes infections, including superficial skin infections, pharyngitis, and invasive diseases in subcutaneous tissues like streptococcal toxic shock syndrome. At present, the clinical diagnostic detection of S. pyogenes is based on serological identification, culture, and PCR. These detection methods are time-consuming and require sophisticated equipment, making these methods challenging for routine laboratories. Thus, there is a need for a detection platform that is capable of quickly and accurately identifying S. pyogenes. In this study, a rapid and sensitive Cas12a/crRNA assay using recombinase RPA and LFB was developed to detect S. pyogenes. The Cas12a/crRNA-based assay exhibited high specificity among different bacteria strains and extremely high sensitivity. This method probably plays an important role for S. pyogenes detection and screening.

Genetic diversity and virulence properties of caprine Trueperella pyogenes isolates

BackgroundTrueperella pyogenes is an opportunistic pathogen that causes suppurative infections in various animal species, including goats. So far, only limited knowledge of phenotypic and genotypic properties of T. pyogenes isolates from goats has been gathered. In our study, we characterized the phenotypic and genotypic properties of caprine T. pyogenes isolates and established their relationship by Random Amplified Polymorphic DNA-Polymerase Chain Reaction (RAPD-PCR).ResultsFrom 2015 to 2023, 104 T. pyogenes isolates were obtained from 1146 clinical materials. In addition, two T. pyogenes isolates were obtained from 306 swabs collected from healthy goats. A total of 51 T. pyogenes isolates were subjected to detailed phenotypic and genotypic characterization. The virulence genotype plo/nanH/nanP/fimA/fimC/luxS was predominant. All of the tested isolates showed the ability to form a biofilm but with different intensities, whereby most of them were classified as strong biofilm formers (72.5%). The high level of genetic diversity among tested caprine T. pyogenes isolates (19 different RAPD profiles) was observed. The same RAPD profiles were found for isolates obtained from one individual, as well as from other animals in the same herd, but also in various herds.ConclusionsThis study provided important data on the occurrence of T. pyogenes infections in goats. The assessment of virulence properties and genetic relationships of caprine T. pyogenes isolates contributed to the knowledge of the epidemiology of infections caused by this pathogen in small ruminants. Nevertheless, further investigations are warranted to clarify the routes of transmission and dissemination of the pathogen.

Lemierre’s Syndrome – Case Report of a 20-Year-Old Male with Post-Anginal Sepsis

<b>Introduction:</b> Lemierre’s syndrome, first described by André Lemierre in 1936, is a rare but life-threatening condition. It is characterized by a triad of symptoms: pharyngeal infection, internal jugular vein thrombosis, and sepsis with distant abscesses, usually in the lungs. The primary pathogen is the anaerobic Gram-negative bacterium <i>Fusobacterium necrophorum</i> (<i>F. necrophorum</i>). In recent years, there has been an increase in the incidence of Lemierre’s syndrome.<b>Case report:</b> A 20-year-old male was admitted to the Emergency Department (ED) with jaundice, dyspnea, sore throat, fever up to 39C, neck pain, and left lower limb weakness. Examination revealed enlarged palatine tonsils with purulent exudates and a right-sided peritonsillar abscess. Laboratory tests showed elevated inflammatory markers, thrombocytopenia, and leukocytosis. Computed topography (CT) confirmed internal jugular vein thrombosis, abscesses in the right sternocleidomastoid muscle, and bilateral pleural effusions. The patient received oxygen therapy, antibiotics, anticoagulation, and pleural drainage. After 26 days of hospitalization, he was discharged with a recommendation to continue antibiotic therapy and low-molecular-weight heparin, as well as planned removal of the palatine tonsils (tonsillectomy).<b>Discussion:</b> Lemierre’s syndrome is a severe complication of upper respiratory tract infections, mainly affecting young individuals. Symptoms include pharyngeal infection, sepsis, and internal jugular vein thrombosis. Early diagnosis and appropriate treatment, including prolonged antibiotics and sometimes anticoagulation, are crucial. The rise in incidence may be linked to the irrational use of antibiotics. Educating clinicians is vital to improve outcomes and reduce complications.<b>Conclusions:</b> Initial symptoms of Lemierre’s syndrome are nonspecific, complicating early diagnosis. Neck imaging and/or positive blood cultures are key for diagnosis. The incidence is 1–2.5 cases per million annually, making it rare but potentially fatal. Mortality before antibiotics was around 90%; currently, it is 5–18%, but higher without proper diagnosis. Early imaging significantly improves prognosis.

Immunodeficiency: Complement disorders.

The complement system is an important component of innate and adaptive immunity that consists of three activation pathways. The classic complement pathway plays a role in humoral immunity, whereas the alternative and lectin pathways augment the innate response. Impairment, deficiency, or overactivation of any of the known 50 complement proteins may lead to increased susceptibility to infection with encapsulated organisms, autoimmunity, hereditary angioedema, or thrombosis, depending on the affected protein. Classic pathway defects result from deficiencies of complement proteins C1q, C1r, C1s, C2, and C4, and typically manifest with features of systemic lupus erythematosus and infections with encapsulated organisms. Alternative pathway defects due to deficiencies of factor B, factor D, and properdin may present with increased susceptibility to Neisseria infections. Lectin pathway defects, including Mannose-binding protein-associated serine protease 2 (MASP2) and ficolin 3, may be asymptomatic or lead to pyogenic infections and autoimmunity. Complement protein C3 is common to all pathways, deficiency of which predisposes patients to severe frequent infections and glomerulonephritis. Deficiencies in factor H and factor I, which regulate the alternative pathway, may lead to hemolytic uremic syndrome. Disseminated Neisseria infections result from terminal pathway defects (i.e., C5, C6, C7, C8, and C9). Diagnosis of complement deficiencies involves screening with functional assays (i.e., total complement activity [CH50], alternative complement pathway activity [AH50], enzyme-linked immunosorbent assay [ELISA]) followed by measurement of individual complement factors by immunoassay. Management of complement deficiencies requires a comprehensive and individualized approach with special attention to vaccination against encapsulated bacteria, consideration of prophylactic antibiotics, treatment of comorbid autoimmunity, and close surveillance.

Phenotypic and genotypic characterization of methicillin resistant Staphylococcus aureus associated with pyogenic infections.

Staphylococcal infections are one of the major infectious diseases affecting globally in spite of advances in development of antimicrobial agents. Knowledge and awareness about the local pattern and prevalence of MRSA infections plays a key role in treatment. The aim of this study was to identify MRSA strains by phenotypic and genotypic methods and to analyze the antibiotic susceptibility pattern of MRSA strains from patients attending a tertiary care hospital. This study was conducted over a period of 1 year, where 296 isolates of Staphylococcus aureus were isolated from various clinical specimens. The isolated strains were examined for antibiotic susceptibility by the modified Kirby Bauer disc diffusion method. Methicillin resistance was detected by cefoxitin disk diffusion test. A total of 104 isolates were found to be MRSA and 192 were found to be MSSA. Among the 104 MRSA isolates, 10 strains that were multidrug resistant were subjected to 16S rRNA gene sequencing analysis. All the 10 strains had a 99% match with S. aureus strains that were responsible for causing some serious biofilm mediated clinical manifestations like cystic fibrosis and device mediated infections. The biofilms were quantified using crystal violet staining and their ability to produce biofilms was analyzed using scanning electron microscopy and matched with the Genbank. Hence these phylogenetic analysis aid in treating the patients and combating resistance to antibiotics.

An overview of various stages and morphology of Histoplasma capsulatum var. farciminosum in the horse.

This article describes the development of the pathogenic dimorphic fungus Histoplasma capsulatum var. farciminosum (HCF), which is the causative agent of Equine epizootic lymphangitis (EEL), from the mycelial form in the soil to the yeast form in the horse. In this study, the stages and morphology of HCF were identified through histopathological analysis and culture with various samples collected in Ethiopia from 15 horses showing clinical signs of EEL. In equids, especially cart horses in Ethiopia, poor-quality harnesses cause cutaneous wounds, which often attract flies facilitating the transmission of the fungus. Also, HCF infection occurs through open wounds or ocular mucous membranes when horses roll on contaminated damp soil. Respiratory histoplasmosis can occur through inhaling fungal spores, which is rare. HCF microconidia enter the lungs and skin wounds and are phagocytized by tissue-resident macrophages. The spores undergo intracellular replication within the macrophages transitioning into yeasts. The infected macrophages undergo lysis releasing pathogenic yeast cells into the surrounding tissue. Consequently, yeast-rich purulent exudate is produced, contaminating the soil in stables where yeast cells germinate into the mycelial form, and the entire process starts from the beginning.

Increase of pyogenic bacterial infections after relaxation of social distancing measures linked to COVID-19 pandemic.

After the relaxation of COVID-19 mitigation measures, we observed a dramatic increase in pyogenic infections. Based on this observation, we retrospectively analysed all cases of invasive bacterial infections of brain, lung and complicated ear-nose-throat (ENT) infections, in the period from 1 August to 31 March from the years 2018-2019 to 2022-2023. The study was conducted in two Paediatric Emergency Departments, at IRCCS 'Burlo Garofolo' of Trieste and at Treviso Hospital. Electronic medical records were searched for all cases with a definitive diagnosis at discharge of mastoiditis, suppurative cervical lymphadenitis, retropharyngeal, parapharyngeal and peritonsillar abscess (ENT group), bacterial brain abscesses, epidural empyema, subdural empyema (central nervous system group), thoracic empyema and necrotising pneumonia (lung group). In 2022-2023, we observed an increase in infections compared to the previous years. Total number of cases were 22, 29, 8, 27 and 63 in 2018-2019, 2019-2020, 2020-2021, 2021-2022 and 2022-2023, respectively. The greater increase occurred in thoracic empyema, with a peak incidence of +120% in 2022-2023 in respect of 2021-2022. We reported an important increase in paediatric bacterial complicated infections in two North East Italian regions, possibly correlated with the relaxation of COVID-19 social distancing measures.