Oral Ulcerative Lesions Research Articles

A novel approach for the treatment of oral ulcerative lesion using mucoadhesive proniosome gel

A mucoadhesive proniosome gel containing a potent corticosteroid drug (fluticasone propionate) was formulated for the local treatment of oral ulcerative lesions. The formula was made-up in an attempt to avoid the drug's severe systemic adverse effects, moreover, ensuring both efficacy and safety. Full factorial design was employed to prove the significant effect of surfactant type and cholesterol concentration on entrapment efficiency and vesicle size of the formulated proniosome gels. The optimum formula with an entrapment efficiency of 85.5 ± 2.4% was incorporated into mucoadhesive gels using different mucoadhesive polymers, namely, xanthan gum or sodium alginate. The effects of the polymer type and its concentration on the quantity of fluticasone propionate release as well as on the mucoadhesion force were studied. The optimum formula was found to possess a mucoadhesion force of 14425 ± 5.4 dyne/cm2 and maximum quantity of drug release of 89 ± 0.09% which showed to follow Higuchi diffusion model of release. High-resolution transmission electron micrographs revealed that the chosen formula was smooth, homogenous and in nano size range. Cytotoxicity assay test was conducted to ensure the safety of the optimum formula. Curing of oral ulcerative lesions using an animal model was assessed and emphasized by the histopathological findings.

A brief review on classification of oral ulcerative lesions

Oral cavity is considered as a mirror of systemic diseases. The oral cavity consists of the lips, teeth, gums, oral mucous membranes, palate, tongue and oral lymphoid system. Various diseases affect the oral cavity of which ulcers are one of the most common disease. While most diseases of the oral cavity can be diagnosed by visual inspection, some disorders can be perplexing and their diagnoses may be elusive. They can be represented as manifestation of systemic disease or can have a specific etiology behind the disease. This article highlights the causes of oral ulcers and various classification added to it. Keywords: Oral ulcers, Chemotherapy, Aphthous.

A Comprehensive Review on Classification of Oral Ulcerative Lesions

Oral mucosal lesions are a broad group of lesions which are located in the soft tissues of the oral cavity identified by its specific etiology, clinical manifestations, differential diagnosis and treatment. White lesions of the oral cavity constitute a rather common group of lesions that are encountered during routine clinical dental practice. The process of clinical diagnosis and treatment planning is of great concern to the patient as it determines the prognosis. There should be in-depth knowledge to the consultant about the varied clinical features, etiology of the disease and various treatment plans. Clinical diagnostic skills and ideal judgment forms the key to successful management of white lesions of the oral cavity This review will discuss many of the most common intraoral white lesions including their clinical presentation, how to make an accurate diagnosis

The effects of adipose tissue-derived stem cells seeded onto the curcumin-loaded collagen scaffold in healing of experimentally- induced oral mucosal ulcers in rat.

Objective(s):Various therapeutic approaches, including stem-cell-based strategies and tissue engineering, have been proposed for oral ulcerative lesions. We investigated the effects of adipose tissue-derived stem cells (ADSCs) seeded onto the curcumin-loaded collagen scaffold in the mucosal healing of oral ulcers in rats.Materials and Methods:The current experimental study was conducted on 40 male Sprague-Dawley rats. Oral ulcers were created over both sides of buccal mucosa, and the rats were randomly divided into four equal groups: 1) an untreated group (negative control); 2) Teriadent-treated group (positive control); 3) group treated with curcumin-loaded collagen scaffold; and 4) group received the ADSCs (3 × 106 cells) seeded onto the curcumin-loaded collagen scaffold. Rats were sacrificed on 3rd and 7th day after ulceration for histopathological examination as well as measurement of tissue levels of myeloperoxidase (MPO), superoxide dismutase (SOD), and Interleukin-1 beta (IL-1β) activity. Results:Compared with the negative control, the tissue levels of MPO and IL-1β were significantly decreased in all treated groups (P<0.0001); however, the SOD activity was elevated (P<0.0001). The highest SOD activity as well as the lowest MPO and IL-1β levels were observed in the ADSCs-curcumin-loaded collagen scaffold group. The ulcer healing process at 3rd and 7th day follow-up was much more progressed in the ADSCs-curcumin-loaded collagen scaffold group in comparison with the untreated group (P=0.037 and P=0.004, respectively).Conclusion:According to the findings of this study, ADSCs seeded onto the curcumin-loaded collagen scaffold seems to have a promising potential for oral ulcer healing applications.

Comparative Efficacy of Different Chemotherapeutic Regimens in the Treatment of Peste des Petits Ruminants in West African Dwarf Goats

The comparative efficacy of different chemotherapeutic regimes in the treatment of natural clinical infection of Peste des petits ruminants (PPR) infection in West African Dwarf (WAD) goats were determined. Twenty WAD male goats divided into five groups, of four each were used. Group 1 was the combined therapy group treated with Acyclovir, Oxytetracycline and Ivermectin, Group 2 was treated with Acyclovir only, Group 3 was treated with Ivermectin only, Group 4 was treated with Oxytetracycline only and Group 5 was left untreated. Clinical signs such as nasal and ocular discharges, emaciation, anorexia, pyrexia, ulcerative oral lesions, respiratory distress and diarrhoea were observed in these goats during the period of their acclimatization. The prominent post-mortem lesion observed was discontinuous streaks of congestion (Zebra markings) in the mucosa of the colon and rectum. The physiologic parameters (temperature, pulse rate, heart rate, and respiratory rate) were taken daily. It was observed that there was a significant increase in the temperature above normal in the untreated group, suggesting pyrexia. It was also observed that the combined therapy group showed a smaller number of mortality and thus, had a better efficacy when compared to the other chemotherapeutic agents used singly

Lifetime prevalence of recurrent aphthous stomatitis and its related factors in Northern Iranian population: The PERSIAN Guilan Cohort Study

Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral inflammatory ulcerative lesions. The aim of this large population base study was estimated lifetime prevalence of RAS and its related factors among the Northern Iranian population. This study was conducted on 10,520 participants aged 35-70years based on the PERSIAN Guilan Cohort Study (PGCS). Prevalence proportions and multivariate logistic regression models were constructed for lifetime RAS prevalence using the SPSS software. Data on potential correlates of RAS including demographic profiles, lifestyle habits, and self-reported past medical histories were obtained. The lifetime prevalence of RAS was 8.3%. Multivariate logistic models showed that urbanization (adjusted odds ratio (AOR) = 1.2) and having a history of systemic disease, including rheumatic disease (AOR = 2.1), genital aphthous disease (AOR = 11.7), depression (AOR = 1.3), chronic headaches (AOR = 1.8), diabetes mellitus (AOR = 1.6), and epilepsy (AOR = 2), were independent predictors of RAS. In addition, smokers (AOR = 0.5) and individuals older than 50years of age (AOR = 0.8) were less likely to have a history of RAS. The lifetime prevalence of RAS among the Northern Iranian population was relatively low. It seems that predisposing factors, such as younger age, urbanization, and systemic disease, including rheumatic disease, genital aphthous disease, depression, chronic headaches, diabetes mellitus, epilepsy, and not smoking, could contribute to RAS prevalence.

PARACOCCIDIOIDOMICOSIS WITH MANIFESTATIONS IN ORAL MUCOSA: 2 CASE REPORTS

Paracoccidioidomycosis is a systemic mycosis, mucocutaneous, caused by the dimorphic fungus Paracoccidioides brasiliensis. This study reports 2 cases of fungus involvement in alcoholic and smoker patients living on the same street in an urban area. In the first case, the female patient had multiple papulo-erosive, ulcerated, and hypertrophic oral lesions. Lesions in the facial skin region and respiratory tract were also observed. Despite treatment with injectable amphotericin B, the patient died due to malnutrition and late diagnosis. After 1 year, another case was diagnosed in the locality. The male patient had nodular lesions on the back of the tongue. The use of oral itraconazole was initiated and there was a favorable clinical evolution after 1-year follow-up. Histopathological diagnosis was made through incisional biopsy in both cases. Early diagnosis is essential, and in many cases the first clinical manifestations are oral lesions, and the dental surgeon plays an important role.

ORAL MANIFESTATIONS OF CELIAC DISEASES: CASE REPORT

Celiac disease is an autoimmune disorder that affects individuals who are genetically susceptible and intolerable to gluten. It is characterized by symptoms such as chronic diarrhea, vomiting, abdominal distension, and bloating. Oral manifestations are also present in celiac patients, with defects in dental enamel and recurrent aphthous stomatitis. In the present study, we report a case of a 59-year-old male celiac patient that presented ulcerative oral lesions after dental treatment and inadequate diet. On physical examination, there were shallow ulcers, with a necrotic fundus in buccal mucosa and tongue border. The diagnosis of celiac disease was performed by intestinal biopsy that revealed serration and atrophy of the duodenal villi and intraepithelial lymphocytic infiltrate. Laboratory tests were requested to rule out vitamin deficiency. Topical treatment with chamomile (Ad-muc), photobiomodulation therapy and diet adequacy were decisive for ulcerated lesions healing. Patient remains in clinical follow-up.

IMPACT OF VIRTUAL LEARNING OBJECT IN THE THEORETICAL KNOWLEDGE AND DIAGNOSTIC CAPACITY OF ORAL ULCERATIVE LESIONS

Objective: To evaluate the influence of a virtual learning object (VLO) in the theoretical knowledge and diagnostic capacity of oral ulcerative lesions of undergraduate dentistry students. Methods: A randomized controlled trial was performed with 35 undergraduate students during the last semesters divided into 2 groups: control (n = 19) and VLO (n = 16) groups. The control group attended a conventional theoretical class and the VLO group was exposed to a virtual environment. The students’ learning performance was tested by using a multiple-choice pre/pre questionnaire that covered the knowledge and understanding of ulcerative lesions. In addition, all students answered a clinical case simulation quiz. The VLO group answered a specific evaluation questionnaire with a reduced version of the learning object review instrument. Results: In the pre/post questionnaire and clinical case quiz, the VLO group showed better results than the control group (P = .011 and P = .013 respectively). In addition, 80% of the students recommend using the VLO and 93% reported that they were willing to use other VLO. Conclusion: VLO is a tool that can be implemented in oral medicine educational environments contributing to improve the competence of future dental surgeons. Objective: To evaluate the influence of a virtual learning object (VLO) in the theoretical knowledge and diagnostic capacity of oral ulcerative lesions of undergraduate dentistry students. Methods: A randomized controlled trial was performed with 35 undergraduate students during the last semesters divided into 2 groups: control (n = 19) and VLO (n = 16) groups. The control group attended a conventional theoretical class and the VLO group was exposed to a virtual environment. The students’ learning performance was tested by using a multiple-choice pre/pre questionnaire that covered the knowledge and understanding of ulcerative lesions. In addition, all students answered a clinical case simulation quiz. The VLO group answered a specific evaluation questionnaire with a reduced version of the learning object review instrument. Results: In the pre/post questionnaire and clinical case quiz, the VLO group showed better results than the control group (P = .011 and P = .013 respectively). In addition, 80% of the students recommend using the VLO and 93% reported that they were willing to use other VLO. Conclusion: VLO is a tool that can be implemented in oral medicine educational environments contributing to improve the competence of future dental surgeons.

Evaluation of 5% Amlexenox Oral Paste and Rebamipide Tablets in Treatment of Recurrent Apthous Stomatitis and Comparison with Dologel CT.

Recurrent aphthous stomatitis (RAS) is a frequently seen oral ulcerative lesion, manifesting as multiple, recurrent, shallow, irregular ulcers encircled by an erythematous halo. The precise etiopathogenesis is obscure, although the recent understanding suggests an underlying immune-mediated etiology. However, there is no defined management protocol and the principal therapy aims to attain symptomatic respite. 150 clinically diagnosed RAS patients of both sexes in the age range of 15-65years were randomly allocated and divided into two cohorts, namely Group A (75 RAS patients receiving 5% Amlexanox paste + 100mg Rebamipide tab.) and Group B (75 RAS patients receiving Dologel CT). Effectiveness of 5% Amlexanox oral paste and Rebamipide tablets in diminution of the ulcer size, erythema and pain was assessed and compared with Dologel CT therapy. The study showed an equal gender distribution. Majority of the patients were in the younger age range (25-35years) and labial and buccal mucosa were the commonest affected sites. Although, both 5% Amlexanox and Rebamipide tablets and Dologel CT showed statistically significant resolution in the ulcer size, erythema, and associated pain. However, 5% oral Amlexanox paste and Rebamipide tablets are more efficacious in the treatment of RAS and tend to heal the ulcer at a more accelerated pace. Our research concluded that 5% oral Amlexanox paste and Rebamipide tablets tend to heal the ulcer at a more accelerated pace as compared to Dologel CT.

Enhanced Healing and Antimicrobial Efficacy of Chitosan-g-Polyacrylamide in a Rat Model of Gingival Ulcers.

Patients in dental hospitals often experience oral ulcerative lesions, which lead to pain and affect the patient's quality of life. At present, the goal of treating oral ulcerative lesions with drugs is to reduce inflammation and promote ulcer healing. However, very few antibacterial and hemostatic drugs are designed to be suitable for the microenvironment of gingival ulcers. Based on this, we have designed a natural therapeutic agent for oral ulcerative lesions that meets the various requirements of oral ulcerative lesion medication. The chitosan-g-polyacrylamide (CP) copolymer is composed of chitosan as the main chain and polyacrylamide polymers as the side chains. Antibacterial experiments show that this polymer can effectively inhibit the proliferation of Gram-negative (Escherichia coli) and Gram-positive bacteria (Staphylococcus aureus). In vitro cell experiments also show that the CP copolymer is non-toxic, which is conducive to ulcer wound healing. Coagulation experiments prove that the CP copolymer can accelerate blood coagulation to stop bleeding. In experiments using a Wistar rat gingival ulcer model, the CP copolymer significantly promoted ulcer healing and shortened the healing time. These results indicate that the CP copolymer may serve as a potential therapeutic agent for oral ulcerative lesions.

Detection of Felis catus papillomavirus type-2 DNA and viral gene expression suggest active infection in feline oral squamous cell carcinoma.

Papillomavirus (PV) infection is associated with development of epithelial cancer in different species, including domestic cat (Felis catus). Felis catus PV type-2 (FcaPV-2) is considered the causative agent of a proportion of feline cutaneous squamous cell carcinoma (SCC), through the transforming properties of its E6 and E7 oncogenes. However, the possible role of FcaPVs in the aetiology of feline oral SCC (FOSCC) is still unclear. The aim of this study was to assess the presence and gene expression of FcaPV-2 in FOSCC samples. We detected FcaPV-2 DNA in 10/32 (31%) of the analysed FOSCC by the use of PCR methods. Importantly, viral mRNA was detected by RT-PCR in 7/10 (70%) of DNA positive samples. In particular, FcaPV-2 L1, E2 and E6E7 genes were found to be expressed in 5/10 (50%), 3/10 (33%) and 5/10 (50%) samples, respectively. Viral DNA was also detected in non neoplastic oral ulcerative lesions (ULs) (4/11, 36%); qPCR suggested a difference in viral load between ULs and FOSCCs, particularly in those expressing E6E7, although it was not statistically significant. These data suggest, but do not definively prove, a possible role of FcaPV-2 in the development of a proportion of FOSCC. Moreover, L1 and E2 gene expression results indicate that FcaPV-2 infection associated with these tumours may possibly be productive.

Multiple Myeloma in a Feline

Background: Multiple myelomas (MM) are malignant neoplasms originating in the bone marrow plasmacytes, and are characterized by the presence of persistent hyperglobulinemia. Although they are rarely found in domestic animals, the canine species is most affected. In felines, they represent less than 1% of hematopoietic neoplasms, and mainly occur in older animals aged 10-12 years. The aim of the present study was to report a case of multiple myeloma, with extramedullary plasmocytosis in a feline.Case: A 3-year-old feline, female, mixed breed, with a history of apathy, anorexia, halitosis, and vomiting was referred to the Laboratório Regional de Diagnóstico (LRD) at the Universidade Federal de Pelotas (UFPel). Oral examination revealed a cyanotic oral mucosa and ulcerative lesions on the gingiva. The necropsy showed generalized lymphadenomegaly, splenomegaly, and hemorrhagic diathesis. Organ fragments were collected and fixed in 10% buffered formalin. After 48 h, the samples were cleaved, embedded in paraffin, and stained using the routine hematoxylin and eosin technique. Selected sections were subjected to immunohistochemistry (IHC) using the streptavidin-biotin method. The CD79a, CD138, CD3, and MUM1 antibodies were used. Histopathological evaluation of the bone marrow revealed hypercellularity with predominant round pleomorphic cells (90%), which presented an eccentric basophilic nucleus and abundant eosinophilic cytoplasm. The same neoplastic cells infiltrated the gingival mucosa, lymph nodes, spleen, liver, kidneys, heart, lungs, and brain. The IHC showed positive immunostaining for MUM1 and CD138 antibodies.Discussion: The diagnosis of MM in the present study was based on histopathology and by IHC. According to the literature, the presence of neoplastic plasmocytes in the bone marrow (&gt;20%), osteolytic lesions, monoclonal gammopathy, and Bence-Jones proteinuria should be investigated in suspected MM cases. The presence of two or more of these characteristics is necessary for confirmed diagnosis. However, studies show that only 50% of felines with MM have two or more of these characteristics, with cell morphology and neoplastic infiltration in other organs being important parameters for the definitive diagnosis of MM in them. For MM diagnosis by IHC, CD79a, CD138, and MUM1 can be used. In this report, there was positive immunostaining for MUM1 and CD138, which allowed the exclusion of other neoplasms of hematopoietic origins. The origin of MM is unknown, but chronic immune stimulation is believed to be involved in humans. In felines, although infection by the feline immunodeficiency virus (FIV) and feline leukemia (FeLV) is commonly associated with the occurrence of lymphomas, the same is not described for MM. This was corroborated in the present study, since the animal in this report tested negative for FIV and FeLV. In cats, MM has no apparent predilection for race or sex, and mainly affects older animals (average age, 10 years). Although MM is rare, it has been described not only in this case, but also in young cats. The infiltration of neoplastic plasmacytes in the extramedullary tissues (extramedullary plasmacytosis) is observed more frequently in felines than in canines, and mainly occurs in the lymph nodes, spleen, and liver. In this case, there was disseminated extramedullary plasmacytosis involving multiple organs, such as the brain, lungs, heart, and kidneys. Persistent hyperglobulinemia is the main clinical manifestation of MM observed in 87.7% of cats with this neoplasm. However, this variation can also be observed in other pathologies, such as chronic lymphocytic leukemia, B cell lymphoma, primary macroglobulinemia, and chronic infections (e.g., ehrlichiosis, leishmaniasis, and heartworm disease). Hence, MM should always be considered as differential diagnosis when diagnosing the aforementioned diseases.

The Effect of Honey as a Treatment for Oral Ulcerative Lesions: A Systematic Review

A healthy oral environment features a rapid turnover rate of epithelium cells capable of regeneration and repair, with the oral epithelium contributing as a physical barrier and immune defense. However, the oral cavity can be subjected to unique damage, such as ulcerations. Honey is reported as a therapeutic agent for wound healing, due to its antioxidant, antibacterial and anti-inflammatory properties.

Prevalence of ulcerative stomatitis in arbovirus infections in a Brazilian Northeast population.

Background Although there are no population-based studies that support an association, there are reports in the literature of mucocutaneous, vesiculobullous and ulcerated lesions in the oral mucosa in cases of arbovirus infection. The aim of this study is to analyze the prevalence of ulcerative stomatitis in individuals affected by arboviruses in a population of the municipality of Arcoverde, Pernambuco, Brazil. Material and Methods 1,003 people living in an area assigned to a Primary Health Care Unit were interviewed. A structured questionnaire was used for data collection, with questions about sociodemographic variables, residence conditions, general health information, as well as information about the general signs and symptoms of arboviruses and specifically about oral lesions. Results Of the 1,003 individuals interviewed, 815 (81.25%) were infected by one or more arboviruses. Of these, 147 (18%) reported ulcerated oral lesions during arbovirus infections. The association between arbovirus infections and the presence of ulcerated oral lesions was statistically significant (p = 0.000). Conclusions In these cases, the ulcerated lesions on the oral mucosa appear to be associated with arbovirus infection, especially Chikungunya, although the pathophysiological mechanisms are not defined, and the studies are not sufficient to confirm this association. Key words:Arbovirus infections, Dengue, Chikungunya fever, Zika virus.

A Comprehensive Review on Classification of Oral Ulcerative Lesions

A brief overview of the superficial oral lesion Oral mucosal lesions are a broad group of lesions which are located in the soft tissues of the oral cavity identified by its specific etiology, clinical manifestations, differential diagnosis and treatment. White lesions of the oral cavity constitute a rather common group of lesions that are encountered during routine clinical dental practice. The process of clinical diagnosis and treatment planning is of great concern to the patient as it determines the prognosis. There should be in-depth knowledge to the consultant about the varied clinical features, etiology of the disease and various treatment plans. Clinical diagnostic skills and ideal judgment forms the key to successful management of white lesions of the oral cavity This review will discuss many of the most common intraoral white lesions including their clinical presentation, how to make an accurate diagnosis

EFFECTS OF CANNABIDIOL, A CANNABIS SATIVA CONSTITUENT, ON ORAL WOUND HEALING

Objective To evaluate the effect of cannabidiol (CBD) on the healing of rats’ oral wounds. Study Design Traumatic ulcers were induced in 60 Wistar rats using a 5-mm biopsy punch on the midline of the ventral tongue. Animals received daily intraperitoneal (ip) injections of CBD at doses of 0 (control), 5 or 10 mg/kg. Rats were weighed daily and sacrificed after 3 and 7 days of treatment. Clinical (ulcer area and weight variation) and histopathologic (inflammation scores) analyses were performed. Data were analyzed statistically at the significance level of 5%. Results CBD was unable to clinically influence the size of ulcerative lesions. However, treatment with CBD in both tested concentrations decreased inflammatory scores after 3 days post-wounding (P < .05) compared to control. Conclusions Five and 10 mg/kg CBD exerted promising anti-inflammatory effect in oral ulcerative lesions, not being enough to accelerate clinical wound healing at 3 and 7 days. To evaluate the effect of cannabidiol (CBD) on the healing of rats’ oral wounds. Traumatic ulcers were induced in 60 Wistar rats using a 5-mm biopsy punch on the midline of the ventral tongue. Animals received daily intraperitoneal (ip) injections of CBD at doses of 0 (control), 5 or 10 mg/kg. Rats were weighed daily and sacrificed after 3 and 7 days of treatment. Clinical (ulcer area and weight variation) and histopathologic (inflammation scores) analyses were performed. Data were analyzed statistically at the significance level of 5%. CBD was unable to clinically influence the size of ulcerative lesions. However, treatment with CBD in both tested concentrations decreased inflammatory scores after 3 days post-wounding (P < .05) compared to control. Five and 10 mg/kg CBD exerted promising anti-inflammatory effect in oral ulcerative lesions, not being enough to accelerate clinical wound healing at 3 and 7 days.

EXTENSIVE ULCERATIONS ASSOCIATED WITH THE USE OF MYCOPHENOLATE MOFETIL IN A PATIENT WITH HISTORY OF RENAL TRANSPLANT

A 54-year-old white female patient presented with bilateral angular cheilitis and several painful ulcerated oral lesions, 11 years after kidney transplantation. The lesions affected the buccal mucosa, the soft palate, and dorsum of the tongue for 8 months. Her current immunosuppressive regimen includes mycophenolate mofetil, tacrolimus, and prednisone. Periodic acid-Schiff (PAS) exfoliative cytology was positive for Candida species. An incisional biopsy was performed on the tongue lesion and the histopathologic examination revealed intense mixed inflammatory infiltrate in the connective tissue. Serologic tests excluded cytomegalovirus and herpes simplex infection. Thus, the diagnosis of oral candidiasis and ulcers associated with mycophenolate mofetil was established. Local therapy with antifungal and corticosteroid agents healed the lesions in buccal mucosa and soft palate. The tongue lesion did not respond to therapy. Buccal mucosa lesions recurred after a follow-up period of 1 month. The patient was referred to the nephrologist to evaluate for the possibility of changing the immunosuppressive therapeutic regimen.

Impact of viral symptoms on the performance of the modified centor score to predict pediatric group A streptococcal pharyngitis

BackgroundClinicians use the Modified Centor Score (MCS) to estimate the risk of group A streptococcal (GAS) pharyngitis in children with sore throat. The Infectious Diseases Society of America (IDSA) recommends neither testing nor treating patients with specific viral symptoms. The goal of this study is to measure the impact of those symptoms on the yield of GAS testing predicted by the MCS. Methods Retrospective cohort study of all patients aged 3–21 years presenting with sore throat and tested for GAS in a pediatric emergency department (ED) in 2016. After identifying all patients tested for GAS, we used natural language processing (NLP) to identify the subgroup complaining of sore throat. We abstracted all MCS variables as well as symptoms suggestive of a viral etiology per the IDSA guideline (conjunctivitis, coryza, cough, diarrhea, hoarseness, ulcerative oral lesions, viral exanthema). We calculated the proportion of patients who tested positive for GAS by MCS with and without viral symptoms. ResultsOf the 1574 patients included, 372 patients (24%) tested GAS positive. Patients with at least one viral symptom had a reduced GAS risk compared to those without any of the viral symptoms 91/547 (17% GAS positive) vs. 281/1027 (27%), odds ratio 0.53 (95% CI 0.41–0.69). ConclusionsThe presence of viral symptoms specified by the IDSA alters the predicted yield of testing by traditional MCS. Clinicians may consider adjusting interpretation of a patient′s MCS based on the presence of viral symptoms, but viral symptoms may not always fully obviate the need for GAS testing.

Clinical presentation of FMD virus SAT1 infections in experimentally challenged indigenous South African goats

Abstract Foot-and-mouth disease (FMD) is a transboundary animal disease that has a major impact on livestock production and trade. Foot-and-mouth disease virus (FMDV) is a single-stranded RNA virus that infects cloven-hoofed livestock and wildlife. The susceptibility of South African indigenous goats to FMDV Southern African Territories 1 (SAT1) was investigated after experimental challenge with a mixed SAT1 virus pool. In this study, we present the clinical manifestation of FMDV in five naive goats challenged via the intra-dermolingual route with 104.57 50% tissue culture infective dose (TCID50) FMDV virus pool containing SAT1 SAR/8/10, SAR/10/10 and SAR/21/10. The clinical responses of two vaccinated unchallenged goats maintained as in-contacts are also presented. Clinical scoring of FMDV infection and daily rectal temperatures were recorded and temperatures ≥40 °C were defined as fever. All five challenged goats developed fever within 48 h post challenge with a median fever duration of 5 days. The two unchallenged goats developed fever at 5 and 9 days post-contact with FMD lesions appearing at 4 and 8 days post-contact. Additional clinical signs observed included nasal discharge, ulcerative oral mucosal lesions of the lip and ulcerative interdigital cleft lesions. The pooled FMDV SAT1 infection caused mild clinical signs and natural transmission to reduced-dose vaccinated in-contact indigenous South African goats occurred.