Co‐circulation of multiple genotypes of African swine fever viruses among domestic pigs in Zambia (2013–2015)

During 2013–2015, several and severe outbreaks of African swine fever (ASF ) affected domestic pigs in six provinces of Zambia. Genetic characterization of ASF viruses (ASFV s) using standardized genotyping procedures revealed that genotypes I, II and XIV were associated with these outbreaks. Molecular and epidemiological data suggest that genotype II ASFV (Georgia 2007/1‐like) detected in Northern Province of Zambia may have been introduced from neighbouring Tanzania. Also, a genotype II virus detected in Eastern Province of Zambia showed a p54 phylogenetic relationship that was inconsistent with that of p72, underscoring the genetic variability of ASFV s. While it appears genotype II viruses detected in Zambia arose from a domestic pig cycle, genotypes I and XIV possibly emerged from a sylvatic cycle. Overall, this study demonstrates the co‐circulation of multiple genotypes of ASFV s, involvement of both the sylvatic and domestic pig cycle in ASF outbreaks in Zambia and possible trans‐boundary spread of the disease in south‐eastern Africa. Indeed, while there is need for regional or international concerted efforts in the control of ASF , understanding pig marketing practices, pig population dynamics, pig housing and rearing systems and community engagement will be important considerations when designing future prevention and control strategies of this disease in Zambia.     

Exploratory investigation of Q fever in apparently healthy meat sheep flocks in Belgium

Q fever is a cosmopolitan disease affecting both humans and many animal species. Although sheep are often implicated in human Q fever outbreaks, the disease remains largely underestimated in meat sheep flocks. In order to fulfil this gap, a preliminary study was performed aiming to investigate the serological and molecular aspects of infection with Coxiella burnetii among meat sheep flocks in Belgium. Five Belgian sheep flocks were recruited for this work. Indirect ELISA was used, and in addition, real‐time PCR was performed on samples of milk, rectal and vaginal swabs, to understand the dynamics of bacterial shedding. Despite the low overall apparent seroprevalence of 1.39% (95% CI : 0.04–7.5), a high rate of bacterial shedding was found, with 27.7% of tested sheep (N  = 72) with a positive result to PCR , especially through the rectal and vaginal routes and in seronegative animals. Furthermore, Coxiella burnetii DNA was detected in 26.76% of seronegative animals. It can be concluded that an overall good clinical condition of the sheep cannot be used to exclude the presence of C. burnetii in a flock. Furthermore in the diagnosis of Q fever in sheep, serology alone was not a sensitive diagnostic tool. On the contrary, molecular biology allowed to detect bacterial shedding, which is an essential element in order to assess the risk due to the contact with shedding animals. At the light of these results, the role of meat sheep flocks in the epidemiology of Q fever in Belgium needs to be better understood.     

Revisiting the genetic diversity of classical swine fever virus: A proposal for new genotyping and subgenotyping schemes of classification

Classical swine fever (CSF ) is a highly contagious febrile viral disease caused by CSF virus (CSFV ), and it is considered one of the most important infectious diseases that affect domestic pigs and wild boar. Previous molecular epidemiology studies have revealed that the diversity of CSFV comprises three main genotypes and different subgenotypes defined using a reliable cut‐off to accurately classify CSFV at genotype and subgenotype levels. However, a growing number of CSFV both complete genome and full E2 gene sequences have been submitted to GenBank (more than 500 sequences are currently available, revised on December 1, 2017). Therefore, the aim of this study was to revisit the taxonomy of CSFV at genotype and subgenotype levels, to unify nomenclature and to provide an update to the classification of CSFV . We propose here a new genotyping scheme with five well‐defined CSFV genotypes (CSFV Genotypes 1–5) and 14 subgenotypes (seven for each of the CSFV Genotype 1 and CSFV Genotype 2). The findings showed in this study are relevant for molecular epidemiology approaches and will help to better understand the genetic diversity and spreading of CSFV at a global scale. The update in the classification of CSFV will allow the scientific community to establish more accurately the links among different outbreaks of the disease.     

Ciprofloxacin therapy for typhoid fever needs reconsideration

Outbreaks of multidrug-resistant Salmonella enterica serotype Typhi in the Indian subcontinent in the late 1980s resulted in the failure of conventional drugs, and ciprofloxacin became the firstline drug to treat enteric fever. However, reduced susceptibility to ciprofloxacin, reported widely since 1994, has posed a therapeutic difficulty. The aim of the present work was to review the situation of drug resistance among S. enterica serotype Typhi in central India from 1988 to 2005. A minimum inhibitory concentration (MIC) study for ciprofloxacin was carried out by the agar dilution method on 314 stock cultures preserved since 1988. The MIC for ciprofloxacin was ≤0.125 mg/l for the 50 isolates isolated during 1989–1994, but during 1998–1999, 60% of the 50 isolates showed MIC > 0.125 mg/l, while in 2002–2003, 82.5 % of the 97 isolates had MIC > 0.125 mg/l and 35% had MIC > 1 mg/l (high-level resistance). In 2004–2005, 88.2% of the 77 isolates had MIC > 0.125 mg/l and 15% had MIC > 1 mg/l (high-level resistance). Sixty-four isolates showing MIC > 1 mg/l with the agar dilution method were also checked by Epsilometer test (E-test, AB Biodisk, Solna, Sweden). Based on the data, it is suggested to withdraw ciprofloxacin as a therapeutic agent for enteric fever. Fortunately, multiple drug resistance, with concurrent resistance to chloramphenicol, cotrimoxazole, and ampicillin, which had reached more than 90% in 1990–1991, started declining over the years and was as low as 5.6% in 2004–2005. According to these observations, older drugs such as chloramphenicol, cotrimoxazole, and ampicillin could be recalled to treat enteric fever.     

儿童不明原因发热137例临床分析

目的 :探讨学龄期儿童不明原因发热 (Feverofunknownorigin ,FUO)的病因及诊断方法。方法 :对不明原因发热患儿的临床资料进行回顾性分析。结果 :137例患儿中 ,明确诊断 12 9例 ,确诊率为 94 .16 % ;未明确诊断 8例 ,占 5 .84 %。明确诊断的 12 9例中感染性疾病 6 5例 ,占 4 7.4 5 % ;结缔组织病 4 1例 ,占 2 9.93% ;肿瘤 13例 ,占9.4 9% ;其他疾病 10例 ,占 7.3%。结论 :根据临床症状、体征和必要的辅助检查可以明确FUO中的大多数的病因诊断 ,感染性疾病、结缔组织疾病及肿瘤是学龄期儿童FUO的主要原因。     

Differential effect of resuscitation on Toll-like receptors in a model of hemorrhagic shock without a septic challenge

It has been shown that the inflammatory response and cellular damage after hemorrhagic shock are influenced by resuscitation strategies. Toll-like receptors (TLRs) play an important role in signal transduction in inflammatory conditions. However, alterations in TLR expression following hemorrhagic shock and resuscitation have not been well documented. This study was conducted to measure the impact of different resuscitation strategies on TLR expression and downstream signaling in key organs. METHODS: Sprague Dawley rats (n=38) were subjected to a severe volume-controlled hemorrhage protocol. After 75 min of shock, they were resuscitated over 45 min as follows: (1) lactated Ringer's (LR, 81 ml/kg), (2) ketone Ringer's (KR, 81 ml/kg), (3) 7.5% hypertonic saline (HTS, 9.7 ml/kg), (4) 6% hetastarch (HEX, 27 ml/kg), (5) pyruvate Ringer's (PR, 81 ml/kg). Sham hemorrhage (NH) and no resuscitation (NR) groups served as controls. The KR and PR solutions were identical to LR except for equimolar substitution of racemic lactate with beta hydroxybutyrate and sodium pyruvate, respectively. At the end of resuscitation, the expression of TLRs (types 1-10), and cytokines (IL-10, IL-1beta and TNF-alpha) were measured in the lung and spleen using RT-PCR. Levels of phosphorylated and total IkB-alpha and NF-kappaB were detected by Western blotting. The systemic and lung protein levels of TNF-alpha were measured using ELISA and immunohistochemistry. RESULTS: Expression of TLRs in the lung was affected more than in the spleen by hemorrhagic shock and resuscitation. In the lung, hemorrhage increased TLR-2, -3 and -6 (but not TLR-4) mRNA expression, with an up-regulation of the ratio of phosphor-NF-kappaBp65 and total NF-kappaBp65, NF-kappaBp65 activation, and enhanced systemic and tissue TNF-alpha protein levels. Post-resuscitation, TLR mRNA profile and subsequent downstream proteins in the lung and spleen were affected by the choice of resuscitation strategy. CONCLUSIONS: Hemorrhagic shock activates TLR signaling in lung, but not the spleen, probably through an up-regulation of TLR gene expression, and activation of NF-kappaB pathway. Resuscitation modulates this response in a fluid- and tissue-specific fashion.     

Is endotoxin and cytokine release related to a decrease in gastric intramucosal pH after hemorrhagic shock?

Objectives: (a) To investigate the relationship between gut ischemia parameters (gastric intramucosal pH [pHi], mucosal–arterial carbon dioxide difference [PCO₂-gap]), and endotoxin or cytokine release during hemorrhagic shock; (b) to compare the predictive value of pHi, PCO₂-gap and arterial lactate concentrations. Design: Prospective study. Setting: Surgical intensive care unit of a university hospital. Patients: 20 multiple trauma patients with severe hemorrhagic shock. Interventions: Intramucosal measurements and blood samples were obtained on admission to the emergency room and repeatedly over 48 h. Measurements and results: Endotoxin was measured using a chromogenic limulus amoebocyte assay. Cytokine [tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6)] values were evaluated by immunoradiometric assays. Only 3 patients had positive blood cultures but endotoxins were detected at least once in all patients. Endotoxin levels were similar in survivors and nonsurvivors over the study period and were not related to pHi or PCO₂-gap. Initially, high levels of IL-6 were observed in both nonsurvivors and survivors [median 1778 pg/ml (range 435–44 540) vs 2068 pg/ml (range 996–92 300)]. IL-6 levels progressively decreased in the survivors but not significantly. On admission, TNFα concentrations were similar in nonsurvivors and survivors (42 ± 35 vs 46 ± 27 pg/ml). From the 24th h, TNFα values were higher in the nonsurvivors than in the survivors (24 h: 72 ± 38 vs 34 ± 17 pg/ml, p < 0.05). The greatest IL-6 levels were found for a pHi < 7.20 (28.5 ± 36.5 vs 1.8 ± 1.3 ng/ml, p < 0.05) or a PCO₂-gap > 7.5 mmHg (1 kPa) (32.5 ± 37.5 vs 1.7 ± 1.3 ng/ml, p < 0.01). With the same pHi threshold, no difference was found in endotoxin levels. The lactate concentrations were predictive for outcome from the 12th h (9.5 ± 5.9 vs 3.6 ± 2.3 mmol/l, p < 0.05). Conclusions: During severe hemorrhagic shock, endotoxin translocation from the gut was a common phenomenon that seemed independent of both pHi values and outcome. It could not explain IL-6 and TNFα release. In severe hemorrhagic shock, neither pHi nor PCO₂-gap provides additional information to the lactate measurements. Received: 17 February 1997 Accepted: 7 August 1997     

Temporal artery and axillary thermometry comparison with rectal thermometry in children presenting to the ED

Background

Accurate temperature readings, often obtained rectally, are an important part of the initial evaluation of pediatric patients in the Emergency Department. Temporal artery thermometry (TAT) is one way to noninvasively measure temperature. We sought to compare the accuracy of axillary and temporal artery temperatures compared to rectal.

高压氧对失血性休克复苏后炎症反应的影响

目的观察高压氧对大白鼠失血性休克复苏后炎症反应的影响并探讨其作用机制。方法Wistar大鼠随机分为三组：高压氧治疗组、休克组和对照组。建立大鼠失血性休克模型，自体血和生理盐水复苏后应用2．0绝对大气压高压氧治疗，于休克前、休克后、复苏后和复苏后24h取血检测血红细胞SOD、血浆卧限a、血浆iNOS值，并进行统计学（one-way ANOVA plus SNK）分析。观察复苏后24h大鼠肝、肠、肺组织病理改变并进行病理损伤评分。结果复苏后24h高压氧治疗组血红细胞SOD值高于休克组，高压氧治疗组血浆iNOS值和TNFoa值低于休克组，差异具有统计学意义（P〈0．05）。病理损伤评分：高压氧治疗组病理损伤与休克组相比减轻，差异具有统计学意义（P〈0．05）。结论 高压氧可能通过增强机体清除活性氧和自由基、阻止炎症介质的产生，进而减轻大鼠失血性休克复苏后的炎症反应和组织脏器的病理损伤。     

我院发热门诊运转过程中存在的问题及对策

笔分析了发热门诊在运转过程中存在布局欠合理、医务人员身心压力大、防SARS的各类用品供应跟不上、发热门诊的维持费用较大、欠费病人急剧增多等问题。针对存在问题。通过每周举行“SARS”专题协调会、向礼会招聘有经验的各类医务人员、适当调节医务人员心理状态、加强对抗SARS物质的后勤保障、减免经济困难的发热病人的费用等措施使存在问题得到妥善解决。笔认为抗击SARS这样的烈性传染病，需要全社会的积极参与。