Co-evolution of Leptospira and Tenrecidae (Afrotheria) on Madagascar

Leptospirosis is one of the most prevalent bacterial zoonoses in the world. The disease is caused by pathogenic Leptospira that are maintained in the kidney lumen of infected animals, mostly mammals, acting as reservoirs and contaminating the environment via infected urine. The investigation of leptospirosis through a One Health framework has been stimulated by notable genetic diversity of pathogenic Leptospira together with a high infection prevalence in certain animal reservoirs. Extensive sampling and associated microbiological and molecular studies of Madagascar's native mammal fauna have revealed a diversity of pathogenic Leptospira with high levels of host-specificity. Native rodents, tenrecids, and bats shelter a number of distinct lineages and species of Leptospira, some of which have also been detected in acute human cases. Specifically, L. mayottensis, first discovered in humans on Mayotte, an island neighboring Madagascar, was subsequently identified in a few species of Malagasy tenrecids, an endemic family. Distinct L. mayottensis lineages were identified in shrew tenrecs (Microgale cowani and Nesogale dobsoni) on Madagascar, and later in spiny tenrecs (Tenrec ecaudatus) on Mayotte. These findings suggest that L. mayottensis (i) has experienced co-evolutionary processes during the radiation of tenrecids on Madagascar, and (ii) has recently emerged in human populations on Mayotte following the introduction of T. ecaudatus from Madagascar. Hitherto, L. mayottensis has not been detected in spiny tenrecs on Madagascar. In the present study, we broaden the investigation of Malagasy tenrecids and describe the presence of L. mayottensis in Malagasy populations of T. ecaudatus, as well as in M. thomasi. These results confirm the hypothesis that L. mayottensis was introduced to Mayotte, presumably via T. ecaudatus, and provide additional data on the co-evolution of Leptospira and Tenrecidae.

Detection of anti-Leptospira spp. agglutinins in captive South American river turtles, Podocnemis expansa

ABSTRACT Leptospirosis is a zoonosis transmitted by contact with infected urine or water contaminated with the agent. Searches for Leptospira spp. in reptiles are scarce although most species have contact with aquatic environments. We evaluated the presence of anti-Leptospira spp. antibodies in Podocnemis expansa housed at the Amazonian Zoobotanical Garden, in Belém, Pará state, Brazil. We analyzed 74 serum samples through the microscopic agglutination test using 31 live antigens from different Leptospira spp. serogroups. Thirty samples (40.5%) were positive against Leptospira spp., with titrations between 100 and 3,200 for one or more serogroups. The Hebdomadis serogroup was the most prevalent, with 26 (87%) out of the 30 positive samples, followed by Djasiman, with two (7%) and Celledoni and Bataviae with one (3%) sample each. The detection of anti-Leptospira spp. agglutinins in P. expansa suggests that the aquatic environment is a transmission route for this pathogen among chelonians.

Infection and extrusion of a subcutaneous access port in a cat: a long-term postoperative complication of a subcutaneous ureteral bypass device

Case summary A 5-year-old domestic shorthair neutered female cat was presented for a wound in the region of the subcutaneous ureteral bypass shunting port with externalisation of the device, 2 years after its initial positioning. The cat had had positive urine bacterial cultures over the previous year and a half without any clinical signs of urinary tract infection. Bacterial cultures of urine and the wound revealed the same bacteria, suggesting a complication caused by infected urine from the implanted system. The wound was successfully treated with surgery and at the time of writing, 3 months later, the cat is healthy with no evidence of recurrence. Relevance and novel information To our knowledge, this is the first report of a subcutaneous ureteral bypass shunting port extrusion as a long-term major complication of the bacterial infection of the device.

Dog: A Friendly Pathway to Zoonoses

Canis lupus familaris (Dog); a companion animal or even considered man’s best friend is believed to have been living in harmony with humans since thousands of years. Recent discovery in Chauvet cave in France: foot print of 8-year-old boy alongside the paw print is believed to have been dated back to Paleolithic period. Reports even suggest that pet owners are less prone to high cholesterol and high blood pressure than the non-pet owners. However, dogs are also the major reservoir of various zoonotic infections. Several bacterial, viral or protozoal diseases that occur in human are transmitted from the dogs. Such diseases are known as zoonotic diseases. These diseases can be transmitted by simple contact with the infected dogs or by infected urine or feces, saliva or aerosols. Viral infections such as rabies and noro virus, bacterial infection such as pasteurellosis, salmonellosis, campylobacteriosis, leptospirosis and Methicillin-Resistant Staphylococcus aureus (MRSA) infections and protozoal infections like ancylostomiasis, toxocariasis and Dipylidium caninum infection are the most common zoonotic infections. This paper focuses on these diseases including information on signs and symptoms, mode of transmission and prevention of these diseases. As much as these infections are concerned, knowledge boosting of the pet owners regarding zoonotic disease along with proper hygiene and good sanitation practices could considerably decline the rate of zoonoses transmission and consequences.

Cytological and Wet Mount Microscopic Observations Made in Urine of Schistosoma haematobium-Infected Children: Hint of the Implication in Bladder Cancer

Background. Schistosomiasis is the second major human parasitic disease next to malaria, in terms of socioeconomic and public health consequences, especially in sub-Saharan Africa. Schistosoma haematobium (S. haematobium) is a trematode and one of the species of Schistosoma that cause urogenital schistosomiasis (urinary schistosomiasis). Although the knowledge of this disease has improved over the years, there are still endemic areas, with most of the reported cases in Africa, including Ghana. Not much has been done in Ghana to investigate cytological abnormalities in individuals within endemic communities, although there are epidemiologic evidences linking S. haematobium infection with carcinoma of the bladder. Aim. The aim of this study was to identify microscopic and cytological abnormalities in the urine deposits of S. haematobium-infected children. Methodology. Three hundred and sixty-seven (367) urine samples were collected from school children in Zenu and Weija communities. All the samples were examined microscopically for the presence of S. haematobium eggs, after which the infected samples and controls were processed for cytological investigation. Results. S. haematobium ova were present in 66 (18.0%) out of the 367 urine samples. Inflammatory cells (82%, 54/66), hyperkeratosis (47%, 31/66), and squamous cell metaplasia (24%, 16/66) were the main observations made during the cytological examination of the S. haematobium-infected urine samples. Conclusion. Cytological abnormalities in S. haematobium-infected children may play an important role in the severity of the disease, leading to the possible development of bladder cancer in later years, if early attention is not given. Therefore, routine cytological screening for urogenital schistosomiasis patients (especially children) at hospitals in S. haematobium-endemic locations is recommended.

Bladder calculi causing irreducible urogenital prolapse

Over 200 000 surgeries for vaginal prolapse are done annually, and these are rarely urgent. However, when the rare event of bladder stones causes incarcerated procidentia, surgical intervention should not be delayed, due to unrelenting pain and end-organs effects. We present such a case below. A 71-year-old woman presents to our department with massive uterovaginal and rectal procidentia. This massive prolapse was found to be irreducible due to numerous dahllite stones in the bladder, and was causing obstructive uropathy with left-sided hydronephrosis. A multidisciplinary approach was necessary to surgically correct the prolapse and implement complete removal of all the stones. The simultaneous occurrence of uterovaginal prolapse, rectal prolapse and urolithiasis is uncommon. Stone formation is a result of chronically infected urine presenting a nidus for stone formation. This presentation has occurred very rarely over the last 70 years of the world’s literature. Surgical cures can be achieved by either the vaginal or abdominal routes but should be treated emergently to alleviate pain, prevent renal impairment from obstructive uropathy and decrease infectious morbidity.

Eyedrop Inoculation Causes Sublethal Leptospirosis in Mice

ABSTRACT Leptospirosis is potentially a fatal zoonosis acquired by contact of skin and mucosal surfaces with soil and water contaminated with infected urine. We analyzed the outcome of infection of C3H/HeJ mice with Leptospira interrogans serovar Copenhageni using an enzootic mode of transmission, the conjunctival route. Infection led to weight loss and L. interrogans dissemination from blood to urine, and spirochetes were detected in blood and urine simultaneously. The infectious dose that led to consistent dissemination to kidney after conjunctival infection was ∼108 leptospires. Interestingly, a lower number of spirochetes appeared to colonize the kidney, given that we quantified ∼105 and ∼10 leptospires per μl of urine and per μg of kidney, respectively. Leptospira-specific IgM and IgG were detected at 15 days postinfection, and isotyping of the Ig subclass showed that the total IgG response switched from an IgG1 response to an IgG3 response after infection with L. interrogans. Histological periodic acid-Schiff D staining of infected kidney showed interstitial nephritis, mononuclear cell infiltrates, and reduced size of glomeruli. Quantification of proinflammatory immunomediators in kidney showed that keratinocyte-derived chemokine, macrophage inflammatory protein 2, RANTES, tumor necrosis factor alpha, gamma interferon, and interleukin-10 were upregulated in infected mice. We show that the kinetics of disease progression after infection via the ocular conjunctiva is delayed compared with infection via the standard intraperitoneal route. Differences may be related to the number of L. interrogans spirochetes that succeed in overcoming the natural defenses of the ocular conjunctiva and transit through tissue.

Editorial

The snow and freezing temperatures will hopefully have passed by the time this edition reaches you; the sight of daffodils may be asignal that the relief of spring is not far off. Winter frequently stretches AMU resources to the limit – in recent years we have had epidemics of seasonal and swine f lu, but this year Norovirus seems to have been the bigger challenge. Ward closures from diarrhoea outbreaks have traditionally been more of a ‘downstream’ problem (no pun intended), but the impact of closure of the AMU would be substantial.At the time of writing this has still, thankfully, been avoided in my own hospital; however it remains a circumstance for which we have to be prepared. This edition’s ‘Viewpoint’ article describes how temporary closure of the AMU was managed in a London hospital. The use of an empty ‘winter pressures ward’ eased the burden in this case, enabling the AMU service to be maintained. Even with the luxury of this spare capacity, there was clearly significant disruption, requiring close collaboration between a variety of departments, which is well described by the authors. Many hospitals have become highly dependent on a functioning AMU to provide timely, safe and effective care for medical emergencies. Major incident plans are in place to deal with mass casualty incidents; we need to consider similar contingencies to deal with AMU closure if patient safety is going to be maintained. This article is a timely reminder of the need for forward planning. Maintaining patient safety is a mantra which will be familiar to acute physicians, particularly those who attended any of the recent SAM meetings, where this theme has been well rehearsed. An acute medical unit can provide significant safety benefits by concentrating resources in a single area. However, for the 60% who cannot go directly home from the AMU, this model creates the need for care to be transferred at some point. It is well recognised that transfer is a time at which patient safety can become compromised; so if safety is our mantra, acute physicians and nurses have a responsibility to manage this process effectively. The article by David Hindmash and Liz Lees provides an important addition to the limited literature in this area. Structured checklists are becoming an increasing part of medical practice; this paper highlights how a checklist can be used to improve the quality of handover from AMU. The authors emphasise the need to keep the form simple, and the importance of regular reinforcement to ensure that it is used. What skills and attributes does an acute physician require? With interview season approaching it’s a question that many prospective trainees will be contemplating – remaining calm under pressure, communication skills and teamworking are some of the standard responses; but what about a good sense of smell? Most of us recognise the characteristic odour of melaena , or the whiff of infected urine. But the absence of body odour might be equally revealing. Luther and Yap noted their patient to be ‘remarkably clean’ – unusual, perhaps, for a young male patient on the AMU; along with his persistent demands to use the showering facilities, this was a clue to the final diagnosis of Cannabis Hyperemesis Syndrome.It’s a case worth reading and highlights the importance of lateral thinking, particularly when patients repeatedly attend – as well as having a ‘good nose’ to sniff out something unusual!