Current Status of Q Fever and the Challenge of Outbreak Preparedness in Korea: One Health Approach to Zoonoses

Human Q fever, a zoonosis caused by Coxiella burnetii, presents with diverse clinical manifestations ranging from mild self-limited febrile illnesses to life-threatening complications such as endocarditis or vascular infection. Although acute Q fever is a benign illness with a low mortality rate, a large-scale outbreak of Q fever in the Netherlands led to concerns about the possibility of blood transfusion-related transmission or obstetric complications in pregnant women. Furthermore, a small minority (< 5%) of patients with asymptomatic or symptomatic infection progress to chronic Q fever. Chronic Q fever is fatal in 5–50% of patients if left untreated. In South Korea, Q fever in humans was designated as a notifiable infectious disease in 2006, and the number of Q fever cases has increased sharply since 2015. Nonetheless, it is still considered a neglected and under-recognized infectious disease. In this review, recent trends of human and animal Q fever in South Korea, and public health concerns regarding Q fever outbreaks are reviewed, and we consider how a One Health approach could be applied as a preventive measure to prepare for zoonotic Q fever outbreaks.

Protection of palmitic acid treatment in RAW264.7 cells and BALB/c mice during Brucella abortus 544 infection

Background@#We previously elucidated the protective mechanism of Korean red ginseng oil (RGO) against Brucella abortus infection, and our phytochemical analysis revealed that palmitic acid (PA) was an abundant component of RGO. Consequently, we investigated the contribution of PA against B. abortus. @*Objectives@#We aimed to investigate the efficacy of PA against B. abortus. infection using a murine cell line and a murine model. @*Methods@#Cell viability, bactericidal, internalization, and intracellular replication, western blot, nitric oxide (NO), and superoxide (O2 - ) analyses and flow cytometry were performed to determine the effects of PA on the progression of B. abortus. infection in macrophages. Flow cytometry for cytokine analysis of serum samples and bacterial counts from the spleens were performed to determine the effect of PA in a mouse model. @*Results@#PA did not affect the growth of B. abortus.. PA treatment in macrophages did not change B. abortus. uptake but it did attenuate the intracellular survivability of B. abortus.. Incubation of cells with PA resulted in a modest increase in sirtuin 1 (SIRT1) expression.Compared to control cells, reduced nitrite accumulation, augmented O2 - , and enhanced pro-inflammatory cytokine production were observed in PA-treated B. abortus.-infected cells.Mice orally treated with PA displayed a decreased serum interleukin-10 level and enhanced bacterial resistance. @*Conclusions@#Our results suggest that PA participates in the control of B. abortus. within murine macrophages, and the in vivo study results confirm its efficacy against the infection. However, further investigations are encouraged to completely characterize the mechanisms involved in the inhibition of B. abortus. infection by fatty acids.

Protection of palmitic acid treatment in RAW264.7 cells and BALB/c mice during Brucella abortus 544 infection

Background@#We previously elucidated the protective mechanism of Korean red ginseng oil (RGO) against Brucella abortus infection, and our phytochemical analysis revealed that palmitic acid (PA) was an abundant component of RGO. Consequently, we investigated the contribution of PA against B. abortus. @*Objectives@#We aimed to investigate the efficacy of PA against B. abortus. infection using a murine cell line and a murine model. @*Methods@#Cell viability, bactericidal, internalization, and intracellular replication, western blot, nitric oxide (NO), and superoxide (O2 - ) analyses and flow cytometry were performed to determine the effects of PA on the progression of B. abortus. infection in macrophages. Flow cytometry for cytokine analysis of serum samples and bacterial counts from the spleens were performed to determine the effect of PA in a mouse model. @*Results@#PA did not affect the growth of B. abortus.. PA treatment in macrophages did not change B. abortus. uptake but it did attenuate the intracellular survivability of B. abortus.. Incubation of cells with PA resulted in a modest increase in sirtuin 1 (SIRT1) expression.Compared to control cells, reduced nitrite accumulation, augmented O2 - , and enhanced pro-inflammatory cytokine production were observed in PA-treated B. abortus.-infected cells.Mice orally treated with PA displayed a decreased serum interleukin-10 level and enhanced bacterial resistance. @*Conclusions@#Our results suggest that PA participates in the control of B. abortus. within murine macrophages, and the in vivo study results confirm its efficacy against the infection. However, further investigations are encouraged to completely characterize the mechanisms involved in the inhibition of B. abortus. infection by fatty acids.

Successfully removed uterine angioleiomyoma by robot-assisted laparoscopic myomectomy

Angioleiomyoma is a rare type of leiomyoma variant and there are a few cases reported to date. Herein, we present a case of angioleiomyoma in a 36-year-old woman with lower abdominal pain, initially diagnosed by degenerated uterine leiomyoma. The transvaginal ultrasonogram showed an ovoid-shaped heterogeneously hyperechoic lesion in left cornual site of uterus and pelvic magnetic resonance image showed an about 5.1 cm sized heterogenous T2 intermediate high mass with poor enhancement. The patient underwent a robot-assisted laparoscopic myomectomy, and final histopathologic diagnosis revealed uterine angioleiomyoma. This case is the first case of angioleiomyoma resected by robotic surgery. The patient is on follow up for over 1 year and shows no evidence of recurrence until now.

Prevalence state of canine brucellosis in South Korea during 2015 and 2016 / 대한수의학회지

We investigated the prevalence of canine brucellosis in companion and stray dogs between March 2015 and December 2016 and determined the disease characteristics based on the geographic distribution, sex and age of the dogs in South Korea. We conducted a large-scale survey using serological and bacteriological tests. Samples were collected from 2,394 dogs (1,825 companions and 569 strays). Thirty (1.3%) samples were positive for Brucella canis antibodies including 16 (0.9%) from companion dogs and 14 (2.5%) from stray dogs. Two (1.0%) of the 196 samples cultured from the stray dogs were positive. When compared with male dogs, the female companion and stray dogs had a significantly higher prevalence of brucellosis. Moreover, the prevalence of canine brucellosis was significantly higher in stray dogs older than 6 years and the prevalence of the disease in companion dogs was highest in Incheon (2.1%) and Jeolla (2.1%) provinces. Stray dogs from the Daejeon metropolitan area had the highest prevalence of brucellosis (7.9%). National control measures for canine brucellosis have not previously been implemented. Our findings suggest that appropriate screening tests and control measures are necessary to improve the health of dogs and to protect public health in Korea, particularly with the rapid growth of the companion animal industry.

Prevalence state of canine brucellosis in South Korea during 2015 and 2016

We investigated the prevalence of canine brucellosis in companion and stray dogs between March 2015 and December 2016 and determined the disease characteristics based on the geographic distribution, sex and age of the dogs in South Korea. We conducted a large-scale survey using serological and bacteriological tests. Samples were collected from 2,394 dogs (1,825 companions and 569 strays). Thirty (1.3%) samples were positive for Brucella canis antibodies including 16 (0.9%) from companion dogs and 14 (2.5%) from stray dogs. Two (1.0%) of the 196 samples cultured from the stray dogs were positive. When compared with male dogs, the female companion and stray dogs had a significantly higher prevalence of brucellosis. Moreover, the prevalence of canine brucellosis was significantly higher in stray dogs older than 6 years and the prevalence of the disease in companion dogs was highest in Incheon (2.1%) and Jeolla (2.1%) provinces. Stray dogs from the Daejeon metropolitan area had the highest prevalence of brucellosis (7.9%). National control measures for canine brucellosis have not previously been implemented. Our findings suggest that appropriate screening tests and control measures are necessary to improve the health of dogs and to protect public health in Korea, particularly with the rapid growth of the companion animal industry.

Removable Partial Denture Using Anterior Implant-Supported Fixed Prostheses for Edentulous Patients: A Case Report

This case study was to report the possible increase in the denture retention and psychological relief using the implant-supported fixed prostheses in a completely edentulous patient. The implants were placed in the anterior portion of the mandible in a patient who had completely edentulous state following the extraction of residual abutment teeth, and consequently a distal extension removable partial denture was fabricated. The patient's adaptation and satisfaction to the new prosthesis was monitored and confirmed in terms of masticatory function and esthetics, by restoring the oral condition similar to initial status before the residual teeth extraction. After 6 months, radiographic examination confirmed that both the abutment teeth and the implants were stable and well maintained. Considering the relatively short clinical follow-up period, however, continuous long-term monitoring was required.

Full Arch Restoration through Orthognathic Surgery after Implantation on the Patients with Mandibular Prognathism and Loss of Posterior Teeth: A Case Report

In case of loss of many teeth due to dental caries or periodontal disease, improvement of masticatory function and aesthetics can be obtained through implant treatment. However, if the patient does not have a normal intercondylar relationship, it is difficult to achieve an ideal occlusal relationship with only prosthetic treatment. In particular, oral reconstruction with orthodontic treatment or orthognathic surgery is necessary for patients with mandibular prognathism. However, if the posterior occlusion collapses due to severe caries or periodontal disease, orthognathic surgery may be difficult. The occlusal vertical stop is very important for the stability of the mandibular position during occlusal reconstruction through orthognathic surgery. The patient in this case had posterior occlusion collapsed due to the caries of a large number of posterior teeth, and showed mandibular prognathism and long face. We planned a full arch restoration with orthognathic surgery and extracted the hopeless teeth. To secure the vertical stop required for orthognathic surgery, the implant was placed before surgery. After the orthognathic surgery and the final prosthesis application, the results were satisfactory for the improvement of the aesthetics and the restoration of the masticatory function.

The Effect of Suffering Experience, Empathy Ability, Caring Behaviors on Terminal Care Performance of Clinical Nurses / 한국호스피스완화의료학회지

PURPOSE: This study was performed to identify factors affecting terminal care performance of clinical nurses. METHODS: The participants in this study were 175 nurses working in hospitals in Daegu and North Gyeongsang Province. Data were collected using a self-reported questionnaire and were analyzed with the IBM SPSS WIN 19.0 program. RESULTS: Nurses' terminal care performance was significantly related with suffering experience, empathy ability and caring behaviors. Significant predictors for terminal care performance were their department, empathy ability and caring behaviors. These factors explained 43.52% of the variance in terminal care performance of clinical nurses. CONCLUSION: Our study results suggest that terminal care performance of clinical nurses can be strengthened by improving empathy ability and caring behaviors.

Effects of Integrated Palliative Care Intervention on Quality of Life in Terminal Cancer Patients: A Meta-analysis / 한국호스피스완화의료학회지

PURPOSE: This study was conducted to evaluate the effects of integrated palliative care intervention on quality of life in terminally ill patients. METHODS: A comprehensive literature search was performed via PubMed, Cochrane Library CENTRAL, LWW (Ovid), CINAHL and several Korean databases. The main search strategy was to combine terms indicating palliative care intervention, presence of terminal illness and study design. Methodological quality was assessed using Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non-randomized studies. Data were analyzed by the Stata 10 program. RESULTS: Eight clinical trials met the inclusion criteria with a total of 356 participants. Integrated palliative care interventions were administered for a mean of 6.5 weeks, 5.6 sessions and an average of 47.8 minutes per session. Effect sizes were heterogeneous, and subgroup analysis was done. Integrated palliative care interventions had a significant effect on quality of life (ES=1.83, P=0.018, l2=92%), spiritual well-being (ES=0.78, P=0.040, l2=0), depression (ES=0.86, P<0.001, l2=32) and anxiety (ES=0.69, P=0.041, l2=71.1). But integrated palliative care interventions had no significant effect on pain (ES=0.365, P=0.230, l2=69.8). CONCLUSION: Results support findings that integrated palliative care interventions were helpful in lessening depression and anxiety and improving quality of life and spiritual well-being, however, the interventions did not assist pain management in terminal cancer patients. These findings suggest that various integrated palliative care interventions can assist terminal cancer patients with better quality of life in the socio-psycho-spiritual dimension.

Identification of Brucella melitensis isolates originating from Mongolia and diagnostic real-time PCR evaluation using a specific SNP / 대한수의학회지

A real-time PCR assay using hybridization probe (HybProbe) has been developed to detect Brucella (B.) melitensis strains. The primer and HybProbe sets were designed based on the gap gene of chromosome I with a specific single nucleotide polymorphism of B. melitensis. Specificity of the assay was confirmed by comparison to reference Brucella species and other related strains. In the melting curve analysis, B. melitensis generated a peak at 67degrees C unlike those for other Brucella species observed at 61degrees C. Sensitivity of the assay for B. melitensis ranged from 20 ng to 200 fg of genomic DNA. The ability to identify 94 Mongolian B. melitensis isolates using the real-time PCR assay was identical to that of classical biotyping methods and differential multiplex PCR. These data showed that this new molecular technique is a simple and quick method for detecting B. melitensis, which will be important for the control and prevention of brucellosis.

Phylogenetic Relationships of 3 Korean Neodiplostomum Species (Digenea: Neodiplostomidae) Based on Partial CO1 Gene

The phylogenetic relationships of the 3 Neodiplostomum spp. (Digenea: Neodiplostomidae) occurring in Korea (N. seoulense, N. leei, and N. boryongense) were analyzed using the partial mitochondrial cytochrome c oxidase subunit 1 (CO1) gene. The adult flukes were recovered from Sprague-Dawley rats (N. seoulense) and newborn chicks (N. leei and N. boryongense) experimentally infected with the neodiplostomula from the grass snake, Rhabdophis tigrinus tigrinus. The genomic DNA was amplified using specific primers, and the sequence of CO1 was obtained. According to the results, the pairwise similarity was 96.1% between N. boryongense and N. seoulense, but was 95.0% between N. boryongense and N. leei and 94.2% between N. leei and N. seoulense. The results demonstrated a closer phylogenetic relationship between N. seoulense and N. boryongense. This high relationship of N. seoulense and N. boryongense may be related to their similar morphologic features including the limited distribution of vitellaria and the presence of a genital cone. N. leei is distinct on the other hand with an extensive distribution of vitellaria and the absence of a genital cone.

Serological monitoring on brucellosis in livestock of Korea / 대한수의학회지

In Korea, brucellosis has been reported periodically in cattle and rarely in dogs; however, it has not previously been screened in domestic animals such as elk, pigs and goats. To investigate the serological prevalence, serum samples were taken from the aforementioned animals annually during 2007-2013 and screened by the rose-bengal test (RBT) or modified RBT, after which positive sera were evaluated by the standard tube agglutination test (STAT). Finally, RBT and STAT-positive sera were confirmed by competitive-ELISA. Brucella abortus biovar 1 was isolated from three elk that were shown to be positive serologically in 2008. There was no evidence of brucellosis in pigs. Based on serological monitoring and investigation of etiological agents, there is no evidence of outbreak of brucellosis in elk, pigs or goats of Korea since 2008. However, the possibility for brucellosis from cattle to affect these other livestock exists; therefore, extensive and continuous serological monitoring is required to maintain their brucellosis-free status.

Protective effects of recombinant Brucella abortus Omp28 against infection with a virulent strain of Brucella abortus 544 in mice

The outer membrane proteins (OMPs) of Brucella (B.) abortus have been extensively studied, but their immunogenicity and protective ability against B. abortus infection are still unclear. In the present study, B. abortus Omp28, a group 3 antigen, was amplified by PCR and cloned into a maltose fusion protein expression system. Recombinant Omp28 (rOmp28) was expressed in Escherichia coli and was then purified. Immunogenicity of rOmp28 was confirmed by Western blot analysis with Brucella-positive mouse serum. Furthermore, humoral- or cell-mediated immune responses measured by the production of IgG1 or IgG2a in rOmp28-immunized mice and the ability of rOmp28 immunization to protect against B. abortus infection were evaluated in a mouse model. In the immunogenicity analysis, the mean titers of IgG1 and IgG2a produced by rOmp28-immunized mice were 20-fold higher than those of PBS-treated mice throughout the entire experimental period. Furthermore, spleen proliferation and bacterial burden in the spleen of rOmp28-immunized mice were approximately 1.5-fold lower than those of PBS-treated mice when challenged with virulent B. abortus. These findings suggest that rOmp28 from B. abortus is a good candidate for manufacturing an effective subunit vaccine against B. abortus infection in animals.

The virulence of Brucella abortus isolated from cattle in Korea / 대한수의학회지

In this study, we isolated 12 of Brucella (B.) spp. from cattle, which have been positive in Rose Bangal test and tube agglutination test in Gyeongbuk province in 2009. According to AMOS PCR analysis, isolated 12 strains were identified as B. abortus. Murine derived macrophage, RAW 264.7 cells, were infected with isolated 12 strains or reference strain (B. abortus 544), and bacterial internalization were characterized. According to these results, we divided the isolated strains into the following three groups: class I, lower internalization than that of B. abortus 544; class II, similar internalization to that of that of B. abortus 544; class III, higher internalization than that of B. abortus 544 within RAW 264.7 cells. Furthermore, intracellular growth, bacterial adherent assay, LAMP-1 colocalization, virulence in mice and surface protein pattern were characterized. From these results, representative strains of class III showed lower LAMP-1 colocalization, higher adherent efficiency, higher virulence in mice than those of B. abortus 544, and showed different pattern of surface proteins. These results suggest that B. abortus field strains, isolated from cattle in Korea, possess various virulence properties and higher internalization ability of field strain may have an important role for its virulence expression.

Detection of Gnathostoma spinigerum Third-Stage Larvae in Snakeheads Purchased from a Central Part of Myanmar

To examine the infection status of freshwater fish with Gnathostoma spp. larvae in Myanmar, we purchased 15 snakeheads, Channa striatus, from a local market in a suburban area of Naypyidaw, the new capital city. Two larval gnathostomes were collected using an artificial digestion technique, and observed by a light microscope and a scanning electron microscope. The size of an intact larva was 2.65 mm long and 0.32 mm wide. The characteristic morphology of the larvae included the presence of a long esophagus (0.80 mm long), 2 pairs of cervical sacs (0.43 mm long), and a characteristic head bulb with 4 rows of hooklets. The number of hooklets in the 1st, 2nd, 3rd, and 4th row was 45, 48, 50, and 52, respectively. Based on these morphological characters, the larvae were identified as the advanced 3rd-stage larvae of Gnathostoma spinigerum. This is the first report of detection of G. spinigerum 3rd-stage larvae in the central part of Myanmar. Our study suggests that intake of raw meat of snakehead fish in Myanmar may result in human gnathostomiasis.

Annual Report on External Quality Assessment in Urinalysis in Korea (2007) / 임상검사와정도관리

Three external quality assesment trials which composed of 16 control materials (12 chemical materials and four microscopic photographs of urinary sediment) for interlaboratory quality control assesment in urinalysis were performed with 638, 645, and 662 participants, in each, in the year of 2007. The response rate were 95.5% (638/668), 96.7% (645/667) and 97.1% (662/682), in the first, the second and the third trials, in each. The test items include pH, glucose, protein, ketone, bilirubin, blood, urobilinogen, nitrite, leukocyte esterase, specific gravity and four microscopic photographs of body fluid and urinary sediment. The survey results are summarized as follows: 1. The chemical quality control test in urinalysis revealed generally good concordance. 2. The percentage of using urinalysis analyzer was slightly increased as 87.5% and the distribution of using reagent strip was similar to the previous year. 3. The percentage of response rate of microscopic photographs of urinary sediment was 80.7% (536/662) and the percentage of good performance of these tests was 60.6% to 99.1%.

Annual Report on External Quality Assessment in Urinalysis in Korea (2007) / 임상검사와정도관리

Three external quality assesment trials which composed of 16 control materials (12 chemical materials and four microscopic photographs of urinary sediment) for interlaboratory quality control assesment in urinalysis were performed with 638, 645, and 662 participants, in each, in the year of 2007. The response rate were 95.5% (638/668), 96.7% (645/667) and 97.1% (662/682), in the first, the second and the third trials, in each. The test items include pH, glucose, protein, ketone, bilirubin, blood, urobilinogen, nitrite, leukocyte esterase, specific gravity and four microscopic photographs of body fluid and urinary sediment. The survey results are summarized as follows: 1. The chemical quality control test in urinalysis revealed generally good concordance. 2. The percentage of using urinalysis analyzer was slightly increased as 87.5% and the distribution of using reagent strip was similar to the previous year. 3. The percentage of response rate of microscopic photographs of urinary sediment was 80.7% (536/662) and the percentage of good performance of these tests was 60.6% to 99.1%.

Decrease of Metagonimus yokogawai Endemicity along the Tamjin River Basin

The Tamjin River which flows from Jangheung-gun via Gangjin-gun to the South Sea was reported to be a highly endemic area of Metagonimus yokogawai infection in 1977 and 1985. However, there were no recent studies demonstrating how much change occurred in the endemicity, in terms of prevalence and worm burden, of metagonimiasis in this river basin. Thus, a small-scale epidemiological survey was carried out on some residents along the Tamjin River basin in order to determine the current status of M. yokogawai infection. A total of 48 fecal samples were collected and examined by the Kato-Katz thick smear and formalin-ether sedimentation techniques. The egg positive rate of all helminths was 50.0%, and that of M. yokogawai was 37.5%, followed by C. sinensis 22.9% and G. seoi 4.2%. To obtain the adult flukes of M. yokogawai, 6 egg positive cases were treated with praziquantel 10 mg/kg in a single dose and purged with magnesium sulfate. A total of 5,225 adult flukes (average 871 specimens per person) of M. yokogawai were collected from their diarrheic stools. Compared with the data reported in 1977 and 1985, the individual worm burdens appeared to have decreased remarkably, although the prevalence did not decrease at all. It is suggested that the endemicity of M. yokogawai infection along the Tamjin River has been reduced. To confirm this suggestion, the status of infection in snail and fish intermediate hosts should be investigated.

Annual Report on External Quality Assessment in Urinalysis in Korea (2005) / 임상검사와정도관리

Three external quality assesment trials which composed of 16 control materials (12 chemical materials and four microscopic photographs of urinary sediment) for interlaboratory quality control assesment in urinalysis were performed with 451, 452, and 476 participants, in each, in the year of 2005. The response rate were 95.6% (451/472), 91.9% (452/492) and 95.6% (476/498), in the first , the second and the third trials, in each. The test items include pH, glucose, protein, ketone, bilirubin, blood, urobilinogen, nitrite, leukocyte estrase, specific gravity and four microscopic photographs of urinary sediment. The survey results are summarized as follows: 1. The chemical quality control test in urinalysis revealed generally good concordance. 2. The percentage of using urinalysis analyzer was slightly increased as 91.2% and the distribution of using reagent strip was similar to the previous year. 3. The percentage of response rate of microscopic photographs of urinary sediment was 76.5%(387/498) and the percentage of good performance of these tests ware 63.6% to 86.5%.