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.

Molecular and serological surveillance of equine piroplasmosis in the Republic of Korea between 2016 and 2017

Equine piroplasmosis (EP) is caused by Babesia caballi and Theileria equi infection. We investigated antigen and antibody of EP in horses in the Republic of Korea during 2016-2017. Antigen and antibody of T. equi was detected 0.06% (1/1,650). Phylogenetic analysis of 18S rRNA revealed that the T. equi was highly homologous with the strains from China, Mongolia, and Spain. Two Theileria spp. were also detected and highly homologous with T. buffeli, T. luwehshuni, and T. orientalis.

Rapidly quantitative detection of Nosema ceranae in honeybees using ultra-rapid real-time quantitative PCR

Background@#The microsporidian parasite Nosema ceranae is a global problem in honeybee populations and is known to cause winter mortality. A sensitive and rapid tool for stable quantitative detection is necessary to establish further research related to the diagnosis, prevention, and treatment of this pathogen. @*Objectives@#The present study aimed to develop a quantitative method that incorporates ultra-rapid real-time quantitative polymerase chain reaction (UR-qPCR) for the rapid enumeration of N. ceranae in infected bees. @*Methods@#A procedure for UR-qPCR detection of N. ceranae was developed, and the advantages of molecular detection were evaluated in comparison with microscopic enumeration. @*Results@#UR-qPCR was more sensitive than microscopic enumeration for detecting two copies of N. ceranae DNA and 24 spores per bee. Meanwhile, the limit of detection by microscopy was 2.40 × 104 spores/bee, and the stable detection level was ≥ 2.40 × 105 spores/ bee. The results of N. ceranae calculations from the infected honeybees and purified spores by UR-qPCR showed that the DNA copy number was approximately 8-fold higher than the spore count. Additionally, honeybees infected with N. ceranae with 2.74 × 104 copies of N. ceranae DNA were incapable of detection by microscopy. The results of quantitative analysis using UR-qPCR were accomplished within 20 min. @*Conclusions@#UR-qPCR is expected to be the most rapid molecular method for Nosema detection and has been developed for diagnosing nosemosis at low levels of infection.

Molecular and serological surveillance of equine piroplasmosis in the Republic of Korea between 2016 and 2017

Equine piroplasmosis (EP) is caused by Babesia caballi and Theileria equi infection. We investigated antigen and antibody of EP in horses in the Republic of Korea during 2016-2017. Antigen and antibody of T. equi was detected 0.06% (1/1,650). Phylogenetic analysis of 18S rRNA revealed that the T. equi was highly homologous with the strains from China, Mongolia, and Spain. Two Theileria spp. were also detected and highly homologous with T. buffeli, T. luwehshuni, and T. orientalis.

Rapidly quantitative detection of Nosema ceranae in honeybees using ultra-rapid real-time quantitative PCR

Background@#The microsporidian parasite Nosema ceranae is a global problem in honeybee populations and is known to cause winter mortality. A sensitive and rapid tool for stable quantitative detection is necessary to establish further research related to the diagnosis, prevention, and treatment of this pathogen. @*Objectives@#The present study aimed to develop a quantitative method that incorporates ultra-rapid real-time quantitative polymerase chain reaction (UR-qPCR) for the rapid enumeration of N. ceranae in infected bees. @*Methods@#A procedure for UR-qPCR detection of N. ceranae was developed, and the advantages of molecular detection were evaluated in comparison with microscopic enumeration. @*Results@#UR-qPCR was more sensitive than microscopic enumeration for detecting two copies of N. ceranae DNA and 24 spores per bee. Meanwhile, the limit of detection by microscopy was 2.40 × 104 spores/bee, and the stable detection level was ≥ 2.40 × 105 spores/ bee. The results of N. ceranae calculations from the infected honeybees and purified spores by UR-qPCR showed that the DNA copy number was approximately 8-fold higher than the spore count. Additionally, honeybees infected with N. ceranae with 2.74 × 104 copies of N. ceranae DNA were incapable of detection by microscopy. The results of quantitative analysis using UR-qPCR were accomplished within 20 min. @*Conclusions@#UR-qPCR is expected to be the most rapid molecular method for Nosema detection and has been developed for diagnosing nosemosis at low levels of infection.

Enhanced alcohol degradation and hepatic protective effects of an Acetobacter Pasteurianus-derived product, CureZyme-ACE, in an acute intoxication rat model / 한국실험동물학회지

Excessive alcohol consumption induces acute intoxication and various hepatic diseases. In this study, we investigated the effect of the CureZyme-ACE (CA), Acetobacter Pasteurianus (AP)-derived product, in acute intoxication rats. The ethanol and acetaldehyde levels of serum were lower in rats treated with CA than those who only treated ethanol. The activities of alcohol dehydrogenase and acetaldehyde dehydrogenase also recovered faster in the CA group than only-ethanol group. The transaminase levels (AST, ALT) in the CA group were significantly lower than only-ethanol group. In addition, Hepatic histological analyses and stomach wall were demonstrated that the CA-treated group recovered faster than only-ethanol group. With regard to most characteristics, we found that CA had dose-dependent effects. At high concentrations of CA, there were no differences in the tested parameters compared to those of normal rats. These findings indicate that CA reduces the serum alcohol concentration and some of the hepatic damage caused by alcohol intoxication.

Seroprevalence and B1 gene Phylogeny of Toxoplasma gondii of Dogs and Cats in Republic of Korea

The outbreak of human toxoplasmosis can be attributed to ingestion of food contaminated with Toxoplasma gondii. Toxoplasmosis recently increased in domestic and stray dogs and cats. It prompted studies on the zoonotic infectious diseases transmitted via these animals. Sero- and antigen prevalences of T. gondii in dogs and cats were surveyed using ELISA and PCR, and B1 gene phylogeny was analyzed in this study. Toxoplasmosis antibodies were measured on sera of 403 stray cats, 947 stray dogs, 909 domestic cats, and 2,412 domestic dogs collected at nationwide regions, Korea from 2017 to 2019. In addition, whole blood, feces, and tissue samples were also collected from stray cats (1,392), stray dogs (686), domestic cats (3,040), and domestic dogs (1,974), and T. gondii-specific B1 gene PCR was performed. Antibody prevalence of stray cats, stray dogs, domestic cats, and domestic dogs were 14.1%, 5.6%, 2.3%, and 0.04%, respectively. Antigen prevalence of these animals was 0.5%, 0.2%, 0.1%, and 0.4%, respectively. Stray cats revealed the highest infection rate of toxoplasmosis, followed by stray dogs, domestic cats, and domestic dogs. B1 gene positives were 5 of stray cats, and identified to high/moderate pathogenic Type I/III group. These findings enforce that preventive hygienic measure should be strengthened at One Health level in dogs and cats, domestic and stray, to minimize human toxoplasmosis infections.

Tissue Fluid Enzyme-Linked Immunosorbant Assay for Piglets Experimentally Infected with Toxoplasma gondii and Survey on Local and Imported Pork in Korean Retail Meat Markets

To investigate the prevalence of Toxoplasma gondii in pork on the market in Korea, an in-house enzyme-linked immunosorbent assay for tissue fluid (CAU-tf-ELISA) was developed using a soluble extract of T. gondii RH strain tachyzoites. As the standard positive controls, the piglets were experimentally infected with T. gondii: Group A (1,000 cysts-containing bradyzoites), Group B (500 cysts-containing bradyzoites) and Group C (1.0×103 or 1.0×104 tachyzoites). The CAU-tf-ELISA demonstrated infection intensity-dependent positivity toward tissue fluids with average cut-off value 0.15: 100% for Group A, 93.8% for Group B and 40.6% for Group C. When tissue-specific cut-off values 0.066–0.199 were applied, CAU-tf-ELISA showed 96.7% sensitivity, 100% specificity, 100% positive and 90.0% negative predictive values. When compared with the same tissue fluids, performance of CAU-tf-ELISA was better than that of a commercial ELISA kit. Of the 583 Korea domestic pork samples tested, anti-T. gondii antibodies were detected from 9.1% of whole samples and 37.9% from skirt meat highest among pork parts. In the 386 imported frozen pork samples, 1.8% (skirt meat and shoulder blade) were positive for anti-T. gondii antibodies. In Korea, prevalence of anti-T. gondii antibodies in the pork on retail markets appeared high, suggesting that regulations on pig farming and facilities are necessary to supply safe pork on the tables.

Ectopic migration of Dirofilaria immitis in a Eurasian otter (Lutra lutra) in Korea / 대한수의학회지

An 8-year-old female Eurasian otter (Lutra lutra) reared in a wetland center, died 2 h after sudden onset of astasia and dyspnea despite medical treatment. Gross examination of internal organs revealed 10 adult filarioid nematodes in the right ventricle of the heart and three between the left and right cerebral hemispheres. All nematodes were identified as Dirofilaria immitis by direct microscopy and polymerase chain reaction assay. Histopathological observation revealed multifocal hemorrhage in the cerebral subarachnoid space and focal necrosis with hemorrhagein the cerebellar parenchyma. Although rare, veterinarians should consider cerebral dirofilariasis as a differential diagnosis in unexplained neurological cases.

Ectopic migration of Dirofilaria immitis in a Eurasian otter (Lutra lutra) in Korea

An 8-year-old female Eurasian otter (Lutra lutra) reared in a wetland center, died 2 h after sudden onset of astasia and dyspnea despite medical treatment. Gross examination of internal organs revealed 10 adult filarioid nematodes in the right ventricle of the heart and three between the left and right cerebral hemispheres. All nematodes were identified as Dirofilaria immitis by direct microscopy and polymerase chain reaction assay. Histopathological observation revealed multifocal hemorrhage in the cerebral subarachnoid space and focal necrosis with hemorrhagein the cerebellar parenchyma. Although rare, veterinarians should consider cerebral dirofilariasis as a differential diagnosis in unexplained neurological cases.

Prevalence and antimicrobial susceptibility of Brachyspira species in pigs in Korea / 대한수의학회지

The purpose of this study was to investigate the prevalence of Brachyspira species and antimicrobial susceptibility of Brachyspira (B.) hyodysenteriae isolates in Korea. A total of fifty-five Brachyspira species were isolated; five (1.0%) beta-hemolytic Brachyspira species and 50 (10.4%) weak hemolytic Brachyspira species from 116 different diarrheic pig samples and 367 apparently normal pig samples. In farm level, beta hemolytic and weak hemolytic Brachyspira species were detected in 7.4% (5/68) and 19.1% (13/68) of tested pig farms, respectively. By phenotypic and genotypic characterization, all beta hemolytic Brachyspira isolates was classified as group I (B. hyodysenteriae), whereas weak hemolytic Brachyspira species isolates were group III (B. innocens or B. murdochii). B. hyodysenteriae isolates showed high level of minimum inhibition concentrations to macrolide antimicrobials. This study shows that the prevalence of pathogenic B. hyodysenteriae in pigs is low but antimicrobial resistance of the pathogens is high in Korea. This is the first report of the prevalence of Brachyspira group III and antimicrobial susceptibility of B. hyodysenteriae in pigs in Korea. Our results could provide basic data for the management and treatment guidelines of Brachyspira infection.

Comparison of tuberculin skin test with Interferon-gamma assay for the diagnosis of bovine tuberculosis in Korean cattle / 대한수의학회지

Bovine tuberculosis (bTB), caused primarily by Mycobacterium bovis, continues to exert an economic loss, even in countries with active control measures, and is one of zoonotic diseases enable to be transmitted to human. The control and eradication of bTB are mainly based on a test and slaughter policy and/or abattoir surveillance. Various factors including limitation of diagnostic tests have been considered as major constraints to eradication. Single intradermal test (SIT) is the official diagnostic test. New diagnostic methods are needed to be developed, because of limitations of the test. In the present study SIT was compared with single intradermal comparative cervical test (SICCT) and interferon (IFN)-gamma assay. There was very low correlation between SIT and SICCT. However, high correlation was shown between SIT and IFN-gamma assay while no correlation was observed between SICCT and IFN-gamma assay. Therefore, our results suggest the possibility of replacement of SIT with IFN-gamma assay for the diagnosis of bovine tuberculosis.

Depression, loneliness and coping in client with Hansen's disease / 나학회지

The purpose of this study was to examine the mental health and coping of patients with Hansen's disease and the correlation between their mental health and coping. Data were gathered from August 25 to September 30, 2009 by conducting a survey on Hansen clients who were at the age of 60 and up. And the collected answer sheets from 116 respondents were analyzed. A SPSS 17.0 program was employed to analyze the collected data. Statistical data on mean and standard deviation were obtained, and frequency analysis, t-test and ANOVA were utilized. Besides, Duncan's multiple range test was carried out to make a post-hoc analysis. The major findings of the study were as follows: First, the Hansen clients investigated got a mean of 18.66(SD=7.68) in depression. As to the level of depression, those who didn't suffered from depression accounted for 31.9 percent, and the rates of the patients with mild depression, moderate depression and severe depression respectively stood at 16.4 percent, 8.6 percent and 43.1 percent. Thus, severe depression was most prevalent. Second, they got a mean of 62.17(SD=9.26) in coping, which was above the average. They got a mean of 30.47(SD=8.55) in loneliness, which was slightly below the average. Third, as for connections between general characteristics and depression, the degree of depression was significantly different according to gender (t=-3.44, p<.001), education(F=2.63, p<.05), employment(F=-1.94, p=0.05), a means of income(F=2.98, p<.05), leisure activities(F=3.41, p<.05) and subjective health status(F=15.95, p<.001). Fourth, three factors were selected as the components of loneliness: communication, self-esteem and conflicts with their children. There was a significant gap in loneliness according to marital status(F=3.20, p<.05), education(F=5.06, p<.01), the type of residence(F=2.83, p<.05), a mean of income(F=2.41, p<.05) and subjective health status(F=10.33, p<.001). In the case of the subfactors of loneliness, academic credential made a significant difference to communication and self-esteem, and conflicts with children significantly varied with the type of residence. A means of income made a significant difference to communication, and subjective health status significantly differed with all the three subfactors. Fifth, concerning relationship between the general characteristics and coping, academic credential(F=3.29, p<.05), presence or absence of spouse (F=2.33, p<.05) and health state(F=3.93, p<.05) made significant differences to coping. Sixth. there was a significantly positive correlation between depression and loneliness(r=0.43, p<.001). Severer depression led to deeper loneliness, but no significant correlation was found between depression and coping and between loneliness and coping. Seventh, in regard to coping patterns, emotion-focused coping was more rampant than problem-focused one.

Clinical Aspects and Rehabilitation Outcome in Patients with Traumatic Brain Injury

The incidence of traumatic brain injury (TBI) has increased with the advanced technology of society. A careful evaluation of associated problems, initial severity, and complications is important for the acute management and rehabilitation of patients with TBI. To predict the rehabilitation potentials of patients with TBI, we have retrospectively investigated the causes, types of injury, associated problems, and complications in 186 patients and also assessed the rehabilitation outcomes by measuring the functional gains according to the types of brain injury and the initial severities evaluated by the Glasgow coma scale in 82 patients. The functional gains were measured by differences of the Mini-mental status examination, PULSES profile, and Barthel index of pre- and post-rehabilitation states. The incidence of TBI was highest in the 3rd decade men and the most common cause was a traffic accident (120 cases, 64.5%). The types of brain injury were a diffuse axonal injury, 87 cases (46.8%); epidural hematoma, 21 cases (11.3 %); subarachnoid hemorrhage, 25 cases (13.4%); subdural hematoma, 28 cases (15.1%); and intracerebral hematoma, 25 cases (12.9%). Common associated problems were fractures and injuries of nervous system. The 7th cranial nerve and the peroneal nerve were the most common injuries for cranial and peripheral nerves, respectively. Common complications were pulmonary and skin disorders. Total hospital stay and the duration for rehabilitation were not significantly different by the types of injury. Functional gain tended to be higher in the intracerebral hematoma compared to the other types of brain injury. The functional gain was statistically higher in patients with initial severity of moderate degree according to the Glasgow coma scale. In conclusion the moderate traumatic brain injured patients seem to have a higher potential for the good functional outcome.

A Correlation of Bulbocavernosus Reflex Test and Urodynamic Investigation in the Spinal Cord Injury Patients

OBJECTIVE: To investigate the correlations of neurological level, BCR and urodynamic study (UDS) in the spinal cord injury(SCI) patients, we analyzed the results of BCR and UDS fundings. METHOD: The sujects were twenty-four patients with SCI who were beyond 3 months following the SCI. According to the level of injury, the patients were divided into 3 groups: above T10 level, 7; T10 to L2 level, 8; below L2 level, 9. Electrophysiological BCR test and UDS were performed in all patients. RESULTS: The results showed a significant correlation between the BCR test and level of injury, however there was no correlation between the UDS and level of injury, nor between the detrusor function and BCR test. The results might be from a differential recovery of the somatic and autonomic nervous system. CONCLUSION: As a part of comprehensive evaluation for the bladder function in the SCI patients, we recommend both the bulbocavernosus reflex test and urodynamic study. Further neurophysiological research would be needed to understand the urodynamic findings which did not correlate with the level of SCI.

Reappraisal of Nerve Conduction Studies in Carpal Tunnel Syndrome

OBJECTIVE: The aim of present study is to obtain the reference values of motor and sensory nerve conduction study (NCS) of the median nerve and to re-assess the values of criteria for abnormal findings in the electrophysiological diagnosis of Carpal tunnel syndrome (CTS). METHOD: Median and ulnar NCS were performed in 62 neurologically healthy adults as controls and 142 patients with CTS. Reference values of the median and ulnar NCS were obtained from the controls and the criteria for the diagnosis of CTS were made. Sensitivities of diagnostic criteria were calculated. RESULTS: The criteria included 7 items: (1) A 5-cm short segment study through carpal tunnel, > or =1.3 msec; (2) median motor latency (8 cm), > or =4.0 msec; (3) median sensory latency (14 cm, onset), > or =3.0 msec; (4) median sensory nerve action potential amplitude (baseline to peak), or =1.5; (6) ratio of median to ulnar sensory latency, > or =1.2; (7) ratio of median to ulnar sensory amplitude, < or =0.6. The order of the highest to lowest sensitivity were as follows: a 5-cm short segment study, median sensory latency, median motor latency, ratio of median to ulnar sensory latency, and ratio of median to ulnar motor latency. Approximately 65% of the patients met all the 7 diagnostic criteria and 95% of the patients met 3 or more. CONCLUSION: The criteria proposed in this study would enhance the diagnostic sensitivity for the CTS.

Does Hydrocephalus in Stroke Affect the Functional Outcome?

Hydrocephalus occurs frequently after stroke and has been reported to affect the functional outcome. We investigated 77 stroke patients retrospectively to evaluate whether or not hydrocephalus affects the functional outcome. The patients were divided into three groups: Group 1, 20 patients without hydrocephalus; Group 2, 28 patients with early onset hydrocephalus; Group 3, 29 patients with delayed onset hydrocephalus. Functional status was evaluated by 3 functional indices, Mini-Mental Status Examination(MMSE), Barthel index, and PULSES profile. These 3 functional indices were compared between pre- and post-rehabilitation stages in Groups 1 and 2, and compared among pre-rehabilitation, post-hydrocephalus, and post-rehabilitation stages in Group 3. Significant functional improvements were shown in the post-rehabilitation stage in Groups 1 and 2 (P<0.05). In Group 3, the functional improvements were shown in the post-rehabilitation stage when compared to the pre-rehabilitation stage, but without statistical significance. However, significant functional improvements were demonstrated in the post-rehabilitation stage compared to the post-hydrocephalus stage in Group 3 (P<0.05). In comparing the three groups, the final functional outcome was found to be best in Group 1 and worst in Group 3. We suggest that the time from the onset of hydrocephalus to diagnosis and management is more important than the presence of hydrocephalus itself in the stroke patient in respect to functional outcome.