Pigbel in the 21st century: still here, and still in need of an effective surveillance system

Pigbel remains a likely significant cause of morbidity and mortality in the highlands of Papua New Guinea (PNG), two decades after the administration of pigbel vaccination ceased. There is a need for an effective surveillance program for pigbel to better understand the disease burden and to target communities for preventive strategies. This paper reviews the epidemiology, pathogenesis, recent history and current data on the burden of pigbel in PNG. We propose a surveillance program based on clinical recognition of likely cases and laboratory confirmation using an ELISA assay for Clostridium perfringens type C beta-toxin. Research aimed at validating this approach in the clinical setting is outlined.

Frecuencia de alelos HLA de clase I y II en una cohorte de pacientes con espondiloartritis provenientes del noroccidente colombiano / Frequency of HLA alleles class I and II in a cohort of northwestern Colombian patients with spondyloarthritis

Introducción. Las espondiloartritis son enfermedades reumatológicas crónicas que afectan el esqueleto axial y las articulaciones periféricas, con varias manifestaciones extraarticulares. La asociación con el HLA-B27 sigue siendo uno de los vínculos más fuertes conocidos entre estas entidades y el complejo mayor de histocompatibilidad; sin embargo, la distribución mundial del HLA-B27 varía considerablemente y se han descrito asociaciones con genes no HLA-B27. Objetivo. Conocer la frecuencia de alelos HLA de clase I y II en pacientes con espondiloartritis provenientes del noroccidente colombiano y su frecuencia en las manifestaciones clínicas y radiológicas específicas. Materiales y métodos. Se condujo un estudio descriptivo, observacional, de corte transversal, retrospectivo y prospectivo entre 2005 y 2008 de 56 pacientes colombianos con espondiloartritis. Se identificaron los alelos correspondientes a los loci HLA de clase I y II (HLA-B, HLADQB1 y HLADRB). Se analizó su frecuencia con las manifestaciones clínicas axiales, periféricas, extraarticulares y radiológicas. Resultados. Se encontró una baja frecuencia de HLA-B27 en la población total (50 %), aunque fue el alelo más frecuente, junto con HLA-DRB4*01 (35,7 %) y HLA-DQB1*0501 (28,6 %), en todos los pacientes en general y en cada una de las manifestaciones clínicas y radiológicas. Se resalta la alta frecuencia de HLA-B27 y HLA-DRB4*01 (64,3 %) en pacientes con dactilitis, hallazgo novedoso sin previa descripción. Conclusión. Los alelos HLA-B27, HLA-DRB4*01 y HLA-DQB1*0501 fueron frecuentes en los diferentes subtipos de espondiloartritis y en las manifestaciones clínicas axiales, periféricas y extraarticulares específicas, además de la sacroiliítis radiológica.

Introduction. Spondyloarthritis is a chronic rheumatic disease that affect the axial skeleton and peripheral joints, along with several extra-articular manifestations. The association with HLA-B27 remains one of the strongest known links between these entities and the major histocompatibility complex. However, the global distribution of HLA-B27 varies considerably and furthermore, associations with non-HLA-B27 genes have been described. Objective. The frequency of HLA class I and II was determined in a population of patients with spondyloarthritis with respect to detection in the clinical setting and by radiology. Materials and methods. A descriptive, observational, cross-sectional, retrospective and prospective study was conducted in 56 patients from northwestern Colombia. Each was diagnosed with spondyloarthritis between 2005 and 2008. In each case, alleles were identified for the loci HLA class I and II (HLA-B; HLADQB1 and HLADRB). The frequency of these alleles in the axial, peripheral, extraarticular and radiological manifestations. Results.The frequency of HLA-B27 was 50% overall, and it was the most frequent allele. The two other alleles were HLA.DRB4*01 at 35.7% and HLA-DQB1*0501 at 28.6%, as detected in each of the clinical and radiological manifestations. A high frequency of HLA-B27 and HLA-DRB4*01 (64.3%) was noted in patients with dactylitis. Conclusion. The alleles HLA-B27, HLA-DRB4*01 and HLA-DQB1*0501 were common in the different subtypes of spondyloarthritis and were frequent in the specific clinical axial, peripheral and extraarticular clinical manifestations, as well as radiological sacroiliitis.

Fibrinonecrotic enteritis of piglets in a commercial farm: a postmortem study of the prevalence and the role of lesion associated agents Isospora suis and Clostridium perfringens

The objectives were to determine the prevalence of fibrinonecrotic enteritis (FNE) on a farrow-to-finish farm of 1,000 sows, to categorize the pathological changes, and to to investigate the lesion associated agents Isospora suis and Clostridium perfringens. Causes of preweaning mortality (PWM) were classified into 8 categories including FNE. Obtained data were evaluated for statistical significance by adjusted Chi-square analysis. Samples of FNE were taken for complementary studies including a PCR technique for genotyping toxin genes of Clostridium perfringens from gut samples fixed in 10 percent neutral formalin. From 3,153 piglets examined, less than 1 percent was classified as FNE. FNE prevalence increased progressively from the first to the third week, the last differing statistically from the others. Eighty percent of gut samples with FNE lesions were positive to Isospora suis, when examined by PCR from 9 severe FNE lesions detected 7 positive samples only for a toxin gene, characteristic of C. perfringens type-A.

Os objetivos deste trabalho foram determinar a prevalência de enterite fibrinonecrótica (EFN) em uma granja tecnificada com 1000 matrizes, classificar as mudanças patológicas e investigar a lesão decorrente da associação dos agentes Clostri-dium perfringens e Isospora suis. As lesões macroscópicas devidas à mortalidade pré-desmame (MPD) foram classificadas em oito categorias incluindo EFN. Os dados obtidos foram avaliados pelo teste Qui-quadrado. Amostras de EFN foram colhidas para estudos complementares incluindo uma técnica de reação em cadeia da polimerase (PCR) para identificação dos genes codificadores de toxinas de C. perfringens a partir de amostras do intestino fixadas em formalina a 10 por cento. Dos 3.153 leitões examinados, menos que 1 por cento foram classificados como EFN. As análises estatísticas revelaram que a EFN aumentou progressivamente a partir da primeira para a terceira semana, sendo que a última semana diferiu estatisticamente das demais. Oitenta porcento das amostras do intestino com EFN foram positivas para I. suis. Por meio da PCR a partir dos 9 casos de EFN severa, 7 foram positivos somente para o gene da toxina alfa, característico de C. perfringens tipo A.

Clinical and epidemiological aspects of canine parvovirus (CPV) enteritis in the State of Rio de Janeiro: 1995 - 2004

This paper relates the clinical and epidemiological aspects of canine parvovirus infection (CPV) in the State of Rio de Janeiro from April 1995 to March 2004. A total of 341 fecal samples were collected from up to 6-months-old puppies with gastroenteritis. The diagnosis of CPV infection was confirmed by hemagglutination/ hemagglutination inhibition tests, enzyme immunoassay, virus isolation in cell culture or polymerase chain reaction. One hundred and fifty-seven samples (46 percent) were positive for CPV. No correlation among sex, breed or age and the occurrence of CPV infection was observed. The classical signs of parvoviral enteritis (anorexia, lethargy, vomiting and hemorrhagic fluid diarrhea) were observed in 70 percent of CPV-positive and in 60 percent of CPV-negative puppies. Although CPV could be detected throughout the studied period, its occurrence was significantly higher from June to September and November to December. These results show that CPV is still circulating in the State of Rio de Janeiro.

Este trabalho relata os aspectos clínicos e epidemiológicos da infecção pelo CPV no Estado do Rio de Janeiro, no período de abril de 1995 a março de 2004. Coletaram-se 341 amostras fecais de cães com até seis meses de idade que apresentavam gastrenterite. O diagnóstico da infecção pelo CPV foi confirmado através dos testes de hemaglutinação/inibição da hemaglutinação, ensaio imunoenzimático, isolamento viral em cultura de células ou reação em cadeia pela polimerase. Cento e cinqüenta e sete amostras (46 por cento) foram consideradas positivas para CPV. Não foi observada correlação entre sexo, raça ou idade e a ocorrência da infecção por CPV. Os sinais clínicos clássicos de parvovirose (vômito, anorexia, apatia e diarréia líquida hemorrágica) foram observados em 70 por cento dos animais positivos e 60 por cento dos animais negativos para CPV. O CPV foi detectado ao longo do período estudado, entretanto observou-se um aumento do número de casos positivos nos períodos de junho a setembro e novembro a dezembro. Estes resultados mostram que o CPV ainda circula no Estado do Rio de Janeiro.

A Virulent Strain of Salmonella enterica Serovar London Isolated in Infants with Enteritis Traced by Active Surveillance and Molecular Epidemiological Study

A total of 74 isolates of Salmonella enterica serovar London were collected through the Laboratory-Based Diarrheal Diseases Surveillance in 2000-2001. In order to characterize the isolates and investigate the source of the epidemic, we performed antimicrobial susceptibility tests and XbaI Pulsed-field gel electrophoresis (PFGE) of 44 Salmonella London isolates. Forty isolates were from feces of infants and four isolates were from adults aged 30, 52, 54, and 59 yr. Two subtypes were identified: a tetracycline-susceptible A 0 PFGE pattern and a tetracyclineresistant A 1 PFGE pattern. Interestingly, the isolates from all infants and one 30-yr-old adult were A 0 PFGE pattern and tetracycline-susceptible. Furthermore, the A 0 PFGE pattern strain was approximately 2 times more virulent than the A 1 PFGE pattern strain, according to the results of in vitro invasion assay using J774A.1 macrophage-like cells. These results indicate that the active surveillance with molecular epidemiological tools would be valuable for promptly finding new epidemic strains. Our results also suggested that the virulent Salmonella London strain might infect the infants through a common contaminated source.

Prevalence of porcine proliferative enteropathy and its control with tylosin in Korea

Porcine proliferative enteropathy(PPE) is an enteric disease been caused by Lawsonia intracellularis. It has become one of the critical problems in the pig industry. To investigate the prevalence of PPE in Korea, serum samples of 828 pigs from 65 herds were tested using indirect immunofluorescence antibody technique(IFA). The infection rate in individual pigs varied from 44 to 69%, whereas 100% in pig farms. The infection frequency was 57, 44.9, and 59.4% according to age respectively. Administration of tylosin in feed at a concentration of 110 ppm for 14 days reduced the infection rate of the farms. These data indicated that the high prevalence of PPE may be controlled by tylosin.

Helicobacter pylori infection in Indian children.

Current epidemiological scenario of Hp in India does not very clearly predict the natural history of this infection in children as they grow old. Positive serology does not seem to be of much clinical significance. Colonization by Hp in the stomach or duodenum per se does not predict a potential ulcer disease in all the cases. Most case control studies from India do not suggest any significant relationship of Helicobacter pylori (Hp) infection and recurrent abdominal pain. A significant relationship has been observed between Hp infection and antral gastritis and duodenitis. Hp related gastric or duodenal ulcers are infrequently reported in children probably because children between 12-18 years of age are not included in most of these studies. Scarce information is available regarding the relationship of Hp infection with failure to thrive, persistent diarrhea, disabled and neurodevelopmentally retarded children and the implications of acquiring infection in infancy. There is an urgent need to have guidelines for management of children with variable spectrum of gastroduodenal disease who are detected to have Hp colonization without any evidence of mucosal inflammation. Since a large number of children fall in this group, treating all of them in the absence of knowing their PCR amplified DNA sequence in Hp genome is impractical and may not be necessary. The ones detected to have evidence of mucosal inflammation attributed to Hp infection may need to be treated since it is not justified to leave these children untreated even after making a definite diagnosis. Secondly, eradication therapy may provide them the much desired symptomatic relief which is the patient's primary concern. For older children with peptic ulcer disease, using adult model for clinical significance and therapeutic options is justified. However, at present, there are no definite guidelines regarding the combinations and duration of antibacterial therapy for children in our setting due to lack of available data.

Enteropathogenic Escherichia coli diarrhoea in children and in young adults.

Enteropathogenic Escherichia coli are still important cause of diarrhoea in children as well as in adults population. In this study 550 cases of diarrhoea were studied for prevalence of enteropathogenic E. coli using culture and serological methods and final confirmation of strain was done from Central Research Institute, Kasauli. Out of 550 cases 385 strains of E. coli were isolated with isolation rate of typable strain being 70 percent. Common serotypes were 086, 055,0111, 028, 020, and rare strains like 0132, 0114, 0152, 0116, 088 were also reported from faecal specimen of diarrhoeal origin. Strains reported for the first time in central India were 0114, and 068.

Necrotizing enteritis simulating Pig-Bel disease in northern India.

OBJECTIVE: A clinicopathological study of patients presenting with necrotizing enteritis, similar to the Pig-Bel disease of Papua New Guinea. METHODS: A clinicopathological study of 95 patients presenting in last ten years with acute abdominal pain with diarrhea and/or bleeding per rectum and vomiting and found to have lesions similar to Pig-Bel disease. RESULTS: 89% of the patients were young adult vegetarians from lower socio-economic strata. 94% of cases presented between May and August every year showing a marked seasonal variation. Jejunum was the most common site (95%) involved. Gross examination showed blackish brown 'skip' lesions with gangrene and perforations. Histology showed marked necrosis and congestion of all the layers with mucosal ulcerations. CONCLUSION: A disease simulating Pig-Bel disease occurs in India. It is more common in young adult vegetarians and may have a different etiology from that proposed in endemic regions.

Acute Campylobacter jejuni enteritis in 385 hospitalised patients.

Twenty healthy controls and 385 adult patients suffering from acute enteritis or gastroenteritis were enrolled for the study of Campylobacter Jejuni infection over a period of 2 years. Thirty five stool samples showed C jejuni on stool culture. The isolation rates were at peak in the monsoon season and from watery and bloody stool specimens. Pure C jejuni culture was obtained in 18 of 35 samples; the other 17 samples showed polymicrobial infection or infestation. Nine of 35 patients were treated with erythromycin 1 g in divided doses for 7 days. Repeat stool cultures did not grow C jejuni. There was no resistance to erythromycin therapy. C jejuni are fastidious organisms and require special medium and microaerophilic environment for culture.

Ileoyeyunitis inespecífica en el Perú / Inespecific ileojejunitis in Peru

Presentamos 11 casos de indígenas y 8 de mestizos, todos ellos aparentemente sanos y residentes en la ciudad de Arequipa, cuya mucosa intestinal muestra alteraciones indistinguibles de lo que se denomina ileo-yeyunitis inespecífica, entidad que es considerada propia de regiones tropicales y/o de climas cálidos y que, hasta donde sabemos, no ha sido descrita aún en Sudamérica. La demostración de la existencia de esta condición anormal en nuestro medio es muy importante, ya que puede reducir la absorción de los alimentos y, por lo tanto, afectar la nutrición de quienes la sufren. Siendo la desnutrición una patología endémica en grandes sectores de nuestra población, es necesario ampliar las investigaciones sobre la real incidencia de esta entoropatía y de su etiopatogenia, a fin de tomar las medidas curativas y preventivas convenientes

Human rotavirus infection in Malaysia. III. A one year survey on the prevalence of rotavirus enteritis in children.

The prevalence of human rotavirus enteritis in children admitted to the gastroenteritis ward of the Kuala Lumpur General Hospital was studied in 1982. Human rotavirus in the stool of the patients was detected by enzyme-linked immunosorbent assay. The survey showed that rotavirus enteritis in children were observed throughout the year, with two broad peaks of rotavirus infection occurring around March and September. The lowest incidence was recorded in July, however, no prolonged period of low prevalence of rotavirus enteritis was observed. The average prevalence for the whole of 1982 was 40% of the total diarrhoeal cases. No significant relationship was noted between the prevalence of the disease and rainfall.

Enteric infections in Singapore with special reference to typhoid.

A review of the epidemiological features of the more important enteric infections in Singapore was given. Enteric fevers (typhoid and paratyphoid), Salmonella gastroenteritis and Shigellosis remained endemic at a rather constant level in spite of vast improvement in environmental sanitation, but amoebic dysentery showed marked decline. Vibrio parahaemolyticus is an important cause of food poisoning since it was first reported in 1973. El tor cholera is believed to be introduced through regional trade and travel. Control measures directed mainly at typhoid include detection of typhoid carriers in the community responsible for transmission of infection, control and licensing of public food handlers and health education.