A Comprehensive Review on the Medicinal Benefits of Honey with an Emphasis on Unani Medicine

Background: Honey has been used medicinally in folk medicine since the dawn of civili-zation. It is a necessary component of medicine and food in a wide variety of cultures. It has been used in Unani Medicine for centuries to treat a variety of ailments. Objective(s): This review article aims to explore the medicinal characteristics of honey in view of Unani and modern concepts, highlight its potential in the treatment of the ailments stated in Unani medical literature, and also explore the relevant evidence-based phytochemistry, pharmacological, and clinical data. Method(s): The authors searched classical texts exhaustively for information on the temperament (Mizaj), pharmacological activities, mechanism of action, and therapeutic benefits of honey. Addition-ally, a comprehensive search of internet databases was conducted to compile all available information on the physicochemical, phytochemical, and pharmacological properties of this compound. Result(s): Evidence suggests that honey contains about 180 different types of various compounds, including carbohydrates, proteins, enzymes, flavonoids, and other chemical substances. In Unani classical literature, it exerts important pharmacological actions besides its immense nutritional signifi-cance. Unani physicians advocated many tested/experimented prescriptions and formulations, which still have their relevance in the amelioration of various diseases. Conclusion(s): This analysis concludes that honey has been successfully utilized in Unani medicine for centuries to treat a variety of maladies and is a potential natural source of remedy for a variety of medical disorders. Future research on honey should include a combination of Unani and modern principles.Copyright © 2023 Bentham Science Publishers.

Differentiating infectious from non-infectious respiratory disease in the cat and dog

This paper describes the clinical signs and use of differential laboratory diagnostic techniques (computed tomography, cytology, histopathology, antigen/antibody detection and polymerase chain reaction) for infectious (viral, bacterial, fungal and parasitic) and non-infectious (inflammatory/immune mediated, neoplastic, cardiac, malformation, foreign body, smoke inhalation, aspiration of caustic material, non-cardiogenic, pulmonary oedema, traumativ, pneumothorax, pulmonary contusions and idiopathic) causes of respiratory diseases in cats and dogs in Ontario, Canada.

Actinomyces europaeus as an emerging cause of necrotizing fasciitis.

Necrotizing fasciitis is a type of necrotizing soft tissue infection (NSTI) that can be polymicrobial or monomicrobial in origin. Polymicrobial infections typically involve anaerobes of the Clostridium or Bacteroides family. This case report highlights necrotizing fasciitis caused by an unusual culprit, Actinomyces europaeus, which is a gram-positive anaerobic filamentous bacillus that has only been documented in one prior report to cause NSTI. Currently, about half of the hospitals in the United States are equipped to perform antibiotic susceptibility testing for anaerobes, but less than one-quarter of hospitals actually utilize these tests routinely. Thus, it is common for polymicrobial actinomycoses to be blindly treated with antibiotics that are beta-lactamase resistant and active against anaerobes, such as with piperacillin-tazobactam. Here we examine the potential impact of this lack of testing, as well as the evolution of A. europaeus to cause necrotizing fasciitis.

Tsukamurella and mycobacterium tuberculosis pneumonia co-infection

Case Report: Tsukamurella species are aerobic, partially acid fast saprophytes commonly isolated from soil and water. They are opportunistic pathogens known to infect multiple organs and can contribute to significant pathologies such as bacteremia, peritonitis, and respiratory tract infections. Moreover, Tsukamurella shares certain characteristic properties to Mycobacterium tuberculosis and Actinomyces species, including the acid fast stain, which can contribute to misdiagnosis of patients. A 68 year old female patient presented to the ED for shortness of breath, fatigue, and weight loss for 6 months. The patient's past medical history includes pulmonary fibrosis, type 2 diabetes, coronary artery disease with stent, hyperlipidemia, hypertension, and M. tuberculosis infection when she was 3 years old in Finland. On admission, labs revealed thrombocytosis (reactive 555 000/microL), leukocytosis (14 450/microL), and microcytic anemia (9.4 microg/dl). Moreover, C reactive protein was elevated and procalcitonin was normal (0.06 microg/l);a COVID-19 PCR was negative. An X-ray revealed severe patchy and interstitial infiltrates throughout both lungs with parenchymal scarring and pleural thickening in the periphery of the left mid-lung zone with multifocal pneumonia. Blood and sputum cultures were performed under the impression of pneumonia, and treatment with azithromycin and ceftriaxone was started. A M. tuberculosis infection was suspected due to a positive AFS. Further chest CT suggested multifocal pneumonia within the left lung in addition to apparent cavitary lesions versus bulla, a chronic interstitial lung disease with traction bronchiectasis, calcified right lower lung nodule, and calcified hilar lymph nodes suggesting a history of granulomatosis diseases. A bronchoscopy with Bronchoalveolar lavage was performed. The initial sputum specimen direct smear showed acid-fast stain positive with Actinomyces growth, and Penicillin G was added to the treatment. Samples were sent to the state department lab, and biopsy revealed granulomatous inflammation negative for malignant cells. One month later, the patient's sputum culture showed Tsukamurella for High-performance liquid chromatography (HPLC). Moreover, a rifampicin sensible M. tuberculosis complex by NAA was also positive six weeks later. The patient was started on a complete TB regimen and continued in the outpatient pulmonology clinic with the addition of levofloxacin for three months and rifampicin substituted for rifabutin. As demonstrated in the case above, a Tsukamurella infection can present similarly to a Mycobacterium infection. Patients may be misdiagnosed or potentially be co-infected. Our patient was further tested and appropriately treated for Tsukamurella after further extensive diagnostic screenings. Due to a high rate of missed cases, it is important to keep Tsukamurella infection on the differential diagnosis as the patient presentation may initially appear to be a Mycobacterium or other pulmonary infection. Copyright © 2023 Southern Society for Clinical Investigation.

The distinct microbial community patterns and pathogen transmission routes in intensive care units

While the microbiome in indoor environments such as hospitals has drawn increasing attention, the transmission routes especially for pathogens in ICUs remain largely unexamined. In this study, we have explored the distinct bacterial communities of ICU compared with Non-ICU in hospital wards. We have then clarified their different transmission patterns by means of microbial source tracking, with results suggesting that bedrail and inside floor were hubs in two wards, respectively. Streptococcus, Staphylococcus were identified as "Transfer-Easy taxa" that were found in both ICU and Non-ICU settings, with potential pathogenicity and cases recorded. We have also detected another 15 pathogenic genera in hospital environment, including Pseudomonas and Acinetobacter, and charted how these pathogenic microorganisms affect patients, demonstrating that there were far more strong routes for pathogens transmitted from environment to patients in ICU. In summary, this work investigates patterns of bacterial transmission in hospital settings, highlights pathogenic genera that are likely to transfer from the environment to humans and cause nosocomial infection, which could provide guidance for healthcare system monitoring and co-infection avoidance.

A BLOODY MASQUERADE: A CURIOUS CASE OF HEMOPTYSIS

SESSION TITLE: Variety in Chest Infections Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Actinomyces is a Gram-positive anaerobic and micro aerophilic filamentous bacillus that normally colonize the human mouth and digestive and urogenital tracts. They most commonly cause cervical and abdominopelvic infections and rarely pulmonary actinomycosis. CASE PRESENTATION: 67-year-old female with past medical history of recurrent DVT with IVC filter placement, non- ischemic cardiomyopathy, atrial fibrillation, 40 pack year history, recent COVID19 infection, lung nodules & COPD presented with complaint of coughing up blood associated with chest pain for the past 2 days. She had a low-grade fever with stable vitals with preliminary labs showing she was anemic and had reactive leukocytosis. She was recommended to hold oral anticoagulation and follow-up outpatient during when her symptoms worsened. On admission she was started on tranexamic acid nebulization for hemostasis and underwent CTA chest which showed no evidence for pulmonary embolism but commented on a right lower lobe perihilar 12.5 mm mass which has increased in size compared to previous scans. Patient underwent bronchoscopy which showed generalized edema of the tracheobronchial tree with bleeding from superior segment of the right lower lobe bronchus with no visualization of mass. PET scan showed hyper-metabolic lung mass with concerns for malignancy. CT guided biopsy of nodule was done and was not staining for malignant cells, acid fast bacilli with no fungal or bacterial growth. Blood cultures and Karius Digital cultures were also negative. She began expectorating blood clots despite being on treatment and cardiothoracic surgery was consulted. A partial lobectomy with lysis of adhesions of the right lower lobe was done. Specimen sent to pathology showed no evidence for malignancy but instead elicited a contained pulmonary abscess containing filamentous bacteria with parenchymal inflammation with areas of chronic hemorrhagic fibrosing pleuritis and hilar thrombi. She was diagnosed with pulmonary actinomycosis and started on IV 24,000,000 IU penicillin. She underwent a panoramic dental x-ray which was read as suboptimal dentition with multiple missing teeth and did not identify a source. Patient symptoms resolved post lobectomy and since discharged on long course of antibiotics. She continued to have no more episodes of hemoptysis. DISCUSSION: Hemoptysis as a symptom of pulmonary actinomycosis is a rather rare presentation. Actinomycosis causes cavities, nodules, and pleural effusions. It is commonly mistaken for chronic suppurative lung disease and sometimes malignancy. Isolation and identification occur only a minority of cases with a high culture failure rate due to previous antibiotic therapy, inadequate incubation time or culture conditions. CONCLUSIONS: Due to it's variable presentation pulmonary actinomyces has a large overlap with other diseases but must be considered in the differential of unexplained hemoptysis. Reference #1: Hemoptysis secondary to actinomycosis: A rare presentation. PMID: 24778485 PMCID: PMC3999682 DOI: 10.4103/0970-2113.129864 DISCLOSURES: No relevant relationships by Victoria Famuyide No relevant relationships by rukhsaar khanam

Concomitant Purulent Pericarditis and Pleuritis Due to Actinomyces odontolyticus Following Endobronchial Biopsy for Pulmonary Sarcoidosis.

The authors present a very rare case of bacterial purulent pericarditis due to Actinomyces odontolyticus 2 weeks following an endobronchial ultrasound bronchoscopy. On his presentation, he was in cardiac tamponade, for which he underwent an emergent pericardiocentesis with purulent drainage. Similar organisms grew in his left pleural effusion. (Level of Difficulty: Intermediate.).

THE TRUTH THE TEETH TOLD: THE UNUSUAL CASE OF A SUBPHRENIC MASS

CASE: A 75-year-old man with a history of aortic stenosis status post transcatheter aortic valve replacement (TAVR), compensated cirrhosis in the setting of alcohol use disorder, and osteoarthritis presented with hyper-acute dyspnea and chest pain that awoke him from sleep. Three years prior to admission, an abdominal computed tomography (CT) for his TAVR evaluation revealed a 2 cm, irregular, peripherally-enhancing mass in the right subphrenic space, most concerning for malignancy but stable in size a year later. Further work-up was delayed due to the COVID-19 pandemic. One week prior to this presentation, he returned to care with 6 months of progressive right shoulder pain, pleuritic chest pain, and 5 kg of unintentional weight loss and was found to have growth of the right subphrenic mass to 4.9 cm, for which he underwent interventional radiology-guided aspiration and biopsy from a subxiphoid approach. Pathology on the core biopsy was inconclusive, revealing granulation tissue with chronic inflammatory changes and negative routine cultures. He was hemodynamically stable and discharged home. On admission, he was afebrile, tachypneic to 26, tachycardic to 120, hypotensive to 80/40, and saturating 94% on room air. He was found to have a large pericardial effusion with tamponade physiology, upon which 500 mL of serous fluid was drained via emergent pericardiocentesis. Laparoscopic biopsy of the subphrenic mass revealed a purulent fluid collection. 16S/18S sequencing and MALDI cultures were most consistent with Actinomyces spp. With further history-taking alongside an Italian language interpreter, he was found to have had prior dental abscesses, the likely origin of his Actinomyces infection, although the curious propensity for the subphrenic location remains unknown. Periodontal disease had been diagnosed but not fully treated given lack of insurance coverage and perceived importance. His pericarditis and ensuing tamponade was attributed to irritation and seeding from the subxiphoid approach for attempted fluid aspiration. IMPACT/DISCUSSION: Actinomyces spp. are a part of the normal human gut and oral cavity flora, but when pathogenic, they are often associated with dental, pulmonary, and urinary tract infections. In addition to periodontal disease, this patient's risk factors for Actinomyces abscess formation include cirrhosis (via transient gut translocation from elevated portal pressures) and alcohol use disorder (via increased aspiration risk). There have been several reports of Actinomyces spp. causing pericarditis and tamponade following seeding from liver, lung, and oral cavity abscesses- to our knowledge, however, none from subphrenic abscesses. CONCLUSION: This case highlights the importance of an oral health history in work-up of an indolent growing thoracic mass and the challenges in comprehensive history-taking in patients with limited English proficiency. Increasing coverage of dental services (e.g. a Medicare dental benefit) is key to health and health equity.

The Surgical Mask Microbiome Among Children with Asthma

Rationale: Exposure to respiratory pathogens, aeroallergens, and air pollution can lead to asthma exacerbations. The SarsCoV2 (COVID-19) pandemic led to widespread public health mandates including mask-wearing. We hypothesize that mask-wearing sequesters respiratory pathogens, leading to observed reduction in asthma exacerbations. The goal of this study was to characterize the bacterial microbiome from surgical masks in a cohort of school children with and without asthma. By identifying what is on both inside and outside the masks, we will be able to build a catalogue as a baseline for future analyses. Methods: We performed a cross-sectional study of children (4-18 years) attending an inner-city public school district. Students wore a surgical mask for a minimum of one school day. Parents completed a questionnaire about their child's demographics, respiratory history, and level of asthma impairment. To establish the protocol, we piloted the extraction and sequencing procedures among a sample of used masks from a hospital clinical personnel. DNA was extracted using a commercial DNA extraction kit on separated mask layers: inner, middle, and outer. 16S rRNA gene sequencing was then performed and then mapped against the most recent Greengene 16S rRNA gene database.Results: Recruitment and mask wearing occurred during an 8-week period (May 2021-July 2021). 34 students (18 with asthma;16 without asthma) from four schools were enrolled and completed the study. 74% of participants were in grades K-4, mean age was 8.4 years, and 53% identified as Hispanic/Puerto Rican. 59% of participants wore the mask one school day. 44% reported an asthma-related ED visit in their lifetime, while only 16% reported an ED visit in the past 12-months;53% of participants reported asthma symptoms with upper respiratory infections, however 77% reported zero respiratory infections in the past 12-months. In the masks worn by medical staff, bacterial genera including Staphyloccus, Haemophilus, Lawsonella, Streptococcus as well as Actinomyces, were identified similarly on inner and outer layers in the masks worn by clinicians. (Figure 1).Conclusions: We have demonstrated that recruiting and enrolling students from a medium-sized, inner-city public school district and obtaining facial mask samples is feasible. We demonstrate that self-reported rates of asthmarelated ED visits and respiratory infections differed pre-pandemic as compared to during. In addition, identifying the microbiome from surgical masks is possible. Bacteria genera identified were similar to known human nasal, oral and skin microbiomes. Current work is now in process characterizing and comparing the mask microbiomes among students with and without asthma.

Quarterly report of investigations of suspected exotic diseases: July to September 2021

Exotic pest and disease investigations are managed and reported by the Ministry for Primary Industries' (MPI's) Diagnostic and Surveillance Directorate. This article presents a summary of investigations of suspect exotic and emerging pests and diseases in New Zealand during the period from July to September 2021.

The Oropharyngeal Microbiome Predicts Need for Respiratory Support Among COVID-19 Patients

Study Objective: The clinical course and severity of infection with respiratory viruses such as SARS-CoV-2, the causative agent of COVID-19, are hypothesized to be affected by the microbes colonizing the upper airway, also known as the oropharyngeal microbiome, where they first establish infection. To determine how the oropharyngeal microbiome interacts SARS-CoV-2 and if it affects the clinical course of COVID-19, we carried out a study of the oropharyngeal microbiome of patients presenting to the emergency department or on the admission wards with symptoms of COVID-19. Methods: We collected oral swabs and clinical data regarding COVID-19 severity including need for respiratory support and mortality. Nucleic acids were extracted from oral swabs and high- throughput metagenomic sequencing was performed on extracted DNA. Out of a total of 115 enrolled patients with complete data, 51 had a laboratory confirmed diagnosis of acute COVID-19 and 40 went on to require some respiratory support. We analyzed the relative abundance of detected organisms in individuals who were COVID-19+ versus COVID-19- and used mixed-effect random forest modeling to identify microbiota and clinical covariates that associated with the need for respiratory support among COVID-19+ subjects. Results: We found 19 species that were significantly different among COVID-19+/ COVID-19– patients, most notably, several Actinomyces species showed significant increases among COVID-19+ patients. We found that among COVID- 19+ patients, microbiome features were highly correlated with need for respiratory support (F1 score 0.876). Conclusions: The contributions of microbiome features such as relative abundances of Prevotella salivae, Campylobacter concisus, and Veillonella infantium as well as the Shannon Diversity Index this model approximated the importance of clinical factors known to contribute to risk for severe COVID-19 such as body mass index (BMI) and age. The composition of the oropharyngeal microbiome may represent a target for diagnostics in the ED to aid in the determination of who is likely to suffer respiratory failure and require oxygen support. [Formula presented]

Actinomyces bacteriemia secondary to pseudomembranous necrotizing oral-tracheobronchial and invasive pulmonary aspergillosis in a patient with CoViD-19

Description of the case: A 79-year-old smoking patient with COPD, diabetes, previous bladder cancer, and family members positive for SARS-CoV2 was admitted to the hospital for pneumonia and severe respiratory insufficiency. During hospitalization, the nasopharynx sample was persistent negative for SARS-CoV-2, but the serology positive. CT showed signs of interstitial pneumonia. Antibiotic therapy, high-dose dexamethasone, and oxygen therapy were introduced. After an initial worsening of clinical conditions, inflammation indices normalization and marked clinical improvement until the suspension of oxygen therapy were observed. In the discharge phase, fever and increase in CRP and IL6 returned without respiratory failure. Black lesions with a necrotic ulcerated base located on the palate and posterior tongue were observed. Blood cultures were positive for Actinomyces oris, and Aspergillus galactomannan- antigen was detected. CT showed consolidations, cavitations, ground-glass opacity. Fibrobronchoscopy found tracheobronchial full-layer involvement with pharyngeal/laryngeal and bronchial obstruction by necrotic pseudomembranes. BAL was positive for SARS-CoV-2 and Aspergillus niger, and Aspergillus fumigatus. Voriconazole and beta-lactam antibiotics were started. The patient improved with the need for repeated FB to eliminate the pseudomembranes, but he died in the ICU due to heart failure. Conclusions: Hematogenous spread of Actinomyces is rare as well as pseudomembranous necrotizing oral-tracheobronchial aspergillosis, but to be considered in CoViD-19 patients receiving high doses of steroids.

Septic hip abscess due to Fusobacterium nucleatum and Actinomyces turicensis in an immunocompetent SARS-CoV-2 positive patient.

A 42-year-old man was referred to the Department of Orthopedic Surgery with pain over his right greater trochanter and signs of systemic infection. CT showed an enhanced mass in his gluteus maximus as well as gas in the biceps femoris over the underlying hip joint. Tissue biopsy yielded Fusobacterium nucleatum and Actinomyces turicensis. The patient was successfully treated for 6 weeks with amoxicillin/clavulanic acid 875mg/125mg and metronidazole 500mg.

Pleural empyema caused by Actinomyces turicensis.

Actinomyces turicensis was first identified in 1995. To the best of our knowledge, pleural empyema caused by A. turicensis has never been reported. In the case reported herein, a patient with pleural empyema was treated surgically, and in the bacterial samples, A. turicensis was isolated.