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Coinfection caused by bacteria, parasites, or viruses complicates almost all feline panleukopenia virus (FPV) infections. Pathogens that colonize the gastrointestinal tract, Clostridium perfingens, Clostridium piliforme, Cryptosporidium spp, Giardia spp, Tritrichomonas fetus, canine parvovirus type 2,Salmonella sp., feline coronavirus, feline bocavirus, and feline astrovirus were isolated in the presence of FPV infection. Complex mechanisms between viruses, bacteria, protozoa, and hosts contribute to the pathogenesis and severity of coinfection. Prompt and accurate diagnosis, vaccination precautions, and appropriate treatment play important roles in reducing morbidity and mortality. This article outlines the etiology, pathogenesis, diagnosis, prevention, and treatment that can help veterinarians and pet owners improve their knowledge of managing the diseases.
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To establish a PCR detection method for Trichomonas foetus, the primers were designed and synthesized according to the 18S rRNA gene sequence of T. foetus published by GenBank. The positive recombinant plasmid pUCm-T-TF18S of T. foetus was used as the template, and the genomic DNA of Giardia felis, Coccidia +e-lis, feline parvovirus and cDNA of feline coronavirus were used as the control for PCR detection to analyze the specificity of this method. The positive T. foetus recombinant plasmid was serial to 8 different concentrations with a gap of 10 folds, and PCR was performed to analyze the sensitivity of this method. The pUCm-T-TF18S plasmids stored at -20 " for 3, 6, 9 and 12 months were detected by PCR to analyze the stability of the method. Twenty cat fecal samples were tested using this established PCR assay and compared with those of microscopic examination. The results showed that the recombinant plasmid pUCm-T- TF18S gave specific bands after PCR amplification. The sequencing results showed that the length of the product sequence was 1 264 bp, and the BLAST sequence comparison analysis showed 99.53% sequence identity, which is consistent with that of T. foetus from cats (GenBank registration number M81842.1). The PCR method for detection of T. foetus had no cross-reactivities with C. felis, G. felis, feline coronavirus and feline parvovirus;the minimum detectable template concentration is 4.52 X 105 copies/xl;The target band of T. foetus DNA can still be detected after being stored in the refrigerator at -20 " for 12 months. This method detected 16 positive samples of T. foetus nucleic acid from 20 cat fecal samples, which is more accurate and sensitive than the results from traditional microscopy (13 samples). It is suggested that the PCR method for the detection of T. foetus is highly specific, sensitive and stable, and can be used for clinical detection and epidemiological investigation of T. foetus.Copyright © 2022, National Institute of Parasitic Diseases. All rights reserved.
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Introduction: The COVID-19 pandemic has had profound effects on access to care, including outpatient sexually transmitted infection (STI) testing and treatment. Many vulnerable populations already relied on the emergency department (ED) for much of their care prior to the pandemic. This study examines trends in STI testing and positivity before and during the pandemic at a large urban medical center and evaluates the role of the ED in providing STI care. Methods: This is a retrospective review of all gonorrhea, chlamydia, and trichomonas tests from November 1, 2018, through July 31, 2021. Demographic information and location and results of STI testing were extracted from the electronic medical record. Trends in STI testing and positivity were examined for 16 month periods before and after the COVID-19 pandemic started (March 15, 2020), with the latter divided into the early pandemic period (EPP: March 15 -July 31, 2020) and late pandemic period (LPP: August 1, 2020 - July 31, 2021). Results: Tests per month decreased by 42.4% during the EPP, but rebounded by July 2020. During the EPP, the proportion of all STI testing originating in the ED increased from 21.4% pre-pandemic to 29.3%, and among pregnant women from 45.2% to 51.5%. Overall STI positivity rate increased from 4.4% pre-pandemic to 6.2% in the EPP. Parallel trends were observed for gonorrhea and chlamydia individually. The ED represented 50.5% of overall positive tests, and as much as 63.1% of positive testing during the EPP. The ED was the source of 73.4% of positive tests among pregnant women, which increased to 82.1% during the EPP. Conclusions: STI trends from this large urban medical center paralleled national trends, with an early decrease in positive cases followed by a rebound by the end of May 2020. The ED represented an important source of testing for all patients, and especially for pregnant patients, throughout the study period, but even more so early in the pandemic. This suggests that more resources should be directed towards STI testing, education, and prevention in the ED, as well as to support linkage to outpatient primary and obstetric care during the ED visit.
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The COVID-19 pandemic has reinforced Australia's need for diagnostic testing frameworks that are well-prepared, well-resourced, responsive, appropriately governed, scalable, interdisciplinary and collaborative.1 Point-of-care (POC) technologies offer diagnostic solutions capable of delivering individual, community and public health benefits in settings where: a) laboratory testing is not available, b) rapid turn-around time is needed, c) high loss to follow-up occurs in high-risk populations with standard of care cascades and/or d) disease transmission rates exceed laboratory response capacity. Key translational research derived from collaborative point-of-care testing networks for a) diabetes management (238 remote health services;3,233 operators;172,069 HbA1c and 51,379 urine albumin:creatinine ratio tests), b) acute care (106 remote health services;2,279 operators;32,950 blood gas, 32,689 cardiac troponin, 46,418 urea/electrolytes, 48,193 international normalised ratio tests), c) hepatitis C virus (HCV) (41 sites;110 operators;5,733 HCV tests;4,978 RNA, 755 antibody), d) syphilis screening (156 sites;1,412 operators), e) chlamydia, gonorrhea or trichomonas (51 sites;795 operators;>50,000 tests) or f) COVID-19 (101 remote health services, 733 operators, 72,624 tests) will be used to highlight operational, clinical, public health, and economic benefits of POC testing. Challenges associated with scale-up and accreditation pathways for decentralised POC testing will be discussed. Reference 1. Revised Testing Framework for COVID-19 in Australia, March 2022 Version 2.1. Communicable Disease Network Australia and Public Health Laboratory Network. Copyright © 2022
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CASE: A 22-year-old woman with h/o asthma initially presented to the hospital with lip swelling and sore throat. She tested positive for COVID-19 and received a casirivimab-imdevimab (monoclonal antibody) infusion. She returned a week later with worsening lip swelling, dysphagia and conjunctivitis. Physical exam revealed edematous lips with vesicular lesions, no tongue swelling, tonsillar exudate, 4+ conjunctival injection bilaterally with purulent discharge, and shallow clean based clitoral ulceration. She reports no history of allergic reactions, angioedema or exposure to new medications. Nasopharyngolaryngoscopy showed no laryngeal edema but visualized exudates throughout the supraglottis and glottis. C4, ANA, CMV, EBV, throat and blood cultures were negative. STI testing was trichomonas positive and gonorrhea/chlamydia negative. Respiratory virus panel remained positive for COVID-19. HSV swab of lip lesion, HSV 1/2 IgG and IgM were negative. Mycoplasma pneumoniae IgG was elevated (0.60, negative is ≤0.09), IgM equivocal (0.85, negative is ≤0.76), and nasopharyngeal PCR negative. Conjunctival culture showed rare bacteria (S. Aureus) and no leukocytes. She initially received methylprednisolone IV due to concern for angioedema, acyclovir for empiric HSV treatment and empiric antibacterial moxifloxacin eye drops. Given lack of infectious trigger, her presentation was concerning for reactive infectious mucocutaneous eruption (RIME) associated with SARSCoV-2 or Mycoplasma. Prednisone 1mg/kg daily was initiated followed by improvement in oral mucositis and conjunctivitis within days. IMPACT/DISCUSSION: A broad differential is important when evaluating oral swelling and mucositis. Her lack of cutaneous involvement, medication exposure or family history and negative infectious, autoimmune and inflammatory workup make other causes including Stevens-Johnson syndrome, erythema multiforme, angioedema, and HSV less likely. Our final diagnosis of RIME describes mucocutaneous eruptions likely due to an immune response triggered by bacterial or viral infection. Our patient's RIME may be due to COVID-19 or Mycoplasma given her equivocal Mycoplasma IgM. Eruptions generally involve two or more mucosal sites and occur mostly in children and adolescents. Common presentations include oral erosions and ulcers, purulent bilateral conjunctivitis, or urogenital lesions, which were all seen in our patient. As this is a relatively rare and new condition, no standard of care treatment exists for RIME but systemic steroids have been effective in case reports for initial treatment and subsequent flares. CONCLUSION: RIME is a rare, newly described condition in young patients who develop postinfectious mucocutaneous eruptions of two or more mucosal sites. It has been recently reported in association with COVID-19 and its association with Mycoplasma infection is important to evaluate. This condition is important to recognize and treat given the requirement for higher dose steroids than that used for angioedema.
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The proceedings contain 17 papers. The topics discussed include: HIV patient preferences for care: resetting for a new normal;who accesses emergency hormonal contraception through an online sexual health service?;menstrual, sexual, and reproductive health interventions in out-of-school girls: a systematic review;three cycle QIP: improving testing and management of mycoplasma genitalium in a tertiary sexual health center 2019 - 2021;the weekend effect in GUM: a preliminary audit into genital herpes management across the week;comparing trichomonas vaginalis clinical care before and after the COVID-19 pandemic;time to start testing for latent tb infection(LTBI) - a quality improvement project;who, what, when, where, how and why? addressing the challenges of patient and public involvement and engagement (PPIE) within STI research and co-producing and applying a PPIE strategy within the SEQUENCE digital research program;an analysis of service users accessing a routine contraception service via an online platform during the COVID-19 pandemic;and effect of the COVID-19 pandemic on chlamydia testing and diagnosis within Scotland's largest sexual health service.
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Introduction During COVID-19, the sexual health service introduced telephone triage to reduce face-to-face consultations but maintain BASHH standards of clinical care. The service does not have TV PCR testing and relies on laboratory diagnosis of TV alone. This audit examines the impact of COVID- 19 changes on presentation and treatment of TV. Method Electronic patient records were searched for patient coded with TV and compared for the periods 01/01/2019 - 01/01/2020 and 01/01/2021-01/01/2022. The year 2020-2021 was not included due to the reduced capacity of services and concerns of data quality during this period. Results 43 cases were identified in 2019 compared to 47 in 2021. All patients were treated with antibiotics as recommended by BASHH guidelines. The most common symptom for females both years was discharge, however males were identified through contact tracing. More patients waited with symptoms and were incorrectly treated for other conditions following service changes due to COVID-19. Cure rates also lower in the 2021 data compared with the 2019 data. The results are summarised in the table attached. Discussion The frequency of Trichomonas diagnosis did not decrease during COVID despite reduced testing overall. The delay in diagnosing and treating TV had increased however with patients having symptoms longer and being treated for other infections first. This could be improved by incorporating PCR testing into local triage algorithms.
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The proceedings contain 159 papers. The topics discussed include: HIV patient preferences for care: resetting for a new normal;who accesses emergency hormonal contraception through an online sexual health service?;menstrual, sexual, and reproductive health interventions in out-of-school girls: a systematic review;three cycle QIP: improving testing and management of mycoplasma genitalium in a tertiary sexual health center 2019 - 2021;the weekend effect in gum: a preliminary audit into genital herpes management across the week;comparing trichomonas vaginalis clinical care before and after the COVID-19 pandemic;and time to start testing for latent tb infection(LTBI)- a quality improvement project.
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Background: Sexually transmitted infection (STI) diagnosis serves as an important linkage to HIV testing and pre-exposure prophylaxis (PrEP) for adolescents. The COVID-19 pandemic disrupted sexual health services for young people, with a potential consequence of increasing undiagnosed STIs. This study aimed to describe STI testing changes and estimate undiagnosed STI cases during the pandemic. Methods: We analyzed electronic medical records for chlamydia, gonorrhea, and trichomonas testing encounters from six pediatric primary care clinics in Philadelphia, July 2014-November 2020. We assessed whether testing was asymptomatic screening, risk-based testing, or symptomatic testing, and whether any result was positive. We evaluated STI trends over time, comparing pre-pandemic (before March 1st, 2020) and pandemic periods (after March 1st, 2020). Missed STI cases during the pandemic were estimated using decreases in patient volume and asymptomatic screening as compared to the previous year. Generalized linear mixed-effects models estimated the effects of patient-level and neighborhood-level characteristics on STI outcomes. Results: 35,548 STI testing encounters were analyzed, including 2,958 during the pandemic period. The median patient age was 17.5 years, 57% of patients were female, and 84% were Black/African American. Mean monthly STI testing encounters decreased from 479/month pre-pandemic to 329/month during the pandemic. Test positivity increased from 12.5% pre-pandemic to a peak of 27.5% in April 2020. The percent of STI tests performed as asymptomatic screening dropped from 72.5% pre-pandemic to a nadir of 54.5% in April 2020 (Figure). We estimate that the decrease in asymptomatic screening in the pandemic period would be associated with 159 missed cases (23.8% of expected cases) based on patient volume from the previous year. In multivariate models controlling for testing type (asymptomatic screening, risk-based testing, or symptomatic testing), the odds of test positivity were 50% higher during the pandemic (OR: 1.50, p<0.001). Conclusion: STI test positivity increased during the pandemic while asymptomatic screening decreased. Test positivity was higher for asymptomatic patients, suggesting increased STI prevalence. These changes likely resulted in a substantial number of undiagnosed STIs, representing missed opportunities for PrEP linkage. Efforts are needed to re-establish and sustain access to STI services for adolescents in response to disruptions caused by the pandemic.
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In Trichomonas vaginalis (T. vaginalis), cyclophilins play a vital role in dislodging Myb proteins from the membrane compartment and leading them to nuclear translocation. We previously reported that TvCyP1 cyclophilin from T. vaginalis forms a dimer and plays an essential role in moving the Myb1 transcription factor toward the nucleus. In comparison, TvCyP2 containing an extended segment at the N-terminus (N-terminal segment) formed a monomer and showed a different role in regulating protein trafficking. Four X-ray structures of TvCyP2 were determined under various conditions, all showing the N-terminal segment interacting with the active site of a neighboring TvCyP2, an unusual interaction. NMR study revealed that this particular interaction exists in solution as well and also the N-terminal segment seems to interact with the membrane. In vivo study of TvCyP2 and TvCyP2-∆N (TvCyP2 without the N-terminal segment) indicated that both proteins have different subcellular localization. Together, the structural and functional characteristics at the N-terminal segment offer valuable information for insights into the mechanism of how TvCyP2 regulates protein trafficking, which may be applied in drug development to prevent pathogenesis and disease progression in T. vaginalis infection.