Recurrent Stroke and Fatal Ruptured Mycotic Aneurysm Caused by Invasive Aspergillus fumigatus Infection.

INTRODUCTION: Aspergillus species are ubiquitous fungi that may cause invasive infection, particularly in immunocompromised patients. Invasive aspergillosis most commonly affects the lungs but can also disseminate to the central nervous system (CNS). Manifestations of CNS aspergillosis include abscesses and, rarely, mycotic aneurysm leading to subarachnoid hemorrhage (SAH). CASE PRESENTATION: A 48-year-old man undergoing treatment for squamous cell cancer of the larynx with chemotherapy and steroids presented with dysarthria and weakness. He was found to have both lung and CNS infection secondary to Aspergillus species. While receiving intravenous antifungal treatment after biopsy-proven Aspergillus infection, he developed a fatal SAH caused by a mycotic aneurysm. DISCUSSION: Intracranial mycotic aneurysms are uncommon. However, mycotic aneurysm leading to a fatal SAH is a well-documented sequela of CNS aspergillosis. Mortality rates for CNS aspergillosis are extremely high. CONCLUSION: In immunosuppressed patients with neutropenia or using chronic steroids who have concurrent pulmonary and CNS infection, there should be a low threshold to treat empirically for fungal infections prior to confirmation of diagnosis.

Influence of beta-agonists (ractopamine HCl and zilpaterol HCl) on fecal shedding of Escherichia coli O157:H7 in feedlot cattle.

Ractopamine HCl and zilpaterol HCl, beta-agonists recently approved for use in feedlot cattle to improve performance traits and carcass leanness, were examined for their effects on fecal shedding of Escherichia coli O157:H7 in feedlot cattle. Fecal samples (n = 2,454) were obtained from four experiments (one ractopamine HCl, three zilpaterol HCl) over the course of a 3-year period, either by rectal palpation (ractopamine HCl experiment) or from pen-floor fecal pats. Samples were cultured quantitatively and qualitatively for E. coli O157:H7. No significant treatment differences were detected for fecal prevalence of E. coli O157:H7 in the ractopamine HCl experiment. Zilpaterol HCl feeding had no effect (P > 0.20) on fecal shedding in the first or second experiments, with overall E. coli O157:H7 prevalence relatively low (<7%). In the third zilpaterol HCl experiment, the percentage of fecal samples that were E. coli O157:H7 positive following qualitative culture was higher (P < 0.05) in the zilpaterol HCl treatment (10.3%) than for the control (6.1%). The current research showed minimal effects of beta-agonists on fecal shedding of E. coli O157:H7 and indicated that these compounds (fed immediately prior to slaughter) are not a cause for concern from a food safety standpoint.

Seasonal shedding of Escherichia coli O157:H7 in ruminants: a new hypothesis.

Seasonal shedding of Escherichia coli O157:H7 in ruminants is well documented; however, viable explanations for this phenomenon are lacking. The fecal prevalence of E. coli O157:H7 in ruminants is the highest in the summer months, decreasing to low or undetectable levels in the winter. To determine if day length is correlated to seasonal shedding, nine reports of E. coli O157:H7 prevalence in cattle were selected for similarity of sampling technique, culture methodology, cattle type, and ability to determine approximate sampling month and location, representing three regions in North America (southern Canada, midwestern United States, and the southern United States/Mexico). Correlation and regression analysis revealed a positive correlation existed between day length (r = 0.67; R2 = 0.45; P = 0.0009) and, to a lesser extent, ambient temperature (r = 0.43; R2 = 0.19; P = 0.05) and E. coli O157:H7 prevalence. Based on these results, a study was conducted in a commercial feedlot to examine the effect of artificial lighting on E. coli O157 prevalence. Four pens of cattle received approximately 5 hours of artificial lighting daily (in addition to the natural light) for 60 days and four pens served as controls. Freshly voided fecal samples (representing approximately 30% of the steers/pen) were collected from the pen floor and cultured for E. coli O157 after 25 and 53 days of artificial lighting and 28 and 43 days following cessation of the lighting treatment. Fecal prevalence of E. coli O157 remained constant in the lighted pens whereas prevalence was lower (P < 0.01) in the control treatment after 53 days of lighting. Forty-three days following cessation of the lighting treatment, prevalence decreased in the lighted treatment group to levels comparable (P > 0.20) to control levels. Understanding the mechanisms underlying the seasonality of this important foodborne pathogen will enable the implementation of effective control strategies when it is most prevalent.