Fatal disseminated cowpox virus infection in an adolescent renal transplant recipient.

BACKGROUND: A 17-year-old boy on long-term immunosuppression following renal transplantation for chronic kidney disease (CKD), the result of dysplastic kidneys, initially presented with a swelling in his neck while attending hospital for an unrelated problem. A clinical diagnosis of tonsillitis was made, and he was treated with broad-spectrum antibiotics. Over a few days, his condition deteriorated, and he developed multiple vesicopustular skin lesions and required an emergency tonsillectomy due to respiratory distress. CASE DIAGNOSIS/TREATMENT: Histological investigation of the skin and tonsillar tissue suggested a viral aetiology, and subsequent electron microscopy and polymerase chain reaction (PCR) tissue examination proved disseminated cowpox infection. The family cat, which was reported as having self-resolving sores on its skin, was likely the source of the infection. The child failed to respond to antiviral treatment and succumbed to multiorgan failure within a month of admission. CONCLUSIONS: We report this case of fatal disseminated cowpox infection to highlight an increasing risk of this illness in the post-transplant population and to detail some unusual features not previously described, such as tonsillar involvement, disseminated skin lesions and multiorgan failure.

Relationship between viral dose and outcome of infection in Atlantic salmon, Salmo salar L., post-smolts bath-challenged with salmonid alphavirus subtype 3.

Salmonid alphavirus subtype 3 (SAV3) causes pancreas disease (PD) and adversely affects salmonid aquaculture in Europe. A better understanding of disease transmission is currently needed in order to manage PD outbreaks. Here, we demonstrate the relationship between viral dose and the outcome of SAV3 infection in Atlantic salmon post-smolts using a bath challenge model. Fish were challenged at 12 °C with 3 different SAV3 doses; 139, 27 and 7 TCID50 L-1 of seawater. A dose of as little as 7 TCID50 L-1 of seawater was able to induce SAV3 infection in the challenged population with a substantial level of variation between replicate tanks and, therefore, likely represents a dose close to the minimum dose required to establish an infection in a population. These data also confirm the highly infectious nature of SAV through horizontal transmission. The outcome of SAV3 infection, evaluated by the prevalence of viraemic fish, SAV3-positive hearts, and the virus shedding rate, was positively correlated to the original SAV3 dose. A maximal shedding rate of 2.4 × 104 TCID50 L-1 of seawater h-1 kg-1 was recorded 10 days post-exposure (dpe) from the highest dose group. The method reported here, for the quantification of infectious SAV3 in seawater, could be useful to monitor PD status or obtain data from SAV3 outbreaks at field locations. This information could be incorporated into pathogen dispersal models to improve risk assessment and to better understand how SAV3 spreads between farms during outbreaks. This information may also provide new insights into the control and mitigation of PD.

Staphylococcus aureus bacteraemia in a UK tertiary referral centre: a 'transoesophageal echocardiogram for all' policy.

OBJECTIVES: Infective endocarditis (IE) is a feared complication in up to 38% of cases of Staphylococcus aureus bacteraemia (SAB). BSAC guidelines recommend echocardiography in all cases of SAB. The aim of this study was to determine the incidence of IE in SAB using transoesophageal echocardiography (TOE) as the first step in diagnostic imaging. This study also sought to identify clinical predictors that could improve stratification of those with and without IE. METHODS: A guideline was implemented that any SAB resulted in the microbiology department (i) recommending that the patient be referred for TOE and (ii) notifying the echocardiography department, resulting in streamlined listing of the patient for TOE. All cases of SAB were then assessed prospectively at University Hospitals Birmingham NHS Foundation Trust between September 2011 and October 2012. Previously identified risk factors for complicated S. aureus bacteraemia were recorded. RESULTS: There were 98 SAB episodes in total. TOE was performed in 58 (59%) with a further 22 episodes imaged by transthoracic echocardiography alone. IE was diagnosed overall in 13 (16%) cases investigated with echocardiography. No risk factor for IE other than presence of a cardiac device was detected in this group (P = 0.013). CONCLUSIONS: The rate of IE found in SAB is high when TOE is performed first line. There are no clear risk factors to improve yield or the type of echocardiography to be performed. Echocardiography should be performed in all cases and TOE should be considered where it is expected to influence management, as long as local resources allow.

The influence of whey protein and glycomacropeptide on satiety in adult humans.

Protein is often considered the most satiating macronutrient. The objective was to determine the short-term effect of mixtures of whey protein and glycomacropeptide (GMP) versus a carbohydrate control on satiety in healthy adult humans. The study was a randomised crossover Latin Square design. On 4 separate days, fifty healthy subjects (19 males and 31 females) received a subject-specific breakfast (08:00 h), a preload drink (12:00 h) and lunch (12:30 h). The preload drink was presented as a milkshake with either maltodextrin carbohydrate (control), whey protein isolate (WPI) with no GMP, WPI with naturally present 21% GMP or WPI with naturally present 21% GMP plus added GMP. Satiety was assessed using visual analogue scales (VAS) and by determining ad libitum food intake during a cafeteria style meal offered 30 min after the preload. The VAS indicated that the lower GMP treatment induced a greater feeling of fullness immediately after consumption of the preload compared with the other treatments. Energy and macronutrient intake at lunch did not differ significantly (p>0.05) between treatments although subjects chose to eat foods higher in carbohydrate and lower in protein after the protein preloads. Women consumed the least amount of protein after the protein preloads whereas no difference was found in men. There was some evidence that whey proteins and their components enhance satiety over a short-term period compared to carbohydrate but there was no consistent effect of either whey protein alone or glycomacropeptide.

Rate and amplitude of adaptation to intermittent and continuous exercise in older men.

PURPOSE: This study determined the amplitude and rate of adaptation to 10 wk of continuous (CEx) and intermittent exercise (IEx) in a group of older men when the training intensity and total amount of work completed by each exercise group were the same. METHODS: Ten healthy men were assigned to either a CEx (63 +/- 1 yr) or IEx (65 +/- 1 yr) group while a further five subjects (65 +/- 1 yr) acted as nonexercising controls (CON). The three groups (CEx, IEx, and CON) were matched for age, peak oxygen uptake (VO2peak), and cardiac output (Qpeak) before commencing training. The CEx group trained for 30 min at an intensity corresponding to 70-75% VO2peak, and the IEx group trained for a total exercise time of 30 min using intermittent exercise (60-s exercise, 60-s rest) at the same absolute intensity as the CEx group (CEx 112 +/- 5W; IEx 112 +/- 5W). The exercise groups trained three times per week and completed a similar amount of work during each training session (CEx, 199 +/- 9 kJ; IEx 195 +/- 9 kJ, P = 0.67). RESULTS: The CEx and IEx groups had similar and significant amplitude increases in peak VO2, ventilation (VEpeak), power, Q, and SV after training. Peak VO2, Qpeak, SVpeak, and peak arteriovenous O2 difference for the CON group were unchanged. The change in VO2peak, peak ventilation, and peak power for CEx and IEx groups were best described by a linear model. Moreover, the CEx and IEx groups had the same rate of change in VO2peak (CEx: 0.02 +/- 0.00 L x min(-1) x wk(-1), IEx: 0.02 +/- 0.00 L x min(-1) x wk(-1), P = 0.32), VEpeak (CEx: 2.0 +/- 0.2 L x min(-1) x wk(-1), IEx: 1.2 +/- 0.5 L x min(-1) x wk(-1), P = 0.10), and peak power (CEx: 2.6 +/- 0.4 W x wk(-1), IEx: 2.6 +/- 0.4 W x wk(-1), P = 0.92). CONCLUSION: These results suggest that the amplitude and rate of change of select adaptations in men aged 60-70 yr are independent of the mode of training (i.e., continuous or intermittent exercise) when the absolute training intensity and the total amount of work completed were similar.