Investigations and actions taken during 2011 due to the first finding of Echinococcus multilocularis in Sweden.

Echinococcus multilocularis is a parasite that can cause alveolar echinococcosis disease. After the first positive finding of E. multilocularis in Sweden in 2011, a consulting group with representatives from relevant authorities was summoned. In this group, all relevant information was shared, strategies for information dissemination and any actions to be taken due to the finding of E. multilocularis were discussed and decided. The present paper describes the actions taken during 2011 and the results thereof, including surveillance in animals, risk assessment for humans to become infected and recommendations given to the public. Further discussion about whether the parasite was introduced, and if so, how, as well as possible future development of the infection in animals and humans in Sweden and future actions are included.

First detection of Echinococcus multilocularis in Sweden, February to March 2011.

Surveillance for the fox tapeworm, Echinococcus multilocularis, has been carried out in Sweden since 2000, with about 300 red foxes analysed annually. We report the first finding of E. multilocularis in Sweden, in a fox shot in December 2010 in the south-west of the country. A second infected fox shot in the same location was detected in March 2011. This paper describes the national monitoring programme and the ongoing work to estimate the prevalence and spread of the infection.

Trichinella pseudospiralis foci in Sweden.

In Sweden, the prevalence of Trichinella infection in domestic pigs has greatly decreased since the 1970s, with no reports in the past 4 years. However, infected wild animals continue to be found. The objective of the present study was to identify the species of Trichinella present in animals of Sweden, so as to contribute to the knowledge on the distribution area and hosts useful for the prevention and control of this zoonosis. In the period 1985-2003, Trichinella larvae were detected in the muscles of 81/1800 (4.5%) red foxes (Vulpes vulpes), 1/6 (16.7%) arctic fox (Alopex lagopus), 1/7 (14.3%) wolf (Canis lupus), 10/200 (5.0%) lynxes (Lynx lynx), 4/8000 (0.05%) wild boars (Sus scrofa), and 27/66 x 10(6) (0.000041%) domestic pigs. All four Trichinella species previously found in Europe were detected (Trichinella spiralis, T. nativa, T. britovi and T. pseudospiralis). The non-encapsulated species T. pseudospiralis was detected in three wild boars from Holo (Stockholm area) and in one lynx from Froso (Ostersund area), suggesting that this species is widespread in Sweden. These findings are consistent with those of a study from Finland, both for the unexpected presence of T. pseudospiralis infection and the presence of the same four Trichinella species, suggesting that this epidemiological situation is present in the entire Scandinavian region. The widespread diffusion of T. pseudospiralis in the Scandinavian region is also important in terms of it potential impact on public health, given that human infection can occur and the difficulties to detect it by the trichinelloscopic examination.

Winter survival in Sweden of L(3)-stage larvae of the ostrich wireworm Libyostrongylus douglassii.

Libyostrongylus douglassii, a pathogenic trichostrongylid nematode of the ostrich, was recently identified as a potentially important parasite in ostriches on Swedish farms. This parasite is well adapted to the hot and dry climates of sub-Saharan Africa, the natural habitat of the ostrich. The influence of low temperatures in colder climates, such as in Sweden, on free-living stages of L. douglassii is however insufficiently known. In this study, parasite free ostrich faeces were mixed with infective L(3)-stage larvae of L. douglassii, which had been cultured from eggs obtained from two Swedish farms. Samples of the mixture were placed on a grass surface, and analyses for L(3)-stage larvae were performed at regular intervals. The results of the study showed that L(3)-stage larvae may remain alive during a period of at least 97 days on pasture during the winter season in Sweden, even when the temperature within the samples was repeatedly below -0.1 degrees C, and the air temperature varied between -19.6 and +14.9 degrees C. It was concluded that L(3)-stage larvae of L. douglassii probably have the ability to remain viable on pastures during winter in Sweden.

Prevalence of Pneumonyssoides caninum infection in dogs in Sweden.

A prospective study of 474 dogs, 145 cats, and 66 wild red foxes submitted for necropsy to the Departments of Pathology at the National Veterinary Institute and the Swedish University of Agricultural Sciences, Uppsala, Sweden, was conducted to examine for the presence of Pneumonyssoides caninum, the canine nasal mite. Pneumonyssoides caninum (P. caninum) was found in 95 (20%) of the dogs but in none of the cats or foxes. The median number of P. caninum mites per infected dog was 13 (range, 1 to 250). Dogs older than 3 years of age were more often infected with P. caninum than younger dogs, and large-breed dogs were more often infected than small-breed dogs. No sex predisposition was found.

Cervical spine surgery in rheumatoid arthritis. A Swedish nation-wide registration of 83 patients.

OBJECTIVE: To investigate diagnostic methods, surgical methods and indications, early complications and short term outcome of cervical spine surgery for rheumatoid arthritis (RA). METHODS: A nation-wide registration of rheumatoid cervical spine surgery carried out in Sweden during 1993. RESULTS: Eighty-six (74 primary) procedures in 83 patients were reported from 11 hospitals. Pain was a more common indication for surgery than was neurologic impairment. C1-C2 instability or subluxation was present in 66/82, subaxial subluxations in 27/82 and atlantoaxial impaction in 10/82 procedures (data partly missing in one case). Indications for surgery and preoperative investigations were found to be reasonably uniform, but surgical methods and post-operative care varied between hospitals. Posterior fusion was performed in 76 patients. C1-C2 wiring with bone grafting was the most common procedure followed by occipito-cervical fusion with wires and bone cement. Subaxial cervical decompression without fusion, posterior fusion with onlay graft only, and carbon fiber grafts were used in a small number of patients. Total mortality was 5/83. The early complication rate was low, but 17 patients showed recurrent subluxation at follow-up at median 7 (1-17) months. Seven of them required reoperation in the same segment. CONCLUSION: The variation in treatment policy and number of operated patients in the different hospitals speak in favor for centralization of cervical spine surgery in RA. New methods for C1-C2-fusion need to be evaluated.

The effect of birdsfoot trefoil (Lotus corniculatus) and white clover (Trifolium repens) in mixed pasture swards on incoming and established nematode infections in young lambs.

Lotus corniculatus L., a leguminous plant containing condensed tannins, is now being evaluated in Sweden as a component of mixed pastures. This is because of its high nutritive value, palatability, modest requirement for water, calcium and phosphorous and particularly because it has the ability to survive harsh weather conditions that typify northern Scandinavia. This trial was undertaken to assess the possible parasitological benefits of using L. corniculatus when fed as a minor component in a mixed pasture sward to young sheep. This was compared with similar sheep that were fed pasture with a comparable legume content consisting of Trifolium repens L. Separate groups of lambs, maintained in pens and provided with fresh pasture cuts containing either L. corniculatus or T. repens each day, were trickle-dosed with infective larvae of mixed parasite species. For each pasture type, groups of 6 lambs had either established worm burdens only, received incoming infections only, or had the combination of both adult and incoming infections. Worm burdens were monitored by serial faecal egg counts and at the termination of the study, all animals were slaughtered for worm recovery, identification and enumeration. The results showed that there were no differential effects between L. corniculatus and T. repens on the different stages of development for a range of nematode parasite species recovered from these lambs. Several reasons may account for this: such as the low level of condensed tannins in the L. corniculatus variety tested, the minor proportion of this plant in the diet and/or the variety of L. corniculatus used in this trial which do not provide any benefits to controlling parasites of sheep.

Intestinal parasites in swine in the Nordic countries: multilevel modelling of Ascaris suum infections in relation to production factors.

In Denmark, Finland, Iceland, Norway and Sweden, 413 sow herds were randomly selected for sampling. Faeces from pigs of 7 age groups/categories were examined for helminth eggs (11,233 individual samples), and an accompanying questionnaire was completed at each visit. In total, 1138 pigs on 230 farms were found to be positive for Ascaris suum. Considerable differences in the occurrence of A. suum could be observed directly for several of 20 independent variables at the herd or category level. However, given that univariate analyses may be severely affected by confounding of covariates resulting in spurious inference, additional multivariate analyses were undertaken. An ordinary logistic regression on Ascaris positive/negative farms showed that Denmark had the highest frequency of infected herds, while Iceland and Finland had the lowest frequencies and that herds using 'late weaning' and 'Class 2' drugs (pyrantel, levamisole) were most often infected. Because many herds were found to be totally negative for A. suum, mixed hierarchical logistic-normal regression models (both the penalized quasi-likelihood and the Markov Chain Monte Carlo methods) were developed for both a full (all herds) and a reduced (the 230 infected herds) data set using either a cut-off of > 0 eggs per gram (epg) or > 200 epg to counter for false-positive egg counts. Estimates for identical models, but where the animal level variance was constrained to the binomial assumption, were also calculated. Significant covariates were robust to model development with 'Age group', 'Country', 'Weaning age', 'Water system' and simple interactions between the latter two and 'Age group' being significantly associated with the occurrence of A. suum, while all variables concerning anthelmintic drug, anthelmintic strategy, floor type, bedding, dung removal, washing and disinfection were not. These findings are discussed in the light of the complex relationship between A. suum and its pig host.

ITS2 sequences of Dictyocaulus species from cattle, roe deer and moose in Sweden: molecular evidence for a new species.

Total DNA was isolated from adult lungworms of the genus Dictyocaulus, collected from cattle, moose (Alces alces) and roe deer (Capreolus capreolus) in Sweden. The second ribosomal internal transcribed spacer was amplified with PCR, and DNA sequences were determined from nine individual worms that all came from different hosts in order to avoid analysis of siblings. The sequence data obtained were aligned and compared with similar data derived from German lungworm isolates from cattle and fallow deer (Cervus dama). These analyses clearly showed that specimens of the cattle lungworm, Dictyocaulus viviparus, were almost identical irrespective of their geographical origin. However, when the second internal transcribed spacer sequence of D. viviparus was compared with that of lungworms from moose and roe deer, major differences were noticed. Although lungworms collected from these cervids had identical second internal transcribed spacer sequences, they proved to be genetically different from Dictyocaulus eckerti of German fallow deer, displaying a 66.5% similarity. In an evolutionary tree, inferred by maximum likelihood analysis, the Dictyocaulus species from cattle and wild cervids clustered as compared with Dictyocaulus filaria from sheep. The study has thus demonstrated that A. alces and C. capreolus in Sweden are parasitised with a Dictyocaulus species that is different from D. viviparus and D. eckerti, indicating that we are dealing with a new species in moose and roe deer.

Cervical laminectomy without fusion in patients with rheumatoid arthritis.

OBJECT: The authors performed a prospective study to determine whether cervical laminectomy without simultaneous fusion results in spinal instability. METHODS: Because of clinical and radiographic signs of cord compression, 15 patients with rheumatoid arthritis (including one with Bechterew's disease) and severe involvement of the cervical spine underwent decompressive laminectomy without fusion performed on one or more levels. Preoperative flexion-extension radiographs demonstrated dislocation but no signs of instability at the level of cord compression. Clinical and radiological reexamination were performed twice at a median of 15 months (6-24 months) and 43 months (28-72 months) postoperatively. One patient developed severe vertical translocation 28 months after undergoing a C-1 laminectomy, which led to sudden tetraplegia. She required reoperation in which posterior fusion was performed. No signs of additional instability at the operated levels were found in the remaining 14 patients. In three patients increased but stable dislocation was demonstrated. The results of clinical examination were favorable in most patients, with improvement of neurological symptoms and less pain. CONCLUSIONS: The authors conclude that decompressive laminectomy in which the facet joints are preserved can be performed in the rheumatoid arthritis-affected cervical spine in selected patients in whom signs of cord compression are demonstrated, but in whom radiographic and preoperative signs of instability are not. Performing a simultaneous fusion procedure does not always appear necessary. Vertical translocation must be detected early, and if present, a C-1 laminectomy should be followed by occipitocervical fusion.

Clinical efficacy of milbemycin oxime in the treatment of nasal mite infection in dogs.

A multicentric clinical trial was done to evaluate the clinical efficacy of milbemycin oxime in the treatment of nasal mite (Pneumonyssoides caninum) infection in dogs. Milbemycin oxime was given to 70 dogs of different breeds, genders, and ages, with clinical signs associated with nasal mite infection. Twenty-five dogs had a verified infection, and 45 dogs had signs suggestive of nasal mite infection. Milbemycin oxime was given at the dosage of 0.5 to 1.0 mg/kg body weight orally once a week for three consecutive weeks. One month after initiation of treatment, 68 of the dogs had no more clinical signs associated with nasal mite infection.

Experimental infection of dogs with the nasal mite Pneumonyssoides caninum.

A successful experimental transmission of the canine nasal mite, Pneumonyssoides caninum, is described. Some 11 weeks after repeated systemic ivermectin treatment, four Beagles were inoculated via the right nostril with 20 P. caninum mites of different sexes and life stages, obtained at the necropsy of an infected dog. The inoculated dogs and a matching uninoculated control were observed for clinical signs for 14 weeks and then euthanised. Vague upper respiratory signs and a transient minor increase in the number of eosinophils in peripheral blood were recorded in the inoculated dogs. At necropsy 4-12 P. caninum mites were found in the nasal cavities and sinuses of the inoculated dogs, but none in the control. In three out of the four infected dogs mites were found in both the right and left nasal cavities and sinuses of the skull. Since in no case more mites than the number used for inoculation were detected it is not clear if the mites managed to reproduce in the dogs. Inflammatory lesions were seen most consistently in the olfactory mucosa, respiratory mucosa and tonsils, and growth of opportunistic bacteria was observed in the tonsils of the infected dogs. The inflammatory lesions seen in the olfactory mucosa may explain why dogs infected with P. caninum sometimes appear to suffer from impaired scenting ability.

Intestinal parasites in swine in the Nordic countries: prevalence and geographical distribution.

In Denmark (DK), Finland (FIN), Iceland (I), Norway (N), and Sweden (S), 516 swine herds were randomly selected in 1986-1988. Individual faecal analyses (mean: 27.9 per herd) from eight age categories of swine showed that Ascaris suum, Oesophagostomum spp., Isospora suis, and Eimeria spp. were common, while Trichuris suis and Strongyloides ransomi-like eggs occurred sporadically. Large fatteners and gilts were most frequently infected with A. suum with maximum prevalences of 25-35% in DK, N and S, 13% in I and 5% in FIN. With the exception of the remarkably low A. suum prevalence rates in FIN, no clear national differences were observed. Oesophagostomum spp. were most prevalent in adult pigs in the southern regions (21-43% in DK and southern S), less common in the northern regions (4-17% adult pigs infected), and not recorded in I. I. suis was common in piglets in DK, I, and S (20-32%), while < 1% and 5% were infected in N and FIN, respectively. Eimeria spp. had the highest prevalences in adult pigs (max. 9%) without clear geographical differences. I. suis and Eimeria spp. were recorded for the first time in I, and I. suis for the first time in N.

Experimental infection with Babesia divergens in cattle persistently infected with bovine virus diarrhoea virus.

Nine Norwegian Red cattle, aged 7-14 months, persistently infected with bovine virus diarrhoea virus (BVDV) were inoculated with a Swedish strain of Babesia divergens. Six persistently infected cattle of the same age and breed were kept as controls. Blood and serum samples were collected regularly during the observation period. Rectal temperatures were recorded every morning for 25 days post infection, and the animals were examined clinically on a daily basis. Sera were examined for antibodies to B. divergens by indirect immunofluorescence antibody test (IFAT). Eight of the infected animals developed fever of 2-5 days duration. Babesia divergens organisms appeared in the erythrocytes of all infected animals on the day after inoculation. The parasitaemia lasted for 4-11 days. One animal had a transient haemoglobinuria. Compared with the control group, there was a 20% decrease in the haematocrit. There was a transient lymphopenia and thrombocytopenia during the period of fever. There were no differences in mean numbers of neutrophils between the two persistently infected groups. Compared with cattle free of BVDV, the persistently infected cattle had consistently lower total leucocyte count that was mainly due to decreased mean numbers of neutrophils and monocytes. All infected animals develop antibodies > or = 1:1280 between day 7 and 10 post infection. The magnitude of the antibody response was considerably lower than that of BVDV-free animals inoculated with the same strain and dosage of B.divergens.

Experimental infection with Ehrlichia phagocytophila and Babesia divergens in cattle.

Nine Norwegian Red Cattle, 9-12 months old, were inoculated simultaneously with Ehrlichia (Cytoecetes) phagocytophila and Babesia divergens. Ten cattle of the same breed and age were kept as controls. Clinical evaluation was done on a daily basis and rectal temperatures were recorded every morning for 4 weeks post inoculation. Blood and serum samples were collected regularly during the observation period. Sera were examined for the presence of antibodies to E. phagocytophila and B. divergens by an indirect immunofluorescence antibody test. All infected animals showed two periods of fever that corresponded to the proliferation of B. divergens and E. phagocytophila in the peripheral blood. The simultaneous infection did not induce more severe clinical symptoms than infection with either organism alone. Compared with the control group, there was a 25% decrease in the mean haematocrit. The leukogram showed a biphasic pattern and corresponded to the changes seen in infection with either organism alone. The simultaneous infection did not suppress antibody formation towards E. phagocytophila or B. divergens.

Observations on the use of ELISA for detection of Babesia bigemina specific antibodies.

An indirect enzyme-linked immunosorbent assay (ELISA) was evaluated to study the cause of the high level of background reactions which hinders the application of ELISA as a field diagnostic test for Babesia bigemina. Different blockers to improve the specificity of the ELISA were compared. THe use of soya milk (25%), gelatin (2.5%) and chicken serum (2%) did not significantly improve the specificity of the test. It was noted that the presence of fibrinogen contributed to the positive ELISA results more than the presence of B. bigemina specific antigen. This conclusion was confirmed by testing bovine fibrinogen as a host protein antigen in ELISA which strongly responded against B. bigemina positive control sera. It is suggested that application of ELISA for B. bigemina is still unreliable until a more purified Babesia-specific antigen or specific monoclonal antibodies are available.

Occipito-cervical fixation in rheumatoid arthritis--an analysis of surgical risk factors in 163 patients.

163 patients with rheumatoid arthritis (RA) and atlanto-axial subluxation treated by posterior occipito-cervical fixation (OCF) over a period of twenty-one years (November 1970-January 1991) were followed. Common complaints prior to surgery were occipital headache, neck pain, radicular pain and myelopathy. The mean age at time of surgery was 61 years. The mean follow-up time was 54 months. Clinical improvement was obtained in 88% of the patients, whereas 7% were unchanged and 5% had progressive symptoms in spite of surgery. There was no pre-operative or immediate postoperative mortality. In 79 patients, one or more potential surgical risk factors were identified. Twenty-four reoperations were performed in the neck. The most common cause for reoperation was mechanical failure due to wire-break or spinous process fracture. Wound infection in the neck was recorded in 16 patients. Five were deep and required removal of the fixation material. Following OCF, new or progressive subaxial subluxation (SAS) led to further surgery in 4%. The study offers support for the beneficial effect of OCF in rheumatoid AAS. We conclude that, in spite of a number of identified risk factors, OCF with the Brattström-Granholm technique remains a safe and effective method for stabilization of upper cervical subluxations in RA.

Bovine bone grafting in occipito-cervical fusion for atlanto-axial instability in rheumatoid arthritis.

Bovine bone chips (Surgibone) were used in occipito-cervical fusion in nine patients with atlanto-axial instability due to rheumatoid arthritis. The patients were examined with CT 12-15 months after surgery. Graft resorbtion was observed in one patient. The other 8 patients showed preserved grafts, in most cases the grafts appeared to be in contact with the underlying bone. One patient was revised, and at the grafted site a bony bridge was found. In conclusion, the use of bovine chips in posterior occipito-cervical fusion will not lead to predictable bone union. However, there seem to be exceptions to that rule.