Pasteurellosis in camels in Southern Mongolia: A case report.

Hemorrhagic septicemia (pasteurellosis) in animals, caused by Pasteurella multocida Trevisan 1887, is a significant but previously undocumented disease in Mongolian camels. Pasteurella multocida, a small Gram-negative coccobacillus, typically exists commensal in the nasopharynx of camels but can cause severe illness under certain environmental stressors. This study reports the first case of cameline hemorrhagic septicemia in Gobi region of Mongolia, specifically in Umnugobi province, where acute septicemia affected 26 camels, resulting in 10 deaths within 24-48 hours. Clinical signs included depression, inappetence, lethargy, increased rectal temperature, and paralysis of the lower lip. Surviving camels responded to treatment with Lactate Ringer solution and antibiotics. Postmortem examinations revealed acute pulmonary congestion and necrotic liver. Molecular diagnostic test, PCR, confirmed the presence of P. multocida with the identification of the KMT1 gene. This case underscores the potential for significant economic losses due to hemorrhagic septicemia in camels and highlights the need for early detection and treatment to mitigate its impact. The initial attempt at implementing a vaccination program effectively controlled the potential further outbreak. This study emphasizes the importance of continuous surveillance and preventive measures in managing hemorrhagic septicemia in livestock.

A septicemia hemorrágica (pasteurelose) em animais, causada por Pasteurella multocida Trevisan 1887, é uma doença significativa, mas anteriormente não documentada, em camelos mongóis. Pasteurella multocida, um pequeno cocobacilo Gram-negativo, normalmente existe como comensal na nasofaringe de camelos, mas pode causar doenças graves sob certos estressores ambientais. Este estudo relata o primeiro caso de septicemia hemorrágica de camelos na região de Gobi, na Mongólia, especificamente na província de Umnugobi, onde a septicemia aguda afetou 26 camelos, resultando em 10 mortes em 24-48 horas. Os sinais clínicos incluíram depressão, inapetência, letargia, aumento da temperatura retal e paralisia do lábio inferior. Os camelos sobreviventes responderam ao tratamento com solução de Lactato Ringer e antibióticos. Os exames post-mortem revelaram congestão pulmonar aguda e fígado necrótico. O teste de diagnóstico molecular, PCR, confirmou a presença de P. multocida com a identificação do gene KMT1. Este caso sublinha o potencial de perdas económicas significativas devido à septicemia hemorrágica em camelos e destaca a necessidade de detecção e tratamento precoces para mitigar o seu impacto. A tentativa inicial de implementar um programa de vacinação controlou eficazmente o potencial novo surto. Este estudo enfatiza a importância da vigilância contínua e de medidas preventivas no manejo da septicemia hemorrágica na pecuária.

Mortality predictors in patients with suspected sepsis in the emergency department of a tertiary care hospital: a retrospective cohort study.

BACKGROUND: Sepsis remains a worldwide major cause of hospitalization, mortality, and morbidity. To enhance the identification of patients with suspected sepsis at high risk of mortality and adverse outcomes in the emergency department (ED), the use of mortality predictors is relevant. This study aims to establish whether quick sofa (qSOFA) and the severity criteria applied in patients with suspicion of sepsis in a monitored ED are in fact predictors of mortality. METHODS: We performed a retrospective cohort study among adult patients with suspicion of sepsis at the ED of a tertiary care hospital in Brazil between January 1st, 2019 and December 31, 2020. All adult patients (ages 18 and over) with suspected sepsis that scored two or more points on qSOFA score or at least one point on the severity criteria score were included in the study. RESULTS: The total of patients included in the study was 665 and the average age of the sample was 73 ± 19 years. The ratio of men to women was similar. Most patients exhibited qSOFA ≥ 2 (58.80%) and 356 patients (53.61%) scored one point in the severity criteria at admission. The overall mortality rate was 19.7% (131 patients) with 98 patients (14.74%) having positive blood cultures, mainly showing Escherichia coli as the most isolated bacteria. Neither scores of qSOFA nor the severity criteria were associated with mortality rates, but scoring any point on qSOFA was considered as an independent factor for intensive care unit (ICU) admission (qSOFA = 1 point, p = 0.02; qSOFA = 2 points, p = 0.03, and qSOFA = 3 points, p = 0.04). Positive blood cultures (RR, 1.63;95% CI, 1.10 to 2.41) and general administration of vasopressors at the ED (RR, 2.14;95% CI, 1.44 to 3.17) were associated with 30-day mortality. The administration of vasopressors at the ED (RR, 2.25; CI 95%, 1.58 to 3.21) was found to be a predictor of overall mortality. CONCLUSIONS: Even though an association was found between qSOFA and ICU admission, there was no association of qSOFA or the severity criteria with mortality. Therefore, patients with a tendency toward greater severity could be identified and treated more quickly and effectively in the emergency department. Further studies are necessary to assess novel scores or biomarkers to predict mortality in sepsis patients admitted to the ED's initial care.

Septicemic salmonellosis in suckling piglets resulting from improper intramuscular administration of an oral vaccine.

We describe an unusual outbreak of mortality in suckling piglets following the misadministration of an oral vaccine against Salmonella Typhimurium and Salmonella Choleraesuis. Within 3-48 h of vaccination of a batch of ~700 piglets, ~300 developed marked swelling in the dorsal neck region, respiratory distress, fever, recumbency, and apathy. In total, ~100 died, and 4 were submitted for autopsy. Gross and microscopic lesions consisted of focally extensive areas of purple discoloration in the skin of the cervical region, associated with edema and hemorrhage in the subcutis and muscles. Additionally, there was interstitial pneumonia with marked interlobular edema and mild fibrinous pleuritis. Aerobic bacterial culture identified Salmonella Typhimurium (3 cases) and Salmonella Choleraesuis (1 case) in samples of skeletal muscle and lung and from pleural swab samples. Marked immunostaining against Salmonella spp. was observed in the skeletal muscle of the cervical region, as well as in blood vessels and macrophages from the lung, liver, spleen, and kidney. We concluded that inappropriate intramuscular administration of an oral vaccine against Salmonella resulted in septicemia and death in a batch of piglets.

Molecular characterization of Aeromonas hydrophila isolates from diseased fishes in district Kasur, Punjab, Pakistan / Caracterização molecular de isolados de Aeromonas hydrophila de peixes doentes no distrito de Kasur, Punjab, Paquistão

Abstract Pakistan is an agricultural country and fisheries play a very important role in the economic development of the country. Different diseases are prevalent in Pakistani fish but information related to the causative agents is not well-known. Keeping in view the significance of bacterial pathogens as the causative agents of multiple fish diseases, the present study was conducted for identification, characterization and analysis of virulence genes of Aeromonas spp. isolated from diseased fishes. A total of fifty fish samples having multiple clinical indications were collected from different fish farms of district Kasur, Punjab Pakistan. For isolation of Aeromonas spp. samples were enriched and inoculated on Aeromonas isolation medium. Isolates were identified and characterized by different biochemical tests, Analytical Profile Index (API) 20E kit and Polymerase Chain Reaction (PCR) assays. All isolates were screened for three putative virulence genes including aerolysin (aer), haemolysin (hyl) and heat labile cytotonic enterotoxin (alt). Seven isolates of Aeromonas (A.) hydrophila were retrieved and identified based on API 20E. These isolates were further confirmed as A. hydrophila on the basis of PCR assays. Three isolates were detected positive for the presence of virulence genes (alt and hyl). Whereas aerolysin (aer) gene was not present in any of A. hydrophila isolates. The present study confirmed A. hydrophila as the causative agent of epizootic ulcerative syndrome and motile Aeromonas septicemia in fish farms of district Kasur, Punjab Pakistan. Moreover, detection of two virulence genes (alt and hyl) in A. hydrophila isolates is a threat for fish consumers of study area.

Resumo O Paquistão é um país agrícola, onde a pesca desempenha um papel muito importante para o desenvolvimento econômico. Diferentes doenças são prevalentes em peixes do Paquistão, mas as informações relacionadas aos agentes causadores não são bem conhecidas. Tendo em vista a importância dos patógenos bacterianos como agentes causadores de múltiplas doenças em peixes, o presente estudo foi conduzido para identificação, caracterização e análise de genes de virulência de isolados de Aeromonas spp. de peixes doentes. Foram coletadas 50 amostras de peixes com múltiplas indicações clínicas em diferentes fazendas do distrito de Kasur, Punjab, Paquistão. Para isolar Aeromonas spp., as amostras foram enriquecidas e inoculadas em meio de isolamento. Os isolados foram identificados e caracterizados por diferentes testes bioquímicos, kit Analytical Profile Index (API) 20E, e ensaios de reação em cadeia da polimerase (PCR). Todos os isolados foram selecionados para três genes de virulência putativos, incluindo aerolisina (aer), hemolisina (hyl) e enterotoxina citotônica termolábil (alt). Sete isolados de Aeromonas hydrophila foram recuperados e identificados com base no API 20E. Esses isolados foram posteriormente confirmados como A. hydrophila de acordo com ensaios de PCR. Três isolados indicaram a presença de genes de virulência (alt e hyl), enquanto o gene aerolisina (aer) não esteve presente em nenhum dos isolados de A. hydrophila. O presente estudo confirmou A. hydrophila como o agente causador da síndrome ulcerativa epizoótica e septicemia móvel por Aeromonas em fazendas de peixes, no distrito de Kasur, Punjab, Paquistão. Além disso, a detecção de dois genes de virulência (alt e hyl) em isolados de A. hydrophila é uma ameaça para os consumidores de peixes da área de estudo.

Molecular characterization of Aeromonas hydrophila isolates from diseased fishes in district Kasur, Punjab, Pakistan

Abstract Pakistan is an agricultural country and fisheries play a very important role in the economic development of the country. Different diseases are prevalent in Pakistani fish but information related to the causative agents is not well-known. Keeping in view the significance of bacterial pathogens as the causative agents of multiple fish diseases, the present study was conducted for identification, characterization and analysis of virulence genes of Aeromonas spp. isolated from diseased fishes. A total of fifty fish samples having multiple clinical indications were collected from different fish farms of district Kasur, Punjab Pakistan. For isolation of Aeromonas spp. samples were enriched and inoculated on Aeromonas isolation medium. Isolates were identified and characterized by different biochemical tests, Analytical Profile Index (API) 20E kit and Polymerase Chain Reaction (PCR) assays. All isolates were screened for three putative virulence genes including aerolysin (aer), haemolysin (hyl) and heat labile cytotonic enterotoxin (alt). Seven isolates of Aeromonas (A.) hydrophila were retrieved and identified based on API 20E. These isolates were further confirmed as A. hydrophila on the basis of PCR assays. Three isolates were detected positive for the presence of virulence genes (alt and hyl). Whereas aerolysin (aer) gene was not present in any of A. hydrophila isolates. The present study confirmed A. hydrophila as the causative agent of epizootic ulcerative syndrome and motile Aeromonas septicemia in fish farms of district Kasur, Punjab Pakistan. Moreover, detection of two virulence genes (alt and hyl) in A. hydrophila isolates is a threat for fish consumers of study area.

Resumo O Paquistão é um país agrícola, onde a pesca desempenha um papel muito importante para o desenvolvimento econômico. Diferentes doenças são prevalentes em peixes do Paquistão, mas as informações relacionadas aos agentes causadores não são bem conhecidas. Tendo em vista a importância dos patógenos bacterianos como agentes causadores de múltiplas doenças em peixes, o presente estudo foi conduzido para identificação, caracterização e análise de genes de virulência de isolados de Aeromonas spp. de peixes doentes. Foram coletadas 50 amostras de peixes com múltiplas indicações clínicas em diferentes fazendas do distrito de Kasur, Punjab, Paquistão. Para isolar Aeromonas spp., as amostras foram enriquecidas e inoculadas em meio de isolamento. Os isolados foram identificados e caracterizados por diferentes testes bioquímicos, kit Analytical Profile Index (API) 20E, e ensaios de reação em cadeia da polimerase (PCR). Todos os isolados foram selecionados para três genes de virulência putativos, incluindo aerolisina (aer), hemolisina (hyl) e enterotoxina citotônica termolábil (alt). Sete isolados de Aeromonas hydrophila foram recuperados e identificados com base no API 20E. Esses isolados foram posteriormente confirmados como A. hydrophila de acordo com ensaios de PCR. Três isolados indicaram a presença de genes de virulência (alt e hyl), enquanto o gene aerolisina (aer) não esteve presente em nenhum dos isolados de A. hydrophila. O presente estudo confirmou A. hydrophila como o agente causador da síndrome ulcerativa epizoótica e septicemia móvel por Aeromonas em fazendas de peixes, no distrito de Kasur, Punjab, Paquistão. Além disso, a detecção de dois genes de virulência (alt e hyl) em isolados de A. hydrophila é uma ameaça para os consumidores de peixes da área de estudo.

First Report of Aeromonas veronii as an Emerging Bacterial Pathogen of Farmed Nile Tilapia (Oreochromis niloticus) in Brazil.

Brazil is one of the world's leading producers of Nile tilapia, Oreochromis niloticus. However, the industry faces a major challenge in terms of infectious diseases, as at least five new pathogens have been formally described in the last five years. Aeromonas species are Gram-negative anaerobic bacteria that are often described as fish pathogens causing Motile Aeromonas Septicemia (MAS). In late December 2022, an epidemic outbreak was reported in farmed Nile tilapia in the state of São Paulo, Brazil, characterized by clinical signs and gross pathology suggestive of MAS. The objective of this study was to isolate, identify, and characterize in vitro and in vivo the causative agent of this epidemic outbreak. The bacterial isolates were identified as Aeromonas veronii based on the homology of 16S rRNA (99.9%), gyrB (98.9%), and the rpoB gene (99.1%). A. veronii showed susceptibility only to florfenicol, while it was resistant to the other three antimicrobials tested, oxytetracycline, enrofloxacin, and amoxicillin. The lowest florfenicol concentration capable of inhibiting bacterial growth was ≤0.5 µg/mL. The phenotypic resistance of the A. veronii isolate observed for quinolones and tetracycline was genetically confirmed by the presence of the qnrS2 (colE plasmid) and tetA antibiotic-resistant genes, respectively. A. veronii isolate was highly pathogenic in juvenile Nile tilapia tested in vivo, showing a mortality rate ranging from 3 to 100% in the lowest (1.2 × 104) and highest (1.2 × 108) bacterial dose groups, respectively. To our knowledge, this study would constitute the first report of highly pathogenic and multidrug-resistant A. veronii associated with outbreaks and high mortality rates in tilapia farmed in commercial net cages in Brazil.

Histophilus somni disease conditions with simultaneous infections by ovine gammaherpesvirus 2 in cattle herds from Southern Brazil.

This report investigated the cause of cattle mortality in two farms in Southern Brazil. The tissues of one animal from each farm (animals #1 and #2) respectively were used in pathological and molecular investigations to determine the possible cause of death. The principal pathological findings observed in animal #1 were pulmonary, myocardial, and encephalitic hemorrhages with vasculitis, and lymphoplasmacytic interstitial pneumonia with proliferative vascular lesions (PVL). The main pathological findings observed in animal #2 were purulent bronchopneumonia, hemorrhagic myocarditis, and lymphoplasmacytic interstitial pneumonia with PVL. An immunohistochemical assay detected intralesional antigens of a malignant catarrhal fever virus (MCFV) from multiple tissues of animal #2 while PCR confirmed that the MCFV amplified was ovine gammaherpesvirus 2 (OvGHV2), genus Macavirus, subfamily Gammaherpesvirinae; OvGHV2 was also amplified from multiple tissues of animal #1. Furthermore, PCR assays amplified Histophilus somni DNA from multiple fragments of both animals. However, the nucleic acids of Mannheimia haemolytica, Pasteurella multocida, Mycoplasma bovis, bovine respiratory syncytial virus, bovine alphaherpesvirus virus 1 and 5, bovine coronavirus, and bovine parainfluenza virus 3 were not amplified from any of the tissues analyzed, suggesting that these pathogens did not participate in the development of the lesions herein described. These findings demonstrated that both animals were concomitantly infected by H. somni and OvGHV2 and developed the septicemic and encephalitic manifestations of H. somni. Furthermore, the interstitial pneumonia observed in cow #2 was more likely associated with infection by OvGHV2.

Perfil clínico-epidemiológico de pacientes classificados com o discriminador sepse possível no departamento de emergência / Perfil clínico-epidemiológico de los pacientes clasificados con el posible discriminador de sepsis en el servicio de urgencias / Clinical-epidemiological profile of patients classified with the possible sepsis discriminator in the emergency department

Objetivo: descrever o perfil clínico-epidemiológico de pacientes classificados com o discriminador "sepse possível" do Sistema Manchester de Classificação de Risco em um departamento de emergência terciário. Método: estudo observacional retrospectivo, realizado no período de janeiro de 2018 a dezembro de 2019. A amostra foi composta por 1522 pacientes. A coleta de dados foi realizada em dados de prontuário eletrônico. A análise foi realizada com o uso de estatística descritiva. Resultados: O sexo feminino foi majoritário (50,6%), com idade média de 63,7 anos (±15,48). A maioria dos atendimentos foi por demanda espontânea (74,1%), com tempos médios de espera para CR e tempo de CR de 3/4 e 4/3 minutos, em 2018 e 2019, respectivamente. Conclusão: É necessário associar o protocolo de classificação de risco, já instituído, outros mecanismos a fim de aprimorar o entendimento e o fluxo assistencial acerca de pacientes potencialmente sépticos.(AU)

Objective: The present study aims to describe the clinical profile of patients classified with the discriminator "possible sepsis" of the Manchester Risk Classification System in a terciary emergency department. Method: Retrospective observational study, carried out from January 2018 to December 2019. The sample composed of 1522 patients. Data collection was performed using electronic medical records. Analysis performed using descriptive statistics. Results: Females were the majority (50.6%), with a mean age of 63.7 years (±15.48). Most attendances were by spontaneous demand (74.1%), with average waiting times for risk classification and risk classification time of 3/4 and 4/3 minutes, in 2018 and 2019, respectively. Conclusion: It is necessary to associate the risk classification protocol, already in place, with other mechanisms in order to improve the understanding and care flow about potentially septic patients.(AU)

Objetivo: describir el perfil clínico-epidemiológico de los pacientes clasificados con el discriminador "posible sepsis" del Manchester Risk Classification System en un servicio de urgencias de tercer nivel. Método: estudio observacional retrospectivo, realizado de enero de 2018 a diciembre de 2019. La muestra estuvo compuesta por 1522 pacientes. La recolección de datos se realizó mediante historias clínicas electrónicas. El análisis se realizó mediante estadística descriptiva. Resultados: el sexo femenino fue mayoritario (50,6%), con una edad media de 63,7 años (±15,48). La mayoría de las atenciones fueron por demanda espontánea (74,1%), con tiempos promedio de espera para clasificación de riesgo y tiempo de clasificación de riesgo de 3/4 y 4/3 minutos, en 2018 y 2019, respectivamente. Conclusión: Es necesario asociar el protocolo de clasificación de riesgo, ya existente, con otros mecanismos para mejorar la comprensión y el flujo de atención sobre pacientes potencialmente sépticos.(AU)

Características epidemiológicas de la endocarditis infecciosa. Experiencia de seis años / Epidemiological characteristics of infective endocarditis. Six years of experience

Resumen Introducción: La endocarditis infecciosa continúa siendo una condición amenazante para la vida, que puede afectar cualquier órgano y sistema, con alta mortalidad, atribuible principalmente a Staphylococcus aureus. Implica un reto diagnóstico y terapéutico, que requiere un cuidado multidisciplinario. Objetivo: Describir las características clínicas y microbiológicas en pacientes con endocarditis infecciosa. Materiales y método: Estudio observacional descriptivo basado en la revisión de historias clínicas en un centro médico de referencia en Medellín, Colombia, incluyendo pacientes mayores de 18 años hospitalizados durante el periodo de enero de 2011 a febrero de 2017. Resultados: 130 pacientes, con edad promedio de 53 años (± 16). La hipertensión arterial y la enfermedad renal crónica fueron la comorbilidad más frecuente (55% y 38%, respectivamente). La fiebre fue el síntoma cardinal (90%). Predominó la endocarditis infecciosa de válvula nativa (85.7%), afectando principalmente la mitral (40%). El agente etiológico más frecuente fue S. aureus (sensible a oxacilina 44%), y se complicaron con embolia el 52.5% y con falla cardiaca el 30.8%. La mortalidad intrahospitalaria fue del 39.2%. Conclusiones: La endocarditis infecciosa tiene variadas manifestaciones clínicas, entre las que destacan la embolia sistémica y la falla cardiaca aguda, que condicionan una mortalidad elevada (mayor que la reportada en otros estudios). El aislamiento microbiológico más frecuente es el bacteriano, principalmente S. aureus, como lo muestra la tendencia global.

Abstract Background: Infective endocarditis continues to be a life-threatening condition, can involve every organ system, with high mortality, attributable mainly to Staphylococcus aureus. It implies a diagnostic and therapeutic challenge, which requires multidisciplinary care. Objective: To describe the clinical and microbiological characteristics in patients with infectious endocarditis. Materials and method: Descriptive observational study, based on the review of medical records in a reference medical center in Medellín, Colombia. Including patients over 18 years hospitalized during the period from January 2011 to February 2017. Results: 130 patients, with an average age of 53 years (± 16). Hypertension and chronic kidney disease was the most common comorbidity (55% and 38%, respectively). Fever was the cardinal symptom (90%). Native valve infective endocarditis predominated (85.7%), mainly affecting the mitral valve (40%). The most frequent etiologic agent was Staphylococcus aureus (oxacillin sensitive 44%), embolism was the main complication by 52.5% followed by heart failure (30.8%). In-hospital mortality was 39.2%. Conclusions: Infective endocarditis has varied clinical manifestations, including systemic embolism and acute heart failure, which lead to high mortality (higher than that reported in other studies). The most frequent microbiological isolation is bacterial, mainly Staphylococcus aureus, as shown by the global trend.

Enterogyrus spp. (Monogenea: Ancyrocephalinae) and Aeromonas jandaei co-infection associated with high mortality following transport stress in cultured Nile tilapia.

Monogenean infection of the internal organs is extremely rare when compared to external infections. This study describes mass mortality of Nile tilapia (Oreochromis niloticus L.) originating from co-infection with Enterogyrus spp. and Aeromonas jandaei following transport stress. The first fish deaths occurred on day 1 post-transport, while cumulative mortality reached approximately 90% by day 10 post-stocking. An atypical amount of pale (whitish) faeces floating on the surface of the water as well as typical clinical signs of motile Aeromonas septicemia, were reported. Adult monogeneans and countless eggs of monogeneans were found in the stomachs and the intestines of both moribund and dead fish, respectively. Two strains of A. jandaei were isolated from the kidneys. Scanning electron microscope microphotographs of the stomach revealed the presence of numerous monogeneans penetrating deep into the gastric tissue, and diffuse lesions filled with bacilliform bacteria. Histopathological examination showed multifocal eosinophilic infiltrate, gastric gland and epithelial necrosis with sloughed necrotic debris in the lumen. This is the first report of co-infection by Enterogyrus spp. and A. jandaei in Nile tilapia and the first report of Enterogyrus coronatus, Enterogyrus foratus, and Enterogyrus malbergi parasitizing tilapia in Brazil. These findings indicate that synergic co-infection by Monogenean stomach parasites (E. coronatus, E. foratus, and E. malbergi) and A. jandaei may induce high mortalities in tilapia following transport stress.

Perfil clínico de pacientes com sepse internados em unidade de terapia intensiva: um estudo transversal / Clinical profile of patients with sepsis admitted to an intensive care unit: a cross-cutting study / Perfil clínico de pacientes con sepsis ingresados en unidad de cuidados intensivos: estudio transversal

Objetivo: identificar o perfil clínico de pacientes com sepse internados em Unidade de Terapia Intensiva. Método: pesquisa documental. A amostra contou com 50 prontuários de pacientes com quadro de sepse. A análise foi realizada através de estatística descritiva e teste de Qui-Quadrado de Pearson. O estudo foi aprovado pelo Comitê de Ética em Pesquisa sob número de protocolo 3.779.654. Resultados: idade média foi de 66,4 anos, prevaleceram os indivíduos do sexo masculino, que eram procedentes da emergência, com acesso venoso central e sondagem vesical de demora, sepse pulmonar, presença de distúrbios cardiovasculares e óbito como desfecho. Observou-se associação significativa entre distúrbios gastrointestinais e envelhecimento com sepse abdominal. Conclusão: é necessário o fortalecimento de políticas públicas de saúde voltadas para a qualificação dos profissionais com intuito de prevenir e reconhecer precocemente a sepse

Objective: to identify the clinical profile of patients with sepsis admitted to the Intensive Care Unit. Method: documentary research. The sample included 50 medical records of patients with sepsis. The analysis was performed using descriptive statistics and Pearson's Chi-Square test. The study was approved by the Research Ethics Committee under protocol number 3,779,654. Results: mean age was 66.4 years, males who came from the emergency room prevailed, with central venous access and indwelling urinary catheter, pulmonary sepsis, presence of cardiovascular disorders and death as an outcome. There was a significant association between gastrointestinal disorders and aging with abdominal sepsis. Conclusion: it is necessary to strengthen public health policies aimed at training professionals in order to prevent and early recognize sepsis

Objetivo: identificar el perfil clínico de los pacientes con sepsis ingresados en la Unidad de Cuidados Intensivos. Método: investigación documental. La muestra incluyó 50 historias clínicas de pacientes con sepsis. El análisis se realizó mediante estadística descriptiva y la prueba de chi-cuadrado de Pearson. El estudio fue aprobado por el Comité de Ética en Investigación con el número de protocolo 3.779.654. Resultados: la edad promedio fue de 66,4 años, predominaron los varones que acudieron a urgencias, con acceso venoso central y sonda vesical permanente, sepsis pulmonar, presencia de trastornos cardiovasculares y muerte como desenlace. Hubo una asociación significativa entre los trastornos gastrointestinales y el envejecimiento con sepsis abdominal. Conclusión: es necesario fortalecer las políticas de salud pública orientadas a la formación de profesionales para prevenir y reconocer precozmente la sepsis

Sepsis mortality and the Human Development Index in Brazilian capitals: 1990-2016 / Mortalidade por sepse e Índice de Desenvolvimento Humano nas capitais brasileiras: 1990-2016 / Mortalidad por sepsis e Índice de Desarrollo Humano en las capitales brasileñas: 1990-2016

Background and Objectives: the Human Development Index is among the determinants associated with access to health services and sepsis assistance. This study aimed to describe the frequency of mortality from sepsis in Brazilian capitals and verify its correlation with the Human Development Index (HDI), in three-year periods that represented from the early 90's to 2016. Methods: a time series ecological epidemiology study, with consultation in secondary database involving Brazilian capital variables, population, deaths from sepsis and HDI. Correlation was assessed with Pearson's/Spearman's correlation coefficient. Results: the three highest mean coefficients of mortality from sepsis were observed in Rio Branco (9082.50), Manaus (6367.25) and Macapá (6085.25). A significant correlation was found between the mean mortality rate and the mean HDI in Aracaju (-0,999; p=0.001), Brasília (-0,991; p=0.009), Campo Grande (-0,977; p=0.023), Cuiabá (-0.983; p=0.017), Florianópolis (0.999; p=0.001), Goiânia (-0.997; p=0.003), Maceió (-0.987; p=0.013), Natal (-0.962; p=0.038), Palmas (-0.982; p=0.018) and Vitória (-0.998; p=0.002). Conclusion: there is a general correlation between the mean mortality coefficients and HDI. As HDI increases, there is a decrease in mortality from sepsis.(AU)

Justificativa e Objetivos: o Índice de Desenvolvimento Humano está entre os determinantes associados ao acesso aos serviços de saúde e assistência à sepse. Este estudo teve como objetivo descrever a frequência de mortalidade por sepse nas capitais brasileiras e verificar sua correlação com o Índice de Desenvolvimento Humano (IDH), em triênios que representaram do início da década de 90 a 2016. Métodos: estudo epidemiológico ecológico de série temporal, com consulta em banco de dados secundário envolvendo variáveis da capital brasileira, população, óbitos por sepse e IDH. A correlação foi avaliada com o coeficiente de correlação de Pearson/Spearman. Resultados: os três maiores coeficientes médios de mortalidade por sepse foram observados em Rio Branco (9.082,50), Manaus (6.367,25) e Macapá (6.085,25). Foi encontrada correlação significativa entre a taxa média de mortalidade e o IDH médio em Aracaju (-0,999; p=0,001), Brasília (-0,991; p=0,009), Campo Grande (-0,977; p=0,023), Cuiabá (-0,983 ; p=0,017), Florianópolis (0,999; p=0,001), Goiânia (-0,997; p=0,003), Maceió (-0,987; p=0,013), Natal (-0,962; p=0,038), Palmas (-0,982; p=0,018) e Vitória (-0,998; p=0,002). Conclusão: existe uma correlação geral entre os coeficientes médios de mortalidade e o IDH. À medida que o IDH aumenta, há uma diminuição na mortalidade por sepse.(AU)

Justificación y Objetivos: el Índice de Desarrollo Humano se encuentra entre los determinantes asociados al acceso a los servicios de salud y asistencia a la sepsis. Este estudio tuvo como objetivo describir la frecuencia de mortalidad por sepsis en las capitales brasileñas y verificar su correlación con el Índice de Desarrollo Humano (IDH), en períodos de tres años que representaron desde principios de la década de 1990 hasta 2016. Métodos: estudio de epidemiología ecológica de serie temporal, con consulta en base de datos secundaria involucrando variables de la capital brasileña, población, muertes por sepsis e IDH. La correlación se evaluó con el coeficiente de correlación de Pearson/Spearman. Resultados: los tres mayores coeficientes medios de mortalidad por sepsis se observaron en Rio Branco (9082,50), Manaus (6367,25) y Macapá (6085,25). Se encontró una correlación significativa entre la tasa de mortalidad media y el IDH medio en Aracaju (-0,999; p=0,001), Brasilia (-0,991; p=0,009), Campo Grande (-0,977; p=0,023), Cuiabá (-0,983 ; p=0,017), Florianópolis (0,999; p=0,001), Goiânia (-0,997; p=0,003), Maceió (-0,987; p=0,013), Natal (-0,962; p=0,038), Palmas (-0,982; p=0,018) y Victoria (-0,998; p=0,002). Conclusión: existe una correlación general entre los coeficientes medios de mortalidad y el IDH. A medida que aumenta el IDH, disminuye la mortalidad por sepsis.(AU)

A rare case of meningitis and septicemia caused by Streptococcus suis in a woman without a history of live pig contact or eating raw pork.

Streptococcus suis (S. suis) is a zoonotic pathogen that primarily inhabits the upper respiratory tract of pigs. Therefore, pigs that carry these pathogens are the major source of infection. Most patients are infected through contact with live pigs or unprocessed pork products and eating uncooked pork. S. Suis mainly causes sepsis and meningitis. The disease has an insidious onset and rapid progress. The patient becomes critically ill and the mortality is high. In this case report, we described a rare case of S. suis isolated from a middle-aged woman in Jinhua City, Zhejiang Province, China, who did not have any contact with live pigs and had not eaten uncooked pork. S. Suis was isolated from both the patient's blood and cerebrospinal fluid samples.

Effectiveness of a proteoliposome-based vaccine against salmonid rickettsial septicaemia in Oncorhynchus mykiss.

Salmonid rickettsial septicaemia (SRS) is a contagious disease caused by Piscirickettsia salmonis, an intracellular bacterium. SRS causes an estimated economic loss of $700 million USD to the Chilean industry annually. Vaccination and antibiotic therapy are the primary prophylactic and control measures used against SRS. Unfortunately, commercially available SRS vaccines have not been shown to have a significant effect on reducing mortality. Most vaccines contain whole inactivated bacteria which results in decreased efficacy due to the limited ability of the vaccine to evoke a cellular mediated immune response that can eliminate the pathogen or infected cells. In addition, SRS vaccine efficacy has been evaluated primarily with Salmo salar (Atlantic salmon). Vaccine studies using Oncorhynchus mykiss (rainbow trout) are scarce, despite SRS being the leading cause of infectious death for this species. In this study, we evaluate an injectable vaccine based on P. salmonis proteoliposome; describing the vaccine security profile, capacity to induce specific anti-P. salmonis IgM and gene expression of immune markers related to T CD8 cell-mediated immunity. Efficacy was determined by experimental challenge with P. salmonis intraperitoneally. Our findings indicate that a P. salmonis proteoliposome-based vaccine is able to protect O. mykiss against challenge with a P. salmonis Chilean isolate and causes a specific antibody response. The transcriptional profile suggests that the vaccine is capable of inducing cellular immunity. This study provides new insights into O. mykiss protection and the immune response induced by a P. salmonis proteoliposome-based vaccine.

Interspecies transmission of Edwardsiella ictaluri in Brazilian catfish (Pseudoplatystoma corruscans) from exotic invasive fish species.

Infections caused by Edwardsiella ictaluri are one of the biggest problems in the catfish industry in North America and have been reported in fishes around the world. E. ictaluri was detected in juvenile pintado Pseudoplatystoma corruscans-a Brazilian catfish-in a farm in Paraná State, Brazil; diseased animals showed ascites and neurological signs of infection, with more than 50% mortality. Exotic invasive species susceptible to this bacterium have been reported in this area. We assessed the susceptibility of pintado to E. ictaluri with experimental infection via intraperitoneal and immersion methods as well as a cohabitation experiment with Nile tilapia Oreochromis niloticus and African walking catfish Clarias gariepinus, 2 exotic invasive species. All pintados challenged by intraperitoneal and immersion routes and those cohabiting with infected C. gariepinus died within 17 d of the challenge. Mortality of Nile tilapia reached 71.42% after the intraperitoneal and 35.71% in the immersion challenges within 28 d, whereas African walking catfish showed zero mortality. Observed clinical signs were comparable to those in the farm and those described in the literature as enteric septicemia of catfish. With this study, we demonstrated the susceptibility of P. corruscans to E. ictaluri, as well as interspecies transmission of this bacterium.

The Analysis of Live-Attenuated Piscirickettsia salmonis Vaccine Reveals the Short-Term Upregulation of Innate and Adaptive Immune Genes in Atlantic Salmon (Salmo salar): An In Situ Open-Sea Cages Study.

Piscirickettsia salmonis, the etiological agent of the Salmon Rickettsial Septicemia (SRS), is one the most serious health problems for the Chilean salmon industry. Typical antimicrobial strategies used against P. salmonis include antibiotics and vaccines, but these applications have largely failed. A few years ago, the first attenuated-live vaccine against SRS (ALPHA JECT LiVac® SRS vaccine) was released to the market. However, there is no data about the agents involved in the activation of the immune response induced under field conditions. Therefore, in this study we evaluated the expression profile of a set of gene markers related to innate and adaptive immunity in the context of a cellular response in Atlantic salmon (Salmo salar) reared under productive farm conditions and immunized with a live-attenuated vaccine against P. salmonis. We analyzed the expression at zero, 5-, 15- and 45-days post-vaccination (dpv). Our results reveal that the administration of the attenuated live SRS LiVac vaccine induces a short-term upregulation of the cellular-mediated immune response at 5 dpv modulated by the upregulation of ifnα, ifnγ, and the cd4 and cd8α T cell surface markers. In addition, we also registered the upregulation of il-10 and tgfß. Altogether, the results suggest that a balanced activation of the immune response took place only at early times post-vaccination (5 dpv). The scope of this short-term upregulation of the cellular-mediated immune response against a natural outbreak in fish subjected to productive farm conditions deserves further research.

ETosis in tambaqui Colossoma macropomum: A programmed cell death pathway and approach of leukocytes immune response.

Tambaqui Colossoma macropomum is the most cultivated native fish in South America and Aeromonas hydrophila is one of the main bacteria infecting tropical fish. Despite the economic importance of this round fish, to date, there has been a paucity of investigations into haematological changes in tambaqui. In this study, detailed blood analyses (0 h, 6 h, 24 h, 7 d and 14 d) following intraperitoneal challenge with A. hydrophila were performed. After analysing the results, there was a suspicion of a novel cell death mechanism via extracellular traps (ETosis) in tambaqui. The search for ETosis was based on differential interference contrast (DIC) microscopy and scanning electron microscopy (SEM) assays through application of an adapted protocol applying co-incubation of leukocytes with A. hydrophila. The cells were investigated at: 0 h (control), 4 h and 7 h after incubation. The complete haemogram profile showed an uncommon severe leukopenia in early phases of infection (6 h, p < 0.001 and ≤ 0.05), due to significant decreases in the three main leukocytes: lymphocytes (6 h, p ≤ 0.001), monocytes (6 h, p ≤ 0.05) and neutrophils (6 h and 24 h, p ≤ 0.01 and p ≤ 0.05). Leucocytosis and lymphocytosis (p ≤ 0.01) were ascertained only 7 days post-infection. Through DIC and SEM, we discovered that leukocyte suicide exposed the nuclear contents between 4 and 7 h after stimuli with bacteria. The leukogram profile associated with DIC and SEM analyses suggested that tambaqui leukocytes underwent a programmed death (ETosis) in order to expose chromatin and granule proteins as a trap to bind and then kill bacteria; thus, preventing A. hydrophila from spreading and resulting in leukopenia during the early phase of bacterial infection. In this paper, we presume that ETosis is one of the last resources for tambaqui to contain the infection, and after this leukocyte strategy, a high number of phagocytic cells are produced and released into the peripheral circulation.

Motile aeromonad septicemia (MAS) at Cyprinus carpio L, 1758 (Actinopterygii: Cyprinidae) in Lake Tödürge (Sivas/Turkey) / [Septicemia móvel por aeromonada (SMA) em Cyprinus carpio L, 1758 (Actinopterygii: Cyprinidae) no lago Tödürge (Sivas, Turquia)]

In this study, fish's morphologic and anatomic lesions caused by motile aeromonad septicemia (MAS) depending on environmental stress in carp, Cyprinus carpio population living in Lake Tödürge were identified. Various morphological and anatomical deformations and lesions were observed in the body of approximately 17% (252 fish specimens) of a total of 1488 carp samples. Bacteria are grown from all wipe samples. Bacterial colonies have a gray-white appearance with round, convex and smooth edges. 15-20 cfu colonies were observed in each aerop culture. As a result of analysis of wet wipe samples from infected fish's skin, gill, kidney and liver, it is determined that the bacteria which causes septicemia is Aeromonas sobria from the Aeromonadaceae family (with 99.2% confidence value). No bacteria were grown in cultures except A. sobria. Some symptoms of the infection are inflammation on different parts of the fish bodies, eruption on skin and scales, dermal necrosis, degeneration at soft rays of the fins, exophthalmos, and purulent liquid accumulation in the abdominal cavity, etc. Infected fish were most commonly encountered in July and August (water temperature above 20ºC), the lowest in October and November (water temperature below 10ºC).(AU)

Neste estudo, foram identificadas lesões morfológicas e anatômicas causadas por septicemia móvel por aeromônios (MPA), dependendo do estresse ambiental da carpa, a população de Cyprinus carpio que vive no lago Tödürge foi identificada. Várias deformações e lesões morfológicas e anatômicas foram observadas no corpo de aproximadamente 17% (252 amostras de peixes) de um total de 1488 amostras de carpa. As bactérias são cultivadas a partir de todas as amostras de limpeza. As colônias bacterianas têm uma aparência branco-acinzentada, com bordas arredondadas, convexas e lisas. Foram observadas 15-20 colônias de UFC em cada cultura de aerop. Como resultado da análise de amostras de lenços umedecidos da pele, brânquias, rins e fígado de peixes infectados, é determinado que a bactéria que causa a septicemia é a Aeromonas sobria, da família Aeromonadaceae (com valor de confiança de 99,2%). Nenhuma bactéria foi cultivada em culturas, exceto A. sobria. Alguns sintomas da infecção são inflamação em diferentes partes dos corpos dos peixes, erupção na pele e escamas, necrose dérmica, degeneração aos raios moles das barbatanas, exoftalmia e acúmulo de líquido purulento na cavidade abdominal, entre outros. Os peixes infectados eram encontrados com maior frequência em julho e agosto (temperatura da água acima de 20ºC), e eram menos comumente encontrados em outubro e novembro (temperatura da água abaixo de 10ºC).(AU)

Salmonelose em bezerros pelo sorovar Dublin no estado do Paraná, Brasil - aspectos clínico-patológicos / Salmonellosis in calves by serovar Dublin in Paraná State, Brazil - clinicopathological aspects

Background: Calf diarrhea remains one of the main diseases affecting the cattle industry. Persistence of this significant problem is associated with the complexity of factors that may be involved (infectious, environmental). An accurate diagnosis is essential for confirming the cause and helping clinicians and cattle producers to apply appropriate strategies in a timely manner. This report describes the histological changes according to the degree of salmonellosis severity, which is a contagious infectious disease caused by Salmonella enterica subsp. enterica, a Gram-negative bacterium, in two beef calves in northern Paraná State, southern Brazil. Cases: Two 90-day-old crossbred Angus and Nellore calves from a beef farm in northern Paraná State were referred to a Veterinary Hospital. Animal 1- developed acute clinical signs (enteritis, ataxia, and muscle rigidity) and died the day after the signs began. Gross findings included heavy and non-collapsed lungs, pulmonary oedema, hepatomegaly, enteritis, and severe diffuse typhlitis. Microscopic analysis revealed severe diffuse necrotic enteritis, typhlitis, severe diffuse interstitial pneumonia, moderate centrilobular hepatic necrosis, mild multifocal nephritis, and severe spleen and lymph node necrosis. Paratyphoid nodules were evidenced on the liver, spleen, and mesenteric lymph nodes. Animal 2- presented apathy, green fibrinous diarrhea, and died three days after the onset of clinical signs. The macroscopic examination showed moderate diffuse enteritis and hepatosplenomegaly. At the microscopic examination, many paratyphoid nodules were observed on the liver, spleen, kidneys, and Peyer's patches, which were associated with intralesional and intravascular bacilli. Additional findings included severe diffuse fibrinous necrotic enteritis with intralesional bacilli, diffuse interstitial pneumonia, multifocal splenic necrosis, lymphoid depletion, and moderate multifocal to coalescent lymphocytic nephritis. Histological Gram staining was performed on selected samples, revealing intralesional Gram-negative bacilli in the liver and intestine. Thus, liver and intestine fragments were used for the microbiological examination. Microbiological culture, isolation and biochemical tests identified the genus Salmonella spp. Then, the colonies were subjected to serological tests for serovar identification, according to ISO/TR 6579-3, which determined the serovar Dublin. After identifying the disease etiological agent, the outbreak was controlled by appropriate antibiotic therapy combined with the correction of sanitary measures. Discussion: Enteritis is a frequent disease in calves, posing a diagnostic challenge in identifying the etiological agent. In the present case, the histological, microbiological, and serological results confirmed a disseminated Salmonella spp. infection. The microscopic findings, such as interstitial pneumonia, fibrinous necrotic enteritis markedly in ileum and paratyphoid nodules in various organs, are the most common aspects of the disease. However, fibrinous cholecystitis, which is considered pathognomonic for salmonellosis, was not observed in this study. Therefore, the absence of such a lesion should not exclude the disease in sick animals. A microscopic injury score was used to determine lesion severity by assigning values from 1 to 4, wherein: 1 = no apparent lesions, 2 = mild lesions, 3 = moderate lesions, and 4 = severe lesions. Both calves were scored as 4. Multiple predisposing factors for the condition were identified in this farm such as different age animals in the same paddock and no specific paddock for sick animals, given that the infectious agent remains in feces, saliva, and nasal discharge. The serovar Dublin induces several clinical signs such as septicemic, respiratory, and enteric manifestations, making a clinical diagnosis a challenge

Why septic patients remain sick after hospital discharge?

Sepsis is well known to cause a high patient death rate (up to 50%) during the intensive care unit (ICU) stay. In addition, sepsis survival patients also exhibit a very high death rate after hospital discharge compared to patients with any other disease. The addressed question is then: why septic patients remain ill after hospital discharge? The cellular and molecular mechanisms involved in the high rate of septic patient deaths are still unknown. We described herein the studies that investigated the percentage of septic patients that died after hospital discharge ranging from 90 days up to 5 years. We also reported the symptoms of septic patients after hospital discharge and the development of the recently called post-sepsis syndrome (PSS). The most common symptoms of the PSS are cognitive disabilities, physical functioning decline, difficulties in performing routine daily activities, and poor life quality. The PSS also associates with quite often reinfection and re-hospitalization. This condition is the cause of the high rate of death mentioned above. We reported the proportion of patients dying after hospital discharge up to 5 years of followed up and the PSS symptoms associated. The authors also discuss the possible cellular and metabolic reprogramming mechanisms related with the low survival of septic patients and the occurrence of PSS.