Hand, foot, and mouth disease: A case report

Hand, foot, and mouth disease is a viral infection related to coxsackieviruses A5, A6, A9, and A10, coxsackieviruses B2 and B5, and echovirus 11. It generally affects children, but this article presents a clinical case of a young woman with hand, foot, and mouth disease. Patients with this disease have oral and skin lesions that may be confused with other diseases. The differential diagnosis is very important because both dental and medical professionals may misdiagnose the disease and sometimes prescribe an inappropriate medication.

Distribution of Xylella fastidiosa in citrus rootstocks and transmission of citrus variegated chlorosis between sweet orange plants through natural root grafts

To study translocation of Xylella fastidiosa to citrus rootstocks, budsticks from citrus variegated chlorosis (CVC)-affected cv. Pera sweet orange (Citrus sinenesis (L.) Osb.) were top grafted on 15 citrus rootstocks. Disease symptoms were conspicuous 3 months later on all 15 rootstocks tested. The presence of X. fastidiosa was confirmed by light microscopy, double-antibody sandwich enzyme-linked immunosorbent assays, and polymerase chain reaction in rootlets and main roots of CVC-symptomatic Pera sweet orange in 11 of the 15 rootstocks tested. These results suggest that bacterial translocation from the aerial plant parts to the root system occurs but is not essential for X. fastidiosa to induce symptoms in the aerial parts. Bacterial translocation to the roots was not correlated with CVC leaf-symptom severity in the Pera scion. To determine if CVC disease could be transmitted by natural root grafts, two matched seedlings of each of four sweet orange cultivars (Pera, Natal, Valencia, and Caipira) were transplanted into single pots. One seedling rootstock of each pair was inoculated by top grafting with a CVC-contaminated budstick while the other seedling rootstock was cut but not graft inoculated. Transmission of X. fastidiosa from an inoculated plant to a noninoculated plant sharing the same pot was observed in all four sweet orange cultivars tested. Transmission was confirmed by observation of natural roots grafts between the two plants, presence of X. fastidiosa in the root grafts, and disease development in the uninoculated plants. This is the first report of transmission of CVC disease through natural root grafts.

Biologic and genetics aspects of chagas disease at endemic areas

The etiologic agent of Chagas Disease is the Trypanosoma cruzi, transmitted through blood-sucking insect vectors of the Triatominae subfamily, representing one of the most serious public health concerns in Latin America. There are geographic variations in the prevalence of clinical forms and morbidity of Chagas disease, likely due to genetic variation of the T. cruzi and the host genetic and environmental features. Increasing evidence has supported that inflammatory cytokines and chemokines are responsible for the generation of the inflammatory infiltrate and tissue damage. Moreover, genetic polymorphisms, protein expression levels, and genomic imbalances are associated with disease progression. This paper discusses these key aspects. Large surveys were carried out in Brazil and served as baseline for definition of the control measures adopted. However, Chagas disease is still active, and aspects such as host-parasite interactions, genetic mechanisms of cellular interaction, genetic variability, and tropism need further investigations in the attempt to eradicate the disease. Copyright 2012 Marilanda Ferreira Bellini et al.

Spatial Management of Wildlife Disease

The spread of wildlife diseases is a major threat to livestock, human health, resource-based recreation, and biodiversity conservation (Cleaveland, Laurenson, and Taylor). The development of economically sound wildlife disease-management strategies requires an understanding of the links between ecological functions (e.g., disease transmission and wildlife dispersal) and economic choices, and the associated tradeoffs. Spatial linkages are particularly relevant. Yet while ecologists have long-argued that space is important (Hudson et al.), prior economic work has largely ignored spatial issues. For instance, Horan and Wolf analyzed a case study of bovine tuberculosis (bTB) in Michigan deer, a problem where the disease appears to be confined to a single, spatially confined, wildlife population—an island. But wildlife disease matters generally are not spatially confined. Barlow, in analyzing bTB in possums in New Zealand, accounted for immigration of susceptible possums into a disease reservoir. However, he modeled immigration as fixed and unaffected by management. Bicknell, Wilen, and Howitt, also focusing on possums in New Zealand, developed a model that incorporates simple density-dependent net migration. This allowed the authors to account for endogenous immigration when deriving optimal culling strategies.

The Economics of Managing Wildlife Disease

The spread of infectious disease among and between wild and domesticated animals has become a major problem worldwide. Upon analyzing the dynamics of wildlife growth and infection when the diseased animals cannot be identified separately from healthy wildlife prior to the kill, we find that harvest-based strategies alone have no impact on disease transmission. Other controls that directly influence disease transmission and/or mortality are required. Next, we analyze the socially optimal management of infectious wildlife. The model is applied to the problem of bovine tuberculosis among Michigan white-tailed deer, with non-selective harvests and supplemental feeding being the control variables. Using a two-state linear control model, we find a two-dimensional singular path is optimal (as opposed to a more conventional bang-bang solution) as part of a cycle that results in the disease remaining endemic in the wildlife. This result follows from non-selective harvesting and intermittent wildlife productivity gains from supplemental feeding.

Scraping Behavior in Male White-tailed Deer as a Potential Means of Transmitting Chronic Wasting Disease

Chronic wasting disease (CWD) has become a concern for wildlife managers and hunters across the United States. High prevalence of chronic wasting disease (CWD) in older male white-tailed deer (Odocoileus virginianus) suggests that sex-specific social behavior may contribute to the spread of the disease among males. Scraping is a marking behavior performed by male white-tailed deer during the rut in which a pawed depression and associated over-hanging branch are marked with saliva, glandular secretions, urine, and feces. We placed 71 and 35 motion-activated cameras on scrapes in DeSoto National Wildlife Refuge in western Nebraska and eastern Iowa from Oct. – Nov. 2005 and Sept. – Nov. 2006, respectively. We recorded 5009 encounters and 1830 direct interactions. We developed an ethogram of behaviors of interest at scrapes. We found that males interacted with scrapes more frequently than females (P < 0.001). Male interactions were more complex, with 69% consisting of ≥2 observed behaviors versus 25% and 13% for females and fawns. We identified individual male deer ≥2.5 years old and determined the minimum number of different scrapes individuals visited and the number of individuals that visit a single scrape. Individuals that appeared on camera ≥5 times visited a mean of 3.9 scrapes (range = 1-15) and traveled a mean minimum distance of 978 m between consecutive scrapes. A mean of 5.1 individuals visited a single scrape, and up to 43% of individuals returned to a scrape previously visited at least once. We modeled Risk Values based on frequency of occurrence, duration, and Threat Values of each behavior, for contacting and transmitting CWD prions at scrapes. Adult males had the highest total Risk Values for contacting CWD prions (114.1) and shedding prions (59.4). The “grasp-lick branch” behavior had the highest Risk Value for adult males for both contacting and transmitting prions. Our study reveals a sex specific social behavior in male white-tailed deer that has the potential to spread chronic wasting disease between adult males in the population.

Clusters of leprosy transmission and of late diagnosis in a highly endemic area in Brazil: focus on different spatial analysis approaches

Objective The Brazilian National Hansens Disease Control Program recently identified clusters with high disease transmission. Herein, we present different spatial analytical approaches to define highly vulnerable areas in one of these clusters. Method The study area included 373 municipalities in the four Brazilian states Maranha o, Para ', Tocantins and Piaui '. Spatial analysis was based on municipalities as the observation unit, considering the following disease indicators: (i) rate of new cases / 100 000 population, (ii) rate of cases < 15 years / 100 000 population, (iii) new cases with grade-2 disability / 100 000 population and (iv) proportion of new cases with grade-2 disabilities. We performed descriptive spatial analysis, local empirical Bayesian analysis and spatial scan statistic. Results A total of 254 (68.0%) municipalities were classified as hyperendemic (mean annual detection rates > 40 cases / 100 000 inhabitants). There was a concentration of municipalities with higher detection rates in Para ' and in the center of Maranha o. Spatial scan statistic identified 23 likely clusters of new leprosy case detection rates, most of them localized in these two states. These clusters included only 32% of the total population, but 55.4% of new leprosy cases. We also identified 16 significant clusters for the detection rate < 15 years and 11 likely clusters of new cases with grade-2. Several clusters of new cases with grade-2 / population overlap with those of new cases detection and detection of children < 15 years of age. The proportion of new cases with grade-2 did not reveal any significant clusters. Conclusions Several municipality clusters for high leprosy transmission and late diagnosis were identified in an endemic area using different statistical approaches. Spatial scan statistic is adequate to validate and confirm high-risk leprosy areas for transmission and late diagnosis, identified using descriptive spatial analysis and using local empirical Bayesian method. National and State leprosy control programs urgently need to intensify control actions in these highly vulnerable municipalities.

Canine heartworm disease in Porto Velho: first record, distribution map and occurrence of positive mosquitoes

The aim of this study was to make the first report on canine heartworm disease in the state of Rondônia and confirm its transmission in this state. Blood samples were randomly collected from 727 dogs in the city of Porto Velho. The samples were analyzed to search for microfilariae and circulating antigens, using three different techniques: optical microscopy on thick blood smears stained with Giemsa; immunochromatography; and PCR. Mosquitoes were collected inside and outside the homes of all the cases of positive dogs and were tested using PCR to search for DNA of Dirofilaria immitis. Ninety-three blood samples out of 727 (12.8%) were positive according to the immunoassay technique and none according to the thick smear method. Among the 93 positive dogs, 89 (95.7%) were born in Porto Velho. No difference in the frequency of infection was observed between dogs raised indoors and in the yard. PCR on the mosquitoes resulted in only one positive pool. This result shows that the transmission of canine heartworm disease is occurring in the city of Porto Velho and that there is moderate prevalence among the dogs. The techniques of immunochromatography and PCR were more effective for detecting canine heartworm than thick blood smears. The confirmation of canine heartworm disease transmission in Porto Velho places this disease in the ranking for differential diagnosis of pulmonary nodules in humans in Rondônia.

Cross-culture perspectives on fear of HIV disease and AIDS in health care workers

Health care workers have been known to carry into the workplace a variety of judgmental and negative attitudes towards their patients. In no other area of patient care has this issue been more pronounced as in the management of patients with AIDS. Health care workers have refused to treat or manage patients with AIDS and have often treated them more harshly than identically described leukemia patients. Some health care institutions have simply refused to admit patients with AIDS and even recent applicants to medical colleges and schools of nursing have indicated a preference for schools in areas with low prevalence of HIV disease. Since the attitudes of health care workers do have significant consequences on patient management, this study was carried out to determine the differences in clinical practice in Nigeria and the United States of America as it relates to knowledge of a patient's HIV status, determine HIV prevalence and culture in each of the study sites and how they impact on infection control practices, determine the relationship between infection control practices and fear of AIDS, and also determine the predictors of safe infection control practices in each of the study sites.^ The study utilized the 38-item fear of AIDS scale and the measure of infection control questionnaire for its data. Questionnaires were administered to health care workers at the university teaching hospital sites of Houston, Texas and Calabar in Nigeria. Data was analyzed using a chi-square test, and where appropriate, a student t-tests to establish the demographic variables for each country. Factor analysis was done using principal components analysis followed by varimax rotation to simple structure. The subscale scores for each study site were compared using t-tests (separate variance estimates) and utilizing Bonferroni adjustments for number of tests. Finally, correlations were carried out between infection control procedures and fear of AIDS in each study site using Pearson-product moment correlation coefficients.^ The study revealed that there were five dimensions of the fear of AIDS in health care workers, namely fear of loss of control, fear of sex, fear of HIV infection through blood and illness, fear of death and medical interventions and fear of contact with out-groups. Fear of loss of control was the primary area of concern in the Nigerian health care workers whereas fear of HIV infection through blood and illness was the most important area of AIDS related feats in United States health care workers. The study also revealed that infection control precautions and practices in Nigeria were based more on normative and social pressures whereas it was based on knowledge of disease transmission, supervision and employee discipline in the United States, and thus stresses the need for focused educational programs in health care settings that emphasize universal precautions at all times and that are sensitive to the cultural nuances of that particular environment. ^

Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers : a response to P.L. 100-607, The Health Omnibus Programs Extension Act of 1988.

Item 499-F-3.

Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014.

Background.  The majority of Lyme disease cases in the United States are acquired on the east coast between northern Virginia and New England. In recent years the geographic extent of Lyme disease has been expanding, raising the prospect of Lyme disease becoming endemic in the southeast. Methods.  We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Virginia Department of Health and North Carolina Department of Public Health and entered them in a geographic information system. We performed spatial and spatiotemporal cluster analyses to characterize Lyme disease expansion. Results.  There was a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards. Northern Virginia experienced intensification and geographic expansion of Lyme disease cases. The most notable area of expansion was to the southwest along the Appalachian Mountains with development of a new disease cluster in the southern Virginia mountain region. Conclusions.  The geographic distribution of Lyme disease cases significantly expanded in Virginia between 2000 and 2014, particularly southward in the Virginia mountain ranges. If these trends continue, North Carolina can expect autochthonous Lyme disease transmission in its mountain region in the coming years.

An impulsive differential equation model for Marek's disease

Many dynamical processes are subject to abrupt changes in state. Often these perturbations can be periodic and of short duration relative to the evolving process. These types of phenomena are described well by what are referred to as impulsive differential equations, systems of differential equations coupled with discrete mappings in state space. In this thesis we employ impulsive differential equations to model disease transmission within an industrial livestock barn. In particular we focus on the poultry industry and a viral disease of poultry called Marek's disease. This system lends itself well to impulsive differential equations. Entire cohorts of poultry are introduced and removed from a barn concurrently. Additionally, Marek's disease is transmitted indirectly and the viral particles can survive outside the host for weeks. Therefore, depopulating, cleaning, and restocking of the barn are integral factors in modelling disease transmission and can be completely captured by the impulsive component of the model. Our model allows us to investigate how modern broiler farm practices can make disease elimination difficult or impossible to achieve. It also enables us to investigate factors that may contribute to virulence evolution. Our model suggests that by decrease the cohort duration or by decreasing the flock density, Marek's disease can be eliminated from a barn with no increase in cleaning effort. Unfortunately our model also suggests that these practices will lead to disease evolution towards greater virulence. Additionally, our model suggests that if intensive cleaning between cohorts does not rid the barn of disease, it may drive evolution and cause the disease to become more virulent.

Salinity influences disease-induced mortality of the oyster Crassostrea gigas and infectivity of the ostreid herpesvirus 1 (OsHV-1)

Mortality of young Pacific oysters Crassostrea gigas associated with the ostreid herpesvirus 1 (OsHV-1) is occurring worldwide. Here, we examined for the first time the effect of salinity on OsHV-1 transmission and disease-related mortality of C. gigas, as well as salinity-related effects on the pathogen itself. To obtain donors for OsHV-1 transmission, we transferred laboratory-raised oysters to an estuary during a disease outbreak and then back to the laboratory. Oysters that tested OsHV-1 positive were placed in seawater tanks (35‰, 21°C). Water from these tanks was used to infect naïve oysters in 2 experimental setups: (1) oysters acclimated or non-acclimated to a salinity of 10, 15, 25 and 35‰ and (2) oysters acclimated to a salinity of 25‰; the latter were exposed to OsHV-1 water diluted to a salinity of 10 or 25‰. The survival of oysters exposed to OsHV-1 water and acclimated to a salinity of 10‰ was >95%, compared to only 43 to 73% survival in oysters acclimated to higher salinities (Expt 1), reflecting differences in the levels of OsHV-1 DNA and viral gene expression (Expts 1 and 2). However, the survival of their non-acclimated counterparts was only 23% (Expt 2), and the levels of OsHV-1 DNA and the expression of 4 viral genes were low (Expt 1). Thus, OsHV-1 may not have been the ultimate cause of mortality in non-acclimated oysters weakened by a salinity shock. It appears that reducing disease risk by means of low salinity is unlikely in the field.

Comparison of koala LPCoLN and human strains of Chlamydia pneumoniae highlights extended genetic diversity in the species

Background Chlamydia pneumoniae is a widespread pathogen causing upper and lower respiratory tract infections in addition to a range of other diseases in humans and animals. Previous whole genome analyses have focused on four essentially clonal (> 99% identity) C. pneumoniae human genomes (AR39, CWL029, J138 and TW183), providing relatively little insight into strain diversity and evolution of this species. Results We performed individual gene-by-gene comparisons of the recently sequenced C. pneumoniae koala genome and four C. pneumoniae human genomes to identify species-specific genes, and more importantly, to gain an insight into the genetic diversity and evolution of the species. We selected genes dispersed throughout the chromosome, representing genes that were specific to C. pneumoniae, genes with a demonstrated role in chlamydial biology and/or pathogenicity (n = 49), genes encoding nucleotide salvage or amino acid biosynthesis proteins (n = 6), and extrachromosomal elements (9 plasmid and 2 bacteriophage genes). Conclusions We have identified strain-specific differences and targets for detection of C. pneumoniae isolates from both human and animal origin. Such characterisation is necessary for an improved understanding of disease transmission and intervention.