Longitudinal Dichelobacter nodosus status in 9 sheep flocks free from clinical footrot

Footrot is a widespread problem in Swiss sheep farming. The objectives of this study were to determine whether flocks which were clinically free from footrot carry virulent strains of Dichelobacter nodosus, and to describe the infection dynamics for flocks and individual sheep. To this purpose, a new PCR-diagnostic tool was used, which is able to distinguish benign from virulent D. nodosus. Nine farms were examined three times at intervals of 6 months. Cotton swabs were used to collect samples from the interdigital skin to analyze for the presence of virulent and benign strains of D. nodosus. Additionally, epidemiological data of the farms were collected with the aid of a standardized questionnaire. On four farms, benign strains were diagnosed at each visit; in one farm, benign strains were detected once only. Two flocks revealed sheep infected with virulent D. nodosus throughout the study but without clinical evidence of footrot. In two flocks, the virulent strains of D. nodosus were introduced into the flock during the study period. In one farm, clinical symptoms of virulent footrot were evident only two weeks after the positive finding by PCR. Only individual sheep with previously negative status, but none with previously benign status became infected with virulent strains during the study. The newly developed competitive RT PCR proved to be more sensitive than clinical diagnosis for detecting footrot infection in herds, as it unequivocally classified the four flocks as infected with virulent D. nodosus, even though they did not show clinical signs at the times of sampling. This early detection may be crucial to the success of any control program. Both new infections with virulent strains could be explained by contact with sheep from herds with virulent D. nodosus as evaluated from the questionnaires. These results show that the within-herd eradication of footrot becomes possible using the competitive PCR assay to specifically diagnose virulent D. nodosus.

An unusual stroke-like clinical presentation of Creutzfeldt-Jakob disease: acute vestibular syndrome

INTRODUCTION Vertigo and dizziness are common neurological symptoms in general practice. Most patients have benign peripheral vestibular disorders, but some have dangerous central causes. Recent research has shown that bedside oculomotor examinations accurately discriminate central from peripheral lesions in those with new, acute, continuous vertigo/dizziness with nausea/vomiting, gait unsteadiness, and nystagmus, known as the acute vestibular syndrome. CASE REPORT A 56-year-old man presented to the emergency department with acute vestibular syndrome for 1 week. The patient had no focal neurological symptoms or signs. The presence of direction-fixed, horizontal nystagmus suppressed by visual fixation without vertical ocular misalignment (skew deviation) was consistent with an acute peripheral vestibulopathy, but bilaterally normal vestibuloocular reflexes, confirmed by quantitative horizontal head impulse testing, strongly indicated a central localization. Because of a long delay in care, the patient left the emergency department without treatment. He returned 1 week later with progressive gait disturbance, limb ataxia, myoclonus, and new cognitive deficits. His subsequent course included a rapid neurological decline culminating in home hospice placement and death within 1 month. Magnetic resonance imaging revealed restricted diffusion involving the basal ganglia and cerebral cortex. Spinal fluid 14-3-3 protein was elevated. The rapidly progressive clinical course with dementia, ataxia, and myoclonus plus corroborative neuroimaging and spinal fluid findings confirmed a clinicoradiographic diagnosis of Creutzfeldt-Jacob disease. CONCLUSIONS To our knowledge, this is the first report of an initial presentation of Creutzfeldt-Jacob disease closely mimicking vestibular neuritis, expanding the known clinical spectrum of prion disease presentations. Despite the initial absence of neurological signs, the central lesion location was differentiated from a benign peripheral vestibulopathy at the first visit using simple bedside vestibular tests. Familiarity with these tests could help providers prevent initial misdiagnosis of important central disorders in patients presenting vertigo or dizziness.