A Case of Bronchioloalveolar Carcinoma - Associated Systemic Toxoplasmosis in a Mountain Lion (Puma Concolor)

Spontaneous lung tumors are more frequently in dogs, cats and sheep, but rarely described in wildlife animals. In dogs and cats this neoplasia occurs as a sporadic geriatric disease, not related to any infectious etiology, while a betaretrovirus is responsible for pulmonary adenocarcinoma in sheep [1]. We described, for the first time, a case of lung cancer in a 6 year-old mountain lion (Puma concolor), serologically negative for Feline immunodeficiency virus (FIV) and Feline leukemia virus (FeLV), maintained in captivity in the Falconara Zoo Park, Ancona, Italy. In August 2017, this malnourished adult male, was present with signs of dyspnea, cyanosis and drooling, followed by sudden death. Postmortem examination was performed. Gross necropsy and histopathologic examination revealed nodules of different sized and coalescing whitish areas of lung parenchima consolidation, associated to multifocal atelectasis alternated with discrete emphysema. The toracic cavity was replete of yellowish exudate, citologically characterized by degenerated neutophilic cells and lipids enriched. Additionally a necrotizing, multifocal myocarditis and necrotizing, neutrophilic, and histiocytic interstitial nephritis were observed. In this animal a concurrent systemic toxoplasmosis, with merozoites found also into neoplastic carcinomatous cells was also detected. According to the classification of the main respiratory tumors types observed in dogs and cats, classified as acinar adenocarcinoma, bronchiolo-alveolar carcinoma, adenosquamous and squamous cell tumors [2], the histopathological examination of lung masses in this mountain lion revealed neoplastic epithelial cells compatible with bronchioloalveolar carcinoma (BAC). The immunohistochemical analysis of tumor cells showed positive labeling for pan-Cytokeratin, CK 7, CK 20 and TTF-1. According to macroscopic features, as well as histological and immunohistochemical findings, this tumor was diagnostic as BAC mixed subtype. Histology revealed a large amount of tachyzoites inside different tissues, as well as spleen, lymph nodes and also many neoplastic cells. An anti-Toxoplasma gondii monoclonal antibody stained positively these tachyzoites, and polymerase chain reaction (PCR) analysis targeting the B1 gene, confirmed the presence of Toxoplasma gondii in all the examined organs. The high parasitic burden detected inside neoplastic cells may be related to an opportunistic relationship by the parasite and the cancerous cells that showing an enhanced metabolic rate and scant differentiation

Prevalence and characterisation of shigatoxigenic Escherichia coli isolated from beef cattle fed with prebiotics

Ten Holstein Friesian calves were divided into two groups of five: one group was given prebiotics in their food, while the other group served as the control group. Every two weeks from birth up to 18 months, samples of feces were taken from the rectal ampulla to determine the concentration of E. coli. At each sampling session, three aliquots per sample were collected. The arithmetic mean was calculated and all values (converted into logs) were analysed with GraphPad InStat for analysis of variance, followed by the Tukey-Kramer test. A total of 69 E. coli strains were detected, 29 (42.03%) from treated animals and 40 (57.97%) from the control group. The isolates were analysed by PCR for the presence of the stx-1, stx-2, hly and eae genes and by the Kirby Bauer test for susceptibility to the most commonly used antimicrobials in cattle breeding. Hierarchical clustering of the isolates was done using Ward’s method. Thirty samples were positive for the stx-1 gene, 18 for stx-2, 12 for both stx-1 and stx-2, 8 for hly, and 10 for eae. 4.3% were resistant to sulfamides, 8.6% to tetracycline, 1.4% to gentamicin, 94.6% to cephalothin, 2.8% to chloramphenicol, 13% to ampicillin, 13% to amoxicillin/clavulanic acid, 7.2% to sulphonamides, 4.3% to ceftriaxone, 5.7% to nalidixic acid, 34.7% to ticarcillin, 88.5% to erythromycin, and 5.7% to streptomycin. The isolates from the samples taken from day 210 to day 300 were grouped into a single cluster. Bacteriological examinations showed a reduction in the concentration of E. coli in the feces of the treated animals compared to the control group. The presence of strains with shigatoxigenic Escherichia coli virulence profiles and the reduction of these in the treated animal group demonstrated that diet can play an important role in reducing E. coli prevalence in cattle

Frequency, predictors and prognostic impact of implantable cardioverter defibrillator shocks in a primary prevention population with heart failure and reduced ejection fraction

INTRODUCTION: The role of the implantable cardioverter defibrillator (ICD) in primary prevention real-world population is debated. We sought to evaluate the incidence, predictors and prognostic impact of ICD shocks in consecutive heart failure patients implanted for primary prevention at our tertiary institution.METHODS AND RESULTS: We retrospectively selected a sample of 497 patients (mean age 64.8 years, 82.1% men, average left ventricular ejection fraction, LVEF, 27.1%). At long-term follow-up (median time 70.4 months), total mortality was 40.8%, and 16.5% of patients had received at least one appropriate shock (3.12%/year). Inappropriate shock [odds ratio (OR) 1.93, 95% confidence interval (95% CI) 1.08-3.47; P\u200a=\u200a0.027] and length of follow-up (1 year, OR 1.01, 95% CI 1.00-1.01; P\u200a=\u200a0.0031) were associated with the occurrence of appropriate shock, whereas atrial fibrillation (OR 2.65, 95% CI 1.55-4.51, P\u200a<\u200a0.001), length of follow-up (1-year OR 1.01, 95% CI 1.00-1.01, P\u200a<\u200a0.001) and appropriate shock (OR 1.93, 95% CI 1.08-3.47, P\u200a=\u200a0.027) were associated with the occurrence of inappropriate shock. Neither appropriate nor inappropriate shock independently increased mortality risk, whereas older age (hazard ratio 1.05; 95% CI 1.04-1.07; P\u200a<\u200a0.001), atrial fibrillation (hazard ratio 2.25; 95% CI 1.67-3.02; P\u200a<\u200a0.001) and lower LVEF (hazard ratio 0.97; 95% CI 0.94-0.99; P\u200a=\u200a0.004) did.CONCLUSION: Incidence of shocks in real-world primary prevention ICD recipients might be lower than expected, and the association between ICD shocks and prolongation of survival is not as clear-cut as might be perceived. Further investigations from larger real-world samples are warranted

Real-world candidacy to mavacamten in a contemporary hypertrophic obstructive cardiomyopathy population

Aims: In the EXPLORER-HCM trial, mavacamten reduced left ventricular outflow tract obstruction (LVOTO) and improved functional capacity of symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients. We sought to define the potential use of mavacamten by comparing real-world HOCM patients with those enrolled in EXPLORER-HCM and assessing their eligibility to treatment. Methods and results: We collected information on HOCM patients followed up at 25 Italian HCM outpatient clinics and with significant LVOTO (i.e. gradient ≥30 mmHg at rest or ≥50 mmHg after Valsalva manoeuvre or exercise) despite pharmacological or non-pharmacological therapy. Pharmacological or non-pharmacological therapy resolved LVOTO in 1044 (61.2%) of the 1706 HOCM patients under active follow-up, whereas 662 patients (38.8%) had persistent LVOTO. Compared to the EXPLORER-HCM trial population, these real-world HOCM patients were older (62.1 ± 14.3 vs. 58.5 ± 12.2 years, p = 0.02), had a lower body mass index (26.8 ± 5.3 vs. 29.7 ± 4.9 kg/m2 , p < 0.0001) and a more frequent history of atrial fibrillation (21.5% vs. 9.8%, p = 0.027). At echocardiography, they had lower left ventricular ejection fraction (LVEF, 66 ± 7% vs. 74 ± 6%, p < 0.0001), higher left ventricular outflow tract gradients at rest (60 ± 27 vs. 52 ± 29 mmHg, p = 0.003), and larger left atrial volume index (49 ± 16 vs. 40 ± 12 ml/m2 , p < 0.0001). Overall, 324 (48.9%) would have been eligible for enrolment in the EXPLORER-HCM trial and 339 (51.2%) for treatment with mavacamten according to European guidelines. Conclusions: Real-world HOCM patients differ from the EXPLORER-HCM population for their older age, lower LVEF and larger atrial volume, potentially reflecting a more advanced stage of the disease. About half of real-world HOCM patients were found eligible to mavacamten

Real-world candidacy to mavacamten in a contemporary hypertrophic obstructive cardiomyopathy population

Aims In the EXPLORER-HCM trial, mavacamten reduced left ventricular outflow tract obstruction (LVOTO) and improved functional capacity of symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients. We sought to define the potential use of mavacamten by comparing real-world HOCM patients with those enrolled in EXPLORER-HCM and assessing their eligibility to treatment.Methods and results We collected information on HOCM patients followed up at 25 Italian HCM outpatient clinics and with significant LVOTO (i.e. gradient >= 30 mmHg at rest or >= 50 mmHg after Valsalva manoeuvre or exercise) despite pharmacological or non-pharmacological therapy. Pharmacological or non-pharmacological therapy resolved LVOTO in 1044 (61.2%) of the 1706 HOCM patients under active follow-up, whereas 662 patients (38.8%) had persistent LVOTO. Compared to the EXPLORER-HCM trial population, these real-world HOCM patients were older (62.1 +/- 14.3 vs. 58.5 +/- 12.2 years, p = 0.02), had a lower body mass index (26.8 +/- 5.3 vs. 29.7 +/- 4.9 kg/m(2), p < 0.0001) and a more frequent history of atrial fibrillation (21.5% vs. 9.8%, p = 0.027). At echocardiography, they had lower left ventricular ejection fraction (LVEF, 66 +/- 7% vs. 74 +/- 6%, p < 0.0001), higher left ventricular outflow tract gradients at rest (60 +/- 27 vs. 52 +/- 29 mmHg, p = 0.003), and larger left atrial volume index (49 +/- 16 vs. 40 +/- 12 ml/m(2), p < 0.0001). Overall, 324 (48.9%) would have been eligible for enrolment in the EXPLORER-HCM trial and 339 (51.2%) for treatment with mavacamten according to European guidelines.Conclusions Real-world HOCM patients differ from the EXPLORER-HCM population for their older age, lower LVEF and larger atrial volume, potentially reflecting a more advanced stage of the disease. About half of real-world HOCM patients were found eligible to mavacamten