Диференційна діагностика жінок з полікістозною та мультіфолікулярною стукрурою яєчників

Синдром полікістозних яєчників (СПКЯ) є найчастішою ендокринопатією у жінок репродуктивного віку як в Україні ,так і за кордоном і становить гетерогенну групу порушень із широкою клінічною і біохімічною варіабельністю. Частота СПКЯ в популяції складає від 4 до 15 % і зустрічається однаково часто в різних етнічних групах: в Україні – від 0,6 до 11 %, у країнах ближнього зарубіжжя -1,8-11%, в Європі - 15-20%, в США - 6-10%.Більшість пацієнток репродуктивного віку з СПКЯ страждають на безпліддя, частота якого складає 35-74%

Man and pigs: sharing the same C. difficile

Clostridium difficile is an anaerobic spore forming gram-positive bacterium. Infection with C. difficile may lead in humans to symptomless carriership, but may also lead to diarrhea varying in severity from mild to life-threatening pseudomembraneous colitis. C. difficile spores can survive for long periods of time in the environment and are resistant to extreme temperatures, drought, radiation, and chemicals including disinfectants. C. difficile was considered a classical nosocomial pathogen, with a risk group consisting of elderly patients with comorbidities, treated with antimicrobials. However, since the beginning of the 21th century C. difficile infection (CDI) is increasing in incidence and severity, and is also reported in younger patients, not receiving antimicrobials, and in patients in the community. Ribotype 078 is associated with this change in epidemiology and has increased in prevalence, to the 3rd most common isolated type in human patients in Europe. The finding of the same 078 ribotype in diarrheal piglets led to the concern that interspecies transmission could occur. The goal of this PhD research was to investigate the risk of transmission of C. difficile from pigs to humans. C. difficile was commonly found in fecal samples of neonatal piglets with diarrhea. The use of a more sensitive detection method for the bacterium resulted in isolating C. difficile in fecal samples of almost all piglets, regardless their disease status. With this method, samples from sows, piglets and the environment were investigated to determine how piglets become infected with C. difficile. Since C. difficile was found in all piglets within 48 hours after birth, while all sows became positive within 113 hours after parturition, contamination of the environment with C. difficile is the most logical source for infection. Indeed, C. difficile was present in environmental samples in the farm. C. difficile was also found in the air of the farrowing ward. Follow-up research on all pig wards at the same pig farm revealed a widespread dissemination of C. difficile. Furthermore, C. difficile was present in air samples 20 meter outside the farm. Consumption of pork meat is considered a possible infection route, because C. difficile was found in retail pork samples. To determine if the source could be slaughter pigs colonized with the bacterium, rectal samples of slaughter pigs were taken at the abattoir. A prevalence of around 10% was found. However, whether C. difficile can subsequently contaminate the carcass depends on the slaughter hygiene. Human and pig C.difficile ribotype 078 seem to be genetically related because a comparison of C. difficile isolates from humans with CDI and piglets with diarrhea revealed a high similarity in antimicrobial susceptibility patterns. Samples from farmers, employees, family members and the pigs at the same farms were investigated for the presence of C. difficile. Colonization rates of C. difficile in pig farmers and their employees were higher then the colonization rates described in healthy adults. C. difficile isolates from pig farmers and their pigs are highly similar, which indicates that working with pigs is an occupational risk for colonization with C. difficile

Clostridium difficile Infection Associated with Pig Farms

Molecular basis of bacterial pathogenesis, virulence factors and antibiotic resistanc

Aerial dissemination of Clostridium difficile on a pig farm and its environment

Molecular basis of bacterial pathogenesis, virulence factors and antibiotic resistanc

The relation between farm specific factors and prevalence of Clostridium difficile in slaughter pigs

Molecular basis of bacterial pathogenesis, virulence factors and antibiotic resistanc

Presence of Clostridium difficile in 11 piglets with suspected CDI in the Netherlands

Molecular basis of bacterial pathogenesis, virulence factors and antibiotic resistanc

Acquisition of Clostridium difficile by piglets

Clostridium difficile is recognized as an important cause of nosocomial diarrhoea in humans especially in association with administration of antibiotics. In pigs, C. difficile can cause neonatal enteritis and can be isolated from faeces from both diseased and healthy animals. The presented prospective study describes how soon C. difficile can be isolated from newborn piglets after normal parturition and how C difficile spreads within a pig farm. Six sows, their farrowing crates and their litters at one farm were sampled until C. difficile was found in all piglets. Within 48 h after birth, all 71 piglets became positive for C. difficile (two piglets were already positive within 1 h post partum), all sows became positive within 11311 after parturition and the farrowing crates were found intermittently positive. C. difficile could also be detected in air samples and in samples of teats of the sows. All isolates belonged to PCR ribotype 078. Twenty-one C. difficile ribotype 078 isolates, found at the farm, were further analyzed by MLVA (multiple-locus variable-number tandem repeat analysis) and belonged to one clonal complex, except one isolate. To be sure that piglets were not born already infected with C. difficile ribotype 078, 38 caesarean derived piglets were sampled immediately after surgery. All piglets tested negative at delivery and stayed negative for C difficile ribotype 078 during the 21 days in which they were kept in sterile incubators. This study shows that C. difficile ribotype 078 spreads easily between sows, piglets and the environment. Vertical transmission of C. difficile ribotype 078 was not found and is very unlikely to occur. (C) 2010 Elsevier B.V. All rights reserved.Molecular basis of bacterial pathogenesis, virulence factors and antibiotic resistanc