A case–control study of incident rheumatological conditions following acute gastroenteritis during military deployment

Objectives The aim of this study was to assess the risk of incident rheumatological diagnoses (RD) associated with self-reported diarrhoea and vomiting during a first-time deployment to Iraq or Afghanistan. Such an association would provide evidence that RD in this population may include individuals with reactive arthritis (ReA) from deployment-related infectious gastroenteritis. Design This case–control epidemiological study used univariate and multivariate logistic regression to compare the odds of self-reported diarrhoea/vomiting among deployed US military personnel with incident RD to the odds of diarrhoea/vomiting among a control population. Setting We analysed health records of personnel deployed to Iraq or Afghanistan, including responses on a postdeployment health assessment and medical follow-up postdeployment. Participants Anonymous data were obtained from 891 US military personnel with at least 6 months of medical follow-up following a first-time deployment to Iraq or Afghanistan in 2008–2009. Cases were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes; controls had an unrelated medical encounter and were representative of the study population. Main outcome measures The primary measure was an association between incident RD and self-reported diarrhoea/vomiting during deployment. A secondary measure was the overall incidence of RD in this population. Results We identified 98 cases of new onset RD, with a total incidence of 161/100 000 persons. Of those, two participants had been diagnosed with Reiter\u27s diseasei (3.3/100 000 persons) and the remainder with non-specific arthritis/arthralgia (157.5/100 000 persons). The OR for acute diarrhoea was 2.67 (p=0.03) after adjusting for important covariates. Conclusions Incident rheumatological conditions, even those classified as ‘non-specific,’ are significantly associated with prior severe diarrhoea in previously deployed military personnel, potentially indicating ReA and need for preventive measures to reduce diarrhoeagenic bacterial exposures in military personnel and other travellers to the developing regions

Pathogen-specific risk of chronic gastrointestinal disorders following bacterial causes of foodborne illness

BACKGROUND: The US CDC estimates over 2 million foodborne illnesses are annually caused by 4 major enteropathogens: non-typhoid Salmonella spp., Campylobacter spp., Shigella spp. and Yersinia enterocoltica. While data suggest a number of costly and morbid chronic sequelae associated with these infections, pathogen-specific risk estimates are lacking. We utilized a US Department of Defense medical encounter database to evaluate the risk of several gastrointestinal disorders following select foodborne infections. METHODS: We identified subjects with acute gastroenteritis between 1998 to 2009 attributed to Salmonella (nontyphoidal) spp., Shigella spp., Campylobacter spp. or Yersinia enterocolitica and matched each with up to 4 unexposed subjects. Medical history was analyzed for the duration of military service time (or a minimum of 1 year) to assess for incident chronic gastrointestinal disorders. Relative risks were calculated using modified Poisson regression while controlling for the effect of covariates. RESULTS: A total of 1,753 pathogen-specific gastroenteritis cases (Campylobacter: 738, Salmonella: 624, Shigella: 376, Yersinia: 17) were identified and followed for a median of 3.8 years. The incidence (per 100,000 person-years) of PI sequelae among exposed was as follows: irritable bowel syndrome (IBS), 3.0; dyspepsia, 1.8; constipation, 3.9; gastroesophageal reflux disease (GERD), 9.7. In multivariate analyses, we found pathogen-specific increased risk of IBS, dyspepsia, constipation and GERD. CONCLUSIONS: These data confirm previous studies demonstrating risk of chronic gastrointestinal sequelae following bacterial enteric infections and highlight additional preventable burden of disease which may inform better food security policies and practices, and prompt further research into pathogenic mechanisms

Vaccines for protecting infants from bacterial causes of diarrheal disease

The global diarrheal disease burden fo

Effect of Benzoic Acid and Essential Oil Blends on Viral Load in Swine Feed and Vitamin Premix

Feed has been shown to harbor viable virus of interest to swine producers over an extended period of time. The use of mitigants and kill steps have been investigated with variable results. This study investigated the use of benzoic acid (BA) and an essential oil blend (EO) to mitigate the presence of porcine epidemic diarrhea virus (PEDV), porcine reproductive and respiratory syndrome virus (PRRSV), and Senecavirus A (SVA) in a complete diet (Exp. 1) and a vitamin premix (Exp. 2). Four treatments consisting of 0.5% BA; 0.5% BA and 200 ppm EO; 0.3% BA and 120 ppm EO; and 0.25% BA and 100 ppm EO were used in the complete feed, in addition to a control with no feed additive to test the mitigant’s effect on PEDV, PRRSV, and SVA detection. For Exp. 2, a vitamin premix without chemical treatment acted as the control and the other treatment was the vitamin premix treated with 2.68% EO, with both used to determine PEDV detection. The inoculated feed or premix was stored for up to 15 d with sampling points at 2, 5, and 15 d post-inoculation. Samples were analyzed using a triplex qRT-PCR to detect changes in RNA quantities for all three viruses. A significant treatment × day interaction was observed in the feed for both PEDV (P = 0.008) and SVA (P \u3c 0.001). Per the decreased cycle threshold (Ct) value, the 0.5% BA treatment had higher (P \u3c 0.05) measurements of detectible PEDV on d 2 and 5, and lower amounts of detectible PEDV on d 15, as compared to the control. The 0.5% BA treated feed had lower (P \u3c 0.05) detectable SVA on d 2 but higher detectible SVA on d 15 compared to the control. There was no evidence of difference in detectable PRRSV between treatments. During this experiment, PEDV and SVA showed a degradation over time with rates of degradation varying between treatments. Increasing time from d 2 to 15 decreased (quadratic, P = 0.038) detectable PRRSV. The use of the EO in the vitamin premix had no evidence of a treatment × day interaction, treatment effect, or degradation over time. In conclusion, the use of 0.5% BA had an increased PEDV Ct on d 15 compared to the control (33.8 vs. 32.7 Ct, respectively). However, the use of BA and EO mitigant in this model did not provide consistent evidence for increased viral degradation, but viral load was reduced in the feed matrix over time

Effect of Benzoic Acid and Essential Oil Blends on Viral Load in Swine Feed and Vitamin Premix

Feed has been shown to harbor viable virus of interest to swine producers over an extended period of time. The use of mitigants and kill steps have been investigated with variable results. This study investigated the use of benzoic acid (BA) and an essential oil blend (EO) to mitigate the presence of porcine epidemic diarrhea virus (PEDV), porcine reproductive and respiratory syndrome virus (PRRSV), and Senecavirus A (SVA) in a complete diet (Exp. 1) and a vitamin premix (Exp. 2). Four treatments consisting of 0.5% BA; 0.5% BA and 200 ppm EO; 0.3% BA and 120 ppm EO; and 0.25% BA and 100 ppm EO were used in the complete feed, in addition to a control with no feed additive to test the mitigant’s effect on PEDV, PRRSV, and SVA detection. For Exp. 2, a vitamin premix without chemical treatment acted as the control and the other treatment was the vitamin premix treated with 2.68% EO, with both used to determine PEDV detection. The inoculated feed or premix was stored for up to 15 d with sampling points at 2, 5, and 15 d post-inoculation. Samples were analyzed using a triplex qRT-PCR to detect changes in RNA quantities for all three viruses. A significant treatment × day interaction was observed in the feed for both PEDV (P = 0.008) and SVA (P \u3c 0.001). Per the decreased cycle threshold (Ct) value, the 0.5% BA treatment had higher (P \u3c 0.05) measurements of detectible PEDV on d 2 and 5, and lower amounts of detectible PEDV on d 15, as compared to the control. The 0.5% BA treated feed had lower (P \u3c 0.05) detectable SVA on d 2 but higher detectible SVA on d 15 compared to the control. There was no evidence of difference in detectable PRRSV between treatments. During this experiment, PEDV and SVA showed a degradation over time with rates of degradation varying between treatments. Increasing time from d 2 to 15 decreased (quadratic, P = 0.038) detectable PRRSV. The use of the EO in the vitamin premix had no evidence of a treatment × day interaction, treatment effect, or degradation over time. In conclusion, the use of 0.5% BA had an increased PEDV Ct on d 15 compared to the control (33.8 vs. 32.7 Ct, respectively). However, the use of BA and EO mitigant in this model did not provide consistent evidence for increased viral degradation, but viral load was reduced in the feed matrix over time

Impact of international travel and diarrhea on gut microbiome and resistome dynamics

International travel contributes to the global spread of antimicrobial resistance. Travelers\u27 diarrhea exacerbates the risk of acquiring multidrug-resistant organisms and can lead to persistent gastrointestinal disturbance post-travel. However, little is known about the impact of diarrhea on travelers\u27 gut microbiomes, and the dynamics of these changes throughout travel. Here, we assembled a cohort of 159 international students visiting the Andean city of Cusco, Peru and applied next-generation sequencing techniques to 718 longitudinally-collected stool samples. We find that gut microbiome composition changed significantly throughout travel, but taxonomic diversity remained stable. However, diarrhea disrupted this stability and resulted in an increased abundance of antimicrobial resistance genes that can remain high for weeks. We also identified taxa differentially abundant between diarrheal and non-diarrheal samples, which were used to develop a classification model that distinguishes between these disease states. Additionally, we sequenced the genomes of 212 diarrheagenic Escherichia coli isolates and found those from travelers who experienced diarrhea encoded more antimicrobial resistance genes than those who did not. In this work, we find the gut microbiomes of international travelers\u27 are resilient to dysbiosis; however, they are also susceptible to colonization by multidrug-resistant bacteria, a risk that is more pronounced in travelers with diarrhea

Evaluating the Impact of Presence of Organic Matter on Environmental Samples and Sample Processing Technique on RNA Detection of PEDV

Environmental sampling has become a commonly accepted diagnostic sampling technique for a means of identifying breaks in biosecurity. However, environmental samples have yet to be validated for reverse transcriptase real-time PCR (qRT-PCR) analysis and there is no standardization for environmental sample processing. Therefore, the objective of this project was to evaluate different types of environmental samples, and whether processing the samples prior to qRT-PCR analysis would impact results. Steel coupons were inoculated with PEDV in different types of environmental conditions, then were environmentally swabbed using cotton gauze. Treatments were arranged as a 5 × 4 factorial with five treatments for the different types of contamination and four treatments for the types of sample processing. Samples were processed in four different ways: no pre-qRT-PCR processing, centrifuging, syringe filtering, and centrifuging then syringe filtering to determine if pre-sample processing impacted the cycle threshold (Ct) value. Once samples were processed, they were submitted for PEDV qRT-PCR analysis. Results were reported as proportion of qRT-PCR positive and the resulting Ct value. If samples had no detectable RNA, they were assigned a Ct value of 45. For the Ct values, there was an inoculated surface × sample processing (P \u3c 0.0001) interaction indicating that the type of environmental sample and the way the sample was processed impacted the Ct value of the sample. For pure virus and virus with PBS, there was no difference in Ct values between different sample processing techniques (PP \u3c 0.05). For virus and fecal contamination, samples that were not processed or samples that were processed with centrifuging only had greater amounts of PEDV RNA detected compared to syringe filtered samples or centrifuged and syringe filtered samples (P \u3c 0.05). For virus and organic matter contamination, samples that were centrifuged had greater amounts of PEDV RNA detected compared to all other sample processing techniques (P \u3c 0.05). Main effects of inoculated surface (P \u3c 0.0001) and sample processing (P \u3c 0.0001) were also significant. For surface inoculation type, pure virus inoculation and virus with PBS inoculation had greater amounts of PEDV RNA compared to virus with feces inoculation or virus with organic matter inoculation, while virus with dirt was intermediate. For sample processing type, centrifuged samples had the greatest amount of PEDV RNA compared to syringe filtered and centrifuged then syringe filtered samples with unprocessed samples being intermediate. In summary, if environmental samples are particularly dirty, processing prior to qRT-PCR analysis will impact the results

Evaluating a Dry vs. Wet Disinfection in Boot Baths on Detection of Porcine Epidemic Diarrhea Virus and Porcine Reproductive and Respiratory Syndrome Virus RNA

Maintaining biosecurity between swine barns is challenging, and boot baths are an easily implementable option some utilize to limit pathogen spread. However, there are concerns regarding their efficacy, especially when comparing wet or dry disinfectants. The objective of this study was to evaluate the efficacy of boot baths in reducing the quantity of detectable porcine epidemic diarrhea virus (PEDV) and porcine reproductive and respiratory syndrome virus (PRRSV) genetic material using wet or dry disinfectants. Treatments included 1) control; 2) dry chlorine powder (Traffic C.O.P., PSP, LLC, Rainsville, AL); and 3) wet quaternary ammonium/glutaraldehyde liquid (1:256 Synergize, Neogen, Lexington, KY). Prior to disinfection, rubber boots were inoculated with 1 mL of co-inoculants of PRRSV (1×105TCID50/mL) and PEDV (1×105 TCID50/mL) and dried for 15 min. After the drying period, a researcher placed the boot on the right foot and stepped directly on a stainless steel coupon (control). Alternatively, the researcher stepped first into a boot bath containing either the wet or dry sanitizer, stood for 3 s, and then stepped onto a steel coupon. After one min, an environmental swab was then collected and processed from each boot and steel coupon. The procedure was replicated 12 times per disinfectant treatment. Samples were analyzed using a duplex qPCR at the Kansas State Veterinary Diagnostic Laboratory. Cycle threshold values, which indicate the presence or absence of the inoculants and their relative concentrations when present, were analyzed using SAS GLIMMIX (v. 9.4, SAS Institute, Inc., Cary, NC). There was no evidence of a disinfectant × surface × virus interaction (P \u3e 0.10). An interaction between disinfectant × surface impacted (P \u3c 0.05) the quantity of detectable viral RNA. As expected, the quantity of the viruses on the coupon were greatest in the control, indicating that a contaminated boot has the ability to transfer viruses from a contaminated surface to a clean surface. Comparatively, the dry disinfectant treatment resulted in no detectable viral RNA on either the boot or subsequent coupon. The wet disinfectant treatment had statistically similar (P \u3e 0.05) viral contamination to the control on the boot, but less viral contamination compared to the control on the metal coupon. In this experiment, a boot bath with dry powder was the most efficacious in reducing the detectable viral RNA on both boots and subsequent surfaces