Serological Diagnosis of Feline Tegumentary Leishmaniasis by Indirect Immunofluorescence (IFI) and Enzyme-Linked Immunosorbent Assay (ELISA) in an Endemic Area in Brazil

Background: American tegumentary leishmaniasis (ATL) is a serious public health problem, and the participation of domestic cats in its epidemiological process has not yet been fully elucidated. Therefore, the standardization of monitoring methodologies of cat populations becomes important for the generation of information on the disease. In Brazil, ATL presents a wide geographical distribution, being Leishmania (Viannia) braziliensis its etiologic agent of ATL in Rio de Janeiro. The main objective of the present study was investigate the presence of specific anti-Leishmania (Viannia) braziliensis Immunoglobulin G (IgG) in 34 cats from an ATL endemic area in this municipality.Materials, Methods & Results: Sera from three cats from the study area naturally infected with Leishmania (Viannia) braziliensis were used as positive control. Analyses were performed with antigen preparations using indirect immunofluorescence (IFI) and enzyme-linked immunosorbent assay (ELISA). We found prevalence rates of 20.6% (7/34) in the IFI and 14.7% (5/34) in the ELISA. Specificity was 87.1% for the IFI and 93.5% for the ELISA, and both tests presented sensitivity of 100%. Concordance between the used tests was assessed as moderate.Discussion: By conducting a feline serological survey in an endemic area for ATL we provide information on the involvement of this species in such epidemiological process. In this context, the participation of the cat in cycles of leishmaniases has been highlighted by several authors; infection of the phlebotomine by parasites originated from this vertebrate host can already be demonstrated by xenodiagnosis and several cases of feline infection have been reported in endemic regions of several countries such as Brazil, Spain, France, Portugal, Greece, Iran, Israel and Italy. Therefore, the standardization of diagnostic techniques that support the screening and monitoring of such populations becomes of utmost importance. In fact, the use of the IFI and ELISA serological techniques, showing sensitivity and NPV of 100%, confirm the use of such tools in epidemiological surveys for the detection of anti-L. (V.) braziliensis antibodies in domestic cats, and these methodologies are frequently employed in canine surveys showing good results. The serological titers found in this study for Leishmania (V.) braziliensis are similar to those of studies carried out with cats in endemic areas of visceral leishmaniasis in Spain. This similarity shows that the titers can be high even when L. (V.). braziliensis is the etiological agent. It is worth mentioning that these values are significant when compared with those of canine studies carried out in ATL endemic regions. Ultimately, the sample refers to an ATL endemic region located in Brazil, one of the countries with the highest endemicity levels of cutaneous leishmaniasis in the world and, therefore, an important area for the implementation and evaluation of diagnostic techniques for the generation of data on the disease and its possible hosts. Thus, the present study provides information on the occurrence of ATL by Leishmania (V.) braziliensis in domestic cats; demonstrates that the methodologies employed were favorable to the use of such techniques as tools in epidemiological surveys for the diagnosis of feline tegumentary leishmaniasis; and paves the way for further studies on the subject

Micobacteriose cutânea atípica felina autóctone no município do Rio de Janeiro-Brasil

Background:  :  : Cutaneous mycobacterioses show a worldwide distribution and manifest as three forms: atypical mycobacteriosis, feline leprosy and cutaneous tuberculosis. Atypical cutaneous mycobacteriosis in cats is a rare disease commonly caused by fast-growing mycobacteria belonging group IV of the Runyon classification. This report describes for the first time an autochthonous case of atypical cutaneous mycobacteriosis in a cat from the municipality of Rio de Janeiro. Case: A castrated female mongrel cat presented multiple ulcerated, exudative and alopecic lesions in different regions of the body. After sedation of the animal with 1% acepromazine hydrochloride (0.1 mg/kg) and 10% ketamine hydrochloride (10 mg/kg), clinical examination was performed and an exudate was collected from the ulcerated skin lesion for cytopathological analysis and mycological culture. The slide containing the lesion impression was stained by a rapid panoptic method. For fungal culture, material was collected with a sterile swab, seeded onto Sabouraud dextrose agar containing chloramphenicol and mycobiotic agar, and incubated at 25ºC. After antisepsis and asepsis, local anesthesia was performed with 2% lidocaine hydrochloride without vasoconstrictor and a 4 mm punch biopsy was collected from the lesion, fixed in 10% buffered formalin and sent for histopathological analysis. No fungal structures were detected by cytopathological or mycological analysis. Histopathological examination revealed ulcerated skin and the presence of a marked and diffuse pyogranulomatous infiltrate in the superficial and deep dermis, which also involving the subcutaneous tissue and underlying muscle tissue. Grocott’s or PAS staining did not identify fungal structures. The Wade method was positive for acid-fast bacteria suggestive of  ycobacterium. Analysis of the hematological and biochemical profiles revealed no noteworthy alterations. After the result of the histopathological exam, exudate material and lesion fragments were collected for bacteriological examination. The clinical specimens were processed and the presence of acid-fast bacteria was confirmed by Ziehl-Neelsen staining. Mycobacterium fortuitum fortuitum was identified based on the Runyon classification and biochemical tests, and was confirmed by molecular tests. Oral administration of enrofloxacin (5 mg/kg) at 24 h intervals was prescribed for 30 days. On the control visit, involution of the skin lesions was observed by physical examination and was also reported by the owner. After 4 months of irregular treatment due to the difficulty in administering the medication because of the cat’s aggressiveness, the animal started to present respiratory difficulties, rapid weight loss, apathy and died. Discussion: The occurrence of atypical mycobacteriosis is rare in Brazil, with isolated reports of mycobacteriosis such as canine leproid granuloma syndrome in São Paulo, canine cutaneous mycobacteriosis in Rio Grande do Sul, one case of feline leprosy in São Paulo, and one case of feline atypical cutaneous mycobacteriosis in São Paulo. The diagnosis and treatment of mycobacterial infections are frequently neglected because they are not included in the differential diagnosis of diverse cutaneous infections. In view of the scarcity of reports and to alert veterinarians that the disease should be included in the differential diagnosis with other feline dermatopathies, this report described a case of atypical feline cutaneous mycobacteriosis that occurred in the state of Rio de Janeiro. In contrast to the previous case report in São Paulo, in which was diagnosed the species Mycobacterium fortuitum biovar peregrinum, the species identified here was Mycobacterium fortuitum biovar fortuitum

Avaliação sorológica para detecção de anticorpos anti-Leishmania em cães e gatos no bairro de Santa Rita de Cássia, Município de Barra Mansa, Estado do Rio de Janeiro Serological evaluation for detection of anti-Leishmania antibodies in dogs and cats in the district of Santa Rita de Cássia, municipality of Barra Mansa, State of Rio de Janeiro

A partir de um caso canino de leishmaniose tegumentar americana na localidade de Santa Rita de Cássia, município de Barra Mansa, Rio de Janeiro, foi realizado um inquérito sorológico em 177 cães e 43 gatos. Na avaliação das amostras de soros caninos, 10% foram positivos na reação de imunofluorescência indireta e 10,7% no ensaio imunoenzimático. Entre as amostras de soros felinos testados, nenhum animal foi positivo na reação de imunofluorescência indireta e apenas um (2,4%) felino apresentou reação positiva ao ensaio imunoenzimático. A detecção de Leishmania braziliensis, autóctone em Barra Mansa, faz um alerta para a instalação de um possível foco de leishmaniose tegumentar americana nessa região.<br>From a canine case of american cutaneous leishmaniasis in the locality of Santa Rita de Cássia, municipality of Barra Mansa, Rio de Janeiro, a serological survey was performed on 177 dogs and 43 cats. Evaluation of the canine serum samples showed that 10% had a positive reaction in the indirect immunofluorescence test and 10.7% in the enzyme-linked immunosorbent assay. Among the feline serum samples tested, none of the animals had a positive reaction in the indirect immunofluorescence test and only one (2.4%) showed a positive reaction in the enzyme-linked immunosorbent assay. The detection of an autochthonous case of Leishmania braziliensis in Barra Mansa gives warning that a focus of american cutaneous leishmaniasis is possibly becoming established in this region

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research