Delayed-type hypersensitivity to subcutaneous enoxaparin

BACKGROUND

Enoxaparin and other low-molecular-weight heparins are widely used to prevent and treat thromboembolic disorders. Cutaneous reactions secondary to enoxaparin injections include delayed hypersensitivity skin reactions described as erythematous, infiltrated plaques at injection sites. We studied three cases of erythematous infiltrated plaques after enoxaparin injection in order to establish the allergenic importance of this low-molecular-weight heparin.

METHODS

Patch tests were performed with sodium heparin, calcium heparin, calcium enoxaparin, and calcium nadroparin. A subcutaneous test with calcium heparin and an intravenous challenge test with sodium heparin were done. A punch biopsy was obtained from an erythematous plaque in one patient.

RESULTS

Patch tests were negative to calcium heparin in all patients, positive to enoxaparin and nadroparin in two patients, and positive to sodium heparin in one patient. In two patients, the subcutaneous challenge test was positive, the intravenous challenge test was negative, and the histopathologic appearance of the biopsy resembled a delayed-type hypersensitivity reaction.

CONCLUSIONS

These cases provide evidence of type IV hypersensitivity and the possibility of crossed-allergenicity among unfractionated heparin and low-molecular-weight heparins. We show that the subcutaneous challenge test is the most reliable diagnostic measure.

Proportional morbidity rates of enteropathogens among diarrheic dairy calves in central Spain

Faecal samples from 218 diarrheic dairy calves in 65 dairy herds, selected by convenience, were screened for the presence of rotavirus, coronavirus, Cryptosporidium spp., F5+ Escherichia coli and Salmonella spp. Animals surveyed were from 1 to 30 days old. Cryptosporidium and rotavirus were the most commonly detected agents (52.3% and 42.7% of the samples positive, respectively). F5+ E. coli was detected in the faeces of 11.9% of the calves and bovine coronavirus was detected in the faeces of 7.3% of the calves. Salmonella spp. was only found in the faeces of two calves (0.9%). Mixed infections with two or more agents occurred in 28% of the calves. Concurrent infection of rotavirus and Cryptosporidium was found in 21.6% of the calves. Two tests were used for the detection of rotavirus (a commercial ELISA and PAGE), F5+ E. coli (ELISA and bacterial culture) and Cryptosporidium (ELISA and microscopy). The validity of the commercial ELISA for the detection of rotavirus, F5+ E. coli and Cryptosporidium in faeces from diarrheic calves was evaluated using PAGE, bacterial culture and microscopy as gold standard, respectively. The ELISA showed a very low sensitivity (28.6%) for the detection of F5+ E. coli compared to bacterial culture.

Use of a chemically defined system for the direct comparison of inner cell mass and trophectoderm distribution in murine, porcine and bovine embryos

The mammalian blastocyst comprises an inner cell mass (ICM) and a trophectoderm cell layer. In this study the allocation of blastomeres to either cell lineage was compared between murine, porcine and bovine blastocysts. Chemical permeation of trophectoderm cells by the Ca2+ ionophore A23187 in combination with DNA-specific fluorochromes resulted in the differential staining of trophectoderm and ICM. Confocal microscopy confirmed the exclusive permeation of trophectoderm and the internal localisation of intact ICM cells in bovine blastocysts. Overall, differential cell counts were obtained in approximately 85% of the embryos assessed. Mean (+/-SEM) total cell numbers were 72.2+/-3.1 and 93.1+/-5 for in vivo derived murine (n = 41) and porcine (n = 21) expanded blastocysts, respectively. Corresponding ICM cell number counts revealed ICM/total cell number ratios of 0.27 and 0.21, respectively. Comparison of in vivo (n = 20) and in vitro derived bovine embryos on day 8 (n = 29) or day 9 (n = 29) revealed a total cell number of 195.25+/-9.9, 166.14+/-9.9 and 105+/-6.7 at the expanded blastocyst stage with corresponding ICM/total cell ratios of 0.27, 0.23 and 0.23, respectively. While total cell numbers differed significantly among the three groups of bovine embryos (p < 0.05), the ICM/total cell ratio did not. These results indicate that a similar proportion of cells is allocated to the ICM among blastocysts of genetically divergent species.

Serogroups, toxins and antibiotic resistance of Escherichia coli strains isolated form diarrhoeic goat kids in Spain

Fifty-five Escherichia coli strains isolated from 55 diarrhoeic goat kids from 13 flocks in Spain were serotyped and investigated for production of enterotoxins (LT and STa), verotoxins (VT1 and VT2), cytotoxic necrotizing factors (CNF1 and CNF2), alpha-hemolysin (Hly) and enterohemolysin (EntHly), and for antibiotic resistance. Only 3 (5%) strains were toxigenic: 1 VT1+EntHly+ (serogroup O8) and 2 CNF2+ (both of serogroup O153). The strains serotyped belonged to 19 serogroups. However, 31 (56%) were of one nine serogroups (O3, O8, O9, O10, O11, O21, O44, O103 and O153) and only three of them (O8, O9 and O11) accounted for 29% of the strains. The highest percentages of antibiotic resistance in order of frequency were: streptomycin (93%), sulfadiazine (89%), tetracyline (84%), kanamycin (82%), neomycin (82%) and ampicillin (69%). We conclude that E. coli strains isolated from diarrhoeic goat kids are usually non-toxigenic and belong to a large number of serogroups.

Influence of age of the donor sheep on the phagocytosis of Staphylococcus aureus subspecies anaerobius and S aureus by neutrophils

The age of the sheep donating neutrophils had a marked influence in vitro on their phagocytic ability with respect to Staphylococcus aureus and S aureus subspecies anaerobius. Neutrophils from lambs five to eight weeks old phagocytosed these organisms significantly less efficiently (P < 0.001) than neutrophils from adults two to four years old. However, neutrophils from the young animals phagocytosed S aureus significantly (P < 0.001) better than S aureus subspecies anaerobius (61.5 v 53.8 per cent), whereas there was no significant difference in the ability of the neutrophils from adult sheep to phagocytose S aureus and S aureus subspecies anaerobius (68.2 v 68.2 per cent).

In vitro susceptibility of Escherichia coli strains isolated from diarrhoeic lambs and goat kids to 14 antimicrobial agents

The in vitro activities of 14 anti-microbial agents were determined against 92 strains of E. coli isolated from lambs (60 strains) and kids (32 strains) affected by neonatal diarrhoea. The overall percentage of resistant strains to streptomycin, sulphadimethoxine and tetracycline was very high (above 70%). A high level of resistance (from 30% to 50%) to ampicillin, kanamycin, neomycin and chloramphenicol was also detected. The E. coli strains were highly susceptible to cephalosporins, polymyxin and quinolones. Most of the strains showed multiresistance: 77.2% of isolates were resistant to at least two antibiotics, 55.4% were resistant to at least four antibiotics and 33.7% were resistant to at least six antibiotics. A total of 34 antibiotypes could be distinguished.

Serogroups, toxins and antibiotic resistance of Escherichia coli strains isolated from diarrhoeic lambs in Spain

One hundred and forty-four Escherichia coli strains isolated from 144 diarrhoeic lambs (5 to 21 days old) from 38 flocks in Spain were serotyped and investigated for production of enterotoxins (LT and STa), verotoxins (VT1 and VT2), cytotoxic necrotizing factors (CNF1 and CNF2), alpha-haemolysin (Hly) and enterohaemolysin (EntHly), for necrotic and lethal activities and for antibiotic resistance. The strains belonged to 39 different serogroups; however, 58% were of one of 13 serogroups (O4, O6, O7, O8, O9, O11, O23, O26, O77, O80, O101, O103 and O161) and only four of them (O8, O9, O11 and O77) accounted for 34% of strains. In total 10 (7%) toxigenic strains were detected: two LT+, two VT1+ EntHly+, four VT1+ EntHly-, one CNF1+ Hly+ and one CNF2+. The highest percentages of antibiotic resistance were reached in the group of antibiotics (tetracycline, streptomycin, sulphadiazine, ampicillin, kanamycin, neomycin, chloramphenicol, trimethoprim and cotrimoxazole) that are most generally used by Spanish veterinary clinics. We conclude that E. coli strains isolated from diarrhoeic lambs are not generally toxigenic and belong to a large number of serogroups.

In vitro activity of fifteen antimicrobial agents against methicillin-resistant and methicillin-susceptible Staphylococcus intermedius

In this study the susceptibility of 91 methicillin-resistant and -susceptible Staphylococcus intermedius strains (MRSI and MSSI, respectively) against 15 antimicrobial agents was determined. The activity of the antimicrobial agents was studied at pH 7.2 and pH 8.5. Methicillin was more active at pH 7.2 (28 strains methicillin-resistant) than at pH 8.5 (55 strains methicillin-resistant). Gentamicin showed excellent activity, with only 3 strains resistant at pH 8.5. However, gentamicin would have to be administered parenterally. Oxytetracycline cannot be recommended for treatment of canine staphylococcal dermatitis, due to the high percentage (over 25%) of strains that were found to be resistant. Clindamycin showed little activity in inhibiting growth of the strains studied, the percent resistance at pH 7.2 was 93.4%. Rifampin behaved differently at the two pH values. However, a close relationship was noted between methicillin-resistant and rifampin-resistant strains, particularly at the lower pH. Of the fluoroquinolones, ciprofloxacin or enrofloxacin would be a good useful alternative for the treatment of methicillin-resistant strains of S. intermedius. Lastly, very high resistance to sulphamethoxypyridazine was found, as was the case with trimethoprim and a combination of trimethoprim/sulphamethoxypyridazine, against not only MRSI but also MSSI strains.

Sex chromosome complement and developmental diversity in pre-and post-hatching porcine embryos

To examine sex and development relationships in porcine embryos in early gestation, 10 gilts were killed on Day 4, 5, or 6 post mating (first day of standing estrus = Day 0). Embryos recovered immediately after slaughter were cultured in Medium 199 with colcemid (0.05mug/ml), fixed on slides, and stained with 4% Giemsa. The number of cells in each specimen was counted from the slides, and, whenever cell dispersion allowed, sex was determined by presence or absence of the Y-chromosome in at least 2 spreads from each embryo. Three gilts slaughtered on Day 4 yielded 2- and 4-cell stage embryos (n = 38), but no data on sex could be obtained due to lack of mitosis or readable metaphase spreads. Three Day 5 litters had individual specimens ranging from 8 to 14 cells (n = 8), 32 to 64 cells (n = 10), and 13 to 31 cells (n = 11), with the sex determined in 15 of these. Cell numbers ranged from 18 to 165 (n = 14), 16 to 32 (n = 9), 36 to 82 (n = 12), and 16 to 30 (n = 9) in the 4 gilts slaughtered on Day 6, with the sex determined in 26 of these. Embryos within each litter were divided into low, medium and high cell numbers by 3 equal divisions of the range of cell numbers. Three Day-5 embryos and 1 Day-6 embryo were lost during preparation; neither the cell numbers nor the sex could be determined in 4 Day-5 and in 3 Day-6 embryos. The overall sex ratio approximated 1:1, but on Day 5, the ratios for males to females were 0:5, 1:3 and 6:0 for the low, medium and high cell number groups, respectively. Embryos of undetermined sex in these same groups numbered 3, 1 and 3, respectively. On Day 6 the distribution was 1:11, 4:2 and 8:0 in favor of the males, while embryos of undetermined sex in the low, medium and high cell number groups numbered 5, 7 and 2, respectively. Chi-square analysis of the combined Day-5 and Day-6 results indicated the presence of significantly more females among embryos with low cell numbers and more males in the high cell number group (P < 0.01).

Comparative in vitro activity of 11 beta-lactam antibiotics against 91 Staphylococcus intermedius strains isolated from staphylococcal dermatitis in dogs

A study was made of the susceptibility of 91 strains of Staphylococcus intermedius, isolated from staphylococcal dermatitis of dogs, to 11 beta-lactam antimicrobial agents. The activity of these antimicrobial agents against all strains was tested at pH 7.2 and 8.5. Finally, a comparative study was made of the susceptibility of these micro-organisms, dividing them into six groups: beta-lactamase positive and negative, methicillin resistant and susceptible and oxacillin resistant and susceptible. Only three of the 11 antimicrobial agents studied exhibited satisfactory behaviour at the two pH levels studied: mezlocillin, cefazolin and cefalotine. There was a good correlation at pH 8.5 between methicillin-resistant strains and those resistant to penicillin G, ampicillin, amoxycillin, cefamandole and cefuroxime. This correlation was not observed, however, between oxacillin-resistant strains and strains resistant to the other antimicrobial agents studied.

In vitro activities of enoxacin, enrofloxacin, sparfloxacin, and ciprofloxacin against Escherichia coli strains isolated from diarrheic lambs and kids

The in vitro activities of four fluoroquinolone compounds were tested against 92 Escherichia coli strains of ovine and caprine origin under aerobic and anaerobic incubation conditions. The four fluoroquinolones proved to be highly effective against the E. coli isolates tested. When bacteria were cultured anaerobically, at least fourfold increases in the MICs of enoxacin for the strains occurred and no detectable changes in enrofloxacin, sparfloxacin, and ciprofloxacin MICs occurred.

Occupational allergy to mites in salty ham, chorizo and cheese

We present three cases of occupational allergy caused by the manipulation of food: cheese, chorizo (typical Spanish salami) and salty ham. A IgE-mediated sensitization is demonstrated by skin tests, RAST and positive challenge tests to Acarus siro and Blomia kulagini of the cheese rind, Euroglyphus maynei of the "chorizo" and Tyrophagus putrescentiae of the salty ham.

Immunotherapy with allergenic extracts in geriatric patients: evaluation of effectiveness and safety

A study has been performed of the prevalence of allergic pathology in the geriatric population attending our department during a period of one year, showing that this type of clinical problem affects 10.4% of our patients 60 years or older. In spite of such considerable prevalence, immunotherapy is not normally used with this age group. This paper describes the results of hyposensitization in 22 of these patients, diagnosed as having extrinsic allergic illness by means of clinical, functional and analytical parameters. We found a significant decrease in cutaneous sensitivity, bronchial hyperreactivity and specific IgE in the patients treated with immunotherapy, as well as a subjective clinical improvement. We feel that immunotherapy can be very effective for the geriatric population, offering the advantages of not requiring self-administration by the older patients and avoiding the secondary effects already described with other kinds of antiallergic medications.

Urticaria by Blastocystis hominis. Successful treatment with paromomycin

Urticaria and angioedema are easily recognized disorders, but in at least 70 percent of individuals, chronic episodes of urticaria are of unknown causes. We present 10 cases of chronic urticaria associated parasitation by blastocystis hominis. This parasite has not been previously related with urticaria. Both intestinal parasitation as well as urticaria responded successfully to paromomycin sulfate.

Sequence analysis of thymidine kinase-defective mutants of equine herpesvirus-1 (EHV-1)

We have amplified, cloned and sequenced the gene encoding the thymidine kinase (TK) of a wild-type strain (Ab4) of equine herpesvirus-1 (EHV-1) and two mutants with defective TK activity isolated for resistance to penciclovir (PCV). One of the mutants, PR1, has suffered a 879-bp deletion which reduces the size of TK to 180 bp. The other mutant, PR3, has an adenine to cytosine mutation resulting in a Lys38-->Thr change. This mutation modifies the amino acid sequence of a domain involved in binding ATP, leading to non-detectable enzymatic activity. Lys38 thus appears to be essential for the activity of the TK of EHV-1.

Asthma and vasculitis. Response to intravenous immunoglobulins

A 17-year old woman suffered progressively worse asthma attacks with hypereosinophilia, patchy lung infiltrates, and acute ischemic lesions of the fingers and purpuric lesions suggesting vasculitis. She developed hypoxemic respiratory failure despite treatment with high-dose corticosteroids. Intravenous cyclophosphamide was introduced with good clinical response, but had to be discontinued because of intolerance. Intravenous immunoglobulins were given in monthly doses for 10 months while the corticosteroid dose was tapered off. This treatment was associated with rapid clinical and biochemical improvement without adverse effects. We conclude that intravenous immunoglobulins is a useful complementary treatment for patients with severe asthma associated with pulmonary vasculitis refractory to corticosteroid therapy alone.

Experimental intramammary infection of ewes with Staphylococcus aureus subsp anaerobius

The susceptibility of the ovine mammary gland to experimental infection with Staphylococcus aureus subsp anaerobius was studied in five lactating Churra ewes. The left mammary gland of each ewe was inoculated with bacteria while the right halves remained untreated and served as a control. A rapid cellular response was elicited in all inoculated glands. The reaction of inoculated mammary glands varied from that of clinical mastitis (ewes C and D) to subclinical mastitis (ewes B and E) or merely to a transient increase of somatic cell counts (ewe A). S aureus subsp anaerobius is less pathogenic for ewes by the intramammary route than S aureus since doses of about 10(8) bacteria caused clinical mastitis in only two of the inoculated animals.