Specific and non-specific effects of Mycobacterium bovis BCG vaccination in dairy calves

Bovine tuberculosis (bTB) is a chronic disease mainly caused by Mycobacterium bovis, a zoonotic pathogen with economic significance as it leads to reduced milk and meat production, and high costs for control measures. The Bacillus Calmette-Guérin (BCG) vaccine, primarily used to prevent tuberculosis in humans, has also been studied for controlling bTB. While showing effectiveness in preventing M. bovis infection and disease in cattle, the BCG vaccine can induce non-specific effects on the immune system, enhancing responses to infections caused by unrelated pathogens, and also having non-specific effects on lactation. The aim of this study is to describe both the specific and non-specific effects of BCG vaccination in calves from a commercial dairy herd in central Chile. Diagnosis of M. bovis infection was performed through the IFNγ release assay (IGRA) using ESAT6/CFP-10 and Rv3615c antigens. The records of milk production, somatic cell count (SCC), clinical mastitis (CM) and retained placenta (RP) during the first lactation were compared between vaccinated and non-vaccinated animals. The breed (Holstein Friesian [HF] v/s HF × Swedish Red crossbred [HFSR]) and the season (warm v/s cold) were also analyzed as categorical explanatory variables. Results of IGRA showed significant differences between vaccinated and control groups, indicating a vaccine efficacy of 58.5% at 18 months post vaccination in HFSR crossbred animals. Although milk production did not vary, SCC and CM showed differences between groups, associated to the breed and the season, respectively. When analyzing CM and RP as a whole entity of disease, BCG showed protection in all but the cold season variables. Overall, the BCG vaccine induced protective specific and non-specific effects on health parameters, which may be influenced by the breed of animals and the season. These results provide new features of BCG protection, supporting initiatives for its implementation as a complementary tool in bTB control.

Is it possible to control bovine tuberculosis without compensation? Reviewing ten years of the Chilean program and its progress

In 2011, the Chilean bovine tuberculosis (bTB) program was launched by the Livestock and Agriculture Service (SAG) as a compulsory countrywide program based on testing and culling of bTB reactors at herd-owners expense. This review outlines the rationale and key components of the bTB program, and the dynamic changes that have occurred since 2011. The paper also examines the problems identified by stakeholders and the initiatives put in place to address the constraints to achieving progress.To date, the program has shown progress in controlling bTB. However, in order to achieve bTB eradication it will be essential to improve the commitment of stakeholders, and to develop a framework of strong and workable regulations that will help to manage bTB outbreaks, particularly where clusters of bTB infection are recorded.

Virulence and antimicrobial resistance factors in Salmonella enterica serotypes isolated from pigs and chickens in central Chile

Salmonella enterica is a food-borne pathogen with a wide host-range that during decades has been of public health concern in developed and developing countries. In Chile, the poultry and pig industries represent the biggest contribution of meat consumption in the population, and sanitary regulations have been imposed for Salmonella control. The aim of this work was to determine and characterize Salmonella strains isolated from pigs and chicken raised on commercials farms in Chile. For this, isolates belonging to pigs (n = 46) and poultry (n = 57) were genotyped by two multiplex PCR reactions and virulotyped by the PCR detection of virulence-associated genes. In addition, isolates were serotyped and analyzed by the Kirby Bauer assay to determine their antimicrobial resistance phenotypes. From these analyses 52 genotypes, six serotypes and several multidrug resistance phenotypes and different combinations of virulence-associated genes were detected. These results suggest that S. enterica in pigs and poultry in central Chile should be monitored due to potential consequences in public and animal health.

A household case evidences shorter shedding of SARS-CoV-2 in naturally infected cats compared to their human owners

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in domestic and wild cats. However, little is known about natural viral infections of domestic cats, although their importance for modelling disease spread, informing strategies for managing positive human-animal relationships and disease prevention. Here, we describe the SARS-CoV-2 infection in a household of two human adults and sibling cats (one male and two females) using real-time RT-PCR, an ELISA test, viral sequencing, and virus isolation. On May 5th, 2020, the cat-owners tested positive for SARS-CoV-2. Two days later, the male cat showed mild respiratory symptoms and tested positive. Four days after the male cat, the two female cats became positive, asymptomatically. Also, one human and one cat showed antibodies against SARS-CoV-2. All cats excreted detectable SARS-CoV-2 RNA for a shorter duration than humans and viral sequences analysis confirmed human-to-cat transmission. We could not determine if cat-to-cat transmission also occurred.

Livestock guarding dogs have minor effects on the parasite burden of wild carnivores

Livestock guarding dogs are increasingly used to reduce carnivore-livestock conflicts, but no information is available to determine any adverse effects that these dogs may have on the health of wild carnivores. We assessed differences in prevalence, richness and severity of parasites in chilla fox (Lycalopex griseus) populations associated with livestock guarding dogs, which were routinely dewormed. We also evaluated whether the parasite assemblages of herding dogs, which were not dewormed, and chilla foxes were more similar in the presence of livestock guarding dogs. Scats of L. griseus and herding dogs were collected and screened for parasite eggs in areas with and without livestock guarding dogs to determine differences in prevalence, richness, intensity and parasite aggregation. We did not find any association between livestock guarding dogs and differences in parasite richness or prevalence of parasites. The intensity of parasites was higher among foxes positive to parasites when LGDs were present. A lower proportion of foxes with low parasite burdens occurred in areas with LGDs compared to areas without LGDs, but this difference was not significant at the population level. Our findings show the need to continue studying the effects of livestock guarding dogs on the health of wildlife with larger sample sizes and more locations.

Vaccination of Holstein heifers with Mycobacterium bovis BCG strain induces protection against bovine tuberculosis and higher milk production yields in a natural transmission setting

Bovine tuberculosis (TB) is a chronic disease caused mainly by Mycobacterium bovis, a zoonotic pathogen that has a worldwide distribution causing serious economic losses for milk and meat producers. In Chile, the disease in dairy cattle has a heterogeneous distribution, where the Metropolitan Region concentrates the highest animal prevalence and the main challenge for the national control and eradication programme. In this epidemiological context, vaccination with the M. bovis Bacillus Calmette-Guerin (BCG) vaccine might be a useful strategy for disease prevention and control. The objective of this study was to assess the efficacy and impacts on productivity and fertility of vaccination with the BCG Russia strain in 11 month-old heifers from a dairy farm, under a natural transmission condition. Sixty-two animals were vaccinated via the subcutaneous route with the equivalent of one human dose of BCG, and 60 control animals received saline. Subsequently, blood sampling was performed at 3, 6, 9, 12, 15 and 18 months post-inoculation, and infection status was determined using the IFNγ release assay (IGRA) with the DIVA (differentiate infected from vaccinated animals) antigens ESAT-6, CFP-10 and Rv3615c. Efficacy was calculated as the percentage of reduction in the incidence of infection attributable to vaccination, which showed a statistically significant level of overall protection of 66.5%. No adverse effects on fertility and production were recorded. In contrast, we observed beneficial effects of vaccination on several milk production parameters, with the milk yield in the first 100 days after calving in the BCG group significantly higher compared to unvaccinated heifers (p < .05). These results suggest that BCG vaccination of heifers in a natural transmission setting might result in both sanitary and productive benefits, supporting its implementation as a new strategy for TB prevention in a high prevalence area of Chile.

Detection of Antimicrobial Resistant Salmonella enterica Strains in Larval and Adult Forms of Lesser Mealworm (Alphitobius diaperinus) From Industrial Poultry Farms

The lesser mealworms (Alphitobius diaperinus) constitute a common cosmopolitan pest in poultry flocks and may colonize the litter in adult and larval forms. Previous studies have documented their potential as carriers of enteric pathogens. In this context, S. enterica constitutes a prioritized zoonotic agent in the poultry industry due to the sanitary risks and economic losses associated with its presence. The aim of this study is to describe the presence of S. enterica strains in larval and adult forms of A. diaperinus collected from poultry litter belonging to industrial farms located in the central zone of Chile. A total of 403 specimens (203 adults and 200 larvae) were sampled from three farms and 25 flocks. For bacteriological isolation, beetles were processed to differentiate external and internal contamination. Then, isolates were serotyped according to the Kauffman-White scheme and antimicrobial resistance phenotypes were determined using the disk diffusion method. Gene sequences from the megaplasmid pESI were identified through a PCR based test. These procedures led to the detection of 15 S. enterica isolates, belonging to serotypes Infantis (14) and Livingstone (1), from both adults (6) and larval (9) specimens, with a similar external (7) and internal (8) distribution. Furthermore, all S. Infantis isolates showed antimicrobial resistance and evidence of megaplasmid pESI carriage, with all possessing multidrug-resistant phenotypes. Our results confirm that A. diaperinus constitutes a potential reservoir of zoonotic Salmonella strains of sanitary and economic concern for the industry and for public health.

Corrigendum: Transduction as a Potential Dissemination Mechanism of a Clonal qnrB19-Carrying Plasmid Isolated From Salmonella of Multiple Serotypes and Isolation Sources

[This corrects the article DOI: 10.3389/fmicb.2019.02503.].

Identification of Coxiella burnetii in Tank Raw Cow Milk: First Findings from Chile

Coxiella burnetii causes Q fever, an important zoonotic disease, and exposure is mainly associated with inhalation of contaminated aerosols. In South America, no systematic studies have been carried out. In Chile, the only official record of Q fever has been an outbreak of occupational context occurring in 1998 with eight confirmed human cases, all workers in the Agriculture and Livestock Service. Recently, in 2017 a Q fever outbreak was reported from dairy farm workers in two regions in southern Chile. This study determined the presence of C. burnetii in bulk tank milk samples from dairy farms obtained during this outbreak. A duplex real time quantitative PCR assay with primers and probes targeting two different gene sequences, IS1111 and com1, was used for diagnosis. C. burnetii was detected in 2 of 105 samples analyzed (2.1%). These results pose a potential public health risk as the milk from these farms was sold to the local human population. This is the first report on detecting C. burnetii in raw tank milk samples in Chile.

Transduction as a Potential Dissemination Mechanism of a Clonal qnrB19-Carrying Plasmid Isolated From Salmonella of Multiple Serotypes and Isolation Sources

Antimicrobial resistance is an increasing problem worldwide, and Salmonella spp. resistance to quinolone was classified by WHO in the high priority list. Recent studies in Europe and in the US reported the presence of small plasmids carrying quinolone resistance in Enterobacteriaceae isolated from poultry and poultry products. The aims of this study were to identify and characterize plasmid-mediated quinolone resistance in Salmonella spp. and to investigate transduction as a possible mechanism associated to its dissemination. First, we assessed resistance to nalidixic acid and/or ciprofloxacin in 64 Salmonella spp. and detected resistance in eight of them. Genomic analyses determined that six isolates of different serotypes and sources carried an identical 2.7-kb plasmid containing the gene qnrB19 which confers quinolone resistance. The plasmid detected also has high identity with plasmids reported in the US, Europe, and South America. The presence of similar plasmids was later surveyed by PCR in a local Salmonella collection (n = 113) obtained from diverse sources: food (eggs), wild and domestic animals (pigs, horse, chicken), and human clinical cases. qnrB19-carrying plasmids were found in 8/113 Salmonella tested strains. A bioinformatics analysis including Chilean and previously described plasmids revealed over 95.0% of nucleotide identity among all the sequences obtained in this study. Furthermore, we found that a qnrB19-carrying plasmid can be transferred between Salmonella of different serotypes through a P22-mediated transduction. Altogether our results demonstrate that plasmid-mediated quinolone resistance (PMQR) is widespread in Salmonella enterica of different serotypes isolated from human clinical samples, wild and domestic animals, and food in Chile and suggest that transduction could be a plausible mechanism for its dissemination. The occurrence of these antimicrobial resistance elements in Salmonella in a widespread area is of public health and food safety concern, and it indicates the need for increased surveillance for the presence of these plasmids in Salmonella strains and to assess their actual impact in the rise and spread of quinolone resistance.

[Salmonella enterica: a review or the trilogy agent, host and environment and its importance in Chile]

Salmonella enterica is a major foodborne pathogen worldwide, being the main cause of outbreaks by food consumption in Chile. Despite all efforts deployed for control and prevention, the high incidence in people still persists, with several factors that could be influencing the epidemiological behavior of this infection. The objective of this review is to identify these factors belonging to the biological agent, the human host and the environment, which probably have a greater importance in Chile. Thus, priority areas for research of S. enterica are inferred, which hopefully will help to understand its spread in nature and its success as a wide host range pathogen. In the future, increased understanding of these determinants will facilitate the implementation of biosecurity and surveillance strategies for the prevention of disease in people and animals.

Prevalence of Salmonella enterica and Shiga toxin-producing Escherichia coli in zoo animals from Chile

Salmonella (S.) enterica and Shiga toxin-producing Escherichia coli (STEC) are foodborne pathogens. Here, we report the prevalence of S. enterica and STEC in feces of 316 zoo animals belonging to 61 species from Chile. S. enterica and STEC strains were detected in 7.5% and 4.4% of animals, respectively. All Salmonella isolates corresponded to the serotype Enteritidis. To the best of our knowledge, this is the first report of S. Enteritidis in the culpeo fox (Lycalopex culpaeus), black-capped capuchin (Sapajus apella) and Peruvian pelican (Pelecanus thagus) and the first STEC report in Thomson's gazelle (Eudorcas thomsonii).

Multidrug-Resistant Outbreak-Associated Salmonella Strains in Irrigation Water from the Metropolitan Region, Chile

Salmonella enterica (S. enterica) is the main cause of foodborne diseases in the Chilean population. With the aim of characterizing the presence of S. enterica in bodies of water, samples from 40 sources were obtained, including rivers and irrigation canals used by agricultural farms in the most populated regions of Chile. As result, 35 S. enterica isolates belonging to several serotypes were detected, with the highest frequency represented by Typhimurium and Enteritidis. All strains showed phenotypic antimicrobial resistance, and most of them were multiresistant to critically important antimicrobials. In addition, the pulse-field gel electrophoresis analysis using XbaI and BlnI endonucleases showed that seven Salmonella isolates belonging to serotypes Typhimurium, Enteritidis and Infantis had identical pulsotypes to outbreak-associated clinical isolates detected in the Chilean population, suggesting a public health risk of water pollution in this region. Among sampling sites, the higher detection rates were observed in rural than urban and peri-urban areas, suggesting that the animal husbandry might contribute for environmental dispersion of this pathogen. Future efforts should address the characterization of cause-and-effect relationship between water contamination and foodborne disease, including the implementation of surveillance programmes to tackle potential risks for both human and animal populations.

Genetic and phenotypic evidence of the Salmonella enterica serotype Enteritidis human-animal interface in Chile

Salmonella enterica serotype Enteritidis is a worldwide zoonotic agent that has been recognized as a very important food-borne bacterial pathogen, mainly associated with consumption of poultry products. The aim of this work was to determine genotypic and phenotypic evidence of S. Enteritidis transmission among seabirds, poultry and humans in Chile. Genotyping was performed using PCR-based virulotyping, pulse-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Pathogenicity-associated phenotypes were determined with survival to free radicals, acidic pH, starvation, antimicrobial resistance, and survival within human dendritic cells. As result of PCR and PFGE assays, some isolates from the three hosts showed identical genotypic patterns, and through MLST it was determined that all of them belong to sequence type 11. Phenotypic assays show diversity of bacterial responses among isolates. When results were analyzed according to bacterial host, statistical differences were identified in starvation and dendritic cells survival assays. In addition, isolates from seabirds showed the highest rates of resistance to gentamycin, tetracycline, and ampicillin. Overall, the very close genetic and phenotypic traits shown by isolates from humans, poultry, and seabirds suggest the inter-species transmission of S. Enteritidis bacteria between hosts, likely through anthropogenic environmental contamination that determines infection of seabirds with bacteria that are potentially pathogenic for other susceptible organism, including humans.

Avian Influenza in wild birds from Chile, 2007-2009

Aquatic and migratory birds, the main reservoir hosts of avian influenza viruses including those with high pathogenic potential, are the wildlife species with the highest risk for viral dissemination across countries and continents. In 2002, the Chilean poultry industry was affected with a highly pathogenic avian influenza strain, which created economic loss and triggered the establishment of a surveillance program in wild birds. This effort consisted of periodic samplings of sick or suspicious animals found along the coast and analyses with standardized techniques for detection of influenza A virus. The aim of this work is to report the detection of three avian influenza strains (H13N2, H5N9, H13N9) in gulls from Chile between 2007-2009, which nucleotide sequences showed highest similitudes to viruses detected in wild birds from North America. These results suggest a dissemination route for influenza viruses along the coasts of Americas. Migratory and synanthropic behaviors of birds included in this study support continued monitoring of avian influenza viruses isolated from wild birds in The Americas and the establishment of biosecurity practices in farms.

Serotype-associated polymorphisms in a partial rpoB gene sequence of Salmonella enterica

Salmonella enterica is a zoonotic bacterium with more than 2500 serotypes, which affect a wide range of hosts and produce diverse clinical outcomes. Strain identification usually involves costly and time-demanding procedures. This paper describes the sequencing of a rpoB hypervariable gene segment (847 bp) that allows identification of serotypes in S. enterica strains isolated from several hosts. The nucleotide similarity values among S. enterica serotypes ranged from 98.23% to 99.88%, with potential usefulness for devising a simple one-step sequencing as a first approach for identification of S. enterica strains. In conclusion, the analysis of polymorphisms in the partial rpoB sequence can discriminate S. enterica strains at the subspecies level.

Identification of diverse Salmonella serotypes, virulotypes, and antimicrobial resistance phenotypes in waterfowl from Chile

Salmonella enterica is a pathogen with a wide host-range that presents great concern in developed and developing countries. To determine and characterize Salmonella strains found in Chile's waterfowl, we sampled 758 birds along 2000 km of the Chilean coast. In this sample, 46 isolates from 10 serotypes were detected, several with multidrug resistance phenotypes and different combinations of virulence-associated genes (virulotypes). These results suggest that Salmonella infection in waterfowl in Chile could have impacts on public and animal health.

[Possible association between Mycobacterium avium subsp paratuberculosis infection and Crohn's disease]

Paratuberculosis is a chronic intestinal disease of animals caused by Mycobacterium avium subsp. paratuberculosis (MAP), which has some pathological features similar to Crohn's disease (CD) in humans. The presence of MAP in food for human consumption and in affected tissues of patients with CD has been detected. Therefore, a causal association between this microorganism and the disease in humans, has been postulated. However, several related studies have failed to confirm this hypothesis and the scientific acceptance of MAP as a zoonotic agent remains controversial. This review presents the main findings related to this issue, contrasting evidences for and against an association between MAP and CD. The need to promote national studies focusing on this area is suggested.

Pandemic (H1N1) 2009 in breeding turkeys, Valparaiso, Chile

Pandemic (H1N1) 2009 virus was detected in breeding turkeys on 2 farms in Valparaiso, Chile. Infection was associated with measurable declines in egg production and shell quality. Although the source of infection is not yet known, the outbreak was controlled, and the virus was eliminated from the birds.

Modified intracellular-associated phenotypes in a recombinant Salmonella Typhi expressing S. Typhimurium SPI-3 sequences

A bioinformatics comparison of Salmonella Pathogenicity Island 3 sequences from S. Typhi and S. Typhimurium serovars showed that ten genes are highly conserved. However three of them are pseudogenes in S. Typhi. Our aim was to understand what functions are lost in S. Typhi due to pseudogenes by constructing a S. Typhi genetic hybrid carrying the SPI-3 region of S. Typhimurium instead of its own SPI-3. We observed that under stressful conditions the hybrid strain showed a clear impairment in resistance to hydrogen peroxide and decreased survival within U937 culture monocytes. We hypothesized that the marT-fidL operon, encoded in SPI-3, was responsible for the new phenotypes because marT is a pseudogen in S. Typhi and has a demonstrated role as a transcriptional regulator in S. Typhimurium. Therefore we cloned and transferred the S. Typhimurium marT-fidL operon into S. Typhi and confirmed that invasion of monocytes was dramatically decreased. Finally, our findings suggest that the genomic and functional differences between SPI-3 sequences have implications in the host specificity of Typhi and Typhimurium serovars.

Characterization of MgtC, a virulence factor of Salmonella enterica Serovar Typhi

The MgtC is a virulence factor in Salmonella Typhimurium that is required for growth at low-Mg2+ concentrations and intramacrophage survival. This gene is codified in a conserved region of the Salmonella pathogenicity island 3 (SPI-3), and is also present in the chromosome of other Salmonella serovars. In this study we characterized the MgtC factor in S. Typhi, a human specific pathogen, by using mgtC and SPI-3 mutant strains. We found that MgtC is the most important factor codified in the SPI-3 of S. Typhi for growth in low-Mg2+ media and survival within human cells. In addition, by using reporter genes we determined that the low-Mg2+ concentration, acidic media and PhoP regulator induce mgtC expression in S. Typhi. We suggest that MgtC is the most important virulence factor codified in the SPI-3 of S. Typhi.

[Tuberculosis: a re-emerging zoonosis?]

Tuberculosis is an infectious disease that is found throughout the world and which can have a dramatic impact on the economy and on human and animal health. In humans, the principal cause of infection is Mycobacterium tuberculosis, but the animal-specific pathogen, M. bovis, is arguablythe most important zoonotic agent in human history. Despite the fact that several countries have implemented control programmes for M. bovis infection in animals, which has resulted in a reduction in the number of human cases as well, recent years have witnessed a re-emergence of tuberculosis. This is due to the appearance of strains that are resistant to the main antibiotics used to treat the infection in humans, the spread of the human immunodeficiency virus, the maintenance of wild reservoirs and the persistence of the infection in livestock, particularly in developing regions. Coordinated efforts by human and animal health services, the improvement of diagnostic techniques and the development of more effective vaccines to prevent the infection are the main strategies for controlling this disease.

[Antidepressant psychopharmacotherapy]

Considering the prevalence of major unipolar depression, the economical costs of its management and the different medications available for its treatment, it is imperative to have a good knowledge of the basic principles used to classify anti depressive medications. A good acquaintance on their mechanisms of action on neurotransmission and receptors, wil allow a better understanding of their therapeutic action and secondary effects. Tricyclics, non selective MAO inhibitors, reversible MAO inhibitors, selective serotonin reuptake inhibitors, dopamine and noradrenalin reuptake inhibitors, 5-HT2 blockers with serotonin reuptake blocking effect, serotonin, noradrenalin and dopamine reuptake inhibitors, alfa 2 receptor blockers and 5-HT/2-3 inhibitors are the eight available types of antidepressants.

[Treatment of bipolar disorder during pregnancy and puerperium period. A case report]

We report a 37 years old woman with a severe bipolar disorder, that became pregnant during treatment with lithium. The patient and her family were informed about the 0.05-0.1% risk of cardiac malformations of the newborn, but decided to maintain her pregnancy and not to discontinue the use of lithium, fearing a relapse of her psychiatric ailment. She continued under medical surveillance and had a normal delivery, but no breast feeding was allowed.

Occurrence of suicide and seasonal variation

OBJECTIVE

To review the estimated suicide rates for the Region Metropolitan, the main socio-political center in Chile, for the period 1979-1994, and to determine whether they follow a seasonal pattern.

METHOD

Data available for the period 1979-94 at the Forensic Services in Chile was analyzed using Analyses of variance.

RESULTS

It was register 5,386 suicides. While the "warm" months (October, November, December & January) concentrated 39.0% of cases, the so called "cold" months reported 28.7%. This contrast is made even clearer by the month-to-month analysis, showing the highest suicide rate in December (10.6%) against the lowest rate in June (7.0%). Further statistical analysis revealed these differences to be significant.

CONCLUSION

The study shows that in Chile, representing as it does the Southern Hemisphere, the suicide rates tend to present a seasonal variation as has elsewhere been determined for in the North Hemisphere.

[The need for psychiatrists in Chile. A projection for the year 2,000]

In less than 15 year's time, the number of psychiatrists available should have increased twofold. It is thus calculated that about 500 psychiatrists would be working by 1990. An uneven regional distribution, however still survives with 80% of professionals congregated in the Chilean capital city area--less than 25% professionals working with the Health Services National System (SNSS) which is supposed to cover 75% of nationwide care. Besides, no psychiatric care is available as far as peripheral offices are concerned. By resorting to several parameters (vg. psychiatric needs according to prevalent pathologies, care demands, and ratio), as well as national data, and various author's opinion, it is estimated that about 650 psychiatrists will be needed in the year 2000. Hence, about 220 new psychiatrists should be trained during the 10 years ahead, if population's vegetative growth as well as replacements due to retirement, death, etc. are taken into account.

[Neuroleptic malignant syndrome]

This is a review article on neuroleptic malignant syndrome. Clinical manifestations and differential diagnosis are discussed. Treatment is based on suppression of the drug and administration of bromocriptine and dantrolene. After recovery, neuroleptics should be withheld or a drug with low dopaminergic blocking effect would be selected.