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Yang Y, Xie S, He F, Xu Y, Wang Z, Ihsan A, Wang X. Recent development and fighting strategies for lincosamide antibiotic resistance. Clin Microbiol Rev 2024; 37:e0016123. [PMID: 38634634 PMCID: PMC11237733 DOI: 10.1128/cmr.00161-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
SUMMARYLincosamides constitute an important class of antibiotics used against a wide range of pathogens, including methicillin-resistant Staphylococcus aureus. However, due to the misuse of lincosamide and co-selection pressure, the resistance to lincosamide has become a serious concern. It is urgently needed to carefully understand the phenomenon and mechanism of lincosamide resistance to effectively prevent and control lincosamide resistance. To date, six mobile lincosamide resistance classes, including lnu, cfr, erm, vga, lsa, and sal, have been identified. These lincosamide resistance genes are frequently found on mobile genetic elements (MGEs), such as plasmids, transposons, integrative and conjugative elements, genomic islands, and prophages. Additionally, MGEs harbor the genes that confer resistance not only to antimicrobial agents of other classes but also to metals and biocides. The ultimate purpose of discovering and summarizing bacterial resistance is to prevent, control, and combat resistance effectively. This review highlights four promising strategies, including chemical modification of antibiotics, the development of antimicrobial peptides, the initiation of bacterial self-destruct program, and antimicrobial stewardship, to fight against resistance and safeguard global health.
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Affiliation(s)
- Yingying Yang
- National Reference Laboratory of Veterinary Drug Residues (HZAU), Huazhong Agricultural University, Wuhan, Hubei, China
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Shiyu Xie
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Fangjing He
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Yindi Xu
- Institute of Animal Husbandry Research, Henan Academy of Agricultural Sciences, Zhengzhou, Henan, China
| | - Zhifang Wang
- Institute of Animal Husbandry Research, Henan Academy of Agricultural Sciences, Zhengzhou, Henan, China
| | - Awais Ihsan
- Department of Biosciences, COMSATS University Islamabad, Sahiwal campus, Islamabad, Pakistan
| | - Xu Wang
- National Reference Laboratory of Veterinary Drug Residues (HZAU), Huazhong Agricultural University, Wuhan, Hubei, China
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
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Costinar L, Badea C, Marcu A, Pascu C, Herman V. Multiple Drug Resistant Streptococcus Strains-An Actual Problem in Pig Farms in Western Romania. Antibiotics (Basel) 2024; 13:277. [PMID: 38534712 DOI: 10.3390/antibiotics13030277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
Streptococci are a type of bacteria that can cause severe illnesses in humans and animals. Some typical species like S. suis, or atypical species like S. porcinus and, S. dysgalactiae subsp. dysgalactiae, can cause infections like septicemia, meningitis, endocarditis, arthritis, and septic shock. S. suis is considered a newly emerging zoonotic pathogen. Although human streptococcal infection outbreaks are rare, it is appropriate to review the main streptococcal species isolated in pig farms in western Romania, due to the high degree of antibiotic resistance among most isolates commonly used in human treatment. This study examines the resistance patterns of these isolates over 5 years (2018-2023). The research investigated the antimicrobial susceptibility of 267 strains of Streptococcus spp. isolated from pigs, primarily from lung and brain tissues. This report is the first to describe the distribution of atypical Streptococcus species (SDSE, S. porcinus, S. hyovaginalis, S. pluranimalium, S. canis) in Romania, as well as the antibiotic resistance profile of these potentially zoonotic species. It is important to re-evaluate and consider the high rates of resistance of S. suis to tetracyclines, lincosamides, macrolides, and aminoglycosides, as well as the high recovery rates of S. suis from the lungs and brain when treating swine diseases.
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Affiliation(s)
- Luminita Costinar
- Department of Infectious Diseases and Preventive Medicine, Faculty of Veterinary Medicine, University of Life Sciences "King Mihai I", 300645 Timisoara, Romania
| | - Corina Badea
- Department of Infectious Diseases and Preventive Medicine, Faculty of Veterinary Medicine, University of Life Sciences "King Mihai I", 300645 Timisoara, Romania
| | - Adela Marcu
- Department of Animal Production Engineering, Faculty of Bioengineering of Animal Recourses, University of Life Science "King Mihai I", 300645 Timișoara, Romania
| | - Corina Pascu
- Department of Infectious Diseases and Preventive Medicine, Faculty of Veterinary Medicine, University of Life Sciences "King Mihai I", 300645 Timisoara, Romania
| | - Viorel Herman
- Department of Infectious Diseases and Preventive Medicine, Faculty of Veterinary Medicine, University of Life Sciences "King Mihai I", 300645 Timisoara, Romania
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Schwarz L, Hamar F, Bernreiter-Hofer T, Loncaric I, Arnold M, Voglmayr T, Ladinig A. Bleeding skin lesions in gestating sows of a piglet producing farm in Austria. Porcine Health Manag 2023; 9:52. [PMID: 37964382 PMCID: PMC10647148 DOI: 10.1186/s40813-023-00348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Stomoxys calcitrans, the stable fly, occurs in pig producing countries worldwide. While in cattle the impact of this blood sucking insect is quite well described, its role in pig production is poorly investigated. Here we describe a case of a massive stable fly overpopulation in the gestation unit of a piglet producing farm in Austria that resulted in bleeding skin lesions in bitten sows. CASE PRESENTATION In October 2021, the responsible herd veterinarian of the case farm reported of sows in the gestation area presenting with bloody crusts on the whole skin surface of the body and of bleeding skin lesions. 33/55 sows were affected by moderate to severe skin lesions. Reproductive performance decreased during the time of massive stable fly overpopulation. Sows in the gestation unit showed defensive behaviour and at a certain time point resigned and accepted being bitten by stable flies. After controlling the fly population, reproductive performance improved and even exceeded the performance before the massive overgrowth of the stable fly population. CONCLUSIONS Stable flies are a serious harm to pigs and should be kept in mind for improved animal health and welfare. Knowledge about the determination of Stomoxys calcitrans and early recognition of an increasing stable fly population in pig farming systems followed by proper insect control measures have to be performed to reduce losses caused by this harming insect.
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Affiliation(s)
- Lukas Schwarz
- University Clinic for Swine, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Vienna, Austria.
| | - Flora Hamar
- University Clinic for Swine, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Tanja Bernreiter-Hofer
- University Clinic for Swine, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Vienna, Austria
- Tierarztpraxis an der Nordbahn, Strasshof, Austria
| | - Igor Loncaric
- Institute of Microbiology, Department of Pathobiology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Mirjam Arnold
- Clinic for Swine, Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Institute for Animal Health I, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | | | - Andrea Ladinig
- University Clinic for Swine, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Vienna, Austria
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Geiping L, Detlefsen H, Trittmacher S, Baums CG, Bergmann R, Hennig-Pauka I. Streptococcus equi subspecies zooepidemicus - a case report of sudden death in a German sow farm. Porcine Health Manag 2023; 9:48. [PMID: 37875963 PMCID: PMC10594803 DOI: 10.1186/s40813-023-00344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
A farm in North-West Germany experienced a high morbidity and mortality in their sow herd. Sows showed fever, lethargy, oedema, mucosal discharge and dyspnoea. Necropsy revealed a severe fibrinous and purulent polyserositis. Haematological and histological examinations confirmed septicaemia. Streptococcus equi subspecies zooepidemicus was isolated in high yields from major organs. Sequence typing of this isolate (21/455) revealed a new sequence type showing a significantly higher proliferation rate in comparison to two other isolates. Other infectious agents (influenza A virus, Porcine Reproductive and Respiratory Syndrome Virus, Porcine Circovirus 2, african swine fever virus, classical swine fever virus, Actinobacillus pleuropneumoniae) were excluded by routine diagnostic examinations. A climate check revealed an insufficient air supply in the area for the gestating sows. This case describes the first disease outbreak in swine due to S. zooepidemicus in Germany.
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Affiliation(s)
- Lukas Geiping
- Field Station for Epidemiology in Bakum, University of Veterinary Medicine Hannover, Foundation, Germany
| | - Henrik Detlefsen
- Tierarztpraxis Bethen, Heideweg 7, 49661, Cloppenburg/Bethen, Germany
| | - Sara Trittmacher
- Field Station for Epidemiology in Bakum, University of Veterinary Medicine Hannover, Foundation, Germany
| | - Christoph Georg Baums
- Institute of Bacteriology and Mycology, Centre for Infectious Diseases, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - René Bergmann
- Institute of Bacteriology and Mycology, Centre for Infectious Diseases, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Isabel Hennig-Pauka
- Field Station for Epidemiology in Bakum, University of Veterinary Medicine Hannover, Foundation, Germany.
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Kaczmarkowska A, Kwiecień E, Didkowska A, Stefańska I, Rzewuska M, Anusz K. The Genetic Diversity and Antimicrobial Resistance of Pyogenic Pathogens Isolated from Porcine Lymph Nodes. Antibiotics (Basel) 2023; 12:1026. [PMID: 37370345 DOI: 10.3390/antibiotics12061026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
According to the Food and Agriculture Organization of the United Nations, pork remains the most consumed meat in the world. Consequently, it is very important to ensure that it is of the highest microbiological quality. Many of the pathogens that cause lymph node lesions in pigs are zoonotic agents, and the most commonly isolated bacteria are Mycobacterium spp., Streptococcus spp., Staphylococcus aureus and Rhodococcus equi (synonymous with Prescottella equi). The prevention and treatment of zoonotic infections caused by these bacteria are mainly based on antimicrobials. However, an overuse of antimicrobials contributes to the emergence and high prevalence of antimicrobial-resistant strains, which are becoming a serious challenge in many countries. The aim of this study was to evaluate the genetic diversity and antimicrobial resistance of the Streptococcus spp. (n = 48), S. aureus (n = 5) and R. equi (n = 17) strains isolated from swine lymph nodes with and without lesions. All isolates of S. dysgalactiae, S. aureus and R. equi were subjected to PFGE analysis, which showed the genetic relatedness of the tested bacteria in the studied pig populations. Additionally, selected tetracycline and macrolide resistance genes in the streptococcal strains were also studied. The results obtained in the present study provide valuable data on the prevalence, diversity, and antimicrobial resistance of the studied bacteria. Numerous isolated bacterial Streptococcus spp. strains presented resistance to doxycycline, and almost half of them carried tetracycline resistance genes. In addition, R. equi and S. aureus bacteria presented a high level of resistance to beta-lactam antibiotics and to cefotaxime, respectively.
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Affiliation(s)
- Aleksandra Kaczmarkowska
- Department of Food Hygiene and Public Health Protection, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), 02-787 Warsaw, Poland
| | - Ewelina Kwiecień
- Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), 02-787 Warsaw, Poland
| | - Anna Didkowska
- Department of Food Hygiene and Public Health Protection, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), 02-787 Warsaw, Poland
| | - Ilona Stefańska
- Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), 02-787 Warsaw, Poland
| | - Magdalena Rzewuska
- Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), 02-787 Warsaw, Poland
| | - Krzysztof Anusz
- Department of Food Hygiene and Public Health Protection, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), 02-787 Warsaw, Poland
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Uezen JD, Ficoseco CA, Fátima Nader-Macías ME, Vignolo GM. Identification and characterization of potential probiotic lactic acid bacteria isolated from pig feces at various production stages. CANADIAN JOURNAL OF VETERINARY RESEARCH = REVUE CANADIENNE DE RECHERCHE VETERINAIRE 2023; 87:127-145. [PMID: 37020571 PMCID: PMC10069149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/16/2022] [Indexed: 04/07/2023]
Abstract
Lactic acid bacteria (LAB) were isolated, identified, and characterized from pig feces at various growth stages and feed rations in order to be used as probiotic feed additives. Lactic acid bacteria numbers ranged from 7.10 ± 1.50 to 9.40 log CFUs/g for growing and lactating pigs, respectively. Isolates (n = 230) were identified by (GTG)5-polymerase chain reaction and partial sequence analysis of 16S rRNA. Major LAB populations were Limosilactobacillus reuteri (49.2%), Pediococcus pentosaceus (20%), Lactobacillus amylovorus (11.4%), and L. johnsonii (8.7%). In-vitro assays were performed, including surface characterization and tolerance to acid and bile salts. Several lactobacilli exhibited hydrophobic and aggregative characteristics and were able to withstand gastrointestinal tract conditions. In addition, lactobacilli showed starch- and phytate-degrading ability, as well as antagonistic activity against Gram-negative pathogens and the production of bacteriocin-like inhibitory substances. When resistance or susceptibility to antibiotics was evaluated, high phenotypic resistance to ampicillin, gentamicin, kanamycin, streptomycin, and tetracycline and susceptibility towards clindamycin and chloramphenicol was observed in the assayed LAB. Genotypic characterization showed that 5 out of 15 resistance genes were identified in lactobacilli; their presence did not correlate with phenotypic traits. Genes erm(B), strA, strB, and aadE conferring resistance to erythromycin and streptomycin were reported among all lactobacilli, whereas tet(M) gene was harbored by L. reuteri and L. amylovorus strains. Based on these results, 6 probiotic LAB strains (L. reuteri F207R/G9R/B66R, L. amylovorus G636T/S244T, and L. johnsonii S92R) can be selected to explore their potential as direct feed additives to promote swine health and replace antibiotics.
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Affiliation(s)
- José D Uezen
- Centro de Referencia para Lactobacilos (CERELA-CONICET), Pharmabiotic Department, Batalla de Chacabuco 145 (CP: T4000ILC). San Miguel de Tucumán, Tucumán, Argentina
| | - Cecilia Aristimuño Ficoseco
- Centro de Referencia para Lactobacilos (CERELA-CONICET), Pharmabiotic Department, Batalla de Chacabuco 145 (CP: T4000ILC). San Miguel de Tucumán, Tucumán, Argentina
| | - María E Fátima Nader-Macías
- Centro de Referencia para Lactobacilos (CERELA-CONICET), Pharmabiotic Department, Batalla de Chacabuco 145 (CP: T4000ILC). San Miguel de Tucumán, Tucumán, Argentina
| | - Graciela M Vignolo
- Centro de Referencia para Lactobacilos (CERELA-CONICET), Pharmabiotic Department, Batalla de Chacabuco 145 (CP: T4000ILC). San Miguel de Tucumán, Tucumán, Argentina
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Wong KY, Megat Mazhar Khair MH, Song AAL, Masarudin MJ, Chong CM, In LLA, Teo MYM. Endolysins against Streptococci as an antibiotic alternative. Front Microbiol 2022; 13:935145. [PMID: 35983327 PMCID: PMC9378833 DOI: 10.3389/fmicb.2022.935145] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
Multi-drug resistance has called for a race to uncover alternatives to existing antibiotics. Phage therapy is one of the explored alternatives, including the use of endolysins, which are phage-encoded peptidoglycan hydrolases responsible for bacterial lysis. Endolysins have been extensively researched in different fields, including medicine, food, and agricultural applications. While the target specificity of various endolysins varies greatly between species, this current review focuses specifically on streptococcal endolysins. Streptococcus spp. causes numerous infections, from the common strep throat to much more serious life-threatening infections such as pneumonia and meningitis. It is reported as a major crisis in various industries, causing systemic infections associated with high mortality and morbidity, as well as economic losses, especially in the agricultural industry. This review highlights the types of catalytic and cell wall-binding domains found in streptococcal endolysins and gives a comprehensive account of the lytic ability of both native and engineered streptococcal endolysins studied thus far, as well as its potential application across different industries. Finally, it gives an overview of the advantages and limitations of these enzyme-based antibiotics, which has caused the term enzybiotics to be conferred to it.
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Affiliation(s)
- Kuan Yee Wong
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Megat Hamzah Megat Mazhar Khair
- Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Adelene Ai-Lian Song
- Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Mas Jaffri Masarudin
- Department of Cell and Molecular Biology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Chou Min Chong
- Department of Aquaculture, Faculty of Agriculture, Universiti Putra Malaysia, Selangor, Malaysia
| | - Lionel Lian Aun In
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
- Lionel Lian Aun In,
| | - Michelle Yee Mun Teo
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
- *Correspondence: Michelle Yee Mun Teo,
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Hennig-Pauka I, Hartmann M, Merkel J, Kreienbrock L. Coinfections and Phenotypic Antimicrobial Resistance in Actinobacillus pleuropneumoniae Strains Isolated From Diseased Swine in North Western Germany-Temporal Patterns in Samples From Routine Laboratory Practice From 2006 to 2020. Front Vet Sci 2022; 8:802570. [PMID: 35155648 PMCID: PMC8831912 DOI: 10.3389/fvets.2021.802570] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Actinobacillus pleuropneumoniae (APP) is one major bacterial porcine respiratory tract pathogen causing disease outbreaks worldwide, although effective commercial vaccines are available. Due to frequent failure of this preventive measure, treatment with antimicrobials is indispensable to prevent animal losses within an outbreak situation. To preserve the effectivity of antimicrobial substances to fight APP should therefore be the primary aim of any interventions. In this study, the temporal development of antimicrobial resistance in APP was analyzed retrospectively in the time period 2006-2020 from a routine diagnostic database. In parallel, frequent coinfections were evaluated to identify most important biotic cofactors as important triggers for disease outbreaks in endemically infected herds. The proportion of APP serotype 2 decreased over time but was isolated most often from diseased swine (57% in 2020). In ~1% of the cases, APP was isolated from body sites outside the respiratory tract as brain and joints. The lowest frequencies of resistant isolates were found for cephalothin and ceftiofur (0.18%), florfenicol (0.24%), tilmicosin (2.4%), tiamulin (2.4%), enrofloxacin (2.7%), and spectinomycin (3.6%), while the highest frequencies of resistant isolates were found for gentamicin (30.9%), penicillin (51.5%), and tetracycline (78.2%). For enrofloxacin, tiamulin, tilmicosin, and tetracycline, significantly lower frequencies of resistant isolates were found in the time period 2015-2020 compared to 2006-2014, while gentamicin-resistant isolates increased. In summary, there is only a low risk of treatment failure due to resistant isolates. In maximum, up to six coinfecting pathogens were identified in pigs positive for APP. Most often pigs were coinfected with Porcine Circovirus 2 (56%), Streptococcus suis (24.8%), or the Porcine Reproductive and Respiratory Syndrome Virus (23.3%). Potential synergistic effects between these pathogens published from experimental findings can be hypothesized by these field data as well. To prevent APP disease outbreaks in endemically infected herds more efficiently in the future, next to environmental trigger factors, preventive measures must also address the coinfecting agents.
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Affiliation(s)
- Isabel Hennig-Pauka
- Field Station for Epidemiology, University of Veterinary Medicine Hannover, Bakum, Germany
| | - Maria Hartmann
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health at the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Jörg Merkel
- Department of Infectious Diseases, Institute for Microbiology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Lothar Kreienbrock
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health at the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Hannover, Germany
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Qu H, Li Y, Chen M, Sun H, Du S, Cheng Y, Zhan S. Cavernous sinus thrombosis: An insidious and dangerous "do-not-miss" diagnosis. Headache 2021; 61:1144-1149. [PMID: 34325491 DOI: 10.1111/head.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Huiyang Qu
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanling Li
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengying Chen
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Honghong Sun
- Department of Radiology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuang Du
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuxuan Cheng
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuqin Zhan
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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