Subclinical mastitis in dairy cattle and buffaloes among small holders in Egypt: Prevalence and evidence of virulence of Escherichia coli causative agent

This study aimed first to estimate the prevalence of subclinical mastitis (SCM) among dairy cows and buffaloes of smallholders who sell milk directly to consumers through bulk tanks of milk distributors. The second aim is to estimate the prevalence of Escherichia coli in milk of SCM cases and identify its virulence genes and to emphasize the public health risk form drinking this milk. A total of 227 and 174 dairy cows and buffaloes, respectively from Kafrelsheikh Governorate, Egypt were examined with California Mastitis Test (CMT) to estimate the prevalence of SCM. Samples were also screened for E. coli using classical bacteriological and molecular methods. The prevalence of CMT-positive cows and buffaloes samples examined was 47.4% (49.9% and 44.3% for cows and buffaloes, respectively). Cows were found to be at a higher risk of getting high CMT score than buffaloes. E. coli was detected bacteriologically in 16.4% and in 27.2% of the CMT-positive cows and buffalo samples, respectively. A total of 83.1% and 75.6% of isolates were confirmed as E. coli using PCR technique. A multiplex PCR assay was used to identify five virulence genes in the E. coli isolates; the eae gene for enteropathogenic E. coli, stx for Shiga toxin-producing E. coli, elt and est for enterotoxigenic E. coli, and the hlyA of the enterohemolysin gene for enterohemorrhagic E. coli. Only one E. coli strain identified carried two virulence genes (eae and est). The high prevalence of SCM among dairy cows and buffaloes in the study area indicated that there is high risk to consumers who consume milk of these animals. Also, control of SCM is a prerequisite among smallholders in Egypt in order to minimize its deleterious effects such as microbial antibiotic resistance and public health hazards. To our knowledge, this is the first study that highlights the ecology of virulence by E. coli causing SCM in Kafrelsheikh governorate, Egypt. This study offers the basis for further phenotypic and molecular characterization of E. coli found in raw milk in order to guarantee safe consumption of raw milk and milk products.

The relationship between hepatitis C virus and schistosomiasis: histopathologic evaluation of liver biopsy specimens

The reported high incidence of anti-HCV seropositivity in the Egyptian population seems surprising. Some suggest that schistosomiasis is the responsible factor, either by producing false positivity for HCV antibodies or by predisposing to actual HCV infection in some way. In an attempt to investigate this unclear relationship on a histological level, we performed a thorough semiquantitative morphological study of liver biopsy specimens from 44 anti-HCV-positive Egyptian patients with chronic liver disease. More than half of these patients (23) had serological evidence of schistosomiasis. The results have shown that all 44 liver biopsy specimens demonstrated the histopathological features known to be characteristic of chronic HCV hepatitis. Statistical analysis showed no significant difference between the schistosomal and nonschistosomal groups regarding the semiquantitative histological scores of these features. This study confirms the presence of definite HCV-induced hepatic pathology in all anti-HCV seropositive cases. More importantly, it shows the lack of enhancement of this pathology in the schistosomal patients.

Closure of tracheoesophageal fistulas with chemotherapy and radiotherapy

In patients who have esophageal cancer with a tracheoesophageal fistula, chemotherapy and radiotherapy are usually contraindicated because it is thought to enlarge the fistula. The records of 50 patients who had esophageal cancer and received simultaneous chemotherapy and radiotherapy from January 1992 to January 1997 were evaluated in the Medical Oncology Section of the Veterans Administration Medical Center, Washington, D.C. All patients were staged radiographically and endoscopically. Four patients developed a tracheoesophageal fistula while receiving treatment. One patient developed a fistula before treatment and another patient developed a fistula after treatment. Closure of the tracheoesophageal fistulas was achieved in 4 of 5 patients who responded to therapy and in those who developed fistulas before or during therapy. One of the patients whose fistula did not close died during therapy, whereas the other who developed a fistula after therapy underwent stenting. This finding indicates that development of a tracheoesophageal fistula is not a contraindication to chemotherapy and radiotherapy, and patients who are responsive to therapy may have closure of their fistulas.

Emphysematous pyelonephritis responding to medical therapy

We describe two type 2 diabetic patients with unilateral emphysematous pyelonephritis who responded to medical treatment alone. Escherichia coli was isolated in both patients. The presence of gas was confirmed early by ultrasound and CT scan of abdomen. Following treatment, good functional recovery was demonstrable in the affected kidneys by isotope renogram. We stress the need for early diagnosis of this condition and aggressive treatment with broad spectrum antibiotics.