Intramammary infections and teat canal colonization with coagulase-negative staphylococci after postmilking teat disinfection: species-specific responses

Coagulase-negative staphylococci (CNS) are the most common pathogens associated with intramammary infections (IMI) in dairy cows. We hypothesized that postmilking teat disinfection would reduce microbial colonization of the teat canal and thus reduce the prevalence of IMI caused by certain CNS species. The efficacy of iodine postmilking teat dip was tested against CNS colonization of the teat canal, and incidence of IMI was measured. Using an udder-half model, 43 Holstein cows at the Washington State University Dairy were enrolled in the trial; postmilking teat dip was applied to one udder-half, treatment (TX), and the remaining half was an undipped control (CX). Teat canal swabbing and mammary quarter milk samples were taken in duplicate once a week for 16 wk for microbial culture. Isolates from agar cultures were presumptively identified as CNS and then speciated using PCR-RFLP and agarose gel electrophoresis. Colonization of the teat canal and IMI by CNS were assessed. Thirty CNS IMI were diagnosed and the number of new IMI in CX quarters (21) was significantly greater than that in TX mammary quarters (9). The majority of CNS IMI were caused by Staphylococcus chromogenes (30%) and Staphylococcus xylosus (40%), and the latter were appreciably reduced by teat dip. Except for S. xylosus, an association was observed between teat canal colonization and IMI by all CNS species in this study, in which the majority of IMI were preceded by teat canal colonization. The total number of CNS IMI was greater for CX group cows compared with TX group cows. However, the effect of disinfection on IMI did not appear to be the same for all CNS species.

Is surgical debridement and topical 5 fluorouracil the optimum treatment for woodworkers' adenocarcinoma of the ethmoid sinuses? A case-controlled study of a 20-year experience

OBJECTIVES

Woodworkers' adenocarcinoma of the ethmoid sinuses is an extremely rare occupational malignancy with a locally aggressive course. Treatment with surgical exenteration and topical 5 fluorouracil (5FU) packs has become standard treatment over the last 10 years in this ENT unit. This study presents level 2 evidence that 5FU provides improved survival over previous management with primary radiotherapy and salvage craniofacial resection.

DESIGN

Retrospective case series with historical control group.

SETTING

District General Hospital.

PARTICIPANTS

The records of 31 consecutive patients with the disease were analysed. Five patients died prior to treatment. One patient was treated with surgery alone and therefore excluded. Twenty-five patients were included in the analysis. Fourteen were treated with primary radiotherapy and 11 with surgery and topical 5FU.

OUTCOME MEASURES

Disease free survival was measured using Kaplan-Meier survival analysis.

RESULTS

Five-year disease free survival improved from 50% with primary radiotherapy to 86% with surgery and 5FU. This improvement is statistically significant (P = 0.03).

CONCLUSION

Topical 5FU treatment improves survival of Woodworker's adenocarcinoma of the ethmoid sinuses. This finding may be useful in the treatment of other locally aggressive sinonasal malignancies.

A novel HLA-C locus allele with codon 54 deletion, Cw*0346

This report describes the discovery and characterization of the novel Cw*0346 allele.

A novel HLA-Cw*05 allele, Cw*0517

This report describes the discovery and characterization of the HLA-Cw*0517 allele.

Transplantation of a fetus with paternal Thy-1(+)CD34(+)cells for chronic granulomatous disease

A fetus diagnosed with X-linked chronic granulomatous disease was transplanted with Thy-1(+)CD34(+) cells of paternal origin. The transplant was performed at 14 weeks gestation by ultrasound guided injection into the peritoneal cavity. The fetus was delivered at 38 weeks gestation after an otherwise uneventful pregnancy. Umbilical cord blood was collected and used to determine the level of peripheral blood chimerism as well as levels of functional engrafted cells. Flow cytometry was used to detect donor leukocytes identified as HLA-A2(-)B7(+) cells, whereas recipient cells were identified as HLA-A2(+)B7(-) cells. No evidence of donor cell engraftment above a level of 0.01% was found. PCR was used to detect HLA-DRB1*15(+) donor cells among the recipient's HLA-DRB1*15(-) cells, but no engraftment was seen with a sensitivity of 1:1000. The presence of functional, donor-derived neutrophils was assessed by flow cytometry using two different fluorescent dyes that measure reactive oxygen species generated by the phagocyte NADPH oxidase. No evidence of paternal-derived functional neutrophils above a level of 0.15% was observed. Peripheral blood and bone marrow samples were collected at 6 months of age. Neither sample showed engraftment by HLA typing using both flow cytometry and PCR. Functional phagocytes were also not observed. Furthermore, no indication of immunological tolerance specific for the donor cells was indicated by a mixed lymphocyte reaction assay performed at 6 months of age. While there appears to be no engraftment of the donor stem cells, the transplant caused no harm to the fetus and the child was healthy at 6 months of age. Analyses of fetal tissues, obtained from elective abortions, revealed that CD3(+) T cells and CD56(+)CD3(-) NK cells are present in the liver at 8 weeks gestation and in the blood by 9 weeks gestation. The presence of these lymphocytes may contribute to the lack of donor cell engraftment in the human fetus.

In utero hematopoietic stem cell transplants prolong survival of postnatal kidney transplantation in monkeys

The authors hypothesized that in utero transplantation of T-cell-depleted paternal marrow into rhesus monkey fetuses would induce tolerance to postnatal kidney grafts from the marrow donor. T-cell-depleted paternal bone marrow was transplanted intraperitoneally into two female fetal rhesus monkeys at 61 +/- 1 days' gestation. Chimeric monkeys (n = 2) received kidney transplants from paternal donors. Control monkeys (n = 2) underwent kidney transplants without prior in utero stem cell transplants. Both chimeric monkeys demonstrated low level (<0.1% donor cells) engraftment in the bone marrow and peripheral blood using the polymerase chain reaction assay for the Y chromosome. The mixed lymphocyte reaction demonstrated hyporeactivity to the donor. Control animals demonstrated severe acute rejection and graft failure 1 week posttransplant. The first chimeric monkey had no significant clinical or sonographic evidence of renal failure until 7 weeks after the transplant. Biopsy findings showed mild rejection 1 week postoperatively, but rejection did not significantly progress until 5 weeks later. The second chimeric monkey had no significant clinical or sonographic changes for 4 weeks, but evidence of moderate rejection was seen on biopsy results. This monkey was given a 10-week course of immunosuppression, and had no clinical or sonographic renal deterioration, although biopsy results showed chronic rejection that was confirmed when electively euthanized 8 months later. Our data suggest that in utero transplantation of hematopoietic stem cells can increase the survival of a kidney allograft in the rhesus monkey.

Long-term engraftment following in utero T cell-depleted parental marrow transplantation into fetal rhesus monkeys

A major concern with allogeneic BMT for treating most inherited diseases is the need to overcome graft rejection with conditioning chemotherapy which is associated with a relatively high morbidity and mortality. This can be eliminated if the transplant is done in utero when the fetus is unable to reject donor hematopoietic stem cells (HSC). We studied the efficacy of T cell-depleted (TCD) parental bone marrow as a source of HSC for transplantation into early gestation non-defective fetal rhesus monkeys. Thirteen opposite sexed TCD transplants were done into 44 day fetal recipients and 12 into 61 day recipients (165 day total gestation). The procedure-related mortality was 8%, all in the earlier age group. The overall survival was 60% at birth with a projected survival of 44 +/- 10% at 1.5 years with no difference between the two age groups. We used a PCR assay for the rhesus Y chromosome to detect male donor cells in female recipients (six animals transplanted at 44 days and five at 63 days). The overall engraftment rate was 73% with no difference as a function of gestational age at transplant. In six long-term surviving engrafted females we detected donor cells in the peripheral blood and bone marrow up to 3 years of age. We found a delay in the appearance of donor cells in the peripheral blood in engrafted animals, in some cases for up to 6 months post-BMT. In vitro mixed lymphocyte reaction and cell-mediated lymphocytotoxicity studies between the recipient and donor cells indicate that tolerance was induced to donor cells. Individual and pooled erythroid and myeloid marrow colonies grown in methyl cellulose were collected and analyzed for donor origin by PCR. The amount of donor cells in marrows from long-term engrafted animals was < 0.1%. In a fetal recipient studied at 35 days post-BMT, donor cells were detected in bone marrow and liver in both erythroid and myeloid lineages. These results indicate that TCD parental marrow can durably engraft in utero. While the engraftment rate is similar to that seen with fetal liver as the source of HSC, the degree of peripheral blood engraftment (percent donor cells) in this non-defective primate model is low. It will require increasing the percent pre-or postnatally for this approach to be clinically relevant in those disorders in which there is no selective survival advantage for normal engrafted donor cells.

Associations of HLA-DR and HLA-DQ types with anti-GBM nephritis by sequence-specific oligonucleotide probe hybridization

Twenty-three patients from the United States with anti-glomerular basement membrane nephritis (Goodpasture's syndrome) were HLA class I and class II typed by serology and HLA-DR and HLA-DQB typed using sequence-specific oligonucleotide (SSO) probes. Protocols used were those of the 11th International HLA Workshop. We were able to confirm the strong association of DR2 with the disease and, using the molecular techniques, showed that all DR2 patients were restricted to DRB1-1501 and DQB1-0602 alleles. We also found highly significant associations between disease and the alleles of DRB1-0301 and DQB1-0201. DR4 alleles as a group were not significantly more frequent among patients, but the allele DRB1-0404 did appear to be associated with the disease. The use of SSO typing provides an expanded opportunity for refined analysis of HLA and disease associated alleles.

Graft vs. host disease after liver transplantation in humans: a report of four cases

Four cases of patients in whom graft vs. host disease developed after liver transplantation are described. The clinical course of each patient was similar with fever, pancytopenia, diarrhea and a skin rash developing 1 or 2 mo after liver transplantation. The clinical diagnosis was made from skin or colon biopsy specimens. Liver dysfunction did not occur in the patients at the time of diagnosis. Extrahepatic donor DNA was identified in the three patients it was tested for. Three patients died from the complications of the disease primarily related to sepsis. The other patient recovered from the graft vs. host disease but died from lymphoproliferative disease.

Study of HLA alloantigens of the Navajo Indians of North America. II. HLA-A, B, C, DR and other genetic markers

This report presents the antigen frequencies for HLA-A, B, C, DR, immunoglobulin, and red blood cell systems for the Navajo Indians of North America. HLA-A-B,B-C, and B-DR haplotype frequencies and significant delta values are given. These data are compared with similar data for other American Indians and major non-Indian ethnic groups. Very restricted HLA polymorphism is unique for the Navajo as well as American Indians in general and this feature has important implications with regard to disease association and transplantation.