Imaging characteristics of too-long anterior process syndrome in children and adolescents

BACKGROUND

In the presence of pain over the lateral aspect of the foot or recurrent ankle sprain in children, medical imaging is often employed to investigate potential causes, such as a calcaneonavicular coalition or a too-long anterior process (TLAP) of the calcaneus. Diagnosis and categorization of calcaneonavicular coalitions (synostosis, synchondrosis, or synfibrosis) is generally facilitated through imaging, in contrast to TLAP, which lacks well-defined semiological characteristics, apart from a calcaneonavicular space measurement of less than 5 mm. However, this measurement initially performed on an oblique view radiograph can be subject to a lack of precision due to positional variations of the foot and overlapping bones. Furthermore, the differentiation between TLAP as an anatomical variant and TLAP syndrome (characterized by symptomatic presentation), remains a subject of uncertainty.

OBJECTIVE

The objective of our retrospective study was to investigate the imaging diagnosis of TLAP syndrome.

MATERIALS AND METHODS

A retrospective unmatched case-control study was conducted, covering data from February 2014 to January 2021. All patients, included retrospectively and consecutively, were initially managed in our hospital with radiography and/or computed tomography (CT) and/or magnetic resonance imaging (MRI). Two radiologists independently reviewed the images taken (radiographs, CT scans, and MRIs) of patients undergoing treatment in pediatric orthopedics for TLAP syndrome and control subjects, utilizing a standardized questionnaire. The control group consisted of subjects with no features suggestive of TLAP syndrome. The questionnaire included measurements of the calcaneonavicular space and identification of indirect signs associated with calcaneonavicular coalitions, as described in the related literature.

RESULTS

A total of 128 patients who met the inclusion criteria were included in the analysis, including 38 patients and 90 controls. The prevalence of TLAP was 71.5% in the study population and 62.6% among controls. A threshold measurement of the calcaneonavicular space at 3.2 mm favored TLAP syndrome (sensitivity=97%, specificity=70%, area under the curve [95% confidence interval] =0.881[0.812-0.949]), with better precision using CT. Three indirect signs were significant: the "anteater nose" sign, the talar beak, and the tapered anterior calcaneal process. These signs demonstrated an even stronger association with TLAP syndrome when observed in conjunction with a reduction in the calcaneonavicular space, particularly in CT scans.

CONCLUSION

TLAP is common among control subjects. Therefore, a variant appears to be the most plausible explanation and it can be considered a mild form of calcaneonavicular coalition. However, in conjunction with symptoms suggestive of TLAP syndrome, the diagnosis is further supported by imaging, specifically with a calcaneonavicular space measurement of less than 3.2 mm. This measurement is most accurately obtained using CT with 2-dimensional reconstructions in all three planes. The simultaneous presence of the "anteater nose" sign, the talar beak, or the tapered anterior calcaneal process provides additional diagnostic evidence. In the diagnostic approach of calcaneonavicular coalition, oblique foot radiography seems useful in initially detecting abnormal coalition (bony or not), and complementarily, CT emerges as the best modality to characterize TLAP syndrome.

AN ANATOMICAL STUDY OF THE THORACIC LIMB OF THE GIANT ANTEATER (MYRMECOPHAGA TRIDACTYLA) COMPARED WITH THE DOMESTIC DOG TO GUIDE SURGICAL APPROACHES TO THE HUMERUS AND RADIUS

The giant anteater (Myrmecophaga tridactyla) is a neotropical mammal considered to be vulnerable to extinction. Recent increased interest in veterinary care in the giant anteater has prompted renewed interest in anatomical descriptions in this species. The terrestrial habits and slow movements of the giant anteater contribute to its susceptibility to vehicular trauma on highways, which is a significant cause of mortality in the species. This study describes the muscular anatomy of the thoracic limb and variations of the long bones with emphasis on the structures surrounding the humerus and radius. It also describes the possible surgical approaches for the management of fractures of humerus and radius, comparing these with the surgical approaches described in dogs (Canis lupus familiaris). Three giant anteater and three domestic dog cadavers, from deaths not related to this project, were used. The medial approach to the humeral diaphysis of the giant anteater resulted in the least tissue trauma, and provided access to the flattest surface for implant attachment. The lateral approach to the radius proved challenging, requiring total detachment of the extensor carpi radialis muscle and incision of the very robust abductor digitorum longus muscle to access the distal diaphysis. Although the giant anteater shares many similarities of the thoracic limb anatomy with the domestic dog, important differences exist. This comparative knowledge will allow veterinary practitioners to directly apply the principles of fracture repair in these species. Safe access to these bones for possible osteosynthesis is essential to allow implant placement and minimize postoperative complications in this species.

Anaplasmataceae presence in Amblyomma calcaratum associated with anteaters (Tamandua tetradactyla) in the rainforest ecoregion, Argentina

Bacteria of the sister genera Ehrlichia and Anaplasma (Anaplasmataceae) are obligate intracellular Alphaproteobacteria that are transmitted mostly through arthropod vectors. These agents can infect different vertebrate cells, depending on the species involved, and can cause diseases in animals and humans. In this study, we evaluated the presence of Anaplasmataceae bacteria in Amblyomma calcaratum ticks collected from a road-killed Tamandua tetradactyla in the Rainforest ecoregion in Argentina. All samples were screened for Anaplasmataceae DNA using a real-time PCR assay targeting the 16S rRNA gene. Evidence of Anaplasmataceae DNA was detected in three out of thirty-nine Am. calcaratum ticks. Phylogenetic analysis of a portion of 16S rRNA gene positioned one sample (Ehrlichia sp. strain Ac124) with Ehrlichia sequences and the other two samples with Anaplasma sequences; Anaplasma sp. strain Ac145 close to Anaplasma odocoilei and Anaplasma sp. strain Ac152 in an ancestral position to most Anaplasma species. The groEL sequence obtained showed that Ehrlichia sp. strain Ac124 was phylogenetically related to Ehrlichia sp. strain Iberá reported infecting Amblyomma tigrinum from Iberá wetlands in Argentina. Phylogenetic analysis using the rpoB sequence positioned Anaplasma sp. strain Ac145 close to the canine pathogen Anaplasma platys, while Anaplasma sp. strain Ac152 was positioned close to the bovine pathogen Anaplasma marginale. In this study, three Anaplasmataceae agents were detected in adults of Am. calcaratum associated with a T. tetradactyla. These results suggest that the number of Anaplasmataceae species, as well as their distribution, is largely unknown.

DISEASES OF THE GIANT ANTEATER (MYRMECOPHAGA TRIDACTYLA) IN CAPTIVITY: STUDY OF MEDICAL DATA FROM 99 INDIVIDUALS IN EUROPEAN ZOOS

The giant anteater (Myrmecophaga tridactyla) is one of the three species in the family Myrmecophagidae of the suborder Vermilingua. It is the only species of the genus Myrmecophaga. The species, subject to increasing threats in its natural environment, is classified as vulnerable on the International Union for the Conservation of Nature Red List of Threatened Species. European zoos are involved in the ex situ conservation of the giant anteater, which is essential for its long-term viability. However, the diseases encountered by European captive populations of giant anteaters are not well documented, and best practice guidelines are not yet available for the species. An online two-part survey was conducted among European institutions hosting or having housed anteaters over a 20-yr period concerning the current management of captive populations and the diseases encountered. Medical data were collected from 99 giant anteaters from 30 institutions. Among the study population, 4% of the individuals were born in the wild and 96% were born in captivity. Seventy animals (71%) were still alive at the time of data collection, with an average age of 8 yr. A predominance of digestive (20%), dermatologic (20%)-with mainly wounds-and internal parasitism (18%) disorders was observed, followed by behavioral (13%), musculoskeletal (12%), respiratory (11%), nutritional (10%), and ocular (9%) disorders. Mortality mainly concerns the most extreme age categories: very young individuals, mostly secondary to trauma, and older individuals with no main cause identified. This paper details all the medical conditions reported in the European captive giant anteaters included in the study. It allows us to formulate some medical and zootechnical recommendations for the species management and to envisage new research perspectives.

Macroscopic and histological aspects of the pharynx and larynx of the giant anteater (Myrmecophaga tridactyla Linnaeus, 1758)

Giant anteater (Myrmecophaga tridactyla) is an endangered species that resides in much of Latin America, but it has been losing its habitat, especially in the Cerrado biome, where it constantly suffers traumas resulting from fires and roadkill. The anatomical knowledge of structures of the respiratory system is important for a better morphophysiological understanding of the species. Thus, this study aimed to perform the macroscopic and histomorphological description of the pharynx and larynx of the giant anteater. Twelve adult giant anteaters were used, three of them fixed in buffered formalin for further dissection and pharynx and larynx macroscopic analysis of structures. From the other animals, samples of the pharynx and larynx were collected and prepared for histological evaluation under optical microscope. Macroscopically, their pharynx and soft palate are extensive, and the anatomical location of these structures and the larynx differs greatly from that described in other species. The larynx, although more caudal, was similar to that of other animals. Histologically, the epithelium of these regions varied between the pseudostratified ciliated columnar and the non-keratinized stratified squamous epithelium. Laryngeal cartilages were composed of elastic (epiglotti) and hyaline cartilages (arytenoid, cricoid and thyroid cartilage), with an ossification process and glandular clusters around the hyaline cartilage. The distinct anatomical location of the pharynx and larynx of Myrmecophaga tridactyla is the main macroscopic finding of this study, besides the length of the pharynx and soft palate of these animals.

A Novel Host of an Emerging Disease: SARS-CoV-2 Infection in a Giant Anteater (Myrmecophaga tridactyla) Kept Under Clinical Care in Brazil

A young male free-ranging giant anteater (Myrmecophaga tridactyla) was found with paralysis of pelvic limbs on a highway and kept under human care. Radiographs confirmed multiple incomplete fractures in the thoracolumbar vertebrae. Due to the poor prognosis, euthanasia was chosen. The infection was established by viral SARS-CoV-2 RNA detection in the rectal swab, spleen and kidney samples. Immunohistochemistry detected the viral nucleocapsid protein in sections of the lungs, liver, spleen, lymph nodes, and large intestine sections, and spike protein antigen in the lung tissue. Pilosa order species should be included as potential hosts of natural infection of SARS-CoV-2.

A second functional furin site in the SARS-CoV-2 spike protein

The ubiquitously-expressed proteolytic enzyme furin is closely related to the pathogenesis of SARS-CoV-2 and therefore represents a key target for antiviral therapy. Based on bioinformatic analysis and pseudovirus tests, we discovered a second functional furin site located in the spike protein. Furin still increased the infectivity of mutated SARS-CoV-2 pseudovirus in 293T-ACE2 cells when the canonical polybasic cleavage site (682-686) was deleted. However, K814A mutation eliminated the enhancing effect of furin on virus infection. Furin inhibitor prevented infection by 682-686-deleted SARS-CoV-2 in 293T-ACE2-furin cells, but not the K814A mutant. K814A mutation did not affect the activity of TMPRSS2 and cathepsin L but did impact the cleavage of S2 into S2' and cell-cell fusion. Additionally, we showed that this functional furin site exists in RaTG13 from bat and PCoV-GD/GX from pangolin. Therefore, we discovered a new functional furin site that is pivotal in promoting SARS-CoV-2 infection.