Campylobacter commonly causes foodborne infections and antibiotic resistance is an imminent concern. It is not clear, however, if the human gut ‘resistome’ is affected by Campylobacter during infection. Application of shotgun metagenomics on stools from 26 cases with Campylobacter infections and 44 healthy family members (controls) identified 406 unique antibiotic resistance genes (ARGs) representing 153 genes/operons, 40 mechanisms, and 18 classes. Cases had greater ARG richness (p < 0.0001) and Shannon diversity (p < 0.0001) than controls with distinct compositions (p = 0.000999; PERMANOVA). Cases were defined by multidrug resistance genes and were dominated by Proteobacteria (40.8%), specifically those representing Escherichia (20.9%). Tetracycline resistance genes were most abundant in controls, which were dominated by Bacteroidetes (45.3%) and Firmicutes (44.4%). Hierarchical clustering of cases identified three clusters with distinct resistomes. Case clusters 1 and 3 differed from controls containing more urban and hospitalized patients. Relative to family members of the same household, ARG composition among matched cases was mostly distinct, though some familial controls had similar profiles that could be explained by a shorter time since exposure to the case. Together, these data indicate that Campylobacter infection is associated with an altered resistome composition and increased ARG diversity, raising concerns about the role of infection in the spread of resistance determinants.
Cattle are the main reservoirs of Shiga toxin producing Escherichia coli (STEC), a major foodborne pathogen associated with acute enteric disease and hemolytic–uremic syndrome in humans. A total of 397 beef and dairy cattle from 5 farms were included in this study, of which 660 samples were collected for 16S rRNA gene sequencing. The microbiota of farms with a high-STEC prevalence (HSP) had greater richness compared to those of farms with a low-STEC prevalence (LSP). Longitudinal analyses showed STEC-shedders from LSP farms had higher microbiome diversity; meanwhile, changes in the microbiome composition in HSP farms were independent of the STEC shedding status. Most of the bacterial genera associated with STEC shedding in dairy farms were also correlated with differences in the percentage of forage in diet and risk factors of STEC carriage such as days in milk, number of lactations, and warm temperatures. Identifying factors that alter the gut microbiota and enable STEC colonization in livestock could lead to novel strategies to prevent fecal shedding and the subsequent transmission to humans.
Acute pancreatitis is an inflammatory process. There can be many causes of pancreatitis, which include alcohol or gallstones but can also be due to hypercalcemia, infections, or hypertriglyceridemia. Most cases of pancreatitis are mild and without complications. Severe cases of pancreatitis can cause complications, including organ failure. Pseudocysts are a rare complication of pancreatitis and may require management. We present a patient with severe acute pancreatitis with organ failure admitted to the intensive care unit, stabilized, and required subsequent management of a pseudocyst with cystogastrostomy with a lumen-apposing metal stent. The patient subsequently improved and is doing well today. Herein, we present an acute severe pancreatitis case report with an extensive workup complicated by pseudocyst development. We review pancreatitis causes, including rare causes and management.
Introduction: Water beads are expanding, non-toxic toys made of water-absorbing polymer. Ingestion of such beads has the potential to cause bowel obstruction due to its ability to continually expand. There are few case reports of ingestion of water beads in infants, however, many required surgical intervention. Here, we describe an infant with water bead ingestions whose symptoms resolved with conservative management, using ultrasound as a supportive imaging modality. Case Description/Methods: A 7-month-old male presented to the emergency department with gagging and poor intake after playing with water beads approximately 16 hours prior to presentation. Physical exam was normal. No foreign body was noted on nose-to-rectum Xray. Pediatric gastroenterology was consulted for esophagogastroduodenoscopy (EGD). Upon intubation, there was concern for foreign body in the right main bronchus due to decreased breath sounds. No foreign body was visible on either rigid bronchoscopy or subsequent EGD. An ultrasound confirmed a circular anechoic structure in the right upper quadrant, likely the small bowel. He was admitted for observation and made NPO due to the potential for developing bowel obstruction. A second ultrasound 16 hours later revealed an increase in size from 2.2cm to 2.5cm and progression to the left lower quadrant, unclear if located in the colon or small bowel. With a benign abdominal exam, the decision was made to resume breastfeeding. Soon after, he passed two stools containing multiple fragments of ruptured water beads and one fully intact bead measuring 2 cm. He was discharged home with no further reported problems. (Figure ) Discussion: The gastrocolic reflex from breastfeeding most likely contributed to our patient's ability to pass the water bead without further medical or surgical intervention. The use of ultrasound, while helpful, is not a widely recognized modality for detection of ingested water beads because it may not accurately depict the number, size, or location. Clinicians must consider the patient's clinical presentation, timing post-ingestion, diet, and suspected size and number of water beads in the management. Future considerations in the management include the utilization of osmotic agents, such as gastrografin or polyethylene glycol, to osmotically impact the bead's ability to enlarge further and thus avoid surgical intervention.[3346] Figure 1. A. Initial ultrasound with circular anechoic structure in right upper quadrant. B Repeat ultrasound with circular anechoic structure now in left lower quadrant, slightly larger in size. C. Intact water bead found in stool. D. Water beads with one intact bead and multiple fragments.
Herein we present a case of severe alkalaemia (pH 7.81) due to suspected acute-on-chronic respiratory alkalosis in a patient with chronic anxiety and metabolic alkalosis secondary to emesis. The patient was managed in the intensive care unit with significant improvement and discharged in stable condition. The case report emphasises considering a broad differential of aetiologies that can cause acid–base status derangements and identifying the appropriate therapeutic approach.
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