No abstract

The foodborne pathogen Yersinia enterocolitica causes gastrointestinal infections worldwide. In the spring of 2019, the Swedish Public Health Agency and Statens Serum Institut in Denmark independently identified an outbreak caused by Yersinia enterocolitica 4/O:3 that after sequence comparison turned out to be a cross-border outbreak. A trace-back investigation suggested shipments of fresh prewashed spinach from Italy as a common source for the outbreak. Here, we determined the genome sequences of five Y. enterocolitica clinical isolates during the Swedish outbreak using a combination of Illumina HiSeq short-read and Nanopore Technologies’ MinION long-read whole-genome sequencing. WGS results showed that all clinical strains have a fully assembled chromosome of approximately 4.6 Mbp in size and a 72-kbp virulence plasmid; one of the strains was carrying an additional 5.7-kbp plasmid, pYE-tet. All strains showed a high pathogen probability score (87.5%) with associated genes for virulence, all of which are closely related to an earlier clinical strain Y11 from Germany. In addition, we identified a chromosomally encoded multidrug-resistance cassette carrying resistance genes against chloramphenicol (catA1), streptomycin (aadA1), sulfonamides (sul1), and a mercury resistance module. This chromosomally encoded Tn2670 transposon has previously been reported associated with IncFII plasmids in Enterobacteriaceae: a Shigella flexneri clinical isolate from Japan in 1950s, a Klebsiella pneumoniae outbreak from Australia in 1997, and Salmonella enterica serovar Typhimurium. Interestingly, we identified an additional 5.7-kbp plasmid with tetB (encoding an ABC transporter), Rep, and its own ORI and ORIt sites, sharing high homology with small tetB-Rep plasmids from Pasteurellaceae. This is the first time that Tn2670 and Pasteurellaceae plasmids have been reported in Y. enterocolitica. Taken together, our study showed that the Swedish Y. enterocolitica outbreak strains acquired multi-antibiotic and metal-resistance genes through horizontal gene transfer, suggesting a potential reservoir of intraspecies dissemination of multidrug-resistance genes among foodborne pathogens. This study also highlights the concern of food-chain contamination of prewashed vegetables as a perpetual hazard against public health.

No abstract

Background: The actual cause of Gestational gigantomastia (Gg) remains a dilemma. Its treatment has ideally been surgical, employing most commonly the different pedicle techniques in the last decade. Aim: This paper reviews the literature on the management of Gg using the inferior pedicle technique (IPT) and supports it with a successful case presentation using the IPT. Method: Using the PubMed search engine and Google scholar, literature search was done for Gg treated with the inferior pedicle reduction method. Published literature from other sources was also included. Data obtained was cleaned and analysed. The inferior pedicle breast reduction technique was employed without any modification in the normal procedure for the case presented. Results: Thirty-one literature addressing Gg and IPT were identified. Most surgeons use this technique with very good outcomes. Our patient confirmed reduced breast mould, firm and adolescent looking breast with no back, shoulder, neck and rib pains. She also experienced with time increased nipple areolar sensation, ability to undertake all tasks with ease and a new sense of confidence. Conclusion: The inferior pedicle breast reduction technique can be the standard treatment for gestational gigantomastia with the length from suprasternal notch to the nipple ≤ 50 cm that present without any anatomical complications.

S. AUREUS growth is not due to the effect of nitric oxide on the innate immune system but from its effect on the bacteria itself. It has been shown that nitric oxide stimulates the expression of inducible lactate dehydrogenase, specific to S. AUREUS, which improves its resistance to oxidative stress, and may give S. AUREUS a survival advantage resulting in increased growth.