An outbreak of brucellosis in a mixed dairy farm with 508 animals (370 cows, 120 sheep, and 18 camels) at Fayoum governorate, North Upper Egypt, was investigated. A storm of abortion and several cases of retained placenta were reported among cows and ewes in April 2020. Serodiagnosis of brucellosis was done using Rose Bengal Test (RBT) and Buffered Acidified Plate Antigen Test (BAPAT). The Milk Ring Test (MRT) was applied to the milk of seropositive animals. A total of 89 samples were used for isolation of Brucella and isolates were confirmed using Abortus, Melitensis, Ovis, Suis-PCR (AMOS-PCR). Test and slaughter strategy was applied to eradicate brucellosis from the farm based on RBT every month until three successive negative tests were obtained. Results showed that the seroprevalences of brucellosis based on RBT and BAPAT were 9.5%, 35%, and 50% in cattle, sheep, and camels, respectively. Despite 50% of male camels being seropositive, no clinical signs have been reported. The MRT identified fewer positive cases than BAPAT and RBT, thus, it cannot be used alone to eliminate the infection from the farm. A total of 31 Brucella isolates were recovered from cows and sheep on the farm. All isolates were confirmed as Brucella melitensis bv3 based on bacteriological examination and Brucella AMOS-PCR confirmed all isolates as Brucella melitensis. No positive reactors at the 6th, 7th, 8th, 9th, and 10th examinations were reported after the implementation of the test and slaughter strategy. In conclusion, extensive animal farming and mixed breeding are potential risk factors for interspecies transmission of brucellosis. Additionally, the test and slaughter strategy could be helpful to release the herd out of quarantine, however, application of biosecurity practices and fair compensation policy for owners should be implemented.
Brucellosis in human is an uncommon disease in Libya and usually diagnosed by serological assays. The clinical symptoms of this disease are none specific which makes differential diagnosis difficult.The patient was a sixteen years old girl, lives in a rural area. She was suffering from intermittent fever for several days associated with chills, mild cough, and headache. Comprehensive physical examination revealed the patient was generally unwell, pallor and, had abdominal tenderness. Laboratory investigations revealed that the patient had pancytopenia and a marked increase in C-reactive protein, procalcitonin, lactate dehydrogenase, aspartate transaminase. Provisional diagnosis was acute leukemia or aplastic anemia. Slow growth of Gram-negative coccobacilli in aerobic blood culture was detected. It could not clearly be identified by phoenix bacterial identification system. It was provisionally misdiagnosed Haemophilus spp; while finally it was identified Brucella spp. Brucellosis may manifest in a delicate manner which makes its diagnosis very challenging. It has the ability to affect various systems in the body, displaying a confusion in differential diagnosis, and delay in medical care, thus raising the risk of complications. Unusual medical laboratory findings should not be overlooked as they could help in bringing up the right clinical diagnosis.
Mucormycosis is an unusual systemic infection caused by multicellular fungi. Despite, few reports have been documented world widely, incidences of mucormycosis are recently increasing due to several predisposing factors such as diabetes, COVID-19 pandemic, and over prescription of corticosteroids. The clinical symptoms of this disease are often unfamiliar and vague. To the best of the authors’ knowledge, this is the first report that describes a case of clinical human mucormycosis during the COVID-19 pandemic in Libya. This report discusses also the risk factors and steps that can be applied to prevent occurrence of this disease. The patient is a 58-year-old Libyan female who presented with a history of COVID-19 infection, diabetes mellitus, hypertension, hypothyroidism, obesity, obstructive sleep apnea, and stable ischemic heart disease. She was complaining of loss of vision of the right eye, redness, and swelling all over the right face with scattered areas of blackish discoloration involving the inner third of the right eye and right face. Clinical examination showed bilateral basal and mid-lung fields fine crepitation, abdominal distension, severe chemosis, proptosis, restriction of all eye movement, aniscoria, upper lid ptosis and loss of corneal sensation of right eye. Computerized tomography (CT-Scan) of brain, para-nasal sinus, and orbit revealed right periorbital cellulitis, right eye proptosis, right ethmoidal, maxillary, sphenoidal sinusitis, and right cavernous sinus thrombosis without bone erosion. The histopathological report showed numerous broad branching aseptate hyphae and spores with acute cellulitis indicating an invasive fungal infection (mucormycosis). Mucormycosis is a rare fatal disease. Physician awareness and early management may significantly reduce mucormycosis severity.
INTRODUCTION: Radiosurgical treatment of numerous lesions in the brain with ‘single-isocenter’ radiosurgery on a linac often requires using multiple isocenters. With our TPS (Elements, Brainlab) multiple plans need to be generated for each set of lesions, and a sum plan calculated. We investigated how to distribute multiple lesions into two groups for two isocenters to achieve a good summed dose distribution. METHODS: The DICOM RS file is exported and the PTV data is extracted by a MATLAB program that calculates the convex hulls, estimated radii, and the centers of mass for each PTV. Two approaches were tried: (1) Lesions close to each other (closer than a certain limit) are put in different groups and (2) Create clusters by kMeans clustering, which allows close lesions but the groups are distant from each other. MATLAB programs were written for all approaches. Treatment plans were generated for three patients (20, 13, 15 lesions) using each method and compared with the actual treatment plan used to treat the patient based on the intuitive grouping of lesions by the planners. Dose maximums outside the lesions, and volumes in the normal tissue exceeding 75, 50 and 25% of the prescription dose were evaluated. RESULTS AND DISCUSSION: The coverage of all lesions for all plans were 95% of the prescription dose. The first approach allowed lowering the maximum dose between lesions, but with summing dose distributions this advantage disappeared. The maximum dose and the 75, 50 and 25% dose volumes were also all worse than in plans generated by experienced planners and higher normal brain doses are delivered if closely spaced lesions are separated into different isocenters for treatment. However, the clustering approach resulted in the same or better values of these same parameters, i.e. improved dose distributions over the dosimetrist’s intuitively chosen separation.
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