本帖最后由 刘欣 于 2018-8-7 21:29 编辑
翻译：王帆（巴哥控）；校对：刘欣 文献一（摘要）： 22只犬在洗澡或美容后出现背部疖病的临床及组织病理学特征 Clinical and histopathologic features of dorsally located furunculosis in dogs following water immersion or exposure to grooming products: 22 cases 研究目的-在洗澡或接触美容产品后出现的犬疖病的临床及组织病理学特征。 设计-回顾性病例分析。 研究动物-22只有疖病皮肤病变表现的患犬，且发病前进行过洗澡或美容。 研究方法-从患犬病例中收集信息，包括特征描述、临床症状、美容程序、诊断性试验、治疗方法和效果。 研究结果-最常感染的犬是德国牧羊犬(4/22 [18%])和拉布拉多犬(4/22 [18%])。皮肤病变表现为：特有的出血性脓疱和结痂，所有犬都位于背部且平均出现在洗澡或梳毛后2天（范围：1-7天）。有20只(91%)犬发病前曾在家洗澡或去宠物美容店美容；1只犬在手术后切口周围出现皮肤病变。常见临床症状有嗜睡、颈部或背部疼痛和发烧。假单胞菌是犬皮肤样本的(10/14)细菌学培养中最常见菌种。主要的病理组织学特征是表皮真皮层急性毛囊破裂，伴有化脓性炎性反应和真皮层出血。全身抗生素治疗，尤其是口服氟喹诺酮类药物，22只患犬中的16只(73%)临床效果良好。 讨论和临床相关性-犬在洗澡或梳毛后急性发作的疖病，描述其临床特点和组织病理学特征进行描述。了解这种症状的病史和临床特征，对患犬的确诊和合理治疗至关重要。 Objective—To describe clinical and histopathologic features of furunculosis in dogs following water immersion or exposure to grooming products. Design—Retrospective case series. Animals—22 dogs with skin lesions consistent with furunculosis and a history of water immersion or grooming prior to onset. Procedures—Information collected from the medical records of affected dogs included signalment, clinical signs, bathing or grooming procedure, diagnostic tests, treatment, and outcome. Results—German Shepherd Dogs (4/22 [18%]) and Labrador Retrievers (4/22 [18%]) were most commonly affected. Skin lesions, particularly hemorrhagic pustules and crusts, were dorsally located in all dogs and occurred a median of 2 days (range, 1 to 7 days) following water immersion or exposure to grooming products. Twenty (91%) dogs were bathed at home or at a commercial grooming facility prior to lesion onset; 1 dog developed skin lesions following hydrotherapy on an underwater treadmill, and 1 dog developed peri-incisional skin lesions after surgery. Lethargy, signs of neck or back pain, and fever were common clinical signs. Pseudomonas aeruginosa was the most common bacterial isolate from dogs with bacteriologic culture performed on skin samples (10/14). The main histologic feature was acute follicular rupture in the superficial dermis with suppurative inflammation and dermal hemorrhage. Systemic antimicrobial treatment, particularly oral administration of fluoroquinolones, resulted in excellent clinical response in 16 of 22 (73%) dogs. Conclusions and Clinical Relevance—Acute-onset furunculosis with characteristic clinical and histopathologic features in dogs following water immersion or exposure to grooming products was described. Knowledge of the historical and clinical features of this syndrome is essential for accurate diagnosis and appropriate treatment of affected dogs. 文献一的病变照片-多只犬美容后疖病。
文献二（全文）：分子学证实香波是假单胞菌诱发的犬美容后疖病的来源 Molecular confirmation of shampoo as the putative source of Pseudomonas aeruginosa-induced postgrooming furunculosis in a dog 背景-美容后出现由假单胞菌引发的急性疖病已被充分了解。虽然怀疑感染源是被污染的香波，但这种关系一直没得到分子学证实。 目的-本病例报告描述了从一只患美容后疖病的犬的皮肤病变处分离的假单胞菌，与发病前使用的香波中提取的假单胞菌的基因纹完全一致。 研究结果-该犬表现为嗜睡、厌食、疼痛和急性皮肤病变表现，即在洗澡后24h内，位于胸背部和两侧以及臀部出现出血性丘疹、脓疱、合并的溃疡和结痂。细胞学表现为化脓性炎症，偶尔可见细胞内的杆菌。皮肤病变和香波内细胞培养产生的假单胞菌的脉冲场凝胶电泳表现一致。经口服环丙沙星和外用抗菌香波治疗后，皮肤病变在8周内完全消退。 结论及临床价值-我们的临床调查提出假单胞菌污染的香波和美容后疖病之间有关联，并且 强调对香波进行卫生管理，才能有助于控制这种疾病。 Background– An acute onset furunculosis due to Pseudomonas aeruginosa following grooming is a well recognized entity. Although contaminated shampoos have been suspected to be the source of the infection, a molecular confirmation of this association has been missing. Objective– This case report describes a dog with postgrooming furunculosis in which Pseudomonas aeruginosa with an identical genetic fingerprint was isolated from the skin lesions as well as from the shampoo used prior to the disease onset. Results– The dog presented for lethargy, anorexia, pain and rapidly progressing skin lesions consistent with haemorrhagic papules, pustules, coalescing ulcers and crusts localized to the dorsal and lateral aspects of the thorax and gluteal region, which developed within 24 h after a bath. Cytology demonstrated suppurative inflammation with occasional intracellular rod-shaped bacteria. Bacterial culture from skin lesions and the shampoo bottle yielded Pseudomonas aeruginosa with an identical pulsed-field gel electrophoresis pattern. Treatment with oral ciprofloxacin and topical antimicrobial shampoo resulted in a complete resolution of skin lesions within eight weeks. Conclusion and clinical importance– Our clinical investigation suggests a link between Pseudomonas-contaminated shampoo and development of postgrooming furunculosis, and underscores the need for hygienic management of shampoos to help limit this disease. 介绍 Introduction 在40多年的时间里，已经发现了人假单胞菌毛囊炎的爆发与使用浴缸和热水桶有关。在犬上已有美容或洗澡后出现急性爆发性疖病的相似临床特性的描述，经鉴定假单胞菌是最常见的微生物。在相似病变中也分离出了其他细菌，比如假中间葡萄球菌、表皮葡萄球菌、阴沟肠杆菌、粘质沙雷氏菌、产酸克雷伯菌和洋葱伯克氏菌。虽然假单胞菌在环境中无处不在，但受污染的抗菌肥皂和化妆品对人体感染构成额外风险。怀疑犬假单胞菌感染的美容后疖病，假单胞菌污染的香波是造成其发生的罪魁祸首，尽管这事不足为奇，但是仅有一篇摘要报道过香波培养阳性。本篇病例报道描述了一只患美容后疖病的犬，从其皮肤病变分离出假单胞菌，与发病前使用的香波中分离出的假单胞菌基因纹完全一致。 Outbreaks of Pseudomonas folliculitis associated with the use of whirlpools and hot tubs have been recognized in people for more than four decades. A similar clinical entity characterized by an acute onset furunculosis shortly after grooming or water immersion has been described in dogs, with Pseudomonas aeruginosa being the most commonly identified organism. Other bacteria such as Staphylococcus pseudintermedius, Staphylococcus epidermidis, Enterobacter cloacae, Serratia marcescens, Klebsiella oxytoca and Burkholderia cepacia also have been isolated from similar lesions. Although P. aeruginosa is ubiquitous in the environment, contaminated antibacterial soaps and cosmetics represent additional risks for infection in people. Not surprisingly, Pseudomonas-contaminated shampoos have been suspected as a key component in the pathogenesis of a Pseudomonas-associated postgrooming furunculosis in dogs, but a positive shampoo culture has been reported only in an abstract form. This case report describes a dog with a postgrooming furunculosis in which P. aeruginosa with an identical genetic fingerprint was isolated from both the skin lesions and the shampoo used prior to the disease onset. 病理报告 Case report 一只两岁已绝育的母的混种德国牧羊犬，出现嗜睡、厌食疼痛和急性皮肤病变表现，主要位于胸背部和两侧以及臀部。体表检查发现多个出血性丘疹、脓疱、融合的溃疡和结痂周围有明显红斑(图1a–c)。患处皮肤触诊疼痛，但未见其他异常。主诉洗澡后24h内出现嗜睡、厌食和疼痛，在出现全身症状表现后的第一天发现皮肤病变。在家使用非药用的非处方香波给该犬洗澡。主人用了7个月前购买的旧瓶中的剩余香波，以及少量近期购买的同品牌的新瓶香波。主人用手给犬洗澡，并没有用很大力。操作前后没有进行美容刷毛。给犬洗澡的主人没有任何皮肤病变表现。血常规检查和生化检查未见异常。从一个完整的脓疱采集的细胞学检查可见退行性中性粒细胞和巨噬细胞，偶见杆菌。基于病史调查、皮肤病变类型和分布以及细胞学检查，怀疑性诊断为美容后疖病。 A two-year-old female, spayed, German shepherd mixed breed dog was presented for lethargy, anorexia, pain and rapidly progressing skin lesions localized predominantly on the dorsal and lateral aspects of her thorax and gluteal region. Multifocal haemorrhagic papules, pustules, coalescing ulcers and crusts surrounded by prominent erythema were found on physical examination (Figure 1a–c). The affected skin was painful to the touch, but no other abnormalities were noted. The owner reported that the lethargy, anorexia and pain developed within 24 h after a bath, and the skin lesions were first noticed one day after the onset of systemic signs. The dog was bathed at home using a nonmedicated, over-the-counter shampoo. The owner used the last remaining shampoo from an old bottle purchased seven months previously, as well as a small amount from a recently purchased, newly opened bottle of the same brand. The dog was scrubbed manually, but not vigorously. There was no history of pre- or postgrooming brushing. The owner performing the bath did not exhibit any skin lesions. A complete blood count and chemistry panel did not reveal any abnormalities. Cytology from an intact pustule showed degenerative neutrophils and macrophages with occasional rod-shaped bacteria. Based on the history, type and distribution of the skin lesions and the cytology findings, a diagnosis of postgrooming furunculosis was suspected. 细菌培养和药敏试验以及脉冲场凝胶电泳技术基因纹分析法（PFGE） Bacterial culture and susceptibility and genetic fingerprinting by pulsed-field gel electrophoresis (PFGE) 使用棉签对一个完整的脓疱进行采集装进一个Port-ACul管（BD; Franklin Lakes, NJ, USA），寄到NCSU临床微生物实验室进行需氧菌培养和药敏试验。样品按照实验室标准操作规程处理，分别在36°C 的5%哥伦比亚羊血琼脂培养基(Remel; Lenexa, KS, USA)上和麦康凯培养基(Remel)上，在5% CO2和瞬时空气环境中，培养48h。用革兰氏染色和生化特性(Sensititre, Thermo Fisher Scientific; Cleveland, OH, USA)对分离菌进行鉴定。用肉汤微量稀释法(Sensititre)和CLSI指南评估分离菌的敏感性。同时对主人提供的旧香波瓶子和新香波瓶子也进行需氧菌培养。分别用棉签在每个瓶子内壁进行无菌采样，并用上述方法进行培养。 A swab from an intact pustule was submitted in a Port-ACul tube (BD; Franklin Lakes, NJ, USA) to the NCSU Clinical Microbiology Laboratory for aerobic culture and susceptibility. The sample was handled following laboratory standard operating procedures, which included incubation at 36°C on 5% Columbia sheep blood agar (Remel; Lenexa, KS, USA) and MacConkey agar (Remel) for up to 48 h under 5% CO2 and transient air conditions, respectively. The isolate was confirmed by Gram stain and biochemical properties (Sensititre, Thermo Fisher Scientific; Cleveland, OH, USA). The susceptibility of the recovered isolates was evaluated using broth microdilution (Sensititre) and CLSI guidelines. Both the previously used and the newly opened shampoo bottles provided by the owner also were submitted for aerobic bacterial culture. A swab from the inside wall of each bottle was collected aseptically and cultured as described above. 从皮肤病变和旧香波瓶内分离出了假单胞菌，而新香波没有。将皮肤和旧香波瓶分离出的假单胞菌放在36°C血琼脂平板上生长24h，用XbaI酶切脉冲场凝胶电泳技术分析基因纹。使用Doc XR+凝胶成像仪(Bio-Rad; Hercules, CA, USA)获得凝胶图像。使用生物数字软件(Applied Maths, Inc.; Austin, TX, USA)将PFGE条带模型标准化并进行对比。PFGE条带模型的分析证实从皮肤病变和旧香波瓶分离菌株的脉冲场模式相同(图1d)。两个菌株对抗生素的药敏谱也一致，对恩诺沙星、阿米卡星、庆大霉素和亚胺培南敏感，对氯霉素、替卡西林和替卡西林/克拉维酸中度敏感，对头孢菌素、多西环素、红霉素和复方新诺明耐药。 Pseudomonas aeruginosa was isolated from the skin sample and from the old shampoo bottle, but not from the newly opened shampoo bottle. The individual P. aeruginosa isolates from the skin and the old bottle were then grown on blood agar plates for 24 h at 36°C for a genetic fingerprinting by PFGE analysis with XbaI restriction enzyme digestion. Gel images were obtained using the Gel Doc XR+ Imager (Bio-Rad; Hercules, CA, USA). The PFGE banding patterns were normalized and compared using BioNumerics software (Applied Maths, Inc.; Austin, TX, USA). The PFGE banding pattern analysis confirmed that the strains isolated from the skin lesions and from the old shampoo bottle had identical pulse-field patterns (Figure 1d). The antimicrobial susceptibility profile was also identical between the two isolates, showing susceptibility to enrofloxacin, amikacin, gentamicin and imipenem, intermediate susceptibility to chloramphenicol, ticarcillin and ticarcillin/clavulonic acid, and resistance to cephalothin, doxycycline, erythromycin and trimethoprim-sulfamethoxazole. 治疗及结果 Treatment and outcome 患犬接受每日一次口服环丙沙星治疗（29mg/kg；环丙沙星片剂，USP，Aurobindo Pharma USA, Inc.; North Dayton, NJ, USA），连用8周，并且每周一次使用3%葡萄糖酸氯己定(Hexadene, Virbac; Fort Worth, TX, USA)香波洗澡，连续8周。患犬在首诊后3周和8周进行复诊。两次的皮肤病变记录都是完全消退。 The dog was treated once daily with oral ciprofloxacin (29 mg/kg; ciprofloxacin tablets, USP, Aurobindo Pharma USA, Inc.; North Dayton, NJ, USA) for eight weeks and bathed once weekly with a 3% chlorhexidine gluconate-containing shampoo (Hexadene, Virbac; Fort Worth, TX, USA) for eight weeks. The dog was rechecked three and eight weeks after the initial visit. A complete resolution of skin lesions was recorded at both time points. 讨论 Discussion 据作者所知，这是首例用基因纹分析法确定被污染的香波是犬美容后疖病的感染源的病理报告。虽然怀疑被假单胞菌污染的香波与犬的这种疾病有关，但是因为这种微生物的性质是无处不在，且支持这一理论的证据有限，人们还提出了其他的细菌感染源，比如梳子、水槽、浴缸、水龙头、被污染的水源和土壤。遍布在不同环境中假单胞菌与其基因组中大量的调控基因有关。与大肠杆菌或葡萄球菌等条件致病菌相比，假单胞菌的基因组明显更大，且调控基因的比例高于所有其他测序细菌基因组。因此，假单胞菌具有广泛的环境适应性，比如能在各种生长基质上生长、营养需求最少、生存温度高达50°C以及在有氧和无氧条件下都能生长。这可以解释这种细菌能在香波瓶或用于常规细胞学染色的染液中存活的能力。此外，在美容后疖病病例中观察到，假单胞菌的大的基因组编码了许多导致严重炎症反应（例如：脂多糖、鞭毛）和组织损伤（如蛋白酶、弹性蛋白酶、外毒素A、细胞毒素ExoU、活性氧自由基）的致病因子。 To the best of the authors’ knowledge, this is the first case report of a postgrooming furunculosis in a dog in which a genetic fingerprint suggested a contaminated shampoo to be the source of its infection. Pseudomonas-contaminated shampoos have been suspected to be involved in the pathogenesis of this disease in dogs; however, because of the ubiquitous nature of this microorganism and limited evidence supporting this theory, other sources of bacterial exposure such as grooming brushes, sinks, tubs, faucets, contaminated water sources and soil have been proposed. This pervasive distribution of P. aeruginosa in different environments is linked to the large number of regulatory genes in its genome. The P. aeruginosa genome is markedly larger when compared to other opportunistic pathogens such as Escherichia coli or Staphylococcus spp., and the proportion of regulatory genes is greater than in all other sequenced bacterial genomes. As a result, P. aeruginosa exhibits a wide range of environmental adaptability such as growth on a variety of growth substrates, minimal nutrient requirements, survival in temperatures as high as 50°C and growth in both aerobic and anaerobic conditions. This could explain the ability of this bacteria to survive in shampoo bottles or in staining solutions used for routine cytology staining. Additionally, the large genome of P. aeruginosa encodes for numerous virulence factors responsible for the severe inflammation (e.g. lipopolysaccharides, flagella) and tissue damage (e.g. proteases, elastases, exotoxin A, cytotoxin ExoU, reactive oxygen species) observed in patients with postgrooming furunculosis. 使用PFGE确定了从皮肤病变和旧香波瓶中分离出的假单胞菌基因高度一致。尽管其他的分子学技术，比如全基因组测序鉴别能力更强，但是PFGE已预先显示出了对假单胞菌的高鉴别能力。此外，两种分离菌的抗生素药敏试验一致，也进一步支持他们可能相同。 The high genetic relatedness of the P. aeruginosa isolates from the skin lesions and the old shampoo bottle was determined using PFGE. Although other molecular techniques such as whole genome sequencing might have provided better discriminatory power, PFGE previously has shown high discriminatory power for P. aeruginosa. Additionally, the identical antimicrobial susceptibility profile of both isolates further supports their likely identity. 因为没有可检测的商业化实验室，所以本研究没有进行基于假单胞菌对O-抗原（一种脂多糖结构）的血清学反应表达的血清型分类。在人类，假单胞菌20种不同的血清型中，从爆发性假单胞菌毛囊炎调查的泳池和浴缸中最常分离出的是O:11型。目前尚不清楚它的增加是否普遍反映了这种血清型在环境中大量存在或有较高毒性。对人的假单胞菌毛囊炎发病机制的实验研究表明，细菌浓度、接触时间、皮肤过湿和机械损伤在该病发病机制中起重要作用（见综述）。类似因素被认为在犬美容后疖病中也有涉及。虽然我们报道的病例中没有暴力刷毛和揉搓，但是此犬的被毛厚，在很长一段时间内都是湿的，这可能导致皮肤过湿，并使污染香波中的细菌附着在皮肤上。 Serotyping, which is based on serological reactivity of the O-antigen (one of the lipopolysaccharide domains) expressed by P. aeruginosa, was not performed in this study due to the lack of commercially available testing laboratories. In people, of the 20 different P. aeruginosa serotypes, O:11 is most commonly isolated from outbreaks of Pseudomonas folliculitis traced to swimming pools and whirlpools. It remains unknown whether its increased prevalence reflects the abundance of this serotype in the environment or higher virulence. Experimental studies on the pathogenesis of Pseudomonas folliculitis in humans suggest that bacterial concentration, the duration of exposure, overhydration of the skin and mechanical injury play important roles in the pathogenesis of the disease (see review). Similar factors are believed to be involved in canine postgrooming furunculosis. Although vigorous brushing or scrubbing during the bath was not reported in our case, the thick hair coat in this dog remained wet for an extended period of time, which could have caused overhydration of the skin and allowed the bacteria from the contaminated shampoo to adhere. 综上所述，我们的临床调查表明，被假单胞菌污染的香波与美容后疖病的发生有相关性，并且需要强调对香波进行卫生管理（例如：丢弃过期香波、确保香波瓶盖始终盖上、避免将稀释后的香波散装存放），有助于控制此病。 In conclusion, our clinical investigation suggests a link between Pseudomonas-contaminated shampoo and development of postgrooming furunculosis, and underscores the need for hygienic management of shampoos (i.e. discarding expired shampoo, ensuring the shampoo bottle is always capped, avoiding storage of diluted shampoo in bulk) to help limit this disease. 图1：一只因假单胞菌感染发生美容后疖病的患犬。组图描述（a）胸腔侧面有许多丘疹、点状溃疡和出血性结痂；（b）胸部近距离观察可见红斑、丘疹、溃疡和结痂；（c）腰部可看到融合的溃疡和结痂；（d）从皮肤病变分离的（凝胶线1）和从旧香波瓶分离的（凝胶线2）假单胞菌，表现的脉冲场凝胶电泳产物的图像的条带模型相同。 Figure 1. Postgrooming furunculosis in a dog due to Pseudomonas infection. A composite figure depicting (a) the lateral thorax with numerous papules, pinpoint ulcers and haemorrhagic crusts; (b) a closer view of the thorax with erythematous macules, papules, ulcers and crusts; (c) a view of a lumbar region with coalescing ulcers and crusts; (d) an image of the pulsed-field gel electrophoresis products showing identical banding patterns between the P. aeruginosa isolated from the skin lesions (gel line 1) and from the old shampoo bottle (gel line 2).
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