Fatal marine
Brucella
infections with histologic lesions specific to the central nervous system (CNS), known as neurobrucellosis, have been described in 5 species of odontocete cetaceans in the UK: ...striped dolphins
Stenella coeruleoalba
, Atlantic white-sided dolphins
Lagenorhynchus acutus
, short-beaked common dolphins
Delphinus delphis
, long-finned pilot whale
Globicephala melas
and Sowerby’s beaked whale
Mesoplodon bidens
. To date, these CNS lesions have only been associated with
Brucella ceti
ST26 and not with
B. pinnipedialis
, which is rarely isolated from cetaceans and, although commonly found in various seal species, has never been associated with any pathology. This paper describes the first report of neurobrucellosis in a common minke whale
Balaenoptera acutorostrata
which was associated with the isolation of
Brucella pinnipedialis
ST24 and co-infection with
Balaenoptera acutorostrata
gamma-herpesvirus 2. This is the first report of neurobrucellosis in any species of mysticete and the first report of
Brucella pinnipedialis
in association with any pathology in any species of marine mammal, which may be due to co-infection with a herpesvirus, as these are known to be associated with immunosuppression.
Summary
Background
The Psoriasis Stratification to Optimise Relevant Therapy (PSORT) consortium has a collective aim to develop a prescribing algorithm to help stratify eligible patients with ...psoriasis to the most appropriate biological treatment. To facilitate the adoption of a stratified approach, it is necessary to first understand the factors driving the choice of first‐line biological therapy.
Objectives
To identify and quantify factors that influence the selection of the first‐line biological therapy for people with psoriasis.
Methods
Multinomial logistic regression was used to determine the factors that influenced the probability of treatment selection, using data from the British Association of Dermatologists Biologic Interventions Register from January 2012 to December 2015. Sensitivity analyses were performed to assess the robustness of the findings to key assumptions.
Results
The main analysis was based on a dataset comprising 3040 people with psoriasis. The identified factors affecting first‐line biological selection within the available therapies were: presence of psoriatic arthritis; patient weight; employment status; country of registration; and baseline disease severity. Importantly, the analysis showed a general shift in prescribing behaviour over time. These results were robust to sensitivity analysis.
Conclusions
This study offers important insights into the factors influencing current prescribing practice for first‐line biological therapies for people with psoriasis. It provides baseline data to inform the evaluation of future potential changes that may affect prescribing behaviour, such as stratified medicine.
What's already known about this topic?
Previous research has explored the effectiveness and safety of different biological therapies for people with psoriasis.
The factors that predict whether or not a person with psoriasis will start a biological therapy have been identified.
What does this study add?
We identify factors that influenced how dermatologists chose between adalimumab, etanercept and ustekinumab for people with psoriasis. Statistically significant factors included presence of psoriatic arthritis, patient weight, registration country, employment status and disease severity.
The study suggests that dermatologists change their prescribing behaviour in line with experiences and emerging evidence on treatment effectiveness and safety.
We provide baseline data to inform the evaluation of new strategies that may influence prescribing.
Respond to this article
Linked Comment: Puig. Br J Dermatol 2017; 177:623–624
Brucella ceti
has been recovered from a number species of cetaceans worldwide over the last 25 yr. Here we report, for the first time, the recovery of
B. ceti
from a Risso’s dolphin
Grampus griseus
...and a killer whale
Orcinus orca
. Recovery from an abdominal mass in the dolphin provides further evidence of the systemic pathogenic potential for
B. ceti
infection in cetaceans. The isolation of
B. ceti
ST23 (porpoise cluster) from a killer whale from a group known to eat other marine mammals raises the possibility of infection via ingestion. This report takes the number of cetacean species in UK coastal waters from which
B. ceti
has been isolated to 11 and highlights the value of routine, comprehensive and specific screening for significant pathogens such as
Brucella
sp. by strandings networks.
Fatal Brucella ceti infection with histological lesions specific to the central nervous system has been described in only 3 species of cetaceans: striped dolphins Stenella coeruleoalba, Atlantic ...white-sided dolphins Lagenorhynchus acutus and short-beaked common dolphins Delphinus delphis. This paper describes the first report of a B. ceti-associated meningoencephalitis in a long-finned pilot whale Globicephala melas, showing the increasing range of species susceptibility. Brucella was recovered in larger numbers from cerebrospinal fluid than from brain tissue and is the sample of choice for isolation.
Examines what "hypertext" means to literary criticism on the one hand (i.e., intertextuality) and computing on the other, to determine how the two concepts may serve each other in a mutually ...productive way. (GLR)
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