Cloacal malformations are characterized by the confluence of the lower urinary tract, the female reproductive tract, and the rectum to create a common channel with a single opening on the perineum. The presence of a cloaca is a normal phase of early human embryological development. Between the 4^th and 7^th weeks of gestation, the cloaca undergoes subdivision to form the hindgut and urogenital sinus. Failure of this process results in the congenital anomaly termed persistent cloaca (PC). The term urorectal septum malformation sequence (URSMS) is also used to describe this anomaly. The classic description of this process which is still cited in many standard textbooks dates from the 19^th century. However, this has been increasingly called into question by the findings of studies using modern scientific methodology. Urogenital sinus anomalies are defined by the confluence of the urethra and vagina to form a common channel of varying length with a single perineal opening. In this condition, the anorectal canal opens separately on the perineum. The presence of a urogenital sinus represents a transient phase of the normal development of the lower genital tract in the female fetus. However, the form of urogenital sinus most commonly encountered in the developed world is a feature of disordered sexual differentiation and does not arise simply from the persistence of the anatomical structure which is a feature of normal fetal development.
Cloaca/embryology* ; Female ; Humans ; Urogenital Abnormalities/embryology* ; Vagina/embryology*

Iran bears a remarkable variety of reptiles. One of the lizard families occurring in Iran is the Family Agamidae which is widely are distributed throughout the old world. The large-scaled rock agamid, Laudakia nupta, is one of the well-known agamid. There are few reports of cloacal microbial on reptiles hence their function in cloacae remains unknown. Laudakia nupta usually live in rural and urban areas and close vicinity to man, they are likely to play an important role in the spread of disease that may be caused by these microorganisms and their transmission to man. Therefore, the aim of this study was to identify the bacterial flora colonizing the cloacal region of Laudakia nupta using molecular studies. The cloacal fluids were directly placed on nutrient agar (NA) plates and incubated at 25 ± 2 ℃ for 48 h. The resulting bacterial colonies were transferred to fresh nutrient agar (NA) plates for molecular studies. Twelve isolates were obtained from 17 specimens of Laudakia nupta. All bacteria isolates were identified as Bacillus subtillis (5), Bacillus cereus (4), Bacillus sp. (1), Pseudomonas putida (1), and Pseudomonas sp. (1) based on partial sequences of the 16 s rRNA gene. This is the first comprehensive report of bacteria spp. associated with cloaca of Laudakia nupta using molecular studies. In this research, we found that Laudakia nupta can be a carrier of bacteria which can transfer microorganisms to hosts.
Agar ; Bacillus ; Bacillus cereus ; Bacteria ; Cloaca ; Colon ; Genes, rRNA ; Humans ; Iran ; Lizards ; Pseudomonas ; Pseudomonas putida ; Reptiles

BACKGROUND: From January 2014 to December 2015, 69 clones of Enterobacter cloacae showing multidrug resistance to six classes of antimicrobial agents were collected from two medical centers in Korea. METHODS: Minimum inhibitory concentrations were determined using the E-test method, and 17 genes were detected using polymerase chain reaction (PCR). The epidemiological relatedness of the strains was identified using repetitive element sequence-based PCR and multilocus sequence typing. RESULTS: The 69 E. cloacae clones produced extended spectrum β lactamase (ESBL) and AmpC and showed multidrug resistance to cefotaxime, ceftazidime, and aztreonam. We identified the following sequence types: ST56 of type VI for ESBL SHV (N=12, 17.4%); ST53, ST114, ST113, and ST550 of types I, IV, VI, and VII, respectively, for CTX-M (N=11, 15.9%); and ST668 of type III for the carbapenemase NDM gene (N=1, 1.5%). The AmpC DHA gene (N=2, 2.89%) was confirmed as ST134, although its type was not identified, whereas EBC (MIR/ACT; N=18, 26.1%) was identified as ST53, ST24, ST41, ST114, ST442, ST446, ST484, and ST550 of types V, I, III, IV, VII, and VI, respectively. The formed subclasses were bla CTX-M-3 and bla CTX-M-22 by CTX-M-1, bla CTX-M-9 and bla CTX-M-125 by CTX-M-9, bla DHA-1 by DHA, and bla MIR-7 and bla ACT-15,17,18,25,27,28 by EBC (MIR/ACT). CONCLUSIONS: There were no epidemiological relationships between the gene products and the occurrence of resistance among the strains.
Anti-Infective Agents ; Aztreonam ; Cefotaxime ; Ceftazidime ; Cloaca ; Clone Cells ; Drug Resistance, Multiple* ; Enterobacter cloacae* ; Enterobacter* ; Korea ; Methods ; Microbial Sensitivity Tests ; Multilocus Sequence Typing ; Polymerase Chain Reaction

Ocular setariases of cattle were reported but those of equine hosts have never been reported in the Republic of Korea (Korea). We found motile worms in the aqueous humor of 15 horses (Equus spp.) from 12 localities in southern parts of Korea between January 2004 and November 2017. After the affected animals were properly restrained under sedation and local anesthesia, 10 ml disposable syringe with a 16-gauge needle was inserted into the anterior chamber of the affected eye to successfully remove the parasites. The male worm that was found in 7 of the cases showed a pair of lateral appendages near the posterior terminal end of the body. The papillar arrangement was 3 pairs of precloacal, a pair of adcloacal, and 3 pairs of postcloacal papillae, plus a central papilla just in front of the cloaca. The female worms found in the eyes of 8 horses were characterized by the tapering posterior terminal end of the body with a smooth knob. Worms were all identified as Setaria digitata (von Linstow, 1906) by the morphologic characteristics using light and electron microscopic observations. This is the first blindness cases of 15 horses infected with S. digitata (Nematoda: Filarioidea) in Korea.
Anesthesia, Local ; Animals ; Anterior Chamber ; Aqueous Humor ; Blindness* ; Cattle ; Cloaca ; Female ; Horses* ; Humans ; Korea ; Male ; Needles ; Parasites ; Republic of Korea* ; Setariasis ; Syringes

Newcastle disease viruses (NDVs) cause systemic diseases in chickens with high mortality. However, little is known about persistence of NDVs in contaminated tissues from infected birds. In this study, we examined viral replication in the feather pulp of chickens inoculated with viscerotropic velogenic NDV (vvNDV) genotype VII. Reverse transcription real-time PCR and immunohistochemistry were used to investigate viral persistence in the samples. vvNDV was detected in the oropharynx and cloaca and viral antigens were detected in the feathers, suggesting that feathers act as sources of viral transmission.
Animals ; Antigens, Viral/analysis ; Chickens ; Cloaca/virology ; Feathers/*virology ; Microbial Viability ; Newcastle Disease/transmission/*virology ; Newcastle disease virus/isolation & purification/*physiology ; Oropharynx/virology ; Poultry Diseases/transmission/*virology ; Virus Replication/*physiology

During 2006, H5N1 HPAI caused an epizootic in wild birds, resulting in a die-off of Laridae in the Novosibirsk region at Chany Lake. In the present study, we infected common gulls (Larus canus) with a high dose of the H5N1 HPAI virus isolated from a common gull to determine if severe disease could be induced over the 28 day experimental period. Moderate clinical signs including diarrhea, conjunctivitis, respiratory distress and neurological signs were observed in virus-inoculated birds, and 50% died. The most common microscopic lesions observed were necrosis of the pancreas, mild encephalitis, mild myocarditis, liver parenchymal hemorrhages, lymphocytic hepatitis, parabronchi lumen hemorrhages and interstitial pneumonia. High viral titers were shed from the oropharyngeal route and virus was still detected in one bird at 25 days after infection. In the cloaca, the virus was detected sporadically in lower titers. The virus was transmitted to direct contact gulls. Thus, infected gulls can pose a significant risk of H5N1 HPAIV transmission to other wild migratory waterfowl and pose a risk to more susceptible poultry species. These findings have important implications regarding the mode of transmission and potential risks of H5N1 HPAI spread by gulls.
Animals ; Birds ; Charadriiformes* ; Cloaca ; Conjunctivitis ; Diarrhea ; Encephalitis ; Hemorrhage ; Hepatitis ; Influenza A Virus, H5N1 Subtype* ; Lakes ; Liver ; Lung Diseases, Interstitial ; Myocarditis ; Necrosis ; Pancreas ; Pathology* ; Poultry ; Virulence

BACKGROUND: Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasingly reported as pathogens in urinary tract infections (UTIs). However, in Sri Lanka, the clinical and molecular epidemiology of ESBL-PE implicated in UTIs has not been well described. MATERIALS AND METHODS: We conducted prospective, laboratory-based surveillance from October to December 2013 at a tertiary care hospital in southern Sri Lanka and enrolled patients ≥1 year of age with clinically relevant UTIs due to ESBL-PE. Isolate identity, antimicrobial drug susceptibility, and ESBL production were determined. Presence of ß-lactamase genes, bla(SHV), bla(TEM), and bla(CTX-M), was identified by polymerase chain reaction. RESULTS: During the study period, Enterobacteriaceae were detected in 184 urine samples, with 74 (40.2%) being ESBL producers. Among 47 patients with ESBL-PE who had medical records available, 38 (80.9%) had clinically significant UTIs. Most UTIs (63.2%) were community acquired and 34.2% were in patients with diabetes. Among 36 cultured ESBL-PE isolates, significant susceptibility (>80%) was only retained to amikacin and the carbapenems. The group 1 bla(CTX-M) gene was present in 90.0% of Escherichia coli isolates and all Klebsiella pneumoniae and Enterobacter cloacae isolates. The bla(SHV) and bla(TEM) genes were more common in K. pneumoniae (75% and 50%) and E. cloacae (50% and 50%) isolates than in E. coli (10% and 20%) isolates, respectively. CONCLUSION: The majority of UTIs caused by ESBL-PE were acquired in the community and due to organisms carrying the group 1 CTX-M ß-lactamase. Further epidemiologic studies of infections due to ESBL-PE are urgently needed to better prevent and treat these infections in South Asia.
Amikacin ; Asia ; Carbapenems ; Cloaca ; Enterobacter cloacae ; Enterobacteriaceae* ; Epidemiologic Studies ; Escherichia coli ; Humans ; Klebsiella pneumoniae ; Medical Records ; Molecular Epidemiology ; Pneumonia ; Polymerase Chain Reaction ; Prospective Studies ; Sri Lanka* ; Tertiary Healthcare ; Urinary Tract Infections* ; Urinary Tract*

PURPOSE: To study the causative microorganism of neonatal bacterial conjunctivitis and its correlation with maternal factors. METHODS: We retrospectively reviewed the medical records of 55 neonates diagnosed with bacterial conjunctivitis and the records of mothers from January 2008 to July 2013. We investigated microbiologic culture of conjunctival discharge, time of occurrence, the mode of delivery, premature rupture of membrane (PROM), microbiologic culture of vaginal swab and the sensitivities to antibiotics. RESULTS: The most common organism was Staphylococcus epidermidis, isolated in 24 (36.4%) neonates, followed by other Coagulase-negative Staphylococcus (CNS) 10 (15.2%), E. cloacae 6 (9.1%), S. marsescens 6 (9.1%), and P. aeruginosa 5 (7.6%). Concerning the time of occurrence, 23 (41.8%) were founded with conjunctivitis within 1 week of life. By mode of delivery, 18 (32.7%) were delivered through vaginal route and 37 (67.3%) delivered by Cesarean section. The most common organism grown in conjunctival discharge of both group was S. epidermidis. Of these 55 neonates' mothers, 9 (16.4%) had history of PROM. Regardless of the presence of PROM, the most common organism was S. epidermidis. A total of 22 (40.0%) microbiologic culture of vaginal swab were examined and 6 (27.2%) of them had detected organisms. The results of vaginal swabs were in discord with results of conjunctival swabs of neonates. CONCLUSION: S. epidermidis was the most common infectious organism of neonatal bacterial conjunctivitis. We could not identify the correlation between neonatal bacterial conjunctivitis and maternal factors. Further comprehensive studies are needed to investigate the risk factors related to bacterial conjunctivitis of neonates.
Anti-Bacterial Agents ; Cesarean Section ; Cloaca ; Conjunctivitis ; Conjunctivitis, Bacterial* ; Female ; Humans ; Infant, Newborn ; Medical Records ; Membranes ; Mothers ; Pregnancy ; Retrospective Studies ; Risk Factors ; Rupture ; Staphylococcus ; Staphylococcus epidermidis

OBJECTIVETo explore the clinical efficacy of the chronic balloon expansion in urethral and vaginal reconstruction for high persistent cloaca.

METHODSClinical data of 21 children with high persistent cloaca undergoing chronic balloon expansion technique in Cangzhou Central Hospital and Capital Pediatric Institute from December 1996 to August 2014 were analyzed retrospectively. The balloon was continuously expand for 3 to 4 weeks. Balloon was filled with water, maintaining the internal pressure at 30 to 50 mmHg. When the diameter of the common channel was 3 cm, the plastic operations of bladder neck, urethra and vagina were performed.

RESULTSAll the 21 patients underwent primary posterior sagital urethro-vaginoplasty by using the expanded urogenital sinus. The average duration of expansion was (26.8±3.1) days and the average diameter of the urogenital sinus was increased up to (2.8±0.2) cm. Infection of urinary tract and common channel wall was not found. Histological examination demonstrated the expanded tissue consisted of a dense fibrous wall lined by a stratified squamous non-cornified epithelium, which was characterized by active cell mitoses and angiogenesis. Patients were followed up for 0.5 to 11.0 years. Efficacy was satisfactory, and no death occurred. After the operation, 9 cases reached grade I( urinary incontinence, 8 cases reached grade II( among the 17 cases with grade IIII( urinary incontinence. One patient had distal urethral dehiscence, and the secondary urethroplasty was employed six months after the operation. Urethral diameter of another 1 case dilated 9 years later, and a tighten urethral angioplasty was performed, then the urine dripping disappeared. All the children were not treated with vaginal dilatation.

CONCLUSIONChronic balloon expansion allows the creation of adequate tissue similar in appearance and type to vagina and urethra, and provides a valuable surgical alternative for managing high persistent cloaca.

PURPOSE: To identify the frequency of bacterial isolates in early-onset neonatal sepsis (EONS) and their antimicrobial resistance pattern. METHODS: A retrospective study of EONS was conducted at the Beni Suef University Hospital from September 2008 to September 2012. A case of EONS was defined as an infant who had clinical signs of infection or who was born to a mother with risk factors for infection, and in whom blood culture obtained within 72 hours of life grew a bacterial pathogen. RESULTS: Of 673 neonates screened, there were 138 positive blood cultures (20.5%) (confirmed EONS). Of the recovered isolates, 86.2% were gram-negative pathogens. Klebsiella pneumoniae (42.8%), Enterobacter cloacae (22.5%), and Escherichia coli (13.8%) were the commonest isolated organisms. The most common gram-positive microorganism was Staphylococcus aureus accounting for only 12 isolates (8.7%). All Klebsiella isolates and 93% of Enterobacter isolates were resistant to ampicillin. Gram-negative pathogens had the maximum overall sensitivity to imipenem, cefepime, and ciprofloxacin; whereas, gram-positive isolates were most susceptible to vancomycin, imipenem, and piperacillin. CONCLUSION: K. pneumoniae was the predominant causative bacteria of EONS followed by E. cloacae and E. coli. There was a high resistance to ampicillin. Imipenem had the maximum overall activity against the causative bacteria. Continuous surveillance is needed to monitor the changing epidemiology of pathogens and antibiotic sensitivity.
Accounting ; Ampicillin ; Bacteria ; Cephalosporins ; Cloaca ; Drug Resistance ; Drug Resistance, Microbial ; Enterobacter ; Enterobacter cloacae ; Escherichia coli ; Humans ; Imipenem ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Klebsiella ; Klebsiella pneumoniae ; Mothers ; Organothiophosphorus Compounds ; Pneumonia ; Retrospective Studies ; Risk Factors ; Sepsis ; Staphylococcus aureus ; Vancomycin