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The introduction of Exhaust Air Dust (EAD) testing by PCR in a health monitoring (HM) program of an animal facility equipped with individually ventilated cages can bring several benefits. These include the improved detection of rodent infectious agents, the reduction/replacement of the animals used as sentinels, labor, time, and cost savings. The authors manage a 600 m2 mouse facility housing around 6,000 ventilated cages, used both for breeding and experimental activities. The facility was opened in 2007 and its HM program was based on traditional soiled bedding sentinels (SBS). In 2016, the efficacy of PCR testing of EAD samples was evaluated in comparison to serology, bacteriology and parasitology carried out on SBS. The results of this test, together with the reports published by different groups, encouraged the authors to include EAD testing in the HM program of the facility. A hybrid program was developed and run for a few years, allowing comparative evaluations between EAD testing Vs SBS. The analysis of the results obtained showed that PCR testing of EAD samples confirmed or outperformed the results obtained by traditional methods on SBS, thus, supporting the authors in the decision to develop a new program, completely SBS-free. This new approach allowed the replacement of a significant number of animals used as sentinels (more than 700 every year) resulting both in ethical and economic benefits. Moreover, the new sentinel-free HM program allowed time and labor savings associated with the simplified samples preparation. Finally, this new solution contributed also to the reduction of the emotional fatigue of the staff of the facility.

BackgroundLeptospirosis, a zoonotic infection caused by Leptospira species, is a rare cause of neurological complications, including meningitis, encephalitis, and intracranial haemorrhage. Subdural haemorrhage (SDH) in leptospirosis is exceptionally rare, with fewer than ten cases reported worldwide. This case highlights an unusual presentation of neuroleptospirosis with atraumatic, bilateral SDH exhibiting irregular, loculated morphology, and a review of the limited literature shows a unique tendency of neuroleptospirosis (especially icterohaemorrhagic leptospirosis) to cause such morphologically unusual spontaneous subdural haematomas.ResultsA 60-year-old woman from rural New South Wales presented with fever, hypotension, renal failure, and cholestatic liver failure, necessitating continuous renal replacement therapy and vasopressor support. On hospital day 11, she developed multiple left hemibody focal motor seizures. Imaging revealed acute, spontaneous, bilateral asymmetrical subdural hematomas with an irregular, loculated appearance and midline shift. Serological testing confirmed acute leptospirosis (IgM and IgG positive). She improved well with ceftriaxone/doxycycline, antiepileptic medication treatments and supportive care for renal and hepatic dysfunction, and serial imaging demonstrated gradual improvement of the subdural haematomas. A review of literature revealed similar unusual morphologies in the few reported cases of neuroleptospirosis-associated subdural haemorrhages.ConclusionNeuroleptospirosis should be considered in the differential diagnosis of atraumatic SDH, especially in patients with epidemiological risk factors. Such SDH is often noticeably irregular in shape with internal heterogeneity, reflecting the systemic coagulopathy, endothelial dysfunction, vasculitis and direct bacterial invasion that pathogenetically underlie the haemorrhagic complications of leptospirosis. Early serological testing and multidisciplinary management are critical to optimising outcomes in this rare but severe complication.