Archive for June 30, 2012

Polyarthritis in four patients with chikungunya arthritis.

Singapore Med J. 2012 Apr  V.53 N.4 P.241-3.

Lui NL, Leong HN, Thumboo J.

Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore 169608.


The incidence of chikungunya infection inSingaporehas been on the rise since the first reported case in 2006. Acute polyarthritis, a common manifestation among affected patients, may precede fever and present with debilitating arthritis to rheumatologists, orthopaedists, internists and primary care physicians. The diagnosis of chikungunya infection requires careful history taking and a high index of suspicion, with supporting evidence from the reverse transcription-polymerase chain reaction or the chikungunya IgM serology test. Treatment of chikungunya arthritis usually involves non-steroidal anti-inflammatory drugs. Rarely, polyarthritis in chikungunya may persist even after resolution of the acute infection, necessitating treatment with disease-modifying anti-rheumatic drugs. In this article, we present the different manifestations of chikungunya arthritis in our local setting and review the literature.


June 30, 2012 at 10:06 pm

Antistreptolysin O titer in health and disease: levels and significance.

Pediatr Rep. 2012 Jan 2 V.4 N.1 e8.

Kotby AA, Habeeb NM, Ezz El Elarab S.

Pediatric Department, Ain Shams University, Early Cancer Detection Unit Ain Shams University Hospital, Cairo, Egypt.


Over diagnosis of acute rheumatic fever (ARF) based on a raised antistreptolysin O titer (ASOT) is not uncommon in endemic areas. In this study, 660 children (aged 9.2 ±1.7 years) were recruited consecutively and classified as: G1 (control group, n=200 healthy children), G2 (n=20 with ARF 1(st) attack), G3 (n=40 with recurrent ARF), G4 (n=100 with rheumatic heart disease (RHD) on long acting penicillin (LAP)), G5 (n=100 with acute follicular tonsillitis), and G6 (n=200 healthy children with history of repeated follicular tonsillitis more than three times a year). Serum ASOT was measured by latex agglutination. Upper limit of normal (ULN) ASOT (80(th) percentile) was 400 IU in G1, 200 IU in G4, and 1600 IU in G6. Significantly high levels were seen in ARF 1st attack when compared to groups 1 and 5 (P<0.001 and P<0.05, respectively). ASOT was significantly high in children over ten years of age, during winter and in those with acute rheumatic carditis. ASOT showed significant direct correlation with the number of attacks of tonsillitis (P<0.05). Egyptian children have high ULN ASOT reaching 400 IU. This has to be taken into consideration when interpreting its values in suspected ARF. A rise in ASOT is less prominent in recurrent ARF compared to 1st attack, and acute and recurrent tonsillitis. Basal levels of ASOT increase with age but the pattern of increase during infection is not age dependent.


June 30, 2012 at 10:03 pm

Antiretroviral therapy and HIV/hepatitis B virus coinfection.

Clin Infect Dis. 2004 Mar 1  V.38 Suppl 2  S98-103.


Benhamou Y.

Service d’Hepato-Gastroenterologie, Hopital Pitie-Salpetriere, Paris, France.

June 30, 2012 at 10:00 pm

Acute Hepatitis B and Acute HIV Coinfection in an Adult Patient: A Rare Case Report.

Case Report Med. 2010  

Bansal R, Policar M, Mehta C.

Department of Medicine, Mount Sinai Elmhurst Hospital Center, 7901 Broadway, Elmhurst, NY 11373, USA.

June 30, 2012 at 9:57 pm

A rational approach to PML for the clinician

Cleveland Clinic Journal of Medicine Nov. 2011 V.78 N. Suppl.2 P.


Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University;R.J. Fasenmyer Chair of Clinical Immunology, Department of Rheumatic and Immunologic Diseases, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, OH

The first step in the management of progressive multifocal leukoencephalopathy (PML) is awareness of the disease. Patients vulnerable to PML are those with immunosuppression, either through their disease or use of immune-modulating therapy. In patients susceptible to PML who exhibit focal neurologic signs and symptoms, brain magnetic resonance imaging can detect the telltale PML brain lesions—subcortical white matter hyperintense areas on T2-weighted images and fluid-attenuated inversion recovery sequences and hypointensity on T1-weighted images, typically without enhancement. Demonstration of JC virus DNA by ultrasensitive polymerase chain reaction in cerebrospinal fluid is diagnostic for PML. Immune restoration whenever possible is the cornerstone of treatment. Highly active antiretroviral therapy has dramatically improved the prognosis for patients infected with human immunodeficiency virus. Alternatively, restoration of immunity is frequently attended by the immune reconstitution inflammatory syndrome which can be clinically devastating or even fatal. In the case of natalizumab-associated PML, withdrawal of therapy and prompt institution of plasmapheresis to desaturate target receptors provides the best chance for long-term survival.


June 30, 2012 at 1:54 pm

Incidence of endophthalmitis after cataract surgery (2002-2008) at a Brazilian university-hospital.

Arq Bras Oftalmol. 2010 Dec;73(6):505-7.

Melo GB, Bispo PJ, Regatieri CV, Yu MC, Pignatari AC, Höfling-Lima AL.


Department of Ophthalmology, Universidade Federal de São Paulo, SP, Brazil.



To report on the incidence, diagnostic technique, and microbiological features of endophthalmitis at a university-setting inBrazil.


All cases of presumed postoperative endophthalmitis from 2002 to 2008 at a teaching-hospital were included. Main data assessed were: number of cataract surgeries performed, incidence of endophthalmitis, microbiological outcome (aqueous and/or vitreous culture and Gram staining), and antimicrobial susceptibility testing of the positive cases.


Seventy-three eyes of 73 patients (43 females and 30 males) developed endophthalmitis after 24,590 cataract surgeries. The incidence decreased from 0.49% in 2003 to 0.17% in 2006 and stabilized afterwards. Coagulase negative Staphylococci (CoNS) and Streptococcus viridans (56.5% and 15%, respectively) were the most common bacterial isolates. Culture and Gram stain were negative in 36.9%. CoNS presented susceptibility rates of 80%-sensitivity to oxacillin, 90% to fourth-generation quinolones and 100% to vancomycin.


The rate of endophthalmitis, diagnostic ability of conventional laboratory investigation, microbial isolates and antibiotic susceptibility are in accordance with other findings of the literature. Despite using prophylactic antibiotic drops, it was possible to identify cases that were susceptible to the antibiotics topically applied.



Patients without exposure to health care environments are as likely as HCWs to be colonized with methicillin-resistant organisms. Increasing methicillin resistance with age may partially explain the increased risk of endophthalmitis reported with older age.


June 30, 2012 at 1:52 pm

Methicillin resistance of Staphylococcus species among health care and nonhealth care workers undergoing cataract surgery.

Clin Ophthalmol. 2010 Dec 10;4:1505-14.

Olson R, Donnenfeld E, Bucci FA Jr, Price FW Jr, Raizman M, Solomon K, Devgan U, Trattler W, Dell S, Wallace RB, Callegan M, Brown H, McDonnell PJ, Conway T, Schiffman RM, Hollander DA.


The John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.



The purpose of this study is to characterize the bacterial flora of the ocular and periocular surface in cataract surgery patients and to determine the prevalence of methicillin resistance among staphylococcal isolates obtained from health care workers (HCWs) and non-HCWs.


In this prospective, multicenter, case series study, eyelid and conjunctival cultures were obtained from the nonoperative eye of 399 consecutive cataract patients on the day of surgery prior to application of topical anesthetics, antibiotics, or antiseptics. Speciation and susceptibility testing were performed at the Dean A. McGee Eye Institute. Logistic regression was utilized to evaluate whether any factors were significant in predicting the presence of methicillin-resistant staphylococcal isolates.


Staphylococcus epidermidis (62.9%), followed by S. aureus (14.0%), was the most frequently isolated organism. Methicillin-resistant S. epidermidis accounted for 47.1% (178/378) of S. epidermidis isolates, and methicillin-resistant S. aureus accounted for 29.5% (26/88) of S. aureus isolates. Methicillin-resistant staphylococcal isolates were found in 157 of 399 (39.3%) patients, the majority (89.2%) of whom were non-HCWs. The likelihood of being colonized with methicillin-resistant organisms increased with age (odds ratio [OR], 1.27; 95% confidence interval [CI]: 1.02-1.58; P = 0.04) but decreased with diabetes (OR, 0.51; 95% CI: 0.29-0.89; P = 0.02). Being a HCW (OR, 1.25; 95% CI: 0.61-2.58; P = 0.54) was not a risk factor for colonization with methicillin-resistant organisms.


Patients without exposure to health care environments are as likely as HCWs to be colonized with methicillin-resistant organisms. Increasing methicillin resistance with age may partially explain the increased risk of endophthalmitis reported with older age.


June 30, 2012 at 1:50 pm

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