Posts filed under ‘Update’

Epstein-Barr Virus-Induced Mononucleosis as an Imitator of Severe Preeclampsia.

AJP Rep. january 2017 V.7 N.1 :e5-e7. doi: 10.1055/s-0036-1597265.

Staley SA1, Smid MC2, Dotters-Katz SK2, Stringer EM2.

1 Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.

2 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.

Abstract

Background

In pregnancy, conditions presenting with hematologic abnormalities, transaminitis, and proteinuria pose diagnostic challenges in pregnancy.

Case

We present the case of an 18-year-old woman, G1P0, at 33 weeks’ gestation with fever of unknown cause, who developed progressively elevated liver enzymes, proteinuria, and thrombocytopenia, due to Epstein-Barr virus (EBV) infection.

Conclusion

Acute infection with EBV should be included in the differential diagnosis of preeclampsia with severe features, particularly in the setting of fever. Supportive treatment and observation may prevent iatrogenic preterm birth.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303016/pdf/10-1055-s-0036-1597265.pdf

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August 18, 2019 at 7:36 pm

Identification of Epstein-Barr Virus in the Human Placenta and Its Pathologic Characteristics.

J Korean Med Sci. December 2017 V.32 N.12 P.1959-1966. doi: 10.3346/jkms.2017.32.12.1959.

Kim Y1,2, Kim HS3, Park JS3, Kim CJ4, Kim WH5.

1 Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.

2 Laboratory of Epigenetics, Cancer Research Institute, Seoul National University, Seoul, Korea.

3 Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

4 Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

5 Department of Pathology, Seoul National University College of Medicine, Seoul, Korea. woohokim@snu.ac.kr.

Abstract

Epstein-Barr virus (EBV), a common pathogen in humans, is suspected as the cause of multiple pregnancy-related pathologies including depression, preeclampsia, and stillbirth. Moreover, transmission of EBV through the placenta has been reported. However, the focus of EBV infection within the placenta has remained unknown to date. In this study, we proved the expression of latent EBV genes in the endometrial glandular epithelial cells of the placenta and investigated the cytological characteristics of these cells. Sixty-eight placentas were obtained from pregnant women. Tissue microarray was constructed. EBV latent genes including EBV-encoding RNA-1 (EBER1), Epstein-Barr virus nuclear antigen 1 (EBNA1), late membrane antigen (LMP1), and RPMS1 were detected with silver in situ hybridization and/or mRNA in situ hybridization. Nuclear features of EBV-positive cells in EBV-infected placenta were compared with those of EBV-negative cells via image analysis. Sixteen placentas (23.5%) showed positive expression of all 4 EBV latent genes; only the glandular epithelial cells of the decidua showed EBV gene expression. EBV infection status was not significantly correlated with maternal, fetal, or placental factors. The nuclei of EBV-positive cells were significantly larger, longer, and round-shaped than those of EBV-negative cells regardless of EBV-infection status of the placenta. For the first time, evidence of EBV gene expression has been shown in placental tissues. Furthermore, we have characterized its cytological features, allowing screening of EBV infection through microscopic examination.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680494/pdf/jkms-32-1959.pdf

August 18, 2019 at 7:35 pm

REVISION – Microbiología del género Raoultella, características clínicas y dificultades para su diagnóstico

Rev Med Inst Mex Seguro Soc. 2018 V.56 N.4 P.486-90

Alberto Castillo-Macías, Amador Flores-Aréchiga, Jorge Llaca-Díaz,a Fernando Pérez-Chávez, Néstor CasillasVega

Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Departamento de Patología Clínica. Monterrey, Nuevo León, México

El género Raoultella, perteneciente a la familia Enterobacteriaceae, engloba bacilos gram negativos, oxidasa negativos, aeróbicos, encapsulados e inmóviles. Actualmente se han descrito cuatro especies de este género: Raoultella terrigena (R. terrigena), Raoultella planticola (R. planticola), Raoultella ornithinolytica (R. ornithinolytica) y Raoultella electrica (R. electrica), entre las que la R. planticola y la R. ornithinolytica son las más importantes por su probable asociación como agentes patógenos. Se ha subestimado la incidencia del género por la dificultad que presenta su caracterización al ser mal

identificado como Klebsiella spp., al usar métodos fenotípicos manuales y automatizados convencionales. La rápida y correcta detección de Raoultella spp. ha ido aumentando desde la llegada de espectrómetros de masas (MALDI-TOF MS), útiles en la diferenciación entre Klebsiella spp. y Raoultella spp. Se han identificado 80 casos de bacteremia por Raoultella spp., con infección primaria en diversos sitios, por lo que es importante hacer énfasis en su correcta detección en los hospitales y centros de atención médica

PDF

https://www.medigraphic.com/pdfs/imss/im-2018/im185i.pdf

August 18, 2019 at 5:49 pm

Emerging role of Raoultella ornithinolytica in human infections: a series of cases and review of the literature

International Journal of Infectious Diseases April 2016 V.45 P.65-71

Highlights

  • Raoultella ornithinolytica pneumonia and pleural effusion were observed in 24% of cases.
  • Cases of osteomyelitis, meningitis, and cerebral abscess are reported for the first time.
  • The proportion of R. ornithinolytica isolates resistant to antibiotics was relatively high.
  • The mortality rate related to infection was 5% of cases.
  • R. ornithinolytica is underreported and particularly associated with invasive procedures.

Background

Raoultella ornithinolytica is known to inhabit aquatic environments. The clinical features and outcomes of human infections caused by R. ornithinolytica have been reported for only a limited number of cases.

Methods

A retrospective study of cases of infection caused by R. ornithinolytica managed at four university hospital centres during the period before and after the introduction of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed. The aim was to describe the clinical and microbiological characteristics, treatments, and outcomes.

Results

Among 187 R. ornithinolytica isolates identified for which clinical information was available, 71 were considered colonizers and 116 were pathogenic. A total of 112 cases of R. ornithinolytica infection were identified. Urinary tract infections, gastrointestinal infections, wound and skin infections, and bacteraemia were observed in 36%, 14%, 13%, and 5% of cases, respectively. Associated infections that have been poorly reported, such as respiratory infections, i.e. pneumonia and pleural effusion, were observed in 24% of cases. Additional diseases reported here for the first time included osteomyelitis, meningitis, cerebral abscess, mediastinitis, pericarditis, conjunctivitis, and otitis. The proportion of R. ornithinolytica isolates resistant to antibiotics was found to be relatively high: 4% of isolates were resistant to ceftriaxone, 6% to quinolones, and 13% to co-trimoxazole. The mortality rate related to infection was 5%.

Conclusions

R. ornithinolytica is an underreported, emerging hospital-acquired infection and is particularly associated with invasive procedures. R. ornithinolytica should never be considered simply a saprophytic bacterium that occasionally contaminates bronchial lavage or other deep respiratory samples or surgical sites. Physicians should be aware of the high rates of antimicrobial resistance of R. ornithinolytica isolates so that immediate broad-spectrum antibiotic treatment can be established before accurate microbiological results are obtained.

FULL TEXT

https://www.sciencedirect.com/science/article/pii/S1201971216000345

PDF (CLIC en PDF)

 

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August 18, 2019 at 5:47 pm

Possible clearance of transfusion-acquired nef/LTR-deleted attenuated HIV-1 infection by an elite controller with CCR5 Δ32 heterozygous and HLA-B57 genotype

J Virus Erad.  Apr 1, 2019 V.5 N.2 P.73-83.

Zaunders J1,2, Dyer WB3,4, Churchill M5, Munier CML2, Cunningham PH1, Suzuki K1, McBride K2, Hey-Nguyen W2, Koelsch K2, Wang B6, Hiener B7, Palmer S7, Gorry PR5, Bailey M2, Xu Y2, Danta M8, Seddiki N9, Cooper DA1,2, Saksena NK10,11, Sullivan JS3,12, Riminton S13, Learmont J3, Kelleher AD1,2.

Author information

1 Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, NSW, Australia.

2 Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

3 Australian Red Cross Blood Service, Sydney, NSW, Australia.

4 Faculty of Medicine and Health, University of Sydney, NSW, Australia.

5 School of Health and Biomedical Sciences, College of Science, Engineering and Health, RMIT University, Bundoora, VIC, Australia.

6 Ingham Institute, Liverpool, NSW, Australia.

7 Centre for Virus Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia.

8 Department of Gastroenterology and Hepatology, St Vincent’s Hospital, Sydney, NSW, Australia.

9 Vaccine Research Institute, Faculté de Médecine, Université Paris Est Créteil, Créteil, France.

10 IGO Neurodegenerative Disease Section, Sydney, NSW, Australia.

11 China National Gene Bank, Beijing Institute of Genomics, Shenzhen, China.

12 Central Clinical School, University of Sydney, NSW, Australia.

13 Department of Clinical Immunology, Concord Repatriation General Hospital, Sydney, NSW, Australia.

Abstract

BACKGROUND:

Subject C135 is one of the members of the Sydney Blood Bank Cohort, infected in 1981 through transfusion with attenuated nef/3′ long terminal repeat (LTR)-deleted HIV-1, and has maintained undetectable plasma viral load and steady CD4 cell count, in the absence of therapy. Uniquely, C135 combines five factors separately associated with control of viraemia: nef/LTR-deleted HIV-1, HLA-B57, HLA-DR13, heterozygous CCR5 Δ32 genotype and vigorous p24-stimulated peripheral blood mononuclear cell (PBMC) proliferation. Therefore, we studied in detail viral burden and immunological responses in this individual.

METHODS:

PBMC and gut and lymph node biopsy samples were analysed for proviral HIV-1 DNA by real-time and nested PCRs, and nef/LTR alleles by nested PCR. HIV-specific antibodies were studied by Western blotting, and CD4+ and CD8+ T lymphocyte responses were measured by proliferation and cytokine production in vitro.

RESULTS:

PBMC samples from 1996, but not since, showed amplification of nef alleles with gross deletions. Infectious HIV-1 was never recovered. Proviral HIV-1 DNA was not detected in recent PBMC or gut or lymph node biopsy samples. C135 has a consistently weak antibody response and a substantial CD4+ T cell proliferative response to a previously described HLA-DR13-restricted epitope of HIV-1 p24 in vitro, which augmented a CD8+ T cell response to an immunodominant HLA-B57-restricted epitope of p24, while his T cells show reduced levels of CCR5.

CONCLUSIONS:

Subject C135’s early PCR and weak antibody results are consistent with limited infection with a poorly replicating nef/LTR-deleted strain of HIV-1. With his HLA-B57-restricted gag-specific CD8 and helper HLA-DR13-restricted CD4 T cell proliferative responses, C135 appears to have cleared his HIV-1 infection 37 years after transfusion.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543488/pdf/jve-5-73.pdf

August 16, 2019 at 3:35 pm

2018 European Guideline on the organization of a consultation for Sexually Transmitted Infections.

J Eur Acad Dermatol Venereol. August 2019 V.33 N.8 P.1452-1458.

Gamoudi D, Flew S, Cusini M, Benardon S, Poder A, Radcliffe K.

This is an update of the 2012 IUSTI guideline. In this new version, we have expanded the sections on sexual history taking to include PEP and PrEP use, intimate partner and gender‐based violence, chemsex, swinging and psychosexual problems. We highlight the potential for the use of technology in the context of sexual health to facilitate sexual history taking and partner notification. We have explained the principle of safeguarding young and other vulnerable people who may present to services.

This guideline is primarily aimed at services provided in mainstream clinic/office environments, but increasingly many countries are seeing an era of rapid transition of sexual health services in which satellite clinics and online service provision are centre stage. Services are moving away from the main hospitals/clinics into smaller peripheral sites and various non‐traditional or outreach type settings such as saunas, brothels, bars, clubs, educational facilities, prisons and gay pride events. The advantage of such services is that it might allow hard‐to‐reach groups to be engaged with clinical services.1 We need a cohesive, multiagency approach to addressing the challenges associated with this style of service provision, if we are to harness the potential for decentralization of sexual health services while safeguarding the most vulnerable and remaining true to the founding principles of sexual health care.

FULL TEXT

https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.15577

PDF

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jdv.15577

August 14, 2019 at 3:49 pm

Streptococcus salivarius Prosthetic Joint Infection following Dental Cleaning despite Antibiotic Prophylaxis.

Case Rep Infect Dis. April 21, 2019   

Olson LB1, Turner DJ2, Cox GM3, Hostler CJ3,4.

Author information

1 Duke University School of Medicine, Durham, USA.

2 Department of Medicine, Duke University School of Medicine, Durham, USA.

3 Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.

4 Infectious Disease Section, Durham VA Health Care System, Durham, USA.

Abstract

We present the case of a 92-year-old man with septic arthritis of a prosthetic hip joint due to Streptococcus salivarius one week following a high-risk dental procedure despite preprocedure amoxicillin. S. salivarius is a commensal bacterium of the human oral mucosa that is an uncommon cause of bacteremia. S. salivarius has previously been described as a causative agent of infective endocarditis and spontaneous bacterial peritonitis but was only recently recognized as a cause of prosthetic joint infection. This case highlights the potential pathogenicity of a common commensal bacteria and the questionable utility of prophylactic antibiotics before dental procedures to prevent periprosthetic joint infections

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501194/pdf/CRIID2019-8109280.pdf

August 9, 2019 at 8:26 am

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