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Sample records for exanthema subitum

  1. About exanthema subitum in children

    Directory of Open Access Journals (Sweden)

    V.S. Androukh

    2018-02-01

    Full Text Available The article describes etiopathogenesis, clinical picture, diagnosis, management and prognosis of exanthema subitum (ES. The disease occurs in nearly all infants and is not well-known in the general medical community. Exanthema subitum in children, mostly aged 6 months to 2 years, is caused by herpes viruses (HSV-6, HSV-7, which are aerosol-transmissible and communicable, and is characterized by hyperthermiс syndrome and rash. Hyperthermic syndrome (≥ 39 °C lasts for about 3 days. On day 4 of disease, body temperature normalizes, but blotchy rash appears, mainly on the trunk. It also lasts for 3 days, sometimes resulting in erythema. The disease must be differentiated with other states, from tooth eruption in a child and to the onset of acute meningococcal infection. Fever of unknown etiology, rubella, measles, scarlet fever, fifth disease, enteroviral enantemа, toxemia and allergic rashes, pneumonia, pyelonephritis, otitis media my have the same manifestations as ES. There are a number of laboratory methods for verifying the disease, but enzyme-linked immunosorbent assay and reverse transcription polymerase chain reaction are being used most often. For the treatment in febrile period, non-steroidal anti-inflammatory drugs should be administered. Symptomatic treatment is also indicated. There are few clinical data on the use of antiviral drugs such as ganciclovir, foscarnet, cidofovir, their effectiveness is controversial. The main criteria for the diagnosis of ES are: age from 6 months to 2 years; sudden onset with fever ≥ 39 °C or higher during 3–4 days at a relatively satisfactory general condition; the appearance of exanthema from the 4th day of illness, mostly on the trunk, against the normalization of body temperature; in most cases has a favorable course and does not require special treatment. However, it may be a mask of other, much more serious diseases and complications, and therefore requires careful medical supervision of a

  2. A case of acute encephalopathy following exanthema subitum with symmetrical hypodensity of bilateral basal ganglia on CT

    International Nuclear Information System (INIS)

    Hiramoto, Kei; Tanimoto, Kiyotaka; Murakami, Ryuhko; Murao, Shoji; Miyake, Susumu

    1988-01-01

    A 7-month-old boy was sent to our hospital because of frequent convulsions and a semicoma which occurred 3 days after the onset of exanthema subitum. There were no particular hematological and biochemical findings except that the protein of cerebro-spinal fluid increased. There was a symmetrical hypodensity of bilateral corpora striata on the CT and a diffuse slowing of the EEG was found. Consciousness was regained 10 days after admission and transient intention tremor was then found. A month after admission, the latency of the 1st wave of ABR transiently became prolonged, but the interpeak latency of the I-V has been continuously within normal limits. Recordings of SSEP were normal. After 2 years' follow-up, we found that he had developed normally and that his EEG recordings had become almost normal, but hypodensity of the bilateral corpora striata on CT still existed. This case was the first report of infantile bilateral striatal necrosis associated with exanthema subitum. (author)

  3. Acute necrotising encephalopathy of childhood after exanthema subitum outside Japan or Taiwan

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    Porto, L.; Lanferman, H.; Moeller-Hartmann, W.; Jacobi, G.; Zanella, F. [Inst. fuer Neuroradiologie, Klinikum der Johann Wolfgang Goethe-Univ., Frankfurt am Main (Germany)

    1999-10-01

    Acute necrotising encephalopathy of childhood (ANE) is an uncommon disease which predominantly affects infants and young children living in Japan and Taiwan. A multifocal encephalopathy with symmetrical lesions in the thalamus, tegmentum of the brain stem, cerebral periventricular white matter and cerebellar medulla is characteristic. We present the imaging features in a 4-year-old Japanese boy who had been living in Germany for 2{sup 1}/{sub 2} years before presentation. (orig.)

  4. Acute necrotising encephalopathy of childhood after exanthema subitum outside Japan or Taiwan

    International Nuclear Information System (INIS)

    Porto, L.; Lanferman, H.; Moeller-Hartmann, W.; Jacobi, G.; Zanella, F.

    1999-01-01

    Acute necrotising encephalopathy of childhood (ANE) is an uncommon disease which predominantly affects infants and young children living in Japan and Taiwan. A multifocal encephalopathy with symmetrical lesions in the thalamus, tegmentum of the brain stem, cerebral periventricular white matter and cerebellar medulla is characteristic. We present the imaging features in a 4-year-old Japanese boy who had been living in Germany for 2 1 / 2 years before presentation. (orig.)

  5. Pediatric Viral Exanthema: A Review Article

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    Mohammed Jafar Saffar

    2017-04-01

    Full Text Available Context Many diseases caused by viral agents are associated with fever and cutaneous manifestations. Viral exanthema is a widespread nonspecific skin rash, commonly characterized by generalized eruption of erythematous macules and papular lesions. Although these rashes are mostly benign and self-limited, some may be serious and life-threatening. Differentiation between severe and benign types is clinically important and life-saving. Evidence Acquisition In this narrative review, electronic databases, including Google Scholar, Science Direct, PubMed (including Medline, Web of Science, Scientific Information Database, and Scopus, were searched. We conducted a narrative review of papers published on pediatric viral exanthema during 2000 - 2016. The used keywords included “viral exanthema”, “fever”, and “skin rash”. Articles on skin rash, caused by drug reactions or nonviral exanthema, were excluded. Results Different viral agents can cause different types of skin reactions. Cutaneous manifestations and skin rashes can be categorized, based on the form of the rash (macular, papular, vesicular, blistery, petechial, and purpuric or the general term, which denotes illnesses such as measles-like morbilliform rash, rubella or rubelliform rash, and scarlatiniform rash, a scarlet-fever like infection. Conclusions Based on the findings, a systematic approach relying on accurate history-taking and analysis of epidemiological cues and rash characteristics is of great significance.

  6. The absence of exanthema is related with death and illness severity in acute enterovirus infection

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    Hong-Tao Zhou

    2014-11-01

    Conclusions: A considerable proportion of children with an acute enterovirus infection in Guangdong Province, China during 2009–2012 presented no exanthema, and the absence of exanthema was found to be related to death and illness severity for these acute enterovirus infections. Clinicians in China should consider enterovirus as the possible pathogen when treating children with an acute pathogen infection without exanthema.

  7. Exanthema after a stress Tc-99m sestamibi study: continue with a rest sestamibi study?

    DEFF Research Database (Denmark)

    Hesse, Birger; Vinberg, Niels; Mosbech, Holger

    2011-01-01

    Purpose:  A mild allergic reaction assumed to be caused by injection of Tc-99m sestamibi for a stress myocardial perfusion imaging (MPI) is presented. We want to discuss the risk involved in completing the MPI with another sestamibi injection, and the precautions and possible treatment in case...... of a further reaction. Material and methods:  A patient experienced a maculo-papular exanthema, i.e. a mild, probably allergic, adverse event (AE) after a stress MPI including administration of a dose of Tc-99m sestamibi. A rest MPI was needed to decide whether coronary bypass surgery should be performed...

  8. Genetic variation in CFH predicts phenytoin-induced maculopapular exanthema in European-descent patients.

    Science.gov (United States)

    McCormack, Mark; Gui, Hongsheng; Ingason, Andrés; Speed, Doug; Wright, Galen E B; Zhang, Eunice J; Secolin, Rodrigo; Yasuda, Clarissa; Kwok, Maxwell; Wolking, Stefan; Becker, Felicitas; Rau, Sarah; Avbersek, Andreja; Heggeli, Kristin; Leu, Costin; Depondt, Chantal; Sills, Graeme J; Marson, Anthony G; Auce, Pauls; Brodie, Martin J; Francis, Ben; Johnson, Michael R; Koeleman, Bobby P C; Striano, Pasquale; Coppola, Antonietta; Zara, Federico; Kunz, Wolfram S; Sander, Josemir W; Lerche, Holger; Klein, Karl Martin; Weckhuysen, Sarah; Krenn, Martin; Gudmundsson, Lárus J; Stefánsson, Kári; Krause, Roland; Shear, Neil; Ross, Colin J D; Delanty, Norman; Pirmohamed, Munir; Carleton, Bruce C; Cendes, Fernando; Lopes-Cendes, Iscia; Liao, Wei-Ping; O'Brien, Terence J; Sisodiya, Sanjay M; Cherny, Stacey; Kwan, Patrick; Baum, Larry; Cavalleri, Gianpiero L

    2018-01-23

    To characterize, among European and Han Chinese populations, the genetic predictors of maculopapular exanthema (MPE), a cutaneous adverse drug reaction common to antiepileptic drugs. We conducted a case-control genome-wide association study of autosomal genotypes, including Class I and II human leukocyte antigen (HLA) alleles, in 323 cases and 1,321 drug-tolerant controls from epilepsy cohorts of northern European and Han Chinese descent. Results from each cohort were meta-analyzed. We report an association between a rare variant in the complement factor H-related 4 ( CFHR4 ) gene and phenytoin-induced MPE in Europeans ( p = 4.5 × 10 -11 ; odds ratio [95% confidence interval] 7 [3.2-16]). This variant is in complete linkage disequilibrium with a missense variant (N1050Y) in the complement factor H ( CFH ) gene. In addition, our results reinforce the association between HLA-A*31:01 and carbamazepine hypersensitivity. We did not identify significant genetic associations with MPE among Han Chinese patients. The identification of genetic predictors of MPE in CFHR4 and CFH, members of the complement factor H-related protein family, suggest a new link between regulation of the complement system alternative pathway and phenytoin-induced hypersensitivity in European-ancestral patients. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

  9. Clindamycin-induced Maculopapular Exanthema with Preferential Involvement of Striae Distensae: A Koebner phenomenon?

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    Monteagudo, Benigno; Cabanillas, Miguel; Iriarte, Pilar; Ramírez-Santos, Aquilina; León-Muinos, Elvira; González-Vilas, Daniel; Suárez-Amor, Óscar

    2018-04-01

    Clindamycin is a lincomycin-derived antibiotic useful for the treatment of anaerobic and Gram-positive aerobic bacterial infections. Cutaneous adverse reactions are usually maculopapular exanthemas, although hypersensitivity syndrome, acute generalized exanthematous pustulosis, and Stevens-Johnson syndrome have also been reported (1). We report the case of a patient with a maculopapular rash triggered by clindamycin who developed cutaneous lesions on striae distensae (SD). A 47-year-old woman was referred to our clinic for pruritic cutaneous lesions which had started 6 days earlier. Her past clinical history included hypertension, hypothyroidism, hyperuricemia, cholecystectomy, caesarean section, and endometriosis-related abdominal surgery, and she was taking levothyroxine, allopurinol, imidapril, and omeprazole. The skin rash first developed on her neck and back on the 3rd day of clindamycin oral treatment (300 mg every 6 hours), which was prescribed as antibiotic prophylaxis for a tooth implant. General malaise (but not fever) was also reported. Physical examination revealed an erythematous maculopapular eruption symmetrically distributed on the neck, abdomen, and back (Figure 1, A), with isolated lesions involving the proximal upper and lower limbs (Figure 1, B). There was a striking vertical distribution of skin lesions along the SD on the lateral sides of the abdomen (Figure 1, C). No mucosal involvement was found, and laboratory studies showed no abnormalities. Clindamycin withdrawal was followed by prescription of a course of oral deflazacort, starting at 30 mg daily and tapering down during a 9-day period. On the 5th day of treatment, the rash had almost cleared with minimal desquamation (Figure 1, D). Eight weeks after clearance of the skin rash, informed consent was obtained in order to perform an allergological evaluation of clindamycin, including prick and intradermal (ID) tests on the forearm and patch tests on the upper back (2). For patch testing

  10. CLINICAL AND VIROLOGIC FOUNDATION FOR PATHOGENETIC THERAPY OF HUMAN HERPES VIRUS TYPE 6 INFECTION IN CHILDREN

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    N.A. Myukke

    2006-01-01

    Full Text Available Information about an infection caused by human herpes virus type 6, its' epidemiology, pathogenesis and clinical variants, is reviewed. Clinical cases, diagnosed at a time of study, are briefly reviewed.Key words: human herpes virus type 6, exanthema subitum (roseola infantum, fever of unknown origin, mononucleosis like syndrome, meningoencephalitis, children.

  11. Etiologia de exantema em crianças em uma área endêmica de dengue Etiology of exanthema in children in a dengue endemic area

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    Delmina de S. Campagna

    2006-10-01

    Full Text Available OBJETIVO: Estudar a etiologia dos casos de exantema com ou sem febre em crianças atendidas no pronto-socorro de um hospital de uma zona endêmica para dengue. MÉTODOS: No período de 21/09/2001 a 20/09/2002, foram inscritas no estudo 95,9% (71/74 das crianças atendidas no pronto-socorro do Hospital Universitário de Campo Grande (MS que apresentassem exantema (percentual de recusa de 4,1%. Após preenchimento do protocolo com os dados das crianças, as mesmas foram submetidas a exame físico seguido da coleta de amostras de sangue para realizar hemograma com contagem de plaquetas e sorologias (IgM e IgG; inicialmente para dengue, rubéola e toxoplasmose e, posteriormente, naqueles casos com resultado negativo, realizou-se sorologia para parvovirose, herpes vírus tipo 6 e sarampo. RESULTADOS: O diagnóstico laboratorial foi confirmado através da pesquisa de anticorpo IgM em 88,7% dos casos investigados: dengue (77,5%, herpes vírus tipo 6 (8,4%, parvovirose (2,8% e diagnóstico inconclusivo em oito pacientes (11,3%. Não foi evidenciada sorologia positiva (IgM para sarampo, rubéola ou toxoplasmose naquela ocasião. As manifestações clínicas mais freqüentes nos pacientes com dengue foram: febre, prurido, prostração, mialgia e prova do laço positiva. Nos pacientes cujo diagnóstico foi dengue, a prova do laço foi positiva em 58,4% (32/55 dos casos, demonstrando diferença estatisticamente significativa quando comparada com o grupo cujo diagnóstico não foi dengue. CONCLUSÕES: Nas crianças com exantema, dengue pode ser a principal enfermidade causal, atentando-se para a epidemiologia do local. É necessário um controle constante da vigilância epidemiológica e sorológica das doenças exantemáticas.OBJECTIVE: To study the etiology of exanthema cases, with or without fever, in children seen in the emergency room of a hospital located in a region where dengue is endemic. METHODS: Enrollment took place between 21/09/2001 and 20

  12. A systematic approach to systemic contact dermatitis and symmetric drug-related intertriginous and flexural exanthema (SDRIFE): a closer look at these conditions and an approach to intertriginous eruptions.

    Science.gov (United States)

    Winnicki, Monika; Shear, Neil H

    2011-06-01

    Systemic contact dermatitis is a condition that occurs when an individual sensitized to a contact allergen is exposed to that same allergen or a cross-reacting molecule through a systemic route. Systemic exposure to allergens can include transcutaneous, transmucosal, oral, intravenous, intramuscular, and inhalational routes. Baboon syndrome is perhaps the most recognizable form of systemic contact dermatitis, presenting with diffuse, well demarcated erythema of the buttocks, upper inner thighs, and axillae. Other forms of systemic contact dermatitis include dermatitis at sites of previous exposure to the allergen such as at a previous site of dermatitis or at sites of previous positive patch tests, dyshidrotic hand eczema, flexural dermatitis, exanthematous rash, erythroderma, and vasculitis-like lesions. The most common causes of systemic contact dermatitis consist of three groups of allergens: (i) metals including mercury, nickel, and gold; (ii) medications including aminoglycoside antibacterials, corticosteroids, and aminophylline; and (iii) plants and herbal products including the Compositae and Anacardiaceae plant families and Balsam of Peru. Baboon syndrome caused by systemic medications without a known history of previous cutaneous sensitization in the patient has been termed drug-related baboon syndrome (DRBS) or symmetric drug-related intertriginous and flexural exanthema (SDRIFE). Criteria for SDRIFE include exposure to systemic drug at first or repeated dose, erythema of the gluteal/perianal area and/or V-shaped erythema of the inguinal area, involvement of at least one other intertriginous localization, symmetry of affected areas, and absence of systemic toxicity. The most common causes are aminopenicillins, β-lactam antibacterials, and certain chemotherapeutic agents, though the list of etiologic agents continues to grow. Baboon syndrome and SDRIFE should be strongly considered in a patient presenting with a symmetric intertriginous eruption involving

  13. [Fever and petechial exanthema in children].

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    Soult Rubio, J A; Navarro González, J; Olano Claret, P

    1992-11-01

    In an attempt to determine clinical and analytical predictive parameters of a possible grave disease, we have carried out a retrospective study of 172 children admitted to our hospital with fever and petechiae as initial symptoms. The ages ranged between 1 month and 10 years. Even though we have not found a clinical symptom or analysis sufficiently sensitive as to predict all grave diseases, the general clinical state of the child associated with either a high or low white cell count and an abnormal coagulation study should be alert signals for a serious infectious disease. On the contrary, if the clinical and analytical parameters are within normal limits the risk of a grave disease is low. We emphasize the high incidence of meningococcal disease (26%).

  14. Predicting the characteristics of the aetiological agent for Kawasaki disease from other paediatric infectious diseases in Japan.

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    Nagao, Y; Urabe, C; Nakamura, H; Hatano, N

    2016-02-01

    Although Kawasaki disease (KD), which was first reported in the 1960s, is assumed to be infectious, its aetiological agent(s) remains unknown. We compared the geographical distribution of the force of infection and the super-annual periodicity of KD and seven other paediatric infectious diseases in Japan. The geographical distribution of the force of infection, which was estimated as the inverse of the mean patient age, was similar in KD and other paediatric viral infections. This similarity was due to the fact that the force of infection was determined largely by the total fertility rate. This finding suggests that KD shares a transmission route, i.e. sibling-to-sibling infection, with other paediatric infections. The super-annual periodicity, which is positively associated with the sum of an infectious disease's incubation period and infectious period, was much longer for KD and exanthema subitum than other paediatric infectious diseases. The virus for exanthema subitum is known to persist across the host's lifespan, which suggests that the aetiological agent for KD may also be capable of persistent infection. Taken together, these findings suggest that the aetiological agent for KD is transmitted through close contact and persists asymptomatically in most hosts.

  15. Asymmetric periflexural exanthema: A report in an adult patient

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    Zawar V

    2003-11-01

    Full Text Available Asymmetric periflexural exanthem (APE is a distinctive exanthem, probably viral in origin. It is largely a disease of childhood and is uncommon in adults. We report an adult man presenting with the typical clinical findings of APE.

  16. Laboratory and Clinical Aspects of Human Herpesvirus 6 Infections

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    Bonnafous, Pascale; Gautheret-Dejean, Agnès

    2015-01-01

    SUMMARY Human herpesvirus 6 (HHV-6) is a widespread betaherpesvirus which is genetically related to human cytomegalovirus (HCMV) and now encompasses two different species: HHV-6A and HHV-6B. HHV-6 exhibits a wide cell tropism in vivo and, like other herpesviruses, induces a lifelong latent infection in humans. As a noticeable difference with respect to other human herpesviruses, genomic HHV-6 DNA is covalently integrated into the subtelomeric region of cell chromosomes (ciHHV-6) in about 1% of the general population. Although it is infrequent, this may be a confounding factor for the diagnosis of active viral infection. The diagnosis of HHV-6 infection is performed by both serologic and direct methods. The most prominent technique is the quantification of viral DNA in blood, other body fluids, and organs by means of real-time PCR. Many active HHV-6 infections, corresponding to primary infections, reactivations, or exogenous reinfections, are asymptomatic. However, the virus may be the cause of serious diseases, particularly in immunocompromised individuals. As emblematic examples of HHV-6 pathogenicity, exanthema subitum, a benign disease of infancy, is associated with primary infection, whereas further virus reactivations can induce severe encephalitis cases, particularly in hematopoietic stem cell transplant recipients. Generally speaking, the formal demonstration of the causative role of HHV-6 in many acute and chronic human diseases is difficult due to the ubiquitous nature of the virus, chronicity of infection, existence of two distinct species, and limitations of current investigational tools. The antiviral compounds ganciclovir, foscarnet, and cidofovir are effective against active HHV-6 infections, but the indications for treatment, as well as the conditions of drug administration, are not formally approved to date. There are still numerous pending questions about HHV-6 which should stimulate future research works on the pathophysiology, diagnosis, and

  17. Acute cholecystitis in a child with scarlet fever: A rare association

    African Journals Online (AJOL)

    clinical features are exudative pharyngitis, fever and bright red exanthema. Otitis media, pneumonia, septicaemia, osteomyelitis, rheumatic fever and acute glomerulonephritis are the common complications associated with scarlet fever. However, hepatitis and vasculitis are other rare complications described in the literature.

  18. Predominant CD4 T-lymphocyte tropism of human herpesvirus 6-related virus.

    OpenAIRE

    Takahashi, K; Sonoda, S; Higashi, K; Kondo, T; Takahashi, H; Takahashi, M; Yamanishi, K

    1989-01-01

    Human herpesvirus 6 (HHV-6)-related virus was isolated from CD4+ CD8- and CD3+ CD4+ mature T lymphocytes but could not be isolated from CD4- CD8+, CD4- CD8-, and CD3- T cells in the peripheral blood of exanthem subitum patients. HHV-6-related virus predominantly infected CD4+ CD8+, CD4+ CD8-, and CD3+ CD4+ cells with mature phenotypes and rarely infected CD4- CD8+ cells from cord blood mononuclear cells, which suggested predominant CD4 mature T-lymphocyte tropism of HHV-6-related virus.

  19. HLA-A*3101 and carbamazepine-induced hypersensitivity reactions in Europeans.

    LENUS (Irish Health Repository)

    McCormack, Mark

    2011-03-24

    Carbamazepine causes various forms of hypersensitivity reactions, ranging from maculopapular exanthema to severe blistering reactions. The HLA-B*1502 allele has been shown to be strongly correlated with carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN) in the Han Chinese and other Asian populations but not in European populations.

  20. Immediate and delayed reactions to radiocontrast media: is there an allergic mechanism?

    Science.gov (United States)

    Brockow, Knut

    2009-08-01

    Radiocontrast media can cause immediate (1 hour) and nonimmediate (>1 hour) hypersensitivity reactions that remain unpredictable and a cause of concern for radiologists and cardiologists. Immediate hypersensitivity reactions resemble anaphylaxis, whereas nonimmediate ones clinically are predominated by exanthemas. Increasing evidence indicates that immediate reactions and nonimmediate skin exanthemas may be allergic reactions involving either contrast media-reactive IgE or T cells, respectively. Skin testing is a useful tool for the diagnosis of contrast media allergy. It may have an important role in the selection of a safe product in previous reactors, although validation data are still lacking. In vitro tests to search for contrast media-specific cell activation are currently under investigation.

  1. Favourable effect of TNF-alpha inhibitor (infliximab) on Blau syndrome in monozygotic twins with a de novo CARD15 mutation

    DEFF Research Database (Denmark)

    Milman, Nils; Andersen, Claus B.; Hansen, Annette

    2006-01-01

    Blau syndrome is a hereditary granulomatous disease caused by mutations in the CARD15 gene that is diagnosed in children of young age with exanthema/erythema, arthritis/periarthritis and/or uveitis. We report two cases of Blau syndrome in Danish Caucasian monozygotic male twins, exhibiting...... a heterozygous de novo R334W mutation in codon 334 of CARD15. The patients were initially diagnosed as having sarcoidosis. In both twins, symptoms (exanthema, arthritis/periarthritis) started at 1 year of age, and were followed by uveitis at 7-10 years of age. There was no involvement of the lungs or other...... organs. An initial course of standard antituberculous treatment had no effect on the symptoms. Hydroxychloroquine and cyclosporine A were also ineffective, and the latter caused impaired renal function. Partial symptomatic relief was obtained with prednisolone and increased benefit was observed...

  2. Favourable effect of TNF-alpha inhibitor (infliximab) on Blau syndrome in monozygotic twins with a de novo CARD15 mutation

    DEFF Research Database (Denmark)

    Milman, Nils; Andersen, Claus B; Hansen, Annette

    2006-01-01

    Blau syndrome is a hereditary granulomatous disease caused by mutations in the CARD15 gene that is diagnosed in children of young age with exanthema/erythema, arthritis/periarthritis and/or uveitis. We report two cases of Blau syndrome in Danish Caucasian monozygotic male twins, exhibiting...... a heterozygous de novo R334W mutation in codon 334 of CARD15. The patients were initially diagnosed as having sarcoidosis. In both twins, symptoms (exanthema, arthritis/periarthritis) started at 1 year of age, and were followed by uveitis at 7-10 years of age. There was no involvement of the lungs or other...... quality of life. At follow up at 20 years of age (after 2-5 years of infliximab treatment) the twins had an almost normal physical appearance and a normal psychomotoric development, indicating a favourable short-term prognosis of the disease. Blau syndrome has pathologic, clinical and therapeutic features...

  3. Non disponible / Not available

    OpenAIRE

    Joëlle , Linck

    2005-01-01

    We report the case of an important cholestatic hepatitis with prolonged cholestasis following two injections of gold salts. We discuss the links between this hepatisis and gold salts. In the context of a hypersensitivity reaction to gold salts, our patient developed other toxic reactions : hemolytic anemia, proeinuria, asepteic meningitis, pancreatitis, stomatitis, colitis, exanthema...We studied the mechanism of drug-induced hepatitis and more specifically gold-induced immuno-allergic reacti...

  4. Rash after measles vaccination: laboratory analysis of cases reported in São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Oliveira Maria I

    2002-01-01

    Full Text Available OBJECTIVE: The clinical differential diagnosis of rash due to viral infections is often difficult, and misdiagnosis is not rare, especially after the introduction of measles and rubella vaccination. A study to determine the etiological diagnosis of exanthema was carried out in a group of children after measles vaccination. METHODS: Sera collected from children with rash who received measles vaccine were reported in 1999. They were analyzed for IgM antibodies against measles virus, rubella virus, human parvovirus B19 (HPV B19 using ELISA commercial techniques, and human herpes virus 6 (HHV 6 using immunofluorescence commercial technique. Viremia for each of those viruses was tested using a polimerase chain reaction (PCR. RESULTS: A total of 17 cases of children with exanthema after measles immunization were reported in 1999. The children, aged 9 to 12 months (median 10 months, had a blood sample taken for laboratory analysis. The time between vaccination and the first rash signs varied from 1 to 60 days. The serological results of those 17 children suspected of measles or rubella infection showed the following etiological diagnosis: 17.6% (3 in 17 HPV B19 infection; 76.5% (13 in 17 HHV 6 infection; 5.9% (1 in 17 rash due to measles vaccine. CONCLUSIONS: The study data indicate that infection due to HPV B19 or HHV 6 can be misdiagnosed as exanthema due to measles vaccination. Therefore, it is important to better characterize the etiology of rash in order to avoid attributing it incorrectly to measles vaccine.

  5. Rash after measles vaccination: laboratory analysis of cases reported in São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Maria I Oliveira

    2002-04-01

    Full Text Available OBJECTIVE: The clinical differential diagnosis of rash due to viral infections is often difficult, and misdiagnosis is not rare, especially after the introduction of measles and rubella vaccination. A study to determine the etiological diagnosis of exanthema was carried out in a group of children after measles vaccination. METHODS: Sera collected from children with rash who received measles vaccine were reported in 1999. They were analyzed for IgM antibodies against measles virus, rubella virus, human parvovirus B19 (HPV B19 using ELISA commercial techniques, and human herpes virus 6 (HHV 6 using immunofluorescence commercial technique. Viremia for each of those viruses was tested using a polimerase chain reaction (PCR. RESULTS: A total of 17 cases of children with exanthema after measles immunization were reported in 1999. The children, aged 9 to 12 months (median 10 months, had a blood sample taken for laboratory analysis. The time between vaccination and the first rash signs varied from 1 to 60 days. The serological results of those 17 children suspected of measles or rubella infection showed the following etiological diagnosis: 17.6% (3 in 17 HPV B19 infection; 76.5% (13 in 17 HHV 6 infection; 5.9% (1 in 17 rash due to measles vaccine. CONCLUSIONS: The study data indicate that infection due to HPV B19 or HHV 6 can be misdiagnosed as exanthema due to measles vaccination. Therefore, it is important to better characterize the etiology of rash in order to avoid attributing it incorrectly to measles vaccine.

  6. [Observations on human parvovirus B19 infection diagnosed in 2011].

    Science.gov (United States)

    Mihály, Ilona; Trethon, András; Arányi, Zsuzsanna; Lukács, Adrienne; Kolozsi, Tímea; Prinz, Gyula; Marosi, Anikó; Lovas, Nóra; Dobner, Ilona Sarolta; Prinz, Géza; Szalai, Zsuzsanna; Pék, Tamás

    2012-12-09

    The incidence of human parvovirus B19 infection is unknown. A retrospective analysis of clinical and laboratory findings was carried out in patients diagnosed with human parvovirus B19 infection in 2011 in a virologic laboratory of a single centre in Hungary. Clinical and laboratory data of patients with proven human parvovirus B19 infection were analysed using in- and out-patient files. In 2011, 72 patients proved to have human parvovirus B19 infection with the use of enzyme immunoassay. The clinical diagnoses of these patients were as follows: human parvovirus B19 infection (30.6%), transient aplastic crisis (16.7%), arthritis (8.3%) and acute hepatitis (4.1%). Symptoms of each of the four phases of the infection occurred in various combinations with the exception of the monophase of cheek exanthema. This occurred without the presence of other symptoms in some cases. Leading symptoms and signs were exanthema (in 74.6% of cases), haematological disorders (in 69% of cases), fever (in 54.9% of cases) and arthritis (in 33.8% of cases). Several atypical dermatological symptoms were also observed. Acute arthritis without exanthema was noted in 8 patients. Of the 72 patients with proven human parvovirus B19 infection there were 7 pregnant women, and one of them had hydrops foetalis resulting spontaneous abortion. In 16 patients (22.5%) human parvovirus B19 IgG was undetectable despite an optimal time for testing. The observations of this study may contribute to a better recognition of clinical symptoms of human parvovirus B19 infection.

  7. Clinical study of FT-207 suppository for head and neck malignancies

    International Nuclear Information System (INIS)

    Tomioka, Masashi; Usami, Masami; Sakamoto, Ayako

    1982-01-01

    Futraful suppository 1.5g per day was administered to 33 patients with head and neck malignancies. Among 33 cases which entered into the study, 16 cases were evaluated. Out of 16 evaluable cases, complete responses (CRs) were obtained in 4 cases and partial responses (PRs) in 7 cases. An overall response rate including 4 CRs and 7 PRs was 68.8%. Side effects due to FT-207 suppository were developed in 14 cases out of 33 patients (42.4%) Side effects such as anal pain, anorexia, diarrhea, pigmentation, exanthema and nail change were observed. No severe side effect was encountered. (author)

  8. External therapy with radioactive urine: a pitfall during sceletal scintigraphy; Heisse Eigenurintherapie: ein ueberraschender Befund bei der Skelettszintigraphie

    Energy Technology Data Exchange (ETDEWEB)

    Scheidhauer, K.; Urbannek, V. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Koeln (Germany)

    1997-12-01

    A 41-year old male patient suffering from psoriasis arthropathica underwent a two-phase bone scan for activity of joint affections. Extensive diffuse skin contamination of the extremities in the delayed images was due to the use of the patient`s own radioactive urine as an embrocation for psoriasis exanthema. (orig.) [Deutsch] Bei einem 41jaehrigen Patienten mit Psoriasisarthropathie fiel in der Skelettszintigraphie in den Aufnahmen der Mineralisationsphase eine flaechige Aktivitaetsbelegung der Beine auf. Als Ursache stellte sich das zwischenzeitliche Einreiben der Extremitaeten durch den Patienten mit dem radioaktiven Eigenurin wegen eines Exantherms heraus. (orig.)

  9. Dress Syndrome - A Case Report

    Directory of Open Access Journals (Sweden)

    Kremić Zorana

    2016-06-01

    Full Text Available The drug reaction with eosinophilia and systemic symptoms (DRESS syndrome is an adverse drug-induced reaction that occurs most commonly after exposure to drugs, most frequently anticonvulsants, sulfa derivates, antidepressants, nonsteroidal anti-inflammatory drugs, and antimicrobials. We present a 61-year-old male, with a generalized maculopapular exanthema on the trunk, face, extremities, palms, soles, palate, and fever (38°C. His medical history was notable for generalized epilepsy, treated with carbamazepine during 1 month. The diagnosis of DRESS syndrome was confirmed by specific RegiSCAR criteria. In our case, skin eruptions were successfully treated with oral methylprednisolone, cephalexin, and topical corticosteroid ointment.

  10. Intravenous immunoglobulin therapy leading to dramatic improvement in a patient with systemic juvenile idiopathic arthritis and severe pericarditis resistant to steroid pulse therapy.

    Science.gov (United States)

    Aizawa-Yashiro, Tomomi; Oki, Eishin; Tsuruga, Kazushi; Nakahata, Tohru; Ito, Etsuro; Tanaka, Hiroshi

    2012-05-01

    A 7-year-old Japanese boy with a 4-month history of systemic juvenile idiopathic arthritis (s-JIA) experienced disease flare with spiking fever, exanthema and arthralgia. He then developed progressive dyspnea due to severe pericarditis, and proinflammatory hypercytokinemia was suspected. Methylprednisolone pulse therapy was ineffective and echocardiography showed massive pericardial effusion had persisted. Alternatively, subsequent intravenous immunoglobulin (IVIG) therapy resulted in dramatic resolution of the pericardial effusion, and his general condition significantly improved within a few days. This case report may lend further support the use of IVIG for selected patients with s-JIA and severe pericarditis.

  11. Clinical and Laboratory evaluation of measleslike rash in children and young adults

    Directory of Open Access Journals (Sweden)

    Stewien Klaus Eberhard

    2000-01-01

    Full Text Available A clinical and laboratory evaluation of 11 children and young adults with measleslike rash was done during the measles outbreak in the Greater São Paulo Metropolitan area at the end of 1996 and spread over the country during 1997. Measles was laboratory confirmed in 07 patients by specific IgM detection in acute serum specimens using an IgM-capture EIA, by specific IgG seroconversion in serum pairs, and by reverse transcription PCR and virus isolation in peripheral blood lymphocytes. Clinical presentations were not always classic; one of the 07 cases had received measles vaccine and corresponded to modified clinical case of measles. The 4 remaining cases were negative for measles and were diagnosed as exanthem subitum (2 cases, scarlet fever and Kawasaki disease. The present study reinforces the view that clinical features alone are not sufficient for establishing an accurate diagnosis in the post-vaccine era, and a surveillance system based on sensitive laboratory results is needed so that it can confirm IgM-negative measles cases.

  12. Human rickettsioses in the Batna area, eastern Algeria.

    Science.gov (United States)

    Mokrani, Khamsa; Tebbal, Soraya; Raoult, Didier; Fournier, Pierre-Edouard

    2012-12-01

    In order to investigate the prevalence of rickettsioses in febrile exanthemas in eastern Algeria, we conducted a prospective serological analysis of all patients presenting with this clinical picture at the Infectious Diseases Department in the Batna Hospital from January 2000 to September 2006. One hundred and eight adult patients were included in the study, 46% of whom younger than 25 years, and 72.5% were admitted from May to September. Patients were tested for antibodies to Rickettsia conorii conorii, R. conorii israelensis, R. aeschlimannii, R. felis, R. sibirica mongolitimonae, R. africae, R. massiliae, R. typhi, and R. prowazekii using microimmunofluorescence and Western blot as confirmation procedure. Both methods confirmed the diagnosis of Mediterranean spotted fever in 5 patients (4.6%), flea spotted fever in 2 patients (1.9%), and R. aeschlimannii infection in 2 patients (1.9%). In addition, 4 patients were diagnosed as having murine typhus (3.7%) and one with epidemic typhus (0.9%). To the best of our knowledge, this is the first report of R. felis infection and R. aeschlimannii infection in Algeria. In conclusion, at least 5 different kinds of rickettsiosis coexist in eastern Algeria and, being responsible for 13% of cases of febrile exanthemas, should be considered among major causes of this clinical picture in this area. In addition, we emphasize the high incidence of typhus group rickettioses, including epidemic typhus, in this area. Copyright © 2012 Elsevier GmbH. All rights reserved.

  13. PENGEMBANGAN SISTEM CERDAS MENGGUNAKAN PENALARAN BERBASIS KASUS (CASE BASED REASONING UNTUK DIAGNOSA PENYAKIT AKIBAT VIRUS EKSANTEMA

    Directory of Open Access Journals (Sweden)

    Agus Sasmito Aribowo

    2015-04-01

    Full Text Available Disease caused by a exanthema virus is a common disease in Indonesia. There are many types of diseases caused by this virus. Examples are chicken pox, measles, variola, etc. with symptoms almost similar to each other. To correctly identify the symptoms  need experts. But the problem is very limited number of experts. Then the expert system is needed which has been given by the expert knowledge to assist in the diagnosis. Expert system in this research uses a case-based reasoning approach. If there is a similar case, the reasoning for considering the case of the nearest using Probabilistic Bayes. The result is the system will still be able to provide the best recommendations solution for new cases based on the solution to an old case that the nearest level of similarity.

  14. Comparison of camelpox viruses isolated in Dubai.

    Science.gov (United States)

    Pfeffer, M; Meyer, H; Wernery, U; Kaaden, O R

    1996-03-01

    Between October 1993 and March 1994, outbreaks of pox-like exanthemas were observed in several camel raising farms in Dubai. Scabs from twenty camels with either local or generalized lesions were examined, seven of them had previously been vaccinated with a modified live camelpox virus vaccine. Inspection of scabs by electron microscopy confirmed an infection with orthopox viruses (OPV) in 10 animals and with parapox virus in one camel. Investigation of the scabs by polymerase chain reaction and dot blot assay revealed the presence of OPV in 15 or 13 samples, respectively. OPV could be isolated in cell culture in 14 cases. Restriction enzyme profiles characterized all isolates as camelpox virus. Their DNA patterns were virtually identical displaying only slight variations in the terminal fragments. In contrast, the vaccine strain showed a distinct restriction enzyme profile, indicating that it was not involved in the infections.

  15. [Severe Yellow fever vaccine-associated disease: a case report and current overview].

    Science.gov (United States)

    Slesak, Günther; Gabriel, Martin; Domingo, Cristina; Schäfer, Johannes

    2017-08-01

    History and physical examination  A 56-year-old man developed high fever with severe headaches, fatigue, impaired concentration skills, and an exanthema 5 days after a yellow fever (YF) vaccination. Laboratory tests  Liver enzymes and YF antibody titers were remarkably elevated. YF vaccine virus was detected in urine by PCR. Diagnosis and therapy  Initially, severe YF vaccine-associated visceral disease was suspected and treated symptomatically. Clinical Course  His fever ceased after 10 days in total, no organ failure developed. However, postencephalitic symptoms persisted with fatigue and impaired concentration, memory, and reading skills and partly incapability to work for over 3 months. A diagnosis was made of suspected YF vaccine-associated neurotropic disease. Conclusion  Severe vaccine-derived adverse effects need to be considered in the indication process for YF vaccination. © Georg Thieme Verlag KG Stuttgart · New York.

  16. [Imported dengue: an emerging arbovirosis in Spain].

    Science.gov (United States)

    Ramos Geldres, T T; García López-Hortelano, M; Baquero-Artigao, F; Montero Vega, D; López Quintana, B; Mellado Peña, M J

    2015-01-01

    Dengue is caused by one of 4 serotypes of dengue virus. Only imported cases have been reported in Spain. The main clinical findings are fever and exanthema, although there may be severe forms, particularly in secondary infections. Five children with a primary, non severe dengue infection are presented. The diagnosis was based on clinical suspicion and epidemiological history, and confirmed by immunochromatography and ELISA tests. The outcome was favourable in all cases. It is important to consider this diagnosis in international travellers that present with fever within the 14 days of returning from an endemic area, in order to get an early diagnosis, adequate treatment and a good prognosis. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  17. Mononucleosis-like drug rash: An interesting case presentation

    Directory of Open Access Journals (Sweden)

    Reshma T Vishnani

    2014-01-01

    Full Text Available Dapsone hypersensitivity syndrome (DHS is a rare adverse effect of the commonly prescribed drug dapsone. We present a case of a 35-year-old male who was referred to us from the gastroenterologist with complaints of rash, nausea, vomiting, and jaundice since 2 days with a provisional differential diagnosis of infectious mononucleosis or viral exanthema. On enquiry patient gave history of taking dapsone a week prior for refractory urticaria. After thorough investigations we diagnosed him with DHS. This syndrome occurs in a relatively small proportion of patients, but it is associated with considerable morbidity and mortality. The reason for presenting this case is to remind physicians of the unpredictability and potential severity of this reaction which makes it a major concern in clinical practice.

  18. The prevalence of acute cutaneous drug reactions in a Scandinavian University hospital

    DEFF Research Database (Denmark)

    Borch, Jacob Eli; Andersen, Klaus Ejner; Bindslev-Jensen, Carsten

    2006-01-01

    2 weeks' duration. Patients were examined clinically and offered investigation for possible drug allergy, including blood tests, and skin tests when appropriate. Subsequent drug challenge tests were performed in selected cases. Finally, the history and test results were evaluated to determine......To investigate the epidemiology of acute cutaneous adverse drug reactions, a cross-sectional study was designed with four visits, equally distributed over one year, to all clinical departments of a large university hospital in order to find patients with possible drug-induced exanthema of less than...... the imputability of each drug as the possible culprit. In a cohort of 11,371 in- and out-patients, 131 were referred for evaluation. Twenty-nine cases of acute cutaneous drug reactions were identified, giving a prevalence of 0.33% in in-patients, 0.14% in out-patients, and 0.25% overall. Twenty-five percent...

  19. Neurological manifestations of Chikungunya and Zika infections

    Directory of Open Access Journals (Sweden)

    Talys J. Pinheiro

    Full Text Available ABSTRACT The epidemics of Chikungunya virus (CHIKV and Zika virus (ZIKV infections have been considered the most important epidemiological occurrences in the Americas. The clinical picture of CHIKV infection is characterized by high fever, exanthema, myalgia, headaches, and arthralgia. Besides the typical clinical picture of CHIKV, atypical manifestations of neurological complications have been reported: meningo-encephalitis, meningoencephalo-myeloradiculitis, myeloradiculitis, myelitis, myeloneuropathy, Guillain-Barré syndrome and others. The diagnosis is based on clinical, epidemiological, and laboratory criteria. The most common symptoms of ZIKV infection are skin rash (mostly maculopapular, fever, arthralgia, myalgia, headache, and conjunctivitis. Some epidemics that have recently occurred in French Polynesia and Brazil, reported the most severe conditions, with involvement of the nervous system (Guillain-Barré syndrome, transverse myelitis, microcephaly and meningitis. The treatment for ZIKV and CHIKV infections are symptomatic and the management for neurological complications depends on the type of affliction. Intravenous immunoglobulin, plasmapheresis, and corticosteroid pulse therapy are options.

  20. Eritema infeccioso: un exantema infantil a considerar en la práctica diaria Fifth disease or infectious erythema: a childhood rash to consider in the daily medical practice

    Directory of Open Access Journals (Sweden)

    AD Pérez-Elizondo

    Full Text Available Se presenta el caso de un escolar con febrícula y leve ataque del estado general, quien desarrolla una erupción maculosa en mejillas, pocos días después un exantema en "encaje" o reticulado en tronco posterior y parte proximal de extremidades inferiores, compatible con la quinta enfermedad y confirmado por la morfología lesional característica y la inmuno-serología (IgM.We present a five years old child with a mild fever and malaise, a maculoedematous eruption on cheeks and a "lace" exanthema located on posterior aspect of the trunk and lower limbs, developed after a few days. A fifth disease was diagnosticated based on characteristic morphological presentation and immunoserological studies.

  1. Kinetic aspects of misonidazole and its major metabolite in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Meering, P.G.; Maes, R.A.A. (Rijksuniversiteit Utrecht (Netherlands). Centre for Human Toxicology); Gonzalez, D.G. (Amsterdam Univ. (Netherlands). Dept. of Radiotherapy); Peperzeel, H.A. van (Rijksuniversiteit Utrecht (Netherlands). Academisch Ziekenhuis)

    1985-01-01

    Oral doses of misonidazole between 0.75 and 1.3 g/m/sup 2/ were administered during 3-5 days per week to 21 patients with various malignancies. Mean plasma levels of misonidazole and desmethylmisonidazole at the times of radiotherapy were in the range 20-50 and 2-12 mg/1 respectively. Slight accumulation of misonidazole and desmethylmisonidazole in plasma was observed with a dosage interval of 24 h. In patients with anticonvulsant comedication plasma elimination half-lives of misonidazole of 4.1-8.9 h were found. Observed side-effects were nausea and vomiting (9%), exanthema or rashes (14%) and mild peripheral neuropathy (9%).

  2. Syndromic classification of rickettsioses: an approach for clinical practice

    Directory of Open Access Journals (Sweden)

    Álvaro A. Faccini-Martínez

    2014-11-01

    Full Text Available Rickettsioses share common clinical manifestations, such as fever, malaise, exanthema, the presence or absence of an inoculation eschar, and lymphadenopathy. Some of these manifestations can be suggestive of certain species of Rickettsia infection. Nevertheless none of these manifestations are pathognomonic, and direct diagnostic methods to confirm the involved species are always required. A syndrome is a set of signs and symptoms that characterizes a disease with many etiologies or causes. This situation is applicable to rickettsioses, where different species can cause similar clinical presentations. We propose a syndromic classification for these diseases: exanthematic rickettsiosis syndrome with a low probability of inoculation eschar and rickettsiosis syndrome with a probability of inoculation eschar and their variants. In doing so, we take into account the clinical manifestations, the geographic origin, and the possible vector involved, in order to provide a guide for physicians of the most probable etiological agent.

  3. [The Antonine plague].

    Science.gov (United States)

    Haas, Charles

    2006-01-01

    During the reign of Marcus Aurelius, the Roman Empire was struck by a long and destructive epidemic. It began in Mesopotamia in late AD 165 or early AD 166 during Verus' Parthian campaign, and quickly spread to Rome. It lasted at least until the death of Marcus Aurelius in AD 180 and likely into the early part of Commodus' reign. Its victims were "innumerable". Galen had first-hand knowledge of the disease. He was in Rome when the plague reached the city in AD 166. He was also present during an outbreak among troops stationed at Aquileia during the winter of AD 168-169. His references to the plague are scattered and brief but enough information is available to firmly identify the plague as smallpox. His description of the exanthema is fairly typical of the smallpox rash, particularly in the hemorrhagic phase of the disease.

  4. Immunological aspects of nonimmediate reactions to beta-lactam antibiotics.

    Science.gov (United States)

    Rodilla, Esther Morena; González, Ignacio Dávila; Yges, Elena Laffond; Bellido, Francisco Javier Múñoz; Bara, María Teresa Gracia; Toledano, Félix Lorente

    2010-09-01

    beta-lactam antibiotics are the agents most frequently implied in immune drug adverse reactions. These can be classified as immediate or nonimmediate according to the time interval between the last drug administration and their onset. Mechanisms of immediate IgE-mediated reactions are widely studied and are therefore better understood. Nonimmediate reactions include a broad number of clinical entities like mild maculopapular exanthemas, the most common, and other less frequent but more severe reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, acute exanthematic pustulosis or cytopenias. These nonimmediate reactions are mainly mediated by T cells but the precise underlying mechanisms are not well elucidated. This fact complicates the allergological evaluation of patients with this type of reaction and available tests have demonstrated poor sensitivity and specificity.

  5. Clinical survey on adverse reaction of contrast media, final report

    International Nuclear Information System (INIS)

    Katayama, Hitoshi; Ishida, Osamu; Osawa, Tadashi

    1988-01-01

    This report is a final analysis of adverse reactions to iodinated contrast media examined in 33,440 patients from 11 hospitals during the period from October 1983 through June 1986. Adverse reactions, such as nausea, exanthema and vomiting, to contrast media occurred in 2,523 patients (7.5 %), with the higher number occuring in patients aged 40 - 60, irrespective of sex. There were no significant alternations in vital signs. Patients positive for pretesting and having a history of allergy had higher incidences of adverse reactions (48 % and 52 %, respectively). A history of allergy is the most potential predictor for adverse reactions to contrast media. There was no definitive correlation between prior medication of contrast media and the occurrence of their adverse reactions. The relationship between the occurrence of adverse reactions and both kinds and dosage of contrast media was unknown. (Namekawa, K.)

  6. Acute Zika Virus Infection in an Endemic Area Shows Modest Proinflammatory Systemic Immunoactivation and Cytokine-Symptom Associations

    Directory of Open Access Journals (Sweden)

    Jéssica Barletto de Sousa Barros

    2018-05-01

    Full Text Available An early immune response to Zika virus (ZIKV infection may determine its clinical manifestation and outcome, including neurological effects. However, low-grade and transient viremia limits the prompt diagnosis of acute ZIKV infection. We have investigated the plasma cytokine, chemokine, and growth factor profiles of 36 individuals from an endemic area displaying different symptoms such as exanthema, headache, myalgia, arthralgia, fever, hyperemia, swelling, itching, and nausea during early-phase infection. These profiles were then associated with symptoms, revealing important aspects of the immunopathophysiology of ZIKV infection. The levels of some cytokines/chemokines were significantly higher in acute ZIKV-infected individuals compared to healthy donors, including interferon (IFN gamma-induced protein 10 (IP-10, regulated on activation, normal T cell expressed and secreted (RANTES, IFN-γ, interleukin (IL-9, IL-7, IL-5, and IL-1ra, including some with predominantly immunoregulatory activity. Of note, we found that higher levels of IP-10 and IL-5 in ZIKV-infected individuals were strongly associated with exanthema and headache, respectively. Also, higher levels of IL-1ra were associated with subjects with arthralgia, whereas those with fever showed lower levels of granulocyte-colony stimulating factor (G-CSF. No correlation was observed between the number of symptoms and ZIKV viral load. Interestingly, only IP-10 showed significantly decreased levels in the recovery phase. In conclusion, our results indicate that acute ZIKV infection in a larger cohort resident to an endemic area displays a modest systemic immune activation profile, involving both proinflammatory and immunoregulatory cytokines and chemokines that could participate of virus control. In addition, we showed that differential cytokine/chemokine levels are related to specific clinical symptoms, suggesting their participation in underlying mechanisms.

  7. Diferenças clínicas observadas em pacientes com dengue causadas por diferentes sorotipos na epidemia de 2001/2002, ocorrida no município do Rio de Janeiro Clinical differences observed in patients with dengue caused by different serotypes in the epidemic of 2001/2002, occurred in Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Maíla Naves Pereira Passos

    2004-08-01

    Full Text Available O objetivo deste estudo foi avaliar as diferenças clínicas e epidemiológicas das infecções causadas pelos distintos sorotipos do vírus do dengue na epidemia 2001-2002 no município do Rio de Janeiro. Foram analisados 362 casos com isolamento viral, sendo 62 do sorotipo 1,62 do sorotipo 2, e 238 do sorotipo 3. Estes casos foram notificados ao Sistema de Informação de Agravos de Notificação (SINAN de janeiro/2001 até junho/2002. Os indivíduos infectados com o sorotipo 3 tiveram uma chance 6,07 vezes maior de apresentar choque em relação aos indivíduos com o sorotipo 2 (OR=6,07; IC:1,10-43,97. A chance de apresentar dor abdominal foi 3,06 maior nos infectados pelo sorotipo 3 do que naqueles por sorotipo 1 (OR=3,06; IC:0,99-9,66. Nos infectados com o sorotipo 3, a chance de ocorrer exantema foi 3,61 vezes maior que naqueles com o sorotipo 1 (OR=3,61; IC:1,16-11,51 e 3,55 vezes maior que aqueles com o sorotipo 2 (OR=3,55; IC:1,28-9,97. Este estudo mostra que indivíduos acometidos pelo sorotipo 3 apresentaram dengue com maior gravidade.The authors evaluated clinical and epidemiological differences among the serotypes of dengue in Rio de Janeiro's 2001-2002 outbreak of the disease. Out of 362 cases that had viral isolation samples, notified by the Information System for Notification Diseases (SINAN, from January/2001 to June/2002, 62 were caused by serotype 1,62 by serotype 2 and 238 by serotype 3. In comparison with serotype 2, an individual infected by serotype 3 had a 6.07 times higher chance (OR = 6.07; CI: 1.10-43.97 of presenting shock and a 3.55 times higher chance (OR = 3.55; CI: 1.28-9.97 of developing exanthema. When compared to serotype 1, serotype 3 had a 3.06 times higher chance (OR = 3.06; CI: 0.99-9.66 of causing abdominal pain and a 3.61 times higher chance of exanthema (OR = 3.61; CI: 1.16-11.51. It was found that individuals infected by serotype 3 of the virus presented signs indicating a more severe disease.

  8. Slow desensitization of imatinib-induced nonimmediate reactions and dynamic changes of drug-specific CD4+CD25+CD134+ lymphocytes.

    Science.gov (United States)

    Klaewsongkram, Jettanong; Thantiworasit, Pattarawat; Sodsai, Pimpayao; Buranapraditkun, Supranee; Mongkolpathumrat, Pungjai

    2016-11-01

    Imatinib is a tyrosine kinase inhibitor indicated for the treatment of gastrointestinal stromal tumors (GISTs) and certain neoplastic diseases; however, nonimmediate adverse reactions are common. To describe the process of imatinib slow desensitization in patients who experienced nonimmediate reactions to imatinib and the dynamic change in drug-specific CD4 + CD25 + CD134 + T-lymphocyte percentages. Five patients diagnosed as having GISTs and with a recent history of imatinib-induced nonimmediate reactions (maculopapular exanthema with eosinophilia, exfoliative dermatitis, palmar-plantar erythrodysesthesia, and drug rash with eosinophilia and systemic symptoms) were desensitized using a slow desensitization protocol. The reintroduced imatinib dosage was stepped up every week starting from 10 mg/d and increasing to 25, 50, 75, 100, 150, 200, and 300 mg/d until the target dose of 400 mg/d was achieved. Prednisolone of up to 30 mg/d was allowed if allergic reactions recurred. The percentages of CD4 + CD25 + CD134 + T cells present after incubating peripheral blood mononuclear cells with imatinib, at baseline and after successful desensitization, were analyzed using flow cytometric analysis. By using a slow desensitization technique, all patients were able to receive 400 mg/d of imatinib, and prednisolone was gradually tapered off. The percentages of imatinib-induced CD4 + CD25 + CD134 + T cells decreased from a mean (SD) of 11.3% (6.5%) and 13.4% (7.3%) at baseline to 3.2% (0.7%) and 3.0% (1.1%) after successful desensitization, when stimulating peripheral blood mononuclear cells with 1 and 2 μM of imatinib, respectively. Slow desensitization is a helpful procedure in treating patients with imatinib-induced nonimmediate reactions other than simple maculopapular exanthema. The reduced percentages of imatinib-induced CD4 + CD25 + CD134 + T cells in these patients may be associated with immune tolerance. Copyright © 2016 American College of Allergy, Asthma & Immunology

  9. Granulomatous rosacea: Like leukemid in a patient with acute myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Škiljević Dušan

    2008-01-01

    Full Text Available Introduction. Skin findings in leukemias may be divided into specific lesions (leukemia cutis and non-specific lesions (leukemids which may be found in up to 80% of all patients with leukemias. The leukemids vary clinically and they are usually a manifestation of bone marrow or immunologic impairment, but also Sweet syndrome, pyoderma gangrenosum, erythroderma, maculopapular exanthema, prurigo-like papules, generalized pigmentation, follicular mucinosis, generalized pruritus may be found during the course of leukemia. Case report. We report a 70-year-old male with a 3-month history of erythema, papules and pustules on the face, ears and neck and over a month history of refractory anemia, anorexia, weight loss, malaise, and fever. Physical examination revealed symmetric erythematous, violaceous papules, papulo-nodules and plaques with slate scale and sparse, small pustules on the face, earlobes and neck. Histopathologic findings of involved skin showed diffuse mixed inflammatory cell infiltrate with perifollicular accentuation and focal granulomatous inflammation in the papillary and upper reticular dermis. Extensive checkup revealed the presence of acute myeloid leukemia French- American-British (FAB classification subtype M2, with signs of three-lineage dysplasia. The patient was treated by L6 protocol which led to complete remission, both in bone marrow and skin, but after seven months he had relapse of leukemia with the fatal outcome. Conclusion. This case indicates the importance of skin eruptions in the context of hematological malignancies.

  10. [Infections after bite wounds : For example rat bite fever due to Streptobacillus moniliformis].

    Science.gov (United States)

    Hof, Herbert; Binder, Rudolf; Schäfer, Christian; Stuber, Madeleine; Licht, Andreas; Bozenhardt-Stavrakidis, Iris; Bode, Konrad

    2018-04-11

    Rat bite fever due to Streptobacillus moniliformis induces typical but not pathognomonic clinical signs, such as local purulent wound infection followed by maculopapular exanthema, myalgia as well as purulent joint infections. Severe complications, such as osteomyelitis and endocarditis are possible. it seems that this infection is rarely diagnosed but this infection could be much more common because the final diagnostic proof is difficult to achieve. Firstly, the culture of these bacteria is critical because the bacteria are fastidious and secondly the exact differentiation of the isolates is hardly possible by standard laboratory methods. Modern techniques such as mass spectroscopy (MALDI-TOF) and molecular biology allow a precise clarification. Surgical cleansing of infection sites in combination with a rational antibiotic therapy, for example with beta-lactam antibiotics, are generally able to cure the infection if treatment is started early enough. In addition, vaccinations, for example against tetanus and rabies have to be considered in this situation as for all other bite wound infections.

  11. Linear immunoglobulin A dermatosis mimicking toxic epidermal necrolysis: a case report of etanercept treatment.

    Science.gov (United States)

    Prieto-Barrios, M; Velasco-Tamariz, V; Tous-Romero, F; Burillo-Martinez, S; Zarco-Olivo, C; Rodriguez-Peralto, J L; Ortiz-Romero, P L

    2018-03-01

    A 65-year-old pluripathological woman attended our hospital with a cutaneous eruption of sudden appearance after vancomycin treatment. She presented targetoid lesions affecting approximately 25-30% of her body surface, large erosions with mucosal lesions and positive Nikolsky sign. Under the initial clinical suspicion of toxic epidermal necrolysis (TEN), and considering the recent literature of successful use of etanercept in these cases, she was treated with a single dose of this antitumour necrosis factor (anti-TNF) agent. Subsequently, the exanthema progression stopped and resolution of the lesions happened in a few days. Later on, histopathology revealed a subepidermal blister with dense neutrophilic infiltrate and linear deposits of immunoglobulin A (IgA) on the dermoepidermal junction, allowing us to establish the diagnosis of drug-induced linear IgA dermatosis mimicking TEN. Linear IgA dermatosis can have severe clinical manifestations, even mimicking TEN, and can have high mortality, especially in drug-induced cases. We have not found any other report of linear IgA dermatosis treated with etanercept in the English literature. Anti-TNF medications could represent useful therapeutic alternatives in this dermatosis. © 2017 British Association of Dermatologists.

  12. Immediate and delayed cutaneous reactions to radiocontrast media.

    Science.gov (United States)

    Brockow, Knut

    2012-01-01

    Hypersensitivity reactions to contrast media (CM) are frequent causes of anaphylaxis and drug exanthemas. Adverse events after CM exposure are classified into immediate (≤1 h) and non-immediate reactions (>1 h), with differing mechanisms. In the majority of patients with immediate reactions, IgE-mediated allergy cannot be demonstrated, and the underlying mechanism remains unknown. However, recent data have provided evidence for skin test positivity and/or specific IgE in some patients. T cell-mediated hypersensitivity is the responsible mechanism for the majority of non-immediate skin eruptions. These insights have consequences for diagnosis and prevention. Skin testing evolves to be a useful tool for diagnosis of CM allergy. Skin tests have been employed to confirm this hypersensitivity. Previous reactors have an increased risk to develop new reactions upon repeated exposure; however, other risk factors are poorly defined. The use of skin tests for the selection of a 'safe' CM is under investigation with promising results. In vitro tests to search for CM-specific cell activation include flow cytometric approaches, lymphocyte cultures and construction of cell lines and hybridomas. Premedication of previous reactors is common practice among radiologists; however, breakthrough reactions are a concern, and physicians should not rely on the efficacy of pharmacological premedication. Copyright © 2012 S. Karger AG, Basel.

  13. Classification and pathophysiology of radiocontrast media hypersensitivity.

    Science.gov (United States)

    Brockow, Knut; Ring, Johannes

    2010-01-01

    Hypersensitivity reactions to radiocontrast media (RCM) are unpredictable and are a concern for radiologists and cardiologists. Immediate hypersensitivity reactions manifest as anaphylaxis, and an allergic IgE-mediated mechanism has been continuously discussed for decades. Non-immediate reactions clinically are exanthemas resembling other drug-induced non-immediate hypersensitivities. During the past years, evidence is increasing that some of these reactions may be immunological. Repeated reactions after re-exposure, positive skin tests, and presence of specific IgE antibodies as well as positive basophil activation tests in some cases, and positive lymphocyte transformation or lymphocyte activation tests in others, indicate that a subgroup of both immediate and non-immediate reactions are of an allergic origin, although many questions remain unanswered. Recently reported cases highlight that pharmacological premedication is not safe to prevent RCM hypersensitivity in patients with previous severe reactions. These insights may have important consequences. A large multicenter study on the value of skin tests in RCM hypersensitivity concluded that skin testing is a useful tool for diagnosis of RCM allergy. It may have a role for the selection of a safe product in previous reactors, although confirmatory validation data is still scarce. In vitro tests to search for RCM-specific cell activation still are in development. In conclusion, recent data indicate that RCM hypersensitivity may have an allergic mechanism and that allergological testing is useful and may indicate tolerability. Copyright 2010 S. Karger AG, Basel.

  14. An Updated Review of the Molecular Mechanisms in Drug Hypersensitivity

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    Chun-Bing Chen

    2018-01-01

    Full Text Available Drug hypersensitivity may manifest ranging from milder skin reactions (e.g., maculopapular exanthema and urticaria to severe systemic reactions, such as anaphylaxis, drug reactions with eosinophilia and systemic symptoms (DRESS/drug-induced hypersensitivity syndrome (DIHS, or Stevens–Johnson syndrome (SJS/toxic epidermal necrolysis (TEN. Current pharmacogenomic studies have made important strides in the prevention of some drug hypersensitivity through the identification of relevant genetic variants, particularly for genes encoding drug-metabolizing enzymes and human leukocyte antigens (HLAs. The associations identified by these studies are usually drug, phenotype, and ethnic specific. The drug presentation models that explain how small drug antigens might interact with HLA and T cell receptor (TCR molecules in drug hypersensitivity include the hapten theory, the p-i concept, the altered peptide repertoire model, and the altered TCR repertoire model. The broad spectrum of clinical manifestations of drug hypersensitivity involving different drugs, as well as the various pathomechanisms involved, makes the diagnosis and management of it more challenging. This review highlights recent advances in our understanding of the predisposing factors, immune mechanisms, pathogenesis, diagnostic tools, and therapeutic approaches for drug hypersensitivity.

  15. Molecular epidemiology of enterovirus and parechovirus infections according to patient age over a 4-year period in Spain.

    Science.gov (United States)

    Cabrerizo, María; Díaz-Cerio, María; Muñoz-Almagro, Carmen; Rabella, Núria; Tarragó, David; Romero, María Pilar; Pena, María José; Calvo, Cristina; Rey-Cao, Sonia; Moreno-Docón, Antonio; Martínez-Rienda, Inés; Otero, Almudena; Trallero, Gloria

    2017-03-01

    The epidemiology and clinical association of enterovirus (EV) and parechovirus (HPeV) infections, as well as the type-distribution-according-to-age, were determined during a 4-year study period in Spain. During 2010-2013, a total of 21,832 clinical samples were screened for EV and the detection frequency was 6.5% (1,430). Of the total EV-negative samples, only 1,873 samples from 2011 to 2013 were available for HPeV testing. HPeV was detected in 42 (2%) of them. Positive samples were genotyped using PCR and sequencing. EV infections occurred in all age groups of patients: neonates (17%), children 28 days to 2 years (29%), children 2-14 years (40%), and adults (14%). Thirty-four different EV types were identified. HPeV infections were detected exclusively in infants 2 years and adults (P < 0.05). Clinically, meningitis was associated with EV (P < 0.01) whereas, encephalitis was more frequent in HPeV-infected patients. CV-B types were associated with myocarditis (90%; P < 0.05) and EV species A with hand-foot-mouth-disease/atypical exanthema (88%; P < 0.05). J. Med. Virol. 89:435-442, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  16. THE IMPORTANCE OF HERPESVIRUSES IN THE ETIOLOGY OF A NUMBER OF INFECTIOUS AND SOMATIC DISEASES OF CHILDREN

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    T. N. Rybalkina

    2017-01-01

    Full Text Available The article is devoted to study the etiological role of herpes viruses in infectious and somatic pathology of children (n = 770 using the complex of methods of laboratory diagnostics. Determined the leading etiological role of HSV in children with neuroinfections (12,7% during primary infection and in children with intrauterine infection (29,0% during its reactivation. It is shown that in 50,9% of cases, the diagnosis of «infectious mononucleosis» confirmed by the detection of markers of acute EBV-infection, and 20,0%, it was replaced by mononucleotides syndrome was discovered markers of acute CMV-infection, and 18,1% — markers of acute HHV-6-infection. The role of HHV-6 as the primary etiologic agent of the disease is established at 36,3% of children admitted with convulsive syndrome on the background of febrile, at 29,1% — a sudden exanthema and 25,5% — with fever of unknown origin.  

  17. Diagnosis and Treatment of Pityriasis Rubra Pilaris

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    Kubanov Alexey

    2014-12-01

    Full Text Available The article deals with clinical diagnosis and treatment of pityriasis rubra pilaris (PRP. The authors analyze the diagnostic errors, present literature review, and their own observations. The clinical study included 23 patients with pityriasis rubra pilaris: 18 women and 5 men, average age of 54 ± 7.2. The clinical diagnosis of all examined patients was subsequently confirmed by histological analysis of the skin. The primary clinical diagnosis was psoriasis in 15 (65.2% patients, 6 (26% patients received treatment for toxic exanthema, and only 2 (8.8% patients were presumptively diagnosed with pityriasis rubra pilaris. In conclusion, pityriasis rubra pilaris was initially misdiagnosed in 91.2% of patients. Considering the great number of diagnostic errors, we analyzed the main diagnostic and differential diagnostic features of PRP. The most effective of all synthetic retinoids in PRP treatment is acitretin. Although symptomatic improvement in PRP occurs within a month, substantial improvement, even clearing is possible within 4 - 6 months.

  18. Paediatric Virology in the Hippocratic Corpus

    Science.gov (United States)

    Mammas, Ioannis N.; Spandidos, Demetrios A.

    2016-01-01

    Hippocrates (Island of Kos, 460 B.C.-Larissa, 370 B.C.) is the founder of the most famous Medical School of the classical antiquity. In acknowledgement of his pioneering contribution to the new scientific field of Paediatric Virology, this article provides a systematic analysis of the Hippocratic Corpus, with particular focus on viral infections predominating in neonates and children. A mumps epidemic, affecting the island of Thasos in the 5th century B.C., is described in detail. ‘Herpes’, a medical term derived from the ancient Greek word ‘ἕρπειν’, meaning ‘to creep’ or ‘crawl’, is used to describe the spreading of cutaneous lesions in both childhood and adulthood. Cases of children with exanthema ‘resembling mosquito bites’ are presented in reference to varicella or smallpox infection. A variety of upper and lower respiratory tract viral infections are described with impressive accuracy, including rhinitis, pharyngitis, tonsillitis, laryngitis, bronchiolitis and bronchitis. The ‘cough of Perinthos’ epidemic, an influenza-like outbreak in the 5th century B.C., is also recorded and several cases complicated with pneumonia or fatal outcomes are discussed. Hippocrates, moreover, describes conjunctivitis, otitis, lymphadenitis, meningoencephalitis, febrile convulsions, gastroenteritis, hepatitis, poliomyelitis and skin warts, along with proposed treatment directions. Almost 2,400 years later, Hippocrates' systematic approach and methodical innovations can inspire paediatric trainees and future Paediatric Virology subspecialists. PMID:27446241

  19. Intensive Care in a Patient with Toxic Epidermal Necrolysis

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    J. Wallenborn

    2017-01-01

    Full Text Available Toxic epidermal necrolysis (TEN is a serious adverse drug reaction with high lethality, which usually requires intensive-medical care. A 44-year-old man developed generalized exanthema with increasing exfoliation and mucosal involvement after taking allopurinol, ibuprofen, and etoricoxib. The clinical diagnosis of TEN was histologically confirmed. Prednisolone therapy with 3 mg/kg body weight (BW was not able to prevent further progress to finally 80% of the body surface, and infliximab 5 mg/kg BW was given as a single dose. This prevented further progression of the TEN. Despite marked improvement in skin findings, the ICU stay was prolonged by a complex analgosedation, transient kidney failure, volume management, positioning therapy, and vegetatively impeded weaning. Moreover, there was colonization with multiresistant bacteria (MRSA and VRE. Nonetheless, the patient could be restored to health and was released after four weeks. Infliximab seems to be effective in the treatment of TEN, especially in cases of rapid progression. Moreover, patients with TEN are difficult to handle in intensive-medical care, whereby attention should especially be paid to sufficient pain therapy, and the positioning of the patient is a particular challenge.

  20. Prevalence of Arbovirus Infections among Pregnant Women at a Maternity Hospital School

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    Maria das Neves Figueiroa

    2017-04-01

    Full Text Available Objective: Survey the prevalence of arbovirus infections among pregnant women provided with care at a maternity hospital school in Recife, Pernambuco, Brazil. Method: Descriptive, cross-sectional, retrospective, and quantitative study, carried out with data collected from the notification forms filled in during obstetric screening between August 2015 and July 2016. Results: Positive serology was found for arboviruses in 40.2% of the 103 suspected cases. Serology was not performed or it showed inconclusive results in 59.8% of the cases. Dengue fever occurred in 44% of the cases, chikungunya in 34%, and zika fever in 22%. Infections were more frequent among pregnant women over 20 years old, with low income and low schooling levels, living in Recife (48.5% and Olinda, Pernambuco, Brazil (24.3%. The most frequently mentioned symptoms were arthralgia (94%, exanthema (82%, and fever (78%. Infections occurred within the first trimester of pregnancy (54.5%, 63.3% of the pregnant women had to be hospitalized, and 45.4% of them did not undergo morphological ultrasonography. Most babies were born full-term and they had adequate weight. The prevalence of microcephaly was 9.7% when considering cases of arbovirose and 62.5% when considering specific cases of zika fever. Conclusion: The prevalence and repercussions of arboviruses justify the consolidation of actions to fight Aedes aegypti, as well as the effective deployment of clinical protocols and recommendations aimed at the mother and child care.

  1. Radiotherapy combined with Tegafur (FT-207s) for brain tumors

    International Nuclear Information System (INIS)

    Aoki, Yoshiro

    1981-01-01

    5-Fluorouracil (5-FU) has anti-tumor effects as an anti-metabolite, but it cannot pass the Blood-Brain-Barrier (BBB). FT-207 a masked-compound of 5-FU, is easily lipid soluble and is able to pass the BBB. Twenty eight patients of primary brain tumor and 8 patients of metastatic brain tumor were treated with irradiation combined with 750 mg of FT-207 suppository. Twenty four patients of primary brain tumor were treated only with irradiation as control. The mean survival time was 20.4 +- 11.8 months for the combined therapy group and 17.6 +- 8.6 months for the control. The concentration of FT-207 and 5-FU in serum and in cerebrospinal fluid (CSF) was investigated after administration of 750 mg of FT-207 suppository per annum. The maximum concentration of FT-207 and of 5-FU in serum was 20.4 +- 11.8 mcg/ml and 0.06 +- 0.02 mcg/ml, respectively. There were observed several side effects, such as anorexia, nausea, exanthema and etc. These side effects were not so great as to interrupt the therapy at the dose level of 750 mg of FT-207. However, at the dose of 1500 mg, one case showed disturbance of consciousness, to which attention should be called. (author)

  2. Drug-induced hypersensitivity syndrome with human herpesvirus-6 reactivation

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    Najeeba Riyaz

    2012-01-01

    Full Text Available A 45-year-old man, on carbamazepine for the past 3 months, was referred as a case of atypical measles. On examination, he had high-grade fever, generalized itchy rash, cough, vomiting and jaundice. A provisional diagnosis of drug hypersensitivity syndrome to carbamazepine was made with a differential diagnosis of viral exanthema with systemic complications. Laboratory investigations revealed leukocytosis with eosnophilia and elevated liver enzymes. Real-time multiplex polymerase chain reaction (PCR on throat swab and blood was suggestive of human herpesvirus-6 (HHV-6. Measles was ruled out by PCR and serology. The diagnosis of drug-induced hypersensitivity syndrome (DIHS was confirmed, which could explain all the features manifested by the patient. HHV-6 infects almost all humans by age 2 years. It infects and replicates in CD4 T lymphocytes and establishes latency in human peripheral blood monocytes or macrophages and early bone marrow progenitors. In DIHS, allergic reaction to the causative drug stimulates T cells, which leads to reactivation of the herpesvirus genome. DIHS is treated by withdrawal of the culprit drug and administration of systemic steroids. Our patient responded well to steroids and HHV-6 was negative on repeat real-time multiplex PCR at the end of treatment.

  3. [Rocky Mountain spotted fever in an American tourist].

    Science.gov (United States)

    de Pender, A M G; Bauer, A G C; van Genderen, P J J

    2005-04-02

    In a 28-year-old male American tourist who presented in the hospital with fever, cold shivers, headache, nausea, myalgia and arthralgia, Rocky Mountain spotted fever was suspected, partly because he came from an endemic region (the state of Georgia). The patient was treated with doxycycline, 100 mg b.i.d.; 9 days after the first appearance of the symptoms, the diagnosis was confirmed by the report of a positive antibody titre against Rickettsia rickettsii. The patient did not have exanthema. He was discharged in good general condition after two weeks of treatment. Rocky Mountain spotted fever, caused by the Gram-negative bacterium R. rickettsii, is a serious rickettsiosis. The disease is seen only sporadically in the Netherlands because the ticks in the Netherlands do not carry the bacterium. The travel history is still not a standard component of the anamnesis and is therefore often forgotten. This can lead to under-diagnosis and delayed treatment of diseases that were formerly limited to the continent. The early recognition and treatment of Rocky Mountain spotted fever is important since delayed treatment is associated with a clear increase in both morbidity and mortality.

  4. An Updated Review of the Molecular Mechanisms in Drug Hypersensitivity

    Science.gov (United States)

    Abe, Riichiro; Pan, Ren-You; Wang, Chuang-Wei

    2018-01-01

    Drug hypersensitivity may manifest ranging from milder skin reactions (e.g., maculopapular exanthema and urticaria) to severe systemic reactions, such as anaphylaxis, drug reactions with eosinophilia and systemic symptoms (DRESS)/drug-induced hypersensitivity syndrome (DIHS), or Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). Current pharmacogenomic studies have made important strides in the prevention of some drug hypersensitivity through the identification of relevant genetic variants, particularly for genes encoding drug-metabolizing enzymes and human leukocyte antigens (HLAs). The associations identified by these studies are usually drug, phenotype, and ethnic specific. The drug presentation models that explain how small drug antigens might interact with HLA and T cell receptor (TCR) molecules in drug hypersensitivity include the hapten theory, the p-i concept, the altered peptide repertoire model, and the altered TCR repertoire model. The broad spectrum of clinical manifestations of drug hypersensitivity involving different drugs, as well as the various pathomechanisms involved, makes the diagnosis and management of it more challenging. This review highlights recent advances in our understanding of the predisposing factors, immune mechanisms, pathogenesis, diagnostic tools, and therapeutic approaches for drug hypersensitivity. PMID:29651444

  5. Different patterns of skin manifestations associated with parvovirus B19 primary infection in adults.

    Science.gov (United States)

    Mage, Valentia; Lipsker, Dan; Barbarot, Sébastien; Bessis, Didier; Chosidow, Olivier; Del Giudice, Pascal; Aractingi, Sélim; Avouac, Jérôme; Bernier, Claire; Descamps, Vincent; Dupin, Nicolas

    2014-07-01

    Skin involvement is reported during primary parvovirus B19 infection in adults. We sought to describe the cutaneous presentations associated with parvovirus B19 primary infection in adults. We conducted a descriptive, retrospective, multicenter study. The patients included (>18 years old) had well-established primary infections with parvovirus B19. Twenty-nine patients were identified between 1992 and 2013 (17 women, 12 men). The elementary dermatologic lesions were mostly erythematous (86%) and often purpuric (69%). Pruritus was reported in 48% of cases. The rash predominated on the legs (93%), trunk (55%), and arms (45%), with a lower frequency of facial involvement (20%). Four different but sometimes overlapping patterns were identified (45%): exanthema, which was reticulated and annular in some cases (80%); the gloves-and-socks pattern (24%); the periflexural pattern (28%); and palpable purpura (24%). The limitations of this study were its retrospective design and possible recruitment bias in tertiary care centers. Our findings suggest that primary parvovirus B19 infection is associated with polymorphous skin manifestations with 4 predominant, sometimes overlapping, patterns. The acral or periflexural distribution of the rash and the presence of purpuric or annular/reticulate lesions are highly suggestive of parvovirus B19 infection. Copyright © 2014 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  6. Parvovirus B19 infections in state of Rio de Janeiro, Brasil: 526 sera analyzed by IgM-enzyme-linked immunosorbent assay and polymerase chain reaction

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    MCL Mendonça

    2005-12-01

    Full Text Available In this study were analyzed 526 sera; the patients aged from two days to 65 years old presenting exanthema, which was the most frequent symptom observed, besides fever, adenomegaly, and arthralgia. These sera were negative by enzyme-linked immunosorbent assay (IgM-ELISA for either rubella (495, toxoplasma (41, cytomegalovirus (12, measles (40, dengue (56, and they were submitted to nested polymerase chain reaction (PCR for B19 DNA and commercial IgM-ELISA for B19. In 39 abortion cases, IgM or DNA were not detected, therefore they were not took into account for analysis. Specific DNA and IgM were detected respectively in 71 (14.5% and IgM in 62 (12.7% sera from 487 sera analyzed. IgM and DNA were simultaneously detected in 43 (8.8%, while agreement among the results by PCR and IgM-ELISA was observed in 440 (90.4%. The sera were collected from January 1999 to December 2000, most of them in 1999 (325, during winter and spring. The major number of clinical cases was observed in the age group from one to ten years old. IgM or DNA were detected in 23 from 51 municipal districts of the state of Rio de Janeiro, where the samples were collected.

  7. Optimization of the Sybr Green real time PCR for the detection of Human Herpes Virus type 6 (HHV-6 Otimização da PCR em tempo real - Sybr Green para detecção do Herpes Vírus Humano tipo 6 (HHV-6

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    Cynthia Liliane Motta do Canto

    2008-02-01

    Full Text Available HHV-6 is the etiological agent of Exanthem subitum which is considered the sixth most frequent disease in infancy. In immuno-compromised hosts, reactivation of latent HHV-6 infection may cause severe acute disease. We developed a Sybr Green Real Time PCR for HHV-6 and compared the results with nested conventional PCR. A 214 pb PCR derived fragment was cloned using pGEM-T easy from Promega system. Subsequently, serial dilutions were made in a pool of negative leucocytes from 10-6 ng/µL (equivalent to 2465.8 molecules/µL to 10-9 (equivalent to 2.46 molecules/µL. Dilutions of the plasmid were amplified by Sybr Green Real Time PCR, using primers HHV3 (5' TTG TGC GGG TCC GTT CCC ATC ATA 3'and HHV4 (5' TCG GGA TAG AAA AAC CTA ATC CCT 3' and by conventional nested PCR using primers HHV1 (outer: 5'CAA TGC TTT TCT AGC CGC CTC TTC 3'; HHV2 (outer: 5' ACA TCT ATA ATT TTA GAC GAT CCC 3'; HHV3 (inner and HHV4 (inner 3'. The detection threshold was determined by plasmid serial dilutions. Threshold for Sybr Green real time PCR was 24.6 molecules/µL and for the nested PCR was 2.46 molecules/µL. We chose the Real Time PCR for diagnosing and quantifying HHV-6 DNA from samples using the new Sybr Green chemistry due to its sensitivity and lower risk of contamination.HHV-6 é o agente etiológico do Exantema Súbito e considerado a sexta doença mais comum na infância. Em indivíduos imunocomprometidos, a reativação da infecção latente pode causar doença aguda ou morte. Padronizamos PCR em Tempo Real utilizando a química Sybr Green na detecção do HHV-6 e comparamos os resultados com a PCR convencional. Um fragmento de 214 pb foi clonado através do kit pGEM-T do sistema Promega. Com este clone, foram feitas diluições seriadas em um pool de leucócitos negativos a partir de 10-6 ng/µL (equivalente a 2465,8 moleculas/µL até 10-9 (equivalente a 2,46 moleculas/µL. As diluições foram amplificadas por PCR em Tempo Real utilizando Sybr Green, com

  8. Reações cutâneas desencadeadas por drogas Skin reactions to drugs

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    Maria Regina Cavariani Silvares

    2008-06-01

    of adverse drug reactions was confirmed in 121 patients. Forty-three patients were included in the study; 51.2% were females and 86% were caucasians. A total of 48.8% were on one drug only. Antibiotics were the most commonly used drug (20% and accounted for 33% of the drug eruptions. The second group comprised anti-inflammatory drugs (16.7%, followed by anticonvulsants (13%, analgesic/antipyretic (13% agents. Skin eruption manifested as maculopapular exanthema in 41.9% patients, erythrodermia in 25.6%, and urticaria in 23.3%. CONCLUSION: Maculopapular exanthema was the main type of skin reaction triggered by use of drugs, and these reactions were most frequently caused by antibiotics.

  9. Common allergies do not influence the prevalence of cutaneous hypersensitivity reactions to antiepileptic drugs.

    Science.gov (United States)

    Bosak, Magdalena; Porębski, Grzegorz; Słowik, Agnieszka; Turaj, Wojciech

    2017-09-01

    The aim of the study was to establish whether the presence of common allergies increases the risk of drug-related hypersensitivity reactions among patients with epilepsy treated with antiepileptic drugs (AEDs). We studied 753 patients with epilepsy seen in tertiary outpatient epilepsy clinic. We obtained data related to epilepsy type, past and ongoing treatment with AEDs, occurrence of maculopapular exanthema or more serious cutaneous adverse reactions (Stevens-Johnson syndrome - SJS) and their characteristics. We noted an occurrence of allergic reactions unrelated to treatment with AED, including rash unrelated to AED, bronchial asthma, persistent or seasonal allergic rhinitis, atopic dermatitis, rash after specific food and other allergic reactions. There were 61 cases of AED-related cutaneous hypersensitivity reaction (including 3 cases of SJS) noted in association with 2319 exposures to AEDs (2.63%) among 55 out of 753 patients (7.3%). Cutaneous hypersensitivity reaction to AED was most commonly noted after lamotrigine (12.1%), carbamazepine (5.4%) and oxcarbazepine (4.1%). Prevalence of allergic reactions unrelated to AED was similar between patients with and without AED-related cutaneous hypersensitivity reaction (rash unrelated to AED: 16.4% vs. 10.2%; bronchial asthma: 1.8% vs. 0.1%; persistent allergic rhinitis: 7.3% vs. 10.2%; seasonal allergic rhinitis: 7.3% vs. 11.7%; atopic dermatitis: 0 vs. 0.7%; rash after specific food: 5.4% vs. 6.4%; other allergic reactions: 5.4% vs. 5.2%, respectively; P>0.1 for each difference). Presence of common allergies is not a significant risk factor for AED-related cutaneous hypersensitivity reaction among patients with epilepsy. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Purification and characterization of enterovirus 71 viral particles produced from vero cells grown in a serum-free microcarrier bioreactor system.

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    Chia-Chyi Liu

    Full Text Available BACKGROUND: Enterovirus 71 (EV71 infections manifest most commonly as a childhood exanthema known as hand-foot-and-mouth disease (HFMD and can cause neurological disease during acute infection. PRINCIPAL FINDING: In this study, we describe the production, purification and characterization of EV71 virus produced from Vero cells grown in a five-liter serum-free bioreactor system containing 5 g/L Cytodex 1 microcarrier. The viral titer was >10(6 TCID(50/mL by 6 days post infection when a MOI of 10(-5 was used at the initial infection. Two EV71 virus fractions were separated and detected when the harvested EV71 virus concentrate was purified by sucrose gradient zonal ultracentrifugation. The EV71 viral particles detected in the 24-28% sucrose fractions had an icosahedral structure 30-31 nm in diameter and had low viral infectivity and RNA content. Three major viral proteins (VP0, VP1 and VP3 were observed by SDS-PAGE. The EV71 viral particles detected in the fractions containing 35-38% sucrose were 33-35 nm in size, had high viral infectivity and RNA content, and were composed of four viral proteins (VP1, VP2, VP3 and VP4, as shown by SDS-PAGE analyses. The two virus fractions were formalin-inactivated and induced high virus neutralizing antibody responses in mouse immunogenicity studies. Both mouse antisera recognized the immunodominant linear neutralization epitope of VP1 (residues 211-225. CONCLUSION: These results provide important information for cell-based EV71 vaccine development, particularly for the preparation of working standards for viral antigen quantification.

  11. Functional changes of dendritic cells in hypersensivity reactions to amoxicillin

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    C.M.F. Lima

    2010-10-01

    Full Text Available A better understanding of dendritic cell (DC involvement in responses to haptenic drugs is needed, because it represents a possible approach to the development of an in vitro test, which could identify patients prone to drug allergies. There are two main DC subsets: plasmacytoid DC (pDC and myeloid DC (mDC. β-lactams form hapten-carrier conjugates and may provide a suitable model to study DC behavior in drug allergy reactions. It has been demonstrated that drugs interact differently with DC in drug allergic and non-allergic patients, but there are no studies regarding these subsets. Our aim was to assess the functional changes of mDC and pDC harvested from an amoxicillin-hypersensitive 32-year-old woman who experienced a severe maculopapular exanthema as reflected in interleukin-6 (IL-6 production after stimulation with this drug and penicillin. We also aim to demonstrate, for the first time, the feasibility of this method for dendritic cell isolation followed by in vitro stimulation for studies of drug allergy physiopathology. DC were harvested using a double Percoll density gradient, which generates a basophil-depleted cell (BDC suspension. Further, pDC were isolated by blood DC antigen 4-positive magnetic selection and gravity filtration through magnetized columns. After stimulation with amoxicillin, penicillin and positive and negative controls, IL-6 production was measured by ELISA. A positive dose-response curve for IL-6 after stimulation with amoxicillin and penicillin was observed for pDC, but not for mDC or BDC suspension. These preliminary results demonstrate the feasibility of this methodology to expand the knowledge of the effect of dendritic cell activation by drug allergens.

  12. Viroses confundíveis com febre aftosa Viral diseases to be differentiated from foot-and-mouth disease

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    Franklin Riet-Correa

    1996-08-01

    Full Text Available Revisam-se as doenças que devem ser consideradas no diagnóstico diferencial de febre aftosa. Dentre as doenças vesiculares ou erosivas, descrevem-se os principais aspectos relacionados ao diagnóstico da estomatite vesicular, diarréia viral bovina, febre catarral maligna, infecções por herpesvírus bovino 1 e 5, e uma estomatite ulcerativa associada a parvovírus bovino, que ocorreu no Rio Grande do Sul; língua azul, para a qual tem sido detectados anticorpos em bovinos e ovinos do Rio Grande do Sul; mamilite herpética que ocorre em outros Estados do País;peste bovina, que foi diagnosticada e erradicada no Estado de São Paulo em 1921; estomatite popular; e duas doenças exóticas:exantema vesicular e doença vesicular do suíno.Diseases to be considered in the differential diagnosis of foot-and-mouth disease are reviewed. The main aspects relating to the diagnosis of vesicular stomatitis, bovine virus diarrhea, malignant catarrhal fever, bovine herpesvirus 1 and 5, andem ulcerative stomatitis associated with bovine parvovirus are described. Bluetongue, that probably occurs in Rio Grande do Sul because antibodies to the virus have been detected in cattle and sheep; is refered. Bovine ulcerative mammilitis, reported in other Brazilian States, rinderpest, reported and eradicated in the State of São Paulo in 1921, and popular stomatitis are also cited, and so are two exotic diseases: vesicular exanthema and swine vesicular disease.

  13. Diagnostic evaluation of a multiplexed RT-PCR microsphere array assay for the detection of foot-and-mouth disease virus and look-alike disease viruses

    Energy Technology Data Exchange (ETDEWEB)

    Hindson, B J; Reid, S M; Baker, B R; Ebert, K; Ferris, N P; Bentley Tammero, L F; Lenhoff, R J; Naraghi-Arani, P; Vitalis, E A; Slezak, T R; Hullinger, P J; King, D P

    2007-07-26

    A high-throughput multiplexed assay was developed for the differential laboratory diagnosis of foot-and-mouth disease virus (FMDV) from viruses which cause clinically similar diseases of livestock. This assay simultaneously screens for five RNA and two DNA viruses using multiplexed reverse transcription PCR (mRT-PCR) amplification coupled with a microsphere hybridization array and flow-cytometric detection. Two of the seventeen primer-probe sets included in this multiplex assay were adopted from previously characterized real-time RT-PCR (rRT-PCR) assays for FMDV. The diagnostic accuracy of the mRT-PCR was evaluated using 287 field samples, including 248 (true positive n= 213, true negative n=34) from suspect cases of foot-and-mouth disease collected from 65 countries between 1965 and 2006 and 39 true negative samples collected from healthy animals. The mRT-PCR assay results were compared with two singleplex rRT-PCR assays, using virus isolation with antigen-ELISA as the reference method. The diagnostic sensitivity of the mRT-PCR assay for FMDV was 93.9% [95% C.I. 89.8-96.4%], compared to 98.1% [95% C.I. 95.3-99.3%] for the two singleplex rRT-PCR assays used in combination. In addition, the assay could reliably differentiate between FMDV and other vesicular viruses such as swine vesicular disease virus and vesicular exanthema of swine virus. Interestingly, the mRT-PCR detected parapoxvirus (n=2) and bovine viral diarrhea virus (n=2) in clinical samples, demonstrating the screening potential of this mRT-PCR assay to identify viruses in FMDV-negative material not previously recognized using focused single-target rRT-PCR assays.

  14. Report from Mongolia – How much do we know about the incidence of rare cases in less developed countries: a case series

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    Dünser Martin W

    2008-11-01

    Full Text Available Abstract Introduction Case reports are important instruments to describe rare disease conditions and give a rough estimation of their global incidence. Even though collected in international databases, most case reports are published by clinicians from industrialized nations and little is known about the incidence of rare cases in less developed countries, which are home to 75% of the world's population. Case presentation We present seven patients who suffered from diseases which are either considered to be rare or have not yet been described before according to international databases, but occurred during a 5-month period in one intensive care unit of a less developed country. During the observation period, patients with a spontaneous infratentorial subdural hematoma (Asian, female, 41 years, general exanthema and acute renal failure after diesel ingestion (Asian, male, 30 years, transient cortical blindness complicating hepatic encephalopathy (Asian, female, 49 years, Fournier gangrene complicating acute necrotizing pancreatitis (Asian, male, 37 years, acute renal failure due to acetic acid intoxication (Asian, male, 42 years, haemolytic uremic syndrome following septic abortion (Asian, female, 45 years, and a metal needle as an unusual cause of chest pain (Asian, male, 41 years were treated. According to the current literature, all seven disease conditions are considered either rare or have so far not yet been reported. Conclusion The global incidence of rare cases may be underestimated by contemporary international databases. Diseases which are currently considered to be rare in industrialized nations may occur at a higher frequency in less developed countries. Reasons may not only be a geographically different burden of certain diseases, limited diagnostic and therapeutic facilities, but also a relevant publication bias.

  15. Survival of viral pathogens in animal feed ingredients under transboundary shipping models

    Science.gov (United States)

    Bauermann, Fernando V.; Niederwerder, Megan C.; Singrey, Aaron; Clement, Travis; de Lima, Marcelo; Long, Craig; Patterson, Gilbert; Sheahan, Maureen A.; Stoian, Ana M. M.; Petrovan, Vlad; Jones, Cassandra K.; De Jong, Jon; Ji, Ju; Spronk, Gordon D.; Minion, Luke; Christopher-Hennings, Jane; Zimmerman, Jeff J.; Rowland, Raymond R. R.; Nelson, Eric; Sundberg, Paul; Diel, Diego G.

    2018-01-01

    The goal of this study was to evaluate survival of important viral pathogens of livestock in animal feed ingredients imported daily into the United States under simulated transboundary conditions. Eleven viruses were selected based on global significance and impact to the livestock industry, including Foot and Mouth Disease Virus (FMDV), Classical Swine Fever Virus (CSFV), African Swine Fever Virus (ASFV), Influenza A Virus of Swine (IAV-S), Pseudorabies virus (PRV), Nipah Virus (NiV), Porcine Reproductive and Respiratory Syndrome Virus (PRRSV), Swine Vesicular Disease Virus (SVDV), Vesicular Stomatitis Virus (VSV), Porcine Circovirus Type 2 (PCV2) and Vesicular Exanthema of Swine Virus (VESV). Surrogate viruses with similar genetic and physical properties were used for 6 viruses. Surrogates belonged to the same virus families as target pathogens, and included Senecavirus A (SVA) for FMDV, Bovine Viral Diarrhea Virus (BVDV) for CSFV, Bovine Herpesvirus Type 1 (BHV-1) for PRV, Canine Distemper Virus (CDV) for NiV, Porcine Sapelovirus (PSV) for SVDV and Feline Calicivirus (FCV) for VESV. For the remaining target viruses, actual pathogens were used. Virus survival was evaluated using Trans-Pacific or Trans-Atlantic transboundary models involving representative feed ingredients, transport times and environmental conditions, with samples tested by PCR, VI and/or swine bioassay. SVA (representing FMDV), FCV (representing VESV), BHV-1 (representing PRV), PRRSV, PSV (representing SVDV), ASFV and PCV2 maintained infectivity during transport, while BVDV (representing CSFV), VSV, CDV (representing NiV) and IAV-S did not. Notably, more viruses survived in conventional soybean meal, lysine hydrochloride, choline chloride, vitamin D and pork sausage casings. These results support published data on transboundary risk of PEDV in feed, demonstrate survival of certain viruses in specific feed ingredients (“high-risk combinations”) under conditions simulating transport between

  16. Genome-wide comparison of cowpox viruses reveals a new clade related to Variola virus.

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    Piotr Wojtek Dabrowski

    Full Text Available Zoonotic infections caused by several orthopoxviruses (OPV like monkeypox virus or vaccinia virus have a significant impact on human health. In Europe, the number of diagnosed infections with cowpox viruses (CPXV is increasing in animals as well as in humans. CPXV used to be enzootic in cattle; however, such infections were not being diagnosed over the last decades. Instead, individual cases of cowpox are being found in cats or exotic zoo animals that transmit the infection to humans. Both animals and humans reveal local exanthema on arms and legs or on the face. Although cowpox is generally regarded as a self-limiting disease, immunosuppressed patients can develop a lethal systemic disease resembling smallpox. To date, only limited information on the complex and, compared to other OPV, sparsely conserved CPXV genomes is available. Since CPXV displays the widest host range of all OPV known, it seems important to comprehend the genetic repertoire of CPXV which in turn may help elucidate specific mechanisms of CPXV pathogenesis and origin. Therefore, 22 genomes of independent CPXV strains from clinical cases, involving ten humans, four rats, two cats, two jaguarundis, one beaver, one elephant, one marah and one mongoose, were sequenced by using massive parallel pyrosequencing. The extensive phylogenetic analysis showed that the CPXV strains sequenced clearly cluster into several distinct clades, some of which are closely related to Vaccinia viruses while others represent different clades in a CPXV cluster. Particularly one CPXV clade is more closely related to Camelpox virus, Taterapox virus and Variola virus than to any other known OPV. These results support and extend recent data from other groups who postulate that CPXV does not form a monophyletic clade and should be divided into multiple lineages.

  17. The Complete Chloroplast Genome of Ye-Xing-Ba (Scrophularia dentata; Scrophulariaceae), an Alpine Tibetan Herb.

    Science.gov (United States)

    Ni, Lianghong; Zhao, Zhili; Dorje, Gaawe; Ma, Mi

    2016-01-01

    Scrophularia dentata is an important Tibetan medicinal plant and traditionally used for the treatment of exanthema and fever in Traditional Tibetan Medicine (TTM). However, there is little sequence and genomic information available for S. dentata. In this paper, we report the complete chloroplast genome sequence of S. dentata and it is the first sequenced member of the Sect. Tomiophyllum within Scrophularia (Scrophulariaceae). The gene order and organization of the chloroplast genome of S. dentata are similar to other Lamiales chloroplast genomes. The plastome is 152,553 bp in length and includes a pair of inverted repeats (IRs) of 25,523 bp that separate a large single copy (LSC) region of 84,058 bp and a small single copy (SSC) region of 17,449 bp. It has 38.0% GC content and includes 114 unique genes, of which 80 are protein-coding, 30 are transfer RNA, and 4 are ribosomal RNA. Also, it contains 21 forward repeats, 19 palindrome repeats and 41 simple sequence repeats (SSRs). The repeats and SSRs within S. dentata were compared with those of S. takesimensis and present certain discrepancies. The chloroplast genome of S. dentata was compared with other five publicly available Lamiales genomes from different families. All the coding regions and non-coding regions (introns and intergenic spacers) within the six chloroplast genomes have been extracted and analysed. Furthermore, the genome divergent hotspot regions were identified. Our studies could provide basic data for the alpine medicinal species conservation and molecular phylogenetic researches of Scrophulariaceae and Lamiales.

  18. The Complete Chloroplast Genome of Ye-Xing-Ba (Scrophularia dentata; Scrophulariaceae, an Alpine Tibetan Herb.

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    Lianghong Ni

    Full Text Available Scrophularia dentata is an important Tibetan medicinal plant and traditionally used for the treatment of exanthema and fever in Traditional Tibetan Medicine (TTM. However, there is little sequence and genomic information available for S. dentata. In this paper, we report the complete chloroplast genome sequence of S. dentata and it is the first sequenced member of the Sect. Tomiophyllum within Scrophularia (Scrophulariaceae. The gene order and organization of the chloroplast genome of S. dentata are similar to other Lamiales chloroplast genomes. The plastome is 152,553 bp in length and includes a pair of inverted repeats (IRs of 25,523 bp that separate a large single copy (LSC region of 84,058 bp and a small single copy (SSC region of 17,449 bp. It has 38.0% GC content and includes 114 unique genes, of which 80 are protein-coding, 30 are transfer RNA, and 4 are ribosomal RNA. Also, it contains 21 forward repeats, 19 palindrome repeats and 41 simple sequence repeats (SSRs. The repeats and SSRs within S. dentata were compared with those of S. takesimensis and present certain discrepancies. The chloroplast genome of S. dentata was compared with other five publicly available Lamiales genomes from different families. All the coding regions and non-coding regions (introns and intergenic spacers within the six chloroplast genomes have been extracted and analysed. Furthermore, the genome divergent hotspot regions were identified. Our studies could provide basic data for the alpine medicinal species conservation and molecular phylogenetic researches of Scrophulariaceae and Lamiales.

  19. Clinical features and phylogenetic analysis of Coxsackievirus A9 in Northern Taiwan in 2011

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    Huang Yi-Chuan

    2013-01-01

    Full Text Available Abstract Background Coxsackievirus A9 (CA9 was one of the most prevalent serotype of enteroviral infections in Taiwan in 2011. After several patient series were reported in the 1960s and 1970s, few studies have focused on the clinical manifestations of CA9 infections. Our study explores and deepens the current understanding of CA9. Methods We analyzed the clinical presentations of 100 culture-proven CA9-infected patients in 2011 by reviewing their medical records and depicted the CA9 phylogenetic tree. Results Of the 100 patients with culture-proven CA9 infections, the mean (SD age was 4.6 (3.4 years and the male to female ratio was 1.9. For clinical manifestations, 96 patients (96% had fever and the mean (SD duration of fever was 5.9 (3.4 days. Sixty one patients (61% developed a skin rash, and the predominant pattern was a generalized non-itchy maculopapular rash without vesicular changes. While most patients showed injected throat, oral ulcers were found in only 19 cases (19%, among whom, 6 were diagnosed as herpangina. Complicated cases included: aseptic meningitis (n=8, bronchopneumonia (n=6, acute cerebellitis (n=1, and polio-like syndrome (n=1. Phylogenetic analysis for current CA9 strains is closest to the CA9 isolate 27-YN-2008 from the border area of mainland China and Myanmar. Conclusions The most common feature of CA9 during the 2011 epidemic in Taiwan is generalized febrile exanthema rather than herpangina or hand, foot, and mouth disease. Given that prolonged fever and some complications are possible, caution should be advised in assessing patients as well as in predicting the clinical course.

  20. DENGUE, CHIKUNGUNYA AND ZIKA INFECTIONS IMPORTED TO PARIS BETWEEN 2009 AND 2016: CHARACTERISTICS AND CORRELATION WITH OUTBREAKS IN THE FRENCH OVERSEAS TERRITORIES OF GUADELOUPE AND MARTINIQUE.

    Science.gov (United States)

    Vasquez, Victor; Haddad, Elie; Perignon, Alice; Jaureguiberry, Stéphane; Brichler, Ségolène; Leparc-Goffart, Isabelle; Caumes, Eric

    2018-05-18

    Dengue (DV), chikungunya (CV) and Zika virus (ZV) infections are rapidly expanding across countries and diagnosed in returned travelers who represent epidemiological sentinels. French Territories of America (FTA) such as Guadeloupe and Martinique are highly touristic places and have experienced three consecutive outbreaks by such viruses in the last decade. We evaluated how ill returned travelers could be deemed as epidemiological sentinels for these three expanding arboviral diseases during eight consecutive years. We estimated the degree of correlation between the cases of ill returned travelers arriving at our hospital and the three outbreaks that occurred in the FTA during the study period. We included all consecutive ill returned travelers diagnosed at a French tertiary hospital in Paris with imported DV, CV or ZV infections from January 2009 to December 2016. Epidemiological and clinical variables were evaluated. Data concerning the incidence of arboviruses in the FTA, and the temporal relationship between the occurrence of imported cases and outbreaks in FTA were analyzed. Overall, 320 cases of arboviral infections with 216 DV, 68 CV and 36 ZV were reported. Most of the patients presented with fever and exanthema. 115 patients were exposed in Guadeloupe or Martinique which were the at-risk destination in 25% of patients with DV, 59% patients with CV, and 58% patients with ZV. The occurrence of cases diagnosed in returning travelers followed the same time pattern as the outbreaks in these areas. We found a temporal correlation between newly diagnosed imported cases of arboviruses, and the three corresponding outbreaks that occurred in Martinique and Guadeloupe during 8 consecutive years. We show that ill returned travelers act as epidemiological sentinels from the beginning up to the end of outbreaks occurring in touristic places. Copyright © 2018. Published by Elsevier Ltd.

  1. Prevalence and genotypic characterization of Human Parvovirus B19 in children with measles- and rubella-like illness in Iran.

    Science.gov (United States)

    Rezaei, Farhad; Sarshari, Behrang; Ghavami, Nastaran; Meysami, Parisa; Shadab, Azadeh; Salimi, Hamid; Mokhtari-Azad, Talat

    2016-06-01

    Human Parvovirus B19 (B19V) is a prototype of the Erythroparvovirus genus in Parvoviridae family. B19V infections are often associated with fever and rash, and can be mistakenly reported as measles or rubella. Differential diagnosis of B19V illness is necessary for case management and also for public health control activities, particularly in outbreak situations in which measles or rubella is suspected. To investigate the causative role of B19V infection in children with measles- and rubella-like illness, a total of 583 sera from children with exanthema were tested for presence of B19V by determining anti-B19V IgG and IgM antibodies by ELISA as well as B19V DNA detection by nested PCR. DNA positive samples were assessed further for determination of viral load and sequence analysis by Real-Time PCR and Sanger sequencing method, respectively. Out of 583 patients, 112 (19.21%) patients were positive for B19V-IgM antibody, 110 (18.87%) were positive for B19V-IgG antibody, and 63 (10.81%) were positive for B19V viral DNA. The frequency of B19V-IgG antibodies were increased with age; that is children under 6 year old showed 7.11% seroprevalence for B19V-IgG as compared to 18.39% and 28.91% for age groups 6 to >11 and 11-14 years old, respectively. Phylogenetic analysis of the NS1-VPu1 overlapping region revealed that all sequenced B19V-DNA belonged to genotype 1. The results of this study may aid the surveillance programs aiming at eradicating measles/rubella virus in Iran, as infections with B19V can be mistakenly reported as measles or rubella if laboratory testing is not conducted. © 2015 Wiley Periodicals, Inc.

  2. Clinical experiences with the radiosensitizer Misonidazol

    International Nuclear Information System (INIS)

    Bamberg, M.; Scherer, C.; Tamulevicius, P.; Streffer, C.

    1981-01-01

    The principle of action of sensitizers with electron affinity is explained and the development of these radiosensitizing substances up to the clinical of Misonidazol (MIS; Ro-07-0582) is shown. With special regard to the pharmacokinetic action of this substance, the therapeutic effects of MIS were examined in ten patients with brain tumors of high malignancy (400 mg/m 2 ) and four patients with oesophageal carcinomas (1 g/m 2 ), all these patients having reached the clinical phase III. Four other patients with recurrent brain tumors received a dose of 1 g/m 2 of MIS before each irradiation. Apart from slight neurotoxic and gastrointestinal side effects, the applicated doses of MIS were generally well tolerated. Only in one case a generalized maculopapular exanthema developed which regressed completely within few days. No correlation could be found between the subjective side effects and the plasma values determined by means of high pressure liquid chromatography (HPLC). After one to four hours following oral application, the maximum plasma concentrations were measured, the half-life (T 1/2) varying in all patients between five and ten hours. It was not possible to demonstrate an influence of dexamethasone on the plasma concentration of half-life of MIS in the brain tumor patients. The cerebrospinal fluid concentrations of MIS which may be used as an index for the concentrations in brain tumors, are closely correlated with the corresponding plasma values. There was no correlation between MIS concentrations in plasma and saliva, so that the determination of MIS in the saliva cannot be recommended as a routine method for control examinations. (orig.) [de

  3. RASopathic skin eruptions during vemurafenib therapy.

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    Jeannine D Rinderknecht

    Full Text Available Vemurafenib is a potent inhibitor of V600 mutant BRAF with significant impact on progression-free and overall survival in advanced melanoma. Cutaneous side effects are frequent. This single-center observational study investigates clinical and histological features of these class-specific cutaneous adverse reactions.Patients were all treated with Vemurafenib 960 mg b.i.d. within local ethic committees approved clinical trials. All skin reactions were collected and documented prospectively. Cutaneous reactions were classified by reaction pattern as phototoxic and inflammatory, hair and nail changes, keratinocytic proliferations and melanocytic disorders.Vemurafenib was well tolerated, only in two patients the dose had to be reduced to 720 mg due to arthralgia. 26/28 patients (93% experienced cutaneous side effects. Observed side effects included UVA dependent photosensitivity (n = 16, maculopapular exanthema (n = 14, pruritus (n = 8, folliculitis (n = 5, burning feet (n = 3, hair thinning (mild alopecia (n = 8, curly hair (n = 2 and nail changes (n = 2. Keratosis pilaris and acanthopapilloma were common skin reactions (n = 12/n = 13, as well as plantar hyperkeratosis (n = 4, keratoacanthoma (n = 5 and invasive squamous cell carcinoma (n = 4. One patient developed a second primary melanoma after more than 4 months of therapy (BRAF and RAS wild type.Vemurafenib has a broad and peculiar cutaneous side effect profile involving epidermis and adnexa overlapping with the cutaneous manifestations of genetic diseases characterized by activating germ line mutations of RAS (RASopathy. They must be distinguished from allergic drug reaction. Regular skin examination and management by experienced dermatologists as well as continuous prophylactic photo protection including an UVA optimized sun screen is mandatory.

  4. Rash after measles vaccination: laboratory analysis of cases reported in São Paulo, Brazil Exantema após vacinação do sarampo: análise laboratorial de casos notificados em São Paulo

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    Maria I Oliveira

    2002-04-01

    Full Text Available OBJECTIVE: The clinical differential diagnosis of rash due to viral infections is often difficult, and misdiagnosis is not rare, especially after the introduction of measles and rubella vaccination. A study to determine the etiological diagnosis of exanthema was carried out in a group of children after measles vaccination. METHODS: Sera collected from children with rash who received measles vaccine were reported in 1999. They were analyzed for IgM antibodies against measles virus, rubella virus, human parvovirus B19 (HPV B19 using ELISA commercial techniques, and human herpes virus 6 (HHV 6 using immunofluorescence commercial technique. Viremia for each of those viruses was tested using a polimerase chain reaction (PCR. RESULTS: A total of 17 cases of children with exanthema after measles immunization were reported in 1999. The children, aged 9 to 12 months (median 10 months, had a blood sample taken for laboratory analysis. The time between vaccination and the first rash signs varied from 1 to 60 days. The serological results of those 17 children suspected of measles or rubella infection showed the following etiological diagnosis: 17.6% (3 in 17 HPV B19 infection; 76.5% (13 in 17 HHV 6 infection; 5.9% (1 in 17 rash due to measles vaccine. CONCLUSIONS: The study data indicate that infection due to HPV B19 or HHV 6 can be misdiagnosed as exanthema due to measles vaccination. Therefore, it is important to better characterize the etiology of rash in order to avoid attributing it incorrectly to measles vaccine.OBJETIVO: O diagnóstico diferencial de doenças exantemáticas causadas por vírus é geralmente difícil, e equívocos não são raros, especialmente depois da introdução da vacina contra o sarampo e a rubéola. Um estudo laboratorial foi conduzido com o objetivo de estabelecer o diagnóstico etiológico de casos de exantema em crianças que receberam a vacina contra o sarampo. MÉTODOS: Soros de casos de exantema em crianças que

  5. Imported Zika Virus in a European City: How to Prevent Local Transmission?

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    Joan-Pau Millet

    2017-07-01

    Full Text Available Background: On February 1st 2016 the WHO declared the Zika Virus (ZIKV infection a worldwide public health emergency because of its rapid expansion and severe complications, such as Guillain-Barré Syndrome or microcephaly in newborn. The huge amount of people traveling to endemic areas and the presence of Aedes albopictus in Barcelona increase the risk of autochtonous transmission. The objective of this study was to describe the first ZIKV cases diagnosed in our city and to analyze the surveillance, prevention, and control measures implemented to avoid autochthonous transmission.Methods: An observational cross-sectional population-based study in Barcelona, Spain was performed.An analysis of the socio-demographic, epidemiological, clinical characteristics, and mosquito control activities of the ZIKV cases detected between January 1st and December 2016 was carried out using a specific ZIKV epidemiological survey of the Barcelona Public Health Agency.Results: A total of 118 notifications of possible ZIKV infections were received, and 44 corresponded to confirmed cases in Barcelona residents.Amongst these, the median age was 35 years and 57% were women. All cases were imported, 48% were Spanish-born and 52% foreign-born. Dominican Republic was the most visited country amongst foreign-born patients and Nicaragua amongst Spanish-born. The most frequent symptoms were exanthema, fever, and arthralgia. Among the 24 diagnosed women, 6 (25% were pregnant. There was one case of microcephaly outside Barcelona city. Entomological inspections were done at the homes of 19 cases (43.2% of the total and in 34 (77.3% public spaces. Vector activity was found in one case of the 44 confirmed cases, and 134 surveillance and vector control were carried out associated to imported ZIKV cases. In all cases prevention measures were recommended to avoid mosquito bites on infected cases.Conclusion: Epidemiological and entomological surveillance are essential for the

  6. Doença de Kawasaki Kawasaki disease

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    Patrícia Aparecida de Castro

    2009-08-01

    Full Text Available A doença de Kawasaki é vasculite sistêmica e aguda de etiologia desconhecida. Constitui a principal causa de doença cardíaca adquirida em crianças nos EUA. Ocorre mais frequentemente em meninos, 80% dos casos em crianças com menos de cinco anos, sendo rara após os oito anos. Pode atingir crianças de todas as raças, tendo maior incidência entre os descendentes asiáticos. Caracteriza-se por febre, conjuntivite bilateral não exsudativa, eritema e edema de língua, lábios e mucosa oral, alterações de extremidades, linfonodomegalia cervical, exantema polimórfico. Aneurismas e estenoses de artérias coronárias são comuns em percentual que varia de 20 a 25% dos pacientes não tratados, podendo posteriormente levar a infarto agudo do miocárdio e morte súbita. O tratamento com imunoglobulina intravenosa é efetivo e deve ser iniciado precocemente a fim de evitar sequelas cardíacas. O desenvolvimento de testes diagnósticos, terapêuticas mais específicas e a prevenção dessa doença potencialmente fatal em crianças dependem dos contínuos avanços na determinação de sua etiopatogenia.Kawasaki disease is a systemic acute vasculitis of unknown etiology. It is the leading cause of acquired heart disease in children in the USA. It occurs more frequently in boys and eighty percent of the cases occur in children under five years of age. The disease rarely occurs after eight years and it can affect children of all races, with higher incidence among Asian descendants. Kawasaki disease is characterized by fever, bilateral non-exudative conjunctivitis, redness and swelling of the tongue, lips and oral mucosa, abnormalities in the extremities, cervical lymph node, and polymorphic exanthema. Aneurysms and stenoses of coronary arteries occur in pproximately 20 to 25% of untreated patients and subsequently can lead to acute myocardial infarction and sudden death. Treatment with intravenous immunoglobulin is effective and should be initiated

  7. Association of HLA-A and HLA-B Alleles with Lamotrigine-Induced Cutaneous Adverse Drug Reactions in the Thai Population

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    Napatrupron Koomdee

    2017-11-01

    Full Text Available Background: Lamotrigine (LTG is commonly used for treatment of epilepsy and bipolar disorder. It is one of the common cause of cutaneous adverse drug reactions (CADR. Clinical symptoms of LTG-induced CADR range from maculopapular exanthema (MPE to severe cutaneous adverse reactions (SCAR. This study aimed to determine the association of the LTG-induced CADR with human leukocyte antigen (HLA alleles in Thai patients.Methods: Fifteen patients with LTG-induced CADR [10 MPE; 4 Stevens–Johnson syndrome; and 1 drug reaction with eosinophilia and systemic symptoms] and 50 LTG-tolerant controls were included in the study. HLA-A and HLA-B genotyping was performed using polymerase chain reaction-sequence-specific oligonucleotides probes.Results: The proportion of HLA-A∗02:07 and HLA-B∗15:02 allele carriers were significantly higher in the LTG-induced CADR group than in the tolerant controls [odds ratio (OR: 7.83; 95% confidence interval (CI: 1.60–38.25; P = 0.013, and OR: 4.89; 95% CI: 1.28–18.67; P = 0.014]. In addition, subjects with HLA-A∗33:03, HLA-B∗15:02, and HLA-B∗44:03 were significantly higher in the LTG-induced MPE group than in the tolerant controls (OR: 8.27; 95% CI: 1.83–37.41; P = 0.005, OR: 7.33; 95% CI: 1.63–33.02; P = 0.005; and OR: 10.29; 95% CI: 1.45–72.81; P = 0.029. In contrast to the LTG-induced MPE group, there were no significant differences between HLA alleles and LTG-induced SCAR group.Conclusion:HLA-A∗02:07 and HLA-B∗15:02 were associated with LTG-induced CADR in Thai patients. We also identified an association between HLA-A∗33:03, HLA-B∗15:02, and HLA-B∗44:03 and LTG-induced MPE in this population. These results suggest that these alleles could be useful screening markers for preventing CADR before LTG treatment in Thai patients, but further replication studies with larger sample sizes are needed.

  8. Absorption and retention of nickel from drinking water in relation to food intake and nickel sensitivity.

    Science.gov (United States)

    Nielsen, G D; Søderberg, U; Jørgensen, P J; Templeton, D M; Rasmussen, S N; Andersen, K E; Grandjean, P

    1999-01-01

    Two studies were performed to examine the influence of fasting and food intake on the absorption and retention of nickel added to drinking water and to determine if nickel sensitization played any role in this regard. First, eight nonallergic male volunteers fasted overnight before being given nickel in drinking water (12 micrograms Ni/kg) and, at different time intervals, standardized 1400-kJ portions of scrambled eggs. When nickel was ingested in water 30 min or 1 h prior to the meal, peak nickel concentrations in serum occurred 1 h after the water intake, and the peak was 13-fold higher than the one seen 1 h after simultaneous intake of nickel-containing water and scrambled eggs. In the latter case, a smaller, delayed peak occurred 3 h after the meal. Median urinary nickel excretion half-times varied between 19.9 and 26.7 h. Within 3 days, the amount of nickel excreted corresponded to 2.5% of the nickel ingested when it was mixed into the scrambled eggs. Increasing amounts were excreted as the interval between the water and the meal increased, with 25.8% of the administered dose being excreted when the eggs were served 4 h prior to the nickel-containing drinking water. In the second experiment, a stable nickel isotope, 61Ni, was given in drinking water to 20 nickel-sensitized women and 20 age-matched controls, both groups having vesicular hand eczema of the pompholyx type. Nine of 20 nickel allergic eczema patients experienced aggravation of hand eczema after nickel administration, and three also developed a maculopapular exanthema. No exacerbation was seen in the control group. The course of nickel absorption and excretion in the allergic groups did not differ and was similar to the pattern seen in the first study, although the absorption in the women was less. A sex-related difference in gastric emptying rates may play a role. Thus, food intake and gastric emptying are of substantial significance for the bioavailability of nickel from aqueous solutions

  9. Canine caliciviruses of four serotypes from military and research dogs recovered in 1963-1978 belong to two phylogenetic clades in the Vesivirus genus.

    Science.gov (United States)

    Binn, Leonard N; Norby, Erica A; Marchwicki, Ruth H; Jarman, Richard G; Keiser, Paul B; Hang, Jun

    2018-02-23

    Vesiviruses (family Caliciviridae) had been shown capable of invading a variety of host species, raising concern of their zoonotic potential. Since the 1980's, several canine caliciviruses (CaCV) isolates have been reported and are phylogenetically related to the vesiviruses with features distinct from both Vesicular exanthema of swine virus (VESV) and Feline calicivirus (FCV) species in phylogeny, serology and cell culture specificities. Etiological studies of canine diseases in dogs used for military services and laboratory studies were conducted in 1963-1978 at the Walter Reed Army Institute of Research. Multiple known and unknown viral pathogens including caliciviruses were recovered. Four unidentified isolates were recovered in Walter Reed Canine Cells (WRCC) from respiratory, fecal and penile specimens. Physicochemical tests, electron microscopy, viral cultivation in human and animal cells, antibody neutralization assays, and recently the genome sequencing were used to characterize the isolates. Sera from these dogs and their cohorts were tested with the isolates to determine origin and prevalence of the infections. The viral isolates were small non-enveloped spherical RNA virions, 27 to 42 nm in diameter with cup-like structures, indicating they are caliciviruses. They propagated in WRCC and MDCK cells, not in either other canine cells or human and other animal cells. Each isolate is antigenically distinct and react with dog sera in respective cohorts. The genomes have nucleotide identities ranging from 70.3% to 90.7% and encode the non-structural polyprotein (1810 amino acids), major capsid protein (691 amino acids) and minor structural protein (134 amino acids). They belong to two different phylogenetic clades in Vesivirus genus with close relation with canine calicivirus (CaCV). These CaCV isolates have restricted cell tropism, antigenic diversity and genetic variation. Further investigation will shed light on antigenic relation to other vesiviruses, and

  10. A multiplex reverse transcription PCR and automated electronic microarray assay for detection and differentiation of seven viruses affecting swine.

    Science.gov (United States)

    Erickson, A; Fisher, M; Furukawa-Stoffer, T; Ambagala, A; Hodko, D; Pasick, J; King, D P; Nfon, C; Ortega Polo, R; Lung, O

    2018-04-01

    Microarray technology can be useful for pathogen detection as it allows simultaneous interrogation of the presence or absence of a large number of genetic signatures. However, most microarray assays are labour-intensive and time-consuming to perform. This study describes the development and initial evaluation of a multiplex reverse transcription (RT)-PCR and novel accompanying automated electronic microarray assay for simultaneous detection and differentiation of seven important viruses that affect swine (foot-and-mouth disease virus [FMDV], swine vesicular disease virus [SVDV], vesicular exanthema of swine virus [VESV], African swine fever virus [ASFV], classical swine fever virus [CSFV], porcine respiratory and reproductive syndrome virus [PRRSV] and porcine circovirus type 2 [PCV2]). The novel electronic microarray assay utilizes a single, user-friendly instrument that integrates and automates capture probe printing, hybridization, washing and reporting on a disposable electronic microarray cartridge with 400 features. This assay accurately detected and identified a total of 68 isolates of the seven targeted virus species including 23 samples of FMDV, representing all seven serotypes, and 10 CSFV strains, representing all three genotypes. The assay successfully detected viruses in clinical samples from the field, experimentally infected animals (as early as 1 day post-infection (dpi) for FMDV and SVDV, 4 dpi for ASFV, 5 dpi for CSFV), as well as in biological material that were spiked with target viruses. The limit of detection was 10 copies/μl for ASFV, PCV2 and PRRSV, 100 copies/μl for SVDV, CSFV, VESV and 1,000 copies/μl for FMDV. The electronic microarray component had reduced analytical sensitivity for several of the target viruses when compared with the multiplex RT-PCR. The integration of capture probe printing allows custom onsite array printing as needed, while electrophoretically driven hybridization generates results faster than conventional

  11. Epidemiological and clinical features of erythema infectiosum in children in Novi Sad from 2000 to 2009

    Directory of Open Access Journals (Sweden)

    Prćić Sonja

    2013-01-01

    Full Text Available Background/Aim. Erythema infectiosum (EI is a common childhood illness, caused by human parvovirus B19. It occurs sporadically or in epidemics and is characterized by mild constitutional symptoms and a blotchy or maculopapular lacy rash on the cheeks (slapped-cheek spreading primarily to the extremities and trunk. The aim of our study was to analyse the epidemiological and clinical characteristics of erythema infectiosum in children. Methods. This study included 88 children observed in the Department of Dermatology of the Institute for Child and Youth Health Care of Vojvodina, in Novi Sad, during the period January 2000-December 2009. We compared the data about the clinical characteristics during and after the outbreak of EI observed from December 2001 to September 2002. The data were retrieved from the hospital database. Results. During the study period, EI was detected in 88 children (44 females and 44 males, 0.213% of the total number of 4 1345 children observed in the Department of Dermatology. An outbreak of erythema infectiosum was observed from December 2001 to September 2002, with the peak frequency in April and May 2002 and 39 diagnosed cases, and stable number of cases from 2005 to 2009 (a total of 49 diagnosed cases. The average age of infected children was 7.59 ± 3.339. Eleven (12.5% children were referred from primary care pediatricians with the diagnosis of urticaria or rash of allergic origin. The most constant clinical sign was reticular exanthema on the limbs, present in 100% of the cases, followed by 89.77% of cheek erythema. Pruritus was present in 9.09% of the children, mild constitutional symptoms in 5.68% and palpable lymph glands in 3.41% of the children. In all the cases the course of the disease was without complications. Conclusion. The results of this study confirm the presence of EI (the fifth disease in our area with a mild course in the majority of patients. Since the diagnosis of EI is usually based on clinical

  12. The complete genome sequence of Yersinia pseudotuberculosis IP31758, the causative agent of Far East scarlet-like fever.

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    Mark Eppinger

    2007-08-01

    Full Text Available The first reported Far East scarlet-like fever (FESLF epidemic swept the Pacific coastal region of Russia in the late 1950s. Symptoms of the severe infection included erythematous skin rash and desquamation, exanthema, hyperhemic tongue, and a toxic shock syndrome. The term FESLF was coined for the infection because it shares clinical presentations with scarlet fever caused by group A streptococci. The causative agent was later identified as Yersinia pseudotuberculosis, although the range of morbidities was vastly different from classical pseudotuberculosis symptoms. To understand the origin and emergence of the peculiar clinical features of FESLF, we have sequenced the genome of the FESLF-causing strain Y. pseudotuberculosis IP31758 and compared it with that of another Y. pseudotuberculosis strain, IP32953, which causes classical gastrointestinal symptoms. The unique gene pool of Y pseudotuberculosis IP31758 accounts for more than 260 strain-specific genes and introduces individual physiological capabilities and virulence determinants, with a significant proportion horizontally acquired that likely originated from Enterobacteriaceae and other soil-dwelling bacteria that persist in the same ecological niche. The mobile genome pool includes two novel plasmids phylogenetically unrelated to all currently reported Yersinia plasmids. An icm/dot type IVB secretion system, shared only with the intracellular persisting pathogens of the order Legionellales, was found on the larger plasmid and could contribute to scarlatinoid fever symptoms in patients due to the introduction of immunomodulatory and immunosuppressive capabilities. We determined the common and unique traits resulting from genome evolution and speciation within the genus Yersinia and drew a more accurate species border between Y. pseudotuberculosis and Y. pestis. In contrast to the lack of genetic diversity observed in the evolutionary young descending Y. pestis lineage, the population

  13. Fase aguda da doença de Chagas na Amazônia brasileira: estudo de 233 casos do Pará, Amapá e Maranhão observados entre 1988 e 2005 Acute phase of Chagas disease in the Brazilian Amazon region: study of 233 cases from Pará, Amapá and Maranhão observed between 1988 and 2005

    Directory of Open Access Journals (Sweden)

    Ana Yecê das Neves Pinto

    2008-12-01

    .5% (50/233 were isolated cases. Cases were taken to be acute if they presented positive direct parasitological tests (fresh blood, thick drop or Quantitative Buffy Coat, QBC and/or positive anti Trypanosoma cruzi IgM. Xenodiagnosis was also performed on 224 patients and blood culturing on 213. All the patients had clinical and epidemiological evaluations. The most frequent clinical manifestations were fever (100%, headache (92.3%, myalgia (84.1%, pallor (67%, dyspnea (58.4%, swelling of the legs (57.9%, facial edema (57.5%, abdominal pain (44.3%, myocarditis (39.9% and exanthema (27%. The electrocardiogram showed abnormalities of ventricular repolarization in 38.5%, low QRS voltage in 15.4%, left-axis deviation in 11.5%, ventricular ectopic beats in 5.8%, bradycardia in 5.8%, tachycardia in 5.8%, right branch block in 4.8% and atrial fibrillation in 4.8%. The most frequently observed abnormality on the echocardiogram was pericardial effusion, in 46.2% of the cases. Thirteen (5.6% patients died: ten (76.9% of them due to cardiovascular involvement, two due to digestive complications and one due to indeterminate causes.

  14. Manifestações cutâneo-mucosas da coccidioidomicose: estudo de trinta casos procedentes dos estados do Piauí e Maranhão Skin and mucous membrane manifestations of coccidioidomycosis: a study of thirty cases in the Brazilian states of Piauí and Maranhão

    Directory of Open Access Journals (Sweden)

    Antônio de Deus Filho

    2010-02-01

    involving 30 patients from the Brazilian states of Piauí and Maranhão with coccidioidomycosis diagnosed by direct microscopy, sputum culture or screening serology using agar gel double immunodiffusion, in association with anamnesis and physical examination. RESULTS: Extrapulmonary lesions were found in 13 cases (43.3%, consisting predominantly of dermatological manifestations of hypersensitivity: erythema nodosum (26.6%, exanthema with erythematosquamous lesions (26.6% and erythema multiforme (23.3%, as well as ulcerations of the tongue (13.3%, lip ulcers (6.6% and subcutaneous abscess (3.3%. These manifestations were seen during the acute phase of the disease. CONCLUSIONS: Skin manifestations associated with an acute respiratory infection reinforce the hypothesis of a diagnosis of coccidioidomycosis, particularly in individuals who hunt armadillos or in those exposed to soil excavation.

  15. Clinical and immunological efficacy of combination therapy of children with measles

    Directory of Open Access Journals (Sweden)

    V. N. Timchenko

    2016-01-01

    of Viferon in the treatment of patients with measles children characterized by rapid positive dynamics of symptoms of acute period (normalization of body temperature, reducing intoxication, catarrhal symptoms and severity of the syndrome exanthema. It was also found reduction in the incidence of complications, reduction in the average bedday and smooth during the period of convalescence later.

  16. Development and Characterization of a Multiplexed RT-PCR Species Specific Assay for Bovine and one for Porcine Foot-and-Mouth Disease Virus Rule-Out Supplemental Materials

    Energy Technology Data Exchange (ETDEWEB)

    Smith, S; Danganan, L; Tammero, L; Lenhoff, R; Naraghi-arani, P; Hindson, B

    2007-08-06

    Lawrence Livermore National Laboratory (LLNL), in collaboration with the Department of Homeland Security (DHS) and the United States Department of Agriculture (USDA), Animal and Plant Health Inspection Services (APHIS) has developed advanced rapid diagnostics that may be used within the National Animal Health Laboratory Network (NAHLN), the National Veterinary Services Laboratory (Ames, Iowa) and the Plum Island Animal Disease Center (PIADC). This effort has the potential to improve our nation's ability to discriminate between foreign animal diseases and those that are endemic using a single assay, thereby increasing our ability to protect animal populations of high economic importance in the United States. Under 2005 DHS funding we have developed multiplexed (MUX) nucleic-acid-based PCR assays that combine foot-and-mouth disease virus (FMDV) detection with rule-out tests for two other foreign animal diseases Vesicular Exanthema of Swine (VESV) and Swine Vesicular Disease (SVD) and four other domestic viral diseases Bovine Viral Diarrhea Virus (BVDV), Bovine Herpes Virus 1 (BHV-1 or Infectious Bovine Rhinotracheitus IBR), Bluetongue virus (BTV) and Parapox virus complex (which includes Bovine Papular Stomatitis Virus BPSV, Orf of sheep, and Pseudocowpox). Under 2006 funding we have developed a Multiplexed PCR [MUX] porcine assay for detection of FMDV with rule out tests for VESV and SVD foreign animal diseases in addition to one other domestic vesicular animal disease vesicular stomatitis virus (VSV) and one domestic animal disease of swine porcine reproductive and respiratory syndrome (PRRS). We have also developed a MUX bovine assay for detection of FMDV with rule out tests for the two bovine foreign animal diseases malignant catarrhal fever (MCF), rinderpest virus (RPV) and the domestic diseases vesicular stomatitis virus (VSV), bovine viral diarrhea virus (BVDV), infectious bovine rhinotracheitus virus (BHV-1), bluetongue virus (BTV), and the Parapox

  17. Clinical characteristics and evolution of syphilis in 24 HIV+ individuals in Rio de Janeiro, Brazil Características clínicas e evolutivas da sífilis em 24 indivíduos HIV+ no Rio de Janeiro, Brasil

    Directory of Open Access Journals (Sweden)

    Maria Clara Gutierrez-Galhardo

    2005-06-01

    Full Text Available A total of 24 patients with syphilis and HIV infection were treated from January 1997 to March 2003 at the Infectious Dermatology Outpatient Clinic of the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. The caseload consisted of 20 males (83.3% and four females (16.7%, with a mean age of 38.04 years and mean T CD4+ count of 389.5 cells/mL. Syphilis was diagnosed as secondary in 16 (62.5% patients, late latent in eight (33.3%, and tertiary in one (4.2%. Manifestations of secondary syphilis were palmar and plantar erythematopapulous cutaneous lesions in nine (37.5%, papulous exanthema in four (16.7%, patchy alopecia in 3 (12.5% and osteochondritis in one patient (4.2%. Tertiary syphilis was characterized by verrucous lesions. Neurosyphilis was diagnosed in four patients (16.7%, with headache as the only manifestation in two patients. Drugs used in treatment included benzathine penicillin, ceftriaxone, erythromycin, and crystalline penicillin. Cure was achieved in 18 patients (75%. Five patients (20.8% were retreated, three of whom presented a history of re-exposure. This study confirms the importance of establishing the diagnosis of neurosyphilis in patients with HIV infection, in addition to performing follow-up on treatment for syphilis.Foram tratados 24 indivíduos com sífilis e infecção pelo HIV, de Março de 1997 a Janeiro de 2003, no ambulatório de Dermatologia Infecciosa do Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. Foram 20 homens (83,3% e quatro mulheres (16,7% com idade média de 38,04 anos e contagem média de linfócitos T CD4 de 389,5 céls/mm³. A sífilis foi classificada como secundária em 16 pacientes (62,5%, latente tardia em oito (33,3% e terciária em uma paciente (4,2%. As manifestações de sífilis secundária foram de lesões cutâneas eritematopapulosas em regiões palmar e plantar em nove (37,5%, exantema papuloso em

  18. Doença de still na gravidez: relato de um caso com óbito neonatal Still's disease in pregnancy: report of a case with neonatal death

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    Ana Pacheco Ribeiro Cascaes

    2003-12-01

    was performed. The newborn had a 7/8 Apgar score, weighted 1,500 g and was admitted to an intensive care unit presenting breathing discomfort, icterus, exanthema and necrotizing enterocolitis, among other complications which led to his death after 41 days in the intensive care unit. The patient presented clinical and laboratorial symptoms suggesting adult-onset Still disease although other feverish pathologies were investigated as differential diagnosis. There was a satisfactory evolution with use of indomethacin, prednisone and methotrexate and the patient is currently in remission, using only methotrexate. The patient has presented a definite diagnosis for adult-onset Still disease according to the criteria proposed for the disease. The newborn's death was a consequence of prematurity and infectious risk, factors which could have been minimized had the mother's condition been precociously diagnosed.

  19. Foot & Mouth Disease & Ulcerative/Vesicular Rule-outs: Challenges Encountered in Recent Outbreaks

    Energy Technology Data Exchange (ETDEWEB)

    Hullinger, P

    2008-01-28

    development and subsequent rupturing of vesicles at the coronary band and in the oral cavity. Vesicles and ulcerations can also occur on the mammary gland. Recovery in adult animals usually occurs in 8-15 days. Clinical signs for most serotypes are less dramatic in sheep and goats. Swine can develop very severe coronary band lesions and high mortality in piglets has been observed. One of the challenges of diagnosing FMD is that it may be clinically similar to several other vesicular or ulcerative diseases. FMD is clinically indistinguishable from Vesicular stomatitis, Swine vesicular disease and Vesicular exanthema of swine. It may also resemble Bovine viral diarrhea, Mucosal disease, Infectious bovine rhinotracheitis, Bluetongue, Bovine papular stomatitis, Bovine mammillitis and Rinderpest.

  20. Development and Characterization of A Multiplexed RT-PCR Species Specific Assay for Bovine and one for Porcine Foot-and-Mouth Disease Virus Rule-Out

    Energy Technology Data Exchange (ETDEWEB)

    Smith, S M; Danganan, L; Tammero, L; Vitalis, B; Lenhoff, R; Naraghi-arani, P; Hindson, B

    2007-08-06

    Lawrence Livermore National Laboratory (LLNL), in collaboration with the Department of Homeland Security (DHS) and the United States Department of Agriculture (USDA), Animal and Plant Health Inspection Services (APHIS) has developed candidate multiplexed assays that may potentially be used within the National Animal Health Laboratory Network (NAHLN), the National Veterinary Services Laboratory (Ames, Iowa) and the Plum Island Animal Disease Center (PIADC). This effort has the ability to improve our nation's capability to discriminate between foreign animal diseases and those that are endemic using a single assay, thereby increasing our ability to protect food and agricultural resources with a diagnostic test which could enhance the nation's capabilities for early detection of a foreign animal disease. In FY2005 with funding from the DHS, LLNL developed the first version (Version 1.0) of a multiplexed (MUX) nucleic-acid-based RT-PCR assay that included signatures for foot-and-mouth disease virus (FMDV) detection with rule-out tests for two other foreign animal diseases (FADs) of swine, Vesicular Exanthema of Swine (VESV) and Swine Vesicular Disease Virus (SVDV), and four other domestic viral diseases Bovine Viral Diarrhea Virus (BVDV), Bovine Herpes Virus 1 (BHV-1), Bluetongue virus (BTV) and Parapox virus complex (which includes Bovine Papular Stomatitis Virus [BPSV], Orf of sheep, and Pseudocowpox). In FY06, LLNL has developed Bovine and Porcine species-specific panel which included existing signatures from Version 1.0 panel as well as new signatures. The MUX RT-PCR porcine assay for detection of FMDV includes the FADs, VESV and SVD in addition to vesicular stomatitis virus (VSV) and porcine reproductive and respiratory syndrome (PRRS). LLNL has also developed a MUX RT-PCR bovine assay for detection of FMDV with rule out tests for the two bovine FADs malignant catarrhal fever (MCF), rinderpest virus (RPV) and the domestic diseases vesicular stomatitis

  1. Reação cutânea grave induzida por carbamazepina no tratamento da neuralgia pós-herpética: relato de caso Reacción cutánea grave inducida por la carbamazepina en el tratamiento de la neuralgia postherpética: relato de caso Severe carbamazepine-induced cutaneous reaction in the treatment of post-herpetic neuralgia: case report

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    João Batista Santos Garcia

    2010-08-01

    . CONCLUSIONES: La SSJ/NET es una reacción cutánea grave con potencial para la morbilidade y mortalidad elevadas y que exige una intervención rápida y un manejo adecuado. También alertamos sobre el uso de la carbamazepina, que debe siempre ser inspeccionado, especialmente en los ancianos.BACKGROUND AND OBJECTIVES: Post-herpetic neuralgia (PHN is the main complication of herpes zoster. Carbamazepine (CBZ, a well-tolerated anticonvulsant, but frequently associated with severe cutaneous reactions, such as the Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN is used in the treatment of this complication. The objective of this article was to report a case of SJS/TEN secondary to CBZ in a patient with PHN. CASE REPORT: This is a female patient with continuous severe, burning, chock-like pain in the thoracic region and dorsum associated with reduced strength in the ipsilateral upper limb and diaphoresis. She had crusty and erythematous lesions in the dorsal region of the thorax with allodynia and dysesthesia in the affected dermatome. She was treated with CBZ 300 mg.day-1, amitriptyline (AMT 12.5 mg at bedtime, and infiltration with local anesthetic in the affected region. After 15 days, she developed malaise, fever, muscle pain, and arthralgia with a mild non-specific cutaneous rash. Carbamazepine was discontinued immediately. One week later, she was hospitalized with urticaria, generalized exanthema, erythematous cutaneous eruptions, bullae, and purpuric maculae all over her body. The impression was of carbamazepine-induced SJS/TEN. She evolved with progressive worsening of her symptoms, with increase in the number and size of cutaneous lesions, besides generalized erythematous macular rash, areas of necrosis, and erosions with symmetrical loosening of the epidermis in face, neck, thorax, dorsum, and limbs, affecting more that 50% of her body surface, besides involvement of buccal, conjunctival, and genital mucosa with vesicular erosions. She had progressive