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Sample records for exanthema

  1. [Spot diagnosis of infectious exanthema].

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    Ishiwada, Naruhiko

    2007-03-01

    There are lots of infectious diseases accompanied with exanthema. When the physicians see the patients with exanthema, they should carefully examine the form of exanthema and accessory symptoms. The physicians also should inquire of the patients about past history, history of vaccination and situation of current infectious disease epidemic in surrounding area. These clinical approaches lead to specific diagnosis. On this manuscript, I show the photos of several major infectious exanthema caused by viral, bacterial, bacterial toxin and so on.

  2. DIFFERENTIAL DIAGNOSTICS OF INFECTIOUS EXANTHEMAS IN CHILDREN

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    D. Yu. Ovsyannikov

    2015-01-01

    Full Text Available The lecture is devoted to the problem of differential diagnosis of infectious exanthemas in children. Information about differential-diagnostic sings of infectious and non-infectious exanthemas is present. Differential diagnosis is proposed on the basis of morphological elements identified in objective research. Presents possible infectious and non-infectious causes of rashes which are characterized by different primary (spot, papula, blister, knob, knot, bubble, abscess, bladder and secondary (scale, erosion, ulcer morphological elements.

  3. Exanthema and acute anuric renal failure.

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    Resch, M; Banas, B; Endemann, D; Mack, M; Riegger, G A J; Gröne, H J; Krämer, B K

    2006-05-01

    A 15-year-old girl with a history of Kawasaki disease was admitted to our nephrological department due to acute renal failure. Despite antibiotic therapy because of fever and the symptoms of a pharyngitis in the last few days, the girl showed persisting fever and developed arthralgias, an exanthema and a rising serum creatinine as well as anuria. A wide variety of differential diagnoses has to be thought of because of the history of the Kawasaki disease (symptoms like fever, pharyngitis, exanthema and arthralgia), i.e. hemolytic-uremic syndrome, vasculitis, ascending infection, postinfection glomerulonephritis. In consideration of etiologically unclear "rapidly progressive renal failure" with anuria and thrombocytopenia an immediate renal biopsy was done and revealed a severe drug induced acute interstitial nephritis. Due to this diagnosis we treated the patient with corticosteroids. Within 4 weeks serum creatinine declined to 1.8 mg/dl but did not normalize.

  4. 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.

  5. Diffuse exanthema in a patient receiving varenicline.

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    Song, Wei; Miller, William A

    2008-07-01

    A diffuse exanthema in a patient receiving varenicline is reported. A 71-year-old white woman, who was initially admitted to the hospital for elective vascular bypass surgery, had a three-day history of a diffuse rash, severe itching, and moderate headache. Her symptoms started two days before her admission. She denied having a fever, chills, nausea, vomiting, diarrhea, and flulike symptoms. She also denied having had contact with anyone who was ill, tick or insect bites, exposure to cats, or any changes in her diet, habits, or personal hygiene. Her medical problems included peripheral vascular disease, chronic obstructive pulmonary disease (COPD), dyslipidemia, hypertension, and hypothyroidism. In addition to several medications she had been taking for over 2 years, she had been taking varenicline as an aid for smoking cessation for eight days. The patient had been smoking for 40 years. The bright-red rash covered 70% of her torso and four extremities. She had mild swelling in her cheeks, but not on the eyelids or lips. Both of her lungs were clear on auscultation, with distant breath sounds caused by her COPD. Varenicline was discontinued, and her symptoms had completely resolved by the eighth day following discontinuation of the medication. While it is possible that other medications caused her symptoms, she had been taking most of them for over 2 years and all of them for over 1 year. Also, continuation of these drugs did not prevent her symptoms from resolving, nor did it cause a recurrence of the skin reaction. A patient developed diffuse exanthema after being treated with varenicline.

  6. Etiology of exanthema in children in a dengue endemic area.

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    Campagna, Delmina de S; Miagostovich, Marize P; Siqueira, Marilda M; Cunha, Rivaldo V da

    2006-01-01

    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. Enrollment took place between 21/09/2001 and 20/09/2002 and included 95.9% (71/74) of children presenting with exanthema at the emergency room of the Hospital Universitário de Campo Grande, MS (4.1% refusals). After the children had had their details taken and entered on the study protocol, they were subjected to physical examination followed by collection of blood samples for blood testing with platelet counts and serology (IgM and IgG); initially for dengue, rubella and toxoplasmosis and then, in negative cases, serology was also run for parvovirus, herpes virus type 6 and measles. Laboratory diagnoses were confirmed by means of IgM antibody assay in 88.7% of the cases investigated: dengue (77.5%), herpes virus type 6 (8.4%), parvovirus (2.8%) and in eight patients diagnosis was inconclusive (11.3%). On this occasion no positive serology (IgM) was observed for measles, rubella or toxoplasmosis. The most common clinical manifestations among the dengue patients were: fever, itching, prostration, myalgia and positive tourniquet test results. In 58.4% (32/55) of those cases diagnosed with dengue, the tourniquet test was positive, which was a statistically significant difference when compared with the remainder of the sample. When children present with exanthema, it is possible that dengue is the primary causative disease, depending on the epidemiology of the location. Constant control of epidemiological and serological surveillance of exanthematous diseases is necessary.

  7. DIAGNOSTIC SIGNIFICATION OF EXANTHEMA IN THE PREHOSPITAL CARE IN INFECTIOUS DISEASES

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    N. F. Plavunov; V. A. Kadyshev; T. Ya. Chernobrovkina; L. N. Proskurina; E. V. Kardonova

    2016-01-01

    Disease, with exanthema, pose a significant differential diagnostic difficulty for physicians multidisciplinary hospitals and require the consultation of an infectious disease physician. The article highlights the problem of early diagnostics of acute infectious diseases proceeding with exanthema. The analysis of quality of diagnostics of infectious disease on the outcomes of the consultative infectious ambulance team for 2013-2014.

  8. DIAGNOSTIC SIGNIFICATION OF EXANTHEMA IN THE PREHOSPITAL CARE IN INFECTIOUS DISEASES

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    N. F. Plavunov

    2016-01-01

    Full Text Available Disease, with exanthema, pose a significant differential diagnostic difficulty for physicians multidisciplinary hospitals and require the consultation of an infectious disease physician. The article highlights the problem of early diagnostics of acute infectious diseases proceeding with exanthema. The analysis of quality of diagnostics of infectious disease on the outcomes of the consultative infectious ambulance team for 2013-2014.

  9. [Rare forms of segmental exanthema in patients with Herpes zoster].

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    Shishov, A S; Blank, I A; Petrova, I S; Kulagina, M V; Rusanova, S A

    2014-01-01

    To describe rare clinical cases of Herpes zoster with a rash appeared simultaneously in different segmental zones (zoster duplex unilateralis and zoster duplex bilateralis). Brief details of medical histories of 3 patients are presented. A very rare possibility of the complete fusion of bilateral exanthema on the same topographic level with the development of an entire zoster that confirm a historical name of the disease has been demonstrated. A mistaken translation of disease name into Russian as "lishai" is emphasized. Recommendations on the complex, stage-by-stage treatment of patients, including psychotherapeutic treatment of the pain syndrome, are presented.

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

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    Zhou, Hong-Tao; Guo, Yong-Hui; Tang, Pei; Zeng, Lei; Pan, Yu-Xian; Ding, Xi-Xia; Wen, Kun; Tao, Shao-Hua; Chen, Man-Jun; Wang, Bin; Yu, Nan; Che, Xiao-Yan

    2014-11-01

    To clarify whether exanthema is related to illness severity in acute enterovirus infection in children. The data of pediatric inpatients at Zhujiang Hospital during 2009-2012 with an acute enterovirus infection were reviewed retrospectively. Enterovirus infection was determined by real-time reverse transcription PCR. Clinical data were summarized and compared between cases with and without exanthema. A total of 780 pediatric inpatients with an acute enterovirus infection were included in this study, of whom 83 (10.6%) presented no exanthema. The percentage of deaths in the group of patients without exanthema was significantly higher than that in the group with exanthema (7.2% vs. 1.1%; p = 0.002). Central nervous system involvement (41.0% vs. 30.0%; p = 0.041), severe central nervous system (CNS) involvement (21.7% vs. 11.0%; p = 0.005), severe CNS involvement with cardiopulmonary failure (9.6% vs. 2.3%; p = 0.002), an altered level of consciousness (15.7% vs. 7.6%; p = 0.013), and convulsions (14.4% vs. 6.3%; p = 0.007) occurred significantly more frequently in the group without exanthema. 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.

  11. [Haemorrhagic exanthema due to dengue virus induced by acetylsalicylic acid].

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    Valerio, L; de Balanzó, X; Jiménez, O; Pedro-Bolet, M L

    2006-01-01

    Dengue fever, a viral infectious disease characteristic of tropical climates, is considered to be a re-emergent pathology responsible for several serious outbreaks in the last decade. Some factors have been involved in the spread of the virus and its vectorial mosquito carrier: human alteration of the ecosystems, improvement and speed in the transit of goods and people and climate changes. As a reflection of this, an increase in imported cases is probable, especially in tourists coming from endemic areas, considering its short period of incubation (7-10 days). The recognition of personal antecedents of journeys, the main symptoms of the disease and the potential presence of complications (haemorrhagic dengue) should be included in the examination of fever of unknown origin or feverish exanthema. The case of a patient is presented whose clinical picture of classic dengue fever was worsened by self-treatment with acetylsalicylic acid.

  12. Diagnostic and Therapeutic Difficulties in Children with Viral Exanthema in the Practice of General Practitioners

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    U.Sh. Rykhsiiev; Yuldashev, M.A.; A.V. Mun

    2016-01-01

    The article presents data on viral exanthema caused by Coxsackie enterovirus (Coxsackie A16) in children. The features of the course and the difficulty in the diagnosis and treatment of this disease in the arid region are described.

  13. Vesicular exanthema of swine virus: isolation and serotyping of field samples.

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    Edwards, J F; Yedloutschnig, R J; Dardiri, A H; Callis, J. J.

    1987-01-01

    Virus isolation was attempted from 262 field samples of vesicular material collected during the outbreaks of vesicular exanthema of swine in the U.S.A. from 1952-54. Using primary swine kidney culture, viral cytopathogenic agents were isolated from 76.3% of the samples. However, an overall recovery rate of 82.1% was obtained after samples negative in tissue culture were inoculated intradermally in susceptible swine. All vesicular exanthema of swine virus isolates were identified as serotype B...

  14. Radiocontrast media-associated exanthema: Identification of cross-reactivity and tolerability by allergologic testing

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    Seitz, Cornelia S.; Pfeuffer, Petra; Raith, Petra; Broecker, Eva-B. [Department of Dermatology, Venereology and Allergology, University of Wuerzburg, Josef Schneider Strasse 2, 97080 Wuerzburg (Germany); Trautmann, Axel [Department of Dermatology, Venereology and Allergology, University of Wuerzburg, Josef Schneider Strasse 2, 97080 Wuerzburg (Germany)], E-mail: trautmann_a@klinik.uni-wuerzburg.de

    2009-10-15

    Background: All iodinated radiocontrast media (RCM) may cause hypersensitivity reactions, either immediate-type within 5-10 min of RCM injection or delayed-type, which become apparent more than 1 h after RCM exposure. Delayed-type hypersensitivity to RCM may pose a problem for future radiologic investigations because due to possible immunological cross-reactivity all iodinated RCM are usually avoided. Objective: The aim of this study was not only to identify the causal RCM for the exanthema but also to demonstrate that patients may receive alternative iodinated RCM despite a history of RCM-induced allergic exanthema. Methods: We evaluated 32 patients with a history of exanthema after RCM application using standardized patch, prick and intradermal skin testing. In case of positive skin tests intravenous challenges with skin-test-negative RCM were performed to identify non-ionic monomer RCM which are tolerated. Results: In 6 out of 32 patients skin tests strongly suggested a delayed-type non-IgE-mediated allergic hypersensitivity to the RCM iomeprol (3 x), iopromide (2x), and iopamidol. In 4 patients alternative non-ionic monomer RCM (2x iosarcol, iopromide, and iomeprol) were identified by controlled challenge tests. Conclusions: The evaluation of patients with RCM-associated exanthema should always include appropriate skin tests ensuring that patients with a delayed-type allergic RCM-induced exanthema are not missed. Moreover, allergologic testing may identify alternative RCM of the group of non-ionic monomers, which are tolerated in future radiologic investigations.

  15. Diagnostic and Therapeutic Difficulties in Children with Viral Exanthema in the Practice of General Practitioners

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    U.Sh. Rykhsiiev

    2016-02-01

    Full Text Available The article presents data on viral exanthema caused by Coxsackie enterovirus (Coxsackie A16 in children. The features of the course and the difficulty in the diagnosis and treatment of this disease in the arid region are described.

  16. [Fever and exanthema as manifestations of the second stage of syphilis].

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    Heijstek, M W; Goslings, W R O; Shamelian, S

    2006-06-17

    A man aged 30 had been suffering from episodes of fever for several weeks. He had diarrhoea and had developed generalized maculopapular exanthema that also affected the palms of his hands and soles of his feet. After viral causes were excluded the symptoms proved to be caused by syphilis. His condition was complicated by uveitis. The patient recovered after a single dose of benzyl penicillin and local mydratics and corticosteroid eye drops. The incidence of syphilis is rising and its clinical spectrum is broad. Therefore in patients with fever and exanthema of unknown origin this disease should be considered. One should be aware of the wide variety of complications that can result from syphilis.

  17. Dermatological spectrum of hand, foot and mouth disease from classical to generalized exanthema.

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    Hubiche, Thomas; Schuffenecker, Isabelle; Boralevi, Franck; Léauté-Labrèze, Christine; Bornebusch, Laure; Chiaverini, Christine; Phan, Alice; Maruani, Annabel; Miquel, Juliette; Lafon, Marie-Edith; Lina, Bruno; Del Giudice, Pascal

    2014-04-01

    Hand, foot and mouth disease (HFMD) is classically defined as a childhood fever accompanied by a rash with vesicles or erosions of the oral mucosa, hands, feet and sometimes the buttocks. Severe neurological complications are associated with enterovirus 71 outbreaks in Asia. Recently, it has been suggested that HFMD is related to coxsackie virus A6 (CV-A6) when there is an atypical rash. The objective of the study is to determine the dermatological pattern of HFMD and to identify the virus serotypes associated with a specific dermatological pattern. A prospective, cross-sectional study was conducted in 7 pediatric dermatology units in France from March 2010 to February 2012. All children with clinically suspected diagnosis of HFMD were included. Clinical data were collected and swabs from the nasopharynx and vesicles were taken for reverse transcription polymerase chain reaction and genotyping. Only children with confirmed HFMD--defined by clinical diagnosis of HFMD and positive enterovirus polymerase chain reaction results--were included for analysis. One hundred and four children consulted for suspected HFMD, including 89 (mean age: 25.7 months; sex ratio M/F 1.54) with confirmed HFMD. Seventy-eight (87.6%) had skin lesions on sites other than hand, feet and mouth. Thirty-seven (41.5%) had 5 or more anatomical sites involved (hand, feet and mouth, buttocks, legs, arms and trunk) considered as widespread exanthema. Widespread vesicular exanthema was observed with both CV-A6 and CV-A16. Peri-oral rash was associated with CV-A6 (P exanthema. Generalized and atypical exanthema were observed with both CV-A6 and CV-A16 infections. CV-A6 is associated with peri-oral rash.

  18. Vesicular exanthema of swine virus: isolation and serotyping of field samples.

    Science.gov (United States)

    Edwards, J F; Yedloutschnig, R J; Dardiri, A H; Callis, J J

    1987-01-01

    Virus isolation was attempted from 262 field samples of vesicular material collected during the outbreaks of vesicular exanthema of swine in the U.S.A. from 1952-54. Using primary swine kidney culture, viral cytopathogenic agents were isolated from 76.3% of the samples. However, an overall recovery rate of 82.1% was obtained after samples negative in tissue culture were inoculated intradermally in susceptible swine. All vesicular exanthema of swine virus isolates were identified as serotype B51 using complement fixation and serum neutralization tests. Two isolates did not react with antisera to known vesicular agents of swine and failed to produce vesicles or clinical signs of disease upon inoculation in swine. One vesicular exanthema of swine virus isolate from tissue of equine origin was pathogenic for swine but produced limited vesiculation at the site of intradermalingual inoculation in the tongue of a pony infected experimentally. Type B51 virus was reisolated from lesions produced in the pony and the pony became seropositive for virus type B51. PMID:3651889

  19. Amoxicillin-induced exanthema in young adults with infectious mononucleosis: demonstration of drug-specific lymphocyte reactivity.

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    Renn, C N; Straff, W; Dorfmüller, A; Al-Masaoudi, T; Merk, H F; Sachs, B

    2002-12-01

    Teenagers and young adults frequently develop maculopapular exanthema following amoxicillin intake within infectious mononucleosis. The underlying pathomechanisms are still largely unknown. To investigate whether amoxicillin-induced exanthema in florid infectious mononucleosis is a disease-associated phenomenon or results from specific sensitization to the drug. Four patients with amoxicillin-induced exanthema within infectious mononucleosis were analysed in vivo by prick, intradermal and patch tests and in vitro by means of the lymphocyte transformation test (LTT) employing amoxicillin, ampicillin, benzylpenicillin and phenoxymethylpenicillin. Drug-specific sensitization to amoxicillin in the LTT was observed in three patients, two of whom showed a side-chain-specific sensitization to amoxicillin and ampicillin. The in vitro results were confirmed in vivo by skin tests. These data suggest that real sensitization to amoxicillin and ampicillin may occur within infectious mononucleosis and may be detected in vivo and in vitro by means of skin tests and the LTT.

  20. Clinical Laboratory and Epidemiological Features of Sudden Exanthema in Children Saint-Petersburg

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    E. V. Sharipova; I. V. Babachenko; Yu. I. Sichkovskaja; Yu. Yu. Chernyshova

    2016-01-01

    The paper studies the clinical and epidemiological features of one of the acute clinical forms of infection caused by the human herpes virus type 6 — «sudden exanthema » — in children of St. Petersburg. The study involved 149 children hospitalized aged 6 months to 15 years in the period from 2012 to 2014. Sudden rash confirmed by molecular genetic studies in 38 children. The disease is mainly observed in patients of the first two years of life. Rash and toxic syndromes dominated in clinical p...

  1. Clinical Laboratory and Epidemiological Features of Sudden Exanthema in Children Saint-Petersburg

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    E. V. Sharipova

    2016-01-01

    Full Text Available The paper studies the clinical and epidemiological features of one of the acute clinical forms of infection caused by the human herpes virus type 6 — «sudden exanthema » — in children of St. Petersburg. The study involved 149 children hospitalized aged 6 months to 15 years in the period from 2012 to 2014. Sudden rash confirmed by molecular genetic studies in 38 children. The disease is mainly observed in patients of the first two years of life. Rash and toxic syndromes dominated in clinical picture.

  2. NEW PERSPECTIVES IN THE DIAGNOSIS AND THE TREATMENT OF CHILDHOOD FEBRILE EXANTHEMAS.

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    Luca, Mihaela Cătălina; Vâţă, A; St Luca, A; Dorobăţ, Carmen Mihaela; Brănişteanu, Daciana Elena

    2015-01-01

    A child with a febrile exanthema is a complex medical problem involving diagnostic challenges, epidemiological threats and a great concern for the parents and any physician, should be prepared to deal with it. Many of the classical ones (measles, rubella, chickenpox) have now a decreased incidence due to a high vaccine coverage, which makes even harder for the physician to establish an early diagnosis. To the untrained eye most of them are difficult to differentiate. Their prompt recognition is necessary in order to manage them adequately and to prevent spreading of the disease.

  3. Up-regulation of CCL17, CCL22 and CCR4 in drug-induced maculopapular exanthema.

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    Tapia, B; Morel, E; Martín-Díaz, M-A; Díaz, R; Alves-Ferreira, J; Rubio, P; Padial, A; Bellón, T

    2007-05-01

    Maculopapular exanthema has been reported to be the most frequently drug-induced cutaneous reaction. Although T lymphocytes are involved in the pathomechanism of this disease, little is know about the recruitment of these cells to the skin. The aim of this work is to study the role of the chemokines TARC/CCL17 and MDC/CCL22 in the lymphocyte trafficking to affected skin in drug-induced exanthemas. Real-time PCR was performed to quantify gene expression levels of CCL17, CCL22 and their receptor CCR4 in lesional skin biopsies and in peripheral blood mononuclear cells from patients. CCL27 and CCL22 proteins were detected in the skin by immunochemistry. Protein expression of CCR4 was determined by flow cytometry in peripheral blood lymphocytes. Functional migration assays to CCL17 and CCL22 were assessed to compare the migratory responses of peripheral blood lymphocytes from patients and healthy subjects. CCL17 and CCL22 were up-regulated in maculopapular exanthema-affected skin. CCR4 mRNA levels and protein expression were increased in peripheral blood mononuclear cells during the acute phase of the disease. The increased expression of the receptor was consistent with a higher response of peripheral blood lymphocytes to CCL17 and CCL22 compared with the migratory response in healthy donors. TARC/CCL17 and MDC/CCL22 might cooperate in attracting T lymphocytes to skin in drug-induced maculopapular exanthemas.

  4. Macular exanthema appearing 5 days after X-ray contrast medium administration

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    Christiansen, Cath; Ekeli, Hege [Research and Development, Amersham Health, P.O. Box 4220 Nydalen, 0401 Oslo (Norway); Dreborg, Sten [Alingsaasvaegen 11, 443 35 Lerum (Sweden); Pichler, Werner J. [Division of Allergology, Clinic for Rheumatology and Clinical Immunology/Allergology, Inselspital, 3010 Bern (Switzerland)

    2002-07-01

    We report a case of widespread, pruritic macular exanthema appearing 5 days after intravenous administration of the X-ray contrast medium, iohexol (Omnipaque) in a patient who had not previously received any X-ray contrast medium. The eruptions resolved in 7 days, leaving no residual lesions. When the patient was challenged intradermally with the same contrast medium 1.5 months after recovery, the same type of eruption developed 1 day after challenge. Histological examination of biopsies from positive skin test sites revealed the presence of a dermal infiltrate of lymphocytes. This case is another example of a late-onset adverse reaction to an X-ray contrast medium, mediated by specific T cells. The usefulness of intradermal skin testing for confirming the allergic nature of the reaction and for studying cross-reactivity pattern is emphasized. (orig.)

  5. Lichenoid exanthema mimicking graft-versus-host disease associated with obstructive lung disease in a non-transplanted patient.

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    Eberle, Franziska Carola; Holland, Angelique; Hörster, Stefan; Vogelmeier, Claus; Hertl, Michael

    2010-01-01

    Lichenoid graft-versus-host disease (GVHD) is commonly observed in patients who have received donor lymphocyte infusions or allogeneic bone marrow transplantation (BMT). Here we report a striking case of lichenoid GVH-like exanthema in a young woman without any history of blood transfusions or BMT. A polymorphous, multiforme-like exanthema was observed after systemic antibiotic therapy of bronchitis and was initially diagnosed as drug eruption. Later on, disseminated lichenoid papules were noticed on the trunk and extremities with all histologic and clinical characteristics of lichenoid GVHD. Cutaneous GVH-like disease developed, as did obstructive lung disease. Pulmonary as well as skin disease were both refractory to various immunosuppressive therapies. The immune pathogenesis that caused the skin and lung disease in this patient remains unclear. Multiple pregnancies with two abortions with the potential induction of microchimerism may play a role in the disease pathogenesis.

  6. Equine coital exanthema and its potential economic implications for the equine industry.

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    Barrandeguy, Maria; Thiry, Etienne

    2012-01-01

    Equine coital exanthema (ECE) caused by equid herpesvirus 3 (EHV-3) is a contagious venereal disease characterised by the formation of painful papules, vesicles, pustules and ulcers on the external genitalia of both mares and stallions. EHV-3 is an alphaherpesvirus that is distinct from the other equine herpesviruses and endemic in most horse breeding populations worldwide. The negative impacts of ECE on equine breeding enterprises are the forced, temporary disruption of mating activities of mares and stallions, the additional care and supportive treatment that is required for affected horses, and the risk of virus spread by either fresh or frozen semen as well as by artificial insemination and embryo transfer. Because there are no effective surveillance systems to report ECE, its true prevalence and economic impact are difficult to assess and are probably underestimated. The purpose of this review is to describe the recent advances in understanding of EHV-3 infections and to consider the economic consequences of ECE within the current context of the equine industry. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Serologic evidence of West Nile virus infection in patients with exanthema in Hungary.

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    Szomor, Katalin N; Rigó, Zita; Bán, Eniko; Nagy, Lívia; Szalkai, Teodóra; Balogh, Zsuzsanna; Ferenczi, Emoke; Takács, Mária

    2011-06-01

    The presence of WNV in Europe has been well known for decades, although the first human infections and avian outbreaks were diagnosed in Hungary only in 2003. An annual average of 6-8 cases of the neuroinvasive form of WNV infection has been detected in the region since then, but a higher number (17) of WNV associated neuroinvasive disease occurred in 2008. In 2004, a surveillance system was established for monitoring WNV-associated meningo-encephalitis cases in Hungary, but a milder type of illness (with fever, rash and/or influenza like symptoms) is not followed. Fifty-two sera of 45 patients with mild clinical symptoms (fever, exanthema) were tested for anti-WNV antibodies in 2008 in a retrospective study by immunofluorescence test and ELISA. Seven patients had antibodies against WNV, serologic evidence of recent WNV infection was found in 4 out of the 7 patients. Infections could be acquired predominantly in August and in September, which seems to be a risk period for WNV in Hungary. The possibility of a recent WNV infection should be taken into consideration in the occurrence of fever and rush at late summer. Differential diagnosis of exanthematous patients should include WNV serology tests and should be done routinely.

  8. Detection of human herpesvirus 7 infection in young children presenting with exanthema subitum.

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    Magalhães, Ivna de Melo; Martins, Rebeca Vazquez Novo; Vianna, Renata Oliveira; Moysés, Natalia; Afonso, Larissa Alves; Oliveira, Solange Artimos; Cavalcanti, Silvia Maria Baeta

    2011-05-01

    In this study, we assessed the prevalence of human herpesvirus-7 (HHV-7) in 141 serum samples from children less than four years of age with exanthematic disease. All samples were negative for measles, rubella, dengue fever and parvovirus B19 infection. Testing for the presence of human herpesvirus-6 (HHV-6)-specific high avidity IgG antibodies by indirect immunofluorescence assay (IFA) revealed two main groups: one composed of 57 patients with recent primary HHV-6 infection and another group of 68 patients showing signs of past HHV-6 infection. Another 16 samples had indeterminate primary HHV-6 infection, by both IgG IFA and IgM IFA. Serum samples were subjected to a nested polymerase chain reaction to detect the presence of HHV-7 DNA. Among patients with a recent primary HHV-6 infection, HHV-7 DNA was present in 1.7% of individuals; however, 5.8% of individuals tested positive for HHV-7 DNA in the group with past primary HHV-6 infection. Among the 16 samples with indeterminate diagnosis, 25% (4/16) had HHV-7 DNA (p exanthema. However, a relationship between clinical manifestations and the detection of virus DNA does not always exist. Therefore, a careful interpretation is necessary to diagnose a primary infection or a virus-associated disease. In conclusion, we detected HHV-7 DNA in young children from the state of Rio de Janeiro, Brazil.

  9. First case of symmetric drug-related intertriginous and flexural exanthema (sdrife) due to rivastigmine?

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    Allain-Veyrac, Gwenaëlle; Lebreton, Anne; Collonnier, Catherine; Jolliet, Pascale

    2011-06-01

    The term 'baboon syndrome' was introduced in 1984 to describe a special form of systemic, contact-type dermatitis that occurs after ingestion or systemic absorption of a contact allergen in individuals previously sensitized by topical exposure to the same allergen in the same areas. Its clinical picture presents as an erythema of the buttocks and upper inner thighs resembling the red bottom of baboons. This reaction was originally observed with mercury, nickel, and ampicillin. In 2004, some authors proposed the acronym SDRIFE standing for 'symmetric drug-related intertriginous and flexural exanthema' specifically for cases elicited by systemically administered drugs. Since 1984, about 100 cases have been reported in the literature; for most of the concerned drugs, previous skin sensitization or possible cross-sensitization has not been shown. We report the first case of SDRIFE due to rivastigmine, with the exception of an erythematous maculopapular eruption due to rivastigmine that was previously reported. Rivastigmine is a reversible and noncompetitive acetylcholinesterase inhibitor used for the treatment of Alzheimer disease. SDRIFE is an important condition to keep in mind in order to avoid a misdiagnosis when dealing with other exanthematous disorders and to prevent re-exposure to the responsible allergen in the future.

  10. Detection of human herpesvirus 7 infection in young children presenting with exanthema subitum

    Directory of Open Access Journals (Sweden)

    Ivna de Melo Magalhães

    2011-05-01

    Full Text Available In this study, we assessed the prevalence of human herpesvirus-7 (HHV-7 in 141 serum samples from children less than four years of age with exanthematic disease. All samples were negative for measles, rubella, dengue fever and parvovirus B19 infection. Testing for the presence of human herpesvirus-6 (HHV-6-specific high avidity IgG antibodies by indirect immunofluorescence assay (IFA revealed two main groups: one composed of 57 patients with recent primary HHV-6 infection and another group of 68 patients showing signs of past HHV-6 infection. Another 16 samples had indeterminate primary HHV-6 infection, by both IgG IFA and IgM IFA. Serum samples were subjected to a nested polymerase chain reaction to detect the presence of HHV-7 DNA. Among patients with a recent primary HHV-6 infection, HHV-7 DNA was present in 1.7% of individuals; however, 5.8% of individuals tested positive for HHV-7 DNA in the group with past primary HHV-6 infection. Among the 16 samples with indeterminate diagnosis, 25% (4/16 had HHV-7 DNA (p < 0.002. We hypothesise that HHV-7 might be the agent that causes exanthema. However, a relationship between clinical manifestations and the detection of virus DNA does not always exist. Therefore, a careful interpretation is necessary to diagnose a primary infection or a virus-associated disease. In conclusion, we detected HHV-7 DNA in young children from the state of Rio de Janeiro, Brazil.

  11. [Difficulties in the diagnosis of a febrile exanthema of different etiologies in a tuberculous patient in Madagascar].

    Science.gov (United States)

    Rakotoarimanana, R; Rakotonirainy, O H; Razanamparany, O; Raonivelo, T; Ralandison, S

    2012-12-01

    This article illustrates the difficulties in the treatment of tuberculosis through the case of a patient with tuberculosis presenting with a haemophagocytic syndrome, severe drug hypersensitivity and a dissemination of the disease. A month after tuberculosis chemotherapy was started, Mrs. R.S, aged 45 years, presented with febrile exanthema, confusion, multiple lymph nodes enlargement/polyadenopathy, bi-cytopenia and a severe hepatic cytolysis. The haemophagocytic syndrome was confirmed by a myelogram and had shown a good response to the administration of methylprednisolone. Tuberculosis chemotherapy was stopped for a month and when resumed, there was a recurrence of the febrile exanthema without haematologic abnormalities but a moderate hepatic cytolysis. The association of haemophagocytic syndrome with tuberculosis is a rare occurrence. It was important to differentiate drug hypersensitivity and recurrence of haemophagocytic syndrome, as the sole treatment interruption was sufficient to heal the patient during the second febrile rash. Corticotherapy, discontinuation of tuberculostatic treatment and a very progressive reintroduction of antituberculosis drugs was successful though it caused the dissemination of the tuberculosis disease.

  12. Occurrence of equine coital exanthema in pastured draft horses and isolation of equine herpesvirus 3 from progenital lesions.

    Science.gov (United States)

    Seki, Yoshihisa; Seimiya, Yukio M; Yaegashi, Gakuji; Kumagai, Shin-Ichi; Sentsui, Hiroshi; Nishimori, Tomoko; Ishihara, Ryoko

    2004-12-01

    During the period from 2001 to the following year, progenital diseases had been epidemic among the draft stallions and mares pastured together in Iwate Prefecture, the northeastern district of Japan. A stallion and 8 of 31 mares were affected in 2001, and 1 of 2 stallions and 10 of 36 mares in 2002. The clinical symptoms consisted of the formation of papules, pustules, ulcers and scabs on the progenital skin and mucosa in stallions and mares. In 2002, Equine herpesvirus 3 (EHV3) was isolated from 2 mares and the glycoprotein G gene of the virus detected from a stallion and 4 mares by polymerase chain reaction. Serum neutralizing tests showed that 12 of 38 horses, 10 clinically and 2 subclinically affected, changed to be positive for the EHV3 antibody. The results suggest that the horses were affected with equine coital exanthema (ECE) through coitus. Five mares with the antibody at the pre-pastured period may have been the possible origins of EHV3 infection in 2002, although the exact origin in 2001 remains unknown. The artificial insemination was performed for the prevention of ECE spreading through coitus on the pasture in 2003. There was no epidemic of the disease in 31 mares, although 3 mares with the antibody at the pre-pastured period showed the significant increase in the titers during the pastured period.

  13. [Childhood diseases with exanthema].

    Science.gov (United States)

    Opstelten, Wim; Eekhof, Just A H; Knuistingh Neven, Arie

    2011-01-01

    - Due to high vaccination coverage, measles and rubella (German measles) are now rarely seen in the Netherlands, which makes recognition of these diseases difficult. - Measles can also occur in people who have been immunized, as a result of vaccination failure. - Swift recognition of measles and rubella is necessary in order to manage them adequately and to prevent spreading of the disease. - Measles, rubella, and erythema infectiosum ('fifth disease') may result in complications during pregnancy. - Measles, rubella, scarlet fever, erythema infectiosum, and roseola ('sixth disease') can be difficult to differentiate. - In the Netherlands, diagnosis of a patient with measles or rubella, or of more than 1 patient with erythema infectiosum within one institution, must be reported to the local health authority within 1 working day. - Exclusion from school or a day-care facility is not required for any if the diseases discussed.

  14. [Recurrent pneumothorax in interstitial lung disease, anogenital and abdominal wall exanthema and secondary amenorrhea in a 20-year-old patient. Langerhans-cell histiocytosis].

    Science.gov (United States)

    Lockhart, I; Meuthen, I; Wolmerstett, M P

    2000-04-15

    A 20-year-old female patient was admitted to the hospital because of a pneumothorax. A secondary amenorrhea was coexisting. On the abdominal wall and in the anogenital area a maculopapular exanthema was visible. Chest X-ray and HR-CT showed an interstitial lung disease with high probability of histiocytosis X which was confirmed by biopsies of lung and skin tissue. The cause of amenorrhea was a histiocytic infiltration of the pituitary stalk. Conventional "consensus-treatment" for adults with vinblastine, prednisone and etoposide did not prevent relapsing bilateral pneumothoraces. Treatment was successful with the protocol as proposed by the international study for children. This treatment is characterized by higher dosage and combination with 6-mercaptopurine.

  15. Genetic relatedness of the caliciviruses: San Miguel sea lion and vesicular exanthema of swine viruses constitute a single genotype within the Caliciviridae.

    Science.gov (United States)

    Neill, J D; Meyer, R F; Seal, B S

    1995-01-01

    The San Miguel sea lion viruses (SMSV) and vesicular exanthema of swine viruses (VESV) are related morphologically and antigenically, but little has been done to determine their genotypic relationship to each other and to other caliciviruses. To examine this relationship, reverse transcriptase PCRs were performed by using oligonucleotide primer sets designed to amplify portions of the 2C RNA helicase-like and RNA-dependent RNA polymerase regions with total cellular RNA purified from virus-infected cell cultures as a template. The 2C RNA helicase primers directed the amplification of this region from eight SMSV serotypes, five VESV serotypes, and four related viruses. The RNA polymerase primer sets amplified products from all these viruses except one. Phylogenetic comparison of the caliciviruses demonstrated that SMSV, VESV, and four related viruses are closely related while being distinct from feline calicivirus, the human caliciviruses (small, round-structured viruses), and rabbit hemorrhagic disease virus and that they should be classified as a single genotype within the Caliciviridae. PMID:7769708

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

    Directory of Open Access Journals (Sweden)

    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

  17. Acute disseminated encephalomyelitis preceding measles exanthema.

    Science.gov (United States)

    Nardone, Raffaele; Golaszewski, Stefan; Trinka, Eugen; Tezzon, Frediano; Zuccoli, Giulio

    2011-12-01

    We report a case of acute disseminated encephalomyelitis preceding measles virus infection. Brain magnetic resonance imaging revealed signal intensity abnormalities in the basal ganglia and cortex consistent with acute disseminated encephalomyelitis. Fever and the first Koplik spots appeared 8 and 10 days later, respectively. This case supports the hypothesis that the immune-mediated demyelinating process may occur before the symptomatic phase of a viral infection. Therefore, children without history of infectious disorders should also have acute disseminated encephalomyelitis included in the differential considerations.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. [Exanthema as a main symptom in the febrile child].

    Science.gov (United States)

    Aebi, C

    2005-08-01

    Distinguishing in febrile children between harmless rashes and those, which require specific action, is a common problem in pediatric primary care. Major exanthematous diseases necessitating emergency hospitalization include invasive meningococcal disease and rarely gram-negative septicaemia caused by other pathogens, staphylococcal and streptococcal toxic shock syndrome, endocarditis, fever and rash in travellers returning from tropical countries and drug hypersensitivity syndrome. Therapeutic intervention is also necessary in patients with scarlet fever, rheumatic fever, varicella in postpuberal and immunocompromised individuals, in Kawasaki's disease, in Still's disease and in other non-infectious, inflammatory diseases (e.g., familial mediterranean fever). Finally, various specific measures need to be taken in reportable diseases, erythema infectiosum (parvovirus B19), primary HIV infection and in Henoch-Schölein purpura.

  20. [Fixed drug-induced exanthema of the glans].

    Science.gov (United States)

    Sánchez Merino, José María; López Pacios, José Carlos; Parra Muntaner, Luis; Alija Senra, Antonio; Piñeiro Fernández, María del Carmen; García Alonso, Jesús

    2003-01-01

    To claim attention on an relatively frequent adverse reaction to drugs affecting genitalia, therefore a reason for consultation to the Urology Department. We report a clinical case and a bibliographic review of this disease. Fixed drug eruption is a cutaneous eruption secondary to drug intake that appears every time the drug is taken, always in the same location, being more common in hands and feet. The course of the disease is usually progressive with increasing number of lesions after each dose of drug taken. Relapsing lesions in the same spot is key for the proper diagnosis of this eruption. To forbid causing drug intake is the treatment of choice, although it may be necessary to administer local or even oral corticosteroids.

  1. Exanthema in Legionnaires' disease mimicking a severe cutaneous drug reaction.

    Science.gov (United States)

    Ziemer, M; Ebert, K; Schreiber, G; Voigt, R; Sayer, H G; Marx, G

    2009-07-01

    Legionnaires' disease is an acute bacterial infection, generally caused by Legionella pneumophila, which primarily involves the lower respiratory tract, although it is often associated with multisystemic extrapulmonary features. Cutaneous features are very uncommon and may include erythematous or petechial, macular or maculopapular lesions. We report a male patient who expressed all features of a severe lobular pneumonia. Over the course of the disease the patient developed a livid erythematous, maculopapular exanthem rapidly extending over the entire body. Given the rapid development and target-like appearance of the skin lesions with extensive skin involvement and blister formation, the initial diagnosis was that of a severe cutaneous drug reaction. However, histological examination of biopsy did not confirm this diagnosis, but instead was suspicious for a viral exanthem or a more aggressive inflammatory response due to sensitization to bacterial antigens. L. pneumophila infection was verified during the course of the disease.

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

    OpenAIRE

    Zawar V

    2003-01-01

    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.

  3. 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

    . After prophylactic treatment with antihistamine and corticosteroid, an uneventful rest MPI was performed. Discussion and conclusion:  International recommendations or guidelines related to treatment of AEs after nuclear medicine studies do not exist. Serious AEs in nuclear medicine are very rare...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  5. Unusual exanthema combined with cerebral vasculitis in pneumococcal meningitis: a case report

    Directory of Open Access Journals (Sweden)

    Raissaki Maria

    2011-08-01

    Full Text Available Abstract Introduction Bacterial meningitis is a complex, rapidly progressive disease in which neurological injury is caused in part by the causative organism and in part by the host's own inflammatory responses. Case presentation We present the case of a two-year-old Greek girl with pneumococcal meningitis and an atypical curvilinear-like skin eruption, chronologically associated with cerebral vasculitis. A diffusion-weighted MRI scan showed lesions with restricted diffusion, reflecting local areas of immunologically mediated necrotizing vasculitis. Conclusions Atypical presentations of bacterial meningitis may occur, and they can be accompanied by serious unexpected complications.

  6. Unilateral laterothoracic exanthema with coincident evidence of Epstein Barr virus reactivation: exploration of a possible link.

    Science.gov (United States)

    Scheinfeld, Noah

    2007-07-13

    Unilateral laterothoracic exanthem (ULE) was first described in 1962 in the United States and comprehensively elaborated in 1992. Although ULE most commonly occurs in children, ULE can occur in adults. ULE may or may not be preceded by a viral prodrome and is marked by coalescing erythematous papules predominately on one side of the body. ULE usually lasts 4-6 weeks but can last as little as 2 weeks. It has inconsistently been linked to viral infection, in particular parvovirus B-19. I note ULE in an adult with concurrent reactivation of Epstein Barr virus (EBV) that lasted 4 weeks. The role of the reactivation of EBV in human disease and ULE is explored.

  7. Unusual exanthema combined with cerebral vasculitis in pneumococcal meningitis: a case report

    OpenAIRE

    Raissaki Maria; Geromarkaki Elisabeth; Ilia Stavroula; Spanaki Anna-Maria; Tavladaki Theonimfi; Briassoulis George

    2011-01-01

    Abstract Introduction Bacterial meningitis is a complex, rapidly progressive disease in which neurological injury is caused in part by the causative organism and in part by the host's own inflammatory responses. Case presentation We present the case of a two-year-old Greek girl with pneumococcal meningitis and an atypical curvilinear-like skin eruption, chronologically associated with cerebral vasculitis. A diffusion-weighted MRI scan showed lesions with restricted diffusion, reflecting local...

  8. Detection of human herpesvirus 7 infection in young children presenting with exanthema subitum

    OpenAIRE

    Ivna de Melo Magalhães; Rebeca Vazquez Novo Martins; Renata Oliveira Vianna; Natalia Moysés; Larissa Alves Afonso; Solange Artimos de Oliveira; Silvia Maria Baeta Cavalcanti

    2011-01-01

    In this study, we assessed the prevalence of human herpesvirus-7 (HHV-7) in 141 serum samples from children less than four years of age with exanthematic disease. All samples were negative for measles, rubella, dengue fever and parvovirus B19 infection. Testing for the presence of human herpesvirus-6 (HHV-6)-specific high avidity IgG antibodies by indirect immunofluorescence assay (IFA) revealed two main groups: one composed of 57 patients with recent primary HHV-6 infection and another group...

  9. [Sub-Saharan traveler with papulovesicular exanthema and flu-like symptoms].

    Science.gov (United States)

    Strub, C; Weisser, M; Bassetti, S

    2004-12-01

    African tick bite fever (ATBF) is an infectious disease commonly observed in travelers to sub-Saharan Africa. Because the presentation of the disease is often not specific, ATBF is frequently not diagnosed or confused with Mediterranean spotted fever. We present the case of a 63-year-old woman with typical history and symptoms. The diagnosis of ATBF was serologically confirmed by immunofluoroscence. ATBF is an important differential diagnosis of fever in patients returning from sub-Saharan Africa.

  10. Exantema hemorrágico por virus dengue inducido por ácido acetil-salicílico Haemorrhagic exanthema due to dengue virus induced by acetylsalicylic acid

    OpenAIRE

    Valerio, L; X. Balanzó; Jiménez, O.; Pedro-Botet, M.L.

    2006-01-01

    El dengue, enfermedad infecciosa vírica propia de los climas tropicales, se considera una patología reemergente que ha dado lugar a graves epidemias en la última década. En la expansión del virus y de su mosquito vector se barajan factores relacionados con la alteración humana del medio, con la rapidez en el tránsito de mercancias y personas y debidos al cambio climático. Como reflejo de ello, se asiste a un aumento de casos importados que, al ser una enfermedad con periodo de incubación cort...

  11. 7 CFR 51.1000 - U.S. No. 1.

    Science.gov (United States)

    2010-01-01

    ... or mushy condition, sprayburn, exanthema (ammoniation), scars, thorn scratches, scale, sunburn, scab, blanching, yellow color, discoloration, buckskin, dirt or other foreign material, disease, insects or...

  12. 7 CFR 51.1002 - U.S. No. 2.

    Science.gov (United States)

    2010-01-01

    ... from serious damage caused by freezing, dryness or mushy condition, sprayburn, exanthema (ammoniation... other foreign material, disease, insects or mechanical or other means. (a) Each fruit in this grade...

  13. Necrolisis epidérmica tóxica. Terapia en UCI con inmunoglobulinas intravenosas en un caso

    OpenAIRE

    Andresen H,Max; Boghero,Yerko; Molgó,Montserrat; Dougnac L,Alberto; Díaz, Orlando

    2000-01-01

    We report a 27 years old homosexual male with AIDS that was admitted to the ICU dehydrated, with fever and severe malaise. He had irregular bullae, an extensive purpuric exanthema and a zone of epidermic detachment in the right arm. A toxic epidermal necrolysis was diagnosed and therapy with i.v. immunoglobulins was started. After four days of treatment, bullous lesions disappeared and the extension of exanthema decreased. Toxic epidermal necrolysis is a potentially fatal disease and the use ...

  14. 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.

  15. Full-texts Representations with Medical Subject Headings, and Co-citations Network Reranking Strategies for TREC 2014 Clinical Decision Support Track

    Science.gov (United States)

    2014-11-01

    as proteinuria and RBC casts.</summary> <MeSH_in_summary>Female ; Arthralgia ; Fa- tigue ; Butterflies ; Exanthema ; DNA ; Pro- teinuria ; DNA...documents. This strategy achieved leading results with patents (see TREC Chem campaigns [3], with up to + 150 % for MAP), but it was the first time we

  16. [Uncommon cutaneous presentation of visceral Leishmaniasis associated with HIV].

    Science.gov (United States)

    Cossart, C; Le Moal, G; Garcia, M; Frouin, E; Hainaut-Wierzbicka, E; Roblot, F

    2016-12-01

    Visceral leishmaniasis is not normally expressed in skin. Herein, we describe the case of an HIV-positive patient who developed two unusual skin manifestations during an episode of visceral leishmaniasis. A 48-year-old female patient consulted initially for infiltrated purpura of all four limbs. Skin biopsy revealed leukocytoclastic vasculitis with Leishman-Donovan bodies. Laboratory tests showed medullary, splenic, gastric and colic involvement, suggesting systemic disease, and enabling visceral leishmaniasis to be diagnosed. Two years later, despite prolonged treatment, the patient presented maculopapular exanthema, and histology revealed persistent Leishman-Donovan bodies. We report herein an association of two rare skin manifestations in an HIV-positive patient with visceral leishmaniasis: infiltrated purpura and maculopapular exanthema. However, the underlying mechanisms remain hypothetical. The initial leukocytoclastic exanthema could be secondary to either polyclonal hypergammaglobulinaemia or to IgA deposits, or possibly to mechanical impairment of blood vessels by the actual parasite. The maculopapular exanthema occurring later raised the possibility of post-Kala-Azar leishmaniasis due to blood-borne dissemination in an anergic subject or perhaps even immune reconstitution inflammatory syndrome. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Disease: H00369 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H00369 Exanthema subitum; Roseolovirus infection; Roseola; Pityriasis rosea Human ...ss have been linked to it. Infectious disease ... Human herpesvirus 6B [GN:T40075]...-6, 7 and their related diseases. ... JOURNAL ... J Dermatol Sci 22:205-12 (2000) DOI:10.1016/S0923-1811(99)00086-9 ...

  18. CPD

    African Journals Online (AJOL)

    Agents may stimulate sensory nerves to release substance P ... job duties and work processes for both patient and co—workers. ... Uncommon: tachycardia, muscle cramps, agitation. rec lessness, nausea dizziness, and sleep disturbances. Rare: exanthema, urticaria, pruritus, skin bruismg and bronchospasm. Other rare or ...

  19. De eerste pasgeborene met congenitaal rubellasyndroom tijdens de rubella-epidemie in Nederland in 2004-'05

    NARCIS (Netherlands)

    Mol, A.C. de; Vrancken, S.L.A.G.; Eggink, A.J.; Verduyn Lunel, F.M.; Warris, A.

    2006-01-01

    A newborn male was diagnosed with congenital rubella syndrome. His 31-year-old mother had had erythematous exanthema during a period of amenorrhea lasting 7 weeks; she was not vaccinated and had never had a rubella infection. The infection was confirmed serologically. The mother gave birth to an

  20. ABACAVIR: ITS USE AND HYPERSENSITIVITY CLiNiCAL

    African Journals Online (AJOL)

    screening for HLA-B*5701 is very costly. Cheaper meth- ods involving PCR for small sequences of the gene are currently under review. Although full testing is avail- able in South Africa, .... on trunk, arms and legs the chest. Papules on the trunk and. Exanthema in mouth left arm. Non-purulent conjunctivitis. Gastrointestinal.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 7 CFR 51.1010 - Damage.

    Science.gov (United States)

    2010-01-01

    ... exceed the area of a circle one-half inch in diameter; (d) Scars which are dark, rough, or deep and in... when dark colored, rough or deep and in the aggregate exceeds the area of a circle one-fourth inch in... area of a circle one-fourth inch in diameter; (c) Exanthema (ammoniation) which materially detracts...

  3. Reemerging threat of epidemic typhus in Algeria.

    Science.gov (United States)

    Mokrani, K; Fournier, P E; Dalichaouche, M; Tebbal, S; Aouati, A; Raoult, D

    2004-08-01

    We report a case of epidemic typhus in a patient from the Batna region of Algeria, who presented with generalized febrile exanthema. The clinical diagnosis was confirmed by serological cross-adsorption followed by Western blotting. Our report emphasizes the threat of epidemic typhus in the highlands of Algeria.

  4. [A girl with desquamation of hands and feet].

    Science.gov (United States)

    Chung, Pui Khi; Vergunst, Clarissa E; van der Kuip, Martijn

    2014-01-01

    A 3-year-old girl presented with desquamation of hands and feet, preceded by sore throat and subfebrile temperature. She developed exanthema with typical skip lesions and orange hyperkeratosis. The diagnosis 'classic juvenile pityriasis rubra pilaris' was made. The girl was successfully treated with acitretin.

  5. [An unsuspected imported disease: meningo-encephalitis contracted in Spain

    NARCIS (Netherlands)

    Thijssen, H.S.; Leroy, P.L.J.M.; Hek, L.G. van 't; Hurkx, G.A.

    2004-01-01

    A 13-year-old boy consulted a doctor during a holiday in Spain because of high fever, headache and exanthema. A local physician prescribed josamycin, but the medication was lost due to vomiting. A few days later, shortly after returning to the Netherlands, he was hospitalised with a life-threatening

  6. 9 CFR 71.3 - Interstate movement of diseased animals and poultry generally prohibited.

    Science.gov (United States)

    2010-01-01

    ... exanthema, screwworms and glanders, scabies in sheep or any other communicable foreign disease not known to... generally prohibited. (a) Animals or poultry affected with any of the following diseases, which are endemic... cattle, pseudorabies, acute swine erysipelas, tuberculosis, Johne's disease, brucellosis, scrapie...

  7. Tetrazepam drug sensitivity -- usefulness of the patch test.

    Science.gov (United States)

    Pirker, C; Misic, A; Brinkmeier, T; Frosch, P J

    2002-09-01

    The muscle relaxant tetrazepam may cause severe cutaneous adverse effects. We report 4 cases of varying intensity: Stevens-Johnson syndrome, erythema-multiforme-like exanthema, maculopapular and maculo-urticarial exanthema. Patch testing with tetrazepam (10% in petrolatum) was strongly positive in the 2 patients with severe skin eruptions and weakly positive in the other 2. Oral rechallenge with tetrazepam was positive in 3 patients (1 not done). Diazepam, with a similar chemical structure to tetrazepam, was negative on patch testing and on oral challenge testing in 2 patients. Although the optimal patch test concentration of tetrazepam has still to be determined, it is a useful diagnostic tool to confirm sensitization, particularly in patients with severe bullous eruptions.

  8. 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...

  9. From past sailors’ eras to the present day: scurvy as a surprising manifestation of an uncommon gastrointestinal disease

    Science.gov (United States)

    Branquinho, Diogo Ferreira; Pinto-Gouveia, Miguel; Mendes, Sofia; Sofia, Carlos

    2015-01-01

    A 45-year-old man presented with follicular exanthema in his lower limbs, alternating bowel habits and significant weight loss. His medical history included seronegative arthritis, bipolar disease and an inconclusive diagnostic laparoscopy. Diagnostic work up revealed microcytic anaemia and multivitamin deficiency. Skin biopsy of the exanthema suggested scurvy. Owing to these signs of malabsorption, upper endoscopy with duodenal biopsies was performed, exhibiting villous atrophy and extensive periodic acid-Schiff-positive material in the lamina propria, therefore diagnosing Whipple's disease (WD). After starting treatment with ceftriaxone and co-trimoxazole, an impressive recovery was noted, as the wide spectrum of malabsorption signs quickly disappeared. After a year of antibiotics, articular and cutaneous manifestations improved, allowing the patient to stop taking corticosteroids and antidepressants. This truly unusual presentation reflects the multisystemic nature of WD, often leading to misdiagnosis of other entities. Scurvy is a rare finding in developed countries, but its presence should raise suspicion for small bowel disease. PMID:26376699

  10. Adverse reaction to tetrazepam.

    Science.gov (United States)

    Palacios Benito, R; Domínguez Ortega, J; Alonso Llamazares, A; Rodríguez Morales, A; Plaza Díaz, A; Chamorro Gómez, M; Martínez-Cócera, C

    2001-01-01

    Adverse reactions caused by benzodiazepines rarely occur. We present a case of a 70-year-old man who developed a maculopapular exanthema after the ingestion of tetrazepam. For his diagnosis, skin tests were performed, including prick and patch tests, not only with the benzodiazepine implicated in the reaction, but also with benzodiazepines of other groups. Single-blind oral challenge tests were also performed in the patient, in order to assess his tolerance to other benzodiazepines.

  11. Mise au point sur les herpesvirus humains 6A, 6B et 7

    OpenAIRE

    Agut, H; Bonnafous, P.; Gautheret-Dejean, A.

    2016-01-01

    International audience; Human herpesviruses 6A, 6B, and 7 (HHV-6A, HHV-6B, HHV-7) are genetically related to cytomegalovirus. They belong to the Roseolovirus genus and to the Betaherpesvirinae subfamily. They infect T cells, monocytes-macrophages, epithelial cells, and central nervous system cells. These viruses are ubiquitous and are responsible for lifelong chronic infections, most often asymptomatic, in the vast majority of the general adult population. HHV-6B is responsible for exanthema ...

  12. A novel mutation in the NOD2 gene associated with Blau syndrome: a Norwegian family with four affected members

    DEFF Research Database (Denmark)

    Milman, N; Ursin, K; Rødevand, E

    2009-01-01

    not previously been described. All of his three children had Blau syndrome and had inherited the NOD2 mutation. The proband's first son had exanthema, arthritis, and uveitis from 10 years of age and later presented with granulomatous lymphadenopathy, granulomatous parotitis, and granulomatous intestinal...... with an autosomal dominant heritage. Most likely the mutation has arisen de novo in the proband. Genetic counselling and antenatal diagnostics should be available to the involved families....

  13. Viral exanthems in the tropics.

    Science.gov (United States)

    Carneiro, Sueli Coelho da Silva; Cestari, Tania; Allen, Samuel H; Ramos e-Silva, Marcia

    2007-01-01

    Viral exanthems are a common problem in tropical regions, particularly affecting children. Most exanthems are transient and harmless, but some are potentially very dangerous. Pregnant women and malnourished or immunocompromised infants carry the greatest risk of adverse outcome. In this article, parvovirus B19; dengue and yellow fever; West Nile, Barmah Forest, Marburg, and Ebola viruses, and human herpesviruses; asymmetric periflexural exanthema of childhood; measles; rubella; enteroviruses; Lassa fever; and South American hemorrhagic fevers will be discussed.

  14. Antidotes for Ricin Intoxication. Effects of Ricin on the Vascular Neuroeffector System

    Science.gov (United States)

    1992-10-25

    pressure, changes in electrocardiogram, asthmatic symptoms, exanthema , liver necrosis, nephritis, proteinuria, rise in excretion of non-protein nitrogen...and increased with time. Of the 38 patients which were evaluated for antitumor effect, 1 had a partial response and 8 patients had stable disease . The...immunotoxin in HTLV-1 disease . A significant problem arose when using the immunoconjugates in vivo. The mannose and fucose residues present on the ricin A

  15. Epidemiologic and Clinical Features of Measles and Rubella in a Rural Area in China

    Directory of Open Access Journals (Sweden)

    Youwang Yan

    2005-12-01

    Conclusion: Measles and rubella are 2 common communicable diseases in the children of Jingzhou District, with outbreaks being the main epidemic form. Some clinical features such as temperature, duration of the prodromal stage and exanthema are different in measles and rubella, and they can be useful in distinguishing between the 2 diseases. Accuracy in the clinical diagnosis of measles should be improved by enhancing serologic testing for measles and rubella, and by identifying patients' specific clinical characteristics.

  16. HLA-A★3101 and Carbamazepine-Induced Hypersensitivity Reactions in Europeans

    Science.gov (United States)

    McCormack, Mark; Alfirevic, Ana; Bourgeois, Stephane; Farrell, John J.; Kasperavičiūtė, Dalia; Carrington, Mary; Sills, Graeme J.; Marson, Tony; Jia, Xiaoming; de Bakker, Paul I.W.; Chinthapalli, Krishna; Molokhia, Mariam; Johnson, Michael R.; O’Connor, Gerard D.; Chaila, Elijah; Alhusaini, Saud; Shianna, Kevin V.; Radtke, Rodney A.; Heinzen, Erin L.; Walley, Nicole; Pandolfo, Massimo; Pichler, Werner; Park, B. Kevin; Depondt, Chantal; Sisodiya, Sanjay M.; Goldstein, David B.; Deloukas, Panos; Delanty, Norman; Cavalleri, Gianpiero L.; Pirmohamed, Munir

    2011-01-01

    BACKGROUND 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. METHODS We performed a genomewide association study of samples obtained from 22 subjects with carbamazepine-induced hypersensitivity syndrome, 43 subjects with carbamazepine-induced maculopapular exanthema, and 3987 control subjects, all of European descent. We tested for an association between disease and HLA alleles through proxy single-nucleotide polymorphisms and imputation, confirming associations by high-resolution sequence-based HLA typing. We replicated the associations in samples from 145 subjects with carbamazepine-induced hypersensitivity reactions. RESULTS The HLA-A★3101 allele, which has a prevalence of 2 to 5% in Northern European populations, was significantly associated with the hypersensitivity syndrome (P = 3.5×10−8). An independent genomewide association study of samples from subjects with maculopapular exanthema also showed an association with the HLA-A★3101 allele (P = 1.1×10−6). Follow-up genotyping confirmed the variant as a risk factor for the hypersensitivity syndrome (odds ratio, 12.41; 95% confidence interval [CI], 1.27 to 121.03), maculopapular exanthema (odds ratio, 8.33; 95% CI, 3.59 to 19.36), and SJS–TEN (odds ratio, 25.93; 95% CI, 4.93 to 116.18). CONCLUSIONS The presence of the HLA-A★3101 allele was associated with carbamazepine-induced hypersensitivity reactions among subjects of Northern European ancestry. The presence of the allele increased the risk from 5.0% to 26.0%, whereas its absence reduced the risk from 5.0% to 3.8%. (Funded by the U.K. Department of Health and others.) PMID:21428769

  17. A novel mutation in the NOD2 gene associated with Blau syndrome: a Norwegian family with four affected members.

    Science.gov (United States)

    Milman, N; Ursin, K; Rødevand, E; Nielsen, F C; Hansen, T V O

    2009-01-01

    Blau syndrome is a chronic granulomatous disease with an autosomal dominant trait characterized by the triad granulomatous dermatitis, arthritis, and uveitis. It is caused by mutations in the NOD2 gene, also termed the CARD15 gene. To report a novel mutation in the NOD2 gene associated with Blau syndrome. The proband was a 68-year-old ethnic Norwegian male who had uveitis and arthritis since 10 years of age followed by lifelong recurrent arthritis and chronic eye involvement. Genetic analysis showed a heterozygous c.1814 C>A, T605N mutation in NOD2 that has not previously been described. All of his three children had Blau syndrome and had inherited the NOD2 mutation. The proband's first son had exanthema, arthritis, and uveitis from 10 years of age and later presented with granulomatous lymphadenopathy, granulomatous parotitis, and granulomatous intestinal inflammation. The proband's daughter had arthritis, uveitis, and exanthema from 3 years of age. The proband's second son had uveitis, exanthema, and arthritis from 1.5 years of age. None of the cases had any involvement of the heart or lungs. We report a novel Blau syndrome-associated mutation with an autosomal dominant heritage. Most likely the mutation has arisen de novo in the proband. Genetic counselling and antenatal diagnostics should be available to the involved families.

  18. 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.

  19. [Blau syndrome in monozygotic twins].

    Science.gov (United States)

    Milman, Nils; Hansen, Annette; van Overeem Hansen, Thomas; Byg, Keld-Erik; Nielsen, Ole Haagen

    2006-10-16

    This case report describes Blau syndrome in monozygotic twins. The disease ran an identical course in both patients, starting with a maculopapulous exanthema at one year of age. Skin biopsies showed epithelioid cell granulomas with multinucleated giant cells. Shortly after arthritis and periarticular swelling developed and uveitis appeared at 8 years of age. Treatment consisted of prednisolone and methotrexate, and from 18 years of age of infliximab, with good effect. DNA analysis showed de novo R334W mutation in the CARD15 gene. The patients have now been followed for 19 years and are in good clinical condition.

  20. [Kawasaki disease: report of 6 cases].

    Science.gov (United States)

    Scarpellini Vera, A; Borque, C; García Sicilia, J; Barrionuevo, J L; Sebastián, M; Hortelano, J G

    1984-06-01

    Six cases of children between 20 months and 6 years old, who suffer Kawasaki disease are presented. All of them had diagnostic parameters required by the Investigation Committee of this disease, with similar clinical symptoms as in other countries but with an upper average age (3 years old) to Japanese patients and nearer to that of the North American patients. It is important to emphasize the appearance of exanthema in one case, as well as a multiforme erythema exudative, a rare fact, and the observation, up to now not shown, of a positive rheumatoid factor in another two of the patients. All have undergone a good evolution without cardiovascular complications.

  1. [Work-related stress urticaria].

    Science.gov (United States)

    Landex, Nadia Lander

    2016-12-12

    A medical doctor occasionally experienced itching papular exanthema during work hours. Careful history taking and a diary of symptoms demonstrated an association between the urticaria and stressful work situations. Urticaria can have many triggers, and stress is among the well-known triggers. The usual treatment of urticaria consists of avoiding triggers and, if necessary, antihistamines. Whereas it might be difficult to follow these recommendations in the case of work-related urticaria, the disorder may be perceived as a reminder of work situations which are going awry.

  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

    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...... in common with sarcoidosis, but rarely involves the lungs or other parenchymatous organs. In children, discrimination between early onset sarcoidosis and Blau syndrome should include a CARD15 mutation analysis....

  3. Erhvervsrelateret stressurticaria

    DEFF Research Database (Denmark)

    Landex, Nadia Lander

    2016-01-01

    A medical doctor occasionally experienced itching papular exanthema during work hours. Careful history taking and a diary of symptoms demonstrated an association between the urticaria and stressful work situations. Urticaria can have many triggers, and stress is among the well-known triggers. The....... The usual treatment of urticaria consists of avoiding triggers and, if necessary, antihistamines. Whereas it might be difficult to follow these recommendations in the case of work-related urticaria, the disorder may be perceived as a reminder of work situations which are going awry....

  4. 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.

  5. Infectious Disease Rates in the U.S. Navy, 1980 to 1995

    Science.gov (United States)

    2001-06-01

    20 to 21-year age group. Military Medicine, Vol. 166, June 2001 546 Infectious Diseases TABLE II Other Exanthema HOSPITALIZED INCIDENCE RATES PER...NAVAL HEALTH RESEARCH CENTER INFECTIOUS DISEASE RATES IN THE U. S. NAVY, 1980 TO 1995 E. K. E. Gunderson C. Garland L. L. Hourani 20040203 063 Report...MEDICINE AND SURGERY (MED-02) 2300 E ST. NW WASHINGTON, DC 20372-5300 MILITARY MEDICINE, 166, 6:544, 2001 Infectious Disease Rates in the U.S. Navy, 1980 to

  6. CLINICAL AND LABORATORY FEATURES OF PARVOVIRUS INFECTION IN CHILDREN

    Directory of Open Access Journals (Sweden)

    E. V. Sharipova

    2013-01-01

    Full Text Available The article is devoted to the study of clinical symptoms and laboratory changes at parvovirus B19 infection in children during the rise of the incidence of infectious erythema. 44 children ailing with laboratory confirmed parvovirus B19 infection aging from 2 months to 14 years were complexly examined. It was established that the disease occurs mainly in boys of preschool and early school age, with a seasonal rise in April and May. General infectious syndrome and syndrome of exanthema dominate the clinical picture. Infectious erythema has benign course.

  7. Anti-oxidant enzyme activities and expression and oxidative damage in patients with non-immediate reactions to drugs.

    Science.gov (United States)

    Cornejo-Garcia, J A; Mayorga, C; Torres, M J; Fernandez, T D; R-Pena, R; Bravo, I; Mates, J M; Blanca, M

    2006-08-01

    Adverse drug reactions with an immunological basis (ADRIB) may involve activation of other concomitant, non-specific mechanisms, amplifying the specific response and contributing to the severity and duration. One concomitant mechanism could be the generation of reactive oxygen species (ROS) and/or their detoxification by anti-oxidants, including anti-oxidant enzymes. We analysed the activity of the anti-oxidant enzymes Cu/Zn-superoxide dismutase (SOD), catalase (CAT) and cellular glutathione peroxidase (GPX), as well as certain markers of oxidative damage (thiobarbituric acid reactive substances (TBARS) and carbonyl content) in peripheral blood mononuclear cells from patients with non-immediate ADRIB using spectrophotometric methods and the anti-oxidant enzymes expression by quantitative real-time reverse transcription-polymerase chain reaction. SOD activity and expression were increased in all types of non-immediate reactions (urticaria, maculopapular exanthema and toxic epidermal necrolysis). Regarding oxidative damage, TBARS were increased in urticaria and maculopapular exanthema, and carbonyl groups in all types of reactions. Our observations indicate that oxidative damage occurs in non-immediate reactions. Carbonyl stress and the inadequacy of the anti-oxidant defences are probable causes.

  8. Suspicion of macrolide allergy after treatment of infectious diseases including Helicobacter pylori: results of allergological testing.

    Science.gov (United States)

    Seitz, Cornelia S; Bröcker, Eva-B; Trautmann, Axel

    2011-01-01

    Macrolides are useful in a wide range of bacterial infections including upper and lower respiratory tract, skin, and sexually transmitted diseases and are used in Helicobacter pylori eradication regimen. Skin symptoms occurring during drug therapy are mostly attributed to the antibiotic, causing considerable limitations of future therapeutic options. The aim of this retrospective analysis was to demonstrate results of diagnostic testing in cases of clinically suspected immediate and delayed macrolide hypersensitivity. A total of 125 patients with a history of immediate or delayed hypersensitivity symptoms in temporal relation to treatment with a macrolide antibiotic were studied using standardised skin tests followed by oral challenges. Selected patients with severe symptoms were further evaluated with in vitro tests. Macrolide hypersensitivity was excluded in 109 patients (87.2%) by tolerated oral challenge tests. During 113 challenges in four patients an exanthema was provoked by the suspected macrolide. Only one patient developed a positive late skin test reaction. Out of the 28 Helicobacter pylori-treated patients, one patient with clarithromycin allergy was identified, whereas in eight cases amoxicillin allergy caused the exanthema. Laboratory tests using the suspected macrolides were constantly negative. History alone leads to an over-estimation of macrolide hypersensitivity. Moreover, skin and in vitro tests seem to be not very useful in identifying hypersensitive patients. Challenge tests appear to be necessary for definitely confirming or ruling out macrolide allergy. Copyright © 2010 SEICAP. Published by Elsevier Espana. All rights reserved.

  9. Comparison of jeopardy game format versus traditional lecture format as a teaching methodology in medical education.

    Science.gov (United States)

    Khan, Mohammad N; Telmesani, Abdulwahab; Alkhotani, Abdulaziz; Elzouki, Abdelaziz; Edrees, Burhan; Alsulimani, Mohammad H

    2011-11-01

    To compare students` performance, satisfaction, and retention of knowledge between a `jeopardy game format` and a `didactic lecture format` in teaching viral exanthema to fifth-year medical students. We conducted a parallel-group randomized controlled trial in the Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia from November 2008 to January 2009. We randomized fifth-year medical students into 2 groups. We taught viral exanthema to group one in lecture format, while group 2 received the same instruction in a jeopardy style game format. Both groups underwent a pretest, post-test I, and satisfaction survey. We conducted post-test II after 2 months to assess the retention of knowledge. The satisfaction survey consisted of 5 questions using a 5 point Likert scale. We used the paired sample t-test, and independent sample t-test to compare the results. Eighty-two students participated in the study (41 in each group). Both groups showed significant improvement in their knowledge on the post-test I compared with the pre-test scores. However, the post-test II conducted after 2 months showed that retention of knowledge was significantly better in the game format. The satisfaction survey showed that the game format was more enjoyable and fun. The game format teaching strategy has an added advantage in retaining knowledge of the subject for a longer time compared with a lecture format.

  10. 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.

  11. Cross-reactivity and tolerability of cephalosporins in patients with cell-mediated allergy to penicillins.

    Science.gov (United States)

    Buonomo, A; Nucera, E; Pecora, V; Rizzi, A; Aruanno, A; Pascolini, L; Ricci, A G; Colagiovanni, A; Schiavino, D

    2014-01-01

    13-Lactams are the most commonly used antibiotics but they can cause hypersensitivity reactions. We sought to estimate cross-reactivity and tolerability of cephalosporins in patients with cell-mediated allergy to penicillins. We studied 97 patients with a clinical history of nonimmediate reactions to a penicillin and a positive patch test result to at least 1 of the penicillins tested. All patients also underwent patch testing with several cephalosporins. Patients with a negative patch test to a cephalosporin underwent test dosing in order to assess tolerability. We recorded 129 reactions. The most commonly involved drugs were aminopenicillins, and the most widely reported symptoms were delayed urticaria and maculopapular exanthema. Seventeen patients had positive patch test results for cephalosporins, mostly for cephalexin (n=10), cefaclor (n=9), and cefuroxime axetil (n=5). All the patients-except 4 who experienced an exanthema after the challenge test with cephalexin-tolerated a therapeutic dose of the cephalosporin tested without any adverse effects. Our data show that cross-reactivity between penicillins and cephalosporins may be as high as 10.9% for first-generation cephalosporins and 1.1% for third-generation cephalosporins, possibly due to the involvement of similar side chains. Patch tests are a useful diagnostic tool to assess cross-reactivity, but a graded challenge is mandatory because a negative patch test does not always mean tolerability.

  12. [Group enterovirus infection due to coxsackievirus A16 in Northwestern Russia].

    Science.gov (United States)

    Bichurina, M A; Romanenkova, N I; Novikova, N A; Golitsyna, L N; Rozaeva, N R; Kanaeva, O I; Ermakova, M V; Kamynina, L S; Madoian, A G; Valdaĭtseva, N V; Leonova, N P; Ivanova, T G

    2014-01-01

    Study features of epidemic process and etiology of oral cavity and limb enterovirus exanthema group diseases in a number of territories of Northwestern Russia. Isolation and identification of non-poliomyelitis enteroviruses from material of patients was carried out according to WHO recommendations. Phenotyping and phylogenetic analysis of enteroviruses was carried out. In 3 territories of Northwestern Russia oral cavity and limb enterovirus group diseases were registered. Children aged less than 14 years, predominately aged less than 3 years, were shown to be involved in the epidemic process. Coxsackie A16 enteroviruses from 27 samples of patients were isolated in cell cultures and identified by using specific sera. Coxsackie A16 enteroviruses from 16 samples were identified by using partial sequencing of VP1 genome area. Phylogenetic analysis has shown that the identified Coxsackie A16 viruses distributed among 2 phylogenetic groups. Coxsackie A16 enteroviruses that had never been detected in the region previously were established to be the etiologic factor of oral cavity and limb enterovirus exanthema group disease in the 3 territories of Northwestern Russia. The data obtained give evidence on the necessity of epidemiologic and virological control for enterovirus infection with the aim of obtaining novel information on the circulation of non-poliomyelitis enteroviruses in the population and the establishment of development patterns for epidemic process of this infection.

  13. From past sailors' eras to the present day: scurvy as a surprising manifestation of an uncommon gastrointestinal disease.

    Science.gov (United States)

    Branquinho, Diogo Ferreira; Pinto-Gouveia, Miguel; Mendes, Sofia; Sofia, Carlos

    2015-09-16

    A 45-year-old man presented with follicular exanthema in his lower limbs, alternating bowel habits and significant weight loss. His medical history included seronegative arthritis, bipolar disease and an inconclusive diagnostic laparoscopy. Diagnostic work up revealed microcytic anaemia and multivitamin deficiency. Skin biopsy of the exanthema suggested scurvy. Owing to these signs of malabsorption, upper endoscopy with duodenal biopsies was performed, exhibiting villous atrophy and extensive periodic acid-Schiff-positive material in the lamina propria, therefore diagnosing Whipple's disease (WD). After starting treatment with ceftriaxone and co-trimoxazole, an impressive recovery was noted, as the wide spectrum of malabsorption signs quickly disappeared. After a year of antibiotics, articular and cutaneous manifestations improved, allowing the patient to stop taking corticosteroids and antidepressants. This truly unusual presentation reflects the multisystemic nature of WD, often leading to misdiagnosis of other entities. Scurvy is a rare finding in developed countries, but its presence should raise suspicion for small bowel disease. 2015 BMJ Publishing Group Ltd.

  14. Impact of the HLA-B(*)58:01 Allele and Renal Impairment on Allopurinol-Induced Cutaneous Adverse Reactions.

    Science.gov (United States)

    Ng, Chau Yee; Yeh, Yu-Ting; Wang, Chuang-Wei; Hung, Shuen-Iu; Yang, Chih-Hsun; Chang, Ya-Ching; Chang, Wan-Chun; Lin, Yu-Jr; Chang, Chee-Jen; Su, Shih-Chi; Fan, Wen-Lang; Chen, Der-Yuan; Wu, Yeong-Jian Jan; Tian, Ya-Chung; Hui, Rosaline Chung-Yee; Chung, Wen-Hung

    2016-07-01

    Allopurinol, a common drug for treating hyperuricemia, is associated with cutaneous adverse drug reactions ranging from mild maculopapular exanthema to life-threatening severe cutaneous adverse reactions, including drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis. We have previously reported that HLA-B*58:01 is strongly associated with allopurinol-induced severe cutaneous adverse reactions in Han Chinese, but the associations of the HLA-B*58:01 genotype in an allopurinol-induced hypersensitivity phenotype remain unclear. To investigate the comprehensive associations of HLA-B*58:01, we enrolled 146 patients with allopurinol-induced cutaneous adverse drug reactions (severe cutaneous adverse reactions, n = 106; maculopapular exanthema, n = 40) and 285 allopurinol-tolerant control subjects. Among these allopurinol-induced cutaneous adverse drug reactions, HLA-B*58:01 was strongly associated with severe cutaneous adverse reactions (odds ratio [OR] = 44.0; 95% confidence interval = 21.5-90.3; P = 2.6 × 10(-41)), and the association was correlated with disease severity (OR = 44.0 for severe cutaneous adverse reactions, OR = 8.5 for maculopapular exanthema). The gene dosage effect of HLA-B*58:01 also influenced the development of allopurinol-induced cutaneous adverse drug reactions (OR = 15.25 for HLA-B*58:01 heterozygotes and OR = 72.45 for homozygotes). Furthermore, coexistence of HLA-B*58:01 and renal impairment increased the risk and predictive accuracy of allopurinol-induced cutaneous adverse drug reactions (heterozygous HLA-B*58:01 and normal renal function: OR = 15.25, specificity = 82%; homozygous HLA-B*58:01 and severe renal impairment: OR = 1269.45, specificity = 100%). This HLA-B*58:01 correlation study suggests that patients with coexisting HLA-B*58:01 and renal impairment (especially estimated glomerular filtration rate < 30ml/minute/1.73 m(2)) should be cautious and avoid using

  15. [Chickenpox, burns and grafts].

    Science.gov (United States)

    Rojas Zegers, J; Fidel Avendaño, L

    1979-01-01

    An outbreak of chickenpox that occurred at the Burns Repair Surgery Unit, Department of Children's Surgery, Hospital R. del Río, between June and November, 1975, is reported. 27 cases of burned children were studied, including analysis of correlations of the stages and outcome of the disease (varicela), the trauma (burns) and the graft (repair surgery). As a result, the authors emphasize the following findings: 1. Burns and their repair are not aggravating factors for varicella. In a small number of cases the exanthema looked more confluent in the graft surgical areas and in the first degree burns healing spontaneously. 2. Usually there was an uneventful outcome of graft repair surgery on a varicella patient, either during the incubation period, the acme or the convalescence. 3. The fact that the outmost intensity of secondary viremia of varicella occurs before the onset of exanthemia, that is, during the late incubation period, is confirmed.

  16. 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.

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

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    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.

  18. Cutaneous reactions to alimentary tract medications: results of a seven-year surveillance program and review of the literature. Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

    Science.gov (United States)

    1996-01-01

    No systemic review of skin reactions to alimentary tract medications is available in the literature. We reviewed the reactions to alimentary tract medications reported to the surveillance system of the Italian Group for Epidemiologic Research in Dermatology (GISED). Between January 1988 and December 1994, 202 dermatologists in Italy reported to the coordinating center for GISED all the adverse reactions they observed during prespecified 2-month monitoring periods. Reactions classified under ATC codes A02-A04, A06, A07 and A09 were used for this analysis. Of 2,789 reactions, 48 were attributed to alimentary tract medications. Urticaria/angioedema and exanthemas accounted for about 70% of these reactions. Fixed eruptions and lichenoid dermatitis accounted for a large part of the remaining reactions. Antiulcers and antiemetics appeared remarkably safe. Our data are reassuring with regard to the cutaneous reaction profile of several drugs taken for diseases of the alimentary tract.

  19. Cutaneous reactions to analgesic-antipyretics and nonsteroidal anti-inflammatory drugs. Analysis of reports to the spontaneous reporting system of the Gruppo Italiano Studi Epidemiologici in Dermatologia.

    Science.gov (United States)

    1993-01-01

    We analyzed the cutaneous reactions to systemic analgesic-antipyretics and non-steroidal anti-inflammatory drugs reported to the spontaneous reporting system of the Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED). The system has been active since 1988, with periodic intensive surveillance exercises, and 202 dermatologists have collaborated. Up to December 1991, 2,137 reactions had been collected, of which 713 were reactions to systemic analgesic-antipyretics and nonsteroidal anti-inflammatory drugs. A general profile of the reactions was identifiable. It included, in order of frequency, urticaria/angioedema, fixed eruptions, exanthemas, erythema multiforme and Stevens Johnson syndrome. Fixed eruptions and Stevens Johnson syndrome were reported with exceedingly high frequency in association with feprazone. Our system also revealed previously unreported reactions, including fixed eruption to nimesulide, fixed eruption to piroxicam and fixed eruption to flurbiprofen.

  20. [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.

  1. Blau syndrome-associated uveitis and the NOD2 gene.

    Science.gov (United States)

    Pillai, Parvathy; Sobrin, Lucia

    2013-01-01

    Blau syndrome (BS), a rare autosomal dominant autoinflammatory syndrome, is an example of a monogenic disease. It was first described as a classic triad of uveitis, arthritis, and exanthema, typically seen in patients less than four years of age. Since that time, the phenotype has been expanded to include fever, cranial neuropathies, cardiovascular abnormalities, and granulomas of the liver and kidney. The ocular inflammation is often a panuveitis that occurs later in the disease course and typically carries the greatest morbidity in BS. BS has been mapped to the chromosomal region 16q12-21, also known as the NOD2 gene (formerly CARD15/NOD2). The disease is secondary to a single amino acid mutation NOD2 that leads to peptidoglycan-independent activity of nuclear factor (NF)-κB. Clinical and genetic aspects of BS will be discussed, as well as recent advances in treatment protocols.

  2. [Blau syndrome--a chronic granulomatous, genetic disease].

    Science.gov (United States)

    Milman, Nils; Byg, Keld-Erik

    2006-10-16

    Blau syndrome is a rare hereditary granulomatous disease presenting in patients of young age with exanthema, granulomatous arthritis and uveitis. Genetic analysis has shown an autosomal dominant inheritance and a number of specific mutations on chromosome 16q in codon 334, of which the most predominant are R334W and R334Q. Blau syndrome exists in Caucasian, Asian and Afro-American families, and de novo mutations have been reported. The estimated minimum incidence in Denmark is 0.05 per 100,000 person-years. Blau syndrome has pathological, clinical and therapeutic features in common with sarcoidosis but rarely involves the lungs or other parenchymatous organs. Discrimination between Blau syndrome and early-onset sarcoidosis should rely on chromosome analysis.

  3. 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.

  4. SEJARAH CHIKUNGUNYA DI INDONESIA, SUATU PENYAKIT RE EMERGING?

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    Wibowo Wibowo

    2012-07-01

    Full Text Available Chikungunya also known as knuckle fever or joint fever, caused by Alphavirus infections. It was first time reported by laboratory test in Indonesia during Chikungunya outbreaks in Jambi and Yogyakarta provinces during 1982-1985. Epidemiology analysis indicated that during 1982-85 Chikungunya epidemic was occurred in 15 provinces, among young and adults. The symptoms were: fever 2-7 days onset of illness: 100%, joint fever: 95%; exanthema: 65% and headache: 100%. Serological test by HAI showed that 96/139% were Chikungunya positive. To 2001-2002 Chikungunya epidemic it was repEorted several chkungunya epidemics occurred in Sumatera and Java islands, 80/238% was serologically positive against IgM and IgG Chikungunya, 25/238% by Chik RT-PCR and there is no significantly different between diseases symptoms. It was also reported that A aegypti is a vektor dominant of the disease.   Keywords: Chikungunya, fever

  5. 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.

  6. 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.

  7. 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...

  8. [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.

  9. [Chikungunya fever in Mexico: confirmed case and notes on the epidemiologic response].

    Science.gov (United States)

    Rivera-Ávila, Roberto Carlos

    2014-01-01

    Chikungunya fever (CHIK) is a viral disease transmitted to human beings by the same vector as dengue -the Aedes mosquito. Besides fever and severe pain in the joints, it produces other symptoms such as myalgias, headache, nausea, fatigue and exanthema. There is no specific treatment for it; the therapeutic management of patients focuses on symptom relief. Historically, outbreaks of large proportions have been reported; even since 2010 it was considered to be a potential emerging epidemic. In 2013 it was introduced into the islands of the Caribbean, and it has recently been reported in the American continent. This paper describes the first confirmed case of chikungunya in Mexico -in the municipality of Tlajomulco de Zúñiga, Jalisco, in May, 2014-, which was imported from the Caribbean island of Antigua and Barbuda by a 39 year-old woman.

  10. Brazilian Spotted Fever: the importance of dermatological signs for early diagnosis*

    Science.gov (United States)

    Couto, Daíne Vargas; Medeiros, Marcelo Zanolli; Hans, Gunter; de Lima, Alexandre Moretti; Barbosa, Aline Blanco; Vicari, Carolina Faria Santos

    2015-01-01

    Brazilian spotted fever is an acute febrile infectious disease caused by Rickettsia rickettsii, transmitted by tick bite. As this disease is rare and has high mortality rates in Brazil, the clinical aspects and epidemiological data may help the diagnosis. We report a case of Brazilian spotted fever in a 19-year-old patient who presented maculopapular exanthema in the palmar region and upper limbs, lymphadenopathy, fever, chills, headache, conjunctival hyperemia, nausea, vomiting, dyspnea, myalgia, developing neurological signs and abdominal pain. He was treated with doxycycline with clinical improvement. We emphasize the importance of the recognition of this disease by dermatologists as cutaneous manifestations are the key findings to establish early diagnosis and prevent complications. PMID:25830998

  11. 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.

  12. Adult-Onset Still's Disease: Still a Serious Health Problem (a Case Report and Literature Review).

    Science.gov (United States)

    Agha-Abbaslou, Mojgan; Bensaci, Ana Maria; Dike, Oluchi; Poznansky, Mark C; Hyat, Arooj

    2017-02-03

    BACKGROUND Adult-onset Still's Disease (AOSD) is a rare systemic inflammatory disease accompanied by a triad of spiking fever, maculopapular exanthema, and arthralgia. To date, there is no definite laboratory or imaging test available for diagnosing AOSD, and the diagnosis is one of exclusion, which can be very challenging. CASE REPORT We report on the case of a 53-year-old female who presented with fever, arthralgia, and abdominal pain. Her initial laboratory tests showed elevated AST and ALT, and normal leukocytes with bandemia. During her hospitalization, we evaluated the patient for other potential differential diagnoses. After an extensive workup, the patient was diagnosed with AOSD based on Yamaguchi criteria. Her serum ferritin levels were measured and found to be markedly elevated, which is a non-specific finding in AOSD patients. CONCLUSIONS This case highlights the important role of a detailed history and physical examination for timely diagnosis of AOSD to prevent complications and improve patient's prognosis.

  13. Multiple organ failure as onset of Mediterranean spotted fever: a review based on a case

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    Pasquale Mansueto

    2016-09-01

    Full Text Available Mediterranean spotted fever (MSF is an infectious disease endemic in the southern regions of Italy, with an incidence of about 400 cases/year. The bacteria responsible of the disease is Rickettsia conorii, transmitted to humans by Rhipicephalus sanguineus, the common dog tick. The infection usually manifests with a characteristic symptomatologic triad: fever, exanthema and the so called tache noire, which is the typical eschar at the site of the tick bite. Immunoglobulin M (IgM and IgG enzymelinked immunosorbent assay and the gold standard micro-immunofluorescent assay, allow serological diagnosis. We report the case of a man suffering from MSF, whose atypical presentation and false-negative diagnostic tests delayed consistently diagnosis and therapy. Afterwards we review the literature about this topic.

  14. Chikungunya fever in Mexico: confirmed case and notes on the epidemiologic response.

    Directory of Open Access Journals (Sweden)

    Roberto Carlos Rivera-Ávila

    2014-07-01

    Full Text Available Chikungunya fever (CHIK is a viral disease transmitted to human beings by the same vector as dengue –the Aedes mosquito. Besides fever and severe pain in the joints, it produces other symptoms such as myalgias, headache, nausea, fatigue and exanthema. There is no specific treatment for it; the therapeutic management of patients focuses on symptom relief. Historically, outbreaks of large proportions have been reported; even since 2010 it was considered to be a potential emerging epidemic. In 2013 it was introduced into the islands of the Caribbean, and it has recently been reported in the American continent. This paper describes the first confirmed case of chikungunya in Mexico –in the municipality of Tlajomulco de Zúñiga, Jalisco, in May, 2014–, which was imported from the Caribbean island of Antigua and Barbuda by a 39 year-old woman.

  15. 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%).

  16. [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.

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

    Science.gov (United States)

    Milman, Nils; Andersen, Claus B; Hansen, Annette; van Overeem Hansen, Thomas; Nielsen, Finn C; Fledelius, Hans; Ahrens, Peter; Nielsen, Ole Haagen

    2006-12-01

    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 in combination with methotrexate. Subsequent introduction of the TNF-alpha inhibitor eternacept did not discernibly benefit the clinical condition, but was associated with recurrent infections. In contrast, a trial of infliximab therapy demonstrated clinical efficacy and eliminated all symptoms, restoring a high 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 in common with sarcoidosis, but rarely involves the lungs or other parenchymatous organs. In children, discrimination between early onset sarcoidosis and Blau syndrome should include a CARD15 mutation analysis.

  18. Non-immediate hypersensitivity reactions to beta-lactam antibiotics in children - our 10-year experience in allergy work-up.

    Science.gov (United States)

    Atanaskovic-Markovic, Marina; Gaeta, Francesco; Medjo, Biljana; Gavrovic-Jankulovic, Marija; Cirkovic Velickovic, Tanja; Tmusic, Vladimir; Romano, Antonino

    2016-08-01

    Non-immediate reactions to beta-lactam antibiotics (BL) occur more than one hour after drug administration, and the most common manifestations are maculopapular exanthemas and delayed-appearing urticaria and/or angioedema. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions (DHR), if a drug is taken at the same time. The most of children are labeled as 'drug allergic' after considering only the clinical history. To diagnose/detect a hypersensitivity or an infection which mimic DHR in children with non-immediate reactions to BL METHODS: A prospective survey was conducted in a group of 1026 children with histories of non-immediate reactions to BL by performing patch tests, skin tests, and in case of negative results, drug provocation tests (DPTs). In 300 children, a study was performed to detect infections by viruses or Mycoplasma pneumoniae. Urticaria and maculopapular exanthemas were the most reported non-immediate reactions. Only 76 (7.4%) of 1026 children had confirmed non-immediate hypersensitivity reactions to BL. Fifty-seven children had positive delayed-reading intradermal tests (18 of these with a positive patch test). Nineteen children had positive DPT. Sixty-six of 300 children had positive tests for viruses or Mycoplasma pneumoniae and 2 of them had a positive allergy work-up. A diagnostic work-up should be performed in all children with non-immediate reactions to BL, to remove a false label of hypersensitivity. Even though only 57 (5.5%) of 1026 children displayed positive responses to delayed-reading intradermal tests to BL, such tests appear to be useful in order to reduce the risk for positive DPTs. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Drug Allergy Clinical Characteristics in Pediatrics

    Directory of Open Access Journals (Sweden)

    R. Devina Fathia Almira

    2017-06-01

    Full Text Available Background: A drug allergy causes a morbidity and a mortality due to its various range of clinical manifestation. Unfortunately, a study  focusing in pediatric drug allergy is insufficient, especially in Bandung. Thus, this study is conducted to determine the clinical characteristic of pediatric drug allergy in Dr. Hasan Sadikin General Hospital Bandung. Methods: This study was a retrospective descriptive study using medical records of pediatric drug allergy patients between 2010–2015 in Dr. Hasan Sadikin General Hospital Bandung taken with total sampling method. The variables were patient age, gender, causative drug, and clinical manifestation. Clinical manifestation was then divided into exanthem, urticaria, erythema multiforme, Steven-Johnson’s syndrome/toxic epidemiolytic necrosis (SJS/TEN, and fixed drug eruption (FDE. Results: Out of 101 patients, only 71 were included in the study due to incomplete medical records of the rest. There were 34 (47.89% males and 37 (52.11% females. Patients’ age ranged from 1–18 years old with the mean of 7.4 years old. The most common clinical manifestation was SJS/TEN with 25 (35.21% patients, followed by exanthem with 22 (30.98% patients. The most common suspected causative drug was non-steriodal anti inflammatory drugs (NSAID (24%, followed with penicillin (21%. Conclusions: Most common manifestation of pediatric drug allergy in female is SJS/TEN, meanwhile in male is exanthema. Steven-Johnson’s syndrome/toxic epidemiolytic necrosis mostly occurs at the age group of 12–18 years old, and exanthema at the age group of 0–3 years old. This condition is mostly caused by NSAID and penicillin. DOI: 10.15850/amj.v4n2.1097

  20. Pityriasis rosea, Gianotti-Crosti syndrome, asymmetric periflexural exanthem, papular-purpuric gloves and socks syndrome, eruptive pseudoangiomatosis, and eruptive hypomelanosis: do their epidemiological data substantiate infectious etiologies?

    Directory of Open Access Journals (Sweden)

    Antonio Chuh

    2016-03-01

    Full Text Available Many clinical and laboratory-based studies have been reported for skin rashes which may be due to viral infections, namely pityriasis rosea (PR, Gianotti-Crosti syndrome (GCS, asymmetric periflexural exanthem/unilateral laterothoracic exanthem (APE/ULE, papularpurpuric gloves and socks syndrome (PPGSS, and eruptive pseudo-angiomatosis (EP. Eruptive hypomelanosis (EH is a newly discovered paraviral rash. Novel tools are now available to investigate the epidemiology of these rashes. To retrieve epidemiological data of these exanthema and analyze whether such substantiates or refutes infectious etiologies. We searched for articles published over the last 60 years and indexed by PubMed database. We then analyzed them for universality, demography, concurrent patients, temporal and spatial-temporal clustering, mini-epidemics, epidemics, and other clinical and geographical associations. Based on our criteria, we selected 55, 60, 29, 36, 20, and 4 articles for PR, GCS, APE/ULE, PPGSS, EP, and EH respectively. Universality or multiple-continental reports are found for all exanthema except EH. The ages of patients are compatible with infectious causes for PR, GCS, APE/ULE, and EH. Concurrent patients are reported for all. Significant patient clustering is demonstrated for PR and GCS. Mini-epidemics and epidemics have been reported for GCS, EP, and EH. The current epidemiological data supports, to a moderate extent, that PR, GCS, and APE could be caused by infectious agents. Support for PPGSS is marginal. Epidemiological evidences for infectious origins for EP and EH are inadequate. There might be growing epidemiological evidence to substantiate or to refute our findings in the future.

  1. Pityriasis Rosea, Gianotti-Crosti Syndrome, Asymmetric Periflexural Exanthem, Papular-Purpuric Gloves and Socks Syndrome, Eruptive Pseudoangiomatosis, and Eruptive Hypomelanosis: Do Their Epidemiological Data Substantiate Infectious Etiologies?

    Science.gov (United States)

    Zawar, Vijay; Sciallis, Gabriel F.; Kempf, Werner; Lee, Albert

    2016-01-01

    Many clinical and laboratory-based studies have been reported for skin rashes which may be due to viral infections, namely pityriasis rosea (PR), Gianotti-Crosti syndrome (GCS), asymmetric periflexural exanthem/unilateral laterothoracic exanthem (APE/ULE), papular-purpuric gloves and socks syndrome (PPGSS), and eruptive pseudo-angiomatosis (EP). Eruptive hypomelanosis (EH) is a newly discovered paraviral rash. Novel tools are now available to investigate the epidemiology of these rashes. To retrieve epidemiological data of these exanthema and analyze whether such substantiates or refutes infectious etiologies. We searched for articles published over the last 60 years and indexed by PubMed database. We then analyzed them for universality, demography, concurrent patients, temporal and spatial-temporal clustering, mini-epidemics, epidemics, and other clinical and geographical associations. Based on our criteria, we selected 55, 60, 29, 36, 20, and 4 articles for PR, GCS, APE/ULE, PPGSS, EP, and EH respectively. Universality or multiple-continental reports are found for all exanthema except EH. The ages of patients are compatible with infectious causes for PR, GCS, APE/ULE, and EH. Concurrent patients are reported for all. Significant patient clustering is demonstrated for PR and GCS. Mini-epidemics and epidemics have been reported for GCS, EP, and EH. The current epidemiological data supports, to a moderate extent, that PR, GCS, and APE could be caused by infectious agents. Support for PPGSS is marginal. Epidemiological evidences for infectious origins for EP and EH are inadequate. There might be growing epidemiological evidence to substantiate or to refute our findings in the future. PMID:27103975

  2. DETECTION OF CASES OF PARVOVIRUS INFECTION IN THE SYSTEM FOR EPIDEMIOLOGICAL SURVEILLANCE OF EXANTHEMATIC DISEASES

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    I. N. Lavrentyeva

    2016-01-01

    Full Text Available The drastic decrease of the incidence of Measles and Rubella at the stage of elimination of these infections is notified on the territory of North- Western Federal Region (NWFR of Russia. At the same time the number of cases with the error clinical diagnosis of Measles and Rubella increased. The most frequent error is the infection caused by Parvovirus (PVI. The disease is of the independent particular medical and social significance for obstetrics, maternity and childhood protection, blood donation service, transplantation of organs/tissue etc. The aim of the current study was to estimate the prevalence of PVI on the territory of NWFR of Russia in different periods of 2009–2012 and 2015–2016. The data of the laboratory diagnosis of PVI for patients with exanthema were analyzed. Materials and methods. The serum specimens of patients with exanthema from bank of sera of St. Petersburg Subnational Measles/Rubella laboratory, collected in 2009–2012 (n = 495 and in 2015 (n = 336 as well as 69 sera of patients with exanthema from the “Infectious Disease Hospital N30” in St. Petersburg, collected in March-May, 2016 were studied. The specific IgM-PV B19 antibodies were determined by the «recomWELL Parvovirus B19 IgM» (MICROGEN GmbH, Germany ELISA test-system. The presen ce of the specific IgM-PV B19 antibodies in sera of patients was the evidence of the acute PVI. Results. The obtained results demonstrated the prevalence of PVI on the territory of NWFR. In 2009–2012 as well as in 2015 years PVI was revealed on the overwhelming majority (9 of 11 of administrative territories of the NWFR. The essential predominance of PVI was determined in St. Petersburg and bordering territories of NWFR (Kaliningrad Oblast’, Leningrad Oblast’, Republic of Karelia. In 2010, 2011 and 2015 years the part of sera detected as IgM-PV B19 positive on an average was equal to 14%. Meanwhile in 2012 the part of the detected IgM-PV B19 positive sera was

  3. The prevalence of suspected and challenge-verified penicillin allergy in a university hospital population.

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    Borch, Jakob E; Andersen, Klaus E; Bindslev-Jensen, C

    2006-04-01

    Suspected penicillin allergy is common among hospitalised patients, but the quality of the information given by the patient is often doubtful. Alleged penicillin allergic are likely to be treated with more toxic, broad-spectrum, and more expensive antibiotics, with effects on microbial resistance patterns and public economy as a consequence. We performed a cross-sectional case-control study with two visits to all clinical departments of a large university hospital in order to find in-patients with medical files labelled "penicillin allergy" or who reported penicillin allergy upon admission. Patient histories were obtained via a questionnaire, and they were offered investigation for penicillin allergy with specific IgE, basophil histamine release, skin prick tests, intradermal tests and drug challenge tests. Finally, the pharmaco-economical consequences of the penicillin allergy were estimated. In a cohort of 3642 patients, 96 fulfilled the inclusion criteria giving a point-prevalence of alleged penicillin allergy of 5% in a hospital in-patient population. Mean time elapsed since the alleged first reaction to penicillin was 20 years. The skin was the most frequently affected organ (82.2%), maculo-papular exanthema (35.4%) and urticaria (10.4%) being the most frequently reported reactions. 25% did not recall the time of their reaction. 82.2% did not remember the name of the penicillin they reacted to. 34.8% had been treated with penicillins after suspicion of penicillin allergy had been raised. None of these reacted to penicillins. 33.3% of the patients receiving antibiotics during their current hospitalisation were prescribed penicillins. 2% developed non-severe exanthema. The average acquisition costs for antibiotics to penicillin allergic patients were euro 278, compared to euro 119 had they been non-allergic. The prevalence of suspected penicillin allergy was lower than reported elsewhere. A substantial number of patients failed to recall basic information about

  4. 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

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    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.

  5. Kawasaki disease in children and adolescents: clinical data of Kawasaki patients in a western region (Tyrol) of Austria from 2003-2012.

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    Binder, Elisabeth; Griesmaier, Elke; Giner, Thomas; Sailer-Höck, Michaela; Brunner, Juergen

    2014-09-02

    Kawasaki disease (KD) is a rare vasculitis seen predominantly in children. In developing countries, it is the leading cause of childhood-acquired heart disease. Besides a case report from 1981 there have been no data published dealing with the epidemiology and clinical aspects of KD in Austria. The purpose of the present study was to investigate the clinical spectrum of KD in a geographically determined cohort of infants, children, and adolescents that were diagnosed and treated at the University Hospital of Innsbruck from 2003-2012. Thirty-two patients were included in the study with a median age of 32.96 months (2-192). 59.4% of the patients were aged between six months and four years. The male-to-female ratio was 1:1.13. Clinical examination revealed non-purulent conjunctivitis and exanthema as the most common symptoms (84.4%). 75% showed oropharyngeal changes, 21.9% had gastrointestinal complaints such as diarrhoe, stomachache or vomiting prior to diagnosis. One third of the patients were admitted with a preliminary diagnosis, whereas 78.1% were pre-treated with antibiotics. The median fever duration at the time of presentation was estimated with 4.96 days (1-14), at time of diagnosis 6.76 days (3-15).75% were diagnosed with complete KD, and 25% with an incomplete form of the disease. There was no significant difference in the duration of fever neither between complete and incomplete KD, nor between the different age groups. Typical laboratory findings included increased C-reactive protein (CRP) (80.6%) and erythrocyte sedimentation rate (ESR) (96%),leukocytosis (48.4%) and thrombocytosis (40.6%) without any significant quantitative difference between complete and incomplete KD. Coronary complications could be observed in six patients: one with a coronary aneurysm and five with tubular dilatation of the coronary arteries. Our patient cohort represents the age distribution as described in literature and emphasizes that KD could affect persons of any age. The

  6. [Cutaneous adverse drug reaction: prospective study of 118 cases].

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    Chaabane, Hend; Masmoudi, Abderrahmen; Amouri, Meriem; Ghorbel, Sonda; Boudaya, Sonia; Hammami, Serriya; Zghal, Khaled; Turki, Hamida

    2013-01-01

    Few prospective studies are available on the incidence and analysis of the characteristics of adverse cutaneous drug reactions. To describe the adverse cutaneous reactions, their epidemiologic characteristics as well as the different causative drugs through a prospective hospital study. A 12-month prospective study was managed in our department of dermatology of the teaching hospital Hedi Chaker of Sfax. Requested information included patient characteristics (associated disorders), drug intake (list and chronology of the drug intake during the 3 weeks preceding the adverse reaction) and characteristics of the skin reaction (type, course). The diagnosis was based on a beam of clinical and anamnestic arguments. The drug imputability was evaluated according to the Begaud's French method. One hundred eighteen cases were collected. A prevalence of 1.08/100 among patients consulting in dermatology department was estimated. The macular and papular exanthema represented the most frequent clinical aspects (42 cases) followed by acute urticaria (23 cases), photosensitivity (19 cases) and fixed drug eruption (15 cases). Principal imputable drugs were antibiotics, mainly penicillins followed by analgesics and non-steroidal anti-inflammatory. Although it was monocentric, this study revealed a high frequency of drug-induced dermatitis with different clinical presentation. The high incidence of drug-induced dermatitis induced by antibiotics, analgesics and anti-inflammatory is due to their widespread use, often in self-medication.

  7. Enfermedad de Kawasaki:: reporte de 3 casos Kawasaki's disease:: report on 3 cases

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    Gladys Fernández Couce

    2010-06-01

    Full Text Available Se presentan 3 pacientes que acudieron al Hospital Pediátrico «Juan M. Márquez» con manifestaciones de exantema y fiebre. Se realizaron estudios para concluir el diagnóstico y en todos los casos los resultados fueron normales. Para arribar al diagnóstico de enfermedad de Kawasaki se aplicaron los criterios de la American Heart Association. Ninguno de los pacientes presentó complicaciones y se excluyeron otras enfermedades según el cuadro clínico y los exámenes complementarios realizados. Los 3 mejoraron con tratamiento de intacglobin en dosis de 400 mg/(kg∙día, durante 5 días.These three patients came to "Juan Manuel Márquez" with manifestations of exanthema and fever. We conducted studies to conclude the diagnosis and in all the cases results were normal. To arrive to diagnosis of Kawasaki's disease criteria from the American Heart Association were applied. No patient had complications excluding other diseases according to clinical picture and complementary examinations performed. The three patients improved with the 400 mg (kg/day Intacglobin treatment for 5 days.

  8. Generalized reactions during skin testing with clindamycin in drug hypersensitivity: a report of 3 cases and review of the literature.

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    Papakonstantinou, Eleni; Müller, Sabine; Röhrbein, Jan H; Wieczorek, Dorothea; Kapp, Alexander; Jakob, Thilo; Wedi, Bettina

    2018-01-22

    The diagnostic approach to drug hypersensitivity includes a detailed medical history, clinical examination, and skin testing and/or oral challenge with a culprit or alternative drug, depending on the type of reaction and the suspected drugs. Although skin testing is considered to be rather safe, cutaneous and systemic, including fatal, reactions have been described. To report 3 cases with generalized delayed reactions after skin testing with clindamycin, and to review the existing literature. Thorough clinical examination, blood tests and prick, intradermal and patch tests were performed in 3 patients. All patients experienced generalized maculopapular exanthema after intradermal and patch testing with clindamycin and amoxicillin in the first patient, and clindamycin alone in the second and third patients. None of the patients showed immediate reactions to skin tests, while positive intradermal reactions after 24 h to amoxicillin and clindamycin were observed in the first patient, and positive intradermal reactions after 24 h to clindamycin were observed in the second and third patients. Skin testing with clindamycin in the diagnosis of drug hypersensitivity carries some risk of adverse reactions. A stepwise and individual diagnostic work-up, considering potential risk factors, and testing in a specialized centre with emergency equipment available is highly recommended. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. [Adverse cutaneous reactions to drugs among hospitalized patients: a one year surveillance].

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    Danza, Alvaro; López, Maynés; Vola, Magdalena; Alvarez-Rocha, Alfredo

    2010-11-01

    Adverse cutaneous reactions to Drugs (CDRs) are of particular interest among all adverse Drug reactions (ADR) due to their frequency, potential severity and because of the importance of an early diagnosis. Antimicrobial agents, anticonvulsants and non-steroidal anti-inflammatory Drugs are the Drugs associated to the highest risk of CDRs. To assess CDRs in hospitalized patients and identify the Drugs involved. All patients hospitalized in the Hospital de Clínicas in Montevideo, Uruguay, with suspected CDRs, detected during one year, were included in this prospective study. The imputability was established using the Karch and Lasagna algorithm modified by Naranjo. We analyzed age, gender, Drugs involved, causal disease, severity, latency and evolution. Seventeen patients, aged 17 to 85 years (15 females) with CDRs were identifed. Twelve had morbilliform exanthemas, four had reactions with eosinophilia and systemic symptoms and one had a Stevens Johnson syndrome. The Drugs involved were antimicrobials in nine cases, hypouricemic agents in four cases, anticonvulsants in three cases and aspartic insulin in one. Twelve patients had a life threatening reaction and one required admission to the intensive care unit. No deaths occurred. CDRs were more common in women and most of them were caused by antimicrobial agents.

  10. Blau syndrome and related genetic disorders causing childhood arthritis.

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    Becker, Mara L; Rose, Carlos D

    2005-12-01

    Blau Syndrome (BS) is an inheritable disorder characterized by granulomatous polyarthritis, panuveitis, and exanthema. It was described by Edward Blau in 1985, the same year in which Douglas Jabs reported a very similar family. Clinically indistinguishable from early onset sarcoidosis (EOS), both are now known to share a mutated form of caspase recruitment domain-15 (CARD 15), a protein involved in activation of nuclear factor kappa B which is in turn an up-regulator of pro-inflammatory cytokine transcription. An association between BS and EOS was suspected for years given the striking similarities of the core triad (arthritis-uveitis-dermatitis) and a common emerging pattern of systemic involvement. Hence, the familial form (BS) and the sporadic form (EOS) are almost certainly the same illness/defect, inherited in the first and acquired in the second as a result in most cases of a de novo mutation. Another form of granulomatous arthritis with uveitis, Crohn's disease, has also been associated with mutations in CARD 15 (albeit at a different domain) and despite similar phenotypes there are obvious differences including gut inflammation and pyoderma gangrenosum in Crohn's disease. This paper will review the clinical characteristics of these three disorders and their association with mutations in the CARD 15 gene.

  11. 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.

  12. 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.

  13. Prevalence and Clinical Profile of Drug Eruptions among Antiretroviral Therapy-Exposed HIV Infected People in Yaoundé, Cameroon

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    Emmanuel Armand Kouotou

    2017-01-01

    Full Text Available Background. Prevalence and incidence of drug eruptions vary around the world and are influenced by some key factors including HIV infection. Objective. This study aimed to find the peculiarities of drug eruptions in people living with HIV (PLHIV and on antiretroviral therapy (ART. Methods. This was a retrospective cross-sectional study including ART-taking PLHIV, aged 15+ years, followed up between January 2010 and December 2014 at the day-care unit of the Yaoundé Central Hospital, and who presented with drug eruptions after ART initiation. Results. Of 6,829 ART-experiencing PLHIV, 41 presented with drug eruptions, giving a prevalence of 0.6%. The M/F sex ratio equaled 0.17. The mean age was 41.07 ± 11.36 years. Benign drug eruptions accounted for 83.3%. Milder forms were essentially maculopapular exanthema (36.6%, fixed pigmented erythema (7.3%, and urticaria (4.9%. Severe forms were represented by multiform erythema (4.9%, toxic epidermal necrolysis (2.4%, and drug hypersensitivity syndrome (2.4%. The Zidovudine + Lamivudine + Efavirenz ART-protocol was received by 48.8% of patients and 69% of patients were receiving Cotrimoxazole prophylaxis. Nevirapine, Efavirenz, Zidovudine, and Cotrimoxazole were suspected as the potential causes in 43.7%, 4.8%, 2.4%, and 26.8% of cases, respectively. Conclusion. Drug eruptions seem infrequent among ART-exposed HIV infected adult Cameroonians.

  14. 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.

  15. Demodex folliculitis mimicking acute graft-vs-host disease.

    Science.gov (United States)

    Cotliar, Jonathan; Frankfurt, Olga

    2013-12-01

    Acute graft-vs-host disease (GVHD) typically requires high-dose systemic steroids as first-line treatment. Like drug eruptions, viral exanthema, and toxic erythema of chemotherapy, Demodex folliculitis is a clinical mimicker of acute GVHD and requires nonimmunosuppressive therapy. This case of Demodex folliculitis mimicking acute GVHD highlights the need for skin biopsy in patients who have undergone a stem cell transplant with eruptions on the head and neck. A 46-year-old white woman with a history of Fms-like tyrosine kinase 3 acute myeloid leukemia presented to the dermatology clinic with a 5-day history of a nonpruritic eruption on her face and neck 28 days after undergoing a double umbilical cord blood hematopoietic stem cell transplant (HSCT). Findings from the skin biopsy demonstrated a deep dermal lymphocytic infiltrate adjacent to follicular units along with an abundance of Demodex mites noted within the hair follicles consistent with Demodex folliculitis. Oral ivermectin, 12 mg, was given, and the eruption cleared within 24 hours. To our knowledge, this is only the fifth reported case of Demodex folliculitis following HSCT, but the first ever reported to be successfully treated with oral ivermectin. Demodex folliculitis should be added to the differential diagnosis of skin eruptions that arise after HSCT.

  16. Detection and quantification of drug-specific T cells in penicillin allergy.

    Science.gov (United States)

    Rozieres, A; Hennino, A; Rodet, K; Gutowski, M-C; Gunera-Saad, N; Berard, F; Cozon, G; Bienvenu, J; Nicolas, J-F

    2009-04-01

    Drug allergic reactions presenting as maculo-papular exanthema (MPE) are mediated by drug-specific T cells. In this study, the frequency of circulating specific T cells was analyzed by interferon-gamma (IFN-gamma) enzyme-linked immunospot assay in 22 patients with an allergic MPE to amoxicillin (amox). Amox-specific circulating T cells were detected in 20/22 patients with frequencies ranging from 1 : 8000 to 1 : 30 000 circulating leucocytes. No reactivity was observed in 46 control patients, including 15 patients with immunoglobulin E-mediated allergy to amoxicillin, 11 patients with a history of drug-induced MPE but tolerant to amoxicillin and 20 healthy individuals. Furthermore, amox-specific T cells were still detectable several years after the occurrence of the allergic reaction even after strict drug avoidance. Finally, analysis of drug-specific T cells in one patient allergic to ticarcillin (a penicillin antibiotic distinct from amox) revealed the presence of IFN-gamma-producing T cells reactive to ticarcillin and several other betalactam antibiotics, suggesting that the IFN-gamma ELISPOT assay is able to detect T cell cross-reactivity against chemically related drugs. These findings confirm that drug-induced MPE is associated with the presence of specific T cells in blood and further suggest that the IFN-gamma ELISPOT is a sensitive assay which could improve the diagnosis of betalactam allergy.

  17. Update on Quinolone Allergy.

    Science.gov (United States)

    Doña, Inmaculada; Moreno, Esther; Pérez-Sánchez, Natalia; Andreu, Inmaculada; Hernández Fernandez de Rojas, Dolores; Torres, María José

    2017-08-01

    Quinolones are a group of synthetic antibiotics widely use as first-line treatment for many infections. There has been an increase in the incidence of hypersensitivity reactions to quinolones in recent years, likely due to increased prescription. The purpose of this review is to summarize the clinical pictures, the methods used for diagnosing and the management of allergic reactions to quinolones. Allergic reactions to quinolones can be immediate or delayed, being anaphylaxis and maculopapular exanthema respectively the most frequent clinical entities. A precise diagnosis is particularly difficult since clinical history is often unreliable, skin tests can induce false-positive results, and commercial in vitro test are not well validated. Therefore, drug provocation testing is considered the gold standard to establish diagnosis, which is not a risk-free procedure. Cross-reactivity between quinolones is difficult to predict due to the small number of patients included in the few published studies. Moreover, hypersensitivity to quinolones has also been associated with beta-lactam and neuromuscular blocking agent allergies, although further studies are needed to understand the underlying mechanisms. Avoidance of the culprit quinolone is indicated in patients with a diagnosis of hypersensitivity to these drugs. When quinolone treatment is the only therapeutic option available, desensitization is necessary. This review summarizes the complex diagnostic approach and management of allergic reactions to quinolones.

  18. [Allergies and pseudoallergic reactions to anesthetics. The clinical symptoms, risk factors and the diagnostic possibilities].

    Science.gov (United States)

    Rosenberger, A D; Treudler, R; Blume-Peytavi, U; Zouboulis, C C; Schaffartzik, W; Orfanos, C E

    1997-11-01

    Nearly all drugs currently used during the course of general anaesthesia may lead to hypersensitivity reactions of various types. There may be an acute type I allergic reactions or to a more or less severe pseudo-allergic reactions, in rare cases with lethal outcome. Routine preoperative testing appears of little predictive value, in spite of the high frequency of so-called risk factors (atopy, other kind of allergy) among the evaluated group of patients. Careful allergological testing should be performed 4 to 6 weeks after any incidents of suspected drug intolerance, in order to discover the underlying causative agent. Skin testing is of diagnostic value for neuromuscular blockers and intravenous narcotics. RAST- and RIA-tests and/or mediator releasing tests may also used additionally. Together with all other administered drugs, all the routinely used neuromuscular blockers (suxamethonium, vecuronium, pancuronium, alcuronium, atracurium, mivacurium) should be tested, since they often represent the cause for such reactions. For other classes of drugs (for example, volatile anesthetics and opioids) the clinical relevance of skin testing still remains uncertain. For less severe incidents seen during general anaesthesia such as pruritus, or exanthema, skin testing seems to be less relevant.

  19. 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.  

  20. 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.

  1. Phenotype-genotype analysis of cryopyrin-associated periodic syndromes (CAPS): description of a rare non-exon 3 and a novel CIAS1 missense mutation.

    Science.gov (United States)

    Jesus, Adriana A; Silva, Clovis A; Segundo, Gesmar R; Aksentijevich, Ivona; Fujihira, Erika; Watanabe, Mônica; Carneiro-Sampaio, Magda; Duarte, Alberto J S; Oliveira, João B

    2008-03-01

    We describe in this paper the phenotype-genotype analysis of a Brazilian cohort of patients with cryopyrin-associated periodic syndromes (CAPS). Patient 1 presented with an urticarial rash and recurrent fever exacerbated by cold weather, arthritis, and anterior uveitis, thus, receiving a clinical diagnosis of familial cold autoinflammatory syndrome. CIAS1 sequencing identified the T436I mutation, previously associated to a clinical phenotype of chronic infantile neurological cutaneous and articular/neonatal onset multisystem inflammatory disease. Patient 2 developed a papular exanthema with daily fever shortly after birth, frontal bossing, patellae enlargement, and cognitive and motor impairments. Sequencing identified the exceedingly rare G755R CIAS1 mutation in exon 4. Patient 3 developed skin rash and articular symptoms 6 h after birth, followed by aseptic meningitis. He was found to have the novel C148Y missense mutation in CIAS1. This report expands the spectrum of CIAS1 mutations associated to clinical disease, suggests that the same mutation can be associated with different clinical syndromes, and supports the evidence that CAPS patients should always be screened for mutations outside exon 3.

  2. Systemic lupus erythematosus presenting as Stevens-Johnson syndrome and toxic epidermal necrolysis: a report of three cases.

    Science.gov (United States)

    Lee, H Y; Tey, H L; Pang, S M; Thirumoorthy, T

    2011-05-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatological conditions that are characterized by mucositis, epidermal detachment and erosions. The underlying etiology in SJS and TEN is almost invariably secondary to drugs. Rarely, other causes such as systemic lupus erythematosus (SLE), infections and vaccinations have been implicated. This report describes three patients with SLE who presented with manifestations of SJS/TEN without a clear drug causality. All three patients presented with photodistributed macular exanthema, which evolved to target lesions, bullae, erosions or sheet-like detachment. This was associated with oral mucositis and conjunctivitis. The onset of the rash was insidious with a protracted clinical course. Ultraviolet exposure and steroid tapering appear to be precipitating factors. In two of the patients, SJS and TEN were the initial presentation of lupus. Although SJS and TEN are almost invariably due to medications, they may, rarely, be an initial presentation of lupus, particularly when associated with an initial photodistribution, absence of genital involvement and a prolonged clinical course.

  3. Infectious diseases in children admitted from a residential child care centre.

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    Lee, W K; Young, B W Y

    2006-04-01

    To describe the pattern of infectious diseases among children admitted from a residential child care centre and to identify any unusual clusters of admissions. Retrospective case review. Regional hospital, Hong Kong. All children from a residential child care centre aged over 28 days who were admitted from the Accident and Emergency Department to paediatric wards for infections from 1 January 1999 to 31 December 2003. Demographic data, clinical diagnoses, infectious diseases identified, and incidence and seasonal pattern of various infections. Of 267 children admitted to the hospital over the 5-year period, 221 had infectious diseases. Respiratory tract infections, viral exanthema, and gastroenteritis were present in 83.7%, 7.2%, and 5.9%, respectively. Among those with a respiratory tract infection, 22.7%, 9.2%, and 8.6% had respiratory syncytial virus, parainfluenza virus, and influenza A or B viruses, respectively. Two unusual clusters of respiratory syncytial virus and parainfluenza virus were recognised in late 2003. Children in this residential child care centre were at risk of infectious diseases. Respiratory tract infection is the most common infectious disease in this centre. An outbreak of respiratory tract infection was recognised. Further efforts may be necessary to improve infection control measures in this setting.

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

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    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.

  5. An unusual case of delayed-type hypersensitivity to ceftriaxone and meropenem.

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    Dias de Castro, E; Leblanc, A; Sarmento, A; Cernadas, J R

    2015-11-01

    Recent studies have demonstrated a low cross-reactivity between β-lactam antibiotics and carbapenems in IgE-mediated reactions. There are no studies on cross-reactivity of meropenem in patients with non-immediate hypersensitivity to cephalosporins. We describe a case of a 13-year-old male, admitted in Neurosurgery with a severe extradural empyema complicating frontal sinusitis, submitted to an emergent bifrontal craniotomy. A generalized maculopapular exanthema, fever and malaise, appeared by the 7th day of meningeal doses of ceftriaxone, clindamycin and vancomycin. Those were replaced by meropenem, with posterior worsening of the reaction and mucosal involvement. A new scheme with amikacin, metronidazole and linezolid was done with improvement. Skin prick, intradermal and patch tests to penicillins, ceftriaxone and meropenem were negative. Lymphocyte transformation test was positive to ceftriaxone and negative to meropenem.Non-immediate T cell mechanism seems to be involved. Diagnosis work-up couldn't exclude cross-reactivity between ceftriaxone and meropenem.

  6. Hypersensitivity reactions to heparins.

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    Gonzalez-Delgado, Purificación; Fernandez, Javier

    2016-08-01

    This article provides an update on hypersensitivity reactions to heparins and novel oral anticoagulants, with special emphasis on diagnostic methods and management of patients. Although heparins are drugs widely used, hypersensitivity reactions are uncommon. Cutaneous delayed hypersensitivity reactions after subcutaneous administration affects up to 7.5% of patients. Heparin-induced thrombocytopenia is another unusual but severe condition in which early recognition is crucial. Immediate hypersensitivity reactions to heparins have been also reported, but with the novel oral anticoagulants are much more uncommon, although reports of exanthemas have been notified.Skin tests and subcutaneous provocation test are useful tools in the diagnosis of hypersensitivity reactions, except in heparin-induced thrombocytopenia in which biopsy of lesional skin and in-vitro tests are the modalities of choice to confirm the diagnosis.Management of hypersensitivity reactions includes finding an alternative depending on the type of reaction. Fondaparinux and novel oral anticoagulants may be safe alternatives. Delayed skin lesions after subcutaneous heparin are the most common type of hypersensitivity reactions, followed by life-threatening heparin-induced thrombocytopenia. Immediate reactions are uncommon. Allergologic studies may be useful to find an alternative option in patients with skin lesions in which heparin-induced thrombocytopenia has been previously excluded, as well as in heparin immediate reactions.

  7. The development of a rapid SYBR one step real-time RT-PCR for detection of porcine reproductive and respiratory syndrome virus

    Science.gov (United States)

    2010-01-01

    Background Prompt detection of PRRSV in the field samples is important for effective PRRS control, thereby reducing the potentially serious economic damage which can result from an outbreak. In this study, a rapid SYBR-based, one step real-time RT-PCR quantitative reverse transcription PCR (qRT-PCR) has been developed for the detection of porcine reproductive and respiratory syndrome virus (PRRSV). Primers were designed based on the sequence of highly conservative region of PRRSV N gene. Results The sensitivity of the real-time qRT-PCR assay was achieved through PRRSV ch-1a RNA for the generation of a standard curve. The detection limit of the assay was found to be 9.6 RNA copies per reaction mixture. This assay had excellent intra- and inter-assay reproducibility as in total 65 field samples were screened for the presence of PRRSV by conventional RT-PCR in parallel with qRT-PCR, and the detection rate increased from 60.0% to 76.9%. Moreover, the specificity result indicated that this assay could reliably differentiate PRRSV from the other swine viral diseases, such as classical swine fever virus (CSFV), swine vesicular disease virus (SVDV) and vesicular exanthema of swine virus (VESV). Conclusion The real-time qRT-PCR assay described in this report allows the rapid, specific and sensitive laboratory detection of PRRSV in field samples. PMID:20459705

  8. Cutaneous manifestations of adult-onset Still's disease: a case report and review of literature.

    Science.gov (United States)

    Cozzi, Alessandra; Papagrigoraki, Anastasia; Biasi, Domenico; Colato, Chiara; Girolomoni, Giampiero

    2016-05-01

    Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology and pathogenesis characterized by high spiking fever, arthralgia or arthritis, sore throat, lymphadenopathy, hepatosplenomegaly, serositis, and transient cutaneous manifestations. Although more common in children, cases are seen also in adults. Cutaneous involvement is common and may be suggestive for the diagnosis. A case of AOSD in a 35-year-old man is reported here, presenting with urticarial maculopapular rash of trunk, high spiking fever, acute respiratory distress syndrome, and myopericarditis. Skin biopsy showed interstitial and perivascular mature CD15(+) neutrophils. A comprehensive review of literature showed that cutaneous involvement occurs in about 80 % of patients, with various clinical presentations. The most common skin manifestation is an evanescent salmon pink or erythematous maculopapular exanthema, predominantly on the trunk and proximal limbs, with rare involvement of face and distal limbs. Less common manifestations include persistent erythematous plaques and pustular lesions. A constant histopathologic finding is the presence of interstitial dermal neutrophils aligned between the collagen bundles. This pattern may provide an easy accessible clue for the definitive diagnosis of AOSD and exclude other diagnosis such as drug eruptions or infectious diseases.

  9. T-cell involvement in drug-induced acute generalized exanthematous pustulosis

    Science.gov (United States)

    Britschgi, Markus; Steiner, Urs C.; Schmid, Simone; Depta, Jan P.H.; Senti, Gabriela; Bircher, Andreas; Burkhart, Christoph; Yawalkar, Nikhil; Pichler, Werner J.

    2001-01-01

    Acute generalized exanthematous pustulosis (AGEP) is an uncommon eruption most often provoked by drugs, by acute infections with enteroviruses, or by mercury. It is characterized by acute, extensive formation of nonfollicular sterile pustules on erythematous background, fever, and peripheral blood leukocytosis. We present clinical and immunological data on four patients with this disease, which is caused by different drugs. An involvement of T cells could be implied by positive skin patch tests and lymphocyte transformation tests. Immunohistochemistry revealed a massive cell infiltrate consisting of neutrophils in pustules and T cells in the dermis and epidermis. Expression of the potent neutrophil-attracting chemokine IL-8 was elevated in keratinocytes and infiltrating mononuclear cells. Drug-specific T cells were generated from the blood and skin of three patients, and phenotypic characterization showed a heterogeneous distribution of CD4/CD8 phenotype and of T-cell receptor Vβ-expression. Analysis of cytokine/chemokine profiles revealed that IL-8 is produced significantly more by drug-specific T cells from patients with AGEP compared with drug-specific T cells from patients that had non-AGEP exanthemas. In conclusion, our data demonstrate the involvement of drug-specific T cells in the pathomechanism of this rather rare and peculiar form of drug allergy. In addition, they indicate that even in some neutrophil-rich inflammatory responses specific T cells are engaged and might orchestrate the immune reaction. PMID:11390425

  10. Regional anesthesia in a patient presenting with varicella

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    Handan Gulec

    2012-06-01

    Full Text Available Varicella zoster virus (VZV is a DNA virus of herpes family. It is characterized by vesicular rash, fever and fatigue and it is a self-limiting disease. 22 years old male patient referred to ER with acute abdominal symptoms. We observed that the patient presenting with exanthema and fever for 10 days was diagnosed with varicella. In the preoperative examination, pulse was detected: 120 beats/minutes, blood pressure: 90/55 mmHg, Mallampathy score (Type 4 was high and neck joint could not manage extension, for this, regional anesthesia was decided to be performed. Detecting a small sized area without rashes between L4-5, 15 mg heavy marcain was injected to subarachnoid distance with 26 G spinal needle. When sensorial block grade was T8 incision was initiated. Intra operative vital results were stabile and the patient was referred to service without any PO problem. [J Contemp Med 2012; 2(2.000: 112-114

  11. Mediterranean spotted fever: clinical and laboratory characteristics of 415 Sicilian children

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    Rubino Raffaella

    2006-03-01

    Full Text Available Abstract Background Mediterranean spotted fever (MSF is an acute febrile, zoonotic disease caused by Rickettsia conorii and transmitted to humans by the brown dogtick Rhipicephalus sanguineus. Nearly four hundred cases are reported every year (mainly from June to September on the Italian island of Sicily. The aim of the study was to analyze the clinical and laboratory characteristics of patients with MSF and the efficacy of the drugs administered. Methods Our study was carried out on 415 children with MSF, during the period January 1997 – December 2004, at the "G. Di Cristina" Children's hospital in Palermo, Sicily, Italy. On admission patients' clinical history, physical and laboratory examination and indirect immunofluorescence antibody test (IFAT for Rickettsia conorii were performed. Diagnosis was considered confirmed if the patients had an MSF diagnostic score greater than or equal to 25 according to the Raoult's scoring system. All patients were treated with chloramphenicol or with macrolides (clarithromycin or azithromycin. Results Fever, rash and tache noire were present in 386 (93%, 392 (94.5% and 263 (63.4% cases respectively. Eighteen (4.6% children showed atypical exanthema. Chloramphenicol and newer macrolides all appeared to be effective and safe therapies. Conclusion Clinical features of 415 children with MSF were similar to those reported by other authors except for a lower incidence of headache, arthralgia and myalgia and a higher frequency of epato-splenomegaly. Concerning therapy, clarithromycin can be considered a valid alternative therapy to tetracyclines or chloramphenicol especially for children aged

  12. Mediterranean spotted fever: clinical and laboratory characteristics of 415 Sicilian children

    Science.gov (United States)

    Colomba, Claudia; Saporito, Laura; Polara, Valentina Frasca; Rubino, Raffaella; Titone, Lucina

    2006-01-01

    Background Mediterranean spotted fever (MSF) is an acute febrile, zoonotic disease caused by Rickettsia conorii and transmitted to humans by the brown dogtick Rhipicephalus sanguineus. Nearly four hundred cases are reported every year (mainly from June to September) on the Italian island of Sicily. The aim of the study was to analyze the clinical and laboratory characteristics of patients with MSF and the efficacy of the drugs administered. Methods Our study was carried out on 415 children with MSF, during the period January 1997 – December 2004, at the "G. Di Cristina" Children's hospital in Palermo, Sicily, Italy. On admission patients' clinical history, physical and laboratory examination and indirect immunofluorescence antibody test (IFAT) for Rickettsia conorii were performed. Diagnosis was considered confirmed if the patients had an MSF diagnostic score greater than or equal to 25 according to the Raoult's scoring system. All patients were treated with chloramphenicol or with macrolides (clarithromycin or azithromycin). Results Fever, rash and tache noire were present in 386 (93%), 392 (94.5%) and 263 (63.4%) cases respectively. Eighteen (4.6%) children showed atypical exanthema. Chloramphenicol and newer macrolides all appeared to be effective and safe therapies. Conclusion Clinical features of 415 children with MSF were similar to those reported by other authors except for a lower incidence of headache, arthralgia and myalgia and a higher frequency of epato-splenomegaly. Concerning therapy, clarithromycin can be considered a valid alternative therapy to tetracyclines or chloramphenicol especially for children aged < eight years. PMID:16553943

  13. Coxsackievirus A6 and Hand,Foot and Mouth Disease:Three Case Reports of FamilialChild-to-Immunocompetent Adult Transmission and a Literature Review

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    Karolina Kaminska

    2013-08-01

    Full Text Available Hand, foot and mouth disease (HFMD is a highly contagious viral infection characterized by typical maculopapular or vesicular eruptions on the hands and feet and in the oral cavity. It affects predominantly children and/or immunocompromised adults. It usually follows a benign and self-limiting course. However, HFMD cases with severe or lethal complications such as encephalitis, meningitis, pulmonary edema and myocarditis have also been reported, mostly in children, but also in adults. High infectivity of HFMD has contributed to several large outbreaks of this disease in recent decades in East and Southeast Asia, the United States and Finland. The most common pathogens were Coxsackievirus A16, Enterovirus 71 and, recently, also Coxsackieviruses A6 and A10. Differences in the course of HFMD have been observed, depending on the virus type. Recently, many cases of atypical HFMD have been described in the literature with unusual morphology and/or localization of skin lesions. Atypical HFMD manifestations including vesiculobullous exanthema, often on the trunk or extremities, and perioral zone involvement were often caused by Coxsackievirus A6 infections. We present 3 cases of familial transmission of HFMD caused by Coxsackievirus A6 with some atypical features, benign course and complete recovery among immunocompetent adults.

  14. Adult-onset Kawasaki disease (mucocutaneous lymph node syndrome and concurrent Coxsackievirus A4 infection: a case report

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    Ueda Y

    2015-09-01

    Full Text Available Yuki Ueda,1 Tsuneaki Kenzaka,1,2 Ayako Noda,1 Yu Yamamoto,1 Masami Matsumura1 1Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, 2Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Japan Introduction: Kawasaki disease (KD most commonly develops in infants, although its specific cause is still unclear. We report here a rare case of adult-onset KD which revealed to be concurrently infected by Coxsackievirus A4. Case presentation: The patient was a 37-year-old Japanese man who presented with fever, exanthema, changes in the peripheral extremities, bilateral non-exudative conjunctival injection, and changes in the oropharynx, signs that meet the diagnostic criteria for KD defined by the Centers for Disease Control and Prevention. In this case, the patient had a significantly high antibody titer for Coxsackievirus A4, which led us to presume that the occurrence of KD was concurrent Coxsackievirus A4 infection. Conclusion: We reported a very rare case of KD which suggests that the disease can be concurrent Coxsackievirus A4 infection. Although KD is an acute childhood disease, with fever as one of the principal features, KD should also be considered in the differential diagnosis when adult patients present with a fever of unknown cause associated with a rash. Keywords: adult-onset, Coxsackievirus A4, Kawasaki disease, mucocutaneous lymph node syndrome, skin rash

  15. The development of a rapid SYBR one step real-time RT-PCR for detection of porcine reproductive and respiratory syndrome virus

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    Liu XiangTao

    2010-05-01

    Full Text Available Abstract Background Prompt detection of PRRSV in the field samples is important for effective PRRS control, thereby reducing the potentially serious economic damage which can result from an outbreak. In this study, a rapid SYBR-based, one step real-time RT-PCR quantitative reverse transcription PCR (qRT-PCR has been developed for the detection of porcine reproductive and respiratory syndrome virus (PRRSV. Primers were designed based on the sequence of highly conservative region of PRRSV N gene. Results The sensitivity of the real-time qRT-PCR assay was achieved through PRRSV ch-1a RNA for the generation of a standard curve. The detection limit of the assay was found to be 9.6 RNA copies per reaction mixture. This assay had excellent intra- and inter-assay reproducibility as in total 65 field samples were screened for the presence of PRRSV by conventional RT-PCR in parallel with qRT-PCR, and the detection rate increased from 60.0% to 76.9%. Moreover, the specificity result indicated that this assay could reliably differentiate PRRSV from the other swine viral diseases, such as classical swine fever virus (CSFV, swine vesicular disease virus (SVDV and vesicular exanthema of swine virus (VESV. Conclusion The real-time qRT-PCR assay described in this report allows the rapid, specific and sensitive laboratory detection of PRRSV in field samples.

  16. The Case of Unilateral Laterothoracic Exanthem

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    Seda Atay

    2016-12-01

    Full Text Available Unilateral laterothoracic exanthem (asymmetric periflexural exanthem of childhood which have a tendency to form plaques in a particular region of the body is characterized by erythematous papules. The lesions usually begin at unilateral axillary or inguinal region. Unilateral laterothoracic exanthem is usually seen in children of 1-5 year-old. Although the etiology is not known very well, viral agents are considered to be the etiologic factor, because in 75% of the patients, prodromal symptoms like fever, diarrhea, fatigue and rhinitis were seen before rash. The histopathologic evidences are nonspecific. The disease is diagnosed clinically. This disease is self-limited and the rash disappears without sequel in 2-6 weeks. In this case, 3 year-old boy was presented with, multiple, erythematous, pruritic millimetric papules which first developed in right axillar region and extended to the same side of abdomen. It was found out that fatigue, loss of appetite, diarrhea before rashes were in the medical history of the patient. The serological examination of the patient’s blood showed that ebstein barr virus, cytomegalovirus, rubella and measles immunoglobulin G were positive, immunoglobulin M were negative, parvovirus B19 immunoglobulin G and M were both negative. The patient was treated with topical moisturizer and oral antihistaminic. This case which was diagnosed with unilateral laterotoracic exanthema due to history of the disease, clinical findings and its rarity found fit to be presented.

  17. Single-agent pegylated liposomal doxorubicin (PLD in the treatment of metastatic breast cancer: results of an Austrian observational trial

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    Pluschnig Ursula

    2011-08-01

    Full Text Available Abstract Background In advanced breast cancer, multiple sequential lines of treatments are frequently applied. Pegylated liposomal doxorubicin (PLD has a favourable toxicity profile and can be used in first or higher lines of therapy. PLD has demonstrated response activity even after prior anthracycline exposure. Methods 129 consecutive patients with advanced breast cancer, of whom the majority had been massively pretreated, received PLD as monotherapy within licensed approval, for which efficacy and toxicities were documented. Results In a routine therapy setting, PLD was administered in a slightly reduced dose (median, 40 mg/m2 per cycle. Response rate (complete and partial remission was 26%, and stable disease was observed in 19% of patients. Progression-free (PFS and overall survival (OS were 5.8 months and 14.2 months, respectively. There was no difference in terms of response and PFS, no matter if patients had already received anthracycline treatment. Interestingly, PFS proved similar regardless whether PLD was administered as palliative therapy in first, second or third line. Furthermore, PFS and OS were similar in patients with response or stable disease, underscoring the view that disease stabilization is associated with a profound clinical benefit. The most common side effects reported were palmar-plantar erythrodysesthesia (17%, exanthema (14% and mucositis (12%. Conclusions Efficacy and toxicity data in these "real life" patients permit the conclusion that PLD is a valuable option in the treatment of advanced breast cancer even in heavily pretreated patients.

  18. [Is it possible to identify dengue in children on the basis of Ministry of Health criteria for suspected dengue cases?].

    Science.gov (United States)

    Rodrigues, Marisa B P; Freire, Heliane B M; Corrêa, Paulo R L; Mendonça, Marislaine L; Silva, Maria Regina I; França, Elizabeth B

    2005-01-01

    To identify clinical characteristics indicative of dengue and to evaluate the applicability to children of the Health Ministry criteria for suspected cases. A cross-sectional study undertaken at the General Pediatrics Center of the Fundação Hospitalar de Minas Gerais. Children were enrolled if presenting acute febrile conditions with no definite etiology, lasting > 24 hours and disease. The subset of children who did have dengue was compared with the subset of nonspecific acute febrile diseases. The Health Ministry criteria for suspected cases was evaluated. Dengue was diagnosed in 50.4% of the 117 children studied. There were no statistically significant associations between the disease and the majority of the symptoms analyzed. Only exanthema was more often associated with dengue (Prevalence Ratio = 1.49; 95% CI: 1.05-2.11). The criteria for suspected cases of dengue had a sensitivity of just 50.8% and a positive predictive value of 62.5%. These values were greater among schoolchildren and during the period of greater disease incidence. Dengue is common among febrile diseases of childhood, with prevalence that varies according to the epidemiological situation. The clinical status of children with dengue was very similar to that of children with other nonspecific diseases. The Health Ministry criteria for suspected cases was shown to be of little use, particularly with smaller children and during periods of reduced incidence.

  19. Ethosuximide-induced Stevens-Johnson syndrome: Beneficial effect of early intervention with high-dose corticosteroid therapy.

    Science.gov (United States)

    Tachibana, Kota; Hamada, Toshihisa; Tsuchiya, Hiroki; Shibata, Takashi; Fujii, Kazuyasu; Kobayashi, Katsuhiro; Iwatsuki, Keiji

    2018-02-11

    We report two rare cases of childhood epilepsy patients who developed ethosuximide-induced Stevens-Johnson syndrome (SJS). Unlike typical SJS, the initial eruption of both patients presented well-demarcated, infiltrating firm papules mainly on the cheeks and the extensor aspects of the arms (case 1), and multiple vesicles on the soles and oral aphthosis (case 2), which closely mimicked viral exanthema. We diagnosed both patients with ethosuximide-induced SJS, based on the dosing period and the positive results of drug-induced lymphocyte stimulation test. Systemic corticosteroids are usually selected as a standard therapy for SJS, despite controversial results regarding their effectiveness. In case 1, an i.v. pulse therapy of methylprednisolone (30 mg/kg, 3 days consecutively) was initiated on day 7 from the onset of illness, and an i.v. immunoglobulin (400 mg/kg, 5 days consecutively) was added the following day. In case 2, an i.v. prednisone treatment (1 mg/kg, for 1 week) was initiated on day 4 from the onset. Eventually, the early therapeutic interventions resulted in good outcomes in both patients. © 2018 Japanese Dermatological Association.

  20. 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.

  1. Immunohistopathological Findings of Severe Cutaneous Adverse Drug Reactions

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    Mari Orime

    2017-01-01

    Full Text Available Diagnosis of severe cutaneous adverse drug reactions should involve immunohistopathological examination, which gives insight into the pathomechanisms of these disorders. The characteristic histological findings of erythema multiforme (EM, Stevens–Johnson syndrome (SJS, and toxic epidermal necrolysis (TEN provide conclusive evidence demonstrating that SJS/TEN can be distinguished from EM. Established SJS/TEN shows full-thickness, extensive keratinocyte necrosis that develops into subepidermal bullae. Drug-induced hypersensitivity syndrome (DIHS and exanthema in drug reaction with eosinophilia and systemic symptoms (DRESS each display a variety of histopathological findings, which may partly correlate with the clinical manifestations. Although the histopathology of DRESS is nonspecific, the association of two or more of the four patterns—eczematous changes, interface dermatitis, acute generalized exanthematous pustulosis- (AGEP- like patterns, and EM-like patterns—might appear in a single biopsy specimen, suggesting the diagnosis and severe cutaneous manifestations of DRESS. Cutaneous dendritic cells may be involved in the clinical course. AGEP typically shows spongiform superficial epidermal pustules accompanied with edema of the papillary dermis and abundant mixed perivascular infiltrates. Mutations in IL36RN may have a definite effect on pathological similarities between AGEP and generalized pustular psoriasis.

  2. 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.

  3. Allergic Reactions to Metamizole: Immediate and Delayed Responses.

    Science.gov (United States)

    Blanca-López, Natalia; Pérez-Sánchez, Natalia; Agúndez, José Augusto; García-Martin, Elena; Torres, María José; Cornejo-García, José Antonio; Perkins, James R; Miranda, Miguel Angel; Andreu, Inmaculada; Mayorga, Cristobalina; Canto, Gabriela; Blanca, Miguel; Doña, Inmaculada

    2016-01-01

    Pyrazolones are the most common causes of selective nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. We studied a large group of patients with immediate and delayed selective responses to metamizole. Patients with suspicion of hypersensitivity to metamizole were evaluated. We verified acetylsalicylic acid tolerance and classified patients as immediate or delayed responders if they showed symptoms less or more than 24 h after metamizole administration. Skin tests were performed and if negative, a basophil activation test (BAT) was performed on immediate responders. If it was negative, we performed a drug provocation test (DPT) with metamizole. A total of 137 patients were included: 132 reacted within 24 h (single NSAID-induced urticaria/angioedema/anaphylaxis; SNIUAA) and 5 after 24 h (single NSAID-induced delayed hypersensitivity reaction; SNIDHR). Most SNIUAA patients developed anaphylaxis (60.60%); for SNIDHR, maculopapular exanthema was the most frequent entity (60%). Skin testing was positive in 62.04% of all cases and BAT in 28% of the SNIUAA patients with negative skin tests. In 5.1% of the cases, DPT with metamizole was needed to establish the diagnosis. In 22.62% of the cases, diagnosis was established by consistent and unequivocal history of repeated allergic episodes in spite of a negative skin test and BAT. SNIUAA to metamizole is the most frequent type of selective NSAID hypersensitivity, with anaphylaxis being the most common clinical entity. It may occur within 1 h after drug intake. SNIDHR occurs in a very low percentage of cases. The low sensitivity of diagnostic tests may be due to incomplete characterization of the chemical structures of metamizole and its metabolites. © 2016 S. Karger AG, Basel.

  4. Fiebre manchada por rickettsias en el Delta del Paraná: Una enfermedad emergente Rickettsial spotted fever in the Paraná Delta: An emerging disease

    Directory of Open Access Journals (Sweden)

    Alfredo Seijo

    2007-12-01

    Full Text Available Se comunica un caso de fiebre manchada por rickettsia autóctono del delta del Paraná correspondiente a la provincia de Buenos Aires. Luego de cinco días de haber permanecido en una región cercana a la localidad de ingeniero Otamendi, partido de Campana, el paciente presentó un síndrome febril agudo caracterizado por hipertermia con escalofríos y sudoración, mialgias, cefalea, astenia y discreta odinofagia, seguido a las 72 horas por un exantema maculopapuloso congestivo con elementos purpúricos, de distribución universal. En la región preauricular izquierda se observaba una lesión papuloerosiva, producida cinco días antes de iniciada la fiebre por una garrapata adquirida en el lugar. El cuadro clínico remitió rápidamente con la administración de doxiciclina. Por inmunofluorescencia indirecta se identificaron anticuerpos reactivos contra el grupo de rickettsias causantes de fiebres manchadas (CDC, Atlanta, EE.UU.. Se realizan consideraciones sobre la especie de rickettsia, el vector involucrado y la posibilidad que la enfermedad fuera debida a Rickettsia parkeri.We describe a case of rickettsial spotted fever in the Paraná Delta region of Buenos Aires province in Argentina. The patient developed an acute febrile syndrome characterized by myalgias, headache, asthenia and moderate odynophagia, followed by a diffuse macular, papular, and purpuric exanthema. The patient had been bitten recently by a tick on the left preauricular region and an erosive papular lesion was evident at the bite site. An indirect immunofluorescence antibody assay identified antibodies reactive with spotted fever group rickettsiae in the patient's serum. The patient improved rapidly with doxycycline. Several considerations relating to the identity of the rickettsial species and tick vector are discussed, including the possibility that this patient's illness may have been caused by Rickettsia parkeri.

  5. Update on infections with human herpesviruses 6A, 6B, and 7.

    Science.gov (United States)

    Agut, H; Bonnafous, P; Gautheret-Dejean, A

    2017-03-01

    Human herpesviruses 6A, 6B, and 7 (HHV-6A, HHV-6B, HHV-7) are genetically related to cytomegalovirus. They belong to the Roseolovirus genus and to the Betaherpesvirinae subfamily. They infect T cells, monocytes-macrophages, epithelial cells, and central nervous system cells. These viruses are ubiquitous and are responsible for lifelong chronic infections, most often asymptomatic, in the vast majority of the general adult population. HHV-6B is responsible for exanthema subitum, which is a benign disease of infants. HHV-6A and HHV-6B also cause opportunistic infections in immunocompromised patients: encephalitis, hepatitis, bone marrow suppression, colitis, and pneumonitis. Their etiological role in chronic diseases such as multiple sclerosis, cardiomyopathy, and thyroiditis is still controversial. The pathogenicity of HHV-7 is less clear and seems to be much more restricted. Chromosomal integration of HHV-6A and HHV-6B is transmissible from parents to offspring and observed in about 1% of the general population. This integration raises the question of potential associated diseases and can be a confounding factor for the diagnosis of active infections by both viruses. The diagnosis of HHV-6A, HHV-6B, and HHV-7 infections is rather based on gene amplification (PCR), which allows for the detection and quantification of the viral genome, than on serology, which is mainly indicated in case of primary infection. Ganciclovir, foscarnet, and cidofovir inhibit the replication of HHV-6A, HHV-6B, and HHV-7. Severe infections may thus be treated but these therapeutic indications are still poorly defined. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. [Epicutaneous patch testing in delayed drug hypersensitivity reactions induced by antiepileptic drugs].

    Science.gov (United States)

    Ben Mahmoud, Lobna; Bahloul, Najla; Ghozzi, Hanen; Kammoun, Brahim; Hakim, Ahmed; Sahnoun, Zouheir; Kammoun, Sami; Zeghal, Khaled

    2017-10-01

    Antiepileptic drugs are widely used and are associated with numerous side effects including skin eruptions. Epicutaneous tests have been used with variable success in skin drug reactions. The purpose of this study was to evaluate the profitability of epicutaneous tests in delayed hypersensitivity reactions induced by antiepileptic drugs. We analyzed all cases of allergic skin reactions to antiepileptic drugs notified in regional pharmacovigilance center of Sfax (Tunisia) between June 1, 2014 and April 30, 2016. The imputation score, determined using the French imputation method, should be at least doubtful. Patch-tests were performed in accordance with the general Europen network on Drug Allergy/European Academy of Allergy and Clinical Immunology (ENDA/EAACI) guidelines. Patch-tests were read according to the generally accepted criteria of the International contact dermatitis research group (ICDRG). In our study, 20 patients were included, among which 23 events were observed. The drug involved in delayed hypersensitivity reactions was carbamazepine in 11 cases, phenobarbital in 10 cases and valproic acid in 4 cases. The clinical reactions caused by the drug were classified as maculopapular exanthema (11 cases), DRESS syndrome (6 cases), Stevens-Johnson syndrome (2 cases), fixed drug eruption (2 cases) and erythroderma (2 cases). Patch-tests were positive in 19 patients (95 %). Cross-reactivity between antiepileptic drugs was observed in 4 cases: between valproic acid and carbamazepine in 2 cases between valproic acid and phenobarbital in 1 case and between phenobarbital and carbamazepine in 1 case. In this study, patch testing was a safe and useful method in confirming the culprit drug in delayed hypersensitivity reactions induced by antiepileptic drugs. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  7. Cutaneous drug reactions to antiepileptic drugs and relation with HLA alleles in the Turkish population.

    Science.gov (United States)

    Büyüköztürk, S; Kekik, Ç; Gökyiğit, A Z; Tezer Filik, F I; Karakaya, G; Saygi, S; Dursun, A B; Kirbaş, S; Tüfekçi, A; Sin, A Z; Aydoğdu, I; Sorgun, M H; Aydin, N; Gelincik, A; Çolakoğlu, B; Çelik, G; Oğuz, F

    2018-01-01

    Background and objective. Many studies have shown associations between HLAB*15:02, HLA-A*31:01 and carbamazepine (CBZ)-induced delayed cutaneous hypersensitivity reactions. The aim of this study is to evaluate a possible association between delayed cutaneous reactions to antiepileptic drugs (AEDs) and certain HLA-A and HLA-B alleles in the Turkish population. Methods. The study consisted of 3 groups: Group I (reactive group) included the patients who had documented delayed cutaneous reactions to any antiepileptic drug. Group II (non-reactive group) included the patients who have been on antiepileptic treatment at least for three months without any adverse reactions. Group III consisted of healthy subjects. The HLA-A and B alleles were analyzed in all groups. Results. Forty patients (29 female) had experienced different hypersensitivity reactions due to AEDs: maculopapular exanthema (26 patients), Stevens-Johnson syndrome (6 patients), drug rash with eosinophilia and systemic symptoms (7 patients), toxic epidermal necrolysis (1 patient). Lamotrigine (11) and CBZ (10) were the most common culprit drugs involved in the reactions. The HLA-B*15:02 was not present in any of the study groups. However, HLA-B*35:02 was found in 4 patients from the reactive group, while it was not observed in non-reactive patients and was detected in only one healthy subject (p = 0.021). Conclusion. Although our preliminary results did not indicate a strong allele association with AED hypersensitivity, HLA-B*35:02 appears to be a candidate allele for MPE / DRESS / DIHSS induced by AED's in Turkish population. Further studies with a larger sample size may result in more comprehensive data about the genetic tendency for AED hypersensitivity in the Turkish population.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Epidemiological and etiological characteristics of hand, foot, and mouth disease in Ningbo, China, 2008-2011.

    Science.gov (United States)

    Ni, Hongxia; Yi, Bo; Yin, Jianhua; Fang, Ting; He, Tianfeng; Du, Yan; Wang, Jin; Zhang, Hongwei; Xie, Lei; Ding, Yibo; Gu, Wenzhen; Zhang, Shu; Han, Yifang; Dong, Hongjun; Su, Tong; Xu, Guozhang; Cao, Guangwen

    2012-08-01

    Outbreaks of hand, foot, and mouth disease (HFMD) in central China have caused public health concerns since 2007. It is of particular public health significance to update epidemiology of HFMD in port cities. To investigate epidemical, etiological and clinical characteristics of HFMD in Ningbo, China, from 2008 to 2011. From May 2008 to December 2011, a total of 37,404 HFMD cases including 196 severe and 12 fatal cases were investigated. Human enteroviruses from 2360 cases were determined by real-time RT-PCR. The VP1 gene of EV71 from 78 cases and CA16 from 21 cases, the VP4 gene from 28 cases, and full-length genomes of 10 isolates were analyzed. Neutralizing antibodies were evaluated in 258 healthy subjects. Parameters associated with severe HFMD were evaluated. Annual incidence of HFMD was 3066.8/100,000 in the population of ≤5 years. EV71 C4a, CA16 B1, and other enteroviruses accounted for 63.7%, 24.0% and 12.3%, respectively. The genomes of EV71 from fatal and non-fatal cases were nearly identical. The positive rates of neutralizing antibody to EV71 increased from 13.5% to 67.6% in 1- to 5-year healthy groups. The neutralizing antibody to CA16 B1 isolate was negative. EV71, exposure history and certain early manifestations including fever, vomiting, limb exanthema and peripheral neutrophil ratio were significantly associated with HFMD severity. HFMD mainly caused by EV71 C4a and CA16 B1 is seriously epidemic in Ningbo. Future emphasis should be paid on EV71 immuno-prophylaxis and early identification of severe cases upon the etiological and clinical characteristics. Copyright © 2012 Elsevier B.V. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-09-18

    A high-throughput multiplexed assay (Multiplex Version 1.0) 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 rRTPCR 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  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. Cutaneous graft versus host disease in pediatric multivisceral transplantation.

    Science.gov (United States)

    Feito-Rodríguez, Marta; de Lucas-Laguna, Raúl; Gómez-Fernández, Cristina; Sendagorta-Cudós, Elena; Collantes, Elena; Beato, Maria Jose; Boluda, Esther Ramos

    2013-01-01

    Multivisceral transplantation (MvTx) is the concurrent transplantation of the stomach, pancreaticoduodenal complex, and intestine, with or without the liver. Its use is increasing worldwide as it has been considered as a therapy for patients with functional disturbance of several organs. Graft-versus-host disease (GvHD) has been a relevant clinical problem in MvTx ever since the procedure was first performed, but little has been reported about its specific cutaneous features. Our study included all pediatric patients with clinical and histopathologic evidence of cutaneous GvHD who received MvTx between October 1999 and December 2010 in University Hospital La Paz. Seventeen children underwent MvTx at our center during this period of time. Five patients developed cutaneous GvHD (29.4%). The median onset was 45.2 days after transplantation. Acute cutaneous GvHD, consisting of symmetrical maculopapular exanthema with prominent acral erythema and accentuated lesions on the face and pinnae, was clinically suspected and pathologically confirmed in four patients (80%). Three children (60%) experienced disease progression to a formation and a positive Nikolsky sign. Only one girl (20%) showed lichenoid GvHD. The first therapeutic approach was steroids and tacrolimus adjustment; many other drugs were used in refractory cases. Three of the five patients (60%) died with concomitant GvHD, the immediate cause of death being another comorbid disease. Knowledge of the features of cutaneous GvHD in MvTx allows clinicians early recognition and prompt therapeutic intervention that may prevent progression to higher-grade disease and improve outcomes for these patients. © 2012 Wiley Periodicals, Inc.

  15. Travel-Associated Zika Virus Disease Acquired in the Americas Through February 2016: A GeoSentinel Analysis.

    Science.gov (United States)

    Hamer, Davidson H; Barbre, Kira A; Chen, Lin H; Grobusch, Martin P; Schlagenhauf, Patricia; Goorhuis, Abraham; van Genderen, Perry J J; Molina, Israel; Asgeirsson, Hilmir; Kozarsky, Phyllis E; Caumes, Eric; Hagmann, Stefan H; Mockenhaupt, Frank P; Eperon, Gilles; Barnett, Elizabeth D; Bottieau, Emmanuel; Boggild, Andrea K; Gautret, Philippe; Hynes, Noreen A; Kuhn, Susan; Lash, R Ryan; Leder, Karin; Libman, Michael; Malvy, Denis J M; Perret, Cecilia; Rothe, Camilla; Schwartz, Eli; Wilder-Smith, Annelies; Cetron, Martin S; Esposito, Douglas H

    2017-01-17

    Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers. To describe clinical manifestations and epidemiology of Zika virus disease in travelers exposed in the Americas. Descriptive, using GeoSentinel records. 63 travel and tropical medicine clinics in 30 countries. Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016. Frequencies of demographic, trip, and clinical characteristics and complications. Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing. Two patients developed Guillain-Barré syndrome, and 3 of 4 pregnancies had adverse outcomes (microcephaly, major fetal neurologic abnormalities, and intrauterine fetal death). Surveillance data collected by specialized clinics may not be representative of all ill returned travelers, and denominator data are unavailable. These surveillance data help characterize the clinical manifestations and adverse outcomes of Zika virus disease among travelers infected in the Americas and show a need for global standardization of diagnostic testing. The serious fetal complications observed in this study highlight the importance of travel advisories and prevention measures for pregnant women and their partners. Travelers are sentinels for global Zika virus circulation and may facilitate further transmission. Centers for Disease Control and Prevention, International Society of Travel Medicine, and Public Health Agency of Canada.

  16. Kawasaki disease in adults: Observations in France and literature review.

    Science.gov (United States)

    Fraison, Jean-Baptiste; Sève, Pascal; Dauphin, Claire; Mahr, Alfred; Gomard-Mennesson, Emeline; Varron, Loig; Pugnet, Gregory; Landron, Cédric; Roblot, Pascal; Oziol, Eric; Chalhoub, Gihane; Galempoix, Jean-Marc; Humbert, Sébastien; Humbert, Philippe; Sbidian, Emilie; Grange, Florent; Bayrou, Olivier; Cathebras, Pascal; Morlat, Philippe; Epaulard, Olivier; Pavese, Patricia; Huong, Du Le Thi; Zoulim, Abdelkader; Stankovic, Katia; Bachelez, Hervé; Smail, Amar; Bachmeyer, C; Granel, Brigitte; Serratrice, Jacques; Brinchault, Graziella; Mekinian, Arsène; Costedoat-Chalumeau, Nathalie; Bourgarit-Durand, Anne; Puéchal, Xavier; Guillevin, Loïc; Piram, Maryam; Koné-Paut, Isabelle; Fain, Olivier

    2016-03-01

    Kawasaki disease (KD) is a vasculitis that mostly occurs in young children and rarely in adults. We analyzed the characteristics of adult-onset KD (AKD) in France. We collected retrospective and prospective data for patients with a diagnosis of KD occurring after the age of 18 years. Cases were obtained via various French medical networks and identified from the international literature. We included 43 patients of AKD at 26 institution from 1992 to 2015, with mean (SD) age 30 (11) years (range 18-68) and sex ratio (M/F) 1.2; 34 patients met the American Heart Association criteria and 9 were incomplete AKD. The median time to diagnosis was 13 days (interquartile range 8-21). The main symptoms were fever (100%), exanthema (98%), changes in the extremities (91%), conjunctivitis (77%), oral cavity changes (89%), cervical adenitis (55%) and cardiac abnormalities (45%). Overall, 35% of patients showed large-vessel vasculitis: coronary vasculitis (26%) and coronary aneurysm (19%). Treatment was mostly intravenous immunoglobulins (79%) and aspirin (81%). Four patients showed myocardial infarction due to coronary vasculitis, but none were treated with IVIg because of late diagnosis. After a median follow-up of 5 months (range 1-117), persistent aneurysm was noted in 9% of cases. Damage was significantly lower with early treatment than late or no treatment (p=0.01). Given the high frequency of cardiac involvement and complications in this series of AKD, diagnosis and treatment should not be delayed, and early IVIg treatment seems to improve the outcome. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Detection of human parechoviruses from clinical stool samples in Aichi, Japan.

    Science.gov (United States)

    Ito, Miyabi; Yamashita, Teruo; Tsuzuki, Hideaki; Kabashima, Yuka; Hasegawa, Akiko; Nagaya, Satoko; Kawaguchi, Mariko; Kobayashi, Shinichi; Fujiura, Akira; Sakae, Kenji; Minagawa, Hiroko

    2010-08-01

    Between April 1999 and March 2008, a total of 4,976 stool specimens collected from patients with suspected viral infection through infectious agent surveillance in Aichi, Japan, were tested for the presence of human parechoviruses (HPeVs). We detected HPeVs in 110 samples by either cell culture, reverse transcriptase PCR (RT-PCR), or both. Serotyping either by neutralization test or by nucleotide sequence determination and phylogenetic analysis of the VP1 region and 5' untranslated region (5'UTR) regions revealed that 63 were HPeV type 1 (HPeV-1), followed by 44 HPeV-3 strains, 2 HPeV-4 strains, and 1 HPeV-6 strain. The high nucleotide and amino acid sequence identities of the Japanese HPeV-3 isolates in 2006 to the strains previously reported from Canada and Netherlands confirmed the worldwide prevalence of HPeV-3 infection. Ninety-seven percent of the HPeV-positive patients were younger than 3 years, and 86.2% younger than 12 months. The clinical diagnoses of HPeV-positive patients were gastroenteritis, respiratory illness, febrile illness, exanthema, "hand, foot, and mouth disease," aseptic meningitis, and herpangina. Among 49 HPeV-positive patients with gastroenteritis, 35 were positive with HPeV-1 and 12 with HPeV-3, and out of 25 with respiratory illness, 11 were positive with HPeV-1 and 14 with HPeV-3. HPeV-3 seemed to be an important etiological agent of respiratory infection of children. While HPeV-1 was detected predominantly during fall and winter, the majority of the HPeV-3 cases were detected during summer and fall. A different pattern of clinical manifestations as well as seasonality suggested that there are different mechanisms of pathogenesis between HPeV-1 and HPeV-3 infections.

  18. Detection of Human Parechoviruses from Clinical Stool Samples in Aichi, Japan▿

    Science.gov (United States)

    Ito, Miyabi; Yamashita, Teruo; Tsuzuki, Hideaki; Kabashima, Yuka; Hasegawa, Akiko; Nagaya, Satoko; Kawaguchi, Mariko; Kobayashi, Shinichi; Fujiura, Akira; Sakae, Kenji; Minagawa, Hiroko

    2010-01-01

    Between April 1999 and March 2008, a total of 4,976 stool specimens collected from patients with suspected viral infection through infectious agent surveillance in Aichi, Japan, were tested for the presence of human parechoviruses (HPeVs). We detected HPeVs in 110 samples by either cell culture, reverse transcriptase PCR (RT-PCR), or both. Serotyping either by neutralization test or by nucleotide sequence determination and phylogenetic analysis of the VP1 region and 5′ untranslated region (5′UTR) regions revealed that 63 were HPeV type 1 (HPeV-1), followed by 44 HPeV-3 strains, 2 HPeV-4 strains, and 1 HPeV-6 strain. The high nucleotide and amino acid sequence identities of the Japanese HPeV-3 isolates in 2006 to the strains previously reported from Canada and Netherlands confirmed the worldwide prevalence of HPeV-3 infection. Ninety-seven percent of the HPeV-positive patients were younger than 3 years, and 86.2% younger than 12 months. The clinical diagnoses of HPeV-positive patients were gastroenteritis, respiratory illness, febrile illness, exanthema, “hand, foot, and mouth disease,” aseptic meningitis, and herpangina. Among 49 HPeV-positive patients with gastroenteritis, 35 were positive with HPeV-1 and 12 with HPeV-3, and out of 25 with respiratory illness, 11 were positive with HPeV-1 and 14 with HPeV-3. HPeV-3 seemed to be an important etiological agent of respiratory infection of children. While HPeV-1 was detected predominantly during fall and winter, the majority of the HPeV-3 cases were detected during summer and fall. A different pattern of clinical manifestations as well as seasonality suggested that there are different mechanisms of pathogenesis between HPeV-1 and HPeV-3 infections. PMID:20519478

  19. Nonallergic hypersensitivity to nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, local anesthetics, volume substitutes and medications used in general anesthesia.

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    Jurakić Toncić, Ruzica; Marinović, Branka; Lipozencić, Jasna

    2009-01-01

    Urticaria and angioedema are common allergic manifestations and medications are one of common triggering factors. The most severe immediate drug reaction is anaphylaxis. Apart from the well established IgE-mediated immediate type hypersensitivity reactions, the pathogenesis of drug-induced urticaria, angioedema and anaphylaxis often remains obscure. In this article, emphasis is put on nonallergic reactions to the most commonly used drug groups of nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, volume expanders and drugs used in general anesthesia. Urticaria is the second most common drug eruption after maculopapular exanthema. The mechanisms of acute urticarial reactions are multiple, mostly IgE mediated, but some drugs can induce immune complex reactions and activate complement cascade, while others can induce direct activation of mast cells and degranulation or activation of complement by non-immune mechanisms. With different types of medications different pathomechanisms are involved. Non-steroid anti-inflammatory drugs are thought to cause reaction due to cyclooxygenase-1 inhibition and overproduction of leukotrienes, blamed for cutaneous and respiratory symptoms. Angiotensin-converting enzyme inhibitors can cause fatal angioedema, which is partially explained with bradykinin excess and impairment of aminopeptidase P and dipeptidyl peptidase IV that are involved in the metabolism of substance P and bradykinin. It remains unknown what additional mechanisms are involved. Radiocontrast media and local anesthetics mostly cause nonallergic hypersensitivity reaction, but in rare cases true allergic reaction can occur. Dextran is known to cause IgG mediated, immune complex anaphylaxis and it is recommended to use human serum albumin as the safest colloid.

  20. Phase 2 study of a combined immunochemotherapy using rituximab and fludarabine in patients with chronic lymphocytic leukemia.

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    Schulz, Holger; Klein, Saskia Karina; Rehwald, Ute; Reiser, Marcel; Hinke, Axel; Knauf, Wolfgang-Ulrich; Aulitzky, Walter-Erich; Hensel, Manfred; Herold, Michael; Huhn, Dieter; Hallek, Michael; Diehl, Volker; Engert, Andreas

    2002-11-01

    This multicenter phase 2 trial investigated safety and efficacy of a new immunochemotherapeutic regimen combining rituximab (R) and fludarabine (F) in patients with fludarabine- and anthracycline-naive chronic lymphocytic leukemia (CLL). The rationale for using R + F includes single-agent efficacy of both drugs, in vitro synergism of R and F, and no apparent overlapping toxicity. Of 31 eligible patients with B-CLL enrolled, 20 were previously untreated and 11 relapsed. Treatment consisted of fludarabine administered at standard doses (25 mg/m(2)/d; days 1-5, 29-33, 57-61, and 85-89) and rituximab (375 mg/m(2)/d) given on days 57, 85, 113, and 151. Side effects such as fever, chills, and exanthema were generally mild (National Cancer Institute Common Toxicity Criteria [NCI-CTC] grade 1/2 in 48% and grade 3 and/or 4 in 3% of patients). Fever and chills were mainly associated with the first rituximab infusion. Hematologic toxicity included neutropenia (grade 1 and/or 2 in 26%, grade 3 and/or 4 in 42%) and thrombocytopenia (grade 1 and/or 2 in 19%, grade 3 and/or 4 in 9%). One patient died of cerebral bleeding during prolonged thrombocytopenia after the second cycle of fludarabine. There were a total of 32 infections in 16 patients, none of which was fatal. The overall response rate (complete remission [CR] and partial remission [PR]) was 87% (27 of 31 evaluable patients). In 20 previously untreated patients, 17 (85%) responded. Ten of 31 patients achieved CR (5 of 20 untreated; 5 of 11 pretreated; 9 of 21 Binet stage B, 1 of 10 Binet stage C). The median duration of response was 75 weeks. We conclude that the combination of rituximab and fludarabine is feasible and effective in patients with B-CLL.

  1. Immunological mechanisms underlying delayed-type hypersensitivity reactions to glatiramer acetate.

    Science.gov (United States)

    Mayorga, Cristobalina; Blazquez, Ana B; Doña, Inmaculada; Gomez, Francisca; Chaves, Patricia; Sanchez-Quintero, Maria J; Blanca-López, Natalia; Melendez, Lidia; Blanca, Miguel; Torres, Maria Jose

    2012-07-01

    Delayed-type hypersensitivity to glatiramer acetate is rare, and the underlying immunological mechanisms are not completely understood. To study the immunologic response in 2 patients with multiple sclerosis who developed maculopapular exanthema related with the administration of glatiramer acetate. The allergologic study included general blood tests, viral serologic tests, and skin tests (patch and intradermal tests). The immunologic study was performed in skin biopsy specimens by immunohistochemistry and in the peripheral blood by flow cytometry and the lymphocyte transformation test. Skin test results were negative in both patients, and the diagnosis was confirmed by a drug provocation test. The evaluation of the acute phase showed an increase in the percentage of CD8 T lymphocytes (>50%) and the percentage of cells expressing skin-homing receptor (cutaneous lymphocyte-associated antigen) (>70%) and chemokine receptors (CCR4 and CXCR3) at T1. A positive proliferative response was observed in T lymphocytes (stimulation index [SI] = 3.5 in patient 1 and 3.59 in patient 2), especially the CD8(+) subpopulation (SI = 5.5 and 4.6 in patients 1 and 2, respectively), and NK lymphocytes (SI = 3.9 and 8.5 in patients 1 and 2, respectively) after glatiramer acetate stimulation. This study demonstrates the important role of T(H)1 cells expressing skin-homing receptors in delayed-type hypersensitivity reactions to glatiramer acetate. A lymphocyte transformation test revealed a specific glatiramer acetate recognition by T lymphocytes and NK lymphocytes. Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  2. 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.

  3. 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.

  4. Age-specific sex-related differences in infections: a statistical analysis of national surveillance data in Japan.

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    Nobuoki Eshima

    Full Text Available BACKGROUND: To prevent and control infectious diseases, it is important to understand how sex and age influence morbidity rates, but consistent clear descriptions of differences in the reported incidence of infectious diseases in terms of sex and age are sparse. METHODS AND FINDINGS: Data from the Japanese surveillance system for infectious diseases from 2000 to 2009 were used in the analysis of seven viral and four bacterial infectious diseases with relatively large impact on the Japanese community. The male-to-female morbidity (MFM ratios in different age groups were estimated to compare incidence rates of symptomatic reported infection between the sexes at different ages. MFM ratios were >1 for five viral infections out of seven in childhood, i.e. male children were more frequently reported as infected than females with pharyngoconjunctival fever, herpangina, hand-foot-and-mouth disease, mumps, and varicella. More males were also reported to be infected with erythema infectiosum and exanthema subitum, but only in children 1 year of age. By contrast, in adulthood the MFM ratios decreased to <1 for all of the viral infections above except varicella, i.e. adult women were more frequently reported to be infected than men. Sex- and age-related differences in reported morbidity were also documented for bacterial infections. Reported morbidity for enterohemorrhagic Escherichia coli infection was higher in adult females and females were reportedly more infected with mycoplasma pneumonia than males in all age groups up to 70 years. CONCLUSIONS: Sex-related differences in reported morbidity for viral and bacterial infections were documented among different age groups. Changes in MFM ratios with age may reflect differences between the sexes in underlying development processes, including those affecting the immune, endocrine, and reproductive systems, or differences in reporting rates.

  5. 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.

  6. 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

  7. Immunological and biochemical characterization of coxsackie virus A16 viral particles.

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    Pele Chong

    Full Text Available BACKGROUND: Coxsackie virus A16 (CVA16 infections have become a serious public health problem in the Asia-Pacific region. It manifests most often in childhood exanthema, commonly known as hand-foot-and-mouth disease (HFMD. There are currently no vaccine or effective medical treatments available. PRINCIPAL FINDING: In this study, we describe the production, purification and characterization of CVA16 virus produced from Vero cells grown on 5 g/L Cytodex 1 microcarrier beads in a five-liter serum-free bioreactor system. The viral titer was found to be >10(6 the tissue culture's infectious dose (TCID(50 per mL within 7 days post-infection when a multiplicity of infection (MOI of 10(-5 was used for initial infection. Two CVA16 virus fractions were separated and detected when the harvested CVA16 viral concentrate was purified by a sucrose gradient zonal ultracentrifugation. The viral particles detected in the 24-28% sucrose fractions had low viral infectivity and RNA content. The viral particles obtained from 35-38% sucrose fractions were found to have high viral infectivity and RNA content, and composed of four viral proteins (VP1, VP2, VP3 and VP4, as shown by SDS-PAGE analyses. These two virus fractions were formalin-inactivated and only the infectious particle fraction was found to be capable of inducing CVA16-specific neutralizing antibody responses in both mouse and rabbit immunogenicity studies. But these antisera failed to neutralize enterovirus 71. In addition, rabbit antisera did not react with any peptides derived from CVA16 capsid proteins. Mouse antisera recognized a single linear immunodominant epitope of VP3 corresponding to residues 176-190. CONCLUSION: These results provide important information for cell-based CVA16 vaccine development. To eliminate HFMD, a bivalent EV71/CVA16 vaccine formulation is necessary.

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

    Science.gov (United States)

    2013-01-01

    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. PMID:23347781

  9. 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; Bataar, Otgon; Rusher, Albert H; Hasibeder, Walter R; Tsenddorj, Ganbat

    2008-01-01

    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. PMID:19032758

  10. Age-Specific Sex-Related Differences in Infections: A Statistical Analysis of National Surveillance Data in Japan

    Science.gov (United States)

    Eshima, Nobuoki; Tokumaru, Osamu; Hara, Shohei; Bacal, Kira; Korematsu, Seigo; Karukaya, Shigeru; Uruma, Kiyo; Okabe, Nobuhiko; Matsuishi, Toyojiro

    2012-01-01

    Background To prevent and control infectious diseases, it is important to understand how sex and age influence morbidity rates, but consistent clear descriptions of differences in the reported incidence of infectious diseases in terms of sex and age are sparse. Methods and Findings Data from the Japanese surveillance system for infectious diseases from 2000 to 2009 were used in the analysis of seven viral and four bacterial infectious diseases with relatively large impact on the Japanese community. The male-to-female morbidity (MFM) ratios in different age groups were estimated to compare incidence rates of symptomatic reported infection between the sexes at different ages. MFM ratios were >1 for five viral infections out of seven in childhood, i.e. male children were more frequently reported as infected than females with pharyngoconjunctival fever, herpangina, hand-foot-and-mouth disease, mumps, and varicella. More males were also reported to be infected with erythema infectiosum and exanthema subitum, but only in children 1 year of age. By contrast, in adulthood the MFM ratios decreased to <1 for all of the viral infections above except varicella, i.e. adult women were more frequently reported to be infected than men. Sex- and age-related differences in reported morbidity were also documented for bacterial infections. Reported morbidity for enterohemorrhagic Escherichia coli infection was higher in adult females and females were reportedly more infected with mycoplasma pneumonia than males in all age groups up to 70 years. Conclusions Sex-related differences in reported morbidity for viral and bacterial infections were documented among different age groups. Changes in MFM ratios with age may reflect differences between the sexes in underlying development processes, including those affecting the immune, endocrine, and reproductive systems, or differences in reporting rates. PMID:22848753

  11. Schizophrenia or Atypical Lupus Erythematosus with Predominant Psychiatric Manifestations over 25 Years: Case Analysis and Review

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    Axel Mack

    2017-07-01

    Full Text Available We observed a case over 25 years of relapsing–remitting schizophrenic spectrum disorder, varying regarding the main symptomatology between more depressive or more schizoaffective or rather typical schizophrenic syndrome. Diseased phases were repeatedly accompanied by minor skin lesions, which were initially classified as mixed tissue disorder. Psychotic phases were waxing–waning over years. During one later relapse, skin involvement was severe, classified to likely represent an allergic reaction to psychopharmaca; this generalized exanthema remitted rapidly with cortisone treatment and azathioprine. Under continued azathioprine and low dose neuroleptics, the patient remitted completely, appearing psychiatrically healthy for 16 years. When azathioprine was set off due to pregnancy, an extraordinary severe relapse of schizophrenia like psychosis accompanied by most severe skin lesions developed within a few weeks, then requiring 2 years of psychiatric inpatient treatment. Finally, a diagnosis of systemic lupus erythematodes plus neuropsychiatric lupus was made. A single CSF sample in 2013 showed suspicious biomarkers, matching with CSF cytokine profiling in schizophrenic and affective spectrum disorder patients and indicated mild neuroinflammation. Complex immune suppressive treatment was reinitiated short after relapse, but was only partially successful. However, surprisingly the psychosis and skin lesions remitted (in parallel when belimumab was given (add-on. The very details of this complicated, long-term disease course are discussed also with regard to general ideas, in particular with respect to the question if this case of seemingly comorbid schizophrenia with minor autoimmunity signs represented a case of one emerging autoimmune disorder with variant manifestations systemically and within the CNS, though atypically with predominant appearance as a schizophrenia spectrum disorder.

  12. RASopathic Skin Eruptions during Vemurafenib Therapy

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    Rinderknecht, Jeannine D.; Goldinger, Simone M.; Rozati, Sima; Kamarashev, Jivko; Kerl, Katrin; French, Lars E.

    2013-01-01

    Purpose 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 and Methods 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. Results 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). Conclusion 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. PMID:23516541

  13. Identification of thymus and activation-regulated chemokine (TARC/CCL17) as a potential marker for early indication of disease and prediction of disease activity in drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS).

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    Ogawa, Kohei; Morito, Hironori; Hasegawa, Ayako; Daikoku, Natsuko; Miyagawa, Fumi; Okazaki, Aiko; Fukumoto, Takaya; Kobayashi, Nobuhiko; Kasai, Takahiko; Watanabe, Hideaki; Sueki, Hirohiko; Iijima, Masafumi; Tohyama, Mikiko; Hashimoto, Koji; Asada, Hideo

    2013-01-01

    Drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS) is a serious acute drug reaction with fever, cutaneous eruption, lymphadenopathy, and several visceral dysfunctions. Eosinophilia is a common hematological abnormality in DIHS/DRESS suggesting that the Th2-type immune response is involved. Thymus and activation-regulated chemokine (TARC/CCL17) is a family of CC chemokines known to play an important role in Th2-mediated immune-inflammatory processes. We investigated the pathogenic role of TARC in patients with DIHS. Sera were obtained from 8 patients with DIHS, 7 patients with Stevens-Johnson syndrome/Toxic epidermal necrolysis (SJS/TEN), and 14 patients with drug-induced maculopapular exanthema (MPE). Serum TARC levels were measured by ELISA. TARC levels were then compared with clinical symptoms and various hematological parameters. In addition, a biopsy was taken from the lesional skin of patients with DIHS and stained with anti-TARC Ab and anti-CD11c Ab. Serum TARC levels in patients with DIHS were significantly higher than those in patients with SJS/TEN and MPE during the acute phase. Serum TARC levels in DIHS patients correlated with skin eruptions, serum sIL-2R levels, eosinophil counts, and serum IL-5 levels. Immunohistochemical staining revealed that TARC was mainly expressed on CD11c+ dermal dendritic cells in patients with DIHS. Serum TARC levels may be associated with the initial presentation of DIHS as well as disease activity during the course. Thus, they could be useful as an indicator for early diagnosis and assessment of disease activity in DIHS. CD11c+ dendritic cells may be the main source of TARC in patients with DIHS. Copyright © 2012 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.

  14. Dissecting Kawasaki disease: a state-of-the-art review.

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    Dietz, S M; van Stijn, D; Burgner, D; Levin, M; Kuipers, I M; Hutten, B A; Kuijpers, T W

    2017-08-01

    Kawasaki disease (KD) is a pediatric vasculitis with coronary artery aneurysms (CAA) as its main complication. The diagnosis is based on the presence of persistent fever and clinical features including exanthema, lymphadenopathy, conjunctival injection, and changes to the mucosae and extremities. Although the etiology remains unknown, the current consensus is that it is likely caused by an (infectious) trigger initiating an abnormal immune response in genetically predisposed children. Treatment consists of high dose intravenous immunoglobulin (IVIG) and is directed at preventing the development of CAA. Unfortunately, 10-20% of all patients fail to respond to IVIG and these children need additional anti-inflammatory treatment. Coronary artery lesions are diagnosed by echocardiography in the acute and subacute phases. Both absolute arterial diameters and z-scores, adjusted for height and weight, are used as criteria for CAA. Close monitoring of CAA is important as ischemic symptoms or myocardial infarction due to thrombosis or stenosis can occur. These complications are most likely to arise in the largest, so-called giant CAA. Apart from the presence of CAA, it is unclear whether KD causes an increased cardiovascular risk due to the vasculitis itself. Many aspects of KD remain unknown, although there is growing knowledge on the etiology, treatment, and development and classification of CAA. Since children with previous KD are entering adulthood, long-term follow-up is increasingly important. What is known: • Kawasaki disease (KD) is a pediatric vasculitis with coronary artery damage as its main complication. • Although KD approaches its 50th birthday since its first description, many aspects of the disease remain poorly understood. What is new: • In recent years, multiple genetic candidate pathways involved in KD have been identified, with recently promising information about the ITPKC pathway. • As increasing numbers of KD patients are reaching adulthood

  15. 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

  16. 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

  17. 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

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

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    Prćić, Sonja; Gajinov, Zorica; Zrnić, Bogdan; Radulović, Anica; Matić, Milan; Djuran, Verica

    2013-12-01

    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. 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. During the study period, EI was detected in 88 children (44 females and 44 males), 0.213% of the total number of 41,345 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. 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 findings, continuing medical education of primary health care

  19. Baboon syndrome and toxic erythema of chemotherapy: Fold (intertriginous) dermatoses.

    Science.gov (United States)

    Wolf, Ronni; Tüzün, Yalçın

    2015-01-01

    Three decades ago, researchers described an eruption with a very characteristic distribution pattern that was confined to the buttocks and the intertriginous and flexor areas. They gave this reaction pattern one of the most unforgettable names in dermatology, baboon syndrome (BS), due to the characteristic, bright-red, well-demarcated eruption predominantly on the buttocks and genital area, reminiscent of the red bottom of a baboon. The authors described three cases provoked by ampicillin, nickel, and mercury. They were convinced that BS represented a special form of hematogenous or systemic contact-type dermatitis, but several important papers that appeared during the past decade disagreed and suggested that BS should be distinguished from hematogenous or systemic contact-type dermatitis. A new acronym, SDRIFE (symmetrical drug-related intertriginous and flexoral exanthema), was proposed along with five diagnostic criteria: (1) exposure to a systemically administered drug at the time of first or repeated doses (contact allergens excluded), (2) sharply demarcated erythema of the gluteal/perianal area and/or V-shaped erythema of the inguinal/perigenital area, (3) involvement of at least one other intertriginous/flexural fold, (4) symmetry of affected areas, and (5) absence of systemic symptoms and signs. Although there are merits to the arguments in favor of SDRIFE, many of us still prefer to use the wittier name baboon syndrome, and even more authors use both terms. We confess that we find it difficult to relinquish the term BS, which has served us so well for years; however, recognition, familiarity, and knowledge of the characteristics of this form of drug eruption must supersede sentimental attachment to a certain nomenclature and so, however reluctantly, we must embrace change. Another intertriginous drug eruption is the one induced by chemotherapy. Toxic erythema of chemotherapy (TEC) is a useful clinical term that recently has been introduced to describe this

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

    Science.gov (United States)

    Millet, Joan-Pau; Montalvo, Tomàs; Bueno-Marí, Ruben; Romero-Tamarit, Arancha; Prats-Uribe, Albert; Fernández, Lidia; Camprubí, Esteve; del Baño, Lucía; Peracho, Victor; Figuerola, Jordi; Sulleiro, Elena; Martínez, Miguel J.; Caylà, Joan A.; Álamo-Junquera, Dolores

    2017-01-01

    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 prevention of

  1. Feasibility and Effectiveness of Indicator Condition-Guided Testing for HIV: Results from HIDES I (HIV Indicator Diseases across Europe Study)

    Science.gov (United States)

    Sullivan, Ann K.; Raben, Dorthe; Reekie, Joanne; Rayment, Michael; Mocroft, Amanda; Esser, Stefan; Leon, Agathe; Begovac, Josip; Brinkman, Kees; Zangerle, Robert; Grzeszczuk, Anna; Vassilenko, Anna; Hadziosmanovic, Vesna; Krasnov, Maksym; Sönnerborg, Anders; Clumeck, Nathan; Gatell, José; Gazzard, Brian; Monforte, Antonella d’Arminio; Rockstroh, Jürgen; Lundgren, Jens D.

    2013-01-01

    Improved methods for targeting HIV testing among patients most likely to be infected are required; HIDES I aimed to define the methodology of a European wide study of HIV prevalence in individuals presenting with one of eight indicator conditions/diseases (ID); sexually transmitted infection, lymphoma, cervical or anal cancer/dysplasia, herpes zoster, hepatitis B/C, mononucleosis-like illness, unexplained leukocytopenia/thrombocytopenia and seborrheic dermatitis/exanthema, and to identify those with an HIV prevalence of >0.1%, a level determined to be cost effective. A staff questionnaire was performed. From October 2009– February 2011, individuals, not known to be HIV positive, presenting with one of the ID were offered an HIV test; additional information was collected on previous HIV testing behaviour and recent medical history. A total of 3588 individuals from 16 centres were included. Sixty-six tested positive for HIV, giving an HIV prevalence of 1.8% [95% CI: 1.42–2.34]; all eight ID exceeded 0.1% prevalence. Of those testing HIV positive, 83% were male, 58% identified as MSM and 9% were injecting drug users. Twenty percent reported previously having potentially HIV-related symptoms and 52% had previously tested HIV negative (median time since last test: 1.58 years); which together with the median CD4 count at diagnosis (400 cell/uL) adds weight to this strategy being effective in diagnosing HIV at an earlier stage. A positive test was more likely for non-white individuals, MSM, injecting drug users and those testing in non-Northern regions. HIDES I describes an effective strategy to detect undiagnosed HIV infection. All eight ID fulfilled the >0.1% criterion for cost effectiveness. All individuals presenting to any health care setting with one of these ID should be strongly recommended an HIV test. A strategy is being developed in collaboration with ECDC and WHO Europe to guide the implementation of this novel public health initiative across Europe. PMID

  2. Impossibility of the treatment of inoperable liver multicystic echinococcosis due to adverse reactions to antihelminitics

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    Mikić Dragan

    2009-01-01

    Full Text Available Introduction. In some cases of multicystic forms of liver echinococcal disease, the advanced method for treatment of cystic echinococcosis faces great problems relating to the final outcome of the treatment. Case report. In May 2005, a computerized tomography of the abdomen obtained in a 27-year -old famale patient with abdominal pain revealed more than 20 echinococcal cysts measuring up to 6.7 cm in both lobes of the liver. Laboratory analyses found the value of eosinophils 6.8%, gamma globulins 29.9%, immunoglobulin E 29 600 IU/mL and the indirect hemagglutination for echinococcosis 1 : 8 196. The treatment started in December that year with the continuous administration of a daily dose of 800 mg (14.5 mg/kg body weight of albendazole, but it was terminated two months later due to high serum transaminases values. By the end of 2006, the largest cyst detected in the left lobe of the liver had a diameter of 5.7 cm and the one in the right lobe of the liver measured 4.1 cm. There were lesions of germinative membrane found on both cysts. Six months later, praziquantel at daily dose of 2 500 mg (45.3 mg/kg body waight was introduced into the therapy, but the treatment was terminated after eight days because of the development of exanthema. The computerized tomography of the abdomen obtained in February 2008 revealed the presence of a large number of echinococcal cysts in the liver. The largest among those cysts measured 3.5 cm while calcifications of the cyst walls were observed on some of them. None of the remaining therapeutic options for further treatmetnt of echinococcal disease could be applied. Conclusion. The presented case confirms medical therapy as the only option for the treatment of some forms of cystic echinococcosis. Benzimidazole carbamates (albendazole, mebendazole and praziquantel are only efficacious antihelminitics currently available, and when they have to be withdrawn due to serious adverse offects, futher treatment of a

  3. É possível identificar a dengue em crianças a partir do critério de caso suspeito preconizado pelo Ministério da Saúde? Is it possible to identify dengue in children on the basis of Ministry of Health criteria for suspected dengue cases?

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    Marisa B. P. Rodrigues

    2005-06-01

    Full Text Available OBJETIVOS: Identificar características clínicas indicativas de dengue e avaliar a aplicabilidade, na criança, do critério de caso suspeito do Ministério da Saúde. MÉTODOS: Estudo transversal, realizado no Centro Geral de Pediatria, Fundação Hospitalar de Minas Gerais. Foram incluídas crianças com doença febril aguda sem etiologia definida, com duração > 24 horas e OBJECTIVES: To identify clinical characteristics indicative of dengue and to evaluate the applicability to children of the Health Ministry criteria for suspected cases. METHODOS: A cross-sectional study undertaken at the General Pediatrics Center of the Fundação Hospitalar de Minas Gerais. Children were enrolled if presenting acute febrile conditions with no definite etiology, lasting > 24 hours and < 7 days and if resident in the Metropolitan Region of Belo Horizonte. Clinical variables were investigated, specific tests were performed and aspartate-aminotransferase assayed, during a period considered both endemic and epidemic for the disease. The subset of children who did have dengue was compared with the subset of nonspecific acute febrile diseases. The Health Ministry criteria for suspected cases was evaluated. RESULTS: Dengue was diagnosed in 50.4% of the 117 children studied. There were no statistically significant associations between the disease and the majority of the symptoms analyzed. Only exanthema was more often associated with dengue (Prevalence Ratio = 1.49; 95% CI: 1.05-2.11. The criteria for suspected cases of dengue had a sensitivity of just 50.8% and a positive predictive value of 62.5%. These values were greater among schoolchildren and during the period of greater disease incidence. CONCLUSIONS: Dengue is common among febrile diseases of childhood, with prevalence that varies according to the epidemiological situation. The clinical status of children with dengue was very similar to that of children with other nonspecific diseases. The Health

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

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    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

  5. FEATURES OF A COURSE OF THE INFECTION CAUSED BY A VIRUS OF HERPES OF THE 6TH TYPE AMONG CHILDREN OF EARLY AGE IN THE SETTING OF A ACUTE RESPIRATORY VIRAL INFECTION

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    N. V. Okolysheva

    2014-01-01

    Full Text Available We examined 95 children aged from 5 months till 3 years (middle age 1,7 ±1,1, who were admitted in children's infectious department of theClinicalInfectionsHospital№1 by diagnosis acute respiratory virus infection in the height of disease. Anti-genes of sharp respiratory viruses by the IF method, markers of HHV-6 type, and also a cytomegalovirus of the person (CMV and Epstein-Barre's virus the ELISA methods and PTsR-rv are studied. Respiratory viruses are found among the hospitalized children in 46,3% of cases, from them paraflu (32,6% in comparison with flu (9,5% and a respiratornosintsitialny virus (4,2%, р < 0,05 statistically significantly is more often revealed. Markers of HHV are revealed at 73,7% of children. During the mixed infection HHV-6 markers are found in the vast majority of children (79,4% in combination with this or that representative of Herpesviridae, is statistically significantly more often with CMV(16,8%, р < 0,05. DNA of HHV-6 is statistically significantly more often (41% and with more viral load (53 400 copies/ml is revealed in a saliva in comparison with blood and urine. DNA of HHV-6 ina saliva statistically significantly is defined among the children visiting child care centers more often, than at unorganized children (72% against 40,4%, р = 0,0001 that testifies about a horizontal transmission of infection. It is observed that markers of HHV-6 are defined statistically significantly more often among children aged from 7 till 12 months (50% and among children older by 1 year (49,2% in comparison with children aged from 0 till 6 months (10%, р < 0,05. It is shown that among children of an early age the exanthema at HHV-6-of an infection is associated with presence of DNA of HHV-6 with high concentration (more than 120 000 copies/ml in blood.

  6. 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.

  7. 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

  8. 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

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    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

  9. 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

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

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    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.

  11. 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.

  12. 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

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    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.

  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

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    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. Comportamiento clínico-epidemiológico de la enfermedad de Kawasaki Clinical-epidemiological behavior of Kawasaky' disease

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    Milagros Morales Leiva

    2011-06-01

    features of patients diagnosed with Kawasaki' disease seen in the "William Soler" Children Hospital between January, 2002 and December, 2009. The study variable were: age, sex, clinical manifestations, date of symptoms onset and of the diagnosis, complementary examinations and treatment and response to treatment. RESULTS. The 100% of patients were under 8 years old. The 57,1`% was of male sex. The disease was more frequent in drought season. Fever was documented n the 100% of patients during more than 5 days of course, conjunctival injection, oropharyngeal lesions and plantar and palmar erythema; in the 85,7% of patients there was a polymorphous exanthema and in the 57,1%, a cervical unique adenopathy. The erythrosedimentation was high in the 100% of cases and in the 85,7% anemia was diagnosed. Three patients (42,8% has coronary irregularities. All patients were treated with intravenous immunoglobulin (Intacglobin and aspirin; in three of cases it was necessary to administer a second dose of intravenous immunoglobulin.

  15. Varicella zoster in children attending day care centers Varicela-zóster em crianças que frequentam creches

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    Ricardo Marcitelli

    2006-04-01

    Full Text Available OBJECTIVE: To describe morbidity associated to varicella in children attending day care centers. METHODS: Descriptive study carried out through inquiries with parents of 664 children who acquired varicella after admission to day care centers in Taubaté (population: 244,165, census of 2004, a prosperous city in the State of São Paulo. RESULTS: The median age was 36 months (range 6 to 80 months; 8.4% of the children had varicella before 1 year of age. The main symptoms were: exanthema (100.0%, fever (85.4% anorexia (39.6%, and headache (15.3%. 517 children (77.9% had at least 1 medical visit, and 80.6% received at least 1 medication; 73 (11.0% received nonsteroidal antiinflammatory drugs, and 52 (7.8% received antibiotics. Complications occurred in 38 children (5.7%; 95% confidence interval: 3% - 8%; 8 (1.2% were hospitalized, and 5 (0.7% had sequelae. Complications and hospitalizations rates were 3 times more frequent in children with less than 1 year of age than in older children. More than half of the children and of the working parents were absent from their regular activities for more than a week. CONCLUSIONS: Varicella was associated with significant morbidity, affected younger children, was complicated in more than 5%, and left sequelae in 0.7% of children. More than 10% of the children received nonsteroidal antiinflammatory drugs, highlighting the need to warn the population about the risks of these drugs. Although varicella vaccination is not recommended for children younger than 12 months, vaccination of the children older than a year could avoid by herd immunity the transmission to babies. Brazilian public health authorities should be alerted to this issue and offer varicella vaccine to children attending day care centers.OBJETIVO: Descrever a morbidade associada à varicela nas crianças usuárias de creches. MÉTODOS: Estudo descritivo, realizado através de inquérito com pais ou responsáveis por 664 crianças que contra

  16. 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.

  17. 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

  18. 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