Clozapine-Induced Myocarditis: Is Mandatory Monitoring Warranted for Its Early Recognition?

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T. A. Munshi

2014-01-01

Full Text Available Clozapine is an atypical antipsychotic used for treatment resistant schizophrenia. Its potential to induce agranulocytosis is well known but it can also cause myocarditis. Clozapine is the only antipsychotic known to induce this side effect, typically early in the treatment, and literature is scarce on this condition. We are presenting a case report of a 21-year-old schizophrenic male who developed myocarditis within 3 weeks of starting on clozapine for his treatment resistant psychosis. We then aim to review some of the available literature and raise awareness among physicians as this condition can potentially be fatal if not detected early.

Bartonella spp. bacteremia in blood donors from Campinas, Brazil.

Science.gov (United States)

Pitassi, Luiza Helena Urso; de Paiva Diniz, Pedro Paulo Vissotto; Scorpio, Diana Gerardi; Drummond, Marina Rovani; Lania, Bruno Grosselli; Barjas-Castro, Maria Lourdes; Gilioli, Rovilson; Colombo, Silvia; Sowy, Stanley; Breitschwerdt, Edward B; Nicholson, William L; Velho, Paulo Eduardo Neves Ferreira

2015-01-01

Bartonella species are blood-borne, re-emerging organisms, capable of causing prolonged infection with diverse disease manifestations, from asymptomatic bacteremia to chronic debilitating disease and death. This pathogen can survive for over a month in stored blood. However, its prevalence among blood donors is unknown, and screening of blood supplies for this pathogen is not routinely performed. We investigated Bartonella spp. prevalence in 500 blood donors from Campinas, Brazil, based on a cross-sectional design. Blood samples were inoculated into an enrichment liquid growth medium and sub-inoculated onto blood agar. Liquid culture samples and Gram-negative isolates were tested using a genus specific ITS PCR with amplicons sequenced for species identification. Bartonella henselae and Bartonella quintana antibodies were assayed by indirect immunofluorescence. B. henselae was isolated from six donors (1.2%). Sixteen donors (3.2%) were Bartonella-PCR positive after culture in liquid or on solid media, with 15 donors infected with B. henselae and one donor infected with Bartonella clarridgeiae. Antibodies against B. henselae or B. quintana were found in 16% and 32% of 500 blood donors, respectively. Serology was not associated with infection, with only three of 16 Bartonella-infected subjects seropositive for B. henselae or B. quintana. Bartonella DNA was present in the bloodstream of approximately one out of 30 donors from a major blood bank in South America. Negative serology does not rule out Bartonella spp. infection in healthy subjects. Using a combination of liquid and solid cultures, PCR, and DNA sequencing, this study documents for the first time that Bartonella spp. bacteremia occurs in asymptomatic blood donors. Our findings support further evaluation of Bartonella spp. transmission which can occur through blood transfusions.

Bartonella quintana in Homeless Persons

Centers for Disease Control (CDC) Podcasts

In this podcast, Dr. Marina Eremeeva discusses an article about Bartonella quintana in homeless populations in San Francisco. Bartonella quintana is a bacterium that is transmitted by human body lice. Findings by the article’s authors suggest that Bartonella quintana may be transmitted by head lice. This could mean that populations other than homeless populations, such as school children, might be at increased risk for Bartonella quintana.

Prevalence and genetic diversity of Bartonella strains in rodents from northwestern Mexico.

Science.gov (United States)

Rubio, André V; Ávila-Flores, Rafael; Osikowicz, Lynn M; Bai, Ying; Suzán, Gerardo; Kosoy, Michael Y

2014-12-01

Bartonella infections were investigated in wild rodents from northwestern Chihuahua, Mexico. A total of 489 rodents belonging to 14 species were surveyed in four areas. Bartonella bacteria were cultured from 50.1% of rodent samples (245/489). Infection rates ranged from 0% to 83.3% per rodent species, with no significant difference between sites except for Cynomys ludovicianus. Phylogenetic analyses of the citrate synthase gene (gltA) of the Bartonella isolates revealed 23 genetic variants (15 novel and 8 previously described), clustering into five phylogroups. Three phylogroups were associated with Bartonella vinsonii subsp. vinsonii, B. vinsonii subsp. arupensis, and B. washoensis, respectively. The other two phylogroups were not genetically related to any known Bartonella species. The genetic variants and phylogenetic groups exhibited a high degree of host specificity, mainly at the genus and family levels. This is the first study that describes the genetic diversity of Bartonella strains in wild rodents from Mexico. Considering that some variants found in this study are associated with Bartonella species that have been reported as zoonotic, more investigations are needed to further understand the ecology of Bartonella species in Mexican wildlife and their implications for human health.

Bartonella spp. bacteremia in blood donors from Campinas, Brazil.

Directory of Open Access Journals (Sweden)

Luiza Helena Urso Pitassi

2015-01-01

Full Text Available Bartonella species are blood-borne, re-emerging organisms, capable of causing prolonged infection with diverse disease manifestations, from asymptomatic bacteremia to chronic debilitating disease and death. This pathogen can survive for over a month in stored blood. However, its prevalence among blood donors is unknown, and screening of blood supplies for this pathogen is not routinely performed. We investigated Bartonella spp. prevalence in 500 blood donors from Campinas, Brazil, based on a cross-sectional design. Blood samples were inoculated into an enrichment liquid growth medium and sub-inoculated onto blood agar. Liquid culture samples and Gram-negative isolates were tested using a genus specific ITS PCR with amplicons sequenced for species identification. Bartonella henselae and Bartonella quintana antibodies were assayed by indirect immunofluorescence. B. henselae was isolated from six donors (1.2%. Sixteen donors (3.2% were Bartonella-PCR positive after culture in liquid or on solid media, with 15 donors infected with B. henselae and one donor infected with Bartonella clarridgeiae. Antibodies against B. henselae or B. quintana were found in 16% and 32% of 500 blood donors, respectively. Serology was not associated with infection, with only three of 16 Bartonella-infected subjects seropositive for B. henselae or B. quintana. Bartonella DNA was present in the bloodstream of approximately one out of 30 donors from a major blood bank in South America. Negative serology does not rule out Bartonella spp. infection in healthy subjects. Using a combination of liquid and solid cultures, PCR, and DNA sequencing, this study documents for the first time that Bartonella spp. bacteremia occurs in asymptomatic blood donors. Our findings support further evaluation of Bartonella spp. transmission which can occur through blood transfusions.

Absence of zoonotic Bartonella species in questing ticks: First detection of Bartonella clarridgeiae and Rickettsia felis in cat fleas in the Netherlands

NARCIS (Netherlands)

Tijsse-Klasen, E.; Fonville, M.; Gassner, F.; Nijhof, A.M.; Hovius, E.K.E.; Jongejan, F.; Takken, W.; Reimerink, J.R.; Overgaauw, P.A.M.; Sprong, H.

2011-01-01

Background: Awareness for flea-and tick-borne infections has grown in recent years and the range of microorganisms associated with these ectoparasites is rising. Bartonella henselae, the causative agent of Cat Scratch Disease, and other Bartonella species have been reported in fleas and ticks. The

Absence of zoonotic Bartonella species in questing ticks: First detection of Bartonella clarridgeiae and Rickettsia felis in cat fleas in the Netherlands

NARCIS (Netherlands)

Tijsse-Klasen, E.; Fonville, M.; Gassner, F.; Nijhof, A.M.; Hovius, E.K.; Jongejan, F.; Takken, F.; Reimerink, J.R.; Overgaauw, P.A.M.; Sprong, H.

2011-01-01

BACKGROUND: Awareness for flea- and tick-borne infections has grown in recent years and the range of microorganisms associated with these ectoparasites is rising. Bartonella henselae, the causative agent of Cat Scratch Disease, and other Bartonella species have been reported in fleas and ticks. The

Giant Asian honeybee stings induced acute myocarditis: a case report

OpenAIRE

NP Dinamithra; S Sivansuthan

2013-01-01

Hymenopterid stings and subsequent allergic reactions including fatal anaphylaxis are a common indication for emergency department visits worldwide. Less commonly, multiple wasp stings can result in multi-system involvement ranging from intravascular hemolysis, rhabdomyolysis, acute renal failure, cardiac involvement, hepatic dysfunction and occasionally thrombocytopenia and coagulopathy. Here we report one case of multiple Giant Asian honey bee stings induced myocarditis.

Giant Asian honeybee stings induced acute myocarditis: a case report

Directory of Open Access Journals (Sweden)

NP Dinamithra

2013-10-01

Full Text Available Hymenopterid stings and subsequent allergic reactions including fatal anaphylaxis are a common indication for emergency department visits worldwide. Less commonly, multiple wasp stings can result in multi-system involvement ranging from intravascular hemolysis, rhabdomyolysis, acute renal failure, cardiac involvement, hepatic dysfunction and occasionally thrombocytopenia and coagulopathy. Here we report one case of multiple Giant Asian honey bee stings induced myocarditis.

Myocarditis - pediatric

Science.gov (United States)

... page: //medlineplus.gov/ency/article/007307.htm Myocarditis - pediatric To use the sharing features on this page, please enable JavaScript. Pediatric myocarditis is inflammation of the heart muscle in ...

Bartonella quintana in Homeless Persons

Centers for Disease Control (CDC) Podcasts

2009-06-30

In this podcast, Dr. Marina Eremeeva discusses an article about Bartonella quintana in homeless populations in San Francisco. Bartonella quintana is a bacterium that is transmitted by human body lice. Findings by the article’s authors suggest that Bartonella quintana may be transmitted by head lice. This could mean that populations other than homeless populations, such as school children, might be at increased risk for Bartonella quintana.  Created: 6/30/2009 by Emerging Infectious Diseases.   Date Released: 6/30/2009.

Ventricular myocarditis coincides with atrial myocarditis in patients

NARCIS (Netherlands)

Begieneman, Mark P. V.; Emmens, Reindert W.; Rijvers, Liza; Kubat, Bela; Paulus, Walter J.; Vonk, Alexander B. A.; Rozendaal, Lawrence; Biesbroek, P. Stefan; Wouters, Diana; Zeerleder, Sacha; van Ham, Marieke; Heymans, Stephane; van Rossum, Albert C.; Niessen, Hans W. M.; Krijnen, Paul A. J.

2016-01-01

Atrial fibrillation (AF) is a common complication in myocarditis. Atrial inflammation has been suggested to play an important role in the pathophysiology of AF. However, little is known about the occurrence of atrial inflammation in myocarditis patients. Here, we analyzed inflammatory cell numbers

Parvovirus Infection Is Associated With Myocarditis and Myocardial Fibrosis in Young Dogs.

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Ford, Jordan; McEndaffer, Laura; Renshaw, Randall; Molesan, Alex; Kelly, Kathleen

2017-11-01

Perinatal parvoviral infection causes necrotizing myocarditis in puppies, which results in acute high mortality or progressive cardiac injury. While widespread vaccination has dramatically curtailed the epidemic of canine parvoviral myocarditis, we hypothesized that canine parvovirus 2 (CPV-2) myocardial infection is an underrecognized cause of myocarditis, cardiac damage, and/or repair by fibrosis in young dogs. In this retrospective study, DNA was extracted from formalin-fixed, paraffin-embedded tissues from 40 cases and 41 control dogs under 2 years of age from 2007 to 2015. Cases had a diagnosis of myocardial necrosis, inflammation, or fibrosis, while age-matched controls lacked myocardial lesions. Conventional polymerase chain reaction (PCR) and sequencing targeting the VP1 to VP2 region detected CPV-2 in 12 of 40 cases (30%; 95% confidence interval [CI], 18%-45%) and 2 of 41 controls (5%; 95% CI, 0.1%-16%). Detection of CPV-2 DNA in the myocardium was significantly associated with myocardial lesions ( P = .003). Reverse transcription quantitative PCR amplifying VP2 identified viral messenger RNA in 12 of 12 PCR-positive cases and 2 of 2 controls. PCR results were confirmed by in situ hybridization, which identified parvoviral DNA in cardiomyocytes and occasionally macrophages of juvenile and young adult dogs (median age 61 days). Myocardial CPV-2 was identified in juveniles with minimal myocarditis and CPV-2 enteritis, which may indicate a longer window of cardiac susceptibility to myocarditis than previously reported. CPV-2 was also detected in dogs with severe myocardial fibrosis with in situ hybridization signal localized to cardiomyocytes, suggesting prior myocardial damage by CPV-2. Despite the frequency of vaccination, these findings suggest that CPV-2 remains an important cause of myocardial damage in dogs.

Bartonella clarridgeiae and Bartonella vinsonii subsp. berkhoffii exposure in captive wild canids in Brazil.

Science.gov (United States)

Fleischman, D A; Chomel, B B; Kasten, R W; André, M R; Gonçalves, L R; Machado, R Z

2015-02-01

SUMMARY Wild canids are potential hosts for numerous species of Bartonella, yet little research has been done to quantify their infection rates in South America. We sought to investigate Bartonella seroprevalence in captive wild canids from 19 zoos in São Paulo and Mato Grosso states, Brazil. Blood samples were collected from 97 wild canids belonging to four different native species and three European wolves (Canis lupus). Indirect immunofluorescent antibody testing was performed to detect the presence of B. henselae, B. vinsonii subsp. berkhoffii, B. clarridgeiae, and B. rochalimae. Overall, Bartonella antibodies were detected in 11 of the canids, including five (12·8%) of 39 crab-eating foxes (Cerdocyon thous), three (11·1%) of 27 bush dogs (Speothos venaticus), two (8·7%) of 23 maned wolves (Chrysocyon brachyurus) and one (12·5%) of eight hoary foxes (Lycalopex vetulus), with titres ranging from 1:64 to 1:512. Knowing that many species of canids make excellent reservoir hosts for Bartonella, and that there is zoonotic potential for all Bartonella spp. tested for, it will be important to conduct further research in non-captive wild canids to gain an accurate understanding of Bartonella infection in free-ranging wild canids in South America.

Role of Hippoboscidae flies as potential vectors of Bartonella spp. infecting wild and domestic ruminants.

Science.gov (United States)

Halos, Lénaïg; Jamal, Taoufik; Maillard, Renaud; Girard, Benjamin; Guillot, Jacques; Chomel, Bruno; Vayssier-Taussat, Muriel; Boulouis, Henri-Jean

2004-10-01

The putative role of biting flies in Bartonella transmission among ruminants was investigated. Amplification of the Bartonella citrate synthase gene from 83 Hippoboscidae was detected in 94% of 48 adult Lipoptena cervi flies, 71% of 17 adult Hippobosca equina flies, 100% of 20 adult Melophagus ovinus flies, and 100% of 10 M. ovinus pupae. Our findings suggest that Hippoboscidae play a role in the transmission of Bartonella among ruminants. The vertical transmission of Bartonella in M. ovinus and the presence of Bartonella DNA in all samples suggest a symbiotic association between Bartonella and M. ovinus.

Diagnostic approach of myocarditis: strike the golden mean.

Science.gov (United States)

Hazebroek, M R; Everaerts, K; Heymans, S

2014-02-01

Myocarditis is a challenging diagnosis due to the extreme diversity of clinical manifestations. The actual incidence of myocarditis is also difficult to determine as endomyocardial biopsy (EMB), the diagnostic gold standard, is used infrequently. Nevertheless, in up to 30 % of patients with biopsy-proven myocarditis, progression to dilated cardiomyopathy (DCM) can occur and is associated with a poor prognosis. Recent position statements of the European Society of Cardiology (ESC) and the American Heart Association vary widely with regard to indications for performing an EMB in these patients. This makes decision-making, in particular for general practitioners (GPs) and regional hospitals, difficult and unclear. Therefore, we will present a short summary of the ESC Working Group on Myocardial and Pericardial Diseases statement and our suggestions for GPs and regional hospitals for the diagnostic approach in patients with suspected myocarditis.

Bartonella Infection in Hematophagous, Insectivorous, and Phytophagous Bat Populations of Central Mexico and the Yucatan Peninsula.

Science.gov (United States)

Stuckey, Matthew J; Chomel, Bruno B; Galvez-Romero, Guillermo; Olave-Leyva, José Ignacio; Obregón-Morales, Cirani; Moreno-Sandoval, Hayde; Aréchiga-Ceballos, Nidia; Salas-Rojas, Mónica; Aguilar-Setién, Alvaro

2017-08-01

Although emerging nonviral pathogens remain relatively understudied in bat populations, there is an increasing focus on identifying bat-associated bartonellae around the world. Many novel Bartonella strains have been described from both bats and their arthropod ectoparasites, including Bartonella mayotimonensis , a zoonotic agent of human endocarditis. This cross-sectional study was designed to describe novel Bartonella strains isolated from bats sampled in Mexico and evaluate factors potentially associated with infection. A total of 238 bats belonging to seven genera were captured in five states of Central Mexico and the Yucatan Peninsula. Animals were screened by bacterial culture from whole blood and/or polymerase chain reaction of DNA extracted from heart tissue or blood. Bartonella spp. were isolated or detected in 54 (22.7%) bats, consisting of 41 (38%) hematophagous, 10 (16.4%) insectivorous, and three (4.3%) phytophagous individuals. This study also identified Balantiopteryx plicata as another possible bat reservoir of Bartonella . Univariate and multivariate logistic regression models suggested that Bartonella infection was positively associated with blood-feeding diet and ectoparasite burden. Phylogenetic analysis identified a number of genetic variants across hematophagous, phytophagous, and insectivorous bats that are unique from described bat-borne Bartonella species. However, these strains were closely related to those bartonellae previously identified in bat species from Latin America.

Molecular Detection of Bartonella Species in Blood-Feeding Bat Flies from Mexico.

Science.gov (United States)

Moskaluk, Alexandra E; Stuckey, Matthew J; Jaffe, David A; Kasten, Rickie W; Aguilar-Setién, Alvaro; Olave-Leyva, José Ignacio; Galvez-Romero, Guillermo; Obregón-Morales, Cirani; Salas-Rojas, Mónica; García-Flores, María Martha; Aréchiga-Ceballos, Nidia; García-Baltazar, Anahí; Chomel, Bruno B

2018-05-01

Bartonellae are emerging blood-borne bacteria that have been recovered from a wide range of mammalian species and arthropod vectors around the world. Bats are now recognized as a potential wildlife reservoir for a diverse number of Bartonella species, including the zoonotic Candidatus B. mayotimonensis. These bat-borne Bartonella species have also been detected in the obligate ectoparasites of bats, such as blood-feeding flies, which could transmit these bacteria within bat populations. To better understand this potential for transmission, we investigated the relatedness between Bartonella detected or isolated from bat hosts sampled in Mexico and their ectoparasites. Bartonella spp. were identified in bat flies collected on two bat species, with the highest prevalence in Trichobius parasiticus and Strebla wiedemanni collected from common vampire bats (Desmodus rotundus). When comparing Bartonella sequences from a fragment of the citrate synthase gene (gltA), vector-associated strains were diverse and generally close to, but distinct from, those recovered from their bacteremic bat hosts in Mexico. Complete Bartonella sequence concordance was observed in only one bat-vector pair. The diversity of Bartonella strains in bat flies reflects the frequent host switch by bat flies, as they usually do not live permanently on their bat host. It may also suggest a possible endosymbiotic relationship with these vectors for some of the Bartonella species carried by bat flies, whereas others could have a mammalian host.

Acquisition of nonspecific Bartonella strains by the northern grasshopper mouse (Onychomys leucogaster)

Science.gov (United States)

Bai, Y.; Kosoy, M.Y.; Cully, J.F.; Bala, T.; Ray, C.; Collinge, S.K.

2007-01-01

Rodent-associated Bartonella species are generally host-specific parasites in North America. Here evidence that Bartonella species can 'jump' between host species is presented. Northern grasshopper mice and other rodents were trapped in the western USA. A study of Bartonella infection in grasshopper mice demonstrated a high prevalence that varied from 25% to 90% by location. Bartonella infection was detected in other rodent species with a high prevalence as well. Sequence analyses of gltA identified 29 Bartonella variants in rodents, 10 of which were obtained from grasshopper mice. Among these 10, only six variants were specific to grasshopper mice, whereas four were identical to variants specific to deer mice or 13-lined ground squirrels. Fourteen of 90 sequenced isolates obtained from grasshopper mice were strains found more commonly in other rodent species and were apparently acquired from these animals. The ecological behavior of grasshopper mice may explain the occurrence of Bartonella strains in occasional hosts. The observed rate at which Bartonella jumps from a donor host species to the grasshopper mouse was directly proportional to a metric of donor host density and to the prevalence of Bartonella in the donor host, and inversely proportional to the same parameters for the grasshopper mouse. ?? 2007 Federation of European Microbiological Societies.

Pediatric Death Due to Myocarditis After Exposure to Cannabis

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Thomas M. Nappe

2017-03-01

Full Text Available Since marijuana legalization, pediatric exposures to cannabis have increased. 1 To date, pediatric deaths from cannabis exposure have not been reported. The authors report an 11-month-old male who, following cannabis exposure, presented with central nervous system depression after seizure, and progressed to cardiac arrest and died. Myocarditis was diagnosed post-mortem and cannabis exposure was confirmed. Given the temporal relationship of these two rare occurrences – cannabis exposure and sudden death secondary to myocarditis in an 11-month-old – as well as histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis-associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death. In areas where marijuana is commercially available or decriminalized, the authors urge clinicians to preventively counsel parents and to include cannabis exposure in the differential diagnosis of patients presenting with myocarditis.

Prevalence of Bartonella spp. by culture, PCR and serology, in veterinary personnel from Spain

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José A. Oteo

2017-11-01

Full Text Available Abstract Background The genus Bartonella includes fastidious, facultative intracellular bacteria mainly transmitted by arthropods and distributed among mammalian reservoirs. Bartonella spp. implicated as etiological agents of zoonoses are increasing. Apart from the classical Bartonella henselae, B. bacilliformis or B. quintana, other species (B. elizabethae, B. rochalimae, B. vinsonii arupensis and B. v. berkhoffii, B. tamiae or B. koehlerae, among others have also been associated with human and/or animal diseases. Laboratory techniques for diagnosis (culture, PCR assays and serology usually show lack of sensitivity. Since 2005, a method based on a liquid enrichment Bartonella alphaproteobacteria growth medium (BAPGM followed by PCRs for the amplification of Bartonella spp. has been developed. We aimed to assess culture, molecular and serological prevalence of Bartonella infections in companion animal veterinary personnel from Spain. Methods Each of 89 participants completed a questionnaire. Immunofluorescence assays (IFA using B. vinsonii berkhoffii (genotypes I, II and III, B. henselae, B. quintana and B. koehlerae as antigens were performed. A cut-off of 1:64 was selected as a seroreactivity titer. Blood samples were inoculated into BAPGM and subcultured onto blood agar plates. Bartonella spp. was detected using conventional and quantitative real-time PCR assays and DNA sequencing. Results Among antigens corresponding to six Bartonella spp. or genotypes, the lowest seroreactivity was found against B. quintana (11.2% and the highest, against B. v. berkhoffii genotype III (56%. A total of 27% of 89 individuals were not seroreactive to any test antigen. Bartonella spp. IFA seroreactivity was not associated with any clinical sign or symptom. DNA from Bartonella spp., including B. henselae (n = 2, B. v. berkhoffii genotypes I (n = 1 and III (n = 2, and B. quintana (n = 2 was detected in 7/89 veterinary personnel. PCR and DNA sequencing

Bartonella and Toxoplasma Infections in Stray Cats from Iraq

Science.gov (United States)

Switzer, Alexandra D.; McMillan-Cole, Audrey C.; Kasten, Rickie W.; Stuckey, Matthew J.; Kass, Philip H.; Chomel, Bruno B.

2013-01-01

Because of overpopulation, stray/feral cats were captured on military bases in Iraq as part of the US Army Zoonotic Disease Surveillance Program. Blood samples were collected from 207 cats, mainly in Baghdad but also in North and West Iraq, to determine the prevalence of Bartonella and Toxoplasma infections. Nine (4.3%) cats, all from Baghdad, were bacteremic with B. henselae type I. Seroprevalence was 30.4% for T. gondii, 15% for B. henselae, and 12.6% for B. clarridgeiae. Differences in Bartonella prevalence by location were statistically significant, because most of the seropositive cats were from Baghdad. There was no association between T. gondii seropositivity and either of the two Bartonella species surveyed. This report is the first report on the prevalence of Bartonella and T. gondii among stray cats in Iraq, which allows for better evaluation of the zoonotic risk potential to the Iraqi people and deployed military personnel by feral cat colonies. PMID:24062480

Bartonella entry mechanisms into mammalian host cells.

Science.gov (United States)

Eicher, Simone C; Dehio, Christoph

2012-08-01

The Gram-negative genus Bartonella comprises arthropod-borne pathogens that typically infect mammals in a host-specific manner. Bartonella bacilliformis and Bartonella quintana are human-specific pathogens, while several zoonotic bartonellae specific for diverse animal hosts infect humans as an incidental host. Clinical manifestations of Bartonella infections range from mild symptoms to life-threatening disease. Following transmission by blood-sucking arthropods or traumatic contact with infected animals, bartonellae display sequential tropisms towards endothelial and possibly other nucleated cells and erythrocytes, the latter in a host-specific manner. Attachment to the extracellular matrix (ECM) and to nucleated cells is mediated by surface-exposed bacterial adhesins, in particular trimeric autotransporter adhesins (TAAs). The subsequent engulfment of the pathogen into a vacuolar structure follows a unique series of events whereby the pathogen avoids the endolysosomal compartments. For Bartonella henselae and assumingly most other species, the infection process is aided at different steps by Bartonella effector proteins (Beps). They are injected into host cells through the type IV secretion system (T4SS) VirB/D4 and subvert host cellular functions to favour pathogen uptake. Bacterial binding to erythrocytes is mediated by Trw, another T4SS, in a strictly host-specific manner, followed by pathogen-forced uptake involving the IalB invasin and subsequent replication and persistence within a membrane-bound intra-erythrocytic compartment. © 2012 Blackwell Publishing Ltd.

Eco-epidemiology of Novel Bartonella Genotypes from Parasitic Flies of Insectivorous Bats.

Science.gov (United States)

Sándor, Attila D; Földvári, Mihály; Krawczyk, Aleksandra I; Sprong, Hein; Corduneanu, Alexandra; Barti, Levente; Görföl, Tamás; Estók, Péter; Kováts, Dávid; Szekeres, Sándor; László, Zoltán; Hornok, Sándor; Földvári, Gábor

2018-04-29

Bats are important zoonotic reservoirs for many pathogens worldwide. Although their highly specialized ectoparasites, bat flies (Diptera: Hippoboscoidea), can transmit Bartonella bacteria including human pathogens, their eco-epidemiology is unexplored. Here, we analyzed the prevalence and diversity of Bartonella strains sampled from 10 bat fly species from 14 European bat species. We found high prevalence of Bartonella spp. in most bat fly species with wide geographical distribution. Bat species explained most of the variance in Bartonella distribution with the highest prevalence of infected flies recorded in species living in dense groups exclusively in caves. Bat gender but not bat fly gender was also an important factor with the more mobile male bats giving more opportunity for the ectoparasites to access several host individuals. We detected high diversity of Bartonella strains (18 sequences, 7 genotypes, in 9 bat fly species) comparable with tropical assemblages of bat-bat fly association. Most genotypes are novel (15 out of 18 recorded strains have a similarity of 92-99%, with three sequences having 100% similarity to Bartonella spp. sequences deposited in GenBank) with currently unknown pathogenicity; however, 4 of these sequences are similar (up to 92% sequence similarity) to Bartonella spp. with known zoonotic potential. The high prevalence and diversity of Bartonella spp. suggests a long shared evolution of these bacteria with bat flies and bats providing excellent study targets for the eco-epidemiology of host-vector-pathogen cycles.

Bartonella infection in shelter cats and dogs and their ectoparasites.

Science.gov (United States)

Tsai, Yi-Lun; Lin, Chao-Chen; Chomel, Bruno B; Chuang, Shih-Te; Tsai, Kun-Hsien; Wu, Wen-Jer; Huang, Chin-Gi; Yu, Jiann-Chung; Sung, Min-Hua; Kass, Philip H; Chang, Chao-Chin

2011-08-01

Mainly through vector transmission, domestic cats and dogs are infected by several Bartonella spp. and represent a large reservoir for human infections. This study investigated the relationship of prevalences of Bartonella infection in shelter dogs and cats and various ectoparasite species infesting them (fleas, ticks, and lice). Moreover, relationships between Bartonella infection and animal gender and age and presence of ectoparasites were analyzed. Blood samples were collected from 120 dogs and 103 cats. There were 386 ticks and 36 fleas harvested on these dogs, and 141 fleas, 4 ticks, and 2 lice harvested on these cats. Isolation/detection of Bartonella sp. was performed by culture, polymerase chain reaction (PCR), and partial sequencing. Bartonella was isolated from 21 (20.4%) cats and detected by PCR from 20 (19.4%) cats, 2 (1.7%) dogs, 55 (39%) fleas collected from cats, 28 (10%) ticks DNA samples, and 1 (2.8%) flea collected from dogs. When combining culture and PCR data, 27 cats and 55 fleas collected on cats were positive for Bartonella henselae or Bartonella clarridgeiae, but none were coinfected. Approximately half of the B. henselae isolates from 21 cats were B. henselae type I. Moreover, B. henselae, Bartonella phoceensis, Bartonella queenslandensis, Bartonella rattimassiliensis, Bartonella elizabethae DNA was detected in ticks collected from dogs and one flea was B. clarridgeiae PCR positive. This is the first report of such a wide variety of Bartonella spp. detected in Rhipicephalus sanguineus. Further studies are required to understand the relative importance of these ectoparasites to transmit Bartonella spp. in dogs and cats.

Saffold virus infection associated with human myocarditis

DEFF Research Database (Denmark)

Nielsen, Trine Skov; Nielsen, Alex Yde; Banner, Jytte

2016-01-01

BACKGROUND: Saffold virus was described in 2007 as one of the first human viruses within the genus cardioviruses. Cardioviruses may cause severe infections of the myocardium in animals, and several studies have associated saffold virus with human disease. As a result, saffold virus has been...... isolated from different anatomical compartments, including the myocardium, but, until now, it has not been possible to demonstrate the accompanying histopathological signs of inflammation. OBJECTIVES: The aim of the study was to examine if saffold virus is capable of causing invasive infection in the human...... myocardium. STUDY DESIGN: Using real-time PCR, we retrospectively examined formalin-fixed paraffin embedded cardiac tissue specimens from 150 deceased individuals diagnosed with myocarditis at autopsy. The results were compared with histological findings. RESULTS AND CONCLUSIONS: Saffold virus was detected...

PCR detection of Bartonella spp. in the dog

Directory of Open Access Journals (Sweden)

Jarmila Konvalinová

2014-01-01

Full Text Available Our study aimed at using PCR to identify the incidence of Bartonella spp. in blood of dogs. Altogether 286 dogs of 92 breeds aged 3 month to 17 years were tested from October 2008 to December 2009. Healthy dogs as well as dogs with various clinical symptoms of disease were included in the group. Samples were tested by polymerase chain reaction (PCR specific for the presence of Bartonella spp. Following the DNA examination in 286 dogs by PCR and subsequent sequencing, two samples were identified as Bartonella henselae (0.7%. Other species of Bartonella were not found. It was the first time in the Czech Republic when incidence of Bartonella spp. was determined in dogs.

Detection of a Potential New Bartonella Species "Candidatus Bartonella rondoniensis" in Human Biting Kissing Bugs (Reduviidae; Triatominae.

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Maureen Laroche

2017-01-01

Full Text Available Among the Reduviidae family, triatomines are giant blood-sucking bugs. They are well known in Central and South America where they transmit Trypanosoma cruzi to mammals, including humans, through their feces. This parasitic protozoan is the causative agent of Chagas disease, a major public health issue in endemic areas. Because of the medical and economic impact of Chagas disease, the presence of other arthropod-borne pathogens in triatomines was rarely investigated.In this study, seven triatomines species involved in the transmission of T. cruzi were molecularly screened for the presence of known pathogens generally associated with arthropods, such as Rickettsia, Bartonella, Anaplasmataceae, Borrelia species and Coxiella burnetii. Of all included triatomine species, only Eratyrus mucronatus specimens tested positive for Bartonella species for 56% of tested samples. A new genotype of Bartonella spp. was detected in 13/23 Eratyrus mucronatus specimens, an important vector of T. cruzi to humans. This bacterium was further characterized by sequencing fragments of the ftsZ, gltA and rpoB genes. Depending on the targeted gene, this agent shares 84% to 91% of identity with B. bacilliformis, the agent of Carrion's disease, a deadly sandfly-borne infectious disease endemic in South America. It is also closely related to animal pathogens such as B. bovis and B. chomelii.As E. mucronatus is an invasive species that occasionally feeds on humans, the presence of potentially pathogenic Bartonella-infected bugs could present another risk for human health, along with the T. cruzi issue.

Isolation of Bartonella capreoli from elk

Science.gov (United States)

Bai, Y.; Cross, P.C.; Malania, L.; Kosoy, M.

2011-01-01

The aim of the present study was to investigate the presence of Bartonella infections in elk populations. We report the isolation of four Bartonella strains from 55 elk blood samples. Sequencing analysis demonstrated that all four strains belong to Bartonella capreoli, a bacterium that was originally described in the wild roe deer of Europe. Our finding first time demonstrated that B. capreoli has a wide geographic range, and that elk may be another host for this bacterium. Further investigations are needed to determine the impact of this bacterium on wildlife.

Low seroprevalence of bartonella species in danish elite orienteers

DEFF Research Database (Denmark)

Schiellerup, Peter; Dyhr, Thomas; Rolain, Jean Marc

2004-01-01

participants were tested for antibodies against B. henselae, B. quintana and B. elizabethae using immunofluorescent antibody tests. Surprisingly, Bartonella antibodies were only detected in sera from 5 persons: B. henselae from 1 elite orienteer, 1 handball player and 1 blood donor. B. elizabethae antibodies...... were detected in 1 handball player and 1 basketball player. We found no association between elite orienteers and the prevalence of Bartonella antibody positivity. This is in contrast to the Swedish study, and might be explained by the use of different serological methods in the 2 studies; to determine...

Vector competence of the tick Ixodes ricinus for transmission of Bartonella birtlesii.

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Caroline Reis

Full Text Available Bartonella spp. are facultative intracellular vector-borne bacteria associated with several emerging diseases in humans and animals all over the world. The potential for involvement of ticks in transmission of Bartonella spp. has been heartily debated for many years. However, most of the data supporting bartonellae transmission by ticks come from molecular and serological epidemiological surveys in humans and animals providing only indirect evidences without a direct proof of tick vector competence for transmission of bartonellae. We used a murine model to assess the vector competence of Ixodes ricinus for Bartonella birtlesii. Larval and nymphal I. ricinus were fed on a B. birtlesii-infected mouse. The nymphs successfully transmitted B. birtlesii to naïve mice as bacteria were recovered from both the mouse blood and liver at seven and 16 days after tick bites. The female adults successfully emitted the bacteria into uninfected blood after three or more days of tick attachment, when fed via membrane feeding system. Histochemical staining showed the presence of bacteria in salivary glands and muscle tissues of partially engorged adult ticks, which had molted from the infected nymphs. These results confirm the vector competence of I. ricinus for B. birtlesii and represent the first in vivo demonstration of a Bartonella sp. transmission by ticks. Consequently, bartonelloses should be now included in the differential diagnosis for patients exposed to tick bites.

Feature-tracking myocardial strain analysis in acute myocarditis. Diagnostic value and association with myocardial oedema

Energy Technology Data Exchange (ETDEWEB)

Luetkens, Julian A.; Schlesinger-Irsch, Ulrike; Kuetting, Daniel L.; Dabir, Darius; Homsi, Rami; Schmeel, Frederic C.; Sprinkart, Alois M.; Naehle, Claas P.; Schild, Hans H.; Thomas, Daniel [University of Bonn, Department of Radiology, Bonn (Germany); Doerner, Jonas [University Hospital Cologne, Department of Radiology, Cologne (Germany); Fimmers, Rolf [University of Bonn, Department of Medical Biometry, Informatics, and Epidemiology, Bonn (Germany)

2017-11-15

To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracking (FT) myocardial strain analysis in patients with suspected acute myocarditis and its association with myocardial oedema. Forty-eight patients with suspected acute myocarditis and 35 control subjects underwent CMR. FT CMR analysis of systolic longitudinal (LS), circumferential (CS) and radial strain (RS) was performed. Additionally, the protocol allowed for the assessment of T1 and T2 relaxation times. When compared with healthy controls, myocarditis patients demonstrated reduced LS, CS and RS values (LS: -19.5 ± 4.4% vs. -23.6 ± 3.1%, CS: -23.0 ± 5.8% vs. -27.4 ± 3.4%, RS: 28.9 ± 8.5% vs. 32.4 ± 7.4%; P < 0.05, respectively). LS (T1: r = 0.462, P < 0.001; T2: r = 0.436, P < 0.001) and CS (T1: r = 0.429, P < 0.001; T2: r = 0.467, P < 0.001) showed the strongest correlations with T1 and T2 relaxations times. Area under the curve of LS (0.79) was higher compared with those of CS (0.75; P = 0.478) and RS (0.62; P = 0.008). FT CMR myocardial strain analysis might serve as a new tool for assessment of myocardial dysfunction in the diagnostic work-up of patients suspected of having acute myocarditis. Especially, LS and CS show a sufficient diagnostic performance and were most closely correlated with CMR parameters of myocardial oedema. (orig.)

Feature-tracking myocardial strain analysis in acute myocarditis. Diagnostic value and association with myocardial oedema

International Nuclear Information System (INIS)

Luetkens, Julian A.; Schlesinger-Irsch, Ulrike; Kuetting, Daniel L.; Dabir, Darius; Homsi, Rami; Schmeel, Frederic C.; Sprinkart, Alois M.; Naehle, Claas P.; Schild, Hans H.; Thomas, Daniel; Doerner, Jonas; Fimmers, Rolf

2017-01-01

To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracking (FT) myocardial strain analysis in patients with suspected acute myocarditis and its association with myocardial oedema. Forty-eight patients with suspected acute myocarditis and 35 control subjects underwent CMR. FT CMR analysis of systolic longitudinal (LS), circumferential (CS) and radial strain (RS) was performed. Additionally, the protocol allowed for the assessment of T1 and T2 relaxation times. When compared with healthy controls, myocarditis patients demonstrated reduced LS, CS and RS values (LS: -19.5 ± 4.4% vs. -23.6 ± 3.1%, CS: -23.0 ± 5.8% vs. -27.4 ± 3.4%, RS: 28.9 ± 8.5% vs. 32.4 ± 7.4%; P < 0.05, respectively). LS (T1: r = 0.462, P < 0.001; T2: r = 0.436, P < 0.001) and CS (T1: r = 0.429, P < 0.001; T2: r = 0.467, P < 0.001) showed the strongest correlations with T1 and T2 relaxations times. Area under the curve of LS (0.79) was higher compared with those of CS (0.75; P = 0.478) and RS (0.62; P = 0.008). FT CMR myocardial strain analysis might serve as a new tool for assessment of myocardial dysfunction in the diagnostic work-up of patients suspected of having acute myocarditis. Especially, LS and CS show a sufficient diagnostic performance and were most closely correlated with CMR parameters of myocardial oedema. (orig.)

Cardiac Sarcoidosis or Giant Cell Myocarditis? On Treatment Improvement of Fulminant Myocarditis as Demonstrated by Cardiovascular Magnetic Resonance Imaging

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Hari Bogabathina

2012-01-01

Full Text Available Giant cell myocarditis, but not cardiac sarcoidosis, is known to cause fulminant myocarditis resulting in severe heart failure. However, giant cell myocarditis and cardiac sarcoidosis are pathologically similar, and attempts at pathological differentiation between the two remain difficult. We are presenting a case of fulminant myocarditis that has pathological features suggestive of cardiac sarcoidosis, but clinically mimicking giant cell myocarditis. This patient was treated with cyclosporine and prednisone and recovered well. This case we believe challenges our current understanding of these intertwined conditions. By obtaining a sense of severity of cardiac involvement via delayed hyperenhancement of cardiac magnetic resonance imaging, we were more inclined to treat this patient as giant cell myocarditis with cyclosporine. This resulted in excellent improvement of patient’s cardiac function as shown by delayed hyperenhancement images, early perfusion images, and SSFP videos.

Bartonella vinsonii subsp. berkhoffii and Bartonella henselae bacteremia in a father and daughter with neurological disease

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Woods Christopher W

2010-04-01

Full Text Available Abstract Background Bartonella vinsonii subsp. berkhoffii is an important, emerging, intravascular bacterial pathogen that has been recently isolated from immunocompetent patients with endocarditis, arthritis, neurological disease and vasoproliferative neoplasia. Vector transmission is suspected among dogs and wild canines, which are the primary reservoir hosts. This investigation was initiated to determine if pets and family members were infected with one or more Bartonella species. Methods PCR and enrichment blood culture in Bartonella alpha Proteobacteria growth medium (BAPGM was used to determine infection status. Antibody titers to B. vinsonii subsp. berkhoffii genotypes I-III and B. henselae were determined using a previously described indirect fluorescent antibody test. Two patients were tested sequentially for over a year to assess the response to antibiotic treatment. Results Intravascular infection with B. vinsonii subsp. berkhoffii genotype II and Bartonella henselae (Houston 1 strain were confirmed in a veterinarian and his daughter by enrichment blood culture, followed by PCR and DNA sequencing. Symptoms included progressive weight loss, muscle weakness, lack of coordination (the father and headaches, muscle pain and insomnia (the daughter. B. vinsonii subsp. berkhoffii genotype II was also sequenced from a cerebrospinal fluid BAPGM enrichment culture and from a periodontal swab sample. After repeated courses of antibiotics, post-treatment blood cultures were negative, there was a decremental decrease in antibody titers to non-detectable levels and symptoms resolved in both patients. Conclusions B. vinsonii subsp. berkhoffii and B. henselae are zoonotic pathogens that can be isolated from the blood of immunocompetent family members with arthralgias, fatigue and neurological symptoms. Therapeutic elimination of Bartonella spp. infections can be challenging, and follow-up testing is recommended. An increasing number of arthropod

Bartonella henselae endocarditis in Laos - 'the unsought will go undetected'.

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Sayaphet Rattanavong

2014-12-01

Full Text Available Both endocarditis and Bartonella infections are neglected public health problems, especially in rural Asia. Bartonella endocarditis has been described from wealthier countries in Asia, Japan, Korea, Thailand and India but there are no reports from poorer countries, such as the Lao PDR (Laos, probably because people have neglected to look.We conducted a retrospective (2006-2012, and subsequent prospective study (2012-2013, at Mahosot Hospital, Vientiane, Laos, through liaison between the microbiology laboratory and the wards. Patients aged >1 year admitted with definite or possible endocarditis according to modified Duke criteria were included. In view of the strong suspicion of infective endocarditis, acute and convalescent sera from 30 patients with culture negative endocarditis were tested for antibodies to Brucella melitensis, Mycoplasma pneumoniae, Bartonella quintana, B. henselae, Coxiella burnetii and Legionella pneumophila. Western blot analysis using Bartonella species antigens enabled us to describe the first two Lao patients with known Bartonella henselae endocarditis.We argue that it is likely that Bartonella endocarditis is neglected and more widespread than appreciated, as there are few laboratories in Asia able to make the diagnosis. Considering the high prevalence of rheumatic heart disease in Asia, there is remarkably little evidence on the bacterial etiology of endocarditis. Most evidence is derived from wealthy countries and investigation of the aetiology and optimal management of endocarditis in low income countries has been neglected. Interest in Bartonella as neglected pathogens is emerging, and improved methods for the rapid diagnosis of Bartonella endocarditis are needed, as it is likely that proven Bartonella endocarditis can be treated with simpler and less expensive regimens than "conventional" endocarditis and multicenter trials to optimize treatment are required. More understanding is needed on the risk factors for

Bartonella henselae and Coxiella burnetii Infection and the ...

African Journals Online (AJOL)

It was reported that Bartonella henselae, B. quintana and Coxiella burnetii was not strongly associated with coronary artery disease but on the basis of geometric mean titer, C. burnetii infection might have a modest association with coronary artery disease. Serum antibodies to B. henselae from 14 patients with acute phase ...

MRI for myocarditis

International Nuclear Information System (INIS)

Gutberlet, M.; Luecke, C.; Krieghoff, C.; Hildebrand, L.; Steiner, J.; Adam, J.; Grotthoff, M.; Lehmkuhl, L.; Lurz, P.; Eitel, I.; Thiele, H.

2013-01-01

Cardiovascular magnetic resonance imaging (CMRI) has become the primary tool for the non-invasive assessment in patients with suspected myocarditis, especially after exclusion of acute coronary syndrome (ACS) for the differential diagnosis. Various MRI parameters are available which have different accuracies. Volumetric and functional ventricular assessment and the occurrence of pericardial effusion alone demonstrate only a poor sensitivity and specificity. The calculation of the T2-ratio (edema assessment), the early or global relative myocardial enhancement (gRE) and the late gadolinium enhancement (LGE), which represents irreversibly injured myocardium, are more specific parameters. All MRI parameters demonstrate the best accuracy in infarct-like acute myocarditis, whereas in chronic myocarditis sensitivity and specificity are less accurate. Therefore, a multisequential (at least two out of three parameters are positive) approach is recommended. The assessment of the value of newer, more quantitative MRI sequences, such as T1 and T2-mapping is still under investigation. (orig.) [de

Bartonellae are Prevalent and Diverse in Costa Rican Bats and Bat Flies.

Science.gov (United States)

Judson, S D; Frank, H K; Hadly, E A

2015-12-01

Species in the bacterial genus, Bartonella, can cause disease in both humans and animals. Previous reports of Bartonella in bats and ectoparasitic bat flies suggest that bats could serve as mammalian hosts and bat flies as arthropod vectors. We compared the prevalence and genetic similarity of bartonellae in individual Costa Rican bats and their bat flies using molecular and sequencing methods targeting the citrate synthase gene (gltA). Bartonellae were more prevalent in bat flies than in bats, and genetic variants were sometimes, but not always, shared between bats and their bat flies. The detected bartonellae genetic variants were diverse, and some were similar to species known to cause disease in humans and other mammals. The high prevalence and sharing of bartonellae in bat flies and bats support a role for bat flies as a potential vector for Bartonella, while the genetic diversity and similarity to known species suggest that bartonellae could spill over into humans and animals sharing the landscape. © 2015 Blackwell Verlag GmbH.

Isolation of Bartonella henselae and Two New Bartonella Subspecies, Bartonella koehlerae Subspecies boulouisii subsp. nov. and Bartonella koehlerae Subspecies bothieri subsp. nov. from Free-Ranging Californian Mountain Lions and Bobcats

Science.gov (United States)

Chomel, Bruno B.; Molia, Sophie; Kasten, Rickie W.; Borgo, Gina M.; Stuckey, Matthew J.; Maruyama, Soichi; Chang, Chao-chin; Haddad, Nadia; Koehler, Jane E.

2016-01-01

Domestic cats are the natural reservoir of Bartonella henselae, B. clarridgeiae and B. koehlerae. To determine the role of wild felids in the epidemiology of Bartonella infections, blood was collected from 14 free-ranging California mountain lions (Puma concolor) and 19 bobcats (Lynx rufus). Bartonella spp. were isolated from four (29%) mountain lions and seven (37%) bobcats. These isolates were characterized using growth characteristics, biochemical reactions, molecular techniques, including PCR-RFLP of selected genes or interspacer region, pulsed-field gel electrophoresis (PFGE), partial sequencing of several genes, and DNA-DNA hybridization. Two isolates were identical to B. henselae genotype II. All other isolates were distinguished from B. henselae and B. koehlerae by PCR-RFLP of the gltA gene using endonucleases HhaI, TaqI and AciI, with the latter two discriminating between the mountain lion and the bobcat isolates. These two novel isolates displayed specific PFGE profiles distinct from B. henselae, B. koehlerae and B. clarridgeiae. Sequences of amplified gene fragments from the three mountain lion and six bobcat isolates were closely related to, but distinct from, B. henselae and B. koehlerae. Finally, DNA-DNA hybridization studies demonstrated that the mountain lion and bobcat strains are most closely related to B. koehlerae. We propose naming the mountain lion isolates B. koehlerae subsp. boulouisii subsp. nov. (type strain: L-42-94), and the bobcat isolates B. koehlerae subsp. bothieri subsp. nov. (type strain: L-17-96), and to emend B. koehlerae as B. koehlerae subsp. koehlerae. The mode of transmission and the zoonotic potential of these new Bartonella subspecies remain to be determined. PMID:26981874

Gallium-positive Lyme disease myocarditis

International Nuclear Information System (INIS)

Alpert, L.I.; Welch, P.; Fisher, N.

1985-01-01

In the course of a work-up for fever of unknown origin associated with intermittent arrhythmias, a gallium scan was performed which revealed diffuse myocardial uptake. The diagnosis of Lyme disease myocarditis subsequently was confirmed by serologic titers. One month following recovery from the acute illness, the abnormal myocardial uptake completely resolved

Prevalence and Potential Risk Factors for Bartonella Infection in Tunisian Stray Dogs.

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Belkhiria, Jaber; Chomel, Bruno B; Ben Hamida, Taoufik; Kasten, Rickie W; Stuckey, Matthew J; Fleischman, Drew A; Christopher, Mary M; Boulouis, Henri-Jean; Farver, Thomas B

2017-06-01

Bartonellae are blood-borne and vector-transmitted pathogens, some are zoonotic, which have been reported in several Mediterranean countries. Transmission from dogs to humans is suspected, but has not been clearly demonstrated. Our objectives were to determine the seroprevalence of Bartonella henselae, Bartonella vinsonii subsp. berkhoffii, Bartonella clarridgeiae, and Bartonella bovis (as a proxy for Candidatus Bartonella merieuxii) in stray dogs from Tunisia, identify the Bartonella species infecting the dogs and evaluate potential risk factors for canine infection. Blood samples were collected between January and November 2013 from 149 dogs in 10 Tunisian governorates covering several climatic zones. Dog-specific and geographic variables were analyzed as potential risk factors for Bartonella spp. seropositivity and PCR-positivity. DNA was extracted from the blood of all dogs and tested by PCR for Bartonella, targeting the ftsZ and rpoB genes. Partial sequencing was performed on PCR-positive dogs. Twenty-nine dogs (19.5%, 95% confidence interval: 14-27.4) were seropositive for one or more Bartonella species, including 17 (11.4%) for B. vinsonii subsp. berkhoffii, 14 (9.4%) for B. henselae, 13 (8.4%) for B. clarridgeiae, and 7 (4.7%) for B. bovis. Statistical analysis revealed a few potential risk factors, mainly dog's age and breed, latitude and average winter temperature. Twenty-two (14.8%) dogs, including 8 of the 29 seropositive dogs, were PCR-positive for Bartonella based on the ftsZ gene, with 18 (81.8%) of these 22 dogs also positive for the rpoB gene. Partial sequencing showed that all PCR-positive dogs were infected with Candidatus B. merieuxii. Dogs from arid regions and regions with cold average winter temperatures were less likely to be PCR-positive than dogs from other climatic zones. The widespread presence of Bartonella spp. infection in Tunisian dogs suggests a role for stray dogs as potential reservoirs of Bartonella species in Tunisia.

In Vitro Activities of Telithromycin (HMR 3647) against Rickettsia rickettsii, Rickettsia conorii, Rickettsia africae, Rickettsia typhi, Rickettsia prowazekii, Coxiella burnetii, Bartonella henselae, Bartonella quintana, Bartonella bacilliformis, and Ehrlichia chaffeensis

OpenAIRE

Rolain, Jean-Marc; Maurin, Max; Bryskier, André; Raoult, Didier

2000-01-01

In vitro activities of telithromycin compared to those of erythromycin against Rickettsia spp., Bartonella spp., Coxiella burnetii, and Ehrlichia chaffeensis were determined. Telithromycin was more active than erythromycin against Rickettsia, Bartonella, and Coxiella burnetii, with MICs of 0.5 μg/ml, 0.003 to 0.015 μg/ml, and 1 μg/ml, respectively, but was inactive against Ehrlichia chaffeensis.

Management of acute myocarditis in children

International Nuclear Information System (INIS)

Merchant, Q.; Haque, A.; Hasan, B.S.

2013-01-01

Myocarditis is defined as the inflammation of the myocardium. It continues to be a significant cause of morbidity and mortality in the paediatric population and is the commonest cause of cardiac failure in a healthy child. Some studies estimate the incidence of myocarditis to be around 1 per 100000. PubMed search was performed using the term myocarditis. The search was limited to age 0-19 years. A total of 50 articles were identified between 1966 to date and reviewed. Myocarditis is a challenging diagnosis to make on clinical grounds and requires high index of suspicion. The cornerstone of treatment remains supportive though therapeutic modalities such as immunosuppressive and intravenous immunoglobulin therapies are being studied extensively. The overall prognosis of the disease is good with survival rates up to 80%. (author)

Inhalant-Abuse Myocarditis Diagnosed by Cardiac Magnetic Resonance.

Science.gov (United States)

Dinsfriend, William; Rao, Krishnasree; Matulevicius, Susan

2016-06-01

Multiple reports of toxic myocarditis from inhalant abuse have been reported. We now report the case of a 23-year-old man found to have toxic myocarditis from inhalation of a hydrocarbon. The diagnosis was made by means of cardiac magnetic resonance imaging with delayed enhancement. The use of cardiac magnetic resonance to diagnose myocarditis has become increasingly common in clinical medicine, although there is not a universally accepted criterion for diagnosis. We appear to be the first to document a case of toxic myocarditis diagnosed by cardiac magnetic resonance. In patients with a history of drug abuse who present with clinical findings that suggest myocarditis or pericarditis, cardiac magnetic resonance can be considered to support the diagnosis.

Bartonella Prevalence and Genetic Diversity in Small Mammals from Ethiopia

DEFF Research Database (Denmark)

Meheretu, Yonas; Leirs, Herwig E.l.; Welegerima, Kiros

2013-01-01

More than 500 small mammals were trapped at 3 localities in northern Ethiopia to investigate Bartonella infection prevalence and the genetic diversity of the Bartonella spp. We extracted total DNA from liver samples and performed PCR using the primers 1400F and 2300R targeting 852 bp of the Barto......More than 500 small mammals were trapped at 3 localities in northern Ethiopia to investigate Bartonella infection prevalence and the genetic diversity of the Bartonella spp. We extracted total DNA from liver samples and performed PCR using the primers 1400F and 2300R targeting 852 bp...

CYTOKINE DISBALANCE AT HERPESVIRUS MYOCARDITIS

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Peremot S. D

2016-12-01

Full Text Available Viral myocarditis is a heterogeneous group of diseases not only by etiologic factors, which belong to different families of Vira kingdom, but is also characterized by a unique mechanism of inflammatory process and cytokine levels specific for each of them. According to numerous researches in сardio-immunology, at herpesvirus infection of the cardiovascular system occur both systemic and localized violations of the immune response. Unfortunately, the accessible literature did not provide the data analysis of complex cardio-immunological research that would take into account the features of herpesvirus myocarditis clinical course. This grounds relevance of immunodiagnosis directed on the exposure of dysimmunities by study of indices of general and local immunity with the estimation of the immune status in patients depending on the stage of exasperation or relapse of chronic herpetic infection in the complex of diagnostic tests. The purpose of our research was to determine features of the state of the immune system with the complex analysis of cytokine profile data, immune and interferon statuses in subacute and chronic forms of herpesvirus myocarditis. Materials and methods. 87 myocarditis patients who were receiving inpatient treatment in medical establishments of Kharkiv were examined. The average age was (M ± m 36 ± 3,46 years old. The diagnosis of myocarditis was established according to the order № 436 by the Ministry of Healthcare of Ukraine from 03.07.2006 of clinical findings protocol. In accordance with the term of myocarditis clinical course, the patients were divided in two sub-groups: 44 patients with subacute (from 2 to 6 months, and 43 patients with chronic (over 6 months clinical course of viral myocarditis. The control group correlated with patients of basic group by age and gender and consisted of 40 practically healthy persons without implications of cardial pathology. Definition of cytokine concentration: IL-2, IL-4, IL-6

Bartonella and Brucella—Weapons and Strategies for Stealth Attack

Science.gov (United States)

Ben-Tekaya, Houchaima; Gorvel, Jean-Pierre; Dehio, Christoph

2013-01-01

Bartonella spp. and Brucella spp. are closely related α-proteobacterial pathogens that by distinct stealth-attack strategies cause chronic infections in mammals including humans. Human infections manifest by a broad spectrum of clinical symptoms, ranging from mild to fatal disease. Both pathogens establish intracellular replication niches and subvert diverse pathways of the host’s immune system. Several virulence factors allow them to adhere to, invade, proliferate, and persist within various host-cell types. In particular, type IV secretion systems (T4SS) represent essential virulence factors that transfer effector proteins tailored to recruit host components and modulate cellular processes to the benefit of the bacterial intruders. This article puts the remarkable features of these two pathogens into perspective, highlighting the mechanisms they use to hijack signaling and trafficking pathways of the host as the basis for their stealthy infection strategies. PMID:23906880

Coexistence of Bartonella henselae and B. clarridgeiae in populations of cats and their fleas in Guatemala.

Science.gov (United States)

Bai, Ying; Rizzo, Maria Fernanda; Alvarez, Danilo; Moran, David; Peruski, Leonard F; Kosoy, Michael

2015-12-01

Cats and their fleas collected in Guatemala were investigated for the presence of Bartonella infections. Bartonella bacteria were cultured from 8.2% (13/159) of cats, and all cultures were identified as B. henselae. Molecular analysis allowed detection of Bartonella DNA in 33.8% (48/142) of cats and in 22.4% (34/152) of cat fleas using gltA, nuoG, and 16S-23S internal transcribed spacer targets. Two Bartonella species, B. henselae and B. clarridgeiae, were identified in cats and cat fleas by molecular analysis, with B. henselae being more common than B. clarridgeiae in the cats (68.1%; 32/47 vs 31.9%; 15/47). The nuoG was found to be less sensitive for detecting B. clarridgeiae compared with other molecular targets and could detect only two of the 15 B. clarridgeiae-infected cats. No significant differences were observed for prevalence between male and female cats and between different age groups. No evident association was observed between the presence of Bartonella species in cats and in their fleas. © 2015 The Society for Vector Ecology.

Bartonella species in small mammals and their potential vectors in Asia

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Tawisa Jiyipong

2014-10-01

Full Text Available In this article, authors review the current knowledge of Bartonella infection in small mammals including rodents, insectivores, bats and exotic small mammal pets and their vectors in Asia. Species of Bartonella are Gram-negative intracellular bacteria that infect erythrocytes of various mammalian and non-mammalian animals and mainly transmitted by blood sucking arthropod vectors. The genus Bartonella includes several species of important human diseases with severe clinical signs. Several new Bartonella species were isolated from rodents and other small mammals, and from human patients in Asia. Bartonella species are identified using standard polymerase chain reaction amplification and a sequencing targeting two housekeeping genes (gltA and rpoB and the internal transcribed spacer fragment. Authors also discuss the implications in term of potential emerging zoonotic diseases.

Eosinophilic Myocarditis due to Toxocariasis: Not a Rare Cause

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Shunichi Shibazaki

2016-01-01

Full Text Available Myocarditis is a clinically important disease because of the high mortality. From the perspective of treatment strategy, eosinophilic myocarditis should be distinguished from other types of myocarditis. Toxocariasis, caused by Toxocara canis or Toxocara cati, is known as a cause of eosinophilic myocarditis but is considered rare. As it is an unpopular disease, eosinophilic myocarditis due to toxocariasis may be underdiagnosed. We experienced two cases of eosinophilic myocarditis due to toxocariasis from different geographical areas in quick succession between 2013 and 2014. Case 1 is 32-year-old man. Case 2 is 66-year-old woman. In both cases, diagnosis was done by endomyocardial biopsy and IgG-ELISA against Toxocara excretory-secretory antigen. Only a corticosteroid was used in Case  1, whereas a corticosteroid and albendazole were used in Case  2 as induction therapy. Both patients recovered. Albendazole was also used in Case  1 to prevent recurrence after induction therapy. Eosinophilic myocarditis by toxocariasis may in actuality not be a rare disease, and corticosteroid is an effective drug as induction therapy even before use of albendazole.

[Bacteremia associated with mycotic aneurysm of the transversal aortic arch and myocarditis caused by Salmonella enteritidis].

Science.gov (United States)

Martínez-Martínez, L; Mesa, E; Rodríguez, J E; Sánchez, M P; Ugarte, J; Algora Weber, A; Dámaso, D; Daza, R M; Mendaza, P

1989-02-01

A 60-year-old male with diabetes mellitus had Salmonella enteritidis bacteremia associated with mycotic aneurysm of the transverse aortic arc and myocarditis. Antibiotic therapy with ampicillin and chloramphenicol was ineffective despite the fact that the microorganism was sensitive in vitro to those antimicrobials, and the patient had a progressive clinical deterioration which culminated in death.

Age-Associated Changes in Estrogen Receptor Ratios Correlate with Increased Female Susceptibility to Coxsackievirus B3-Induced Myocarditis

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Andreas Koenig

2017-11-01

Full Text Available Sexual bias is a hallmark in various diseases. This review evaluates sexual dimorphism in clinical and experimental coxsackievirus B3 (CVB3 myocarditis, and how sex bias in the experimental disease changes with increased age. Coxsackieviruses are major causes of viral myocarditis, an inflammation of the heart muscle, which is more frequent and severe in men than women. Young male mice infected with CVB3 develop heart-specific autoimmunity and severe myocarditis. Females infected during estrus (high estradiol develop T-regulatory cells and when infected during diestrus (low estradiol develop autoimmunity similar to males. During estrus, protection depends on estrogen receptor alpha (ERα, which promotes type I interferon, activation of natural killer/natural killer T cells and suppressor cell responses. Estrogen receptor beta has opposing effects to ERα and supports pro-inflammatory immunity. However, the sexual dimorphism of the disease is significantly ameliorated in aged animals when old females become as susceptible as males. This correlates to a selective loss of the ERα that is required for immunosuppression. Therefore, sex-associated hormones control susceptibility in the virus-mediated disease, but their impact can alter with the age and physiological stage of the individual.

ETIOLOGIC FACTOR IN THE DEVELOPMENT OF MYOCARDITIS IN THE KHARKIV REGION

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Smelyanskaya MV

2016-09-01

into medical practice of new non-invasive methods of myocarditis diagnosis and their etiology specification will enable to examine viral myocarditis as a much more common pathology than it would seem. Conclusion. During virological examination of biological material of myocarditis patients, a high proportion (87% of antigens of Herpesviridae viruses were revealed. In patients with myocarditis, association of herpesvirus antigens of various types (in 75% of detection dominate, while in healthy people of the control group - mono infection can be detected more often. Chronic myocarditis patients in 61% of cases are detected with three or four antigens of viruses of the family Herpesviridae, basically HHV6 with CMV, HSV1,2, EBV; with subacute myocarditis – HHV6 with CMV, HSV1,2 and VZV. The findings point to the need for mandatory examination for Herpesviridae virus of patients diagnosed with myocarditis.

An expanded dengue syndrome patient with manifestation myocarditis: case report

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Arifijanto, M. V.; Luqmana, H. P.; Rusli, M.; Bramantono

2018-03-01

Dengue infection may manifest asymptomatic, dengue fever, dengue hemorrhagic fever, dengue shock syndrome. However, atypical manifestations in other organs have been increasingly reported and called expanded dengue syndrome. One of the cardiac complications in dengue is myocarditis. An 18-year-old woman complains of high fever since 3 days, epistaxis, chest pain, dyspnea, and vomiting. Laboratory examination obtained thrombocytopenia, hemoconcentration, NS1, IgG-IgM dengue positive, CKMB and Troponin- I increase. Electrocardiogram result ischemic anterior-posterior. Echocardiography results hyperechogenic on myocardial suspicious a myocarditis. The patient was diagnosed with acute myocarditis and dengue hemorrhagic fever. Condition improved after five days of treatment. Cardiac complications in dengue are now increasingly observed with the most common case is myocarditis. The main mechanism of dengue myocarditis is still unknown though both direct viral infection and immune mediated damage have been suggested to be the cause of myocardial damage. The low incidence of dengue myocarditis is because it’s asymptomatic and diagnosis is easily missed. Almost all cases of dengue myocarditis are self-limiting and severe myocarditis leading to dilated cardiomyopathy is extremely rare. There have been reported a patient with dengue hemorrhagic fever with manifestation myocarditis. Condition improve with supportive management.

Speckle tracking echocardiography in acute lupus myocarditis: comparison to conventional echocardiography

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Riëtte Du Toit

2017-07-01

Full Text Available Aims: Lupus myocarditis occurs in 5–10% of patients with systemic lupus erythematosus (SLE. No single feature is diagnostic of lupus myocarditis. Speckle tracking echocardiography (STE can detect subclinical left ventricular dysfunction in SLE patients, with limited research on its utility in clinical lupus myocarditis. We report on STE in comparison to conventional echocardiography in patients with clinical lupus myocarditis. Methods and results: A retrospective study was done at a tertiary referral hospital in South Africa. SLE patients with lupus myocarditis were included and compared to healthy controls. Echocardiographic images were reanalyzed, including global longitudinal strain through STE. A poor echocardiographic outcome was defined as final left ventricular ejection fraction (LVEF <40%. 28 SLE patients fulfilled the criteria. Global longitudinal strain correlated with global (LVEF: r = −0.808; P = 0.001 and regional (wall motion score: r = 0.715; P < 0.001 function. In patients presenting with a LVEF ≥50%, global longitudinal strain (P = 0.023, wall motion score (P = 0.005 and diastolic function (P = 0.004 were significantly impaired vs controls. Following treatment, LVEF (35–47% (P = 0.023 and wall motion score (1.88–1.5 (P = 0.017 improved but not global longitudinal strain. Initial LVEF (34%; P = 0.046 and global longitudinal strain (−9.5%; P = 0.095 were lower in patients with a final LVEF <40%. Conclusions: This is the first known report on STE in a series of patients with clinical lupus myocarditis. Global longitudinal strain correlated with regional and global left ventricular function. Global longitudinal strain, wall motion score and diastolic parameters may be more sensitive markers of lupus myocarditis in patients presenting with a preserved LVEF ≥50%. A poor initial LVEF and global longitudinal strain were associated with a persistent LVEF <40%. Echocardiography is a non-invasive tool with diagnostic and

Clinical Presentation of Pediatric Myocarditis in Taiwan

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Hsiang-Ju Hsiao

2011-06-01

Conclusions: Pediatric myocarditis presents primarily with gastrointestinal symptoms in Taiwan. Careful check of heart rhythm may provide a useful objective marker of myocarditis. The predictors of a poor prognosis were gastrointestinal symptoms, hepatomegaly, and hypotension.

Elucidating transmission dynamics and host-parasite-vector relationships for rodent-borne Bartonella spp. in Madagascar

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Cara E. Brook

2017-09-01

Full Text Available Bartonella spp. are erythrocytic bacteria transmitted via arthropod vectors, which infect a broad range of vertebrate hosts, including humans. We investigated transmission dynamics and host-parasite-vector relationships for potentially zoonotic Bartonella spp. in invasive Rattus rattus hosts and associated arthropod ectoparasites in Madagascar. We identified five distinct species of Bartonella (B. elizabethae 1, B. elizabethae 2, B. phoceensis 1, B. rattimassiliensis 1, and B. tribocorum 1 infecting R. rattus rodents and their ectoparasites. We fit standard epidemiological models to species-specific age-prevalence data for the four Bartonella spp. with sufficient data, thus quantifying age-structured force of infection. Known zoonotic agents, B. elizabethae 1 and 2, were best described by models exhibiting high forces of infection in early age class individuals and allowing for recovery from infection, while B. phoceensis 1 and B. rattimassiliensis 1 were best fit by models of lifelong infection without recovery and substantially lower forces of infection. Nested sequences of B. elizabethae 1 and 2 were recovered from rodent hosts and their Synopsyllus fonquerniei and Xenopsylla cheopsis fleas, with a particularly high prevalence in the outdoor-dwelling, highland-endemic S. fonquerniei. These findings expand on force of infection analyses to elucidate the ecological niche of the zoonotic Bartonella elizabethae complex in Madagascar, hinting at a potential vector role for S. fonquerniei. Our analyses underscore the uniqueness of such ecologies for Bartonella species, which pose a variable range of potential zoonotic threats.

Myocarditis in Paediatric Patients: Unveiling the Progression to Dilated Cardiomyopathy and Heart Failure

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Inês Teixeira Farinha

2016-11-01

Full Text Available Myocarditis is a challenging and potentially life-threatening disease associated with high morbidity in some paediatric patients, due to its ability to present as an acute and fulminant disease and to ultimately progress to dilated cardiomyopathy. It has been described as an inflammatory disease of the myocardium caused by diverse aetiologies. Viral infection is the most frequent cause of myocarditis in developed countries, but bacterial and protozoal infections or drug hypersensitivity may also be causative agents. The prompt diagnosis in paediatric patients is difficult, as the spectrum of clinical manifestation can range from no myocardial dysfunction to sudden cardiac death. Recent studies on myocarditis pathogenesis have revealed a triphasic nature of this disease, which influences the diagnostic and therapeutic strategies to adopt in each patient. Endomyocardial biopsy remains the gold standard for diagnosing myocarditis, and several non-invasive diagnostic tools can be used to support the diagnosis. Intravenous immunoglobulin has become part of routine practice in the treatment of myocarditis in paediatric patients at many centres, but its true effect on the cardiac function has been the target of many studies. The aim of this review is to approach the recently discovered facets of paediatric myocarditis regarding its progression to dilated cardiomyopathy.

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis.

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Xu, Duo; Zhao, Ruo-Chi; Gao, Wen-Hui; Cui, Han-Bin

2017-04-05

Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients. However, little is known about the predictors of in-hospital mortality in patients with suspected myocarditis. Thus, the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model. A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013. A total of 238 males (59%) and 165 females (41%) were enrolled in this study. We divided the above patients into two subgroups (survival and nonsurvival), according to their clinical in-hospital outcomes. To maximize the effectiveness of the prediction model, we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis, based on data pertaining to previously established risk factors and basic patient characteristics. We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses. Finally, we identified the independent risk factors for in-hospital mortality using our risk prediction model. The following prediction model for in-hospital mortality in patients with suspected myocarditis, including creatinine clearance rate (Ccr), age, ventricular tachycardia (VT), New York Heart Association (NYHA) classification, gender and cardiac troponin T (cTnT), was established in the study: P = ea/(1 + ea) (where e is the exponential function, P is the probability of in-hospital death, and a = -7.34 + 2.99 × [Ccr model demonstrated that a Ccr prediction model for in-hospital mortality in patients with suspected myocarditis. In addition, sufficient life support during the early stage of the disease might improve the prognoses of patients with

Myocardial imaging. Coxsackie myocarditis

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Wells, R.G.; Ruskin, J.A.; Sty, J.R.

1986-09-01

A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1.

Myocardial imaging. Coxsackie myocarditis

International Nuclear Information System (INIS)

Wells, R.G.; Ruskin, J.A.; Sty, J.R.

1986-01-01

A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1

Pancreatitis and myocarditis followed by pulmonary hemorrhage, a rare presentation of leptospirosis- A case report and literature survey

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Ranawaka Nuwan

2013-01-01

Full Text Available Abstract Background Leptospirosis is a potentially fatal disease which can cause multi-organ dysfunction. It can rarely present as acute pancreatitis. This is the first ever report of leptospirosis presenting with acute pancreatitis and myocarditis followed by diffuse pulmonary hemorrhages to the best of our knowledge. Case presentation A 15-year-old South Asian boy presented with high grade fever, epigastric discomfort and was anicteric on admission. He developed tachycardia, transient hypotension, changes of electro-cardiogram and positive troponin I suggestive of myocarditis. Acute pancreatitis was diagnosed with 12 fold high serum amylase and with the evidence of computerized tomography. Then he developed diffuse pulmonary hemorrhages and later acute renal failure. Leptospirosis was confirmed by positive leptospira IgM, negative IgG and strongly positive Microscopic Agglutination Test. Other possible infective and autoimmune causes were excluded. Patient recovered completely with antibiotics and the supportive care. Conclusion This case illustrates diagnostic difficulties especially in resource poor settings where leptospirosis is common. Additionally it highlights the fact that leptospirosis should be considered in patients presenting with pancreatitis which can be complicated with myocarditis and diffuse pulmonary hemorrhages. We hypothesize that Toll like receptors may play a role in such systemic involvement.

Modern imaging of myocarditis. Possibilities and challenges

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Baessler, B.; Maintz, D.; Bunck, A.C. [University Hospital of Cologne (Germany). Dept. of Radiology; Koeln Univ. (Germany). Radiology; Schmidt, M. [University Hospital of Cologne (Germany). Dept. of Nuclear Medicine; Luecke, C. [Universitaetsklinikum Leipzig, Herzzentrum Leipzig GmbH (Germany). Diagnostic and Interventional Radiology; Blazek, S. [Universitaetsklinikum Leipzig, Herzzentrum Leipzig GmbH (Germany). Dept. of Internal Medicine/Cardiology; Ou, P. [Universite Paris Diderot (France). Dept. of Cardiovascular Imaging

2016-10-15

Myocarditis is known as the chameleon of cardiac diseases. The symptoms and the course of disease vary greatly so that it is often challenging to establish a diagnosis. Early and accurate diagnosis is of utmost importance, since myocarditis is one of the leading causes of sudden cardiac death in young adults and represents an important precursor to dilated cardiomyopathy. Due to the constraints of the routinely used diagnostic approach, including clinical history and examination, laboratory testing, and electrocardiogram, different imaging modalities have emerged over the last decades as contributors to the noninvasive diagnosis of myocarditis. With this interdisciplinary review we would like to present the current state-of-the-art imaging of myocarditis across all available imaging modalities (i.e., echocardiography, cardiac magnetic resonance, cardiac computed tomography, and nuclear medicine). Furthermore, we present novel imaging techniques that might become useful in the near future for easier and more accurate diagnosis of this highly relevant disease.

Infectious myocarditis (Clinic, diagnostics, principles of treatment

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Yu. P. Finogeev

2016-01-01

Full Text Available Infective myocarditis can be considered as a case of myocardial damage caused by different infectious agents. Traditionally discusses the questions of diagnostics and treatment infectious myocarditis. The paper has repeatedly stressed the difficulty of clinical diagnosis, and the laboriousness and economic costs of laboratory tests and additional researches. Endomyocardial biopsy findings remain the gold standard for unequivocally establishing the diagnosis. However, it is technically extremely invasive test and can be performed only in specialized cardiology centers. The paper analyzes in detail not only own materials, but also results of researches published in numerous domestic and foreign sources of literature. Publication of «Infectious myocarditis» is necessary due to the fact that patients with a diagnosis of «Myocarditis » account for 11% of all cardiovascular disease in the world. Article is timely and necessary for many professionals, senior students of medical universities.

[Bartonellosis. II. Other Bartonella responsible for human diseases].

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Piémont, Y; Heller, R

1999-01-01

In addition to Bartonella henselae, five other Bartonella species were involved in human pathology. As for B. henselae, ectoparasites seem to be responsible for the transmission of most or all these bacterial species. B. bacilliformis is responsible for Carrion's disease that occurs in some valleys of Colombia, Ecuador and Peru. This disease is transmitted by biting of infected sandflies. The bacterial reservoir is constituted by humans only. That disease occurs either as an acute form with severe infectious hemolytic anemia (or Oroya fever), or as benign cutaneous tumors, also called verruga peruana. Healthy blood carriers of the bacterium exist. Trench fever was described during the First World War. This non-lethal disease is constituted of recurrent febrile attacks associated particularly with osseous pains. The causative agent of the disease is B. quintana, transmitted by the body louse. Humans seem to be the reservoir of that bacterium. In some patients, B. quintana can be responsible for endocarditis, bacillary angiomatosis and chronic or recurrent bacteremia. Other human infections due to Bartonella sp. have been described: B. vinsonii, isolated from blood of small rodents, and B. elizabethae, the reservoir of which is currently unknown, can be responsible for endocardites. B. clarridgeiae (isolated from blood of 5% of pet cats and 17% of stray cats) may be responsible for human cat scratch disease. All these bartonelloses are diagnosed by non-standard blood culture or by in vitro DNA amplification or by serological testing. Their treatment requires tetracyclines or chloramphenicol or macrolides.

Prevalence of zoonotic Bartonella species among rodents and shrews in Thailand.

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Pangjai, Decha; Maruyama, Soichi; Boonmar, Sumalee; Kabeya, Hidenori; Sato, Shingo; Nimsuphan, Burin; Petkanchanapong, Wimol; Wootta, Wattanapong; Wangroongsarb, Piyada; Boonyareth, Maskiet; Preedakoon, Poom; Saisongkorh, Watcharee; Sawanpanyalert, Pathom

2014-03-01

We investigated the prevalence of Bartonella species in 10 rodent and one shrew species in Thailand. From February 2008 to May 2010, a total of 375 small animals were captured in 9 provinces in Thailand. Bartonella strains were isolated from 57 rodents (54 from Rattus species and 3 from Bandicota indica) and one shrew (Suncus murinus) in 7 of the 9 provinces, and identified to the species level. Sequence analysis of the citrate synthase and RNA polymerase β subunit genes identified the 58 isolates from each Bartonella-positive animal as B. tribocorum in 27 (46.6%) animals, B. rattimassiliensis in 17 (29.3%) animals, B. elizabethae in 10 (17.2%) animals and B. queenslandensis in 4 (6.9%) animals. R. norvegicus, R. rattus, and Suncus murinus carried B. elizabethae, which causes endocarditis in humans. The prevalence of Bartonella bacteremic animals by province was 42.9% of the animals collected in Phang Nga, 26.8% in Chiang Rai, 20.4% in Sa Kaeo, 16.7% in Nakhon Si Thammarat, 12.0% in Surat Thani, 9.1% in Mae Hong Son and Loei Provinces. These results indicate that Bartonella organisms are widely distributed in small mammals in Thailand and some animal species may serve as important reservoirs of zoonotic Bartonella species in the country. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

MULTIPLEX SYBR® GREEN-REAL TIME PCR (qPCR ASSAY FOR THE DETECTION AND DIFFERENTIATION OF Bartonella henselae AND Bartonella clarridgeiae IN CATS

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Rodrigo Staggemeier

2014-04-01

Full Text Available A novel SYBR® green-real time polymerase chain reaction (qPCR was developed to detect two Bartonella species, B. henselae and B. clarridgeiae, directly from blood samples. The test was used in blood samples obtained from cats living in animal shelters in Southern Brazil. Results were compared with those obtained by conventional PCR targeting Bartonella spp. Among the 47 samples analyzed, eight were positive using the conventional PCR and 12 were positive using qPCR. Importantly, the new qPCR detected the presence of both B. henselae and B. clarridgeiae in two samples. The results show that the qPCR described here may be a reliable tool for the screening and differentiation of two important Bartonella species.

Gallium-67 imaging in patients with dilated cardiomyopathy and biopsy-proven myocarditis

International Nuclear Information System (INIS)

O'Connell, J.B.; Henkin, R.E.; Robinson, J.A.; Subramanian, R.; Scanlon, P.J.; Gunnar, R.M.

1984-01-01

Current standards for detection of myocarditis in a clinical setting rely on endomyocardial biopsy for accurate diagnosis. With this technique a subset of patients with dilated cardiomyopathy show unsuspected myocarditis histologically. Endomyocardial biopsy, despite its specificity, may lack sensitivity due to sampling error if the inflammation is patchy or focal. Therefore, inflammation-sensitive radioisotopic imaging may be a useful adjunct in the diagnosis of myocarditis. This study was designed to evaluate the applicability of gallium-67 (67Ga) myocardial imaging as an adjunct to endomyocardial biopsy in the diagnosis of myocarditis. Sixty-eight consecutive patients referred for evaluation of dilated cardiomyopathy underwent 71 parallel studies with 67Ga imaging and biopsies that served as the basis of comparison for this study. Histologic myocarditis was identified in 8% of biopsy specimens. Clinical and hemodynamic parameters could not be used to predict the presence of myocarditis. Five of six biopsy samples (87%) with myocarditis showed dense 67Ga uptake, whereas only nine of 65 negative biopsy samples (14%) were paired with equivocally positive 67Ga scans. The single patient with myocarditis and no myocardial 67Ga uptake had dense mediastinal lymph node uptake that may have obscured cardiac uptake. The incidence of myocarditis on biopsy with a positive 67Ga scan was 36% (5/14); however, the incidence of myocarditis with a negative 67Ga scan was only 1.8% (1/57). Follow-up scans for three patients showed close correlation of 67Ga uptake with myocarditis on biopsy. In conclusion 67Ga may be a useful screening test for identifying patients with a high yield of myocarditis on biopsy, and serial scans may eliminate the need for frequent biopsies in patients with proven myocarditis

Bartonella species in bats (Chiroptera) and bat flies (Nycteribiidae) from Nigeria, West Africa.

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Kamani, Joshua; Baneth, Gad; Mitchell, Mark; Mumcuoglu, Kosta Y; Gutiérrez, Ricardo; Harrus, Shimon

2014-09-01

Previous and ongoing studies have incriminated bats as reservoirs of several emerging and re-emerging zoonoses. Most of these studies, however, have focused on viral agents and neglected important bacterial pathogens. To date, there has been no report investigating the prevalence of Bartonella spp. in bats and bat flies from Nigeria, despite the fact that bats are used as food and for cultural ritual purposes by some ethnic groups in Nigeria. To elucidate the role of bats as reservoirs of bartonellae, we screened by molecular methods 148 bats and 34 bat flies, Diptera:Hippoboscoidea:Nycteribiidae (Cyclopodia greeffi) from Nigeria for Bartonella spp. Overall, Bartonella spp. DNA was detected in 76 out of 148 (51.4%) bat blood samples tested and 10 out of 24 (41.7%) bat flies tested by qPCR targeting the 16S-23S internal transcribed spacer (ITS) locus. Bartonella was isolated from 23 of 148 (15.5%) bat blood samples, and the isolates were genetically characterized. Prevalence of Bartonella spp. culture-positive samples ranged from 0% to 45.5% among five bat species. Micropterus spp. bats had a significantly higher relative risk of 3.45 for being culture positive compared to Eidolon helvum, Epomophorus spp., Rhinolophus spp., and Chaerephon nigeriae. Bartonella spp. detected in this study fall into three distinct clusters along with other Bartonella spp. isolated from bats and bat flies from Kenya and Ghana, respectively. The isolation of Bartonella spp. in 10.0-45.5% of four out of five bat species screened in this study indicates a widespread infection in bat population in Nigeria. Further investigation is warranted to determine the role of these bacteria as a cause of human and animal diseases in Nigeria.

COMPARISON OF CARDIAC BIOMARKERS AND ECHOCARDIOGRAPHY IN DIAGNOSING MYOCARDITIS

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Nimi Bharathan

2017-03-01

Full Text Available BACKGROUND Conventional methods used to diagnose or rule out myocarditis is not useful in detecting cardiac myocyte injury in clinically suspected cases. Endomyocardial biopsy and histopathological examination is not feasible in most government hospitals in India. Sensitive parameters have yet to be found out. The study was conducted to find out whether diagnosis of myocarditis in clinically suspected cases can be done by measurement of serum levels of cardiac troponinI (cTnI and MB isoform of creatine kinase (CK-MB. MATERIALS AND METHODS 19 patients with clinically suspected myocarditis were screened for CK-MB activity and cTnI. Echocardiography, ECG and IgM for leptospirosis were also checked in these patients. RESULTS cTnI was elevated in 10 out of 19 patients with clinically suspected myocarditis. CK-MB was elevated in 7 patients. CONCLUSION Elevation of cTnI level in blood can be taken as an indicator of cardiac muscle cell injury in suspected cases of myocarditis.

Effects of rodent community diversity and composition on prevalence of an endemic bacterial pathogen - Bartonella

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Bai, Y.; Kosoy, M.Y.; Calisher, C.H.; Cully, J.F.; Collinge, S.K.

2009-01-01

By studying Bartonella prevalence in rodent communities from 23 geographic sites in the western United States and one site in northern Mexico, the present study focused on the effects of rodent community diversity (measured by richness and Shannon index) and composition on prevalence of Bartonella infections. The analysis showed negative correlations of Bartonella prevalence with rodent richness and Shannon index. Further, Bartonella prevalence varied among rodent genera/species. Three models were applied to explain the observations. (1) Within-species/genus transmission: Bartonella strains usually are host-specific and adding non-host species would decrease Bartonella prevalence in its principal host through reduction of host contact (encounter reduction); (2) Frequency-dependence: Adding hosts would decrease the proportion of all infected individuals in the community, resulting in a reduction in the number of contacts between susceptible and infected individuals that usually leads to transmission (transmission reduction); and (3) Dominant species effect: Dominant species, if not susceptible to Bartonellae, can constrain the abundance of susceptible hosts (susceptible host regulation). These mechanisms work in concert; and the level of Bartonella prevalence is an outcome of regulation of all of these mechanisms on the entire system.

A Family History of Dilated Cardiomyopathy Induced by Viral Myocarditis

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Thomas Cognet

2012-01-01

Full Text Available Myocarditis can lead to acute heart failure, cardiogenic shock, or sudden death and later, dilated cardiomyopathy (DCM with chronic heart failure. We report the cases of two DCM induced by acute and past myocarditis in the same family and expressed by its two main complications within few weeks: an hemodynamic presentation as a fulminant myocarditis rapidly leading to cardiac tranplantation and a rythmologic presentation as an electrical storm leading to catheter ablation of ventricular tachycardia. These cases ask the question of the family predisposition to viral myocarditis leading to DCM.

Bartonella in Rodents and Ectoparasites in the Canary Islands, Spain: New Insights into Host-Vector-Pathogen Relationships.

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Abreu-Yanes, Estefania; Martin-Alonso, Aaron; Martin-Carrillo, Natalia; Livia, Katherine Garcia; Marrero-Gagliardi, Alessandro; Valladares, Basilio; Feliu, Carlos; Foronda, Pilar

2018-01-01

Bartonella genus is comprised of several species of zoonotic relevance and rodents are reservoirs for some of these Bartonella species. As there were no data about the range of Bartonella species circulating among rodents in the Canary Islands, our main aim was to overcome this lack of knowledge by targeting both the citrate synthase (gltA) and the RNA polymerase beta subunit (rpoB) genes. A total of 181 small mammals and 154 ectoparasites were obtained in three of the Canary Islands, namely Tenerife, La Palma, and Lanzarote. The overall prevalence of Bartonella DNA in rodents was 18.8%, whereas the prevalence in ectoparasites was 13.6%. Bartonella sequences closely related to the zoonotic species Bartonella elizabethae, Bartonella tribocorum, and Bartonella rochalimae were identified in rodents, whereas two different gltA haplotypes similar to B. elizabethae were also detected in fleas. Furthermore, Bartonella queenslandensis DNA was also identified in rodents. A strong host specificity was observed, since B. elizabethae DNA was only found in Mus musculus domesticus, whereas gltA and rpoB sequences closely related to the rest of Bartonella species were only identified in Rattus rattus, which is probably due to the host specificity of the arthropod species that act as vectors in these islands. Our results indicate that humans may contract Bartonella infection by contact with rodents in the Canary Islands.

Role of Hippoboscidae Flies as Potential Vectors of Bartonella spp. Infecting Wild and Domestic Ruminants

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Halos, Lénaïg; Jamal, Taoufik; Maillard, Renaud; Girard, Benjamin; Guillot, Jacques; Chomel, Bruno; Vayssier-Taussat, Muriel; Boulouis, Henri-Jean

2004-01-01

The putative role of biting flies in Bartonella transmission among ruminants was investigated. Amplification of the Bartonella citrate synthase gene from 83 Hippoboscidae was detected in 94% of 48 adult Lipoptena cervi flies, 71% of 17 adult Hippobosca equina flies, 100% of 20 adult Melophagus ovinus flies, and 100% of 10 M. ovinus pupae. Our findings suggest that Hippoboscidae play a role in the transmission of Bartonella among ruminants. The vertical transmission of Bartonella in M. ovinus ...

The Trw type IV secretion system of Bartonella mediates host-specific adhesion to erythrocytes.

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Muriel Vayssier-Taussat

2010-06-01

Full Text Available Bacterial pathogens typically infect only a limited range of hosts; however, the genetic mechanisms governing host-specificity are poorly understood. The alpha-proteobacterial genus Bartonella comprises 21 species that cause host-specific intraerythrocytic bacteremia as hallmark of infection in their respective mammalian reservoirs, including the human-specific pathogens Bartonella quintana and Bartonella bacilliformis that cause trench fever and Oroya fever, respectively. Here, we have identified bacterial factors that mediate host-specific erythrocyte colonization in the mammalian reservoirs. Using mouse-specific Bartonella birtlesii, human-specific Bartonella quintana, cat-specific Bartonella henselae and rat-specific Bartonella tribocorum, we established in vitro adhesion and invasion assays with isolated erythrocytes that fully reproduce the host-specificity of erythrocyte infection as observed in vivo. By signature-tagged mutagenesis of B. birtlesii and mutant selection in a mouse infection model we identified mutants impaired in establishing intraerythrocytic bacteremia. Among 45 abacteremic mutants, five failed to adhere to and invade mouse erythrocytes in vitro. The corresponding genes encode components of the type IV secretion system (T4SS Trw, demonstrating that this virulence factor laterally acquired by the Bartonella lineage is directly involved in adherence to erythrocytes. Strikingly, ectopic expression of Trw of rat-specific B. tribocorum in cat-specific B. henselae or human-specific B. quintana expanded their host range for erythrocyte infection to rat, demonstrating that Trw mediates host-specific erythrocyte infection. A molecular evolutionary analysis of the trw locus further indicated that the variable, surface-located TrwL and TrwJ might represent the T4SS components that determine host-specificity of erythrocyte parasitism. In conclusion, we show that the laterally acquired Trw T4SS diversified in the Bartonella lineage

THE ROLE OF HERPESVIRUS IN THE PARADIGM OF INFECTIOUS MYOCARDITIS (REVIEW

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Peremot S.

2016-03-01

Full Text Available According to the research of the last decade, there has been growth in the noncoronary disease infarction, increased their share among the causes temporary or persistent disability, disability and deaths. Among others myocarditis, which constitute 11% of all diseases of the cardiovascular system and is responsible for almost 20% of cases of sudden death in people physically safe. The disease is an inflammatory damage to cardiomyocytes, which is caused by direct action or indirectly through immune mechanisms of infectious agents of bacterial, viral, protozoan nature, as well as chemical and physical factors. The term "myocarditis" was first proposed I F Soberheim in 1837 and in 1900. A. Fiedler described the myocardial injury and justified the very concept of primary myocarditis. It is widely accepted that myocarditis - natural complications of infectious diseases in which etiological factor may be any infectious agent. However, at the present stage bacterial pathogens give way to viral. Those viruses according to numerous studies result in the development of myocarditis and consequently lead to the development of myocardial dysfunction. Until recently, most were considered cardiotropic ECHO viruses, Coxsackie group A, B, causing half of all cases of viral myocarditis. However recently reviewed the role of enteroviruses in favor of persistent virus and particularly the family Herpesviridae. The significance in the etiology of myocarditis herpes simplex virus, human herpes type 6, Epstein - Barr virus, cytomegalovirus. Published data indicate that the development of viral myocarditis patients after serous meningoencephalitis caused by the varicella-zoster virus. Widespread herpesvirus diseases their tropism for endothelial cells and myocardium, the capacity for long-term persistence in the body the opportunity to explain virus inducted inflammatory damage to cardiomyocytes. Increased attention to this issue recently linked with the present stage

Myocarditis in auto-immune or auto-inflammatory diseases.

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Comarmond, Cloé; Cacoub, Patrice

2017-08-01

Myocarditis is a major cause of heart disease in young patients and a common precursor of heart failure due to dilated cardiomyopathy. Some auto-immune and/or auto-inflammatory diseases may be accompanied by myocarditis, such as sarcoidosis, Behçet's disease, eosinophilic granulomatosis with polyangiitis, myositis, and systemic lupus erythematosus. However, data concerning myocarditis in such auto-immune and/or auto-inflammatory diseases are sparse. New therapeutic strategies should better target the modulation of the immune system, depending on the phase of the disease and the type of underlying auto-immune and/or auto-inflammatory disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea.

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Chin, Jung Yeon; Kang, Ki-Woon; Moon, Kyung Min; Kim, Jongwoo; Choi, Yu Jeong

2018-03-01

Scrub typhus is known as a self-limited infectious disease. Cardiac complication is uncommon and usually not life-threatening. Until now, few cases of fulminant myocarditis by scrub typhus have been reported. So, we investigated incidence and predictors of acute myocarditis in severe scrub typhus. We retrospectively reviewed 89 patients among 91 scrub typhus confirmed patients who examined an echocardiogram and cardiac biomarkers from 2005 to 2015 in the intensive care unit at our hospital. We excluded two patients who didn't have electrocardiography. Patients were divided into two groups and compared between scrub typhus with (n = 13) and without (n = 76) acute myocarditis. Age, sex, and underlying diseases were similar between the groups. The existence of eschar and duration of general ache and fever were similar between the groups. However, patients with acute myocarditis had more elevated total bilirubin, high incidence of ST elevations and paroxysmal atrial fibrillation (PAF) than those without acute myocarditis. Receiver operating characteristic analysis showed that the PAF was a predictor of myocarditis with a sensitivity of 70% and specificity of 84%. Predictive power of combination of ST-segment elevation and PAF was significantly associated with myocarditis in the multivariate analysis (odds ratio, 1.57; 95% confidence interval [CI], 1.21 to 11.7; p = 0.041) and area under the curve was 0.947 (95% CI, 0.878 to 0.983; p scrub typhus may be more common than previously reported. Patients with high bilirubin and PAF are at increased risk of acute myocarditis with scrub typhus. These patients warrant closer follow-up and echocardiogram would be needed.

PCR amplification of Bartonella koehlerae from human blood and enrichment blood cultures

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Breitschwerdt Edward B

2010-08-01

Full Text Available Abstract Background Cats appear to be the primary reservoir host for Bartonella koehlerae, an alpha Proteobacteria that is most likely transmitted among cat populations by fleas (Ctenocephalides felis. Bartonella koehlerae has caused endocarditis in a dog and in one human patient from Israel, but other clinically relevant reports involving this bacterium are lacking. Despite publication of numerous, worldwide epidemiological studies designed to determine the prevalence of Bartonella spp. bacteremia in cats, B. koehlerae has never been isolated using conventional blood agar plates. To date, successful isolation of B. koehlerae from cats and from the one human endocarditis patient has consistently required the use of chocolate agar plates. Results In this study, Bartonella koehlerae bacteremia was documented in eight immunocompetent patients by PCR amplification and DNA sequencing, either prior to or after enrichment blood culture using Bartonella alpha Proteobacteria growth medium. Presenting symptoms most often included fatigue, insomnia, joint pain, headache, memory loss, and muscle pain. Four patients were also infected with Bartonella vinsonii subsp. berkhoffii genotype II. After molecular documentation of B. koehlerae infection in these patients, a serological test was developed and serum samples were tested retrospectively. Bartonella koehlerae antibodies were not detected (titers B. koehlerae antibody titers of 1:64 or greater. Conclusions Although biased by a study population consisting of individuals with extensive arthropod and animal exposure, the results of this study suggest that B. koehlerae bacteremia is more common in immunocompetent people than has been previously suspected. Future studies should more thoroughly define modes of transmission and risk factors for acquiring infection with B. koehlerae. In addition, studies are needed to determine if B. koehlerae is a cause or cofactor in the development of arthritis, peripheral

Molecular detection of Bartonella spp. and Rickettsia spp. in bat ectoparasites in Brazil.

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do Amaral, Renan Bressianini; Lourenço, Elizabete Captivo; Famadas, Kátia Maria; Garcia, Amanda Barbosa; Machado, Rosangela Zacarias; André, Marcos Rogério

2018-01-01

The family Streblidae comprises a monophyletic group of Hippoboscoidea, hematophagous dipterans that parasitize bats. Bartonella spp. and Rickettsia spp. have been reported in bats sampled in Europe, Africa, Asia, North, Central and South America. However, there are few reports on the Bartonella and Rickettsia bacteria infecting Hippoboscoidea flies and mites. While Spinturnicidae mites are ectoparasites found only in bats, those belonging to the family Macronyssidae comprise mites that also parasitize other mammal species. This study investigates the occurrence and assesses the phylogenetic positioning of Bartonella spp. and Rickettsia spp. found in Streblidae flies and Spinturnicidae and Macronyssidae mites collected from bats captured in Brazil. From May 2011 to April 2012 and September 2013 to December 2014, 400 Streblidae flies, 100 Macronyssidaes, and 100 Spinturnicidae mites were collected from bats captured in two sites in northeastern Nova Iguaçu, Rio de Janeiro, southeastern Brazil. Forty (19.8%) out of 202 Streblidae flies were positive for Bartonella spp. in qPCR assays based on the nuoG gene. Among the flies positive for the bacterium, six (18%) were Paratrichobius longicrus, seven (29%) Strebla guajiro, two (40%) Aspidoptera phyllostomatis, five (11%) Aspidoptera falcata, one (10%) Trichobius anducei, one (25%) Megistopoda aranea, and 18 (32%) Trichobius joblingi, and collected from bats of the following species: Artibeus lituratus, Carollia perspicillata, Artibeus planirostris, Sturnira lilium, and Artibeus obscurus. Six sequences were obtained for Bartonella (nuoG [n = 2], gltA [n = 2], rpoB [n = 1], ribC = 1]). The phylogenetic analysis based on gltA (750pb) gene showed that the Bartonella sequences clustered with Bartonella genotypes detected in bats and ectoparasites previously sampled in Latin America, including Brazil. Only one sample (0.49%) of the species Trichobius joblingi collected from a specimen of Carollia perspicillata was positive

Parvovirus B19 is a bystander in adult myocarditis.

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Koepsell, Scott A; Anderson, Daniel R; Radio, Stanley J

2012-01-01

The genomic DNA of parvovirus B19, a small single-stranded DNA virus of the genus Erythrovirus, has been shown to persist in solid tissues of constitutionally healthy, immunocompetent individuals. Despite these data, many case reports and series have linked the presence of parvovirus B19 genomic DNA, detected through nucleic acid amplification testing, with myocarditis and cardiomyopathy. Herein, we use multiple tools to better assess the relationship between parvovirus B19 and myocarditis and cardiomyopathy. Nucleic acid amplification testing, immunohistochemistry, in situ hybridization, and electron microscopy were used to assess the location and activity of parvovirus B19 in cases of myocarditis and in cases with no significant cardiac disease. Nucleic acid amplification testing for parvovirus B19 genomic DNA was positive in 73% of patients with myocarditis/cardiomyopathy and in 26% of patients with no significant disease. In situ hybridization and immunohistochemistry showed that, in cases with amplifiable parvovirus B19 DNA, parvovirus B19 genomic DNA and viral protein production were present in rare mononuclear cells. In a majority of cases of myocarditis and a significant number of otherwise normal hearts, nucleic acid amplification testing detected persistent parvovirus B19 genomic DNA that did not play a significant pathogenic role. The source of parvovirus B19 DNA appeared to be interstitial mononuclear inflammatory cells and not myocardial or endothelial cells. Therefore, nucleic acid amplification testing alone is not diagnostically helpful for determining the etiology of adult myocarditis. Copyright © 2012 Elsevier Inc. All rights reserved.

Bartonella and intraocular inflammation: a series of cases and review of literature

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Kalogeropoulos C

2011-06-01

Full Text Available Chris Kalogeropoulos1, Ioannis Koumpoulis1, Andreas Mentis2, Chrisavgi Pappa1, Paraskevas Zafeiropoulos1, Miltiadis Aspiotis11Department of Ophthalmology, Medical School, University of Ioannina, Greece; 2Laboratory of Medical Microbiology, Hellenic Pasteur Institute, Athens, GreecePurpose: To present various forms of uveitis and/or retinal vasculitis attributed to Bartonella infection and review the impact of this microorganism in patients with uveitis.Methods: Retrospective case series study. Review of clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2001 to 2010 in the Ocular Inflammation Department of the University Eye Clinic, Ioannina, Greece. Presentation of epidemiological and clinical data concerning Bartonella infection was provided by the international literature.Results: Eight patients with the diagnosis of Bartonella henselae and two patients with B. quintana intraocular inflammation were identified. Since four patients experienced bilateral involvement, the affected eyes totaled 14. The mean age was 36.6 years (range 12–62. Uveitic clinical entities that we found included intermediate uveitis in seven eyes (50%, vitritis in two eyes (14.2%, neuroretinitis in one eye (7.1%, focal retinochoroiditis in one eye (7.1%, branch retinal vein occlusion (BRVO due to vasculitis in one eye (7.1%, disc edema with peripapillary serous retinal detachment in one eye (7.1%, and iridocyclitis in one eye (7.1%. Most of the patients (70% did not experience systemic symptoms preceding the intraocular inflammation. Antimicrobial treatment was efficient in all cases with the exception of the case with neuroretinitis complicated by anterior ischemic optic neuropathy and tubulointerstitial nephritis.Conclusion: Intraocular involvement caused not only by B. henselae but also by B. quintana is being diagnosed with increasing frequency. A high index of suspicion is needed because the

Heme degrading protein HemS is involved in oxidative stress response of Bartonella henselae.

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MaFeng Liu

Full Text Available Bartonellae are hemotropic bacteria, agents of emerging zoonoses. These bacteria are heme auxotroph Alphaproteobacteria which must import heme for supporting their growth, as they cannot synthesize it. Therefore, Bartonella genome encodes for a complete heme uptake system allowing the transportation of this compound across the outer membrane, the periplasm and the inner membranes. Heme has been proposed to be used as an iron source for Bartonella since these bacteria do not synthesize a complete system required for iron Fe³⁺ uptake. Similarly to other bacteria which use heme as an iron source, Bartonellae must transport this compound into the cytoplasm and degrade it to allow the release of iron from the tetrapyrrole ring. For Bartonella, the gene cluster devoted to the synthesis of the complete heme uptake system also contains a gene encoding for a polypeptide that shares homologies with heme trafficking or degrading enzymes. Using complementation of an E. coli mutant strain impaired in heme degradation, we demonstrated that HemS from Bartonella henselae expressed in E. coli allows the release of iron from heme. Purified HemS from B. henselae binds heme and can degrade it in the presence of a suitable electron donor, ascorbate or NADPH-cytochrome P450 reductase. Knocking down the expression of HemS in B. henselae reduces its ability to face H₂O₂ induced oxidative stress.

[Antimicrobial resistance of Bartonella bacilliformis strains from regions endemic to bartonellosis in Peru].

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Mendoza-Mujica, Giovanna; Flores-León, Diana

2015-10-01

To evaluate in vitro antimicrobial susceptibility to chloramphenicol (CHL) and ciprofloxacin (CIP) in strains of Bartonella bacilliformis from areas that are endemic to Bartonellosis in Peru, through three laboratory methods. Antimicrobial susceptibility to CHL and CIP from 100 strains of Bartonella bacilliformis isolated in patients from the regions of Ancash, Cusco, Cajamarca, Lima and La Libertad were evaluated. Strains were evaluated by: disk diffusion, E-test and agar dilution. 26% of the strains of Bartonella bacilliformis evaluated were resistant to CIP and 1% to CHL. Similar patterns of antimicrobial sensitivity / resistance were obtained in all three methods. Bartonella bacilliformis strains circulating in Peru have high levels of in vitro resistance to CIP, so it is advisable to expand research on the use of drug treatment regimens of the Bartonellosis. The methods of E-test and disk diffusion were the most suitable for assessment in vitro of antimicrobial susceptibility of the microorganism.

Fatal interstitial lung disease associated with icotinib.

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Zhang, Jiexia; Zhan, Yangqing; Ouyang, Ming; Qin, Yinyin; Zhou, Chengzhi; Chen, Rongchang

2014-12-01

The most serious, and maybe fatal, yet rare, adverse reaction of gefitinib and erlotinib is drug-associated interstitial lung disease (ILD), which has been often described. However, it has been less well described for icotinib, a similar orally small-molecule tyrosine kinase inhibitor (TKI). The case of a 25-year-old female patient with stage IV lung adenocarcinoma who developed fatal ILD is reported here. She denied chemotherapy, and received palliative treatment with icotinib (125 mg po, three times daily) on March 1, 2013. One month after treatment initiation, the patient complained of continuous dry cough and rapid progressive dyspnea. Forty one days after icotinib treatment, icotinib associated ILD was suspected when the patient became increasingly dyspnoeic despite of treatment of pericardial effusion, left pleural effusion and lower respiratory tract infection, and X-ray computed tomography (CT) of chest revealed multiple effusion shadows and ground-glass opacities in bilateral lungs. Then, icotinib was discontinued and intravenous corticosteroid was started (methylprednisolone 40 mg once daily, about 1 mg per kilogram) respectively. Forty three days after icotinib treatment, the patient died of hypoxic respiratory failure. ILD should be considered as a rare, but often fatal side effect associated with icotinib treatment.

Splenic vasculitis, thrombosis, and infarction in a febrile dog infected with Bartonella henselae.

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Friedenberg, Steven G; Balakrishnan, Nandhakumar; Guillaumin, Julien; Cooper, Edward S; Lewis, Kristin; Russell, Duncan S; Breitschwerdt, Edward B

2015-01-01

To describe the clinical course and successful management of a febrile dog with polyarthritis, splenic vasculitis, thrombosis, and infarction that was infected with Bartonella henselae. An 8-year-old female spayed Labrador Retriever was referred to The Ohio State University Veterinary Medical Center Emergency Service for evaluation of limping, fever, vomiting, and malaise of 4 days' duration. Physical examination abnormalities included generalized weakness, diminished conscious proprioception, bilateral temporalis muscle atrophy, and diarrhea. Peripheral lymph nodes were normal, and there were no signs of abdominal organomegaly, joint effusion, or spinal pain. Abdominal ultrasound identified a nonocclusive splenic vein thrombus. Fine-needle aspirates of the spleen revealed pyogranulomatous inflammation, mild reactive lymphoid hyperplasia, and mild extramedullary hematopoiesis. Splenic histopathology found marked, multifocal to coalescing acute coagulation necrosis (splenic infarctions) and fibrinoid necrotizing vasculitis. Bartonella henselae DNA was amplified by polymerase chain reaction and sequenced from the splenic tissue. The dog responded favorably to antimicrobials and was healthy at the time of follow-up evaluation. Bartonella henselae is an incompletely characterized emerging canine pathogen. This case report establishes a potential role for this bacterium as a cause of vasculitis and thromboembolism, which have not been previously reported in association with B. henselae infection in dogs. © Veterinary Emergency and Critical Care Society 2015.

Candidatus Bartonella merieuxii, a Potential New Zoonotic Bartonella Species in Canids from Iraq

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2012-09-27

using an insect PLOS Neglected Tropical Diseases | www.plosntds.org 1 September 2012 | Volume 6 | Issue 9 | e1843 Report Documentation Page Form... Tropical Diseases, vol 6, no. 9, Published September 27, 2012, Government or Federal Purpose Rights License. 14. ABSTRACT Bartonellae are emerging...added to the test wells. Positive and negative controls were included on each slide. Three conjugate (Cappel fluorescein- conjugate goat anti-dog IgG

Contrasting Patterns in Mammal–Bacteria Coevolution: Bartonella and Leptospira in Bats and Rodents

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Lei, Bonnie R.; Olival, Kevin J.

2014-01-01

Background Emerging bacterial zoonoses in bats and rodents remain relatively understudied. We conduct the first comparative host–pathogen coevolutionary analyses of bacterial pathogens in these hosts, using Bartonella spp. and Leptospira spp. as a model. Methodology/Principal Findings We used published genetic data for 51 Bartonella genotypes from 24 bat species, 129 Bartonella from 38 rodents, and 26 Leptospira from 20 bats. We generated maximum likelihood and Bayesian phylogenies for hosts and bacteria, and tested for coevoutionary congruence using programs ParaFit, PACO, and Jane. Bartonella spp. and their bat hosts had a significant coevolutionary fit (ParaFitGlobal = 1.9703, P≤0.001; m2 global value = 7.3320, P≤0.0001). Bartonella spp. and rodent hosts also indicated strong overall patterns of cospeciation (ParaFitGlobal = 102.4409, P≤0.001; m2 global value = 86.532, P≤0.0001). In contrast, we were unable to reject independence of speciation events in Leptospira and bats (ParaFitGlobal = 0.0042, P = 0.84; m2 global value = 4.6310, P = 0.5629). Separate analyses of New World and Old World data subsets yielded results congruent with analysis from entire datasets. We also conducted event-based cophylogeny analyses to reconstruct likely evolutionary histories for each group of pathogens and hosts. Leptospira and bats had the greatest number of host switches per parasite (0.731), while Bartonella and rodents had the fewest (0.264). Conclusions/Significance In both bat and rodent hosts, Bartonella exhibits significant coevolution with minimal host switching, while Leptospira in bats lacks evolutionary congruence with its host and has high number of host switches. Reasons underlying these variable coevolutionary patterns in host range are likely due to differences in disease-specific transmission and host ecology. Understanding the coevolutionary patterns and frequency of host-switching events between bacterial pathogens and

Fatal interstitial lung disease associated with icotinib

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Zhang, Jiexia; Zhan, Yangqing; Ouyang, Ming; Qin, Yinyin; Zhou, Chengzhi; Chen, Rongchang

2014-01-01

The most serious, and maybe fatal, yet rare, adverse reaction of gefitinib and erlotinib is drug-associated interstitial lung disease (ILD), which has been often described. However, it has been less well described for icotinib, a similar orally small-molecule tyrosine kinase inhibitor (TKI). The case of a 25-year-old female patient with stage IV lung adenocarcinoma who developed fatal ILD is reported here. She denied chemotherapy, and received palliative treatment with icotinib (125 mg po, th...

Molecular prevalence of Bartonella, Babesia, and hemotropic Mycoplasma sp. in dogs with splenic disease.

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Varanat, M; Maggi, R G; Linder, K E; Breitschwerdt, E B

2011-01-01

Among diseases that cause splenomegaly in dogs, lymphoid nodular hyperplasia (LNH), splenic hemangiosarcoma (HSA), and fibrohistiocytic nodules (FHN) are common diagnoses. The spleen plays an important role in the immunologic control or elimination of vector-transmitted, blood-borne pathogens, including Bartonella sp., Babesia sp., and hemotropic Mycoplasma sp. To compare the prevalence of Bartonella sp., Babesia sp., and hemotropic Mycoplasma sp. DNA in spleens from dogs with LNH, HSA, and FHN. Paraffin-embedded, surgically obtained biopsy tissues from LNH (N = 50), HSA (N = 50), and FHN (N = 37) were collected from the anatomic pathology archives. Spleens from specific pathogen-free (SPF) dogs (N = 8) were used as controls. Bartonella sp., Babesia sp., and Mycoplasma sp. DNA was amplified by PCR, followed by DNA sequencing. Bartonella sp. DNA was more prevalent in FHN (29.7%) and HSA (26%) as compared to LNH (10%) (P = .019, .0373, respectively) or control spleens (0.0%). The prevalence of Babesia sp. and hemotropic Mycoplasma sp. DNA was significantly lower than Bartonella sp. DNA in HSA (P = .0005, .006, respectively) and FHN (P = .003, .0004, respectively). There was no statistically significant difference in DNA prevalence among the 3 genera in the LNH group. The higher prevalence of Bartonella sp. in FHN and HSA warrants future investigations to determine if this bacterium plays a role in the development of these splenic diseases. Copyright © 2011 by the American College of Veterinary Internal Medicine.

Substance P Receptor Antagonism: A Potential Novel Treatment Option for Viral-Myocarditis

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Prema Robinson

2015-01-01

Full Text Available Viral-myocarditis is an important cause of heart failure for which no specific treatment is available. We previously showed the neuropeptide substance P (SP is associated with the pathogenesis of murine myocarditis caused by encephalomyocarditis virus (EMCV. The current studies determined if pharmacological inhibition of SP-signaling via its high affinity receptor, NK1R and downstream G-protein, Ras homolog gene family, member-A (RhoA, will be beneficial in viral-myocarditis. Aprepitant (1.2 mg/kg, a SP-receptor antagonist, or fasudil (10 mg/kg, a RhoA inhibitor, or saline control was administered daily to mice orally for 3 days, prior to, or 5 days following, intraperitoneal infection with and without 50 PFU of EMCV, following which disease assessment studies, including echocardiogram and cardiac Doppler were performed in day 14 after infection. Pretreatment and posttreatment with aprepitant significantly reduced mortality, heart and cardiomyocyte size, and cardiac viral RNA levels (P<0.05 all, ANOVA. Only aprepitant pretreatment improved heart functions; it significantly decreased end systolic diameter, improved fractional shortening, and increased peak aortic flow velocity (P<0.05 all, ANOVA. Pre- or posttreatment with fasudil did not significantly impact disease manifestations. These findings indicate that SP contributes to cardiac-remodeling and dysfunction following ECMV infection via its high affinity receptor, but not through the Rho-A pathway. These studies suggest that SP-receptor antagonism may be a novel therapeutic-option for patients with viral-myocarditis.

Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction.

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Gilson, Julieta; Khalighi, Koroush; Elmi, Farhad; Krishnamurthy, Mahesh; Talebian, Amirsina; Toor, Rubinder S

2017-01-01

A 45-year-old woman presented with a sudden episode of typical chest pain, radiating to her neck. The patient denied premature coronary artery disease in the family. Initial EKG showed normal sinus rhythm with a 1 mm ST-elevation involving lead II and lead aVF and a 1 mm ST-depression in lead V1 with associated T-wave inversion. Initial Troponin I (normal disease. Two days later the patient developed right-sided facial palsy. Diagnosis of Lyme disease was confirmed by ELISA with positive IgM and IgG antibodies. Treatment with intravenous ceftriaxone and oral steroids was started. Eventually resolution of symptoms and, normalization of cardiac markers and EKG changes, were achieved. This is a rare case of Lyme myocarditis associated with markedly elevated Troponin I, normal left ventricle function, and an absence of conduction abnormalities. To the best of our knowledge, Lyme myocarditis mimicking acute coronary syndrome with such high levels of Troponin I and neurologic compromise has not been previously described. Lyme myocarditis may be a challenging diagnosis in endemic areas especially in patients with coronary artery disease risk factors, presenting with typical chest pain, EKG changes and positive cardiac biomarkers. Therefore, it should be considered a differential diagnosis in patients presenting with clinical symptoms suggestive of acute coronary syndrome. Abbreviations AV: Atrioventricular; CK-MB: Creatinine Kinase-MB; EKG: Electrocardiogram; ELISA: Enzyme-Linked Immunosorbent Assay; IgG: Immunoglobulin G; IgM: Immunoglobulin M.

Associations between drug use and motorcycle helmet use in fatal crashes.

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Rossheim, Matthew E; Wilson, Fernando; Suzuki, Sumihiro; Rodriguez, Mayra; Walters, Scott; Thombs, Dennis L

2014-01-01

Helmet use reduces mortality risk for motorcyclists, regardless of drug and alcohol use. However, the association between drug use and motorcycle helmet utilization is not well known. This study examines the relationship between drug use and motorcycle helmet use among fatally injured motorcycle riders. Using data from the 2005-2009 Fatality Analysis Reporting System (FARS), we examined the association between drug use and motorcycle helmet use in a multivariable logistic regression analysis of 9861 fatally injured motorcycle riders in the United States. For fatally injured motorcycle riders, use of alcohol, marijuana, or other drugs was associated with increased odds of not wearing a motorcycle helmet, controlling for the effects of state motorcycle helmet laws and other confounding variables. Predicted probabilities indicate that helmet use substantially decreases among fatally injured riders mixing alcohol with marijuana and other drugs. Furthermore, the likelihood of helmet use between marijuana-only users and other drug users is virtually the same across all blood alcohol content (BAC) levels. This study provides evidence that alcohol, marijuana, and other drug use is associated with not wearing a motorcycle helmet in fatal motorcycle crashes. There is a clear need for additional prevention and intervention efforts that seek to change helmet and drug use norms among motorcycle riders.

[Cardiac tamponade and myocarditis in Churg-Strauss syndrome].

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Baili, L; Aydi, Z; Soussi, G; Ben Dhaou B, B; Zidi, A; Berraies, A; Boussema, F; Kammoun, S; Hamzaoui, A; Kraiem, S; Ben Miled M'rad, K; Rokbani, L

2014-09-01

The successive occurrence of pericardial tamponade and myocarditis during a Churg-Strauss syndrome is exceptionally described. We report a patient in whom pericardial tamponade and myocarditis were the presenting manifestation of a Churg-Strauss syndrome. A 58-year-old woman was admitted because of alteration of the clinical status with eosinophilia. One month ago, she was hospitalized for a pericardial tamponade treated by pericardial drainage. Acute myocarditis was diagnosed on chest pain during the second hospitalization. The etiologic inquiry ended in the diagnosis of Churg-Strauss complicated with a double cardiac involvement. A good response of clinical and biological anomalies was obtained after corticosteroid and immunosuppressive treatment. Isolated or multiple involvements of cardiac tunics should lead to make diagnosis of systemic vasculitis. A complete initial assessment and a close observation of the patients followed for Churg-Strauss syndrome is imperative to detect a cardiac achievement and set up an early treatment. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Parinaud syndrome caused by Bartonella henselae: case report Síndrome de Parinaud causada por Bartonella henselae: relato de caso

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Carlos Alberto Yamashita

1996-12-01

Full Text Available The authors report a case of Parinaud syndrome (conjunctivitis with pre-auricular satellite adenitis caused by Bartonella henselae, the etiologic agent of Cat Scratch Disease. The etiologic assessment of this case was performed by serum indirect immunofluorescence reaction and allowed for a better therapeutics and follow up, avoiding ineffective antibiotics and surgical interventions.Os autores relatam um caso do Síndrome de Parinaud (conjuntivite com adenite satélite pré-auricular causada por Bartonella henselae, o agente etiológico da Doença da Arranhadura do Gato. O esclarecimento etiológico deste caso foi feito através da reação de imunofluorescência indireta o que permitiu um adequado enfoque terapêutico e acompanhamento do paciente, evitando o uso de antibióticos inadequados e intervenções cirúrgicas.

Lyme myocarditis diagnosed by indium-111-antimyosin antibody scintigraphy

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Casans, I.; Villar, A.; Almenar, V.; Blanes, A.

1989-06-01

We report a new case of Lyme disease with cardiac manifestations, which has been possible to follow during the long period of 12 years. We have detected the usual ECG abnormalities, and concentric hypertrophic myocardiopathy, by echocardiography. The acute myocarditis was demonstrated by /sup 111/In-antimyosin scintigraphy, which showed global myocardial uptake of the tracer, constituting the first report, to our knowledge, of Lyme myocarditis diagnosed by this method.

Lyme myocarditis diagnosed by indium-111-antimyosin antibody scintigraphy

International Nuclear Information System (INIS)

Casans, I.; Villar, A.; Almenar, V.; Blanes, A.

1989-01-01

We report a new case of Lyme disease with cardiac manifestations, which has been possible to follow during the long period of 12 years. We have detected the usual ECG abnormalities, and concentric hypertrophic myocardiopathy, by echocardiography. The acute myocarditis was demonstrated by 111 In-antimyosin scintigraphy, which showed global myocardial uptake of the tracer, constituting the first report, to our knowledge, of Lyme myocarditis diagnosed by this method. (orig.)

Swiss cheese ventricular septal defect with myocarditis - A rare coexistence in a neonate

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A R Saboo

2012-01-01

Full Text Available Myocarditis is defined as acute inflammation of the myocardium, usually following a non-specific flu-like illness, and encompasses a wide range of clinical presentations ranging from mild or subclinical disease to heart failure. We report a 12-day-old healthy full-term neonate who presented with abrupt onset of congestive cardiac failure (CCF following a viral prodrome. Examination revealed persistent sinus tachycardia, lymphocytosis, gross cardiomegaly, nonspecific electrocardiogram changes with echocardiography showing Swiss cheese ventricular septal defect (VSD. VSD alone very rarely presents as early-onset cardiac failure in the absence of other precipitating factors like anemia, sepsis, hypoglycemia etc. Myocarditis, however, can mimic VSD and can present as fulminant cardiac failure in an otherwise healthy newborn. Myocarditis is usually diagnosed based on circumstantial evidence such as a recent viral infection and the sudden onset of cardiac dysfunction while ruling out other diagnostic possibilities. Elevated troponin T level is one of the most crucial noninvasive diagnostic modalities. Several trials have concluded that levels >0.055 ng/ml are statistically significant for diagnosing myocarditis in children. In our case an abrupt onset of cardiac failure following a viral prodrome and markedly elevated cardiac troponin T without sepsis and in the presence of normal coronary anatomy clinched the diagnosis of myocarditis. An early and aggressive treatment for CCF along with regular long-term follow-up plays a key role in the management of myocarditis. Role of high-dose Intravenous immunoglobulin in myocarditis has been studied by many trials with different outcomes. This is the first case report showing coexistence of VSD with myocarditis in a neonate presenting as early-onset acute cardiac failure. The report highlights the importance of screening for myocarditis in all previously normal babies presenting primarily with cardiogenic

Total artificial heart implantation for biventricular failure due to eosinophilic myocarditis.

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Kawabori, Masashi; Kurihara, Chitaru; Miller, Yair; Heck, Kent A; Bogaev, Roberta C; Civitello, Andrew B; Cohn, William E; Frazier, O H; Morgan, Jeffrey A

2017-09-01

Idiopathic hypereosinophilic syndrome is a condition of unknown etiology characterized by proliferation of eosinophils and their infiltration into tissues. Although cardiac involvement is rare, eosinophilic myocarditis can lead to life-threating fulminant congestive heart failure. Treatment of patients with eosinophilic myocarditis is challenging as heart failure can be caused by biventricular dysfunction. To our knowledge, this is the first case reported in the literature describing a patient with acute severe biventricular heart failure caused by eosinophilic myocarditis with mural left ventricular apical thrombus who was successfully treated with implantation of a total artificial heart as a bridge to heart transplant.

Acute myocarditis with normal wall motion detected with 2D speckle tracking echocardiography

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Thomas Sturmberger

2016-05-01

Full Text Available We present the case of a 26-year-old male with acute tonsillitis who was referred for coronary angiography because of chest pain, elevated cardiac biomarkers, and biphasic T waves. The patient had no cardiovascular risk factors. Echocardiography showed no wall motion abnormalities and no pericardial effusion. 2D speckle tracking revealed distinct decreased regional peak longitudinal systolic strain in the lateral and posterior walls. Ischemic disease was extremely unlikely in view of his young age, negative family history regarding coronary artery disease, and lack of regional wall motion abnormalities on the conventional 2D echocardiogram. Coronary angiography was deferred as myocarditis was suspected. To confirm the diagnosis, cardiac magnetic resonance tomography (MRT was performed, showing subepicardial delayed hyperenhancement in the lateral and posterior walls correlating closely with the strain pattern obtained by 2D speckle tracking echocardiography. With a working diagnosis of acute myocarditis associated with acute tonsillitis, we prescribed antibiotics and nonsteroidal anti-inflammatory drugs. The patient’s clinical signs resolved along with normalization of serum creatine kinase (CK levels, and the patient was discharged on the third day after admission. Learning points: • Acute myocarditis can mimic acute coronary syndromes. • Conventional 2D echocardiography lacks specific features for detection of subtle regional wall motion abnormalities. • 2D speckle tracking expands the scope of echocardiography in identifying myocardial dysfunction derived from edema in acute myocarditis.

Bartonella native valve endocarditis: the first brazilian case alive and well

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C. Lamas

Full Text Available Bartonella is an important cause of blood culture-negative endocarditis in recent studies. Seroprevalence studies in the States of Minas Gerais and Rio de Janeiro have shown Bartonella IgG positivity around 14% in healthy adults and 40% in HIV seropositive adults, respectively. A case report of a 46-year-old white male with moderate aortic regurgitation (AR due to rheumatic heart disease (RHD, admitted due to worsening heart failure, is presented. Clinical features were apyrexia, anemia, polyclonal hypergammaglobulinemia, hematuria and splenomegaly. He was submitted to surgery due to worsening AR. Histopathology of the excised valve showed active bacterial endocarditis and underlying RHD. Routine blood cultures were negative. Indirect immunofluorescence (IFI assays for Coxiella burnetii were non-reactive. Bartonella henselae IgG titer was 1:4096 prior to antibiotics and 1:512 14 months after treatment. History of close contact with a young cat during the months preceding his admission was elicited.

Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node.

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Cary, N. R.; Fox, B.; Wright, D. J.; Cutler, S. J.; Shapiro, L. M.; Grace, A. A.

1990-01-01

A fatal case of Lyme carditis occurring in a Suffolk farmworker is reported. Post-mortem examination of the heart showed pericarditis, focal myocarditis and prominent endocardial and interstitial fibrosis. The additional finding of endodermal heterotopia ('mesothelioma') of the atrioventricular node raises the possibility that this could also be related to Lyme infection and account for the relatively frequent occurrence of atrioventricular block in this condition. Lyme disease should always be considered in a case of atrioventricular block, particularly in a young patient from a rural area. The heart block tends to improve and therefore only temporary pacing may be required. Images Figure 1 Figure 2 Figure 3 PMID:2349186

Changes in perfusion and fatty acid metabolism of rat heart with autoimmune myocarditis

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Tsujimura, Eiichiro; Kusuoka, Hideo; Fukuchi, Kazuki; Hasegawa, Shinji; Yutani, Kenji; Nishimura, Tsunehiko [Osaka Univ., Suita (Japan). Biomedical Research Center; Hori, Masatsugu; Hirono, Satoru; Izumi, Tohru

2000-10-01

To elucidate the change in perfusion and aerobic metabolism in myocarditis, tissue counting and dual tracer ex vivo autoradiography with Tl-201 and free fatty acid analog, I-123- or I-125-labeled (p-iodophenyl)-methyl-pentadecanoic acid (BMIPP), were performed in rats with myocarditis induced by immunization with cardiac myosin. Inflammatory damage was classified histologically. At the acute stage (2-4 weeks after the antigen-injection), total heart uptakes of Tl and BMIPP and the ratio (BMIPP/Tl) were significantly reduced in myocarditis rats (N=15) compared with the controls (N=12). Myocardial distribution of Tl and BMIPP was not homogeneous. Relative uptake of Tl and BMIPP (N=9, 128 regions) was gradually decreased with the extent of inflammation, and the regional BMIPP/Tl was smaller than the control. At the subacute stage (7 weeks after the antigen-injection), total Tl uptake in myocarditis rats (N=5) recovered to the control level (N=4), but that of BMIPP was still significantly lower than the control. BMIPP/Tl was still significantly lower in myocarditis. Myocardial distribution of Tl and BMIPP recovered to be more homogeneous. Relative uptake of Tl and BMIPP (N=6, 78 regions) still gradually but significantly decreased with the extent of inflammation. Regional BMIPP/Tl was still depressed in myocarditis. These results indicate that myocardial perfusion and aerobic metabolism were discrepant and heterogeneously suppressed with severe inflammation during the acute stages, but the difference decreases with time. Examination with Tl-201 and BMIPP may provide information about the severity of myocarditis. (author)

Pulmonary and central nervous system pathology in fatal cases of hand foot and mouth disease caused by enterovirus A71 infection.

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Wang, Zijun; Nicholls, John M; Liu, Fengfeng; Wang, Joshua; Feng, Zijian; Liu, Dongge; Sun, Yanni; Zhou, Cheng; Li, Yunqian; Li, Hai; Qi, Shunxiang; Huang, Xueyong; Sui, Jilin; Liao, Qiaohong; Peiris, Malik; Yu, Hongjie; Wang, Yu

2016-04-01

In the past 17 years, neurological disease associated with enterovirus A71 (EV-A71) has increased dramatically in the Asia-Pacific region with a high fatality rate in young infants, often due to pulmonary oedema, however the mechanism of this oedema remains obscure. We analysed the brainstem, heart and lungs of 15 fatal cases of confirmed EV-A71 infection in order to understand the pathophysiological mechanism of death and pulmonary oedema. In keeping with other case studies, the main cause of death was neurogenic pulmonary oedema. In the brainstem, 11 cases showed inflammation and all cases showed parenchymal inflammation with seven cases showing moderate or severe clasmatodendrosis. No viral antigen was detected in sections of the brainstem in any of the cases. All fatal cases showed evidence of pulmonary oedema; however, there was absence of direct pulmonary viral damage or myocarditis-induced damage and EV-A71 viral antigen staining was negative. Though there was no increase in staining for Na/K-ATPase, 11 of the 15 cases showed a marked reduction in aquaporin-4 staining in the lung, and this reduction may contribute to the development of fatal pulmonary oedema. Copyright © 2016. Published by Elsevier B.V.

Zoonotic pathogens in Atlantic Forest wild rodents in Brazil: Bartonella and Coxiella infections.

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Rozental, Tatiana; Ferreira, Michelle Santos; Guterres, Alexandro; Mares-Guia, Maria Angélica; Teixeira, Bernardo R; Gonçalves, Jonathan; Bonvicino, Cibele Rodrigues; D'Andrea, Paulo Sergio; de Lemos, Elba Regina Sampaio

2017-04-01

Zoonotic pathogens comprise a significant and increasing fraction of all emerging and re-emerging infectious diseases that plague humans. Identifying host species is one of the keys to controlling emerging infectious diseases. From March 2007 until April 2012, we collected a total of 131 wild rodents in eight municipalities of Rio de Janeiro, Brazil. We investigated these rodents for infection with Coxiella burnetii, Bartonella spp. and Rickettsia spp. In total, 22.1% (29/131) of the rodents were infected by at least one pathogen; co-infection was detected in 1.5% (2/131) of rodents. Coxiella burnetii was detected in 4.6% (6/131) of the wild animals, 17.6% of the rodents harbored Bartonella spp. No cases of Rickettsia were identified. Bartonella doshiae and Bartonella vinsonii were the species found on the wild mammals. This report is the first to note C. burnetii, B. doshiae and B. vinsonii natural infections in Atlantic Forest wild rodents in Brazil. Our work highlights the potential risk of transmission to humans, since most of the infected specimens belong to generalist species that live near human dwellings. Copyright © 2017 Elsevier B.V. All rights reserved.

INTEGRAL EVALUATION OF THE CYTOKINE SYSTEM IN VIRAL MYOCARDITIS

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Peremot S. D.

2017-10-01

Full Text Available The need for an individual approach in the choice of means for the prevention of complications in inflammatory processes in cardiomyocytes, the course of which unfolds against a persistent viral infection, dictates the need to determine the general mechanisms for maintaining and progressing of the pathological process and an objective evaluation of immunological changes. The aim of the study was to determine changes in the system of inflammatory mediators in patients with subacute and chronic herpesviral infectious myocarditis on the basis of an integral assessment of the levels of opposing groups of cytokines. Materials & methods. To achieve this goal, we conducted a determination and analysis of changes in the cytokine profile in 87 patients with subacute (from 2 to 6 months and chronic (more than 6 months myocarditis due to an integral assessment of the mediator levels of inflammation of opposing groups in patients with herpesviral myocarditis on treatment in medical institutions of the Kharkov city. The average age of the patients was (27 ± 7.4 years. The control group was attracted to 40 people without clinical manifestations of cardiovascular diseases and in whose anamnesis there were no data on the transferred inflammatory diseases of the myocardium. Both groups of subjects were comparable in age and gender. The main group of subjects was divided into two subgroups. The first was 44 patients with subacute flow, the second - 43 patients with chronic infectious myocarditis. The diagnosis was established in accordance with the recommendations of the Association of Cardiologists of Ukraine and experts of the European Society of Cardiology, according to the formation of definitions of diseases in the International Classification of Diseases (ICD-10 of the tenth revision. The removal of material from patients was carried out according to the rules for the collection of infectious material. The concentration of cytokines: IL-2, IL-4, IL-6, IL

Trends and factors associated with dengue mortality and fatality in Brazil

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Enny Santos Paixão

2015-08-01

Full Text Available AbstractINTRODUCTION:Studies that generate information that may reduce the dengue death risk are essential. This study analyzed time trends and risk factors for dengue mortality and fatality in Brazil from 2001 to 2011.METHODS:Time trends for dengue mortality and fatality rates were analyzed using simple linear regression. Associations between the dengue mortality and the case fatality rates and socioeconomic, demographic, and health care indicators at the municipality level were analyzed using negative binomial regression.RESULTS:The dengue hemorrhagic fever case fatality rate increased in Brazil from 2001 to 2011 (β=0.67; p=0.036, in patients aged 0-14 years (β=0.48; p=0.030 and in those aged ≥15 years (β=1.1; p<0.01. Factors associated with the dengue case fatality rate were the average income per capita (MRR=0.99; p=0.038 and the number of basic health units per population (MRR=0.89; p<0.001. Mortality rates increased from 2001 to 2011 (β=0.350; p=0.002.Factors associated with mortality were inequality (RR=1.02; p=0.001 high income per capita (MRR=0.99; p=0.005, and higher proportions of populations living in urban areas (MRR=1.01; p<0.001.CONCLUSIONS:The increases in the dengue mortality and case fatality rates and the associated socioeconomic and health care factors, suggest the need for structural and intersectoral investments to improve living conditions and to sustainably reduce these outcomes.

Bartonella spp. - a chance to establish One Health concepts in veterinary and human medicine.

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Regier, Yvonne; O Rourke, Fiona; Kempf, Volkhard A J

2016-05-10

Infectious diseases remain a remarkable health threat for humans and animals. In the past, the epidemiology, etiology and pathology of infectious agents affecting humans and animals have mostly been investigated in separate studies. However, it is evident, that combined approaches are needed to understand geographical distribution, transmission and infection biology of "zoonotic agents". The genus Bartonella represents a congenial example of the synergistic benefits that can arise from such combined approaches: Bartonella spp. infect a broad variety of animals, are linked with a constantly increasing number of human diseases and are transmitted via arthropod vectors. As a result, the genus Bartonella is predestined to play a pivotal role in establishing a One Health concept combining veterinary and human medicine.

Evolutionary Dynamics of Pathoadaptation Revealed by Three Independent Acquisitions of the VirB/D4 Type IV Secretion System in Bartonella.

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Harms, Alexander; Segers, Francisca H I D; Quebatte, Maxime; Mistl, Claudia; Manfredi, Pablo; Körner, Jonas; Chomel, Bruno B; Kosoy, Michael; Maruyama, Soichi; Engel, Philipp; Dehio, Christoph

2017-03-01

The α-proteobacterial genus Bartonella comprises a group of ubiquitous mammalian pathogens that are studied as a model for the evolution of bacterial pathogenesis. Vast abundance of two particular phylogenetic lineages of Bartonella had been linked to enhanced host adaptability enabled by lineage-specific acquisition of a VirB/D4 type IV secretion system (T4SS) and parallel evolution of complex effector repertoires. However, the limited availability of genome sequences from one of those lineages as well as other, remote branches of Bartonella has so far hampered comprehensive understanding of how the VirB/D4 T4SS and its effectors called Beps have shaped Bartonella evolution. Here, we report the discovery of a third repertoire of Beps associated with the VirB/D4 T4SS of B. ancashensis, a novel human pathogen that lacks any signs of host adaptability and is only distantly related to the two species-rich lineages encoding a VirB/D4 T4SS. Furthermore, sequencing of ten new Bartonella isolates from under-sampled lineages enabled combined in silico analyses and wet lab experiments that suggest several parallel layers of functional diversification during evolution of the three Bep repertoires from a single ancestral effector. Our analyses show that the Beps of B. ancashensis share many features with the two other repertoires, but may represent a more ancestral state that has not yet unleashed the adaptive potential of such an effector set. We anticipate that the effectors of B. ancashensis will enable future studies to dissect the evolutionary history of Bartonella effectors and help unraveling the evolutionary forces underlying bacterial host adaptation. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

A case report and literature review of Churg-Strauss syndrome presenting with myocarditis.

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Qiao, Lu; Gao, Dengfeng

2016-12-01

Churg-Strauss syndrome (CSS) is a multisystem disorder characterized by asthma, prominent peripheral blood eosinophilia, and vasculitis signs. Here we report a case of CSS presenting with acute myocarditis and heart failure and review the literature on CSS with cardiac involvement. A 59-year-old man with general fatigue, numbness of limbs, and a 2-year history of asthma was admitted to the department of orthopedics. Eosinophilia, history of asthma, lung infiltrates, peripheral neurological damage, and myocarditis suggested the diagnosis of CSS. Transthoracic echocardiography revealed a dilated hypokinetic left ventricle (left ventricular ejection fraction ∼40%) with mild segmental abnormalities in the septal and apical segments. By reviewing the present case reports, we concluded that (1) the younger age of CSS, the greater occurrence rate of complicating myocarditis and the poorer prognosis; (2) female CSS patients are older than male patients; (3) patients with cardiac involvement usually have a history of severe asthma; (4) markedly increased eosinophil count suggests a potential diagnosis of CSS (when the count increases to 20% of white blood cell counts or 8.1 × 109/L, eosinophils start to infiltrate into myocardium); and (5) negative ANCA status is associated with heart disease in CSS.

Factors Associated with Fatal Occupational Accidents among Mexican Workers: A National Analysis

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Gonzalez-Delgado, Mery; Gómez-Dantés, Héctor; Fernández-Niño, Julián Alfredo; Robles, Eduardo; Borja, Víctor H.; Aguilar, Miriam

2015-01-01

Objective To identify the factors associated with fatal occupational injuries in Mexico in 2012 among workers affiliated with the Mexican Social Security Institute. Methods Analysis of secondary data using information from the National Occupational Risk Information System, with the consequence of the occupational injury (fatal versus non-fatal) as the response variable. The analysis included 406,222 non-fatal and 1,140 fatal injuries from 2012. The factors associated with the lethality of the injury were identified using a logistic regression model with the Firth approach. Results Being male (OR=5.86; CI95%: 4.22-8.14), age (OR=1.04; CI95%: 1.03-1.06), employed in the position for 1 to 10 years (versus less than 1 year) (OR=1.37; CI95%: 1.15-1.63), working as a facilities or machine operator or assembler (OR: 3.28; CI95%: 2.12- 5.07) and being a worker without qualifications (OR=1.96; CI95%: 1.18-3.24) (versus an office worker) were associated with fatality in the event of an injury. Additionally, companies classified as maximum risk (OR=1.90; CI 95%: 1.38-2.62), workplace conditions (OR=7.15; CI95%: 3.63-14.10) and factors related to the work environment (OR=9.18; CI95%:4.36-19.33) were identified as risk factors for fatality in the event of an occupational injury. Conclusions Fatality in the event of an occupational injury is associated with factors related to sociodemographics (age, sex and occupation), the work environment and workplace conditions. Worker protection policies should be created for groups with a higher risk of fatal occupational injuries in Mexico. PMID:25790063

Neuroretinitis Caused by Bartonella henselae (Cat-Scratch Disease in a 13-Year-Old Girl

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Teodoro Durá-Travé

2010-01-01

Full Text Available Cat-scratch disease-related neuroretinitis is a relatively unusual pathology, with suspicious clinical epidemiological and serological diagnosis. We present a case of an adolescent suffering from unilateral neuroretinitis associated with Bartonella henselae infection characterized by abrupt loss of vision, optic disc swelling, and macular star exudates with optimal response to antibiotic treatment.

Polymerase chain reaction analysis for viruses in paraffin-embedded myocardium from dogs with dilated cardiomyopathy or myocarditis.

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Maxson, T R; Meurs, K M; Lehmkuhl, L B; Magnon, A L; Weisbrode, S E; Atkins, C E

2001-01-01

To perform polymerase chain reaction (PCR) analysis on paraffin-embedded myocardium from dogs with dilated cardiomyopathy (DCM) and dogs with myocarditis to screen for canine parvovirus, adenovirus types 1 and 2, and herpesvirus. Myocardial specimens from 18 dogs with an antemortem diagnosis of DCM and 9 dogs with a histopathologic diagnosis of myocarditis were evaluated. Paraffin-embedded myocardial specimens were screened for viral genome by PCR analysis. Positive-control specimens were developed from cell cultures as well as paraffin-embedded tissue specimens from dogs with clinical and histopathologic diagnoses of viral infection with canine parvovirus, adenovirus types 1 and 2, and herpesvirus. The histologic characteristics of all myocardial specimens were classified regarding extent, location, and type of inflammation and fibrosis. Canine adenovirus type 1 was amplified from 1 specimen from a dog with DCM. Canine parvovirus, adenovirus type 2, and herpesvirus were not amplified from any myocardial specimens. Histologic analysis of specimens from dogs with DCM revealed variable amounts of fibrosis; myocardial inflammation was observed in 1 affected dog. Histopathologic analysis of specimens from dogs with myocarditis disclosed variable degrees of inflammation and fibrosis. Viral agents canine parvovirus, adenovirus types 1 and 2, and herpesvirus are not commonly associated with DCM or active myocarditis in dogs. Additional studies evaluating for nucleic acid from viruses that less commonly affect dogs or different types of infectious agents may be warranted to gain insight into the cause of DCM and myocarditis in dogs.

Severe human parechovirus type 3 myocarditis and encephalitis in an adolescent with hypogammaglobulinemia

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Stacey K. Mardekian

2015-07-01

Full Text Available Human parechovirus (HPeV belongs to the Picornaviridae family of RNA viruses. HPeV infections can be asymptomatic, lead to mild respiratory and/or gastrointestinal symptoms, or less frequently cause severe diseases such as sepsis, meningitis, encephalitis, and myocarditis. Severe neurological HPeV infections occur most commonly in infants and neonates. There are currently 16 recognized types of HPeV. HPeV type 3 (HPeV3 has been the predominant type associated with severe central nervous system disease in neonates and newborns since its discovery in 1999. Although HPeV-related infections have been reported in adults, symptomatic HPeV3 infections in adolescents and adults are uncommon. A case of severe HPeV3 myocarditis and encephalitis in an adolescent is described.

Role of Electrophysiological Study and Catheter Ablation for Recurrent Ventricular Tachycardia Complicating Myocarditis

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Emanuele Cecchi

2012-01-01

Full Text Available Here we report the case of a 31-year-old man admitted to our hospital with echocardiografic and Cardiac Magnetic Resonance signs of myocarditis complicated by ventricular tachycardia, initially resolved with direct current shock. After the recurrence of ventricular tachycardia the patient was submitted to electrophysiological study revealing a re-entrant circuit at the level of the medium segment of interventricular septum, successfully treated with transcatheter ablation. This case highlights how the presence of recurrent ventricular arrhythmias at the onset of acute myocarditis, suspected or proven, could be associated with a pre-existing arrhythmogenic substrate, therefore these patients should be submitted to electrophysiological study in order to rule out the presence of arrhythmogenic focuses that can be treated with transcatheter ablation.

Acute myocarditis mimicking myocardial infarction can misdirect the diagnostic approach

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Erkan Yildirim

2016-03-01

Full Text Available Acute myocarditis is a well-recognized but rare manifestation of mostly viral infections. It can present with various clinical manifestations and may mimic myocardial infarction (MI since patients usually present with chest pain, and the electrocardiographic changes similar to those observed in acute ST-elevation MI. We, herein, present such an extreme case of acute myocarditis characterized by dynamic ST segment elevation with reciprocal changes in the electrocardiogram.

Left and right atrial feature tracking in acute myocarditis: A feasibility study

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Dick, Anastasia; Schmidt, Björn; Michels, Guido; Bunck, Alexander C.; Maintz, David; Baeßler, Bettina

2017-01-01

Purpose: The present study aims at evaluating the feasibility and reproducibility of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain and strain rate (SR) parameters of the left and right atrium (LA, RA) in patients with acute myocarditis as well as their potential to detect diastolic dysfunction. In addition, the diagnostic value of LA and RA strain parameters in the setting of acute myocarditis is investigated. Methods: CMR cine data of 30 patients with CMR-positive acute myocarditis were retrospectively analyzed. 25 age- and gender-matched healthy individuals served as a control. Analysis of longitudinal strain and SR of both atria was performed in two long-axis views using a dedicated FT-software. LA and RA deformation was analyzed including reservoir function (total strain [ε s ], peak positive SR [SR s ]), conduit function (passive strain [ε e ], peak early negative SR [SR e ]) and booster pump function (active strain [ε a ], peak late negative SR [SR a ]). Intra- and inter-observer reproducibility was assessed for all strain and SR parameters using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation (CV). Results: FT analyses of both atria were feasible in all patients and controls. Reproducibility was good for reservoir and conduit function parameters and moderate for booster pump function parameters. Myocarditis patients demonstrated an impaired LA reservoir and conduit function when compared to healthy controls (LA ε s : 32 ± 17 vs. 46 ± 13, p = 0.019; LA SR s : 1.5 ± 0.5 vs. 1.8 ± 0.5, p = 0.117; LA SR e : −1.3 ± 0.5 vs. −1.9 ± 0.5, p < 0.001), while LA booster pump function was preserved. In logistic regression and ROC-analyses, LA SR e proved to be the best independent predictor of acute myocarditis (AUC 0.80), and using LA SR e with a cut-off of −1.6 s −1 resulted in a diagnostic sensitivity of 83% and a specificity of 80%. Changes in RA phasic function parameters

Left and right atrial feature tracking in acute myocarditis: A feasibility study

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Dick, Anastasia, E-mail: anastasia-dick@web.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Schmidt, Björn, E-mail: bjoernschmidt1989@gmx.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Michels, Guido, E-mail: guido.michels@uk-koeln.de [Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Bunck, Alexander C., E-mail: alexander.bunck@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Maintz, David, E-mail: david.maintz@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Baeßler, Bettina, E-mail: bettina.baessler@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany)

2017-04-15

Purpose: The present study aims at evaluating the feasibility and reproducibility of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain and strain rate (SR) parameters of the left and right atrium (LA, RA) in patients with acute myocarditis as well as their potential to detect diastolic dysfunction. In addition, the diagnostic value of LA and RA strain parameters in the setting of acute myocarditis is investigated. Methods: CMR cine data of 30 patients with CMR-positive acute myocarditis were retrospectively analyzed. 25 age- and gender-matched healthy individuals served as a control. Analysis of longitudinal strain and SR of both atria was performed in two long-axis views using a dedicated FT-software. LA and RA deformation was analyzed including reservoir function (total strain [ε{sub s}], peak positive SR [SR{sub s}]), conduit function (passive strain [ε{sub e}], peak early negative SR [SR{sub e}]) and booster pump function (active strain [ε{sub a}], peak late negative SR [SR{sub a}]). Intra- and inter-observer reproducibility was assessed for all strain and SR parameters using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation (CV). Results: FT analyses of both atria were feasible in all patients and controls. Reproducibility was good for reservoir and conduit function parameters and moderate for booster pump function parameters. Myocarditis patients demonstrated an impaired LA reservoir and conduit function when compared to healthy controls (LA ε{sub s}: 32 ± 17 vs. 46 ± 13, p = 0.019; LA SR{sub s}: 1.5 ± 0.5 vs. 1.8 ± 0.5, p = 0.117; LA SR{sub e}: −1.3 ± 0.5 vs. −1.9 ± 0.5, p < 0.001), while LA booster pump function was preserved. In logistic regression and ROC-analyses, LA SR{sub e} proved to be the best independent predictor of acute myocarditis (AUC 0.80), and using LA SR{sub e} with a cut-off of −1.6 s{sup −1} resulted in a diagnostic sensitivity of 83% and a specificity of

Predominance of HA-222D/G polymorphism in influenza A(H1N1pdm09 viruses associated with fatal and severe outcomes recently circulating in Germany.

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Marianne Wedde

Full Text Available Influenza A(H1N1pdm09 viruses cause sporadically very severe disease including fatal clinical outcomes associated with pneumonia, viremia and myocarditis. A mutation characterized by the substitution of aspartic acid (wild-type to glycine at position 222 within the haemagglutinin gene (HA-D222G was recorded during the 2009 H1N1 pandemic in Germany and other countries with significant frequency in fatal and severe cases. Additionally, A(H1N1pdm09 viruses exhibiting the polymorphism HA-222D/G/N were detected both in the respiratory tract and in blood. Specimens from mild, fatal and severe cases were collected to study the heterogeneity of HA-222 in A(H1N1pdm09 viruses circulating in Germany between 2009 and 2011. In order to enable rapid and large scale analysis we designed a pyrosequencing (PSQ assay. In 2009/2010, the 222D wild-type of A(H1N1pdm09 viruses predominated in fatal and severe outcomes. Moreover, co-circulating virus mutants exhibiting a D222G or D222E substitution (8/6% as well as HA-222 quasispecies were identified (10%. Both the 222D/G and the 222D/G/N/V/Y polymorphisms were confirmed by TA cloning. PSQ analyses of viruses associated with mild outcomes revealed mainly the wild-type 222D and no D222G change in both seasons. However, an increase of variants with 222D/G polymorphism (60% was characteristic for A(H1N1pdm09 viruses causing fatal and severe cases in the season 2010/2011. Pure 222G viruses were not observed. Our results support the hypothesis that the D222G change may result from adaptation of viral receptor specificity to the lower respiratory tract. This could explain why transmission of the 222G variant is less frequent among humans. Thus, amino acid changes at HA position 222 may be the result of viral intra-host evolution leading to the generation of variants with an altered viral tropism.

Murine model of acute myocarditis and cerebral cortical neuron edema induced by coxsackievirus B4

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Zhao-Peng Dong

2018-01-01

Full Text Available Globally, coxsackievirus B4 (CV-B4 has been continuously isolated and evidence suggests an association with the development of pancreatitis and type I diabetes. In addition, CV-B4 is also associated with myocarditis and severe central nervous system (CNS complications, which remain poorly studied and understood. In the present study, we established an ICR mouse model of CV-B4 infection and examined whether CV-B4 infection resulted in a predisposition to myocarditis and CNS infection. We found high survival in both the treatment and control group, with no significant differences in clinical outcomes observed. However, pathological lesions were evident in both brain and heart tissue of the CV-B4-infected mice. In addition, high viral loads were found in the neural and cardiac tissues as early as 2 d postinfection. Expressions of IFN-γ and IL-6 in sera were significantly higher in CV-B4-infected mice compared to uninfected negative controls, suggesting the involvement of these cytokines in the development of histopathological lesions. Our murine model successfully reproduced the acute myocarditis and cerebral cortical neuron edema induced by CV-B4, and may be useful for the evaluation of vaccine candidates and potential antivirals against CV-B4 infection.

Bartonella melophagi in blood of domestic sheep (Ovis aries) and sheep keds (Melophagus ovinus) from the southwestern US: Cultures, genetic characterization, and ecological connections.

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Kosoy, Michael; Bai, Ying; Enscore, Russell; Rizzo, Maria Rosales; Bender, Scott; Popov, Vsevolod; Albayrak, Levent; Fofanov, Yuriy; Chomel, Bruno

2016-07-15

Bartonella melophagi sp. nov. was isolated from domestic sheep blood and from sheep keds (Melophagus ovinus) from the southwestern United States. The sequence analyses of the reference strain performed by six molecular markers consistently demonstrated that B. melophagi relates to but differ from other Bartonella species isolated from domestic and wild ruminants. Presence of 183 genes specific for B. melophagi, being absent in genomes of other Bartonella species associated with ruminants also supports the separation of this bacterial species from species of other ruminants. Bartonella DNA was detected in all investigated sheep keds; however, culturing of these bacteria from sheep blood rejects a speculation that B. melophagi is an obligatory endosymbiont. Instead, the results support the hypothesis that the domestic sheep is a natural host reservoir for B. melophagi and the sheep ked its main vector. This bacterium was not isolated from the blood of bighorn sheep and domestic goats belonging to the same subfamily Caprinae. B. melophagi has also been shown to be zoonotic and needs to be investigated further. Published by Elsevier B.V.

De novo development of eosinophilic myocarditis with left ventricular assist device support as bridge to transplant.

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Pereira, Naveen L; Park, Soon J; Daly, Richard C; Kushwaha, Sudhir S; Edwards, William D

2010-10-01

The de novo development of myocarditis during left ventricular assist device support for dilated cardiomyopathy has not been previously described. We report a case of severe eosinophilic myocarditis associated with the use of leukotriene-receptor antagonist montelukast that developed during left ventricular assist device support accompanied by intra-device thrombus formation that was hemodynamically tolerated and subsequently discovered in the explanted heart. There may be no visible change in cardiac function as assessed by echocardiography, but the diagnosis should be entertained with the development of peripheral eosinophilia. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Eosinophilic myocarditis due to Churg-Strauss syndrome with markedly elevated eosinophil cationic protein.

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Hara, Tomoya; Yamaguchi, Koji; Iwase, Takashi; Kadota, Muneyuki; Bando, Mika; Ogasawara, Kozue; Bando, Sachiko; Ise, Takayuki; Niki, Toshiyuki; Ueda, Yuka; Tomita, Noriko; Taketani, Yoshio; Yamada, Hirotsugu; Soeki, Takeshi; Wakatsuki, Tetsuzo; Sata, Masataka

2013-01-01

A 67-year-old woman with asthma visited our hospital with increasing dyspnea and new-onset paresthesia and purpura in her legs. Physical examination showed a wheeze, pretibial edema, and surrounding purpura. Chest X-rays showed cardiac decompensation and an electrocardiogram revealed a new ST-T change. Laboratory data showed leukocytosis, hypereosinophilia (10,450/μL), troponin T(+), elevated BNP, and markedly elevated eosinophil cationic protein (ECP) (> 150 ng/mL). Echocardiography revealed diffuse left ventricular hypokinesis (ejection fraction 30%) with increased wall thickness. Coronary angiography was normal. Cardiac magnetic resonance imaging implied diffuse myocardial edema and subendocardial late gadolinium enhancement. Skin biopsy of purpura showed superfi cial perivascular dermatitis with remarkable eosinophilic infiltrations. No evidence of drug allergies, parasitic infection, or myeloproliferative disorder was detected. Based on these findings, a diagnosis of eosinophilic myocarditis due to Churg-Strauss syndrome was considered. She was administered prednisolone at a dose of 1 mg/kg, cyclophosphamide, and diuretics. Several markers of eosinophilic myocarditis and heart failure gradually improved, including ECP. She was discharged 30 days later with no cardiac event. Eosinophilic myocarditis is characterized by predominantly eosinophilic infi ltration. Eosinophilic granule proteins, such as ECP and major basic protein, play important roles in the pathogenesis of eosinophilic myocarditis. We experienced a rare case of eosinophilic myocarditis due to Churg-Strauss syndrome. Markedly elevated ECP played an important role in the early diagnosis and subsequent reduction in ECP served as a marker of monitoring. In an asthmatic patient with dyspnea, hypereosinophilia, and vasculitis, Churg-Strauss syndrome with eosinophilic myocarditis should be considered.

Th2 Regulation of Viral Myocarditis in Mice: Different Roles for TLR3 versus TRIF in Progression to Chronic Disease

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Eric D. Abston

2012-01-01

Full Text Available Viral infections are able to induce autoimmune inflammation in the heart. Here, we investigated the role of virus-activated Toll-like receptor (TLR3 and its adaptor TRIF on the development of autoimmune coxsackievirus B3 (CVB3 myocarditis in mice. Although TLR3- or TRIF-deficient mice developed similarly worse acute CVB3 myocarditis and viral replication compared to control mice, disease was significantly worse in TRIF compared to TLR3-deficient mice. Interestingly, TLR3-deficient mice developed an interleukin (IL-4-dominant T helper (Th2 response during acute CVB3 myocarditis with elevated markers of alternative activation, while TRIF-deficient mice elevated the Th2-associated cytokine IL-33. Treatment of TLR3-deficient mice with recombinant IL-33 improved heart function indicating that elevated IL-33 in the context of a classic Th2-driven response protects against autoimmune heart disease. We show for the first time that TLR3 versus TRIF deficiency results in different Th2 responses that uniquely influence the progression to chronic myocarditis.

Seroprevalence of Bartonella species, Coxiella burnetii and Toxoplasma gondii among patients with hematological malignancies: A pilot study in Romania.

Science.gov (United States)

Messinger, C J; Gurzau, E S; Breitschwerdt, E B; Tomuleasa, C I; Trufan, S J; Flonta, M M; Maggi, R G; Berindan-Neagoe, I; Rabinowitz, P M

2017-09-01

Patients receiving immunosuppressive cancer treatments in settings where there is a high degree of human-animal interaction may be at increased risk for opportunistic zoonotic infections or reactivation of latent infections. We sought to determine the seroprevalence of selected zoonotic pathogens among patients diagnosed with haematologic malignancies and undergoing chemotherapeutic treatments in Romania, where much of the general population lives and/or works in contact with livestock. A convenience sample of 51 patients with haematologic cancer undergoing chemotherapy at a referral clinic in Cluj-Napoca, Romania, was surveyed regarding animal exposures. Blood samples were obtained and tested for evidence of infection with Bartonella species, Coxiella burnetii and Toxoplasma gondii, which are important opportunistic zoonotic agents in immunocompromised individuals. 58.8% of participants reported living or working on a farm, and living or working on a farm was associated with contact with livestock and other animals. 37.5% of participants were IgG seroreactive against one or more of five Bartonella antigens, and seroreactivity was statistically associated with living on farms. Farm dwellers were 3.6 times more likely to test IgG seroreactive to Bartonella antibodies than non-farm dwellers. 47.1% of the participants tested T. gondii IgG positive and 13.7% tested C. burnetii IgG positive, indicating past or latent infection. C. burnetii IgM antibodies were detected in four participants (7.8%), indicating possible recent infection. These results indicate that a large proportion of patients with haematologic cancer in Romania may be at risk for zoonotic infections or for reactivation of latent zoonotic infections, particularly with respect to Bartonella species. Special attention should be paid to cancer patients' exposure to livestock and companion animals in areas where much of the population lives in rural settings. © 2017 Blackwell Verlag GmbH.

Neorickettsia risticii, Rickettsia sp. and Bartonella sp. in Tadarida brasiliensis bats from Buenos Aires, Argentina.

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Cicuttin, Gabriel L; De Salvo, María N; La Rosa, Isabel; Dohmen, Federico E Gury

2017-06-01

Bats are potential reservoirs of many vector-borne bacterial pathogens. The aim of the present study was to detect species of Anaplasma, Ehrlichia, Neorickettsia, Rickettsia, Borrelia and Bartonella in Brazilian free-tailed bats (Tadarida brasiliensis, Molossidae) from Buenos Aires city, Argentina. Between 2012 and 2013, 61 T. brasiliensis from urban areas of Buenos Aires city were studied. The samples were molecularly screened by PCR and sequencing. Five bats (8.2%) were positive to Neorickettsia risticii, one (1.6%) was positive to Rickettsia sp. and three bats (4.9%) to Bartonella sp. For molecular characterization, the positive samples were subjected to amplification and sequencing of a fragment of p51 gene for N. risticii, a fragment of citrate synthase gene (gltA) for Rickettsia genus and a fragment of gltA for Bartonella genus. Phylogenetic tree was constructed using the maximum-likelihood method. Phylogenetic analysis of N. risticii detect in our study revealed that it relates to findings in the USA West Coast; Rickettsia sp. detected is phylogenetically within R. bellii group, which also includes many other Rickettsia endosymbionts of insects; and Bartonella sp. found is related to various Bartonella spp. described in Vespertilionidae bats, which are phylogenetically related to Molossidae. Our results are in accordance to previous findings, which demonstrate that insectivorous bats could be infected with vector-borne bacteria representing a potential risk to public health. Future research is necessary to clarify the circulation of these pathogens in bats from Buenos Aires. Copyright © 2017 Elsevier Ltd. All rights reserved.

The role of extracorporeal life support in acute myocarditis: a bridge to recovery?

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Sanders, D Bradford; Sowell, Steven R; Willis, Brigham; Lane, John; Pierce, Christopher; Pophal, Stephen; Arabia, Francisco A; Nigro, John J

2012-12-01

Acute myocardial failure associated with myocarditis is highly lethal. Left ventricular assist device support for these patients has been advocated to decompress the left ventricle and facilitate myocardial remodeling and recovery. Concerns exist regarding the ability of venoarterial (VA) extracorporeal life support (ECLS) to decompress the left ventricle and allow effective myocardial recovery. ECLS has several advantages, including availability, rapid deployment, and flexibility, as compared with contemporary ventricular assist devices. The objective of this study was to provide a brief review of acute myocarditis and present our series of patients. After Institutional Review Board approval, we conducted a retrospective data analysis of patients on ECLS experiencing rapidly progressive myocardial failure from a normal baseline. Patients with a history of intrinsic heart disease were excluded. All patients were thought to have myocarditis and had failed medical therapy requiring emergent ECLS support. Five patients demographics are detailed in Table 1. Patients experienced life-threatening intractable dysrhythmias or cardiac arrest and were refractory to medical therapy with severe acidosis and impending multisystem organ failure. All patients were stabilized with VA ECLS, and the left ventricle and atrium were decompressed in four of five patients. A left atrial vent was placed in one patient. Myocardial recovery with successful weaning from ECLS was obtained in four of five patients and to a normal ejection fraction in three of the five. One patient failed ECLS weaning and required biventricular VAD support secondary to severe myocardial necrosis from giant cell myocarditis and was transplanted, one died, all others are alive at follow-up. ECLS is safe and effective to treat acute myocardial failure and may be used to obtain myocardial recovery in certain subsets. We devised a decision algorithm for ECLS deployment in this patient cohort and routinely use ECLS.

Detection of serum antibodies against Bartonella species in cats with sporotrichosis from Rio de Janeiro, Brazil.

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Kitada, Amanda A B; Favacho, Alexsandra R M; Oliveira, Raquel V C; Pessoa, Adonai A; Gomes, Raphael; Honse, Carla O; Gremião, Isabella D F; Lemos, Elba R S; Pereira, Sandro A

2014-04-01

Cat scratch disease is a zoonosis caused by Bartonella species, transmitted to humans through scratches or bites from infected cats and via direct contact with infected feces. Sporotrichosis, caused by the fungal complex Sporothrix, is transmitted by traumatic inoculation of the fungus. Cats are important in zoonotic transmission. Serum samples from 112 domestic cats with sporotrichosis and 77 samples from healthy cats were analyzed by indirect immunofluorescence assay (IFA), using the commercial kit Bartonella henselae IFA IgG (Bion). The presence of antibodies against feline leukemia virus (FeLV) and of feline immunodeficiency virus (FIV) core antigens was detected using the commercial kit Snap Combo FIV-FeLV (Idexx). The group of animals with sporotrichosis contained 93 males with a median age of 22 months, eight (7.1%) of which were positive for FIV and 15 (13.4%) for FeLV. The group of animals without sporotrichosis contained 36 males with a median age 48 months, 10 (13.0%) of which were positive for FIV and eight (10.4%) for FeLV. Of the 112 cats with sporotrichosis and 77 cats without mycosis, 72 (64.3%) and 35 (45.5%), respectively, were IFA reactive. No association was found between age, sex, FIV/FeLV and the presence of antibodies to Bartonella species. The results suggest that the study population can be considered a potential source of zoonotic infection for both diseases.

Bartonella, a Common Cause of Endocarditis: a Report on 106 Cases and Review

Science.gov (United States)

Edouard, Sophie; Nabet, Cecile; Lepidi, Hubert; Fournier, Pierre-Edouard

2014-01-01

Bartonella spp. are fastidious bacteria that cause blood culture-negative endocarditis and have been increasingly reported. In this study, we included all patients retrospectively and prospectively diagnosed with Bartonella endocarditis in our French reference center between 2005 and 2013. Our diagnosis was based on the modified Duke criteria and microbiological findings, including serological and PCR results. To review the published literature, we searched all human Bartonella endocarditis cases published in the PubMed database between January 2005 and October 2013. We report here a large series of 106 cases, which include 59 cases that had not previously been reported or mentioned. Indirect immunofluorescence assays, Western blotting, and real-time PCR from total blood, serum, and valve tissue exhibited sensitivities of 58%, 100%, 33%, 36%, and 91%, respectively. The number of cases reported in the literature between 2005 and 2013 increased to reach a cumulative number of 196 cases. The number of cases reported in the literature by other centers is increasing more rapidly than that reported by our French reference center (P endocarditis. We suggest that a positive PCR result from a cardiac valve or blood specimen, an IgG titer of ≥800 using an immunofluorescence assay, or a positive Western blot assay be considered major Duke criteria for Bartonella endocarditis. There is no real increase in the incidence of these infections but rather a better understanding and interest in the disease resulting from the improvement of diagnostic tools. PMID:25540398

Investigation of Rickettsia, Coxiella burnetii and Bartonella in ticks from animals in South Africa.

Science.gov (United States)

Halajian, Ali; Palomar, Ana M; Portillo, Aránzazu; Heyne, Heloise; Luus-Powell, Wilmien J; Oteo, José A

2016-03-01

Ticks are involved in the epidemiology of several human pathogens including spotted fever group (SFG) Rickettsia spp., Coxiella burnetii and Bartonella spp. Human diseases caused by these microorganisms have been reported from South Africa. The presence of SFG Rickettsia spp., C. burnetii and Bartonella spp. was investigated in 205 ticks collected from domestic and wild animals from Western Cape and Limpopo provinces (South Africa). Rickettsia massiliae was detected in 10 Amblyomma sylvaticum and 1 Rhipicephalus simus whereas Rickettsia africae was amplified in 7 Amblyomma hebraeum. Neither C. burnetii nor Bartonella spp. was found in the examined ticks. This study demonstrates the presence of the tick borne pathogen R. massiliae in South Africa (Western Cape and Limpopo provinces), and corroborates the presence of the African tick-bite fever agent (R. africae) in this country (Limpopo province). Copyright © 2015 Elsevier GmbH. All rights reserved.

Non-fatal self-poisoning in Sri Lanka: associated triggers and motivations.

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Rajapakse, Thilini; Griffiths, Kathleen Margaret; Christensen, Helen; Cotton, Sue

2015-11-24

Attempted or non-fatal self-poisoning is common in Sri Lanka. To date, most preventive strategies have focused on limitation of access to toxic pesticides, which has reduced the rates of fatal self-poisoning. However the ongoing phenomenon of non-fatal self-poisoning indicates the need for exploration of alternate preventive strategies. Self-poisoning in Sri Lanka has been described as impulsive, with little premeditation, but the motivations associated with this act have not been studied in depth. This research describes the triggers and motivations associated with non-fatal self-poisoning in Sri Lanka. It is anticipated that the findings would help guide future preventive strategies. Two studies were carried out, at Teaching Hospital Peradeniya, Sri Lanka, each using a different methodology - Study 1 consisted of qualitative semi-structured interviews, and Study 2 was a cross sectional survey. Both studies were conducted among those who had recently attempted self-poisoning, and explored associated triggers and motivations associated with the act of self-poisoning. There was no overlap between participants of the two studies. A total of 24 persons participated in the semi-structured interviews (Study 1), and 921 took part in the cross-sectional survey (Study 2). Interpersonal conflict was the most common trigger prior to the act of non-fatal self-poisoning. A mixture of motivations was associated with the act of self-poisoning, including intent to die, to escape, and difficulty tolerating distress associated with interpersonal conflict. Development of interpersonal skills and interpersonal problem solving skills, particularly in adolescents and young people, emerges as a key primary preventive strategy. Further, there is value in exploring and helping people to develop more adaptive strategies to cope with emotional distress associated with interpersonal conflict. While distress tolerance and interpersonal skill training strategies used in the West may be

Fatal acute pulmonary injury associated with everolimus.

Science.gov (United States)

Depuydt, Pieter; Nollet, Joke; Benoit, Dominique; Praet, Marleen; Caes, Frank

2012-03-01

To report a case of fatal alveolar hemorrhage associated with the use of everolimus in a patient who underwent a solid organ transplant. In a 71-year-old cardiac transplant patient, cyclosporine was replaced with everolimus because of worsening renal function. Over the following weeks, the patient developed nonproductive cough and increasing dyspnea. His condition deteriorated to acute respiratory failure with hemoptysis, requiring hospital admission. Bilateral patchy alveolar infiltrates were apparent on chest X-ray and computed tomography. Cardiac failure was ruled out and empiric antimicrobial therapy was initiated. Additional extensive workup could not document opportunistic infection. Everolimus was discontinued and high-dose corticosteroid therapy was initiated. Despite this, the patient required invasive mechanical ventilation and died because of refractory massive hemoptysis. Autopsy revealed diffuse alveolar hemorrhage. Everolimus is a mammalian target of rapamycin inhibitor approved for use as an immunosuppressant and antineoplastic agent. Its main advantage over calcineurin inhibitors (tacrolimus and cyclosporine) is a distinct safety profile. Although it has become clear that everolimus induces pulmonary toxicity more frequently than initially thought, most published cases thus far represented mild and reversible disease, and none was fatal. Here, we report a case of pulmonary toxicity developing over weeks following the introduction of everolimus, in which a fatal outcome could not be prevented by drug withdrawal and corticosteroid treatment. The association of everolimus and this syndrome was probable according to the Naranjo probability scale. This case indicates that with the increasing use of everolimus, clinicians should be aware of the rare, but life-threatening manifestation of pulmonary toxicity.

A Case Report of Salmonella muenchen Enteritis Causing Rhabdomyolysis and Myocarditis in a Previously Healthy 26-Year-Old Man.

Science.gov (United States)

Chapple, Will; Martell, Jon; Wilson, Joy S; Matsuura, Don T

2017-04-01

This case report examines an unusual presentation of a non-typhoidal Salmonella serovar with limited prevalence in the literature. This is the first case report to associate specifically the Salmonella muenchen serovar with rhabdomyolysis and myocarditis. This case report reviews the diagnostic criteria for myocarditis and explores the diagnostic dilemma of troponin elevation in the setting of rhabdomyolysis. It demonstrates that Salmonella muenchen has the ability to present in a broad range of individuals with complications extending beyond classical gastrointestinal symptoms. This report also concludes that diagnosis of the many possible complications from non-typhoidal Salmonella infections can be difficult due to patient comorbidities, variability in the severity of the illnesses, laboratory test limitations, and imaging limitations. When a patient presents with elevated troponins in the setting of rhabdomyolysis a careful workup should be done to evaluate for ischemic causes, myocarditis, or false elevation secondary to rhabdomyolysis.

EXPERIENCE IN THE OBSERVATION OF ACUTE AND FULMINANT MYOCARDITIS IN CHILDREN

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L. V. Bregel

2017-01-01

Full Text Available The results of observation of 17 patients aged 2 monthsto 16 years with acute and fulminant myocarditis(FM were analyzed. Patients were observed in the period 2013-2016. Diagnostics used clinical data, laboratory and instrumental studies. Of 17 patients, acute myocarditis was diagnosed in 14 children, fulminant in 3. Therapy included, first of all, measures for the treatment of heart failure – diuretics (furosemide, verospiron, triampur, angiotensin converting enzyme (ACE inhibitors (captopril, beta-blockers, digoxin inotropic agents. Intravenous human immunoglobulin was administered at a dose of 1-2 g/kg/course in 5 of 17 (29.4% patients. When the pathogen was verified, specific antiviral therapy (acyclovir, ganciclovir, cymevene was administered in a standard mode. Immunosuppressive therapy (prednisolone, delagil was prescribed for two of them. Nonsteroidal anti-inflammatory drugs (ibuprofen, diclofenac was obtained in children with acute myocarditis duration of over 2 weeks (13 children prior to 2016. Nonsteroidal antiinflammatory drugs were not administered to hemodynamically unstable patients, regardless of the time period of observation. Overall, 16 out of 17 (94.4% patients recovered with apparent regression of signs of myocarditis on the background of treatment – the symptoms of acute heart failure and cardiogenic shock were treated, and then manifestations of chronic congestive heart failure gradually decreased. 1 (5,6% child with fulminant myocarditis died. After 6 months to 3 years, 14 children were observed. Follow-up within 6 months to 3 years showed that the diameter of the left ventricle normalized in 10 out of 14 (71.4%. Two out of 14 children (14.3% formed postmyocardial dilated cardiomyopathy.

Strategy for identification & characterization of Bartonella henselae with conventional & molecular methods

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Kavita Diddi

2013-01-01

Full Text Available Background & objectives: Bartonella henselae is a fastidious gram-negative bacterium usually causing self limiting infections in immunocompetent individuals but often causes potentially life threatening infection, such as bacillary angiomatosis in immunocompromised patients. Both diagnosis of infections and research into molecular mechanisms of pathogenesis have been hindered by lack of appropriate and reliable diagnostic techniques. We undertook this study to standardize methods to characterize B. henselae in clinical samples to diagnose Bartonella infection correctly. Methods: B. henselae ATCC 49882 strain was procured from American type culture collection, USA. This strain was revived and maintained in the laboratory, and identification and characterization of this strain was done by conventional and molecular techniques, which included culture on various media, staining by different methods including electron microscopy, biochemical analysis by conventional methods and API, polymerase chain reaction (PCR for amplification of citrate synthase gene followed by restriction fragment length polymorphism (RFLP. Results: This organism was biochemically inert due to slow growth and generated unique identification code with API. The amplification of the citrate-synthase gene with primers yielded a 381 bp product followed by specific RFLP profile for B. henselae. Interpretation & conclusions: Bartonella is fastidious and fragile organism and should be handled carefully. Extra effort and careful observation are required to isolate and characterize this organism.

Cardiac Function Remains Impaired Despite Reversible Cardiac Remodeling after Acute Experimental Viral Myocarditis

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Peter Moritz Becher

2017-01-01

Full Text Available Background. Infection with Coxsackievirus B3 induces myocarditis. We aimed to compare the acute and chronic phases of viral myocarditis to identify the immediate effects of cardiac inflammation as well as the long-term effects after resolved inflammation on cardiac fibrosis and consequently on cardiac function. Material and Methods. We infected C57BL/6J mice with Coxsackievirus B3 and determined the hemodynamic function 7 as well as 28 days after infection. Subsequently, we analyzed viral burden and viral replication in the cardiac tissue as well as the expression of cytokines and matrix proteins. Furthermore, cardiac fibroblasts were infected with virus to investigate if viral infection alone induces profibrotic signaling. Results. Severe cardiac inflammation was determined and cardiac fibrosis was consistently colocalized with inflammation during the acute phase of myocarditis. Declined cardiac inflammation but no significantly improved hemodynamic function was observed 28 days after infection. Interestingly, cardiac fibrosis declined to basal levels as well. Both cardiac inflammation and fibrosis were reversible, whereas the hemodynamic function remains impaired after healed viral myocarditis in C57BL/6J mice.

Obesity is associated with fatal coronary heart disease independently of traditional risk factors and deprivation.

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Logue, Jennifer; Murray, Heather M; Welsh, Paul; Shepherd, James; Packard, Chris; Macfarlane, Peter; Cobbe, Stuart; Ford, Ian; Sattar, Naveed

2011-04-01

The effect of body mass index (BMI) on coronary heart disease (CHD) risk is attenuated when mediators of this risk (such as diabetes, hypertension and hyperlipidaemia) are accounted for. However, there is now evidence of a differential effect of risk factors on fatal and non-fatal CHD events, with markers of inflammation more strongly associated with fatal than non-fatal events. To describe the association with BMI separately for both fatal and non-fatal CHD risk after accounting for classical risk factors and to assess any independent effects of obesity on CHD risk. In the West of Scotland Coronary Prevention Study BMI in 6082 men (mean age 55 years) with hypercholesterolaemia, but no history of diabetes or CVD, was related to the risk of fatal and non-fatal CHD events. After excluding participants with any event in the first 2 years, 1027 non-fatal and 214 fatal CHD events occurred during 14.7 years of follow-up. A minimally adjusted model (age, sex, statin treatment) and a maximally adjusted model (including known CVD risk factors and deprivation) were compared, with BMI 25-27.4 kg/m² as referent. The risk of non-fatal events was similar across all BMI categories in both models. The risk of fatal CHD events was increased in men with BMI 30.0-39.9 kg/m² in both the minimally adjusted model (HR = 1.75 (95% CI 1.12 to 2.74)) and the maximally adjusted model (HR = 1.60 (95% CI 1.02 to 2.53)). These hypothesis generating data suggest that obesity is associated with fatal, but not non-fatal, CHD after accounting for known cardiovascular risk factors and deprivation. Clinical trial registration WOSCOPS was carried out and completed before the requirement for clinical trial registration.

MRI for myocarditis; MRT bei Myokarditis

Energy Technology Data Exchange (ETDEWEB)

Gutberlet, M.; Luecke, C.; Krieghoff, C.; Hildebrand, L.; Steiner, J.; Adam, J.; Grotthoff, M.; Lehmkuhl, L. [Herzzentrum, Universitaet Leipzig, Abteilung fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany); Lurz, P.; Eitel, I.; Thiele, H. [Herzzentrum, Universitaet Leipzig, Abteilung Kardiologie, Leipzig (Germany)

2013-01-15

Cardiovascular magnetic resonance imaging (CMRI) has become the primary tool for the non-invasive assessment in patients with suspected myocarditis, especially after exclusion of acute coronary syndrome (ACS) for the differential diagnosis. Various MRI parameters are available which have different accuracies. Volumetric and functional ventricular assessment and the occurrence of pericardial effusion alone demonstrate only a poor sensitivity and specificity. The calculation of the T2-ratio (edema assessment), the early or global relative myocardial enhancement (gRE) and the late gadolinium enhancement (LGE), which represents irreversibly injured myocardium, are more specific parameters. All MRI parameters demonstrate the best accuracy in infarct-like acute myocarditis, whereas in chronic myocarditis sensitivity and specificity are less accurate. Therefore, a multisequential (at least two out of three parameters are positive) approach is recommended. The assessment of the value of newer, more quantitative MRI sequences, such as T1 and T2-mapping is still under investigation. (orig.) [German] Die kardiale MRT stellt die primaere nichtinvasive bildgebende Modalitaet bei Verdacht auf Myokarditis dar, insbesondere auch nach Ausschluss eines akuten Koronarsyndroms (ACS) zur Differenzialdiagnose. Verschiedene MR-Parameter mit unterschiedlicher Wertigkeit stehen zur Verfuegung. Die Beurteilung der Volumetrie und Ventrikelfunktion weisen ebenso wie der Nachweis eines Perikardergusses alleine nur eine geringe Sensitivitaet und Spezifitaet auf. Die spezifischeren MRT-Inflammationsparameter stellen die T2-Ratio (Oedemnachweis), die fruehe Kontrastmittelanreicherung bzw. das globale relative Enhancement (gRE) und die spaete Kontrastmittelanreicherung, das so genannte Late-Gadolinium-Enhancement (LGE) als Zeichen eines irreversiblen Myokardschadens dar. Alle MR-Parameter zeigen die beste diagnostische Genauigkeit bei einer ''infarktaehnlichen'' akuten

Diagnosis of Acute Global Myocarditis Using Cardiac MRI with Quantitative T1 and T2 Mapping: Case Report and Literature Review

Energy Technology Data Exchange (ETDEWEB)

Park, Chul Hwan [Department of Radiology and Research Institute of Radiological Science, Yonsei University Health System, Seoul 135-720 (Korea, Republic of); Choi, Eui-Young [Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720 (Korea, Republic of); Greiser, Andreas [Healthcare Sector, Siemens AG, Erlangen D-91052 (Germany); Paek, Mun Young [Siemens Ltd., Seoul 120-837 (Korea, Republic of); Hwang, Sung Ho; Kim, Tae Hoon [Department of Radiology and Research Institute of Radiological Science, Yonsei University Health System, Seoul 135-720 (Korea, Republic of)

2013-07-01

The diagnosis of myocarditis can be challenging given that symptoms, clinical exam findings, electrocardiogram results, biomarkers, and echocardiogram results are often non-specific. Endocardial biopsy is an established method for diagnosing myocarditis, but carries the risk of complications and false negative results. Cardiac magnetic resonance imaging (MRI) has become the primary non-invasive imaging tool in patients with suspected myocarditis. Myocarditis can be diagnosed by using three tissue markers including edema, hyperemia/capillary leak, and necrosis/fibrosis. The interpretation of cardiac MR findings can be confusing, especially when the myocardium is diffusely involved. Using T1 and T2 maps, the diagnosis of myocarditis can be made even in cases of global myocarditis with the help of quantitative analysis. We herein describe a case of acute global myocarditis which was diagnosed by using quantitative T1 and T2 mapping.

High prevalence of Rickettsia typhi and Bartonella species in rats and fleas, Kisangani, Democratic Republic of the Congo

NARCIS (Netherlands)

Laudisoit, A.; Falay, D.; Amundala, N.; de Bellock, J.G.; van Houtte, N.; Breno, M.; Verheven, E.; Wilschut, Liesbeth; Parola, P.; Raoult, D.; C., Socolovschi

2014-01-01

The prevalence and identity of Rickettsia and Bartonella in urban rat and flea populations were evaluated in Kisangani, Democratic Republic of the Congo (DRC) by molecular tools. An overall prevalence of 17% Bartonella species and 13% Rickettsia typhi, the agent of murine typhus, was found in the

Anaplasma phagocytophilum, Bartonella spp., haemoplasma species and Hepatozoon spp. in ticks infesting cats: a large-scale survey.

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Duplan, Florent; Davies, Saran; Filler, Serina; Abdullah, Swaid; Keyte, Sophie; Newbury, Hannah; Helps, Chris R; Wall, Richard; Tasker, Séverine

2018-03-20

Ticks derived from cats have rarely been evaluated for the presence of pathogens. The aim of this study was to determine the prevalence of Anaplasma phagocytophilum, Bartonella spp., haemoplasma species and Hepatozoon spp. in ticks collected from cats in the UK. Five hundred and forty DNA samples extracted from 540 ticks collected from cats presenting to veterinarians in UK practices were used. Samples underwent a conventional generic PCR assay for detection of Hepatozoon spp. and real-time quantitative PCR assays for detection of Anaplasma phagocytophilum and three feline haemoplasma species and a generic qPCR for detection of Bartonella spp. Feline 28S rDNA served as an endogenous internal PCR control and was assessed within the haemoplasma qPCR assays. Samples positive on the conventional and quantitative generic PCRs were submitted for DNA sequencing for species identification. Feline 28S rDNA was amplified from 475 of the 540 (88.0%) ticks. No evidence of PCR inhibition was found using an internal amplification control. Of 540 ticks, 19 (3.5%) contained DNA from one of the tick-borne pathogens evaluated. Pathogens detected were: A. phagocytophilum (n = 5; 0.9%), Bartonella spp. (n = 7; 1.3%) [including Bartonella henselae (n = 3; 0.6%) and Bartonella clarridgeiae (n = 1; 0.2%)], haemoplasma species (n = 5; 0.9%), "Candidatus Mycoplasma haemominutum" (n = 3; 0.6%), Mycoplasma haemofelis (n = 1; 0.2%), "Candidatus Mycoplasma turicensis" (n = 1; 0.2%), Hepatozoon spp. (n = 2; 0.4%), Hepatozoon felis (n = 1; 0.2%) and Hepatozoon silvestris (n = 1; 0.2%). These data provide important information on the prevalence of tick-borne pathogens in ticks infesting cats, with the identification of haemoplasma species, A. phagocytophilum, H. felis and Bartonella spp. (including B. henselae and B. clarridgeiae). This study also documents the first report of H. silvestris in ticks collected from domestic cats.

Adverse cardiac events in out-patients initiating clozapine treatment

DEFF Research Database (Denmark)

Rohde, C; Polcwiartek, C; Kragholm, K

2018-01-01

OBJECTIVE: Using national Danish registers, we estimated rates of clozapine-associated cardiac adverse events. Rates of undiagnosed myocarditis were estimated by exploring causes of death after clozapine initiation. METHOD: Through nationwide health registers, we identified all out-patients initi......OBJECTIVE: Using national Danish registers, we estimated rates of clozapine-associated cardiac adverse events. Rates of undiagnosed myocarditis were estimated by exploring causes of death after clozapine initiation. METHOD: Through nationwide health registers, we identified all out...... the maximum rate of clozapine-associated fatal myocarditis to 0.28%. CONCLUSION: Cardiac adverse effects in Danish out-patients initiating clozapine treatment are extremely rare and these rates appear to be comparable to those observed for other antipsychotic drugs....

Acute Toxic Myocarditis and Pulmonary Oedema Developing from Scorpion Sting

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Cem Sahin

2015-03-01

Full Text Available The majority of scorpion stings are generally seen with a set of simple clinical findings, such as pain, oedema, numbness, and tenderness in the area of the sting. However, occasionally events, such as toxic myocarditis, acute heart failure, acute pulmonary oedema, and Acute Respiratory Distress Syndrome (ARDS, which occur in scorpion sting cases are a significant problem which determine mortality and morbidity. The case presented here was a 38-year-old man who developed acute toxic myocarditis, acute heart failure, and acute pulmonary oedema following a scorpion sting on the 3rd finger of his right hand.

Cat fleas (Ctenocephalides felis) carrying Rickettsia felis and Bartonella species in Hong Kong.

Science.gov (United States)

Šlapeta, Jan; Lawrence, Andrea; Reichel, Michael P

2018-04-01

Fleas are commonly recorded on stray as well as domestic dogs and cats in Hong Kong. Fleas can be a major cause of pruritus in dogs and cats and also vectors of potentially zoonotic bacteria in the genera Rickettsia and Bartonella. Morphological examination of 174 fleas from dogs and cats living in Hong Kong revealed only cat fleas (Ctenocephalides felis). Cytochrome c oxidase subunit 1 gene (cox1) genotyping of 20 randomly selected specimens, revealed three cox1 haplotypes (HK-h1 to HK-h3). The most common haplotype was HK-h1 with 17 specimens (17/20, 85%). HK-h1 was identical to cox1 sequences of fleas in Thailand and Fiji. HK-h1 and HK-h2 form a distinct cat flea cox1 clade previously recognized as the Clade 3. HK-h3 forms a new Clade 6. A multiplex Bartonella and Rickettsia real-time PCR of DNA from 20 C. felis found Bartonella and Rickettsia DNA in three (15%) and ten (50%) C. felis, respectively. DNA sequencing confirmed the presence of R. felis, B. clarridgeiae and Bartonella henselae. This is the first reported study of that kind in Hong Kong, and further work is required to expand the survey of companion animals in the geographical region. The sampling of fleas on domestic cats and dogs in Hong Kong revealed them to be exclusively infested by the cat flea and to be harbouring pathogens of zoonotic potential. Copyright © 2017 Elsevier B.V. All rights reserved.

Bartonella melophagi in Melophagus ovinus (sheep ked) collected from sheep in northern Oromia, Ethiopia.

Science.gov (United States)

Kumsa, Bersissa; Parola, Philippe; Raoult, Didier; Socolovschi, Cristina

2014-01-01

Melophagus ovinus (sheep ked) is one of the most common ectoparasites that contributes to enormous economic losses in the productivity of sheep in many countries. The present study was conducted from January 2012 to July 2013 on M. ovinus collected from sheep at three sites in Ethiopia. Of the sheep studied, 65.7% (88/134) were infested with M. ovinus. The prevalence of M. ovinus was 76% (76/100), 47% (8/17) and 23.5% (4/17) at the Kimbibit, Chacha and Shano sites, respectively. An overall number of 229 M. ovinus specimens (138 females, 86 males and five pupae) and 554 M. ovinus specimens (272 females, 282 males) were collected from young and adult sheep, respectively. Bartonella DNA was detected in 89% (694/783) of M. ovinus using a quantitative Bartonella genus-specific PCR assay targeting the 16S/23S rRNA intergenic spacer region. The sequencing of the PCR products of fragments of the gltA and rpoB genes showed 99.6-100% and 100% homology, respectively, with B. melophagi. Statistically significant variation was not noted in the overall prevalence of Bartonella DNA between female and male M. ovinus. All of the sheep infested with M. ovinus 100% (88/88) harbored at least one M. ovinus specimen that contained Bartonella DNA. This study highlights that B. melophagi in M. ovinus from sheep in highlands in Ethiopia possibly has certain zoonotic importance. Copyright © 2013 Elsevier Ltd. All rights reserved.

Mononuclear cell secretome protects from experimental autoimmune myocarditis.

Science.gov (United States)

Hoetzenecker, Konrad; Zimmermann, Matthias; Hoetzenecker, Wolfram; Schweiger, Thomas; Kollmann, Dagmar; Mildner, Michael; Hegedus, Balazs; Mitterbauer, Andreas; Hacker, Stefan; Birner, Peter; Gabriel, Christian; Gyöngyösi, Mariann; Blyszczuk, Przemyslaw; Eriksson, Urs; Ankersmit, Hendrik Jan

2015-03-14

Supernatants of serum-free cultured mononuclear cells (MNC) contain a mix of immunomodulating factors (secretome), which have been shown to attenuate detrimental inflammatory responses following myocardial ischaemia. Inflammatory dilated cardiomyopathy (iDCM) is a common cause of heart failure in young patients. Experimental autoimmune myocarditis (EAM) is a CD4+ T cell-dependent model, which mirrors important pathogenic aspects of iDCM. The aim of this study was to determine the influence of MNC secretome on myocardial inflammation in the EAM model. BALB/c mice were immunized twice with an alpha myosin heavy chain peptide together with Complete Freund adjuvant. Supernatants from mouse mononuclear cells were collected, dialysed, and injected i.p. at Day 0, Day 7, or Day 14, respectively. Myocarditis severity, T cell responses, and autoantibody formation were assessed at Day 21. The impact of MNC secretome on CD4+ T cell function and viability was evaluated using in vitro proliferation and cell viability assays. A single high-dose application of MNC secretome, injected at Day 14 after the first immunization, effectively attenuated myocardial inflammation. Mechanistically, MNC secretome induced caspase-8-dependent apoptosis in autoreactive CD4+ T cells. MNC secretome abrogated myocardial inflammation in a CD4+ T cell-dependent animal model of autoimmune myocarditis. This anti-inflammatory effect of MNC secretome suggests a novel and simple potential treatment concept for inflammatory heart diseases. © The Author 2013. Published by Oxford University Press on behalf of the European Society of Cardiology.

Clinical and pathologic findings of myocarditis in two families with dilated cardiomyopathy

International Nuclear Information System (INIS)

O'Connell, J.B.; Fowles, R.E.; Robinson, J.A.; Subramanian, R.; Henkin, R.E.; Gunnar, R.M.

1984-01-01

The use of endomyocardial biopsy and gallium-67 scans in patients with dilated cardiomyopathy (DCM) has demonstrated the presence of myocardial inflammation in a subset of patients. A family with DCM was studied with endomyocardial biopsy and gallium-67 scanning; both identified the presence of myocarditis in the proband. Evaluation of histologic sections from deceased family members revealed myocarditis as the principal pathologic finding. This patient identified during life demonstrated a defect in suppressor lymphocytic function and improved with immunosuppressive therapy. A second family with DCM was discovered when postmortem examination of the proband and his father's heart showed myocarditis. A living sibling was identified with asymptomatic myocardial dysfunction. Longitudinal follow-up of surviving members of both families are in progress. This study indicates that thorough diagnostic evaluation of all patients with familial DCM should be pursued to identify subgroups with potentially treatable inflammation

Chronic lymphadenopathy caused by a Brazilian strain of Bartonella henselae.

Science.gov (United States)

Velho, Paulo Eduardo Neves Ferreira; Drummond, Marina Rovani; Adad, Marcio Antonio Haro; Cintra, Maria Letícia; Sowy, Stanley; Diniz, Pedro Paulo Vissotto de Paiva

2017-09-04

Bartonella henselae is a relevant causative agent of bartonelloses in humans. We described an immunocompetent patient with clinical manifestation of chronic cervical lymphadenopathy after a cat-scratch in her forearm. This case shows B. henselae infection persistence even after prolonged antibiotic treatment.

Myocarditis caused by Feline Immunodeficiency Virus in Five Cats with Hypertrophic Cardiomyopathy.

Science.gov (United States)

Rolim, V Machado; Casagrande, R Assis; Wouters, A Terezinha Barth; Driemeier, D; Pavarini, S Petinatti

2016-01-01

Viral infections have been implicated as the cause of cardiomyopathy in several mammalian species. This study describes hypertrophic cardiomyopathy (HCM) and myocarditis associated with feline immunodeficiency virus (FIV) infection in five cats aged between 1 and 4 years. Clinical manifestations included dyspnoea in four animals, one of which also exhibited restlessness. One animal showed only lethargy, anorexia and vomiting. Necropsy examination revealed marked cardiomegaly, marked left ventricular hypertrophy and pallor of the myocardium and epicardium in all animals. Microscopical and immunohistochemical examination showed multifocal infiltration of the myocardium with T lymphocytes and fewer macrophages, neutrophils and plasma cells. An intense immunoreaction for FIV antigen in the cytoplasm and nucleus of lymphocytes and the cytoplasm of some macrophages was observed via immunohistochemistry (IHC). IHC did not reveal the presence of antigen from feline calicivirus, coronavirus, feline leukaemia virus, feline parvovirus, Chlamydia spp. or Toxoplasma gondii. The results demonstrate the occurrence of FIV infection in inflammatory cells in the myocardium of five cats with myocarditis and HCM. Copyright © 2015 Elsevier Ltd. All rights reserved.

Fatal and nonfatal risk associated with recycle of D&D-generated concrete

Energy Technology Data Exchange (ETDEWEB)

Boren, J.K.; Ayers, K.W.; Parker, F.L. [Vanderbilt Univ., Nashville, TN (United States)

1997-02-01

As decontamination and decommissioning activities proceed within the U.S. Department of Energy Complex, vast volumes of uncontaminated and contaminated concrete will be generated. The current practice of decontaminating and landfilling the concrete is an expensive and potentially wasteful practice. Research is being conducted at Vanderbilt University to assess the economic, social, legal, and political ramifications of alternate methods of dealing with waste concrete. An important aspect of this research work is the assessment of risk associated with the various alternatives. A deterministic risk assessment model has been developed which quantifies radiological as well as non-radiological risks associated with concrete disposal and recycle activities. The risk model accounts for fatal as well as non-fatal risks to both workers and the public. Preliminary results indicate that recycling of concrete presents potentially lower risks than the current practice. Radiological considerations are shown to be of minor importance in comparison to other sources of risk, with conventional transportation fatalities and injuries dominating. Onsite activities can also be a major contributor to non-fatal risk.

Factors associated with the severity of fatal accidents in construction workers.

Science.gov (United States)

Khodabandeh, Farideh; Kabir-Mokamelkhah, Elaheh; Kahani, Mahsa

2016-01-01

Background: Construction work (building houses, roads, workplaces, and repairing and maintaining infrastructures) is a dangerous land-based job. This includes many hazardous tasks and conditions such as working at the following conditions: Height, excavation, noise, dust, power tools and equipment. Construction work has been increased in developed and underdeveloped countries over the past few years. Occupational fatalities have increased with an increase in this type of work. Occupational fatalities refer to individuals who pass way while on the job or performing work related tasks. In the present study, to identify the factors, personal characteristics and work-related factors associated with fatal occupational mortality were assessed using data for Tehran, Iran, 2014-2016. Methods: We conducted a retrospective study, using 967 postmortem reports from fatal occupational injuries collected through postmortem investigations during 2014-2016. A sampling frame of 967 postmortem reports from fatal occupational injuries was used to draw a total sample of 714 fatal construction accidents for this cross-sectional study. Pearson χ2 test and Kruskal-Wallis tests were used for statistical analysis. Results: Based on the results of this study, male gender (n=714; 100%), age range of 30-39 years (n=183; 25.6%), secondary educational level (n=273; 38.2%), being married (317; 44.4%), causal employee (n=389; 54.5%), unskilled performance (389; 54.5%), no insurance coverage (472; 66.1%), and daytime duty work (287; 40.2%) were identified as risk factors for fatality in the event of construction fatal injury. A significant relationship was found between the type of injury and sociodemographic and work related variables. Conclusion: Workers' characteristics such as age, gender, experience, and educational background, and work related variables such as skill training, safety measurement, and close monitoring could be used to discriminate among different severity levels of

A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder

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Ronny Cohen

2015-01-01

Full Text Available We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB. An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine versus acute coronary syndrome. He was managed conservatively and transferred to another facility for endomyocardial biopsy confirming myocarditis. This case is an example of one of the most typical presentations of suspected drug-induced acute myocarditis and will hopefully prompt the reader to think of this underdiagnosed entity in the right clinical setting.

A CLINICAL CASE OF ACUTE ALLERGIC MYOCARDITIS SIMULATING MYOCARDIAL INFARCTION

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N. A. Shostak

2015-01-01

Full Text Available Objective: to describe a clinical case of evolving acute eosinophilic myocarditis simulating coronary heart disease. Subjects and methods. Patient B. aged 62 years was admitted to Intensive Care Unit Fifteen, N.I. Pirogov First Moscow City Clinical Hospital, by being transferred from Thailand with a referral diagnosis of acute myocardial infarction made on November 1, 2012, with complaints of pressing and aching heart pains. At a Phuket hospital, his electrocardiogram recorded atrial fibrillation; indirect cardiac massage, electric pulse therapy, and mechanical ventilation were performed. After being admitted to the N.I. Pirogov First Moscow City Clinical Hospital, the patient underwent examination: estimation of laboratory indicators over time, electrocardiography (ECG, echocardiography, Holter ECG monitoring, and myocardial scintigraphy. Results. The patient had a history of an allergic reaction as urticaria to the ingestion of fish products. His examination showed practically all diagnostic criteria for allergic myocarditis: hypereosinophilia (the admission level of eosinophils was 9% with their further normalization; the characteristic clinical presentation of myocarditis (pressing retrosternal pain; elevated levels of cardiac specific enzymes (creatinine phosphokinase-MB, lactate dehydrogenase, troponin T; ECG changes – myocardial hypokinesis in the acute period, followed by its pattern normalization. of the pattern. Myocardial scintigraphy (by taking into account the fact that the patient had had a new allergic reaction episode, the investigators decided not to perform coronary angiography revealed decreased radiopharmaceutical accumulation in the lower left ventricular wall in the right coronary arterial bed; perfusion remained in the other myocardial walls. Conclusion. This clinical case reflects the specific features of the course of and difficulties in the diagnosis of acute allergic myocarditis that, in most cases, has no specific

Cardiac Magnetic Resonance Imaging in Myocarditis Reveals Persistent Disease Activity Despite Normalization of Cardiac Enzymes and Inflammatory Parameters at 3-Month Follow-Up.

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Berg, Jan; Kottwitz, Jan; Baltensperger, Nora; Kissel, Christine K; Lovrinovic, Marina; Mehra, Tarun; Scherff, Frank; Schmied, Christian; Templin, Christian; Lüscher, Thomas F; Heidecker, Bettina; Manka, Robert

2017-11-01

There is a major unmet need to identify high-risk patients in myocarditis. Although decreasing cardiac and inflammatory markers are commonly interpreted as resolving myocarditis, this assumption has not been confirmed as of today. We sought to evaluate whether routine laboratory parameters at diagnosis predict dynamic of late gadolinium enhancement (LGE) as persistent LGE has been shown to be a risk marker in myocarditis. Myocarditis was diagnosed based on clinical presentation, high-sensitivity troponin T, and cardiac magnetic resonance imaging, after exclusion of obstructive coronary artery disease by angiography. Cardiac magnetic resonance imaging was repeated at 3 months. LGE extent was analyzed with the software GT Volume. Change in LGE >20% was considered significant. Investigated cardiac and inflammatory markers included high-sensitivity troponin T, creatine kinase, myoglobin, N-terminal B-type natriuretic peptide, C-reactive protein, and leukocyte count. Twenty-four patients were enrolled. Absolute levels of cardiac enzymes and inflammatory markers at baseline did not predict change in LGE at 3 months. Cardiac and inflammatory markers had normalized in 21 patients (88%). LGE significantly improved in 16 patients (67%); however, it persisted to a lesser degree in 17 of them (71%) and increased in a small percentage (21%) despite normalization of cardiac enzymes. This is the first study reporting that cardiac enzymes and inflammatory parameters do not sufficiently reflect LGE in myocarditis. Although a majority of patients with normalizing laboratory markers experienced improved LGE, in a small percentage LGE worsened. These data suggest that cardiac magnetic resonance imaging might add value to currently existing diagnostic tools for risk assessment in myocarditis. © 2017 American Heart Association, Inc.

Churg-Strauss syndrome presenting with eosinophilic myocarditis: a diagnostic challenge.

Science.gov (United States)

Correia, Ana Sofia; Gonçalves, Alexandra; Araújo, Vítor; Almeida e Silva, João; Pereira, José Manuel; Rodrigues Pereira, Pedro; Pizarro, Manuel; Silva, João Carlos; Maciel, Maria Júlia

2013-09-01

Churg-Strauss syndrome (CSS) is an unusual disease that presents as systemic vasculitis and peripheral eosinophilia in patients with an atopic constitution. Cardiac involvement is unusual and often not prominent on initial presentation, but is an important cause of morbidity and mortality in patients with CSS. We report the case of a young woman with severe acute myocarditis. Coronary arteriography demonstrated extensive focal vasculopathy, consistent with coronary vasculitis, and myocardial biopsy showed eosinophilic myocarditis. This presentation led to an initial diagnosis of CSS in this patient and appropriate therapy resulted in a spectacular remission of disease activity. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

sup(99m)Tc-pyrophosphate and /sup 201/Tl myocardial scintigrams in a patient with myocarditis

Energy Technology Data Exchange (ETDEWEB)

Kondo, M.; Nishimura, T.; Shimoto, Y.; Fuzioka, S.; Kobayashi, K. (Shimada City Hospital, Shizuoka (Japan))

1981-09-01

Myocardial necrosis in acute myocarditis was investigated by scintigraphy. sup(99m)Tc-pyrophosphate (PYP) and /sup 201/TI myocardial scintigrams were obtained on a patient with acute myocarditis due to mycoplasma infection. sup(99m)Tc-PYP myocardial scintigrams in the acute stage demonstrated grade 2+ findings, which remained until the chronic stage. /sup 201/TI myocardial scintigrams in the acute stage revealed impaired perfusion restricted to the posterolateral wall, and this decrease continued through the chronic stage. It was concluded that both of sup(99m)Tc-PYP and /sup 201/TI myocardial scintigrams can reveal abnormality of acute myocarditis.

The effect of experimental streptococcus infection in myocarditis on ...

African Journals Online (AJOL)

EB

faecalis induction of myocarditis and its effect on some blood parameters, inflammatory markers and .... LSD. 41. 5. 0.9. Similar characters denote insignificance between groups. *** denote .... detectable in serum, brain and intestine of rat pups.

Detection of eosinophilic myocarditis using contrast-enhanced magnetic resonance imaging: case report

International Nuclear Information System (INIS)

Takahashi, N.; Murakami, Y.; Shimada, T.; Kashima, Y.; Nakamura, K.; Inoue, S.-I.; Sugamori, T.; Katoh, H.; Ishibashi, Y.; Maruyama, R.

2001-01-01

Hypereosinophilic syndrome is characterized by idiopathic eosinophilia in the peripheral blood and multiorgan dysfunction secondary to mature eosinophil infiltration. It is essential to diagnose myocardial involvement in the early stage of the disease when active myocarditis due to cardiotoxic substances from eosinophils is still taking place, but clinical tools for the diagnosis of myocardial lesions in patients without overt cardiac dysfunction are not yet available. We present a case of successful detection of myocarditis due to hypereosinophilic syndrome by gadolinium-diethylenetriaminepentaascetic acid (Gd-DTPA) enhanced magnetic resonance imaging (MRI). (author)

Detection of eosinophilic myocarditis using contrast-enhanced magnetic resonance imaging: case report

Energy Technology Data Exchange (ETDEWEB)

Takahashi, N.; Murakami, Y.; Shimada, T.; Kashima, Y.; Nakamura, K.; Inoue, S.-I.; Sugamori, T.; Katoh, H.; Ishibashi, Y. [Shimane Medical Univ., The Fourth Dept. of Internal Medicine, Izumo City, Shimane (Japan); Maruyama, R. [Shimane Medical Univ., Dept. of Laboratory Medicine, Izumo City, Shimane (Japan)

2001-02-01

Hypereosinophilic syndrome is characterized by idiopathic eosinophilia in the peripheral blood and multiorgan dysfunction secondary to mature eosinophil infiltration. It is essential to diagnose myocardial involvement in the early stage of the disease when active myocarditis due to cardiotoxic substances from eosinophils is still taking place, but clinical tools for the diagnosis of myocardial lesions in patients without overt cardiac dysfunction are not yet available. We present a case of successful detection of myocarditis due to hypereosinophilic syndrome by gadolinium-diethylenetriaminepentaascetic acid (Gd-DTPA) enhanced magnetic resonance imaging (MRI). (author)

Factors associated with urban non-fatal road-accident severity.

Science.gov (United States)

Potoglou, Dimitris; Carlucci, Fabio; Cirà, Andrea; Restaino, Marialuisa

2018-02-05

This paper reports on the factors associated with non-fatal urban-road accident severity. Data on accidents were gathered from the local traffic police in the City of Palermo, one of the six most populated cities in Italy. Findings from a mixed-effects logistic-regression model suggest that accident severity increases when two young drivers are involved, road traffic conditions are light/normal and when vehicles crash on a two-way road or carriageway. Speeding is more likely to cause slight or serious injury even when compared to a vehicle moving towards the opposite direction of traffic. An accident during the summer is more likely to result in a slight or serious injury than an accident during the winter, which is in line with evidence from Southern Europe and the Middle East. Finally, the severity of non-fatal accident injuries in an urban area of Southern Europe was significantly associated with speeding, the age of the driver and seasonality.

Exposure to Rats and Rat-Associated Leptospira and Bartonella Species Among People Who Use Drugs in an Impoverished, Inner-City Neighborhood of Vancouver, Canada.

Science.gov (United States)

McVea, David A; Himsworth, Chelsea G; Patrick, David M; Lindsay, L Robbin; Kosoy, Michael; Kerr, Thomas

2018-02-01

Rat infestations are common, particularly in impoverished, inner-city neighborhoods. However, there has been little research into the nature and consequences of rat exposure in these neighborhoods, particularly in Canada. In this study, we sought to characterize exposure to rats and rat-associated Leptospira interrogans and Bartonella tribocorum, as well as risk factors associated with exposure, in residents (n = 202) of the Downtown Eastside (DTES) neighborhood of Vancouver, Canada. There was no evidence of exposure to rat-associated L. interrogans but 6/202 (3.0%) of participants were exposed to B. tribocorum, which is known to be circulating among DTES rats. We also found that frequent and close rat exposure was common among DTES residents, and that this exposure was particularly associated with injection drug use and outdoor income-generating activities (e.g., drug dealing). These risk factors may be good targets for interventions geared toward effectively reducing rat exposure.

Ebi3 Prevents Trypanosoma cruzi-Induced Myocarditis by Dampening IFN-γ-Driven Inflammation

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Tiago Silva Medina

2017-09-01

Full Text Available The identification of anti-inflammatory mediators can reveal important targetable molecules capable of counterbalancing Trypanosoma cruzi-induced myocarditis. Composed of Ebi3 and IL-27p28 subunits, IL-27 is produced by myeloid cells and is able to suppress inflammation by inducing IL-10-producing Tr1 cells, thus emerging as a potential candidate to ameliorate cardiac inflammation induced by T. cruzi. Although IL-27 has been extensively characterized as a suppressive cytokine that prevents liver immunopathogenesis after T. cruzi infection, the mechanisms underlying its effects on T. cruzi-induced myocarditis remain largely unknown. Here, wild-type (WT and Ebi3-deficient animals were intraperitoneally infected with trypomastigotes of T. cruzi Y strain and used to evaluate the potential anti-inflammatory properties of Ebi3 during T. cruzi infection. The survival rates of mice were daily recorded, the frequency of inflammatory cells was analyzed by flow cytometry and inflammatory mediators were measured by ELISA, real-time PCR and PCR array. We reported that T. cruzi-induced myocarditis was prevented by Ebi3. Stressors mainly recognized by TLR2 and TLR4 receptors on myeloid cells were essential to trigger IL-27p28 production. In addition, Ebi3 regulated IFN-γ-mediated myocarditis by promoting an anti-inflammatory environment through IL-10, which was most likely produced by Tr1 cells rather than classical regulatory T cells (Tregs, in the heart tissue of T. cruzi-infected animals. Furthermore, in vivo IFN-γ blockade ameliorated the host survival without compromising the parasite control in the bloodstream. In humans, IL-27p28 was correlated with cardiac protection during Chagas disease. Patients with mild clinical forms of the disease produced high levels of IL-27p28, whereas lower levels were found in those with severe forms. In addition, polymorphic sites at Ebi3 gene were associated with severe cardiomyopathy in patients with Chagas disease

Ebi3 Prevents Trypanosoma cruzi-Induced Myocarditis by Dampening IFN-γ-Driven Inflammation

Science.gov (United States)

Medina, Tiago Silva; Oliveira, Gabriela Gonçalves; Silva, Maria Cláudia; David, Bruna Araújo; Silva, Grace Kelly; Fonseca, Denise Morais; Sesti-Costa, Renata; Frade, Amanda Farage; Baron, Monique Andrade; Ianni, Barbara; Pereira, Alexandre Costa; Chevillard, Christophe; Cunha-Neto, Edécio; Marin-Neto, José Antonio; Silva, João Santana

2017-01-01

The identification of anti-inflammatory mediators can reveal important targetable molecules capable of counterbalancing Trypanosoma cruzi-induced myocarditis. Composed of Ebi3 and IL-27p28 subunits, IL-27 is produced by myeloid cells and is able to suppress inflammation by inducing IL-10-producing Tr1 cells, thus emerging as a potential candidate to ameliorate cardiac inflammation induced by T. cruzi. Although IL-27 has been extensively characterized as a suppressive cytokine that prevents liver immunopathogenesis after T. cruzi infection, the mechanisms underlying its effects on T. cruzi-induced myocarditis remain largely unknown. Here, wild-type (WT) and Ebi3-deficient animals were intraperitoneally infected with trypomastigotes of T. cruzi Y strain and used to evaluate the potential anti-inflammatory properties of Ebi3 during T. cruzi infection. The survival rates of mice were daily recorded, the frequency of inflammatory cells was analyzed by flow cytometry and inflammatory mediators were measured by ELISA, real-time PCR and PCR array. We reported that T. cruzi-induced myocarditis was prevented by Ebi3. Stressors mainly recognized by TLR2 and TLR4 receptors on myeloid cells were essential to trigger IL-27p28 production. In addition, Ebi3 regulated IFN-γ-mediated myocarditis by promoting an anti-inflammatory environment through IL-10, which was most likely produced by Tr1 cells rather than classical regulatory T cells (Tregs), in the heart tissue of T. cruzi-infected animals. Furthermore, in vivo IFN-γ blockade ameliorated the host survival without compromising the parasite control in the bloodstream. In humans, IL-27p28 was correlated with cardiac protection during Chagas disease. Patients with mild clinical forms of the disease produced high levels of IL-27p28, whereas lower levels were found in those with severe forms. In addition, polymorphic sites at Ebi3 gene were associated with severe cardiomyopathy in patients with Chagas disease. Collectively, we

Evaluación de la transmisión vertical de Bartonella bacilliformis en Lutzomyia verrucarum (Diptera: Psychodidae

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Carlos Ponce G

2002-04-01

Full Text Available Objetivos: Identificar la existencia de transmisión vertical de Bartonella bacilliformis en Lutzomyia verrucarum. Materiales y métodos: en este estudio experimental, se realizó la crianza individual y masiva (Tº 22°C±2ºC, humedad relativa: 80%±5% de Lutzomyia verrucarum en el Laboratorio de Entomología del Centro de Investigaciones del Hospital de Caraz (Ancash- Perú. Con la finalidad de lograr la infección de las hembras se procedió a alimentarlas con sangre infectada obtenida por éstas directamente al picar la piel de pacientes con bartonelosis aguda frotis positivo. Las hembras, luego de poner sus huevos, fueron evaluadas a través de la prueba de PCR para Bartonella baciliformis. Resultados: 13 de 18 (72,2% hembras alimentadas con sangre infectada con bacteremia al 3% lograron poner huevos y de éstas ninguna resultó ser positiva al PCR. 12 de 54 (22,2% hembras alimentadas con sangre infectada con bacteremia al 80% ovipusieron y de éstas sólo una (8,3% resultó ser positiva al PCR. Ninguno de los descendientes adultos de esta hembra resultó positivo al PCR. Conclusiones: el bajo porcentaje de infección por Bartonella baciliformis encontrado en hembras oviponedoras no permitió determinar la existencia de transmisión vertical de Bartonella bacilliformis en Lutzomyia verrucarum.

Eco-epidemiology of Novel Bartonella Genotypes from Parasitic Flies of Insectivorous Bats.

NARCIS (Netherlands)

Sándor, Attila D; Földvári, Mihály; Krawczyk, Aleksandra I; Sprong, Hein; Corduneanu, Alexandra; Barti, Levente; Görföl, Tamás; Estók, Péter; Kováts, Dávid; Szekeres, Sándor; László, Zoltán; Hornok, Sándor; Földvári, Gábor

2018-01-01

Bats are important zoonotic reservoirs for many pathogens worldwide. Although their highly specialized ectoparasites, bat flies (Diptera: Hippoboscoidea), can transmit Bartonella bacteria including human pathogens, their eco-epidemiology is unexplored. Here, we analyzed the prevalence and diversity

Isolation of Bartonella henselae from a serologically negative cat in Bloemfontein, South Africa

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A-M Pretorius

1999-07-01

Full Text Available Sera collected from apparently healthy 6-12-month-old cats (n = 31 presented to the Society for the Prevention of Cruelty to Animals Veterinary Clinic in Bloemfontein for neutering were tested for antibodies reactive to Bartonella henselae (Houston-1 strain by indirect fluorescent antibody testing. Whole blood collected from the cats was used in isolation experiments and subsequent identification of Bartonella species was based on comparison of the nucleotide base sequence of polymerase chain reaction-amplified citrate synthase gene fragments. While none of the cats had antibodies reactive with B. henselae at titres > 1/64, an organism with a partial citrate synthase gene sequence identical to that of B. henselae (Houston-1 was isolated from 1 cat.

In vivo T2* weighted MRI visualizes cardiac lesions in murine models of acute and chronic viral myocarditis.

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Xavier Helluy

Full Text Available Acute and chronic forms of myocarditis are mainly induced by virus infections. As a consequence of myocardial damage and inflammation dilated cardiomyopathy and chronic heart failure may develop. The gold standard for the diagnosis of myocarditis is endomyocardial biopsies which are required to determine the etiopathogenesis of cardiac inflammatory processes. However, new non-invasive MRI techniques hold great potential in visualizing cardiac non-ischemic inflammatory lesions at high spatial resolution, which could improve the investigation of the pathophysiology of viral myocarditis.Here we present the discovery of a novel endogenous T2* MRI contrast of myocardial lesions in murine models of acute and chronic CVB3 myocarditis. The evaluation of infected hearts ex vivo and in vivo by 3D T2w and T2*w MRI allowed direct localization of virus-induced myocardial lesions without any MRI tracer or contrast agent. T2*w weighted MRI is able to detect both small cardiac lesions of acute myocarditis and larger necrotic areas at later stages of chronic myocarditis, which was confirmed by spatial correlation of MRI hypointensity in myocardium with myocardial lesions histologically. Additional in vivo and ex vivo MRI analysis proved that the contrast mechanism was due to a strong paramagnetic tissue alteration in the vicinity of myocardial lesions, effectively pointing towards iron deposits as the primary contributor of contrast. The evaluation of the biological origin of the MR contrast by specific histological staining and transmission electron microscopy revealed that impaired iron metabolism primarily in mitochondria caused iron deposits within necrotic myocytes, which induces strong magnetic susceptibility in myocardial lesions and results in strong T2* contrast.This T2*w MRI technique provides a fast and sensitive diagnostic tool to determine the patterns and the severity of acute and chronic enteroviral myocarditis and the precise localization of

Anticipating Early Fatality: Friends', Schoolmates' and Individual Perceptions of Fatality on Adolescent Risk Behaviors

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Soller, Brian; Williams, Kristi

2015-01-01

Past research indicates that anticipating adverse outcomes, such as early death (fatalism), is associated positively with adolescents' likelihood of engaging in risky behaviors. Health researchers and criminologists have argued that fatalism influences present risk taking in part by informing individuals' motivation for delaying gratification for the promise of future benefits. While past findings highlight the association between the anticipation of early death and a number of developmental outcomes, no known research has assessed the impact of location in a context characterized by high perceptions of fatality. Using data from Add Health and a sample of 9,584 adolescents (51 % female and 71 % white) nested in 113 schools, our study builds upon prior research by examining the association between friends', school mates', and individual perceptions of early fatality and adolescent risk behaviors. We test whether friends' anticipation of being killed prior to age 21 or location in a school where a high proportion of the student body subscribes to attitudes of high fatality, is associated with risky behaviors. Results indicate that friends' fatalism is positively associated with engaging in violent delinquency, non-violent delinquency, and drug use after controlling for individual covariates and prior individual risk-taking. Although friends' delinquency accounts for much of the effect of friends' fatalism on violence, none of the potential intervening variables fully explain the effect of friends' fatalism on youth involvement in nonviolent delinquency and drug use. Our results underscore the importance of friendship contextual effects in shaping adolescent risk-taking behavior and the very serious consequences perceptions of fatality have for adolescents' involvement in delinquency and drug use. PMID:23828725

99mTc-Hynic-annexin V imaging to evaluate inflammation and apoptosis in rats with autoimmune myocarditis

International Nuclear Information System (INIS)

Tokita, Naoki; Izumi, Tohru; Hasegawa, Shinji; Maruyama, Kaoru; Blankenberg, Francis G.; Tait, Jonathan F.; Strauss, William H.; Nishimura, Tsunehiko

2003-01-01

Inflammation and cell death are two important components of myocarditis. We evaluated the distribution of inflammation and apoptotic cell death in rats with autoimmune myocarditis using two radiotracers - technetium-99m Hynic-annexin V ( 99m Tc-annexin) as a marker of apoptotic cell death and carbon-14 deoxyglucose ( 14 C-DG) as a marker of inflammation - in comparison with histologic findings. Three, 7 and 14 weeks after immunization with porcine cardiac myosin (acute, subacute, and chronic phases, respectively) 99m Tc-annexin and 14 C-DG were injected. The uptake in the total heart was determined as the percentage of injected dose per gram (% ID/g) by tissue counting. Dual-tracer autoradiography with 99m Tc-annexin and 14 C-DG was performed. The distribution of each of these agents was compared with the results of hematoxylin and eosin staining to identify areas of inflammation, and TUNEL staining to identify areas of apoptosis. Total cardiac uptake of 99m Tc-annexin in the acute phase of myocarditis was significantly higher than that in normal rats (1.28%±0.30% vs 0.46%±0.01%; P 14 C-DG in the acute phase of myocarditis was significantly higher than that in normal rats (2.78%±0.95% vs 1.02%±0.25%; P 14 C-DG uptake; some also corresponded to areas of high 99m Tc-annexin uptake in the acute phase of myocarditis. 99m Tc-annexin localization was strongly correlated with the number of TUNEL-positive cells (P 14 C-DG showed no relationship with it. There is a marked difference in the distribution of inflammation and apoptotic cell death in the myocardium of animals with immune myocarditis. These changes are mirrored by the localization of 14 C-DG and 99m Tc-annexin. Sites of inflammation and zones of apoptotic cell death change over the course of immune myocarditis. (orig.)

Juvenile Churg-Strauss Syndrome as an Etiology of Myocarditis and Ischemic Stroke in Adolescents; a Case Report

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Moradinejad, Mohammad-Hassan; Rezaei, Amir; Ziaee, Vahid

2011-01-01

Background Churg-Strauss syndrome (CSS), a systemic vasculitis accompanied by asthma and eosinophilia, almost invariably affects the lung and is frequently associated with cutaneous involvement. It rarely has cardiac involvement. We report an unusual case of CSS with myocardial involvement and stroke. Case Presentation A 16-year old female suffered of allergic asthma for 4 years. She was under treatment with oral prednisolone and seretide inhalation. After CSS diagnosis, she developed paroxysmal atrial tachycardia. Serum levels of Troponin I and Troponin T were increased indicating massive myocardial damage probably due to myocarditis. After 5 months she developed acute hemiparesis without any evidence of ischemic or hemorrhagic event. She was treated with IVIg, intravenous pulses of methylprednisone and cyclophosphamide for each complication. Conclusion Myocarditis and stroke may also complicate CSS which should be taken in consideration for better management. PMID:23056844

The presence of enterovirus, adenovirus, and parvovirus B19 in myocardial tissue samples from autopsies: an evaluation of their frequencies in deceased individuals with myocarditis and in non-inflamed control hearts.

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Nielsen, Trine Skov; Hansen, Jakob; Nielsen, Lars Peter; Baandrup, Ulrik Thorngren; Banner, Jytte

2014-09-01

Multiple viruses have been detected in cardiac tissue, but their role in causing myocarditis remains controversial. Viral diagnostics are increasingly used in forensic medicine, but the interpretation of the results can sometimes be challenging. In this study, we examined the prevalence of adenovirus, enterovirus, and parvovirus B19 (PVB) in myocardial autopsy samples from myocarditis related deaths and in non-inflamed control hearts in an effort to clarify their significance as the causes of myocarditis in a forensic material. We collected all autopsy cases diagnosed with myocarditis from 1992 to 2010. Eighty-four suicidal deaths with morphologically normal hearts served as controls. Polymerase chain reaction was used for the detection of the viral genomes (adenovirus, enterovirus, and PVB) in myocardial tissue specimens. The distinction between acute and persistent PVB infection was made by the serological determination of PVB-specific immunoglobulins M and G. PVB was detected in 33 of 112 (29 %) myocarditis cases and 37 of 84 (44 %) control cases. All of the samples were negative for the presence of adenovirus and enterovirus. Serological evidence of an acute PVB infection, determined by the presence of immunoglobulin M, was only present in one case. In the remaining cases, PVB was considered to be a bystander with no or limited association to myocardial inflammation. In this study, adenovirus, enterovirus, and PVB were found to be rare causes of myocarditis. The detection of PVB in myocardial autopsy samples most likely represents a persistent infection with no or limited association with myocardial inflammation. The forensic investigation of myocardial inflammation demands a thorough examination, including special attention to non-viral causes and requires a multidisciplinary approach.

Novel Combination of Impella and Extra Corporeal Membrane Oxygenation as a Bridge to Full Recovery in Fulminant Myocarditis

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Sachin Narain

2012-01-01

Full Text Available A 31-year-old male was transferred to our hospital with severe heart failure due to viral myocarditis. He progressed to multiorgan failure requiring intubation and maximal doses of multiple vasopressors. Circulatory support was provided with an Impella device as a bridge to an extracorporeal membrane oxygenation (ECMO system. On full mechanical cardiovascular support, the patient's hemodynamic status improved and ECMO and Impella were explanted after 48 hours. Three days later, he was extubated and continued on to a full recovery. There are no specific therapies for fulminant myocarditis but first-line treatment is supportive care. ECMO is commonly used in patients with severe heart failure. In severe systolic dysfunction, left ventricular decompression is required to reduce myocardial wall stress, decrease myocardial oxygen requirements, and enhance the chances of recovery. The Impella, an active support system, is less invasive than classical decompressive techniques and is associated with lower requirements for blood products with fewer thromboembolic complications. This is the only case reported of the contemporary use of Impella and ECMO as a bridge to full recovery in an adult with myocarditis. It also presents a novel use of the Impella device in decompressing the left ventricle of an adult patient on ECMO.

Fulminant myocarditis mimicking acute coronary syndrome = Miocarditis fulminante, simuladora de síndrome coronario agudo

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Senior, Juan Manuel

2014-07-01

Full Text Available Fulminant myocarditis mimicking acute coronary syndrome We report the case of a 48 year-old man with chest pain and history of coronary and autoimmune diseases, who developed acute heart failure and hemodynamic collapse. We present his clinical evolution and the tests that allowed the diagnosis of fulminant myocarditis secondary to systemic lupus erythematosus. A review of the most important aspects of this disease is also included.

Functional and morphological parameters with tissue characterization of cardiovascular magnetic imaging in clinically verified ''infarct-like myocarditis''

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Schwab, Johannes [Paracelsus Medical Univ., General Hospital Nuremberg (Germany). Dept. of Cardiology and Radiology; Rogg, H.J.; Pauschinger, M.; Fessele, K. [Paracelsus Medical Univ., General Hospital Nuremberg (Germany). Dept. of Cardiology; Bareiter, T.; Baer, I. [Paracelsus Medical Univ., General Hospital Nuremberg (Germany). Dept. of Cardiology and Neuroradiology; Loose, R. [Paracelsus Medical Univ., General Hospital Nuremberg (Germany). Dept. of Radiology

2016-04-15

Cardiac magnetic resonance (CMR) has increasingly proved to be a valuable diagnostic tool for evaluating patients with suspected myocarditis. The objective of this study was to evaluate the diagnostic value of functional and morphological parameters including tissue characterization in patients with ''infarct-like myocarditis''. 43 patients with clinically verified cases of ''infarct-like myocarditis'' (median time to MRI scanning after admission for acute symptoms 3 days) and 35 control patients matched by age and sex were included in this retrospective case control study. In this study we used a 1.5 T MRI scanner conducting steady-state-free-precession sequences, T2-weighted imaging, T1-weighted imaging before and after contrast administration and late gadolinium enhancement sequences. According to the recommendations for CMR diagnosis of myocarditis (Lake Louise consensus criteria), a scan was positive for acute myocarditis if 2 of 3 CMR criteria were present. 30 % of the patients with ''infarct-like myocarditis'' had a reduced left ventricular ejection fraction, 11 % had an increased LV end-diastolic volume index and 35 % had an increased LV mass index. The sensitivity of wall motion abnormalities was 63 % with a regional distribution in 49 %. In 47 % of cases regional wall motion abnormalities were present in the lateral left ventricular segments. Pericardial effusions were discovered in 65 % of cases with a circular appearance in 21 % and focal manifestation in 44 %. The diagnostic sensitivity, specificity, and accuracy of CMR in patients with ''infarct-like myocarditis'' were 67 %, 100 % and 82 %, respectively. The LGE alone was the most sensitive test parameter with 86 %, providing a specificity of 100 % and accuracy of 92 %. Our study results can be applied to the subgroup of patients with ''infarct-like myocarditis'', where we found that LGE alone was the

Fatal toxic epidermal necrolysis associated with minoxidil.

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Karaoui, Lamis R; Chahine-Chakhtoura, Corinne

2009-04-01

Minoxidil is a direct-acting peripheral vasodilator for the treatment of symptomatic hypertension, or refractory hypertension associated with target organ damage, that is not manageable with a diuretic and two other antihypertensive drugs. The most frequent adverse events associated with minoxidil include hypertrichosis and cardiovascular events related to its powerful antihypertensive effect, and less frequently, rashes, bullous eruptions, and Stevens-Johnson syndrome (SJS). Evidence suggests that SJS and toxic epidermal necrolysis (TEN) are variants of a single disease with common causes and mechanisms, but differing severities. Epidermal detachment is mild in SJS, moderate in overlap SJS-TEN, and severe (> 30% of body surface area) in TEN. We describe a case of minoxidil-associated SJS that evolved into fatal TEN. A 69-year-old African-American woman with a history of chronic kidney disease was admitted to the hospital for a cerebrovascular accident and uncontrolled hypertension. On hospital day 12, oral minoxidil was added to her drug regimen. On day 23, she developed a maculopapular rash on her face that gradually diffused to her chest and back. Vesicles and papular lesions extended to her extremities and mucosal membranes; results of a skin biopsy revealed SJS. A positive Nikolsky's sign (blisters spread on application of pressure) was detected. On days 27-31, diffuse bullae developed with rash exacerbation. Skin detachment exceeded 30% and was consistent with TEN. The patient died on day 39. An evaluation of the causality and time course suggested that minoxidil was the most likely culpable drug, with a Naranjo adverse drug reaction probability scale score indicating that the likelihood of the association was possible (score of 3). The mechanism of this reaction has not been well elucidated. It may be related to an impaired clearance of the minoxidil metabolite, or an immune stimulation resulting in apoptosis and epidermis destruction. To our knowledge, this

Molecular screening by polymerase chain reaction detects panleukopenia virus DNA in formalin-fixed hearts from cats with idiopathic cardiomyopathy and myocarditis.

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Meurs, K M; Fox, P R; Magnon, A L; Liu, S; Towbin, J A

2000-01-01

Viral myocarditis has been suggested as an etiology for cardiomyopathy in several mammalian species. Myocarditis and idiopathic cardiomyopathy have been reported in the domestic cat, although a viral etiology has not been demonstrated. Because of the continuing interest in the potential relationship between viral myocarditis and cardiomyopathy, we evaluated hearts from cats with spontaneous, idiopathic cardiomyopathy for viral genomic material within myocytes by polymerase chain reaction, and for the presence of myocarditis by light microscopy. Thirty-one (31) formalin-fixed hearts from domestic cats who died of idiopathic cardiomyopathy were randomly selected from pathology archives. Seventeen (17) formalin-fixed hearts from healthy cats were similarly selected as normal controls. The polymerase chain reaction (PCR) was used to evaluate myocardial tissue for the presence of viral genome from feline panleukopenia virus, herpes virus, calici virus, and corona virus. Hearts were examined using light microscopy for histologic evidence of myocarditis according to the Dallas criteria. Panleukopenia virus was identified by PCR in 10 of 31 cats with cardiomyopathy but in none of the controls. Neither cardiomyopathic or control cats tested positive by PCR for herpes virus, calici virus, and corona virus. Myocarditis was detected by histologic examination in 18 of 31 cardiomyopathic cats and in none of 17 control cats. Myocarditis and or feline panleukopenia virus genome was detected in felines with idiopathic hypertrophic, dilated, and restrictive cardiomyopathy, suggesting a possible role of viral infection and inflammation in the pathogenesis of cardiomyopathy in this species.

A bipartite signal mediates the transfer of type IV secretion substrates of Bartonella henselae into human cells.

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Schulein, Ralf; Guye, Patrick; Rhomberg, Thomas A; Schmid, Michael C; Schröder, Gunnar; Vergunst, Annette C; Carena, Ilaria; Dehio, Christoph

2005-01-18

Bacterial type IV secretion (T4S) systems mediate the transfer of macromolecular substrates into various target cells, e.g., the conjugative transfer of DNA into bacteria or the transfer of virulence proteins into eukaryotic host cells. The T4S apparatus VirB of the vascular tumor-inducing pathogen Bartonella henselae causes subversion of human endothelial cell (HEC) function. Here we report the identification of multiple protein substrates of VirB, which, upon translocation into HEC, mediate all known VirB-dependent cellular changes. These Bartonella-translocated effector proteins (Beps) A-G are encoded together with the VirB system and the T4S coupling protein VirD4 on a Bartonella-specific pathogenicity island. The Beps display a modular architecture, suggesting an evolution by extensive domain duplication and reshuffling. The C terminus of each Bep harbors at least one copy of the Bep-intracellular delivery domain and a short positively charged tail sequence. This biparte C terminus constitutes a transfer signal that is sufficient to mediate VirB/VirD4-dependent intracellular delivery of reporter protein fusions. The Bep-intracellular delivery domain is also present in conjugative relaxases of bacterial conjugation systems. We exemplarily show that the C terminus of such a conjugative relaxase mediates protein transfer through the Bartonella henselae VirB/VirD4 system into HEC. Conjugative relaxases may thus represent the evolutionary origin of the here defined T4S signal for protein transfer into human cells.

Multi-locus sequence typing of Bartonella henselae isolates from three continents reveals hypervirulent and feline-associated clones.

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Mardjan Arvand

Full Text Available Bartonella henselae is a zoonotic pathogen and the causative agent of cat scratch disease and a variety of other disease manifestations in humans. Previous investigations have suggested that a limited subset of B. henselae isolates may be associated with human disease. In the present study, 182 human and feline B. henselae isolates from Europe, North America and Australia were analysed by multi-locus sequence typing (MLST to detect any associations between sequence type (ST, host species and geographical distribution of the isolates. A total of 14 sequence types were detected, but over 66% (16/24 of the isolates recovered from human disease corresponded to a single genotype, ST1, and this type was detected in all three continents. In contrast, 27.2% (43/158 of the feline isolates corresponded to ST7, but this ST was not recovered from humans and was restricted to Europe. The difference in host association of STs 1 (human and 7 (feline was statistically significant (P< or =0.001. eBURST analysis assigned the 14 STs to three clonal lineages, which contained two or more STs, and a singleton comprising ST7. These groups were broadly consistent with a neighbour-joining tree, although splits decomposition analysis was indicative of a history of recombination. These data indicate that B. henselae lineages differ in their virulence properties for humans and contribute to a better understanding of the population structure of B. henselae.

In vivo T2* weighted MRI visualizes cardiac lesions in murine models of acute and chronic viral myocarditis

Science.gov (United States)

Helluy, Xavier; Sauter, Martina; Ye, Yu-Xiang; Lykowsky, Gunthard; Kreutner, Jakob; Yilmaz, Ali; Jahns, Roland; Boivin, Valerie; Kandolf, Reinhard; Jakob, Peter M.; Hiller, Karl-Heinz; Klingel, Karin

2017-01-01

Objective Acute and chronic forms of myocarditis are mainly induced by virus infections. As a consequence of myocardial damage and inflammation dilated cardiomyopathy and chronic heart failure may develop. The gold standard for the diagnosis of myocarditis is endomyocardial biopsies which are required to determine the etiopathogenesis of cardiac inflammatory processes. However, new non-invasive MRI techniques hold great potential in visualizing cardiac non-ischemic inflammatory lesions at high spatial resolution, which could improve the investigation of the pathophysiology of viral myocarditis. Results Here we present the discovery of a novel endogenous T2* MRI contrast of myocardial lesions in murine models of acute and chronic CVB3 myocarditis. The evaluation of infected hearts ex vivo and in vivo by 3D T2w and T2*w MRI allowed direct localization of virus-induced myocardial lesions without any MRI tracer or contrast agent. T2*w weighted MRI is able to detect both small cardiac lesions of acute myocarditis and larger necrotic areas at later stages of chronic myocarditis, which was confirmed by spatial correlation of MRI hypointensity in myocardium with myocardial lesions histologically. Additional in vivo and ex vivo MRI analysis proved that the contrast mechanism was due to a strong paramagnetic tissue alteration in the vicinity of myocardial lesions, effectively pointing towards iron deposits as the primary contributor of contrast. The evaluation of the biological origin of the MR contrast by specific histological staining and transmission electron microscopy revealed that impaired iron metabolism primarily in mitochondria caused iron deposits within necrotic myocytes, which induces strong magnetic susceptibility in myocardial lesions and results in strong T2* contrast. Conclusion This T2*w MRI technique provides a fast and sensitive diagnostic tool to determine the patterns and the severity of acute and chronic enteroviral myocarditis and the precise

Detection and characterization of feline Bartonella henselae in the Czech Republic

Czech Academy of Sciences Publication Activity Database

Melter, O.; Hercík, Kamil; Weyant, R. S.; Janeček, Jiří; Němec, A.; Mecera, J.; Gonzorová, L.; Branny, Pavel

2003-01-01

Roč. 93, - (2003), s. 261-273 ISSN 0378-1135 R&D Projects: GA ČR GA310/98/0417; GA ČR GP204/02/D121 Institutional research plan: CEZ:AV0Z5020903 Keywords : bartonella henselae * cat * molecular typing Subject RIV: EE - Microbiology, Virology Impact factor: 1.571, year: 2003

Immunoperoxidase technique in experimental chronic chagasic myocarditis

OpenAIRE

M.d. Maria Celina Morales; M.D. José Milei

1987-01-01

Chagas'disease has been described as the commonest form of chronic myocarditis. An immunologic pathogenesis has been discribed for this form of the disease. So far, no immunoperoxidase technique has been used for the detection of immunological deposits in chronic experimental Chagas'myocardiopathy. Forty-one Swiss mice, three months old were inoculated intraperitoneally with doses between 10 and 10(5) Tulahuen trypomastigotes. Mice were reinoculated one month after with doses between 10² and ...

Distinct activities of Bartonella henselae type IV secretion effector proteins modulate capillary-like sprout formation.

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Scheidegger, F; Ellner, Y; Guye, P; Rhomberg, T A; Weber, H; Augustin, H G; Dehio, C

2009-07-01

The zoonotic pathogen Bartonella henselae (Bh) can lead to vasoproliferative tumour lesions in the skin and inner organs known as bacillary angiomatosis and bacillary peliosis. The knowledge on the molecular and cellular mechanisms involved in this pathogen-triggered angiogenic process is confined by the lack of a suitable animal model and a physiologically relevant cell culture model of angiogenesis. Here we employed a three-dimensional in vitro angiogenesis assay of collagen gel-embedded endothelial cell (EC) spheroids to study the angiogenic properties of Bh. Spheroids generated from Bh-infected ECs displayed a high capacity to form sprouts, which represent capillary-like projections into the collagen gel. The VirB/VirD4 type IV secretion system and a subset of its translocated Bartonella effector proteins (Beps) were found to profoundly modulate this Bh-induced sprouting activity. BepA, known to protect ECs from apoptosis, strongly promoted sprout formation. In contrast, BepG, triggering cytoskeletal rearrangements, potently inhibited sprouting. Hence, the here established in vitro model of Bartonella- induced angiogenesis revealed distinct and opposing activities of type IV secretion system effector proteins, which together with a VirB/VirD4-independent effect may control the angiogenic activity of Bh during chronic infection of the vasculature.

Microcephaly Case Fatality Rate Associated with Zika Virus Infection in Brazil: Current Estimates.

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Cunha, Antonio José Ledo Alves da; de Magalhães-Barbosa, Maria Clara; Lima-Setta, Fernanda; Medronho, Roberto de Andrade; Prata-Barbosa, Arnaldo

2017-05-01

Considering the currently confirmed cases of microcephaly and related deaths associated with Zika virus in Brazil, the estimated case fatality rate is 8.3% (95% confidence interval: 7.2-9.6). However, a third of the reported cases remain under investigation. If the confirmation rates of cases and deaths are the same in the future, the estimated case fatality rate will be as high as 10.5% (95% confidence interval: 9.5-11.7).

Seroprevalence of Toxoplasma gondii and concurrent Bartonella spp., feline immunodeficiency virus, feline leukemia virus, and Dirofilaria immitis infections in Egyptian cats.

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Al-Kappany, Y M; Lappin, M R; Kwok, O C H; Abu-Elwafa, S A; Hilali, M; Dubey, J P

2011-04-01

Toxoplasma gondii and Bartonella spp. are zoonotic pathogens of cats. Feline immunodeficiency virus (FIV) and feline leukemia virus (FeLv) are related to human immunodeficiency virus and human leukemia virus, respectively, and these viruses are immunosuppressive. In the present study, the prevalence of antibodies to T. gondii , Bartonella spp., FIV, as well as FeLv and Dirofilaria immitis antigens was determined in sera from feral cats (Felis catus) from Cairo, Egypt. Using a modified agglutination test, antibodies to T. gondii were found in 172 (95.5%) of the 180 cats with titers of 1∶5 in 9, 1∶10 in 9, 1∶20 in 3, 1∶40 in 5, 1∶80 in 5, 1∶160 in 15, 1∶320 in 22, and 1∶640 or higher in 104. Thus, 57.4% had high T. gondii titers. Antibodies to Bartonella spp. were found in 105 (59.6%) of 178, with titers of 1∶64 in 45, 1∶128 in 39, 1∶256 in 13, 1∶512 in 3, 1∶1,024 in 4, and 1∶2,048 in 1 cat. Antibodies to FIV were detected in 59 (33.9%) of 174 cats. Of 174 cats tested, antigens to FeLv, and D. immitis were detected in 8 (4.6%) and 6 (3.4%) cats, respectively. The results indicate a high prevalence of T. gondii, Bartonella spp., and FIV infections in cats from Cairo, Egypt. This is the first report of Bartonella spp., and D. immitis infection in cats in Egypt.

A nested-PCR with an Internal Amplification Control for the detection and differentiation of Bartonella henselae and B. clarridgeiae: An examination of cats in Trinidad

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Ramsubeik Shalini

2005-08-01

Full Text Available Abstract Background Bartonella species are bacterial blood parasites of animals capable of causing disease in both animals and man. Cat-Scratch Disease (CSD in humans is caused mainly by Bartonella henselae and is acquired from the cat, which serves as a reservoir for the bacteria. A second species, B. clarridgeiae is also implicated in the disease. Diagnosis of Bartonellosis by culture requires a week or more of incubation on enriched media containing blood, and recovery is often complicated by faster growing contaminating bacteria and fungi. PCR has been explored as an alternative to culture for both the detection and species identification of Bartonella, however sensitivity problems have been reported and false negative reactions due to blood inhibitors have not generally been addressed in test design. Methods A novel, nested-PCR was designed for the detection of Bartonella henselae and B. clarridgeiae based on the strategy of targeting species-specific size differences in the 16S-23S rDNA intergenic regions. An Internal Amplification Control was used for detecting PCR inhibition. The nested-PCR was utilized in a study on 103 blood samples from pet and stray cats in Trinidad. Results None of the samples were positive by primary PCR, but the Nested-PCR detected Bartonella in 32/103 (31% cats where 16 were infected with only B. henselae, 13 with only B. clarridgeiae and 3 with both species. Of 22 stray cats housed at an animal shelter, 13 (59% were positive for either or both species, supporting the reported increased incidence of Bartonella among feral cats. Conclusion The usefulness of a single PCR for the detection of Bartonella henselae and B. clarridgeiae in the blood of cats is questionable. A nested-PCR offers increased sensitivity over a primary PCR and should be evaluated with currently used methods for the routine detection and speciation of Bartonella henselae and B. clarridgeiae. In Trinidad, B. henselae and B. clarridgeiae are the

Work-related fatalities associated with tree care operations--United States, 1992-2007.

Science.gov (United States)

2009-04-24

Workers in various industries and occupations are involved in the care and maintenance of trees, such as tree trimming, pruning, and removal. This work is recognized as having many safety hazards. Although previous analyses have involved subgroups of workers who perform this type of work, no analysis has focused on identifying injured workers from all industries and occupations that perform tree care operations. This report summarizes the characteristics of fatal occupational injuries, using data from the Census of Fatal Occupational Injuries (CFOI) and a case series of fatality investigations conducted by CDC's National Institute for Occupational Safety and Health (NIOSH) Fatality Assessment and Control Evaluation (FACE) program. During 1992--2007, a total of 1,285 workers died while performing tree care and maintenance; 44% were trimming or pruning a tree when fatally injured. The most common causes of death were being struck by or against an object (42% of deaths), most commonly a tree or branch; falls to a lower level (34%); and electrocutions (14%). Most of the decedents (57%) worked for small establishments with 10 or fewer employees. Employers, trade and worker associations, and policymakers should take additional steps to improve the safety of workers involved in tree care, such as providing formal training to workers and ensuring that personal protective equipment (e.g., fall protection equipment) is used properly.

Isolation of Bartonella henselae, Bartonella koehlerae subsp. koehlerae, Bartonella koehlerae subsp. bothieri and a new subspecies of B. koehlerae from free-ranging lions (Panthera leo) from South Africa, cheetahs (Acinonyx jubatus) from Namibia and captive cheetahs from California.

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Molia, S; Kasten, R W; Stuckey, M J; Boulouis, H J; Allen, J; Borgo, G M; Koehler, J E; Chang, C C; Chomel, B B

2016-11-01

Bartonellae are blood- and vector-borne Gram-negative bacteria, recognized as emerging pathogens. Whole-blood samples were collected from 58 free-ranging lions (Panthera leo) in South Africa and 17 cheetahs (Acinonyx jubatus) from Namibia. Blood samples were also collected from 11 cheetahs (more than once for some of them) at the San Diego Wildlife Safari Park. Bacteria were isolated from the blood of three (5%) lions, one (6%) Namibian cheetah and eight (73%) cheetahs from California. The lion Bartonella isolates were identified as B. henselae (two isolates) and B. koehlerae subsp. koehlerae. The Namibian cheetah strain was close but distinct from isolates from North American wild felids and clustered between B. henselae and B. koehlerae. It should be considered as a new subspecies of B. koehlerae. All the Californian semi-captive cheetah isolates were different from B. henselae or B. koehlerae subsp. koehlerae and from the Namibian cheetah isolate. They were also distinct from the strains isolated from Californian mountain lions (Felis concolor) and clustered with strains of B. koehlerae subsp. bothieri isolated from free-ranging bobcats (Lynx rufus) in California. Therefore, it is likely that these captive cheetahs became infected by an indigenous strain for which bobcats are the natural reservoir.

Therapy with granulocyte colony-stimulating factor in the chronic stage, but not in the acute stage, improves experimental autoimmune myocarditis in rats via nitric oxide.

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Shimada, Kana; Okabe, Taka-aki; Mikami, Yu; Hattori, Miki; Fujita, Masatoshi; Kishimoto, Chiharu

2010-09-01

We systematically investigated serial efficacy of granulocyte colony-stimulating factor (G-CSF) therapy upon experimental autoimmune myocarditis (EAM) in rats treated with and without the inhibition of nitric oxide (NO) with the analyses of tissue regeneration. G-CSF could mobilize multipotent progenitor cells of bone marrow into the peripheral blood and may improve ventricular function. A rat model of porcine myosin-induced EAM was used. After the immunization of myosin, G-CSF (10 microg/kg/day) or saline was injected intraperitoneally on days 0-21 in experiment 1 and on days 21-42 in experiment 2. Additional myosin-immunized rats were orally given 25 mg/kg/day of N(G)-nitro-L-arginine methylester (L-NAME), an inhibitor of nitric oxide synthase (NOS), in each experiment (each group; n=8-21). Serum cytokines and peripheral blood cell counts were measured in each group. In experiment 1, G-CSF treatment aggravated cardiac pathology associated with increased macrophage inflammatory protein-2 (MIP-2) and interleukin-6 (IL-6) levels and enhanced superoxide production. In experiment 2, G-CSF treatment reduced the severity of myocarditis with increased capillary density and improved left ventricular ejection fraction. In the rats with EAM treated with G-CSF associated with oral L-NAME treatment in experiment 2, the severity of myocarditis was not reduced. Myocardial c-kit(+) cells were demonstrated only in G-CSF-treated group in experiment 2 but not in other groups. G-CSF has differential effects on EAM in rats associated with the modulation of cytokine network. The overwhelming superoxide production by G-CSF administration in the acute stage may worsen the disease. G-CSF therapy improved cardiac function via NO system in a rat model of myocarditis in the chronic stage, but not in the acute stage, possibly through the myocardial regeneration and acceleration of healing process. Copyright 2010 Elsevier Ltd. All rights reserved.

Resolution of spontaneous hemoabdomen secondary to peliosis hepatis following surgery and azithromycin treatment in a Bartonella species infected dog.

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Berkowitz, Steven T; Gannon, Kristi M; Carberry, Carol A; Cortes, Yonaira

2016-11-01

To describe a case of hemoperitonium in a dog with Bartonellosis and peliosis hepatis (PH) lesions that resolved following antimicrobial therapy. A 3-year-11-month-old 22.5 kg female spayed mixed breed dog presented for progressive lethargy and vomiting. An abdominal ultrasonographic examination revealed moderate ascites, which when sampled was nonclotting hemorrhagic fluid. An exploratory laparotomy revealed a large volume of nonclotted blood in the dog's abdomen and blood-filled vesicular lesions dispersed diffusely along multiple lobes of the liver. Biopsies revealed lesions indicative of PH. Serology testing for Bartonella species was positive. Treatment with azithromycin resulted in Bartonella serology negative status and no further evidence of hemoperitonium at recheck examination 12 months after initial presentation. This is the first reported case of PH and hemoperitoneum in a Bartonella species serology positive dog wherein treatment with azithromycin resulted in serology negative status. There have been no subsequent episodes of hemoperitoneum in the 12 months since treatment. © Veterinary Emergency and Critical Care Society 2016.

Human cardiac-derived adherent proliferating cells reduce murine acute Coxsackievirus B3-induced myocarditis.

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Kapka Miteva

Full Text Available BACKGROUND: Under conventional heart failure therapy, inflammatory cardiomyopathy typically has a progressive course, indicating a need for alternative therapeutic strategies to improve long-term outcomes. We recently isolated and identified novel cardiac-derived cells from human cardiac biopsies: cardiac-derived adherent proliferating cells (CAPs. They have similarities with mesenchymal stromal cells, which are known for their anti-apoptotic and immunomodulatory properties. We explored whether CAPs application could be a novel strategy to improve acute Coxsackievirus B3 (CVB3-induced myocarditis. METHODOLOGY/PRINCIPAL FINDINGS: To evaluate the safety of our approach, we first analyzed the expression of the coxsackie- and adenovirus receptor (CAR and the co-receptor CD55 on CAPs, which are both required for effective CVB3 infectivity. We could demonstrate that CAPs only minimally express both receptors, which translates to minimal CVB3 copy numbers, and without viral particle release after CVB3 infection. Co-culture of CAPs with CVB3-infected HL-1 cardiomyocytes resulted in a reduction of CVB3-induced HL-1 apoptosis and viral progeny release. In addition, CAPs reduced CD4 and CD8 T cell proliferation. All CAPs-mediated protective effects were nitric oxide- and interleukin-10-dependent and required interferon-γ. In an acute murine model of CVB3-induced myocarditis, application of CAPs led to a decrease of cardiac apoptosis, cardiac CVB3 viral load and improved left ventricular contractility parameters. This was associated with a decline in cardiac mononuclear cell activity, an increase in T regulatory cells and T cell apoptosis, and an increase in left ventricular interleukin-10 and interferon-γ mRNA expression. CONCLUSIONS: We conclude that CAPs are a unique type of cardiac-derived cells and promising tools to improve acute CVB3-induced myocarditis.

Unusual Presentation of Dengue Fever; A child with acute myocarditis

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Moaz Aslam

2016-02-01

Full Text Available Dengue fever (DF is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes.

[Comparison analysis of muscle enzymes in children with myocarditis and Duchene/Becker muscular dystrophy].

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Zhang, Yali; Wang, Hong; Yu, Xuexin; Xing, Yanlin; Wang, Ce; He, Rong

2016-09-28

To compare the changes in muscle enzyme between children with myocarditis and Duchene/Becker muscular dystrophy (DMD/BMD), and to seek the explanations for variation.
 The retrospective analysis for 83 myocarditis children (myocarditis group) and 69 DMD/BMD children (DMD/BMD group), who were collected from Department of Pediatric of Shengjing Hospital affiliated to China Medical University since January 2008 to May 2015, was carried out. At the same time, 24 healthy children from the Department of Pediatric Development served as a control group. The examination indexes included creatine kinase (CK), creatine kinase-isoenzyme MB (CK-MB), creatine kinase isoenzyme MB mass (CK-MB mass), cardiac troponin I (cTnI) and high-sensitive-cTnT (hs-cTnT).
 1) In the myocarditis group, the CK increased from 100 to 1 000 U/L, reached a peak after 5 days, which lasted for a week and then dropped to the normal; the CK-MB reached a peak after 5 to 7 days and dropped to the normal a month later; the CK-MB mass reached a peak on the first day and dropped to the normal after 3 weeks; the cTn reached to a peak after 5 days and dropped to the normal after about 17 days; hs-cTnT reached to a peak on the first day and dropped to the normal after about 19 days. 2) In the DMD/BMD group, the CK increased significantly and 27 cases had a CK value of more than 10 000 U/L. After the treatment for 1 to 2 weeks, their enzyme rose again after a slight drop. In terms of cTnI, 6 cases showed a moderate increase, 5 of them couldn't drop to the normal level until more than 3 weeks later; the hs-cTnT increased in the 45 cases, which lasted for more than 3 weeks in the 31 cases of them and showed a tendency of persisting increase.
 The cTnI and hs-cTnT rise significantly and possess wider observation window than CK and CK-MB mass in myocarditis children, with more sensitive and specific changes. The myocardial damage can occur before myasthenia and keep this trend for a long time in the DMD

Detection of Bartonella henselae DNA in clinical samples including peripheral blood of immune competent and immune compromised patients by three nested amplifications

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Karina Hatamoto Kawasato

2013-02-01

Full Text Available Bacteria of the genus Bartonella are emerging pathogens detected in lymph node biopsies and aspirates probably caused by increased concentration of bacteria. Twenty-three samples of 18 patients with clinical, laboratory and/or epidemiological data suggesting bartonellosis were subjected to three nested amplifications targeting a fragment of the 60-kDa heat shock protein (HSP, the internal transcribed spacer 16S-23S rRNA (ITS and the cell division (FtsZ of Bartonella henselae, in order to improve detection in clinical samples. In the first amplification 01, 04 and 05 samples, were positive by HSP (4.3%, FtsZ (17.4% and ITS (21.7%, respectively. After the second round six positive samples were identified by nested-HSP (26%, eight by nested-ITS (34.8% and 18 by nested-FtsZ (78.2%, corresponding to 10 peripheral blood samples, five lymph node biopsies, two skin biopsies and one lymph node aspirate. The nested-FtsZ was more sensitive than nested-HSP and nested-ITS (p < 0.0001, enabling the detection of Bartonella henselae DNA in 15 of 18 patients (83.3%. In this study, three nested-PCR that should be specific for Bartonella henselae amplification were developed, but only the nested-FtsZ did not amplify DNA from Bartonella quintana. We conclude that nested amplifications increased detection of B. henselae DNA, and that the nested-FtsZ was the most sensitive and the only specific to B. henselae in different biological samples. As all samples detected by nested-HSP and nested-ITS, were also by nested-FtsZ, we infer that in our series infections were caused by Bartonella henselae. The high number of positive blood samples draws attention to the use of this biological material in the investigation of bartonellosis, regardless of the immune status of patients. This fact is important in the case of critically ill patients and young children to avoid more invasive procedures such as lymph nodes biopsies and aspirates.

Lyme carditis with isolated left bundle branch block and myocarditis successfully treated with oral doxycycline.

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Cunha, Burke A; Elyasi, Maekal; Singh, Prince; Jimada, Ismail

2018-01-01

Lyme disease may present with a variety of cardiac manifestations ranging from first degree to third degree heart block. Cardiac involvement with Lyme disease may be asymptomatic, or symptomatic. Atrioventrical conduction abnormalities are the most common manifestation of Lyme carditis. Less common, are alternating right bundle branch block (RBBB) and left bundle branch block (LBBB). We present an interesting case of a young male whose main manifestation of Lyme carditis was isolated LBBB. He also had mild Lyme myocarditis. The patient was successfully treated with oral doxycycline, and his isolated LBBB and myocarditis rapidly resolved.

Molecular phenotypes of human parvovirus B19 in patients with myocarditis.

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Bock, C-Thomas; Düchting, Anja; Utta, Friederike; Brunner, Eva; Sy, Bui Tien; Klingel, Karin; Lang, Florian; Gawaz, Meinrad; Felix, Stephan B; Kandolf, Reinhard

2014-04-26

To investigate molecular phenotypes of myocardial B19V-infection to determine the role of B19V in myocarditis and dilated cardiomyopathy (DCM). Endomyocardial biopsies (EMBs) from 498 B19V-positive patients with myocarditis and DCM were analyzed using molecular methods and functional experiments. EMBs were obtained from the University Hospitals of Greifswald and Tuebingen and additionally from 36 German cardiology centers. Control tissues were obtained at autopsy from 34 victims of accidents, crime or suicide. Identification of mononuclear cell infiltrates in EMBs was performed using immunohistological staining. Anti-B19V-IgM and anti-B19V-IgG were analyzed by enzyme-linked immunosorbent assay (ELISA). B19V viral loads were determined using in-house quantitative real-time polymerase chain reaction (PCR). For B19V-genotyping a new B19V-genotype-specific restriction fragment length polymorphism (RFLP)-PCR was established. B19V-genotyping was verified by direct DNA-sequencing and sequences were aligned using BLAST and BioEdit software. B19V P6-promoter and HHV6-U94-transactivator constructs were generated for cell culture experiments. Transfection experiments were conducted using human endothelial cells 1. Luciferase reporter assays were performed to determine B19V-replication activity. Statistical analysis and graphical representation were calculated using SPSS and Prism5 software. The prevalence of B19V was significantly more likely to be associated with inflammatory cardiomyopathy (iCMP) compared to uninflamed DCM (59.6% vs 35.3%) (P reactivation of B19V-infection by HHV6-coinfection in B19V-associated iCMP. Our findings suggest that B19V-infection of the human heart can be a causative event for the development of an endothelial cell-mediated inflammatory disease and that this is related to both viral load and genotype.

Are markers of inflammation more strongly associated with risk for fatal than for nonfatal vascular events?

LENUS (Irish Health Repository)

Sattar, Naveed

2009-06-23

Circulating inflammatory markers may more strongly relate to risk of fatal versus nonfatal cardiovascular disease (CVD) events, but robust prospective evidence is lacking. We tested whether interleukin (IL)-6, C-reactive protein (CRP), and fibrinogen more strongly associate with fatal compared to nonfatal myocardial infarction (MI) and stroke.

Field and laboratory evidence that Bungowannah virus, a recently recognised pestivirus, is the causative agent of the porcine myocarditis syndrome (PMC).

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Finlaison, Deborah S; King, Katherine R; Frost, Melinda J; Kirkland, Peter D

2009-05-12

In 2003 an outbreak of sudden deaths occurred in 2-3-week-old piglets on a piggery in New South Wales, Australia. There was a marked increase in the birth of stillborn piglets and preweaning losses associated with a multifocal non-suppurative myocarditis with myonecrosis. The aim of this study was to review existing data and to undertake further investigations of specimens from naturally infected pigs to provide evidence to support the hypothesis that Bungowannah virus, a recently recognised pestivirus, causes the porcine myocarditis syndrome (PMC). Sera collected from gilts and sows from affected and unaffected units were tested for Bungowannah virus antibody by a peroxidase-linked assay and Bungowannah virus RNA by qRT-PCR in selected cases. Stillborn piglets from affected and an unaffected unit were also tested for Bungowannah virus antibody and RNA. Body fluid IgG levels and the incidence of myocardial lesions in these stillborn piglets are summarised. Tissue sections from stillborn piglets with myocarditis/myonecrosis were examined for Bungowannah virus RNA by in situ hybridisation. A clear temporal association between the occurrence of PMC on a unit or module and exposure to Bungowannah virus was identified by serological tests in both breeding aged animals and stillborn pigs. In addition, at the individual animal level on affected units, Bungowannah virus RNA was detected in stillborn piglets in large amounts by qRT-PCR and in association with myocardial lesions by in situ hybridisation. The examination of field material from cases of PMC by serology, qRT-PCR and in situ hybridisation provides strong indirect evidence that Bungowannah virus is the causative agent for PMC.

Factors associated with pilot fatality in work-related aircraft crashes, Alaska, 1990-1999.

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Bensyl, D M; Moran, K; Conway, G A

2001-12-01

Work-related aircraft crashes are the leading cause of occupational fatality in Alaska, with civilian pilots having the highest fatality rate (410/100,000/year). To identify factors affecting survivability, the authors examined work-related aircraft crashes that occurred in Alaska in the 1990s (1990-1999), comparing crashes with pilot fatalities to crashes in which the pilot survived. Using data from National Transportation Safety Board reports, the authors carried out logistic regression analysis with the following variables: age, flight experience, use of a shoulder restraint, weather conditions (visual flight vs. instrument flight), light conditions (daylight vs. darkness), type of aircraft (airplane vs. helicopter), postcrash fire, crash location (airport vs. elsewhere), and state of residence. In the main-effects model, significant associations were found between fatality and postcrash fire (adjusted odds ratio (AOR) = 6.43, 95% confidence interval (CI): 2.38, 17.37), poor weather (AOR = 4.11, 95% CI: 2.15, 7.87), and non-Alaska resident status (AOR = 2.10, 95% CI: 1.05, 4.20). Protective effects were seen for shoulder restraint use (AOR = 0.40, 95% CI: 0.21, 0.77) and daylight versus darkness (AOR = 0.50, 95% CI: 0.25, 0.99). The finding that state of residence was associated with survivability offers new information on pilot survivability in work-related aircraft crashes in Alaska. These results may be useful in targeting safety interventions for pilots who fly occupationally in Alaska or in similar environments.

Clinical Profile and Outcome of Myocarditis in Children at Dr. Hasan Sadikin General Hospital Bandung from 2008 to 2012

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Erza Nurtriandari

2017-03-01

Full Text Available Background: Diagnosis of myocarditis in children is still challenging due to its inconsistent and wide spectrum of clinical manifestations. There is no specific laboratory test available. This may obscure the true incidence of myocarditis. The purpose of this study was to describe clinical profile and outcome of myocarditis in children. Methods: A descriptive study was performed using 80 medical records of hospitalized pediatrics patients with myocarditis in Dr. Hasan Sadikin General Hospital Bandung from January 2008 to December 2012. The obtained data were age, gender, nutritional status, etiology, chief complaint, physical examination, laboratory findings, other examinations and outcome of the disease. The collected data were analyzed and presented in the form of frequency distribution. Results: The mean age of the patients was 91.46 (45.93 months old, predominantly male. The most etiology was dengue infections (61%. High fever was found as the most common chief complaint (38% and the most common found in physical examinations were tachypnea (65% and hepatomegaly (55%. Electrocardiography (ECG showed the first degree atrioventricular block (AV block (35%, aspartate aminotransferase (AST and creatine kinase myocardial band (CKMB was increased in more than 80% of patients. The majority of patient was improved. Shock was the common complication. Conclusions: Dengue is the most etiology of myocarditis etiology. Tachypnea, hepatomegaly, the first degree AV block in ECG, elevated AST and CKMB were the most common presentations. Most of the patients were improved during treatment.

Are markers of inflammation more strongly associated with risk for fatal than for nonfatal vascular events?

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Naveed Sattar

2009-06-01

Full Text Available BACKGROUND: Circulating inflammatory markers may more strongly relate to risk of fatal versus nonfatal cardiovascular disease (CVD events, but robust prospective evidence is lacking. We tested whether interleukin (IL-6, C-reactive protein (CRP, and fibrinogen more strongly associate with fatal compared to nonfatal myocardial infarction (MI and stroke. METHODS AND FINDINGS: In the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER, baseline inflammatory markers in up to 5,680 men and women aged 70-82 y were related to risk for endpoints; nonfatal CVD (i.e., nonfatal MI and nonfatal stroke [n = 672], fatal CVD (n = 190, death from other CV causes (n = 38, and non-CVD mortality (n = 300, over 3.2-y follow-up. Elevations in baseline IL-6 levels were significantly (p = 0.0009; competing risks model analysis more strongly associated with fatal CVD (hazard ratio [HR] for 1 log unit increase in IL-6 1.75, 95% confidence interval [CI] 1.44-2.12 than with risk of nonfatal CVD (1.17, 95% CI 1.04-1.31, in analyses adjusted for treatment allocation. The findings were consistent in a fully adjusted model. These broad trends were similar for CRP and, to a lesser extent, for fibrinogen. The results were also similar in placebo and statin recipients (i.e., no interaction. The C-statistic for fatal CVD using traditional risk factors was significantly (+0.017; p<0.0001 improved by inclusion of IL-6 but not so for nonfatal CVD events (p = 0.20. CONCLUSIONS: In PROSPER, inflammatory markers, in particular IL-6 and CRP, are more strongly associated with risk of fatal vascular events than nonfatal vascular events. These novel observations may have important implications for better understanding aetiology of CVD mortality, and have potential clinical relevance.

DETECTION OF ANTIBODIES TO ANAPLASMA, BARTONELLA AND COXIELLA IN RURAL INHABITANTS OF THE CARIBBEAN AREA OF COLOMBIA

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Salim Máttar

2006-12-01

Full Text Available Objetivo. Establecer la seroprevalencia de Bartonella spp, Anaplasma phagocytophilum (antesErlichia y Coexiella burnetii. Materiales y métodos. Se analizaron sueros representativos de unsector de la población en el año 2003, recolectados de personas que trabajan en actividades delcampo en los departamentos de Córdoba y Sucre que sirvieron como población base de las muestrasque se obtuvieron. Los trabajadores rurales elegidos a participar tenían entra 16 – 65 años deedad. Los sueros fueron examinados por IFA para detección de anticuerpos contra IgG para Bartonellaspp, Erlichia Anaplasma phagocytophilum y Coexiella burnetii. Resultados. La seroprevalencia deanticuerpos de todos los microorganismos estudiados fue de 56.8%. De 81 muestras de sueroanalizadas el 26.6% fueron seropositivas contra C. burnetii, el 37.7% tuvieron anticuerpos contraBartonella y el 20% de los individuos evaluados fueron seropositivos para Anaplasmaphagocytophilum. Conclusiones. Nuestros datos indican que la prevalencia de anticuerpos contraBartonella, A. phagocytophilum y C. burnetii son altos en nuestra región. Los resultados indicanque estas enfermedades zoonoticas son muy comunes en las personas que residen en el área delcaribe colombiano. Este estudio demuestra por primera vez la presencia de estos microorganismosen Colombia.

Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke

DEFF Research Database (Denmark)

Ricci, Cristian; Wood, Angela; Muller, David

2018-01-01

OBJECTIVE: To investigate the association between alcohol consumption (at baseline and over lifetime) and non-fatal and fatal coronary heart disease (CHD) and stroke. DESIGN: Multicentre case-cohort study. SETTING: A study of cardiovascular disease (CVD) determinants within the European Prospecti...

Detection of Rickettsia felis, Rickettsia typhi, Bartonella Species and Yersinia pestis in Fleas (Siphonaptera) from Africa.

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Leulmi, Hamza; Socolovschi, Cristina; Laudisoit, Anne; Houemenou, Gualbert; Davoust, Bernard; Bitam, Idir; Raoult, Didier; Parola, Philippe

2014-10-01

Little is known about the presence/absence and prevalence of Rickettsia spp, Bartonella spp. and Yersinia pestis in domestic and urban flea populations in tropical and subtropical African countries. Fleas collected in Benin, the United Republic of Tanzania and the Democratic Republic of the Congo were investigated for the presence and identity of Rickettsia spp., Bartonella spp. and Yersinia pestis using two qPCR systems or qPCR and standard PCR. In Xenopsylla cheopis fleas collected from Cotonou (Benin), Rickettsia typhi was detected in 1% (2/199), and an uncultured Bartonella sp. was detected in 34.7% (69/199). In the Lushoto district (United Republic of Tanzania), R. typhi DNA was detected in 10% (2/20) of Xenopsylla brasiliensis, and Rickettsia felis was detected in 65% (13/20) of Ctenocephalides felis strongylus, 71.4% (5/7) of Ctenocephalides canis and 25% (5/20) of Ctenophthalmus calceatus calceatus. In the Democratic Republic of the Congo, R. felis was detected in 56.5% (13/23) of Ct. f. felis from Kinshasa, in 26.3% (10/38) of Ct. f. felis and 9% (1/11) of Leptopsylla aethiopica aethiopica from Ituri district and in 19.2% (5/26) of Ct. f. strongylus and 4.7% (1/21) of Echidnophaga gallinacea. Bartonella sp. was also detected in 36.3% (4/11) of L. a. aethiopica. Finally, in Ituri, Y. pestis DNA was detected in 3.8% (1/26) of Ct. f. strongylus and 10% (3/30) of Pulex irritans from the villages of Wanyale and Zaa. Most flea-borne infections are neglected diseases which should be monitored systematically in domestic rural and urban human populations to assess their epidemiological and clinical relevance. Finally, the presence of Y. pestis DNA in fleas captured in households was unexpected and raises a series of questions regarding the role of free fleas in the transmission of plague in rural Africa, especially in remote areas where the flea density in houses is high.

Absence of kynurenine 3-monooxygenase reduces mortality of acute viral myocarditis in mice.

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Kubo, Hisako; Hoshi, Masato; Mouri, Akihiro; Tashita, Chieko; Yamamoto, Yasuko; Nabeshima, Toshitaka; Saito, Kuniaki

2017-01-01

Infection of the encephalomyocarditis virus (EMCV) in mice is an established model for viral myocarditis. Previously, we have demonstrated that indoleamine 2,3-dioxygenase (IDO), an L-tryptophan - kynurenine pathway (KP) enzyme, affects acute viral myocarditis. However, the roles of KP metabolites in EMCV infection remain unclear. Kynurenine 3-monooxygenase (KMO) is one of the key regulatory enzymes, which metabolizes kynurenine to 3-hydroxykynurenine in the KP. Therefore, we examined the role of KMO in acute viral infection by comparing between KMO -/- mice and KMO +/+ mice. KMO deficiency resulted in suppressed mortality after EMCV infection. The number of infiltrating cells and F4/80 + cells in KMO -/- mice was suppressed compared with those in KMO +/+ mice. KMO -/- mice showed significantly increased levels of serum KP metabolites, and induction of KMO expression upon EMCV infection was involved in its effect on mortality through EMCV suppression. Furthermore, KMO -/- mice showed significantly suppression of CCL2, CCL3 and CCL4 on day 2 and CXCL1 on day 4 after infection. These results suggest that increased KP metabolites reduced chemokine production, resulting in suppressed mortality upon KMO knockdown in EMCV infection. KP metabolites may thus provide an effective strategy for treating acute viral myocarditis. Copyright © 2016 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved.

TYPHOID FEVER WITH FATAL OUTCOME IN PEOPLE WITH SEVERE TROPHOLOGICAL FAILURE IN EXTREME CONDITIONS

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Yu. I. Lyashenko

2017-01-01

Full Text Available For purpose of clinical and morphological characterization of typhoid fever with fatal outcome was perform analysis of medical documentation as well as postmortem studies of internal tissues in 36men aged 21 to 34 years with severe body weight loss and in the conditions of combat stress in period from 1983 to 1985. The results of the study find a number of clinical and pathomorphological features of typhoid fever in patients with body weight deficiency that were in extreme conditions. Focal changes of the central nervous system were detected. The defeat of the respiratory system was characterized from the first days of the disease by bronchitis, and in the subsequent development of pneumonia, plevritis and empyema of the pleura. Majority of patients had symptoms of cardiovascular and renal failure. In died in the first week of the disease and in 2/3 parts – in a later period were combined with the symptoms of infectious-toxic encephalopathy and severe acute respiratory failure. All died had postmortem dystrophic changes of cardiomyocytes, and in patients had fatal outcome in 2–5 weeks – also focal or diffuse myocarditis. In a third of the patients who died, the disease was complicated by intestinal perforations. In a number of cases, peritonitis was a consequence of necrosis of mesenteric lymph nodes. In all patients with a fatal outcome, hemorrhagic (thrombohemorrhagic syndrome was diagnosed. A significant proportion of patients posthumously detected signs of sepsis and other complications, many of which could be the cause of death.

Activated nuclear transcription factor κB in patients with myocarditis and dilated cardiomyopathy-relation to inflammation and cardiac function

International Nuclear Information System (INIS)

Alter, Peter; Rupp, Heinz; Maisch, Bernhard

2006-01-01

Objectives and background: Myocarditis is caused by various agents and autoimmune processes. It is unknown whether viral genome persistence represents inactive remnants of previous infections or whether it is attributed to ongoing adverse processes. The latter also applies to the course of autoimmune myocarditis. One principal candidate for an adverse remodeling is nuclear factor-κB (NFκB). Methods: A total of 93 patients with suspected myocarditis/cardiomyopathy was examined. Hemodynamics were assessed by echocardiography as well as right and left heart catheterization. Endomyocardial biopsies were taken from the left ventricle. Biopsies were examined by immunohistochemistry and PCR for viral genomes. Selective immunostaining of activated NFκB was performed. Results: NFκB was increased in patients with myocarditis when compared with controls (11.1 ± 7.1% vs. 5.0 ± 5.3%, P 2 = 0.72, P 2 = 0.43, P < 0.02). Increased activated NFκB was found in adenovirus persistence when compared with controls (P = 0.001). Only a trend of increased NFκB activation was seen in cytomegalovirus persistence. Parvovirus B19 persistence did not affect NFκB activation. Conclusions: Increased activation of NFκB is related to inflammatory processes in myocarditis. Since activated NFκB correlates with left ventricular function, it could be assumed that NFκB activation occurs at early stages of inflammation. Potentially, NFκB could inhibit loss of cardiomyocytes by apoptosis and protect from cardiac dilation. Since NFκB is a crucial key transcription factor of inflammation, its prognostic and future therapeutic relevance should be addressed

Value of Cine-MRI sequences before and after injection in the diagnosis of acute myocarditis.

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Zidi, Asma; Zairi, Ihsen; Mzoughi, Khadija; Zakhama, Lilia; Kamoun, Ikram; Ben Halima, Afef; Ridene, Imen

2016-11-01

Cardiovascular magnetic resonance (CMR) has become the examination of choice in case of suspicion of acute myocarditis. Late gadolinium enhancement (LGE) imaging is very important to establish this diagnosis. Cine MRI sequences are useful for the study of the myocardial contractility.   The purpose is to estimate the value of cine MRI sequences before and after injection for the diagnosis of acute myocarditis compared with late gadolinium enhanced sequences. We prospectively included 40 patients having a high suspicion of acute myocarditis and examined using a 1.5 Tesla CMR. Cine MRI sequences before and after injection were performed. The protocol also include  T2-weighted  short- tau-inversion-recovery (STIR T2) fast spin echo MRI and LGE imaging eight minutes after injection with visual adjustment of inversion time. Delayed enhancement was found among 23 patients. Fifteen patients (65 %) presented a spontaneous hyper signal detected visually on Cine MRI sequences before injection and 11 patients (48 %) on STIR T2. The hyper signal on Cine MRI sequences after injection of gadolinium was the same topography that the late raising at 23 patients. In addition, we highlighted a significant difference between this hyper signal before injection and the left ventricle ejection fraction (p=0.022) as well as with the telesystolic volume of the left ventricle (LV) indexed by the body mass (p=0.039). Our study suggests that Cine MRI sequences after injection are of equal performance in the diagnosis of acute myocarditis as the LGE sequences and its contibution is important when we want to shorten the examination or when inversion time isn't optimal.

Bartonella quintana and Typhus Group Rickettsiae Exposure among Homeless Persons, Bogotá, Colombia.

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Faccini-Martínez, Álvaro A; Márquez, Andrea C; Bravo-Estupiñan, Diana M; Calixto, Omar-Javier; López-Castillo, Christian A; Botero-García, Carlos A; Hidalgo, Marylin; Cuervo, Claudia

2017-11-01

In 2015, we investigated Bartonella quintana and typhus group rickettsiae in body lice from homeless persons in Bogotá, Colombia. We found B. quintana-infected body lice and seroprevalence of this microorganism in 19% of homeless persons and typhus group rickettsiae in 56%. Public health professionals should start preemptive measures and active vector control.

A translocated effector required for Bartonella dissemination from derma to blood safeguards migratory host cells from damage by co-translocated effectors.

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Okujava, Rusudan; Guye, Patrick; Lu, Yun-Yueh; Mistl, Claudia; Polus, Florine; Vayssier-Taussat, Muriel; Halin, Cornelia; Rolink, Antonius G; Dehio, Christoph

2014-06-01

Numerous bacterial pathogens secrete multiple effectors to modulate host cellular functions. These effectors may interfere with each other to efficiently control the infection process. Bartonellae are Gram-negative, facultative intracellular bacteria using a VirB type IV secretion system to translocate a cocktail of Bartonella effector proteins (Beps) into host cells. Based on in vitro infection models we demonstrate here that BepE protects infected migratory cells from injurious effects triggered by BepC and is required for in vivo dissemination of bacteria from the dermal site of inoculation to blood. Human endothelial cells (HUVECs) infected with a ΔbepE mutant of B. henselae (Bhe) displayed a cell fragmentation phenotype resulting from Bep-dependent disturbance of rear edge detachment during migration. A ΔbepCE mutant did not show cell fragmentation, indicating that BepC is critical for triggering this deleterious phenotype. Complementation of ΔbepE with BepEBhe or its homologues from other Bartonella species abolished cell fragmentation. This cyto-protective activity is confined to the C-terminal Bartonella intracellular delivery (BID) domain of BepEBhe (BID2.EBhe). Ectopic expression of BID2.EBhe impeded the disruption of actin stress fibers by Rho Inhibitor 1, indicating that BepE restores normal cell migration via the RhoA signaling pathway, a major regulator of rear edge retraction. An intradermal (i.d.) model for B. tribocorum (Btr) infection in the rat reservoir host mimicking the natural route of infection by blood sucking arthropods allowed demonstrating a vital role for BepE in bacterial dissemination from derma to blood. While the Btr mutant ΔbepDE was abacteremic following i.d. inoculation, complementation with BepEBtr, BepEBhe or BIDs.EBhe restored bacteremia. Given that we observed a similar protective effect of BepEBhe on infected bone marrow-derived dendritic cells migrating through a monolayer of lymphatic endothelial cells we propose that

A translocated effector required for Bartonella dissemination from derma to blood safeguards migratory host cells from damage by co-translocated effectors.

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Rusudan Okujava

2014-06-01

Full Text Available Numerous bacterial pathogens secrete multiple effectors to modulate host cellular functions. These effectors may interfere with each other to efficiently control the infection process. Bartonellae are Gram-negative, facultative intracellular bacteria using a VirB type IV secretion system to translocate a cocktail of Bartonella effector proteins (Beps into host cells. Based on in vitro infection models we demonstrate here that BepE protects infected migratory cells from injurious effects triggered by BepC and is required for in vivo dissemination of bacteria from the dermal site of inoculation to blood. Human endothelial cells (HUVECs infected with a ΔbepE mutant of B. henselae (Bhe displayed a cell fragmentation phenotype resulting from Bep-dependent disturbance of rear edge detachment during migration. A ΔbepCE mutant did not show cell fragmentation, indicating that BepC is critical for triggering this deleterious phenotype. Complementation of ΔbepE with BepEBhe or its homologues from other Bartonella species abolished cell fragmentation. This cyto-protective activity is confined to the C-terminal Bartonella intracellular delivery (BID domain of BepEBhe (BID2.EBhe. Ectopic expression of BID2.EBhe impeded the disruption of actin stress fibers by Rho Inhibitor 1, indicating that BepE restores normal cell migration via the RhoA signaling pathway, a major regulator of rear edge retraction. An intradermal (i.d. model for B. tribocorum (Btr infection in the rat reservoir host mimicking the natural route of infection by blood sucking arthropods allowed demonstrating a vital role for BepE in bacterial dissemination from derma to blood. While the Btr mutant ΔbepDE was abacteremic following i.d. inoculation, complementation with BepEBtr, BepEBhe or BIDs.EBhe restored bacteremia. Given that we observed a similar protective effect of BepEBhe on infected bone marrow-derived dendritic cells migrating through a monolayer of lymphatic endothelial cells we

Myocarditis with ST elevation and elevated cardiac enzymes misdiagnosed as an ST-elevation myocardial infarction.

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Sheldon, Seth H; Crandall, Mark A; Jaffe, Allan S

2012-12-01

Acute myocarditis can mimic ST-elevation myocardial infarction (STEMI). Quickly determining the correct diagnosis is critical given the "time is muscle" implication with a STEMI and the potential adverse effects associated with use of fibrinolytic therapy. A 46-year-old man presented to a rural emergency department with chest pain, and an electrocardiogram (ECG) read as showing 0.1 mV of ST-segment elevation in leads III and aVF. His initial cardiac troponin T was 0.44 ng/mL. He received fibrinolytic therapy for presumed STEMI. Cardiac magnetic resonance imaging was later performed and showed epicardial delayed enhancement consistent with myocarditis. Upon further questioning, he acknowledged 3 days of stuttering chest discomfort and a recent upper respiratory infection, as well as similar chest pain in his wife. A systematic evaluation is essential for acute chest pain, including a focused history, identification of cardiac risk factors, and ECG interpretation. A history of recent viral illness, absence of cardiac risk factors, or ECG findings inconsistent with a single anatomic lesion would suggest a potential alternate diagnosis to STEMI. This case emphasizes the importance of a focused history in the initial evaluation of chest pain. Copyright © 2012 Elsevier Inc. All rights reserved.

Detection of hemoplasma and Bartonella species and co-infection with retroviruses in cats subjected to a spaying/neutering program in Jaboticabal, SP, Brazil Detecção de hemoplasmas e Bartonella sp. e co-infecção com retrovírus em gatos submetidos a um programa de castração/esterilização em Jaboticabal, SP, Brasil

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Caroline Plácidi de Bortoli

2012-09-01

Full Text Available Hemotrophic mycoplasmas and Bartonella species are important pathogens that circulate between cats and invertebrate hosts, occasionally causing diseases in humans. Nevertheless, there are few reports on occurrences of these agents in cats in Brazil. The present study aimed to detect the presence of hemoplasma and Bartonella DNA by means of PCR and sequencing. FIV antigens and anti-FeLV antibodies, were studied by using a commercial kit on blood and serum samples, respectively, among 46 cats that were sampled during a spaying/neutering campaign conducted in Jaboticabal, SP. Three (6.5% cats were positive for hemoplasmas: two (4.3% for 'Candidatus M. haemominutum' and one (2.2% for both M. haemofelis and 'Candidatus M. turicensis'. One of the two 'Candidatus M. haemominutum'-infected cats was also positive for FeLV antigens and showed antibodies for FIV. Two cats (4.3% were positive for B. henselae. One of them was also positive for FeLV antigens. Eight cats (17.4% were positive for FeLV, and just one (2.2% showed anti-FIV antibodies. Bartonella species and hemoplasmas associated with infection due to retroviruses can circulate among apparently healthy cats.Micoplasmas hemotróficos e espécies de Bartonella são importantes patógenos que circulam entre gatos e hospedeiros invertebrados, causando ocasionalmente doenças no homem. Apesar disto, poucos são os estudos acerca da ocorrência destes agentes entre gatos no Brasil. O presente estudo objetivou detectar o DNA de hemoplasmas e Bartonella sp. pela PCR e sequenciamento. Antígeno de FIV e anticorpos anti-FeLV foram estudados utilizando um "kit" comercial, em amostras de sangue e soro, respectivamente, de 46 gatos amostrados em uma campanha de castração em Jaboticabal, SP. Três gatos (6,5% foram positivos para hemoplasmas: dois (4,3% para 'Candidatus M. haemominutum' e um (2,2% para M. haemofelis and 'Candidatus M. turicensis'. Um dos gatos positivos para 'Candidatus M. haemominutum

Resistencia antimicrobiana de cepas de Bartonella bacilliformis procedentes de regiones endémicas de la Enfermedad de Carrión en EL Perú

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Giovanna Mendoza-Mujica

Full Text Available Objetivos. Evaluar la susceptibilidad antimicrobiana in vitro a cloranfenicol (CHL y ciprofloxacino (CIP de cepas de Bartonella bacilliformis procedentes de áreas endémicas de la enfermedad de Carrión (EC en el Perú, mediante tres métodos de laboratorio. Materiales y métodos. Se evaluó la susceptibilidad antimicrobiana a CHL y CIP de 100 cepas de Bartonella bacilliformis, los aislamientos procedieron de pacientes de los departamentos de Ancash, Cusco, Cajamarca, Lima y La Libertad; las cepas se evaluaron mediante: disco difusión, E-Test y dilución en agar. Resultados. El 26% de las cepas de Bartonella bacilliformis evaluadas, presentaron resistencia a CIP y 1% a CHL. Se obtuvieron patrones similares de sensibilidad/resistencia antimicrobiana en los tres métodos utilizados. Conclusiones. Las cepas de Bartonella bacilliformis circulantes en el Perú, presentan elevados niveles de resistencia in vitro a CIP, por lo que se recomienda ampliar la investigación sobre la utilización del fármaco en los esquemas de tratamiento de la EC. Los métodos de E-test y disco difusión resultaron más convenientes para la evaluación de la susceptibilidad antimicrobiana in vitro del microorganismo

Pharmacokinetics of indium-111-labeled antimyosin monoclonal antibody in murine experimental viral myocarditis

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Yamada, T.; Matsumori, A.; Watanabe, Y.; Tamaki, N.; Yonekura, Y.; Endo, K.; Konishi, J.; Kawai, C.

1990-01-01

The pharmacokinetics of indium-111-labeled antimyosin monoclonal antibody Fab were investigated with use of murine experimental viral myocarditis as a model. The biodistribution of indium-111-labeled antimyosin antibody Fab on days 3, 5, 7, 14, 21 and 28 after encephalomyocarditis virus inoculation demonstrated that myocardial uptake increased significantly on days 5, 7 and 14 (maximum on day 7) in infected versus uninfected mice (p less than 0.001). In vivo kinetics in infected mice on day 7 demonstrated that the heart to blood ratio reached a maximum 48 h after the intravenous administration of indium-111-labeled antimyosin Fab, which was considered to be the optimal time for scintigraphy. The scintigraphic images obtained with indium-111-labeled antimyosin Fab demonstrated positive uptake in the cardiac lesion in infected mice. The pathologic study demonstrated that myocardial uptake correlated well with pathologic grades of myocardial necrosis. High performance liquid chromatography revealed the presence of an antigen-antibody complex in the circulation of infected mice after the injection of indium-111-labeled antimyosin Fab. This antigen bound to indium-111-labeled antimyosin Fab in the circulation might be whole myosin and this complex may decrease myocardial uptake and increase liver uptake. It is concluded that indium-111-labeled antimyosin monoclonal antibody Fab accumulates selectively in damaged heart tissue in mice with acute myocarditis and that indium-111-labeled antimyosin Fab scintigraphy may be a useful method for the visualization of acute myocarditis

Illicit use of opioid substitution drugs: prevalence, user characteristics, and the association with non-fatal overdoses.

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Bretteville-Jensen, Anne Line; Lillehagen, Mats; Gjersing, Linn; Andreas, Jasmina Burdzovic

2015-02-01

Diversion of opioid substitution drugs (OSD) is of public concern. This study examined the prevalence, frequency, and predictors of illicit OSD use in a group of injecting drug users (IDUs) and assessed if such use was associated with non-fatal overdoses. Semi-annual cross-sectional interviews conducted in Oslo, Norway (2006-2013), from 1355 street-recruited IDUs. Hurdle, logistic, and multinomial regression models were employed. Overall, 27% reported illicit OSD use in the past four weeks; 16.8% methadone, 12.5% buprenorphine, and 2.9% both drugs. Almost 1/10 reported at least one non-fatal overdose in the past four weeks, and roughly 1/3 reported such experience in the past year. Use of additional drugs tended to be equally, or more prevalent among illicit OSD users than other IDUs. In terms of illicit OSD use being a risk factor for non-lethal overdoses, our results showed significant associations only for infrequent buprenorphine use (using once or less than once per week). Other factors associated with non-fatal overdoses included age, education, homelessness, as well as the benzodiazepines, stimulants, and heroin use. Users of diverted OSD may represent a high-risk population, as they used more additional drugs and used them more frequently than other IDUs. However, illicit OSD use may be less harmful than previously assumed. After accounting for an extensive set of covariates, only infrequent illicit buprenorphine use, but not methadone use, was associated with non-fatal overdoses. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Local experience with extracorporeal membrane oxygenation in children with acute fulminant myocarditis.

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Botao Ning

Full Text Available To analyze the clinical effect of extracorporeal membrane oxygenation (ECMO in children with acute fulminant myocarditis, we retrospectively analyzed the data of five children with acute fulminant myocarditis in the intensive care unit (ICU at the Affiliated Children's Hospital, Zhejiang University from February 2009 to November 2012. The study group included two boys and three girls ranging in age from 9 to 13 years (median 10 years. Body weight ranged from 25 to 33 kg (mean 29.6 kg. They underwent extracorporeal membrane oxygenation (ECMO through a venous-arterial ECMO model with an average ECMO supporting time of 89.8 h (40-142 h. Extracorporeal circulation was established in all five children. After treatment with ECMO, the heart rate, blood pressure, and oxygen saturation were greatly improved in the four children who survived. These four children were successfully weaned from ECMO and discharged from hospital machine-free, for a survival rate of 80% (4/5. One child died still dependent on the machine. Cause of death was irrecoverable cardiac function and multiple organ failure. Complications during ECMO included three cases of suture bleeding, one case of acute hemolytic renal failure and suture bleeding, and one case of hyperglycemia. During the follow-up period of 4-50 months, the four surviving children recovered with normal cardiac function and no abnormal functions of other organs. The application of ECMO in acute fulminant myocarditis, even in local centers that experience low incidence of this disease, remains an effective approach. Larger studies to determine optimal timing of placement on ECMO to guide local centers are warranted.

Bartonella and Coxiella infective endocarditis in Brazil: molecular evidence from excised valves from a cardiac surgery referral center in Rio de Janeiro, Brazil, 1998 to 2009.

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Lamas, Cristiane da Cruz; Ramos, Rosana Grandelle; Lopes, Gabriel Quintino; Santos, Marisa Silva; Golebiovski, Wilma Felix; Weksler, Clara; Ferraiuoli, Giovanna Ianini D'Almeida; Fournier, Pierre-Edouard; Lepidi, Hubert; Raoult, Didier

2013-01-01

PCR was used to detect Coxiella burnetii and Bartonella spp in heart valves obtained during the period 1998-2009 from patients operated on for blood culture-negative endocarditis in a cardiac surgery hospital in Brazil. Of the 51 valves tested, 10 were PCR-positive; two were positive for Bartonella and one for C. burnetii. Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Coffee consumption and risk of fatal cancers.

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Snowdon, D A; Phillips, R L

1984-01-01

In 1960, the coffee consumption habits and other lifestyle characteristics of 23,912 white Seventh-day Adventists were assessed by questionnaire. Between 1960 and 1980, deaths due to cancer were identified. There were positive associations between coffee consumption and fatal colon and bladder cancer. The group consuming two or more cups of coffee per day had an estimated relative risk (RR) of 1.7 for fatal colon cancer and 2.0 for fatal bladder cancer, compared to the group that consumed less than one cup per day (RR = 1.0). These positive associations were apparently not confounded by age, sex, cigarette smoking, or meat consumption habits. In this study, there were no significant or suggestive associations between coffee consumption and fatal pancreatic, breast, and ovarian cancer, or a combined group of all other cancer sites. PMID:6742274

Four cases of acute chagasic myocarditis in French Guiana.

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Carme, B; Aune, I; Nguyen, G; Aznar, C; Beaudet, B

2001-01-01

The authors report four cases of acute chagasic myocarditis which had been diagnosed and treated in Cayenne, French Guiana, in the past 6 years. This French territory, which has the highest standard of living in South America, should be considered an area of risk for sporadic Chagas disease with epidemiologic features similar to those of the disease found in dense Amazon forest areas. Appropriate measures must be taken to screen and promptly manage Chagas disease in the French Guiana population.

Review of Dengue hemorrhagic fever fatal cases seen among adults: a retrospective study.

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Sing-Sin Sam

Full Text Available BACKGROUND: Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it is becoming more of an adult disease. Malaysia experienced a large dengue outbreak in 2006 to 2007, involving mostly adults, with a high number of deaths. METHODOLOGY/PRINCIPAL FINDINGS: We undertook a retrospective study to examine dengue death cases in our hospital from June 2006 to October 2007 with a view to determine if there have been changes in the presentation of severe to fatal dengue. Nine of ten fatal cases involved adult females with a median age of 32 years. All had secondary dengue infection. The mean duration of illness prior to hospitalization was 4.7 days and deaths occurred at an average of 2.4 days post-admission. Gastrointestinal pain, vomiting, diarrhea, intravascular leakages and bleeding occurred in the majority of cases. DSS complicated with severe bleeding, multi-organ failure and coagulopathy were the primary causes of deaths. Seven patients presented with thrombocytopenia and hypoalbuminemia, five of which had hemoconcentration and increased ALT and AST indicative of liver damage. Co-morbidities particularly diabetes mellitus was common in our cohort. Prominent unusual presentations included acute renal failure, acute respiratory distress syndrome, myocarditis with pericarditis, and hemorrhages over the brain and heart. CONCLUSIONS: In our cohort, dengue fatalities are seen primarily in adult females with secondary dengue infection. The majority of the patients presented with common clinical and laboratory warning signs of severe dengue. Underlying co-morbidities may contribute to the rapid clinical deterioration in severe dengue. The uncommon presentations of dengue are likely a reflection of the changing demographics where adults are now more likely to contract dengue in dengue endemic regions.

Car crash fatalities associated with fire in Sweden.

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Viklund, Åsa; Björnstig, Johanna; Larsson, Magnus; Björnstig, Ulf

2013-01-01

To study the epidemiology and causes of death in fatal car crashes on Swedish roads in which the victim's vehicle caught fire. The data set is from the Swedish Transport Administrations in-depth studies of fatal crashes 1998-2008. Autopsies from all cases provided data on injuries, toxicological analyses, and cause of death. In total, 181 people died in 133 burning cars, accounting for 5 percent of all deaths in passenger cars, sport utility vehicles, vans, and minibuses during 1998 to 2008. The cause of death for a third of the victims was fire related, as burns and/or smoke inhalation injuries, with no fatal trauma injuries. Twenty-five of these 55 deaths were persons 19 years or younger and included 15 of 18 rear seat deaths. Over half of the 181 deaths were in vehicles that had collided with another vehicle and, of these cases, half were killed in collisions with heavy vehicles. The percentage of drivers with illegal blood alcohol concentrations (27%) and suicides (5.5%) were not higher than in other fatal crashes on Swedish roads. The ignition point of the fire was indicated in only half of the cases and, of those, half started in the engine compartment and one fourth started around the fuel tank or lines. Car fires are a deadly postcrash problem. Reducing this risk would be primarily a responsibility for the automotive industry. A multifactor approach could be considered as follows: risk-reducing design, insulation, reduced flammability in motor compartment fluids and plastics, and automatic fire extinguishing equipment. Inspiration could be found in how, for example, the auto racing and aviation industries handle this problem.

Possible vertical transmission of Bartonella bacilliformis in Peru.

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Tuya, Ximena L; Escalante-Kanashiro, Raffo; Tinco, Carmen; Pons, Maria J; Petrozzi, Verónica; Ruiz, Joaquim; del Valle, Juana

2015-01-01

A 22-day-old male was admitted with a 2-day history of irritability, dyspnea, jaundice, fever, and gastrointestinal bleeding. A thin blood smear was performed, which showed the presence of intraerythrocyte bacteria identified as Bartonella bacilliformis, and subsequently, the child was diagnosed with Carrion's disease. The diagnosis was confirmed by specific polymerase chain reaction. The child was born in a non-endemic B. bacilliformis area and had not traveled to such an area before hospitalization. However, the mother was from an endemic B. bacilliformis area, and posterior physical examination showed the presence of a wart compatible with B. bacilliformis in semi-immune subjects. These data support vertical transmission of B. bacilliformis. © The American Society of Tropical Medicine and Hygiene.

L’infarctus du myocarde du jeune adulte -Analyse rétrospective des cas colligés au CHU de Dakar

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Nobila Valentin Yameogo

2010-09-01

Full Text Available Les données relatives à l’infarctus du myocarde chez le jeune adulte sont rares en Afrique noir. Nous rapportons une série rétrospective de 14 cas d’infarctus du myocarde chez l’adulte jeune noir africain. Pour analyser les caractéristiques épidémiologiques, cliniques, électriques, échographiques, biologiques, thérapeutiques et évolutives de l’infarctus aigu du myocarde chez le jeune adulte nous avons étudié de manière rétrospective les dossiers médicaux d’une série consécutive des patients admis entre Janvier 2003 et Décembre 2008 pour prise en charge d’infarctus aigu du myocarde. Quatre-vingt quatre (84 cas d’infarctus du myocarde ont été pris en charge durant la période d’étude ,14 patients (16,6% avaient un âge inférieur ou égal à 40 ans. L’âge moyen était de 34 +ou-5ans (extrêmes 27ans et 40 ans. Les facteurs de risque cardio-vasculaire étaient dominés par le sexe masculin (n=11, la dyslipidémie (n=7 et le tabagisme par cigarette (n=6. La contraception orale était absente chez le 1/3 des patients. Le délai moyen d’admission était tardif (15 plus ou moins 4 heures. L’IDM était antérieur dans la moitié des cas. L’acide acétylsalicylique, les inhibiteurs de l’enzyme de conversion Les bétabloquants et les statines étaient les médicaments les plus prescrits. La thrombolyse et l’angioplastie étaient respectivement réalisées chez 3 patients et 0 patient. 4 cas d’insuffisance cardiaque, 2 cas de bloc atrio-ventriculaire complet et 1 cas de décès étaient les principales complications. L’infarctus du myocarde concerne également le sujet jeune noir africain. Les facteurs de risque sont essentiellement représentés par le sexe, la dyslipidémie, le tabagisme et la contraception orale.

Myocarditis exacerbation in a child undergoing inguinal hernioplasty after viral infection

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Simić Dušica

2009-01-01

Full Text Available Introduction Immunosuppressive effects of general anesthesia and surgery could have unexpected consequences in a child with recent infection. The incidence of myocarditis in childhood is unknown. Case outline During general anesthesia for inguinal hernia repair, a seven-year-old boy suddenly developed heart failure. Clinical presentation included hypotension, pulmonary edema, drop in hemoglobin oxygen saturation, ST segment elevation and premature ventricular contractions. Homodynamic stability and adequate oxygenation were achieved with dopamine and furosemide. Preoperative history, physical examination and complete blood count were unremarkable. Moderate cardiomegaly and pulmonary edema were present on chest radiography. Diminished left ventricular contractility found on echocardiography increased troponin I and CK-MB levels suggested myocardial injury. Increased C-reactive protein with lymphocytosis suggested inflammation as its cause. Parents failed to report rubella 10 days before the operation. A clinical diagnosis of myocarditis as a complication of rubella was based on increased titer of IgM to rubella. With intravenous immunoglobulin, corticosteroids and symptomatic treatment for heart failure, his condition improved and ejection fraction reached 68 % one month after operation. Conclusion In future, we need protocols with instructions for pediatric patients undergoing elective surgery and anesthesia after viral infections.

Coxsackievirus B3 vaccines: use as an expression vector for prevention of myocarditis.

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Henke, Andreas; Jarasch, Nadine; Wutzler, Peter

2008-12-01

Coxsackievirus B3 (CVB3), a member of the Picornaviridae family, is considered to be one of the most important infectious agents to cause virus-induced myocarditis. Despite improvements in studying virus pathology, structure and molecular biology, as well as the diagnosis of this disease, there is still no virus-specific drug or vaccine in clinical use. During the last 20 years many investigations have been performed to develop classic and modern immunization techniques against CVB3-induced heart disease. One promising approach among others includes the insertion of coding sequences of cytokines into the viral genome. The application of an IFN-gamma-expressing recombinant coxsackievirus vector is especially efficient against CVB3-induced myocarditis. Beside direct IFN-gamma-mediated antiviral effects, the local and simultaneous expression of IFN-gamma by the virus itself activates the immune system in a strong and long-lasting manner, which protects animals completely against subsequent lethal infections independently of the age of the immunized individual and the route of vaccine administration.

Dynamic changes of serum TNF-α and cTnI levels in BALB/c Mouse models of autoimmune myocarditis

International Nuclear Information System (INIS)

Han Li'na

2007-01-01

Objective: To prepare mouse models of experimental autoimmune myocarditis (EAM) with subcutaneous injection of synthesized peptide (containing heavy chain segment of cardiac myosin) and examine the dynamic changes of cardiac pathology as well as TNF -α, cTnI and autoimmune antibody contents. Methods: BALB/c mice were subcutaneously injected with 0.8 mg of the synthesized peptide to produce the experimental autoimmune myocarditis (EAM) models. The animals were sacrificed 14, 21, 30 and 60d after establishment of the models, heart muscle was examined pathologically to assess the severity of myocarditis and blood were examined for the plasma contents of TNF-α (with RIA) cTnI (with ELISA) and anti-cardiac myosin heavy chain (CMHC) antibody titier (with ELISA). Results: Evidence of myocardial damage appeared on d14 specimens and progressed there after with interstitial infiltration of macrophages and myocardial necrosis. In the 60d specimens, fibrosis was obvious. The plasma TNF-α and cTnI levels were highest in the d30 specimens and declined in the d60 specimens but still remained much higher than normal. Most of the models demonstrated anti-CMHC antibodies in the 21d and 30d specimens. Conclusion: It is feasible to prepare EMC mouse models with subcutaneous injection of synthesized peptide containing heavy chain segment of cardiac myosin and the plasma levels of TNF-α, cTnI in the models are well correlated to the pathologic change of myocarditis. (authors)

Estimation of fatality and injury risk by means of in-depth fatal accident investigation data.

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Yannis, George; Papadimitriou, Eleonora; Dupont, Emmanuelle; Martensen, Heike

2010-10-01

In this article the factors affecting fatality and injury risk of road users involved in fatal accidents are analyzed by means of in-depth accident investigation data, with emphasis on parameters not extensively explored in previous research. A fatal accident investigation (FAI) database is used, which includes intermediate-level in-depth data for a harmonized representative sample of 1300 fatal accidents in 7 European countries. The FAI database offers improved potential for analysis, because it includes information on a number of variables that are seldom available, complete, or accurately recorded in road accident databases. However, the fact that only fatal accidents are examined requires for methodological adjustments, namely, the correction for two types of effects on a road user's baseline risk: "accident size" effects, and "relative vulnerability" effects. Fatality and injury risk can be then modeled through multilevel logistic regression models, which account for the hierarchical dependences of the road accident process. The results show that the baseline fatality risk of road users involved in fatal accidents decreases with accident size and increases with the vulnerability of the road user. On the contrary, accident size increases nonfatal injury risk of road users involved in fatal accidents. Other significant effects on fatality and injury risk in fatal accidents include road user age, vehicle type, speed limit, the chain of accident events, vehicle maneuver, and safety equipment. In particular, the presence and use of safety equipment such as seat belt, antilock braking system (ABS), and electronic stability program (ESP) are protection factors for car occupants, especially for those seated at the front seats. Although ABS and ESP systems are typically associated with positive effects on accident occurrence, the results of this research revealed significant related effects on accident severity as well. Moreover, accident consequences are more severe

Early morning awakening and nonrestorative sleep are associated with increased minor non-fatal accidents during work and leisure time.

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Chiu, Hsiao-Yean; Wang, Mei-Yeh; Chang, Cheng-Kuei; Chen, Ching-Min; Chou, Kuei-Ru; Tsai, Jen-Chen; Tsai, Pei-Shan

2014-10-01

The relationship between a composite measure of insomnia and occupational or fatal accidents has been investigated previously; however, little is known regarding the effect of various insomnia symptoms on minor non-fatal accidents during work and leisure time. We investigated the predicting role of insomnia symptoms on minor non-fatal accidents during work and leisure time. Data from the 2005 Taiwan Social Development Trend Survey of 36,473 Taiwanese aged ≥18 years were analyzed in 2013. Insomnia symptoms, including difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA), and nonrestorative sleep (NRS) were investigated. A minor non-fatal accident was defined as any mishap such as forgetting to turn off the gas or faucets, accidental falls, and abrasions or cuts occurring during work and leisure time in the past month that do not require immediate medical attention. Multivariable logistic regression was performed to assess the odds ratios (ORs) and associated 95% confidence interval (CI) of minor non-fatal accidents (as a binary variable) for each insomnia symptom compared with those of people presenting no symptoms, while controlling for possible confounders. EMA and NRS increased the odds of minor non-fatal accidents occurring during work and leisure time (adjusted OR=1.19, 95% CI=1.08-1.32 and adjusted OR=1.27, 95% CI=1.17-1.37, respectively). EMA and NRS are two symptoms that are significantly associated with an increased likelihood of minor non-fatal accidents during work and leisure time after adjusting for of a range of covariates. Copyright © 2014 Elsevier Ltd. All rights reserved.

Firearm Legislation and Fatal Police Shootings in the United States.

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Kivisto, Aaron J; Ray, Bradley; Phalen, Peter L

2017-07-01

To examine whether stricter firearm legislation is associated with rates of fatal police shootings. We used a cross-sectional, state-level design to evaluate the effect of state-level firearm legislation on rates of fatal police shootings from January 1, 2015, through October 31, 2016. We measured state-level variation in firearm laws with legislative scorecards from the Brady Center, and for fatal police shootings we used The Counted, an online database maintained by The Guardian. State-level firearm legislation was significantly associated with lower rates of fatal police shootings (incidence rate ratio = 0.961; 95% confidence interval = 0.939, 0.984). When we controlled for sociodemographic factors, states in the top quartile of legislative strength had a 51% lower incidence rate than did states in the lowest quartile. Laws aimed at strengthening background checks, promoting safe storage, and reducing gun trafficking were associated with fewer fatal police shootings. Legislative restrictions on firearms are associated with reductions in fatal police shootings. Public Health Implications. Although further research is necessary to determine causality and potential mechanisms, firearm legislation is a potential policy solution for reducing fatal police shootings in the United States.

Fatal dengue hemorrhagic fever in adults: emphasizing the evolutionary pre-fatal clinical and laboratory manifestations.

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Ing-Kit Lee

Full Text Available BACKGROUND: A better description of the clinical and laboratory manifestations of fatal patients with dengue hemorrhagic fever (DHF is important in alerting clinicians of severe dengue and improving management. METHODS AND FINDINGS: Of 309 adults with DHF, 10 fatal patients and 299 survivors (controls were retrospectively analyzed. Regarding causes of fatality, massive gastrointestinal (GI bleeding was found in 4 patients, dengue shock syndrome (DSS alone in 2; DSS/subarachnoid hemorrhage, Klebsiella pneumoniae meningitis/bacteremia, ventilator associated pneumonia, and massive GI bleeding/Enterococcus faecalis bacteremia each in one. Fatal patients were found to have significantly higher frequencies of early altered consciousness (≤24 h after hospitalization, hypothermia, GI bleeding/massive GI bleeding, DSS, concurrent bacteremia with/without shock, pulmonary edema, renal/hepatic failure, and subarachnoid hemorrhage. Among those experienced early altered consciousness, massive GI bleeding alone/with uremia/with E. faecalis bacteremia, and K. pneumoniae meningitis/bacteremia were each found in one patient. Significantly higher proportion of bandemia from initial (arrival laboratory data in fatal patients as compared to controls, and higher proportion of pre-fatal leukocytosis and lower pre-fatal platelet count as compared to initial laboratory data of fatal patients were found. Massive GI bleeding (33.3% and bacteremia (25% were the major causes of pre-fatal leukocytosis in the deceased patients; 33.3% of the patients with pre-fatal profound thrombocytopenia (<20,000/µL, and 50% of the patients with pre-fatal prothrombin time (PT prolongation experienced massive GI bleeding. CONCLUSIONS: Our report highlights causes of fatality other than DSS in patients with severe dengue, and suggested hypothermia, leukocytosis and bandemia may be warning signs of severe dengue. Clinicians should be alert to the potential development of massive GI bleeding

Characteristics of schools in which fatal shootings occur.

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de Apodaca, Roberto Flores; Brighton, Lauren M; Perkins, Ashley N; Jackson, Kiana N; Steege, Jessica R

2012-04-01

School-based violence, and fatal school shootings in particular, have gained increased attention in the media and psychological literature. Most reports have focused on the characteristics of perpetrators, but there is a growing awareness that school-related factors may also influence the occurrence of fatal school shootings. The current study examined several key characteristics of all schools where random (38) and targeted (96) fatal shootings occurred in the United States between 1966 and 2009. These were compared with a group (138) of schools randomly selected to represent the population of all schools in the United States. The size of a school's enrollment, urban or suburban locale, public funding, and predominantly non-white enrollment were positively associated with fatal shootings. Universities and colleges were disproportionately associated with random shootings and high schools with targeted ones. It was proposed that characteristics of schools that allow feelings of anonymity or alienation among students may help create environmental conditions associated with fatal school shootings. Implications for future research and interventions are considered.

Has the great recession and its aftermath reduced traffic fatalities?

Science.gov (United States)

Noland, Robert B; Zhou, Yuhan

2017-01-01

An analysis of state-level data from 1984 to 2014 provides evidence on the relationship between economic recessions and US traffic fatalities. While there are large reductions associated with decreases in household median income, other policy variables tend to have additional and in some cases, larger effects. An increase in the inequality of the income distribution, measured by the Gini index, has reduced traffic fatalities. Graduated licensing policies, cell phone laws, and motorcycle helmet requirements are all associated with reductions in fatalities. Other factors include a proxy for medical technology, and access to emergency medical services (based on the percent of vehicle miles traveled in rural areas); reductions in the latter accounted for a substantial reduction in fatalities and is likely another indicator of reduced economic activity. Changes in the road network, mainly increases in the percent of collector roads has increased fatalities. Population growth is associated with increased traffic fatalities and changes in age cohorts has a small negative effect. Overall, results suggest that there has been a beneficial impact on traffic fatalities from reduced economic activity, but various policies adopted by the states have also reduced traffic fatalities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of adenosine cyclophosphate combined with vitamin C on cellular immune function of children with viral myocarditis

Directory of Open Access Journals (Sweden)

Xiu Chang

2016-06-01

Full Text Available Objective: To investigate the curative effect of adenosine cyclophosphate combined with vitamin C on children with viral myocarditis andon cellular immune function. Methods: A total of 96 cases of children with viral myocarditis were randomly divided into control group and observation group, 48 cases in each. The control group received routine treatment for viral myocarditis. The observation group received routine treatment for viral myocarditis as well as vitamin C and adenosine cyclophosphate. Results: The total effective rate of observation group 89.59% was higher than that of control group 64.58%, and differences were statistical significant. The electrocardiogram total effective rate of observation group 91.67% was higher than that of control group 68.75%, and differences were statistical significant. After treatment, the level of CD3+ (65.09±10.35%, the level of CD4+ (42.93±6.22%, the level of CD8+ (29.55±4.87% and the level of NK (47.37±8.52% of observation group were higher than the level of CD3+ (51.85±9.33%, the level of CD4+ (35.18±5.73%, the level of CD8+ (24.46±4.03% and the level of NK (35.64±7.72% of control group, and differences were statistical significant. After treatment, myocardial enzyme indexes lactate dehydrogenase (329.65±19.76 U/L, creatine phosphate kinase (126.36±12.92 U/L, hydroxybutyrate dehydrogenase (271.68±14.73 U/L, glutamic oxaloacetic transaminase (31.22±3.76 U/ L and creatine kinase (185.28±13.83 U/L of observation group were lower than lactate dehydrogenase (348.06±20.51 U/L, creatine phosphate kinase (163.19±13.15 U/L, hydroxybutyrate dehydrogenase (305.50±16.42 U/L, glutamic oxaloacetic transaminase (37.87±4.07 U/L and creatine kinase (202.79±15.47 U/L of control group, and differences were statistical significant. After treatment, heart function indexes CI, FS and EF levels of observation group were higher than those of control group, and differences were statistical significant

Left ventricular hypertrophy and risk of fatal and non-fatal stroke EUROSTROKE: a collaborative study among research centres in Europe

NARCIS (Netherlands)

M.L. Bots (Michiel); J. Tuomilehto; D.E. Grobbee (Diederick); P.J. Koudstaal (Peter Jan); Y. Nikitin; J.T. Salonen; P.C. Elwood; S. Malyutina; A. Freire de Concalves; J. Sivenius; A. di Carlo; P. Lagiou

2002-01-01

textabstractBACKGROUND: This study investigated the association between electrocardiographically assessed left ventricular hypertrophy (LVH) and fatal, non-fatal, haemorrhagic and ischaemic stroke in four European cohorts participating in EUROSTROKE. METHODS: EUROSTROKE is a

Myocarditis Complicated by Complete Atrioventricular Block: Nine Years' Experience in a Medical Center

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Shao-Ju Chien

2008-12-01

Conclusion: The outcome of CAVB complicated with myocarditis is variable. Most of our patients resumed normal heart function. The incidence of persistent CAVB was 22%. VT is a common and serious complication, but it can be effectively treated medically. Persistent low cardiac output after pacemaker implantation and late onset VT should be considered as risk factors of mortality.

Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome.

Science.gov (United States)

Thipmontree, Wilawan; Tantibhedhyangkul, Wiwit; Silpasakorn, Saowaluk; Wongsawat, Ekkarat; Waywa, Duangdao; Suputtamongkol, Yupin

2016-10-05

Scrub typhus is endemic in Thailand. Of the 495 patients with acute undifferentiated fever studied in Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand, from June 1, 2011, to December 31, 2012, 146 patients (29.5%) had confirmed scrub typhus. The majority of cases were male, farmers, with the mean (±standard deviation) age of 54.1 ± 15.2 years. A total of 59 patients (40.4%) had eschar lesion. The commonest sites for an eschar in male patients were the perineum, inguinal, and buttock area; whereas in females, it was the head and neck area. Abnormal electrocardiogram was found in 39 of 79 patients (49.4%) with sinus tachycardia being the most frequent finding (17, 21.5%). A total of 73 patients (50%) had at least one complication. Myocarditis was the cause of complete heart block in a scrub typhus patient, and he fully recovered after receiving intravenous chloramphenicol treatment. The case fatality rate was 6.2% (nine deaths).The independent predictors for fatal outcome were age over 65 years (odds ratio [OR] = 14.49, 95% confidence interval [CI] = 1.26-166.44, P = 0.03), acute kidney injury (OR = 12.75, 95% CI = 1.77-92.07, P = 0.01), and hyperbilirubinemia (OR = 24.82, 95% CI = 2.12-286.61, P = 0.01). Early diagnosis and prompt appropriate treatment can improve the patient's outcome. © The American Society of Tropical Medicine and Hygiene.

Detection of experimental myocarditis by monoclonal antimyosin antibody, Fab fragment

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Rezkalla, S.; Kloner, R.A.; Khaw, B.A.; Haber, E.; Fallon, J.T.; Smith, F.E.; Khatib, R.

1989-02-01

The purpose of this study was to determine whether monoclonal antimyosin Fab (antigen binding fragment) was capable of labeling hearts with experimental coxsackievirus myocarditis, and to determine whether Fab could be used for detecting myocardial damage in either early or chronic phases of the disease. Sixty-five, 3-week-old cesarean-derived 1 (CD 1) mice were divided into two groups: group I (noninfected animals) and group II (infected with coxsackievirus B3). Mice from each group were killed on days 7, 17, 30, or 90 of infection. Forty-eight hours before killing, mice were injected with monoclonal I-125 antimyosin, Fab (25 microCi/injection) and radioactivity was counted in the heart. Selected heart sections were also examined by autoradiography. Heart radioactivity, count/m/mg (m +/- SEM) on days 7, 17, 30, and 90 of infection was 10.8 +/- 1.7, 21.3 +/- 1.1, 11.2 +/- 3.4, and 12.4 +/- 1.5 for group I, versus 36.7 +/- 8.0 (p less than 0.01), 50.0 +/- 4.5 (p less than 0.001), 33.4 +/- 16.1 (p = NS), and 40.6 +/- 8.5 (p less than 0.01) for group II, respectively. Autoradiography revealed focal uptake within areas of necrotic myocardium. We conclude that I125 Fab may be useful in detecting myocardial damage in the experimental model of murine myocarditis up to day 90 of infection.

Detection of experimental myocarditis by monoclonal antimyosin antibody, Fab fragment

International Nuclear Information System (INIS)

Rezkalla, S.; Kloner, R.A.; Khaw, B.A.; Haber, E.; Fallon, J.T.; Smith, F.E.; Khatib, R.

1989-01-01

The purpose of this study was to determine whether monoclonal antimyosin Fab (antigen binding fragment) was capable of labeling hearts with experimental coxsackievirus myocarditis, and to determine whether Fab could be used for detecting myocardial damage in either early or chronic phases of the disease. Sixty-five, 3-week-old cesarean-derived 1 (CD 1) mice were divided into two groups: group I (noninfected animals) and group II (infected with coxsackievirus B3). Mice from each group were killed on days 7, 17, 30, or 90 of infection. Forty-eight hours before killing, mice were injected with monoclonal I-125 antimyosin, Fab (25 microCi/injection) and radioactivity was counted in the heart. Selected heart sections were also examined by autoradiography. Heart radioactivity, count/m/mg (m +/- SEM) on days 7, 17, 30, and 90 of infection was 10.8 +/- 1.7, 21.3 +/- 1.1, 11.2 +/- 3.4, and 12.4 +/- 1.5 for group I, versus 36.7 +/- 8.0 (p less than 0.01), 50.0 +/- 4.5 (p less than 0.001), 33.4 +/- 16.1 (p = NS), and 40.6 +/- 8.5 (p less than 0.01) for group II, respectively. Autoradiography revealed focal uptake within areas of necrotic myocardium. We conclude that I125 Fab may be useful in detecting myocardial damage in the experimental model of murine myocarditis up to day 90 of infection

Postpartum Clostridium sordellii infection associated with fatal toxic shock syndrome

DEFF Research Database (Denmark)

Rørbye, C; Petersen, Ina Sleimann; Nilas, Lisbeth

2000-01-01

, respectively) are responsible for this potential. Reviewing the obstetric literature, only six cases of postpartum endometritis caused by C. sordellii, are described - all being fatal. In addition, one lethal case of spontaneous endometritis resulting from C. sordellii is reported. The clinical aspects...... of these cases include: - sudden onset with influenza-like symptoms in previously healthy women - progressive refractory hypotension - local and spreading tissue edema - absence of fever Laboratory findings include: - marked leukocytosis - elevated hematocrit. This paper reports the seventh fatal postpartum C...

Myositis, Ganglioneuritis, and Myocarditis with Distinct Perifascicular Muscle Atrophy in a 2-Year-Old Male Boxer

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Paul M. Rossman

2018-02-01

Full Text Available A 2-year-old male, intact Boxer was referred for chronic diarrhea, hyporexia, labored breathing, weakness and elevated creatine kinase, and alanine aminotransferase activities. Initial examination and diagnostics revealed a peripheral nervous system neurolocalization, atrial premature complexes, and generalized megaesophagus. Progressive worsening of the dog’s condition was noted after 36 h; the dog developed aspiration pneumonia, was febrile and oxygen dependent. The owners elected humane euthanasia. Immediately postmortem biopsies of the left cranial tibial and triceps muscles and the left peroneal nerve were obtained. Postmortem histology revealed concurrent myositis, myocarditis, endocarditis, and ganglioneuritis. Mixed mononuclear cell infiltrations and a distinct perifascicular pattern of muscle fiber atrophy was present in both muscles. This is a novel case of diffuse inflammatory myopathy with a distinct perifascicular pattern of atrophy in addition to endocarditis, myocarditis, and epicarditis.

Pericardial disease and myocarditis: management guide

International Nuclear Information System (INIS)

Marin, Jorge E; Duque, Mauricio; Uribe, William; Medina, Eduardo

2005-01-01

Pericardium is a structure that can be primarily affected by a series of different agents and in a secondary way by systemic processes. Its response is not specific and in general it corresponds to an inflammatory process that can be acute, chronic or recurrent. The recognition of these pathologies is of vital significance in the making of a right therapeutic approach. Some basic orientations for the correct classification, diagnosis and therapy of main pericardial syndromes, based on clinical and etiological aspects and para clinical available aids are presented. Likewise, some recommendations for the specific treatment of each one of the main entities usually affecting the pericardium are given. Next, a brief mention of some pathophysiological aspects of acute myocarditis, its main etiologies, and the treatment of the cardiac failure secondary to the disease with its specific differences, is made, and the controversy on its handling with immuno suppressors and the experimental therapy measures are studied in depth

Disentangling age-gender interactions associated with risks of fatal and non-fatal road traffic injuries in the Sultanate of Oman.

Science.gov (United States)

Al-Aamri, Amira K; Padmadas, Sabu S; Zhang, Li-Chun; Al-Maniri, Abdullah A

2017-01-01

Road traffic injuries (RTIs) are the leading cause of disability-adjusted life years lost in Oman, Saudi Arabia and United Arab Emirates. Injury prevention strategies often overlook the interaction of individual and behavioural risk factors in assessing the severity of RTI outcomes. We conducted a systematic investigation of the underlying interactive effects of age and gender on the severity of fatal and non-fatal RTI outcomes in the Sultanate of Oman. We used the Royal Oman Police national database of road traffic crashes for the period 2010-2014. Our study was based on 35 785 registered incidents: of these, 10.2% fatal injuries, 6.2% serious, 27.3% moderate, 37.3% mild injuries and 19% only vehicle damage but no human injuries. We applied a generalised ordered logit regression to estimate the effect of age and gender on RTI severity, controlling for risk behaviours, personal characteristics, vehicle, road, traffic, environment conditions and geographical location. The most dominant group at risk of all types of RTIs was young male drivers. The probability of severe incapacitating injuries was the highest for drivers aged 25-29 (26.6%) years, whereas the probability of fatal injuries was the highest for those aged 20-24 (26.9%) years. Analysis of three-way interactions of age, gender and causes of crash show that overspeeding was the primary cause of different types of RTIs. In particular, the probability of fatal injuries among male drivers attributed to overspeeding ranged from 3%-6% for those aged 35 years and above to 13.4% and 17.7% for those aged 25-29 years and 20-24 years, respectively. The high burden of severe and fatal RTIs in Oman was primarily attributed to overspeed driving behaviour of young male drivers in the 20-29 years age range. Our findings highlight the critical need for designing early gender-sensitive road safety interventions targeting young male and female drivers.

Codon and amino acid usage in two major human pathogens of genus Bartonella--optimization between replicational-transcriptional selection, translational control and cost minimization.

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Das, Sabyasachi; Paul, Sandip; Chatterjee, Sanjib; Dutta, Chitra

2005-01-01

Intra-genomic variation in synonymous codon and amino acid usage in two human pathogens Bartonella henselae and B. quintana has been carried out through multivariate analysis. Asymmetric mutational bias, coupled with replicational-transcriptional selection, has been identified as the prime selection force behind synonymous codon selection--a characteristic of the genus Bartonella, not exhibited by any other alpha-proteobacterial genome. Distinct codon usage patterns and low synonymous divergence values between orthologous sequences of highly expressed genes from the two Bartonella species indicate that there exists a residual intra-strand synonymous codon bias in the highly expressed genes, possibly operating at the level of translation. In the case of amino acid usage, the mean hydropathy level and aromaticity are the major sources of variation, both having nearly equal impact, while strand-specific mutational pressure and gene expressivity strongly influence the inter-strand variations. In both species under study, the highly expressed gene products tend not to contain heavy and/or aromatic residues, following the cost-minimization hypothesis in spite of their intracellular lifestyle. The codon and amino acid usage in these two human pathogens are, therefore, consequences of a complex balance between replicational-transcriptional selection, translational control, protein hydropathy and cost minimization.

Cilia-associated bacteria in fatal Bordetella bronchiseptica pneumonia of dogs and cats

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Bordetella bronchiseptica frequently causes nonfatal tracheobronchitis, but its role in fatal pneumonia is less well-studied. The objectives of this study were to identify the frequency of Bordetella bronchiseptica infection in fatal cases of bronchopneumonia in dogs and cats and to compare the diag...

Comparative Activity of Pradofloxacin, Enrofloxacin, and Azithromycin against Bartonella henselae Isolates Collected from Cats and a Human ▿

Science.gov (United States)

Biswas, Silpak; Maggi, Ricardo G.; Papich, Mark G.; Keil, Daniel; Breitschwerdt, Edward B.

2010-01-01

Using Bartonella henselae isolates from cats and a human, the activity of pradofloxacin was compared with those of enrofloxacin and azithromycin. By Etest and disc diffusion assay, pradofloxacin showed greater antimicrobial activity than did other antibiotics. We conclude that pradofloxacin may prove useful for the treatment of B. henselae infections. PMID:20007401

Association between mobile phone traffic volume and road crash fatalities: A population-based case-crossover study.

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Gariazzo, Claudio; Stafoggia, Massimo; Bruzzone, Silvia; Pelliccioni, Armando; Forastiere, Francesco

2018-06-01

Use of mobile phones while driving is known to cause crashes with possible fatalities. Different habits of mobile phone use might be distracting forces and display differential impacts on accident risk; the assessment of the relative importance is relevant to implement prevention, mitigation, and control measures. This study aimed to assess the relationship between the use of mobile phones at population level and road crash fatalities in large urban areas. Data on road crashes with fatalities were collected from seven Italian metropolitan areas and matched in time and space with high resolution mobile phone traffic volume data about calls, texts, Internet connections and upload/download data. A case-crossover study design was applied to estimate the relative risks of road accident for increases in each type of mobile phone traffic volumes in underlying population present in the small areas where accidents occurred. Effect modification was evaluated by weekday/weekend, hour of the day, meteorological conditions, and street densities. Positive associations between road crashes rates and the number of calls, texts, and Internet connections were found, with incremental risks of 17.2% (95% Confidence Interval [CI] 7.7, 27.6), 8.4% (CI 0.7, 16.8), and 54.6% (CI 34.0, 78.5) per increases (at 15 min intervals) of 5 calls/100 people, 3 text/100 people, and 40 connections/100 people, respectively. Small differences across cities were detected. Working days, nighttime and morning hours were associated with greater phone use and more road accidents. The relationship between mobile phone use and road fatalities at population level is strong. Strict controls on cellular phone in the vehicle may results in a large health benefit. Copyright © 2018 Elsevier Ltd. All rights reserved.

Advances in the Traditional Chinese Medicine-Based Management of Viral Myocarditis.

Science.gov (United States)

Cao, Yong; Xu, Xia; Zhang, Peiying

2015-09-01

Viral myocarditis (VMC) is a common clinical condition; however, no specific treatment has been available from the perspective of modern western medicine, and typically only symptomatic treatment is provided in clinical settings. The traditional Chinese medicine (TCM) has shown certain advantages in treating VMC. Last few years have witnessed certain advances in the TCM-based research on the etiology and pathogenesis of VMC and its clinical management. This article reviews the clinical advances made in the TCM-based management of VMC in the last 5 years.

Different features of Vδ2 T and NK cells in fatal and non-fatal human Ebola infections.

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Cimini, Eleonora; Viola, Domenico; Cabeza-Cabrerizo, Mar; Romanelli, Antonella; Tumino, Nicola; Sacchi, Alessandra; Bordoni, Veronica; Casetti, Rita; Turchi, Federica; Martini, Federico; Bore, Joseph A; Koundouno, Fara Raymond; Duraffour, Sophie; Michel, Janine; Holm, Tobias; Zekeng, Elsa Gayle; Cowley, Lauren; Garcia Dorival, Isabel; Doerrbecker, Juliane; Hetzelt, Nicole; Baum, Jonathan H J; Portmann, Jasmine; Wölfel, Roman; Gabriel, Martin; Miranda, Osvaldo; Díaz, Graciliano; Díaz, José E; Fleites, Yoel A; Piñeiro, Carlos A; Castro, Carlos M; Koivogui, Lamine; Magassouba, N'Faly; Diallo, Boubacar; Ruibal, Paula; Oestereich, Lisa; Wozniak, David M; Lüdtke, Anja; Becker-Ziaja, Beate; Capobianchi, Maria R; Ippolito, Giuseppe; Carroll, Miles W; Günther, Stephan; Di Caro, Antonino; Muñoz-Fontela, César; Agrati, Chiara

2017-05-01

Human Ebola infection is characterized by a paralysis of the immune system. A signature of αβ T cells in fatal Ebola infection has been recently proposed, while the involvement of innate immune cells in the protection/pathogenesis of Ebola infection is unknown. Aim of this study was to analyze γδ T and NK cells in patients from the Ebola outbreak of 2014-2015 occurred in West Africa, and to assess their association with the clinical outcome. Nineteen Ebola-infected patients were enrolled at the time of admission to the Ebola Treatment Centre in Guinea. Patients were divided in two groups on the basis of the clinical outcome. The analysis was performed by using multiparametric flow cytometry established by the European Mobile Laboratory in the field. A low frequency of Vδ2 T-cells was observed during Ebola infection, independently from the clinical outcome. Moreover, Vδ2 T-cells from Ebola patients massively expressed CD95 apoptotic marker, suggesting the involvement of apoptotic mechanisms in Vδ2 T-cell loss. Interestingly, Vδ2 T-cells from survivors expressed an effector phenotype and presented a lower expression of the CTLA-4 exhaustion marker than fatalities, suggesting a role of effector Vδ2 T-cells in the protection. Furthermore, patients with fatal Ebola infection were characterized by a lower NK cell frequency than patients with non fatal infection. In particular, both CD56bright and CD56dim NK frequency were very low both in fatal and non fatal infections, while a higher frequency of CD56neg NK cells was associated to non-fatal infections. Finally, NK activation and expression of NKp46 and CD158a were independent from clinical outcome. Altogether, the data suggest that both effector Vδ2 T-cells and NK cells may play a role in the complex network of protective response to EBOV infection. Further studies are required to characterize the protective effector functions of Vδ2 and NK cells.

Different features of Vδ2 T and NK cells in fatal and non-fatal human Ebola infections.

Directory of Open Access Journals (Sweden)

Eleonora Cimini

2017-05-01

Full Text Available Human Ebola infection is characterized by a paralysis of the immune system. A signature of αβ T cells in fatal Ebola infection has been recently proposed, while the involvement of innate immune cells in the protection/pathogenesis of Ebola infection is unknown. Aim of this study was to analyze γδ T and NK cells in patients from the Ebola outbreak of 2014-2015 occurred in West Africa, and to assess their association with the clinical outcome.Nineteen Ebola-infected patients were enrolled at the time of admission to the Ebola Treatment Centre in Guinea. Patients were divided in two groups on the basis of the clinical outcome. The analysis was performed by using multiparametric flow cytometry established by the European Mobile Laboratory in the field. A low frequency of Vδ2 T-cells was observed during Ebola infection, independently from the clinical outcome. Moreover, Vδ2 T-cells from Ebola patients massively expressed CD95 apoptotic marker, suggesting the involvement of apoptotic mechanisms in Vδ2 T-cell loss. Interestingly, Vδ2 T-cells from survivors expressed an effector phenotype and presented a lower expression of the CTLA-4 exhaustion marker than fatalities, suggesting a role of effector Vδ2 T-cells in the protection. Furthermore, patients with fatal Ebola infection were characterized by a lower NK cell frequency than patients with non fatal infection. In particular, both CD56bright and CD56dim NK frequency were very low both in fatal and non fatal infections, while a higher frequency of CD56neg NK cells was associated to non-fatal infections. Finally, NK activation and expression of NKp46 and CD158a were independent from clinical outcome.Altogether, the data suggest that both effector Vδ2 T-cells and NK cells may play a role in the complex network of protective response to EBOV infection. Further studies are required to characterize the protective effector functions of Vδ2 and NK cells.

Parallel evolution of a type IV secretion system in radiating lineages of the host-restricted bacterial pathogen Bartonella.

Science.gov (United States)

Engel, Philipp; Salzburger, Walter; Liesch, Marius; Chang, Chao-Chin; Maruyama, Soichi; Lanz, Christa; Calteau, Alexandra; Lajus, Aurélie; Médigue, Claudine; Schuster, Stephan C; Dehio, Christoph

2011-02-10

Adaptive radiation is the rapid origination of multiple species from a single ancestor as the result of concurrent adaptation to disparate environments. This fundamental evolutionary process is considered to be responsible for the genesis of a great portion of the diversity of life. Bacteria have evolved enormous biological diversity by exploiting an exceptional range of environments, yet diversification of bacteria via adaptive radiation has been documented in a few cases only and the underlying molecular mechanisms are largely unknown. Here we show a compelling example of adaptive radiation in pathogenic bacteria and reveal their genetic basis. Our evolutionary genomic analyses of the α-proteobacterial genus Bartonella uncover two parallel adaptive radiations within these host-restricted mammalian pathogens. We identify a horizontally-acquired protein secretion system, which has evolved to target specific bacterial effector proteins into host cells as the evolutionary key innovation triggering these parallel adaptive radiations. We show that the functional versatility and adaptive potential of the VirB type IV secretion system (T4SS), and thereby translocated Bartonella effector proteins (Beps), evolved in parallel in the two lineages prior to their radiations. Independent chromosomal fixation of the virB operon and consecutive rounds of lineage-specific bep gene duplications followed by their functional diversification characterize these parallel evolutionary trajectories. Whereas most Beps maintained their ancestral domain constitution, strikingly, a novel type of effector protein emerged convergently in both lineages. This resulted in similar arrays of host cell-targeted effector proteins in the two lineages of Bartonella as the basis of their independent radiation. The parallel molecular evolution of the VirB/Bep system displays a striking example of a key innovation involved in independent adaptive processes and the emergence of bacterial pathogens

Urban sprawl as a risk factor in motor vehicle occupant and pedestrian fatalities.

Science.gov (United States)

Ewing, Reid; Schieber, Richard A; Zegeer, Charles V

2003-09-01

We sought to determine the association between urban sprawl and traffic fatalities. We created a sprawl index by applying principal components analysis to data for 448 US counties in the largest 101 metropolitan areas. Regression analysis was used to determine associations between the index and traffic fatalities. For every 1% increase in the index (i.e., more compact, less sprawl), all-mode traffic fatality rates fell by 1.49% (P Urban sprawl was directly related to traffic fatalities and pedestrian fatalities. Subsequent studies should investigate relationships at a finer geographic scale and should strive to improve on the measure of exposure used to adjust pedestrian fatality rates.

Halofuginone alleviates acute viral myocarditis in suckling BALB/c mice by inhibiting TGF-β1

Energy Technology Data Exchange (ETDEWEB)

Sun, Xiao-Hua [Department of Emergency, Xi’an Children’s Hospital, Xi' an, 710003, Shanxi (China); Fu, Jia [Department of Infection, Xi’an Children’s Hospital, Xi' an, 710003, Shanxi (China); Sun, Da-Qing, E-mail: daqingsuncd@163.com [Department of Respiration, Xi’an Children’s Hospital, NO. 69 Xijuyuan Lane, Xi' an 710003, Shanxi (China)

2016-04-29

Viral myocarditis (VMC) is an inflammation of heart muscle in infants and young adolescents. This study explored the function of halofuginone (HF) in Coxsackievirus B3 (CVB3) -treated suckling mice. HF-treated animal exhibited higher survival rate, lower heart/body weight, and more decreased blood sugar concentration than CVB3 group. HF also reduced the expressions of interleukin(IL)-17 and IL-23 and the numbers of Th17 cells. Moreover, HF downregulated pro-inflammatory cytokine levels and increased anti-inflammatory cytokine levels. The expressions of transforming growth factor(TGF-β1) and nuclear factor kappa-light-chain-enhancer of activated B (NF-κB) p65/ tumor necrosis factor-α (TNF-α) proteins were decreased by HF as well. Finally, the overexpression of TGF-β1 counteracted the protection effect of HF in CVB3-treated suckling mice. In summary, our study suggests HF increases the survival of CVB3 suckling mice, reduces the Th17 cells and pro-inflammatory cytokine levels, and may through downregulation of the TGF-β1-mediated expression of NF-κB p65/TNF-α pathway proteins. These results offer a potential therapeutic strategy for the treatment of VMC. - Highlights: • Halofuginone (HF) increases the survival of suckling BALB/c mice infected with acute CVB3. • HF reduces the expression of Th17 cell markers (IL-17 and IL-23) and the number of CD4{sup +} IL17{sup +} cells. • Pro-inflammatory cytokines levels associated with myocarditis were reduced by HF in CVB3-treated suckling mice. • HF alleviates VMC via inhibition of TGF-β1-mediated NF-κB p65/TNF-α pathway.

Insomnia symptoms and risk for unintentional fatal injuries--the HUNT Study.

Science.gov (United States)

Laugsand, Lars Erik; Strand, Linn B; Vatten, Lars J; Janszky, Imre; Bjørngaard, Johan Håkon

2014-11-01

To assess the association between insomnia symptoms and risk of fatal unintentional injuries. Population-based prospective cohort study with a mean follow-up of 14 y, linking health survey data with information on insomnia symptoms to the National Cause of Death Registry. Nord-Trøndelag County, Norway. A total of 54,399 men and women 20-89 y of age who participated in the Nord-Trøndelag Health Study between 1995 and 1997. N/A. There were 277 unintentional fatal injuries, including 57 fatal motor vehicle injuries during follow-up. There was a dose-dependent association between the number of insomnia symptoms and risk of unintentional fatal injuries (P for trend 0.001) and fatal motor vehicle injuries (P for trend 0.023), respectively. The proportion of unintentional fatal injuries cases that could have been prevented in the absence of difficulties initiating sleep, difficulties maintaining sleep, and having a feeling of nonrestorative sleep were 8%, 9%, and 8%, respectively. The corresponding estimates for motor vehicle injuries were 34%, 11%, and 10%. Insomnia is a major contributor to both unintentional fatal injuries in general as well as fatal motor vehicle injuries. Increasing public health awareness about insomnia and identifying persons with insomnia may be important in preventing unintentional fatal injuries.

Diagnóstico da infecção por Bartonella spp.: a propósito de um caso de angiomatose bacilar Diagnosis of Bartonella spp. infection: study of a bacillary angiomatosis case

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Paulo Eduardo Neves Ferreira Velho

2006-08-01

Full Text Available Várias dermatoses são consideradas idiopáticas. Muitas vezes, afecções como eritema nodoso ou eritema multiforme, por exemplo, não podem ter sua etiologia definida. A infecção humana por Bartonella spp. pode determinar várias expressões clínicas sindrômicas. A partir de um caso de angiomatose bacilar com documentação clínica, histológica e ultra-estrutural, foi feita a revisão da literatura médica para avaliar os critérios diagnósticos disponíveis para a infecção por esses agentes. Conclui-se que a avaliação histológica é, na prática, um importante e útil método diagnóstico, especialmente quando a sorologia não estiver disponível.Several dermatoses are considered idiopathic diseases. Many times lesions such as erythema nodosum or erythema multiformis, for example, cannot have their etiology defined. Human infection caused by Bartonella spp. may determine several clinical syndromic expressions. Starting with a clinically, histologically and ultrastructurally documented bacillary angiomatosis case, a review of medical literature was undertaken to evaluate the available diagnostic criteria regarding infection caused by these agents. Histological evaluations were concluded to be, practically speaking, an important and useful diagnostic method, especially when serology is not available.

Seroprevalence of Toxoplasma gondii and concurrent bartonella spp., feline immunodeficiency virus, and feline leukemia infections in cats from Grenada, West Indies

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Toxoplasma gondii and Bartonella spp. are zoonotic pathogens of cats. Feline Immunodeficiency Virus (FIV), and Feline Leukemia Virus (FeLv) are related to Human Iimmunodeficiency Virus, and Human Leukemia Virus, respectively, and these viruses are immunosuppressive. In the present study, the prevale...

Mao-to Prolongs the Survival of and Reduces TNF-α Expression in Mice with Viral Myocarditis

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Zhu Shijie

2010-01-01

Full Text Available Goal of this study was to evaluate effects of Mao-to on development of myocarditis induced by encephalomyocarditis (EMC virus in mice. Mice were randomly divided into five groups. Group N included uninfected controls (n = 18, while group A, B and C underwent intraperitoneal injection of EMC virus. Group A was administered oral saline from day 0 to day 4. Group B was administered oral Mao-to (500 mg−1 kg−1 day−1 from day 0 to day 4. Group C was administered Mao-to from day 2 to day 6. Group D was administered Mao-to from day 5 to day 10. Treated mice were followed for survival rates during 2 weeks after infection. Body weight (BW and organ weights including heart (HW, lungs, thymus and spleen were examined on days 4, 6 and 14. Survival rate of group C (36.4% was significantly improved compared with group A, B or D (0% of each, P < 0.05. HW and HW/BW ratio in group C was significantly (P < 0.05 lower than those in group A, B or D. Viral titers of hearts were significantly different among groups A, B and C. Cardiac expression in tumor necrosis factor-α (TNF-α was significantly reduced in group C in comparison with group A, B or D on day 6 by immunohistochemical study. Administration of Mao-to starting on day 2 improves mortality resulting from viral myocarditis in mice with reduced expression of cardiac TNF-α. These findings suggest that timing of Mao-to is crucial for preventing cardiac damage in mice with viral myocarditis.

Detection of relapsing fever Borrelia spp., Bartonella spp. and Anaplasmataceae bacteria in argasid ticks in Algeria.

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Lafri, Ismail; El Hamzaoui, Basma; Bitam, Idir; Leulmi, Hamza; Lalout, Reda; Mediannikov, Oleg; Chergui, Mohamed; Karakellah, Mohamed; Raoult, Didier; Parola, Philippe

2017-11-01

Argasid ticks (soft ticks) are blood-feeding arthropods that can parasitize rodents, birds, humans, livestock and companion animals. Ticks of the Ornithodoros genus are known to be vectors of relapsing fever borreliosis in humans. In Algeria, little is known about relapsing fever borreliosis and other bacterial pathogens transmitted by argasid ticks. Between May 2013 and October 2015, we investigated the presence of soft ticks in 20 rodent burrows, 10 yellow-legged gull (Larus michahellis) nests and animal shelters in six locations in two different bioclimatic zones in Algeria. Six species of argasid ticks were identified morphologically and through 16S rRNA gene sequencing. The presence and prevalence of Borrelia spp., Bartonella spp., Rickettsia spp. and Anaplasmataceae was assessed by qPCR template assays in each specimen. All qPCR-positive samples were confirmed by standard PCR, followed by sequencing the amplified fragments. Two Borrelia species were identified: Borrelia hispanica in Ornithodoros occidentalis in Mostaganem, and Borrelia cf. turicatae in Carios capensis in Algiers. One new Bartonella genotype and one new Anaplasmataceae genotype were also identified in Argas persicus. The present study highlights the presence of relapsing fever borreliosis agents, although this disease is rarely diagnosed in Algeria. Other bacteria of unknown pathogenicity detected in argasid ticks which may bite humans deserve further investigation.

Reporting Fatal Neglect in Child Death Review.

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Scott, Debbie

2018-01-01

Child death reviews are conducted with the aim of preventing child deaths however, definitions, inclusion criteria for the review of child deaths and reporting practices vary across Child Death Review Teams (CDRTs). This article aims to identify a common context and understanding of fatal neglect reporting by reviewing definitional issues of fatal neglect and comparing reporting practice across a number of CDRTs. Providing a consistent context for identifying and reporting neglect-related deaths may improve the understanding of the impact of fatal neglect and the risk factors associated with it and therefore, improve the potential of CDRT review to inform prevention programs, policies, and procedures.

Bartonella henselae trimeric autotransporter adhesin BadA expression interferes with effector translocation by the VirB/D4 type IV secretion system.

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Lu, Yun-Yueh; Franz, Bettina; Truttmann, Matthias C; Riess, Tanja; Gay-Fraret, Jérémie; Faustmann, Marco; Kempf, Volkhard A J; Dehio, Christoph

2013-05-01

The Gram-negative, zoonotic pathogen Bartonella henselae is the aetiological agent of cat scratch disease, bacillary angiomatosis and peliosis hepatis in humans. Two pathogenicity factors of B. henselae - each displaying multiple functions in host cell interaction - have been characterized in greater detail: the trimeric autotransporter Bartonella adhesin A (BadA) and the type IV secretion system VirB/D4 (VirB/D4 T4SS). BadA mediates, e.g. binding to fibronectin (Fn), adherence to endothelial cells (ECs) and secretion of vascular endothelial growth factor (VEGF). VirB/D4 translocates several Bartonella effector proteins (Beps) into the cytoplasm of infected ECs, resulting, e.g. in uptake of bacterial aggregates via the invasome structure, inhibition of apoptosis and activation of a proangiogenic phenotype. Despite this knowledge of the individual activities of BadA or VirB/D4 it is unknown whether these major virulence factors affect each other in their specific activities. In this study, expression and function of BadA and VirB/D4 were analysed in a variety of clinical B. henselae isolates. Data revealed that most isolates have lost expression of either BadA or VirB/D4 during in vitro passages. However, the phenotypic effects of coexpression of both virulence factors was studied in one clinical isolate that was found to stably coexpress BadA and VirB/D4, as well as by ectopic expression of BadA in a strain expressing VirB/D4 but not BadA. BadA, which forms a dense layer on the bacterial surface, negatively affected VirB/D4-dependent Bep translocation and invasome formation by likely preventing close contact between the bacterial cell envelope and the host cell membrane. In contrast, BadA-dependent Fn binding, adhesion to ECs and VEGF secretion were not affected by a functional VirB/D4 T4SS. The obtained data imply that the essential virulence factors BadA and VirB/D4 are likely differentially expressed during different stages of the infection cycle of

Severe necrotizing myocarditis caused by serratia marcescens infection in an axolotl (Ambystoma mexicanum).

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Del-Pozo, J; Girling, S; Pizzi, R; Mancinelli, E; Else, R W

2011-05-01

This report provides the first account of the pathological changes associated with infection by Serratia marcescens in an adult male axolotl. The infection resulted in septicaemia with severe multifocal necrotizing myocarditis. The latter lesion evolved to cardiac rupture, haemopericardium and death resulting from cardiac tamponade. This animal was exposed to higher than usual temperatures (24-25 °C) 2 weeks before the onset of disease and this may have resulted in immunocompromise and opportunistic bacterial infection. S. marcescens was isolated from the coelomic and pericardial cavity. Both isolates were identical and were resistant to β-lactam antibiotics, but not to aminoglycosides or fluoroquinolones. The production of red prodigiosin pigment by the bacterium suggested an environmental origin. Overall, the clinical and histopathological presentation suggests that S. marcescens should be included in the list of aetiological agents of the 'red-leg'/bacterial dermatosepticaemia syndrome of amphibians. Copyright © 2010 Elsevier Ltd. All rights reserved.

Uber and Metropolitan Traffic Fatalities in the United States.

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Brazil, Noli; Kirk, David S

2016-08-01

Uber and similar rideshare services are rapidly dispersing in cities across the United States and beyond. Given the convenience and low cost, Uber has been characterized as a potential countermeasure for reducing the estimated 121 million episodes of drunk driving and the 10,000 resulting traffic fatalities that occur annually in the United States. We exploited differences in the timing of the deployment of Uber in US metropolitan counties from 2005 to 2014 to test the association between the availability of Uber's rideshare services and total, drunk driving-related, and weekend- and holiday-specific traffic fatalities in the 100 most populated metropolitan areas in the United States using negative binomial and Poisson regression models. We found that the deployment of Uber services in a given metropolitan county had no association with the number of subsequent traffic fatalities, whether measured in aggregate or specific to drunk-driving fatalities or fatalities during weekends and holidays. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Unusual echocardiographic features seen in a case of giant cell myocarditis.

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Kochar, Minisha; López-Candales, Angel; Ramani, Gautam; Rajagopalan, Navin; Edelman, Kathy

2008-11-01

The case of an 18-year-old college football player with a recent history of streptococcal pharyngitis who was experiencing progressive disabling dyspnea on exertion with easy fatigability and lack of stamina, and was taken to the hospital after a syncopal episode is described. The patient was initially diagnosed with heart failure and treated accordingly. However, because of a fulminant clinical deterioration, an endomyocardial biopsy was recommended, which showed focal giant cell transformation consistent with giant cell myocarditis. Treatment with methylprednisolone and cyclosporine was promptly initiated. Several apical clots were noted during treatment, but the patient attained full recovery with treatment.

Fatal work injuries involving natural disasters, 1992-2006.

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Fayard, Gregory M

2009-12-01

Although a goal of disaster preparedness is to protect vulnerable populations from hazards, little research has explored the types of risks that workers face in their encounters with natural disasters. This study examines how workers are fatally injured in severe natural events. A classification structure was created that identified the physical component of the disaster that led to the death and the pursuit of the worker as it relates to the disaster. Data on natural disasters from the Census of Fatal Occupational Injuries for the years 1992 through 2006 were analyzed. A total of 307 natural disaster deaths to workers were identified in 1992-2006. Most fatal occupational injuries were related to wildfires (80 fatalities), hurricanes (72 fatalities), and floods (62 fatalities). Compared with fatal occupational injuries in general, natural disaster fatalities involved more workers who were white and more workers who were working for the government. Most wildfire fatalities stemmed directly from exposure to fire and gases and occurred to those engaged in firefighting, whereas hurricane fatalities tended to occur more independently of disaster-produced hazards and to workers engaged in cleanup and reconstruction. Those deaths related to the 2005 hurricanes occurred a median of 36.5 days after landfall of the associated storm. Nearly half of the flood deaths occurred to passengers in motor vehicles. Other disasters included tornadoes (33 fatalities), landslides (17), avalanches (16), ice storms (14), and blizzards (9). Despite an increasing social emphasis on disaster preparation and response, there has been little increase in expert knowledge about how people actually perish in these large-scale events. Using a 2-way classification structure, this study identifies areas of emphasis in preventing occupational deaths from various natural disasters.

Community Poverty and Child Abuse Fatalities in the United States.

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Farrell, Caitlin A; Fleegler, Eric W; Monuteaux, Michael C; Wilson, Celeste R; Christian, Cindy W; Lee, Lois K

2017-05-01

Child maltreatment remains a problem in the United States, and individual poverty is a recognized risk factor for abuse. Children in impoverished communities are at risk for negative health outcomes, but the relationship of community poverty to child abuse fatalities is not known. Our objective was to evaluate the association between county poverty concentration and rates of fatal child abuse. This was a retrospective, cross-sectional analysis of child abuse fatalities in US children 0 to 4 years of age from 1999 to 2014 by using the Centers for Disease Control and Prevention Compressed Mortality Files. Population and poverty statistics were obtained from US Census data. National child abuse fatality rates were calculated for each category of community poverty concentration. Multivariate negative binomial regression modeling assessed the relationship between county poverty concentration and child abuse fatalities. From 1999 to 2014, 11 149 children 0 to 4 years old died of child abuse; 45% (5053) were poverty concentration had >3 times the rate of child abuse fatalities compared with counties with the lowest poverty concentration (adjusted incidence rate ratio, 3.03; 95% confidence interval, 2.4-3.79). Higher county poverty concentration is associated with increased rates of child abuse fatalities. This finding should inform public health officials in targeting high-risk areas for interventions and resources. Copyright © 2017 by the American Academy of Pediatrics.

Underlying causal factors associated with construction worker fatalities involving stepladders

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Aneurin Thomas James Grant

2013-03-01

Full Text Available Stepladders are frequently utilized on construction projects as a means of access to elevation. Stepladder heights commonly range from 4 feet (1.2 m to 14 feet (4.3 m. Since these heights are not extreme, there is a common misperception that stepladder use presents a low risk. On the contrary, extreme care must be exercised to ensure that work on stepladders is performed safely, as described in the conspicuously located recommendations and brightly-colored warnings that adorn virtually all newly-purchased equipment. Despite this, accidents involving stepladders occur on a regular basis.  This study was conducted to better understand the underlying causes of these accidents. The narrative descriptions of 180 stepladder-related fatalities were obtained from the U.S. Occupational Safety and Health Administration and were analyzed to identify the at-risk behaviors that preceded the fatality incidents. The results showed that most of the incidents should have been anticipated and could have been avoided. Unsafe practices such as improper lockout-tagout of electrical equipment, loss of balance, working on a folded stepladder, over-reaching, straddling the ladder, “walking” the ladder, poor footing, and unstable/shifting ladders, among others were identified. Virtually all of these fatalities could have been avoided by adhering to the guidelines posted on the stepladders and by complying with basic safe construction practices. 

Underlying causal factors associated with construction worker fatalities involving stepladders

Directory of Open Access Journals (Sweden)

Aneurin Thomas James Grant

2013-03-01

Full Text Available Stepladders are frequently utilized on construction projects as a means of access to elevation. Stepladder heights commonly range from 4 feet (1.2 m to 14 feet (4.3 m. Since these heights are not extreme, there is a common misperception that stepladder use presents a low risk. On the contrary, extreme care must be exercised to ensure that work on stepladders is performed safely, as described in the conspicuously located recommendations and brightly-colored warnings that adorn virtually all newly-purchased equipment. Despite this, accidents involving stepladders occur on a regular basis.  This study was conducted to better understand the underlying causes of these accidents. The narrative descriptions of 180 stepladder-related fatalities were obtained from the U.S. Occupational Safety and Health Administration and were analyzed to identify the at-risk behaviors that preceded the fatality incidents. The results showed that most of the incidents should have been anticipated and could have been avoided. Unsafe practices such as improper lockout-tagout of electrical equipment, loss of balance, working on a folded stepladder, over-reaching, straddling the ladder, “walking” the ladder, poor footing, and unstable/shifting ladders, among others were identified. Virtually all of these fatalities could have been avoided by adhering to the guidelines posted on the stepladders and by complying with basic safe construction practices.

Initial Experience With Simultaneous 18F-FDG PET/MRI in the Evaluation of Cardiac Sarcoidosis and Myocarditis.

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Hanneman, Kate; Kadoch, Michael; Guo, Henry H; Jamali, Mehran; Quon, Andrew; Iagaru, Andrei; Herfkens, Robert

2017-07-01

The purpose of this study was to compare combined PET/MRI with PET/CT and cardiac MRI in the evaluation of cardiac sarcoidosis and myocarditis. Ten patients (4 men and 6 women; 56.1 ± 9.6 years old) were prospectively enrolled for evaluation of suspected cardiac sarcoidosis or myocarditis. Written informed consent was obtained. Following administration of 9.9 ± 0.9 mCi F-FDG, patients underwent standard cardiac PET/CT followed by combined PET/MRI using a simultaneous 3-T scanner. Cardiac MRI sequences included ECG-triggered cine SSFP, T2-weighted, and late gadolinium-enhanced imaging. Myocardial involvement was assessed with separate analysis of combined PET/MRI, PET/CT, and cardiac MRI data using dedicated postprocessing software. Estimates of radiation dose were derived from the applied doses of F-FDG and CT protocol parameters. Imaging was acquired with a delay from F-FDG injection of 90.2 ± 27.4 minutes for PET/CT and 207.7 ± 40.3 minutes for PET/MRI. Total scan time for PET/MRI was significantly longer than for PET/CT (81.4 ± 14.8 vs 12.0 minutes, P PET/MRI compared with PET/CT (6.9 ± 0.6 vs 8.2 ± 1.1 mSv, P = 0.007). There was no significant difference in the number of positive cases identified between combined PET/MRI (n = 10 [100%]), PET/CT (n = 6 [60%]), and cardiac MRI (n = 8 [80%]), P = 0.091. Simultaneous cardiac PET/MRI is feasible in the evaluation of cardiac sarcoidosis and myocarditis achieving diagnostic image quality.

Effect of mobile phone proliferation on crash notification times and fatality rates.

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Stickles, Jimmy L; Kempema, James M; Brown, Lawrence H

2018-01-01

The purpose of this study was to evaluate whether increased proliferation of mobile telephones has been associated with decreased MVC notification times and/or decreased MVC fatality rates in the United States (US). We used World Bank annual mobile phone market penetration data and US Fatality Analysis Reporting System (FARS) fatal MVC data for 1994-2014. For each year, phone proliferation was measured as mobile phones per 100 population. FARS data were used to calculate MVC notification time (time EMS notified - time MVC occurred) in minutes, and to determine the MVC fatality rate per billion vehicle miles traveled (BVMT). We used basic vector auto-regression modeling to explore relationships between changes in phone proliferation and subsequent changes in median and 90th percentile MVC notification times, as well as MVC fatality rates. From 1994 to 2014, larger year-over-year increases in phone proliferation were associated with larger decreases in 90th percentile notification times for MVCs occurring during daylight hours (p=0.004) and on the national highway system (p=0.046) two years subsequent, and crashes off the national highway system three years subsequent (p=0.023). There were no significant associations between changes in phone proliferation and subsequent changes in median crash notification times, nor with subsequent changes in MVC fatality rates. Between 1994 and 2014 increased mobile phone proliferation in the U.S. was associated with shorter 90th percentile EMS notification times for some subgroups of fatal MVCs, but not with decreases in median notification times or overall MVC fatality rates. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors Associated with Fatality during the Intensive Phase of Anti-Tuberculosis Treatment

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Casals, M.; Caminero, J. A.; García-García, J. M.; Jiménez-Fuentes, M. A.; Medina, J. F.; Millet, J. P.; Ruiz-Manzano, J.; Caylá, J.

2016-01-01

Objective To determine the case-fatality rate (CFR) at the end of the intensive phase of tuberculosis (TB) treatment, and factors associated with fatality. Methods TB patients diagnosed between 2006 and 2013 were followed-up during treatment. We computed the CFR at the end of the intensive phase of TB treatment, and the incidence of death per 100 person-days (pd) of follow-up. We performed survival analysis using the Kaplan-Meier method and Cox regression, and calculate hazard ratios (HR) and 95% confidence intervals (CI). Results A total of 5,182 patients were included, of whom 180 (3.5%) died; 87 of these deaths (48.3%) occurred during the intensive phase of treatment, with a CFR of 1.7%. The incidence of death was 0.028/100 pd. The following factors were associated with death during the intensive phase: being >50 years (HR = 36.9;CI:4.8–283.4); being retired (HR = 2.4;CI:1.1–5.1); having visited the emergency department (HR = 3.1;CI:1.2–7.7); HIV infection (HR = 3.4;CI:1.6–7.2); initial standard treatment with 3 drugs (HR = 2.0;CI:1.2–3.3) or non-standard treatments (HR = 2.68;CI:1.36–5.25); comprehension difficulties (HR = 2.8;CI:1.3–6.1); and smear-positive sputum (HR = 2.3-CI:1.0–4.8). Conclusion There is a non-negligible CFR during the intensive phase of TB, whose reduction should be prioritised. The CFR could be a useful indicator for evaluating TB programs. PMID:27487189

Value of CT in the Discrimination of Fatal from Non-Fatal Stercoral Colitis

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Wu, Cheng Hsien; Huang, Chen Chin; Wang, Li Jen; Wong, Yon Cheng; Wang, Chao Jan; Lo, Wang Chak; Lin, Being Chuan; Wan, Yung Liang; Haueh, Chuen [Chang Gung Memorial Hospital, Chang Gung University, Taoyuan (China)

2012-06-15

Clinical presentation and physical signs may be unreliable in the diagnosis of stercoral colitis (SC). This study evaluates the value of computed tomography (CT) in distinguishing fatal from non-fatal SC. Ten patients diagnosed as SC were obtained from inter-specialist conferences. Additional 13 patients with suspected SC were identified via the Radiology Information System (RIS). These patients were divided into two groups; fatal and non-fatal SCs. Their CT images are reviewed by two board-certified radiologists blinded to the clinical data and radiographic reports. SC occurred in older patients and displayed no gender predisposition. There was significant correlation between fatal SC and CT findings of dense mucosa (p 0.017), perfusion defects (p = 0.026), ascites (p = 0.023), or abnormal gas (p = 0.033). The sensitivity, specificity, and accuracy of dense mucosa were 71%, 86%, and 81%, respectively. These figures were 75%, 79%, and 77% for perfusion defects; 75%, 80%, and 78% for ascites; and 50%, 93%, and 78% for abnormal gas, respectively. Each CT sign of mucosal sloughing and pericolonic abscess displayed high specificity of 100% and 93% for diagnosing fatal SC, respectively. However, this did not reach statistical significance in diagnosing fatal SC. CT appears to be valuable in discriminating fatal from non-fatal SC.

Value of CT in the Discrimination of Fatal from Non-Fatal Stercoral Colitis

International Nuclear Information System (INIS)

Wu, Cheng Hsien; Huang, Chen Chin; Wang, Li Jen; Wong, Yon Cheng; Wang, Chao Jan; Lo, Wang Chak; Lin, Being Chuan; Wan, Yung Liang; Haueh, Chuen

2012-01-01

Clinical presentation and physical signs may be unreliable in the diagnosis of stercoral colitis (SC). This study evaluates the value of computed tomography (CT) in distinguishing fatal from non-fatal SC. Ten patients diagnosed as SC were obtained from inter-specialist conferences. Additional 13 patients with suspected SC were identified via the Radiology Information System (RIS). These patients were divided into two groups; fatal and non-fatal SCs. Their CT images are reviewed by two board-certified radiologists blinded to the clinical data and radiographic reports. SC occurred in older patients and displayed no gender predisposition. There was significant correlation between fatal SC and CT findings of dense mucosa (p 0.017), perfusion defects (p = 0.026), ascites (p = 0.023), or abnormal gas (p = 0.033). The sensitivity, specificity, and accuracy of dense mucosa were 71%, 86%, and 81%, respectively. These figures were 75%, 79%, and 77% for perfusion defects; 75%, 80%, and 78% for ascites; and 50%, 93%, and 78% for abnormal gas, respectively. Each CT sign of mucosal sloughing and pericolonic abscess displayed high specificity of 100% and 93% for diagnosing fatal SC, respectively. However, this did not reach statistical significance in diagnosing fatal SC. CT appears to be valuable in discriminating fatal from non-fatal SC.

STUDY OF CARDIAC INVOLVEMENT IN DIPHTHERIA

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Bala Raju Gundam

2016-07-01

Full Text Available BACKGROUND Diphtheria still endemic in many developing countries and is responsible for high case fatality. Myocardial involvement is a serious complication of diphtheria and diphtheria myocarditis frequently complicated by arrhythmias causes sudden death if not managed properly. So, early and adequate administration of Anti-Diphtheritic Serum (ADS and frequent monitoring particularly 24 hrs. ECG monitoring is helpful to detect any serious cardiac arrhythmias. METHODS A prospective study on patients who were culture positive diagnosed on the basis of WHO definition were treated and analysed in respect to homographic details, immunisation strategy, and clinical features with particular attention to myocarditis. RESULTS In the study, common age group affected by diphtheria was 5 to 10 years. Incidence of myocarditis more in same age group. Out of 64 patients with myocarditis, 23 patients died. CONCLUSION Incidence of diphtheria has increased in the recent years. Commonly effected age group is 5 to 10 years and most of them are presented with asymptomatic myocarditis. Symptomatic diphtheritic myocarditis has high mortality rate even with aggressive management. Patient who presented with either LBBB alone are with combination of other conduction of abnormalities has high mortality rate.

Parallel Evolution of a Type IV Secretion System in Radiating Lineages of the Host-Restricted Bacterial Pathogen Bartonella

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Engel, Philipp; Salzburger, Walter; Liesch, Marius; Chang, Chao-Chin; Maruyama, Soichi; Lanz, Christa; Calteau, Alexandra; Lajus, Aurélie; Médigue, Claudine; Schuster, Stephan C.; Dehio, Christoph

2011-01-01

Adaptive radiation is the rapid origination of multiple species from a single ancestor as the result of concurrent adaptation to disparate environments. This fundamental evolutionary process is considered to be responsible for the genesis of a great portion of the diversity of life. Bacteria have evolved enormous biological diversity by exploiting an exceptional range of environments, yet diversification of bacteria via adaptive radiation has been documented in a few cases only and the underlying molecular mechanisms are largely unknown. Here we show a compelling example of adaptive radiation in pathogenic bacteria and reveal their genetic basis. Our evolutionary genomic analyses of the α-proteobacterial genus Bartonella uncover two parallel adaptive radiations within these host-restricted mammalian pathogens. We identify a horizontally-acquired protein secretion system, which has evolved to target specific bacterial effector proteins into host cells as the evolutionary key innovation triggering these parallel adaptive radiations. We show that the functional versatility and adaptive potential of the VirB type IV secretion system (T4SS), and thereby translocated Bartonella effector proteins (Beps), evolved in parallel in the two lineages prior to their radiations. Independent chromosomal fixation of the virB operon and consecutive rounds of lineage-specific bep gene duplications followed by their functional diversification characterize these parallel evolutionary trajectories. Whereas most Beps maintained their ancestral domain constitution, strikingly, a novel type of effector protein emerged convergently in both lineages. This resulted in similar arrays of host cell-targeted effector proteins in the two lineages of Bartonella as the basis of their independent radiation. The parallel molecular evolution of the VirB/Bep system displays a striking example of a key innovation involved in independent adaptive processes and the emergence of bacterial pathogens

Parallel evolution of a type IV secretion system in radiating lineages of the host-restricted bacterial pathogen Bartonella.

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Philipp Engel

2011-02-01

Full Text Available Adaptive radiation is the rapid origination of multiple species from a single ancestor as the result of concurrent adaptation to disparate environments. This fundamental evolutionary process is considered to be responsible for the genesis of a great portion of the diversity of life. Bacteria have evolved enormous biological diversity by exploiting an exceptional range of environments, yet diversification of bacteria via adaptive radiation has been documented in a few cases only and the underlying molecular mechanisms are largely unknown. Here we show a compelling example of adaptive radiation in pathogenic bacteria and reveal their genetic basis. Our evolutionary genomic analyses of the α-proteobacterial genus Bartonella uncover two parallel adaptive radiations within these host-restricted mammalian pathogens. We identify a horizontally-acquired protein secretion system, which has evolved to target specific bacterial effector proteins into host cells as the evolutionary key innovation triggering these parallel adaptive radiations. We show that the functional versatility and adaptive potential of the VirB type IV secretion system (T4SS, and thereby translocated Bartonella effector proteins (Beps, evolved in parallel in the two lineages prior to their radiations. Independent chromosomal fixation of the virB operon and consecutive rounds of lineage-specific bep gene duplications followed by their functional diversification characterize these parallel evolutionary trajectories. Whereas most Beps maintained their ancestral domain constitution, strikingly, a novel type of effector protein emerged convergently in both lineages. This resulted in similar arrays of host cell-targeted effector proteins in the two lineages of Bartonella as the basis of their independent radiation. The parallel molecular evolution of the VirB/Bep system displays a striking example of a key innovation involved in independent adaptive processes and the emergence of bacterial

States with low non-fatal injury rates have high fatality rates and vice-versa.

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Mendeloff, John; Burns, Rachel

2013-05-01

State-level injury rates or fatality rates are sometimes used in studies of the impact of various safety programs or other state policies. How much does the metric used affect the view of relative occupational risks among U.S. states? This paper uses a measure of severe injuries (fatalities) and of less severe injuries (non-fatal injuries with days away from work, restricted work, or job transfer-DART) to examine that issue. We looked at the correlation between the average DART injury rate (from the BLS Survey of Occupational Injuries and Illnesses) and an adjusted average fatality rate (from the BLS Census of Fatal Occupational Injuries) in the construction sector for states for 2003-2005 and for 2006-2008. The RAND Human Subjects Protection Committee determined that this study was exempt from review. The correlations between the fatal and non-fatal injury rates were between -0.30 and -0.70 for all construction and for the subsector of special trade contractors. The negative correlation was much smaller between the rate of fatal falls from heights and the rate of non-fatal falls from heights. Adjusting for differences in the industry composition of the construction sector across states had minor effects on these results. Although some have suggested that fatal and non-fatal injury rates should not necessarily be positively correlated, no one has suggested that the correlation is negative, which is what we find. We know that reported non-fatal rates are influenced by workers' compensation benefits and other factors. Fatality rates appear to be a more valid measure of risk. Efforts to explain the variations that we find should be undertaken. Copyright © 2012 Wiley Periodicals, Inc.

Adult Kawasaki's disease with myocarditis, splenomegaly, and highly elevated serum ferritin levels.

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Cunha, Burke A; Pherez, Francisco M; Alexiadis, Varvara; Gagos, Marios; Strollo, Stephanie

2010-01-01

Kawasaki's disease is a disease of unknown cause. The characteristic clinical features of Kawasaki's disease are fever> or =102 degrees F for> or =5 days accompanied by a bilateral bulbar conjunctivitis/conjunctival suffusion, erythematous rash, cervical adenopathy, pharyngeal erythema, and swelling of the dorsum of the hands/feet. Kawasaki's disease primarily affects children and is rare in adults. In children, Kawasaki's disease is more likely to be associated with aseptic meningitis, coronary artery aneurysms, and thrombocytosis. In adult Kawasaki's disease, unilateral cervical adenopathy, arthritis, conjunctival suffusion/conjunctivitis, and elevated serum transaminases (serum glutamic oxaloacetic transaminase [SGOT]/serum glutamate pyruvate transaminase [SGPT]) are more likely. Kawasaki's disease in adults may be mimicked by other acute infections with fever and rash, that is, group A streptococcal scarlet fever, toxic shock syndrome (TSS), and Rocky Mountain Spotted Fever (RMSF). Because there are no specific tests for Kawasaki's disease, diagnosis is based on clinical criteria and the syndromic approach. In addition to rash and fever, scarlet fever is characterized by circumoral pallor, oropharyngeal edema, Pastia's lines, and peripheral eosinophilia, but not conjunctival suffusion, splenomegaly, swelling of the dorsum of the hands/feet, thrombocytosis, or an elevated SGOT/SGPT. In TSS, in addition to rash and fever, there is conjunctival suffusion, oropharyngeal erythema, and edema of the dorsum of the hands/feet, an elevated SGOT/SGPT, and thrombocytopenia. Patients with TSS do not have cervical adenopathy or splenomegaly. RMSF presents with fever and a maculopapular rash that becomes petechial, first appearing on the wrists/ankles after 3 to 5 days. RMSF is accompanied by a prominent headache, periorbital edema, conjunctival suffusion, splenomegaly, thrombocytopenia, an elevated SGOT/SGPT, swelling of the dorsum of the hands/feet, but not oropharyngeal

Fuel economy and traffic fatalities: multivariate analysis of international data

International Nuclear Information System (INIS)

Noland, Robert B.

2005-01-01

In the US motor vehicle fuel economy standards were imposed in the late 1970s, in response to the oil crises of that decade. Since then, efforts to increase the standards have not occurred, one reason being the argument that smaller vehicles (which are generally more efficient) are considered less safe. Recent analyses (Energy J.( 2004)) suggests that variance in vehicle weights may be more important than the absolute weights of vehicles in making the highway network less safe. In Europe and other countries, which generally have smaller more efficient vehicle fleets, due to relatively high gasoline taxes, this debate has not occurred. In particular, countries such as Great Britain and Sweden have far safer road transport systems than the US but also have much more efficient vehicle fleets. This suggests that either vehicle weight and size are unimportant or if they have an effect it is small compared to other factors. This paper uses international data to build econometric models that examine whether average vehicle fuel economy has any association with road traffic fatalities, while controlling for other factors that are associated with fatalities. The effect on pedestrian fatalities is also analyzed. Cross-sectional time-series data on traffic fatalities from OECD countries is used and negative binomial regression models are developed using panel data to determine whether any associations are present. Results find that changes in vehicle efficiency are not associated with changes in traffic fatalities, suggesting either that size and weight changes over time have not had a strong effect or are not associated with fuel economy improvements

Detection of relapsing fever Borrelia spp., Bartonella spp. and Anaplasmataceae bacteria in argasid ticks in Algeria.

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Ismail Lafri

2017-11-01

Full Text Available Argasid ticks (soft ticks are blood-feeding arthropods that can parasitize rodents, birds, humans, livestock and companion animals. Ticks of the Ornithodoros genus are known to be vectors of relapsing fever borreliosis in humans. In Algeria, little is known about relapsing fever borreliosis and other bacterial pathogens transmitted by argasid ticks.Between May 2013 and October 2015, we investigated the presence of soft ticks in 20 rodent burrows, 10 yellow-legged gull (Larus michahellis nests and animal shelters in six locations in two different bioclimatic zones in Algeria. Six species of argasid ticks were identified morphologically and through 16S rRNA gene sequencing. The presence and prevalence of Borrelia spp., Bartonella spp., Rickettsia spp. and Anaplasmataceae was assessed by qPCR template assays in each specimen. All qPCR-positive samples were confirmed by standard PCR, followed by sequencing the amplified fragments. Two Borrelia species were identified: Borrelia hispanica in Ornithodoros occidentalis in Mostaganem, and Borrelia cf. turicatae in Carios capensis in Algiers. One new Bartonella genotype and one new Anaplasmataceae genotype were also identified in Argas persicus.The present study highlights the presence of relapsing fever borreliosis agents, although this disease is rarely diagnosed in Algeria. Other bacteria of unknown pathogenicity detected in argasid ticks which may bite humans deserve further investigation.

Macroeconomic fluctuations and motorcycle fatalities in the U.S.

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French, Michael T; Gumus, Gulcin

2014-03-01

The effects of business cycles on health outcomes in general, and on traffic fatalities in particular, have received much attention recently. In this paper, we focus on motorcycle safety and examine the impact of changing levels of economic activity on fatal crashes by motorcyclists in the United States. We analyze state-level longitudinal data with 1,104 state/year observations from the 1988-2010 Fatality Analysis Reporting System (FARS). Using the extensive motorcycle crash characteristics available in FARS, we examine not only total fatality rates but also rates decomposed by crash type, day, time, and the level of the motorcycle operator's blood alcohol content. Our results are consistent with much of the existing literature showing that traffic fatality rates are pro-cyclical. The estimates suggest that a 10% increase in real income per capita is associated with a 10.4% rise in the total motorcycle fatality rate. Along with potential mechanisms, policymakers and public health officials should consider the effects of business cycles on motorcycle safety. Copyright © 2013 Elsevier Ltd. All rights reserved.

Fatal acute pancreatitis associated with reactive AA amyloidosis in rheumatoid arthritis with end-stage renal disease: a report of three cases.

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Kuroda, Takeshi; Sato, Hiroe; Hasegawa, Hisashi; Wada, Yoko; Murakami, Shuichi; Saeki, Takako; Nakano, Masaaki; Narita, Ichiei

2011-01-01

We report three cases of fatal pancreatitis associated with systemic AA amyloidosis in rheumatoid arthritis (RA). All of the patients showed end-stage renal failure, and hemodialysis was introduced during the course of treatment. Autopsy was performed on two of the three patients, and this revealed amyloid deposition on the vascular walls in the pancreas. It was strongly suggested that the acute pancreatitis in all three patients was attributable to deposition of amyloid in vascular and pancreatic tissues. Acute pancreatitis is considered to be a rare complication of end-stage amyloidosis associated with RA, and is frequently fatal. It is important to treat RA patients intensively to avoid such deposition of amyloid.

An examination of the environmental, driver and vehicle factors associated with the serious and fatal crashes of older rural drivers.

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Thompson, J P; Baldock, M R J; Mathias, J L; Wundersitz, L N

2013-01-01

Motor vehicle crashes involving rural drivers aged 75 years and over are more than twice as likely to result in a serious or fatal injury as those involving their urban counterparts. The current study examined some of the reasons for this using a database of police-reported crashes (2004-2008) to identify the environmental (lighting, road and weather conditions, road layout, road surface, speed limit), driver (driver error, crash type), and vehicle (vehicle age) factors that are associated with the crashes of older rural drivers. It also determined whether these same factors are associated with an increased likelihood of serious or fatal injury in younger drivers for whom frailty does not contribute to the resulting injury severity. A number of environmental (i.e., undivided, unsealed, curved and inclined roads, and areas with a speed limit of 100km/h or greater) and driver (i.e., collision with a fixed object and rolling over) factors were more frequent in the crashes of older rural drivers and additionally associated with increased injury severity in younger drivers. Moreover, when these environmental factors were entered into a logistic regression model to predict whether older drivers who were involved in crashes did or did not sustain a serious or fatal injury, it was found that each factor independently increased the likelihood of a serious or fatal injury. Changes, such as the provision of divided and sealed roads, greater protection from fixed roadside objects, and reduced speed limits, appear to be indicated in order to improve the safety of the rural driving environment for drivers of all ages. Additionally, older rural drivers should be encouraged to reduce their exposure to these risky circumstances. Copyright © 2012 Elsevier Ltd. All rights reserved.

111indium-antimyosin immunoscintigraphy in suspected myocarditis

International Nuclear Information System (INIS)

Krause, T.; Schuemichen, C.; Joseph, A.; Moser, E.; Zeiher, A.

1991-01-01

111 Indium-monoclonal antimyosin scans were carried out in 21 patients with suspected myocarditis, confirmed by reduced ejection volume, pericardial effusion and clinical follow up in 12 patients. Coronary heart disease was excluded angiographically in all cases. Quantitative evaluation of myocardial 111 In-antimyosin accumulation 48 hours after injection showed a pathological uptake in 10/12 patients with increased heart/lung ratios (Q 48 >1,58). Ratios were also elevated in 2 patients with cardiomyopathy, 2 suffering from vasculitis and 1 with dermatomyositis. Four patients without proven cardiac disease had normal ratios (Q 48 ≤1,58). Examination after 24 hours was of limited value, depending on the residual blood pool activity. Visual analysis of the scans showed a high interobserver variation despite a positive correlation with quantitative analysis (48 h p.i.: r=0,72; p 111 In-antimyosin scan as a screening method prior to myocardial biopsy. However, scintigraphy cannot definitely elucidate the cause of myocardial damage. Therefore, myocardial biopsy is still recommended after positive antimyosin scans. (orig.) [de

Fatal toxoplasmosis in a vinaceous Amazon parrot (Amazona vinacea).

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Ferreira, Francisco Carlos; Donatti, Rogerio Venâncio; Marques, Marcus Vinícius Romero; Ecco, Roselene; Preis, Ingred Sales; Shivaprasad, H L; Vilela, Daniel Ambrózio da Rocha; Martins, Nelson Rodrigo da Silva

2012-12-01

Toxoplasmosis was diagnosed in a vinaceous Amazon parrot based on histopathology and immunohistochemistry. The bird was prostrate on the bottom of the cage and died. Necropsy revealed edema and congestion of the lungs, cloudy air sacs, and mild hepatomegaly. Histopathology revealed severe pulmonary congestion and edema and interstitial mononuclear cell inflammation associated with many cysts containing bradyzoites of Toxoplasma gondii scattered throughout. The heart had mild multifocal lymphocytic myocarditis and free tachyzoites in the muscle fibers, and the kidneys had mild interstitial nephritis and a few cysts containing bradyzoites of T. gondii. Immunohistochemistry was negative for Sarcocystis falcatula and Neospora caninum and confirmed the protozoa as T. gondii. This is the first description of T. gondii in an endangered species ofa Brazilian psittacine.

Islamic fatalism

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Helmer Ringgren

1967-02-01

Full Text Available The author sketches the historical background, then the teaching of the Koran, and finally, the development of the typical Islamic fatalism. The fatalism of Islam has to be viewed against the background of the ideas of pre-Islamic Arabia. Unfortunately, there is no other evidence from this epoch that a few poems on a very restricted range of topics which have been able to survive Islamic censure. The conventional and stereotyped character of these poems makes it difficult to decide to what extent they reflect commonly accepted views or the ideas of a certain group. In any case, they present a picture of the pagan Arab which is extremely idealized and formed after a rigid pattern. Historically speaking, Islamic 'fatalism' is the result of a combination of pre-Islamic fatalism and Muhammad's belief in God's omnipotence. From another point of view it is an interpretation of destiny that expresses man's feeling of total dependence, not on an impersonal power or universal order, but on an omnipotent God.

Rapid reversal of heart failure in a patient with pheochromocytoma and catecholamine-induced myocarditis/cardiomyopathy

International Nuclear Information System (INIS)

Ahmed, I.; Sankaran, R.; Al-Addad, A.

2002-01-01

Pheochromocytoma is rare and usually presents as paroxysal or sustained hypertension, nonetheless, it can also cause severe acute pulmonary edema in normotensive individuals. We present a case with pheochromocytoma and severe left ventricular failure caused by catecholamine induced myocarditis/cardiomyopathy. Severe left ventricular failure resolved rapidly and left ventricular systolic function became normal within two weeks of medical treatment. Later, patient underwent elective and uneventful surgical removal of pheochromocytoma. (author)

Predictive value of cardiac magnetic resonance imaging-derived myocardial strain for poor outcomes in patients with acute myocarditis

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Lee, Ji Won; Jeong, Yeon Joo; Lee, Gee Won; Lee, Nam Kyung; Lee, Hye Won; Kim, Jin You [Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of); Choi, Bum Sung; Choo, Ki Seok [Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

2017-08-01

To evaluate the utility of cardiovascular magnetic resonance (CMR)-derived myocardial strain measurement for the prediction of poor outcomes in patients with acute myocarditis We retrospectively analyzed data from 37 patients with acute myocarditis who underwent CMR. Left ventricular (LV) size, LV mass index, ejection fraction and presence of myocardial late gadolinium enhancement (LGE) were analyzed. LV circumferential strain (EccSAX), radial strain (ErrSAX) from mid-ventricular level short-axis cine views and LV longitudinal strain (EllLV), radial strain (ErrLax) measurements from 2-chamber long-axis views were obtained. In total, 31 of 37 patients (83.8%) underwent follow-up echocardiography. The primary outcome was major adverse cardiovascular event (MACE). Incomplete LV functional recovery was a secondary outcome. During an average follow-up of 41 months, 11 of 37 patients (29.7%) experienced MACE. Multivariable Cox proportional hazard regression analysis, which included LV mass index, LV ejection fraction, the presence of LGE, EccSAX, ErrSAX, EllLV, and ErrLax values, indicated that the presence of LGE (hazard ratio, 42.88; p = 0.014), together with ErrLax (hazard ratio, 0.77 per 1%, p = 0.004), was a significant predictor of MACE. Kaplan-Meier analysis demonstrated worse outcomes in patient with LGE and an ErrLax value ≤ 9.48%. Multivariable backward regression analysis revealed that ErrLax values were the only significant predictors of LV functional recovery (hazard ratio, 0.54 per 1%; p = 0.042). CMR-derived ErrLax values can predict poor outcomes, both MACE and incomplete LV functional recovery, in patients with acute myocarditis, while LGE is only a predictor of MACE.

Estimating cost ratio distribution between fatal and non-fatal road accidents in Malaysia

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Hamdan, Nurhidayah; Daud, Noorizam

2014-07-01

Road traffic crashes are a global major problem, and should be treated as a shared responsibility. In Malaysia, road accident tragedies kill 6,917 people and injure or disable 17,522 people in year 2012, and government spent about RM9.3 billion in 2009 which cost the nation approximately 1 to 2 percent loss of gross domestic product (GDP) reported annually. The current cost ratio for fatal and non-fatal accident used by Ministry of Works Malaysia simply based on arbitrary value of 6:4 or equivalent 1.5:1 depends on the fact that there are six factors involved in the calculation accident cost for fatal accident while four factors for non-fatal accident. The simple indication used by the authority to calculate the cost ratio is doubted since there is lack of mathematical and conceptual evidence to explain how this ratio is determined. The main aim of this study is to determine the new accident cost ratio for fatal and non-fatal accident in Malaysia based on quantitative statistical approach. The cost ratio distributions will be estimated based on Weibull distribution. Due to the unavailability of official accident cost data, insurance claim data both for fatal and non-fatal accident have been used as proxy information for the actual accident cost. There are two types of parameter estimates used in this study, which are maximum likelihood (MLE) and robust estimation. The findings of this study reveal that accident cost ratio for fatal and non-fatal claim when using MLE is 1.33, while, for robust estimates, the cost ratio is slightly higher which is 1.51. This study will help the authority to determine a more accurate cost ratio between fatal and non-fatal accident as compared to the official ratio set by the government, since cost ratio is an important element to be used as a weightage in modeling road accident related data. Therefore, this study provides some guidance tips to revise the insurance claim set by the Malaysia road authority, hence the appropriate method

Effects of urban sprawl and vehicle miles traveled on traffic fatalities.

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Yeo, Jiho; Park, Sungjin; Jang, Kitae

2015-01-01

Previous research suggests that urban sprawl increases auto-dependency and that excessive auto use increases the risk of traffic fatalities. This indirect effect of urban sprawl on traffic fatalities is compared to non-vehicle miles traveled (VMT)-related direct effect of sprawl on fatalities. We conducted a path analysis to examine the causal linkages among urban sprawl, VMT, traffic fatalities, income, and fuel cost. The path diagram includes 2 major linkages: the direct relationship between urban sprawl and traffic fatalities and the indirect effect on fatalities through increased VMT in sprawling urban areas. To measure the relative strength of these causal linkages, path coefficients are estimated using data collected nationally from 147 urbanized areas in the United States. Through both direct and indirect paths, urban sprawl is associated with greater numbers of traffic fatalities, but the direct effect of sprawl on fatalities is more influential than the indirect effect. Enhancing traffic safety can be achieved by impeding urban sprawl and encouraging compact development. On the other hand, policy tools reducing VMT may be less effective than anticipated for traffic safety.

Incidence of paediatric fatal and non-fatal low speed vehicle run over events in Queensland, Australia: eleven year analysis

Science.gov (United States)

2014-01-01

Background The purpose of this study was to estimate the incidence of fatal and non-fatal Low Speed Vehicle Run Over (LSVRO) events among children aged 0–15 years in Queensland, Australia, at a population level. Methods Fatal and non-fatal LSVRO events that occurred in children resident in Queensland over eleven calendar years (1999-2009) were identified using ICD codes, text description, word searches and medical notes clarification, obtained from five health related data bases across the continuum of care (pre-hospital to fatality). Data were manually linked. Population data provided by the Australian Bureau of Statistics were used to calculate crude incidence rates for fatal and non-fatal LSVRO events. Results There were 1611 LSVROs between 1999–2009 (IR = 16.87/100,000/annum). Incidence of non-fatal events (IR = 16.60/100,000/annum) was 61.5 times higher than fatal events (IR = 0.27/100,000/annum). LSVRO events were more common in boys (IR = 20.97/100,000/annum) than girls (IR = 12.55/100,000/annum), and among younger children aged 0–4 years (IR = 21.45/100000/annum; 39% or all events) than older children (5–9 years: IR = 16.47/100,000/annum; 10–15 years IR = 13.59/100,000/annum). A total of 896 (56.8%) children were admitted to hospital for 24 hours of more following an LSVRO event (IR = 9.38/100,000/annum). Total LSVROs increased from 1999 (IR = 14.79/100,000) to 2009 (IR = 18.56/100,000), but not significantly. Over the 11 year period, there was a slight (non –significant) increase in fatalities (IR = 0.37-0.42/100,000/annum); a significant decrease in admissions (IR = 12.39–5.36/100,000/annum), and significant increase in non-admissions (IR = 2.02-12.77/100,000/annum). Trends over time differed by age, gender and severity. Conclusion This is the most comprehensive, population-based epidemiological study on fatal and non-fatal LSVRO events to date. Results from this study indicate

Chores at Times of Fatal or Serious Injuries Associated with Tractor Overturns with and without Rollover Protection

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Henry P. Cole

2016-09-01

Full Text Available This study describes chores when farmers were either fatally or seriously injured and required emergency medical treatment as a result of overturns of tractors with or without rollover protective structures (ROPS. Data from the 2002 Kentucky Farm Tractor Overturn Survey were used for this study. The data were collected by a telephone survey of a population-based random sample of 6063 (7.98% of Kentucky’s 76,017 farm operators as listed in the Kentucky Agricultural Statistics Service database. Of farm operators interviewed, 551 (9.1% reported 603 overturns and 5512 (90.9% reported no overturns in the history of their farm, covering a period from 1925 to February 2002. Only the latest overturn was considered to improve recall accuracy. In addition, since the 1925 to 1959 time period had only 49 (8.1% of the overturns reported, (14 farmers did not provide the year of most recent overturn; only data from the 1960 to 2002 period (approximately 41 years were used. After making these adjustments, incidents evaluated included 25 cases (one fatal and four serious nonfatal injuries that involved ROPS-equipped tractor overturns and 88 cases (24 fatal and 64 serious nonfatal injuries that involved non-ROPS tractor overturns. Chores at highest risk for tractor overturns were identified for which educational and ROPS retrofit interventions could be emphasized. The highest frequency of overturn-related fatalities and nonfatal injuries were associated with hay harvesting, rotary mowing, and on-farm travel chores. These three chores represented 68.2% of fatal events and 50.0% of permanent and 56.6% of temporary disability overturn incidents. Tragically, in countries such as India and China with emerging mechanization, a large majority of tractors are produced without ROPS that can be expected to result in the same overturn-related epidemic of deaths experienced in highly mechanized countries, despite evidence of the protection provided by ROPS.

[Fatal occupational accidents in Lombardy].

Science.gov (United States)

Pianosi, G

1995-01-01

All fatal occupational accidents compensated in Lombardy from 1984 to 1989 were analyzed (1259 cases): significant differences between geographical distribution of fatal occupational accidents and workers were observed. Males accounted for about 95% of fatalities; an excess of cases was shown in both young and elderly workers. Death was the consequence of injuries involving most frequently the head, thorax and spinal cord. An excess of fatalities was observed in agriculture and, at a lower level, in manufacturing industries; small enterprises were involved in approximately 25% of fatalities occurring in the manufacturing industries and services. Employers were the victims of fatal accidents in 50% of cases in agriculture and in 70% of cases in craft industries. Construction, agriculture and transport accounted for about 50% of all fatalities. About 50% of fatal occupational accidents were related to vehicle use: the victim was the driver in the majority of cases, sometimes the victim was run over by a vehicle or fell from a vehicle. The results agree with some previous observations (e.g.: sex and age distribution; construction, agriculture and transport as working activities at high accident risk); but some original observations have emerged, in particular about the frequency of employers as victims and the role of vehicles in the genesis of fatal occupational accidents. If further studies confirm these latter observations, important developments could follow in preventive action design and implementation.

Serum expression of HA and LN in lewis rat models of autoimmune myocarditis

International Nuclear Information System (INIS)

Han Li'na; Li Tieling; Zhang Yajing; Yang Tingshu; Ding Yu; Guo Shuli; Zhao Xiaoning

2011-01-01

Objective: To study the clinical significance of dynamic changes of serum expressions of hyaluronic acid (HA) and laminin (LN) in Lewis rat models of experimental autoimmune myocarditis (EAM). Methods: Fifty Lewis rat models of experimental autoimmune myocarditis (EAM) were established with injection of recombinant cardiac C protein with complete freund adjuvant into two foot-pads plus intraperitoneal injection of pertussis toxin. At 1w, 2w, 4w, 6w and 8w, 10 models were sacrificed each time;cardiac tissues were examined with HE stain for myocardial inflammatory score and examined with picrosirius red stain for myocardial fibrosis score, also, serum HA and LN expressions were determined with RIA. These examinations were performed in 10 undisturbed animals as controls. Results: The myocardial inflammatory scores of the models at 1w were about the same as those in the controls, but the scores rapidly increased from 2w on to 4w then fell gradually. The myocardial fibrosis scores of the models at 1wk were also not much different from those in controls. The fibrosis scores increased rapidly at 4w and maintained at high level up to 8w. The changes of serum expressions of HA and LN roughly paralleled those of myocardial fibrosis scores i. e. rapidly increased at 4w up to 8w. Conclusion: Serum expressions of HA and LN could faithfully reflect the degree of myocardial fibrosis in rat models of EAM. HA and LN were useful markers of myocardial fibrois and were of prognostic importance. (authors)

[Fatal toxic leukoencephalopathy associated with consumption of pasta base of cocaine: Report of three cases].

Science.gov (United States)

Cartier R, Luis; González L, Daniela; Harán D, Jorge

2015-11-01

The prevalence of drug-associated toxic encephalopathy is unknown, but it is an uncommon condition. Toxic leukoencephalopathy was described associated with heroin consumption, it has been less commonly described with the use of cocaine and there are no reports of its association with consumption pasta base of cocaine (PBC). We report two females aged 31 years and a male aged 19 years, consumers of PBC who developed a fatal toxic leukoencephalopathy. They initiated their disease with severe and persistent headache, sequential focal neurologic deficits and a progressive impairment of consciousness that culminated with their death. Laboratory parameters such as blood count, cerebrospinal fluid analyses or infectious biological indices were normal. MRI showed multifocal lesions in brain white matter of both hemispheres confirming the leukoencephalopathy. There was no response to the use of methylprednisolone.

Clinical Features of Fatal Asthma

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Chiung-Zuei Chen

2006-05-01

Full Text Available To characterize the clinical features of fatal asthma, we retrospectively analyzed the clinical characteristics of patients who died of an acute asthma attack in our hospital during a 15-year period from 1989 to 2003. Twelve patients had fatal asthma during this period, including eight who were dead on arrival in the emergency room (ER and three who died within 1 hour of admission to the ER. Patients were categorized into three groups according to the clinical presentations during the fatal attack: (1 rapid (< 3 hours decompensation in four patients; (2 gradual development of respiratory failure over several days in two patients; and (3 acute deterioration after unstable asthma lasting several days in six patients. All patients in groups 1 and 2 had reported previous near-fatal attacks. The proportion of young patients was highest in group 3, with half of them (3/6 younger than 35 years of age. Only one patient in group 3 had had a previous near-fatal attack. Five of the seven patients, with previous near-fatal attacks, had a pattern of decompensation during their fatal attack that was similar to their previous attacks. In conclusion, nearly all patients with fatal asthma in this study died outside of the hospital or within 1 hour after admission to the ER. Patients had patterns of decompensation during the fatal attack that were similar to those of their previous attacks. Early detection of warning signs, early admission to the ER, adequate treatment, and extremely close observation of patients, especially within 1 hour after ER arrival, may prevent or decrease the incidence of fatal asthmatic attack.

Obesity and non-fatal motor vehicle crash injuries: sex difference effects.

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Ma, X; Laud, P W; Pintar, F; Kim, J-E; Shih, A; Shen, W; Heymsfield, S B; Allison, D B; Zhu, S

2011-09-01

Obesity and motor vehicle crash (MVC) injuries are two parallel epidemics in the United States. An important unanswered question is whether there are sex differences in the associations between the presence of obesity and non-fatal MVC injuries. To further understand the association between obesity and non-fatal MVC injuries, particularly the sex differences in these relations. We examined this question by analyzing data from the 2003 to 2007 National Automotive Sampling System Crashworthiness Data System (NASS CDS). A total of 10,962 drivers who were aged 18 years or older and who survived frontal collision crashes were eligible for the study. Male drivers experienced a lower rate of overall non-fatal MVC injuries than did female drivers (38.1 versus 52.2%), but experienced a higher rate of severe injuries (0.7 versus 0.2%). After adjusting for change in velocity (ΔV) during the crashes, obese male drivers showed a much higher risk (logistic coefficients of body mass index (BMI) for moderate, serious and severe injury are 0.0766, 0.1470 and 0.1792, respectively; all Pobese male drivers and these risks increased with injury severity. Non-fatal injury risks were not found to be increased in obese female drivers. The association between obesity and risk of non-fatal injury was much stronger for male drivers than for female drivers. The higher risk of non-fatal MVC injuries in obese male drivers might result from their different body shape and fat distribution compared with obese female drivers. Our findings should be considered for obesity reduction, traffic safety evaluation and vehicle design for obese male drivers and provide testable hypotheses for future studies.

Global earthquake fatalities and population

Science.gov (United States)

Holzer, Thomas L.; Savage, James C.

2013-01-01

Modern global earthquake fatalities can be separated into two components: (1) fatalities from an approximately constant annual background rate that is independent of world population growth and (2) fatalities caused by earthquakes with large human death tolls, the frequency of which is dependent on world population. Earthquakes with death tolls greater than 100,000 (and 50,000) have increased with world population and obey a nonstationary Poisson distribution with rate proportional to population. We predict that the number of earthquakes with death tolls greater than 100,000 (50,000) will increase in the 21st century to 8.7±3.3 (20.5±4.3) from 4 (7) observed in the 20th century if world population reaches 10.1 billion in 2100. Combining fatalities caused by the background rate with fatalities caused by catastrophic earthquakes (>100,000 fatalities) indicates global fatalities in the 21st century will be 2.57±0.64 million if the average post-1900 death toll for catastrophic earthquakes (193,000) is assumed.

Fatal injuries among grounds maintenance workers: United States, 2003--2008.

Science.gov (United States)

2011-05-06

A total of 1,142 grounds maintenance workers (GMWs) were fatally injured at work during 2003--2008, an average of 190 each year. GMWs accounted for 3.4% of all occupational fatalities, and 31% of those GMWs were Hispanic or Latino. Approximately 83% of the Hispanic or Latino GMWs who died were born outside the United States. In 2008, approximately 1.52 million persons were employed as GMWs, constituting 1.0% of the U.S. workforce. During 2003--2007, an average of 13.3 per 100,000 employed GMWs died each year, compared with an overall rate of 4.0 fatalities per 100,000 U.S. workers. The rate of on-the-job fatal injuries among GMWs has remained elevated relative to other workers for >20 years. This report characterizes events leading to GMW fatalities and differences in fatality characteristics across demographic groups among GMWs, based on an evaluation of 2003--2008 data from the U.S. Department of Labor's Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) program. The report also identifies workplace interventions that might reduce the incidence of fatal injuries. Major events leading to GMW occupational fatalities included transportation incidents (31%), contact with objects and equipment (25%), falls (23%), and traumatic acute exposures to harmful substances or environments (e.g., electrocution and drowning) (16%). To reduce the incidence of such fatalities, employers, trade and worker associations, and policy makers should focus on effective, targeted workplace safety interventions such as frequent hazard identification and training for specific hazards. Diversity among the populations of workers requires use of culture- and language-appropriate training techniques as part of comprehensive injury and illness prevention programs.

Non-medical use of psychoactive prescription drugs is associated with fatal poisoning.

Science.gov (United States)

Haukka, Jari; Kriikku, Pirkko; Mariottini, Claudia; Partonen, Timo; Ojanperä, Ilkka

2018-03-01

The aims of this study were to estimate the prevalence and predictors of non-medical substance use, and to assess the association between non-medical substance use and fatal poisoning or history of drug abuse in Finland. Retrospective cohort study of all medico-legally investigated death cases in Finland. The postmortem toxicology database was linked together with the register on reimbursed prescription medicines. All postmortem cases between 2011 and 2013 positive for one or more of the following drugs: oxycodone, fentanyl, tramadol, clonazepam, gabapentin, pregabalin, tizanidine, olanzapine, quetiapine, risperidone, alprazolam, zolpidem, mirtazapine and bupropion, n = 2974. Non-medical use of substance was the outcome variable. Predictors were the following: gender, residence at the time of death, place of death, blood alcohol concentration, age, drug abuse, number of prescriptions of any psychoactive drugs in last year and proportion of prescriptions issued by psychiatrist in last year. In 50.4% of the studied cases, at least one drug was detected without a prescription. Clonazepam, alprazolam and tramadol were the most prevalent non-medical findings in these cases (6.6, 6.1 and 5.6%, respectively). The risk of non-medical use of prescription drugs was especially high in cases with history of drug abuse (88.5%) and in fatal poisonings (71.0%). The proportion of non-medical use of the studied substances varied between 5.9% [95% confidence interval (CI) = 3.1-10.1%)] for risperidone and 55.7% for fentanyl (95% CI = 44.1-66.9%). Valid prescription for one or more of any psychoactive drug was associated with lower odds for non-medical use of the studied substances. Additionally, the higher the proportion of psychoactive drugs prescribed by a psychiatrist, the lower the probability of non-medical use. Non-prescribed psychoactive drugs are found commonly at postmortem in drug poisoning deaths in Finland, with history of drug abuse being a major contributing

Ga-67 citrate myocardial uptake in a patient with AIDS, toxoplasmosis, and myocarditis

International Nuclear Information System (INIS)

Memel, D.S.; DeRogatis, A.J.; William, D.C.

1991-01-01

A 38-year-old man with AIDS presented with fever of unknown origin, splenomegaly, anemia, and thrombocytopenia. Admission laboratory data revealed a positive toxoplasmosis titer in the blood. The initial chest x-ray showed small bilateral pleural effusions, a normal cardiac silhouette, no infiltrates, and no interstitial edema. Ga-67 imaging revealed markedly abnormal uptake in the myocardium. A diagnosis of toxoplasmosis myocarditis was made based on laboratory and imaging data. The patient was treated for toxoplasmosis. No myocardial uptake of tracer was demonstrated on a follow-up Ga-67 scan, performed after completion of treatment for toxoplasmosis

The legacy of fear: is fear impacting fatal and non-fatal drowning of African American children?

Science.gov (United States)

Irwin, Carol C; Irwin, Richard L; Ryan, Timothy D; Drayer, Joris

2011-01-01

African American children’s rates for fatal and non-fatal drowning events are alarmingly elevated, with some age groups having three times the rate as compared to White peers. Adequate swimming skills are considered a protective agent toward the prevention of drowning, but marginalized youth report limited swimming ability. This research examined minority children’s and parents/caregivers’ fear of drowning as a possible variable associated with limited swimming ability. Results confirmed that there were significant racial differences concerning the fear of drowning, and adolescent African American females were notably more likely to fear drowning while swimming than any other group. The “fear of drowning” responses by parents/ caregivers of minority children were also significantly different from their White counterparts.

Bioterrorism Preparedness for Infectious Disease (BTPID) Proposal

Science.gov (United States)

2007-01-01

ranging from eczema vaccinatum, to myocarditis, to accinial encephalitis, resulting in fatal complications and ubstantial morbidity in some...1893, when it was known locally as ‘boohoo fever’, a name arising from the emotional distress that usually accompanies the disease. The first

Dataset on psychosocial risk factors in cases of fatal and near-fatal physical child abuse

Directory of Open Access Journals (Sweden)

Mary Clyde Pierce

2017-10-01

Full Text Available This article presents the psychosocial risk factors identified in the cases of 20 children less than four years of age who were victims of fatal or near-fatal physical abuse during a 12 month period in the Commonwealth of Kentucky. These data are related to the article “History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse” (Pierce et al., 2017 [1].

A pediatric case with peripheral facial nerve palsy caused by a granulomatous lesion associated with cat scratch disease.

Science.gov (United States)

Nakamura, Chizuko; Inaba, Yuji; Tsukahara, Keiko; Mochizuki, Mie; Sawanobori, Emi; Nakazawa, Yozo; Aoyama, Kouki

2018-02-01

Cat scratch disease is a common infectious disorder caused by Bartonella henselae that is transmitted primarily by kittens. It typically exhibits a benign and self-limiting course of subacute regional lymphadenopathy and fever lasting two to eight weeks. The most severe complication of cat scratch disease is involvement of the nervous system, such as encephalitis, meningitis, and polyneuritis. Peripheral facial nerve palsy associated with Bartonella infection is rare; few reported pediatric and adult cases exist and the precise pathogenesis is unknown. A previously healthy 7-year-old boy presented with fever, cervical lymphadenopathy, and peripheral facial nerve palsy associated with serologically confirmed cat scratch disease. The stapedius muscle reflex was absent on the left side and brain magnetic resonance imaging revealed a mass lesion at the left internal auditory meatus. The patient's symptoms and imaging findings were gradually resolved after the antibiotics and corticosteroids treatment. The suspected granulomatous lesion was considered to have resulted from the host's immune reaction to Bartonella infection and impaired the facial nerve. This is the first case report providing direct evidence of peripheral facial nerve palsy caused by a suspected granulomatous lesion associated with cat scratch disease and its treatment course. Copyright © 2017. Published by Elsevier B.V.

Drug and Alcohol Involvement in Four Types of Fatal Crashes*

Science.gov (United States)

Romano, Eduardo; Voas, Robert B.

2011-01-01

Objective: The aim of this study was to explore the relationship of drunk and drugged driving to the occurrence of fatal crashes associated with speeding, failure to obey/yield, inattention, and seat belt nonuse. Method: We examined data for fatally injured drivers involved in single-vehicle crashes killed in states in which more than 79% of the drivers were tested for drugs other than alcohol and had a known result. Results: About 25% of the drivers tested positive for drugs, a figure almost double that estimated by the 2007 National Roadside Survey. Cannabinoids and stimulants each contributed to about 23% of the drug-positive results (6% among all fatally injured single-vehicle drivers). Stimulants more than cannabinoids were found to be associated with the four types of crashes under study. Some drugs showed a protective effect over the four crash types under study. Significant interactions between drugs and alcohol were observed. Stimulants contributed to the different types of fatal crashes irrespective of the levels of alcohol consumed by the drivers. Conclusions: This study provides further evidence of a link between drug consumption and fatal crashes. It also opens the door to some interesting and sometimes unexpected questions regarding the way drugs contribute to crashes, which we found varies depending on the type of crash considered, the class of drug, and the presence of alcohol. Research is also needed on drugs that could have a protective effect on the occurrence of fatal crashes. These findings could be highly relevant to the design of drug-related traffic laws and programs targeted at curbing drugged driving. PMID:21683038

Cathelicidin Insufficiency in Patients with Fatal Leptospirosis.

Science.gov (United States)

Lindow, Janet C; Wunder, Elsio A; Popper, Stephen J; Min, Jin-Na; Mannam, Praveen; Srivastava, Anup; Yao, Yi; Hacker, Kathryn P; Raddassi, Khadir; Lee, Patty J; Montgomery, Ruth R; Shaw, Albert C; Hagan, Jose E; Araújo, Guilherme C; Nery, Nivison; Relman, David A; Kim, Charles C; Reis, Mitermayer G; Ko, Albert I

2016-11-01

Leptospirosis causes significant morbidity and mortality worldwide; however, the role of the host immune response in disease progression and high case fatality (>10-50%) is poorly understood. We conducted a multi-parameter investigation of patients with acute leptospirosis to identify mechanisms associated with case fatality. Whole blood transcriptional profiling of 16 hospitalized Brazilian patients with acute leptospirosis (13 survivors, 3 deceased) revealed fatal cases had lower expression of the antimicrobial peptide, cathelicidin, and chemokines, but more abundant pro-inflammatory cytokine receptors. In contrast, survivors generated strong adaptive immune signatures, including transcripts relevant to antigen presentation and immunoglobulin production. In an independent cohort (23 survivors, 22 deceased), fatal cases had higher bacterial loads (P = 0.0004) and lower anti-Leptospira antibody titers (P = 0.02) at the time of hospitalization, independent of the duration of illness. Low serum cathelicidin and RANTES levels during acute illness were independent risk factors for higher bacterial loads (P = 0.005) and death (P = 0.04), respectively. To investigate the mechanism of cathelicidin in patients surviving acute disease, we administered LL-37, the active peptide of cathelicidin, in a hamster model of lethal leptospirosis and found it significantly decreased bacterial loads and increased survival. Our findings indicate that the host immune response plays a central role in severe leptospirosis disease progression. While drawn from a limited study size, significant conclusions include that poor clinical outcomes are associated with high systemic bacterial loads, and a decreased antibody response. Furthermore, our data identified a key role for the antimicrobial peptide, cathelicidin, in mounting an effective bactericidal response against the pathogen, which represents a valuable new therapeutic approach for leptospirosis.

Cathelicidin Insufficiency in Patients with Fatal Leptospirosis.

Directory of Open Access Journals (Sweden)

Janet C Lindow

2016-11-01

Full Text Available Leptospirosis causes significant morbidity and mortality worldwide; however, the role of the host immune response in disease progression and high case fatality (>10-50% is poorly understood. We conducted a multi-parameter investigation of patients with acute leptospirosis to identify mechanisms associated with case fatality. Whole blood transcriptional profiling of 16 hospitalized Brazilian patients with acute leptospirosis (13 survivors, 3 deceased revealed fatal cases had lower expression of the antimicrobial peptide, cathelicidin, and chemokines, but more abundant pro-inflammatory cytokine receptors. In contrast, survivors generated strong adaptive immune signatures, including transcripts relevant to antigen presentation and immunoglobulin production. In an independent cohort (23 survivors, 22 deceased, fatal cases had higher bacterial loads (P = 0.0004 and lower anti-Leptospira antibody titers (P = 0.02 at the time of hospitalization, independent of the duration of illness. Low serum cathelicidin and RANTES levels during acute illness were independent risk factors for higher bacterial loads (P = 0.005 and death (P = 0.04, respectively. To investigate the mechanism of cathelicidin in patients surviving acute disease, we administered LL-37, the active peptide of cathelicidin, in a hamster model of lethal leptospirosis and found it significantly decreased bacterial loads and increased survival. Our findings indicate that the host immune response plays a central role in severe leptospirosis disease progression. While drawn from a limited study size, significant conclusions include that poor clinical outcomes are associated with high systemic bacterial loads, and a decreased antibody response. Furthermore, our data identified a key role for the antimicrobial peptide, cathelicidin, in mounting an effective bactericidal response against the pathogen, which represents a valuable new therapeutic approach for leptospirosis.

Survival in fatal road crashes: body mass index, gender, and safety belt use.

Science.gov (United States)

Sivak, Michael; Schoettle, Brandon; Rupp, Jonathan

2010-02-01

This study evaluated the associations of body mass index (BMI), gender, and use of safety belts with the survival of drivers involved in fatal road crashes. The census data of all U.S. fatal crashes that did not involve pedestrians, bicyclists, or motorcyclists were examined for an 11-year period. If involved in a crash with one or more fatalities, the odds of female drivers being among the fatalities are 1.28 times higher than those of male drivers, and the odds of unbelted drivers being among the fatalities are 5.43 times higher than those of belted drivers. The relationship of survivability to BMI depends on the gender and safety belt use of the driver. For male drivers, increased BMI appears beneficial when safety belts are used but detrimental when not used. For belted female drivers, normal BMI is associated with the lowest odds of being killed, and both increased and decreased BMIs increase the odds. For unbelted female drivers, no reliable trends were present among the BMI categories.

Meningococcal meningitis: clinical and laboratorial characteristics, fatality rate and variables associated with in-hospital mortality

Directory of Open Access Journals (Sweden)

Vanessa L. Strelow

Full Text Available ABSTRACT Meningococcal meningitis is a public health problem. The aim of this study was to describe the clinical characteristics of patients with meningococcal meningitis, and to identify associated factors with mortality. This was a retrospective study, between 2006 and 2011, at a referral center in São Paulo, Brazil. Logistic regression analysis was used to identify factors associated with mortality. We included 316 patients. The median age was 16 years (IQR: 7–27 and 60% were male. The clinical triad: fever, headache and neck stiffness was observed in 89% of the patients. The cerebrospinal triad: pleocytosis, elevated protein levels and low glucose levels was present in 79% of patients. Factors associated with mortality in the multivariate model were age above 50 years, seizures, tachycardia, hypotension and neck stiffness. The classic clinical and laboratory triads of meningococcal meningitis were variable. The fatality rate was low. Age, seizures and shock signs were independently associated with mortality.

Femme fatale

Directory of Open Access Journals (Sweden)

Francisco Javier Tardío Gastón

2011-12-01

Full Text Available Our history is full of myths and topics. Therefore the image of femme fatale is frequent in the works of all periods and places. The author of this article first analyzes how the history and literature consistently showed and defined these women, and then presents examples that come from ancient Greece. The art is powered by their power of seduction and the article explains how this femme fatale appeared in literature and film. The article concludes with a brief overview of various arguments concerning women and feminism, present in the literary criticism.

Carrion’s disease: an eradicable illness?

OpenAIRE

Gomes, Cláudia; Pons, Maria J.; Del Valle Mendoza, Juana Mercedes; Ruiz, Joaquim

2016-01-01

Carrion's disease is a neglected tropical disease caused by Bartonella bacilliformis, a vector-borne pathogen restricted to the Andean valleys of Peru, Ecuador and Colombia. Carrion's disease is a biphasic illness; in the acute phase the case-fatality rate can be as high as 88 %, related to high parasitemia, arriving to almost all erythrocytes, and secondary bacterial infections c...

Dietary relationships with fatal colorectal cancer among Seventh-Day Adventists.

Science.gov (United States)

Phillips, R L; Snowdon, D A

1985-02-01

Associations between fatal colon or colorectal cancer and frequency of use of meat, cheese, milk, eggs, green salad, and coffee, as well as percent desirable weight, are described with the use of 21 years of follow-up for 25,493 white California Seventh-Day Adventists. Associations are presented in terms of relative risk (RR) of colorectal cancer for heavy or light exposure versus rare exposure. There were no clear relationships evident between colon or rectal cancer and meat, cheese, milk, or green salad use. Egg use was positively associated with risk of fatal colon cancer in both males (RR = 1.6) and females (RR = 1.7). Coffee use was positively associated with both colon and rectal cancer mortality in males and females, particularly for colon cancer during the last 11 years of follow-up (male RR = 3.5; female RR = 1.9). Overweight (percent of desirable weight greater than or equal to 125) was associated with an increased risk of fatal rectal cancer in both sexes combined (RR = 2.8) and colon cancer in males only (RR = 3.3). Furthermore, eggs, coffee, and overweight appear to be independently associated with risk of both colon and colorectal cancer. These three factors may explain a substantial portion of the colorectal cancer mortality differential between Adventists and U.S. whites (62% for males; 30% for females).

Work-related fatal motor vehicle traffic crashes: Matching of 2010 data from the Census of Fatal Occupational Injuries and the Fatality Analysis Reporting System.

Science.gov (United States)

Byler, Christen; Kesy, Laura; Richardson, Scott; Pratt, Stephanie G; Rodríguez-Acosta, Rosa L

2016-07-01

Motor vehicle traffic crashes (MVTCs) remain the leading cause of work-related fatal injuries in the United States, with crashes on public roadways accounting for 25% of all work-related deaths in 2012. In the United States, the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) provides accurate counts of fatal work injuries based on confirmation of work relationship from multiple sources, while the National Highway Traffic Safety Administration (NHTSA) Fatality Analysis Reporting System (FARS) provides detailed data on fatal MVTCs based on police reports. Characterization of fatal work-related MVTCs is currently limited by data sources that lack either data on potential risk factors (CFOI) or work-relatedness confirmation and employment characteristics (FARS). BLS and the National Institute for Occupational Safety and Health (NIOSH) collaborated to analyze a merged data file created by BLS using CFOI and FARS data. A matching algorithm was created to link 2010 data from CFOI and FARS using date of incident and other case characteristics, allowing for flexibility in variables to address coding discrepancies. Using the matching algorithm, 953 of the 1044 CFOI "Highway" cases (91%) for 2010 were successfully linked to FARS. Further analysis revealed systematic differences between cases identified as work-related by both systems and by CFOI alone. Among cases identified as work-related by CFOI alone, the fatally-injured worker was considerably more likely to have been employed outside the transportation and warehousing industry or transportation-related occupations, and to have been the occupant of a vehicle other than a heavy truck. This study is the first step of a collaboration between BLS, NHTSA, and NIOSH to improve the completeness and quality of data on fatal work-related MVTCs. It has demonstrated the feasibility and value of matching data on fatal work-related traffic crashes from CFOI and FARS. The results will lead to

Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

Science.gov (United States)

Uhrenholt, Lars; Freeman, Michael D; Webb, Alexandra L; Pedersen, Michael; Boel, Lene Warner Thorup

2015-12-01

Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to

Is pregnancy fatalism normal? An attitudinal assessment among women trying to get pregnant and those not using contraception.

Science.gov (United States)

Jones, Rachel K

2018-05-21

To assess factors associated with pregnancy fatalism among U.S. adult women. I used data from the Change and Consistency in Contraceptive Use study, which collected information from a national sample of 4634U.S. women aged 18-39 at baseline (59% response rate). I assessed pregnancy fatalism based on agreement with the statement: "It doesn't matter whether I use birth control, when it is my time to get pregnant, it will happen." I compare fatalism among all respondents to fatalism among respondents who were trying to get pregnant and those who did not want to get pregnant but were not using contraception. I used logistic regression to assess associations between nonuse of contraception and pregnancy fatalism at baseline and whether respondents were trying to get pregnant six months later. Overall, 36% of the sample expressed some degree of pregnancy fatalism, and proportions were higher for respondents trying to get pregnant (55%) and those not using contraception (57%). The association between pregnancy fatalism and trying to get pregnant was maintained after controlling for other characteristics (OR 1.4, p=.01), as was the association for nonuse of contraception (OR 2.08, p<.001). Contraceptive nonusers at baseline were more likely than users to be trying to get pregnant six months later, especially if they expressed a fatalistic outlook at baseline. Pregnancy fatalism may be a common outlook among women who are trying to get pregnant. Associations between fatalism and nonuse of contraception may be more complex than previously recognized. Gaining a better understanding of the dynamics of pregnancy planning might inform our understanding of why some women do not use contraception. Copyright © 2018. Published by Elsevier Inc.

Lake tourism fatalities: a 46-year history of death at Lake Powell.

Science.gov (United States)

Heggie, Travis W

2018-05-01

This study investigates tourist mortality at Lake Powell over a 46-year period. To date no comprehensive long-term investigation examining the relationship between the lake environment and tourist mortality exists. A retrospective study was conducted of all tourist fatalities between 1959 and 2005. There were 351 fatal incidents resulting in 386 deaths between 1959 and 2005. Over the 46-year period, the average number of fatalities was 8.4 (±5.26) per year. Out of all fatalities, 282 were classified as accidental, 80 were classified as natural deaths, 13 were suicides and 5 were classified as homicides. Males accounted for 80% of fatalities and tourists aged 20-29 years and 10-19 years accounted for 36% of all fatalities. The highest number of fatalities was recorded in July (74), May (64), August (63) and June (59). Out of all accidental deaths, boating (29%) and swimming (22%) were the most common pre-death activities. High winds capsizing boats and carbon monoxide poisoning from boat engines were common factors contributing to 31 boating fatalities. Fatigue and exhaustion contributed to 22 swimming deaths. Recreational boating and swimming account for over half of all accidental deaths. Tourists visiting Lake Powell for recreational purposes should be informed of the risks associated with the lake environment.

Occupational fatality risks in the United States and the United Kingdom.

Science.gov (United States)

Mendeloff, John; Staetsky, Laura

2014-01-01

There are very few careful studies of differences in occupational fatality rates across countries, much less studies that try to account for those differences. We compare the rate of work injury fatalities (excluding deaths due to highway motor vehicle crashes and those due to violence) identified by the US Census of Fatal Occupational Injuries in recent years with the number reported to the Health and Safety Executive in the United Kingdom (UK) and by other European Union (EU) members through Eurostat. In 2010, the fatality rate in the UK was about 1/3 the rate in the US. In construction the rate was about ¼ the US rate, a difference that had grown substantially since the 1990s. Several other EU members had rates almost as low as the UK rate. Across EU countries, lower rates were associated with high-level management attention to safety issues and to in-house preparation of "risk assessments." Although work fatality rates have declined in the US, fatality rates are much lower and have declined faster in recent years in the UK. Efforts to find out the reasons for the much better UK outcomes could be productive. © 2013 Wiley Periodicals, Inc.

Fatal occupational injuries in the Malaysian construction sector–causes and accidental agents

Science.gov (United States)

Ayob, A.; Shaari, A. A.; Zaki, M. F. M.; Munaaim, M. A. C.

2018-04-01

The construction sector is associated with various accidents and fatal injuries. These occupational accidents are caused by numerous factors, such as lack of supervision; lack of adherence to safe work technique; failure to wear personal protective equipment; and failure to comply with the safe use of tools, vehicles, and machines. Using 2013–2016 secondary data from the Department of Occupational Safety and Health and Social Security Organization, this study conducted a descriptive exploration survey to identify common fatal occupational injuries associated with the Malaysian construction sector, as well as their causes and accidental agents. Results indicated that construction, followed by manufacturing, agriculture, forestry, logging, and fishery, are the riskiest job sectors in Malaysia. The highest incidences of occupational casualties were reported in Sarawak, Johor, and Selangor. These states accounted for approximately 13.33% to 18.18% of all cases of fatal occupational accidents. In these states, the lack of safety and health regulations and poor execution of risk management increased the risk of occupational accidents. Falls from heights accounted for 46.28% of fatal occupational injuries. Furthermore, being crushed by objects, materials, or vehicles accounted for 9.09% to 17.36% of fatal occupational injuries. Substandard work environment and transportation and lifting equipment, such as scaffolds, are primary accidental agents. Results of this study could enhance the knowledge and awareness of construction workers and management of job-related injuries to decrease the incidence of fatal occupational accidents.

Fatal hemolytic disease of the fetus and newborn associated with anti-Jr.

Science.gov (United States)

Peyrard, Thierry; Pham, Bach-Nga; Arnaud, Lionel; Fleutiaux, Sophie; Brossard, Yves; Guerin, Bénédicte; Desmoulins, Isabelle; Rouger, Philippe; Le Pennec, Pierre-Yves

2008-09-01

Jr(a) is a high-prevalence red cell (RBC) antigen. The clinical significance of anti-Jr(a) is controversial. When hemolytic disease of the fetus and newborn (HDFN) occurred, most reported cases were clinically mild. We report the first case of fatal HDFN due to anti-Jr(a). A 28-year-old Caucasian woman with transfusion history was monitored at the 29th week of pregnancy (G4P1). An ultrasound scan showed fetal cardiomegaly and hepatomegaly. An antibody directed against a high-prevalence antigen was detected, but without conclusive identification. An emergency cesarean section was performed at the 36th week. The newborn was hydropic and showed severe anemia. Death occurred 30 hours after birth. Serologic methods were performed to investigate the mother's RBCs and serum. An in vitro functional cellular assay and semiquantitative measurement of anti-Jr(a) were used to determine the clinical significance of the antibody. Anti-Jr(a) was identified in the serum and Jr(a-) phenotype was confirmed. The anti-Jr(a) titer was 1024, with predominant immunoglobulin (Ig)G1 and minor IgG4 subclasses. The functional cellular assay was consistent with an antibody unlikely to cause HDFN. Semiquantitative measurement of anti-Jr(a) showed a reactivity equivalent to a 25 IU per mL (5 microg/mL) concentration of anti-D, a value associated with a significant risk of HDFN. This is the first documented case of fatal HDFN due to anti-Jr(a). Therefore, we recommend close monitoring of pregnant women with a high-titer anti-Jr(a), especially those with an incompatible transfusion history and/or multiple pregnancies. This case report provides new arguments about the clinical significance of anti-Jr(a) in the transfusion setting.

Associations between substance use and type of crime in prisoners with substance use problems – a focus on violence and fatal violence

Directory of Open Access Journals (Sweden)

Håkansson A

2018-01-01

Full Text Available Anders Håkansson, Virginia Jesionowska Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden Aim: The present study aimed to study the associations between substance use patterns and types of crimes in prisoners with substance use problems, and specifically whether substance use patterns were different in violent offenders.Methods: Interview data of prisoners with substance use problems (N=4,202, mean age 33.5 years, SD 9.8, derived from the Addiction Severity Index, were run against criminal register data on main types of crimes in the verdict.Results: In binary analyses, compared to those with acquisitive and drug crimes, violent offenders had lower prevalence of illicit drugs and homelessness, but higher prevalence of binge drinking, and higher prevalence of sedative use than clients sentenced with drug crimes. Clients with violent crime had lower prevalence of injecting drug use, compared to all other crimes. In logistic regression, binge drinking and sedatives were positively associated with violent crime (as opposed to non-violent crime, whereas heroin, amphetamine, cocaine, and injecting drug use were negatively associated with violent crime. Among violent offenders only, sedatives tended to be associated with fatal violence (p=0.06, whereas amphetamine, homelessness, age, and (marginally significant, p=0.05 heroin were negatively associated with fatal violence, as opposed to non-fatal violence.Conclusion: Treatment and risk assessment in violent perpetrators with substance use may need to address sedatives and alcohol specifically. Limitations of the study are due to self-reported and cross-sectional data and because a large majority of the prison sample studied here are men. Keywords: Addiction Severity Index, prison, criminal justice, violence, substance use disorder, alcohol, sedatives 

Gross domestic product and health expenditure associated with incidence, 30-day fatality, and age at stroke onset: a systematic review.

Science.gov (United States)

Sposato, Luciano A; Saposnik, Gustavo

2012-01-01

Differences in definitions of socioeconomic status and between study designs hinder their comparability across countries. We aimed to analyze the correlation between 3 widely used macrosocioeconomic status indicators and clinical outcomes. We selected population-based studies reporting incident stroke risk and/or 30-day case-fatality according to prespecified criteria. We used 3 macrosocioeconomic status indicators that are consistently defined by international agencies: per capita gross domestic product adjusted for purchasing power parity, total health expenditures per capita at purchasing power parity, and unemployment rate. We examined the correlation of each macrosocioeconomic status indicator with incident risk of stroke, 30-day case-fatality, proportion of hemorrhagic strokes, and age at stroke onset. Twenty-three articles comprising 30 population-based studies fulfilled the eligibility criteria. Age-adjusted incident risk of stroke using the standardized World Health Organization World population was associated to lower per capita gross domestic product adjusted for purchasing power parity (ρ=-0.661, P=0.027, R(2)=0.32) and total health expenditures per capita at purchasing power parity (ρ=-0.623, P=0.040, R(2)=0.26). Thirty-day case-fatality rates and proportion of hemorrhagic strokes were also related to lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity. Moreover, stroke occurred at a younger age in populations with low per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity. There was no correlation between unemployment rates and outcome measures. Lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity were associated with higher incident risk of stroke, higher case-fatality, a greater

Molecular characterization of complete genome of a canine distemper virus associated with fatal infection in dogs in Gabon, Central Africa.

Science.gov (United States)

Maganga, Gael D; Labouba, Ingrid; Ngoubangoye, Barthélémy; Nkili-Meyong, Andriniaina A; Obame Ondo, Daniel; Leroy, Eric M; Berthet, Nicolas

2018-03-02

Canine distemper (CD) is the most deadly disease in dogs with mortality rates reaching 50%. The pathological agent, the CD virus (CDV), generally causes a severe systemic disease, although the nervous form can coexist with the acute catarrhal form in the same individual. In this study, we describe an outbreak of 18 cases of CD that occurred in 2015 in a German Shepherd dog population in northwestern Gabon. In addition, we determined the sequence of the CDV genotype associated with this fatal distemper infection in Gabon and compared it with other published CDV sequences. The CDV was detected using RT-PCR on cDNA from RNA of harvested brains and other organs. The identification was confirmed by sequencing amplicons. Moreover, we obtained the whole genome sequence using high-throughput sequencing. Phylogenetic analysis revealed that Gabonese CDV strain clustered with European strains belonging to the Europe genotype. This study provided the first molecular detection of the CDV strain associated with this fatal distemper infection in Central Africa region. Copyright © 2018 Elsevier B.V. All rights reserved.

Extended investigation on road fatality in Brunei.

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Yusof, N B; Hoque, M A; Steele, M C; Yong, S Y

2018-06-08

Road fatality is one of the leading causes of death in Brunei with 79 deaths in 1993, the highest ever recorded. The Brunei government has been trying to reduce this by implementing new traffic measures and successfully reduced fatalities to 24 fatalities in 2014. Yearly road fatality has been fluctuating, but there has been a declining tendency overall. The aim of this study is to investigate road fatality in Brunei by extending the research. We developed a multiple regression model and carried out an analysis on road fatality in Brunei. Our analysis indicates that the road fatality appears to rise depending on the increase in the number of young drivers between 15 to 24 years and the number of unemployed people. Comparisons of Brunei road fatality rate per 10,000 vehicles are made with some other countries and we conclude that Brunei has approximately the same rate as Australia in 2014.

A gene transfer agent and a dynamic repertoire of secretion systems hold the keys to the explosive radiation of the emerging pathogen Bartonella.

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Lionel Guy

2013-03-01

Full Text Available Gene transfer agents (GTAs randomly transfer short fragments of a bacterial genome. A novel putative GTA was recently discovered in the mouse-infecting bacterium Bartonella grahamii. Although GTAs are widespread in phylogenetically diverse bacteria, their role in evolution is largely unknown. Here, we present a comparative analysis of 16 Bartonella genomes ranging from 1.4 to 2.6 Mb in size, including six novel genomes from Bartonella isolated from a cow, two moose, two dogs, and a kangaroo. A phylogenetic tree inferred from 428 orthologous core genes indicates that the deadly human pathogen B. bacilliformis is related to the ruminant-adapted clade, rather than being the earliest diverging species in the genus as previously thought. A gene flux analysis identified 12 genes for a GTA and a phage-derived origin of replication as the most conserved innovations. These are located in a region of a few hundred kb that also contains 8 insertions of gene clusters for type III, IV, and V secretion systems, and genes for putatively secreted molecules such as cholera-like toxins. The phylogenies indicate a recent transfer of seven genes in the virB gene cluster for a type IV secretion system from a cat-adapted B. henselae to a dog-adapted B. vinsonii strain. We show that the B. henselae GTA is functional and can transfer genes in vitro. We suggest that the maintenance of the GTA is driven by selection to increase the likelihood of horizontal gene transfer and argue that this process is beneficial at the population level, by facilitating adaptive evolution of the host-adaptation systems and thereby expansion of the host range size. The process counters gene loss and forces all cells to contribute to the production of the GTA and the secreted molecules. The results advance our understanding of the role that GTAs play for the evolution of bacterial genomes.

Pilot Certification, Age of Pilot, and Drug Use in Fatal Civil Aviation Accidents.

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Akparibo, Issaka Y; Stolfi, Adrienne

2017-10-01

This study examined the association between mean age of pilot, pilot license, pilot medical certificate and drug use trends in pilots fatally injured in aircraft accidents. The prevalence of prescription drugs, OTC drugs, controlled drugs and drugs that may be potentially impairing was also examined. This study was a descriptive observational study in which the NTSB Aviation Accident Database was searched from the period beginning January 1, 2012 to December 31, 2014. During the study period a total of 706 accidents involving 711 fatalities were investigated by the NTSB. This study included 633 of these accidents, involving 646 fatalities. Of these pilots, 42.1% had drugs in their biological samples. The prevalence of prescription drugs, controlled drugs, OTC drugs, opioids, and potentially impairing drugs in the fatally injured pilot population over the study period was 28.9%, 15.0%, 20.1%, 5.1%, and 25.5%, respectively. Pilots with any drugs in their samples were significantly older than those without drugs. Medical certificate held was associated with drug use; pilots who held third class certificates had the highest prevalence at 54.1%. Pilot license was not associated with drug use. In 3.8% of the accidents, drugs were a contributing factor in the cause. Despite current FAA medical regulations, potentially impairing drugs are frequently found in biological samples of fatally injured pilots in the U.S. More education of airmen by aviation medical examiners is needed on the safety of drug use.Akparibo IY, Stolfi A. Pilot certification, age of pilot, and drug use in fatal civil aviation accidents. Aerosp Med Hum Perform. 2017; 88(10):931-936.

Children in Hot Cars Result in Fatal Consequences

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Full Text Available ... Tips Campaigns SUBSCRIBE Health Tips Share this! Home » Health Tips » Holiday and Seasonal Children in Hot Cars Result in Fatal Consequences Emergency physicians are warning the public about the overwhelming dangers associated with leaving anyone, ...

[Anaerobiospirillum thomasii bacteremia with fatal outcome].

Science.gov (United States)

Streitenberger, Edgardo R; Chavez, Claudio M; Rizzo, Mabel S; Suarez, Ariel I

2015-01-01

Anaerobiospirillum thomasii has been reported as a causative agent of diarrhea in humans; however no bacteremia associated with this pathogen has been described so far. We present here the first case of fatal A. thomasii bacteremia in an alcoholic patient. Copyright © 2015 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

Phylogeography of Rickettsia rickettsii genotypes associated with fatal Rocky Mountain spotted fever.

Science.gov (United States)

Paddock, Christopher D; Denison, Amy M; Lash, R Ryan; Liu, Lindy; Bollweg, Brigid C; Dahlgren, F Scott; Kanamura, Cristina T; Angerami, Rodrigo N; Pereira dos Santos, Fabiana C; Brasil Martines, Roosecelis; Karpathy, Sandor E

2014-09-01

Rocky Mountain spotted fever (RMSF), a tick-borne zoonosis caused by Rickettsia rickettsii, is among the deadliest of all infectious diseases. To identify the distribution of various genotypes of R. rickettsii associated with fatal RMSF, we applied molecular typing methods to samples of DNA extracted from formalin-fixed, paraffin-embedded tissue specimens obtained at autopsy from 103 case-patients from seven countries who died of RMSF. Complete sequences of one or more intergenic regions were amplified from tissues of 30 (29%) case-patients and revealed a distribution of genotypes consisting of four distinct clades, including the Hlp clade, regarded previously as a non-pathogenic strain of R. rickettsii. Distinct phylogeographic patterns were identified when composite case-patient and reference strain data were mapped to the state and country of origin. The phylogeography of R. rickettsii is likely determined by ecological and environmental factors that exist independently of the distribution of a particular tick vector. © The American Society of Tropical Medicine and Hygiene.

Cannabis, alcohol and fatal road accidents.

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Martin, Jean-Louis; Gadegbeku, Blandine; Wu, Dan; Viallon, Vivian; Laumon, Bernard

2017-01-01

This research aims to estimate the relative risks of responsibility for a fatal accident linked to driving under the influence of cannabis or alcohol, the prevalence of these influences among drivers and the corresponding attributable risk ratios. A secondary goal is to estimate the same items for three other groups of illicit drugs (amphetamines, cocaine and opiates), and to compare the results to a similar study carried out in France between 2001 and 2003. Police procedures for fatal accidents in Metropolitan France during 2011 were analyzed and 300 characteristics encoded to provide a database of 4,059 drivers. Information on alcohol and four groups of illicit drugs derived from tests for positivity and potential confirmation through blood analysis. The study compares drivers responsible for causing the accident, that is to say having directly contributed to its occurrence, to drivers involved in an accident for which they were not responsible, and who can be assimilated to drivers in general. The proportion of persons driving under the influence of alcohol is estimated at 2.1% (95% CI: 1.4-2.8) and under the influence of cannabis at 3.4% (2.9%-3.9%). Drivers under the influence of alcohol are 17.8 times (12.1-26.1) more likely to be responsible for a fatal accident, and the proportion of fatal accidents which would be prevented if no drivers ever exceeded the legal limit for alcohol is estimated at 27.7% (26.0%-29.4%). Drivers under the influence of cannabis multiply their risk of being responsible for causing a fatal accident by 1.65 (1.16-2.34), and the proportion of fatal accidents which would be prevented if no drivers ever drove under the influence of cannabis is estimated at 4.2% (3.7%-4.8%). An increased risk linked to opiate use has also been found to be significant, but with low prevalence, requiring caution in interpreting this finding. Other groups of narcotics have even lower prevalence, and the associated extra risks cannot be assessed. Almost a

Cannabis, alcohol and fatal road accidents.

Directory of Open Access Journals (Sweden)

Jean-Louis Martin

Full Text Available This research aims to estimate the relative risks of responsibility for a fatal accident linked to driving under the influence of cannabis or alcohol, the prevalence of these influences among drivers and the corresponding attributable risk ratios. A secondary goal is to estimate the same items for three other groups of illicit drugs (amphetamines, cocaine and opiates, and to compare the results to a similar study carried out in France between 2001 and 2003.Police procedures for fatal accidents in Metropolitan France during 2011 were analyzed and 300 characteristics encoded to provide a database of 4,059 drivers. Information on alcohol and four groups of illicit drugs derived from tests for positivity and potential confirmation through blood analysis. The study compares drivers responsible for causing the accident, that is to say having directly contributed to its occurrence, to drivers involved in an accident for which they were not responsible, and who can be assimilated to drivers in general.The proportion of persons driving under the influence of alcohol is estimated at 2.1% (95% CI: 1.4-2.8 and under the influence of cannabis at 3.4% (2.9%-3.9%. Drivers under the influence of alcohol are 17.8 times (12.1-26.1 more likely to be responsible for a fatal accident, and the proportion of fatal accidents which would be prevented if no drivers ever exceeded the legal limit for alcohol is estimated at 27.7% (26.0%-29.4%. Drivers under the influence of cannabis multiply their risk of being responsible for causing a fatal accident by 1.65 (1.16-2.34, and the proportion of fatal accidents which would be prevented if no drivers ever drove under the influence of cannabis is estimated at 4.2% (3.7%-4.8%. An increased risk linked to opiate use has also been found to be significant, but with low prevalence, requiring caution in interpreting this finding. Other groups of narcotics have even lower prevalence, and the associated extra risks cannot be assessed

Toxicological effect of TiO2 nanoparticle-induced myocarditis in mice

Science.gov (United States)

Hong, Fashui; Wang, Ling; Yu, Xiaohong; Zhou, Yingjun; Hong, Jie; Sheng, Lei

2015-08-01

Currently, impacts of exposure to TiO2 nanoparticles (NPs) on the cardiovascular system are not well understood. The aim of this study was to investigate whether TiO2 NPs induce myocarditis and its underlying molecular mechanism in the cardiac inflammation in mice. Mice were exposed to TiO2 NPs for 6 months; biochemical parameters of serum and expression of Th1-related and Th2-related cytokines in the heart were investigated. The results showed that TiO2 NP exposure resulted in cardiac lesions coupling with pulmonary inflammation; increases of aspartate aminotransferase (AST), creatine kinase (CK), C-reaction protein (CRP), lactate dehydrogenase (LDH), alpha-hydroxybutyrate dehydrogenase (HBDH), adhesion molecule-1 (ICAM-1), and monocyte chemoattractant protein-1 (MCP-1) levels; and a reduction of nitric oxide (NOx) level in the serum. These were associated with increases of nuclear factor-κB (NF-κB), tumor necrosis factor-α (TNF-α), interleukin (IL)-4, IL-6, transforming growth factor-β (TGF-β), creatine kinase, CRP, adhesion molecule-1, and monocyte chemoattractant protein-1, interferon-γ (IFN-γ), signal transducers and activators of transcription (STAT)1, STAT3, or STAT6, GATA-binding domain-3, GATA-binding domain-4, endothelin-1 expression levels, and T-box expressed in T cells expression level that is the master regulator of pro-inflammatory cytokines and transcription factors in the heart. These findings imply that TiO2 NP exposure may increase the occurrence and development of cardiovascular diseases.

Renal involvement in fatal cases of chikungunya virus infection.

Science.gov (United States)

Mercado, Marcela; Acosta-Reyes, Jorge; Parra, Edgar; Guzmán, Luis; Beltrán, Mauricio; Gasque, Philippe; Mejía-García, Carlos; Viasus, Diego

2018-06-01

Information regarding physiopathology and complications in fatal cases of chikungunya virus (CHIKV) is scarce. The aim of this study was to describe the frequency and severity of renal complications in fatal cases associated with CHIKV infection based on the clinical and histopathological features from post-mortem tissue biopsies. This retrospective study included fatal cases associated with CHIKV infection occurring from September 2014 through October 2015, reported to National System for Public Health Surveillance (SIVIGILA) and laboratory-confirmed by the National Institute of Health of Colombia. Medical records from 13 patients were available. Information was collected on history, physical examination, and haematological, biochemical, radiological, and virologic investigation reports. Diagnosis of CHIKV infection was performed by positive CHIKV-PCR on post-mortem tissue in 10 cases, positive CHIKV-PCR in serum in 6 cases and anti-CHIKV virus IgM in 2 cases. Only 3 cases were children (≤5 years old). Four cases had underlying diseases, mainly systemic arterial hypertension. The median value of creatinine at admission was 2.8 mg/dL (interquartile range 1.52-4.51). During hospitalization, 9 cases required ICU admission, 8 vasopressor support and 6 mechanical ventilation. Kidney histopathological findings were mainly acute interstitial nephritis (11 cases), congestion/oedema glomerular (10 cases) and acute tubular necrosis (5 cases). Renal impairment in fatal cases of CHIKV infection is frequent and related mainly to acute interstitial nephritis. These data demonstrate evidence of acquired kidney injuries during CHIKV infection. Copyright © 2018 Elsevier B.V. All rights reserved.

Boxing fatalities in relation to rule changes in Japan: secondary data analysis.

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Teramoto, Masaru; Cross, Chad L; Cushman, Daniel M; Willick, Stuart E

2018-01-18

To examine whether changing weigh-in from the same day of the match to the day before the match and prohibiting 6-oz gloves are associated with fatalities in boxing matches sanctioned by the Japan Boxing Commission (JBC). We analyzed the rates of boxing fatalities before and after the two rule changes above via secondary analysis of data. Demographics and boxing records of deceased boxers were examined using descriptive statistics, exact binomial test the Mann-Whitney-Wilcoxon test and Fisher's exact tests. As of this study, a total of 38 boxers (23.9 ± 3.3 years of age) reportedly died due to injuries sustained in JBC-sanctioned boxing matches since 1952. Changing weigh-in to the day before the match or prohibiting 6-oz gloves was not significantly associated with the rates of boxing fatalities 5 years and 10 years before and after the rule changes (p > 0.05). Deceased boxers after these rule changes were significantly older, completed significantly more rounds in the final match, and were significantly less likely to lose the previous match (prior to the final match) and to do so by knockouts (p boxing fatalities.

Gasoline-related injuries and fatalities in the United States, 1995-2014.

Science.gov (United States)

Drago, Dorothy A

2018-02-12

This descriptive study examines twenty years of gasoline-related fatalities and emergency department treated injuries in the United States, based on data from the US Consumer Product Safety Commission. Thermal burns consistently accounted for the majority (56%) of gasoline-related injuries and for most (82%) gasoline-related deaths, and were commonly (57-71%) associated with the use of gasoline as an accelerant. Poisoning accounted for 13% of injuries and 17% of deaths. The primary poisoning injury pattern was ingestion; the primary fatality pattern was inhalation, with about half of those associated with deliberate abuse. The estimated number of ingestions decreased from 60 to 23% of poisoning-related injuries, while injuries associated with inhalation abuse increased from 6 to 23%. Chemical burns and dermatitis were less represented in the injury data and were primarily associated with gasoline spills or splashes. Gasoline cans reportedly ignited or exploded in about 5% of thermal burn injuries and fatalities. While mandatory requirements for child resistant closures on gasoline cans (a primary intervention) have potentially impacted poisonings, the use of flame mitigation devices to address thermal injuries, if successful, would be a secondary intervention, and could address only a small percentage (about 5%) of injuries and deaths.

Repeat non-fatal suicidal behaviour at Johannesburg Hospital

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M YH Moosa

2005-12-01

Full Text Available Objective. To describe the characteristics of non-fatal suicide behaviour (NFSB in a group of patients and to determine factors, if any, that may be associated with repetition of this behaviour. Method. The study included all patients treated for NFSB at Johannesburg Hospital during the period August 2002 - October 2002. The information was gathered by means of a structured questionnaire designed to evaluate characteristics of the behaviour. Results. The study sample comprised 43 patients with NFSB (mean age 29.7 years, range of 16 - 75 years, of whom 26 (60% were female. Sixty-three per cent of the patients overdosed with medication and 33% ingested household poisons. Events that precipitated the event included relationship problems (70%, illness (12%, financial difficulties (9%, and depressed mood (9%. In 65% of patients the behaviour was impulsive. Factors associated with non-fatal repetition included being in the 18 - 30-year age group (76% (χ2 = 6.74, p < 0.05; being female (90% (χ2 = 4.75, p < 0.05; having children (90% (χ2 = 4.72, p < 0.05; a past psychiatric history (50% (χ2 = 4.08, p < 0.05; and the current attempt deemed medically serious (50% (χ2 = 6.67, p < 0.05. Conclusions. NFSB is a major problem in South Africa and the incidence is still increasing. Hospital-based interventions following admission are recommended to reduce repeat attempts in such patients. Significant factors associated with non-fatal repetition include among others, a history of a previous medically serious attempt and/or a known psychiatric illness.

Learning from myocarditis: mimicry, chaos and black holes.

Science.gov (United States)

Rose, Noel R

2014-01-01

Autoimmune myocarditis and its sequel, dilated cardiomyopathy, are major causes of heart failure, especially in children and young adults. We have developed animal models to investigate their pathogenesis by infecting genetically susceptible mice with coxsackievirus B3 or by immunizing them with cardiac myosin or its immunodominant peptide. A number of valuable lessons have emerged from our study of this paradigm of an infection-induced autoimmune disease. We understand more clearly how natural autoimmunity, as an important component of normal physiology, must be recalibrated regularly due to changes caused by infection or other internal and external stimuli. A new normal homeostatic platform will be established based on its evolutionary fitness. A loss of homeostasis with out-of-control normal autoimmunity leads to autoimmune disease. It is signified early on by a spread of an adaptive autoimmune response to novel epitopes and neighboring antigens. The progression from infection to normal, well-balanced autoimmunity to autoimmune disease and on to irreversible damage is a complex, step-wise process. Yet, chaos theory provides hope that the pattern is potentially predictable. Infection-induced autoimmune disease represents a sequence of events heading for a train wreck at the end of the line. Our aim in autoimmune disease research must be to stop the train before this happens.

Fatal Rocky Mountain spotted fever in the United States, 1999-2007.

Science.gov (United States)

Dahlgren, F Scott; Holman, Robert C; Paddock, Christopher D; Callinan, Laura S; McQuiston, Jennifer H

2012-04-01

Death from Rocky Mountain spotted fever (RMSF) is preventable with prompt, appropriate treatment. Data from two independent sources were analyzed to estimate the burden of fatal RMSF and identify risk factors for fatal RMSF in the United States during 1999-2007. Despite increased reporting of RMSF cases to the Centers for Disease Control and Prevention, no significant changes in the estimated number of annual fatal RMSF cases were found. American Indians were at higher risk of fatal RMSF relative to whites (relative risk [RR] = 3.9), and children less than 10 years of age (RR=5.1) [corrected] and adults ≥ 70 years of age (RR = 3.0) were also at increased risk relative to other ages. Persons with cases of RMSF with an immunosuppressive condition were at increased risk of death (RR = 4.4). Delaying treatment of RMSF was also associated with increased deaths. These results may indicate a gap between recommendations and practice.

Disaster-related fatalities among US citizens traveling abroad.

Science.gov (United States)

Partridge, Robert; Bouslough, David; Proano, Lawrence

2013-01-01

To describe the locations and risk of death associated with natural disaster fatalities for US citizens traveling abroad. A retrospective database review of US citizen disaster deaths occurring worldwide. None. Information on fatalities due to disasters was abstracted from the US Department of State Web site reporting deaths of US citizens abroad by non-natural causes from October 2002 through June 2012. The main outcome measures were the frequency of disaster deaths and countries where disasters occurred. Descriptive statistics and rates were used to evaluate the study data. There were 7,963 total non-natural deaths of US citizens traveling abroad during the study period. Of these, 163 (2.0 percent) were disaster-related deaths, involving 19 disaster events in 15 countries. Only two disaster-related events resulted in more than two deaths of US travelers-the 2010 earthquake in Haiti causing 121 fatalities (74.2 percent of disaster deaths), and the 2004 tsunami in Thailand causing 22 fatalities (13.5 percent of disaster deaths). The approximate annual mean death rate for US citizen travelers as a result of disaster events is 0.27 deaths/1 million travelers, compared with 1.4 deaths/1 million residents due to disaster annually within the United States. The risk of disaster-related fatality is low for US citizens traveling abroad. Although disaster-related death among travelers is unpredictable, during a period of almost 10 years, there was only one reported death due to disaster in the five countries most frequently visited by US travelers. Further investigation may identify population-, seasonal-, country-, or location-specific risks from which prevention strategies can be developed.

The Relationship between Safety Climate with Fatalism and Perceived Helplessness among Workers: Implication for Health Promotion

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Fariba Kiani

2013-10-01

Conclusion: The perception of fatalism and helplessness in work environments can be obstacles to prevent occupational accidents. Promoting safety climate can be associated with fatalism culture change and also perceived helplessness reduction among workers.

Targeted Therapy for Acute Autoimmune Myocarditis with Nano-Sized Liposomal FK506 in Rats.

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Keiji Okuda

Full Text Available Immunosuppressive agents are used for the treatment of immune-mediated myocarditis; however, the need to develop a more effective therapeutic approach remains. Nano-sized liposomes may accumulate in and selectively deliver drugs to an inflammatory lesion with enhanced vascular permeability. The aims of this study were to investigate the distribution of liposomal FK506, an immunosuppressive drug encapsulated within liposomes, and the drug's effects on cardiac function in a rat experimental autoimmune myocarditis (EAM model. We prepared polyethylene glycol-modified liposomal FK506 (mean diameter: 109.5 ± 4.4 nm. We induced EAM by immunization with porcine myosin and assessed the tissue distribution of the nano-sized beads and liposomal FK506 in this model. After liposomal or free FK506 was administered on days 14 and 17 after immunization, the cytokine expression in the rat hearts along with the histological findings and hemodynamic parameters were determined on day 21. Ex vivo fluorescent imaging revealed that intravenously administered fluorescent-labeled nano-sized beads had accumulated in myocarditic but not normal hearts on day 14 after immunization and thereafter. Compared to the administration of free FK506, FK506 levels were increased in both the plasma and hearts of EAM rats when liposomal FK506 was administered. The administration of liposomal FK506 markedly suppressed the expression of cytokines, such as interferon-γ and tumor necrosis factor-α, and reduced inflammation and fibrosis in the myocardium on day 21 compared to free FK506. The administration of liposomal FK506 also markedly ameliorated cardiac dysfunction on day 21 compared to free FK506. Nano-sized liposomes may be a promising drug delivery system for targeting myocarditic hearts with cardioprotective agents.

Targeted Therapy for Acute Autoimmune Myocarditis with Nano-Sized Liposomal FK506 in Rats.

Science.gov (United States)

Okuda, Keiji; Fu, Hai Ying; Matsuzaki, Takashi; Araki, Ryo; Tsuchida, Shota; Thanikachalam, Punniyakoti V; Fukuta, Tatsuya; Asai, Tomohiro; Yamato, Masaki; Sanada, Shoji; Asanuma, Hiroshi; Asano, Yoshihiro; Asakura, Masanori; Hanawa, Haruo; Hao, Hiroyuki; Oku, Naoto; Takashima, Seiji; Kitakaze, Masafumi; Sakata, Yasushi; Minamino, Tetsuo

2016-01-01

Immunosuppressive agents are used for the treatment of immune-mediated myocarditis; however, the need to develop a more effective therapeutic approach remains. Nano-sized liposomes may accumulate in and selectively deliver drugs to an inflammatory lesion with enhanced vascular permeability. The aims of this study were to investigate the distribution of liposomal FK506, an immunosuppressive drug encapsulated within liposomes, and the drug's effects on cardiac function in a rat experimental autoimmune myocarditis (EAM) model. We prepared polyethylene glycol-modified liposomal FK506 (mean diameter: 109.5 ± 4.4 nm). We induced EAM by immunization with porcine myosin and assessed the tissue distribution of the nano-sized beads and liposomal FK506 in this model. After liposomal or free FK506 was administered on days 14 and 17 after immunization, the cytokine expression in the rat hearts along with the histological findings and hemodynamic parameters were determined on day 21. Ex vivo fluorescent imaging revealed that intravenously administered fluorescent-labeled nano-sized beads had accumulated in myocarditic but not normal hearts on day 14 after immunization and thereafter. Compared to the administration of free FK506, FK506 levels were increased in both the plasma and hearts of EAM rats when liposomal FK506 was administered. The administration of liposomal FK506 markedly suppressed the expression of cytokines, such as interferon-γ and tumor necrosis factor-α, and reduced inflammation and fibrosis in the myocardium on day 21 compared to free FK506. The administration of liposomal FK506 also markedly ameliorated cardiac dysfunction on day 21 compared to free FK506. Nano-sized liposomes may be a promising drug delivery system for targeting myocarditic hearts with cardioprotective agents.

Role of motorcycle type in fatal motorcycle crashes.

Science.gov (United States)

Teoh, Eric R; Campbell, Marvin

2010-12-01

Motorcycles vary in design and performance capability, and motorcyclists may select certain motorcycle types based on driving preferences. Conversely, motorcycle performance capability may influence the likelihood of risky driving behaviors such as speeding. Both mechanisms may affect fatal crash risk when examined by motorcycle type. Although it was not possible to estimate the effect of each mechanism, the current study analyzed fatal crash data for evidence of motorcycle type differences in risky driving behaviors and risk of driver death. Street legal motorcycles were classified into 10 types based on design characteristics and then further grouped as cruiser/standard, touring, sport touring, sport/unclad sport, supersport, and all others. For each motorcycle type, driver death rates per 10,000 registered vehicle years and the prevalence of fatal crash characteristics such as speeding were analyzed. Differences among motorcycle types concerning the effect of engine displacement were examined using Poisson regression. Overall, driver death rates for supersport motorcycles were four times as high as those for cruiser/standard motorcycles. Fatally injured supersport drivers were most likely to have been speeding and most likely to have worn helmets, but least likely to have been impaired by alcohol compared with drivers of other motorcycle types. The patterns in driver factors held after accounting for the effects of age and gender. Increased engine displacement was associated with higher driver death rates for each motorcycle type. Strong effects of motorcycle type were observed on driver death rates and on the likelihood of risky driving behaviors such as speeding and alcohol impairment. Although the current study could not completely disentangle the effects of motorcycle type and rider characteristics such as age on driver death rates, the effects of both motorcycle type and rider age on the likelihood of risky driving behaviors were observed among fatally

M cell-targeting strategy facilitates mucosal immune response and enhances protection against CVB3-induced viral myocarditis elicited by chitosan-DNA vaccine.

Science.gov (United States)

Ye, Ting; Yue, Yan; Fan, Xiangmei; Dong, Chunsheng; Xu, Wei; Xiong, Sidong

2014-07-31

Efficient delivery of antigen to mucosal associated lymphoid tissue is a first and critical step for successful induction of mucosal immunity by vaccines. Considering its potential transcytotic capability, M cell has become a more and more attractive target for mucosal vaccines. In this research, we designed an M cell-targeting strategy by which mucosal delivery system chitosan (CS) was endowed with M cell-targeting ability via conjugating with a CPE30 peptide, C terminal 30 amino acids of clostridium perfringens enterotoxin (CPE), and then evaluated its immune-enhancing ability in the context of coxsackievirus B3 (CVB3)-specific mucosal vaccine consisting of CS and a plasmid encoding CVB3 predominant antigen VP1. It had shown that similar to CS-pVP1, M cell-targeting CPE30-CS-pVP1 vaccine appeared a uniform spherical shape with about 300 nm diameter and +22 mV zeta potential, and could efficiently protect DNA from DNase I digestion. Mice were orally immunized with 4 doses of CPE30-CS-pVP1 containing 50 μg pVP1 at 2-week intervals and challenged with CVB3 4 weeks after the last immunization. Compared with CS-pVP1 vaccine, CPE30-CS-pVP1 vaccine had no obvious impact on CVB3-specific serum IgG level and splenic T cell immune responses, but significantly increased specific fecal SIgA level and augmented mucosal T cell immune responses. Consequently, much milder myocarditis and lower viral load were witnessed in CPE30-CS-pVP1 immunized group. The enhanced immunogenicity and immunoprotection were associated with the M cell-targeting ability of CPE30-CS-pVP1 which improved its mucosal uptake and transcytosis. Our findings indicated that CPE30-CS-pVP1 may represent a novel prophylactic vaccine against CVB3-induced myocarditis, and this M cell-targeting strategy indeed could be applied as a promising and universal platform for mucosal vaccine development. Copyright © 2014 Elsevier Ltd. All rights reserved.

Causes of Fatal Accidents Involving Cranes in the Australian Construction Industry

OpenAIRE

Gharaie, Ehsan; Lingard, Helen; Cooke, Tracy

2015-01-01

In ten years from 2004 to 2013, 359 workers died in the Australian construction industry because of work related causes. This paper investigates crane-related fatalities in order to find the upstream causation of such accidents. The National Coroners’ Information System (NCIS) database was searched to identify fatal accidents in the construction industry involving the use of a crane.  The narrative description of the cases provided in the coroners’ findings and associated documents were conte...

Non-fatal self-poisoning across age groups, in Sri Lanka.

Science.gov (United States)

Rajapakse, Thilini; Christensen, Helen; Cotton, Sue; Griffiths, Kathleen Margaret

2016-02-01

Attempted or non-fatal self-poisoning in common in Sri Lanka, but little is known about variation of psychiatric morbidity and suicidal intent across differing ages. The aim of this study was to investigate factors associated with non-fatal self-poisoning in Sri Lanka across three different age groups (namely 14-24 years, 25-34 years and ≥ 35 years). It was anticipated that the findings of the study would inform and guide development of preventive interventions for non-fatal self-poisoning in this country. 935 participants were interviewed within one week of admission to hospital for medical management of non-fatal self-poisoning, over a consecutive 14-month period. Socio-demographic factors, types of poison ingested, triggers and psychiatric morbidity was examined as a function of age. Results showed that a majority (83%) of participants were aged below 35 years. Younger participants aged aged 25-34 years, and ≥ 35 years), who were more likely to ingest pesticides. Recent interpersonal conflict was a proximal trigger seen in all age groups, but suicidal intent, depression and alcohol use disorders increased with age. The overall study findings indicate that most who carry out acts of non-fatal self-poisoning in Sri Lanka are young (aged age groups, but psychiatric morbidity and suicidal intent is higher in the older age groups, as is pesticide ingestion. Age specific interventions may be efficacious in the prevention of non-fatal self-poisoning in Sri Lanka. Copyright © 2016 Elsevier B.V. All rights reserved.

Drugs taken in fatal and non-fatal self-poisoning : A study in South London

NARCIS (Netherlands)

Neeleman, J; Wessely, S

This study compared the number and type of substances taken in deliberate self-poisoning with fatal (n=127) and non-fatal (n=521) outcome. The aims were (i) to describe substances typically involved in self-poisoning in England and Wales, (ii) to examine the role of drug 'cocktails' and (iii) to

Prostate cancer (PCa) risk variants and risk of fatal PCa in the National Cancer Institute Breast and Prostate Cancer Cohort Consortium.

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Shui, Irene M; Lindström, Sara; Kibel, Adam S; Berndt, Sonja I; Campa, Daniele; Gerke, Travis; Penney, Kathryn L; Albanes, Demetrius; Berg, Christine; Bueno-de-Mesquita, H Bas; Chanock, Stephen; Crawford, E David; Diver, W Ryan; Gapstur, Susan M; Gaziano, J Michael; Giles, Graham G; Henderson, Brian; Hoover, Robert; Johansson, Mattias; Le Marchand, Loic; Ma, Jing; Navarro, Carmen; Overvad, Kim; Schumacher, Fredrick R; Severi, Gianluca; Siddiq, Afshan; Stampfer, Meir; Stevens, Victoria L; Travis, Ruth C; Trichopoulos, Dimitrios; Vineis, Paolo; Mucci, Lorelei A; Yeager, Meredith; Giovannucci, Edward; Kraft, Peter

2014-06-01

Screening and diagnosis of prostate cancer (PCa) is hampered by an inability to predict who has the potential to develop fatal disease and who has indolent cancer. Studies have identified multiple genetic risk loci for PCa incidence, but it is unknown whether they could be used as biomarkers for PCa-specific mortality (PCSM). To examine the association of 47 established PCa risk single-nucleotide polymorphisms (SNPs) with PCSM. We included 10 487 men who had PCa and 11 024 controls, with a median follow-up of 8.3 yr, during which 1053 PCa deaths occurred. The main outcome was PCSM. The risk allele was defined as the allele associated with an increased risk for PCa in the literature. We used Cox proportional hazards regression to calculate the hazard ratios of each SNP with time to progression to PCSM after diagnosis. We also used logistic regression to calculate odds ratios for each risk SNP, comparing fatal PCa cases to controls. Among the cases, we found that 8 of the 47 SNPs were significantly associated (pPCa, but most did not differentiate between fatal and nonfatal PCa. Rs11672691 and rs10993994 were associated with both fatal and nonfatal PCa, while rs6465657, rs7127900, rs2735839, and rs13385191 were associated with nonfatal PCa only. Eight established risk loci were associated with progression to PCSM after diagnosis. Twenty-two SNPs were associated with fatal PCa incidence, but most did not differentiate between fatal and nonfatal PCa. The relatively small magnitudes of the associations do not translate well into risk prediction, but these findings merit further follow-up, because they may yield important clues about the complex biology of fatal PCa. In this report, we assessed whether established PCa risk variants could predict PCSM. We found eight risk variants associated with PCSM: One predicted an increased risk of PCSM, while seven were associated with decreased risk. Larger studies that focus on fatal PCa are needed to identify more markers that

Serotonin transporter gene polymorphism and myocardial infarction: Etude Cas-Témoins de l'Infarctus du Myocarde (ECTIM).

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Fumeron, Frédéric; Betoulle, Dina; Nicaud, Viviane; Evans, Alun; Kee, Frank; Ruidavets, Jean-Bernard; Arveiler, Dominique; Luc, Gérald; Cambien, François

2002-06-25

Depression is a risk factor for myocardial infarction (MI). Selective serotonin reuptake inhibitors reduce this risk. The site of action is the serotonin transporter (SLC6A4), which is expressed in brain and blood cells. A functional polymorphism in the promoter region of the SLC6A4 gene has been described. This polymorphism may be associated with the risk of MI. The SLC6A4 polymorphism has been investigated by polymerase chain reaction in 671 male patients with MI and in 688 controls from the Etude Cas-Témoins de l'Infarctus du Myocarde (ECTIM) multicentric study. Percentages for LL, LS, and SS genotypes were 35.5%, 45.4%, and 19.1%, respectively, for cases versus 28.1%, 49.1%, and 22.8%, respectively, for controls. S allele frequency was 41.8% and 47.4% for cases and controls, respectively. After adjustment for age and center by using multivariable logistic regression, the odds ratio for MI associated with the LL genotype was 1.40 (95% CI 1.11 to 1.76, P=0.0047). The LL genotype of the SLC6A4 polymorphism is associated with a higher risk of MI. This could be attributable to the effect of the polymorphism on serotonin-mediated platelet activation or smooth muscle cell proliferation or on other risk factors, such as depression or response to stress.

Urban violence is the biggest cause of fatal work-related accidents in Brazil.

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Cordeiro, Ricardo; Luz, Verônica Gronau; Hennington, Élida Azevedo; Martins, Ana Cláudia Alves; Tófoli, Luís Fernando

2017-12-11

To quantify the occurrence of deaths directly associated with urban violence among fatal work-related accidents. Verbal autopsies were performed with the relatives and coworkers of residents of Campinas, state of São Paulo, Brazil, who died from external causes in 2015. We have also analyzed police reports and reports of the Legal Medical Institute related to these deaths. We have identified 82 fatal work-related accidents in Campinas in 2015, of which 25 were murders, 35 were traffic accidents not directly related to work activities, and three were suicides at work. The proportional mortality rate for homicides, traffic accidents, and suicides among fatal work-related accidents was estimated at 30.5%, 42.7%, and 3.7%, respectively. Urban violence accounted for three-fourths of the fatal work-related accidents recorded in the period studied.

[Biochemical diagnostics of fatal opium intoxication].

Science.gov (United States)

Papyshev, I P; Astashkina, O G; Tuchik, E S; Nikolaev, B S; Cherniaev, A L

2013-01-01

Biochemical diagnostics of fatal opium intoxication remains a topical problem in forensic medical science and practice. We investigated materials obtained in the course of forensic medical expertise of the cases of fatal opium intoxication. The study revealed significant differences between myoglobin levels in blood, urine, myocardium, and skeletal muscles. The proposed approach to biochemical diagnostics of fatal opium intoxication enhances the accuracy and the level of evidence of expert conclusions.

Identifying characteristics and outcomes that are associated with fall-related fatalities: multi-year retrospective summary of fall deaths in older adults from 2005-2012.

Science.gov (United States)

Deprey, Sara M; Biedrzycki, Lynda; Klenz, Kristine

2017-12-01

Fall-related deaths continue to be the leading cause of accidental deaths in the older adult (65+ year) population. However, many fall-related fatalities are unspecified and little is known about the fall characteristics and personal demographics at the time of the fall. Therefore, this report describes the characteristics, circumstances and injuries of falls that resulted in older adult deaths in one U.S. County and explores the variables associated with fatal injuries from falls. This is a continued retrospective analysis of 841older adults whose underlying cause of death was due to a fall over an 8-year period (2005-2012). Demographics and logistic regression of fall characteristics and injuries were analyzed. Falls that led to death most often occurred when walking in one's own home. Most of the residents in this study were community-dwellers who had previous comorbidities taking an average of six medications prior to their fall. Survival after a fall was on average 31 days. The two most common injuries after a fatal fall were hip fractures (54%), and head injuries (21%). A logistic regression identified two variables associated with hip fracture, advancing age (OR = 1.05, 95% confidence interval [CI] = 1.02-1.08) and diagnosis of a prior neurological condition (OR = 2.1, 95% CI = 1.4-3.1). Variables associated with head injuries included younger age (OR = .91, 95% CI = .89-.94), male gender (OR = 2.5, 95% CI = 1.7-3.8), prescribed anticoagulants (OR = 2.4, 95% CI = 1.5-3.9) and negative musculoskeletal comorbidity (OR = 1.9. 95% CI = 1.1-3.0). Hip fractures and head injuries were the most common injury after a fall that led to death in older adults greater than 65 years. There are opposing risk factors for older adults who incur a hip fracture compared to a head injury. Thus, health professionals will need to individualize prevention efforts to reduce fall fatalities.

Individual and occupational factors related to fatal occupational injuries: a case-control study.

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Villanueva, Vicent; Garcia, Ana M

2011-01-01

This study has been designed in order to identify factors increasing the risk of a fatal outcome when occupational accidents occur. The aim is to provide further evidence for the design and implementation of preventive measures in occupational settings. The Spanish Ministry of Labour registry of occupational injuries causing absence from work includes information on individual and occupational characteristics of injured workers and events. Registered fatal occupational injuries in 2001 (n=539) were compared to a sample of non-fatal injuries in the same year (n=3493). Risks for a fatal result of occupational injuries, adjusted by individual and occupational factors significantly associated, were obtained through logistic regression models. Compared to non-fatal injuries, fatal occupational injuries were mostly produced by trapping or by natural causes, mostly related to elevation and transport devices and power generators, and injured parts of body more frequently affected were head, multiple parts or internal organs. Adjusted analyses showed increased risk of fatality after an occupational injury for males (adjusted odds ratio aOR=10.92; 95%CI 4.80-24.84) and temporary workers (aOR=5.18; 95%CI 2.63-10.18), and the risk increased with age and with advancing hour of the work shift (p for trends accidents in agricultural or construction companies. These data can help to select and define priorities for programmes aimed to prevent fatal consequences of occupational injuries. Copyright © 2010 Elsevier Ltd. All rights reserved.

Fatal occupational injuries in Taiwan, 1994-2005.

Science.gov (United States)

Ho, Shu-Chen; Wang, Li-Yu; Ho, Chi-Kung; Yang, Chun-Yuh

2010-04-01

This study examines the trends in rates of fatal occupational injuries in Taiwan by demographic group and occupation for 1994-2005. Data on deaths due to injuries at work from 1994 through 2005 were obtained from the Department of Health which is responsible for the death registration system in Taiwan. Employment data, which were used as the denominators of fatality rates in this study, were retrieved from the Directorate-General of Budget and Accounting Statistics 'Employment and Earnings' database. A Poisson regression model was used to examine the trends in rates of fatal occupational injuries in various occupations while controlling for demographic characteristics. Overall fatal occupational injury rates declined during the study period among all demographic groups and occupations. Adjusted annual changes in rates of fatal injuries ranged from a decrease of 13.6% a year in machine operators/related workers to a decrease of 35.9% in clerks. The annual decrement was faster for males than for females and for older workers compared to young workers. Despite declining rates, the number of fatal occupational injuries in Taiwan remains significant because of the growing work force. Future research should focus on the disparities in fatal injury trends.

Highway Safety: Trends in Highway Fatalities 1975-1987

Science.gov (United States)

1990-03-01

pattern of fatalities as the overall trend. This pattern applies to many of the general fatality statis- tics we present, and, in all cases, it serves as a...Fatalities 1975-87 Appemfx IV Vehicle-Related Statistics Figure IV.17: Vehicle Fatalities by Direction of Principal Impacto NNNumber of PddUlsils lwam 0 1975

Risk factors for fatality among confirmed adult dengue inpatients in Singapore: a matched case-control study.

Directory of Open Access Journals (Sweden)

Tun-Linn Thein

Full Text Available OBJECTIVES: To identify demographic, clinical and laboratory risk factors for death due to dengue fever in adult patients in Singapore. METHODS: Multi-center retrospective study of hospitalized adult patients with confirmed dengue fever in Singapore between 1 January 2004 and 31 December 2008. Non-fatal controls were selected by matching age and year of infection with fatal cases. World Health Organization 1997, 2009 criteria were applied to define dengue hemorrhagic fever (DHF, warning signs and severe dengue. Statistical significance was assessed by conditional logistic regression modeling. RESULTS: Significantly more fatal cases than matched controls had pre-existing co-morbid conditions, and presented with abdominal pain/tenderness. Median pulse rates were significantly higher while myalgia was significantly less frequent in cases. . Fatal cases also had higher leucocyte counts, platelet counts, serum sodium, potassium, urea, creatine and bilirubin levels on admission compared to controls. There was no statistical significant difference between the prevalence of DHF and hematocrit level among cases and controls. Multivariate analysis showed myalgia and leucocyte count at presentation were independent predictors of fatality (adjusted odds ratios 0.09 and 2.94 respectively. None of the controls was admitted to intensive care unit (ICU or given blood transfusion, while 71.4% and 28.6% of fatal cases received ICU admission and blood transfusion. CONCLUSIONS: Absence of myalgia and leucocytosis on admission were independently associated with fatality in our matched case-control study. Fatalities were also commonly associated with co-morbidities and clinicians should be alarmed if dengue patients fulfilled severe dengue case definition on admission.

Correlates of Community-Based Colorectal Cancer Screening in a Rural Population: The Role of Fatalism.

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Crosby, Richard A; Collins, Tom

2017-09-01

One largely unexplored barrier to colorectal cancer (CRC) screening is fatalistic beliefs about cancer. The purpose of this study was to identify correlates of ever having endoscopy screenings for CRC and to determine whether fatalism plays a unique role. Because evidence suggests that cancer-associated fatalistic beliefs may be particularly common among rural Americans, the study was conducted in a medically underserved area of rural Appalachia.  METHODS: Rural residents (N = 260) between 51 and 75 years of age, from a medically underserved area of Appalachia, Kentucky, were recruited for a cross-sectional study. The outcome measure was assessed by a single item asking whether participants ever had a colonoscopy or flexible sigmoidoscopy. Demographic and health-related correlates of this outcome were selected based on past studies of rural populations. A single item assessed perceptions of fatalism regarding CRC. Age-adjusted analyses of correlates testing significant at the bivariate level were conducted.  RESULTS: The analytic sample was limited to 135 rural residents indicating they had ever had CRC endoscopy and 107 indicating never having endoscopy. In age-adjusted analyses, only the measure of fatalism had a significant association with having endoscopy. Those endorsing the statement pertaining to fatalism were 2.3 times more likely (95% CI = 1.24-4.27, P = .008) than the remainder to indicate never having endoscopy.  CONCLUSIONS: A community-based approach to the promotion of endoscopy for CRC screening could focus on overcoming CRC-associated fatalism, thereby potentially bringing more unscreened people to endoscopy clinics. © 2017 National Rural Health Association.

Unresolved issues in theories of autoimmune disease using myocarditis as a framework.

Science.gov (United States)

Root-Bernstein, Robert; Fairweather, DeLisa

2015-06-21

Many theories of autoimmune disease have been proposed since the discovery that the immune system can attack the body. These theories include the hidden or cryptic antigen theory, modified antigen theory, T cell bypass, T cell-B cell mismatch, epitope spread or drift, the bystander effect, molecular mimicry, anti-idiotype theory, antigenic complementarity, and dual-affinity T cell receptors. We critically review these theories and relevant mathematical models as they apply to autoimmune myocarditis. All theories share the common assumption that autoimmune diseases are triggered by environmental factors such as infections or chemical exposure. Most, but not all, theories and mathematical models are unifactorial assuming single-agent causation of disease. Experimental and clinical evidence and mathematical models exist to support some aspects of most theories, but evidence/models that support one theory almost invariably supports other theories as well. More importantly, every theory (and every model) lacks the ability to account for some key autoimmune disease phenomena such as the fundamental roles of innate immunity, sex differences in disease susceptibility, the necessity for adjuvants in experimental animal models, and the often paradoxical effect of exposure timing and dose on disease induction. We argue that a more comprehensive and integrated theory of autoimmunity associated with new mathematical models is needed and suggest specific experimental and clinical tests for each major theory that might help to clarify how they relate to clinical disease and reveal how theories are related. Copyright © 2014 Elsevier Ltd. All rights reserved.

Unresolved issues in theories of autoimmune disease using myocarditis as a framework

Science.gov (United States)

Root-Bernstein, Robert; Fairweather, DeLisa

2014-01-01

Many theories of autoimmune disease have been proposed since the discovery that the immune system can attack the body. These theories include the hidden or cryptic antigen theory, modified antigen theory, T cell bypass, T cell-B cell mismatch, epitope spread or drift, the bystander effect, molecular mimicry, anti-idiotype theory, antigenic complementarity, and dual-affinity T cell receptors. We critically review these theories and relevant mathematical models as they apply to autoimmune myocarditis. All theories share the common assumption that autoimmune diseases are triggered by environmental factors such as infections or chemical exposure. Most, but not all, theories and mathematical models are unifactorial assuming single-agent causation of disease. Experimental and clinical evidence and mathematical models exist to support some aspects of most theories, but evidence/models that support one theory almost invariably supports other theories as well. More importantly, every theory (and every model) lacks the ability to account for some key autoimmune disease phenomena such as the fundamental roles of innate immunity, sex differences in disease susceptibility, the necessity for adjuvants in experimental animal models, and the often paradoxical effect of exposure timing and dose on disease induction. We argue that a more comprehensive and integrated theory of autoimmunity associated with new mathematical models is needed and suggest specific experimental and clinical tests for each major theory that might help to clarify how they relate to clinical disease and reveal how theories are related. PMID:25484004

Fatal and non-fatal injury outcomes: results from a purposively sampled census of seven rural subdistricts in Bangladesh.

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Alonge, Olakunle; Agrawal, Priyanka; Talab, Abu; Rahman, Qazi S; Rahman, Akm Fazlur; Arifeen, Shams El; Hyder, Adnan A

2017-08-01

90% of the global burden of injuries is borne by low-income and middle-income countries (LMICs). However, details of the injury burden in LMICs are less clear because of the scarcity of data and population-based studies. The Saving of Lives from Drowning project, implemented in rural Bangladesh, did a census on 1·2 million people to fill this gap. This Article describes the epidemiology of fatal and non-fatal injuries from the study. In this study, we used data from the baseline census conducted as part of the Saving of Lives from Drowning (SoLiD) project. The census was implemented in 51 unions from seven purposively sampled rural subdistricts of Bangladesh between June and November, 2013. Sociodemographic, injury mortality, and morbidity information were collected for the whole population in the study area. We analysed the data for descriptive measures of fatal and non-fatal injury outcomes. Age and gender distribution, socioeconomic characteristics, and injury characteristics such as external cause, intent, location, and body part affected were reported for all injury outcomes. The census covered a population of 1 169 593 from 270 387 households and 451 villages. The overall injury mortality rate was 38 deaths per 100 000 population per year, and 104 703 people sustained major non-fatal injuries over a 6-month recall period. Drowning was the leading external cause of injury death for all ages, and falls caused the most number of non-fatal injuries. Fatal injury rates were highest in children aged 1-4 years. Non-fatal injury rates were also highest in children aged 1-4 years and those aged 65 years and older. Males had more fatal and non-fatal injuries than females across all external causes except for burns. Suicide was the leading cause of injury deaths in individuals aged 15-24 years, and more than 50% of the suicides occurred in females. The home environment was the most common location for most injuries. The burden of fatal and non-fatal injuries

Fatal Rocky Mountain Spotted Fever in the United States, 1999–2007

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Dahlgren, F. Scott; Holman, Robert C.; Paddock, Christopher D.; Callinan, Laura S.; McQuiston, Jennifer H.

2012-01-01

Death from Rocky Mountain spotted fever (RMSF) is preventable with prompt, appropriate treatment. Data from two independent sources were analyzed to estimate the burden of fatal RMSF and identify risk factors for fatal RMSF in the United States during 1999–2007. Despite increased reporting of RMSF cases to the Centers for Disease Control and Prevention, no significant changes in the estimated number of annual fatal RMSF cases were found. American Indians were at higher risk of fatal RMSF relative to whites (relative risk [RR] = 3.9), and children 5–9 years of age (RR = 6.0) and adults ≥ 70 years of age (RR = 3.0) were also at increased risk relative to other ages. Persons with cases of RMSF with an immunosuppressive condition were at increased risk of death (RR = 4.4). Delaying treatment of RMSF was also associated with increased deaths. These results may indicate a gap between recommendations and practice. PMID:22492159

On the road again: traffic fatalities and auto insurance minimums

Directory of Open Access Journals (Sweden)

Pavel A. Yakovlev

2018-03-01

Full Text Available Prior research on policy-induced moral hazard effects in the auto insurance market has focused on the impact of compulsory insurance, no-fault liability, and tort liability laws on traffic fatalities. In contrast, this paper examines the moral hazard effect of a previously overlooked policy variable: minimum auto insurance coverage. We hypothesize that state-mandated auto insurance minimums may “over-insure” some drivers, lowering their incentives to drive carefully. Using a longitudinal panel of American states from 1982 to 2006, we find that policy-induced increases in auto insurance minimums are associated with higher traffic fatality rates, ceteris paribus.

Neglecting safety precautions may lead to trenching fatalities.

Science.gov (United States)

Deatherage, J Harold; Furches, Lisa K; Radcliffe, Mike; Schriver, William R; Wagner, John P

2004-06-01

Trench collapses ranked as the seventh leading cause of the possible twenty-nine causes of OSHA-inspected fatal construction events during the period 1991-2001. This study aims to examine why these fatalities occurred. Forty-four case files from OSHA inspections of fatal trench collapses were reviewed. Improper protection of the excavation site where work was taking place was the leading fatality cause. Several organizational or physical conditions were present at many fatal sites; the most frequent was that no training had been provided for trenching. Presence of a competent, diligent person at the site would have prohibited most fatalities. The top cited violation was lack of protection, that is, benching, shoring, sloping, trench boxes, etc. (29 CFR 1926.652 (a) (1)). Copyright 2004 Wiley-Liss, Inc.

Age trajectories of stroke case fatality

DEFF Research Database (Denmark)

Olsen, Tom Skyhøj; Andersen, Zorana Jovanovic; Andersen, Klaus Kaae

2011-01-01

Mortality rates level off at older ages. Age trajectories of stroke case-fatality rates were studied with the aim of investigating prevalence of this phenomenon, specifically in case-fatality rates at older ages....

Are 1994 alcohol production and the sales deregulation policy in Japan associated with increased road traffic fatalities among adult and teenage males and females in Japan?

Science.gov (United States)

Desapriya, Ediriweera; Fujiwara, Takeo; Scime, Giulia; Sasges, Deborah; Pike, Ian; Shimizu, Shinji

2009-10-01

International studies have shown a significant association between alcohol availability and traffic crashes that involve alcohol-impaired drivers. A key limitation to previous alcohol availability and motor vehicle crash (MVC) evaluation research is the assumption of population homogeneity in responding to the policies. The present analysis focuses on the evaluation of the impact of alcohol availability on different segments of the Japanese population by comparing MVC fatality rates from before and after implementation of the alcohol deregulation policy in 1994. Poisson regression with robust standard error was used to model the before-to-after change in incidence rate ratios (IRR) in adult males, adult females, teenage males and teenage females. To control potential confounders, unemployment rate, vehicle miles of travel (VMT), vehicle registration, and number of drivers licensed in Japan were added to the model. The exponents of the fitted coefficients are equivalent to incidence rate ratios. Implementation of the policy deregulating alcohol sales and production did not appear to increase traffic fatalities among adult or teenage males or females in Japan. We found that male adult fatalities demonstrated a statistically significant decline following enactment of the deregulation policy in 1994. Contrary to previous research, the findings of this study demonstrated lower rates of fatalities and higher compliance with alcohol-related driving legislation in Japanese society following implementation of the deregulation policy in 1994. Further well designed, nonaligned studies on alcohol availability and traffic fatalities in other countries are urgently needed.

Intergenerational differences in occupational injury and fatality rates among Canada's immigrants.

Science.gov (United States)

Tiagi, R

2016-12-01

Empirical evidence on occupational injury and/or fatality rates among Canada's immigrants has been largely mixed and has almost exclusively focused on the first generation. Over time, as immigrants assimilate into the economy, future generations may be expected to work in less hazardous occupations compared with prior generations. There has been no prior analysis of the differences in occupational injury and fatality rates among later generations. To analyse whether there are intergenerational differences in occupational injury and fatality rates among the first, second and third (or more) immigrant generations in Canada. Data drawn from the 2011 National Household Survey and the Association of Workers' Compensation Boards of Canada were used to determine the difference in occupational injury and fatality rates between the first or the third generation and the second generation, using a Poisson regression framework. Second-generation immigrants worked in jobs with lower occupational injury rates compared with the first generation and the third generation (or more). Similar results were observed for occupational fatality rates. Second-generation immigrants worked in less hazardous jobs compared with the first generation and compared with the third (or more) generations. These results suggest that the second generation may not face the same economic hurdles and challenges, in terms of workplace injuries or fatalities, as those faced by the first or third (or more) generations of immigrants. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Lung function and risk of fatal and non-fatal stroke. The Copenhagen City Heart Study

DEFF Research Database (Denmark)

Truelsen, T; Prescott, E; Lange, P

2001-01-01

results on the relation between forced expiratory volume in one second (FEV1) and risk of incident and fatal first-ever stroke. SUBJECTS AND METHODS: The analyses are based on prospective cohort data from 12 878 eligible men and women aged 45-84 years, who participated in the first health examination...... adjustment for potential confounders: sex, age, smoking, inhalation, body mass index, systolic blood pressure, triglycerides, physical activity in leisure time, education, diabetes mellitus, and antihypertensive treatment. RESULTS: We found an inverse association between FEV1 and risk of first-time stroke...

Bacillary angiomatosis: A rare finding in the setting of antiretroviral ...

African Journals Online (AJOL)

eases in humans.[1] The two most commonly associated with HIV are B. quintana and. B. henselae.[1,2,5] Transmission of Bartonella to humans occurs via a cat scratch that is contaminated with Bartonella-infected fleas.[1,2,5,6] The prevalence of Bartonella in. HIV-positive persons is reported to be very. CASE REPORT.

Medical marijuana laws, traffic fatalities, and alcohol consumption

OpenAIRE

Anderson, D. Mark; Rees, Daniel I.

2011-01-01

To date, 16 states have passed medical marijuana laws, yet very little is known about their effects. Using state-level data, we examine the relationship between medical marijuana laws and a variety of outcomes. Legalization of medical marijuana is associated with increased use of marijuana among adults, but not among minors. In addition, legalization is associated with a nearly 9 percent decrease in traffic fatalities, most likely to due to its impact on alcohol consumption. Our estimates pro...

Risk of Fatal Cerebrovascular Accidents after External Beam Radiation Therapy for Early Stage Glottic Larynx Cancer

Science.gov (United States)

Swisher-McClure, Samuel; Mitra, Nandita; Lin, Alexander; Ahn, Peter; Wan, Fei; O’Malley, Bert; Weinstein, Gregory S.; Bekelman, Justin E.

2013-01-01

Background This study compared the risk of fatal cerebrovascular accidents (CVA) in patients with early stage glottic larynx cancer receiving surgery or external beam radiation therapy (EBRT). Methods and Materials Using a competing risks survival analysis, we compared the risk of death due to CVA among patients with early stage glottic larynx cancer receiving surgery or EBRT in the SEER database. Results The cumulative incidence of fatal CVA at 15 years was higher in patients receiving EBRT (2.8 %; 95% CI 2.3%–3.4%) compared to surgery (1.5 %; 95% CI 0.8 %–2.3%, p= 0.024). In multivariable competing risks regression models, EBRT remained associated with an increased risk of fatal CVA compared to surgery (adjusted HR 1.75; 95% CI 1.04–2.96, p= 0.037). Conclusion Treatment of early stage glottic larynx cancer with EBRT was associated with a small increase in the risk of late fatal CVA events relative to surgery. PMID:23595858

Work-related agricultural fatalities in Australia, 1982-1984.

Science.gov (United States)

Erlich, S M; Driscoll, T R; Harrison, J E; Frommer, M S; Leigh, J

1993-06-01

Work-related agricultural fatalities were examined as part of a larger population-based study of all work-related fatalities in Australia in the period 1982-1984. A total of 257 farm-related fatalities were identified, of which 223 were deaths of persons in the employed civilian labor force (19.4 deaths per 100,000 persons per year) and 34 were deaths of children less than 15 years of age. The fatality incidence was higher among men, older age groups, and nonmanagers in general and in certain occupations in particular. Mobile mechanical equipment (particularly tractors) was the main fatal agent, roll-overs accounting for many of the fatalities. Better provision of information to agricultural workers, improvements in compliance to and enforcement of legislation, and changes in farming work practices are recommended to improve the safety of farms and farm work.

Different features of V?2 T and NK cells in fatal and non-fatal human Ebola infections

OpenAIRE

Cimini, Eleonora; Viola, Domenico; Cabeza-Cabrerizo, Mar; Romanelli, Antonella; Tumino, Nicola; Sacchi, Alessandra; Bordoni, Veronica; Casetti, Rita; Turchi, Federica; Martini, Federico; Bore, Joseph A.; Koundouno, Fara Raymond; Duraffour, Sophie; Michel, Janine; Holm, Tobias

2017-01-01

Background Human Ebola infection is characterized by a paralysis of the immune system. A signature of ?? T cells in fatal Ebola infection has been recently proposed, while the involvement of innate immune cells in the protection/pathogenesis of Ebola infection is unknown. Aim of this study was to analyze ?? T and NK cells in patients from the Ebola outbreak of 2014?2015 occurred in West Africa, and to assess their association with the clinical outcome. Methodology/Principal findings Nineteen ...

Re-evaluation of a novel approach for quantitative myocardial oedema detection by analysing tissue inhomogeneity in acute myocarditis using T2-mapping.

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Baeßler, Bettina; Schaarschmidt, Frank; Treutlein, Melanie; Stehning, Christian; Schnackenburg, Bernhard; Michels, Guido; Maintz, David; Bunck, Alexander C

2017-12-01

To re-evaluate a recently suggested approach of quantifying myocardial oedema and increased tissue inhomogeneity in myocarditis by T2-mapping. Cardiac magnetic resonance data of 99 patients with myocarditis were retrospectively analysed. Thirthy healthy volunteers served as controls. T2-mapping data were acquired at 1.5 T using a gradient-spin-echo T2-mapping sequence. T2-maps were segmented according to the 16-segments AHA-model. Segmental T2-values, segmental pixel-standard deviation (SD) and the derived parameters maxT2, maxSD and madSD were analysed and compared to the established Lake Louise criteria (LLC). A re-estimation of logistic regression models revealed that all models containing an SD-parameter were superior to any model containing global myocardial T2. Using a combined cut-off of 1.8 ms for madSD + 68 ms for maxT2 resulted in a diagnostic sensitivity of 75% and specificity of 80% and showed a similar diagnostic performance compared to LLC in receiver-operating-curve analyses. Combining madSD, maxT2 and late gadolinium enhancement (LGE) in a model resulted in a superior diagnostic performance compared to LLC (sensitivity 93%, specificity 83%). The results show that the novel T2-mapping-derived parameters exhibit an additional diagnostic value over LGE with the inherent potential to overcome the current limitations of T2-mapping. • A novel quantitative approach to myocardial oedema imaging in myocarditis was re-evaluated. • The T2-mapping-derived parameters maxT2 and madSD were compared to traditional Lake-Louise criteria. • Using maxT2 and madSD with dedicated cut-offs performs similarly to Lake-Louise criteria. • Adding maxT2 and madSD to LGE results in further increased diagnostic performance. • This novel approach has the potential to overcome the limitations of T2-mapping.

Analyzing temozolomide medication errors: potentially fatal.

Science.gov (United States)

Letarte, Nathalie; Gabay, Michael P; Bressler, Linda R; Long, Katie E; Stachnik, Joan M; Villano, J Lee

2014-10-01

The EORTC-NCIC regimen for glioblastoma requires different dosing of temozolomide (TMZ) during radiation and maintenance therapy. This complexity is exacerbated by the availability of multiple TMZ capsule strengths. TMZ is an alkylating agent and the major toxicity of this class is dose-related myelosuppression. Inadvertent overdose can be fatal. The websites of the Institute for Safe Medication Practices (ISMP), and the Food and Drug Administration (FDA) MedWatch database were reviewed. We searched the MedWatch database for adverse events associated with TMZ and obtained all reports including hematologic toxicity submitted from 1st November 1997 to 30th May 2012. The ISMP describes errors with TMZ resulting from the positioning of information on the label of the commercial product. The strength and quantity of capsules on the label were in close proximity to each other, and this has been changed by the manufacturer. MedWatch identified 45 medication errors. Patient errors were the most common, accounting for 21 or 47% of errors, followed by dispensing errors, which accounted for 13 or 29%. Seven reports or 16% were errors in the prescribing of TMZ. Reported outcomes ranged from reversible hematological adverse events (13%), to hospitalization for other adverse events (13%) or death (18%). Four error reports lacked detail and could not be categorized. Although the FDA issued a warning in 2003 regarding fatal medication errors and the product label warns of overdosing, errors in TMZ dosing occur for various reasons and involve both healthcare professionals and patients. Overdosing errors can be fatal.

Unintentional, non-fatal drowning of children: US trends and racial/ethnic disparities.

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Felton, Heather; Myers, John; Liu, Gil; Davis, Deborah Winders

2015-12-15

The current study aimed to better understand trends and risk factors associated with non-fatal drowning of infants and children in the USA using two large, national databases. A secondary data analysis was conducted using the National Inpatient Sample and the Nationwide Emergency Department Sample databases. The analytic sample (n=19,403) included children near-drowning/non-fatal drowning. Descriptive, χ(2) and analysis of variance techniques were applied, and incidence rates were calculated per 100,000 population. Non-fatal drowning incidence has remained relatively stable from 2006 to 2011. In general, the highest rates of non-fatal drowning occurred in swimming pools and in children from racial/ethnic minorities. However, when compared with non-Hispanic Caucasian children, children from racial/ethnic minorities were more likely to drown in natural waterways than in swimming pools. Despite the overall lower rate of non-fatal drowning among non-Hispanic Caucasian children, the highest rate of all non-fatal drowning was for non-Hispanic Caucasian children aged 0-4 years in swimming pools. Children who were admitted to inpatient facilities were younger, male and came from families with lower incomes. Data from two large US national databases show lack of progress in preventing and reducing non-fatal drowning admissions from 2006 to 2011. Discrepancies are seen in the location of drowning events and demographic characteristics. New policies and interventions are needed, and tailoring approaches by age and race/ethnicity may improve their effectiveness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A Rare Fatal Complication of Llizarov Procedure.

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Sikary, Asit Kumar; Kumar, Mahesh; Dhaka, Shivani; Subramanian, Arulselvi

2018-03-01

Ilizarov process is used for the management of multiple fractures, polytrauma conditions, cosmetic limb lengthening, and fracture malunion. Complications associated with the process are nerve palsy, joint contracture, premature or delayed osseous consolidation, a nonunion and permanent stiffness of the joint, pin tract infection, edema, and transient paresthesia, etc. In our case, there was a fatal complication. A 25-year-old African lady underwent the Ilizarov procedure for femur lengthening in a hospital in New Delhi, India. During her first distraction process, she suddenly collapsed at the hospital and could not be revived. At postmortem, a small hematoma was seen around the surgically fractured area. On histopathology of internal organs, fat globules were present in the vasculature of brain and lungs. Cause of death was opined as due to fat embolism. This is the first case reported of a fatal fat embolism following Ilizarov procedure for limb lengthening in a healthy adult. © 2018 American Academy of Forensic Sciences.

Fatal versus non-fatal heroin "overdose": blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers.

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Meissner, Christoph; Recker, Sabine; Reiter, Arthur; Friedrich, Hans Juergen; Oehmichen, Manfred

2002-11-05

The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxication. The majority of both survivors and non-survivors were found to show a concomitant use of depressants including alcohol or stimulants. Blood morphine levels in both groups varied widely, with a large area of overlap between survivors (free morphine: 0-128 ng/ml, total morphine: 10-2,110 ng/ml) and non-survivors (free morphine: 0-2,800 ng/ml, total morphine: 33-5,000 ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28-93 ng/ml, total morphine: 230-1,451 ng/ml; non-survivors-free morphine: 0-2,800 ng/ml, total morphine: 119-4,660 ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (N=207) was 0.293, for those that survived (N=27) 0.135, in cases of intoxication only by morphine 0.250 (N=87) and 0.080 (N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200 ng/ml and more of free morphine displayed a fatal outcome.

Impact of on-site cardiac catheterization on resource utilization and fatal and non-fatal outcomes after acute myocardial infarction

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Richard Hugues

2006-11-01

Full Text Available Abstract Background Patterns of care for acute myocardial infarction (AMI strongly depend on the availability of on-site cardiac catheterization facilities. Although the management found at hospitals without on-site catheterization does not lead to increased mortality, little it known about its impact on resource utilization and non-fatal outcomes. Methods We identified all patients (n = 35,289 admitted with a first AMI in the province of Quebec between January 1, 1996 and March 31, 1999 using population-based administrative databases. Medical resource utilization and non-fatal and fatal outcomes were compared among patients admitted to hospitals with and without on-site cardiac catheterization facilities. Results Cardiac catheterization and PCI were more frequently performed among patients admitted to hospitals with catheterization facilities. However, non-invasive procedures were not used more frequently at hospitals without catheterization facilities. To the contrary, echocardiography [odds ratio (OR, 2.04; 95% confidence interval (CI, 1.93–2.16] and multi-gated acquisition imaging (OR, 1.24; 95% CI, 1.17–1.32 were used more frequently at hospitals with catheterization, and exercise treadmill testing (OR, 1.02; 95% CI, 0.91–1.15 and Sestamibi/Thallium imaging (OR, 0.93; 95% CI, 0.88–0.98 were used similarly at hospitals with and without catheterization. Use of anti-ischemic medications and frequency of emergency room and physician visits, were similar at both types of institutions. Readmission rates for AMI-related cardiac complications and mortality were also similar [adjusted hazard ratio, recurrent AMI: 1.02, 95% CI, 0.89–1.16; congestive heart failure: 1.02; 95% CI, 0.90–1.15; unstable angina: 0.93; 95% CI, 0.85–1.02; mortality: 0.99; 95% CI, 0.93–1.05]. Conclusion Although on-site availability of cardiac catheterization facilities is associated with greater use of invasive cardiac procedures, non-availability of

Prevalence of Ehrlichia canis, Anaplasma platys, Babesia canis vogeli, Hepatozoon canis, Bartonella vinsonii berkhoffii, and Rickettsia spp. in dogs from Grenada.

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Yabsley, Michael J; McKibben, John; Macpherson, Calum N; Cattan, Peggy F; Cherry, Natalie A; Hegarty, Barbara C; Breitschwerdt, Edward B; O'Connor, Tom; Chandrashekar, Ramaswamy; Paterson, Tara; Perea, Marta Lanza; Ball, Geoffrey; Friesen, Stanley; Goedde, Jill; Henderson, Brooke; Sylvester, Wayne

2008-02-14

To identify the tick-borne pathogens in dogs from Grenada, we conducted a serologic survey for Ehrlichia canis in 2004 (104 dogs) and a comprehensive serologic and molecular survey for a variety of tick-borne pathogens in 2006 (73 dogs). In 2004 and 2006, 44 and 32 dogs (42.3% and 43.8%) were seropositive for E. canis, respectively. In 2006, several tick-borne pathogens were identified by serology and PCR. DNA of E. canis, Anaplasma platys, Babesia canis vogeli, Hepatozoon canis, and Bartonella sp. were identified in 18 (24.7%), 14 (19.2%), 5 (7%), 5 (7%), and 1 (1.4%) dogs, respectively. Six (8.2%) dogs were seropositive for Bartonella vinsonii subsp. berkhoffii. All dogs were seronegative and PCR-negative for Rickettsia spp. Coinfection with two or three pathogens was observed in eight dogs. Partial 16S rRNA E. canis and A. platys sequences were identical to sequences in GenBank. Partial 18S rRNA gene sequences from the Grenadian H. canis were identical to each other and had one possible mismatch (ambiguous base) from H. canis detected from Spain and Brazil. Grenadian B. c. vogeli sequences were identical to B. c. vogeli from Brazil and Japan. All of the detected pathogens are transmitted, or suspected to be transmitted, by Rhipicephalus sanguineus. Results of this study indicate that dogs from Grenada are infected with multiple tick-borne pathogens; therefore, tick-borne diseases should be included as differentials for dogs exhibiting thrombocytopenia, leukopenia, fever, or lethargy. One pathogen, E. canis, is also of potential public health significance.

The extent of evidence-based information about child maltreatment fatalities in social science textbooks.

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Douglas, Emily M; Serino, Patricia J

2013-10-01

Previous research has established that child welfare workers lack important information about child maltreatment fatalities and risk factors leading to death. Further, training has not been associated with improvements in knowledge. The authors assessed the presence of evidence-based information about child maltreatment fatalities and risk factors for death in 24 social science textbooks about child abuse and neglect or child welfare. The results indicate that basic information, such as definitions and incidence rates of child maltreatment fatalities are routinely included in social science textbooks, but information about child, parent, and household risk factors are not, and that inaccurate information is often included. Implications of the findings are discussed.

Different features of Vδ2 T and NK cells in fatal and non-fatal human Ebola infections

OpenAIRE

Cimini, Eleonora; Viola, Domenico; Cabeza-Cabrerizo, Mar; Romanelli, Antonella; Tumino, Nicola; Sacchi, Alessandra; Bordoni, Veronica; Casetti, Rita; Turchi, Federica; Martini, Federico; Bore, Joseph A.; Koundouno, Fara Raymond; Duraffour, Sophie; Michel, Janine; Holm, Tobias

2017-01-01

Background: Human Ebola infection is characterized by a paralysis of the immune system. A signature of αβ T cells in fatal Ebola infection has been recently proposed, while the involvement of innate immune cells in the protection/pathogenesis of Ebola infection is unknown. Aim of this study was to analyze γδ T and NK cells in patients from the Ebola outbreak of 2014–2015 occurred in West Africa, and to assess their association with the clinical outcome. Methodology/Principal findings: ...

Cirrus Airframe Parachute System and Odds of a Fatal Accident in Cirrus Aircraft Crashes.

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Alaziz, Mustafa; Stolfi, Adrienne; Olson, Dean M

2017-06-01

General aviation (GA) accidents have continued to demonstrate high fatality rates. Recently, ballistic parachute recovery systems (BPRS) have been introduced as a safety feature in some GA aircraft. This study evaluates the effectiveness and associated factors of the Cirrus Airframe Parachute System (CAPS) at reducing the odds of a fatal accident in Cirrus aircraft crashes. Publicly available Cirrus aircraft crash reports were obtained from the National Transportation Safety Board (NTSB) database for the period of January 1, 2001-December 31, 2016. Accident metrics were evaluated through univariate and multivariate analyses regarding odds of a fatal accident and use of the parachute system. Included in the study were 268 accidents. For CAPS nondeployed accidents, 82 of 211 (38.9%) were fatal as compared to 8 of 57 (14.0%) for CAPS deployed accidents. After controlling for all other factors, the adjusted odds ratio for a fatal accident when CAPS was not deployed was 13.1. The substantial increased odds of a fatal accident when CAPS was not deployed demonstrated the effectiveness of CAPS at providing protection of occupants during an accident. Injuries were shifted from fatal to serious or minor with the use of CAPS and postcrash fires were significantly reduced. These results suggest that BPRS could play a significant role in the next major advance in improving GA accident survival.Alaziz M, Stolfi A, Olson DM. Cirrus Airframe Parachute System and odds of a fatal accident in Cirrus aircraft crashes. Aerosp Med Hum Perform. 2017; 88(6):556-564.

Fatal poisonings in Oslo: a one-year observational study.

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Bjornaas, Mari A; Teige, Brita; Hovda, Knut E; Ekeberg, Oivind; Heyerdahl, Fridtjof; Jacobsen, Dag

2010-06-06

Acute poisonings are common and are treated at different levels of the health care system. Since most fatal poisonings occur outside hospital, these must be included when studying characteristics of such deaths. The pattern of toxic agents differs between fatal and non-fatal poisonings. By including all poisoning episodes, cause-fatality rates can be calculated. Fatal and non-fatal acute poisonings in subjects aged > or =16 years in Oslo (428 198 inhabitants) were included consecutively in an observational multi-centre study including the ambulance services, the Oslo Emergency Ward (outpatient clinic), and hospitals, as well as medico-legal autopsies from 1st April 2003 to 31st March 2004. Characteristics of fatal poisonings were examined, and a comparison of toxic agents was made between fatal and non-fatal acute poisoning. In Oslo, during the one-year period studied, 103 subjects aged > or =16 years died of acute poisoning. The annual mortality rate was 24 per 100 000. The male-female ratio was 2:1, and the mean age was 44 years (range 19-86 years). In 92 cases (89%), death occurred outside hospital. The main toxic agents were opiates or opioids (65% of cases), followed by ethanol (9%), tricyclic anti-depressants (TCAs) (4%), benzodiazepines (4%), and zopiclone (4%). Seventy-one (69%) were evaluated as accidental deaths and 32 (31%) as suicides. In 70% of all cases, and in 34% of suicides, the deceased was classified as drug or alcohol dependent. When compared with the 2981 non-fatal acute poisonings registered during the study period, the case fatality rate was 3% (95% C.I., 0.03-0.04). Methanol, TCAs, and antihistamines had the highest case fatality rates; 33% (95% C.I., 0.008-0.91), 14% (95% C.I., 0.04-0.33), and 10% (95% C.I., 0.02-0.27), respectively. Three per cent of all acute poisonings were fatal, and nine out of ten deaths by acute poisonings occurred outside hospital. Two-thirds were evaluated as accidental deaths. Although case fatality rates were

Occupational injury and fatality investigations: the application of forensic nursing science.

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Harris, Colin

2013-01-01

The forensic evaluation of trauma in occupational injuries and fatalities can provide the benefit of a more thorough analysis of incident causation. Forensic nursing science applied during workplace investigations can assist investigators to determine otherwise unknown crucial aspects of the incident circumstances that are important to event reconstruction, the enforcement of occupational health and safety requirements, and the direction of workplace prevention initiatives. Currently, a medical and forensic medical knowledge gap exists in the subject-matter expertise associated with occupational accident investigations. This gap can be bridged with the integration of forensic nursing in the investigation of workplace fatalities and serious injuries.

Urban violence is the biggest cause of fatal work-related accidents in Brazil

OpenAIRE

Cordeiro, Ricardo; Luz, Verônica Gronau; Hennington, Élida Azevedo; Martins, Ana Cláudia Alves; Tófoli, Luís Fernando

2017-01-01

ABSTRACT OBJECTIVE To quantify the occurrence of deaths directly associated with urban violence among fatal work-related accidents. METHODS Verbal autopsies were performed with the relatives and coworkers of residents of Campinas, state of São Paulo, Brazil, who died from external causes in 2015. We have also analyzed police reports and reports of the Legal Medical Institute related to these deaths. RESULTS We have identified 82 fatal work-related accidents in Campinas in 2015, of which 25...

Occurrence of Babesia spp., Rickettsia spp. and Bartonella spp. in Ixodes ricinus in Bavarian public parks, Germany

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Mahling Monia

2011-07-01

Full Text Available Abstract Background Only limited information is available about the occurrence of ticks and tick-borne pathogens in public parks, which are areas strongly influenced by human beings. For this reason, Ixodes ricinus were collected in public parks of different Bavarian cities in a 2-year survey (2009 and 2010 and screened for DNA of Babesia spp., Rickettsia spp. and Bartonella spp. by PCR. Species identification was performed by sequence analysis and alignment with existing sequences in GenBank. Additionally, coinfections with Anaplasma phagocytophilum were investigated. Results The following prevalences were detected: Babesia spp.: 0.4% (n = 17, including one pool of two larvae in 2009 and 0.5 to 0.7% (n = 11, including one pool of five larvae in 2010; Rickettsia spp.: 6.4 to 7.7% (n = 285, including 16 pools of 76 larvae in 2009. DNA of Bartonella spp. in I. ricinus in Bavarian public parks could not be identified. Sequence analysis revealed the following species: Babesia sp. EU1 (n = 25, B. divergens (n = 1, B. divergens/capreoli (n = 1, B. gibsoni-like (n = 1, R. helvetica (n = 272, R. monacensis IrR/Munich (n = 12 and unspecified R. monacensis (n = 1. The majority of coinfections were R. helvetica with A. phagocytophilum (n = 27, but coinfections between Babesia spp. and A. phagocytophilum, or Babesia spp. and R. helvetica were also detected. Conclusions I. ricinus ticks in urban areas of Germany harbor several tick-borne pathogens and coinfections were also observed. Public parks are of particularly great interest regarding the epidemiology of tick-borne pathogens, because of differences in both the prevalence of pathogens in ticks as well as a varying species arrangement when compared to woodland areas. The record of DNA of a Babesia gibsoni-like pathogen detected in I. ricinus suggests that I. ricinus may harbor and transmit more Babesia spp. than previously known. Because of their high recreational value for human beings, urban green

Occurrence of Babesia spp., Rickettsia spp. and Bartonella spp. in Ixodes ricinus in Bavarian public parks, Germany.

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Schorn, Sabine; Pfister, Kurt; Reulen, Holger; Mahling, Monia; Silaghi, Cornelia

2011-07-15

Only limited information is available about the occurrence of ticks and tick-borne pathogens in public parks, which are areas strongly influenced by human beings. For this reason, Ixodes ricinus were collected in public parks of different Bavarian cities in a 2-year survey (2009 and 2010) and screened for DNA of Babesia spp., Rickettsia spp. and Bartonella spp. by PCR. Species identification was performed by sequence analysis and alignment with existing sequences in GenBank. Additionally, coinfections with Anaplasma phagocytophilum were investigated. The following prevalences were detected: Babesia spp.: 0.4% (n = 17, including one pool of two larvae) in 2009 and 0.5 to 0.7% (n = 11, including one pool of five larvae) in 2010; Rickettsia spp.: 6.4 to 7.7% (n = 285, including 16 pools of 76 larvae) in 2009. DNA of Bartonella spp. in I. ricinus in Bavarian public parks could not be identified. Sequence analysis revealed the following species: Babesia sp. EU1 (n = 25), B. divergens (n = 1), B. divergens/capreoli (n = 1), B. gibsoni-like (n = 1), R. helvetica (n = 272), R. monacensis IrR/Munich (n = 12) and unspecified R. monacensis (n = 1). The majority of coinfections were R. helvetica with A. phagocytophilum (n = 27), but coinfections between Babesia spp. and A. phagocytophilum, or Babesia spp. and R. helvetica were also detected. I. ricinus ticks in urban areas of Germany harbor several tick-borne pathogens and coinfections were also observed. Public parks are of particularly great interest regarding the epidemiology of tick-borne pathogens, because of differences in both the prevalence of pathogens in ticks as well as a varying species arrangement when compared to woodland areas. The record of DNA of a Babesia gibsoni-like pathogen detected in I. ricinus suggests that I. ricinus may harbor and transmit more Babesia spp. than previously known. Because of their high recreational value for human beings, urban green areas are likely to remain in the research focus on

A bacterial toxin-antitoxin module is the origin of inter-bacterial and inter-kingdom effectors of Bartonella.

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Harms, Alexander; Liesch, Marius; Körner, Jonas; Québatte, Maxime; Engel, Philipp; Dehio, Christoph

2017-10-01

Host-targeting type IV secretion systems (T4SS) evolved from conjugative T4SS machineries that mediate interbacterial plasmid transfer. However, the origins of effectors secreted by these virulence devices have remained largely elusive. Previous work showed that some effectors exhibit homology to toxins of bacterial toxin-antitoxin modules, but the evolutionary trajectories underlying these ties had not been resolved. We previously reported that FicT toxins of FicTA toxin-antitoxin modules disrupt cellular DNA topology via their enzymatic FIC (filamentation induced by cAMP) domain. Intriguingly, the FIC domain of the FicT toxin VbhT of Bartonella schoenbuchensis is fused to a type IV secretion signal-the BID (Bep intracellular delivery) domain-similar to the Bartonella effector proteins (Beps) that are secreted into eukaryotic host cells via the host-targeting VirB T4SS. In this study, we show that the VbhT toxin is an interbacterial effector protein secreted via the conjugative Vbh T4SS that is closely related to the VirB T4SS and encoded by plasmid pVbh of B. schoenbuchensis. We therefore propose that the Vbh T4SS together with its effector VbhT represent an evolutionary missing link on a path that leads from a regular conjugation system and FicTA toxin-antitoxin modules to the VirB T4SS and the Beps. Intriguingly, phylogenetic analyses revealed that the fusion of FIC and BID domains has probably occurred independently in VbhT and the common ancestor of the Beps, suggesting parallel evolutionary paths. Moreover, several other examples of TA module toxins that are bona fide substrates of conjugative T4SS indicate that their recruitment as interbacterial effectors is prevalent and serves yet unknown biological functions in the context of bacterial conjugation. We propose that the adaptation for interbacterial transfer favors the exaptation of FicT and other TA module toxins as inter-kingdom effectors and may thus constitute an important stepping stone in the

A bacterial toxin-antitoxin module is the origin of inter-bacterial and inter-kingdom effectors of Bartonella.

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Alexander Harms

2017-10-01

Full Text Available Host-targeting type IV secretion systems (T4SS evolved from conjugative T4SS machineries that mediate interbacterial plasmid transfer. However, the origins of effectors secreted by these virulence devices have remained largely elusive. Previous work showed that some effectors exhibit homology to toxins of bacterial toxin-antitoxin modules, but the evolutionary trajectories underlying these ties had not been resolved. We previously reported that FicT toxins of FicTA toxin-antitoxin modules disrupt cellular DNA topology via their enzymatic FIC (filamentation induced by cAMP domain. Intriguingly, the FIC domain of the FicT toxin VbhT of Bartonella schoenbuchensis is fused to a type IV secretion signal-the BID (Bep intracellular delivery domain-similar to the Bartonella effector proteins (Beps that are secreted into eukaryotic host cells via the host-targeting VirB T4SS. In this study, we show that the VbhT toxin is an interbacterial effector protein secreted via the conjugative Vbh T4SS that is closely related to the VirB T4SS and encoded by plasmid pVbh of B. schoenbuchensis. We therefore propose that the Vbh T4SS together with its effector VbhT represent an evolutionary missing link on a path that leads from a regular conjugation system and FicTA toxin-antitoxin modules to the VirB T4SS and the Beps. Intriguingly, phylogenetic analyses revealed that the fusion of FIC and BID domains has probably occurred independently in VbhT and the common ancestor of the Beps, suggesting parallel evolutionary paths. Moreover, several other examples of TA module toxins that are bona fide substrates of conjugative T4SS indicate that their recruitment as interbacterial effectors is prevalent and serves yet unknown biological functions in the context of bacterial conjugation. We propose that the adaptation for interbacterial transfer favors the exaptation of FicT and other TA module toxins as inter-kingdom effectors and may thus constitute an important stepping

[Risk of fatal/non-fatal events in patients with previous coronary heart disease/acute myocardial infarction and treatment with non-steroidal anti-inflammatory drugs].

Science.gov (United States)

Muñoz Olmo, L; Juan Armas, J; Gomariz García, J J

2017-09-04

Primary Care is the fundamental axis of our health system and obliges us to be consistent with our prescriptions. The non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with increased cardiovascular risk and increased risk of all causes of death, as well as acute myocardial infarction (AMI) in patients with a previous myocardial infarction. Pain and cardiac patient management are 2 basic pillars in our daily activity, and we must know the limitations of NSAIDs in patients with established cardiovascular risk. We present a review of the scientific literature with primary interest in the role of NSAIDs and cardiovascular risk. The objective is to determine the relationship between the consumption of different NSAIDs and the fatal and non-fatal events among patients with known coronary disease. This is a review of the scientific literature with primary interest in the role of NSAIDs and cardiovascular risk. The literature review was conducted in PubMed search engines like Tripdatabase and with certain keywords. Of the 15 original papers found, 9 did not correspond completely to the central focus, so the approach was decided from 6 original articles from the past 5 years, which address the central focus of increased cardiovascular risk found (fatal and non-fatal events) in patients with prior cardiovascular disease or AMI being prescribed NSAIDs for any reason. The risk of fatal/non-fatal events in each of the studies is expressed by the odds ratio (OR)/hazard ratio (HR), defined as the probability of an event occurring. A moderate risk was observed for ibuprofen. It increases the risk of acute coronary syndrome after 5 years of cardiovascular event, especially in the 2nd year (OR 1.63; 95% CI 1.42-1.87). It also increases the risk of stroke (HR 1.23; 95% IC 1.10-1.38). Cyclo-oxygenase-2 inhibitors were the third risk group, after nabumetone and diclofenac. Celecoxib increases risk from the 14th day of treatment (HR 2.3; 95% CI 1.79-3.02), having an OR

Genetic influences on incidence and case-fatality of infectious disease.

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Liselotte Petersen

Full Text Available BACKGROUND: Family, twin and adoption studies suggest that genetic susceptibility contributes to familial aggregation of infectious diseases or to death from infections. We estimated genetic and shared environmental influences separately on the risk of acquiring an infection (incidence and on dying from it (case fatality. METHODS: Genetic influences were estimated by the association between rates of hospitalization for infections and between case-fatality rates of adoptees and their biological full- and half- siblings. Familial environmental influences were investigated in adoptees and their adoptive siblings. Among 14,425 non-familial adoptions, granted in Denmark during the period 1924-47, we selected 1,603 adoptees, who had been hospitalized for infections and/or died with infection between 1977 and 1993. Their siblings were considered predisposed to infection, and compared with non-predisposed siblings of randomly selected 1,348 adoptees alive in 1993 and not hospitalized for infections in the observation period. The risk ratios presented were based on a Cox regression model. RESULTS: Among 9971 identified siblings, 2829 had been hospitalised for infections. The risk of infectious disease was increased among predisposed compared with non-predisposed in both biological (1.18; 95% confidence limits 1.03-1.36 and adoptive siblings (1.23; 0.98-1.53. The risk of a fatal outcome of the infections was strongly increased (9.36; 2.94-29.8 in biological full siblings, but such associations were not observed for the biological half siblings or for the adoptive siblings. CONCLUSION: Risk of getting infections appears to be weakly influenced by both genetically determined susceptibility to infection and by family environment, whereas there appears to be a strong non-additive genetic influence on risk of fatal outcome.

Causes of fatal accidents for instrument-certified and non-certified private pilots.

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Shao, Bob Siyuan; Guindani, Michele; Boyd, Douglas D

2014-11-01

Instrument certification (IFR) enhances a pilot's skills in precisely controlling the aircraft and requires a higher level of standards in maintaining heading and altitude compared with the less stringent private pilot certificate. However, there have been no prior studies to compare fatal accident causes for airmen with, and without, this rating, The NTSB accident database was queried for general aviation fatal accidents for private pilots with, and without IFR certification. Exact Poisson tests were used to calculate whether two rate parameters were equal (ratio of 1), normalized to the number of IFR-rated pilots and flight hours in the given time period. Proportion tests were used to determine whether there were significant differences in fatal accident causes between IFR-certified and non-certified pilots. A logistic regression for log-odds success was used in determining the trend and effect of age on fatal accident rates. IFR certification was associated with a reduced risk of accidents due to failure to maintain obstacle/terrain clearance and spatial disorientation for day and night operations respectively. In contrast, the likelihood of fatal accident due to equipment malfunction during day operations was higher for IFR-certified pilots. The fatal accident rate decreased over the last decade for IFR-certified but not for non-IFR-certified private pilots. However, the overall accident rate for IFR-certified private pilots was more than double that of the cohort lacking this certification. Finally, we found a trend for an increased fatality rate with advancing age for both group of pilots. Our findings informs on where training and/or technology should be focused. Both training for aerodynamic stalls, which causes over a quarter of all fatal accidents, should be intensified for both IFR-certified and non-certified private pilots. Similarly, adherence to minimum safe altitudes for both groups of pilots should be encouraged toward reducing the fatal accidents

Risk of fatal cerebrovascular accidents after external beam radiation therapy for early-stage glottic laryngeal cancer.

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Swisher-McClure, Samuel; Mitra, Nandita; Lin, Alexander; Ahn, Peter; Wan, Fei; O'Malley, Bert; Weinstein, Gregory S; Bekelman, Justin E

2014-05-01

This study compared the risk of fatal cerebrovascular accidents (CVAs) in patients with early-stage glottic laryngeal cancer receiving surgery or external beam radiation therapy (EBRT). Using a competing risks survival analysis, we compared the risk of death because of CVA among patients with early-stage glottic laryngeal cancer receiving surgery or EBRT in the Surveillance, Epidemiology, and End Results (SEER) database. The cumulative incidence of fatal CVA at 15 years was higher in patients receiving EBRT (2.8%; 95% confidence interval [CI], 2.3% to 3.4%) compared to surgery (1.5%; 95% CI, 0.8% to 2.3%; p = .024). In multivariable competing risks regression models, EBRT remained associated with an increased risk of fatal CVA compared to surgery (adjusted hazard ratio [HR], 1.75; 95% CI, 1.04-2.96; p = .037). Treatment for early-stage glottic laryngeal cancer with EBRT was associated with a small increase in the risk of late fatal CVA events relative to surgery. Copyright © 2013 Wiley Periodicals, Inc.

Fatal crashes involving large numbers of vehicles and weather.

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Wang, Ying; Liang, Liming; Evans, Leonard

2017-12-01

Adverse weather has been recognized as a significant threat to traffic safety. However, relationships between fatal crashes involving large numbers of vehicles and weather are rarely studied according to the low occurrence of crashes involving large numbers of vehicles. By using all 1,513,792 fatal crashes in the Fatality Analysis Reporting System (FARS) data, 1975-2014, we successfully described these relationships. We found: (a) fatal crashes involving more than 35 vehicles are most likely to occur in snow or fog; (b) fatal crashes in rain are three times as likely to involve 10 or more vehicles as fatal crashes in good weather; (c) fatal crashes in snow [or fog] are 24 times [35 times] as likely to involve 10 or more vehicles as fatal crashes in good weather. If the example had used 20 vehicles, the risk ratios would be 6 for rain, 158 for snow, and 171 for fog. To reduce the risk of involvement in fatal crashes with large numbers of vehicles, drivers should slow down more than they currently do under adverse weather conditions. Driver deaths per fatal crash increase slowly with increasing numbers of involved vehicles when it is snowing or raining, but more steeply when clear or foggy. We conclude that in order to reduce risk of involvement in crashes involving large numbers of vehicles, drivers must reduce speed in fog, and in snow or rain, reduce speed by even more than they already do. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Involvement of unendorsed motorcycle operators in fatal crashes in Cuyahoga County, Ohio, 2005-2011.

Science.gov (United States)

Connor, Susan M

2014-01-01

This study examines the role of unendorsed motorcycle operators in fatal motorcycle crashes and the interrelationships of endorsement status and motorcycle type with operator characteristics like riding impaired. Cases were drawn from a database tracking fatal crashes occurring within Cuyahoga County, Ohio, from 2005 to 2011. Analysis focused on 75 fatal motorcycle crashes in which the deceased motorcycle operators were male and coroner's reports, police crash reports, and license endorsement status were available. Analysis included comparison of means, chi square testing, and binary logistic regression. More than half of motorcyclists (53%) did not have motorcycle endorsements. Mean age of unendorsed riders was 36.8 years, compared to 44.2 years for endorsed riders. Motorcyclists were considered at fault in 69 percent of cases, most often due to reckless operation, failure to control, or speeding. Mean blood alcohol concentration for fatally injured motorcyclists was 0.06 percent. Marijuana was the most common drug identified in blood tests. Nonendorsement was associated with younger age, single-vehicle crash, and having a prior license suspension. Neither endorsement status nor bike type was associated with likelihood of testing positive for alcohol or drugs of abuse. Riders of sport motorcycles were more likely than cruiser/touring bike operators to be wearing helmets and less likely to be endorsed. The large proportion of unendorsed motorcyclists involved in fatal crashes in northeast Ohio highlights the need for more stringent licensing requirements that make it more difficult to ride without an endorsement and limit learner's permit renewals.

Using speeding detections and numbers of fatalities to estimate relative risk of a fatality for motorcyclists and car drivers.

Science.gov (United States)

Huggins, Richard

2013-10-01

Precise estimation of the relative risk of motorcyclists being involved in a fatal accident compared to car drivers is difficult. Simple estimates based on the proportions of licenced drivers or riders that are killed in a fatal accident are biased as they do not take into account the exposure to risk. However, exposure is difficult to quantify. Here we adapt the ideas behind the well known induced exposure methods and use available summary data on speeding detections and fatalities for motorcycle riders and car drivers to estimate the relative risk of a fatality for motorcyclists compared to car drivers under mild assumptions. The method is applied to data on motorcycle riders and car drivers in Victoria, Australia in 2010 and a small simulation study is conducted. Copyright © 2013 Elsevier Ltd. All rights reserved.

To Be or Not to Be Associated: Power study of four statistical modeling approaches to identify parasite associations in cross-sectional studies

Directory of Open Access Journals (Sweden)

Elise eVaumourin

2014-05-01

Full Text Available A growing number of studies are reporting simultaneous infections by parasites in many different hosts. The detection of whether these parasites are significantly associated is important in medicine and epidemiology. Numerous approaches to detect associations are available, but only a few provide statistical tests. Furthermore, they generally test for an overall detection of association and do not identify which parasite is associated with which other one. Here, we developed a new approach, the association screening approach, to detect the overall and the detail of multi-parasite associations. We studied the power of this new approach and of three other known ones (i.e. the generalized chi-square, the network and the multinomial GLM approaches to identify parasite associations either due to parasite interactions or to confounding factors. We applied these four approaches to detect associations within two populations of multi-infected hosts: 1 rodents infected with Bartonella sp., Babesia microti and Anaplasma phagocytophilum and 2 bovine population infected with Theileria sp. and Babesia sp.. We found that the best power is obtained with the screening model and the generalized chi-square test. The differentiation between associations, which are due to confounding factors and parasite interactions was not possible. The screening approach significantly identified associations between Bartonella doshiae and B. microti, and between T. parva, T. mutans and T. velifera. Thus, the screening approach was relevant to test the overall presence of parasite associations and identify the parasite combinations that are significantly over- or under-represented. Unravelling whether the associations are due to real biological interactions or confounding factors should be further investigated. Nevertheless, in the age of genomics and the advent of new technologies, it is a considerable asset to speed up researches focusing on the mechanisms driving interactions

Buses involved in fatal accidents codebook 2008.

Science.gov (United States)

2011-03-01

This report provides documentation for UMTRIs file of Buses Involved in Fatal Accidents (BIFA), 2008, : including distributions of the code values for each variable in the file. The 2008 BIFA file is a census of all : buses involved in a fatal acc...

Buses involved in fatal accidents codebook 2007.

Science.gov (United States)

2009-12-01

This report provides documentation for UMTRIs file of Buses Involved in Fatal Accidents (BIFA), 2007, : including distributions of the code values for each variable in the file. The 2007 BIFA file is a census of all : buses involved in a fatal acc...

[«All of a sudden…» preventability and priorities of construction fatalities: an experience in Piedmont].

Science.gov (United States)

Pasqualini, Osvaldo; Libener, Marcello; Farina, Elena; Bena, Antonella

2011-01-01

To examine the usefulness for prevention of the National Surveillance System on occupational fatalities, which is based on the narrative description of the work accident collected by OSH inspectors and on the subsequent classification of the injury dynamics by means of a standardized model of analysis. The system ability of providing useful recommendations for prevention was evaluated on one hand by analyzing the effectiveness of inspections in preventing fatalities, on the other hand by identifying the most frequent accident mechanisms. Data analyzed consisted of investigation reports of construction fatalities occurred during 2002-2008 in the Piedmont Region, collected by surveillance system. The injury narrative description was used to assess whether the fatality would have been preventable by an inspection hypothetically conducted the day before the event; injuries were classified as probably preventable, probably not preventable, and uncertain. A standardized model of classification of injury dynamics was employed to identify mechanisms and circumstances related to the construction fatalities, and particularly those caused by falls from height. Among 122 construction fatalities occurred, 25%were considered probably preventable and 60%probably not preventable. Half of the construction fatalities was caused by fall from height, most of which were caused by sudden breaking of a surface walkway, and almost 20% by fall of objects, including burial. The analysis of the preventability of construction fatalities in Piedmont seems partly to rebut the assumption that more inspections are necessarily associated with a reduction in fatalities. The interpretation of the injury narrative descriptions, which are implemented by OHS inspectors as part of their usual activity, through a standardized model of analysis allows to identify the breaking of surface walkways as the most important mechanism of fatality among falls from height.

How did the economic recession (2008-2010) influence traffic fatalities in OECD-countries?

Science.gov (United States)

Wegman, Fred; Allsop, Richard; Antoniou, Constantinos; Bergel-Hayat, Ruth; Elvik, Rune; Lassarre, Sylvain; Lloyd, Daryl; Wijnen, Wim

2017-05-01

This paper presents analyses of how the economic recession that started in 2008 has influenced the number of traffic fatalities in OECD countries. Previous studies of the relationship between economic recessions and changes in the number of traffic fatalities are reviewed. Based on these studies, a causal diagram of the relationship between changes of the business cycle and changes in the number of traffic fatalities is proposed. This causal model is tested empirically by means of multivariate analyses and analyses of accident statistics for Great Britain and Sweden. Economic recession, as indicated both by slower growth of, or decline of gross national product, and by increased unemployment is associated with an accelerated decline in the number of traffic fatalities, i.e. a larger decline than the long-term trend that is normal in OECD countries. The principal mechanisms bringing this about are a disproportionate reduction of driving among high-risk drivers, in particular young drivers and a reduction of fatality rate per kilometre of travel, probably attributable to changes in road user behaviour that are only partly observable. The total number of vehicle kilometres of travel did not change very much as a result of the recession. The paper is based on an ITF-report that presents the analyses in greater detail. Copyright © 2017 Elsevier Ltd. All rights reserved.

Characteristics, Classification, and Prevention of Child Maltreatment Fatalities.

Science.gov (United States)

McCarroll, James E; Fisher, Joscelyn E; Cozza, Stephen J; Robichaux, Renè J; Fullerton, Carol S

2017-01-01

, and community level. Early interventions for children and families are facilitated by the increased awareness of service providers who understand the risk and protective factors for intentional and unintentional child death. There is currently no roadmap for the prevention of child maltreatment death, but increased awareness and improved fatality review are essential to improving policies and practices. Prevention strategies include improving fatality review recommendations, using psychological autopsies, serious case reviews, and conducting research. We recommend a public health approach to prevention, which includes a high level of collaboration between agencies, particularly between the military and civilian. The adoption of a public health model can promote better prevention strategies at individual, family, community, and societal levels to address and improve practices, policies, and public attitudes and beliefs about child maltreatment. The process of making recommendations on the basis of fatality review is important in terms of whether they will be taken seriously. Recommendations that are too numerous, impractical, expensive, lack relevance, and are out of step with social norms are unlikely to be implemented. They can be helpful if they are limited, focused, lead to definitive action, and include ways of measuring compliance. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Fatal accidents among Danes with multiple sclerosis

DEFF Research Database (Denmark)

Brønnum-Hansen, Henrik; Hansen, Thomas; Koch-Henriksen, Nils

2006-01-01

We compared the rate of fatal accidents among Danes with multiple sclerosis (MS) with that of the general population. The study was based on linkage of the Danish Multiple Sclerosis Registry to the Cause of Death Registry and covered all 10174 persons in whom MS was diagnosed during the period 19...... for deaths from burns (SMR = 8.90) and suffocation (SMR = 5.57). We conclude that persons with MS are more prone to fatal accidents than the general population. The excess risk is due not to traffic accidents but to burns and suffocation.......-1996. The end of follow-up was 1 January 1999. We calculated standardized mortality ratios (SMRs) for various types of fatal accidents. A total of 76 persons (48 men and 28 women) died from accidents, whereas the expected number of fatalities from such causes was 55.7 (31.4 men and 24.3 women). Thus, the risk...... for death from accidents among persons with MS was 37% higher than that of the general population (SMR = 1.37). We found no significant excess risk for fatal road accidents (SMR = 0.80). The risk for falls was elevated (SMR = 1.29) but not statistically significantly so. The risks were particularly high...

Results from the Hawaii domestic violence fatality review, 2000-2009

Science.gov (United States)

Pobutsky, Ann; Brown, Melissa; Nakao, Lisa; Reyes-Salvail, Florentina

2014-01-01

Abstract: Background: Patterns of domestic violence fatalities and agency responses in Hawaii have not been explicated. Methods: Retrospective reviews of events leading up to domestic violence related fatalities in Hawaii were assessed from 45 adjudicated cases that resulted in 62 fatalities for the ten year period from 2000-2009. Results: Almost one-half of the fatalities were homicide/suicide combinations. Females were disproportionately more likely to be fatal victims of domestic violence relative to their proportion in the population. Those aged 21-40 years and those over 80 years were more likely to be fatal victims of domestic violence, relative to their proportion in the population. Filipinas and ‘Other” ethnic groups are disproportionately more likely to be fatal victims of domestic violence while Native Hawaiians and Japanese are less likely to be fatal victims, relative to their proportions in the population. In more than two-thirds of the cases, the victim had made some attempt to leave the relationship prior to the fatality. Conclusions: In the majority of cases there was agency involvement in some form: either the victim alone or the perpetrator alone, or both. However, less than one-third (31.1%) of the cases over the past ten years had documentation of prior violence from medical reports, so this may be an area to further document and address domestic violence. PMID:24292165

Results from the Hawaii domestic violence fatality review, 2000-2009

Directory of Open Access Journals (Sweden)

Ann Pobutsky

2014-07-01

Full Text Available Abstract: Background: Patterns of domestic violence fatalities and agency responses in Hawaii have not been explicated. Methods: Retrospective reviews of events leading up to domestic violence related fatalities in Hawaii were assessed from 45 adjudicated cases that resulted in 62 fatalities for the ten year period from 2000-2009. Results: Almost one-half of the fatalities were homicide/suicide combinations. Females were disproportionately more likely to be fatal victims of domestic violence relative to their proportion in the population. Those aged 21-40 years and those over 80 years were more likely to be fatal victims of domestic violence, relative to their proportion in the population. Filipinas and „Other” ethnic groups are disproportionately more likely to be fatal victims of domestic violence while Native Hawaiians and Japanese are less likely to be fatal victims, relative to their proportions in the population. In more than two-thirds of the cases, the victim had made some attempt to leave the relationship prior to the fatality. Conclusions: In the majority of cases there was agency involvement in some form: either the victim alone or the perpetrator alone, or both. However, less than one-third (31.1% of the cases over the past ten years had documentation of prior violence from medical reports, so this may be an area to further document and address domestic violence.

Re-evaluation of a novel approach for quantitative myocardial oedema detection by analysing tissue inhomogeneity in acute myocarditis using T2-mapping

Energy Technology Data Exchange (ETDEWEB)

Baessler, Bettina; Treutlein, Melanie; Maintz, David; Bunck, Alexander C. [University Hospital of Cologne, Department of Radiology, Cologne (Germany); Schaarschmidt, Frank [Leibniz Universitaet Hannover, Institute of Biostatistics, Faculty of Natural Sciences, Hannover (Germany); Stehning, Christian [Philips Research, Hamburg (Germany); Schnackenburg, Bernhard [Philips, Healthcare Germany, Hamburg (Germany); Michels, Guido [University Hospital of Cologne, Department III of Internal Medicine, Heart Centre, Cologne (Germany)

2017-12-15

To re-evaluate a recently suggested approach of quantifying myocardial oedema and increased tissue inhomogeneity in myocarditis by T2-mapping. Cardiac magnetic resonance data of 99 patients with myocarditis were retrospectively analysed. Thirthy healthy volunteers served as controls. T2-mapping data were acquired at 1.5 T using a gradient-spin-echo T2-mapping sequence. T2-maps were segmented according to the 16-segments AHA-model. Segmental T2-values, segmental pixel-standard deviation (SD) and the derived parameters maxT2, maxSD and madSD were analysed and compared to the established Lake Louise criteria (LLC). A re-estimation of logistic regression models revealed that all models containing an SD-parameter were superior to any model containing global myocardial T2. Using a combined cut-off of 1.8 ms for madSD + 68 ms for maxT2 resulted in a diagnostic sensitivity of 75% and specificity of 80% and showed a similar diagnostic performance compared to LLC in receiver-operating-curve analyses. Combining madSD, maxT2 and late gadolinium enhancement (LGE) in a model resulted in a superior diagnostic performance compared to LLC (sensitivity 93%, specificity 83%). The results show that the novel T2-mapping-derived parameters exhibit an additional diagnostic value over LGE with the inherent potential to overcome the current limitations of T2-mapping. (orig.)

Re-evaluation of a novel approach for quantitative myocardial oedema detection by analysing tissue inhomogeneity in acute myocarditis using T2-mapping

International Nuclear Information System (INIS)

Baessler, Bettina; Treutlein, Melanie; Maintz, David; Bunck, Alexander C.; Schaarschmidt, Frank; Stehning, Christian; Schnackenburg, Bernhard; Michels, Guido

2017-01-01

To re-evaluate a recently suggested approach of quantifying myocardial oedema and increased tissue inhomogeneity in myocarditis by T2-mapping. Cardiac magnetic resonance data of 99 patients with myocarditis were retrospectively analysed. Thirthy healthy volunteers served as controls. T2-mapping data were acquired at 1.5 T using a gradient-spin-echo T2-mapping sequence. T2-maps were segmented according to the 16-segments AHA-model. Segmental T2-values, segmental pixel-standard deviation (SD) and the derived parameters maxT2, maxSD and madSD were analysed and compared to the established Lake Louise criteria (LLC). A re-estimation of logistic regression models revealed that all models containing an SD-parameter were superior to any model containing global myocardial T2. Using a combined cut-off of 1.8 ms for madSD + 68 ms for maxT2 resulted in a diagnostic sensitivity of 75% and specificity of 80% and showed a similar diagnostic performance compared to LLC in receiver-operating-curve analyses. Combining madSD, maxT2 and late gadolinium enhancement (LGE) in a model resulted in a superior diagnostic performance compared to LLC (sensitivity 93%, specificity 83%). The results show that the novel T2-mapping-derived parameters exhibit an additional diagnostic value over LGE with the inherent potential to overcome the current limitations of T2-mapping. (orig.)

Fatal injuries to teenage construction workers in the US.

Science.gov (United States)

Suruda, Anthony; Philips, Peter; Lillquist, Dean; Sesek, Richard

2003-11-01

The construction industry is second only to agriculture in the annual number of fatal injuries in workers less than 18 years of age. We examined fatal injury reports for youth and adult workers to determine risk factors for injury and applicability of existing child labor regulations. The US Occupational Safety & Health Administration (OSHA) investigation data for fatal work injuries from 1984 through 1998 were reviewed with respect to type of event, employer characteristics, and apparent violations of existing child labor laws under the Fair Labor Standards Act (FLSA). We also examined whether the employer met exemption criteria for federal enforcement of child labor or OSHA regulations. The fatality rate for teenage construction workers age 19 and younger was 12.1 per 100,000 per year, slightly less than for adult workers. Teenage workers who were fatally injured were more likely than adults to have been employed at non-union construction firms (odds ratio (OR) = 4.96, P worker. Fatalities in teenagers were more likely to occur in special construction trades such as roofing. Among fatalities in workers less than 18 years of age, approximately one-half (49%) of the 76 fatal injuries were in apparent violation of existing child labor regulations. We estimated that in 41 of the 76 cases (54%) the employer's gross annual income exceeded the $500,000 threshold for federal enforcement of child labor laws. Only 28 of 76 cases (37%) were at construction firms with 11 or more employees, which are subject to routine OSHA inspections. Fatal injuries in teenage construction workers differed from those in adults in that they were more likely to be at small, non-union firms of which a substantial proportion were exempt from federal enforcement of child labor laws and from routine OSHA inspections. Safety programs for young construction workers should include small, non-union construction firms and those in special construction trades such as roofing. We did not identify

Fatal accidents at railway level crossings in Great Britain 1946-2009.

Science.gov (United States)

Evans, Andrew W

2011-09-01

This paper investigates fatal accidents and fatalities at level crossings in Great Britain over the 64-year period 1946-2009. The numbers of fatal accidents and fatalities per year fell by about 65% in the first half of that period, but since then have remained more or less constant at about 11 fatal accidents and 12 fatalities per year. At the same time other types of railway fatalities have fallen, so level crossings represent a growing proportion of the total. Nevertheless, Britain's level crossing safety performance remains good by international standards. The paper classifies level crossings into three types: railway-controlled, automatic, and passive. The safety performance of the three types of crossings has been very different. Railway-controlled crossings are the best-performing crossing type, with falling fatal accident rates. Automatic crossings have higher accident rates per crossing than railway controlled or passive crossings, and the accident rates have not decreased. Passive crossings are by far the most numerous, but many have low usage by road users. Their fatal accident rate has remained remarkably constant over the whole period at about 0.9 fatal accidents per 1000 crossings per year. A principal reason why fatal accidents and fatalities have not fallen in the second half of the period as they did in the first half is the increase in the number of automatic crossings, replacing the safer railway controlled crossings on some public roads. However, it does not follow that this replacement was a mistake, because automatic crossings have advantages over controlled crossings in reducing delays to road users and in not needing staff. Based on the trends for each type of crossing and for pedestrian and non-pedestrian accidents separately, in 2009 a mean of about 5% of fatal accidents were at railway controlled crossings, 52% were at automatic crossings, and 43% were at passive crossings. Fatalities had similar proportions. About 60% of fatalities were

Hispanic women's health care provider control expectations: the influence of fatalism and acculturation.

Science.gov (United States)

Roncancio, Angelica M; Ward, Kristy K; Berenson, Abbey B

2011-05-01

In order to understand how culture influences Hispanic women's views about their health care provider (HCP), we examined the relationship between acculturation and fatalism in the HCP control expectations of Hispanic women. (A HCP control expectation is the extent to which an individual believes that her HCP has control over her health.) We predicted that acculturation would be negatively associated with HCP control expectations, and fatalism would be positively associated with HCP control expectations. A group of 1,027 young Hispanic women (mean age 21.24 years; SD=2.46) who were University of Texas Medical Branch clinic patients completed a comprehensive survey. Structural equation modeling was employed and, as predicted, acculturation was negatively associated with HCP control expectations (pexpectations will help us understand this population's perceptions of their HCPs. This knowledge will assist HCPs in providing culturally competent care which will increase adherence to medical treatment and screening guidelines.

Nordic ski jumping fatalities in the United States: a 50-year summary.

Science.gov (United States)

Wright, J R

1988-06-01

Nordic ski-jumping fatalities are rare events. Six jumping fatalities have occurred in the United States during the past 50 years. The fatality rate for nordic ski jumping, estimated to be roughly 12 fatalities/100,000 participants annually, appears to be within the range of fatality rates for other "risky" outdoor sports. Cervical fractures appear to be the most frequent fatal ski-jumping injury.

Postpartum Clostridium sordellii infection associated with fatal toxic shock syndrome

DEFF Research Database (Denmark)

Rørbye, C; Petersen, Ina Sleimann; Nilas, Lisbeth

2000-01-01

Clostridium bacteria are anaerobic Gram positive spore-form-ing bacilli, known to cause distinct clinical syndromes such as botulism, tetanus, pseudomembranous colitis and myonecrosis. The natural habitats of Clostridium species are soil, water and the gastrointestinal tract of animals and humans....... In 5-10% of all women, Clostridium species are also found to be normal inhabitants in the microbial flora of the female genital tract. In case of a non-sexually transmitted genital tract infection, Clostridium species are isolated in 4-20%, and clostridium welchii seems to be the most common isolate....... Clostridium sordellii is rarely encountered in clinical specimens (1% of Clostridium species), but it has been described as a human pathogen with fatal potential. Two toxins, a lethal and a hemorrhagic (that antigenically and pathophysiologically appear similar to Clostridium difficile toxins B and A...

Relevance of feline calicivirus, feline immunodeficiency virus, feline leukemia virus, feline herpesvirus and Bartonella henselae in cats with chronic gingivostomatitis.

Science.gov (United States)

Belgard, Sylvia; Truyen, Uwe; Thibault, Jean-Christophe; Sauter-Louis, Carola; Hartmann, Katrin

2010-01-01

Despite its common occurrence, the aetiology of chronic gingivostomatitis in cats remains uncertain. Aetiology is likely multifactorial, and several infectious agents may be associated with chronic gingivostomatitis. The purpose of this study was to investigate the prevalence of feline calicivirus (FCV), feline immunodeficiency virus (FIV), feline leukemia virus (FeLV), feline herpesvirus (FHV), and Bartonella henselae (B. henselae) in cats with chronic gingivostomatitis and in an age-matched control group. In addition, other factors, e. g., environmental conditions were investigated. In 52 cats with chronic gingivostomatitis and 50 healthy age-matched control cats, the presence of FCV ribonucleic acid (RNA), and FHV deoxyribonucleic acid (DNA) (polymerase chain reaction [PCR] from oropharyngeal swabs), and B. henselae DNA (PCR from oropharyngeal swabs and blood), as well as FeLV antigen (serum), and antibodies against FCV, B. henselae, and FIV (serum) were examined. FCV RNA was significantly more common in cats with chronic gingivostomatitis (53.8%, p < 0.001) than in controls (14.0%); a significant difference was also found in the prevalence of antibodies to FCV between the cats with chronic gingivostomatitis (78.8%, p = 0.023) and controls (58.0%). Of the other infectious agents investigated, there was no significant difference in the prevalence between the cats with chronic gingivostomatitis and the controls. The results of this study allow the conclusion that FCV, but no other infectious agents, is commonly associated with chronic gingivostomatitis in cats.

An animal model for human EBV-associated hemophagocytic syndrome: herpesvirus papio frequently induces fatal lymphoproliferative disorders with hemophagocytic syndrome in rabbits.

Science.gov (United States)

Hayashi, K; Ohara, N; Teramoto, N; Onoda, S; Chen, H L; Oka, T; Kondo, E; Yoshino, T; Takahashi, K; Yates, J; Akagi, T

2001-04-01

Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS) is often associated with fatal infectious mononucleosis. However, the animal model for EBV-AHS has not been developed. We reported the first animal model for EBV-AHS using rabbits infected with EBV-related herpesvirus of baboon (HVP). Eleven of 13 (85%) rabbits inoculated intravenously with HVP-producing cells developed fatal lymphoproliferative disorders (LPD) between 22 and 105 days after inoculation. LPD was also accompanied by hemophagocytic syndrome (HPS) in nine of these 11 rabbits. The peroral spray of cell-free HVP induced the virus infection with increased anti-EBV-viral capsid antigen-IgG titers in three of five rabbits, and two of these three infected rabbits died of LPD with HPS. Autopsy revealed hepatosplenomegaly and swollen lymph nodes. Atypical lymphoid T cells expressing EBV-encoded small RNA-1 infiltrated diffusely in many organs, frequently involving the lymph nodes, spleen, and liver. Hemophagocytic histiocytosis was observed in the lymph nodes, spleen, bone marrow, and thymus. HVP-DNA was detected in the tissues and peripheral blood from the infected rabbits by polymerase chain reaction or Southern blot analysis. Reverse transcriptase-polymerase chain reaction revealed both HVP-EBNA1 and HVP-EBNA2 transcripts, suggesting latency type III infection. These data indicate that the high rate of rabbit LPD with HPS induction is caused by HVP. This system is useful for studying the pathogenesis, prevention, and treatment of human EBV-AHS.

Fatal and non-fatal cardiovascular events in a general population prescribed sibutramine in New Zealand: a prospective cohort study.

Science.gov (United States)

Harrison-Woolrych, Mira; Ashton, Janelle; Herbison, Peter

2010-07-01

The cardiovascular safety of sibutramine is currently under review by medicines regulatory authorities worldwide after the SCOUT (Sibutramine Cardiovascular Outcome Trial) showed an increased risk of cardiovascular events in patients taking sibutramine. Further data regarding the cardiovascular safety of sibutramine in a general population are now required. To quantify the risk of fatal and non-fatal cardiovascular adverse events in a general population prescribed sibutramine in postmarketing use. Observational prospective cohort study of patients dispensed sibutramine during a 3-year period (2001-4) and followed up for at least 1 year after their last prescription. The study included record-linkage to national mortality datasets to identify fatal events. Postmarketing 'real-life' use of sibutramine in a general population in New Zealand. All New Zealand patients dispensed a prescription for sibutramine in a 3-year period (for whom a National Health Identification number could be validated). 15 686 patients were included in the record linkage study for fatal events. A subgroup of 9471 patients was followed up by intensive methods for non-fatal events. (i) Rate of death from all causes and from cardiovascular events; and (ii) rates of non-fatal cardiovascular adverse events. Total exposure to sibutramine for 15 686 patients in the validated cohort was 5431 treatment-years. The rate of death from all causes in this cohort was 0.13 (95% CI 0.05, 0.27) per 100 treatment-years exposure. The rate of death from a cardiovascular event was 0.07 (95% CI 0.02, 0.19) per 100 treatment-years exposure. The most frequent non-fatal cardiovascular events in the intensively followed up cohort were hypertension, palpitations, hypotensive events and tachycardia. Risk of death from a cardiovascular event in this general population of patients prescribed sibutramine was lower than has been reported in other overweight/obese populations. The results of this study suggest that further

Fatal intra-abdominal hemorrhage as a result of avulsion of the gallbladder: a postmortem case report

International Nuclear Information System (INIS)

Usui, Akihito; Kawasumi, Yusuke; Hosokai, Yoshiyuki; Saito, Haruo; Igari, Yui; Funayama, Masato

2013-01-01

Gallbladder injuries are extremely rare in blunt trauma, with a reported incidence of <2%. We report an autopsy case of fatal hemorrhagic shock due to intra-abdominal bleeding resulting from complete avulsion of the gallbladder associated with liver cirrhosis. Multiplanar images derived from multislice computed tomography (MSCT) performed as part of pre-autopsy screening showed complete avulsion of the gallbladder without any other associated intra-abdominal injuries, facilitating forensic autopsy planning. In this report, we discuss the role of MSCT in cases of fatal intra-abdominal bleeding caused by avulsion of the gallbladder and discuss the mechanism of this injury

Fatal poisoning among patients with drug addiction

DEFF Research Database (Denmark)

Simonsen, Kirsten Wiese; Christoffersen, Dorte J; Banner, Jytte

2015-01-01

INTRODUCTION: Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies. METHODS: All fatal poisonings examined at the three institutes of forensic medicine in Denmark...... on Funen and in South Jutland. Cocaine was most frequently detected in East Denmark, while amphetamine was more frequent in West Denmark. CONCLUSIONS: The number of fatal poisonings among drug addicts has stabilised around 200. The increase in methadone deaths continued and, as in 2007, methadone...... with 2007, indicating that a considerable number of drug addicts also have psychiatric illness. FUNDING: none. TRIAL REGISTRATION: not relevant....

Fatal poisoning among patients with drug addiction

DEFF Research Database (Denmark)

Simonsen, K. W.; Christoffersen, D. J.; Banner, J.

2015-01-01

Introduction: Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies. Methods: All fatal poisonings examined at the three institutes of forensic medicine in Denmark...... on Funen and in South Jutland. Cocaine was most frequently detected in East Denmark, while amphetamine was more frequent in West Denmark. ConclusionS: The number of fatal poisonings among drug addicts has stabilised around 200. The increase in methadone deaths continued and, as in 2007, methadone...... with 2007, indicating that a considerable number of drug addicts also have psychiatric illness....

Clinical diagnosis versus autopsy findings in polytrauma fatalities

Directory of Open Access Journals (Sweden)

Fakler Johannes K

2010-10-01

Full Text Available Abstract Objectives The aim of the study was to determine if differences in clinical diagnosis versus autopsy findings concerning the cause of death in polytrauma fatalities would be detected in 19 cases of fatal polytrauma from a Level 1 trauma centre. Methods Clinical diagnoses determining the cause of death in 19 cases of fatal polytrauma (2007 - 2008 from a Level 1 trauma centre were correlated with autopsy findings. Results In 13 cases (68%, the clinical cause of death and the cause of death as determined by autopsy were congruent. Marginal differences occurred in three (16% patients while obvious differences in interpreting the cause of death were found in another three (16% cases. Five fatalities (three with obvious differences and two with marginal differences were remarked as early death (1-4 h after trauma and one fatality with marginal differences as late death (>1 week after trauma. Obvious and marginal discrepancies mostly occurred in the early phase of treatment, especially when severely injured patients were admitted to the emergency room undergoing continued cardiopulmonary resuscitation, i. e. limiting diagnostic procedures, and thus the clinical cause of death was essentially determined by basic emergency diagnostics. Conclusions Autopsy as golden standard to define the cause of death in fatal polytrauma varies from the clinical point of view, depending on the patient's pre-existing condition, mechanism of polytrauma, necessity of traumatic cardiopulmonary resuscitation, survival time, and thus the possibility to perform emergency diagnostics. An autopsy should be performed at least in cases of early fatal polytrauma to help establishing the definite cause of death. Moreover, autopsy data should be included in trauma registries as a quality assessment tool.

Air pollution and case fatality of SARS in the People's Republic of China: an ecologic study

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Yu Shun-Zhang

2003-11-01

Full Text Available Abstract Background Severe acute respiratory syndrome (SARS has claimed 349 lives with 5,327 probable cases reported in mainland China since November 2002. SARS case fatality has varied across geographical areas, which might be partially explained by air pollution level. Methods Publicly accessible data on SARS morbidity and mortality were utilized in the data analysis. Air pollution was evaluated by air pollution index (API derived from the concentrations of particulate matter, sulfur dioxide, nitrogen dioxide, carbon monoxide and ground-level ozone. Ecologic analysis was conducted to explore the association and correlation between air pollution and SARS case fatality via model fitting. Partially ecologic studies were performed to assess the effects of long-term and short-term exposures on the risk of dying from SARS. Results Ecologic analysis conducted among 5 regions with 100 or more SARS cases showed that case fatality rate increased with the increment of API (case fatality = - 0.063 + 0.001 * API. Partially ecologic study based on short-term exposure demonstrated that SARS patients from regions with moderate APIs had an 84% increased risk of dying from SARS compared to those from regions with low APIs (RR = 1.84, 95% CI: 1.41–2.40. Similarly, SARS patients from regions with high APIs were twice as likely to die from SARS compared to those from regions with low APIs. (RR = 2.18, 95% CI: 1.31–3.65. Partially ecologic analysis based on long-term exposure to ambient air pollution showed the similar association. Conclusion Our studies demonstrated a positive association between air pollution and SARS case fatality in Chinese population by utilizing publicly accessible data on SARS statistics and air pollution indices. Although ecologic fallacy and uncontrolled confounding effect might have biased the results, the possibility of a detrimental effect of air pollution on the prognosis of SARS patients deserves further investigation.

Dehydration Comes on Fast and Can Be Fatal

Science.gov (United States)

... can be fatal Dehydration comes on fast and can be fatal During the hot summer months,the ... and keeping hydrated. “Dehydration is very dangerous. It can lead to an emergency visit, and it can ...

Synchronous advanced pulmonary tuberculosis and acute virus myocarditis mimicked wegener granulomatosis in a 26-year-old man: A case report

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Pešut Dragica P.

2016-01-01

Full Text Available Introduction. Tuberculosis patients are rarely asymptomatic. Acute virus myocarditis presents with a wide range of symptoms, from mild dyspnea or chest pain to cardiogenic shock and death. Case Outline. A 26-year-old Caucasian man non-smoker presented with one-week history of lower extremities’ swelling. The patient’s medical history also revealed a two-day episode of subfebrile temperature with scanty hemoptysis three weeks prior to admission. The episode had not provoked him to seek medical care. Physical examination revealed generalized oedema, and laboratory analysis showed signs of acute renal insufficiency. Enlarged heart and hilar shadows, bilateral massive cavitary pulmonary opacities and pleural effusion were found at chest radiography. Sputum smears were Mycobacteria negative on direct microscopy. Electrocardiogram changes and echocardiography were suggestive of acute myocarditis with dilated cardiomyopathy. IgM titer to adenovirus was positive. Under diuretics, angiotensin-converting-enzyme inhibitor, beta-blocker, antibiotics and bed rest, fast heart compensation and renal function repair were achieved. Radiographic pulmonary changes promptly regressed except for a cavity in the right upper lobe. Bronchial aspirate from the affected lobe was Mycobacteria positive on direct microscopy and culture positive for Mycobacterium tuberculosis. Standard anti-tuberculosis drug regimen led to recovery. Conclusion. In the unusual common existence of two diseases whose presentation initially mimicked Wegener’s granulomatosis, acute dilated cardiomyopathy contributed to pulmonary tuberculosis detection. To prevent diagnostic delay in tuberculosis, further efforts in population education are necessary together with continual medical education. [Projekat Ministarstva nauke Republike Srbije, br. 175095

Alcohol Advertising and Motor Vehicle Fatalities

OpenAIRE

Henry Saffer

1994-01-01

The purpose of this paper is to empirically estimate the effect of alcohol advertising on motor vehicle fatalities. The concept of an industry level advertising response function is developed and other empirical issues in estimating the effects of advertising are reviewed. The data set consists of quarterly observations, from 1986 to 1989, for 75 advertising markets in the United States and includes 1200 observations. Since motor vehicle fatalities and alcohol advertising are jointly determin...

No to fatalism

International Nuclear Information System (INIS)

Pecqueur, Michel

1980-01-01

By saying 'No to fatalism', M. Pecqueur is forming the wish that the recent awarness of the energy situation, far from bringing about resignation, speeds up the implementation of the indispensable measures on which the economic and political stability of the world depends in the decade ahead [fr

Regulatory T cells protect mice against coxsackievirus-induced myocarditis through the transforming growth factor beta-coxsackie-adenovirus receptor pathway.

Science.gov (United States)

Shi, Yu; Fukuoka, Masahiro; Li, Guohua; Liu, Youan; Chen, Manyin; Konviser, Michael; Chen, Xin; Opavsky, Mary Anne; Liu, Peter P

2010-06-22

Coxsackievirus B3 infection is an excellent model of human myocarditis and dilated cardiomyopathy. Cardiac injury is caused either by a direct cytopathic effect of the virus or through immune-mediated mechanisms. Regulatory T cells (Tregs) play an important role in the negative modulation of host immune responses and set the threshold of autoimmune activation. This study was designed to test the protective effects of Tregs and to determine the underlying mechanisms. Carboxyfluorescein diacetate succinimidyl ester-labeled Tregs or naïve CD4(+) T cells were injected intravenously once every 2 weeks 3 times into mice. The mice were then challenged with intraperitoneal coxsackievirus B3 immediately after the last cell transfer. Transfer of Tregs showed higher survival rates than transfer of CD4(+) T cells (P=0.0136) but not compared with the PBS injection group (P=0.0589). Interestingly, Tregs also significantly decreased virus titers and inflammatory scores in the heart. Transforming growth factor-beta and phosphorylated AKT were upregulated in Tregs-transferred mice and coxsackie-adenovirus receptor expression was decreased in the heart compared with control groups. Transforming growth factor-beta decreased coxsackie-adenovirus receptor expression and inhibited coxsackievirus B3 infection in HL-1 cells and neonatal cardiac myocytes. Splenocytes collected from Treg-, CD4(+) T-cell-, and PBS-treated mice proliferated equally when stimulated with heat-inactivated virus, whereas in the Treg group, the proliferation rate was reduced significantly when stimulated with noninfected heart tissue homogenate. Adoptive transfer of Tregs protected mice from coxsackievirus B3-induced myocarditis through the transforming growth factor beta-coxsackie-adenovirus receptor pathway and thus suppresses the immune response to cardiac tissue, maintaining the antiviral immune response.

Fatal falls in the US construction industry, 1990 to 1999.

Science.gov (United States)

Derr, J; Forst, L; Chen, H Y; Conroy, L

2001-10-01

The Occupational Safety and Health Administration's (OSHA's) Integrated Management Information System (IMIS) database allows for the detailed analysis of risk factors surrounding fatal occupational events. This study used IMIS data to (1) perform a risk factor analysis of fatal construction falls, and (2) assess the impact of the February 1995 29 CFR Part 1926 Subpart M OSHA fall protection regulations for construction by calculating trends in fatal fall rates. In addition, IMIS data on fatal construction falls were compared with data from other occupational fatality surveillance systems. For falls in construction, the study identified several demographic factors that may indicate increased risk. A statistically significant downward trend in fatal falls was evident in all construction and within several construction categories during the decade. Although the study failed to show a statistically significant intervention effect from the new OSHA regulations, it may have lacked the power to do so.

Aviation-Related Wildland Firefighter Fatalities--United States, 2000-2013.

Science.gov (United States)

Butler, Corey R; O'Connor, Mary B; Lincoln, Jennifer M

2015-07-31

Airplanes and helicopters are integral to the management and suppression of wildfires, often operating in high-risk, low-altitude environments. To update data on aviation-related wildland firefighting fatalities, identify risk factors, and make recommendations for improved safety, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed reports from multiple data sources for the period 2000-2013. Among 298 wildland firefighter fatalities identified during 2000-2013, 78 (26.2%) were aviation-related occupational fatalities that occurred during 41 separate events involving 42 aircraft. Aircraft crashes accounted for 38 events. Pilots, copilots, and flight engineers represented 53 (68%) of the aviation-related fatalities. The leading causes of fatal aircraft crashes were engine, structure, or component failure (24%); pilot loss of control (24%); failure to maintain clearance from terrain, water, or objects (20%); and hazardous weather (15%). To reduce fatalities from aviation-related wildland firefighting activities, stringent safety guidelines need to be followed during all phases of firefighting, including training exercises. Crew resource management techniques, which use all available resources, information, equipment, and personnel to achieve safe and efficient flight operations, can be applied to firefighting operations.

Fatal Child Maltreatment in England, 2005-2009

Science.gov (United States)

Sidebotham, Peter; Bailey, Sue; Belderson, Pippa; Brandon, Marian

2011-01-01

Objective: This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England. Methods: Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of…

Fatal veno-occlusive disease of the liver associated with herbal tea consumption and radiation

Energy Technology Data Exchange (ETDEWEB)

Feigen, M [Westmead Centre, Sydney (Australia)

1984-02-01

A case is presented of fatal veno-occlusive disease of the liver in a patient undergoing treatment by whole abdomen irradiation for carcinoma of the ovary. She had also been exposed to herbal tea and chemotherapy, each of which may cause veno-occlusive disease in its own right. Interaction of these agents is postulated and should be considered before submitting patients to combination treatment.

Fatal veno-occlusive disease of the liver associated with herbal tea consumption and radiation

International Nuclear Information System (INIS)

Feigen, M.

1984-01-01

A case is presented of fatal veno-occlusive disease of the liver in a patient undergoing treatment by whole abdomen irradiation for carcinoma of the ovary. She had also been exposed to herbal tea and chemotherapy, each of which may cause veno-occlusive disease in its own right. Interaction of these agents is postulated and should be considered before submitting patients to combination treatment

Structural and functional characteristics of myocard in patients with different forms of atrial fibrillation

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L. I. Vasilyeva

2015-02-01

Full Text Available Aim. To study structural and functional characteristics of myocard in patients with different forms of atrial fibrillation. Atrial fibrillation is the most prevalent arrhythmia in clinical practice. Atrial fibrillation is a progressive disease: the duration of paroxysms increases over time and paroxysmal atrial fibrillation transforms to persistent, the last one becomes refractory to pharmacological and electrical cardioversion in time and transforms to permanent. So assessment of myocardial remodeling in patients with persistent and permanent atrial fibrillation is very actual. Methods and results. According to the aim of the study 133 patients with persistent atrial fibrillation and 100 patients with permanent atrial fibrillation were included into the study. Echocardiographic parameters of left and right atria function were studied. Conclusion. It was found that patients with persistent and permanent atrial fibrillation are characterized with both left and right atrias remodeling. Remodeling of the atrias is less pronounced in patients with permanent atrial fibrillation in comparison with persistent atrial fibrillation patients and arrhythmia recurrence.

Epsilon wave on an electronic loop in a case of arrhythmogenic right ventricular dysplasia with myocarditis: an updated definition of the Epsilon wave.

Science.gov (United States)

Fontaine, Guy Hugues; Duthoit, Guillaume; Li, Guoliang; Andreoletti, L; Gandjbakhch, Estelle; Frank, Robert

2017-07-01

A young man presented with a history of myocarditis with palpitations and dizziness. He had implantation of a loop recorder that showed repetitive short episodes of VT. In addition, there were fragmented potentials immediately following the large and sharp electrograms (EGMs) before as well as after episodes of VT suggesting an Epsilon wave. This signal can be observed in multiple cardiac conditions including coronary artery disease. It was originally recorded on the epicardium as well as on the endocardium. However, in ARVD it can be defined as an electric signal observed after the end of the QRS complex in the right as opposed to the left precordial leads (difference ≥ 25 ms). It can also be an aid to the diagnosis of patients with ARVD who have other signs or symptoms suggesting ARVD including episodes of myocarditis. This potential consists of a slurring at the end of the QRS complex or an independent potential after the return to the isoelectric line. It can be better observed by increasing amplification of the ECG tracing as well as double speed using the Fontaine lead system. Epsilon wave too small to be recorded on the standard ECG can be extracted by Signal Averaging ECG SAECG). Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

Comparing avian and bat fatality rate estimates among North American wind energy projects

Energy Technology Data Exchange (ETDEWEB)

Smallwood, Shawn

2011-07-01

.6-24.8) and 10.3 birds (80% CI: 8.6-12.0), including 0.9 raptors (80% CI: 0.5-1.2). Only considering mean fatality rates, and with 36,698 MW of installed capacity as of September 2010 (American Wind Energy Association), wind energy in the United States may be causing annual fatalities of 462,000 to 631,000 bats and 371,000 to 407,000 birds, including 33,000 to 58,700 raptors, depending on whether the Altamont Pass is included. However, potentially large biases and sources of uncertainty remain, field methods vary, and reporting has been inconsistent and increasingly incomplete. Fatality rate estimates should also be interpreted by estimates of utilization rates, but estimates of the latter have also been based on multiple methods and were vulnerable to potentially large biases due to variability in maximum survey distance, proportions of the airspace that were visible to the observer, and degrees of overlap in the surveyed airspace from multiple observation stations. (Author)

Crash Fatality Rates After Recreational Marijuana Legalization in Washington and Colorado.

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Aydelotte, Jayson D; Brown, Lawrence H; Luftman, Kevin M; Mardock, Alexandra L; Teixeira, Pedro G R; Coopwood, Ben; Brown, Carlos V R

2017-08-01

To evaluate motor vehicle crash fatality rates in the first 2 states with recreational marijuana legalization and compare them with motor vehicle crash fatality rates in similar states without recreational marijuana legalization. We used the US Fatality Analysis Reporting System to determine the annual numbers of motor vehicle crash fatalities between 2009 and 2015 in Washington, Colorado, and 8 control states. We compared year-over-year changes in motor vehicle crash fatality rates (per billion vehicle miles traveled) before and after recreational marijuana legalization with a difference-in-differences approach that controlled for underlying time trends and state-specific population, economic, and traffic characteristics. Pre-recreational marijuana legalization annual changes in motor vehicle crash fatality rates for Washington and Colorado were similar to those for the control states. Post-recreational marijuana legalization changes in motor vehicle crash fatality rates for Washington and Colorado also did not significantly differ from those for the control states (adjusted difference-in-differences coefficient = +0.2 fatalities/billion vehicle miles traveled; 95% confidence interval = -0.4, +0.9). Three years after recreational marijuana legalization, changes in motor vehicle crash fatality rates for Washington and Colorado were not statistically different from those in similar states without recreational marijuana legalization. Future studies over a longer time remain warranted.

Fatal thrombocytopenia: A rare case with possible explanation

Science.gov (United States)

Barik, Ramachandra; Patnaik, A. N.; Gulati, A. S.

2012-01-01

A 22 year old male presented with breathlessness on exertion, ecchymosis, jaundice and features of worsening right heart failure for the last fifteen days. On physical examination, he had a mid diastolic murmur in the tricuspid area and an ejection systolic murmur in the pulmonary area. Bone marrow histopathology report showed an increased in megakaryocytes count. Routine investigations reports were normal. Echocardiography and computerized tomography (CT) revealed a single mobile large intra cardiac mass originating from the right atrium and causing dynamic obstruction of the right ventricular inflow and outflow tract. Associated fatal thrombocytopenia did not respond to intravenous steroids or platelet transfusion. Patient could not be operated because of very low platelet count, and died during hospital stay before excision biopsy could be done. Pathological autopsy was not done. This is a rare case, as the fatal thrombocytopenia observed here was the result of mechanical effects like frictional and shear force, which can be attributed to the physical presence of a large intra cardiac mass resulting in obstruction to flow. PMID:22629036

A fatal case of Perthes syndrome

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Jérôme Jobé

2013-01-01

Full Text Available Perthes syndrome, or traumatic asphyxia, is a clinical syndrome associating cervicofacial cyanosis with cutaneous petechial haemorrhages and subconjonctival bleeding resulting from severe sudden compressive chest trauma. Deep inspiration and a Valsalva maneuver just prior to rapid and severe chest compression, are responsible for the development of this syndrome. Current treatment is symptomatic: urgent relief of chest compression and cardiopulmonary resuscitation if needed. Outcome may be satisfactory depending on the duration and severity of compression. Prolonged thoracic compression may sometimes lead to cerebral anoxia, irreversible neurologic damage and death. We report a fatal case of Perthes syndrome resulting from an industrial accident.

Economic and cultural correlates of road-traffic accident fatality rates in OECD countries.

Science.gov (United States)

Gaygisiz, Esma

2009-10-01

The relationships between economic conditions, cultural characteristics, personality dimensions, intelligence scores, and road-traffic accident mortality rates were investigated in 30 member and five accession countries of the Organisation for Economic Co-operation and Development (OECD). Economic indicators included the Gross Domestic Product (GDP) per capita, the unemployment rate, and the Gini index. Cultural variables included five Hofstede's cultural dimensions, seven Schwartz cultural value dimensions, NEO-PI-R scales, and the intelligence quotient (IQ). The results showed positive associations between favorable economic conditions (high income per capita, high employment rate, and low income inequality) and high traffic safety. Countries with higher road-traffic accident fatality rates were characterized by higher power distance and uncertainty avoidance as well as embeddedness and emphasis on social hierarchy. Countries with lower road-traffic accident fatality rates were more individualistic, egalitarian, and emphasized autonomy of individuals. Conscientiousness (from NEO-PI-R) and IQ correlated negatively with road-traffic accident fatalities.

Does a feline leukemia virus infection pave the way for Bartonella henselae infection in cats?

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Buchmann, Alexandra U; Kershaw, Olivia; Kempf, Volkhard A J; Gruber, Achim D

2010-09-01

Domestic cats serve as the reservoir hosts of Bartonella henselae and may develop mild clinical symptoms or none after experimental infection. In humans, B. henselae infection can result in self-limiting cat scratch disease. However, immunocompromised patients may suffer from more-severe courses of infection or may even develop the potentially lethal disease bacillary angiomatosis. It was reasoned that cats with immunocompromising viral infections may react similarly to B. henselae infection. The aim of our study was to investigate the influence of the most important viruses known to cause immunosuppression in cats-Feline leukemia virus (FeLV), Feline immunodeficiency virus (FIV), and Feline panleukopenia virus (FPV)-on natural B. henselae infection in cats. Accordingly, 142 cats from animal shelters were necropsied and tested for B. henselae and concurrent infections with FeLV, FIV, or FPV by PCR and immunohistochemistry. A significant association was found between B. henselae and FeLV infections (P = 0.00028), but not between B. henselae and FIV (P = 1.0) or FPV (P = 0.756) infection, age (P = 0.392), or gender (P = 0.126). The results suggest that susceptibility to B. henselae infection is higher in cats with concurrent FeLV infections, regardless of whether the infection is latent or progressive. Histopathology and immunohistochemistry for B. henselae failed to identify lesions that could be attributed specifically to B. henselae infection. We conclude that the course of natural B. henselae infection in cats does not seem to be influenced by immunosuppressive viral infections in general but that latent FeLV infection may predispose cats to B. henselae infection or persistence.

Fatal accidents at work in agriculture associated with alcohol intoxication in Lower Silesia in Poland.

Science.gov (United States)

Jurek, Tomasz; Rorat, Marta

2017-02-28

Determining the prevalence of alcohol intoxication and the level of intoxication in victims of fatal occupational accidents is necessary to improve work safety. The circumstances of the accident and the time between alcohol consumption and death are important factors. A retrospective review of 18 935 medico-legal autopsy reports and toxicological reports performed in the Department of Forensic Medicine at the Wroclaw Medical University, Poland, in the years 1991-2014. The study protocol included circumstances, time and cause of death, injuries, quantitative testing for the presence of ethyl alcohol, gender and age. There were 98 farm-related fatalities. There were 41.8% (N = 41) of victims who had been intoxicated - 95.1% (N = 39) of them were males aged 19-70 years old, 4,9% (N = 2) were females aged 37-65 years old. In 8 cases the blood alcohol concentration (BAC) was 50-150 mg/dl; in 15 cases it was 150-250 mg/dl and in 18 cases it was > 250 mg/dl. In 21 cases, the BAC was determined using alternative material and 76% (N = 16) victims were in the alcohol elimination phase with 19% (N = 4) victims in the alcohol absorption phase. The most common causes of death were traffic accidents, drowning and deaths resulting from being caught in or hit by moving parts of machinery or equipment. Alcohol consumption is a crucial risk factor in fatal agricultural accidents. In order to establish the time of alcohol consumption, all victims of agricultural accidents should be tested for alcohol concentration in their blood and urine or vitreous. Improving safety at work requires that the sobriety of employees should be monitored before and during work. Med Pr 2017;68(1):23-30. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Fatal accidents at work in agriculture associated with alcohol intoxication in Lower Silesia in Poland

Directory of Open Access Journals (Sweden)

Tomasz Jurek

2017-02-01

Full Text Available Background: Determining the prevalence of alcohol intoxication and the level of intoxication in victims of fatal occupational accidents is necessary to improve work safety. The circumstances of the accident and the time between alcohol consumption and death are important factors. Material and Methods: A retrospective review of 18 935 medico-legal autopsy reports and toxicological reports performed in the Department of Forensic Medicine at the Wroclaw Medical University, Poland, in the years 1991–2014. The study protocol included circumstances, time and cause of death, injuries, quantitative testing for the presence of ethyl alcohol, gender and age. Results: There were 98 farm-related fatalities. There were 41.8% (N = 41 of victims who had been intoxicated – 95.1% (N = 39 of them were males aged 19–70 years old, 4,9% (N = 2 were females aged 37–65 years old. In 8 cases the blood alcohol concentration (BAC was 50–150 mg/dl; in 15 cases it was 150–250 mg/dl and in 18 cases it was > 250 mg/dl. In 21 cases, the BAC was determined using alternative material and 76% (N = 16 victims were in the alcohol elimination phase with 19% (N = 4 victims in the alcohol absorption phase. The most common causes of death were traffic accidents, drowning and deaths resulting from being caught in or hit by moving parts of machinery or equipment. Conclusions: Alcohol consumption is a crucial risk factor in fatal agricultural accidents. In order to establish the time of alcohol consumption, all victims of agricultural accidents should be tested for alcohol concentration in their blood and urine or vitreous. Improving safety at work requires that the sobriety of employees should be monitored before and during work. Med Pr 2017;68(1:23–30

Review

African Journals Online (AJOL)

ebutamanya

2015-06-12

Jun 12, 2015 ... Abstract. Tuberculosis is a rare cause of myocarditis. It is however associated with a high mortality when it occurs and is often diagnosed at post-mortem. Tuberculous myocarditis prevalence in males is twice that in females. Most of the reported cases of tuberculous myocarditis are predominantly in.