Generalized fatal Cowpox virus infection in a cat with transmission to a human contact case

A 4-month-old female domestic shorthair cat was infected by a virus of the Poxvirus family. The animal developed a severe pneumonia and generalized ulcerating lesions of the skin. Histologically, typical eosinophilic intracytoplasmic inclusion bodies indicative of an Orthopoxvirus (OPV) infection were present. The lung showed grey-white to haemorrhagic nodular lesions with a central zone of complete necrosis of alveolar and bronchial tissue. Electron microscopy from skin and lung nodules revealed typical square-shaped OPV particles. Cultivation of the virus on chorio-allantoic membranes of embryonated chicken eggs resulted in haemorrhagic plaques. Restriction enzyme analysis, PCR and sequencing of the D8L gene identified the OPV isolate as a typical Cowpox virus. It was transmitted by the cat to a human contact person who developed a local nodular dermatitis at the inoculation site in association with signs of general infection and had an increase of OPV-specific neutralizing antibodies in paired serum samples.

A Virological Survey in Migrating Waders and Other Waterfowl in One of the Most Important Resting Sites of Germany

Wild birds are considered a potential reservoir or a carrier of viral diseases and may therefore play a role in the epidemiology of economically important or zoonotic diseases. In 2001 and 2002, a survey with special emphasis on virus isolation in migrating waders and some other birds were conducted. In one of the most important inland resting sites for migratory waterfowl, tracheal and cloacal swabs were collected from 465 waders representing 19 different species, and 165 other birds that were not captured on purpose. A total of 42 avian viruses were isolated, 34 of these were identified as paramyxoviruses (PMVs). The majority of isolates came from waders and wild ducks, and were characterized as PMV-1. In contrast, PMV-4 was found in wild ducks only, PMV-6 was mainly detected in wader species. Four avian influenza viruses (AIVs), belonging to H4 and H3 haemagglutinin subtype, were isolated from wild duck species. Furthermore, four reo-like viruses were isolated from one particular wader species for the first time. The majority of virus positive birds were <1 year old and did not show any clinical symptoms. There was no evidence for the presence of West Nile virus in these birds. These results confirm that the restricted resting sites in Western Europe must be considered as important locations for the intra- and interspecies transmission of avian viruses.

[Case report: Porcine circovirus type 2 infection in an European wild boar (Sus scrofa) in the state of Brandenburg, Germany]

This case represents the first case of Porcine Circovirus Type 2 (PCV-2)--infection in a free living European wild boar associated with morphological lesions, which are regarded as characteristic for Postweaning Multisystemic Wasting Syndrome (PMWS) in domestic pigs. The animal, an approximately 10 month old male, was found dead in a rural area within the state of Brandenburg, Germany. The closest commercial pig farm is located in 3 km distance from the spot where the carcass was found. At necropsy, the animal was found to be in a runted condition. Morphological investigation revealed two lesion complexes. Firstly, lymphatic depletion was present in different organs. Mainly the white pulp of the spleen was affected, where lymph follicles and periarteriolar lymphatic sheaths were nearly completely depleted of lymphoid cells. The former lymphatic areas could only be identified by the presence of histiocytic cells. Secondly, there were widely distributed lesions indicative of a bacterial septicemia i.e. purulent-necrotizing lymphadenitis, pulpous hyperplasia of the spleen, miliary lytic liver necroses and foci of fibrinous pneumonia. Within the lesions, bacterial colonies were found (short Gram-negative rods). Bacteriology revealed a septicemic Salmonella choleraesuis var. Kunzendorf--infection. Virologically, the animal was tested with negative results for Classical Swine Fever Virus and PRRSV. The unusual depletion of the lymphatic tissue mainly in the spleen led to the suspicion of a PCV-2 infection. Typical circoviral particles were found by negative-contrast electron microscopy in samples from spleen and lymph nodes. Using a commercial antiserum against Porcine Circovirus, positive staining was found by fluorescence microscopy in tonsils, spleen and lymph nodes. Finally, the virus was identified to be PCV-2 by species-specific PCR. The presented case rises the questions if PCV-2 is endemic in the European wild boar population at least in certain areas, if it is of pathogenetic importance for wild boars and if the virus present in wild boars is identical to that present in domestic pigs with PMWS.

Proton dynamics in letovicite, (NH4)3H(SO4)2: a 1H and 14N NMR spectroscopic study

The improper ferroelastic phase letovicite (NH4)3H(SO4)2 has been studied by 1H MAS NMR as well as by static 14N NMR experiments in the temperature range of 296-425 K. The 1H MAS NMR resonance from ammonium protons can be well distinguished from that of acidic protons. A third resonance appears just below the phase transition temperature which is due to the acidic protons in the paraelastic phase. The lowering of the second moment M2 for the ammonium protons takes place in the same temperature range as the formation of domain boundaries, while the signals of the acidic protons suffer a line narrowing in the area of Tc. The static 14N NMR spectra confirm the temperature of the motional changes of the ammonium tetrahedra. Two-dimensional 1H NOESY spectra indicate a chemical exchange between ammonium protons and the acidic protons of the paraphase.

Neuropeptide content of peripheral nerve in relation to nerve function in neuropathy

OBJECTIVE

In this study an APAAP (alcalic-phophatase-anti-alcalic-phosphatase) technique was used to distinguish afferent (calcitonin-gene-related-peptide (CGRP) or substance-P-(SP) positive) and autonomic (tyrosin-hydroxylase (TH), neuropeptide Y (NPY) or vasoactive-intestinal-polypeptide- (VIP) positive) nerve fibers in sural nerve biopsy material from patients with moderate sensory neuropathy. A panneuronal marker against protein-gene-product 9.5 (PGP 9.5) was used for detection of the total amount of nerve fibers. Second aim was to analyze possible correlations between the impairment in tests for the function of unmyelinated fibers (i.e. thermal threshold testings, sensitivity to painful mechanical stimulation, axon reflex-mediated flare reaction and sudomotor activity) and nerve pathology.

RESULTS

A high correlation between CGRP and SP (p < 0.00003) and between TH and NPY, respectively, (p < 0.004) was found, but not between afferent and autonomic markers or between specific markers and PGP 9.5. While no correlations between sensory neuropeptides (CGRP and SP) and specific testings of afferent fiber function or between neuropeptide content and clinical data could be demonstrated, there was a significant correlation between the TH content of the sural nerve and the sweat output, stimulated by acetylcholine iontophoresis at the level of the foot (p = 0.019) and upper leg (p = 0.011).

CONCLUSION

This study demonstrates the possibility of visualizing subgroups of unmyelinated nerve fibers in sural nerve biopsies selectively with this technique. The density of TH-positive sympathetic nerve fibers, but not the density of afferent c-fibers, is correlated with corresponding results in specific tests of c-fiber function.

No evidence for heterogeneity in oculopharyngeal muscular dystrophy

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[Hepatitis C-associated vasculitic mononeuritis multiplex]

HISTORY AND CLINICAL FINDINGS

A 56-year-old woman with hepatitis C had symptoms of a polyneuropathy with asymmetrical distal pareses and painful sensory disturbances in the limbs.

INVESTIGATION

In addition to positive serology for hepatitis C cryoglobulins were demonstrated and complement C4 was reduced. Biopsy of the sural nerve showed a vasculitic neuropathy.

TREATMENT AND COURSE

The multiple neuropathy (cryoglobulinaemia neuropathy), associated with hepatitis C, was treated with corticosteroids (starting with 60 mg/d prednisolone) and the neurological abnormalities regressed well.

CONCLUSION

Vasculitis associated with hepatitis C should be included in the differential diagnosis of peripheral neuropathy.

[Urine test strips for cerebrospinal fluid diagnosis of bacterial meningitis]

BACKGROUND

Diagnosis of bacterial meningitis is due to granulocytic pleocytosis of CSF. In developing countries and in hospitals without continuous availability of a clinical laboratory a bedside-method of diagnosing meningitis is desired.

METHODS

75 CSF samples were tested for granulocytes and protein with reagent strips and the results were compared with those obtained from the clinical laboratory.

RESULTS

All 48 samples with normal cell count were correctly diagnosed negative using reagent strips. Twenty-five samples of 27 samples with granulocytic pleocytosis were correctly recognised as right positive (sensitivity 92.6%; specificity 100%). All 48 samples with normal protein were correctly tested normal. Twenty-one samples of 27 samples with elevated protein were correctly diagnosed right positive (sensitivity 77.8%; specificity 100%).

CONCLUSION

Testing CSF for granulocytes and protein with urine reagent strips is a bedside-method which allows a rapid and reliable decision whether CSF is normal or granulocytically pleocytotic.

[Myositis--a rare complication of Crohn disease]

Crohn's disease is a chronic relapsing inflammatory disorder primarily affecting the gastrointestinal system. Extraintestinal manifestations such as erythema nodosum, iridocyclitis, arthritis and sclerosing cholangitis are frequent. We report on a 57-year old male patient with the symptoms of Crohn's disease. Clinically he showed signs of a muscle disorder and muscle biopsy demonstrated a perimysial inflammation with lymphocytes and histiocytes. Complete remission was achieved by immunosuppressive treatment. Six cases presented in the literature are reviewed and the autoimmunological aspects of the pathogenesis discussed.

[Follow-up studies and disorders of endocrinologic function in MELAS syndrome]

The clinical course of MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, stroke-like episodes) is described in five cases. The age of onset was 9.2 years on average. Cerebral symptoms occurred at an age of 24.6 years on average. The diagnosis was only made later. Three patients died during the follow-up period. The mean age at death was 33.3 years, the average duration of the disease, 19.6 years. All patients suffered from progressive hearing loss, multiple strokes, and complex-partial and generalized seizures. They all had short stature, normal early development and 'ragged red fibers' in the muscle biopsy. Imaging studies (CT and MRI) showed bilateral calcification of basal ganglia and multiple strokes. One patient, admitted with epileptic status as initial symptom, showed lymphocytic pleocytosis in the cerebrospinal fluid; thus, in her case the differential diagnosis included encephalitis. Four patients were studied by dynamic endocrinological testing. Endocrinological disturbances were detected in three patients. Two of them suffered from hypothalamic-pituitary failure and one patient exhibited hyperprolactinemia. Endocrinological disturbances were considered an expression of the underlying cytopathy. Cerebral symptoms occurred rather late in the course of the disease and indicated poor prognosis.

99m-Tc-HMPAO-SPECT in diagnosis of early cerebral vasculitis

The objective of this study was to evaluate whether mild neurological symptoms suggestive of neuropsychiatric involvement may be associated with cerebral perfusion defects as detected by functional brain imaging with 99m-Tc-HMPAO-SPECT (single photon emission computed tomography). SPECT analysis for the early detection of central nervous system (CNS) involvement was evaluated in 40 consecutive patients with systemic vasculitis or with Sneddon's syndrome. Of these, 18 patients showed overt neuropsychiatric symptoms, so-called major symptoms (e.g. motoric or sensible defects); 6 had mild symptoms like headache or cognitive disorders, so-called minor symptoms: 16 patients did not present with any of these symptoms. SPECT abnormalities were detected in 16 of the 18 patients with overt neuropsychiatric symptoms (89%). Five of the 6 patients with minor symptoms (83%) and 5 of the 16 patients without neurological symptoms (31%) also had SPECT abnormalities. There was no relation to disease activity or duration. We concluded that the high sensitivity of SPECT (87.5%) in detecting perfusion abnormalities among the evaluated group of patients indicates its suitability for early diagnosis of vasculitic CNS involvement.

Expression of NCAM (neural cell adhesion molecule) in mitochondrial myopathy

In muscle, the neural cell adhesion molecule (NCAM) is known to be expressed in denervated and regenerating fibers. Our present study, performed with immunohistochemical detection procedures, attempts to demonstrate the expression of NCAM in mitochondrial myopathy. Biopsy specimens from 29 patients were investigated. The following conditions were represented: nonweak control subjects (8 cases), chronic progressive external ophthalmoplegia (7 cases), Kearns-Sayre syndrome (5 cases), unclassified mitochondrial myopathy (2 cases), idiopathic polymyositis (7 cases). We demonstrate the expression of NCAM in mitochondrial myopathy. But NCAM is expressed in ragged-red fibers both in mitochondrial and idiopathic inflammatory myopathy. Furthermore, NCAM-immunoreactive fibers are more abundant than ragged-red and cytochrome-c-deficient fibers. Thus, we conclude that NCAM expression precedes histochemical and enzyme-histochemical demonstrable mitochondrial abnormalities. NCAM expression may reflect compensatory regenerating tendency of ragged-red fibers. Vimentin expression in mitochondrial myopathy favors this view. Probably, NCAM plays a role in the enrichment of abnormal mitochondria as a compensatory process for the biochemical deficit. The expression of NCAM in mitochondrial myopathies suggests that NCAM is related to the pathophysiology of these diseases and can be a helpful clue in the diagnosis of mitochondrial myopathy. But NCAM expression is not a specific phenomenon in mitochondrial myopathy, because in secondary mitochondrial changes like in idiopathic polymyositis NCAM expression is observed, too.

A case of Alzheimer's disease with extensive focal white matter changes

The case of a patient is reported who suffered from disturbed concentration and memory and constructive apraxia. She had only mild neuropsychological deficits at the first examination. T2-weighted MRI presented extensive focal white matter changes. A brain biopsy showed changes typical for Alzheimer's disease (AD). The extent of the white matter lesions was surprising compared to the mild clinical signs she had. This case confirms that AD may result in prominent white matter disease caused by incomplete infarction or demyelination.

Myopathological findings in interstitial myositis in type II polyendocrine autoimmune syndrome (Schmidt's syndrome)

We report on a patient with an interstitial myositis in type II polyendocrine autoimmune disease (Schmidt's syndrome) showing an immunohistochemical demonstrated perifascicular expression of Leu 19 indicating perifascicular denervation, which could not be detected with classical histological methods. In neurogenic muscular atrophy, idiopathic polymyositis and normal muscle we could not find such an exclusive perifascicular expression of the Leu 19 antigen. We conclude that perifascicular denervation is a characteristic feature in IM and thus might have diagnostic value. Furthermore the interstitial myositis is characterized by a complement-mediated angiopathy (vascular deposition of the membranolytic attack complex C5b-9). This pattern is comparable to well-known changes in dermatomyositis. Interstitial myositis and dermatomyositis are evidently pathogenetically similar according to myopathological criteria, but show phenotypic differences. Additional in interstitial myositis and idiopathic polymyositis inflammatory infiltrates surrounding Leu 19 expressing myocytes are regarded as the cause of disseminated intrafascicular muscle fibre denervation.

Light-microscopic study of phosphoprotein B-50 in myopathies

The growth-associated protein B-50, also termed GAP-43, is a membrane-bound phosphoprotein that is expressed in neurons. It is particularly abundant during periods of axonal outgrowth in development and regeneration of the central and peripheral nervous system. In this paper we study the expression of B-50 in inflammatory and dystrophic myopathies. To investigate the state of regeneration, N-CAM and vimentin serial sections were performed, because N-CAM and cytoskeletal protein vimentin are excellent markers for regenerating muscle. Light-microscopic evaluation showed that muscle fiber regeneration in myopathies corresponds closely to B-50 immunoreactivity in satellite cells, myoblasts, myotubes and small regenerating myocytes in cytoplasmatic distribution. In normal muscle and in biopsies of neurogenic muscular atrophy, however, no light-microscopically demonstrable B-50 staining was found. B-50 in muscles apparently plays a role in the growth morphology of regenerating myocytes, and the phosphoprotein B-50 can no longer be regarded as a neuron-specific molecule.

Probable Creutzfeldt-Jakob disease after a cadaveric dural graft

A 26-year old female who had received a cervical cadaveric dural graft 7 years earlier developed psychotic behavior and generalized myoclonic jerks. Following rapid deterioration and appearance of high-charge sharp periodic waves on electroencephalography she died within two months. We believe that this patient is the first German who acquired Creutzfeldt-Jakob disease by dural implant.

Ascending central nervous spreading of a spinal astrocytoma

A 43-year-old man died from the complications of astrocytoma metastasis. He first noticed symptoms of a lumbar disc prolapse in 1979. In 1987 a pilocytic astrocytoma (grade I) of the spinal cauda was removed. In 1989 a tumor recidivation at the same site was partially removed. Histology showed a grade II astrocytoma. Two months later the patient developed symptoms of increased intracerebral pressure. CSF cytology showed polymorphic giant tumor cells with hyperchromatic nuclei and a glioblastoma of the cerebral ventricles was diagnosed. The patient died from cardiovascular complications. The post-mortem investigation revealed an astrocytoma of the conus medullaris with an anaplastic ventral area (grade IV). This area was inaccessible to the biopsy. It is believed that tumor metastases from anaplastic parts spread along the spinal cord and brainstem and finally invaded the brain and cerebral ventricles.

Expression of growth associated protein 43 and neural cell adhesion molecule in congenital fibre type disproportion with interstitial myositis

We report on the expression of growth associated protein (GAP)43 and neural cell adhesion molecule (NCAM) in congenital fibre type disproportion (CFTD) with myopathological additional signs of interstitial myositis. We assume that sarcolemmal GAP43 in developmental disordered myocytes plays a role in maintenance of growth morphology. In muscular dystrophy light microscopical evaluation reveals no GAP43 immunoreactivity in regenerating fibres. The expression of GAP43 seems to be a characteristic feature of CFTD. The expression of NCAM, particularly in the sarcolemma of small muscle fibres of CFTD, indicates a functional state of permanent partial denervation. Whether the steroid-responsive interstitial myositis is pathogenetically related to CFTD or a coincidental inflammation is not known. Because of the clinical and myopathological data the differential diagnosis of Emery-Dreifuss muscular dystrophy is considered.