[Idiopathic hypereosinophilic syndrome and bullous pemphigoid]

BACKGROUND

We report the case of bullous pemphigoid associated with hypereosinophilic syndrome. This association has only been report only once in the literature.

CASE REPORT

A 58 year-old man was admitted for a surinfected, pruriginous and generalized bullous dermatosis. Physical examination revealed bronchial rales. The cutaneous histology showed a junctional and intradermic cleavage associated with massive dermal infiltration by eosinophils. The diagnosis of a pemphigoid was confirmed by immunology. In parallel, the idiopathic hypereosinophilic syndrome was evoked in view of persisting hypereosinophilia without detected aetiology and associated with pulmonary infiltration. The skin lesions disappeared under symptomatic treatment, but the patient was rehospitalized 4 months later for severe relapse of dermatosis associated with medullary infiltration by eosinophils. Oral corticosteroid therapy gave spectacular results on both skin and blood formula.

DISCUSSION

This association is rare, but seems to be related by the same immunological factors highlighting eosinophils. In addition, the presence of hypereosinophilic syndrome gives the pemphigoid some particular clinical, histological and evolutive characteristics.

In vitro antiviral activity of dermaseptins against herpes simplex virus type 1

The in vitro antiviral activity of dermaseptins (S1-S5) against herpes simplex virus type 1 (HSV1) was investigated. These peptides were incubated with the virus and its target cells under various conditions, and their effects were examined by the cytopathic effect inhibition assay or by reduction in virus yield in Hep-2 cell cultures as well as by direct immunofluorescence. Dermaseptin S4 displayed the strongest antiviral effect against HSV1, at micromolar doses. Experiments including acyclovir as a reference antiviral agent were performed to investigate the mode of action of this dermaseptin. In contrast to acyclovir, dermaseptin S4 showed its inhibitory effect only when applied to the virus before, or during virus adsorption to the target cells. This suggested that the activity of this dermaseptin was exerted at a very early stage of the viral multiplication cycle, most likely at the virus-cell interface.

[Takayasu's disease in Morocco. Report of 47 cases]

PURPOSE

Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. We studied Moroccan patients to evaluate clinical, biological, radiological and evolution features of this disease in our country.

METHODS

Forty-seven patients with Takayasu's arteritis were studied retrospectively between 1988 et 1999.

RESULTS

In our series involvement of the aortic arch and its branches was more frequent than the abdominal aorta and its branches. Stenotic lesions of renal arteries were rare. Ultrasound was useful in the diagnosis and the monitoring of the disease. Treatment with glucocorticoids gave good results, with improvement in half of the patients and remission with stabilisation in 40% of cases. Tuberculosis occurred in 8.5% of patients.

CONCLUSION

The use of ultrasound and computed tomography angiography is helpful for the diagnosis and monitoring of the disease progression. Glucocorticoids help to induce long remission in about 80% of treated patients. We don't find any relationship between Takayasu's arteritis and tuberculosis.

[Cholesterol crystal embolism]

Cholesterol crystal emboli are a serious complication of atheroma. The incidence of this syndrome appears to be much more common in patients in their sixties with severe atheromatous disease of the aorta (20 to 30% vs less than 5%). 80% of crystal embolism result from medical interventions (aortic or cardiac surgery, arterial invasive procedure of aorta, thrombolytic therapy). Embolisation of cholesterol crystals can give rise to a confusing clinical pictures, depending of the site (organ) of the embolisation. It also can simulate a systemic disease. The diagnosis must be discuss in all atheromatous patients. The prognosis is poor because of the patient's clinical context and because there is no specific treatment. The best treatment is prevention by improving the recognition of the high risk patients and avoiding in those cases the predisposing factors.

Variations in the recognition of echovirus type 11 strains by a group-specific anti-VP1 monoclonal antibody

BACKGROUND

Mab 5-D8/1 is a monoclonal antibody (Mab) that was shown to be directed towards a conserved epitope of the capsid protein VP1 among the genus enterovirus. The use of this Mab for the routine detection of enteroviruses in clinical specimens led to the observation that several strains of echovirus type 11 (EV-11) could not be detected on spontaneously detached cells from 26-h cultures using a two-step immunofluorescence (IF) assay. Conversely, these strains were detected positive with the same Mab when tested on adherent or trypsinizated cells.

OBJECTIVES

The aim of this study was to understand the misrecognition of some strains of EV-11 by this Mab.

STUDY DESIGN AND RESULTS

IF tests at different times of the viral cycle brought evidence that the detection of a variant strain of EV-11 decreased rapidly with time, becoming undetectable 26 h post-infection, since the reference strain remained positive up to 46 h post-infection. The infective titres of the variant strains were shown to be high in comparison with those of well-recognised strains. Sequencing the Mab binding epitope confirmed that the variant strains exhibited no antigenic shift.

CONCLUSION

These results suggest that the poor recognition of some strains of EV-11 by Mab 5-D8/1 is due to a rapid decrease of the expression of the binding epitope in the cell, maybe in relation with the high lytic power of these strains. From a practical point of view, our data indicate that a negative result when Mab 5-D8/1 is used for enterovirus typing must be interpreted cautiously with highly replicative strains and that detached cells should not be used for enterovirus identification under these circumstances.

[Behçet disease. 162 cases]

We report 162 cases of Behçet's disease, seen at the Internal Medicine Unit of Ibn Sina Hospital at Rabat, between January 1983 and June 1996. This series concerned 124 men et 38 women, Moroccans, whose mean age at first hospitalization was 32 years, and mean age at disease onset was 26 years. Diagnosis of Behçet's disease was established on Mason and Barnes and/or International Study Group for Behçet's Disease criteria. There was a muco-cutaneous involvement in 100%, eye involvement in 50%, joint involvement in 45%, neurological symptoms in 43.2%, vascular involvement in 62.34%, thoracic involvement symptoms in 13%, digestive involvement in 8 cases, cardiac involvement in 5 patients, long term fever in 5 patients, and one case of amyloidosis. We compared our results to the literature and we noticed that our series had an elevated frequency of neurological involvement, mostly benign intra-cranial hypertension and deep vein thrombosis. We also found that gut involvement was particularly low.

[Association of pulmonary artery aneurysm, right heart thromboses and antiphospholipid antibodies in Behcet's disease]

INTRODUCTION

Cardiac thromboses are unusual in the course of Behçet's disease and are frequently associated with endomyocardial fibrosis of the right heart. Vascular pulmonary involvement with either pulmonary aneurysm or parenchyma alterations is also often observed. However, pathogenesis of thromboses occurring in the course of Behçet's disease is still unclear.

CASE REPORT

The authors report the case of a 28-year-old man who presented with Behçet's disease accompanied by pulmonary aneurysm, multiple thrombi of the right heart and antiphospholipid antibodies.

CONCLUSION

The choice of therapeutical strategies for curative treatment of this association as well as the interpretation of the role of antiphospholipid antibodies in this polyvascular disease raises questions.

Comparison of a rapid culture method combining an immunoperoxidase test and a group specific anti-VP1 monoclonal antibody with conventional virus isolation techniques for routine detection of enteroviruses in stools

In order to shorten the time required for the detection of enteroviruses in stool specimens, an 18-h immunoperoxidase test combining low-speed centrifugation and the use of a group specific anti-VP1 monoclonal antibody (5-D8/1, Dako) was developed. This rapid culture assay (RCA) was compared blindly to a conventional culture assay (CCA) on a panel of 180 children's stool specimens received for routine diagnosis of enterovirus infection. The same cell lines (human embryonic fibroblasts and KB continuous cell line) were used in both tests. Discrepancies in results were analysed by a PCR technique with primers located in a conserved part of the 5' non-coding region of the enterovirus genome. Fourteen specimens were positive and 158 were negative with both tests. Four samples were positive with the RCA yet negative with the CCA and 3 others showed the opposite pattern; an additional sample positive by RCA was uninterpretable by CCA due to bacterial contamination. Subsequent PCR testing of these 8 samples showed no discrepancies; all were positive. Using CCA as the reference, the sensitivity and specificity of RCA were 77.8 and 98% respectively. Kinetic studies using enterovirus isolates demonstrated that RCA was much more sensitive than CCA during the first three days of culture. These results further suggested that RCA sensitivity could be improved by a factor of at least 10 times by prolonging the incubation period by 24 hr. With this change, the RCA assay described below is suggested as a rapid alternative to CCA for the routine diagnosis of enterovirus infection in stool specimens. When an identification at the serotype level is required, samples found positive using RCA could then be subjected to CCA.

Evaluation of an enterovirus group-specific anti-VP1 monoclonal antibody, 5-D8/1, in comparison with neutralization and PCR for rapid identification of enteroviruses in cell culture

We evaluated the usefulness of a commercially available monoclonal antibody (MAb) directed against a group-specific epitope of the capsid protein VP1 of enteroviruses for the rapid identification of these viruses in cell culture. The MAb was assayed in an indirect immunofluorescence test with cultured cells infected by various serotypes of enterovirus; all 39 serotypes tested, including echoviruses 22 and 23, which are considered atypical enteroviruses, were reactive. The MAb was also tested with 61 strains recovered from clinical specimens inoculated into cell cultures in comparison with seroneutralization with intersecting pools of hyperimmune sera and PCR with primers from the 5' untranslated region of enteroviruses. There was total agreement between the results obtained with the MAb and those obtained by PCR, even for those strains of enteroviruses which were found to be untypeable with polyclonal antisera. These data demonstrate the usefulness of the MAb for rapid identification of enteroviruses in cell culture.

Detection of neutralizing IgM antibodies in the diagnosis of enterovirus infections

Data are presented of IgM detection by a neutralization test used routinely in 1,062 patients. Antigens isolated during the period of investigation were EV4, EV7, EV11, EV18, EV21, EV24, EV33, CA9, CB2, CB4, and CB5. No difference was observed in the distribution of IgM-positive sera according to age and sex. Total antibodies are at higher titres when IgM antibodies are present. Polytypic IgM responses are not frequent (less than 10%). The frequency of the IgM-positive sera for a given serotype correlated with the frequency of isolates for the serotype except for CA9. Other than for babies under age 6 months, IgM detection is more frequent than is isolation. The susceptibility of the elderly and the frequency of IgM-positive sera among adults over age 40 years suggests possible underestimation of enterovirus infections in adults. The duration of IgM remains a major question.

Characterization of a non-structural 147-kDa precursor polypeptide of echovirus 33 and its immunogenicity in man

Zinc chloride (0.9 mM)--an inhibitor of the processing of the initial polypeptides of Picornaviridae--was used to accumulate large precursors of echovirus 33 (EV33) and notably two proteins of 147- and 97-kDa. Polyclonal hyperimmune sera were raised in mice against these polypeptides and assayed by immunoblotting against EV33-infected cells blocked or not with ZnCl2, showing that protein 147--2ABC3ABCD according to the L434 convention--can be considered to be the precursor of the two non-structural proteins P2 and P3. Sixty-three serum specimens from subjects exhibiting varying antibody status against EV33 by seroneutralization were investigated by immunoblotting against an EV33 ZnCl2-blocked antigen. Some subjects infected with EV33 were shown to elicit antibodies which recognize the non-structural precursor polypeptides, a fact whose clinical significance needs further evaluation.

Comparative evaluation of immunoglobulin M neutralizing antibody response in acute-phase sera and virus isolation for the routine diagnosis of enterovirus infection

A total of 314 patients exhibiting symptoms consistent with a viral disease provided, during the early stage of hospitalization, at least one specimen from a peripheral site (throat or stools or both) and a serum specimen in order to evaluate the neutralizing immunoglobulin M (IgM) antibody response in acute-phase serum in comparison with virus isolation for the rapid diagnosis of enterovirus (EV) infection. IgM antibodies were fractionated by ion-exchange chromatography and tested by seroneutralization against the various types of EV that have been recently circulating. A total of 189 patients (60%) were negative, and 21 (7%) were positive by both methods; in 51 patients (16%), a virus was isolated without IgM antibody response; 53 patients (17%) showed the opposite pattern. In all age groups except for children under 6 months, the frequency of positive results was higher with IgM serology than with virus isolation (27 and 22%, respectively). Apart from meningitis, for which isolation was more efficient, the other clinical conditions were associated with similar percentages of positivity by both methods. Regarding the 21 cases with positive results by the two techniques, the same serotype was detected in 9 cases and different serotypes were detected in 12, suggesting crossreactivities. Thus, IgM neutralizing antibody response on acute-phase serum appears to be of limited value in the rapid diagnosis of acute EV infection but may prove useful for the investigation of the wide range of chronic diseases associated with EV.

Detection of antibodies against initial polypeptides in patients infected with an enterovirus (EV-33)

Antibodies against initial polypeptides have been detected in sera of patients infected with an Echo virus 33. The technique is an IF test using infected cells in which the virus multiplication cycle is blocked at 2 hrs p.i.