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Unusual initial presentation of herpes simplex virus as inguinal lymphadenopathy. Case Rep Pathol 2015; 2015:573230. [PMID: 25815228 PMCID: PMC4357043 DOI: 10.1155/2015/573230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/17/2015] [Indexed: 11/19/2022] Open
Abstract
Genital herpes simplex virus (HSV) infections are a common cause of inguinal lymphadenopathy. However, surgical excision of enlarged inguinal nodes is almost never performed to initially diagnose genital herpes simplex virus, due to the distinct external presentation of genital herpetic vesicles that usually occur with the first symptoms of infection. Therefore, the histologic and immunophenotypic features of HSV-associated inguinal lymphadenopathy are unfamiliar to most pathologists. The current report describes the lymph node pathology of two immunocompetent patients, whose initial HSV diagnosis was established through surgical excision of enlarged inguinal lymph nodes. Histologic examination showed features consistent with viral lymphadenopathy, including florid follicular hyperplasia, monocytoid B-cell hyperplasia, and paracortical hyperplasia without extensive necrosis. Immunohistochemical stains for HSV antigens, using polyclonal anti-HSV I and II antibodies, demonstrate strong immunoreactivity for HSV in a small number of cells in the subcapsular sinuses, especially in areas with monocytoid B-cell hyperplasia. Rare scattered HSV-positive cells also are identified in paracortical areas and germinal centers. We conclude that an initial diagnosis of genital HSV infection may be established by inguinal lymph node biopsy.
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Wiśniewska K, Piórkowska A, Kasprzyk J, Bronk M, Świeć K. Clonal distribution of bone sialoprotein-binding protein gene among Staphylococcus aureus isolates associated with bloodstream infections. Folia Microbiol (Praha) 2014; 59:465-71. [PMID: 24827510 PMCID: PMC4194700 DOI: 10.1007/s12223-014-0321-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 05/06/2014] [Indexed: 11/30/2022]
Abstract
Staphylococcus aureus is a leading cause of bloodstream infections (BSI) and diseases that may be caused by hematogenous spread. The staphylococcal adhesin, for which the association with the infections emerging as a complication of septicemia has been well documented, is a bone sialoprotein-binding protein (Bbp). The aim of the study was to assess the prevalence of a bbp gene in S. aureus bloodstream isolates associated with BSI and to investigate to what degree the distribution of this gene is linked to the clonality of the population. Spa typing, used in order to explore the genetic population structure of the isolates, yielded 29 types. Six spa clusters and seven singletons were identified. The most frequent was spa clonal complex CC021 associated with MLST CC30 (38 %). The bbp gene was found in 47 % of isolates. Almost all isolates (95 %) clustered in spa clonal complex CC021 were positive for this gene. All isolates carrying the bbp gene were sensitive to methicillin, and if clustered in the spa CC021, belonged to agr group III. Our study shows that Bbp is not strictly associated with BSI. However, one may conclude that for clonally related S. aureus strains most commonly causing BSI, the risk of Bbp-mediated complications of septicemia is expected to be higher than for other strains.
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Affiliation(s)
- Katarzyna Wiśniewska
- Department of Medical Microbiology, Medical University of Gdańsk, Do Studzienki 38, 80-227, Gdańsk, Poland,
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Shim JO. Differential diagnosis of acute diarrheal disorders in children. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2012. [DOI: 10.5124/jkma.2012.55.6.516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jung Ok Shim
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
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Haveman LM, Scherrenburg J, Maarschalk-Ellerbroek LJ, Hoek PD, Schuurman R, de Jager W, Ellerbroek PM, Prakken BJ, van Baarle D, van Montfrans JM. T-cell response to viral antigens in adults and children with common variable immunodeficiency and specific antibody deficiency. Clin Exp Immunol 2010; 161:108-17. [PMID: 20408855 DOI: 10.1111/j.1365-2249.2010.04159.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Several T cell abnormalities have been described in common variable immunodeficiency (CVID), a B cell disorder of mainly unknown origin. A subset of CVID patients suffers from frequent reactivations of herpes viruses. We studied T cell function in CVID [and in a subset of paediatric patients with specific antibody deficiency (SAD)] by measuring T cell proliferation and cytokine production in response to herpes virus-antigens in paediatric CVID patients (n=9) and paediatric SAD patients (n=5), in adult CVID patients (n=14) and in healthy controls. Paediatric CVID patients, but not SAD patients, displayed moderately increased CD8+ T cell proliferation in response to cytomegalovirus, human herpes virus type 6B (HHV6-B) and herpes simplex virus compared to controls. CD8+ T cell responses in adult CVID patients tended to be increased in response to cytomegalovirus and herpes simplex virus. In response to stimulation with herpes virus antigens, the proinflammatory cytokines interleukin (IL)-1beta, IL-6, tumour necrosis factor (TNF)-alpha and interferon inducible protein (IP)-10 were produced. Overall, no major differences were detected in cytokine production upon stimulation between patients and controls, although higher IL-10 and IL-12 production was detected in paediatric patients. In conclusion, cellular immunity against herpes virus antigens appears undisturbed in CVID patients, although defects in subpopulations of CVID patients cannot be excluded.
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Affiliation(s)
- L M Haveman
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
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Patel NN, Patel DN. Erythema multiforme syndrome. Am J Med 2009; 122:623-5. [PMID: 19559161 DOI: 10.1016/j.amjmed.2008.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 08/02/2008] [Accepted: 08/05/2008] [Indexed: 11/26/2022]
Affiliation(s)
- Nilesh N Patel
- Department of Medicine, Citrus Valley Medical Centers, West Covina, California 91791, USA.
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Oo K, Xiao W, Hameed A, Xiao P. Concurrent herpes simplex viral lymphadenitis and chronic lymphocytic leukemia/small lymphocytic lymphoma, mimicking large-cell (Richter) transformation. Leuk Lymphoma 2009; 50:1535-7. [PMID: 19562615 DOI: 10.1080/10428190903062083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tsolia MN, Psarras S, Bossios A, Audi H, Paldanius M, Gourgiotis D, Kallergi K, Kafetzis DA, Constantopoulos A, Papadopoulos NG. Etiology of community-acquired pneumonia in hospitalized school-age children: evidence for high prevalence of viral infections. Clin Infect Dis 2004; 39:681-6. [PMID: 15356783 PMCID: PMC7107828 DOI: 10.1086/422996] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2003] [Accepted: 04/14/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) in young children is most commonly associated with viral infections; however, the role of viruses in CAP of school-age children is still inconclusive. METHODS Seventy-five school-age children hospitalized with CAP were prospectively evaluated for the presence of viral and bacterial pathogens. Nasopharyngeal washes were examined by polymerase chain reaction for viruses and atypical bacteria. Antibody assays to detect bacterial pathogens in acute-phase and convalescent-phase serum samples were also performed. RESULTS A viral infection was identified in 65% of cases. Rhinovirus RNA was detected in 45% of patients; infection with another virus occurred in 31%. The most common bacterial pathogen was Mycoplasma pneumoniae, which was diagnosed in 35% of cases. Chlamydia pneumoniae DNA was not detected in any patient; results of serological tests were positive in only 2 patients (3%). Mixed infections were documented in 35% of patients, and the majority were a viral-bacterial combination. CONCLUSIONS The high prevalence of viral and mixed viral-bacterial infections supports the notion that the presence of a virus, acting either as a direct or an indirect pathogen, may be the rule rather than the exception in the development of CAP in school-age children requiring hospitalization.
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Affiliation(s)
- M N Tsolia
- Second Department of Pediatrics, University of Athens School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece.
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Kraemer CK, Benvenuto C, Weber CW, Zampese MS, Cestari TF. Chronic cutaneous herpes simplex in a patient with hypogammaglobulinemia. Skinmed 2004; 3:111-3. [PMID: 15010642 DOI: 10.1111/j.1540-9740.2004.02585.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Cristine Kloeckner Kraemer
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, 90610-000 Porto Alegre RS, Brazil
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Esposito S, Droghetti R, Faelli N, Lastrico A, Tagliabue C, Cesati L, Bianchi C, Principi N. Serum Concentrations of Pneumococcal Anticapsular Antibodies in Children with Pneumonia Associated with Streptococcus pneumonia Infection. Clin Infect Dis 2003; 37:1261-4. [PMID: 14557973 DOI: 10.1086/378740] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2003] [Accepted: 07/01/2003] [Indexed: 11/03/2022] Open
Abstract
The levels of specific IgG antibody to pneumococcal capsular polysaccharides were investigated in 182 children, aged 2-5 years, who were hospitalized for community-acquired pneumonia, including 55 (30.2%) with evidence of acute pneumococcal infection. Results show that children with concentrations of specific IgG antibody that would protect against invasive disease do not seem to be protected against pneumonia associated with pneumococcal infection.
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Cregin RG. Current Management Issues Associated with Community-Acquired Pneumonia. J Pharm Pract 2003. [DOI: 10.1177/0897190003260552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community-acquired pneumonia (CAP) is a significant cause of morbidity, mortality, and increased cost. Despite numerous managementguidelines, CAP continues to existas a challenge to the learned clinician. Due to a lack of sensitive diagnostic testing, causative pathogens are often not identified, making most therapy empiric. Increasing levels of bacterial resistance to available antimicrobials worldwide has been implicated in driving up the costs of treatment and adversely effecting clinical outcomes. Pharmacists can be part of the solution by encouraging appropriate antimicrobial selection based on resistance patterns in their communities and ensuring appropriate vaccines are employed to prevent CAP.
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Affiliation(s)
- Regina G. Cregin
- Antibiotic Utilization Pharmacist, Pharmacy Department, New York Hospital Queens, Flushing, New York
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Smith C. Pharmacokinetic/Pharmacodynamic Considerations in Community-Acquired Lower Respiratory Tract Infections. J Pharm Pract 2003. [DOI: 10.1177/0897190003260653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To accomplish the goal of both clinical and microbiological cure in the treatment of lower respiratory tract infections, microbiological data along with pharmacokinetic and pharmacodynamic data should be used. Recent studies have determined 2important antibacterial pharmacokinetic/ pharmacodynamic parameters that differ among classes of antimicrobial agents. The 2major groups include the antibiotics that exhibit concentration-dependent killing with a postantibiotic effect and time-dependent killing with minimal to moderate postantibiotic effects. For drugs that are concentration dependent (aminoglycosides, fluoroquinolones), the area under the concentration-time curve (AUC/MIC) is the most important predictor of bacteriological eradication. Alternatively, for antibiotics that exhibit time-dependent killing (-lactams, macrolides), time above the MIC ( T >MIC) is probably the major parameter that determines efficacy. Using these parameters provides the tools needed for appropriate antibiotic dosing.
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Affiliation(s)
- Candace Smith
- St. John's University College of Pharmacy & Allied Health, Professions, 34 Van Brunt Manor Rd, E Setauket, New York 11733
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Taddesse-Heath L, Feldman JI, Fahle GA, Fischer SH, Sorbara L, Raffeld M, Jaffe ES. Florid CD4+, CD56+ T-cell infiltrate associated with Herpes simplex infection simulating nasal NK-/T-cell lymphoma. Mod Pathol 2003; 16:166-72. [PMID: 12591970 DOI: 10.1097/01.mp.0000051680.14007.d7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of Herpes simplex virus (HSV) infection of the nasopharynx associated with a dense CD4+, CD56+ T-cell infiltrate that simulated lymphoma on clinical, histologic, and immunophenotypic grounds. Histologic examination showed a tumorlike lymphoid infiltrate with extensive necrosis. Multinucleated giant cells with "ground-glass" nuclei characteristic of HSV were observed in necrotic areas but were not prominent. Immunohistochemical studies of the lymphoid infiltrate revealed a predominance of T cells, positive for CD3, CD4, CD5, and CD56. Immunohistochemical staining with HSV antibody was focally positive in the multinucleated giant cells. Molecular studies using PCR and Southern blot were positive for HSV Type II. PCR studies for T-cell receptor gamma and immunoglobulin heavy chain gene rearrangements showed no evidence of a clonal population. In situ hybridization studies for Epstein-Barr virus (EBV) were negative. The clinical presentation of a large fungating mass, the extent of the lymphoid infiltrate, and the expression of CD56 all raised the possibility of a nasal NK/T cell lymphoma. However, the presence of HSV, lack of angioinvasion and angiodestruction, absence of EBV, and polyclonal T-cell nature of the infiltrate argued against this diagnosis. Although prior studies have not fully characterized the immunophenotypic features of the lymphocyte response to HSV in infected tissues, we postulate that the CD56+, CD4+ T-cell reaction represents a florid antiviral immune response.
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Affiliation(s)
- Lekidelu Taddesse-Heath
- Laboratory of Pathology, Hematopathology Section, National Cancer Institute, National Institutes of Health, Building 10, Room 2N202, 10 Center Drive MSC-1500, Bethesda, MD 20892-1500, USA
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