Quantitative monitoring of multi-donor chimerism: a systematic, validated framework for routine analysis

Despite therapeutic advantages, double-donor (DD) HSCTs present technical problems for molecular chimerism (CHM) monitoring. These DD chimeras contain three matched DNAs, so that the genomes of donor(s) and recipient often share the same alleles. In the STR assay, shared recipient/donor alleles are common and have identical physico-chemical properties. As a consequence of the latter, they co-migrate in the same band ('shared peak'), which prevents measuring each allele separately. Without individual allelic measurements, the direct calculation of the chimeric recipient/donor DNA ratio is precluded. This is the first study to document and systematically examine these problems. Its goal was to provide a validated framework for accurate, routine monitoring based on a stepwise analytic paradigm for approximating percent CHM (%CHM) from shared STR-alleles. Analysis of STR-DNA from DD loci showed that at least four of six alleles were typically shared. Despite such extensive allelic sharing, we show how simple arithmetic procedures can be applied for standardized calculation of %CHM based on peak measurements. Criteria for selecting loci suitable for such analysis are provided. Validation of the computational results required analyzing 18 'informative' loci with pre-established reference values for %CHM. In all cases, the results for %CHM, calculated from peak measurements, were +/-5% of the reference value. The conclusions of the study are as follows: (1) Multi-donor chimeras, with shared alleles, can be accurately and simply analyzed within the usual limits of STR measurement error; (2) by examining these various facets of DD CHM analysis, this novel study has provided a basis for standardized, routine quantitative monitoring using the STR/VNTR assay.

Lessons from the clinical course of IgE-mediated cow milk allergy in Israel

Cow milk and milk products are the most common food products consumed in Israel; rates of allergy to cow milk exceed those of peanuts in infants and children. The aim of the present study was to evaluate retrospectively the clinical features and natural course of immunoglobulin (Ig) E-mediated cow milk allergy (CMA) in Israel. Data of children diagnosed with CMA from 1995 to 2003, were collected regarding age at first and most recent reactions, symptoms and signs, family history of atopy, other allergic diseases, emergency department visits, hospitalizations, and treatment. Patients with transient CMA were compared to those with persistent CMA (> or =3 yr old). The study group consisted of 105 patients, 43 with transient CMA (age range: 0.48-11 yr). The remaining 62 patients (age range: 3-16.5 yr) did not achieve tolerance to cow milk during the follow-up period. No differences were found between the groups in mean age and symptoms and signs at the first allergic reaction and family history of atopy. Patients with persistent CMA had a higher rate of asthma than patients with transient CMA (61.2% vs. 18.6%, p < 0.001). Fifty patients with persistent CMA had 137 subsequent allergic reactions after diagnosis, 25% of the reactions were due to oral milk challenge at the clinic and 75% due to accidental exposure, of which 13% required an emergency department visit and 8%, hospitalization. Only 19% of the reactions were treated with epinephrine injection. In conclusion, in our experience, less than half of the children diagnosed with IgE-mediated CMA during 9 yr, outgrew it. The patients with persistent CMA have a higher prevalence of asthma compared with the general population or to children with transient CMA. The high number of recurrent allergic reactions due to accidental exposure and the low rate of epinephrine usage in these patients point to a need for better education of patients and their families.

Guttate psoriasis following Kawasaki disease

Guttate psoriasis developed in a 3.5-year-old boy during the course of Kawasaki disease (KD). The pathogenesis of this unusual complication may be production of superantigens, which is also considered to be a cause of KD.

[Life-threatening echovirus 11 infection during first month of life]

Infection with Echovirus 11 is mostly asymptomatic, but it may cause a wide variety of clinical diseases, from gastroenteritis to serious diseases such as meningitis and myocarditis. In small infants, especially during the first days of life, echovirus infection may appear as a sepsis-like illness, and cause disseminated intravascular coagulopathy and shock. We present 2 infants with severe Echovirus 11 infections. A 3.5-month-old died within 24 hours of shock and probably myocarditis. The other, 6-days old, presented with meningitis, hepatitis and disseminated intravascular coagulopathy. It recovered after treatment with intravenous immunoglobulin. Echovirus 11 may cause life-threatening infections in small infants. Pediatricians should be alert to the special characteristics of this disease.

Erythema annulare centrifugum in a patient with polyglandular autoimmune disease type 1

The dermatologic disorders in polyglandular autoimmune disease (PGAD) type 1 (previously called chronic mucocutaneous candidiasis) are nail dystrophy, vitiligo, and alopecia. A patient with PGAD and erythema annulare centrifugum (EAC) is presented. This association has not been reported previously. EAC may be related to occult or low-grade Candida infection in PGAD.

[Benign intracranial hypertension following minocycline]

A 15-year-old girl, who had been treated with minocyclin for acne for 2 months, was admitted for investigation of headache, nausea and papilledema. A space-occupying lesion was ruled out by computerized brain tomography. The diagnosis of benign intracranial pressure (pseudo-tumor cerebri) was made because of elevated cerebrospinal fluid pressure with normal biochemistry and cytology. Tetracyclines, especially minocyclin, commonly used for treating acne in adolescents, can cause benign intracranial pressure.

Peripheral intravenous infusion--another cause of air embolism

We report an unusual complication of intravenous infusion. A 4-week-old baby developed acute cardiopulmonary distress because of air embolism caused by improper preparation of peripheral intravenous set. The estimated amount of infused air was 12 ml (approximately 3.5 ml/kg). The infant recovered promptly after short supportive treatment.

The immunosuppressive human placental ferritin subunit p43 is produced by activated CD4+ lymphocytes

Human placental ferritin is an immunosuppressive protein composed of a 43-kDa subunit (p43) and ferritin light chains. Its physiological action seems to be downregulation of the immune response of the mother against her embryo. Elevated levels of p43 in serum are associated with pregnancy, lymphomas, breast cancer, and AIDS. Although it is known that p43 is produced by activated T lymphocytes, the specific T-lymphocyte subset involved is unknown. p43 is measured by enzyme-linked immunosorbent assays with CM-H-9 monoclonal antibody specific for p43. We studied the de novo biosynthesis of p43 by isolated activated CD4+ and CD8+ T lymphocytes in a normal donor and in a patient with elevated levels of p43 in serum. The results indicated that p43 was synthesized by activated CD4+ lymphocytes from the normal donor (0.45% of the total de novo proteins) but that its biosynthesis by CD8+ lymphocytes was below the level of detection. The activated CD4+ lymphocytes from the patient with elevated levels of p43 in serum overproduced p43 (3.8% of the nascent proteins). Since it was shown that a subset of CD8+ lymphocytes has receptors for p43, the latter may be considered an immunoregulatory cytokine produced mainly by activated CD4+ lymphocytes.

[Subdural empyema complicating sinusitis]

Paranasal sinusitis complicated by subdural empyema (SDE) in a 14-year-old boy is described. He presented with fever, headache and vomiting. X-rays revealed left maxillary and bilateral frontal sinusitis. While in the emergency room he had seizures; CT-scan showed an air leak adjacent to the right frontal sinus. Despite intravenous antibiotics, left hemiparesis developed and repeat CT showed interhemispheric SDE. Frontal craniotomy was performed and a large amount of purulent material was drained. Recovery followed 4 weeks of intravenous antibiotic treatment without neurologic sequelae. SDE is a rare complication of paranasal sinusitis and constitutes approximately 20% of all localized intracranial infections. Clinical features include fever, headache, vomiting, convulsions and neurologic deficits. Modern imaging methods and combined surgical and antibiotic treatment have lowered mortality to 5-10%. A high index of suspicion is important for early diagnosis and successful treatment.

Swimming pool granuloma associated with erythema nodosum

Erythema nodosum was the presenting feature of swimming pool granuloma in a twelve-year-old girl. This entity should be added to the list of disorders associated with erythema nodosum.

T cell subsets in children with mumps meningitis

Nineteen children with mumps meningitis were investigated. Peripheral blood T cell subset function and number were tested during the acute phase of meningitis and again when the children recovered. No significant difference in the total number of T cells, or T helper: suppressor lymphocyte cell ratio was found in the children with mumps meningitis as compared with the controls. However, a significant increase in the number of T suppressor/cytotoxic cells in the peripheral blood of children with mumps meningitis in the acute phase was found. This increase in the T suppressor subset was still present even after the children recovered from the disease. Two children who showed deafness had the highest increases in the T suppressor/cytotoxic lymphocyte subset. Functional analysis of T suppressor cell activity demonstrated a significant suppressive activity of lymphocytes obtained during the acute phase of the disease. However, after recovery the suppressive activity found was not significant (P greater than or equal to 0.1).

Clinical manifestations and laboratory data of subacute cutaneous lupus erythematosus

Nine patients with subacute cutaneous lupus erythematosus (SCLE) are described, all of whom had systemic involvement of the disease although usually milder than in systemic lupus erythematosus. None of the patients had renal disease or died of SCLE.

Familial multiple naevi flammei

The third family with multiple naevi flammei and the first description of its occurrence in unidentical twins is presented. Autosomal dominant inheritance is confirmed.

Primary gonadal failure and precocious adrenarche in a boy with Prader-Labhart-Willi syndrome

A 7-year-old boy with Prader-Labhart-Willi syndrome who had precocious adrenarche was found to have primary gonadal failure, as evidenced by appropriate laboratory investigations: elevated basal levels of plasma FSH and LH with exaggerated responses to LH-RH stimulation and unresponsiveness of plasma testosterone to repeated hCG stimulations. The elevated values of plasma DHEA which were found indicate an early activation of the adrenal gland. This patient demonstrates the variability of pubertal development in the Prader-Labhart-Willi syndrome, with the unusual association of primary gonadal failure and precocious adrenarche.

Uncombable hair: a condition with autosomal dominant inheritance

Uncombable hair is a familial abnormality of scalp hair structure which affects children and lessens as they grow older. It is suggested that the mode of inheritance of the condition is autosomal dominant.