Histopathological Analysis of Brains from Dogs Infected with Canine Distemper Virus

We describe the use of conventional histology and immunohistochemistry against canine distemper virus (CDV) to examine the brains of domestic dogs with a confirmed diagnosis of CDV infection. Histologically, to identify the main typical lesions, we used conventional H&E stain; to evaluate the progressive demyelination, we used Luxol Fast Blue stain; and to identify the presence of viral particles in these affected regions, we used immunohistochemistry against CDV. We confirm that the histopathological analysis of brains of distemper-infected dogs is a powerful tool to evaluate the typical brain lesions and could be used as an interesting natural model to continue studying the pathogenesis of canine distemper in different species and/or other morbillivirus infections, like measles.

Maternal undernutrition during pregnancy and lactation increases transcription factors, ETV5 and GDNF, and alters regulation of apoptosis and heat shock proteins in the testis of adult offspring in the rat

We tested whether changes in Sertoli cell transcription factors and germ cell heat shock proteins (HSPs) are linked to the effects of maternal undernutrition on male offspring fertility. Rats were fed ad libitum with a standard diet (CONTROL) throughout pregnancy and lactation or with 50% of CONTROL intake throughout pregnancy (UNP) or lactation (UNL) or both periods (UNPL). After postnatal Day 21, 10 male pups per group were fed a standard diet ad libitum until postnatal Day 160 when testes were processed for histological, mRNA and immunohistochemical analyses. Compared with CONTROL: caspase-3 was increased in UNP and UNPL (P=0.001); Bax was increased in UNL (P=0.002); Bcl-2 (P<0.0001) was increased in all underfed groups; glial cell line-derived neurotrophic factor (P=0.002) was increased in UNP and UNL; E twenty-six transformation variant gene 5 and HSP70 were increased, and HSP90 was diminished in all underfed groups (P<0.0001). It appears that maternal undernutrition during pregnancy and lactation disrupts the balance between proliferation and apoptosis in germ cells, increasing germ cell production and perhaps exceeding the support capacity of the Sertoli cells. Moreover, fertility could be further compromised by changes in meiosis and spermiogenesis mediated by germ cell HSP90 and HSP70.

Time-course of transcriptome response to respiratory syncytial virus infection in lung epithelium cells

Respiratory syncytial virus (RSV) is the major cause of acute lower respiratory tract infection in infants. Winter outbreaks in Chile result in 5% of infected children hospitalized, with 0.01% mortality. Increased evidence indicates that viral and host factors modulate the severity of infection. Using DNA microarrays, we characterized the genome-wide transcriptional response of lung mucoepidermoid cells (NCI-H292) at 0, 24, 48, 72 and 96 hours post-infection (hpi) with a single dose of RSV/A. During the whole studied period, a bi-phasic gene expression profile was observed by a total of 330 differentially expressed genes. About 60% of them were up-regulated between 24-72 hpi and then turned-off at 96 hpi. This transient, early gene expression pattern was significantly enriched in biological processes like interferon signaling, antigen processing and presentation, double-stranded RNA binding and chemokine activity. We detected 27 common genes up-regulated between 24-72 hpi, from which IFIT1, IFI44, MX1, CXCL11 and OAS1 had the highest expression. The second pattern comprised over 120 genes, which remained silenced until 72 hpi, but were steeply up-regulated by 96 hpi. Biological processes of this late-response profile included cell cycle division and microtubule cytoskeleton organization. Conversely, the genes belonging to virus response pathway showed a decreased expression at 96 hpi. We conclude that RSV induces an early innate immune activation profile response until 72 hpi. Thereafter, the viral response is inhibited, leading to host cell recovery. The presented cellular model allows to study the specific pathways involved in elimination of infection at prolonged time intervals and their subsequent analysis in severe RSV disease of infants and/or older adults.

[Management of hypertension in pregnancy]

Hypertensive states of pregnancy are a set of disorders that occur during gestation whose common nexus is hypertension. They must be given special emphasis due to their implication in maternal and neonatal morbidity and mortality. A classification is made of the different hypertensive states, with special emphasis placed on preeclampsia. This article defines the symptoms and signs of the disease and a differential diagnosis is made amongst diseases that must be ruled out. It is important to identify expectant mothers with preeclampsia, and it is of even greater importance in such cases to rule out some criterion of seriousness, as this will enable a different management to be carried out. The article includes the indications and the moment when the pregnancy finalises. Similarly, it details the controls that must be made if an expectant management is chosen for the benefit of the premature baby. The different anti-hypertensive therapeutical options are detailed, as well as the prophylactic treatment of eclampsia with magnesium sulphate. Because of their intrinsic interest, we draw special attention to the HELLP syndrome and to eclampsia as complications. The treatment and conduct that must be followed in gestation is described.

[Haemorrhage in gestation]

A haemorrhage is one of the most frequent, and potentially most serious, causes for emergency consultation during gestation. In this review we offer an overall approach to managing a pregnant woman who attends Accidents and Emergencies due to vaginal bleeding and then, in a more specific way, we consider how to manage some of the most frequent entities of the obstetric haemorrhage. With respect to haemorrhages in the second trimester, we give greater attention to how to manage a miscarriage, since other entities that are also frequent receive a specific evaluation in other chapters. In the second trimester three entities account for the greatest percentage of haemorrhages, such as placenta praevia, the premature detachment of the normally inserted placenta and uterine rupture. In each case we have evaluated the etiopathology, diagnostic attitude and management in the most systematic way possible.

[Medical disorders and pregnancy. Gastrointestinal, neurological, cardiovascular and dermatological disorders]

A pregnant woman can present medical pathologies similar to a woman who is not pregnant. However, the clinical features of some pathologies and the diagnostic or therapeutic process might be altered due to changes produced by pregnancy and the presence of the foetus. In some cases this can limit the diagnostic methods or the therapies to be applied. This article sets out the digestive and cardiovascular pathologies, pathologies of the nervous system and dermatoses of greatest relevance due to their frequency or severity, which might be encountered in an emergency consultation. It also offers a practical approach for the initial handling and the prognosis for the mother and the foetus.

Hospital-acquired adenovirus 7h infantile respiratory infection in Chile

BACKGROUND

Adenoviruses are the second most common cause of viral acute lower respiratory tract infection (ALRI) requiring hospitalization in Chile. Little information is available with respect to nosocomial infection rate by adenovirus. This issue is important because of its potential severity and long term sequelae.

METHODS

Infants hospitalized for ALRI were studied to determine the rate of nosocomial cross-infection with respiratory adenovirus and its corresponding genome type. The group studied included all cases younger than 2 years of age admitted to a seven crib ward in the Roberto del Rio Children's Hospital (Santiago, Chile) between May, 1995, and October, 1996. Nasopharyngeal aspirates for immunofluorescence assay and viral isolation were obtained on admission and the next day. On identification of a positive case for adenovirus, samples were obtained from contacts for 2 consecutive days and twice weekly thereafter for 2 weeks.

RESULTS

Fifteen index positive cases for adenovirus and their 65 contacts were identified. Secondary attack rate for adenoviral cross-infection was 55%, most of which were diagnosed by viral isolation. Mortality occurred in 4 cases; 3 had underlying diseases. Four secondary cases presented mild respiratory infection after acquiring the cross-infection, and 16 patients developed a moderate and severe ALRI. Twelve patients required supplemental oxygen and 4 needed mechanical respiratory support. Genome types for the 10 index cases and 19 contacts were obtained. All of these corresponded to adenovirus 7h.

CONCLUSIONS

The high secondary attack rate observed, stresses the importance of adequate isolation of patients and the need for rapid and sensitive viral diagnosis.

Adenovirus surveillance on children hospitalized for acute lower respiratory infections in Chile (1988-1996)

Adenoviruses (Ad) play an important role in the etiology of acute lower respiratory tract infections (ALRI) in young children in Chile. Our aim was to correlate the clinical severity of the infections with the Ad strains isolated during surveillance over 8 years. From 1988 through 1996, nasopharyngeal aspirates (NPA) were obtained for viral isolation and immunofluorescence assay (IFA) from children under 2 years of age hospitalized for ALRI; Ad isolates were further studied by restriction enzyme analysis of genomic DNA. Of 3,097 cases enrolled, the Ad isolation rate was 12.6%. The most common admission diagnoses among Ad-positive cases were pneumonia and wheezing bronchitis (69.8%). Duration of Ad shedding was studied in 74 cases by IFA. Children excreting Ad for 4 or more days had a longer hospital stay than those shedding for 1-3 days (mean: 16.8 and 7.2 days, respectively; P <.01). Viral shedding for more than 3 days was associated with more severe outcomes. Genome typing of 221 out of 390 Ad isolates resulted in 87 subgenus C and 134 subgenus B strains, including 123 Ad genome type 7h (55.6%, P <.01). The IFA from the NPA was more sensitive for the detection of subgenus B (51. 5%) than subgenus C infections (24.1%, P <.01). Children shedding Ad 7h had longer hospital stays (P <.01), a higher frequency of rectal temperatures over 39 degrees C (P <.01), and greater need for additional oxygen (P <.02) than subgenus C cases. Four cases requiring mechanical ventilation were associated with Ad 7h infections. The data presented show that, in children hospitalized for ALRI, the genome type 7h was associated with a more severe clinical outcome.

Treatment of respiratory syncytial virus infection with vitamin A: a randomized, placebo-controlled trial in Santiago, Chile

BACKGROUND

Treatment with high dose vitamin A reduces complications and duration of hospitalization for children with measles. In respiratory syncytial virus (RSV) infection, as with measles, low serum vitamin A concentrations correlate with increased severity of illness.

METHODS

To determine whether high dose vitamin A treatment is also effective for treating RSV disease, we conducted a randomized, double blind, placebo-controlled trial among 180 RSV-infected children between 1 month and 6 years of age at three hospitals in Santiago, Chile. Children with nasal washes positive for RSV antigen were given oral vitamin A (50,000 to 200,000 IU of retinyl palmitate, doses according to age; n = 89) or placebo (n = 91) within 2 days of admission.

RESULTS

There was no significant benefit from vitamin A treatment for the overall group in duration of hospitalization, need for supplemental oxygen or time to resolve hypoxemia. For the subgroup of children with significant hypoxemia on admission (room air oxygen saturation level < or = 90%), those given vitamin A had more rapid resolution of tachypnea (P = 0.01) and a shorter duration of hospitalization (5.5 vs. 9.3 days, P = 0.09). No toxicities were seen, including excess vomiting or bulging fontanel.

CONCLUSIONS

If vitamin A has a beneficial effect on the course of RSV disease, it may be seen only in more severely ill children.

[Progression of viral infection in twins born from a mother infected with human immunodeficiency virus]

We studied the evolution of HIV-1 infection and immune response during six years in two twins born from an infected mother. The children had a continuous progression of the infection, proved by CD4+ cell count, serum anti-HIV antibodies, cultivable virus and proviral load. Now, both children are on antiviral treatment. The analysis of serum antibodies showed a different immune response in both children. One of them developed higher levels of antibodies directed against viral proteins and synthetic peptides derived from their aminoacid sequence. In this child, the amount of cultivable virus increased less than in his twin. Nucleotide sequencing of a part of viral genoma, showed that the virus belonged to the B subtype, prevalent in America and Europe. The observed differences in viral sequences suggest a different selective pressure in both twins. This phenomenon could be related to the observed differences in immune response.

Genome type analysis of Chilean adenovirus strains isolated in a children's hospital between 1988 and 1990

In a study designed to evaluate the genetic variability of adenovirus strains associated with infantile cases of respiratory disease requiring hospitalization, a collection of 136 adenovirus isolates obtained in the Roberto del Rio Children's Hospital of Santiago, Chile between June 1988 and November 1990 was studied by restriction enzyme analysis. Nasopharyngeal aspirates were obtained on admission from children under 2 years. During the study period a total of 227 adenovirus respiratory infections (ARI) were diagnosed at the ward for ARI by immunofluorescence, representing 23% of all admissions. Fifty percent of the 136 typed strains were found to belong to subgenus B, and the other 50% corresponded to subgenus C. Digestion with a set of seven enzymes allowed the identification of nine different genome types of subgenus C, three of which had not been previously described, exhibiting novel restriction patterns with either BgI II or BstEII. Ad7h, identified in 66 isolates, was the predominant genome type and was associated with the nine cases requiring mechanical respiratory assistance and with the two fatalities recorded during the 29 months. No differences were found between the age and sex distribution of subgenus B and C genomic variants, but the mean length of hospital stay (X +/- 2 SE) recorded among patients infected with subgenus B types was significantly higher (17.72 + 4.52 days (n = 55) vs. 7.54 + 1.70 days (n = 53); F = 17.22; P < 0.0001).

Community- and hospital-acquired respiratory syncytial virus infections in Chile

Nasopharyngeal aspirates were obtained on admission from 614 patients younger than 2 years of age who were hospitalized in a ward for acute respiratory infections from June 1988 through October, 1989, in Santiago, Chile. Patients in two rooms were followed during the cold seasons by sampling aspirates every other day during the child's entire hospital stay. Clinical features were recorded daily. Indirect monoclonal immunofluorescent assay and isolation in HEp-2 were used for respiratory syncytial virus (RSV) diagnosis. The mean RSV detection rate was 39% at the time of admission, ranging from 8% in April, 1989, to 62% in July, 1988. During the cold months 43 of 288 (15%) nosocomial RSV cases were detected. Pneumonia and wheezing bronchitis were the principal diagnoses of both groups admitted, whether they were shedding RSV or not. It is concluded that RSV plays a major role in admissions for acute respiratory infections, as well as in nosocomial infections, in Santiago. Because clinical features do not allow one to differentiate viral from bacterial acute respiratory infections, the importance of rapid viral diagnosis is emphasized.

[Congenital infection due to herpes simplex virus]

Five cases of probably intrauterine herpesvirus infection are discussed. Four of them had clinical evidence of neonatal herpes, which was disseminated in two patients, localized to skin in one case and with SNC compromised in other. Natal or post natal infections were not considered to be possible in these infants due to the presence of symptoms in the first 24 hours of life, which made ascending transcervical or transplacental the most probable route for viral transmission. All cases were treated with a ten days course of intravenous acyclovir during 10 days. There of them had satisfactory evolution and the other two died at 9 days and at 2 months of life.