1
|
Goaz S, Rasis M, Binsky Ehrenreich I, Shapira L, Halutz O, Graidy-Varon M, Leibovitch C, Maisler N, Glikman D, Ephros M, Giladi M. Molecular Diagnosis of Cat Scratch Disease: a 25-Year Retrospective Comparative Analysis of Various Clinical Specimens and Different PCR Assays. Microbiol Spectr 2022; 10:e0259621. [PMID: 35262411 PMCID: PMC9045166 DOI: 10.1128/spectrum.02596-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/14/2022] [Indexed: 02/07/2023] Open
Abstract
Cat-scratch disease (CSD), caused primarily by Bartonella henselae, is a common etiology of infectious regional lymphadenopathy. Lymphadenopathy is preceded by a primary inoculation lesion and may progress to suppuration. Laboratory diagnosis of CSD is hampered by the limitations of available confirmatory tests. PCR, in general, is highly sensitive and specific; however, clinical sensitivity in CSD varies greatly between studies. We aimed to identify clinical specimens and PCR assays best suited for CSD diagnosis using a national CSD registry and a uniform case definition. Different clinical specimens and PCR assays, including conventional and real-time PCR, were evaluated. PCR was positive in 335/390 (86%) CSD patients and 425/482 (88%) PCR tests. The highest PCR sensitivity was achieved in lymph node pus aspirates (96%; n = 278 tests) followed by primary lesions (88%; n = 50), lymph node fine needle aspirations (85%; n = 46), lymph node biopsy specimens (73%; n = 91) and paraffin-embedded lymph nodes (59%; n = 17), (P < 0.001). Sensitivity was similar in all types of PCR assays studied. PCR negative predictive value of pus aspirate and lymph node biopsy specimen patient groups was 82% and 72%, respectively. Specificity was 100% based on 125 non-CSD patients with negative PCR. In conclusion, the specimen type rather than the PCR assay type has a major impact on CSD molecular diagnosis. We assume that the inadequate sensitivity of the biopsy specimens was due to sampling errors or the presence of inhibitory factors. Primary lesions should be sampled more frequently for CSD diagnosis. Physicians should be aware of the low PCR negative predictive value of lymph node biopsy specimens. IMPORTANCE Polymerase chain reaction (PCR) for the detection of Bartonella henselae is an important tool for the diagnosis of cat scratch disease (CSD); however, clinical sensitivity varies greatly between studies. The current study shows that the specimen type, with pus aspiration, fine needle aspiration, and primary inoculation lesion having significantly higher sensitivity than fresh or formalin-fixed paraffin-embedded lymph node biopsy specimen, rather than the type of the PCR assay, whether a conventional or a real-time assay, has a major impact on the performance of diagnostic PCR for CSD. The new data provide new tools for the clinical microbiologist when interpreting the results of the PCR assays. Primary inoculation lesions, although easily accessible, are often neglected and should be sampled more frequently for molecular diagnosis of CSD. Physicians should be aware that negative PCR, particularly if performed on fresh or paraffin-embedded lymph node biopsy specimens, does not exclude CSD.
Collapse
Affiliation(s)
- Sher Goaz
- The Bernard Pridan Laboratory for Molecular Biology of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Michal Rasis
- The Bernard Pridan Laboratory for Molecular Biology of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Lev Shapira
- The Bernard Pridan Laboratory for Molecular Biology of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ora Halutz
- Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Merav Graidy-Varon
- Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Cecilia Leibovitch
- Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Daniel Glikman
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
- Infectious Disease Unit, Padeh Poriya Medical Center, Tiberias, Israel
| | - Moshe Ephros
- Pediatric Infectious Disease Unit, Carmel Medical Center and the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Giladi
- The Bernard Pridan Laboratory for Molecular Biology of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
2
|
Molad M, Gover A, Ephros M, Lavie-Nevo K, Waisman D, Levin T, Kanaaneh Y, Indenbaum V. Expect the Unexpected-First Case of Congenital Rubella Syndrome in Israel in 20 Years: A Case Report. J Pediatric Infect Dis Soc 2021; 10:1105-1107. [PMID: 34309677 DOI: 10.1093/jpids/piab030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/17/2021] [Indexed: 11/14/2022]
Abstract
Congenital rubella syndrome (CRS) is a devastating condition associated with significant morbidity. Due to universal vaccination programs, it is currently a rare condition, especially in developed countries. We report an infant born in Israel to a foreign worker from the Philippines who presented with a blueberry muffin rash immediately after birth. Initial workup revealed sonographic brain anomalies, abnormal hearing tests, and a patent ductus arteriosus. CRS was subsequently confirmed by laboratory diagnosis. Rubella virus genotype 1E was detected in the infant's nasopharyngeal swab and urine samples. This was the first case of CRS in Israel in 20 years, emphasizing the need to "think outside the box" when dealing with infants of mothers who are foreign workers, refugees, or visitors of foreign relatives, in which rubella immune status is unknown. Additionally, public health authorities should consider the routine assessment of rubella immunity status of foreign workers in order to avoid such tragic, preventable diseases. We present a case of congenital rubella syndrome - rarely seen in developed countries. This emphasis the need to "think out of the box" when dealing with infants of mothers who come from countries in which the vaccination program is not well established.
Collapse
Affiliation(s)
- Michal Molad
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa, Israel.,Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ayala Gover
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa, Israel.,Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Moshe Ephros
- Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Department, Carmel Medical Center, Haifa, Israel
| | - Karen Lavie-Nevo
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa, Israel.,Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dan Waisman
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa, Israel.,Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tal Levin
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yara Kanaaneh
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel-Hashomer, Israel
| | - Victoria Indenbaum
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel-Hashomer, Israel
| |
Collapse
|
3
|
Iflah M, Kassem E, Rubinstein U, Goren S, Ephros M, Cohen D, Muhsen K. Convulsions in children hospitalized for acute gastroenteritis. Sci Rep 2021; 11:15874. [PMID: 34354134 PMCID: PMC8342430 DOI: 10.1038/s41598-021-95202-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/21/2021] [Indexed: 11/09/2022] Open
Abstract
The study aim was to examine possible correlates of convulsions in children hospitalized for acute gastroenteritis (AGE). Data collected in a prospective study of AGE hospitalizations in children aged 0-59 months in 3 hospitals in Israel during 2008-2015 were analyzed. Stool samples were tested for rotavirus using immunochromatography and stool culture was performed for the detection of Salmonella, Shigella and Campylobacter We compared clinical and demographic characteristics of children hospitalized for AGE who had convulsions (n = 68, cases) with children hospitalized for AGE without convulsions (n = 3505, controls). Age differed between children with and without convulsions (p = 0.005); the former were mostly toddlers aged 12-23 months (51%) compared to 30% of the control group. A higher percentage of cases tested positive for Shigella (11% vs. 4%, p = 0.002), the opposite was found for rotavirus (2% vs. 30% p < 0.001). A multivariable model showed that body temperature (OR 2.91 [95% CI 1.78-4.76], p < 0.001) and high blood glucose level (> 120 mg/dL) (OR 5.71 [95% CI 1.27-25.58] p = 0.023) were positively related to convulsions in children with AGE, while severe AGE (Vesikari score ≥ 11) was inversely related with convulsions (OR 0.09 [95% CI 0.03-0.24], p < 0.001). Conclusion: Elevated body temperature is associated with convulsions in children with AGE, but not severity of AGE, while hyperglycemia might reflect a neuroendocrine stress reaction to convulsions, AGE or both.
Collapse
Affiliation(s)
- Moti Iflah
- School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Uri Rubinstein
- Department of Pediatrics, Laniado Medical Center, Netanya, Israel
| | - Sophy Goren
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| | - Moshe Ephros
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel.
| |
Collapse
|
4
|
Landes M, Maor Y, Mercer D, Habot-Wilner Z, Bilavsky E, Chazan B, Cohen R, Glikman D, Strahilevitz J, Katzir M, Litachevsky V, Melamed R, Guri A, Shaked H, Perets O, Wiener-Well Y, Stren A, Paul M, Zimhony O, Srugo I, Rahav G, Bishara J, Kuperman AA, Ben-Ami R, Ephros M, Giladi M. Cat Scratch Disease Presenting as Fever of Unknown Origin Is a Unique Clinical Syndrome. Clin Infect Dis 2021; 71:2818-2824. [PMID: 31758684 DOI: 10.1093/cid/ciz1137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 11/21/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Fever of unknown origin (FUO) is a rare manifestation of cat scratch disease (CSD). Data regarding CSD-associated FUO (CSD-FUO), particularly in adults, are limited. We aimed to study disease manifestations and long-term clinical outcome. METHODS A national CSD surveillance study has been conducted in Israel since 1991. Data are obtained using questionnaires, review of medical records, and telephone interviews. FUO was defined as fever of ≥14 days without an identifiable cause. CSD-FUO patients were identified in the 2004-2017 CSD national registry. Follow-up included outpatient clinic visits and telephone/e-mail surveys. RESULTS The study included 66 CSD-FUO patients. Median age was 35.5 years (range, 3-88). Median fever duration was 4 weeks (range, 2-9). Relapsing fever pattern was reported in 52% of patients, weight loss in 57%, and night sweats in 48%. Involvement of ≥1 organs occurred in 59% of patients; hepatosplenic space-occupying lesions (35%), abdominal/mediastinal lymphadenopathy (20%), ocular disease (18%), and multifocal osteomyelitis (6%) were the most common. Malignancy, particularly lymphoma, was the initial radiological interpretation in 21% of patients; 32% underwent invasive diagnostic procedures. Of the 59 patients available for follow-up (median duration, 31 weeks; range, 4-445), 95% had complete recovery; 3 patients remained with ocular sequelae. CONCLUSION This is the first attempt to characterize CSD-FUO as a unique syndrome that may be severe and debilitating and often mimics malignancy. Relapsing fever is a common clinical phenotype. Multiorgan involvement is common. Recovery was complete in all patients except in those with ocular disease.
Collapse
Affiliation(s)
- Michal Landes
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Maor
- Infectious Disease Unit, Wolfson Medical Center, Holon, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Diego Mercer
- Department of Radiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar Habot-Wilner
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efraim Bilavsky
- Schneider Children's Medical Center, Petah Tiqva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Regev Cohen
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniel Glikman
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Jacob Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University, Jerusalem, Israel
| | - Michal Katzir
- Infectious Disease Unit, Meir Medical Center, Kfar Saba, Israel
| | | | - Rimma Melamed
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alex Guri
- Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel, and School of Medicine, Hebrew University and Hadassah Medical Center, Jerusalem, Israel
| | - Hila Shaked
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Odelya Perets
- Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Yonit Wiener-Well
- Infectious Disease Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Anat Stren
- Infectious Diseases Institute, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Oren Zimhony
- Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel, and School of Medicine, Hebrew University and Hadassah, Jerusalem, Israel
| | - Isaac Srugo
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Galia Rahav
- Infectious Disease Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir A Kuperman
- Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Center, Nahariya, Israel, and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ronen Ben-Ami
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Ephros
- Pediatric Infectious Disease Unit, Carmel Medical Center and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Giladi
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
5
|
Muhsen K, Kassem E, Rubenstein U, Goren S, Ephros M, Shulman LM, Cohen D. No evidence of an increase in the incidence of norovirus gastroenteritis hospitalizations in young children after the introduction of universal rotavirus immunization in Israel. Hum Vaccin Immunother 2019; 15:1284-1293. [PMID: 30945960 DOI: 10.1080/21645515.2019.1599522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Following the introduction of universal immunization against rotavirus, concerns were raised regarding pathogen-replacement of rotavirus by norovirus. The study aim was to examine the incidence and characteristics and norovirus gastroenteritis before and after the introduction of universal rotavirus immunization in Israel. We studied 1179 stool samples collected between November 2007 and December 2014 for a prospective hospital-based surveillance study of children aged 0-59 months hospitalized for gastroenteritis. A real-time RT-PCR assay was used to identify genogroup II (GII) norovirus in extracted fecal RNA samples. Overall, the weighted percentage of norovirus positive patients was 10.9%. Norovirus positivity was similar in the pre-universal rotavirus immunisation years (2008-2010) and the universal years (2011-2014), the respective average annual incidence of norovirus gastroenteritis was 1.6 (95% CI 0.6-2.3) per 1000 and 1.1 (95% CI 0.8-1.4) per 1000 children. Rotavirus was detected in 36.8% and 19.6% of the patients in the pre-vaccine years and the universal vaccine years, with an estimated incidence of 5.5 (95% CI 3.4-7.6) per 1000 and 2.1 (95% CI 1.6-2.7) per 1000 children, respectively. Most patients (59.1%) with norovirus gastroenteritis were infants aged 0-11 months. Norovirus was detected all year round with a significant 3-month peak from September through November. In conclusion, norovirus continues to be a leading cause of acute gastroenteritis associated with hospitalizations in young children. Future norovirus vaccines should target young infants. There was no evidence of pathogen-replacement by norovirus following the introduction of universal rotavirus immunization in Israel.
Collapse
Affiliation(s)
- Khitam Muhsen
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel
| | - Eias Kassem
- b Department of Pediatrics , Hillel Yaffe Medical Center , Hadera , Israel
| | - Uri Rubenstein
- c Department of Pediatrics , Laniado Medical Center , Netanya , Israel
| | - Sophy Goren
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel
| | - Moshe Ephros
- d Department of Pediatrics , Carmel Medical Center , Haifa , Israel.,e Faculty of Medicine , Technion-Israel Institute of Technology , Haifa , Israel
| | - Lester M Shulman
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel.,f Central Virology Laboratory , Ministry of Health , Tel Hashomer , Israel
| | - Dani Cohen
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel
| |
Collapse
|
6
|
Bercovich S, Anis E, Kassem E, Rubinstein U, Ephros M, Cohen D, Muhsen K. Validation of parental reports of rotavirus vaccination of their children compared to the national immunization registry. Vaccine 2019; 37:2791-2796. [DOI: 10.1016/j.vaccine.2019.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/17/2019] [Accepted: 04/12/2019] [Indexed: 12/20/2022]
|
7
|
Rohoušová I, Talmi-Frank D, Vlková M, Spitzová T, Rishpon K, Jaffe CL, Volf P, Baneth G, Ephros M. Serological Evaluation of Cutaneous Leishmania tropica Infection in Northern Israel. Am J Trop Med Hyg 2018; 98:139-141. [PMID: 29141753 DOI: 10.4269/ajtmh.17-0370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Leishmania spp. are medically important unicellular parasites transmitted by phlebotomine sand flies. The World Health Organization recently highlighted the importance of reliable diagnostic tools for leishmaniasis. Our study of human infection was conducted in two endemic foci of Leishmania tropica in the Galilee region, northern Israel. Elevated anti-Leishmania antibodies were present in the majority (78.6%) of L. tropica-PCR positive individuals. Moreover, the enzyme-linked immunosorbent assay showed high sensitivity, specificity, and negative and positive predictive values (ranging between 73% and 79%), thus fulfilling the basic requirement for future development of a serodiagnostic and screening tool. The anti-sand fly saliva antibodies used as biomarkers of exposure reflected the composition of the local sand fly fauna as well as the abundance of individual species. High levels of antibodies against vector salivary proteins may further indicate frequent exposure to sand flies and consequently a higher probability of Leishmania transmission.
Collapse
Affiliation(s)
- Iva Rohoušová
- Department of Parasitology, Charles University, Faculty of Science, Prague, Czech Republic
| | | | - Michaela Vlková
- Department of Parasitology, Charles University, Faculty of Science, Prague, Czech Republic
| | - Tatiana Spitzová
- Department of Parasitology, Charles University, Faculty of Science, Prague, Czech Republic
| | - Koranit Rishpon
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel
| | - Charles L Jaffe
- Department of Microbiology and Molecular Genetics, The Institute for Medical Research Israel-Canada, The Kuvin Centre for the Study of Infectious and Tropical Diseases, The Hebrew University - Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Petr Volf
- Department of Parasitology, Charles University, Faculty of Science, Prague, Czech Republic
| | - Gad Baneth
- School of Veterinary Medicine, Hebrew University, Rehovot, Israel
| | - Moshe Ephros
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel
| |
Collapse
|
8
|
Habot-Wilner Z, Trivizki O, Goldstein M, Kesler A, Shulman S, Horowitz J, Amer R, David R, Ben-Arie-Weintrob Y, Bakshi E, Almog Y, Sartani G, Vishnevskia-Dai V, Kramer M, Bar A, Kehat R, Ephros M, Giladi M. Cat-scratch disease: ocular manifestations and treatment outcome. Acta Ophthalmol 2018; 96:e524-e532. [PMID: 29504674 DOI: 10.1111/aos.13684] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/26/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To characterize cat-scratch disease (CSD) ocular manifestations and visual outcome and evaluate the effect of systemic antibiotics and corticosteroids on final visual acuity (VA). METHODS Multicentre retrospective cohort study. Medical records of 86 patients with ocular disease (107 eyes) of 3222 patients identified in a national CSD surveillance study were reviewed. RESULTS Mean age was 35.1 ± 14.2 years. Median follow-up was 20 weeks (range 1-806 weeks). Of 94/107 (88%) eyes with swollen disc, 60 (64%) had neuroretinitis at presentation, 14 (15%) developed neuroretinitis during follow-up, and 20 (21%) were diagnosed with inflammatory disc oedema. Optic nerve head lesion, uveitis, optic neuropathy and retinal vessel occlusion were found in 43 (40%), 38 (36%), 34 (33%) and 8 (7%) eyes, respectively. Good VA (better than 20/40), moderate vision loss (20/40-20/200) and severe vision loss (worse than 20/200) were found in 26/79 (33%), 35/79 (44%) and 18/79 (23%) eyes at baseline and in 63/79 (80%), 11/79 (14%) and 5/79 (6%) eyes at final follow-up, respectively (p < 0.001). Significant VA improvement (defined as improvement of ≥3 Snellen lines at final follow-up compared to baseline) occurred in 12/24 (50%) eyes treated with antibiotics compared with 14/16 (88%) eyes treated with antibiotics and corticosteroids (p = 0.02). Multivariate logistic regression was suggestive of the same association (odds ratio 7.0; 95% CI 1.3-37.7; p = 0.024). CONCLUSION Optic nerve head lesion is a common and unique manifestation of ocular CSD. Most patients improved and had final good VA. Combined antibiotics and corticosteroid treatment was associated with a better visual outcome.
Collapse
Affiliation(s)
- Zohar Habot-Wilner
- Division of Ophthalmology; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Omer Trivizki
- Division of Ophthalmology; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michaella Goldstein
- Division of Ophthalmology; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Anat Kesler
- Division of Ophthalmology; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Shiri Shulman
- Division of Ophthalmology; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Josepha Horowitz
- Department of Ophthalmology; Carmel Medical Center; The Ruth and Bruce Rappaport Faculty of Medicine; Technion; Israel Institute of Technology; Haifa Israel
| | - Radgonde Amer
- Department of Ophthalmology; Hadassah Medical Center; The Hebrew University Hadassah Medical School; Jerusalem Israel
| | - Ran David
- Department of Ophthalmology; Hadassah Medical Center; The Hebrew University Hadassah Medical School; Jerusalem Israel
| | - Yael Ben-Arie-Weintrob
- Department of Ophthalmology; Rambam Medical Center; The Ruth and Bruce Rappaport Faculty of Medicine; Technion; Israel Institute of Technology; Haifa Israel
| | - Erez Bakshi
- Department of Ophthalmology; Assaf Harofeh Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yehoshua Almog
- Department of Ophthalmology; Meir Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Gil Sartani
- Department of Ophthalmology; Haemek Medical Center; The Ruth and Bruce Rappaport Faculty of Medicine; Technion; Israel Institute of Technology; Haifa Israel
| | - Vicktoria Vishnevskia-Dai
- The Goldschleger Eye Institute; Department of Ophthalmology; Sheba Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michal Kramer
- Division of Ophthalmology; Rabin Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Asaf Bar
- Department of Ophthalmology; Wolfson Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Rinat Kehat
- Department of Ophthalmology; Bnai Zion Medical Center; The Ruth and Bruce Rappaport Faculty of Medicine; Technion; Israel Institute of Technology; Haifa Israel
| | - Moshe Ephros
- Pediatric Infectious Disease Unit; Carmel Medical Center; The Ruth and Bruce Rappaport Faculty of Medicine; Technion; Israel Institute of Technology; Haifa Israel
| | - Michael Giladi
- Infectious Disease Unit and The Bernard Pridan Laboratory for Molecular Biology of Infectious Diseases; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| |
Collapse
|
9
|
Liburkin-Dan T, Schlisselberg D, Fischer-Weinberger R, Pescher P, Inbar E, Ephros M, Rentsch D, Späth GF, Zilberstein D. Stage-specific expression of the proline-alanine transporter in the human pathogen Leishmania. Mol Biochem Parasitol 2018; 222:1-5. [PMID: 29655799 DOI: 10.1016/j.molbiopara.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
Abstract
Leishmania are obligatory intracellular parasites that cycle between the sand fly midgut (extracellular promastigotes) and mammalian macrophage phagolysosomes (intracellular amastigotes). They have developed mechanisms of adaptation to the distinct environments of host and vector that favor utilization of both proline and alanine. LdAAP24 is the L. donovani proline-alanine transporter. It is a member of Leishmania system A that translocates neutral amino acids. Since system A is promastigote-specific, we aimed to assess whether LdAAP24 is also expressed exclusively in promastigotes. Herein, we established that upon exposing L. donovani promastigotes to amastigote differentiation signal (pH 5.5 and 37 °C), parasites rapidly and completely degrade LdAAP24 protein in both axenic and in spleen-derived amastigotes. In contrast, LdAAP24 mRNA remained unchanged throughout differentiation. Addition of either MG132 or Bafilomycin A1 partially inhibited LdAAP24 protein degradation, indicating a role for both lysosome- and proteasome-mediated degradation. This work provides the first evidence for post-translational regulation of stage-specific expression of LdAAP24.
Collapse
Affiliation(s)
- T Liburkin-Dan
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa 3200003, Haifa, Israel
| | - D Schlisselberg
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa 3200003, Haifa, Israel
| | - R Fischer-Weinberger
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa 3200003, Haifa, Israel
| | - P Pescher
- Institut Pasteur, INSERM U1201, Unité de Parasitologie moléculaire et Signalisation, 75015 Paris, France
| | - E Inbar
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa 3200003, Haifa, Israel
| | - M Ephros
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa 3200003, Haifa, Israel
| | - D Rentsch
- Institute of Plant Sciences, University of Bern, Altenbergrain 21, 3013 Bern, Switzerland
| | - G F Späth
- Institut Pasteur, INSERM U1201, Unité de Parasitologie moléculaire et Signalisation, 75015 Paris, France
| | - D Zilberstein
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa 3200003, Haifa, Israel.
| |
Collapse
|
10
|
Muhsen K, Anis E, Rubinstein U, Kassem E, Goren S, Shulman L, Ephros M, Cohen D. Effectiveness of rotavirus pentavalent vaccine under a universal immunization programme in Israel, 2011–2015: a case–control study. Clin Microbiol Infect 2018; 24:53-59. [DOI: 10.1016/j.cmi.2017.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 11/30/2022]
|
11
|
Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2017; 63:1539-1557. [PMID: 27941143 DOI: 10.1093/cid/ciw742] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/22/2016] [Indexed: 11/12/2022] Open
Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
Collapse
Affiliation(s)
- Naomi Aronson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Michael Libman
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Peter Weina
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Selma Jeronimo
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alan Magill
- Bill and Melinda Gates Foundation, Seattle, Washington
| |
Collapse
|
12
|
Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho E, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Am J Trop Med Hyg 2016; 96:24-45. [PMID: 27927991 PMCID: PMC5239701 DOI: 10.4269/ajtmh.16-84256] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Naomi Aronson
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | | | - Richard Pearson
- University of Virginia School of Medicine, Charlottesville, VA
| | | | - Peter Weina
- Walter Reed Army Institute of Research, Silver Spring, MD
| | | | | | - Selma Jeronimo
- Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Alan Magill
- Bill and Melinda Gates Foundation, Seattle, WA
| |
Collapse
|
13
|
Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2016; 63:e202-e264. [PMID: 27941151 DOI: 10.1093/cid/ciw670] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022] Open
Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
Collapse
Affiliation(s)
- Naomi Aronson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Michael Libman
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Peter Weina
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Selma Jeronimo
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alan Magill
- Bill and Melinda Gates Foundation, Seattle, Washington
| |
Collapse
|
14
|
Muhsen K, Kassem E, Rubenstein U, Goren S, Ephros M, Cohen D, Shulman LM. Incidence of rotavirus gastroenteritis hospitalizations and genotypes, before and five years after introducing universal immunization in Israel. Vaccine 2016; 34:5916-5922. [PMID: 27771186 DOI: 10.1016/j.vaccine.2016.10.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Uncertainty exists about the sustainability of the reduction in rotavirus gastroenteritis (RVGE) following the introduction of rotavirus vaccines into national immunization programs, and on its potential impact on circulating genotypes. RotaTeq was introduced into the Israeli national immunization program in December 2010, and vaccination coverage is around 80%. AIMS To examine the change in incidence of RVGE hospitalization and rotavirus genotypes, during the five years after introduction of RotaTeq into the Israeli national immunization program. METHODS Data were obtained prospectively on hospitalization of children aged 0-59months due to acute gastroenteritis (N=7346) from three hospitals in northern Israel. Stool samples were tested for rotavirus by immunochromatography. Rotavirus was genotyped (N=506) by RT-PCR and/or sequencing. RESULTS The average incidence of RVGE hospitalization declined by 61.0% (95% CI 49.0-73.4%), from 5.6 per 1000 (95% CI 5.0-6.2) in the pre-universal immunization period (2008-2010) to 2.2 per 1000 (95% CI 1.8-2.5) during the universal immunization period (2012-2015), but yearly fluctuations were still observed. The most common genotypes in the pre-universal immunization period were G1P[8] (35.3%) followed by G2P[4] (15.5%), G3P[8] (8.8%), G4P[8] (4.3%) and G9P[8] (4.3%), and 19.5% were mixed infections. The dominance of G1P[8] continued into the universal immunization period (48.6%), followed by G3P[8] (21.5%), G9P[8] (15.9%) and G12P[8] (4.7%), while mixed rotavirus infections were no longer detected. CONCLUSIONS Universal immunization with RotaTeq in Israel was associated a sustained reduction in RVGE hospitalization. It is unclear whether changes in the circulating rotavirus genotypes are due to vaccine-induced selective pressure. Assessment of the long-term impact of rotavirus vaccination on the incidence of rotavirus gastroenteritis and continued strain surveillance is warranted.
Collapse
Affiliation(s)
- Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Uri Rubenstein
- Department of Pediatrics, Laniado Medical Center, Netanya, Israel
| | - Sophy Goren
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Moshe Ephros
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel; Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Lester M Shulman
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Central Virology Laboratory, Ministry of Health, Tel Hashomer, Israel
| |
Collapse
|
15
|
Segal N, Nissani R, Kordeluk S, Holcberg M, Hertz S, Kassem F, Mansour A, Segal A, Gluck O, Roth Y, Honigman T, Ephros M, Cohen Kerem R. Orbital complications associated with paranasal sinus infections - A 10-year experience in Israel. Int J Pediatr Otorhinolaryngol 2016; 86:60-2. [PMID: 27260581 DOI: 10.1016/j.ijporl.2016.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Orbital involvement is the most common complication of sinus infections. The epidemiology of the disease is continuously changing in the antibiotic era. MATERIALS AND METHODS Data on patients who were hospitalized due to acute sinusitis and orbital complications were retrospectively collected and analyzed from four medical centers in Israel during the years 2002-2012. RESULTS 288 patients were included in the study, the average age was 14.4 years, 180 were males, and 220 were children. No significant annual increase in the number of patients was noted. The lowest number of patients was found during the summer 19.4%. A linear direct correlation was found between older age and prolonged hospital stay. Children were presented with a significantly higher Chandler score than adults. No patient had cavernous sinus thrombosis. 101 (35%) patients received antibiotics before hospital admission. Their average hospital stay was similar to those who were not treated prior to admission. 106 patients (39.8%) had fever. A direct correlation was found between older age and the presence of fever. 102 (35.4%) patients had leukocytosis. The difference in white blood cell count between patients younger than two years of age to the other groups was statistically significant. Forty four (15.3%) patients underwent surgical intervention. A direct correlation was found between leukocytosis and older age to surgery. CONCLUSIONS Periorbital cellulitis occurs mainly in children and males and is less frequent in the summer. Children tend to have worse orbital involvement with lower temperatures than adults. Older age and leukocytosis are associated with surgical intervention.
Collapse
Affiliation(s)
- Nili Segal
- Department of Otolaryngology-Head & Neck Surgery, Soroka Medical Center, Faculty of Health Sciences Ben Gurion University, Beer Sheva, Israel.
| | - Roni Nissani
- Department of Otolaryngology-Head & Neck Surgery, Soroka Medical Center, Faculty of Health Sciences Ben Gurion University, Beer Sheva, Israel
| | - Sofia Kordeluk
- Department of Otolaryngology-Head & Neck Surgery, Soroka Medical Center, Faculty of Health Sciences Ben Gurion University, Beer Sheva, Israel
| | - Meni Holcberg
- Department of Otolaryngology-Head & Neck Surgery, Soroka Medical Center, Faculty of Health Sciences Ben Gurion University, Beer Sheva, Israel
| | - Shay Hertz
- Department of Otolaryngology-Head & Neck Surgery, Soroka Medical Center, Faculty of Health Sciences Ben Gurion University, Beer Sheva, Israel
| | - Firas Kassem
- Department of Otolaryngology-Head & Neck Surgery, Meir Medical Center, Israel
| | - Anwar Mansour
- Department of Otolaryngology-Head & Neck Surgery, Meir Medical Center, Israel
| | - Avichai Segal
- Ophthalmology Department, Soroka Medical Center, Beer Sheva, Israel
| | - Ofer Gluck
- Department of Otolaryngology-Head & Neck Surgery, Wolfson Medical Center, Israel
| | - Yehudah Roth
- Department of Otolaryngology-Head & Neck Surgery, Wolfson Medical Center, Israel
| | - Tal Honigman
- Department of Otolaryngology-Head & Neck Surgery, Carmel Medical Center, Israel
| | - Moshe Ephros
- Department of pediatrics, Carmel Medical Center, Israel
| | - Ranan Cohen Kerem
- Department of Otolaryngology-Head & Neck Surgery, Carmel Medical Center, Israel
| |
Collapse
|
16
|
Muhsen K, Rubenstein U, Kassem E, Goren S, Schachter Y, Kremer A, Shulman LM, Ephros M, Cohen D. A significant and consistent reduction in rotavirus gastroenteritis hospitalization of children under 5 years of age, following the introduction of universal rotavirus immunization in Israel. Hum Vaccin Immunother 2016. [PMID: 26212174 DOI: 10.1080/21645515.2015.1056951] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Universal rotavirus vaccination with RotaTeq was introduced in Israel in December 2010. We examined hospitalization rates of children under 5 years of age due to all-cause and rotavirus gastroenteritis, both before and 3 years after universal introduction of the vaccination. An ongoing hospital-based surveillance network that was established in November 2007, accessed information regarding hospitalization of children due to gastroenteritis (n = 6205) in 3 hospitals in northern Israel, with an annual average of about 60,000 children under 5 years of age living in the catchment area of these hospitals. Stool samples were tested for rotavirus by immunochromatography. Compared to the period preceding implementation of the universal rotavirus vaccination (2008-2010), hospitalizations due to rotavirus gastroenteritis in children <5 years of age decreased significantly, by 55% (95% CI 43%-67%) during the period of universal vaccination (2011-2013), a decrease that was sustained throughout the 3 year period. This reduction was greater in children aged 0-23 months (60-61%) than in toddlers aged 24-59 months (36%). A 32% (95% CI 21%-45%) decrease in the incidence of all-cause gastroenteritis was also observed. During the period preceding universal vaccination, rotavirus diarrhea showed typical winter seasonality, with highest incidence in December. However, the winter peak was substantially blunted during the period of universal immunization. Surveillance of rotavirus gastroenteritis should continue to assess the long-term impact of such a program. Our findings are of relevance to high and middle-income countries considering the introduction of a universal rotavirus immunization program.
Collapse
Affiliation(s)
- Khitam Muhsen
- a Department of Epidemiology and Preventive Medicine ; School of Public Health; Sackler Faculty of Medicine; Tel Aviv University Ramat Aviv ; Tel Aviv , Israel
| | - Uri Rubenstein
- b Department of Pediatrics ; Laniado Medical Center ; Netanya , Israel
| | - Eias Kassem
- c Department of Pediatrics ; Hillel Yaffe Medical Center ; Hadera , Israel
| | - Sophy Goren
- a Department of Epidemiology and Preventive Medicine ; School of Public Health; Sackler Faculty of Medicine; Tel Aviv University Ramat Aviv ; Tel Aviv , Israel
| | - Yaakov Schachter
- b Department of Pediatrics ; Laniado Medical Center ; Netanya , Israel
| | - Adi Kremer
- c Department of Pediatrics ; Hillel Yaffe Medical Center ; Hadera , Israel
| | - Lester M Shulman
- a Department of Epidemiology and Preventive Medicine ; School of Public Health; Sackler Faculty of Medicine; Tel Aviv University Ramat Aviv ; Tel Aviv , Israel.,d Central Virology Laboratory; Ministry of Health ; Tel Hashomer , Israel
| | - Moshe Ephros
- e Department of Pediatrics ; Carmel Medical Center ; Haifa , Israel.,f Faculty of Medicine; Technion-Israel Institute of Technology ; Haifa , Israel
| | - Dani Cohen
- a Department of Epidemiology and Preventive Medicine ; School of Public Health; Sackler Faculty of Medicine; Tel Aviv University Ramat Aviv ; Tel Aviv , Israel
| |
Collapse
|
17
|
Abstract
BACKGROUND Breastfeeding is the recommended method for feeding newborns and infants. It confers significant health benefits upon both infant and mother and provides developmental, social, and economic advantages. OBJECTIVE This study explored possible correlations between breastfeeding and neonatal fever (NF). MATERIALS AND METHODS One hundred and forty infants hospitalized for fever during the first month of life (NF) were identified by retrospective chart review. These were matched with healthy infants born on the same day in the study hospital and who were not hospitalized in the first month of life. A structured telephone interview to determine breastfeeding practice was conducted with the parents of all study participants. RESULTS The prevalence of children who were formula fed or only partially breastfed was significantly higher among hospitalized children compared to healthy controls (66% versus 34%, respectively, p < 0.001). This association remained after adjusting for exposure to smoke, gender, and household crowding. Exposure to household smoke was also independently associated with hospitalization for NF. CONCLUSION Increased rates of breastfeeding should result in fewer hospitalizations for NF, fewer laboratory investigations, less intravenous antibiotic therapy and its complications, and lower indirect expenses. This study demonstrates that exclusive or predominant breastfeeding, as opposed to formula or partial breastfeeding, of infants less than 1 month of age reduces the risk of NF-related hospitalization by over two-fold. Our data provide new evidence of the health benefits of breastfeeding. The retrospective nature of the study and possible recall bias are limitations of the study.
Collapse
Affiliation(s)
| | - Lisa Rubin
- 2 Department of Maternal and Child Health, Ministry of Health , Jerusalem, Israel .,3 School of Public Health, University of Haifa , Haifa, Israel
| | - Moshe Ephros
- 4 Department of Pediatrics, Carmel Medical Center , Haifa, Israel .,5 Faculty of Medicine, Technion-Israel Institute of Technology , Haifa, Israel
| |
Collapse
|
18
|
Goldman-Pinkovich A, Balno C, Strasser R, Zeituni-Molad M, Bendelak K, Rentsch D, Ephros M, Wiese M, Jardim A, Myler PJ, Zilberstein D. An Arginine Deprivation Response Pathway Is Induced in Leishmania during Macrophage Invasion. PLoS Pathog 2016; 12:e1005494. [PMID: 27043018 PMCID: PMC4846328 DOI: 10.1371/journal.ppat.1005494] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/15/2016] [Indexed: 11/18/2022] Open
Abstract
Amino acid sensing is an intracellular function that supports nutrient homeostasis, largely through controlled release of amino acids from lysosomal pools. The intracellular pathogen Leishmania resides and proliferates within human macrophage phagolysosomes. Here we describe a new pathway in Leishmania that specifically senses the extracellular levels of arginine, an amino acid that is essential for the parasite. During infection, the macrophage arginine pool is depleted due to its use to produce metabolites (NO and polyamines) that constitute part of the host defense response and its suppression, respectively. We found that parasites respond to this shortage of arginine by up-regulating expression and activity of the Leishmania arginine transporter (LdAAP3), as well as several other transporters. Our analysis indicates the parasite monitors arginine levels in the environment rather than the intracellular pools. Phosphoproteomics and genetic analysis indicates that the arginine-deprivation response is mediated through a mitogen-activated protein kinase-2-dependent signaling cascade. Protozoa of the genus Leishmania are the causative agents of leishmaniasis in humans. These parasites cycle between promastigotes in the sand fly mid-gut and amastigotes in phagolysosome of mammalian macrophages. During infection, host cells up-regulate nitric oxide while/or parasites induce expression of host arginase, both of which use arginine as a substrate. These elevated activities deplete macrophage arginine pools, a situation that invading Leishmania must overcome since it is an essential amino acid. Leishmania donovani imports exogenous arginine via a mono-specific amino acid transporter (AAP3) and utilizes it primarily through the polyamine pathway to provide precursors for trypanothione biosynthesis as well as hypusination of eukaryotic translation Initiation Factor 5A. Here we report the discovery of a pathway whereby Leishmania sense the lack of environmental arginine and respond with rapid up-regulation in the expression and activity of AAP3, as well as several other transporters. Significantly, this arginine deprivation response is also activated in parasites during macrophage infection. Phosphoproteomic analyses of L. donovani promastigotes have implicated a mitogen-activated protein kinase 2 (MPK2)-mediated signaling cascade in this response, and L. mexicana mutants lacking MPK2 are unable to respond to arginine deprivation. The arginine-sensing pathway might play an important role in Leishmania virulence and hence serve as target for drug development.
Collapse
Affiliation(s)
| | - Caitlin Balno
- Faculty of Biology, Technion—Israel Institute of Technology, Haifa, Haifa, Israel
| | - Rona Strasser
- Institute of Parasitology, McGill University, Ste Anne de Bellevue, Quebec, Canada
| | - Michal Zeituni-Molad
- Carmel Medical Center and Faculty of Medicine, Technion,—Israel institute of Technology, Haifa, Israel
| | - Keren Bendelak
- The Smoler Proteomic Center, Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Doris Rentsch
- Institute of Plant Sciences, University of Bern, Bern, Switzerland
| | - Moshe Ephros
- Carmel Medical Center and Faculty of Medicine, Technion,—Israel institute of Technology, Haifa, Israel
| | - Martin Wiese
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Armando Jardim
- Institute of Parasitology, McGill University, Ste Anne de Bellevue, Quebec, Canada
| | - Peter J. Myler
- Center for Infectious Disease Research, formerly Seattle Biomedical Research Institute, Seattle, Washington, United States of America
- Departments of Global Health and Biomedical Informatics & Medical Education, University of Washington, Seattle, Washington, United States of America
| | - Dan Zilberstein
- Faculty of Biology, Technion—Israel Institute of Technology, Haifa, Haifa, Israel
- * E-mail:
| |
Collapse
|
19
|
Goldstein I, Grefat R, Ephros M, Rishpon S. Intent-to-adhere and adherence to malaria prevention recommendations in two travel clinics. J Travel Med 2015; 22:130-2. [PMID: 25159037 DOI: 10.1111/jtm.12156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/28/2014] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Abstract
Malaria infects 30,000 travelers annually worldwide. At greatest risk are those who travel for long duration. Prevention of malaria includes chemoprophylaxis. This prospective study on 121 travelers who visited two travel clinics shows that adherence to prophylactic treatment was low, especially in long duration trips, and that adherence rate could be predicted by the much more available intent-to-adhere rate.
Collapse
|
20
|
Tobias J, Kassem E, Rubinstein U, Bialik A, Vutukuru SR, Navaro A, Rokney A, Valinsky L, Ephros M, Cohen D, Muhsen K. Involvement of main diarrheagenic Escherichia coli, with emphasis on enteroaggregative E. coli, in severe non-epidemic pediatric diarrhea in a high-income country. BMC Infect Dis 2015; 15:79. [PMID: 25887696 PMCID: PMC4339106 DOI: 10.1186/s12879-015-0804-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/04/2015] [Indexed: 12/31/2022] Open
Abstract
Background Bacterial and viral enteric pathogens are the leading cause of diarrhea in infants and children. We aimed to identify and characterize the main human diarrheagenic E. coli (DEC) in stool samples obtained from children less than 5 years of age, hospitalized for acute gastroenteritis in Israel, and to examine the hypothesis that co-infection with DEC and other enteropathogens is associated with the severity of symptoms. Methods Stool specimens obtained from 307 patients were tested by multiplex PCR (mPCR) to identify enteroaggregative E. coli (EAEC), enterohemorrhagic (EHEC), enteropathogenic E. coli (EPEC) and enterotoxigenic E. coli (ETEC). Specimens were also examined for the presence of rotavirus by immunochromatography, and of Shigella, Salmonella and Campylobacter by stool culture; clinical information was also obtained. Results Fifty nine (19%) children tested positive for DEC; EAEC and atypical EPEC were most common, each detected in 27 (46%), followed by ETEC (n = 3; 5%), EHEC and typical EPEC (each in 1 child; 1.5%). Most EAEC isolates were resistant to cephalexin, cefixime, cephalothin and ampicillin, and genotypic characterization of EAEC isolates by O-typing and pulsed-field gel electrophoresis showed possible clonal relatedness among some. The likelihood of having > 10 loose/watery stools on the most severe day of illness was significantly increased among patients with EAEC and rotavirus co-infection compared to children who tested negative for both pathogens: adjusted odds ratio 7.0 (95% CI 1.45-33.71, P = 0.015). Conclusion DEC was common in this pediatric population, in a high-income country, and mixed EAEC and rotavirus infection was characterized by especially severe diarrhea.
Collapse
Affiliation(s)
- Joshua Tobias
- University of Gothenburg Vaccine Research Institute (GUVAX), Department of Microbiology and Immunology, The Sahlgrenska Academy of University of Gothenburg, Gothenburg, P.O. Box 435, S-40530, Sweden.
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Uri Rubinstein
- Department of Pediatrics, Laniado Medical Center, Natanya, Israel.
| | - Anya Bialik
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Sreekanth-Reddy Vutukuru
- University of Gothenburg Vaccine Research Institute (GUVAX), Department of Microbiology and Immunology, The Sahlgrenska Academy of University of Gothenburg, Gothenburg, P.O. Box 435, S-40530, Sweden.
| | - Armando Navaro
- Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM). 3er piso Edificio de Investigación, Circuito interior s/n Ciudad Universitaria, Coyoacán, Mexico.
| | - Assaf Rokney
- Central Laboratories, Ministry of Health, Jerusalem, Israel.
| | - Lea Valinsky
- Central Laboratories, Ministry of Health, Jerusalem, Israel.
| | - Moshe Ephros
- Pediatric Infectious Disease Unit, Carmel Medical Center, Haifa; and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| |
Collapse
|
21
|
Yagupsky P, Dubnov-Raz G, Gené A, Ephros M. Differentiating Kingella kingae septic arthritis of the hip from transient synovitis in young children. J Pediatr 2014; 165:985-9.e1. [PMID: 25217199 DOI: 10.1016/j.jpeds.2014.07.060] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/04/2014] [Accepted: 07/31/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To conduct a retrospective multicenter study to assess the ability of a predictive algorithm to differentiate between children with Kingella kingae infection of the hip and those with transient synovitis. STUDY DESIGN Medical charts of 25 Israeli and 9 Spanish children aged 6-27 months with culture-proven K kingae arthritis of the hip were reviewed, and information on the 4 variables included in the commonly used Kocher prediction algorithm (body temperature, refusal to bear weight, leukocytosis, and erythrocyte sedimentation rate) was gathered. RESULTS Patients with K kingae arthritis usually presented with mildly abnormal clinical picture and normal serum levels of or near-normal acute-phase reactants. Data on all 4 variables were available for 28 (82%) children, of whom 1 child had none, 6 children had 1, 13 children had 2, 5 had 3, and only 3 children had 4 predictors, implying ≤ 40% probability of infectious arthritis in 20 (71%) children. CONCLUSIONS Because of the overlapping features of K kingae arthritis of the hip and transient synovitis in children younger than 3 years of age, Kocher predictive algorithm is not sensitive enough for differentiating between these 2 conditions. To exclude K kingae arthritis, blood cultures and nucleic acid amplification assay should be performed in young children presenting with irritation of the hip, even in the absence of fever, leukocytosis, or a high Kocher score.
Collapse
Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
| | - Gal Dubnov-Raz
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amadeu Gené
- Molecular Microbiology Department, University Hospital Sant Joan de Deu, Barcelona, Spain
| | - Moshe Ephros
- Pediatric Infectious Diseases Unit, Carmel Medical Center, and the Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | |
Collapse
|
22
|
Muhsen K, Shulman L, Kasem E, Rubinstein U, Shachter J, Kremer A, Goren S, Zilberstein I, Chodick G, Ephros M, Cohen D. Effectiveness of rotavirus vaccines for prevention of rotavirus gastroenteritis-associated hospitalizations in Israel: A case-control study. Human Vaccines 2014; 6:450-4. [DOI: 10.4161/hv.6.6.11759] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
23
|
Muhsen K, Kassem E, Efraim S, Goren S, Cohen D, Ephros M. Incidence and risk factors for intussusception among children in northern Israel from 1992 to 2009: a retrospective study. BMC Pediatr 2014; 14:218. [PMID: 25174640 PMCID: PMC4236660 DOI: 10.1186/1471-2431-14-218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/29/2014] [Indexed: 01/19/2023] Open
Abstract
Background Determining the background incidence of intussusception is important in countries implementing rotavirus immunization. Rotavirus immunization was introduced into the routine infant immunization program in Israel during late 2010. Incidence and risk factors for intussusception were examined in children aged less than five years between 1992 and 2009. Methods Data were collected from medical records of children hospitalized due to intussusception (N = 190), and from control children (N = 295), at Carmel and Hillel Yaffe hospitals in northern Israel. Results The average annual incidence of intussusception in Jewish and Arab children aged less than five years was estimated at 36.1 (95% CI 17.0-76.5) vs. 23.2 per 100,000 (95% CI 9.3-57.9); for infants less than 12 months of age- 128.1 (95% CI 53.0-309.6) vs. 80.1 (95% CI 29.1-242.6) per 100,000. The risk of intussusception was higher in infants aged 3–5 months: OR 5.30 (95% CI 2.11-13.31) and 6–11 months: OR 2.53 (95% CI 1.13-5.62) when compared to infants aged less than 3 months; in those living in low vs high socioeconomic communities: OR 2.81 (95% CI 1.45-5.43), and in children with recent gastroenteritis: OR 19.90 (95% CI 2.35-168.32) vs children without recent gastroenteritis. Surgical reduction was required in 23.2%. The likelihood of surgery was significantly increased in patients presenting with bloody stool, in Arabs and those who were admitted to Hillel Yaffe Hospital. Conclusions The incidence of intussusception prior to universal rotavirus immunization was documented in northern Israel. Despite the lower incidence, Arab patients underwent surgery more often, suggesting delayed hospital admission of Arab as opposed to Jewish patients.
Collapse
Affiliation(s)
- Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel.
| | | | | | | | | | | |
Collapse
|
24
|
Ben-Shimol S, Dagan R, Schonmann Y, Givon-Lavi N, Keller N, Block C, Kassis I, Ephros M, Greenberg D. Dynamics of childhood invasive meningococcal disease in Israel during a 22-year period (1989-2010). Infection 2013; 41:791-8. [PMID: 23475472 DOI: 10.1007/s15010-013-0439-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/19/2013] [Indexed: 01/24/2023]
Abstract
AIM To describe the dynamics in the incidence of childhood invasive meningococcal disease (IMD) in Israel during a 22-year period (1989-2010). METHODS A longitudinal prospective surveillance in all 27 medical centers with pediatric services in Israel. All cases of children <15 years old with positive blood/cerebrospinal fluid (CSF) culture for Neisseria meningitidis were reported. Demographic, clinical, and bacteriological data were recorded. Meningococcal vaccine was not routinely given to Israeli children during the study period. RESULTS The mean age ± standard deviation (SD) among the 743 cases was 40.7 ± 40.2 months. The mean yearly incidence/100,000 was 2.0 ± 0.8. Age-specific incidences were 8.7 ± 2.8, 2.9 ± 1.5, and 0.8 ± 0.5 for children <1, 1-4, and >4 years old, respectively. The overall incidence decreased significantly from 3.7 in 1989 to 1.5 in 2010. Meningitis constituted 69.2 % of all cases. The most common serogroups were: B (76.9 %), C (10.9 %), Y (8.0 %), and W(135) (2.9 %). 78.6 % of all serogroup B isolates were from children <5 years old (p < 0.01). Serogroup C was found mainly in children ≥5 years old (63.4 %). The case fatality rates (CFRs) for children <1, 1-4, >4 years old, and the total study population were 9.2, 12.3, 7.7, and 9.9 %, respectively. CFRs were higher for children without meningitis (14.9 %) compared to children with meningitis (7.9 %) (p < 0.01). CONCLUSIONS Overall, and for serogroups B and W135, childhood IMD rates decreased significantly in Israel during the study period, without routine vaccine usage. The most common serogroup in all age groups was B, which was most prevalent in children <5 years old. No change in the trend of the overall CFR was noted during the study period.
Collapse
Affiliation(s)
- S Ben-Shimol
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Solomon M, Pavlotsky F, Leshem E, Ephros M, Trau H, Schwartz E. Liposomal amphotericin B treatment of cutaneous leishmaniasis due to Leishmania tropica. J Eur Acad Dermatol Venereol 2010; 25:973-7. [DOI: 10.1111/j.1468-3083.2010.03908.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Cohen D, Tobias J, Spungin-Bialik A, Sela T, Kayouf R, Volovik Y, Yavzori M, Ephros M. Phenotypic Characteristics of EnterotoxigenicEscherichia coliAssociated with Acute Diarrhea Among Israeli Young Adults. Foodborne Pathog Dis 2010; 7:1159-64. [DOI: 10.1089/fpd.2009.0510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dani Cohen
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel-Aviv University, Tel-Aviv, Israel
| | - Joshua Tobias
- Department of Microbiology and Immunology, WHO Collaborating Center for Research on Enterotoxigenic Escherichia coli (ETEC), Institute of Biomedicine, Göteborg University, Göteborg, Sweden
| | - Anya Spungin-Bialik
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar Sela
- Medical Corps, Israel Defense Forces, Tel-Aviv, Israel
| | - Raid Kayouf
- Medical Corps, Israel Defense Forces, Tel-Aviv, Israel
| | - Yael Volovik
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel-Aviv University, Tel-Aviv, Israel
| | - Miri Yavzori
- Medical Corps, Israel Defense Forces, Tel-Aviv, Israel
| | - Moshe Ephros
- Department of Pediatrics, Faculty of Medicine, Carmel Medical Center and Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
27
|
Elenberg Y, Shani-Adir A, Hecht Y, Ephros M, Bibi H. Pyoderma gangrenosum after bone marrow transplantation for leukocyte adhesion deficiency type 1. Isr Med Assoc J 2010; 12:119-120. [PMID: 20550039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Yigal Elenberg
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel.
| | | | | | | | | |
Collapse
|
28
|
Ephros M, Friedman BC, Elhasid R, Kra-Oz Z, Shaked-Mishan P, Sattinger J, Kassis I. Incidence and clinical manifestations of adenoviral infection among children undergoing allogeneic stem cell transplantation. Isr Med Assoc J 2009; 11:744-748. [PMID: 20166342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Adenoviral infection in children undergoing stem cell transplantation is associated with significant morbidity and mortality. Identification of adenoviral infection by polymerase chain reaction from blood facilitates accurate and rapid diagnosis and surveillance. The incidence of adenoviral infection among children undergoing SCT in Israel is not known. OBJECTIVE To estimate the incidence of adenoviral infection in pediatric SCT patients and to characterize the morbidity associated with proven infection. METHODS Blood samples obtained weekly from children who underwent allogeneic SCT were retrospectively tested for adenovirus using standard PCR. A total of 657 samples collected from 32 patients were examined. Correlation was made between the presence of adenovirus in samples and clinical records. RESULTS Of the 32 patients 4 had adenoviral infection by PCR (12.5%). Clinical disease was present in all four patients concurrent with positive PCR. Gastrointestinal complaints and abnormal hepatocellular enzymes were uniformly present. One patient died due to disseminated disease. T cell depletion was a significant risk factor for adenoviral infection (P = 0.03). CONCLUSIONS In the patient population studied, the incidence of adenoviral infection in children undergoing SCT was 12.5%. The combination of gastrointestinal symptoms and abnormal hepatocellular enzymes should raise the suspicion of adenoviral infection, especially when occurring during the first few months after SCT.
Collapse
Affiliation(s)
- Moshe Ephros
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel.
| | | | | | | | | | | | | |
Collapse
|
29
|
Muhsen K, Shulman L, Rubinstein U, Kasem E, Kremer A, Goren S, Zilberstein I, Chodick G, Ephros M, Cohen D. Incidence, Characteristics, and Economic Burden of Rotavirus Gastroenteritis Associated with Hospitalization of Israeli Children <5 Years of Age, 2007–2008. J Infect Dis 2009; 200 Suppl 1:S254-63. [DOI: 10.1086/605425] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
30
|
Maman E, Bickels J, Ephros M, Paran D, Comaneshter D, Metzkor-Cotter E, Avidor B, Varon-Graidy M, Wientroub S, Giladi M. Musculoskeletal manifestations of cat scratch disease. Clin Infect Dis 2008; 45:1535-40. [PMID: 18190312 DOI: 10.1086/523587] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Musculoskeletal manifestations (MMs) are considered to be rare in cat scratch disease (CSD) and are not well characterized. We aimed to study MMs of CSD. METHODS A surveillance study performed over 11 years identified patients with CSD on the basis of compatible clinical presentation and confirmatory serological test or PCR results for Bartonella henselae. Patients with CSD who had MMs (i.e., myalgia, arthritis, arthralgia, tendinitis, osteomyelitis, and neuralgia) were compared with patients with CSD who did not have MMs (control subjects). RESULTS Of 913 patients with CSD, 96 (10.5%) had MMs. Myalgia (in 53 patients [5.8%]) was often severe, with a median duration of 4 weeks (range, 1-26 weeks). Arthropathy (arthralgia and/or arthritis; in 50 patients [5.5%]) occurred mainly in the medium and large joints and was classified as moderate or severe in 26 patients, with a median duration of 5.5 weeks (range, 1-240 weeks). In 7 patients, symptoms persisted for >or=1 year; 5 developed chronic disease. Tendinitis, neuralgia, and osteomyelitis occurred in 7, 4, and 2 patients, respectively. Patients with MMs were significantly older than patients in the control group (median age, 31.5 years vs. 15.0 years). In multivariate analysis, age >20 years was associated with having any MM (relative risk [RR], 4.96; 95% confidence interval [CI], 2.79-8.8), myalgia (RR, 4.69; 95% CI, 2.22-9.88), and arthropathy (RR, 11.0; 95% CI, 4.3-28.2). Arthropathy was also associated with female sex (RR, 1.89; 95% CI, 1.01-3.52) and erythema nodosum (RR, 4.07; 95% CI, 1.38-12.02). CONCLUSIONS MMs of CSD are more common than previously thought and affect one-tenth of patients with CSD. MMs occur mostly in patients aged >20 years and may be severe and prolonged. Osteomyelitis, the most well known MM of CSD is, in fact, the rarest.
Collapse
Affiliation(s)
- Eran Maman
- Department of Pediatric Orthopaedics, Dana Children's Hospital
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Harrus S, Lior Y, Ephros M, Grisaru-Soen G, Keysary A, Strenger C, Jongejan F, Waner T, Baneth G. Rickettsia conorii in humans and dogs: a seroepidemiologic survey of two rural villages in Israel. Am J Trop Med Hyg 2007; 77:133-5. [PMID: 17620644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
The prevalence of IgG-antibodies reactive with an Israeli strain of Rickettsia conorii (Israeli strain 487), the agent of Israeli spotted fever, was examined in humans and dogs from two rural villages in Israel where the disease has been reported in humans. Sixty-nine of 85 (81%) canine sera and 14 of 136 (10%) of human sera had anti-R. conorii antibodies. No direct association could be made between seropositivity of people and ownership of a seropositive dog. This study indicates that exposure to spotted fever group rickettsiae was highly prevalent among dogs compared with humans in the two villages examined, probably reflecting a greater exposure rate of canines to the tick vector. These results support a previous suggestion that canine serology could be a sensitive indicator for the presence and magnitude of human exposure to R. conorii.
Collapse
Affiliation(s)
- Shimon Harrus
- School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Harrus S, Lior Y, Ephros M, Strenger C, Jongejan F, Waner T, Grisaru-Soen G, Baneth G, Keysary A. Rickettsia conorii in Humans and Dogs: A Seroepidemiologic Survey of Two Rural Villages in Israel. Am J Trop Med Hyg 2007. [DOI: 10.4269/ajtmh.2007.77.133] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
33
|
Giladi M, Maman E, Paran D, Bickels J, Comaneshter D, Avidor B, Varon-Graidy M, Ephros M, Wientroub S. Cat-scratch disease-associated arthropathy. ACTA ACUST UNITED AC 2005; 52:3611-7. [PMID: 16255053 DOI: 10.1002/art.21411] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To characterize the articular manifestations of cat-scratch disease (CSD) and to evaluate the long-term clinical outcome of those manifestations. METHODS A community- and hospital-based surveillance study of CSD was conducted in Israel between 1991 and 2002. CSD was defined as present in a patient when a compatible clinical syndrome and a positive confirmatory finding of Bartonella henselae (by serology and/or polymerase chain reaction) were identified. CSD patients with arthropathy (arthritis/arthralgia) that limited or precluded usual activities of daily living constituted the study group. Patients were followed up until > or =6 weeks after resolution of symptoms, or if symptoms persisted, for >/=12 months. CSD patients without arthropathy served as controls. RESULTS Among 841 CSD patients, 24 (2.9%) had rheumatoid factor-negative arthropathy that was often severe and disabling. Both univariate and multivariate analyses identified female sex (67% of arthropathy patients versus 40% of controls; relative risk [RR] 2.5, P = 0.047), age older than 20 years (100% of arthropathy patients versus 43% of controls; RR 4.9, P = 0.001), and erythema nodosum (21% of arthropathy patients versus 2% of controls; RR 7.9, P = 0.001) as variables significantly associated with arthropathy. Knee, wrist, ankle, and elbow joints were most frequently affected. Ten patients (42%) had severe arthropathy in the weight-bearing joints, which substantially limited their ability to walk, and 4 of these patients were hospitalized. All of the patients had regional lymphadenopathy, 37.5% had nocturnal joint pain, and 25% had morning stiffness. Nineteen patients (79.2%) recovered after a median duration of 6 weeks (range 1-24 weeks), whereas 5 patients (20.8%) developed chronic disease persisting 16-53 months (median 30 months) after the onset of arthropathy. CONCLUSION This is the first comprehensive study of arthropathy in CSD. CSD-associated arthropathy is an uncommon syndrome affecting mostly young and middle-age women. It is often severe and disabling, and may take a chronic course.
Collapse
Affiliation(s)
- Michael Giladi
- Pridan Laboratory for Molecular Biology of Infectious Diseases, Ichilov Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Shani-Adir A, Kamil S, Rozenman D, Schwartz E, Ramon M, Zalman L, Nasereddin A, Jaffe CL, Ephros M. Leishmania tropica in northern Israel: A clinical overview of an emerging focus. J Am Acad Dermatol 2005; 53:810-5. [PMID: 16243129 DOI: 10.1016/j.jaad.2005.07.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Revised: 07/06/2005] [Accepted: 07/09/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Israel, most cutaneous leishmaniasis (CL) is caused by Leishmania major. Recently a new focus of CL caused by Leishmania tropica has been described in Tiberias and the surrounding area of northern Israel. OBJECTIVE The aim of this study was to evaluate clinical (size, number, location, and type of lesion) and laboratory (culture and polymerase chain reaction [PCR] analysis) parameters at diagnosis, response to treatment, and outcome of patients with CL due to L tropica. METHODS Between September 2002 and March 2004, patients with direct smear-confirmed CL were evaluated; clinical records were reviewed and a telephone survey was performed. RESULTS Forty nine patients, 34 (69%) male and 15 (31%) female, were studied. Mean age was 31.1 years (median 26 years, range 1-70); 76% of patients live in Tiberias and the surrounding area. The mean number of lesions was 2.6 (median 2, range 1-10). Lesions were commonly located on the face (61%) and upper limbs (57%). PCR analysis was performed in 27 patients and was positive for L tropica in 26. Fifty percent of patients studied received multiple therapeutic regimens because of incomplete response or treatment failure. Topical paromomycin was used in 44 patients (90%), with a complete response reported in only 17 (39%); of the 9 patients treated with intralesional sodium stibogluconate, a complete response was reported in 6 (67%); of the 5 patients treated with intravenous sodium stibogluconate, 4 (80%) were cured. LIMITATIONS The relatively small number of patients studied combined with the fact that some were assessed retrospectively limit our conclusions. In addition, 50% of the patients studied received multiple therapeutic regimens because of failure of, or incomplete responses to, their initial therapy, thereby making comparisons difficult. CONCLUSIONS The cure rate in those completing a course of antimony therapy, either 10 or more days of intravenous therapy or therapy administered intralesionally, was 75% (95% confidence interval [CI], 50.5-99.5%) as compared with 45% (95% CI, 28.9-60.5%) among those completing at least 10 days of topical paromomycin. To date, no standardized, simple, safe, and highly effective regimen for treating L tropica exists. Large, controlled clinical trials to evaluate current treatment regimens as well as new medications for CL, and especially CL attributed to L tropica, are urgently needed.
Collapse
|
35
|
Ben-Ami R, Ephros M, Avidor B, Katchman E, Varon M, Leibowitz C, Comaneshter D, Giladi M. Cat-scratch disease in elderly patients. Clin Infect Dis 2005; 41:969-74. [PMID: 16142661 DOI: 10.1086/432934] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2005] [Accepted: 05/24/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cat-scratch disease (CSD) is mostly contracted by children and young adults. To our knowledge, CSD in elderly patients has never been characterized, and it may be underrecognized in this age group. METHODS The study population included all patients with CSD diagnosed at our reference laboratory during 1991-2002. Demographic, clinical, and laboratory data for patients with CSD aged >or=60 years (elderly group) were compared with data for patients with CSD aged <60 years (nonelderly group). RESULTS There were 846 immunocompetent patients with CSD included in this study. Fifty-two patients (6%) were >or=60 years old. Lymphadenopathy was less common in elderly patients than in nonelderly patients (76.5% vs. 94.4%; P<.001), and general malaise was more frequent in elderly patients (70.8% vs. 51.4%; P=.009). Atypical CSD was more common in elderly patients than in nonelderly patients (32.7% vs. 13.6%), including endocarditis (odds ratio [OR], 61.6; P<.001), encephalitis (OR, 6.3; P=.013), and fever of unknown origin (OR, 7.3; P<.001). The time period from onset of symptoms to diagnosis was >6 weeks for 29.5% of elderly patients versus 13.3% of nonelderly patients (P=.003). CONCLUSIONS CSD affects elderly persons as well as nonelderly persons, but clinical features differ between the patient groups. Atypical CSD, including endocarditis, is more frequent in elderly than in nonelderly patients. Conversely, lymphadenitis, the hallmark of typical CSD, is often absent in elderly patients. Lack of awareness among clinicians may delay the diagnosis of CSD in elderly persons and result in unnecessary and often invasive diagnostic procedures.
Collapse
Affiliation(s)
- Ronen Ben-Ami
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Mussaffi H, Rivlin J, Shalit I, Ephros M, Blau H. Nontuberculous mycobacteria in cystic fibrosis associated with allergic bronchopulmonary aspergillosis and steroid therapy. Eur Respir J 2005; 25:324-8. [PMID: 15684298 DOI: 10.1183/09031936.05.00058604] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nontuberculous mycobacterial (NTM) infection, particularly due to Mycobacterium abscessus, is an emerging disease that can be relentlessly progressive, particularly in cystic fibrosis (CF) patients. The risk factors that were associated with this increasingly symptomatic infection in a group of CF patients were investigated. A total of 139 CF patients aged 2-52 yrs were reviewed. Sputum was cultured for NTM annually or whenever clinical deterioration was unexplained. In total, 12 patients (8.6%) had positive cultures and six (4.3%) met the criteria for NTM pulmonary disease (five with M. abscessus). Five had allergic bronchopulmonary aspergillosis (ABPA) compared with one out of 133 patients without NTM disease. Five had received systemic steroids (four as a treatment for ABPA) compared with only one out of 133 without NTM lung disease. All six NTM patients deteriorated markedly following mycobacterial infection, and forced expiratory volume in one second dropped 18-46%. Despite prolonged triple antibiotic therapy, M. abscessus was not eradicated, and four out of six did not return to baseline clinically. In conclusion, severe nontuberculous mycobacterial lung disease, particularly with Mycobacterium abscessus, is becoming a perplexing challenge in cystic fibrosis patients. Allergic bronchopulmonary aspergillosis and systemic steroids appear to be risk factors, although small patient numbers limit this to a descriptive observation. When pulmonary condition deteriorates, increased surveillance for mycobacteria would enable prompt diagnosis and treatment.
Collapse
Affiliation(s)
- H Mussaffi
- Kathy and Lee Graub Cystic Fibrosis Center and Pulmonary Unit, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petah Tikva, 49202, Israel
| | | | | | | | | |
Collapse
|
37
|
Metzkor-Cotter E, Kletter Y, Avidor B, Varon M, Golan Y, Ephros M, Giladi M. Long-term serological analysis and clinical follow-up of patients with cat scratch disease. Clin Infect Dis 2003; 37:1149-54. [PMID: 14557957 DOI: 10.1086/378738] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2002] [Accepted: 06/18/2003] [Indexed: 02/06/2023] Open
Abstract
A highly specific enzyme immunoassay (EIA) was recently described for use in the diagnosis of cat scratch disease (CSD). However, data regarding EIA antibody kinetics or its correlation with long-term clinical follow-up data are lacking. The association between antibody kinetics, clinical spectrum, and disease duration were studied in 98 patients with CSD. The median duration of follow-up was 35.3 weeks (range, 2-211.3 weeks). Results of EIA testing for detection of anti-Bartonella henselae immunoglobulin M (IgM) antibodies (detected in 53% of the patients) remained positive for < or =3 months. Therefore, the presence of IgM indicated acute infection. Titers of immunoglobulin G (IgG) also decreased over time; 25% of the patients remained seropositive for >1 year after the onset of CSD. Onset of CSD in patients with an IgG titer with an optical density of > or =1.0 occurred within the prior 12 months. No association was found between antibody titers or their kinetics and the clinical manifestations or duration of disease. EIA allows for the identification of atypical manifestations of CSD that were unrecognized before the use of serological assays. Complete recovery from these manifestations may take months. Results of this study provide additional data supporting the utility of EIA in the serodiagnosis of CSD.
Collapse
Affiliation(s)
- Einat Metzkor-Cotter
- Bernard Pridan Laboratory for Molecular Biology of Infectious Diseases, Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
Asymptomatic human visceral leishmaniasis was identified in Israel by using an enzyme-linked immunosorbent assay. Positive serum samples were more prevalent in visceral leishmaniasis-endemic (2.97%) compared to nonendemic (1.01%) regions (p=0.021). Parasite exposure was higher than expected, despite the small number of clinical cases, suggesting factors other than infection per se influence clinical outcome.
Collapse
Affiliation(s)
- Irit Adini
- The Hebrew University–Hadassah Medical School, Jerusalem, Israel
| | - Moshe Ephros
- Technion-Israel Institute of Technology, Haifa, Israel
| | - Jacopo Chen
- The Hebrew University–Hadassah Medical School, Jerusalem, Israel
| | - Charles L. Jaffe
- The Hebrew University–Hadassah Medical School, Jerusalem, Israel
| |
Collapse
|
39
|
Giladi M, Kletter Y, Avidor B, Metzkor-Cotter E, Varon M, Golan Y, Weinberg M, Riklis I, Ephros M, Slater L. Enzyme immunoassay for the diagnosis of cat-scratch disease defined by polymerase chain reaction. Clin Infect Dis 2001; 33:1852-8. [PMID: 11692296 DOI: 10.1086/324162] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2000] [Revised: 07/02/2001] [Indexed: 11/03/2022] Open
Abstract
Whole-cell immunofluorescent antibody (IFA) tests for detection of anti-Bartonella henselae immunoglobulin (Ig) G are commonly used to diagnose cat-scratch disease (CSD). The need to cultivate B. henselae in Vero cells for antigen preparation and the absence of routinely applied IFA assays for IgM constitute the major disadvantages of this form of test. We describe the results of an enzyme immunoassay (EIA) for IgM and IgG that used N-lauroyl-sarcosine-insoluble outer membrane antigens from agar-grown B. henselae performed in 84 patients with definite CSD (regional lymphadenitis, cat contact, and > or =1 confirmatory test: polymerase chain reaction, skin test, or B. henselae culture). Although this method has been used as a diagnostic tool in several case reports, it has not previously been evaluated in a large study of definitively proven CSD cases. Results of this study indicate that the EIA described herein can play an important role in the serodiagnosis of CSD, although improvement of the sensitivity, particularly that of the IgM, would be desirable.
Collapse
Affiliation(s)
- M Giladi
- Bernard Pridan Laboratory for Molecular Biology of Infectious Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Avidor B, Varon M, Marmor S, Lifschitz-Mercer B, Kletter Y, Ephros M, Giladi M. DNA amplification for the diagnosis of cat-scratch disease in small-quantity clinical specimens. Am J Clin Pathol 2001; 115:900-9. [PMID: 11392888 DOI: 10.1309/y468-82g5-achw-yrmv] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Diagnosis of cat-scratch disease (CSD) by polymerase chain reaction (PCR) of lymph node fineneedle aspiration (FNA) and primary lesion specimens can be difficult owing to the minute amount of available material. A PCR assay specifically suited to test these specimens was developed. First, small-quantity (10 microL) samples were prepared from 17 CSD-positive and 16 CSD-negative specimens, and DNA extraction and amplification from these samples were compared using 3 methods. Sensitivity and specificity of PCR were 100% using material collected on glass microscope slides and by using Qiagen (Hilden, Germany) columns for DNA extraction. Then, this method was used to test 11 archival glass microscope slides of FNA (7 malignant neoplasms, 4 undiagnosed lymphadenitis) and 2 primary lesion specimens. Two of the 4 lymphadenitis samples and the 2 primary lesion specimens were PCR positive. The technique presented could facilitate CSD diagnosis from a wider range of clinical samples.
Collapse
Affiliation(s)
- B Avidor
- Laboratory for Molecular Biology of Infectious Diseases, Ichilov Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman St, Tel-Aviv 64239, Israel
| | | | | | | | | | | | | |
Collapse
|
41
|
Avidor B, Varon M, Marmor S, Lifschitz-Mercer B, Kletter Y, Ephros M, Giladi M. DNA Amplification for the Diagnosis of Cat-Scratch Disease in Small-Quantity Clinical Specimens. Am J Clin Pathol 2001. [DOI: 10.1309/y5wn-8dfd-wlvt-kkad] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
42
|
Shaked-Mishan P, Ulrich N, Ephros M, Zilberstein D. Novel Intracellular SbV reducing activity correlates with antimony susceptibility in Leishmania donovani. J Biol Chem 2001; 276:3971-6. [PMID: 11110784 DOI: 10.1074/jbc.m005423200] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The standard treatment of human visceral leishmaniasis involves the use of pentavalent antimony (Sb(V)). Its mechanism of action is unknown because of the limited information available about intracellular antimony metabolism and about the genes that regulate these processes. Herein, flow injection-inductively coupled plasma mass spectrometry (ICP-MS), flow injection hydride generation ICP-MS, and ion chromatography ICP-MS were used to measure antimony accumulation and intracellular metabolism in the human protozoan parasite Leishmania donovani. Amastigotes (the intracellular form) and promastigotes (the extracellular form) accumulate Sb(V) and Sb(III) via separate transport systems. Stage-specific intracellular Sb(V) reducing activity was apparent in amastigotes, which reduced the negligibly toxic Sb(V) to highly toxic Sb(III). This amastigote-specific reducing activity was deficient in the Pentostam-resistant mutant L. donovani Ld1S.20. These data indicate that parasite susceptibility to Sb(V) correlates with its level of Sb(V) reducing activity. Also, in promastigotes of both wild-type L. donovani and the Pentostam-resistant mutant L. donovani Ld1S.20, Sb(V) inhibited the toxicity of Sb(III) but not of As(III). Both Sb(V) and Sb(III) were toxic to wild-type amastigotes. However, as observed in promastigotes, in mutant amastigotes Sb(V) inhibits Sb(III) but not As(III) activity. Anion exchange chromatography showed that intracellular antimony metabolism occurred in both promastigotes and amastigotes. These data demonstrate that the interaction between the two antimony oxidation states occurs intracellularly, within the parasite. The results also indicate that Sb(V) anti-leishmanial activity is dependent on its reduction to Sb(III). The mechanism of this novel intracellular Sb(V) reduction has yet to be identified, and it may or may not be enzymatic. This is the first description of intracellular Sb(V) reducing activity in Leishmania as well as in any prokaryotic or eukaryotic cell.
Collapse
Affiliation(s)
- P Shaked-Mishan
- Departments of Biology and Pediatrics, Carmel Medical Center and the Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | | | | | | |
Collapse
|
43
|
Abstract
BACKGROUND Measles vaccination at ages 12-15 months is a routine part of standard health care in developed countries. Nonetheless, the prevention and control of measles outbreaks remain a challenge, owing to incomplete or variable compliance with immunization programs and primary vaccine failure (approximately 5%). In Israel, vaccination coverage against measles is high, yet sero-epidemiological studies conducted in the early 1990s showed that 15% of 18-year-olds were unprotected. METHODS 1994 there was a countrywide epidemic of measles, which spread to the military. The Israel Defense Forces Medical Corps immediately launched a wide-scale vaccination campaign, targeting primarily field units and training bases, where crowded living conditions are the rule. RESULTS The immunization campaign led to an abrupt cessation of morbidity in the military. In the civilian sector, where no intervention was undertaken, the epidemic continued for another 4 months. CONCLUSIONS Institutional measles outbreaks, especially in the presence of crowded conditions or high contact rates, may be effectively controlled by mass vaccination.
Collapse
Affiliation(s)
- M Gdalevich
- Medical Corps, Israel Defense Forces, Haifa, Israel.
| | | | | | | | | | | | | |
Collapse
|
44
|
Cohen D, Orr N, Haim M, Ashkenazi S, Robin G, Green MS, Ephros M, Sela T, Slepon R, Ashkenazi I, Taylor DN, Svennerholm AM, Eldad A, Shemer J. Safety and immunogenicity of two different lots of the oral, killed enterotoxigenic escherichia coli-cholera toxin B subunit vaccine in Israeli young adults. Infect Immun 2000; 68:4492-7. [PMID: 10899847 PMCID: PMC98356 DOI: 10.1128/iai.68.8.4492-4497.2000] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Enterotoxigenic Escherichia coli (ETEC) is one of the leading causes of diarrhea among Israeli soldiers serving in field units. Two double-blind placebo-controlled, randomized trials were performed among 155 healthy volunteers to evaluate the safety and immunogenicity of different lots of the oral, killed ETEC vaccine consisting of two doses of whole cells plus recombinantly produced cholera toxin B subunit (rCTB). The two doses of vaccine lot E005 and the first dose of vaccine lot E003 were well tolerated by the volunteers. However, 5 (17%) vaccinees reported an episode of vomiting a few hours after the second dose of lot E003; none of the placebo recipients reported similar symptoms. Both lots of vaccine stimulated a rate of significant antibody-secreting cell (ASC) response to CTB and to colonization factor antigen I (CFA/I) after one or two doses, ranging from 85 to 100% and from 81 to 100%, respectively. The rate of ASC response to CS2, CS4, and CS5 was slightly lower than the rate of ASC response induced to CTB, CFA/I, and CS1. The second vaccine dose enhanced the response to CTB but did not increase the frequencies or magnitude of ASC responses to the other antigens. The two lots of the ETEC vaccine induced similar rates of serum antibody responses to CTB and CFA/I which were less frequent than the ASC responses to the same antigens. Based on these safety and immunogenicity data, an efficacy study of the ETEC vaccine is under way in the Israel Defense Force.
Collapse
Affiliation(s)
- D Cohen
- Army Health Branch Research Unit, Medical Corps, Israel Defence Force, Israel.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Cat scratch disease (CSD) is a common infectious cause of subacute regional lymphadenopathy. Bartonella henselae is the principal etiologic agent. About 10% of CSD patients experience atypical manifestations, including rashes. The most common cutaneous manifestation of CSD is a papule at the inoculation site. We report a case of CSD presenting with an eruption on the upper trunk, reminiscent of Sweet's syndrome, accompanied by lymphadenopathy, arthralgia, and fever. Response to systemic corticosteroids was remarkable. Histopathologic findings refuted the diagnosis of Sweet's syndrome. Identification of anti-B henselae antibodies and B henselae DNA in the affected lymph node confirmed the diagnosis of CSD. This is a first report of extensive papuloedematous eruption as a cutaneous manifestation of CSD. Accurate diagnosis is possible due to the availability of serological tests and DNA amplification techniques.
Collapse
Affiliation(s)
- M Landau
- Department of Dermatology, Tel Aviv-Elias Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Israel.
| | | | | | | | | | | | | |
Collapse
|
46
|
Ephros M, Bitnun A, Shaked P, Waldman E, Zilberstein D. Stage-specific activity of pentavalent antimony against Leishmania donovani axenic amastigotes. Antimicrob Agents Chemother 1999; 43:278-82. [PMID: 9925518 PMCID: PMC89063 DOI: 10.1128/aac.43.2.278] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The standard treatment of human visceral leishmaniasis involves the use of pentavalent antimony (SbV) compounds. In recent years increasing numbers of clinical failures of treatment with SbV have been reported, probably due to the development of parasite resistance to this compound. The mode of action and mechanisms of resistance to SbV have not been fully elucidated. In the present study an axenic amastigote culture was used to study the in vitro responses of Leishmania donovani to SbV. Susceptibility to both sodium stibogluconate and meglumine antimoniate was found to be stage specific. Amastigotes were 73 to 271 times more susceptible to SbV than were promastigotes. As opposed to SbV, trivalent antimony (SbIII) was similarly toxic to both developmental stages. When promastigotes were transformed to amastigotes, susceptibility to meglumine antimoniate developed after 4 to 5 days, upon the completion of differentiation. In contrast, with transformation from amastigotes to promastigotes, resistance to meglumine antimoniate was acquired rapidly, within 24 h, before the completion of differentiation. The culture of promastigotes at an acidic pH (5.5) or at an elevated temperature (37 degrees C) alone did not lead to the appearance of SbV susceptibility, emphasizing the requirement of both these environmental factors for the development of SbV susceptibility. A previously isolated sodium stibogluconate (Pentostam)-resistant L. donovani mutant (Ld1S.20) is also resistant to meglumine antimoniate, indicating cross-resistance to SbV-containing compounds. In contrast, no cross-resistance was found with SbIII, suggesting a mechanism of SbV resistance different from that described in Leishmania tarentolae. These data show that L. donovani susceptibility to SbV is parasite intrinsic, stage specific, and macrophage independent.
Collapse
Affiliation(s)
- M Ephros
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel
| | | | | | | | | |
Collapse
|
47
|
Bisharat N, Strahilevitz J, Ephros M, Raz R. Outbreak of acute schistosomiasis among Israeli rafters on the Omo River in Ethiopia. Am J Trop Med Hyg 1998; 59:504. [PMID: 9790417 DOI: 10.4269/ajtmh.1998.59.504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
48
|
Giladi M, Avidor B, Kletter Y, Abulafia S, Slater LN, Welch DF, Brenner DJ, Steigerwalt AG, Whitney AM, Ephros M. Cat scratch disease: the rare role of Afipia felis. J Clin Microbiol 1998; 36:2499-502. [PMID: 9705382 PMCID: PMC105152 DOI: 10.1128/jcm.36.9.2499-2502.1998] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/1998] [Accepted: 05/22/1998] [Indexed: 11/20/2022] Open
Abstract
Since its isolation in 1988, Afipia felis has been associated with cat scratch disease (CSD) in only one report and its role in CSD has been questioned. We have cultured A. felis from a lymph node of a patient with CSD. 16S rRNA gene sequencing, DNA relatedness studies, fatty acid analysis, and PCR of the A. felis ferredoxin gene showed that the isolate is identical to the previously reported A. felis isolate. To determine the role of A. felis in CSD, PCR of the 16S rRNA gene followed by hybridizations with specific probes were performed with lymph node specimens from CSD patients. All 32 specimens tested positive for Bartonella henselae and negative for A. felis. We conclude that A. felis is a rare cause of CSD. Diagnostic tests not conducive to the identification of A. felis might cause the diagnosis of CSD due to A. felis to be missed.
Collapse
Affiliation(s)
- M Giladi
- The Bernard Pridan Laboratory for Molecular Biology of Infectious Diseases, Ichilov Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Yeast-derived recombinant DNA hepatitis B vaccines usage became widely accepted since the early 1990s. Severe adverse events have been reported infrequently in adults and rarely in infants and children given hepatitis B vaccine in the ten years which have passed since the introduction of the vaccine. Some of the data were summarized in previous review articles. Our review of the literature revealed reports of serious adverse reactions which included immediate reactions (anaphylaxis and urticaria) as well as delayed reactions, including skin, rheumatic, vasculitic (including Systemic Lupus Erythematosus and glumerulonephritis), hematologic, ophthalmologic and neurologic reactions. These cases were summarized and a pathogenetic mechanism is offered.
Collapse
Affiliation(s)
- I Grotto
- Israel Defense Force, Medical Corps, Israel
| | | | | | | | | |
Collapse
|
50
|
Abstract
Amplification of Bartonella henselae DNA has been proposed as a diagnostic test for cat scratch disease (CSD). The sensitivities of the following three PCR assays were compared. PCR/rRNA with universal primers amplifies part of the 16S rRNA gene, followed by hybridization with a specific B. henselae probe; PCR/CS and PCR/HSP amplify portions of the gltA and the htrA genes, respectively, each followed by restriction fragment length polymorphism analysis. The threshold of detection of B. henselae DNA in pus was 10(-4), 10(-3), and 10(-2) ng for PCR/rRNA, PCR/CS, and PCR/HSP, respectively. By these three assays, B. henselae DNA was detected in 100, 94, and 69% of 32 pus and lymph node specimens from CSD patients, respectively. The similar sensitivities of the PCR/rRNA and the PCR/CS assays for detecting B. henselae DNA in clinical specimens are in contrast to the 10-fold difference in sensitivities in favor of PCR/rRNA demonstrated with purified B. henselae DNA in sterile pus, suggesting that in the majority of cases, the bacterial load in clinical specimens is large enough to be identified by the PCR/CS assay. A two-step approach is suggested to achieve maximal sensitivity for detecting B. henselae in clinical specimens: initial testing by PCR/CS (which does not require hybridization), followed by PCR/rRNA with PCR/CS-negative specimens when CSD is strongly suspected.
Collapse
Affiliation(s)
- B Avidor
- The Bernard Pridan Laboratory for Molecular Biology of Infectious Diseases, Ichilov Hospital, Tel-Aviv Sourasky Medical Center, Israel
| | | | | | | | | | | |
Collapse
|