POS1464 TOXOPLASMOTIC CHORIORETINITIS IN A PATIENT WITH RHEUMATOID ARTHRITIS

Background

Biological disease-modifying antirheumatic drugs (bDMARD) are one of the most effective in the treatment of rheumatoid arthritis. Infectious complications are one of the most common complications of this type of therapy. Before the therapy is started, patients are examined for tuberculosis, human immunodeficiency virus and hepatitis B and C, but the spectrum of chronic infections is much wider, for example toxoplasmosis infection is widespread. Toxoplasma gondii mainly affects the brain, lungs, liver and organ of vision.

Objectives

To present a clinical case of toxoplasma chorioretinitis in a patient with rheumatoid arthritis.

Methods

Case report. The patient was treated and examined based on real clinical practice.

Results

A 59-year-old woman was admitted to the rheumatology department with symmetric arthritis of the hand joints, long morning stiffness duration (up to 4 hours). The diagnosis of rheumatoid arthritis was previously verified according to the ACR / EULAR 2010 criteria (three years ago). She received treatment in accordance with the clinical guidelines of the Ministry of Health of the Russian Federation: methotrexate 12.5 mg per week with a subsequent increase in dosage to 20 mg per week. Due to the increase in transaminases, the dosage of methotrexate was reduced to 17.5 mg per week, the daily intake of glucocorticosteroids (prednisone 7.5 mg per day). Nevertheless she had high disease activity (Disease Activity Score (DAS28) 5.54, Clinical Disease Activity Index (CDAI) 26.6, Simplied Disease Activity Index (SDAI) 30.12). Considering the continued high activity of the disease against the background of ongoing therapy lasting more than 6 months, infliximab was added to the treatment at a dose of 3 mg per kg of body weight. A good clinical response was achieved (DAS28 2.67, CDAI 4.0, SDAI 9.4, prednisone canceled). After 4 months, there were complaints of acute decrease in vision in the right eye. Referred to an ophthalmologist. Visual Acuity: best corrected visual acuity (BCVA) on right eye is 0.4 (Snellen Chart), BCVA on left eye is 0.9 (Snellen Chart), intraocular pressure: right eye - 18 mmHg (non-contact), left eye - 19 mmHg (non-contact). Right eye: palpation is painful; cornea and anterior chamber humor are transparent; mild cataract in lens; inflammation cells in vitreous body (3+). Fundus (right eye): disc of optic nerve is normal; edema along upper-temporal vessels in macular region, exudates with pigmentation; periphery is normal. Left eye: findings are not clinical significant. Optical coherence tomography of retina (OCT): macular depression is normal; in paramacular region is epiretinal membrane, no traction; along upper-temporal vessels in macular region is chorioretinal focus with retina layer disorganization and tractions. Laboratory: Diaskintest is negative; Toxoplasma IgG = 170 ME / ml (positive is> 8 ME / ml). Diagnosis: Toxoplasma chorioretinitis, infiltration phase of right eye. Topical therapy: dexamethasone 0.1% - 1 x 6 times / day - 20 days, nepafenac 0.1% - 1 x 3 TID - 20 days. Oral: rovamycine 3 mil. ME - 2 TID - 20 days. Infliximab and methotrexate were canceled for the entire period of toxoplasma chorioretinitis treatment. Ophthalmologist’s follow-up after 20 days: no complaints on visual acuity, BCVA on right eye is 1.0 (Snellen Chart). No cells in vitreous body. Fundus: decrease evidence of edema. OCT: decrease evidence of edema. Taking into account the presence of chronic toxoplasmosis infection, the patient was prescribed sulfasalazine 3 g per day as a basic therapy.

Conclusion

In this clinical case we demonstrated the possibility of activating chronic infections such as toxoplasmosis during therapy with bDMARD infliximab. To avoid risk of activating toxoplasmosis patients with rheumatoid arthritis should be screened for this infection before start bDMARD therapy.

Figure 1.

References

[1]B. Bobić, I. Klun, A. Nikolić and O. Djurković-Djaković (2012). Toxoplasma gondii Infection in South-East Europe: Epidemiology and Epizootiology, Toxoplasmosis - Recent Advances, Olgica Djurković Djaković, IntechOpen, DOI: 10.5772/50831.

Disclosure of Interests

None declared

Mass screening for active case finding of pulmonary tuberculosis in the Russian Federation: how to save costs

BACKGROUND: In Russia, mass chest X-ray (CXR) screening for tuberculosis (TB) is mandatory.OBJECTIVE: To compare the yield and the cost per TB case detected and the total cost of CXR screening, passive case finding and contact tracing among adolescents and adults in the Arkhangelsk Oblast, Russian Federation, 2013-2017.DESIGN: This was an analysis of costing strategies using aggregated data. Costing information was obtained from the Finance Department of the Arkhangelsk Clinical TB Dispensary, Arkhangelsk, and the Territorial Fund of Mandatory Medical Insurance, Arkhangelsk, Russian Federation.RESULTS: TB cases were detected using CXR screening (n = 684, 46%), contact tracing (n = 61, 4%) and passive case finding (n = 743, 46%). The number of cases detected using CXR screening, contact tracing and passive case finding was respectively 28,753 and 960/100 000. The mean costs/test were respectively US$3.54 (US$12 541/case), US$20.28 (US$2693/case) and US$11.85 (US$1235/case) using CXR screening, contact tracing and passive case finding The number of cases/100 000 in targeted groups was as follows: HIV-positive persons, 645; homeless persons, 461; and migrants, 441. The cost/TB case detected was respectively US$549, US$768 and US$803.CONCLUSION: Mass CXR screening (excluding HIV-positive, migrant and homeless populations) has low yield and high cost per TB case detected. It should be stopped and resources should instead be used to strengthen the screening of targeted high-risk groups, contacts and passive case finding.

Mycotoxins in herbal teas marketed in Latvia and dietary exposure assessment

The occurrence of 12 mycotoxins has been analysed by liquid chromatography - time of flight mass spectrometry in the batch of 60 herbal teas purchased from drugstores in Latvia. Among the dry tea samples, 90% were positive for one to eight mycotoxins. Enniatin B and deoxynivalenol (DON) were the most frequently detected mycotoxins in 55% and 45% of the samples, respectively. DON reached the highest level, from 129 µg kg^-1 in herbal blend to 5,463 µg kg^-1 in wormwood tea. Ochratoxin A (OTA) and aflatoxin B₁ (AFB₁) were found in 10% and 20% of the samples at the concentrations ranged between 2.99-30.3 µg kg^-1 and 3.40-23.7 µg kg^-1. Studies of the tea infusion process indicated that 32-100% of DON and zearalenone present in dry teas were extracted into the infusions. Dietary exposure assessment was performed, using the determined mycotoxin levels and the available consumption data.

Recent applications of carbonaceous nanosorbents for the analysis of mycotoxins in food by liquid chromatography: a short review

Carbonaceous nanomaterials (multi-walled carbon nanotubes (MWCNTs), graphene, and graphene oxide (GO)) have attracted attention over the last decade as adsorbents suitable for the analysis of organic and inorganic pollutants. In the present paper we review methods of mycotoxin analysis that involve sample extraction with carbonaceous nanosorbents, reported from 2011 onwards. Recent studies have highlighted the advantages of magnetically modified MWCNTs and GO in mycotoxin analysis, which may enable sample isolation through magnetic separation, reduce the interaction of nanoparticles, and enhance the recovery of analytes. The papers covered in this review point to promising applications of functionalised carbonaceous nanosorbents in mycotoxin analysis. While GO based sorbents can be effective for the adsorption of relatively polar aflatoxins, MWCNTs with high specific surface area and reduced agglomeration achieved through modification with silica and magnetic particles are preferred for the extraction of less polar mycotoxins.

A rapid and sensitive method for the control of selected regulated and emerging mycotoxins in beer

A fast method using automated online solid-phase extraction (SPE) coupled to liquid-chromatography/high resolution mass spectrometric (LC-HRMS) detection for the determination of 12 mycotoxins in beer was developed and fully validated according to the performance criteria set in the European Union (EU) guidelines. Mycotoxin detection was achieved by full-scan HRMS with electrospray ionisation in positive ion mode within 13 min. No significant matrix interferences were observed. The lowest limits of detection (LODs) were achieved for emerging mycotoxins (beauvericin and enniatins) and ochratoxin A at levels between 0.01 and 0.02 μg/l, while the overall LODs were in the range of 0.01-0.30 μg/l. The elaborated method showed good performance in the analysis of beer samples with good linearity (R2>0.999), intra-day and inter-day precision at the levels of <12% and <13%, respectively, and recoveries in the range of 80-119%. Finally, this fully automated, sensitive, and reliable online SPE-HPLC-HRMS method was successfully applied for the analysis of 25 Latvian beers and the obtained results were comparable or even better than those obtained using the well-established Quick, Easy, Cheap, Effective, Rugged, and Safe, the QuEChERS, methodology.

Cold sensitivity of thermophilic and mesophilic RNA polymerases

RNA polymerase from mesophilic Deinococcus radiodurans displays the same cold sensitivity of promoter opening as RNA polymerase from the closely related thermophilic Thermus aquaticus. This suggests that, contrary to the accepted view, cold sensitivity of promoter opening by thermophilic RNA polymerases may not be a consequence of their thermostability.

Class II broad-spectrum mercury resistance transposons in Gram-positive bacteria from natural environments

We have studied the mechanisms of the horizontal dissemination of a broad-spectrum mercury resistance determinant among Bacillus and related species. This mer determinant was first described in Bacillus cereus RC607 from Boston Harbor, USA, and was then found in various Bacillus and related species in Japan, Russia and England. We have shown that the mer determinant can either be located at the chromosome, or on a plasmid in the Bacillus species, and is carried by class II mercury resistance transposons: Tn5084 from B. cereus RC607 and B. cereus VKM684 (ATCC10702) and Tn5085 from Exiguobacterium sp. TC38-2b. Tn5085 is identical in nucleotide sequence to TnMERI1, the only other known mer transposon from Bacillus species, but it does not contain an intron like TnMERI1. Tn5085 is functionally active in Escherichia coli. Tn5083, which we have isolated from B. megaterium MK64-1, contains an RC607-like mer determinant, that has lost some mercury resistance genes and possesses a merA gene which is a novel sequence variant that has not been previously described. Tn5083 and Tn5084 are recombinants, and are comprised of fragments from several transposons including Tn5085, and a relative of a putative transposon from B. firmus (which contains similar genes to the cadmium resistance operon of Staphylococcus aureus), as well as others. The sequence data showed evidence for recombination both between transposition genes and between mer determinants.

Amplification of cDNA ends based on template-switching effect and step-out PCR

A new method for amplifying cDNA ends is described which requires only first-strand cDNA synthesis and a single PCR to generate a correct product with very low or no background. The method can be successfully applied to total RNA as well as poly A+ RNA. The same first-strand cDNA can be used to amplify flanking sequences of any cDNA species present in the sample.

Inductive interactions regulating body patterning in planarian, revealed by analysis of expression of novel gene scarf

Subtractive hybridization was used to search for the early difference in gene expression between anteriorly and posteriorly regenerating tissues of the same region of the planarian body. A sequence (named scarf) specific for posteriorly regenerating tissue was isolated, encoding a soluble C-type lectin consisting of two slightly different carbohydrate-recognition domains. Such an unusual bivalent structure allows attribution of the protein to a novel subfamily of C-type lectins. scarf expression in intact planarian is rather abundant and follows a characteristic pattern not linked to any known morphological structure. We performed a series of experiments using scarf as a molecular marker. Its expression was monitored during different types of regeneration by whole-mount in situ hybridization and reverse-transcription polymerase chain reaction. The obtained data suggest that scarf expression is positively regulated by anterior tissues closely adjacent to the scarf-expressing region, so that their surgical removal results in rapid scarf switch-off. In turn, tissues expressing scarf seem to inhibit its activation anteriorly. This indicates that at least some of the body patterning events in planarians are based on a system of reciprocal inductive interactions rather than on a global morphogen gradient.

Ordered differential display: a simple method for systematic comparison of gene expression profiles

A method for display of 3'-end restriction fragments of cDNAs is proposed, extending the idea reported recently. First, representative pools of such fragments are selectively amplified using PCR suppression effect. Then, simplified subsets of these fragments suitable for comparison by PAGE are amplified by adapter-specific primers extended by two randomly picked bases at their 3'ends. By testing all possible combinations of extended primers the whole mRNA pool may be systematically investigated. The method was applied to search for molecular regional markers of freshwater planarian Dugesia tigrina .

Genes from the medicinal leech (Hirudo medicinalis) coding for unusual enzymes that specifically cleave endo-epsilon (gamma-Glu)-Lys isopeptide bonds and help to dissolve blood clots

We previously detected in salivary gland secretions of the medicinal leech (Hirudo medicinalis) a novel enzymatic activity, endo-epsilon(gamma-Glu)-Lys isopeptidase, which cleaves isopeptide bonds formed by transglutaminase (Factor XIIIa) between glutamine gamma-carboxamide and the epsilon-amino group of lysine. Such isopeptide bonds, either within or between protein polypeptide chains are formed in many biological processes. However, before we started our work no enzymes were known to be capable of specifically splitting isopeptide bonds in proteins. The isopeptidase activity we detected was specific for isopeptide bonds. The enzyme was termed destabilase. Here we report the first purification of destabilase, part of its amino acid sequence isolation and sequencing of two related cDNAs derived from the gene family that encodes destabilase proteins, and the detection of isopeptidase activity encoded by one of these cDNAs cloned in a baculovirus expression vector. The deduced mature protein products of these cDNAs contain 115 and 116 amino acid residues, including 14 highly conserved Cys residues, and are formed from precursors containing specific leader peptides. No homologous sequences were found in public databases.