Postpartum cryptococcosis in an HIV-negative patient

PURPOSE AND METHODS

We present an unusual case of an HIV-negative patient with postpartum pulmonary cryptococcosis and cryptococcemia.

RESULTS

The diagnostic methods and treatment of cryptococcosis in a postpartum patient are presented in this case report. Due to anaphylaxis to liposomal amphotericin B, desensitisation to the drug was performed.

CONCLUSION

We would like to raise awareness about rare infections such as cryptococcosis in pregnancy and the postpartum period. In addition, we were able to document a successful desensitisation to liposomal amphotericin B.

[Rare cause of necrotizing pneumonia : A case report]

A 29-year-old Indian patient was admitted to the authors' pulmonary clinic with cough and fever. Community-acquired pneumonia was initially suspected. Various antibiotic therapies were administered, which did not lead to any clinical improvement. Despite detailed diagnostics, no pathogen was found. Computed tomography showed rapidly progressive pneumonia in the left upper lobe. Since the infection could not be managed conservatively, upper lobe resection was performed. Histologically, an amoebic abscess was found to be the cause of the infection. Since cerebral and hepatic abscesses were also found, hematogenous dissemination may be assumed.

Low prevalence of p53, p16(INK4a) and Ha-ras tumour-specific mutations in low-graded actinic keratosis

BACKGROUND

Ultraviolet radiation induces DNA damage and is the major risk factor for the development of non-melanoma skin cancer (NMSC). Different mutation rates of p53, p16(INK4a) and Ha-ras in cutaneous squamous cell carcinoma (SCC) and the earlier stage actinic keratosis (AK) have been reported.

OBJECTIVES

To assess the presence of missense mutations in hotspot exons of p53, p16(INK4a) and Ha-ras in low-graded AK.

PATIENTS/METHODS

Cryo-biopsies of 75 sun-exposed AK lesions and 75 sun-shielded areas of normal skin from 75 AK patients were analysed to identify mutations in p53 (exons 7 and 8), p16(INK4a) (exon 2) and Ha-ras (exon 1) using polymerase chain reaction (PCR) followed by direct sequencing. As a representative subset of the specimens, ten mutation-negative AK were also micro-dissected in order to exclude the possibility that additional mutations were undetected.

RESULTS

Eight missense and one nonsense point mutations were found in the 75 AK lesions examined (12%), of which seven (9%) were tumour-specific (i.e. present in AK lesions only) and two (3%) were p16(INK4a) mutations (i.e. also detected in normal skin). Three of the tumour-specific mutations (42%) were cytosine (C) to thymine (T) transitions at pyrimidine-rich sequences. Tumour-specific mutations were identified in 1% of p16(INK4a) (exon 2), 1% of Ha-ras (exon 1) and at a higher rate of 7% in p53 (exons 7 and 8), including one nonsense mutation.

CONCLUSIONS

The evaluation of a large number of AK specimens in this study have found a low gene mutation rate in low-graded AK lesions. p53 mutations rather than p16(INK4a) and/or Ha-ras mutations may be an early event in the development of AK to cutaneous SCC.

Tenascin-C patterns and splice variants in actinic keratosis and cutaneous squamous cell carcinoma

BACKGROUND

Tenascin-C (Tn-C) is an extracellular matrix protein with multiple functions that is present at low levels in normal tissues, but which is highly present in various tumours. The mRNA expression and protein level of Tn-C including its various isoforms have not been investigated comprehensively so far in cutaneous squamous cell carcinoma (SCC) and the precursor lesion actinic keratosis (AK).

OBJECTIVES

To assess the dysregulated expression and splice variants of Tn-C in cutaneous squamous cell dysplasia and carcinoma.

METHODS

Biopsies from 66 patients (or representative subsets) that comprised 25 specimens from normal skin, 19 AK and 22 cutaneous SCC were analysed for Tn-C splice variants using splice-specific primers. The amount of Tn-C mRNA was investigated by quantitative real-time reverse transcription-polymerase chain reaction. In addition, the presence of Tn-C protein was analysed in sections of paraffin-embedded tissues using immunohistochemistry.

RESULTS

The large Tn-C splice variant was present in only 5% of normal skin samples, in comparison with 63% of AK (P < 0.001) and 88% of SCC (P < 0.001). Tn-C mRNA expression was significantly increased in AK and SCC compared with normal skin (P < 0.001). The corresponding proteins were rarely detected in cells of the vascular epithelial layers and perifollicular layers of some normal skin specimens, and their spatial localization expanded into the papillary dermis of AK. The largest amount and the widest distribution were found in samples of SCC, in which Tn-C was located in the basal cells at the tumour invasion front and additionally in the papillary dermis and reticular dermis.

CONCLUSIONS

Tn-C is present in the dermis, its expression is increased during skin cancer development, and the large splice variant is characteristic for AK and SCC, which may prove useful for diagnostic approaches in cutaneous SCC.

Evolution of funnel-revolver flowers and ornithophily in nasa (loasaceae)

Floral morphology, distribution, and flower visitors for 60 taxa of Nasa are investigated and compared to molecular trees inferred both from a combined marker analysis (ITS1 and trnL (UAA)) and from a single marker (ITS1). Flowers conform to two different floral types: Firstly, "tilt-revolver flowers", with spreading to reflexed, white to yellow petals and small, brightly coloured floral scales contrasting with the petals and firmly enclosing the nectar (Saccatae and Carunculatae); secondly, "funnel-revolver flowers", with half-erect to erect, orange to red petals and floral scales not contrasting with the petals, or enclosed in the corolla, and nectar freely accessible by funnel-shaped floral scales ( Alatae, Grandiflorae, and N. venezuelensis species group). Phylogenetic analysis shows that "tilt-revolver flowers" represent the plesiomorphic condition by outgroup comparison. The two groups with tilt-revolver flowers in Nasa are not monophyletic ( Saccatae are paraphyletic, Carunculatae are polyphyletic). Most Saccatae fall into two monophyletic assemblages, the N. poissoniana species group and the N. triphylla species group. The remainder of Saccatae group either with Grandiflorae ( N. insignis species group) or with Alatae ( N. laxa species group). The clades retrieved in the molecular analysis contradict the traditional classification, but are congruent with vegetative morphology, details of the flower morphology, and biogeography. "Funnel-revolver flowers" represent the derived condition, but molecular data suggest a convergent development (at least twice independently), since the corresponding species do not constitute a monophyletic group. "Tilt-revolver flowers" are visited and pollinated by bees (especially Colletidae), whereas "funnel-revolver flowers" are mostly visited by hummingbirds. The transition from melittophily to ornithophily may have been the license for the colonization of, and the diversification in, both cloud forest and high Andean habitats.