Cerebriform sebaceous nevus: a subtype of organoid nevus due to specific postzygotic FGFR2 mutations

BACKGROUND

Postzygotic mutations in FGFR2 have been identified in mosaic forms of acne, keratinocytic epidermal nevi, nevoid acanthosis nigricans / rounded and velvety epidermal nevus and in two fetuses with papillomatous pedunculated sebaceous nevus (PPSN).

OBJECTIVES

To determine the clinical and genetic characteristics of children with cerebriform, papillomatous and pedunculated variants of sebaceous nevi.

METHODS

Infants diagnosed with sebaceous nevi characterized by a cerebriform, papillomatous and/or pedunculated morphology over a 10-year period (2010-2019) at three paediatric dermatology centres in Switzerland and France were included in this case series. Clinical and histological characteristics were assessed. Next-generation sequencing was used to assess for FGFR2 mutations.

RESULTS

All nevi were located on the head, with a rounded or linear shape and a typical cerebriform, sometimes papillomatous and pedunculated, surface. No associated extracutaneous anomalies were found. Nevi harboured postzygotic mutations in the transmembrane domain of FGFR2 in 6/8 children (75%), either the known specific p.(Cys382Arg) mutation in 5 cases, or a novel mutation, p.(Val395Asp), in one.

CONCLUSIONS

We found an exquisite genotype-phenotype correlation in these rare nevi, with specific postzygotic mutations in the transmembrane domain of FGFR2. As not all lesions were truly papillomatous and pedunculated, the term cerebriform sebaceous nevus (CSN) appears more suitable than PPSN to describe this entity. The cerebriform pattern of CSN is reminiscent of cutis gyrata, as seen in Beare-Stevenson syndrome, which is caused by closely related germline FGFR2 mutations. While clinically impressive, CSN seem to carry a good prognosis and a low risk for extracutaneous associations.

Skin-related quality of life in children and adolescents with congenital melanocytic naevi - an analysis of self- and parent reports

BACKGROUND

Congenital melanocytic naevi (CMN) may affect patient quality of life (QoL) due to medical complications (development of malignant melanoma or involvement of the central nervous system), skin-related discomfort or psychosocial sequelae.

OBJECTIVES

To analyse skin-related QoL in children and adolescents with CMN and to identify predictors of low QoL.

METHODS

Worldwide recruitment of participants through patient support groups. Data collection through a Web-based survey. QoL was assessed using the Children's Dermatology Life Quality Index© (CDLQI). Demographic and CMN-related characteristics were examined as possible predictors of impaired QoL.

RESULTS

A total of 135 proxy reports for children affected by CMN aged 4-18 years (M = 9.34 years, SD = 4.16 years) and 28 self-reports of adolescents aged 14-18 years (M = 16.3 years, SD = 1.2 years) were included. The mean CDLQI score was 4.00 (SD = 4.39) for proxy reports and 6.89 (SD = 5.85) for self-reports. Most parents (76%) reported 'no' or a 'small' impact, 19% a 'moderate' and 5% a 'very large' or 'extremely large' impact on their child's QoL. In self-reports, 46% of the adolescents reported 'no' or a 'small impact', 43% a 'moderate' and 11% a 'very large' or 'extremely large' impact. Visible CMN location, malignant melanoma and higher child's age were important predictors of QoL impairments.

CONCLUSIONS

Most CMN have a modest effect on QoL. However, there is large variability with a significant proportion of adolescents experiencing a moderate-to-large impact on QoL in contrast to children. Healthcare professionals should be aware of the predictors of QoL in children with CMN.

Safe and effective use of alitretinoin in children with recalcitrant hand eczema and other dermatoses - a retrospective analysis

BACKGROUND

Alitretinoin is a systemic retinoid licensed for use in adult patients suffering from chronic hand eczema recalcitrant to potent topical steroids. Experience with its use in childhood is lacking.

OBJECTIVES

To report on the efficacy and safety of alitretinoin treatment in a cohort of children and adolescents with chronic hand eczema (CHE) and other inflammatory skin diseases.

METHODS

We performed a retrospective chart review of all consecutive patients under the age of 18 years treated with alitretinoin at our paediatric skin centre. Physician's Global Assessment (PGA) was used as the primary outcome measure.

RESULTS

Thirteen children (9 girls and 4 boys) were enrolled in this study. The median age at start of treatment with alitretinoin was 11.5 years (range 5.8-15.8 years). Nine children were diagnosed with CHE, two with severe atopic dermatitis (AD), and two with inherited ichthyosis [netherton syndrome (NS), autosomal recessive congenital ichthyosis (ARCI)]. Moderate to excellent response (PGA decrease of ≥1 point) was observed in 7 (78%) of the nine patients with CHE, one of the two patients with extensive AD and in the one patient with ARCI. In the remaining four subjects, no convincing effect was documented. Tolerability was overall very good. The most common adverse event was headache in 10 patients (77%) during the initiation of treatment, leading to interruption of therapy in one subject.

CONCLUSIONS

Alitretinoin seems to be highly effective and safe for the treatment of paediatric CHE and should thus be considered in children with refractory disease under topical therapy. Larger studies are required to corroborate these findings.

[Acute skin infections and their imitators in children : A photo quiz]

BACKGROUND

Skin infections account for 40% of emergency visits in pediatric dermatology. It is important to promptly recognize skin infections with potential complications and initiate treatment. However some characteristic skin findings may imitate skin infections and are often misdiagnosed.

OBJECTIVES

To illustrate frequent pediatric skin infections and pitfalls in view of imitators and differential diagnoses.

MATERIALS AND METHODS

A photo quiz is presented with the discussion of a selection of acute pediatric skin infections in comparison to their infectious or noninfectious differential diagnoses.

RESULTS

The following infectious skin conditions and imitators are described and clinical clues for differentiation highlighted: eczema herpeticum and bacterial superinfection of atopic dermatitis; exanthematous hand, foot and mouth disease and varicella infection; erythema chronicum multilocularis and anular urticaria; Gianotti-Crosti syndrome and Gianotti-Crosti-like reaction; bacterial folliculitis of the scalp and kerion celsi and eosinophilic pustular folliculitis of the scalp; cutaneous Leishmaniasis and idiopathic facial aseptic granuloma; allergic and bacterial lymphangitis; bullous impetigo contagiosa and nonaccidental scalding.

CONCLUSIONS

Careful anamnesis and skin examination with attention to the here illustrated differential diagnoses are essential to avoid pitfalls in the evaluation of acute pediatric skin infections.

HIV-1 Neutralizing Antibody Signatures and Application to Epitope-Targeted Vaccine Design

Eliciting HIV-1-specific broadly neutralizing antibodies (bNAbs) remains a challenge for vaccine development, and the potential of passively delivered bNAbs for prophylaxis and therapeutics is being explored. We used neutralization data from four large virus panels to comprehensively map viral signatures associated with bNAb sensitivity, including amino acids, hypervariable region characteristics, and clade effects across four different classes of bNAbs. The bNAb signatures defined for the variable loop 2 (V2) epitope region of HIV-1 Env were then employed to inform immunogen design in a proof-of-concept exploration of signature-based epitope targeted (SET) vaccines. V2 bNAb signature-guided mutations were introduced into Env 459C to create a trivalent vaccine, and immunization of guinea pigs with V2-SET vaccines resulted in increased breadth of NAb responses compared with Env 459C alone. These data demonstrate that bNAb signatures can be utilized to engineer HIV-1 Env vaccine immunogens capable of eliciting antibody responses with greater neutralization breadth.

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HIV-1 bNAb sensitivity signatures from 4 large virus panels mapped across 4 Ab classes

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Non-contact hypervariable region characteristics are critical for bNAb sensitivity

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HIV-1 Env 459C used alone as a vaccine can elicit modest tier 2 NAbs in guinea pigs

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V2 bNAb signature-guided modifications in 459C enhanced neutralization breadth

THE USE OF YELLOW FEVER VIRUS MODIFIED BY IN VITRO CULTIVATION FOR HUMAN IMMUNIZATION

The response of rhesus monkeys to a subcutaneous inoculation with varying amounts of virus modified by prolonged cultivation in vitro has been studied. The tissue components of the medium consisted of chick embryo tissue containing minimal amounts of nervous tissue. The immunity produced in monkeys, as measured by the antibody titer developed, has no relation to the amount of virus inoculated. Monkeys inoculated subcutaneously with the tissue culture virus are rendered immune to a subsequent injection of a highly virulent yellow fever virus. This resistance is already present 7 days after vaccination. The subcutaneous inoculation of the culture virus into immune persons leads to a substantial increase of the serum antibody titer. The results of vaccinating eight normal persons with culture virus are presented. The reactions were minimal. The highest temperature recorded following vaccination was 37.4°C. The sera taken from the eight vaccinated persons 2 to 4 weeks after inoculation with the tissue culture virus showed the presence of yellow fever antibodies.

THE ADAPTATION OF UNMODIFIED STRAINS OF YELLOW FEVER VIRUS TO CULTIVATION IN VITRO

1. In a search for suitable tissues for the cultivation of yellow fever virus in vitro, mouse embryos were inoculated with this virus in utero. A titration for virus content of the various organs of the embryos indicated that the virus was present in the brain in greatest concentration. 2. Unmodified strains of yellow fever virus were readily adapted to cultivation in vitro in a medium consisting of minced mouse embryo brain tissue and Tyrode solution containing 10 per cent normal monkey serum. 3. After a continued cultivation in mouse embryo brain tissue cultures for twenty to twenty-five subcultures, these strains were readily adapted to cultivation in whole mouse embryo tissue medium. 4. There is evidence to indicate that a prolonged cultivation of the virus in mouse embryo brain medium increases its neurotropic properties. 5. Attempts to employ monkey tissues for in vitro cultivation of yellow fever virus gave entirely negative results.

SPONTANEOUS ENCEPHALOMYELITIS OF MICE, A NEW VIRUS DISEASE

1. The characteristics of a filterable virus obtained from mice found spontaneously paralyzed and showing lesions of encephalomyelitis are described. 2. The course of the disease in mice, following intracerebral inoculation, is briefly as follows: After an incubation period varying from 7 to over 30 days a flaccid paralysis of one of the limbs appears. This paralysis usually spreads rapidly until all four limbs are affected. Young mice are more susceptible than older ones, and very young mice, less than 4 weeks of age, usually die without showing signs of paralysis. 3. Adult mice often show no signs of infection after an intracerebral inoculation of virus. A number of these mice, although showing no signs of paralysis, nevertheless have become infected, a fact which is demonstrated by recovery of the virus from the mice as well as by histopathological studies. 4. Intranasal instillation of the virus is the only other method of producing the infection. This method, however, produces paralysis in only a small percentage of the mice. Following intranasal instillation of the virus, there often develops a slight immunity to a subsequent intracerebral injection of virus. 5. The paralysis in the surviving mice recedes gradually, but a permanent residual paralysis, usually of the hind legs, is almost invariable. Such mice, however, are virus carriers, as the virus can be recovered from the spinal cord for 1 year after infection. 6. Paralyzed mice are immune to a subsequent intracerebral injection of the virus. There is evidence that neutralizing substances are present in the immune mice. A considerable proportion of the mice which have remained well after an intracerebral injection of virus are immune to a second injection. 7. The virus resists the action of 50 per cent glycerine at from 2–4°C. for at least 150 days. It passes all grades of Berkefeld filters with ease. By the use of graded collodion filters, the size of the virus particle has been determined to be probably about 13 to 19 mµ. 8. The virus of mouse encephalomyelitis is not pathogenic for rhesus monkeys. No evidence of immunological relationship with the virus of human poliomyelitis has been obtained. 9. The anatomical basis of the paralysis is an acute necrosis of the ganglion cells of the anterior horn of the spinal cord. Isolated ganglion cells of the cerebrum also undergo necrosis. Following the acute necrosis of the ganglion cells, there is a marked neuronophagia. A perivascular infiltration is observed in the brain and spinal cord.

ULTRAFILTRATION OF THE VIRUS OF POLIOMYELITIS

From the ultrafiltration analysis the size of the virus of human poliomyelitis has been estimated to be somewhere between 12 and 17 mµ. Technical difficulties encountered and the low concentration of the virus make it seem possible that the virus is even smaller.

THE EFFECT OF PROLONGED CULTIVATION IN VITRO UPON THE PATHOGENICITY OF YELLOW FEVER VIRUS

1. Experimental evidence is presented to show that prolonged cultivation of yellow fever virus in vitro results in a change in its pathogenicity, and that this change varies with the type of tissues used for the cultivation. 2. In the tissue cultures used for the propagation of the virus, three different types of tissues were used. They included whole mouse embryo, chick embryo from which the head and spinal cord had been removed, and testicular tissues of mice and guinea pigs. 3. The changes in the pathogenicity of the virus cultivated for a period of over 3 years in a medium containing the tissues of whole mouse embryo were not striking. The viscerotropic virulence of the virus appeared somewhat diminished, in that when injected subcutaneously into rhesus monkeys or hedgehogs it failed to produce a fatal infection, although there is evidence to indicate that a generalized infection takes place as demonstrated by the appearance of virus in the circulating blood in relatively high concentration during infection. The neurotropic virulence of the virus remained unaltered during the cultivation in this medium. 4. The changes in the pathogenicity of the virus cultivated in medium containing tissues of chick embryo from which the head and spinal cord had been removed were very pronounced. The viscerotropic virulence of the virus was lost to a large extent. When injected subcutaneously into monkeys there was as a rule a very mild generalized infection, as demonstrated by the minimal quantities of virus found in the circulating blood. Its neurotropism was also much diminished. When injected into monkeys intracerebrally, it no longer produced a fatal encephalitis but only a moderate febrile reaction, followed by recovery and solid immunity to reinoculation with a highly virulent strain of virus. When injected intracerebrally into mice, the mortality ratio was not diminished but the incubation period was markedly prolonged. 5. The changes in the pathogenicity of the virus cultivated in medium containing testicular tissues were somewhat similar to those observed after cultivation in chick embryo medium which contained only a minimal amount of nervous tissue. Its viscerotropic affinity had been largely lost and only very small amounts of virus were found in the circulating blood of monkeys inoculated subcutaneously. Given intracerebrally, it produced death from encephalitis in monkeys. The incubation period in mice inoculated intracerebrally with this virus was also prolonged but somewhat less so than with the virus grown in chick embryo tissues without the central nervous system.

ENCEPHALOMYELITIS OF MICE : III. EPIDEMIOLOGY

1. In the feces of approximately two-thirds of normal mice 6 weeks of age an agent in all respects similar to the virus of mouse encephalomyelitis can be recovered. 2. In isolated mice, fed on sterile food and water, excretion of virus has been shown to persist up to 53 days after isolation. 3. In normal mice known to be virus carriers virus has been demonstrated in the gastro-intestinal tract but not in the central nervous system, thoracic or abdominal viscera, or any organs of the head. 4. The source of the virus excreted in the feces has been shown to be located in all probability in the intestinal wall. 5. Evidence is presented that the virus can invade the animal organism, as virus has been demonstrated in the mesenteric lymph glands.

ENCEPHALOMYELITIS OF MICE : I. CHARACTERISTICS AND PATHOGENESIS OF THE VIRUS

1. The two strains of virus named GD VII and FA, respectively, accidentally discovered during experiments with yellow fever, have been shown to be immunologically related to each other, as well as to the virus of mouse encephalomyelitis. 2. Infection of the central nervous system can be produced with both strains by intracerebral, intranasal, or intraperitoneal inoculations. The cardinal symptom produced by the GD VII strain of virus by all three methods of inoculation is a flaccid paralysis of the limbs. The symptoms produced by the FA strain are referable to lesions of the brain when infection is produced by intracerebral and intranasal inoculation. Following intraperitoneal inoculation of the FA strain of virus, however, a flaccid paralysis is usually produced. 3. By the use of graded collodion membranes the particle size of the virus of mouse encephalomyelitis has been shown to be from 9 to 13 mµ 4. The stability of the virus at different hydrogen ion concentrations has been tested. It has been found that there are two optima of stability, one at about pH 8.0 and the other at pH 3.3. 5. The virus is readily inactivated at 37°C. by 1 per cent hydrogen peroxide. 6. Of organic solvents tested, ether had no action, whereas ethyl alcohol in 20 per cent concentration almost completely inactivated the virus after 45 minutes in the cold. 7. The virus can be precipitated by means of ammonium sulfate. 8. With increasing age mice acquire a relative resistance to the virus. 9. Immunity to a subsequent intracerebral inoculation can be produced by intraperitoneal, as well as intranasal, administrations of relatively large amounts of virus. 10. Mice infected by the intracerebral inoculation of a relatively avirulent virus acquire a high degree of immunity to a subsequent inoculation of a highly virulent strain. 11. The course of infection in mice following intracerebral, intranasal, and intraperitoneal inoculation of the FA strain of virus has been studied.

The molecular weights of plasma and intestinal kallikreins in rats

1. The molecular weights of kallikreins of rat intestine and rat plasma have been estimated using gel filtration. 2. Extracts of pooled tissue from rat jejunum, ileum, caecum and colon activated by autolytic processes gave a single peak of kallikrein activity with a molecular weights of 33000. 3. Acid-activated rat plasma gave two peaks of kallikrein activity with molecular weight of 125000 and 61500. 4. Rat intestinal tissue contains a kinin forming enzyme having a molecular weight similar to those of glandular kallikreins and different from those of the rat plasma kallikreins.

The relative resistance of dengue-immune monkeys to yellow fever virus

Dengue-immune rhesus monkeys were challenged with a South American and two African strains of yellow fever virus. Levels of viremia were reduced as compared with control nonimmunized monkeys. The results support the hypothesis that immunity to dengue in a human population acts as a barrier to establishment of yellow fever in that population.

The Hemagglutinins of Semliki Forest and Bunyamwera Viruses, Their Demonstration and Use

A technique is described for the preparation of hemagglutinins for Semliki Forest and Bunyam wera viruses from infected suckling mouse serum. The titer of hemagglutinin appeared to be related to the infective titer of the serum. No hemagglutinin could be demonstrated for either virus in suckling mouse brain despite a high infective virus titer.

Specificity tests with homologous and heterologous immune mouse sera demonstrated the relative specificity of the Semliki antigen and the absolute specificity of the Bunyamwera in HI tests.

HI tests were carried out with selected human sera previously studied by neutralization test with the two viruses. Correlation between the two types of test was obtained with 73% of the sera for Semliki and 87% of the sera for Bunyamwera.

It is suggested that the antigens are of value for preliminary survey purposes and perhaps for diagnosis of recent infection. The technique of antigen production should be useful for the identification of these viruses as well as being applicable to other viruses.