CT-morphological characterization of respiratory syncytial virus (RSV) pneumonia in immune-compromised adults

PURPOSE

Characterization and follow-up evaluation of chest CT of RSV pneumonia in immune-compromised adults during a seasonal epidemic.

MATERIALS AND METHODS

Retrospective analysis of 132 chest CT examinations of 51 adult immune-compromised patients (29 m/22f, Ø58 years) with clinical signs of pneumonia and positive RSV test in winter 2011/2012. Two experienced chest radiologists evaluated the morphology (bronchial wall thickening, tree-in-bud, nodules, halo, ground-glass opacities, consolidations, pleural fluid) of the CT scans by consensus.

RESULTS

Pathological findings were in 86 % of the chest CT scans: Areas of ground-glass attenuation in 64 %, consolidations in 56 %, nodules in 55 % (Ø 8 mm in maximal diameter, with halo in 71 %), pleural fluid in 44 % (Ø 2 cm), tree-in-bud in 36 %, bronchial wall thickening in 27 % and more than one morphological finding in 72 %. There were no pathological CT findings in 14 % of patients with clinical symptoms of pneumonia because these patients did not undergo follow-up. Radiological progression was found in 45 % of patients and regression in 33 % in follow-up examinations. In 37 % an additional examination of the paranasal sinuses was performed and showed sinusitis in 63 % of cases. 90 % of the patients had sinusitis as well as pneumonia. In addition to RSV, a further pathogenic agent was found in bronchoalveolar lavage of five patients (Aspergillus spec., herpes simplex virus, Pseudomonas aeruginosa).

CONCLUSION

The most characteristic signs in chest CT scans were at the beginning of pneumonia with nodules and tree-in-bud often combined with bronchial wall thickening. The following CT scans showed characteristic but not pathognomonic chest CT findings of RSV pneumonia. These morphological findings should be recognized seasonally (winter) especially at the beginning of the case of pneumonia. RSV-associated additional sinusitis is probably common and should be noticed.

Brief treatment with the glucocorticoid receptor antagonist mifepristone normalises the corticosterone-induced reduction of adult hippocampal neurogenesis

The glucocorticoid receptor antagonist mifepristone has been shown to rapidly and effectively ameliorate symptoms of psychotic major depression. To better understand its mechanism, we investigated mifepristone's cellular effects, and found that it rapidly reversed a chronic corticosterone-induced reduction of adult neurogenesis in rats. Unlike other antidepressants, mifepristone is particularly potent in a high corticosterone environment. These data indicate that similarly to its clinical efficacy, mifepristone's effects on adult neurogenesis are rapid and positive, and may therefore be important for its mechanism of action.

Varicella-associated thrombocytopenia: autoantibodies against platelet surface glycoprotein V

Varicella zoster infection in children can be complicated by acute idiopathic thrombocytopenic purpura (ITP). To determine the etiologic mechanism of this thrombocytopenia, we studied three children with clinically diagnosed varicella infection. Immunoblot analysis of these patients' anti-platelet antibodies identified a unique band at 85 kD. Characterization of this protein revealed that it was platelet surface glycoprotein V (GPV) because it was not affected by a disulfide bond reduction but was cleaved by thrombin. Bernard-Soulier syndrome (BSS) platelets deficient in GPIb-IX and GPV did not react with the sera from our varicella-infected study patients. There was no apparent cross-reactivity between anti-varicella antibody and patients' anti-GPV Ig. We report here the first cases of GPV as the target antigen in autoimmune thrombocytopenia.

Translocation (5;6) associated with spontaneously remitting congenital leukemia

We describe a newborn with acute monocytic leukemia who underwent spontaneous remission. Chromosomal analysis of this patient's leukemic blasts identified a translocation between 5q31 and 6q21. Chromosome 5 has been implicated in adult leukemogenesis but only rarely in childhood leukemia. Several hematopoietic growth factors and growth factor receptors have been mapped to the long arm of chromosome 5. This report discusses the possible role of these gene products in inducing leukemia in our index case.

Comparison of questionnaire-derived and tumour registry-derived smoking histories

Information on cigarette smoking, an exposure of great epidemiological interest, is occasionally obtained from tumour registry data. We compared smoking histories from a hospital tumour registry with those from a questionnaire administered to 94 lung cancer patients. Reliability of tumour registry data was good for classifying individuals as ever-smokers and non-smokers (sensitivity 0.96, specificity 0.86). There was higher discrepancy in classifying smokers as current or former smokers. Current smokers had lower reliability for amount of smoking than former smokers, whereas both groups had high reliability for duration of smoking. These results suggest that tumour registry derived data on smoking must be used with caution.

Relationship between Machiavellianism, external control, and cognitive style among college students

This experiment determined relationships between Machiavellianism, locus of control, and cognitive style. 115 subjects, 56 males, 59 females, ages 18 to 21, were selected from Interim students at Texas Lutheran College, Seguin, Texas. The M Mach IV test measured Machiavellian tendencies. The I-E scale measured external attitudes. The Object Sorting Test measured categorizing style and cognitive structure by having subjects divide 50-word representations into groups. A significant correlation for all subjects was found between M Mach IV and I-E, none between M Mach IV and Object Sorting or between I-E and Object Sorting. No sex differences were noted. A multiple correlation among the three scores indicated some relationship between Machiavellianism, locus of control, and cognitive style.