Hepatitis C-induced Sjögren's Syndrome With Positive Serology: A Case Report

Sjögren's syndrome (SjS) is a chronic autoimmune disease with a tendency to inflame the exocrine glands, and hepatitis C virus (HCV) infection is considered an exclusion criterion for the diagnosis of this condition; however, it is a highly debated topic, mainly because HCV is viewed as a possible etiopathogenic factor in the disease onset. We report a case of a female patient diagnosed with HCV chronic infection with positive serological markers of SjS (anti-Ro and anti-La autoantibodies). She presented with neuropsychiatric manifestations and casual sicca symptoms and was eventually diagnosed with HCV-induced SjS. Initially, the patient developed symptoms that fulfilled the histopathological criteria of primary SjS and co-existence of mixed cryoglobulinemia, which is viewed as an HCV-related marker.

High prevalence of the PER-1 gene among carbapenem-resistant Acinetobacter baumannii in Riyadh, Saudi Arabia

The prevalence of carbapenem-resistant Acinetobacter baumannii in Saudi Arabia and their resistance genetic mechanisms are yet to be identified. We studied the prevalence and genetic diversity of extended-spectrum beta-lactamase genes, particularly the PER-1 gene, among carbapenem-resistant A. baumannii strains from patients at a tertiary care hospital in Riyadh, Saudi Arabia between 2006 and 2014. Fresh subcultured samples were tested for antimicrobial susceptibility minimum inhibitory concentration (MIC). Total genomic DNA was extracted from each isolate and further used for polymerase chain reaction (PCR) genotyping, sequence-based typing (SBT) of PER-1 and OXA-51-like gene, and multilocus sequence typing (MLST) of positive isolates. Randomly selected clinical isolates (n = 100) were subjected to MLST. A total of 503 isolates were characterized as multidrug-resistant (MDR) using the MIC. Isolates were further PCR tested for bla _-TEM and bla _-PER-1 resistance genes (n = 503). The genotyping results showed that 68/503 (14 %) isolates were positive to bla TEM. The genotyping results of PER-1-like genes showed that 384/503 (76.3 %) were positive among MDR Acinetobacter isolates. Based on SBT, the majority of these isolates were clustered into three main groups including isolates harboring PER-1: AB11 (bla _-PER-1), isolate AB16 (bla _-PER-1), and, finally, the plasmid pAB154 (bla _-PER-7). Remarkably, many isolates were concealing the PER-1 gene and harboring the TEM resistance genes as well. MLST results for selected isolates (n = 100) identified four main sequence types (STs: 2, 19, 20, and 25) and four novel isolates (ST 486-489). We report 76.3 % prevalence of the PER-1 resistance gene among Acinetobacter clinical isolates from Riyadh, Saudi Arabia. Further work is needed to explore the clinical risks and patient outcome with such resistance related to healthcare-associated infections and investigate the genetic and molecular mechanisms that confer the MDR phenotype.

Evolution of highly pathogenic avian influenza H5N1 viruses in Egypt indicating progressive adaptation

Highly pathogenic avian influenza (HPAI) virus of the H5N1 subtype was first diagnosed in poultry in Egypt in 2006, and since then the disease became enzootic in poultry throughout the country, affecting the poultry industry and village poultry as well as infecting humans. Vaccination has been used as a part of the control strategy to help to control the disease. Epidemiological data with sequence analysis of H5N1 viruses is important to link the mechanism of virus evolution in Egypt. This study describes the evolutionary pattern of Egyptian H5N1 viruses based on molecular characterization for the isolates collected from commercial poultry farms and village poultry from 2006 to 2011. Genetic analysis of the hemagglutinin (HA) gene was done by sequencing of the full-length H5 gene. The epidemiological pattern of disease outbreaks in Egyptian poultry farms seems to be seasonal with no specific geographic distribution across the country. The molecular epidemiological data revealed that there are two major groups of viruses: the classic group of subclade 2.2.1 and a variant group of 2.2.1.1. The classic group is prevailing mainly in village poultry and had fewer mutations compared to the originally introduced virus in 2006. Since 2009, this group has started to be transmitted back to commercial sectors. The variant group emerged by late 2007, was prevalent mainly in vaccinated commercial poultry, mutated continuously at a higher rate until 2010, and started to decline in 2011. Genetic analysis of the neuraminidase (NA) gene and the other six internal genes indicates a grouping of the Egyptian viruses similar to that obtained using the HA gene, with no obvious reassortments. The results of this study indicate that HPAI-H5N1 viruses are progressively evolving and adapting in Egypt and continue to acquire new mutations every season.

Avian influenza H5N1 virus infections in vaccinated commercial and backyard poultry in Egypt

In this paper, we describe results from a high-pathogenic H5N1 avian influenza virus (AIV) surveillance program in previously H5-vaccinated commercial and family-backyard poultry flocks that was conducted from 2007 to 2008 by the Egyptian National Laboratory for Veterinary Quality Control on Poultry Production. The real-time reverse transcription PCR assay was used to detect the influenza A virus matrix gene and detection of the H5 and N1 subtypes was accomplished using a commercially available kit real-time reverse transcription PCR assay. The virus was detected in 35/3,610 (0.97%) and 27/8,682 (0.31%) of examined commercial poultry farms and 246/816 (30%) and 89/1,723 (5.2%) of backyard flocks in 2007 and 2008, respectively. Positive flocks were identified throughout the year, with the highest frequencies occurring during the winter months. Anti-H5 serum antibody titers in selected commercial poultry ranged from <2 (negative) to 9.6 log(2) when determined in the hemagglutination inhibition test using a H5 AIV antigen. In conclusion, despite the nationwide vaccination strategy of poultry in Egypt to combat H5N1 AIV, continuous circulation of the virus in vaccinated commercial and backyard poultry was reported and the efficacy of the vaccination using a challenge model with the current circulating field virus should be revised.

Isolation of highly pathogenic avian influenza H5N1 from table eggs after vaccinal break in commercial layer flock

In May 2009, during routine monitoring of a commercial layer flock of about 87,000 birds kept in cages in 4 different houses that had been vaccinated 3 times with an inactivated H5N1 vaccine at weeks 1, 7, and 16, highly pathogenic avian influenza (HPAI) virus of subtype H5N1 was isolated and detected by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in tracheal and cloacal swabs collected from houses 3 and 4; 7 days after onset of clinical signs, there was an increase in mortality accompanied by a decrease in egg production and egg quality. In addition, using RT-PCR, the viral RNA could be detected from albumin and eggshell as well. Seven days after the onset of the clinical signs, the hemagglutination inhibition (HI) titers in the affected houses were 3.2 and 1.9 log2. In the other two houses, there were no clinical signs, and all tested samples were negative using virus isolation and real-time RT-PCR. The HI titers were 6.6 and 7.0 log2 in nonaffected houses. The isolated virus from egg albumin showed high nucleotides and amino-acid identities and clustered with viruses from recently H5N1-confirmed human infections and poultry from different places in Egypt. Moreover, several amino-acid substitutions of viral H5 protein were observed. The vaccinal break seems to be associated with immune escape mutants and/or improper vaccination. The role of contaminated eggs as a source of infection and as a vehicle for spread of the virus should be considered in area with avian influenza outbreaks.

Circulation of avian influenza H5N1 in live bird markets in Egypt

The poultry meat trade in Egypt depends mainly on live bird markets (LBMs) because of insufficient slaughterhouses, lack of marketing infrastructure, and cultural preference for consumption of freshly slaughtered poultry. There are two types of LBMs in Egypt: retail shops and traditional LBMs where minimal, if any, food safety standards or veterinary inspection are implemented. Before January 2009, LBMs were considered to be a missing link in the epidemiology of avian influenza in Egypt. This incited us to initiate this surveillance to better understand the perpetuation of H5N1 and the risk of infection in poultry markets. Seventy-one out of 573 (12.4%) examined LBMs were positive for the H5N1 subtype by real-time--quantitative polymerase chain reaction (RT-qPCR) from January to April 2009. Where a 70.4% detection rate from LBMs had waterfowl only as a solitary sold species, a 26.8% detection rate from LBMs had waterfowl mixed with chicken and/or turkey, and 2.8% from LBMs had only turkey. Higher incidence, 40.8%, of positive LBMs was recorded during the cold month of February and concentrated mainly in the highly populated Nile Delta. These findings revealed wide circulation of H5N1 avian influenza virus in LBMs in Egypt, which poses a threat to public health and the poultry industry. Long-term control measures are required, and routine surveillance of bird markets should be conducted year-round.

Isolation of a low pathogenic avian influenza virus (H7N7) from a black kite (Milvus migrans) in Egypt in 2005

Avian influenza is endemic in some species of wild birds and is generally believed to cause only an asymptomatic infection. These viruses are routinely transmitted from this wild bird reservoir to poultry in many areas all over the world. Low pathogenic avian influenza (LPAI) was previously reported in Egypt from different types of wild birds. This report describes the isolation and genetic characterization of H7N7 LPAI virus from a black kite (Milvus migrans), the first reported from this species, during surveillance done on wild birds in 2005. The black kite is a migratory bird that has breeding habitat in Europe and migrates in the winter to North Africa and the Middle East. Eight samples were collected in South Sinai, Egypt, and tested by virus isolation in embryonating chicken eggs. One sample had positive hemagglutination activity after the second passage in specific-pathogen-free embryos. Virus identification and characterization were done and the isolate was confirmed as H7N7 LPAI. The sequence data showed that this isolate was most closely related to European H7 strains isolated from domestic and wild birds.

Enhancement of reticuloendotheliosis virus-induced bursal lymphomas by serotype 2 Marek's disease virus

The effect of serotype 2 and 3 Marek's disease virus (MDV) vaccines on the pathogenesis of reticuloendotheliosis virus (REV)-induced bursal and non-bursal lymphomas was examined in chickens of RPRL lines 15I(5) X 7(1) and 6(3) X 0, respectively. At hatch, chickens were vaccinated with strain 301B/1 of serotype 2 MDV or strain FC126 of turkey herpesvirus (HVT), a serotype 3 MDV and inoculated with spleen necrosis virus (SNV), a non-defective strain of REV. In another experiment, bursas from 14-week-old 15I(1) X 7(1) chickens coinfected with strain 301B of serotype 2 MDV and SNV strain of REV at hatch were examined microscopically for REV-induced transformed follicles by methyl green pyronin stain and for the presence of MDV by in situ hybridization. The incidence of REV-induced bursal lymphomas was significantly higher in 15I(5) X 7(1) chickens vaccinated with serotype 2 MDV than in unvaccinated chickens or chickens vaccinated with HVT. On the other hand, the incidence of REV induced nonbursal lymphoma in chickens of line 63 X 0 vaccinated with serotype 2 MDV was comparable to that in unvaccinated chickens or chickens vaccinated with HVT. The average number of hyperplastic follicles in bursas from REV-infected 15I(5) X 7(1) chickens was significantly higher in chickens vaccinated with serotype 2 MDV than that in unvaccinated chickens or chickens vaccinated with HVT, and the MDV was more frequently detected in REV-transformed than in untransformed bursal follicles. Data from this study suggest that serotype 2, but not serotype 3, of MDV may enhance the development of REV-induced bursal lymphomas, and that neither serotype 2 nor serotype 3 MDV influence the development of REV-induced nonbursal lymphomas. The data also suggest that the enhancement effects of serotype 2 MDV on REV bursal lymphomas may be at the stage of formation of hyperplastic or transformed bursal follicles.

Genetic resistance of Egyptian chickens to infectious bursal disease and Newcastle disease

Genetic resistance of native Egyptian breeds to very virulent infectious bursal disease virus (vvIBDV) and Newcastle disease virus (NDV) was investigated in two experiments. In the first experiment, birds from four breeds (Gimmizah, Sina, Dandrawi and Mandarah) were challenged with vvIBDV. The Mandarah chickens had the lowest mortalities (10%) compared to the Gimmizah, Sina and Dandrawi chickens (55%, 35%, and 55%, respectively). Antibody response, lymphocyte response to mitogen, and bursal lesions did not clearly correlate with the mortality rates. In the second experiment, the four chicken breeds were challenged with virulent NDV. The Mandarah chickens re-emerged as a resistant breed (20%, mortality), while the Sina, Dandrawi and Gimmizah breeds were highly susceptible (85%, 100% and 100% mortality, respectively). Further studies on the resistance mechanism are warranted.

Anisakis and fish induced urticaria

Skin tests using prepared Anisakis antigen and commercially available fish antigen were done. Also, specific IgE detection for Anisakis was done by RAST method. Two patients out of 20 showed positive skin test and positive RAST to larval Anisakis antigen, and negative skin test to fish antigen. These 2 patients were considered hypersensitive to Anisakis.

The use of colchicine in treatment of experimental toxoplasmosis

Colchicine was given in 2 doses (3 and 15 micrograms/mouse) at the time of infection or 48 hours late. It proved effective in both doses, but better results were obtained with early treatment. The mortality rates were 30% & 30%, and Toxoplasma carriers among the surviving mice was 28.6% and 42.9% with high and low doses respectively. When the treatment was given 48 hours after infection, the mortality rates were 50% and 60%, Toxoplasma carriers were 40% and 50% with high and low doses respectively.

Development of Eimeria stiedae in a non-specific host

Infection with E. stiedae was established in immunocompromised mice given dexamethasone for ten days prior to the infection and for two weeks later. The infection was similar to that of rabbits as regard the pathological and clinical picture.

Synthesis and antimicrobial activity of some new 2,5-imidazolidinediones

1,3-Diphenyl-4-thione-2,5-imidazolidinedione (3) was reacted with amino compounds and o-diamines to give 1,3-diphenyl-4-substituted imino-2,5-imidazolinediones (4a-m) and 1,3-diphenyl-1H-imidazo[4,5-b]quinoxaline-2(3H)-ones (5a-c), respectively. Condensation of 3 with hydrazines afforded the corresponding hydrazone derivatives (6a-c). Reaction of 6a with acetyl chloride, aromatic aldehydes, arylsulphonyl chlorides, phthalic acid anhydrides and isocyanates or thiocyanates furnished 6d, furnished the acetyl-amido derivative 6b, the benzylidenimino derivatives 7a-d, the arylsulphonamido derivatives 8a-b, the phthalimido derivatives 9a-b and the ureido and thioureido derivatives 10a-b, respectively. Again compound 3 was reacted with n-butylmagnesium bromide or diazomethane to give the dibutyl derivative 12 or 13.