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Yamaguchi Y, Fujita Y, Ikeda T, Mai Y, Miyazawa H, Matsumura W, Nomura T, Shimizu H. Severe Septic Vasculitis Preceding Thoracic Empyema: Staphylococcus aureus Enterotoxin Deposition in Vessel Walls as a Possible Pathomechanism. Acta Derm Venereol 2019; 99:464-465. [PMID: 30653244 DOI: 10.2340/00015555-3122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yasuyuki Yamaguchi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
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2
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Whitaker L, Priest O, Pestana IA. Necrotizing Soft Tissue Infection Complicating Levamisole-Induced Vasculitis. Am Surg 2019; 85:e145-e147. [PMID: 30947791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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3
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Smits LP, Kootte RS, Levin E, Prodan A, Fuentes S, Zoetendal EG, Wang Z, Levison BS, Cleophas MCP, Kemper EM, Dallinga-Thie GM, Groen AK, Joosten LAB, Netea MG, Stroes ESG, de Vos WM, Hazen SL, Nieuwdorp M. Effect of Vegan Fecal Microbiota Transplantation on Carnitine- and Choline-Derived Trimethylamine-N-Oxide Production and Vascular Inflammation in Patients With Metabolic Syndrome. J Am Heart Assoc 2018; 7:e008342. [PMID: 29581220 PMCID: PMC5907601 DOI: 10.1161/jaha.117.008342] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/16/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Intestinal microbiota have been found to be linked to cardiovascular disease via conversion of the dietary compounds choline and carnitine to the atherogenic metabolite TMAO (trimethylamine-N-oxide). Specifically, a vegan diet was associated with decreased plasma TMAO levels and nearly absent TMAO production on carnitine challenge. METHODS AND RESULTS We performed a double-blind randomized controlled pilot study in which 20 male metabolic syndrome patients were randomized to single lean vegan-donor or autologous fecal microbiota transplantation. At baseline and 2 weeks thereafter, we determined the ability to produce TMAO from d6-choline and d3-carnitine (eg, labeled and unlabeled TMAO in plasma and 24-hour urine after oral ingestion of 250 mg of both isotope-labeled precursor nutrients), and fecal samples were collected for analysis of microbiota composition. 18F-fluorodeoxyglucose positron emission tomography/computed tomography scans of the abdominal aorta, as well as ex vivo peripheral blood mononuclear cell cytokine production assays, were performed. At baseline, fecal microbiota composition differed significantly between vegans and metabolic syndrome patients. With vegan-donor fecal microbiota transplantation, intestinal microbiota composition in metabolic syndrome patients, as monitored by global fecal microbial community structure, changed toward a vegan profile in some of the patients; however, no functional effects from vegan-donor fecal microbiota transplantation were seen on TMAO production, abdominal aortic 18F-fluorodeoxyglucose uptake, or ex vivo cytokine production from peripheral blood mononuclear cells. CONCLUSIONS Single lean vegan-donor fecal microbiota transplantation in metabolic syndrome patients resulted in detectable changes in intestinal microbiota composition but failed to elicit changes in TMAO production capacity or parameters related to vascular inflammation. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl. Unique identifier: NTR 4338.
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Affiliation(s)
- Loek P Smits
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Ruud S Kootte
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Evgeni Levin
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Andrei Prodan
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Susana Fuentes
- Laboratory of Microbiology, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Erwin G Zoetendal
- Laboratory of Microbiology, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Zeneng Wang
- Department of Cellular and Molecular Medicine, Lerner Research Institute Cleveland Clinic, Cleveland, OH
| | - Bruce S Levison
- Department of Cellular and Molecular Medicine, Lerner Research Institute Cleveland Clinic, Cleveland, OH
- Department of Pediatrics, College of Medicine and Life Sciences, University of Toledo, OH
| | - Maartje C P Cleophas
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - E Marleen Kemper
- Department of Clinical Pharmacy, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Geesje M Dallinga-Thie
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Albert K Groen
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Willem M de Vos
- Laboratory of Microbiology, Wageningen University and Research Center, Wageningen, The Netherlands
- Immunobiology Research Program, Department of Bacteriology and Immunology, University of Helsinki, Finland
| | - Stanley L Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute Cleveland Clinic, Cleveland, OH
| | - Max Nieuwdorp
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
- Department of Internal Medicine, VUMC Free University, Amsterdam, The Netherlands
- Wallenberg Laboratory, Sahlgrenska Hospital, University of Gothenburg, Sweden
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Gensure RH, Hsu J, Federman J, Park C, Spirn MJ. COAGULASE-NEGATIVE STAPHYLOCOCCUS-INDUCED FROSTED BRANCH ANGIITIS AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTION. Retin Cases Brief Rep 2017; 11:60-62. [PMID: 26954782 DOI: 10.1097/icb.0000000000000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To describe a case of frosted branch angiitis after intravitreal ranibizumab injection. METHODS Retrospective chart review. RESULTS A patient with a history of neovascular age-related macular degeneration underwent intravitreal ranibizumab injection and subsequently developed coagulase-negative Staphylococcus endophthalmitis with findings of frosted branch angiitis. CONCLUSION Endophthalmitis presenting as frosted branch angiitis is a rare complication after intravitreal anti-vascular endothelial growth factor injection. Early recognition is critical to optimize outcomes. To our knowledge, this is the second reported case of frosted branch angiitis as a presentation of endophthalmitis with coagulase-negative Staphylococcus.
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Affiliation(s)
- Rebekah H Gensure
- *Thomas Jefferson School of Medicine, Philadelphia, Pennsylvania; and †Mid Atlantic Retina, The Retina Service of Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Moreno B, Martín-Burriel I, Bolea R, Morales M, Sanz-Rubio D, Marín B, Espada J, Badiola JJ. Pathology in Practice. J Am Vet Med Assoc 2017; 250:509-512. [PMID: 28207323 DOI: 10.2460/javma.250.5.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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6
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Jud P, Valentin T, Regauer S, Gary T, Hackl G, Rief P, Brodmann M, Hafner F. Invasive Candida krusei infection and Candida vasculitis of a leg ulcer in an immunocompetent patient: A case report. Int J Infect Dis 2017; 55:96-98. [PMID: 28104503 DOI: 10.1016/j.ijid.2017.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 12/27/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022] Open
Abstract
A 71year old female Caucasian farmer without any known immunosuppression presented with a painful ulcer of her right lower leg after a trauma caused by a wood billet. There was no response to empirical antibacterial treatment. An ulcer biopsy showed an invasive Candida infection of the soft tissue and leucocytoclastic vasculitis. Voriconazole treatment was followed by wound healing. Invasive Candida infection and localized Candida vasculitis represent a rare cause of persisting leg ulcers. The similar clinical picture of chronic venous leg ulcers might blur the true cause and refractory cases should therefore promptly be processed by histopathological diagnostics.
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Affiliation(s)
- Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sigrid Regauer
- Institute of Pathology, Medical University Graz, Graz, Austria
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Rief
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Lee J, Kim DM, Yun NR, Kim YD, Park CG, Kim MW. The Correlation of Endoscopic Findings and Clinical Features in Korean Patients with Scrub Typhus: A Cohort Study. PLoS One 2016; 11:e0155810. [PMID: 27195943 PMCID: PMC4873011 DOI: 10.1371/journal.pone.0155810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/04/2016] [Indexed: 11/18/2022] Open
Abstract
Scrub typhus is an infectious disease caused by Orientia tsutsugamushi-induced systemic vasculitis, but the involvement of the gastrointestinal tract and the endoscopic findings associated with scrub typhus are not well understood. We performed a prospective study and recommend performing esophagogastroduodenoscopy (EGD) for all possible scrub typhus patients, regardless of gastrointestinal symptoms. Gastrointestinal symptoms, endoscopic findings and clinical severity based on organ involvement and ICU admission were analyzed. Gastrointestinal symptoms occurred in up to 76.4% of scrub typhus patients. The major endoscopic findings were ulcers (43/127, 33.9%). Interestingly, 7.1% (9/127) of the patients presented with esophageal candidiasis. There was no correlation between the presence or absence of gastrointestinal symptoms and the endoscopic grade (P = 0.995). However, there was a positive correlation between the clinical severity and the endoscopic findings (P = 0.001). Sixty-three percent of the patients presented with erosion or ulcers on prospectively performed endoscopic evaluations, irrespective of gastrointestinal symptoms. Gastrointestinal symptoms did not reflect the need for endoscopy. Scrub typhus patients could have significant endoscopic abnormalities even in the absence of gastrointestinal symptoms.
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Affiliation(s)
- Jun Lee
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Dong-Min Kim
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
- * E-mail:
| | - Na Ra Yun
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Young Dae Kim
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Chan Guk Park
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Man Woo Kim
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
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Affiliation(s)
- Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Suhnggwon Kim
- Research Institute of Salt and Health, Seoul K-Clinic, Seoul, Korea
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Satta R, Biondi G. Vasculitis and infectious diseases. GIORN ITAL DERMAT V 2015; 150:211-220. [PMID: 25876145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Vasculitis usually presents without a well-known underline cause (idiopathic vasculitis), nevertheless, it is sometimes possible to find out one or more causative agents (secondary vasculitis). Nowadays, thanks to the increasing amount of precise diagnostic tools, a piece of idiopathic vasculitis is reclassified as associated with probable etiology, which can be set off by several factors, such as infections. Infections are considered to be the most common cause of secondary vasculitis. Virtually, every infectious agent can trigger a vasculitis by different mechanisms which can be divided in two main categories: direct and indirect. In the former, infectious agents destroy directly the vascular wall leading, eventually, to a subsequent inflammatory response. In the latter, indirect form, they stimulate an immune response against blood vessels. Different infectious agents are able to directly damage the vascular wall. Among these, it is possible to recognize Staphylococcus spp, Streptococcus spp, Salmonella spp, Treponema spp, Rickettsia spp, Cytomegalovirus, Herpes Simplex Virus 1 and 2, and many others which have a peculiar tropism for endothelial cells. Conversely, another group of microbial agents, such as Mycobacterium tuberculosis, Mycobacterium leprae, Hepatits B Virus, Human Immunodeficiency Virus and others, trigger vasculitis in the indirect way. This is due to the fact that they can share epitopes with the host or modify self-antigens, thus leading to a cross-self reaction of the immune system. These mechanism, in turn, leads to immunological responses classified as type I-IV by Gell-Coombs. Nevertheless, it is difficult to strictly separate the direct and indirect forms, because most infectious agents can cause vasculitis in both ways (mixed forms). This paper will analyze the link between infectious agents and vasculitis, focusing on direct and indirect secondary vasculitis, and on a group of probable infection-related idiopathic vasculitis, and finally on a group of idiopathic vasculitis with microbiological triggers. Furthermore, a diagnostic and therapeutic approach to vasculitis when an underline infection has been suspected is suggested.
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Affiliation(s)
- R Satta
- Department of Surgical, Microsurgical and Medical Sciences, Dermatology University of Sassari, Sassari, Italy -
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Tomasini C. Septic vasculitis and vasculopathy in some infectious emergencies: the perspective of the histopathologist. GIORN ITAL DERMAT V 2015; 150:73-85. [PMID: 25592669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sepsis is a potentially life-threatening complication of an infection where cutaneous lesions often represent one of the early signs. A myriad of microorganisms including bacteria, fungi, yeasts, viruses, protozoas, helminths and algae can be implicated. A broad spectrum of clinical and histopathologic findings can be observed in the skin and the common denominator is a thrombotic vasculopathy. The pathogenesis of cutaneous septic vasculitis (SV)/vasculopathy is complex and includes five main mechanisms: disseminated intravascular coagulation, direct invasion and occlusion of blood vessel walls by microorganisms, hypersensitivity reaction with immune complex deposition into blood vessel walls, embolism from a distant infectious site and vascular effects of toxins. Herein we describe the clinicopathologic findings of some selected cases of SV recently observed in our hospital, including purpura fulminans, necrotizing fasciitis, cutaneous meningococcemia, malignant syphilis and disseminated alternaria infection. Histopathologically, a wide spectrum of histopathologic changes was observed in skin specimens from the various entities, involving the intensity and composition of the inflammatory infiltrate, the degree of vascular changes and the presence of microorganisms, that ranged from a predominant not inflammatory, thrombotic-occlusive vasculopathy in purpura fulminans to leukocytoclastic vasculitis like changes in cutaneous meningococcemia to a dermal angiomatosis-like pattern in disseminated Alternaria infection. The different pathologic presentations may be related to the microorganism involved, the main pathogenetic mechanism that induced the vascular injury and the individual immunologic burden. Early skin biopsy for histopathologic examination and microbiologic culture is a cornerstone in the diagnosis of life-threatening diseases that present with cutaneous septic vasculitis. Ancillary techniques, such as immunohistochemistry and polymerase chain reaction are additional novel and helpful tools to identify pathogens, leading to definite diagnosis in cases with challenging or ambiguous clinical and/or pathologic findings.
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Affiliation(s)
- C Tomasini
- Department of Medical Sciences and Human Oncology, Azienda Ospedaliero‑Universitaria, Città della Salute e della Scienza, Turin, Italy -
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Garriga-Grimau L, Laveglia V. Gammaglobulin treatment in an unusual meningococcal case. Indian J Pediatr 2014; 81:628. [PMID: 24057970 DOI: 10.1007/s12098-013-1226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/14/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Laura Garriga-Grimau
- Department of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma Barcelona, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain,
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12
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Rodríguez-Alvarez R, Goikoetxea J, García M, Figueras Y, Hernández L, Montejo M. [Endovascular Campylobacter infections: report of two cases]. Rev Esp Quimioter 2014; 27:127-129. [PMID: 24940895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Regino Rodríguez-Alvarez
- Miguel Montejo, Unidad de Enfermedades Infecciosas. Hospital Universitario Cruces. Plaza Cruces S/N, 48903 Barakaldo. Bizkaia. Spain.
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Abstract
Autoimmune skin diseases are characterized by dysregulation of the immune system resulting in a loss of tolerance to skin self-antigen(s). The prolonged interaction between the bacterium and host immune mechanisms makes Helicobacter pylori (H. pylori) a plausible infectious agent for triggering autoimmunity. Epidemiological and experimental data now point to a strong relation of H. pylori infection on the development of many extragastric diseases, including several allergic and autoimmune diseases. H. pylori antigens activate cross-reactive T cells and induce autoantibodies production. Microbial heat shock proteins (HSP) play an important role of in the pathogenesis of autoimmune diseases because of the high level of sequence homology with human HSP. Eradication of H. pylori infection has been shown to be effective in some patients with chronic autoimmune urticaria, psoriasis, alopecia areata and Schoenlein-Henoch purpura. There is conflicting and controversial data regarding the association of H. pylori infection with Behçet’s disease, scleroderma and autoimmune bullous diseases. No data are available evaluating the association of H. pylori infection with other skin autoimmune diseases, such as vitiligo, cutaneous lupus erythematosus and dermatomyositis. The epidemiological and experimental evidence for a possible role of H. pylori infection in skin autoimmune diseases are the subject of this review.
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Tada R, Yamanaka D, Nagi-Miura N, Adachi Y, Ohno N. Vasculitis and anaphylactoid shock induced in mice by cell wall extract of the fungus Candida metapsilosis. Pol J Microbiol 2014; 63:223-230. [PMID: 25115117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
To investigate whether cell wall mannan from Candida metapsilosis induces vasculitis similar to that in Kawasaki syndrome and anaphylactoid shock in mice, we examined the pathogenic effects of C. metapsilosis cell wall extracts. Our results show that intraperitoneal injection of cell wall extracts induced severe coronary arteritis, and intravenous injection induced acute anaphylactoid shock similar to extracts from Candida albicans (C. albicans). Structural analysis of cell wall mannan from C. metapsilosis using NMR spectroscopy showed it to contain only a-mannan, indicating that a-mannan might be contributing to Candida pathogenicity by inducing coronary arteritis and acute shock.
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Abstract
PURPOSE To analyse the indocyanine green angiography (ICGA) patterns of hypofluorescence that are compatible with choriocapillaritis that occur secondarily to toxoplasmic retinochoroiditis (ToRC), ocular tuberculosis (including tuberculous choroiditis, TuCR and multifocal serpiginoid choroiditis, TMSC) and syphilitic chorioretinitis (SyCR). METHODS This was a single centre, retrospective case review study. Patients with a diagnosis of ToRC, TuCR, TMSC or SyCR were identified, their charts were reviewed and fundus photographs, fluorescein angiography (FA) and ICGA pictures were assessed. RESULTS Indocyanine green angiography was performed at the initial presentation in 63 of the 105 patients with ToRC, in 37 of the 38 patients with TuCR, in six of six patients with TMSC and in two of four patients with SyCR. The following four ICGA patterns indicated choriocapillaritis: extension of hypofluorescence beyond the hypofluorescence of the actual infectious focus as seen on fundus photography or FA (seen only in ToRC and TuCR); small dark dots around the infectious focus (seen only in ToRC); multiple 'confetti-like' hypofluorescent areas or hypofluorescent geographical confluent areas (seen only in TMSC); and widespread areas of nonperfusion visible only in ICGA (seen only in SyCR). CONCLUSIONS Patients with secondary choriocapillaritis have distinct typical ICGA findings. ICGA is thus an important diagnostic tool that can provide an explanation for otherwise obscure visual loss and that might have diagnostic value for specific conditions like ToRC and SyCR.
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Affiliation(s)
- Pascal B Knecht
- Retinal and Inflammatory Eye Disease, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi, Lausanne, SwitzerlandDepartment of Ophthalmology, University Hospital Zurich, Zurich, SwitzerlandDepartment of Neurosciences, Eye Clinic, Ophthalmology and Genetics, University of Genova, Genova, ItalyUniversity of Lausanne, Lausanne, Switzerland
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Chen S, Chen J, Chen L, Zhang Q, Luo X, Zhang W. Mycobacterium tuberculosis infection is associated with the development of erythema nodosum and nodular vasculitis. PLoS One 2013; 8:e62653. [PMID: 23650522 PMCID: PMC3641092 DOI: 10.1371/journal.pone.0062653] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 03/25/2013] [Indexed: 11/25/2022] Open
Abstract
Background Mycobacterium tuberculosis (MTB) infection has been suggested to contribute to the pathogenesis of erythema nodosum (EN) and nodular vasculitis (NV), the classic forms of panniculitis. However, there is little evidence to demonstrate the presence of MTB in the skin lesions. This study is aimed at evaluating the association between MTB infection and the development of EN and NV in a Chinese population. Methods A total of 107 patients (36 EN, 27 NV, and 44 others) with vasculitis and 40 control cases with other skin diseases were recruited and their skin lesion samples were subjected to real time polymerase chain reaction (PCR) analysis of the IS6110 and mpt64 gene fragments of MTB. Their blood mononuclear cells were tested for MTB antigen-specific IFN-γ responses by QuantiFERON®-TB Gold In-Tube (IT) assays. Results PCR analysis revealed that 7/23 (30.4%) and 7/18 (38.9%) of the EN and NV samples were positive for the IS6110 DNA, respectively, which were significantly higher than 3/34 (8.8%) of other vasculitis (OV) and 3/40 (7.5%) of the control samples (p<0.05). The nested Real-Time PCR assay indicated that 6/7 (86%) of the IS6110-positive EN samples, all of the IS6110-positive NV and control samples, but only 1/3 of the IS6110-positive OV samples, were positive for the mpt64 gene. Similarly, 19/32 (59.4%) of the EN patients, 20/26 (76.9%) of the NV patients, and 17/36 (47.2%) of the OV patients were positive for MTB antigen-specific IFN-γ responses, which were significantly higher than 6/40 (15%) of the controls (p<0.05). Conclusion Our data strongly suggest that MTB infection and active TB are associated with the development of NV and EN in Chinese.
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Affiliation(s)
- Sheng’an Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiazhen Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Lianjun Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiao’an Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoqun Luo
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
- * E-mail: (XL); (WZ)
| | - Wenhong Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
- * E-mail: (XL); (WZ)
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Chen PL, Tang HJ, Ko WC. Reply to Chien et al. Clin Infect Dis 2013; 56:308-9. [PMID: 23024293 PMCID: PMC3888139 DOI: 10.1093/cid/cis835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024] Open
Affiliation(s)
- Po-Lin Chen
- Department of Internal Medicine
- Department of Medicine
- Graduate Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine
- Center for Infection Control, National Cheng Kung University Hospital
- Department of Medicine
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Kontic M, Radovanovic S, Nikolic M, Bonaci-Nikolic B. Concomitant drug- and infection-induced antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis with multispecific ANCA. Med Princ Pract 2012; 21:488-91. [PMID: 22538212 DOI: 10.1159/000337944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 03/05/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report the first case of concomitant drug- and infection-induced antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in a patient treated with propylthiouracil (PTU) and suffering from tuberculosis. PRESENTATION AND INTERVENTION A 28-year-old woman with PTU-treated hyperthyroidism presented with fever, purpura, pulmonary cavitations and ANCA to myeloperoxidase, bactericidal/permeability-increasing protein (BPI), proteinase-3 and elastase. Skin histopathology confirmed vasculitis. However, sputum examination revealed Mycobacterium tuberculosis. Remission was achieved after PTU withdrawal and treatment with antituberculosis drugs. CONCLUSION Our case confirmed that BPI-ANCA are elevated in active tuberculosis. Multispecific ANCA were helpful for the diagnosis of concomitant PTU- and M. tuberculosis-induced AAV.
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Affiliation(s)
- Milica Kontic
- Dermatology and Allergy and Clinical Immunology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Niiyama S, Funatsu S, Katsuoka K. Microscopic polyangiitis accompanied by septic vasculitis and Henoch-Schönlein purpura. Eur J Dermatol 2010; 20:811-813. [PMID: 20876040 DOI: 10.1684/ejd.2010.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Kono H, Ikewaki J, Kimoto K, Furushima M, Yae Y, Shinoda K, Nakatsuka K. Frosted branch angiitis associated with streptococcal infection: optical coherence tomography as a follow-up tool. Acta Ophthalmol 2009; 87:909-11. [PMID: 18937817 DOI: 10.1111/j.1755-3768.2008.01335.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Hirofumi Kono
- Department of Brain and Neuroscience, Division of Sensory and Locomotive Science, Ophthalmology, Faculty of Medicine, Oita University, Oita, Japan
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Abstract
Chlamydophila pneumoniae is a highly prevalent intracellular human pathogen with a unique biphasic life cycle. It is a common cause of upper respiratory infection and pneumonia, and is currently being studied as a potential risk factor for the development of atherosclerotic cardiovascular disease. The outer membrane surface antigens of C. pneumoniae are highly complex: some, such as the major outer membrane protein, are specific, but poorly immunodominant, whereas others have stronger immunogenicity, but are cross-reactive among Chlamydia species. Therefore, new, highly immunodominant, species-specific antigens should be sought. In this regard, the polymorphic membrane proteins (PMPs) are a) unique to Chlamydiae, b) often exposed on the surface of the bacteria, and c) highly immunogenic; these factors make them potential candidates for application in laboratory assays. Other chlamydial antigens, such as heat shock protein (HSP) 60, have been associated with atherosclerotic lesions because of their ability to induce an immunological attack on the endothelial wall. Over the last decade, several studies have suggested a potential role of chronic C. pneumoniae infection in human atherosclerosis. Nevertheless, prospective studies with sufficiently large samples and a healthy comparison group, using a combination of direct and indirect microbiological techniques in the same subject and sample, are needed to establish a relationship between the infection and disease activity.
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Affiliation(s)
- Enrique Villegas
- Departamento de Microbiología, Universidad de Granada, Granada, Spain
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Abstract
INTRODUCTION Lyme disease is a multisystemic disease with protean ocular manifestations. We describe the occurrence of inflammatory choroidal neovascular membrane (CNVM) in two patients suffering from presumed Lyme disease. METHODS Descriptive review of the clinical records of two patients. RESULTS Patient 1: 16-year-old healthy male presenting with a visual acuity of counting fingers [oculus dexter (OD)] and 6/6 [oculus sinister (OS)] 3 months after a tick bite. He had papillitis and an exudative subretinal macular lesion OD. Treatment was started with intravenous (IV) ceftriaxone; a week later, IV methylprednisolone was administered with a tapering dose of oral steroids thereafter. Three months later, VA had improved to 3/60 OD. Patient 2: 38-year-old healthy female presenting with reduced left-eye vision (6/24) 6 weeks after a tick bite. She also suffered from erythema migrans and arthralgias. She had left-eye papillitis, macular haemorrhages and vascular sheathing. Treatment was started with IV ceftriaxone. One month later, there was profound loss of vision with development of CNVM. Treatment was declined by the patient and eventually retinal fibrosis developed. CONCLUSION Inflammatory CNVM has not been described previously in the setting of ocular Lyme borreliosis. We herein describe the occurrence of inflammatory CNVM in two patients whose diagnosis with Lyme disease was clinically based--both were sero-negative. Visual outcome in the two patients was profoundly impaired because of the ensuing macular scar.
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Affiliation(s)
- Radgonde Amer
- Department of Ophthalmology, Aberdeen Royal Infirmary, University of Aberdeen, Foresterhill, UK.
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Abstract
Vasculitis may be associated with infection, immunization or anti-microbial drugs. Infections are responsible for a number of different types of vasculitis. Conversely, patients with vasculitis may develop infections, which sometimes mimic relapse. The aim of this review is to summarize the various aspects of the inter-relationship between vasculitis and infection, and the physiopathological mechanisms involved, in light of our current knowledge from animal models. Currently, a causal relationship between infection and vasculitis has only been established in a few instances and many mechanisms remain hypothetical. This inter-relationship is further assessed from the point of view of clinical presentation and therapeutic options, based on case reports and prospective observational data.
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Del Giudice P. Microscopic polyangiitis or septic vasculitis? Clin Exp Rheumatol 2008; 26:511; author reply 511. [PMID: 18578983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Avcin T, Canova M, Guilpain P, Guillevin L, Kallenberg CGM, Tincani A, Tonon M, Zampieri S, Doria A. Infections, connective tissue diseases and vasculitis. Clin Exp Rheumatol 2008; 26:S18-S26. [PMID: 18570750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In genetically predisposed individuals, viruses, bacteria, or parasitic infectious agents are suspected of inducing autoimmunity and/or exacerbating autoimmune rheumatic diseases (ARD) once self-tolerance is broken. Although direct evidence for this association is still lacking, numerous data from animal models as well as from humans support the hypothesis of a direct contribution of pathogens to the induction of several ARD. This review focuses on the possible role of infectious agents as triggers of autoimmunity in systemic lupus erythematosus, polymyositis-dermatomyositis, antiphospholipid antibody syndrome, and primary vasculitis. Indeed, vasculitis may be a clinical manifestation of an infectious disease (secondary vasculitis). In addition, immune response abnormalities and immunosuppressive medications may be responsible for the high percentage of infectious complications in ARD patients. Recent therapeutic approaches aimed at lowering doses of cytotoxic agents and shortening duration of treatment with the most toxic drugs, have proved to be as effective as conventional regimens. New drugs and strategies aimed at preventing infections could further improve the outcome of ARD patients.
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Affiliation(s)
- T Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Center Ljubljana, Slovenia
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Fonseca-Reyes S, López Maldonado FJ, Miranda-Ackerman RC, Vélez-Gómez E, Alvarez-Iñiguez P, Velarde-Rivera FA, Ascensio-Esparza EP. Extracutaneous sporotrichosis in a patient with liver cirrhosis. Rev Iberoam Micol 2007; 24:41-3. [PMID: 17592891 DOI: 10.1016/s1130-1406(07)70010-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We report an unusual case of disseminated cutaneous sporotrichosis with oral mucous and tracheal involvement in a forty-year-old male with a history of heavy drinking and liver cirrhosis. We also review the literature and other similar published cases.
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Affiliation(s)
- Salvador Fonseca-Reyes
- Department of Internal Medicine, Hospital Civil Dr Juan I Menchaca, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Jalisco, Mexico.
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31
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Abstract
AbstractEndothelial cells were once viewed as relatively inert cells lining the vasculature. They are now recognized as active and responsive regulators of coagulation, platelet adhesion, fluid homeostasis, wound healing, leukocyte extravasation and vascular tone. Endothelial cells play a key role in the host response to infectious agents by regulating leukocyte trafficking, producing inflammatory cytokines and presenting antigen in association with major histocompatibility class II (MHC II) molecules. A number of infectious agents have a tropism for endothelial cells. Infection of endothelial cells can promote thrombosis, vascular leakage, and increased adherence and emigration of leukocytes. Furthermore, activation of a systemic inflammatory response, in the absence of direct endothelial cell infection, can also lead to endothelial cell dysfunction. The purpose of this review is to highlight the interactions between endothelial cells and infectious or inflammatory agents that contribute to coagulation disturbances, vasculitis and edema. A select group of viral and bacterial pathogens will be used as examples to demonstrate how endothelial cell dysfunction contributes to the pathogenesis of infectious and inflammatory disorders.
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Affiliation(s)
- E Behling-Kelly
- Department of Pathobiological Sciences, University of Wisconsin, School of Veterinary Medicine, 2015 Linden Drive, Madsion, WI 53706, USA
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32
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Abstract
Mycoplasma pneumoniae is an important bacterial agent that causes pneumonia in pediatric patients; it can also affect other organs or systems. Extrapulmonary manifestations include neurological, cardiac, hematologic, renal, gastrointestinal, osteoarticular, cutaneous, and ocular involvement. This report presents a 7-year-old male affected with cutaneous and retinal vasculitis due to M pneumoniae infection without pulmonary detection. The available literature on cutaneous vasculitis and M pneumoniae infection is also reviewed.
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Affiliation(s)
- Filippo Greco
- Department of Pediatrics, University of Catania, Catania, Italy.
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Abstract
A 50-year-old man with alcoholic liver disease presented with fever, tenosynovitis, polyarthritis and a vasculitic rash on the hands and feet for 4 days. He had neutrophilia and raised inflammatory markers. He had no history of sore throat, urethral discharge or travel abroad. His initial blood cultures were negative, and he was treated for vasculitis with steroids. The rash and arthritis seemed to improve initially, but he had another episode of fever. Repeat blood cultures grew Neisseria gonorrhoeae,and he received intravenous ceftriaxone followed by oral ciprofloxacin. He had marked improvement in rash, tenosynovitis and arthritis, and the fever dropped. He also had chlamydial urethritis and received azithromycin. The presentation of disseminated gonococcal infection after a presumptive episode of asymptomatic urethral gonorrhoea is highlighted.
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Affiliation(s)
- Sangita Jain
- Department of Microbiology, Mid Staffordshire General Hospital, Stafford, Staffordshire, UK.
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Sánchez J, Souriau A, Buendía AJ, Arricau-Bouvery N, Martínez CM, Salinas J, Rodolakis A, Navarro JA. Experimental Coxiella burnetii infection in pregnant goats: a histopathological and immunohistochemical study. J Comp Pathol 2006; 135:108-115. [PMID: 16997003 DOI: 10.1016/j.jcpa.2006.06.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Accepted: 06/10/2006] [Indexed: 11/27/2022]
Abstract
Pregnant goats were inoculated subcutaneosly with Coxiella burnetii and the course of infection was studied. Abortion in the last third of pregnancy occurred in all infected animals. Tissues from the placenta and other organs were studied before and after abortion by immunohistochemistry and PCR analysis. After infection, mild lesions were observed in several maternal organs, mainly the mammary gland but also the lung and the liver. The trophoblast cells of the choriallantoic membrane were the first target cells of the placenta; there was, however, a substantial delay between initial infection and placental colonization. In the last weeks of pregnancy, just before abortion, massive bacterial multiplication was detected in the placenta. In this stage of infection a necrotic and suppurative placentitis separated the fetal trophoblast cells from maternal syncytial epithelium. Vasculitis was observed in the fetal mesenchyme. A strong maternal T-cell response was detected in the inter-placentomal areas but not in the placentomes, where only neutrophils and smaller numbers of macrophages were associated with the lesions. Neither lesions nor C. burnetii DNA were found in maternal organs in animals maintained until day 120 post-abortion.
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Affiliation(s)
- J Sánchez
- Departamento de Anatomía y Anatomía Patológica Comparadas.
| | - A Souriau
- Pathologie Infectieuse et Immunologie, INRA, Tours-Nouzilly, 37380 Nouzilly, France
| | - A J Buendía
- Departamento de Anatomía y Anatomía Patológica Comparadas
| | - N Arricau-Bouvery
- Pathologie Infectieuse et Immunologie, INRA, Tours-Nouzilly, 37380 Nouzilly, France
| | - C M Martínez
- Departamento de Anatomía y Anatomía Patológica Comparadas
| | - J Salinas
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de Murcia, Campus de Espinardo, 30100 Murcia, Spain
| | - A Rodolakis
- Pathologie Infectieuse et Immunologie, INRA, Tours-Nouzilly, 37380 Nouzilly, France
| | - J A Navarro
- Departamento de Anatomía y Anatomía Patológica Comparadas
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Mercadal L, Hulot JS, Isnard-Bagnis C, Baumelou A, Beaufils H, Deray G. Favorable outcome of IgA nephropathy on antituberculous treatment. MINERVA UROL NEFROL 2006; 58:355-7. [PMID: 17268402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We report the case of an association of IgA nephropathy and tuberculosis with superimposed vasculitis lesions on the renal biopsy. Three previous cases of the same association are discussed. The nephropathy had a favorable course in all of these cases on antituberculous treatment only. Tuberculosis is another infection related to IgA nephropathy.
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Affiliation(s)
- L Mercadal
- Department of Nephrology, Pitié-Salpétrière Hospital, Paris, France.
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Snowden MJ, McAlindon TE, Morosan CG, Lo GH. Small vessel vasculitis in a patient with botryomycosis. J Rheumatol 2006; 33:2545-7. [PMID: 17143990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We describe a 53 year-old woman with primary biliary cirrhosis presenting with left ankle swelling and a purpuric rash. The skin biopsy of the rash revealed a small vessel vasculitis and a botryomycosis with Splendore-Hoeppli phenomenon. Botryomycosis is an uncommon histologic finding of a chronic suppurative bacterial infection whereby bacteria form aggregates, which are surrounded by an eosinophilic matrix. With guidance from the skin biopsy findings, the patient was appropriately treated with antibiotics, resulting in complete resolution of symptoms.
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Affiliation(s)
- Monica J Snowden
- Division of Rheumatology, Tufts University, Boston, Massachusetts 02111, USA
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37
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Kramer J, Hennig H, Lensing C, Krüger S, Helmchen U, Steinhoff J, Dodt C. Multi-organ affecting CMV-associated cryoglobulinemic vasculitis. Clin Nephrol 2006; 66:284-90. [PMID: 17063996 DOI: 10.5414/cnp66284] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report on a 67-year-old female patient who was admitted to our intensive care unit with acute renal failure and severe hypoxemia. Transiently, the patient had to be treated with kidney replacement therapies and artificial ventilation. The actual illness started with general weakness, recurrent bloody diarrhea and intermittent dermatitis of the lower legs. Skin symptoms were initially observed 2 years before the actual clinical findings. The bloody diarrhea was attributed to an inflammatory stenosis of the sigma. The life-threatening clinical aggravation was due to diffuse alveolar hemorrhage and alveolitis. In the search for the cause of the systemic disease, both a monoclonal y-globulinemia, causing a cryoglobulinemia type II and an acute cytomegalovirus infection were diagnosed. Additionally, the course of the disease was complicated by a secondary antibody deficiency as well as an endocarditis of the aortic valve caused by Enterococcus faecium. A cryoglobulinemic vasculitis type II was histologically found in biopsy specimen of the kidney. Thus, the present case reports on a coincidence of a monoclonal gammopathy causing a cryoglobulinemia type II with extensive organ involvement and a florid CMV infection. We hypothesize that the CMV infection has triggered the cryoglobulinemia and its particular severe organ involvement.
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Affiliation(s)
- J Kramer
- Medical Department 1, Division of Nephrology and Transplantation Unit, University Clinics of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Stavropoulos PG, Boubouka DC, Anyfantakis NV, Panagiotopoulos KA, Kostakis GP, Georgala S, Katsambas AD. Cutaneous small vessel vasculitis and pulmonary tuberculosis: an unusual association. Int J Dermatol 2006; 45:996-8. [PMID: 16911400 DOI: 10.1111/j.1365-4632.2006.02733.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Lainscak M, Hocevar A, Logar D, Beović B, Matos T, Tomsic M. Subcutaneous infection with Pseudallescheria boydii in an immunocompromised patient. Clin Rheumatol 2006; 26:1023-4. [PMID: 16572287 DOI: 10.1007/s10067-006-0263-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 02/16/2006] [Accepted: 02/22/2006] [Indexed: 10/24/2022]
Abstract
With the broad employment of immunosuppressive therapy, the incidence of Pseudallescheria boydii infections is rising. We report a first case of the localized subcutaneous P. boydii infection in a patient with microscopic polyangiitis. Favorable outcome related to the treatment with voriconazole adds to the growing body of evidence supporting the use of this particular agent in P. boydii infections.
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Affiliation(s)
- Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, 9000, Murska Sobota, Slovenia.
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41
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Abstract
An 84-year-old woman with a past medical history significant for haemolytic anaemia necessitating chronic steroid therapy presented with skin induration and erythema initially thought to be cellulitis. After a rapid progression of symptoms and failure to respond to antibiotics, a clinical diagnosis of necrotising vasculitis was made. Necrotising cryptococcal vasculitis was confirmed by histopathology and culture.
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Pagnoux C, Cohen P, Guillevin L. Vasculitides secondary to infections. Clin Exp Rheumatol 2006; 24:S71-81. [PMID: 16859600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Many viruses can be responsible for systemic vasculitis, the most frequent being hepatitis B virus-related polyarteritis nodosa (HBV-PAN), even though its incidence has decreased over the past few decades. Mixed cryoglobulinemia has been shown to be associated with hepatitis C virus (HCV) infection in more than 80% of the patients, but it remains asymptomatic in most of them with only a minority developing vasculitis. Human immunodeficiency virus (HIV), erythrovirus B19, cytomegalovirus, varicella-zoster virus and human T-cell lymphotropic virus (HTLV)-1 have also been reported to be associated with or implicated in the development of vasculitides. On the other hand, some bacteria, fungi or parasites can also cause vasculitis, mainly by direct invasion of blood vessels or septic embolization, leading, e.g., to the well-known feature of 'mycotic aneurysm'. Syphilitic aortitis and/or cerebrovascular disease and rickettsial diseases are other, more specific, bacteria-induced vasculitides. Recognizing an infectious origin of vasculitides is of great importance because treatment strategies differ from those applied to non-infectious forms. Effective antimicrobial drugs are mandatory to treat bacterial, parasitic or fungal infections, while the combination of antiviral agents and plasma exchanges has been proven to be effective against HBV-PAN. This latter strategy might also be effective against HIV-associated vasculitis and, unlike cytotoxic agents, does not jeopardize the outcome of HIV-infected patients. In the context of HCV-related cryoglobulinemic vasculitis, antiviral drugs are necessary to achieve recovery, in combination with low-dose corticosteroids and/or rituximab. In the near future, newer antiviral agents will probably also have their place in the therapeutic armamentarium for these patients.
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Affiliation(s)
- C Pagnoux
- Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris 5, Paris, France.
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Kvantaliani TG, Pargalava NS, Tsiklauri PA, Abzianidze TG. [Chronic bacterial-and-viral vasculitis as a possible risk factor of disordered stability of the coronary atherosclerosis course]. Angiol Sosud Khir 2006; 12:35-9. [PMID: 17641612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In order to assess the real significance of some plasma and vascular indices in disorders of the stable course of coronary heart disease (CHD) in chronic bacterial- and viral infection-invasion, we determined the blood plasma lipid hydrogen peroxide (LHP) activity, a direct index of the lipid peroxidation degree, and measured the concentration of specific antibodies to Chlamydia pneumoniae (C. pneunoniae), herpes simplex virus type 1 (HSV-1), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) by means of the enzyme-linked immunosorbent assay (ELISA). We examined a total of 70 patients presenting with CHD combined with a concomitant infection both with a stable course of the disease (Group One) and acute coronary syndrome (Group Two), as well as 50 infected people without verified signs of coronary atherosclerosis (Group Three). The comparison group consisted of patients with CHD, being seronegative for the causative agents referred to above. The condition of the major vessels was appropriately assessed by means of duplex ultrasonography (DU). Resulting from the findings of the carried out investigation, we singled out a triad of symptoms characteristic of the transformation of the chronic infectious process into the recurrent phase, which for the CHD patients with the presence of the conventional risk factors of atherosclerosis might become a cause of the disordered stable course of the disease and development of acute ischaemic attacks. The revealed alterations seemed to have been based upon an infectious-origin inflammatory lesion of the vessels, which was duly confirmed by duplex ultrasonography.
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Affiliation(s)
- T G Kvantaliani
- Institute of Cardiology named after Academician M D Tsinamdzgvrishvili, Scientific Research Laboratory Test House of Physicians, Centre of Angiology and Vascular Surgery named after N K Bokhua, Tbilisi, Georgia
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45
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Abstract
Infection-related vasculitis constitutes the most common cause of secondary vasculitis. A great variety of microorganisms can induce directly or indirectly inflammatory vascular damage resulting in vascular occlusion, tissue ischemia, and necrosis. In the developed world hepatitis B and C-related vasculitis remain the most common clinical syndromes, while HIV-associated vasculitis remains a concern in developing countries.
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Affiliation(s)
- Omondi Oyoo
- Section of Rheumatology, Department of Medicine, LSU Health Sciences Center, New Orleans, LA 70112, USA
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Johnston SC, Zhang H, Messina LM, Lawton MT, Dean D. Chlamydia pneumoniae burden in carotid arteries is associated with upregulation of plaque interleukin-6 and elevated C-reactive protein in serum. Arterioscler Thromb Vasc Biol 2005; 25:2648-53. [PMID: 16210572 DOI: 10.1161/01.atv.0000189157.88630.d1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Chlamydia pneumoniae (Cpn) infection of vascular smooth muscle cells increases interleukin-6 (IL-6) secretion in vitro. In vivo, IL-6 stimulates liver C-reactive protein (CRP) production. Because serum levels of IL-6 and CRP are independent risk factors for stroke and myocardial infarction (MI), we investigated whether Cpn burden in carotid plaques might provide a link between plaque IL-6 expression and elevated serum levels of IL-6 and CRP. METHODS AND RESULTS Consecutive patients undergoing elective carotid endarterectomy were studied. Serum levels of CRP and IL-6 were measured before surgery. Immunohistochemistry and real-time quantitative (k)RT-PCR were used to detect Cpn and the expression of IL-6 within carotid plaques. Cpn mRNA was present in 19 (37%) of 51 patients, suggesting viable infections. These patients had evidence for infection by PCR and immunohistochemistry. The Cpn burden, measured by real-time quantitative (k)-PCR using the number of organisms normalized against the number of eukaryotic cells in the tissue, was associated with plaque expression of IL-6 (Spearman R=0.55; P<0.0001), which was associated with serum levels of IL-6 (R=0.56; P<0.0001) and CRP (R=0.80; P<0.0001). CONCLUSIONS IL-6 secretion in atherosclerotic plaques infected with Cpn could explain elevated serum inflammatory markers in individuals at risk for stroke and MI.
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Yang X, Coriolan D, Schultz K, Golenbock DT, Beasley D. Toll-like receptor 2 mediates persistent chemokine release by Chlamydia pneumoniae-infected vascular smooth muscle cells. Arterioscler Thromb Vasc Biol 2005; 25:2308-14. [PMID: 16179594 DOI: 10.1161/01.atv.0000187468.00675.a3] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The intracellular bacterium Chlamydia pneumoniae is present in many atherosclerotic lesions, where it could promote inflammation. This study determined whether monocyte chemoattractant protein 1 (MCP-1) release is stimulated in vascular smooth muscle cells (VSMCs) that are exposed to or infected by C pneumoniae and whether toll-like receptor 2 (TLR2) or TLR4 mediate these effects. METHODS AND RESULTS TLR2 mRNA was expressed constitutively and was upregulated by C pneumoniae exposure in mouse aortic SMC and was inducible by C pneumoniae and TLR3 and TLR4 agonists in human coronary artery SMCs. Exposure to inactivated or viable extracellular C pneumoniae evoked a robust increase in MCP-1 release and activated nuclear factor-kappaB and extracellular signal-regulated kinase 1/2 in wild-type and TLR4 signaling-deficient mouse aortic SMCs but not in TLR2-deficient SMCs, probably because of TLR2-mediated recognition of a chlamydial antigen. Brief exposure to viable C pneumoniae led to active infection of VSMCs, shown by chlamydial protein synthesis, and caused a persistent (>48-hour) MCP-1 release that was also TLR2 dependent. CONCLUSIONS The results show that VSMCs express functional TLR2 and that TLR2 mediates both a persistent activation of chemokine release in C pneumoniae-infected VSMCs and its acute stimulation by extracellular C pneumoniae. Therefore, TLR2 expressed in VSMCs may promote inflammation within the arterial wall.
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Affiliation(s)
- Xin Yang
- Molecular Cardiology Research Institute, Department of Medicine, Tufts-New England Medical Center, Boston, MA, USA
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48
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Kvantaliani T, Tsiklauri P, Pargalava N. Chronic bacterial-viral vasculitis as manifestation of systemic inflammatory response syndrome in females. Georgian Med News 2005:37-41. [PMID: 16234591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Study involved 52 women (mean age 43+/-1,3) without any evidence of CHD, suffering from dull or acute prolonged non-anginal chest pain, with undergoing chronic bacterial-viral infection--Chlamydia pneumonia in combination with HSV-I, CMV and/or EBV. 30--patients serum-positive to plasma markers (IgG antibodies) of previous infection were enclosed in group I, 22--with plasma consumption of IgA+IgG antibody complex demonstrating re-infection/reactivation phase of disease--in group II and 20 healthy serum-negative females (median age 47+/-2,8 years)--controls (group III). The intergroup analysis revealed the complex of disturbances in some plasma parameters of II group patients, namely significant elevation of CRP, F and LPO activity vs. I and III group data, along with reduced parameters of immune status in both groups of infected persons. The patients with mixed infections showed the high frequency of specific re-polarization phase abnormalities, cardiac rhythm and conduction disturbances. These changes together with intimate-medial wall injuries of inflammatory origin disclosed by DS technique enables us to suggest that in women with previous chronic untreated or insufficiently treated infection, in cases of their overload activity, recurrent or super-infection may provide deep immunosuppressive conditions leading to farther cardio-vascular abnormalities.
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Affiliation(s)
- T Kvantaliani
- Tsinamdzgvrishvili Institute of Cardiology, Research Laboratory 'Test-Physician's House', Center of Angiology and Vascular Surgery, Tbilisi
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Harwood CA, Stevens JC, Orton D, Bull RC, Paige D, Lessing MPA, Mortimer PS, Marsden RA, Cerio R. Chronic meningococcaemia: a forgotten meningococcal disease. Br J Dermatol 2005; 153:669-71. [PMID: 16120166 DOI: 10.1111/j.1365-2133.2005.06771.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Elkind MSV, Sciacca RR, Boden-Albala B, Tondella MLC, Feikin DR, Fields BS, Sacco RL, Di Tullio MR, Homma S. Leukocyte count is associated with reduced endothelial reactivity. Atherosclerosis 2005; 181:329-38. [PMID: 16039287 DOI: 10.1016/j.atherosclerosis.2005.01.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 11/15/2004] [Accepted: 01/18/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Leukocyte count has been associated with cardiovascular and cerebrovascular disease in several studies. We hypothesized that white blood cell count is associated with endothelial reactivity. METHODS AND RESULTS Leukocyte count was measured in a sample of stroke-free community participants undergoing brachial artery testing for endothelial reactivity. Flow-mediated dilation (FMD) during reactive hyperemia was assessed in each subject using high-resolution B-mode ultrasound. Multivariate linear regression was used to calculate the effect of leukocyte count on endothelial reactivity after adjusting for potential confounding factors. Mean age of the 868 participants was 66.7+/-8.8 years; 57% were women. Mean leukocyte count was (6.1+/-1.8)x10(9)/L. Each unit increase in leukocyte count was associated with a mean 0.18% decrease in FMD (p = 0.01). After adjusting for other atherosclerosis risk factors, including age, sex, hypertension, diabetes, hyperlipidemia, and smoking, the relationship persisted (mean decrease in FMD per unit leukocyte count = 0.17%, p = 0.02). There was a linear decrease in FMD by quartile of leukocyte count (p = 0.0014). The effect of leukocyte count on FMD was greater for women, those under age 70, and non-diabetics. CONCLUSIONS Relative elevations in leukocyte count are associated with a reduction in brachial artery endothelial reactivity. These findings are consistent with current hypotheses regarding the inflammatory or infectious etiology of risk of atherosclerosis and stroke, but also suggest interactions with demographic and other risk factors.
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Affiliation(s)
- Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Columbia University Medical Center of New York Presbyterian Hospital, New York, NY, USA.
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