Psychiatric diseases presenting as infectious diseases

BACKGROUND: Cytomegalovirus (CMV) disease is an important cause of organ transplant-related morbidity and mortality. During the last 5 years at our institution, prophylactic ganciclovir and hyperimmune globulin have been routinely administered to lung transplant recipients whenever the donor or the recipient was CMV antibody-positive. We sought to assess the efficacy of prophylaxis on viremia, CMV disease, and bronchiolitis obliterans syndrome (BOS). METHODS: A retrospective chart review of 61 consecutive lung transplants performed between recipients between January 1993 and August 1995 was performed. Fifty-six patients who survived at least 1 month were analyzed. Patients were considered at risk for CMV disease whenever pretransplant donor or recipient serology was positive. RESULTS: Fourteen of the 39 patients at risk (36%) had viremia while on prophylaxis. The rate of CMV disease was 13% during the first 6 months following transplantation. A donor whose CMV serology was positive appeared to increase the risk of BOS in a Cox regression model (relative risk=2.4; 95% confidence interval=0.86-6.74; p=0.0957). Neither age, CMV infection (viremia or a positive specimen from BAL), recipient's serology at the time of transplantation, or CMV disease was associated with BOS. None of these variables was associated with mortality on Cox regression analysis or univariate analysis. CONCLUSIONS: Administration of combination ganciclovir and hyperimmune globulin prophylactic therapy to lung transplant recipients at risk for CMV infection and disease is associated with a relatively low incidence of disease, which appears only after prophylaxis treatment with ganciclovir is completed. Ganciclovir prophylaxis does not prevent CMV viremia; however, viremia while on prophylaxis is not predictive of disease.     

Feedlot diseases

This article includes a brief discussion of common diseases, listed by body systems, affecting feedlot cattle. Each disease is approached from a practitioner's point of view. This includes interactions with other management factors, differential list, and practical diagnostic procedures. Also included are guidelines for initiating case management before a definitive diagnosis is made.     

Ionic-channel diseases

This review illustrates several hereditary diseases caused by mutations in genes which encode various ion channels activated by voltage or neurotransmitters. Many physiological processes depend upon the proper functioning of plasma membrane ion channels and this is most apparent in absorptive and secretory epithelia, and in electrically excitable tissues such as nerve and muscle. By combining the information from electrophysiological recordings with molecular biological techniques, further insight can be gained into the gene expression and protein structure of ionic channels. This combination has resulted in a structure-function analysis revealing the molecular substructures of the ionic channels responsible for the processes of permeation and selectivity of activation and inactivation and different types of block. Using molecular biologic tools, these abnormal channels can be identified and their molecular defects defined. Advances in these areas now provide the basis for a rational approach to the classification and treatment of these disorders of membrane excitation.     

Orbital diseases

Presentation of a series of orbital diseases at the University Hospitals of Lausanne during the years 1964--1978. Diseases without exophthalmus (36), with bilateral exophthalmus (20) and with monolateral exophthalmus (128) are discussed with regard to differential diagnosis and general diagnostic procedures.     

Hair diseases

A few common causes of hair loss account for the vast majority of cases. A well-directed history and simple physical examination is often sufficient to make a diagnosis. Laboratory testing is often unnecessary. A scalp biopsy can be useful, but only if processed and interpreted correctly. Androgenetic alopecia, alopecia areata, senescent alopecia, telogen effluvium, traction alopecia, trichotillomania, and cosmetic hair damage are common causes of non-scarring alopecia. Discoid lupus erythematosus, lichen planopilaris, and central, centrifugal scarring alopecia are the most common forms of scarring hair loss.     

Prion diseases

Empathy plays a central role in social relationships, and lack of empathy has been suggested as part of expressed emotion in the relatives of patients with schizophrenia. The aim of this research is to measure empathy in the relatives of schizophrenia patients and to establish the relationship between lack of empathy and relapse. Eighty schizophrenia patients were followed up in a 2-year prospective cohort study. Relatives' empathy, defined as the ability to perceive the patient's mood state, was measured at the beginning of the study with a questionnaire given after a 10-minute interaction between the patient and his or her relative. Several other attitudinal, clinical, and social variables were also measured. A significant relationship was found between poor empathic attitude and relapse. Lack of treatment compliance, negative symptoms, unemployment, and poor premorbid adjustment were also associated with relapse. In a multivariate analysis, the association between poor empathic attitude and relapse was maintained. Statistical control of the relatives' critical attitude showed that each kind of attitude predicts relapse independently.     

Pigmentary diseases

Abnormalities of pigmentation are common and frequently produce great concern in patients presenting to primary care physicians. Although many pigmentary changes arise as a consequence of inflammatory skin disorders, it is important to differentiate a primary skin disease from postinflammatory changes. Early recognition of a pigmentary disease allows the clinician to begin appropriate therapy at a stage when medical intervention may be more effective. Although many skin disorders are mainly of cosmetic concern, the condition may be devastating psychologically, requiring the clinician to be sensitive to the overall impact of the disorder and treat it accordingly.     

Infectious diseases

Routine antenatal screening can detect some potentially serious infectious diseases or susceptibility to infection and allow intervention to prevent adverse outcomes. However, screening programmes can only be justified if appropriate criteria are met for the quality of laboratory tests and interventions. For many infections that are associated with adverse maternal or fetal effects, there are no suitable, cost-effective methods of screening or prevention. However, early diagnosis of infection in high-risk women or those with symptoms can allow preventive intervention. Acute febrile illness or other symptoms consistent with infection during pregnancy should be investigated more diligently than in a non-pregnant woman. Early diagnosis of an apparently trivial maternal infection may prevent serious fetal disease. When the diagnosis of maternal infection is made, appropriate action depends on the nature of infection and the stage of pregnancy at which it occurs. The results of serological test should be confirmed, preferably by a reference laboratory, by retesting the original specimen(s) and/or testing further specimens, as appropriate. Management decisions generally should be made in consultation with an infectious disease physician or clinical microbiologist with experience of infectious diseases in pregnancy.     

Anorectal diseases

Fracture of the tibia is a well-known, often occult cause of limping and leg pain in young children. This fracture is typically a hairline, oblique fracture of the shaft of the tibia, and in some cases the fracture can be so subtle that bone scintigraphy or follow-up radiography may be required for its detection. In addition, a variety of other fractures that are less well known and just as difficult to detect can occur in the tibia and the foot in young children. These fractures include plastic bowing and buckle-type fractures, especially of the fibula; impaction, compression, or stress (fatigue) fractures of the tibia and fibula; and fractures of the metatarsal and tarsal bones. All of these fractures can be remarkably similar to the non-displaced spiral tibial fracture in their clinical appearance and should be included under the rubric of "toddler's fracture."     

Relationships between chronic oral infectious diseases and systemic diseases

Contact-inhibited catalase-deficient fibroblast cell strain has been established from the homozygous hypocatalasemic C3H/Csb mutant mouse. This cell strain has low level of catalase enzyme activity and has normal level of enzyme activities of both glutathione peroxidase and superoxide dismutase. Catalase-deficient C3H/Csb mutant cell strain is markedly more sensitive to the toxicity of hydrogen peroxide compared to wild-type C3H/Csa cell strain. In addition, mutant cell strain is sensitive to X-rays and near-UV compared to wild-type cell strain, but shows the same sensitivities to topoisomerase II inhibitors, adriamycin and 4'-(9-acridinylamino) methanesulfon-m-anisidide (m-AMSA), and the DNA cross-linking agents, cisdiamminedichloroplatinum (II) (cis-Pt) and trans-diamminedichloroplatinum (II) (trans-Pt). These cell strains will be of use in the study of the roles which catalase plays in the intracellular prevention of DNA damage induced by oxidative stress.     

Primary immunodeficiency diseases

A substantial proportion of patients with primary immunodeficiency diseases develop tumors, particularly those of lymphoreticular system caused by Epstein-Barr virus (EBV). Primary immunodeficiency renders patients susceptible to EBV by reducing immune reactions and surveillance abilities against the virus or inducing overreaction of the responding cells to the antigens. Recent progress in molecular biology has unraveled the genes responsible for several types of primary immunodeficiency diseases. The cloning of the ATM gene demonstrated that the mutations in this gene were observed in the members of all the families affected with ataxia telangiectasia (AT), indicating the crucial role of this gene in the pathogenesis of AT. The protein encoded by the ATM gene shows a high sequence homology with several proteins which are presumed to be involved in the regulation of the cell cycle transition. Accumulating evidence indicates that AT-derived cells are sensitive to irradiation due to the abnormalities in p53-dependent cell cycle arrest at G1 phase. Thus, the ATM product may regulate the cell cycle at G1 phase in a p53-dependent manner and the defect of the gene may lead to the accumulation of cells with DNA damages, thereby causing malignant transformation.     

Collagen vascular diseases

Collagen vascular diseases are multisystem disorders that frequently affect the skin. At times, cutaneous disease is the initial manifestation. This article focuses on lupus erythematosus, dermatomyositis, and sclerodermoid syndromes.