Human and rodent hantavirus infection in New York State: public health significance of an emerging infectious disease

BACKGROUND: A case of hantavirus pulmonary syndrome with possible exposure in New York and/or Rhode Island was confirmed in February 1994. OBJECTIVE: To conduct four studies to determine the historical and geographic distribution of human and small-mammal infection with hantaviruses in New York State. METHODS: Enzyme-linked immunosorbent assays were performed on serum samples obtained from 130 humans during a 1978 babesiosis survey, 907 small mammals collected in New York State since 1984, 12 rodents collected in 1994 near the residences of the patients with hantavirus pulmonary syndrome, and 76 New York patients with acute respiratory distress syndrome-like illness (as suspected cases of hantavirus pulmonary syndrome). RESULTS: None of the human serum samples from the 1978 serosurvey showed evidence of hantavirus exposure by enzyme-linked immunosorbent assay. Statewide historical serum samples from white-footed mice showed evidence of Sin Nombre virus infection in 12.0% (97/809) and Seoul-like virus infection in 9.6% (78/809). Site-specific seropositivity rates were as high as 48.5% with Sin Nombre virus during 1 year (1984). Two of 12 mice captured near the residences of a human patient were positive for Sin Nombre virus by enzyme-linked immunosorbent assay, yet were negative for viral RNA by polymerase chain reaction. None of the patients with suspected hantavirus pulmonary syndrome was serologically reactive for Sin Nombre virus. CONCLUSIONS: We provide serologic evidence of small-mammal infection with hantaviruses in New York State as long ago as 1984. Human cases of hantavirus pulmonary syndrome are rare in New York, and data indicate that transmission to humans is probably infrequent. A unique set of host, agent, and environmental factors may be necessary to cause hantavirus pulmonary syndrome in humans.     

Moyamoya disease and pregnancy: case report and review of the literature

OBJECTIVE AND IMPORTANCE: Many female patients with moyamoya disease are of childbearing years, including those who were diagnosed before entering their childbearing years. However, there have been no extensive reviews of the management of pregnancy and delivery in association with moyamoya disease. The purpose of this report is to describe the case of a patient with moyamoya disease complicated by pregnancy and to review the literature on other such cases. CLINICAL PRESENTATION AND INTERVENTION: We report a 23-year-old primipara with moyamoya disease who delivered uneventfully by cesarean section under spinal anesthesia at 38 weeks of gestation. In the literature, 30 cases were reported of patients who had been diagnosed with moyamoya disease before pregnancy and delivery, and 23 patients who were symptomatic and were diagnosed for the first time with moyamoya disease in association with pregnancy. CONCLUSION: There is no evidence that pregnancy increases the risk of cerebrovascular accident or that bypass surgery decreases its risk. Poor prognosis of the patient or the newborn is mostly caused by cerebral hemorrhage and not by cerebral ischemia. It is important to control blood pressure and especially to avoid toxemia during pregnancy. Either cesarean section or vaginal delivery can be accomplished safely. Any anesthetic method can be used, provided special attention is given to avoiding hypocapnia, hypotension, and hypertension. Oral contraceptives should be avoided.     

Chlorambucil-induced pulmonary disease: a case report and review of the literature

This paper is a retrospection of hospitals and some outstanding physicians who lived in Pancevo, written in the honor of 50th anniversary of "Medical Review". Hospital bed capacity and the process of building hospitals have been: described briefly. Fire and wars have destroyed a lot of written evidence important for Pancevo health services. Nevertheless, the preserved sources let us read about facts that have already or will soon become part of the history of medicine. Apart from this, the paper also contains important details from the life and work of Konstantin Peici? (1802-1882), a famous physician, writer of the first Serbian original medical book "De pauperum aegrorum" (About Treating the Sick and Poor) and many other medical and fine literature works. He had worked in Pancevo for more than 30 years, but after he had retired, he moved to Budapest to become the manager of the Tekelianum in 1874. He spoke Latin, Hungarian, French, Italian, German and of course Serbian language. The paper also gives data on some other physicians: Ljubomir Nenadovi? a dentist and a writer, Jovan Jovanovi?-Zmaj, a physician and a great Serbian poet and a founder of the journal "Ziza" and assistant of the journal "Pancevac" founded in 1869, and so on. The above mentioned physicians had lived and worked in Pancevo since the first medical institution "Kontumac" was built in 1726, but then others were built too: the first civil hospital in 1803 and the first army hospital in 1830. Modern departments were built in 1965, whereas the Children's Department for Internal Diseases and the Department for Internal Diseases were built in 1974. This retrospection tried to present the history of Pancevo as well as great people from our past who worked there to our readers. They were great physicians, educators and gifted writers.     

Oerskovia xanthineolytica bacteremia in an immunocompromised host: case report and review

Oerskovia species, once thought to be nocardiform-like bacteria, have been only rarely associated with human infection. In this report we describe a case of central venous catheter-associated infection that was successfully treated with antibiotics. With the increased use of indwelling devices, these organisms may be more commonly recognized causes of infection. Appropriate antibiotic therapy appears to successfully treat oerskovia infection and may decrease the need for removal of some indwelling access devices.     

Drinking and driving in an urban setting in Kenya

A roadside alcohol prevalence survey of drivers randomly selected from the general traffic was conducted in Eldoret, Kenya. Blood alcohol concentration (BAC) data obtained by a breath test in 90% of the sample (n = 479) was analysed by demographic and travel characteristics. 19.9% had a positive breath test (BAC > or = 5 mg%), 8.4% had BACs greater than 50 mg%, and 4% exceeded 80 mg%. A greater proportion of males (20%) had been drinking compared to females (12.5%): all drivers with high BACs (> or = 50 mg%) were males. The likelihood of having consumed alcohol was greater in motorists aged 25 years and above (20.4%) than in younger drivers aged 16-24 years (15.4%), their mean BACs were also more elevated (57 mg% versus 31 mg%). In comparison to operators of public service vehicles (PSV), people driving personal cars were more than twice as likely to have been drinking: with 21.9% being BAC positive against 10.8% (OR = 2.3; 95% CI, 1.0 to 6.3, p = 0.05). Educated individuals with skilled careers tended to indulge in drink-driving to a greater extent than professional drivers (operators of public transport, taxi and heavy goods vehicles), with BAC prevalence rates of 23.7% and 15.5%, respectively. Other circumstances influencing the probability of drink-driving were number of vehicle occupants, distance to destination, road location, time of the night and whether it was a weekend or weekday. These findings are discussed in relation to the potential for promotion of relevant deterrent measures, including the establishment of an appropriate BAC legal limit for drivers in Kenya.     

Leptospirosis. Description of a clinical case and review of the literature

Leptospirosis is a world-wide diffused anthropozoonosis due to many strains of Leptospira. Initial symptoms may be mild, although in many cases severe systemic symptoms, including high fever, hypotension, etc. may be present since the beginning. In these latter circumstances, the diagnosis of leptospirosis can be very difficult because of the complexity of clinical picture especially when the history is lacking or incomplete. A case report of a 45 year-old man admitted to the hospital after severe jaundice and fever of unknown origin associated to altered mental status, renal failure and hypoxemia is presented. Because of the presence of septic shock and severe respiratory failure, the patient was transferred to the intensive care unit. The diagnostic hypothesis, based on clinical history, was confirmed by laboratory tests (leptospiral IgM antibodies detection). Therapeutical approach with the use of selected antibiotics (penicillin 24,000,000 U for day) and therapy of septic shock led to improvement of the patient's clinical conditions who was then transferred to a regular medical ward.     

Tuberculosis in the newborn: an emerging disease

During the last three years 172 diagnostic laparoscopies (DL) were performed at our department in patients with an acute abdomen of unclear causes. This corresponds to 17% of all patients who underwent operation due to an acute abdomen in the same period. Always the indication for a diagnostic laparoscopy arose then, when the cause or the localization of the acute abdomen could not be found by conventional diagnostic methods. The advantages of DL were either the confirmation (93%) or the exclusion (7%) of the diagnosis "acute abdomen", the exact localization and simultaneously a definitive operative treatment of the cause by minimal invasive interventions (n = 109/65%). In these patients with acute abdomen the main causes were acute inflammations of gallbladder (n = 48) and appendix (n = 29), ulcus perforations (n = 9) and ileus (n = 9). The conversion rate amounted to 2.7%, the postoperative complication rate to 11% and the lethality rate to 1.8% in these patients. A new indication is the so-called "bedside laparoscopy" as means to control the postoperative course of mesenteric embolism (n = 9) and diffuse peritonitis (n = 3) in order to avoid the stress of a second-look operation for these seriously ill patients or to secure the indication for relaparotomy.     

A disease management case study in infectious disease

One of the earliest attempts at risk sharing between a managed-care organization and a pharmaceutical company is the infectious disease management program developed since late 1993 by Intergroup of Arizona and Eli Lilly and Company (Indianapolis, Indiana) in conjunction with the Center for Pharmaceutical Economics at The University of Arizona (Tucson, Arizona) and other entities. In the first phase of the program, protocols were built around eight infectious disease states, and it was recognized that second-line antibiotics were often prescribed when more economical first-line antibiotics would be equally effective. The second phase of the program emphasized developing treatment algorithms focused on patient outcomes, using merged medical and pharmacy claims databases to determine the effects of the antibiotic changes. To implement the program successfully, some significant shifts in corporate, medical, and patient mind-sets had to be addressed. A primary goal was to encourage a movement from a rebate, volume-driven, cost structure to a shared-risk, appropriate-use, reimbursement method in which both managed-care and the pharmaceutical company incentives could mesh as far as possible. Over the long term, it is hoped that this project will lay the groundwork for other disease management programs for high-impact, frequently occurring diseases.     

Muscular involvement in Beh?et's disease: case report and review of the literature

Acute necrotizing myositis is described in a 22-yr-old man with clinically diagnosed Beh?et's disease. Light microscopic examination revealed a prominently granulocytic-monocytic infiltration of the muscle with severe necrosis. An infectious (bacterial, fungal or parasitic) etiology could be excluded by specific staining techniques and by immunohistochemistry. Vascular deposition of immune complexes was detected by direct immunofluorescence. Electron microscopy revealed severe structural damage and phagocytosis of muscle fibers. In the endomysium, leukocytes and occasional erythrocytes were found. Virus-like particles were not seen. The relevant literature on muscular involvement in Beh?et's disease is reviewed. It is suggested that two different stages of inflammation occur in Beh?et's disease. In the acute stage it presents as a granulocytic-monocytic necrotizing reaction developing from a neutrophil-mediated vasculitis. In the later phase lymphocytic infiltrations predominate. Despite the rare involvement of muscles the diagnosis of Beh?et's disease should be considered particularly in younger patients presenting with muscular symptoms like pain and swelling pre-dominantly of the lower extremities.     

Streptococcal pyomyositis: case report and review

Pyomyositis is most often associated with Staphylococcus aureus infections after trauma. We describe an unusual presentation of pyomyositis of the chest wall secondary to group A betahemolytic streptococcus infection in a 15-month-old child with acute abdominal symptoms. In addition, the patient had no history or evidence of trauma to the affected area. Pyomyositis presenting in this manner secondary to group A beta-hemolytic streptococcus infection in the absence of a primary varicella infection has not been previously reported.     

MURCS association: case report and review

We report on a 25 year old woman with aplasia of the Müllerian duct, unilateral renal agenesis, and anomalies of the cervicothoracic somites (MURCS association). Growth retardation and facial asymmetry were also present. A review of published reports allows MURCS association to be distinguished from related associations, sequences, and syndromes. Moreover, sporadic occurrence, the broad spectrum of associated anomalies, and the involvement of different organ systems closely related in early embryogenesis are arguments for considering MURCS association as the consequence of a developmental field defect.     

Invasive sinonasal disease due to Scopulariopsis candida: case report and review of scopulariopsosis

Sinonasal infection with fungi of the order Mucorales--termed mucormycosis or zygomycosis--is sometimes seen in immunosuppressed patients, including those with diabetic ketoacidosis and malignancy. We describe a case of invasive sinonasal infection with Scopulariopsis candida (not among the Mucorales organisms) in a 12-year-old girl who was being treated for non-Hodgkin's lymphoma. Only a few cases of invasive infection with Scopulariopsis species have been reported previously; five of six of these cases were associated with persistent or fatal disease. Our patient survived without undergoing radical surgical debridement and was treated with granulocyte colony-stimulating factor, amphotericin B, and itraconazole; chemotherapy was stopped. In vitro susceptibility testing of our patient's Scopulariopsis isolate showed that it was resistant to amphotericin B and that it was relatively susceptible to itraconazole and miconazole. The case described herein demonstrates the expanding spectrum of fungal organisms that may cause invasive sinonasal infection in immunocompromised hosts and the need for reliable antifungal susceptibility testing.     

Chylothorax: case report and review of literature

C57BL/6J-Min/+ mice, which are heterozygous for a non-sense mutation in the Apc gene, provide a model for both familial adenomatous polyposis and sporadic colon cancers. In our study, gut tumors and small intestine lymphoid nodules were counted in Min mice fed fiber-enriched diets for 6 weeks. Neither starch-free wheat bran nor resistant starch modified the number of tumors. However, short-chain fructo-oligosaccharides dramatically reduced the incidence of colon tumors and concomitantly developed gut-associated lymphoid tissue. Our experiment shows that short-chain fructo-oligosaccharides counteract advanced stages of colon carcinogenesis, possibly via stimulation of antitumoral immunity by modulation of the colonic ecosystem.     

Experiences of injectable contraceptive users in an urban setting

Anti-invasive and anti-metastatic effects of anti-integrin antibodies (against VLA-alpha 2, alpha 4, beta 1) were examined on human fibrosarcoma cells using in vitro invasion assay in a reconstituted basement membrane (Matrigel) and experimental metastatic assay in a chick embryo. The effects of anti-integrin antibodies were compared with those of RGD-containing peptides (GRGDS), which have been known as effective inhibitors of tumor cell metastasis. Although slight differences in effective concentration among antibodies were observed, invasion and metastasis were significantly inhibited by anti-integrin antibodies. The results also showed partial inhibitory effect of GRGDS on the invasion and metastasis of human fibrosarcoma cells. These results indicate that integrin receptors mediating cell-cell/cell-extracellular matrix components interactions play a key role in the invasion and metastasis of human fibrosarcoma cells.     

Splenic complications in malaria: case report and review

Clinicians are increasingly confronted with diagnosis and management of malarial complications. In nonfalciparum malaria, severe complications usually involve the spleen, most notably among them the condition termed spontaneous splenic rupture. A case of infection due to Plasmodium malariae resulting in a symptomatic splenic hematoma is presented. Malarial splenic enlargement and pathology are reviewed, as well as splenic complications such as spontaneous rupture, hematoma, hyperreactive malarial syndrome, hypersplenism, ectopic spleen, torsion, and formation of cysts. Also evaluated are the 11 reported cases of spontaneous splenic rupture in malaria in the English-language literature from 1960 to 1991. Most cases of spontaneous splenic rupture in malaria occur during acute infection and are associated with Plasmodium vivax. Lack of prior immunity to malaria appears to be a major predisposing factor. Increasingly, splenic complications are managed by supportive care and spleen-conserving procedures to avoid postoperative and asplenic morbidity.     

Unusual case of Meckel''s diverticulum: a case report and review of an atypical form of presentation

This is a review of two children who developed acute glomerulonephritis (AGN) following acute gangrenous appendicitis (AGA) with periappendicular collections. The first patient presented with AGN during the course of appendicitis. The second patient developed AGN after appendectomy. Both patients did not have any other predisposing factors. AGN resolved in both patients after massive intravenous antibiotics. This is the first report of acute appendicitis as a predisposing factor for AGN.     

A review of Lewy body disease, an emerging concept of cortical dementia

Small-diameter vascular grafts rapidly fail after implantation, due to occlusion caused by thrombosis. This problem cannot be overcome using medication. A promising improvement of graft patency is the seeding of endothelial cells (EC) on the luminal surface of the vascular graft. Conjugates of albumin and heparin, which were developed to obtain nonthrombogenic coatings, could form an ideal coating for vascular grafts. Besides presenting anticoagulant function, heparin will bind proteins with cell adhesive properties, thus facilitating adherence of EC to the graft surface. EC were able to grow to confluency on CO(2) gas plasma-treated polystyrene (PS-CO(2)) coated with albumin-heparin conjugate. CO(2) gas plasma treatment resulted in the introduction of functional groups at the surface (e.g., hydroxyl, aldehyde, carboxylic acid, and epoxide groups). Addition of albumin-heparin conjugate to the functionalized surface in an aqueous solution with pH 8.2 yielded a stable monolayer of covalently bound conjugate. The number of cells adhering and proliferating on this surface was comparable to the number of cells on fibronectin-coated PS-CO(2). However, the structure and size of EC proliferating on surface-immobilized albumin-heparin was more irregular. Long-term adherence might be improved by adding fibronectin to the albumin-heparin surface, either as a mixture with albumin-heparin or in a separate incubation step.