Infectious Entities Research Articles

What Can Mimic Multiple Sclerosis?

This article discusses mimics of multiple sclerosis (MS). Excluded in this discussion are neuromyelitis optica and vasculitis, discussed in other articles in this journal. Covered entities include posterior reversible encephalopathy syndrome, reversible vasoconstriction syndrome, acute disseminated encephalomyelitis, Sussac's Syndrome, and chronic idiopathic demyelinating polyneuropathy. There are also multiple infectious entities that mimic MS including; progressive multi-focal leukoencephalopathy (PML), Toxoplasmosis, Tuberculosis, Herpes Simplex Virus, Cytomegalovirus, Varicella zoster virus, Epstein Barr virus, Cryptococcus and Human immunodeficiency virus. In addition, there are leukoencephalopathies that can present in adulthood including Adrenoleukodystrophy, Metachromatic leukodystrophy, Cerebral autosomal dominant idiopathic leukoencephalopathy, Leigh's and Alexanders disease that could be mistaken for MS.

Etiologies of Proptosis: A review.

Proptosis, the protrusion of the eyeball from the orbit, results from a wide variety of pathologies that can be vision- or life-threatening. Clinical history, associated physical exam findings, and imaging features are all crucial in establishing the underlying etiology. The differential diagnosis is broad, and includes infectious, inflammatory, vascular, and neoplastic entities that range from benign and indolent, to malignant and aggressive. While treatment varies significantly based on the disease process, all are aimed at preserving vision, salvaging the globe, preventing disfigurement, and reducing mortality. Both internists and general ophthalmologists should be familiar with the causes of proptosis in order to initiate the work-up for, and appropriately triage, affected patients.

Post-fever retinitis - Newer concepts.

Post-fever retinitis (PFR) is an infectious or para-infectious uveitic entity caused by bacterial or viral agents and seen mainly in tropical countries. Systemic symptoms such as joint pain, skin rash are common during the febrile stage. On the basis of only clinical presentation, it is difficult to pin-point the exact etiology for PFR. Serological investigations, polymerase chain reaction, and knowledge of concurrent epidemics in the community may help to identify the etiological organism. Bacterial causes of PFR such as rickettsia and typhoid are treated with systemic antibiotics, with or without systemic steroid therapy, whereas PFR of viral causes such as chikungunya, dengue, West Nile virus, and Zika virus have no specific treatment and are managed with steroids. Nevertheless, many authors have advocated mere observation and the uveitis resolved with its natural course of the disease. In this article, we have discussed the clinical features, pathogenesis, investigations, and management of PFR.

Can Coronaviridae Viruses Reappear with their Novel Variants in Upcoming Years?

SARS-CoV2, the infectious biological entity has made havoc across the globe and created a question mark on the survival of humans. This infectious agent is a variant of SARS-CoV spread in 2003 and more dangerous than previous infectious particles belonging to the same family. Biological objects get a mutation in their genetic makeup which is either beneficial or harmful. If a mutation is useful, the entity is selected by nature for survival. Such genetic changes are continuous processes, and organisms generate their variants. In this review, we have highlighted whether this theory is true regarding SARS-CoV2 or not. We have estimated the probability of reappearance of coronaviridae members in the future with their variant forms.

Viral and subviral derived small RNAs as pathogenic determinants in plants and insects.

The phenotypic manifestations of disease induced by viruses and subviral infectious entities are the result of complex molecular interactions between host and viral factors. The viral determinants of the diseased phenotype have traditionally been sought at the level of structural or non-structural proteins. However, the discovery of RNA silencing mechanisms has led to speculations that determinants of the diseased phenotype are caused by viral nucleic acid sequences in addition to proteins. RNA silencing is a gene regulation mechanism conserved within eukaryotic kingdoms (with the exception of some yeast species), and in plants and insects it also functions as an antiviral mechanism. Non-coding RNAs of viral origin, ranging in size from 21 to 24 nucleotides (viral small interfering RNAs, vsiRNAs) accumulate in virus-infected tissues and organs, in some cases to comparable levels as the entire complement of host-encoded small interfering RNAs. Upon incorporation into RNA-induced silencing complexes, vsiRNAs can mediate cleavage or induce translational inhibition of nucleic acid targets in a sequence-specific manner. This review focuses on recent findings that suggest an increased complexity of small RNA-based interactions between virus and host. We mainly address plant viruses, but where applicable discuss insect viruses as well. Prominence is given to studies that have indisputably demonstrated that vsiRNAs determine diseased phenotype by either carrying sequence determinants or, indirectly, by altering host-gene regulatory pathways. Results from these studies suggest biotechnological applications, which are also discussed.

Fisiopatología de la elefantiasis vulvar de origen filarial. A propósito de un caso

Genital filariasis is an uncommon infectious entity in the western world. It has characteristic clinical features and a well-recognized endemic area that causes typical histological alterations.We report a case of a 32-year-old woman, a native of Mozambique, who presented with vulvar elephantiasis as a pendulous tumor with a maximum diameter of 15cm. A large part of the genital mass was resected. Microscopically, hyperkeratosis with irregular acanthosis, a notable thickening of dermis with dense fibrosis and inflammatory clusters of patchy distribution, mostly made up of plasma cells, was seen.Since the parasite was not observed, an exclusion diagnosis was made, as frequently happens with this lesion.

Cellular Spindled Histiocytic Pseudotumor: A Benign Mimic of Spindle Cell Neoplasia of the Breast.

Cellular spindled histiocytic pseudotumor (CSHPT) is an exuberant, dense histiocytic proliferation seen in the setting of mammary fat necrosis. CSHPT has a broad histologic differential diagnosis, including benign, malignant, and inflammatory etiologies. To highlight the most important histologic and immunohistochemical findings of CSHPT and provide comparisons to entities within the broad differential diagnosis. Recently published literature regarding CSHPT and other diagnostic considerations. CSHPT is a benign histiocytic proliferation with a broad differential diagnosis, for which comprehensive ancillary studies may be required to exclude malignant and infectious entities.

Radiologic Imaging of Bowel Infections

Although radiologic imaging of bowel infections is often a precursor to definitive diagnosis by endoscopy, biopsy, or stool cultures, imaging can provide critical information for diagnosis and management. Many infectious entities such as viral, bacterial, and parasitic infections can be discovered on imaging. Furthermore, imaging characterizes the extent of infection, involvement of specific bowel segments, and presence of complications in the abdomen. Utilizing a multimodality approach using ultrasound, computed tomography, and magnetic resonance imaging, we describe the spectrum of imaging findings that distinguish a number of infectious etiologies that affect the bowel, as well as differentiate from ischemic and inflammatory bowel processes.

RETRACTED ARTICLE: Childhood iron deficiency anemia leads to recurrent respiratory tract infections and gastroenteritis

Anemia affects approximately 30% of children all over the world. Acute respiratory tract infections (ARTI), urinary tract infections (UTI) and gastroenteritis (GE) are common infectious entities in children. Here, we assessed the association between anemia and development of recurrent ARTI, UTI, and GE in children. This was a case-control study in hospitalized 2–5 years old children in Professorial Pediatric Unit at Teaching Hospital Anuradhapura, Sri Lanka. An 18-month follow up was done to assess the risk factors for the development of recurrent ARTI, GE, UTI, and control presented without infections. Further, 6-month follow up done after 3-month iron supplementation to assess the occurrence of recurrences. Blood Hb concentration was measured using Drabking’s reagent. Logistic regression was used to find the risk factors for the development of recurrences. In ARTI, 121/165 (73.3%), GE, 88/124 (71%), UTI 46/96 (47.9%) and control 40/100 (40%) were having anemia. Initial ARTI group, recurrent ARTI was 24 (14.5%, p = 0.03); initial GE group: recurrent GE was 14 (11.3%, p = 0.03), recurrent ARTI was 11 (8.9%, p = 0.04); initial UTI group, development of; recurrent UTI was 8 (8.3%, p = 0.04); control, recurrent ARTI was 11 (11%, p = 0.03). Following 3-month iron supplementation reduction of recurrences was significant: initial ARTI recurrent ARTI in 90%, recurrent GE in 77.7%; initial GE recurrent GE in 83.3%, recurrent ARTI in 80%; initial UTI recurrent ARTI in 71.4% and control recurrent ARTI in 88.8%. Iron deficiency is a major type of anemia and anemic children are more prone to develop recurrent ARTI and GE. Once iron deficiency being corrected the rate of recurrent ARTI and GE was reduced. This would be a boost for policy developers to implement strategies at the community level to prevent iron deficiency in children to reduce ARTI and GE recurrences.

Diagnosis and Management of Cutaneous Tinea Infections.

To provide information about the epidemiology, clinical features, and management of cutaneous tinea infections. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After completing this continuing education activity, you should be better able to:1. Summarize the epidemiology related to cutaneous tinea infections.2. Describe the clinical features of cutaneous tinea infections.3. Identify features related to the diagnosis and management of cutaneous tinea infections. Dermatophyte or tinea infection refers to a group of superficial fungal infections of the hair, skin, and nails. Tinea infections are most commonly caused by fungi of the genus Trichophyton, Microsporum, or Epidermophyton. Cutaneous manifestations of tinea infections are seen worldwide and classified based on the affected body site. The diagnosis of these conditions is complicated by morphologic variations in presentation and overlap with other common infectious and noninfectious entities. As a result, diagnosis and appropriate management of these conditions are essential to avoid patient morbidity. This case-based review summarizes the epidemiology, relevant clinical features, microbiology, and management considerations for commonly encountered tinea infections.

RARE INFECTIONS OF THE HEAD AND NECK: A CASE SERIES

Protozoal, invasive fungal and mycobacterial infections in the head and neck region are exceedingly rare in the developed world. However, in developing countries, endemic infections may involve the oral mucosa or facial skin. Here we present three unusual infections involving these sites. Case 1: A 48-year-old male presented with difficulty in swallowing for a couple of months. Intraoral exam showed ulceration on the palate extending down to the oropharynx. Although a malignant diagnosis was favored initially, that was ruled out since a destructive lesion involving the left auricle and helix was also present. Histopathologically the case was diagnosed as leishmaniasis following identification of small oval organisms in macrophages which was confirmed with Giemsa stain. Case 2: A 38-year-old female presented with multiple nodules on the temporal skin that had been progressively enlarging over the past 2 years and hypo-pigmented skin patches. A prior biopsy was inconclusive. The repeat biopsy of the largest nodule showed presence of bright red colored bacilli on Fite staining confirming a diagnosis of leprosy. Case 3: A 19-yr-old male presented with a one year history of an extra-oral draining sinus after extraction of mandibular posteriors. Following a radiographic diagnosis of osteomyelitis, multiple courses of antibiotics were administered with no resolution and increase in the size of sequestrum. During surgical removal of sequestrum, a soft tissue mass was also noted in the vicinity. Sections from the necrotic bone and tumor-like mass showed chronic granulomatous inflammation along with septate hyphae, consistent with aspergillosis. All patients were referred to an infectious disease expert for further care. Each of this case enforces the need for histopathological awareness of infectious entities, so that appropriate treatment can be rendered.

Immunosuppressives and biologicals in uveitis: The way forward – Current concepts

Uveitis constitutes a sight-threatening group of diseases, which includes infectious and noninfectious entities. In this review, we consider the current evidence base for treatments in noninfectious uveitis including immunosuppressives and biologicals. Future treatment will require a better understanding of the mechanisms involved in autoimmune diseases and better delivery systems in order to provide targeted treatment with minimal side effects.

Bloody tears: a case of bilateral ulcerative blepharitis

Chronic blepharitis leading to bilateral ulceration is rare to encounter. A 49-year-old African American female presents with bloody tears, severe pain, and photophobia in both eyes. Clinical presentation called for ulceration on the upper lid margins with excavated wound which bled on gentle rubbing. A systemic health review in combination of the symptoms and clinical picture led to the diagnosis of severe ulcerative blepharitis. Immediate oral antibiotics were started along with topical antibiotic cream. Ulcerative blepharitis can be easily misdiagnosed with sebaceous cell carcinoma. The pathophysiology of ulcerative blepharitis points to synergy between infectious entity and inflammatory aetiology, with either bacterial or fungal microorganisms as the trigger agents. Almost all cases of ulcerative blepharitis should include a dermatological evaluation given there is a strong association between ulcerative blepharitis and atopic dermatitis.

Multimodal imaging of retinal metastasis masquerading as an acute retinal necrosis

BackgroundTo report the multimodal imaging and histology of a case of metastatic esophageal cancer with vitreoretinal involvement resembling acute retinal necrosis (ARN) in a patient receiving systemic chemotherapy.Case presentationA 69-year-old Japanese man with a history of stage 4 esophageal carcinoma, treated with three cycles of 5-fluorouracil (5-FU) and cisplatin (CDDP) chemotherapy as well as 30 sessions of radiation therapy, presented with new onset of blurry vision in the right eye (OD). Visual acuity was 20/200 OD. Fundus examination OD revealed 2+ nuclear cataract, veil-like vitreous opacity, a tractional retinal detachment, and white retinal lesions in the macula and periphery masquerading as an ARN. Due to the poor view and uncertainty regarding diagnosis, combined cataract extraction and 25 gauge pars plana vitrectomy was performed. Polymerase chain reaction and cytologic analysis were performed on the vitreous samples, which was negative for all infectious entities but positive for poorly differentiated malignant cells. The vitreous biopsy was consistent with the primary endoscopic esophageal biopsy. Ultra-wide view fundus imaging revealed multifocal white intraretinal lesions in the macula and periphery. Optical coherence tomography through these white opacities displayed hyper-reflective inner retinal lesions with no choroidal involvement, suggestive of retinal metastasis. Observation and palliative support was continued until the patient passed away 3 months after diagnosis.ConclusionRetinal metastasis may mimic infectious syndromes such as ARN and are associated with a very poor prognosis. Outside of the retina, no further central nervous system metastasis was found. 5-FU is known to cross the blood–brain-barrier but may be inadequate in preventing retinal metastasis.

Mielopatía compresiva por Mycobacterium tuberculosis en una niña de origen indígena: un caso clínico de zona endémica amazónica

Introducción. La mielopatía compresiva es ocasionada por diversidad de condiciones. Los abscesos espinales se cuentan como una de sus causas de menor incidencia, con 0.2 a 2 casos por cada 10,000 ingresos hospitalarios, según estadísticas reportadas por el Hospital General de Massachusetts. El Mycobacterium tuberculosis es el segundo patógeno más frecuentemente implicado, con 25% de los casos. Objetivo. Presentar un caso de tuberculosis espinal en edad pediátrica, que es infrecuente pero de relevancia epidemiológica. Presentación del caso. Paciente femenina de siete años de edad, procedente de área endémica amazónica, con sintomatología de compresión de médula espinal. Su historia clínica, nexos epidemiológicos y hallazgos paraclínicos y quirúrgicos llevaron al diagnóstico de tuberculosis espinal. Recibió manejo descompresivo y terapia farmacológica con tetraconjugado, con evolución favorable al momento de su egreso. Conclusiones. La tuberculosis espinal, entidad infecciosa de baja frecuencia, requiere un alto índice de sospecha y un tratamiento oportuno. Las imágenes de resonancia magnética espinal orientan el diagnóstico, confirmándose mediante el aislamiento microbiológico del bacilo. Países como Colombia, con alta endemicidad para el Mycobacterium tuberculosis y con gran proporción de su población en riesgo, deben vigilar de manera constante la tuberculosis y tener presente esta entidad dentro de los diagnósticos diferenciales a descartar. [LeguizamónCastillo DC, Espinosa-García E, Vélez-Pachón CV, CedielEcheverry M. Mielopatía compresiva por Mycobacterium tuberculosis en una niña de origen indígena: un caso clínico de zona endémica amazónica. MedUNAB. 2018;21(1):138146. doi: 10.29375/01237047.2700].

Adenocarcinoma insitu presenting as extensive crazy paving pattern: HRCT findings and review of literature

The crazy-paving pattern seen on HRCT is comprised of diffuse areas of ground glass attenuation. This imaging finding has numerous differentials including idiopathic, infectious, neoplastic and other miscellaneous entities. A 52-year-old non-smoker presented with mild to moderate dyspnoea with occasional cough and restrictive pattern on PFT. Chest radiograph showed bilateral diffuse air space opacities with crazy paving pattern on High resolution CT of the lung. This pattern has numerous differentials with pattern of lung involvement, the patient’s history and clinical findings being helpful in narrowing the diagnosis.

GROUP A STREPTOCOCCUS AND RESPIRATORY SYNCYTIAL VIRUS INFECTION COMPLICATED BY ACUTE MYOPERICARDITIS AND DIFFUSE ALVEOLAR HEMORRHAGE

SESSION TITLE: Critical Care 2 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: The incidence of acute myopericardtis (AMP) is estimated to be 1 in 10 cases per 100,000 persons, with acute viral infections accounting for most (1% to 5%) of the cases (1). Diffuse Alveolar Hemorrhage (DAH) has a spectrum of disorders associated with it, systemic vasculitis being the most frequent one (2). However, Group A streptococcus (GAS) and Respiratory syncytial virus (RSV) are rarely reported as causative pathogens of AMP or DAH. We report a case of GAS and RSV infection complicated by AMP and DAH. CASE PRESENTATION: A 36-year-old male with Addison's disease on hydrocortisone and fludrocortisone, presented with lethargy and shortness of breath for 2 days. His vital signs were significant for a temperature of 101.7°F and blood pressure of 78/53 mm/Hg. On physical exam he had neck edema, palpable tender cervical lymph nodes and tonsillar exudates bilaterally. Centor score was 4.His labs were remarkable for a leukocytosis, lactic acidosis and elevated creatinine at 1.7mg/dl. The rapid streptococcal test and RSV polymerase chain reaction were positive. Computed tomography of the neck revealed severe edema of bilateral palatine tonsils extending to aryepiglottic folds, high-grade stenosis at the level of the nasopharynx and bilateral cervical lymphadenopathy. The patient was emergently intubated for airway protection. He was administered broad spectrum antibiotics and stress dose steroids and transferred to the intensive care unit. Despite initial treatment, he clinically deteriorated and progressed to shock. An Electrocardiogram showed diffuse ST- segment elevation and PR-segment depression in V5, V6 and lead II. Troponin I was elevated at 17ng/ml. A transthoracic echocardiogram was performed which showed diffusely hypokinetic left and right ventricle suggesting a component of AMP. Colchicine was initiated. Due to progressive hypoxemia, the patient underwent bronchoscopy which revealed increasing red blood cells in sequential bronchoalveolar lavage aliquots. During a prolonged ICU course, there was gradual clinical improvement with resolution of shock, AMP and DAH. The patient was successfully extubated and had a complete recovery. DISCUSSION: GAS and RSV are frequently encountered infections that typically have an innocuous course in immunocompetent adults. However, there is a paucity of literature describing RSV or GAS in correlation with fulminant AMP and DAH. AMP and DAH are medical emergencies that can be fatal if left untreated. High index of suspicion and prompt diagnosis and treatment are crucial for complete recovery. CONCLUSIONS: We not only depict rare infectious entities through our case, but we stress the importance of considering AMP and DAH as potential life threatening complications of RSV and DAH, especially in immunocompromised adults. Reference #1: Bhaduri-McIntosh S, Prasad M, Moltedo J, Vαzquez M. Purulent pericarditis caused by group A streptococcus. Texas Heart Institute Journal. 2006;33(4):519. Reference #2: Park MS. Diffuse Alveolar Hemorrhage. Tuberculosis and Respiratory Diseases. 2013;74(4):151-162. https://doi.org/10.4046/trd.2013.74.4.151. DISCLOSURES: No relevant relationships by DHRUBAJYOTI BANDYOPADHYAY, source=Web Response No relevant relationships by Karishma Bhatia, source=Web Response No relevant relationships by Susannah Kurtz, source=Web Response No relevant relationships by James Salonia, source=Web Response

Causes of mediastinal/hilar granulomatous lymphadenitis

Granulomatous lung disease (GLD) is caused by a wide range of conditions and it is challenge for pulmonologist. A detailed history of exposures is fundamental in GDL and has been found pivotal to reach a precise diagnosis. Between September 2014 and December 2016, the distribution of patients diagnosed with granulomatous lymphadenitis in the mediastinal/hilar lymph nodes by endobronchial ultrasound (EBUS) or mediastinoscopy was analyzed. To be listed as 'confident', a diagnosis of sarcoidosis required compatible histological, radiological and clinical findings in conjunction with negative cultures. Infectious entities listed as 'confident' had either microorganisms in tissue section, positive culture, positive serology or positive antigen detection in a consistent clinical pathological setting. Granulomatous lymphadenitis was detected in 110 patients. The included 110 cases consisted of 70.9% women and median age of 53 (range 44-61) years. The final diagnosis of the patients was accepted to be sarcoidosis in 79 (71.8%), sarcoid like granulomas in 7 (6.4%), tuberculosis in 4 (3.6%), silicosis in 4 (3.6%), drug-associated granuloma in 2 (1.8%), hypersensitivity pneumonitis in 1 (0.9%), Chron disease in 1 (0.9%), unspecified in 12 (10.9%). Three patients were classified as tuberculosis based on culture. In this study, we found that the most common cause of granulomatous lymphadenitis was sarcoidosis. Contrary to expectations, the number of patients diagnosed with tuberculosis was very low.

The Periodontium as a Potential Cause of Orofacial Pain: A Comprehensive Review.

Introduction:Orofacial pain of periodontal origin has a wide range of causes, and its high prevalence and negative effect on patients' quality of life make intervention mandatory. This review provides a periodontological overview of the field of orofacial pain, focusing on the entities which involve the periodontal tissues and may be the cause of this pain or discomfort.Methods:The study comprised a literature search of these pathologies conducted in the MEDLINE/PubMed Database. Acute infectious entities such as gingival and periodontal abscesses are emergencies that require a rapid response. Periodontitis associated with endodontic processes, necrotizing periodontal disorders, desquamative gingivitis, gingival recession, and mucogingival herpetic lesions, cause mild to severe pain due to tissue destruction and loss. Other lesions that lead to periodontal discomfort include gingival enlargement and periodontal ligament strains associated with occlusal trauma, parafunctional habit and the impaction of food or foreign bodies.Conclusion:A range of therapeutic, pharmacological and surgical alternatives are available for the management of these injuries. However, the wide variety of causes of orofacial pain or periodontal discomfort may confuse the clinician during diagnosis and may lead to the wrong choice of treatment.

Viral species, viral genomes and HIV vaccine design: is the rational design of biological complexity a utopia?

A common logical confusion is prevalent in the whole of biology, namely that biological species are viewed both as an abstract category in an hierarchical classification and as a concrete kind of organism. This is partly due to the fact that the vast majority of living organisms do not have common names that differ from the Latin name of the species to which the organism belongs. However, it is somewhat astonishing that the same confusion exists in virology since every virus has a common name, different from the species name to which the virus belongs, which could be used to refer to the infectious viral entity as a concrete material object. The original 1991 ICTV definition of virus species stated that a virus species is a polythetic class of viruses and thus that a species is a class, namely a conceptual construction of the mind and not a physical, real object located in space and time. In 2013, the ICTV redefined a virus species no longer as a class but as a material object consisting of a monophyletic group of viruses that were all physically part of the species. This new definition is reminiscent of an earlier school of thought known as bionominalism which considered species to be concrete individuals rather than classes. Both bionominalism and the new ICTV definition are based on the logical fallacy of reification which treats abstractions such as classes as if they were concrete physical entities. The implications of this new ontology of virus species for virus taxonomy and for the possibility of incorporating nucleotide metagenomic sequences in the current ICTV classification is discussed.