Manifestations Of Chronic Infection Research Articles

Atherosclerosis as Extrahepatic Manifestation of Chronic Infection with Hepatitis C Virus.

Chronic hepatitis C virus infection is associated with significant morbidity and mortality, as a result of progression towards advanced natural course stages including cirrhosis and hepatocellular carcinoma. On the other hand, the SVR following successful therapy is generally associated with resolution of liver disease in patients without cirrhosis. Patients with cirrhosis remain at risk of life-threatening complications despite the fact that hepatic fibrosis may regress and the risk of complications such as hepatic failure and portal hypertension is reduced. Furthermore, recent data suggest that the risk of HCC and all-cause mortality is significantly reduced, but not eliminated, in cirrhotic patients who clear HCV compared to untreated patients and nonsustained virological responders. Data derived from studies have demonstrated a strong link between HCV infection and the atherogenic process. Subsequently HCV seems to represent a strong, independent risk factor for coronary heart disease, carotid atherosclerosis, stroke, and, ultimately, CVD related mortality. The advent of new direct acting antiviral therapy has dramatically increased the sustained virological response rates of hepatitis C infection. In this scenario, the cardiovascular risk has emerged and represents a major concern after the eradication of the virus which may influence the life expectancy and the quality of patients' life.

Strongyloidiasis in immigrants and refugees in Canada.

Strongyloides stercoralis is an intestinal roundworm transmitted primarily through barefoot skin exposure in the tropics or subtropics. Acute infection may present with papular rash, cough or wheezing, and gastrointestinal symptoms.[1][1] Manifestations of chronic infection are present in up to half

Lymphatic filariasis and associated morbidities in rural communities of Ogun State, Southwestern Nigeria

Lymphatic filariasis caused by Wuchereria bancrofti is a serious public health problem in rural communities of Nigeria. The study assessed the prevalence of lymphatic filariasis and associated clinical morbidities in Ado-Odo Ota Local Government Area of Ogun State. Microscopic examination of thick blood smears of 500 participants of both sexes and age ranging from 1 to 79 years was conducted. Visual observations of clinical manifestations of chronic infection were also conducted. The overall prevalence and intensity of infection were 21% and 21.4 mf/mL of blood respectively. Microfilaraemic prevalence was significantly higher in males (27.1%) than in females (16%) (P < 0.001). However, intensity of infection was not gender and age dependent (P > 0.05). The overall prevalence of all clinical manifestations of infection due to W. bancrofti is 15% with hydrocele, limb and breast elephantiasis constituting 16.9%, 4.6% and 5.1% of the total population respectively. Prevalence of hydrocele and limb elephantiasis was significantly higher in the older age groups (P < 0.05). Occurrence of elephantiasis of the breast in women however was not associated with age (P > 0.05). Integrated approach through chemotherapy and vector control is therefore advocated to reduce morbidity due to infection in this study area.

Chronic Q Fever: Different Serological Results in 3 Countries--Results of a Follow-up Study 6 Years After a Point Source Outbreak

Acute and chronic Q fever/Coxiella burnetii infection is diagnosed principally by serology. The management of patients who have serological evidence of chronic Q fever but no other manifestation of chronic infection is challenging. This paper describes a follow-up study of individuals 6 years after a point source outbreak. The study compares serological and polymerase chain reaction (PCR) results between 3 international reference laboratories in a well-defined cohort of Q fever patients. Concordance in microimmunofluorescence result interpretation from the 3 centers was only 35%. Australian and UK results had the greatest concordance and French and UK results the lowest. Serological testing revealed no chronic serological profiles when tested in either France or Australia but 10 when tested in the UK. Serological results from a patient with treated Q fever endocarditis suggested treated (France), chronic (UK), and borderline chronic (Australia) infection. PCR results on blood were universally negative. This study has shown that the results from Q fever micro-immunofluorescence vary according to the center in which they are carried out. This has implications for the interpretation of such tests, raises questions regarding the validity of using serological criteria alone as a means of diagnosing chronic Q fever, and affects the interpretation of epidemiological studies. We recommend that all results are interpreted according to the clinical picture and particular caution is applied in the interpretation of chronic serological profiles. In order to further our understanding of Q fever infection we propose that an international standard of Q fever serological investigation be developed.

Painful red nodules of the legs: A manifestation of chronic infection with gram-negative organisms

Skin infection secondary to gram-negative organisms is uncommon and is typically limited to persons who are immunocompromised. When these do occur, they are acute, progressive, and severe. Here we report 2 cases of painful red nodules that presented with a waxing and waning course over a long period. One case is that of a 45-year-old healthy white man who developed Serratia marcescens infection in 1 leg. The other case is that of a 78-year-old man with chronic lymphocytic leukemia treated with prednisone who developed infection of the leg secondary to Pseudomonas aeruginosa. In the first case, symptoms were present for 2 years before definitive diagnosis and treatment. In the second case, 4 months elapsed. Ultimately, both patients responded to antibiotic therapy and recovered. These cases illustrate an unusual presentation of chronic red painful nodules of the leg secondary to infection with gram-negative organisms and underscore the importance of culture even when infection seems unlikely. (J Am Acad Dermatol 1999;40:319-21.)

Restriction of Avian Reovirus in Primary Chicken Embryo Tendon Cells

Upon infection of the gastrointestinal tract, some avian reovirus strains spread to multiple organs of their natural hosts, chickens, and establish persistent infections. One manifestation of chronic infection is the development of arthritis in the tendons of the chickens. In order to study events associated with persistent infections in the tendon, primary cultures of chick embryo tendon (CET) cells were infected with avian reovirus. The CET cells supported a noncytopathic infection for at least 16 days, shedding lower amounts of progeny virus than a permissive cell culture, chick embryo fibroblasts (CEF). The virus from the CET cells was predominantly cell-associated unlike virus from the CEF cells. Initiation of infection was much slower in CET cells as indicated by fewer cells expressing antigen or exporting virus over the first 48 hr. However, most CET cells gained these abilities over the course of infection. Initial events in virus infection, binding, and penetration were not impaired in tendon cells but transcription of single-strand RNA was delayed and double-strand RNA production was clearly inhibited. The CET cells supported efficient replication of another avian virus, Newcastle disease virus, suggesting that restriction for avian reovirus is virus specific, in addition to being tissue specific.

Q-fever endocarditis and treatment with the fluoroquinolones

To the Editor.— Endocarditis is the most frequently reported manifestation of chronic infection with Coxiella burnetii . Many antibiotic regimens have been tried against Q-fever endocarditis with variable success. Recently, the fluoroquinolones have been suggested useful in the treatment of chronic Q-fever infection, such as endocarditis. 1 We report a case of Q-fever endocarditis, in which the treatment with pefloxacine has failed. Report of a Case.— A 66-year-old man was admitted in March 1989 for persistentfever. This patient had a long history of rheumatic aortic stenosis for which a Bjork's aortic valve replacement had been carried out in November 1975. He was well until November 1983, when intermittent episodes of fever began and persisted until November 1986. At this time, endocarditis was suspected and high titers of antibody to C burnetii suggested the diagnosis of Q fever. The associated treatment using rifampicine, 600 mg/d, and doxycycline, 200 mg/d was administered.

Bilateral mammary abscess and uveitis caused by brucella melitensis — Report of a case

Soft tissue locations of Brucella are a rare finding. We report the isolation of Brucella melitensis from a suspected breast tumour of a woman who also showed signs of uveitis. Three weeks after surgical drainage and despite antimicrobial therapy a new abscess developed on the other breast whose culture also yielded Brucella. As observed, unusual localization of brucellosis without previous penetrating injury may be the only manifestation of chronic infection.

On the diagnostic and prognostic significance of prolonged subfebrile temperatures

The study of prolonged subfebrile temperatures is of great practical importance, because the clinic of these temperatures is very poorly studied, we do not know the genesis of this phenomenon, and in this regard, our therapeutic measures in this kind of patients are very chaotic. Brought up on the idea that the subfebrile temperature is almost exceptional manifestation of chronic infection, our thought is unwilling to accept the possibility of its other origin. Having before him a patient with a long subfebrile fever, the practitioner tries to associate it with some chronic infection, most often with chronic malaria or tuberculosis, - especially since the complaints of such patients often easily fit into the clinical picture of one or the other of these diseases.