Positive IgG Antibodies Research Articles

Toxoplasma gondii primary infection in renal transplant recipients. Two case reports and literature review

Toxoplasmosis after solid organ transplantation is a complication associated with high morbidity and mortality. Universal prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is effective to prevent post-transplant toxoplasmosis. We report two cases of renal transplant recipients with negative antibodies against Toxoplasma gondii pretransplant who developed toxoplasmosis after TMP-SMX discontinuation. We have also performed a review of published cases of primary toxoplasmosis after renal transplantation. Of 20 cases reviewed, 11 were male and the mean age was 37.8 years (SD = 13.8). Donor serology for T. gondii was determined in 15 donors, two of them (13%) with negative immunoglobulin (Ig)G and four (27%) with positive IgG and IgM antibodies. Fever was present in 85% of primary toxoplasmosis and hematologic abnormalities were observed in 69% of the cases. Ten patients died (50%). All patients with fatal outcomes had clinical evidence of toxoplasmosis during the early post-transplant period (first 90 days), while no patient with late toxoplasmosis died (P = 0.003). Primary toxoplasmosis is associated with high mortality rates and TMP-SMX prophylaxis can delay the onset of symptoms resulting in an improvement of prognosis.

Ovine rotavirus strain LLR-85-based bovine rotavirus candidate vaccines: Construction, characterization and immunogenicity evaluation

Group A bovine rotaviruses (BRVs) are the most important cause of diarrheal diseases in neonatal calves and cause significant morbidity and mortality in the young animals, and epidemiologic surveillance of bovine rotavirus G genotypes conducted in various cattle populations throughout the world has shown that approximately 90% of the bovine rotavirus isolates belong to G6 and G10. Based on the modified Jennerian approach to immunization, we constructed and characterized a reassortant rotavirus stain, which bears a single bovine rotavirus VP7 gene encoding G genotype 6 specificity while the remaining 10 genes are derived from the ovine attenuated rotavirus LLR-85. The reassortant rotavirus strain, named as R191, and its parental virus strain LLR-85 were combined as bivalent vaccine candidates to inoculate the colostrums-deprived neonatal calves for evaluation of the immunogenicity. The calves were orally inoculated with the reassortant R191 (group 1), the parental rotavirus LLR-85 (group 2), or combined the R191 and LLR-85 (group 3), and serum specimens were detected to determine the immune response of IgG and IgA antibodies. Results showed that seroconversion to positivity for IgG and IgA antibodies occurred at postinoculation day (PID) 10 in all of the inoculated calves, and the highest titers of the serum IgG (range 1:800 to 1:6400) and IgA (range 1:800 to 1:3200) antibodies were obtained at PID 21 for all calves. Meanwhile, virus shedding was detected after inoculation, showing that the inoculated virus was positive in 2 of 77 fecal specimens (2.6%) collected from the inoculated calves during the first 7 days of oral inoculation with the rotavirus vaccine candidates. The results suggested that the rotavirus strains R191 and LLR-85 are promising bivalent vaccine candidates for the prevention of bovine G6 and G10 rotavirus infection.

Abstract 2845: Candidate genes related to CagA signal transduction pathway and risk of gastric cancer: A nested case-control study

Abstract Objectives: Cytotoxin-associated antigen (CagA) produced by Helicobacter pylori (H. pylori) plays a role in gastric carcinogenesis, but the role of genes coding proteins in the CagA pathway remains unclear. This genetic association study aimed to evaluate which genes involved in CagA signal transduction pathway are associated with gastric cancer development. Methods: By literature reviews, we selected 34 candidate genes involved in CagA signal transduction pathway and screened a total of 580 SNPs within +/- 5kbp of target gene location. Within the Korean Multi-Center Cancer Cohort (KMCC), a 100 incident gastric cancer cases were matched to a cancer-free subject by age, sex, residential area and enrollment. Both raw and permutated p-values by 10,000 permutation tests were computed using the LRT with 1 degree of freedom in the trend model. Gastric cancer risk was estimated as odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age, smoking status, H. pylori infection, and CagA IgG antibody positivity in each genetic model. Results: Twenty five SNPs in 8 genes, Erk, Dock180, C3G, Rap1, Src, CrkL, Mek and Crk, were significantly associated with gastric cancer risk in the single SNP analysis (p<0.05). Specifically, Erk rs5999749 and Dock180 rs9418677 remained significant after correction of multiple comparisons. Except for Dock180 rs9418677 and Rap1 rs17028287, most SNPs downstream CagA/Crk signaling (Dock180, C3G, Rap1 and Mek) were significantly associated with a reduced risk for gastric cancer. Conclusions: Our findings indicate that genes involved in the CagA signal transduction pathway can be major susceptible factors related to tyrosine kinase action, especially interaction with Crk. Further replication studies with wider genomic coverage and a greater number of subjects are still needed. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2845.

Serum immunoglobulin G, M and A response to Cryptosporidium parvum in Cryptosporidium-HIV co-infected patients

BackgroundCryptosporidium parvum, the protozoan parasite, causes a significant enteric disease in immunocompromised hosts such as HIV patients. The present study was aimed to compare serum IgG, IgM and IgA responses to crude soluble antigen of C. parvum in HIV seropositive and seronegative patients co-infected with Cryptosporidium and to correlate the responses with symptomatology.MethodsCryptosporidium parvum specific serum antibody (IgG, IgM and IgA) responses were assessed by ELISA in 11 HIV seropositive Cryptosporidium positive (Group I), 20 HIV seropositive Cryptosporidium negative (Group II), 10 HIV seronegative Cryptosporidium positive (Group III), 20 HIV seronegative Cryptosporidium negative healthy individuals (Group IV) and 25 patients with other parasitic diseases (Group V).ResultsA positive IgG and IgA antibody response was observed in significantly higher number of Cryptosporidium infected individuals (Gp I and III) compared to Cryptosporidium un-infected individuals (Gp II, IV and V) irrespective of HIV/immune status. Sensitivity of IgG ELISA in our study was found to be higher as compared to IgM and IgA ELISA. The number of patients with positive IgG, IgM and IgA response was not significantly different in HIV seropositive Cryptosporidium positive patients with diarrhoea when compared to patients without diarrhoea and in patients with CD4 counts <200 when compared to patients with CD4 counts >200 cells/μl.ConclusionThe study showed specific serum IgG and IgA production in patients infected with Cryptosporidium, both HIV seropositive and seronegative as compared to uninfected subjects suggesting induction of Cryptosporidium specific humoral immune response in infected subjects. However, there was no difference in number of patients with positive response in HIV seropositive or seronegative groups indicating that HIV status may not be playing significant role in modulation of Cryptosporidium specific antibody responses. The number of patients with positive IgG, IgM and IgA response was not significantly different in patients with or without history of diarrhoea thereby indicating that Cryptosporidium specific antibody responses may not be necessarily associated with protection from symptomatology.

Isolated Ptosis as Acute Ophthalmoplegia Without Ataxia, Positive for Anti-GQ1b Immunoglobulin G

Anti-GQ1b IgG antibody syndrome comprises a wide range of diseases presenting with ophthalmoplegia and ataxia. Anti-GQ1b antibodies have been strongly associated in the literature with Miller Fisher Syndrome, with acute ophthalmoplegia associated with Guillain-Barré syndrome, and with isolated ophthalmoplegia. Acute ophthalmoplegia presents as various combinations of external and internal ophthalmoplegia. Reported here is a novel case of isolated ptosis as a manifestation of ophthalmoplegia. The present finding of bilateral ptosis and areflexia with anti-GQ1b IgG antibody positivity helps confirm the existence of the syndrome. Further research is needed on diagnosis and treatment.

High‐sensitivity Detection of Autoantibodies Against Proteinase‐3 by a Novel Third‐generation Enzyme‐linked Immunosorbent Assay

The aim of this study was to evaluate a novel third-generation enzyme-linked immunosorbent assay (ELISA) for the high-sensitivity detection of autoantibodies to proteinase-3 (PR3) in patients with Wegener's granulomatosis (WG). First- and second-generation ELISA for the detection of antineutrophil cytoplasmic antibodies (ANCA) frequently demonstrate insufficient sensitivity due to inadequate presentation of autoantigenic epitopes. Human PR3 was immobilized on the solid phase of ELISA plates by anchoring technique. Anti-PR3 reactivity was measured in 34 C-ANCA positive patients with WG, 11 MPO-ANCA-positive patients with other autoimmune vasculitides, 65 patients with systemic lupus erythematosus (SLE), and 137 healthy blood donors. Thirty-three of 34 patients with WG (97.1%) showed positive anti-PR3 IgG antibody reactivity. None of 11 MPO-ANCA positive vasculitis patients, none of 137 blood donors, and 3 of 65 SLE patients expressed elevated IgG reactivity to PR3 (specificity: 98.4%). Comparison with another third-generation ELISA did not reveal different qualitative results. However, there was no significant correlation between quantitative results of both assays. Receiver operating characteristic (ROC) curve analysis revealed a significantly better assay performance compared with first (direct)- and second (capture)-generation assays (P = 0.011 and P = 0.001, respectively). Third-generation (anchor) anti-PR3 ELISA exhibit significantly higher sensitivity than previous generation assays. Anchoring of PR3 renders the granulocyte protein more autoantigenic compared with direct or capture immobilization.

Infectious Serologies and Autoantibodies in Wegener's Granulomatosis and Other Vasculitides

In this study we assess the presence of antibodies against infectious agents as well as for a variety of autoantibodies in an attempt to establish associations between various vasculitides and infections in order to shed light on the etiopathogenesis of these diseases and perhaps implicate a potential cure. Sera from patients with Wegener's granulomatosis (WG), polyarteritis nodosa, microscopic polyangiitis, Churg Strauss, and giant cell arteritis were compared to healthy control sera. Serum samples were assessed, using the Bio-Rad BioPlex 2200, for the presence of Toxoplama gondii, cytomegalovirus (CMV), Epstein-Barr virus (EBV), Treponema pallidum, and Saccharomyces cerevisiae. Hepatitis B virus (HBV), hepatitis C virus (HCV), and anti-Helicobacter pylori antibodies were assessed by ELISA. In addition, sera were tested for a panel of antibodies associated with thrombophilia as well as various autoantibodies. The prevalence of antibodies toward HCV and H. pylori was significantly higher among patients with WG. IgG antibodies toward T. gondii and IgM antibodies toward CMV were significantly more common among WG patients than among controls. WG patients exhibited more antibodies toward EBV viral capsid antigen IgG and EBV early antigen IgG compared to sera from healthy controls. In WG, positive associations were disclosed between CMV IgG antibodies and the presence of gastrointestinal manifestations and renal involvement, and there was a higher Birmingham vasculitis activity score in association with elevated titers of EBV viral capsid antigen IgG antibodies. Otorhinolaryngeal manifestations were more common in those with positive IgG antibodies for EBV early antigen. Our results unveil novel associations between WG and various infectious agents, including HCV, H. pylori, T. gondii, CMV, and EBV. In addition to putative roles in initiation and exacerbation of the vasculitic process, it seems that these infectious agents also modulate the clinical phenotype of the disease.

Anaplasma phagocytophilum Infektion bei einer Katze in der Schweiz

The following case report describes the diagnosis and therapy of a cat with an Anaplasma phagocytophilum infection. The cat from the canton of St. Gallen was presented because of lethargy and lack of appetite. The clinical symptoms established were fever and minor exsiccosis. The diagnosis of granulocytic anaplasmosis was established through microscopic evidence of inclusion bodies in neutrophil granulocytes, the detection of pathogen DNA in the blood by PCR and positive IgM and IgG antibody titers by serological testing. Following this diagnosis the cat was treated for 20 days with doxycycline. As the body temperature normalised, the activity of the cat improved while normalisation of food intake was delayed. After therapy Anaplasma phagocytophilum DNA could not be detected by PCR and a complete remission of abnormal serum chemistry and hematological parameters could be shown.

Deficient immune response to Mycoplasma pneumoniae in childhood asthma

Prospective studies have suggested that some individuals have a persistent IgM response to Mycoplasma pneumoniae infection with relatively little IgG production over many months. Persistence of the organism in patients with an allergic phenotype might predispose to the development of asthma. This study was designed to analyze the prevalence of M. pneumoniae infection and the immune response to that infection among children with asthma compared with controls. A prospective study was performed in 82 children with physician-diagnosed asthma and 98 nonasthmatic controls over a 5-year period comparing them for evidence of current or prior infection by M. pneumoniae using serology (IgG and IgM), culture, and polymerase chain reaction (PCR), and in vitro cellular responses to M. pneumoniae antigen. Similar numbers of controls (9/98) and asthmatic children (6/82) were PCR(+) for M. pneumoniae at some time during the study. IgM antibody to M. pneumoniae was detected in similar numbers of controls (21/98) and asthmatic children (18/82), but positive IgG antibody titers were detected in significantly more controls (13/98) than asthmatic children (3/82; p = 0.03). Similar numbers from each group were IgM(+) on more than one annual visit (9/98 controls and 7/82 asthmatic children). Antigen-driven proliferation and interferon (IFN) gamma production by mononuclear cells from IgM(+) controls were significantly greater than that of IgM(-) controls, but there was no difference in proliferation and IFN-gamma production by cells from IgM(+) and IgM(-) asthmatic children. These results suggest that asthmatic children have deficient cellular and humoral responses to M. pneumoniae infection compared with nonasthmatic controls.

The Usefulness of Computerized Scoring System for Assessing the Severity and Outcome of Therapy in Patients with Dengue Infection

Introduction: The clinical manifestations of dengue infection range from asymptomatic infection, undifferentiated fever, an influenza-like symptom as dengue fever (DF) to a severe, sometimes fatal disease characterized by hemorrhage and shock known as dengue hemorrhagic fever (DHF). In mild degrees of DHF (WHO grades I and II), the changes in the vital signs are minimal and transient while the severe degrees (WHO grades III and IV), also known as dengue shock syndrome (DSS), the blood pressure ranges from narrowing pulse pressure (<20 mmHg) with a characteristically elevated diastolic pressure (e.g. 100/90 mmHg) to profound shock. Bleeding diathesis is caused by vasculopathy, thrombocytopenia and coagulopathy. Vasculopathy resulting in plasma leakage is significantly found during the end of febrile stage and the toxic stage when an abrupt fall to normal or subnormal temperature occurs. The evidence of plasma leakage is manifested by hemoconcentration, hypoproteinemia, pleural effusion, ascites and shock. The toxic stage lasts 24–48 hours followed by the uneventful convalescent stage in the majority of patients. Therapy of DHF is wholly symptomatic and aims at controlling the clinical manifestations of bleeding and shock. The rate and volume of fluid replacement should be adjusted according to the rate of plasma leakage as guided by hematocrit, vital signs and urine output. Frequent monitoring of vital signs, hematocrit and urine output is necessary for evaluating the outcome of therapy. Patients who do not receive the appropriate treatment usually die within 12–24 hours after the occurrence of shock. Prolonged shock is often complicated with metabolic acidosis that may precipitate disseminated intravascular coagulation (DIC) or enhance the ongoing DIC to aggravate massive bleeding. The close monitoring of clinical manifestations and results of laboratory tests by the attending physicians and nurses is essential for favorable outcome.Methods: A computerized program of scoring system for assessing the clinical manifestations and outcome of management in patients with dengue infection, was created. It was written by Microsoft Access. Sixteen items involving vital signs of pulse rate, blood pressure, duration to achieve the pulse pressure ≥ 20 mmHg, urine output; number of bleeding site; amount of required crystalloid, colloid, packed red cells and platelet concentrate; manifestations of hepatic failure, encephalopathy, respiratory distress syndrome, reshock or requiring inotropic drugs; as well as the requirement of central line application, ventilator or dialysis, were included. The scores of 3 to 10 were given to each item with a total score of 100. The scores in each item was also classified by the severity of clinical manifestations according to the patient's age. The higher scores were given to a more severe manifestation. The total scores would be automatically shown on the computerized screen when the clinical data input was added.Results: The scoring system was retrospectively and prospectively applied to children with dengue infection whose ages ranged from 5–15 years. All patients had positive dengue-specific IgM and IgG antibodies in the acute and convalescent sera determined by capture ELISA technique. The results revealed that the scores increased accordingly with the severity of the manifestations (DF 0–10, DHF grade I 5–15, grade II 10–25, Grade III 20–50, grade IV 40–75 and DSS with reshock or uncontrolled bleeding 50–100). The case-fatality was found in patients with higher scores of 75–100.Conclusion: The computerized scoring system for assessing the severity of patients with dengue infection is helpful in the clinical practice especially for the management of high risk patients with severe degree or DSS.

Ascites consuming an exudate due to meconium peritonitis as presentation of cytomegalovirus congenital infection

UENPS.161 Ascites consuming an exudate due tomeconium peritonitis as presentation of cytomegalovirus congenital infection George Mitsiakos, Despoina Lavou⁎, Apostolos Athanasiadis, Hlias Chatziioannidis, Aggelos Dimitrakoudis, Emmanouil Roilides, Nikolaos Nikolaidis B' NICU, Aristotle University of Thessaloniki, Thessaloniki, Greece A' Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece 3rdDepartment of Paediatric, Aristotle University of Thessaloniki, Thessaloniki, Greece Background and aim Introduction: Ascites in neonates is observed in many conditions and can be biliary, urinary, chylous or caused by infection [toxoplasma, rubella, syphilis, adenovirus and extremely rarely from cytomegalovirus (CMV)]. Objective: To present a case of congenital CMV infection with ascites in utero, consuming an exudates. Materials and methods Case presentation: The neonate was born by caesarian section after a gestation of 30 weeks. Maternal history revealed an uneventful IVF pregnancy, until ultrasound scanat 17weeks showed thepresenceof fetal ascites as isolated finding and normal anatomy till delivery. Maternal serology for CMV showed positive IgG and negative IgM, prior to pregnancy, at 15th and 22nd weeks of gestation. The neonate was intubated at birth due to respiratory distress and improved rapidly with the aspiration of 150ml of peritoneal fluid, revealing the composition of an exudate. TORCH screening of the neonate showed positive IgG antibodies for CMV, increasing titres of 250 to 975 AU/ml in 15 days. Further investigations included PCR for viral DNA CMVwhich tested positive in all samples given (urine, peripheral blood, peritoneal and cerebrospinal fluid). Quantitative PCR in peripheral blood showed 103,000 copies/ml. The neonate was treated with Gancyclovir for 42 days, generally well tolerated. The neonate was systematically screened for the adverse effects of thrombocytopenia and neutropenia.

Case of Adult Mumps Infection After Renal Transplantation

Viruses are the most common cause of opportunistic infections, important complications of transplantation. Mumps infection in renal transplant recipients is uncommon. This report focused on a 23-year-old woman who received immunosuppressive therapy based on tacrolimus, prednisolone, and mycophenolate mofetil for renal transplantation. Sixteen months after transplantation, she was admitted with pain and swelling in both infra-auricular areas. Laboratory findings demonstrated positive mumps IgM and IgG antibodies and an increased serum amylase level. Computed tomography revealed both parotid glands to be diffusely enlarged. After the diagnosis of mumps parotitis, the patient's immunosuppression was reduced and the clinical course was satisfactory.

Regional UK TTP Registry: correlation with laboratory ADAMTS 13 analysis and clinical features

Thrombotic thrombocytopenic purpura (TTP) is an acute, rare, life-threatening disorder. This report presents the South East (SE) England registry for TTP, from April 2002 to December 2006, which included 176 patients and 236 acute episodes; 75% of patients were female and 25% were male, overall median age at presentation was 42 years. Mortality was 8.5%, most cases died before treatment was instigated. The main ethnic groups were Caucasian (64%) and Afro Caribbean (27%). Seventy-seven percent of cases were idiopathic, 5% were congenital and the remaining cases had a defined precipitant. Neurological features were the most prevalent, but cardiac involvement accounted for 42% of presenting features. The overall median number of plasma exchanges (PEXs) to remission was 15; between April 2002 and December 2003, the median number of PEXs was 19 and it was 12 between January 2004 and December 2006 (P < 0.0001). In the latter period, adjuvant therapies were reduced, but Rituximab was increased. ADAMTS 13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity was <10% in 74% and 95% of these cases had positive IgG antibodies to ADAMTS 13. Renal impairment and delayed normalisation of platelet count were the main differences between idiopathic and secondary TTP.

Influenza Virus Infection and Risk of Acute Myocardial Infarction

Increasing evidences have shown that pathogens might promote atherosclerosis and trigger acute myocardial infarction (AMI). But the conclusions from various studies on the correlation between previous influenza virus (IV) infection and AMI were inconsistent. We conducted a case-control study to assess the association of previous IV infection and AMI. Questionnaire survey was conducted to collect information about demographic characteristics and heart disease risk factors. Fasting blood sample was obtained to measure IgG antibodies to influenza virus A(IV-A), influenza virus B(IV-B), cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1) and type-2 (HSV-2), adenovirus (ADV), rubella virus (RV) and Chlamydia pneumoniae (CP) and measure the level of some biochemistry markers. Compared to controls, cases were more likely to have positive IgG antibodies to IV-A and IV-B (IV-A: OR, 3.3; 95%CI, 1.5 to 7.4; IV-B: OR, 17.2; 95%CI, 7.7 to 38.0). After adjustment for potential confounding variables, the risk of AMI was still associated with the presence of IgG antibodies to IV-A (adjusted OR, 7.5; 95%CI, 1.3 to 43.0) and IV-B (adjusted OR, 27.3; 95%CI, 6.6 to 113.8). The study supported the hypothesis that previous IV infection took part in the development of atherosclerosis and trigger the occurrence of AMI.

Bickerstaff's brainstem encephalitis and Fisher syndrome form a continuous spectrum

Whether Bickerstaff's brainstem encephalitis (BBE) is a distinct disease or a subtype of Fisher syndrome (FS) is unclear as there have been no clinical studies with sufficiently large numbers of patients with FS or BBE. Our aim was to clarify the nosological relationship. Medical records of patients suffering acute ophthalmoplegia and ataxia within four weeks of onset were reviewed. BBE was the diagnosis for patients with impaired consciousness, FS for those with clear consciousness and areflexia. Clinical features, neuroimages, and laboratory findings were analyzed. Patients were grouped as having BBE (n = 53), FS (n = 466), or as unclassified (n = 62). The BBE and FS groups had similar features; positive serum anti-GQ1b IgG antibody (68 % versus 83 %), antecedent Campylobacter jejuni infection (23 % versus 21 %), CSF albuminocytological dissociation (46 % versus 76 %), brain MRI abnormality (11 % versus 2 %), and abnormal EEG findings (57 % versus 25 %). BBE (n = 4) and FS (n = 28) subgroups underwent detailed electrophysiological testing. Both groups frequently showed absent soleus H-reflexes, but normal sensory nerve conduction (75 % versus 74 %) and a 1-Hz power spectrum peak on postural body sway analysis (67 % versus 72 %). Common autoantibodies, antecedent infections, and MRI and neurophysiological results found in this large study offer conclusive evidence that Bickerstaff's brainstem encephalitis and Fisher syndrome form a continuous spectrum with variable CNS and PNS involvement.

Smoking impairs human papillomavirus (HPV) type 16 and 18 capsids antibody response following natural HPV infection

The natural history of oncogenic human papillomavirus (HPV) infections results from interactions of the virus, the host, and multiple cofactors. We studied the association between humoral immune response to HPV and smoking in 191 HPV infected women prospectively. Two follow-up samples (first and last) were analysed for serum cotinine levels, IgA and IgG antibodies to HPV16 and 18, and Chlamydia trachomatis using ELISA methods. HPV DNA analyses were also performed, and HPV16/18 antibodies were detectable in 23 of 40 (57.5%) HPV DNA-positive women. We performed age-stratified analyses and found that young smokers were less likely to develop HPV16/18 antibodies than non-smokers (OR: 0.2, 95% CI 0.0-0.9). Furthermore, they had a significantly decreased tendency of maintaining constant HPV16/18 IgG antibody positivity by the end of the follow-up (OR: 0.1, 95% CI 0.0-0.8). Smoking did not affect the development of HPV antibody responses in women over 30 y of age. Our results suggest that smoking may induce impaired antibody response in HPV16/18-infected young women.

First-ever Ischemic Stroke after a Flight in a Patient with Prior Poliomyelitis

Survivors of poliomyelitis sometimes travel by air with mobility assistance. However, prolonged seating during long-haul flights may also possibly produce stroke events on polio-inflicted patients. A 48-year-old polio-inflicted male suffered a stroke after an extended flight. A two-dimensional echocardiography was normal without detected patent foramen ovale or dyskinetic segment. The venodynamic variables were all within normal limits. MR Imaging studies revealed acute cerebral infarction in the distribution of the right middle cerebral artery and posterior watershed area. Hematological examination revealed positive anti-cardiolipin IgG antibody which might contribute to the risk of thrombosis as an underlying condition in addition to immobilization. This is the first presentation of ischemic stroke after a flight in a patient with prior poliomyelitis. In addition to decompression sickness, economy class stroke syndrome and postpoliomyelitis syndrome, the physician should also take other coagulation disorders into consideration during the investigation.

Transmission of toxoplasmosis in two renal allograft recipients receiving an organ from the same donor

Toxoplasma gondii is a ubiquitous protozoan parasite. After acute infection it continues to exist as cysts in the muscles and brain. Recipients of organ allografts are susceptible to the disease as a result of reactivation of quiescent infection either by transmission from the organ donor or by consumption of undercooked meat. We describe 2 cases of fatal toxoplasmosis in renal allograft recipients who received their organs from the same cadaveric donor. Both recipients died 5 weeks after renal transplantation, within days of each other. Multiorgan involvement with toxoplasmosis was demonstrated at autopsy. No evidence of the parasite was found in the transplanted kidney, either at the time of insertion or at autopsy. Neither recipient had serologic evidence of previous exposure to T. gondii. The donor had positive IgG but indeterminate IgM antibodies suggesting acute infection at the time of death; there was no clinical suspicion that the donor died from acute toxoplasmosis. We conclude that toxoplasmosis was transmitted by the donor kidneys. In an attempt to minimize the possibility of future transmission, donors are now tested for anti-toxoplasma IgM antibodies and recipients are treated with trimethoprim/sulfamethoxazole for the first 6 months after renal transplantation.

Multiple sclerosis and gluten sensitivity

Objective To compare the frequency of gluten sensitivity in patients with multiple sclerosis (MS) and healthy controls. Patients and Methods The patients were 161 clinically definite MS patients who referred to neurology outpatient clinic of Nemazee Hospital, Shiraz, south of Iran from March 2004 to October 2005. IgG and IgA antigliadin antibodies were measured by enzyme immuno assay (EIA) method. The test of IgA antitranstissue glutaminase (tTG) and duodenal biopsy were carried out in patients with either IgA or IgG AGA positive sera. Antigliadin antibodies were also measured for 166 age and sex matched control group. Results Neither IgG nor IgA antigliadin antibodies showed significant differences between MS patients and controls. Anti-tTG antibody and histopathologic studies were negative in all patients with positive IgG or IgA antigliadin antibodies results. Mean values of IgG and IgA antigliadin antibodies in MS patients with different sex, age, course, and functional systems involvement were not significantly different. Conclusion Gluten sensitivity is not associated with MS in Iran.

Active ocular toxoplasmosis in Turkish patients: a report on 109 cases

To describe the clinical characteristics of active ocular toxoplasmosis in a large population of Turkish patients. A retrospective study of 109 consecutive patients with active ocular toxoplasmosis seen at the Department of Ophthalmology, Istanbul Faculty of Medicine, from 1995 to 2005. Fifty-seven patients were female and 52 were male. The mean age at presentation was 25.7 +/- 6.8 years. All patients had positive serum anti-toxoplasma IgG antibodies, but negative IgM antibodies. Preexisting retinochoroidal scars were found in 90 (83%) patients. Central active lesions were significantly more common in eyes without previous involvement than in eyes with preexisting scars (97% vs. 59%). Active lesions were adjacent to a scar in 60 (78.9%) of 76 eyes with preexisting scars. The most common accompanying signs were vitritis (100%), anterior uveitis (49.5%), and periphlebitis (33%). All patients received antiparasitic treatment. Systemic corticosteroids were used in 86% of the patients. Kaplan-Meier survival analysis estimated the cumulative risk of recurrence as 74% at 42 months of follow-up. In 29 (80.5%) of 36 recurrent attacks, active lesions were associated with the scars of the most recent attack. After the resolution of the presenting attack, visual acuity was better than 0.5 in 90%, between 0.1 and 0.5 in 5%, and less than 0.1 in 5% of eyes. Further decrease in visual acuity occurred in only two eyes during our follow-up. Most of the patients with active ocular toxoplasmosis have asymptomatic retinochoroidal scars. Proximity of active lesions to the scars, and especially to those of the most recent episode, may have implications for treatment. Although the recurrence risk is high, the visual prognosis is good in most patients with typical ocular toxoplasmosis.