Association of Tonate virus (subtype IIIB of the Venezuelan equine encephalitis complex) with encephalitis in a human.

Tonate virus, subtype IIIB of the Venezuelan equine encephalitis (VEE) complex, was first isolated in 1973 in French Guiana, South America. However, very little is known about its pathogenicity; it was considered to be responsible for only mild dengue-like syndromes. In 1998, a 2-month-old boy living along the Oyapock river in French Guiana was hospitalized for fever and generalized status myoclonus, and despite treatment the patient died 72 h after admission. Testing showed the presence of IgM specific for viruses of the VEE complex. A sensitive seminested polymerase chain reaction derived from a previous study was developed to detect viruses from the VEE complex, since no virus could be recovered from clinical specimens cultured on mosquito cells or from intracerebral inoculation into newborn mice. The genome of a virus from the VEE complex was detected in postmortem brain biopsies, and Tonate virus was identified by direct sequencing. This is the first reported case of human encephalitis due to Tonate virus.     

A review of Japanese encephalitis cases in the Philippines (1972-1985)

Few studies have shown that JE does occur in the Philippines with the majority of the cases affecting the 1-10 year age group in places where rice fields abound. The morbidity rate is 15-17%, with a mortality rate of about 7-30%.     

新疆中哈边境地区分离到远东型和西伯利亚型蜱传脑炎病毒

目的研究新疆中哈边境阿拉套山夏尔西里自然保护区蜱传脑炎疫源地病原的基因型及生物学特征。方法采用布旗法采集蜱,活蜱保存或液氮冻存;采用BALB/c小鼠与BHK-21细胞进行蜱传脑炎病毒分离培养;采用RT-PCR扩增蜱传脑炎病毒远东型FE和西伯利亚型S特异基因片段并测定其序列。结果从新疆中哈边境阿拉套山夏尔西里自然保护区全沟硬蜱和森林革蜱中分离出16株蜱传脑炎病毒株,通过对扩增基因序列比对分析,明确其中13株为远东型,3株为西伯利亚型。结论从新疆中哈边境阿拉套山夏尔西里自然保护区分离到远东型和西伯利亚型蜱传脑炎病毒,该地区为两种亚型病毒共存的蜱传脑炎自然疫源地。     

Lactobacillus endocarditis: case report and review of cases reported since 1992

Lactobacillus is a rare cause of endocarditis with only 78 reported cases in the literature. We report a case of Lactobacillus endocarditis and review reported adult cases since the introduction of the Duke's criteria for endocarditis. An analysis is presented with a focus on outcomes. Mortality from reported cases of Lactobacillus endocarditis was found to have substantially improved since 1992. Surgical rates for persistent disease remain the same. Possible reasons for this improvement include better antibiotics, earlier recognition of cases, and more aggressive treatment regimens.     

Idiopathic systemic capillary leak syndrome (SCLS): case report and systematic review of cases reported in the last 16 years

'Idiopathic systemic capillary leak syndrome (SCLS), or Clarkson's disease is an unusual entity first described 45 years ago. It presents with recurrent episodes of shock due to leakage of the plasma, which is reflected by accompanying hemo-concentration, hypo-albuminemia and edema. We report the case of a young man with multiple episodes of shock with generalized edema and pleural effusion. An initial diagnosis of sepsis was made, but the lack of fever and absence of a demonstrable organism or source led to a revision of diagnosis to SLCS. The last review of this syndrome which analyzed 24 cases was published in 1990. Since then, 75 more cases have been reported. This article reviews these cases.     

West Nile virus encephalitis acquired via liver transplantation and clinical response to intravenous immunoglobulin: case report and review of the literature

C. Rhee, E.F. Eaton, W. Concepcion, B.G. Blackburn. West Nile virus encephalitis acquired via liver transplantation and clinical response to intravenous immunoglobulin: case report and review of the literature.
Transpl Infect Dis 2011: 13: 312–317. All rights reserved Abstract: A patient developed West Nile virus (WNV) encephalitis 2 weeks after receiving a liver transplant and recovered fully, following treatment with intravenous immunoglobulin (IVIg). Laboratory testing documented transmission from the organ donor. Clinicians should be suspicious for organ‐transmitted WNV in any post‐transplant patient who develops fever and neurological symptoms. We review previous cases of organ‐transmitted WNV, the use of IVIg for WNV encephalitis, and the issue of organ donor screening.     

Gallbladder torsion: case report and review of 245 cases reported in the Japanese literature

We report here a case of torsion of the gallbladder in a 73-year-old woman. The patient was admitted to our hospital with right hypochondralgia. Ultrasonography and computed tomography demonstrated a distended gallbladder, with a multilayered wall, which contained no stones. Since the symptoms did not respond to antibiotics, laparotomy was performed. The gallbladder was found to be twisted around its pedicle and to be gangrenous. Cholecystectomy was performed, and the patient had an uneventful postoperative course. We also reviewed 245 cases reported in the Japanese literature. The clinical features of gallbladder torsion, which include low frequency of fever and jaundice, poor response to antibiotic therapy, and acute onset of abdominal pain, may be helpful in the differential diagnosis from acute cholecystitis. Moreover, a highly suggestive sign of gallbladder torsion observed by ultrasonography or computed tomography is a markedly enlarged “floating” gallbladder with a continuous hypoechoic line indicating edematous change in the wall.     

Non-catheter associated venous thrombosis in hemophilia A and B. A critical review of all reported cases

All reported cases of non-catheter induced venous thrombosis in patients with hemophilia A or B have been carefully evaluated. A total of 27 cases were reported,12 patients with hemophilia A and 15 patients with hemophilia B. The age of patients varied between 9 and 67 years. There were 10 cases of deep vein thrombosis, 8 patients with pulmonary embolism accompanied or not by deep vein thrombosis, 5 cases of superficial vein thrombosis. In addition, there were 3 cases of thrombosis in unusual sites (1 retinal central vein thrombosis and 2 portal vein thrombosis). Finally, in one case, venous thrombosis was multiple. There was a fatality in a hemophilia B patient with pulmonary embolism. The most frequent risk or triggering factor in hemophilia A was the administration of Feiba or rFVIIa concentrates in patients with inhibitors. Surgery together with Prothrombin Complex concentrates was the most frequent cause in hemophilia B patients. Congenital associated prothrombotic risk factors were present in two patients. No or very few therapeutic procedures were initiated in these patients but for a suspension or reduction of concentrates infusion. In a few instances low molecular weight heparin was given for a few days. The frequent association of venous thrombosis with infusion of concentrates indicates the need for a careful evaluation of patients about to receive such therapy.     

Seroprevalence of West Nile virus and tick-borne encephalitis virus in southeastern Turkey: first evidence for tick-borne encephalitis virus infections

West Nile virus (WNV) and tick-borne encephalitis virus (TBEV) are among the medically important Flaviviruses that cause significant morbidity and mortality in humans. In this study, seroprevalence of WNV and TBEV in sera from two state medical hospitals from the southeastern part of Turkey was investigated. One hundred eighty-one serum samples were evaluated for WNV immunoglobulin G (IgG) by an indirect immunofluorescence test (IIFT) and for IgG antibodies against TBEV by a commercial enzyme-linked immunosorbent assay (ELISA) kit with enhanced sensitivity and specificity. Sera positive for WNV IgG were further analyzed by plaque reduction neutralization assay (PRNA). TBEV IgM was also investigated by ELISA in all seroreactive samples. Of 181 sera, 29 (16%) were positive for WNV IgG by IIFT and 17 of 179 (9.5%) were confirmed by PRNA. Nineteen of 181 (10.5%) sera were detected to have TBEV IgG. Mean titer of TBEV IgG was 43.0 RU/mL (median, 33.9 RU/mL; cutoff: 20 RU/mL). Four samples with WNV IgG antibodies were also positive for TBEV IgG antibodies. TBEV IgM was detected in 9 of 39 (23%) of all seroreactive sera, where IgM positivity were accompanied by IgG for 6 samples. These results suggest the presence of possible human WNV and TBEV infections in southeastern Turkey where vector activity have previously been detected.     

Rehabilitation of West Nile Fever (WNF) encephalitis in elderly

In the summer of 2000, an outbreak of WNF affected Israel. Thirty-two elderly patients were admitted to Meir Hospital. WNF encephalitis may result in residual functional damage. However, little information is available regarding the rehabilitation of these patients. Five elderly subjects with residual functional damage were referred to geriatric rehabilitation. Patients were treated with the routine program for neurological rehabilitation after stroke, including daily physiotherapy and occupational therapy. All five were over 77 years and independent before admission. The mean FIM score on admission was 71 (S.D. = +/-8.5) and increased to 102 (S.D. = +/-14) on discharge. MMSE on admission was 60% (S.D. = +/-7.5%), and increased to over 90% on discharge in all of the patients. Clock Completion Test was normal in four on admission, and improved to normal in the fifth patient on discharge. WNF encephalitis may present with functional and intellectual impairment in the elderly. Routine geriatric neurological rehabilitation may benefit those with prolonged functional decline.     

Cronkhite-Canada syndrome. A case report and analytical review of 23 other cases reported in Japan

A case study is presented of a 57-year-old male who showed typical clinical features of Cronkhite-Canada syndrome. Numerous polypoid lesions were found in the stomach, duodenum, ileum, colon and rectum accompanied with characteristic ectodermal changes. Tests indicated a protein-losing gastroenteropathy. Intestinal lactase deficiency was demonstrated by the lactose tolerance test. Scanning electronmicroscopy of the gastric and colonic mucosa revealed prominent secretion of mucoid substances and distortion in the gastric pits and colonic crypts. These abnormal findings were interpreted as having a direct relationship to the loss of protein into the gastrointestinal tract.     

Liver cell adenoma: A case report and a review of 30 cases reported in Japan

A 38 year old man with a huge liver cell adenoma extending to the pelvis was treated by left lateral lobectomy. The tumour, which was well-encapsulated by fibrous membrane, was 18 × 19 × 6 cm in size and weighed 1500g. Histopathologically, this tumour was composed of well-differentiated liver cell trabeculae and a small number of pseudobiliary ducts, but no Glisson sheaths. For the past 4 years 8 months he has remained asymptomatic. Thirty cases of liver cell adenoma found in Japanese literature are reviewed here and possible pathogenic implications are discussed.     

Acute-onset autoimmune hepatitis resembling acute hepatitis: a case report and review of reported cases

We report a 54-year-old Japanese man, whose ALT level was 1689 IU/L, without increased gamma-globulin level or autoantibodies. He could not be diagnosed as autoimmune hepatitis (AIH) using scoring systems, and his liver function became normalized after steroid treatment. Recently, AIH with acute presentation of disease and acute-onset AIH without bridging fibrosis have been increasingly reported but cases without the character of increasing gamma-globulin level or autoantibodies before immunosuppressive treatment are extremely rare. This is the third such case report in the literature.