Dengue,chikungunya and Zika virus infections among Dutch travellers to Suriname: a prospective study during the introduction of chikungunya and Zika virus, 2014 to 2017

BackgroundSuriname, a country endemic for dengue virus (DENV), is a popular destination for Dutch travellers visiting friends and relatives and tourist travellers. Chikungunya and Zika virus (CHIKV, ZIKV) were introduced in 2014 and 2015, respectively. Data on infection risks among travellers are limited.AimWe aimed to prospectively study incidence rate (IR) and determinants for DENV, ZIKV and CHIKV infection in adult travellers to Suriname from 2014 through 2017.MethodsParticipants kept a travel diary and were tested for anti-DENV, anti-ZIKV and anti-CHIKV IgG antibodies (Euroimmun). Selected samples were subjected to an in-house DENV and ZIKV PRNT50. The IR (infections/1,000 person-months of travel) and IR ratio and determinants for infection were calculated.ResultsTravel-acquired infections were found in 21 of 481 participants: 18 DENV, four ZIKV and two CHIKV, yielding an IR_DENV of 47.0 (95% CI: 29.6–74.6), IR_ZIKV of 11.6 (95% CI: 4.4–31.0) and IR_CHIKV of 5.6 (95% CI: 1.4–22.2)/1,000 person-months. In nine DENV and three ZIKV infected participants, infections were PRNT50-confirmed, yielding a lower IR_DENV of 23.3 (95% CI: 12.1–44.8) and an IR_ZIKV of 8.4 (95% CI: 2.7–26.1) per 1,000 person-months. Tourist travel was associated with DENV infection. ZIKV and CHIKV infections occurred soon after their reported introductions.ConclusionsDespite an overestimation of serologically confirmed infections, Dutch travellers to Suriname, especially tourists, are at substantial risk of DENV infection. As expected, the risk of contracting ZIKV and CHIKV was highest during outbreaks. Cross-reaction and potential cross-protection of anti-DENV and -ZIKV antibodies should be further explored.     

基孔肯雅病毒实验诊断进展

基孔肯雅病毒属于披膜病毒科甲病毒属,主要通过携带病毒的蚊媒叮咬感染人类引起基孔肯雅热,表现为自限性发热、皮疹、肌痛、关节痛,其中关节疼痛可延续数月至数年,甚至导致关节畸形。由于基孔肯雅病毒与登革病毒、寨卡病毒等虫媒病毒具有相同的传播媒介,且急性期临床症状相似,但治疗原则与疾病结局完全不同,因此,实验室的确切诊断是基孔肯雅热防治的关键。本文就近几年基孔肯雅病毒在实验室诊断方面的进展作一综述。     

Zika病毒:虫媒病毒传染病的新挑战

Zika病毒(Zika virus,ZIKV)是一种新发的虫媒病毒,伊蚊是其主要的传播媒介。Zika病毒感染后主要引起发热,皮疹,关节痛等轻症症状。2015年起,Zika病毒在拉丁美洲及南美洲多个国家流行,并且Zika病毒感染患者不仅出现发热,皮疹和关节痛等症状,还发现Zika病毒病的流行与婴儿小头畸形,格林巴利综合征,病毒性脑膜炎病例的发生相关。不仅如此,Zika病毒感染还可以通过性途径传播。因此,从病毒感染症状的复杂性来看,目前流行的Zika病毒已经与1947年刚发现时的Zika病毒完全不同,而是成为了一种“新病毒”。 本文系统地梳理总结了Zika病毒感染相关的最新研究进展,并提出Zika病毒及其感染是对虫媒病毒传染病的新挑战的概念。     

Exacerbation of branch retinal vein occlusion post SARS-CoV2 vaccination: Case reports

Rationale:In this paper, we report on 2 patients who developed branch retinal vein occlusion (BRVO) exacerbation 1 day after administration of the BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine.Patient concerns:Case 1: A 71 year-old female developed vision loss in her left eye 1 day after receiving a second dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal inferior BRVO and secondary macular edema (ME) in her left eye. ME resolved after 3 doses of intravitreal aflibercept (IVA). After treatment, no recurrence of ME was observed.Case 2: A 72 year-old man developed vision loss in his right eye 1 day after receiving the first dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal superior BRVO in the right eye without ME. The patient was followed up and did not undergo any additional treatment.Diagnoses:Case1: Temporal superior BRVO and secondary ME were observed in the left eye. Her best-corrected visual acuity (BCVA) was 20/30.Case2: Temporal superior BRVO recurrence and secondary ME were observed in the right eye. BCVA was 20/25.Interventions:Case1: Additional dose of IVA was administered. Case2: Two times of Intravitreal ranibizumab was administered twice.Outcomes:Case1: Subsequently, ME resolved BCVA was 20/20. Case2: Subsequently, ME resolved BCVA was 20/25.Lessons:Both cases showed a possible association between SARS-CoV-2 vaccination and the exacerbation of BRVO.     

Hepatitis B virus infection increases the risk of cholangiocarcinoma: A meta-analysis and systematic review

Background and Aim: A number of studies have shown that hepatitis virus infections may be associated with cholangiocarcinoma (CC). However, the relationship between hepatitis B virus (HBV) infection and CC, especially intrahepatic cholangiocarcinoma (ICC), is still controversial. Methods: Relevant studies were identified by searching PUBMED, EMBASE and Web of Science Datebases up to September 2011. Pooled risk estimates were calculated using a random-effects model. Potential sources of heterogeneity were performed by subgroup analyses. A total of 18 papers were included in this meta-analysis. Results: The pooled risk estimate of all studies showed a statistically significant increased risk of CC among individuals with HBV infection (rate ratio [RR]: 2.66; 95% confidence interval [CI]: 1.97, 3.60). Compared with those without HBV infection, persons with HBV infection had an increased risk of intra-CC (ICC) (RR: 3.42; 95% CI: 2.46, 43.74), extrahepatic CC (OR: 1.46; 95% CI: 0.98, 2.17), and CC (OR: 2.03; 95% CI: 1.15, 3.56). In a subgroup analysis of HBV infection and risk of ICC, the pooled risk estimate of studies in Asians (RR: 3.63; 95% CI: 2.56, 5.13) was higher than that in non-Asians (RR: 1.93; 95% CI: 0.78, 4.76). A Begg funnel plot and Egger test revealed no evidence for publication bias. Conclusions: This meta-analysis shows that HBV is associated with increased risk of CC, especially for ICC. Further investigation is needed to focus on the mechanism by which HBV may be involved in the pathogenesis of CC.     

Dacryoendoscopy-guided re-canalization of canaliculops: Two case reports

Rationale:Canaliculops is a rare condition, and only 11 cases have been reported previously. We report 2 cases of canaliculops, which were successfully treated using the new recanalization technique under dacryoendoscopy followed by bicanalicular lacrimal intubation.Patient concerns:A 78-year-old man and a 76-year-old woman had 3- and 1-year histories of medial-upper eyelid swelling (left and right, respectively) without any inflammatory signs, history of periocular trauma, herpes infection, use of specific drugs, or ophthalmic diseases of note.Diagnoses:The cystic lesions were evaluated using ultrasound biometry or computed tomography to find the lumen of the horizontal canaliculus was exceedingly expanded, and to confirm the clinical diagnosis of canaliculops.Interventions:As the 2 cases of canaliculops were caused by upper puncta and common canaliculus obstructions, canaliculops of the upper eyelid were recanalized under dacryoendoscopic guidance, followed by bicanalicular intubation. The tubes were kept in situ involving bi-weekly irrigation and instillation of antibiotic and anti-inflammatory eye drops, and were removed after 2 to 3 months of follow-up.Outcomes:Epiphora, and eyelid swelling were completely resolved immediately after the procedure, and the lesions did not recur on follow-up after more than 6 months.Lessons:Eleven case series of canaliculops have been described previously, but this is the first report of this recanalization procedure offering a new, less invasive treatment option compared to complete or partial resection of the cystic lesion.     

Acute liver failure due to herpes simplex virus: diagnostic clues and potential role of plasmapheresis: A case report

Introduction:Acute liver failure (ALF) is a life-threatening condition that remains challenging for physicians despite several advances in supportive care. Etiologies vary worldwide, with herpes simplex virus (HSV) hepatitis representing less than 1% of cases. Despite its low incidence, ALF is a lethal cause of acute necrotizing hepatitis and has a high mortality. Early antiviral treatment is beneficial for survival and decreased liver transplantation necessity. However, plasmapheresis, despite its theoretical potential benefit, is scarcely reported.Patient concerns:A 25-year-old woman with no known disease presented with painful pharynx ulcers, increased transaminases and impaired liver function.Diagnosis:ALF due to a disseminated HSV-2 primary infection was diagnosed with a positive polymerase chain reaction for HSV-2 in the biopsied liver tissue and blood.Interventions:Empiric antiviral treatment was initiated. After clinical deterioration, plasmapheresis was also initiated.Outcomes:After 6 cycles of plasmapheresis and supportive care, the patient''s condition improved without undergoing liver transplantation.Conclusions:ALF is a life-threatening condition, and HSV as an etiology must be suspected based on background, clinical manifestation, and laboratory information. The potential role of plasmapheresis in HSV hepatitis should be considered.     

Timely identification and successful treatment of acute fatty liver of pregnancy without obvious clinical symptoms: Case reports

Rationale:Acute fatty liver of pregnancy (AFLP) is a rare and potentially fatal complication that occurs in the third trimester or early postpartum period. The diagnosis of AFLP is based on typical clinical and laboratory features and imaging examinations.Patient concerns:Case 1: a 25-year-old pregnant woman was hospitalized for threatened preterm birth at gestation of 35weeks and 2 days gestation. Laboratory tests revealed liver dysfunction, coagulopathy, hypoglycemia, hypoproteinemia, leukocytosis, and elevated creatinine and uric acid levels. Case 2: a 28-year-old (nulliparous) became pregnant after in vitro fertilization-embryo transfer at 29 weeks and 1 days’ gestation and came to the obstetric ward for vaginal bleeding. At 34 weeks and 1 day, laboratory investigations showed high serum creatinine, uric acid, liver dysfunction, coagulopathy, and hypoglycemia.Diagnoses:Two patients did not show obvious clinical symptoms, while the ultrasound findings confirmed a diagnosis of AFLP.Interventions:Immediate delivery and comprehensive supportive treatment are the most important methods for the treatment of AFLP.Outcomes:The 2 patients and their babies were discharged from the hospital in a good condition.Lessons:Special attention should be paid to mothers with AFLP after in vitro fertilization-embryo transfer. The clinical presentation of AFLP is variable, hence laboratory features and ultrasound examination may be important methods for screening for AFLP.     

Chronic hepatitis B virus infection and risk of dyslipidaemia: A cohort study

Hepatitis B virus (HBV) infection has been associated with a decreased prevalence of dyslipidaemia in cross‐sectional studies, but cohort studies are limited. We investigated the longitudinal effects of chronic HBV infection on the development of dyslipidaemia. We performed a cohort study of 62 287 non‐cirrhotic adult men and women free of dyslipidaemia who underwent serologic testing for hepatitis B surface antigen (HBsAg) and were followed annually or biennially for an average of 4.46 years. A parametric proportional hazard model was used to estimate the adjusted hazard ratio with 95% confidence interval (CI) for incident dyslipidaemia according to HBsAg seropositivity status. We identified 12 331 incident cases of hypercholesterolaemia during 278 004.4 person‐years of follow‐up (incident rate 44.4 per 1000 person‐years). In models adjusted for age, sex, body mass index, year of screening exam, smoking status, alcohol intake, regular exercise and education level, the adjusted hazard ratios (95% CIs) for incident hypercholesterolaemia, high LDL cholesterolaemia; hypertriglyceridaemia, high non‐HDL cholesterolaemia and low HDL cholesterolaemia comparing HBsAg‐positive to HBsAg‐negative participants was 0.71 (0.64‐0.79), 0.83 (0.78‐0.89), 0.61 (0.54‐0.70), 0.69 (0.63‐0.75) and 1.10 (0.98‐1.24), respectively. An inverse association between HBsAg positivity and incident high apolipoprotein B were also identified, with a corresponding a hazard ratio of 0.63 (0.55‐0.72). In a large cohort of apparently healthy Korean adults, HBsAg seropositivity was associated with lower risk of development of dyslipidaemia, suggesting a role of HBV infection in lipid metabolism.     

罕见成人慢性活动性EB病毒感染1例报告

正1病例资料患者男性,27岁,因反复发热7周,发现肝功能异常1个月于2014年8月20日入本院。患者于7周前无明显诱因出现发热,多发生于晚间(约16∶00~19∶00),体温最高为38.5℃,伴有咽痛,偶有咳嗽、咳痰,痰为白色泡沫样,伴有散在皮肤疱疹,约米粒大小,自服布洛芬后体温逐渐降至正常,不曾系     

北京市2例恶性疟死亡病例报告

本文报告了2例北京市恶性疟死亡病例。2例病例均系非洲输入性病例,回国后1周内发病,初诊时均诊断为感冒;病情发展迅速,入院后24h内死亡。输入性恶性疟病例起病急、发展迅速,应加强对归国人员和医务人员的健康教育工作,争取最佳治疗时间,以减少恶性疟感染及死亡病例的发生。     

Hepatitis C virus enhances incidence of idiopathic pulmonary fibrosis

AIM： To investigate the cumulative development incidence and predictive factors for idiopathic pulmonary fibrosis in hepatitis C virus （HCV） positive patients. METHODS： We studied 6150 HCV infected patients who were between 40-70 years old （HCV-group）. Another 2050 patients with hepatitis B virus （HBV） were selected as control （HBV-group）. The mean observation period was 8.0 ± 5.9 years in HCV-group and 6.3 ± 5.5 years in HBV-group. The primary goal is the development of idiopathic pulmonary fibrosis （IPF） in both groups. The cumulative appearance rate of IPF and independent factors associated with the incidence rate of IPF were calculated using the Kaplan- Meier method and the Cox proportional hazard model. All of the studies were performed retrospectively by collecting and analyzing data from the patient records in our hospital. RESULTS： Fifteen patients in HCV-group developed IPF. On the other hand, none of the patients developed IPF in HBV-group. In HCV-group, the cumulative rates of IPF development were 0.3% at 10th year and 0.9% at 20th year. The IPF development rate in HCV-group was higher than that in HBV-group （P = 0.021）. The IPF development rate in patients with HCV or HBV was high with statistical significance in the following cases： （1） patients ≥ 55 years （P 〈 0.001）; （2） patients who had smoking index （package per day x year） of ≥20 （P = 0.002）; （3） patients with liver cirrhosis （P = 0.042）. CONCLUSION： Our results indicate that age, smoking and liver cirrhosis enhance the development of IPF in HCV positive patients.     

Transformation from polycythemia vera to acute promyelocytic leukemia: Case report and literature review

Introduction:Transformation from chronic myeloproliferative neoplasm to acute leukemia is a feature of myeloproliferative neoplasm; however, the rate is not high. Transformation to acute promyelocytic leukemia is rare. Here, we report a case of transformation of polycythemia vera to acute promyelocytic leukemia and describe a process of clonal evolution that has not yet been reported.Patient concerns:In this case, a 51-year-old woman was diagnosed with polycythemia vera and concomitant JAK2/V617F mutations in July 2019. She underwent intermittent phlebotomy and oral hydroxyurea irregularly. After 2 years, the patient complained of fatigue and poor sleep quality for 2 months.Diagnosis:Further examination revealed marked hypercellularity and grade 1 bone marrow fibrosis with the PML/RARαV variant (23.85% mutation load), WT1-Exon1 (37.8%), WT1-Exon9 (4.1%), JAK3-Exon7 (49.3%), and RELN-Exon55 (45.8%). According to the World Health Organization classification of tumors of hematopoietic and lymphoid tissues, the patient was ultimately diagnosed with a rare transformation of polycythemia vera to acute promyelocytic leukemia.Interventions:The patient underwent dual induction therapy with all-trans-retinoic acid and arsenic trioxide.Outcomes:After 28 days of induction therapy, the patient achieved complete remission, was compliant and the treatment was well tolerated.Conclusion:Polycythemia vera can transform into acute promyelocytic leukemia; therefore, it is important to review bone aspiration and other tests to perform a comprehensive assessment and monitor the disease status, to detect disease progression and intervene early when it transforms into acute promyelocytic leukemia.     

Surgical management of intraoperatively diagnosed portal annular pancreas: Two case reports

Rationale:Portal annular pancreas (PAP) is a rare pancreatic anomaly characterized by portal vein encasement in the pancreatic parenchyma. Due to its rarity, PAP may often be missed on preoperative computed tomography (CT) review, and surgeons may face challenges in dealing with an unexpected intraoperative encounter with PAP. We documented 2 such intraoperatively diagnosed cases and illustrated their surgical management.Patients’ concerns:In case 1, a 70-year-old man was found to have a 15-mm mass in the pancreatic body and dilatation of the peripheral main pancreatic duct on enhanced CT. Case 2 involved a 46-year-old woman with a history of familial adenomatous polyposis, and rectal cancer with a mass in the duodenal papilla.Diagnoses:The patient in case 1 was diagnosed with resectable pancreatic cancer. In case 2, the patient was diagnosed with duodenal papillary carcinoma.Interventions:In case 1, the patient underwent distal pancreatectomy with lymph node dissection. In case 2, the patient underwent pancreaticoduodenectomy. Intraoperatively, PAP was observed in both cases. In case 1, after the usual transection at the right border of the portal vein, an additional dissection was performed on the dorsal pancreas using a powered linear stapler. In case 2, an additional section was made in the pancreatic body caudal to the cricoid pancreatic junction so that the pancreatic cross-section was oriented in 1 plane.Outcomes:The patient in case 1 was discharged without complications. In case 2, although the patient had a grade-B pancreatic fistula (International Study Group of Pancreatic Fistula Classification), the patient recovered conservatively and was discharged without significant complications. In both cases, a retrospective review identified PAP in patients’ preoperative CT images.Lessons:Both cases required ingenuity during pancreatectomy. Awareness about PAP and its management will enable surgeons to prepare for unexpected encounters with the condition. Moreover, surgeons (especially pancreatic surgeons) should consider the possibility of PAP while managing pancreatic anomalies to make appropriate treatment decisions.     

Clinical relevance of receptor conversion in metastatic breast cancer: Case report

Introduction:Breast cancer comprises several different pathological entities defined by the presence or absence of hormonal receptors and human epidermal growth factor receptor 2 (HER2). During the disease course, the increase in tumor heterogeneity contributes to the discordant expression of estrogen/progesterone receptors and HER2 status between primary and metastatic lesions. We describe a case that demonstrates the clinical relevance of molecular reassessment during metastatic breast cancer progression.Patient concerns:A 40-year-old Caucasian woman with germline breast cancer gene mutation was referred to a general surgery appointment after breast ultrasound revealed a suspicious nodular lesion in 2012.Diagnosis:Ultrasound-guided microbiopsy revealed an invasive ductal carcinoma of no special type, hormone receptor-positive, and HER2-negative.Interventions:The patient underwent modified radical left mastectomy, adjuvant radiotherapy, chemotherapy, and endocrine therapy. Four years after the diagnosis, HER2 positive lung progression was documented, and the patient received anti-HER2 targeted systemic therapy for 15 months. New disease progression with a triple-negative profile was found, and palliative systemic treatment was changed to carboplatin for 3 months until new progression. Based on the results of the OlympiAD trial, monotherapy with Olaparib 300 mg twice daily for 28 days was initiated.Outcomes:After seven cycles of treatment, patient showed progressive improvement in quality of life and maintained stable disease without significant adverse events.Conclusion:The clinical relevance of hormone receptor and HER2 status discordance between primary tumors and metastatic lesions has been studied in recent years. This case report illustrates the clinical impact of molecular changes during disease progression and the adaptation of treatment options. This allows for an increase in both survival and quality of life in patients with metastatic breast cancer.