Ecthyma gangrenosum in a burned child

The history of ecthyma gangrenosum has been presented, as well as its pathological diagnosis, prognosis and natural history. The history of forms of treatment has been outlined and the grave prognosis is emphasized. A case presentation introduces the experience at the Cincinnati Shriners Burns Institute. From a review of the literature and the experience at the Shriners Burns Institute, a suggestion for optimal treatment has been proposed. The particulars of this treatment include: early recognition, general nutritional and metabolic support, as well as high-dose aminoglycoside and semi-synthetic penicillin therapy, administered parentally and by sub-eschar clysis. Despite the grave prognosis, attention to these factors should result in optimal survival of patients with ecthyma gangrenosum.     

Antipneumococcal effects of C-reactive protein and monoclonal antibodies to pneumococcal cell wall and capsular antigens.

Antibodies to pneumococcal capsular polysaccharides are well known for their ability to protect against pneumococcal infection. Recent studies indicate that antibodies to cell wall antigens, including pneumococcal surface protein A and the phosphocholine (PC) determinant of teichoic acids as well as human C-reactive protein (which also binds to PC), can protect mice against pneumococcal infection. In the present study we compared the protective effects of these agents as measured by mouse protection, the blood bactericidal assay, and clearance of pneumococci from the blood and peritoneal cavity. Our findings extend previous results indicating that human C-reactive protein and antibodies to noncapsular antigens are generally less protective than anticapsular antibodies. The new results obtained indicate the following: (i) mouse protection studies with intraperitoneal and intravenous infections provide very similar results; (ii) monoclonal immunoglobulin G2a (IgG2a) antibodies to PC, like IgG1, IgG2b, and IgG3 antibodies to PC, are highly protective against pneumococcal infection in mice; (iii) human antibody to PC is able to protect against pneumococcal infection in mice; (iv) antibodies to PspA are effective at mediating blood and peritoneal clearance of pneumococci; (v) complement is required for the in vivo protective effects of both IgG and IgM antibodies to PC; (vi) IgG1, IgG2b, and IgG3 anti-PC antibodies all mediate complement-dependent lysis of PC-conjugated erythrocytes; and (vii) antibodies and human C-reactive proteins that are reactive with capsular antigens but not cell wall antigens are able to mediate significant antibacterial activity in the blood bactericidal assay.     

Dystonia in 61-year-old identical twins: observations over 45 years

We examined 61-year-old identical twin women of Jewish extraction with a probable autosomal recessive form of torsion dystonia. The dystonia in each was relatively mild and discovered only because a young relative developed dystonia. The twins were said to be discordant for dystonia, but personal evaluation led to the diagnosis of dystonia in both. Their slow course, with prolonged spontaneous remission in one twin, is in contrast to that described in most published reports. Although similar in mode of onset and initial course, the twins were dissimilar in age at onset, influence of pregnancy, diurnal variation in symptoms, need for medication, later course, and degree of disability at age 61. Normal plasma levels of norepinephrine and dopamine-beta-hydroxylase are consistent with autosomal recessive hereditary torsion dystonia. The importance of personal evaluation of key family members in establishing the correct genetic basis for a heterogeneous group of disorders, such as the hereditary dystonias, is stressed.     

Traumatic cerebral aneurysm formation following ventriculoperitoneal shunt insertion

Introduction Iatrogenic intracranial aneurysms are rare in children.Case report A 15-year-old girl presented in coma with a fixed dilated left pupil six weeks following removal of a long-standing left-sided ventriculoperitoneal shunt. Computed tomography (CT) and cerebral angiography revealed a left temporoparietal intracerebral haemorrhage with a fusiform distal middle cerebral artery aneurysm. The patient underwent image-guided localisation of the aneurysm to enable evacuation of the haemorrhage and resection of the fusiform aneurysm.Conclusion A high index of suspicion is required for diagnosis and early treatment to prevent unnecessary morbidity and mortality.     

Occurrence and evolutionary significance of a California encephalitis-like virus in Aedes squamiger (Diptera: Culicidae)

More than 12,000 Aedes increpitus Dyar and 4,600 Aedes squamiger (Coquillett) were tested for the presence of arboviruses to test the hypothesis that there is a coevolutionary relationship between Aedes (Ochlerotatus) mosquitoes and California serogroup viruses. Five strains of a California encephalitis-like virus were isolated from adults reared from larvae of Ae. squamiger collected in January 1989 from a coastal salt marsh at Morro Bay, San Luis Obispo County, California. Viruses were isolated in Vero cell cultures and serotyped by cross-neutralization tests. These isolates represent the first arboviruses isolated from this species. On the basis of morphology, Aedes squamiger has been included in the Aedes stimulans group of the subgenus Ochlerotatus. Other species within the Ae. stimulans group are vectors of California (CAL) serogroup viruses elsewhere in North America. Analysis of isozyme variability supports the inclusion of Ae. squamiger in the Ae. stimulans group and suggests that coastal populations of Ae. increpitus are the closest California relatives of Ae. squamiger. Recovery of virus from Ae. squamiger reinforces the relationship between CAL serogroup viruses and Aedes (Ocherlotatus) mosquitoes. However, the failure to isolate virus from large samples of Ae. increpitus from coastal and low elevation inland habitats suggests a complex evolutionary history involving both vertical and horizontal transmission mechanisms.     

Seroepidemiology of California and Bunyamwera serogroup bunyavirus infections in humans in California.

Several human populations in California were surveyed cross-sectionally and longitudinally for neutralizing antibodies to selected arthropod-borne bunyaviruses in the California and Bunyamwera serogroups. Overall, the prevalence of antibodies to California serogroup viruses was 6.4% in 702 individuals sampled during 1963-1988. Comparative antibody titers in individual sera indicated that 4.1% and 1.6% of these infections were caused by viruses similar or identical to Jamestown Canyon and California encephalitis, respectively. Evidence of prior infection with the Jamestown Canyon serotype was found in 10% of 118 humans employed outdoors in high elevation areas and sampled in 1988, including 5 of 16 persons (31%) employed as rangers patrolling in remote forests and meadows. This probably reflects increased exposure to bites of boreal mosquitoes that breed in pools of melted snow. Antibodies to Bunyamwera serogroup viruses, including the Northway serotype, which was recently shown to be enzootic in California, were found in only 2 of 702 humans studied. No seroconversions were detected to selected California or Bunyamwera serogroup viruses in paired samples from 392 humans, including 349 patients with acute central nervous system disease or undifferentiated febrile illnesses who were sampled during 1963-1988, and thus these viruses are currently unconfirmed as human pathogens in California.     

Diffuse fatty infiltration of the liver: Pitfalls in computed tomography diagnosis

The presence of a fatty liver often complicates the interpretation of abdominal computed tomography (CT). Abnormalities in or adjacent to the liver, including dilated bile ducts, liver masses and subphrenic collections, may be masked by the fatty liver. Furthermore, normal structures may simulate pathological conditions. Five cases are presented to illustrate some of these diagnostic pitfalls.