Efficacy of prolonged valganciclovir therapy for congenital cytomegalovirus infection

We report prolonged valganciclovir (VGCV) treatment of a symptomatic cytomegalovirus infection case. Automated auditory brainstem evoked response performed at 5 days of age revealed severe hearing impairment. Cranial magnetic resonance (MR) imaging at 11 days of age showed abnormal findings. At 5 weeks of age, VGCV was started. The viral load in blood cells, plasma, and urine decreased during the 6-week treatment. Because of improvement of hearing level and no adverse effects, VGCV was restarted for an additional 6 weeks. Neither the patient’s hearing impairment nor results of cranial MR imaging have become worse in 6 months. It is crucial to gather information from as many cases as possible treated with VGCV to establish a standard protocol for VGCV treatment.     

Infectious mononucleosis with atypical manifestations accompanied by transient IgM antibody response for cytomegalovirus

Infectious mononucleosis (IM) is a clinical syndrome caused by primary infection with Epstein–Barr virus (EBV) that is common in adolescents. In adults, particularly in elderly people, the clinical picture of IM tends to be atypical, often leading to a diagnostic challenge. Diagnosis is also complicated because infection with EBV can induce the synthesis of cross-reacting immunoglobulin M antibodies for other herpesviruses. We report an unusual case of infectious mononucleosis in a 34-year-old immunocompetent adult. Epidemiological studies indicate that the average age of primary EBV infection in developed countries is increasing. IM with atypical presentation will be a diagnostic challenge in the future as the number of EBV-naïve adults increases.     

High white blood cell count and low estimated glomerular filtration rate are independently associated with serum level of monocyte chemoattractant protein-1 in a general population

Background

Monocyte chemoattractant protein‐1 (MCP‐1) plays a role in cardiovascular disease (CVD) and renal injury. Recent clinical studies have suggested that circulating levels of MCP‐1 could be a biomarker of atherosclerosis and future cardiovascular events in humans. Because chronic kidney disease (CKD) is one of the risk factors of CVD, it is conceivable that elevated MCP‐1 levels may link the increased risk of CVD in CKD patients. However, as far as we know, in addition to well‐known traditional risk factors for atherosclerosis, whether renal dysfunction could be independently associated with the elevation of MCP‐1 levels in a general population remains unknown. Therefore, we examined here which anthropometric and metabolic variables, including renal function, could be independent correlates of circulating levels of MCP‐1 in a general population.

Hypothesis

We hypothesized that renal function was one of the independent correlates of serum MCP‐1 levels.

Methods

A total of 860 Japanese residents (318 males and 542 females, mean age 65.4 ± 9.8 years) in a small fishing community underwent a complete history and physical examination with determination of blood chemistries, including serum levels of MCP‐1.

Results

Mean MCP‐1 levels were 281.4 pg/mL. Multiple stepwise regression analyses revealed that male sex (P < 0.0001), age (P = 0.03), estimated glomerular filtration rate (eGFR) (P < 0.0001, inversely), and white blood cell count (P = 0.037) were independently associated with MCP‐1 levels.

Conclusions

The present study demonstrated for the first time that other than white blood cell count, eGFR was an independent correlate of serum levels of MCP‐1 in a Japanese general population. Elevated MCP‐1 levels may partly explain the increased risk of CVD in CKD patients. © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

Altered Gut Flora Are Associated with Septic Complications and Death in Critically Ill Patients with Systemic Inflammatory Response Syndrome

Background

Gut under severe insult is considered to have an important role in promoting infection and multiple organ dysfunction syndrome from the viewpoint of altered intestinal epithelium, immune system and commensal bacteria. There are few reports, however, about the relationship between gut flora and septic complications.

Methods

We analyzed gut flora in patients with systemic inflammatory response syndrome (SIRS) and evaluated key bacteria and their cutoff values for infectious complications and mortality by using classification and regression trees (CART). Eighty-one SIRS patients with a serum C-reactive protein level higher than 10 mg/dL treated in the intensive care unit (ICU) for more than 2 days were included for the study. We quantitatively evaluated nine types of bacteria in fecal samples by plate or tube technique. Two hundred seventy-one samples were analyzed using CART and logistic regression.

Results

The dominant factors for complication of enteritis were the minimum number of total obligate anaerobes and the maximum number of Staphylococcus and Enterococcus. The dominant factors for complication of bacteremia were the minimum numbers of total obligate anaerobes and total facultative anaerobes. The dominant factors for mortality were the numbers of total obligate anaerobes and total facultative anaerobes and age.

Conclusions

A decrease in total obligate anaerobes and an increase in pathogenic bacteria in the gut are associated with septic complications and mortality in patients with SIRS. The altered gut flora may be a potential prognostic marker in SIRS patients.