Diffuse lamellar keratitis complicating laser in situ keratomileusis: post-marketing surveillance of an emerging disease in British Columbia, Canada, 2000-2002

PURPOSE: To describe a surveillance system and summarize data between January 2000 and December 2002 regarding diffuse lamellar keratitis (DLK), a complication of laser in situ keratomileusis (LASIK) surgery. SETTING: Community-based clinics in British Columbia, Canada, in which LASIK surgery is performed. METHODS: Monthly, all clinics in which LASIK is performed reported the number of LASIK procedures and nonnominal cases of DLK (by grade and onset date) to the British Columbia Centre for Disease Control. Diffuse lamellar keratitis outbreaks were investigated, and prevention and control measures were recommended. RESULTS: From 2000 to 2002, approximately 72,000 LASIK procedures were performed, with a mean DLK incidence rate of 0.67% (95% confidence interval, 0.61-0.73). The overall proportion of DLK cases attributed to outbreaks was 64%, decreasing from 72% in 2000 to 40% in 2003. CONCLUSIONS: An effective DLK surveillance program was implemented at all laser refractive clinics in British Columbia. Reported DLK incidence was 0.67 cases per 100 procedures, with 64% occurring in outbreaks.     

Communicable Diseases Network Australia National Arbovirus and Malaria Advisory Committee annual report, 2006-07

This report describes the epidemiology of mosquito-borne disease in Australia for the mosquito-borne disease season 1 July 2006 to 30 June 2007, which was moderately low compared to previous seasons. Ross River virus (RRV) infections (55%), Barmah Forest virus (BFV) infections (29%) and overseas acquired malaria (11%) were the most common mosquito-borne diseases reported in 2006-07. The number, proportion and rate of national BFV notifications were the second highest on record since 1998-99. The Northern Territory reported the highest BFV notification rate this season. BFV notification rates were the highest in the 40-59 year age groups when compared to other age groups. The number, proportion and rate of RRV notifications were moderately low this season compared with previous seasons. The highest RRV rate was reported by Western Australia from the Kimberley region. The highest age-specific RRV notification rate was observed in the 40-59 year age groups. Locally acquired dengue virus notifications were low this season compared to previous seasons, with a small outbreak of dengue serotype 3 in 39 cases confined to the greater Townsville region. There were 640 notifications of malaria in 2006-07 of which none were reported as locally acquired. This was the third highest number of malaria notifications since 2001. Plasmodium falciparum was reported as the infecting species in 47% of the malaria notifications and Plasmodium vivax for 40% of cases. Young adolescents and adults in the 15-29 year age group had the highest number of cases accounting for 32% of notifications. Sentinel chicken surveillance data for flaviviruses and sentinel pig surveillance data for Japanese encephalitis virus are also reported.     

Musculoskeletal ultrasonography in routine rheumatology practice: data from Central and Eastern European countries

The main aim was to gain structured insight into the use of musculoskeletal ultrasonography (MSUS) in routine rheumatology practices in Central and Eastern European (CEE) countries. In a cross-sectional, observational, international, multicenter survey, a questionnaire was sent to investigational sites in CEE countries. Data on all subsequent routine MSUS examinations, site characteristics, MSUS equipment, and investigators were collected over 6 months or up to 100 examinations per center. A total of 95 physicians at 44 sites in 9 countries provided information on a total of 2810 MSUS examinations. The most frequent diagnoses were rheumatoid arthritis (RA) and spondyloarthritis (34.8 and 14.9 % of cases, respectively). Mean number of joints examined was 6.8. MSUS was most frequently performed for diagnostic purposes (58 %), particularly in patients with undifferentiated arthritis, suspected soft tissue disorders, or osteoarthritis (73.0–85.3 %). In RA patients, 56.3 % of examinations were conducted to monitor disease activity. Nearly all investigations (99 %) had clinical implications, while the results of 78.6 % of examinations (51.6–99.0 %) were deemed useful for patient education. This first standardized multicountry survey performed in CEEs provided a structured documentation of the routine MSUS use in participating countries. The majority of MSUS examinations were performed for diagnostic purposes, whereas one-third was conducted to monitor disease activity in RA. A majority of examinations had an impact on clinical decision making and were also found to be useful for patient education.     

Nucleic Acid Preservation Card Surveillance Is Effective for Monitoring Arbovirus Transmission on Crocodile Farms and Provides a One Health Benefit to Northern Australia

The Kunjin strain of West Nile virus (WNV_KUN) is a mosquito-transmitted flavivirus that can infect farmed saltwater crocodiles in Australia and cause skin lesions that devalue the hides of harvested animals. We implemented a surveillance system using honey-baited nucleic acid preservation cards to monitor WNV_KUN and another endemic flavivirus pathogen, Murray Valley encephalitis virus (MVEV), on crocodile farms in northern Australia. The traps were set between February 2018 and July 2020 on three crocodile farms in Darwin (Northern Territory) and one in Cairns (North Queensland) at fortnightly intervals with reduced trapping during the winter months. WNV_KUN RNA was detected on all three crocodile farms near Darwin, predominantly between March and May of each year. Two of the NT crocodile farms also yielded the detection of MVE viral RNA sporadically spread between April and November in 2018 and 2020. In contrast, no viral RNA was detected on crocodile farms in Cairns during the entire trapping period. The detection of WNV_KUN and MVEV transmission by FTA^TM cards on farms in the Northern Territory generally correlated with the detection of their transmission to sentinel chicken flocks in nearby localities around Darwin as part of a separate public health surveillance program. While no isolates of WNV_KUN or MVEV were obtained from mosquitoes collected on Darwin crocodile farms immediately following the FTA^TM card detections, we did isolate another flavivirus, Kokobera virus (KOKV), from Culex annulirostris mosquitoes. Our studies support the use of the FTA^TM card system as a sensitive and accurate method to monitor the transmission of WNV_KUN and other arboviruses on crocodile farms to enable the timely implementation of mosquito control measures. Our detection of MVEV transmission and isolation of KOKV from mosquitoes also warrants further investigation of their potential role in causing diseases in crocodiles and highlights a “One Health” issue concerning arbovirus transmission to crocodile farm workers. In this context, the introduction of FTA^TM cards onto crocodile farms appears to provide an additional surveillance tool to detect arbovirus transmission in the Darwin region, allowing for a more timely intervention of vector control by relevant authorities.     

Comparison of an in vitro tuberculosis interferon-gamma assay with delayed-type hypersensitivity testing for detection of latent Mycobacterium tuberculosis: a pilot study in rheumatoid arthritis

OBJECTIVE: Recommendations for screening for latent Mycobacterium tuberculosis (MTB) infection have been proposed but are not well studied in patients with rheumatoid arthritis (RA). We estimated the prevalence of anergy in RA and evaluated different methods to detect MTB exposure. METHODS: This was a prospective pilot study of 61 patients with RA and 42 healthy controls. Tuberculin skin test (TST) antigen, Candida, and tetanus toxoid were injected intradermally using the Mantoux method. Subjects negative for TST returned for a second-step test. Whole-blood interferon-gamma (IFN-gamma) release to mycobacterial antigens was evaluated with the first-generation QuantiFeron test (QIFN). RESULTS: Cutaneous anergy in patients with RA was not significantly different than healthy controls (p = 0.154), and was not affected by disease modifying antirheumatic drugs (p = 0.270). In patients with RA, 16.4% had positive TST with 10 mm cutoff vs 11.9% of controls. Using a 5 mm cutoff, 21.3% of patients with RA were positive, and this increased to 29.5% with a second-step TST. QIFN detected MTB exposure in 18% of patients with RA and 19% of controls (p = 0.897). However, indeterminate QIFN tests were higher in RA patients (11.5%) compared to controls (2.4%), demonstrating a lower sensitivity to detect latent MTB. CONCLUSION: Cutaneous anergy may be less common than previously reported in patients with RA. patients. However, the single-step TST and 10 mm cutoff may fail to detect all cases of latent exposure in RA patients. High rates of indeterminate results in QIFN testing suggest that QIFN should not be employed as an alternative, single-screening test in patients with RA. These pilot results require confirmation in larger studies to determine the optimal screening strategy in RA.     

A directed screen for genes involved in Drosophila blood cell activation

An attack by a parasitic wasp activates a vigorous cellular immune response in Drosophila larvae. This response is manifested by an increased number of circulating cells, the hemocytes, and by the appearance of a specialized class of hemocyte, the lamellocytes, which participate in the encapsulation and killing of the parasite. To study the molecular mechanisms of this response, we have overexpressed different genes in the hemocytes, by using the GAL4-upstream activating sequence system and a hemocyte-specific Hemese-GAL4 driver. Multiple transgenes were tested, representing several important signaling pathways. We found that the proliferation response and the activation of lamellocyte formation are independent phenomena. A drastic increase in the number of circulating hemocytes is caused by receptor tyrosine kinases, such as Egfr, Pvr, and Alk, as well as by the downstream signaling components Ras85D and pointed, supporting the notion that the Ras-mitogen-activated protein kinase pathway regulates hemocyte numbers. In the case of Pvr and Alk, this phenotype also is accompanied by lamellocyte formation. By contrast, constitutively active hopscotch and hemipterous give massive activation of lamellocyte formation with little or no increase in total hemocyte numbers. This finding indicates that both the Jak/Stat and the Jun kinase pathways affect lamellocyte formation. Still other signals, mediated by aop(ACT), Toll(10b), and Rac1 expression, cause a simultaneous increase in lamellocyte and total cell numbers, and the same effect is seen when WNT signaling is suppressed. We conclude that the activation of a cellular response is complex and affected by multiple signaling pathways.     

Targeting of influenza epitopes to murine CR1/CR2 using single-chain antibodies.

Single-chain variable fragment (scFv) antibodies are genetically engineered molecules comprising the variable regions responsible for specific binding. scFv that recognize certain surface molecules on professional antigen presenting cells could therefore be suitable for targeting Ag to these cells. We have produced an scFv that recognizes murine complement receptors 1 and 2 (CR1/CR2) and genetically fused it with different numbers of influenza hemagglutinin peptides which contain both B and T cell epitopes. The CR1/CR2 specific hybridoma 7G6 was used for RT-PCR to obtain the variable regions, which were then combined to create an scFv fragment. The influenza hemagglutinin intersubunit peptide HA317-41 (IP) was engineered to the N terminus of the scFv in one, two or three copies. The so obtained IP(1-3)7G6scFv still bound the complement receptors; the peptides in the construct were recognized by the peptide specific monoclonal IP2-11-1 on Western blots and ELISAs. The CR1/CR2 positive B lymphomas A20 and 2PK3 presented the peptide to an I-Ed restricted IP specific T cell hybridoma more efficiently when incubated with the IP(1)7G6 constructs as compared to the free peptide. The results suggest that scFv could work as targeting devices in subunit vaccines.     

The role of hsp60 and hsp70 kDa heat shock protein families in different types of diabetes mellitus

The role of stress proteins in the different forms of diabetes has not been elucidated yet, but the most recent data suggest their important role in the development both of the diabetic metabolic disturbances and complications. In type 1 diabetes, where the beta-cells are destroyed by autoimmune processes, the 60 kDa heat shock proteins are among the beta-cell specific antigens, and one of its analogs (DiaPep277) has already been used with success in human studies for immunization. Studies done in type-2 diabetic patients proved that the expression of the 72 kDa heat shock protein in the skeletal muscle highly correlates with the metabolic status of the diabetic patients. Diabetic patients with an order of magnitude less expression of 72 kDa heat shock gene have lower insulin stimulated glucose uptake,--storage and--oxidation and the lipid oxidation is less sensitive to the insulin effect. Both the expression of the 72 kDa heat shock gene and the insulin stimulated glucose uptake are lower in twins with type-2 diabetes even before the manifestation of the disease suggesting the pathological role of this gene. The 72 kDa heat shock protein gene in the circulating mononuclear blood cells of type-2 diabetics can not be stimulated by heat stress, and the magnitude of this heat stress answer negatively correlates with the rate of urinary albumin excretion. These data suggest that the stimulation of heat shock protein genes may improve insulin resistance and this may mean a new intervention area of pharmacology.