Secondary cutaneous aspergillosis due to Aspergillus flavus in an acute myeloid leukaemia patient following stem cell transplantation.

In a 64-year-old man suffering from hypoblastic myelodysplastic syndrome a secondary acute myeloid leukaemia developed. After induction chemotherapy with resulting partial remission he received an allogenic (related) peripheral blood stem cell transplantation conditioned with 2 Gy total body irradiation. After haematopoietic reconstitution chest pain and dyspnoea appeared. Computer tomography revealed diffuse bilateral infiltrates which were considered to be suspicious for an invasive pulmonary aspergillosis of the left upper lobe. Respiratory and circulatory insufficiency occurred. In bronchoalveolar lavage fluid Aspergillus antigen was detected. In addition, Aspergillus flavus was isolated on Sabouraud-dextrose agar. Ambisome (liposomal encapsulated amphotericin B) was applied in high dosages. On the skin of the sides and the back five livid red stained nodular lesions with haemorrhagic infarctions appeared. Pathohistologically, both in PAS (periodate acid Schiff) and Grocott-Gomori staining conglomerates of septated hyphae were detected in corium and subcutis. In addition, Aspergillus flavus grew from skin tissue. Despite antifungal treatment the patient died from Aspergillus pneumonia and generalized aspergillosis with dissemination to heart, brain, and skin.     

The behavior of membrane receptors of peripheral blood lymphocytes in bullous pemphigoid

In 35 patients with bullous pemphigoid (BP) various parameters of the cellular immune system were studied. It was shown that the average 29% decrease in the number rosette-forming lymphocytes in sheep red blood cells is converted by the immune complexes and by a second serum factor in the acute stage of BP that has not yet been characterized precisely. These changes were reversible in patients who were placed on immunosuppressants. Obviously, this mechanism is partly due to the binding of immune complexes via Fc receptors on T-lymphocytes and is consequently due to the steral blocking of sheep erythrocyte receptors. No decrease in the number of T-cells was found by means of monoclonal antibodies (CD2, CD3), and the number of suppressor cells was also normal (CD8). On the other hand, the number of T-helper cells increased by an average of 15% (CD4). In addition, in the acute stage, there is a significant increase in the number of activation antigen Tac (CD25) and DR-bearing lymphocytes: 29% and 37% respectively (the normal values are 2% and 11%, respectively). Double staining permitted the phenotype of activated lymphocytes to be detected within the T-cells and the T-helper cell subpopulation, respectively. The number of activated T-helper cells correlates with the disease activity, and from that point it seems to be useful as a marker of activity in follow-up studies.     

Zur Beziehung zwischen chronischer Urtikaria und Depression/ Somatisierungsstörung

Zusammenfassung In einer Multicenterstudie wurden insgesamt 100 Patienten mit chronischer Urtikaria mittels eines standardisierten Pers?nlichkeitstests (Gie?en-Test), eines standardisierten Beschwerdebogens (Gie?ener Beschwerdebogen) und eines selbstentwickelten Fragebogens zu Symptomatik, Krankengeschichte und Verhalten im Krankheitsschub befragt. Ein knappes Drittel der untersuchten Patienten zeigte erh?hte Depressionswerte und einen hohen Beschwerdedruck, der sich aus K?rpersymptomen zusammensetzt, die im Rahmen einer Depression auftreten k?nnen. Die vorliegenden Ergebnisse erlauben es nicht, eine chronische Urtikaria per se als Somatisierungsst?rung aufzufassen. Da bei einem Drittel der untersuchten Patienten hinsichtlich der Depressivit?t Abweichungen von der Normalbev?lkerung zu finden sind, wird für eine dermatologisch-psychosomatische Simultandiagnostik pl?diert, um den Urtikariapatienten eine der unterschiedlich individuellen Gesamtproblematik entsprechende Behandlung zukommen zu lassen. Eingegangen am 12. Januar 1995 Angenommen am 21. Juni 1995     

Year in review 2009: <Emphasis Type="Italic">Critical Care</Emphasis>- infection

In 2009 Critical Care provided important and clinically relevant research data for management and prevention of infections in critically ill patients. The present review summarises the results of these observational studies and clinical trials and discusses them in the context of the current relevant scientific and clinical background. In particular, we discuss recent epidemiologic data on nosocomial infections in intensive care units, present new approaches to prevention of ventilator-associated pneumonia, describe recent advances in biomarker-guided antibiotic stewardship and attempt to briefly summarise specific challenges related to the management of infections caused by multidrug-resistant microorganisms and influenza A (H1N1).     

Cross-reactivity within the profilin panallergen family investigated by comparison of recombinant profilins from pear (Pyr c 4), cherry (Pru av 4) and celery (Api g 4) with birch pollen profilin Bet v 2.

Profilin is a panallergen which is recognised by IgE from about 20% of birch pollen- and plant food-allergic patients. Little is known about epitope diversity among these homologous proteins, and about the correlation between IgE-cross-reactivity and allergenic reactivity. Plant food profilins from pear (Pyr c 4) and cherry (Pru av 4) were cloned by polymerase chain reaction and produced in Escherichia coli BL21. The profilins were purified as non-fusion proteins by affinity chromatography on poly-(L-proline)-Sepharose and characterized by immunoblotting, IgE-inhibition experiments and histamine release assays. The coding regions of the cDNA of pear and cherry profilin were identified as a 393 bp open reading frame. The deduced amino acid sequences showed high identities with birch pollen profilin Bet v 2 (76-83%) and other allergenic plant profilins. Pyr c 4 and Pru av 4 were investigated for their immunological properties in comparison with profilins from celery (Api g 4) and birch pollen (Bet v 2). Fourty-three of 49 patients (88%), preselected for an IgE-reactivity with Bet v 2 showed specific IgE-antibodies to the recombinant pear protein, 92% of the sera were positive with the recombinant cherry allergen and 80% of the sera were reactive with the celery protein. Inhibition experiments showed a strong cross-reactivity of IgE with profilins from plant food and birch pollen. However, IgE binding profiles also indicated the presence of epitope differences among related profilins. All investigated profilins, Pyr c 4, Pru av 4, Api g 4 and Bet v 2, presented almost identical allergenic properties in cellular mediator release tests. Therefore, cross-reactivities between related profilins may explain pollen-related allergy to food in a minority of patients. The nucleotide sequences reported have been submitted to the Genbank database under accession numbers AF129424 (Pyr c 4) and AF129425 (Pru av 4).     

Biomechanische Zustand der Hornhaut als neuer Indikator für pathologische und strukturelle Veränderungen

Aim

Several methods permit the measurement of geometric parameters of the cornea, but until now biomechanical conditions of the cornea have been ignored (e.g. in refractive corneal surgery). Besides the geometric condition, biomechanical properties of the cornea have been shown to influence applanation measurement of intra-ocular pressure (IOP) and epidemiological studies have identified corneal thickness as an independent risk factor for the development and progression of glaucoma. The aim of this investigation was to characterize the biomechanical properties of the cornea using the ocular response analyzer (ORA).

Methods

The ocular response analyzer (ORA) is a new method available for non-contact measurement of the biomechanical properties of the cornea. We evaluated the reproducibility of measurements, the difference between static and dynamic factors and the impact of independent factors (e.g. IOP, age, CCT, swelling of the cornea) on 2,500 measurements of corneal hysteresis (CH) and corneal resistance factor (CRF).

Results

In a large sample size we observed changes in CH and CRF after refractive surgery procedures (LASIK, UV-A cross-linking, keratoplasty) and in other corneal disorders (keratoconus, corneal dystrophies).

Conclusions

CRF and CH changes may reflect structural changes of the cornea. Thus, the ORA provides valuable information for a better understanding and characterization of the biomechanical condition of the cornea, especially with regard to diseases such as keratoconus and glaucoma.     

Speziesdifferenzierung von Hefen der Gattung Malassezia mittels Fourier-Transform-Infrarot-Spektroskopie

BACKGROUND: 83 Malassezia strains (65 wild isolates and 18 reference strains) were differentiated to the species level using conventional methods including morphological and biochemical features. These strains were further analyzed by Fourier transform infrared spectroscopy (FT-IRS).RESULTS: FT-IRS analysis allowed a clear separation of Malassezia strains according to species-specific cluster formation. The main differences were found between Malassezia furfur and other Malassezia species. In addition, within the species Malassezia furfur, a separation in two similar groups could be demonstrated. A disadvantage of FT-IRS is the relatively expensive apparatus. A great advantage is the speed and simplicity of the procedure, producing results within minutes.CONCLUSION: In pityriasis versicolor, Malassezia globosa was the dominant species found in 62% of cases. In addition, Malassezia furfur was found in 60% of dandruff cases.     

Recombinant food allergens.

Allergenic (glyco)proteins are the elicitors of food allergies and can cause acute severe hypersensitivity reactions. Recombinant food allergens are available in standardised quantity and constant quality. Therefore, they offer new perspectives to overcome current difficulties in the diagnosis, treatment and investigation of food allergies. This review summarises the expression strategies and characteristics of more than 40 recombinant food allergens that have been produced until today. Their IgE-binding properties are compared to those of their natural counterparts, in addition their application as diagnostic tools, the generation of hypoallergenic recombinant isoforms and mutants for therapeutic purposes, the determination of epitopes and cross-reactive structures are described.