Int. J. Med. Sci. 2009, 6 http://www.medsci.org 114IInntteerrnnaattiioonnaall JJoouurrnnaall ooff MMeeddiiccaall SScciieenncceess 2009; 6(3):114-115 © Ivyspring International Publisher. All rights reserved Short Communication Ocular Manifestations of West Nile Virus Infection Salim Ben Yahia, Moncef Khairallah Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir (Tunisia) Published: 2009.05.26 West Nile Virus (WNV), first isolated in 1937 in the West Nile district of Uganda, is a single-stranded RNA flavivirus. It is a member of the Japanese en-cephalitis serogroup. WNV infection is a zoonotic disease transmitted by a mosquito vector (type Culex), with wild birds serving as its reservoir. The disease is endemic in Europe, Australia, Asia, Africa, and North and Central America since its appearance in New York in 1999.1 Most human infections are subclinical (80%) or manifest as febrile illness (20%). Severe neurologic disease (meningoencephalitis), frequently associated with advanced age and diabetes, was initially re-ported to occur in less than 1% of patients. However, over time, WNV infection has increased in severity. The diagnosis is confirmed by detection of IgM anti-body in serum or cerebrospinal fluid.1 A typical multifocal chorioretinitis, frequently asymptomatic, is the most common ocular manifesta-tion of WNV infection (80%).2 Active chorioretinal lesions appear as circular, deep, creamy lesions on ophthalmoscopy, with early hyopofluorescence and late staining on fluorescein angiography (FA). Inac-tive chorioretinal lesions typically are partially atro-phic and partially pigmented with a “targetlike ap-pearance”: central hypofluorescence and peripheral hyperfluorescence on FA (Figure 1). Chorioretinal lesions vary in number and size, involving the mid-periphery, with or without involvement of the poste-rior pole. Linear clustering of chorioretinal lesions, following the course of retinal nerve fibers, is a prominent feature (> 80%). Indocyanine green an-giography shows more lesions, in the form of hy-pofluorescent spots, than those appreciated clinically or by FA. Other ocular manifestations of WNV infection include anterior uveitis, retinal vasculitis, optic neuri-tis, subconjunctival hemorrhage, sixth nerve palsy, nystagmus, and congenital chorioretinal scarring.2,3 Ocular disease usually has a self-limited course, and visual acuity returns to baseline in most patients. However, persistent visual loss may occur due to fo-veal chorioretinal scar, choroidal neovascularization, vitreous hemorrhage, tractional retinal detachment, severe ischemic maculopathy, optic atrophy, and ret-rogeniculate damage. Figure 1. Midphase fluorescein angiogram of a 64-year-old diabetic woman with a 20-day history of fever and headache shows chorioretinal lesions with central hypofluorescence and peripheral hyperfluorescence. Note the presence of mild non-proliferative diabetic retinopathy. There is no proven treatment for WNV infection. In cases of severe disease, therapy is supportive, with hospitalization, intravenous fluids, respiratory sup-port, and prevention of secondary infection. Prevention is the mainstay of WNV infection control, with public health measures to reduce the number of mosquitos (draining standing water, lar- Int. J. Med. Sci. 2009, 6 http://www.medsci.org 115vicides…) and personal protection against mosquito bites (repellants, window screens, protective cloth-ing,…). Vaccination, a long term solution, is still in the research phase. In conclusion, chorioretinal involvement, fre-quently asymptomatic and self-limited, is present in almost 80% of patients with WNV infection associated with neurologic disease. The unique Diseases Associated with Depressed or Overactive Immune Responses Diseases Associated with Depressed or Overactive Immune Responses Bởi: OpenStaxCollege This section is about how the immune system goes wrong When it goes haywire, and becomes too weak or too strong, it leads to a state of disease The factors that maintain immunological homeostasis are complex and incompletely understood Immunodeficiencies As you have seen, the immune system is quite complex It has many pathways using many cell types and signals Because it is so complex, there are many ways for it to go wrong Inherited immunodeficiencies arise from gene mutations that affect specific components of the immune response There are also acquired immunodeficiencies with potentially devastating effects on the immune system, such as HIV Inherited Immunodeficiencies A list of all inherited immunodeficiencies is well beyond the scope of this book The list is almost as long as the list of cells, proteins, and signaling molecules of the immune system itself Some deficiencies, such as those for complement, cause only a higher susceptibility to some Gram-negative bacteria Others are more severe in their consequences Certainly, the most serious of the inherited immunodeficiencies is severe combined immunodeficiency disease (SCID) This disease is complex because it is caused by many different genetic defects What groups them together is the fact that both the B cell and T cell arms of the adaptive immune response are affected Children with this disease usually die of opportunistic infections within their first year of life unless they receive a bone marrow transplant Such a procedure had not yet been perfected for David Vetter, the “boy in the bubble,” who was treated for SCID by having to live almost his entire life in a sterile plastic cocoon for the 12 years before his death from infection in 1984 One of the features that make bone marrow 1/8 Diseases Associated with Depressed or Overactive Immune Responses transplants work as well as they is the proliferative capability of hematopoietic stem cells of the bone marrow Only a small amount of bone marrow from a healthy donor is given intravenously to the recipient It finds its own way to the bone where it populates it, eventually reconstituting the patient’s immune system, which is usually destroyed beforehand by treatment with radiation or chemotherapeutic drugs New treatments for SCID using gene therapy, inserting nondefective genes into cells taken from the patient and giving them back, have the advantage of not needing the tissue match required for standard transplants Although not a standard treatment, this approach holds promise, especially for those in whom standard bone marrow transplantation has failed Human Immunodeficiency Virus/AIDS Although many viruses cause suppression of the immune system, only one wipes it out completely, and that is the previously mentioned HIV It is worth discussing the biology of this virus, which can lead to the well-known AIDS, so that its full effects on the immune system can be understood The virus is transmitted through semen, vaginal fluids, and blood, and can be caught by risky sexual behaviors and the sharing of needles by intravenous drug users There are sometimes, but not always, flu-like symptoms in the first to weeks after infection This is later followed by seroconversion The anti-HIV antibodies formed during seroconversion are the basis for most initial HIV screening done in the United States Because seroconversion takes different lengths of time in different individuals, multiple AIDS tests are given months apart to confirm or eliminate the possibility of infection After seroconversion, the amount of virus circulating in the blood drops and stays at a low level for several years During this time, the levels of CD4+ cells, especially helper T cells, decline steadily, until at some point, the immune response is so weak that opportunistic disease and eventually death result CD4 is the receptor that HIV uses to get inside T cells and reproduce Given that CD4+ helper T cells play an important role in other in T cell immune responses and antibody responses, it should be no surprise that both types of immune responses are eventually seriously compromised Treatment for the disease consists of drugs that target virally encoded proteins that are necessary for viral replication but are absent from normal human cells By targeting the virus itself and sparing the cells, this approach has been successful in significantly prolonging the lives of HIV-positive individuals On the other hand, an HIV vaccine has been 30 years in development and is still years away Because the virus mutates rapidly to evade the immune system, scientists have been looking for parts of the virus that not change and thus would be good targets for a vaccine candidate 2/8 Diseases Associated with Depressed or Overactive Immune Responses Hypersensitivities The word “hypersensitivity” simply means ...Int. J. Med. Sci. 2009, 6 http://www.medsci.org 106IInntteerrnnaattiioonnaall JJoouurrnnaall ooff MMeeddiiccaall SScciieenncceess 2009; 6(2):106-110 © Ivyspring International Publisher. All rights reserved Research Paper Clinical Symptoms Associated with Asystolic or Bradycardic Responses on Implantable Loop Recorder Monitoring in Patients with Recurrent Syncope Khalil Kanjwal, Yousuf Kanjwal, Beverly Karabin, Blair P. Grubb Department of Medicine, University of Toledo Medical Center, Toledo OH 43614, USA Correspondence to: Blair P Grubb, MD, Director Electrophysiology Services, Division of Cardiology, Department of Medicine, Health Sciences Campus, University of Toledo Medical Center, Mail Stop 1118, 3000 Arlington Ave, Toledo OH 43614, USA Received: 2009.02.16; Accepted: 2009.04.08; Published: 2009.04.09 Abstract Background: Implantable loop recorders (ILR) have been found to be useful in the diagnosis and management of syncope of unclear etiology. The clinical symptoms of abnormalities seen during ILR monitoring have not been adequately studied. Aim: The aim of this retrospective study was to determine the clinical symptoms which were the best predictors of asystolic or bradycardic responses during ILR monitoring. Methods: Patients with either asystole or bradycardia recorded during ILR monitoring were analyzed from our database. The clinical characteristics of these patients were compared to the patients with ILR’s who did not have recorded bradycardic episodes. The episodes were characterized as being convulsive or nonconvulsive, brief (<5 minutes) or prolonged (> 5 minutes), and having had a prodrome or no prodrome. Results: Eleven patients (4 males and 7 females; age 39 ±11years) had asystole or bradycardia on ILR monitoring. Eleven patients (2 males and 9 females; age 46±23) had no bradycardiac events. Palpitations, convulsive syncope, prolonged episode, and prodrome were present in 37% vs. 74% (P = 0.125), 62% vs. 0% (P = 0.002), 87% vs. 0% (P=0), and 73% vs. 13% (P=0.009) patients, respectively, in the asystole/bradycardia and non-bradycardia groups. In the asystole/bradycardia group eight patients had bradycardia (HR < 20) for > 10 seconds and three patients had asystole >10 seconds. Conclusion: Convulsive syncope, prolonged loss of consciousness during syncopal episode, and absence of prodrome or aura are clinical predictors of asystole or bradycardia on ILR monitoring. Key words: Implantable loop recorders, bradycardia, asystole, convulsions. Introduction Ambulatory cardiac monitoring with Holter or external loop recorders is frequently employed in the evaluation of patients with recurrent syncope. How-ever, several non-randomized studies demonstrate a relatively low (<40%) diagnostic yield from this ap-proach [1-5]. Implantable loop recorders (ILR’s), by contrast, allow for a more prolonged period of moni-toring as well as automatic activation during events, resulting in a higher diagnostic yield than traditional monitoring techniques [6-12]. During ILR monitoring of patients with recurrent syncope, bradycardic events are encountered more frequently than are tachycardiac ones [13-15]. The clinical symptoms most predictive of significant bradycardic events (such as prolonged sinus pauses or complete heart block) re-corded during ILR monitoring have not been well Int. J. Med. Sci. 2009, 6 http://www.medsci.org 107reported. The aim of the present study was to identify the clinical JOURNAL OF Veterinary Science J. Vet. Sci. (2007), 8(4), 383 392 † Present address: Department of Microbiology, Research Institute for Medical Sciences, College of Medicine, Chungnam National Univer- sity, Daejeon 301-747, Korea *Corresponding author Tel: +82-2-880-1263; Fax: +82-2-874-2738 E-mail: yoohs@snu.ac.kr Enhancement of protective immune responses by oral vaccination with Saccharomyces cerevisiae expressing recombinant Actinobacillus pleuropneumoniae ApxIA or ApxIIA in mice Sung Jae Shin 1, † , Seung Won Shin 1 , Mi Lan Kang 1 , Deog Yong Lee 1 , Moon-Sik Yang 2 , Yong-Suk Jang 2 , Han Sang Yoo 1, * 1 Department of Infectious Diseases, College of Veterinary Medicine, BK21 for Veterinary Science and KRF Zoonotic Disease Priority Research Institute, Seoul National University, Seoul 151-742, Korea 2 Division of Biological Science, Institute for Molecular Biology and Genetics, Chonbuk National University, Jeonju 561-756, Korea We previously induced protective immune response by oral immunization with yeast expressing the ApxIIA antigen. The ApxI antigen is also an important factor in the protection against Actinobacillus pleuropneumoniae se- rotype 5 infection; therefore, the protective immunity in mice following oral immunization with Saccharomyces cer- evisiae expressing either ApxIA (group C) or ApxIIA (group D) alone or both (group E) was compared with that in two control groups (group A and B). The immuno- genicity of the rApxIA antigen derived from the yeast was confirmed by a high survival rate and an ApxIA-specific IgG antibody response (p ＜ 0.01). The highest systemic (IgG) and local (IgA) humoral immune responses to ApxIA and ApxIIA were detected in group E after the third immunization (p ＜ 0.05). The levels of IL-1 β and IL-6 after challenge with an A. pleuropneumoniae field iso- late did not change significantly in the vaccinated groups. The level of TNF- α increased in a time-dependent manner in group E but was not significantly different after the challenge. After the challenge, the mice in group E had a significantly lower infectious burden and a higher level of protection than the mice in the other groups (p ＜ 0.05). The survival rate in each group was closely correlated to the immune response and histopathological observations in the lung following the challenge. These results suggested that immunity to the ApxIA antigen is required for opti- mal protection. Key words: Actinobacillus pleuropneumoniae, Apx toxins, oral immunization, protective immunity Introduction Most pathogens infect their host across mucosal surfaces, particularly those of the gastrointestinal tract or respiratory tract [24]. Immunoglobulin A (IgA) is the most abundant Ig isotype present in the mucosal tissue during infection and is crucial as a first line of defense. The main role of se- cretory IgA in oral immunization [8,22] is to protect the host by inhibiting pathogen attachment, immune ex- clusion, and facilitating the clearance of toxic products [37]. IgA may also function in lung defense by influencing the trafficking of specific cells through the common mu- cosal immune system [19]. The important roles that both specific local IgA and systemic IgG play in the protection from respiratory diseases have been well documented [11,12]. Although most bacterial extracts that are com- monly administered orally produce nonspecific or poor immune responses, we previously demonstrated that the protection against Actinobacillus pleuropneumoniae in- creased with the production of specific IgA in the lung [34]. In addition, the induction of protective immunity in A. pleuropneumoniae infection by eliciting specific IgA and IgG after natural and experimental infection has been investigated [18]. A. pleuropneumoniae is the etiological agent of porcine pleuropneumonia, a severe respiratory disease affecting swine, is characterized by necrotizing fibrinous pneumo- nia and pleuritis BioMed Central Page 1 of 11 (page number not for citation purposes) Journal of Immune Based Therapies and Vaccines Open Access Original research Mycobacterial immune reconstitution inflammatory syndrome in HIV-1 infection after antiretroviral therapy is associated with deregulated specific T-cell responses: Beneficial effect of IL-2 and GM-CSF immunotherapy A Pires 1 , M Nelson 2 , AL Pozniak 2 , M Fisher 3 , B Gazzard 2 , F Gotch 1 and N Imami* 1 Address: 1 Department of Immunology Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London. UK, 2 Department of HIV/GU Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK and 3 Department of HIV/GU Medicine, Royal Sussex County Hospital, Brighton, UK Email: A Pires - antonio.pires@meditechmedia.com; M Nelson - sandra.mead@chelwest.nhs.uk; AL Pozniak - anton.pozniak@chelwest.nhs.uk; M Fisher - martin.fisher@bsuh.nhs.uk; B Gazzard - eileen.whitney@chelwest.nhs.uk; F Gotch - f.gotch@imperial.ac.uk; N Imami* - n.imami@imperial.ac.uk * Corresponding author Immune reconstitutionT cellsHIV-1Mycobacterial infectionMAC Abstract Background: With the advent of antiretroviral therapy (ART) cases of immune reconstitution inflammatory syndrome (IRIS) have increasingly been reported. IRIS usually occurs in individuals with a rapidly rising CD4 T-cell count or percentage upon initiation of ART, who develop a deregulated immune response to infection with or without reactivation of opportunistic organisms. Here, we evaluated rises in absolute CD4 T-cells, and specific CD4 T-cell responses in 4 HIV-1 + individuals presenting with mycobacterial associated IRIS who received in conjunction with ART, IL-2 plus GM- CSF immunotherapy. Methods: We assessed CD4 T-cell counts, HIV-1 RNA loads, phenotype for naïve and activation markers, and in vitro proliferative responses. Results were compared with those observed in 11 matched, successfully treated asymptomatic clinical progressors (CP) with no evidence of opportunistic infections, and uninfected controls. Results: Median CD4 T-cell counts in IRIS patients rose from 22 cells/µl before initiation of ART, to 70 cells/µl after 8 months of therapy (median 6.5 fold increase). This coincided with IRIS diagnosis, lower levels of naïve CD4 T-cells, increased expression of immune activation markers, and weak CD4 T-cell responses. In contrast, CP had a median CD4 T-cell counts of 76 cells/µl at baseline, which rose to 249 cells/µl 6 months post ART, when strong T-cell responses were seen in > 80% of patients. Higher levels of expression of immune activation markers were seen in IRIS patients compared to CP and UC (IRIS > CP > UC). Immunotherapy with IL-2 and GM-CSF paralleled clinical recovery. Conclusion: These data suggest that mycobacterial IRIS is associated with inadequate immune reconstitution rather than vigorous specific T-cell responses, and concomitant administration of IL-2 and GM-CSF immunotherapy with effective ART may correct/augment T-cell immunity in such setting resulting in clinical benefit. Published: 25 September 2005 Journal of Immune Based Therapies and Vaccines 2005, 3:7 doi:10.1186/1476- 8518-3-7 Received: 06 April 2004 Accepted: 25 September 2005 This article is available from: http://www.jibtherapies.com/content/3/1/7 © 2005 Pires et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Journal of Immune Based Therapies and Vaccines 2005, 3:7 http://www.jibtherapies.com/content/3/1/7 Page 2 of 11 (page number not for citation purposes) Background The degree of immune reconstitution observed in HIV-1 + individuals following initiation of antiretroviral therapy (ART), is variable [1-4]. Although seen even in late-stage RESEARC H Open Access Factors associated with internalizing or somatic symptoms in a cross-sectional study of school children in grades 1-10 Audhild Løhre 1,2* , Stian Lydersen 3 , Lars J Vatten 1 Abstract Background: School related factors that may contribute to children’s subjective health have not been extensively studied. We assessed whether factors assumed to promote health and factors assumed to have adverse effects were associated with self-reported internalizing or somatic symptoms. Methods: In a cross-sectional study, 230 boys and 189 girls in grades 1-10 from five schools responded to the same set of questions. Proportional odds logistic regression was used to assess associations of school related factors with the prevalence of sadness, anxiety, stomach ache, and headache. Results: In multivariable analyses, perceived loneliness showed strong and positive associations with sadness (odds ratio, 1.94, 95% CI 1.42 to 2.64), anxiety (odds ratio, 1.78, 95% CI 1.31 to 2.42), and headache (odds ratio, 1.47, 95% CI 1.10 to 1.96), with consistently stronger associations for girls than boys. Among assumed health promoting factors, receiving necessary help from teachers was associated with lower prevalence of stomach ache in girls (odds ratio, 0.51, 95% CI 0.30 to 0.87). Conclusions: These findings suggest that perceived loneliness may be strongly related to both internalizing and somatic symptoms among school children, and for girls, the associations of loneliness appear to be particularly strong. Background Children’s perceived health status influences t heir daily life [1,2], and childhood health is also a powerful predic- tor for health in adulthood [3,4]. Health complaints are typically classified as either emotional or somatic, and a combination of these typesofsymptomsisnotuncom- mon [5-10]. Anxiety and depression are the most common emo- tional problems, and appear to be mo re prevalent among girls, with fairly high co-morbidity (20-50%) [11]. Anxiety t ends to predate depression [6,9], and the pre- valence may range from 6% to 18% in childhood and adolescence [11]. Depressive disorders are rare among young children, but in adolescence the prevalence may be as high as 8% [11]. The results of long term follow- up studies suggest that early emotional symptoms may predict higher risk of mental and physical disease in middle age [12-14]. Headache and stomach pain are the most prevalent physical complaints at a young age [15]. Before elemen- tary school, children rarely complain about headache [16], but the prevalence increases w ith age [10,17,1 8]. Around puberty, about 15% may report frequent or severe headache, and more than half of the students in high school may report l ess frequent episodes of head- ache [17]. Before puberty, the prevalence of reported headache seems to be higher in boys than girls, but after puberty, the prevalence appears to be higher among girls [17,18]. Stomach pain appears to be more frequent among younger than older children [16,19,20]. Recurrence of abdominal pain may range from 10-45% [21], and in adolescence (11-15 years), the total prevalence of self- reported episodes of stomach pain is around 50%, and the estimates are higher for girls than boys [20,22]. Per- ceived abdominal pain in childhood has been associated * Correspondence: audhild.lohre@ntnu.no 1 Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Full list of author information is available at the end of the article Løhre et al. Child and Adolescent Psychiatry and Mental Health 2010, 4:33 http://www.capmh.com/content/4/1/33 © 2010 Løhre et al; licensee BioMed Central Ltd. This is an Open A ccess article distributed under the terms of the Creative Commons Attribution License (http://cre ativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. with higher risk of both ... time it takes for this reaction to occur accounts for the 24- to 72-hour delay in development 4/8 Diseases Associated with Depressed or Overactive Immune Responses The classical test for delayed... permeability and increased blood flow of nasal 3/8 Diseases Associated with Depressed or Overactive Immune Responses blood vessels As these mediators are released with mast cell degranulation, type I hypersensitivity... infection with Streptococcus bacteria, which causes strep throat The antibodies to this pathogen’s M protein cross-react with 5/8 Diseases Associated with Depressed or Overactive Immune Responses