Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review.

OBJECTIVES: To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections. METHODS: Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted. RESULTS: 52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001). CONCLUSIONS: CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.

Cerebral venous thrombosis: comparing characteristics of infective and non-infective aetiologies: a 12-year retrospective study.

BACKGROUND: Most cases of cerebral venous thrombosis (CVT) have non-infective causes. Infective CVT, though less common, often results in a catastrophic outcome. The distinctive clinical characteristics of infection-associated CVT (IACVT) and non-infection-associated CVT (NIACVT) would facilitate early detection and proper management. OBJECTIVE: To compare the characteristics of IACVT and NIACVT. METHODS: All patients with CVT admitted to Songklanagarind Hospital between January 2002 and December 2013 with the ICD10 codes I636, I676, O225 and G08 were identified and recruited. We compared the clinical presentations, neuroimaging results and hospital outcomes for patients with IACVT and those with NIACVT. We analysed the differences using descriptive statistics. Additionally, for patients with IACVT, we described the primary sites of infection, associated CVT, host immune status and microbiological results. RESULTS: Twenty of the 83 patients with CVT (24.1%) had IACVT. Male gender (70.0% vs 34.9%) and pre-existing diabetes mellitus (35.0% vs 4.8%) were significantly more prevalent in the IACVT than the NIACVT group. Additionally, cavernous sinus thrombosis predominated in IACVT (80.0% vs 11.1%), whereas focal neurological syndrome was more common among patients with NIACVT (50.8% vs 15.0%). Paracranial infections, mostly sinusitis and orbital cellulitis, were common primary infections (80.0%) among patients with IACVT. Lastly, fungus was a devastating causative pathogen in IACVT-five of six patients with fungal infection had intracranial complications. CONCLUSIONS: Cavernous sinus thrombosis is a distinctive clinical presentation of IACVT, whereas focal neurological syndrome is a hallmark feature of NIACVT. Paracranial fungal infections are highly virulent and frequently associated with intracranial complications.

Immunoglobulin and CD8⁺ T-cell distribution in histologically distinctive tonsils of individuals with tonsillar focal infection.

CONCLUSION: This study demonstrated that the common immunological mechanism, which involves aberration of immunoglobulin and T-cell distribution in histologically distinctive tonsils, may be associated with the pathogenesis of tonsillar focal infection. OBJECTIVES: Tonsillar focal infection comprises a group of relatively common diseases combined with chronic tonsillar infection, is associated with unusual immune responses in tonsils, and may cause lesions in another distant target organ. This study aimed to investigate the distribution of inflammatory T cells and T-cell regulatory elements, such as programmed cell death-1 (PD-1) and Fork head box protein 3 (Foxp3), immunoglobulin production, and histological characteristics in tonsils from patients with tonsillar focal infection. METHODS: Immunohistochemistry and reverse transcription-polymerase chain reaction (PCR) were used to compare the expression of CD8(+) T cells, immunoglobulins, and cytokines associated with immunoglobulin production in the tonsils of patients with IgA nephropathy (IgAN), palmoplantar pustulosis (PPP), rheumatoid arthritis (RA), and chronic tonsillitis. RESULTS: The overexpression of CD8(+) T cells combined with decreased expression of Foxp3 and PD-1 and the aberration of immunoglobulin production, which may be due to the elevated expression of activation-induced deaminase (AID), B-cell-activating factor of the TNF family (BAFF), supporting isotype switching, and B-cell survival in the histologically distinctive tonsils.

[The molecular biological characteristics of the pathogen of tuberculosis and the pathoanatomic aspects of its fatal outcomes in Irkutsk in 2008-2011].

The paper gives the results of examining 163 autopsy cases of tuberculosis in Irkutsk. The forms of the disease are characterized, by identifying generalized large focal necrotic focal tuberculosis. MIRU-VNTR genotyping defined M. tuberculosis genotypes and established the leading role of the Beijing genotype (65%) in the development of the most severe generalized alterative and exudative changes. 48% of all generalized large focal tuberculosis cases were shown to be HIV-infected. A DS-SIGN gene polymorphism at the -336 A/G position was studied; the most unfavorable combination of AG or GG polymorphism (in 84% of cases) was shown in a patient with the M. tuberculosis Beijing genotype. Not only the patient's immune status, but also the genotypes of mycobacteria and the host affect the most unfavorable course of tuberculosis with the development of generalized alterative and exudative lesions.

IgA production and tonsillar focal infection in IgA nephropathy.

IgA nephropathy (IgAN), the common primary glomerulonephritis, is a tonsillar focal infection characterized by the qualitative abnormality of IgA in circulation and IgA deposition in the renal mesangium. Mesangial deposition of IgA, which is composed predominantly of poorly galactosylated polymeric IgA1 (pIgA1), seems to be the initiating event in the pathogenesis of IgAN. The origin of poorly galactosylated IgA, however, remains unclear. Recent studies suggest that the mesangial polymeric IgA1 deposition could be derived from mucosally primed plasma cells. B cells may undergo IgA class switching to acquire the expression of IgA via T-cell-dependent or T-cell-independent pathways in mucosa-associated lymphoid tissue and then differentiate to IgA plasma cells or home in on systemic sites. Dendritic cells, including plasmacytoid dendritic cells and another type of antigen-retaining cell, follicular dendritic cells, have an irreplaceable role in IgA class-switch mechanisms by producing IgA-inducing signals. Furthermore, an increased number of pIgA1-secreting plasma cells in the bone marrow and tonsil, as well as increased IgA class switching, have been found in IgAN, providing a link between the mucosal immunity and IgAN. The favorable effect of tonsillectomy on patients with IgAN showed that tonsillar focal infection may be closely related to pIgA1 deposition in glomerular mesangium of patients with IgAN and at least a part of pIgA1 may originate from affected tonsils. Therefore, the indication for tonsillectomy should be considered in patients with IgA nephropathy, especially at a mild or early stage, to prevent future renal deterioration. In this paper, we focus on IgA class switching and the role of tonsils with focal infection in IgAN.

Multidetector CT features of pulmonary focal ground-glass opacity: differences between benign and malignant.

OBJECTIVE: To evaluate different features between benign and malignant pulmonary focal ground-glass opacity (fGGO) on multidetector CT (MDCT). METHODS: 82 pathologically or clinically confirmed fGGOs were retrospectively analysed with regard to demographic data, lesion size and location, attenuation value and MDCT features including shape, margin, interface, internal characteristics and adjacent structure. Differences between benign and malignant fGGOs were analysed using a χ(2) test, Fisher's exact test or Mann-Whitney U-test. Morphological characteristics were analysed by binary logistic regression analysis to estimate the likelihood of malignancy. RESULTS: There were 21 benign and 61 malignant lesions. No statistical differences were found between benign and malignant fGGOs in terms of demographic data, size, location and attenuation value. The frequency of lobulation (p=0.000), spiculation (p=0.008), spine-like process (p=0.004), well-defined but coarse interface (p=0.000), bronchus cut-off (p=0.003), other air-containing space (p=0.000), pleural indentation (p=0.000) and vascular convergence (p=0.006) was significantly higher in malignant fGGOs than that in benign fGGOs. Binary logistic regression analysis showed that lobulation, interface and pleural indentation were important indicators for malignant diagnosis of fGGO, with the corresponding odds ratios of 8.122, 3.139 and 9.076, respectively. In addition, a well-defined but coarse interface was the most important indicator of malignancy among all interface types. With all three important indicators considered, the diagnostic sensitivity, specificity and accuracy were 93.4%, 66.7% and 86.6%, respectively. CONCLUSION: An fGGO with lobulation, a well-defined but coarse interface and pleural indentation gives a greater than average likelihood of being malignant.

Tonsil-related skin diseases and possible involvement of T cell co-stimulation in chronic focal infection.

Some inflammatory skin diseases are known to be related to tonsil focal infection at their onset. Administration of antibiotics is adequate treatment in most acute or subacute cases. However, chronic focal infections in the tonsils could cause chronic skin diseases like pustulosis palmaris et plantaris (PPP), and it is our frequent experience that tonsillectomy leads to a dramatic and persistent improvement of PPP skin lesions. The expression of inducible co-stimulator (ICOS), a co-stimulatory receptor on activated T cells, was significantly higher in tonsil tissues from PPP patients than in tonsil tissues from non-PPP patients. Moreover, ICOS expression in tonsil tissues from 3 patients with psoriasis vulgaris that was strongly suspected to be related to tonsil focal infection was also high, suggesting that the activation of T cells via ICOS costimulation in focal infections likely triggers inflammation associated with tonsil-related skin diseases. PPP is notable today for paradoxically induced skin lesions in patients treated with TNF-α antagonists for rheumatoid arthritis, Crohn's disease, psoriasis and psoriatic arthritis. It is important to clarify the immunological milieu in PPP not only for the treatment approach but also for understanding these unexpected reactions.

Triggering role of focal infection in the induction of extra-palmoplantar lesions and pustulotic arthro-osteitis associated with palmoplantar pustulosis.

Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles of middle-aged women. Whether PPP is the acral type of pustular psoriasis or a distinct entity has long been discussed; however, the clinical features of PPP are really heterogeneous and different between Asians and Caucasians, which may depend on the race with backgrounds of different HLAs. PPP is closely related with psoriasis, but considered to be a distinct entity in Japan. Although the pathogenesis of PPP is still poorly understood, PPP is a representative skin disorder showing a close relationship with focal infections such as tonsillitis, chronic sinusitis, and dental infection. In particular, tonsillitis often triggers or deteriorates PPP. In Japanese patients, regions other than the palms and soles are occasionally affected manifesting scaly erythemas which resemble psoriasis, and solitary pustules are also seen. Some of these extra-palmoplantar lesions are induced by the Koebner phenomenon or occur after focal infections. Further, arthralgia is also induced on the sternum, clavics, sacroiliac joints, and upper ribs following focal infections. This paper makes a focus on the triggering role of focal infection in the induction of extra-palmoplantar lesions as well as arthralgia (putulotic arthro-osteitis).

A case of infection-associated antiproteinase-3-negative cytoplasmic antineutrophil cytoplasmic antibody pauci-immune focal necrotizing glomerulonephritis.

We present the case of a man with Gram-negative sepsis and exposure to oral silica who developed pauci-immune focal necrotizing glomerulonephritis (PI-FNGN) in the setting of a subacute polymicrobial central venous line (CVL) infection. He developed a cytoplasmic antineutrophil cytoplasmic autoantibody (C-ANCA) that was antiproteinase-3 (PR-3) and antimyeloperoxidase (MPO) antibody negative. We believe this is the first reported case of Gram-negative sepsis-associated PI-FNGN. Chronic silica exposure is a leading environmental risk factor in the development of ANCA vasculitis. Oral silica is a common pharmaceutical additive and its bioavailability is being recognized. Oral silica, therefore, may also be a risk for development of autoreactivity. The PI-FNGN resolved with antibiotic therapy alone. The C-ANCA titer declined as the PI-FNGN resolved. The case supports experimental and observational research that environmental exposures act as adjuvants for an immune response and also provide epigenetic triggers for autoreactivity. The C-ANCA was negative for PR-3, its major antigen. C-ANCA antigen specificity may depend on the pathogenesis of the underlying disease, potentially elicited by a cross-reaction of an antibody to foreign and self target antigen sequence homology or alternatively elicited by antigenic epitope spread.

Clinical periodontal profile in pre-eclampsia / Perfil clínico periodontal em pré-eclâmpsia

Objective: To investigate the association between periodontaldisease and pre-eclampsia. Methods: A method preliminary study was carried out on 25 pre-eclamptic women and 25 normotensive healthy, normotensive pregnant, women. The clinical parameters and missing teeth were determined. Data were analyzed by using SPSS version 7. Results: The mean pocket depth and missing teeth (periodontal disease characteristics) for pre-eclampsia patients were not significant as ompared those of normotensive. Conclusion: The present study shows that maternal periodontal disease during pregnancy is not associated with increased risk for development of pre-eclampsia. The nature of both preeclampsia and periodontitis is multi factorial, and caution should be exercised when implicating periodontal disease in causation of pre eclampsia.

Objetivo: Investigar a associação entre doença periodontal e pré eclâmpsia. Método: O estudo foi desenvolvido em 25 mulheres pré eclâmpticas e em 25 mulheres grávidas normotensas, saudáveis. Avaliou-se alguns parâmetros clínicos e a perda dentária. Os dados foram analisados por meio do SPSS versão 7. Resultados: A profundidade média da bolsa periodontal e perda dentária (características da doença periodontal) nas pacientes pré-eclâmpitcas não foi estatisticamente significante quando comparadas as gestantes normotensas. Conclusão: Este estudo mostrou que a doença periodontal durante a gravidez não está associada com o aumento no risco para o desenvolvimento de pré eclâmpsia. A etiologia de ambas as patologias - pré-eclâmpsia e periodontite é multifatorial e deve-se ter cautela ao se relacionar a doença periodontal como causa da pré-eclâmpsia.

Acute focal nephritis: its true sonographic face.

BACKGROUND: Acute focal nephritis is an inflammatory process of the renal parenchyma affecting principally the cortex of the kidney. It is considered a midpoint in the spectrum of upper urinary tract infections, ranging from uncomplicated pyelonephritis to intrarenal abscesses. Until recently the hyperechoic sonographic appearance of this lesion was considered uncommon. OBJECTIVES: To determine the relative prevalence of hyperechoic and hypoechoic sonographic appearance of focal renal lesions in patients with the clinical diagnosis of acute pyelonephritis and to correlate the findings with those of the color Doppler examinations. METHODS: We reviewed the sonograms of 367 patients hospitalized with the clinical diagnosis of acute pyelonephritis. The sonograms were reviewed for acute renal inflammatory changes. When a focal lesion was detected, we noted the echogenicity, side, form, location and color Doppler characteristics. RESULTS: Abnormal sonographic findings related to the infection were found in 78 cases. In 52 patients a focal lesion was diagnosed. Forty-seven focal lesions appeared hyperechoic related to the adjacent parenchyma. These lesions were more frequently located at the upper pole and were wedge-shaped in most of the cases. The areas appeared hypo/avascular on the color Doppler examination. CONCLUSIONS: Our data suggest that the most common appearance of acute focal nephritis is an area of increased echogenicity in the parenchyma of the affected kidney.

Therapy of focal viral encephalitis in children with aciclovir and recombinant beta-interferon - results of a placebo-controlled multicenter study.

Focal viral encephalitis in childhood is a rare but life-threatening disease. Animal experiments and case reports suggest a positive effect of an additional therapy with interferon-beta on the course of the disease. Therefore, we initiated a prospective, double-blind placebo-controlled study to investigate the benefit of a combination therapy of Aciclovir (ACV) and recombinant interferon-beta (rIFN-beta) in juvenile focal viral encephalitis. - Initial inclusion criterium was suspicion of focal viral encephalitis. Diagnosis was proven by demonstration of characteristic focal lesions in cerebral imaging or virological evidence of HSV in cerebrospinal fluid. Patients were treated with ACV plus rIFN-beta or ACV plus placebo. Neurological outcome was determined 21 days and 3 months after onset of the disease. - Initially 59 patients were enrolled in the study. Encephalitis was proven in 14 patients (7 ACV + rIFN-beta, 7 ACV + placebo). The study groups were balanced in terms of important prognostic criteria. 10 patients (5 ACV + rIFN-beta, 5 ACV + placebo) were cured or had slight defects, 4 patients (2 ACV + rIFN-beta, 2 ACV + placebo) showed moderate to severe defects. There was no significant difference in favour of the additive therapy with rIFN-beta.

[Lethal complication of an odontogenic infection developing after tooth extraction in a patient with untreated diabetes. Case report]. / Odontogén fertózés foghúzás után kialakult halálos szövódménye egy kezeletlen diabeteses betegben (Esetismertetés).

The extraction of a tooth led to the acute exacerbation of existing chronic osteomyelitis then phlegmon, and sepsis as a result. Persisting coma developed after three reanimations of the patient, on account of septic shock. Finally, in more than two weeks following the extraction the patient died due to multiorgan failure. This case description wishes to call attention to the risks of complications of diabetes, to summarize the relevant documents of diagnosis and treatment of osteomyelitis and phlegmon and the data of mortality. Hopefully we offer some useful advice to the general dentist about patients with immunosuppressive diseases.

Focal bacterial nephritis (lobar nephronia) presenting as renal mass.

A focal infection of the kidney can cause a diagnostic dilemma by mimicking a neoplasm. We describe a case of focal bacterial nephritis (acute lobar nephronia) caused by Escherichia coli in which the diagnosis was confirmed only after surgical exploration. Although the patient had fever on admission, urine and blood cultures were negative and fine needle aspiration of the kidney could not rule out a well-differentiated carcinoma.

Herpes simplex replication and dissemination is not increased by corticosteroid treatment in a rat model of focal Herpes encephalitis.

Neurological damage in Herpes simplex type 1 encephalitis results from neuronal cell death secondary to viral invasion, and from inflammatory changes and cerebral oedema secondary to the immune response to the virus. Corticosteroids could have an important role in the management of Herpes simplex encephalitis because their anti-inflammatory action reduces cerebral oedema. However their use has been limited by concerns that their immunosuppressive actions could increase viral replication and spread. The present study examined this issue in a rat model in which injection of HSV-1 into the cervical vagus nerve produced a well-defined focal encephalitis, characterised by an orderly progression of the virus through central neural pathways connected with vagal afferent termination sites in the medulla oblongata. After injection of HSV-1, rats were treated twice a day, either with vehicle (saline, 400 microl i.p.), with acyclovir (30 mg/kg i.p.), with dexamethasone (5 mg/kg i.p.), or with both acyclovir and dexamethasone. Animals were sacrificed after 72 h, and viral load in different brain regions was quantified by computer-assisted measurement of the area occupied by immunohistochemical reaction product. Treatment with acyclovir reduced viral load to 17 +/- 5% of the saline value (P < 0.01). After dexamethasone treatment, the viral load (63 +/- 13% of the saline value) was also reduced (P < 0.05). Treatment with both acyclovir and dexamethasone reduced viral load to 26 +/- 8% of the saline value (P < 0.01 compared with saline, and P > 0.05 compared to acyclovir alone). Our results confirm the effectiveness of acyclovir in a new model of HSV-1 infection, and provide evidence that corticosteroids do not inhibit the antiviral action of acyclovir. In addition corticosteroids may decrease the extent of infection in their own right. The acute time course studied in our model parallels the time course of acute Herpes simplex encephalitis in humans. Our data suggests that corticosteroids are not detrimental when combined with acyclovir in the management of this condition.

[The effect of antibodies to microorganisms in a focus of purulent inflammation]. / Vliianie antitel na mikroorganizmy v ochage gnoinogo vospaleniia.

The rats were infected with a suspension of dissociated or agglutinated Pseudomonas aeruginosa [correction of B. pynocyaneus]. Infection with the agglutinated agent drastically improved the clinical course, lowered the indices of the process generalization (mortality, metastatic foci, spread in the internal organs); no hemorrhages, necrosis or abscesses were noted. A rapid (within the first day) death of almost all agglutinated bacteria in the primary focus was observed, this not being due to phagocytosis or complement-dependent lysis.

[The efficacy of the combined antibacterial treatment of patients with colonic cancer complicated by perifocal inflammation]. / Effektivnost' kombinirovannogo antibakterial'nogo lecheniia bol'nykh rakom obodochnoi kishki, oslozhnennym perifokal'nym vospaleniem.

In patients with colonic cancer complicated by inflammation since 1989 we have been using irrigations of tumor area with antibacterial drugs (dioxidin, betadin) side by side with conventional antibacterial and detoxicating therapy. The complex antibacterial therapy having been applied in 47 patients eliminated clinical manifestation of inflammatory process. Histological and morphometrical biopsy of tumor tissue and surrounding mucosa gives a reason to conclude that the complex therapy has proved to be effective.

Hepatic candidiasis: persistent pyrexia in a patient with acute myeloid leukaemia after recovery from consolidation therapy-induced neutropenia.

Fever, a frequent manifestation in acute leukaemia patients who develop treatment-induced neutropenia, usually resolves when the neutrophil count returns to normal irrespective of whether an infective agent is isolated or not. A persistent pyrexia following neutrophil recovery and associated with multiple negative microbiological cultures should signal a careful search for a deep-seated fungal infection in any leukaemic patient who is complete remission. We report here a 39-year-old Chinese man with acute myeloid leukaemia in first complete remission whose unresolved fever after recovery from consolidation therapy-induced neutropenia was ultimately confirmed to be caused by focal hepatic candidal microabscesses by an open liver biopsy.

Characterisation of the local inflammatory response in appendicitis.

In this study we have characterised the local inflammatory response in acute suppurative appendicitis (S), focal appendicitis (F), and normal appendices (C). Enumeration of lymphocyte subpopulations, cells expressing IL-2 receptor, natural killer (NK) cells, monocytes and plasma cell isotypes and subclasses infiltrating the lamina propria was carried out on all specimens using immunoperoxidase staining procedures. Total T cells were significantly increased in both acute suppurative appendicitis and focal appendicitis compared with controls (p < 0.001). Cells infiltrating the lamina propria expressed IL-2 receptor in all appendiceal specimens but were significantly increased in both acute and focal appendicitis (p < 0.01). IgG and IgA plasma cell isotypes were significantly increased in all S and F appendiceal specimens (p < 0.001). Monocyte and NK cell numbers, however, were only increased in acute suppurative appendiceal specimens. The increased lymphocyte and plasma cell isotypes seen in focal appendicitis occurred throughout the entire organ even through the inflammatory focus was confined to only three to seven serial sections. These results clearly show a differential pattern of cellular infiltration in focal appendicitis from that seen in acute suppurative appendicitis. The selective lymphocyte and plasma cell nature of the cellular infiltrate in the lamina propria of focal appendicitis may reflect the presence of a specific immune response to an as yet unidentified luminal antigen as a possible cause of appendicitis.