Antinuclear antibodies in infectious diseases.

Introduction: Antinuclear antibody (ANA) tests are widely used for the diagnosis of autoimmune diseases, but ANAs are also commonly found in patients with various infections. This retrospective study aimed to investigate the relationship between infections and ANA status.Methods: Patients that visited the Department of Infectious Diseases at Inha University Hospital between January 2007 and July 2018 were investigated. We analysed their ANA test results and reviewed rheumatic and infectious diagnoses of patients with positive ANA findings.Results: Of the 9,320 patients during the study period, 1,111 underwent ANA testing and 110 tested positive. Seven of the 110 patients were previously diagnosed with ANA-positive disease, and 21 were diagnosed with autoimmune disease during the present study. Of the remaining 82 patients, 43 were confirmed with infectious disease. The most common pathogen was Mycobacterium tuberculosis (n = 10), followed by Treponema pallidum (n = 5), Orientia tsutsugamushi (n = 5), Escherichia coli (n = 5), Bartonella henselae (n = 3), and human immunodeficiency virus (n = 3). Of the 39 patients without a confirmed pathogen, 7 were seropositive for O. tsutsugamushi, B. henselae, or Rickettsia spp. Patients were observed at an average of 24 weeks in our hospital. One patient developed systemic lupus erythematosus after being diagnosed with Epstein-Barr virus-induced infectious mononucleosis, and another patient developed adult-onset Still's disease after being diagnosed with scrub typhus.Conclusion: This study showed that various relationships exist between infections and rheumatic diseases. In particular, several patients with a positive ANA test result were found to have intracellular infections such as mycobacterial infections, syphilis, or scrub typhus.

Rare infections mimicking MS.

The diagnosis of multiple sclerosis (MS), despite well defined clinical criteria is not always simple. On many occasions it is difficult to differentiate MS from various non-MS idiopathic demyelinating disorders, specific and infectious inflammatory diseases or non-inflammatory demyelinating diseases. Clinicians should be aware of various clinical and MRI "red flags" that may point to the other diagnosis and demand further diagnostic evaluation. It is generally accepted that atypical clinical symptoms or atypical neuroimaging signs determine necessity for broad differential diagnostic work up. Of the infectious diseases that are most commonly mistaken for MS the clinician should take into account Whipple's disease, Lyme disease, Syphilis, HIV/AIDS, Brucellosis, HHV-6 infection, Hepatitis C, Mycoplasma and Creutzfeld-Jacob disease, among others. Cat scratch disease caused by Bartonella hensellae, Mediterranean spotted fever caused by Riketssia connore and Leptospirosis caused by different Leptospira serovars rarely cause focal neurological deficit and demyelinating MRI changes similar to MS. When atypical clinical and neuroimaging presentations are present, serology on rare infectious diseases that may mimic MS may be warranted. This review will focus on the infectious diseases mimicking MS with presentation of rare illustrative cases.

Levantamento de anticorpos anti-bartonella henselae em felinos domiciliados na cidade de São Paulo, estado de São Paulo e sua importância em saúde pública / A survey of anti-bartonella henselae antibodies in domiciliated cats in the city of São Paulo, state of São Paulo and its importance in public health

A Doença da Arranhadura do Gato (DAG) é uma zoonose transmitida pelos gatos que caracteriza-se por linfoadenopatiaregional acompanhada por febre, anorexia e perda de peso. Em pacientes imunodeprimidos, como os aidéticos, o quadroevolui para outras formas, desde encefalopatias até para a Angiomatose e a Peliose Bacilares, de evolução fatal. Os felídeos,principalmente os gatos domésticos, são o reservatório do agente, a Bartonella henselae, restando confirmar a idade na qualeles estão mais aptos a transmitir a doença. Foram analisados 200 soros de felinos na cidade de São Paulo, estado de SãoPaulo, no período de janeiro de 1996 até dezembro de 1997 através da técnica da imunofluorescência indireta. A metade delesera saudável e a outra metade era composta por animais atendidos no Ambulatório do Hospital Veterinário da Universidade deSão Paulo. Os animais foram divididos em 4 grupos baseados em sua faixa etária: animais de até 6 meses de idade, entre 7e 12 meses, animais de mais de 1 ano até 2 anos e outros com mais de 2 anos. O objetivo foi avaliar a presença de anticorposIgG anti-B henselae nos quatro grupos de animais, bem como o encontro desses anticorpos e o sexo ou o estado de higidezdos felinos. Foi encontrada soropositividade de 16% para B. henselae e observou-se que o maior número de animaisreagentes se encontrava na faixa etária de 7 a 12 meses, e que não houve diferença entre a soropositividade e os sexos, ouentre os animais hígidos ou doentes. Concluiu-se, assim, que a infecção nos felinos se dá nas faixas etárias mais jovens como desenvolvimento de anticorpos humorais, que diminuem conforme a idade dos animais

Cat Scratch Disease (CSD) is a human disease transmited by scratch or bite of asyntomatics cats and characterized byregional limphadenopaty with fever, anorexy and weigh loss. In immunosupressed patients, like AIDS patients, there aresystemic clinical presentations (bacillary angiomatosis or bacillary splenits), gerally fatal. Domestic cats are the main reservoirof Bartonella henselae, the agent of CSD and this prevalence is evaluated by serological test. In the period from January 1996to December 1997, two hundred sera samples of domestic cat from city of São Paulo were analized by using indirectimunofluorescence test. Fifty percent of the animals were clinically healthy and other half was comprised by felines attended atVeterinary Hospital – University of São Paulo estate of São Paulo - Brasil . Felines were divided in four groups according to theirages: animal up to six months old, between seven and twelve months old, between one and two years old, and older than twoyears old. We intended to evaluate the presence of IgG- Bartonella henselae antibodies in the four groups of animals, relationshipsbetween antibodis and gender, and health status of the felines, as well. Seropositivity of 16 % was found for B. henselae. Whenthe age was analyzed, the evidence that within the group between seven and twelve months of age, was significantly higher thanthe other groups. There were no diference between genders, or between health and sick animals. We concluded, that theinfection of felines happens at younger age, due to development of humoral antibodies that decrease with the age of animals

Granulomatous infections: etiology and classification.

Granulomatous disorders are frequently due to a wide variety of infections. Over the past decade advances in molecular diagnostic techniques have allowed identification of organisms involved in granulomatous disorders that previously were of unknown etiology. On the basis of currently available information, granulomatous infections can now be classified in three categories. Group 1 infections are due to a well-recognized organism. Group 2 comprises infections due to organisms that have been recently identified in granulomas by molecular methods but are not readily isolated by conventional microbiological techniques. Group 3 consists of disorders for which the causal organisms have not yet been identified but are strongly suspected; further advances in diagnostic techniques will lead to reclassification of some of these disorders as group 2. This review describes the etiology, histopathologic features, and classification of granulomatous disorders, with an emphasis on those of groups 2 and 3.

Ocular manifestation of systemic infections.

Patients with various systemic infections can often be diagnosed on the basis of their presenting ocular signs and symptoms. Recognition of the ocular manifestations of systemic infections will expedite diagnosis and allow rapid institution of appropriate therapy thereby reducing morbidity and mortality. Recent literature discussing ophthalmologic findings in the following diseases are reviewed: Whipple's disease, endogenous endophthalmitis, cat-scratch disease, toxoplasmosis, and hepatitis C.