Hepatitis E virus and Zoonosis: Recent Advances and Therapeutic Implications.

Hepatitis E is viral hepatitis caused by infection with the hepatitis E virus (HEV). This article aims to review HEV disease and recent advances in the management of hepatitis E. We used PubMed Clinical Queries and keywords of "hepatitis E", "hepatitis E virus" AND "zoonosis" as the search engine. "Therapy", "Clinical Prediction Guides", "Diagnosis", "Etiology" and "Prognosis" were used as filters, and "Narrow" scope was used. The search was conducted in April 2022. The information retrieved from the above search was used in the compilation of the present article. Hepatitis E is viral hepatitis caused by infection with the hepatitis E virus (HEV). Hepatitis E has mainly a fecal-oral transmission route. Hepatitis E infection usually follows an acute and self-limiting course of illness with low death rates in resource-rich areas; however, it can be more severe in pregnant women and immunocompromised people. The mortality rates in these groups are substantially higher. A vaccine for HEV is available but is not universally approved. Ribavirin remains the most efficacious medication for the treatment of HEV but is contraindicated in pregnancy. Sofosbuvir and pegylated interferon, with or without ribavirin, have not been shown in the latest literature reviews to provide reliable additional benefits to the treatment of hepatitis. Sofosbuvir should not be used as monotherapy for HEV. Food is an important source of infection in many countries while rats are the primary vector in developing nations. Management must include an understanding of the rat habitats for this zoonotic disease. Hepatitis E remains an important cause of hepatitis and a zoonotic disease globally. Public health policies are key to containing this viral infectious disease, including policy in the transfusion of blood products.

Molluscum Contagiosum: An Update.

BACKGROUND: Molluscum contagiosum is a viral cutaneous infection in childhood that occurs worldwide. Physicians should familiarize themselves with this common condition. OBJECTIVE: To review in depth the epidemiology, pathophysiology, clinical manifestations, complications and, in particular, treatment of molluscum contagiosum. METHODS: A PubMed search was completed in Clinical Queries using the key term "molluscum contagiosum". Patents were searched using the key term "molluscum contagiosum" from www.google.com/patents, http: //espacenet.com, and www.freepatentsonline.com. RESULTS: Molluscum contagiosum is caused by a poxvirus of the Molluscipox genus. Preschool and elementary school-aged children are more commonly affected. The virus is transmitted by close physical contact, autoinoculation, and fomites. Typically, molluscum contagiosum presents as asymptomatic, discrete, smooth, flesh-colored, dome-shaped papules with central umbilication from which a plug of cheesy material can be expressed. Some authors suggest watchful waiting of the lesions.Many authors suggest active treatment of lesions for cosmetic reasons or concerns of transmission and autoinoculation. Active treatments may be mechanical (e.g. cryotherapy, curettage, pulsed dye laser therapy), chemical (e.g. cantharidin, potassium hydroxide, podophyllotoxin, benzoyl peroxide, tretinoin, trichloroacetic acid, lactic acid, glycolic acid, salicylic acid), immune-modulating (e.g. imiquimod, interferon-alpha, cimetidine) and anti-viral (e.g. cidofovir). Recent patents related to the management of molluscum contagiosum are also retrieved and discussed. These patents comprise of topical compositions and herbal Chinese medicine with limited documentation of their efficacy. CONCLUSION: The choice of treatment method should depend on the physician's comfort level with the various treatment options, the patient's age, the number and severity of lesions, location of lesions, and the preference of the child/parents. In general, physical destruction of the lesion, in particular, cryotherapy with liquid nitrogen and chemical destruction with cantharidin are the methods of choice for the majority of patients.

Cutaneous Larva Migrans.

BACKGROUND: Cutaneous larva migrans is one of the most common skin diseases reported in travelers returning from tropical regions. Western physicians, however, are often not familiar of this condition. OBJECTIVE: To review in depth the epidemiology, pathophysiology, clinical manifestations, complications, and treatment of cutaneous larva migrans. METHODS: A PubMed search was completed in Clinical Queries using the key term "cutaneous larva migrans". The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Patents were searched using the key term "cutaneous larva migrans" from www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. RESULTS: Cutaneous larva migrans is a zoonotic infestation caused by penetration and migration in the epidermis of filariform larva of different kinds of animal hookworms through contact with feces of infected animals. Cutaneous larva migrans is endemic in tropical and subtropical regions. Clinically, cutaneous larva migrans is characterized by an intensely pruritic erythematous migrating tortuous or serpiginous, slightly raised track. The diagnosis is mainly clinical, based on the history of travel to an endemic area and exposure to contaminated soil/sand and the characteristic serpiginous track. Treatment options as well as recent patents related to the management of cutaneous larva migrans are also discussed. Compared with oral antihelminthics, topical treatment over the affected area is less effective. Oral ivermectin is the treatment of choice. CONCLUSION: The pruritic serpiginous track is pathognomonic. Oral ivermectin is the treatment of choice.

Specific IgE of common foods in Chinese children with eczema.

Food atopy is important but inadequately studied among children with atopic dermatitis (AD). We evaluated whether any association existed between AD severity, quality of life, total IgE, eosinophil counts, and the number of food items sensitized. Specific IgE of ten common food items was measured for a group of consecutive AD patients (n=85) enrolled during a randomized trial and correlated the findings with eczema severity. Twenty-four patients (28%) were negative for any of the ten common food items. The most commonly sensitized foods were shrimp (54%), egg white (43%), wheat (42%), and peanut (41%). Atopy to beef as a protein and orange as a fruit were least common among the food items studied, even among patients positive for 8-9 IgE items. Patients with severe AD (objective SCORAD>40) were more likely to be positive for at least one of the food items (Yates corrected p=0.024 for ≥1 food-specific IgE in severe vs. moderate AD, OR 3.42 and 95% CI 1.15-10.32); and for at least seven of the food items (p=0.001 for ≥7 food-specific IgE vs. nil with OR 11.67 and 95% CI 2.29-67.77), respectively. The Spearman coefficients between the number of positive food-specific IgE and total SCORAD, objective SCORAD, area of AD involvement, Children's Dermatology Life Quality Index (CDLQI), total IgE levels, and eosinophil counts were 0.42 (p<0.001), 0.45 (p<0.001), 0.50 (p<0.001), 0.17 (p=0.116), 0.80 (p<0.001), and 0.22 (p=0.043), respectively. Specific IgE levels for beef correlated with all the other food-specific IgE levels, including cow's milk (ρ=0.061, p<0.001) and soy (ρ=0.70, p<0.001). The number of common food items sensitized correlated with disease severity, extent, and total IgE levels. IgE sensitization to beef protein is unlikely in the majority of children with AD, but its serum IgE level is associated with disease severity and risk of sensitization to other foods.

Influenza or not influenza: analysis of a case of high fever that happened 2000 years ago in Biblical time.

The Bible describes the case of a woman with high fever cured by our Lord Jesus Christ. Based on the information provided by the gospels of Mark, Matthew and Luke, the diagnosis and the possible etiology of the febrile illness is discussed. Infectious diseases continue to be a threat to humanity, and influenza has been with us since the dawn of human history. If the postulation is indeed correct, the woman with fever in the Bible is among one of the very early description of human influenza disease. Infectious diseases continue to be a threat to humanity, and influenza has been with us since the dawn of human history. We analysed a case of high fever that happened 2000 years ago in Biblical time and discussed possible etiologies.

Severe congenital myasthenia gravis of the presynaptic type with choline acetyltransferase mutation in a Chinese infant with respiratory failure.

We report a severe case of congenital myasthenia gravis in a Chinese newborn who presented with complete ptosis, severe hypotonia, dysphagia and respiratory insufficiency with recurrent apnea that required mechanical ventilatory support since birth. Routine neurophysiologic studies, including the 3-Hz repetitive stimulation test and electromyogram were normal. Neostigmine and edrophonium tests were also negative. However, decremental response to 3-Hz stimulation became apparent after depleting the muscles with trains of 10-Hz stimuli for 10 min. The infant was subsequently confirmed to have heterozygous mutations in the choline acetyltransferase genes, p.T553N and p.S704P. Both missense mutations are novel mutations. The child remained on positive pressure ventilation at 3 years of age despite treatment with high-dose anticholinesterase. This case highlights the difficulty of making an early diagnosis based on clinical presentation and routine electrophysiologic tests, especially when neonatologists are not familiar with this condition. Further, as there are different genetic defects causing different types of congenital myasthenia gravis, anticholinesterase therapy may be beneficial to some but detrimental to others. Therefore, the exact molecular diagnosis is an important guide to therapy. A high index of suspicion coupled with extended electrodiagnostic tests in clinically suspected patients will ensure the selection of appropriate genetic molecular study for confirming the diagnosis.