Innate and adaptive immune responses against human Puumala virus infection: immunopathogenesis and suggestions for novel treatment strategies for severe hantavirus-associated syndromes.

Two related hyperinflammatory syndromes are distinguished following infection of humans with hantaviruses: haemorrhagic fever with renal syndrome (HFRS) seen in Eurasia and hantavirus pulmonary syndrome (HPS) seen in the Americas. Fatality rates are high, up to 10% for HFRS and around 35%-40% for HPS. Puumala virus (PUUV) is the most common HFRS-causing hantavirus in Europe. Here, we describe recent insights into the generation of innate and adaptive cell-mediated immune responses following clinical infection with PUUV. First described are studies demonstrating a marked redistribution of peripheral blood mononuclear phagocytes (MNP) to the airways, a process that may underlie local immune activation at the site of primary infection. We then describe observations of an excessive natural killer (NK) cell activation and the persistence of highly elevated numbers of NK cells in peripheral blood following PUUV infection. A similar vigorous CD8 Tcell response is also described, though Tcell responses decline with viraemia. Like MNPs, many NK cells and CD8 T cells also localize to the lung upon acute PUUV infection. Following this, findings demonstrating the ability of hantaviruses, including PUUV, to cause apoptosis resistance in infected target cells, are described. These observations, and associated inflammatory cytokine responses, may provide new insights into HFRS and HPS disease pathogenesis. Based on similarities between inflammatory responses in severe hantavirus infections and other hyperinflammatory disease syndromes, we speculate whether some therapeutic interventions that have been successful in the latter conditions may also be applicable in severe hantavirus infections.

Palliative parenteral nutrition use in patients with intestinal failure as a consequence of advanced pseudomyxoma peritonei: a case series.

Pseudomyxoma peritonei (PMP) is a rare condition complicated by intra-abdominal spread that can cause multilevel gastrointestinal (GI) obstruction. Parenteral nutrition (PN) use in the context of palliative care and malignancy remains controversial. We describe the use of palliative PN in three patients with progressive PMP causing multilevel GI obstruction and intestinal failure. All patients received > 90 days of PN. PN was safe in this cohort of patients. However, patient selection and the timing of intervention are important factors when considering the initiation of PN.

[Drug-induced pruritus]. / Arzneimittelinduzierter Pruritus.

BACKGROUND: Pruritus, especially chronic pruritus, has long been underestimated and leads to high psychological strain in the affected patients. Even today, in spite of receiving increased attention, the underlying etiology cannot always be identified. METHODS: We review potential underlying pathologic mechanisms of drug-induced pruritus, focusing among others on current dermato-oncological medications in terms of their pruritogenic risks. RESULTS: Acute pruritus must be distinguished from chronic pruritus which lasts for a minimum of 6 weeks. There are various therapeutic approaches for drug-induced pruritus. As a first step, the drug causing the pruritus has to be identified; then the intake of that drug has to be ceased or modified. This may not always be possible, as in the case of chemotherapy agents. CONCLUSIONS: With regard to the demographic development of the population with increasing life expectancy and the resulting increasing polypharmacy, drugs will have to be taken into account as a possible cause for pruritus more often in the future. It would be desirable to routinely assess pruritus as a possible adverse effect in regulatory drug studies.

Biochemical analysis of serum and cerebrospinal fluid in clinically normal adult camels (Camelus dromedarius).

The concentrations of total protein, glucose, cholesterol, triglyceride, urea nitrogen, creatinine, sodium, potassium, chloride, calcium, inorganic phosphorus, copper, magnesium, and iron and the activities of aspartate aminotransferase (AST), alanine aminotransferase, (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LD), creatine kinase (CK) and amylase were determined in cerebrospinal fluid (CSF) and serum from 21 clinically healthy adult camels. The concentrations of sodium, potassium and chloride in CSF were similar to those of serum; whereas the values for all other constituents were significantly higher (P<0.05) in serum than in CSF.