Molecular-genetic characterization of human parvovirus B19 prevalent in Kerala State, India.

BACKGROUND: Human parvovirus B19V is a DNA virus, and a member of the family Parvoviridae, that causes various clinical manifestations, from asymptomatic to persistent infection that is associated with different autoimmune diseases. The parvovirus B19 evolves with a very high mutation rate that is closer to those of existing RNA viruses. Globally circulating B19V is currently classified into three genotypes, but their distribution is not spatially and temporally correlated. Except for a few recent reports on B19V entry into the human host and its genetic diversity, there is a lack of sufficient studies on this virus from distinct geographical locations and no clear understanding of its evolution has been documented. METHODS: To better understand the evolution of the Human parvo B19V virus from India's southern part, a geographically distinct location with no reports of B19V genomes, we have screened for B19V in 456 suspected cases using VP1/2 surface marker genes, and its characteristics were studied in detail. Amongst 456 clinically suspected B19V samples, 7.2% (33/456) were found positive by nested PCR (nPCR) were subsequently validated by real-time PCR, Sanger sequencing, and metagenome analysis. RESULTS: Human parvovirus B19 infection was shown among 33 of 456 patients when tested by nPCR; 30 among these were also positive by qPCR and were subsequently confirmed by sequencing 75% nPCR positive samples and 76% qPCR positive samples were from patients with age. ≥ 50 years respectively (Additional file 1: Table S1). The complete VP1/2 gene assembly from the South Indian strain showed three novel mutations (T122A, V128I, I283V), which might significantly impact the stability and virulence of the B19V virus circulating in this part of the world. These mutations might be crucial for its adaptive evolutionary strategies facilitating the spread and infectivity potential of the virus. In maximum likelihood phylogeny of VP1/2 sequences, the South Indian B19V strain forms a separate clade closer to the existing genotype two strains circulating worldwide. CONCLUSION: Our study contributes to a better understanding of the human parvovirus's genetic and evolutionary characteristics in South India. Also, it highlights the possibility that a positive selection pressure acting on VP1/2 could increase the survival and replication capabilities of the viruses.

Association between matrix metalloproteinases-2 and -9 gene polymorphism with basement membrane disruption in oral lichen planus: A case-control pilot study.

Objectives: This study investigated genetic polymorphism of matrix metalloproteinases (MMP) -2 and -9 in oral lichen planus (OLP) and their association with the basement membrane status. Study design: This case-control study involved genotyping of peripheral blood sample of 32 OLP patients and 106 ethnically matched controls. Single nucleotide polymorphisms (SNP) that were assessed in the groups were- MMP9 rs3918242, MMP9 rs17576 and MMP2 rs865094. Basement membrane status of the OLP biopsy samples was microscopically assessed and recorded following Periodic acid Schiff staining. Results: MMP9 rs3918242 showed significant genotypic and allelic associations between OLP subjects and controls. It was also significantly associated with intact basement membranes in OLP cases with increased frequency of 'TT' genotype and 'T' allele. No association was found with regard to MMP9 rs17576 and MMP2 rs865094. Conclusion: Biallelic substitution at the promoter region of MMP9 (rs3918242) gene may be associated with increased risk of development of OLP. It may be involved in compromising the integrity of the basement membrane junction.

Comparative Study of Molecular Approaches for the Detection of Influenza Virus from Patient Samples Using Real-time PCR: Prospective Disease Burden Study in Kerala (India) from 2010 to 2016.

PURPOSE OF REVIEW: Acute respiratory infections caused by influenza virus are a major cause of viral respiratory diseases globally. Surveillance of circulating subtypes and estimation of disease burden is of utmost clinical importance. Molecular surveillance and proper disease burden estimates are scarce in India although clinical influenza infections are on the rise. Our study aims to delineate the prevalent influenza subtypes in a South Indian population from cases requiring hospital visits. Using real-time polymerase chain reaction (RT-PCR), 2154 throat/nasopharyngeal swabs from patients attending Government Medical College, Thiruvananthapuram, Kerala, India, with suspected influenza-like illness, were tested for the presence of different influenza subtypes. RESEARCH FINDINGS: Forty-three percent of specimens were positive for the influenza virus. Among these, prevalence of influenza A(H3N2), influenza B, and H1N1pdm09 was 26.7, 6.3, and 10%, respectively. Nominal co-infections were detected. An easy to use commercial kit was used for the majority of the study after proper evaluation for sensitivity and specificity against a gold standard protocol. Specific diagnosis using molecular tools caters to the urgency, and a precise measure of the disease burden and management actions are needed, especially in developing countries like India. Infection rate estimation using a sensitive RT-PCR assay signified that influenza was highly prevalent in the region. The study data generated will help understand the epidemiology of influenza in India as well as generate information for global influenza surveillance and disease burden.

Hemangioendothelioma of palate: A case report with review of literature.

Hemangioendothelioma commonly occurs in the superficial or deep soft tissue of the extremities, lungs, liver, bone and lymph nodes, with oral cavity being a rare location. It is usually benign but can show variable grades of malignancy. According to the histological presentation, hemangioendothelioma has been classified as epithelioid, Kaposiform, hobnail (Dabska-Retiform), epithelioid sarcoma like and composite. We present a case of ulcerated swelling of palate clinically diagnosed as pyogenic granuloma which presented a diagnostically challenging histological picture. We discuss the differential diagnoses obtained from various oral pathologists and general pathologists and substantiate the diagnosis of hemangioendothelioma based on its clinical behavior, histological features and immunohistochemical findings. In addition, we attempt to highlight the diagnostic dilemma that such cases can pose to the attending pathologists.

Basaloid squamous cell carcinoma of oral cavity: Report of two cases.

Basaloid squamous cell carcinoma (BSCC) is an aggressive, high-grade, variant of squamous cell carcinoma (SCC), which is uncommon in the oral cavity but slightly more common in the oropharynx. We present two cases of BSCC, one arising in the floor of the mouth and the other arising on the lateral border of the tongue. The diagnosis of this subtype of SCC is important owing to its particular behavior, with an aggressive course, a high incidence of local recurrence, regional lymph node metastases and mortality rate.

Solitary fibrous tumor of maxilla: A rare entity.

Solitary fibrous tumor (SFT) is a ubiquitous rare mesenchymal neoplasm. Pleura is the favored site of origin and is rare in the oral cavity. SFT occurs across a wide histopathologic spectrum. Fibrous form characterized by hyalinized, thick-walled vessels with opened lumina and strong CD34 reactivity constitute one end and on the other end, a cellular form representing the conventional hemangiopericytoma, with branched, thin-walled vessels and focal or negative CD34 reactivity characterize the spectrum. A case of oral SFT in a 30-year-old female patient with its clinical, histopathological and immunohistochemical features is being presented here.

Development of a multiplex RT-PCR for simultaneous diagnosis of human metapneumovirus (HMPV) and human respiratory syncytial virus (HRSV) from clinical specimens.

Human metapneumovirus (HMPV) and human respiratory syncytial virus (HRSV) are ubiquitous respiratory viral pathogens. They belong to the family Paramyxoviridae (subfamily Pneumovirinae) and is responsible for acute respiratory tract infections in children, elderly and immunocompromised patients. We designed and tested a multiplex reverse transcriptase polymerase chain reaction (mRT-PCR) as a cost-effective alternative to real-time PCR and cell culture based detection for HMPV and HRSV. The newly developed PCR was used to screen nasal/throat swab samples from 356 patients with suspected acute respiratory infection attending the Government Medical College, Thiruvananthapuram, Kerala, India. The method was compared with a commercially available kit employing real time PCR, for its sensitivity and specificity. 53 (14.9 %) samples were positive for at least one tested pathogen by mRT-PCR. All except one among the positive samples showed similar pathogen profile when tested using real time PCR. 8 (15.1 %) among these 53 were positive for HRSVA, 33 (62.3 %) positive for HRSVB and 12 (22.6 %) were positive for HMPV. 17 (32.7 %) samples showed co-infections in them. Sensitivity and specificity of the mRT-PCR was comparable to that of the commercial kit. Our findings indicate that this newly developed mRT-PCR can be used as a cost-effective alternative for laboratory diagnosis of HMPV/HRSV infection and will significantly reduce diagnostic costs for these viruses in clinical settings.

Decoding the 'embryonic' nature of embryonal rhabdomyosarcoma.

Embryonal rhabdomyosarcoma is one of the major defined histologic variants of rhabdomyosarcoma that is mainly reported in children. The histologic appearance of this neoplastic entity recapitulates normal myogenesis. The tumor cells variably exhibit the different cellular phases of myogenesis ranging from undifferentiated mesenchymal cells to elongated myoblasts, multinucleated myotubes and differentiated muscle fibers. The carefully orchestrated embryonic signaling pathways that are involved in myogenesis, conceivably also result in the genesis of rhabdomyosarcoma; albeit as a corollary to an imbalance. We have attempted to review the pathogenesis of embryonal rhabdomyosarcoma in an endeavor to understand better, how closely it is linked to normal myogenesis in terms of its molecular dynamics and histologic presentation.

Human immunodeficiency virus vaccine an update.

Since the discovery of acquired immuno deficiency syndrome (AIDS) in late1980s, the spread of human immunodeficiency virus (HIV) has reached pandemic proportions, representing a global developmental and public health threat. Finding of a safe, globally effective and affordable HIV vaccine offers the best hope for the future control of the disease pandemic. Significant progress has been made over the past years in the areas of basic virology, immunology, and pathogenesis of HIV/AIDS and the development of anti-retroviral drugs. However, the search for an HIV vaccine faces formidable scientific challenges related to the high genetic variability of the virus, the lack of immune correlates of protection, limitations with the existing animal models and logistical problems associated with the conduct of multiple clinical trials. Most of the vaccine approaches developed so far aim at inducing cell-mediated immune responses. Multiple vaccine concepts and vaccination strategies have been tested, including DNA vaccines, subunit vaccines, live vectored recombinant vaccines, various prime-boost vaccine combinations and vaccine based on broadly neutralizing human anti-HIV Antibody 2G12. This article reviews the state of the art in HIV vaccine research, summarizes the results obtained so far and discusses the challenges to be met in the development of a successful HIV vaccine.

Strawberry gingivitis: A diagnostic feature of gingival Wegener's granulomatosis!

Wegener's granulomatosis (WG) is an immunologically mediated inflammatory disease characterized by granulomatous vasculitis of the upper and lower aerodigestive tracts together with glomerulonephritis. We are reporting a rare case of gingival WG that presented with erythematous and painful generalized gingival enlargement. Correlation of histopathology with routine hematoxylin and eosin and special stains [Grocott-Gomori methenamine-silver nitrate and Periodic Acid Schiff (PAS)], Mantoux test, peripheral blood smear and clinical presentation were established in diagnosing this rare entity. By the above-mentioned procedures and methodology, we have arrived at the diagnosis of Wegner's granulomatosis limited to the upper aerodigestive tract. Therefore, the aim of reporting this case was to emphasize that, the dental surgeon often being the first person to examine the oral cavity, should be familiar with the typical appearance of gingival WG as "strawberry gingivitis," its clinical course as well as diagnostic parameters and adequate management. To the best of our knowledge, this is the first reported case of WG manifesting as "strawberry gingivitis" in the Indian population.

Peripheral ameloblastoma: a case report and review of literature.

Peripheral ameloblastoma, a rare and unusual variant of odontogenic tumour, comprises about 2-10% of all ameloblastomas. The extraosseous location is the peculiar feature of this type of tumour, which is otherwise similar to the classical ameloblastoma. This paper describes a case of peripheral ameloblastoma in a 67-year-old female affecting the lingual alveolar mucosa of the mandibular 32-34 region which was clinically diagnosed as pyogenic granuloma. This paper becomes important due to availability of all data, makeing it a well-documented case.

Radicular dens invaginatus: report of a rare case.

Dens invaginatus is a developmental anomaly resulting from invagination of a portion of crown forming within the enamel organ during odontogenesis. The invagination ranges from a slight pitting (coronal type) to an anomaly occupying most of the crown and root (radicular type). Although a clinical examination may reveal a deep fissure or pit on the surface of an anterior tooth, radiographic examination is the most realistic way to diagnose the invagination. The objective of this case presentation is to report a rare case of radicular dens in dente, which is a rare dental anomaly.

Oral cancer in young non-habituè females: a report of four cases and review of the literature.

BACKGROUND: The aim of this study is to highlight the growing incidence of oral cancer in young females without apparent traditional risk factors. METHODS: We present a case series of young female patients with histopathologically diagnosed squamous cell carcinoma of the tongue and no known exposure to major risk factors, reporting to our institution over one year. A review of the literature was carried out to find documented studies on oral cancer in young females. RESULTS: We found an increase in the number of young female patients presenting with squamous cell carcinomas on the lateral border of the tongue who did not have any of the traditional risk factors associated with the disease, which is in contrast with the number of male patients presenting with the same disease. CONCLUSIONS: Our study highlights the increasing incidence of oral cancer in young females without apparent traditional risk factors, an area of growing concern. Published studies in this particular group are limited. Nevertheless, the situation is alarming owing to the seriousness this problem poses for the community. More research is required to determine the aetiological and risk factors associated with this outcome.

Multiple metastatic tumors in the oral cavity.

Metastatic lesions to the oral region are uncommon and account for approximately 1% of all malignant oral tumors. In 25% of the cases, oral metastases are found to be the first sign of the metastatic spread; and in 23% of the cases, it is the first indication of an undiscovered malignancy at a distant site. Metastases to oral soft tissues are even less frequent than jaw bones. Because of its rarity, the clinical presentation of a metastatic lesion in the oral cavity can be deceiving, leading to a misdiagnosis of a benign process; therefore, in any case where the clinical presentation is unusual, especially in patients with a known malignant disease, a biopsy is mandatory. Here, we are presenting a rare case of multiple secondary tumors in the attached gingiva in an otherwise apparently healthy patient with no other symptoms of the primary tumor. It subsequently led to the diagnosis of Pancoast tumor (bronchoalveolar carcinoma) metastasizing simultaneously to multiple sites in the oral cavity and bilateral adrenal glands.