Severe Myasthenic Manifestation of Leptospirosis Associated with New Sequence Type of Leptospira interrogans.

We report the rapid development of a myasthenic crisis as the first-time manifestation of myasthenia gravis. The symptoms developed in the course of acute leptospirosis associated with a new sequence type of Leptospira interrogans. Antibiotic treatment led to rapid amelioration of myasthenia.

Critical analysis of a doxycycline treatment trial of rhesus macaques infected with Borrelia burgdorferi.

A critical analysis was conducted of a doxycycline treatment trial of Indian rhesus macaques. In this treatment trial, the investigators attempted to infect the primates with Borrelia burgdorferi sensu stricto by at least 10 tick bites from artificially infected ticks. None of the primates became ill; nevertheless, 5 primates were treated with a 28-day course of oral doxycycline. In contrast to the conclusions of the authors, the data did not convincingly document the existence of viable B. burgdorferi in antibiotic-treated primates. The investigators were unable to cultivate the spirochete from any animal after treatment using highly sensitive in vitro methods. Like many prior animal studies, the current study also did not document that the doxycycline exposure in these animals was similar to that expected in humans. Numerous additional methodologic problems are discussed.

Lactoferrin is a natural inhibitor of plasminogen activation.

The plasminogen system is essential for dissolution of fibrin clots, and in addition, it is involved in a wide variety of other physiological processes, including proteolytic activation of growth factors, cell migration, and removal of protein aggregates. On the other hand, uncontrolled plasminogen activation contributes to many pathological processes (e.g. tumor cells' invasion in cancer progression). Moreover, some virulent bacterial species (e.g. Streptococci or Borrelia) bind human plasminogen and hijack the host's plasminogen system to penetrate tissue barriers. Thus, the conversion of plasminogen to the active serine protease plasmin must be tightly regulated. Here, we show that human lactoferrin, an iron-binding milk glycoprotein, blocks plasminogen activation on the cell surface by direct binding to human plasminogen. We mapped the mutual binding sites to the N-terminal region of lactoferrin, encompassed also in the bioactive peptide lactoferricin, and kringle 5 of plasminogen. Finally, lactoferrin blocked tumor cell invasion in vitro and also plasminogen activation driven by Borrelia Our results explain many diverse biological properties of lactoferrin and also suggest that lactoferrin may be useful as a potential tool for therapeutic interventions to prevent both invasive malignant cells and virulent bacteria from penetrating host tissues.

Bacillary angiomatosis presenting with facial tumor and multiple abscesses: A case report.

BACKGROUND: The clinical manifestation of bacillary angiomatosis (BA) can be limited to one organ, most commonly the skin, but systemic courses can also occur. We report a human immunodeficiency virus (HIV)-positive patient with a systemic manifestation of BA caused by Bartonella quintana, diagnosed in Vienna, Austria. The pathogen was detected in multiple organs including a facial tumor which is an unusual finding for BA. Furthermore, infections with B quintana are rare in our area and no other autochthonous cases have been reported. METHODS AND RESULTS: The clinical manifestation included multiple papules and nodules on the entire body, several organic abscesses, and a facial tumor influencing the patient's view.The main laboratory finding indicated HIV infection combined with severe immunosuppression with 47 CD4 cells/µL. Contrast-enhanced computed tomography of the chest and the abdomen showed multiple and abscesses. Histological examination of the facial tumor confirmed inflammatory process. Bartonella quintana was detected by PCR in blood and in the facial tumor as well as by culture in the skin tissue. Antibiotic treatment with doxycycline and antiretroviral therapy resulted in clinical improvement. CONCLUSION: Our case shows that rare opportunistic, vector-borne infections, usually associated with poverty, can lead to diagnosis of HIV even in well-developed countries. Furthermore, we provide details on clinical manifestation and diagnostic work-up which might expand the knowledge on disseminated infections with B quintana. As far, tumorous deformations have rarely been reported as consequence of BA. In our patient the pathogen was detected in the facial tumor using PCR techniques.

Human blood monocytes support persistence, but not replication of the intracellular pathogen C. pneumoniae.

BACKGROUND: Intracellular pathogens have devised various mechanisms to subvert the host immune response in order to survive and replicate in host cells. Here, we studied the infection of human blood monocytes with the intracellular pathogen C. pneumoniae and the effect on cytokine and chemokine profiles in comparison to stimulation with LPS. RESULTS: Monocytes purified from peripheral blood mononuclear cells by negative depletion were infected with C. pneumoniae. While immunofluorescence confirmed the presence of chlamydial lipopolysaccharide (LPS) in the cytoplasm of infected monocytes, real-time PCR did not provide evidence for replication of the intracellular pathogen. Complementary to PCR, C. pneumoniae infection was confirmed by an oligonucleotide DNA microarray for the detection of intracellular pathogens. Raman microspectroscopy revealed different molecular fingerprints for infected and non-infected monocytes, which were mainly due to changes in lipid and fatty acid content. Stimulation of monocytes with C. pneumoniae or with LPS induced similar profiles of tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6, but higher levels of IL-1ß, IL-12p40 and IL-12p70 for C. pneumoniae which were statistically significant. C. pneumoniae also induced release of the chemokines MCP-1, MIP-1α and MIP-1ß, and CXCL-8, which correlated with TNF-α secretion. CONCLUSION: Infection of human blood monocytes with intracellular pathogens triggers altered cytokine and chemokine pattern as compared to stimulation with extracellular ligands such as LPS. Complementing conventional methods, an oligonucleotide DNA microarray for the detection of intracellular pathogens as well as Raman microspectroscopy provide useful tools to trace monocyte infection.

Multiple site sampling does not increase the sensitivity of Chlamydia trachomatis detection in infertility patients.

OBJECTIVE: Persistent Chlamydia trachomatis infections are associated with tubal pathology. We studied whether sampling from multiple sites would increase the identification of the infections. DESIGN: Prospective cohort study. SETTING: Tertiary care facility. PATIENT(S): Two hundred two infertile women. INTERVENTION(S): Smears were taken from the cervix, urethra, high vagina, fimbriae and the Douglas cavity. Blood samples were collected and tubal patency was assessed by pertubation with lipiodol and methylene blue. MAIN OUTCOME MEASURE(S): Detection of C. trachomatis DNA, detection of IgA and IgG antibodies against C. trachomatis, and antibodies against chlamydial heat-shock protein 60, tubal patency. RESULT(S): Chlamydia trachomatis was detected in 2 of 202 patients, for an overall prevalence of 1%. In both patients PCR results were positive in the cervical, vaginal, and urethral specimens. Chlamydia trachomatis IgG, IgA, and chlamydial heat-shock protein 60 IgG were significantly more prevalent in women with distal tubal pathology than in those without (26/40 [65.0%] vs. 16/162 [9.9%], 9/40 [22.5%] vs. 7/162 [4.3%], and 34/40 [85.0%] vs. 34/162 [21.0%]). Bacterial colonization was found in 1 of 202 samples from the Douglas cavity. CONCLUSION(S): Routine DNA testing for C. trachomatis should be confined to cervical sampling. The association between tubal pathology and seropositivity of IgG, IgA, and cHSP60 IgG was confirmed but did not add clinically valuable information during the diagnostic workup of infertility patients.

Presence of cytomegalovirus in cerebrospinal fluid of patients with Guillain-Barre syndrome.

BACKGROUND: Because poliomyelitis has been almost completely eradicated, Guillain-Barre syndrome (GBS) now accounts for most cases of acute flaccid paralysis. Understanding of the role of cytomegalovirus (CMV) in the pathogenesis of GBS is still very limited. METHODS: We identified 42 CMV-seropositive patients with GBS between 1998 and 2001. Cerebrospinal fluid (CSF) and serum samples obtained from these patients were tested by CMV-specific polymerase chain reaction, and the glycoprotein B (gB) segment of the detected CMV genome was analyzed. Virological findings were compared with clinical characteristics and CSF laboratory values. RESULTS: CMV DNA was detected in 13 (31%) of 42 CSF samples from patients with GBS but was not detected in 42 CSF samples from age-matched control subjects with acute encephalopathy. CSF samples obtained early after the onset of GBS were significantly more likely to be positive for CMV DNA (P=.048). gB1 was the most prevalent genotype detected in patients with GBS (88%), followed by gB3 (8%) and gB2 (4%). CONCLUSIONS: CMV DNA was detected frequently in CSF samples from CMV-seropositive patients with GBS, especially early during the course of the disease. The clinical significance of this finding has yet to be elucidated, but early administration of antiviral therapy might prove to be beneficial for selected patients with GBS.

Emergence of lyme arthritis after autologous chondrocyte transplantation.

We report herein the first known incidence of the emergence of borrelial arthritis following autologous chondrocyte transplantation for repair of a cartilage defect. The patient had no recent manifestation of Lyme borreliosis, but 15 years earlier had had an expanding erythematous lesion after a tick bite. The current infection resulted in massive joint swelling, elevated body temperature, dissemination of the graft, and transplant failure. Results of routine bacteriologic studies were negative. A diagnosis of Lyme arthritis was first considered following the detection of Borrelia-specific serum antibodies. Additional evidence was provided when borrelial DNA sequences were detected in the synovial fluid through polymerase chain reaction. The diagnosis was confirmed by culture of Borrelia burgdorferi from the synovial fluid. The possibility of a dormant borrelial infection should be considered in patients who undergo repair of cartilage defects with autologous chondrocyte transplantation. We recommend that synovial fluid and joint tissue be screened for the presence of viable Borrelia before transplantation of an autologous graft.