ABSTRACT
Spotted fever rickettsiosis is rarely observed in solid organ transplant recipients, and all previously reported cases have been associated with tick bite months to years after transplantation. We describe a kidney transplant recipient in North Carolina, USA, who had a moderately severe Rickettsia parkeri infection develop during the immediate posttransplant period.
Subject(s)
Kidney Transplantation , Rickettsia Infections , Rickettsia , Humans , Kidney Transplantation/adverse effects , Rickettsia/genetics , Rickettsia/isolation & purification , North Carolina , Rickettsia Infections/diagnosis , Rickettsia Infections/microbiology , Male , Transplant Recipients , Middle Aged , Anti-Bacterial Agents/therapeutic use , FemaleABSTRACT
Bacillus anthracis has traditionally been considered the etiologic agent of anthrax. However, anthrax-like illness has been documented in welders and other metal workers infected with Bacillus cereus group spp. harboring pXO1 virulence genes that produce anthrax toxins. We present 2 recent cases of severe pneumonia in welders with B. cereus group infections and discuss potential risk factors for infection and treatment options, including antitoxin.
Subject(s)
Anthrax , Antitoxins , Bacillus anthracis , Anthrax/diagnosis , Anthrax/drug therapy , Bacillus anthracis/genetics , Bacillus cereus/genetics , Humans , Metal Workers , PlasmidsABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic continues to produce substantial morbidity and mortality. To understand the reasons for the wide-spectrum complications and severe outcomes of COVID-19, we aimed to identify cellular targets of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tropism and replication in various tissues. METHODS: We evaluated RNA extracted from formalin-fixed, paraffin-embedded autopsy tissues from 64 case patients (age range, 1 month to 84 years; 21 COVID-19 confirmed, 43 suspected COVID-19) by SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR). For cellular localization of SARS-CoV-2 RNA and viral characterization, we performed in situ hybridization (ISH), subgenomic RNA RT-PCR, and whole-genome sequencing. RESULTS: SARS-CoV-2 was identified by RT-PCR in 32 case patients (21 COVID-19 confirmed, 11 suspected). ISH was positive in 20 and subgenomic RNA RT-PCR was positive in 17 of 32 RT-PCR-positive case patients. SARS-CoV-2 RNA was localized by ISH in hyaline membranes, pneumocytes, and macrophages of lungs; epithelial cells of airways; and endothelial cells and vessel walls of brain stem, leptomeninges, lung, heart, liver, kidney, and pancreas. The D614G variant was detected in 9 RT-PCR-positive case patients. CONCLUSIONS: We identified cellular targets of SARS-CoV-2 tropism and replication in the lungs and airways and demonstrated its direct infection in vascular endothelium. This work provides important insights into COVID-19 pathogenesis and mechanisms of severe outcomes.
Subject(s)
COVID-19/virology , Endothelium, Vascular/virology , Respiratory System/virology , SARS-CoV-2/physiology , Virus Replication , Adolescent , Adult , Aged , Aged, 80 and over , Autopsy , COVID-19/complications , COVID-19 Nucleic Acid Testing , Child , Child, Preschool , Female , Humans , In Situ Hybridization , Infant , Lung/virology , Male , Middle Aged , RNA, Viral/isolation & purification , Real-Time Polymerase Chain Reaction , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Viral Tropism , Whole Genome Sequencing , Young AdultABSTRACT
Fetal bacterial infections are a common cause of fetal/neonatal morbidity and mortality. The pathologic correlates of congenital bacterial infection include acute chorioamnionitis, acute villitis, and acute intervillositis. The strength of the association of congenital bacterial infection differs among these pathologies. Acute chorioamnionitis results usually from an ascending infection, and damage to the fetus is thought to be cytokine driven rather than damage secondary to bacteremia. Acute villitis is strongly associated with fetal sepsis due to congenital infections. A much less common variant on acute villitis pattern has been described with additional presence of bacteria in the fetal capillaries of the chorionic villi. We describe the spectrum of bacteria that would induce this unique pattern. The histological archives were searched from 2 institutions for cases with intravascular bacteria present in the villous capillaries of the placenta. Thirteen cases were identified, of which 11 cases had acute chorioamnionitis and all cases showed an acute villitis. Eight cases had Escherichia coli identified and 3 cases had Group B Streptococcus. All cases were associated with fetal death. In 9 cases, the mother showed signs of a significant infection including 1 maternal death. We conclude that finding intravascular bacteria is a serious complication of congenital infection with serious fetal and maternal sequela.
Subject(s)
Chorioamnionitis/pathology , Escherichia coli Infections/pathology , Placenta Diseases/pathology , Sepsis/pathology , Streptococcal Infections/pathology , Acute Disease , Adolescent , Adult , Chorioamnionitis/microbiology , Chorionic Villi/microbiology , Chorionic Villi/pathology , Escherichia coli/isolation & purification , Escherichia coli Infections/microbiology , Female , Fetal Death , Fetus/pathology , Gestational Age , Humans , Maternal Death , Placenta/microbiology , Placenta/pathology , Placenta Diseases/microbiology , Pregnancy , Sepsis/microbiology , Streptococcal Infections/microbiology , Streptococcus agalactiae/isolation & purification , Young AdultABSTRACT
Human protothecosis is a rare microalgae infection, and its dissemination typically occurs in immunocompromised individuals, but no specific immune defect has been reported. Here, we describe an 8-year-old daughter of a consanguineous union with abdominal pain and bloody diarrhea for 3 months who was found to have pancolitis with numerous microalgae identified as Prototheca zopfii. In the absence of a known immunodeficiency, exome sequencing was performed, which uncovered a novel recessive frameshift mutation in CARD9 (p.V261fs). This report highlights that CARD9 deficiency should be investigated in patients with unexplained systemic/visceral protothecosis and suggests a new mechanistic insight into anti-Prototheca immunity.
Subject(s)
CARD Signaling Adaptor Proteins/genetics , Candidiasis, Chronic Mucocutaneous/complications , Colitis/genetics , Colitis/pathology , Prototheca/isolation & purification , Child , Female , Frameshift Mutation , HumansABSTRACT
Protothecosis is a rare disease caused by environmental algae of the genus Prototheca. These are saprophytic, non-photosynthetic, aerobic, colorless algae that belong to the Chlorellaceae family. Seven different species have been described. Prototheca zopfii genotype 2 and P. wickerhamii are most commonly involved in pathogenic infections in humans and animals. The objective of this work is to describe, for the first time, a case of protothecosis caused by P. zopfii genotype 1 in a dog. The dog, a 4-year-old mix bred male, was presented to a veterinary clinic in Montevideo, Uruguay, with multiple skin nodules, one of which was excised by surgical biopsy. The sample was examined histologically and processed by PCR, DNA sequencing, and restriction fragments length polymorphisms for the detection and genotyping of P. zopfii. In addition, transmission electron microscopy and scanning electron microscopy were performed. Histology showed severe ulcerative granulomatous dermatitis and panniculitis with myriads of pleomorphic algae. Algal cells were 4-17 µm in size, with an amphophilic, 2-4-µm-thick wall frequently surrounded by a clear halo, contained flocculant material and a deeply basophilic nucleus, and internal septae with daughter cells (endospores) consistent with endosporulation. Ultrastructurally, algal cells/endospores at different stages of development were found within parasitophorous vacuoles in macrophages. Prototheca zopfii genotype 1 was identified by molecular testing, confirming the etiologic diagnosis of protothecosis.
Subject(s)
Dog Diseases/diagnosis , Dog Diseases/pathology , Infections/veterinary , Prototheca/isolation & purification , Animals , Biopsy , DNA, Algal/chemistry , DNA, Algal/genetics , Dog Diseases/microbiology , Dogs , Genotype , Histocytochemistry , Infections/diagnosis , Infections/microbiology , Infections/pathology , Male , Microscopy, Electron, Scanning , Microscopy, Electron, Transmission , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length , Prototheca/classification , Prototheca/genetics , Sequence Analysis, DNA , Skin/pathology , UruguayABSTRACT
Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients. These sudden cardiac deaths associated with Lyme carditis occurred from late summer to fall, ages ranged from young adult to late 40s, and four patients were men. Autopsy tissue samples were evaluated by light microscopy, Warthin-Starry stain, immunohistochemistry, and PCR for B. burgdorferi, and immunohistochemistry for complement components C4d and C9, CD3, CD79a, and decorin. Post-mortem blood was tested by serology. Interstitial lymphocytic pancarditis in a relatively characteristic road map distribution was present in all cases. Cardiomyocyte necrosis was minimal, T cells outnumbered B cells, plasma cells were prominent, and mild fibrosis was present. Spirochetes in the cardiac interstitium associated with collagen fibers and co-localized with decorin. Rare spirochetes were seen in the leptomeninges of two cases by immunohistochemistry. Spirochetes were not seen in other organs examined, and joint tissue was not available for evaluation. Although rare, sudden cardiac death caused by Lyme disease might be an under-recognized entity and is characterized by pancarditis and marked tropism of spirochetes for cardiac tissues.
Subject(s)
Borrelia burgdorferi/isolation & purification , Death, Sudden, Cardiac/pathology , Lyme Disease/pathology , Myocarditis/pathology , Adult , Autopsy , Female , Heart/microbiology , Humans , Immunoglobulin G/metabolism , Immunoglobulin M/metabolism , Male , Real-Time Polymerase Chain ReactionABSTRACT
Anaerobic bacteria are often difficult to detect, especially after the initiation of antibiotics. We describe the application of PCR-electrospray ionization mass spectrometry (PCR/ESI-MS) using a sample of cerebrospinal fluid to identify an anaerobic Gram-negative bacillus, Fusobacterium nucleatum, in a patient with "culture-negative" meningitis and cerebral abscesses.
Subject(s)
Brain Abscess/diagnosis , Fusobacterium Infections/diagnosis , Fusobacterium nucleatum/isolation & purification , Meningitis, Bacterial/diagnosis , Polymerase Chain Reaction , Spectrometry, Mass, Electrospray Ionization , Adult , Anti-Bacterial Agents/therapeutic use , Biopsy , Brain Abscess/complications , Brain Abscess/drug therapy , Brain Abscess/microbiology , Cerebrospinal Fluid/microbiology , Fusobacterium Infections/drug therapy , Fusobacterium Infections/microbiology , Head/diagnostic imaging , Histocytochemistry , Humans , Magnetic Resonance Imaging , Male , Meningitis, Bacterial/complications , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/microbiology , Microscopy , Radiography , Treatment OutcomeABSTRACT
Pathological studies on fatal cases caused by 2009 pandemic influenza H1N1 virus (2009 pH1N1) reported extensive diffuse alveolar damage and virus infection predominantly in the lung parenchyma. However, the host immune response after severe 2009 pH1N1 infection is poorly understood. Herein, we investigated viral load, the immune response, and apoptosis in lung tissues from 50 fatal cases with 2009 pH1N1 virus infection. The results suggested that 7 of the 27 cytokines/chemokines showed remarkably high expression, including IL-1 receptor antagonist protein, IL-6, tumor necrosis factor-α, IL-8, monocyte chemoattractant protein-1, macrophage inflammatory protein 1-ß, and interferon-inducible protein-10 in lung tissues of 2009 pH1N1 fatal cases. Viral load, which showed the highest level on day 7 of illness onset and persisted until day 17 of illness, was positively correlated with mRNA levels of IL-1 receptor antagonist protein, monocyte chemoattractant protein-1, macrophage inflammatory protein 1-ß, interferon-inducible protein-10, and regulated on activation normal T-cell expressed and secreted. Apoptosis was evident in lung tissues stained by the TUNEL assay. Decreased Fas and elevated FasL mRNA levels were present in lung tissues, and cleaved caspase-3 was frequently seen in pneumocytes, submucosal glands, and lymphoid tissues. The pathogenesis of the 2009 pH1N1 virus infection is associated with viral replication and production of proinflammatory mediators. FasL and caspase-3 are involved in the pathway of 2009 pH1N1 virus-induced apoptosis in lung tissues, and the disequilibrium between the Fas and FasL level in lung tissues could contribute to delayed clearance of the virus and subsequent pathological damages.
Subject(s)
Chemokines/metabolism , Host-Pathogen Interactions/immunology , Immunity/immunology , Influenza A Virus, H1N1 Subtype/immunology , Influenza, Human/immunology , Lung/immunology , Pandemics , Adolescent , Adult , Aged , Apoptosis/genetics , Caspase 3/metabolism , Chemokines/genetics , Child , Child, Preschool , Demography , Female , Gene Expression Regulation , Humans , Infant , Influenza, Human/epidemiology , Influenza, Human/pathology , Influenza, Human/virology , Lung/enzymology , Lung/pathology , Lung/virology , Male , Middle Aged , RNA, Messenger/genetics , RNA, Messenger/metabolism , Viral Load , Young AdultABSTRACT
On December 13, 2013, MMWR published a report describing three cases of sudden cardiac death associated with Lyme carditis. State public health departments and CDC conducted a follow-up investigation to determine 1) whether carditis was disproportionately common among certain demographic groups of patients diagnosed with Lyme disease, 2) the frequency of death among patients diagnosed with Lyme disease and Lyme carditis, and 3) whether any additional deaths potentially attributable to Lyme carditis could be identified. Lyme disease cases are reported to CDC through the Nationally Notifiable Disease Surveillance System; reporting of clinical features, including Lyme carditis, is optional. For surveillance purposes, Lyme carditis is defined as acute second-degree or third-degree atrioventricular conduction block accompanying a diagnosis of Lyme disease. During 2001-2010, a total of 256,373 Lyme disease case reports were submitted to CDC, of which 174,385 (68%) included clinical information. Among these, 1,876 (1.1%) were identified as cases of Lyme carditis. Median age of patients with Lyme carditis was 43 years (range = 1-99 years); 1,209 (65%) of the patients were male, which is disproportionately larger than the male proportion among patients with other clinical manifestations (p<0.001). Of cases with this information available, 69% were diagnosed during the months of June-August, and 42% patients had an accompanying erythema migrans, a characteristic rash. Relative to patients aged 55-59 years, carditis was more common among men aged 20-39 years, women aged 25-29 years, and persons aged ≥75 years.
Subject(s)
Death, Sudden, Cardiac/etiology , Lyme Disease/complications , Myocarditis/complications , Population Surveillance , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Child, Preschool , Death, Sudden, Cardiac/epidemiology , Female , Humans , Infant , Infant, Newborn , Lyme Disease/epidemiology , Male , Middle Aged , Myocarditis/epidemiology , Risk Assessment , Risk Factors , Sex Distribution , United States/epidemiology , Young AdultABSTRACT
A 23-y-old gelding was presented to a veterinary teaching hospital with a history of chronic, refractory diarrhea. Clinically, the horse was in poor body condition, with a thickened and corrugated large intestine identified by transcutaneous abdominal ultrasonography. At postmortem examination following euthanasia, the large colon and cecum had segmental thickening of the intestinal wall with innumerable mucosal ulcers and prominent polypoid mucosal masses. Many mesenteric and hepatic lymph nodes were enlarged. Histology revealed granulomatous and ulcerative typhlocolitis and granulomatous lymphadenitis with myriad acid-fast, variably gram-positive, intrahistiocytic bacilli that stained by immunohistochemistry for mycobacteria. Molecular testing by PCR and sequencing identified the causative agent as Mycobacterium genavense, which is an unusual presentation of infection in a horse.
Subject(s)
Horse Diseases , Mycobacterium , Animals , Horses , Horse Diseases/microbiology , Horse Diseases/pathology , Horse Diseases/diagnosis , Mycobacterium/isolation & purification , Mycobacterium/genetics , Male , Mycobacterium Infections/veterinary , Mycobacterium Infections/microbiology , Mycobacterium Infections/pathology , Mycobacterium Infections/diagnosis , Typhlitis/veterinary , Typhlitis/pathology , Typhlitis/microbiology , Typhlitis/diagnosis , Colitis/veterinary , Colitis/microbiology , Colitis/pathology , Fatal OutcomeABSTRACT
Molecular techniques were used to characterize genetic features of Staphylococcus aureus in 66 fatal cases of pneumonia caused by S. aureus and influenza A or B viruses. Nucleic acids were extracted from formalin-fixed, paraffin-embedded tissues. The majority of cases revealed genetic markers for Panton-Valentine leukocidin, mecA, and spa type t008.
Subject(s)
Coinfection/microbiology , Coinfection/virology , Influenza, Human/complications , Orthomyxoviridae/isolation & purification , Pneumonia, Staphylococcal/complications , Staphylococcus aureus/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , Bacterial Proteins/genetics , Bacterial Toxins/genetics , Child , Child, Preschool , Exotoxins/genetics , Female , Genotype , Humans , Infant , Influenza, Human/virology , Leukocidins/genetics , Male , Middle Aged , Orthomyxoviridae/genetics , Penicillin-Binding Proteins , Pneumonia, Staphylococcal/microbiology , Staphylococcal Protein A/genetics , Staphylococcus aureus/genetics , Young AdultABSTRACT
The frequency of fatalities due to acute bacterial meningitis has decreased significantly due to vaccinations, early diagnoses, and treatments. We studied brain tissues of patients with fatal neutrophilic meningitis referred to the Centers for Disease Control for etiologic diagnosis from 2000-2009 to highlight aspects of the disease that may be preventable or treatable. Demographic, clinical, and laboratory data were extracted from records. Of 117 cases in the database with a diagnosis of meningitis or meningoencephalitis, 39 had neutrophilic inflammation in the meninges. Inflammatory cells infiltrated the superficial cortex in 16 of 39 (41%) cases. Bacteria were found using Gram and bacterial silver stains in 72% of cases, immunohistochemistry in 69% (including two cases where the meningococcus was found outside the meninges), and PCR in 74%. Streptococcus pneumoniae was the cause of the meningitis in 14 patients and Neisseria meningitidis in 9. In addition, Streptococcus spp. were found to be the cause in six cases, while Staphylococcus aureus, Staphylococcus spp., Enterococcus spp., and Fusobacterium were the cause of one case each. There were six cases in which no specific etiological agent could be determined. The mean age of the patients with S. pneumoniae was 39 years (range 0-65), with N. meningitidis was 19 years (range 7-51), whereas that for all others was 31 years (range 0-68). In summary, our study shows that S. pneumoniae continues to be the most frequent cause of fatal neutrophilic bacterial meningitis followed by N. meningitidis, both vaccine preventable diseases.
Subject(s)
Meningitis, Bacterial/microbiology , Meningitis, Bacterial/pathology , Neutrophils/pathology , Adolescent , Adult , Aged , Child , Child, Preschool , Female , History, Ancient , Humans , Immunohistochemistry , Infant, Newborn , Male , Middle Aged , Young AdultABSTRACT
BACKGROUND: Influenza B virus infection causes rates of hospitalization and influenza-associated pneumonia similar to seasonal influenza A virus infection and accounts for a substantial percentage of all influenza-related hospitalizations and deaths among those aged <18 years; however, the pathogenesis of fatal influenza B virus infection is poorly described. METHODS: Tissue samples obtained at autopsy from 45 case patients with fatal influenza B virus infection were evaluated by light microscopy and immunohistochemical assays for influenza B virus, various bacterial pathogens, and complement components C4d and C9, to identify the cellular tropism of influenza B virus, characterize concomitant bacterial pneumonia, and describe the spectrum of cardiopulmonary injury. RESULTS: Viral antigens were localized to ciliated respiratory epithelium and cells of submucosal glands and ducts. Concomitant bacterial pneumonia, caused predominantly by Staphylococcus aureus, was identified in 38% of case patients and occurred with significantly greater frequency in those aged >18 years. Pathologic evidence of myocardial injury was identified in 69% of case patients for whom cardiac tissue samples were available for examination, predominantly in case patients aged <18 years. CONCLUSIONS: Our findings suggest that bacterial pneumonia and cardiac injury contribute to fatal outcomes after infection with influenza B virus and that the frequency of these manifestations may be age related.
Subject(s)
Heart Injuries/pathology , Influenza B virus/pathogenicity , Influenza, Human/microbiology , Influenza, Human/mortality , Myocardium/pathology , Pneumonia, Bacterial/pathology , Adolescent , Adult , Antigens, Viral/analysis , Antigens, Viral/immunology , Autopsy , Child , Child, Preschool , Cohort Studies , Female , Heart Injuries/complications , Heart Injuries/microbiology , Heart Injuries/virology , Hospitalization , Humans , Infant , Infant, Newborn , Influenza, Human/complications , Influenza, Human/pathology , Male , Middle Aged , Pneumonia, Bacterial/complications , Specimen Handling , Staphylococcus aureus/pathogenicity , Viral Tropism , Young AdultABSTRACT
Clostridium sordellii and Clostridium perfringens are infrequent human pathogens; however, the case-fatality rates for the infections are very high, particularly in obstetric C. sordellii infections (>90%). Deaths from Clostridium sordellii and Clostridium perfringens toxic shock (CTS) are sudden, and diagnosis is often challenging. Formalin-fixed, paraffin-embedded (FFPE) tissues usually are the only specimens available for sudden fatal cases, and immunohistochemistry (IHC) for Clostridia is generally performed but it cannot identify species. A clear need exists for a rapid, species-specific diagnostic assay for FFPE tissues. We developed a duplex PCR-based microsphere assay for simultaneous detection of C. sordellii and C. perfringens and evaluated DNA extracted from 42 Clostridium isolates and FFPE tissues of 28 patients with toxic shock/endometritis (20 CTS, 8 non-CTS, as confirmed by PCR and sequencing). The microsphere assay correctly identified C. sordellii and C. perfringens in all known isolates and in all CTS patients (10 C. sordellii, 8 C. perfringens, 2 both) and showed 100% concordance with PCR and sequencing results. The microsphere assay is a rapid, specific, and cost-effective method for the diagnosis of CTS and offers the advantage of simultaneous testing for C. sordellii and C. perfringens in FFPE tissues using a limited amount of DNA.
Subject(s)
Clostridium Infections/diagnosis , Clostridium perfringens/isolation & purification , Clostridium sordellii/isolation & purification , Polymerase Chain Reaction/methods , Pregnancy Complications, Infectious/diagnosis , Shock, Septic/diagnosis , Adolescent , Adult , Female , Humans , Microspheres , Pregnancy , Young AdultABSTRACT
Melioidosis, a potentially fatal infectious disease of humans and animals, including nonhuman primates (NHPs), is caused by the high-consequence pathogen Burkholderia pseudomallei. This environmental bacterium is found in the soil and water of tropical regions, such as Southeast Asia, where melioidosis is endemic. The global movement of humans and animals can introduce B. pseudomallei into nonendemic regions of the United States, where environmental conditions could allow establishment of the organism. Approximately 60% of NHPs imported into the United States originate in countries considered endemic for melioidosis. To prevent the introduction of infectious agents to the United States, the Centers for Disease Control and Prevention (CDC) requires newly imported NHPs to be quarantined for at least 31 d, during which time their health is closely monitored. Most diseases of public health concern that are transmissible from imported NHPs have relatively short incubation periods that fall within the 31-d quarantine period. However, animals infected with B. pseudomallei may appear healthy for months to years before showing signs of illness, during which time they can shed the organism into the environment. Melioidosis presents diagnostic challenges because it causes nonspecific clinical signs, serologic screening can produce unreliable results, and culture isolates are often misidentified on rapid commercial testing systems. Here, we present a case of melioidosis in a cynomolgus macaque (Macaca fascicularis) that developed a subcutaneous abscess after importation from Cambodia to the United States. The bacterial isolate from the abscess was initially misidentified on a commercial test. This case emphasizes the possibility of melioidosis in NHPs imported from endemic countries and its associated diagnostic challenges. If melioidosis is suspected, diagnostic samples and culture isolates should be submitted to a laboratory in the CDC Laboratory Response Network for conclusive identification and characterization of the pathogen.
Subject(s)
Burkholderia pseudomallei , Melioidosis , Humans , United States , Animals , Melioidosis/diagnosis , Melioidosis/epidemiology , Melioidosis/veterinary , Macaca fascicularis , Abscess , CambodiaABSTRACT
The Phylum Microsporidia comprises >1,200 species, only 15 of which are known to infect humans, including the genera Trachipleistophora, Pleistophora, and Brachiola. We report an infection by Tubulinosema sp. in an immunosuppressed patient.
Subject(s)
Immunocompromised Host , Microsporidia , Myositis/diagnosis , Acute Kidney Injury/complications , Acute Kidney Injury/immunology , Aged , Fatal Outcome , Female , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/immunology , Muscle, Skeletal/microbiology , Muscle, Skeletal/pathology , Myositis/complications , Myositis/microbiologyABSTRACT
In the spring of 2009, a novel influenza A (H1N1) virus emerged in North America and spread worldwide to cause the first influenza pandemic since 1968. During the first 4 months, over 500 deaths in the United States had been associated with confirmed 2009 pandemic influenza A (H1N1) [2009 H1N1] virus infection. Pathological evaluation of respiratory specimens from initial influenza-associated deaths suggested marked differences in viral tropism and tissue damage compared with seasonal influenza and prompted further investigation. Available autopsy tissue samples were obtained from 100 US deaths with laboratory-confirmed 2009 H1N1 virus infection. Demographic and clinical data of these case-patients were collected, and the tissues were evaluated by multiple laboratory methods, including histopathological evaluation, special stains, molecular and immunohistochemical assays, viral culture, and electron microscopy. The most prominent histopathological feature observed was diffuse alveolar damage in the lung in all case-patients examined. Alveolar lining cells, including type I and type II pneumocytes, were the primary infected cells. Bacterial co-infections were identified in >25% of the case-patients. Viral pneumonia and immunolocalization of viral antigen in association with diffuse alveolar damage are prominent features of infection with 2009 pandemic influenza A (H1N1) virus. Underlying medical conditions and bacterial co-infections contributed to the fatal outcome of this infection. More studies are needed to understand the multifactorial pathogenesis of this infection.
Subject(s)
Influenza A Virus, H1N1 Subtype/pathogenicity , Influenza, Human/epidemiology , Influenza, Human/mortality , Influenza, Human/virology , Pandemics , Adolescent , Adult , Autopsy , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Influenza A Virus, H1N1 Subtype/genetics , Influenza, Human/pathology , Lung/pathology , Lung/virology , Male , Middle Aged , United States/epidemiology , Young AdultSubject(s)
Brain Abscess/pathology , Gram-Positive Bacterial Infections/pathology , HIV Infections/pathology , Adult , Anti-HIV Agents/therapeutic use , Brain , Brain Abscess/complications , Brain Abscess/microbiology , CD4 Lymphocyte Count , Coinfection , Drug Therapy, Combination , Gram-Positive Bacterial Infections/complications , Gram-Positive Bacterial Infections/microbiology , HIV Infections/complications , HIV Infections/virology , HIV-1 , Humans , Male , Propionibacterium acnes , RNA, Ribosomal, 16S/analysis , Viral LoadABSTRACT
We report the use of a prototype Invader Plus method (Third Wave Technologies, Inc., Madison, WI) for the qualitative detection of varicella-zoster virus (VZV) and differentiation of wild-type and Oka vaccine VZV. The analytical sensitivity of the VZV Invader Plus reagents is at 10 copies per reaction. A total of 174 skin and mucous swab specimens were used to validate the assay's performance. The sensitivity and specificity were 98.3% and 98.1%, respectively, in comparison to a PCR-EIA assay. A perfect 100% agreement was obtained when VZV wild-type and vaccine differentiation was performed on 54 VZV-positive swab specimens against an allele-specific FRET real-time assay. The Invader Plus method provides another reliable tool for qualitative detection of VZV and differentiation of wild-type and vaccine virus.