RESUMEN
Epithelial Cell Adhesion Molecule (EpCAM), or CD326, is a trans-membrane glycoprotein expressed by multiple normal epithelia as well as carcinoma. Human hepatic stem cells and bile duct epithelium of the liver are EpCAM positive. In tumor cell lines, its intracellular domain can be released after cleavage of the extracellular domain. Within the cell nucleus, it induces cell proliferation, but cleavage depends on cell contact. Fragments of various lengths have been described in tumor cells. Despite its described important role in proliferation in tumor cells, there is not much known about the expression and role of EpCAM fragments in primary human liver cells. Here, we demonstrate that EpCAM protein fragments and function are considerable different between tumor cells, normal fetal and adult liver cells. Contrary to previously reported findings in tumor cells, gene knockdown or treatment with an inhibitor of the cleavage enzyme ADAM17 (TACE) rather increased cell numbers in primary human fetal liver-derived EpCAM-positive cells. EpCAM fragment sizes were not affected by treatment with inhibitor. Knockdown of EPCAM gene expression by siRNA in sorted cells did not significantly affect proliferation-associated genes or cell numbers. The intracellular domain could not be detected within cell nuclei of fetal and adult liver cells. In conclusion, signaling through the intracellular domain of EpCAM appears to be a mechanism that induces proliferation specifically in tumorigenic cells but not in normal primary EpCAM-positive liver cells.
Asunto(s)
Células Madre Adultas/metabolismo , Proliferación Celular , Neoplasias Colorrectales/metabolismo , Molécula de Adhesión Celular Epitelial/metabolismo , Células Madre Fetales/metabolismo , Hígado/metabolismo , Células Madre Neoplásicas/metabolismo , Fragmentos de Péptidos/metabolismo , Transducción de Señal , Proteína ADAM17/genética , Proteína ADAM17/metabolismo , Células Madre Adultas/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Molécula de Adhesión Celular Epitelial/genética , Células Madre Fetales/efectos de los fármacos , Regulación de la Expresión Génica , Glicosilación , Células HT29 , Humanos , Ácidos Hidroxámicos/farmacología , Hígado/citología , Hígado/efectos de los fármacos , Células Madre Neoplásicas/efectos de los fármacos , Células Madre Neoplásicas/patología , Cultivo Primario de Células , Dominios Proteicos , Transducción de Señal/efectos de los fármacosRESUMEN
AIM: The transcription factor CCAAT/enhancer-binding protein alpha (C/EBPα) has been shown to play an important role in liver development, cell proliferation and differentiation. It is, however, largely unknown if C/EBPα regulates cell differentiation and proliferation differently in the diverse cell types of the human liver. We investigated the role of C/EBPα in primary human fetal liver cells and liver cell subpopulations in vitro using a 3-D perfusion bioreactor as an advanced in vivo-like human organ culture model. METHODS: Human fetal liver cells were investigated in vitro. C/EBPα gene expression was knocked down using siRNA or overexpressed by plasmid transfection. Cell type-specific gene expression was studied, cell populations and their proliferation were investigated, and metabolic parameters were analyzed. RESULTS: When C/EBPα gene expression was knocked down, we observed a significantly reduced expression of typical endothelial, hematopoietic and mesenchymal genes such as CD31, vWF, CD90, CD45 and α-smooth muscle actin in fetal cells. The intracellular expression of hepatic proteins and genes for liver-specific serum proteins α-fetoprotein and albumin were reduced, their protein secretion was increased. Fetal endothelial cell numbers were reduced and hepatoblast numbers were increased. C/EBPα overexpression in fetal cells resulted in increased endothelial numbers, but did not affect mesenchymal cell types or hepatoblasts. CONCLUSION: We demonstrated that the effects of C/EBPα are specific for the different human fetal liver cell types, using an advanced 3-D perfusion bioreactor as a human in vivo-like model.
RESUMEN
Ionic liquids are an emerging class of materials with applications in a variety of fields. Steady progress has been made in the creation of ionic liquids tailored to specific applications. However, the understanding of the underlying structure-property relationships has been slower to develop. As a step in the effort to alleviate this deficiency, the influence of side groups on ionic liquid properties has been studied through an integrated approach utilizing synthesis, experimental determination of properties, and simulation techniques. To achieve this goal, a classical force field in the framework of OPLS/Amber force fields has been developed to predict ionic liquid properties accurately. Cu(I)-catalyzed click chemistry was employed to synthesize triazolium-based ionic liquids with diverse side groups. Values of densities were predicted within 3% of experimental values, whereas self-diffusion coefficients were underestimated by about an order of magnitude though the trends were in excellent agreement, the activation energy calculated in simulation correlates well with experimental values. The predicted Henry coefficient for CO(2) solubility reproduced the experimentally observed trends. This study highlights the importance of integrating experimental and computational approaches in property prediction and materials development, which is not only useful in the development of ionic liquids for CO(2) capture but has application in many technological fields.
RESUMEN
A computational scheme was used to screen physical solvents for CO2 pre-combustion capture by integrating the commercial NIST database, an in-house computational database, chem-informatics, and molecular modeling. A commercially available screened hydrophobic solvent, diethyl sebacate, was identified from the screening with favorable physical properties and promising absorption performance. The promising performance to use diethyl sebacate in CO2 pre-combustion capture has also been confirmed from experiments. Water loading in diethyl sebacate is very low, and therefore, water is kept with H2 in the gas stream. The favorable CO2 interaction with diethyl sebacate and the intermediate solvent free volume fraction leads to both high CO2 solubility and high CO2/H2 solubility selectivity in diethyl sebacate. An in-house NETL computational database was built to characterize CO2, H2, N2, and H2O interactions with 202 different chemical functional groups. It was found that 13% of the functional groups belong to the strong interaction category with the CO2 interaction energy between -15 and -21 kJ/mol; 62% of the functional groups interact intermediately with CO2 (-8 to -15 kJ/mol). The remaining 25% of functional groups interact weakly with CO2 (below -8 kJ/mol). In addition, calculations show that CO2 interactions with the functional groups are stronger than N2 and H2 interactions but are weaker than H2O interactions. The CO2 and H2O interactions with the same functional groups exhibit a very strong linear positive correlation coefficient of 0.92. The relationship between CO2 and H2 gas solubilities and solvent fractional free volume (FFV) has been systematically studied for seven solvents at 298.2 K. A skewed bell-shaped relation was obtained between CO2 solubility and solvent FFV. When an organic compound has a density approximately 10% lower than its density at 298.2 K and 1 bar, it exhibits the highest CO2 loading at that specific solvent density and FFV. Note that the solvent densities were varied using simulations, which are difficult to be obtained from the experiment. In contrast, H2 solubility results exhibit an almost perfect positive linear correlation with the solvent FFV. The theoretical maximum and minimum physical CO2 solubilities in any organic compound at 298.2 K were estimated to be 11 and 0.4 mol/MPa L, respectively. An examination of 182 experimental CO2 physical solubility data and 29 simulated CO2 physical solubilities shows that all the CO2 physical solubility data are within the maximum and minimum with only a few exceptions. Finally, simulations suggest that in order to develop physical solvents with both high CO2 solubility and high CO2/H2 solubility selectivity, the solvents should contain functional groups which are available to interact strongly with CO2 while minimizing FFV.
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Although the hepatic and hematopoietic progenitors of the liver are well characterized, the interactions between these two lineages remain mostly elusive. Hepatoblasts express delta-like noncanonical Notch ligand 1 (Dlk1), whose cleaved extracellular domain can become a soluble protein. We assessed the effects of DLK1 gene expression knockdown in cultures of total fetal liver cells. Furthermore, we separated Dlk1+ hepatoblasts from the total liver cell fraction and investigated effects of direct cell contact. Dlk1- cells were cultured either without Dlk1+ hepatoblasts, in direct contact with hepatoblasts, or separated from hepatoblasts by a porous membrane in inserts to inhibit cell contact but allow free exchange of molecules. Expression of the hepatic and hematopoietic genes, colony forming unit potential of various hematopoietic progenitors, and cell numbers and types were investigated. We found that DLK1 knockdown in total fetal liver cell cultures decreased total cell numbers. The expression of hepatic progenitor genes and mature hematopoietic genes was affected. Hematopoietic BFU-E and CFU-GM colony numbers were reduced significantly. The depletion of Dlk1+ hepatoblasts in culture decreased the potential of all hematopoietic progenitors to form colonies of all types and reduced the percentage of mature hematopoietic cells. The addition of hepatoblasts in inserts to Dlk1- cells further decreased the potential to form the CFU-GM and CFU-GEMM colonies and the percentage of mature hematopoietic cells but increased total cell numbers. Conclusively, direct contact of Dlk1 supports hematopoietic progenitor expansion and functionality that cannot be reconstituted in coculture without direct cell contact.
RESUMEN
Prolonged physiological stresses, including abnormal pH and temperature, are deleterious. However, human hepatic progenitors have been shown to be quite tolerant of temporary temperature stress such as in cold ischemia. We aimed at identifying how various stresses affect liver progenitors, and at determining whether distinct effects exist on different progenitor cells of the human liver. Total fetal liver cells were exposed to low (25°C), normal (37°C), or high (40°C) temperatures, or low (6.76), normal (7.35), or high (7.88) pH in vitro. Culture at 25°C increased cell numbers and percentages of proliferation marker Ki67+ total cells. In total cell cultures, percentages of CD326+ hepatic progenitors co-expressing DLK1 (delta-like 1 homolog), SSEA4, or CD90 increased, as well as proliferation of SSEA4+ and CD235a+ progenitors. Analyses of presorted hepatic progenitors revealed that culture at 25°C increased cell numbers of CD326+ hepatic stem/progenitor cells but not DLK+ hepatoblasts. The expression of several mesenchymal genes was reduced, and distinct hepatic stem/progenitor cell colonies emerged. At 40°C, numbers of adherent hepatic cells decreased but those of hematopoietic nonadherent cells increased. High pH did not cause major effects. Acidic pH resulted in decreased total cell numbers and affected hematopoietic cells. Percentages of DLK1+ hepatoblasts were increased, but those of hematopoietic mature CD45+ cells were decreased. In particular, proliferation of adherent hepatic CD326+, SSEA4+ progenitors, and hematopoietic CD45+ cells and CD235a+ erythroblasts was reduced. Conclusively, our data indicate that low-temperature stress stimulates hepatic progenitor and erythroblast proliferation, whereas acidic pH promotes hepatic maturation and reduces hematopoietic cells.
Asunto(s)
Eritroblastos/citología , Hepatocitos/citología , Hígado/citología , Hígado/embriología , Células Madre/citología , Diferenciación Celular , Linaje de la Célula , Proliferación Celular , Separación Celular , Supervivencia Celular , Células Cultivadas , Isquemia Fría , Citometría de Flujo , Perfilación de la Expresión Génica , Edad Gestacional , Células Madre Hematopoyéticas/citología , Humanos , Concentración de Iones de Hidrógeno , Magnetismo , TemperaturaRESUMEN
Importance: Rotavirus infection is the global leading cause of diarrhea-associated morbidity and mortality among children younger than 5 years. Objectives: To examine the extent of rotavirus infection among children younger than 5 years by country and the number of deaths averted because of the rotavirus vaccine. Design, Setting, and Participants: This report builds on findings from the Global Burden of Disease Study 2016, a cross-sectional study that measured diarrheal diseases and their etiologic agents. Models were used to estimate burden in data-sparse locations. Exposure: Diarrhea due to rotavirus infection. Main Outcomes and Measures: Rotavirus-associated mortality and morbidity by country and year and averted deaths attributable to the rotavirus vaccine by country. Results: Rotavirus infection was responsible for an estimated 128â¯500 deaths (95% uncertainty interval [UI], 104â¯500-155â¯600) among children younger than 5 years throughout the world in 2016, with 104â¯733 deaths occurring in sub-Saharan Africa (95% UI, 83â¯406-128â¯842). Rotavirus infection was responsible for more than 258 million episodes of diarrhea among children younger than 5 years in 2016 (95% UI, 193 million to 341 million), an incidence of 0.42 cases per child-year (95% UI, 0.30-0.53). Vaccine use is estimated to have averted more than 28â¯000 deaths (95% UI, 14â¯600-46â¯700) among children younger than 5 years, and expanded use of the rotavirus vaccine, particularly in sub-Saharan Africa, could have prevented approximately 20% of all deaths attributable to diarrhea among children younger than 5 years. Conclusions and Relevance: Rotavirus-associated mortality has decreased markedly over time in part because of the introduction of the rotavirus vaccine. This study suggests that prioritizing vaccine introduction and interventions to reduce diarrhea-associated morbidity and mortality is necessary in the continued global reduction of rotavirus infection.
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Diarrea/prevención & control , Infecciones por Rotavirus/prevención & control , Vacunas contra Rotavirus/farmacología , Vacunación/estadística & datos numéricos , Preescolar , Estudios Transversales , Diarrea/epidemiología , Diarrea/virología , Femenino , Salud Global , Humanos , Incidencia , Masculino , Pronóstico , Estudios Retrospectivos , Infecciones por Rotavirus/epidemiología , Tasa de Supervivencia/tendenciasRESUMEN
Two young chimpanzees showed retention of self-recognition after 1 year without access to mirrors. A year earlier the animals were positive on the Gallup dye test. One year later they were once again anesthetized, marked on the brow and ears, and following recovery, exposed individually to a large mirror. Both demonstrated mirror-orientated mark-directed responses. Time-sample observations of behavior toward the mirror further support self-recognition. The chimpanzee's self-awareness, as inferred from its self-recognition, appears to be a stable characteristic of the animal.
RESUMEN
A new theoretical method was developed to compute the Henry's law constant for gas absorption in a solvent through strong nonphysical interactions. The new method was created by expanding the test particle insertion method typically applied to physisorbing systems to account for the strong intermolecular interactions present in chemisorbing systems. By using an ab initio (AI)-based Boltzmann-averaged potential to model the interaction between CO2 and the tetra-n-butylphosphonium acetate ([P4444][CH3COO]) ionic liquid, the total Henrys's law constant at 298 K was computed to be 0.011 to 0.039 bar, reasonably comparable to the experimental value of 0.18 bar measured in this work. Three different AI potentials were used to verify the applicability of this approach. In contrast, when a classical force field (FF) was used to describe the interaction between CO2 and [P4444][CH3COO], the Henry's law constant was computed to be 27 bar, significantly larger than the experimental value. The classical FF underestimates the CO2-[P4444][CH3COO] interaction compared with the AI calculations, which in turn leads to the smaller simulated CO2 solubility. Simulations further indicate that the CO2 interaction with the [CH3COO](-) anion is much stronger than with the [P4444](+) cation. This result strongly suggests that the large CO2 solubility in [P4444][CH3COO] is due to the strong CO2-[CH3COO](-) interaction.
RESUMEN
Involvement of osteochondromas in the spinal canal occurs in patients with multiple hereditary exostosis, but the exact prevalence is unknown. A recent study found an incidence of 68%, with 27% of these lesions encroaching into the spinal canal. We studied MRI findings of 27 patients with multiple hereditary exostosis and found only six (23.1%) patients with osteochondromas arising from the spinal column and three (11.5%) patients with encroachment into the spinal canal. We also found three (11.5%) patients with an incidental syringomyelia. Only five of the nine (55.6%) patients with positive findings on MRI had symptoms prompting the MRI and two patients had significant symptoms that required surgical excision. Although the incidence of spinal osteochondroma in our population is lower than that of previous studies, we found a relatively high incidence of syringomyelia in these patients, which has not been previously reported.
Asunto(s)
Exostosis Múltiple Hereditaria/complicaciones , Neoplasias de la Columna Vertebral/etiología , Siringomielia/etiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Kentucky/epidemiología , Masculino , Prevalencia , Estudios Retrospectivos , Neoplasias de la Columna Vertebral/epidemiología , Siringomielia/epidemiologíaRESUMEN
The presence of mesenchymal stem cells (MSCs) has been described in various organs. Pericytes possess a multilineage differentiation potential and have been suggested to be one of the developmental sources for MSCs. In human liver, pericytes have not been defined. Here, we describe the identification, purification, and characterization of pericytes in human adult and fetal liver. Flow cytometry sorting revealed that human adult and fetal liver contains 0.56%±0.81% and 0.45%±0.39% of CD146(+)CD45(-)CD56(-)CD34(-) pericytes, respectively. Of these, 41% (adult) and 30% (fetal) were alkaline phosphatase-positive (ALP(+)). In situ, pericytes were localized around periportal blood vessels and were positive for NG2 and vimentin. Purified pericytes could be cultured extensively and had low population doubling times. Immunofluorescence of cultures demonstrated that cells were positive for pericyte and mesenchymal cell markers CD146, NG2, CD90, CD140b, and vimentin, and negative for endothelial, hematopoietic, stellate, muscle, or liver epithelial cell markers von Willebrand factor, CD31, CD34, CD45, CD144, CD326, CK19, albumin, α-fetoprotein, CYP3A7, glial fibrillary acid protein, MYF5, and Pax7 by gene expression; myogenin and alpha-smooth muscle actin expression were variable. Fluorescence-activated cell sorting analysis of cultures confirmed surface expression of CD146, CD73, CD90, CD10, CD13, CD44, CD105, and ALP and absence of human leukocyte antigen-DR. In vitro differentiation assays demonstrated that cells possessed robust osteogenic and myogenic, but low adipogenic and low chondrogenic differentiation potentials. In functional in vitro assays, cells had typical mesenchymal strong migratory and invasive activity. In conclusion, human adult and fetal livers harbor pericytes that are similar to those found in other organs and are distinct from hepatic stellate cells.
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Feto/citología , Hígado/citología , Células Madre Mesenquimatosas/citología , Pericitos/citología , Adulto , Fosfatasa Alcalina/metabolismo , Antígenos/metabolismo , Antígeno CD146/metabolismo , Diferenciación Celular , Linaje de la Célula , Movimiento Celular , Separación Celular , Perfilación de la Expresión Génica , Células Estrelladas Hepáticas , Humanos , Hígado/embriología , Proteoglicanos/metabolismo , Receptor beta de Factor de Crecimiento Derivado de Plaquetas/metabolismo , Antígenos Thy-1/metabolismo , Vimentina/metabolismoRESUMEN
The ability of human fetal liver cells to survive, expand, and form functional tissue in vitro is of high interest for the development of bioartificial extracorporeal liver support systems, liver cell transplantation therapies, and pharmacologic models. Conventional static two-dimensional culture models seem to be inadequate tools. We focus on dynamic three-dimensional perfusion technologies and developed a scaled-down bioreactor, providing decentralized mass exchange with integral oxygenation. Human fetal liver cells were embedded in a hyaluronan hydrogel within the capillary system to mimic an in vivo matrix and perfusion environment. Metabolic performance was monitored daily, including glucose consumption, lactate dehydrogenase activity, and secretion of alpha-fetoprotein and albumin. At culture termination cells were analyzed for proliferation and liver-specific lineage-dependent cytochrome P450 (CYP3A4/3A7) gene expression. Occurrence of hepatic differentiation in bioreactor cultures was demonstrated by a strong increase in CYP3A4/3A7 gene expression ratio, lower alpha-fetoprotein, and higher albumin secretion than in conventional Petri dish controls. Cells in bioreactors formed three-dimensional structures. Viability of cells was higher in bioreactors than in control cultures. In conclusion, the culture model implementing three-dimensionality, constant perfusion, and integral oxygenation in combination with a hyaluronan hydrogel provides superior conditions for liver cell survival and differentiation compared to conventional culture.
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Reactores Biológicos , Diferenciación Celular/fisiología , Feto/citología , Hígado/citología , Albúminas/metabolismo , Técnicas de Cultivo de Célula/métodos , Supervivencia Celular/fisiología , Células Cultivadas , Citocromo P-450 CYP3A/metabolismo , Glucosa/metabolismo , Humanos , Ácido Hialurónico/química , Hidroliasas/metabolismo , Hidrogel de Polietilenoglicol-Dimetacrilato/química , alfa-Fetoproteínas/metabolismoRESUMEN
Bio-artificial liver support systems have been utilized as bridging devices to support acute and chronic liver injury. However, prolonged function of adult hepatocytes has not been achieved due to compromised proliferation and long-term survival of adult cells in vitro. As an alternative cell source, we investigated the potential of human fetal hepatocytes (hFH) in a four-compartment hollow fiber-based three-dimensional (3D) perfusion culture system. hFH were isolated from 17- to 19-gestational-week livers and cultured in the 3D perfusion bioreactors for 14 days. Metabolism activity, hepatocyte-specific gene expression, protein expression, and hepatic function were investigated. Increased glucose consumption and lactate production indicated cell proliferation in the bioreactor. The ratio of cytochrome P450 3A4 to 3A7 gene expression and the increase of the number of asialoglycoprotein receptor-positive cells indicated cell differentiation into mature hepatocytes. Histological and immunohistochemical analysis revealed reorganization of fetal liver cells. Hepatic function was further examined for ammonia metabolism and for albumin production using colorimetric assays and enzyme-linked immunosorbent assay, respectively. In contrast to conventional 2D culture, the 3D perfusion culture system induced functional maturation to hFH; these cells may be useful as an alternative cell source for extracorporeal liver support.
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Hepatocitos/citología , Hígado/embriología , Reactores Biológicos , Células Cultivadas , Medios de Cultivo , Expresión Génica , Humanos , Inmunohistoquímica , Hígado/metabolismo , Hígado/fisiologíaRESUMEN
Scattered in the amniotic epithelium of the human term placenta are pluripotent stem cell marker-positive cells. Unlike other parts of the placenta, amniotic epithelial (AE) cells are derived from pluripotent epiblasts. It is hypothesized that most epiblast-derived fetal AE cells are positive for stem cell markers at the beginning of pregnancy and that the stem cell marker-positive cells scattered through the term amnion are remaining, epiblast-like stem cells. To test this hypothesis, human fetal amnia from early-stage pregnancies were evaluated for expression of the stem cell-specific cell surface markers TRA 1-60 and TRA 1-81 and of the pluripotent stem cell marker genes Oct4, Nanog, and Sox2. Whole-mount immunohistochemical analysis demonstrated that a greater proportion of AE cells in the 17-19 week human fetal amnion are positive for both TRA 1-60 and TRA 1-81 than in the term amnion. Quantitative real-time RT-PCR analysis confirmed that the fetal AE cells exhibit greater stem cell marker gene expression than those in term placentae. Expression of both Nanog and Sox2 mRNAs were significantly higher in the fetal amnion, while Oct4 mRNA expression was not significantly changed. These differences in abundance of stem cell marker-positive cells and stem cell marker gene expression together indicate that some stem cell marker-positive cells are conserved over the course of pregnancy. The results suggest that stem cell marker-positive AE cells in the term amnion are retained from epiblast-derived fetal AE cells.
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Amnios/metabolismo , Antígenos de Diferenciación/metabolismo , Proteínas de Homeodominio/metabolismo , Células Madre Pluripotentes/metabolismo , Factores de Transcripción SOXB1/metabolismo , Amnios/patología , Antígenos de Diferenciación/genética , Antígenos de Superficie/genética , Antígenos de Superficie/metabolismo , Células Epiteliales/metabolismo , Células Epiteliales/patología , Femenino , Desarrollo Fetal , Regulación del Desarrollo de la Expresión Génica , Edad Gestacional , Proteínas de Homeodominio/genética , Humanos , Inmunohistoquímica , Proteína Homeótica Nanog , Factor 3 de Transcripción de Unión a Octámeros/genética , Factor 3 de Transcripción de Unión a Octámeros/metabolismo , Placenta/metabolismo , Placenta/patología , Embarazo , Proteoglicanos/genética , Proteoglicanos/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Transcripción SOXB1/genéticaRESUMEN
A 56-year-old man with diabetes mellitus and cadaveric renal transplantation had vancomycin-resistant Enterococcus faecium tricuspid valve endocarditis. Relapse followed 6 weeks of treatment with intravenous gentamicin and high-dose ampicillin. On the basis of previous data suggesting the potential for synergistic activity of quinupristin/dalfopristin plus high-dose ampicillin, therapy with this combination was administered for 63 days. Cure was achieved and later confirmed at 2-year follow-up.
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Bacteriemia/microbiología , Endocarditis Bacteriana/microbiología , Enterococcus faecium , Infecciones por Bacterias Grampositivas/microbiología , Huésped Inmunocomprometido , Resistencia a la Vancomicina , Virginiamicina/análogos & derivados , Ampicilina/uso terapéutico , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/inmunología , Diabetes Mellitus Tipo 1/complicaciones , Farmacorresistencia Bacteriana , Quimioterapia Combinada/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/inmunología , Gentamicinas/uso terapéutico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/inmunología , Humanos , Huésped Inmunocomprometido/inmunología , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/inmunología , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Penicilinas/uso terapéutico , Recurrencia , Resultado del Tratamiento , Virginiamicina/uso terapéuticoRESUMEN
Five persons contracted tick-borne relapsing fever after staying in a cabin in western Montana. Borrelia hermsii was isolated from the blood of two patients, and Ornithodoros hermsi ticks were collected from the cabin, the first demonstration of this bacterium and tick in Montana. Relapsing fever should be considered when patients who reside or have vacationed in western Montana exhibit a recurring febrile illness.