Unusual Epstein-Barr esophageal infection in an immunocompetent patient: a case report.

INTRODUCTION: Epstein-Barr virus esophagitis in an immunocompetent host is a rare entity. It represents either primary infection or reactivation and is usually characterized by acute onset and extensive ulcerative involvement of the upper and middle third of the esophagus. CASE PRESENTATION: A case of Epstein-Barr virus esophagitis in a 27-year-old woman with no immunosuppressive factors, and having gastrointestinal symptoms is reported here. Using real-time polymerase chain reaction, biopsy and blood specimens were tested for candida and herpes viruses. Epstein-Barr virus DNA was detected in tissue samples. The patient was treated with acyclovir with resolution of the symptomatology. CONCLUSIONS: The prevalence of esophagitis remains undefined in both immunodeficient and immunocompetent individuals and should be taken into consideration in a patient presenting with esophageal symptoms. This case report stresses the role of Epstein-Barr virus infection in the pathogenesis of esophagitis, a rare condition in an immunocompetent host. In this setting, active infection may represent a primary infection or reactivation. Histopathological examination alone may miss the diagnosis, while polymerase chain reaction techniques optimize the diagnostic sensitivity, establish a diagnosis, and lead to an appropriate therapy.

Stability and antibacterial potency of ceftazidime and vancomycin eyedrops reconstituted in BSS against Pseudomonas aeruginosa and Staphylococcus aureus.

PURPOSE: We aimed to study the stability and the in vitro antibacterial potency of ceftazidime and vancomycin eyedrops against Pseudomonas aeruginosa and Staphylococcus aureus, respectively, under different storage temperatures and light conditions. METHODS: Solutions of ceftazidime 50 mg/ml and vancomycin 50 mg/ml were prepared by reconstituting with balanced salt solution (BSS) and stored at 4 degrees C and at 24 degrees C with and without exposure to light. The minimum bactericidal concentrations against P. aeruginosa and S. aureus were measured to evaluate the antimicrobial potency over a 4-week period. Changes in the pH values and physical characteristics of the solutions were recorded over the same period of time. RESULTS: The antibacterial potency of ceftazidime decreased significantly from days 3 and 7 onwards at storage temperatures of 24 degrees C and 4 degrees C, respectively, but was not affected by light exposure. The pH value progressed from acidic to alkaline, peaking at day 3, in all solutions. The antibacterial potency of vancomycin remained stable during the 4-week period, but its pH showed a slight progression from acidic to less acidic, in all solutions. CONCLUSIONS: Ceftazidime eyedrops in BSS appear to remain effective against P. aeruginosa for > or = 7 days when stored at 4 degrees C, but were less effective when stored at 24 degrees C. Loss of antibacterial potency coincides with the appearance of visual and olfactory signs of degradation. The transient rise in pH at day 3 is a matter of possible concern, however, as it may affect patient tolerance. By contrast, vancomycin eyedrops in BSS can be safely used for > or = 4 weeks, stored at either 4 degrees C or 24 degrees C.

Acute hepatitis associated with Q fever in a man in Greece: a case report.

Coxiella burnetii is the causative agent of Q fever. Q fever is a worldwide zoonosis that is responsible for various clinical manifestations. However, in Greece hepatitis due to Coxiella is rarely encountered. A case of Q fever associated with hepatitis is reported here. Diagnosis was made by specific serological investigation (enzyme-linked immunosorbent and indirect immunofluorescene assays) for Coxiella burnetii.

Portal hypertension caused by acute cytomegalovirus infection with liver involvement in an immunocompetent patient.

Primary infection by cytomegalovirus in immunocompetent patients is usually unapparent. We report a case of severe acute cytomegalovirus infection in a young immunocompetent male with pulmonary and hepatic involvement and portal hypertension who recovered without specific antiviral therapy with complete resolution of sonographic signs of portal hypertension after 6 months.

Epstein-Barr virus DNA in bronchoalveolar lavage fluid from patients with idiopathic pulmonary fibrosis.

BACKGROUND: Idiopathic pulmonary fibrosis is the most common idiopathic interstitial pneumonia. The human herpesviruses and especially Epstein-Barr virus have been implicated in the etiology of idiopathic pulmonary fibrosis in a number of studies. AIM: The aim of this study was to investigate the potential association between idiopathic pulmonary fibrosis and Epstein-Barr virus. METHODS: Bronchoalveolar lavage fluid and sera were collected from 63 patients out of whom 17 suffered of idiopathic pulmonary fibrosis and 46 of other interstitial lung diseases. Sera from 50 healthy, age-matched individuals were also collected. Antibodies to the early, nuclear, and capsid antigens of Epstein-Barr virus were determined by enzyme immunoassay and indirect immunofluorescence. Additionally polymerase chain reaction was performed in bronchoalveolar lavage fluid in order to investigate the presence of Epstein-Barr virus DNA. Positive polymerase chain reaction results were confirmed by nucleotide sequencing. RESULTS: Statistically significant differences were observed in the frequency of IgA antibodies to viral capsid antigen among patients with idiopathic pulmonary fibrosis, patients with other interstitial lung diseases and healthy controls (60%, 24.4% and 22% respectively, p = 0.013). Epstein-Barr virus DNA was detected in the bronchoalveolar lavage fluid of 3 patients with idiopathic pulmonary fibrosis but in none of the patients with other diseases (p = 0.024). CONCLUSIONS: The results of this study support the association between IPF and EBV, at least in some cases, and provide evidence that BALF is an alternative for the detection of viral DNA in patients with IPF. However further investigation is required concerning the etiology of idiopathic pulmonary fibrosis.

Severe case of Mediterranean spotted fever in Greece with predominantly neurological features.

Rickettsia conorii is endemic in Greece, though only a few cases of infection have been published to date. The case of a 58-year-old man from northern Greece with a severe form of Mediterranean spotted fever and rapid neurological deterioration is presented here. The patient received antibiotic treatment with doxycycline, showing immediate clinical and laboratory improvement. Diagnosis was confirmed later, during the second week after disease onset, by detection of elevated titres of IgM and IgG antibodies against R. conorii using an indirect immunofluorescence assay.

A multicenter evaluation of genotypic methods for the epidemiologic typing of Legionella pneumophila serogroup 1: results of a pan-European study.

OBJECTIVES: To compare genotypic methods for epidemiologic typing of Legionella pneumophila serogroup (sg) 1, in order to determine the best available method within Europe for implementation and standardization by members of the European Working Group on Legionella Infections. METHODS: Coded isolates (114) of L. pneumophila sg 1 comprising one epidemiologically 'unrelated' (79) and one 'related' panel of isolates (35) were sent to 12 laboratories in 11 European countries. Analysis was undertaken in each laboratory using one or more of the following methods: ribotyping, restriction fragment length polymorphism analysis, restriction endonuclease analysis, pulsed-field gel electrophoresis (PFGE), PCR using arbitrary/repeat sequence primers (AP-, AP/rep-PCR), and amplified fragment length polymorphism (AFLP) analysis. Results were analyzed visually or using gel analysis software. Each method was assessed for its: index of discrimination (D), epidemiologic concordance (E), speed of application and ease of use. In addition, phenotypic analysis was performed in two laboratories using monoclonal antibodies (mAbs). RESULTS: The D of each of the genotypic methods ranged from 0.840 for ribotyping to 0.990 for PFGE using Sfil: E ranged from 0.06 for AP- and AP/rep-PCR to 1.00 for ribotyping using Pstl/EcoRI and AFLP: in general, E was inversely related to D. Although offering only limited discrimination (D=0.838), mAb typing was both rapid and highly epidemiologically concordant (E=1.00). CONCLUSIONS: Two methods, PFGE using Sfil and AFLP, were selected for further study. AFLP is rapid and highly epidemiologically concordant (E=1.00), but is not highly discriminatory. This method will be developed as a rapid screening tool. PFGE using Sfil is highly discriminatory but, in the present study, yielded low values of E (0.12-0.71). Attempts will be made to rigorously standardize this method for use as the reference method. Primary screening of isolates by mAb subgrouping is recommended.

A multicenter evaluation of the Biotest legionella urinary antigen EIA.

OBJECTIVES: To undertake a multicenter study to evaluate the Biotest legionella urinary antigen enzyme immunoassay (EIA) performance against those EIAs already in use in 14 European laboratories. METHODS: Each laboratory examined urine specimens from appropriate patients using both their current assay and the Biotest EIA. Each examined: a standard panel of 12 coded urine samples (distributed by Biotest); a panel of 10 coded urine samples provided as part of a European external quality assurance (EQA) scheme; urine samples from patients with proven legionnaires' disease (LD); urine samples from patients with pneumonia of microbiologically proven cause other than LD; and urine samples submitted for routine examination. Thus, the performance of the Biotest assay (in comparison with current EIAs), its specificity and utility, and the inter-laboratory agreement were assessed. RESULTS: Inter-laboratory agreement was excellent, with all participants obtaining the expected results for 20 of 22 coded urine specimens. Specificity, determined using 123 specimens from patients with infections of known etiology, was 100%. The Biotest EIA gave positive results in 86% of specimens which had been positive in the laboratories' current EIAs, and in 94.6% of those specimens which were positive for Legionella pneumophila serogroup 1. CONCLUSION: The Biotest EIA is simple to use and specific and the results obtained in different laboratories show excellent agreement. The assay compares well existing EIAs, at least for L. pneumophila serogroup 1