Pulmonary sarcoidosis: diagnostic and treatment update.

Sarcoidosis is a multisystem disorder of uncertain etiology, characterized by non-caseating granuloma formation in the affected organs. Significant progress has been made in the understanding of the immunopathological aspects of this disease over recent years. However, the causative agent(s) remain unknown. There remains controversy around the best treatment regimens and duration of immunosuppressive therapy. This is largely related to the heterogeneity of disease, a paucity of large randomized controlled trials and the fact that a significant proportion of patients do not require treatment. This review aims to summarize the evidence for the management of pulmonary sarcoidosis and to provide an update on recent developments in diagnosis and treatment.

A geographically-restricted but prevalent Mycobacterium tuberculosis strain identified in the West Midlands Region of the UK between 1995 and 2008.

BACKGROUND: We describe the identification of, and risk factors for, the single most prevalent Mycobacterium tuberculosis strain in the West Midlands region of the UK. METHODOLOGY/PRINCIPAL FINDINGS: Prospective 15-locus MIRU-VNTR genotyping of all M. tuberculosis isolates in the West Midlands between 2004 and 2008 was undertaken. Two retrospective epidemiological investigations were also undertaken using univariable and multivariable logistic regression analysis. The first study of all TB patients in the West Midlands between 2004 and 2008 identified a single prevalent strain in each of the study years (total 155/3,056 (5%) isolates). This prevalent MIRU-VNTR profile (32333 2432515314 434443183) remained clustered after typing with an additional 9-loci MIRU-VNTR and spoligotyping. The majority of these patients (122/155, 79%) resided in three major cities located within a 40 km radius. From the apparent geographical restriction, we have named this the "Mercian" strain. A multivariate analysis of all TB patients in the West Midlands identified that infection with a Mercian strain was significantly associated with being UK-born (OR =  9.03, 95%CI = 4.56-17.87, p<0.01), Black Caribbean (OR = 5.68, 95%CI = 2.96-10.91, p < 0.01) resident in Wolverhampton (OR = 9.29, 95%CI = 5.69-15.19, p < 0.01) and negatively associated with age >65 years old (OR = 0.25, 95% CI = 0.09-0.67, p < 0.01). A second more detailed investigation analyzed a cohort of 82 patients resident in Wolverhampton between 2003 and 2006. A significant association with being born in the UK remained after a multivariate analysis (OR = 9.68, 95% CI = 2.00-46.78, p < 0.01) and excess alcohol intake and cannabis use (OR = 6.26, 95%CI = 1.45-27.02, p =  .01) were observed as social risk factors for infection. CONCLUSIONS/SIGNIFICANCE: The continued consistent presence of the Mercian strain suggests ongoing community transmission. Whilst significant associations have been found, there may be other common risk factors yet to be identified. Future investigations should focus on targeting the relevant risk groups and elucidating the biological factors that mediate continued transmission of this strain.

Plant thorn tenosynovitis.

We report a case of plant thorn injury-induced tenosynovitis of the index finger of the left hand that was cured after surgical removal of the foreign body and partial synovectomy. We review current literature on this infrequently reported topic. Pathologically, thorn synovitis represents a foreign body reaction to retained plant material and is mostly aseptic. The presentation is delayed with the history of preceding injury often forgotten, and the diagnosis thus relies on careful elicitation of history. Imaging may be helpful to localize the plant material when the history is not clear. When possible, removal of the foreign material leads to complete remission, although some patients need partial or total synovectomy.