IB80-A Novel Infectious Bronchitis Virus Genotype (GVIII).

Since mid-2015, there has been an increasing number of chicken samples that are positive for infectious bronchitis virus (IBV) in a screening PCR but which do not show positive results in any established, variant-specific PCR tests (793B, QX, D1466, Massachusetts, D274, Italy 02, Arkansas, Variant 2, Q1). Partial sequencing of the viral genome of those samples shows great similarities, but nucleotide similarity in the S1 gene is only about 57%-61% when compared to any other known GI-GVII IBV genotype and lineage. With nucleotide identity in the S1 gene of approximately 80%, the closest related strain in the National Center for Biotechnology Information database (as of March 15, 2020) is the North American PA/1220/98 isolate (AY789942) designated as a unique variant by Valastro et al. in 2016. Due to its divergence from other IBV strains, we propose that strain, designated IB80, is the type strain of a novel IBV genotype GVIII. So far, IB80 has been detected in commercial layer and broiler parent flocks, frequently showing severe drops in egg production as well as in broiler flocks in Europe and beyond.

IB80­un nuevo genotipo del virus de la bronquitis infecciosa (GVIII). Desde mediados del 2015, ha habido un número creciente de muestras de pollo que resultan positivas para el virus de la bronquitis infecciosa (IBV) por la detección mediante PCR de escrutinio, pero que no muestran resultados positivos en ninguna prueba de PCR específica para las variantes establecidas (793B, QX, D1466, Massachusetts, D274, Italia 02, Arkansas, variante 2, Q1). La secuenciación parcial del genoma viral de esas muestras muestra grandes similitudes, pero la similitud de nucleótidos en el gene S1 es solo del 57% al 61% en comparación con cualquier otro genotipo y linaje GI-GVII conocidos del virus de bronquitis. Con una identidad de nucleótidos en el gene S1 de aproximadamente el 80 %, la cepa relacionada más cercana en la base de datos del Centro Nacional de Información Biotecnológica (al 15 de marzo de 2020) es el aislamiento norteamericano PA/1220/98 (AY789942) designado como variante única por Valastro et al. en 2016. Debido a su divergencia con otras cepas del virus de bronquitis infecciosa, se propone que la cepa, denominada IB80, es la cepa tipo de un nuevo genotipo GVIII del virus de bronquitis infecciosa. Hasta ahora, se ha detectado IB80 en parvadas de reproductoras de pollos de engorde y ponedoras comerciales, y con frecuencia muestra disminuciones severas en la producción de huevo, así como en parvadas de pollos de engorde en Europa y otras regiones.

[Rashes in HIV-infected patients undergoing therapy with nevirapine or efavirenz]. / Arzneimittelexantheme bei Therapie der HIV-Infektion mit Efavirenz und Nevirapin.

Efavirenz and nevirapine are frequently used drugs in antiretroviral therapy. Rashes are common side effects of these drugs. In this study, we examined the characteristics of efavirenz- and nevirapine-associated rashes. This prospective nonrandomized multicenter study included 662 HIV-infected patients (efavirenz: 325, nevirapine: 337) to determine incidence, duration, cross-reactivity, and outcome upon reexposure. Of the treated patients, 4.5% (n=30) developed rashes (nevirapine: 2.4% and efavirenz: 6.4%). In four patients treatment was not interrupted. Three patients were re-exposed to the initial drug without any side effects. Therapy with nevirapine or efavirenz does not have to be interrupted if rashes exhibit no blistering, mucosal manifestations, or systemic signs.

Evaluation of a didanosin-containing regimen including genotypic resistance testing: an open-label, multicenter study.

PURPOSE: To show Didanosin in a new formulation as a once-a-day capsula as a well-tolerated and effective HIV-therapy when used in a protease sparing regimen including genotypic resistance pattern in blood, semen and cerebrospinal fluid before and during treatment. METHOD: Two groups of 58 patients, each containing 9 patients who had not been previously treated with any antiretroviral medication, and 49 patients heavily pretreated for 3,7 (DDI group) and 2,8 (non-DDI group) years, have been followed up for at least half a year. A group of 24 patients taking a special combination of Didanosin plus Efavirenz and Stavudine have been analysed with genotypic resistance testing concerning viral load response and resistance pattern under therapy. RESULTS: Suppression of plasma HIV-1 RNA to <50 copies/mL and <500 copies/mL in the DDI group was achieved in 74% and 84% of the pretreated patients, respectively, and in 100% of the naive patients after 24 weeks. In the non-DDI group suppression was achieved in 59% and 69% of the pretreated patients, respectively, and in also 100% of the naive patients. The viral load reduction in the DDI containing regimen at week 24 was 1.7 log subset 10 for the pretreated and 3,4 log subset 10 for the naive patients. In the non-DDI group, the reduction was 1.5 for the pretreated and 4,0 for the naive patients. CD4 cell counts increased from 440 to 517 cells/microL at week 24 for the pretreated, and from 171 to 289 for the naive patients in the DDI containing regimen. In the other group, cells increased from 396 to 406 for the pretreated and from 155 to 321 for the naive patients. In each group, 12 patients discontinued treatment; 4 patients in the DDI group and 7 patients in the non-DDI group because of adverse events. There were no AIDS-defining events in the antiretroviral-treated patients in both groups. 16 patients of the special combination group (DDI, D4T and EFV) were evaluated for more than 24 weeks. Suppression of HIV-1 RNA to <50 copies /mL were found in 75% of the naive and 43% of the pretreated patients. No relevant mutations were found during treatment. CONCLUSION: The new formulation of Didanosin as a once-a-day capsula in a protease sparing regimen was well-tolerated, effective in reducing viral load and in preventing AIDS-defining events. The combination of DDI, D4T and EFV proved to be a potent therapy without developing relevant mutations.

Tufted hair folliculitis associated with pemphigus vulgaris.

Tufted hair folliculitis (THF) is a rare disease which is characterized by the emergence of multiple hairs from widely dilated follicular orifices surrounded by an inflammatory infiltrate resulting in scarring alopecia. The pathogenesis is not yet fully understood. Although colonization with Staphylococcus aureus could not always be detected and systemic treatment with antibiotics alone is not sufficient, this microorganism is considered to play an important role. Around 30 patients with THF have been reported since the first publication. We present a patient with pemphigus vulgaris who developed THF. To our knowledge, this is the fourth case with an association of these two entities. Amongst other causing mechanisms, the autoimmune reaction may play an important role for the development of THF.

C3 in seminal plasma has no additional informative value in the diagnosis of infection/inflammation of the male genital tract.

The objective of this study was to determine the clinical significance of complement fraction C3 (C3c) in seminal plasma. Therefore 120 samples from randomly chosen subfertile males without signs of genital tract infection were screened for C3 and for seminal leucocytes as markers for subclinical infection/inflammation. A comprehensive semen evaluation included sperm analysis, sperm migration testing, immunocytochemical round cell differentiation to determine seminal leucocyte counts and the leucocyte ratio and semen cultures, in aliquots of the same ejaculates. C3 concentrations were significantly correlated with leucocyte counts per ml (P < 0.002) and per ejaculate (P < 0.001), and with the leucocyte ratio (P < 0.001). No association of C3 concentrations with semen quality or with the bacterial colonization of semen samples was found. The significant association with seminal leucocytes suggests that C3 might be used as an additional marker for silent male genital tract infection. In comparison with semen leucocytes, C3 screening does not reveal any further information about semen quality or infection/inflammation pathogenesis of the male genital tract.

Sexually transmitted diseases in Germany.

In the former West Germany, in specific venereal diseases legislation passed in 1953, only syphilis, gonorrhoea, ulcus molle, and lymphogranuloma venereum were defined as venereal diseases and subject to mandatory notification. The proportion of unreported cases was as high as 75% for syphilis and up to 90% for gonorrhoea. Epidemiological data for the past 10 years exist only on selected populations from research studies and are summarized in this article. In the former East Germany reporting of sexually transmitted infections (STIs) was mandatory and, due to the centralized organization, underreporting was considered to be low, although no specific studies have examined this. After the unification in 1990 of the two German states the West German laws were adopted in East Germany. Since 1982 - when the first AIDS case was reported in Germany - information on AIDS cases has voluntarily been collected at the national register at the AIDS Centre of the Robert Koch Institute in Berlin. The law governing the reporting of infectious diseases has recently been revised. Under the new Protection against Infection Act, which became effective on 1 January 2001, clinical diagnoses of STIs (with the exception of hepatitis B) are no longer notifiable diseases. Laboratory reporting of positive test results for Treponema pallidum has been introduced. With T. pallidum and HIV notifications, additional disaggregated data are collected. Since T. pallidum and HIV remain the only notifiable STIs, all other STIs have to be monitored through sentinel surveillance systems. These surveillance systems are currently being established. Under the new legislation, local health authorities have to provide adequate counselling and testing services for STIs, which may be provided free of charge if necessary.

Evaluation of an efavirenz-containing regimen: an open-label, multicenter study.

PURPOSE: Efavirenz (EFV) has been shown to be a highly effective HIV therapy in antiretroviral-naïve patients when used with nucleoside reverse transcriptase inhibitors. METHOD: The study participants were 314 patients, 45 of whom had not been previously treated with any antiretroviral medication. The other patients were heavily pretreated for about 3 years (1,047 days); 34 with two nucleoside reverse transcriptase inhibitors, 147 with triple therapy, and 88 with a quadruple regimen. RESULTS: Suppression of plasma HIV-1 RNA to <50 copies/mL and <500 copies/mL was achieved in 56% and 72% of the pretreated patients and in 82% and 91% of the naïve patients, respectively, at week 80 (intention-to-treat analysis: noncompleters = failure: 10% and 15% and 20% and 22%, respectively). The viral load reduction at week 80 was 0.7 log(10) for the pretreated patients and 2.6 log(10) for the naïve patients. CD4 cell counts increased from 386 to 474 cells/microL at week 80 in the pretreated group and from 264 to 431 in the naïve patients. 118 patients discontinued the treatment due to adverse events (37 patients due to nervous system symptoms and 15 patients because of exanthema). There were no AIDS-defining events in the group of antiretroviral-treated patients. CONCLUSION: EFV in combination with nucleoside reverse transcriptase inhibitors as antiretroviral therapy was potent and effective in reducing viral load, mainly in treating therapy-naïve patients and in preventing AIDS-defining events.

[Granuloma annulare disseminatum: successful therapy with fumaric acid ester]. / Granuloma anulare disseminatum--erfolgreiche Therapie mit Fumarsäureester.

A 64-year old female patient was treated for a therapy-resistant generalized granuloma annulare with fumaric acid esters (Fumaderm initial). One week following begin of therapy with an initial dose of 30 mg per day, the papules had regressed significantly. A 6-week therapy with a final dose of 90 mg Fumaderm initial per day led to a nearly complete healing of the illness.

[Successful long-term therapy of Stewart-Bluefarb syndrome]. / Erfolgreiche Langzeittherapie bei Stewart-Bluefarb-Syndrom.

The Stewart-Bluefarb syndrome is defined as an unilateral angiodermatitis due to multiple arterio-venous fistules accompanied by acroangiodermatitis resembling Kaposi sarcoma (pseudo-kaposi sarcoma). The acroangiodermatitis is most common on the lower limb. It leads to ulcerated nodules with a high risk of bleeding and infection, as well as edema, pain and seldom limb hypertrophy. Curative therapy requires elimination of the arteriovenous shunts. Surgical destruction of the multiple small fistulae is a limitating factor. A better alternative is embolisation, but this approach carries the risk of ischemia and necrosis. A 32 year old female patient with Stewart-Bluefarb syndrome is presented; she has been successfully treated with embolisation on eight occasions.

[Lipodystrophy syndrome in HIV infection]. / Lipodystrophiesyndrom bei der HIV-Infektion.

Since the availability of protease inhibitors in 1997, there has been a great change in antiretroviral therapy but also new long term side effects have emerged, mainly metabolic changes such as hypertriglyceridemia, hypercholesteremia and hyperglycemia. Besides, fat redistribution has been observed. Fat wastes in the face and limbs but accumulates in the adipose tissue of the dorsocervical and abdominal region and the breasts. The mechanism of these changes remains unclear. For therapy a protease inhibitor free therapy or lipid lowering drugs may be tried. 29 of our 224 patients developed lipodystrophy. 27 of these patients had been treated with a protease inhibitor (17 patients with indinavir); 2 of the patients had never received protease inhibitors.

[Determining the severity of venous insufficiency with duplex sonography]. / Bestimmung des Schweregrades einer venösen Insuffizienz mittels Duplexsonographie.

OBJECTIVE: The volume flow in the common femoral vein (SV) as a representative parameter of the venous hemodynamics of the leg can be measured using duplex-sonography. A direct correlation between the SV-data and the clinical grade of the venous disease was postulated. PATIENTS/METHODS: SV was measured in 36 patients (62 limbs) with complete varicosis of the long saphenous vein, 18 patients (24 limbs) with an incomplete form of varicosis and 40 healthy persons (78 limbs). The assessments were done under standardized conditions. We found a significant difference of the SV-data between the three groups. RESULTS: The values of SV were significantly elevated in varicosis compared with the healthy limbs. The data determined in legs with complete varicosis were significantly raised compared to incomplete varicosis. The means were 0.38 l/min in complete varicosis, 0.26 l/min in incomplete varicosis and 0.13 l/min in healthy limbs. During a time course of 30 minutes the values were stable. CONCLUSIONS: The results demonstrate a significant correlation between the measured SV data and the grade of venous disease.

[Interstitial granulomatous dermatitis with arthritis]. / Interstitielle granulomatöse Dermatitis mit Arthritis.

Interstitial granulomatous dermatitis with arthritis is a rare dermatologic disorder seen in patients suffering from diseases in which circulating immune complexes occur. The typical cutaneous signs are linear cords usually located on the lateral aspect of the trunk. The characteristic, although not specific, histology reveals a dense diffuse infiltrate composed mostly of histiocytes, accompanied by neutrophils and eosinophils, and degenerated collagen surrounded by palisades of histiocytes. We discuss this disorder and its differential diagnosis.

Herpes simplex virus infection of the uterine cervix--relationship with a cervical factor?

OBJECTIVE: To determine the prevalence of genital herpes simplex virus (HSV) in women of reproductive age and to evaluate a potential relation of asymptomatic HSV shedding with a cervical factor. DESIGN: Prospective study. SETTING: Outpatient infertility clinic of a university hospital. PATIENT(S): Randomly chosen asymptomatic women (n = 1,262) with a median age of 30 years. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Prevalence of cervical HSV, cervical index parameters, and other variables of CM quality, including CM penetrability in vivo and in vitro. RESULT(S): The prevalence of HSV infection of the uterine cervix was 5.2% (identified with cell culture). There was a tendency toward increased viscosity of the CM in HSV-positive women, but no significant relation with the other variables of CM quality (amount, spinnbarkeit, ferning, cervical appearance, and cellularity of the CM), or with the summarized Insler score or the cervical index according to World Health Organization guidelines. Postcoital testing and the in vitro penetration test, using either partners' or donors' semen, showed that the penetrability of the CM did not differ significantly between women with and without cervical HSV shedding. Asymptomatic cervical HSV infection was not significantly associated with bacterial colonization of the lower genital tract, with leukocyte counts in cervical secretions, with the pH of the CM or the vaginal fluid, or with antisperm antibodies in the CM. CONCLUSION(S): The results suggest that in asymptomatic women under controlled endocrine conditions, cervical HSV infection is not a significant cause of impaired quality and penetrability of the CM.

[Ultrasound imaging of the sentinel lymph node in malignant melanoma]. / Sonographie des Sentinel-Lymphknotens bei malignem Melanom.

BACKGROUND AND OBJECTIVE: In the therapy of malignant melanoma sentinel lymph node(SLN) excision has assumed increased importance. The localization of the sentinel node is possible by lymphoscintigraphy and gamma probe guidance. Aim of the study was to prove whether SLN can be identified sonographically. PATIENTS/METHODS: 23 patients (16 women, 7 men; average age 42.7 years) with malignant melanoma required SLN excision. Before the patient underwent lymphoscintigraphy, sonography of the regional lymph nodes was performed. The position of lymph nodes (LN) with asymmetrical extension of the cortical substance was marked cutaneously according to the probe position in two axis (M1). During lymphoscintigraphy the gamma probe position orthograd to the skin with the highest count rate was marked (M2). Then a second sonography of the region was performed. RESULTS: In all patients M1 and M2 marked the same point. During the operation the sonographically documented position of the SLN could be confirmed in all cases. The second sonography after the lymphoscintigraphy showed a more blurred distinction between the cortical substance and the center of the lymph nodes. CONCLUSIONS: Our results show that sonography allows an identification of SLN. We think that the preoperative sonography of the SLN is an important supplementary method in addition to lymphoscintigraphy.

[Periorbital lipogranuloma following endonasal sinus surgery]. / Periorbitales Lipogranulom nach endonasaler Nebenhöhlenoperation.

A 60-year-old woman developed a periorbital lipogranuloma after endonasal surgery on her paranasal sinuses. The granulomatous inflammation was caused by nonabsorbable lipids introduced by the postoperative nasal tamponade which was soaked in antibiotic ointment. These lipids were transported into the periorbital tissue by the postoperative hemorrhage. Since the course of the inflammatory process is chronic, surgical removal is the best treatment.