RESUMO
Chronic arthritis may occur in association with antibody deficiency and chromosomal aberrations. This report presents the case of a 6-year-old girl with chromosome 22q11 deletion syndrome and chronic arthritis. The onset of arthritis occurred at 4 years of age. The chronic arthritis course has been the polyarticular type. Neither antinuclear antibody nor rheumatoid factor was detected. Serum IgA was extremely low. She was diagnosed with juvenile idiopathic polyarticular arthritis (JIA) complicated by IgA deficiency in the 22q11 deletion syndrome. There is an increased prevalence of chronic arthritis in association with 22q11 deletion syndrome with IgA deficiency, but the reasons for this association are unknown. This study evaluated the possible correlation between cytokines and the susceptibility to chronic arthritis in the 22q11 deletion syndrome with IgA deficiency. The expression of pro-inflammatory cytokines such as IL-8, IL-6, MIP-1ß, and MCP-1 suggests that T and B cells, macrophages and neutrophils modulate joint inflammation by an immune response. And the presence of IL-10 and IL-5 might suggest that the synovitis is associated with JIA and IgA deficiency.
Assuntos
Artrite Juvenil/imunologia , Deleção Cromossômica , Cromossomos Humanos Par 22 , Deficiência de IgA/imunologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Artrite Juvenil/genética , Artrite Juvenil/patologia , Criança , Quimioterapia Combinada , Feminino , Humanos , Ibuprofeno/uso terapêutico , Deficiência de IgA/genética , Metotrexato/uso terapêutico , Sinovite/genética , Sinovite/imunologia , Sinovite/patologiaRESUMO
Antimicrobial susceptibilities of 205 Streptococcus pneumoniae strains isolated between 2002 and 2004 in Japan were examined and the distribution of genes for resistance to penicillins and macrolides were investigated by polymerase chain reaction. The molecular epidemiology of 92 randomly selected isolates was also examined by pulsed-field gel electrophoresis (PFGE). The numbers of S. pneumoniae isolates resistant to benzylpenicillin, clarithromycin and tetracycline were, respectively, 39 (19%), 111 (54%) and 155 (76%), and the numbers increased annually. All isolates were susceptible to amoxicillin, fluoroquinolones, vancomycin and linezolid. Analysis of mutations in the genes for penicillin-binding protein showed that 92% of isolates had mutations in pbp1a, pbp2b and/or pbp2x. Susceptibility to benzylpenicillin decreased with increasing number of mutated pbp genes. The macrolide resistance genes ermB and mefA were found in 99 (48%) and 76 (37%) isolates, respectively. The presence of ermB was associated with high-level resistance to macrolides, and the percentage of isolates with ermB increased annually. The presence of mefA also increased with increasing number of mutated pbp genes. Although the 92 isolates belonged to 74 PFGE types, three groups with an 80% similarity in their PFGE patterns were found at high frequency. Two of the three groups contained no isolates susceptible to penicillin and/or tetracycline, and their percentages increased annually. Our results suggest that the number of S. pneumoniae isolates with reduced susceptibility due to accumulation of resistance genes has been increasing.
Assuntos
Farmacorresistência Bacteriana/genética , Macrolídeos/farmacologia , Streptococcus pneumoniae/efeitos dos fármacos , beta-Lactamas/farmacologia , Adulto , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Criança , DNA Bacteriano/análise , Eletroforese em Gel de Campo Pulsado , Humanos , Proteínas de Membrana/genética , Metiltransferases/genética , Testes de Sensibilidade Microbiana , Mutação , Proteínas de Ligação às Penicilinas/genética , Peptídeo Sintases/genética , Peptidil Transferases/genética , Filogenia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Especificidade da Espécie , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/isolamento & purificação , Tóquio/epidemiologia , Resistência beta-Lactâmica/genéticaRESUMO
We describe an 11-year-old female patient who presented with a 7-day history of diplopia and difficulty walking. On examination she had ataxia, areflexia and ophthalmoplegia, and a diagnosis of Miller Fisher syndrome (MFS) was made after the exclusion of other conditions. Monocyte chemotactic protein-1 (MCP-1) and interleukin (IL)-8 chemokine levels in the cerebrospinal fluid (CSF) were significantly increased in the acute phase. We believe MFS in this patient was due to both peripheral nervous system dysfunction, and central nervous system (CNS) involvement. The cause of MFS in this patient was suggested by the localized chemokine production in the CSF. The high expression of MCP-1 and IL-8 chemokines suggest that macrophages and T cells may stimulate inflammation of the CNS in MFS.
Assuntos
Quimiocina CCL2/sangue , Quimiocina CCL2/líquido cefalorraquidiano , Interleucina-8/sangue , Interleucina-8/líquido cefalorraquidiano , Síndrome de Miller Fisher/sangue , Síndrome de Miller Fisher/líquido cefalorraquidiano , Criança , Feminino , HumanosRESUMO
We report on a 23-month-old boy with a rare complication of rotavirus gastroenteritis. He was diagnosed as acute encephalopathy with DIC accompanied with high levels of cytokines. The liver pathology also revealed mild infiltration and fatty changes. He was suspected to be suffering from a cytokine storm followed by Reye syndrome.