Streptobacillus moniliformis and IgM and IgG Immune Response in Patient with Endocarditis1.

We describe a case of endocarditis caused by Streptobacillus moniliformis bacteria, a known cause of rat-bite fever, in a 32-year-old woman with pet rats in Germany. The patient had a strong serologic response, with high IgM and IgG titers. Serologic analysis is a promising tool to identify S. moniliformis bacterial infection.

Transcriptomes of MPO-Deficient Patients with Generalized Pustular Psoriasis Reveals Expansion of CD4+ Cytotoxic T Cells and an Involvement of the Complement System.

Generalized pustular psoriasis is a severe psoriatic subtype characterized by epidermal neutrophil infiltration. Although variants in IL36RN and MPO have been shown to affect immune cells, a systematic analysis of neutrophils and PBMC subsets and their differential gene expression dependent on MPO genotypes was not performed yet. We assessed the transcriptomes of MPO-deficient patients using single-cell RNA sequencing of PBMCs and RNA sequencing of neutrophils in a stable disease state. Cell-type annotation by multimodal reference mapping of single-cell RNA-sequencing data was verified by flow cytometry of surface and intracellular markers; the proportions of CD4+ cytotoxic T lymphocytes and other CD4+ effector cells were increased in generalized pustular psoriasis, whereas the frequencies of naïve CD4+ T cells were significantly lower. The expression of FGFBP2 marking CD4+ cytotoxic T lymphocytes and CD8+ effector memory T cells was elevated in patients with generalized pustular psoriasis with disease-contributing variants compared with that in noncarriers (P = 0.0015). In neutrophils, differentially expressed genes were significantly enriched in genes of the classical complement activation pathway. Future studies assessing affected cell types and pathways will show their contribution to generalized pustular psoriasis's pathogenesis and indicate whether findings can be transferred to the acute epidermal situation and whether depletion or inactivation of CD4+ cytotoxic T lymphocytes may be a reasonable therapeutic approach.

[Functional outcome following high-pressure injection injuries of the hand]. / Funktionelle Ergebnisse nach Hochdruckeinspritzverletzungen der Hand.

Background High-pressure injection injuries are devastating injuries that often lead to an amputation of the primarily affected finger. The available literature mainly focuses on amputation rates, while there is a lack of knowledge regarding functional results. Patients and Methods Between 1998 and 2016, 47 cases of high-pressure injection injuries of the hand were registered in our department. Out of these, data of 26 patients, all men with an average age of 42 (18-62) years, were included in a retrospective follow-up examination after 4 (1-12) years. We recorded DASH scores, pain intensity on visual analogue scales (VAS, 1-10), fingertip-to-palm distance, active range of wrist motion, grip strength, and two-point-discrimination ability (2PD). The statistical analysis was descriptive and was performed by analysis of correlation. Results The average DASH score of these 26 patients was 45 (30-93), pain intensity was 2.5 (0-9) on the VAS, fingertip-to-palm distance was 1 (0-4) cm. Active range of wrist motion was 99 (77-122) % of the contralateral side. Average grip strength was reduced to 67 (0-164) % of the contralateral side. Average 2PD was 9 (2-25) mm. Nineteen out of 26 patients returned to work. An amputation was necessary in 7 out of 26 cases. These patients had more pain and less grip strength. High latency from injury to operative treatment impaired functional outcome, which was statistically significant for DASH (p < 0.05). A trend to poorer outcomes was noted in cases of a more distal lesion and injection of toxic substances, whereas high injection pressure had no negative influence. Conclusion High-pressure injection injuries have serious consequences regarding hand function and frequently cause chronic pain. This affects patients with finger preservation as well as patients requiring an amputation. A further evaluation of prognostic factors requires a metaanalysis of functional parameters. The DASH score seems to be an expedient assessment tool.