Summary A previously well infant aged 9 months presented with an acute, self-limiting illness characterised by high fever and a papular eruption that started on the face. Although fever subsided ...within 3 days, the rash worsened and extended over the whole body, with some papules evolving into vesiculobullous lesions. The infant had been exposed to children with a similar illness 1 week before onset. PCR of vesicular swabs and stool samples taken on day 6 of illness showed Coxsackie virus A6. The illness resolved within 10 days of onset, although onychomadesis was seen on both big toes at follow-up 5 weeks later. Our case exemplifies the severe, atypical cases of hand, foot, and mouth disease that have been reported worldwide since 2008, and in the USA since the 2011. Atypical hand, foot, and mouth disease is caused by a new lineage of Coxsackie virus A6 and is characterised by high fever and vesiculobullous eruptions on the calves and backs of the hands. Infants with eczema might be predisposed to severe disease.
"COVID Toes" in Three Siblings Feder, Jr, Henry M
The Pediatric infectious disease journal,
12/2021, Letnik:
40, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Dermatologists reported an outbreak of pernio (red to purple swollen painful toes) during the COVID-19 pandemic. Most subjects lacked positive CoV-19 polymerase chain reaction (PCR) or antibodies or ...a preceding illness. The dermatologists termed the illness "COVID toes." Pernio usually affects adults versus "COVID toes" usually children. Pernio is preceded by a clear history of exposure to wet and cold. Patients with "COVID toes" lack this history. Also, it is not unusual for multiple family members to have "COVID toes." Our case report describes "COVID toes" in an 18-year-old with no preceding illness, a negative SARS-CoV-19 PCR, and an initially negative SARS-CoV-19 antibody, and also his 2 siblings also developed "COVID toes." In our index case, repeat SARS-CoV-19 antibodies were positive. Seroconversion has rarely been reported in patients with "COVID toes." Why most "COVID toes" patients lack a clinical history of COVID-19 and are SARS-CoV-19 PCR and antibody negative is a mystery.
A 12-day-old baby was admitted to our hospital with a fever, irritability, and poor feeding. His temperature was 39° C. On physical examination, he was irritable but consolable. His anterior ...fontanelle was full but not bulging. Laboratory tests included a complete blood cell count, which showed a white blood cell count of 4·8×10⁹ per L, with 72% neutrophils. Analysis of the infant’s cerebrospinal fluid (CSF) showed 3 050 white blood cells per µL, with 94% neutrophils, protein concentration was 110 mg/dL, and glucose concentration 49 mg/dL (normal 60–80).
A rapid antigen detection test for streptococcus was negative, and because of exudates on the patient's tonsils and very enlarged cervical lymph nodes, the physician tested for infectious ...mononucleosis or glandular fever. Epstein-Barr virus (EBV) antibodies—viral capsid antigen IgM and IgG, and EBV-associated nuclear antigen antibodies—were also negative. In 1921, C A McKinlay showed Hal Downey—who did much pioneering work on the morphology of blood cells—a blood smear from a University of Minnesota college student with a presumed diagnosis of leukaemia.
On examination, the patient was pale and breathless; her temperature was 38·8°C, blood pressure was 110/60 mm Hg, and she had petechiae scattered about her body with oedema of both legs. Laboratory ...investigations showed a haematocrit of 31·3% (normal >35), an elevated aspartate aminotransferase (AST) concentration of 110 units per L (normal <40), alanine aminotransferase (ALT) was normal, total bilirubin concentration of 1·7 mg/dL (normal <1·2), a platelet count of 17 × 109 (normal >150), and a 3+ proteinuria. The patient was transfused platelets and packed red blood cells and treated for babesiosis with a combination of intravenous clindamycin and oral quinine, which notably cross the placenta.
A critical appraisal of "chronic Lyme disease" Feder, Jr, Henry M; Johnson, Barbara J B; O'Connell, Susan ...
The New England journal of medicine,
10/2007, Letnik:
357, Številka:
14
Journal Article
Powassan virus (POWV) is a tick-transmitted pathogen that may cause severe encephalitis; experimentally, it can be transmitted within just 15 minutes following a tick bite. The deer tick virus ...subtype of POWV (DTV) is transmitted by the deer tick and is the likely cause of the increase in the number of POWV cases reported in the United States. However, DTV has only been definitively documented in 6 patients by molecular analysis of the virus.
Two patients from Connecticut with encephalitis, who had a recent deer tick bite, were evaluated by the relevant serologic tests to determine if they had been infected with POWV. Evaluation also included molecular testing of an adult deer tick that had been removed from one of the patients.
We documented neuroinvasive POWV infection in 2 children from Connecticut. Based on the results of testing the tick removed from case 2, this patient was infected by DTV, representing the 7th reported case and the first documented case of DTV infection in a child. Of note, the duration of the tick bites in both cases was very short.
We provide the first clinical and epidemiologic evidence that POWV/DTV can be rapidly transmitted to a human host, that is, within hours of tick attachment, which is distinctive when compared to other deer tick-transmitted infections such as Lyme disease.
Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most common periodic fever syndrome in children. The disease appears to cluster in families, but the ...pathogenesis is unknown. We queried two European–American cohorts and one Turkish cohort (total n = 231) of individuals with PFAPA for common variants previously associated with two other oropharyngeal ulcerative disorders, Behçet’s disease and recurrent aphthous stomatitis. In a metaanalysis, we found that a variant upstream of IL12A (rs17753641) is strongly associated with PFAPA (OR 2.13, P = 6 × 10−9). We demonstrated that monocytes from individuals who are heterozygous or homozygous for this risk allele produce significantly higher levels of IL-12p70 upon IFN-γ and LPS stimulation than those from individuals without the risk allele. We also found that variants near STAT4, IL10, and CCR1-CCR3 were significant susceptibility loci for PFAPA, suggesting that the pathogenesis of PFAPA involves abnormal antigen-presenting cell function and T cell activity and polarization, thereby implicating both innate and adaptive immune responses at the oropharyngeal mucosa. Our results illustrate genetic similarities among recurrent aphthous stomatitis, PFAPA, and Behçet’s disease, placing these disorders on a common spectrum, with recurrent aphthous stomatitis on the mild end, Behçet’s disease on the severe end, and PFAPA intermediate. We propose naming these disorders Behçet’s spectrum disorders to highlight their relationship. HLA alleles may be factors that influence phenotypes along this spectrum as we found new class I and II HLA associations for PFAPA distinct from Behçet’s disease and recurrent aphthous stomatitis.
PDF
