Fatal consequences of freshwater pearl diving Phu, Nguyen Hoan, MD; Hoang Mai, Nguyen Thi, MD; Nghia, Ho Dang Trung, MD ...
The Lancet (British edition),
01/2013, Volume:
381, Issue:
9861
Journal Article
Peer reviewed
Open access
Polymerase chain reaction (PCR) amplification targeting the 18s RNA gene was done retrospectively.1 The PCR amplicon was sequenced and confirmed to have 100% homology with the 18s RNA gene of ...Naegleria fowleri, which is the cause of primary amoebic meningoencephalitis. Within the central nervous system N fowleri amoebae cause an intense inflammatory reaction accompanied by necrosis and haemorrhage.3 Amoebic meningoencephalitis seems to be increasing in frequency with an expanding geographic footprint.4,5 Clinical and CSF findings are difficult to distinguish from bacterial meningitis.5 A history of freshwater exposure and symptoms such as the loss of the sense of smell should prompt consideration of the disease.4 The infection has a very high case-fatality rate and very few survivors have been documented.
Influenza A (H5N1) virus with an amino acid substitution in neuraminidase conferring high-level resistance to oseltamivir was isolated from two of eight Vietnamese patients during oseltamivir ...treatment. Both patients died of influenza A (H5N1) virus infection, despite early initiation of treatment in one patient. Surviving patients had rapid declines in the viral load to undetectable levels during treatment. These observations suggest that resistance can emerge during the currently recommended regimen of oseltamivir therapy and may be associated with clinical deterioration and that the strategy for the treatment of influenza A (H5N1) virus infection should include additional antiviral agents.
The influenza A virus is an RNA virus that is responsible for seasonal epidemics worldwide with up to five million cases of severe illness and 500,000 deaths annually according to the World Health ...Organization estimates. The factors associated with severe diseases are not well defined, but more severe disease is more often seen among persons aged >65 years, infants, pregnant women, and individuals of any age with underlying health conditions.
Using gene expression microarrays, the transcriptomic profiles of influenza-infected patients with severe (N = 11), moderate (N = 40) and mild (N = 83) symptoms were compared with the febrile patients of unknown etiology (N = 73). We found that influenza-infected patients, regardless of their clinical outcomes, had a stronger induction of antiviral and cytokine responses and a stronger attenuation of NK and T cell responses in comparison with those with unknown etiology. More importantly, we found that both interferon and ubiquitination signaling were strongly attenuated in patients with the most severe outcomes in comparison with those with moderate and mild outcomes, suggesting the protective roles of these pathways in disease pathogenesis.
The attenuation of interferon and ubiquitination pathways may associate with the clinical outcomes of influenza patients.
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