Utility of fluorodeoxyglucose positron emission tomography/computed tomography in patients with fever of unknown origin diagnosed as lymphoma

To assess the efficacy of fluorine-18 fluorodeoxyglucose positron emission tomography [[18]F-FDG PET]/computed tomography [CT] in the diagnosis of patients with fever of unknown origin [FUO], who were finally diagnosed as lymphoma. A retrospective study was performed in the First Affiliated Hospital, School of Medicine of Zhejiang University, China, from March 2009 to March 2012. The PET/CT images of consecutive patients with FUO were analyzed. Within 1 week of PET/CT scanning, additional histological tests were also performed if clinically needed. A total of 73 consecutive patients were included. Of these, 34 [47%] had a PET/CT finding suggestive of the presence of lymphoma and 29 [85%] had a diagnosis of confirmed lymphoma; 39 [53%] had a PET/CT result revealing the absence of lymphoma and 4 [10%] were diagnosed by biopsy as having lymphoma. The most frequent lymphoma diagnosis was peripheral T cell lymphoma [n = 16; 55%], followed by diffuse large B cell lymphoma [n = 9; 31%]. The accuracy of PET/CT was 88%. In this study, PET/CT had high diagnostic accuracy in patients with FUO resulting from lymphoma, which indicated that PET/CT scanning was a valuable diagnostic tool for these groups of patients with FUO

Acute Brucellosis with Myelodysplastic syndrome presenting as pancytopenia and fever of unknown origin

To report a rare case of brucellosis with myelo-dysplastic syndrome [MDS]. A 70-year-old woman presented with pancytopenia and fever of unknown origin [FUO]. The initial diagnosis was brucellosis; the woman was treated with doxycycline and rifampin against Brucella melitensis but was later diagnosed as suffering from MDS. She was immediately transferred to the Department of Hematology for further evaluation. This study highlights the rarity of brucellosis with MDS, and we recommend that brucellosis with MDS be considered in patients presenting with pancytopenia and FUO

Regional prevalence and transmission route of Kaposi's sarcoma-associated herpes virus in Zhejiang, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The infection of Kaposi's sarcoma-associated herpes virus (KSHV) is most likely the cause of clinical Kaposi's sarcoma, primary effusion lymphoma, and multi-center Castleman's disease. KSHV infection has very limited epidemiological survey data in China, and its definite mode of transmission remains controversial. This study aimed to determine the infection status and the main transmission route of KSHV in Chinese population.</p><p><b>METHODS</b>An enzyme-linked immunosorbent assay (ELISA) utilizing KSHV ORF65 recombinant protein was employed to analyze the antibody response to KSHV ORF65 in sera from 122 healthy physical examination people, 107 intravenous drug users, 135 non-intravenous drug users, 211 hepatitis B (HBV) patients infected via blood transmission, 107 kidney transplant recipients, and 72 female sex workers in Zhejiang Province in Southeast China.</p><p><b>RESULTS</b>KSHV infection occurred relatively common (13.1%) in healthy population in Zhejiang, China. Infection rate was 16.7% in female sex workers, but significantly elevated in intravenous drug addicts (58.9%), blood-transmitted HBV patients (28.0%) and kidney transplant patients (41.1%).</p><p><b>CONCLUSION</b>Blood borne transmission of KSHV is probably the main route of infection in Zhejiang Province.</p>

Emergence of Klebsiella pneumoniae carbapenemase-producing Proteus mirabilis in Hangzhou, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Carbapenems are used to treat severe infections caused by multi-drug-resistant organisms, however, the emergence of carbapenem-resistant bacterial isolates is becoming an increasing therapeutic challenge. Since the first Klebsiella (K.) pneumoniae carbapenemase (KPC)-producing K. pneumoniae was reported in 2001, KPC-producing isolates have been found increasingly, specially in Enterobacteriaceae. The aim of this study was to characterize the mechanisms of a carbapenem-resistant Proteus (P.) mirabilis.</p><p><b>METHODS</b>A carbapenem-resistant P. mirabilis isolate was recovered from pleural drainage fluid of a patient admitted to surgical intensive care unit. Antimicrobial susceptibility testing of the isolate was performed by disk diffusion according to Clinical and Laboratory Standards Institute guidelines, and subsequent minimal inhibitory concentrations were determined with the E-test. Amplification of the bla(KPC) gene generated a positive band and the PCR products were sequenced subsequently. The plasmid of the isolate was extracted and was successfully transformed into Escherichia (E.) coli DH5α.</p><p><b>RESULTS</b>The P. mirabilis isolate was resistant to all detected antimicrobial agents except tigecycline. KPC-2 was confirmed by DNA sequence analysis. The transformant E. coli was resistant to carbapenems. Further study demonstrated that upstream and downstream regions of bla(KPC-2) were identical to that observed in K. pneumoniae submitted to GenBank from China in 2007.</p><p><b>CONCLUSION</b>Carbapenem resistance in the P. mirabilis isolate in this study is mainly due to production of KPC-2.</p>