Dexamethasone reduces infectious bursal disease mortality in chickens

Very virulent infectious bursal disease virus (vvIBDV) causes high mortality in chickens but measures to reduce the mortality have not been explored. Chickens (8–9 weeks) were treated with 3 agents before and during vvIBDV inoculation. Dexamethasone treatment reduced the mortality of infected chickens (40.7% vs. 3.7%; p < 0.001), but treatment with aspirin or vitamin E plus selenium did not affect the mortality. The bursa of Fabricius appeared to have shrunk in both dead and surviving chickens (p < 0.01). The results indicate that dexamethasone can reduce mortality in vvIBDV-infected chickens and may provide therapeutic clues for saving individual birds infected by the virus.

Dexamethasone reduces infectious bursal disease mortality in chickens

Very virulent infectious bursal disease virus (vvIBDV) causes high mortality in chickens but measures to reduce the mortality have not been explored. Chickens (8–9 weeks) were treated with 3 agents before and during vvIBDV inoculation. Dexamethasone treatment reduced the mortality of infected chickens (40.7% vs. 3.7%; p < 0.001), but treatment with aspirin or vitamin E plus selenium did not affect the mortality. The bursa of Fabricius appeared to have shrunk in both dead and surviving chickens (p < 0.01). The results indicate that dexamethasone can reduce mortality in vvIBDV-infected chickens and may provide therapeutic clues for saving individual birds infected by the virus.

Correlation of respiratory syncytial virus infection with climate parameters and air pollution levels in Korean children during 2005–2012

PURPOSE: Respiratory syncytial virus (RSV) is the major cause of acute lower respiratory tract infection (LRTI) in infants and children. We investigated the association of meteorological conditions and air pollution with the prevalence of RSV infection. METHODS: Between January 2005 and December 2012, a total of 9,113 nasopharyngeal swab specimens from children under 3 years of age who were admitted to the hospital with acute LRTI were tested for RSV antigens using a direct immunofluorescence kit. Meteorological data (mean temperature, precipitation, wind speed, and relative humidity) and air pollutant levels including PM₁₀ (particulate matter with a median aerodynamic diameter less than or equal to 10 µm in diameter), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and carbon monoxide (CO) in Seoul during the study period were collected from the national monitoring system. The correlations of the monthly incidence of RSV infection with climate factors and air pollutant levels were analyzed. RESULTS: RSV infection mainly occurred between October and February, and showed the peak in November. The prevalence of RSV infection had a moderate negative correlation with mean temperature (r=−0.60, P < 0.001), a weak negative correlation with relative humidity (r=−0.26, P=0.01), and precipitation (r=−0.34, P=0.001). Regarding air pollutants, RSV activity moderately correlated with NO₂ (r=0.40, P < 0.001), SO₂ (r=0.41, P < 0.001), and CO (r=0.58, P < 0.001). In the RSV peak season in Korea (between October and February), RSV epidemics showed a weak positive correlation with relative humidity (r=0.35, P=0.03) and precipitation (r=0.38, P=0.02). CONCLUSION: Meteorological factors and air pollutant levels may be associated with RSV activity. Therefore, further nationwide large-scaled intensive evaluations to prove factors affecting RSV activity are warranted.

Recent advances in norovirus infection

Norovirus (NoV) infections are an important cause of epidemic and sporadic viral gastroenteritis and a major cause of foodborne and waterborne outbreaks. NoV is characterized by genetic diversity, frequent mutations, and stability in a wide range of external environmental conditions. In recent years, a number of major advances that could overcome technical barriers have been made. The complex mechanisms of NoV pathogenesis and persistent infection involving interactions between the virus and the host immune system are being delineated. Human histo-blood group antigens, receptors for NoV attachment, play an important role in infection, which makes this interaction a critical target for the development of anti-NoV drugs. A number of vaccine candidates, chiefly based on virus-like particles, have entered phase 2 clinical development, and increasing efforts are being made to develop antiviral drugs. This review presents the current understanding of NoV immunology, epidemiology, therapeutic options, and vaccine development.

Isolated Myeloid Sarcoma Presenting as Cord Compression by Paraspinal Mass / 이화의대지

Myeloid sarcoma is a rare tumor mass consisting of immature granulocytic cells occurring in an extramedullary site or in a bone. It has often been observed during the course of an acute leukemia, myelodysplastic syndrome or myeloproliferative neoplasms, and it can involve any site of the body. However, it rarely present in the absence of bone marrow infiltration, especially for the isolated spinal myeloid sarcoma. In this report, we describe a case of isolated myeloid sarcoma that showed spinal compression. A 66-year-old male, with no underlying disease or medication history, presented with a progressive back pain and numbness in bilateral lower extremities that had begun two weeks before. He was diagnosed with myeloid sarcoma with no evidence of bone marrow involvement. Tumor cells were positive for CD34, c-KIT, and Bcl-2 on the immunohistochemical stain. He was treated with systemic chemotherapy with daunorubicin plus cytosine arabinoside and achieved a partial response.

Successful Treatment of Relapsed Acquired Amegakaryocytic Thrombocytopenia with Repeat Cyclosporine / 대한내과학회지

Acquired amegakaryocytic thrombocytopenia (AAMT) is an unusual disease characterized by severe thrombocytopenia resulting from a marked decrease in bone marrow megakaryocytes. Various pathogenic mechanisms have been suggested, and several treatments have been tried, with varying outcomes. In some case reports, cyclosporine and anti-thymocyte globulin have had good clinical results in the treat of AAMT. There are few reports on the treatment of relapsed AAMT with cyclosporine. We report a patient with relapsed AAMT who was treated successfully with an additional course of cyclosporine. The initial remission was achieved with cyclosporine 4 years earlier and a second remission was induced by cyclosporine. Cyclosporine may be effective for relapsed AAMT that previously responded to cyclosporine.

Distinctive clinical features of HPeV-3 infection in 2 neonates with a sepsis-like illness / 소아과

We report a human parechovirus-3 (HPeV-3) infection in 2 neonates who had prolonged fever (>5 days) with palmar-plantar erythema. This distinctive rash was observed 4–5 days after fever onset, just before defervescence. Elevated aspartate aminotransferase, lactate dehydrogenase, and ferritin levels were characteristic laboratory findings in the 2 cases, suggesting tissue damage caused by hypercytokinemia. Case 1 was treated with intravenous immunoglobulin, considering the possibility of severe systemic inflammatory responses. The initial ferritin level was 385 ng/mL (range, 0–400 ng/mL); however, the level increased to 2,581 ng/dL on day 5 after fever onset. Case 2 presented with milder clinical symptoms, and the patient recovered spontaneously. HPeV-3 was detected in cerebrospinal fluid and/or blood samples, but no other causative agents were detected. The findings from our cases, in accordance with recent studies, suggest that clinical features such as palmar-plantar erythema and/or hyperferritinemia might be indicators of HPeV-3 infection in neonates with sepsis-like illness. In clinical practice, where virology testing is not easily accessible, clinical features such as palmar-plantar erythema and/or hyperferritinemia might be helpful to diagnose HPeV-3 infection.

Possible Transfusion-Related Acute Lung Injury Following Convalescent Plasma Transfusion in a Patient With Middle East Respiratory Syndrome

No abstract available.

Gene Frequency of Human Neutrophil Alloantigen-3 in the Korean Population / 대한수혈학회지

BACKGROUND: In the Korean population, gene frequencies of Human Neutrophil Alloantigen-1 (HNA-1), HNA-2, HNA-4, and HNA-5 were determined using serological and genotyping methods. However, no study assessing the gene frequencies of HNA-3 among the Korean population has been conducted. The aims of this study were to report the gene frequencies of HNA-3, to estimate the risk of HNA-3a (or HNA-3b) alloimmunization, and to secure donors of granulocytes for anti-HNA-3 antibodies among the Korean population. METHODS: Genotyping of HNA-3a and HNA-3b genes of 110 healthy and unrelated Korean donors was performed using a polymerase chain reaction with sequence-specific primers. RESULTS: The observed frequencies of HNA-3a and HNA-3b were 0.695 and 0.305, respectively, among the Korean population. The HNA-3a gene frequency of Koreans was significantly lower than those of American Whites and Germans (P<0.05). The risk of HNA-3a and HNA-3b alloimmunization due to pregnancy (transfusion) was 0.065 (0.084) and 0.147 (0.250), respectively, among the Korean population. The risk of HNA-3a alloimmunization was significantly higher in the Korean population than in the German and American White populations (P<0.05). CONCLUSION: The gene frequencies of HNA-3 and the risk of HNA-3a (HNA-3b) alloimmunization due to pregnancy or transfusion among the Korean population were determined. We also identified individuals who were HNA-3a/3a or HNA-3b/3b for the granulocyte panel which could be used for anti-HNA antibody identification.

Distribution of Human Rotavirus Genotypes in a Tertiary Hospital, Seoul, Korea During 2009-2013

PURPOSE: Group A rotavirus (RV) is most common etiologic agent of acute gastroenteritis (AGE) in children worldwide. Recently, vaccination has been introduced in several countries to reduce the disease burden caused by RV infections, but continuous surveillance of RV strains is necessary to detect the emergence of potential variants induced by vaccine-immune pressure. This study aimed to investigate the changing pattern of RV genotypes in children with AGE, following the introduction of vaccination in Korea. METHODS: Genotyping of RVs by RT-PCR on the basis of VP7 and VP4 gene segment sequence was carried out on 201 rotavirus-positive stool samples, from children hospitalized with AGE between August 2009 and June 2013. We have directly sequenced PCR products and analyzed the phylogenetic tree. RESULTS: The most prevalent G genotype was G9 (33.3%), followed by G1 (22.4%), G3 (15.9%), G2 (6.0%), G4 (3.0%), G10 (1.5%), and mixed G-type (15.4%), with some nontypeable cases (2.5%). The detected P genotypes were P[4] (45.3%), P[8] (43.8%), mixed P-type (10.4%), and P[2] (0.5%). The G9P[4] genotype was predominantly observed in hospitalized cases in Seoul in 2010/2011, however G1P[8] has been re-emerged as the predominant genotype in the following season (P=0.004). CONCLUSIONS: It seems that the periodic fluctuation in predominance of the G1, G3, and G9 strains occurred in Korea during 2009-2013, following the introduction of RV vaccination.

Human Neutrophil Alloantigen-3a Alloimmunization among Pregnant Korean Women / 대한수혈학회지

BACKGROUND: Alloantibodies against human neutrophil alloantigen (HNA)-3a are associated with severe and fatal transfusion related acute lung injury (TRALI). HNA-3 genotyping and HNA-3a antibody (Ab) identification are essential to diagnosis and prevention of TRALI caused by HNA-3a Ab. However there had been no laboratory for HNA-3a Ab identification in Korea. The aims of this study were to establish the HNA-3a Ab test in Korea and to estimate the incidence of HNA-3a alloimmunization among pregnant Korean women. METHODS: HNA-3a homozygotes and HNA-3b homozygotes were identified by HNA-3 genotyping. Three HNA-3a homozygotes and three HNA-3b homozygotes are included in the granulocytes panel, which consisted of 10 donors for granulocytes. Sera from 650 pregnant Korean women were tested for granulocyte Ab using a mixed passive hemagglutination assay (MPHA). When a HNA-3a Ab was detected, the woman's HNA-3 was typed to support her HNA-3a alloimmunization. RESULTS: MPHA showed positive reactions in the sera from 26 women (4.0%, 26/650). HLA Abs were detected in 18 women (2.8%, 18/650), among whom HNA Abs were identified simultaneously in 7 women. Granulocyte Abs were detected in sera from 15 women (2.3%, 15/650). The incidence of HNA-3a, HNA-1b, HNA-1a, HNA-2a, and unidentified HNA Abs among pregnant Korean women was 0.77% (5/650), 0.77% (5/650), 0.62% (4/650), 0.15 (1/650), and 0.31% (2/650), respectively. CONCLUSION: In this study, we established the HNA-3a Ab test using MPHA for diagnosis and prevention of TRALI caused by HNA-3a Ab. The incidence of HNA-3a Ab in pregnant Korean women was 0.77% (5/650).

Prevalence of human parechovirus and enterovirus in cerebrospinal fluid samples in children in Jinju, Korea / 소아과

PURPOSE: Human parechovirus (HPeV) and enterovirus (EV) are causative agents of a sepsis-like illness in neonates and of infections of the central nervous system in young children. The objectives of this study were to assess the prevalence of HPeV3 and EV infection in young children with a sepsis-like illness or with meningitis in Jinju, Korea. METHODS: Cerebrospinal fluid (CSF) samples were collected from 267 patients (age range, 1 day to 5 years) and assessed for HPeV and EV by performing reverse transcription polymerase chain reaction assay. Amplification products of the VP3/VP1 region of HPeV and of the VP1 region of EV were sequenced to identify the virus type. RESULTS: HPeV and EV were detected in 3.4% and 7.5% of the total CSF samples assessed, respectively. The age distribution of EV-positive patients (median age, 1.4 months) had a significantly broader range than that of HPeV-positive patients (median age, 7.8 months). The peak seasons for HPeV and EV infection were spring and summer, respectively. The clinical symptoms for HPeV and EV infection were similar, and fever was the most common symptom. Pleocytosis was detected in 22.2% of HPeV-positive patients and 35.5% of EV-positive patients. The VP3/VP1 gene sequence of the nine Korean strains clustered most closely with the Japanese strain (AB759202). CONCLUSION: The data indicate that HPeV infection is predominant in young infants (<6 months) and that meningitis without pleocytosis was caused by both HPeV and EV infection in children.

Influence of Pathogen Inactivation on the Quality of Platelet Rich Plasma Derived Platelets / 대한수혈학회지

BACKGROUND: Pathogen inactivation (PI) is a proactive approach to overcome the limitations of the current testing system and donor questionnaires. Effect of PI on non-leukoreduced platelet rich plasma derived platelets (PRP-PLTs) suspended in plasma has not yet been evaluated. This study was conducted in order to evaluate the effect of PI on the quality of non-leukoreduced PRP-PLTs suspended in plasma. METHODS: PRP-PLTs treated with the Mirasol PRT System and the Intercept Blood System were tested for PLT count, blood gas, PLT activation, and apoptosis on days 3, 5, and 7 of storage. RESULTS: PLT number showed a decrease after PI. No difference in pH was observed until day 5. At day 7, PLTs treated with Mirasol had a lower pH value (6.5), however, it satisfied the quality control criteria. PLTs treated with Mirasol had a lower pO2 compared to pre-inactivation PLTs. pO2 during storage differed significantly between the two PI groups. pCO2 showed a decrease after inactivation and both groups showed a significant difference, compared with the control. PLTs treated with Mirasol had increased P-selectin expression after inactivation; however, difference of P-selectin during storage was not significant compared to the control. P-selectin of PLTs treated with Intercept was significantly different compared to those treated with Mirasol and control. Annexin V showed an increase after inactivation in Mirasol treated PLTs and difference during storage was significant compared to control and Intercept. CONCLUSION: As both PI systems showed satisfactory pH values, the criteria showing a high correlation with in vivo PLT viability and generally applied to monitor quality of PLTs, quality of PRP-PLTs after PI appears not to be negatively affected.

Urinalysis: The Usefulness and Limitations of Urine Dipstick Testing

The urinalysis is an essential part of the diagnostic work-up for kidney disease and other renal system disorders. The dipstick test allows rapid and simultaneous chemical analyses of urine, including factors such as pH, specific gravity, protein, glucose, ketones, occult blood, bilirubin, urobilinogen, nitrite, and leukocyteesterase. The chemical reactions on dipstick are complicated and can be affected by oxidizing, reducing, and discoloring substances in the urine. Therefore, false positive and false negative results are common in dipstick testing. To obtain reliable results with the dipstick, it is necessary to collect urine cleanly and examine the urine carefully. It is mandatory to clearly understand the principles of dipstick testing to evaluate abnormal findings. If the urine dipstick results suggest hematuria, proteinuria, or urinary tract infection, microscopy of the urine should be performed to confirm the findings.

Frequency of unexpected antibody and consideration during transfusion / 대한마취과학회지

BACKGROUND: In this retrospective study, we measured the frequency of unexpected antibodies in the blood. Specific considerations for preoperative preparations were kept in mind for the patients undergoing surgery positive for these antibodies. METHODS: After reviewing the results of antibody screening tests lasted for 2 years, the frequency of unexpected antibodies was determined. Surgical patients who were positive for unexpected antibodies were selected and divided into two groups based on their potential need for an intra-operative transfusion (groups with high versus low possibility of transfusion). Blood for the high possibility group was prepared before surgery. For the low possibility group for which preoperative blood preparation was not performed, cases of this group were reviewed whether a blood preparation was delayed or not in case of transfusion. RESULTS: Among a total 22,463 cases, 340 (1.52%) had positive results for antibody screening tests. Among the 243 patients who were positive for unexpected antibodies, Lewis, Rh, Xga, and mixed antibodies were found in 85, 25, five, and eight cases, respectively. Out of 243 patients, 117 patients, specificities of the unexpected antibodies were not determined and 125 (51.4%) had a history of pregnancy and delivery, and 49 (20.2%) had a history of transfusion. In the low probability group, transfusions were administered for nine patients; transfusion was delayed for two patients due to difficulties with obtaining matched blood. CONCLUSIONS: Patients with unexpected blood antibodies may be at increased risk for delayed transfusion. For rapid transfusion, it might be helpful to keep a record about blood antibodies and introduce a notification system such as medical alert cards. Preoperative blood preparation is needed for timely intraoperative transfusion.

Cat-Scratch Disease: A Case Report and Literature Review of Human and Animal Studies Performed in Korea / 감염과화학요법

Cat-scratch disease is a self-limited zoonotic disease characterized by regional lymphadenopathy and fever. It is caused by Bartonella henselae, less frequently by B. clarridgeiae, and is transmitted to humans by scratches or bites from cats and dogs. Up to now, only a handful of cases have been reported in Korea. However, the number of pet cats and dogs is increasing in Korea and thus more frequent human contact with cats and dogs is expected. We present a case of cat-scratch disease diagnosed by indirect immunofluorescence assay and analysis of polymerase chain reaction results, and twenty a literature review of Bartonella infections in humans and animals in Korea.

A Case of Plasmodium ovale Malaria Imported from West Africa

In Korea, the majority of imported malaria cases are Plasmodium vivax and P. falciparum, but Plasmodium ovale cases are rarely reported. We describe an imported case of P. ovale that was confirmed by peripheral blood smear and nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene. A 37-yr-old male had visited the Republic of Ghana in tropical West Africa 3 months ago, and suffered from fever and headache since 2 weeks after his return to Korea. The results of rapid malaria test using SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea) were negative, but Plasmodium species was observed in Wright-Giemsa-stained peripheral blood smear. For the evaluation of possible mixed infection and identification of species, we performed a nested PCR targeting the SSU rRNA gene. P. ovale single infection was confirmed by PCR. The sequence analysis of the P. ovale SSU rRNA gene showed that our isolate was P. ovale classic type. We should confirm P. ovale infection for an accurate diagnosis and treatment of imported malaria cases in Korea because the number of travelers to P. ovale-endemic regions has recently increased.

Direct Corticosteroid Modulation of GABAergic Neurons in the Anterior Hypothalamic Area of GAD65-eGFP Mice

Corticosterone is known to modulate GABAergic synaptic transmission in the hypothalamic paraventricular nucleus. However, the underlying receptor mechanisms are largely unknown. In the anterior hypothalamic area (AHA), the sympathoinhibitory center that project GABAergic neurons onto the PVN, we examined the expression of glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) of GABAergic neurons using intact GAD65-eGFP transgenic mice, and the effects of corticosterone on the burst firing using adrenalectomized transgenic mice. GR or MR immunoreactivity was detected from the subpopulations of GABAergic neurons in the AHA. The AHA GABAergic neurons expressed mRNA of GR (42%), MR (38%) or both (8%). In addition, in brain slices incubated with corticosterone together with RU486 (MR-dominant group), the proportion of neurons showing a burst firing pattern was significantly higher than those in the slices incubated with vehicle, corticosterone, or corticosterone with spironolactone (GR-dominant group; 64 vs. 11~14%, p<0.01 by chi2-test). Taken together, the results show that the corticosteroid receptors are expressed on the GABAergic neurons in the AHA, and can mediate the corticosteroid-induced plasticity in the firing pattern of these neurons. This study newly provides the experimental evidence for the direct glucocorticoid modulation of GABAergic neurons in the AHA in the vicinity of the PVN.

A suspected case of Transfusion-related acute lung injury in a 30-year old parturient with gestational ITP: A case report

Transfusion-related acute lung injury (TRALI) is defined as a new episode of acute lung injury that occurs during or within 6 hours of a completed transfusion, which has been the leading cause of transfusion-related death. We present a suspected case of TRALI in a 30-year-old parturient with gestational ITP scheduled for cesarean section. The parturient developed hypoxemia and pulmonary edema after platelet concentrate transfusion during perioperative period. The parturient completely recovered after an oxygen support for 4 days. It is important to recognize TRALI as soon as possible to minimize perioperative morbidity and mortality.

A case of hemophagocytic syndrome complicated by acute viral hepatitis A infection / 대한간학회지

Hemophagocytic syndrome (HPS) is a rare but serious condition that is histopathologically characterized by activation of macrophage or histiocytes with hemophagocytosis in bone marrow and reticuloendothelial systems. Clinically it presents with high fever, hepatosplenomegaly, pancytopenia, liver dysfunction, and hyperferritinemia. Hepatitis A virus is a very rare cause of secondary HPS. We report a case of a 22-year-old woman infected by hepatitis A virus who was consequently complicated with HPS. She presented typical clinical features of acute hepatitis A, and showed clinical and biochemical improvements. However, HPS developed as a complication of acute hepatitis A and the patient died of intraperitoneal bleeding caused by hepatic decompensation and disseminated intravascular coagulation.