Term neonate with intracranial hemorrhage and hereditary hemorrhagic telangiectasia: a case report and review of the literature.

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by mucocutaneous telangiectases and arteriovenous malformations (AVMs). The disease rarely presents in the neonatal period, primarily manifesting with epistaxis and gastrointestinal bleeding in adulthood. Occasionally, HHT can also present with symptoms related to AVMs in the cerebral, pulmonary or gastrointestinal vasculature. In prior reports, intracranial hemorrhage (ICH) secondary to cerebral AVM in neonates with HHT has been catastrophic and uniformly fatal. Here we report a case of a newborn with HHT and ICH from a suspected AVM who survived with aggressive medical management and surgical intervention, and provide a comprehensive review of the literature on ICH in neonates with HHT.

Implications of pathogenesis by Erwinia amylovora on rosaceous stigmas to biological control of fire blight.

As a prerequisite to infection of flowers, Erwinia amylovora grows epiphytically on stigmas, which provide a conducive habitat for bacterial growth. Stigmas also support growth of several other bacterial genera, which allows for biological control of fire blight; although, in practice, it is very difficult to exclude E. amylovora completely from this habitat. We investigated the dynamics of growth suppression of E. amylovora by comparing the ability of virulent and avirulent strains of E. amylovora to compete with each other on stigmas of pear, apple, and blackberry, and to compete with a co-inoculated mixture of effective bacterial antagonists. When strains were inoculated individually, virulent E. amylovora strain Ea153N attained the highest population size on stigmas, with population sizes that were approximately double those of an avirulent hrpL mutant of Ea153 or the bacterial antagonists. In competition experiments, growth of the avirulent derivative was suppressed by the antagonist mixture to a greater extent than the virulent strain. Unexpectedly, the virulent strain enhanced the population size of the antagonist mixture. Similarly, a small dose of virulent Ea153N added to inoculum of an avirulent hrpL mutant of Ea153 significantly increased the population size of the avirulent strain. A pathogenesis-gene reporter strain, Ea153 dspE::gfp, was applied to flowers and a subset of the population expressed the green fluorescent protein while growing epiphytically on stigmas of apple. These results are consistent with the hypothesis that virulent E. amylovora modifies the epiphytic habitat presented by the stigma through a pathogenesis-related process, which increases host resources available to itself and, coincidentally, to nonpathogenic competitors. Over nine orchard trials, avirulent Ea153 hrpL significantly suppressed the incidence of fire blight four times compared with six for the antagonist mixture. The degree of biological control achievable with an avirulent strain of E. amylovora likely is limited by its inability to utilize the stigmatic habitat to the same degree as a virulent strain.

Rates of Epiphytic Growth of Erwinia amylovora on Flowers Common in the Landscape.

We evaluated epiphytic growth of the fire blight bacterium, Erwinia amylovora, on flowers of plant species common to landscapes where pears and apples are grown. The plants were from genera regarded as important nectar and pollen sources for pollinating insects: Acer, Amelanchier, Brassica, Cytisus, Populus, Prunus, Rubus, Salix, Taraxacum, Trifolium, and Symphoricarpos. Floral bouquets were inoculated with E. amylovora and incubated in growth chambers at 15°C for 96 h. Regardless of their susceptibility to fire blight, all species from the rose family except Prunus domestica (European plum) supported epiphytic populations of E. amylovora that exceeded 1 × 106 CFU/flower with relative growth rates for the populations that averaged 7% per hour. Nonrosaceous plants were generally poor supporters of epiphytic growth of the fire blight pathogen with relative growth rates averaging <4% per hour. In two seasons of field inoculations, the rosaceous non-disease-host plants, Prunus avium (sweet cherry) and Rubus armeniacus (Himalayan blackberry), yielded mean population sizes of E. amylovora that exceeded 1 × 106 CFU/flower; in contrast, at 8 days after inoculation, mean population sizes of the pathogen were in the range of 5 × 103 to 5 × 104 CFU/flower on Cytisus scoparius (Scotch broom) and <1 × 102 CFU on Acer macrophylum (big leaf maple). Because vectors of E. amylovora, principally bees, visit many kinds of flowers in landscape areas between pear and apple orchards, flowers of rosaceous, non-disease-host species could serve as potential sites of inoculum increase during their periods of bloom.

Adaptation of Fire Blight Forecasting to Optimize the Use of Biological Controls.

We investigated adaptation of fire blight forecasting concepts to incorporate and optimize the use of biological agents for disease suppression. The effect of temperature on growth of the bacterial antagonists, Pseudomonas fluorescens A506 and Pantoea agglomerans C9-1S, and of the pathogen Erwinia amylovora153N, on pear and apple blossoms was evaluated in growth chamber and screenhouse experiments. New blossoms were inoculated with the strains and subsequent growth was measured over 96 h. Bacterial growth rates on blossoms were described as functions of temperature. A degree hour-based "bacterial growth index" (96-h moving total of degree hours >10°C) was created to assess conduciveness of orchard environments for antagonist colonization. A comparison of this index to a disease risk index indicated that biocon-trol treatments could be timed such that the antagonists could be expected to grow to an effective population size before the disease index shifted from "low" to "moderate" risk. For six pear- and apple-production areas of Oregon and Washington, regression of actual values of the bacterial growth and disease risk indices on index values derived from 4-day temperature forecasts resulted in coefficients of determination that averaged 0.75. The "bacterial growth index" and its estimation via temperature forecasts were incorporated into a decision matrix designed to guide optimal treatment timing.

Assessment of Environmental Factors Influencing Growth and Spread of Pantoea agglomerans on and Among Blossoms of Pear and Apple.

ABSTRACT We evaluated effects of both physical and biological components of the environment on growth of Pantoea agglomerans on inoculated pear and apple blossoms and on spread of the bacterium to blossoms on non-inoculated trees. The center three rows of 0.35- to 0.5-ha blocks of four pear cultivars and four apple cultivars were sprayed with a suspension of streptomycin-resistant P. agglomerans strain C9-1S (C9-1S) at 20 to 60% and 60 to 90% bloom. Cultivars were chosen to create a sequence of continuous bloom from late March (d'Anjou pear) through mid-May (Red Rome apple). Each cultivar block was quartered into plots; two plots were treated twice with streptomycin sulfate near mid- and full bloom to suppress populations of indigenous bacterial epiphytes and the other two plots were treated with water. Colonization of blossoms by C9-1S and by indigenous bacterial epiphytes were monitored on inoculated trees and along transects of noninoculated trees. Immediately after spraying, C9-1S was detected principally on blossoms sampled from inoculated trees. As bloom progressed, trees up to 18 m from inoculated trees had high proportions of blossoms colonized by C9-1S. Streptomycin significantly (P

Analysis of Resistance to Eastern Filbert Blight in Corylus avellana.

Inheritance of resistance to eastern filbert blight, caused by Anisogramma anomala, in European hazelnut (Corylus avellana) was evaluated in the progeny of seven cultivars crossed in 12 combinations. The progeny were subjected to inoculation with A. anomala in the greenhouse and in the field. Three disease responses were measured: disease incidence, number of cankers, and proportion of wood diseased. In both the greenhouse and the field, progeny produced by crossing VR6-28 with three susceptible cultivars segregated 1:1 for complete resistance to eastern filbert blight, confirming a previous report that VR6-28 is heterozygous for a single, dominant resistance gene. Histograms of disease responses in progeny of the remaining six parents showed continuous distributions for all crosses examined. Consequently, these parents were analyzed for general and specific combining abilities for each disease response. In the field, general and specific combining ability were both significant (P < 0.05) for all disease responses, with general combining ability having twice the magnitude of specific combining ability. These results suggest these disease responses are controlled by additive gene action in the cultivars examined, with nonadditive gene action being of some importance. Based on general combining ability values, high levels of partial resistance were transmitted by the pollen parents, Gem and Tonda di Giffoni, and the seed parent, Willamette. Heritability of disease incidence, number of cankers, and proportion of wood diseased were calculated to be 0.21, 0.39, and 0.47, respectively, for this set of nine crosses after the first exposure period in the field. This suggests that it will be possible to use partially resistant parents to breed for hazelnuts exhibiting fewer and smaller cankers.