First successful pregnancy outcome after twelve abortions in a Tunisian-woman with the rare p phenotype.

INTRODUCTION: Anti-PP1P k alloantibody, is produced in the serum of individuals with the rare p phenotype. It is associated with severe haemolytic transfusion reactions, recurrent spontaneous early abortions as well as haemolytic disease of the foetus and newborn. Anti-PP1P k alloimmunization in pregnancy differ from others in their physiopathology. It seems that the placenta would be the main target of anti-PP1P k antibody. CASE REPORT: This report concerns a 35 year old female, with a history of a high incidence (12) of early and recurrent miscarriages. She was found to have the extremely rare p phenotype and anti-PP1P k antibody in her serum. Her 13th pregnancy was successfully managed by plasmapheresis. No substitution fluid was added. Oral hydration was recommended before and after the apheresis sessions. 12 plasmapheresis cycles were performed before a healthy term female infant weighing 3kg600g, was delivered by caesarean section at 38 weeks of gestation. CONCLUSION: Plasmapheresis seems to be the treatment of choice in the management of anti-PP1P k fetomaternal incompatibilities. However in this case, we opted for an original and less expensive protocol. We did resort, neither to substitution fluid nor to intravenous immunoglobulin.

Structural variability and originality of the Bordetella endotoxins.

Structural studies of Bordetella endotoxins (LPSs) have revealed remarkable differences: (i) between their LPSs and those of other bacterial pathogens; (ii) among the LPSs of the seven identified Bordetella species; and (iii) among the LPSs of some Bordetella strains. The lipid As have the "classical" bisphosphorylated diglucosamine backbone but tend to have fewer and species-specific fatty acid components compared to those of other genera. Nevertheless, three strains of B. bronchiseptica have at least three different fatty acid distributions; however, the recently identified B. hinzii and B. trematum LPSs had identical lipid A structures. The B. pertussis core is a dodecasaccharide multi-branched structure bearing amino and carboxylic groups. Another unusual feature is the presence of free amino sugars in the central core region and a complex distal trisaccharide unit containing five amino groups of which four are acetylated and one is methylated. The B. pertussis LPS does not have O-chains and that of B. trematum had only a single O-unit, unlike the LPSs of all the other species of the smooth-type. The O-chain-free cores of non-B. pertussis LPSs were always built on the B. pertussis core model but most were species-specifically incomplete. The LPS structures of three B. bronchiseptica strains were found to be different from each other. The O-chains of B. bronchiseptica and B. parapertussis were almost identical and had some features in common with B. hinzii O-chain. Serological analyses are consistent with the determined LPS structures.

Structural characterization of the lipids A of three Bordetella bronchiseptica strains: variability of fatty acid substitution.

The structures of lipids A isolated from the lipopolysaccharides (LPSs; endotoxins) of three different pathogenic Bordetella bronchiseptica strains were investigated by chemical composition and methylation analysis, gas chromatography-mass spectrometry, nuclear magnetic resonance, and plasma desorption mass spectrometry (PDMS). The analyses revealed that the LPSs contain the classical lipid A bisphosphorylated beta-(1-->6)-linked D-glucosamine disaccharide with hydroxytetradecanoic acid in amide linkages. Their structures differ from that of the lipid A of Bordetella pertussis endotoxin by the replacement of hydroxydecanoic acid on the C-3 position with hydroxydodecanoic acid or dodecanoic acid and the presence of variable amounts of hexadecanoic acid. The dodecanoic acid is the first nonhydroxylated fatty acid to be found directly linked to a lipid A glucosamine. The lipids A were heterogeneous and composed of one to three major and several minor molecular species. The fatty acids in ester linkage were localized by PDMS of chemically modified lipids A. B. pertussis lipids A are usually hypoacylated with respect to those of enterobacterial lipids A. However, one of the three B. bronchiseptica strains had a major hexaacylated molecular species. C-4 and C-6' hydroxyl groups of the backbone disaccharide were unsubstituted, the latter being the proposed attachment site of the polysaccharide. The structural variability seen in these three lipids A was unusual for a single species and may have consequences for the pathogenicity of this Bordetella species.

[Cutaneous manifestations of AIDS]. / Les manifestations cutanées du SIDA.

PIP: HIV destroys the immune system, causing group of clinical signs which are referred to as AIDS. Some of these signs are cutaneous in nature. An acute rash on the trunk is associated with HIV seroconversion. It usually disappears in 8 days but can last for several hours or 30 days. Infectious manifestations of HIV infection are common. Candidiasis represents 90% of mycoses. It usually manifests on the tongue but can also occur on oral or genital mucosa. Antifungal medication usually treats it effectively. Yeastlike fungi cause seborrheic dermatitis, which is characterized by profuse inflammatory lesions resembling psoriasis. Topical and general antifungal medication do not effectively treat it. Dermacorticoids are more likely to be successful. Dermaphyte infections also occur HIV-infected persons. Organisms responsible for cutaneous profound mycoses, which tend to be rare but fatal, include Cryptococcus neoformans, Histoplasma capsulatum, sporotrichoses, scopulariopsis, and Pneumocystis carinii. Amphotericin B is the treatment of choice for manifestation of the first 2 organisms. Cutaneous viral infections in HIV-infected persons are caused by herpes simplex virus, herpes zoster, cytomegalovirus, Epstein Barr virus, Pox virus, and human papilloma virus. A patient who has had chronic cutaneous or mucosal herpes simplex infection for more than 1 month should be suspected of having HIV infection. Actclovir can treat herpes simplex infection, herpes zoster infection, and Epstein Barr virus (to make lesions disappear). Cytomegalovirus lesions are not specific. Cytomegalovirus infection is generally fatal. Cutaneous bacteria infections include banal infections (e.g., acne and folliculitis), syphilitic chancre lesions, and granulomatous tuberculosis. Protozoans and arthropods also cause cutaneous conditions in HIV-infected patients. Cutaneous neoplasms include Kaposi's sarcoma and other tumors (e.g., lymphomas). Other dermatoses are rare but may include psoriasis and toxidermia.^ieng

[Correlation between epithelioid sarcoma and poorly differentiated fibroblastic synovialosarcoma]. / Rapport nosologique du sarcome épithélioïde et du synovialosarcome fibroblastique peu différencié.

The authors report an original case of tendosynovial sarcoma localizated in the side of the palm of the hand of an eight year old child. This tumor has two morphological forms. One is characteristic of undifferentiated synovialosarcoma, and the other of epitheloid sarcoma. The immuno-histochemical study confirms the diagnosis of undifferentiated synovialosarcoma. On the basis of this case and with reference to the literature, the authors suggest that epithelioid sarcoma and synovialosarcoma constitute the same entity.