Colitis in a patient with familial Mediterranean fever: Is it Crohn's disease or ulcerative colitis?

A 24-year-old woman was referred to our hospital with joint pain, fever, abdominal pain, and diarrhea. A colonoscopy revealed longitudinal ulcers with a cobblestone appearance throughout the entire colon, suggestive of Crohn's disease. However, treatment with 5-aminosalicylic acid, azathioprine, and infliximab failed to achieve clinical remission. A colonoscopy 5 months later revealed a diffusely spreading granular mucosa without visible vasculature, compatible with active ulcerative colitis. Based on these serial changes in colonic lesions, we tested the patient for MEFV gene mutations and found variants E148Q and L110P in exon 2. Administration of colchicine resulted in complete clinical remission. Our experience suggests that drastic changes in the features of colonic inflammation may be a clue to the diagnosis of enterocolitis associated with familial Mediterranean fever.

Sterilization of free-ranging female capybaras (Hydrochoerus hydrochaeris): a comparison between two surgical techniques.

This study evaluated two surgical sterilization techniques in free-ranging female capybaras (n = 21). The first group underwent uterine horn ligature (HL; n = 11), while the second was subjected to partial salpingectomy (S; n = 10). We assessed total operative time, incision length, the ease of identifying reproductive structures, the adequacy of exposure for surgical performance through flank or midline approaches, and the extent of abdominal viscera manipulation for each method. The HL method emerged as faster, with an average operative time difference of 16 minutes. In the S group, a flank mini-laparotomy over the ovarian topography facilitated easy exposure of the ipsilateral ovary and uterine tube, enabling ligature and partial resection of the uterine tube but not the uterine horn exposure. However, accessing the contralateral uterine tube without a bilateral incision was impractical, thus prolonging the total operative time due to the need for patient repositioning and new antisepsis procedures. Conversely, a post-umbilical approach for the HL method necessitated only one mini-laparotomy incision, offering ample uterine exposure for hysterotomy in pregnant females. Both methods involved minimal abdominal viscera manipulation and resulted in no fatalities or postoperative complications. Although direct comparison is limited by the distinct sterilization techniques and surgical approaches, this study underscores the challenges and surgical access of each method. Our findings endorse the HL technique as an effective contraception method for female capybaras to prevent the birth of seronegative offspring that could amplify Rickettsia sp., the causative agent of Brazilian spotted fever.

Facet joint septic arthritis: A review of cases.

Facet joint septic arthritis is a rare; yet, severe spinal infection often misdiagnosed due to its non-specific clinical presentation and radiological mimickers. This case series illustrates various clinical presentations, imaging features, and outcomes of patients with facet joint septic arthritis. We demonstrate different disease stages to aid clinicians and radiologists in recognizing this condition. Key diagnostic pitfalls are also discussed to enhance diagnostic accuracy in clinical practice.

Manic Episode Following Dengue Fever: A Case Report.

Dengue fever, a mosquito-borne viral disease, can present with a variety of symptoms, ranging from mild flu-like illness to more severe conditions such as dengue hemorrhagic fever and dengue shock syndrome. Although neurological symptoms such as headaches, dizziness, and altered sensorium are more frequently observed, psychiatric symptoms such as euphoria, delusions, hallucinations, and aggression, though rare, can occur. We present the case of a previously healthy 22-year-old male from South Asia who developed manic and psychotic symptoms, including insomnia, irritability, grandiosity, and auditory hallucinations, following his recovery from dengue fever. His psychiatric symptoms emerged shortly after discharge and necessitated psychiatric intervention with olanzapine, a second-generation antipsychotic, chosen for its suitability in managing manic symptoms. This case underscores the importance of considering psychiatric evaluations in the management of dengue fever, especially in endemic areas. The pathophysiology of dengue's neuropsychiatric effects remains complex and multifactorial, necessitating further research. This case report aims to highlight the potential for significant psychiatric manifestations post-dengue fever, advocate for increased clinical awareness and research to investigate any potential correlation between dengue fever and psychiatric symptoms, and improve patient outcomes.

Diagnosis of COVID-19: Is Fever the Best Indicator of COVID-19 in Vaccinated SARS-CoV-2-Positive Adults?

OBJECTIVES: Coronavirus disease 2019 (COVID-19) vaccination is highly recommended to prevent the onset and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Japan. However, the impact of COVID-19 vaccination on the manifestations or presenting symptoms of SARS-CoV-2 infection in daily clinical practice remains unclear. METHODS: This retrospective single-center study was conducted from April 2021 to July 2022 in Japan. We compared the clinical manifestations of SARS-CoV-2 infection in 636 COVID-19-positive patients who visited our outpatient fever clinic, both COVID-19-vaccinated and unvaccinated. RESULTS: During the study period, the COVID-19 vaccination rate at the time of infection was 77.2% (n=491/636), with a median of two doses. Most manifestations, including fever, were reduced in the vaccinated group (n=196) compared to the non-vaccinated group (n=142). The temperature at the clinic decreased significantly as the number of vaccinations increased. Fever was the most common manifestation in the non-vaccinated group (76%, n=108/142), while only 30% (n=59/196) of those who received three or more COVID-19 vaccinations experienced fever. However, sore throat and cough were observed more frequently in the vaccinated group compared to the non-vaccinated group. CONCLUSION: Fever may not be a reliable indicator of SARS-CoV-2 infection in vaccinated individuals, as its frequency is significantly reduced by vaccination. However, since sore throat and cough are more frequently observed in vaccinated individuals, these symptoms could be useful for recommending COVID-19 testing even in the absence of fever, aiding in the prevention of infectious outbreaks.

A Rare Intersection: Managing Thrombotic Thrombocytopenic Purpura in the Context of Dengue Fever.

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening condition that can lead to severe morbidity and mortality if untreated. This case report discusses a 31-year-old male with dengue fever who developed TTP, resulting in fatality despite timely diagnosis and comprehensive treatment. The patient presented with worsening symptoms, including body aches, gastrointestinal bleeding, and neurological issues. Initial treatment focused on managing dengue hemorrhagic fever, but TTP was later suspected, leading to the cessation of platelet transfusions and initiation of plasma exchange, steroids, and rituximab. Despite these efforts, the patient's condition deteriorated. This case underscores the challenges in managing TTP, especially when triggered by infections like dengue. The use of the PLASMIC score can be highly effective in suspecting TTP in these patients, allowing for the initiation of early management. While standard treatments include plasma exchange and immunosuppressive therapy, emerging treatments such as caplacizumab and the potential use of splenectomy may offer hope for better outcomes in the future.

Associations between Ornithodoros spp. Ticks and Mojave Desert Tortoises (Gopherus agassizii) Obtained from Health Assessment Documents.

Soft ticks in the genus Ornithodoros occur throughout the Mojave Desert in southern Nevada, southeastern California, and parts of southwestern Utah and northwestern Arizona, USA, and are frequently observed parasitizing Mojave desert tortoises (Gopherus agassizii). However, limited research exists examining the relationship between ticks and desert tortoises. Mojave desert tortoises are listed as threatened by the US Fish and Wildlife Service, and as such, their populations are monitored and individual tortoise health is routinely assessed. These health assessments document the presence and abundance of ticks present on tortoises, but detailed examination of the relationship between ticks and tortoise health has been lacking. This study analyzed the relationship between tick presence and desert tortoise health assessments as a function of season, location, age (adult vs. juvenile), foraging behavior, evidence of clinical signs of disease, body condition score, and sex. Our results indicate that more ticks were found on tortoises in the summer than in any other season. Ticks were observed more frequently on captive tortoises versus wild tortoises, and more ticks were likely to be present on adult tortoises than on juveniles. Ticks were also more likely to be observed on tortoises that lacked evidence of foraging and on tortoises with observed clinical signs of disease. These findings provide valuable insights into the biology of ticks in relation to tortoises that may be useful for management of both captive and free-living threatened tortoise populations where ticks are detected. Our study also may improve understanding of potential tick-borne disease dynamics in the Mojave desert tortoise habitat, including Borrelia sp. carried by Ornithodoros ticks, which cause tick-borne relapsing fever in people.

MIS-C Like Features in a Patient of Atypical Kawasaki Disease: A Case Report.

ABSTRACT: Kawasaki Disease is multisystem vasculitis affecting young children and infants. While the diagnosis of a typical form of Kawasaki Disease is obvious, there are some patients who do not fulfill the classic diagnostic criteria for the disease which is termed as 'incomplete Kawasaki Disease' or 'Atypical Kawasaki Disease'. We present a case of a 6 months old child with fever who after failing to respond to IV antibiotics showed considerable improvement after administering aspirin and Intravenous Immunoglobulin thus diagnosed as Atypical Kawasaki Disease. Moreover, due to sharing of similar features by both Kawasaki Disease and Multiple Inflammatory Syndrome in Children, the case posed a diagnostic dilemma.

Efficacy of human interleukin-11 analogs for treating dengue fever-associated thrombocytopenia: a prospective cohort.

AIM: Dengue fever (DF), carried by Aedes mosquitoes, affects millions worldwide. Platelet-inducing human IL-11 analogues may be effective in treating DF-associated thrombocytopenia. METHODOLOGY: A prospective study was done at Dr. Ziauddin Hospital, a tertiary care hospital in Karachi, Pakistan, from September 2023 to April 30, 2024. RESULTS: This study recruited 300 DF patients characterized by thrombocytopenia (platelet count < 30,000), including 159 in the treatment and 141 in the control group. The median age of patients was 34 ± 11.05 years, with 187 males (62.3%) and 113 females (37.7%). The treatment group had a higher proportion of fever (80%, p < 0.0001) and headache (96%, p = 0.012) compared to the control group; however, no significant changes were observed in other clinical parameters between the two groups. Following treatment for 5 days, platelet counts of the treatment group increased significantly in response to IL-11 treatment compared to the control group at all time intervals (day 0, day 1, day 2, day 3, day 4, and day 5). Following treatment, males consistently exhibited higher platelet counts than females (all p < 0.05). In addition, patients admitted on day 3 of their course of illness showed a significantly slow response to the treatment compared to those admitted on day 5. Although young individuals exhibited a significant increase in platelet count, the age showed no significant intergroup differences. CONCLUSIONS: IL-11 analogs have promising potential for treating DF-associated thrombocytopenia. Additional investigation is necessary to refine administration protocols and examine the wider therapeutic ramifications of IL-11 in managing DF.

A rosin-functionalized plastic surface inactivates African swine fever virus.

African swine fever virus (ASFV) causes a severe hemorrhagic disease in pigs, leading to up to 100% case fatality. The virus May persist on solid surfaces for long periods; thus, fomites, such as contaminated clothing, footwear, farming tools, equipment, and transport vehicles, May contribute to the indirect transmission of the virus. Here, a plastic surface functionalized with tall oil rosin was tested against ASFV. The rosin-functionalized plastic reduced ASFV infectious virus titers by 1.3 log10 after 60 min of contact time and killed all detectable viruses after 120 min, leading to a ~ 6 log10 reduction. In contrast, the infectious virus titer of ASFV in contact with low-density polyethylene (LDPE) plastic reduced <1 log10 after 120 min. Transmission electron microscopy (TEM) showed significant morphological changes in the virus after 2 h of contact with the rosin-functionalized plastic surface, but no changes were observed with the LDPE plastic. The use of antiviral plastic in the farming sector could reduce the spread of ASFV through fomites and could thus be part of an integrated program to control ASFV.

Attenuated African swine fever viruses and the live vaccine candidates: a comprehensive review.

The African swine fever virus (ASFV) is spreading worldwide and causing huge economic losses to the global pig industry. The ASFV genome is 170-193 kb in length, contains approximately 150 open reading frames, and encodes more than 200 proteins, most of which have unknown functions. Owing to the unique viral structure, replication strategy, large number of genes of unknown function, and complicated pathogenesis, vaccine development research is challenging. Several naturally attenuated ASFV isolates have been extensively investigated and many genetically manipulated, gene-deleted, and cell-adapted ASFVs have been reported. Currently, live attenuated viruses prepared from weakly virulent strains are an efficient method to provide effective protection in vaccinated pigs; however, these have seldom been widely approved for vaccine use, except in Vietnam. Herein, we summarize the attenuated isolates or vaccine candidates for live vaccines derived from different sources, including naturally mutated, attenuated, cell-adapted, and genetically modified recombinant ASFVs. This will help to understand the gene function and immunogenicity of attenuated live ASFV, as well as the shortcomings of these viruses as vaccine candidates, and provide clues to prepare live, efficient, and safe vaccines for African swine fever.IMPORTANCEOutbreaks of African swine fever (ASF) have caused devastating losses to the global pig industry. Pigs immunized with ASFV attenuated virus can resist the lethal challenge of a strongly virulent virus. Here, we summarize the virulence of naturally mutated, cell-adapted, and genetically recombinant ASFV for pigs, and the protective effect after facing an attack challenge. We also analyze the advantages and disadvantages of ASFV attenuated viruses as vaccine candidates to provide clues for the preparation of efficient and safe live African swine fever vaccines.

Molecular mechanisms of Coxiella burnetii formalin-fixed cellular vaccine reactogenicity.

Local and systemic reactogenic responses to Q-VAX have prevented licensing of this vaccine outside of Australia. These reactogenic responses occur in previously sensitized individuals and have not been well defined at the cellular level, in part because many studies have been done in guinea pigs that have limited molecular tools. We previously characterized a mouse model of reactogenicity where local reaction sites showed an influx of CD8+ and IFNγ-expressing IL17a+ CD4+ T cells consistent with a Th1 delayed-type hypersensitivity. In this study, we determined, using depletion and adoptive transfer experiments, that both anti-Coxiella antibodies and CD4+ T cells were essential for localized reactions at the site of vaccination. Furthermore, IFNγ depletion showed significant histological changes at the local reaction sites demonstrating the essential nature of this cytokine to reactogenicity. In addition to the cells and cytokines required for this response, we determined that whole cell vaccine (WCV) material remained at the site of vaccination for at least 26 weeks post-injection. Transmission electron microscopy (TEM) of these sites demonstrated intact rod-shaped bacteria at 2 weeks post-injection and partially degraded bacteria within macrophages at 26 weeks post-injection. Finally, because small cell variants (SCVs) are an environmentally stable form, we determined that local reactions were more severe when the WCV material was prepared with higher levels of SCVs compared to typical WCV or with higher levels of large cell variant (LCV). These studies support the hypothesis that antigen persistence at the site of injection contributes to this reactogenicity and that anti-Coxiella antibodies, CD4+ T cells, and IFNγ each contribute to this process.

Fever and Chimpanzees: An Unexpected Life-Threatening Diagnosis.

Tropic fever can have several causes. It is important to investigate thoroughly and consider less obvious explanations. This paper presents the case of a biologist in close contact with chimpanzees, who developed fever in the tropics. Despite treatment for some tropical diagnosis, the fever persisted. On arrival in Belgium, further diagnostics revealed an unexpected diagnosis: Citrobacter koseri endocarditis of the native aortic valve. He was treated with ceftriaxone and amikacin and underwent aortic valve replacement. C koseri is a commensal in humans and animals. It is likely that the patient was infected with this bacterium through his close contact with chimpanzees. Only a few cases of C koseri endocarditis have been published worldwide, with most patients being immunocompromised. Patients with tropical fever may have unsuspected underlying causes, like endocarditis.

Benefits and costs of measures to tackle the outbreak of African swine fever in Sweden.

A common rule in many countries for mitigating the damage caused by African swine fever (ASF) is to eradicate the virus at the outbreak in order to prevent its dispersal and the associated social costs of depopulating infected domestic pigs. The economic performance of this practice, as measured by five different evaluation criteria (net present value, benefit-cost ratio, rate of return, internal rate of return, and payback time), depends on the type of control cost and the spatial and dynamic allocation of benefits, i.e. avoided losses from infected domestic pig farms. The present paper calculates the direct and indirect costs of immediate control measures during an ASF outbreak in wild boars in Mid Sweden. The direct costs include expenses incurred for surveillance, laboratory tests, depopulation of wild boar etc., while the indirect costs are borne by firms and people in the area in relation to movement restrictions. The calculations showed that the total cost of control measures amounted to 28 million euros, with indirect costs making up 40 % of this figure. The benefits were greatly dependent on the speed of ASF dispersal and assumptions about pig farmers' investment responses, which implied large variations in each of the five evaluation criteria.

From soil to clinic: current advances in understanding Coccidioides and coccidioidomycosis.

SUMMARYCoccidioides immitis and Coccidioides posadasii are fungal pathogens that cause systemic mycoses and are prevalent in arid regions in the Americas. While C. immitis mainly occurs in California and Washington, C. posadasii is widely distributed across North and South America. Both species induce coccidioidomycosis (San Joaquin Valley fever or, more commonly, Valley fever), with reported cases surging in the United States, notably in California and Arizona. Moreover, cases in Argentina, Brazil, and Mexico are on the rise. Climate change and environmental alterations conducive to Coccidioides spp. proliferation have been recently explored. Diagnostic challenges contribute to delayed treatment initiation, compounded by limited therapeutic options. Although antifungal drugs are often effective treatments, some patients do not respond to current therapies, underscoring the urgent need for a vaccine, particularly for vulnerable populations over 60 years old relocating to endemic areas. Despite recent progress, gaps persist in the understanding of Coccidioides ecology, host immune responses, and vaccine development. This review synthesizes recent research advancements in Coccidioides ecology, genomics, and immune responses, emphasizing ongoing efforts to develop a human vaccine.

Epidemiology of scarlet fever in Victoria, Australia, 2007-2017.

In the last 10-15 years, there has been a global resurgence of scarlet fever, an infection historically associated with significant morbidity and mortality. It is unknown whether scarlet fever incidence has increased in Australia. We aimed to examine the incidence, predictors and severity of scarlet fever in the state of Victoria, Australia from 2007 to 2017, analyzing scarlet fever emergency department (ED) presentations, hospitalizations and deaths. Of the 1 578 scarlet fever cases during the study period, most occurred in children aged <10 years (1 344, 85%), in males (882, 56%), and during winter and spring months (918, 57%). There were no deaths with scarlet fever, however, 374 cases (24%) were admitted to hospital. The annual incidence of scarlet fever was stable during the study period (mean, 2.5; range, 1.9-3.1 cases per 100 000). Annual incidence was highest in children aged <5 years (19.3 per 100 000), and was 21% higher in males than females, adjusting for age and year (incidence rate ratio, 1.21, 95%CI 1.09-1.34). Whilst scarlet fever ED presentations and hospitalizations were stable in Victoria from 2007 to 2017, the recent identification of a Streptococcus pyogenes variant in Australia associated with epidemic scarlet fever overseas highlights the risk of future outbreaks.

Recurrent Rash and Anemia: A Diagnostic Challenge of Angioimmunoblastic T-cell Lymphoma Mimicking Parvovirus B19 Infection.

Angioimmunoblastic T-cell lymphoma (AITL) is a rare and challenging subtype of T-cell lymphoma often presenting with skin rashes and difficult diagnostic features. Its presentation can mimic other conditions, complicating accurate diagnosis. This case shows AITL in a 74-year-old man initially presenting with anemia that mimicked pure red cell anemia caused by parvovirus B19. The patient exhibited direct Coombs-positive anemia and recurrent urticarial-like rashes, which were initially misleading. This case emphasizes the critical need for considering lymphoma in patients presenting with direct Coombs-positive anemia and recurrent urticarial-like rashes It underscores the importance of revisiting and thoroughly assessing medical histories to enable accurate diagnosis, even when initial presentations suggest alternative diagnoses. Early recognition and appropriate management of AITL are crucial for improving patient outcomes.

Body temperature, systemic inflammation and risk of adverse events in patients with acute coronary syndromes.

BACKGROUND: Inflammatory processes can trigger acute coronary syndromes (ACS) which may increase core body temperature (BT), a widely available low-cost marker of systemic inflammation. Herein, we aimed to delineate baseline characteristics of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS) patients stratified by initial BT and to assess its predictive utility towards major adverse cardiovascular events (MACE) after the index ACS. METHODS: From 2012 until 2017, a total of 1044 ACS patients, 517 with STEMI and 527 with NSTE-ACS, were prospectively recruited at the University Hospital Zurich. BT was measured by digital tympanic thermometer along with high-sensitivity C-reactive protein (hs-CRP) and cardiac troponin-T (hs-cTnT) levels prior to coronary angiography. Patients were stratified according to initial BT and uni- and multivariable regression models were fit to assess associations of BT with future MACE risk. RESULTS: Among patients with STEMI, BT was not predictive of 1-year MACE, but a U-shaped relationship between BT and MACE risk was noted in those with NSTE-ACS (p = .029), translating into a 2.4-fold (HR, 2.44, 95% CI, 1.16-5.16) increased 1-year MACE risk in those with BT >36.8°C (reference: 36.6-36.8°C). Results remained robust in multivariable-adjusted analyses accounting for sex, age, diabetes, renal function and hs-cTnT. However, when introducing hs-CRP, the BT-MACE association did not prevail. CONCLUSIONS: In prospectively recruited patients with ACS, initial BT shows a U-shaped relationship with 1-year MACE risk among those with NSTE-ACS, but not in those with STEMI. BT is a broadly available low-cost marker to identify ACS patients with high inflammatory burden, at high risk for recurrent ischaemic events, and thus potentially suitable for an anti-inflammatory intervention. REGISTRATION: ClinicalTrials.gov Identifier: NCT01000701.

The PARK2_e01(-697) Polymorphism does not Associate with Susceptibil-ity to Typhoid in Punjabi Population, Pakistan: A Case Control Study.

BACKGROUND: SNP based association studies have revolutionized the field of biomed-icines. Enteric fever is a systemic disease with etiologic agents Salmonella enterica serovar typhi and paratyphi. It is a serious health issue worldwide and presents wide variations in incidence, rates, and severity. Previous investigations have revealed that genetic variations may lead to sus-ceptibility to typhoid fever. A current study was performed to investigate the potential association of PARK2_e01(-697) polymorphism with the susceptibility to typhoid in the Punjabi population. METHODS: For this case-control study, blood samples obtained from typhoid patients with positive Typhidot or blood culture test (n=72) and healthy controls (n=73) were processed for DNA ex-traction. The polymorphism PARK2_e01(-697) analysis was carried out by using PCR and RFLP. RESULTS: No allelic association was found between PARK2_e01(-697) and susceptibility to ty-phoid fever in the understudy population. CONCLUSION: This case control study is the demonstration of the non-association of PARK2_e01(-697) with typhoid in the Pakistani population. Future research, using a larger population size, will help to elucidate the role of PARK2_e01(-697) polymorphism in typhoid pathogenesis.