First Report of Powdery Mildew Caused by Golovinomyces sp. on Plantago australis in Brazil.

The plantain Plantago australis Lam. (Plantaginaceae) is a herbaceous species native to southern Brazil that is known for the analgesic, antibiotic, and anti-inflammatory properties of its leaf extracts (2). Powdery mildew was observed on wild P. australis plants in the cities of Tapejara, Jari, and Santa Maria (State of Rio Grande do Sul, Brazil) during the summer of 2011. Affected plants were more often observed in shaded areas. Signs included sparse to abundant white powdery masses of conidia and mycelium on pseudo-petioles and leaves, mostly on the adaxial surface. Severely affected plants (≥80% of foliar area affected) had small chlorotic leaves and reduced size compared to healthy ones. Mycelia were superficial and presented nipple-shaped appressoria. Conidiophores were often curved at the base, unbranched, cylindrical, 81 to 125 µm long (average 97.3 ± 14.9 µm) and composed of a cylindrical foot cell 52 to 73 µm long (average 65.4 ± 7.5 µm) and 9 to 14 µm wide (average 11.6 ± 1.5 µm) followed by one to two shorter cells 17 to 29 µm long (average 23.4 ± 3.6 µm). Conidia were produced in chains of up to eight cells, did not contain fibrosin bodies, ranged from ellipsoid-ovoid to subcylindrical, and measured 24 to 35 µm long (average 30.5 ± 3.7 µm) and 12 to 19 µm wide (average 15.8 ± 1.7 µm). Germ tubes were produced apically (reticuloidium type). Chasmothecia were not observed on sampled leaves. Genomic DNA was extracted from conidia, conidiophores, and mycelium and used to amplify the internal transcribed spacer (ITS) (ITS1-5.8s-ITS2) region using the ITS1 and ITS4 primers. The resulting sequence (558 bp) was deposited under accession number JX312220 in GenBank. Searches with the BLASTn algorithm revealed similarity of 100% with Golovinomyces orontii (Castagne) V.P. Heluta 1988 from Veronica arvensis L. (AB077652.1) (3), 99% with G. orontii from Galium spurium L. and Galium aparine L. (AB430818.1 and AB430813.1) (2) and 99% with G. sordidus (L. Junell) V.P. Heluta 1988 from P. lanceolata L. (AB077665.1) (3). Based on morphological characteristics and sequence analysis of the ITS region, the fungus was identified as belonging to Golovinomyces sp. To fulfill Koch's postulates, five cultivated plants of P. australis with four to five expanded leaves were inoculated by dusting conidia (10 to 15 conidia cm-2) on their leaves. Inoculated and non-inoculated control plants were kept in a greenhouse at 27 ± 5°C and relative humidity of 80 ± 15%. Powdery mildew symptoms identical to those of wild plants were observed 8 to 10 days after in inoculated plants. Although G. sordidus was previously reported on P. australis subsp. hirtella in Argentina and on several species of Plantago in others world regions (1), to our knowledge, Golovinomyces sp. has not been previously reported as a pathogen of P. australis in Brazil. Although the economic impact of the disease is limited, the reduction in plant size and leaves affects biomass production used in the extraction of pharmaceutical compounds. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series 11, 2012. (2) G. C. Sousa et al. J. Ethnopharmacol. 90:135, 2004. (3) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

Initial management of pneumonia and sepsis: factors associated with improved outcome.

Processes of care and adherence to guidelines have been associated with improved survival in community-acquired pneumonia (CAP). In sepsis, bundles of processes of care have also increased survival. We aimed to audit compliance with guideline-recommended processes of care and its impact on outcome in hospitalised CAP patients with sepsis. We prospectively studied 4,137 patients hospitalised with CAP in 13 hospitals. The processes of care evaluated were adherence to antibiotic prescription guidelines, first dose within 6 h and oxygen assessment. Outcome measures were mortality and length of stay (LOS). Oxygen assessment was measured in 3,745 (90.5%) patients; 3,024 (73.1%) patients received antibiotics according to guidelines and 3,053 (73.8%) received antibiotics within 6 h. In CAP patients with sepsis, the strongest independent factor for survival was antibiotic adherence (OR 0.4). In severe sepsis, only compliance to antibiotic adherence plus first dose within 6 h was associated with lower mortality (OR 0.60), adjusted for fine prognostic scale and hospital. Antibiotic adherence was related to shorter hospital stay. In sepsis, antibiotic adherence is the strongest protective factor of care associated with survival and LOS. In severe sepsis, combined antibiotic adherence and first dose within 6 h may reduce mortality.

First Report of Powdery Mildew on Flamboyant Tree Caused by Erysiphe quercicola in Brazil.

Flamboyant (Delonix regia) is an ornamental tree that is native to Madagascar and frequently used in gardens and parks worldwide. Powdery mildew was observed on flamboyant plants in the cities of Piracicaba and São Carlos (State of São Paulo, Brazil) during the springs of 2010 and 2011. All sampled plants (~15 plants) were affected by the disease. Affected plants had abundant, white powdery masses of conidia and mycelium on floral buds that is typical of powdery mildew, but these structures were not observed on leaves and petioles. Diseased buds were observed at all developmental stages. The fungus was identified as Erysiphe quercicola on the basis of scanning electron microscopy, light microscopy, and sequence analysis of the internal transcribed spacer (ITS) region. Conidia were produced in short chains of four to five spores on erect conidiophores. Conidiophores were unbranched, cylindrical, 50 to 80 µm long (mean 68.8 ± 10.8 µm), composed of a cylindrical foot cell 25 to 40 µm long (mean 32.2 ± 4.9 µm), and one to two shorter cells. Conidia were ellipsoid-ovoid to subcylindrical, 22 to 37 µm long (mean 30.9 ± 4.4 µm), and 10 to 18 µm wide (mean 15.1 ± 2.8 µm). Germ tubes were produced apically and ended in a lobed appressorium. Colonizing hyphae also had a well-developed lobed appressorium. Chasmothecia were not observed on buds. DNA was extracted from conidia, conidiophores, and mycelium and used to amplify the ITS (ITS1-5.8s-ITS2) region using the ITS1 and ITS4 primers (2) and its sequence (612 nt) was deposited under Accession No. JQ034229 in the GenBank. Searches with the BLASTn algorithm revealed 100% similarity with E. quercicola from oak (Accession Nos. AB292693.1, AB292691.1, and AB292690.1) (1). To fulfill Koch's postulates, 10 detached young floral buds, 0.4 to 0.8 cm in diameter, were inoculated with five to eight conidia collected on floral buds using an eyelash brush. Inoculated buds were placed on moistened filter paper in petri dishes. The negative control consisted of noninoculated young floral buds. Inoculated and noninoculated buds were incubated in a growth chamber at 25°C and a 12-h photoperiod. Powdery mildew structures were observed 6 to 8 days after inoculation. To our knowledge, E. quercicola has not been reported previously as a pathogen of flamboyant tree since there is no record in the Erysipahales database ( http://erysiphales.wsu.edu/ ). Although the economic impact of the disease is limited, its incidence might induce the abortion of floral buds and accelerate the senescence of flowers, thus reducing the aesthetic value of the trees. References: (1) S. Takamatsu et al. Mycol Res. 111:809, 2007. (2) T. J. White et al. PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

Extended cervical mediastinoscopy in the staging of bronchogenic carcinoma.

BACKGROUND: Extended cervical mediastinoscopy (ECM) is a technique in the staging of bronchogenic carcinoma described first by Ginsberg in 1984. To update our experience we have prospectively evaluated our results on 106 patients who underwent the technique from 1985 to 1998. METHODS: The ECM technique is performed once the operability of the patient has been evaluated, according to the computed tomography findings. The intervention is carried out at the same time as a standard cervical mediastinoscopy through the same incision following the same technique as previously published. The ECM is considered positive when metastatic nodes or tumor involvement directly in the paraaortic or subaortic regions is detected and confirmed histologically. Negative cases of ECM and positive cases of standard cervical mediastinoscopy are excluded from this study. A false-negative ECM is defined as the presence of infiltrated adenopathies at the paraortic level detected on postoperative histologic study. RESULTS: We had performed ECM in 106 patients, and a total of 13 were subsequently excluded for the reasons stated above. Of the remaining cases, 26 were positive, 61 negative and 6 had false-negative results with no false-positive results. Sensitivity was 81.2%, specificity 100%, accuracy 93.3%, positive predictive value 100%, and negative predictive value 91%. There were no complications with the technique. CONCLUSIONS: We conclude that ECM is a useful technique for staging bronchogenic carcinoma that allows samples to be taken from paraortic and subaortic regions with minimally invasive techniques.

Association of HLA-DR11 with the anaphylactoid reaction caused by nonsteroidal anti-inflammatory drugs.

BACKGROUND: Several HLA alleles have been associated with asthma induced by nonsteroidal anti-inflammatory drugs (NSAIDs). The existence of HLA markers linked to other NSAID-induced reactions, such as cutaneous and anaphylactoid reactions, has not been established. OBJECTIVE: The purpose of our work was to study the HLA-DRB1 and HLA-DQB1 alleles in patients with cutaneous and anaphylactoid reactions caused by NSAIDs. METHODS: We have analyzed 114 HLA DRB1 and 26 HLA-DQB1 alleles in 21 patients with anaphylactoid reactions caused by NSAIDs, 47 patients who had exclusively cutaneous reactions during single-blind, placebo-controlled oral challenges with NSAIDs, and 167 tolerant control subjects (29 of whom had also had an IgE-mediated anaphylaxis to different agents). HLA-DRB1 and HLA-DQB1 alleles were typed by the polymerase chain reaction sequence-specific primers method with genomic DNA. RESULTS: The frequency of HLA-DR11 alleles was 58.8% in the anaphylactoid reaction group, compared with 15.9% in the NSAID-tolerant healthy control subjects (OR, 7:3; 95% confidence interval, 2.8-19.0; P <.02) and 6.3% in the group of the patients with a tolerance for NSAIDs and with IgE-mediated anaphylaxis (OR, 18.75; 95% confidence interval, 4.3-81.1; P <.004). No differences were observed among HLA-DR11 alleles analyzed. There were no significant HLA-DQB1 associations with NSAID-induced anaphylactoid reactions. Patients with cutaneous reactions had HLA frequencies that did not differ significantly from the tolerant control subjects. CONCLUSION: The HLA-DRB1*11 alleles showed a positive association with NSAID-induced anaphylactoid reactions.

Urticarial pathology in Schnitzler's (hyper-IgM) syndrome.

BACKGROUND: Schnitzler's syndrome is a rare disorder characterized by chronic urticaria and monoclonal IgM gammopathy. The mechanisms of the urticarial flares remain poorly understood. OBJECTIVE: To more accurately define the histopathologic changes in urticarial lesions, we reviewed 25 original biopsies from 15 cases of Schnitzler's syndrome, 11 of which have previously been reported. RESULTS: Thirteen specimens from 9 patients showed urticaria with neutrophils (neutrophilic urticaria). Necrotizing leukocytoclastic vasculitis with positive immunofluorescence studies was found only in 2 biopsies from 1 patient who was genetically deficient in C4. Five specimens showed lymphocytic urticaria. Four biopsies demonstrated a spongiotic dermatitis; an eosinophilic spongiosis was seen in 2 biopsies from a patient who later developed pemphigus vulgaris. Epidermal changes were seen in 17 specimens from 10 patients. CONCLUSIONS: The histopathologic findings in Schnitzler's syndrome are not uniform although most cases demonstrated neutrophilic urticaria. Neutrophils in Schnitzler's syndrome are not usually related to immune complex vasculitis. Epidermal changes in Schnitzler's syndrome need to be further analyzed.

Henoch-Schönlein purpura: clinicopathologic correlation of cutaneous vascular IgA deposits and the relationship to leukocytoclastic vasculitis.

Significant cutaneous vascular IgA deposits are common in Henoch-Schönlein purpura but not in other vasculitides. The specificity for IgA vascular deposits for Henoch-Schönlein purpura is not well defined. To examine the specificity of IgA vascular deposits for this disease, we compared clinicopathologic features of 92 cases with IgA vascular deposits and a direct immunofluorescence impression of vasculitis with 90 similar cases without IgA deposits. Henoch-Schönlein purpura was diagnosed in 24% of cases with vascular IgA deposits on direct immunofluorescence examination. IgA deposits were frequent in erythema nodosum and venous stasis-related problems and in cryoglobulinemia, coagulopathic vasculopathies, and livedoid vasculitis. Of our cases, 78% exhibited vascular fluorescence with multiple conjugates. No histologic or immunofluorescence pattern alone was specific. The diagnostic specificity for Henoch-Schönlein purpura is improved if gastrointestinal involvement, upper respiratory infection, or age < 20 years is present. We propose diagnostic criteria for Henoch-Schönlein purpura incorporating clinical findings yielding sensitivity and specificity > 90%.

Experimental tracheal revascularization with omentum.

We assessed omental revascularization of heterotopic tracheal implants in rats, and investigated the influence of factors that can enhance revascularization. The trachea of the donor animal was excised in two parts, and each tracheal allograft was implanted in the omentum of two recipients. The influence of mechanical factors was evaluated by applying traction at both ends of the graft with and without drainage of the tracheal lumen, and the influence of pharmacologic factors by giving cefonicid, hydrocortisone, cefonicid plus hydrocortisone, or cyclosporine and azathioprine during the postoperative period. Revascularization of the graft from the omentum with preservation of the tracheal structure was established. Graft viability showed significant differences between the tracheal implants to which no traction had been applied and those with traction at both ends. Tracheal allografts from animals receiving immunosuppressants were completely viable and no significant differences were found between the controls and animals in this group.

Allergy to limpet.

Allergy to mollusk has rarely been described. The limpet, belonging to Phylum mollusca, is one of the most frequent mollusks in the Canary Islands, as in all warm maritime regions. We report two cases of atopic patients who developed anaphylactic reactions after ingestion of this mollusk. Type I hypersensitivity to limpet antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, and histamine release test to cooked limpet extract. The controls did not react to any of these tests. Allergic activity was only found with a cooked limpet extract; this suggests that the offending antigen/s may have been released by cooking this food.

Effects of ocular blood flow changes on the efferent activity of cat ciliary nerves.

The efferent activity of the short ciliary nerves was studied in 23 anesthetized cats. Spontaneous activity was recorded in all preparations, and 33% showed a rhythmic discharge. Ipsilateral common carotid occlusion (ICCO) at constant intraocular and arterial pressures changed the discharge frequency in 14 of 33 filaments. Of these, 13 filaments showed a decrease in their firing frequency whereas in only one the discharge increased. Contralateral common carotid occlusion (CCCO), at constant intraocular pressure, changed the firing frequency in 8 of 20 filaments: 5 of them showed a decrease in their discharge frequency, whereas in 3 of them the discharge increased. This occurred when systemic arterial pressure was allowed to increase. These results suggest the presence of an efferent pathway involved in the nervous modulation or control of intraocular blood flow, aqueous humor dynamics, and/or intraocular pressure.