Southern California neuroinvasive West Nile virus case series.

Approximately 80% of individuals infected with West Nile virus (WNV) are asymptomatic, and less than 1% suffer from neuroinvasion that can result in permanent neurological deficits or mortality. Our institution's location in southern California predisposes it to a sizable case volume of neuroinvasive WNV. A 2-year retrospective study was performed at the Olive View-UCLA Medical Center to identify patients with confirmed WNV infection with neuroinvasion. Patient demographics, neurological exam findings, and laboratory diagnostics were reviewed. Data were tabulated and are presented as percentage, mean ± standard deviation, or median [range]. Twenty-two patients (36.4% female, age 50.2 ± 10.6 years) were identified between 20 August 2012 and 24 September 2013. The most common positive findings on review of symptoms included fever (81.8%), nausea/vomiting (81.8%), and headache (68.2%). Thirteen patients (59.1%) presented with fever defined as ≥ 37.8 °C. Motor strength was reduced in nine patients (40.9%) and eight patients (36.4%) were hyporeflexive. Lumbar puncture was performed in all but three patients (cerebrospinal fluid [CSF] protein 76.8 ± 29.6 mg/dL and glucose 71.0 ± 18.8 mg/dL). Elevated CSF anti-WNV IgM and IgG antibody was detected in 93.8% and 62.5% of the 16 tested cases, respectively. Elevated serum anti-WNV IgM and IgG antibody was detected in 100% and 72.2% of the 18 tested cases, respectively. Encephalitic presentations, with or without focal neurological deficits (e.g., motor weakness, hypotonia), dominated this series. In endemic areas, seasonal presentation of such symptoms should raise suspicion for WNV with neuroinvasion.

Increased Likelihood of Bacterial Pathogens in the Coronal Sulcus and Urethra of Uncircumcised Men in a Diverse Group of HIV Infected and Uninfected Patients in India.

BACKGROUND: The biological mechanism of circumcision as potentiating HIV prevention is poorly understood. Foreskin microbiota has been postulated as having a potential role; however, little is known about the relationship between bacterial pathogens and circumcision in adults. MATERIALS AND METHODS: We sampled the coronal sulcus of a diverse group of circumcised and uncircumcised men (n=315) from a government chest hospital and fertility clinic in Hyderabad, Andhra Pradesh, India. Genital examination was conducted on three groups of men: Group 1 - HIV infected; Group 2 - TB infected; Group 3 - control. Aerobic and anaerobic specimens were cultured according to standard clinical protocols, and results were analyzed following multivariate logistic regression models. RESULTS: Three hundred fifteen study participants - 47.6% of Group 1, 36.5% of Group 2, and 15.9% of Group 3 - were enrolled in the study and included in all analyses. Overall 37.1% of the participants were circumcised without variation across groups (P=0.29). Smegma was observed in 18.7% of the participants with no cases observed in Group 3 (P<0.001). Gram-negative pathogens were more prevalent among study participants in Group 1 (22.7%) and Group 2 (30.4%) as compared with those in Group 3 (6.0%) (P=0.003). In multivariate regression analysis, controlling for group, age, and presence of smegma, uncircumcised men were more likely to be colonized with gram positives [Adjusted Odds Ratio (AOR) 1.9; P<0.05)], gram negatives (AOR 2.4; P<0.05), or any pathogen (AOR 2.8; P<0.005). CONCLUSIONS: Uncircumcised men in this population in South India are more likely to harbor bacterial pathogens in the coronal sulcus than do their circumcised counterparts. Future studies should examine the relationship between foreskin microbiota and HIV transmission.