Delayed diagnosis of human immunodeficiency virus infection in a patient with non-specific neurological symptoms and pancytopenia: a case report

INTRODUCTION: Both non-specific presentation and asymptomatic course of human immunodeficiency virus infection lead to undiagnosed long-term persistence of the virus in a patient's organism. CASE PRESENTATION: Here, we present a case of a 31-year-old Caucasian man with non-specific neurological symptoms and pancytopenia, who was referred to an internal medicine ward for further diagnosis. Upon admission to our hospital, he denied any past risky behaviors and refused to have his blood collected for human immunodeficiency virus testing. Later, he eventually provided consent to conduct the human immunodeficiency virus test which turned out to have a positive result. The overall clinical pattern indicated an advanced-stage of acquired immunodeficiency syndrome, which contrasted with the history he had provided. CONCLUSIONS: This case report indicates the need to consider human immunodeficiency virus/acquired immunodeficiency syndrome diagnosis in patients with non-specific neurological and hematological disorders. Our report also demonstrates difficulties that can be experienced by the physician while trying to obtain both a clear history and consent to perform human immunodeficiency virus testing

Concentrations of plasminogen activator inhibitor-1 (PAI-1) and urokinase plasminogen activator (uPA) in induced sputum of asthma patients after allergen challenge.

Urokinase plasminogen activator (uPA) and its inhibitor (PAI-1) are involved in tiisue remodeling and repair processes associated with acute and chronic inflammation. The aim of the study was to evaluate the effect of allergen challenge on concentration of uPA and PAI-1 in induced sputum of house dust mite allergic asthmatics (HDM-AAs). Thirty HDM-AAs and ten healthy persons (HCs)were recruited for the study. In 24 HDM-AAs bronchial challenge with Dermatophagoides pteronyssinus (Dp) and in 6 HDM-AAs sham challenege with saline were performed. In HDM-AAs sputum was induced 24 hours before (T0) and 24 hours (T24) after the challenge. Concentration of uPA and PAI-1 in induced sputum were determined using immunoenzymatic assays. At T0 in HDM-AAs mean sputum uPA (151 Âą 96 pg/ml) and PAI-1 (4341 Âą 1262 pg/ml) concentrations were higher than in HC (18.8 Âą 6.7 pg/ml; p=0.0002 and 596 Âą 180 pg/ml;

Bronchial macrophages in asthmatics reveal decreased CD16 expression and substantial levels of receptors for IL-10, but not IL-4 and IL-7.

The role of different subpopulations of bronchial macrophages (BMs) in asthma pathogenesis has not yet been completely elucidated. In addition, little is known about potential in vivo responsiveness of BMs to pro- and anti-inflam-matory cytokines present in the bronchial milieu. We aimed to characterize asthmatic patients' BM subpopulations delineated by common markers of macrophage/monocyte cells, CD16 and CD14, and subsequently to analyze cytokine receptor expression on those subsets. Subjects included eighteen patients with moderate asthma (six steroid-naive and twelve steroid-treated) and ten healthy control subjects. Flow cytometry was used to analyze phenotypical features of BMs including expression of receptors for IL-10, IL-4 and IL-7. Exhaled nitric oxide analysis and induced sputum eosinophil counts were used to assess airway inflammation. BMs from both steroid-naive and steroid-treated asthmatic patients showed significantly decreased expression of CD16, as compared to healthy subjects' BMs. CD16, but not CD14, expression inversely correlated with exhaled nitric oxide levels and sputum eosinophilia. Short-term administration of inhaled cortiocosteroids (ICS) in steroid-naive asthmatic patients led to significant reduction of CD16 expression and enhancement of CD14 expression. Next, we analyzed the expression of receptors for IL-10, IL-4 and IL-7 on the surface of BM subpopulations characterized by different levels of CD14 and CD16 expression. We observed substantial levels of IL-10R on the surface of BMs collected from asthmatic and healthy subjects. Interestingly, IL-10R was found mostly on those macrophages that co-expressed CD14. In contrast, independently on co-expression of CD14, the levels of IL-4R and IL-7R on BMs were low in both asthmatic and healthy subjects. The results suggest that different BM subsets may be differentially involved in regulating the inflammatory response in allergic asthma

Cytometric evaluation of intracellular IFN-γ and IL-4 levels in thyroid follicular cells from patients with autoimmune thyroid diseases

<p>Abstract</p> <p>Background</p> <p>In recent few years is underlined that altered balance of pro- and anti-inflammatory cytokines play an important role in the pathogenesis of AITD.</p> <p>The aim of this study was to estimate intracellular INF-γ and IL-4 levels in thyroid-infiltrating lymphocytes and thyrocytes isolated from thyroid tissues in 54 adolescent patients aged 8-21 years, with Graves' disease (GD; n = 18), Hashimoto's thyroiditis (HT; n = 18) and non-toxic multinodular goiter (NTMG; n = 18).</p> <p>Methods</p> <p>Fresh thyroid tissues were taken on culture medium RPMI -1640, it was mechanically prepared. In next step were added cell activators -12- myristate 13- the acetate (PMA) and Ionomycin as well as the inhibitor of transportation of proteins - Breferdin A. They were cultured 24 hours in 50 ml flasks at 37°C in a 5-95% CO2-air water-saturated atmosphere. After that, thyrocytes were identified by mouse mAb directed against human TPO epitope 64 conjugated with rabbit anti-mouse antibodies IgG (Fab')₂labeled by FITC. After incubation at room temperature to each of samples added reagent A fixative the cellular membrane. In next step into the cell suspensions were added reagent B to permeabilization of cellular membrane and specific anti-IL-4-PE or anti-IFN-γ-PE mAbs. Identification of intracellular cytokines in T lymphocytes was performed in the same procedure with application of anti-CD4-PerCP and anti-CD8-PerCP mAbs specific for T lymphocytes. The cells were analyzed in a flow cytometry (Coulter EPICS XL).</p> <p>Results</p> <p>In examined group of patients with GD we observed statistically significant higher mean percentage of cells with phenotype CD4+IL-4 (p < 0.05; p < 0.025), CD8+IL-4 (p < 0.033; p < 0.01) and TFCs-IL-4+ (p < 0.05; p < 0.01) in comparison to patients with HT and NTMG. The analysis of mean percentages of positive TILs and TFCs with intracellular INF-g levels in patients with HT revealed statistically significant increase percentage of CD4+INF-γ (p < 0.04; p < 0.001), CD8+ INF-γ (NS; p < 0.025), TFCs+INF-γ (p < 0.03; p < 0.001) cells in comparison to the percentage of positive cells from patients with GD and NTMG.</p> <p>Conclusions</p> <p>We conclude that human thyrocytes in autoimmune thyroid disorders could be a source of cytokine production and that their activation influences local interaction with T lymphocytes inflowing to the thyroid gland.</p

Plasminogen activator inhibitor-1 (PAI-1) and urokinase plasminogen activator (uPA) in sputum of allergic asthma patients.

Urokinase plasminogen activator (uPA) and its inhibitor (PAI-1) have been associated with asthma. The aim of this study was to evaluate concentration of uPA and PAI-1 in induced sputum of house dust mite allergic asthmatics (HDM-AAs). The study was performed on 19 HDM-AAs and 8 healthy nonatopic controls (HCs). Concentration of uPA and PAI-1 was evaluated in induced sputum supernatants using ELISA method. In HDM-AAs the median sputum concentration of uPA (128 pg/ml; 95% CI 99 to 183 pg/ml) and PAI-1 (4063 pg/ml; 95%CI 3319 to 4784 pg/ml) were significantly greater than in HCs (17 pg/ml; 95%CI 12 to 32 pg/ml;

Zgon w przebiegu kleszczowego zapalenia mózgu – opis serii przypadków

Tick-borne encephalitis (TBE) is a disease which may present as meningitis, encephalomeningitis and myeloencephalomeningitis. The course of the disease is usually mild although it may result in the patient's death in 1–4% of cases. Patients with myeloencephalomeningitis are the most endangered group, but also encephalomeningitis may have a fatal outcome. There are many risk factors which influence the severity of TBE, including patient's age, immunosuppression and concomitant diseases. We present four cases of patients who died because of TBE. The aim of the paper was to underline that in elderly patients or patients suffering from chronic diseases and additional infections, special attention should be paid to their treatment, including mechanical ventilation and steroid use.Kleszczowe zapalenie mózgu (KZM) może przebiegać pod trzema postaciami: zapalenia opon mózgowo-rdzeniowych, zapalenia mózgu i opon mózgowo-rdzeniowych oraz zapalenia rdzenia, mózgu i opon mózgowo-rdzeniowych. Przebieg choroby jest zazwyczaj łagodny, jednak w przypadku 1–4% pacjentów choroba może zakończyć się zgonem. Grupami najbardziej narażonymi na zgon są pacjenci z zapaleniem rdzenia, mózgu i opon mózgowo-rdzeniowych oraz z zapaleniem mózgu i opon mózgowo-rdzeniowych. Istnieje wiele czynników wpływających na ciężkość KZM, m.in. wiek pacjentów, upośledzenie układu odpornościowego i współistnienie innych chorób. W pracy zaprezentowano opisy czterech przypadków pacjentów, którzy zmarli z powodu KZM. Celem pracy jest podkreślenie, iż w przypadku starszych pacjentów lub pacjentów z chorobami przewlekłymi czy z innymi zakażeniami towarzyszącymi, chorujących na KZM należy zwrócić uwagę na leczenie, w tym respiratoro- i steroidoterapię

Czy oznaczanie stężeń peptydów natriuretycznych BNP i NT-proBNP przynosi korzyści w postępowaniu z pacjentem z nagłą dusznością?

W badaniach z ostatnich lat wykazano, że ocena peptydów natriuretycznych przeprowadzona u pacjentów z dusznością pozwala znacznie zwiększyć dokładność, z jaką może być wykluczone lub potwierdzone rozpoznanie niewydolności serca. Tym niemniej do dziś nie udało się jednoznacznie ustalić, czy wprowadzenie do rutynowej diagnostyki oznaczeń peptydów natriuretycznych u tych pacjentów mogłoby przynieść wymierne korzyści farmakoekonomiczne. Część badaczy sugeruje wręcz, że oznaczanie BNP i NT-proBNP w tej grupie pacjentów ma jedynie znaczenie poznawcze i nie przekłada się na zmianę postępowania diagnostyczno-terapeutycznego. Celem niniejszej pracy jest przedstawienie wyników badań &#8212; zarówno tych, w których skupiono się na ocenie roli peptydów natriuretycznych w dokonaniu właściwego rozpoznania, jak i tych, w których analizowano potencjalne farmakoekonomiczne korzyści wykonania takiego oznaczenia. Choroby Serca i Naczyń 2011, 8 (4), 215&#8211;22

Znaczenie kliniczne zakażeń wirusem Zachodniego Nilu w Europie w świetle doniesień prezentowanych na konferencji „Aktualne problemy dotyczące czynników zakaźnych przenoszonych przez krew” (10 marca 2017 r., Warszawa)

West Nile Virus (WNV) is a RNA virus belonging to the Flaviviridae family. It is the most widespreadvirus in the world. Culex mosquitoes are vectors of this virus, while birds inhabiting humid areas are the reservoir. The paper presents epidemiological data, the clinical picture, diagnostic methods and treatment of West Nile fever. Special emphasis was put on prevention, especially in pregnant women.Wirus Zachodniego Nilu (WNV) należy do wirusów RNA z rodziny Flaviviridae. Obecnie jest najszerzej rozpowszechnionym flawiwirusem na świecie. Wektorem wirusa na świecie są komary z gatunków Culex, a jego rezerwuarem — ptaki zamieszkujące tereny wilgotne. W pracy omówiono dane epidemiologiczne gorączki Zachodniego Nilu, obraz kliniczny, leczenie oraz diagnostykę. Zwrócono uwagę na znaczenie działań zapobiegawczych, szczególnie u kobiet w ciąży

Meningitis, clinical presentation of tetanus.

Background. Tetanus is an acute disease caused by a neurotoxin produced by Clostridium tetani. Tetanus immunization has been available since the late 1930s but sporadic cases still occur, usually in incompletely vaccinated or unvaccinated individuals. Case Report. An elderly previously vaccinated female contracted tetanus following foot injury. Clinically she presented with meningitis causing diagnostic and therapeutic delays. Why Should Physician Be Aware of This? Even in developed countries the differential diagnosis of meningitis, especially in the elderly, should include tetanus. Treatment in intensive care unit is required. General population might benefit from vaccine boosters and education on this potentially fatal disease.Peer Reviewe