Outcome of patients with arthritis and parvovirus B19 DNA in synovial membranes

To investigate the follow-up of the 17 patients during the period of 1995-2001 of the outpatient Clinic for Rheumatology at the University Hospital of Zurich with arthritis and the presence of parvovirus B19 DNA demonstrated by PCR in synovial biopsies. Seventeen patients of 163 with arthritis, which were routinely examined by needle arthroscopy during 1995-2001 with a positive parvovirus B19 DNA by PCR of synovial biopsy were reevaluated. Investigations included medical history, clinical examination and blood tests. Joint fluid was taken on patients with joint effusion. The observation period of the 17 patients (F:M=11:6) was 2-8years (Ø=6.5years). In 8 of 17 patients the arthritis could not be classified neither at entry nor during the follow up of the study. The arthritis could be diagnosed in six patients early in the onset of the disease and included three cases of lyme arthritis of the knee joint, two cases with arthritis following a gastrointestinal infection (one with Salmonella typhimurium—positive faecal test—and the other one with a culture negative agent), one patient probably had an infection-associated arthritis after a gastrointestinal infection with Entamöeba histolytica (Schirmer et al. in Rheumatol Int 18:37-38, 1998; Kasliwal in Am J Proctol Gastroenterol Colon Rectal Surg 32:12, 16, 28, 1981; Haslock and Wright in J R Coll Phys Lond 8:1554-162, 1974; Than-Saw et al. in Trop Geogr Med 44:355-358, 1992) with remission after antibiotic therapy. After a disease course of 9months one patient could be classified as rheumatoid arthritis in the presence of anti-cyclic citrullinated antibodies but lack of rheumatoid factor. One patient with polyarthritis developed psoriasis of the skin 22months later. From the nine patients with unclassified arthritis 4 (45%) got into complete remission with no symptoms or signs of joint inflammation after a disease course of 9-45months, whereas 5 (55%) still demonstrate active non erosive arthritis (disease duration between 3 and 10years). The presence of parvovirus B19 DNA in synovial tissue of patients with joint inflammation does not allow the diagnosis of parvovirus induced arthritis. If the arthritis remains unclassified and without erosions over time a virus associated aetiology may be assumed. However, no definitive diagnosis is possible even in the presence of parvovirus B19 DNA in synovial tissu

Polyclonal Proliferation of Large Granular Lymphocytes during Cytomegalovirus Primary Infection in a Human Immunodeficiency Virus—Infected Patient Receiving Antiretroviral Therapy

We report the first case of a patient infected with HIV in whom polyclonal CD8+/CD57- T lymphocyte large granular lymphocyte (LGL) proliferation was observed in association with cytomegalovirus primary infection. Because the differential diagnosis of an increased number of LGLs includes both monoclonal LGL leukemia and polyclonal proliferation of LGL, patients in whom LGL proliferation is detected always need close hematological and clinical observation to determine whether therapeutic intervention is necessar

Acute Cytomegalovirus Colitis Presenting during Primary HIV Infection: an Unusual Case of an Immune Reconstitution Inflammatory Syndrom

Severe ulcerous cytomegalovirus pancolitis developed during primary human immunodeficiency virus (HIV) infection in a patient who underwent early combination antiretroviral treatment. This massive inflammatory process led to acute colon perforation. Serological testing demonstrated cytomegalovirus reactivation. Severe immunosuppression caused by primary HIV infection resulted in cytomegalovirus colitis, and initiation of early combination antiretroviral therapy triggered an immune reconstitution inflammatory syndrome potentially leading to colonic perforatio

Multifocal Vasculopathy Due to Varicella-Zoster Virus (VZV): Serial Analysis of VZV DNA and Intrathecal Synthesis of VZV Antibody in Cerebrospinal Fluid

Recognition of multifocal vasculopathy due to varicella-zoster virus (VZV) is often problematic. We describe a human immunodeficiency virus—infected patient who had progressive central nervous system disease for >3 months. Both VZV DNA and antibody were detected in cerebrospinal fluid (CSF) specimens; serial polymerase chain reaction analyses confirmed the diagnosis and guided the duration of therapy. Reduced ratios of VZV antibody in serum to that in CSF were also demonstrate

Chronic Norovirus Infection after Kidney Transplantation: Molecular Evidence for Immune-Driven Viral Evolution

Background. Norovirus infection is the most common cause of acute self-limiting gastroenteritis. Only 3 cases of chronic norovirus infection in adult solid organ transplant recipients have been reported thus far. Methods. This case series describes 9 consecutive kidney allograft recipients with chronic norovirus infection with persistent virus shedding and intermittent diarrhea for a duration of 97-898 days. The follow-up includes clinical course, type of immunosuppression, and polymerase chain reaction for norovirus. Detailed molecular analyses of virus isolates from stool specimens over time were performed. Results. The intensity of immunosuppression correlated with the diarrheal symptoms but not with viral shedding. Molecular analysis of virus strains from each patient revealed infection with different variants of GII.4 strains in 7 of 9 patients. Another 2 patients were infected with either the GII.7 or GII.17 strain. No molecular evidence for nosocomial transmission in our outpatient clinic was found. Capsid sequence alignments from follow-up specimens of 4 patients showed accumulation of mutations over time, resulting in amino acid changes predominantly in the P2 and P1-2 region. Up to 25 amino acids mutations were accumulated over a 683-day period in the patient with an 898-day shedding history. Conclusion. Norovirus infection may persist in adult renal allograft recipients with or without clinical symptoms. No evidence for nosocomial transmission in adult renal allograft recipients was found in our study. Molecular analysis suggests continuous viral evolution in immunocompromised patients who are unable to clear this infectio

Demonstration of two-beam acceleration in CTF II

The second phase of the Compact LInear Collider (CLIC) Test Facility (CTF II) at CERN has demon-strated the feasibility of two-beam acceleration at 30 GHz using a high-charge drive beam, running paral lel to the main beam, as the RF power source. To date accelerating gradients of 59 MV/m at 30 GHz have been achieved. In CTF II, the two beams are generated by 3 GHz RF photo-injectors and are acceler ated in 3 GHz linacs, before injection into the 30 GHz modules. The drive beam linac has to accelerate a 16 ns long train of 48 bunches, each with a nominal charge of 13.4 nC. To cope with the very su bstantial beam-loading special accelerating structures are used (running slightly off the bunch repetition frequency). A magnetic chicane compresses the bunches to less than 5 ps fwhm, this is needed for efficient 30 GHz power generation. The 30 GHz modules are fully-engineered representative sections of CLIC, they include a 30 GHz decelerator for the drive beam, a 30 GHz accelerator for the main beam, high resolution BPM's and a wire-based active align-ment system. The performance achieved so far, as well as the operational experience with the first accelerator of this type, are reported

Results from the CLIC Test Facility

In order to study the principle of the Compact Linear Collider (CLIC) based on the Two Beam Acceleration (TBA) scheme at high frequency, a CLIC Test Facility (CTF) has been set-up at CERN. After four years of successful running, the experimental programme is now fully completed and all its objectives reached, particularly the generation of a high intensity drive beam with short bunches by a photo-injector, the production of 30 GHz RF power and the acceleration of a probe beam by 30 GHz structures. A summary of the CTF results and their impact on linear collider design is given. This covers 30 GHz high power testing, study of intense, short single bunches; as well as RF-Gun, photocathode and beam diagnostic developments. A second phase of the test facility (CTF2) is presently being installed to demonstrate the feasibility of the TBA scheme by constructing a fully engineered, 10 m long, test section very similar to the CLIC drive and main linacs, producing up to 480 MW of peak RF power at 30 GHz and accelerating the beam up to 320 MeV. The present status of CTF2 is reported

CLIC: a Two-Beam Multi-TeV e±e\pm Linear Collider

The CLIC study of a high-energy (0.5 - 5 TeV), high-luminosity (1034 - 1035 cm-2 sec-1) e+e- linear collider is presented. Beam acceleration using high frequency (30 GHz) normal-conducting structures operating at high accelerating fields (150 MV/m) significantly reduces the length and, in consequence, the cost of the linac. Using parameters derived from general scaling laws for linear colliders, the beam stability is shown to be similar to lower frequency designs in spite of the strong wake-field dependency on frequency. A new cost-effective and efficient drive beam generation scheme for RF power production by the so-called "Two-Beam Acceleration" method is described. It uses a thermionic gun and a fully-loaded normal-conducting linac operating at low frequency (937 MHz) to generate and accelerate the drive beam bunches, and RF multiplication by funnelling in compressor rings to produce the desired bunch structure. Recent 30 GHz hardware developments and CLIC Test Facility (CTF) results are described