Clinical features and outcome of sporadic serogroup W135 disease Taiwan

BACKGROUND: Few published reports have evaluated the clinical features and outcome of serogroup W135 meningococcal disease. In Taiwan, W135 is the second most prevalent meningococcal disease serogroup. METHOD: A nationwide study was conducted to retrospectively analyze epidemiologic data from 115 patients with laboratory confirmed meningococcal disease that occurred from 2001 through 2003. RESULTS: Serogroup W135 accounted for 26% of all cases and most (76.7%) were older than 20 years. There were no cases of serogroup W135 meningococcal disease associated with Hajj pilgrims, and all cases were sporadic. In 88 patients with complete case records, we compared the presenting symptoms, signs, laboratory data, and outcomes between W135 and non-W135 patients. There were no differences in presenting symptoms except for the higher prevalence of pneumonia found in W135 patients (23.8% vs. 1.5%; OR: 20.6; 95%CI: 2.3–189.0; p = 0.003). The distribution of inflammatory cells in CSF in patients with meningitis was also different between W135 and non-W135 patients. W135 patients had a trend toward more intubations and shock but it did not achieve statistical significance. In multivariate analysis of factors associated with death, three independent factors were found: bacteremia without meningitis, altered mental status, and petechiae or purpura on admission. CONCLUSION: Sporadic serogroup W135 meningococcal disease is an important component of the meningococcal disease burden in Taiwan, but it is not directly associated with Hajj pilgrims. Compared with patients infected by other serogroups of meningococci, patients with serogroup W135 were older and more likely to have extrameningeal involvement such as pneumonia

Serial Studies of Circulating Immune Complexes in Poststreptococcal Glomerulonephritis

Levels of circulating immune complexes were determined in 30 children who suffered from acute poststreptococcal glomerulonephritis. The study was started in the acute phase of the disease and continued for one year. Raji cell radioimmune assay was used for the detection of immune complexes. The patients had significantly elevated levels of immune complexes during the acute phase, especially in the first three days after the onset of hematuria. Six months later the levels of immune complexes declined to slightly elevated levels, and nine months after the initial attack, no immune complexes were detectable. However, the patients who had persistent hematuria and proteinuria continued to have detectable immune complexes during this time.</jats:p

Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon

Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon. An open, randomized trial study on the therapeutic effect of recombinant α-interferon (IFNα) in 40 patients with hepatitis B virus membranous nephropathy (HBVMN) was conducted. All were pathologically proven to have HBVMN which showed no response to corticosteroid treatment represented by persistent heavy proteinuria. Both HBeAg and HBsAg were positive in all. Group 1 was composed of 20 patients who were treated with recombinant IFNα (5 subjects, body wt < 20 kg; 8 subjects, body weight ≥ 20 kg) by subcutaneous (s.c.) injection three times a week for 12 months. In group 2 there were 20 patients who received supportive treatment only. At the end of the third month of treatment, all patients in Group 1 were free of proteinuria. In contrast, 10 patients (50%) in Group 2 had persistent heavy proteinuria and another 10 patients (50%) had light proteinuria with exacerbation during respiratory tract infection. At the end of the twelfth month, 8 patients (40%) in Group 2 still had persistent heavy proteinuria and 12 patients (60%) had light proteinuria with frequent relapses. Eight patients (40%) in Group 1 had HBeAg seroconversion between the fourth and sixth months and HBsAg seroconversion between the tenth and twelfth months. HBe seroconversion only [HBeAg (-)/HBsAg (+)] was found in four patients. Four patients had no change in HBV serological markers [HBeAg (+)/HBsAg (+)]. The remaining 4 patients had HBeAg (-)/ HBeAb (+) HBsAg (-)/HBsAb (-) at the end of the twelfth month. In contrast, there was no seroconversion of HBeAg (+)/HBsAg (+) in Group 2 patients. Flu-like symptoms were found in all patients during the first two weeks of IFNα treatment and disappeared spontaneously. Psychiatric problems were late side-effects found in 30% of patients which disappeared when the dosage of IFN was reduced. These results suggest that IFNα therapy is of value in complete resolution of heavy proteinuria, and provides some benefit in seroconversion of HBeAg (+)/HBsAg (+) in children with HBVMN

Elevation of cAMP Levels in Cerebrospinal Fluid of Patients with Neonatal Meningitis

The cyclic 3',5'-adenosine monophosphate (cAMP) concentrations in the cerebrospinal fluid of 20 children with neonatal bacterial meningitis and aseptic meningitis were measured by radioimmunoassay method. The cAMP levels were found to be significantly elevated above control levels (P &amp;lt; .01) during the acute phase in most of the patients. In the convalescent stage the cAMP concentration was decreased but levels remained significantly elevated (P &amp;lt; .01) in patients with complications. During the acute phase, the cAMP levels were higher in neonatal bacterial meningitis than in aseptic meningitis (P &amp;lt; .01). The results suggest that cAMP is a sensitive indicator of transient cellular metabolic disturbance in the brain and may be used to monitor the course of neonatal meningitis.</jats:p

Treatment of hepatitis B virus-associated membranous nephropathy with adenine arabinoside and thymic extract

Treatment of hepatitis B virus-associated membranous nephropathy with adenine arabinoside and thymic extract. Previously we found that corticosteroid treatment in the hepatitis B virus (HBV)-associated membranous nephropathy (HBVMN) was not associated with a favorable outcome. To distinguish the differences of the HBV DNA in macrophage, T and B cells among HBVMN patients with or without corticosteroid treatment, serial studies at different time points were investigated. HBV DNA appeared as an “episomal” molecule as with 3.2kb in macrophage, T and B cells. This molecule disappeared after 12 months among HBVMN patients without corticosteroid treatment. HBV DNA, by contrast, appeared as episomal form even three years later in T cells, with frequent proteinuria among HBVMN patients with corticosteroid treatment. This finding indicates that the use of corticosteroids leads to a potential risk of enhancing HBV viral replication in T cells. We studied 24 HBVMN patients who had previously received corticosteroid treatment and had persistent proteinuria, who were administered combination therapy with adenine arabinoside for two weeks and thymic extract (Thymostimulin) for six months to decrease urine protein loss and obtain seroconversion. These 24 patients had heavy (22 of 24, 91.6%) or mild (2 of 24, 8.4%) proteinuria prior to adenine arabinoside and thymostimulin treatment. All 24 patients demonstrated HBV DNA in mononuclear cells and simultaneously exhibited sera positive with HBsAg and HBeAg. In contrast, after treatment only one case (4.2%) had heavy and two cases (8.4%) mild proteinuria; HBV DNA was demonstrated in macrophage (4 of 24, 16.7%), T cells (9 of 24, 37.5%), and B cells (6 of 24, 25%) as well as serum (24 of 24, 100%) prior to treatment. The decreases to 16.7%, 37.5%, 25% and 41.6% in the macrophage, T cell, B cell, and serum respectively, were statistically significant (P<0.01) in each instance. In addition, six cases with complete remission of proteinuria changed their hepatitis B markers. Four cases (16.7%) changed from HBe (+)/anti-HBe (-) to HBe (-)/anti-HBe (-). These results suggest that combination therapy of adenine arabinoside and Thymostimulin in HBVMN patients is more effective in the improvement of proteinuria than corticosteroid treatment