65 research outputs found

    Therapeutic Down-Modulators of Staphylococcal Superantigen-Induced Inflammation and Toxic Shock

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    Staphylococcal enterotoxin B (SEB) and related superantigenic toxins are potent stimulators of the immune system and cause a variety of diseases in humans, ranging from food poisoning to toxic shock. These toxins bind directly to major histocompatibility complex (MHC) class II molecules on antigen-presenting cells and specific Vβ regions of T-cell receptors (TCR), resulting in hyperactivation of both monocytes/macrophages and T lymphocytes. Activated host cells produce massive amounts of proinflammatory cytokines and chemokines, activating inflammation and coagulation, causing clinical symptoms that include fever, hypotension, and shock. This review summarizes the in vitro and in vivo effects of staphylococcal superantigens, the role of pivotal mediators induced by these toxins in the pathogenic mechanisms of tissue injury, and the therapeutic agents to mitigate the toxic effects of superantigens

    Mycobacterium avium: A potentially treatable cause of pericardial effusions

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    We present a patient with a very large pericardial effusion due to disseminated Mycobacterium avium complex (MAC) infection with associated bacteraemia and gastroenteritis. He was HIV antibody-positive with a CD4+ lymphocyte count of 10 × 106/l. He complained of fevers, diarrhoea and dyspnoea and an echocardiogram showed a pericardial effusion. Chest X-ray showed progressive enlargement of the cardiac silhouette over a 3-month period. The effusion was drained surgically and antimycobacterial therapy (clarithromycin, clofazamine, rifampicin, ciprofloxacin, amikacin) was initiated. The patient had complete resolution of this pericardial effusion both clinically and radiologically. Three other AIDS patients with pericardial effusions caused by MAC are described in the medical literature, two died of cardiac dysfunction shortly after diagnosis. There is a case described of MAC-related pericardial effusion in a HIV-negative immunocompetent patient which resolved antimycobacterial therapy. MAC should be included in the differential diagnosis of pericardial effusions in AIDS patients. A combination of medical therapy and surgical intervention may give rise to considerable clinical benefit especially if initiated early
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