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Abiotrophia species are relatively slow growing pathogens, which may be present as commensal flora. However, invasive infections are frequently reported, like endocarditis, septic arthritis, osteomyelitis, and many other types of infection. In this case report we describe a 65-year-old male patient with an intracardiac device- (ICD-) lead infection caused by Abiotrophia defectiva. Diagnosis was confirmed by 18F-FDG-PET scanning. This is remarkable, since Abiotrophia defectiva is a slow growing pathogen causing low-grade infections. This case demonstrates that although infection of ICD-leads cannot be excluded in case of 18F-FDG-PET-negative findings, positive findings are highly suggestive for infection

A conditional limit theorem for independent random variables

In this paper, we prove a conditional limit theorem for independent not necessarily identically distributed random variables. Namely, we obtain the asymptotic distribution of a large number of them given the sum

Phylogeographic Distribution of Human and Hare Francisella Tularensis Subsp. Holarctica Strains in the Netherlands and Its Pathology in European Brown Hares (Lepus Europaeus)

Sequence-based typing of Francisella tularensis has led to insights in the evolutionary developments of tularemia. In Europe, two major basal clades of F. tularensis subsp. holarctica exist, with a distinct geographical distribution. Basal clade B.6 is primarily found in Western Europe, while basal clade B.12 occurs predominantly in the central and eastern parts of Europe. There are indications that tularemia is geographically expanding and that strains from the two clades might differ in pathogenicity, with basal clade B.6 strains being potentially more virulent than basal clade B.12. This study provides information on genotypes detected in the Netherlands during 2011–2017. Data are presented for seven autochthonous human cases and for 29 European brown hares (Lepus europaeus) with laboratory confirmed tularemia. Associated disease patterns are described for 25 European brown hares which underwent post-mortem examination. The basal clades B.6 and B.12 are present both in humans and in European brown hares in the Netherlands, with a patchy geographical distribution. For both genotypes the main pathological findings in hares associated with tularemia were severe (sub)acute necrotizing hepatitis and splenitis as well as necrotizing lesions and hemorrhages in several other organs. Pneumonia was significantly more common in the B.6 than in the B.12 cases. In conclusion, the two major basal clades present in different parts in Europe are both present in the Netherlands. In hares found dead, both genotypes were associated with severe acute disease affecting multiple organs. Hepatitis and splenitis were common pathological findings in hares infected with either genotype, but pneumonia occurred significantly more frequently in hares infected with the B.6 genotype compared to hares infected with the B.12 genotype

Additional file 1 of Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case report

Additional file 1. Laboratory values at first presentation

Additional file 2 of Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case report

Additional file 2. Medication administered from admission until the sudden clinical deterioration

Highly active antiretroviral therapy with or without mycophenolate mofetil in treatment-naive HIV-1 patients

Objective: To study the effect of mycophenolate mofetil (MMF) on the decay rate of plasma HIV-1 RNA and the latently infected cellular reservoir in treatment-naive patients starting antiretroviral therapy. Design: Randomized trial. Methods: A group of 19 HIV-1 infected patients (9 with a chronic and 10 with a primary infection) starting a triple antiretroviral drug regimen were randomized to a group with or without MMF. Plasma samples for HIV-1 RNA were taken and HLA-DR-CD4+ T cells were co-cultured for HIV-1 isolation. Slopes of plasma HIV-1 RNA and cellular viral load decay were calculated for the first 14 days and the first 24 weeks of treatment, respectively. Results: The median plasma HIV-1 RNA daily decay rate in chronically infected patients was 0.25 log(10) copies/ml [interquartile range (IQR), 0.18-0.30] with MMF and 0.28 log(10) copies/ml (IQR, 0.22-0.32) without MMF (P = 0.56); in primary infected patients, it was 0.31 log(10) copies/ml (IQR, 0.31-0.32) with MMF and 0.32 log(10) copies/ml (IQR, 0.26-0.34) without MMF (P = 0.75). The median daily decay rate of latently infected cells was 0.017 and 0.004 infected cells/10(6) cells in patients with and without MMF, respectively (P = 0.89). The increase in CD4 T cells was comparable between patients with and without MMF. After stopping MMF, there was an increase in the cellular reservoir in six of eight patients. Conclusion: The addition of MMF to a triple class antiretroviral regimen in treatment-naive patients does not significantly increase the plasma HIV-1 RNA decay rate or the decay rate of the latently infected cellular reservoir. (C) 2004 Lippincott Williams Wilkin