Severe eosinophilic colitis caused by neuropathic agents in a patient with chronic fatigue syndrome and functional abdominal pain: case report and review of the literature

Eosinophilic colitis is a rare clinical condition that belongs to the group of eosinophilic gastrointestinal disorders. Its occurrence can be primary or secondary to infection, medications, or autoimmune/hematological conditions. We present a case of a young female adult with severe chronic fatigue syndrome, widespread chronic pain, including functional abdominal pain, who developed severe eosinophilic colitis following successive treatments with gabapentin and pregabalin. On both occasions, symptoms manifested as abdominal pain, diarrhea, and eosinophilia and improved upon discontinuation of the medications. Magnetic resonance imaging of the small bowel demonstrated an ascending colon colitis, and endoscopic investigations confirmed florid colitis mainly in the ascending colon with biopsies demonstrating a dense eosinophilic infiltrate with micro-abscesses. Serum eosinophil counts correlated well with the timing of the agents’ administration. There was no other organ involvement. Symptoms improved upon discontinuation of the drugs and steroid administration. Eosinophilic colitis is an exceptionally rare entity and its mechanism of action is still unclear. Suspicion of eosinophilic colitis should be raised if a patient presents with abdominal pain, diarrhea, and peripheral eosinophilia following treatment with pregabalin or gabapentin. / Die eosinophile Kolitis ist eine sehr seltene Krankheit aus der Gruppe der eosinophilen Magen-Darm-Erkrankungen. Als Auslöser gelten Primär- und Sekundärinfektionen, Medikamente, sowie autoimmune und hämatologische Erkrankungen. Unser Fall beschreibt eine junge, weibliche Erwachsene mit schwerem chronischem Müdigkeitssyndrom und generalisierten chronischen Schmerzen, darunter funktionellen Unterleibsschmerzen, welche unter Behandlung mit Gabapentin und Pregabalin an einer schweren eosinophilen Kolitis erkrankte. Zu zwei unterschiedlichen Zeitpunkten wies die Patientin abdominelle Schmerzen, Diarrhoe und ein Eosinophilie auf, mit jeweils Verbesserung der Symptomatik nach Sistieren der Medikamenteneinnahme. In einer Kernspintomografie stellte sich eine Kolitis des aufsteigenden Kolons dar. Endoskopisch konnte eine floride Kolitis, vorwiegend im Kolon ascendens, bestätigt werden, mit Nachweis einer dichten eosinophilen Infiltration mit Mikroabszessen in den Biopsien. Die serologische Eosinophilie korrelierte zeitlich mit der Medikamenteneinnahme. Andere Organe waren nicht beteiligt. Die Symptomatik verbesserte sich nach Absetzen der Medikamente und Verabreichung von Steroiden. Die eosinophile Kolitis ist eine ausgesprochen seltene Erkrankung mit bisher noch unklarem Wirkmechanismus. Bei Patienten mit abdominellen Schmerzen, Diarrhoe und peripherer Eosinophilie unter einer Therapie mit Pregabalin oder Gabapentin sollte der Verdacht auf eine eosinophile Kolitis gestellt werden

A cross-layer architecture to improve mobile host rate performance and to solve unfairness problem in WLANs

The evolution of the Internet has been mainly promoted in recent years by the emergence and pro- liferation of wireless access networks towards a global ambient and pervasive network accessed from mobile devices. These new access networks have introduced new MAC layers independently of the legacy "wire- oriented" protocols that are still at the heart of the pro- tocol stacks of the end systems. This principle of isola- tion and independence between layers advocated by the OSI model has its drawbacks of maladjustment between new access methods and higher-level protocols built on the assumption of a wired Internet. In this paper, we introduce and deliver solutions for several pathologi- cal communication behaviors resulting from the malad- justment between WLAN MAC and higher layer stan- dard protocols such as TCP/IP and UDP/IP. Specially, based on an efficient analytical model for WLANs band- width estimation, we address in this paper the two fol- lowing issues: 1) Performance degradation due to the lack of flow control between the MAC and upper layer resulting in potential MAC buffer overflow; 2) Unfair bandwidth share issues between various type of flows. We show how these syndromes can be efficiently solved from neutral "cross layer" interactions which entail no changes in the considered protocols and standards

Differing patterns of selection and geospatial genetic diversity within two leading Plasmodium vivax candidate vaccine antigens

Although Plasmodium vivax is a leading cause of malaria around the world, only a handful of vivax antigens are being studied for vaccine development. Here, we investigated genetic signatures of selection and geospatial genetic diversity of two leading vivax vaccine antigens--Plasmodium vivax merozoite surface protein 1 (pvmsp-1) and Plasmodium vivax circumsporozoite protein (pvcsp). Using scalable next-generation sequencing, we deep-sequenced amplicons of the 42 kDa region of pvmsp-1 (n = 44) and the complete gene of pvcsp (n = 47) from Cambodian isolates. These sequences were then compared with global parasite populations obtained from GenBank. Using a combination of statistical and phylogenetic methods to assess for selection and population structure, we found strong evidence of balancing selection in the 42 kDa region of pvmsp-1, which varied significantly over the length of the gene, consistent with immune-mediated selection. In pvcsp, the highly variable central repeat region also showed patterns consistent with immune selection, which were lacking outside the repeat. The patterns of selection seen in both genes differed from their P. falciparum orthologs. In addition, we found that, similar to merozoite antigens from P. falciparum malaria, genetic diversity of pvmsp-1 sequences showed no geographic clustering, while the non-merozoite antigen, pvcsp, showed strong geographic clustering. These findings suggest that while immune selection may act on both vivax vaccine candidate antigens, the geographic distribution of genetic variability differs greatly between these two genes. The selective forces driving this diversification could lead to antigen escape and vaccine failure. Better understanding the geographic distribution of genetic variability in vaccine candidate antigens will be key to designing and implementing efficacious vaccines

Histo-blood group antigen-binding specificities of human rotaviruses are associated with gastroenteritis but not with in vitro infection

Human strains of rotavirus A (RVAs) recognize fucosylated glycans belonging to histo-blood group antigens (HBGAs) through their spike protein VP8*. Lack of these ligands due to genetic polymorphisms is associated with resistance to gastroenteritis caused by P[8] genotype RVAs. With the aim to delineate the contribution of HBGAs in the process, we analyzed the glycan specificity of VP8* proteins from various P genotypes. Binding to saliva of VP8* from P[8] and P[4] genotypes required expression of both FUT2 and FUT3 enzymes, whilst binding of VP8* from the P[14] genotype required FUT2 and A enzymes. We further defined a glycan motif, GlcNAc beta 3Gal beta 4GlcNAc, recognized by P[6] clinical strains. Conversion into Lewis antigens by the FUT3 enzyme impaired recognition, explaining their lower binding to saliva of Lewis positive phenotype. In addition, the presence of neutralizing antibodies was associated with the presence of the FUT2 wild type allele in sera from young healthy adults. Nonetheless, in vitro infection of transformed cell lines was independent of HBGAs expression, indicating that HBGAs are not human RV receptors. The match between results from saliva-based binding assays and the epidemiological data indicates that the polymorphism of human HBGAs controls susceptibility to RVAs, although the exact mechanism remains unclear.Funding Agencies|Agence Nationale de la Recherche (France): GASTROVIM; Region des Pays de la Loire (France): ARMINA; Merieux Research Grant GOMMs; Russian Science Foundation [14-5-00131]; Swedish Research Council [320301]</p

The worldwide antibiotic resistance and prescribing in european children (ARPEC) point prevalence survey : Developing hospital-quality indicators of antibiotic prescribing for children

Objectives: Previously, web-based tools for cross-sectional antimicrobial point prevalence surveys (PPSs) have been used in adults to develop indicators of quality improvement. We aimed to determine the feasibility of developing similar quality indicators of improved antimicrobial prescribing focusing specifically on hospitalized neonates and children worldwide. Methods: A standardized antimicrobial PPS method was employed. Included were all inpatient children and neonates receiving an antimicrobial at 8:00 am on the day of the PPS. Denominators included the total number of inpatients. A web-based application was used for data entry, validation and reporting. We analysed 2012 data from 226 hospitals (H) in 41 countries (C) from Europe (174H; 24C), Africa (6H; 4C), Asia (25H; 8C), Australia (6H), Latin America (11H; 3C) and North America (4H). Results: Of 17 693 admissions, 6499 (36.7%) inpatients received at least one antimicrobial, but this varied considerably between wards and regions. Potential indicators included very high broad-spectrum antibiotic prescribing in children of mainly ceftriaxone (ranked first in Eastern Europe, 31.3%; Asia, 13.0%; Southern Europe, 9.8%), cefepime (ranked third in North America, 7.8%) and meropenem (ranked first in Latin America, 13.1%). The survey identified worryingly high use of critically important antibiotics for hospital-acquired infections in neonates (34.9%; range from 14.2% in Africa to 68.0% in Latin America) compared with children (28.3%; range from 14.5% in Africa to 48.9% in Latin America). Parenteral administration was very common among children in Asia (88%), Latin America (81%) and Europe (67%). Documentation of the reasons for antibiotic prescribing was lowest in Latin America (52%). Prolonged surgical prophylaxis rates ranged from 78% (Europe) to 84% (Latin America). Conclusions: Simple web-based PPS tools provide a feasible method to identify areas for improvement of antibiotic use, to set benchmarks and to monitor future interventions in hospitalized neonates and children. To our knowledge, this study has derived the first global quality indicators for antibiotic use in hospitalized neonates and children