Síndrome de activación macrofágica en paciente pediátrico con enfermedad de Still

Introduction: Still's disease in childhood constitutes an inflammatory disorder, of autoimmune origin, which is framed within the group of juvenile idiopathic arthritis, probably being the most peculiar entity of the group. It usually occurs in the form of repeated outbreaks of activity, combined with periods of remission. Case report: a sixteen-year-old patient with a history of systemic juvenile arthritis is presented, with a clinical picture of 72 hours of evolution characterized by intermittent fever, cough, pyodermitis, generalized rash and arthritis. During the clinical evolution, it was considered base-disease activation versus sepsis supported on clinical criteria, which was later corroborated by laboratory findings. The patient underwent treatment with broad-spectrum antibiotics, non-steroidal anti-inflammatory drugs, steroids at a rate of 1mg / kg / day, without improvement. Subsequently, the treatment with pulses of methylprednisolone and immunomodulator-therapy was initiated. Finally, a macrophage activation syndrome was diagnosed, supported on clinical laboratory parameters. Patient’s evolvement was slowly and died in the Intensive Care Unit, 22 days after the admission. Conclusions: the macrophage activation syndrome is one of the secondary forms within the group of hemophagocytic lymphohistiocytosis. The factors that in this context have been associated with its onset are very diverse. Clinically, these processes are characterized by prolonged fever that does not disappear despite antibiotic-therapy. Typically, arthritis is usually absent. The first line of treatment is corticosteroids at high doses.Introducción: la enfermedad de Still en la infancia constituye un trastorno inflamatorio, de origen autoinmune, que se enmarca dentro del grupo de las artritis idiopáticas juveniles, constituyendo probablemente la entidad más peculiar del grupo. Suele cursar en forma de brotes de actividad repetidos, intercalados por períodos de remisión.Presentación del caso: se presenta el caso de un paciente de dieciséis años de edad, con antecedentes de artritis juvenil sistémica, con un cuadro clínico de 72 horas de evolución caracterizado por fiebre intermitente, tos, piodermitis, exantema generalizado y artritis. Durante la evolución clínica se consideró activación de la enfermedad de base versus sepsis con base en los criterios clínicos, lo cual fue sustentado posteriormente por los hallazgos de laboratorio. Recibió tratamiento con antibióticos de amplio espectro, antiinflamatorios no esteroideos, esteroides a razón de 1mg/kg/día, sin presentar mejoría. Posteriormente, se inició tratamiento con pulsos de metilprednisolona e inmunomoduladores. Finalmente, se diagnosticó un síndrome de activación macrofágica, con base en los parámetros de laboratorio clínico. Evolucionó tórpidamente y falleció en la Unidad de Cuidados Intensivos a los 22 días de su ingreso.Conclusiones: el síndrome de activación macrofágica constituye una de las formas secundarias dentro del grupo de linfohistiocitosis hemocitofágicas. Son muy diversos los factores que en este contexto se han asociado a su aparición. Clínicamente estos procesos se caracterizan por fiebre prolongada que no cede a pesar de antibióticos. Característicamente la artritis suele estar ausente. La primera línea de tratamiento la constituyen los corticoides a dosis altas

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Sex-dependent grades of haematopoietic modulation in patients with major depressive episodes are associated with suicide attempts

International audienceSuicide is the leading cause of non-natural death worldwide, and major depressive disorder (MDD) is the mood disorder with the highest prevalence among individuals with suicidal behaviour (SB). The role of inflammation and immunomodulation in mood disorders has raised interest in recent years, as inflammation biomarkers have been reported to be increased in mood disorder patients, suggesting a role of inflammation in their pathogenesis. The influence of inflammation on the haematopoietic production is well known; however, a comprehensive study of the haematopoietic production in patients with major depressive episodes (MDE) is lacking. We examined global haematopoietic parameters from complete blood counts (CBC) of patients with MDE, in search of prognostic patterns. MDE patients presented differences in several CBC parameters, differences that were clearly pronounced and/or significant in concurrence with suicide attempts (SA). Red and white blood cell lineage parameters were affected, suggesting general haematopoietic modulation or imbalance. We observed distinct haematological parameter changes in women versus men, with men presenting milder alterations than women. Interestingly, we found that the List of Threatening Experiences (LTE) score, but not the Childhood Trauma Questionnaire (CTQ), was associated with the haematopoietic alterations observed exclusively in women and, more importantly, served as a parameter to stratify female MDE patients based on concurrence or non-concurrence with SA. In conclusion, grades of haematopoietic modulation in MDE patients are associated with absence or presence of SA. Haematopoietic manifestations differ between men and women and, in the latter, are markedly influenced by late, and not early, traumatic events