Deadly Carousel or Difficult Interpretation of New Diagnostic Tools for Whipple's Disease: Case Report and Review of the Literature

Abstract : Whipple's disease is a rare systemic disorder classically presenting with weight loss, arthralgias, and diarrhea, which was first described in 1907. The causative bacterium Tropheryma whipplei, is a fastidious organism not growing on conventional media. Before the introduction of polymerase chain reaction (PCR)-based methods, the diagnostic gold standard was histological detection of diastase-resistant periodic acid Schiff (PAS)-positive macrophages or electron microscopy. As in the present case, contradictory results between the former and new diagnostic methods may obscure the correct diagnosis. We critically summarize the performance of the different diagnostic methods and discuss their impact on the clinical management of patients with suspected Whipple's diseas

Exact Likelihoods for N-mixture models with Time-to-Detection Data

This paper is concerned with the formulation of $N$-mixture models for estimating the abundance and probability of detection of a species from binary response, count and time-to-detection data. A modelling framework, which encompasses time-to-first-detection within the context of detection/non-detection and time-to-each-detection and time-to-first-detection within the context of count data, is introduced. Two observation processes which depend on whether or not double counting is assumed to occur are also considered. The main focus of the paper is on the derivation of explicit forms for the likelihoods associated with each of the proposed models. Closed-form expressions for the likelihoods associated with time-to-detection data are new and are developed from the theory of order statistics. A key finding of the study is that, based on the assumption of no double counting, the likelihoods associated with times-to-detection together with count data are the product of the likelihood for the counts alone and a term which depends on the detection probability parameter. This result demonstrates that, in this case, recording times-to-detection could well improve precision in estimation over recording counts alone. In contrast, for the double counting protocol with exponential arrival times, no information was found to be gained by recording times-to-detection in addition to the count data. An R package and an accompanying vignette are also introduced in order to complement the algebraic results and to demonstrate the use of the models in practice.Comment: 21 pages, 1 figur

44-jähriger Patient mit kulturnegativer, purulenter Perikarditis

Zusammenfassung: Wir berichten über einen Patienten mit purulenter Perikarditis und drohender Perikardtamponade, verursacht durch Neisseria meningitidis. Bei negativen Kulturen aus Blut und Perikardpunktat, wahrscheinlich bedingt durch die Vorbehandlung mit Antibiotika, konnten wir mittels Breitspektrumpolymerasekettenreaktion aus dem Perikardpunktat und einem Latexagglutinationstest aus Pleurapunktat Meningokokken der SerogruppeC nachweisen. Eine Meningokokkenperikarditis ohne Meningitis ist selten. Diagnostische Methoden auf nicht-kultureller Basis spielen bei Patienten, die bereits mit Antibiotika vorbehandelt sind, eine wichtige Roll

Spondylodiscitis as the first manifestation of Whipple's disease -a removal worker with chronic low back pain

Whipple's disease is a rare systemic infectious disease caused by the actinobacterium Tropheryma whipplei. Spondylodiscitis is an extremely rare manifestation of the infection and has previously been described in only three case reports. We present a 55-year-old man with persistent lumbago and signs of systemic illness, but without any gastrointestinal symptoms or arthralgia. The signal response in the lumbar spine in magnetic resonance tomography, both native and after intravenous gadolinium administration, was compatible with spondylodiscitis at the L4/L5 level. Culture of a specimen obtained by radiographically guided disc puncture and repeated blood cultures remained sterile. Tropheryma whipplei was detected by PCR amplification in material obtained from the disc specimen, from a biopsy of the terminal ileum and from the stool. The histology of duodenum, terminal ileum, colon and disc material was normal and, in particular, showed no PAS-positive inclusions in macrophages. Long-term antibiotic treatment with sulphamethoxazole and trimethoprim was successful, with marked improvement of the low back pain and normalisation of the systemic inflammatory signs. The possibility of Whipple's disease must be suspected in the case of a ‘culture-negative' spondylodiscitis even if there are no gastrointestinal symptoms and no arthralgia presen

Ribosomal RNA Gene Restriction Patterns Provide Increased Sensitivity for Typing Salmonella typhi Strains

To date, epidemiologic associations among strains of Salmonella typhi are based exclusively on phage typing, which may be of limited value if a common phage type is involved. Analysis of ribosomal RNA gene restriction patterns allows separation of most independently isolated strains of identical phage types. The sensitivity of the method is dependent on the restriction enzymes used to digest chromosomal DNA. It was highest for PstI, which separated 16 of 20 strains that belonged to 8 phage types including 3 untypable strains. Three strains differed in their phage types but had identical ribosomal RNA gene restriction patterns. Also, two pairs of strains indistinguishable by phage typing exhibited identical patterns; however, two of these strains were expected to be identical because they were isolated from two patients who were likely exposed to the same source. Ribosomal RNA gene restriction patterns appear to be stable. Thus, the method may complement phage typing and aid in further differentiation of strain

Hall Effect in the coma of 67P/Churyumov-Gerasimenko

Magnetohydrodynamics simulations have been carried out in studying the solar wind and cometary plasma interactions for decades. Various plasma boundaries have been simulated and compared well with observations for comet 1P/Halley. The Rosetta mission, which studies comet 67P/Churyumov-Gerasimenko, challenges our understanding of the solar wind and comet interactions. The Rosetta Plasma Consortium observed regions of very weak magnetic field outside the predicted diamagnetic cavity. In this paper, we simulate the inner coma with the Hall magnetohydrodynamics equations and show that the Hall effect is important in the inner coma environment. The magnetic field topology becomes complex and magnetic reconnection occurs on the dayside when the Hall effect is taken into account. The magnetic reconnection on the dayside can generate weak magnetic filed regions outside the global diamagnetic cavity, which may explain the Rosetta Plasma Consortium observations. We conclude that the substantial change in the inner coma environment is due to the fact that the ion inertial length (or gyro radius) is not much smaller than the size of the diamagnetic cavity.Comment: 23 pages, 6 figur

A protosolar nebula origin for the ices agglomerated by Comet 67P/Churyumov-Gerasimenko

The nature of the icy material accreted by comets during their formation in the outer regions of the protosolar nebula is a major open question in planetary science. Some scenarios of comet formation predict that these bodies agglomerated from crystalline ices condensed in the protosolar nebula. Concurrently, alternative scenarios suggest that comets accreted amorphous ice originating from the interstellar cloud or from the very distant regions of the protosolar nebula. On the basis of existing laboratory and modeling data, we find that the N$_2$/CO and Ar/CO ratios measured in the coma of the Jupiter family comet 67P/Churyumov-Gerasimenko by the ROSINA instrument aboard the European Space Agency's Rosetta spacecraft match those predicted for gases trapped in clathrates. If these measurements are representative of the bulk N$_2$/CO and Ar/CO ratios in 67P/Churyumov-Gerasimenko, it implies that the ices accreted by the comet formed in the nebula and do not originate from the interstellar medium, supporting the idea that the building blocks of outer solar system bodies have been formed from clathrates and possibly from pure crystalline ices. Moreover, because 67P/Churyumov-Gerasimenko is impoverished in Ar and N$_2$, the volatile enrichments observed in Jupiter's atmosphere cannot be explained solely via the accretion of building blocks with similar compositions and require an additional delivery source. A potential source may be the accretion of gas from the nebula that has been progressively enriched in heavy elements due to photoevaporation.Comment: The Astrophysical Journal Letters, in pres

Interpretation of the ion mass spectra in the mass range 25-35 obtained in the inner coma of Halley's comet by the HIS-sensor of the Giotto IMS Experiment

The IMS-HIS double-focussing mass spectrometer that flew on the Giotto spacecraft covered the mass per charge range from 12 to 56 (AMU/e). By comparing flight data, calibration data, and results of model calculations of the ion population in the inner coma, the absolute mass scale is established, and ions in the mass range 25 to 35 are identified. Ions resulting from protonation of molecules with high proton affinity are relatively abundant, enabling us to estimate relative source strengths for H2CO, CH3OH, HCN, and H2S, providing for the first time a positive in situ measurement of methanol. Also, upper limits for NO and some hydrocarbons are derived

Identification and characterization of a new ensemble of cometary organic molecules.

In-situ study of comet 1P/Halley during its 1986 apparition revealed a surprising abundance of organic coma species. It remained unclear, whether or not these species originated from polymeric matter. Now, high-resolution mass-spectrometric data collected at comet 67P/Churyumov-Gerasimenko by ESA's Rosetta mission unveil the chemical structure of complex cometary organics. Here, we identify an ensemble of individual molecules with masses up to 140 Da while demonstrating inconsistency of the data with relevant amounts of polymeric matter. The ensemble has an average composition of C1H1.56O0.134N0.046S0.017, identical to meteoritic soluble organic matter, and includes a plethora of chain-based, cyclic, and aromatic hydrocarbons at an approximate ratio of 6:3:1. Its compositional and structural properties, except for the H/C ratio, resemble those of other Solar System reservoirs of organics-from organic material in the Saturnian ring rain to meteoritic soluble and insoluble organic matter -, which is compatible with a shared prestellar history