John D Carter MD
Division of Rheumatology, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 81, Tampa, FL 33612, USA Reactive arthritis ReA is an inflammatory arthritis that arises after certain types of gastrointestinal or genitourinary infections. It belongs to the group of arthritidies known as the spondyloarthropathies. The earliest description of ReA might date back to the writings of Hippocrates A youth does not suffer from gout until sexual intercourse'' 1 . In 1916, Hans Reiter described...
Antiphospholipid syndrome
Antiphospholipid syndrome is an autoimmune disease characterized by arterial or venous thrombosis and often by multiple fetal losses and throm-bocytopenia, in association with the presence of antiphospholipid antibodies mainly aCL and lupus anticoagulant antiphospholipid antibodies have also been detected in patients with acute and chronic infections and malignant diseases 99 . Initially, a high prevalence of antiphospholipid antibodies with a low frequency of associated thrombosis has also...
Crosssectional imaging
CT provides images with high spatial and contrast resolution of bone and surrounding soft tissue, and exceptional cortical bony detail. It can provide a good definition of cortical bone destruction, periosteal reaction Fig. 12 , and soft tissue changes. postcontrast images are more useful for soft tissue abnormalities than for bony changes. Increased density of the medullary cavity can be seen replacing the normal low-density fatty marrow, but this finding is nonspecific and may be seen not...
Acknowledgments
The authors thank Dr. Robert Quinet for support and generosity Dr. Raquel Cuchacovich for expertise in immunology Ms. Carol Kelly for patience and kind assistance Ms. Amanda Riley, librarian Drs. Portia Harris and Joythi Mallepalli Dr. Robert Wallis for thoughtfulness, prepublica-tion transmission of JID article, and sharing unpublished data on de novo TB infection Dr. Leonard Calabrese for prepublication transmission Drs. Karen Wood, Joan Bathon, Shunsuke Mori, and Raymond Chung for assistance...
Immune reconstitution inflammatory syndrome
Immune reconstitution inflammatory syndrome has been described as a syndrome attributed to immune reconstitution occasionally observed following initiation of HAART. During the first 8 to 12 weeks following suppression of HIV replication with HAART, there is a rapid influx of memory T cells that have been trapped within inflamed lymphatic tissues and a slow recovery of naive T cells that seem to derive from both redistribution from the periphery and new thymic production 128,129 . Functional...
Neoplasia
AIDS-associated malignancies are a major complication associated with AIDS patients on immunosuppression 140 . Three cancers are considered an AIDS-defining neoplasm 1 Kaposi's sarcoma, 2 high-grade B-cell non-Hodgkin's lymphoma, and 3 invasive cervical cancer 141 . Before the introduction of HAART, non-Hodgkin's lymphoma represented one of the most prevalent causes of neoplasia in HIV-infected people 142145 . The incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma, have fallen sharply...
Is there an association between hepatitis C virus infection and arthritis
The topic of HCV infection and arthritis has attracted more attention from the rheumatologists than the infectious diseases specialists, yet the prevalence of HCV among patients who have arthritis is comparatively low, whereas the prevalence of arthritis among patients who have HCV infection is comparatively high. Data on the first topic is scant. Maillefert and colleagues 15 in France found that of 309 patients who had rheumatoid arthritis according to criteria by the American College of...
Human endogenous retroviruses and systemic lupus erythematosus
A role of retroviruses in SLE pathogenesis is supported by an increasing body of evidence. A possible retroviral link with SLE was suspected initially because of the similarity of autoimmune manifestations and immune dysregulation between patients who have SLE and those infected with known human retroviruses, such as HIV-1. It has been shown that one third of patients who have SLE produce high-titer antibodies to various retroviral proteins, including Gag, Env, and Nef, and the p24 capsid...
Tuberculosis 1
Approval of infliximab in August of 1998 was preceded by only one TB case identified. The immediate months to follow saw a wave of TB cases reported to the Food and Drug Administration FDA in striking temporal association with anti-TNF-a use. Keane and colleagues 22 , by systematic review, established a temporal and disease pattern that implicated infliximab in causal relation to development of TB. Time to diagnosis was made 12 weeks from initiation of treatment with greater than 50 of patients...
Box 2 Triggering microbes of reactive arthritis
Definite causes Postvenereal Chlamydia trachomatis Salmonella S enteritidis, S typhimurium, S bovismorbificans, S blockley Shigella S flexneri, S dysenteriae, S sonnei, S boydii Yersinia Y enterocolitica, Y pseudotuberculosis Chlamydophila Chlamydia pneumoniae Bacille Calmette-Guenn intravesicular Possible causes Bacillus cereus Brucella abortis Clostridium difficile Escherichia coli Helicobacter pylori Hafnia alvei Lactobacillus Neisseria meningitidis serogroup B Pseudomona Intestinal...
Aja M Sanzone MDa Rodolfo E Begue MDb
aPediatric Infectious Diseases, Combined Fellowship Training Program of Tulane University and Louisiana State University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA 70112, USA bDivision of Infectious Diseases, Department of Pediatrics, Louisiana State University Health Sciences Center, Children's Hospital, 200 Henry Clay Avenue, New Orleans, LA 70118, USA Hepatitis C virus HCV infects approximately 3 of the world's population or 170 million people. In the United States, HCV...
Info Vgp
with breakdown of skin and subcutaneous tissue Data from Resnick D, Niwayama G. Osteomyelitis, septic arthritis and soft tissue infection mechanisms and situations. In Resnick D, editor. Diagnosis of bone and joint disorders. 3rd edition. Philadelphia WB Saunders 1995. p. 2335. Data from Resnick D, Niwayama G. Osteomyelitis, septic arthritis and soft tissue infection mechanisms and situations. In Resnick D, editor. Diagnosis of bone and joint disorders. 3rd edition. Philadelphia WB Saunders...
References
1 Phillips PE, Inman RD, Christian CL. Infectious agents in chronic rheumatic diseases. In Koopman WJ, editor. Arthritis and allied conditions. 9th edition. Philadelphia Lea amp Febiger 1979. p. 320. 2 Phillips PE, Inman RD, Christian CL. Infectious agents in chronic rheumatic diseases. In Koopman WJ, editor. Arthritis and allied conditions. 10th edition. Philadelphia Lea amp Febiger 1985. p. 431-9. 3 Phillips PE, Inman RD, Christian CL. Infectious agents in chronic rheumatic diseases. In...
Clinical manifestations
Arthritis can occur at any stage of HIV infection, but the true prevalence of arthritic syndromes and the nature of their association with HIV infection remain unclear. The pattern of HIV-associated arthritis is similar to that of other viral disorders acute onset, short duration, no recurrences, and no erosive changes 11 . Prospective studies have shown a high prevalence of rheumatic complaints in 30 to 40 of HIV-infected patients, with arthralgias the most common rheumatic manifestation in...
Graciela S Alarcon MD MPH
Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294-3408, USA Systemic lupus erythematosus SLE , scleroderma, and polymyositis der-matomyositis PM DM are autoimmune diseases with high morbidity and mortality 1 . The important role infections play in these diseases has been documented in the literature over the years 2-17 . This article reviews the role of infections...
Viruses
TNF-a has variable effects on viral pathogens. In some instances, the presence of TNF-a interferes with viral pathology in others it may be causative in pathogenesis 112 . Influenza is the most common serious infection likely to be contracted in patients receiving TNF-a inhibition. Administration of influenza vaccine seems to be safe 113 . At least six cases of varicella-zoster virus 114-116 have been described after first infusion of infliximab. Varicella-zoster virus usually occurs as a...
Ines Colmegna MDa Robert F Garry PhDb
aSection of Rheumatology, Department of Medicine, Louisiana State University Health Sciences Center, 2020 Gravier Street, New Orleans, LA 70112, USA bDepartment of Microbiology and Immunology, Tulane University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA 70112, USA Definition and characteristics of human endogenous retroviruses The human genome sequencing project and similar initiatives for other species have revealed that a large portion of vertebrate genomic DNA consists of...
Subacute osteomyelitis
Brodie's abscess, single or multiple radiolucent abscesses, can be evident during subacute or chronic stages of osteomyelitis. It is best diagnosed by the combination of conventional radiography and MRI 73 . The central abscess cavity is of low signal intensity on T1-weighted images and high signal Fig. 17. A Sagittal T1-weighted MRI TR TE, 500 12 shows a soft tissue abscess in the posterior aspect of the distal tibia. B Gadolinium enhanced T1-imaging demonstrates the extent of the infectious...
References Cag
1 Muir A, Lever A, Moffett A. Expression and functions of human endogenous retroviruses in the placenta an update. Placenta 2004 18 S16-25. 2 Nelson PN, Carnegie PR, Martin J, et al. Demystified. Human endogenous retroviruses. Mol Pathol 2003 56 11-8. 3 Lower R, Lower J, Kurth R. The viruses in all of us characteristics and biological significance of human endogenous retrovirus sequences. Proc Natl Acad Sci USA 1996 93 5177-84. 4 Mi S, Lee X, Li X, et al. Syncytin is a captive retroviral...
Hlab27
Because HLA-B27 is a class I histocompatibility antigen, it has been postulated that HLA-B27 presents arthritogenic microbial peptides to T cells stimulating an autoimmune response, so called molecular mimicry.'' A previous study has shown a high degree of conservation in the T-cell responses obtained from the synovial fluid of patients with recent ReA irrespective of the triggering organism 70 . Conversely, B27 itself may serve as the autoantigen that is targeted by the immune system. It is...
Combined antiretroviral treatment
From its introduction in 1997, HAART has become the cornerstone of HIV therapy 84 . Lipodystrophy, hyperlipidemia, hypertriglyceridemia, insulin resistance 85 , hyperglycemia, cardiovascular symptoms 86 , and hypothyroidism have been described as long-term side effects of HAART. From Rheumatic manifestations in HIV-positive patients before group 1 and after group 2 the advent of highly active antiretroviral therapy Rheumatic manifestations in HIV-positive patients before group 1 and after group...
Erysipelas
An infection of the upper dermis, erysipelas classically presents abruptly as a painful superficial cellulitis with associated fever, regional lymphade-nopathy, and lymphangitis. A prodrome of a flu-like illness may precede the appearance of rash by several hours to 2 days. Distinct elevated borders surround brightly erythematous plaques that have no central clearing. Usually involving the lower extremities in more than 75 to 90 of cases, the face also is reported to be involved in 2.5 to 10 of...
Human endogenous retroviruses and other autoimmune conditions
In this autoimmune condition characterized by an aberrant T-cell response against hair follicle self-antigens, serum antibodies reacting with human intracisternal A-type retrovirus proteins have been found 53 . Evidence implicating retroviruses in rheumatoid arthritis can be drawn from the parallels between human and animal retroviral infections. Animal retroviral pathogens, such as caprine arthritis encephalitis virus and maedi visna virus, cause chronic arthritis in sheep and goats with...
References Azw
1 Thomas DL, Lemon SM, Hepatitis C. In Mandell Gl, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 6th edition. Philadelphia Churchill Livingstone 2005. p. 1950-81. 2 Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines. MMWR 2006 55 No. RR-11 1-94. 3 Sterling RK, Bralow S. Extrahepatic manifestations of hepatitis C virus. Curr Gastroenterol Rep 2006 8 1 53-9. 4 Giordano N, Amendola A, Papakostas P, et al. Immune and...
Lesley Ann Saketkoo MD MPHabc Luis R Espinoza MDbc
aDivision of Rheumatology, Ochsner Clinic Foundation, New Orleans, LA, USA hSection of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, LA, USA cDepartment of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA Chronic inflammatory diseases lead to disabling destruction of joints, end-stage organ damage, hematologic derangements, and neurologic compromise. The introduction of biologic agents has produced an astounding transformation by...
Septic bursitis
Bursae are small sac-like cavities that contain fluid and are lined by a synovial membrane. They are located subcutaneously between bony prominences and tendons or in deeper fascial tissue between bone and muscle, essentially serving to reduce friction between these structures. Inflammation of bursae ie, bursitis can be caused by infection, particularly when the superficial subcutaneously located bursae are involved. These infections are typically secondary to local trauma and rarely...
News Prognostic Indicators Of Hospitalized Patients With Systemic Lupus
a Inferred from data presented includes patients in whom no pathogen was isolated but who responded to antibiotic treatment. b Mycobacterium tuberculosis is the most frequent isolate. c Only major infections included. d Minor and major infections included. Fig. 1. Lateral radiograph of the thoracic spine. There is loss of intervertebral disc space at T7-8 with loss of the endplate cortex anteriorly and little reactive bone formation Courtesy of Robert Lopez-Ben, Division of Diagnostic...
Furuncles and carbuncles
Furuncles ie, boils are single hair follicle-associated inflammatory nodules extending into the dermis and the subcutaneous tissue, usually affecting moist, hairy, friction-prone areas of the body, such as the face, axillae, neck, and buttocks. Firm and tender, these nodular erythematous lesions may spontaneously drain purulent material. Fever and other constitutional symptoms rarely are present. The most common causative microorganism is S aureus, but the microbiology of furuncles depends on...
Folliculitis
Folliculitis refers to a circumscribed superficial pustular infection of the hair follicle. These pruritic lesions, which are up to 5 mm in diameter, often present as small red papules with a central area of purulence that may rupture and drain. Systemic signs and symptoms are rare. Lesions typically are located on the head, back, buttocks, and extremities. The most common organism isolated is S aureus. A condition known as hot tub folliculitis is attributable to hot tub or whirlpool water...
Fred A Lopez MD Serge Lartchenko MD
Section of Infectious Diseases, Department of Internal Medicine, Louisiana State University Health Sciences Center, Box E7-17, 2020 Gravier Street, New Orleans, LA 70112, USA Primary skin infections ie, pyodermas typically are initiated by some breach in the epidermis, resulting in infection by organisms, such as Streptococcus pyogenes and Staphylococcus aureus, that colonize the skin. Host-associated factors, such as immunosuppression, vasculopathy, neuropathy, or decreased lymphatic drainage,...
Infectious tenosynovitis
Infection of the synovial sheaths that surround a tendon is known as te-nosynovitis. The flexor muscle-associated tendons and tendon sheaths of the hand are most commonly involved flexor tenosynovitis . Penetrating trauma is the most common inciting event and infection then can travel rapidly from the digit to ulnar and radial bursae. Acute infection is most commonly attributable to S aureus and other skin-associated flora, such as streptococci, although the nature of the traumatic injury may...
Polymerase chain reaction
Molecular technologies have increased the speed of antigen detection methods. The most widely used of these methods is PCR, a technique that enables the amplification of specific sequences of nucleic acids. The technique was originally described by Saiki and coworkers and subsequently perfected by Mullis in 1987. PCR can amplify minute amounts of target DNA 10 to 100 copies in clinical samples within a few hours. In the laboratory PCR is used for DNA sequencing, cloning, gene isolation, and...
Clinical applications of polymerase chain reaction
Newer DNA amplification methods have the potential significantly to influence the diagnosis and management of a variety of infectious diseases. Conventional laboratory diagnostic methods require a minimum of 24 hours and, in many cases, the time required is significantly longer. Moreover, cultures may yield no bacterial growth if there has been a delay in transporting the specimen to the laboratory, the number of viable infecting organisms is low, or the patient had been taking antibiotics at...