Eli Ben-Chetrit

Coxsackievirus A6-related hand foot and mouth disease: Skin manifestations in a cluster of adult patients

BACKGROUND Hand foot and mouth disease (HFMD) is a common childhood manifestation of enterovirus (EV) infection. It predominantly affects young children, and has been mainly associated with coxsackievirus (CV) A16 and EV 71. OBJECTIVES We report an unusual cluster of adult patients with HFMD. STUDY DESIGN Throat swabs and vesicular fluid samples obtained from patients admitted to the emergency room (ER) with HFMD were tested for EV by reverse transcription (RT)-real time PCR, and further subjected to sequencing and phylogenetic analysis. RESULTS CVA6 was identified as the causative agent of HFMD in five epidemiologically-unrelated adult patients (28-37 years old) admitted to the ER between December 2012 and February 2013. Phylogenetic analysis mapped the CVA6 strains into one cluster. All patients manifested with fever and a severe vasculitis-like rash, followed by spontaneous recovery. CONCLUSIONS This cluster identifies CVA6 as an emerging cause of HFMD of unusual age distribution, seasonality, and clinical severity, underscoring the need for continued alertness and clinical-genotypic surveillance of EV HFMD.

Pregnancy outcomes in women with Familial Mediterranean Fever receiving colchicine: Is amniocentesis justified?

To evaluate the outcome of pregnancies in women with familial Mediterranean fever (FMF) who are taking colchicine, and to reconsider the justification for amniocentesis in these women.

Antiphospholipid antibodies during infectious mononucleosis and their long term clinical significance

BACKGROUND The prevalence of antiphospholipid antibodies (aPLs) during acute Epstein-Barr virus (EBV) infection may be as high as 30-60%. The role of these autoantibodies in the development of antiphospholipid syndrome (APS) is not clear. OBJECTIVE To investigate the prevalence, persistence and clinical significance of aPLs in a series of patients diagnosed with acute EBV infection. STUDY DESIGN A cohort of 94 patients aged 15 or older, recently diagnosed with acute EBV was retrieved. Serum samples obtained during diagnosis were tested for the presence of aPLs and anti-β2GP antibodies. Patients with positive sera for aPLs were assessed for the persistence of aPLs and the development of APS. RESULTS The prevalence of aPLs among 94 patients with acute EBV was 37.2%. Five of 27 available serum samples were also positive for anti-β2 glycoprotein (anti-β2GP) antibodies. Repeat testing for aPLs after a median of 21 months post acute infection (range 13-50 months) was performed in 17 of the 35 patients with positive aPL test. All 17 patients were found negative for aPL-IgG antibodies. Two of them had positive aPL-IgM antibodies and positive anti-β2GP antibodies. None of the patients who had positive aPLs experienced any manifestations of APS. CONCLUSION The disappearance of aPLs in the majority of the patients after acute EBV infection, along with the absence of consistent clinical findings, suggests that the detection of aPLs during acute EBV is not associated with the development APS over time.

Schistosomiasis in Pregnant Travelers: A Case Series

BACKGROUND Travel-related acquisition of schistosomiasis in Africa is well established. Data concerning Schistosoma infection in pregnant travelers are lacking and treatment derives from studies in endemic regions. METHODS This study was a retrospective case-series of pregnant patients who were infected with Schistosoma species. Data regarding exposure history, clinical presentation, diagnosis, treatment, and fetal outcomes were collected and analyzed. Diagnosis of schistosomiasis was based on serology tests and/or ova recovery. RESULTS Travel-related schistosomiasis during pregnancy was diagnosed in 10 travelers (with 20 pregnancies). Of the 10 women, 4 pregnant travelers with recent exposure were treated during their pregnancy with praziquantel (PZQ). The course and outcome of pregnancy in these patients was uneventful, and treatment had no apparent adverse effects on either the mothers or their babies. Six asymptomatic women were diagnosed years after exposure. During this period, they gave birth to 13 babies. They were never treated with PZQ. Birth weights of their infants were significantly smaller as compared with those of the infants of the women who were treated during their pregnancy (median 2.8 vs 3.5 kg). One baby was born preterm. One patient had three miscarriages. CONCLUSION This is the first case-series of pregnant travelers with schistosomiasis. Although a small case-series with possible confounders, it suggests that schistosomiasis in pregnant travelers can be treated. A trend of lower birth weights was observed in the infants of the pregnant travelers who were not treated. PZQ therapy during pregnancy was not associated with adverse pregnancy or fetal outcomes in those four cases. Our results emphasize the importance of screening female travelers of childbearing age with a relevant history of freshwater exposure. Further studies are needed to reinforce these recommendations.

Serum levels of anti-streptolysin O antibodies: their role in evaluating rheumatic diseases

Background:  Family physicians measure serum levels of anti‐streptolysin O antibodies (ASO) in the routine evaluation of patients with rheumatic conditions.

Ten years with colistin: a retrospective case series.

At the Shaare Zedek Medical Center, we have been using colistimethate sodium (CMS) for empiric as well as pathogen‐directed treatment. We present our 10‐year experience.

Vector-borne diseases in Haiti: a review.

Haiti lies on the western third of the island of Hispaniola in the Caribbean, and is one of the poorest nations in the Western hemisphere. Haiti attracts a lot of medical attention and support due to severe natural disasters followed by disastrous health consequences. Vector-borne infections are still prevalent there with some unique aspects comparing it to Latin American countries and other Caribbean islands. Although vector-borne viral diseases such as dengue and recently chikungunya can be found in many of the Caribbean islands, including Haiti, there is an apparent distinction of the vector-borne parasitic diseases. Contrary to neighboring Carribbean islands, Haiti is highly endemic for malaria, lymphatic filariasis and mansonellosis. Affected by repeat natural disasters, poverty and lack of adequate infrastructure, control of transmission within Haiti and prevention of dissemination of vector-borne pathogens to other regions is challenging. In this review we summarize some aspects concerning diseases caused by vector-borne pathogens in Haiti.

Ciprofloxacin-Induced Psychosis

A 64-year-old male patient was admitted with fever and productive cough. Past medical history included chronic obstructive pulmonary disease (COPD), bronchiectasis, and hypertension. He was regularly treated with ramipril. Auscultation of the chest revealed mild expiratory wheezes in both lung

Colchicine dose reduction in patients with normal liver and kidney function: Comment on the article by Terkeltaub et al

addition, B cells attracted by CXCL13 are capable of releasing cytokines, such as tumor necrosis factor, which in turn activate fibroblast-like synoviocytes in the synovial lining, the area where MMPs are expressed in the synovium (5). Whether CXCL13 directly induces MMPs from a synovial cell population is currently unknown. However, correlation does not constitute evidence of causation, and there are currently no data to support the notion of CXCL13 as a key causative factor in the pathology of RA. It is therefore entirely possible that the aforementioned relationships between CXCL13 and measures of erosion reflect the usefulness of CXCL13 as a marker of burden of synovitis, rather than indicating a direct link between the two. We look forward to further studies of the potential role of CXCL13 as both a causative factor in, and a biomarker of, synovial inflammation and, like Meeuwisse et al, we believe that circulating levels of CXCL13 might offer a window into the environment of inflammation in the rheumatic joint.

Ventricular Septal Defect Associated Right-sided Infective Endocarditis Complicated by Septic Pulmonary Emboli☆

A 29-year-old white male was admitted to the hospital due to fever, dyspnea and cough over the past week. The patient was generally healthy and did not take any medications. He denied use of alcohol, illicit drugs or recent travel. His social history was notable for parrot exposure while visiting a relative a week before the onset of his symptoms. On examination, the patient had a temperature of 38.41C, blood pressure 110/80 and pulse 130 beats/ minute. Respiratory rate was 32 breaths/minute and oxygen saturation was 86% on room air. A grade 4/6 holosystolic murmur was heard at the left lower sternal border. There were fine inspiratory crackles over both lung fields. No rash was noted.