Manisha J. Patel

Tumor Regression and Allograft Rejection after Administration of Anti–PD-1

Cancers, especially skin cancers, may develop in patients undergoing solid-organ transplantation who receive long-term immunosuppression. The use of anti–PD-1 in one such patient produced an antitumor response but led to rejection of the transplanted kidney.

Use of the Self-Administered Eczema Area and Severity Index by parent caregivers: results of a validation study.

Summary Background  The Eczema Area and Severity Index (EASI) is used by dermatological investigators world‐wide to assess eczema disease severity. EASI measures are, however, time‐consuming and require trained personnel, thereby limiting its application to large‐scale epidemiological studies. Additionally, the use of self‐assessed severity indices in dermatology is restricted to adult subjects and conditions, thereby not addressing the needs of paediatric patients.

Meningococcal Carriage Following a Vaccination Campaign With MenB-4C and MenB-FHbp in Response to a University Serogroup B Meningococcal Disease Outbreak—Oregon, 2015–2016

Background Limited data exist on the impact of the serogroup B meningococcal (MenB) vaccines MenB-FHbp and MenB-4C on meningococcal carriage and herd protection. We therefore assessed meningococcal carriage following a MenB vaccination campaign in response to a university serogroup B meningococcal disease outbreak in 2015. Methods A convenience sample of students recommended for vaccination provided oropharyngeal swab specimens and completed questionnaires during 4 carriage surveys over 11 months. Isolates were tested by real-time polymerase chain reaction analysis, slide agglutination, and whole-genome sequencing. Vaccination history was verified via university records and the state immunization registry. Results A total of 4225 oropharyngeal swab specimens from 3802 unique participants were analyzed. Total meningococcal and genotypically serogroup B carriage prevalence among sampled students were stable, at 11%-17% and 1.2%-2.4% during each round, respectively; no participants carried the outbreak strain. Neither 1-3 doses of MenB-FHbp nor 1-2 doses of MenB-4C was associated with decreased total or serogroup B carriage prevalence. Conclusions While few participants completed the full MenB vaccination series, limiting analytic power, these data suggest that MenB-FHbp and MenB-4C do not have a large, rapid impact on meningococcal carriage and are unlikely to provide herd protection in the context of an outbreak response.

Mumps Outbreak in a Highly Vaccinated University-Affiliated Setting Before and After a Measles-Mumps-Rubella Vaccination Campaign—Iowa, July 2015–May 2016

Background In response to a mumps outbreak at the University of Iowa and surrounding community, university, state, and local health officials implemented a vaccination campaign targeting students <25 years of age with an additional dose of measles-mumps-rubella (MMR) vaccine. More than 4700 vaccine campaign doses were administered; 97% were documented third doses. We describe the epidemiology of the outbreak before and after the campaign, focusing on cases in university students. Methods Mumps cases were identified from reportable disease databases and university health system records. Detailed information on student cases was obtained from interviews, medical chart abstractions, university and state vaccination records, and state public health laboratory results. Pre- and postcampaign incidence among students, university faculty/staff, and community members <25 vs ≥25 years old were compared using Fisher exact test. Multivariable regression modeling was performed to identify variables associated with a positive mumps polymerase chain reaction test. Results Of 453 cases in the county, 301 (66%) occurred in university students. Student cases were primarily undergraduates (90%) and highly vaccinated (86% had 2 MMR doses, and 12% had 3 MMR doses). Fewer cases occurred in students after the campaign (75 [25%]) than before (226 [75%]). Cases in the target group (students <25 years of age) declined 9% postcampaign (P=.01). A positive mumps polymerase chain reaction test was associated with the presence of parotitis and early sample collection, and inversely associated with recent receipt of MMR vaccine. Conclusions Following a large additional dose MMR vaccination campaign, fewer mumps cases occurred overall and in the target population.

HIV and Leprosy in the Eastern United States

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Visual discrimination testing of ultraviolet transmitting and ultraviolet blocking acrylic thermoplastics

Background: Visual perception has hindered the development of blinded, placebo‐controlled ultraviolet light exposure conditions in humans. New acrylic thermoplastics that block or transmit ultraviolet light have visual properties that may provide a solution.

Locally invasive dermal squamomelanocytic tumor with matrical differentiation: a peculiar case with review of the literature.

Abstract:Dermal-based combined squamous and melanocytic neoplasms are emerging clinicopathologic entities that tend to appear on sun-exposed areas of elderly patients. The biologic behavior of such cutaneous neoplasms remains uncertain because of their rarity. Histopathologic differential includes the following diagnostic entities: (1) dermal squamomelanocytic tumor, (2) melanocytic matricoma, and (3) rare histologic variant of pilomatrical carcinoma, the so-called pilomatrical carcinoma with intralesional melanocytes. Herein, we present a novel case of locally invasive dermal squamomelanocytic tumor. A 72-year-old man presented with a pigmented papule on nasal ala that was clinically concerning for basal cell carcinoma. Histopathologic evaluation demonstrated atypical melanocytic cells architecturally and intimately intermixed with single units and clusters of atypical squamous cells. Most notable feature of this case is focal matrical differentiation and locally invasive tumor growth, characterized by multifocal perineural invasion.

Cutaneous Small Vessel Vasculitis including Urticarial Vasculitis

Publisher Summary Vasculitis refers to inflammation and necrosis of blood vessels, whether they are arteries, veins or both. It can be local or systemic, and may be primary or secondary to another disease process. The classic cutaneous manifestation of vasculitis is palpable purpura; however, the clinical manifestation greatly depends on the size of the vessel affected. Leukocytoclastic vasculitis is a pathological description used to describe inflammation of post-capillary venules and is clinically more correctly termed “cutaneous small vessel vasculitis (CSVV).” CSVV occurs equally in both sexes and at all ages. It is estimated that 10% of affected patients are children. The histopathologic pattern is that of a leukocytoclastic vasculitis—angiocentric, segmental inflammation with nuclear dust, endothelial-cell swelling, and fibrinoid necrosis. The American College of Rheumatology (ACR) has proposed criteria for the diagnosis of hypersensitivity vasculitis, which corresponds to CSVV.