scholarly journals Unusual presentations of a severe type 2 leprosy reaction mimicking sepsis induced by helminth infection

2021 ◽  
Vol 15 (7) ◽  
pp. e0009453
Author(s):  
Sri Linuwih Menaldi ◽  
Anastasia Asylia Dinakrisma ◽  
Hok Bing Thio ◽  
Iris Rengganis ◽  
Salma Oktaria
Keyword(s):  
Septic Shock ◽  
Unusual Case ◽  
Helminth Infection ◽  
Endoscopic Examination ◽  
Course Of Illness ◽  
Source Of Infection ◽  
Helminth Infections ◽  
History Of ◽  
Severe Type

We describe an unusual case of type 2 leprosy reaction (T2R) with septic shock–like features induced by helminth infection in a 31-year-old Moluccan male patient with a history of completed treatment of WHO multidrug therapy (MDT)–multibacillary (MB) regimen 2 years before admission. During the course of illness, the patient had numerous complications, including septic shock, anemia, and disseminated intravascular coagulation (DIC). Nevertheless, antibiotic therapies failed to give significant results, and the source of infection could not be identified. Helminth infection was subsequently revealed by endoscopic examination followed by parasitological culture. Resolution of symptoms and normal level of organ function–specific markers were resolved within 3 days following anthelmintic treatment. This report demonstrated the challenge in the diagnosis and treatment of severe T2R. Given that helminth infections may trigger severe T2R that mimics septic shock, health professionals need to be aware of this clinical presentation, especially in endemic regions of both diseases.

Cutibacterium acnes sternoclavicular joint osteomyelitis in an otherwise healthy 55-year-old man

2021 ◽  
Vol 14 (7) ◽  
pp. e241778
Author(s):  
Sean Yaphe ◽  
Kemal Bahcheli
Keyword(s):  
Unusual Case ◽  
Left Knee ◽  
Sternoclavicular Joint ◽  
Joint Injection ◽  
Cutibacterium Acnes ◽  
History Of ◽  
Haematogenous Spread ◽  
Body Joint ◽  
Full Body

Sternoclavicular joint osteomyelitis is extremely rare, with only 225 reported cases in the last 45 years. We present an unusual case in an otherwise healthy 55-year-old man with a history of well-controlled type 2 diabetes mellitus and hypertension. He presented to the emergency department after a week of left knee pain that worsened to full-body joint pain with left sternoclavicular swelling. He was started on antibiotics with multiple washouts of the left knee and treated for septic arthritis. By MRI and CT, he was found to have left sternoclavicular joint osteomyelitis and abscess and underwent debridement and resection. We believe that the initial joint injection resulted in haematogenous spread to the left sternoclavicular joint, stressing the importance of a sterile field for joint procedures.

Primary lung abscess due to multidrug-resistant Klebsiella pneumoniae

2021 ◽  
Vol 14 (9) ◽  
pp. e244759
Author(s):  
Mascarenhas Chrystle ◽  
Acharya Vishak ◽  
Kamath Sindhu ◽  
Mendonca Jane
Keyword(s):  
Klebsiella Pneumoniae ◽  
Unusual Case ◽  
Early Recognition ◽  
Multidrug Resistant ◽  
Community Acquired Pneumonia ◽  
Lung Abscess ◽  
Drug Resistant ◽  
Management Guidelines ◽  
History Of

Primary lung abscess as a complication of necrotising community-acquired pneumonia due to multidrug-resistant (MDR) Klebsiella pneumoniae is rare. A 63-year-old man with a medical history of type 2 diabetes mellitus and chronic kidney disease was diagnosed with lung abscess due to MDR Klebsiella pneumoniae, a rare organism as a causative agent for community-acquired pneumonia. This unusual case revealed therapeutic challenges faced owing to factors such as drug-resistant pathogen, longer duration of antibiotics required for lung abscess and the chronic kidney status of the patient limiting the dosage of antibiotics. The clinical nuggets discussed in this case might pave the way in the future for management guidelines to be formulated in optimising the selection and duration of therapy for lung abscesses with MDR aetiology and in early recognition of this rare but dreaded entity.

scholarly journals Glycosylated haemoglobin: a false sense of security

2018 ◽  
Vol 11 (1) ◽  
pp. e227668
Author(s):  
Emily Finan ◽  
Joe Joseph
Keyword(s):  
Unusual Case ◽  
Hereditary Spherocytosis ◽  
Reticulocyte Count ◽  
Blood Film ◽  
Glycosylated Haemoglobin ◽  
Sense Of Security ◽  
Peripheral Blood Film ◽  
False Sense ◽  
History Of

We report the unusual case of a patient found to have a low glycosylated haemoglobin (HbA1c) despite having recently been diagnosed with diabetes mellitus type 2. The patient, who was not anaemic, with no symptoms or family history of haematological conditions, was subsequently found to have an elevated reticulocyte count, inferring increased red cell turnover as the culprit for the discordant HbA1c result. A diagnosis of hereditary spherocytosis was made based on characteristic peripheral blood film appearances and confirmed by eosin-5-maleimide binding test. Exposure of an undiagnosed haemolytic anaemia by virtue of a low HbA1c is uncommon. However, conditions that distort HbA1c measurements are not infrequent. This case should serve to remind clinicians of the limitations of HbA1c in specified situations, and to remain vigilant when interpreting results.

scholarly journals ILC2s mediate systemic innate protection by priming mucus production at distal mucosal sites

2019 ◽  
Vol 216 (12) ◽  
pp. 2714-2723 ◽  
Author(s):  
Laura Campbell ◽  
Matthew R. Hepworth ◽  
Jayde Whittingham-Dowd ◽  
Seona Thompson ◽  
Allison J. Bancroft ◽  
...  
Keyword(s):  
Goblet Cell ◽  
Helminth Infection ◽  
Host Immunity ◽  
Mucosal Barrier ◽  
Parasitic Nematodes ◽  
Cell Hyperplasia ◽  
Mucus Production ◽  
Mucin Production ◽  
Helminth Infections

Host immunity to parasitic nematodes requires the generation of a robust type 2 cytokine response, characterized by the production of interleukin 13 (IL-13), which drives expulsion. Here, we show that infection with helminths in the intestine also induces an ILC2-driven, IL-13–dependent goblet cell hyperplasia and increased production of mucins (Muc5b and Muc5ac) at distal sites, including the lungs and other mucosal barrier sites. Critically, we show that type 2 priming of lung tissue through increased mucin production inhibits the progression of a subsequent lung migratory helminth infection and limits its transit through the airways. These data show that infection by gastrointestinal-dwelling helminths induces a systemic innate mucin response that primes peripheral barrier sites for protection against subsequent secondary helminth infections. These data suggest that innate-driven priming of mucus barriers may have evolved to protect from subsequent infections with multiple helminth species, which occur naturally in endemic areas.

scholarly journals Macrophage Activation and Functions during Helminth Infection: Recent Advances from the Laboratory Mouse

2018 ◽  
Vol 2018 ◽  
pp. 1-17 ◽  
Author(s):  
Marion Rolot ◽  
Benjamin G. Dewals
Keyword(s):  
Immune Responses ◽  
Helminth Infection ◽  
Laboratory Mouse ◽  
Alternative Activation ◽  
Recent Advances ◽  
Helminth Infections ◽  
Classically Activated Macrophages

Macrophages are highly plastic innate immune cells that adopt an important diversity of phenotypes in response to environmental cues. Helminth infections induce strong type 2 cell-mediated immune responses, characterized among other things by production of high levels of interleukin- (IL-) 4 and IL-13. Alternative activation of macrophages by IL-4 in vitro was described as an opposite phenotype of classically activated macrophages, but the in vivo reality is much more complex. Their exact activation state as well as the role of these cells and associated molecules in type 2 immune responses remains to be fully understood. We can take advantage of a variety of helminth models available, each of which have their own feature including life cycle, site of infection, or pathological mechanisms influencing macrophage biology. Here, we reviewed the recent advances from the laboratory mouse about macrophage origin, polarization, activation, and effector functions during parasitic helminth infection.

scholarly journals Pre-conception maternal helminth infection transfers via nursing long-lasting cellular immunity against helminths to offspring

2019 ◽  
Vol 5 (5) ◽  
pp. eaav3058 ◽  
Author(s):  
Matthew G. Darby ◽  
Alisha Chetty ◽  
Dunja Mrjden ◽  
Marion Rolot ◽  
Katherine Smith ◽  
...  
Keyword(s):  
Cellular Immunity ◽  
Helminth Infection ◽  
Maternal Transfer ◽  
T Helper ◽  
T Helper 2 ◽  
Source Of Infection ◽  
Systemic Development ◽  
Immune Transfer

Maternal immune transfer is the most significant source of protection from early-life infection, but whether maternal transfer of immunity by nursing permanently alters offspring immunity is poorly understood. Here, we identify maternal immune imprinting of offspring nursed by mothers who had a pre-conception helminth infection. Nursing of pups by helminth-exposed mothers transferred protective cellular immunity to these offspring against helminth infection. Enhanced control of infection was not dependent on maternal antibody. Protection associated with systemic development of protective type 2 immunity in T helper 2 (TH2) impaired IL-4Rα−/− offspring. This maternally acquired immunity was maintained into maturity and required transfer (via nursing) to the offspring of maternally derived TH2-competent CD4 T cells. Our data therefore reveal that maternal exposure to a globally prevalent source of infection before pregnancy provides long-term nursing-acquired immune benefits to offspring mediated by maternally derived pathogen-experienced lymphocytes.

scholarly journals The ChAT-acetylcholine pathway promotes group 2 innate lymphoid cell responses and anti-helminth immunity

2021 ◽  
Vol 6 (57) ◽  
pp. eabe3218
Author(s):  
Coco Chu ◽  
Christopher N. Parkhurst ◽  
Wen Zhang ◽  
Lei Zhou ◽  
Hiroshi Yano ◽  
...  
Keyword(s):  
Acetylcholine Receptors ◽  
Helminth Infection ◽  
Allergic Inflammation ◽  
Lymphoid Cells ◽  
Nippostrongylus Brasiliensis ◽  
Interleukin 5 ◽  
Helminth Infections ◽  
Group 2

Group 2 innate lymphoid cells (ILC2s) reside in multiple tissues, including lymphoid organs and barrier surfaces, and secrete type 2 cytokines including interleukin-5 (IL-5), IL-9, and IL-13. These cells participate in multiple physiological processes including allergic inflammation, tissue repair, metabolic homeostasis, and host defense against helminth infections. Recent studies indicate that neurotransmitters and neuropeptides can play an important role in regulating ILC2 responses; however, the mechanisms that underlie these processes in vivo remain incompletely defined. Here, we identify that activated ILC2s up-regulate choline acetyltransferase (ChAT)—the enzyme responsible for the biosynthesis of acetylcholine (ACh)—after infection with the helminth parasite Nippostrongylus brasiliensis or treatment with alarmins or cytokines including IL-25, IL-33, and thymic stromal lymphopoietin (TSLP). ILC2s also express acetylcholine receptors (AChRs), and ACh administration promotes ILC2 cytokine production and elicits expulsion of helminth infection. In accordance with this, ChAT deficiency in ILC2s leads to defective ILC2 responses and impaired immunity against helminth infection. Together, these results reveal a previously unrecognized role of the ChAT-ACh pathway in promoting type 2 innate immunity to helminth infection.

An Unusual Case of a Nasal Foreign Body in a Cat with Chronic Nasal Discharge

2015 ◽  
Vol 51 (4) ◽  
pp. 249-251 ◽  
Author(s):  
Emma Bellei ◽  
Luciano Pisoni ◽  
Monika Joechler ◽  
Marco Pietra
Keyword(s):  
Unusual Case ◽  
Infectious Virus ◽  
Endoscopic Examination ◽  
Nasal Discharge ◽  
Complete Disappearance ◽  
Canine Tooth ◽  
Maxillary Canine ◽  
History Of ◽  
The Right

This report describes a cat infected with the feline infectious virus and a 1 yr history of unilateral mucopurulent nasal discharge. Intraoral radiography and endoscopic examination revealed the presence of a large fragment of tooth root in the right nasal cavity. The cat had previously undergone maxillary canine tooth (104) extraction. The root was successfully removed by an endoscopic-assisted procedure, and follow-up examination 1 yr later documented complete disappearance of the respiratory signs.

scholarly journals Rare and unusual case of hepatic and disseminated tuberculosis in an immunocompetent patient

2019 ◽  
Vol 12 (6) ◽  
pp. e229384 ◽  
Author(s):  
Celestine Eshiwe ◽  
Farah Shahi ◽  
Neil Gordon ◽  
Patrick Lillie
Keyword(s):  
Septic Shock ◽  
Complex Disease ◽  
Unusual Case ◽  
Recovery Period ◽  
Central Nervous System Disease ◽  
Immunocompetent Patient ◽  
Immunocompetent Individual ◽  
System Disease ◽  
Liver Abscesses ◽  
History Of

Mycobacterium tuberculosis complex disease (tuberculosis (TB)) of the liver is rare and liver abscesses as a result are even rarer. In an immunocompetent individual, the disease tends to be localised. To the best of our knowledge, we report one of the most severe TB involvements of the liver in an immunocompetent individual. A young woman with a history of previous TB infection, presented in septic shock. Scans showed a liver filled with possible abscesses, one of which was aspirated and confirmed TB. Multiple HIV tests were negative but she remained lymphopaenic. Although she improved substantially with anti-tuberculous treatment, she later developed non-tuberculous central nervous system disease that we were unable to fully explain. Despite a stormy recovery period, she continues to do well.

scholarly journals Heterogeneous Tfh cell populations that develop during enteric helminth infection predict the quality of type 2 protective response

2021 ◽  
Author(s):  
Aidil Zaini ◽  
Lennard Dalit ◽  
Amania A. Sheikh ◽  
Daniel Thiele ◽  
Yan Zhang ◽  
...  
Keyword(s):  
Helminth Infection ◽  
Protective Role ◽  
Chromatin Accessibility ◽  
Cell Populations ◽  
Trichuris Muris ◽  
Cell Responses ◽  
Tfh Cells ◽  
Follicular Helper ◽  
Helminth Infections

T follicular helper (Tfh) cells are an important component of the germinal centre (GC)-mediated humoral immunity. Yet, how regulation of Tfh-GC responses impacts on effective responses to helminth infection are poorly understood. Here we show that chronic helminth Trichuris muris infection fails to induce Tfh-GC B cell responses, with Tfh cells expressing T-bet and IFN-γ. In contrast, Tfh cells that express GATA-3 and IL-4 dominate responses to an acute, resolving infection. Accordingly, heightened expression and increased chromatin accessibility of Th1- and Th2 cell-associated genes is observed in chronic and acute induced Tfh cells, respectively. However, both acute and chronic Tfh cell populations retained the capacity to produce IL-21 in spite of the Th-biased response. Blockade of Tfh-GC interactions impaired type 2 immunity, highlighting the protective role of GC-dependent Th2-like Tfh cell responses against helminths. Collectively, these results provide new insights into the protective roles of Tfh-GC responses and identify distinct transcriptional and epigenetic features of Tfh cells that emerge during resolving or chronic helminth infections.

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