1/9. Human herpesvirus-6 and sudden death in infancy: report of a case and review of the literature.Investigation of sudden death in infancy is a vital function of the medical examiner's office. Surveillance of these cases may lead to recognition of new diseases or new manifestations of previously described diseases. Human herpesvirus-6 (HHV-6) is a relatively newly described virus that has been recognized as a cause of acute febrile illness in early childhood. While most cases are apparently self-limited, seven fatal cases have been reported. We present a case of a seven-month-old Latin American male with recent otitis media and vomiting who was found dead in bed. autopsy revealed interstitial pneumonitis with an atypical polymorphous lymphocytic infiltrate in the liver, kidney, heart, spleen, lymph nodes, and bone marrow, associated with erythrophagocytosis. polymerase chain reaction (PCR) analysis of formalin-fixed paraffin-embedded tissue was positive for HHV-6 and negative for Epstein-Barr virus (EBV) and cytomegalovirus (CMV). HHV-6 was also detected in the atypical lymphoid infiltrate by in-situ hybridization.- - - - - - - - - - ranking = 1keywords = hybridization (Clic here for more details about this article) |
2/9. Fatal BK polyoma viral pneumonia associated with immunosuppression.BK polyoma virus has a worldwide distribution in the human population. Primary BK infection takes place during childhood, with the virus remaining latent in many sites. Immunosuppressive states can lead to viral reactivation associated with many clinical sequelae. We report a case of fatal BK-related pneumonia in a 69-year-old patient who was immunocompromised because of chemotherapy for chronic lymphocytic leukemia. Immunohistochemical, in situ hybridization, and polymerase chain reaction studies on paraffin-embedded lung tissue proved bk virus as the etiologic agent of pneumonia. The histological picture was remarkable for numerous intranuclear large basophilic viral inclusions with ground-glass appearance mainly in type II pneumocytes. Similar to many other infectious agents, bk virus is emerging as an important pathogen in immunocompromised patients, making it important to consider in the differential diagnosis.- - - - - - - - - - ranking = 1keywords = hybridization (Clic here for more details about this article) |
3/9. Fatal neonatal pneumonia caused by adenovirus type 35. Report of one case and review of the literature.A 3680-g term male neonate developed bilateral bronchopneumonia at 9 days of age. The labor, delivery, and immediate postnatal period had been unremarkable. Despite standard antibiotic therapy, the patient progressed to respiratory failure and died 4 days later. Adenovirus particles were found in oropharyngeal secretions 1 day prior to death. autopsy revealed an extensive necrotizing bronchiolitis and alveolitis with frequent "smudge cells." Adenovirus was identified by culture, electron microscopy, and in situ dna hybridization. The adenovirus was serotyped as type 35, which, to our knowledge, has not been previously described in neonatal adenovirus pneumonia.- - - - - - - - - - ranking = 1keywords = hybridization (Clic here for more details about this article) |
4/9. ganciclovir and standard high-dose immunoglobulins for the treatment of cytomegalovirus interstitial pneumonia in a bone marrow recipient.A 47-year-old woman received an allogeneic bone marrow infusion because of chronic myeloid leukemia. Two months after the transplant she developed an interstitial pneumonia: bronchoalveolar lavage yielded cytomegalic cells with intranuclear bodies, and cytomegalovirus dna was detected by in situ hybridization techniques. ganciclovir and standard high-dose immunoglobulins were administered to the patient with resolution of the pneumonia. No relapse of pneumonia was observed after a 4-month follow-up. It seems that the favorable outcome of the potentially fatal pneumonia observed in this patient might be related to early diagnosis, and prompt administration of ganciclovir and standard high-dose immunoglobulins.- - - - - - - - - - ranking = 1keywords = hybridization (Clic here for more details about this article) |
5/9. Pulmonary infection in human immunodeficiency disease: viral pulmonary infections.Viral pneumonitides are among the known pulmonary complications of human immunodeficiency virus (hiv) infection. cytomegalovirus (CMV) pneumonitis is the most frequently recognized viral infection involving the lung. Although CMV may occasionally be the sole pathogen found to be responsible for severe pneumonitis in patients with the acquired immunodeficiency syndrome (AIDS), in most cases, its role in causing pulmonary disease is less clear, primarily because of the propensity to infect with a variety of other copathogens. CMV pneumonitis has been difficult to diagnose during life, although techniques utilizing in situ dna hybridization or monoclonal antibodies for detection of the virus may improve the diagnostic yield of less invasive procedures such as bronchoalveolar lavage. Pneumonitis due to herpes simplex virus, varicella-zoster, and respiratory syncytial virus have occasionally been reported in AIDS patients, and are of practical importance because of the availability of effective treatment. The role of influenza and adenoviruses in causing hiv-related pulmonary complications is unknown, but could be of importance during outbreaks of these infections. Finally, data from several studies now suggest that Epstein-Barr virus or hiv itself or both have a role in the pneumonitis. Further study in this area could provide information leading to more effective management of this common complication of childhood AIDS.- - - - - - - - - - ranking = 1keywords = hybridization (Clic here for more details about this article) |
6/9. Fatal adenovirus pneumonia in a newborn identified by electron microscopy and in situ hybridization.A male infant born at 25 weeks' gestation died at 2 weeks of age from progressive respiratory insufficiency, metabolic acidosis, and renal failure. autopsy revealed extensive hemorrhage and necrosis in the lungs, as well as hyaline membrane disease. Alveolar and bronchiolar lining cells contained frequent intranuclear inclusions visible by light microscopy that corresponded to arrays of icosahedral particles suggestive of adenovirus by electron microscopy. Confirmation of overwhelming adenovirus infection was made with in situ dna hybridization. This case demonstrates the advantage of dna probe analysis for retrospective diagnosis when no adequate specimen is available for culture or antigen detection. This case is also unusual in that a premature newborn had severe adenovirus infection.- - - - - - - - - - ranking = 5keywords = hybridization (Clic here for more details about this article) |
7/9. Adenovirus pneumonia in lung transplant recipients.Although Adenovirus (ADV) pneumonia has been documented in bone marrow, kidney, and liver transplantation recipients, it has only been sporadically reported in lung transplantation recipients. Among our 308 lung transplantation recipients, we identified four who developed ADV pneumonia. Formalin-fixed paraffin-embedded biopsy and autopsy specimens on all cases were studied by routine histology, immunohistochemistry (IHC), and by in situ hybridization (ISH) for evidence of ADV, and the results were correlated with the patients' clinical progression. Three of the four patients were children, and all four had a progressive and rapidly fatal course within 45 days posttransplantation. The lungs showed necrotizing bronchocentric pneumonia with tendency to spread diffusely to produce alveolar damage and organizing pneumonia. The occurrence of this rapidly fatal ADV pneumonia mainly affecting the pediatric population, early in the posttransplantation course, suggests that the infection is primary to the recipient with ADV either originating and reactivating in the donor lung or acquired from the upper respiratory tract of the recipient. The characteristic smudgy intranuclear inclusions of ADV, as well as IHC and ISH positivity, were observed in the lungs of all autopsies. Antemortem biopsy demonstration of ADV by inclusion formation, IHC, and ISH was observed in two patients. In another patient, antemortem ADV was shown only by ISH, and the recognition of inclusions was made difficult by coexistent CMV infection. Although IHC and ISH may have the potential for detecting early infection, recognition of the characteristic clinical setting with necrotizing bronchocentric pneumonia and smudgy intranuclear inclusions should alert one to the diagnosis of ADV pneumonia.- - - - - - - - - - ranking = 1keywords = hybridization (Clic here for more details about this article) |
8/9. Neonatal adenovirus infection: a case report with in situ hybridization confirmation of ascending intrauterine infection.Adenovirus infection is a rare, but serious infection, during the neonatal period. The actual model of infection at birth is currently unknown, however, several mechanisms have been proposed. We describe a case of fatal neonatal adenovirus pneumonia in a 25-wk gestational age infant. Adenovirus was confirmed by electron microscopy and by in situ hybridization. The maternal cervical/endocervical smear taken prior to the delivery contained epithelial cells with changes suggestive of adenovirus, which was confirmed by in situ hybridization on the smear. These findings suggest that ascending viral infection is a factor in the pathogenesis of neonatal adenovirus infection. The identification and reporting of adenovirus may be important during pregnancy in order to avoid delay in delivery of the fetus once membranes have ruptured.- - - - - - - - - - ranking = 6keywords = hybridization (Clic here for more details about this article) |
9/9. Rapid detection cytomegalovirus pneumonia in recipients of bone marrow transplant: evaluation and comparison of five survey methods for bronchoalveolar lavage fluid.To detect cytomegalovirus-associated interstitial pneumonia (CMV-IP) in recipients of BMT in its earliest stage, five CMV methods were assessed for their usefulness using bronchoalveolar lavage fluid as the test specimen. Of the 43 cases enrolled in the study, PCR was positive in 12 cases, shell vial in eight, culture in eight and cytology in three. There were no positive cases in in situ hybridization. Based on this result, the 43 cases were classified into four groups: Group 1, three cases: positive in PCR, shell vial and cytology; Group 2, five cases: positive in PCR and shell vial; Group 3, four cases: positive only in PCR; and Group 4, 31 cases: negative in all CMV tests. Cases in Group 1 were judged as having the highest risk of overt CMV-IP. They were successfully treated with a combination of ganciclovir and immunoglobulin. Group 2 was diagnosed as having active CMV infection and ganciclovir monotherapy was effective for these patients. Groups 3 and 4 were not given anti-CMV therapy, but they were free from CMV-related manifestations throughout the study. The sensitivity and specificity of each survey method for the detection of Groups 1 and 2 were 1.0 and 0.89 in PCR, 1.0 and 1.0 in shell vial, 0.88 and 1.0 in culture, and 0.38 and 1.0 in cytology. Similarly, the positive and negative predictive values were 0.67 and 1.0 in PCR, 1.0 and 1.0 in shell vial, 1.0 and 0.97 in culture, and 1.0 and 0.88 in cytology. Thus, CMV survey on bronchoalveolar fluid was thought to be useful in detecting post BMT CMV-IP in its earliest stage.- - - - - - - - - - ranking = 1keywords = hybridization (Clic here for more details about this article) |