Case report: atypical presentation of vancomycin induced DRESS syndrome: a case report and review of the literature

Background

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity drug reaction involving the skin and multiple internal organ systems. The symptoms typically present with fever and skin rash, and rapidly progress to multiple organ failures. Vancomycin is a rare drug to cause DRESS syndrome with 23 cases reported to date.

Case presentation

We described a case of a 39 year-old man who was treated with vancomycin for osteomyelitis of the foot. The patient subsequently developed acute respiratory distress syndrome (ARDS) followed by rash and acute interstitial nephritis. These symptoms were improved by withdrawal of vancomycin and a pulsed corticosteroid regimen. According to the European Registry of Severe Cutaneous Adverse Reaction Criteria (RegiSCAR) (Kardaun et al, British Journal of Dermatology, 169:1071-1080, 2013), the probability of vancomycin induced DRESS syndrome was scored as “Definite”. A literature search of vancomycin induced DRESS syndrome was also performed and the overall pulmonary involvement was estimated as 5%. To our knowledge, this was the first case reported with pulmonary involvement as the initial symptom.

Conclusion

This is the first case to report pulmonary manifestation as the initial symptom in vancomycin induced DRESS syndrome. Prompt recognition of this entity can expedite proper treatment and hasten recovery.

     

VISTA deficiency attenuates antibody-induced arthritis and alters macrophage gene expression in response to simulated immune complexes

Background

In addition to activated T cells, the immune checkpoint inhibitor “V domain-containing Ig suppressor of T-cell activation” (VISTA) is expressed by myeloid cell types, including macrophages and neutrophils. The importance of VISTA expression by myeloid cells to antibody-induced arthritis and its potential for relevance in human disease was evaluated.

Methods

VISTA was immunolocalized in normal and arthritic human synovial tissue sections and synovial tissue lysates were subjected to western blot analysis. The collagen antibody-induced arthritis model (CAIA) was performed with DBA/1 J mice treated with antibodies against VISTA and with VISTA-deficient mice (V-KO). Total mRNA from arthritic joints, spleens, and cultured macrophages was analyzed with NanoString arrays. Cytokines secreted by splenic inflammatory macrophages were determined. In-vitro chemotaxis and signal transduction assays were performed with cultured macrophages.

Results

VISTA protein was localized to synovial membrane cells, neutrophils, and scattered cells in lymphocyte-rich foci and was detected by western blot analysis in normal synovium and synovium from rheumatoid arthritis patients. Deficiency of VISTA or treatment of mice with anti-VISTA monoclonal antibodies attenuated CAIA. Joint damage and MMP-3 expression were significantly reduced in V-KO mice. Surface expression of C5a receptor was reduced on monocytes, neutrophils, and cultured macrophages from V-KO. Upon Fc receptor engagement in vitro, gene expression by V-KO macrophages was altered profoundly compared to WT, including a significant induction of IL-1 receptor antagonist (IL1rn).

Conclusions

VISTA expression supports immune-complex inflammation in CAIA and VISTA is expressed in human synovium. VISTA supports optimal responses to C5a and modulates macrophage responses to immune complexes.

     

Sunflower stem weevil and its larval parasitoids in the Central and Northern Plains of the USA

The sunflower stem weevil, Cylindrocopturus adspersus (LeConte) (Coleoptera:Curculionidae), is apest of cultivated sunflower (Helianthusannuus L) from the southern to the northernGreat Plains. The incidence of weevilinfestation in fields from the six differentstates sampled during 1996 and 1997 ranged from33% (Minnesota) to 100% (Kansas, Colorado,Nebraska). Weevil populations in the fieldssampled were statistically greater in thecentral Plains (Colorado, Kansas, Nebraska)with a mean of 12.3 and 19.5 larvae per stalkcompared with the northern Plains (North andSouth Dakota, Minnesota) of 0.7 and 1.3 larvaeper stalk in 1996 and 1997, respectively.Parasitization of weevils varied from field tofield ranging from 1 to 100%, but was usuallyless than 20%. The nine species oflarval parasitoids recovered were allHymenoptera and included: Nealioluscurculionis (Fitch), N. collaris(Brues), Bracon sp. (Braconidae); Neocatolaccus tylodermae (Ashmead), Chlorocytus sp., Pteromalus sp.(Pteromalidae); Quadrastichus ainslieiGahan (Eulophidae), Eurytoma tylodermatisAshmead (Eurytomidae); and Eupelmus sp.(Eupelmidae). Nealiolus curculionis wasthe most prevalent parasitoid reared from C. adspersus, and it was recovered from allstates sampled. Parasitoid species richness wasgreatest in the central Plains. Thereduced number of parasitoid species foundattacking C. adspersus in the northernPlains may be caused by low host populationlevels, slow migration by parasitoids into theregion, or lack of adaptation to climaticconditions. Additional work to understandthe population dynamics of the parasitoidcomplex associated with C. adspersus mayresult in improved biological control of thesunflower stem weevil in cultivatedsunflower.     

Direct capture and cloning of receptor kinase and peroxidase genes from genomic DNA.

A direct DNA capture and cloning procedure with magnetic bead separation was used to isolate receptor kinase like and peroxidase genes from oat (Avena sativa) and wheat (Triticum aestivum L.) genomic DNA, respectively. In this procedure, the digoxigenin-labeled probe DNA and target genomic DNA fragments were mixed, denatured, and hybridized. The double-helix complexes formed were captured with anti-digoxigenin immunoglobulin-coated magnetic beads and then cloned into either the lambdaBlueSTAR or pUC18 vector. The effectiveness of this procedure was demonstrated by using two specific DNA probes to capture receptor-like kinase genes and surrounding sequences from oat genomic DNA and a peroxidase gene from wheat genomic DNA.     

Genetic and physical mapping of Lrk10-like receptor kinase sequences in hexaploid oat (Avena sativa L.).

Oat receptor-like kinase gene sequences, homologous to the Lrk10 gene from wheat (Triticum aestivum L.), were mapped in oat (Avena sativa L.). PCR primers designed from the wheat Lrk10 were used to produce ALrk10 from oat. Two DNA sequences, ALrk1A1 and ALrk4A5, were produced from primers designed from coding and noncoding regions of ALrk10. Their use as RFLP probes indicated that the kinase genes mapped to four loci on different hexaploid oat 'Kanota' x 'Ogle' linkage groups (4_12, 5, 6, and 13) and to a fifth locus unlinked to other markers. Three of these linkage groups contain a region homologous to the short arm of chromosome I of wheat and the fourth contains a region homologous to chromosome 3 of wheat. Analysis with several nullisomics of oat indicated that two of the map locations are on satellite chromosomes. RFLP mapping in a 'Dumont' x 'OT328' population indicated that one map location is closely linked to Pg9, a resistance gene to oat stem rust (Puccinia graminis subsp. avenae). Comparative mapping indicates this to be the region of a presumed cluster of crown rust (Puccinia coronata subsp. avenae) and stem rust resistance genes (Pg3, Pg9, Pc44, Pc46, Pc50, Pc68, Pc95, and PcX). The map position of several RGAs located on KO6 and KO3_38 with respect to Lrk10 and storage protein genes are also reported.     

Body-weight-support treadmill training improves blood glucose regulation in persons with incomplete spinal cord injury.

The impact of a 6-mo body-weight-supported treadmill training program on glucose homeostasis and muscle metabolic characteristics was investigated. Nine individuals (31 +/- 3 yr, 8.1 +/- 2.5 yr postinjury; means +/- SE) with incomplete spinal cord injury trained three times weekly for a total of 6 mo. Training session duration and intensity (velocity) increased by 54 +/- 10% (P < 0.01) and 135 +/- 20%, respectively. Muscle biopsies and a modified glucose tolerance test (100 g glucose with [U-(13)C]glucose) were performed before (Pre) and after training (Post). Training resulted in a reduction in area under the curve of glucose x time (-15 +/- 4%) and insulin x time (-33 +/- 8%; both P < 0.05). Oxidation of exogenous (ingested) glucose increased as a result of training (Pre = 4.4 +/- 0.7 g/h, Post = 7.4 +/- 0.6 g/h; P < 0.05), as did oxidation of endogenous (liver) glucose (Pre = 3.8 +/- 0.3 g/h, Post = 5.2 +/- 0.3 g/h; P < 0.05). Training resulted in increased muscle glycogen (80 +/- 23%; P < 0.05) and GLUT-4 content and hexokinase II enzyme activity (126 +/- 34 and 49 +/- 4%, respectively, both P < 0.01). Resting muscle phosphocreatine content also increased after training (Pre = 62.1 +/- 4.3, Post = 78.7 +/- 3.8, both mmol/kg dry wt and P < 0.05). Six months of thrice-weekly body-weight-supported treadmill training in persons with an incomplete spinal cord injury improved blood glucose regulation by increasing oxidation and storage of an oral glucose load. Increases in the capacity for transport and phosphorylation glucose in skeletal muscle likely play a role in these adaptations.     

Fish don't read textbooks: juvenile salmon prove ignorant of foraging theory

The rules governing the selection of feeding patches by foraging animals is an area of intense interest. Much work has focussed on the development of theoretical models that predict when individuals should switch patches. Tests of these models have often been conducted in laboratory environments, but it is not clear how much influence patch‐switching decisions have on population‐level parameters such as growth and distribution in more complex natural environments. We used juvenile Atlantic salmon as a model species to investigate the effects of randomly fluctuating food levels on growth and site selection. We used PIT technology to monitor in detail individuals' patterns of patch use and activity in an artificial stream, at natural densities. This allowed us experimental control of food supplies and sufficient replication, while retaining many features of a natural system. Only a few individuals of high social rank switched patches as predicted by an appropriate foraging model; otherwise, although frequent, patch‐switching was not related to food availability. Thus, while laboratory experiments indicate that this species has the potential to choose foraging sites on the basis of food availability, it is unlikely that this behavioural mechanism is of great importance in natural systems; further tests of foraging models under natural conditions are essential if we are to understand their effects at the level of populations.     

Exploring the Radial and Longitudinal Aeration of Primary Maize Roots by Means of Clark-Type Oxygen Microelectrodes

Clark-type oxygen microelectrodes were used to measure the radial and longitudinal oxygen distribution in aerenchymatous and nonaerenchymatous primary roots of intact maize seedlings. A radial intake of oxygen from the rooting medium was restricted by embedding the roots in 1% agar causing aeration to be largely dependent upon longitudinal internal transport from the shoot. In both root types, oxygen concentrations declined with distance from the base, and were lower in the stele than in the cortex. Also, the bulk of the oxygen demand was met internally by transport from the shoots, but a little oxygen was received by radial inward diffusion from the surrounding agar, and in some positions the hypodermal layers received oxygen from both the agar and the cortex. Near to the base, the oxygen partial pressure difference between the cortex and the center of the stele could be as much as 6–8 kPa. Nearer to the tip, the differences were smaller but equally significant. In the nonaerenchymatous roots, cortical oxygen partial pressures near the apex were becoming very low (< 1 kPa) as root lengths approached 100 mm, and towards the center of the stele values reached 0.1 kPa or lower. However, the data indicated that respiratory activity did not decline until the cortical oxygen pressure was less than 2 kPa. Mathematical modeling based on Michaelis–Menten kinetics supported this and suggested that the respiratory decline would be mostly restricted to the stele until cortical oxygen pressures approached very low values. At a cortical oxygen pressure of 0.75 kPa, it was shown that respiratory activity in the pericycle and phloem might remain as high as 80–100% of maximum even though in the center of the stele it could be less than 1% of maximum. Aerenchyma production resulted in increases in oxygen concentration throughout the roots with cortical partial pressures of ca. 5–6 kPa and stelar values of ca. 3–4 kPa near the tips of 100 mm long roots. In aerenchymatous roots, there was some evidence of a decline in the oxygen permeability of the epidermal–hypodermal cylinder close to the apex; a decline in stelar oxygen permeability near the base was indicated for both root types. There was some evidence that the mesocotyl and coleoptile represented a very significant resistance to oxygen transport to the root.     

Separation, identification, and characterization of microorganisms by capillary electrophoresis.

The use of capillary electrophoresis (CE) for the analysis, identification, and characterization of microorganisms has been gaining in popularity. The advantages of CE, such as small sample requirements, minimal sample preparation, rapid and simultaneous analysis, ease of quantitation and identification, and viability assessment, make it an attractive technique for the analysis of microbial analytes. As this instrumental method has evolved, higher peak efficiencies have been achieved by optimizing CE conditions, such as pH, ionic strength, and polymer additive concentration. Experimental improvements have allowed better quantitation and more accurate results. Many practical applications of this technique have been investigated. Viability and identification of microbes can be accomplished in a single analysis. This is useful for evaluation of microbial analytes in consumer products. Diagnosis of microbe-based diseases is now possible, in some cases, without the need for culture methods. Microbe-molecule, virus-antibody, or bacteria-antibiotic interactions can be monitored using CE, allowing for the screening of possible drug candidates. Fermentation can be monitored using this system. This instrumental approach can be adapted to many different applications, including assessing the viability of sperm cells. Progress has been made in the development of microelectrophoresis instrumentation. These advances will eventually allow the development of small, dedicated devices for the rapid, repetitive analyses of specific microbial samples. Although these methods may never fully replace traditional approaches, they are proving to be a valuable addition to the collection of techniques used to analyze, quantitate, and characterize microbes. This review outlines the recent developments in this rapidly growing field.