Malaria, erythrocytic infection, and anemia.

Authors: Haldar K; Mohandas N Author Address: Center for Rare and Neglected Diseases, University of Notre Dame, South Bend, IN, USA. khaldar@nd.edu Source: Hematology / The Education Program Of The American Society Of Hematology. American Society Of Hematology. Education Program [Hematology Am Soc Hematol Educ Program] 2009, pp. 87-93. Publication Type: Journal Article; Research Support, N.I.H., Extramural; Review Language: English Journal Information: Country of Publication: United States NLM ID: 100890099 Publication Model: Print Cited Medium: Internet ISSN: 1520-4383 (Electronic) Linking ISSN: 15204383 NLM ISO Abbreviation: Hematology Am Soc Hematol Educ Program Subsets: MEDLINE MeSH Terms: Anemia/*etiology Erythrocytes/*parasitology Malaria/*blood Parasitemia/*blood Animals ; Child ; Cytokines/secretion ; Erythropoiesis ; Host-Parasite Interactions ; Humans ; Inflammation ; Malaria/complications ; Malaria/immunology ; Malaria/parasitology ; Malnutrition/blood ; Malnutrition/complications ; Mice ; Parasitemia/complications ; Parasitemia/immunology ; Parasitology/methods ; Plasmodium/immunology ; Plasmodium/physiology ; Protozoan Proteins/blood ; Protozoan Proteins/immunology ; Protozoan Proteins/physiology ; Spleen/physiopathology Abstract: Malaria is a major world health problem. It results from infection of parasites belonging to the genus Plasmodium. Plasmodium falciparum and Plasmodium vivax cause the major human malarias, with P falciparum being the more virulent. During their blood stages of infection, both P falciparum and P vivax induce anemia. Severe malarial anemia caused by P falciparum is responsible for approximately a third of the deaths associated with disease. Malarial anemia appears to be multi-factorial. It involves increased removal of circulating erythrocytes as well as decreased production of erythrocytes in the bone marrow. The molecular mechanisms underlying malarial anemia are largely unknown. Over the last five years, malaria parasite ligands have been investigated for their remodeling of erythrocytes and possible roles in destruction of mature erythrocytes. Polymorphisms in cytokines have been associated with susceptibility to severe malarial anemia: these cytokines and malaria "toxins" likely function by perturbing erythropoiesis.

Finally a number of co-infections increase susceptibility to malarial anemia, likely because they exacerbate inflammation caused by malaria. Because of the complexities involved, the study of severe malarial anemia may need a "systems approach" to yield comprehensive understanding of defects in both erythropoiesis and immunity associated with disease. New and emerging tools such as (i) mathematical modeling of the dynamics of host control of malarial infection, (ii) ex vivo perfusion of human spleen to measure both infected and uninfected erythrocyte retention, and (iii) in vitro development of erythroid progenitors to dissect responsiveness to cytokine imbalance or malaria toxins, may be especially useful to develop integrated mechanistic insights and therapies to control this major and fatal disease pathology. Number of References: 42 Grant Information: P01 HL 078826 United States HL NHLBI NIH HHS; P01 HL078826-05 United States HL NHLBI NIH HHS; R01 AI 039071 United States AI NIAID NIH HHS; R01 AI039071-10 United States AI NIAID NIH HHS; R01 HL 079397 United States HL NHLBI NIH HHS; R01 HL069630 United States HL NHLBI NIH HHS; R01 HL06963009 United States HL NHLBI NIH HHS; R01 HL079397-04 United States HL NHLBI NIH HHS Contributed Indexing: Indexing Agency: NLM Local ID #: NIHMS216235. Substance Nomenclature: 0 (Cytokines) 0 (Protozoan Proteins) Entry Dates: Date Created: 20091216 Date Completed: 20100315 Latest Revision: 20110609 Update Code: 20110610 PubMed Central ID: PMC2933134 PMID: 20008186 Database: MEDLINE with Full Text

Study of respiratory influenza A H1N1 Virus (pH1N1) in hospitalized children in the pandemic year. Experience in 34 centers in Argentina

Transliterated Title: Estudio de las enfermedades respiratorias por virus Influenza A H1N1 (pH1N1) en nios internados durante el ao de la pandemia. Experiencia de 34 centros en la Argentina. Authors: Gentile ; Bakir J; Russ C; Ruvinsky S; Ensinck G; Falaschi A; Can A; Lucin F; Bruno M; Moreno R; Bidone N Author Address: Hospital de Nios Ricardo Gutirrez. angelagentile@fibertel.com.ar Source: Archivos Argentinos De Pediatra [Arch Argent Pediatr] 2011 Jun; Vol. 109 (3), pp. 198203. Publication Type: English Abstract; Journal Article Language: Spanish Journal Information: Country of Publication: Argentina NLM ID: 0372460 Publication Model: Print Cited Medium: Internet ISSN: 1668-3501 (Electronic) Linking ISSN: 03250075 NLM ISO Abbreviation: Arch Argent Pediatr Subsets: In Process; MEDLINE Abstract: Introduction: In Argentina, pandemic influenza pH1N1 caused nearly 10,000 confirmed cases with high impact in pediatrics. Objectives: To describe clinical and epidemiological characteristics and analyse the risk factor of lethality in children hospitalized with infection pH1N1 confirmed by PCR. Population and Methods: We identifed all suspected cases (according to Ministry of health) in 34 centers and we included all the confirmed cases of 0-18 years from 1/4/09 to 31/8/09 in a retrospective cohort study. The viral diagnosis was confirmed by RT-PCR method. Data are expressed in percentages, average, median, standard deviation, and range (IQR) as appropriate; and as a measure of association, relative risk (RR), with 95% confidence interval (95%CI). Multiple logistic regression was conducted to determine the independent risk predictors. Results: Total number of suspected cases were: 2367; PCR was performed to 47.8% (n: 1131) being positive for pH1N1 65.5% (n: 741/1131); 57.2% males; 61.5% <24 months, median age: 14 months (IQR 6-46 months); 45.1% with underlying disease; more frequent clinical pictures were: pneumonia (39,7%) and bronchiolitis 25.8%; Casefatality rate: 5.9% (44/741). Mortality risk factors were [RR (95%CI)]: neurological disease [5.00 (2.84-8.81)], genetic disease [3.67 (1.58-8.52)], malnutrition [3,07 (1.466.48)] and prematurity [2.28 (1.14-4.56)]. Independent mortality predictor: neurological disease [3.84 (1.81-8.14)]. No significant association between age, chronic respiratory disease, immunosuppression and viral co-infection with lethality was observed.

Conclusions: Almost half of children with pH1N1 infection had underlying disease; the neurological condition was a separate CFR predictor. Entry Dates: Date Created: 20110610 Update Code: 20110729 PMID: 21660384 Database: MEDLINE with Full Text

The role of parenteral nutrition in acute leukemia.

Authors: Jacobson NB; Parekh N; Kalaycio M Author Address: Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Source: Current Hematologic Malignancy Reports [Curr Hematol Malig Rep] 2006 Sep; Vol. 1 (3), pp. 188-94. Publication Type: Journal Article; Review Journal Information: Country of Publication: United States NLM ID: 101262565 Publication Model: Print Cited Medium: Internet ISSN: 1558-822X (Electronic) Linking ISSN: 15588211 NLM ISO Abbreviation: Curr Hematol Malig Rep Subsets: MEDLINE MeSH Terms: Parenteral Nutrition*/adverse effects Leukemia/*complications Malnutrition/*therapy Acute Disease ; Adrenal Cortex Hormones/adverse effects ; Adrenal Cortex Hormones/therapeutic use ; Antineoplastic Agents/adverse effects ; Antineoplastic Agents/therapeutic use ; Combined Modality Therapy ; Eating Disorders/complications ; Enteral Nutrition ; Fatty Liver/etiology ; Gastrointestinal Diseases/complications ; Graft vs Host Disease/complications ; Hematopoietic Stem Cell Transplantation/adverse effects ; Humans ; Hyperglycemia/etiology ; Immunosuppression/adverse effects ; Infection/complications ; Leukemia/therapy ; Malnutrition/diagnosis ; Malnutrition/etiology ; Mucositis/complications ; Nutritional Requirements ; Radiotherapy/adverse effects ; Risk Factors Abstract: Patients with acute leukemia who undergo hematopoietic stem cell transplantation (HSCT) are susceptible to malnutrition caused by several factors including intensive cytotoxic therapy. This paper discusses the significance of malnutrition in these patients and provides an overview of nutrition therapy by the oral, enteral, and parenteral routes. The goal is to investigate whether the use of parenteral nutrition (PN) produces improved clinical outcomes in patients with acute leukemia and to identify criteria for the selection of patients most likely to benefit from this therapy. Although PN may be appropriate for patients suffering from complications such as graft-versus-host disease (GVHD) and mucositis, the data available at this time do not support PN as first-line therapy for all recipients of HSCT. Number of References: 58 Substance Nomenclature: 0 (Adrenal Cortex Hormones) 0 (Antineoplastic Agents) Entry Dates: Date Created: 20100428 Date Completed: 20100806 Update Code:

Liver glutathione and cytochrome P450 activity in experimental infection: study of the relative effects of infectious stress and malnutrition.
Authors: Lescut D; Fouin-Fortunet H; Moore N; Petit J; Hecketsweiler B; Lemeland JF; Denis P; Colin R Author Address: Groupe de Biochimie et de Physiopathologie Digestive et Nutritionnelle, Hpital Charles Nicolle, Rouen, France. Source: Critical Care Medicine [Crit Care Med] 1991 Sep; Vol. 19 (9), pp. 1183-7. Publication Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Journal Information: Country of Publication: UNITED STATES NLM ID: 0355501 Publication Model: Print Cited Medium: Print ISSN: 0090-3493 (Print) Linking ISSN: 00903493 NLM ISO Abbreviation: Crit. Care Med. Subsets: Core Clinical (AIM); MEDLINE MeSH Terms: Cytochrome P-450 Enzyme System/*metabolism Escherichia coli Infections/*metabolism Glutathione/*metabolism Liver/*metabolism Nutrition Disorders/*metabolism Staphylococcal Infections/*metabolism Stress, Physiological/*metabolism Animals ; Disease Models, Animal ; Endocarditis, Bacterial/metabolism ; Male ; Peritonitis/metabolism ; Pyelonephritis/metabolism ; Rats ; Rats, Inbred Strains Abstract: Objective: To study the effects of infection and malnutrition on liver glutathione and cytochrome P450 (P450) in rats. Design: Controlled experimental groups (12 groups). Animals: Adult male Sprague-Dawley rats. Interventions: Experimental endocarditis, pyelonephritis, or peritonitis were caused. Controls included free-fed rats and sham-operated rats, pair-fed to infected animals. Infection was verified by tissue culture. Rats were killed 3 days (acute infection) or 10 days (chronic infection, except endocarditis) after the induction of infection. Results: Sham rats had lower liver weights, liver/body weight, and liver glutathione values than controls. Infected rats had larger liver weights and liver/body weight ratios and liver glutathione content than shams, and larger liver/body weight ratios than controls (acute infection). Infected rats had lower P450 values than both shams and controls. Conclusion: The malnutrition associated with infection caused decreased liver weight and glutathione content. Infection increased the liver weight, and liver glutathione content, but caused severe reduction in liver P450. If the same finding is true in infected patients, it could have consequences for the management of such patients. Substance Nomenclature:

70-18-8 (Glutathione) 9035-51-2 (Cytochrome P-450 Enzyme System) Entry Dates: Date Created: 19911009 Date Completed: 19911009 Latest Revision: 20081121 Update Code: 20101124 PMID: 1884618 Database: MEDLINE with Full Text

Pneumonia in the immunocompetent patient.

Authors: Reynolds JH; McDonald G; Alton H; Gordon SB Author Address: Department of Radiology, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK. john.reynolds@heartofengland.nhs.uk Source: The British Journal Of Radiology [Br J Radiol] 2010 Dec; Vol. 83 (996), pp. 998-1009. Publication Type: Journal Article; Review Journal Information: Country of Publication: England NLM ID: 0373125 Publication Model: Print Cited Medium: Internet ISSN: 1748-880X (Electronic) Linking ISSN: 00071285 NLM ISO Abbreviation: Br J Radiol Subsets: Core Clinical (AIM); MEDLINE MeSH Terms: Immunocompromised Host* Lung/*radiography Pneumonia/*radiography Female ; Humans ; Male ; Pneumonia/epidemiology ; Pneumonia/etiology ; Reproducibility of Results ; Risk Factors ; Streptococcus pneumoniae Abstract: Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Streptoccocus pneumoniae. In adults, pneumonia can be broadly classified, on the basis of chest radiographic appearance, into lobar pneumonia, bronchopneumonia and pneumonia producing an interstitial pattern. Lobar pneumonia is most commonly associated with community acquired pneumonia, bronchopneumonia with hospital acquired infection and an interstitial pattern with the so called atypical pneumonias, which can be caused by viruses or organisms such as Mycoplasma pneumoniae. Most cases of pneumonia can be managed with chest radiographs as the only form of imaging, but CT can detect pneumonia not visible on the chest radiograph and may be of value, particularly in the hospital setting. Complications of pneumonia include pleural effusion, empyema and lung abscess. The chest radiograph may initially indicate an effusion but ultrasound is more sensitive, allows characterisation in some cases and can guide catheter placement for drainage. CT can also be used to characterise and estimate the extent of pleural disease. Most lung abscesses respond to medical therapy, with surgery and image guided catheter drainage serving as options for those cases who do not respond. Entry Dates: Date Created: 20101122 Date Completed: 20110208 Update Code: 20110208

The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition.
Authors: Fagundes-Neto U; Scaletsky IC Author Address: Escola Paulista de Medicina, Universidade Federal de So Paulo, So Paulo, Brazil. Source: So Paulo Medical Journal = Revista Paulista De Medicina [Sao Paulo Med J] 2000 Jan 6; Vol. 118 (1), pp. 21-9. Publication Type: Journal Article; Review Journal Information: Country of Publication: BRAZIL NLM ID: 100897261 Publication Model: Print Cited Medium: Print ISSN: 1516-3180 (Print) Linking ISSN: 15163180 NLM ISO Abbreviation: Sao Paulo Med J Subsets: MEDLINE MeSH Terms: Escherichia coli*/classification Escherichia coli*/isolation & purification Diarrhea, Infantile/*microbiology Escherichia coli Infections/*complications Nutrition Disorders/*microbiology Acute Disease ; Brazil/epidemiology ; Child, Preschool ; Diarrhea, Infantile/mortality ; Duodenum/ultrastructure ; Feces/microbiology ; Humans ; Infant ; Microscopy, Electron, Scanning ; Microvilli ; Prospective Studies ; Serotyping Abstract: Diarrheal disease is still the most prevalent and important public health problem in developing countries, despite advances in knowledge, understanding, and management that have occurred over recent years. Diarrhea is the leading cause of death in children under 5 years of age. The impact of diarrheal diseases is more severe in the earliest periods of life, when taking into account both the numbers of episodes per year and hospital admission rates. This narrative review focuses on one of the major driving forces that attack the host, namely the enteropathogenic Escherichia coli (EPEC) and the consequences that generate malnutrition in an early phase of life. EPEC serotypes form dense microcolonies on the surface of tissue-culture cells in a pattern known as localized adherence (LA). When EPEC strains adhere to epithelial cells in vitro or in vivo they cause characteristic changes known as Attaching and Effacement (A/E) lesions. Surface abnormalities of the small intestinal mucosa shown by scanning electron microscopy in infants with persistent diarrhea, although non-specific, are intense enough to justify the severity of the clinical aspects displayed in a very young phase in life. Decrease in number and height of microvilli, blunting of borders of enterocytes, loss of the glycocalyx, shortening of villi and presence of a mucus pseudomembrane coating the mucosal surface were the abnormalities observed in the majority of patients. These ultrastructural derangements may be due to an association of the enteric enteropathogenic

agent that triggers the diarrheic process and the onset of food intolerance responsible for perpetuation of diarrhea. An aggressive therapeutic approach based on appropriate nutritional support, especially the utilization of human milk and/or lactose-free protein hydrolyzate-based formulas and the adequate correction of the fecal losses, is required to allow complete recovery from the damage caused by this devastating enteropathogenic agent. Number of References: 23 Entry Dates: Date Created: 20000824 Date Completed: 20000824 Latest Revision: 20051116