Antenatal and early postnatal etiological verification of relevant congenital viral infectious diseases

Nonspecificity of clinical, laboratory and instrumental manifestations of congenital infectious diseases, including viral infections, and the diversity of methods for etiological verification of pathogens define both the need to choose the optimal approaches to the diagnosis of this pathology, and the feasibility of testing for a broad range of etiologic agents in case of suspected congenital viral infection. The analysis of current guidelines, international consensus documents issued by specialists, and published results of some studies has shown that identification of the genetic material of the pathogen with the use of amniocentesis/ cordocentesis (for cytomegalovirus and parvovirus infections) or in the birth canal (for herpes simplex infection) is the key method for antenatal etiological verification of the widespread viral infections. During the postnatal period, molecular genetic testing is combined with serological diagnosis involving determining specific immunoglobulins M and G, as well as their avidity index.

Reactive Infectious Mucosal Eruptions (RIME) Secondary to Chlamydia pneumoniae Infection

Reactive infectious mucosal eruptions (RIME) following Chlamydia pneumoniae infection is a rare and poorly understood clinical presentation that can pose a diagnostic challenge. We report the case of a previously healthy 21-year old male with a cough, fever, numerous penile and mouth ulcers, and severe conjunctivitis. Several differential diagnoses, including Herpes simplex infection, were considered before Chlamydia pneumoniae was established as the causative agent. The patient’s condition improved following treatment with clarithromycin and prednisolone tablets, and he had almost fully recovered at follow-up 10 days after discharge.

Age-specific incidence of herpes simplex infection in the light of clinical appearance

Herpes simplex virus (HSV) infection is extremely common in both children and adults. HSV has two serotypes, HSV-1 primarily causes orolabial while HSV-2 anogenital symptoms. In recent decades there has been a change in the predilection to affected anatomical regions in both serotypes, participation of HSV-1 serotype in genital infections is increasing. The primary acquisition of HSV-1 has increasingly shifted from early childhood to young adulthood over the past years. Asymptomatic infection and virulence factors are crucial in the spread of the virus. Cutaneous symptoms, erosions and crusted lesions after vesicular stage present various differential diagnostic problems in the involved regions. Early diagnosis and timely adequate therapy in serious cases are essential as well as suppressive treatment of recurrent symptoms. Several clinical trials are underway to develop more effective antivirals. Vaccination against HSV would be a key to prevent latent infections, transmission and reactivation. The authors present characteristics of HSV, age-specific clinical manifestations, differential diagnostic problems and adequate treatment strategies.

Human Uterus Transplantation from Living and Deceased Donors: The Interim Results of the First 10 Cases of the Czech Trial

Introduction: Uterus transplantation (UTx) is a rapidly evolving treatment of uterine-factor infertility. We report the results of the first 10 UTx procedures performed at our institution. Methods: The program started in April 2016 as a two-arm study comparing the efficacy of UTx from live donors (LD) and deceased donors (DD). Results: Between April 2016 and April 2018, we performed five DD UTx and five LD UTx. Two grafts had to be removed early due to thrombosis. One graft was removed due to chronic rejection and previous herpes simplex infection at month 7. Graft survival is 70% at one year. Recipient survival is 100% at two years. Live donor survival is 100% at three years. Three live-births have been achieved, two from a LD and one from a graft from a nulliparous DD. Vaginal anastomotic stenosis occurred in 63% (5/8) of grafts. Self-expanding stents have shown preliminary suitability for the treatment of vaginal stenosis. Three recipients developed severe acute rejection. Conclusion: The interim results of our study demonstrate mid-term viability in 70% of grafts. The LD UTx produced two live births and the DD UTx produced one live birth. Nulliparous donors should be considered for donation.

What is the True Etiology of “Recurrent Shingles”?

Purpose: To determine the true etiology of cases of putative recurrent shingles referred to a dermatology clinic. Methods: A prospective cohort study of patients aged 15-87 years with reported recurrent herpes zoster was conducted. Vesicular fluid and serology for herpes simplex 1, 2, and varicella zoster virus immunoglobulins were obtained from patients presenting with vesicles. Biopsies were obtained from patients with ambiguous presentations. Results: 44 patients (56%) had evidence of herpes simplex virus infection. 32% of patients had positive herpes simplex virus cultures or polymerase chain reaction sequencing, and 24% additional patients were diagnosed with presumptive simplex infection based on elevated antibody titers. 44% of patients had a diagnosis other than zoster or simplex. One individual had a positive viral culture for varicella zoster virus. 99% of patients who presented with suspected recurrent herpes zoster had no definitive evidence of varicella zoster virus reactivation. Conclusions: The most common diagnosis was herpes simplex infection. Our results suggest that true recurrent shingles in immunocompetent patients is rare.