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Maria M Choudhary,
Maureen G Metcalfe,
Kathryn Arrambide,
Caryn Bern,
Govinda S Visvesvara,
Norman J Pieniazek,
Rebecca D Bandea,
Marlene Deleon-Carnes, Patricia Adem,
Moaz M Choudhary,
Sherif R Zaki,
Musab U Saeed
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ABSTRACT: The Phylum Microsporidia comprises >1,200 species, only 15 of which are known to infect humans, including the genera Trachipleistophora, Pleistophora, and Brachiola. We report an infection by Tubulinosema sp. in an immunosuppressed patient.
Emerging Infectious Diseases 09/2011; 17(9):1727-30. · 6.79 Impact Factor
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Amy M Denison,
Dianna M Blau,
Heather A Jost,
Tara Jones,
Dominique Rollin,
Rongbao Gao,
Lindy Liu,
Julu Bhatnagar,
Marlene Deleon-Carnes,
Wun-Ju Shieh, [......],
Brigid Batten,
Patricia W Greer,
Chalanda S Smith,
Jeanine Bartlett,
Jeltley L Montague,
Mitesh Patel,
Xiyan Xu,
Stephen Lindstrom,
Alexander I Klimov,
Sherif R Zaki
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ABSTRACT: The recent influenza pandemic, caused by a novel H1N1 influenza A virus, as well as the seasonal influenza outbreaks caused by varieties of influenza A and B viruses, are responsible for hundreds of thousands of deaths worldwide. Few studies have evaluated the utility of real-time reverse transcription-PCR to detect influenza virus RNA from formalin-fixed, paraffin-embedded tissues obtained at autopsy. In this work, respiratory autopsy tissues from 442 suspect influenza cases were tested by real-time reverse transcription-PCR for seasonal influenza A and B and 2009 pandemic influenza A (H1N1) viruses and the results were compared to those obtained by immunohistochemistry. In total, 222 cases were positive by real-time reverse transcription-PCR, and of 218 real-time, reverse transcription-PCR-positive cases also tested by immunohistochemistry, only 107 were positive. Although formalin-fixed, paraffin-embedded tissues can be used for diagnosis, frozen tissues offer the best chance to make a postmortem diagnosis of influenza because these tissues possess nucleic acids that are less degraded and, as a consequence, provide longer sequence information than that obtained from fixed tissues. We also determined that testing of all available respiratory tissues is critical for optimal detection of influenza virus in postmortem tissues.
The Journal of molecular diagnostics: JMD 03/2011; 13(2):123-8. · 3.48 Impact Factor
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Amira A Roess,
Anjela Galan,
Edward Kitces,
Yu Li,
Hui Zhao,
Christopher D Paddock, Patricia Adem,
Cynthia S Goldsmith,
Debra Miller,
Mary G Reynolds,
Sherif R Zaki,
Inger K Damon
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ABSTRACT: Parapoxviruses are a genus of the double-stranded DNA family of poxviruses that infect ruminants, and zoonotic transmission to humans often results from occupational exposures. Parapoxvirus infection in humans begins with an incubation period of 3 to 7 days, followed by the development of one or more erythematous maculopapular lesions that evolve over the course of several weeks into nodules. In 2009, parapoxvirus infection was diagnosed in two deer hunters in the eastern United States after the hunters had field-dressed white-tailed deer. We describe the clinical and pathological features of these infections and the phylogenetic relationship of a unique strain of parapoxvirus to other parapoxviruses. Deer populations continue to increase, leading to the possibility that there will be more deer-associated parapoxvirus infections.
New England Journal of Medicine 12/2010; 363(27):2621-7. · 53.30 Impact Factor
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Wun-Ju Shieh,
Dianna M Blau,
Amy M Denison,
Marlene Deleon-Carnes, Patricia Adem,
Julu Bhatnagar,
John Sumner,
Lindy Liu,
Mitesh Patel,
Brigid Batten, [......],
Cynthia Seales,
Heather Jost,
Maureen Metcalfe,
Cynthia S Goldsmith,
Charles Humphrey,
Ann Schmitz,
Clifton Drew,
Christopher Paddock,
Timothy M Uyeki,
Sherif R Zaki
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ABSTRACT: In the spring of 2009, a novel influenza A (H1N1) virus emerged in North America and spread worldwide to cause the first influenza pandemic since 1968. During the first 4 months, over 500 deaths in the United States had been associated with confirmed 2009 pandemic influenza A (H1N1) [2009 H1N1] virus infection. Pathological evaluation of respiratory specimens from initial influenza-associated deaths suggested marked differences in viral tropism and tissue damage compared with seasonal influenza and prompted further investigation. Available autopsy tissue samples were obtained from 100 US deaths with laboratory-confirmed 2009 H1N1 virus infection. Demographic and clinical data of these case-patients were collected, and the tissues were evaluated by multiple laboratory methods, including histopathological evaluation, special stains, molecular and immunohistochemical assays, viral culture, and electron microscopy. The most prominent histopathological feature observed was diffuse alveolar damage in the lung in all case-patients examined. Alveolar lining cells, including type I and type II pneumocytes, were the primary infected cells. Bacterial co-infections were identified in >25% of the case-patients. Viral pneumonia and immunolocalization of viral antigen in association with diffuse alveolar damage are prominent features of infection with 2009 pandemic influenza A (H1N1) virus. Underlying medical conditions and bacterial co-infections contributed to the fatal outcome of this infection. More studies are needed to understand the multifactorial pathogenesis of this infection.
American Journal Of Pathology 07/2010; 177(1):166-75. · 4.89 Impact Factor
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Janet Cox-Singh,
Jessie Hiu,
Sebastian Lucas,
Paul Divis,
Mohammad Zulkarnaen,
Patricia Chandran,
Kum Wong, Patricia Adem,
Sherif Zaki,
Balbir Singh,
Sanjeev Krishna
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ABSTRACT: Abstract
Background
Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here.
Case presentation
A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent.
Conclusions
The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further study of knowlesi malaria will aid the interpretation of, often conflicting, information on malaria pathophysiology in humans.
Malaria Journal. 01/2010;
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Janet Cox-Singh,
Jessie Hiu,
Sebastian B Lucas,
Paul C Divis,
Mohammad Zulkarnaen,
Patricia Chandran,
Kum T Wong, Patricia Adem,
Sherif R Zaki,
Balbir Singh,
Sanjeev Krishna
[show abstract]
[hide abstract]
ABSTRACT: Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here.
A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent.
The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further study of knowlesi malaria will aid the interpretation of, often conflicting, information on malaria pathophysiology in humans.
Malaria Journal 01/2010; 9:10. · 3.19 Impact Factor
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David Wong,
Margaret A Wild,
Matthew A Walburger,
Charles L Higgins,
Michael Callahan,
Lawrence A Czarnecki,
Elisabeth W Lawaczeck,
Craig E Levy,
J Gage Patterson,
Rebecca Sunenshine, [......],
Christopher D Paddock,
Sherif R Zaki,
Jeannine M Petersen,
Martin E Schriefer,
Rebecca J Eisen,
Kenneth L Gage,
Kevin S Griffith,
Ingrid B Weber,
Terry R Spraker,
Paul S Mead
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ABSTRACT: Primary pneumonic plague is a rare but often fatal form of Yersinia pestis infection that results from direct inhalation of bacteria and is potentially transmissible from person to person. We describe a case of primary pneumonic plague in a wildlife biologist who was found deceased in his residence 1 week after conducting a necropsy on a mountain lion.
To determine cause of death, a postmortem examination was conducted, and friends and colleagues were interviewed. Physical evidence was reviewed, including specimens from the mountain lion and the biologist's medical chart, camera, and computer. Human and animal tissues were submitted for testing. Persons in close contact (within 2 meters) to the biologist after he had developed symptoms were identified and offered chemoprophylaxis.
The biologist conducted the necropsy in his garage without the use of personal protective equipment. Three days later, he developed fever and hemoptysis and died approximately 6 days after exposure. Gross examination showed consolidation and hemorrhagic fluid in the lungs; no buboes were noted. Plague was diagnosed presumptively by polymerase chain reaction and confirmed by culture. Tissues from the mountain lion tested positive for Y. pestis, and isolates from the biologist and mountain lion were indistinguishable by pulsed-field gel electrophoresis. Among 49 contacts who received chemoprophylaxis, none developed symptoms consistent with plague.
The biologist likely acquired pneumonic plague through inhalation of aerosols generated during postmortem examination of an infected mountain lion. Enhanced awareness of zoonotic diseases and appropriate use of personal protective equipment are needed for biologists and others who handle wildlife.
Clinical Infectious Diseases 07/2009; 49(3):e33-8. · 9.15 Impact Factor
