Dermatology patients routinely ask how long their skin condition may last, yet this critical aspect of their care has not been emphasized in the literature. When a given diagnosis may be self-limited, it is essential that clinicians meet patient expectations by properly discussing the possible time course for resolution. Furthermore, being aware of, and prioritizing the knowledge of the duration of a skin disease can help limit continued exposure to side effects of prescribed treatments once the condition may have self-resolved or remitted.

Measles (rubeola) is a highly contagious airborne disease that was declared eliminated in the U.S.in the year 2000. Only sporadic U.S. cases and minor outbreaks occurred until the larger outbreakbeginning in 2014 that has become a public health emergency. The “Identify-Isolate-Inform” toolwill assist emergency physicians to be better prepared to detect and manage measles patientspresenting to the emergency department. Measles typically presents with a prodrome of high fever,and cough/coryza/conjunctivitis, sometimes accompanied by the pathognomonic Koplik spots.Two to four days later, an erythematous maculopapular rash begins on the face and spreads downthe body. Suspect patients must be immediately isolated with airborne precautions while awaitinglaboratory confirmation of disease. Emergency physicians must rapidly inform the local public healthdepartment and hospital infection control personnel of suspected measles cases. [West J EmergMed. 2015;16(2):212–219.]

Copyright © 2015 by the article author(s). Measles (rubeola) is a highly contagious airborne disease that was declared eliminated in the U.S.in the year 2000. Only sporadic U.S. cases and minor outbreaks occurred until the larger outbreakbeginning in 2014 that has become a public health emergency. The "Identify-Isolate- Inform" toolwill assist emergency physicians to be better prepared to detect and manage measles patientspresenting to the emergency department. Measles typically presents with a prodrome of high fever,and cough/coryza/conjunctivitis, sometimes accompanied by the pathognomonic Koplik spots.Two to four days later, an erythematous maculopapular rash begins on the face and spreads downthe body. Suspect patients must be immediately isolated with airborne precautions while awaitinglaboratory confirmation of disease. Emergency physicians must rapidly inform the local public healthdepartment and hospital infection control personnel of suspected measles cases.

Background

Members of the Parvovirus genus cause a variety of diseases in mammals, including humans. One of the major defences against viral infection is the presence of neutralizing antibodies that prevent virus particles from infecting target cells. The mechanism of neutralization is not well understood. We therefore studied the structure of canine parvovirus (CPV) complexed with the Fab fragment of a neutralizing antibody, A3B10, using image reconstruction of electron micrographs of vitrified samples, together with the already known structure of CPV from X-ray crystallographic data.

Results

The structure of the complex of CPV with Fab A3B10 has been determined to 23 A resolution. The known CPV atomic structure was subtracted from the electron density of the complex, and the difference map was used to fit the atomic coordinates of a known Fab fragment, HyHEL-5. The long axis of each Fab molecule is oriented in a near radial direction, inclined away from the two-fold axes. The viral epitope consists of 14 amino acid residues found in loops 1, 2 and 3 on the capsid surface, which include previously identified escape mutations.

Conclusions

The mode of Fab binding suggests that the A3B10 neutralizing antibody cannot bind bivalently to the capsid across the two-fold axes, consistent with the observation that whole A3B10 antibody readily precipitates CPV. Since Fab A3B10 can also neutralize the virus, mechanisms of neutralization such as interference with cell attachment, cell entry, or uncoating, must be operative.

Background and purpose

Case-control studies suggest that acute infection transiently increases the risk of childhood arterial ischemic stroke. We hypothesized that an unbiased pathogen discovery approach utilizing MassTag-polymerase chain reaction would identify pathogens in the blood of childhood arterial ischemic stroke cases.

Methods

The multicenter international VIPS study (Vascular Effects of Infection in Pediatric Stroke) enrolled arterial ischemic stroke cases, and stroke-free controls, aged 29 days through 18 years. Parental interview included questions on recent infections. In this pilot study, we used MassTag-polymerase chain reaction to test the plasma of the first 161 cases and 34 controls enrolled for a panel of 28 common bacterial and viral pathogens.

Results

Pathogen DNA was detected in no controls and 14 cases (8.7%): parvovirus B19 (n=10), herpesvirus 6 (n=2), adenovirus (n=1), and rhinovirus 6C (n=1). Parvovirus B19 infection was confirmed by serologies in all 10; infection was subclinical in 8. Four cases with parvovirus B19 had underlying congenital heart disease, whereas another 5 had a distinct arteriopathy involving a long-segment stenosis of the distal internal carotid and proximal middle cerebral arteries.

Conclusions

Using MassTag-polymerase chain reaction, we detected parvovirus B19-a virus known to infect erythrocytes and endothelial cells-in some cases of childhood arterial ischemic stroke. This approach can generate new, testable hypotheses about childhood stroke pathogenesis.

Coronavirus disease 2019 (COVID-19), an emergent disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the globe since its discovery in December 2019. Although first appreciated to cause pneumonia, numerous organ systems are now known to be involved. The objective of this article is to review the broad spectrum of cutaneous manifestations reported in association with SARS-CoV-2 infection. The most commonly reported cutaneous manifestations associated with COVID-19 infection include pernio (chilblain)-like acral lesions, morbilliform (exanthematous) rash, urticaria, vesicular (varicella-like) eruptions, and vaso-occlusive lesions (livedo racemosa, retiform purpura). It is important to consider SARS-CoV-2 infection in the differential diagnosis of a patient presenting with these lesions in the appropriate clinical context, as cutaneous manifestations may be present in otherwise asymptomatic individuals, or present before developing other symptoms of infection. With increased access to diagnostic testing, we are beginning to understand the utility and limitations of currently available assays.