Invasive Klebsiella pneumoniae syndrome in North America.

Invasive liver abscess syndrome, which is caused by hypervirulent Klebsiella pneumoniae subtypes, has been emerging worldwide over the past 2 decades. The syndrome is associated with the hypermucoviscosity phenotype of K. pneumoniae strains and with the magA and rmpA genes.

Acute graft-versus-host disease after liver transplantation: role of withdrawal of immunosuppression in therapeutic management.

Graft-versus-host disease (GVHD) after liver transplantation is rare but associated with a very high mortality (over 85%). Most treatments focus on increasing immunosuppression, addition of antibody preparations such as OKT3 and antithymocyte globulin to eliminate the donor lymphocytes, and supporting myelopoiesis by use of cytokines. However, the results are very poor.

Graft-vs-host disease as a complication of lung transplantation.

We report a rare case of acute graft-vs-host disease (aGVHD) after a lung transplant. The patient presented with advanced disease manifested by skin rash, fever, diarrhea, liver dysfunction and severe pancytopenia. He went on to die of sepsis and multi-organ failure.

Diagnostic molecular pathology: an increasingly indispensable tool for the practicing pathologist.

Context: Diagnostic molecular pathology is rapidly becoming an indispensable tool for anatomic pathologists. Familiarity with some of the technologic principles and current, as well as upcoming, molecular diagnostic applications is greatly advantageous for today's practice of pathology.

Objectives: To provide a discussion of the most common techniques currently used in molecular pathology laboratories and review their essential applications to diagnosis and management of neoplastic diseases.

Cutaneous lymphoid hyperplasia and marginal zone B-cell lymphoma following vaccination.

Atypical lymphoid infiltrations arose within the influenza inoculation sites of two adult female patients. One patient developed a low-grade cutaneous marginal zone B-cell lymphoma (MZL) that was responsive to local excision and radiation therapy despite spread to a distant cutaneous site. The second patient's clinical course was characterized by a locally aggressive, histologically reactive inflammatory reaction responsive only to radiation therapy after multiple failed attempts at surgical resection.

Nucleic acid testing for viral burden and viral genotyping.

Background: Molecular diagnostics plays an important role in the diagnosis and clinical management of a wide array of infectious diseases.

Methods: Advances in molecular technology and methods of detecting nucleic acid sequences have revolutionized the field of virology. These developments are reflected by the rapid diagnosis and monitoring of viral agents as well as assessment of clinical disease associated with viral infections.

Experimental infection of NOD/SCID mice reconstituted with human CD34+ cells with Epstein-Barr virus.

Epstein-Barr virus (EBV)-induced lymphoproliferative disease is an important complication in the context of immune deficiency. Impaired T-cell immunity allows the outgrowth of transformed cells with the subsequent production of predominantly B-cell lymphomas. Currently there is no in vivo model that can adequately recapitulate EBV infection and its association with B-cell lymphomas.

ZAP-70 expression in B-cell hematologic malignancy is not limited to CLL/SLL.

ZAP-70 is a tyrosine kinase expressed in normal T cells and NK cells. Expression of ZAP-70 has been associated with poor prognosis in B-cell chronic lymphocytic leukemia and might be a surrogate marker for immunoglobin heavy chain (IGH) mutational status in that disease. Little is known about ZAP-70 expression in other hematologic malignant neoplasms.

Development of real-time PCR assays for the quantitative detection of Epstein-Barr virus and cytomegalovirus, comparison of TaqMan probes, and molecular beacons.

Human Epstein-Barr virus (EBV) and cytomegalovirus (CMV) can cause serious complications in immunocompromised patients. Rapid diagnosis of EBV and CMV infection is critical in the management of the disease so that anti-viral therapy can be started early. Here we describe the development of real-time PCR assays using TaqMan probes and molecular beacons and compare the performance of both assays with a well-established, validated, gel-based PCR method for the quantification of EBV and CMV in patients' samples.

Liver transplant-associated graft-versus-host disease.

Background: Graft-versus-host disease (GVHD) is an important, underdiagnosed cause of mortality associated with liver transplantation. We identified 12 cases of GVHD among 1,082 liver transplantations performed in patients at our institution between 1991 and 1998. Patients typically developed fever, skin rash, diarrhea, or pancytopenia within 2 to 6 weeks after their transplant.

Absence of the G1528C (E474Q) mutation in the alpha-subunit of the mitochondrial trifunctional protein in women with acute fatty liver of pregnancy.

Acute fatty liver of pregnancy (AFLP) is a rare and dreaded complication of pregnancy, almost exclusively seen in the third trimester. The histopathologic features of AFLP closely resemble those seen in metabolic disorders characterized by deficiency of fatty acid oxidative enzymes. Several reports have established a strong association between AFLP in the mother and fetal deficiency of the enzyme long-chain L-3-hydroxyacyl-CoA dehydrogenase (LCHAD).