Biomedical subjects
Publications and source records attributed to Auli Toivanen.
A 42-year-old woman developed a rapidly progressing fatal heart failure. At the autopsy extensive necrosis of the myocardium was seen, with an almost complete absence of inflammatory cells and the presence of bacterial structures identified as Staphylococcus lugdunensis by PCR. In addition, the cytomegalovirus genome was found to be located inside the cardiomyocytes.
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Reactive arthritis is an infectious disease which may be initiated by several microbes in genetically susceptible hosts. The best known predisposing genetic factor is HLA-B27, but the mechanisms behind its action are still elusive. Worldwide agreement exists regarding the general guidelines in the diagnosis, differential diagnosis and management, even though official diagnostic criteria are not yet available. Several studies indicate that antibiotics are effective only if started before the immunological mechanisms of pathogenesis have been turned on. However, recent observations suggest that a 3-month course of antibiotics may diminish the late risk of chronic sequelae, especially in HLA-B27-positive patients with reactive arthritis.
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This review is concentrated on specifically diagnosable viral diseases causing recent onset polyarthritis. A suspicion of viral etiology of arthritis should arise when there are symptoms of infection such as fever, skin manifestations, neurologic signs, or when several cases are occurring at the same time, suggesting an outbreak. In addition to the history and clinical examination, serology is a key element in the diagnosis. Some of these infections are known to occur at certain geographic areas, and the local clinicians are aware of this possibility. HIV and HCV infections occur worldwide, and they should be kept in mind when treating patients with recent-onset arthritis.