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Drugs in pregnancy and lactation
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
A similar situation has been documented with the rubella vaccine. While the rubella virus is highly teratogenic, there is no such evidence for the attenuated live virus used for the vaccine. Yet women who have inadvertently received the vaccine in pregnancy tend to abort their pregnancies due to such misinformation.
Rubella
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Following respiratory transmission of rubella virus, replication of the virus is thought to occur in the nasopharynx and regional lymph nodes. A viremia occurs 5–7 days after exposure with spread of the virus throughout the body. Transplacental infection of the fetus occurs during viremia. Fetal damage occurs through destruction of cells as well as mitotic arrest. The pathogenesis of the neurological syndromes associated with rubella virus is not well understood. Virus invasion and replication in the brain has been definitively demonstrated in CRS and appears to account for the majority of neurological lesions observed in this disease. Infection of the ciliary body in the eye is thought to be the cause of development of cataracts since the lens is avascular and requires aqueous humor produced by the ciliary body for development [9]. Patients with CRS are unable to mount an immune response against the E2 envelope glycoprotein or the core antigen which may explain in part the reason for viral persistence [10]. The pathogenesis of rubella encephalitis following acute infection has not been determined [11]; however, the presence of virus in the CSF of these patients suggests that direct invasion by the virus may occur [12]. Immune-mediated pathology is particularly evident in Progressive rubella panencephalitis (PRP) and may be autoimmune in nature, possibly triggered by molecular mimicry between viral and host epitopes, considering the apparent lack of virus in the brain [13]. Molecular mimicry may occur between rubella antigens and retinal or myelin antigens [14,15].
HLA-A,B Restriction of Cytotoxic T Cells
Published in Soldano Ferrone, B. G. Solheim, HLA Typing: Methodology and Clinical Aspects, 2019
Studies by Sethi et al.28 demonstrated HLA restriction in the lytic activity towards HSV and HCMV infected skin fibroblast target cells. The presence of virus-specific cytotoxic lymphocytes (CTLs) was shown by using long-term cultures derived from peripheral blood lymphocytes from in vivo sensitized patients. A recent report by Quinan et al.28a demonstrated the development of HLA-restricted CTL in vivo in four bone marrow transplant recipients during acute CMV infection. Earlier attempts to demonstrate HLA restricted cytotoxic T cells during primary infections have failed; Steele et al.29: rubella virus; Perrin et al.30: vaccinia virus; Perrin et al.31: measles virus.
Changing Trends in Uveitis in the United Kingdom: 5000 Consecutive Referrals to a Tertiary Referral Centre
Published in Ocular Immunology and Inflammation, 2023
N. P. Jones, S. Pockar, L. R. Steeples
The relevance of Rubella virus in a substantial proportion of patients with FHU is now well established,11,12 and there is supportive evidence in that in the USA, the incidence of FHU has been found to decrease following the introduction of rubella vaccination.13 It is therefore interesting to witness the profound reduction in the incidence of this disease over a period in this clinic, where 30 years ago it was once four times more common than it is now. In the UK nearly 95% of children are rubella-vaccinated by 5 years of age, infection levels are so low that the World Health Organisation has described the disease as “eliminated” in the UK and 5 years ago routine Rubella screening in pregnancy was discontinued owing to low risk. It is likely that the incidence of FHU will reduce further. However, it will not disappear as there is evidence of other potential triggers including cytomegalovirus14 (UK incidence possibly to be increased by immigration from the Far East), and toxoplasmosis.15
Comparison of Intraocular Antibody Measurement, Quantitative Pathogen PCR, and Metagenomic Deep Sequencing of Aqueous Humor in Secondary Glaucoma Associated with Anterior Segment Uveitis
Published in Ocular Immunology and Inflammation, 2022
Li Wang, Zhujian Wang, Jinmin Ma, Qiongfang Li, Xueli Chen, Yuhong Chen, Xinghuai Sun
Metagenomic DNA sequencing is a key technology to explore DNA/RNA-based etiology from not-yet-cultivated microbes by bioinformatic analysis and can theoretically detect all pathogens in a clinical sample. MDS can identify bacterium, fungi, parasites, and DNA and RNA viruses in minute volume of intraocular fluid samples for ocular diseases. In 2015, Lee et al.16 identified torque teno viruses in seven culture-negative endophthalmitis cases by deep-DNA sequencing and five of whom were confirmed by qPCR. Thus, they provided a testable hypothesis for a pathogenic mechanism in culture-negative endophthalmitis. Moreover, Doan T et al.39 identified rubella virus by MDS in aqueous fluid specimen from one eye and in vitreous sample from the other eye of a 40-year-old man with bilateral, idiopathic chronic anterior and intermediate uveitis, which was subsequently confirmed with RT-PCR. Afterward, the same study group detected six pathogens including CMV, HHV-6, HSV-2, HTLV-1, Klebsiella pneumoniae, and Candida dubliniensis by MDS in 8 of 36 (22%) vitreous samples with infectious uveitis which were tested negative by pathogen-directed PCRs (CMV, VZV, HSV, and T. gondii).40 In 2018, MDS was reported to find fungal, bacterial, amoebal, and cytomegalovirus pathogens in 18 of 20 formalin-fixed corneal specimens with infectious keratitis, which showed potential applications in clinical diagnostics and research.17
Alteration of MCP-1 and MMP-9 in Aqueous Humor Is Associated with Secondary Glaucoma in Fuchs Uveitis Syndrome
Published in Ocular Immunology and Inflammation, 2020
D. Bauer, M. Kasper, K. Walscheid, J. M. Koch, P. S. Müther, B. Kirchhof, A. Heiligenhaus, C. Heinz
Mild vitritis is common without the presence of cystoid macular edema. In many cases angiography reveals a mild papillary leakage.3,4 Iris atrophy may occur later with heterochromia due to a loss of iris crypts. An infectious etiology of FUS eyes as a result of toxoplasmosis5,6 or cytomegalovirus (CMV) infection7 has been discussed previously. Another important study proposed that infections with rubella virus (RV) could also be linked to FUS.8 In another study 13/14 FUS subjects showed intraocular antibody production (Goldmann-Witmer coefficient>3) against RV, but not against herpes simplex virus (HSV), varicella zoster virus (VZV), or Toxoplasma gondii.9 Other groups have also reported a relationship of FUS with RV.10,11