New Antibody Discovered Highly Effective Against HIV

A recent article in the Journal of Immunology highlighted a groundbreaking discovery in the fight against the human immunodeficiency virus (HIV). Funded by the National Institute of Health (NIH) and the National Institute of Allergy and Infectious Diseases (NIAID), Dr. Mark Connors and his team discovered an antibody named N6 that appeared to neutralize over 98 percent of the HIV isolates tested. What is particularly promising was the ability to eradicate even the known resistant strains.

To date, the discovery of a vaccine has been difficult due to the rapidly changing structure of the proteins on the surface of the virus. The N6 antibody, however, is particularly adept at binding a more consistent portion of the virus called the CD4 binding site, which allows it to attach to human cells.

The N6 antibody joins the ranks of the VRC01 antibody, which was discovered in 2010 and is in clinical trials, but it's effectiveness is far greater. This may translate to a vaccine that will finally prevent HIV from evading our immune system, saving countless lives and cutting healthcare costs. 

Protect Your Baby From Bronchiolitis

Bronchiolitis is a relatively common respiratory condition seen in children younger than 2 years old.  According to a recent study out of Finland published in the Scandanavian journal Acta Paediatrica, bronchiolitis is a major cause of lower respiratory tract illness and hospitalization in babies, especially those younger than 6 months old. The condition is mostly caused by the respiratory syncytial virus (RSV), which is the infectious agent in over 75% of cases.  Other viruses, including influenza (flu) and adenovirus represent the remaining 25% and in many cases exist as co-infections.

RSV season typically begins in October and ends in April.  The virus is spread via the hands of caregivers and other inanimate surfaces (fomites), and can stay alive on them for several hours. The virus enters the respiratory tract and infiltrates the top cell layer of the lungs, known as bronchiolar epithelium, causing inflammation and swelling and obstructing the small airways. Once this happens, air passing through these small spaces emits a whistle-like sound that can be heard as a wheeze outside of the body.

This wheeze, along with a runny nose (rhinitis), cough, and fever, is suggestive of  RSV bronchiolitis. It is important, however, for the pediatrician to rule out other disease processes, such as pneumonia or foreign body aspiration. Studies have shown that infants <12 weeks old, particularly those who were premature at birth, have an increased risk of requiring hospitalization and medical intervention. For many babies, though, this disease is self-limiting and no tests or treatments are necessary.

There are established risk factors for RSV that you can’t avoid; childcare attendance, school aged siblings, prematurity, congenital cardiopulmonary disease and immunodeficiency. But the steps listed below have been shown to reduce the risk of spreading RSV:

• When in a group setting such as daycare or doctors offices, be sure that you and others caring for your children decontaminate their hands with alcohol-based sanitizer before and after direct contact with children or inanimate objects

• Do not smoke tobacco or wear clothing that has been around cigarette smoke unless it has been thoroughly washed

• Avoid exposing your infant to air pollutants

• Always breastfeed your infant whenever possible to allow your infant's immune system to strengthen

• Always follow current vaccination guidelines, including the flu vaccine

References

Bronchiolitis. Dynamed Database. Updated 2014 May 12 02:17:00 PM. Accessed June 6 2014. 

Pruikkonen H1, Uhari M, Dunder T, Pokka T, Renko M. Infants Under Six Months With Bronchiolitis Are Most Likely To Need Major Medical Interventions In The Five Days After Onset. Acta Paediatr. 2014 [Epub ahead of print]

The Importance of Identifying a Morbilliform Rash

The term "morbilliform" is used to describe any skin finding that resembles the measles rash. The macular lesions are typically diffuse, red and 2-10 mm in diameter. They may become confluent (come together to form clusters) in some areas. 

It is very important for doctors to know the differential diagnosis for a morbilliform rash, since some of the conditions are deadly. The process occurring within the body leading up to the rash, known as the prodrome, will help the physician narrow the diagnosis.This prodrome can be learned by ascertaining a good history. 

Some notable causes of morbilliform rash are:

• Fifth Disease (erythema infectiosum/parvovirus B19/)
• Sixth disease (roseola infantum/herpesvirus 6)
• Streptococcal infection (Groups A, C)
• Echovirus
• Adenovirus
• Kawasaki Disease
• Rubella
• Measles
• Syphilis
• Meningeal Petechiae (or Waterhouse Friedrichsen Syndorme)
• Drug hypersensitivity Reaction (especially nevirapine, abacavir, phenytoin)

A study by Ramsay et al in 2002 evaluated the laboratory samples of 93 vaccinated children in England, and noted that the most common cause of the rash was a parvovirus B19 infection (17%). Group A strep was found in 15% of cases, and sixth disease (roseola infantum or herpesvirus 6) in 11%. None of the cases were caused by measles. The use of widespread vaccination has nearly eliminated the measles infection, making way for other viruses that cause similar rashes. It is paramount that physicians discern the cause of the findings.

Reference

Ramsay M, Reacher M, O'Flynn C, Buttery R, Hadden F, Cohen B, Knowles W, Wreghitt T, Brown D. Causes of morbilliform rash in a highly immunised English population. Arch Dis Child. 2002 Sep;87(3):202-6.