Correlations between physiological, clinical and self-reported assessments of spasticity are often weak. Our aims were to quantify functional, self-reported and physiological indices of spasticity in individuals with thoracic spinal cord injury (SCI; 3 women, 9 men; 19–52 years), and to compare the strength and direction of associations between these measures. The functional measure we introduced involved recording involuntary electromyographic activity during a transfer from wheelchair to bed which is a daily task necessary for function. High soleus (SL) and tibialis anterior (TA) F-wave/M-wave area ratios were the only physiological measures that distinguished injured participants from the uninjured (6 women, 13 men, 19–67 years). Hyporeflexia (decreased SL H/M ratio) was unexpectedly present in older participants after injury. During transfers, the duration and intensity of involuntary electromyographic activity varied across muscles and participants, but coactivity was common. Wide inter-participant variability was seen for self-reported spasm frequency, severity, pain and interference with function, as well as tone (resistance to imposed joint movement). Our recordings of involuntary electromyographic activity during transfers provided evidence of significant associations between physiological and self-reported measures of spasticity. Reduced low frequency H-reflex depression in SL and high F-wave/M-wave area ratios in TA, physiological indicators of reduced inhibition and greater motoneuron excitability, respectively, were associated with long duration SL and biceps femoris (BF) electromyographic activity during transfers. In turn, participants reported high spasm frequency when transfers involved short duration TA EMG, decreased co-activation between SL and TA, as well as between rectus femoris (RF) vs. BF. Thus, the duration of muscle activity and/or the time of agonist-antagonist muscle coactivity may be used by injured individuals to count spasms. Intense electromyographic activity and high tone related closely (possibly from joint stabilization), while intense electromyographic activity in one muscle of an agonist-antagonist pair (especially in TA vs. SL, and RF vs. BF) likely induced joint movement and was associated with severe spasms. These data support the idea that individuals with SCI describe their spasticity by both the duration and intensity of involuntary agonist-antagonist muscle coactivity during everyday tasks.

At the International Congress of Virology (ICV) in San Francisco in July 2005, the International Committee on Taxonomy of Viruses (ICTV) held a Plenary Session. This note summarizes the reports made to the meeting by the President and the chairs of the ICTV subcommittees acknowledged at the end of this note. It also reports the results of elections to positions on the ICTV Executive Committee (EC) and changes made to the statutes that govern how ICTV operates. President's reportThe composition of the EC will change greatly after the Congress because three of the four officers, 5 of the 6 subcommittee chairs and 5 of the 8 elected members will change. The memberships of the ICTV EC for 2002 to 2005 and for 2005 to 2008 (following the results of the elections at the Plenary Session) are shown in Table 1.

No abstract

Charcot Marie Tooth (CMT) is a heterogeneous group of genetic disorders characterized by progressive motor and sensory neuropathy. CMT is a multi-gene disorder with several possible mutations responsible for a wide range of clinical presentations. A specific mutation of the ganglioside-induced-differentiation-associated protein 1 (GDAP1) gene is associated with the axonal subtype of CMT (CMT2K) which is inherited in an autosomal dominant fashion, as well as the demyelinating subtype (CMT4A) which is inherited in an autosomal recessive pattern. Phenotypic disease expression is largely dependent on these inheritance patterns. While the autosomal recessive form (CMT4A) exhibits severe disease with an early onset, the autosomal dominant variant (CMT2K) tends to have milder phenotypes and a later onset. We describe an atypical presentation of a patient with severe CMT2K with rapidly progressive polyneuropathy, respiratory failure, and dysphonia. We suggest that this case will inspire further evaluation of disease heterogeneity and variants.

INTRODUCTION: Cryptococcus neoformans and Coccidioides immitis are important opportunistic mycoses. C. neoformans is widely found in soil and bird droppings while C. immitis is endemic to the southwestern US. These infections behave more aggressively in immunocompromised hosts and may present as pulmonary nodules mimicking malignancy. We present a case of a pulmonary nodule revealing coinfection with both mycoses. CASE PRESENTATION:A 47-year-old male was brought to the ED due to erratic behavior. He was hemodynamically stable, but had choreoathetoid movements, lip smacking and garbled speech. He had a history of polysubstance abuse, baseline chorea of unknown etiology, and HIV not on ART. He was on vacation from California. Initial chemistries were normal. UDS was positive for amphetamines and methamphetamines. CT brain showed global cerebral atrophy. RPR was positive. Due to concern for CNS infection, LP was performed. Opening pressure and CSF studies were normal. MRI revealed global and caudate atrophy concerning for neurodegenerative disease. On hospital day 2, the patient was febrile to 102.7 degrees F with associated nonproductive cough. CXR revealed pneumonic consolidation in the LLL and a well-defined RLL nodule. Broad spectrum antibiotics were initiated. Chest CT confirmed a pleural based mass measuring 2.4x2.2 cm concerning for malignancy. CT guided lung biopsy revealed benign pulmonary parenchyma with extensive necrosis. GMS stain was positive for two morphologically distinct fungal species consistent with C. immitis and C. neoformans coinfection. Oral fluconazole was initiated with improvement in his clinical condition. His chorea and speech improved throughout his hospitalization. Underlying Huntington's disease exacerbated by amphetamine use was suspected.DISCUSSION: Pulmonary cryptococcosis is rare, representing 20% of pulmonary fungal infections. In immunocompetent hosts, it may present as a consolidation, reticulonodular process, or lung mass that mimics cancer. In those with altered immune function, it may establish latent infection through persistence within granulomas or may cause disseminated disease, such as meningitis. Similarly, C. immitis usually causes a severe pneumonia and may cause disseminated disease in immunocompromised patients. In non-immunocompromised patients, coccidiomycosis presents similarly to bacterial CAP with cough, fever and a consolidation on CXR (75%). However, thoracic manifestations are variable and include nodules, cavities, and peribronchial thickening. Pulmonary nodules caused by both fungal species may be positive on FDG-PET imaging, further mimicking malignancy. CONCLUSIONS: Our literature review returned no prior reports of pulmonary coinfection C. neoformans and C. immitis. We postulate that such a coinfection occurred due impaired host immune function and geographic prevalence of both organisms.