Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome characterized by unregulated macrophage and T-lymphocyte activation resulting in cytokine overproduction and subsequent histiocytic phagocytosis. Variant infections, particularly viruses have been postulated as the inciting factor for this potentially fatal disease. Herein, we will report a case of HLH associated with anaplasmosis.

Seminiferous tubules of rats exposed to x-irradiation before birth were subjected to micropuncture in situ at 50 days of age to obtain samples of fluid 4 h after ligation of efferent ducts. The concentrations of cations in this fluid were: potassium, 39.7 +/- 1.2 mM, and sodium, 136.3 +/- 1.2 mM (means and standard errors, n = 5). Histologic examination revealed that germ cells constitute less than 1% of the cell population within the seminiferous tubules of these rats; the remaining cells were all Sertoli cells. Sertoli cells showed efflux of 86Rb+ with t1/2 of approximately 11 min and an active ATPase in plasma membranes. These activities were similar to those of Sertoli cells from normal rats. Germ cells from normal rats showed less rapid efflux of 86Rb+ (t1/2 greater than 60 min) and less active Na+/K+ ATPase in plasma membranes. It is concluded that Sertoli cells are responsible for the high concentration of potassium in seminiferous tubule fluid and that plasma membranes of these cells contain an active K+ pump that is not inhibited by ouabain (1 mM).

Having diabetes can have profound implications for individuals in the workplace. Due to the increasing number of people who are diagnosed with this disease and the often complex treatment it requires, this issue continues to pose challenges for not only employees with this illness, but also for their employers. The 1990 Americans with Disabilities Act (ADA) was influential in promoting accommodations for and nondiscrimination against people with diabetes in the workplace. This article discusses 3 of the elements that can make it difficult for persons with diabetes to file a successful claim under the ADA. These important elements include employee disability status, the ability to perform essential job functions, and direct threat concerns.

BackgroundPre-exposure prophylaxis (PrEP) is a highly effective method for preventing HIV transmission among at-risk patients. There is limited and conflicting data regarding the risk of other STIs following PrEP initiation. The objective of this study was to compare the incidence of STIs before and during PrEP therapy.MethodsA retrospective observational study of patients seeking PrEP therapy at an inner-city clinic in Newark, New Jersey, between May 1, 2016 and March 30, 2018. Patients who were MSM, intravenous drug users, or heterosexual with multiple or HIV-positive partners were considered at risk for HIV and offered PrEP. Patients were initially screened and tested every 3 months for HIV, Chlamydia trachomatis, Neisseria gonorrhoea, syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis A virus (HAV), herpes simplex virus (HSV), medication adherence and continued high-risk behavior. Patients were also counseled on risk-reduction behaviors. STI incidence before and during PrEP was compared.ResultsBetween May 1, 2016 to March 30, 2018, 125 patients were considered at risk. Fifty-one (41%) patients were lost to follow-up after the initial visit and were excluded. Seventy-four (59%) patients completed screening and were included in the study. The mean age was 35.0 ± 11.6 years. The majority of the patients were males 74% (54). 29 (40%) were MSM, and 33 (45%) had HIV-positive partners. The mean duration of PrEP was 386 ± 183 days. Upon initial screening 14 (19%) patients were positive for at least one STI; 3 (21%) patients had HCV, 3 (21%) had chlamydia, 2 (14.3%) had HBV, 2 (14.3%) had gonorrhea, 2(14.3%) had syphilis, one had HSV II and one was found to have HIV. Two patients acquired a new STI on PreP. One tested positive for chlamydia and gonorrhea 1 month after initiating prep and another contracted syphilis after 6 months. No patient had recurrent STIs nor acquired HIV while on PrEP therapy.ConclusionThe use of PrEP not only reduces the transmission of HIV but also appears to reduce the incidence of other STIs. Frequent STI screenings and behavioral counseling on risk reduction likely contributed toward lower STI incidence. Larger studies examining similar data over longer durations are needed to confirm these findings.Disclosures All authors: No reported disclosures.