It is has been shown that the majority of T. cruzi strains isolated from Mexico belong to the T. cruzi I (TCI). The immune response produced in response to Mexican T. cruzi I strains has not been well characterized. In this study, two Mexican T. cruzi I strains were used to infect Balb/c mice. The Queretaro (TBAR/MX/0000/Queretaro)(Qro) strain resulted in 100% mortality. In contrast, no mortality was observed in mice infected with the Ninoa (MHOM/MX/1994/Ninoa) strain. Both strains produced extended lymphocyte infiltrates in cardiac tissue. Ninoa infection induced a diverse humoral response with a higher variety of immunoglobulin isotypes than were found in Qro-infected mice. Also, a stronger inflammatory TH1 response, represented by IL-12p40, IFNγ, RANTES, MIG, MIP-1β, and MCP-1 production was observed in Qro-infected mice when compared with Ninoa-infected mice. We propose that an exacerbated TH1 immune response is a likely cause of pathological damage observed in cardiac tissue and the primary cause of death in Qro-infected mice.

QUESTIONS1. What data exist regarding an association between vascular disease and psoriasis?2. What methods were employed to evaluate the risk of stroke in patients with psoriasis? 3. What were the major findings of this study? 4. What are the limitations of this study? 5. How might the results of this study influence patient care?The past decade has been a roller-coaster ride for patients with psoriasis. Excitement surrounding the advent of biologic agents for the treatment of psoriasis has been displaced by sobering reports that patients with psoriasis are at increased risk for severe vascular disease (Shelling et al., 2008). This increased risk is imparted by both a predilection for patients with psoriasis to have traditional vascular disease risk factors (e.g., diabetes, hypertension, smoking, dyslipidemia) (Federman et al., 2009) and the recent recognition that psoriasis itself is an independent risk factor for vascular disease (Gelfand et al., 2006). The latter is probably mediated by systemic inflammation associated with psoriasis, similar to that observed in patients with rheumatoid arthritis. Patients whose psoriasis develops at a young age and those with more severe disease are at the greatest risk (Gelfand et al., 2006).Initial psoriasis comorbidity studies focused on cardiovascular disease, but atherosclerosis is a systemic disease (Prodanovich et al., 2009). It is reasonable to postulate that if the likelihood of myocardial infarction is increased in patients with psoriasis, other manifestations of atherosclerosis, such as stroke, might also be more common in these patients. Stroke is a leading cause of mortality, and many who survive experience functional disability, with up to 30% being permanently disabled and 20% requiring institutional care (Rosamond et al., 2008).Gelfand and colleagues returned to a large medical-records database in the United Kingdom that they had used previously for epidemiological research (Gelfand et al., 2009, this issue) to study the association between psoriasis and stroke. Nearly 133,000 patients with psoriasis included in this database were evaluated (129,143 with mild psoriasis, 3,603 with severe psoriasis) and compared with more than half a million matched control patients for the risk of stroke. Patients with psoriasis were more likely to have vascular disease risk factors than were controls. After adjusting for major risk factors for stroke, patients with psoriasis were found to be more likely to suffer a stroke. For mild psoriasis, a 6% increase in risk was identified (hazard ratio 1.06, 95% confidence interval 1.01-1.11); for severe psoriasis, the increased risk was determined to be 43% (1.43, 95% confidence interval 1.1-1.87).Through the following questions, we examine this paper in greater detail. For discussion and brief answers, please refer to the supplementary information linked to the online version of the paper at http://www.nature.com/jid. references

Coxsackie eruptions concentrated in areas of atopic dermatitis, a phenomenon termed "eczema coxsackium," has been well described in the literature but, to our knowledge, the concentration of coxsackie viral lesions to areas of ichthyosis has not been reported. This case describes a rare presentation of coxsackie viral lesions concentrated in areas of epidermolytic ichthyosis in a 3-year-old boy.

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