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Physiological Reviews Apr 2020Despite anti-retroviral therapy (ART), human immunodeficiency virus-1 (HIV)-related pulmonary disease continues to be a major cause of morbidity and mortality for people... (Review)
Review
Despite anti-retroviral therapy (ART), human immunodeficiency virus-1 (HIV)-related pulmonary disease continues to be a major cause of morbidity and mortality for people living with HIV (PLWH). The spectrum of lung diseases has changed from acute opportunistic infections resulting in death to chronic lung diseases for those with access to ART. Chronic immune activation and suppression can result in impairment of innate immunity and progressive loss of T cell and B cell functionality with aberrant cytokine and chemokine responses systemically as well as in the lung. HIV can be detected in the lungs of PLWH and has profound effects on cellular immune functions. In addition, HIV-related lung injury and disease can occur secondary to a number of mechanisms including altered pulmonary and systemic inflammatory pathways, viral persistence in the lung, oxidative stress with additive effects of smoke exposure, microbial translocation, and alterations in the lung and gut microbiome. Although ART has had profound effects on systemic viral suppression in HIV, the impact of ART on lung immunology still needs to be fully elucidated. Understanding of the mechanisms by which HIV-related lung diseases continue to occur is critical to the development of new preventive and therapeutic strategies to improve lung health in PLWH.
Topics: AIDS-Related Opportunistic Infections; Animals; Anti-HIV Agents; Anti-Inflammatory Agents; Asthma; Disease Models, Animal; HIV; HIV Infections; Host-Pathogen Interactions; Humans; Hypertension, Pulmonary; Immunocompromised Host; Lung; Lung Neoplasms; Prognosis; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections; Risk Factors
PubMed: 31600121
DOI: 10.1152/physrev.00039.2018 -
CA: a Cancer Journal For Clinicians Nov 2021Infection is the second leading cause of death in patients with cancer. Loss of efficacy in antibiotics due to antibiotic resistance in bacteria is an urgent threat... (Review)
Review
Infection is the second leading cause of death in patients with cancer. Loss of efficacy in antibiotics due to antibiotic resistance in bacteria is an urgent threat against the continuing success of cancer therapy. In this review, the authors focus on recent updates on the impact of antibiotic resistance in the cancer setting, particularly on the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.). This review highlights the health and financial impact of antibiotic resistance in patients with cancer. Furthermore, the authors recommend measures to control the emergence of antibiotic resistance, highlighting the risk factors associated with cancer care. A lack of data in the etiology of infections, specifically in oncology patients in United States, is identified as a concern, and the authors advocate for a centralized and specialized surveillance system for patients with cancer to predict and prevent the emergence of antibiotic resistance. Finding better ways to predict, prevent, and treat antibiotic-resistant infections will have a major positive impact on the care of those with cancer.
Topics: Anti-Bacterial Agents; Antimicrobial Stewardship; Drug Resistance, Multiple, Bacterial; Humans; Immunocompromised Host; Neoplasms; Opportunistic Infections; Prescription Drug Misuse
PubMed: 34546590
DOI: 10.3322/caac.21697 -
Infectious Disease Clinics of North... Mar 2022Recipients of solid organ and hematopoietic stem cell transplantation undergo substantial immune suppression, placing them at risk for opportunistic viral infection. Few... (Review)
Review
Recipients of solid organ and hematopoietic stem cell transplantation undergo substantial immune suppression, placing them at risk for opportunistic viral infection. Few randomized controlled trials have been dedicated to the treatment of viral infections in children, and current practices are extrapolated from data generated from adult patients. Here we discuss the prevention and treatment of viral infections using available antiviral drugs, as well as novel agents that may provide benefit to pediatric patients in the future.
Topics: Adult; Antiviral Agents; Child; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppression Therapy; Opportunistic Infections; Transplant Recipients
PubMed: 35168706
DOI: 10.1016/j.idc.2021.11.004 -
Pediatric Research Jan 2022Tuberculosis (TB) is an increasing global emergency in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients, in which host immunity is... (Review)
Review
Tuberculosis (TB) is an increasing global emergency in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients, in which host immunity is dysregulated and compromised. However, the pathogenesis and efficacy of therapeutic strategies in HIV-associated TB in developing infants are essentially lacking. Bacillus Calmette-Guerin vaccine, an attenuated live strain of Mycobacterium bovis, is not adequately effective, which confers partial protection against Mycobacterium tuberculosis (Mtb) in infants when administered at birth. However, pediatric HIV infection is most devastating in the disease progression of TB. It remains challenging whether early antiretroviral therapy (ART) could maintain immune development and function, and restore Mtb-specific immune function in HIV-associated TB in children. A better understanding of the immunopathogenesis in HIV-associated pediatric Mtb infection is essential to provide more effective interventions, reducing the risk of morbidity and mortality in HIV-associated Mtb infection in infants. IMPACT: Children living with HIV are more likely prone to opportunistic infection, predisposing high risk of TB diseases. HIV and Mtb coinfection in infants may synergistically accelerate disease progression. Early ART may probably induce immune reconstitution inflammatory syndrome and TB pathology in HIV/Mtb coinfected infants.
Topics: AIDS-Related Opportunistic Infections; Anti-Retroviral Agents; Child; HIV Infections; Humans; Tuberculosis
PubMed: 33731810
DOI: 10.1038/s41390-021-01393-x -
Monaldi Archives For Chest Disease =... Nov 2020Opportunistic infections caused by fungi and unusual bacteria are predominantly encountered in the setting of immunosuppressed host. Co-infections with multiple such...
Opportunistic infections caused by fungi and unusual bacteria are predominantly encountered in the setting of immunosuppressed host. Co-infections with multiple such organisms can pose multiple challenges even to the astute clinician from establishing the diagnosis to drug interactions during treatment of such infections. We hereby present one such case of a triple opportunistic infection in an immunocompetent host and the difficulties faced in the therapeutic decision making.
Topics: Antifungal Agents; Aspergillus niger; Bronchoalveolar Lavage; Bronchoscopy; Cough; Dyspnea; Fever; Humans; Immunocompromised Host; Male; Middle Aged; Mucorales; Nocardia; Opportunistic Infections; Pneumonia; Sputum; Thoracentesis; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography
PubMed: 33169596
DOI: 10.4081/monaldi.2020.1493 -
Infectious Disease Clinics of North... Sep 2019Great progress has been made in caring for persons with human immunodeficiency virus. However, a significant proportion of individuals still present to care with... (Review)
Review
Great progress has been made in caring for persons with human immunodeficiency virus. However, a significant proportion of individuals still present to care with advanced disease and a low CD4 count. Careful considerations for selection of antiretroviral therapy as well as close monitoring for opportunistic infections and immune reconstitution inflammatory syndrome are vitally important in providing care for such individuals.
Topics: AIDS-Related Opportunistic Infections; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Disease Management; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome
PubMed: 31255383
DOI: 10.1016/j.idc.2019.05.005 -
Biomedica : Revista Del Instituto... Mar 2020In Colombia, especially in intensive care units, candidemia is a frequent cause of infection, accounting for 88% of fungal infections in hospitalized patients, with...
In Colombia, especially in intensive care units, candidemia is a frequent cause of infection, accounting for 88% of fungal infections in hospitalized patients, with mortality ranging from 36% to 78%. Its incidence in Colombia is higher than that reported in developed countries and even higher than in other Latin American countries. First, the patient’s risk factors should be considered, and then clinical characteristics should be assessed. Finally, microbiological studies are recommended and if the evidence supports its use, molecular testing. In general, American, Latin American, and European guides place the echinocandins as the first-line treatment for candidemia and differ in the use of fluconazole based on evidence, disease severity, previous exposure to azoles, and prevalence of Candida non-albicans. Taking into account the high incidence of this disease in our setting, it should be looked for in patients with risk factors to start a prompt empirical anti-fungal treatment.
Topics: APACHE; Antifungal Agents; Candida; Candidemia; Catheter-Related Infections; Colombia; Comorbidity; Drug Resistance, Fungal; Humans; Immunocompromised Host; Infant, Premature; Infant, Premature, Diseases; Neoplasms; Neutropenia; Opportunistic Infections; Postoperative Complications; Prognosis; Renal Dialysis; Respiration, Artificial; Risk Factors; Species Specificity
PubMed: 32220174
DOI: 10.7705/biomedica.4400 -
Viruses Jul 2023Opportunistic viral infections of the central nervous system represent a significant cause of morbidity and mortality among an increasing number of immunocompromised... (Review)
Review
Opportunistic viral infections of the central nervous system represent a significant cause of morbidity and mortality among an increasing number of immunocompromised patients. Since antiviral treatments are usually poorly effective, the prognosis generally relies on the ability to achieve timely immune reconstitution. Hence, strategies aimed at reinvigorating antiviral immune activity have recently emerged. Among these, virus-specific T-cells are increasingly perceived as a principled and valuable tool to treat opportunistic viral infections. Here we briefly discuss how to develop and select virus-specific T-cells, then review their main indications in central nervous system infections, including progressive multifocal leukoencephalopathy, CMV infection, and adenovirus infection. We also discuss their potential interest in the treatment of progressive multiple sclerosis, or EBV-associated central nervous system inflammatory disease. We finish with the key future milestones of this promising treatment strategy.
Topics: Humans; Central Nervous System; Leukoencephalopathy, Progressive Multifocal; Cytomegalovirus Infections; Opportunistic Infections; Central Nervous System Diseases; Antiviral Agents; Cell- and Tissue-Based Therapy
PubMed: 37515196
DOI: 10.3390/v15071510 -
Reumatismo Nov 2020Systemic lupus erythematosus (SLE) is an inflammatory and multi-systemic autoimmune disorder, characterized by an uncontrolled auto-reactivity of B and T lymphocytes,... (Review)
Review
Systemic lupus erythematosus (SLE) is an inflammatory and multi-systemic autoimmune disorder, characterized by an uncontrolled auto-reactivity of B and T lymphocytes, leading to the production of autoantibodies against self-directed antigens and tissue damage. The life expectancy in patients with SLE has improved tremendously in the last two decades, but the mortality rates still remain three times greater compared to those of the general population. Despite increased awareness and improved management, infections remain a major source of morbidity, mortality, hospitalization, and death in patients with SLE. The infections in SLE patients widely range from opportunistic to common bacterial and viral infections with typical or atypical presentations. Moreover, SLE patients exhibit an increased susceptibility to hospital-acquired infections. Factors associated with increased risk of infections include high disease activity, specific immune dysregulation, drug-induced immune deficiency, and organ failure with irreversible damage. Furthermore, immunosuppressive agents may make patients more susceptible to opportunistic infections. A big challenge faced by physicians in these patients is to distinguish between infections and flares of SLE, as infections may mimic them, leading to predicament in diagnosis and appropriate management. Immunosuppression used to treat severe flares of lupus can have catastrophic complications in patients with active infections. There is an urgent need for biomarkers to make an accurate differential diagnosis in this situation. In spite of increased understanding of SLE, many questions remain unanswered. Further research is needed to determine specific immune dysregulation underlying the increased susceptibility to specific infections, predictors of infection in SLE such as genetic markers, and biomarkers that discriminate between disease activity and active infections. Also, measures must be evaluated appropriately to prevent infections, and their complications in SLE.
Topics: Antineoplastic Agents; Bacterial Infections; Biomarkers; Common Variable Immunodeficiency; Cross Infection; Diagnosis, Differential; Genetic Predisposition to Disease; Humans; Immunity, Cellular; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mycoses; Opportunistic Infections; Symptom Flare Up; Vaccination; Virus Diseases
PubMed: 33213128
DOI: 10.4081/reumatismo.2020.1303 -
Thorax Dec 2023Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare disease, predisposing to an increased risk of infection. A complete picture of these infections is lacking.
BACKGROUND
Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare disease, predisposing to an increased risk of infection. A complete picture of these infections is lacking.
RESEARCH QUESTION
Describe the characteristics and clinical outcomes of patients diagnosed with aPAP, and to identify risk factors associated with opportunistic infections.
METHODS
We conducted a retrospective cohort including all patients diagnosed with aPAP between 2008 and 2018 in France and Belgium. Data were collected using a standardised questionnaire including demographics, comorbidities, imaging features, outcomes and microbiological data.
RESULTS
We included 104 patients, 2/3 were men and median age at diagnosis was 45 years. With a median follow-up of 3.4 years (IQR 1.7-6.6 years), 60 patients (58%), developed at least one infection, including 23 (22%) with opportunistic infections. spp was the main pathogen identified (n=10). Thirty-five (34%) patients were hospitalised due to infection. In univariate analysis, male gender was associated with opportunistic infections (p=0.04, OR=3.88; 95% CI (1.02 to 22.06)). Anti-granulocyte macrophage colony-stimulating factor antibody titre at diagnosis was significantly higher among patients who developed nocardiosis (1058 (316-1591) vs 580 (200-1190), p=0.01). Nine patients had died (9%), but only one death was related to infection.
INTERPRETATION
Patients with aPAP often presented with opportunistic infections, especially nocardiosis, which highlights the importance of systematic search for slow-growing bacteria in bronchoalveolar lavage or whole lung lavage.
Topics: Humans; Male; Middle Aged; Female; Pulmonary Alveolar Proteinosis; Retrospective Studies; Granulocyte-Macrophage Colony-Stimulating Factor; Autoimmune Diseases; Nocardia Infections; Opportunistic Infections; Autoantibodies
PubMed: 37758458
DOI: 10.1136/thorax-2023-220040