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OBM Genetics 2018Over the past decade, there has been rising interest in the interaction of with the environment. This interest has arisen in part from the demonstration that...
BACKGROUND
Over the past decade, there has been rising interest in the interaction of with the environment. This interest has arisen in part from the demonstration that environmental factors have important effects on the viability and transmission of microbes, including . Environmental factors include climatological factors such as temperature, humidity, and precipitation, and air pollution factors including carbon monoxide, nitrogen dioxide, sulfur dioxide, and particulate matter.
METHODS
We undertook a systematic review in order to identify environmental factors associated with infection or PCP, and their effects on human and animal hosts.
RESULTS
The systematic review found evidence of associations between infection in animal and human hosts, and climatological and air pollution factors. Data from human studies infers that rather than a seasonal association, presentation with PCP appears to be highest when the average temperature is between 10 and 20°C. There was evidence of an association with hospitalization with PCP and ambient air pollution factors, as well as evidence of an effect of air pollution on both systemic and bronchoscopic lavage fluid humoral responses to . Interpretation of human studies was confounded by possible genetically-determined predisposition to, or protection from infection.
CONCLUSIONS
This systematic review provides evidence of associations between infection in both animal and human hosts, and climatological and environmental air pollution factors. This information may lead to an improved understanding of the conditions involved in transmission of in both animal and human hosts. Such knowledge is critical to efforts aimed at prevention.
PubMed: 30815637
DOI: 10.21926/obm.genet.1804045 -
Journal of Infection in Developing... Oct 2018Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an...
INTRODUCTION
Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality. PJ is a unique fungal pathogen which is increasingly common and maybe associated with a higher mortality rate in patients without AIDS. We present the characteristics of PJP, diagnosis, and treatment outcomes between AIDS and non-AIDS patients.
METHODOLOGY
We conducted a review of studies of AIDS and non-AIDS patients with PJP using PubMed to search for studies until December 2017.
RESULTS
The annual incidence of AIDS-PJP decreased from 13.4 to 3.3 per 1000 person-years in industrialized countries, while the incidence of non-AIDS-PJP varied widely. Both groups had similar clinical manifestations and radiological features, but the non-AIDS-PJP group potentially had a more fulminant course, more diffuse ground glass opacities, and fewer cystic lesions. The mortality rate decreased in the AIDS-PJP group after the advent of antiretroviral therapy; however, the mortality rate remained high in both groups. A laboratory diagnosis was usually nonspecific; CD4+ T-cell < 200 cells/mL or < 14% favored AIDS-PJP. Serum 1,3-β-D-glucan (BDG) had a high diagnostic odds ratio. Combining BDG and lactic dehydrogenase improved the diagnosis of AIDS-PJP. Histopathological staining and polymerase chain reactions could not discriminate infection from colonization when the result was positive. The use of antibiotics, prophylaxis, and adjunctive corticosteroids was controversial.
CONCLUSIONS
Early diagnosis and treatment can be achieved through vigilance, thereby improving the survival rate for PJP in immunocompromised patients.
Topics: AIDS-Related Opportunistic Infections; Case-Control Studies; Early Diagnosis; Humans; Immunocompromised Host; Pneumocystis carinii; Pneumonia, Pneumocystis; Survival Rate
PubMed: 32004150
DOI: 10.3855/jidc.10357 -
Journal of Clinical Oncology : Official... Oct 2018To provide an updated joint ASCO/Infectious Diseases Society of America (IDSA) guideline on antimicrobial prophylaxis for adult patients with immunosuppression...
PURPOSE
To provide an updated joint ASCO/Infectious Diseases Society of America (IDSA) guideline on antimicrobial prophylaxis for adult patients with immunosuppression associated with cancer and its treatment.
METHODS
ASCO and IDSA convened an update Expert Panel and conducted a systematic review of relevant studies from May 2011 to November 2016. The guideline recommendations were based on the review of evidence by the Expert Panel.
RESULTS
Six new or updated meta-analyses and six new primary studies were added to the updated systematic review.
RECOMMENDATIONS
Antibacterial and antifungal prophylaxis is recommended for patients who are at high risk of infection, including patients who are expected to have profound, protracted neutropenia, which is defined as < 100 neutrophils/µL for > 7 days or other risk factors. Herpes simplex virus-seropositive patients undergoing allogeneic hematopoietic stem-cell transplantation or leukemia induction therapy should receive nucleoside analog-based antiviral prophylaxis, such as acyclovir. prophylaxis is recommended for patients receiving chemotherapy regimens that are associated with a > 3.5% risk for pneumonia as a result of this organism (eg, those with ≥ 20 mg prednisone equivalents daily for ≥ 1 month or on the basis of purine analog usage). Treatment with a nucleoside reverse transcription inhibitor (eg, entecavir or tenofovir) is recommended for patients at high risk of hepatitis B virus reactivation. Recommendations for vaccination and avoidance of prolonged contact with environments that have high concentrations of airborne fungal spores are also provided within the updated guideline. Additional information is available at .
Topics: Anti-Infective Agents; Humans; Immunocompromised Host; Infection Control; Infections; Neoplasms
PubMed: 30179565
DOI: 10.1200/JCO.18.00374 -
Clinical Transplantation Aug 2018A growing number of publications have reported the outbreaks of post-transplant pneumocystis pneumonia (PJP). In most studies, the onset of PJP was beyond 6-12 months... (Meta-Analysis)
Meta-Analysis
A growing number of publications have reported the outbreaks of post-transplant pneumocystis pneumonia (PJP). In most studies, the onset of PJP was beyond 6-12 months of prophylaxis. Cytomegalovirus (CMV) infection and allograft rejection have been repeatedly reported as probable risk factors for post-transplant PJP. In this systematic review and meta-analysis, we determined the pooled effect estimates of these 2 variables as risk factors. Data sources included PUBMED, MEDLINE-OVID, EMBASE-OVID, Cochrane Library, Networked Digital Library of Theses and Dissertations, World Health Organization, and Web of Science. We excluded publications related to hematopoietic stem cell transplantation (HSCT) or Human Immunodeficiency Virus (HIV) patients. Eventually, 15 studies remained for the final stage of screening. Cytomegalovirus infection (OR: 3.30, CI 95%: 2.07-5.26, I : 57%, P = 0.006) and allograft rejection (OR:2.36, CI95%: 1.54-3.62, I2: 45.5%, P = 0.05) significantly increased the risk of post-transplant PJP. Extended prophylaxis targeting recipients with allograft rejection or CMV infection may reduce the risk of PJP.
Topics: Cytomegalovirus; Cytomegalovirus Infections; Graft Rejection; Humans; Organ Transplantation; Pneumonia, Pneumocystis; Risk Factors; Transplant Recipients
PubMed: 29956379
DOI: 10.1111/ctr.13339 -
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue Apr 2018To study the accuracy of lactic dehydrogenase (LDH) in the diagnosis of pneumocystis pneumonia (PCP). (Review)
Review
OBJECTIVE
To study the accuracy of lactic dehydrogenase (LDH) in the diagnosis of pneumocystis pneumonia (PCP).
METHODS
The data of this systemic review was retrieved from the PubMed, China Biology Medicine disc, Wanfang, Weipu and China National Knowledge Infrastructure (CNKI) databases from establishment till to October 31st, 2017. Case-control studies about the diagnosis of PCP were enrolled. Enrolled studies were required that patients in case group ware PCP and patients in control group were lung diseases other than PCP. The QUADAS tool was used to evaluate the quality of studies. The RevMan 5.3 software was used to draw a forest plot. The StataMP 14 software was used to make subgroup analyses by drawing receiver operator characteristic (SROC) curves for the whole group, the acquired immune deficiency syndrome (AIDS) group, and the not all-AIDS group, and calculating their diagnostic odds ratio (DOR) and 95% confidential interval (95%CI).
RESULTS
Thirteen studies, all in English, were included. There were 825 patients in the case group, in which 650 patients were AIDS. There were 1 341 patients in control group, in which 888 patients were AIDS and most of them were Pulmonary Kaposi Sarcoma, bacterial pneumonia, pulmonary tuberculosis etc. Although there were different positive values of LDH in different studies, from 200 U/L to 598 U/L, sensitivities were good, especially in AIDS patients all values were above 80% (80%-100%). The specificities had big fluctuations, from 6% to 85%, which made them poor. The DOR (95%CI) of LDH in PCP diagnosis of all patients, AIDS patients and not-all AIDS patients were 6.73 (3.19-14.21), 9.17 (3.79-22.18) and 5.07 (1.30-19.80) respectively.
CONCLUSIONS
The sensitivity of LDH in the diagnosis of PCP is high, especially in AIDS group. In practice if LDH is negative, there should be more evidences to support the treatment of PCP.
Topics: Humans; AIDS-Related Opportunistic Infections; China; L-Lactate Dehydrogenase; Oxidoreductases; Pneumocystis; Pneumonia, Pneumocystis
PubMed: 29663992
DOI: 10.3760/cma.j.issn.2095-4352.2018.04.007 -
American Journal of Hematology Mar 2018Ruxolitinib exerts immunosuppressive activity that may increase the risk of infectious complications. We performed a systematic review of the literature with the aim of... (Meta-Analysis)
Meta-Analysis
Ruxolitinib exerts immunosuppressive activity that may increase the risk of infectious complications. We performed a systematic review of the literature with the aim of estimating the risk of infections in patients treated with ruxolitinib. Studies were identified by electronic search of MEDLINE and EMBASE database. Differences in the incidence of infectious events between ruxolitinib and comparison groups were expressed as odds ratios (ORs) and 95% confidence intervals (95% CI). Five phase III randomized clinical trials (RCTs) (3 phase IIIa with their extended phase and 2 phase IIIb), 6 phase IV studies and 28 case reports were included in this systematic review. Ruxolitinib was associated with a statistically significant increased risk of herpes zoster infection compared to control group in 3 RCTs including patients with polycythemia vera (OR 7.39 [1.33, 41.07]) and in a pooled analysis of the extended phase IIIa RCTs (OR 5.20 [95%CI 1.27, 21.18]). In the larger phase IV post-marketing study, the incidence of the most frequent infections was 8% for herpes zoster, 6.1% for bronchitis and 6% for urinary tract infections. In the published case reports, the most frequent infections were tuberculosis (N = 10), hepatitis B reactivation (N = 5) and pneumocystis jeroveci infection (N = 2). Evidence is not solid enough to accurately estimate the risk of infection in ruxolitinib-treated patients. However, published data clearly suggest that the infection risk may be clinically relevant. Well-designed studies are warranted to evaluate the risk of ruxolitinib-associated infection, in order to identify the most appropriate antimicrobial prophylactic strategy.
Topics: Antibiotic Prophylaxis; Bacterial Infections; Clinical Trials, Phase III as Topic; Confidence Intervals; Disease Susceptibility; Herpes Zoster; Humans; Immunocompromised Host; Immunosuppressive Agents; Incidence; Infections; Janus Kinase 1; Janus Kinase 2; Mycoses; Nitriles; Odds Ratio; Product Surveillance, Postmarketing; Pyrazoles; Pyrimidines; Randomized Controlled Trials as Topic; Risk
PubMed: 29150886
DOI: 10.1002/ajh.24976 -
Sixteen-year history of rituximab therapy for 1085 pemphigus vulgaris patients: A systematic review.International Immunopharmacology Jan 2018Pemphigus vulgaris (PV) is a rare autoimmune disease due to the production of pathogenic autoantibodies directed against desmoglein 1 and 3, usually affecting both skin... (Review)
Review
Pemphigus vulgaris (PV) is a rare autoimmune disease due to the production of pathogenic autoantibodies directed against desmoglein 1 and 3, usually affecting both skin and mucous membranes. Recently, rituximab, a chimeric IgG1 monoclonal antibody which targets the CD20 molecules have been regarded as a promising treatment for PV. In this study, a systematic review was conducted to conclude on how and which PV patients could benefit from rituximab infusion. Search in PubMed results in 114 relevant studies, which met the criteria. Total of 1085 PV patients with different conditions, including unresponsive childhood/juvenile or adult PV patients, women of childbearing age, those with chronic infections with the risk of reactivation have been evaluated. Although the majority of these patients well responded to rituximab, some of them did not respond, and the paucity of patients experienced exacerbation of disease. In addition to the rituximab monotherapy or its combination with conventional therapies, different novel combination therapies of rituximab with immunoadsorption and/or IVIg have shown promising results. Moreover, using rituximab as the first-line treatment has emerged recently. Pneumocystis carinii pneumonia and septicemia were found as the two fatal and serious adverse events associated with rituximab. Moreover, development or reactivation of herpes simplex and herpes zoster and cytomegalovirus should be warned. Similar to the adults, those with childhood and juvenile PV could be successfully treated with rituximab. Although rituximab seems to trigger reactivation of chronic infections, such as viral hepatitis and HIV infection, no related report was found. Administration of rituximab in approximately ten months before conception also was found safe and effective for a successful pregnancy. In conclusion, rituximab is very effective in adult and childhood/juvenile PV. However, there is a risk of not responding, exacerbation of disease and development of fatal infections. Moreover, it seems to be a promising first-line treatment for refractory PV.
Topics: Antigens, CD20; Autoantibodies; Combined Modality Therapy; Desmoglein 1; Desmoglein 3; Drug-Related Side Effects and Adverse Reactions; Herpesviridae; Humans; Immunoglobulins, Intravenous; Immunotherapy; Mucous Membrane; Pemphigus; Rituximab; Skin; Virus Activation
PubMed: 29132070
DOI: 10.1016/j.intimp.2017.11.005 -
Open Access Macedonian Journal of... Apr 2017Methotrexate (MTX) is the most commonly used disease-modifying drug in the treatment of rheumatoid arthritis (RA); however, it causes many side effects, including... (Review)
Review
BACKGROUND
Methotrexate (MTX) is the most commonly used disease-modifying drug in the treatment of rheumatoid arthritis (RA); however, it causes many side effects, including pulmonary lesions. In this review, we characterised the histopathological features of MTX-induced pulmonary lesions in RA patients.
AIM
We carried out an electronic search of the relevant literature published during the period from 1990 to 2016. We included only the cases with definitive histo-pathological findings caused by MTX therapy.
MATERIAL AND METHODS
The total number of cases is 27. Male: female ratio was 1:3, and ages ranged from 48 to 87 years old, with a mean (SD) = 65.7 (1.0). The cases were originally from Asia (55%), Europe (41%), and America (4%). The major complications of methotrexate therapy were lymphoproliferative disorders (42%) followed by interstitial fibrosis (33), and infections (25%). The incidence of these complications significantly increases with the duration of MTX treatment (p = 0.044). Among the infections, the most common causative organism was pneumocystis jiroveci. The majority of patients who developed infections following methotrexate therapy were from Europe whereas the majority of those who developed lymphoproliferative disorders were from Asia (p = 0.003).
CONCLUSION
In conclusion, methotrexate therapy in rheumatoid arthritis patients causes different types pulmonary complications.
PubMed: 28507640
DOI: 10.3889/oamjms.2017.049 -
Transplantation Direct Mar 2017Randomized trials show a mortality benefit to adjunctive corticosteroids for human immunodeficiency virus (HIV)-related pneumonia (HIV-PCP). Guidelines for non-HIV PCP...
BACKGROUND
Randomized trials show a mortality benefit to adjunctive corticosteroids for human immunodeficiency virus (HIV)-related pneumonia (HIV-PCP). Guidelines for non-HIV PCP (NH-PCP) recommend adjunctive corticosteroids based on expert opinion. We conducted a systematic review and meta-analysis characterizing adjunctive corticosteroids for NH-PCP.
METHODS
We searched MEDLINE from 1966 through 2015. Data on clinical outcomes from NH-PCP were extracted with a standardized instrument. Heterogeneity was assessed with the I index. Pooled odds ratios and 95% confidence interval were calculated using a fixed effects model.
RESULTS
Our search yielded 5044 abstracts, 277 articles were chosen for full review, and 6 articles described outcomes in moderate to severe NH-PCP. Studies were limited by variable definitions, treatment selection bias, concomitant infections and small sample size. Individual studies reported shorter intensive care unit stay and duration of mechanical ventilation of patients given adjunctive corticosteroids. There was no association between corticosteroids and survival in NH-PCP (odds ratio, 0.66; 95% confidence interval, 0.38-1.15; = 0.14).
CONCLUSIONS
The literature does not support an association between adjunctive corticosteroids and survival from NH-PCP but data are limited and findings should not be considered conclusive. Further research with improved methodology is needed to better understand the role of adjunctive corticosteroids for NH-PCP.
PubMed: 28361121
DOI: 10.1097/TXD.0000000000000642 -
Transplant Infectious Disease : An... Apr 2017In recent years, the incidence of Pneumocystis jirovecii pneumonia (PJP) has increased in immunocompromised patients without human immunodeficiency virus (HIV)... (Review)
Review
The role of CD4 cell count as discriminatory measure to guide chemoprophylaxis against Pneumocystis jirovecii pneumonia in human immunodeficiency virus-negative immunocompromised patients: A systematic review.
BACKGROUND
In recent years, the incidence of Pneumocystis jirovecii pneumonia (PJP) has increased in immunocompromised patients without human immunodeficiency virus (HIV) infection. Chemoprophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is highly effective in preventing PJP in both HIV-positive and -seronegative patients. In HIV-positive patients, the risk of PJP is strongly correlated with decreased CD4 cell count. The role of CD4 cell count in the pathogenesis of PJP in non-HIV immunocompromised patients is less well studied. For most immunosuppressive conditions, no clear guidelines indicate whether to start TMP-SMX.
METHOD
We conducted a systematic literature review with the aim to provide a comprehensive overview on the role of CD4 cell counts in managing the risk of PJP in HIV-seronegative patients.
RESULTS
Of the 63 individual studies retrieved, 14 studies report on CD4 cell counts in a variety of immunosuppressive conditions. CD4 cell count were <200/μL in 73.1% of the patients.
CONCLUSION
CD4 cell count <200/μL is a sensitive biomarker to identify non-HIV immunocompromised patients who are at risk for PJP. Measuring CD4 cell counts could help clinicians identify patients who may benefit from TMP-SMX prophylaxis.
Topics: AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Antibiotic Prophylaxis; CD4 Lymphocyte Count; HIV Seronegativity; Humans; Immunocompromised Host; Kidney Transplantation; Pneumocystis carinii; Pneumonia, Pneumocystis; Practice Guidelines as Topic; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 28035717
DOI: 10.1111/tid.12651