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World Journal of Gastroenterology Jun 2015Human nocardiosis, caused by Nocardia spp., an ubiquitous soil-borne bacteria, is a rare granulomatous disease close related to immune dysfunctions. Clinically can occur... (Review)
Review
Human nocardiosis, caused by Nocardia spp., an ubiquitous soil-borne bacteria, is a rare granulomatous disease close related to immune dysfunctions. Clinically can occur as an acute life-threatening disease, with lung, brain and skin being commonly affected. The infection was classically diagnosed in HIV infected persons, organ transplanted recipients and long term corticosteroid treated patients. Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario. Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings. We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals. Eleven cases of nocardiosis associated with anti-tumor necrosis factor (TNF) prescription (9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease (IBD), 4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients, lung disease in 4 patients, hepatic in one and disseminated disease in 3 patients. From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine. In conclusion, nocardiosis requires high levels of clinical suspicion and experience of laboratory staff, in order to establish a timely diagnosis and by doing so avoid worst outcomes. Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential. The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated.
Topics: Anti-Bacterial Agents; Bacteriological Techniques; Humans; Immunocompromised Host; Immunosuppressive Agents; Inflammatory Bowel Diseases; Nocardia Infections; Opportunistic Infections; Predictive Value of Tests; Risk Assessment; Risk Factors; Tumor Necrosis Factor-alpha
PubMed: 26074688
DOI: 10.3748/wjg.v21.i21.6491 -
Anterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome.Indian Journal of Ophthalmology 2008Ocular complications are known to occur as a result of human immunodeficiency virus (HIV) disease. They can be severe leading to ocular morbidity and visual handicap.... (Review)
Review
Ocular complications are known to occur as a result of human immunodeficiency virus (HIV) disease. They can be severe leading to ocular morbidity and visual handicap. Cytomegalovirus (CMV) retinitis is the commonest ocular opportunistic infection seen in acquired immune deficiency syndrome (AIDS). Though posterior segment lesions can be more vision-threatening, there are varied anterior segment manifestations which can also lead to ocular morbidity and more so can affect the quality of life of a HIV-positive person. Effective antiretroviral therapy and improved prophylaxis and treatment of opportunistic infections have led to an increase in the survival of an individual afflicted with AIDS. This in turn has led to an increase in the prevalence of anterior segment and adnexal disorders. Common lesions include relatively benign conditions such as blepharitis and dry eye, to infections such as herpes zoster ophthalmicus and molluscum contagiosum and malignancies such as squamous cell carcinoma and Kaposi's sarcoma. With the advent of highly active antiretroviral therapy, a new phenomenon known as immune recovery uveitis which presents with increased inflammation, has been noted to be on the rise. Several drugs used in the management of AIDS such as nevirapine or indinavir can themselves lead to severe inflammation in the anterior segment and adnexa of the eye. This article is a comprehensive update of the important anterior segment and adnexal manifestations in HIV-positive patients with special reference to their prevalence in the Indian population.
Topics: AIDS-Related Opportunistic Infections; Anterior Eye Segment; Anti-Retroviral Agents; HIV; Humans; India; Morbidity; Prognosis; Uveitis, Anterior
PubMed: 18711264
DOI: 10.4103/0301-4738.42412 -
Medical Mycology Journal 2016
Topics: Aged; Cysts; Humans; Kidney Diseases; Male; Mycoses; Opportunistic Infections; Paecilomyces; Urinary Bladder Neoplasms
PubMed: 26936350
DOI: 10.3314/mmj.57.J33 -
Maturitas Dec 2021
Topics: Aged; COVID-19; Humans; Immunocompromised Host; Mucormycosis; Opportunistic Infections; SARS-CoV-2
PubMed: 34364730
DOI: 10.1016/j.maturitas.2021.07.009 -
Clinical Microbiology Reviews Oct 1989The mycobacteria are an important group of acid-fast pathogens ranging from obligate intracellular parasites such as Mycobacterium leprae to environmental species such... (Review)
Review
The mycobacteria are an important group of acid-fast pathogens ranging from obligate intracellular parasites such as Mycobacterium leprae to environmental species such as M. gordonae and M. fortuitum. The latter may behave as opportunistic human pathogens if the host defenses have been depleted in some manner. The number and severity of such infections have increased markedly with the emergence of the acquired immunodeficiency syndrome (AIDS) epidemic. These nontuberculous mycobacteria tend to be less virulent for humans than M. tuberculosis, usually giving rise to self-limiting infections involving the cervical and mesenteric lymph nodes of young children. However, the more virulent serovars of M. avium complex can colonize the bronchial and intestinal mucosal surfaces of healthy individuals, becoming virtual members of the commensal gut microflora and thus giving rise to low levels of skin hypersensitivity to tuberculins prepared from M. avium and M. intracellulare. Systemic disease develops when the normal T-cell-mediated defenses become depleted as a result of old age, cancer chemotherapy, or infection with human immunodeficiency virus. As many as 50% of human immunodeficiency virus antibody-positive individuals develop mycobacterial infections at some time during their disease. Most isolates of M. avium complex from AIDS patients fall into serotypes 4 and 8. The presence of these drug-resistant mycobacteria in the lungs of the AIDS patient makes their effective clinical treatment virtually impossible. More effective chemotherapeutic, prophylactic, and immunotherapeutic reagents are urgently needed to treat this rapidly increasing patient population.
Topics: Acquired Immunodeficiency Syndrome; Animals; Humans; Immune Tolerance; Immunosuppression Therapy; Mycobacterium; Mycobacterium Infections; Mycobacterium avium-intracellulare Infection; Opportunistic Infections; Tuberculosis; Virulence
PubMed: 2680057
DOI: 10.1128/CMR.2.4.360 -
Experimental and Clinical... Apr 2016Rituximab is a monoclonal antibody directed against the CD20 molecule on pre-B and mature B cells and is used in transplant recipients for the prevention and treatment...
OBJECTIVES
Rituximab is a monoclonal antibody directed against the CD20 molecule on pre-B and mature B cells and is used in transplant recipients for the prevention and treatment of alloantibody-mediated rejection or for the treatment of disease recurrence after transplant. In most patients, rituximab has been safe and well-tolerated, but the long-term adverse effects of rituximab are currently unknown.
MATERIALS AND METHODS
We retrospectively evaluated 78 pediatric renal transplant recipients for the occurrence of infectious disease. Patients who received rituximab therapy were divided into 2 groups: those who developed an infection and those who did not. The 2 groups were compared for serious infections, hospitalization, graft loss, and death rates.
RESULTS
Eighteen transplant patients received rituximab therapy for various causes. The number of rituximab courses given varied according to the cause and ranged from 1 to 8 courses. The dose at each course was 375 mg/m(2). Median age of all recipients was 16.00 years (min-max:, 5.00-22.00 y), and median follow-up time was 2.00 years (min-max:, 1.00-3.00 y). Serious infections (bacterial sepsis, tuberculosis, Cytomegalovirus infection, varicella-zoster virus infection, Polyomavirus-associated nephropathy, and acute pyelonephritis) were observed in 8 patients who received rituximab therapy. We observed that patients with antibody-mediated rejection had significantly increased infection rate. Patients who had used rituximab combined with antithymocyte globulin and higher rituximab course number and higher pretreatment CD19 and CD20 levels had higher risk of infection (P < .05).
CONCLUSIONS
The combined use of rituximab with additional treatments such as antithymocyte globulin, intravenous immunoglobulin, and repeated plasma exchange may be associated with high risk of infectious disease. Especially for those patients who required intensive and repetitive treatment, such as antibody-mediated rejection, rituximab treatment should be used with caution. Infection risk should be closely monitored, although mainly in patients who receive T-cell-depleting agents.
Topics: Adolescent; Age Factors; Child; Child, Preschool; Drug Therapy, Combination; Female; Graft Survival; Hospitalization; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Male; Opportunistic Infections; Plasma Exchange; Retrospective Studies; Risk Assessment; Risk Factors; Rituximab; Time Factors; Treatment Outcome; Young Adult
PubMed: 26742572
DOI: 10.6002/ect.2014.0156 -
Annals of the Rheumatic Diseases Dec 2008Progressive multifocal leucoencephalopathy (PML) is a rare and often fatal opportunistic infection that has been well reported in patients with rheumatic diseases. The... (Review)
Review
Progressive multifocal leucoencephalopathy (PML) is a rare and often fatal opportunistic infection that has been well reported in patients with rheumatic diseases. The contributions of predisposing factors such as underlying disease and immunosuppressive drug selection are incompletely understood but it would appear that patients with systemic lupus erythematosus may be at highest risk. Natalizumab, a biological agent approved for multiple sclerosis and Crohn's disease has the clearest pattern of small but definite risk. Although the risk due to rituximab is difficult to assess given the multiple confounders, continued vigilance is warranted. Rheumatologists need to become familiar with PML and feel able to help patients make shared and informed decisions about the risks when starting treatment with immunosuppressive therapies. In particular, rheumatologists need to be vigilant and pursue the diagnosis of PML in all patients with unexplained neurological signs or symptoms with clinical and MRI findings compatible with the diagnosis.
Topics: Humans; Immunosuppressive Agents; Leukoencephalopathy, Progressive Multifocal; Opportunistic Infections; Rheumatic Diseases
PubMed: 19022817
DOI: 10.1136/ard.2008.097972 -
Ethiopian Journal of Health Sciences Jul 2022Opportunistic infection (OI) is the most significant complication of the human immunodeficiency virus (HIV). Differences in the characteristics of HIV patients make the...
BACKGROUND
Opportunistic infection (OI) is the most significant complication of the human immunodeficiency virus (HIV). Differences in the characteristics of HIV patients make the prevalence of Opportunistic infection different between regions. The study aimed to identify variables associated with OI incidence among HIV-infected patients in Semarang City, Indonesia.
METHODS
This study uses secondary data sourced from special HIV surveillance for 2019-2021 with a cross-sectional method. 1362 HIV patients with variables health care facilities; year of diagnosis; area of residence; age; sex; pregnancy status; occupation; risk factors; risk group determined based on purposive sampling were included in the chi-square analysis and logistic regression.
RESULTS
This study showed 12.3% (n=167) of HIV patients experienced OI, where OI was more common in HIV patients with risk groups of sex workers (28.70%), high-risk partners (18.60%), and Male Sex with Men (MSM) (15.40). The most common types of OI were tuberculosis infection (43%), candidiasis (21%), and diarrhea (9%). Age was the variable most associated with the incidence of OI (p-value 0.001).
CONCLUSIONS
Age groups 45-54 years and 55-64 years have the most influential association with Opportunistic infection incidence in HIV patients, so planning an appropriate intervention program for this subpopulation is necessary.
Topics: AIDS-Related Opportunistic Infections; Cross-Sectional Studies; Female; HIV Infections; Homosexuality, Male; Humans; Male; Middle Aged; Pregnancy; Prevalence; Sexual and Gender Minorities
PubMed: 35950061
DOI: 10.4314/ejhs.v32i4.18 -
Medizinische Klinik, Intensivmedizin... Jun 2012The life expectancy and prevalence of malignant diseases is continuously on the rise, which inevitably leads to an increase of critically ill cancer patients. This... (Review)
Review
The life expectancy and prevalence of malignant diseases is continuously on the rise, which inevitably leads to an increase of critically ill cancer patients. This article explains why the prognosis of cancer patients in the intensive care unit has markedly improved over the last decades, what the reasons for admission are and which risk factors affect mortality. Furthermore, the importance of correct patient selection and other specific topics will be discussed. Accordingly, acute respiratory failure for example is the most common organ dysfunction in these patients and has specific prognostic, diagnostic and therapeutic characteristics. The successful management of cancer patients in the intensive care unit requires specific knowledge of the intensive care physician and an excellent cooperation with the treating hematologist and oncologist.
Topics: Cause of Death; Cooperative Behavior; Critical Care; Cross Infection; Hematologic Neoplasms; Hospital Mortality; Humans; Intensive Care Units; Interdisciplinary Communication; Opportunistic Infections; Palliative Care; Prognosis; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory Insufficiency; Risk Factors; Sepsis
PubMed: 22689258
DOI: 10.1007/s00063-012-0121-2 -
Pneumologie (Stuttgart, Germany) May 2010Recognition of and therapy for fungal infections of the lungs still presents problems even for the experienced clinician. The distinction between invasive mycoses of the... (Review)
Review
Recognition of and therapy for fungal infections of the lungs still presents problems even for the experienced clinician. The distinction between invasive mycoses of the lungs and fungal colonisations that do not require therapy is cinically difficult and can often not be made satisfactorily even with advanced microbiological diagnostics. One must differentiate between a primary, often locally limited, endemic pulmonary mycosis and a pulmonary mycosis against the background of a locally or systemically compromised immune system. Patients at risk include those with advanced HIV infections, patients under long-term antibiotic therapy as well as oncological and multimorbid patients. The pulmonary manifestation of a mycosis may not only be the starting point for a systemic dissemination but can also arise in the course of hematogenous spread of the infection. The latter can appear, for example, as an invasive pulmonary aspergillosis in immunesuppressed patients. Thus, early clinical, radiological and biological confirmation of the diagnosis is essential in order to avoid the possible complications of pulmonary mycosis.
Topics: Blastomycosis; Coccidioidomycosis; Endemic Diseases; Geography; Histoplasmosis; Humans; Immunosuppression Therapy; Lung Diseases, Fungal; Mycoses; Opportunistic Infections; Radiography; Risk Factors
PubMed: 20455177
DOI: 10.1055/s-0029-1244004