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BMJ Case Reports Dec 2013A 40-year-old man with a previous AIDS-defining opportunistic infection and five negative HIV tests presented to our outpatient clinic. The laboratory test was relevant...
A 40-year-old man with a previous AIDS-defining opportunistic infection and five negative HIV tests presented to our outpatient clinic. The laboratory test was relevant for less than 300 total lymphocytes on two separate occasions. He was diagnosed with idiopathic CD4 lymphocytopenia and was started on antibiotic prophylaxis for Pneumocystis carinii pneumonia and Micobacterium avium-intracellulare infection (MAI). This case report summarises the importance of further immunological characterisation in patients presenting with opportunistic infections and decreased cellular immunity.
Topics: Adult; Anti-Infective Agents; CD4 Lymphocyte Count; Diagnosis, Differential; HIV Seronegativity; Humans; Male; Opportunistic Infections; Pneumonia, Pneumocystis
PubMed: 24311427
DOI: 10.1136/bcr-2013-201687 -
Clinical Microbiology and Infection :... Dec 2018Severe infections are among the most common causes of death in immunocompromised patients admitted to the intensive care unit. The epidemiology, diagnosis and treatment... (Review)
Review
BACKGROUND
Severe infections are among the most common causes of death in immunocompromised patients admitted to the intensive care unit. The epidemiology, diagnosis and treatment of these infections has evolved in the last decade.
AIMS
We aim to provide a comprehensive review of these severe infections in this population.
SOURCES
Review of the literature pertaining to severe infections in critically ill solid organ transplant recipients. PubMed and Embase databases were searched for documents published since database inception until November 2017.
CONTENT
The epidemiology of severe infections has changed in the immunocompromised patients. This population is presenting to the intensive care unit with specific transplantation procedure-related infections, device-associated infections, a multitude of opportunistic viral infections, an increasing number of nosocomial infections and bacterial diseases with a more limited therapeutic armamentarium. Both molecular diagnostics and imaging techniques have had substantial progress in the last decade, which will, we hope, translate into faster and more precise diagnoses, as well as more optimal empirical treatment de-escalation.
IMPLICATIONS
The key clinical elements to improve the outcome of critically ill solid organ transplant recipients depend on the knowledge of geographic epidemiology, specific surgical procedures, net state of immunosuppression, hospital microbial ecology, aggressive diagnostic strategy and search for source control, rapid initiation of antimicrobials and minimization of iatrogenic immunosuppression.
Topics: Anti-Infective Agents; Bacterial Infections; Critical Illness; Cross Infection; Humans; Immunocompromised Host; Intensive Care Units; Mycoses; Opportunistic Infections; Organ Transplantation; Transplant Recipients; Virus Diseases
PubMed: 29715551
DOI: 10.1016/j.cmi.2018.04.022 -
The British Journal of Ophthalmology Mar 2006Has important management implications
Has important management implications
Topics: Eye Infections; Humans; Opportunistic Infections; Symbiosis
PubMed: 16488937
DOI: 10.1136/bjo.2005.084095 -
Current Rheumatology Reports Aug 2014Patients with rheumatoid arthritis (RA) suffer an increased burden of infectious disease-related morbidity and mortality and have twice the risk of acquiring a severe... (Review)
Review
Patients with rheumatoid arthritis (RA) suffer an increased burden of infectious disease-related morbidity and mortality and have twice the risk of acquiring a severe infection compared to the general population. This increased risk is not only a result of the autoimmune disease but is also attributed to the immunosuppressive therapies that are commonly used in this patient population. Given the increase in infection-related risks in RA, there is great interest in mitigating such risk. A number of vaccines are available to the rheumatologist, with a handful that are of importance for RA patients in the United States. The goal of this paper is to highlight the most recent literature on the key vaccines and the specific considerations for the rheumatologist and their RA patients, with a particular focus on influenza, pneumococcal, and herpes zoster vaccines. It is important for rheumatologist to understand and be aware of which vaccines are live and what potential contraindications exist for giving vaccines to RA patients.
Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Contraindications; Herpes Zoster Vaccine; Humans; Immunocompromised Host; Influenza Vaccines; Opportunistic Infections; Pneumococcal Vaccines; Practice Guidelines as Topic; Vaccination
PubMed: 24925587
DOI: 10.1007/s11926-014-0431-x -
Life Sciences Oct 2022This manuscript aims to explain the relationship between mucositis caused by 5-FU over gut bacterial species and susceptibility to opportunistic infection caused by P....
AIMS
This manuscript aims to explain the relationship between mucositis caused by 5-FU over gut bacterial species and susceptibility to opportunistic infection caused by P. aeruginosa.
MAIN METHODS
BALB/c mice were intraperitoneally treated with PBS or 5-FU. Bodyweight and faecal consistency were checked daily. Mice faecal DNA was extracted, and bacterial phylogenetic groups were analysed using qPCR or high-throughput sequencing. Immunofluorescence was used to evaluate BMDM activation by mice-treated faecal content. Mice were challenged intratracheally with virulent P. aeruginosa, and the CFU and histology were analysed. Faecal microbiota were transplanted to evaluate the gut microbiota and resistance to pulmonary P. aeruginosa recovery.
KEY FINDINGS
The animals treated with 5-FU presented mucositis with great weight loss, altered faecal consistency, bacterial gut dysbiosis and histological changes in the intestinal mucosa. Mice under 5-FU treatment were more susceptible to lung infection by the bacteria P. aeruginosa and had more extensive tissue damage during their lung infection with greater pro-inflammatory gene expression. It was observed that the mucositis remained in the groups with 5-FU even with the FMT. The results caused by mucositis in animals that received allogeneic FMT were reversed, however, with a decrease in P. aeruginosa susceptibility in animals treated with 5-FU and allogeneic FMT compared to animals treated with 5-FU and autologous FMT.
SIGNIFICANCE
Treatment with 5-FU in a murine model makes it more susceptible to pulmonary infection by the bacterium P. aeruginosa, FMT offers an opportunity to protect against this susceptibility to infection.
Topics: Animals; Antineoplastic Agents; Bacteria; Dysbiosis; Fluorouracil; Intestinal Mucosa; Mice; Mice, Inbred BALB C; Mucositis; Opportunistic Infections; Phylogeny; Pseudomonas Infections; Pseudomonas aeruginosa
PubMed: 35988752
DOI: 10.1016/j.lfs.2022.120890 -
Virulence May 2012Acinetobacter baumannii is an opportunistic bacterial pathogen primarily associated with hospital-acquired infections. The recent increase in incidence, largely... (Review)
Review
Acinetobacter baumannii is an opportunistic bacterial pathogen primarily associated with hospital-acquired infections. The recent increase in incidence, largely associated with infected combat troops returning from conflict zones, coupled with a dramatic increase in the incidence of multidrug-resistant (MDR) strains, has significantly raised the profile of this emerging opportunistic pathogen. Herein, we provide an overview of the pathogen, discuss some of the major factors that have led to its clinical prominence and outline some of the novel therapeutic strategies currently in development.
Topics: Acinetobacter Infections; Acinetobacter baumannii; Communicable Diseases, Emerging; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Incidence; Opportunistic Infections
PubMed: 22546906
DOI: 10.4161/viru.19700 -
British Journal of Haematology Jan 2006There is an increasing use of monoclonal antibodies in the treatment of haematological malignancies. Alemtuzumab (Campath-1H; Ilex Pharmaceuticals, San Antonio, TX, USA)... (Review)
Review
There is an increasing use of monoclonal antibodies in the treatment of haematological malignancies. Alemtuzumab (Campath-1H; Ilex Pharmaceuticals, San Antonio, TX, USA) is a monoclonal antibody reactive with the CD52 antigen used as first and second line therapy for two types of lymphoproliferative disorders: chronic lymphocytic leukaemia (CLL), and T-cell lymphomas [both peripheral (PTCL) and cutaneous (CTCL)]. With alemtuzumab therapy, viral, bacterial and fungal infectious complications are frequent, and may be life threatening. An understanding of the patients at highest risk and duration of risk are important in developing recommendations for empirical management, antimicrobial prophylaxis and targeted surveillance. This review discusses the infection risks associated with these lymphoproliferative disorders and their treatment, and provide detailed recommendations for screening and prophylaxis.
Topics: Alemtuzumab; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm; Antineoplastic Agents; Antiviral Agents; Humans; Immunocompromised Host; Lymphoproliferative Disorders; Opportunistic Infections
PubMed: 16371014
DOI: 10.1111/j.1365-2141.2005.05789.x -
Experimental and Clinical... Aug 2016Cytomegalovirus infection and disease remain an issue in solid-organ transplant. Universal prophylaxis is more cost-effective than a preemptive strategy and is... (Review)
Review
OBJECTIVES
Cytomegalovirus infection and disease remain an issue in solid-organ transplant. Universal prophylaxis is more cost-effective than a preemptive strategy and is associated with significantly less Cytomegalovirus resistance after kidney transplant, especially in Cytomegalovirus-seropositive donors and Cytomegalovirus-seronegative recipients.
MATERIALS AND METHODS
Registry data and meta-analyses have shown that mammalian target of rapamycin inhibitors (sirolimus- and everolimus-based immunosuppression) are associated with significantly less Cytomegalovirus events in de novo kidney transplant patients than in patients who are treated with calcineurin inhibitors plus mycophenolate-based immunosuppression.
RESULTS
Recent pooled analyses of 3 randomized controlled trials in de novo kidney transplant patients, where immunosuppression was based on cyclosporine with either mycophenolate or everolimus, showed that patients who received everolimus had significantly less Cytomegalovirus events (Cytomegalovirus viremia, Cytomegalovirus infection/disease) than those who received mycophenolate, with or without cytomegalovirus as prophylaxis. An even more recent prospective randomized controlled study on de novo kidney transplant patients with no anticytomegalovirus prophylaxis demonstrated that everolimus-based immunosuppression plus low-dose tacrolimus was associated with significantly less Cytomegalovirus infection than standard-dose tacrolimus plus mycophenolate.
CONCLUSIONS
The potential benefits are not fully known of such a therapeutic strategy to limit the long-term indirect effects mediated by Cytomegalovirus infections.
Topics: Cytomegalovirus; Drug Therapy, Combination; Everolimus; Evidence-Based Medicine; Graft Rejection; Graft Survival; Host-Pathogen Interactions; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Opportunistic Infections; Protein Kinase Inhibitors; Risk Factors; TOR Serine-Threonine Kinases; Time Factors; Treatment Outcome; Virus Activation
PubMed: 27041365
DOI: 10.6002/ect.2015.0292 -
International Journal of... 2020Talaromycosis is a rare deep fungal infection caused by . Currently, methamphetamine has become the second-largest drug abuse category in the world after cannabis and...
Talaromycosis is a rare deep fungal infection caused by . Currently, methamphetamine has become the second-largest drug abuse category in the world after cannabis and has become a serious public health problem. Methamphetamine can inhibit human immune system and increase the probability of pathogenic microorganism infection. On 8 October 2016, a 20-year-old man with a fever history of 2 months was admitted to our hospital. He had bloody stools and abdominal pain during hospitalization. There was no significant abnormality in physical examination. Because of the misdiagnosis, he underwent improper treatment. Periodic acid-Schiff stain (PAS) staining showed that the mucosa of distal ileum, ascending colon, transverse colon, and sigmoid colon were infiltrated by a large number of tissue cells, which contained a large number of blue purple particles. In addition, a large number of histiocytes and multinucleated giant cells can be seen in the lamina propria of ileum mucosa, and fungal spores can be seen in histiocytes. Finally, he was diagnosed as talaromycosis and took itraconazole 0.2 g twice a day. After 5 days, the temperature dropped to normal and the inflammation disappeared, and he continued to take itraconazole for 6 months. Due to the neglect of the history of drug abuse and the concealment, drug-related talaromycosis is often misdiagnosed. Pathological examination is warranted for diagnosis talaromycosis. This condition requires a long-term anti-fungal therapy.
Topics: Amphetamine-Related Disorders; Antifungal Agents; Central Nervous System Stimulants; Humans; Immunocompromised Host; Itraconazole; Male; Methamphetamine; Mycoses; Opportunistic Infections; Treatment Outcome; Young Adult
PubMed: 32674642
DOI: 10.1177/2058738420934611 -
British Journal of Haematology Nov 2008Respiratory virus infections in hematopoietic cell transplant (HCT) recipients are a major cause of morbidity and mortality. While respiratory syncytial virus (RSV),... (Review)
Review
Respiratory virus infections in hematopoietic cell transplant (HCT) recipients are a major cause of morbidity and mortality. While respiratory syncytial virus (RSV), human metapneumovirus, parainfluenzaviruses, and influenza viruses are well known for their potential to cause fatal pneumonia, information has only recently emerged regarding the significance of the newly discovered viruses, such as human coronaviruses NL63 and HKU1, and human bocavirus. Lymphopenia seems to be the most important risk factor for progression to lower respiratory tract disease. Airflow obstruction is another complication of respiratory virus infections after HCT, and data to date indicate this complication may occur following parainfluenza virus and RSV infection. Infection control procedures are key for prevention. Unfortunately, there are no randomized treatment studies, which make the interpretation of the literature on interventions difficult. This article reviews the spectrum of pathogens, epidemiology, risk factors and clinical manifestations of infection, as well as recent advances in diagnostic and clinical management.
Topics: Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Opportunistic Infections; Respiratory Tract Infections; Virus Diseases
PubMed: 18785968
DOI: 10.1111/j.1365-2141.2008.07295.x