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Current Rheumatology Reports Oct 2015The development of B cell-targeted biologics represents a major advance in the treatment of autoimmune rheumatic diseases. As with other immunosuppressive agents, risk... (Review)
Review
The development of B cell-targeted biologics represents a major advance in the treatment of autoimmune rheumatic diseases. As with other immunosuppressive agents, risk of infection is a key clinical concern. This review summarises safety data from 15 years of experience of rituximab in autoimmune diseases with a particular focus on opportunistic infection and class-specific complications and infection risk. Rarely, cases of progressive multifocal leucoencephalopathy in rituximab-treated patients (5/100 000) have accumulated over time although no proven causal association has yet been shown. With repeat cycles of therapy, hypogammaglobulinaemia has been observed in a larger proportion of patients and is associated with increased risk of serious infections. The infection profile of the newer B cell-targeted agent, belimumab, in patients with active systemic lupus erythematosus is also discussed. Data from registries are needed to extend insights further and also to evaluate for any impact with the difference in mode of action of belimumab and infection risk in this population.
Topics: Antiviral Agents; Autoimmune Diseases; B-Lymphocytes; Humans; Immunocompromised Host; Immunosuppressive Agents; Molecular Targeted Therapy; Opportunistic Infections; Rheumatic Diseases; Risk Factors; Vaccination
PubMed: 26290110
DOI: 10.1007/s11926-015-0539-7 -
The Kurume Medical Journal 2001The early diagnosis of 58 patients with hematological neoplasms accompanied by severe pulmonary infections of Pneumocystis carini (Pc), or Cytomegalovirus (CMV)...
The early diagnosis of 58 patients with hematological neoplasms accompanied by severe pulmonary infections of Pneumocystis carini (Pc), or Cytomegalovirus (CMV) pneumonia was made by polymerase chain reaction (PCR) using sputum samples, and of pulmonary mycosis by measuring blood beta-glucan levels by a Limulus test. The effectiveness of early treatment for opportunistic infection based on these early stage diagnosis was evaluated and the results of pathological analyses of the lung at autopsy were analyzed. PCR identified Pc pneumonia in 7 of the total 58 patients (12.1%), and early treatment was effective in all 7 patients (100%). PCR identified CMV pneumonia in 5 patients (8.6%), and early treatment was effective in 2 of the 5 patients. The level of beta-glucan confirmed mycotic pneumonia in 9 of these 58 patients (15.5%), and early treatment was effective in 7 of these (66.7%). These findings indicate that PCR and the beta-glucan method effectively enabled clinicians to diagnose pulmonary opportunistic infection in the early stage in 21 of the 58 patients (36.2%), and that early treatment was effective in 16 of the 21 patients (76.2%). The results of the pathological analyses of the lung at autopsy were: pulmonary tumor cell infiltration in a total of 5 patients (2 with ATL, 2 with NAE and 1 with AML); infection in a total of 6 patients (2 with ML and 4 with ATL); and diffused alveolar damage in a total of 4 patients (2 with ML, 1 with ATL and 1 with AML). CMV infection was confirmed in a total of 5 patients (2 with ML and 3 with ATL), and mucormycosis in a total of 2 patients (1 with ML and 1 with ATL). Despite these findings, Pc and other fungi or bacteria were not detected. Early diagnosis and treatment by the present PCR and beta-glucan method were useful, but the underlying disease and its disease state influenced the clinical outcomes of patients with terminal pulmonary infection caused by CMV or mucor, suggesting that prevention and early diagnostic measures for these infections remain to be established.
Topics: Aged; Cytomegalovirus Infections; Female; Glucans; Hematologic Neoplasms; Humans; Lung; Male; Middle Aged; Opportunistic Infections; Pneumonia, Pneumocystis; Pneumonia, Viral; Polymerase Chain Reaction; Respiratory Insufficiency
PubMed: 11501492
DOI: 10.2739/kurumemedj.48.117 -
Frontiers in Immunology 2021Infections are the major cause of morbidity and mortality in patients with primary immunodeficiency disease (PID). Timely and accurate microbiological diagnosis is... (Comparative Study)
Comparative Study
BACKGROUND
Infections are the major cause of morbidity and mortality in patients with primary immunodeficiency disease (PID). Timely and accurate microbiological diagnosis is particularly important in these patients. Metagenomic next-generation sequencing (mNGS) has been used for pathogen detection recently. However, few reports describe the use of mNGS for pathogen identification in patients with PID.
OBJECTIVE
To evaluate the utility of mNGS for detecting pathogens in patients with PID, and to compare it with conventional microbiological tests (CMT).
METHODS
This single center retrospective study investigated the diagnostic performance of mNGS for pathogens detection in PID patients and compared it with CMT. Sixteen PID patients with suspected infection were enrolled, and medical records were analyzed to extract detailed clinical characteristics such as gene variation, immune status, microbial distribution, time-consuming of mNGS and CMT, treatment, and outcomes.
RESULTS
mNGS identified pathogenic microbe in 93.75% samples, compared to 31.25% for culture and 68.75% for conventional methods, and detected an extra 18 pathogenic microorganisms including rare opportunistic pathogens and . Pathogen identification by mNGS required 48 hours, compared with bacterial culture for 3-7 days and even longer for fungus and culture.
CONCLUSIONS
mNGS has marked advantages over conventional methods for pathogenic diagnosis, particularly opportunistic pathogens and mixed infections, in patients with PID. This method might enable clinicians to make more timely and targeted therapeutic decisions, thereby improving the prognosis of these patients.
Topics: Adolescent; Bacterial Infections; Bacteriological Techniques; Child; Child, Preschool; Female; High-Throughput Nucleotide Sequencing; Host-Pathogen Interactions; Humans; Immunocompromised Host; Infant; Male; Metagenome; Metagenomics; Mycoses; Opportunistic Infections; Predictive Value of Tests; Primary Immunodeficiency Diseases; Reproducibility of Results; Retrospective Studies
PubMed: 34484193
DOI: 10.3389/fimmu.2021.696403 -
Journal of Neuroimmune Pharmacology :... Dec 2011Infection rate among intravenous drug users (IDU) is higher than the general public, and is the major cause of morbidity and hospitalization in the IDU population.... (Review)
Review
Infection rate among intravenous drug users (IDU) is higher than the general public, and is the major cause of morbidity and hospitalization in the IDU population. Epidemiologic studies provide data on increased prevalence of opportunistic bacterial infections such as TB and pneumonia, and viral infections such as HIV-1 and hepatitis in the IDU population. An important component in the intravenous drug abuse population and in patients receiving medically indicated chronic opioid treatment is opioid withdrawal. Data on bacterial virulence in the context of opioid withdrawal suggest that mice undergoing withdrawal had shortened survival and increased bacterial load in response to Salmonella infection. As the body of evidence in support of opioid dependency and its immunosuppressive effects is growing, it is imperative to understand the mechanisms by which opioids exert these effects and identify the populations at risk that would benefit the most from the interventions to counteract opioid immunosuppressive effects. Thus, it is important to refine the existing animal model to closely match human conditions and to cross-validate these findings through carefully controlled human studies. Better understanding of the mechanisms will facilitate the search for new therapeutic modalities to counteract adverse effects including increased infection rates. This review will summarize the effects of morphine on innate and adaptive immunity, identify the role of the mu opioid receptor in these functions and the signal transduction activated in the process. The role of opioid withdrawal in immunosuppression and the clinical relevance of these findings will also be discussed.
Topics: Analgesics, Opioid; Animals; Humans; Immune System; Morphine; Morphine Dependence; Opportunistic Infections; Receptors, Opioid, mu; Substance Withdrawal Syndrome; Substance-Related Disorders
PubMed: 21789507
DOI: 10.1007/s11481-011-9292-5 -
American Journal of Transplantation :... Mar 2016Microbiological spectrum and outcome of infectious complications following small bowel transplantation (SBT) have not been thoroughly characterized. We performed a...
Microbiological spectrum and outcome of infectious complications following small bowel transplantation (SBT) have not been thoroughly characterized. We performed a retrospective analysis of all patients undergoing SBT from 2004 to 2013 in Spain. Sixty-nine patients underwent a total of 87 SBT procedures (65 pediatric, 22 adult). The median follow-up was 867 days. Overall, 81 transplant patients (93.1%) developed 263 episodes of infection (incidence rate: 2.81 episodes per 1000 transplant-days), with no significant differences between adult and pediatric populations. Most infections were bacterial (47.5%). Despite universal prophylaxis, 22 transplant patients (25.3%) developed cytomegalovirus disease, mainly in the form of enteritis. Specifically, 54 episodes of opportunistic infection (OI) occurred in 35 transplant patients. Infection was the major cause of mortality (17 of 24 deaths). Multivariate analysis identified retransplantation (hazard ratio [HR]: 2.21; 95% confidence interval [CI]: 1.02-4.80; p = 0.046) and posttransplant renal replacement therapy (RRT; HR: 4.19; 95% CI: 1.40-12.60; p = 0.011) as risk factors for OI. RRT was also a risk factor for invasive fungal disease (IFD; HR: 24.90; 95% CI: 5.35-115.91; p < 0.001). In conclusion, infection is the most frequent complication and the leading cause of death following SBT. Posttransplant RRT and retransplantation identify those recipients at high risk for developing OI and IFD.
Topics: Adult; Child; Child, Preschool; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Incidence; Intestinal Diseases; Intestine, Small; Male; Mycoses; Opportunistic Infections; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; Young Adult
PubMed: 26560685
DOI: 10.1111/ajt.13535 -
Transplantation Proceedings Oct 2023We report the results of an observational study, analyzing the clinical course of kidney transplant patients hospitalized for COVID-19 and comparing it with a control to... (Observational Study)
Observational Study
BACKGROUND
We report the results of an observational study, analyzing the clinical course of kidney transplant patients hospitalized for COVID-19 and comparing it with a control to determine if outcomes, nosocomial, and opportunistic infections were different between groups.
METHODS
An observational, retrospective, case-control, single-center study, including a group of kidney transplant adults diagnosed with COVID-19, from March 2020 to April 2022. Transplant patients hospitalized for COVID-19 comprised the cases. The control group consisted of non-transplanted adults, without immunosuppressive treatment, hospitalized for COVID-19, and matched by age, sex, and month at diagnosis of COVID-19. Study variables were collected, including demographic/clinical, epidemiologic, clinical/biological at diagnosis, evolutive, and outcome variables.
RESULTS
Fifty-eight kidney transplant recipients were included. Thirty required hospital admission. Ninety controls were included. Transplant recipients had a higher frequency of intensive care unit (ICU) admission, ventilatory support, and death. The relative risk for death was 2.45. When adjusted by baseline estimated glomerular filtration rate (eGFR) and comorbidity, only the risk for opportunistic infection remained high. Variables independently associated with death were dyslipidemia, eGFR at admission, MULBSTA score, and ventilatory support. Pneumonia by Klebsiella oxytoca was the most frequent nosocomial infection. Pulmonary aspergillosis was the most frequent opportunistic infection overall. Pneumocystosis and cytomegalovirus colitis were more frequent among transplant patients. The relative risk for opportunistic infection in this group was 1.88. Baseline eGFR, serum interleukin 6 level, and coinfection were independently associated with it.
CONCLUSIONS
Evolutive course of COVID-19 requiring hospitalization in renal transplant recipients was primarily determined by comorbidity and baseline kidney function. At equal comorbidity and renal function, there were no differences in mortality, ICU admission, nosocomial infection, and hospital stay. However, the risk for opportunistic infection remained high.
Topics: Adult; Humans; COVID-19; Retrospective Studies; Kidney Transplantation; Transplant Recipients; Cross Infection; Opportunistic Infections; Hospitals; Disease Progression; Risk Factors
PubMed: 37302863
DOI: 10.1016/j.transproceed.2023.05.009 -
Transplant International : Official... Nov 2005
Topics: Biological Evolution; Humans; Immunosuppression Therapy; Opportunistic Infections; Transplants
PubMed: 16221150
DOI: 10.1111/j.1432-2277.2005.00150.x -
Clinical Microbiology Reviews Apr 2003Acanthamoeba spp. are free-living amebae that inhabit a variety of air, soil, and water environments. However, these amebae can also act as opportunistic as well as... (Review)
Review
Acanthamoeba spp. are free-living amebae that inhabit a variety of air, soil, and water environments. However, these amebae can also act as opportunistic as well as nonopportunistic pathogens. They are the causative agents of granulomatous amebic encephalitis and amebic keratitis and have been associated with cutaneous lesions and sinusitis. Immuno compromised individuals, including AIDS patients, are particularly susceptible to infections with Acanthamoeba. The immune defense mechanisms that operate against Acanthamoeba have not been well characterized, but it has been proposed that both innate and acquired immunity play a role. The ameba's life cycle includes an active feeding trophozoite stage and a dormant cyst stage. Trophozoites feed on bacteria, yeast, and algae. However, both trophozoites and cysts can retain viable bacteria and may serve as reservoirs for bacteria with human pathogenic potential. Diagnosis of infection includes direct microscopy of wet mounts of cerebrospinal fluid or stained smears of cerebrospinal fluid sediment, light or electron microscopy of tissues, in vitro cultivation of Acanthamoeba, and histological assessment of frozen or paraffin-embedded sections of brain or cutaneous lesion biopsy material. Immunocytochemistry, chemifluorescent dye staining, PCR, and analysis of DNA sequence variation also have been employed for laboratory diagnosis. Treatment of Acanthamoeba infections has met with mixed results. However, chlorhexidine gluconate, alone or in combination with propamidene isethionate, is effective in some patients. Furthermore, effective treatment is complicated since patients may present with underlying disease and Acanthamoeba infection may not be recognized. Since an increase in the number of cases of Acanthamoeba infections has occurred worldwide, these protozoa have become increasingly important as agents of human disease.
Topics: Acanthamoeba; Amebiasis; Animals; Disease Models, Animal; Humans; Opportunistic Infections
PubMed: 12692099
DOI: 10.1128/CMR.16.2.273-307.2003 -
Clinical Microbiology Reviews Oct 2009Globally, the number of immunosuppressed people increases each year, with the human immunodeficiency virus (HIV) pandemic continuing to spread unabated in many parts of... (Review)
Review
Globally, the number of immunosuppressed people increases each year, with the human immunodeficiency virus (HIV) pandemic continuing to spread unabated in many parts of the world. Immunosuppression may also occur in malnourished persons, patients undergoing chemotherapy for malignancy, and those receiving immunosuppressive therapy. Components of the immune system can be functionally or genetically abnormal as a result of acquired (e.g., caused by HIV infection, lymphoma, or high-dose steroids or other immunosuppressive medications) or congenital illnesses, with more than 120 congenital immunodeficiencies described to date that either affect humoral immunity or compromise T-cell function. All individuals affected by immunosuppression are at risk of infection by opportunistic parasites (such as the microsporidia) as well as those more commonly associated with gastrointestinal disease (such as Giardia). The outcome of infection by enteric protozoan parasites is dependent on absolute CD4(+) cell counts, with lower counts being associated with more severe disease, more atypical disease, and a greater risk of disseminated disease. This review summarizes our current state of knowledge on the significance of enteric parasitic protozoa as a cause of disease in immunosuppressed persons and also provides guidance on recent advances in diagnosis and therapy for the control of these important parasites.
Topics: AIDS-Related Opportunistic Infections; Antiprotozoal Agents; Humans; Immunocompromised Host; Intestinal Diseases, Parasitic; Opportunistic Infections; Protozoan Infections
PubMed: 19822892
DOI: 10.1128/CMR.00017-09 -
[Is it possible that monkeypox can behave as an opportunistic infection in people living with HIV?].Revista Chilena de Infectologia :... Jun 2022
Topics: HIV Infections; Humans; Mpox (monkeypox); Opportunistic Infections
PubMed: 36156683
DOI: 10.4067/s0716-10182022000200233