BACKGROUND:Prompt pathogen identification can have a substantial impact on the optimization of antimicrobial treatment.The objective of the study was to assess the diagnostic value of next-generation sequencing(NGS)fo...BACKGROUND:Prompt pathogen identification can have a substantial impact on the optimization of antimicrobial treatment.The objective of the study was to assess the diagnostic value of next-generation sequencing(NGS)for identifying pathogen and its clinical impact on antimicrobial intervention in immunocompromised patients with suspected infections.METHODS:This was a retrospective study.Between January and August 2020,47 adult immunocompromised patients underwent NGS testing under the following clinical conditions:1)prolonged fever and negative conventional cultures;2)new-onset fever despite empiric antimicrobial treatment;and 3)afebrile with suspected infections on imaging.Clinical data,including conventional microbial test results and antimicrobial treatment before and after NGS,were collected.Data were analyzed according to documented changes in antimicrobial treatment(escalated,no change,or deescalated)after the NGS results.RESULTS:The median time from hospitalization to NGS sampling was 19 d.Clinically relevant pathogens were detected via NGS in 61.7% of patients(29/47),more than half of whom suffered from fungemia(n=17),resulting in an antimicrobial escalation in 53.2% of patients(25/47)and antimicrobial de-escalation in 0.2% of patients(1/47).Antimicrobial changes were mostly due to the identification of fastidious organisms such as Legionella,Pneumocystis jirovecii,and Candida.In the remaining three cases,NGS detected clinically relevant pathogens also detected by conventional cultures a few days later.The antimicrobial treatment was subsequently adjusted according to the susceptibility test results.Overall,NGS changed antimicrobial management in 55.3%(26/47)of patients,and conventional culture detected clinically relevant pathogens in 14.9% of the patients(7/47).CONCLUSION:With its rapid identification and high sensitivity,NGS could be a promising tool for identifying relevant pathogens and enabling rapid appropriate treatment in immunocompromised patients with suspected infections.展开更多
Escherichia coli is the commonest bacterial uropathogen of UTIs, the commonest infections in immunocompromised diabetic patients. Better understanding of their main resistance mechanisms to commonly used antibacterial...Escherichia coli is the commonest bacterial uropathogen of UTIs, the commonest infections in immunocompromised diabetic patients. Better understanding of their main resistance mechanisms to commonly used antibacterial agents will help to reduce the burden of this infection. The prevalence of drug resistant uropathogenic Escherichia coli isolates from immunocompromised diabetic patients attending selected health facilities in Benue State was investigated. Two hundred and ninety-six midstream urine samples were collected for both study and control diabetic patients. Bacterial isolation was done using semi-quantitative method. Drug resistant Escherichia coli were identified as multidrug resistant (MDR), extensive drug resistant (XDR) and pan-drug resistant organisms (PDR). Statistical significance was considered at p E. coli isolates from the study and control subjects with overall prevalence of 20.9% and 8.4% respectively. The isolates were highly resistant to penicillin (ampicillin), monobactam (aztreonam), older quinolone (nalidixic acid) whereas the majority of them showed high susceptibility to aminoglycoside (streptomycin), cephalosporin (cefotaxime) and carbapenem (imipenem). None showed complete susceptibility to all the tested antibiotics. Twenty-five E. coli were identified in this MDR, eight, XDR while 5 were PDR. High numbers of drug resistant E. coli isolates were identified in the study group of which 25 were MDR, 8 XDR while 5 were PDR isolates. High prevalence of UTI and drug resistant isolates occur in diabetic patients with hyperglycemic condition.展开更多
We report the remission of primary gastric lymphoma of the mucosa-associated lymphoid tissue （MALT） type in two immunocompromised pediatric patients. Patient 1, a 14-year-old boy in an immunocompromised state of unk...We report the remission of primary gastric lymphoma of the mucosa-associated lymphoid tissue （MALT） type in two immunocompromised pediatric patients. Patient 1, a 14-year-old boy in an immunocompromised state of unknown cause, complained of repeated abdominal pain. Examinations revealed gastric MALT with local invasion and lymph node involvement. Serum anti-Helicobacter pylori （H pylon） antibody was positive. H pylori eradication was abandoned due to its adverse effects. The MALT lesion spontaneously regressed over the next 24 months without any treatment for lymphoma. Patient 2, a 6-year-old boy, underwent cord blood transplantation for the treatment of adrenoleukodystrophy. He was administered immunosuppressants for graft-versus-host disease after transplantation. Nausea and hematochezia appeared and further examinations revealed gastric MALT with H pylori gastritis. Treatment consisting of medication for the Hpylori infection alone eradicated the Hpylori and completely resolved the patient＇s MALT lesion, as well. Patients i and 2 were followed up over periods of 10 years and 3 years, respectively, without any signs of relapse. In conclusion, gastric lymphoma of the MALT type can be cured by conservative treatment even in immunocompromised pediatric patients.展开更多
Parasites can increase infection rates and pathogenicity in immunocompromised human immunodeficiency virus （HIV） patients. However, in vitro studies and epidemiological investigations also suggest that parasites mig...Parasites can increase infection rates and pathogenicity in immunocompromised human immunodeficiency virus （HIV） patients. However, in vitro studies and epidemiological investigations also suggest that parasites might escape immunocompromised hosts during HIV infection Due to the lack of direct evidence from animal experiments, the effects of immunocompromised hosts parasitic infections on remain unclear. Here we detected 14 different parasites in six northern pig-tailed macaques （NPMs） before or at the 50th week of simian immunodeficiency virus （SIV） infection by ELISA. The NPMs all carried parasites before viral injection. At the 50th week after viral injection, the individuals with negative results in parasitic detection （i.e., 08247 and 08287） were characterized as the Parasites Exit （PE） group, with the other individuals （i.e., 09203, 09211, 10205, and 10225） characterized as the Parasites Remain （PR） group. Compared with the PR group, the NPMs in the PE group showed higher viral loads, lower CD4＋ T cells counts, and lower CD4/CD8 rates. Additionally, the PE group had higher immune activation and immune exhaustion of both CD4~ and CD8~ T cells. Pathological observation showed greater injury to the liver, cecum, colon, spleen, and mesenteric lymph nodes in the PE group This study showed more seriously compromised immunity in the PE group, strongly indicating that parasites might exit an immunocompromised host.展开更多
Hepatitis E virus(HEV)originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States.While ther...Hepatitis E virus(HEV)originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States.While there are eight identified genotypes to date,genotype 1(HEV1),HEV2,HEV3,HEV4 are the most common to infect humans.HEV1 and HEV2 are most common in developing countries including Latina America,Africa and Asia,and are commonly transmitted through contaminated water supplies leading to regional outbreaks.In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat.The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing.In majority of cases,HEV infection is a selflimiting hepatitis requiring only symptomatic treatment.However,this is not the case in immunocompromised individuals,including those that have undergone solid organ or stem cell transplantation.In this subset of patients,chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death.The need for re-transplantation as a result of post-transplant hepatitis is of great concern.In addition,there have been many reported incidents of extrahepatic manifestations,for which the exact mechanisms remain to be elucidated.The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies,while attempting to minimize the risk of organ rejection.Subsequent treatment options include ribavirin,and pegylated interferon alpha in those who have demonstrated ribavirin resistance.Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden.Given this concern,vaccination has been approved in China with other investigations underway throughout the world.In this review we introduce the epidemiology,diagnosis,clinical manifestations,and treatment of HEV,with emphasis on immunocompromised individuals in the United States.展开更多
We report three cases of ileocolic mucormycosis in adult immunocompromised patients presenting as acute abdomen.All patients underwent laparotomy but two of them died from multiorgan failure before the diagnoses were ...We report three cases of ileocolic mucormycosis in adult immunocompromised patients presenting as acute abdomen.All patients underwent laparotomy but two of them died from multiorgan failure before the diagnoses were confirmed.The diagnosis of gastrointestinal mucormycosis is rarely suspected,and antemortem diagnosis is made in only 25%-50% of cases.These cases illustrate the difficulty encountered by surgeons in managing acute abdomen in neutropenic patients with hematological malignancy.The management of colonic mucormycosis in the published literature is also reviewed.展开更多
BACKGROUND Epstein-Barr virus associated smooth muscle tumor(EBV-SMT)is a rare oncological entity.However,there is an increasing incidence of EBV-SMTs,as the frequency of organ transplantation and immunosuppression gr...BACKGROUND Epstein-Barr virus associated smooth muscle tumor(EBV-SMT)is a rare oncological entity.However,there is an increasing incidence of EBV-SMTs,as the frequency of organ transplantation and immunosuppression grows.EBV-SMT diagnosis relies on histopathology and immunochemical staining to distinguish it from post-transplant lymphoproliferative disorder(PTLD).There is no clear consensus on the treatment of EBV-SMTs.However,surgical resection,chemotherapy,radiation therapy,and immunosuppression reduction have been explored with varying degrees of success.CASE SUMMARY Our case series includes six cases of EBV-SMTs across different age groups,with different treatment modalities,adding to the limited existing literature on this rare tumor.The median latency time between immunosuppression and disease diagnosis is four years.EBV-SMTs present with variable degrees of aggressiveness and seem to have worse clinical outcomes in patients with tumor multiplicity and worse immunocompetency.CONCLUSION It is imperative to continue building on this knowledge and keeping EBV-SMTs on the differential in immunocompromised individuals.展开更多
Dear Editor,I am Dr. Feng Hu, from the Department of Ophthalmology of Beijing Tongren Hospital, Beijing, China. I write to present a case report of cytomegalovirus retinitis (CMVR) in Good’s syndrome (GS).GS is an ex...Dear Editor,I am Dr. Feng Hu, from the Department of Ophthalmology of Beijing Tongren Hospital, Beijing, China. I write to present a case report of cytomegalovirus retinitis (CMVR) in Good’s syndrome (GS).GS is an extremely rare primary immune-deficiency syndrome,which consists of simultaneous occurrence of展开更多
AIM: To characterize the prevalence of rotavirus(RV) and adenovirus(Ad V) infections in immunocompromised patients with acute gastroenteritis. METHODS: The presence of RV and Ad V(serotypes 40 and 41) was evaluated in...AIM: To characterize the prevalence of rotavirus(RV) and adenovirus(Ad V) infections in immunocompromised patients with acute gastroenteritis. METHODS: The presence of RV and Ad V(serotypes 40 and 41) was evaluated in 509 stool samples obtained between January 2009 and December 2010 from 200 immunocompromised patients(83 females and 117 males; median age 21 years old, range 0-72. The diagnosis of infection was performed as a routine procedure and the presence of RV and Ad V(serotypes 40 and 41) was determined by immunochromatography using the RIDA® Quick Rota-Adeno-Kombi kit(r-Biopharm, Darmstadt, Germany). The data analysis and description of seasonal frequencies were performed using computer software IBM® SPSS®(Statistical Package for Social Sciences) Statistics version 20.0 for Mac. The frequencies of infection were compared into different age and gender groups by χ2 test.RESULTS: The study revealed 12.4% Ad V positive samples and 0.8% RV positive samples, which correspond to a prevalence of 6.5% and 1.5%, respectively. Ad V was more frequent between October 2009 and April 2010, while RV was identified in April 2010 and July 2010. The stool analysis revealed that from the 509 samples, 63(12.4%) were positive for Ad V and 4(0.8%) positive for RV, which by resuming the informationof each patient, lead to an overall prevalence of Ad V and RV of 6.5%(13/200 patients) and 1.5%(3/200 patients), respectively. The stratification of the analysis regarding age groups showed a tendency to an increased prevalence of infection in paediatric patients between 0-10 years old. Considering the seasonal distribution of these infections, our study revealed that Ad V infection was more frequent between October 2009 and April 2010, while RV infection was characterized by two distinct peaks(April 2010 and July 2010). CONCLUSION: The overall prevalence of Ad V and RV infection in immunocompromised patients with acute gastroenteritis was 8% and Ad V was the most prevalent agent.展开更多
Infections caused by Strongyloides stercoralis(S.stercoralis) in human are generally asymptomatic,however in immunocompromised individual,hyperinfection may develop with dissemination of larvae to extra-intestinal org...Infections caused by Strongyloides stercoralis(S.stercoralis) in human are generally asymptomatic,however in immunocompromised individual,hyperinfection may develop with dissemination of larvae to extra-intestinal organs.The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself,which may lead to low index of suspicion as a consequence.In this report,a case of a Malaysian male with underlying diabetes mellitus,hypertension,cerebrovascular accident,bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented.However,he developed septicemic shock later,and S.stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli.Regardless of aggressive resuscitation,the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome.It was revealed that the current case has alarmed us via incidental finding of S.stercoralis larvae in the tracheal aspirate,indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.展开更多
Eighty four throat swabs were obtained from Basrah General Hospital inpatients （N = 34）： 17 were suffering from renal failure and the other 17 were diabetics; and from outpatients （N = 50）. Throat swabs were cult...Eighty four throat swabs were obtained from Basrah General Hospital inpatients （N = 34）： 17 were suffering from renal failure and the other 17 were diabetics; and from outpatients （N = 50）. Throat swabs were cultured first in the selective media Ashdown＇s broth then subcultured on Ashdown＇s agar to isolate Burkholderia pseudomallei which was recovered from seven cases （8.33%）. Four isolates were from renal failure patients （23.53%）, two from diabetic patients （11.76%） and the seventh isolate was from an outpatient with tonsillitis. All isolates were able to produce capsules, form filament chains, exhibit swarming motility and were arabinose non assimilators （Ara-） indicative of their virulence. Additionally, isolated B. pseudomallei were found to produce protease, lipase, hemolysin, and lecithinase and were able to produce biofilm, the root of many troublesome persistent infections that resist antibiotic treatment. Susceptibility of the seven isolates of B. pseudomallei toward 11 antibiotics was assessed, isolates were found multiply resistant to all antibiotics apart from ciproflaxin. This study confirms for the first time isolation of B. pseudomallei from immunocompromised patients in Basrah city of Iraq and describes their virulence potentials.展开更多
Objective To analyze the clinical featuresof COVID-19 infection in hospitalized immunocompromised patients in comparison with immunocompetent patients.Methods A single-center retrospective observational study was cond...Objective To analyze the clinical featuresof COVID-19 infection in hospitalized immunocompromised patients in comparison with immunocompetent patients.Methods A single-center retrospective observational study was conducted on 213 inpatients diagnosed with COVID-19 in the Peking University People's Hospital between December 2022 and October 2023.They were divided into an immunocompromised group(102 patients,47.9%)and an immunocompetent group(111 patients,52.1%),and clinical data were compared between the two groups.The immunocompromised group was further divided into death group(18 cases,17.6%)and nondeath group(84 cases,82.4%).The differences in laboratory examination findings were compared.Further analysis was performed on the lymphocyte subset differences between the death group(10 patients,9.8%)and the non-death group(36 patients,35.3%)with complete data.Results The proportion of severe and critical cases and the mortality rate,were significantly higher in the immunocompromised group than the immunocompetent group(47.1%vs.40.5%,18.6%vs.9.0%,17.6%us.9.0%,P<0.05).The immunocompromised group had lower vaccination rate(26.5%vs.44.1%,P<0.05).Hypertension,kidney disease and infections were more common in the immunocompromised group(63.7%us.48.6%,30.4%us.9.0%,49.0%vs.19.8%,all P<0.05).CT findings of consolidation(40.2%us.18.9%),rate of antiviral treatment(48.0%vs.30.6%)and the positive duration of viral nucleic acid[median 14(7.0,19.3)days us.9(7.0,18.0)days]were higher in the immunocomprised group(all P<0.05).Lactate dehydrogenase(LDH),Fprocalcitonin(PCT),interleukin-6(IL-6)and ferritin were higher in the immunocompromised group thanthose inthe immunocompetent group(all P<0.05).In the death group,neutrophils(NEU),C-reactive protein(CRP),PCT,IL-6,ferritin and D-dimer were higher,while lymphocytes(LY),CD4^(+)T-cells,CD8^(+)T-cells,B-cell counts and hemoglobin(HGB)were significantly lower than those in the non-death group(all P<0.05).Conclusion More than 60%of patients in the immunocompromised group are classified as severoe r critical type,with a higher mortality rate and decreased ability to clear severe acuterespiratorySsyndrome coronavirus 2(SARS-CoV-2).Decreasesintotal lymphocytes,CD4^(+)T lymphocytes,CD8^(+)T lymphocytes,and B lymphocytes,along with elevated levels of procalcitonin,ferritin,and D-dimer,indicate poor prognosis.展开更多
Histoplasmosis is a serious fungal disease commonly reported in the Americas,Southeast Asia,and sub-Saharan Africa[1].The classical or American type is caused by Histoplasma capsulatum var.capsulatum while African his...Histoplasmosis is a serious fungal disease commonly reported in the Americas,Southeast Asia,and sub-Saharan Africa[1].The classical or American type is caused by Histoplasma capsulatum var.capsulatum while African histoplasmosis is caused by H.capsulatum var.duboisii[2].展开更多
Diverse pathogenic fungi can produce severe infections in immunocompromised patients, thereby justifying intensive care unit (ICU) admissions. In some cases, the infections can develop in immunocompromised patients wh...Diverse pathogenic fungi can produce severe infections in immunocompromised patients, thereby justifying intensive care unit (ICU) admissions. In some cases, the infections can develop in immunocompromised patients who were previously admitted to the ICU. Aspergillus spp., Pneumocystis jirovecii, Candida spp., and Mucorales are the fungi that are most frequently involved in these infections. Diagnosis continues to be challenging because symptoms and signs are unspecific. Herein, we provide an in-depth review about the diagnosis, with emphasis on recent advances, and treatment of these invasive fungal infections in the ICU setting.展开更多
Health care-associated infections(HCAIs)pose a substantial threat to immunocompromised individuals and represent a frequent adverse event in health care delivery.The aim of this study was to evaluate the global resear...Health care-associated infections(HCAIs)pose a substantial threat to immunocompromised individuals and represent a frequent adverse event in health care delivery.The aim of this study was to evaluate the global research landscape of HCAIs among immunocompromised populations before and during the COVID-19 pandemic.A systematic search of articles published between 2013 and 2022 in the Web of Science Core Collection database was conducted,and content analytics and integrated science mapping were used for data analysis and interpretation.The review identified 1,473 articles.Only 633 articles authored by 4,151 individuals and published in 366 journals were included.The average citation rate was 14.27 per document,and research production grew annually by 9.07%peaking in 2021 during the COVID-19 pandemic but declining in 2022.The United States emerged as the most productive country,with 743 publication appearances and 2,485 citations.Keywords such as“epidemiology,”“infection,”“mortality,”and“risk factors”were frequently encountered in the analyzed literature.The main research themes,including“mortality,”“sepsis,”“immunosuppression,”“expression,”and“pneumonia,”underscored the focal points of importance within this domain.This study highlighted the growing interest regarding HCAIs in immunocompromised populations,especially during the COVID-19 pandemic.The study findings underscore the need to advance research efforts to understand different immunocompromised states,develop tailored infection prevention measures,and address health care disparities to mitigate the burden of HCAIs among immunocompromised individuals.展开更多
Background:Multiple sclerosis(MS),a chronic neurological disorder,is characterized by damage to the central nervous system,auto-immune processes,and deterioration of the myelin sheath,which lead to a variety of physic...Background:Multiple sclerosis(MS),a chronic neurological disorder,is characterized by damage to the central nervous system,auto-immune processes,and deterioration of the myelin sheath,which lead to a variety of physical,cognitive,and emotional symptoms.Cur-rently,a cure for MS does not exist,and treatments aim only to manage symptoms and enhance quality of life.Betaferon(interferon beta-1b),a disease-modifying therapy,is used to minimize the frequency of relapses and the progression of disability by altering immune re-sponses.However,this therapeutic strategy also increases the risk of infectious diseases,such as tricuspid endocarditis,which is a severe infection of the heart valve that is often associated with chronic intravenous drug use and carries potential life-threatening consequences.Case presentation:We present a case of a 48-year-old male who was undergoing Betaferon therapy for MS.He was admitted to the emergency room owing to fever,shortness of breath,and altered mental state.Physical examination revealed clinical signs of endocarditis,and laboratory results indicated severe thrombocytopenia,anemia,and elevated inflammatory markers.Imaging confirmed lung abnor-malities and vegetations on the tricuspid valve.Blood cultures identified methicillin-sensitive Staphylococcus aureus.Intravenous antibi-otics were initiated,and surgical intervention was planned.Despite initial antibiotic therapy improving his clinical and laboratory conditions,the patient experienced multiple pulmonary embolic events that led to death after 16 days of hospitalization.Conclusion:This case underscores the challenges of identifying and managing endocarditis in immunocompromised patients and high-lights the complexities of treating infections in individuals with chronic diseases.展开更多
Data on severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in patients at early stage of immune reconstitution after hematopoietic stem cell transplantation(HSCT)are limited.In the present study,we r...Data on severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in patients at early stage of immune reconstitution after hematopoietic stem cell transplantation(HSCT)are limited.In the present study,we retrospectively investigated the incidence and clinical features of SARS-CoV-2 infection in patients who underwent HSCT in 2022.Patients(allo-HSCT,n=80;auto-HSCT,n=37)were consecutively included in the study.The SARS-CoV-2 infection rate was 59.8%,and the median interval of HSCT to coronavirus disease 2019(COVID-19)was 4.8(range:0.5–12)months.Most patients were categorized as mild(41.4%)or moderate(38.6%),and 20%as severe/critical.No deaths were attributable to COVID-19.Further analysis showed that lower circulating CD8^(+)T-cell counts and calcineurin inhibitor administration increased the risk of SARS-CoV-2 infection.Exposure to rituximab significantly increased the probability of severe or critical COVID-19 compared with that of mild/moderate illness(P<.001).In the multivariate analysis,rituximab use was associated with severe COVID-19.Additionally,COVID-19 had no significant effect on immune reconstitution.Furthermore,it was found that Epstein–Barr virus infection and rituximab administration possibly increase the risk of developing severe illness.Our study provides preliminary insights into the effect of SARS-CoV-2 on immune reconstitution and the outcomes of allo-HSCT recipients.展开更多
BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdia...BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.展开更多
BACKGROUND Aseptic meningitis is defined as meningeal inflammation caused by various etio-logies with negative cerebrospinal fluid(CSF)bacterial culture.The most common etiologies are viruses[enteroviruses,arboviruses...BACKGROUND Aseptic meningitis is defined as meningeal inflammation caused by various etio-logies with negative cerebrospinal fluid(CSF)bacterial culture.The most common etiologies are viruses[enteroviruses,arboviruses,and herpes simplex virus type 2(HSV-2)].Aseptic meningitis can have various presentations,including sensori-neural deafness.While sensorineural deafness from mumps meningoencephalitis has been reported,cases of HSV-2-induced hearing loss are rare.Herein,we re-port a case of HSV-2-induced meningitis that presented with sudden deafness.CASE SUMMARY A 68-year-old man experienced a profound sudden onset of left-sided hearing loss for one day.Pure-tone audiograms demonstrated sudden left-sided sensorineural hearing loss(thresholds 80-90 dB).After treatment with high-dose steroids for 1 week,he experienced an acute consciousness change with left hemiparesis.The laboratory data showed no significant abnormalities.Brain computed tomography without contrast and magnetic resonance imaging revealed no intracranial hemo-rrhage or obvious brain lesion.The CSF analysis and the Multiplex PCR panels showed HSV-2 positivity.Hence,under the diagnosis of herpes meningoenceph-alitis,acyclovir was prescribed and his symptoms gradually resolved.CONCLUSION This case report further demonstrates that a viral infection could be a cause of sudden sensorineural hearing loss.展开更多
BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfu...BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.展开更多
基金supported by National Natural Science Foundation of China(72274067)。
文摘BACKGROUND:Prompt pathogen identification can have a substantial impact on the optimization of antimicrobial treatment.The objective of the study was to assess the diagnostic value of next-generation sequencing(NGS)for identifying pathogen and its clinical impact on antimicrobial intervention in immunocompromised patients with suspected infections.METHODS:This was a retrospective study.Between January and August 2020,47 adult immunocompromised patients underwent NGS testing under the following clinical conditions:1)prolonged fever and negative conventional cultures;2)new-onset fever despite empiric antimicrobial treatment;and 3)afebrile with suspected infections on imaging.Clinical data,including conventional microbial test results and antimicrobial treatment before and after NGS,were collected.Data were analyzed according to documented changes in antimicrobial treatment(escalated,no change,or deescalated)after the NGS results.RESULTS:The median time from hospitalization to NGS sampling was 19 d.Clinically relevant pathogens were detected via NGS in 61.7% of patients(29/47),more than half of whom suffered from fungemia(n=17),resulting in an antimicrobial escalation in 53.2% of patients(25/47)and antimicrobial de-escalation in 0.2% of patients(1/47).Antimicrobial changes were mostly due to the identification of fastidious organisms such as Legionella,Pneumocystis jirovecii,and Candida.In the remaining three cases,NGS detected clinically relevant pathogens also detected by conventional cultures a few days later.The antimicrobial treatment was subsequently adjusted according to the susceptibility test results.Overall,NGS changed antimicrobial management in 55.3%(26/47)of patients,and conventional culture detected clinically relevant pathogens in 14.9% of the patients(7/47).CONCLUSION:With its rapid identification and high sensitivity,NGS could be a promising tool for identifying relevant pathogens and enabling rapid appropriate treatment in immunocompromised patients with suspected infections.
文摘Escherichia coli is the commonest bacterial uropathogen of UTIs, the commonest infections in immunocompromised diabetic patients. Better understanding of their main resistance mechanisms to commonly used antibacterial agents will help to reduce the burden of this infection. The prevalence of drug resistant uropathogenic Escherichia coli isolates from immunocompromised diabetic patients attending selected health facilities in Benue State was investigated. Two hundred and ninety-six midstream urine samples were collected for both study and control diabetic patients. Bacterial isolation was done using semi-quantitative method. Drug resistant Escherichia coli were identified as multidrug resistant (MDR), extensive drug resistant (XDR) and pan-drug resistant organisms (PDR). Statistical significance was considered at p E. coli isolates from the study and control subjects with overall prevalence of 20.9% and 8.4% respectively. The isolates were highly resistant to penicillin (ampicillin), monobactam (aztreonam), older quinolone (nalidixic acid) whereas the majority of them showed high susceptibility to aminoglycoside (streptomycin), cephalosporin (cefotaxime) and carbapenem (imipenem). None showed complete susceptibility to all the tested antibiotics. Twenty-five E. coli were identified in this MDR, eight, XDR while 5 were PDR. High numbers of drug resistant E. coli isolates were identified in the study group of which 25 were MDR, 8 XDR while 5 were PDR isolates. High prevalence of UTI and drug resistant isolates occur in diabetic patients with hyperglycemic condition.
文摘We report the remission of primary gastric lymphoma of the mucosa-associated lymphoid tissue （MALT） type in two immunocompromised pediatric patients. Patient 1, a 14-year-old boy in an immunocompromised state of unknown cause, complained of repeated abdominal pain. Examinations revealed gastric MALT with local invasion and lymph node involvement. Serum anti-Helicobacter pylori （H pylon） antibody was positive. H pylori eradication was abandoned due to its adverse effects. The MALT lesion spontaneously regressed over the next 24 months without any treatment for lymphoma. Patient 2, a 6-year-old boy, underwent cord blood transplantation for the treatment of adrenoleukodystrophy. He was administered immunosuppressants for graft-versus-host disease after transplantation. Nausea and hematochezia appeared and further examinations revealed gastric MALT with H pylori gastritis. Treatment consisting of medication for the Hpylori infection alone eradicated the Hpylori and completely resolved the patient＇s MALT lesion, as well. Patients i and 2 were followed up over periods of 10 years and 3 years, respectively, without any signs of relapse. In conclusion, gastric lymphoma of the MALT type can be cured by conservative treatment even in immunocompromised pediatric patients.
基金partly supported by grants from the National Natural Science Foundation of China(8147162081671627+7 种基金815716068160180881172876U0832601)the National Basic Research Program of China(2012CBA01305)the 13th Five-Year Key Scientific and Technological Program of China(2017ZX10304402-002-0042017ZX10202102-001-005)the National Key Research & Development(R&D)Plan(2016YFC1201000)
文摘Parasites can increase infection rates and pathogenicity in immunocompromised human immunodeficiency virus （HIV） patients. However, in vitro studies and epidemiological investigations also suggest that parasites might escape immunocompromised hosts during HIV infection Due to the lack of direct evidence from animal experiments, the effects of immunocompromised hosts parasitic infections on remain unclear. Here we detected 14 different parasites in six northern pig-tailed macaques （NPMs） before or at the 50th week of simian immunodeficiency virus （SIV） infection by ELISA. The NPMs all carried parasites before viral injection. At the 50th week after viral injection, the individuals with negative results in parasitic detection （i.e., 08247 and 08287） were characterized as the Parasites Exit （PE） group, with the other individuals （i.e., 09203, 09211, 10205, and 10225） characterized as the Parasites Remain （PR） group. Compared with the PR group, the NPMs in the PE group showed higher viral loads, lower CD4＋ T cells counts, and lower CD4/CD8 rates. Additionally, the PE group had higher immune activation and immune exhaustion of both CD4~ and CD8~ T cells. Pathological observation showed greater injury to the liver, cecum, colon, spleen, and mesenteric lymph nodes in the PE group This study showed more seriously compromised immunity in the PE group, strongly indicating that parasites might exit an immunocompromised host.
文摘Hepatitis E virus(HEV)originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States.While there are eight identified genotypes to date,genotype 1(HEV1),HEV2,HEV3,HEV4 are the most common to infect humans.HEV1 and HEV2 are most common in developing countries including Latina America,Africa and Asia,and are commonly transmitted through contaminated water supplies leading to regional outbreaks.In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat.The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing.In majority of cases,HEV infection is a selflimiting hepatitis requiring only symptomatic treatment.However,this is not the case in immunocompromised individuals,including those that have undergone solid organ or stem cell transplantation.In this subset of patients,chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death.The need for re-transplantation as a result of post-transplant hepatitis is of great concern.In addition,there have been many reported incidents of extrahepatic manifestations,for which the exact mechanisms remain to be elucidated.The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies,while attempting to minimize the risk of organ rejection.Subsequent treatment options include ribavirin,and pegylated interferon alpha in those who have demonstrated ribavirin resistance.Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden.Given this concern,vaccination has been approved in China with other investigations underway throughout the world.In this review we introduce the epidemiology,diagnosis,clinical manifestations,and treatment of HEV,with emphasis on immunocompromised individuals in the United States.
文摘We report three cases of ileocolic mucormycosis in adult immunocompromised patients presenting as acute abdomen.All patients underwent laparotomy but two of them died from multiorgan failure before the diagnoses were confirmed.The diagnosis of gastrointestinal mucormycosis is rarely suspected,and antemortem diagnosis is made in only 25%-50% of cases.These cases illustrate the difficulty encountered by surgeons in managing acute abdomen in neutropenic patients with hematological malignancy.The management of colonic mucormycosis in the published literature is also reviewed.
文摘BACKGROUND Epstein-Barr virus associated smooth muscle tumor(EBV-SMT)is a rare oncological entity.However,there is an increasing incidence of EBV-SMTs,as the frequency of organ transplantation and immunosuppression grows.EBV-SMT diagnosis relies on histopathology and immunochemical staining to distinguish it from post-transplant lymphoproliferative disorder(PTLD).There is no clear consensus on the treatment of EBV-SMTs.However,surgical resection,chemotherapy,radiation therapy,and immunosuppression reduction have been explored with varying degrees of success.CASE SUMMARY Our case series includes six cases of EBV-SMTs across different age groups,with different treatment modalities,adding to the limited existing literature on this rare tumor.The median latency time between immunosuppression and disease diagnosis is four years.EBV-SMTs present with variable degrees of aggressiveness and seem to have worse clinical outcomes in patients with tumor multiplicity and worse immunocompetency.CONCLUSION It is imperative to continue building on this knowledge and keeping EBV-SMTs on the differential in immunocompromised individuals.
基金Supported by the Capital Health Research and Development of Special(No.SF-2018-2-1081)
文摘Dear Editor,I am Dr. Feng Hu, from the Department of Ophthalmology of Beijing Tongren Hospital, Beijing, China. I write to present a case report of cytomegalovirus retinitis (CMVR) in Good’s syndrome (GS).GS is an extremely rare primary immune-deficiency syndrome,which consists of simultaneous occurrence of
文摘AIM: To characterize the prevalence of rotavirus(RV) and adenovirus(Ad V) infections in immunocompromised patients with acute gastroenteritis. METHODS: The presence of RV and Ad V(serotypes 40 and 41) was evaluated in 509 stool samples obtained between January 2009 and December 2010 from 200 immunocompromised patients(83 females and 117 males; median age 21 years old, range 0-72. The diagnosis of infection was performed as a routine procedure and the presence of RV and Ad V(serotypes 40 and 41) was determined by immunochromatography using the RIDA® Quick Rota-Adeno-Kombi kit(r-Biopharm, Darmstadt, Germany). The data analysis and description of seasonal frequencies were performed using computer software IBM® SPSS®(Statistical Package for Social Sciences) Statistics version 20.0 for Mac. The frequencies of infection were compared into different age and gender groups by χ2 test.RESULTS: The study revealed 12.4% Ad V positive samples and 0.8% RV positive samples, which correspond to a prevalence of 6.5% and 1.5%, respectively. Ad V was more frequent between October 2009 and April 2010, while RV was identified in April 2010 and July 2010. The stool analysis revealed that from the 509 samples, 63(12.4%) were positive for Ad V and 4(0.8%) positive for RV, which by resuming the informationof each patient, lead to an overall prevalence of Ad V and RV of 6.5%(13/200 patients) and 1.5%(3/200 patients), respectively. The stratification of the analysis regarding age groups showed a tendency to an increased prevalence of infection in paediatric patients between 0-10 years old. Considering the seasonal distribution of these infections, our study revealed that Ad V infection was more frequent between October 2009 and April 2010, while RV infection was characterized by two distinct peaks(April 2010 and July 2010). CONCLUSION: The overall prevalence of Ad V and RV infection in immunocompromised patients with acute gastroenteritis was 8% and Ad V was the most prevalent agent.
文摘Infections caused by Strongyloides stercoralis(S.stercoralis) in human are generally asymptomatic,however in immunocompromised individual,hyperinfection may develop with dissemination of larvae to extra-intestinal organs.The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself,which may lead to low index of suspicion as a consequence.In this report,a case of a Malaysian male with underlying diabetes mellitus,hypertension,cerebrovascular accident,bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented.However,he developed septicemic shock later,and S.stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli.Regardless of aggressive resuscitation,the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome.It was revealed that the current case has alarmed us via incidental finding of S.stercoralis larvae in the tracheal aspirate,indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.
文摘Eighty four throat swabs were obtained from Basrah General Hospital inpatients （N = 34）： 17 were suffering from renal failure and the other 17 were diabetics; and from outpatients （N = 50）. Throat swabs were cultured first in the selective media Ashdown＇s broth then subcultured on Ashdown＇s agar to isolate Burkholderia pseudomallei which was recovered from seven cases （8.33%）. Four isolates were from renal failure patients （23.53%）, two from diabetic patients （11.76%） and the seventh isolate was from an outpatient with tonsillitis. All isolates were able to produce capsules, form filament chains, exhibit swarming motility and were arabinose non assimilators （Ara-） indicative of their virulence. Additionally, isolated B. pseudomallei were found to produce protease, lipase, hemolysin, and lecithinase and were able to produce biofilm, the root of many troublesome persistent infections that resist antibiotic treatment. Susceptibility of the seven isolates of B. pseudomallei toward 11 antibiotics was assessed, isolates were found multiply resistant to all antibiotics apart from ciproflaxin. This study confirms for the first time isolation of B. pseudomallei from immunocompromised patients in Basrah city of Iraq and describes their virulence potentials.
文摘Objective To analyze the clinical featuresof COVID-19 infection in hospitalized immunocompromised patients in comparison with immunocompetent patients.Methods A single-center retrospective observational study was conducted on 213 inpatients diagnosed with COVID-19 in the Peking University People's Hospital between December 2022 and October 2023.They were divided into an immunocompromised group(102 patients,47.9%)and an immunocompetent group(111 patients,52.1%),and clinical data were compared between the two groups.The immunocompromised group was further divided into death group(18 cases,17.6%)and nondeath group(84 cases,82.4%).The differences in laboratory examination findings were compared.Further analysis was performed on the lymphocyte subset differences between the death group(10 patients,9.8%)and the non-death group(36 patients,35.3%)with complete data.Results The proportion of severe and critical cases and the mortality rate,were significantly higher in the immunocompromised group than the immunocompetent group(47.1%vs.40.5%,18.6%vs.9.0%,17.6%us.9.0%,P<0.05).The immunocompromised group had lower vaccination rate(26.5%vs.44.1%,P<0.05).Hypertension,kidney disease and infections were more common in the immunocompromised group(63.7%us.48.6%,30.4%us.9.0%,49.0%vs.19.8%,all P<0.05).CT findings of consolidation(40.2%us.18.9%),rate of antiviral treatment(48.0%vs.30.6%)and the positive duration of viral nucleic acid[median 14(7.0,19.3)days us.9(7.0,18.0)days]were higher in the immunocomprised group(all P<0.05).Lactate dehydrogenase(LDH),Fprocalcitonin(PCT),interleukin-6(IL-6)and ferritin were higher in the immunocompromised group thanthose inthe immunocompetent group(all P<0.05).In the death group,neutrophils(NEU),C-reactive protein(CRP),PCT,IL-6,ferritin and D-dimer were higher,while lymphocytes(LY),CD4^(+)T-cells,CD8^(+)T-cells,B-cell counts and hemoglobin(HGB)were significantly lower than those in the non-death group(all P<0.05).Conclusion More than 60%of patients in the immunocompromised group are classified as severoe r critical type,with a higher mortality rate and decreased ability to clear severe acuterespiratorySsyndrome coronavirus 2(SARS-CoV-2).Decreasesintotal lymphocytes,CD4^(+)T lymphocytes,CD8^(+)T lymphocytes,and B lymphocytes,along with elevated levels of procalcitonin,ferritin,and D-dimer,indicate poor prognosis.
文摘Histoplasmosis is a serious fungal disease commonly reported in the Americas,Southeast Asia,and sub-Saharan Africa[1].The classical or American type is caused by Histoplasma capsulatum var.capsulatum while African histoplasmosis is caused by H.capsulatum var.duboisii[2].
文摘Diverse pathogenic fungi can produce severe infections in immunocompromised patients, thereby justifying intensive care unit (ICU) admissions. In some cases, the infections can develop in immunocompromised patients who were previously admitted to the ICU. Aspergillus spp., Pneumocystis jirovecii, Candida spp., and Mucorales are the fungi that are most frequently involved in these infections. Diagnosis continues to be challenging because symptoms and signs are unspecific. Herein, we provide an in-depth review about the diagnosis, with emphasis on recent advances, and treatment of these invasive fungal infections in the ICU setting.
文摘Health care-associated infections(HCAIs)pose a substantial threat to immunocompromised individuals and represent a frequent adverse event in health care delivery.The aim of this study was to evaluate the global research landscape of HCAIs among immunocompromised populations before and during the COVID-19 pandemic.A systematic search of articles published between 2013 and 2022 in the Web of Science Core Collection database was conducted,and content analytics and integrated science mapping were used for data analysis and interpretation.The review identified 1,473 articles.Only 633 articles authored by 4,151 individuals and published in 366 journals were included.The average citation rate was 14.27 per document,and research production grew annually by 9.07%peaking in 2021 during the COVID-19 pandemic but declining in 2022.The United States emerged as the most productive country,with 743 publication appearances and 2,485 citations.Keywords such as“epidemiology,”“infection,”“mortality,”and“risk factors”were frequently encountered in the analyzed literature.The main research themes,including“mortality,”“sepsis,”“immunosuppression,”“expression,”and“pneumonia,”underscored the focal points of importance within this domain.This study highlighted the growing interest regarding HCAIs in immunocompromised populations,especially during the COVID-19 pandemic.The study findings underscore the need to advance research efforts to understand different immunocompromised states,develop tailored infection prevention measures,and address health care disparities to mitigate the burden of HCAIs among immunocompromised individuals.
文摘Background:Multiple sclerosis(MS),a chronic neurological disorder,is characterized by damage to the central nervous system,auto-immune processes,and deterioration of the myelin sheath,which lead to a variety of physical,cognitive,and emotional symptoms.Cur-rently,a cure for MS does not exist,and treatments aim only to manage symptoms and enhance quality of life.Betaferon(interferon beta-1b),a disease-modifying therapy,is used to minimize the frequency of relapses and the progression of disability by altering immune re-sponses.However,this therapeutic strategy also increases the risk of infectious diseases,such as tricuspid endocarditis,which is a severe infection of the heart valve that is often associated with chronic intravenous drug use and carries potential life-threatening consequences.Case presentation:We present a case of a 48-year-old male who was undergoing Betaferon therapy for MS.He was admitted to the emergency room owing to fever,shortness of breath,and altered mental state.Physical examination revealed clinical signs of endocarditis,and laboratory results indicated severe thrombocytopenia,anemia,and elevated inflammatory markers.Imaging confirmed lung abnor-malities and vegetations on the tricuspid valve.Blood cultures identified methicillin-sensitive Staphylococcus aureus.Intravenous antibi-otics were initiated,and surgical intervention was planned.Despite initial antibiotic therapy improving his clinical and laboratory conditions,the patient experienced multiple pulmonary embolic events that led to death after 16 days of hospitalization.Conclusion:This case underscores the challenges of identifying and managing endocarditis in immunocompromised patients and high-lights the complexities of treating infections in individuals with chronic diseases.
基金supported by the National Key Research and Development Program of China(no.2022YFC2502600)the National Natural Science Foundation of China(nos.82170206,82300228)Shanghai Municipal Health Commission Project of Disciplines of Excellence(no.20234Z0002).
文摘Data on severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in patients at early stage of immune reconstitution after hematopoietic stem cell transplantation(HSCT)are limited.In the present study,we retrospectively investigated the incidence and clinical features of SARS-CoV-2 infection in patients who underwent HSCT in 2022.Patients(allo-HSCT,n=80;auto-HSCT,n=37)were consecutively included in the study.The SARS-CoV-2 infection rate was 59.8%,and the median interval of HSCT to coronavirus disease 2019(COVID-19)was 4.8(range:0.5–12)months.Most patients were categorized as mild(41.4%)or moderate(38.6%),and 20%as severe/critical.No deaths were attributable to COVID-19.Further analysis showed that lower circulating CD8^(+)T-cell counts and calcineurin inhibitor administration increased the risk of SARS-CoV-2 infection.Exposure to rituximab significantly increased the probability of severe or critical COVID-19 compared with that of mild/moderate illness(P<.001).In the multivariate analysis,rituximab use was associated with severe COVID-19.Additionally,COVID-19 had no significant effect on immune reconstitution.Furthermore,it was found that Epstein–Barr virus infection and rituximab administration possibly increase the risk of developing severe illness.Our study provides preliminary insights into the effect of SARS-CoV-2 on immune reconstitution and the outcomes of allo-HSCT recipients.
基金Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Program,No.2023ZF075.
文摘BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.
文摘BACKGROUND Aseptic meningitis is defined as meningeal inflammation caused by various etio-logies with negative cerebrospinal fluid(CSF)bacterial culture.The most common etiologies are viruses[enteroviruses,arboviruses,and herpes simplex virus type 2(HSV-2)].Aseptic meningitis can have various presentations,including sensori-neural deafness.While sensorineural deafness from mumps meningoencephalitis has been reported,cases of HSV-2-induced hearing loss are rare.Herein,we re-port a case of HSV-2-induced meningitis that presented with sudden deafness.CASE SUMMARY A 68-year-old man experienced a profound sudden onset of left-sided hearing loss for one day.Pure-tone audiograms demonstrated sudden left-sided sensorineural hearing loss(thresholds 80-90 dB).After treatment with high-dose steroids for 1 week,he experienced an acute consciousness change with left hemiparesis.The laboratory data showed no significant abnormalities.Brain computed tomography without contrast and magnetic resonance imaging revealed no intracranial hemo-rrhage or obvious brain lesion.The CSF analysis and the Multiplex PCR panels showed HSV-2 positivity.Hence,under the diagnosis of herpes meningoenceph-alitis,acyclovir was prescribed and his symptoms gradually resolved.CONCLUSION This case report further demonstrates that a viral infection could be a cause of sudden sensorineural hearing loss.
文摘BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.
