BACKGROUND Acyclovir(ACV)-resistant herpes simplex virus(HSV)strains have emerged and gradually increased in number.Prolonged treatment,such as for immunocompromised patients,has been observed on many occasions to lea...BACKGROUND Acyclovir(ACV)-resistant herpes simplex virus(HSV)strains have emerged and gradually increased in number.Prolonged treatment,such as for immunocompromised patients,has been observed on many occasions to lead to the development of resistance.Additionally,some strains of HSV exist that are ACV resistant,and they can cause severe complications that may be impossible to treat with current therapies.We report the first case of ACV-resistant herpes encephalitis(ARHE)recurring in an immunocompromised adult patient without neurosurgical intervention.CASE SUMMARY A 58-year-old man with a fever of 38°C had tremors.Evaluation revealed 14 points on the Glasgow Coma Scale with 39°C fever but unremarkable physical examination.Diagnosis was infection of unknown origin;fever continued,and the Glasgow Coma Scale worsened to 8.Imaging showing a high-intensity area between the left temporal lobe and insular cortex suggested herpes encephalitis.ACV was started.Cerebrospinal fluid(CSF)was positive for HSV DNA,confirming the diagnosis.However,unresolved symptoms suggested ARHE;therefore,we initiated vidarabine treatment.Later testing confirmed ARHE.Foscarnet was started based on a hospital day 25 blood test revealing pancytopenia,possibly from vidarabine.Consciousness improved,and the patient moved to rehabilitation.However,symptoms worsened,suggesting recurrence.Diffusion-weighted magnetic resonance imaging revealed a high high-intensity area around the right temporal lobe;CSF was positive for HSV DNA,confirming recurrent herpes encephalitis.ACV and foscarnet were initiated.Fever decreased,consciousness improved,and HSV DNA on hospital days 78 and 93 was CSF negative.Treatment was terminated on hospital day 86.CONCLUSION ARHE recurred in the patient following remission;therefore,it is necessary to discuss the length of the treatment period.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
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
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
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
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
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
BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patie...BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patients with certain risk factors,including immunocompromised status.We recently diagnosed a case of spontaneous bacterial peritonitis(SBP)due to E.tarda in an immuno-compromised dialysis patient.CASE SUMMARY Patient was a 55-year-old male,with a history of diabetic nephropathy being treated with hemodialysis three times a week.He was referred to our hospital due to an increased volume of ascites,and blood examination revealed increased inflammatory reaction.At our emergency department,he developed fever,disturbance of consciousness,abdominal distension,and abdomen-wide pain.In addition,a dialysis shunt was confirmed in his right forearm,and the shunt site showed no signs of inflammation.No wounds were confirmed on or in his body.A blood examination revealed increased values of white blood cells,C-reactive protein,and creatinine.Plain chest and abdominal computed tomography scanning revealed increased ascites volume.Abdominal paracentesis was performed and a Gram stain revealed Gramnegative bacillus.These findings prompted diagnosis of SBP.The patient was admitted and treated with cefmetazole,causing fever resolution and symptom improvements.Later,E.tarda was identified in ascites culture.The patient improved with decreased inflammatory response and was discharged on the 12th day of hospitalization.The antibiotic was terminated after 14 days of treatment.SBP in this case may have developed from chronic renal failure and diabetes mellitus.CONCLUSION We report the first known case of SBP due to E.tarda in an immuno-compromised dialysis patient.展开更多
Background： Although radiological features ofpneumocystis pneumonia （PCP） in non-Acquired Immune Deficiency Syndrome （AIDS） immunocompromised patients have been reported by other authors, there were no studies on...Background： Although radiological features ofpneumocystis pneumonia （PCP） in non-Acquired Immune Deficiency Syndrome （AIDS） immunocompromised patients have been reported by other authors, there were no studies on the radiological stages of PCP previously. This study aimed to elucidate the radiological stages and prognoses of PCP in non-AIDS immunocompromised patients. Methods： Retrospective analysis ofradiological manifestations and prognoses of 105 non-AIDS PCP immunocompromised patients from August 2009 to April 2016 was conducted. Chest radiograph was divided into three stages： early stage （normal or nearly normal chest radiograph）, mid stage （bilateral pulmonary infiltrates）, and late stage （bilateral pulmonary consolidations）; chest high-resolution computed tomography （HRCT） was also divided into three stages： early stage （bilateral diffuse ground-glass opacity [GGO]）, mid stage （bilateral diffuse GGO and patchy consolidations）, and late stage （bilateral diffuse consolidations）. Results： The case fatality rate （CFR） of all patients was 34.3% （36/105）, all of them took routine chest X-ray （CXR）, and 84 underwent chest CT examinations. According to the CXR most near the beginning ofanti-PCP therapy, 18 cases were at early stage and CFR was 0 （0/18, P 〈 0.01）, 50 cases were at mid stage and CFR was 28.0% （14/50, P〉 0.05）, and 37 cases were at late stage and CFR was 59.5% （22/37, P 〈 0.01）. According to the chest HRCT most near the beginning ofanti-PCP therapy, 40 cases were at early stage and CFR was 20.0% （8/40, P 〉 0.05）, 34 cases were at mid stage and CFR was 47.1% （l 6/34, P 〉 0.05）, and 10 cases were at late stage and CFR was 80.0% （8/10, P 〈 0.05）; barotrauma, including pneumothorax, pneumomediastinum, and pneumohypoderma, was found in 18 cases and the CFR was 77.8% （14/18, P 〈 0.01）. Conclusions： Based on the radiological manifestations, the course of PCP in non-A1DS immunocompromised patients can be divided into three stages： early stage, mid stage, and late stage. The prognoses of patients treated at early stage are good, and those at late stage are poor. Furthermore, the CFR of patients with barotrauma is high.展开更多
Background The diagnosis of Pneumocystis pneumonia （PCP） in immunocompromised patients is still challenging today due to the absence of an in vitro culture system and the low diagnostic accuracy of microscopic exami...Background The diagnosis of Pneumocystis pneumonia （PCP） in immunocompromised patients is still challenging today due to the absence of an in vitro culture system and the low diagnostic accuracy of microscopic examinations. Herein, we performed a meta-analysis to evaluate the accuracy of real-time polymerase chain reaction （PCR） in the diagnosis of PCP. Methods We searched Web of Knowledge and Medline from 1990 to May 2010 for studies reporting diagnostic accuracy data regarding the use of real-time PCR in the diagnosis of PCP in immunocompromised patients. Results Ten individual studies were included. Overall, the sensitivity of real-time PCR was 97% （95% CI： 93%-99%）; the specificity was 94% （95% CI： 90%-96%）. The area under the HSROC curve （95% CO for real-time PCR was 0.99 （0.97-0.99）. In a subgroup analysis regarding studies involving HIV patients among the study population, the sensitivity and specificity were 97% （95% CI： 93%-99%） and 93% （95% CI： 89%-96%）, respectively. Regarding studies using Bronchoalveolar lavage （BAL） samples only： sensitivity =98% （95% CI： 94%-99%）; specificity =93% （95% CI： 89%- 96%）, respectively. Regarding studies using microscopy as a reference standard： sensitivity =97% （95% CI： 92%-99%）; specificity =93% （95% CI： 88%-96%）. However, high between-study statistical heterogeneity was observed in all analyses. Conclusions Real-time PCR has a good diagnostic accuracy and may provide a useful adjunctive tool for the diagnosis of PCP in immunocompromised patients. Further studies are needed in order to identify any differences in the diagnostic performance of real-time PCR in HIV and non-HIV immunocompromised patients.展开更多
Human cytomegalovirus (HCMV) infection is common and affects between 40–100% of the worldwide population. However, the majority of cases are asymptomatic and when severe disease occurs, it is usually restricted to im...Human cytomegalovirus (HCMV) infection is common and affects between 40–100% of the worldwide population. However, the majority of cases are asymptomatic and when severe disease occurs, it is usually restricted to immunocompromised patients. Liver involvement by HCMV differs significantly, accordingly to the immune status of the host. In immunocompromised patients, particularly liver transplant patients, it often causes clinically significant hepatitis. On the other hand, in immunocompetent patients, HCMV hepatitis requiring hospitalization is extremely rare. This review aims to appraise studies regarding the pathophysiology of HCMV hepatitis, including mechanisms of latency and reactivation and its contribution to disease development, clinical presentation, diagnostic modalities and treatment, with a focus on comparing different aspects between immunocompromised and immunocompetent hosts.展开更多
Background The number of critically ill immunocompromised （CIIC） patients has increased dramatically in recent years,and they represent a high risk population for invasive pulmonary aspergillosis （IPA） infection.H...Background The number of critically ill immunocompromised （CIIC） patients has increased dramatically in recent years,and they represent a high risk population for invasive pulmonary aspergillosis （IPA） infection.Host immunity should play a major role in determining the outcome and recovery of these patients.The purpose of this study was to evaluate the dynamic changes in host immune status and its potential influence on prognosis in CIIC patients with IPA.Methods We monitored the evolution of a number of key cellular and humoral parameters on days 1,3,and 10 （D1,D3 and D10） following ICU admission in sixty-two CIIC patients with microbiological evidence of IPA.We included immunoglobulins IgG,IgA and IgM,complement factors C3 and C4,and lymphocyte subgroups CD3＋,CD4＋,CD8＋,CD28＋CD4＋,and CD28＋CD8＋ T cells,CD19＋B cells,and CD3-CD16＋CD56＋ natural killer cells （NK）.Results The primary outcome was 28-day mortality.Thirty-eight （61.3％） patients died within the 28 days following ICU admission.Compared to patients who died,CD3＋,CD8＋,CD28＋CD8＋ T-cell counts on D1,D3,and D10,CD28＋CD4＋ T-cell counts on D3 and D10,and NK counts on D3 and D10 were significantly higher in survivors.Receiver operating characteristic （ROC） analysis of immune parameters predicting 28-day mortality revealed area under the curve （AUC） values of 0.82 （95％ CI 0.71-0.92）,0.94 （95％ CI 0.87-0.99）,and 0.94 （95％ CI 0.85-0.99） for CD8＋ T-cell counts for D1,D3,and D10 respectively,and 0.84 （95％ CI 0.75-0.94）,0.92 （95％ CI 0.85-0.99）,and 0.90 （95％ CI 0.79-0.99） for CD28＋CD8＋ T-cell counts for D1,D3,and D10 respectively.Kaplan-Meier survival analysis showed that CD8＋ T-cell counts ＜149.5×106 cells/L and CD28＋CD8＋ T-cell counts ＜75×106 cells/L at ICU admission were associated with lower survival probabilities in CIIC patients with IPA （both Log rank：P＜0.001）.Conclusions Low CD8＋ and CD28＋CD8＋ T-cell counts were associated with high mortality in CIIC patients with IPA.Early counts of CD8＋ and CD28＋CD8＋ T cells in CIIC patients with IPA may be valuable for predicting outcome.展开更多
Despite recent advances in antibiotic use, in creasing numbers of human immunodeficiency virus (HIV)- negative patients with Pneumocystis jirovecii pneumonia (PCP) are being admitted to intensive care units (ICUs), an...Despite recent advances in antibiotic use, in creasing numbers of human immunodeficiency virus (HIV)- negative patients with Pneumocystis jirovecii pneumonia (PCP) are being admitted to intensive care units (ICUs), and show a mortality rate of over 50%.[1] A high neutrophil count in bronchoalveolar lavage (BAL) fluid is a predictor of poor prognosis in HIV-negative patients with PCP.展开更多
基金Supported by the Japan Society for the Promotion of Science KAKENHI Grant,No.JP24K15491.
文摘BACKGROUND Acyclovir(ACV)-resistant herpes simplex virus(HSV)strains have emerged and gradually increased in number.Prolonged treatment,such as for immunocompromised patients,has been observed on many occasions to lead to the development of resistance.Additionally,some strains of HSV exist that are ACV resistant,and they can cause severe complications that may be impossible to treat with current therapies.We report the first case of ACV-resistant herpes encephalitis(ARHE)recurring in an immunocompromised adult patient without neurosurgical intervention.CASE SUMMARY A 58-year-old man with a fever of 38°C had tremors.Evaluation revealed 14 points on the Glasgow Coma Scale with 39°C fever but unremarkable physical examination.Diagnosis was infection of unknown origin;fever continued,and the Glasgow Coma Scale worsened to 8.Imaging showing a high-intensity area between the left temporal lobe and insular cortex suggested herpes encephalitis.ACV was started.Cerebrospinal fluid(CSF)was positive for HSV DNA,confirming the diagnosis.However,unresolved symptoms suggested ARHE;therefore,we initiated vidarabine treatment.Later testing confirmed ARHE.Foscarnet was started based on a hospital day 25 blood test revealing pancytopenia,possibly from vidarabine.Consciousness improved,and the patient moved to rehabilitation.However,symptoms worsened,suggesting recurrence.Diffusion-weighted magnetic resonance imaging revealed a high high-intensity area around the right temporal lobe;CSF was positive for HSV DNA,confirming recurrent herpes encephalitis.ACV and foscarnet were initiated.Fever decreased,consciousness improved,and HSV DNA on hospital days 78 and 93 was CSF negative.Treatment was terminated on hospital day 86.CONCLUSION ARHE recurred in the patient following remission;therefore,it is necessary to discuss the length of the treatment period.
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.
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.
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.
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BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patients with certain risk factors,including immunocompromised status.We recently diagnosed a case of spontaneous bacterial peritonitis(SBP)due to E.tarda in an immuno-compromised dialysis patient.CASE SUMMARY Patient was a 55-year-old male,with a history of diabetic nephropathy being treated with hemodialysis three times a week.He was referred to our hospital due to an increased volume of ascites,and blood examination revealed increased inflammatory reaction.At our emergency department,he developed fever,disturbance of consciousness,abdominal distension,and abdomen-wide pain.In addition,a dialysis shunt was confirmed in his right forearm,and the shunt site showed no signs of inflammation.No wounds were confirmed on or in his body.A blood examination revealed increased values of white blood cells,C-reactive protein,and creatinine.Plain chest and abdominal computed tomography scanning revealed increased ascites volume.Abdominal paracentesis was performed and a Gram stain revealed Gramnegative bacillus.These findings prompted diagnosis of SBP.The patient was admitted and treated with cefmetazole,causing fever resolution and symptom improvements.Later,E.tarda was identified in ascites culture.The patient improved with decreased inflammatory response and was discharged on the 12th day of hospitalization.The antibiotic was terminated after 14 days of treatment.SBP in this case may have developed from chronic renal failure and diabetes mellitus.CONCLUSION We report the first known case of SBP due to E.tarda in an immuno-compromised dialysis patient.
文摘Background： Although radiological features ofpneumocystis pneumonia （PCP） in non-Acquired Immune Deficiency Syndrome （AIDS） immunocompromised patients have been reported by other authors, there were no studies on the radiological stages of PCP previously. This study aimed to elucidate the radiological stages and prognoses of PCP in non-AIDS immunocompromised patients. Methods： Retrospective analysis ofradiological manifestations and prognoses of 105 non-AIDS PCP immunocompromised patients from August 2009 to April 2016 was conducted. Chest radiograph was divided into three stages： early stage （normal or nearly normal chest radiograph）, mid stage （bilateral pulmonary infiltrates）, and late stage （bilateral pulmonary consolidations）; chest high-resolution computed tomography （HRCT） was also divided into three stages： early stage （bilateral diffuse ground-glass opacity [GGO]）, mid stage （bilateral diffuse GGO and patchy consolidations）, and late stage （bilateral diffuse consolidations）. Results： The case fatality rate （CFR） of all patients was 34.3% （36/105）, all of them took routine chest X-ray （CXR）, and 84 underwent chest CT examinations. According to the CXR most near the beginning ofanti-PCP therapy, 18 cases were at early stage and CFR was 0 （0/18, P 〈 0.01）, 50 cases were at mid stage and CFR was 28.0% （14/50, P〉 0.05）, and 37 cases were at late stage and CFR was 59.5% （22/37, P 〈 0.01）. According to the chest HRCT most near the beginning ofanti-PCP therapy, 40 cases were at early stage and CFR was 20.0% （8/40, P 〉 0.05）, 34 cases were at mid stage and CFR was 47.1% （l 6/34, P 〉 0.05）, and 10 cases were at late stage and CFR was 80.0% （8/10, P 〈 0.05）; barotrauma, including pneumothorax, pneumomediastinum, and pneumohypoderma, was found in 18 cases and the CFR was 77.8% （14/18, P 〈 0.01）. Conclusions： Based on the radiological manifestations, the course of PCP in non-A1DS immunocompromised patients can be divided into three stages： early stage, mid stage, and late stage. The prognoses of patients treated at early stage are good, and those at late stage are poor. Furthermore, the CFR of patients with barotrauma is high.
文摘Background The diagnosis of Pneumocystis pneumonia （PCP） in immunocompromised patients is still challenging today due to the absence of an in vitro culture system and the low diagnostic accuracy of microscopic examinations. Herein, we performed a meta-analysis to evaluate the accuracy of real-time polymerase chain reaction （PCR） in the diagnosis of PCP. Methods We searched Web of Knowledge and Medline from 1990 to May 2010 for studies reporting diagnostic accuracy data regarding the use of real-time PCR in the diagnosis of PCP in immunocompromised patients. Results Ten individual studies were included. Overall, the sensitivity of real-time PCR was 97% （95% CI： 93%-99%）; the specificity was 94% （95% CI： 90%-96%）. The area under the HSROC curve （95% CO for real-time PCR was 0.99 （0.97-0.99）. In a subgroup analysis regarding studies involving HIV patients among the study population, the sensitivity and specificity were 97% （95% CI： 93%-99%） and 93% （95% CI： 89%-96%）, respectively. Regarding studies using Bronchoalveolar lavage （BAL） samples only： sensitivity =98% （95% CI： 94%-99%）; specificity =93% （95% CI： 89%- 96%）, respectively. Regarding studies using microscopy as a reference standard： sensitivity =97% （95% CI： 92%-99%）; specificity =93% （95% CI： 88%-96%）. However, high between-study statistical heterogeneity was observed in all analyses. Conclusions Real-time PCR has a good diagnostic accuracy and may provide a useful adjunctive tool for the diagnosis of PCP in immunocompromised patients. Further studies are needed in order to identify any differences in the diagnostic performance of real-time PCR in HIV and non-HIV immunocompromised patients.
文摘Human cytomegalovirus (HCMV) infection is common and affects between 40–100% of the worldwide population. However, the majority of cases are asymptomatic and when severe disease occurs, it is usually restricted to immunocompromised patients. Liver involvement by HCMV differs significantly, accordingly to the immune status of the host. In immunocompromised patients, particularly liver transplant patients, it often causes clinically significant hepatitis. On the other hand, in immunocompetent patients, HCMV hepatitis requiring hospitalization is extremely rare. This review aims to appraise studies regarding the pathophysiology of HCMV hepatitis, including mechanisms of latency and reactivation and its contribution to disease development, clinical presentation, diagnostic modalities and treatment, with a focus on comparing different aspects between immunocompromised and immunocompetent hosts.
文摘Background The number of critically ill immunocompromised （CIIC） patients has increased dramatically in recent years,and they represent a high risk population for invasive pulmonary aspergillosis （IPA） infection.Host immunity should play a major role in determining the outcome and recovery of these patients.The purpose of this study was to evaluate the dynamic changes in host immune status and its potential influence on prognosis in CIIC patients with IPA.Methods We monitored the evolution of a number of key cellular and humoral parameters on days 1,3,and 10 （D1,D3 and D10） following ICU admission in sixty-two CIIC patients with microbiological evidence of IPA.We included immunoglobulins IgG,IgA and IgM,complement factors C3 and C4,and lymphocyte subgroups CD3＋,CD4＋,CD8＋,CD28＋CD4＋,and CD28＋CD8＋ T cells,CD19＋B cells,and CD3-CD16＋CD56＋ natural killer cells （NK）.Results The primary outcome was 28-day mortality.Thirty-eight （61.3％） patients died within the 28 days following ICU admission.Compared to patients who died,CD3＋,CD8＋,CD28＋CD8＋ T-cell counts on D1,D3,and D10,CD28＋CD4＋ T-cell counts on D3 and D10,and NK counts on D3 and D10 were significantly higher in survivors.Receiver operating characteristic （ROC） analysis of immune parameters predicting 28-day mortality revealed area under the curve （AUC） values of 0.82 （95％ CI 0.71-0.92）,0.94 （95％ CI 0.87-0.99）,and 0.94 （95％ CI 0.85-0.99） for CD8＋ T-cell counts for D1,D3,and D10 respectively,and 0.84 （95％ CI 0.75-0.94）,0.92 （95％ CI 0.85-0.99）,and 0.90 （95％ CI 0.79-0.99） for CD28＋CD8＋ T-cell counts for D1,D3,and D10 respectively.Kaplan-Meier survival analysis showed that CD8＋ T-cell counts ＜149.5×106 cells/L and CD28＋CD8＋ T-cell counts ＜75×106 cells/L at ICU admission were associated with lower survival probabilities in CIIC patients with IPA （both Log rank：P＜0.001）.Conclusions Low CD8＋ and CD28＋CD8＋ T-cell counts were associated with high mortality in CIIC patients with IPA.Early counts of CD8＋ and CD28＋CD8＋ T cells in CIIC patients with IPA may be valuable for predicting outcome.
基金grants from the National Natural Science Foundation of China (No. 81470270, No. 81700083, and No. 81870072)the National Key Research and Development Program of China (No. 2016YFC1304300)+2 种基金the Capital Clinical Features Applied Research and Achievement Promotion Project of Beijing, China (No. Z161100000516116)the Major projects of the National Natural Science Foundation of China (No. 81490534)the Fundamental Research Funds for the Central Universities of China (No. 3332018183).
文摘Despite recent advances in antibiotic use, in creasing numbers of human immunodeficiency virus (HIV)- negative patients with Pneumocystis jirovecii pneumonia (PCP) are being admitted to intensive care units (ICUs), and show a mortality rate of over 50%.[1] A high neutrophil count in bronchoalveolar lavage (BAL) fluid is a predictor of poor prognosis in HIV-negative patients with PCP.
