BACKGROUND Histoplasmosis is a rare infectious condition with mainly pulmonary involvement which is generally self-limiting in immunocompetent individuals.Its manifestation varies and lacks specificity.This study repo...BACKGROUND Histoplasmosis is a rare infectious condition with mainly pulmonary involvement which is generally self-limiting in immunocompetent individuals.Its manifestation varies and lacks specificity.This study reports a case of primary disseminated liver histoplasmosis in a normal host presenting as liver failure cured by liver transplantation and voriconazole.CASE SUMMARY A 43-year-old Chinese man with intermittent fever,malaise,jaundice and extreme hepatomegaly for more than 40 days was admitted to the Second Xiang-ya Hospital.The patient was immunocompetent and lacked a definitive history of exposure.His condition deteriorated to liver failure,and he promptly underwent liver transplantation to ensure survival.One year later,the patient presented with severe gastrointestinal symptoms,including fever,abdominal pain,and diarrhea.Subsequently,tissue samples acquired via gastrointestinal endoscopy were subjected to pathological examination and next-generation sequencing analysis.Through a comprehensive amalgamation of clinical presentation,biopsy pathology,and next-generation sequencing analysis,the patient was ultimately diagnosed with disseminated hepatic histoplasmosis.The patient achieved complete recovery after 6 months of voriconazole treatment.CONCLUSION In patients with chronic-hepatitis-B having atypical symptoms,histoplasmosis can be a differential diagnosis.Voriconazole is effective in treating histoplasmosis.展开更多
BACKGROUND: The use of corticosteroids in septic shock has been studied for many decades but yielded conflicting results. We conducted a systematic review to evaluate the efficacy and the safety of corticosteroids in ...BACKGROUND: The use of corticosteroids in septic shock has been studied for many decades but yielded conflicting results. We conducted a systematic review to evaluate the efficacy and the safety of corticosteroids in immunocompetent patients with septic shock.METHODS: Medline via Pub Med, Cochrane Central Register of Controlled Trials(CENTRAL) in the Cochrane Library, and EMBASE were searched from inception to March 2020. Two reviewers independently identified randomized controlled trials(RCTs) comparing corticosteroids with a control group for immunocompetent patients with septic shock. Data were abstracted and reported following the Cochrane Handbook for Systematic Review of Intervention and Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) statement. The efficacy outcome included mortality and shock reversal. The safety outcomes were infection, gastrointestinal bleeding, and hyperglycemia.RESULTS: Nine RCTs with a total of 1,298 patients were included. Compared with the control group, corticosteroid group did not lower the short-term(28 or 30 days) mortality(risk ratio [RR] 0.95, 95% confidence interval(CI) 0.85 to 1.06, inconsistency [I2]=0%, trial sequential analysis [TSA]-adjusted CI 0.83 to 1.09, moderate-certainty evidence). Corticosteroids significantly shortened the time to shock reversal compared with the control group(mean difference [MD] –21.56 hours;95% CI –32.95 to –10.16, I2=0%;TSA-adjusted CI –33.33 to –9.78, moderate-certainty evidence). The corticosteroid treatment was associated with an increased risk of hyperglycemia but not the infection or gastrointestinal bleeding.CONCLUSIONS: The corticosteroid treatment is not associated with lower short-or longterm mortality compared with placebo in immunocompetent patients with septic shock. However, corticosteroids significantly shorten the time to shock reversal without increasing the risk of infection. The patient's immune status should also be considered during clinical treatment and clinical trials in future.展开更多
Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients.We reported a case of 36 year o...Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients.We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever,cough with scanty sputum,hemoptysis,left sided chest pain and exertional dyspnea for two weeks.There was no past history of tuberculosis,diabetes mellitus or steroid therapy.Chest X-ray showed homogenous peripherally based opacity in the left upper zone.Bronchoscopy was done and brushing sent for culture,which showed colonies with features of Nocardia species after 48 hours.Further phenotypic characterization revealed it to be Nocardia otitidiscaviarum.Patient was treated with cotrimaxazole for six months after which complete recovery was evidenced symptomatically and radiologically.We report this case to emphasize the fact that among the Nocardia species,Nocardia otitidiscaviarum as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals.展开更多
Cytomegalovirus enteritis is most usually associated with patients positive for human immunodeficiency virus or immunosuppressed transplant patients. The gastrointestinal tract may be affected anywhere from the esopha...Cytomegalovirus enteritis is most usually associated with patients positive for human immunodeficiency virus or immunosuppressed transplant patients. The gastrointestinal tract may be affected anywhere from the esophagus to the colon, but the small bowel involvement is rare. We report a case of cytomegalovirus ileitis in an immunocompetent adult, which was confirmed by histopathologic findings through colonoscopic biopsy.展开更多
BACKGROUND Pulmonary mucormycosis is a rare but life-threatening invasive fungal infection that mostly affects immunocompromised patients.This disease usually develops acutely and progresses rapidly,often leading to a...BACKGROUND Pulmonary mucormycosis is a rare but life-threatening invasive fungal infection that mostly affects immunocompromised patients.This disease usually develops acutely and progresses rapidly,often leading to a poor clinical prognosis.Chronic pulmonary mucormycosis is highly unusual in immunocompetent patients.CASE SUMMARY A 43-year-old man,who was a house improvement worker with a long history of occupational dust exposure,presented with an irritating cough that had lasted for two months.The patient was previously in good health,without dysglycemia or any known immunodeficiencies.Chest computed tomography revealed a mass in the left lower lobe,measuring approximately 6 cm in diameter,which was suspected to be primary lung carcinoma complicated with obstructive pneumonia.Thoracoscopic-assisted left lower lobectomy was performed,and metagenomic next-generation sequencing detection,along with special pathological staining of surgical specimens,suggested Rhizopus microsporus infection.Postoperatively,the patient’s respiratory symptoms were relieved,and no signs of recurrence were found during the six-month follow-up.CONCLUSION This article reports a rare case of chronic pulmonary mucormycosis caused by Rhizopus microsporus in a middle-aged male without dysglycemia or immunodeficiency.The patient’s surgical outcome was excellent,reaffirming that surgery remains the cornerstone of pulmonary mucormycosis treatment.展开更多
Burkholderia cepacia(6.cepacia)infection is rarely reported in an immunocompetent host.It is a well known occurence in patients with cystic fibrosis and chronic granulomatous disease where it increases both morbidity ...Burkholderia cepacia(6.cepacia)infection is rarely reported in an immunocompetent host.It is a well known occurence in patients with cystic fibrosis and chronic granulomatous disease where it increases both morbidity and mortality.It has also been included in the list of organisms causing nosocomial infections in an immunocompetent host,most of them transmitted from the immunocompromised patient in which this organism harbors.We report a rare case of isolation of B.cepacia from the bronchoalveolar lavage fluid of an immunocompetent agriculturist who presented with productive cough and fever associated with a pyopneumothorax.This is the first case of community acquired infection reported in an immunocompetent person in India.展开更多
Cat scratch's disease caused by Bartonella henselae,is known to be a self-limited benign process in immunocompetent children.The association with neurologic manifestations is very uncommon especially in patient wi...Cat scratch's disease caused by Bartonella henselae,is known to be a self-limited benign process in immunocompetent children.The association with neurologic manifestations is very uncommon especially in patient with no immunologic defects and in cases without specific treatment.A 7 years old male patient,without any immunocromised defect,presented an atypic presentation of the cat scratch disease.The patient came to the hospital in two opportunities in a status epilepticus,in both cases the diagnosis was encephalitis by Bartonella henselae and the evolution with treatment was monitored with PCR(polymerase chain reaction)in cerebrospinal fluid and blood,as well as IFI(IgM,IgG)serology(indirect immunofluorescence).The patient had a favorable clinical and laboratory evolution for 6 months showing no recurrence of the disease.展开更多
Cytomegalovirus （CMV） colitis rarely occurs in immunocompetent patients. We report a case of disabling and life threatening diarrhea in an immunocompetent elderly woman due to CMV colitis. The diagnosis of CMV was b...Cytomegalovirus （CMV） colitis rarely occurs in immunocompetent patients. We report a case of disabling and life threatening diarrhea in an immunocompetent elderly woman due to CMV colitis. The diagnosis of CMV was based on histological examination of tissues biopsied at colonoscopy, positive CMV antigen and high CMV-lgM titer in peripheral blood samples and a good response to systemic gancyclovir treatment. We conclude that CMV should be considered in the differential diagnosis of colitis in elderly immunocompetent patients.展开更多
BACKGROUND Cytomegalovirus(CMV) enterocolitis presenting in the form of pancolitis or involving the small and large intestines in an immunocompetent patient is rarely encountered, and CMV enterocolitis presenting with...BACKGROUND Cytomegalovirus(CMV) enterocolitis presenting in the form of pancolitis or involving the small and large intestines in an immunocompetent patient is rarely encountered, and CMV enterocolitis presenting with a serious complication, such as toxic megacolon, in an immunocompetent adult has only been reported on a few occasions.CASE SUMMARY We describe the case of a 70-year-old male with no history of inflammatory bowel disease or immunodeficiency who presented with toxic megacolon and subsequently developed massive hemorrhage as a complication of CMV ileopancolitis. The patient was referred to our institute for abdominal pain and distension. Abdominal X-ray showed marked dilatation of ileum and whole colon without air-fluid level, and sigmoidoscopy with biopsy failed to reveal any specific finding. After 7 d of conservative treatment, massive hematochezia developed, and he was diagnosed to have CMV enterocolitis by colonoscopy with biopsy. Although the diagnosis of CMV enterocolitis was delayed, the patient was treated successfully by repeat colonoscopic decompression and antiviral therapy with intravenous ganciclovir.CONCLUSION This report cautions that CMV-induced colitis should be considered as a possible differential diagnosis in a patient with intractable symptoms of enterocolitis or megacolon of unknown cause, even when the patient is nonimmunocompromised.展开更多
BACKGROUND Pulmonary cryptococcosis is an opportunistic infection that mainly occurs among immunocompromised patients although it can sometimes occur in immunocompetent individuals.However,the imaging findings of pulm...BACKGROUND Pulmonary cryptococcosis is an opportunistic infection that mainly occurs among immunocompromised patients although it can sometimes occur in immunocompetent individuals.However,the imaging findings of pulmonary cryptococcosis in immunocompetent hosts differ from those in immunosuppressed patients.In addition,the most common imaging findings of isolated pulmonary cryptococcosis are single or multiple nodules.Cavities and the halo sign are,however,prevalent in immunosuppressed patients.In immunocompetent patients,lung consolidation,pleural effusion or cavities are scarce.CASE SUMMARY A 29-year-old Asian male was admitted to our hospital with complaints of cough and fever that had persisted for a month.As a chest computed tomography scan showed consolidation in his left lower lobe,he was initially diagnosed with pneumonia and received antibiotic treatment.A second review of the chest computed tomography image revealed multiple cavities and pleural effusion.Flexible fiberoptic bronchoscopy was subsequently performed,bronchoalveolar lavage fluid and serum cryptococcal antigen tests were positive.Cryptococcus capsules were observed in bronchoalveolar lavage fluid ink stain.Histopathological examination of a percutaneous lung biopsy from the left lower lobe further revealed granulomatous inflammation,and periodic acid-Schiff staining showed red-colored yeast walls,signifying pulmonary cryptococcosis.The patient was then treated with a daily dose of fluconazole(0.4 g),but the cough and fever still persisted.We therefore changed treatment to voriconazole(0.2 g,twice a day),and the patient’s clinical outcome was satisfactory.CONCLUSION Although rare,clinicians should not disregard the possibility of cavities and pleural effusion occurring in immunocompetent hosts without underlying diseases.展开更多
BACKGROUND Cryptococcus presenting as an opportunistic pathogen mainly affects immunocompromised patients,but the disseminated form of infection is rare among immunocompetent populations.The partial radiographic chara...BACKGROUND Cryptococcus presenting as an opportunistic pathogen mainly affects immunocompromised patients,but the disseminated form of infection is rare among immunocompetent populations.The partial radiographic characteristics of pulmonary cryptococcosis mimic lung carcinoma,leading to unnecessary open chest exploratory surgery,and the lack of a gold-standard noninvasive diagnostic increases the risk of misdiagnosis.Positron emission tomography/computed tomography(PET/CT),a sensitive method for distinguishing malignant tumors,coupled with cryptococcal latex agglutination test showing a high positive rate may overcome these issues.CASE A 36-year-old man presented for general examination,without health complaints.Routine CT showed multiple pulmonary nodules and a mass with high maximum standardized uptake value.Initially,we suspected primary malignancy with hematogenous metastasis.Although his routine fungal analysis had been negative,subsequent CT-guided percutaneous core needle biopsy and histopathology examination indicated a diagnosis of pulmonary cryptococcosis.Fluconazole(200 mg/d)antifungal drug treatment was initiated,and 1 mo later the pulmonary mass had reduced in size markedly(on chest CT scan)without any complications.CONCLUSION Serologic and PET/CT examinations may not rule out cryptococcosis,and percutaneous lung puncture is critical under all circumstances.展开更多
BACKGROUND Almost 80 percent of adults in the United States have had cytomegalovirus(CMV)infection by age 40.The number of symptomatic CMV hepatitis cases has been increasing along with non-alcoholic fatty liver disea...BACKGROUND Almost 80 percent of adults in the United States have had cytomegalovirus(CMV)infection by age 40.The number of symptomatic CMV hepatitis cases has been increasing along with non-alcoholic fatty liver disease(NAFLD)cases in the United States that is estimated to be 25 percent of the population.In this paper,we try to link these two entities together.CASE SUMMARY In this case report,we describe a young female who presented with fever,nausea,and vomiting who was found to have NAFLD and CMV hepatitis that was treated supportively.CONCLUSION In this case report,we describe NAFLD as a risk factor for CMV hepatitis and discuss the possible impact on clinical practice.We believe,it is essential to consider NAFLD and it’s disease mechanisms’localized immu-nosuppression,as a risk factor of CMV hepatitis and severe coronavirus disease 2019 infection.展开更多
BACKGROUND Pneumocystis pneumonia(PCP)is a serious fungal infection usually seen in patients with human immunodeficiency virus,and it is more frequently found and has a high fatality rate in immunocompromised people.S...BACKGROUND Pneumocystis pneumonia(PCP)is a serious fungal infection usually seen in patients with human immunodeficiency virus,and it is more frequently found and has a high fatality rate in immunocompromised people.Surprisingly,it rarely occurs in immunocompetent patients.However,the clinical diagnosis of this pathogen is made more difficult by the difficulty of obtaining accurate microbiological evidence with routine tests.This case reports a PCP patient with normal immune function who was diagnosed through next-generation sequencing(NGS).CASE SUMMARY A 23-year-old female who had no special disease in the past was admitted to the hospital with a persistent fever and cough.Based on the initial examination results,the patient was diagnosed with bipulmonary pneumonia,and empirical broad-spectrum antibiotic therapy was administered.However,due to the undetermined etiology,the patient's condition continued to worsen.She was transferred to the intensive care unit because of acute respiratory failure.After the diagnosis of Pneumocystis jirovecii infection through NGS in bronchoalveolar lavage fluid and treatment with trimethoprim/sulfamethoxazole and caspofungin,the patient gradually recovered and had a good prognosis.CONCLUSION This case emphasizes that,for patients with normal immune function the possibility of PCP infection,although rare,cannot be ignored.NGS plays an important role in the diagnosis of refractory interstitial pneumonia and acute respiratory failure.展开更多
Cryptococcosis is rare in children. We report a case of cryptococcal meningitis in an infant whose mother works as a poultry farmer (chicken farm). The infant was received in the context of fever with convulsions. We ...Cryptococcosis is rare in children. We report a case of cryptococcal meningitis in an infant whose mother works as a poultry farmer (chicken farm). The infant was received in the context of fever with convulsions. We performed a lumbar puncture and started antibiotic treatment. Cerebrospinal fluid (CSF) analysis was performed including Indian ink staining. CSF results showed the presence of yeast and we replaced antibiotics with fluconazol-based treatment. After the loss of sight and the appearance of a motor deficit, a brain scan was performed showing cerebral edema. Several lumbar punctures were performed for 02 weeks until partial recovery of visual acuity and motor deficit. This case highlights the importance of taking into account the patient’s history when making the diagnosis. In our case, the working conditions and the employment of the mother guided the realization of the Indian ink coloring of the CSF. Treatment with fluconazol continued for 22 weeks with a completely regained visual acuity and gradual improvement in motor deficit despite limited resources.展开更多
Reports of combined candidal and herpetic esophagitis in immunocompetent states are rare and sporadic.A 44-year-old previously healthy lady presented with a one week history of progressive dysphagia,odynophagia and fe...Reports of combined candidal and herpetic esophagitis in immunocompetent states are rare and sporadic.A 44-year-old previously healthy lady presented with a one week history of progressive dysphagia,odynophagia and fever.Esophagogastroduodenoscopy(EGD) showed extensive desquamation of the entire esophagus except for distal 4 cm.Histopathological examination revealed ulcerated and inflamed squamous epithelium with the margin of ulcer showing a few overhanging squamous cells with dense eosinophilic cytoplasm,multinucleated and faceted nuclei with glassy chromatin,and an occasional Cowdry type A intranuclear inclusion bodies.Few candidal spores were seen in the underlying stroma.Intravenous acyclovir,fluconazole and pantoprazole were initiated.Oral analgesics were given for pain relief.She was treated for a total of 14 days.She showed significant improvement and was tolerating oral intake after discharge.The patient was asymptomatic with no evidence of recurrence at a 2-month follow-up.展开更多
Gastrointestinal involvement in cytomegalovirus (CMV) infection is well documented among immunocompromised patients and is also observed in immunocompetent individuals. The presentation of this infection can sometimes...Gastrointestinal involvement in cytomegalovirus (CMV) infection is well documented among immunocompromised patients and is also observed in immunocompetent individuals. The presentation of this infection can sometimes mimic those of other diseases, thus making accurate diagnosis difficult. We herein report a rare case of an immunocompetent elderly adult with gastrointestinal CMV infection that presented as a vanishing tumor at the cecum. A 76-year old man initially presented with lower abdominal pain. Colonoscopy revealed a tumorous lesion with irregular ulceration observed at the ileocecal valve. Histological findings of a biopsy specimen revealed intranuclear inclusions which were positive for CMV on immunohistochemical staining. However, this tumorous lesion disappeared within 7 wk from the initialhospital visit without any further treatment. Inflammatory pseudotumors associated with CMV infection should be considered as a differential diagnosis of tumorous lesions in the colon, even in immunocompetent adults.展开更多
Rationale:Cryptococcal infections commonly occur in immunosuppressed patients and are uncommon in immunocompetent persons.Patient concerns:A 32 year old lady,active smoker presented with right chest pain,dry cough and...Rationale:Cryptococcal infections commonly occur in immunosuppressed patients and are uncommon in immunocompetent persons.Patient concerns:A 32 year old lady,active smoker presented with right chest pain,dry cough and loss of weight.Initial chest radiograph showed a lobulated lung mass in the right lower lobe.She developed headache and right cranial nerve palsy during admission.Various investigations were done including lumbar puncture,brain and chest imaging.Diagnosis:Cryptococcal meningitis with pulmonary cryptococcoma.Interventions:She received five months of effective antifungal treatment;however,the patient did not respond well.Subsequently,removal of pulmonary cryptococcoma was done.Outcomes:Her condition improved and she no longer had any headache.Lessons:Disseminated cryptococcosis is rare in immunocompetent patient.Our case highlights the importance of high index of suspicion and we postulate that lobectomy helped in reducing the cryptococcal burden in her body,thus facilitating better response to antifungal therapy.展开更多
Gastric cancer(GC)is a major cause of cancer-related mortality worldwide.GC is determined by multiple(epi)genetic and environmental factors;can occur at distinct anatomic positions of the stomach;and displays high het...Gastric cancer(GC)is a major cause of cancer-related mortality worldwide.GC is determined by multiple(epi)genetic and environmental factors;can occur at distinct anatomic positions of the stomach;and displays high heterogeneity,with different cellular origins and diverse histological and molecular features.This heterogeneity has hindered efforts to fully understand the pathology of GC and develop efficient therapeutics.In the past decade,great progress has been made in the study of GC,particularly in molecular subtyping,investigation of the immune microenvironment,and defining the evolutionary path and dynamics.Preclinical mouse models,particularly immunocompetent models that mimic the cellular and molecular features of human GC,in combination with organoid culture and clinical studies,have provided powerful tools for elucidating the molecular and cellular mechanisms underlying GC pathology and immune evasion,and the development of novel therapeutic strategies.Herein,we first briefly introduce current progress and challenges in GC study and subsequently summarize immunocompetent GC mouse models,emphasizing the potential application of genetically engineered mouse models in antitumor immunity and immunotherapy studies.展开更多
Laryngeal Tuberculosis generally occurs in association with Pulmonary Tuberculosis and that too in an immunocompromised host,Here,We are presenting a case report of an immunocompetent host,initially thought of sufferi...Laryngeal Tuberculosis generally occurs in association with Pulmonary Tuberculosis and that too in an immunocompromised host,Here,We are presenting a case report of an immunocompetent host,initially thought of suffering from Pulmonary Tuberculosis but was finally diagnosed a case of Primary Laryngeal Tuberculosis on serial investigations with review of literature.展开更多
Objective:To investigate clinical features,ocular findings,management and follow-up data in a series of immunocompetent patients with active ocular toxoplasmosis.Methods:A prospective study of 25 immunocompetent patie...Objective:To investigate clinical features,ocular findings,management and follow-up data in a series of immunocompetent patients with active ocular toxoplasmosis.Methods:A prospective study of 25 immunocompetent patients with first attack of active ocular toxoplasmosis. Age,gender,clinical presentation and ophthalmic examination finding were recorded.The diagnosis was based on typical finding in ophthalmic examination.Systemic antimicrobials and corticosteroids were given to all patients.The treatment outcome and side-effects of drugs were observed.Results:Thirteen(52%) patients were male and 12(48%) were female.The mean±SD age at presentation was(26.8±11.1) years.Eye involvement was unilateral in 92% of patients and bilateral only in 8%.Lesions were located at the peripheral retina in 48%,at the macula retina in 28%,and at the macula and peripheral retina in 24%of the patients.The most common presenting symptom was blurred vision(96%),followed by eye pain(28%).All patients received antimicrobials treatment.Systemic corticosteroids were used in 48%of the patients. Clinical response were observed in 44%2 weeks before and in 56%2 weeks after.Vision was improved with treatment except in two cases.No recurrences occurred during one year follow up.Conclusions:Our study shows that active ocular toxoplasmosis has no gender predilection and affects young individuals.Unilateral involvement is more common in our study.Response to treatment is good in patients and no recurrences occur during one year follow-up.It may have implications in favor of treatment of active ocular toxoplasmosis.展开更多
文摘BACKGROUND Histoplasmosis is a rare infectious condition with mainly pulmonary involvement which is generally self-limiting in immunocompetent individuals.Its manifestation varies and lacks specificity.This study reports a case of primary disseminated liver histoplasmosis in a normal host presenting as liver failure cured by liver transplantation and voriconazole.CASE SUMMARY A 43-year-old Chinese man with intermittent fever,malaise,jaundice and extreme hepatomegaly for more than 40 days was admitted to the Second Xiang-ya Hospital.The patient was immunocompetent and lacked a definitive history of exposure.His condition deteriorated to liver failure,and he promptly underwent liver transplantation to ensure survival.One year later,the patient presented with severe gastrointestinal symptoms,including fever,abdominal pain,and diarrhea.Subsequently,tissue samples acquired via gastrointestinal endoscopy were subjected to pathological examination and next-generation sequencing analysis.Through a comprehensive amalgamation of clinical presentation,biopsy pathology,and next-generation sequencing analysis,the patient was ultimately diagnosed with disseminated hepatic histoplasmosis.The patient achieved complete recovery after 6 months of voriconazole treatment.CONCLUSION In patients with chronic-hepatitis-B having atypical symptoms,histoplasmosis can be a differential diagnosis.Voriconazole is effective in treating histoplasmosis.
基金supported by the CAMS Innovation Fund for Medical Sciences(CIFMS)(2020-I2M-C&T-B-014)CAMS Teaching Reform Research Fund(2018zlgc0101)CAMS Online Open Course Construction Fund(J2009022861)。
文摘BACKGROUND: The use of corticosteroids in septic shock has been studied for many decades but yielded conflicting results. We conducted a systematic review to evaluate the efficacy and the safety of corticosteroids in immunocompetent patients with septic shock.METHODS: Medline via Pub Med, Cochrane Central Register of Controlled Trials(CENTRAL) in the Cochrane Library, and EMBASE were searched from inception to March 2020. Two reviewers independently identified randomized controlled trials(RCTs) comparing corticosteroids with a control group for immunocompetent patients with septic shock. Data were abstracted and reported following the Cochrane Handbook for Systematic Review of Intervention and Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) statement. The efficacy outcome included mortality and shock reversal. The safety outcomes were infection, gastrointestinal bleeding, and hyperglycemia.RESULTS: Nine RCTs with a total of 1,298 patients were included. Compared with the control group, corticosteroid group did not lower the short-term(28 or 30 days) mortality(risk ratio [RR] 0.95, 95% confidence interval(CI) 0.85 to 1.06, inconsistency [I2]=0%, trial sequential analysis [TSA]-adjusted CI 0.83 to 1.09, moderate-certainty evidence). Corticosteroids significantly shortened the time to shock reversal compared with the control group(mean difference [MD] –21.56 hours;95% CI –32.95 to –10.16, I2=0%;TSA-adjusted CI –33.33 to –9.78, moderate-certainty evidence). The corticosteroid treatment was associated with an increased risk of hyperglycemia but not the infection or gastrointestinal bleeding.CONCLUSIONS: The corticosteroid treatment is not associated with lower short-or longterm mortality compared with placebo in immunocompetent patients with septic shock. However, corticosteroids significantly shorten the time to shock reversal without increasing the risk of infection. The patient's immune status should also be considered during clinical treatment and clinical trials in future.
文摘Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients.We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever,cough with scanty sputum,hemoptysis,left sided chest pain and exertional dyspnea for two weeks.There was no past history of tuberculosis,diabetes mellitus or steroid therapy.Chest X-ray showed homogenous peripherally based opacity in the left upper zone.Bronchoscopy was done and brushing sent for culture,which showed colonies with features of Nocardia species after 48 hours.Further phenotypic characterization revealed it to be Nocardia otitidiscaviarum.Patient was treated with cotrimaxazole for six months after which complete recovery was evidenced symptomatically and radiologically.We report this case to emphasize the fact that among the Nocardia species,Nocardia otitidiscaviarum as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals.
文摘Cytomegalovirus enteritis is most usually associated with patients positive for human immunodeficiency virus or immunosuppressed transplant patients. The gastrointestinal tract may be affected anywhere from the esophagus to the colon, but the small bowel involvement is rare. We report a case of cytomegalovirus ileitis in an immunocompetent adult, which was confirmed by histopathologic findings through colonoscopic biopsy.
基金Supported by Hunan Provincial Natural Science Foundation of China,No.2022JJ40247,No.2022JJ40256。
文摘BACKGROUND Pulmonary mucormycosis is a rare but life-threatening invasive fungal infection that mostly affects immunocompromised patients.This disease usually develops acutely and progresses rapidly,often leading to a poor clinical prognosis.Chronic pulmonary mucormycosis is highly unusual in immunocompetent patients.CASE SUMMARY A 43-year-old man,who was a house improvement worker with a long history of occupational dust exposure,presented with an irritating cough that had lasted for two months.The patient was previously in good health,without dysglycemia or any known immunodeficiencies.Chest computed tomography revealed a mass in the left lower lobe,measuring approximately 6 cm in diameter,which was suspected to be primary lung carcinoma complicated with obstructive pneumonia.Thoracoscopic-assisted left lower lobectomy was performed,and metagenomic next-generation sequencing detection,along with special pathological staining of surgical specimens,suggested Rhizopus microsporus infection.Postoperatively,the patient’s respiratory symptoms were relieved,and no signs of recurrence were found during the six-month follow-up.CONCLUSION This article reports a rare case of chronic pulmonary mucormycosis caused by Rhizopus microsporus in a middle-aged male without dysglycemia or immunodeficiency.The patient’s surgical outcome was excellent,reaffirming that surgery remains the cornerstone of pulmonary mucormycosis treatment.
文摘Burkholderia cepacia(6.cepacia)infection is rarely reported in an immunocompetent host.It is a well known occurence in patients with cystic fibrosis and chronic granulomatous disease where it increases both morbidity and mortality.It has also been included in the list of organisms causing nosocomial infections in an immunocompetent host,most of them transmitted from the immunocompromised patient in which this organism harbors.We report a rare case of isolation of B.cepacia from the bronchoalveolar lavage fluid of an immunocompetent agriculturist who presented with productive cough and fever associated with a pyopneumothorax.This is the first case of community acquired infection reported in an immunocompetent person in India.
基金supported by the Programa Nacional de Innovación para la Competitividad y Productividad(Innóvate Perú)under the contract 116-PNICP-PIAP-2015
文摘Cat scratch's disease caused by Bartonella henselae,is known to be a self-limited benign process in immunocompetent children.The association with neurologic manifestations is very uncommon especially in patient with no immunologic defects and in cases without specific treatment.A 7 years old male patient,without any immunocromised defect,presented an atypic presentation of the cat scratch disease.The patient came to the hospital in two opportunities in a status epilepticus,in both cases the diagnosis was encephalitis by Bartonella henselae and the evolution with treatment was monitored with PCR(polymerase chain reaction)in cerebrospinal fluid and blood,as well as IFI(IgM,IgG)serology(indirect immunofluorescence).The patient had a favorable clinical and laboratory evolution for 6 months showing no recurrence of the disease.
文摘Cytomegalovirus （CMV） colitis rarely occurs in immunocompetent patients. We report a case of disabling and life threatening diarrhea in an immunocompetent elderly woman due to CMV colitis. The diagnosis of CMV was based on histological examination of tissues biopsied at colonoscopy, positive CMV antigen and high CMV-lgM titer in peripheral blood samples and a good response to systemic gancyclovir treatment. We conclude that CMV should be considered in the differential diagnosis of colitis in elderly immunocompetent patients.
基金Supported by the 2019 Yeungnam University Research Grant
文摘BACKGROUND Cytomegalovirus(CMV) enterocolitis presenting in the form of pancolitis or involving the small and large intestines in an immunocompetent patient is rarely encountered, and CMV enterocolitis presenting with a serious complication, such as toxic megacolon, in an immunocompetent adult has only been reported on a few occasions.CASE SUMMARY We describe the case of a 70-year-old male with no history of inflammatory bowel disease or immunodeficiency who presented with toxic megacolon and subsequently developed massive hemorrhage as a complication of CMV ileopancolitis. The patient was referred to our institute for abdominal pain and distension. Abdominal X-ray showed marked dilatation of ileum and whole colon without air-fluid level, and sigmoidoscopy with biopsy failed to reveal any specific finding. After 7 d of conservative treatment, massive hematochezia developed, and he was diagnosed to have CMV enterocolitis by colonoscopy with biopsy. Although the diagnosis of CMV enterocolitis was delayed, the patient was treated successfully by repeat colonoscopic decompression and antiviral therapy with intravenous ganciclovir.CONCLUSION This report cautions that CMV-induced colitis should be considered as a possible differential diagnosis in a patient with intractable symptoms of enterocolitis or megacolon of unknown cause, even when the patient is nonimmunocompromised.
文摘BACKGROUND Pulmonary cryptococcosis is an opportunistic infection that mainly occurs among immunocompromised patients although it can sometimes occur in immunocompetent individuals.However,the imaging findings of pulmonary cryptococcosis in immunocompetent hosts differ from those in immunosuppressed patients.In addition,the most common imaging findings of isolated pulmonary cryptococcosis are single or multiple nodules.Cavities and the halo sign are,however,prevalent in immunosuppressed patients.In immunocompetent patients,lung consolidation,pleural effusion or cavities are scarce.CASE SUMMARY A 29-year-old Asian male was admitted to our hospital with complaints of cough and fever that had persisted for a month.As a chest computed tomography scan showed consolidation in his left lower lobe,he was initially diagnosed with pneumonia and received antibiotic treatment.A second review of the chest computed tomography image revealed multiple cavities and pleural effusion.Flexible fiberoptic bronchoscopy was subsequently performed,bronchoalveolar lavage fluid and serum cryptococcal antigen tests were positive.Cryptococcus capsules were observed in bronchoalveolar lavage fluid ink stain.Histopathological examination of a percutaneous lung biopsy from the left lower lobe further revealed granulomatous inflammation,and periodic acid-Schiff staining showed red-colored yeast walls,signifying pulmonary cryptococcosis.The patient was then treated with a daily dose of fluconazole(0.4 g),but the cough and fever still persisted.We therefore changed treatment to voriconazole(0.2 g,twice a day),and the patient’s clinical outcome was satisfactory.CONCLUSION Although rare,clinicians should not disregard the possibility of cavities and pleural effusion occurring in immunocompetent hosts without underlying diseases.
基金The Colleges and Universities in Anhui Province Natural Science Research Projects,No.KJ2018A0208.
文摘BACKGROUND Cryptococcus presenting as an opportunistic pathogen mainly affects immunocompromised patients,but the disseminated form of infection is rare among immunocompetent populations.The partial radiographic characteristics of pulmonary cryptococcosis mimic lung carcinoma,leading to unnecessary open chest exploratory surgery,and the lack of a gold-standard noninvasive diagnostic increases the risk of misdiagnosis.Positron emission tomography/computed tomography(PET/CT),a sensitive method for distinguishing malignant tumors,coupled with cryptococcal latex agglutination test showing a high positive rate may overcome these issues.CASE A 36-year-old man presented for general examination,without health complaints.Routine CT showed multiple pulmonary nodules and a mass with high maximum standardized uptake value.Initially,we suspected primary malignancy with hematogenous metastasis.Although his routine fungal analysis had been negative,subsequent CT-guided percutaneous core needle biopsy and histopathology examination indicated a diagnosis of pulmonary cryptococcosis.Fluconazole(200 mg/d)antifungal drug treatment was initiated,and 1 mo later the pulmonary mass had reduced in size markedly(on chest CT scan)without any complications.CONCLUSION Serologic and PET/CT examinations may not rule out cryptococcosis,and percutaneous lung puncture is critical under all circumstances.
文摘BACKGROUND Almost 80 percent of adults in the United States have had cytomegalovirus(CMV)infection by age 40.The number of symptomatic CMV hepatitis cases has been increasing along with non-alcoholic fatty liver disease(NAFLD)cases in the United States that is estimated to be 25 percent of the population.In this paper,we try to link these two entities together.CASE SUMMARY In this case report,we describe a young female who presented with fever,nausea,and vomiting who was found to have NAFLD and CMV hepatitis that was treated supportively.CONCLUSION In this case report,we describe NAFLD as a risk factor for CMV hepatitis and discuss the possible impact on clinical practice.We believe,it is essential to consider NAFLD and it’s disease mechanisms’localized immu-nosuppression,as a risk factor of CMV hepatitis and severe coronavirus disease 2019 infection.
基金Supported by the National Natural Science Foundation of China,No.81860273the Guizhou Provincial Science and Technology Projects,No.QKHJC-ZK[2022]-260+1 种基金the Science and Technology Fund of Guizhou Provincial Health Commission,No.gzwkj2021-320Guizhou Provincial People's Hospital National Natural Science Foundation,No.[2018]5764-09.
文摘BACKGROUND Pneumocystis pneumonia(PCP)is a serious fungal infection usually seen in patients with human immunodeficiency virus,and it is more frequently found and has a high fatality rate in immunocompromised people.Surprisingly,it rarely occurs in immunocompetent patients.However,the clinical diagnosis of this pathogen is made more difficult by the difficulty of obtaining accurate microbiological evidence with routine tests.This case reports a PCP patient with normal immune function who was diagnosed through next-generation sequencing(NGS).CASE SUMMARY A 23-year-old female who had no special disease in the past was admitted to the hospital with a persistent fever and cough.Based on the initial examination results,the patient was diagnosed with bipulmonary pneumonia,and empirical broad-spectrum antibiotic therapy was administered.However,due to the undetermined etiology,the patient's condition continued to worsen.She was transferred to the intensive care unit because of acute respiratory failure.After the diagnosis of Pneumocystis jirovecii infection through NGS in bronchoalveolar lavage fluid and treatment with trimethoprim/sulfamethoxazole and caspofungin,the patient gradually recovered and had a good prognosis.CONCLUSION This case emphasizes that,for patients with normal immune function the possibility of PCP infection,although rare,cannot be ignored.NGS plays an important role in the diagnosis of refractory interstitial pneumonia and acute respiratory failure.
文摘Cryptococcosis is rare in children. We report a case of cryptococcal meningitis in an infant whose mother works as a poultry farmer (chicken farm). The infant was received in the context of fever with convulsions. We performed a lumbar puncture and started antibiotic treatment. Cerebrospinal fluid (CSF) analysis was performed including Indian ink staining. CSF results showed the presence of yeast and we replaced antibiotics with fluconazol-based treatment. After the loss of sight and the appearance of a motor deficit, a brain scan was performed showing cerebral edema. Several lumbar punctures were performed for 02 weeks until partial recovery of visual acuity and motor deficit. This case highlights the importance of taking into account the patient’s history when making the diagnosis. In our case, the working conditions and the employment of the mother guided the realization of the Indian ink coloring of the CSF. Treatment with fluconazol continued for 22 weeks with a completely regained visual acuity and gradual improvement in motor deficit despite limited resources.
文摘Reports of combined candidal and herpetic esophagitis in immunocompetent states are rare and sporadic.A 44-year-old previously healthy lady presented with a one week history of progressive dysphagia,odynophagia and fever.Esophagogastroduodenoscopy(EGD) showed extensive desquamation of the entire esophagus except for distal 4 cm.Histopathological examination revealed ulcerated and inflamed squamous epithelium with the margin of ulcer showing a few overhanging squamous cells with dense eosinophilic cytoplasm,multinucleated and faceted nuclei with glassy chromatin,and an occasional Cowdry type A intranuclear inclusion bodies.Few candidal spores were seen in the underlying stroma.Intravenous acyclovir,fluconazole and pantoprazole were initiated.Oral analgesics were given for pain relief.She was treated for a total of 14 days.She showed significant improvement and was tolerating oral intake after discharge.The patient was asymptomatic with no evidence of recurrence at a 2-month follow-up.
文摘Gastrointestinal involvement in cytomegalovirus (CMV) infection is well documented among immunocompromised patients and is also observed in immunocompetent individuals. The presentation of this infection can sometimes mimic those of other diseases, thus making accurate diagnosis difficult. We herein report a rare case of an immunocompetent elderly adult with gastrointestinal CMV infection that presented as a vanishing tumor at the cecum. A 76-year old man initially presented with lower abdominal pain. Colonoscopy revealed a tumorous lesion with irregular ulceration observed at the ileocecal valve. Histological findings of a biopsy specimen revealed intranuclear inclusions which were positive for CMV on immunohistochemical staining. However, this tumorous lesion disappeared within 7 wk from the initialhospital visit without any further treatment. Inflammatory pseudotumors associated with CMV infection should be considered as a differential diagnosis of tumorous lesions in the colon, even in immunocompetent adults.
文摘Rationale:Cryptococcal infections commonly occur in immunosuppressed patients and are uncommon in immunocompetent persons.Patient concerns:A 32 year old lady,active smoker presented with right chest pain,dry cough and loss of weight.Initial chest radiograph showed a lobulated lung mass in the right lower lobe.She developed headache and right cranial nerve palsy during admission.Various investigations were done including lumbar puncture,brain and chest imaging.Diagnosis:Cryptococcal meningitis with pulmonary cryptococcoma.Interventions:She received five months of effective antifungal treatment;however,the patient did not respond well.Subsequently,removal of pulmonary cryptococcoma was done.Outcomes:Her condition improved and she no longer had any headache.Lessons:Disseminated cryptococcosis is rare in immunocompetent patient.Our case highlights the importance of high index of suspicion and we postulate that lobectomy helped in reducing the cryptococcal burden in her body,thus facilitating better response to antifungal therapy.
基金supported by the National Key R&D Program of China(Grant No.2020YFA0803200 and 2023YFC2505903)National Natural Science Foundation of China(Grant Nos.82003014,31930026,81972876,82150112,92168116,81725014,81822035,and 82222052)+1 种基金China Postdoctoral Science Foundation(Grant No.2020M671231)Fundamental Research Funds for the Central Universities(Grant No.22120240327)。
文摘Gastric cancer(GC)is a major cause of cancer-related mortality worldwide.GC is determined by multiple(epi)genetic and environmental factors;can occur at distinct anatomic positions of the stomach;and displays high heterogeneity,with different cellular origins and diverse histological and molecular features.This heterogeneity has hindered efforts to fully understand the pathology of GC and develop efficient therapeutics.In the past decade,great progress has been made in the study of GC,particularly in molecular subtyping,investigation of the immune microenvironment,and defining the evolutionary path and dynamics.Preclinical mouse models,particularly immunocompetent models that mimic the cellular and molecular features of human GC,in combination with organoid culture and clinical studies,have provided powerful tools for elucidating the molecular and cellular mechanisms underlying GC pathology and immune evasion,and the development of novel therapeutic strategies.Herein,we first briefly introduce current progress and challenges in GC study and subsequently summarize immunocompetent GC mouse models,emphasizing the potential application of genetically engineered mouse models in antitumor immunity and immunotherapy studies.
文摘Laryngeal Tuberculosis generally occurs in association with Pulmonary Tuberculosis and that too in an immunocompromised host,Here,We are presenting a case report of an immunocompetent host,initially thought of suffering from Pulmonary Tuberculosis but was finally diagnosed a case of Primary Laryngeal Tuberculosis on serial investigations with review of literature.
文摘Objective:To investigate clinical features,ocular findings,management and follow-up data in a series of immunocompetent patients with active ocular toxoplasmosis.Methods:A prospective study of 25 immunocompetent patients with first attack of active ocular toxoplasmosis. Age,gender,clinical presentation and ophthalmic examination finding were recorded.The diagnosis was based on typical finding in ophthalmic examination.Systemic antimicrobials and corticosteroids were given to all patients.The treatment outcome and side-effects of drugs were observed.Results:Thirteen(52%) patients were male and 12(48%) were female.The mean±SD age at presentation was(26.8±11.1) years.Eye involvement was unilateral in 92% of patients and bilateral only in 8%.Lesions were located at the peripheral retina in 48%,at the macula retina in 28%,and at the macula and peripheral retina in 24%of the patients.The most common presenting symptom was blurred vision(96%),followed by eye pain(28%).All patients received antimicrobials treatment.Systemic corticosteroids were used in 48%of the patients. Clinical response were observed in 44%2 weeks before and in 56%2 weeks after.Vision was improved with treatment except in two cases.No recurrences occurred during one year follow up.Conclusions:Our study shows that active ocular toxoplasmosis has no gender predilection and affects young individuals.Unilateral involvement is more common in our study.Response to treatment is good in patients and no recurrences occur during one year follow-up.It may have implications in favor of treatment of active ocular toxoplasmosis.
