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
Exophiala is a genus comprising several species of opportunistic black yeasts,which belongs to Ascomycotina.It is a rare cause of fungal infections.However,infections are often chronic and recalcitrant,and while the n...Exophiala is a genus comprising several species of opportunistic black yeasts,which belongs to Ascomycotina.It is a rare cause of fungal infections.However,infections are often chronic and recalcitrant,and while the number of cases is steadily increasing in both immunocompromised and immunocompetent people,detailed knowledge remains scarce regarding infection mechanisms,virulence factors,specific predisposing factors,risk factors,and host response.The most common manifestations of Exophiala infection are skin infections,and the most frequent type of deep infection is pulmonary infection due to inhalation.The invasive disease ranges from cutaneous or subcutaneous infection to systemic dissemination to internal organs.The final identification of the causative organism should be achieved through a combination of several methods,including the newly introduced diagnostic analysis,matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry,together with sequencing of the ribosomal ribonucleic acid internal transcribed spacer region of the fungi,and histological and culture findings.Regarding treatment,because anti-infective agents and natural compounds exhibited poor antibiofilm activity,few treatments have ultimately been found to be effective for specific antifungal therapy,so the optimal antifungal therapy and duration of therapy for these infections remain unknown.Therefore,most forms of disease caused by Exophiala dermatitidis require aggressive combination therapies:Both surgical intervention and aggressive antifungal therapy with novel compounds and azoles are necessary for effective treatment.展开更多
Background:Varicella-zoster virus infection is associated with significant morbidity and mortality in immune-compromised children,despite treatment with antiviral agents.Universal varicella vaccine programs have signi...Background:Varicella-zoster virus infection is associated with significant morbidity and mortality in immune-compromised children,despite treatment with antiviral agents.Universal varicella vaccine programs have significantly decreased this risk in many highincome countries,but in most low-income and middleincome countries,the burden of varicella in children treated for malignancy is poorly defi ned.Methods:We retrospectively reviewed records of children at the National Unit of Pediatric Oncology(UNOP)in Guatemala diagnosed with varicella between January 2009 and March 2013 in order to calculate incidence of varicella and evaluate morbidity,mortality,treatment interruption,and cost.Results:Fifty-nine cases of varicella were identified.Incidence was 23.4 cases per 1000 person-years(p-y).66.1%of cases occurred in children with leukemia(median age 5.2 years;interquantile range 3.4-7 years)and 41.0%of these occurred during maintenance therapy.Source of exposure was identified for 14/59(23.7%)children.Most were hospitalized(71.2%)and given intravenous acyclovir(64.4%).Eight(13.6%)children required critical care,and two(3.4%)died from disseminated varicella with multiorgan failure.Chemotherapy was delayed or omitted due to varicella in 50%.No signifi cant differences in outcomes based on nutritional and immunologic status were detected.The minimum average cost of treatment per episode was 598.75 USD.Conclusions:Varicella is a significant problem in children treated for cancer in Guatemala,where effective post-exposure prophylaxis is limited.In the absence of universal varicella vaccination,strategies to improve recognition of exposure and the future use of novel inactivated vaccines currently under investigation in clinical trials could mitigate this burden.展开更多
文摘Infections caused by Strongyloides stercoralis(S.stercoralis) in human are generally asymptomatic,however in immunocompromised individual,hyperinfection may develop with dissemination of larvae to extra-intestinal organs.The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself,which may lead to low index of suspicion as a consequence.In this report,a case of a Malaysian male with underlying diabetes mellitus,hypertension,cerebrovascular accident,bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented.However,he developed septicemic shock later,and S.stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli.Regardless of aggressive resuscitation,the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome.It was revealed that the current case has alarmed us via incidental finding of S.stercoralis larvae in the tracheal aspirate,indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.
文摘Exophiala is a genus comprising several species of opportunistic black yeasts,which belongs to Ascomycotina.It is a rare cause of fungal infections.However,infections are often chronic and recalcitrant,and while the number of cases is steadily increasing in both immunocompromised and immunocompetent people,detailed knowledge remains scarce regarding infection mechanisms,virulence factors,specific predisposing factors,risk factors,and host response.The most common manifestations of Exophiala infection are skin infections,and the most frequent type of deep infection is pulmonary infection due to inhalation.The invasive disease ranges from cutaneous or subcutaneous infection to systemic dissemination to internal organs.The final identification of the causative organism should be achieved through a combination of several methods,including the newly introduced diagnostic analysis,matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry,together with sequencing of the ribosomal ribonucleic acid internal transcribed spacer region of the fungi,and histological and culture findings.Regarding treatment,because anti-infective agents and natural compounds exhibited poor antibiofilm activity,few treatments have ultimately been found to be effective for specific antifungal therapy,so the optimal antifungal therapy and duration of therapy for these infections remain unknown.Therefore,most forms of disease caused by Exophiala dermatitidis require aggressive combination therapies:Both surgical intervention and aggressive antifungal therapy with novel compounds and azoles are necessary for effective treatment.
文摘Background:Varicella-zoster virus infection is associated with significant morbidity and mortality in immune-compromised children,despite treatment with antiviral agents.Universal varicella vaccine programs have significantly decreased this risk in many highincome countries,but in most low-income and middleincome countries,the burden of varicella in children treated for malignancy is poorly defi ned.Methods:We retrospectively reviewed records of children at the National Unit of Pediatric Oncology(UNOP)in Guatemala diagnosed with varicella between January 2009 and March 2013 in order to calculate incidence of varicella and evaluate morbidity,mortality,treatment interruption,and cost.Results:Fifty-nine cases of varicella were identified.Incidence was 23.4 cases per 1000 person-years(p-y).66.1%of cases occurred in children with leukemia(median age 5.2 years;interquantile range 3.4-7 years)and 41.0%of these occurred during maintenance therapy.Source of exposure was identified for 14/59(23.7%)children.Most were hospitalized(71.2%)and given intravenous acyclovir(64.4%).Eight(13.6%)children required critical care,and two(3.4%)died from disseminated varicella with multiorgan failure.Chemotherapy was delayed or omitted due to varicella in 50%.No signifi cant differences in outcomes based on nutritional and immunologic status were detected.The minimum average cost of treatment per episode was 598.75 USD.Conclusions:Varicella is a significant problem in children treated for cancer in Guatemala,where effective post-exposure prophylaxis is limited.In the absence of universal varicella vaccination,strategies to improve recognition of exposure and the future use of novel inactivated vaccines currently under investigation in clinical trials could mitigate this burden.
