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
目的对近年来中性粒细胞缺乏伴发热(FN)抗菌治疗相关文献进行计量与可视化分析,探讨该领域研究趋势与热点。方法检索Web of Science数据库,分析文献发表趋势、国家/地区、研究机构、期刊分布、作者影响力及关键词共现情况。利用VOSviewe...目的对近年来中性粒细胞缺乏伴发热(FN)抗菌治疗相关文献进行计量与可视化分析,探讨该领域研究趋势与热点。方法检索Web of Science数据库,分析文献发表趋势、国家/地区、研究机构、期刊分布、作者影响力及关键词共现情况。利用VOSviewer、Citespace和Scimago Graphica软件进行图谱分析,呈现FN抗菌治疗的研究热点与发展趋势。结果共纳入536篇文献,2014-2019年的年均发文量约为43篇,2020-2024年的年均发文量约为54篇,呈上升趋势。发文量最多的国家是美国(134篇,占25.00%);发文量最多的机构是墨尔本大学(18篇);发文量最多的作者是GUDIOL C(9篇)。关键词聚类分析显示,研究热点主要集中于“中性粒细胞缺乏伴发热”“抗菌药物管理”“免疫功能受损宿主”“风险评估”“成本效益分析”“经验性治疗”“金黄色葡萄球菌”方面。结论抗菌药物治疗FN相关研究的发文量近年来呈上升趋势,抗菌药物管理、免疫功能受损宿主治疗、耐药性控制及个性化治疗可能成为未来主要研究方向。展开更多
BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdia...BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.展开更多
BACKGROUND Aseptic meningitis is defined as meningeal inflammation caused by various etio-logies with negative cerebrospinal fluid(CSF)bacterial culture.The most common etiologies are viruses[enteroviruses,arboviruses...BACKGROUND Aseptic meningitis is defined as meningeal inflammation caused by various etio-logies with negative cerebrospinal fluid(CSF)bacterial culture.The most common etiologies are viruses[enteroviruses,arboviruses,and herpes simplex virus type 2(HSV-2)].Aseptic meningitis can have various presentations,including sensori-neural deafness.While sensorineural deafness from mumps meningoencephalitis has been reported,cases of HSV-2-induced hearing loss are rare.Herein,we re-port a case of HSV-2-induced meningitis that presented with sudden deafness.CASE SUMMARY A 68-year-old man experienced a profound sudden onset of left-sided hearing loss for one day.Pure-tone audiograms demonstrated sudden left-sided sensorineural hearing loss(thresholds 80-90 dB).After treatment with high-dose steroids for 1 week,he experienced an acute consciousness change with left hemiparesis.The laboratory data showed no significant abnormalities.Brain computed tomography without contrast and magnetic resonance imaging revealed no intracranial hemo-rrhage or obvious brain lesion.The CSF analysis and the Multiplex PCR panels showed HSV-2 positivity.Hence,under the diagnosis of herpes meningoenceph-alitis,acyclovir was prescribed and his symptoms gradually resolved.CONCLUSION This case report further demonstrates that a viral infection could be a cause of sudden sensorineural hearing loss.展开更多
BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfu...BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.展开更多
Purpureocillium lilacinum(formerly Paecilomyces lilacinus)is a hyaline hyphomycete with a ubiquitous distribution.In the last decade this fungus has been increasingly found as the causal agent of infections in humans ...Purpureocillium lilacinum(formerly Paecilomyces lilacinus)is a hyaline hyphomycete with a ubiquitous distribution.In the last decade this fungus has been increasingly found as the causal agent of infections in humans and other vertebrates.It is an emerging opportunistic pathogen and is increasingly reported,and can cause a wide spectrum of clinical manifestations,especially among immunocompromised patients or following surgical procedures.The pathogenic mechanisms are not yet fully understood.Ocular and cutaneous/subcutaneous infections are the most familiar clinical presentations,and these can also cause disseminated infections.Early and accurate species identification and suscept-ibility testing are vital.In general,surgical debridement combined with antifungal drug therapy,or the correction of predisposing factors,are usually required to obtain improvement.Infections present a therapeutic challenge,as they have intrinsic resistance to many antifungal agents,but voriconazole and posaconazole are good in vitro activity.The overall mortality was 22%and death was attributed to the infection in 46%of cases.Accurate diagnoses can be achieved through newer molecular biological techniques,and these can lead to appropriate management of infections due to this organism.Future studies should ideally aim to elucidate pathogenesis and determine more effective diagnoses and effective antifungal treatment.展开更多
BACKGROUND Cytomegalovirus(CMV)is a ubiquitous herpesvirus that can cause significant ocular morbidity,particularly in immunocompromised individuals.AIM To summarize the current understanding of the ophthalmic impact ...BACKGROUND Cytomegalovirus(CMV)is a ubiquitous herpesvirus that can cause significant ocular morbidity,particularly in immunocompromised individuals.AIM To summarize the current understanding of the ophthalmic impact of CMV,with a focus on its epidemiology,clinical manifestations,diagnosis,and management,ocular symptoms of CMV floaters,blurred vision,and loss of peripheral vision,eventually progressing to retinal necrosis and detachment.CMV retinitis(CMVR)is a sight-threatening condition that can lead to retinal detachment,blindness,and even death.METHODS We discuss the pathophysiology of CMVR,including the role of immune suppression and viral reactivation.We also examine the clinical features of CMVR,including its characteristic retinal lesions and associated ocular complications.Diagnostic approaches are reviewed,including polymerase chain reaction and fundus photography.RESULTS We discuss treatment options,including antiviral medications,intravitreal injections,and surgical interventions.Finally,we highlight areas of ongoing research and future directions in managing CMV-related ocular disease.CONCLUSION CMV poses a significant threat to ocular health,particularly in immunocompromised populations such as those with human immunodeficiency virus/acquired immune deficiency syndrome.展开更多
Dear Editor,The COVID-19 pandemic,caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has resulted in millions of deaths worldwide.It poses significant challenges in the management of immunocompr...Dear Editor,The COVID-19 pandemic,caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has resulted in millions of deaths worldwide.It poses significant challenges in the management of immunocompromised patients,particularly people with HIV(PWH).Whether PWH are more vulnerable to COVID with more adverse outcomes has been extensively studied,but the findings are inconsistent.Many cohort studies and meta-analyses support that PWH have a higher risk of SARSCoV-2 infection and more severe COVID-19 outcomes(Bertagnolio et al.,2022;Ssentongo et al.,2021).展开更多
Objective:To explore the epidemiological trends and clinical presentations of brucellosis in patients diagnosed with different types of cancer.Methods:A systematic review was performed utilizing PubMed,Embase,Scopus,W...Objective:To explore the epidemiological trends and clinical presentations of brucellosis in patients diagnosed with different types of cancer.Methods:A systematic review was performed utilizing PubMed,Embase,Scopus,Web of Science,and Google Scholar following PRISMA guidelines until September 2022.An update in December 2023 was conducted to ensure thorough coverage of the literature.Results:A total of 28 articles met the eligibility criteria,reporting 38 cases of brucellosis in patients with cancer.Among these cases,hematological cancers were the most common,comprising 66%of the cases,and B.melitensis was identified as the predominant species.The primary clinical manifestations of brucellosis infection included constitutional symptoms in a notable 60.5%of cases and febrile neutropenia in 21%.Additionally,six cases(15.8%)experienced relapse or recurrence of brucellosis,all of which were managed using a combination therapy of rifampin and doxycycline.While 28 patients successfully achieved remission from both brucellosis and their underlying neoplastic conditions,unfortunately,nine cases resulted in mortality attributed to septic shock,progressive liver failure,and massive embolism;no deaths directly related to brucellosis were reported.Among the non-surviving cases,hematologic malignancies were the most prevalent neoplastic conditions(77.7%).Conclusions:Brucellosis-cancer co-occurrence is rare but is not related to increasing mortality.The risk of relapse is higher in cancer patients,especially with hematologic malignancies.Screening,monitoring,and judicious antibiotic use can mitigate brucellosis risks in neoplastic patients.展开更多
This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and...This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and therapeutic complexities in the context of advanced age,comorbidities,and immunocompromised populations.The study’s strengths included its integration of immunological profiling and precision medicine,demonstrating that a tailored low-dose trimethoprimsulfamethoxazole regimen with pharmacokinetic monitoring can improve outcomes in geriatric patients with chronic renal insufficiency while mitigating nephrotoxicity risks.However,its limitations included a single-case design,reliance on phenotypic diagnostics,and the lack of information regarding comorbidity interactions.The findings support the use of advanced molecular tools for rapid pathogen identification and identification of co-infection.Future studies should prioritize elucidating the synergistic effects of chronic kidney disease-uremia and immunosuppression on Nocardia colonization,developing biomarkers for early detection,and conducting global epidemiological studies in endemic regions.This case underscores the importance of interdisciplinary collaboration and innovative diagnostics to optimize management of nocardiosis in vulnerable populations.展开更多
基金supported by National Natural Science Foundation of China(72274067)。
文摘BACKGROUND:Prompt pathogen identification can have a substantial impact on the optimization of antimicrobial treatment.The objective of the study was to assess the diagnostic value of next-generation sequencing(NGS)for identifying pathogen and its clinical impact on antimicrobial intervention in immunocompromised patients with suspected infections.METHODS:This was a retrospective study.Between January and August 2020,47 adult immunocompromised patients underwent NGS testing under the following clinical conditions:1)prolonged fever and negative conventional cultures;2)new-onset fever despite empiric antimicrobial treatment;and 3)afebrile with suspected infections on imaging.Clinical data,including conventional microbial test results and antimicrobial treatment before and after NGS,were collected.Data were analyzed according to documented changes in antimicrobial treatment(escalated,no change,or deescalated)after the NGS results.RESULTS:The median time from hospitalization to NGS sampling was 19 d.Clinically relevant pathogens were detected via NGS in 61.7% of patients(29/47),more than half of whom suffered from fungemia(n=17),resulting in an antimicrobial escalation in 53.2% of patients(25/47)and antimicrobial de-escalation in 0.2% of patients(1/47).Antimicrobial changes were mostly due to the identification of fastidious organisms such as Legionella,Pneumocystis jirovecii,and Candida.In the remaining three cases,NGS detected clinically relevant pathogens also detected by conventional cultures a few days later.The antimicrobial treatment was subsequently adjusted according to the susceptibility test results.Overall,NGS changed antimicrobial management in 55.3%(26/47)of patients,and conventional culture detected clinically relevant pathogens in 14.9% of the patients(7/47).CONCLUSION:With its rapid identification and high sensitivity,NGS could be a promising tool for identifying relevant pathogens and enabling rapid appropriate treatment in immunocompromised patients with suspected infections.
文摘Escherichia coli is the commonest bacterial uropathogen of UTIs, the commonest infections in immunocompromised diabetic patients. Better understanding of their main resistance mechanisms to commonly used antibacterial agents will help to reduce the burden of this infection. The prevalence of drug resistant uropathogenic Escherichia coli isolates from immunocompromised diabetic patients attending selected health facilities in Benue State was investigated. Two hundred and ninety-six midstream urine samples were collected for both study and control diabetic patients. Bacterial isolation was done using semi-quantitative method. Drug resistant Escherichia coli were identified as multidrug resistant (MDR), extensive drug resistant (XDR) and pan-drug resistant organisms (PDR). Statistical significance was considered at p E. coli isolates from the study and control subjects with overall prevalence of 20.9% and 8.4% respectively. The isolates were highly resistant to penicillin (ampicillin), monobactam (aztreonam), older quinolone (nalidixic acid) whereas the majority of them showed high susceptibility to aminoglycoside (streptomycin), cephalosporin (cefotaxime) and carbapenem (imipenem). None showed complete susceptibility to all the tested antibiotics. Twenty-five E. coli were identified in this MDR, eight, XDR while 5 were PDR. High numbers of drug resistant E. coli isolates were identified in the study group of which 25 were MDR, 8 XDR while 5 were PDR isolates. High prevalence of UTI and drug resistant isolates occur in diabetic patients with hyperglycemic condition.
文摘目的对近年来中性粒细胞缺乏伴发热(FN)抗菌治疗相关文献进行计量与可视化分析,探讨该领域研究趋势与热点。方法检索Web of Science数据库,分析文献发表趋势、国家/地区、研究机构、期刊分布、作者影响力及关键词共现情况。利用VOSviewer、Citespace和Scimago Graphica软件进行图谱分析,呈现FN抗菌治疗的研究热点与发展趋势。结果共纳入536篇文献,2014-2019年的年均发文量约为43篇,2020-2024年的年均发文量约为54篇,呈上升趋势。发文量最多的国家是美国(134篇,占25.00%);发文量最多的机构是墨尔本大学(18篇);发文量最多的作者是GUDIOL C(9篇)。关键词聚类分析显示,研究热点主要集中于“中性粒细胞缺乏伴发热”“抗菌药物管理”“免疫功能受损宿主”“风险评估”“成本效益分析”“经验性治疗”“金黄色葡萄球菌”方面。结论抗菌药物治疗FN相关研究的发文量近年来呈上升趋势,抗菌药物管理、免疫功能受损宿主治疗、耐药性控制及个性化治疗可能成为未来主要研究方向。
基金Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Program,No.2023ZF075.
文摘BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.
文摘BACKGROUND Aseptic meningitis is defined as meningeal inflammation caused by various etio-logies with negative cerebrospinal fluid(CSF)bacterial culture.The most common etiologies are viruses[enteroviruses,arboviruses,and herpes simplex virus type 2(HSV-2)].Aseptic meningitis can have various presentations,including sensori-neural deafness.While sensorineural deafness from mumps meningoencephalitis has been reported,cases of HSV-2-induced hearing loss are rare.Herein,we re-port a case of HSV-2-induced meningitis that presented with sudden deafness.CASE SUMMARY A 68-year-old man experienced a profound sudden onset of left-sided hearing loss for one day.Pure-tone audiograms demonstrated sudden left-sided sensorineural hearing loss(thresholds 80-90 dB).After treatment with high-dose steroids for 1 week,he experienced an acute consciousness change with left hemiparesis.The laboratory data showed no significant abnormalities.Brain computed tomography without contrast and magnetic resonance imaging revealed no intracranial hemo-rrhage or obvious brain lesion.The CSF analysis and the Multiplex PCR panels showed HSV-2 positivity.Hence,under the diagnosis of herpes meningoenceph-alitis,acyclovir was prescribed and his symptoms gradually resolved.CONCLUSION This case report further demonstrates that a viral infection could be a cause of sudden sensorineural hearing loss.
文摘BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.
基金Supported by The Japan Society for the Promotion of Science KAKENHI Grant,No.24K15491.
文摘Purpureocillium lilacinum(formerly Paecilomyces lilacinus)is a hyaline hyphomycete with a ubiquitous distribution.In the last decade this fungus has been increasingly found as the causal agent of infections in humans and other vertebrates.It is an emerging opportunistic pathogen and is increasingly reported,and can cause a wide spectrum of clinical manifestations,especially among immunocompromised patients or following surgical procedures.The pathogenic mechanisms are not yet fully understood.Ocular and cutaneous/subcutaneous infections are the most familiar clinical presentations,and these can also cause disseminated infections.Early and accurate species identification and suscept-ibility testing are vital.In general,surgical debridement combined with antifungal drug therapy,or the correction of predisposing factors,are usually required to obtain improvement.Infections present a therapeutic challenge,as they have intrinsic resistance to many antifungal agents,but voriconazole and posaconazole are good in vitro activity.The overall mortality was 22%and death was attributed to the infection in 46%of cases.Accurate diagnoses can be achieved through newer molecular biological techniques,and these can lead to appropriate management of infections due to this organism.Future studies should ideally aim to elucidate pathogenesis and determine more effective diagnoses and effective antifungal treatment.
文摘BACKGROUND Cytomegalovirus(CMV)is a ubiquitous herpesvirus that can cause significant ocular morbidity,particularly in immunocompromised individuals.AIM To summarize the current understanding of the ophthalmic impact of CMV,with a focus on its epidemiology,clinical manifestations,diagnosis,and management,ocular symptoms of CMV floaters,blurred vision,and loss of peripheral vision,eventually progressing to retinal necrosis and detachment.CMV retinitis(CMVR)is a sight-threatening condition that can lead to retinal detachment,blindness,and even death.METHODS We discuss the pathophysiology of CMVR,including the role of immune suppression and viral reactivation.We also examine the clinical features of CMVR,including its characteristic retinal lesions and associated ocular complications.Diagnostic approaches are reviewed,including polymerase chain reaction and fundus photography.RESULTS We discuss treatment options,including antiviral medications,intravitreal injections,and surgical interventions.Finally,we highlight areas of ongoing research and future directions in managing CMV-related ocular disease.CONCLUSION CMV poses a significant threat to ocular health,particularly in immunocompromised populations such as those with human immunodeficiency virus/acquired immune deficiency syndrome.
基金National Key Research and Development Project of China(2023YFC2306600)Key Program of the National Natural Science Foundation of China(82430070)+6 种基金Shanghai Pujiang Program(No.23PJ1410800)National Natural Science Foundation of China(82072260,32370168)Eastern Talent Plan Leading Project,Shanghai Hospital Development Center Foundation(SHDC12022121)Shanghai 2020“Science and Technology Innovation Action Plan”Medical Innovation Research Special(20Z11900900)Three-year Action Plan(2023-2025)Key Discipline Program on Public Health System Construction of Shanghai(GWVI-11.1-15)Construction of the Major Infectious Disease Medical Treatment System(GWVI-2.2).
文摘Dear Editor,The COVID-19 pandemic,caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has resulted in millions of deaths worldwide.It poses significant challenges in the management of immunocompromised patients,particularly people with HIV(PWH).Whether PWH are more vulnerable to COVID with more adverse outcomes has been extensively studied,but the findings are inconsistent.Many cohort studies and meta-analyses support that PWH have a higher risk of SARSCoV-2 infection and more severe COVID-19 outcomes(Bertagnolio et al.,2022;Ssentongo et al.,2021).
文摘Objective:To explore the epidemiological trends and clinical presentations of brucellosis in patients diagnosed with different types of cancer.Methods:A systematic review was performed utilizing PubMed,Embase,Scopus,Web of Science,and Google Scholar following PRISMA guidelines until September 2022.An update in December 2023 was conducted to ensure thorough coverage of the literature.Results:A total of 28 articles met the eligibility criteria,reporting 38 cases of brucellosis in patients with cancer.Among these cases,hematological cancers were the most common,comprising 66%of the cases,and B.melitensis was identified as the predominant species.The primary clinical manifestations of brucellosis infection included constitutional symptoms in a notable 60.5%of cases and febrile neutropenia in 21%.Additionally,six cases(15.8%)experienced relapse or recurrence of brucellosis,all of which were managed using a combination therapy of rifampin and doxycycline.While 28 patients successfully achieved remission from both brucellosis and their underlying neoplastic conditions,unfortunately,nine cases resulted in mortality attributed to septic shock,progressive liver failure,and massive embolism;no deaths directly related to brucellosis were reported.Among the non-surviving cases,hematologic malignancies were the most prevalent neoplastic conditions(77.7%).Conclusions:Brucellosis-cancer co-occurrence is rare but is not related to increasing mortality.The risk of relapse is higher in cancer patients,especially with hematologic malignancies.Screening,monitoring,and judicious antibiotic use can mitigate brucellosis risks in neoplastic patients.
文摘This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and therapeutic complexities in the context of advanced age,comorbidities,and immunocompromised populations.The study’s strengths included its integration of immunological profiling and precision medicine,demonstrating that a tailored low-dose trimethoprimsulfamethoxazole regimen with pharmacokinetic monitoring can improve outcomes in geriatric patients with chronic renal insufficiency while mitigating nephrotoxicity risks.However,its limitations included a single-case design,reliance on phenotypic diagnostics,and the lack of information regarding comorbidity interactions.The findings support the use of advanced molecular tools for rapid pathogen identification and identification of co-infection.Future studies should prioritize elucidating the synergistic effects of chronic kidney disease-uremia and immunosuppression on Nocardia colonization,developing biomarkers for early detection,and conducting global epidemiological studies in endemic regions.This case underscores the importance of interdisciplinary collaboration and innovative diagnostics to optimize management of nocardiosis in vulnerable populations.
