BACKGROUND Acyclovir(ACV)-resistant herpes simplex virus(HSV)strains have emerged and gradually increased in number.Prolonged treatment,such as for immunocompromised patients,has been observed on many occasions to lea...BACKGROUND Acyclovir(ACV)-resistant herpes simplex virus(HSV)strains have emerged and gradually increased in number.Prolonged treatment,such as for immunocompromised patients,has been observed on many occasions to lead to the development of resistance.Additionally,some strains of HSV exist that are ACV resistant,and they can cause severe complications that may be impossible to treat with current therapies.We report the first case of ACV-resistant herpes encephalitis(ARHE)recurring in an immunocompromised adult patient without neurosurgical intervention.CASE SUMMARY A 58-year-old man with a fever of 38°C had tremors.Evaluation revealed 14 points on the Glasgow Coma Scale with 39°C fever but unremarkable physical examination.Diagnosis was infection of unknown origin;fever continued,and the Glasgow Coma Scale worsened to 8.Imaging showing a high-intensity area between the left temporal lobe and insular cortex suggested herpes encephalitis.ACV was started.Cerebrospinal fluid(CSF)was positive for HSV DNA,confirming the diagnosis.However,unresolved symptoms suggested ARHE;therefore,we initiated vidarabine treatment.Later testing confirmed ARHE.Foscarnet was started based on a hospital day 25 blood test revealing pancytopenia,possibly from vidarabine.Consciousness improved,and the patient moved to rehabilitation.However,symptoms worsened,suggesting recurrence.Diffusion-weighted magnetic resonance imaging revealed a high high-intensity area around the right temporal lobe;CSF was positive for HSV DNA,confirming recurrent herpes encephalitis.ACV and foscarnet were initiated.Fever decreased,consciousness improved,and HSV DNA on hospital days 78 and 93 was CSF negative.Treatment was terminated on hospital day 86.CONCLUSION ARHE recurred in the patient following remission;therefore,it is necessary to discuss the length of the treatment period.展开更多
BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patie...BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patients with certain risk factors,including immunocompromised status.We recently diagnosed a case of spontaneous bacterial peritonitis(SBP)due to E.tarda in an immuno-compromised dialysis patient.CASE SUMMARY Patient was a 55-year-old male,with a history of diabetic nephropathy being treated with hemodialysis three times a week.He was referred to our hospital due to an increased volume of ascites,and blood examination revealed increased inflammatory reaction.At our emergency department,he developed fever,disturbance of consciousness,abdominal distension,and abdomen-wide pain.In addition,a dialysis shunt was confirmed in his right forearm,and the shunt site showed no signs of inflammation.No wounds were confirmed on or in his body.A blood examination revealed increased values of white blood cells,C-reactive protein,and creatinine.Plain chest and abdominal computed tomography scanning revealed increased ascites volume.Abdominal paracentesis was performed and a Gram stain revealed Gramnegative bacillus.These findings prompted diagnosis of SBP.The patient was admitted and treated with cefmetazole,causing fever resolution and symptom improvements.Later,E.tarda was identified in ascites culture.The patient improved with decreased inflammatory response and was discharged on the 12th day of hospitalization.The antibiotic was terminated after 14 days of treatment.SBP in this case may have developed from chronic renal failure and diabetes mellitus.CONCLUSION We report the first known case of SBP due to E.tarda in an immuno-compromised dialysis patient.展开更多
We report the remission of primary gastric lymphoma of the mucosa-associated lymphoid tissue （MALT） type in two immunocompromised pediatric patients. Patient 1, a 14-year-old boy in an immunocompromised state of unk...We report the remission of primary gastric lymphoma of the mucosa-associated lymphoid tissue （MALT） type in two immunocompromised pediatric patients. Patient 1, a 14-year-old boy in an immunocompromised state of unknown cause, complained of repeated abdominal pain. Examinations revealed gastric MALT with local invasion and lymph node involvement. Serum anti-Helicobacter pylori （H pylon） antibody was positive. H pylori eradication was abandoned due to its adverse effects. The MALT lesion spontaneously regressed over the next 24 months without any treatment for lymphoma. Patient 2, a 6-year-old boy, underwent cord blood transplantation for the treatment of adrenoleukodystrophy. He was administered immunosuppressants for graft-versus-host disease after transplantation. Nausea and hematochezia appeared and further examinations revealed gastric MALT with H pylori gastritis. Treatment consisting of medication for the Hpylori infection alone eradicated the Hpylori and completely resolved the patient＇s MALT lesion, as well. Patients i and 2 were followed up over periods of 10 years and 3 years, respectively, without any signs of relapse. In conclusion, gastric lymphoma of the MALT type can be cured by conservative treatment even in immunocompromised pediatric patients.展开更多
Parasites can increase infection rates and pathogenicity in immunocompromised human immunodeficiency virus （HIV） patients. However, in vitro studies and epidemiological investigations also suggest that parasites mig...Parasites can increase infection rates and pathogenicity in immunocompromised human immunodeficiency virus （HIV） patients. However, in vitro studies and epidemiological investigations also suggest that parasites might escape immunocompromised hosts during HIV infection Due to the lack of direct evidence from animal experiments, the effects of immunocompromised hosts parasitic infections on remain unclear. Here we detected 14 different parasites in six northern pig-tailed macaques （NPMs） before or at the 50th week of simian immunodeficiency virus （SIV） infection by ELISA. The NPMs all carried parasites before viral injection. At the 50th week after viral injection, the individuals with negative results in parasitic detection （i.e., 08247 and 08287） were characterized as the Parasites Exit （PE） group, with the other individuals （i.e., 09203, 09211, 10205, and 10225） characterized as the Parasites Remain （PR） group. Compared with the PR group, the NPMs in the PE group showed higher viral loads, lower CD4＋ T cells counts, and lower CD4/CD8 rates. Additionally, the PE group had higher immune activation and immune exhaustion of both CD4~ and CD8~ T cells. Pathological observation showed greater injury to the liver, cecum, colon, spleen, and mesenteric lymph nodes in the PE group This study showed more seriously compromised immunity in the PE group, strongly indicating that parasites might exit an immunocompromised host.展开更多
Hepatitis E virus(HEV)originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States.While ther...Hepatitis E virus(HEV)originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States.While there are eight identified genotypes to date,genotype 1(HEV1),HEV2,HEV3,HEV4 are the most common to infect humans.HEV1 and HEV2 are most common in developing countries including Latina America,Africa and Asia,and are commonly transmitted through contaminated water supplies leading to regional outbreaks.In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat.The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing.In majority of cases,HEV infection is a selflimiting hepatitis requiring only symptomatic treatment.However,this is not the case in immunocompromised individuals,including those that have undergone solid organ or stem cell transplantation.In this subset of patients,chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death.The need for re-transplantation as a result of post-transplant hepatitis is of great concern.In addition,there have been many reported incidents of extrahepatic manifestations,for which the exact mechanisms remain to be elucidated.The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies,while attempting to minimize the risk of organ rejection.Subsequent treatment options include ribavirin,and pegylated interferon alpha in those who have demonstrated ribavirin resistance.Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden.Given this concern,vaccination has been approved in China with other investigations underway throughout the world.In this review we introduce the epidemiology,diagnosis,clinical manifestations,and treatment of HEV,with emphasis on immunocompromised individuals in the United States.展开更多
BACKGROUND Epstein-Barr virus associated smooth muscle tumor(EBV-SMT)is a rare oncological entity.However,there is an increasing incidence of EBV-SMTs,as the frequency of organ transplantation and immunosuppression gr...BACKGROUND Epstein-Barr virus associated smooth muscle tumor(EBV-SMT)is a rare oncological entity.However,there is an increasing incidence of EBV-SMTs,as the frequency of organ transplantation and immunosuppression grows.EBV-SMT diagnosis relies on histopathology and immunochemical staining to distinguish it from post-transplant lymphoproliferative disorder(PTLD).There is no clear consensus on the treatment of EBV-SMTs.However,surgical resection,chemotherapy,radiation therapy,and immunosuppression reduction have been explored with varying degrees of success.CASE SUMMARY Our case series includes six cases of EBV-SMTs across different age groups,with different treatment modalities,adding to the limited existing literature on this rare tumor.The median latency time between immunosuppression and disease diagnosis is four years.EBV-SMTs present with variable degrees of aggressiveness and seem to have worse clinical outcomes in patients with tumor multiplicity and worse immunocompetency.CONCLUSION It is imperative to continue building on this knowledge and keeping EBV-SMTs on the differential in immunocompromised individuals.展开更多
We report three cases of ileocolic mucormycosis in adult immunocompromised patients presenting as acute abdomen.All patients underwent laparotomy but two of them died from multiorgan failure before the diagnoses were ...We report three cases of ileocolic mucormycosis in adult immunocompromised patients presenting as acute abdomen.All patients underwent laparotomy but two of them died from multiorgan failure before the diagnoses were confirmed.The diagnosis of gastrointestinal mucormycosis is rarely suspected,and antemortem diagnosis is made in only 25%-50% of cases.These cases illustrate the difficulty encountered by surgeons in managing acute abdomen in neutropenic patients with hematological malignancy.The management of colonic mucormycosis in the published literature is also reviewed.展开更多
Dear Editor,I am Dr. Feng Hu, from the Department of Ophthalmology of Beijing Tongren Hospital, Beijing, China. I write to present a case report of cytomegalovirus retinitis (CMVR) in Good’s syndrome (GS).GS is an ex...Dear Editor,I am Dr. Feng Hu, from the Department of Ophthalmology of Beijing Tongren Hospital, Beijing, China. I write to present a case report of cytomegalovirus retinitis (CMVR) in Good’s syndrome (GS).GS is an extremely rare primary immune-deficiency syndrome,which consists of simultaneous occurrence of展开更多
AIM: To characterize the prevalence of rotavirus(RV) and adenovirus(Ad V) infections in immunocompromised patients with acute gastroenteritis. METHODS: The presence of RV and Ad V(serotypes 40 and 41) was evaluated in...AIM: To characterize the prevalence of rotavirus(RV) and adenovirus(Ad V) infections in immunocompromised patients with acute gastroenteritis. METHODS: The presence of RV and Ad V(serotypes 40 and 41) was evaluated in 509 stool samples obtained between January 2009 and December 2010 from 200 immunocompromised patients(83 females and 117 males; median age 21 years old, range 0-72. The diagnosis of infection was performed as a routine procedure and the presence of RV and Ad V(serotypes 40 and 41) was determined by immunochromatography using the RIDA® Quick Rota-Adeno-Kombi kit(r-Biopharm, Darmstadt, Germany). The data analysis and description of seasonal frequencies were performed using computer software IBM® SPSS®(Statistical Package for Social Sciences) Statistics version 20.0 for Mac. The frequencies of infection were compared into different age and gender groups by χ2 test.RESULTS: The study revealed 12.4% Ad V positive samples and 0.8% RV positive samples, which correspond to a prevalence of 6.5% and 1.5%, respectively. Ad V was more frequent between October 2009 and April 2010, while RV was identified in April 2010 and July 2010. The stool analysis revealed that from the 509 samples, 63(12.4%) were positive for Ad V and 4(0.8%) positive for RV, which by resuming the informationof each patient, lead to an overall prevalence of Ad V and RV of 6.5%(13/200 patients) and 1.5%(3/200 patients), respectively. The stratification of the analysis regarding age groups showed a tendency to an increased prevalence of infection in paediatric patients between 0-10 years old. Considering the seasonal distribution of these infections, our study revealed that Ad V infection was more frequent between October 2009 and April 2010, while RV infection was characterized by two distinct peaks(April 2010 and July 2010). CONCLUSION: The overall prevalence of Ad V and RV infection in immunocompromised patients with acute gastroenteritis was 8% and Ad V was the most prevalent agent.展开更多
Infections caused by Strongyloides stercoralis(S.stercoralis) in human are generally asymptomatic,however in immunocompromised individual,hyperinfection may develop with dissemination of larvae to extra-intestinal org...Infections caused by Strongyloides stercoralis(S.stercoralis) in human are generally asymptomatic,however in immunocompromised individual,hyperinfection may develop with dissemination of larvae to extra-intestinal organs.The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself,which may lead to low index of suspicion as a consequence.In this report,a case of a Malaysian male with underlying diabetes mellitus,hypertension,cerebrovascular accident,bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented.However,he developed septicemic shock later,and S.stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli.Regardless of aggressive resuscitation,the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome.It was revealed that the current case has alarmed us via incidental finding of S.stercoralis larvae in the tracheal aspirate,indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.展开更多
BACKGROUND:Prompt pathogen identification can have a substantial impact on the optimization of antimicrobial treatment.The objective of the study was to assess the diagnostic value of next-generation sequencing(NGS)fo...BACKGROUND:Prompt pathogen identification can have a substantial impact on the optimization of antimicrobial treatment.The objective of the study was to assess the diagnostic value of next-generation sequencing(NGS)for identifying pathogen and its clinical impact on antimicrobial intervention in immunocompromised patients with suspected infections.METHODS:This was a retrospective study.Between January and August 2020,47 adult immunocompromised patients underwent NGS testing under the following clinical conditions:1)prolonged fever and negative conventional cultures;2)new-onset fever despite empiric antimicrobial treatment;and 3)afebrile with suspected infections on imaging.Clinical data,including conventional microbial test results and antimicrobial treatment before and after NGS,were collected.Data were analyzed according to documented changes in antimicrobial treatment(escalated,no change,or deescalated)after the NGS results.RESULTS:The median time from hospitalization to NGS sampling was 19 d.Clinically relevant pathogens were detected via NGS in 61.7% of patients(29/47),more than half of whom suffered from fungemia(n=17),resulting in an antimicrobial escalation in 53.2% of patients(25/47)and antimicrobial de-escalation in 0.2% of patients(1/47).Antimicrobial changes were mostly due to the identification of fastidious organisms such as Legionella,Pneumocystis jirovecii,and Candida.In the remaining three cases,NGS detected clinically relevant pathogens also detected by conventional cultures a few days later.The antimicrobial treatment was subsequently adjusted according to the susceptibility test results.Overall,NGS changed antimicrobial management in 55.3%(26/47)of patients,and conventional culture detected clinically relevant pathogens in 14.9% of the patients(7/47).CONCLUSION:With its rapid identification and high sensitivity,NGS could be a promising tool for identifying relevant pathogens and enabling rapid appropriate treatment in immunocompromised patients with suspected infections.展开更多
The Food and Drug Administration (FDA) has issued a warning on numerous herbal drugs, including many popular products at General Nutrition Centers (GNC), regarding unstudied hepatotoxicity. There have been recent repo...The Food and Drug Administration (FDA) has issued a warning on numerous herbal drugs, including many popular products at General Nutrition Centers (GNC), regarding unstudied hepatotoxicity. There have been recent reports of GNC products such as hydroxycut and herbalife, causing drug-induced hepatitis. Herbal medications are over-the-counter products and are not investigated thoroughly by the FDA. Given that the mostcommon outpatient laboratory abnormality is elevated liver transaminases, a sign of hepatocellular toxicity; it is not surprising that some of these products end up causing hepatic dysfunction, especially when taken in large volume. There are numerous herbal supplements that are hepatotoxic, however, these medications have a much more significant effect in human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome patients, which is secondary to depleted glutathione. We present a rare case of drug induced hepatitis secondary to herbal medications used to treat HIV and elucidate the role of glutathione depletion in immunocompromised patients.展开更多
Escherichia coli is the commonest bacterial uropathogen of UTIs, the commonest infections in immunocompromised diabetic patients. Better understanding of their main resistance mechanisms to commonly used antibacterial...Escherichia coli is the commonest bacterial uropathogen of UTIs, the commonest infections in immunocompromised diabetic patients. Better understanding of their main resistance mechanisms to commonly used antibacterial agents will help to reduce the burden of this infection. The prevalence of drug resistant uropathogenic Escherichia coli isolates from immunocompromised diabetic patients attending selected health facilities in Benue State was investigated. Two hundred and ninety-six midstream urine samples were collected for both study and control diabetic patients. Bacterial isolation was done using semi-quantitative method. Drug resistant Escherichia coli were identified as multidrug resistant (MDR), extensive drug resistant (XDR) and pan-drug resistant organisms (PDR). Statistical significance was considered at p E. coli isolates from the study and control subjects with overall prevalence of 20.9% and 8.4% respectively. The isolates were highly resistant to penicillin (ampicillin), monobactam (aztreonam), older quinolone (nalidixic acid) whereas the majority of them showed high susceptibility to aminoglycoside (streptomycin), cephalosporin (cefotaxime) and carbapenem (imipenem). None showed complete susceptibility to all the tested antibiotics. Twenty-five E. coli were identified in this MDR, eight, XDR while 5 were PDR. High numbers of drug resistant E. coli isolates were identified in the study group of which 25 were MDR, 8 XDR while 5 were PDR isolates. High prevalence of UTI and drug resistant isolates occur in diabetic patients with hyperglycemic condition.展开更多
Eighty four throat swabs were obtained from Basrah General Hospital inpatients （N = 34）： 17 were suffering from renal failure and the other 17 were diabetics; and from outpatients （N = 50）. Throat swabs were cult...Eighty four throat swabs were obtained from Basrah General Hospital inpatients （N = 34）： 17 were suffering from renal failure and the other 17 were diabetics; and from outpatients （N = 50）. Throat swabs were cultured first in the selective media Ashdown＇s broth then subcultured on Ashdown＇s agar to isolate Burkholderia pseudomallei which was recovered from seven cases （8.33%）. Four isolates were from renal failure patients （23.53%）, two from diabetic patients （11.76%） and the seventh isolate was from an outpatient with tonsillitis. All isolates were able to produce capsules, form filament chains, exhibit swarming motility and were arabinose non assimilators （Ara-） indicative of their virulence. Additionally, isolated B. pseudomallei were found to produce protease, lipase, hemolysin, and lecithinase and were able to produce biofilm, the root of many troublesome persistent infections that resist antibiotic treatment. Susceptibility of the seven isolates of B. pseudomallei toward 11 antibiotics was assessed, isolates were found multiply resistant to all antibiotics apart from ciproflaxin. This study confirms for the first time isolation of B. pseudomallei from immunocompromised patients in Basrah city of Iraq and describes their virulence potentials.展开更多
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
基金Supported by the Japan Society for the Promotion of Science KAKENHI Grant,No.JP24K15491.
文摘BACKGROUND Acyclovir(ACV)-resistant herpes simplex virus(HSV)strains have emerged and gradually increased in number.Prolonged treatment,such as for immunocompromised patients,has been observed on many occasions to lead to the development of resistance.Additionally,some strains of HSV exist that are ACV resistant,and they can cause severe complications that may be impossible to treat with current therapies.We report the first case of ACV-resistant herpes encephalitis(ARHE)recurring in an immunocompromised adult patient without neurosurgical intervention.CASE SUMMARY A 58-year-old man with a fever of 38°C had tremors.Evaluation revealed 14 points on the Glasgow Coma Scale with 39°C fever but unremarkable physical examination.Diagnosis was infection of unknown origin;fever continued,and the Glasgow Coma Scale worsened to 8.Imaging showing a high-intensity area between the left temporal lobe and insular cortex suggested herpes encephalitis.ACV was started.Cerebrospinal fluid(CSF)was positive for HSV DNA,confirming the diagnosis.However,unresolved symptoms suggested ARHE;therefore,we initiated vidarabine treatment.Later testing confirmed ARHE.Foscarnet was started based on a hospital day 25 blood test revealing pancytopenia,possibly from vidarabine.Consciousness improved,and the patient moved to rehabilitation.However,symptoms worsened,suggesting recurrence.Diffusion-weighted magnetic resonance imaging revealed a high high-intensity area around the right temporal lobe;CSF was positive for HSV DNA,confirming recurrent herpes encephalitis.ACV and foscarnet were initiated.Fever decreased,consciousness improved,and HSV DNA on hospital days 78 and 93 was CSF negative.Treatment was terminated on hospital day 86.CONCLUSION ARHE recurred in the patient following remission;therefore,it is necessary to discuss the length of the treatment period.
文摘BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patients with certain risk factors,including immunocompromised status.We recently diagnosed a case of spontaneous bacterial peritonitis(SBP)due to E.tarda in an immuno-compromised dialysis patient.CASE SUMMARY Patient was a 55-year-old male,with a history of diabetic nephropathy being treated with hemodialysis three times a week.He was referred to our hospital due to an increased volume of ascites,and blood examination revealed increased inflammatory reaction.At our emergency department,he developed fever,disturbance of consciousness,abdominal distension,and abdomen-wide pain.In addition,a dialysis shunt was confirmed in his right forearm,and the shunt site showed no signs of inflammation.No wounds were confirmed on or in his body.A blood examination revealed increased values of white blood cells,C-reactive protein,and creatinine.Plain chest and abdominal computed tomography scanning revealed increased ascites volume.Abdominal paracentesis was performed and a Gram stain revealed Gramnegative bacillus.These findings prompted diagnosis of SBP.The patient was admitted and treated with cefmetazole,causing fever resolution and symptom improvements.Later,E.tarda was identified in ascites culture.The patient improved with decreased inflammatory response and was discharged on the 12th day of hospitalization.The antibiotic was terminated after 14 days of treatment.SBP in this case may have developed from chronic renal failure and diabetes mellitus.CONCLUSION We report the first known case of SBP due to E.tarda in an immuno-compromised dialysis patient.
文摘We report the remission of primary gastric lymphoma of the mucosa-associated lymphoid tissue （MALT） type in two immunocompromised pediatric patients. Patient 1, a 14-year-old boy in an immunocompromised state of unknown cause, complained of repeated abdominal pain. Examinations revealed gastric MALT with local invasion and lymph node involvement. Serum anti-Helicobacter pylori （H pylon） antibody was positive. H pylori eradication was abandoned due to its adverse effects. The MALT lesion spontaneously regressed over the next 24 months without any treatment for lymphoma. Patient 2, a 6-year-old boy, underwent cord blood transplantation for the treatment of adrenoleukodystrophy. He was administered immunosuppressants for graft-versus-host disease after transplantation. Nausea and hematochezia appeared and further examinations revealed gastric MALT with H pylori gastritis. Treatment consisting of medication for the Hpylori infection alone eradicated the Hpylori and completely resolved the patient＇s MALT lesion, as well. Patients i and 2 were followed up over periods of 10 years and 3 years, respectively, without any signs of relapse. In conclusion, gastric lymphoma of the MALT type can be cured by conservative treatment even in immunocompromised pediatric patients.
基金partly supported by grants from the National Natural Science Foundation of China(8147162081671627+7 种基金815716068160180881172876U0832601)the National Basic Research Program of China(2012CBA01305)the 13th Five-Year Key Scientific and Technological Program of China(2017ZX10304402-002-0042017ZX10202102-001-005)the National Key Research & Development(R&D)Plan(2016YFC1201000)
文摘Parasites can increase infection rates and pathogenicity in immunocompromised human immunodeficiency virus （HIV） patients. However, in vitro studies and epidemiological investigations also suggest that parasites might escape immunocompromised hosts during HIV infection Due to the lack of direct evidence from animal experiments, the effects of immunocompromised hosts parasitic infections on remain unclear. Here we detected 14 different parasites in six northern pig-tailed macaques （NPMs） before or at the 50th week of simian immunodeficiency virus （SIV） infection by ELISA. The NPMs all carried parasites before viral injection. At the 50th week after viral injection, the individuals with negative results in parasitic detection （i.e., 08247 and 08287） were characterized as the Parasites Exit （PE） group, with the other individuals （i.e., 09203, 09211, 10205, and 10225） characterized as the Parasites Remain （PR） group. Compared with the PR group, the NPMs in the PE group showed higher viral loads, lower CD4＋ T cells counts, and lower CD4/CD8 rates. Additionally, the PE group had higher immune activation and immune exhaustion of both CD4~ and CD8~ T cells. Pathological observation showed greater injury to the liver, cecum, colon, spleen, and mesenteric lymph nodes in the PE group This study showed more seriously compromised immunity in the PE group, strongly indicating that parasites might exit an immunocompromised host.
文摘Hepatitis E virus(HEV)originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States.While there are eight identified genotypes to date,genotype 1(HEV1),HEV2,HEV3,HEV4 are the most common to infect humans.HEV1 and HEV2 are most common in developing countries including Latina America,Africa and Asia,and are commonly transmitted through contaminated water supplies leading to regional outbreaks.In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat.The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing.In majority of cases,HEV infection is a selflimiting hepatitis requiring only symptomatic treatment.However,this is not the case in immunocompromised individuals,including those that have undergone solid organ or stem cell transplantation.In this subset of patients,chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death.The need for re-transplantation as a result of post-transplant hepatitis is of great concern.In addition,there have been many reported incidents of extrahepatic manifestations,for which the exact mechanisms remain to be elucidated.The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies,while attempting to minimize the risk of organ rejection.Subsequent treatment options include ribavirin,and pegylated interferon alpha in those who have demonstrated ribavirin resistance.Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden.Given this concern,vaccination has been approved in China with other investigations underway throughout the world.In this review we introduce the epidemiology,diagnosis,clinical manifestations,and treatment of HEV,with emphasis on immunocompromised individuals in the United States.
文摘BACKGROUND Epstein-Barr virus associated smooth muscle tumor(EBV-SMT)is a rare oncological entity.However,there is an increasing incidence of EBV-SMTs,as the frequency of organ transplantation and immunosuppression grows.EBV-SMT diagnosis relies on histopathology and immunochemical staining to distinguish it from post-transplant lymphoproliferative disorder(PTLD).There is no clear consensus on the treatment of EBV-SMTs.However,surgical resection,chemotherapy,radiation therapy,and immunosuppression reduction have been explored with varying degrees of success.CASE SUMMARY Our case series includes six cases of EBV-SMTs across different age groups,with different treatment modalities,adding to the limited existing literature on this rare tumor.The median latency time between immunosuppression and disease diagnosis is four years.EBV-SMTs present with variable degrees of aggressiveness and seem to have worse clinical outcomes in patients with tumor multiplicity and worse immunocompetency.CONCLUSION It is imperative to continue building on this knowledge and keeping EBV-SMTs on the differential in immunocompromised individuals.
文摘We report three cases of ileocolic mucormycosis in adult immunocompromised patients presenting as acute abdomen.All patients underwent laparotomy but two of them died from multiorgan failure before the diagnoses were confirmed.The diagnosis of gastrointestinal mucormycosis is rarely suspected,and antemortem diagnosis is made in only 25%-50% of cases.These cases illustrate the difficulty encountered by surgeons in managing acute abdomen in neutropenic patients with hematological malignancy.The management of colonic mucormycosis in the published literature is also reviewed.
基金Supported by the Capital Health Research and Development of Special(No.SF-2018-2-1081)
文摘Dear Editor,I am Dr. Feng Hu, from the Department of Ophthalmology of Beijing Tongren Hospital, Beijing, China. I write to present a case report of cytomegalovirus retinitis (CMVR) in Good’s syndrome (GS).GS is an extremely rare primary immune-deficiency syndrome,which consists of simultaneous occurrence of
文摘AIM: To characterize the prevalence of rotavirus(RV) and adenovirus(Ad V) infections in immunocompromised patients with acute gastroenteritis. METHODS: The presence of RV and Ad V(serotypes 40 and 41) was evaluated in 509 stool samples obtained between January 2009 and December 2010 from 200 immunocompromised patients(83 females and 117 males; median age 21 years old, range 0-72. The diagnosis of infection was performed as a routine procedure and the presence of RV and Ad V(serotypes 40 and 41) was determined by immunochromatography using the RIDA® Quick Rota-Adeno-Kombi kit(r-Biopharm, Darmstadt, Germany). The data analysis and description of seasonal frequencies were performed using computer software IBM® SPSS®(Statistical Package for Social Sciences) Statistics version 20.0 for Mac. The frequencies of infection were compared into different age and gender groups by χ2 test.RESULTS: The study revealed 12.4% Ad V positive samples and 0.8% RV positive samples, which correspond to a prevalence of 6.5% and 1.5%, respectively. Ad V was more frequent between October 2009 and April 2010, while RV was identified in April 2010 and July 2010. The stool analysis revealed that from the 509 samples, 63(12.4%) were positive for Ad V and 4(0.8%) positive for RV, which by resuming the informationof each patient, lead to an overall prevalence of Ad V and RV of 6.5%(13/200 patients) and 1.5%(3/200 patients), respectively. The stratification of the analysis regarding age groups showed a tendency to an increased prevalence of infection in paediatric patients between 0-10 years old. Considering the seasonal distribution of these infections, our study revealed that Ad V infection was more frequent between October 2009 and April 2010, while RV infection was characterized by two distinct peaks(April 2010 and July 2010). CONCLUSION: The overall prevalence of Ad V and RV infection in immunocompromised patients with acute gastroenteritis was 8% and Ad V was the most prevalent agent.
文摘Infections caused by Strongyloides stercoralis(S.stercoralis) in human are generally asymptomatic,however in immunocompromised individual,hyperinfection may develop with dissemination of larvae to extra-intestinal organs.The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself,which may lead to low index of suspicion as a consequence.In this report,a case of a Malaysian male with underlying diabetes mellitus,hypertension,cerebrovascular accident,bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented.However,he developed septicemic shock later,and S.stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli.Regardless of aggressive resuscitation,the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome.It was revealed that the current case has alarmed us via incidental finding of S.stercoralis larvae in the tracheal aspirate,indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.
基金supported by National Natural Science Foundation of China(72274067)。
文摘BACKGROUND:Prompt pathogen identification can have a substantial impact on the optimization of antimicrobial treatment.The objective of the study was to assess the diagnostic value of next-generation sequencing(NGS)for identifying pathogen and its clinical impact on antimicrobial intervention in immunocompromised patients with suspected infections.METHODS:This was a retrospective study.Between January and August 2020,47 adult immunocompromised patients underwent NGS testing under the following clinical conditions:1)prolonged fever and negative conventional cultures;2)new-onset fever despite empiric antimicrobial treatment;and 3)afebrile with suspected infections on imaging.Clinical data,including conventional microbial test results and antimicrobial treatment before and after NGS,were collected.Data were analyzed according to documented changes in antimicrobial treatment(escalated,no change,or deescalated)after the NGS results.RESULTS:The median time from hospitalization to NGS sampling was 19 d.Clinically relevant pathogens were detected via NGS in 61.7% of patients(29/47),more than half of whom suffered from fungemia(n=17),resulting in an antimicrobial escalation in 53.2% of patients(25/47)and antimicrobial de-escalation in 0.2% of patients(1/47).Antimicrobial changes were mostly due to the identification of fastidious organisms such as Legionella,Pneumocystis jirovecii,and Candida.In the remaining three cases,NGS detected clinically relevant pathogens also detected by conventional cultures a few days later.The antimicrobial treatment was subsequently adjusted according to the susceptibility test results.Overall,NGS changed antimicrobial management in 55.3%(26/47)of patients,and conventional culture detected clinically relevant pathogens in 14.9% of the patients(7/47).CONCLUSION:With its rapid identification and high sensitivity,NGS could be a promising tool for identifying relevant pathogens and enabling rapid appropriate treatment in immunocompromised patients with suspected infections.
文摘The Food and Drug Administration (FDA) has issued a warning on numerous herbal drugs, including many popular products at General Nutrition Centers (GNC), regarding unstudied hepatotoxicity. There have been recent reports of GNC products such as hydroxycut and herbalife, causing drug-induced hepatitis. Herbal medications are over-the-counter products and are not investigated thoroughly by the FDA. Given that the mostcommon outpatient laboratory abnormality is elevated liver transaminases, a sign of hepatocellular toxicity; it is not surprising that some of these products end up causing hepatic dysfunction, especially when taken in large volume. There are numerous herbal supplements that are hepatotoxic, however, these medications have a much more significant effect in human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome patients, which is secondary to depleted glutathione. We present a rare case of drug induced hepatitis secondary to herbal medications used to treat HIV and elucidate the role of glutathione depletion in immunocompromised patients.
文摘Escherichia coli is the commonest bacterial uropathogen of UTIs, the commonest infections in immunocompromised diabetic patients. Better understanding of their main resistance mechanisms to commonly used antibacterial agents will help to reduce the burden of this infection. The prevalence of drug resistant uropathogenic Escherichia coli isolates from immunocompromised diabetic patients attending selected health facilities in Benue State was investigated. Two hundred and ninety-six midstream urine samples were collected for both study and control diabetic patients. Bacterial isolation was done using semi-quantitative method. Drug resistant Escherichia coli were identified as multidrug resistant (MDR), extensive drug resistant (XDR) and pan-drug resistant organisms (PDR). Statistical significance was considered at p E. coli isolates from the study and control subjects with overall prevalence of 20.9% and 8.4% respectively. The isolates were highly resistant to penicillin (ampicillin), monobactam (aztreonam), older quinolone (nalidixic acid) whereas the majority of them showed high susceptibility to aminoglycoside (streptomycin), cephalosporin (cefotaxime) and carbapenem (imipenem). None showed complete susceptibility to all the tested antibiotics. Twenty-five E. coli were identified in this MDR, eight, XDR while 5 were PDR. High numbers of drug resistant E. coli isolates were identified in the study group of which 25 were MDR, 8 XDR while 5 were PDR isolates. High prevalence of UTI and drug resistant isolates occur in diabetic patients with hyperglycemic condition.
文摘Eighty four throat swabs were obtained from Basrah General Hospital inpatients （N = 34）： 17 were suffering from renal failure and the other 17 were diabetics; and from outpatients （N = 50）. Throat swabs were cultured first in the selective media Ashdown＇s broth then subcultured on Ashdown＇s agar to isolate Burkholderia pseudomallei which was recovered from seven cases （8.33%）. Four isolates were from renal failure patients （23.53%）, two from diabetic patients （11.76%） and the seventh isolate was from an outpatient with tonsillitis. All isolates were able to produce capsules, form filament chains, exhibit swarming motility and were arabinose non assimilators （Ara-） indicative of their virulence. Additionally, isolated B. pseudomallei were found to produce protease, lipase, hemolysin, and lecithinase and were able to produce biofilm, the root of many troublesome persistent infections that resist antibiotic treatment. Susceptibility of the seven isolates of B. pseudomallei toward 11 antibiotics was assessed, isolates were found multiply resistant to all antibiotics apart from ciproflaxin. This study confirms for the first time isolation of B. pseudomallei from immunocompromised patients in Basrah city of Iraq and describes their virulence potentials.
文摘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.
