[The clinical characteristics of 70 cases of fungemia].

OBJECTIVE: To evaluate the etiological and clinical characteristics of fungemia in Peking Union Medical College Hospital. METHODS: Microbial and clinical information of patients with fungemia consulted in Peking Union Medical College Hospital during 2008 to 2010 were retrospectively analyzed. RESULTS: A total of 70 patients were diagnosed with fungemia, and 100% of them had underlying diseases or potential risk factors. Of them, 40 (57.1%) patients were monomicrobial fungemia, and the other 30 (42.9%) patients with positive blood cultures were caused by at least two different microbes during hospitalization. Among 122 strains of microbes isolated from blood cultures, 72 were fungi and 50 were bacteria. Among the isolated fungi, 61 (84.7%) were Candida species, 31 (50.8%) were Candida albicans and 30 (49.2%) were non-albicans. According to the colonization or infected sites other than blood of the isolated fungi, 35 cases (50.0%) were primary fungemia; 18 (25.7%) were colonizing at lower respiratory tract simultaneously; 10 (14.3%) caused central-line related fungemia; 3(4.3%) were secondary to intra-abdominal fungal infection; and another 4 (5.7%) isolates had multiple colonization sites. During hospitalization, 37 cases died with a crude mortality rate of 52.9%, and 22 (32.9%) died of fungemia itself. In single factor analysis, ICU hospitalization (χ(2) = 15.136, P < 0.001), operation history within 30 days (χ(2) = 3.540, P = 0.060) and invasive mechanical ventilation (χ(2) = 4.450, P = 0.035) were related to crude mortality. Bacteremia during hospitalization (χ(2) = 5.657, P = 0.017), circulatory underlying diseases (χ(2) = 3.399, P = 0.065) and ICU treatment (χ(2) = 4.955, P = 0.026) increased attributable mortality. In the multivariate analysis, ICU history increased mortality during hospitalization, however, the operation history within 30 days was independently irrelevant to crude mortality during hospitalization. ICU history and bacteremia during hospitalization were independently correlated to attribution mortality of the patients with fungemia. CONCLUSIONS: Fungemia, usually accompanied with bacteremia, occurs often in the patients with underlying diseases. Patients with fungemia have poor prognosis and more than 50% patients die. ICU history increases the risk both to crude and attributable mortality. The patients with fungemia who had polymicrobial bloodstream infection have a higher attribution mortality. Operation history within 30 days is independently negatively correlated to attributable mortality.

[The microbiological and clinical analysis of bloodstream infections with identifiable sources].

OBJECTIVE: To evaluate the microbial spectrum and clinical characteristics of microbiological diagnosed bloodstream infections (BSI) with identified infective sources. METHODS: The hospitalized patients microbiologically diagnosed as BSI with identified infective sources were included in this study from January 2008 to December 2009. Data were collected retrospectively and analyzed by software SPSS 17.0. RESULTS: In this 2-year study, 301 strains of microbes were isolated from 249 patients. There were 205 (82.33%) patients with monomicrobial BSI, while the other 44 (17.67%) patients with polymicrobial BSI. The most common identified source of bloodstream infections was lower respiratory tract infection (125, 41.5%), followed by intraabdominal infection (55, 18.3%) and intravascular devices related infection (54, 17.9%). The four most common isolated pathogens were Acinetobacter species (60, 19.9%), Escherichia coli (50, 16.6%), Pseudomonas species (35, 11.6%) and Staphylococcus Aureus (34, 11.3%). Eighty-eight (35.3%) patients died during hospitalization due to all causes, out of which 62 (24.9%) patients died owing to BSI. The patients with BSI originated from lower respiratory tract had a higher crude in-hospital case-fatality ratio than those with BSI originated from other resources (OR = 2.186; 95%CI 1.260 - 3.792; χ(2) = 7.879, P = 0.005). In the multivariate regression, age ≥ 65, invasive mechanical ventilation, reservation of central line and polymicrobial BSI during hospitalization were independent risk factors of death due to all causes. CONCLUSIONS: Lower respiratory tract is the most common originated source of BSI with microbiological identified sources. Gram-negative bacillus taking advantage, the microbial spectrum of BSI with identified sources in our study is different from those reported before both in primary and secondary BSI. The patients with BSI originated from respiratory tract have a higher crude in-hospital case-fatality ratio.

[Clinical analysis of adult primary bloodstream infection].

OBJECTIVE: Evaluate the microbiological and epidemiological characteristics of primary bloodstream infections as well as the associated patients' clinical features at Peking Union Medical College Hospital. METHOD: Microbiological and clinical data of the adult patients with primary bloodstream infections during January 1, 2008 and December 31, 2009 were retrospectively collected and evaluated. Pearson χ(2) test was used to compare the difference between proportions and Logistic regression was used in multivariate analysis. RESULT: Five hundred and eighty-six strains of microbes were isolated from 494 adult patients with primary bloodstream infections. There were 80 patients with polymicrobial primary bloodstream infection of the 586 isolates, coagulase-negative staphylococci (175, 29.9%) was the most common, followed by Escherichia coli (93, 15.9%), Enterococcus species (60, 10.2%), Streptococcus species (41, 7.0%), and Staphylococcus Aureus (39, 6.7%). Central-line was the leading suspected infective source among the suspected infective source involving 108 (18.4%) isolates. Excluded the 108 isolates with suspected sources, 77 (45.3%) out of 167 patients with the primary bloodstream infections caused by coagulase-negative staphylococci or Staphylococcus Aureus had a central-line, with a higher proportion of the patients with a central-line than the patients with bloodstream infection caused by other pathogens (χ(2) = 10.419, P = 0.001). One hundred and fourteen patients died during hospitalization, with the crude mortality rate 23.0%. Fifty-nine patients (11.9%) died due to primary bloodstream infection. The patients with polymicrobial bloodstream infection were with a higher attributable mortality (OR = 2.159;95%CI 1.165 - 4.002; χ(2) = 6.194, P = 0.013). In the multivariate analysis, the independent risk factors of crude mortality rate to primary bloodstream infections were elderly patients, central neurological disorder, mechanical ventilation, and reservation a central-line. CONCLUSION: The most common microbe causing primary bloodstream infections was G+ cocci. Polymicrobial primary bloodstream infection added risk to attributable in-hospital fatality ratio. Elderly patients, neurological disorder, reservation of central-line, and mechanical ventilation were the independent risk factors of crude in-hospital fatality ratio.

Rapid identification of Streptococcus pneumoniae serotypes by cpsB gene-based sequetyping combined with multiplex PCR.

BACKGROUND/PURPOSE: Streptococcus pneumoniae is an important human pathogen that causes invasive infections in adults and children. Accurate serotyping is important to study its epidemiological distribution and to assess vaccine efficacy. METHODS: Invasive S. pneumoniae isolates (n = 300) from 27 teaching hospitals in China were studied. The Quellung reaction was used as the gold standard to identify the S. pneumoniae serotypes. Subsequently, multiplex PCR and cpsB gene-based sequetyping methods were used to identify the serotypes. RESULTS: Based on the Quellung reaction, 299 S. pneumoniae isolates were accurately identified to the serotype level and 40 different serotypes were detected. Only one strain was non-typeable, and five most common serotypes were identified: 23F (43, 14.3%), 19A (41, 13.7%), 19F (41, 13.7%), 3 (31, 10.3%), and 14 (27, 9.0%). Overall, the multiplex PCR method identified 73.3 and 20.7% of the isolates to the serotype and cluster levels, respectively, with 1.7% of the isolates misidentified. In contrast, the cpsB sequetyping method identified 59.0 and 30.3% of the isolates to the serotype and cluster levels, respectively, and 7% were misidentified. CONCLUSIONS: The cpsB gene sequetyping method combined with multiplex PCR, can greatly improve the accuracy and efficiency of serotyping, besides reducing the associated costs.

[A report of eight cases of Behcet's disease with intracardiac thrombus and literatures review].

OBJECTIVE: To analyze the clinical characteristics of Behcet's disease with intracardiac thrombus. METHODS: The data of 8 patients diagnosed as Behcet's disease with intracardiac thrombus in Peking Union Medical College Hospital from January, 1990 to January, 2011 were studied retrospectively. RESULTS: Behcet's disease with intracardiac thrombus was found in 8 patients (5 men and 3 women) with a median age of 28.5 years. Most of them were young men. Thrombus was mostly found in the right side of the heart. Most of the patients had pulmonary thromboembolism with negative anticardiolipid antibody and basically normal C-reactive protein and erythrocyte sedimentation rate. CONCLUSION: Intracardiac thrombus associated with Behcet's disease most commonly occurs in young men and usually involves the right side of the heart.

Progressive liver injury and increased mortality risk in COVID-19 patients: A retrospective cohort study in China.

BACKGROUND: Liver injury is common and also can be fatal, particularly in severe or critical patients with coronavirus disease 2019 (COVID-19). AIM: To conduct an in-depth investigation into the risk factors for liver injury and into the effective measures to prevent subsequent mortality risk. METHODS: A retrospective cohort study was performed on 440 consecutive patients with relatively severe COVID-19 between January 28 and March 9, 2020 at Tongji Hospital, Wuhan, China. Data on clinical features, laboratory parameters, medications, and prognosis were collected. RESULTS: COVID-19-associated liver injury more frequently occurred in patients aged ≥ 65 years, female patients, or those with other comorbidities, decreased lymphocyte count, or elevated D-dimer or serum ferritin (P < 0.05). The disease severity of COVID-19 was an independent risk factor for liver injury (severe patients: Odds ratio [OR] = 2.86, 95% confidence interval [CI]: 1.78-4.59; critical patients: OR = 13.44, 95%CI: 7.21-25.97). The elevated levels of on-admission aspartate aminotransferase and total bilirubin indicated an increased mortality risk (P < 0.001). Using intravenous nutrition or antibiotics increased the risk of COVID-19-associated liver injury. Hepatoprotective drugs tended to be of assistance to treat the liver injury and improve the prognosis of patients with COVID-19-associated liver injury. CONCLUSION: More intensive monitoring of aspartate aminotransferase or total bilirubin is recommended for COVID-19 patients, especially patients aged ≥ 65 years, female patients, or those with other comorbidities. Drug hepatotoxicity of antibiotics and intravenous nutrition should be alert for COVID-19 patients.

[A clinical analysis of 25 cases of prosthetic valve endocarditis].

OBJECTIVE: To report the clinical characteristics of prosthetic valve endocarditis (PVE). METHODS: All 25 cases of definite PVE (Duke criteria) diagnosed at our hospital between January 1992 to December 2008 were retrospectively analyzed. Among them, 7 cases were pathologically confirmed and the others were clinically confirmed with either 2 major criteria or 1 major and ≥ 3 minor criteria. Their clinical characteristics, underlying heart diseases, previous heart operations, presenting manifestations, causative microbes, echocardiographic findings and prognosis, were studied. RESULTS: (1) Although most cases underwent valve transplantations for underlying heart diseases of rheumatic heart diseases and congenital heart diseases, 10 patients were complicated with infectious endocarditis (IE) prior to the operations, 4 of them were PVE. (2) Eleven of them developed PVE within 2 months postoperatively. Fever (100%), major vessel embolism (48%), and anemia (36%) were the most frequently manifestations. Fourteen cases (56%) had positive culture results with 15 causative pathogens, including 5 coagulase-negative Staphylococcus (CNS, 3 were methicillin-resistant coagulase-negative Staphylococcus, MRSCoN), 4 fungi, 2 Enterococcus faecalis, 2 Burkholderia cepacia, 1 Stenotrophomonas maltophilia, and 1 Streptococcus. (3) Prosthetic valve vegetations, periannular leakage, regurgitation, were the main echocardiographic findings. Transesophageal echocardiography (TEE) revealed 13 PVE who had no positive findings on previous transthoracic echocardiography (TTE). (4) Eighteen PVE (72%) developed peri-annular complications (12 leakage, 3 dehiscence, 2 abscesses, 1 fistula), major vessel embolism, congestive heart failure (16%) were frequently observed, 9 of the 17 patients died in hospital, in spite of intensive managements. CONCLUSIONS: PVE has a high mortality and is a severe complication for patients who underwent heart surgery. Its causative pathogen spectrum is quite different from that of native valve endocarditis. TTE is not sensitive for some PVE cases.

[Clinical significance of positive sputum culture for filamentous fungi].

OBJECTIVE: To investigate the clinical significance of positive sputum culture for filamentous fungi. METHODS: The medical data of 140 patients positive for filamentous fungi in sputum culture at Peking Union Medical College Hospital were reviewed retrospectively. Based on the diagnostic criteria by European Organization for Research and Treatment of Cancer/Mycoses Study Group, invasive pulmonary fungal infection (IPFI) was diagnosed. The clinical characteristics of cases with and without IPFI were analyzed respectively. RESULTS: Among all 140 cases positive for filamentous fungi in sputum culture, only 22 cases could be diagnosed as IPFI. Two of 22 IPFI cases were confirmed by post-operative pathology, 1 case was confirmed by positive blood culture for filamentous fungi and the remaining 19 cases were diagnosed clinically according to the nature of hosts, characteristics of pulmonary infections and microbiological evidence (positive sputum culture for filamentous fungi, 2 - 5 times for each case). Most of etiological fungi in IPFI patients belonged to Aspergillus. And the identity of isolated fungal strain was mostly one strain for each patient. In IPFI group, patients who had been treated with broad-spectrum antibiotics (100%), steroids (13, 59.1%) or immunosuppressant (7, 31.8%) or who had pulmonary X-ray imaging changes (100%), primary diseases (21, 95.5%), hypoalbuminemia (18, 81.8%) or hemoptysis (10, 45.5%), were significantly more than those in non-IPFI group (66.9%, 34.7%, 18.6%, 79.7%, 72.0%, 45.8% and 4.2% respectively; P < 0.05 for each item). In IPFI group, itraconazole, amphotericin B and/or voriconazole were administrated, 8 patients (36.4%) were cured and 14 patients (63.6%) passed away. In non-IPFI group, the patients were treated with antibiotics, fluconazole, anti-tuberculosis, steroids or combined with immunosuppressant, chemotherapy or bronchoalveolar lavage; 96 cases (81.4%) were cured or showed improvement, and 22 cases (18.6%) died or gave up further treatment. CONCLUSIONS: The clinical significance of positive sputum culture for filamentous fungi are associated with the times of positive culture, the number and species of isolated fungal strains. Meanwhile it is important to determine whether there is IPFI according to the nature and clinical characteristics of patients.

[Clinical analysis of 120 cases of infective endocarditis].

OBJECTIVE: To improve the diagnosis and treatment of infective endocarditis (IE) by exploring its causes, pathogenic microorganism and clinical characteristics. METHODS: The clinical data of 120 IE patients treated in Peking Union Medical College Hospital from October 1997 to September 2007 were analyzed retrospectively. RESULTS: Of the 120 consecutive cases diagnosed as IE according to the Duke's new criteria, 79 were male and 41 female with a average age of (43.2 +/- 16.7) years old. Twelve cases were prosthetic valve endocarditis (PVE) and 108 cases native valve endocarditis (NVE) and there were no previously known heart diseases in 29 of the cases. Seventy-nine of the 108 (73.1%) NVE patients had basic cardiac abnormalities before IE diagnosis, such as congenital cardiovascular disease (30 cases), idiopathic mitral valve prolapse (23 cases) and rheumatic heart disease (11 cases). Fever (100.0%), anemia (54.2%) and embolism (48.3%) were the most common clinical manifestations in the IE development. Of the 83 patients who had a positive blood culture result, Streptococcus viridans (51.8%) was the most common isolated microorganism. CONCLUSIONS: Congenital cardiovascular diseases and idiopathic mitral valve prolapse are the two most commonly heart diseases in IE. Blood culture and echocardiogram should always be done to exclude IE, especially presenting with fever of unknown reasons.

[Common variable immunodeficiency: report of 12 cases and review of literature].

OBJECTIVE: To study the clinical features of a heterogeneous immunodeficiency disease, common variable immunodeficiency (CVID), and to enhance the understanding of it. METHODS: 12 cases of CVID treated in Peking Union Medical College Hospital from January 1990 to March 2007 were analyzed retrospectively, including the clinical characteristics, laboratory results, treatment and prognosis. RESULTS: Among the 12 patients, the ratio of male to female was 2:1, the average onset age (26 +/- 9) years old and the median time from onset to diagnosis 18 months. The main symptoms were fever (with a percentage of 67.0%), recurrent cough and expectoration (58.3%) and diarrhea(41.6%). Anemia and leukocytopenia were the common laboratory changes. All the cases were diagnosed due to the presence of hypoimmunoglobulinemia. The tests available for subtypes of lymphocytes in 9 patients showed that B cells and CD. T cells decreased obviously, with an inverse ratio of CD4/CD8, indicating T cell dysfunction. Clinical improvement was demonstrated after treatment with intravenously administered immunoglobulin (IVIG) in 10 cases. CONCLUSIONS: CVID is a heterogeneous group of immunologic disorders of unknown etiology, characterized by impaired antibody responses and recurrent airway and/or gastrointestinal infection and accompanied with autoimmune diseases or cancer. Hypo-immunoglobulinemia is the main evidence of its diagnosis. IVIG as a replacement therapy is an effective way of management.

[A clinical analysis of 9 cases of actinomycosis].

OBJECTIVE: To study the clinical features of actinomycosis and to increase the understanding of it. METHODS: To review the clinical data of 9 cases of actinomycosis retrospectively in Peking Union Medical College Hospital from January 1990 to June 2006. RESULTS: (1) Nine patients including 7 female and 2 male, with age ranging from 30 to 50 years (mean age 39.8 years) were studied and they suffered from the disease for a mean period of 13.1 months (2 - 36 months). (2) Three of the 9 patients had cervicofacial actinomycosis, 2 pelvic actinomycosis, 2 thoracic actinomycosis, 1 breast and 1 intestinal actinomycosis. In 3 cases the lesion spread to many other organs from the primary site. (3) The diagnosis was made with biopsy in 6 cases, sputum or sulphur granules in 2 and clinical as well as laboratory examination in one. (4) All the 9 patients accepted appropriate therapy of antibiotics and the treatment was effective in 8. The one failed to respond to antibiotics died. CONCLUSION: Actinomycosis is infrequent clinically. It usually presents as chronic abscess and may be misdiagnosed as malignant tumor. Clinical doctors should be vigilant of it, in order to diagnose and treat it in good season and to greatly improve the prognosis.

[Tuberculous meningitis in Chinese adults: a report of 100 cases].

OBJECTIVE: To investigate the clinical features, cerebrospinal fluid (CSF) changes, imaging characteristics, diagnostic methods, treatment regimens and outcomes of Chinese adult patients with tuberculous meningitis (TBM). METHODS: Clinical data of 100 cases of TBM admitted to Peking Union Medical College Hospital from January 1982 to December 2003 were investigated retrospectively. Data were collected with regard to the clinical, laboratory and demographic characteristics of the patients as well as the results of radiological investigations and data of clinical outcome. RESULTS: One hundred TBM cases were included in this study; there were 49 males and 51 females. The mean age was (31 +/- 11) years. Seventy percent of the patients was of chronic duration (11.1 +/- 9.2) weeks. Thirteen cases were definitely diagnosed through positive CSF culture and smear or brain biopsy, the remaining 87 cases were diagnosed clinically. Fever (97%), headache (92%), decreased level of consciousness (71%), meningeal irritation (77%) and impairment of cranial nerve function were the most frequent symptoms and signs. Thirty-five cases were accompanied with active pulmonary tuberculosis and 12 cases with extrapulmonary tuberculosis. Raised intracranial pressure was present in 86%. CSF was non-purulent with lymphocytic pleocytosis, marked elevation of protein concentration and significant decrease of glucose. Sixty-seven cases had imaging data; abnormalities were found in 52 with ventricular enlargement, hydrocephalus and infarction the most frequent findings. All the patients received anti-tuberculosis therapy, nine underwent neurosurgical drain due to hydrocephalus, eighty-one improved and seven died. CONCLUSIONS: TBM should be suspected when chronic meningitis was accompanied with active pulmonary or extrapulmonary tuberculosis. Differential diagnosis and trial anti-tuberculosis therapy may be of help for the diagnosis. Positive CSF smear and culture and biopsy of brain or meninges are the golden standards for the diagnosis of TBM. Early diagnosis and treatment are very important for improving the outcome.

Clinical outcomes and immune reconstitution in 103 advanced AIDS patients undergoing 12-month highly active antiretroviral therapy.

BACKGROUND: Highly active antiretroviral therapy (HAART) produces profound suppression of HIV replication, substantial increase in CD4(+) T cells, and partial reconstitution of the immune system. However, the numbers of subjects were small in previous Chinese studies. This study evaluated the efficacy and side effects of HAART in Chinese advanced AIDS patients. METHODS: One hundred and three antiretroviral drug naive AIDS patients were enrolled in this study and were divided into two groups by their baseline CD4(+) count: < 100 cells/microl or > or = 100 cells/microl. Clinical, virological and immunological outcomes were monitored at baseline and at 1, 3, 6, 9 and 12 months during the course of treatment with HAART. RESULTS: One patient died and another was lost from the follow-up. For the remaining 101 HIV/AIDS patients at the 12th month during the HAART, the plasma viral load (VL) was reduced to (3.2 +/- 0.7) lg copies/ml, the CD4(+) count increased to (168 +/- 51) cells/microl [among which the naive phenotype (CD45RA(+)CD62L(+)) increased to (49 +/- 27) cells/microl and the memory phenotype (CD45RA(-)) increased to (119 +/- 55) cells/microl], and the percentage of CD4(+)CD28(+) cells increased. At the same time, there was a significant reduction of CD8(+) T cell activation. In the 69 patients with the baseline CD4(+) count < 100 cells/microl, 37 had a VL < 50 copies/ml; while in the 34 patients with the baseline CD4(+) count > or = 100 cells/microl, 25 had a VL < 50 copies/ml, the difference between the two groups was statistically significant. The CD4(+) T cell count showed a two-phase increase during HAART and a significant positive correlation was shown between the change of CD4(+) count and plasma VL. Over 12 months of HAART, 10 patients had gastrointestinal side effects, 13 peripheral neuritis, 7 hepatic lesions, 8 hematological side effects, 8 skin rashes, 10 lipodystrophy and 1 renal calculus. CONCLUSIONS: Immune reconstitution as well as the significantly improved clinical outcomes is observed in Chinese advanced AIDS patients after HAART. Side effects are common during HAART and require clinical attention.

[The clinical outcome and immune reconstitution in 45 advanced AIDS patients undergoing highly active antiretroviral therapy for 12 months].

OBJECTIVE: To investigate the efficacy and side effects of highly active antiretroviral therapy (HAART) in Chinese AIDS patients. METHODS: 45 antiretroviral drug-naive AIDS patients were enrolled and divided into two groups by their baseline CD(4) count < 100/microl or > or = 100/microl. Clinical, virological and immunological outcomes as well as side effects were followed at baseline and at the end of month 1, 3, 6, 9, 12 after receiving HAART. RESULTS: Among the 45 HIV/AIDS patients included, by the end of 12 months of HAART, the plasma viral load (VL) got a mean reduction by 2.8 lg copies/ml, CD(4) count had a mean gain of 187/microl, among which the naive phenotype increased by 68/microl and the memory phenotype by 119/microl. The CD(4)(+)CD(28)(+) T cell percentage went up from (62.5 +/- 25.8)% to (82.6 +/- 15.6)% (P < 0.001); and there was a significant reduction of CD(8)(+) T-cell activation. In the 31 patients with their baseline CD(4) count < 100/microl, 11 had a VL < 50 copies/ml, and 14 had fluctuations in their VL; while in 14 patients with their baseline CD(4) count > or = 100/microl, 10 had a VL < 50 copies/ml and 2 had fluctuations in their VL, respectively, with statistic significance between the two groups. CD(4) count showed a bi-phase increase during HAART and there was significant positive correlation between the change of CD(4) count and plasma VL. Throughout the 12 months of HAART, 39 patients had gastrointestinal side effects, 15 peripheral neuritis, 3 hepatic lesions, 4 hematological side effects and 1 renal calculus. 9 patients had adjustment of their initial therapy because of side effects. CONCLUSIONS: Immune reconstitution as well as significant therapeutic effect was observed in advanced Chinese AIDS patients after HAART. Side effects were common during HAART, so close clinical attention is needed.

[Characteristics of immunophenotypic alterations in 263 HIV/AIDS patients].

OBJECTIVE: To explore the characteristics of immunophenotypic alterations of HIV-infected persons/AIDS patients--people living with AIDS (PLWA). METHODS: The clinical data and anti-coagulated blood samples of 263 treatment naive PLWA and 56 healthy controls were collected. Flow cytometry was used to determine the sets of peripheral lymphocytes: B cell, NK cell, CD4(+) T cell including the functional subset (CD28(+)CD4(+) cell), naïve subset (CD4(+)CD45RA(+)CD62L(+) cell), and memory subset (CD4(+)CD45RA(-)cell) of CD4(+) T cell, CD8(+) T cell including the activated subset (CD8(+)CD38(+) cell). Branch DNA (bDNA) assay was used to detect the plasma viral load. RESULTS: The mean CD4(+) T cell count, naïve CD4(+) T cell percentage, and CD28 expression rate in CD4(+) T cells of the PLWA were 205 (348, 63) x 10(6) cells/L, 18.5 (32.0, 6.5)%, and 86.1 (94.0, 68.3)% respectively, all significantly lower than those of the healthy controls [787 (1058, 615) x 10(6) cells/L, 35.4 (45.5, 30.0)%, and 95.7 (97.6, 91.0)% respectively, all P < 0.01]. The percentage of CD38 expression in CD8(+) T cells of the PLWA was 84.3 (92.7, 69.0)%, significantly higher than that of the controls [42.6 (50.6, 36.1)%, P < 0.01]. In the PLWA the CD4(+) T cell count was positively correlated with its CD28 expression (r = 0.480, P < 0.01), and the percentage of CD38 expression in CD8(+) T cells was positively correlated with eh plasma viral load (r = 0.331, P < 0.01). The PLWA were divided into 3 groups according to the CD4(+) T cell count: Group A with the he CD4(+) T cell count < 200 x 10(6) cells/L, Group B with the CD4(+) T cell count of 200 - 350 x 10(6) cells/L, and Group C with the CD4(+) T cell count > 350 x 10(6) cells/L. In comparison with Groups B and C the plasma viral load, activated CD8(+) T cell subset proportion, and percentage of memory CD4(+) T cells of Group A were all significantly higher, and the naive CD4(+) T cell percentage and CD28 expression rate were both significantly lower (all P < 0.01). There were no significant differences in the percentage of memory CD4(+) T cells, CD28 expression, and CD8(+) T cell activated subset proportion between Groups B and C. CONCLUSION: The major immunophenotypic alternations in the PLWA in China include significantly lower counts of CD4(+) T cells and their naive subsets, marked down-regulation of CD28 expression and extremely activated CD8(+) T cells. Distinct features of the immunophenotypic alteration may exist in different disease stages. The CD4(+) T cell count < 200 x 10(6) cells/L may predict more severe immunodeficiency.

[Clinical characteristics of 143 Chinese HIV/AIDS patients].

OBJECTIVE: To investigate the clinical characteristics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in China. METHODS: Totally 143 HIV/AIDS patients who were first diagnosed in Peking Union Medical College Hospital form January 1988 to April 2006 were enrolled in this study. Clinical characteristics were retrospectively analyzed. RESULTS: Among 143 HIV/ AIDS patients, 57 patients had no clinical symptoms and were confirmed by routine examinations; 86 patients had clinical symptoms, including fever (n = 50), weight loss (n = 18), and discomforts involving respiratory system (n = 34), gastrointestinal system (n = 16), and derma and mucosa (n = 17). Opportunistic infections (OIs) such as pneumocystis jiroveci pneumonia (PCP) (n = 27), oropharyngeal candidiasis (n = 16), tuberculosis (n = 15) , and cytomegalovirus (CMV) infection (n = 9) were also observed in patients whose CD4 + T cell counts were less than 200/mm3. Most CMV infection and cryptococcal meningitis occurred in patients whose CD4 + T cell counts were less than 100/mm3. CD4 + T cell count was negatively correlated with plasma viral load (r = -0.420, P = 0.001). CONCLUSIONS: Fever, dyspnea, and weight loss are the most common symptoms in the patients of this study. The respiratory system, gastrointestinal system, derma and mucosa are the most commonly affected areas by OIs, and PCP is the most common OI. The occurrence of OIs corelates with CD4 + T cell count.

NFKB2 mutation in common variable immunodeficiency and isolated adrenocorticotropic hormone deficiency: A case report and review of literature.

BACKGROUND: Common variable immunodeficiency (CVID) with central adrenal insufficiency is a recently defined clinical syndrome caused by mutations in the nuclear factor kappa-B subunit 2 (NFKB2) gene. We present the first case of NFKB2 mutation in Asian population. METHODS AND RESULTS: An 18-year-old Chinese female with adrenocorticotropic hormone (ACTH) deficiency was admitted due to adrenal crisis and pneumonia. She had a history of recurrent respiratory infections since childhood and ectodermal abnormalities were noted during physical examination. Immunologic tests revealed panhypogammaglobulinemia and deficient natural killer (NK)-cell function. DNA sequencing of NFKB2 identified a heterozygous nonsense mutation (c.2563 A>T, p.855: Lys>*) in the patient but not her parents. CONCLUSION: Clinicians should be alert to comorbidities of adrenal insufficiency and ectodermal dysplasia in CVID patients as these might suggest a rare hereditary syndrome caused by NFKB2 mutation.

[A clinical analysis of 22 cases of Pneumocystis pneumonia in acquired immunodeficiency syndrome].

OBJECTIVE: To investigate the clinical characteristics, therapeutical approaches and outcome of Pneumocystis pneumonia (PCP) in patients with AIDS. METHODS: The clinical data of 22 PCP patients with AIDS who were treated in Peking Union Medical College Hospital from January 1992 to October 2004 were analyzed, including the routes of HIV infection, clinical profiles, immunological status, chest radiological characteristics, therapeutic managements and outcome. RESULTS: (1) Of the 22 PCP patients, 16 were male and 6 female. The average age was (35.0 +/- 9.4) years old. The majority of patients got HIV infection through blood transfusion (54.5%) and sexual transmission (27.3%). (2) The common clinical presentations were fever (21/22), progressive exertional dyspnea (20/22), cough (16/22), sputum (12/22) and weight loss (18/22). 68.2% (15/22) of the patients had normal or mild coarse breath sounds on auscultation. 14 patients had an PaO(2) less than 60 mm Hg (1 mm Hg = 0.133 kPa). (3) All the 22 PCP cases were in their late stage of AIDS. For the 20 patients who had an immunological test, the peripheral CD(4)(+) T lymphocyte count was ranging from 3 x 10(6)/L to 148 x 10(6)/L and 90% of the cases had a CD(4)(+) T cell count less than 100 x 10(6)/L, 95% of the cases had a CD(4)(+)/CD(8)(+) ratio less than 0.20; (4) The most common abnormal chest radiological findings were bilateral diffuse interstitial infiltrations (19/22) and patchy shadows (14/22); (5) All patients were given trimethoprim-sulfamethoxazole (SMZco) and 86.4% of the patients were treated with corticosteroids concomitantly. Of the 22 PCP patients, 13 recovered, 5 gave up after knowing their definite diagnosis, 4 died. Comparing with the recovery patients, the 4 patients who died of PCP had much lesser CD(4)(+) T cell count (P = 0.07). CONCLUSIONS: Most PCP occurred in patients who were in their late stage of AIDS and with a CD(4)(+) T cell count below 100 x 10(6)/L. For these reasons, we suggest that whenever encountering a young patient presenting with fever, dyspnea, hypoxia, loss of weight, the possibility of PCP complicating AIDS should be considered, especially when chest radiological study revealed interstitial infiltration or patchy shadows. If HIV was confirmed to be positive, the combined therapy of SMZco and corticosteroids should be started immediately.

Low-dose adefovir dipivoxil may induce Fanconi syndrome: clinical characteristics and long-term follow-up for Chinese patients.

BACKGROUND: Adefovir dipivoxil (ADV) nephrotoxicity is well known at a dose of 60 mg day(-1) or 120 mg day(-1). However, renal toxicity at a low-dose of 10 mg ADV for HBV-infected patients is not fully described. Our objective was to analyse the clinical features and outcomes of ADV-related Fanconi's syndrome in the Chinese population. METHODS: This was a retrospective study. A total of 35 patients with ADV-related Fanconi's syndrome were studied. Clinical manifestations and biochemical parameters were analysed. 19 patients were from Peking Union Medical College Hospital (PUMCH) included from August 2010 to December 2012. A total of 16 patients were eligible from case reports in the Chinese population retrieved in PUBMED, WANFANG and CNKI database. Bone mineral density and biochemical parameters including serum phosphate, calcium, creatinine, alkaline phosphatase (ALP) were measured before and after ADV cessation and during the follow-up. RESULTS: All recruited patients had hypophosphataemia, increased urinary phosphate excretion and elevated alkaline phosphatase. Serum phosphate levels rapidly increased especially within the 4 weeks after ADV cessation. Serum creatinine remained high or at the upper limit of normal range even after ADV cessation for 1 year. ALP increased in the first three months of ADV cessation and decreased at the 24th week. Bone mineral density was significantly improved after 6 months cessation of ADV. CONCLUSIONS: ADV can be nephrotoxic at prolonged low doses of 10 mg. For those who take ADV long term, regular monitoring of serum phosphate, creatinine levels and urine routine tests are required.