Nocardiosis pulmonar y del sistema nervioso central: el alcoholismo como factor de inmunocompromiso / Pulmonary and central nervous system nocardiosis: Alcoholism as an immunocompromising factor

La nocardiosis es una enfermedad de distribución mundial; de forma habitual se encuentra en zonas tropicales y afecta principalmente a pacientes inmunocomprometidos, sin embargo, también existen casos reportados de infección en personas inmunocompetentes. Esta infección es causada por actinomicetos del género Nocardia spp. que son bacterias Gram positivas, saprófitos ambientales. Aunque la exposición a Nocardia spp. es casi universal, solo una pequeña fracción de las personas expuestas desarrollan la enfermedad. Se presenta el caso de un hombre de 47 años, sin dato de inmunosupresión, procedente de un área rural de Boyacá, que consultó por un cuadro clínico de cefalea intensa e intermitente, con parestesias y, finalmente, alteración del estado de conciencia. Se practicó una resonancia magnética cerebral, en la que se evidenció una lesión que ocupaba espacio de localización córtico-subcortical en la región fronto-témporo-parietal izquierda, con efecto compresivo y desplazamiento de las cavidades del sistema ventricular. Se sospechó, inicialmente, una lesión neoplásica o un absceso cerebral. El paciente fue sometido a una resección quirúrgica, y el cultivo de la lesión documentó Nocardia africana/nova; en estudios posteriores, se evidenció un posible foco pulmonar primario. Como único factor de riesgo en el paciente, se documentó alcoholismo. Completó seis semanas de tratamiento antibiótico intrahospitalario con evolución clínica y radiológica, y egresó con plan de un año de terapia antibiótica ambulatoria. Aunque la enfermedad por Nocardia spp. afecta principalmente a pacientes inmunocomprometidos, la "evidencia" clínica demuestra que este microorganismo también puede ser una amenaza para individuos sin los factores de riesgo tradicionales para inmunosupresión.

Nocardiosis is a disease with worldwide distribution. It is usually found in tropical areas and mainly affects immunocompromised patients, however, there are also cases where its infection has been reported in immunocompetent patients. This pathology is caused by bacteria known as Nocardia spp., which are gram-positive microorganisms and environmental saprophytes, and although exposure to Nocardia spp. is almost universal, only a small fraction of exposed people develops the disease. We present the case of a 47-year-old man, with no evidence of immunosuppression, from a rural area of Boyacá, who was admitted due to intense and intermittent headache accompanied by paresthesia and, finally, a decrease in consciousness. A brain magnetic resonance was performed and evidenced a fronto-temporo- occipital space-occupying lesion in the cortico-subcortical region with a compressive effect and displacement of the ventricular system cavities. It was suspected at first a neoplastic lesion or a brain abscess. The lesion was surgically resected, and its culture showed Nocardia africana/nova. In later studies a possible primary pulmonary focus was evidenced. Alcoholism was the only risk factor documented. The patient completed 6 weeks of hospital antibiotic treatment with favorable clinical and radiological evolution and was discharged with a 1-year plan of outpatient antibiotic therapy. Although Nocardia spp. mainly affects immunocompromised patients, evidence shows that this microorganism can also be a threat to individuals without traditional immunosuppression risk factors.

Loss of an eye to mucormycosis following corticosteroid therapy for COVID-19

Mucormycosis is a rare, sometimes severe fungal infection that has emerged as a possible complication of COVID-19. We report a case of a non-diabetic, apparently immunocompetent patient diagnosed with rhino-orbital-cerebral mucormycosis shortly after COVID-19 treatment with dexamethasone. The patient received optimized systemic antifungal therapy and extensive surgical treatment. So far, four months after the last hospital discharge, the patient has been in good general condition. This case is a dramatic reminder that beneficial corticosteroid therapy in general inevitably carries a risk of opportunistic infection, and corticosteroid therapy for COVID-19 risks orbital-rhinocerebral mucormycosis that clinicians should watch for with vigilance.

Rendimiento de dos índices predictores de mortalidad (PSI y CURB-65) en pacientes adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad / Yield of two mortality predictors in immunocompetent patients with community acquired pneumonia

Background: The severity of community acquired pneumonia (CAP) can be evaluated by the PSI and CURB-65 scales. However, it is unknown whether their predictive capacity varies according to the etiology of the disease. Aim: To compare the performance of these scales in adults with viral, bacterial, mixed, and no agent detected CAP. Material and Methods: We studied 725 patients hospitalized for CAP aged 18 to 95 years (47% females) Urinary S. pneumoniae and Legionella antigens were detected by immuno-chromatography (Binax®). Respiratory viruses and bacteria were detected by PCR in nasopharyngeal smears. The proportions of deaths, admission to the intensive care unit (ICU), and oxygen therapy were compared between mild and non-severe patients defined by PSI (I/II and I-III) and CURB-65 (1 and 1-2), according to the causative agent. Results: Ten percent of patients died. A causative agent was detected in 65%. The proportion of mild and non-severe patients according to PSI and CURB-65, and of deceased patients, admitted to the ICU and with oxygen therapy was similar in the four categories per agent. There were no deaths among non-severe patients with bacterial CAP. However, 6% of patients with CAP caused by virus or without causative agents, died. No deaths occurred among mild patients with bacterial CAP. In viral CAP, no deaths occurred among patients classified as mild only by PSI. The yields of PSI were greater than those of CURB-65 in non-severe patients who died and were admitted to the ICU with bacterial and viral CAP (5 and 14%; 7 and 12% respectively, p = 0.04). Conclusions: The prognostic performance of PSI in CAP varies according to the causative agent in adults. It is higher in non-severe bacterial cases, and superior to CURB-65.

Immune system: development and acquisition of immunological competence

Abstract Objectives: To describe the ontogeny of the immune system and the adaptive mechanisms of the immune system in the neonatal period, with an emphasis on transplacental antibody transport and breastfeeding. Source of data: Non-systematic literature review in the PubMed database. Summary of the findings: The last two decades have witnessed a great advance in the knowledge of the immune system since conception. Several investigation tools have provided insight on phenomena that were previously inadequately understood. Still expanding, the functional and molecular investigation of various aspects of the immune system will make it possible to understand how intra-uterus maternal-fetal exchanges, the maternal microbiota interacting with the fetus and newborn, and the acquisition of immunological competence occur in healthy and disease scenarios. Conclusions: In-depth knowledge of the development of the immune system and of the adaptive mechanisms that allow a safer transition to the extrauterine environment are fundamental components of optimizing maternal and young infant vaccination, as well as the strategies associated with full postnatal development, and the early diagnosis and treatment of innate errors of immunity.

Bilateral cavernous sinus and left dural sigmoid sinus thrombosis associated with extreme exertion: a case report / Trombose bilateral do seio cavernoso e do seio sigmoide esquerdo associada a exercício extremo: relato de caso

ABSTRACT Septic cavernous sinus thrombosis is a rare but often debilitating and potentially fatal disease. We describe a case of bilateral orbital cellulitis with rapidly progressing cavernous sinus thrombosis and left sigmoidal sinus thrombosis in an immunocompetent 20-year-old military man who had undergone intensive physical training. The patient presented with rapid painful swollen left eye for 2 days. The examination results were gross proptosis with total ophthalmoplegia. He was treated with intravenous antibiotics and corticosteroid. At 1 week, visual acuity improved to 20/20 OU, with a normal intraocular pressure. There was a significant improvement in proptosis. The ocular motility of the right eye was fully restored, with slight residual ophthalmoplegia in the left eye. There was no residual illness or recurrence of illness at 3 months' follow-up.

RESUMO A trombose séptica do seio cavernoso é uma condição rara, mas frequentemente debilitante e potencialmente fatal. Descrevemos um caso de celulite orbital bilateral com progressão rápida para trombose do seio cavernoso e trombose do seio sigmoide esquerdo, em um militar imunocompetente de 20 anos de idade que havia sido submetido a treinamento físico intenso. O paciente apresentou um inchaço rápido e doloroso no olho esquerdo por 2 dias. Os resultados do exame foram proptose macroscópica com oftalmoplegia total. Ele foi tratado com antibióticos intravenosos e costicosteróide. Em 1 semana, a acuidade visual melhorou para 20/20, com pressão intraocular normal. Houve uma melhora significativa na proptose. A motilidade ocular do olho direito foi totalmente restaurada, com leve oftalmoplegia residual no olho esquerdo. Não houve doença residual ou recorrência da doença após três meses de acompanhamento.

Study on Separation and Immunocompetence of Water Extract of Polysaccharide from Cistanche tubulosa / 中国药房

OBJECTIVE：To isolate the water extract of polysaccharide from Cistanche tubulosa ，and to investigate their immunocompetence in vitro . METHODS ：AB-8 macroporous adsorption resin was used to decolorize C. tubulosa polysaccharide. The decolorization process was optimized by orthogonal test with retention rate and decolorization rate of polysaccharide as comprehensive score ，and using adsorption rate ，decolorization time ，sample concentration as factors. The verification tests were conducted. DEAE- 650M ion exchange column was used to separate the water extract of decolorized C. tubulosa polysaccharide. CCK-8 assay was used to detect the effect s of different concentration of polysaccharide （6.25-100 μg/mL）before and after isolation on the proliferation rate of mice macrophage RAW 264.7. Griess method and ELISA assay were adopted to detect the effects of low ， medium and high concentration of polysaccharide （12.5，25，50 μg/mL）on the release of NO ，IL-6 and TNF-α in LPS-induced RAW264.7 cells. RESULTS ：In the optimal decolorization process of AB- 8 macroporous adsorption resin ，the adsorption flow rate was 1.2 BV/h，the decolorization time was 9 h，and sample concentration was 25 mg/mL. The comprehensive scores of 3 times of verification tests were 63.43％，63.29％ and 63.34％，respectively，with an average of 63.35％（RSD＝0.11％，n＝3）. One neutral polysaccharide （CTZ）and 5 acid polysaccharides （CT1，CT2，CT3，CT4，CT5）were isolated from the polysaccharide of C. cistanche ，the contents were 299.2，168.0，123.2，121.6，54.4，11.2 mg/g. Compared with control group ，6.25-100 μg/mL CTZ （except for 6.25 μg/mL），CT2，CT4，CT5 and 6.25 μg/mL CTC（the polysaccharide before seperation ）could significantly increase the proliferation rate of RAW 264.7 cells（P＜0.05），while 6.25-100 μg/mL CT1，CT3 and 50 μg/mL CTC could decrease te proliferation rate of RAW 264.7 cells（P＜0.05）. Compared with LPS group ，the release of NO were decreased significantly in low，medium and high concentration groups of CTC ，CT2，CT3 and CT 5，CTZ low concentration group （P＜0.05），while were increased significantly in high concentration groups of CT 1 and CT 4 （P＜0.05）. The release of IL- 6 （except for CT 1 high concentration group and CT 5 low concentration group ）and TNF-α（except for CT 1 medium concentration group ）were decreased significantly in low ，medium and high concentration groups （P＜0.05）. CONCLUSIONS ：The optimized decolorization technology of macroporous adsorption resin is stable and feasible in the study. One neutral polysaccharide and 5 acidic polysaccharides can be isolated from water extract of C. tubulosa polysaccharides，among which CT 2 polysaccharide has stronger anti-inflammatory ability.

Extensively drug-resistant Salmonella typhi causing rib osteomyelitis: A case report

Rationale: Salmonella (S.) typhi is a rare cause of osteomyelitis in immunocompetent adults. Extensive drug resistance (XDR) may lead to more complicated cases of S. typhi osteomyelitis. Patient concern: A 55-year-old female presented with a persistent low-grade fever and a swelling on her lower left chest with a sinus discharging purulent fluid for the past 8 months. Her symptoms had been unresponsive to previous anti-microbial therapy. Diagnosis: Rib osteomyelitis caused by XDR S. typhi. Interventions: Surgical wound debridement, left 7th-9th rib resection and intravenous IV meropenem were done. Outcome: Fever resolved and left-sided swelling resected without recurrence. Lessons: The prevalence of XDR S. typhi is growing in South Asia and should be considered as the differential diagnosis of chronic osteomyelitis.

Primary cutaneous histoplasmosis difficult to treat in immunocompetent patient: case report and literature review / Histoplasmose cutânea primária de difícil tratamento em paciente imunocompetente: relato de caso e revisão da literatura

ABSTRACT Histoplasmosis is an infection caused by the dimorphic fungus Histoplasma capsulatum. The disease is endemic in several regions of tropical and temperate climate. The fungus presents opportunistic behavior, causing widespread infection in immunocompromised patients, resulting from complication of primary pulmonary infection, due to exogenous reinfection or reactivation of a quiescent source. In immunocompetent individuals, approximately 95% of pulmonary infections are asymptomatic. However, prolonged exposure to high amount spores may lead to acute or chronic lung infection. Due to the low amount of inoculum, primary cutaneous histoplasmosis caused by traumatic implantation is extremely rare and effectively treated with triazoles. Thus, the present study aims to report a case of primary cutaneous histoplasmosis that is difficult to treat in an immunocompetent patient, and to review the literature on the incidence of drug-resistant Histoplasma capsulatum strains in clinical practice.

RESUMO A histoplasmose é uma infecção causada pelo fungo dimórfico Histoplasma capsulatum. A doença é endêmica em diversas regiões de clima tropical e temperado. O fungo apresenta comportamento oportunístico, causando infecção disseminada em pacientes imunocomprometidos, resultante da complicação da infecção pulmonar primária, por reinfecção exógena ou reativação de um foco quiescente. Em indivíduos imunocompetentes, cerca de 95% das infecções pulmonares são assintomáticas. No entanto, a exposição prolongada à quantidade elevada de esporos pode levar à infecção pulmonar aguda ou crônica. Devido à baixa quantidade de inóculo, a histoplasmose cutânea primária causada por implantação traumática é extremamente rara e efetivamente tratada com triazóis. Assim, o presente estudo tem como objetivos relatar um caso de histoplasmose cutânea primária de difícil tratamento em paciente imunocompetente, e revisar a literatura a respeito da incidência de cepas de Histoplasma capsulatum resistentes aos fármacos utilizados na prática clínica.

Achados Epidemiológicos de Neurocriptococose em Pacientes Imunocompetentes: Relato de Casos de um Hospital Público de Joinville, Brasil / Epidemiological Findings of Neurocriptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, Brazil / Hallazgos epidemiológicos de la neurocriptococosis en pacientes inmunocompetentes: relato de casos de un hospital público en Joinville, Brasil

Justificativa e Objetivos: Neurocriptococose é uma doença fúngica que acomete principalmente pacientes imunocomprometidos. Casos em pacientes imunocompetentes têm sido descritos em alguns relatos de casos; no entanto, por não ser uma doença de notificação compulsória no Brasil até 2020, ainda pouco se sabe sobre sua epidemiologia no sul do país. O presente estudo teve como objetivo descrever aspectos epidemiológicos relacionados à doença em pacientes supostamente imunocompetentes. Métodos: Estudo retrospectivo, observacional, baseado em uma série de casos atendidos entre 2018 e 2019, em um hospital público de Joinville, Santa Catarina, Brasil. Pacientes com diagnóstico clínico confirmado pela presença do fungo do gênero Cryptococcus spp. no líquido cefalorraquidiano pelo método tinta da China foram avaliados quanto aos aspectos clínicos, tratamento e complicações durante o período de internação. Resultados: Houve dois pacientes em 2018 e seis pacientes em 2019 com diagnóstico confirmado. Todos sem fatores aparentes para imunocomprometimento e sem fator de risco ambiental evidente. A maioria eram homens com média de idade de 39 anos. Febre e confusão mental foram os achados mais comuns na apresentação. A variante C. neoformans foi encontrada em 75% dos casos. Todos receberam Anfotericina B, no mínimo, durante 13 dias, associado ou não a Fluconazol. Seis pacientes apresentaram nefrotoxicidade pela Anfotericina B, dois evoluíram para óbito intra-hospitalar e dois permaneceram com sequelas neurológicas. Conclusão: A mortalidade e as complicações relacionadas ao tratamento da neurocriptococose em pessoas imunocompetentes foram altas na amostra estudada. A recente inclusão da doença como uma patologia de notificação compulsória poderá aprimorar dados epidemiológicos para o melhor entendimento e a prevenção dessa doença.(AU)

Background and Objectives: Neurocryptococcosis is a fungal disease that affects mainly immunocompromised patients. Cases in immunocompetent patients have been described in some case reports. However, as its reporting was not mandatory in Brazil until 2020, little is known about its epidemiology in the South Region of the country. The present study had the objective of describing epidemiological aspects related to the disease in presumably immunocompetent patients. Methods: A retrospective and observational study was developed, based on cases of patients who received care in a public hospital in Joinville, Santa Catarina, Brazil, between 2018 and 2019. Patients with a clinical diagnosis confirmed by the presence of the fungus Cryptococcus spp. in cerebrospinal fluid by means of the Chinese ink staining were evaluated regarding clinical aspects, treatment, and complications during hospitalization. Results: The diagnosis of the disease was confirmed for two patients in 2018 and six patients in 2019. All of them showed no apparent factors for immunodeficiency and no evident environmental risk factors. Most were men with an average age of 39 years. Fever and mental confusion were the most common symptoms at admission. The variant C. neoformans was found in 75% of the cases. All patients received amphotericin B for at least 13 days with or without combined fluconazole. Six patients had nephrotoxicity due to amphotericin B, two evolved to in-hospital death, and two had neurological sequelae. Conclusion: Mortality and complications related to the treatment of neurocryptococcosis in immunocompetent people showed high rates in the studied sample. The recent inclusion of this disease as a mandatory reporting pathology can improve epidemiological data, which will be used to achieve better understanding and prevention of this problem.(AU)

Justificación y Objetivos: La neurocriptococosis es una enfermedad fúngica que afecta especialmente a pacientes inmunocomprometidos. Fueron citados casos en pacientes inmunocompetentes en algunos relatos. Por no considerársela de notificación obligatoria en Brasil hasta 2020, poco se sabe aún sobre su epidemiología en el sur del país. El estudio objetivó describir aspectos epidemiológicos relativos a la enfermedad en pacientes supuestamente inmunocompetentes. Métodos: Estudio retrospectivo, observacional, en base a una serie de casos atendidos entre 2018 y 2019 en un hospital público de Joinville, Santa Catarina. Pacientes con diagnóstico clínico confirmado por presencia de Cryptococcus spp., utilizándose el método de tinta china en líquido cefalorraquídeo fueron evaluados respecto de aspectos clínicos, tratamiento y complicaciones durante su internación. Resultados: Hubo 2 pacientes en 2018 y 6 en 2019 con diagnóstico confirmado, todos sin factores aparentes de inmunocompromiso y sin factor de riesgo ambiental evidente. Mayoría de hombre, media etaria de 39 años. Fueron hallazgos comunes en su presentación la fiebre y confusión mental. La variante C. neoformans fue hallada en 75% de los casos. Todos recibieron anfotericina B como mínimo durante 13 días, en asociación o no con fluconazol. Seis pacientes presentaron nefrotoxicidad por anfotericina B, dos sufrieron fallecimiento intrahospitalario, y dos resultaron con secuelas neurológicas. Conclusión: La mortalidad y las complicaciones relativas al tratamiento de la neurocriptococosis en inmunocompetentes fueron altas en la muestra estudiada. La inclusión de la enfermedad como patología de notificación obligatoria podrá mejorar los datos epidemiológicos para entender mejor y prevenir la enfermedad.(AU)

Caracterización clínica de pacientes con infecciones del sistema nervioso central en un centro de atención terciaria / Clinical description of patients with central nervous system infections at a tertiary care center

Introducción: Las infecciones del sistema nervioso central constituyen un problema de salud a nivel mundial por la elevada morbimortalidad que produce. Objetivo: Caracterizar clínicamente a pacientes con infección del sistema nervioso central. Métodos: Estudio observacional, descriptivo y retrospectivo (2009-2018) en pacientes con infección del sistema nervioso central atendidos en el Hospital Hermanos Ameijeiras. Las variables estudiadas fueron: edad, sexo, tipo de infección, estado de inmunocompetencia, manifestaciones clínicas, complicaciones, agentes etiológicos, celularidad en el líquido cefalorraquídeo, estado al egreso, estadía hospitalaria. Resultados: Fueron incluidos 133 pacientes, 52,6 por ciento eran del sexo masculino y 45,9 por ciento tenían entre 40-59 años. Prevalecieron los pacientes con infecciones bacteriana en 58,6 por ciento, el staphylococcus sp fue el agente etiológico que más se identificó, la meningoencefalitis representó 36,8 por ciento, estaban inmunodeprimidos 56,4 por ciento, la cefalea y la fiebre estuvieron presente en 82,7 por ciento y la rigidez nucal en 15 por ciento. Las complicaciones respiratorias y la hidrocefalia representaron 21 por ciento y 12,8 por ciento respectivamente. El estado al egreso se asoció al estado de inmunocompetencia (p=0,002), la estadía hospitalaria (p=0,001) y el tipo de infección (p=0,002). Conclusiones: El principal tipo de infección según predominio de la celularidad fue la bacteriana, fue bajo el número de agentes etiológicos identificados. La meningoencefalitis fue la infección más frecuente. La cefalea, la fiebre y la rigidez nucal los síntomas y signos que predominaron, así como las complicaciones respiratorias y la hidrocefalia. Hubo asociación del estado al egreso con el tipo de infección, estado de inmunocompetencia y la estadía hospitalaria(AU)

Introduction: Central nervous system infections constitute a health problem worldwide due to the high morbidity and mortality that it produces. Objective: To clinically describe patients with central nervous system infection. Methods: An observational, descriptive and retrospective study was carried out from 2009 to 2018, in patients with central nervous system infection treated at Hermanos Ameijeiras Hospital. The variables studied were age, sex, type of infection, immunocompetence status, clinical manifestations, complications, etiological agents, cellularity in the cerebrospinal fluid, state at discharge, hospital stay. Results: One hundred thirty three patients were included, 52.6 percent were male and 45.9 percent aged between 40-59 years. Patients with bacterial infections prevailed in 58.6 percent, staphylococcus sp was the most identified etiological agent, meningoencephalitis accounted 36.8 percent, 56.4 percent were immunosuppressed, headache and fever were present in 82.7 percent and nuchal rigidity in 15 percent. Respiratory complications and hydrocephalus covered 21 percent and 12.8 percent respectively. Status at discharge was associated with immunocompetence status (p = 0.002), hospital stay (p = 0.001) and type of infection (p = 0.002). Conclusions: Bacterial infection was the main type of infection according to the cellularity predominance; the number of etiological agents identified was low. Meningoencephalitis was the most frequent infection. Headache, fever and nuchal stiffness were the predominant symptoms and signs, as well as respiratory complications and hydrocephalus. There was an association of the state at discharge with the type of infection, immunocompetence status and hospital stay(AU)

Pneumonia por toxoplasmose em paciente imunocompetente / Toxoplasma pneumonia in an immunocompetent patient: case repor

Com grande distribuição mundial e incidência significativa, a toxoplamose é uma doença comum em mamíferos e pássaros, causada pelo protozoário Toxoplasma gondii. No homem, o parasitismo na fase proliferativa intracelular pode se apresentar sem sintomas, ou causar clínica transitória caracterizada por febre, fadiga e linfadenopatia. Por se tratar de patologia com sintomas inespecíficos e comuns a muitas outras, é fundamental a correta pesquisa de diagnósticos diferenciais, como citomegalovírus e Epstein-Barr. Relatamos o caso de um jovem e hígido, que desenvolveu pneumonia e, após confirmação sorológica para toxoplasmose e o tratamento adequado, apresentou melhora clínica.

With great worldwide distribution and significant incidence, toxoplamosis is a common disease in mammals and birds, caused by the protozoan Toxoplasma gondii. In humans, the parasitism in its intracellular proliferative phase may present no symptoms, or cause a transient condition characterized by fever, fatigue, and lymphadenopathy. Because it is a pathology with nonspecific symptoms that are common to many other conditions, it is fundamental to find the correct research of differential diagnoses, such as for Cytomegalovirus and Epstein Barr. We report a case of a young and healthy man who developed pneumonia and, after serological confirmation for toxoplasmosis and the appropriate treatment, presented clinical improvement

Immunogenicity analysis of sequential inoculation of different strains of poliomyelitis vaccines in Shanghai / 中华预防医学杂志

Objective@#To evaluate the immunogenicity of different strains of inactivated poliomyelitis vaccines (IPV) by sequential program.@*Methods@#This parallel-group controlled trial was conducted in immunization clinics in Shanghai from March 2016 to September 2017. Sabin strains inactivated poliomyelitis vaccines (sIPV), WPV strains inactivated poliomyelitis vaccines (wIPV) and live poliomyelitis Type Ⅰ Type Ⅲ vaccine (bOPV) as the investigational vaccine were used at 2, 3, 4 months old in 325 infants in Shanghai. Infants vaccinated by four sequential program were divided into 4 groups: sIPV+sIPV+bOPV, sIPV+wIPV+bOPV, wIPV+sIPV+bOPV and wIPV+wIPV+bOPV. A total of 230 investigators′ blood samples were collected before primary immunization and 163 investigators′ blood samples were collected after primary immunization. A total of 151 investigators (36, 44, 30 and 41 in each group) finished primary immunization and blood sampling before and after the primary immunization. The geometric mean titer (GMT) of poliovirus typesⅠ and Ⅲ neutralizing antibody was tested and calculated, and the positive results of antibody before and after primary immunization were analyzed.@*Results@#Among the 151 investigators, the age were (2.27±0.61) months and birth weight were (3.27±0.43) kg, and 70 were male. The positive rates of typeⅠwas 98.68% (149 cases), and type Ⅲ was 97.35% (147 cases); the number of investigators tested in each group was 36, 44, 30 and 41, respectively; the positive rates of typeⅠwas 97.22% (35 cases), 100.00% (44 cases), 96.67% (29 cases) and 100.00% (41 cases) (P=0.345); the positive rates of type Ⅲ were 97.22% (35 cases), 95.45% (42 cases), 96.67% (29 cases) and 100.00% (41 cases) (P=0.614).@*Conclusion@#Using sIPV and wIPV simultaneously or alternately for sequential immunization of poliomyelitis vaccines showed good immunogenicity for infants at appropriate age.

The correlation between 25-hydroxy-vitamin D and serological indexes, immunological indexes in patients with rheumatoid arthritis / 中华风湿病学杂志

Objective To explore the expression and significance of vitamin D (VitD) in patients with rheumatoid arthritis (RA),and analyze the relationship between its expression and clinical indicators.Methods Clin-ical parameters and laboratory examinations of RA cases (n=250) were collected.Clinical parameters included were gender,age,disease course,swollen joints number,tenderness joints number,visual analog pain score (VAS),disease activity score (DAS)28 score.Laboratory examinations included erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibody,antinuclear (ANA) antibody,antikeratin (AKA) antibody,anti-perinuclear factor (APF),anti-mutated citrullinated vimentin (MCV),antibody and anti-6-glucose phosphate isomerase (GPI) antibody,lymphocyte subsets in the peripheral blood and lymphocyte subsets of CD4+T cells.The level of 25-(OH)-Vit-D and clinical parameters,laboratory examinations were analyzed retrospectively.One-way ANOVA and KruskalWallis test were used for comparison among the groups;and the correlation analysis was performed by Pearson and Spearman rank correlation analysis.Results ① The level of 25-(OH) D in RA patients was significantly lower than that in healthy controls (t=11.676,P＜0.01).② According to 25-(OH)D level,RA patients were divided into the deficiency group,insufficient group and normal group,the tender joints count (x2=17.793,P＜0.001),the number of swollen joints (x2=12.635,P=0.002),ESR (F=6.330,P=0.002),VAS score (F=5.095,P=0.007,DAS28 (F=4.990,P=0.008) were different significantly amorg the three groups.③RF (x2=6.742,P=0.034) and anti-CCP antibody (x2=6.836,P=0.033) were different significantly among the three groups and the level of 25-(OH) D was negatively correlated with RF (r=-0.202,P=0.001),anti-CCP antibody (r=-0.220,P＜0.01),anti-MCV antibody (r=-0.109,P=0.002) and AKA (r=-0.215,P=0.001).④ The level of 25-(OH) D in the RF (t=-2.715,P=0.007),anti-CCP antibody (t=-2.03,P=0.044),AKA (t=-2.108,P=0.036) negative group was significantly higher than that in patients with antibody positive group.⑤ The level of Th1 (IFN-γ) cells (F=3.259,P=0.043) and Treg (CD4+CD25+Foxp3+) cells (F=4.342,P=0.031) were significantly different among the three groups and the level of 25-(OH) D was positively correlated with Treg (CD4+CD25+Foxp3+) cells (r=0.146,P=0.025).Conclusion Vitamin D is generally deficient in RA patients,which is significantly correlated with disease activity,RF,anti-CCP antibody,anti-MCV antibody,AKA and Th1,Treg cells.It is suggested that vitamin D may play an important role in the immunological pathogenesis and disease progression of RA.

Two cases of pyogenic liver abscess due to Klebsiella pneumoniae in immunocompetent children

Pyogenic liver abscess (PLA) can be caused by bacteria entering the liver via the portal vein or primary bacteremia, or it can be cryptogenic. Recently, Klebsiella pneumoniae has been increasingly found as a PLA pathogen. PLA due to this bacterium often leads to formation of extrahepatic abscesses. The treatment of choice is dual therapy with insertion of percutaneous catheter drainage and antibiotic therapy. We report 2 cases of PLA due to K. pneumoniae in immunocompetent children. We successfully treated patient 1 with percutaneous catheter drainage for 18 days and 6-week course of antibiotic therapy. Patient 2 was treated with percutaneous needle aspiration and antibiotic therapy for the same period. In both patients, the PLAs showed the ultrasound-confirmed resolutions after the dual therapy.

Gastric Ulcers with Cytomegalovirus Infection in an Immunocompetent Patient

Cases of cytomegalovirus (CMV) infection are rare, and this infection is commonly asymptomatic in immunocompetent patients. Here, we report a pathologically proven case of CMV infection in gastric ulcers in an immunocompetent patient. A 35-year-old man visited our hospital for a surveillance esophagogastroduodenoscopy. Except fatigue, he had no other symptoms. Laboratory data showed that his white cell count was 9.28×10³/µL with 60.1% lymphocytes. However, aspartate transaminase and alanine aminotransferase levels were elevated. Esophagogastroduodenoscopy revealed multiple gastric ulcers that were healing. Two endoscopic biopsies were performed to obtain specimens at the ulcer base. Histological examination and immunohistochemistry confirmed CMV infection; subsequently, we decided that the best option was observation without medication. He revisited a month later, and the ulcers had disappeared.

Identification and clinical significance of Bordetella holmesii isolated from a rare case of bacteremia in Nantong China / 中华微生物学和免疫学杂志

Objective To analyze the identification, drug resistance and clinical significance of a rare bacterium of Bordetella holmesii ( B. holmesii) to improve its detection and clinical diagnosis and treat-ment. Methods A strain isolated from a bacteremia case was identified by bacterial culture, biochemical tests and 16S rRNA gene sequencing. Mega 7. 0 software was used to conduct a similarity analysis of 16S rRNA gene sequences between the type strains of Bordetella spp. and the isolate, and then a phylogenetic tree was constructed. Antibiotic resistance of the isolate was determined by E-test. Changes in bacterial growth were measured after adding different concentrations of riboflavin or its inhibitor lumiflavin to the cul-ture medium. Results B. holmesii ABD2 was the pathogen causing bacteremia in the immunocompetent pa-tient. It was deposited under the number of CGMCC 1. 13721 in China General Microbiological Culture Col-lection Center (CGMCC), and the 16S rRNA gene sequences were deposited in National Center for Biotech-nology Information ( NCBI) with the accession number of KT828544. 1. Unrooted tree showed that the B. holmesii strain was highly homologous with B. pertussis. Antibiotic susceptibility test showed that the mini-mum inhibitory concentrations ( MIC) of piperacillin, ceftazidime, cefepime, imipenem, meropenem, cipro-floxacin, levofloxacin, gentamicin, amikacin, erythromycin, tetracycline and polymyxin B against the isolate were low, while the MIC values of cefazolin, cefuroxime, cefoxitin, cefotaxime, aztreonam and trime-thoprim-sulfamethoxazole were high. Riboflavin accelerated the growth of B. holmesii ABD2, while its inhibi-tor lumiflavin had an inhibitory effect. Conclusions As B. holmesii is hard to isolate and identify, limited clinical, microbiological and epidemiological data are available. It is an under-recognized pathogen with a considerable amount of information that remains to be studied.

Cryptococcoma mimicking a brain tumor in an immunocompetent patient: case report of an extremely rare presentation

ABSTRACT CONTEXT: Central nervous system (CNS) infectious diseases have high prevalence in developing countries and their proper diagnosis and treatment are very important for public health planning. Cryptococcus neoformans is a fungus that may cause several CNS manifestations, especially in immunocompromised patients. Cryptococcal meningitis is the most common type of involvement. Mass-effect lesions are uncommon: they are described as cryptococcomas and their prevalence is even lower among immunocompetent patients. The aim here was to report an extremely rare case of cryptococcoma causing a mass effect and mimicking a brain tumor in an immunocompetent patient. The literature on CNS cryptococcal infections was reviewed with emphasis on cryptococcomas. Clinical, surgical and radiological data on a female patient with this rare presentation of cryptococcoma mimicking a brain tumor are described. Case Report: A 54-year-old female patient presented to the emergency department with a rapid-onset progressive history of confusion and completely dependency for basic activities. Neuroimaging showed a left occipital lesion and neurosurgical treatment was proposed. From histopathological evaluation, a diagnosis of cryptococcoma was established. She received clinical support with antifungals, but despite optimal clinical treatment, her condition evolved to death. CONCLUSIONS: Cryptococcal infections have several forms of presentation and, in immunocompetent patients, their manifestation may be even more different. Cryptococcoma is an extremely rare presentation in which proper surgical and clinical treatment should be instituted as quickly as possible, but even so, there is a high mortality rate.

Neumonia por Pneumocystis jirovecii en niño inmunocompetente: revisión de un caso / Pneumocystis jirovecii in immunocompetent children: a case report

We describe an unusual case of severe pneumonia due to Pneumocystis jirovecii in a previously healthy 2-month-old patient who had been hospitalized for RSV bronchiolitis.

Se describe un caso inusual de neumonía grave por Pneumocystis jirovecci en un paciente de 2 meses de vida previamente sano, quien había sido hospitalizado por una bronquiolitis por VRS.

Colitis por citomegalovirus en paciente inmunocompetente / Cytomegalovirus colitis in an immunocompetent patient

RESUMEN La infección grave por citomegalovirus en pacientes inmunocompetentes es inusual, siendo la colitis su principal manifestación. Se observa predominantemente en pacientes ancianos con alta carga de comorbilidades. Presentamos el caso de una mujer con falla cardiaca de origen isquémico agudamente descompensada, quien presentó hemorragia digestiva inferior secundaria a colitis por citomegalovirus en ausencia de inmunosupresión aparente.

SUMMARY Severe cytomegalovirus infection in immunocompetent patients is unusual with colitis being its main manifestation. It occurs predominantly in elderly patients with high burden of comorbidities. A case of a woman with acute heart failure and coronary heart disease who had lower gastrointestinal bleeding due to cytomegalovirus colitis in the absence of apparent immunosuppression is presented.