ABSTRACT
Mendelian susceptibility to mycobacterial disease (MSMD) is a rare genetic disorder characterized by impaired immunity against intracellular pathogens, such as mycobacteria, attenuated Mycobacterium bovis-Bacillus Calmette-Guérin (BCG) vaccine strains, and environmental mycobacteria in otherwise healthy individuals. Retrospective study reviewed the clinical, immunological, and genetic characteristics of patients with MSMD in Mexico. Overall, 22 patients diagnosed with MSMD from 2006 to 2021 were enrolled: 14 males (64%) and eight females. After BCG vaccination, 12 patients (70%) developed BCG infection. Furthermore, 6 (22%) patients developed bacterial infections mainly caused by Salmonella, as what is described next in the text is fungal infections, particularly Histoplasma. Seven patients died of disseminated BCG disease. Thirteen different pathogenic variants were identified in IL12RB1 (n = 13), IFNGR1 (n = 3), and IFNGR2 (n = 1) genes. Interleukin-12Rß1 deficiency is the leading cause of MSMD in our cohort. Morbidity and mortality were primarily due to BCG infection.
Subject(s)
Mycobacterium Infections , Mycobacterium bovis , Male , Female , Humans , Retrospective Studies , BCG Vaccine , Genetic Predisposition to Disease , Mexico/epidemiology , Receptors, Interleukin-12/genetics , Mycobacterium Infections/epidemiology , Mycobacterium Infections/geneticsABSTRACT
An amendment to this paper has been published and can be accessed via the original article.
ABSTRACT
BACKGROUND: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. OBJECTIVE: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). METHODS: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. RESULTS: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. CONCLUSIONS: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.
Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Abdominal Pain/epidemiology , Adult , Aged , Ambulatory Care , Biomarkers/blood , Body Mass Index , COVID-19 , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/therapy , Critical Care , Dyspnea/etiology , Female , Gastrointestinal Diseases/epidemiology , Humans , Inpatients/statistics & numerical data , Male , Mexico , Middle Aged , Obesity/epidemiology , Outpatients/statistics & numerical data , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , SARS-CoV-2 , Severity of Illness Index , Tertiary Care Centers/statistics & numerical data , Treatment OutcomeABSTRACT
BACKGROUND: The study of stool microbiota has taken great relevance in the last years, given its role in the maintenance of the intestinal metabolic, physiological, and immunological homeostasis, as well as, its effect over HIV biomarkers levels such as CD4/CD8 ratio, high sensitivity C-Reactive Protein (hs-CRP), related to poor outcomes (rapid progression to AIDS). Several efforts have been made to characterize the gut microbiome. In HIV infection, most of the studies report the presence of a dysbiotic pattern; however, few of them have made an approach in elderly HIV-positive subjects despite the fact that nowadays this subgroup is rising. In this study, we compared the composition of faecal microbiota, Short Chain Fatty Acids (SCFAs), and systemic biomarkers between elderly HIV-positive and HIV-negative subjects. METHODS: A cross-sectional study with 18 HIV-negative controls and 20 HIV-positive patients. The quantification of Bacteroidetes, Firmicutes, Proteobacteria, Actinobacteria, Lactobacillus, Enterobacteriaceae, Bifidobacterium, Escherichia coli, Clostridium leptum, Clostridium coccoides was performed in faecal samples by qPCR. The analysis was performed by calculating the ΔCq of each microorganism using 16S rDNA as a reference gene. Faecal SCFAs were measured by HPLC. The hs-CRP and sCD14 were performed by ELISA. RESULTS: An increase in the Firmicutes/Bacteroidetes ratio, coupled with a significant increase in the proteobacteria phylum was detected in HIV-positive subjects. In contrast, a decrease in the Clostridium leptum group was observed. Nevertheless, these elderly HIV-positive patients showed higher levels of total SCFAs mainly by an augmented propionic acid values, compared to HIV-negative subjects. Whereas high levels of hs-CRP were positively correlated with sCD14 in the HIV-positive group. CONCLUSIONS: Alterations in bacterial communities reveals a dysbiotic state related to an unbalance of faecal SCFAs. Therefore, these intestinal conditions might drive an increase of poor prognostic biomarkers in elderly HIV-positive subjects.
Subject(s)
Bacteria/genetics , Biomarkers/analysis , Fatty Acids, Volatile/analysis , Gastrointestinal Microbiome , HIV Infections/pathology , Aged , Bacteria/isolation & purification , C-Reactive Protein/analysis , CD4 Lymphocyte Count , Chromatography, High Pressure Liquid , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay , Feces/microbiology , Female , Humans , Lipopolysaccharide Receptors/analysis , Male , Mexico , Middle Aged , RNA, Ribosomal, 16S/genetics , RNA, Ribosomal, 16S/metabolism , Real-Time Polymerase Chain ReactionSubject(s)
Antirheumatic Agents/administration & dosage , Dermatomyositis/diagnosis , Lung Diseases, Interstitial , Methylprednisolone/administration & dosage , Parapsoriasis , Still's Disease, Adult-Onset , Adult , Biopsy/methods , Bronchoalveolar Lavage/methods , Diagnosis, Differential , Female , Humans , Immunologic Tests/methods , Immunosuppressive Agents/administration & dosage , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Parapsoriasis/diagnosis , Parapsoriasis/etiology , Prognosis , Respiratory Function Tests/methods , Still's Disease, Adult-Onset/diagnosis , Still's Disease, Adult-Onset/physiopathology , Tomography, X-Ray Computed/methodsABSTRACT
Systemic lupus erythematosus is a chronic autoimmune disease with a relapsing and remitting course characterized by disease flares. Flares are a major cause of hospitalization, morbidity and mortality in patients with systemic lupus erythematosus. Some triggers for these exacerbations have been identified, including infections, vaccines, pregnancy, environmental factors such as weather, stress and drugs. We report a patient who presented with a lupus flare with predominantly mucocutaneous, serosal and cardiac involvement after being bitten by a spider and we present the possible mechanisms by which the venom elicited such a reaction. To the best of our knowledge, this is the first such case reported in the literature.
Subject(s)
Lupus Erythematosus, Systemic/etiology , Spider Bites/complications , Adult , Female , Humans , Spider Venoms/adverse effects , Symptom Flare UpABSTRACT
Abstract Acute respiratory distress syndrome (ARDS) is a respiratory process of acute onset, showing on X rays as bilateral pulmonary infiltrates and severe respiratory failure, Coccidiodomycosis is a unusual cause of acute respiratory distress syndrome, the incidence of coccidiomycosis in a solid organ trasplant recipientes ranges from 1.4% a 6.9%, inadecuancy of cellular inmunity is a well established risk factor for development of coccididomcosis, less than 1% of patients develop disseminaded infecction and carrying high mortality, the case that we are presenting add to the small list of reports documenting the ocasionally acute and agressive nature of the disseminated clinical form of coccidiodomycosis.
Resumen El síndrome de dificultad respiratoria aguda (SDRA) es un proceso respiratorio de inicio agudo, que se manifiesta en las radiografías como infiltrados pulmonares bilaterales, clinicamente como insuficiencia respiratoria grave, la coccidiodomicosis es una causa inusual de síndrome de dificultad respiratoria aguda, la incidencia de coccidiomicosis en receptores de trasplante de órgano sólido varía desde 1.4% a 6.9%, una inadecuada inmunidad celular es un factor de riesgo bien establecido para el desarrollo de coccidomicosis, menos del 1% de los pacientes desarrollan enfermedad diseminada y alta mortalidad, el caso que presentamos se suma a la pequeña lista de informes que documentan la naturaleza ocasionalmente aguda y agresiva de la forma clínica diseminada de coccidiodomicosis.
Subject(s)
Humans , Male , Middle Aged , Respiratory Distress Syndrome, Newborn , Organ Transplantation , Liver Transplantation , Respiratory Insufficiency , Coccidioidomycosis , Immunity, CellularABSTRACT
Abstract Cryptococcocis is a fungal infection that primarily affects immunocompromised hosts; disseminated infection is uncommon in immunocompetent patients. We describe a case of a previously healthy woman without risk factors, who was admitted to the emergency department with headache, fever and altered mental status. As a result, a cryptococcal disseminated infection was diagnosed.
Resumen La criptococosis es una infección por hongos que afecta principalmente a huéspedes inmunodeprimidos; la infección diseminada es infrecuente en pacientes inmunocompetentes. Reportamos el caso de una mujer previamente sana, sin factores de riesgo, ingresada a urgencias por cefalea, fiebre y alteración del estado mental quien posteriormente fue diagnosticada con criptococosis diseminada.
ABSTRACT
ABSTRACT Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Pandemics , Betacoronavirus , Severity of Illness Index , Biomarkers/blood , Abdominal Pain/epidemiology , Body Mass Index , Comorbidity , Treatment Outcome , Critical Care , Dyspnea/etiology , Tertiary Care Centers/statistics & numerical data , Ambulatory Care , Gastrointestinal Diseases/epidemiology , SARS-CoV-2 , COVID-19 , Inpatients/statistics & numerical data , Mexico , Obesity/epidemiologySubject(s)
Ecthyma/etiology , Mediastinal Neoplasms/diagnostic imaging , Nose Diseases/etiology , Opportunistic Infections/etiology , Pneumonia, Bacterial/diagnostic imaging , Pseudomonas Infections/diagnostic imaging , Sarcoma, Synovial/diagnostic imaging , Tomography, X-Ray Computed , Aged , Colitis, Ulcerative/complications , Colitis, Ulcerative/drug therapy , Ecthyma/pathology , Fatal Outcome , Gangrene , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Male , Mediastinal Neoplasms/complications , Mesalamine/adverse effects , Mesalamine/therapeutic use , Necrosis , Nose Diseases/microbiology , Nose Diseases/pathology , Opportunistic Infections/microbiology , Opportunistic Infections/pathology , Pneumonia, Bacterial/etiology , Pseudomonas Infections/etiology , Pseudomonas Infections/pathology , Sarcoma, Synovial/complications , Shock, Septic/etiologySubject(s)
Arthritis/diagnostic imaging , Hematopoietic Stem Cell Transplantation/adverse effects , Immune Reconstitution Inflammatory Syndrome/etiology , Arthritis/etiology , Enterobacteriaceae Infections/microbiology , Female , Humans , Magnetic Resonance Imaging , Morganella morganii , Recurrence , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Immunocompromised Host/immunology , Pseudomonas aeruginosa/isolation & purification , Pseudomonas Infections/diagnosis , Pseudomonas Infections/drug therapy , Necrosis/microbiology , Turbinates/microbiology , Turbinates/pathologyABSTRACT
Plasmablastic lymphoma is an aggressive variant of large B-cells lymphoma in which the infection by Human Immunodeficiency Virus and Epstein-Barr herpesvirus are involved. This recently denominated neoplasia has a special tropism through the oral cavity. However, its presence has been reported in the digestive tract, abdominal cavity and retroperitoneum. We describe two Human Immunodeficiency Virus infected patient cases with rectal presentation of PL in the HIV service of the Hospital Civil de Guadalajara.