ABSTRACT
Background: Clostridium difficile infection (CDI) is a frequent complication in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT), who receive intensive treatments that significantly disrupt the intestinal microbiota. In this study, we examined the microbiota composition of allo-HSCT recipients to identify bacterial colonizers that confer protection against CDI after engraftment. Methods: Feces collected from adult recipients allo-HSCT at engraftment were analyzed; 16S ribosomal RNA genes were sequenced and analyzed from each sample. Bacterial taxa with protective effects against development of CDI were identified by means of linear discriminant analysis effect size analysis and then further assessed with clinical predictors of CDI using survival analysis. Results: A total of 234 allo-HSCT recipients were studied; postengraftment CDI developed in 53 (22.6%). Within the composition of the microbiota, the presence of 3 distinct bacterial taxa was correlated with protection against CDI: Bacteroidetes, Lachnospiraceae, and Ruminococcaceae. Colonization with these groups at engraftment was associated with a 60% lower risk of CDI, independent of clinical factors. Conclusions: Colonization with these 3 bacterial groups is associated with a lower risk of CDI. These groups have been shown to be vital components of the intestinal microbiota. Targeted efforts to maintain them may help minimize the risk of CDI in this at-risk population.
Subject(s)
Clostridium Infections/microbiology , Gastrointestinal Microbiome , Hematopoietic Stem Cell Transplantation/adverse effects , Adult , Bacteroidetes/classification , Bacteroidetes/isolation & purification , Clostridiales/classification , Clostridiales/isolation & purification , Clostridioides difficile , Feces/microbiology , Female , Humans , Male , Middle Aged , Protective Factors , RNA, Ribosomal, 16S/genetics , Transplantation, HomologousABSTRACT
The risk of infection among patients receiving immune checkpoint blockade is unknown. We retrospectively reviewed medical records of 740 patients with melanoma who received immune checkpoint blockers. Serious infection occurred in 54 patients (7.3%). The main risk factors were receipt of corticosteroids and/or infliximab.
Subject(s)
Adrenal Cortex Hormones/adverse effects , Immunologic Factors/therapeutic use , Infections/epidemiology , Infliximab/adverse effects , Melanoma/complications , Melanoma/drug therapy , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal/therapeutic use , Cell Cycle Checkpoints , Child , Child, Preschool , Female , Humans , Immunologic Factors/administration & dosage , Immunotherapy/adverse effects , Infections/etiology , Infections/microbiology , Infections/virology , Infliximab/therapeutic use , Male , Medical Records , Melanoma/microbiology , Middle Aged , Retrospective Studies , Risk Factors , Young AdultABSTRACT
The spectrum of West Nile virus (WNV) infection continues to be elucidated. Many cases of WNV are asymptomatic; however, in immunocompromised patients, symptoms are more likely to be severe. We describe fatal WNV central nervous system disease in lymphoma patients who received rituximab, blunting the inflammatory response and complicating diagnosis.
ABSTRACT
Arcobacter butzleri is an emerging pathogen that has been implicated as the causative agent of persistent watery diarrhea. We describe a case involving a patient with chronic lymphocytic leukemia who developed invasive A. butzleri bacteremia. This case illustrates the unique challenges involved in diagnosing infections caused by emerging gastrointestinal pathogens.
