RESUMEN
Carbapenem-resistant Enterobacteriaceae (CRE) usually infect patients with significant comorbidities and health care exposures. We present a case of a pregnant woman who developed community-acquired pyelonephritis caused by KPC-producing Klebsiella pneumoniae. Despite antibiotic treatment, she experienced spontaneous prolonged rupture of membranes, with eventual delivery of a healthy infant. This report demonstrates the challenge that CRE may pose to the effective treatment of common infections in obstetric patients, with potentially harmful consequences to maternal and neonatal health.
Asunto(s)
Proteínas Bacterianas/metabolismo , Infecciones Comunitarias Adquiridas/microbiología , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/patogenicidad , Pielonefritis/microbiología , Adulto , Antibacterianos/uso terapéutico , Carbapenémicos/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Femenino , Humanos , Lactante , Infecciones por Klebsiella/tratamiento farmacológico , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/metabolismo , EmbarazoRESUMEN
Immune reconstitution syndrome has rarely been reported in the context of syphilis infection. We report a patient with AIDS (CD4 42 cells/mm(3), viral load 344,000 cp/ml), treated previously for secondary syphilis and started on an integrase inhibitor-based single-tablet antiretroviral treatment regimen. After four weeks of antiretroviral treatment, he presented with non-tender, non-blanching erythematous nodules on his chest, an elevated rapid plasma reagin (1:1024) and immune reconstitution (CD4 154 cells/mm(3), HIV-RNA 130 cp/ml). A detailed workup to exclude opportunistic infections including secondary and neurosyphilis was performed. The patient was continued on antiretroviral treatment and treated empirically for neurosyphilis given cerebrospinal lymphocytosis and dermatopathology suggesting treponemal antigen-driven B-cell hyperplasia. We favour a diagnosis of immune reconstitution in association with prior syphilis infection attributable to rapid and potent immune restoration afforded by integrase inhibitors.
Asunto(s)
Antirretrovirales/efectos adversos , Infecciones por VIH/complicaciones , Síndrome Inflamatorio de Reconstitución Inmune/complicaciones , Sífilis/diagnóstico , Adulto , Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Diagnóstico Diferencial , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/inmunología , Masculino , Sífilis/microbiología , Serodiagnóstico de la Sífilis , Resultado del Tratamiento , Carga ViralRESUMEN
Efficacious adjuvants are important components of new vaccines. The neisserial outer membrane protein, PorB, is a TLR2 ligand with unique adjuvant activity. We demonstrate that PorB promotes Th2-skewed cellular immune response to the model Ag, OVA, in mice, including Ag-specific recall eosinophil recruitment to the peritoneum. PorB induces chemokine secretion by myeloid cells using both TLR2-dependent and -independent mechanisms, suggesting that anatomical distribution of TLR2(+) cells may not be a limiting factor for potential vaccine strategies. The results from this study suggest that PorB, and other TLR2 ligands, may be ideal for use against pathogens where eosinophilia may be protective, such as parasitic helminths.