ABSTRACT
PURPOSE: To report a unique case of pacemaker-related infective endocarditis manifesting as endogenous endophthalmitis with chorioretinitis secondary to Histoplasma capsulatum. METHOD: Case Report. RESULTS: A 75-year-old man was diagnosed with blood culture-negative infective endocarditis and was admitted with deteriorating vision and ocular inflammation. Examination of the eye indicated significant vitreous inflammation and retinitis. Vitreous cultures were negative, but universal fungal PCR of the vitreous fluid was positive for Histoplasma capsulatum. Histopathology of the fibrous cuff around the extracted right atrial lead demonstrated hyphal and yeast forms and PCR of this material identified Histoplasma capsulatum. Despite aggressive antifungal and surgical treatment, the eye became phthisical. CONCLUSION: We highlight the importance of considering Histoplasma capsulatum in the differential diagnosis of endogenous endophthalmitis, particularly among patients from endemic areas who present with possible endovascular infection.
ABSTRACT
Coronavirus disease 2019 (COVID-19), mediated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can manifest with flu-like illness and severe pneumonia with acute respiratory distress syndrome (ARDS). Immunocompromised patients merit particular attention as altered host immunity may influence both disease severity and duration of viral shedding as is described with several other ribonucleic acid respiratory viruses. Yet immunocompromised status alone, in the absence of other comorbidities, may not necessarily predict severe illness presentations and poorer clinical outcomes as indicated by recent reports of COVID-19-infected solid organ transplant recipients and people living with human immunodeficiency virus (HIV). Such patients may even be spared the robust inflammatory response that precipitates ARDS associated with COVID-19, complicating the management of iatrogenic immunosuppression in this setting. We present a case of an orthotopic liver transplant recipient with well-controlled HIV who successfully recovered from a mild, flu-like illness attributed to SARS-CoV-2.
Subject(s)
Anti-HIV Agents/adverse effects , COVID-19/diagnosis , HIV Infections/drug therapy , Liver Transplantation/adverse effects , SARS-CoV-2/immunology , Adult , Anti-HIV Agents/administration & dosage , COVID-19/immunology , COVID-19/virology , Chemical and Drug Induced Liver Injury/etiology , Chemical and Drug Induced Liver Injury/surgery , Dose-Response Relationship, Drug , Drug Therapy, Combination/methods , Graft Rejection/immunology , Graft Rejection/prevention & control , HIV Infections/immunology , Humans , Hydroxychloroquine/administration & dosage , Immunocompromised Host , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Male , Prednisone/administration & dosage , SARS-CoV-2/isolation & purification , Treatment Outcome , COVID-19 Drug TreatmentABSTRACT
Testing for Lyme disease is challenging and if done incorrectly can lead to unnecessary treatment. To interpret serologic test results, first assess the patient's pretest probability of infection based on the probability of exposure and clinical findings. Two-tiered testing remains the gold standard in diagnosing Lyme disease, although new guidelines may be published soon.
Subject(s)
Lyme Disease/diagnosis , Clinical Laboratory Techniques/methods , Humans , Practice Guidelines as TopicSubject(s)
Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active/methods , CD4 Lymphocyte Count , HIV Infections/drug therapy , Cohort Studies , Female , HIV Infections/epidemiology , HIV Infections/virology , Humans , Male , Ohio/epidemiology , Retrospective Studies , Sustained Virologic Response , Time Factors , Time-to-Treatment , Treatment OutcomeABSTRACT
Human immunodeficiency virus (HIV) has become a chronic disease with a near normal life span resulting in increased risk of organ failure. HIV organ transplantation is a proven and accepted intervention in appropriately selected cases. HIV-positive organ transplantation into HIV-positive recipients is in its nascent stages. Hepatitis C virus, high rates of organ rejection, and immune dysregulation are significant remaining barriers to overcome. This article provides an overview of the transplantation needs in the HIV population focusing on kidney and liver transplants.
Subject(s)
HIV Infections/complications , Hepatitis C/transmission , Hepatitis C/virology , Organ Transplantation , Graft Rejection , Humans , Tissue Donors , Transplant RecipientsABSTRACT
BACKGROUND: Paradoxically, advances in anti-retroviral therapy that has increased survival for patients with human immunodeficiency virus (HIV) have resulted in greater numbers of HIV+ patients developing other chronic diseases, including obesity. Little comparative literature exists detailing perioperative or metabolic outcomes of bariatric surgery in the HIV+ population compared to HIV negative (HIV-) controls. METHODS: This is a retrospective case-control study with both HIV+ (case) and HIV- control patients. Individuals undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between January 1, 2006 and December 31, 2015 were included. HIV+ status was defined as any individual with documented history of HIV. RESULTS: Eleven HIV+ patients underwent RYGB or SG during the study period. After matching (1:5 HIV+: HIV-) both cohorts had similar mean age (42 years), gender distribution (63% female), and preoperative BMI (48 kg/m2), as well as comorbidities. There were no differences in postoperative length of stay, or all cause 30-day morbidity. There were 63.7% HIV+ and 76.4% with 1-year follow-up available. Both percent excess weight loss (56% HIV+ vs. 60% HIV-) and BMI (32 HIV+ vs. 34 kg/m2 HIV-) were similar in both groups. There were minimal changes to CD4 count or HIV viral load in the patients during the follow-up period. CONCLUSION: Bariatric surgery is safe and feasible in HIV-infected population well controlled on anti-retroviral medication. The short-term surgical and metabolic outcomes are similar to HIV- controls with minimal effect on the CD4 count and viral load in HIV+ cohort for long-term follow-up.
Subject(s)
Bariatric Surgery/methods , HIV Infections/complications , Obesity, Morbid/surgery , Weight Loss , Adult , CD4 Lymphocyte Count , Case-Control Studies , Female , Gastrectomy/methods , Humans , Laparoscopy/methods , Male , Middle Aged , Obesity, Morbid/complications , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: The incidence of anal carcinoma has risen in recent decades. Exfoliative cytology screening of selected high risk patients is performed in many centers. Unsatisfactory cytology results are frustrating to patients, clinicians, and laboratorians. The aim of this study is to ascertain outcomes of patients with non-diagnostic anal cytology. METHODS: A retrospective review of anal cytology testing performed at the Cleveland Clinic between 01/01/2001 and 12/31/2015 was performed. All cases were received as liquid-based samples and processed as ThinPreps (Hologic, Marlborough, MA). Co-testing for HR-HPV DNA was performed using Hybrid Capture 2® (Qiagen, Germantown, MD) in the majority of patients. RESULTS: Of 1,276 ThinPrep anal cytology samples, 130 (10%) were deemed unsatisfactory. 77% of patients were HIV positive. 85% were males. Of the unsatisfactory cases, 116 (89%) were co-tested for HR-HPV DNA. Of those, 40 patients (34%) had a simultaneous positive HR-HPV DNA. Adequate follow up cytology within a one year and a two year period revealed that 18/130 (14%) and 26/130 (20%) of patients had ASC or SIL respectively. Histologic follow-up within one and two years showed 3 patients (2%) and 8 patients (6%) with HSIL or worse. CONCLUSIONS: High risk patients with unsatisfactory anal cytology are not "negative". At least one-third proved to be concomitantly HR-HPV DNA positive with one-fifth showing subsequent cytologic squamous abnormalities and with more than 5% being diagnosed with a high grade intraepithelial lesion within two years. Prompt repeat cytology and/or HR-HPV DNA is recommended for high risk patients with non-diagnostic cytology.
Subject(s)
Anus Neoplasms/pathology , Carcinoma/pathology , Papanicolaou Test/standards , Anus Neoplasms/metabolism , Biomarkers, Tumor/metabolism , Biomarkers, Tumor/standards , Carcinoma/metabolism , HumansABSTRACT
The processing of specimens often occurs in a central processing area within laboratories. We demonstrated that plasma centrifuged in the central laboratory but allowed to remain within the primary tube following centrifugation was associated with spuriously elevated HIV viral loads compared with recentrifugation of the plasma just prior to testing.
Subject(s)
HIV Infections/diagnosis , HIV Infections/virology , Specimen Handling/methods , Viral Load/methods , HumansSubject(s)
HIV Infections/epidemiology , Herpes Zoster/prevention & control , Vaccination , Aged , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Major improvements in the care of liver transplant recipients have mitigated but not eliminated the risk of potentially life-threatening infectious complications. This review provides general information about risk factors, prophylactic strategies, diagnostic workup, and therapy for some of the most commonly encountered infections after liver transplant.
Subject(s)
Immunosuppression Therapy/adverse effects , Infections , Liver Transplantation/adverse effects , Global Health , Humans , Incidence , Infections/epidemiology , Infections/etiology , Infections/therapy , Risk FactorsABSTRACT
The US Centers for Disease Control and Prevention has revised its recommendations for screening for human immunodeficiency virus (HIV) (MMWR Recomm Rep 2006; 55(RR14):1-17) and now recommends HIV screening for all patients age 13 to 64 years in all health care settings, including hospital emergency departments, urgent care clinics, inpatient services, sexually transmitted disease clinics, tuberculosis clinics, and primary care offices.
Subject(s)
HIV Infections/diagnosis , Mass Screening/standards , Practice Guidelines as Topic , Adolescent , Adult , Centers for Disease Control and Prevention, U.S. , Humans , Middle Aged , United StatesSubject(s)
Acquired Immunodeficiency Syndrome/virology , Drug Resistance, Viral , HIV-1/pathogenicity , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/transmission , Antiviral Agents/therapeutic use , HIV-1/drug effects , HIV-1/isolation & purification , Humans , Male , Virulence/drug effectsABSTRACT
Morbidity and mortality rates of human immunodeficiency virus (HIV) have plummeted where highly active antiretroviral therapy (HAART) is available. However, therapy is out of reach for most people who need it in developing nations, where the infrastructure to deliver care and resources for medications is lacking. Worldwide, the epidemic is increasing at alarming rates.
Subject(s)
AIDS Vaccines , Antiretroviral Therapy, Highly Active , Global Health , HIV Infections/drug therapy , HIV Infections/classification , HIV Infections/epidemiology , HIV Infections/prevention & control , HIV-1 , HIV-2 , HumansABSTRACT
Human herpesvirus-6 (HHV-6), a beta herpesvirus closely related to cytomegalovirus (CMV), infects the majority of the population in childhood. Human herpesvirus-6 can be reactivated in the immunosuppressed patient. After bone marrow and orthotopic liver transplant, it has been linked to various clinical syndromes, including undifferentiated febrile illness, encephalitis, pneumonitis and bone marrow suppression. To date its infectious role after orthotopic heart transplant has not been well documented. We present the case of a 32-year-old cardiac transplant recipient who initially presented 8 weeks after his transplant with high fever and headache. He developed increasing confusion, pulmonary infiltrates and neutropenia. Cytomegalovirus viral loads were negative. Polymerase chain reaction (PCR) of blood and cerebrospinal fluid detected HHV-6 DNA, consistent with HHV-6-related encephalitis, pneumonitis and bone marrow suppression. He was treated with foscarnet with gradual improvement in clinical status. We review the literature on the significance of this virus post cardiac transplant.
Subject(s)
Encephalitis/etiology , Heart Transplantation/methods , Herpesviridae Infections/etiology , Herpesvirus 6, Human/metabolism , Adult , Antiviral Agents/pharmacology , Cytomegalovirus/metabolism , DNA, Viral/analysis , Encephalitis/pathology , Encephalitis/virology , Foscarnet/therapeutic use , Heart Transplantation/adverse effects , Humans , Immunosuppressive Agents/pharmacology , Leukocytosis/cerebrospinal fluid , Leukocytosis/metabolism , Male , Neutropenia/therapy , Polymerase Chain ReactionABSTRACT
The development of cytomegalovirus (CMV) disease and subsequent emergence of drug-resistant strains was examined in a large group of solid organ transplant recipients; drug-resistant CMV was detected in a total of 30 transplant recipients (20 lung, 5 kidney, 4 heart, and 1 liver). Drug resistance was confirmed both phenotypically and genotypically. The sequences of drug-resistant CMV strains from the same patient differed from drug-susceptible baseline sequences only at single sites previously confirmed to confer drug resistance. At least 1 isolate from each patient had a mutation in the UL97 phosphotransferase coding sequence. Mutations in the DNA polymerase gene were found in 6 of 38 sequenced strains. Lung transplant recipients had the highest incidence of drug-resistant virus: of the 30 patients, 28 were CMV-seronegative transplant recipients of CMV-seropositive organs, which strongly supports the premise that drug resistance is most prevalent in that transplant population.
Subject(s)
Cytomegalovirus Infections/virology , Cytomegalovirus/genetics , Cytomegalovirus/isolation & purification , Drug Resistance, Viral/genetics , Organ Transplantation , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use , Cohort Studies , Cytomegalovirus/drug effects , Cytomegalovirus Infections/drug therapy , DNA, Viral/analysis , Genes, Viral/genetics , Genetic Variation , Humans , Mutation , Phenotype , Polymerase Chain ReactionABSTRACT
Pathogens responsible for foodborne illness are changing, owing to changes in the American diet as well as in food production and distribution. Microbial adaptations to heat, acid, cold, and antibiotics have made food safety a challenging task. This article reviews the common pathogens, their sources, and treatment.