RESUMO
A 46-year-old Hispanic male from Ecuador presented with fever, malaise, weight loss, and dyspnea. He was HIV-positive with a CD4+ cell count of 4/microL. He was hospitalized, and therapy for community-acquired pneumonia with broad-spectrum antibiotics was started. Both Histoplasma capsulatum and Cryptococcus neoformans were cultured from bronchial lavage, blood, and bone marrow specimens. Despite aggressive therapy with amphotericin B, the patient died 8 days after admission.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Síndrome da Imunodeficiência Adquirida/microbiologia , Criptococose/virologia , HIV , Histoplasmose/virologia , Cryptococcus neoformans/isolamento & purificação , Histoplasma/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We applied 16S rRNA gene sequencing to identify bacterial species present in formalin-fixed, paraffin-embedded heart valve tissue. In 40% (12/30) of the cases, we were able to identify the bacterium to the species-genus level. For more recent cases (Assuntos
Bactérias/isolamento & purificação
, Genes de RNAr
, Valvas Cardíacas/microbiologia
, Inclusão em Parafina
, RNA Ribossômico 16S/genética
, Fixação de Tecidos
, Bactérias/classificação
, Bactérias/genética
, DNA Bacteriano/química
, DNA Bacteriano/genética
, DNA Ribossômico/química
, DNA Ribossômico/genética
, Formaldeído
, Humanos
, Dados de Sequência Molecular
, Reação em Cadeia da Polimerase
, Análise de Sequência de DNA
RESUMO
Efforts to reduce relapse of non-Hodgkin lymphoma after autologous transplantation have included ex vivo stem cell selection and/or peritransplantation immunotherapy. The late infectious and immunologic consequences of these maneuvers are not well understood, although an increase in early cytomegaloviral disease after CD34(+) stem cell selection and an alteration in immunoglobulin and T-cell recovery after peritransplantation rituximab has been noted. We report the first 2 cases of progressive multifocal leukoencephalopathy caused by JC papovavirus after autologous peripheral blood stem cell transplantation and a case each of cytomegalovirus retinitis and pneumonitis. All 4 patients experienced significant impairment of CD4 T-cell recovery, placing them at risk for these unusual viral infections. The clustering of cases is concerning because all occurred shortly after the introduction of peritransplantation rituximab into treatment protocols (4 of 62 immunotherapy recipients compared with 0 of 276 without; z = 3.595; P <.001), although a direct association with this CD20 B-cell-directed therapy remains speculative.
