RESUMO
Epstein-Barr virus (EBV) DNAemia and reactivation is a typical complication after allogeneic hematopoietic stem cell transplantation (HSCT). The degree of immunosuppression is closely linked to the risk of developing EBV DNAemia. An association of cyclosporine levels with EBV DNAemia has not been interrogated. Here, we analyzed cyclosporine levels in 58 patients after allogeneic HSCT. We discovered a wide range of cyclosporine trough level variation in the individual patient (median coefficient of variation [CV] 0.29, range 0.19-0.78). To overcome this high intra-individual variation in serum trough levels of cyclosporine, we calculated respective areas under the curve (AUC) and performed correlations with EBV DNAemia in 28 stem cell recipients at increased risk for EBV DNAemia. This resulted in a significant association of high cyclosporine AUC (> 6000 ng/mL × days) with EBV DNAemia after day 30 (relative risk [RR] 6.067, 95% confidence interval [CI] 1.107-33.238, p = 0.038). Conversely, mean cyclosporine values (threshold 200 ng/mL) between days 0 and 30 were not found to correlate with EBV DNAemia after day 30. Furthermore, CD3 + CD8 + graft content was inversely correlated with EBV DNAemia after day 30. These findings might establish a clinical role for the AUC of cyclosporine.
Assuntos
Ciclosporina/efeitos adversos , Infecções por Vírus Epstein-Barr/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Herpesvirus Humano 4/fisiologia , Imunossupressores/efeitos adversos , Viremia/etiologia , Adulto , Idoso , Fatores de Confusão Epidemiológicos , Ciclosporina/sangue , Feminino , Herpesvirus Humano 4/genética , Humanos , Imunossupressores/sangue , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de Risco , Transplante Homólogo , Adulto JovemRESUMO
Chronic carriers of hepatitis B virus (HBV) who have to be immunosuppressed are at risk for HBV reactivation and hepatitis. Continuing immunosuppression in such patients and in immunosuppressed patients with active hepatitis B is strongly discouraged yet frequently inevitable. We here report on both the successful control of hepatitis and seroconversion after HBV reactivation following allogeneic hematopoietic stem cell transplantation (HSCT) with entecavir despite systemic immunosuppression.
Assuntos
Antivirais/uso terapêutico , Bronquiolite Obliterante/complicações , Doença Enxerto-Hospedeiro/complicações , Guanina/análogos & derivados , Hepatite B/diagnóstico , Imunossupressores/uso terapêutico , Bronquiolite Obliterante/tratamento farmacológico , Feminino , Doença Enxerto-Hospedeiro/tratamento farmacológico , Guanina/uso terapêutico , Anticorpos Anti-Hepatite B/sangue , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
An infection with Bartonella henselae transmitted from domestic cats to humans by scratching normally leads to cat-scratch disease. When the human host has severe immunosuppression or HIV infection, the potentially life-threatening disease bacillary angiomatosis can develop. A 79-year-old man presented with livid-erythematous, angioma-like skin lesions. We considered a cutaneous infiltrate from his known chronic lymphocytic leukemia, Merkel cell carcinoma, cutaneous metastases of internal tumors, cutaneous sarcoidosis, mycobacterial infection and even atypical herpes simplex infection. The correct diagnosis was proven histologically and by PCR. Because of increasing numbers of immunosuppressed and HIV-positive patients, as well as an infection rate of 13% for B. henselae in domestic cats in Germany, one must be alert to the presence of bacillary angiomatosis.
Assuntos
Angiomatose Bacilar/diagnóstico , Angiomatose Bacilar/microbiologia , Bartonella henselae/isolamento & purificação , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/microbiologia , Idoso , Diagnóstico Diferencial , Herpes Simples/diagnóstico , Humanos , Masculino , Neoplasias Cutâneas/diagnósticoRESUMO
OBJECTIVE: The aim of this study is to describe a case of fulminant myocarditis caused by co-infection with Chlamydophila pneumoniae and Chlamydophila psittaci in order to facilitate diagnosis and clinical management of patients suffering from this rare but life-threatening condition. DESIGN: Case report. SETTING: Intensive care unit of Innsbruck Medical University. PATIENT: A 24-yr-old patient admitted with septicemia and cardiac failure. INTERVENTIONS: Cardiopulmonary resuscitation, extracorporal membrane oxygenation, implantation of an extracorporal cardiac assist device, and antibiotic treatment with erythromycin. MEASUREMENTS AND MAIN RESULTS: Cp. pneumoniae and Cp. psittaci were identified by means of polymerase chain reaction and electron microscopy in the patient's myocytes. Successful weaning off the ventricular assist device was performed within 2 wks after commencement of antibiotic therapy. CONCLUSIONS: This case report demonstrates co-infection with Cp. pneumoniae and Cp. psittaci to be a hitherto unknown cause of fulminant myocarditis. There is a particular risk of misdiagnosis of viral myocarditis, which must be avoided. Patients should be transferred to a center where extracorporal membrane oxygenation therapy and molecular diagnosis of all members of the family Chlamydiaceae are available.
Assuntos
Infecções por Chlamydophila , Chlamydophila pneumoniae , Chlamydophila psittaci , Miocardite/microbiologia , Adulto , Feminino , Humanos , Miocardite/diagnóstico , Miocardite/tratamento farmacológicoRESUMO
BACKGROUND: Recent publications brought up the hypothesis that an infection with Chlamydia Pneumoniae (CP) might be a major cause of coronary artery disease (CAD). Therefore, we investigated whether endothelial dysfunction (ED) as a precursor of atherosclerosis might be detectable in patients with previous infection with CP but without angiographic evidence of CAD. METHODS: We included 16 patients (6 male / 10 female) of 52 consecutive patients with normal coronary angiography who had typical angina pectoris and pathologic findings in the stress test. Exclusion criteria were: active smoker, elevated cholesterol, hypertension, age > 65 years, diabetes mellitus, treatment with ACE-inhibitors, or known CAD. Blood sample analysis for serum titer against CP (aCP-IgG) was performed after coronary angiography. We looked for endothelial dysfunction analyzing the diameter of the left anterior descending coronary artery (LAD) before and after acetylcholine (ACh) i. c. Quantitative analysis of luminal diameter (LD) was performed in at least two planes during baseline conditions and after ACh for 2 minutes in dosages of 7.2 microg/min and 36 microg/min with an infusion speed of 2 ml/min. Using Doppler guide wire, the coronary flow velocity was measured continuously in the LAD. The coronary flow velocity reserve (CFVR) was measured after 20 microg adenosine i. c. RESULTS: 10 patients had an elevated aCP-IgG (> 1:8). 6 patients with negative titers (aCP-IgG Assuntos
Infecções por Chlamydophila/diagnóstico por imagem
, Chlamydophila pneumoniae/isolamento & purificação
, Doença da Artéria Coronariana/diagnóstico por imagem
, Doença da Artéria Coronariana/microbiologia
, Vasos Coronários/diagnóstico por imagem
, Endotélio Vascular/diagnóstico por imagem
, Interpretação de Imagem Assistida por Computador/métodos
, Adulto
, Infecções por Chlamydophila/sangue
, Infecções por Chlamydophila/complicações
, Doença da Artéria Coronariana/sangue
, Feminino
, Humanos
, Masculino
, Prognóstico
, Reprodutibilidade dos Testes
, Medição de Risco
, Sensibilidade e Especificidade
, Testes Sorológicos
, Estatística como Assunto
, Ultrassonografia
RESUMO
We previously reported a high degree of variation in the sensitivities of serodiagnostic kits for the detection of Chlamydophila pneumoniae in sera from healthy donors. Since a low predictive value of a test can impair its diagnostic value, we have extended our studies to samples from patients with pneumonia. We focused on the most promising enzyme-linked immunosorbent assays (ELISAs) (SeroCP and SeroCP Quant; Savyon) identified in our previous study and included a new ELISA (sELISA; Medac). The agreement between all ELISAs for immunoglobulin G (IgG) and a reference microimmunofluorescence (MIF) test for IgG (SeroFIA; Savyon) was > or = 90% for a collective of 80 patients. The positive predictive values were all > or = 93%. The negative predictive values ranged from 68 to 83%. False-negative results were obtained only for samples that had low titers in the MIF test. The correlation of the IgG antibody titers determined by the MIF and SeroCP Quant tests was high (r(sp) = 0.9). Since the semiquantitative SeroCP and quantitative SeroCP Quant ELISAs achieved the highest sensitivities, they were evaluated further by using a second batch of sera from 50 patients with predominantly medium and low antibody titers in the MIF test and a control collection of sera from 80 children with negative MIF results. Again, the tests showed a high concordance with the MIF results (96%), and the antibody titers in the SeroCP Quant and MIF tests correlated well (r(sp) = 0.8). The specificities determined with the negative sera were > or = 99% for the SeroCP Quant test and 86% for the SeroCP test. These results show that ELISAs that are fast and objective deliver seroprevalence results, sensitivities, and specificities that are very similar to those of the MIF test.
Assuntos
Anticorpos Antibacterianos/sangue , Chlamydophila pneumoniae/imunologia , Imunoglobulina G/sangue , Infecções Respiratórias/microbiologia , Adolescente , Adulto , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Imunofluorescência , Humanos , LactenteRESUMO
Urogenital strains of Chlamydia trachomatis are divided into several serogroups (D-K). Since these serovars are represented with differing prevalence in the population a serotyping of strains is necessary, when characterising the epidemiological situation. The aim of this study was the genotyping of C. trachomatis strains, the comparison of the results with those of serotyping, and the genotyping of positive specimens using commercial nucleic acid amplification tests (NAAT). The Chlamydia trachomatis major outer membrane protein gene (omp1) from 55 isolated strains and 36 NAAT-positive specimens was amplified by polymerase chain reaction (PCR). The restriction fragment length polymorphism (RFLP) patterns of these amplicons were compared with those of reference strains. The genotypes E and F were found to be most prevalent. The results are discussed considering other studies, genovariants and epidemiology.
Assuntos
Chlamydia trachomatis/classificação , Ascite/microbiologia , Colo do Útero/microbiologia , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Olho/microbiologia , Feminino , Genótipo , Alemanha/epidemiologia , Hospitais Privados , Hospitais Universitários , Humanos , Epidemiologia Molecular , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Porinas/genética , Uretra/microbiologiaRESUMO
This study reports an extraordinarily severe and prolonged course of neuroornithosis with generalized status epilepticus as an initial symptom. Direct invasion of the central nervous system by Chlamydophila psittaci was confirmed by the demonstration of specific DNA in the patient's cerebrospinal fluid. The patient recovered slowly under administration of doxycycline.
Assuntos
Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Chlamydophila psittaci/isolamento & purificação , DNA Bacteriano/análise , Psitacose/diagnóstico , Estado Epiléptico/etiologia , Antibacterianos , Sequência de Bases , Infecções Bacterianas do Sistema Nervoso Central/complicações , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Chlamydophila psittaci/efeitos dos fármacos , Quimioterapia Combinada , Ensaio de Imunoadsorção Enzimática , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Reação em Cadeia da Polimerase , Psitacose/complicações , Psitacose/tratamento farmacológico , Medição de Risco , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamento farmacológico , Resultado do TratamentoRESUMO
We report the first documented case of an extragestational infection with Chlamydophila abortus in humans. The pathogen was identified in a patient with severe pelvic inflammatory disease (PID) by sequence analysis of the ompA gene. Our findings raise the possibility that Chlamydiaceae other than Chlamydia trachomatis are involved in PID.