Case Report and Literature Review: Disseminated Histoplasmosis Infection Diagnosed by Metagenomic Next-Generation Sequencing.

Background: Histoplasmosis is a deep fungal infection caused by Histoplasma capsulatum and can be classified as pulmonary, disseminated or central. Disseminated histoplasmosis is the most dangerous of all clinical types and is characterized by rapid onset, rapid progression, high mortality, and difficulty in diagnosis and treatment. Case Presentation: This report describes a 31-year-old female who presented with fever, with a maximum temperature of 39.8 °C. There were no concomitant symptoms, such as cough, sputum, abdominal pain and diarrhoea, before the onset of fever, and the illness lasted for more than 20 days. On examination, the liver and spleen were enlarged, and laboratory tests showed a significant decrease in CD4 cell count, suggesting immune deficiency. Broad-spectrum antibiotic treatment was ineffective, and specific infectious diseases and haematological neoplasms were considered likely. She was finally diagnosed with disseminated histoplasmosis after undergoing bone marrow aspiration and metagenomic next-generation sequencing (mNGS) and was treated with amphotericin B, fluorouracil and itraconazole, with good results. Conclusion: This case demonstrates that disseminated histoplasmosis infection can present with unexplained fever and that mNGS can be an important complement to bone marrow aspiration for the diagnosis of this disease.

A case report and literature review: diagnosis and treatment of human immunodeficiency virus coinfected with visceral leishmania by metagenomic next-generation sequencing in China.

Background: human immunodeficiency virus (HIV) can disrupt the body's immune system, increasing the chance of various opportunistic infections. The risk of misdiagnosis and underdiagnosis is high for HIV and Leishmania coinfection. Visceral leishmaniasis (VL) has become a significant opportunistic infection in HIV type 1 (HIV-1)-infected patients in the epidemic region. Co-infection is difficult to diagnose, especially in non-endemic areas. Case Description: This study presents a case of VL in a middle-aged male patient with HIV coinfection, where the diagnosis was circuitous and complex. The patient was a 44-year-old male who was hospitalized due to fever. We considered common pathogen infection or hemophagocytic syndrome, so we did various etiological examinations and bone marrow biopsy smears, but no positive pathogens were found. Then we used a variety of empirical treatment, but the patient's temperature did not drop significantly. After the final diagnosis of VL using metagenomic next-generation sequencing (mNGS), we read the bone marrow smear and biopsy specimens again, and ultimately the Leishman-Donovan body and tissue intracellular pathogens were found. The patient responded well to treatment with sodium stibogluconate (SSG), his temperature gradually recovered from hyperthermia to normal, liver and spleen size gradually decreased, hemoglobin and platelet count rebounded, and weight increased by 1.5 kg after discharge from the hospital. We hope to deepen clinicians' understanding of mNGS for VL diagnosis and provide a review of the literature. Conclusions: For patients with HIV coinfection, mNGS-a test that can detect multiple pathogens simultaneously-can be used routinely when multiple pathogen tests showed no positive results, multiple empiric anti-infective therapies failed, and hospital technology and the patient's economy are adequate. While giving highly active antiretroviral therapy (HAART), liposomal amphotericin B (L-AMB) is highly recommended because of its better efficacy and lower side effects. Not only is the treatment of leishmaniasis critical but also follow-up at a later stage is essential. After discharged, the patient had no significant discomfort and no increase in body temperature, his hemoglobin and platelets increased further. He demonstrated a further reduction in liver and spleen size and a weight gain of 1.5 kg.

Risk Factors for Acquired Stenotrophomonas maltophilia Pneumonia in Intensive Care Unit: A Systematic Review and Meta-Analysis.

Background and Aims: Stenotrophomonas maltophilia is increasingly found in critically ill patients, but it is considered a pathogen of limited pathogenicity and therefore it is not often targeted. We systematically evaluated risk factors for S. maltophilia pneumonia in ICU patients for better clinical management. Methods: Prospective and retrospective studies of S. maltophilia infection in the ICU from database establishment to August 8, 2021, were searched through PubMed, web of science, Cochrane Library Embase and CNKI. The literature was independently screened and extracted by two authors according to inclusion and exclusion criteria, evaluated for quality by the NOS scale, and meta-analyzed by stata 14.0 software. Results: A total of eight studies with a sample size of 2,320 cases were included. Meta-analysis showed that APACHE-II score > 20 (OR = 10.98, 95% CI: 5.67 ~ 21.26), COPD (OR = 3.97, 95% CI: 2.39 ~ 6.61), malignant tumor (OR = 2.15, 95% CI: 1.03 ~ 4.50), mechanical ventilation (OR = 8.75, 95% CI: 2.59 ~ 29.58), tracheotomy (OR = 6.12, 95% CI: 2.06 ~ 18.18), endotracheal intubation (OR = 4.25, 95% CI: 2.30 ~ 7.84), ß- Lactamase inhibitors (OR = 9.98, 95% CI: 1.51 ~ 65.96), aminoglycosides (OR = 4.01, 95% CI: 2.06 ~ 7.80), carbapenems (OR = 2.82, 95% CI: 1.49 ~ 5.31), and quinolones (OR = 2.17, 95% CI: 1.21 ~ 3.89) were risk factors for ICU-acquired S. maltophilia pneumonia. Conclusion: Many risk factors are associated with S. maltophilia pneumonia in ICU patients. Clinical workers should pay more attention to assessing the risk of infection in ICU patients and enhance the prevention and management of high-risk groups, which will help reduce their risk of S. maltophilia infection.

The association between SNPs and hepatitis B virus related acute-on-chronic liver failure.

OBJECTIVE: This study intended to investigate the association between ten single nucleotide polymorphisms (rs1143623, rs12692386, rs1799983, rs2297518, rs2910164, rs3129859, rs4251961, rs4846085, rs641738, rs873457) with susceptibility and prognosis of hepatitis B related acute-on-chronic liver failure (HBV-ACLF). METHODS: This is a hospital-based case-control study included 274 patients with HBV-ACLF and 534 patients with chronic hepatitis B. The patients who were successfully followed were divided into the survival group and the death group according to the clinical outcome during the hospitalization and 90 days after discharge. The ten SNPs were genotyped in all subjects by using imLDR. Genotype, allele frequency, dominant model, recessive model and codominant model were constructed to investigate the association between single nucleotide polymorphisms with susceptibility and prognosis of HBV-ACLF. RESULTS: The genotype distribution of rs1143623 was statistically different between the two groups (P = 0.04), but the allele frequency was not statistically significant (P = 0.44). GC and GG + CG genotypes at rs1143623 reduced the risk of HBV-ACLF. There were only two GG and GT genotypes in rs1799983 in our study, and the genotype and allele frequency were statistically different between the death group and the survival group (P = 0.027, P = 0.023). Patients with T allele may reduce the risk of death in patients with HBV-ACLF. The genotype and allele frequency of rs2297518 showed no significant difference. In dominant models, patients with GA + AA genotypes at rs2297518 had a reduced risk of death.