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1.
Parasit Vectors ; 17(1): 284, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38956725

RESUMO

BACKGROUND: Toxoplasma gondii infection affects a significant portion of the global population, leading to severe toxoplasmosis and, in immunocompromised patients, even death. During T. gondii infection, disruption of gut microbiota further exacerbates the damage to intestinal and brain barriers. Therefore, identifying imbalanced probiotics during infection and restoring their equilibrium can regulate the balance of gut microbiota metabolites, thereby alleviating tissue damage. METHODS: Vimentin gene knockout (vim-/-) mice were employed as an immunocompromised model to evaluate the influence of host immune responses on gut microbiota balance during T. gondii infection. Behavioral experiments were performed to assess changes in cognitive levels and depressive tendencies between chronically infected vim-/- and wild-type (WT) mice. Fecal samples were subjected to 16S ribosomal RNA (rRNA) sequencing, and serum metabolites were analyzed to identify potential gut probiotics and their metabolites for the treatment of T. gondii infection. RESULTS: Compared to the immunocompetent WT sv129 mice, the immunocompromised mice exhibited lower levels of neuronal apoptosis and fewer neurobehavioral abnormalities during chronic infection. 16S rRNA sequencing revealed a significant decrease in the abundance of probiotics, including several species of Lactobacillus, in WT mice. Restoring this balance through the administration of Lactobacillus murinus and Lactobacillus gasseri significantly suppressed the T. gondii burden in the intestine, liver, and brain. Moreover, transplantation of these two Lactobacillus spp. significantly improved intestinal barrier damage and alleviated inflammation and neuronal apoptosis in the central nervous system. Metabolite detection studies revealed that the levels of various Lactobacillus-related metabolites, including indole-3-lactic acid (ILA) in serum, decreased significantly after T. gondii infection. We confirmed that L. gasseri secreted much more ILA than L. murinus. Notably, ILA can activate the aromatic hydrocarbon receptor signaling pathway in intestinal epithelial cells, promoting the activation of CD8+ T cells and the secretion of interferon-gamma. CONCLUSION: Our study revealed that host immune responses against T. gondii infection severely disrupted the balance of gut microbiota, resulting in intestinal and brain damage. Lactobacillus spp. play a crucial role in immune regulation, and the metabolite ILA is a promising therapeutic compound for efficient and safe treatment of T. gondii infection.


Assuntos
Lesões Encefálicas , Microbioma Gastrointestinal , Camundongos Knockout , Toxoplasma , Animais , Camundongos , Toxoplasma/imunologia , Lesões Encefálicas/imunologia , Probióticos/administração & dosagem , Encéfalo/imunologia , Lactobacillus , Modelos Animais de Doenças , Hospedeiro Imunocomprometido , Toxoplasmose/imunologia , RNA Ribossômico 16S/genética , Masculino , Intestinos/imunologia
2.
J Assoc Physicians India ; 72(7): 100-101, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38990595

RESUMO

Aspergillosis mostly involves the lung and sinuses in severely immunocompromised patients like those with hematological malignancies, postorgan transplants, acquired immunodeficiency syndrome (AIDS), and secondary to chemotherapeutic agents. Duodenal aspergillosis is very rare and mostly occurs as a part of disseminated disease or in classical immunosuppressive conditions. We report a middle-aged female with uncontrolled diabetes who presented to us with epigastric pain and was finally diagnosed as a case of primary duodenal aspergillosis. Diabetes mellitus should also be kept as one of the predisposing conditions for it, and a high index of suspicion should be kept for it to reduce morbidity and mortality.


Assuntos
Aspergilose , Humanos , Feminino , Aspergilose/diagnóstico , Aspergilose/complicações , Pessoa de Meia-Idade , Duodenopatias/diagnóstico , Duodenopatias/etiologia , Antifúngicos/uso terapêutico , Complicações do Diabetes , Hospedeiro Imunocomprometido , Diabetes Mellitus Tipo 2/complicações
3.
Am J Case Rep ; 25: e943128, 2024 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-38971966

RESUMO

BACKGROUND Crusted scabies is a severe skin infection resulting from hyper-infestation with the obligate parasite Sarcoptes scabiei var. hominis. In contrast to classic scabies, crusted scabies may involve as many as hundreds to millions of mites. Importantly, this condition is associated with a mortality rate of 60% in 5 years, and is more likely to develop in immunosuppressed hosts, presumably due to an impaired T-cell response against the mite. CASE REPORT We present a case of crusted scabies in a 13-year-old girl during her early post-liver transplant period receiving immunosuppression successfully treated with topical 5% permethrin. She had pruritic erythematous papules, confirmed as scabies through skin scraping. The challenge of misdiagnosis during the initial presentation is noteworthy, given atypical manifestations and more common differentials. To our knowledge, only 2 cases of crusted scabies in pediatric solid-organ transplant recipients have been reported. Despite the absence of guidelines for pediatric solid-organ transplant recipients, urgent treatment is required due to the high associated mortality rates. In our case, early treatment proved successful without any secondary bacterial infections or clinical evidence of relapse during a 6-month follow-up. CONCLUSIONS We report a case of scabies in a pediatric liver transplant recipient that was successfully treated. It is crucial to consider the diagnosis of scabies given the associated morbidity and the risk of secondary bacterial infections among other more common differentials. Notably, the response to standard anti-scabies treatment may lead to resolution without relapse in pediatric solid-organ transplant recipients.


Assuntos
Transplante de Fígado , Escabiose , Humanos , Escabiose/diagnóstico , Escabiose/tratamento farmacológico , Feminino , Transplante de Fígado/efeitos adversos , Adolescente , Permetrina/uso terapêutico , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Inseticidas/uso terapêutico , Terapia de Imunossupressão/efeitos adversos
4.
Support Care Cancer ; 32(8): 496, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38980433

RESUMO

PURPOSE: Immunocompromised individuals, such as those diagnosed with cancer, are at a significantly higher risk for severe illness and mortality when infected with SARS-CoV-2 (COVID-19) than the general population. Two oral antiviral treatments are approved for COVID-19: Paxlovid® (nirmatrelvir/ritonavir) and Lagevrio® (molnupiravir). There is a paucity of data regarding the benefit from these antivirals among immunocompromised patients with cancer, and recent studies have questioned their efficacy among vaccinated patients, even those with risk factors for severe COVID-19. METHODS: We evaluated the efficacy and safety of nirmatrelvir/ritonavir and molnupiravir in preventing severe illness and death using our database of 457 patients with cancer and COVID-19 from Brown University-affiliated hospitals. RESULTS: Sixty-seven patients received nirmatrelvir/ritonavir or molnupiravir and were compared to 45 concurrent controls who received no antiviral treatment despite being eligible to receive it. Administration of nirmatrelvir/ritonavir or molnupiravir was associated with improved survival and lower 90-day all-cause and COVID-19-attributed mortality (p < 0.05) and with lower peak O2 requirements (ordinal odds ratio [OR] 1.52, 95% confidence interval [CI] 0.92-2.56). CONCLUSION: Acknowledging the small size of our sample as a limitation, we concluded that early antiviral treatment might be beneficial to immunocompromised individuals, particularly those with cancer, when infected with SARS-CoV-2. Larger-scale, well-stratified studies are needed in this patient population.


Assuntos
Antivirais , Tratamento Farmacológico da COVID-19 , Neoplasias , Ritonavir , Humanos , Neoplasias/tratamento farmacológico , Neoplasias/complicações , Masculino , Antivirais/uso terapêutico , Antivirais/administração & dosagem , Feminino , Pessoa de Meia-Idade , Idoso , Ritonavir/uso terapêutico , Ritonavir/administração & dosagem , Administração Oral , Citidina/análogos & derivados , Citidina/uso terapêutico , Citidina/administração & dosagem , Hidroxilaminas/uso terapêutico , Hidroxilaminas/administração & dosagem , COVID-19 , Adulto , Hospedeiro Imunocomprometido , Leucina/análogos & derivados , Leucina/uso terapêutico , Idoso de 80 Anos ou mais , SARS-CoV-2 , Estudos Retrospectivos
5.
Am J Trop Med Hyg ; 111(1): 132-135, 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38964313

RESUMO

Blood stream infection with Microbacterium species in humans is rare and frequently linked to the presence of immunosuppressed conditions such as patients on chemotherapy or corticosteroids. Presence of indwelling catheters is also a potential risk factor for M. aurum infection. No case report has been documented in the literature regarding the pathogenic potential of M. aurum in causing bacteremia. This is the first case series reporting bacteremia by M. aurum describing the risk factors and sensitivity pattern of this pathogen. In this case series, we have described bacteremia caused by M. aurum. The risk factors and sensitivity pattern of this pathogen have also been evaluated. Here, we describe the clinical course and presentation of three patients whose blood culture showed growth of M. aurum. Indwelling venous catheter for hemodialysis or for chemotherapy for the treatment of acute lymphoblastic leukemia was found to be a risk factor in two patients. Rheumatoid arthritis was the underlying condition in the second patient and was started on immunosuppressants. Blood samples were collected during the febrile period. The blood culture samples of all these patients had pure isolates of M. aurum, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. All three patients were managed according to the sensitivity reports and were discharged in stable condition.


Assuntos
Bacteriemia , Hospedeiro Imunocomprometido , Microbacterium , Humanos , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Masculino , Feminino , Pessoa de Meia-Idade , Infecções por Actinomycetales/microbiologia , Infecções por Actinomycetales/tratamento farmacológico , Antibacterianos/uso terapêutico , Adulto , Fatores de Risco , Idoso , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico
6.
Tunis Med ; 102(7): 394-398, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38982962

RESUMO

INTRODUCTION: Healthcare-associated infections pose a significant public health burden, leading to morbidity, mortality, prolonged hospital stays, and substantial social and economic costs. Immunocompromised patients are at a heightened risk of nosocomial infections. AIM: This prospective study conducted at Mohammed VI University Hospital of Oujda aimed to assess the microbial ecology of surfaces and air in an immunosuppressed patient room compared to a double hospitalization room. METHODS: Microbiological air purity tests were conducted employing both the sedimentation method and the collision method with the assistance of Microflow Alpha. The sedimentation method used Mueller Hinton with 5% human blood, facilitating the free fall of contaminated dust particles. The collection program employed was set for 10 minutes per 1 m3. For surface sampling, swabs were taken from a 25 cm2 surface. The swabs were immediately forwarded to the Microbiology Laboratory. We carried out both macroscopic and microscopic identification of colonies, followed by definitive biochemical identification using the BD phoenixTM system. Antibiotic susceptibility was assessed through agar diffusion on Muller Hinton medium coupled with the determination of the minimum inhibitory concentration. RESULTS: The results revealed a decreased bacterial count within the protective isolation room, in contrast to the standard hospital room. We noted the predominance of coagulase-negative Staphylococcus spp and Bacillus spp. Staphylococcus aureus and Aspergillus spp, common pathogens in healthcare-associated infections, were notably absent in the protective isolation room. The findings underline the pivotal role of hospital environments in the transmission of healthcare-associated infections. CONCLUSION: The protective isolation room demonstrated effective control of microbial contamination, with fewer and less resistant germs. The study highlighted the significance of air treatment systems in preventing the spread of opportunistic infections. Our study underscored the critical role of microbiological cleanliness in preventing nosocomial infections.


Assuntos
Microbiologia do Ar , Infecção Hospitalar , Humanos , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Estudos Prospectivos , Quartos de Pacientes/organização & administração , Quartos de Pacientes/estatística & dados numéricos , Isolamento de Pacientes/métodos , Hospitais Universitários , Hospedeiro Imunocomprometido , Tunísia/epidemiologia
7.
Exp Clin Transplant ; 22(5): 329-340, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38970276

RESUMO

OBJECTIVES: The immunocompromised status in transplant recipients promotes the development and exacerbation of rhinosinusitis. However, there are no formal guidelines on pretransplant sinonasal evaluations. Here, we aimed to identify the prevalence and mortality rates of rhinosinusitis in the transplant population and to provide an evidence-based pretransplant screening protocol. MATERIALS AND METHODS: For our meta-analysis and systematic review of available literature, we performed an online search on PubMed, Scopus, and Google Scholar. We included 27 articles for review, which included 22 articles for meta-analysis. We assessed the risk of bias on outcome by using the GRADE system. Primary outcome measures were pretransplant prevalence of rhinosinusitis and overall mortality rates. RESULTS: The prevalence of pretransplant rhinosinusitis in hematopoietic stem cell transplant recipients (22.2%) was significantly higher than the prevalence in solid-organ transplant recipients (3.9%) (relative risk 4.9; 95% CI, 4.2-5.6; P < .01). We found no significant difference in overall mortality between transplant recipients with or without rhinosinusitis. However, hematopoietic stem cell transplant recipients with pretransplant rhinosinusitis showed significantly higher risk of overall mortality (relative risk 2.8; 95% CI, 2.1-3.9; P < .05) compared with solid-organ transplant recipients. CONCLUSIONS: Our research assessed the need for a clinical pretransplant sinonasal assessment in all transplant recipients and advised for routine paranasal sinus computed tomography before hematopoietic stem cell transplant, due to the higher prevalence of rhinosinusitis and risk of mortality in this group. We also presented a proposed screening protocol on pretransplant sinonasal evaluation.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Hospedeiro Imunocomprometido , Valor Preditivo dos Testes , Rinite , Sinusite , Humanos , Sinusite/mortalidade , Sinusite/diagnóstico , Sinusite/epidemiologia , Rinite/mortalidade , Rinite/diagnóstico , Rinite/epidemiologia , Prevalência , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/mortalidade , Fatores de Risco , Medição de Risco , Resultado do Tratamento , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/mortalidade , Adulto , Pessoa de Meia-Idade , Feminino , Masculino , Adulto Jovem , Adolescente
8.
Turkiye Parazitol Derg ; 48(2): 111-116, 2024 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-38958436

RESUMO

Objective: In patients with end-stage kidney disease, kidney transplantation is the kidney replacement therapy option that provides the most successful survival. However, immunosuppression agents administered after kidney transplantation can increase the risk of opportunistic infections. Microsporidia are obligate intracellular pathogens that can be fatal in immunosuppressed patients. The present study aimed to determine the prevalence of microsporidia in kidney transplantation recipients and the molecular characterization of the detected species. Methods: To evaluate the prevalence of renal microsporidiosis in kidney transplant recipients, the urine samples from a total of 325 patients were analyzed by real-time and nested polymerase chain reaction for Encephalitozoon spp. and Enterocytozoon bieneusi. Results: Only one (0.4%) sample from the adult patient was positive for the Encephalitozoon species, while no positivity was found in pediatric patients. It was determined as Encephalitozoon intestinalis by ITS rRNA gene region sequence analysis. A microsporidia species obtained from humans in Türkiye has been characterized for the first time and registered in GenBank. Conclusion: Our epidemiological results show that the prevalence of renal microsporidiosis in kidney transplant recipients is very low. In addition, as a result of the phylogenetic analysis of the detected isolate, it was observed that it was 100% identical to the isolates reported from dogs in Kayseri, Türkiye. This situation provided essential data regarding the zoonotic transmission dynamics of microsporidia.


Assuntos
Encephalitozoon , Encefalitozoonose , Transplante de Rim , Microsporidiose , Filogenia , Humanos , Transplante de Rim/efeitos adversos , Prevalência , Masculino , Adulto , Encefalitozoonose/epidemiologia , Feminino , Encephalitozoon/genética , Encephalitozoon/isolamento & purificação , Criança , Turquia/epidemiologia , Microsporidiose/epidemiologia , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Reação em Cadeia da Polimerase , Hospedeiro Imunocomprometido , Pré-Escolar , Idoso , Enterocytozoon/genética , Enterocytozoon/isolamento & purificação , Animais
9.
Cleve Clin J Med ; 91(7): 437-445, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38950984

RESUMO

Herpes zoster (HZ) incidence is much higher in immunocompromised individuals than in immunocompetent individuals. HZ also occurs at a younger age and is often more severe in immunocompromised persons. Preventive strategies center around the recombinant zoster vaccine (RZV), which is approved for immunocompromised adults age 19 and older. Identifying those at greatest risk is critical. For those considering vaccination, evidence gaps regarding vaccine efficacy, toxicity, length of protection, and potential effects on underlying conditions may complicate shared and informed decision-making. Recent data have filled some of these gaps, with several societies issuing recommendations regarding vaccination. Remaining gaps are currently addressed by expert opinion.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Hospedeiro Imunocomprometido , Humanos , Herpes Zoster/prevenção & controle , Herpes Zoster/epidemiologia , Vacinação/métodos
11.
BMJ Case Rep ; 17(6)2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38890117

RESUMO

Actinomycosis is a rare endogenous infection characterised by indolent progression, contiguous spreading, abscess formation and draining sinuses. Here, we present a case of Schaalia odontolytica causing a mediastinal abscess that is unique in its acuity and location. Our patient presented with worsening dysphagia, and CT of her chest revealed a new mass in the posterior mediastinum displacing the oesophagus. Oesophagram revealed mild motility disorder, but no masses or ulcers within the oesophagus. Oesophagogastroduodenoscopy with endoscopic ultrasound revealed extrinsic compression of the oesophagus. Fine-needle aspiration of the mass yielded purulent fluid, which was cultured. A single colony of S. odontolytica was isolated. Initially, medical treatment was favoured, but as she developed worsening dysphagia, the abscess was drained. She continued on long-term antibiotic therapy after drainage and had complete resolution of the abscess at 1 year.


Assuntos
Actinomicose , Transtornos de Deglutição , Hospedeiro Imunocomprometido , Doenças do Mediastino , Humanos , Feminino , Actinomicose/diagnóstico , Actinomicose/complicações , Actinomicose/tratamento farmacológico , Transtornos de Deglutição/etiologia , Doenças do Mediastino/diagnóstico , Diagnóstico Diferencial , Abscesso/diagnóstico , Abscesso/microbiologia , Antibacterianos/uso terapêutico , Tomografia Computadorizada por Raios X , Drenagem , Pessoa de Meia-Idade , Mediastino
12.
J Infect Public Health ; 17(7): 102473, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38865774

RESUMO

BACKGROUND: Cancer patients often have weakened immune systems, resulting in a lower response to vaccines, especially those receiving immunosuppressive oncological treatment (OT). We aimed to assess the impact of OT on the humoral and T-cell response to the B.1 lineage and Omicron variant following COVID-19 vaccination in patients with solid and hematological neoplasms. METHODS: We conducted a prospective study on cancer patients, stratified into OT and non-OT groups, who received a two-dose series of the COVID-19 mRNA vaccine and a booster six months later. The outcomes measured were the humoral (anti-SARS-CoV-2 S IgG titers and ACE2-S interaction inhibition capacity) and cellular (SARS-CoV-2 S-specific T-cell spots per million PBMCs) responses against the B.1 lineage and Omicron variant. These responses were evaluated four weeks after the second dose (n = 98) and eight weeks after the booster dose (n = 71). RESULTS: The humoral response after the second vaccine dose against the B.1 lineage and Omicron variant was significantly weaker in the OT group compared to the non-OT group (q-value<0.05). A booster dose of the mRNA-1273 vaccine significantly improved the humoral response in the OT group, making it comparable to the non-OT group. The mRNA-1273 vaccine, designed for the original Wuhan strain, elicited a weaker humoral response against the Omicron variant compared to the B.1 lineage, regardless of oncological treatment or vaccine dose. In contrast, T-cell responses against SARS-CoV-2, including the Omicron variant, were already present after the second vaccine dose and were not significantly affected by oncological treatments. CONCLUSIONS: Cancer patients, particularly those receiving immunosuppressive oncological treatments, should require booster doses and adapted COVID-19 vaccines for new SARS-CoV-2 variants like Omicron. Future studies should evaluate the durability of the immune response and the efficacy of individualized regimens.


Assuntos
Anticorpos Antivirais , Vacinas contra COVID-19 , COVID-19 , Neoplasias , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus , Humanos , Estudos Prospectivos , Masculino , COVID-19/imunologia , COVID-19/prevenção & controle , Feminino , Pessoa de Meia-Idade , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , Glicoproteína da Espícula de Coronavírus/imunologia , SARS-CoV-2/imunologia , Idoso , Neoplasias/imunologia , Anticorpos Antivirais/sangue , Linfócitos T/imunologia , Imunização Secundária , Vacinação , Adulto , Imunidade Humoral , Imunoglobulina G/sangue , Hospedeiro Imunocomprometido , Imunidade Celular
13.
BMC Infect Dis ; 24(1): 605, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38898444

RESUMO

BACKGROUND PAECILOMYCES: and Penicillium are considered as rare opportunistic pathogens in immunocompromised hosts, and pneumonia caused by Paecilomyces and Penicillium is rare. In this study, we present first case of severe pneumonia with pleural effusion caused by co-infection of Paecilomyces variotii (P. variotii) and Penicillium oxalicum (P. oxalicum) in a 66-year-old female with poorly controlled type 2 diabetes. CASE PRESENTATION: A 56-year-old woman patient presented to hospital for nausea, poor appetite, and vomiting for one day. On the second day of admission, blood culture and renal puncture fluid culture grew multidrug-resistant Escherichia coli (imipenem/cilastatin sensitive), and she received combination therapy with imipenem/cilastatin (1 g, every 8 h) and vancomycin (0.5 g, every 12 h). On the fourth day, she developed symptoms of respiratory failure. Pulmonary computed tomography (CT) showed an increase in pneumonia compared to before, with minor pleural effusion on both sides. Two fungi were isolated repeatedly from BALF culture, which were confirmed as P. variotii and P. oxalicum by Internal transcribed spacer (ITS) sequencing. Her pleural effusion was completely absorbed, pneumonia symptoms have significantly improved and discharged with receiving liposomal amphotericin B treatment for four weeks. CONCLUSIONS: It is worth noting that clinicians and laboratory personnel should not simply consider Paecilomyces and Penicillium species as contaminants, especially in immunocompromised patients. Early fungal identification and antifungal drug sensitivity are crucial for clinical drug selection and patient prognosis.


Assuntos
Coinfecção , Diabetes Mellitus Tipo 2 , Paecilomyces , Penicillium , Derrame Pleural , Humanos , Feminino , Penicillium/isolamento & purificação , Derrame Pleural/microbiologia , Derrame Pleural/tratamento farmacológico , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus Tipo 2/complicações , Coinfecção/microbiologia , Coinfecção/tratamento farmacológico , Paecilomyces/isolamento & purificação , Pneumonia/microbiologia , Pneumonia/tratamento farmacológico , Micoses/microbiologia , Micoses/tratamento farmacológico , Hospedeiro Imunocomprometido , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico
14.
PLoS Negl Trop Dis ; 18(6): e0012232, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38843299

RESUMO

BACKGROUND: Ocular toxoplasmosis (OT) is the most common cause of infectious uveitis worldwide, including Thailand. This study describes the clinical presentation, visual acuity (VA) outcomes, and factors associated with VA loss in patients with active OT following antiparasitic treatment. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective chart review of patients with active OT treated with antiparasitic drugs between 2010 and 2020 was performed. Outcome measures included clinical characteristics, interval VA, and predictive factors associated with loss of VA ≤ 20/50 at 6 months post-treatment. Ninety-two patients (95 eyes) were enrolled. The median follow-up time was 10.9 months (IQR 4.9-31.8 months). The median age at presentation was 35.9 years, 51% were male, and 92.4% had unilateral OT. Eleven patients (12%) were immunocompromised (HIV infection, eight patients; receiving immunosuppressive agents, three patients). Patients mainly presented with primary retinitis without previous scar (62%), posterior pole lesion (56%), and lesion size of ≤ 2-disc area (75%). Immunocompromised patients showed a significantly larger size of retinitis than immunocompetent patients. Oral trimethoprim/sulfamethoxazole monotherapy was the primary short-term antiparasitic drug prescribed (85%). At the final visit, 21% of all affected eyes suffered VA ≤ 20/200. The cumulative incidence of recurrent OT at three years was 33.9% (95% CI, 19.7%-54.2%). Immunocompromised patients [adjusted odds ratio (aOR) 4.9, p = 0.041], macular lesion (aOR 5.4, p = 0.032), and initial VA ≤ 20/200 (aOR 9.1, p = 0.014) were predictive of having VA ≤ 20/50 at 6 months post-treatment. CONCLUSIONS: Ocular toxoplasmosis mainly presents as unilateral primary retinitis within the posterior pole. Severe VA loss was observed in one-fifth of eyes following treatment with lesion resolution. Immunocompromised patients, eyes with macular lesions, and poor initial VA were associated with poor VA outcomes.


Assuntos
Centros de Atenção Terciária , Toxoplasmose Ocular , Acuidade Visual , Humanos , Toxoplasmose Ocular/tratamento farmacológico , Toxoplasmose Ocular/fisiopatologia , Toxoplasmose Ocular/complicações , Toxoplasmose Ocular/epidemiologia , Masculino , Estudos Retrospectivos , Adulto , Feminino , Tailândia/epidemiologia , Pessoa de Meia-Idade , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem , Hospedeiro Imunocomprometido , Antiparasitários/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adolescente , Resultado do Tratamento , População do Sudeste Asiático
15.
Curr Opin Infect Dis ; 37(4): 238-244, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38842472

RESUMO

PURPOSE OF REVIEW: Arbovirus infections are a challenge for immunocompromised hosts who travel to or live in endemic regions or who receive organs or tissues from donors who travel or live in such areas. This review addresses Dengue (DENV), Chikungunya (CHIKV), and Zika (ZIKV) infections in hematological patients, hematopoietic cell or solid organ transplant recipients, and people with HIV (PWH). RECENT FINDINGS: Transmission is mainly due through Aedes mosquito bite. DENV and ZIKV may also be transmitted through blood, tissues or donor grafts. Clinical manifestations are quite similar and diagnosis requires laboratory confirmation to provide appropriate management. The best diagnostic method is PCR since serology may present false negative results in immunocompromised patients, or cross-reactivity as in the case of DENV and ZIKV. There is no specific treatment for any of these infections. SUMMARY: Educational and preventive measures are the best strategy: vector control, knowledge of the vector's habits, protection against mosquito bites, avoiding travel to endemic areas or with a current epidemic, and avoiding nonvector transmission according to local recommendations for donor deferral. Vaccination, currently only available for DENV, has not yet been studied in immunocompromised patients and is not currently recommended.


Assuntos
Febre de Chikungunya , Dengue , Hospedeiro Imunocomprometido , Infecção por Zika virus , Humanos , Dengue/imunologia , Dengue/epidemiologia , Dengue/transmissão , Febre de Chikungunya/imunologia , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/transmissão , Infecção por Zika virus/imunologia , Infecção por Zika virus/transmissão , Infecção por Zika virus/epidemiologia , Doenças Endêmicas , Animais
16.
Curr Microbiol ; 81(7): 208, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38833191

RESUMO

Diabetes mellitus (DM) leads to impaired innate and adaptive immune responses. This renders individuals with DM highly susceptible to microbial infections such as COVID-19, tuberculosis and melioidosis. Melioidosis is a tropical disease caused by the bacterial pathogen Burkholderia pseudomallei, where diabetes is consistently reported as the most significant risk factor associated with the disease. Type-2 diabetes is observed in 39% of melioidosis patients where the risk of infection is 13-fold higher than non-diabetic individuals. B. pseudomallei is found in the environment and is an opportunistic pathogen in humans, often exhibiting severe clinical manifestations in immunocompromised patients. The pathophysiology of diabetes significantly affects the host immune responses that play a critical role in fighting the infection, such as leukocyte and neutrophil impairment, macrophage and monocyte inhibition and natural killer cell dysfunction. These defects result in delayed recruitment as well as activation of immune cells to target the invading B. pseudomallei. This provides an advantage for the pathogen to survive and adapt within the immunocompromised diabetic patients. Nevertheless, knowledge gaps on diabetes-infectious disease comorbidity, in particular, melioidosis-diabetes comorbidity, need to be filled to fully understand the dysfunctional host immune responses and adaptation of the pathogen under diabetic conditions to guide therapeutic options.


Assuntos
Burkholderia pseudomallei , Melioidose , Melioidose/microbiologia , Melioidose/imunologia , Humanos , Burkholderia pseudomallei/imunologia , Complicações do Diabetes/microbiologia , Diabetes Mellitus/imunologia , Diabetes Mellitus/microbiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/imunologia , Diabetes Mellitus Tipo 2/microbiologia , Hospedeiro Imunocomprometido
17.
Turk J Ophthalmol ; 54(3): 175-179, 2024 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-38860516

RESUMO

A 78-year-old man with a history of lung cancer, chemotherapy, radiotherapy, and coronavirus disease 2019 infection experienced visual deterioration of two-weeks' duration in his right eye. There was multifocal, yellowish-white retinitis foci, vascular engorgement, and scattered intraretinal hemorrhages extending from posterior pole to retinal periphery in the right eye, whereas the left eye was normal. Intravitreal vancomycin, ceftazidime, clindamycin, and dexamethasone were given for endogenous endophthalmitis initially. Vitreous culture confirmed the presence of Aspergillus lentulus, and he was treated with intravitreal amphotericin-B and voriconazole injections together with systemic amphotericin-B, voriconazole, posaconazole, and micafungin therapy. During follow-up, vitreoretinal surgery was performed because of rhegmatogenous retinal detachment, and he received one additional cycle of chemotherapy due to recurrence of the cancer. Although the retina was attached, enucleation was eventually required due to painful red eye. Atypical squamous cells beneath the neurosensory retina suggesting metastasis were noted on histopathological examination. Timely ocular examination is crucial for any immunocompromised patient having ocular symptoms. High level of suspicion for a fungal etiology is a must in these patients.


Assuntos
Aspergilose , Aspergillus , Endoftalmite , Infecções Oculares Fúngicas , Hospedeiro Imunocomprometido , Neoplasias Pulmonares , Humanos , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Masculino , Idoso , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/microbiologia , Neoplasias Pulmonares/diagnóstico , Aspergilose/diagnóstico , Aspergilose/microbiologia , Aspergillus/isolamento & purificação , Antifúngicos/uso terapêutico , COVID-19/complicações , Corpo Vítreo/microbiologia , Injeções Intravítreas , SARS-CoV-2
19.
BMC Med ; 22(1): 237, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38858672

RESUMO

BACKGROUND: Immunocompromised individuals are at increased risk of severe COVID-19 outcomes, underscoring the importance of COVID-19 vaccination in this population. The lack of comprehensive real-world data on vaccine uptake, effectiveness and safety in these individuals presents a critical knowledge gap, highlighting the urgency to better understand and address the unique challenges faced by immunocompromised individuals in the context of COVID-19 vaccination. METHODS: We analysed data from 12,274,946 people in the UK aged > 12 years from 01/12/2020 to 11/04/2022. Of these, 583,541 (4.8%) were immunocompromised due to immunosuppressive drugs, organ transplants, dialysis or chemotherapy. We undertook a cohort analysis to determine COVID-19 vaccine uptake, nested case-control analyses adjusted for comorbidities and sociodemographic characteristics to determine effectiveness of vaccination against COVID-19 hospitalisation, ICU admission and death, and a self-controlled case series assessing vaccine safety for pre-specified adverse events of interest. RESULTS: Overall, 93.7% of immunocompromised individuals received at least one COVID-19 vaccine dose, with 80.4% having received three or more doses. Uptake reduced with increasing deprivation (hazard ratio [HR] 0.78 [95%CI 0.77-0.79] in the most deprived quintile compared to the least deprived quintile for the first dose). Estimated vaccine effectiveness against COVID-19 hospitalisation 2-6 weeks after the second and third doses compared to unvaccinated was 78% (95%CI 72-83) and 91% (95%CI 88-93) in the immunocompromised population, versus 85% (95%CI 83-86) and 86% (95%CI 85-89), respectively, for the general population. Results showed COVID-19 vaccines were protective against intensive care unit (ICU) admission and death in both populations, with effectiveness of over 92% against COVID-19-related death and up to 95% in reducing ICU admissions for both populations following the third dose. COVID-19 vaccines were generally safe for immunocompromised individuals, though specific doses of ChAdOx1, mRNA-1273 and BNT162b2 raised risks of specific cardiovascular/neurological conditions. CONCLUSIONS: COVID-19 vaccine uptake is high in immunocompromised individuals on immunosuppressive drug therapy or who have undergone transplantation procedures, with documented disparities by deprivation. Findings suggest that COVID-19 vaccines are protective against severe COVID-19 outcomes in this vulnerable population, and show a similar safety profile in immunocompromised individuals and the general population, despite some increased risk of adverse events. These results underscore the importance of ongoing vaccination prioritisation for this clinically at-risk population to maximise protection against severe COVID-19 outcomes.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Hospedeiro Imunocomprometido , Imunossupressores , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , COVID-19/prevenção & controle , COVID-19/epidemiologia , Adulto , Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/administração & dosagem , Idoso , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Estudos de Coortes , Inglaterra/epidemiologia , Adolescente , Adulto Jovem , SARS-CoV-2/imunologia , Estudos de Casos e Controles , Eficácia de Vacinas , Vacinação , Criança , Idoso de 80 Anos ou mais
20.
Curr Opin Organ Transplant ; 29(4): 271-276, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38847176

RESUMO

PURPOSE OF REVIEW: Solid organ transplantation recipients have an increased risk of infection, exacerbated by immunosuppressant medications that need to finely balance suppression of the immune system to prevent allograft rejection while avoiding over-suppression leading to infections and malignancy. Exercise modulates immune functions, with moderate-intensity activities particularly associated with enhanced antiviral immunity and reduced infection incidence. However, investigations of the effects of exercise and physical activity on immune function and infection risk posttransplantation are scarce. This review highlights areas where the relationship between exercise, immune function and infection risk has greatest potential for benefit for solid organ transplantation and therefore greatest need for investigation. RECENT FINDINGS: Moderate and higher intensity exercise do not appear to cause adverse immunological effects in kidney transplantation recipients, although evidence from other organ transplantation is lacking. Evidence from healthy younger and older adults suggests that regular exercise can reduce risk of respiratory infections and latent herpesvirus reactivation and improves antibody responses to vaccination, which is of great importance for organ transplantation recipients. SUMMARY: There is a strong need for research to investigate the role of exercise on immune function and infection risk in solid organ transplantation to improve both allograft survival and long-term health of the recipient.


Assuntos
Transplante de Órgãos , Humanos , Transplante de Órgãos/efeitos adversos , Fatores de Risco , Sistema Imunitário/imunologia , Sistema Imunitário/efeitos dos fármacos , Imunossupressores/efeitos adversos , Resultado do Tratamento , Exercício Físico/fisiologia , Medição de Risco , Exercício Pré-Operatório , Sobrevivência de Enxerto/efeitos dos fármacos , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Terapia por Exercício , Hospedeiro Imunocomprometido
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