Immune-compromised Patients Research Articles

Surgical site infection in clean cases with or without antibiotics.

Objective: To assess the rate of infection in clean cases with antibiotics or without antibiotics. Study Design: Observational Prospective study. Setting: Surgical Unit 1, Independent University Hospital, Faisalabad. Period: Oct 2022 to February 2023. Methods: All patients were selected from surgical wards and OPD. Patients of any age group undergoing clean surgeries were included in this study. The demographic details such as age, gender and type of surgery were recorded for statistical analysis. Patients with Diabetes mellitus, hypertension and immune-compromised patients were excluded from these studies. All patients were kept under observation for 30 days to look any evidence of SSI. Results: One group is given antibiotics and the other does not. But No significant difference between the infection rate in both group. Conclusion: It was concluded that there is no role of antibiotics in infection control in clean cases.

Evaluation of metronidazole oral monotherapy in anaerobic oral infections.

To evaluate the indications and dosing regimens for oral metronidazole monotherapy (OMM) for the management of oral anaerobic infections (OAIs) other than periodontitis. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in literature of PubMed/Medline, Scopus, and Cochrane databases. Data were retrieved from reports published in English in the period January 1, 1980 - August 30, 2023. Joanna Briggs Institute Critical Appraisal Tools were used to assess study risk of bias. A total of 228 articles were retrieved from the databases of which 16 met the inclusion criteria necessary for achieving the aims of the study. OAIs in which OMM was used or recommended included pericoronitis; necrotizing ulcerative gingivitis/periodontitis/stomatitis, osteomyelitis, acute periapical infection, and cellulitis. OMM was prescribed in dosages ranging from 200 to 500 mg t.i.d. for periods ranging from 2 to 7 days. Osteomyelitis of the jaw was the only infection for which the dosage regimen of metronidazole was not clearly described. Evidence from the databases searched support the view that OMM has clinical efficacy in the treatment of specific OAIs namely pericoronitis and necrotizing oral infections in immune-competent and immune-compromised patients. The evidence does not support the use of OMM in "deep tissue" infections such as osteomyelitis, and odontogenic infections such as acute apical infection and cellulitis. Clinical trials are warranted to determine the efficacy of OMM in comparison with other antibiotic regimens.

Stenotrophomonas maltophilia – A Threatening Nosocomial Pathogen

Abstract Stenotrophomonas maltophilia is a ubiquitous Gram-negative rod which has emerged as one of the major causes of nosocomial infections. It can cause pneumonia, septicemia, meningitis, urinary tract, and wound infections, and is associated with high mortality in immune-compromised patients. Pathogenesis in S. maltophilia infections is an outcome of multiple virulence factors, including outer membrane lipopolysaccharide, extracellular enzymes, porins, pilli, biofilm formation, motility, and small colony variants, among others. S. maltophilia shows high intrinsic and acquired resistance to all commonly used antibiotics, limiting the number of therapeutic choices. The aim of this review is to summarize the virulence factors, antibiotic resistance mechanisms, diagnosis, and treatment of S. maltophilia infections.

OMIBONE: Omics-driven computer model of bone regeneration for personalized treatment

Treatment of bone fractures are standardized according to the AO classification, which mainly refers to the mechanical stabilization required in a given situation but neglect individual differences due to patient's healing potential or accompanying diseases. Specially in elderly or immune-compromised patients, the complexity of individual constrains on a biological as well as mechanical level are hard to account for. Here, we introduce a novel framework that allows to predict bone regeneration outcome using combined proteomic and mechanical analyses in a computer model. The framework uses Ingenuity Pathway Analysis (IPA) software to link protein changes to alterations in biological processes and integrates these in an Agent-Based Model (ABM) of bone regeneration. This combined framework allows to predict bone formation and the potential of an individual to heal a given fracture setting. The performance of the framework was evaluated by replicating the experimental setup of a mouse femur fracture stabilized with an intramedullary pin. The model was informed by serum derived proteomics data. The tissue formation patterns were compared against experimental data based on x-ray and histology images. The results indicate the framework potential in predicting an individual's bone formation potential and hold promise as a concept to enable personalized bone healing predictions for a chosen fracture fixation.

Clinical and pathological features of cerebrospinal meningitis caused by Pantoea agglomerans : a case report

BackgroundPantoea agglomerans (P. agglomerans) is a gram-negative bacterium that is commonly isolated from plant surfaces, seeds, and the environment. As an opportunistic pathogen, it can cause blood, urinary and soft tissue infections in immunocompromised patients. In central nervous system, P. agglomerans infection has been report in children and immune-compromised patients, however, infection by such bacterium in nontraumatized immune competent adults has not been reported. Here, we report a case of P. agglomerans cerebrospinal meningitis accompanied by positive anti-myeloperoxidase (MPO) antibody in a 49-year-old female who has a history of black fungus planting.Case presentationThe patient manifested with repeated fever, headache, generalized muscle pain, and neurological defects. Cerebrospinal fluid (CSF) tests revealed a moderately elevated number of polymorphonuclear leukocytes (50–193 × 106/L), low glucose levels (0.54–2.44 mmo1/L), and extremely high protein content (2.42–25.42 g/L). Blood tests showed positive anti-myeloperoxidase antibodies lasting for 1.5 year before turning negative. Spine MRI showed thickening and enhancement of the whole spinal meninges. CSF metagenomic next-generation sequencing (mNGS) revealed 75,189 specific DNA reads of P. agglomerans. The patient underwent spinal laminectomy due to meningeal adhesions. Pathological results revealed fibrous tissue proliferation, inflammatory infiltration with focal necrosis and calcification in the dura mater. The patient was successfully treated with sufficient antibiotics at 1-year follow-up.ConclusionsPeople should be alert to CNS infections caused by P. agglomerans which presented with relatively mild clinical symptoms at onset, especially for those who contucts relevant agricultural and forestry work. The CSF characterization of P. agglomerans meningitis is elevated multiple nuclei white blood cells, significantly reduced glucose content, and markedly increased protein level which may be related to the secondary spinal membrane adhesions.

Anti-Fungal (Aspergillus fumigatus) Activity of Pseudomonas aeruginosa in Cystic Fibrosis Synthetic Sputum.

Aspergillus fumigatus (Af) and Pseudomonas aeruginosa (Pa) are pathogens inhabiting the lungs of persons with cystic fibrosis (CF), or immune-compromised patients, causing or aggravating disease. We previously investigated their microbial interaction as well as susceptibility to anti-fungal drugs using RPMI medium (contains undetectable iron concentrations), as is standard for susceptibility testing. Here we investigated microbial interaction in synthetic sputum medium (SSPM), a complex mixture designed to mimic the milieu in CF lungs. SSPM contains Fe2+. Pa laboratory strain PA14 or PA14 siderophore mutant planktonic culture filtrate, prepared in RPMI or SSPM, were compared for inhibition of Af biofilm formation. SSPM enhanced bacterial and fungal growth and the production of the Pa molecules pyoverdine, phenazines, and rhamnolipids. Af was more susceptible to these molecules in SSPM (with the exception of pyoverdine). SSPM interfered with fungal susceptibility to pyoverdine. Studies with the mutant helped to reveal that the reduced anti-fungal activity of pyoverdine in SSPM appears to be compensated by higher production of other anti-fungal molecules, e.g., rhamnolipids, phenazines, and PQS, and higher Af sensitivity to these molecules. In summary, SSPM better defines Pa-Af intermicrobial competition in the milieu of CF lungs.

Protocol for a clinically annotated biorepository of samples from Australian immune-compromised patients to investigate the host–microbiome interaction

IntroductionThe human gut microbiota has the potential to modulate the outcomes of several human diseases. This effect is likely to be mediated through interaction with the host immune system. This...

Clinical features of pneumocystis pneumonia in non-human immunodeficiency virus-infected patients: A systemic review and meta-analysis

Objectives: Pneumocystis pneumonia (PCP) is an opportunistic disease that causes potentially fatal pneumonia in immunocompromised individuals. The clinical features of PCP without HIV remain incompletely understood. Methods: This study aimed to identify the clinical features of PCP without HIV in a systematic review following a meta-analysis. Results: 65 articles that included 10,133 PCP patients without HIV infection were enrolled. PCP occurred most commonly at age 59.2 years (95%CI: 57.7, 60.7) in a gender ratio of approximately 3 to 2 (males to females). Dyspnea, fever, cough, and sputum were nonspecific clinical findings in 73% (95%CI: 69, 79), 73% (95%CI: 65, 81), 56% (95%CI: 48%, 64%), and 32% (96%CI: 16, 48) of patients, respectively. Viral, bacterial, and fungal co-infection were observed in 28% (95%CI: 13, 44), 19% (95%CI: 13, 25), and 11% (95%CI: 6, 16) of patients, respectively. Laboratory data showed a trend of elevated WBC, LDH, CRP, β-D glucan, and KL-6. Ground glass opacity (GGO) was found in 87% (95%CI: 83, 91) of patients. In-hospital mortality was 41% (95%CI: 35, 46). Conclusions: PCP is a life-threatening disease in immune-compromised patients. Despite being a nonspecific clinical finding, GGO might offer a clue to diagnosing PCP in high-risk patients.

Anticandidal effect of cinnamic acid characterized from Cinnamomum cassia bark against the fluconazole resistant strains of Candida.

Candida spp., causes invasive fungal infections, especially in immune-compromised patients and the propensity of antifungal resistance against azole-based drugs need to be addressed. This study is thus aimed to characterize the anticandidal effect of the cinnamic acid extracted from the barks of Cinnamomum cassia. Five species of Fluconazole-resistant Candida sp. were retrieved from the department repertoire. The extraction of CA was performed by three different methods followed by silica gel column chromatography. Eluant was subjected to FTIR and XRD analysis for confirmation. The anticandidal activity of the CA was checked by the agar disc diffusion method and the MIC and MFC were determined. The anti-biofilm effect of CA was assessed using the CLSM technique followed by the biocompatibility check using MTT assay in normal HGF cell lines. CA was best extracted with the hot maceration method using ethanol with a maximum yield of 6.73mg. Purification by column chromatography was achieved using benzene, acetic acid, and water (6:7:3) mobile phase. CA was confirmed by FTIR with absorption peaks and by XDR based on strong intensity. CA was found to possess promising anticandidal activity at 8µg/mL with MIC and MFC values determined as 0.8µg/mL and 0.08µg/mL respectively. Antibiofilm activity by CLSM analysis revealed biofilm inhibition and was biocompatible at 8.5µg/ml concentrations in HGF cell lines until 24h. The study findings conclude that CA is the best alternative to treat candidal infection warranting further experimental preclinical studies.

The Triterpenoid MOMORDIN-Ic Inhibits HCMV by Preventing the Initiation of Gene Expression in Eukaryotic Cells.

Human cytomegalovirus (HCMV) primary infection, re-infection, and reactivation from latency cause morbidity in immune-compromised patients. Consequently, potential therapeutic strategies remain of interest for the treatment of infection. Naturally occurring triterpenoids derived from plants have been demonstrated to have anti-viral activity, although their precise mechanisms of action are not always fully understood. Here, we investigate the activity of Mormordin Ic (Mc) and demonstrate that it is potently anti-viral against HCMV. Through investigation of the mechanistic basis of this anti-viral activity, we identify that it is inhibitory to both viral and host gene expression, and to highly induced genes in particular. We go on to observe that Mc impacts on RNA Pol II activity and, specifically, reduces the occupancy of elongating RNA Pol II at a viral promoter. Next, we demonstrate that Mc is inhibitory to HCMV reactivation, and in doing so identify that it has greater activity against the canonical major immediate early promoter compared to the alternative ip2 promoter located downstream. Finally, we see evidence of RNA Pol II occupancy at the ip2 promoter in undifferentiated myeloid cells. Thus, Mc is potently anti-viral and a potential tool to probe the activity of multiple promoters considered important for controlling HCMV reactivation.

Cryptococcal meningitis patients associated with HIV co-infection admitted in tertiary care hospital–A Case Series

Meningitis is a significant infection of the central nervous system that is followed by inflammation of the meninges, resulting in catastrophic neurologic consequences. The inflammation may be caused by infection with viruses, bacteria, fungi, or other microorganisms and less commonly by certain drugs. Meningitis can be life-threatening because of the inflammation’s proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. In the present case series, we encompass patient demographics, initial clinical symptoms, physical examinations, laboratory results, cerebrospinal fluid examination findings, treatment side effects, the occurrence of complications, and hospital outcomes. Furthermore, documented were any instances of recurrent cryptococcal meningitis (CM) during follow-up, along with the potential causes of recurrence, the treatment modalities administered, any complications that arose, and the ultimate outcomes. This series reveals CM can manifest alongside HIV co-infection in male patients. Therefore, it is essential to consider the possibility of CM when an immune-compromised patient presents with symptoms such as headaches and other indications of central nervous system involvement. These cases reveal cryptococcosis with HIV-infected patients for rapid and early diagnosis and appropriate treatment of opportunistic infections.

Antibiotic Susceptibility and Biofilm Production among Coagulase Negative Staphylococci Isolated from Clinical Samples at Tertiary Care Hospital.

Coagulase Negative Staphylococci have been widely associated with medical device implant treatment and immune-compromised patients. Despite having increasing interest in Coagulase Negative Staphylococci, few studies from Nepal have reported the association of these organisms with urinary tract infections, conjunctivitis, high vaginal swabs, and cerebrospinal fluid. This study was carried out to determine antibiotic susceptibility pattern and biofilm production among Coagulase Negative Staphylococci isolated from clinical samples at tertiary care hospital. This study was a hospital based cross-sectional study in which 3690 clinical samples were included. Isolation and identification of isolates was done following standard microbiological protocol. Coagulase Negative Staphylococci were identified phenotypically on the basis of gram staining, slide and tube coagulase test and by various sugar fermentation tests. Antibiotic susceptibility test was done following Kirby Bauer disk diffusion method (Clinical and Laboratory Standards Institute 2020). Biofilm production was determined by Tissue Culture Plate technique. A total of 113 isolates of Coagulase Negative Staphylococci were detected. Among them S. epidermidis (45.1%), S. saprophyticus (23.9%), S. haemolyticus (16.8%), S. hominis (5.3%), S. capitis (2.7%), -----S. cohini (1.8%), S. lugdunensis (1.8%) and S. sciuri (2.7%) were identified phenotypically. All isolates were found to be resistant against Ampicillin and 111 (98.2%) were sensitive against Linezolid.23.9% of CoNS were strong biofilm producers, 19.5% moderate and 56.6 % were non/weak biofilm producers. It requires susceptibility test for prescribing antibiotics against Coagulase Negative Staphylococci in hospital and the misuse of antibiotics should be prevented.

Recurrent Non Typhoidal Salmonella Infection of the Thyroglossal Duct Cyst in a Diabetic Patient - A Case Report

The occurrence of extra-intestinal Salmonella neck infections is uncommon, especially with non-typhoidal Salmonella (NTS). We report a case of non-typhoidal Salmonella infection of a thyroglossal cyst in a 78-year-old diabetic woman admitted with gastroenteritis along with a neck swelling. The ultrasound revealed a thyroglossal cyst and fine needle aspiration cytology (FNAC) was done. Culture of the aspirate grew Salmonella species enterica subspecies enterica serogroup C. The patient was treated with amoxicillin/clavulanic acid for 10 days on discharge. She was readmitted two months later with an increasing neck mass and FNAC was repeated. Culture of the aspirate grew Salmonella species enterica subspecies enterica serogroup C. She was treated with amoxicillin/clavulanic acid for 5 days on discharge. Extra-intestinal infections, though uncommon, should be considered among immune-compromised patients presenting with gastrointestinal symptoms caused by Salmonella species.

Infratemporal Fossa Abscess Managed by Nasal Endoscopic Drainage Using a Navigation System.

The infratemporal fossa (ITF) is an area surrounded by bony structures and contains vital organs. Although a large abscess in the ITF is not common, it requires prompt surgical management. Recently, the authors had a patient who presented with fever, pain, and trismus. The patient was diagnosed with an abscess in the ITF, although the authors were not able to determine the exact cause of the infection. The lesion was accessed through the posterolateral maxillary wall using nasal endoscopy with a navigation system. The abscess was safely drained through a small bony window. This case suggests that the nasal endoscopic approach, combined with the use of a navigation system, allows for an easy and safe surgical approach to the ITF. In addition, the authors' observations indicate that minimal mucosal thickening without definite evidence of sinusitis could result in an abscess in the ITF in immune-compromised patients, as was the case with the authors' patients.

An In-Depth Analysis of Microorganisms Linked to Various Forms of Hospital-Acquired Infections: A Systematic Review

Nosocomial infections (NIs) represent one of the serious public health concerns worldwide that are linked with healthcare-associated infections. The present study reviewed the microorganisms associated with various types of NIs. The data search strategy was guided by the PRISMA-P protocol with the utilization of various search engine databases (PubMed, Springer Link, Science Direct, and Google Scholar) and pre-determined keywords. The search retrieved 504 articles from 2014 to 2019. Based on the inclusion and exclusion criteria stated, only a total of 63 articles have been discussed further in this study. The signatures of NIs can be described by microorganisms associated with the transmission route groups (Nosocomial bloodstream infections-BSI, Hospital Acquired Pneumonia-HAP, Catheter-Associated Urinary Tract Infection-CAUTI, Surgical Site Infection-SSI). BSI is the major cause of morbidity and mortality in hospitals. HAP is the most frequently reported case including Ventilator-associated Pneumonia-VAP. Microorganisms such as Acinetobacter Baumannii spp., Escherichia spp., Streptococcus spp., Staphylococcus aureus spp., and Pseudomonas spp. pathogens are commonly associated with NIs. Recently, the healthcare challenge is also associated with Multi-Drug Resistant (MDR) related strains that contribute to a significantly high mortality rate, especially in immune-compromised patients. Hence, the emergence of various nosocomial infections marked the relevant steps and measures that need to be taken with effective precautions.

Clinico-mycological profile of fungal infections in a tertiary care hospital

The fungal infections are increasing at high rate especially in immune-compromised patients and elderly population. In high risk population, antifungal resistance is becoming a major concern. Antifungal susceptibility testing is important for appropriate management and better outcome of patients. The aim of the study was to know clinico-Mycological profile of fungal infections in admitted patients.This prospective study was carried out in a tertiary care hospital. Various samples were received from patients with suspected fungal infections. All samples were inoculated on SDA except blood & body fluids which were directly inoculated into blood culture bottles and processed in BACTEK/BacTAlert system. Fungal infections were characterized and antifungal susceptibility was done for yeast isolates with VITEK-AST panel. : Out of total 19698 patients suspected of fungal infection, fungal infection was seen in 365 patients , 100% susceptibility was seen to Fluconazole and Echinocandins. Whereas in NAC (non-albicans ), 72.5% susceptibility was seen to fluconazole and Voriconazole (82.5%). Antifungal resistance is major cause of morbidity and mortality. Prompt diagnosis and antifungal susceptibility will offer the early appropriate treatment and better clinical outcome of patient.

Therapeutic Effects of Vitamins and Nutritional Supplements on Sinusitis: A Narrative Review.

Sinusitis, one of the most prevalent and undertreated disorders, is a term used to describe inflammation of the paranasal sinuses caused by either infectious or non-infectious sources. Bacterial, viral, or fungal infections can all cause sinusitis. Sinusitis is classified into 3 types: acute, subacute, and chronic. Acute sinusitis lasts for less than 1 month, subacute sinusitis lasts from 1 to 3 months, and chronic sinusitis persists for over 3 months. This condition affects a significant portion of the population, imposing a substantial burden on the healthcare system. Antibiotics are the gold standard of bacterial sinusitis treatment. However, due to the rise of antimicrobial resistance, especially in immune-compromised patients, it is necessary to investigate potential adjunctive therapies. Based on the literature, vitamins (eg, vitamin D) have antioxidant, anti-inflammatory, and immune-modulatory properties and may effectively treat sinusitis and reduce mucous membrane inflammation. Besides vitamins, many other supplements like quercetin, sinupret, and echinacea have immunomodulatory effects and have shown promising results in sinusitis treatment. In this review, we look at the therapeutic role, safety, and efficacy of vitamins and nutritional supplements in sinusitis treatment.

Level of confidence in management of medically compromised patients among senior dental students and interns in Madinah

Background: Planning for dental treatment for medically compromised patients (MCP) generally involves understanding the nature of the patient\'s condition and its influence on their general and dental health, response to treatment, and post-treatment healing. Dental senior students and interns need to be confident about formulating a treatment plan to treat MCP with impaired health status, like systemic diseases and immune-compromised patients who require modification of their dental treatment according to their condition. This study aims to assess the knowledge, confidence, and ability of senior dental students and interns to manage MCP at Taibah University, College of Dentistry, Madinah, Saudi Arabia. Methods: A cross-sectional observational study was conducted using an online-based self-administrated questionnaire consisting of 26 close-ended questions. It was divided into three sections dealing with demographic data, knowledge, and confidence about the management of MCP. Results: The study group comprised 82 participants. Most participants were males, 52.4%, and half were senior dental students. Most participants reported that they have sufficient knowledge about the dental management of MCP. Only 45.1% agreed that evaluating risk factors is necessary for MCP and think the patient\'s postoperative outcome depends on the patient\'s medical status. However, 50% were less confident in dealing with MCP, while 87.8% may need more training to handle MCP. Conclusions: The present study revealed a need to enhance confidence and knowledge about managing MCP among dental students and interns. Diagnosing complex cases and choosing a suitable treatment regimen is vital to reducing possible adverse side effects and achieving treatment outcomes. Hence, further training to improve the management of MCP in dental settings is essential

Data analysis of patients with positive mould or dimorphic fungal cultures from sterile sites.

Moulds and dimorphic fungi are increasingly recognised as pathogens carrying high morbidity and mortality in critically ill and immune-compromised patients. The lack of surveillance data limits our understanding of these infections. To determine the distribution, patient characteristics, risk factors, therapy and treatment outcome in patients with positive mould or dimorphic fungal cultures from sterile sites at a tertiary hospital in central South Africa. All moulds or dimorphic fungi cultured from sterile specimens from 1 July 2014 to 30 June 2017 were identified retrospectively. Laboratory and clinical records were reviewed. Information collected included gender and age, type of specimen collected for investigation, specific fungi isolated, underlying conditions, other contributing risk factors, treatment and outcome of the patients. Forty-eight patient records were analysed. Male and female patients were equally distributed. The mean age was 40.5 years (range 7-78 years). Aspergillus spp. were most commonly isolated. The most common underlying condition was HIV infection, followed by haematological conditions. Twenty-six (54.2%) patients received treatment involving antifungal therapy alone (n = 19; 73.1%), surgery alone (n = 5; 19.2%) or a combined medical and surgical approach (n = 2; 7.7%). Twenty-two (45.8%) patients received no treatment. The overall mortality rate was 25.0% (n = 12). The diagnosis of fungal infections remains challenging. In the current study, moulds and dimorphic fungi were isolated from at-risk patients' specimens. Despite treatment with appropriate antifungal agents, the associated mortality rate was high. This study contributes to the growing body of knowledge on these potentially life-threatening infections.

Unbiased immunome characterisation correlates with COVID-19 mRNA vaccine failure in immunocompromised adults.

Coronavirus disease 2019 (COVID-19) affects the population unequally, with a greater impact on older and immunosuppressed people. Hence, we performed a prospective experimental cohort study to characterise the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in immune-compromised patients (older adults and oncohaematologic patients), compared with healthy counterparts, based on deep characterisation of the circulating immune cell subsets. While acquired humoral and cellular memory did not predict subsequent infection 18 months after full vaccination, spectral and computational cytometry revealed several subsets within the CD8+ T-cells, B-cells, natural killer (NK) cells, monocytes and TEMRA Tγδ cells that were differentially expressed in individuals who were subsequently infected and not infected not just following immunisation, but also prior to vaccination. Of note, we found up to seven clusters within the TEMRA Tγδ cell population, with some of them being expanded and others decreased in subsequently infected individuals. Moreover, some of these cellular clusters were also related to COVID-19-induced hospitalisation in oncohaematologic patients. Therefore, we have identified a cellular signature that even before vaccination is related to COVID-19 vulnerability as opposed to the acquisition of cellular and/or humoral memory following vaccination with SARS-CoV-2 messenger RNA (mRNA) vaccines.