Immunocompromised Group Research Articles

Diagnosis and treatment of mycoplasmal septic arthritis: a systematic review.

Septic arthritis caused by Mycoplasma is rare. The diagnosis and effective treatment of mycoplasmal septic arthritis remains a serious problem for clinicians. The aim of this systematic review was to document the available evidence on the diagnosis and treatment methods for mycoplasmal septic arthritis and to provide guidance for clinicians. The PubMed, EMBASE, and Cochrane Library databases were searched in December 2018.The searches were limited to the English language. Article screening and data extraction and compilation were conducted by two independent reviewers. All the included studies were assessed using the Methodological Index for Non-randomized Studies (MINORS) tool. There was a total of 33 articles including 34 cases of mycoplasmal septic arthritis and eight of them were periprosthetic joint infection (PJI). Twenty-four patients (70.6%) were immunocompromised, and the synovial fluid white blood cell (WBC) count was significantly lower in the immunocompromised group than in the immunocompetent group (48,527 × 106/L vs. 100,640 × 106/L; P = 0.009). The traditional culture method took longer, and the positivity rate was lower than that of nucleic acid testing (50% vs. 100%; P = 0.016). Only 19.2% (5/26) of patients treated with empiric antibiotics were relieved of symptoms, while 82.4% (28/34) of patients achieved satisfactory results after being treated with antibiotics against Mycoplasma. The possibility of mycoplasmal septic arthritis should be considered if patients with joint infections have a history of immunocompromised, repeated negative cultures, and poor empiric antibiotic treatment results. The rational use of nucleic acid testing technologies can help in the clinical diagnosis and treatment of mycoplasmal septic arthritis.

Evaluation of Candidemia Cases

Systemic candida infections are becoming more important day by day. Candidemia is an important cause of morbidity and mortality in all critically ill patients, especially the immunocompromised group. In this study, we aimed to investigate the incidence, demographic data, risk factors, fungal species, antifungal susceptibilities and clinical results of patients with candidemia in our hospital. The patients diagnosed with candidemia in Uşak Education and Research Hospital between January 1, 2017, and December 31, 2018, were evaluated retrospectively. In the two-year period, 45 episodes of candidemia were detected in 45 patients. The mean age of the patients was 70.91 ± 13.44 and 23 (51%) of the patients were male. Candidemia incidences per 1000 patients admitted to the hospital and ICUs were determined as 0.47 and 3.67 respectively. The most common risk factors for the development of candidemia were the use of broad-spectrum antibiotics (93.3%), presence of urinary catheter (93.3%), total parenteral nutrition (80%), ICU admission (73.3%), mechanical ventilation and intubation (73.3%). Among the isolated Candida species, 31 (69%) were identified as C. albicans, while the others were non-albicans Candida strains. Three C. albicans strains were resistant to fluconazole and two showed decreased sensitivity. Two of the C. glabrata strains also had decreased sensitivity to fluconazole. The crude mortality rate associated with candidemia was 68.9%. When C. albicans and non- albicans Candida species were compared, in the C. albicans group patients older than 65 years and in the non-albicans Candida species group concurrent bacteremia were found to be statistically higher (p <0.05). Early diagnosis and effective treatment of candidemia have a positive effect on mortality, morbidity and economic losses. Therefore, it is useful to perform candidaemia surveillance for empirical antifungal therapy and necessary infection control measures. Key Words: Candidemia, Incidence, Candida species, Risk factors, Antifungal susceptibility DOI: 10.7176/JSTR/5-12-18

1699. Presentations and Outcomes of Histoplasma capsulatum Infection Vary by Immune Status: A Retrospective Cohort Study

BackgroundFew large cohorts have examined Histoplasma infection across patients with varying immune status in the era of modern antiretroviral therapy. We describe the differences in clinical presentation and outcomes of Histoplasma infection by immune status.MethodsWe conducted a single-center retrospective cohort study of adult patients diagnosed with histoplasmosis from 2002 through 2017. Data included demographics, clinical features, diagnostics, and mortality. Patients were separated into three groups based on their immune status: Immunocompetent (IC), People living with HIV (PLWH), and patients who were HIV-negative but were otherwise immunocompromised (OIC). OIC was defined as the presence of any of the following: cancer, chemotherapy, solid-organ or stem-cell transplant, or immunosuppressive medications. Immunocompetence was defined as the absence of HIV and any of the conditions that defined OIC. Localized histoplasmosis was defined as histoplasma infection confined to the lungs and/or hilar and mediastinal lymph nodes. Disease that occurred outside these locations was defined as disseminated.ResultsWe identified 263 patients with histoplasma infection: 54 (21%) were PLWH, 99 (28%) were OIC, and 110 (42%) were IC. Disseminated disease was more common among PLWH (76%) and OIC (52%) than among IC patients (32%) (P < 0.001). For survival analysis the HIV and OIC groups were pooled to create a single immunocompromised group. In localized disease mean survival was longer in the immunocompetent group (12.7 years) than in the immunocompromised group (8.9 years) (P = 0.029). For patients with disseminated disease, however, there was no significant difference in mean survival between the immunocompetent group (9.4 years) and the immunocompromised group (9.1 years) (P = .838).ConclusionDisseminated disease was more common among immunocompromised than immunocompetent patients. In patients with localized histoplasmosis, mean survival was longer for immunocompetent patients, whereas for patients with disseminated disease there was no significant difference in mean survival. Disclosures All authors: No reported disclosures.

Fetal Cell Microchimerism; Normal and Immunocompromised Gestations in Mice

Objective: To compare fetal cell microchimerism in normal and immunocompromised gestations. Materials and methods: The study consists of two groups of mature female mice. In the control group and the immunocompromised study group, 5 mg of saline and cyclosporine were injected intraperitoneally, respectively. In the second step, all female mice were mated with “Actine-Luc (+) green fluorescent protein (GFP)” transgenic male mice. Immunohistochemical studies (ALPL-antiluciferase, cytokeratin-antiluciferase, and CD 105-antiluciferase) were carried out on maternal liver, skin, and lung tissues at 6–7th and 14–15th gestational days, and postpartum 3–4th, 12th, and 18–24 months. Results: GFP (+) cells were detected in maternal liver and skin but not in lung tissue. Liver was the most affected tissue. GFP was found to be more intense in the immunocompromised group. Conclusion: Fetal microchimerism was demonstrated in maternal liver and skin and found to be more intensive in the immunocompromised group.

Pulmonary cryptococcosis characteristics in immunocompetent patients-A 20-year clinical retrospective analysis in China.

SummaryBackgroundPulmonary cryptococcosis (PC) is not considered an rare, opportunistic infection anymore. The immunocompetent population accounts for an increasing proportion of the morbidity.ObjectiveThis study investigated the clinical characteristics of PC patients spanning 20 years, in a referral centre of China.Patients/MethodsWe retrospectively investigated the clinical data of 99 patients with PC who were diagnosed at Peking Union Medical College Hospital (PUMCH) from January 1998 to December 2017.ResultsPulmonary cryptococcosis incidence in PUMCH has seen sharp increase in two decades. There were 40.4% (40/99), 17.2% (17/99) and 42.4% (42/99) immunocompetent, mildly immunocompromised and severe immunocompromised patients, respectively. Significantly higher (P = .035) male predominance in immunocompetent and mildly immunocompromised groups (68.4%, 39/57) compared with severe immunocompromised group (45.2%, 19/42) was found. Overall, 27.5% (11/40) immunocompetent patients reported a significant difference (P = .02) in history of more than weekly drinking, higher than mildly or severe immunocompromised. No significant difference occurred in symptoms and radiographic characteristics among the groups. In pulmonary computerised tomography findings, the non‐air pathway feature was the dominant distribution characteristics in all patients with PC (P = .002). The gap in body dissemination frequency between immunocompetent combined with mildly immunocompromised (5.26%, 3/57) and severe immunocompromised (19.0%, 8/42) was marginally significant (P = .05).ConclusionsGender and alcohol drinking could be PC risk factors of concern in patients without severe immunodeficiency. No significant difference occurred in symptoms or radiographic characteristics between patients with different levels of immune status. The unique radiographic non‐air pathway distribution in the lung may be the feature of Cryptococcus invasion that may enhance accurate diagnosis.

Dynamic research of serum cryptococcal capsular polysaccharide antigen titer and chest CT of pulmonary cryptococcosis after antifungal therapy

Objective: To observe the dynamic changes of serum cryptococcal capsular polysaccharide antigen (CrAg) titer and chest CT of pulmonary cryptococcosis (PC) after antifungal therapy. Methods: A retrospective study was performed for patients with PC admitted to the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from January 2015 to April 2018. Serum CrAg titers and Chest CT examination were performed for all the cases before and after treatment. The difference between immunocompetent hosts group and immunocompromised hosts group were compared and analyzed. Results: Eighty-two patients with PC including 46 male (56.1%) and 36 (43.9%) female were enrolled. Fifty-two (63.4%) patients were proven PC and thirty (36.6%) patients were probable PC. Forty-five (54.9%) patients had underlying diseases. Fifty-four (65.9%) patients were immunocompetent hosts and twenty-eight (34.1%) patients were immunocompromised hosts. The mean duration of treatment was (7.9±2.4) months and the mean follow-up was (24.0±10.0) months. Improvement (≥75%) in chest CT were found in 64.8% of the cases in immunocompetent group and 67.9% in immunocompromised group after 6 months' treatment. Improvement (≥75%) was found in 88.9% of the cases with patchy infiltrates or consolidation and only 63.0% in nodular or mass-like type and mixed patterns of PC. The serum CrAg titer of 55 cases ranged from 1∶4 to 1∶160 before treatment (median 1∶40) and decreased for all cases after treatment. The serum CrAg titer became negative in 20 cases at last. Mean time of serum CrAg titer turning negative was (11.8±8.1) months. The serum CrAg titer became negative or decreased to 1∶1 in 24 cases after treatment cessation, of whom the serum CrAg titer ranged from 1∶5 to 1∶160 before treatment (median 1∶20). The serum CrAg titer of 31 cases ranged from 1∶4 to 1∶640 before treatment (median 1∶64), of whom the serum CrAg detections were still positive after treatment cessation, and CrAg titer was 1∶10 (ranged from 1∶2 to 1∶160). Conclusions: In PC, chest CT improves after antifungal treatment, and the infiltrates or consolidation type of PC resolves faster than nodular or mass-like shadows and mixed patterns in CT. The serum CrAg titer decreases after antifungal treatment.

Total joint arthroplasty in immunocompromised patients: a matched pair analysis for comorbidities

Background: The prevalence and demand for total joint arthroplasty (TJA) in patients with human immunodeficiency virus (HIV) and hepatitis C (HCV) have steadily increased. However, the relationship between these immunocompromising viruses and perioperative complications such as postoperative infection has yet to be fully established. Methods: TJA was performed in 109 immunocompromised (IC) patients (50 THAs and 59 TKAs) between 2008 and 2014. Patients were matched based on sex, age, body mass index, and operation (TKA vs. THA) to patients who were nonimmunocompromised (N-IC). A cohort of 66 IC patients were also matched with 66 N-IC based on medical comorbidities to assess for medical comorbidities that may increase the risk of infection. Results: The overall complication rate in the IC group and N-IC groups was 20% (22 patients) and 14.6% (16 patients), respectively, which was not statistically significant (P=0.34). There were no differences between the two groups in the incidence of deep (n=6; 5.5% vs. n=3; 2.7%; P=0.36) or superficial infections (n=4; 2.1% vs. n=1; 0.9%; P=0.50), or re-admissions (n=12; 11% vs. 14; 12.8%; P=0.80). However, there was a significant difference for reoperation (16 vs. 6, P=0.04). When data were adjusted for confounding factors for complications, matched for comorbidities, the rate of infection and reoperation were 7.5% and 4.5% in IC and 9% and 6% in N-IC groups, respectively, which were not statistically significant. Conclusions: IC patients were not at a significant increased risk for perioperative complications, postoperative infections, or readmissions, but they were at higher risk of reoperation.

Comparison of ELISA and PCR of the 18S rRNA gene for detection of human strongyloidiasis using serum sample

Background: Strongyloides stercoralis infection is a neglected tropical disease with global distribution which is fatal in immunosuppressed patients. This study aimed to determine the prevalence of strongyloidiasis in immunocompromised individuals and cases with infectious diseases, as well as comparing ELISA and conventional PCR with coprological examination, in the central parts of Mazandaran province, northern Iran.Methods: A single serum and a fresh stool samples were obtained from 272 and 220 patients, respectively. Serum was tested by ELISA and PCR of the 18S rRNA gene, and stool samples were examined with various parasitological methods. The optimum point for ELISA reaction and cut-off points were recognized by receiver operating characteristic curves (ROC).Results: Out of 220 stool specimens, 14(6.3%) cases were positive for S. stercoralis larvae. The overall seroprevalence rate was 27.9% (76/272). The seroprevalence rate was 25.2% and 30.1% in immunocompromised group and patients with infection, respectively. Based on the ROC curve of ELISA compared with microscopy, the optimum cut-off point was 12.74 with 79% sensitivity and 76% specificity. The optimum cut-off point was 10.42 with 69% sensitivity and specificity using ROC curve of ELISA compared with PCR.Conclusions: This study seroprevalence rate for Strongyloides infection in the studied group. It also observed that the ELISA technique and the PCR used here have 100 demonstrated a high % sensitivity and acceptable specificity compared with coprological examination. It seems that the ELISA technique is a good screening assay in ruling out strongyloidiasis in such patients.

A clinico-epidemiological multicenter study of herpes zoster in immunocompetent and immunocompromised hospitalized children.

PurposeThere are limited population-based data regarding herpes zoster in children. Thus we conducted a multi-institutional epidemiological analysis of herpes zoster in children and comparative analysis according to their immune status.Materials and MethodsThe study included 126 children under the age of 18 years who were hospitalized for herpes zoster at 8 hospitals in South Korea, between July 2009 and June 2015. The subjects were divided into 2 groups according to their immune status, and medical records were reviewed.ResultsThere were 61 cases (48.4%) in the immunocompetent group and 65 cases (51.6%) in the immunocompromised group. Median age was older in immunocompromised group (11.4 vs. 8.6) (p<0.001). The mean duration of hospitalization was longer in immunocompromised group (11.0 vs. 6.6) (p<0.001). Patients were treated with oral or intravenous antiviral agents. A total of 12 in immunocompetent group were cured only by oral acyclovir. No treatment failure was found in both groups. Six immunocompromised patients had postherpetic neuralgia and 1 case was in immunocompetent group. In immunocompetent children, herpes zoster was likely caused by early varicella infection. There was no increase in progression of severity in both groups due to appropriate treatment.ConclusionEarly initiation of therapy is necessary for those in immunocompromised conditions. And inactivated herpes zoster vaccination may be considered in immunocompromised adolescents in the future.

Pulmonary tuberculosis in the immunocompromised patients

Background/Aim. During the last few decades, immunocompromising diseases led to an increase in the number of tuberculosis cases. The aim of this study was to examine the influence of immunocompromising diseases on the course of tuberculosis. Methods. The research included two groups, each consisting of 40 subjects with tuberculosis, who were treated at the Institute for Pulmonary Diseases of Vojvodina during 2010 and 2011. The first group had no immunocompromising diseases (the kontrol group), whereas the second group contained patients with accompanying immunocompromising diseases. The data from the patients? medical history, from the Center for Microbiology and from the Radiology Center were used. The two groups were compared according to the following characteristics: age, sex, bacteriological status, radiological presence of the disease, presence of adverse effects of drugs, presence of resistance to drugs, duration of the therapy regimen and the duration of hospitalization. Results. The group of immunocompromised patients was older in average than the control group and included a higher percentage of males. The immunocompromised group had statistically important longer average time required for the sputum smear conversion (p = 0.000) and for the conversion of sputum cultures to M. tuberculosis (p = 0.010), more frequent presence of cavity (p = 0.030), longer average therapy regimen duration (p = 0.000) and higher average number of hospital days (p = 0.000) compared to the control group. The most frequent localization of changes in the immunocompromised patients was in all lobes of both lungs (32.5%) whereas the changes in the control group were mostly localized in the upper lung lobes (62.5%). There was no statistically important difference in the finding of sputum smear positive acidfast bacilli on direct micoscropy, the presence of adverse effects of drugs and M. tuberculosis resistance to drugs between the two groups of patients. Conclusion. The immunocompromising diseases change the course of tuberculosis, primarily by affecting bacteriological status, radiological presentation, the length of therapy regimen and the duration of hospitalization.

Incidence of Isospora belli in Leukemic Children in Erbil City

This study was conducted in Erbil city to investigate the incidence of Isospora belli infection among leukemic children, by laboratory examination of stool samples obtained from 26 children suffering from leukemia using different methods like N. saline, Iodine fecal smears, Sheathers flotation and modified Ziel-Neelson techniques. Isospora belli was detected in only one out of 26 (3.8%) ill children. To investigate the rate of infection with Isospora belli in children suffering from diarrhea especially the immunocompromised and leukemic group.

Does administration of broad-spectrum antibiotics in febrile neutropenic children trigger the emergence of BMR? A French experience

Background Blood stream infections (BSI) remain a major cause of morbidity and mortality in immunocompromised children and increase the length of hospitalisation as well as the cost of treatment. The difficulty of documenting bacteremia at the onset of fever in neutropenic patients led to an early administration of broad-spectrum antibiotics, without waiting for further clinical or microbiological evidence of infection. Furthermore, gut decontamination is performed in children with a high-risk of BSI. Does this practice trigger the emergence of multidrug resistant bacteria? Methods We performed a monocentric, retrospective and descriptive study between January 2014 and December 2017, using a large cohort of pediatric patients with hematological and oncological diseases in a tertiary care pediatric center in France, the Institute of Hematology and Oncology Pediatric (IHOPe) in Lyon. This includes patients with acute leukemia, lymphoma, children who underwent hematopoietic stem cell transplantation (HSCT) (allogenic and autogenic), children with severe combined immunodeficiency syndromes as well as children suffering from solid tumors. A bacteremia was defined by a positive blood culture sample, associated with fever. For coagulase-negative staphylococci (CoNS), two distinct positive blood cultures within 48 h were mandatory. The children were divided into 4 infectious risk groups regarding their immunosuppression level. Groups 3 and 4 received non-absorbable antibiotics for gut and oral decontamination. The empirical antibacterial therapy was adjusted to the risk group, as well as a prior identified bacteria colonisation: all patients with a central venous access received vancomycin (stopped after 48 hours in the absence of bacterial identification), amikacin and a broad-spectrum penicillin. Results During these 4 years, our institution recorded more than 8000 hospitalisations distributed within 3 units: 2 conventional hospitalisation wards and the HSCT unit. Our protected unit is equipped with spacious positive air pressure rooms, for child and parent, with high-efficiency particulate air (HEPA) filters where only a clean non-sterile outfit (gown and mask) are required. We identified 350 cases of BSI, thus an overall incidence of 4,5%. Fifteen to twenty per cent of these children suffered from a second or more re-infection. The incidence of BSI was stable throughout the four years of our study. Gram-positive bacteria represented more than 50% of BSI and CoNS was the most frequent pathogen agent found. Among the others gram-positive isolates, we counted around 5 to 6 cases/year of Streptococcus and Staphylococcus aureus. Among Gram-negative bacteria, enterobacteries accounted for 14 to 20 BSI per year and Pseudomonas aeruginosa for 2 to 4 cases per year. Among the identified bacteria, only 6.5% were multidrug resistant for all our study time. Three highly resistant bacteria were identified in 2 children priorly treated in Romania and Tunisia: 2 Klebsiella pneumoniae producing Carbapenemase (KPC), 1 Enterococcus faecium resistant to glycopeptides. Interestingly, 35% of the BSI occurred in the less immunocompromised group. The other cases were evenly distributed between the 3 more severely immunocompromised groups. Conclusion Our empirical initial broad-spectrum antimicrobial coverage is well adapted to the epidemiology of our bacterial agents and shortens hospitalisations. Furthermore, it is not associated with the emergence of antibiotic resistance patterns. The microbiological spectrum of incriminated bacteria is relatively stable over time and we do not observe the emergence of multidrug resistant gram-negative bacteria as well as the absence of vancomycin-resistant enterococci (VRE) in our tertiary center.

Immunocompromised patients with metastatic cutaneous nodal squamous cell carcinoma of the head and neck: Poor outcome unrelated to the index lesion.

Immunocompromised patients with metastatic cutaneous nodal head and neck squamous cell carcinoma (HNSCC) have worse outcomes compared to the immunocompetent. The purpose of this study was to investigate the characteristics of the primary cutaneous squamous cell carcinoma (SCC), nodal pathology, and outcome between these 2 groups. Analysis of a prospective database was performed. A 2:1 pooled analysis selected 46 immunocompetent patients matched with 23 immunocompromised patients. Overall survival (OS) and relapse-free survival (RFS) were calculated using the Kaplan-Meier method. No significant difference was found in the primary tumor characteristics between the 2 groups. In the immunocompromised group, RFS (hazard ratio [HR] 2.70; P = .01) and OS (HR 2.32; P = .04) were significantly worse. Extracapsular spread was present in 100% of the immunocompromised patients. No significant difference was identified in the primary cutaneous SCC between the immunocompetent and immunocompromised patients. Immunosuppression predicted worse outcome.

Clinical characteristics of cytomegalovirus colitis: a 15-year experience from a tertiary reference center.

BackgroundCytomegalovirus (CMV) colitis is considered rare in immunocompetent patients.ObjectiveThe predictors of mortality and the differences between immunocompetent and immunocompromised patients with this disease remain unknown. Thus, the aim of this retrospective cohort study was to clarify these issues.Patients and methodsWe enrolled all patients who were histologically diagnosed with CMV colitis between April 2002 and December 2016 in the Linkou Chang Gung Memorial Hospital. Patients were divided into two groups: immunocompetent and immunocompromised, and the differences between them were analyzed to develop in-hospital mortality predictors.ResultsA total of 69 patients (42, immunocompetent; 27, immunocompromised) were enrolled. The most common symptoms were melena in the immunocompetent group and diarrhea in the immunocompromised group. The in-hospital mortality rate showed no statistically significant difference between the two groups (26.2% vs 25.9%, P=0.981). Early diagnosis was the only significant independent predictor of in-hospital mortality (odds ratio [OR] 1.075, 95% CI 1.005–1.149, P=0.035). The cutoff of diagnostic timing was 9 days from admission, derived from the receiver operating characteristic curve using the Youden index.ConclusionCMV colitis in immunocompetent patients is markedly more common and fatal than has generally been acknowledged. Being alert to different ways in which this disease can present itself will enable early diagnosis and significantly reduce mortality.

An assessment of food safety information provision for UK chemotherapy patients to reduce the risk of foodborne infection

ObjectivesGiven the increased risk of foodborne infection to cancer patients receiving chemotherapy treatment, and the risk of listeriosis reportedly five-times greater to this immunocompromised patient group, there is a need to ensure the implementation of domestic food safety practices among chemotherapy patients and their family caregivers. However, information regarding the adequacy of resources to inform and enable patients to implement domestic food safety practices to reduce the risk of foodborne infection is limited. Consequently, this study aimed to evaluate the provision of food safety information available to UK chemotherapy patients. Study designIn-depth semi-structured interviews and content analysis of online patient information resources. MethodsInterviews with patients and family caregivers (n = 15) were conducted to explore food-related experiences during chemotherapy treatment. Online food-related information resources for chemotherapy patients (n = 45) were obtained from 35 of 154 National Health Service chemotherapy providers in England, Scotland, and Wales, the Department of Health (DoH) and three of 184 identified UK cancer charities. Identified food-related information resources were reviewed using a content-analysis approach to assess the inclusion of food safety information for chemotherapy patients. ResultsIn-depth interviews established that many patients indicated awareness of immunosuppression during treatment. Although patients reported practicing caution to reduce the risk of communicable diseases by avoiding crowded spaces/public transport, food safety was reported to be of minimal concern during treatment and the risk of foodborne infection was often underestimated. The review of online food-related patient information resources established that many resources failed to highlight the increased risk of foodborne infection and emphasize the importance of food safety for patients during chemotherapy treatment. Considerable information gaps exist, particularly in relation to listeriosis prevention practices. Cumulatively, information was inconsistent, insufficient, and varied between resources. ConclusionThe study has identified the need for an effective, standardized food safety resource specifically targeting chemotherapy patients and family caregivers. Such intervention is essential to assist efforts in reducing the risks associated with foodborne infection among chemotherapy patients.

The expression of triggering receptor expressed on myeloid cells receptor-1 in Aspergillus infected mice

Objective: To investigate the expression of triggering receptor expressed on myeloid cells receptor-1 (TREM-1) in plasma and bronchoalveolar lavage fluid (BALF) and its correlation with Galactomannan, IFNγ, IL-6 and IL-10 in Aspergillus infected mice. Methods: Cyclophosphamide(CTX) was intraperitoneally injected and fumigatus spore suspension was inhaled by nose to establish the immunocompromised invasive pulmonary aspergillosis(IPA) mouse model.Healthy controls, immunocompromised only and IPA only groups were also established. Each group had 6 mice. After inoculation, mice were sacrificed. Lung tissue specimens, BALF, and plasma samples were collected. Plasma and BALF soluble TREM-1 (sTREM-1), Galactomannan, IFNγ, IL-6, and IL-10 were detected by ELISA. Results: Positive Aspergillus fumigatus was found by tissue culture in the lung. Infiltration of inflammatory cells, blood congestion and interstitial lung tissue injury were observed in histological sections of both IPA and immunocompromised IPA mice. Compared to IPA group [(453.78±74.18) ng/L, P<0.001; (10.21±1.46) ng/L, P<0.001] and control group [(245.16±65.85) ng/L, P<0.001; (6.60±3.74) ng/L, P<0.001], the plasma and BALF sTREM-1 significantly increased in immunocompromised IPA group [(1 537.64±359.52) ng/L; (20.12±2.72) ng/L]. Compared to control group, both the BALF sTREM-1 in IPA group (P=0.041) and the plasma and BALF Galactomannan, IFNγ, IL-6, and IL-10 levels in IPA and immunocompromised IPA groups were significantly higher (P<0.01). Pearson correlation analysis showed that plasma and BALF sTREM-1 were significantly correlated with Galactomannan (r=0.83, P<0.001; r=0.82, P<0.001), IFNγ (r=0.79, P<0.001; r=0.61, P<0.01), IL-6 (r=0.81, P<0.001; r=0.66, P<0.01), and IL-10 (r=0.70, P=0.001; r=0.54, P=0.02). Conclusions: Plasma and BALF sTREM-1 appears highly expressed in Aspergillus infected mice. sTREM-1 in mice plasma and BALF is closely correlated with Galactomannan, IFNγ, IL-6, and IL-10 levels, which suggests that sTREM-1 has great diagnostic value during invasive fungal infection.

Radiological Manifestations of Pulmonary Tuberculosis - A Comparative Study between Immunocompromised and Immunocompetent Patients.

Pulmonary tuberculosis has atypical radiological manifestations in patients with underlying immunocompromised disease like diabetes and human immunodeficient virus infection. Computed tomography has important role in such patients for early diagnosis of disease and management to minimize complication. To evaluate and compare the computed tomography chest features of pulmonary tuberculosis in between immunocompromised patients and immunocompetent patients. This cross-sectional study was conducted in the hospital on newly diagnosed 60 pulmonary tuberculosis patients of which 30 patients had no underlying disease (Immunocompetent Group) and 30 patients had diabetes mellitus or were human immunodeficiency virus seropositive (Immunocompromised Group). CT scan of chest were evaluated for each patient. In immunocompetent patients, 36.7% had radiologically atypical presentation,90% had nodular opacities, 73.3% had consolidation, 23.3% had lymphadenopathy, 60% had cavitation and cavitatory lesion were single in 94.4% patients. Isolated upper lung field were involved in 60% patients. In immunocompromised patients 76.7% had radiologically atypical presentation, 66.7% had nodular opacities, 46.7% had consolidation, 63.3% had lymphadenopathy, 20% had cavitation and cavitatory lesions were multiple in 60% patients. Isolated lower lung field were involved in 23.3% patients. We concluded that immunocompromised patients have more atypical involvement of lung fields, higher prevalence of lymphadenopathy as compared to immunocompetent patients. Diabetic patients have multiple cavitatory lesions as compared to non-diabetic patients. HIV seropositive patients have more prevalence of lymphadenopathy as compared to HIV seronegative patients.

Effective use of oral ribavirin for respiratory syncytial viral infections in allogeneic haematopoietic stem cell transplant recipients

Respiratory syncytial virus (RSV) is a frequent cause of respiratory viral infections, increasing the morbidity and mortality in allogeneic haematopoietic stem cell transplantation (HSCT) recipients. Little is known about the best management strategy in this immunocompromised group and there are very few data on oral ribavirin treatment. To evaluate the effectiveness of oral ribavirin in allogeneic HSCT patients with RSV infection. Twenty-three RSV cases treated with oral ribavirin were analysed retrospectively. RSV diagnosis was established by polymerase chain reaction assay. Oral ribavirin was initiated at 15mg/kg/day in three divided doses for 10 days, with no subsequent dose escalation, as per centre policy. At diagnosis, seven patients presented with lower respiratory tract infection (RTI), whereas 16 had upper RTI. Oral ribavirin was well tolerated with minor adverse effects. The median treatment duration was 10 days (range: 5-47). After a median follow-up of 17 months (range: 4-48), 17 patients are alive. We recorded one RSV-related and five non-related deaths. To our knowledge, this is the largest single centre study yet performed on adult allogeneic HSCT recipients with RSV infection treated with oral ribavirin. Prompt initiation of treatment is essential and may avoid hospital admission. Our experience supports the use of oral ribavirin, but large prospective studies are needed to determine the optimal therapy in this patient group.

Introducing Miltefosine as an Anti-cryptosporidial Agent in Immunocompromised Mice

Cryptosporidiosis is a clinically significant opportunistic infection causing diarrhea especially among immunocompromised patients includes those with immunodeficiency syndrome and certain immunosuppressed patients undergoing chemotherapy, organ transplant recipients treated with drugs that suppress the immune system, and patients with autoimmune disorders. The aim of this study was to evaluate the potential antiparasitic effect of miltefosine, (a phospholipid drug used for the treatment of visceral and cutaneous leishmaniasis) in immunocompromised (Dexamethasone treated) mice infected with Cryptosporidium. Parasitological examination of feces for oocysts count was performed ten and twenty days after start of treatment. Histopathological examination of intestinal, liver and spleen sections was held. Results revealed no significant reduction in mean Cryptosporidium oocyst number detected in immunocompromised infected group ten days post treatment (1.44%). Twenty days post treatment showed statistical significant reduction (p<0.001) reaching (38.63 %) when compared to the mean oocysts counts of infected untreated immunosuppressed group of mice. Histopathological sections of small intestine, liver and spleen showed several degrees of inflammatory changes before treatment. In treated group with miltefosine no improvements of small intestinal photomicrographs were seen; in contrast, significant improvement was observed in liver and spleen histopathological sections. Ziehl–Neelsen acid-fast stain was originally undertaken for the detection of Cryptosporidium oocysts within intestinal mice tissue. In conclusion, oral administration of miltefosine in vivo showed moderate efficiency against cryptosporidiosis in immunocompromised infected mice.

PREVALENCE OF SOME GASTRO-INTESTINAL PARASITES IN DIABETIC PATIENTS IN TANTA CITY, GHARBIA GOVERNORATE, EGYPT.

It is well known that diabetes mellitus affects the immune system negatively through various ways. Diabetic patients are also considered as the immunocompromised group of patients. Infections with intestinal parasites are uncommon to cause high morbidity or mortalilty to man, but they are risky to diabetic patients. The study investigated the prevalence of comnion intestinal parasites in diabetic patients in Tanta City. Among the patients who were attending gastrointestinal department (360 patients), complaining of variouse abdominal symptom and discomfort, thirty three (33) patients were known to be diabetic and on current treatment. Fecal samples were collected from diabetic patients and the same number from nondiabetic patients. Samples were examined macroscopically and microscopically by direct smear and different concentration methods then stained with iodine. The study was carried out through six months from March to August 2015 for common intestinal parasites. In diabetic group E histolytica were detected in 13 patients (39.4%), compared to (43%) among controls, G. lamblia was detected in a patient (3%) compared to (3%) in controls, A. lumbricoides was detected in one patient (3%) compared to (5%) in controls, and E. vermicularis was detected in one patient (3%) compared to (3.8%) in controls. The highest level of parasitosis among diabetic patients was E. histolytica (39%), but without significant difference between controls and patients. There for one can assume that E. histolytica could be considered as a monitor for environmental pollution, low stander hygiene and low standard of living.