Immunocompromised Patients Research Articles

Lyme Borreliosis Incognito-Expanding the Spectrum of Invisible Dermatoses.

We present a 55-year-old patient with rheumatoid arthritis, concomitant small vessel vasculitis, and autoimmune inflammatory myositis who developed a multilocular annular erythema under immunosuppressive therapy. Clinically highly suspicious for Lyme borreliosis, histologically only a minimal perivascular and interstitial dermatitis with discrete mucin deposits was found. Infectious pathogenesis was proven by the detection of borrelia DNA using PCR. This case extends the spectrum of histologically invisible dermatoses and illustrates that in immunocompromised patients, clinically prototypical Lyme borreliosis may only show extremely subtle microscopic features.

Acute infectious gastroenteritis in childhood: the role of rapid multiplex molecular syndromic panels in diagnosis and clinical management.

Acute infectious diarrhea is a major global health issue, especially in children, as gastrointestinal infections are the second most common infectious disease after respiratory infections. The implementation of rapid multiplex molecular syndromic panels (RMMSP) for the comprehensive detection and identification of enteric pathogens in stool samples has enhanced diagnostic precision, supplementing-or, in some cases, replacing-traditional methodologies. This narrative, non-systematic review synthesized the available evidence on the clinical performance of gastrointestinal RMMSP up to December 31, 2024. On May 27, 2024, specialists in Pediatrics and Microbiology met to assess the use of RMMSP in pediatric gastrointestinal infection diagnosis. This review focused on RMMSP applicable to urgent management of infectious acute gastroenteritis (AGE), excluding those panels unsuitable for immediate diagnosis. RMMSP facilitated rapid pathogen detection in pediatric infectious AGE and have shown potential advantages over traditional microbiological methods, including a reduction in time to appropriate treatment. Their use appeared particularly useful in emergency and inpatient settings for inflammatory AGE, prolonged traveler's diarrhea, or cases at risk for complications. They were also considered for outpatient diagnosis in moderate/severe cases, chronic diarrhea, or immunocompromised patients. Within a diagnostic stewardship framework, current evidence suggests that RMMSP can contribute to minimizing unnecessary testing and hospitalizations, improving outbreak control, and optimizing antimicrobial use. However, further research is necessary to refine diagnostic workflows and ensure timely result delivery. This document evaluated key aspects regarding the application of RMMSP in pediatric infectious AGE, aiming to establish standardized protocols, support clinical decision-making, and facilitate optimal patient management.

Target Trial Emulation of Empiric Antibiotics on Clinical Outcomes in Moderately Immunocompromised Patients Hospitalized with Pneumonia.

Immunocompromised patients are often excluded from pneumonia trials, guidelines, and stewardship interventions.The objective of this study was to evaluate whether empiric broad-spectrum antibiotic treatment impacts mortality and other clinical outcomes in moderately immunocompromised patients without risk factors for multidrug-resistant organisms hospitalized with community-acquired pneumonia. This was a target trial emulation including moderately immunocompromised (asplenia, hematologic malignancies, solid organ malignancy receiving chemotherapy, kidney transplant >1 year prior, congenital/acquired immunodeficiency and receiving immunosuppressive medications) patients with pneumonia without risk factors for multidrug-resistant organisms at 69 hospitals in the Michigan Hospital Medicine Safety ConsortiumThis study compared the receipt of empiric broad-spectrum antibiotics against antibiotics targeting typical respiratory pathogens on hospital day 1 or 2.The primary outcome was mortality. Secondary outcomes included length of stay, transfer to the intensive care unit and 30-day readmission, emergency department visit, Clostridioides difficile infection and antibiotic-associated adverse events. Of 2706 moderately immunocompromised patients with pneumonia, 59% (N=1596) received empiric broad-spectrum antibiotics. MRSA and resistant gram-negative bacteria were rare (94/2706, 3.5%). After adjustment, empiric broad-spectrum antibiotic treatment was not associated with mortality, but was associated with readmission (adjusted hazard ratio [aHR], 1.32 [1.05-1.66]), transfer to ICU (aHR, 2.65 [1.32-5.30]) and longer hospitalization (adjusted rate ratio [aRR], 1.14 [1.10-1.19]). Immunocompromised patients hospitalized with pneumonia often receive empiric broad-spectrum antibiotics despite low rates of multidrug-resistant organisms. Empiric broad-spectrum antibiotic use was not associated with mortality, but was associated with harm, including 30-day readmission, transfer to ICU and longer duration of hospitalization.

In Silico Analysis of Mechanisms of Maribavir-Induced Inhibition and Drug Resistance Mutations in pUL97 Kinase Structural Prediction with AlphaFold2

Infections with cytomegalovirus (CMV) can result in increased morbidity and mortality in immunocompromised patients. The pUL97 kinase is a critical enzyme in the regulation of CMV replication. Although it does not phosphorylate deoxynucleosides, this enzyme is involved in the first phosphorylation step of ganciclovir (GCV), a viral DNA polymerase inhibitor. In contrast, maribavir (MBV) is a specific inhibitor of pUL97 kinase activity. In this paper, we analyzed the already-reported amino acid changes, conferring resistance to MBV and cross-resistance to GCV, in the pUL97 protein structure, predicted with AlphaFold2. Docking experiments suggest that MBV is a dual-site inhibitor, targeting ATP binding and substrate phosphorylation. Substitutions that confer resistance to MBV only may directly or indirectly alter the shape of the cavity in the vicinity of the invariant K355 in the putative ATP binding site, without affecting the viral growth. The most frequently encountered T409M substitution may correspond to a gatekeeper mutation. Substitutions that induce cross-resistance to MBV and GCV may directly or indirectly affect the environment of D456 and N461 residues in the catalytic loop, with reduced viral replicative capacity. These results have implications for the clinical use of MBV as well as for the design of novel pUL97 kinase inhibitors.

Extraintestinal Manifestations of Clostridioides difficile Infections: An Overview

Introduction: Clostridioides difficile (C. difficile) is primarily associated with colonic disease, including pseudomembranous colitis. However, in rare instances, it may cause extraintestinal infectious and non-infectious manifestations, particularly in immunocompromised patients or those with significant underlying conditions. Search Methods: A literature review was performed using PubMed, Embase, and Researchgate databases up to 15 February 2025. The following search strings were used: “extraintestinal manifestations”, “extracolonic manifestations”, “extraintestinal infections”, “extracolonic infections”, “Clostridium difficile”, and “Clostridioides difficile”. Results: Extraintestinal manifestations of C. difficile appear to represent fewer than 1% of all reported infections. The most frequently reported infectious complications include bacteremia and abdominopelvic infections and abscesses, often involving polymicrobial cultures, with the isolation of C. difficile alongside microorganisms typically found in the normal intestinal microbiota. Rare non-infectious cases, such as reactive arthritis, have also been described. The underlying pathogenetic mechanism is believed to involve disruption of the intestinal barrier and translocation of bacteria or toxins to sterile sites. Conclusions: Though rare, extraintestinal C. difficile manifestations pose important clinical challenges. Better understanding of their mechanisms is essential for early recognition and appropriate management. Further research is warranted to define potential mechanisms and therapeutic approaches.

The Role of Ribavirin for Treatment of Respiratory Syncytial Virus in Immunocompromised Patients

The Role of Ribavirin for Treatment of Respiratory Syncytial Virus in Immunocompromised Patients

Encephalitis in Immunocompromised vs Immunocompetent Patients: A Comparative Study.

Encephalitis is characterized by brain parenchymal inflammation caused by infection or autoimmunity. There are limited recent data on how immunocompromised patients with encephalitis differ from the general encephalitis population. This retrospective study of 2 large medical institutions compares clinical characteristics and outcomes of immunocompromised and immunocompetent patients with all-cause encephalitis. Of the 657 patients, 151 (23%) were immunocompromised. Immunocompromised patients were more likely to have an infectious etiology, comorbidities, inflammatory cerebrospinal fluid (CSF) profile, abnormal neuroimaging, and worse clinical outcomes as assessed by discharge Glasgow Outcome Scale (GOS) and in-hospital mortality (all P < .05). The most commonly identified etiologies in immunocompromised patients were herpes simplex virus (HSV) and varicella zoster virus. HSV accounted for similar proportions in the immunocompromised (18%) and immunocompetent (14%) groups, though it was more commonly associated with a CSF neutrophilia in the immunocompromised group (P = .001). Strikingly, >10% of immunocompromised patients with encephalitis had autoimmune causes, two-thirds of which were checkpoint inhibitor associated. Factors associated with poor GOS on discharge differed, with poorer outcomes in the infectious group associated with immunocompromised state and poorer outcomes in the autoimmune group associated with immunocompetent state. Immunocompromised patients with encephalitis have differing causes, atypical clinical presentations, higher in-hospital mortality, and distinct factors associated with poor outcome as compared with immunocompetent patients. While HSV and opportunistic infections cause encephalitis in the immunocompromised, the diagnosis of autoimmune encephalitis should also be considered and can be checkpoint inhibitor associated.

Nocardia species prevalent in India and their antimicrobial susceptibility profiles.

Nocardia species prevalent in India and their antimicrobial susceptibility profiles.

Intracranial Pressure.

Intracranial Pressure.

Ultrasound-Guided Serratus Anterior Plane Block for Acute Zoster Pain in an Immunocompromised Heart Transplant Patient in the Emergency Department.

Ultrasound-Guided Serratus Anterior Plane Block for Acute Zoster Pain in an Immunocompromised Heart Transplant Patient in the Emergency Department.

Monitoring the emergence of resistance with sotrovimab in immunocompromised patients with COVID-19: LUNAR study.

Monitoring the emergence of resistance with sotrovimab in immunocompromised patients with COVID-19: LUNAR study.

Biological modifications of the immune response to COVID-19 vaccine in patients treated with rituximab and immune checkpoint inhibitors.

Biological modifications of the immune response to COVID-19 vaccine in patients treated with rituximab and immune checkpoint inhibitors.

&lt;i&gt;&lt;b&gt;Respiratory Syncytial Virus&lt;/b&gt;&lt;/i&gt;&lt;b&gt; (RSV): Virologi, Patogenesis, Respon Imun, dan Vaksin Pada Dewasa&lt;/b&gt;

Respiratory syncytial virus (RSV) is classified within the Pneumoviridae family, genus Orthopneumovirus. RSV is a single-stranded, negative-sense RNA virus and has two genotypes, A and B. It is primarily associated with lower respiratory tract infections, including bronchiolitis and bronchopneumonia, and is a common cause of hospitalization in infants, elderly individuals, and immunocompromised patients. RSV also has the potential to become systemic infection. Symptoms of RSV infection, such as fever, cough, sore throat, and runny nose, are usually mild in adults. However, in some cases, especially for specific high-risk individuals, the infection can become severe enough to require hospitalization, and complications may lead to death. Understanding the pathogenesis and immune response to RSV are crucial for recognizing the virus’s effects and potential risks. This literature review covers the virology, pathogenesis, immune response, and recent advancements in RSV vaccine development in adult populations. Comprehensive knowledge of RSV is essential for developing effective prevention and treatment strategies.

Clinical Reasoning: A 64-Year-Old Man With Confusion, Nausea, Seizure, and Fever.

Evaluating patients with encephalitis is common, but it can be complicated in immunocompromised patients. In this case, a 64-year-old man with a medical history of multiple myeloma and previous Lyme disease presented with acute onset of confusion, nausea, and fever; developed generalized tonic-clonic seizures; and subsequently became comatose. This case highlights the importance of thinking broadly beyond common viral and bacterial encephalitides and developing a comprehensive differential diagnosis.

Analysis of humoral and cellular responses after vaccination against SARS-CoV-2 in patients with immune-mediated diseases.

Analysis of humoral and cellular responses after vaccination against SARS-CoV-2 in patients with immune-mediated diseases.

Aspergillus ochraceus: A Rare Cause of Paranasal Fungal Ball

Infection of paranasal sinuses is not uncommon. Fungal ball of the paranasal sinuses is a non-invasive form of paranasal sinus infection that has been documented to be more frequently caused by Aspergillus fumigatus than by other Aspergillus species and typically affects immunocompetent individuals more than those who are immunocompromised. Here, we report the first case of Aspergillus ochraceus (A. ochraceus) in an immunocompromised patient with post-trauma maxillary implant who presented with transient ischemic attack and incidental findings of fungal ball within the right maxillary sinus from the Computed Tomography (CT) scan. A. ochraceus is a species under the Aspergillus section Circumdati, a widely distributed fungus which is pathogenic to humans that can lead to various clinical implications. A. ochraceus was detected from paranasal tissue sent for culture. The laboratory culture findings were further supported by histopathological evidence of fungal hyphae and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) identification.

Measles and Solid Organ Transplantation: Diagnosis, Treatment, and Prevention.

The recent international resurgence of measles has led to significant public health concerns and poses significant risks to immunocompromised patients, including those who have undergone solid organ transplantation (SOT). SOT recipients may present atypically and are at an increased risk of severe complications of measles infection, underscoring the importance of preventative measures. This review summarizes contemporary data regarding measles transmission, the clinical presentation, diagnosis, and treatment of SOT recipients, as well as strategies for measles prevention, infection control considerations, postexposure prophylaxis, and opportunities for the mitigation of donor-derived measles and measles vaccine viruses.

Improvement in Palivizumab Administration in Severely Immunocompromised Children: A Single-institution Quality Improvement Initiative.

Palivizumab reduces severe respiratory syncytial virus (RSV) infection risk in immunocompromised children. However, guidance on palivizumab prophylaxis for immunocompromised children has remained vague. We developed an institutional program to allocate palivizumab in a predefined high-risk group of patients. We aimed to increase provider adherence to palivizumab administration in profoundly immunocompromised children through education, identifying clinical pharmacists, and informing primary providers of eligible patients. The primary process metric was palivizumab guideline adherence, indicated by the percentage of patients receiving all recommended doses each season. The primary metric was the percentage of eligible patients receiving monthly follow-up doses. Balancing metrics were the percentage of inappropriate doses and patients not meeting our definition of profoundly immunocompromised who did not receive palivizumab prophylaxis and had severe RSV infection. A statistical process control P-chart analyzed the outcome metric before program implementation (baseline: 2009-2013) and throughout interventions (seasons 1-8; 2014-2021). More than 80% of patients received all expected monthly doses, with 89% (584 of 656) of eligible monthly palivizumab doses administered over 8 RSV seasons. The percentage of eligible patients receiving all recommended palivizumab doses increased from 30% to 99% in season 3, remaining more than 95%. Before intervention, 21 patients received palivizumab without meeting criteria; this decreased to 4 during season 1 postimplementation and to 0 thereafter. No profoundly immunocompromised patients meeting the operational definition or receiving palivizumab experienced severe RSV. We improved adherence to palivizumab administration guidelines for profoundly immunocompromised children over 8 consecutive RSV seasons without increasing RSV infection incidence or severity.

Ralstonia mannitolilytica Infections: A Systematic Review of Case Reports Unveiling Clinical Patterns and Therapeutic Insights.

Ralstonia mannitolilytica is an emerging opportunistic pathogen that has been increasingly reported in clinical settings. Despite its low pathogenicity in immunocompetent individuals, it poses a significant threat to immunocompromised patients, particularly those with underlying medical conditions or invasive medical interventions. This study aimed to evaluate the clinical impact and management strategies based on the analysis of individual case reports on Ralstonia mannitolilytica . A comprehensive search of PubMed was conducted from inception until July 31, 2023, using the terms "Ralstonia mannitolilytica" and/or "Pseudomonas thomasii". Inclusion criteria for our systematic review included human-centered case reports of Ralstonia mannitolilytica infections, excluding case series and review articles. Data extraction followed PRISMA guidelines, including study details and patient characteristics. Case reports were systematically assessed using the JBI critical appraisal checklist, evaluating patient demographics, clinical history, diagnostic methods, interventions, post-intervention outcomes, adverse events, and lessons learned to minimize bias risk. A total of 17 case reports of Ralstonia mannitolilytica infections were included in our systematic review. Studies published from 2001 to 2023 revealed diverse global contributions, with 29.41% from China. Infection origins varied, with catheter-related cases being predominant. Mortality was reported in two studies. Antibiotic sensitivity analysis showed sensitivity to third-generation cephalosporins, notably Ceftazidime. Quality appraisal revealed that all studies had a low risk of bias, ensuring the overall robustness of the case reports. This study emphasizes the importance of understanding Ralstonia mannitolilytica infections, given their varied clinical presentations and antibiotic responses. The study also underscores the necessity for precise identification, customized treatments, and ongoing research to manage these infections effectively.

A Cause of Bicytopenia in Infancy: CMV

Bicytopenia is frequently observed in the pediatric population as a result of transient bone marrow suppression, which may occur following vaccination or as a consequence of viral infections, including influenza, Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Symptoms of CMV infection, one of these agents, vary according to age and host immune competence. Although it is usually asymptomatic in healthy children, it can cause various infectious clinical presentations. In immunocompromised patients, it may cause pneumonia, retinitis, hepatitis, fever, thrombocytopenia and leukopenia. Here, we present a 4-month-old girl who was investigated for bicytopenia and subsequently diagnosed with CMV infection.