Infections In Immunocompromised Patients Research Articles

Umbilicated papules in an immunocompromised patient.

A 68-year-old male with HIV (CD4 count: 167 cells/mm³) presented with multiple umbilicated papules on the face and chest and a giant pedunculated nodule on the forehead, persisting for six months. Differential diagnoses included molluscum contagiosum, histoplasmosis, and cryptococcosis for the papules, and giant molluscum contagiosum or squamous cell carcinoma for the nodule. Histopathology revealed epidermal hyperplasia with Henderson Patterson bodies, confirming molluscum contagiosum. Fungal stains, cultures, and antigen tests for cryptococcosis and histoplasmosis were negative. The patient was started on highly active antiretroviral therapy (HAART) for immune reconstitution. This case underscores the importance of histopathology in differentiating molluscum contagiosum from opportunistic infections in immunocompromised patients and highlights HAART as a key therapeutic intervention.

Disseminated Mucormycosis in an Immunocompromised Patient with Richter Transformation of Chronic Lymphocytic Leukemia: A Case Report of Concurrent Findings on [18F]-Fluorodeoxyglucose PET-CT

Abstract A case of chronic lymphocytic leukemia/small lymphocytic lymphoma with Richter transformation. After initiating R-CHOP chemotherapy, patient developed severe neutropenia and necrotizing cellulitis, necessitating an above-knee amputation. Subsequent positron emission tomography-computed tomography (PET-CT) imaging revealed new lesions suggestive of an abscess, confirmed as mucormycosis upon biopsy. This report highlights the importance of fludeoxyglucose PET-CT in detecting fungal infections in immunocompromised patients and its role in disease management.

BK Virus-Specific T Cell Response Associated with HLA Genotypes, RhD Status, and CMV or EBV Serostatus in Healthy Donors for Optimized Cell Therapy

PurposeThe increasing application of virus-specific T cell therapy for treating BK virus infections in immunocompromised patients highlights the necessity for rapid identification of compatible cell donors with optimal BK-specific T cell response. This study aims to characterize the BK virus-specific T cell response in relation to demographic factors, blood group, serological status, and HLA genotypes using samples from a cell donor registry.MethodsPeripheral blood mononuclear cells from cell donors were stimulated with peptide pools derived from VP1 and LTA proteins, and the IFN-γ production was analyzed using ELISpot and validated by flow cytometry.ResultsOur findings provide an overview of the T cell response to BK virus proteins in healthy donors, revealing associations with demographic characteristics, RhD status, CMV or EBV serological status, and HLA alleles. Remarkably, RhD-negative, CMV-seronegative, and EBV-seronegative donors showed a major T cell response against BK virus proteins. Notably, certain HLA alleles were associated with either enhanced or diminished T cell response. Furthermore, our results suggest that HLA-B leader dimorphism, specifically the presence of threonine at position 2, influences the VP1-specific immune response, resulting in enhanced T cell activation.ConclusionThis study, beyond advancing our understanding of the relationship between donor characteristics and BK virus-specific T cell response, has significant implications for improving the selection of optimal cell donors for patient-specific adoptive therapy.

Aspergillary Infections in Immunocompromised Patients in the Parasitology Department of Chu Mohamed VI de Marrakech 23 Cases

This retrospective study analyzed the records of 23 immunocompromised patients with aspergillosis at CHU Mohamed VI in Marrakech between January 2022 and June 2024. The main risk factors were diabetes (43.5%) and HIV infection (26%). Samples were taken in different hospital departments, with a predominance of dermatology (39%) and infectious diseases/hematology (17%). The samples were directly examined by optical microscopy after MGG staining, and then cultured on Sabouraud medium at 30-35°C for 30 days. The identification of species was based on macroscopic and microscopic features of colonies. Galactomannan antigen assay was performed when requested by clinicians. The results show a male predominance (sex-ratio 3.2) with an average age of 50 years. A. fumigatus was the most common species (48%), followed by A. flavus (35%) and A. niger (17%). The majority of samples were superficial mycoses (74%). This study highlights the importance of aspergillary infections in immunocompromised people in Morocco and underlines the need for early diagnosis combining mycological examinations and antigen detection. Limitations include small size and retrospective nature, justifying additional studies.

The Mycology Profile in Immunocompromised Patients of CHU Mohammed VI of Marrakech

Introduction: This Moroccan study focuses on fungal infections in immunocompromised patients, a particularly vulnerable population. Conducted over two years at CHU Mohamed VI in Marrakech, the research involved 271 patients with various forms of immunosuppression. Result: The results reveal that Candida spp. led the identified pathogens, accounting for 39.5% of cases, with a predominance of Candida albicans (56%). Dermatophytes occupy the second position (24%), followed by Aspergillus spp. (8.5%). Notably, researchers observed a worrying resistance to fluconazole in 28% of cases, while amphotericin B retains excellent efficacy (98% sensitivity). Discussion: The detailed analysis shows distinct profiles according to the underlying pathologies : HIV patients mainly present candidiasis, diabetics develop dermatophyte infections, and cases of mucormycosis occur exclusively in the latter population. The most concerned departments are those of infectious diseases, dermatology and hematology. These findings highlight several key issues. On the one hand, early diagnosis requires more sophisticated techniques such as molecular biology. On the other hand, therapeutic management must adapt to the emergence of resistance to common antifungal agents. The authors emphasize the importance of close collaboration between different specialists to optimize the management of these serious infections. Conclusion: This research provides valuable data for the Moroccan and African context, while confirming some trends observed on a global scale. It also opens up avenues for improving diagnostic and treatment strategies in hospital settings.

Urinary tract infections in immunocompromised patients.

Urinary tract infections (UTIs) are a major source of morbidity in immunocompromised patients, including transplant recipients, individuals with hematologic malignancies, people living with HIV, and those receiving immunosuppressive therapies. This review provides a synthesis of recent evidence, highlighting challenges in diagnosis, management, and antimicrobial resistance in these high-risk populations. Recent literature highlights the high burden of UTIs among immunocompromised patients. These infections are often caused by multidrug-resistant pathogens. Across these groups, common risk factors include immunosuppression, diabetes, urologic instrumentation, and catheterization. Diagnostic uncertainty - particularly distinguishing true infection from asymptomatic bacteriuria - frequently leads to overtreatment. Emerging stewardship tools, such as reflex urinalysis protocols and electronic phenotyping of antimicrobials (e.g. the use of the 'Acute Urinary Antibiotics' labelling), show promise for reducing inappropriate antibiotic use in outpatient settings. UTIs in immunocompromised patients are increasingly complex due to atypical presentations and resistant pathogens. Clinical care must prioritize accurate diagnosis, judicious use of antibiotics, and implementation of stewardship interventions. Further research is needed to validate risk-based diagnostic tools and expand outpatient stewardship infrastructure in transplant and oncology settings.

Double infections in the gastrointestinal mucosal biopsies.

Gastrointestinal infections are an important cause of morbidity and mortality worldwide. There are a few reports of gastrointestinal double infections in immunocompromised patients. In this study, we retrospectively analyzed double infections identified in gastrointestinal mucosal biopsies in a tertiary care center. This was a hospital-based, observational, retrospective study that included cases from January 2018 to March 2024. The histomorphology of 6352 endoscopic mucosal biopsies was reviewed for the presence of double infections. These cases were analyzed concerning their clinical scenarios and background comorbidities. The prevalence of gastrointestinal infections was found to be 21.22%, the majority affecting the upper gastrointestinal tract (93.1%). Infections caused by various organisms other than H. pylori, including helminths, protozoa, viruses, mycobacteria, and fungi, were detected in a total of 195 cases. Of all the infections, double infections were detected in 10 cases (0.74%). The most common pathogen in the double infections was cytomegalovirus (CMV), in 70% of the cases; followed by Strongyloides stercoralis found in 40% of the cases. Two patients with disseminated infections developed secondary HLH and died. Double infections of the GI tract are rare and are cited in the literature mainly in immunocompromised patients. CMV infection or reactivation, and Strongyloides hyperinfection syndrome, should be suspected in refractory IBD patients, even during the first flare, and is a major cause of mortality in these patients. A high index of clinical suspicion and accurate histopathological diagnosis of these infections can reduce morbidity and mortality in immunocompromised patients.

Environmental investigation of 10 cases of nosocomial Bacillus cereus bacteraemia between 2018 and 2023

BackgroundBacillus cereus can cause severe and potentially fatal bloodstream infections in immunocompromised patients, including preterm neonates. When the infection is nosocomial, investigating a potential environmental source is crucial to mitigate the transmission. This study investigated the potential environmental sources of ten cases of B. cereus bacteraemia in a neonatal intensive care unit.MethodsWe retrospectively analysed strains from 6 temporal groups of cases involving 10 preterm neonates with bacteraemia (December-2018 to November-2023) and 28 related environmental samples. Strain typing used Multi-locus Sequence Typing (MLST) to identify sequence types (ST), followed by core-genome analysis (cgMLST) and whole genome sequencing (WGS) for strains within the same ST.ResultsThe 10 clinical strains belonged to 10 different STs, while environmental strains fell into 18 STs. Fourteen strains across four STs matched clinical and environmental sources and were grouped into 4 groups (G1 to G4). Two environmental strains linked to clinical cases were isolated from medical offices, and five from nurses’ locker rooms. These strains were analysed by WGS (Illumina) alongside other Bacillus species. G1 and G2 corresponded to B. cereus species whereas strains of G3 and G4 were closely related to B. pacificus and B. paranthracis, respectively.ConclusionWe determined that severe B. cereus infections cases in 10 preterm neonates were not linked to each other, but rather to multiple potential environmental reservoirs within the NICU, often located farther from clinical wards than expected. These areas are not subject to same hygienic standards as medical units. Our findings highlight the need for routine monitoring of hand hygiene practices along with close surveillance and systematic biocleaning that targets not only direct patient care areas but also the broader hospital environment.

Clinical characteristics, risk factors and prognosis of Klebsiella pneumoniae infection in patients with different states of immune function: a retrospective study.

The aim of our study was to investigate the epidemiology and risk factors of Klebsiella pneumoniae (KP) infection in immunocompromised patients and to compare the differences in prognosis among patients with different immune states in the extended-spectrum beta-lactamase KP (ESBL-KP), the carbapenem-resistant KP (CRKP), and the non-multidrug-resistant KP (non-MDR-KP) groups. We conducted a retrospective study in immunocompromised and immunocompetent patients with KP infections who were admitted to Chaohu Hospital of Anhui Medical University from January 2023 to December 2023. We compared demographics, clinical characteristics, treatments, and outcomes across these groups and examined the impact of ESBL-KP, CRKP and non-MDR-KP on cumulative survival rates in populations with different immune states by plotting Kaplan-Meier curves. Our study included 228 immunocompromised patients and 200 immunocompetent patients. Compared to the immunocompetent group, immunocompromised patients were more likely to have a history of surgery and to use hormone frequently. They tended to rely more on medical devices, including urinary catheters, nasogastric catheters, arterial catheters, venous catheters, mechanical ventilation and endoscopy. Immunocompromised patients had a poorer recovery and were rehospitalized more often than those in immunocompetent patients. In the multivariable analysis, age-adjusted Charlson comorbidity index (aCCI) (OR: 1.292, 95%CI: 1.086-1.537, P < 0.004) and microbiological clearance failure (OR: 4.175, 95%CI: 1.966-8.866, P < 0.001) were the most important risk factors for mortality in immunocompromised patients infected with KP. It was further observed that immunocompromised patients in the ESBL-KP group had the lowest cumulative survival. In contrast, among both all participants and immunocompetent patients, the CRKP group had the lowest cumulative survival, followed by the ESBL-KP group. The clinical characteristics, treatment process and prognosis in immunocompromised patients with KP infections are significantly different from those in immunocompetent patients. In clinical settings, the standardization of invasive procedures and the rational use of antibiotics represent the most effective strategies for preventing and treating KP infection.

Comparison of a modified broth microdilution Sensititre™ SLOMYCOI assay with the CLSI-recommended agar disk elution method for antimicrobial susceptibility testing of Mycobacterium haemophilum.

Mycobacterium haemophilum is a fastidious nontuberculous mycobacterium that causes severe infections in immunocompromised patients. Due to its complex growth requirements, its detection and antimicrobial susceptibility testing (AST) remain challenging. This study aimed to compare the performance of a modified commercial broth microdilution method (Sensititre™ Myco susceptibility plates with added haemin) with the standard Clinical and Laboratory Standards Institute (CLSI) agar disk elution method for AST of M. haemophilum. We conducted 20 comparative AST tests on M. haemophilum ATCC 29548 and 10 clinical isolates, using the CLSI agar disk elution method as the reference. MICs were determined using both methods, and categorical concordance was assessed for multiple antibiotics. The overall concordance between methods was 81.4%. High agreement was observed for clarithromycin, linezolid, trimethoprim-sulfamethoxazole and rifampicin (90%-100%), while lower concordance was noted for amikacin (40%), ciprofloxacin (75%) and doxycycline (65%). Sensititre™ microdilution plates demonstrated superior standardization, ease of use and reduced contamination risks compared to the agar disk method. The modified Sensititre™ microdilution method is a reliable alternative to the agar disk elution method for AST of M. haemophilum. It provides precise MIC values and is better suited for routine clinical use due to improved reproducibility and efficiency.

LAVR-289, an Acyclo-Nucleoside Phosphonate, Has Broad-Spectrum Activity against Herpesviruses.

Human herpesviruses are large dsDNA viruses that primarily cause opportunistic infections in healthy adults but can trigger life-threatening infections in immunocompromised patients. Previously, antivirals have been developed against a variety of herpesviruses; these include acyclovir for herpes simplex viruses (HSV1 and 2) and ganciclovir and letermovir for human cytomegalovirus (hCMV). However, broad-spectrum inhibitors of herpesvirus infections are still lacking. Here we report the efficacy of LAVR-289, a new acyclic nucleoside analogue, on a broad range of herpesviruses of human and animal origin. LAVR-289 displays nanomolar efficacy in vitro, is active on viral strains resistant to gold-standard antivirals and is efficacious ex vivo on reconstituted human skin infected with HSV1. In addition, the activity of LAVR-289 against poxviruses and adenoviruses is an indication of its potential for the management of opportunistic virus infections in immunocompromised patients.

Overcoming resistance of Candida albicans using photodynamic inactivation.

The increasing resistance to conventional antifungal agents, such as Amphotericin B (AmB), has led to a growing demand for alternative therapeutic approaches for Candida albicans, an opportunistic fungal pathogen responsible for infections in immunocompromised patients. This study aimed to evaluate the effectiveness of photodynamic inactivation (PDI) in combination with AmB for controlling C. albicans growth, particularly in its yeast and hyphal forms, and to assess the impact of multiple PDI doses. C. albicans (ATCC 90028) was cultured in yeast and hyphal suspensions that were adjusted to 108 CFU/mL and treated with AmB at varying concentrations (0.065-1.04 μg/mL), with and without PDI. PDI was performed using the photosensitizer curcumin (2.5 μM), activated by a 450 nm LED light source at a fluence of 15 J/cm2. The effect of single and repeated PDI doses was evaluated in the fungal biomolecules, which were assessed using Fourier transform infrared (FTIR) spectroscopy. Optical density (OD) measurements quantified fungal growth reduction at 540 nm. The combination of AmB and PDI significantly reduced C. albicans growth, achieving a 75% reduction in the yeast form and an 87.5% reduction in the hyphal form. Two doses of PDI further enhanced antifungal efficacy, particularly against hyphae, which exhibited higher sensitivity to treatment. These findings suggest that PDI enhances the antifungal action of AmB, particularly in more resistant C. albicans forms such as hyphae and biofilms. The observed synergistic effect supports the potential use of PDI as an effective strategy to combat antifungal resistance in clinical applications.

A Case of Delayed Refractory Mycobacterium mageritense Abdominal Wall Abscess in a Kidney Transplant Recipient

ABSTRACTIntroductionMycobacterium mageritense (M. mageritense), a rare non‐tuberculous mycobacterium (NTM), can cause infections in immunocompromised patients, including kidney transplant recipients. We present a case of an abdominal wall abscess caused by M. mageritense following a living donor kidney transplant.Case PresentationA 58‐year‐old woman, post‐ABO‐incompatible kidney transplant, developed an abscess at the site of a removed peritoneal dialysis catheter. Initial antibiotics were ineffective, and pus cultures identified M. mageritense. Surgical drainage and levofloxacin‐linezolid therapy controlled the infection temporarily. Despite clinical improvement, the abscess recurred 30 days post‐discharge, which required repeated antibiotic use and adjustments to immunosuppression. Reducing mycophenolate mofetil while maintaining tacrolimus stabilized the infection, and prophylactic levofloxacin was continued post‐discharge to prevent relapse.ConclusionEffective infection control requires careful immunosuppressive adjustment and long‐term antibiotic use to balance graft preservation with infection risk.

A case of relapsing visceral leishmaniasis: the potential role of steroids and RANKL inhibitors in worsening disease outcome

ABSTRACT Background Individuals pharmacologically immunosuppressed, whether by chemical or biological drugs, are prone to severe infections, including leishmaniasis. In Leishmania -infected immunocompromised patients, numerous factors contribute to the clinical picture and response to treatment, including the parasite, the immune system, and the co-medications. Case Summary Here, we present the case of a 2-year relapsing visceral leishmaniasis (VL) in an immunocompromised patient suffering from undifferentiated connective tissue disease and undergoing treatment for osteoporosis with a monoclonal antibody targeting the bone resorption mediator receptor activator of nuclear factor-κB ligand (RANKL). The ultimate resolution of VL was achieved by an integrated approach that included the administration of combined antiparasitic treatment followed by secondary prophylaxis, tapering of immunosuppression including drastic reduction of oral steroids and suspension of hydroxychloroquine and the suspension of RANKL inhibitor. As RANKL restrains Leishmania replication by activating macrophages, we hypothesize that the RANKL inhibitor may have synergized with the immunosuppressive treatment in inducing parasite expansion and relapsing of VL in the index case. Conclusion This case highlights the need to consider Leishmania -infected immunocompromised patients as complex systems; numerous factors can be implicated in the balance between the parasite, the immune system, and co-medications and may contribute to the response to treatment.

Human Cytomegalovirus Virion-Associated mRNA as a Marker of Productive Infection in Immunocompromised Patients.

Human Cytomegalovirus (HCMV) transcripts (including UL21.5 mRNA) have been found to be packaged in virions, and their detection in plasma may indicate the presence of infectious viral particles. The objective of this study was to verify whether UL21.5 mRNA detected in the plasma was indeed encapsulated in viral particles, representing an indirect marker of active replication. To distinguish between virion-packaged and free-floating RNA, plasma samples from 22 immunocompromised patients were tested before and after ribonuclease (RNAse) digestion. UL21.5 mRNA was detected 1-2 weeks before preemptive therapy administration in 20 episodes (from 18 patients) of clinically significant DNAemia, while it was undetectable in three of the four patients with transient, self-resolving DNAemia. After RNAse digestion, UL21.5 mRNA was still detectable, with a median reduction of 0.1 (IQR: 0-0.3) Log10. Concentrations of UL21.5 mRNA in plasma correlated significantly with HCMV DNA in whole blood or plasma (R = 0.67), and 75% of samples positive for UL21.5 mRNA had HCMV DNA concentrations above 104 copies/mL blood or 103 copies/mL plasma. Moreover, UL21.5 mRNA was positive in patients who developed HCMV infection resistant to letermovir or maribavir, whereas it was undetectable in the plasma of patients with transient self-resolving DNAemia blips during letermovir prophylaxis (not associated with drug-resistance). HCMV UL21.5 mRNA in plasma is virion-associated and represents a marker for productive HCMV infection. The determination of UL21.5 mRNA could improve current strategies for the management of HCMV infection in immunocompromised patients.

Dynamics understanding of novel solvated drug molecules against emerging Burkholderia Cepacia infections in immunocompromised patients

Dynamics understanding of novel solvated drug molecules against emerging Burkholderia Cepacia infections in immunocompromised patients

Differentiation of nodular pulmonary infections in immunocompromised patients using CT-based radiomics

Differentiation of nodular pulmonary infections in immunocompromised patients using CT-based radiomics

How we diagnose and manage refractory and resistant herpes simplex virus mucocutaneous infection after haematopoietic cell transplantation.

How we diagnose and manage refractory and resistant herpes simplex virus mucocutaneous infection after haematopoietic cell transplantation.

NTM infections in immunocompromised patients: A growing threat

NTM infections in immunocompromised patients: A growing threat

Invasive Magnusiomyces Capitatus Infection in a Patient Followed for Acute Myeloblastic Leukemia: A Case Report

Magnusiomyces capitatus is a rare cause of invasive fungal infection in immuno-compromised patients. We report the case of magnusiomyces infection of the central nervous system, the lungs and sinus with a palatal lesion, in a patient treated for acute myeloid leukemia. While Magnusiomyces infections pose diagnostic and therapeutic challenges, a comprehensive understanding of their epidemiology, clinical manifestations, and microbiological aspects is essential to guide effective management. The patient improved under antifungal treatments despite a reduced sensitivity of the different antifungals to the antifungogram. The important delays between chemotherapy cycles and its reduced intensity due to the Magnusiomyces infection has made managing the anticancer treatment more challenging.