Opportunistic Bacterial Infections Research Articles

A bibliometric analysis of inflammatory bowel disease and COVID-19 researches.

Patients with inflammatory bowel disease (IBD) often require immunosuppressive therapy and are hence susceptible to various opportunistic viral and bacterial infections. In this regard, many studies on IBD and COVID-19 have been conducted. However, no bibliometric analysis has been performed. This study provides a general overview of IBD and COVID-19. Publications about IBD and COVID-19 from 2020 to 2022 were retrieved from the Web of Science Core Collection (WoSCC) database. Bibliometric analysis was performed using VOSviewer, CiteSpace, and HistCite. A total of 396 publications were retrieved and considered in this study. The maximum number of publications were from the United States, Italy, and England, and the contributions of these countries were significant. Kappelman ranked first in article citations. The Icahn School of Medicine at Mount Sinai and Inflammatory Bowel Diseases were the most prolific affiliation and journal, respectively. The most influential research topics were "management", "impact", "vaccination", and "receptor". The following keywords represented research frontiers: "depression", "the quality of life of IBD patients", "infliximab", "COVID-19 vaccine", and "second vaccination". Over the past 3 years, most studies on IBD and COVID-19 have focused on clinical research. In particular, topics such as "depression", "the quality of life of IBD patients", "infliximab", "COVID-19 vaccine", and "second vaccination" were noted to have received much attention recently. Future research should focus on our understanding of the immune response to COVID-19 vaccination in biologically treated patients, the psychological impact of COVID-19, IBD management guidelines, and the long-term impact of COVID-19 in IBD patients. This study will provide researchers with a better understanding of research trends on IBD during COVID-19.

Profiling of mucormycosis in district of central rural India during COVID-19 pandemic: a record-based study

Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with a wide range of opportunistic bacterial and fungal infections. Several cases of Mucormycosis in people with COVID-19 have been increasingly reported world-wide, in particular from India. The primary reason that appears to be facilitating Mucorales spores to germinate in people with COVID-19 is an ideal environment of low oxygen (hypoxia), high glucose (diabetes, new onset hyperglycemia, steroid-induced hyperglycemia). Methods: Secondary data was obtained from District health office Wardha. We took Mucormycosis related data for May 2021 to August 2021. A Secondary data analysis was done as an age wise distribution, Sex wise distribution, classification of Mucormycosis and case load in Wardha district. Results: Total cases (overall) was about 132. 91% cases are totally recovered. In overall cases, 106 males and 26 females were affected due to Mucormycosis. Out of 132 cases, 128 cases were of Rhino cerebral type of Mucormycosis. 48% cases of Mucormycosis were from 45 to 60 years old patients.127 cases of Mucormycosis were related with COVID history and only 5 cases of Mucormycosis were not related with COVID history. 53% cases were needed oxygen support prior onset of case. Conclusions: A multidisciplinary strategy should incorporate early diagnosis, antifungal therapy, any necessary surgical consultation and treatment, as well as reversal of the underlying illness. Identification of individuals at risk, strict glycaemic control and avoidance of unnecessary corticosteroid in non-severe COVID-19 cases (normal oxygen saturation on room air) can help in preventing this complication.

Morganella morganii septicemia and concurrent renal crassicaudiasis in a Cuvier’s beaked whale (Ziphius cavirostris) stranded in Italy

Information regarding bacterial diseases in Cuvier’s beaked whale (CBW, Ziphius cavirostris) is scattered and mostly incomplete. This report describes a case of septicemia byMorganella morganiiin a juvenile male CBW with concurrent renal crassicaudiasis. The animal stranded along the Ligurian coastline (Italy) and underwent a systematic post-mortem examination to determine the cause of death. Histopathology showed lesions consistent with a septicemic infection, severe meningoencephalitis, and renal crassicaudiasis. AnM. morganiialpha-hemolytic strain was isolated in pure culture from liver, lung, prescapular lymph node, spleen, hepatic and renal abscesses, and central nervous system (CNS). The antimicrobial susceptibility profile of the strain was evaluated with the minimum inhibitory concentrations (MICs) method and reduced susceptibility to Trimethoprim-Sulfamethoxazole is reported. Crassicauda sp. nematodes were retrieved from both kidneys. No other pathogens were detected by immunohistochemistry, serology, or biomolecular analyses. Toxicological investigations detected high concentrations of immunosuppressant pollutants in the blubber. The chronic parasitic infestation and the toxic effects of xenobiotics likely compromised the animal's health, predisposing it to an opportunistic bacterial infection. To our knowledge, this is the first description ofM. morganiisepticemia with CNS involvement in a wild cetacean.

The Clinical Characteristic and Management of Patients with Nocardiosis in a Tertiary Hospital in China.

Nocardiosis is an uncommon opportunistic bacterial infection which becomes a significant health problem due to its increasing incidence and high mortality rate. However, many nocardiosis patients are underdiagnosed by physicians. To summarize the clinical characteristics and management of nocardiosis would help with better diagnosis and prognosis of nocardiosis. This retrospective study was conducted based on the medical records of nocardiosis patients between January 2015 and December 2021 in a tertiary hospital in China. Overall, 44 nocardiosis patients with 54 specimens were included. The patients consisted of 26 males and 18 females with a mean age of 50.4 ± 13.2 years. Among 44 patients, 26 (59.1%) were previously given immunosuppressive therapy. Connective tissue diseases (CTDs) were the most common underlying disease (16/44). The most frequent infection sites were the lungs (17/44) and skin or soft tissues (8/44). Common symptoms included cough (23/44), expectoration (18/44), fever (15/44), and subcutaneous abscesses (15/44). Forty-five out of 54 specimens (83.3%) required over 48 hours of culture time for nocardiosis detection. Thirty-six patients were cured or improved, 5 patients were discharged from the hospital due to poor prognosis, and 1 patient died. The average diagnosis time of poor prognosis cases was 19.7 days, which was significantly longer than those of improved or cured patients (7.3 days). Immunosuppressed patients comprise a large part of nocardiosis cases, which is worth attention in clinical practice. Early diagnosis, specifically through prolonged cultivation time of specimen, could help achieve better prognosis of nocardiosis patients.

Aquaculture Bacterial Pathogens

A significant part of Indian food production involves fisheries and aquaculture, which contribute to agricultural exports and employ around fourteen million people. Since independence, the nation has consistently increased fish production as a result of its vast aquatic resources. A total of 6.3 percent of world fish production comes from the industry, which contributes 1.1 percent to GDP and 5.15 percent to agricultural GDP. A total of 10.07 million metric tons of fish are produced in the inland sector, and around 65 percent are produced in the cultural sector. Increasing fish diseases have slowed aquaculture production and product trade in India, threatening fishermen's livelihoods. Infections can be caused by a number of factors, including low physicochemical and microbiological quality of culture water, high stocking density, and poor nutrition. It is possible for seed fish and adults to become deformed and die from exposure to pollution and suspended particles. As a result of different opportunistic bacterial infections and parasites, the fish industry suffers a significant loss in mortality and morbidity, decreased growth, and increased chemical control and prevention costs.

Vitamin A Deficiency, COVID-19, and Rhino-Orbital Mucormycosis (Black Fungus): An Analytical Perspective.

Mucormycosis is a rare but serious opportunistic fungal disease characterized by rhino-orbito-cerebral and pulmonary involvement. It is mainly seen in people with secondary immunosuppression, isolated vitamin A deficiency, measles, and AIDS patients. It showed a rise during the second wave of the COVID-19 epidemic in the spring of 2021 in India, especially in diabetic COVID-19 patients. Vitamin A deficiency is known to cause nutritional immunodeficiency and hence leading the way to increased opportunistic fungal, bacterial, and viral infections. In the eye, it causes keratitis, night blindness, xerophthalmia, conjunctivitis, Bitot spots, keratomalacia, and retinopathy. It also causes decreased tear secretion and deterioration of the anatomical/physiological defense barrier of the eye. The negative impact of vitamin A deficiency has been previously demonstrated in measles, AIDS, and COVID-19. We think that mucormycosis in COVID-19 might be rendered by vitamin A deficiency and that vitamin A supplementation may have preventive and therapeutic values against mucormycosis and other ocular symptoms associated with COVID-19. However, any vitamin A treatment regimen needs to be based on laboratory and clinical data and supervised by medical professionals.

A Case of Negligence in the Diagnosis of Canine Juvenile Demodicosis. Case Report

Canine demodicosis is a parasitic dermatopathy caused by Demodex canis, a mite that is part of cutaneous microbiota of dogs. Its overgrowth inside hair follicles and sebaceous glands causes alopecia and erythema in the localized form, and its generalized form usually goes along with a severe case of folliculitis. Its diagnosis is performed through skin scraping, trichogram by epilation or impression with acetate tape of the affected areas and visualization of material by optical microscopy. The treatment consists by the use of specific parasiticides, and in cases of opportunistic bacterial infection, the use of antibiotics is recommended. This case report describes the generalized form of demodicosis in a 2-month-old male puppy, Dachshund breed, whose diagnosis was initially was not defined by not performing a skin scraping and viewing the material obtained under a microscope.

Etiology of Post-Covid Fungal Infections among Various Age Groups at Teritiary Care Hospital

Background: In patients with comorbid illnesses, COVID 19 disease is a severe acute respiratory syndrome that is linked to a variety of opportunistic bacterial and fungal infections. Finding the cause of fungal infections among post-covid patients in tertiary care hospitals is the aim of the study.Objectives: To study the etiology of post-covid fungal infections among various age groupsMethods: Out of 578 samples (pus/tissue/biopsy) collected from patients attending Koti ENT hospital with complaints of pain in eye, cheek swelling, headache. All samples were subjected to direct KOH mount and inoculated on SDA, incubated for 1 week at 25°C.Result: Out of 578 samples 214 are KOH positive and 291 are culture positive with fungi isolated – Mucor species, Aspergillus species and Candida species.Conclusion: As post covid fungal infections are rapidly progressive and devascularised disease, timely diagnosis helps in effective management and treatment of patients

Clinical and Epidemiologic Characteristics and Therapeutic Management of Patients with Vibrio Infections, Bay of Biscay, France, 2001-2019.

Noncholera vibriosis is a rare, opportunistic bacterial infection caused by Vibrio spp. other than V. cholerae O1/O139 and diagnosed mainly during the hot summer months in patients after seaside activities. Detailed knowledge of circulating pathogenic strains and heterogeneities in infection outcomes and disease dynamics may help in patient management. We conducted a multicenter case-series study documenting Vibrio infections in 67 patients from 8 hospitals in the Bay of Biscay, France, over a 19-year period. Infections were mainly caused by V. alginolyticus (34%), V. parahaemolyticus (30%), non-O1/O139 V. cholerae (15%), and V. vulnificus (10%). Drug-susceptibility testing revealed intermediate and resistant strains to penicillins and first-generation cephalosporins. The acute infections (e.g., those involving digestive disorder, cellulitis, osteitis, pneumonia, and endocarditis) led to a life-threatening event (septic shock), amputation, or death in 36% of patients. Physicians may need to add vibriosis to their list of infections to assess in patients with associated risk factors.

Magneto-Fluorescent Mesoporous Nanocarriers for the Dual-Delivery of Ofloxacin and Doxorubicin to Tackle Opportunistic Bacterial Infections in Colorectal Cancer

Cancer-related opportunistic bacterial infections are one major barrier for successful clinical therapies, often correlated to the production of genotoxic factors and higher cancer incidence. Although dual anticancer and antimicrobial therapies are a growing therapeutic fashion, they still fall short when it comes to specific delivery and local action in in vivo systems. Nanoparticles are seen as potential therapeutic vectors, be it by means of their intrinsic antibacterial properties and effective delivery capacity, or by means of their repeatedly reported modulation and maneuverability. Herein we report on the production of a biocompatible, antimicrobial magneto-fluorescent nanosystem (NANO3) for the delivery of a dual doxorubicin–ofloxacin formulation against cancer-related bacterial infections. The drug delivery capacity, rendered by its mesoporous silica matrix, is confirmed by the high loading capacity and stimuli-driven release of both drugs, with preference for tumor-like acidic media. The pH-dependent emission of its surface fluorescent SiQDs, provides an insight into NANO3 surface behavior and pore availability, with the SiQDs working as pore gates. Hyperthermia induces heat generation to febrile temperatures, doubling drug release. NANO3-loaded systems demonstrate significant antimicrobial activity, specifically after the application of hyperthermia conditions. NANO3 structure and antimicrobial properties confirm their potential use in a future dual anticancer and antimicrobial therapeutical vector, due to their drug loading capacity and their surface availability for further modification with bioactive, targeting species.

528 Linking CFTR modulators to opportunistic bacterial infections in cystic fibrosis

528 Linking CFTR modulators to opportunistic bacterial infections in cystic fibrosis

P365 Upsurge of Mucormycosis in COVID-19—a retrospective study in a tertiary care hospital in Punjab

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesCoronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been linked to a variety of opportunistic bacterial and fungal infections. Mucorales have been reported as the main fungal pathogens to exist as co-infection with COVID-19. Factors that contribute to a higher incidence of Mucormycosis or Mucorales to germinate in COVID-19 patients are high glucose levels in their blood (diabetes, steroid-induced hyperglycemia), low oxygen content (hypoxia), high iron levels, and decreased phagocytic activity of neutrophils due to immunosuppression because of cytokine storm in SARS-CoV-2 infection. Mucormycosis is an angioinvasive disease caused by order Mucorales and genus Rhizopus, Mucor, Rhizomucor, Cunnighamella, and Lichthemia. The most common species amongst all is Rhizopus arrhizus which is responsible for 90% cases of Rhino-Orbital Cerebral form and accounts for 60% cases of mucormycosis cases in India.MethodsA retrospective study was conducted at Christian Medical College and Hospital, Ludhiana from May 1, 2021 to February 28, 2022 for a duration of 10 months. Most of the samples obtained were necrotic bone/tissue or mucosa from the rhino-cerebral part. The obtained sample was inoculated on Sabouraud's Dextrose Agar (SDA) at 22°C as well as 37°C followed by 40% KOH examination. The tubes were routinely checked once in a week and Lactophenol Cotton Blue (LPCB) preparation was made from teasing the isolate once it becomes culture positive.ResultsTotal 29 samples were smear-positive for broad, sparsely septate hyphae in KOH examination under the microscope. Out of those 29 cases, 18 (62.06%) patients were COVID-19 positive (either RTPCR positive, TrueNat PCR positive, or Rapid Antigen positive), 5 patients were COVID-19 negative and COVID-19 testing was not done in 6 patients. Out of 29 smear-positive cases, 17 (58.62%) were culture positive for Mucorales, 7 (24.13%) grew contaminants namely Aspergillus species (mainly Aspergillus flavus), Penicillium species, bacterial contamination, and 5 (17.24%) were culture negative. Amongst 17 cases of Mucorales, 9 (52.94%) were Rhizopus species, 6 (35.29%) were Mucor species and 2 (11.76%) were Rhizomucor species. Amongst the culture-positive cases for Mucorales, 13 (72.22%) cases were COVID-19 positive.ConclusionCOVID-19 has thrown the entire globe into chaos, and there is still no specific cure for this viral illness. Patients are susceptible to secondary fungal infections such as Mucormycosis as a result of the infection, immunosuppression, previous comorbidities, and medicines. Mucormycosis infection is severe because of its rapid disease progression and angioinvasive nature. As a result, researchers and healthcare practitioners should take immediate steps to control this mucormycosis infection by understanding its impact and severity, particularly in COVID-19 patients. A multidisciplinary approach should involve quick diagnosis, antifungal therapy, any surgical consultation, and treatment that may help to reverse the underlying disease.

Nanotoxoid vaccination protects against opportunistic bacterial infections arising from immunodeficiency.

The rise in nosocomial infections caused by multidrug-resistant pathogens is a major public health concern. Patients taking immunosuppressants or chemotherapeutics are naturally more susceptible to infections. Thus, strategies for protecting immunodeficient individuals from infections are of great importance. Here, we investigate the effectiveness of a biomimetic nanotoxoid vaccine in defending animals with immunodeficiency against Pseudomonas aeruginosa. The nanotoxoids use a macrophage membrane coating to sequester and safely present bacterial virulence factors that would otherwise be too toxic to administer. Vaccination with the nanoformulation results in rapid and long-lasting immunity, protecting against lethal infections despite severe immunodeficiency. The nanovaccine can be administered through multiple routes and is effective in both pneumonia and septicemia models of infection. Mechanistically, protection is mediated by neutrophils and pathogen-specific antibodies. Overall, nanotoxoid vaccination is an attractive strategy to protect vulnerable patients and could help to mitigate the threat posed by antibiotic-resistant superbugs.

IHNV Infection Induces Strong Mucosal Immunity and Changes of Microbiota in Trout Intestine.

The fish intestinal mucosa is among the main sites through which environmental microorganisms interact with the host. Therefore, this tissue not only constitutes the first line of defense against pathogenic microorganisms but also plays a crucial role in commensal colonization. The interaction between the mucosal immune system, commensal microbiota, and viral pathogens has been extensively described in the mammalian intestine. However, very few studies have characterized these interactions in early vertebrates such as teleosts. In this study, rainbow trout (Oncorhynchus mykiss) was infected with infectious hematopoietic necrosis virus (IHNV) via a recently developed immersion method to explore the effects of viral infection on gut immunity and microbial community structure. IHNV successfully invaded the gut mucosa of trout, resulting in severe tissue damage, inflammation, and an increase in gut mucus. Moreover, viral infection triggered a strong innate and adaptive immune response in the gut, and RNA−seq analysis indicated that both antiviral and antibacterial immune pathways were induced, suggesting that the viral infection was accompanied by secondary bacterial infection. Furthermore, 16S rRNA sequencing also revealed that IHNV infection induced severe dysbiosis, which was characterized by large increases in the abundance of Bacteroidetes and pathobiont proliferation. Moreover, the fish that survived viral infection exhibited a reversal of tissue damage and inflammation, and their microbiome was restored to its pre−infection state. Our findings thus demonstrated that the relationships between the microbiota and gut immune system are highly sensitive to the physiological changes triggered by viral infection. Therefore, opportunistic bacterial infection must also be considered when developing strategies to control viral infection.

HERPETIC GINGIVOSTOMATITIS ASSOCIATED WITH OPPORTUNIST SECONDARY BACTERIAL INFECTION IN ODONTOPEDRIATRIC PATIENT

Herpetic gingivostomatitis is a primary infection caused by the manifestation of the herpes simplex virus (HSV). The present study outlines the case of a White 1.6-year-old male patient complaining of pain, dysphagia, bulging in the right submandibular region, and the presence of multiple ulcerations in the mouth. On oroscopic examination, besides the ulcerations, the presence of exudate, which indicates the existence of an opportunistic secondary bacterial infection, was also noted. Palpable submandibular, submental, and digastric lymph nodes were observed. Bacterial culture was requested. The treatment was carried out with antibiotic therapy with a prednisone ointment with lidocaine. Concomitantly, 7 sessions of photodynamic therapy were completed along with a daily mechanical cleaning with chlorhexidine digluconate solution. The procedures adopted in the case were based on 2 infections of different origins. The result was satisfactory because there was a complete regression of the lesions.

Study of Molds in Post COVID -19 Patients: An experience from Tertiary Care Centre

Introduction: Coronavirus disease 2019 (COVID-19) pandemic has emerged as a global health crisis in the century with a heavy toll on human life. The second wave of COVID-19 was lethal for the patients as they had to combat the virus along with the opportunistic fungal and bacterial infections triggered by it. Mucormycosis gained attention for its widespread existence during this period of the second wave of COVID-19. Material & Methods: Various clinical samples like biopsy tissues from paranasal sinuses, deep nasal swabs, bronchoalveolar lavage, sputum, etc. were studied for the presence of fungal elements by KOH examination and culture on Sabouraud’s dextrose agar. Identification of fungal isolate was done by growth characteristics, LPCB wet mount, and slide culture. Result: During the study period, a total of 214 samples were received of which 17 (7.9%) were positive for fungal growth. Rhizopus arrhizus was most frequently isolated. Diabetes mellitus and the use of steroid during COVID-19 hospitalization was observed to be common risk factors. Rhino-cerebral mucormycosis was found to be the commonest type. Conclusion: Invasive mould infections can lead to fatal outcomes, if not detected timely. Accurate identification of the fungus is important for the administration of appropriate antifungal therapy.

Cytotoxic and Hemolytic Activities of Extracts of the Fish Parasite Dinoflagellate Amyloodinium ocellatum.

The dinoflagellate Amyloodinium ocellatum is the etiological agent of a parasitic disease named amyloodiniosis. Mortalities of diseased fish are usually attributed to anoxia, osmoregulatory impairment, or opportunistic bacterial infections. Nevertheless, the phylogenetic proximity of A. ocellatum to a group of toxin-producing dinoflagellates from Pfiesteria, Parvodinium and Paulsenella genera suggests that it may produce toxin-like compounds, adding a new dimension to the possible cause of mortalities in A. ocellatum outbreaks. To address this question, extracts prepared from different life stages of the parasite were tested in vitro for cytotoxic effects using two cell lines derived from branchial arches (ABSa15) and the caudal fin (CFSa1) of the gilthead seabream (Sparus aurata), and for hemolytic effects using erythrocytes purified from the blood of gilthead seabream juveniles. Cytotoxicity and a strong hemolytic effect, similar to those observed for Karlodinium toxins, were observed for the less polar extracts of the parasitic stage (trophont). A similar trend was observed for the less polar extracts of the infective stage (dinospores), although cell viability was only affected in the ABSa15 line. These results suggest that A. ocellatum produces tissue-specific toxic compounds that may have a role in the attachment of the dinospores’ and trophonts’ feeding process.

Aftermath of COVID-19 and Critical Care in India.

The coronavirus disease-2019 (COVID-19) pandemic had overwhelmed the healthcare system and forced many patients to be treated at home with oxygen, antibiotics, and steroids, particularly during the second wave. There was increased misuse of antimicrobials in hospitals as well as unguarded self-prescription of these medications among the common people. We are likely to see an increase in the incidence of antimicrobial resistance (AMR), change in the susceptibility pattern of the organisms causing community-acquired infections, and an increase in opportunistic bacterial, tubercular, viral, and fungal infections.How to cite this article: Panda R, Hirolli D, Baidya DK. Aftermath of COVID-19 and Critical Care in India. Indian J Crit Care Med 2021; 25(10):1173–1175.

THE SWEETEST TOOTH: A CASE OF PULMONARY MUCORMYCOSIS IN A PATIENT WITH COVID-19

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: COVID-19 has been associated with opportunistic bacterial and fungal infections. Both aspergillus and candida have been reported as the main fungal pathogens for coinfection but there has been an increasing number of cases of mucormycosis as the fungus thrives in low oxygen states and high glucose environments. CASE PRESENTATION: A 51-year-old with the past medical history of type 2 diabetes with glycohemoglobin A1C of 16. Seven days post Covid 19 diagnosis, she presented due to altered mentation and hypotension. Found to have DKA, with concomitant hypovolemic and septic shock. Noted to have profound anion gap metabolic acidosis and acute kidney injury. Initial infective pathogens included candidemia, with pulmonary aspergillosis and mucormycosis. Subsequently developed MSSA and stenotrophomonas pneumonia. Her course was complicated by acute renal failure requiring dialysis, large tracheal pleural fistula with tension pneumothorax and empyema. Bronchoscopy (Image 1) showed grossly necrotic trachea, right mainstem and right upper lobe segments. Despite timely appropriate treatment, she expired. DISCUSSION: Immunocompromised individuals such as uncontrolled diabetics, organ transplants, prolonged neutropenia and steroid use are prone to Mucormycosis infections. Sites include sinus, lungs, skin and mediastinum. Several triggers precipitate Mucormycosis in the setting of active infection along with steroid use. CONCLUSIONS: Increasing co infections including mucormycosis have been noted in COVID 19 patients due to uncontrolled diabetes and with steroid treatment. Efforts should be made to maintain euglycemia and judicious steroid use while remaining vigilant for unusual coinfections. DISCLOSURE: Nothing to declare. KEYWORD: mucor

Bendamustine treatment of haematological malignancies: significant risks of opportunistic viral, fungal and bacterial infections

ABSTRACT Objectives Bendamustine is a standard treatment for low-grade B-cell lymphomas, and considered safe in clinical trials. Its safety in routine practice might be different. Methods We retrospectively analyzed the infection complications in an unselected cohort of patients treated with bendamustine over a nine-year period. Patients were regularly monitored for blood counts and cytomegalovirus (CMV) reactivation by antigen assay and polymerase chain reaction. They received granulocyte colony stimulating factor for neutropenia, and routine anti-pneumocystis and optional anti-fungal prophylaxis. Results There were 179 men and 127 women at a median age of 61.5 (20–90) years, 52% receiving bendamustine for relapsed/refractory disease. Malignancies included low-grade B-cell lymphomas (54%), myeloma (10%), T-cell lymphomas (11%), Hodgkin lymphoma (2%) and other lymphoid neoplasms (23%). Most patients had good performance status (Eastern Cooperative Oncology Group score: 0–1, 72%). CMV reactivation occurred in 58 patients (19%) at a median age of 68 (39–85) years. Univariate analysis showed CMV reactivation to be significantly associated with elevated lactate dehydrogenase (P = 0.045), decreased albumin (P = 0.003) and older age (reactivation versus no reactivation: 66.3 ± 11.4 versus 59.4 ± 14.5 years, P = 0.0016). Age remained the only significant risk on multivariate analysis. CMV reactivation resulted in retinitis (N = 4), ependymitis/ventriculitis (N = 1) and duodenitis/colitis (N = 1). Invasive fungal disease occurred in five patients (candidemia, N = 2; aspergillosis N = 1; cryptococcemia, N = 1; scedosporiosis, N–1). Nineteen patients had culture positive septicaemia. Conclusion Our observations showed that even with a vigorous anti-infective strategy, bendamustine treatment was still associated with significant risks of bacterial and opportunistic viral and fungal infections.