Opportunistic Infections In Patients Research Articles

Neumonía por Pneumocystis jiroveci como debut de un Linfoma de Hodgkin con predominio linfocitario nodular EC IIIB

El Pneumocystis jiroveci (PJ) es un hongo atípico que produce cuadro de neumonía atípica, y representa una infección oportunista que puede ser grave y mortal en sujetos inmunodeprimidos, Aun hoy es la infección oportunista más prevalente en pacientes con vih-sida, y algún tipo cáncer como Linfomas siendo su frecuencia elevada entre sujetos que presentan este contexto en el Ecuador. Respecto al linfoma de Hodgkin es una neoplasia poco frecuente sin embargo constituye un importante problema de salud a nivel mundial, los pacientes suelen sucumbir a las infecciones oportunistas, siendo las infecciones respiratorias causa importante de morbilidad. En este sentido se presenta un caso clínico de dos entidades el linfoma Hodking asociado a la infección por pneumocytis en un paciente masculino que presento cuadro respiratorio con evolución poco favorable incluso con el tratamiento oportuno y adecuado ingresa a UCI con pronóstico reservado.

Opportunistic Infection in Hospitalised Patients with Inflammatory Bowel Disease.

To investigate the incidence, clinical features, and risk factors of opportunistic infections in elderly patients with inflammatory bowel disease (IBD). Observational study. Department of Digestive and Geriatrics Center, Sichuan University West China Hospital, China between January 2012 and January 2019. Patients (≥18 years) with IBD were enrolled in this study. Clinical data from the infected elderly group (age ≥60 years), non-infected elderly group (age ≥60 years) and infected adult group (age: 18-59 years) were compared. Logistic regression analysis was used for risk factors associated with opportunistic infection. A total of 8.9% (307/3,456) of patients with IBD had opportunistic infection. The opportunistic infection rate of elderly group was 16.5% (80/485), which was significantly higher than that of adult group (7.6%, 227/2,971, p <0.05). Compared with infected adult group or non-infected elderly group, infected elderly group had less fever and leukocytosis, but more hypoproteinemia and several activities (p <0.05). Cytomegalovirus and Epstein-Barr virus were the most common agents in elderly group and adult group, respectively. Multiple episodes (three or more) were more common in infected elderly group; the time of opportunistic infections was associated with systemic inflammatory reaction syndrome (SIRS, p <0.05). Logistic regression analysis showed that age ≥60 years, corticosteroids, immunosuppressive and biological agents were risk factors for opportunistic infections in patients with IBD. Hospitalised elderly IBD patients, receiving corticosteroids, immunosuppressive, and biological agents, are at higher risk for infection. The symptoms of opportunistic infections in elderly patients are atypical, but they are prone to multiple infections with poor prognosis. Key Words: Elderly patients, Inflammatory bowel disease, Opportunistic infection, Systemic inflammation reaction syndrome.

The Role of Cytokines and Cellular Receptors in the TuberculosisAssociated Immune Reconstitution Inflammatory Syndrome

Tuberculosis (TB) is the most prevalent opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS) and the major reason for morbidity and mortality. In this review, we focus on pathological immune restoration in AIDS patients after antiretroviral therapies (ART) initiation. This manuscript discusses the importance of T cell immunity for antigen-specific immune reconstitution and the production of cytokines, which are divided into 2 subgroups: interferons (IFN), and interleukins (IL). We overview the role they play in connection between innate and adaptive immunity during immune restoration. We describe how hypercytokinemia produced by innate and adaptive immune cells, leads to the manifestations of tuberculosisassociated immune reconstitution inflammatory syndrome (TB-IRIS) in AIDS patients during the recovery of CD4+ T cells on ART. We conclude with a brief synopsis of treatment approaches

Opportunistic Cryptococcal Antigenemia in the HAART Era at HIV Epidemic Settings of Northwest Ethiopia.

Background Cryptococcus neoformans is a frequent opportunistic infection in patients with the acquired immunodeficiency syndrome. While the advent of ART reduces the occurrence of cryptococcal meningitis in HIV patients, cryptococcal disease remains a leading cause of morbidity and mortality in the developing world especially in sub-Saharan Africa which is the epicenter of HIV. This study aimed to assess the cryptococcal antigenemia, CD4+ Th cell counts, HIV RNA viral load, and clinical presentations among HIV-positive patients in Northwest Ethiopia. Method A total of two hundred (200) HIV-positive patients were recruited for this study. Cryptococcus antigenemia prevalence in plasma samples of HIV‐positive patients was determined by using Antigen lateral flow assay (CrAg‐LFA) also, and CD4+ Th cell counts and HIV‐RNA levels were quantified from blood specimen. Patients' demographic data, clinical manifestation, and concurrent opportunistic infection were recorded. Result The sex distributions of study participants were 105(52.5%) male and 94(47.5%) female with an age range of 15–65 (mean 39.42 ± 9) years. All patients had a CD4+ T-cell count <100 cells/µl with the median 54 cells/μl and median HIV-RNA viral load 2.16 × 105 RNA copies/ml (50–3.66 × 105 RNA copies/ml); the prevalence of cryptococcal antigenemia was found to be 4% in HIV-positive patients. More than half and two third of CrAg‐positive patients had a CD4 count <25 cells/μl and HIV viral load >10,000 copies/ml, respectively, as well; Tuberculosis, Candidiasis, and herpes zoster are the most often observed concurrent infections while cryptococcal antigenemia is significantly associated with oral candidiasis (p < 0.001). Conclusion Although the advent of ART, early diagnosis of cryptococcosis, and application of antifungal interventions, HIV-induced cryptococcal antigenemia positivity in HIV infected individuals is still the countries' big challenge. Thus, stringent follow-up and case management should be considered.

Disseminated talaromycosis: an AIDS defining fungal infection

&lt;p&gt;Talaromycosis is a systemic mycosis caused by &lt;em&gt;Talaromyces marneffi&lt;/em&gt;. It mostly occurs as an opportunistic infection in patients with human immunodeficiency virus (HIV). In India, its endemic in Manipur. We report 3 cases of disseminated talaromycosis with skin eruptions in HIV sero-positive patients from Manipur.&lt;/p&gt;

Atypical Infections in Chronic Myeloid Leukaemia- Staphylococcus furunculosis and Aspergillosis

Incidence of opportunistic infection in patients of Chronic Myeloid Leukemia (CML) on Imatinib therapy is low. We report a case of a 47 year old lady, a known case of CML for one year on imatinib therapy who presented with CML in blast crisis with Staphylococcus furunculosis. Two weeks later she developed fever, cough and expectoration. She had cavitatory lesion in the right middle zone on chest x-ray. CECT Chest was suggestive of aspergilloma in right middle lobe. Infections in chronic myeloid leukemia are not very common. Also, developing such infections within such a short span of time, within one year of initiation of imatinib therapy is also rare. Hence, this case of CML with Staphylococcal furunculosis and Aspergillosis is being reported.

A Case of Chronic Invasive Rhinocerebral Mucormycosis with Pott’s Puffy Tumor

Mucormycosis is one of the most fatal and rapidly progressive fungal infections in humans; among its many forms. rhinocerebral mucormycosis is the most common. It is known to occur as opportunistic infection in patients with uncontrolled diabetes, metabolic disorders, organ transplantation, or autoimmune disease with prolonged steroid use. Pott’s puffy tumor is the subperiosteal abscess of the frontal bone caused by trauma complication or frontal sinusitis. It is considered as a very rare complication since the dawn of antibiotic treatments. We report a case of chronic rhinocerebral mucormycosis involving Pott’s puffy tumor in a patient receiving immunosuppressive therapy after lung transplantation.

Assessment of Immunological Markers in Patients with Tuberculosis of Respiratory System and Oportunistic Infection

The purpose of the study: evaluation of the demographic, clinical and laboratory features of the patients with infiltrative, generalized and disseminated forms of tuberculosis.Materials and methods. 114 patients with pulmonary tuberculosis were included in our study. To evaluate subpopulations of immune cells we used immunofluorescent reaction with monoclonal antibodies.Results. Most of the patients with generalized and disseminated tuberculosis were co-infected with Human Immunodeficiency Virus with CD4+ level less than 200 cells/mkl and Hepatitis C Virus. Almost half of the patients with infiltrative and disseminated tuberculosis had elevated level of hepatic transaminases. In patients with generalized form of tuberculosis CD4+- and CD8+-levels were considerably lower than in patients with infiltrative form of tuberculosis. Discussion. In most patients with disseminated tuberculosis were estimated drug addict and prisons in anamnesis. In those patients were diagnosed secondary infections: candidiasis, papillomatosis, ascariasis, herpes zoster.Conclusions. We reveal decreasing of the level of CD4, CD8, CD16, CD20 in the patients with generalized, disseminated tuberculosis and in patients opportunistic infections.

The decreased number and function of lymphocytes is associated with Penicillium marneffei infection in HIV-negative patients.

Penicillium marneffei (P. marneffei) infection, which has been traditionally considered as an indicator of immunosuppression, is one of the most common systemic opportunistic infections in patients with AIDS. Recently, more and more P. marneffei infections have been documented in HIV-negative patients without underlying diseases, which challenges the traditional view that P. marneffei infection is an indicator of immunosuppression. We aimed to evaluate the number and function of lymphocytes in HIV-negative patients with P. marneffei infection. 15 HIV-negative P. marneffei-infected patients and 18 healthy controls were recruited and investigated. The number and function of lymphocytes were analyzed by flow cytometry. Most laboratory tests were within the reference ranges, except for a significant increase in total IgE in P. marneffei-infected patients. Lymphocyte subset analysis showed that the number of CD4+ T cells and NK cells was significantly decreased in HIV-negative marneffei-infected patients compared with healthy controls. However, almost half of the marneffei-infected patients still had normal levels of lymphocytes. A further analysis of cell function showed that the activation and proliferation of CD4+ T cells, the cytotoxicity of CD8+ T cells and NK cells, and the cytokine secretion potential of CD4+ T cells and NK cells were all impaired, in comparison with healthy controls. P. marneffei infection has to be regarded as an indicator of immunosuppression. A further investigation of cell function is required in patients with opportunistic infection, as the cell function may be impaired in this condition.

Multidrug-resistant Pseudomonas aeruginosa isolated from ear and wound swabs in some selected hospital laboratories in Sokoto Metropolis, Nigeria

Objective: Pseudomonas aeruginosa is a metabolically versatile bacterium that can cause a wide range of severe opportunistic infections in patients with serious underlying conditions and can be found in most communities in Nigeria. The study was to determine the prevalence, resistance pattern and distribution of multiple drug resistant P. aeruginosa (MDR-PA) isolated from ear and wound specimens in patients attending Specialist Hospital Sokoto and Maryam Abacha Women and Children Hospital Sokoto. Materials and Methods: A total of 150 samples were analysed by standard bacteriological methods. Screening for MDR-PA was carried out by antibiotic sensitivity testing using disc diffusion method with ceftazidime (30 µg), ofloxacin (5 µg), cefuroxime (30 µg), cloxacillin (30 µg), amoxicillin (30 µg), ceftriaxone (30 µg), imipenem (10 µg), gentamycin (10 µg) and colistin (10 µg) discs on Mueller Hinton agar. Results: Of a total of 55 (36.7%) isolates of P. aeruginosa strains were obtained, 30 (54.5%) isolates were resistant to imipenem, 31 (56.3%) were resistant to ofloxacin, 44 (80.0%) to gentamycin, 53 (96.3%) to ceftazidime and cefuroxime, 50 (90.9%) to ceftrizone, 54 (98.1%) to cloxacillin and amoxycillin and lastly 15 (27.2%) to colistin. All the isolates were multi drug resistant, this probably due to improper use or over the counter purchase of antibiotics without professional oversight. Conclusion: Almost all the isolates were resistant to all the antibiotics used including colistin. There is need to improve on the public health awareness on the indiscriminate use of antimicrobial agents as it is one of the major ways microbes develop resistance to them.

Opportunistic Infections in Patients Living with HIV at Brazzaville University Hospital: Prevalence and Associated Factors

Objectives: To determine the prevalence of opportunistic infections in the Infectious Diseases Department and to look for associated factors. Patients and Methods: A descriptive and analytical retrospective study of patients living with HIV, diagnosed in pre- or per-hospitalization, receiving or not receiving highly active antiretroviral therapy, in which an opportunistic infection related to AIDS has been documented. Results: A total of 548 patients included (22.7% of admissions) of average age of 39.9±11.2 years (17-82 years), mostly female (n-339; 61.9%), singles (n-403;73.5%), with a primary education level (n-218;39.8%). The majority (n=403; 73,5%) came from an urban area, with a primary education level (n-218;39.8%), residing in cities (n-403;73).77 Patients working in the informal sector were overwhelmingly represented (n-357;65.1) followed by the unemployed (n-51; 9.3%). The average consultation time was 29 ±3.5 (6-42) days. Type 1 HIV was the most found (419; 78.1%) and Lower CD4< 200/mm3 in 93 patients. The most common opportunistic infections found were Tuberculosis (n-231;42.2%), Toxoplasmosis (n-85;15.5%) and Neuromeningeal Cryptococcosis (n-58; 10.6%). Only 381 patients were on ARTV (69.5%), first-line (n-124; 74.3%). The average length of hospital stay was 20.4-11.8 (5-60) days. The overall lethality was 68%. Conclusion: Opportunistic infections remain common at the Brazzaville University Hospital in an HIV-depressed population1. Tuberculosis affects lethality, which is high as a result of therapeutic non-compliance. This is to say the importance of early HIV testing and management to minimize the emergence of opportunistic diseases in this area.

Antifungal resistance of candida species isolated from HIV patients in a tertiary care hospital, Mysuru, Karnataka

Context:Candidiasis still remains as a common opportunistic infection in patients with human immunodeficiency virus (HIV). Drug resistance has become a serious health concern because of indiscriminate usage and dosage.Aim:To determine the antifungal resistance pattern of Candida albicans and non-albicans Candida (NAC) from HIV patients.Subjects and Methods:The study was carried out in the department of microbiology at a tertiary care hospital. Candida isolates obtained from HIV patients were tested for drug susceptibility by Vitek-2 automated system.Results:Antifungal susceptibility pattern (n=109) revealed that 15% of the isolates were resistant to at-least one and 85% were sensitive to all the drugs tested. About 10% and 19% of C. albicans showed resistance to fluconazole and flucytosine respectively. Among non-albicans tested, only C. tropicalis (14%) exhibited resistance to flucytosine.Conclusions:Knowledge on epidemiology, species prevalence, and drug resistance pattern may guide for effective therapy. This reduces morbidity and also improves the quality of life.

Incidence of Tuberculosis as a Opportunistic Infection in Patients with HIV Getting Combined Anti Retroviral Therapy

Introduction: The risk of active Tuberculosis increases after HIV seroconversion. It progressively increases with declining immunity. Tuberculosis (TB) epidemics in HIV has led to a dramatic upsurge in global TB incidence, resulting in remarkable increase in morbidity and mortality. Many clinical studies had shown that TB is one of the commonest opportunistic infection. This study is conducted to see the incidence of tuberculosis as an opportunistic infection in patients with HIV getting combined antiretroviral therapy (cART)&#x0D; Materials and Methods: This was a hospital based cross-sectional comparative study. Five hundred patients with HIV who are getting cART were enrolled in the study.&#x0D; Results: Analysis of individuals with HIV in our study amongst the 500 patients 266 (53.2%) were males and the remaining 234 (46.68%) were females. Amongst these HIV patients 48(18.04%) males and 17(7.26%) females had tuberculosis. 65(13%) of patients were TB/HIV co-infected. 2(4.1%) of these male TB/HIV patients had cervical gland TB.&#x0D; Conclusion: The incidence of tuberculosis in HIV infected individuals is high. TB is the commonest opportunistic infection (OIs) in people living with HIV/AIDS. Males are predominant gender to have TB/HIV co-infection.

STUDY OF THE DISTRIBUTION OF PNEUMOCYSTOSIS IN BULGARIA BETWEEN SEPTEMBER 2017 AND APRIL 2019 BY USING REAL- TIME PCR

Pneumocystis jirovecii is an opportunistic organism that inhabits predominantly the human pulmonary alveoli. The fully sequenced genome of P. jirovecii was first reported in 2012. According to some authors, P. jirovecii is an obligate pathogen because genes encoding virulence factors and most enzymes for amino acid biosynthesis were not found in the genome. This suggests that the microorganism normally colonises the human lungs but causes disease only in immunocompromised persons. Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections in patients developing acquired immune deficiency syndrome (AIDS). The use of conventional microscopic methods in diagnosis is associated with considerable limitations. Therefore, detection of Pneumocystis DNA in clinical samples by PCR techniques leads to significant advances in the diagnosis of PCP.&#x0D; The aim of this study is to determine the importance of PCR-based methods in the diagnosis of human pneumocystosis and to evaluate their diagnostic value in comparison with conventional microscopy methods. For a period of 20 months in the National Reference Laboratory “Diagnosis of Parasitic Diseases” at the National Centre of Infectious and Parasitic Diseases 33 patients were tested by real-time PCR and 11 of them were found positive for the presence of P. jirovecii DNA. Eight of the patients (72.7%) were HIV-infected. Although limited in extent, this is the first real-time PCR study on the distribution of human pneumocystosis in Bulgaria. Our data shows that PCR techniques have higher sensitivity and specificity than microscopic methods and provide new opportunities for the diagnosis of Pneumocystis pneumonia.

Efficacy of voriconazole in vitro and in invertebrate model of cryptococcosis.

Cryptococcosis is a common opportunistic infection in patients with advanced HIV infection and may also affect immunocompetent patients. The available antifungal agents are few and other options are needed for the cryptococcosis treatment. In this work, we first analyzed the virulence of twelve C. neoformans and C. gattii strains assessing capsule thickness, biofilms formation, and survival and morbidity in the invertebrate model of Galleria mellonella and then we evaluated the antifungal activity of voriconazole (VRC) in vitro and in vivo also using G. mellonella. Our results showed that all Cryptococcus spp. isolates were able to produce capsule and biofilms, and were virulent using G. mellonella model. The VRC has inhibitory activity on planktonic cells with MIC values ranging from 0.03 to 0.25 μg/mL on Cryptococcus spp.; and these isolates were more tolerant to fluconazole (ranging from 0.25 to 16 μg/mL), the triazol agent often recommended alone or in combination with amphotericin B in the cryptococcosis therapy. In contrast, mature biofilms were less susceptible to the VRC treatment. The VRC (10 or 20 mg/kg) treatment of infected G. mellonella larvae significantly increased the larval survival when compared to the untreated group for the both Cryptococcus species and significantly decreased the fungal burden and dissemination in the larval tissue. Our findings corroborate with the literature data, supporting the potential use of VRC as an alternative for cryptococcosis treatment. Here, we emphasize the use of G. mellonella larval model as an alternative animal model for studies of antifungal efficacy on mycosis, including cryptococcosis.

A correlation analysis of HHV infection and its predictive factors in an HIV-seropositive population in Yunnan, China.

Human herpesviruses (HHVs) have a particularly high prevalence in certain high‐risk populations and cause increased morbidity and mortality in patients with acquired immunodeficiency syndrome (AIDS). Screening and treating subclinical HHV infections reduce human immunodeficiency virus (HIV) infection incidence, disease progression, and transmission. However, there are few studies on HHVs, HIV coinfection rates, and their related risk factors. We aimed to clarify the prevalence of all eight HHVs in peripheral blood samples collected from HIV‐positive patients, and explore the association of HHV infection in HIV‐positive patients in an HIV‐seropositive population in Yunnan. We recruited 121 HIV‐positive patients with highly active antiretroviral therapy (HAART) and 45 healthy individuals. All the eight HHVs were detected using polymerase chain reaction and their epidemiological information and clinical data were collected and statistically analyzed. A high prevalence of HHVs (89.3%) was observed in individuals with HIV infections and with herpes simplex virus (HSV)‐2 (65.3%), and HSV‐1 (59.5%) being the most common. Coinfection with more than two different HHVs was more common in patients with HIV infections receiving HAART (72.7%) than in healthy controls. Older age, being married, higher HIV‐1 plasma viral loads, and use of antiviral protease inhibitors were independently correlated with an increased frequency of HHVs, but we found no association with CD4 count, WHO HIV clinical stage, and HIV infection duration. Our findings are of great significance for the prevention of HHV opportunistic infection in patients with AIDS and their clinical treatment.

3237 CMV Gastric Ulcer in a Patient With Pauci Immune Cresenteric Glomerulonephritis on Rituximab: A Rare Combination

INTRODUCTION: CMV infections are asymptomatic in immunocompetent patients but in immunocompromised patients, CMV have varying manifestations depending on their location. Patient who are organ transplant recipients, taking immunosuppressive therapy for a long time are at increased risk of CMV infections. CMV induced gastric ulcer is very rare but many cases have been reported in the literature. No case describing association between CMV related gastric ulcer and glomerulonephritis has not been reported in the literature so far. CASE DESCRIPTION/METHODS: In this manuscript, we describe a case of pauci immune cresenteric glomerulonephritis in a patient who was on rituximab and long-term steroid therapy and found to have CMV related gastric ulcer. The association of small vessel vasculitis and CMV related gastrointestinal infection has not been studied in the literature. DISCUSSION: Pauci immune cresenteric glomerulonephritis is a subtype of rapidly progressive glomerulonephritis manifested by continuous loss of renal functions with features of dysmorphic red blood cells and glomerular proteinuria. Treatment of such condition is a genetically engineered chimeric murine/human monoclonal IgG1 kappa antibody directed against the CD20 antigen known as Rituximab. We also discussed the pathogenesis of CMV induced gastric ulcer after rituximab therapy. This case emphasizes the importance of opportunistic infections in glomerulonephritis patients and raises the awareness that glomerunephritis patients are at increased risk of opportunistic infections as well. Rituximab was considered to be a safer drug but over the years, the incidence if opportunistic infections in patients on rituximab has been increasing.

Incidence of epilepsy and brain toxoplasmosis in hospital Mario Rivas, Honduras

The presence of neurological alterations is a frequent manifestation in patients with HIV, especially focal onset epilepsy. The cerebral toxoplasmosis represents the main cause of occupational injury in an immunological patient for HIV related to a CD4 T lymphocyte count less than 100/uL. A descriptive, cross-sectional study was carried out in which the clinical characteristics associated with cerebral toxoplasmosis were determined, as well as the alterations in the main encephalographic alterations and the findings in neuroimaging studies (cranial tomography or cerebral magnetic resonance). All patients underwent a complete medical history including history of neurological diseases. A total of 26 patients with a diagnosis of HIV-AIDS infection and cerebral toxoplasmosis were evaluated, of which 15 (57.7%) were women. The age of the patients ranged between 23 and 65 years (standard deviation 11,081). The manifestation by which the patients were admitted (main symptom) were altered state of consciousness (2, 7.7%), acute psychotic outbreak (4, 15.3%), headache (1, 3.8%), seizures (10, 38.5 %), focal motor deficit (5, 19.2%), vertigo (1, 3.8%), diarrhea (1, 3.8%), fever (1, 3.8%) and alteration of cranial nerves (1, 3.8%). Differents findings was found in patients: slow-wave, spike-slow wave complex, polymorphic slow wave. Toxoplasmosis is a frequent opportunistic infection in patients with HIV, with epilepsy being one of the main manifestations of this. Neuroimaging studies (brain CT or brain MRI) allow diagnosis. The encephalogram study is frequently associated with alterations in patients with toxoplasmosis. Timely diagnosis is associated with a good prognosis in our patients.

Risk of opportunistic infections in patients with antineutrophil cytoplasmic antibody-associated vasculitis, using a Japanese health insurance database.

Opportunistic infections (OIs) adversely affect outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). This study aimed to identify the incidence proportion of risk factors for OIs in patients with AAV who were on remission-induction therapy, using a Japanese health insurance database. This retrospective longitudinal population-based study was conducted using claims data provided by Medical Data Vision Co., Ltd. We defined individuals as AAV cases receiving remission-induction therapy if they met all of the following criteria: (a) having OIs with at least 1 specified International Statistical Classification of Diseases and Related Health Problems, 10th Revision code (M300, M301, M313, or M318); (b) receiving at least 1 prescription of oral corticosteroids (CS) with prednisolone (PSL)-equivalent dosage ≥30mg/d, CS pulse therapy, immunosuppressive agents or rituximab during hospitalization between April 2008 and April 2017; and (c) at least 7days of hospitalization while on the above-mentioned therapies. We calculated incidence and proportion of OIs during the year following remission-induction therapy and the adjusted odds ratio (OR) using a logistic regression model. We included 2299 patients with AAV in this study. OIs occurred in 460 patients (20.0%), with the most frequently occurring OI being cytomegalovirus infection (n=122, 6.5%). After adjusting for covariates, age by decade (OR 1.24, 95% CI: 1.12-1.36), daily PSL dose per 10mg (OR 1.16, 95% CI: 1.08-1.25), and CS pulse therapy (OR 1.29, 95% CI: 1.04-1.60) were found to be significantly associated with occurrence of OIs. Older age and corticosteroid use were found to be significant risk factors for OIs in patients with AAV on remission-induction therapy, using a health insurance database.

Infectious Considerations for Patients on Immune Checkpoint Inhibitors

Chronic inflammatory states lead to T cell exhaustion, characterized by reduced T cell proliferation and activity. Immune checkpoint inhibitors (ICPI) reactivate T cells to restore the immune system’s natural defenses against foreign antigens. The widespread use of these agents in the treatment of malignancy has led to markedly reduced tumor burden and improved patient survival, sparking curiosity about their potential role in chronic inflammatory states, including infectious diseases. While ICPI have been associated with the development of several reactivated and opportunistic infections in patients with malignancy, recent studies also highlight the efficacy of these agents in managing infections alongside first-line antimicrobial therapy. Future research of ICPI should continue to build on our understanding of their infectious complications as well as their utility in preventing and treating infectious diseases.