- Brainstem dysfunction heralding disseminated cryptococcosis. [Journal Article]
- CNClin Neurol Neurosurg 2018 Feb 12; 167:62-64
- Cryptococcal meningoencephalitis is one of the most common central nervous system infections affecting immunocompromised patients. However, brainstem involvement is extremely rare and may represent a...
Cryptococcal meningoencephalitis is one of the most common central nervous system infections affecting immunocompromised patients. However, brainstem involvement is extremely rare and may represent a diagnostic challenge to clinicians. We report a non-HIV infected, chronically immunosuppressed, patient with fatal disseminated cryptococcosis presented with subcutaneous masses at both thighs and progressive brainstem dysfunction. Magnetic resonance imaging demonstrated multiple brainstem infarcts likely derived from small vessel vasculopathy. Anti-fungal treatment led to partial neurologic improvement but the patient succumbed to a fatal sepsis from hospital-acquired pneumonia.
- Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections. [Journal Article]
- EREur Respir J 2018 Feb 08
- The aim of this planned analysis of the prospective multinational TAVeM database was to determine the incidence, aetiology and impact on outcome of ventilator-associated lower respiratory tract infec...
The aim of this planned analysis of the prospective multinational TAVeM database was to determine the incidence, aetiology and impact on outcome of ventilator-associated lower respiratory tract infections (VA-LRTI) in immunocompromised patients.All patients receiving mechanical ventilation for >48 h were included. Immunocompromised patients (n=663) were compared with non-immunocompromised patients (n=2297).The incidence of VA-LRTI was significantly lower in immunocompromised than in non-immunocompromised patients (16.6%versus24.2%, p<0.0001, Subhazard ratio 0.65 (0.53-0.80)). Similar results were found regarding ventilator-associated tracheobronchitis (VAT) (7.3%versus11.6%, p=0.002, 0.61 (0.45-0.84)), and ventilator-associated pneumonia (VAP) (9.3%versus12.7%, p=0.019, 0.72 (0.54-0.95)). Among patients with VA-LRTI, the rates of multidrug resistant (MDR) bacteria (72%versus59%, p=0.011), and ICU mortality were significantly higher in immunocompromised compared with non-immunocompromised patients (54%,versus30%, p<0.0001, OR 2.68 (95% CI 1.78-4.02)). In patients with VAP, mortality rates were higher in immunocompromised than in non-immunocompromised patients (64%versus34%, p<0.001).Incidence of VA-LRTI was significantly lower in immunocompromised compared with non-immunocompromised patients, but it was associated with significantly higher mortality rate. MDR pathogens were more frequently found in immunocompromised patients with VA-LRTI.
- Double invasive fungal infection due to dematiaceous moulds in a renal transplant patient. [Journal Article]
- BCBMJ Case Rep 2018 Feb 08; 2018
- AlternariaandVerruconisare two dematiaceous moulds that occasionally cause disease in immunocompromised hosts. We present the case of a 58-year-old man with history of deceased do...
AlternariaandVerruconisare two dematiaceous moulds that occasionally cause disease in immunocompromised hosts. We present the case of a 58-year-old man with history of deceased donor renal transplantation 14 months prior, who presented with fevers and cough. He was found to have right upper lobe pneumonia and a non-healing eschar of his right knee. Dematiaceous fungi grew from bronchoalveolar lavage (BAL) and was sent to reference lab for identification. Meanwhile, the eschar on his right knee was biopsied and grewAlternariaspp. Pathology was consistent with invasive mould infection and he was treated as having disseminatedAlternariainfection with voriconazole and amphotericin B lipid complex. Later on, the dematiaceous mould from a BAL specimen was identified asVerruconis gallopavaThe patient was discharged on voriconazole awaiting minimal inhibitory concentrations forV. gallopavabut was readmitted 2 days later with high fevers and died from acute respiratory failure.
- [Burkholderia cepacia infection in children: a clinical analysis of 16 cases]. [Journal Article]
- ZDZhongguo Dang Dai Er Ke Za Zhi 2018; 20(2):112-115
- CONCLUSIONS: Burkholderia cepacia is an opportunistic pathogen often found in immunocompromised children and can produce drug resistance. The presence or absence of underlying diseases should be considered during anti-infective therapy. The children with Burkholderia cepacia infection often have a poor prognosis, and an understanding of the disease spectrum of Burkholderia cepacia infection helps with clinical diagnosis and treatment.
- Guinea pig infection with the intracellular pathogen Rhodococcus equi. [Journal Article]
- VMVet Microbiol 2018; 215:18-22
- Rhodococcus equi is an opportunistic, intracellular pathogen that causes pyogranulomatous pneumonia in foals and immunocompromised people. Currently, there is no experimental model of R. equi pneumon...
Rhodococcus equi is an opportunistic, intracellular pathogen that causes pyogranulomatous pneumonia in foals and immunocompromised people. Currently, there is no experimental model of R. equi pneumonia other than intra-bronchial experimental infection of foals with R. equi, which is labor-intensive and costly. This study's objective was to develop a guinea pig (GP) model of R. equi pneumonia that would facilitate development of novel approaches for controlling and preventing this disease. Guinea pigs were infected with either 101, 102, 103, or 104colony forming units (CFUs) of a virulent strain of R. equi using a Madison aerosol chamber, or 106or 107CFUs of this strain intratracheally. Animals were monitored daily for clinical signs of pneumonia, and were euthanized and necropsied on days 1, 3, 7, or 35 post-infection (PI). Lung homogenates were plated onto selective agar to determine bacterial load. No clinical signs of disease were observed regardless of the inoculum dose or infection method. No bacteria were recovered from GPs euthanized at 35 days PI. Histology and immunostaining of T-cells, B-cells, and macrophages in lungs showed that inflammatory responses in infected GPs were similarly unremarkable irrespective of dose or route of infection. Guinea pigs appear to be resistant to pulmonary infection with virulent R. equi even at doses that reliably produce clinical pneumonia in foals.
- Stewardship opportunities in viral pneumonia: why not the immunocompromised? [Journal Article]
- TITranspl Infect Dis 2018 Feb 08
- Antimicrobial management of viral pneumonia has proven to be a challenge in hospitalized immunocompromised patients. A host of factors contribute to the dilemma, such as diagnostic uncertainty, lack ...
Antimicrobial management of viral pneumonia has proven to be a challenge in hospitalized immunocompromised patients. A host of factors contribute to the dilemma, such as diagnostic uncertainty, lack of organism identification, and clinical status of the patient. Respiratory virus panel (RVP) use was compared between 131 immunocompromised patients who received send-out (n=56) versus in-house (n=75) testing. Antimicrobial optimization interventions consisted of antiviral addition/discontinuation, antibiotic discontinuation/de-escalation, or modification of immunosuppressive regimen. Turnaround time of the RVP was reduced from 46.7 to 5.5 hours (p <0.001) and time to intervention was reduced from 52.1 to 13.9 hours (p <0.001), yet the frequency of antimicrobial optimization interventions was unchanged (30.7 vs 35.7%). Differences were not observed in duration of empiric antibiotic therapy or length of stay. The overall discontinuation rate for patients tested with a RVP was low (4.6%), and those with positive RVP (n=43) had antibiotics stopped in 14% of cases. Bacterial pneumonia coinfection was confirmed in two patients. Further systematic efforts should be taken to reduce antibiotic use in viral pneumonia and identify the major barriers in the immunocompromised population. This article is protected by copyright. All rights reserved.
- Low Levels of Immunoglobulins and Mannose-Binding Lectin Are Not Associated With Etiology, Severity, or Outcome in Community-Acquired Pneumonia. [Journal Article]
- OFOpen Forum Infect Dis 2018; 5(2):ofy002
- CONCLUSIONS: In hospitalized adults with CAP, low admission levels of Igs or complement were in general not associated with microbial etiology, disease severity, short-term outcome, or long-term outcome.
- Voltammeric monitoring of linezolid, meropenem and theophylline in plasmas. [Journal Article]
- ABAnal Biochem 2018 Jan 25; 545:54-64
- Treatment of healthcare associated Pneumonia (HCAP) caused by Methicillin-resistant Staphylococcus aureus (MRSA) requires therapeutic protocols formed of linezolid (LIN) either alone or in combinatio...
Treatment of healthcare associated Pneumonia (HCAP) caused by Methicillin-resistant Staphylococcus aureus (MRSA) requires therapeutic protocols formed of linezolid (LIN) either alone or in combination with meropenem (MERO) and theophylline (THEO). The inter-individual pharmacokinetic variations require the development of reliable therapeutic drug monitoring (TDM) tools especially in immunocompromised patients. A sensitive square wave voltammetric sensor using multiwalled carbon nanotubes (MWCNTs) modified carbon paste electrode in Britton-Robinson buffer was developed and validated. Experimental parameters such as pH, percentage of MWCNTs, and pre-concentration time were optimized. The sensor was employed at pH 11.0 for the determination of LIN in plasma within a concentration range of 2.5 × 10-8- 8.0 × 10-6 mol L-1without interference from co-administered medications. On the other hand, simultaneous monitoring of LIN, MERO and THEO in plasma was feasible at pH 3.0 over concentration ranges of 4.0 × 10-7- 9.0 × 10-5, 8.0 × 10-7- 9.0 × 10-5and 8.0 × 10-7- 9.0 × 10-5 mol L-1, respectively. The performance of the proposed sensor was validated and the applicability for TDM has been demonstrated in plasma of healthy volunteers.
- Distribution of different genes responsible for invasive characteristics, detection of point mutations in capsular gene wchA and biofilm production among the invasive and non-invasive isolates ofStreptococcus pneumoniae. [Journal Article]
- IJIndian J Med Microbiol 2017 Oct-Dec; 35(4):511-517
- CONCLUSIONS: The results of our study implies a possible capsular variations among the isolates and this may have an impact on capsular typing.
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- Colonization, Infection, and the Accessory Genome ofKlebsiella pneumoniae. [Review]
- FCFront Cell Infect Microbiol 2018; 8:4
- Klebsiella pneumoniaeis a Gram-negative pathogen that has a large accessory genome of plasmids and chromosomal gene loci. This accessory genome dividesK. pneumoniaestrains into op...
Klebsiella pneumoniaeis a Gram-negative pathogen that has a large accessory genome of plasmids and chromosomal gene loci. This accessory genome dividesK. pneumoniaestrains into opportunistic, hypervirulent, and multidrug-resistant groups and separatesK. pneumoniaefrom two closely related species,Klebsiella variicolaandKlebsiella quasipneumoniae. Some strains ofK. pneumoniaeact as opportunistic pathogens, infecting critically ill and immunocompromised patients. TheseK. pneumoniaeare a common cause of health-care associated infections including pneumonia, urinary tract infections (UTIs), and bloodstream infections.K. variicolaandK. quasipneumoniaeare often clinically indistinguishable from opportunisticK. pneumoniae. Other strains ofK. pneumoniaeare hypervirulent, infecting healthy people in community settings and causing severe infections including pyogenic liver abscess, endophthalmitis, and meningitis. A third group ofK. pneumoniaeencode carbapenemases, making them highly antibiotic-resistant. These strains act as opportunists but are exceedingly difficult to treat. All of these groups ofK. pneumoniaeand related species can colonize the gastrointestinal tract, and the accessory genome may determine if a colonizing strain remains asymptomatic or progresses to cause disease. This review will explore the associations between colonization and infection with opportunistic, antibiotic-resistant, and hypervirulentK. pneumoniaestrains and the role of the accessory genome in distinguishing these groups and related species. AsK. pneumoniaeinfections become progressively more difficult to treat in the face of antibiotic resistance and hypervirulent strains, an increased understanding of the epidemiology and pathogenesis of these bacteria is vital.