scholarly journals BartonellaInfection in Immunocompromised Hosts: Immunology of Vascular Infection and Vasoproliferation

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Mosepele Mosepele ◽  
Dana Mazo ◽  
Jennifer Cohn
Keyword(s):  
Immune System ◽  
Immune Escape ◽  
Current Understanding ◽  
Immunocompromised Patients ◽  
Cat Scratch Disease ◽  
Trench Fever ◽  
Immunosuppressed Patients ◽  
Life Threatening ◽  
Living With Hiv ◽  
Immunocompromised Hosts

Most infections by genusBartonellain immunocompromised patients are caused byB. henselaeandB. quintana. Unlike immunocompetent hosts who usually develop milder diseases such as cat scratch disease and trench fever, immunocompromised patients, including those living with HIV/AIDS and posttransplant patients, are more likely to develop different and severe life-threatening disease. This paper will discussBartonella'smanifestations in immunosuppressed patients and will examineBartonella'sinteraction with the immune system including its mechanisms of establishing infection and immune escape. Gaps in current understanding of the immunology ofBartonellainfection in immunocompromised hosts will be highlighted.

Toxoplasma Appendicitis: A Once-in-a-Lifetime Diagnosis!

2017 ◽  
Vol 26 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Anisha M. Fernandes ◽  
Maheshkumar M. Lakhe ◽  
Sanjay A. Pai
Keyword(s):  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Muscularis Propria ◽  
Immunocompromised Patients ◽  
Lymphoid Follicles ◽  
Negative Results ◽  
Immunosuppressed Patients ◽  
Life Threatening

Toxoplasmosis is generally asymptomatic in immunocompetent individuals, but it can be life-threatening in immunocompromised patients. We present a case of a 62-year-old man with clinical features of acute appendicitis. Histology showed a transmural infiltrate of eosinophils. In addition, there were reactive lymphoid follicles with histiocytes in the submucosa and tachyzoites in the muscularis propria. Immunohistochemistry confirmed the diagnosis of toxoplasma appendicitis. Serological evaluation yielded negative results. Retrospective review of the history revealed that the patient was on long-term immunosuppressive therapy with methotrexate. The patient was treated with sulfamethoxazole-trimethoprim and is asymptomatic at 7-month follow-up. Toxoplasma appendicitis must be considered in the differential diagnosis of appendicitis in immunosuppressed patients.

scholarly journals Cryptococcal Infection with Ruxolitinib in Primary Myelofibrosis: A Case Report and Literature Review

2021 ◽  
Author(s):  
Zachary Ciochetto ◽  
Njeri Wainaina ◽  
Anna Corey ◽  
Mary Beth Graham ◽  
Muhammad Bilal Abid
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Cryptococcus Neoformans ◽  
Primary Myelofibrosis ◽  
Intracellular Pathogens ◽  
Cryptococcal Infection ◽  
Immunosuppressed Patients ◽  
Life Threatening ◽  
Disseminated Disease ◽  
Immunocompromised Hosts

Cryptococcus neoformans (CN) is an encapsulated yeast that causes disseminated and potentially life-threatening in immunocompromised hosts. We present a patient with primary myelofibrosis on ruxolitinib who developed disseminated disease due to CN. The report underscores the importance of suspecting infections with intracellular pathogens in immunosuppressed patients on ruxolitinib.

A Serological Storm

1970 ◽  
Vol 9 (2) ◽  
Author(s):  
Bertha Wong MD ◽  
Maria Bagovich MD ◽  
Ivan Blasutig PhD ◽  
Simon Carette MD MPhil
Keyword(s):  
Differential Diagnosis ◽  
Hepatitis C Virus ◽  
Immune System ◽  
Hepatitis C ◽  
Hcv Infection ◽  
Clinical Context ◽  
Autoantibody Profile ◽  
Life Threatening ◽  
Clinically Significant ◽  
Sensory Polyneuropathy

This article describes a patient presenting with a sensory polyneuropathy and multiple autoantibodies, leading to the diagnosis of hepatitis C virus (HCV) infection. His widely positive autoantibody profile in the absence of clinically significant rheumatic disease illustrates the importance of interpreting autoimmune serology in the appropriate clinical context and the concept of HCV being a non-specific activator of the immune system. In addition, it highlights the importance of considering untreated HCV infection in the differential diagnosis of rheumatic complaints, particularly if the workup reveals multiple autoantibodies, as HCV is a potentially severe and life-threatening disease, which can be appropriately managed with effective antiviral therapy.

scholarly journals COVID-19—Importance for Patients on the Waiting List and after Kidney Transplantation—A Single Center Evaluation in 2020–2021

Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 429
Author(s):  
Simone C. Boedecker ◽  
Pascal Klimpke ◽  
Daniel Kraus ◽  
Stefan Runkel ◽  
Peter R. Galle ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Waiting List ◽  
Smoking History ◽  
Immunocompromised Patients ◽  
Dialysis Patients ◽  
Vaccination Programs ◽  
Mild Disease ◽  
Probability Of Survival ◽  
Number Of Patients ◽  
Immunosuppressed Patients

(1) Background: Dialysis patients and recipients of a kidney allograft are at high risk for infection with SARS-CoV-2. It has been shown that the development of potent neutralizing humoral immunity against SARS CoV-2 leads to an increased probability of survival. However, the question of whether immunocompromised patients develop antibodies has not yet been sufficiently investigated; (2) Methods: SARS-CoV-2 antibodies were examined in hemodialysis patients on the waiting list for kidney transplantation as well as patients after kidney transplantation. Patients were interviewed about symptoms and comorbidities, BMI, and smoking history; (3) Results: SARS-CoV-2 antibodies were found in 16 out of 259 patients (6%). The trend of infections here reflects the general course of infection in Germany with a peak in November/December of 2020. Remarkably, patients on the waiting list experienced only mild disease. In contrast, transplanted patients had to be hospitalized but recovered rapidly from COVID-19. Most interesting is that all immunosuppressed patients developed antibodies against SARS-CoV-2 after infection; (4) Conclusions: Even with extensive hygiene concepts, an above-average number of patients were infected with SARS-CoV-2 during the second wave of infections in Germany. Because SARS-CoV-2 infection triggered the formation of antibodies even in these immunocompromised patients, we expect vaccination to be effective in this group of patients. Thus, dialysis patients and patients after kidney transplantation should be given high priority in vaccination programs.

scholarly journals A “Terrible” Headache in a HIV Patient

2021 ◽  
pp. 014556132110141
Author(s):  
Marios Stavrakas ◽  
Ioannis Koskinas ◽  
Jannis Constantinidis ◽  
Petros D Karkos
Keyword(s):  
Differential Diagnosis ◽  
Surgical Treatment ◽  
Fungal Infection ◽  
Early Identification ◽  
Fungal Sinusitis ◽  
Immunocompromised Patients ◽  
Immunosuppressed Patients ◽  
Distant Spread ◽  
Nose And Throat

Mucormycosis is a type of fungal infection more prevalent among immunosuppressed patients, requires prompt identification and surgical treatment, as it can is associated with local and distant spread. This case is aiming to highlight the importance of early identification of subtle symptoms in immunocompromised patients. The clinician should be aware of fungal sinusitis, consider it in the differential diagnosis, and seek for an ear, nose, and throat opinion.

scholarly journals Gastrointestinal Histoplasmosis Mimicking Crohn’s Disease

2021 ◽  
Author(s):  
Esfandiar Shojaei ◽  
Joanna C Walsh ◽  
Nikhil Sangle ◽  
Brian Yan ◽  
Michael S Silverman ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Antifungal Therapy ◽  
Immunocompetent Patient ◽  
Immunocompromised Patients ◽  
Disseminated Histoplasmosis ◽  
Gastrointestinal Histoplasmosis ◽  
Life Threatening ◽  
Inflammatory Drugs ◽  
Tissue Specimens

Abstract Disseminated histoplasmosis is a life-threatening disease usually seen in immunocompromised patients living in endemic areas. We present an apparently immunocompetent patient with gastrointestinal histoplasmosis who was initially diagnosed as biopsy-proven Crohn’s disease. Following discontinuation of anti-inflammatory drugs and institution of antifungal therapy, his GI illness completely improved. Specific fungal staining should be routinely included in histopathologic assessment of tissue specimens diagnosed as Crohn’s disease.

scholarly journals Human papillomavirus-driven immune deviation: challenge and novel opportunity for immunotherapy

2017 ◽  
Vol 5 (3) ◽  
pp. 69-82 ◽  
Author(s):  
Sigrun Smola ◽  
Connie Trimble ◽  
Peter L. Stern
Keyword(s):  
Human Papillomavirus ◽  
Immune System ◽  
Immune Escape ◽  
Hpv Vaccination ◽  
Suppressor Cells ◽  
Clinical Problem ◽  
Hpv Infection ◽  
Treatment Protocols ◽  
Increased Risk ◽  
Risk Of Cancer

It is now recognized that the immune system can be a key component of restraint and control during the neoplastic process. Human papillomavirus (HPV)-associated cancers of the anogenital tract and oropharynx represent a significant clinical problem but there is a clear opportunity for immune targeting of the viral oncogene expression that drives cancer development. However, high-risk HPV infection of the target epithelium and the expression of the E6/E7 oncogenes can lead to early compromise of the innate immune system (loss of antigen-presenting cells) facilitating viral persistence and increased risk of cancer. In these circumstances, a succession of interacting and self-reinforcing events mediated through modulation of different immune receptors, chemokine and cytokine responses (CCL20; CCL2; CCR2; IL-6; CCR7; IL-12) further promote the generation of an immune suppressive microenvironment [increased levels of Tregs, Th17, myeloid-derived suppressor cells (MDSCs) and PD-L1]. The overexpression of E6/E7 expression also compromises the ability to repair cellular DNA, leading to genomic instability, with the acquisition of genetic changes providing for the selection of advantaged cancer cells including additional strategies for immune escape. Therapeutic vaccines targeting the HPV oncogenes have shown some encouraging success in some recent early-phase clinical trials tested in patients with HPV-associated high-grade anogenital lesions. A significant hurdle to success in more advanced disease will be the local and systemic immune suppressive factors. Interventions targeting the different immunosuppressive components can provide opportunity to release existing or generate new and effective antitumour immunity. Treatments that alter the protumour inflammatory environment including toll-like receptor stimulation, inhibition of IL-6-related pathways, immune-checkpoint inhibition, direct modulation of MDSCs, Tregs and macrophages could all be useful in combination with therapeutic HPV vaccination. Future progress in delivering successful immunotherapy will depend on the configuration of treatment protocols in an insightful and timely combination.

scholarly journals Occupational Exposure to Varicella Zoster in a Tertiary-Care Healthcare Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s333-s334
Author(s):  
Zachary Yetmar ◽  
Debra Apenhorst ◽  
Priya Sampathkumar ◽  
Elena Beam
Keyword(s):  
Occupational Exposure ◽  
Varicella Zoster Virus ◽  
Tertiary Care ◽  
Occupational Exposures ◽  
Inpatient Setting ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Varicella Zoster ◽  
Delayed Initiation ◽  
Immunosuppressed Patients

Background: Disseminated varicella zoster virus (dVZV) infection is a feared complication of varicella zoster virus (VZV) reactivation in immunocompromised patients. The CDC recommends contact and airborne precautions for localized VZV in immunocompromised patients until dissemination has been ruled out. Pre-emptive isolation can be problematic for medical centers without access to negative-pressure rooms. When we identify a case of dVZV at our facility, we perform an investigation to identify occupational exposures. Methods: We conducted a retrospective, descriptive review of occupational exposure investigations related to dVZV from January 2016 to December 2018. We collected baseline characteristics of the dVZV patient, and we evaluated whether the exposure occurred due to a delay in diagnosis or a progression from “localized” to disseminated VZV disease. Results: We identified 21 immunosuppressed patients with dVZV whose infection resulted in an occupational exposure during the specified study period. Average age was 58.6 years, with 10 males and 12 females. The immunocompromised patients included 11 with hematologic malignancy, 5 with solid-organ malignancy, 3 with rheumatologic disease on immunosuppressive therapy, and 2 with a solid-organ transplant. Most of the exposures (72.7%) occurred in an inpatient setting. The exposures resulted from either delayed recognition of dVZV or delayed initiation of appropriate precautions for all of the immunosuppressed patients. Two additional exposures occurred as a result of a change from “localized” to “disseminated” VZV. These patients whose diagnosis changed from localized to dVZV were considered previously immunocompetent, and dissemination took place 2 days after seeking healthcare evaluation. Conclusions: Most occupational exposures to varicella zoster are the result of delayed initiation of appropriate isolation precautions due to delayed diagnosis of dVZV infection or failure to recognize the need for instituting precautions in disseminated disease. Instituting preemptive airborne precautions for immunocompromised patients with localized varicella zoster would be unlikely to reduce occupational exposures.Funding: NoneDisclosures: Consulting fee- Merck Priya Sampathkumar

Cardiovascular complications of Streptococcus pneumoniae bacteraemia

2021 ◽  
Vol 14 (4) ◽  
pp. e240341
Author(s):  
Michelle M de Leau ◽  
Remko S Kuipers
Keyword(s):  
Antibiotic Resistance ◽  
Streptococcus Pneumoniae ◽  
Cardiovascular Complications ◽  
Diagnosis And Treatment ◽  
Immunocompromised Patients ◽  
Correct Treatment ◽  
Life Threatening ◽  
Pneumococcal Bacteraemia

The incidence of Streptococcus pneumoniae bacteraemia has risen due to a worldwide increase in immunocompromised patients and antibiotic resistance. We describe three patients who experienced severe, including cardiovascular, complications of pneumococcal bacteraemia. Cardiovascular complications related to pneumococci may run a fulminant course. However, some of these life-threatening complications (eg, endocarditis and aortitis) may long remain unnoticed or be misdiagnosed and therefore delay correct treatment. We review the literature with regards to the incidence, diagnosis and treatment of these rare but possibly lethal and hence important cardiovascular complications.

scholarly journals Defining HIV-1 Envelope N-Glycan Microdomains through Site-Specific Heterogeneity Profiles

2018 ◽  
Vol 93 (1) ◽  
Author(s):  
Audra A. Hargett ◽  
Qing Wei ◽  
Barbora Knoppova ◽  
Stacy Hall ◽  
Zhi-Qiang Huang ◽  
...  
Keyword(s):  
Immune System ◽  
Immune Evasion ◽  
Immune Escape ◽  
High Resolution Mass Spectrometry ◽  
National Laboratory ◽  
Site Specific ◽  
Los Alamos National Laboratory ◽  
Glycosylation Sites ◽  
Env Protein ◽  
Hiv 1

ABSTRACT The HIV-1 envelope (Env) glycans shield the surface of Env from the immune system and form integral interactions important for a functional Env. To understand how individual N-glycosylation sites (NGS) coordinate to form a dynamic shield and evade the immune system through mutations, we tracked 20 NGS in Env from HIV-transmitted/founder (T/F) and immune escape variants and their mutants involving the N262 glycan. NGS were profiled in a site-specific manner using a high-resolution mass spectrometry (MS)-based workflow. Using this site-specific quantitative heterogeneity profiling, we empirically characterized the interdependent NGS of a microdomain in the high-mannose patch (HMP). The changes (shifts) in NGS heterogeneity between the T/F and immune escape variants defined a range of NGS that we further probed for exclusive combinations of sequons in the HMP microdomain using the Los Alamos National Laboratory HIV sequence database. The resultant sequon combinations, including the highly conserved NGS N262, N448, and N301, created an immune escape map of the conserved and variable sequons in the HMP microdomain. This report provides details on how some clustered NGS form microdomains that can be identified and tracked across Env variants. These microdomains have a limited number of N-glycan-sequon combinations that may allow the anticipation of immune escape variants. IMPORTANCE The Env protein of HIV is highly glycosylated, and the sites of glycosylation can change as the virus mutates during immune evasion. Due to these changes, the glycan location and heterogeneity of surrounding N-glycosylation sites can be altered, resulting in exposure of different glycan or proteoglycan surfaces while still producing a viable HIV variant. These changes present a need for vaccine developers to identify Env variants with epitopes most likely to induce durable protective responses. Here we describe a means of anticipating HIV-1 immune evasion by dividing Env into N-glycan microdomains that have a limited number of N-glycan sequon combinations.

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