scholarly journals Clinical Pathway in the Treatment of Nocardial Brain Abscesses following Systemic Infections

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Yun-Cong Zheng ◽  
Tse-Lun Wang ◽  
Jee-Ching Hsu ◽  
Yung-Hsing Hsu ◽  
Wen-Hsing Hsu ◽  
...  
Keyword(s):  
Medical Center ◽  
Immunosuppressive Agents ◽  
Cerebral Lesions ◽  
Neurological Outcomes ◽  
Immunocompromised Status ◽  
Brain Abscesses ◽  
Cerebral Nocardiosis ◽  
Immunocompromised State ◽  
Systemic Infections ◽  
Immunocompromised Hosts

Nocardial infections are commonly encountered in patients with immunocompromised states. Cerebral nocardiosis is an uncommon clinical entity, representing only 2% of all cerebral abscesses. It has a higher mortality rate, especially for multiple cerebral lesions in immunocompromised hosts following systemic infections. However, an optimal treatment policy to deal with these immunocompromised patients in Asia is still lacking. We retrospectively reviewed the subjects with nocardial brain abscesses from 2001 to 2011 at our medical center. All of them had multiple brain abscesses, underlying with immunocompromised state following systemic infections. All cases were under steroid control due to their comorbidities for more than six months. The comorbidities and misdiagnosis often lead to poor prognosis. The change in the environments of the microorganisms caused by immunosuppressive agents and multiple antibiotic uses may play an important role in this critical disorder. Aggressive craniotomy should be performed in time to avoid grievous neurological outcomes. Our conclusion is that early diagnosis and appropriate antibiotic uses should be implemented promptly, and aggressive craniotomy should be performed for nocardial brain abscesses in subjects with systemic infections under an immunocompromised status.

scholarly journals Cerebral Nocardiosis in a patient with Waldenstrom’s Macroglobulinaemia

2008 ◽  
Vol 7 (3) ◽  
pp. 128-130
Author(s):  
Patrick Tapley ◽  
◽  
Tanya G Cranfield ◽  
Godwin K Simon ◽  
◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Gram Positive ◽  
Nocardia Species ◽  
Brain Abscesses ◽  
Cerebral Nocardiosis ◽  
Waldenstrom’S Macroglobulinaemia

Abstract Nocardiosis is caused by nocardia species, a Gram positive aerobic filamentous bacillus. It is ubiquitous in the environment and often presents as pulmonary disease in more than 70% of patients.1 Dissemination of the disease may manifest as brain abscesses, and is reported to account for approximately 2% of all brain abscesses.2,3 We present a case of cerebral nocardiosis in a patient with Waldenstrom’s macroglobulinaemia, previously unreported in the literature…

scholarly journals Clinical characteristics and prognosis of patients with Pneumocystis jirovecii pneumonia without a compromised illness

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246296
Author(s):  
Tae-Ok Kim ◽  
Jae-Kyeong Lee ◽  
Yong-Soo Kwon ◽  
Yu-Il Kim ◽  
Sung-Chul Lim ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Hematological Malignancy ◽  
Immunosuppressive Agents ◽  
Mortality Rates ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Solid Organ ◽  
Immunodeficiency Virus ◽  
Immunocompromised Status ◽  
Median Interval

Objective Pneumocystis jirovecii pneumonia (PCP) is a fatal respiratory infection, mostly associated with immunocompromised conditions. Several reports have described PCP development in patients who were not immunocompromised, but the clinical course and prognosis of PCP are not well understood. We compared the clinical characteristics and prognoses between patients with and without immunocompromised conditions who developed PCP. Methods We retrospectively analyzed patients who had been treated for PCP from three hospitals. We defined immunocompromised (IC) status as following: human immunodeficiency virus (HIV) infection; hematological malignancy; solid organ tumor under chemotherapy; rheumatic disease; medication with immunosuppressive agents. Patients without immunocompromised status were defined as being non-immunocompromised (non-IC). Results The IC and non-IC groups comprised 173 and 14 patients. The median ages were 62.0 and 74.0 years in the IC and the non-IC group, respectively. The median interval between admission and anti-PCP treatment was significantly longer for patients in the non-IC group than that for patients in the IC group (7 vs. 2 days). The in-hospital mortality rates were significantly higher for patients in the non-IC group than that for patients in the IC group (71.4% vs. 43.9%; P = 0.047). A longer interval between admission and anti-PCP therapy was associated with increased 90-day mortality rate in patients with PCP (hazard ratio, 1.082; 95% confidence interval, 1.015–1.153; P = 0.016). Conclusions Patients with PCP with no predisposing illnesses were older and had higher mortality rates than IC patients with PCP. Delayed anti-PCP treatment was associated with increased 90-day mortality.

scholarly journals Evaluation of short term neurological outcomes in children diagnosed with brain abscesses

2016 ◽  
Author(s):  
Manolya Acar ◽  
Murat Sutcu ◽  
Hacer Akturk ◽  
Aygozel Muradova ◽  
Selda Hancerli-torun ◽  
...  
Keyword(s):  
Short Term ◽  
Neurological Outcomes ◽  
Brain Abscesses

Pneumocystis jirovecii Pneumonia in Children

2017 ◽  
Vol 13 (01) ◽  
pp. 002-009
Author(s):  
Dhulika Dhingra ◽  
Amitabh Singh ◽  
Anirban Mandal
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Immunosuppressive Agents ◽  
Pneumocystis Carinii ◽  
Underlying Disease ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
High Morbidity ◽  
Healthy Children ◽  
Direct Demonstration ◽  
Immunocompromised Hosts

Abstract Pneumocystis jirovecii (previously known as Pneumocystis carinii), a yeast-like, atypical fungus, is an important human pathogen especially in the immunocompromised hosts. It primarily causes pneumonia (P. jirovecii pneumonia or PJP), but rarely can infect other extrapulmonary sites, such as lymph nodes, spleen, liver, and bone marrow. Though an early age of colonization/infection has been documented even in healthy children, children with human immunodeficiency virus (HIV) infection, those with immunosuppression secondary to malignancies, cancer chemotherapy, and other immunosuppressive agents, and primary immunodeficiency are the ones primarily affected with the disease. The mode of presentation is variable depending on the underlying disease, immune status, and age of the patient, but clinical features of PJP are largely nonspecific. Though diffuse, perihilar predominant, bilaterally symmetrical interstitial infiltrates with apical sparing is characteristically seen in pulmonary imaging, it is very difficult to differentiate between PJP and other causes of pneumonia in immunocompromised hosts. The growth of the organism being extremely difficult in the laboratory, direct demonstration of the organism or its DNA in pulmonary secretions (induced sputum, bronchoalveolar lavage [BAL], etc.) by either direct stains or polymerase chain reaction (PCR) is the predominant mode of diagnosis. Chemoprophylaxis is indicated for HIV-infected infants and other children with profound immunosuppression. Co-trimoxazole is the drug of choice for both prophylaxis and therapy in children with PJP; pentamidine, atovaquone, dapsone, and clindamycin/primaquine are other alternatives. Following the advent of highly active antiretroviral therapy (HAART) for the treatment of HIV disease and co-trimoxazole prophylaxis, both the incidence of PJP and associated mortality have decreased dramatically in the developing regions. Developing countries still have very high morbidity and mortality with PJP, especially in HIV-infected children.

scholarly journals Multiple Brain Abscesses of Odontogenic Origin. May Oral Microbiota Affect Their Development? A Review of the Current Literature

2021 ◽  
Vol 11 (8) ◽  
pp. 3316
Author(s):  
Nicola Montemurro ◽  
Paolo Perrini ◽  
Walter Marani ◽  
Bipin Chaurasia ◽  
Massimo Corsalini ◽  
...  
Keyword(s):  
Oral Microbiota ◽  
High Morbidity ◽  
Oral Diseases ◽  
Oral Infections ◽  
Odontogenic Infections ◽  
Odontogenic Origin ◽  
Brain Abscesses ◽  
Systemic Infections ◽  
Systemic Condition

In the last few years, the role of oral microbiota in the setting of oral diseases such as caries, periodontal disease, oral cancer and systemic infections, including rheumatoid arthritis, cardiovascular disease and brain abscess (BA), has attracted the attention of physicians and researchers. Approximately 5–7% of all BAs have an odontogenic origin, representing an important pathological systemic condition with a high morbidity and mortality. A systematic search of two databases (Pubmed and Ovid EMBASE) was performed for studies published up to 5 January 2021, reporting multiple BAs attributed to an odontogenic origin. According to PRISMA guidelines, we included a total of 16 papers reporting multiple BAs due to odontogenic infections. The aim of this review is to investigate the treatment modality and the clinical outcome of patients with multiple BAs due to odontogenic infections, as well as to identify the most common pathogens involved in this pathological status and their role, in the oral microbiota, in the onset of oral infections. A multidisciplinary approach is essential in the management of multiple BAs. Further studies are required to understand better the role of microbiota in the development of multiple BAs.

scholarly journals Immunosuppressant Management in Renal Transplant Patients with COVID-19

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Elham Ahmadian ◽  
Sepideh Zununi Vahed ◽  
Shakar Mammadova ◽  
Sima Abediazar
Keyword(s):  
Side Effects ◽  
Immunosuppressive Agents ◽  
Immunosuppressive Treatment ◽  
Potential Drug ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
Immunosuppressed Patients ◽  
Immunocompromised Hosts ◽  
Special Risk

The coronavirus disease 2019 (COVID-19) pandemic poses a special risk for both immunosuppressed patients, especially transplant recipients. Although the knowledge about this infection is growing, many uncertainties remain, particularly regarding the kidney. Kidney transplant recipients (KDRs) should be considered immunocompromised hosts since a potential risk for infection, comorbidity, and immunosuppression exposure exists. Additionally, the management of immunosuppressive agents in KDRs remains challenging. Potential drug interactions with immunosuppressive treatment escalated the risk of unwanted side effects. In this review, we aimed to attain an augmented awareness and improved management immunosuppressant for COVID-19 KDRs.

scholarly journals Prevalence of Latent Tuberculosis (TB) in the Multiple Sclerosis (MS) Clinic and Effect of MS Treatment on TB Testing

2020 ◽  
pp. 0000-0000
Author(s):  
Andrew J. Bouley ◽  
Ursela Baber ◽  
Emily Egnor ◽  
Soleil Samaan ◽  
Jacob A. Sloane
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Medical Center ◽  
Immunosuppressive Agents ◽  
Latent Tuberculosis ◽  
Dimethyl Fumarate ◽  
Tuberculosis Infection ◽  
High Rate ◽  
Tuberculosis Screening ◽  
Immunomodulating Therapy

Abstract Background: Patients with a compromised immune system are at risk for converting from latent tuberculosis infection (LTBI) to active tuberculosis infection. Multiple sclerosis (MS) therapies may put individuals with LTBI at higher risk of developing tuberculosis. Methods: Patients of the Beth Israel Deaconess Medical Center MS Center were screened for tuberculosis as part of routine testing with the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay from 2013 to 2017. Patients were tested either prior to or while on immunomodulating therapy. Results: 4 out of 222 patients (1.8%, 95% CI 0.1-3.6%) had positive QFT-GIT testing; 3 patients had risk factors for tuberculosis, having emigrated from TB endemic countries or worked in the health care industry. 28 out of 222 patients (12.6%) had an indeterminate assay result and 75.0% of these occurred in patients taking dimethyl fumarate (DMF). Fingolimod, natalizumab, or anti-CD20 treatments showed 0-7.7% indeterminate results. Conclusions: LTBI was seen at 1.8% prevalence in the Beth Israel Deaconess MS Center. Not all LTBI cases were associated with known risk factors for tuberculosis. Screening for LTBI prior to starting immunosuppressive agents for MS could help prevent activation of tuberculosis. DMF use is associated with indeterminate results in the QFT-GIT assay, possibly due to functional effects on lymphocytes and levels of cytokines, like interferon gamma. In contrast, fingolimod use was rarely associated with indeterminate QFT-GIT results in spite of a high rate of lymphopenia in virtually all cases.

Pemphigus of the Air and Food Passages

1977 ◽  
Vol 86 (5) ◽  
pp. 584-587 ◽  
Author(s):  
Leslie J. Block ◽  
Paul H. Holinger ◽  
David D. Caldarelli ◽  
Roger W. Pearson
Keyword(s):  
Medical Center ◽  
Immunosuppressive Agents ◽  
Pemphigus Vulgaris ◽  
Corticosteroid Treatment ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Prednisone Dosage ◽  
Bullous Diseases ◽  
Dose Corticosteroid ◽  
Treatment Mortality

Pemphigus vulgaris is one among many bullous diseases which involve the mucous membranes of the oropharynx and the larynx. The pernicious nature and previous high mortality of this disease have been greatly reduced with early diagnosis and the appropriate use of corticosteroids and immunosuppressive agents. Thirteen patients with pemphigus vulgaris were seen at Rush-Presbyterian-St. Luke's Medical Center from 1970 through 1976. All patients had moderate-to-severe generalized eruptions and were biopsy-positive for pemphigus vulgaris. A moderate prednisone dosage of 80 to 120 mg/day in moderate-to-severe cases was utilized in 11 out of 13 patients. All patients were treated initially with prednisone only, and after control of the acute generalized eruptions was achieved, Cytoxan® was added to the regimen to allow reduction of the prednisone dosage. One patient in our series died as a result of disseminated herpes simplex, probably secondary to high-dose corticosteroid treatment. Mortality in our series was 7.6% This investigation suggests that lower prednisone doses of 80 to 120 mg/day, except in recalcitrant cases, may be efficacious in the treatment of pemphigus vulgaris, especially in conjunction with adjuvant immunosuppressive therapy.

Sign in / Sign up

Export Citation Format

Share Document