1
|
Perez-Lopez CJ, Arroyo E, Rodriguez M, Ortiz D, Nazario S. Disseminated Mycobacterium avium intracellulare leading to protein-losing enteropathy in an elderly man with idiopathic CD4 lymphocytopenia. Ann Allergy Asthma Immunol 2017; 119:390-391.e1. [PMID: 28958380 DOI: 10.1016/j.anai.2017.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/21/2017] [Accepted: 07/28/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Carlos J Perez-Lopez
- Department of Internal Medicine, VA Caribbean Health Care System, San Juan, Puerto Rico.
| | - Erving Arroyo
- Department of Allergy and Immunology, University of Puerto Rico, San Juan, Puerto Rico
| | - Maristely Rodriguez
- Department of Allergy and Immunology, University of Puerto Rico, San Juan, Puerto Rico
| | - Damarys Ortiz
- Department of Internal Medicine, VA Caribbean Health Care System, San Juan, Puerto Rico
| | - Sylvette Nazario
- Department of Allergy and Immunology, University of Puerto Rico, San Juan, Puerto Rico
| |
Collapse
|
2
|
Ahmad DS, Esmadi M, Steinmann WC. Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases. Avicenna J Med 2013; 3:37-47. [PMID: 23930241 PMCID: PMC3734630 DOI: 10.4103/2231-0770.114121] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Idiopathic CD4 lymphocytopenia (ICL) was first defined in 1992 by the US Centers for Disease Control and Prevention (CDC) as the repeated presence of a CD4+ T lymphocyte count of fewer than 300 cells per cubic millimeter or of less than 20% of total T cells with no evidence of human immunodeficiency virus (HIV) infection and no condition that might cause depressed CD4 counts. Most of our knowledge about ICL comes from scattered case reports. The aim of this study was to collect comprehensive data from the previously published cases to understand the characteristics of this rare condition. We searched the PubMed database and Science Direct for case reports since 1989 for Idiopathic CD4 lymphocytopenia cases. We found 258 cases diagnosed with ICL in 143 published papers. We collected data about age, sex, pathogens, site of infections, CD4 count, CD8 count, CD4:CD8 ratio, presence of HIV risk factors, malignancies, autoimmune diseases and whether the patients survived or died. The mean age at diagnosis of first opportunistic infection (or ICL if no opportunistic infection reported) was 40.7 ± 19.2 years (standard deviation), with a range of 1 to 85. One-sixty (62%) patients were males, 91 (35.2%) were females, and 7 (2.7%) patients were not identified whether males or females. Risk factors for HIV were documented in 36 (13.9%) patients. The mean initial CD4 count was 142.6 ± 103.9/mm3 (standard deviation). The mean initial CD8 count was 295 ± 273.6/mm3 (standard deviation). The mean initial CD4:CD8 ratio was 0.6 ± 0.7 (standard deviation). The mean lowest CD4 count was 115.4 ± 87.1/mm3 (standard deviation). The majority of patients 226 (87.6%) had at least one infection. Cryptococcal infections were the most prevalent infections in ICL patients (26.6%), followed by mycobacterial infections (17%), candidal infections (16.2%), and VZV infections (13.1%). Malignancies were reported in 47 (18.1%) patients. Autoimmune diseases were reported in 37 (14.2%) patients.
Collapse
Affiliation(s)
- Dina S Ahmad
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | | | | |
Collapse
|
3
|
Hirasaki S, Murakami K, Mizushima T, Ohmori K, Fujita S, Hanayama Y, Kanamori T, Yokota R, Ebara H, Kusano N, Kudo C, Yamaguchi T, Akagi T, Koide N. Successful treatment of sepsis caused by Staphylococcus lugdunensis in an adult with 22q11.2 deletion syndrome. Intern Med 2012; 51:377-80. [PMID: 22333372 DOI: 10.2169/internalmedicine.51.6257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 27-year-old woman visited our hospital because of high fever. She had been diagnosed as 22q11.2 deletion syndrome (22q11.2DS) due to her cardiac history (tetralogy of Fallot), thymic hypoplasia and 22q11.2 deletion. She had a normal CD4/CD8 ratio, a slightly decreased lymphocyte count and normal serum immunoglobulin levels. Blood cultures were positive for Staphylococcus lugdunensis (S. lugdunensis). Infection route of S. lugdunensis in this case was unclear. The patient was successfully treated with several intravenous antibiotics. Infection should be considered when managing patients with 22q.11.2DS. regardless of whether their immune system is impaired.
Collapse
Affiliation(s)
- Shoji Hirasaki
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Luo L, Li T. Idiopathic CD4 lymphocytopenia and opportunistic infection — an update: Table 1. ACTA ACUST UNITED AC 2008; 54:283-9. [DOI: 10.1111/j.1574-695x.2008.00490.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
Opportunistic Infections in Persons With Idiopathic CD4 Lymphocytopenia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2008. [DOI: 10.1097/ipc.0b013e31816fd577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
6
|
Bonilla FA, Bernstein IL, Khan DA, Ballas ZK, Chinen J, Frank MM, Kobrynski LJ, Levinson AI, Mazer B, Nelson RP, Orange JS, Routes JM, Shearer WT, Sorensen RU. Practice parameter for the diagnosis and management of primary immunodeficiency. Ann Allergy Asthma Immunol 2005; 94:S1-63. [PMID: 15945566 DOI: 10.1016/s1081-1206(10)61142-8] [Citation(s) in RCA: 311] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Francisco A Bonilla
- Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Calbo Mayo JM, Mateos Rodríguez F, Martínez Alfaro E, Rivera Vaquerizo P. Tuberculosis intestinal en paciente con linfocitopenia CD4 idiopática. Med Clin (Barc) 2005; 124:559. [PMID: 15847762 DOI: 10.1157/13073957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
8
|
Kawabata T, Matsuyama W, Higashimoto I, Koreeda Y, Eiraku N, Kawabata M, Osame M. Pleural cryptococcosis with idiopathic CD4 positive T-lymphocytopenia. Intern Med 2004; 43:977-81. [PMID: 15575251 DOI: 10.2169/internalmedicine.43.977] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 19-year-old man was admitted to our hospital because of chest pain. He was diagnosed as having pleural cryptococcosis by pleural biopsy. His CD4 positive T-lymphocyte count was low (< 300 microl) and there was no evidence of human immunodeficiency virus infection. He was successfully treated with fluconazole. However, his CD4 positive lymphocyte counts remained low after the recovery and he was diagnosed as idiopathic CD4 positive T-lymphocytopenia. Pleural cryptococcosis is rare and its predisposing condition is still controversial. To our knowledge, this is the first case of pleural cryptococcosis associated with idiopathic CD4 positive T lymphocytopenia.
Collapse
Affiliation(s)
- Takashi Kawabata
- Third Department of Internal Medicine, Kagoshima University Faculty of Medicine, Sakuragaoka 8-35-1, Kagoshima 890-8520
| | | | | | | | | | | | | |
Collapse
|
9
|
Yakoob J, Jafri W, Abid S, Jafri N, Islam M, Hamid S, Shah HA, Hussainy AS. Candida esophagitis: Risk factors in non-HIV population in Pakistan. World J Gastroenterol 2003; 9:2328-31. [PMID: 14562403 PMCID: PMC4656488 DOI: 10.3748/wjg.v9.i10.2328] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Candida esophagitis is a frequent infection in immunocompromised patients. This study was designed to determine its characteristics in non-human immune deficiency virus (HIV) infected patients attending a teaching hospital.
METHODS: Clinical records of all patients coded by international classification of diseases 9th revision with clinical modifications’ (ICD-9-CM), with candida esophagitis diagnosed by esophagogastroduodenoscopy (EGD) and histopathology over a period of 5 years were studied.
RESULTS: Fifty-one patients (27 males, 24 females, range 21-77 years old and mean age 52.9 years) fulfilled the criteria (0.34% of the EGD). The common predisposing factors were carcinoma (OR 3.87, CI 1.00-14.99) and diabetes mellitus (OR 4.39, CI 1.34-14.42). The frequent clinical symptoms were retrosternal discomfort, dysphagia and epigastric abdominal pain with endoscopic appearance of scattered mucosal plaques. Another endoscopic lesion was associated with candida esophagitis in 15% patients.
CONCLUSION: Carcinomas, diabetes mellitus, corticosteroid and antibiotic therapy are major risk factors for candida esophagitis in Pakistan. It is an easily managed complication that responds to treatment with nystatin.
Collapse
Affiliation(s)
- Javed Yakoob
- Section of Gastroenterology, Department of Medicine, Agha Khan University Hospital, Karachi, Pakistan.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Immunocompromised patients, including patients with AIDS, solid organ and bone marrow transplant recipients, patients with leukemia and lymphoma, patients with inherited immune deficiencies, and patients on immunosuppressive therapy for a variety of disorders, are at risk for infections-particularly opportunistic infections, which, by definition, do not infect the healthy host. All systems of the body, including the gastrointestinal tract, are susceptible. The esophagus, stomach, small intestine, and large intestine are sites of infection for viruses, bacteria, fungi, and protozoa. Symptoms can range in severity from fevers of unknown etiology to life-threatening hemorrhage and perforation. This review summarizes recent case reports, clinical studies, and reviews pertaining to pathogens that uniquely cause disease, more frequently cause disease, or cause more severe disease in the immunocompromised host than in the immunocompetent host.
Collapse
Affiliation(s)
- Lori Fantry
- Institute of Human Virology, University of Maryland Medical School, Baltimore, Maryland 21201, USA.
| |
Collapse
|
11
|
Kassubek J, Zucker B, Oehm E, Serr A, Arnold SM, Lücking CH, Els T. Tuberculous meningoencephalitis in HIV-seronegative patients: variety of clinical presentation and impact on diagnostics and treatment. Acta Neurol Scand 2001; 104:389-96. [PMID: 11903096 DOI: 10.1034/j.1600-0404.2001.00115.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Tuberculous meningoencephalitis (TBM), an infrequent disease in Western European countries, shows a wide heterogeneity of clinical symptoms. MATERIAL AND METHODS We present 4 patients (age range 42-72 years) with the definite diagnosis of isolated TBM. All patients were HIV-seronegative, only 1 patient was known to be immunoincompetent on admission due to acute myelocytic leukemia; other reasons for immune suppression were detected in 2 other patients (leukemia and idiopathic CD4+ T-lymphocytopenia, respectively). RESULTS The diagnosis of TBM was confirmed in 3 cases by culture from CSF, in 1 case Mycobacterium tuberculosis was proven only in tracheal aspirate. In 1 patient M. bovis was found, which is an extremely rare cause of TBM in Germany. We report the contributions of different diagnostic tools (CSF analysis, neuroimaging) in reaching the presumptive diagnosis and in monitoring the further course. All patients developed neurological complications despite prompt tuberculostatic treatment. Three of the patients presented a chronic severe loss of consciousness of unclear origin. CONCLUSION The possible causative relationships of these complications and their impact on the prognosis are discussed.
Collapse
Affiliation(s)
- J Kassubek
- Department of Neurology and Neurophysiology, University of Freiburg, Germany
| | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
The gastrointestinal tract is a common site of infection in the opportunistic host. Pathogens range from highly virulent organisms, which infect people with well functioning immune systems as well as people with poorly functioning immune systems, to opportunistic organisms, which infect only those with impaired immune systems. Viruses, bacteria, fungi, and protozoa lead to disease that can be especially severe, debilitating, and difficult to treat in the immunocompromised host. Yet in this era of highly active antiretroviral therapy for HIV-infected patients and strategies to reduce immunosuppression in transplant and oncology patients, appropriate diagnostic tests and treatment can both improve the quality of life and decrease mortality. In this article, I review the changing pathogenesis, epidemiology, clinical presentation, diagnosis, and treatment of gastrointestinal infections in the immunocompromised host.
Collapse
Affiliation(s)
- L Fantry
- University of Maryland Medical School, Baltimore, Maryland 21201, USA.
| |
Collapse
|