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Logan C, Singh M, Fox N, Brown G, Krishna S, Gordon K, Macallan D, Bicanic T. Chromoblastomycosis treated with posaconazole and adjunctive imiquimod: lending innate immunity a helping hand. Open Forum Infect Dis 2023; 10:ofad124. [PMID: 37035498 PMCID: PMC10077821 DOI: 10.1093/ofid/ofad124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/13/2023] [Indexed: 03/16/2023] Open
Abstract
Abstract
Chromoblastomycosis (CBM) is a difficult-to-treat, chronic fungal infection of the skin and subcutaneous tissue. The evidence base for treatment is scarce, with no standardised therapeutic approach. Chronicity of CBM infection is postulated to be due in part to a failure of host cell-mediated immunity to generate a proinflammatory response sufficient for fungal clearance. We present a case of a chronic chromoblastomycosis lesion of the hand present for nearly four decades, previously refractory to itraconazole monotherapy, that was successfully treated with a combination of posaconazole and adjunctive immunotherapy with topical Imiquimod, a toll-like receptor 7 agonist. Serial biopsies and images demonstrate the clinical and histopathological improvement of the lesion. Randomised trials of antifungal therapy with adjunctive imiquimod are warranted to determine whether a combination of antifungal and host-directed therapy improves outcomes for this neglected tropical mycosis.
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Affiliation(s)
- C Logan
- Clinical Infection Unit, St George’s University Hospitals NHS Foundation Trust , Blackshaw Road, London , United Kingdom
- Institute of Infection & Immunity, St Georges University London , Cranmer Terrace, London , United Kingdom
| | - M Singh
- Department of Cellular Pathology, St George’s University Hospitals NHS Foundation Trust , Blackshaw Road, London , United Kingdom
| | - N Fox
- Department of Dermatology, St George’s University Hospitals NHS Foundation Trust , London , United Kingdom
| | - G Brown
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building , Stocker Road, Exeter, EX4 4QD , UK
| | - S Krishna
- Department of Dermatology, St George’s University Hospitals NHS Foundation Trust , London , United Kingdom
| | - K Gordon
- Department of Dermatology, St George’s University Hospitals NHS Foundation Trust , London , United Kingdom
| | - D Macallan
- Clinical Infection Unit, St George’s University Hospitals NHS Foundation Trust , Blackshaw Road, London , United Kingdom
- Institute of Infection & Immunity, St Georges University London , Cranmer Terrace, London , United Kingdom
| | - T Bicanic
- Clinical Infection Unit, St George’s University Hospitals NHS Foundation Trust , Blackshaw Road, London , United Kingdom
- Institute of Infection & Immunity, St Georges University London , Cranmer Terrace, London , United Kingdom
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building , Stocker Road, Exeter, EX4 4QD , UK
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GAMA R, Dunleavy A, Ray Chaudhury A, popoola J, Macallan D, Banerjee D. WCN23-0024 MANAGEMENT AND OUTCOME OF RECIPIENT RENAL TRANSPLANTATION FROM A TUBERCULOSIS POSITIVE DONOR. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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Ratnappuli A, Collinson S, Gaspar-García E, Richardson L, Bernard J, Macallan D. Pott's disease in twenty-first century London: spinal tuberculosis as a continuing cause of morbidity and mortality. Int J Tuberc Lung Dis 2016; 19:1125, i-ii. [PMID: 26260836 DOI: 10.5588/ijtld.15.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Ratnappuli
- Immunity Research Centre, St George's, University of London, UK
| | - S Collinson
- Infection & Immunity Research Centre, St George's, University of London, UK
| | - E Gaspar-García
- Clinical Infection Unit, St George's Healthcare NHS Trust London, UK
| | - L Richardson
- Clinical Infection Unit, St George's Healthcare NHS Trust London, UK
| | - J Bernard
- Trauma & Orthopaedics Department, St George's Healthcare NHS Trust, London, UK.
| | - D Macallan
- Infection & Immunity Research Centre, St George's, University of London, UK; Clinical Infection UnitSt George's Healthcare NHS Trust London, UK
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Ockenga J, Grimble R, Jonkers-Schuitema C, Macallan D, Melchior JC, Sauerwein HP, Schwenk A, Süttmann U. ESPEN Guidelines on Enteral Nutrition: Wasting in HIV and other chronic infectious diseases. Clin Nutr 2006; 25:319-29. [PMID: 16698147 DOI: 10.1016/j.clnu.2006.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 01/20/2006] [Indexed: 01/10/2023]
Abstract
Undernutrition (wasting) is still frequent in patients infected with the human immunodeficiency virus (HIV), despite recent decreases in the prevalence of undernutrition in western countries (as opposed to developing countries) due to the use of highly active antiretroviral treatment. Undernutrition has been shown to have a negative prognostic effect independently of immunodeficiency and viral load. These guidelines are intended to give evidence-based recommendations for the use of enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) in HIV-infected patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. Nutritional therapy is indicated when significant weight loss (>5% in 3 months) or a significant loss of body cell mass (>5% in 3 months) has occurred, and should be considered when the body mass index (BMI) is <18.5 kg/m(2). If normal food intake including nutritional counselling and optimal use of ONS cannot achieve an adequate nutrient intake, TF with standard formulae is indicated. Due to conflicting results from studies investigating the impact of immune-modulating formulae, these are not generally recommended. The results obtained in HIV patients may be extrapolated to other chronic infectious diseases, in the absence of available data.
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Affiliation(s)
- J Ockenga
- Department Gastroenterology, CCM, Universitätsmedizin Berlin, Berlin, Germany.
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Hellerstein M, Hanley MB, Cesar D, Siler S, Papageorgopoulos C, Wieder E, Schmidt D, Hoh R, Neese R, Macallan D, Deeks S, McCune JM. Directly measured kinetics of circulating T lymphocytes in normal and HIV-1-infected humans. Nat Med 1999; 5:83-9. [PMID: 9883844 DOI: 10.1038/4772] [Citation(s) in RCA: 455] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The dynamic basis for T-cell depletion in late-stage HIV-1 disease remains controversial. Using a new, non-radioactive, endogenous labeling technique, we report direct measurements of circulating T-cell kinetics in normal and in HIV-1-infected humans. In healthy, HIV-1-seronegative subjects, CD4+ and CD8+ T cells had half-lives of 87 days and 77 days, respectively, with absolute production rates of 10 CD4+ T cells/microl per day and 6 CD8+ T cells/microl per day. In untreated HIV-1-infected subjects (with a mean CD4 level of 342 cells/microl), the half-life of each subpopulation was less than 1/3 as long as those of healthy, HIV-1-seronegative subjects but was not compensated by an increased absolute production rate of CD4+ T cells. After viral replication was suppressed by highly active antiretroviral therapy for 12 weeks, the production rates of circulating CD4+ and CD8+ T cells were considerably elevated; the kinetic basis of increased CD4 levels was greater production, not a longer half-life, of circulating cells. These direct measurements indicate that CD4+ T-cell lymphopenia is due to both a shortened survival time and a failure to increase the production of circulating CD4+ T cells. Our results focus attention on T-cell production systems in the pathogenesis of HIV-1 disease and the response to antiretroviral therapy.
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Affiliation(s)
- M Hellerstein
- Department of Medicine, San Francisco General Hospital, University of California at San Francisco, 94110, USA
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