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Saleh H, Abraham P, Chahine H, Subbiah S, Grace-Abraham N. A Rare Case of Invasive Central Nervous System Aspergillus niger in a Previously Immunocompetent Patient After Corticosteroid Treatment for COVID-19. Cureus 2024; 16:e57923. [PMID: 38725734 PMCID: PMC11081636 DOI: 10.7759/cureus.57923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Aspergillus is a ubiquitous saprophyte found in air, soil, and organic matter. Humans inhale the spore form of the fungus, but manifestations of the disease are typically predominantly seen in immunocompromised patients. Invasive central nervous system (CNS) aspergillosis is even more uncommon, and epidemiological data is sparse, particularly in immunocompetent patients. We report the case of a 67-year-old previously immunocompetent female with no known comorbidities who was treated with corticosteroids for COVID-19 one month prior to admission for altered mental status (AMS). Subsequent imaging and biopsy demonstrated invasive CNS Aspergillus niger. Though a rare cause of AMS in immunocompetent patients, this report draws attention to the detrimental immunosuppressive effects of corticosteroid therapy in COVID-19.
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Affiliation(s)
- Hussein Saleh
- College of Osteopathic Medicine, Michigan State University, East Lansing, USA
| | - Peter Abraham
- Radiology, University of California San Diego, San Diego, USA
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2
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Pandey S, Tan EFS, Tun MM, Bellamkonda A, Htet SY, Kunwar K, Kalavar M. Primary Effusion Lymphoma Secondary to Human Herpesvirus 8 (HHV-8) Infection in an Immunocompetent Host: A Case Report. Cureus 2024; 16:e55774. [PMID: 38586723 PMCID: PMC10999059 DOI: 10.7759/cureus.55774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Primary effusion lymphoma (PEL) is a rare, aggressive, mature type of B-cell lymphoma that usually causes malignant, lymphomatous effusions in the absence of a solid mass. This is commonly seen in immunosuppressed individuals such as those with underlying malignancies, human immunodeficiency virus infection (HIV), cirrhosis, and a history of solid organ transplantation who are infected with human herpesvirus 8 (HHV-8). Clinical presentation varies depending on the extent of disease like shortness of breath, abdominal distention, and typical B symptoms like weight loss, fever, and night sweats. Morphological and immunohistochemical analysis of pleural fluid is required for diagnosis of PEL. Recent case studies are increasingly being reported with cases of PEL presenting in immunocompetent individuals infected with HHV-8. We present a case of PEL in an immunocompetent host and highlight its presentation, diagnosis, and management approaches. Due to the well-known association of PEL with immunocompromised status, the diagnosis is often overlooked in immunocompetent individuals. This case would further highlight the increasing association and the need for clinical vigilance in diagnosing PEL in immunocompetent patients.
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Affiliation(s)
- Sagar Pandey
- Internal Medicine, One Brooklyn Health/Interfaith Medical Center, Brooklyn, USA
| | | | - Myo Myint Tun
- Internal Medicine, NewYork-Presbyterian Westchester Hospital, Bronxville, USA
| | - Amulya Bellamkonda
- Internal Medicine, One Brooklyn Health/Interfaith Medical Center, Brooklyn, USA
| | - Shwe Yee Htet
- Internal Medicine, One Brooklyn Health/Interfaith Medical Center, Brooklyn, USA
| | - Kalendra Kunwar
- Internal Medicine, One Brooklyn Health/Interfaith Medical Center, Brooklyn, USA
| | - Madhumati Kalavar
- Hematology and Oncology, One Brooklyn Health/Interfaith Medical Center, Brooklyn, USA
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3
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Hedary AS, DeBord NL, Marshall D. A Case Report of Necrotizing Pneumonia Due to Burkholderia cepacia Syndrome. Cureus 2024; 16:e52955. [PMID: 38406162 PMCID: PMC10894023 DOI: 10.7759/cureus.52955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Burkholderia cepacia (B. cepacia) complex is a highly resistant gram-negative pathogen known to cause lung infection in cystic fibrosis, chronic granulomatous disease, and immunocompromised patients. However, it may rarely infect immunocompetent patients as well. Here, we present the case of a 30-year-old male patient who was treated for B. cepacia pneumonia in the hospital, discharged with oral antibiotics, and returned two months later with recurring B. cepacia pneumonia and bacteremia. The patient rapidly declined over the next 24 hours and expired in the intensive care unit. This case is significant as it is one of very few published cases of cepacia syndrome in a patient with no evidence of immunodeficiency. In conclusion, cases of B. cepacia pneumonia must be monitored vigilantly for progression to cepacia syndrome, even in immunocompetent patients. Additional studies regarding optimized antibiotic regimens and effective treatment modalities for B. cepacia infection are warranted.
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Affiliation(s)
- Antoine S Hedary
- Family Medicine, Louisiana State University Health Sciences Center, Alexandria, USA
| | - Nikki L DeBord
- Family Medicine, Louisiana State University Health Sciences Center, Alexandria, USA
| | - Diahann Marshall
- Family Medicine, Louisiana State University Health Sciences Center, Alexandria, USA
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4
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Lin CS, Chang CH. Disseminated Herpes Zoster Following Protein Subunit and mRNA COVID-19 Vaccination in Immunocompetent Patients: Report of Two Cases and Literature Review. Medicina (Kaunas) 2023; 59:1542. [PMID: 37763662 PMCID: PMC10532883 DOI: 10.3390/medicina59091542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
Disseminated herpes zoster (DHZ), resulting from the reactivation of the varicella-zoster virus (VZV), typically occurs in immunocompromised persons. To date, only four cases of DHZ following mRNA, viral vector, or inactivated COVID-19 vaccinations have been reported in immunocompetent patients. Herein, we present the first case of DHZ following the protein subunit COVID-19 vaccination (case 1, 64 years old) and a case of DHZ following mRNA COVID-19 vaccination (case 2, 67 years old) in elderly, immunocompetent male patients. Both cases were generally healthy, without a remarkable underlying disease and without a history of immunosuppressant use. Case 1 developed DHZ (left C3-5 predominant) 1 month after receiving the third dose of the SARS-CoV-2 spike protein vaccine (MVC-COV1901). Case 2 developed DHZ (right V1-3 predominant) 7 days after receiving the second dose of the mRNA-1273 SARS-CoV-2 vaccine. Through skin examination, Tzanck smears, and dermoscopy, the diagnosis of COVID-19 vaccination-related DHZ was established in both cases. Oral famciclovir (250 mg, three times/day for 7 days) was administered, and both cases achieved total remission of skin lesions without visceral involvement or severe post-herpetic neuralgia. Our cases demonstrate that DHZ, as a rare cutaneous adverse event in immunocompetent patients, can be secondary not only to mRNA COVID-19 vaccination but also to the protein subunit COVID-19 vaccination. It is speculated that the spike protein of SARS-CoV-2 could be the common trigger for the reactivation of VZV among different types of vaccinations.
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Affiliation(s)
- Chia-Shuen Lin
- Department of Dermatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan;
| | - Chung-Hsing Chang
- Department of Dermatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan;
- Doctoral Degree Program in Translational Medicine, Tzu Chi University and Academia Sinica, College of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien 97004, Taiwan
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5
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Taniyama D, Imoto K, Suzuki M, Imaoka K. A Case of Uncomplicated Bacteremia Caused by Capnocytophaga canimorsus in an Immunocompetent Patient. Cureus 2023; 15:e44293. [PMID: 37779790 PMCID: PMC10533748 DOI: 10.7759/cureus.44293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 10/03/2023] Open
Abstract
This report describes uncomplicated bacteremia caused by Capnocytophaga canimorsus in an immunocompetent woman who presented with rigor and fever. She was hemodynamically stable. Two blood samples were immediately cultured because rigor indicated bacteremia. Although her symptoms were relieved, Gram-negative rods grew from blood cultures. She noted that she had been bitten by her dog before the first examination. The bacterium was confirmed as C. canimorsus by gene analysis. Infection with C. canimorsus can be fatal when accompanied by sepsis in elderly or immunocompromised patients. However, this case was considered rare as the patient was 41 years old and immunocompetent.
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Affiliation(s)
- Daisuke Taniyama
- Department of Infectious Diseases, Showa General Hospital, Tokyo, JPN
| | - Kazuya Imoto
- Department of General Internal Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, JPN
| | - Michio Suzuki
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo, JPN
| | - Koichi Imaoka
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo, JPN
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Mehta S, Gupta K, Patel Nakshiwala N. Orbital Apex Syndrome Due to Aspergillus flavus Infection in Immunocompetent Patients: A Report of Two Cases. Cureus 2023; 15:e43508. [PMID: 37719524 PMCID: PMC10500615 DOI: 10.7759/cureus.43508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Aspergillus species are fungi that are commonly found in soil and decaying vegetation and have the potential to cause an orbital apex syndrome that is marked by ophthalmoplegia or vision loss. We report the clinical and investigational findings and outcomes of two patients with orbital apex syndrome. The first patient was a 26-year-old female, premorbidly healthy, who presented with a gradually increasing proptosis of the left eye with a reduction in vision. An MRI revealed findings consistent with proptosis, pansinusitis with a soft tissue opacity involving the left orbital apex with optic nerve compression, extending to the cavernous sinus with an associated temporal meningeal enhancement. Following functional endoscopic sinus surgery (FESS), Aspergillus flavus was grown in culture, and oral voriconazole was initiated. The second patient was a 53-year-old male who presented with bilateral reduction of vision and ptosis, proptosis with total ophthalmoplegia (third, fourth, and sixth nerve palsies) of the right eye. An MRI study revealed extensive involvement of the apex of the right orbit, the right cavernous sinus, the medial aspect of the left cavernous sinus, and the pituitary gland. A FESS was done, and the histopathology specimen was suggestive of aspergillosis, and the tissue fungal polymerase chain reaction (PCR) test was positive for Aspergillus flavus. He was treated with amphotericin B and oral voriconazole with significant improvement. Physicians need to have a high index of suspicion for invasive fungal sino-orbital infections, even in immunocompetent patients. The presence of nasal congestion, recurrent sinusitis, facial pain, headache, orbital cellulitis, proptosis, or ophthalmoplegia should prompt early investigations.
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Affiliation(s)
- Salil Mehta
- Ophthalmology, Lilavati Hospital, Mumbai, IND
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Sousa B, Silva J, Araújo E, Costa R, Calheiros A. Herpetic Esophagitis: A Cause of Dysphagia in a Malnourished Patient. Cureus 2023; 15:e43858. [PMID: 37736443 PMCID: PMC10510948 DOI: 10.7759/cureus.43858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Herpetic esophagitis (HE) is an esophageal infection caused by herpes simplex virus (HSV). Although less common, it can occasionally affect immunocompetent hosts. It can manifest as odynophagia and/or dysphagia and should lead to an investigation by upper digestive endoscopy with a biopsy. The authors report a case of a 65-year-old man with a past medical history relevant for schizophrenia, oligophrenia, and malnutrition, and no other history or evidence of immunosuppression, who presented with severe dysphagia over weeks and recent episodes of food aspiration with consequent pneumonia. An upper gastrointestinal endoscopy was performed, revealing severe stenosis at the level of the gastroesophageal junction with scar tissue, not transposable with the endoscope. The biopsy led to the diagnosis of hepatic esophagitis. Despite the immunocompetent status (excepting only the risk factor malnutrition) and treatment with acyclovir, with initial clinical improvement, the patient died a few weeks after diagnosis after multiple respiratory complications such as nosocomial infection. This case highlights that herpetic esophagitis is sometimes observed in immunocompetent hosts. HE has a self-limited course, with severe complications more frequent in immunosuppressed patients. However, it is also important to suspect this condition in immunocompetent patients and look for risk factors, given the potential morbidity this disease entails. In this group of patients, the presence of predisposing factors and associated comorbidities, such as malnutrition, alcohol consumption, or use of corticosteroids, have been associated with the development of viral esophagitis (including HE). HE remains a clinical challenge, especially in patients with risk factors for immunosuppression, such as malnutrition, as in the reported case.
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Affiliation(s)
- Bárbara Sousa
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Ponte de Lima, PRT
| | - Joana Silva
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Ponte de Lima, PRT
| | - Elsa Araújo
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Ponte de Lima, PRT
| | - Raquel Costa
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Ponte de Lima, PRT
| | - Andre Calheiros
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Ponte de Lima, PRT
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Tomlinson MG, Chidarala S, Lobo BC, Kalyatanda GS. Non-tuberculous Mycobacterium Rhinosinusitis in an Immunocompetent Patient. Cureus 2023; 15:e44002. [PMID: 37746497 PMCID: PMC10516704 DOI: 10.7759/cureus.44002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) are slow-growing opportunistic pathogens that cause a variety of cutaneous, soft tissue, and pulmonary infections. On rare occasions, NTM causes chronic rhinosinusitis, with the majority of cases presenting in immunocompromised individuals. Other potential risk factors include the presence of foreign bodies, previous sinus surgery or chemoradiation, and use of contaminated water in sinus rinses. We report here a rare case of NTM rhinosinusitis in an otherwise immunocompetent 66-year-old female. The patient underwent functional endoscopic sinus surgery where intraoperative acid-fast bacteria cultures grew Mycobacterium abscessus. She received five weeks of broad-spectrum IV antibiotic therapy followed by three months of oral azithromycin, tigecycline, and linezolid. A one-year post-operative visit showed appropriate healing without crusting or visible infection. This case contributes to the small handful of documented presentations of NTM rhinosinusitis in immunocompetent patients. NTM should be considered when patients present with refractory rhinosinusitis as they may require extended courses of antibiotic treatment. Familiarity with risk factors can further expedite making a diagnosis, ensuring prompt initiation of treatment and relief of symptoms for patients.
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Affiliation(s)
- Michelle G Tomlinson
- Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, USA
| | - Shreya Chidarala
- Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, USA
| | - Brian C Lobo
- Otolaryngology - Head and Neck Surgery, University of Florida, Gainesville, USA
| | - Gautam S Kalyatanda
- Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, USA
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Okan T, Esmati S, Lodeen H, Abawkaw M, Kaur J, Doshi K, Islam MA. Brain Abscess Caused by Nocardia farcinica in a Young Immunocompetent Patient. Cureus 2023; 15:e40823. [PMID: 37489194 PMCID: PMC10362991 DOI: 10.7759/cureus.40823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023] Open
Abstract
Cerebral nocardiosis is a rare opportunistic infectious disease that occurs mainly in immunocompromised hosts; however, immunocompetent patients may be affected too. It often results in the formation of intraparenchymal brain abscess, which represents only 2% of all cerebral abscesses. The overall mortality rate exceeds 20% in immunocompetent patients and 55% in immunocompromised patients. Bacteriological diagnosis is often confirmed only after the surgical excision of the abscess. Thus, the initiation of effective therapy is frequently delayed. Our goal is to highlight a diagnostic approach to cerebral nocardiosis in an immunocompetent patient with the purpose of accelerating the initiation of the appropriate therapy. We report a rare case of brain abscess caused by Nocardia farcinica in a 39-year-old male, a resident of New York City, USA, with a past medical history of intravenous (IV) drug use, who was admitted for altered mental status. The patient was cachectic and ill-appearing. Initial laboratory tests showed neutrophilic leukocytosis. Computed tomography (CT) of the head revealed a large ill-defined multilobulated mass of size 6 × 5 × 4.5 cm in the right cerebral hemisphere, which was confirmed with magnetic resonance imaging (MRI). The hospital course was complicated by the deterioration of mental status requiring endotracheal intubation. The patient underwent a right-sided hemicraniectomy; a wound culture identified Nocardia farcinica. The patient was started on intravenous (IV) Bactrim, which caused an allergic reaction. Thus, he was switched to IV imipenem-cilastatin. After E-test was performed, the patient was switched to oral linezolid. The initiation of targeted antibiotic therapy was crucial for the management of this patient and resulted in a good clinical outcome. In conclusion, cerebral nocardiosis, being an unusual and a potentially fatal infection, should be considered in the differential diagnosis of brain abscess even in immunocompetent hosts. Prompt bacteriological diagnosis helps to initiate a specific antimicrobial therapy. Long-term antimicrobial therapy and long-term follow-up are necessary to prevent relapse.
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Affiliation(s)
- Tetyana Okan
- Department of Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Saliman Esmati
- Department of Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Homayoon Lodeen
- Department of Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Michael Abawkaw
- Department of Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Jashandeep Kaur
- Department of Internal Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Kaushik Doshi
- Department of Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Md Aticul Islam
- Department of Infectious Diseases, Jamaica Hospital Medical Center, New York, USA
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Lagarto M, Santos A, Freitas BD, Anastácio M, Jesus S. The Overlooked Agent: Cytomegalovirus Colitis in an Immunocompetent Patient. Cureus 2023; 15:e36926. [PMID: 37128542 PMCID: PMC10148746 DOI: 10.7759/cureus.36926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/03/2023] Open
Abstract
Cytomegalovirus (CMV) colitis is usually associated with immunosuppressed patients, which by the classic definition are individuals who have immunosuppressed associated conditions (human immunodeficiency virus [HIV], oncology diseases, inflammatory bowel disease, transplant patients) or who are submitted to immunosuppressing therapies (for instance, corticosteroids, chemotherapeutic agents or immunomodulation therapies). In immunocompetent patients, this diagnosis tends to be often missed, leading to a delay in initiating proper management. We present a case of a 91-year-old woman that was diagnosed with CMV colitis without any identified formal immunocompromising factors. We intend to highlight the need to review the definition of an immunosuppressed individual and emphasize that CMV colitis should be considered in the differential diagnosis, especially in elderly patients and those with underlying conditions that can possibly affect their immune status, since prompt diagnosis and treatment are essential and influence the prognosis.
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Affiliation(s)
- Margarida Lagarto
- Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Ana Santos
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Bruno D Freitas
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Marta Anastácio
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Susana Jesus
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
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Song Y, Zhou M, Gong Q, Guo J. Scedosporium apiospermum and Lichtheimia corymbifera Co-Infection Due to Inhalation of Biogas in Immunocompetent Patients: A Case Series. Infect Drug Resist 2022; 15:6423-6430. [PMID: 36349214 PMCID: PMC9637341 DOI: 10.2147/idr.s388166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/27/2022] [Indexed: 01/24/2023] Open
Abstract
This is the first report describing co-infection of Scedosporium apiospermum and Lichtheimia corymbifera caused by biogas inhalation in two people without underlying medical conditions. Two patients fell into the same pig manure pit at the same time while rescuing another patient (this person died in a few hours) and inhaled biogas. Both patients were diagnosed with pulmonary fungal disease and developed acute liver failure around Day 52. Their results were negative for the 1,3-β-d-glucan test and weakly positive for the galactomannan test. They were treated with amphotericin B and/or posaconazole without surgery. The patient in case 2 required amphotericin B deoxycholate aerosol inhalation to complete the treatment. Both patients recovered completely. For patients with mucormycosis confined to the lungs who cannot tolerate intravenous drip amphotericin B, increasing the dose of nebulised administration maybe a salvage regimen.
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Affiliation(s)
- Yu Song
- Department of Intensive Care Unit, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, 030012, People’s Republic of China
| | - Mi Zhou
- Department of Pharmacy, Children’s Hospital of Soochow University, Suzhou, Jiangsu, 215000, People’s Republic of China
| | - Qingmei Gong
- Department of Intensive Care Unit, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, 030012, People’s Republic of China,Correspondence: Qingmei Gong, Intensive Care Unit, Shanxi Provincial People’s Hospital, Shuangtasi Street 59#, Taiyuan, Shanxi, 030012, People’s Republic of China, Tel +86-13934647196, Email
| | - Jinlin Guo
- Department of Pharmacy, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, 030012, People’s Republic of China,Jinlin Guo, Department of Pharmacy, Shanxi Provincial People’s Hospital, Shuangtasi Street 59#, Taiyuan, Shanxi, 030012, People’s Republic of China, Tel +86-18335136581, Email
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12
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Eimer J, Fernström L, Rohlén L, Grankvist A, Loo K, Nyman E, Henningsson AJ, Haglund M, Hultqvist V, Sjöwall J, Wennerås C, Schön T. Spiroplasma ixodetis Infections in Immunocompetent and Immunosuppressed Patients after Tick Exposure, Sweden. Emerg Infect Dis 2022; 28:1681-1685. [PMID: 35876734 PMCID: PMC9328919 DOI: 10.3201/eid2808.212524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report 2 cases of Spiroplasma ixodetis infection in an immunocompetent patient and an immunocompromised patient who had frequent tick exposure. Fever, thrombocytopenia, and increased liver aminotransferase levels raised the suspicion of anaplasmosis, but 16S rRNA PCR and Sanger sequencing yielded a diagnosis of spiroplasmosis. Both patients recovered after doxycycline treatment.
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Abravanel F, Parraud D, Chapuy-Regaud S, Miedouge M, Bonnin E, Larrieu M, Aversenq A, Lhomme S, Izopet J. Diagnostic Performance of an Automated System for Assaying Anti-Hepatitis E Virus Immunoglobulins M and G Compared with a Conventional Microplate Assay. Viruses 2022; 14. [PMID: 35632806 DOI: 10.3390/v14051065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/17/2022] Open
Abstract
To evaluate the diagnostic performance of the Liaison® Murex anti-HEV IgM and IgG assays running on the Liaison® instrument and compare the results with those obtained with Wantai HEV assays. We tested samples collected in immunocompetent and immunocompromised patients during the acute (HEV RNA positive, anti-HEV IgM positive) and the post-viremic phase (HEV RNA negative, anti-HEV IgM positive) of infections. The specificity was assessed by testing HEV RNA negative/anti-HEV IgG-IgM negative samples. The clinical sensitivity of the Liaison® IgM assay was 100% for acute-phase samples (56/56) and 57.4% (27/47) for post-viremic samples from immunocompetent patients. It was 93.8% (30/32) for acute-phase (viremic) samples and 71%% (22/31) for post-viremic samples from immunocompromised patients. The clinical sensitivity of the Liaison® IgG assay was 100% for viremic samples (56/56) and 94.6% (43/47) for post-viremic samples from immunocompetent patients. It was 84.3% (27/32) for viremic samples and 93.5% (29/31) for post-viremic samples from immunocompromised patients. Specificity was very high (>99%) in both populations. We checked the limit of detection stated for the Liaison® IgG assay (0.3 U/mL). The clinical performance of the Liaison® ANTI-HEV assays was good. These rapid, automated assays for detecting anti-HEV antibodies will greatly enhance the arsenal for diagnosing HEV infections.
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Xu Y, Yang Q, Zhou J, Zhou F, Hezhang Y, Gao Y, Shao L, Shi J, Ruan Q, Zhang W. Comparison of QuantiFERON-TB Gold In-Tube and QuantiFERON-TB Gold-Plus in the Diagnosis of Mycobacterium tuberculosis Infections in Immunocompromised Patients: a Real-World Study. Microbiol Spectr 2022;:e0187021. [PMID: 35234509 DOI: 10.1128/spectrum.01870-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
QuantiFERON-TB Gold Plus (QFT-Plus) is an emerging QuantiFERON test after QuantiFERON-TB Gold In-Tube (QFT-GIT) for tuberculosis infection detection; it is an IFN-γ release assay. We compared QFTPlus, which has an additional TB antigen 2 (TB2) tube to induce cell-mediated (CD8+ T cell) immune responses, with QFT-GIT. We conducted this study to assess the agreement of the QFT-GIT and QFT-Plus assays in immunocompromised patients in a clinical setting. A total of 278 immunocompromised patients and 175 immunocompetent patients from different departments were continuously enrolled from August 2020 to March 2021, and each patient underwent both tests. Correlations between QFT-GIT and QFT-Plus assays showed good agreement (κ value = 0.859). Patients receiving long-term immunosuppressant therapy had the lowest concordance between QFT-GIT and QFT-Plus assays; 9 out of 11 positive latent tuberculosis infection (LTBI) cases were diagnosed by the QFT-Plus assay, implying that QFT-Plus may detect more LTBI than QFT-GIT does in these patients. Indeterminate results were associated with lower lymphocyte, CD4+ T cell, and CD8+ T cell absolute counts, and with lower CD4/CD8 ratios. In conclusion, we found that the QFT-GIT and QFT-Plus assays had high agreement not only in immunocompetent patients but also in immunocompromised patients. QFT-Plus may detect more LTBI than QFT-GIT in patients receiving long-term immunosuppressant therapy. Thresholds were established for lymphocyte absolute counts of >1.15 × 109 cells, and for CD4+ T cell absolute counts of >467.7 × 106 to 478.5 × 106 cells, which may lessen the incidence of indeterminate results. IMPORTANCE This study evaluated the performance of QFT-GIT and QFT-Plus in the diagnosis of M. tuberculosis infection in immunocompromised patients and found that QFT-Plus may detect more LTBI than QFT-GIT does in patients receiving long-term immunosuppressant therapy. We believe that our study makes a significant contribution to the literature because it highlights the different diagnostic accuracies of QFT-GIT and QFT-Plus in different subpopulations of immunocompromised and immunocompetent patients. Selecting a test with better performance, particularly in patients with a high risk of developing active TB, may assist the health sector in better managing TB. Furthermore, we believe that this study will be of significance to the diagnosis of LTBI.
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Abstract
Reactivation of herpsviruses, mainly HSV, CMV and EBV, are frequent among critically ill patients. Although they are not immunocompromised from a classical point of view, these patients often present an alteration of their immune system favoring viral reactivation. Seropositive patients with sepsis and under mechanical ventilation are particularly at risk. Herpesviruses have a pulmonary tropism and can be responsible for non-resolving forms of acute respiratory distress syndrome with high mortality. However, the direct causality between herpesviruses reactivation and impaired outcomes among severely ill patients remains under debate.
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Zavaglio F, Frangipane V, Morosini M, Gabanti E, Zelini P, Sammartino JC, Ferrari A, Gregorini M, Rampino T, Asti A, Seminari E, Di Matteo A, Cattadori B, Pellegrini C, Tonello S, Mallela VR, Minisini R, Rizzi M, Sainaghi PP, Meloni F, Lilleri D, Baldanti F. Robust and Persistent B- and T-Cell Responses after COVID-19 in Immunocompetent and Solid Organ Transplant Recipient Patients. Viruses 2021; 13:2261. [PMID: 34835067 DOI: 10.3390/v13112261] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 12/18/2022] Open
Abstract
The development and persistence of SARS-CoV-2-specific immune response in immunocompetent (IC) and immunocompromised patients is crucial for long-term protection. Immune response to SARS-CoV-2 infection was analysed in 57 IC and 15 solid organ transplanted (TX) patients. Antibody responses were determined by ELISA and neutralization assay. T-cell response was determined by stimulation with peptide pools of the Spike, Envelope, Membrane, and Nucleocapsid proteins with a 20-h Activation Induced Marker (AIM) and 7-day lymphoproliferative assays. Antibody response was detected at similar levels in IC and TX patients. Anti-Spike IgG, IgA and neutralizing antibodies persisted for at least one year, while anti-Nucleocapsid IgG declined earlier. Patients with pneumonia developed higher antibody levels than patients with mild symptoms. Similarly, both rapid and proliferative T-cell responses were detected within the first two months after infection at comparable levels in IC and TX patients, and were higher in patients with pneumonia. T-cell response persisted for at least one year in both IC and TX patients. Spike, Membrane, and Nucleocapsid proteins elicited the major CD4+ and CD8+ T-cell responses, whereas the T-cell response to Envelope protein was negligible. After SARS-CoV-2 infection, antibody and T-cell responses develop rapidly and persist over time in both immunocompetent and transplanted patients.
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Lijeskić O, Štajner T, Srbljanović J, Radosavljević A, Bobić B, Klun I, Stanojević-Paović A, Djurković-Djaković O. Postnatal ocular toxoplasmosis in immunocompetent patients. J Infect Dev Ctries 2021; 15:1515-1522. [PMID: 34780375 DOI: 10.3855/jidc.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Ocular toxoplasmosis is the most common cause of infectious posterior uveitis worldwide. It can be prenatal or postnatal in origin. Despite estimations that postnatal ocular toxoplasmosis is more prevalent, only several cases of proven postnatal ocular toxoplasmosis have been reported in non-epidemic settings. Here, the clinical evolution of ocular toxoplasmosis of conclusively proven postnatal origin in immunocompetent patients is reported. METHODOLOGY Postnatal ocular toxoplasmosis was diagnosed based on clinical diagnosis supported by the longitudinal detection of Toxoplasma gondii-specific IgG, IgM and IgA antibodies in the serum as well as by direct detection of the parasite (bioassay) and/or its DNA (real-time PCR) in aqueous humor. RESULTS Three cases involved adults in whom ocular toxoplasmosis developed during primary T. gondii infection, as part of the clinical presentation in two and as the sole manifestation in one patient. The fourth patient was a case of inactive ocular toxoplasmosis in a 14-year-old boy, where postnatal infection was confirmed by exclusion of maternal infection. The causative parasite strain was genotyped in only one case and it belonged to genotype II, the dominant type in Europe. One patient acquired the infection in Africa, suggesting an atypical strain. CONCLUSIONS The distinction between prenatal and postnatal ocular toxoplasmosis is only possible in particular clinical situations, and requires extensive laboratory investigation. Genotyping of the parasite strain involved may be important, particularly if atypical strains are suspected, requiring tailored treatment approaches.
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Affiliation(s)
- Olivera Lijeskić
- National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Tijana Štajner
- National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Jelena Srbljanović
- National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | | | - Branko Bobić
- National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Ivana Klun
- National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | | | - Olgica Djurković-Djaković
- National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, Belgrade, Serbia.
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Alotaibi NH, Omar OA, Altahan M, Alsheikh H, Al Mana F, Mahasin Z, Othman E. Chronic Invasive Fungal Rhinosinusitis in Immunocompetent Patients: A Retrospective Chart Review. Front Surg 2020; 7:608342. [PMID: 33392248 PMCID: PMC7772145 DOI: 10.3389/fsurg.2020.608342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: We report cases of Chronic Invasive Fungal Sinusitis (CIFS) in patients considered as immunocompetent at tertiary care center (King Faisal Specialist Hospital), to analyze their clinical, biological, radiological features, and management. Material and methods: A retrospective chart review of CIFS in immunocompetent patients. The inclusion criteria as the following: immunocompetent patients of any age with histopathological findings of CIFS. Immunocompromised patients, acute Invasive Fungal Sinusitis (IFS), non-invasive fungal rhinosinusitis, and no positive histological findings were excluded. Results: Seventeen (17) patients were included. The species isolated included: Aspergillus (most frequent) & Mucor. Surgical treatment approaches were described. Complications reported include CSF leak, blindness, recurrence, and death. Conclusions: Early diagnosis and management of CIFS improve clinical outcomes.
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Affiliation(s)
- Naif H Alotaibi
- Department of Otolaryngology, Head and Neck Surgery and Communication Sciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Omar Abu Omar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mays Altahan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Haifa Alsheikh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fawziah Al Mana
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zeyad Mahasin
- Department of Otolaryngology, Head and Neck Surgery and Communication Sciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Eyas Othman
- Department of Otolaryngology, Head and Neck Surgery and Communication Sciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Huang L, Sun L, Yan Y. Characteristics of nocardiosis patients with different immune status from a Chinese tertiary general hospital during 8-year period: A STROBE-compliment observational study. Medicine (Baltimore) 2019; 98:e17913. [PMID: 31702669 PMCID: PMC6855654 DOI: 10.1097/md.0000000000017913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nocardia is an opportunistic pathogen from environment, which is generally thought to infect immunosuppressed patients (ISPs), but recent studies showed it could also cause infections in immunocompetent patients (ICPs).The aim of this study was to compare the clinical characteristics, patients' outcome, Nocardia species' identification, and antibiotic susceptibility profiles of nocardiosis between ICPs and ISPs.The detailed clinical data were collected from all the nonrepetitive nocardiosis patients during 2011 and 2018, from a tertiary general hospital in Beijing, China. Then each Nocardia isolate was identified to species level by DNA sequencing. The antibiotic susceptibility testing was performed by E test method, and interpreted following CLSI M24 document. The clinical and microbiological characteristics between ICPs and ISPs were compared statistically.A total of 23 nonrepetitive nocardiosis patients with detailed clinical data were enrolled in this study. Among them, 9 were ICPs and 14 were ISPs. All the skin and soft tissue infections occurred in ICPs (33.3% vs 0%, P < .05). Bronchiectasis occurred more frequently in ICPs (44.4% vs 21.4%), whereas chronic kidney diseases and coinfection with aspergillosis occurred more frequently in ISPs (35.7% vs 0%, 35.7% vs 0%, respectively), although they did not reach the statistical significance. There were no significant differences in other clinical characteristics, Nocardia species' identification, and antibiotic susceptibility between ISPs and ICPs (P > .05).Nocardiosis could occur in both ISPs and ICPs. Skin and soft tissue infection and bronchiectasis occurred more frequently in ICPs. Chronic kidney diseases and co-infection with aspergillosis occurred more frequently in ISPs. These characteristics should be noticed by physicians in diagnosis of nocardiosis.
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Bertin N, Brosolo G, Pistola F, Pelizzo F, Marini C, Pertoldi F, Vriz O. Capnocytophaga canimorsus: An Emerging Pathogen in Immunocompetent Patients-Experience from an Emergency Department. J Emerg Med 2018; 54:871-5. [PMID: 29523423 DOI: 10.1016/j.jemermed.2018.01.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Capnocytophaga canimorsus is a bacterium of the normal oral flora of dogs and cats. Human infection is caused by animal bite but is rarely observed, mainly in immunocompromised patients. We present 2 cases of C. canimorsus infection that occurred in immunocompetent patients and caused multiorgan failure and in both cases severe neurologic involvement. CASE REPORT In the first case, we present a 69-year-old immunocompetent woman with septic shock derived from skin and soft tissue infection after a dog's bite. She developed ischemic necrosis evolving to gangrene of both forefeet and hands, infective aortic endocarditis, and neurologic involvement caused by large hemispheric hypodense lesions compatible with ischemic septical lesions. In the second case, we present a 65-year-old immunocompetent man with meningitis after a dog's bite. Despite antibiotic therapy, he developed neurologic clinical deterioration, with right sensitive hemisyndrome associated with lack of strength and motor skills of the right hand. Radiologic findings were consistent with the diagnosis of cerebritis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians should always be aware of this pathogen, both in immunocompromised and immunocompetent patients, and consider prophylactic antibiotics after exposure.
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Yang R, Yan Y, Wang Y, Liu X, Su X. Plain and contrast-enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients. Exp Ther Med 2017; 14:4417-4424. [PMID: 29104652 DOI: 10.3892/etm.2017.5096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/23/2017] [Indexed: 11/05/2022] Open
Abstract
Pulmonary cryptococcosis is most commonly reported in immunocompromised patients, whereas immunocompetent hosts are rarely affected and may be asymptomatic, resulting in reduced diagnostic performance of computed tomography (CT) imaging. Thus, the aim of the present study was to review the plain and contrast-enhanced chest CT scan findings of primary pulmonary cryptococcosis in immunocompetent patients, with the aim of improving the diagnosis of this type of pulmonary disease. In the present study, a total of 27 immunocompetent patients of clinically confirmed pulmonary cryptococcosis were analyzed retrospectively. Of the 27 patients, 14 patients underwent plain and contrast-enhanced chest CT scans, while 13 patients only underwent plain chest CT scanning. The clinical and imaging characteristics, including the location, shape, size, number, edge and attenuation or intensity of each lesion, in unenhanced and contrast-enhanced CT scans were reviewed. The results indicated that the most common CT finding was pulmonary nodules (40.74%), with multiple nodules (25.93%) being more common compared with solitary nodules (14.81%). The majority of the nodules were poorly defined and inhomogeneous with observed air-bubble sign. Other findings included consolidation (25.93%), ground-glass opacities (GGO; 22.22%) and a mass (11.11%). The halo, air bronchogram and cavity signs were observed more frequently (22.22, 18.52 and 14.81%, respectively). The pulmonary lesions presented a predominant distribution in the lower lung lobes and peripheral area in 55.55 and 74.07% of the cases, respectively. On the contrast-enhanced CT images, the majority of nodules presented ring enhancement with the mean maximal enhancement value of 20.92±5.67 Hu, and masses demonstrated inhomogeneous enhancement with a mean maximal enhancement value of 35.61±8.32 Hu. In conclusion, familiarity with the CT findings and occupational environment exposure history will assist in earlier and easier diagnosis of pulmonary cryptococcosis in immunocompetent patients.
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Affiliation(s)
- Rongshui Yang
- Department of Radiology, Xinglin Branch Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Yan Yan
- Department of Radiology, Xinglin Branch Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Yuhuan Wang
- Department of Pathology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Xiaohuan Liu
- Department of Radiology, Xinglin Branch Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Xinhui Su
- Department of Nuclear Medicine, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
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Bai Y, Wang Z, Sun K, Yao H. HHV-6-associated acute lymphadenitis in immunocompetent patients: a case report and review of literature. Int J Clin Exp Pathol 2014; 7:3413-3417. [PMID: 25031769 PMCID: PMC4097211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/26/2014] [Indexed: 06/03/2023]
Abstract
Human herpesvirus type 6 (HHV-6) has been well described as an agent in immunocompromised hosts, but is a rare cause of acute lymphadenitis in immunocompetent adults. We report an immunocompetent adult with HHV-6-associated acute lymphadenitis. The patient was an elderly man who presented with fever and generalized lymphadenopathy. Microscopically, the lymph node showed diffuse paracortical expansion and scattered large atypical lymphoid cells with large nucleus and eosinophilic nucleoli, resembled immunoblasts. Intranuclear eosinophilic viral inclusions can be found. Immunohistochemical study showed that the large atypical lymphoid cells were positive for CD3 and CD4, but negative for CD8, CD20, CD79a, CD30, ALK, CK, EBV-LMP, and CD56. The antibody against HHV-6 envelope glycoprotein highlighted the viral inclusions which were mostly cytoplasmic with a Golgi distribution. Literatures of HHV-6 associated acute lymphadenitis in immunocompetent patients were reviewed.
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Affiliation(s)
- Yanfeng Bai
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University Hangzhou, Zhejiang Province, China
| | - Zhaoming Wang
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University Hangzhou, Zhejiang Province, China
| | - Ke Sun
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University Hangzhou, Zhejiang Province, China
| | - Hongtian Yao
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University Hangzhou, Zhejiang Province, China
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