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https://www.readbyqxmd.com/read/28088990/prevention-and-management-of-glucocorticoid-induced-side-effects-a-comprehensive-review-infectious-complications-and-vaccination-recommendations
#1
REVIEW
Avrom Caplan, Nicole Fett, Misha Rosenbach, Victoria P Werth, Robert G Micheletti
Part 3 of this 4-part continuing medical education series reviews several important infectious complications of corticosteroid use, including a focus on pneumocystis pneumonia (PCP) prophylaxis, tuberculosis, viral hepatitis, and other infections, followed by a discussion of vaccination recommendations in immunosuppressed patients.
February 2017: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/28080991/minimizing-fungal-disease-deaths-will-allow-the-unaids-target-of-reducing-annual-aids-deaths-below-500-000-by-2020-to-be-realized
#2
REVIEW
David W Denning
Deaths from AIDS (1 500 000 in 2013) have been falling more slowly than anticipated with improved access to antiretroviral therapy. Opportunistic infections account for most AIDS-related mortality, with a median age of death in the mid-30s. About 360 000 (24%) of AIDS deaths are attributed to tuberculosis. Fungal infections deaths in AIDS were estimated at more than 700 000 deaths (47%) annually. Rapid diagnostic tools and antifungal agents are available for these diseases and would likely have a major impact in reducing deaths...
December 5, 2016: Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences
https://www.readbyqxmd.com/read/28074607/the-use-of-intravenous-pentamidine-for-the-prophylaxis-of-pneumocystis-pneumonia-in-pediatric-patients
#3
Matthijs D Kruizinga, Dorine Bresters, Frans J Smiers, Arjan C Lankester, Robbert G M Bredius
Pneumocystis jiroveci pneumonia was common in the immunocompromised host before the widespread use of prophylaxis. When trimethoprim-sulfamethoxazole is not tolerated, prophylaxis with intravenous pentamidine (IVP) may be initiated. We performed a retrospective analysis of all pediatric patients who received IVP regarding efficacy, safety, and reason for initiation. Of 106 patients included in our analysis, one patient tested positive for Pneumocystis DNA. Adverse events were reported in 18% of IVP courses, and main reason for initiation was cytopenia (59%)...
January 11, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28062161/-rapid-diagnostic-test-for-respiratory-infections
#4
José María Marimón, José María Navarro-Marí
Acute respiratory infections are the second cause of morbidity and mortality in children and adults worldwide, being viruses, bacteria and fungi involved in their etiology. The rapid diagnosis allows for a better clinical management of the patient, for adopting public health measures and for controlling possible outbreaks. The main etiologic agents can be diagnosed within the first hours after the onset of symptoms with antigen detection techniques, primarily immunochromatography. Results are obtained in 15-30minutes, with 70-90% sensitivity and >95% specificity for the diagnosis of Streptococcus pneumoniae and Legionella pneumophila serogroup O1 infections from urine, Streptococcus pyogenes from throat swabs and respiratory syncytial virus from nasopharyngeal aspirates...
January 3, 2017: Enfermedades Infecciosas y Microbiología Clínica
https://www.readbyqxmd.com/read/28050417/diffuse-parenchymal-lung-diseases-with-clinicoradiological-discordance-role-of-transbronchial-lung-biopsy-as-a-diagnostic-tool-an-observational-study
#5
K P Suraj, Kiran Vishnu Narayan, Jyothi Edakalavan, Neethu Kesava Kumar
INTRODUCTION: The diagnosis of Diffuse Parenchymal Lung Disease (DPLD) requires a multidisciplinary approach with reconciliation of clinicoradiological and histopathological data. But when the preliminary clinicoradiological profile fails to suggest a diagnosis, an adequate lung biopsy specimen with meticulous histological examination and a multidisciplinary approach usually yields results. There is also a high chance of sampling error due to patchy and heterogeneous involvement of the disease process and due to the small volume of tissue taken...
November 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28035717/the-role-of-cd4-cell-count-as-discriminatory-measure-to-guide-chemoprophylaxis-against-pneumocystis-jirovecii-pneumonia-in-human-immunodeficiency-virus-negative-immunocompromised-patients-a-systematic-review
#6
Peter E Messiaen, Senne Cuyx, Tom Dejagere, Jeroen C Van der Hilst
BACKGROUND: In recent years, the incidence of Pneumocystis jirovecii pneumonia (PJP) has increased in immunocompromised patients without human immunodeficiency virus (HIV) infection. Chemoprophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is highly effective in preventing PJP in both HIV-positive and -seronegative patients. In HIV-positive patients, the risk of PJP is strongly correlated with decreased CD4 cell count. The role of CD4 cell count in the pathogenesis of PJP in non-HIV immunocompromised patients is less well studied...
December 30, 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28033170/a-rare-cause-of-cavitary-lung-lesions
#7
Nika Pierre-Louis, Brian Dlugos
Pneumocystis jirovecii pneumonia (PJP) is a common infection among susceptible patients with compromised immune function and can lead to life-threatening complications without prompt recognition and appropriate treatment. Clinicians should be aware that patients can develop severe infection even while receiving approved prophylactic medications for PJP. Furthermore, atypical radiographic findings, such as the cavitary lung lesions found in the patient in this case report, can make the diagnosis even more challenging...
January 2017: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/28031260/immunization-with-pca1-protects-mice-against-pneumocystis-pneumonia-and-generates-antibody-to-pneumocystis-jirovecii
#8
Brenda L Tesini, Terry W Wright, Jane E Malone, Constantine G Haidaris, Martha Harber, Andrea J Sant, Jennifer L Nayak, Francis Gigliotti
Pneumocystis pneumonia (PcP) is a life-threatening infection that affects immunocompromised individuals. Nearly half of all PcP cases occur in those prescribed effective chemoprophylaxis, suggesting that additional preventive methods are needed. To this end, we have identified a unique mouse Pc surface protein, designated Pneumocystis cross-reactive antigen 1 (Pca1), as a potential vaccine candidate. Mice were immunized with a recombinant fusion protein containing Pca1. Subsequently, CD4(+) T cells were depleted and the mice were exposed to P...
December 28, 2016: Infection and Immunity
https://www.readbyqxmd.com/read/28019110/severe-kaposi-sarcoma-in-an-urban-public-hospital
#9
Shirin Kasturia, Clifford Gunthel, Cheng Zheng, Minh Ly Nguyen
INTRODUCTION: The national incidence of epidemic Kaposi Sarcoma (KS) has decreased dramatically since the availability of combined antiretroviral therapy (cART). Despite national trends, we continue to see admissions for KS. Methods: Electronic medical records were queried to identify patients with HIV who were admitted with active KS between 2010 and 2013 and records were reviewed to determine patient characteristics and factors affecting survival. Data were collected from all hospital admissions until death or May 1, 2015...
December 26, 2016: AIDS Research and Human Retroviruses
https://www.readbyqxmd.com/read/28018911/a-quantitative-model-to-estimate-drug-resistance-in-pathogens
#10
Frazier N Baker, Melanie T Cushion, Aleksey Porollo
Pneumocystis pneumonia (PCP) is an opportunistic infection that occurs in humans and other mammals with debilitated immune systems. These infections are caused by fungi in the genus Pneumocystis, which are not susceptible to standard antifungal agents. Despite decades of research and drug development, the primary treatment and prophylaxis for PCP remains a combination of trimethoprim (TMP) and sulfamethoxazole (SMX) that targets two enzymes in folic acid biosynthesis, dihydrofolate reductase (DHFR) and dihydropteroate synthase (DHPS), respectively...
December 2016: Journal of Fungi (Basel, Switzerland)
https://www.readbyqxmd.com/read/28013116/low-risk-of-pneumonia-from-pneumocystis-jirovecii-infection-in-patients-with-inflammatory-bowel-disease-receiving-immune-suppression
#11
Thomas G Cotter, Nicola Gathaiya, Jelena Catania, Edward V Loftus, William J Tremaine, Larry M Baddour, W Scott Harmsen, Alan R Zinsmeister, William J Sandborn, Andrew H Limper, Darrell S Pardi
BACKGROUND & AIMS: Use of immunosuppressants and inflammatory bowel disease (IBD) may increase the risk of pneumonia caused by Pneumocystis jirovecii (PJP). We assessed the risk of PJP in a population-based cohort of patients with IBD treated with corticosteroids, immune-suppressive medications, and biologics. METHODS: We performed a population-based cohort study of residents of Olmsted County, Minnesota, diagnosed with Crohn's disease (n=427) or ulcerative colitis (n=510) from 1970 through 2011...
December 21, 2016: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28013100/the-impact-of-highly-active-antiretroviral-therapy-on-obstetric-conditions-a-review
#12
REVIEW
Hannah M Sebitloane, Dhayendre Moodley
HIV is the leading cause of maternal and neonatal morbidity and mortality in resource constrained countries. Highly active antiretroviral treatment (HAART) initiated in pregnancy has now almost eliminated mother to child transmission of the virus, and is beginning to show the desired effect of reducing HIV related maternal mortality. By modulating host immunological responses HAART has the potential to alter infections during pregnancy, in addition to modifying clinical conditions such as preeclampsia. There is increasing evidence of the benefits of HAART given to pregnant women, however there is paucity of data that distinguishes HIV or HAART as the cause or exacerbation of pre-existing medical conditions or conditions specific to pregnancy...
December 9, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28012778/b-cell-and-antibody-responses-in-mice-induced-by-a-putative-cell-surface-peptidase-of-pneumocystis-murina-protect-against-experimental-infection
#13
Sanbao Ruan, Yang Cai, Alistair J Ramsay, David A Welsh, Karen Norris, Judd E Shellito
RATIONALE: Pneumocystis pneumonia is a major cause of morbidity and mortality in HIV-infected subjects, cancer patients undergoing chemotherapy and solid organ transplant recipients. No vaccine is currently available. By chemical labeling coupled with proteomic approach, we have identified a putative surface protein (SPD1, Broad Institute gene accession number PNEG_01848) derived from single suspended P. murina cysts. SPD1 was expressed in an insect cell line and tested for vaccine development...
December 21, 2016: Vaccine
https://www.readbyqxmd.com/read/28005039/-intrauterine-pneumocystis-infection
#14
E R Samitova, T N Ermak, I E Koltunov, A N Kislyakov, N V Karazhas, T N Rybalkina, M Yu Kornienko
Pneumocystosis is well known as an opportunistic infection that is presently most frequently registered in patients with HIV infection and in those with other immunodeficiency states. Earlier, after the Second World War, Pneumocystis pneumonia was most commonly detected in debilitated and premature children; nosocomial outbreaks of pneumocystosis were studied in detail in the 1960s and 1970s. The pathogen is transmitted through the air, but a number of references indicate that it can be transmitted through the placenta...
2016: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/27997332/delivering-on-antimicrobial-resistance-agenda-not-possible-without-improving-fungal-diagnostic-capabilities
#15
David W Denning, David S Perlin, Eavan G Muldoon, Arnaldo Lopes Colombo, Arunaloke Chakrabarti, Malcolm D Richardson, Tania C Sorrell
Antimicrobial resistance, a major public health concern, largely arises from excess use of antibacterial and antifungal drugs. Lack of routine diagnostic testing for fungal diseases exacerbates the problem of antimicrobial drug empiricism, both antibiotic and antifungal. In support of this contention, we cite 4 common clinical situations that illustrate this problem: 1) inaccurate diagnosis of fungal sepsis in hospitals and intensive care units, resulting in inappropriate use of broad-spectrum antibacterial drugs in patients with invasive candidiasis; 2) failure to diagnose chronic pulmonary aspergillosis in patients with smear-negative pulmonary tuberculosis; 3) misdiagnosis of fungal asthma, resulting in unnecessary treatment with antibacterial drugs instead of antifungal drugs and missed diagnoses of life-threatening invasive aspergillosis in patients with chronic obstructive pulmonary disease; and 4) overtreatment and undertreatment of Pneumocystis pneumonia in HIV-positive patients...
February 15, 2017: Emerging Infectious Diseases
https://www.readbyqxmd.com/read/27993972/differential-macrophage-polarization-from-pneumocystis-in-immunocompetent-and-immunosuppressed-hosts-potential-adjunctive-therapy-during-pneumonia
#16
Vijayalakshmi Nandakumar, Deanne Hebrink, Paige Jenson, Theodore Kottom, Andrew Limper
We explored differential polarization of macrophages during infection using a rat model of Pneumocystis pneumonia. We observed enhanced pulmonary M1 macrophage polarization in immunosuppressed (IS) hosts, but an M2 predominant response in immunocompetent (IC) hosts following Pneumocystis carinii (Pc) challenge. Increased inflammation and iNOS levels characterized the M1 response. However, macrophage ability to produce nitric oxide was defective. In contrast, the lungs of IC animals revealed a prominent M2 gene signature and these macrophages effectively elicited an oxidative burst associated with clearance of Pneumocystis In addition, during Pc-infection the expression of Dectin-1, a critical receptor for recognition and clearance of Pc, was upregulated in macrophages of IC animals but was suppressed in IS animals...
December 19, 2016: Infection and Immunity
https://www.readbyqxmd.com/read/27990117/a-case-of-proliferative-diabetic-retinopathy-with-hiv-infection-in-which-haart-possibly-influenced-the-prognosis-of-visual-function
#17
Takakuni Kitagaki, Takaki Sato, Junko Hirai, Daisaku Kimura, Keigo Kakurai, Masanori Fukumoto, Kensuke Tajiri, Takatoshi Kobayashi, Teruyo Kida, Shota Kojima, Tsunehiko Ikeda
BACKGROUND: We report on a patient with proliferative diabetic retinopathy (PDR) and human immunodeficiency virus (HIV) infection who exhibited extremely active PDR followed by a rapid onset of blindness in the right eye. The progression of visual disturbance in the patient's left eye was slowed after starting highly active anti-retroviral therapy (HAART), and vision in that eye was rescued after vitrectomy. CASE REPORT: A 72-year-old male developed pneumocystis carinii pneumonia stemming from an HIV infection and began HAART at the Department of Hematology, Osaka Medical College, Takatsuki City, Japan...
September 2016: Case Reports in Ophthalmology
https://www.readbyqxmd.com/read/27965450/functional-characterization-of-pneumocystis-carinii-inositol-transporter-1
#18
Melanie T Cushion, Margaret S Collins, Thomas Sesterhenn, Aleksey Porollo, Anish Kizhakkekkara Vadukoot, Edward J Merino
: Fungi in the genus Pneumocystis live in the lungs of mammals, where they can cause a fatal pneumonia (PCP [Pneumocystis pneumonia]) in hosts with compromised immune systems. The absence of a continuous in vitro culture system for any species of Pneumocystis has led to limited understanding of these fungi, especially for the discovery of new therapies. We recently reported that Pneumocystis carinii, Pneumocystis murina, and most significantly, Pneumocystis jirovecii lack both enzymes necessary for myo-inositol biosynthesis but contain genes with homologies to fungal myo-inositol transporters...
December 13, 2016: MBio
https://www.readbyqxmd.com/read/27960210/community-acquired-pneumonia-in-latin-america
#19
Hernán A Iannella, Carlos M Luna
Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality in Latin America and the Caribbean (LAC) region. Poverty, socioeconomic factors, and malnutrition influence the incidence and outcome of CAP in LAC. In LAC, Streptococcus pneumoniae is the most frequent microorganism responsible for CAP, (incidence: 24-78%); the incidence of atypical microorganisms is similar to other regions of the world. Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a growing problem in the LAC region, with the Caribbean being the second most affected area worldwide after Sub-Saharan Africa...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27951623/clinical-significance-of-positive-pneumocystis-jirovecii-polymerase-chain-reaction-in-non-human-immunodeficiency-virus-immunocompromised-patients-in-a-real-practice
#20
Hea Yon Lee, Hye Seon Kang, Hwa Young Lee, Chin Kook Rhee, Sook Young Lee, Seok Chan Kim, Seung Joon Kim, Yeon Joon Park, Young Kyoon Kim, Ji Young Kang
Background/Aims: Pneumocystis jirovecii polymerase chain reaction (PCR) can be helpful in diagnosing Pneumocystis pneumonia (PCP); however it has limitations. We evaluated the prevalence of positive P. jirovecii PCR from non-human immunodeficiency virus (HIV) immunocompromised patients and tried to determine the risk of PCP development. Methods: Between May 2009 and September 2012, P. jirovecii PCR was performed in bronchoscopic specimens from 1,231 adult non-HIV immunocompromised patients suspected of respiratory infection...
December 13, 2016: Korean Journal of Internal Medicine
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