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[Legionnaires' disease in the Paris area: epidemiology and mortality. Apropos of a series of 81 culture-positive cases].

OBJECTIVES: Evaluate etiological circumstances and prognosis in Legionnaires' disease. METHODS: A series of 81 culture-proven cases of Legionnaires' disease was collected in the Paris area between 1989 and 1994. RESULTS: Direct immunofluorescence assay was positive for Legionella pneumophilia in 48% of the cases. Serogroup 1 was isolated in 88% of the cases. The median age of the patients was 51 years and 74% were males. Infection was nosocomial in 28% of the cases. Immunosuppression was present in 45% of the patients (transplantation, cancer, leukemia). Among the immunosuppressed patients,

Opportunistic osteomyelitis in the jaws of children on immunosuppressive chemotherapy.

PURPOSE: Four children with an osteomyelitic process in the jaw bones while on cytotoxic chemotherapy were treated by radical surgery and antimicrobial chemotherapy. PATIENTS AND METHODS: Symptoms (local swelling and pain in the jaw, necrotic gingivitis, and spontaneous loss of teeth) appeared 3 weeks, 4 weeks, and 8 months after diagnosis of leukemia, and 8 days posttransplant in a patient with severe aplastic anemia. Three had the process in the mandible and one in the maxilla. Specific diagnoses of Aspergillus flavus, Saccharomyces cerevisiae, and Actinomyces species were obtained histolog

Immunohistochemical localization of Epstein-Barr virus receptor on hyperplastic gingiva of kidney allotransplant patient immunocompromised by cyclosporin A.

The strong association between Epstein-Barr Virus (EBV) and certain tumours of the oro-maxillo-laryngeal region aroused our present interest. A pre-requisite for the molecular interplay of oncogenesis by EBV is the expression of the EBV receptor on the target cell of the host. As a possible contribution to this concept, we adopted immunohistochemical technique to examine a hyperplastic gingival tissue obtained from a subject on kidney allotransplant immunosuppressed with cyclosporin A (CSA). Our results demonstrate expression of EBV/C3d receptor on the superficial layers of the hyperplastic gi

Ogilvie's syndrome from disseminated varicella-zoster infection and infarcted celiac ganglia.

We report a patient who had refractory Hodgkin's disease and who received an autologous bone marrow transplantation and 8 months later developed abdominal pain associated with acute colonic dilation. The course of the patient was rapidly fatal due to a lobar pneumonia. Autopsy revealed signs of disseminated herpesvirus infection with marked hemorrhagic infarction of celiac sympathetic ganglia. This finding supports the hypothesis that denervation caused by virus reactivation and secondary hemorrhage is a main mechanism of acute colonic pseudoobstruction.

Pneumonia caused by Nocardia species.

There are nine species of Nocardia. Nocardia asteroides accounts for 80% of infections caused by this organism in man. N brasiliensis causes 3% to 9% of these infections, and N farcinica is being recognized with increasing frequency. We present three cases of Nocardia pneumonia two of which were caused by N asteroides and one was caused by N farcinica. These cases illustrate the diverse nature of nocardiosis and show that sometimes it is difficult to determine whether the Nocardia was community- or nosocomially-acquired.

[Cerebral toxoplasmosis in a kidney transplant patient. A clinical case and review of the literature].

Infection caused by Toxoplasma gondii is a frequent event in Portugal. When this occurs in immunocompetent individuals it is rarely a matter of concern; the contrary occurs with immunosuppressed patients or in pregnancy. Transplant patients are treated with immunosuppressive drugs which mainly disturb their mechanisms of cellular immunity, and that opens the way to infections by opportunistic intracellular microorganisms. We recently treated a renal transplant patient who suffered from cerebral toxoplasmosis, and this provided an opportunity for a review of the other 20 patients reported in me

[Disease caused by Mycobacterium kansasii in patients with HIV infection].

BACKGROUND: To describe the clinical features and response to therapy in Mycobacterium kansasii disease among HIV infected patients, an increasing problem in our setting. METHODS: A retrospective survey of all charts from patients with HIV infection with Mycobacterium kansasii infection recorded between April 1985 and December 1991. RESULTS: A total of 13 patients were identified. All of them had clinically significant respiratory tract samples with a definite M. kansasii isolation. Only three had disseminated disease. In all but two cases, CD4 cell count at diagnosis time was lower than 200

Efficacy of liposomal amphotericin B (AmBisome) in the eradication of Fusarium infection in a leukaemic patient.

We recently succeeded in eradicating a Fusarium infection by treatment with liposomal amphotericin B (L-AmB). The patient, a 22-year-old man with acute lymphoblastic leukaemia (ALL), developed fever and diffuse cutaneous maculopapular necrotising nodules during post-chemotherapy neutropenia. Fusarium verticilloides was isolated from the skin, and hyphae were observed on direct microscopy. Despite increased WBC and amphotericin B (AmB) treatment (0.7 mg/kg/day for 11 days), he remained febrile and a chest X-ray revealed pulmonary lesions. Fusarium infection was confirmed by bronchial aspirate.

Isolated ocular cryptococcosis in an immunocompetent patient.

A 62-year-old woman without evidence of immunocompromise was evaluated for uveitis and a subretinal lesion in the right eye. Laboratory evaluation, including cerebrospinal fluid analysis, revealed no apparent cause. The diagnosis of subretinal cryptococcosis was established by transscleral needle biopsy of the subretinal mass. Treatment with intravenous amphotericin B and oral 5-flucytosine brought recovery of visual acuity to 20/30-1 and resolution of the inflammation. This patient demonstrates that ocular cryptococcal infection must be suspected, even in the absence of predisposing factors o

Glioblastoma, transforming growth factor-beta, and Candida meningitis: a potential link.

The development of Candida meningitis in a patient following partial resection of a glioblastoma raised suspicion that transforming growth factor (TGF-beta), an immunosuppressive cytokine known to be produced by this tumor, would be elevated in his cerebrospinal fluid (CSF). By using a highly specific bioassay, the concentration of TGF-beta was found to be 609 pg/mL, which was 10-fold greater than the mean CSF TGF-beta value in control subjects with no neurologic disease. Increased CSF TGF-beta levels were also detected in patients with other central nervous system (CNS) diseases: malignancies

Transmission of multidrug-resistant tuberculosis among immunocompromised persons in a correctional system--New York, 1991.

During 1990 and 1991, nosocomial transmission of multidrug-resistant tuberculosis (MDR-TB) was documented in four hospitals in New York and Florida. Subsequently, additional MDR-TB outbreaks have been investigated by CDC. This report summarizes preliminary results of an investigation of transmission of MDR-TB in a correctional facility in New York.

Effects of ethanol on parameters of cellular immunity and host defense mechanisms to infectious agents.

Results of several studies have associated ethanol abuse with an increased incidence of infections, including opportunistic infections and those caused by microorganisms, as well as of certain types of cancer. Research findings from several laboratories clearly indicate that one possible mechanism in this association is an effect of ethanol on the immune system. We have developed an animal model fo ethanol ingestion in a liquid diet to study the effects of ethanol on immune responses. In most of the studies, we have used a pair-feeding design in which control animals are given a liquid diet th

[Human herpesviruses infections (I)--EBV infection and immunity in cancer patients].

Human herpesviruses have been known to be reactivated from latent infection iin immunosuppressed individuals. To assess the immunity, antibodies to human herpesviruses (VZV, HSV, CMV and EBV) were measured in patients with gastrointestinal cancer and normal persons ranging from 40 to 80 in age. CF antibodies to herpesviruses except for EBV were negative in normal persons below the age of 60 and cancer patients aged 60 and over. The CF antibody titer higher than 1:64 occurred only in young cancer patients and older normal persons. The titer of VCA antibody to EBV ranged from 1:40 to 1:160 in mo

Early bone marrow transplantation in an infant with Wiskott-Aldrich syndrome.

The Wiskott-Aldrich Syndrome (WAS) is a rare X-linked immunohematological disorder characterized by eczema, profound thrombocytopenia, and progressive immunodeficiency. Severe hemorrhage, overwhelming sepsis, or lymphoreticular malignancy usually cause death in childhood. Recently, bone marrow transplantation (BMT) has been curative in some well-established cases, but there is no general agreement about the place of BMT in infants with WAS before the development of significant immunological abnormalities. We describe the successful use of early histocompatible BMT in a 10-month-old infant in w

Immune monitoring, immune phenotyping, and precision intervention in severe pneumonia: current evidence and translational challenges

Severe pneumonia remains a major cause of mortality in critically ill patients, with severe community-acquired pneumonia representing a clinically important and representative scenario. This review focuses primarily on severe community-acquired pneumonia as the clinical context, in which outcomes are determined by the interplay between pathogen burden and heterogeneity of host responses. Beyond pathogen-directed therapies, severe pneumonia is frequently characterized by dynamic and partially overlapping states of hyperinflammation, immune dysfunction, and subsequent immunosuppression. Differen

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… Immune heterogeneity in special host populations Building upon the multidimensional dysregulation of immunopathological mechanisms described above, heterogeneity among special populations—including immunocompromised hosts, elderly patients, post-sepsis individuals, and pediatric populations—further … Immunodeficiency characteristics in immunocompromised hosts Immunocompromised hosts constitute a highly heterogeneous population, in which the source and degree of immune deficiency directly influence the pathogen spectrum, inflammatory responses, and disease progression. …

A Computational Structural Analysis of Host Insertions in the Polyproline Region of the Hepatitis E Virus pORF1 Polyprotein.

Hepatitis E virus, a single-stranded positive-sense RNA virus, is the causative agent of acute viral hepatitis in humans and can lead to chronic infection in immunocompromised individuals. In this setting, strains containing host genome insertions within the polyproline region (PPR) of the pORF1 polyprotein were characterized and shown to display an increased replication rate across all systems. Using in silico modeling of pORF1 across 25 strains, combined with molecular dynamics (MD) simulations, we explored the structural variations caused by these insertions to investigate potential mechani

Transformative approaches in SARS-CoV-2 management: Vaccines, therapeutics and future direction.

The global healthcare and economic challenges caused by the pandemic of COVID-19 reinforced the urgent demand for quick and effective therapeutic and preventative interventions. While vaccines served as the frontline of defense, antivirals emerged as adjunctive countermeasures, especially for people who developed infection, were immunocompromised, or were reluctant to be vaccinated. Beyond the serious complications of SARS-CoV-2 infection, the threats of long-COVID and the potential for zoonotic spillover continue to be significant health concerns that cannot be overlooked. Moreover, the inces

Anti-TB Drugs for Drug-Sensitive and Drug-Resistant Mycobacterium tuberculosis: A Review.

Tuberculosis (TB) is a global health challenge caused by Mycobacterium tuberculosis, with drug resistance, treatment toxicity, and treatment adherence challenges continuing to impede control efforts. The objective of this review is to explore current advancements in TB treatment, for both drug-sensitive and drug-resistant TB, focusing on pharmacologic regimens, diagnostics, and adjunctive therapies. For drug-sensitive TB, a 4-month rifapentine-moxifloxacin regimen has been proven to be non-inferior to the traditional 6-month standard, while optimized pyrazinamide dosing or faropenem substituti

Synergistic antiviral activity against human adenovirus through combination of itraconazole and brincidofovir.

BACKGROUND AND PURPOSE: Human adenovirus (HAdV) causes respiratory or gastrointestinal tract infections depending on the virus subtype. While HAdV infections are generally self-limiting in immunocompetent people, they can result in significant morbidity and mortality in immunocompromised adults and children. Due to the limited availability of effective therapeutic options, there is an urgent need for novel therapeutics to combat HAdV infection and mitigate its severity. EXPERIMENTAL APPROACH: Here, we have repurposed the clinically well-used antifungal, itraconazole, to control HAdV infection