Clinicopathological features of pulmonary cryptococcosis with cryptococcal titan cells: a comparative analysis of 27 cases

In addition to the typical size, Cryptococcus neoformans can enlarge its size to form titan cells during infection, and its diameter can reach up to 100 μm. Clinical reports about cryptococcal titan cells are rare. Most studies focus on aspects of animal models of infection with titan cells. Herein, we report the clinical and imaging characteristics and histopathologic features of 3 patients with titan cells and 27 patients with pathogens of typical size, and describe the morphological characteristics of titan cells in details. Histologically, 3 patients with titan cells show necrosis, fibrosis and macrophage accumulation. The titan cells appear in necrotic tissue and between macrophages, and have thick wall with unstained halo around them and diameters range from 20 to 80 μm with characteristic of narrow-necked single budding. There are also organisms with typical size. All 27 patients with normal pathogens show epithelioid granulomatous lesions. There is no significantly difference in clinical and imaging feature between the two groups. Cryptococcus neoformans exhibits a striking morphological change for the formation of titan cells during pulmonary infection, which will result in misdiagnosis and under diagnosis. The histopathological changes may be new manifestation, which need to be further confirmed by the study with animal models of infection and the observation of more clinical cases. Careful observation of the tissue sections is necessary.     

Roles of Department of Clinical Laboratory in infection control

The Department of Clinical Laboratory plays an important role in the hospital and has much information about patients and pathogens. Laboratory data are essential to support clinical physicians who diagnose and treat patients. For nosocomial infections, laboratory-based surveillance is recognized as essential to confirm outbreaks. Therefore, the role of the Department of Clinical Laboratory is very important in infection control. In Tohoku University Hospital, we have an Infection Control Unit located in the Department of Clinical Laboratory. The core role of the Infection Control Unit is diagnosis, treatment and preventative healthcare associated with infections. The Infection Control Team (ICT) performs rounds in the hospital (The ICT members are ICN, ICD, a microbiological technologist and a dietician), consultations about clinical cases, infection control, and organize the regional infection control network, "Miyagi Infection Control Network". The ICT rounds are performed once a week in two wards, and two times a year for one ward. The consultations are an important role of the ICD, and concern clinical infection cases and infection control in our hospital and the other regional hospitals, and produce advice on appropriate clinical information. The regional network is important for the collection of information about the pathogens and the susceptibility of antimicrobial agents in the region. "Miyagi Infection Control Network" has held a forum 5 times a year from 1999, and 300-400 healthcare workers join the forum and discuss infection control.     

Renal failure due to BK virus infection in an immunodeficient child

We report a child with cartilage-hair hypoplasia and Hodgkin's disease who developed progressive renal failure and died following infection with a polyomavirus, BK virus. Renal biopsy showed interstitial inflammation, tubular atrophy, and intranuclear inclusions in tubular epithelium, with large numbers of papovavirus particles within the cells. BK virus infection was confirmed by polymerase chain reaction on renal biopsy material and in urine and the demonstration of a high titre of haemagglutination inhibition (HI) and IgM antibody to the virus in the patient's serum. This case emphasises the need to study in depth any unusual clinical manifestation in immunocompromised patients to delineate better the full clinical impact of less well-established pathogens such as BK virus. © 1995 Wiley-Liss, Inc.     

多重PCR检测婴幼儿腹泻样本中常见病毒

目的初步了解深圳地区引起临床婴幼儿急性腹泻中常见病毒的病原分布情况,为临床防治提供依据。方法采用多重RT-PCR方法检测婴幼儿急性腹泻常见病毒：轮状病毒（RV）、星状病毒（AstV）、诺如病毒（NV）,采用单重PCR法筛查临床腹泻标本肠道腺病毒（EAdV）。结果在440份标本中,共检出197例至少感染一种腹泻病毒,总阳性率为44.77%（197/440）,其中183例为一种病毒感染,14例（3.18%）为混合感染。4种腹泻病毒以RV感染为主,阳性率为28.64%（126/440）;其次是EAdV,阳性率为8.86%（39/440）;NV阳性率为5.45%（24/440）;AstV阳性率为1.82%（8/440）。混合感染以RV合并其他病毒感染为主,占92.86%。结论 RV、EAdV和NV是引起深圳地区婴幼儿急性腹泻的主要病毒致病原,混合感染以RV联合其他病毒感染为主,临床上应根据所感染病原体制定有针对性的诊治措施。     

Occupational biohazards affecting clinical engineers & BMETs. Part V: Skin and urogenital diseases.

BMETs and clinical engineers must be aware of the biological hazards they face in the hospital so they can take precautions to avoid work-related illnesses. A need for educational material on the subject prompted this series of papers examining various biohazards. This paper, the last in the series, reviews a variety of common diseases of the skin and urogenital systems. Common pathogens, their routes of transmission, isolation precautions, and infection control techniques are discussed. The precautions cited are not intended to constitute a full infection control program. Persons interested in further information are advised to contact the infection control officer at their facility, or the Centers for Disease Control.     

Clinical significance and antibiotic resistance patterns of Leminorella spp., an emerging nosocomial pathogen

Although Leminorella spp., members of the family Enterobacteriaceae, were previously isolated from feces and urine specimens, clinical correlates have not been studied. We conducted a retrospective study to investigate the clinical significance and disease spectrum of these organisms, as well as their antibiotic susceptibility patterns. Identification and susceptibility testing were performed by an automated system. Eighteen cases were identified retrospectively during a 28-month period (1/97 to 4/99), representing an incidence of 11 cases per 100,000 patient admissions. The medical records of 14 patients were reviewed. The average patient age was 67 years, and 78% were males. Patients had multiple and diverse underlying conditions which might have predisposed them to infection. Leminorella spp. were classified as definite pathogens in 43% of the cases, probable pathogens in 29%, and possible pathogens in 21%. In one case of asymptomatic bacteriuria, the isolate had no clinical significance. All infections but one were nosocomial. Clinical syndromes included urinary tract infection in six patients, surgical site infection in three patients, and primary bacteremia, peritonitis, respiratory tract infection, and soft tissue infection in one patient each. Isolates were uniformly susceptible to imipenem. Other beta-lactam agents had poor activity against the isolates. We conclude that Leminorella spp. are significant nosocomial pathogens that are capable of causing a variety of clinical syndromes and are resistant to multiple antibiotic agents.     

A probabilistic and decision-theoretic approach to the management of infectious disease at the ICU

The medical community is presently in a state of transition from a situation dominated by the paper medical record to a future situation where all patient data will be available on-line by an electronic clinical information system. In data-intensive clinical environments, such as intensive care units (ICUs), clinical patient data are already fully managed by such systems in a number of hospitals. However, providing facilities for storing and retrieving patient data to clinicians is not enough; clinical information systems should also offer facilities to assist clinicians in dealing with hard clinical problems. Extending an information system's capabilities by integrating it with a decision-support system may be a solution. In this paper, we describe the development of a probabilistic and decision-theoretic system that aims to assist clinicians in diagnosing and treating patients with pneumonia in the intensive-care unit. Its underlying probabilistic-network model includes temporal knowledge to diagnose pneumonia on the basis of the likelihood of laryngotracheobronchial-tree colonisation by pathogens, and symptoms and signs actually present in the patient. Optimal antimicrobial therapy is selected by balancing the expected efficacy of treatment, which is related to the likelihood of particular pathogens causing the infection, against the spectrum of antimicrobial treatment. The models were built on the basis of expert knowledge. The patient data that were available were of limited value in the initial construction of the models because of problems of incompleteness. In particular, detailed temporal information was missing. By means of a number of different techniques, among others from the theory of linear programming, these data have been used to check the probabilistic information elicited from infectious-disease experts. The results of an evaluation of a number of slightly different models using retrospective patient data are discussed as well.     

Unique Aspects of the Care of HIV-Positive Latino Patients Living in the United States

Latinos are disproportionately affected by HIV, with a higher risk of infection and a delayed presentation to care as compared to non-Hispanic whites. Over the last decade many Latinos, especially foreign-born migrants, have settled in regions of the country with historically low Latino representation. Therefore, clinicians who care for HIV-infected patients are likely to encounter Latino patients, regardless of their practice location. Providing optimal care to this population may be especially challenging for clinicians practicing in areas of newer Latino expansion, where culturally appropriate services may be sparse. In this article, we argue that an understanding of the HIV epidemic among Latinos requires an appreciation of the diversity and heterogeneity of the Latino population in the United States. We also review unique clinical aspects of HIV care among Latinos, including manifestation of co-infections with pathogens endemic in Latin America but rare in the United States.     

Lymphadenopathy and antibodies to HTLV-III in homosexual men

Summary The study provides information on the epidemiology of HTLV-III infection and the lymphadenopathy syndrome (LAP) in 374 German homosexual men. Sexual contacts in the USA and rectal enemas before receptive anal intercourse are the main risk factors associated with virus transmission. HTLV-III seropositivity is significantly correlated with LAP. Prominent clinical signs are infreqquent. Immunological and haematological abnormalities are prevalent, and the retrovirus infection is frequently associated with serological markers of other viruses (hepatitis B, herpes group viruses). Lymphadenopathy as a manifestation of HTLV-III infection is discussed within the context of AIDS-related disorders.Abbreviations AIDS Acquired Immunodeficiency Syndrome - CMV Cytomegalovirus - EBV Epstein-Barr virus - HBV Hepatitis B virus - HTLV-III Human leukaemia retrovirus type III - LAP Lymphadenopathy     

Occupational biohazards affecting clinical engineers & BMETs. Part IV: Respiratory and gastrointestinal systems.

A previously published survey indicated that clinical engineers and BMETs may not be aware of the scope of biological hazards they may encounter in their work (Baker, 1989). In this third article of a four-part series, various pathogens affecting the respiratory and gastrointestinal systems are discussed. Infection hazards and methods of transmission are examined, and recommendations are provided to help ensure the safety of CEs, BMETs, and patients. The recommendations presented include suggested disinfection procedures for contaminated equipment. Persons interested in further information are advised to contact the infection control officer at their facility, or the Centers for Disease Control.     

Severe anemia, panserositis, and cryptogenic hepatitis in an HIV patient infected with Bartonella henselae

Bartonella spp. constitute emerging pathogens of worldwide distribution. Bacillary angiomatosis is the most frequent skin manifestation of bartonelloses; nevertheless, B. henselae infection should always be considered systemic, especially in immunodeficient individuals. The authors report the case of an AIDS patient with bacillary angiomatosis, who had concurrent severe anemia, hepatitis, peritonitis, pleuritis, and pericarditis. Clinical manifestation, electronic microscopic examination of erythrocytes, and histopathology of a papule biopsy suggested a Bartonella sp. infection. Multiple genes were target by PCR and B. henselae DNA was amplified and sequenced (GenBank accession number EF196804) from the angiomatous papule. Treatment with clarithromycin resulted in resolution of the bacillary angiomatosis, fever, anemia, panserosites, and hepatitis.     

From prions to prionic viruses

The pathogens causing scrapie and other similar degenerative neurological diseases are called "prions" and classified either as viruses or, more often, as a novel class of pathogens. It is argued herein that prions are not the pathogens producing these diseases. The pathogens involved are endogenous viral systems inherited by the host. These endogenous parasites, tentatively named prionic viruses, produce the prions which are horizontally transmitted. The prions trigger the pathological manifestation of prionic viruses.     

Severe Anemia,Panserositis, and Cryptogenic Hepatitis in an HIV Patient Infected with Bartonella henselae

Bartonella spp. constitute emerging pathogens of worldwide distribution. Bacillary angiomatosis is the most frequent skin manifestation of bartonelloses; nevertheless, B. henselae infection should always be considered systemic, especially in immunodeficient individuals. The authors report the case of an AIDS patient with bacillary angiomatosis, who had concurrent severe anemia, hepatitis, peritonitis, pleuritis, and pericarditis. Clinical manifestation, electronic microscopic examination of erythrocytes, and histopathology of a papule biopsy suggested a Bartonella sp. infection. Multiple genes were target by PCR and B. henselae DNA was amplified and sequenced (GenBank accession number EF196804) from the angiomatous papule. Treatment with clarithromycin resulted in resolution of the bacillary angiomatosis, fever, anemia, panserosites, and hepatitis.     

Human cryptosporidiosis

Cryptosporidium is an enteric coccidial protozoan recognized in humans in 1976. Since its manifestation as an acquired immunodeficiency syndrome (AIDS)-related infection, new diagnostic techniques have improved recognition of Cryptosporidium oocysts, making apparent its true prevalence in human populations. Cryptosporidium represents 5 to 15% of all enteric pathogens in children in warm climate countries. It is responsible for both endemic and epidemic disease. Day-care center spread is well known, and evidence is strong for person-to-person transmission. The spectrum of illness caused by Cryptosporidium is broad, and while self-limited in immunocompetent individuals, gastrointestinal symptoms can be severe. Asymptomatic infection has been described in population surveys and outbreak investigations. Severe dehydration with malabsorption and failure-to-thrive in children from developing countries has been attributed to this organism. Intractable, incurable diarrhea can be fetal in immunosuppressed adults. Cryptosporidiosis in human immunodeficiency virus-infected individuals is declining in frequency in New York City, possibly reflecting changing sexual behaviors and comparatively low infectivity. No effective treatment for Cryptosporidium has been documented, but clinical trials are in progress.     

CCL2 as a trigger of manifestations of compensatory anti-inflammatory response syndrome in mice with severe systemic inflammatory response syndrome

Patients with compensatory anti-inflammatory response syndrome (CARS) are at a higher risk for infection with various opportunistic pathogens. CARS develops commonly in association with the manifestation of systemic inflammatory response syndrome (SIRS). In the present study, the role of SIRS-associated soluble factors on the CARS development was examined in mice with pancreatitis, a carrier of typical SIRS. Following the production of SIRS-related cytokines [tumor necrosis factor alpha and interleukin (IL)-1beta], CC chemokine ligand 2 (CCL2), IL-4, and IL-10 (typical CARS cytokines) were detected in the sera of mice with pancreatitis. CCL2 has been described as an essential chemokine for the T helper cell type 2 manifestation. CARS effector cells (cells with an ability to produce IL-4 and IL-10) were not generated from normal T cells after stimulation with SIRS-related cytokines. However, these cells were generated from normal T cells after cultivation with peripheral blood neutrophils (PMN) from SIRS mice in a dual-chamber transwell. Normal T cells did not convert to CARS effector cells after transwell cultures with PMN from normal mice. CCL2 was detected in culture fluids of PMN from SIRS mice, and PMN from normal mice did not produce CCL2 into their culture fluids. CARS effector cells did not appear in PMN-depleted SIRS mice or SIRS mice treated with anti-CCL2 monoclonal antibody, and these cells were demonstrated in PMN-depleted SIRS mice after treatment with recombinant murine CCL2. These results indicate that CCL2 produced by PMN from SIRS mice is an active molecule on the SIRS-associated CARS manifestation.     

Community-acquired pathogens associated with prolonged coughing in children: a prospective cohort study

A 2-year prospective study was performed of children with prolonged coughing to investigate the frequency of different respiratory pathogens, the rate of mixed infections, and possible differences in severity of disease between single and mixed infections. Sera from 135 children (136 episodes of prolonged coughing lasting 1-6 weeks) were tested for antibodies to different viruses and bacteria. Swabs were taken for culture and PCR to detect different viral and bacterial pathogens. One or more pathogens were found in 91 (67%) patients. One infectious agent was found in 49 (36%) patients, two agents in 35 (26%) patients, and more than two agents in seven (5%) patients. The most frequent pathogens encountered were rhinovirus (n = 43; 32%), Bordetella pertussis (n = 23; 17%) and respiratory syncytial virus (n = 15; 11%). The most frequent mixed infection was B. pertussis and rhinovirus (n = 14; 10%). No significant differences in clinical symptoms were observed between patients with or without pathogens; however, patients with mixed infections were significantly older. There was a strong seasonal influence on the number of infections, but not on the number of mixed infections. In children with prolonged coughing, there was a high frequency of mixed infections regardless of the season. However, mixed infection was not associated with increased disease severity. No clinical symptoms were found that allowed discrimination between specific pathogens.     

Porphyromonas gingivalis coinfects with KSHV in oral cavities of HIV+ patients and induces viral lytic reactivation

Kaposi's sarcoma-associated herpesvirus (KSHV) infection causes several human cancers, including Kaposi's sarcoma (KS), one of the most common AIDS-associated tumors. The involvement of the oral cavity represents one common clinical manifestation of AIDS-KS individuals with periodontal diseases and an oral carriage of a variety of pathogenic bacteria, including Porphyromonas gingivalis. In the current study, we report the clinical relevance of P. gingivalis and KSHV coinfection in the oral cavity of a cohort of HIV+ patients. Furthermore, we found that P. gingivalis conditioned medium or derived lipopolysaccharide effectively induced KSHV lytic reactivation from infected oral cells. This reactivation requires TLR4 as well as the activities of p38 and Jun N-terminal kinase- mitogen-activated protein kinase signaling pathways. Our findings reveal the mechanisms through which coinfected periodontal pathogens potentially promote oncogenic virus pathogenesis in the unique niche of immunocompromised patients.     

A case of diagnosis of Landry ascending paralysis of herpetic etiology]

One clinical and pathomorphologic case of Landry paralysis with a proven etiological role of herpetic infection is reported. Acute clinical syndrome developed as a manifestation of exacerbation of chronic inflammation in the central nervous system. Advancement of the process and generalisation of herpetic infection was connected with immunodeficiency in this patient.     

Emphysematous cholecystitis complicating liver abscess due to Clostridium baratii infection

Clostridium baratii bacteremia is a rare but severe anaerobic infection. Its major clinical features are neurological presentation, and significant risk factors include hemodialysis, intestinal disease or malignancy. We describe a case of emphysematous cholecystitis complicated by a liver abscess due to C baratii infection in a healthy adult without neurological manifestation.