Mycobacterium avium-intracellulare and the unpredictable course of hypercalcemia in an AIDS patient

A 37-year-old man with AIDS presented with altered mental status four weeks after stopping his medications for Mycobacterium avium-intracellulare (MAI). He had low CD4 cell count and severe hypercalcemia. Bone marrow biopsy revealed bone marrow infiltration by granulomas positive for acid-fast bacilli and cultures grew MAI. His hypercalcemia continued to worsen with the initiation of MAI therapy but we were able to treat it successfully with pamidronate and calcitonin.     

G试验水平对艾滋病合并肺孢子菌肺炎机械通气患者脱机结局的预测价值

目的 探讨G试验能否预测艾滋病合并肺孢子菌肺炎(PCP)机械通气患者的撤机.方法 回顾性分析北京佑安医院感染科监护病房2010年5月至2017年5月收治的艾滋病合并重症PCP且行机械通气治疗患者的临床资料,根据患者脱机成功与否将患者分为两组,比较两组患者G试验水平.结果 共入选49例患者,脱机成功组9例,失败组40例.两组患者基线资料比较结果显示,白蛋白、CD4计数、G试验水平差异均有统计学意义(P均＜0.05).成功组G试验水平显著低于失败组,分别为331.0 ng/L(299.0～488.7 ng/L)和267.0 ng/L(236.0～294.5 ng/L).多因素分析结果显示,血清G试验水平是影响艾滋病合并重度PCP患者能够脱机与否的独立危险因素(0R=0.978,95％CI:0.959～0.998,P=0.032).结论 G试验可以作为一项脱机结局预测指标,用来预测艾滋病合并PCP患者撤机预后.     

Macrophage accumulation in gut mucosa differentiates AIDS from chronic SIV infection in rhesus macaques

The relationship between recruitment of mononuclear phagocytes to lymphoid and gut tissues and disease in HIV and SIV infection remains unclear. To address this question, we conducted cross‐sectional analyses of dendritic cell (DC) subsets and CD163⁺ macrophages in lymph nodes (LNs) and ileum of rhesus macaques with acute and chronic SIV infection and AIDS. In LNs significant differences were only evident when comparing uninfected and AIDS groups, with loss of myeloid DCs and CD103⁺ DCs from peripheral and mesenteric LNs, respectively, and accumulation of plasmacytoid DCs and macrophages in mesenteric LNs. In contrast, there were fourfold more macrophages in ileum lamina propria in macaques with AIDS compared with chronic infection, and this increased to 40‐fold in Peyer's patches. Gut macrophages exceeded plasmacytoid DCs and CD103⁺ DCs by ten‐ to 17‐fold in monkeys with AIDS but were at similar low frequencies as DCs in chronic infection. Gut macrophages in macaques with AIDS expressed IFN‐α and TNF‐α consistent with cell activation. CD163⁺ macrophages also accumulated in gut mucosa in acute infection but lacked expression of IFN‐α and TNF‐α. These data reveal a relationship between inflammatory macrophage accumulation in gut mucosa and disease and suggest a role for macrophages in AIDS pathogenesis.     

Functional advantage of educated KIR2DL1+ natural killer cells for anti‐HIV‐1 antibody‐dependent activation

Evidence from the RV144 HIV‐1 vaccine trial implicates anti‐HIV‐1 antibody‐dependent cellular cytotoxicity (ADCC) in vaccine‐conferred protection from infection. Among effector cells that mediate ADCC are natural killer (NK) cells. The ability of NK cells to be activated in an antibody‐dependent manner is reliant upon several factors. In general, NK cell‐mediated antibody‐dependent activation is most robust in terminally differentiated CD57⁺ NK cells, as well as NK cells educated through ontological interactions between inhibitory killer immunoglobulin‐like receptors (KIR) and their major histocompatibility complex class I [MHC‐I or human leucocyte antigen (HLA‐I)] ligands. With regard to anti‐HIV‐1 antibody‐dependent NK cell activation, previous research has demonstrated that the epidemiologically relevant KIR3DL1/HLA‐Bw4 receptor/ligand combination confers enhanced activation potential. In the present study we assessed the ability of the KIR2DL1/HLA–C2 receptor/ligand combination to confer enhanced activation upon direct stimulation with HLA‐I‐devoid target cells or antibody‐dependent stimulation with HIV‐1 gp140‐pulsed CEM.NKr‐CCR5 target cells in the presence of an anti‐HIV‐1 antibody source. Among donors carrying the HLA‐C2 ligand for KIR2DL1, higher interferon (IFN)‐γ production was observed within KIR2DL1⁺ NK cells than in KIR2DL1^– NK cells upon both direct and antibody‐dependent stimulation. No differences in KIR2DL1⁺ and KIR2DL1^– NK cell activation were observed in HLA‐C1 homozygous donors. Additionally, higher activation in KIR2DL1⁺ than KIR2DL1^– NK cells from HLA–C2 carrying donors was observed within less differentiated CD57^– NK cells, demonstrating that the observed differences were due to education and not an overabundance of KIR2DL1⁺ NK cells within differentiated CD57⁺ NK cells. These observations are relevant for understanding the regulation of anti‐HIV‐1 antibody‐dependent NK cell responses.     

Multi-system infection – tuberculosis or melioidosis?

Melioidosis is a multi-system disorder which is often mistaken for tuberculosis in the Indian sub-continent. It is caused by the gram-negative bacterium Burkholderia pseudomallei. The imaging findings of melioidosis often mimic many other bacterial infections and the differentiation is sometimes difficult. The clinical manifestations of melioidosis range from asymptomatic and subclinical to acute localized forms, acute septicemia and chronic forms. We report a case of melioidosis presenting with multi-visceral abscesses (with adrenal involvement).     

Humanistic and cost burden of systemic sclerosis: A review of the literature

Background

Systemic sclerosis (SSc), or systemic scleroderma, is a chronic multisystem autoimmune disease characterised by widespread vascular injury and progressive fibrosis of the skin and internal organs. Patients with SSc have decreased survival, with pulmonary involvement as the main cause of death. Current treatments for SSc manage a range of symptoms but not the cause of the disease. Our review describes the humanistic and cost burden of SSc.

肝病和艾滋病细胞治疗的机遇和挑战——第二届全国传染病高峰论坛纪要

2017年11月3日—4日,第二届全国传染病高峰论坛——肝病和艾滋病临床免疫与细胞治疗会议在北京召开.来自感染病、免疫、创伤修复、肿瘤、生物治疗等多个领域的专家学者共聚一堂,大会围绕以下几个主题进行了学术交流和讨论:①细胞治疗政策管理法规;②艾滋病的免疫治疗;③病毒性肝炎治愈;④疑难危重肝病细胞治疗临床研究.