Invasive Trichosporon cutaneum infection: an increasing problem in immunosuppressed patients

Trichosporon cutaneum (syn. T. beigelii), a saprophytic fungal organism normally found in the soil, is increasingly being recognized as a cause of life-threatening systemic illness in immunosuppressed patients. Of 42 cases reported in the literature, 27 (64%) have died, including all four occurring after bone marrow transplantation. We report here a 44-year-old man who developed an invasive pulmonary infection and fungemia with T. cutaneum following bone marrow transplantation. The infection was manifest by severe respiratory distress and hypoxemia despite a clear chest X-ray, and was diagnosed by the identification of fungal hyphae on a percutaneous lung aspirate and by culture of the organism from the blood. Despite the previous reports indicating that there is a high mortality rate in this situation, the patient recovered following treatment with amphotericin B, miconazole and ketoconazole. T. cutaneum needs to be recognized as a potentially serious but treatable pathogen in severely immunosuppressed patients, including bone marrow transplant recipients.     

Campylobacter fetus infection in human subjects: association with raw milk

Within a three week period, four cases of Campylobacter fetus infection were identified in a hospital in Los Angeles County. Three of the four patients had drunk large quantities of an identical brand of commercially available certified raw milk. Campylobacter fetus subspecies jejuni was isolated from the blood of these three patients. The fourth patient, who did not drink raw milk, had Campylobacter fetus subspecies intestinalis isolated from his blood. A telephone survey comparing cases and controls for possible risk factors associated with Campylobacter fetus infection confirmed the association with raw milk (P = 0.003). In a serologic survey, evidence suggested that Campylobacter fetus infection was associated with raw milk consumption.     

Campylobacter fetus Bacteremia in an Immunocompetent Traveler

Campylobacter fetus bacteremia is a rare human infection that occurs almost exclusively in the setting of advanced age, immunosuppression, human immunodeficiency virus infection, alcoholism, or recent gastrointestinal surgery. This report of C. fetus bacteremia in a 39-year-old immunocompetent traveler who ate raw beef identifies C. fetus as a potential emerging pathogen in normal hosts.Campylobacter fetus is a common pathogen of cattle, sheep, and other ungulates. Human C. fetus infection is associated with consumption of raw or undercooked meat, unpasteurized milk, and other uncooked foods.¹ Although the Campylobacter genus is a common cause of gastrointestinal symptoms in humans, C. fetus bacteremia is very rare, occurring almost exclusively in the setting of advanced age, immunosuppression, human immunodeficiency virus (HIV) infection, alcoholism, or recent gastrointestinal surgery.² We report a case of C. fetus bacteremia in an immunocompetent patient after travel to Ethiopia.A 39-year-old Ethiopian male presented with fever, hypotension, tachycardia, watery diarrhea, lower back and hip pain, nausea, and vomiting. His symptoms began 2 days after returning from a trip to Addis Ababa, Ethiopia, where he stayed within the city for 3 months to visit his family. He reported eating uncooked beef and raw honey during his trip. He did not take malarial prophylaxis because of the high elevation of the area. He reported consuming two to three alcoholic beverages a week, and his medical history was significant only for mild hepatic steatosis, treated latent tuberculosis infection 15 years before, and obstructive sleep apnea. His initial hospital treatment included intravenous fluid resuscitation as well as intravenous vancomycin and piperacillin/tazobactam. An abdominal computed tomography scan without contrast revealed a diffusely distended colon with multiple air–fluid levels. The patient was transitioned to oral ciprofloxacin and metronidazole as he clinically improved. Blood cultures were positive for C. fetus on day 3 of hospitalization. Because fluoroquinolone resistance in C. fetus can exceed 30%,³ antibiotic therapy was empirically changed to azithromycin, and the patient was discharged to complete a 14-day total antibiotic course. Other laboratory testing revealed three negative malaria smears, normal immunoglobulin levels, a negative serum HIV enzyme-linked immunosorbent assay, negative anti-Hepatitis C virus antibodies, and positive Hepatitis B surface antibodies.Reports on the incidence of C. fetus bacteremia vary. Of 183 episodes of Campylobacter bacteremia in 23 French hospitals between 2000 and 2004, 53% were caused by C. fetus.³ Other investigators have identified C. fetus less frequently; 19% of 71 Campylobacter bacteremia episodes were C. fetus in one Spanish teaching hospital over 23 years, and 8.6% of 394 Campylobacter bacteremia cases were C. fetus in an English report spanning 11 years.^4,5 Although the Centers for Disease Control and Prevention Foodborne Outbreak Online Database (FOOD) reported only one confirmed case of C. fetus infection from 1998 to 2011, US cases may be underreported.⁶ Cases of C. fetus bacteremia are more likely to occur in patients with advanced age, comorbid illness, or immunodeficiency.³ Our case shows that systemic infection from this organism can occur in immunocompetent individuals and highlights the importance of pre-travel education on sanitary food practices.     

Recurrent septicemia due to Campylobacter fetus and Campylobacter lari in an immunocompetent patient

We describe a severe and recurrent septicemia due to Campylobacter in a 75-year-old immunocompetent patient. Two Campylobacter strains were detected in several blood cultures. Campylobacter fetus and Campylobacter lari were identified with PCR tests based on species-specific nucleotide sequences for the 16S rRNA gene. Received: August 10, 2001 · Revision accepted: December 27, 2001     

Clinical and serological studies in patients with Campylobacter fetus ssp. jejuni infection: II. Serological findings

Summary The serological responses of 53 patients withCampylobacter fetus ssp.jejuni enteritis were determined with formalinized, boiled and autoclaved antigen suspensions of four reference strains and the autologous isolate. Agglutinin titres of 400 or greater were found against both formalinized and boiled reference antigens in 64% of the patients. Using boiled reference antigens five seropositive patients were found who had not been detected with the formalinized reference antigens, and vice versa. Autoclaved antigens were less useful. The use of paired sera permitted the demonstration of a serological response in some additional patients, although their maximal titre did not exceed 200. The total number of patients with serological responses to reference antigens was thus 48 (91%). The use of autologous antigens detected only one further patient.

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Klinische und serologische Untersuchungen an Patienten mit Campylobacter fetus ssp. jejuni Infektion: II. Serologische Befunde

Zusammenfassung Die serologischen Reaktionen von 53 Patienten mitCampylobacter fetus ssp.jejuni Enteritis wurde unter Verwendung von Formalin behandelten, gekochten und im Autoklaven behandelten Antigensuspensionen von vier Referenzstämmen und des autologen Isolats bestimmt. Bei 64% der Patienten wurden Agglutinintiter von 400 oder darüber gegen Formalin behandelte und gekochte Referenzantigene gefunden. Mittels gekochter Referenzantigene fanden sich fünf seropositive Patienten, die mit Formol behandelten Referenzantigenen nicht entdeckt worden waren und umgekehrt. Im Autoklaven behandelte Antigene waren weniger nützlich. Die Verwendung von gepaarten Seren ermöglichte den Nachweis einer serologischen Reaktion bei einigen weiteren Patienten, obwohl der maximale Titer dabei nicht über 200 lag. Die Gesamtzahl von seropositiven Patienten gegenüber Referenzantigenen betrug folglich 48 (91%). Die Verwendung von autologen Antigenen führte lediglich zur Identifizierung eines einzigen zusätzlichen Patienten.

     

Cardiovascular and bacteremic manifestations of Campylobacter fetus infection: case report and review

A case of bacteremia due to Campylobacter fetus subspecies fetus with concomitant pleuropericarditis in a previously healthy patient is presented. The organism is ubiquitous, but most commonly causes infection in patients with chronic underlying illnesses. The pathogenesis of human infection has not been definitively elucidated. Bacteremia is the most common clinical manifestation of this infection, although cases of thrombophlebitis, mycotic aneurysm, endocarditis, and pericarditis have also been reported. The treatment of choice for most infections is gentamicin, with chloramphenicol recommended for infection involving the central nervous system. Tetracyclines and erythromycin are alternative agents. Prolonged therapy is essential to the prevention of relapse. A high index of suspicion is necessary for the recognition of this organism in the appropriate clinical settings.     

Pulmonary involvement during cytomegalovirus infection in immunosuppressed patients

Abstract: Although cytomegalovirus (CMV) pulmonary involvement after solid organ transplantation is infrequently seen nowadays, CMV pneumonitis is still a potential lethal complication. Introduction of the pp65 antigenemia assay enabled early and rapid diagnosis of CMV viremia in transplant patients prior to symptoms. Also, in asymptomatic patients with CMV viremia, a decreased pulmonary diffusion capacity could be demonstrated. In this review, we discuss clinical and subclinical pulmonary involvement of CMV infection in the immunocompromised host with an emphasis on transplant recipients. The clinical course, diagnosis, therapy, prophylaxis, and pathophysiology of CMV pneumonitis are discussed.     

Disseminated Trichosporon capitatum infection in an immunosuppressed host.

Trichosporon is a frequent cause of superficial mycotic infections but has rarely been associated with invasive disease. A patient undergoing bone marrow transplantation who died from disseminated Trichosporon capitatum infection with endocarditis is reported, and the clinical spectrum of human infection caused by fungi of this genus is reviewed. To our knowledge, this is the first reported case of clearly invasive disease caused by this specific organism and emphasizes the expanding spectrum of unusual infections in the severely immunosuppressed patient.     

Accidental Leishmania mexicana infection in an immunosuppressed laboratory technician

A 30 year-old female laboratory technician under immunosuppressive treatment because of systemic lupus erythematosus (SLE) developed cutaneous leishmaniasis 8 months after accidental percutaneous inoculation of amastigote culture forms of Leishmania mexicana . Leishmania -specific PCR and restriction analysis patterns were identical for both the laboratory strain and the clinical specimen. The lesion was resistant to local paromomycin and oral ketoconazole, but responded to local application of meglumine antimonate. No signs of dissemination or visceralization occurred during the 5-month period of observation. However, a future recurrence cannot be excluded since a persistent infection even after clinical cure has always to be considered in leishmaniasis. Patients under immunosuppressive therapy are possibly at risk of clinical relapse or disseminating infection although there is no experience with regard to leishmaniasis mexicana . Serious infection may require interferon gamma as part of the treatment which may contribute to deterioration of concomitant diseases like SLE. In any case, the exposure of immunodeficient laboratory workers to Leishmania spp . should be avoided.     

Recurrent skin infection with Rhodococcus in an immunosuppressed patient

A renal transplant patient taking prednisone and azathioprine has had repeated episodes of skin infection with the soil saphrophyte Rhodococcus. Human disease with this organism has not been proved before. Although the lesions have always responded to antibiotics, frequent recurrence makes the long-term outlook uncertain.     

Experimental rhesus lymphocryptovirus infection in immunosuppressed macaques: an animal model for Epstein-Barr virus pathogenesis in the immunosuppressed host

To develop a model for Epstein-Barr virus (EBV) pathogenesis in immunosuppressed hosts, we studied experimental infections of immunocompetent versus SHIV 89.6P-infected, immunosuppressed rhesus macaques with the EBV-related rhesus lymphocryptovirus (LCV). Primary LCV infection after oral inoculation of 4 immunocompetent animals was characterized by an acute viremia and seroconversion followed by asymptomatic LCV persistence. Four immunosuppressed macaques infected orally with LCV failed to develop an LCV-specific humoral response and viremia was more pronounced, but there was no evidence of LCV-induced lymphoproliferative disease. A more aggressive primary challenge was administered by intravenous inoculation of 10(8) autologous, LCV-immortalized B cells in 4 additional immunosuppressed animals. Two animals with modest immunosuppression remained asymptomatic, and 1 of 2 severely immunosuppressed animals developed an aggressive, monoclonal LCV-positive lymphoma. These studies demonstrate the potential for lymphomagenesis in an experimental model system for EBV infection and underscore the strength and depth of immune control in limiting LCV-induced lymphoproliferative disease.     

Helicobacter pylori infection in hemodialysis patients

BACKGROUND/AIMS: Studies on the relationship between high serum urea nitrogen, creatinine and Helicobacter pylori infection in hemodialysis patients still give conflicting results. In the present study we investigated the prevalence of Helicobacter pylori positivity in patients with hemodialysis [HD(+)] and without hemodialysis [HD(-)] and assessed the relationship between clinical factors, serum urea nitrogen, creatinine levels and Helicobacter pylori prevalence in these patients. METHODOLOGY: 117 patients with dyspeptic complaints were included in the study. They consisted of 36 HD(+) patients (31%) and 81 HD(-) patients (69%). Endoscopy was performed and gastric antral biopsies were obtained for immunohistochemical analysis for Helicobacter pylori in all patients. RESULTS: Helicobacter pylori was positive in 53(45%) of 117 patients [Hp(+)]. In univariate analysis Hp(+) patients received hemodialysis therapy significantly less often (P = 0.002) and had lower serum urea nitrogen (P = 0.0008) and creatinine (P = 0.003) levels than Hp(-) patients. There was no significant difference in age, gender, endoscopic findings or comorbid conditions (hypertension or diabetes mellitus) between these groups. Multivariate logistic regression analysis revealed that only the serum urea nitrogen level was significantly associated with Helicobacter pylori prevalence (P = 0.008). CONCLUSIONS: These results indicate that high serum urea nitrogen seems to correlate with a low prevalence of Helicobacter pylori infection and hemodialysis patients with high serum urea nitrogen may be protected against Helicobacter pylori infection.