Lung infection

2005204 Radiological features of AIDS complicated by pulmonary tuberculosis and the association with CD4+ lymphocytes. LU Pu-xuan(陆普选), et al. Dept Radiol, Shenzhen East Lake Hosp, Shenzhen 518020. Chin J Tubere Respir Dis, 2005; 28(1): 13-16. Objective: To explore the imaging features in cases with AIDS complicated by pulmonary tuberculosis and the accociation with CD4+ T lymphocytes.     

Pertussis--a re-emerging infection?

Seven cases of pertussis in patients aged between 1 and 6 months detected over 3 months were reported. Paroxysmal cough (six cases), post-tussive vomiting (three cases) and poor feeding (three cases) were the most common presenting symptoms. Bordetella pertussis was isolated from six patients. The total leucocyte counts were mildly increased (10.8-15.6x10(9)/L). The lymphocyte counts were markly raised (59-73%) and appear to be useful indicators of pertussis. It appears that herd immunity does not offer adequate protection to the vulnerable group even in well-vaccinated populations. High vaccination coverage should be maintained, and vaccination should be given as early an age as possible. Aggressive efforts to identify cases and contacts are essential. Health care workers should have a high index of suspicion for pertussis, in particular for those with paroxysmal cough and high lymphocyte counts so as to give timely diagnosis and treatment.     

Respiratory syncytial virus infection: an emerging or unappreciated infection?

Respiratory syncytial virus (RSV) is a ubiquitous cause of respiratory infection with a worldwide distribution and seasonal occurrence. Natural immunity does not normally follow infection, and reinfection is the rule. Reinfection may even occur within a single season. Although its role in serious lower respiratory tract infection (LRTI) in infants is well recognized, the importance of RSV in disease of older children, adults and, especially in the elderly, is poorly appreciated. In large surveillance studies, RSV is at least as important in contributing to respiratory morbidity and mortality as influenza. These data would suggest that tens of millions of Americans suffer respiratory disease (LRTI and upper respiratory tract infection [URTI]) from RSV each winter. In addition, otitis media and episodic bronchospasm are complications following RSV infection. Unfortunately, there is no vaccine yet available for prevention. Prevention of disease with a hyperimmune globulin (RSVIG) and with a monoclonal antibody (MAb) (palivizuMab) is possible, but only for those neonates and infants at highest risk of morbidity and mortality from RSV infection. Therapy with the only approved antiviral for this indication, ribavirin, is difficult, is of questionable efficacy, and the compound itself is teratogenic. Infection by RSV constitutes an enormous but unappreciated medical need worldwide.     

Does HIV infection alter the incidence or pathology of Helicobacter pylori infection?

Gastrointestinal (GI) discomfort is a common complaint among patients infected with HIV. GI symptoms can be caused by a myriad of factors including but not limited to coinfections, antiretroviral therapy, medications for opportunistic infections, and nutritional status. Some researchers have hypothesized that Helicobacter pylori infection may be more common among HIV-infected patients as a result of immune suppression. An increased incidence of H. pylori infection would contribute to the prevalence of GI complaints in this population. Several epidemiologic studies have examined the relationship between H. pylori infection and HIV. While studies have generally reported conflicting results that may be related to the use of varied study designs, some identifiable patterns can be discerned. It does appear that the incidence of H. pylori infection is lower among patients with AIDS compared to matched HIV-infected and -uninfected controls. This review discusses the various epidemiologic trials that have been conducted in this area and describes the potential physiologic mechanisms to explain these findings. The clinical applicability of these studies as well as limitations are also discussed. A greater number of well-designed and controlled trials are needed before any definitive conclusions regarding these diseases can be made, until such time clinicians should be aware of the potential issues regarding H. pylori screening and management in the context of HIV. Research in this area might also provide information relating to HIV-associated GI changes and the role of these changes in HIV pathogenesis.     

Cytomegalovirus infection in systemic necrotizing vasculitis: causative agent or opportunistic infection?

We report on a 69-year-old woman who presented with myalgia, hearing impairment, fever, night sweats, weight loss, muscular weakness, paresthesia, hypesthesia, and hypalgesia. Sural nerve biopsy showed demyelinative and axonal polyneuropathy due to necrotizing vasculitis with fibrinoid necrosis. A positive test for antineutrophil cytoplasmic antibodies (ANCA) with a perinuclear immunofluorescence pattern directed against myeloperoxidase was more suggestive of microscopic polyangiitis (MPA) than of polyarteritis nodosa (PAN), the possible differential diagnoses. In addition, positive tests for cytomegalovirus (CMV) antibodies (immunoglobulin (Ig)M and IgG) and the detection of CMV-DNA in sputum specimens by polymerase chain reaction (PCR) were indicative of active CMV infection. Treatment with ganciclovir and anti-CMV immunoglobulin in addition to prednisolone medication for 6 months resulted in rapid improvement of the clinical symptoms without relapse. CMV infection has been described to be related to ANCA-associated vasculitis in non-immunocompromized patients and may be either a causative agent or an opportunistic infection. Identification of a viral etiology in patients with atypical ANCA-associated vasculitides may lead to different, less aggressive treatment approaches, including antiviral therapy. Received: 5 April 2000 / Accepted: 16 June 2000     

Is malarial placental infection related to peripheral infection at any time of pregnancy?

Placental infection measured by placental smear at delivery is a standard indicator, widely used to characterize malaria infection in pregnant women. However, a single measure can hardly reflect the entire history of infection during pregnancy. To investigate the relation between this indicator and peripheral infection during pregnancy, we used data collected in a randomized trial of malaria prophylaxis in 928 pregnant women in Burkina Faso, 1987-1988, during which repeated measures of peripheral infection were taken. We analyzed placental infection using a logistic model, with two methods for handling missing data. Peripheral infection during two periods of pregnancy was significantly related to placental infection at delivery, before the fifth month: OR = 2.9 [1.3; 6.3]; after 7 months: OR = 4.9 [2.7; 8.8]). Therefore, an early peripheral infection may persist throughout gestation, and placental infection is a good indicator of the women's parasitological status during pregnancy.     

Catheter-related infection in gastrointestinal fistula patients

AIM:To study the incidence,bacterial spectrum and drugsensitivity of catheter-related infection (CRI) in gastrointestinalfistula patients.METHODS:A total of 216 patients with gastrointestinalfistulae during January 1998 to April 2001 were studiedretrospectively.Two hundred and sixteen catheters of the358 central venous catheters used in 216 gastrointestinalfistula patients were sent for microbiology analysis.RESULTS:Ninety-five bacteria were cultivated in 88catheters (24.6%).There were 54 Gram-negative bacteria(56.8%),35 Gram-positive bacteria (36.8%),and 6 fungi(6.4%).During the treatment of CRI,20 patients changedto use antibiotics or antifungal,and all patients were cured.The mean time of catheters used was 16.9±13.0 d.CONCLUSION:CRI is still the common complication duringtotal parenteral nutrition (TPN) treatment in patients withgastrointestinal fistulae,and Gram-negative bacteria arethe main pathogens,and bacterial translocation is consideredthe common reason for CRI.     

Mebendazole treatment for intestinal nematode infection.

A total of 270 cases with intestinal nematode infection were selected as study subjects,amongthem 156 cases received 2％ mebendazole oral suspension 400 mg/day(200mg,bid)for three days forhe treatment of ascariasis,trichuriasis,and hookworm infection,200 mg/day(200mg,qd)for 3 daysfor the treatment of enterobiasis;114 cases received levamizole for the same treatment as a controlgroup.Before and after the treatment,all the patients'feces were examined by Kato's method.The     

Impact of human immunodeficiency virus infection on the course of hepatitis C virus infection： A meta-analysis

AIM： TO analyze the influence of human immunodeficiency virus （HIV） infection on the course of hepatitis C virus （HCV） infection. METHODS： We performed a meta-analysis to quantify the effect of HIV co-infection on progressive liver disease in patients with HCV infection. Published studies in the English or Chinese-language medical literature involving cohorts of HIV-negative and -positive patients coinfected with HCV were obtained by searching the PUBMED, EMBASE and CBM. Data were extracted independently from relevant studies by 2 investigators and used in a fixed-effect meta analysis to determine the difference in the course of HCV infection in the 2 groups. RESULTS： Twenty-nine trails involving 16750 patients were identified including the outcome of histological fibrosis or cirrhosis or de-compensated liver disease or hepatocellular carcinoma or death. These studies yielded a combined adjusted odds ratio （OR） of 3.40 [95% confidence interval （CI） = 2.45 and 4.73]. Of note, studies that examined histological fibrosis/ cirrhosis, decompensated liver disease, hepatocellular carcinoma or death had a pooled OR of 1.47 （95% CI = 1.27 and 1.70）, 5.45 （95% CI = 2.54 and 11.71）, 0.76 （95% CI = 0.50 and 1.14）, and 3.60 （95% CI = 3.12 and 4.15）, respectively. CONCLUSION： Without highly active antiretroviral therapies （HAART）, HIV accelerates HCV disease progression, including death, histological fibrosis/ cirrhosis and decompensated liver disease. However, the rate of hepatocellular carcinoma is similar in persons who had HCV infection and were positive for HIV or negative for HIV.     

Guillain-Barré syndrome and Mycoplasma pneumoniae infection

Guillain-Barré syndrome subsequent to Mycoplasma pneumoniae is uncommon and difficult to confirm. We report one case. Clinical presentation and therapy were unremarkable. The interest of antibiotics (preventive or curative) is unresolved. The pathophysiology remains hypothetical but Mycoplasma pneumoniae and some surface gangliosides of peripheral nerves share homologous epitopes leading to the production of antibodies. Induced antibodies to ganglioside may cross-react with neural tissues.     

Respiratory pasteurellosis: infection or colonization?

Respiratory infection by Pasteurella multocida is uncommon and usually occurs in patients with an underlying lung disease, advanced age and/or immunodepression. In this study, we describe the clinical and microbiological characteristics of a series of 14 patients in whom Pasteurella multocida was isolated from lower respiratory tract samples, over a period of 21 y (1986-2006). Differentiation between colonization and infection allows establishment of early antibiotic treatment.     

Inflammation,infection and coronary heart disease

It has become clear that inflammation is an important component of coronary heart disease. Atherosclerotic dis- ease usually begins with injury to endothelial cells. This injury can occur upon exposure to many injurious agents such as high levels of low density lipoprotein cholesterol (LDL-C), hypertension, diabetes mellitus, and tobacco smoke as well as infectious agents. Once the injury occurs, lipo- proteins and inflammatory cells are attracted to the area. Activated macrophages and T lymphocytes contribute to the inflammatory process and release cytokines into the circulation attracting further inflammatory cells to the area of injury. Many of these inflammatory cytokines can be measured in the plasma and correlate with both the extent of coronary disease and complications of the disease.