Search PubMed⌕ Search

Biomedical subjects

Donald C Vinh

Publications and source records attributed to Donald C Vinh.

14 recordsLinked to original sources
PubMed2026

Affinity-matured B cell responses neutralizing type-I interferons underlie severe viral infections.

Autoantibodies neutralizing type-I interferons (AAN-I-IFNs) emerge as global, common, and strong determinants of a growing number of severe viral diseases. We report that AAN-I-IFNs+ patients with life-threatening COVID-19 pneumonia harbor circulating type-I IFN-specific B cells indistinguishable from patients bearing T cell tolerance defects of genetic origin. This autoimmune response mobilizes a highly diverse and stable circulating B cell response that is detected prior to severe viral infection and acquires high affinity and neutralization potential to type-I IFNs through extended somatic hypermutation. X-ray crystallography and AlphaFold3 structural analysis of hundreds of patient-derived monoclonal antibodies reveals the extended breadth of this response, targeting three major B cell epitopes covering all facets of type-I IFNs. These findings support a model in which a germinal-center-derived memory B cell response directed against type-I IFNs is established before severe viral infection, providing a core mechanism linking T cell tolerance defect to pathogenic AAN-I-IFNs underlying severe viral diseases.

Humans↗
PubMed2025

Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM.

Candida species are the predominant cause of fungal infections in patients treated in hospital, contributing substantially to morbidity and mortality. Candidaemia and other forms of invasive candidiasis primarily affect patients who are immunocompromised or critically ill. In contrast, mucocutaneous forms of candidiasis, such as oral thrush and vulvovaginal candidiasis, can occur in otherwise healthy individuals. Although mucocutaneous candidiasis is generally not life-threatening, it can cause considerable discomfort, recurrent infections, and complications, particularly in patients with underlying conditions such as diabetes or in those taking immunosuppressive therapies. The rise of difficult-to-treat Candida infections is driven by new host factors and antifungal resistance. Pathogens, such as Candida auris (Candidozyma auris) and fluconazole-resistant Candida parapsilosis, pose serious global health risks. Recent taxonomic revisions have reclassified several Candida spp, potentially causing confusion in clinical practice. Current management guidelines are limited in scope, with poor coverage of emerging pathogens and new treatment options. In this Review, we provide updated recommendations for managing Candida infections, with detailed evidence summaries available in the appendix.

Humans↗
PubMed2006

Native-valve bacterial endocarditis caused by Lactococcus garvieae.

We report a case of definite Lactococcus garvieae native-valve endocarditis. The diagnosis was suspected in a patient presenting with congestive heart failure and found to have Enterococcus hirae bacteremia, with a history of L. garvieae bacteremia 1 month prior. Diagnosis was confirmed by 16S rRNA gene sequencing of the 2 isolates and the demonstration of aortic valve vegetations.

Aged, 80 and over↗
PubMed2006

Severe skin and soft tissue infections and associated critical illness.

Skin and soft tissue infections (SSTIs) span a broad spectrum of clinical entities from limited cellulitis to rapidly progressive necrotizing fasciitis, which may be associated with septic shock or a toxic shock-like syndrome. These infections may manifest initially as pyodermas that then progress; alternatively, they may arise from metastatic spread of microorganisms from a distant focus. Regardless of the source, SSTIs may lead to critical illness. The complex interplay of environment, host, and pathogen are important to consider when evaluating SSTIs and planning appropriate therapy. The keys to a successful outcome are early identification of risk factors for specific pathogens and early initiation of empiric antimicrobial therapy. For certain types of SSTIs, surgical intervention for diagnosis and/or therapy is also required.

Journal Article↗
PubMed2006

Famciclovir for the treatment of recurrent genital herpes: a clinical and pharmacological perspective.

Herpes simplex virus is one of the most common causes of genital ulcer disease worldwide. Herpes simplex virus-2 is the more common cause of genital herpes, a chronic infection that is characterised by periodic reactivation, with the capacity to produce recurrent symptomatic disease in the host (e.g., vesicular eruption), as well as intermittent asymptomatic shedding. Relapsing episodes may be physically and psychologically distressing. Shedding accounts for the majority of cases of transmission of genital herpes to sexual partners. Pregnant women who are shedding may transmit the virus at the time of delivery, with severe and potentially fatal consequences to the baby. Famciclovir, a synthetic acyclic guanine derivative, is the prodrug of penciclovir, which demonstrates in vitro antiviral activity against various types of herpes virus, including herpes simplex virus-2. Its pharmacokinetics allow for administration in a convenient dosing regimen compared with acyclovir, which may improve compliance. Clinical studies have demonstrated its efficacy in the episodic treatment of relapses, with the most recent report demonstrating its efficacy and tolerance as a single-day treatment. It is also efficacious and well tolerated for the suppression of frequently recurring episodes. These results have been demonstrated in various patient populations, including immunocompetent patients and those infected with HIV. Famciclovir is well tolerated, with an adverse events profile similar to placebo.

2-Aminopurine↗
PubMed2005

Breast implant infection with Mycobacterium fortuitum group: report of case and review.

There has been a marked increase in the frequency with which breast prosthesis are being used, both for reconstructive and cosmetic purposes. Although breast implant-related infections are uncommon, they are typically caused by bacterial skin flora, specifically Staphylococcus aureus and the coagulase negative staphylococci. There have been infrequent reports of breast implant infection caused by the atypical mycobacteria. This report summarizes the case of a young female who underwent augmentation mammoplasty who presented shortly thereafter with clinical evidence of an infected breast prosthesis. Despite a protracted course of empiric antibiotic therapy and multiple surgical interventions, she failed to improve. Additional microbiologic investigations allowed for a diagnosis of Mycobacterium fortuitum group breast implant infection to be established. A prolonged course of anti-mycobacterial therapy, based upon susceptibility results, allowed for eradication of the infection and subsequent successful re-implantation of the prosthesis.

Adult↗
PubMed2005

Rapidly progressive soft tissue infections.

Skin and soft tissue infections are among the most common reasons for people to seek medical advice. They also represent one of the most common indications for antimicrobial therapy and account for approximately 7-10% of hospitalisations in North America. Although non-limb and non-life threatening infections may be treated on an out-patient basis with oral antibiotics, patients with more serious acute skin and soft tissue infections may require admission to hospital for management; this decision is especially true if the infection is rapidly progressive. We provide a concise overview of the differential diagnosis and approach to management of community-acquired rapidly progressive skin and soft tissue infections.

Animals↗
PubMed2005

Device-related infections: a review.

The use of surgically implanted devices has increased as a result of their beneficial effect on quality of life, and in some circumstances, on patient survival rates. They can, however, be associated with a variety of complications, the most dreaded being infection. Device-related infections are important to understand because of the morbidity and mortality associated with them. Frequently, patients are managed with hospitalization, prolonged courses of antibiotics, and surgical interventions, all of which can negatively impact on patients' quality of life. Such care is also associated with increased costs to health care systems. Furthermore, these infections often represent a diagnostic challenge because of the lack of consensus definition of what constitutes an infection and its severity, as well as the paucity of well-designed, large studies addressing optimal methods of investigation and management. An implant-associated infection is defined as a host immune response to one or more microbial pathogens on an indwelling implant. An understanding of the pathogenesis of these infections provides a rationale for management. Development of device-related infections begins with colonization of the foreign material, followed by a complex metamorphosis by the microorganisms with resultant biofilm formation. In this surface-associated form, bacteria have altered phenotypic properties. This change, in conjunction with the physical protective layer provided by the biofilm, renders antimicrobial therapy ineffective when used alone. Because the microorganisms are able to reside on the hardware, they proliferate and cause local damage, such as loosening of implanted devices, wound dehiscence, or disruption of prosthetic valves, as well as systemic manifestations, such as fever or embolic phenomenon. The onset and clinical manifestations of device-related infections vary with the pathogen involved, as well as which component of the device is affected. The time period after device implantation that signs and symptoms develop can assist in the selection of empiric antimicrobial therapy. Optimal diagnostic microbiologic specimens are paramount in tailoring the antimicrobial therapy, which almost always has to be given for a prolonged period of time. Surgical removal of the device is usually necessary. Some studies of limited types of device-related infections, however, have defined indications for which salvage therapy may be warranted. In addition, some patients are not candidates for, or may not want, further surgical interventions, in which case indefinite suppressive antimicrobial therapy may be considered. This review provides an overview of infections related to various neurosurgical, cardiac, and orthopedic devices, as well as those related to cochlear, breast, and penile prostheses, with discussion of definitions of such infections, along with microbiology, pathogenesis, and management guidelines, including the limited indications for salvage techniques.

Anti-Bacterial Agents↗
PubMed2003

Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management.

Cases of active tuberculosis have been reported worldwide with the use of therapeutic agents that inhibit tumour necrosis factor (TNF) alpha. TNFalpha has a central role in mycobacterial infection and disease. Accordingly, progression of recently acquired tuberculosis infection or reactivation of remotely acquired infection should be expected with the use of anti-TNF agents. The available in-vitro and epidemiological evidence for the two currently approved agents, infliximab and etanercept, shows that the risk of development of active tuberculosis is greater with infliximab. Tuberculin skin testing (TST) should be undertaken before any significant immunosuppressive therapy including these agents, though the possibility of false-negative reactions in immunocompromised populations must be borne in mind. A positive TST should be followed by medical assessment and chest radiography, as well as by other tests judged appropriate by the physician to identify active disease. Active tuberculosis must be treated appropriately before initiation of treatment with an anti-TNF agent. Treatment of latent tuberculosis can be considered on an individual basis for TST-negative patients receiving anti-TNF agents when significant risk factors for infection are present.

Algorithms↗