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[Guidelines for the treatment of invasive fungal infection. Invasive fungal infection by Candida spp. Invasive Fungal Infection Study Group (MICOMED) and Infection in Transplantation Study Group (GESITRA) of the Spanish Society for Infectious Diseases and Clinical Microbiology (SEIMC)].

These guidelines resume different issues related to the clinical management of invasive candidosis in the immunossuppressed patients. They are based on the recommendations of the different Drug's Agencies.

Antifungal Agents↗

Influence of HIV-1 infection on GBV-C infection in multiply infected haemophilic patients.

Two hundred thirteen haemophilic patients were studied for the presence of GBV-C RNA and anti-E2 antibodies soon after their first treatment with unsterilised factor concentrates and in their most recent sample. An assessment was made to determine whether coinfection with HIV had any effect on the progression of GBV-C infection. All of the patients were infected with HCV and 81 patients (37%) were also infected with HIV. GBV-C RNA was detected using the Abbott LCx(TM) assay and by RT-PCR. Anti-E2 antibodies were detected using the microPLATE Anti-HGenv assay and by Abbott Laboratories. The HIV-negative patients were more likely than the HIV-positive patients to lose GBV-C RNA between the two time points. A proportion of the patients lost their anti-E2 antibodies over the time period, however, the majority of these were HIV-positive. This study shows that infection with HIV does affect the progression of GBV-C infection, however, this effect is little understood as yet.

Disease Progression↗

Impact of chronic hepatitis B virus (HBV) infection on outcomes of patients infected with HIV in an area where HBV infection is hyperendemic.

Between June 1994 and February 2003, a total of 111 human immunodeficiency virus (HIV)-infected patients with chronic hepatitis B virus (HBV) coinfection and 387 HIV-infected patients without HBV or hepatitis C virus coinfection were prospectively observed to assess the impact of HBV infection on outcomes of HIV-infected patients. After a median duration of observation of 25 months, coinfected patients were more likely to develop hepatitis (adjusted hazard ratio [AHR], 2.54; 95% confidence interval [CI], 1.69-3.82) and hepatic decompensation (adjusted odds ratio [AOR], 9.94; 95% CI, 1.89-52.35). Although similar proportions of the 2 patient groups had an increase in the CD4 count by > or =100x10(6) cells/L (AOR, 0.78; 95% CI, 0.45-1.36) and development of new opportunistic illnesses (AOR, 0.94; 95% CI, 0.53-1.66), HBV-infected patients had an increased risk for virologic failure (AOR, 1.76; 95% CI, 1.03-2.99) and death (AHR, 1.71; 95% CI, 1.19-2.47) after highly active antiretroviral therapy was initiated.

Adolescent↗

Concurrent infection with Theileria buffeli caused depression of parasitaemia in Babesia bovis and Anaplasma centrale infections in splenectomised calves but not in B bigemina infections.

In five experiments undertaken in splenectomised calves it was found that Theileria buffeli infections depressed the parasitaemias of superimposed Babesia bovis and Anaplasma centrale infections, but not B bigemina infections. The course of A centrale infections did not appear to be affected by a concurrent Eperythrozoon teganodes infection.

Anaplasmosis↗

Experimental Echinococcus granulosus infection in mice: immunocytochemical analysis of lymphocyte populations in local lymphoid infections during early infection.

The influence of subcutaneous infection with protoscoleces of Echinococcus granulosus on the distribution of lymphocyte subsets in draining lymph nodes has been evaluated by immunocytochemical labelling of lymphocyte surface antigens. These studies reveal marked expansion of paracortical Thy-1+, Lyt-1+ cells and moderate proliferation of surface immunoglobulin-bearing B-cells immediately after infection. The Lyt-1+:Lyt-2+ ratio decreases rapidly during the first 21 days post-infection and remains below unity until at least 12 weeks post-infection due to severe depletion of Lyt-1+ cells in draining lymph nodes and a significant increase in the percentage of Lyt-2+ cells. The potential role of these Lyt-1-,2+ (putative T-suppressor) cells in regulation of the anti-parasite immune response and mediation of generalized immunosuppression is discussed in the light of evidence of inhibition of anti-parasite immunity in infected mice.

Animals↗

Resistance and disease in Brugia malayi infection of ferrets following prior infection, injection of attenuated infective larvae and injections of larval extracts.

A partial resistance expressed by a 53% to 78% reduction in lymphatic filariae from a challenge infection was induced in ferrets (Mustela putorius furo) by a prior infection and by injection of radiation attenuated infective larvae (L3) but not by injections of lyophilized microfilariae (mf) or L3. Equivalent acquired resistance was demonstrated with and without overt filarial disease. A prior infection resulted in peripheral lymphoedema in approximately one-third of the amicrofilaraemic resistant ferrets following challenge infection and injection of attenuated larvae resulted in inflammatory responses characteristic of a hyper-responsive syndrome in one-half of the amicrofilaraemic ferrets. Injections of lyophilized mf inhibited microfilaraemia and promoted development of lymphostatic disease. A limited examination of immune responses and histopathology suggested that disease in partially resistant ferrets was associated with high TH2 dependent responses directed, at least in part, to mature filariae and to mf. Mechanisms of resistance were not identified.

Animals↗

Interval estimation of the risk ratio between a secondary infection, given a primary infection, and the primary infection.

This paper discusses interval estimation of the risk ratio (RR) between a secondary infection, given a primary infection, and the primary infection. Three asymptotic closed-form interval estimators are developed using Wald's test statistic, the logarithmic transformation, and Fieller's theorem. The performance of these interval estimators is compared with respect to the coverage probability and the expected length of the resulting confidence intervals. When the underlying probability of a primary infection is high (say, 0.80), all three estimators perform reasonably well. In fact, in this case, they are all essentially equivalent when the number of subjects n > or = 100. When the probability of a primary infection is small (say, 0.20) or moderate (say, 0.30 to 0.50), the interval estimator using the logarithmic transformation outperforms the other two estimators when n < or = 100. In fact, the coverage probability of the former estimator is consistently greater than or equal to the desired confidence level in all the situations considered in this paper and hence is recommended for general use.

Animals↗

[Studies on respiratory infections in the field of primary care (I). Correlation between viral infection and secondary bacterial infection in patients visiting a doctor in private practice].

We attempted to find out whether there is a correlation between viral infection and secondary bacterial infection on the basis of the analysis of the results of the culture of virus and bacteria in the same specimen from the throat swabs of 95 patients who had an acute upper respiratory inflammation when they visited a doctor in private practice in Sendai city during the epidemic caused by influenza virus. Viral culture was performed by a microplate-method devised originally by Numazaki. The influenza virus was recovered from 56 cases (59%) consisting of 43 cases of type A (Hong-Kong) and 13 cases of type B. From 73 cases, (77%), 79 strains of possibly pathogenic bacteria were recovered, consisting of 43 strains of H. influenzae, 18 strains of S. aureus, seven strains of S. pneumoniae, four strains each of C. freundii and S. liquefaciens and one strain each of beta-haemolytic Streptococcus and B. catarrhalis. The incidence of positive culture of both virus and possibly pathogenic bacteria was high already at the early stage (2-3 days) of the disease. We found no correlation between the type of virus and the species of the microbial isolates. There was no difference in the incidence of positive bacterial culture in relation to age group. We suggest that a secondary bacterial infection occurs already at the early stage of the disease after viral infection because the incidence of positive culture of possibly pathogenic bacteria was high at the above stage.

Adolescent↗

[The study on bacterial infection in chronic lower respiratory tract infection--from the viewpoints of acute and chronic infection].

Using mainly changes in the amount of sputum as an index of the infectious course of chronic lower respiratory tract infection associated with purulent sputum over years, the disease was divided into stable and acute exacerbated phases and a bacteriological investigation using transtracheal aspiration (TTA) conducted. TTA was performed 107 and 45 episodes during stable phases and acute exacerbated phases respectively. Monomicrobial and polymicrobial infection were detected most frequently during the stable and acute exacerbated phases respectively (p less than 0.01). During the stable phases, the single organisms detected most frequently were H. influenzae (26 episodes) and P. aeruginosa (20 episodes), while in the cases in which multiple organisms were detected during stable phases, combination including H. influenzae were most common (19 episodes). H. influenzae was the most frequently detected organism in cases showing single organisms during acute exacerbated phases (7 episodes). In the cases in which multiple organisms were detected as well, H. influenzae was the most commonly detected organism assumed to predispose to exacerbation (7 episodes), while P. aeruginosa was not found. These results suggest that in chronic lower respiratory tract infection. H. influenzae and P. aeruginosa are important as persistent infective organisms, while H. influenzae are important in acute exacerbation.

Acute Disease↗

Pulmonary mycobacterium Simiae infection and HTLV1 infection: an incidental co-infection or a predisposing factor?

There is little information on atypical mycobacterium and human T lymphotropic virus Type I (HTLV-I) co-infection. We present the first case of pulmonary M. simiae infection in co-infection with HTLV-1, confirmed by ELISA antibody test and Western Blot. We discuss the clinical characteristics and laboratory tests of the patient and presumptive immunological relation. We propose that in patients with the HTLV infection and pulmonary symptoms and signs compatible with tuberculosis, evaluation for atypical mycobacteriosis may be recommendable.

Blotting, Western↗

Sarcocystis neurona infections in raccoons (Procyon lotor): evidence for natural infection with sarcocysts, transmission of infection to opossums (Didelphis virginiana), and experimental induction of neurologic disease in raccoons.

Equine protozoal myeloencephalitis (EPM) is a serious neurologic disease of horses in the Americas and Sarcocystis neurona is the most common etiologic agent. The distribution of S. neurona infections follows the geographical distributions of its definitive hosts, opossums (Didelphis virginiana, Didelphis albiventris). Recently, cats and skunks were reported as experimental and armadillos as natural intermediate hosts of S. neurona. In the present report, raccoons (Procyon lotor) were identified as a natural intermediate host of S. neurona. Two laboratory-raised opossums were found to shed S. neurona-like sporocysts after ingesting tongues of naturally-infected raccoons. Interferon-gamma gene knockout (KO) mice fed raccoon-opossum-derived sporocysts developed neurologic signs. S. neurona was identified immunohistochemically in tissues of KO mice fed sporocysts and the parasite was isolated in cell cultures inoculated with infected KO mouse tissues. The DNA obtained from the tongue of a naturally-infected raccoon, brains of KO mice that had neurological signs, and from the organisms recovered in cell cultures inoculated with brains of neurologic KO mice, corresponded to that of S. neurona. Two raccoons fed mature S. neurona sarcocysts did not shed sporocysts in their feces, indicating raccoons are not likely to be its definitive host. Two raccoons fed sporocysts from opossum feces developed clinical illness and S. neurona-associated encephalomyelitis was found in raccoons killed 14 and 22 days after feeding sporocysts; schizonts and merozoites were seen in encephalitic lesions.

Animals↗

Comparison of clinical features of acute HIV-1 infection in patients infected sexually or through injection drug use. The Investigators of the Québec Primary HIV Infection Study.

Acute HIV-1 infection (AHI) may present with a clinical picture that represents a diagnostic challenge. We tested the hypothesis that two different routes of infection, that is, sexual versus parenteral, might be associated with a difference in the clinical features of AHI. A prospective cohort of seroconvertors was established in Montréal in private medical clinics and hospitals from February 1996 to May 1999. The prevalence of the symptomatic presentation was almost overlapping within the two groups of newly infected individuals 69% (42 of 61) for men having sex with men (MSM) and 69% (18 of 26) for injection drug users (IDUs; p =.98). Comparison of all types of symptoms and signs as well as their duration was also similar in both groups. Of particular interest, the site of lymph node enlargement was not different despite the estimated sites of intravenous inoculation. Oral and anal ulcers were more frequently observed in MSM than in IDUs (6 versus 0 and 4 versus 1, respectively). Neither the mean CD4+ count (514.8 and 414.7 cells/mm3; p =.14) nor the mean viral load (4.45 and 4.70 log copies/ml; p =.40) were different between the two groups at the time of the first study visit. Our study results clearly indicate that health care workers can expect similar clinical presentation of AHI in MSM and in IDUs despite the different routes of infection.

Adolescent↗

Bartonella henselae infection in cats: evaluation during primary infection, treatment, and rechallenge infection.

Bartonella henselae infection was established in eight cats of various ages by experimental inoculation. All cats remained persistently bacteremic until they were treated 4 to 7 weeks after primary inoculation. Antibody titers increased and peaked between 4 and 12 weeks for all cats. Treatment with doxycycline for 1 week was effective in suppressing bacteremia in all cats but was effective in clearing infection from only four cats. Amoxicillin, given subsequently, was effective in clearing the infection from three of the remaining cats. One kitten that remained bacteremic was treated unsuccessfully with enrofloxacin, and its bacteremia was finally cleared when it was treated with a clavulanate-amoxicillin combination. After the bacteremia was cleared, with a corresponding reduction in serum antibody titers, all eight cats were rechallenged with B. henselae. None of the cats became bacteremic after secondary challenge, and all had higher and more rapid increases in serum antibody titers than after primary inoculation. The cats became resistant to reinfection following recovery from infection, indicating that immunoprophylaxis in cats might be beneficial in helping to reduce their public health risk.

Angiomatosis, Bacillary↗

Pathogenesis of murine cytomegalovirus infection: identification of infected cells in the spleen during acute and latent infections.

Spleen cells which replicate murine cytomegalovirus (MCMV) during acute infection in vivo were identified by electron microscopy and combined immunocytochemical staining and in situ cytohybridization. Most infected cells, as defined by in situ hybridization for viral RNA with MCMV-specific probes, were shown to be positive for factor VIII-related antigen and negative for Ia, Thy-1, and F4/80 antigens. Electron microscopic ultrastructural observations indicated that the infected cells in the spleen are predominantly sinusoidal-lining cells. We also studied reactivation of MCMV from latently infected mice by cocultivation of spleen cells with mouse embryo fibroblasts. Virus was only recovered from cells in preparations of stromal (or reticular) fragments, and not from spleen cell suspensions. Neither removal of immunoglobulin-bearing cells from the stromal fragments by panning nor depletion of Thy-1- and Ia-bearing stromal cells by treatment with monoclonal antibodies and complement reduced the frequency of reactivation of MCMV. These data suggest that T lymphocytes, mature B lymphocytes, and other Ia-bearing cells are not predominant reservoirs of latent MCMV.

Acute Disease↗

[Focal infection? Did you say focal infection ... focal infection and uveitis].

A chronic seat of infection more often than not situated in the E.N.T. area is responsible for remote pathological symptoms commonly called focal infection. The eye may be a target organ, where focal infection appears in the form of a uveitis. Four clinical observations are reported as demonstration. The transmission mechanism operates through an immune phenomenon from bacterial antigens which engender reactions of hypersensitivity. The E.N.T. specialist must be aware of these symptoms and seek a pharyngeal, sinusal or latent buccodental infection.

Adult↗

[Prevention of bacterial infections in immunocompromised hosts, excluding HIV infection and mycobacterium infections].

The immunocompromised host is an individual whose defense mechanisms against infectious agents are altered in such a significant way that he is abnormally susceptible to infections agents in general and bacterial "opportunists" in particular. The type of infection and etiologic agents vary with the nature and the severity of the immune defect. The goal of prophylactic treatments is to prevent the occurrence or recurrence of infections, and so, to reduce the infectious morbidity and mortality when the nature of severity of immunosuppression make these complications probable. Beside specific measures, which are detailed in this article, the strict application of the so-called universal precautions, particularly handwashing, remain at the basis of the prevention of bacterial infections in the immunocompromised host.

Bacterial Infections↗