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At least 19 recordsLinked to original sources
PubMed2001

Oral valganciclovir: a new option for treatment of cytomegalovirus infection and disease in immunocompromised hosts.

Immunocompromised hosts are at increased risk of cytomegalovirus (CMV) infection and serious CMV disease. CMV infection is an important cause of morbidity among patients infected with HIV and after solid organ transplantation (SOT) and may cause life-threatening disease in allogeneic stem cell transplant (SCT) recipients. The introduction into clinical use of potent antiviral compounds and of rapid detection assays for CMV during the past two decades has allowed development of strategies for the prevention and treatment of disease caused by CMV in these groups of immunocompromised patients. At present, the antiviral drugs ganciclovir, foscarnet and cidofovir are commonly used in the treatment of CMV infection and disease. However, these agents have a poor oral bioavailability and, for systemic use, require iv. administration for most indications. Valganciclovir is an oral prodrug of ganciclovir, with a 10-fold greater bioavailability than oral ganciclovir. Studies of the pharmacokinetics of valganciclovir among HIV-infected CMV-seropositive patients and liver transplant recipients suggest that this oral compound has the potential to replace both oral and iv. ganciclovir in many situations if it is shown to be as efficacious and safe as those ganciclovir formulations in immunodeficient patients. In the first part of this review, currently established approaches to the management of CMV infection and disease in SCT and SOT recipients and HIV-infected patients are discussed to highlight possible indications for future valganciclovir use; in the second part, data from human studies of valganciclovir are presented.

Administration, Oral↗
PubMed1988

The acute abdomen in the immunocompromised host.

Immunocompromised hosts are a heterogeneous group, including patients receiving transplants, those receiving chemotherapy for malignant disease, and those receiving steroids for autoimmune disease, as well as patients with AIDS. Each group has specific abdominal conditions, and the clinician must be familiar with the specific causes of the acute abdomen within each subset. The causes of the acute abdomen in immunocompromised patients may be divided into two broad categories: (1) those disorders that are closely associated with the immunocompromised state and (2) those processes that can occur in any patient regardless of the immune status. Physicians at every level of specialization must become familiar with the unusual complications that occur in this population and with the ways in which the underlying disease and its therapy can modify the clinical presentation and management of common abdominal conditions. This article outlines broad principles of common clinical findings and surgical therapy in these patients.

Abdomen, Acute↗
PubMedDate not supplied

MRI in varicella-zoster virus leukoencephalitis in the immunocompromised host.

Immunocompromised patients are at increased risk for CNS and disseminated varicella zoster virus (VZV) infection. In this report we present the MR findings in a leukemic patient with active, biopsy-proven VZV leukoencephalitis. The characteristic MR features of this infection were clustered subcortical plaque-like lesions demonstrating rapid demyelination. Active lesions enhanced with intravenous contrast medium administration. Edema and hemorrhage were not prominent early findings but developed as the infection evolved. These findings were strikingly similar to those reported in prior autopsy studies of immunocompromised patients with VZV leukoencephalitis.

Adolescent↗
PubMed2002

Gastrointestinal infections in the immunocompromised host.

Immunocompromised patients, including patients with AIDS, solid organ and bone marrow transplant recipients, patients with leukemia and lymphoma, patients with inherited immune deficiencies, and patients on immunosuppressive therapy for a variety of disorders, are at risk for infections-particularly opportunistic infections, which, by definition, do not infect the healthy host. All systems of the body, including the gastrointestinal tract, are susceptible. The esophagus, stomach, small intestine, and large intestine are sites of infection for viruses, bacteria, fungi, and protozoa. Symptoms can range in severity from fevers of unknown etiology to life-threatening hemorrhage and perforation. This review summarizes recent case reports, clinical studies, and reviews pertaining to pathogens that uniquely cause disease, more frequently cause disease, or cause more severe disease in the immunocompromised host than in the immunocompetent host.

Journal Article↗
PubMed1990

Fluconazole treatment of fungal infections in the immunocompromised host.

Immunocompromised patients are predisposed to opportunistic fungal infections. Candidiasis is reported most frequently both as a localized infection (eg, oropharyngeal candidiasis) and as life-threatening systemic candidiasis. With relatively few antifungal agents in the clinical armamentarium, the optimal management of candidiasis remains controversial. Among the agents that are available, amphotericin B is difficult to administer, 5-fluorocytosine cannot be used alone due to the frequent emergence of resistant yeasts, and ketoconazole, which is effective for esophageal and oropharyngeal candidiasis, is not recommended for systemic candidiasis, especially in granulocytopenic patients. Recently, fluconazole, a new triazole antifungal agent, has been found to be active against Candida spp and is being studied in various clinical settings. In addition to its oral formulation, it is available for intravenous (IV) administration, which is a significant advantage in treating debilitated or noncompliant patients. In a randomized, double-blind study, we compared the efficacy of 100 mg/d oral fluconazole with that of 400 mg/d ketoconazole in cancer patients with oropharyngeal candidiasis. Although clinical and microbiological outcomes were similar for both groups, relapses occurred earlier in ketoconazole- than in fluconazole-treated patients. In another study, we administered fluconazole IV 100 to 300 mg/d to 13 patients, eight of whom had fungemia. Preliminary results are encouraging. Further studies of fluconazole as prophylaxis in granulocytopenic patients and as therapy for documented systemic candidiasis are under way. These studies are expected to define specific indications for fluconazole in immunocompromised patients.

Adolescent↗
PubMed1988

Anorectal and colonic disease and the immunocompromised host.

The immunocompromised host is becoming increasingly ubiquitous in the authors' patient population. There are growing numbers of long-term transplant recipients, and combination chemotherapy is producing many long-term survivors. Of greatest concern is that the number of patients with human immunodeficiency virus (HIV) causing immunosuppression is increasing. The literature is reviewed to produce a current summary of conditions affecting the anorectum and colon and arising as a direct consequence of the immunocompromised host. Pathophysiology and theoretic considerations are mentioned where applicable and current therapy is discussed. The conditions are classified under infectious, neoplastic, iatrogenic, and congenital. Although the colorectal surgeon will encounter most of these conditions sometime during a career, many are infrequent, and a current review is provided herein to provide categorization and updated information.

Colonic Diseases↗
PubMed2001

Acute lung disease in the immunocompromised host.

The immunocompromised host is an individual with a decreased defense mechanism or immunity. Pulmonary complications commonly seen in these patients include infections, neoplasms, drug-induced lung disease, and pulmonary hemorrhage. High-resolution CT plays an invaluable role in confirming the presence of pulmonary disease and narrowing down the differential diagnosis in this group of patients. It also is helpful as a guide to the optimal type and site of biopsy. The pattern and prevalence of disease varies considerably between the AIDS and the non-AIDS group, and therefore, these two groups are considered separately.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Sinusitis in the immunocompromised host.

In the immunocompromised host, uncommon pathogens have been documented as causing sinusitis. Resistance to standard antibiotics for sinusitis in the immunocompromised individual must prompt nasal culture and biopsy for early diagnosis. Immunocompromised host include neutropenic patients, Human Immuno-Deficiency (HIV) infected patients and non-HIV-suppressed patients. Unusual bacterial organisms (Pseudomonas Aeruginosa), mycobacteria, fungi (Aspergillosis) and viral infection (Cytomegalovirus) have all been found to cause sinusitis in immunocompromised patients. Early detection of these infections with appropriate anti-infective agents associated with radical or functional endoscopic surgery seems to be the optimal treatment. Recovery of immunity remains the major prognostic factor.

AIDS-Related Opportunistic Infections↗
PubMed1997

Infection control of nosocomial respiratory viral disease in the immunocompromised host.

Among immunocompromised adults, such as bone marrow transplant recipients, more than half of respiratory viral infections are complicated by pneumonia, with an associated mortality rate > 50%. Nosocomial transmission of respiratory viral pathogens, such as respiratory syncytial virus (RSV) and influenza, in the immunocompromised patient has been reported frequently and usually occurs during a community outbreak. In view of the poor outcome in this subset of patients, intensive efforts should be directed at instituting prevention measures that would interrupt nosocomial transmission. At M.D. Anderson Cancer Center, a multifaceted infection control strategy resulted in a significant decrease in and almost complete interruption of the nosocomial transmission of RSV infections in immunocompromised patients over a 3-year period (1994-1996). For influenza virus, special emphasis should be given to vaccination of hospital personnel before the influenza season to prevent and control nosocomial transmission. In highly immunocompromised patients, prophylactic use of antiviral agents should be considered during an outbreak or when the frequency of nosocomial transmission is high. An aggressive multifaceted infection control strategy appears to be effective in reducing the frequency of nosocomial transmission of respiratory viral infections in immunocompromised patients. Universal and timely influenza vaccination of hospital personnel who care for immunocompromised patients is necessary.

Adenoviridae Infections↗
PubMed2005

Breakdown of pulmonary host defense in the immunocompromised host: cancer chemotherapy.

The number of immunocompromised patients is steadily increasing due to HIV infection, solid organ and stem cell transplantation, intensified chemotherapy, immunosuppression for autoimmune diseases, and a marked increase in the use of monoclonal antibodies. Prevention strategies for pulmonary infections and diagnostic methods have evolved and patient outcome has improved. However, therapies affecting the immune system are also given to older patients and patients with comorbidities. While the rate of pulmonary complications in HIV patients has dramatically decreased under antiretroviral therapy, we are seeing more patients with pulmonary problems after chemotherapy. Neutropenia is still the most important risk factor for bacterial and fungal infection. Flexible bronchoscopy with BAL remains an important diagnostic method with a low morbidity and high diagnostic yield in patients with pulmonary infiltrates following cancer chemotherapy.

Antineoplastic Agents↗
PubMedDate not supplied

A review of the treatment of ocular herpes simplex infections in the neonate and immunocompromised host.

Infection of newborns and immunocompromised hosts with herpes simplex virus appears to be no more common than in the normal adult. However, the disease tends to be more difficult to treat in the newborn because of poor patient compliance, delay in the diagnosis, and the tendency for retinal disease to occur. The disease is more difficult to treat in the immunocompromised host because of the necessity for maintenance of immunosuppression. Initial treatment is usually the same as used for adults unless intraocular infection occurs. Early diagnosis and treatment in the newborn can prevent corneal opacification and amblyopia, whereas ocular disease in the immunocompromised host may be an insignificant problem compared with infection elsewhere in the host's body.

Antiviral Agents↗
PubMed1988

Fungal mastoiditis in the immunocompromised host.

An immunocompromised patient is subject to unusual, severe opportunistic infections. We report a case of Aspergillus fumigatus mastoiditis in a patient with leukemia who also had cryptococcal meningitis. A fatal outcome ensued, despite extensive surgical and antimicrobial intervention.

Aged↗
PubMed1987

The immunocompromised host.

The immunocompromised patient, with or without superimposed granulocytopenia, provides a wide range of life-threatening challenges for the primary medical and nursing care management group. In the context of haematological malignancy, particularly leukaemia and bone marrow transplantation, special expertise needs to be developed which includes competence in many aspects of general medical, nursing, and intensive care techniques. Clearly, the range of essential knowledge extends to other disciplines including respiratory, cardiac, and renal medicine, with important contributions from microbiology, virology, dietetics and parenteral nutrition. The increasing cure rate achieved in haematological malignancy and the ever-widening indications for bone marrow transplantation require a dedicated and experienced group, able to handle all challenges. Integral to managing the complete patient, both through the acute phase and into periods of recovery and long-term rehabilitation, is inclusion of the paramedical specialists--social workers, occupational therapists, physical medicine physicians and physiotherapists. Proper balance in the cost-effective use of expertise from each of these groups and the provision of a suitable physical facility with protected environment and intensive care facilities are the cornerstones on which individual patient survival and ultimately increase in cure rates depend.

Agranulocytosis↗
PubMed1992

Modulation of host defenses by cytokines: evolving adjuncts in prevention and treatment of serious infections in immunocompromised hosts.

Traditional management of infectious complications, especially in immunocompromised hosts, has depended on the prompt initiation of therapy with broad-spectrum antibiotics. During the past several years, however, a number of cytokines (interleukins, hematopoietic growth factors, interferons) have been developed and produced by recombinant DNA technology, and preclinical and clinical studies of cytokines in immunocompromised hosts have begun. The data being generated suggest that certain cytokines can accelerate neutrophil and monocyte/macrophage production, enhance their function, and potentially decrease infectious complications. The role of these agents in both the prevention and treatment of infectious diseases represents an important research challenge and offers new approaches to the prevention and treatment of infection in immunocompromised hosts.

Cytokines↗
PubMed1993

Biologicals and hematopoietic cytokines in prevention or treatment of infections in immunocompromised hosts.

The number of immunocompromised hosts has dramatically increased in recent years. The primary reason for this increase has been the intensification of antineoplastic therapy for the treatment of various malignancies and the explosive spread of human immunodeficiency virus infection. Although the treatment and prevention of many infections have been improved with the rational use of antimicrobial agents, ultimate success can be blunted by protracted impairment of essential host defenses or by the virulence of certain organisms.

Cytokines↗
PubMed1989

Opportunistic fungal infections in immunocompromised hosts.

Fungal infections in immunocompromised hosts cause major morbidity and mortality. The Candida and Aspergillus species are the most common causes, but many rarer organisms, once considered "contaminants," are being reported. The number of patients who receive immunosuppressive agents for the treatment of malignancy or for organ transplantation is increasing as well as the potential for local or disseminated fungal infections. The diagnosis of these infections is often difficult and the existing methods for treatment are often ineffective. A high degree of suspicion to identify fungal infections and to prompt initiation of treatment must be maintained if the survival rate of these patients is expected to improve.

Amphotericin B↗
PubMed1993

Diagnostic value of pleural adenosine deaminase in tuberculous effusions of immunocompromised hosts.

To investigate the diagnostic value of adenosine deaminase (ADA) in immunocompromised hosts with tuberculous pleural effusions, we collected and checked 60 pleural effusion specimens from admitted patients. These patients were divided into three groups: group I (n = 20), immunocompetent hosts with tuberculous pleural effusions; group II (n = 10), immunocompromised hosts with tuberculous pleural effusions; and group III (n = 30), patients with malignant pleural effusions. Using statistical analysis to compare the ADA value in each group, the p value was found to be significant between groups I and II (p < 0.01), groups I and III (p < 0.001) and groups I+II and III (p < 0.001); however, the p value was not significant between groups II and III. If the lowest ADA value for the tuberculous pleural effusion was designed as 80 U/L, the sensitivity/specificity was 1.0/0.90 (group I), 0.40/0.90 (group II), and 0.80/0.90 (group I+II), respectively. We conclude that the diagnostic value of ADA in immunocompromised hosts with tuberculous pleural effusions is not as significant as in immunocompetent hosts.

Adenosine Deaminase↗
PubMed2005

[Candida infections in immunocompromised hosts].

Candida infections in the immunocompromised patients represent a major therapeutic challenge. In immunocompromised host candidiasis can range from asymptomatic oral thrush to life-threatening candidemia. Invasive Candida infections parallel increase in the immunocompromised patient population and are characterized by high mortality. Diagnosis of Candida infections is difficult and is based on clinical picture, microbiological and histological examinations. Mainstay of treatment are systemic antimycotic agents (fluconazole, amphotericin B, itraconazole, voriconazole and caspofungin). Empirical and prophylactic treatment is warranted in selected groups of high risk patients.

Antifungal Agents↗