Cytokines and T-Lymphocyte count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in peru: a pilot study
This cross-sectional pilot study evaluated immunology patterns in patients with acute and chronic phases of Bartonella bacilliformis infection in Peru. Patients between 5-60 years old from endemic areas were included. For those in the acute phase, elevated levels of the anti-inflammatory cytokine IL-10 and abnormal CD4+ and CD8+ T-lymphocyte counts correlated with an unfavorable immune state that may allow bacterial persistence. During the chronic phase, elevated IFN-γ and IL-4 levels correlated with previous findings of endothelial invasion in animal models. The study provides initial immunology data to inform future research on Human Bartonellosis.
This document provides guidelines from the Infectious Diseases Society of America for the use of antimicrobial agents in neutropenic patients with cancer. Key points include:
1) Patients should be assessed for risk of infection and categorized as high or low risk to guide treatment approach. High risk patients require hospitalization and IV antibiotics.
2) Initial evaluation should include blood cultures and tests to assess organ function. Imaging is indicated if respiratory symptoms are present.
3) High risk patients require broad-spectrum IV antibiotics targeting both gram-positive and gram-negative bacteria. Antifungal therapy or investigation should be considered if fever persists after 4-7 days of antibiotics.
4) Treatment duration depends on infection status and marrow
Fungal infections can occur due to the increasing use of broad-spectrum antibiotics and patients with immunodeficiency. Some pathogens, such as Cryptococcus, Candida,and Fusarium, rarely cause serious diseases in the normal host, while other endemic fungi, such as Histoplasmosis, Coccidiodes,and Paracoccidiodes can cause disease in a normal host, but has a tendency to be aggressive on immunocompromise.
Candida species are normal flora that may be an apportunistic pathogen. Candidiasis occurs in some diseases such as gastrointestinal mucosal esophagitis, a fungal disease associated with the use of catheters and in - patients who have mucosal damage or obtain broad – spectrum antibiotics. Other candidiasis consist of skin candidiasis, funguria candidiasis, disseminated candidiasis and endocarditis candidiasis. Candidemia is the fourth most common cause of nosocomial bloodstream infections in the United States and in many of the developed country. Invasive candidiasis has a significant impact on patient outcomes, and it has been estimated that the mortality of invasive candidiasis is as high as 47%. The mortality rates are 15%-25% for adults and 10%-15% for neonates and children. Diagnostic approach to fungal infection is a priority. The knowledge of the changes in epidemiology and risk factors for fungal infections, has become the main reference to measure optimal treatment of fungal infections.
Clinical presentation and outcomes of HIV positive patients with diagnosis of...Oscar Malpartida-Tabuchi
This document summarizes a study on tuberculosis (TB) in HIV-positive patients at a hospital in Lima, Peru in 2014. It finds that:
- 22 HIV+ patients were diagnosed with TB, most were male with low CD4 counts. Extra-pulmonary TB was most common.
- 21 cases were microbiologically confirmed, with high rates of drug resistance including 30% MDR and 5% XDR.
- Outcomes differed by HIV treatment group: no mortality in groups receiving HIV drugs >6 months or <6 months, but 18.2% mortality in group not receiving HIV drugs.
ABSTRACT- Invasive fungal infections have become a major source of morbidity and mortality in post operative
patients. Critically ill patients after extended surgical procedure are more risk to post surgical fungal infections. Life
saving devices like central venous catheters can increases risk for fungal infections. Surgical infections are infections of
the tissues, organs or spaces exposed by surgeons during performances of surgical procedure. Mold infection is
increasingly common in post operative patients. Postoperative surgical infection represents an uncommon but potentially
devastating complication of surgery. Unfortunately, medical community is not much aware of such secondary infections
due to fungi in post operative patients leading to grave consequences. Better diagnostic methods are needed to improve
the outcome of successful surgery and better health care for public. The diagnosis of invasion and dissemination in the
majority of cases requires the acquisition and proper interpretation of clinical evidence.
Key-words- Postoperative, Surgical infections, Secondary infections, Diagnostic method
Epidemiology treatment and_outcomes_of_sa_nosocomial_pneumonia_chest_2005-1Christian Wilhelm
This study examined outcomes of nosocomial bacteremic Staphylococcus aureus pneumonia (NBSAP) in 60 patients over 5 years. It found that NBSAP commonly developed late in a patient's hospital stay among critically ill patients on mechanical ventilation. NBSAP was associated with high mortality and infection-related mortality rates of 55.5% and 40%, respectively. While delayed appropriate antibiotic therapy did not predict worse outcomes compared to early therapy, the study was limited by small sample size. The findings suggest a need for new antibiotics with better activity against NBSAP.
1. The document provides guidelines from the Infectious Diseases Society of America (IDSA) for using antimicrobial agents in neutropenic patients with cancer.
2. It recommends assessing patient risk level, performing diagnostic tests and cultures, providing appropriate empiric antibiotic therapy based on risk, modifying treatment based on clinical response, considering antifungal therapy for persistent fever, and using prophylaxis in high-risk patients.
3. The guidelines stratify patients as high-risk or low-risk based on factors like anticipated neutropenia duration and comorbidities. This determines treatment venue and duration. Immediate broad-spectrum antibiotics are recommended for high-risk patients.
Management of infections in immunocompromised patientsSujay Iyer
This document provides an overview of managing infections in immunocompromised patients. It discusses various conditions that can cause immunosuppression like cancer, HIV, malnutrition, and immunosuppressive drugs. It focuses on febrile neutropenia, describing the definition, etiology, risk stratification, diagnosis, and management depending on if the patient is high-risk or low-risk. It also covers catheter-related infections, pneumonia, gastrointestinal infections, and prevention of infections. The management of febrile neutropenia involves broad-spectrum antibiotics, monitoring response, and modifying treatment based on culture results and patient risk factors.
This document summarizes a case report of tularemia (Francisella tularensis infection) in British Columbia and reviews 16 other cases over 15 years. All cases were acquired rurally and presented most commonly with skin lesions and lymphadenopathy. Two severe cases of sepsis and pulmonary infection were also reported. Physicians and public health workers should be aware of this rare but potentially serious disease endemic to BC, especially for those exposed to wildlife.
This document provides guidelines from the Infectious Diseases Society of America for the use of antimicrobial agents in neutropenic patients with cancer. Key points include:
1) Patients should be assessed for risk of infection and categorized as high or low risk to guide treatment approach. High risk patients require hospitalization and IV antibiotics.
2) Initial evaluation should include blood cultures and tests to assess organ function. Imaging is indicated if respiratory symptoms are present.
3) High risk patients require broad-spectrum IV antibiotics targeting both gram-positive and gram-negative bacteria. Antifungal therapy or investigation should be considered if fever persists after 4-7 days of antibiotics.
4) Treatment duration depends on infection status and marrow
Fungal infections can occur due to the increasing use of broad-spectrum antibiotics and patients with immunodeficiency. Some pathogens, such as Cryptococcus, Candida,and Fusarium, rarely cause serious diseases in the normal host, while other endemic fungi, such as Histoplasmosis, Coccidiodes,and Paracoccidiodes can cause disease in a normal host, but has a tendency to be aggressive on immunocompromise.
Candida species are normal flora that may be an apportunistic pathogen. Candidiasis occurs in some diseases such as gastrointestinal mucosal esophagitis, a fungal disease associated with the use of catheters and in - patients who have mucosal damage or obtain broad – spectrum antibiotics. Other candidiasis consist of skin candidiasis, funguria candidiasis, disseminated candidiasis and endocarditis candidiasis. Candidemia is the fourth most common cause of nosocomial bloodstream infections in the United States and in many of the developed country. Invasive candidiasis has a significant impact on patient outcomes, and it has been estimated that the mortality of invasive candidiasis is as high as 47%. The mortality rates are 15%-25% for adults and 10%-15% for neonates and children. Diagnostic approach to fungal infection is a priority. The knowledge of the changes in epidemiology and risk factors for fungal infections, has become the main reference to measure optimal treatment of fungal infections.
Clinical presentation and outcomes of HIV positive patients with diagnosis of...Oscar Malpartida-Tabuchi
This document summarizes a study on tuberculosis (TB) in HIV-positive patients at a hospital in Lima, Peru in 2014. It finds that:
- 22 HIV+ patients were diagnosed with TB, most were male with low CD4 counts. Extra-pulmonary TB was most common.
- 21 cases were microbiologically confirmed, with high rates of drug resistance including 30% MDR and 5% XDR.
- Outcomes differed by HIV treatment group: no mortality in groups receiving HIV drugs >6 months or <6 months, but 18.2% mortality in group not receiving HIV drugs.
ABSTRACT- Invasive fungal infections have become a major source of morbidity and mortality in post operative
patients. Critically ill patients after extended surgical procedure are more risk to post surgical fungal infections. Life
saving devices like central venous catheters can increases risk for fungal infections. Surgical infections are infections of
the tissues, organs or spaces exposed by surgeons during performances of surgical procedure. Mold infection is
increasingly common in post operative patients. Postoperative surgical infection represents an uncommon but potentially
devastating complication of surgery. Unfortunately, medical community is not much aware of such secondary infections
due to fungi in post operative patients leading to grave consequences. Better diagnostic methods are needed to improve
the outcome of successful surgery and better health care for public. The diagnosis of invasion and dissemination in the
majority of cases requires the acquisition and proper interpretation of clinical evidence.
Key-words- Postoperative, Surgical infections, Secondary infections, Diagnostic method
Epidemiology treatment and_outcomes_of_sa_nosocomial_pneumonia_chest_2005-1Christian Wilhelm
This study examined outcomes of nosocomial bacteremic Staphylococcus aureus pneumonia (NBSAP) in 60 patients over 5 years. It found that NBSAP commonly developed late in a patient's hospital stay among critically ill patients on mechanical ventilation. NBSAP was associated with high mortality and infection-related mortality rates of 55.5% and 40%, respectively. While delayed appropriate antibiotic therapy did not predict worse outcomes compared to early therapy, the study was limited by small sample size. The findings suggest a need for new antibiotics with better activity against NBSAP.
1. The document provides guidelines from the Infectious Diseases Society of America (IDSA) for using antimicrobial agents in neutropenic patients with cancer.
2. It recommends assessing patient risk level, performing diagnostic tests and cultures, providing appropriate empiric antibiotic therapy based on risk, modifying treatment based on clinical response, considering antifungal therapy for persistent fever, and using prophylaxis in high-risk patients.
3. The guidelines stratify patients as high-risk or low-risk based on factors like anticipated neutropenia duration and comorbidities. This determines treatment venue and duration. Immediate broad-spectrum antibiotics are recommended for high-risk patients.
Management of infections in immunocompromised patientsSujay Iyer
This document provides an overview of managing infections in immunocompromised patients. It discusses various conditions that can cause immunosuppression like cancer, HIV, malnutrition, and immunosuppressive drugs. It focuses on febrile neutropenia, describing the definition, etiology, risk stratification, diagnosis, and management depending on if the patient is high-risk or low-risk. It also covers catheter-related infections, pneumonia, gastrointestinal infections, and prevention of infections. The management of febrile neutropenia involves broad-spectrum antibiotics, monitoring response, and modifying treatment based on culture results and patient risk factors.
This document summarizes a case report of tularemia (Francisella tularensis infection) in British Columbia and reviews 16 other cases over 15 years. All cases were acquired rurally and presented most commonly with skin lesions and lymphadenopathy. Two severe cases of sepsis and pulmonary infection were also reported. Physicians and public health workers should be aware of this rare but potentially serious disease endemic to BC, especially for those exposed to wildlife.
This document from the American Thoracic Society provides treatment guidelines for fungal infections in adult pulmonary and critical care patients. It was approved by the ATS Board of Directors in May 2010. The document focuses on 3 areas: endemic mycoses like histoplasmosis; fungal infections in immunocompromised patients like cryptococcosis and aspergillosis; and rare/emerging fungal infections. It reviews antifungal drug classes, provides treatment recommendations graded by evidence quality, and offers guidance for challenging clinical situations. The goal is to provide a concise clinical summary of current therapeutic approaches for fungal infections relevant to pulmonary and critical care practice.
Diretrizes para o Manejo da Histoplasmose 2007Flávia Salame
This document provides guidelines for the management of patients with histoplasmosis. It summarizes recommendations for treating various clinical manifestations of histoplasmosis, including acute and chronic pulmonary histoplasmosis, mediastinal lymphadenitis, mediastinal granuloma, mediastinal fibrosis, and broncholithiasis. It recommends antifungal therapies like amphotericin B and itraconazole for moderate to severe cases. Corticosteroids are recommended for severe pulmonary disease or symptoms lasting over a month. Most mild or asymptomatic cases do not require treatment.
This document summarizes a study of 82 patients with pneumonia who were treated as outpatients and re-evaluated after 14 days in an emergency department in Spain. The average age was 49 years old, and most patients had mild symptoms. Bacteria were detected in 29% of cases, most commonly Streptococcus pneumoniae and Mycoplasma pneumoniae. All patients recovered without deaths, though two needed further hospital consultation. The study concludes that outpatient treatment can be effective for mildly ill pneumonia patients when monitored in the emergency department.
This study analyzed 415 patients with brucellosis in Tehran, Iran between 1998-2005. Most patients were female, aged 20-40 years, and had symptoms for less than 2 months. The most common symptoms were sweating and fever, while the most frequent signs were fever, arthritis, and splenomegaly. The majority of patients consumed non-pasteurized dairy products. Rifampin plus cotrimoxazole was the most common treatment, but resulted in the highest relapse rate, while doxycycline and cotrimoxazole led to the fewest relapses. Relapse remained a complication even following appropriate treatment.
Clinical features of patients infected with 2019 novel copyMadhumitaSingh23
- The document reports on 41 early patients in Wuhan, China who were infected with the 2019 novel coronavirus. It found that most patients were men under the age of 65, with common symptoms being fever, cough, and fatigue. All patients had pneumonia seen on chest CT scans. About 15% of patients died, with ICU patients having more severe illness and higher mortality. The study helps characterize the clinical features and severity of the new coronavirus.
Management of neutropenic fever in cancer patients Prof Hamdy ZawamMuhammad El Hady
This document discusses the management of neutropenic fever in cancer patients. It covers factors that predispose patients to infection, defines neutropenic fever, and outlines risk stratification methods. For workup, it recommends cultures, imaging, and labs. For treatment, it suggests empiric antibiotic therapy based on risk level, with modifications for specific infections. Initial empiric regimens for high-risk patients include broad-spectrum IV antibiotics like ceftazidime, cefepime, imipenem, or meropenem. It provides guidance on adding anti-gram positive or modifying treatment.
This document discusses Candida infections in the ICU, including epidemiology, risk factors, pathogenesis, diagnosis, and treatment. Some key points:
- Candida species are the most common fungal pathogens in hospitals and ICUs, responsible for 17% of healthcare-associated infections. Non-albicans Candida species now account for around 50% of infections.
- Risk factors for invasive Candida infections include prolonged ICU stay, broad-spectrum antibiotic use, surgery, and underlying conditions like diabetes that impair immunity. Heavy Candida colonization is an independent risk factor.
- Diagnosis is challenging as symptoms mimic bacterial infections. Culture-based methods are slow. Biomarkers like beta-D-
Diretriz para tratamento da blastomicose 2008Flávia Salame
The document provides clinical practice guidelines from the Infectious Diseases Society of America (IDSA) for the management of blastomycosis. It summarizes recommendations for treating various forms of the disease, including pulmonary, disseminated extrapulmonary, and central nervous system blastomycosis. It also provides guidance on treating special populations such as pregnant women and children. The recommendations are based on published evidence between 2000-2006 and aim to help healthcare providers effectively treat patients with this fungal infection.
Yeasts such as Candida are common causes of bloodstream infections in ICU patients. Candida infections in the ICU have a high mortality rate of 15-25% and are the 4th most common cause of hospital-acquired bloodstream infections. Diagnosis can be challenging due to low sensitivity of blood cultures, but newer tests such as PCR, antigen detection assays, and MALDI-TOF mass spectrometry provide more rapid detection of Candida compared to standard culture methods. The presence of risk factors such as abdominal surgery, central venous catheters, antibiotics use, and prolonged ICU stay increase the risk of developing Candida bloodstream infections in critically ill patients.
This document provides guidelines for the diagnosis and treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in adults. Some of the key recommendations include:
1) Using noninvasive sampling with semiquantitative cultures rather than invasive sampling with quantitative cultures to diagnose VAP.
2) If invasive quantitative cultures are performed for a patient with suspected VAP and results are below the diagnostic threshold, antibiotics should be withheld rather than continued.
3) For patients with suspected HAP (non-VAP), treatment should be guided by microbiologic studies of respiratory samples rather than being empirically treated.
4) For patients with suspected HAP/V
Antifungal Strategies in the Intensive Care UnitsYazan Kherallah
Discuss the different anti-fungal treatment strategies for suspected systemic candidiasis in the intensive care units: prophylaxis, preemptive, empiric and definitive.
Fungal infections in hematology patients: advances in prophylaxis and treatmentspa718
This document summarizes advances in prophylaxis and treatment of fungal infections in hematology patients. It discusses risk stratification approaches and various randomized controlled trials comparing different antifungal agents for prophylaxis. Trials showed posaconazole, micafungin, and voriconazole reduced incidence of invasive fungal infections compared to fluconazole or itraconazole in high-risk patients. The document also reviews empirical antifungal therapy approaches and measures of success in clinical trials comparing liposomal amphotericin B, voriconazole, and caspofungin.
This document summarizes guidelines for the evaluation and management of fever in neutropenic patients. It discusses the initial evaluation, appropriate antimicrobial therapy including both combination regimens and monotherapy options. It also addresses criteria for adding antifungal therapy if fever persists after initial treatment and antibiotics.
Fungal infections caused by Candida and Aspergillus species are increasingly common in critically ill patients. These infections are associated with high morbidity and mortality. Clinicians must have a high index of suspicion given the challenges of diagnosis in ICU patients. Treatment is complicated by potential adverse drug reactions and interactions.
This document provides an outline of José Ramón Paño-Pardo's track at the ICAAC 2015 conference. The conference focused on antimicrobial agents and chemotherapy. Key topics included antimicrobial stewardship, bloodstream infections, new antimicrobials, and clinical infectious disease syndromes. Sessions covered emerging resistance issues like carbapenemase-producing Enterobacteriaceae and rapid diagnostics for sepsis.
This document reports a case of Saccharomyces cerevisiae fungemia in an 8-month-old baby receiving chemotherapy for acute myeloid leukemia. The patient was receiving Saccharomyces boulardii capsules as prophylaxis against diarrhea when a strain of S. cerevisiae was isolated from their blood culture. While S. boulardii and S. cerevisiae are difficult to distinguish, this case raises concerns about potential infectious risks from biotherapeutic agents in immunocompromised patients. The patient recovered after treatment with amphotericin-B and removal of their central venous catheter.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Associations of MHC Ancestral Haplotypes with Resistance/Susceptibility to AI...Dr. Juan Rodriguez-Tafur
This document analyzes the association between MHC ancestral haplotypes and rates of progression to AIDS. It finds that the 8.1 and 44.2 ancestral haplotypes are associated with rapid progression to AIDS, while the 35.2 and 57.1 haplotypes are associated with slow progression. Analysis of recombinant fragments of these haplotypes identifies MHC regions within the 35.1, 35.2, and 44.2 haplotypes associated with rapid progression, and within the 44.1 and 57.1 haplotypes associated with slow progression. Previous studies identified single HLA alleles associated with progression; this study confirms the direct role of HLA-B35 in rapid progression through haplotype analysis.
Este documento describe las citoquinas producidas principalmente por los linfocitos Th1, incluyendo la interleuquina-2 (IL-2). Explica que la IL-2 estimula la proliferación de linfocitos T y B, induce la producción de interferón-gamma, y activa las células asesinas naturales. También describe el receptor de IL-2 y cómo se compone de tres cadenas (α, β y γ) que forman un complejo trimérico de alta afinidad. Finalmente, resume algunos usos terapéuticos de la IL-
This document from the American Thoracic Society provides treatment guidelines for fungal infections in adult pulmonary and critical care patients. It was approved by the ATS Board of Directors in May 2010. The document focuses on 3 areas: endemic mycoses like histoplasmosis; fungal infections in immunocompromised patients like cryptococcosis and aspergillosis; and rare/emerging fungal infections. It reviews antifungal drug classes, provides treatment recommendations graded by evidence quality, and offers guidance for challenging clinical situations. The goal is to provide a concise clinical summary of current therapeutic approaches for fungal infections relevant to pulmonary and critical care practice.
Diretrizes para o Manejo da Histoplasmose 2007Flávia Salame
This document provides guidelines for the management of patients with histoplasmosis. It summarizes recommendations for treating various clinical manifestations of histoplasmosis, including acute and chronic pulmonary histoplasmosis, mediastinal lymphadenitis, mediastinal granuloma, mediastinal fibrosis, and broncholithiasis. It recommends antifungal therapies like amphotericin B and itraconazole for moderate to severe cases. Corticosteroids are recommended for severe pulmonary disease or symptoms lasting over a month. Most mild or asymptomatic cases do not require treatment.
This document summarizes a study of 82 patients with pneumonia who were treated as outpatients and re-evaluated after 14 days in an emergency department in Spain. The average age was 49 years old, and most patients had mild symptoms. Bacteria were detected in 29% of cases, most commonly Streptococcus pneumoniae and Mycoplasma pneumoniae. All patients recovered without deaths, though two needed further hospital consultation. The study concludes that outpatient treatment can be effective for mildly ill pneumonia patients when monitored in the emergency department.
This study analyzed 415 patients with brucellosis in Tehran, Iran between 1998-2005. Most patients were female, aged 20-40 years, and had symptoms for less than 2 months. The most common symptoms were sweating and fever, while the most frequent signs were fever, arthritis, and splenomegaly. The majority of patients consumed non-pasteurized dairy products. Rifampin plus cotrimoxazole was the most common treatment, but resulted in the highest relapse rate, while doxycycline and cotrimoxazole led to the fewest relapses. Relapse remained a complication even following appropriate treatment.
Clinical features of patients infected with 2019 novel copyMadhumitaSingh23
- The document reports on 41 early patients in Wuhan, China who were infected with the 2019 novel coronavirus. It found that most patients were men under the age of 65, with common symptoms being fever, cough, and fatigue. All patients had pneumonia seen on chest CT scans. About 15% of patients died, with ICU patients having more severe illness and higher mortality. The study helps characterize the clinical features and severity of the new coronavirus.
Management of neutropenic fever in cancer patients Prof Hamdy ZawamMuhammad El Hady
This document discusses the management of neutropenic fever in cancer patients. It covers factors that predispose patients to infection, defines neutropenic fever, and outlines risk stratification methods. For workup, it recommends cultures, imaging, and labs. For treatment, it suggests empiric antibiotic therapy based on risk level, with modifications for specific infections. Initial empiric regimens for high-risk patients include broad-spectrum IV antibiotics like ceftazidime, cefepime, imipenem, or meropenem. It provides guidance on adding anti-gram positive or modifying treatment.
This document discusses Candida infections in the ICU, including epidemiology, risk factors, pathogenesis, diagnosis, and treatment. Some key points:
- Candida species are the most common fungal pathogens in hospitals and ICUs, responsible for 17% of healthcare-associated infections. Non-albicans Candida species now account for around 50% of infections.
- Risk factors for invasive Candida infections include prolonged ICU stay, broad-spectrum antibiotic use, surgery, and underlying conditions like diabetes that impair immunity. Heavy Candida colonization is an independent risk factor.
- Diagnosis is challenging as symptoms mimic bacterial infections. Culture-based methods are slow. Biomarkers like beta-D-
Diretriz para tratamento da blastomicose 2008Flávia Salame
The document provides clinical practice guidelines from the Infectious Diseases Society of America (IDSA) for the management of blastomycosis. It summarizes recommendations for treating various forms of the disease, including pulmonary, disseminated extrapulmonary, and central nervous system blastomycosis. It also provides guidance on treating special populations such as pregnant women and children. The recommendations are based on published evidence between 2000-2006 and aim to help healthcare providers effectively treat patients with this fungal infection.
Yeasts such as Candida are common causes of bloodstream infections in ICU patients. Candida infections in the ICU have a high mortality rate of 15-25% and are the 4th most common cause of hospital-acquired bloodstream infections. Diagnosis can be challenging due to low sensitivity of blood cultures, but newer tests such as PCR, antigen detection assays, and MALDI-TOF mass spectrometry provide more rapid detection of Candida compared to standard culture methods. The presence of risk factors such as abdominal surgery, central venous catheters, antibiotics use, and prolonged ICU stay increase the risk of developing Candida bloodstream infections in critically ill patients.
This document provides guidelines for the diagnosis and treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in adults. Some of the key recommendations include:
1) Using noninvasive sampling with semiquantitative cultures rather than invasive sampling with quantitative cultures to diagnose VAP.
2) If invasive quantitative cultures are performed for a patient with suspected VAP and results are below the diagnostic threshold, antibiotics should be withheld rather than continued.
3) For patients with suspected HAP (non-VAP), treatment should be guided by microbiologic studies of respiratory samples rather than being empirically treated.
4) For patients with suspected HAP/V
Antifungal Strategies in the Intensive Care UnitsYazan Kherallah
Discuss the different anti-fungal treatment strategies for suspected systemic candidiasis in the intensive care units: prophylaxis, preemptive, empiric and definitive.
Fungal infections in hematology patients: advances in prophylaxis and treatmentspa718
This document summarizes advances in prophylaxis and treatment of fungal infections in hematology patients. It discusses risk stratification approaches and various randomized controlled trials comparing different antifungal agents for prophylaxis. Trials showed posaconazole, micafungin, and voriconazole reduced incidence of invasive fungal infections compared to fluconazole or itraconazole in high-risk patients. The document also reviews empirical antifungal therapy approaches and measures of success in clinical trials comparing liposomal amphotericin B, voriconazole, and caspofungin.
This document summarizes guidelines for the evaluation and management of fever in neutropenic patients. It discusses the initial evaluation, appropriate antimicrobial therapy including both combination regimens and monotherapy options. It also addresses criteria for adding antifungal therapy if fever persists after initial treatment and antibiotics.
Fungal infections caused by Candida and Aspergillus species are increasingly common in critically ill patients. These infections are associated with high morbidity and mortality. Clinicians must have a high index of suspicion given the challenges of diagnosis in ICU patients. Treatment is complicated by potential adverse drug reactions and interactions.
This document provides an outline of José Ramón Paño-Pardo's track at the ICAAC 2015 conference. The conference focused on antimicrobial agents and chemotherapy. Key topics included antimicrobial stewardship, bloodstream infections, new antimicrobials, and clinical infectious disease syndromes. Sessions covered emerging resistance issues like carbapenemase-producing Enterobacteriaceae and rapid diagnostics for sepsis.
This document reports a case of Saccharomyces cerevisiae fungemia in an 8-month-old baby receiving chemotherapy for acute myeloid leukemia. The patient was receiving Saccharomyces boulardii capsules as prophylaxis against diarrhea when a strain of S. cerevisiae was isolated from their blood culture. While S. boulardii and S. cerevisiae are difficult to distinguish, this case raises concerns about potential infectious risks from biotherapeutic agents in immunocompromised patients. The patient recovered after treatment with amphotericin-B and removal of their central venous catheter.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Associations of MHC Ancestral Haplotypes with Resistance/Susceptibility to AI...Dr. Juan Rodriguez-Tafur
This document analyzes the association between MHC ancestral haplotypes and rates of progression to AIDS. It finds that the 8.1 and 44.2 ancestral haplotypes are associated with rapid progression to AIDS, while the 35.2 and 57.1 haplotypes are associated with slow progression. Analysis of recombinant fragments of these haplotypes identifies MHC regions within the 35.1, 35.2, and 44.2 haplotypes associated with rapid progression, and within the 44.1 and 57.1 haplotypes associated with slow progression. Previous studies identified single HLA alleles associated with progression; this study confirms the direct role of HLA-B35 in rapid progression through haplotype analysis.
Este documento describe las citoquinas producidas principalmente por los linfocitos Th1, incluyendo la interleuquina-2 (IL-2). Explica que la IL-2 estimula la proliferación de linfocitos T y B, induce la producción de interferón-gamma, y activa las células asesinas naturales. También describe el receptor de IL-2 y cómo se compone de tres cadenas (α, β y γ) que forman un complejo trimérico de alta afinidad. Finalmente, resume algunos usos terapéuticos de la IL-
The WAO is nominating Dr. Juan Rodriguez-Tafur to join their editorial board as an Editor-at-Large. As an editor, he would work with the chief editor and other editors on strategic initiatives and editorial functions to ensure the website provides international, diverse, and scientifically superior content. He would be asked to contribute content and review other submissions. His five-year term would aim to help the WAO website continue successfully disseminating relevant scientific literature on allergy and immunology globally.
Este documento resume un estudio que evaluó la expresión de los receptores de glucocorticoides alfa y beta en el tejido amigdalino y adenoideo de niños con apnea obstructiva del sueño u infecciones de garganta recurrentes. Los resultados mostraron que ambos receptores estaban presentes en estos tejidos linfoides, pero la expresión del receptor alfa era mayor que la del receptor beta. Además, la expresión del receptor alfa fue mayor en pacientes con apnea obstructiva del sueño en comparación con aquellos con infecciones de garganta recurrentes
Primary Immunodeficiency Diseases in Latin America: The Second Report of the ...Dr. Juan Rodriguez-Tafur
This report summarizes the findings of the Latin American Group for Primary Immunodeficiency Diseases (LAGID) registry, which tracks cases of primary immunodeficiency diseases (PID) across 12 Latin American countries. Some key findings:
- A total of 3,321 PID patients have been registered since the registry began. The most common type of PID was predominantly antibody deficiency (53.2%), with IgA deficiency being most frequent.
- All 12 countries reported an increase in registered PID cases ranging from 10-80% compared to the first LAGID report in 1998.
- Estimated minimal incidence rates of select PID types like X-linked agammaglobulinemia, chronic
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
1) El documento describe el desarrollo e introducción al mercado de los inhibidores de la Cox-2 como Celebrex y Vioxx para tratar el dolor y la inflamación. 2) Estos nuevos fármacos se promocionaron como más seguros que los analgésicos tradicionales debido a un menor riesgo de úlceras, aunque los estudios no lo demostraron claramente. 3) La fuerte campaña de marketing llevó a un rápido aumento de las ventas, aunque luego surgieron interrogantes sobre la seguridad a largo pl
Este documento presenta una revisión de las reacciones alérgicas y seudoalérgicas que ocurren durante la anestesia general. Los relajantes musculares son los fármacos más frecuentemente implicados en reacciones alérgicas, mientras que la sensibilización al látex es la segunda causa más común. Estas reacciones pueden variar de leves a graves y potencialmente mortales. Una buena historia clínica y pruebas de alergia son importantes para identificar factores de riesgo y prevenir reacc
Este documento describe las principales citoquinas producidas por células fagocíticas como macrófagos e incluye la Interleuquina 1 (IL-1), la Interleuquina 6 (IL-6) e Interleuquina 8 (IL-8). Explica que estas citoquinas participan en la respuesta inmune y procesos inflamatorios, activando células T y B e induciendo la síntesis de proteínas. También señala que son producidas por otros tipos celulares como queratinocitos y endotelio
El estudio analiza el papel de Daniel Alcides Carrión como héroe cultural central de la tradición médica peruana y cómo su significado se ha elaborado en un contexto de lucha política y reconstrucción nacional que confluye con el positivismo de las élites del país a inicios del siglo XX. Asimismo, examina cómo la recomposición social de las instituciones médicas y el ingreso del sector emergente a la Facultad de Medicina han hecho que la imagen de Carrión creada a fines del siglo XIX se convierta en un icon
Las células NKT son linfocitos T no convencionales que expresan tanto receptores de célula T como receptores de célula NK. Estas células reconocen antígenos glicolipídicos presentados por la molécula CD1d y secretan citoquinas que regulan tanto la inmunidad innata como la adquirida. Las células NKT desempeñan funciones importantes en el control de infecciones, el rechazo de tumores, y la modulación de enfermedades autoinmunes a través de la producción de cito
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Clinical analysis of 228 patients with pulmonary fungal diseases iWilheminaRossi174
Clinical analysis of 228 patients with pulmonary fungal diseases in China
Abstract
Background: Due to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary fungal diseases is difficult. This study aims to investigate the clinical features of pulmonary fungal diseases.
Methods: We retrospectively analyzed the demographics, types of fungus,radiological characteristics,underlying diseases, the usage of steroid and immunosuppresants, laboratory tests of 228patients with pulmonary fungal disease diagnosed by pathological examination or laboratory culture from October 2011 to July 2018in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.
Results: A total of 228 patients, had a median age of 49years, which included 130 (57%) males and 98(43%) females. The most common fungal species identified were aspergillus (39.5 %), cryptococcus (18.4%), and mucormycosis (3.5 %).The main imaging findings were nodules or mass in 144 patients (63.2%), cavitation in 57 patients (25%),consolidation shadows or ground glass infiltrates in 15 patients (6.6%), and reverse halo sign in 12 patients (5.3%). The main infection sites were right upper lobe (26.8%), right lower lobe (21.5%) and the bronchus infection were 18 (7.9%) persons. For the underlying diseases, the prevalence of diseases was pulmonary tuberculosis (17.5%), bronchiectasis (16.2%), diabetes mellitus (9.2%) and the previous thoracic malignancy (6.6%) was common. The number of patients using steroid was 50% and the number of patients using immunosuppressant was 7%.
Conclusions: The imaging findings and the underlying diseases of patients should be taken into account when making diagnosis of pulmonary funga1disease for the purpo se to speculate the probable fungal pathogen and choose the most appropriate diagnostic tool.
Keywords:Pulmonary fungal disease; pathogen; imaging manifestation; Underlying disease; Clinical analysis; Chinese
(pneumomycosis; pulmonary mycosis?)invasive mould infection (IMI)Invasive fungal infections (IFIs),invasive aspergillosis
invasive mold disease, invasive aspergillosis, diabetes mellitus.
1. INTRODUCTION
In environment, the fungi produce small spores that are routinely inhaled and rapidly cleared from the normal host. However after long standing inhalation makes people more vulnerable to get effected .Moreover pulmonary fungal diseases are an opportunistic infection that predominantly attacks immunocompromised just as immunocompetent patients, however extensive utilization of gluccocorticoids and chemotherapeutics utilizes in patients make the pulmonary fungal disease no longer an uncommon occurrence. The complex underlying conditions such as pulmonary tuberculosis, bronchectasis, COPD and diabetes mellitus in the patients of pulmonary fungal disease and the non-specific nature of pathogen can confound identification and lead to under diagnosis. Due to its vague nature the dia ...
This study evaluated the validity of procalcitonin (PCT) for diagnosing bacterial infections in elderly patients aged 75 years or older. 161 patients were included in the study and divided into two groups: 95 patients with probable bacterial infections and 66 patients without infections. PCT levels above 0.5 ng/mL were found in 72% of patients with probable bacterial infections and 8% of patients without infections. The study found that PCT has a sensitivity of 72% and specificity of 92% for diagnosing bacterial infections in elderly patients using a cutoff of 0.5 ng/mL. The researchers concluded that PCT can be reliably used to diagnose bacterial infections in elderly patients due to its good sensitivity and high specificity.
This study examined the prevalence of candidaemia among immunosuppressed patients with persistent fever at University College Hospital in Ibadan, Nigeria. The researchers found a prevalence of candidaemia was 5.2% among the 230 patients studied. The most common Candida species isolated were C. parapsilosis, C. tropicalis, and C. albicans. Risk factors associated with increased candidaemia risk included isolation of Candida from blood, intravenous cut down sites, mucositis, and diarrhea. Crude and attributable mortality rates for candidaemia were 91.7% and 50% respectively, highlighting the need for prompt antifungal treatment.
CLINICAL FEATURES, DIFFERENCES IN COVID FIRST, SECOND, THIRD WAVES- A DATA BA...DrHeena tiwari
This study compared the clinical features of COVID-19 in children and youth across the first three waves in multiple countries. A total of 397 patients aged 18 or younger were included. More patients were asymptomatic in the second and third waves compared to the first wave. Most illnesses were mild in all waves. A few patients presented with unusual manifestations like chilblains or multisystem inflammatory syndrome. The study found differences in symptoms and hospital length of stay across the three waves.
Characteristic and outcomes of patients with ptb requiring icu careEArl Copina
This document summarizes a study of 58 patients with active pulmonary tuberculosis who required admission to an intensive care unit. The mean age was 48 years and 37.9% required mechanical ventilation. The in-hospital mortality rate was 25.9% with a mean survival of 53.6 days for those who died. Factors independently associated with increased mortality included acute renal failure, need for mechanical ventilation, chronic pancreatitis, sepsis, acute respiratory distress syndrome, and hospital-acquired pneumonia. The study identified risk factors for high mortality rates in tuberculosis patients requiring intensive care.
Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Erwin Chiquete, MD, PhD
34. Chiquete E, Ochoa-Guzmán A, García-Lamas L, Anaya-Gómez F, Gutiérrez-Manjarrez JI, Sánchez-Orozco LV, Godínez-Gutiérrez SA, Maldonado M, Román S, Panduro A. Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Rev Med Inst Mex Seguro Soc. 2012;50(5):481-6. [PMID: 23282259]
FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY INSTITUTIONAnil Haripriya
Fournier’s gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals is now changing its pattern. Both genders can be affected and the mortality is still high (around10%). The clinical presentation in many patients in early stage may not be prominent. Thus rapid and accurate diagnosis is must for prompt treatment. Extensive surgical debridement and broad spectrum intravenous antibiotic remains the mainstay of treatment in order to reduce the morbidity and mortality.
This randomized trial compared quality of life (QOL) outcomes between inpatient and outpatient intravenous antibiotic management of pediatric oncology patients with low risk febrile neutropenia (LRFN). 81 patients presented with 159 fever episodes, of which 37 presentations involving 27 patients were randomized to inpatient (18) or outpatient (19) groups. Patients received intravenous cefepime for at least 48 hours until fever resolution for 24 hours. QOL questionnaires completed daily by parents and patients showed higher combined and domain-specific scores for outpatients, indicating benefits to parents and patients across several QOL measures. Length of fever and adverse events were equivalent between groups, demonstrating outpatient management was both feasible and safe.
This study aimed to identify risk factors for death in children under 15 years old admitted for treatment of visceral leishmaniasis (VL) in northeast Brazil. The researchers reviewed records of 546 patients and found that 57 died, giving a case fatality rate of 10%. Multivariate analysis identified several independent risk factors for death: presence of mucosal bleeding increased the risk 4 times, jaundice 4 times, dyspnea (fast breathing) 3 times, suspected bacterial infections 3 times, and very low neutrophil and platelet counts 3 times and 12 times, respectively. Based on these factors, the researchers created a prognostic score that classified patients as high or low risk, with 88% sensitivity and 79% specificity.
Clinical and Laboratory Prognostic Factors in Malignant form of Mediterranean...inventionjournals
The document summarizes a study of 55 patients with malignant forms of Mediterranean spotted fever (MSF). The study aimed to identify clinical and laboratory prognostic factors for fatal outcomes in these patients. 19 patients died, while 36 survived. Key findings were that advanced age, delayed hospital admission of over 6 days, presence of pre-existing conditions like diabetes or hypertension, and failure to receive full antibiotic treatment were associated with higher mortality. Laboratory factors predicting death included higher white blood cell and kidney function test levels, as well as lower fibrinogen and prolonged blood clotting times. The most commonly affected organ systems in severe cases were the central nervous system, liver, kidneys, lungs and heart.
Clinical and Laboratory Prognostic Factors in Malignant form of Mediterranean...inventionjournals
Mediterranean spotted fever (MSF) caused by Rickettsia conorii has become a significant health risk for suffering people and international travelers. In the past, overlooked as a serious disease, at present it is known that MSF was wrongly considered a benign condition. In this report, we present a set of clinical features and laboratory parameters in 55 patients (19 fatalities and 36 survivors) with malignant forms of the disease. The purpose of the study was to outline the prognostic factors of the fatal outcome in patients with malignant MSF. Based on our data, the main prediction factors for mortality in malignant MSF patients were: advanced age, delayed hospital admission, severe concomitant diseases, and failure to start or to complete appropriate antibiotic treatment. Laboratory prognostic factors in fatalities were: leukocytosis with a marked shift to the left; extremely high serum urea and creatinine levels; low levels of fibrinogen and prolongation of thrombin time. The most frequently involved organ systems of malignant cases were: central nervous system 100%, liver 92.72%, kidneys 60%, lungs 58.18%, myocardium 30.9%, and gastrointestinal tract 23.63%. The conducted histopathological investigations revealed lethal complications: encephalitis, brain edema, acute respiratory distress syndrome, non-cardiogenic lung swelling, acute myocarditis, gastrointestinal bleeding, hemorrhagicnecrotizing pancreatitis and acute renal failure
Clinical and Laboratory Prognostic Factors in Malignant form of Mediterranean...inventionjournals
Mediterranean spotted fever (MSF) caused by Rickettsia conorii has become a significant health risk for suffering people and international travelers. In the past, overlooked as a serious disease, at present it is known that MSF was wrongly considered a benign condition. In this report, we present a set of clinical features and laboratory parameters in 55 patients (19 fatalities and 36 survivors) with malignant forms of the disease. The purpose of the study was to outline the prognostic factors of the fatal outcome in patients with malignant MSF. Based on our data, the main prediction factors for mortality in malignant MSF patients were: advanced age, delayed hospital admission, severe concomitant diseases, and failure to start or to complete appropriate antibiotic treatment. Laboratory prognostic factors in fatalities were: leukocytosis with a marked shift to the left; extremely high serum urea and creatinine levels; low levels of fibrinogen and prolongation of thrombin time. The most frequently involved organ systems of malignant cases were: central nervous system 100%, liver 92.72%, kidneys 60%, lungs 58.18%, myocardium 30.9%, and gastrointestinal tract 23.63%. The conducted histopathological investigations revealed lethal complications: encephalitis, brain edema, acute respiratory distress syndrome, non-cardiogenic lung swelling, acute myocarditis, gastrointestinal bleeding, hemorrhagicnecrotizing pancreatitis and acute renal failure.
This study aimed to understand the magnitude and characteristics of infectious diseases among patients admitted to the internal medicine ward of a Portuguese hospital over one month. A total of 25 out of 73 patients admitted during the study period had infectious diseases, representing 41 infectious episodes. The most common infections were urinary tract infections (44%) and pneumonia (29%). The majority (83%) of cultures grew pathogens, most commonly E. coli (21%), Pseudomonas aeruginosa (11%), and fungi (11%). Infections increased patient mortality by 10% and length of stay by 3.5 days compared to other patients. Pressure ulcers accounted for 12% of infections and were all hospital-acquired. Empiric antibiotic therapy was ineffective in
Telemedicine: Maintaining The Control and Clinical Outcomes During COVID-19 P...semualkaira
COVID-19 is a global challenge for health systems. The pandemic impacted traditional practice of our hospital's IBD program, favoring the implementation of telemedicine
appointments (TM).
1.2. Objectives: To describe and evaluate TM appointment effectiveness in a public IBD center in Chile during the pandemic.
Telemedicine: Maintaining The Control and Clinical Outcomes During COVID-19 P...semualkaira
COVID-19 is a global challenge for health systems. The pandemic impacted traditional practice of our hospital's IBD program, favoring the implementation of telemedicine
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This study evaluated the diagnostic validity of cerebrospinal fluid (CSF) parameters for distinguishing tuberculous meningitis (TBM) from other causes of meningitis. The study assessed CSF analyses of adenosine deaminase activity, protein and glucose levels, and lymphocyte count in 157 patients in Peru, which has a high tuberculosis incidence. Adenosine deaminase activity above 6 U/l had the best performance, with 95% specificity and a positive likelihood ratio of 10.7, but only 55% sensitivity. No combination of CSF parameters achieved good performance for ruling out TBM. The study found that an elevated CSF adenosine deaminase level strongly supports a diagnosis of TBM
articulo de divulgación científica: a large outbreak of histoplasmosis acapul...IPN
This document summarizes a large outbreak of histoplasmosis among American travelers who stayed at a hotel in Acapulco, Mexico in spring 2001. A total of 757 travelers who stayed at the hotel were contacted, with 262 meeting the clinical case definition of fever and respiratory symptoms. Of 273 serum samples tested, 148 were positive for histoplasmosis. Frequent use of the hotel's stairwells, where construction was ongoing, was associated with a greatly increased risk of illness. This represents the first documented histoplasmosis outbreak associated with a hotel undergoing construction.
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Aspectos básicos en Vacunación, Inmunización, Inmunología Vacunacional y Reac...Dr. Juan Rodriguez-Tafur
Este documento describe los componentes y tipos de respuesta del sistema inmunológico, incluyendo moléculas, células, respuestas innatas y adaptativas. También resume los diferentes tipos de vacunas, sus mecanismos de acción y los correlatos de protección inducidos, como anticuerpos e inmunidad celular. Finalmente, analiza las limitaciones en la respuesta a vacunas en los extremos de la vida.
El documento discute cómo la dieta y el estilo de vida afectan el microbioma intestinal y cómo esto influye en la inflamación y el riesgo de enfermedades. Se describe que las dietas ricas en fibra y vegetales promueven una mayor biodiversidad microbiana y niveles más altos de ácidos grasos de cadena corta, lo que reduce la inflamación. Por el contrario, las dietas occidentales modernas con alimentos procesados y el uso de antibióticos han disminuido la biodiversidad microbiana y aumentado el riesgo de
El documento discute varios temas relacionados con el hierro y la inmunidad. Explica el metabolismo del hierro en el cuerpo y cómo se distribuye en las células como los eritrocitos y los macrófagos. También describe cómo el hierro juega un papel importante tanto en la inmunidad innata como en la adaptativa, y cómo la deficiencia o exceso de hierro pueden afectar negativamente al sistema inmunológico. Además, analiza el efecto de la anemia ferropénica en el desarrollo cerebral de los ni
El documento describe aspectos del SARS-CoV-2 y la respuesta inmune al virus. Explica que el SARS-CoV-2 es un betacoronavirus que saltó de animales a humanos, causando la actual pandemia. Describe la estructura y clasificación del virus, así como sus mecanismos de entrada a las células y evasión de la respuesta inmune. Resalta que estudios genómicos confirman que el virus se originó de forma natural y no fue producido en un laboratorio.
Este documento presenta información sobre infecciones respiratorias e infecciones respiratorias recurrentes. Se discuten los mecanismos inmunológicos involucrados y el papel de los inmunomoduladores, en particular los lisados bacterianos. El documento incluye cinco secciones que cubren la introducción a las infecciones respiratorias y las infecciones respiratorias recurrentes, el sistema inmune de las mucosas, los inmunomoduladores como los lisados bacterianos, y los mecanismos inmunológicos de estos
Este documento presenta los resultados de un estudio piloto sobre la respuesta inmune en pacientes con bartonelosis humana (enfermedad de Carrión) en Perú. Los investigadores estudiaron pacientes en fases aguda y crónica de la enfermedad, midiendo marcadores inflamatorios e inmunológicos. En la fase aguda, encontraron elevados niveles de IFN-alfa e IL-10, similares a otras infecciones graves. Algunos pacientes mostraron recuentos bajos de linfocitos CD4+, recuperánd
Rice forms sticky masses in the stomach that remove gastric mucus as they move through peristalsis, exposing the stomach lining to damage from acid and pepsin. This mucus removal can cause heartburn or ulcers. However, drinking water with rice can prevent this by turning the rice masses into a slurry rather than sticky masses, avoiding excessive mucus removal.
1) El documento resume la historia del fármaco losartan, desde su desarrollo en los años 1980 hasta su lanzamiento comercial en 1995. 2) Explica cómo losartan actúa como antagonista del receptor de angiotensina II para tratar la hipertensión y sus comorbilidades. 3) Discuten los mecanismos por los cuales losartan reduce la inflamación y aterosclerosis a través de la inhibición del sistema renina-angiotensina y factores proinflamatorios.
Este documento resume brevemente la historia de la medicina basada en la evidencia. Comenzó en el siglo XIX con médicos franceses que promovieron el uso de grandes series de datos para guiar el tratamiento médico en lugar de la experiencia o especulación individual. Más tarde, en la década de 1970, epidemiólogos británicos como Archie Cochrane criticaron que los médicos no sistematizaran y resumieran los ensayos clínicos controlados aleatorios. Esto llevó al desarrollo de la Colaboración Cochrane
El documento presenta varias teorías sobre el origen del virus de la inmunodeficiencia humana (VIH). Estas incluyen la teoría de los cazadores que involucra el contacto con sangre de monos durante la caza, la teoría del uso de agujas contaminadas y la teoría del "error humano" sobre una vacuna contaminada. La teoría más aceptada científicamente es la "transferencia natural" del virus de los chimpancés a los humanos a través de la caza y manipulación de estos animales.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Mecanismos inmunologicos del reconocimiento y como el cancer presenta sus autoantigenos, ausencia de estimulacion frente a tumores y las vacunas y extrategias.
El documento trata sobre el envejecimiento de la piel. Explica que existen tres tipos principales de envejecimiento cutáneo: intrínseco, extrínseco y mecánico. También describe varias hipótesis sobre la patogénesis del envejecimiento cutáneo como la teoría de los radicales libres y la muerte celular programada. Finalmente, resume los principales cambios moleculares asociados al envejecimiento como la oxidación del ADN y las proteínas, y la degradación de colágeno y fibras elástic
El documento describe la historia y características del eosinófilo. Paul Ehrlich descubrió y nombró el eosinófilo en 1879. Los eosinófilos se desarrollan en la médula ósea y migran a los tejidos, donde residen durante varios días. Contienen gránulos proteicos que les permiten desempeñar funciones como la defensa contra parásitos y la respuesta alérgica.
Este documento resume los principales antecedentes históricos del desarrollo de la inmunología, desde las primeras observaciones sobre la inmunidad natural en la antigua Grecia hasta los descubrimientos más recientes sobre la regulación del sistema inmune. Cubre hitos como el desarrollo de la variolización y la vacunación contra la viruela, el descubrimiento de los anticuerpos y células inmunes, y el establecimiento de las bases celulares y moleculares de la respuesta inmune.
1) El documento describe los aspectos moleculares de la alergia, incluyendo los mecanismos mediados por anticuerpos IgE y receptores, así como factores ambientales como la contaminación y su papel en la inducción de respuestas alérgicas. 2) También discute factores genéticos como genes ligados a la atopia en cromosomas específicos, e implica a infecciones tempranas en la protección contra el desarrollo de alergias. 3) Finalmente, menciona la influencia del crecimiento fetal y peso al nacer en el
Toxicologia y distribucion geografica de las serpientes venenosas en el PeruDr. Juan Rodriguez-Tafur
Este documento describe diferentes aspectos de las serpientes venenosas. Describe que hay cerca de 9,800 especies de serpientes en el mundo, de las cuales 375 son venenosas. Más de 5 millones de mordeduras ocurren anualmente, causando más de 125,000 muertes. Las serpientes se clasifican en familias como Colubridae, Elapidae y Viperidae. Algunas serpientes venenosas comunes en Sudamérica son varias especies de Bothrops, Lachesis, Micrurus y Crotalus. El documento también proporcion
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
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Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
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Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
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Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
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Pharmacology of 5-hydroxytryptamine and Antagonist
Cytokines and T-Lymphocyte count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in peru: a pilot study
1. Rev. Inst. Med. Trop. Sao Paulo
53(3):149-154, May-June, 2011
doi: 10.1590/S0036-46652011000300006
CYTOKINES AND T-LYMPHOCYTE COUNT IN PATIENTS IN THE ACUTE AND CHRONIC PHASES OF
Bartonella bacilliformis INFECTION IN AN ENDEMIC AREA IN PERU: A PILOT STUDY
Erick HUARCAYA (1), Ivan BEST (1), Juan RODRIGUEZ-TAFUR (2), Ciro MAGUIÑA (1), Nelson SOLÓRZANO (3), Julio MENACHO (4),
Douglas LOPEZ DE GUIMARAES (4), Jose CHAUCA (1) & Palmira VENTOSILLA (1)
SUMMARY
Human Bartonellosis has an acute phase characterized by fever and hemolytic anemia, and a chronic phase with bacillary
angiomatosis-like lesions. This cross-sectional pilot study evaluated the immunology patterns using pre- and post-treatment samples
in patients with Human Bartonellosis. Patients between five and 60 years of age, from endemic areas in Peru, in the acute or chronic
phases were included. In patients in the acute phase of Bartonellosis a state of immune peripheral tolerance should be established
for persistence of the infection. Our findings were that elevation of the anti-inflammatory cytokine IL-10 and numeric abnormalities
of CD4+ and CD8+ T-Lymphocyte counts correlated significantly with an unfavorable immune state. During the chronic phase, the
elevated levels of IFN-g and IL-4 observed in our series correlated with previous findings of endothelial invasion of B. henselae in
animal models.
KEYWORDS: Carrion’s Disease; Human Bartonellosis; Cytokines; Immunology.
INTRODUCTION
Infection with Bartonella species has been associated with Carrion’s
Disease, Trench Fever, Cat Scratch Disease, bacillary angiomatosis,
endocarditis, and bacillary peliosis21,22. In Peru, Carrion’s Disease or
Human Bartonellosis (HB) has been recorded since the times of preColumbian cultures1. The female sandfly of the genus Lutzomyia ssp. is
the vector of transmission28, and has been mainly reported between 500
and 3200 meters of elevation21,28. The etiologic agent of HB is Bartonella
bacilliformis, an aerobic, pleomorphic and monopolar flagellated Gramnegative bacterium which is surrounded by aggregative fimbriae22,24.
These bacteria may produce an acute (Oroya Fever) or chronic (Peruvian
Verruca) infection with different clinical presentations21,22,28.
The acute phase (Oroya Fever) is characterized by fever and severe
hemolytic anemia with hepatosplenomegaly, jaundice and pallor. The
mortality rate of the acute phase varies between 1% in hospitalized
patients and 88% in untreated patients 21,28. Asymptomatic carriers
have been described in endemic areas, with prevalence up to 5% in the
population21,22,28.
as early as 1926, Dr. Weiss in Peru theorized that an immune “anergic” state
must exist during the HB infection based on clinical observation of severe
co-infections and a failure in some patients to respond to the tuberculin skin
test6,10,21,22,29. Non-infectious complications such as congestive heart failure,
thrombocytopenia, severe anemia, seizures, intracranial hypertension, and
multi-organ dysfunction have been reported21,22,28.
The chronic phase of Bartonellosis may follow the acute process,
usually after one or two months2, and is characterized by the development
of a single or hundreds of verrucas that may histopathologically resemble
bacillary angiomatosis or Kaposi’s sarcoma21,22,25,28. The verruca is
characterized by angioblastic hyperplasia, activation of Langerhans
cells, deposit of IgM, IgA, and complement C3 in endothelial cells, with
subsequent altered morphology and function6,28,33.
As a pilot study, we measured Th1/Th2 and regulatory cytokines,
as well as CD4+ and CD8+ T cells in patients in the acute and chronic
phases of HB, to determine immunological patterns, differences, and
data for future research.
MATERIALS AND METHODS
Complications of the acute phase include myocarditis, subacute
pericarditis, neurobartonellosis, and co-infections with Salmonella sp.,
Toxoplasmosis, Tuberculosis, pneumococcal pneumonia, Pneumocystis
jiroveci pneumonia, and Staphylococcus aureus sepsis21,22. As explanation,
Patients and clinical evaluation: For this pilot study, patients were
enrolled at a reference hospital in Lima-Peru, Hospital Nacional Cayetano
Heredia, and two hospitals located in endemic areas for HB, Hospital
(1) Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru.
(2) Pharmacology Section, Dynamic Sciences Department, Universidad Nacional Mayor de San Marcos, Lima, Peru.
(3) Hospital de Apoyo de Caraz, Ancash, Peru.
(4) Hospital Regional de Huaraz, Ancash, Peru.
Correspondence to: Palmira Ventosilla, M.Sc. Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia. Av. Honorio Delgado 430, SMP, Lima,
Peru. Phone: + 51-1-4823910, Fax: + 51-1-4823404. E-mail: palmira.ventosilla@upch.pe
2. HUARCAYA, E.; BEST, I.; RODRIGUEZ-TAFUR, J.; MAGUIÑA, C.; SOLÓRZANO, N.; MENACHO, J.; LOPEZ DE GUIMARAES, D.; CHAUCA, J. & VENTOSILLA, P. - Cytokines
and T-lymphocyte count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in Peru: a pilot study. Rev. Inst. Med. Trop. Sao Paulo,
53(3): 149-54, 2011.
Regional de Huaraz and Hospital de Apoyo de Caraz, in Ancash-Peru
(Fig. 1).
Data analysis: Because most of the variables showed non-normal
distribution (Table 1 and Table 2), the Cytokines and CD4+/CD8+ T-cells
counts from acute and chronic patients, both before and after treatment,
were compared using the non-parametric Wilcoxon test. Differences
among pre-treatment, post-treatment, and control samples were evaluated
using the non-parametric Kruskal-Wallis test. We considered every
difference for which the probability of similarity was less than 0.05
(p < 0.05) as being significant.
Table 1
Descriptive statistics of immunology pattern in patients with acute-phase
human Bartonellosis
Fig. 1 - Map of endemic area in Peru
The patients were selected using the following criteria: aged between
five and 60 years old, resident of endemic area, and clinical diagnosis of
B. bacilliformis infection (acute or chronic), according to standard criteria
of the Peruvian Ministry of Health28 and confirmed by peripheral smear
and/or blood culture in patients with acute-phase HB. The exclusion
criteria were: pregnancy or amenorrhea during the previous month,
use of antibiotics in the previous two weeks7,11, previous use of oral or
systemic steroids, chemotherapy, cancer, and co-infection with HIV or
other immunodeficiency. Healthy subjects considered as controls were
non-pregnant residents from Lima, without previous infection of B.
bacilliformis, recent illnesses, or previous history of primary or secondary
immunodeficiency. No controls were considered from the endemic area
because of the possibility of including asymptomatic patients infected
with B. bacilliformis21.
Patients or tutors signed an informed consent, previously approved by
the Ethics Committee of the Universidad Peruana Cayetano de Heredia
(ID CIE: 04095).
Immunohistochemical analysis and cytokines measurement:
Specimens were collected upon enrollment in the study, at discharge
from the hospital for those admitted, or during the follow up visit for
those outpatients. The specimens were collected in 10 mL vacutainer
tubes with EDTA, and sent to Lima for analysis.
WBC
CD4+
CD8+
CD4/CD8
IFN-g
TNF-α
IL-4
IL-10
TGF-b
n
09
13
13
13
11
12
12
12
09
WBC
CD4+
CD8+
CD4/CD8
IFN-g
TNF-α
IL-4
IL-10
TGF-b
n
06
06
06
06
06
06
05
06
00
A. Pre Treatment
minimum
maximum
5300
10250
81
1279
75
3285
0.36
3.48
13.13
1248.75
0.00
3.61
0.00
22.33
7.20
343.46
12.25
27.70
B. Post Treatment
minimum
maximum
5500
9800
261
1871
245
3765
0.27
1.82
6.88
50.52
0.00
30.25
0.00
4.40
2.81
107.44
median
7054.77*
675.00
455.00
1.65
50.63
1.39*
3.85
49.30
15.45
median
7641.67*
929.33*
1230.00
0.88
24.15*
1.95
2.16
14.51
* mean
RESULTS
The immunological studies were performed in the Laboratory of
Immunology of the “Alexander von Humboldt” Institute of Tropical
Medicine (IMT-AvH), of the Universidad Peruana Cayetano Heredia
in Lima-Peru. The absolute number of CD4+ and CD8+ T cells were
measured in peripheral blood using saturating concentrations of
combinations of anti-CD3-peridinin chlorophyll protein (PerCP), antiCD4-fluorescein isothiocyanate (FITC) and anti-CD8-phycoerythrin
(PE) (Becton Dickinson, Erembodegem, Belgium), according to the
manufacturer’s instructions. Data were analyzed using the CellQuest
software (Becton Dickinson, San Diego) in a fluorescence activated cell
sorter (FACS Calibur) (Becton Dickinson, San Diego).
The levels of IFN-γ, TNF-α, IL-4, IL-10, and TGF-b in the patient’s
plasma were evaluated using commercial Kits (BD OptEIATM ELISA
kits-®). The concentrations of cytokines (in pg/mL) and TGF-b (in
ng/mL) were measured using an ELISA reader (Biorad-®).
150
General Data: Patients were included in this study between October
2004 and June 2006. Nine healthy subjects were included as controls.
Thirty patients in the acute phase were initially included in the study.
Subsequently, three of them were excluded for pregnancy, and fourteen
others whose infection was not confirmed (negative peripheral smear and
blood culture). Finally, 13 patients were included in the analysis. The
mean age of the 13 patients with acute-phase HB was 26.4 years (range:
5 - 49 years old), with a mean duration of illness of 16.3 days (range: 2 30 days). Because hemolyzed samples and samples that arrived after 12
hours from the endemic area were not analyzed, only eight post-treatment
blood samples were included in the study. The descriptive statistics are
shown in Table 1.
Forty -two patients were initially included with diagnosis of chronic-
3. HUARCAYA, E.; BEST, I.; RODRIGUEZ-TAFUR, J.; MAGUIÑA, C.; SOLÓRZANO, N.; MENACHO, J.; LOPEZ DE GUIMARAES, D.; CHAUCA, J. & VENTOSILLA, P. - Cytokines
and T-lymphocyte count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in Peru: a pilot study. Rev. Inst. Med. Trop. Sao Paulo,
53(3): 149-54, 2011.
Table 2
Descriptive statistics of immunology pattern in patients with chronic-phase
human Bartonellosis
WBC
CD4+
CD8+
CD4/CD8
IFN-g
TNF-α
IL-4
IL-10
TGF-b
n
15
18
18
18
21
21
20
21
20
WBC
CD4+
CD8+
CD4/CD8
IFN-g
TNF-α
IL-4
IL-10
TGF-b
n
04
05
05
05
10
10
11
11
00
A. Pre Treatment
minimum
maximum
2200
10700
188
1952
181
1548
0.21
3.28
0.00
790.67
0.00
6.22
0.00
42.65
0.60
105.24
11.60
117.55
B. Post Treatment
minimum
maximum
4700
7100
791
1175
574
997
0.82
1.47
0.00
134.00
0.00
2.99
0.00
135.00
0.00
18.90
differences in post-treatment samples between the acute phase cases and
controls were significant only for IL-10 (p = 0.007) (Fig. 2).
median
5953.33*
813.00
676.28*
1.51*
17.50
0.32
1.65
14.36
19.55
median
5100.00
880.00
744.00
1.38
9.78
0.88*
1.47
3.20
* mean
phase HB. However, 21 patients were excluded from the analysis (twenty
because of previous use of antibiotics and one for an age outside the
inclusion criterion). Post-treatment samples were obtained from eleven
patients. The mean age of the patients in the chronic phase was 27.2
years (range: 9 - 51 years old), and the mean duration of illness was
42 days (range: 14 - 120 days). The descriptive statistics are shown in
Table 2.
Quantitative analysis of Cytokines in plasma: The differences
in pre-treatment values obtained in the acute phase patients at time
of enrollment and those obtained in the controls were not statistically
significant for white blood cells (WBC) count, IFN-g, TNF-a level,
IL-4, and TGF-b, except for IL-10 (p < 0.05). Similar findings were
observed in the post-treatment samples compared with controls, with
p < 0.05 for IL-10.
Fig. 2 - Cytokine’ counts in patients with human Bartonellosis.
The differences in pre-treatment samples from acute-phase (Table
1) and chronic-phase (Table 2) patients were not statistically significant
for WBC count, TNF-a level, TGF-b, and IL-4, except for IFN-g (p =
0.018) and IL-10 (p = 0.011). The post-treatment samples from acutephase (Table 1) and chronic-phase (Table 2) patients were not statistically
significantly different for WBC count, TNF-a level, IFN-g, TGF-b, and
IL-4, except for IL-10 (p = 0.048).
Four of the 13 cases of acute-phase HB were considered complicated,
due to co-infection with Epstein-Barr virus and CMV, a case of pericarditis
(with 78% of parasitemia), a case of neuro-bartonellosis (with 98% of
parasitemia), and a death. The patient who died showed the highest
level of IL-10 in the series (343.46 pg/mL). No numeric abnormalities
in T-Lymphocyte count were seen in these patients (Table 1).
The pre-treatment samples analysis from acute phase cases and
controls were significantly different only for IL-10 (p = 0.003). The
The difference between pre-treatment samples from chronic-phase
patients and samples from controls were not statistically significant
151
4. HUARCAYA, E.; BEST, I.; RODRIGUEZ-TAFUR, J.; MAGUIÑA, C.; SOLÓRZANO, N.; MENACHO, J.; LOPEZ DE GUIMARAES, D.; CHAUCA, J. & VENTOSILLA, P. - Cytokines
and T-lymphocyte count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in Peru: a pilot study. Rev. Inst. Med. Trop. Sao Paulo,
53(3): 149-54, 2011.
for WBC count, TNF-a level, and IL-10, except for p-value of IFN-g
(p = 0.07) and IL-4 (p = 0.015). The post-treatment samples from the
chronic-phase cases and controls were significantly different only in
IFN-g (p = 0.010).
acute cases and from the controls showed no statistical difference in
either CD4+ or CD8+ T-lymphocyte count. The post-treatment samples
from chronic cases were significantly higher than the controls in CD8+
count with p = 0.042 (Fig. 3).
Quantitative analysis of T-Lymphocyte cell count in plasma:
During the acute phase, the lowest CD4+ T-lymphocyte count was 81.
Four patients in total had a CD4+ T-lymphocytes count below 150 in the
acute-phase HB sample (Table1). One patient had a CD8+ T-lymphocyte
count of 75, with a normal count of CD4+ (261 cell/µL) and the highest
count of IFN-g (1248.75 pg/mL). No numeric abnormalities were noted
in patients with chronic-phase HB (Table 2). Pre-treatment samples from
DISCUSSION
During the previous several decades, studies have focused on the
effects of B. bacilliformis on the host. Based on studies performed during
the 1980’s and 1990’s it is accepted that during the acute-phase of the
disease the humoral response is activated6,28. The antigen-presenting
cells are activated, as is the complement cascade (including the classic
and alternative pathway), due to antigenic proteins exposed on red blood
cells, as well as increased IgM levels3,6,24,29. Clinically focused studies
have shown that the acute phase of HB may be manifested in the host
with a diversity of severities, from asymptomatic to acute life-threatening
hemolytic anemia with multiple complications6,21,22,28 characteristics
of patients with IRIS. A similar variety in presentations and severities
due to Bartonella henselae has been shown to have a close correlation
with the host’s immune status30. Interestingly, HENRIQUEZ et al.12
described a case of persistent B. bacilliformis bacteremia in a situation
of altered immunological state. It has been reported that the intensity of
the inflammatory response in any case, depends on previous exposure to
B. bacilliformis22 and probably on genetic predisposition32.
Recently the significance of Th1-cell derived cytokines in resistance
to bacterial invasion has been seen to play important roles during B.
henselae infection and in the induction of angiogenesis27,30, a process that
may explain the effective phagocytic function in the immunocompetent
individual is responsible for the localized, non-systemic expression of
Cat Scratch Disease14,30. Due to limited research in HB in this area, we
looked for similarities, but no clear Th1- or Th2- cell derived cytokines
were found. However, similar to an induction of IFN-g and IL-12 (not
measured in our study) observed with B. henselae stimulation in rodents26,
our series of patients showed a significant initial elevation of IFN-g
(Fig. 2) and a non-significant elevation of TNF-a (Table 1) as part of
the inflammatory process that also can be seen in other gram-negative
infections4,19.
Although the immunopathology that develops during HB is unclear,
some theoretical models have been proposed6,32. A few important findings
described recently implicated the role of Toll-like receptors (TLRs).
TLRs are part of an important family of innate immune receptors that
recognize pathogen-associated molecular patterns, but is not activated by
flagellin molecules of B. bacilliformis2,31. Thus the bacteria avoid being
recognized by epithelial cells and dendritic cells, and thus do not activate
the pro-inflammatory response14. The bacterias are therefore able to bind
and to invade red blood cells6,21,28. In addition, the lack of activation of
dendritic cells will prevent the reversal of Treg cells in anergic states15,34.
Thus, preventing the activation of dendritic cells, B. bacilliformis may
establish and maintain an immune peripheral tolerance in the host6,32.
Finally, this impairment in the cellular immunity favors the reactivation
of intracellular infections such as tuberculosis and Toxoplasmosis, which
are commonly reported in the endemic areas21,22.
Fig. 3 - T-lymphocyte cells count in patients with human Bartonellosis.
152
The phenomenon of peripheral tolerance may be enhanced by
cytokines such as IL-10, which by disarming innate as well as adaptive
responses creates conditions for microbe persistence and chronic
5. HUARCAYA, E.; BEST, I.; RODRIGUEZ-TAFUR, J.; MAGUIÑA, C.; SOLÓRZANO, N.; MENACHO, J.; LOPEZ DE GUIMARAES, D.; CHAUCA, J. & VENTOSILLA, P. - Cytokines
and T-lymphocyte count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in Peru: a pilot study. Rev. Inst. Med. Trop. Sao Paulo,
53(3): 149-54, 2011.
infectious disease23. Elevation of IL-10 is due mainly to CD43+CD4+
T-cells, which are important in the equilibrium between Th1 and Th2
responses18. Th2 cytokines, including IL-10, inhibit the secretion of
pro-inflammatory cytokines19,20. Given these observations, our finding
of statistically significant elevated levels of IL-10 in patients with
acute-phase HB (Fig. 2) may not be surprising. Unfortunately, we did
not find significant differences in concentration of pre-treatment TGFbeta, which is also involved in immune suppression and angiogenesis9,35.
These observations suggest further studies, including the measurement
of cytokines in directly stimulated Lymphocytes with B. bacilliformis
antigens which will avoid the possibility of erroneous attribution of
cytokine levels due to other multiple factors other than the bacteria
of interest. In addition, because of its short half-life in plasma5,17, it is
important to measure IL-10 immediately after sample collection.
Descriptions of anergy and clinical complications seen only in
immunocompromised patients, as in AIDS, were the reasons why
T-Lymphocytes were counted in early studies. PATRUCCO29, was the
first to report patients with a decreased number of CD4+ T-Lymphocytes,
but also, and more importantly, deficiencies in their function. Among
our patients, significantly low counts of CD4+ and CD8+ T-Lymphocytes
were found, that are resolved following appropriate treatment (Tables 1
and 2). Cytotoxic T-Lymphocytes may be required to clear bacteria from
sequestered sites such as the vascular endothelial tissue and lymphoid
organs12,14. This transitory numeric abnormality in T-cell count may also
explain co-infections and other complications previously described21,22,28.
Further studies with a more adequate sample size may confirm this
finding, as well as the functional compromise in the cellular immune
response described initially by PATRUCCO29.
The eruptive phase of HB is characterized by endothelial compromise,
by mechanisms that are still unclear, but it is known that B. bacilliformis,
B. henselae, and B. quintana can produce similar angiogenic factors16,21,22
and that B. bacilliformis is captured by endothelial cells in a process that
involves the GTPase Rho protein3,8. Interestingly, the vascular proliferation
as seen in the chronic-phase of HB resembles the morphologic findings
in patients with AIDS, Kaposi’s sarcoma, and Bacillary Angiomatosis,
all of which exist only in immune-deficient states6,10.
In our group of patients in the chronic phase we found significantly
elevated levels of IFN-g and IL-4 (Fig. 2 and Table 2). These finding
may be explained by the active role of the humoral immune reaction
in limiting the bacterial presence to the vascular epithelial tissue and
the role of IFN-g in the enhancing phagocytic activity14. These findings
also resemble observations in an animal model with elevated levels of
IFNg- and IL-4 after a systemic inoculation with B. henselae antigen13, 14.
In summary, the varied severity of clinical presentation by patients
with acute-phase HB should be considered to be related to the patient’s
immune status, with a state of immune peripheral tolerance needed
to establish persistent infection2,14,15,34. Our findings of statistically
significant elevation of the anti-inflammatory cytokine IL-10 and
numeric abnormalities in the CD4+ and CD8+ T-Lymphocyte counts
correlates with an immune state unfavorable for infection clearance.
The chronic phase of HB resembles histologically diseases prevalent in
immune-deficient conditions, such as Kaposi’s sarcoma, and Bacillary
Angiomatosis6,10,16. However, there is no clear explanation for this
resemblance. Finally, elevated levels of IFN-g and IL-4 observed in our
work correlated positively with previous findings in animal models of
B. henselae endothelial invasion26.
RESUMEN
Citoquinas y recuento de Linfocitos T en pacientes en fase aguda
y crónica de infección por Bartonella bacilliformis, en una área
endémica del Perú: estudio piloto
La Bartonelosis Humana, tiene una fase aguda caracterizada por
fiebre y anemia hemolítica, así como una fase crónica con lesiones
semejantes a angiomatosis bacilar. En un estudio transversal piloto los
patrones inmunológicos en pacientes con Bartonelosis Humana fueron
estudiados mediante muestras pre y post tratamiento. Pacientes entre 5
y 60 años en fase aguda y crónica fueron incluidos en área endémica
del Perú. En aquellos pacientes con fase aguda, una fase de tolerancia
inmunológica periférica es necesaria para la persistencia de la infección.
Los hallazgos de significativa elevación de citoquina anti-inflamatoria
(IL-10) y anormalidades numéricas en el recuentos de Linfocitos T CD4+
y CD8+ correlacionan con un estado inmune que favorece la infección.
Durante la fase crónica, elevados niveles de INF-g y IL-4 observados
en la serie de pacientes correlacionan con previos hallazgos en modelos
animales que favorecen la invasión del endotelio por B. henselae.
ACKNOWLEDGEMENTS
The authors thank biologists from the immunology laboratory of
the “Alexander von Humboldt” Tropical Medicine Institute for their
collaboration, Dr. Augusto Tarazona and Dr. Carlos Seas for their help with
patient recruitments, Dr. Betty Skipper for reviewing the statistical analysis,
and Dr Krishna Radnakrishna PhD for the review of the manuscript. This
study was partially financed by the Instituto Fundacion Hipolito Unanue.
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Received: 8 August 2010
Accepted: 11 March 2011
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