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PubMed1995

Cytokines as adjuvants in immunocompromised hosts.

Vaccination of immunocompromised subjects may be ineffective due to the poor immune responses induced. In addition, vaccination with live attenuated organisms may also be dangerous due to the possible lack of control of the infection. This review describes the protection of cytokines in the vaccination of immunocompromised individuals. Cytokines have possible roles as immunological adjuvants, enhancing immune responses to vaccination, and can also have effects on the growth of live vaccines or vaccine vectors.

Adjuvants, Immunologic↗
PubMedDate not supplied

The impact of adenovirus infection on the immunocompromised host.

Adenovirus (Ad) infections in immunocompromised hosts have increased in frequency as the number of patients with transplants of bone marrow, liver, kidney, heart and other organs increase in number and survive longer. The numbers of such patients have also increased because of the emergence of the HIV epidemic. Ad infections with the 51 different serotypes recognised to date have few pathognomonic signs and symptoms, and thus require a variety of laboratory-based procedures to confirm infection. These viruses have the ability to target various organs with relative serotype specificity and can cause diverse manifestations including serious life-threatening diseases characteristic of the organs involved. Ads have cytolytic and immunoregulatory properties. The clinical dilemma remains the prompt recognition of Ad-related disease, the differentiation of Ad infection from Ad disease and the differentiation from other causative agents. Since the armamentarium of effective antiviral agents available to treat Ads is unproven by controlled trials and the virus is often not acquired de novo, it is difficult to prevent reactivation in immunodeficient hosts or new acquisition from donor organs. Timely discontinuation of immunosuppressive agents is necessary to prevent morbid outcomes. The clinical diseases, diagnostic tests, antiviral agents and biological aspects of the Ads as pathogens in immunocompromised patients are discussed in the context of this review. Some of the newer diagnostic tests are based on the well-studied molecular biology of Ads, which also have been attenuated by selective viral DNA deletions for use as vectors in numerous gene therapy trials in humans.

Acquired Immunodeficiency Syndrome↗
PubMed1997

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

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

Bacterial Infections↗
PubMed2000

Gastrointestinal infections in the immunocompromised host.

Infectious diseases of the gastrointestinal tract continue to be an important source of morbidity and mortality. Viruses, bacteria, fungi, and protozoa that infect normal hosts also infect the gastrointestinal tract in immunocompromised hosts. Disease caused by these pathogens may be more severe and more difficult to treat in immunocompromised hosts. In addition, pathogens that rarely cause disease in normal hosts cause significant disease in immunosuppressed hosts. Diagnostic decisions need to take into account expected pathogens and response to therapy. Treatment decisions must be based on the findings of diagnostic procedures; expected pathogens; and recent data suggesting that highly active antiretroviral therapy, with its ability to reconstitute immune function, is an essential component of treatment. This review summarizes the most important developments made in the pathogenesis, clinical presentation, diagnosis, and treatment of gastrointestinal infections in immunocompromised hosts in the past year.

Journal Article↗
PubMed2006

Gastrointestinal infections in immunocompromised hosts.

PURPOSE OF REVIEW: Gastrointestinal infections in the immunocompromised host continue to have significant morbidity and mortality throughout the world. They all have similar exposures to viruses, bacteria and parasites and respond to these infections in a similar way. This review will summarize the latest reports on the epidemiology, diagnosis and treatment of known and emerging infections over the last 12 months. RECENT FINDINGS: Highly active antiretroviral therapy has reduced esophageal opportunistic infections in HIV patients compared to patients who are not taking this therapy. Esophageal candidiasis responds to escalating doses of micafungin as effectively as fluconazole. HIV-infected patients with untreated Mycobacterium avium-complex diarrhea are associated with a wasting syndrome that disrupts the somatostatin axis. Polymerase chain reaction testing has improved diagnosis of microsporidial infections. Cytomegalovirus polymerase chain reaction of tissue may improve the diagnosis of cytomegalovirus disease of the gastrointestinal tract in organ-transplant recipients. The treatment of hypogammaglobulinemia in transplant recipients with recurrent cytomegalovirus gastrointestinal disease may resolve their symptoms. Community viruses are an emerging threat to transplant recipients and may affect drug levels. Lastly, anti-tumor necrosis factor alpha therapy in the treatment of inflammatory conditions may cause Listeria monocytogenes to disseminate. SUMMARY: Immunocompromised hosts remain at risk for severe gastrointestinal and even disseminated infections. Management includes an early rapid diagnosis with rapid restoration of the immune system and appropriate anti-infective therapy. With the immunocompromised population rapidly increasing, prevention of these infections remains the greatest challenge.

AIDS-Related Opportunistic Infections↗
PubMed1987

Visceral leishmaniasis in immunocompromised hosts.

Visceral leishmaniasis is infrequently reported in immunocompromised hosts; hence, the clinical manifestations and outcome of the disease in these patients are unknown. In a series of 10 patients with visceral leishmaniasis complicating renal transplantation (three), hematologic neoplasms (two), systemic lupus erythematosus (two), or infection with human immunodeficiency virus (three), typical hallmarks of kalaazar such as enlargement of spleen or hyperglobulinemia were absent in three and six patients, respectively. Extensive visceral involvement was noted by biopsies or autopsies in four patients. Diagnosis was made during evaluation for fever of unknown origin. Myriads of amastigotes were seen in bone marrow smears. Measurement of antibodies against Leishmania donovani was positive in each patient tested. Ultimately, three patients died, and chronic infections refractory to treatment developed in two other patients. Visceral leishmaniasis is a potentially fatal infection in immunocompromised hosts. Current antiparasitic therapy frequently fails to eradicate L. donovani from infected tissues.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Central nervous system infections in the immunocompromised host.

Central nervous system (CNS) infections in the immunocompromised host are predictable according to the arm of the immune defense which is most defective. A limited number of organisms with a tendency to cause CNS infections will take advantage of the different types of immune defects. Signs and symptoms of CNS infection are often quite subtle in the immunocompromised host because of the diminished inflammatory response. Serologic responses may not be as reliable as in a normal host. Aggressive diagnostic approaches are often necessary, including early brain biopsy and abscess drainage. Aggressive therapy is often also necessary, including multiple potentially toxic antibiotics and devices to deliver them, such as indwelling intraventricular reservoirs. The role of the third generation cephalosporins is still not clear, and certainly they should not be used alone to treat aerobic gram-negative rod meningitis in neutropenic patients. Patients with the acquired immune deficiency syndrome (AIDS) have developed CNS infections with familiar agents producing familiar syndromes. The main CNS infection, however, is a subacute encephalitis and the causative agent remains undocumented.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Clinical spectrum of hepatic tuberculosis: comparison between immunocompetent and immunocompromised hosts.

BACKGROUND: Hepatic tuberculosis has been reported in normal and immunocompromised hosts. However, no published comparisons between these two groups of subjects with hepatic tuberculosis have been found. The aim of this study was to compare the clinical manifestations, biochemical tests, radiologic features and pathological findings of hepatic tuberculosis in immunocompromised and immunocompetent patients. METHOD: The authors reviewed retrospectively 20 patients with hepatic tuberculosis admitted between January 1993 and October 2000 to Chulalongkorn University Hospital, Thailand. There were 12 immunocompromised patients (10 HIV-infected males, 1 systemic lupus erythematosus (SLE) male, 1 SLE female) and 8 immunocompetent patients (6 males, 2 females). The clinical manifestations, biochemical tests, radiologic features and pathological findings were compared between these 2 groups. The diagnosis of Mycobacterium tuberculosis (M. tb) was the combination of a demonstrated organism in hemo- or specimen culture, histopathology (positive acid fast bacilli) and rapid identification of M. tb from nested polymerase chain reaction (nPCR) assay based on amplification of the IS 6110 insertion sequences. RESULTS: The clinical features were similar in both groups with fever, weight loss and hepatomegaly as the main manifestations. The biochemical findings were also similar but the alkaline phosphatase (ALP) was significantly higher in the immunocompromised group (p < 0.001). Hepatomegaly and diffuse increased echogenicity were common in both groups. Ascitis and calcifications were found more commonly in the immunocompetent subjects, although the differences were not statistically significant. Non-caseating granuloma without detection of acid fast bacilli was a common finding in both groups. The nested PCR assay increased the sensitivity from 49 per cent to 86 per cent compared to the regular PCR assay but specificity was 100 per cent in both techniques. The mortality was significantly higher in immunocompetent patients (p < 0.05) due to the extreme age and severe coexisting diseases. CONCLUSION: Fever, weight loss, hepatomegaly, disproportionate elevation of ALP and reverse A/G ratio were common in hepatic tuberculosis. A disproportionate elevation of ALP was significantly higher in the immunocompromised hosts. Nested PCR assay showed good sensitivity and specificity in the diagnosis of this disease.

Adolescent↗
PubMed1994

[Ocular murine cytomegalovirus infection in immunocompromised hosts].

Cytomegalovirus (CMV) chorioretinitis is one of the commonest complications in immunocompromised hosts. However, the entire scope of ocular involvement during generalized CMV infection in immunocompromised hosts is yet to be elucidated. Balb/c nude mice were inoculated intraperitoneally with Smith strain of salivary gland passaged murine cytomegalovirus. Eight days after infection, they were sacrificed and the pathological features of virus spread were studied by immunofluorescence method. Subconjunctival tissues, corneal stroma, outer ocular muscles and occasional choroidal tissue are the site of positive fluorescence in the eye. At the same time, viral antigens were detected in the various organs such as spleen, liver, salivary glands, etc. Balb/c nude mice were injected intraperitoneally with silica three days and one day prior to virus infection to suppress their macrophages. The localization of viral antigens in the silica-treated mice was similar to that in untreated mice. When the peripheral blood obtained from the nude mice infected for 8 days was titrated for the virus, cell-free virus and blood-cell-associated virus was detected. These results indicated that cell-free virus is the major source of its spread.

Animals↗
PubMed1977

Diagnostic fibreoptic bronchoscopy in the immunocompromised host with pulmonary infiltrates.

Nineteen immunocompromised patients with pulmonary infiltrates underwent diagnostic fibreoptic bronchoscopy with transbronchial forceps and brush biopsy. A specific diagnosis was obtained in 21/25 procedures (10/11 focal lesions and 11/14 diffuse legions). The most common diagnosis was infection, and organisms isolated included bacteria, fungi, Pneumocystis carinii, and herpes simplex. A pneumothroax requiring tube drainage occurred in two cases and mild lung parenchymal bleeding was noted in two others. It is concluded that fibreoptic bronchoscopy with forceps and brush biopsy can be performed safely with an excellent diagnostic yield in immunocompromised hosts with lung lesions. Supplemental oxygen should be administered during fibreoptic procedures in these patients and platelet transfusions should be given when thrombocytopenia is present.

Adult↗
PubMed2003

Prevention of fungal infections in the immunocompromised host.

The incidence and severity of invasive fungal infections have significantly increased among immunocompromised hosts leading to excessive morbidity and mortality. Several preventative antifungal strategies (prophylaxis, empirical and pre-emptive) have been developed to improve the outcome of these infections. Although effective, these strategies are associated with toxicity, high cost and potential emergence of resistance. An alternative strategy, in the attempt to optimize the use of antifungal agents in preventing fungal infections, is a risk-adjusted approach based on the risk for, and severity of, infection in a given patient. This strategy has the potential to provide patients likely to suffer severe fungal infection the benefits of antifungal agents while avoiding the negative aspects (toxicity, cost and risk of resistance) in patients at low risk for these infections. In this review we focus on this strategy in cancer patients but it may also be applied to other immunocompromised hosts.

Antifungal Agents↗
PubMed1997

Oral infections in the immunocompromised host.

The prevalence of infections in the immunocompromised host is increasing. The oral cavity is a primary or sole site in many cases. It is important for the practicing clinician to recognize the more common infections in this growing patient population. Oral examinations are an essential component of all physical examinations, especially when immunosuppression is known or suspected. We recommend that all patients starting immunosuppressive therapy receive a comprehensive oral examination before the institution of such therapy to eliminate potential sources of oral and odontogenic infections. The examination should include full mouth dental radiographs and a complete soft-tissue examination. Timely, accurate diagnoses may have important implications with regard to management, prognosis, cost, morbidity, and mortality.

Bacterial Infections↗
PubMedDate not supplied

Empiric therapy for the immunocompromised host.

The use of empiric therapy for immunocompromised hosts has been one of the major advances in the management of such patients. Such therapy has been put into practice primarily for patients with neutropenia induced by cytotoxic chemotherapy. The empiric antibiotic regimens include in their coverage the bowel, skin, and intravenous-catheter flora anticipated for patients in a particular hospital. Less often, physicians treat empirically for opportunistic infections that complicate defects in helper cells, although empiric therapy for presumed Pneumocystis carinii pneumonia and Toxoplasma gondii infection of the central nervous system has become commonplace for patients infected with human immunodeficiency virus. Physicians also should consider environmental factors that expose patients to certain opportunistic organisms. Examples of such pathogens include Mycobacterium tuberculosis and Histoplasma capsulatum. The particular microorganisms considered to be opportunistic vary in different parts of the world and in different hospitals, and their designation as such may change rapidly. Multiple environmental exposures and immune defects, rather than just one factor, may be responsible for opportunistic infections and should be investigated and taken into account when empiric therapy is planned. Preventive measures, including simply rigorous hygiene, should precede and may obviate the need for empiric therapy.

Bacterial Infections↗
PubMed2000

Pulmonary infections in immunocompromised hosts: the importance of correlating the conventional radiologic appearance with the clinical setting.

The lung is one of the most frequently involved organs in a variety of complications in the immunocompromised host. Among the pulmonary complications that occur in this kind of patient, infection is the most common and is associated with high morbidity and mortality. Although chest radiography and computed tomography (CT) are essential diagnostic tools, radiologists often have difficulty in establishing the correct diagnosis on the basis of radiologic findings alone. The reasons are that the immunocompromised host is potentially susceptible to infection from many different microorganisms and that radiologic findings are seldom specific for the detection of a particular pathogen. Experience has shown that a particular clinical setting predisposes patients to infection by particular pathogens. The setting comprises (a) the specific epidemiologic or environmental exposure, (b) the type of underlying immune defect, (c) the duration and severity of immune compromise, and (d) the progression rate and pattern of the radiologic abnormality. Correlating the radiologic appearance with the clinical setting can expedite diagnosis and appropriate therapy. In this review, the authors describe the clinical settings that are helpful in choosing the radiologic approach to treatment of the immunocompromised host who presents with suspected pulmonary infection.

B-Lymphocytes↗