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Background@#The concurrent detection of human cytomegalovirus (CMV) with UL97 and UL54 mutations is crucial for prescribing adequate antiviral treatment when drug-resistant CMV infection is suspected. We investigated the frequency of resistance-conferring mutations among patients with persistent or recurrent CMV infection and further reviewed the subgroup with UL54 mutations without UL97 mutations. @*Methods@#Patients with persistent or recurrent CMV infection after 4 weeks of treatment with ganciclovir or foscarnet were consecutively enrolled between November 2012 and May 2019.The direct sequencing of UL97 and UL54 was performed to detect resistance mutations in CMV. @*Results@#A total of 101 sequencing datasets were obtained from 65 enrolled patients.CMV UL97 and UL54 mutations were detected in 15.4% (10/65) and 9% (6/65) of patients, respectively. The CMV retrieved from two patients (3%) had mutations in both genes. Four patients with CMV UL54 mutations alone had a history of haploidentical peripheral blood stem cell transplantation, and foscarnet was administered for over 4 weeks to these patients; 21.5% of patients had suspected resistant CMV infection with either UL97 or UL54 mutations. @*Conclusion@#In this study, CMV UL54 mutations but not UL97 mutations were found in patients subjected to prolonged foscarnet administration for CMV disease.
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Background@#Bacterial infections are well known factors underlying acute exacerbations in bronchiectasis. However, viral infections may also contribute to acute exacerbations. We aimed to assess the rate of viral detection in acute exacerbations of bronchiectasis, and the associated clinical factors. @*Methods@#Diagnostic tests for viral and bacterial etiologies were performed in 792 patients with bronchiectasis who visited the emergency room or the respiratory care inpatient unit in a tertiary referral center in South Korea. All patients were diagnosed with bronchiectasis by chest computerized tomography and were prescribed antibiotics for a minimum of 3 days. @*Results@#Viral pathogens were detected in 202 of the 792 enrolled patients (25.5%). The most common viral pathogen isolated was influenza A virus (24.8%), followed by rhinovirus (22.4%), influenza B virus (9.8%), respiratory syncytial virus B (8.9%), and human metapneumovirus (6.1%). In 145 patients, a viral, but not bacterial, pathogen was detected, whereas no pathogens were found in 443 patients with exacerbations. Multivariable analysis revealed that female sex and chronic heart disease as a comorbidity were positively associated with viral detection in acute exacerbations of patients with bronchiectasis, whereas the presence of radiographic infiltration was negatively associated. @*Conclusion@#Respiratory viruses were identified in approximately 25% of the acute exacerbations observed among patients with bronchiectasis. Of the viruses detected, influenza viruses and rhinovirus made up over 50%. More attention to viruses as possible causative pathogens for acute deteriorating symptoms in patients with bronchiectasis is warranted.
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Background@#Rapid detection of carbapenemase-producing Enterobacterales (CPE) is desirable to guide antimicrobial therapy and infection control. The NG-Test Carba5 (Carba5;NG Biotech, France) rapid multiplex lateral flow immunoassay and BD MAX Check-Points CPO Assay (CPO; BD Diagnostic Systems, USA) fully automated real-time PCR assay were evaluated for the detection of KPC, NDM, VIM, IMP, and OXA-48-like group in a culture colony compared to genotyping using conventional PCR. @*Methods@#Among the clinical isolates of carbapenem-resistant Enterobacterales (CRE) collected from 2013 to 2019, up to 20 isolates for each carbapenemase type, and approximately 60 carbapenemase-negative CRE were enrolled. Genotyping of carbapenemases were performed using single-target PCR for KPC, NDM, and OXA-48-like group and the multiplex PCR for VIM, IMP, GIM, SIM, and SPM. All isolates were tested with Carba5 and CPO. The discrepant results were resolved by single-target specific conventional PCR or GeneXpert Carba-R Assay (Carba-R; Cepheid, USA). @*Results@#Of 147 CREs, 82 were CPE (55.8%) including 20 KPC, 22 NDM, 17 VIM, three IMP, and 13 OXA-48-like group, and seven double carbapenemase-positive (three KPC/VIM, two NDM/ VIM, one KPC/NDM, and one NDM/OXA-48-like group) isolates. Carba5 and CPO detected all CPE correctly along with two more IMP-producing CPE. The sensitivity and specificity of both kits were equally 100% and 97%. Two false IMP-positives were confirmed IMP-positive with Carba-R and IMP-specific single-target PCR. @*Conclusion@#Carba5 and CPO reliably detect and differentiate five common carbapenemases in cultured colonies. Carba5, faster and simpler, is preferred as a spot test.
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Background@#Bacterial infections are well known factors underlying acute exacerbations in bronchiectasis. However, viral infections may also contribute to acute exacerbations. We aimed to assess the rate of viral detection in acute exacerbations of bronchiectasis, and the associated clinical factors. @*Methods@#Diagnostic tests for viral and bacterial etiologies were performed in 792 patients with bronchiectasis who visited the emergency room or the respiratory care inpatient unit in a tertiary referral center in South Korea. All patients were diagnosed with bronchiectasis by chest computerized tomography and were prescribed antibiotics for a minimum of 3 days. @*Results@#Viral pathogens were detected in 202 of the 792 enrolled patients (25.5%). The most common viral pathogen isolated was influenza A virus (24.8%), followed by rhinovirus (22.4%), influenza B virus (9.8%), respiratory syncytial virus B (8.9%), and human metapneumovirus (6.1%). In 145 patients, a viral, but not bacterial, pathogen was detected, whereas no pathogens were found in 443 patients with exacerbations. Multivariable analysis revealed that female sex and chronic heart disease as a comorbidity were positively associated with viral detection in acute exacerbations of patients with bronchiectasis, whereas the presence of radiographic infiltration was negatively associated. @*Conclusion@#Respiratory viruses were identified in approximately 25% of the acute exacerbations observed among patients with bronchiectasis. Of the viruses detected, influenza viruses and rhinovirus made up over 50%. More attention to viruses as possible causative pathogens for acute deteriorating symptoms in patients with bronchiectasis is warranted.
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Background@#Rapid detection of carbapenemase-producing Enterobacterales (CPE) is desirable to guide antimicrobial therapy and infection control. The NG-Test Carba5 (Carba5;NG Biotech, France) rapid multiplex lateral flow immunoassay and BD MAX Check-Points CPO Assay (CPO; BD Diagnostic Systems, USA) fully automated real-time PCR assay were evaluated for the detection of KPC, NDM, VIM, IMP, and OXA-48-like group in a culture colony compared to genotyping using conventional PCR. @*Methods@#Among the clinical isolates of carbapenem-resistant Enterobacterales (CRE) collected from 2013 to 2019, up to 20 isolates for each carbapenemase type, and approximately 60 carbapenemase-negative CRE were enrolled. Genotyping of carbapenemases were performed using single-target PCR for KPC, NDM, and OXA-48-like group and the multiplex PCR for VIM, IMP, GIM, SIM, and SPM. All isolates were tested with Carba5 and CPO. The discrepant results were resolved by single-target specific conventional PCR or GeneXpert Carba-R Assay (Carba-R; Cepheid, USA). @*Results@#Of 147 CREs, 82 were CPE (55.8%) including 20 KPC, 22 NDM, 17 VIM, three IMP, and 13 OXA-48-like group, and seven double carbapenemase-positive (three KPC/VIM, two NDM/ VIM, one KPC/NDM, and one NDM/OXA-48-like group) isolates. Carba5 and CPO detected all CPE correctly along with two more IMP-producing CPE. The sensitivity and specificity of both kits were equally 100% and 97%. Two false IMP-positives were confirmed IMP-positive with Carba-R and IMP-specific single-target PCR. @*Conclusion@#Carba5 and CPO reliably detect and differentiate five common carbapenemases in cultured colonies. Carba5, faster and simpler, is preferred as a spot test.
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Background@#Coronavirus disease 2019 (COVID-19) outbreaks emerged at two universityaffiliated hospitals in Seoul (hospital A) and Uijeongbu City (hospital S) in the metropolitan Seoul area in March 2020. The aim of this study was to investigate epidemiological links between the outbreaks using whole genome sequencing (WGS) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). @*Methods@#Fifteen patients were enrolled in the study, including four non-outbreak (A1–A4) and three outbreak cases (A5–A7) in hospital A and eight cases (S1–S8) in hospital S. Patients' hospital stays, COVID-19 symptoms, and transfer history were reviewed. RNA samples were submitted for WGS and genome-wide single nucleotide variants and phylogenetic relationships were analyzed. @*Results@#The index patient (A5) in hospital A was transferred from hospital S on 26 March.Patients A6 and A7 were the family caregiver and sister, respectively, of the patient who shared a room with A5 for 4 days. Prior to transfer, A5 was at the next bed to S8 in the emergency room on 25 March. Patient S6, a professional caregiver, took care of the patient in the room next to S8's room for 5 days until 22 March and then S5 for another 3 days.WGS revealed that SARS-CoV-2 in A2, A3, and A4 belong to clades V/B.2, S/A, and G/B.1, respectively, whereas that of A5–A7 and S1-S5 are of the V/B.2.1 clade and closely clustered. In particular, SARS-CoV-2 in patients A5 and S5 showed perfect identity. @*Conclusion@#WGS is a useful tool to understand epidemiology of SARS-CoV-2. It is the first study to elucidate the role of patient transfer and caregivers as links of nosocomial outbreaks of COVID-19 in multiple hospitals.
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Background@#HLA-DQ typing in deceased donors is not mandatory in Korea. Therefore, when patients develop DQ antibodies after kidney transplantation (KT) from deceased donor, it is impossible to determine whether they are donor-specific antibodies (DSA). We developed DQ prediction programs for the HLA gene and evaluated their clinical utility. @*Methods@#Two HLA-DQ prediction programs were developed: one based on Lewontin’s linkage disequilibrium (LD) and haplotype frequency and the other on an artificial neural network (ANN). Low-resolution HLA-A, -B, -DR, and -DQ typing data of 5,603 Korean patients were analyzed in terms of haplotype frequency and used to develop an ANN DQ prediction program. Predicted DQ (pDQ) genotype accuracy was analyzed using the typed DQ data of 403 patients. pDQ DSA agreement, sensitivity, specificity, and false-negative rate was evaluated using 1,970 single-antigen bead assays performed on 885 KT recipients. The clinical significance of DQ and pDQ DSA was evaluated in 411 KT recipients. @*Results@#pDQ genotype accuracies were 75.4% (LD algorithm) and 75.7% (ANN). When the second most likely pDQ (LD algorithm) was also considered, the genotype accuracy increased to 92.6%. pDQ DSA (LD algorithm) agreement, sensitivity, specificity, and falsenegative rate were 97.5%, 97.3%, 98.6%, and 2.4%, respectively. The antibody-mediated rejection treatment frequency was significantly higher in DQ or pDQ DSA-positive patients than in DQ or pDQ DSA-negative patients (P < 0.001). @*Conclusions@#Our DQ prediction programs showed good accuracy and could aid DQ DSA detection in patients who had undergone deceased donor KT without donor HLA-DQ typing.
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Background/Aims@#We evaluated the usefulness in kidney transplant (KT) candidates of cytomegalovirus (CMV)-specific enzyme-linked immunospot (ELISPOT) assays for predicting the development of post-transplant CMV infections. @*Methods@#All adult recipients admitted for living-donor KT between March 2014 and March 2015 were prospectively enrolled except donor CMV-seropositive and recipient seronegative (D+/R–) recipients. All the enrolled patients underwent CMV-specific ELISPOT assays before transplant, and a researcher blinded to the results of these assays examined the patients for CMV infection at least 6 months post-transplant. @*Results@#Of 133 KT recipients, 44 (33%) developed CMV infections. When we used the cut-off determined by receiver operator characteristic curve, 16 of the 34 patients (47%) with negative pp65-specific ELISPOT results (< 11 spots/200,000 cells) developed CMV infections, whereas 28 of the 99 patients (39%) with positive pp65-specific ELISPOT results at baseline (≥ 11 spots/200,000 cells) developed CMV infections after KT (p = 0.02). Based on the multivariable Cox regression model, negative pp65-specific ELISPOT assay results was an independent risk factor for CMV infection (adjusted hazard ratio [AHR], 1.87; 95% confidence interval [CI], 1.01 to 3.46; p = 0.047) as well as age (AHR, 1.05; 95% CI, 1.01 to 1.08; p = 0.007). @*Conclusions@#Pre-transplant CMV-specific ELISPOT assay appears to predict the development of CMV infections after KT in recipients at moderate risk such as CMV-seropositive recipients (Clinical Trial Registration Number NCT 02025335).
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The outbreak of coronavirus disease 2019 (COVID-19), which began in December 2019, is still ongoing in Korea, with >9,000 confirmed cases as of March 25, 2020. COVID-19 is a severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection, and real-time reverse transcription-PCR is currently the most reliable diagnostic method for COVID-19 around the world. Korean Society for Laboratory Medicine and the Korea Centers for Disease Prevention and Control propose guidelines for diagnosing COVID-19 in clinical laboratories in Korea. These guidelines are based on other related domestic and international guidelines, as well as expert opinions and include the selection of test subjects, selection of specimens, diagnostic methods, interpretation of test results, and biosafety.
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Background@#Inconclusive SARS-CoV-2 real-time reverse transcription-PCR (rRT-PCR) test results, which are positive for one or more target genes but not all, are problematic in clinical laboratories. In this study, we aimed to investigate the cause and clinical relevance of such inconclusive results. @*Methods@#rRT-PCR was performed using the Allplex 2019-nCoV assay kit (Seegene Inc., Korea) targeting the following three genes: E, RdRp, and N. For all inconclusive test results reported from March to June 2020, the frequency per kit, lot number, specimen type, cycle threshold (Ct) and peak values of the amplification curves, positive target genes, and results of repeated or consecutive tests were analyzed. @*Results@#A total of 43,268 tests were conducted, of which 93 (0.21%) were inconclusive—49 from 11 coronavirus disease 2019 (COVID-19) patients and 44 from non-COVID-19 patients.In COVID-19 patients, the results were inconclusive 11.9 ± 4.7 days after diagnosis and were negative 8.8 ± 5.5 days after the inconclusive results were reported. However, in nonCOVID-19 patients, they were all negative upon retest and 81.8% of them were identified to have yielded in 2 out of 8 lots. The most frequently positive target genes were N (55.4%) in COVID-19 and RdRp (61.2%) in non-COVID-19 patients, respectively. No difference was observed in the Ct or peak values of the amplification curves for inconclusive samples between COVID-19 and non-COVID-19 cases. @*Conclusion@#Inconclusive test results should be reported neither positive nor negative. Such results can be reported as inconclusive without retesting in COVID-19 patients; however, they should certainly be confirmed by a retest in non-COVID-19 patients or newly diagnosed cases.
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This study investigated resistance mechanisms and epidemiology of emerging linezolid-nonsusceptible Enterococcus faecalis (LNSEF) in a tertiary care hospital. LNSEF isolated from clinical samples were collected from November 2017 to June 2019. The isolates were investigated for linezolid resistance and the associated molecular mechanisms, including mutations of 23S rRNA domain V and acquisition of the cfr or optrA resistance gene. We used pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing for the molecular typing of the isolates. Among 4,318 E. faecalis isolates, 10 (0.23%) were linezolid-nonsusceptible. All LNSEF isolates were optrA-positive and cfr-negative. Of these isolates, five were sequence type (ST) 476, two ST585, one ST16, one ST16-like, and one ST480. Six LNSEF isolates obtained in the first year clustered to three types in the PFGE analysis: two ST476 isolates of type A, two ST585 isolates of type B, and two ST16 or ST16-like isolates of type C. Seven cases were of community-onset and three were hospital acquired, but total of eight were healthcare-associated including five community-onset. None of the patients had a history of linezolid treatment, and in one patient, we detected linezolid-susceptible E. faecalis one month before LNSEF detection. In conclusion, heterogenous clones of optrA-positive LNSEF emerged in the hospital mainly via community-onset.
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Background@#Inconclusive SARS-CoV-2 real-time reverse transcription-PCR (rRT-PCR) test results, which are positive for one or more target genes but not all, are problematic in clinical laboratories. In this study, we aimed to investigate the cause and clinical relevance of such inconclusive results. @*Methods@#rRT-PCR was performed using the Allplex 2019-nCoV assay kit (Seegene Inc., Korea) targeting the following three genes: E, RdRp, and N. For all inconclusive test results reported from March to June 2020, the frequency per kit, lot number, specimen type, cycle threshold (Ct) and peak values of the amplification curves, positive target genes, and results of repeated or consecutive tests were analyzed. @*Results@#A total of 43,268 tests were conducted, of which 93 (0.21%) were inconclusive—49 from 11 coronavirus disease 2019 (COVID-19) patients and 44 from non-COVID-19 patients.In COVID-19 patients, the results were inconclusive 11.9 ± 4.7 days after diagnosis and were negative 8.8 ± 5.5 days after the inconclusive results were reported. However, in nonCOVID-19 patients, they were all negative upon retest and 81.8% of them were identified to have yielded in 2 out of 8 lots. The most frequently positive target genes were N (55.4%) in COVID-19 and RdRp (61.2%) in non-COVID-19 patients, respectively. No difference was observed in the Ct or peak values of the amplification curves for inconclusive samples between COVID-19 and non-COVID-19 cases. @*Conclusion@#Inconclusive test results should be reported neither positive nor negative. Such results can be reported as inconclusive without retesting in COVID-19 patients; however, they should certainly be confirmed by a retest in non-COVID-19 patients or newly diagnosed cases.
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Strongyloides stercoralis is an intestinal nematode that often causes chronic diarrhea and may develop severe complicated form of hyperinfection or disseminated infection in immunocompromised patients. Here, we report a case of recurrent strongyloidiasis presenting with pulmonary and meningeal involvement. A 55-year-old male diagnosed with pancreatic cancer 4 months ago was admitted due to chronic diarrhea, abdominal pain, and weight loss for 2–3 months. He had been treated with albendazole for chronic recurrent strongyloidiasis 13 years ago and again 2 years ago. He developed sepsis of Klebsiella pneumoniae and Escherichia coli on Days 3 and 7, respectively, and then meningitis of E. coli on Day 42. Strongyloidiasis was diagnosed by detection of abundant filariform larvae in sputum specimens on Day 15. He was treated for disseminated strongyloidiasis with albendazole and ivermectin for five weeks until clearance of larvae was confirmed in sputum and stool specimens. Laboratory diagnosis is important to guide appropriate treatment and to prevent chronic and recurrent strongyloidiasis.
Subject(s)
Humans , Male , Middle Aged , Abdominal Pain , Albendazole , Clinical Laboratory Techniques , Diarrhea , Escherichia coli , Immunocompromised Host , Ivermectin , Klebsiella pneumoniae , Larva , Meningitis , Pancreatic Neoplasms , Sepsis , Sputum , Strongyloides stercoralis , Strongyloidiasis , Weight LossABSTRACT
OBJECTIVE: Human bocavirus (HBoV) is a newly identified pathogen that can cause upper and lower respiratory infections usually in children; however, its clinical characteristics and significance in respiratory infections in adults have not been well known. Our objective was to evaluate the clinical features of respiratory HBoV infection and to describe the CT findings of HBoV pneumonia in adults. MATERIALS AND METHODS: A total of 185 adult patients diagnosed with HBoV infection at a tertiary referral center between January 2010 and December 2017 were retrospectively evaluated with respect to the clinical characteristics of HBoV infection and its risk factors for pneumonia. Chest CT findings for 34 patients with HBoV pneumonia without co-infection were analyzed and compared between immunocompetent (n = 18) and immunocompromised (n = 16) patients. RESULTS: HBoV infections were predominantly noted between February and June. Among the 185 patients with HBoV infection, 119 (64.3%) had community-acquired infections and 110 (59.5%) had pneumonia. In multivariable analysis, older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00–1.04; p = 0.045) and nosocomial infection (OR, 2.07; 95% CI, 1.05–4.10; p = 0.037) were associated with HBoV pneumonia. The main CT findings were bilateral consolidation (70.6%) and/or ground-glass opacities (64.7%); centrilobular nodules (14.7%) were found less frequently. The pattern of CT findings were not significantly different between immunocompetent and immunocompromised patients (all, p > 0.05). CONCLUSION: HBoV infection can be a potential respiratory tract infection in adults. The most frequent CT findings of HBoV pneumonia were bilateral consolidation and/or ground-glass opacities.
Subject(s)
Adult , Child , Humans , Coinfection , Community-Acquired Infections , Cross Infection , Human bocavirus , Immunocompromised Host , Pneumonia , Respiratory Tract Infections , Retrospective Studies , Risk Factors , Tertiary Care Centers , Tomography, X-Ray ComputedABSTRACT
Dysgonomonas capnocytophagoides is a gram-negative, facultatively anaerobic coccobacillus that was formerly designated CDC group dysgonic fermenter (DF)-3, occurring as a normal flora in human gut and rarely causing human infections such as bacteremia, abscess, diarrhea, and cholecystitis. In this study, we report a case of biliary sepsis caused by D. capnocytophagoides in a patient with biliary obstruction. A seventy four-year-old man, admitted to the hospital due to common bile-duct stone, also had cholangitis caused by D. capnocytophagoides and Enterococcus avium, which were isolated from his blood cultures. D. capnocytophagoides was initially identified as D. gadei by MALDI-TOF mass spectrometry, but later confirmed as D. capnocytophagoides by 16S rRNA gene sequencing. To the best of our knowledge, this is the first report of human infection by D. capnocytophagoides in Korea.
Subject(s)
Humans , Abscess , Bacteremia , Cholangitis , Cholecystitis , Cholelithiasis , Diarrhea , Enterococcus , Genes, rRNA , Korea , Mass Spectrometry , SepsisABSTRACT
BACKGROUND: Helicobacter pylori infection in children causes gastrointestinal symptoms and iron deficiency anemia. This study aimed to investigate trends in H. pylori stool antigen (HpSA) positivity in children and the relationship between HpSA test results and anemia. METHODS: We analyzed the results of 2,762 HpSA tests and the correlation of hemoglobin and ferritin with HpSA in patients aged 0–18 years from 2008 to 2014 at a tertiary care center. Additionally, we prospectively evaluated HpSA test results and correlation with hemoglobin in 352 specimens obtained from five centers. RESULTS: From 2008-2014, the mean positive rate of the HpSA test was 5.8%, with a high of 9.1% in 2012 and a low of 2.3% in 2013. The positive rate correlated with age: 2.9% in 0–6-year-olds, 5.8% in 7–12-year-olds, and 10.6% in 13–18-year-olds (P < 0.0001). There was no difference in HpSA positivity in patients with (7.0%) and without (5.7%) anemia. Ferritin was significantly lower in patients with positive HpSA results than in those with negative results (P=0.0001). In a multicenter study, the positive rate of HpSA was 16.8%. CONCLUSION: The rate of HpSA positivity was 5.8% in pediatric patients at a single center from 2008–2014, and this rate increased with age. Helicobacter pylori infection may be associated with iron deficiency, as ferritin level was significantly lower in HpSA-positive patients than HpSA-negative patients.
Subject(s)
Child , Humans , Anemia , Anemia, Iron-Deficiency , Ferritins , Helicobacter pylori , Helicobacter , Iron , Prospective Studies , Tertiary Care CentersABSTRACT
BACKGROUND: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients. MATERIALS AND METHODS: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group). RESULTS: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8–40%] vs. 47% [IQR, 15–62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20–18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08–18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47–34.58) were independently associated with the case group in multivariate analysis. CONCLUSION: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.
Subject(s)
Adult , Humans , Bronchoalveolar Lavage Fluid , Bronchoalveolar Lavage , Diabetes Mellitus , Drug-Related Side Effects and Adverse Reactions , Glomerular Filtration Rate , Korea , Lymphocyte Count , Lymphocytes , Medical Records , Multivariate Analysis , Odds Ratio , Pneumocystis carinii , Pneumocystis , Pneumonia , Risk Factors , Salvage Therapy , Seoul , Treatment FailureABSTRACT
BACKGROUND: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients. MATERIALS AND METHODS: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group). RESULTS: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8–40%] vs. 47% [IQR, 15–62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20–18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08–18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47–34.58) were independently associated with the case group in multivariate analysis. CONCLUSION: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.
Subject(s)
Adult , Humans , Bronchoalveolar Lavage Fluid , Bronchoalveolar Lavage , Diabetes Mellitus , Drug-Related Side Effects and Adverse Reactions , Glomerular Filtration Rate , Korea , Lymphocyte Count , Lymphocytes , Medical Records , Multivariate Analysis , Odds Ratio , Pneumocystis carinii , Pneumocystis , Pneumonia , Risk Factors , Salvage Therapy , Seoul , Treatment FailureABSTRACT
The detailed kinetics of the cytomegalovirus (CMV)-specific T cell response in hematopoietic stem cell transplant (HCT) recipients have not yet been fully assessed. We evaluated these kinetics of CMV-specific T cell response and factors associated with high CMV-specific T cell responses 1 year after HCT. In HCT recipients, CMV pp65 and IE1-specific ELISPOT assay were performed before HCT (D0), and at 30 (D30), 90 (D90), 180 (D180), and 360 (D360) days after HCT. Of the 51 HCT recipients with donor-positive (D+)/recipient-positive (R+) serology, 26 (51%) developed CMV infections after HCT. The patterns of post-transplantation reconstitution for CMV-specific T cell response were classified into 4 types: 1) an initial decrease at D30 followed by gradual T cell reconstitution without CMV infection (35%), 2) an initial decrease at D30 followed by gradual T cell reconstitution preceded by CMV infection (35%), 3) failure of gradual or constant T cell reconstitution (26%), and 4) no significant T cell reconstitution (4%). There was no significant difference between ELISPOT counts of D360 and those of D0. High CMV-specific T cell responses at D360 were not associated with high CMV-specific T cell response at D0, CMV infection, ganciclovir therapy, graft versus host disease (GVHD), and immunosuppressant use. In conclusion, there are 4 distinct patterns of reconstitution of the CMV-specific T cell response after HCT. In addition, reconstituted donor-origin CMV-specific T cell responses appeared to be constant until day 360 after HCT, regardless of the level of the pre-transplant CMV-specific T cell response, CMV infection, and immunosuppressant use.