Inmunizaciones en niños, adolescentes y adultos inmunosuprimidos / Immunizations in children, adolescent and adult immunocompromised hosts

Los pacientes inmunosuprimidos presentan un riesgo mayor de infecciones, debido a sus disfunciones inmunes, producto de la actividad de su enfermedad y la terapia inmunosupresora. El uso de vacunas disminuye este riesgo, otorgando protección directa e indirecta, a través de la vacunación del paciente y sus contactos. Las vacunas inactivadas han demostrado un perfil de seguridad adecuado en estos pacientes, por lo que no están contraindicadas, aunque su respuesta inmune puede ser inadecuada. Las vacunas vivas atenuadas, formalmente contraindicadas, poseen una información creciente que permite evaluar su riesgo/beneficio de manera individual. Por este motivo es necesario procurar mantener el calendario de vacunas actualizado y complementado, evitando el retraso en esquemas de vacunación y poniéndolo al día lo antes posible, con estrategias basadas en el individuo. Para llevar a cabo esto, se debe conocer y considerar los intervalos entre las vacunas, los esquemas acelerados, la solicitud de vacunas especiales, las aprobaciones vigentes y, finalmente, sus contraindicaciones.

Immunecompromised patients are at higher risk of infections due to their immune dysfunction caused by ongoing disease processes and immunosuppressive therapy. Patient vaccination or vaccination of the people in contact with patients diminishes their risk of infection. Although the immune response of immunocompromised patients might be impaired, the use of inactivated vaccines is safe and it is not contraindicated in these patients. Formerly, live attenuated vaccines were contraindicated in immunecompromised patients, but recently more data supports their use when evaluating case by case the risks and benefits of their application. Thus, it is important to keep and up-to-date, taylor-based and enhanced vaccination schedule in these cases. For this, specialists need to be informed about the availability of regular and special vaccines, their current approvals, vaccine administration protocols under specific situations and vaccine contraindications.

Clinical presentation of vernal keratoconjunctivitis in an immunocompromised patient: a case report

Vernal keratoconjunctivitis(VKC)is a chronic bilateral inflammation of the conjunctiva, commonly associated with a personal or family history of atopy. It is characterized by severe itching, foreign body sensation, thick ropy discharge, photophobia and conjunctival injection. VKC has palpebral, limbal and mixed forms. The classical conjunctival sign in palpebral VKC is the presence of giant papillae, which are predominantly seen on the superior tarsal conjunctiva. The limbal form occurs in dark skinned individuals and the papillae tend to occur at the limbus and have a thick gelatinous appearance. Clinical findings and laboratory investigations support the presence of IgE mediated type1 hypersensitivity reaction. Involvement of CD4 T helper (Th2) driven type IV hypersensitivity has also been confirmed. There has been an increase in the prevalence of allergic disorders in recent years and exaggerated manifestations of these diseases have been recognized in patients living with Human immunodeficiency virus

Infectious Diseases of the Stomach in Immune-compromised Patients

The gastrointestinal tract is a vast reservoir for internal microbiota; it is exposed directly to various externally introduced microbes, including bacteria, viruses, parasites and others. In immune-compromised conditions, the gastrointestinal tract is frequently affected by infectious diseases that seldom manifest clinically in immune-competent hosts. Immune-compromised conditions result from a variety of reasons, including human immunodeficiency virus infection, anti-cancer chemo-radiotherapy, immune suppressive therapy for autoimmune diseases, and organ transplantations. The stomach is a relatively rare site for opportunistic infections in immune-compromised patients compared to the esophagus and colon, where esophagitis and colitis develop frequently and cause significant clinical consequences. Helicobacter pylori infection is majorly involved in gastric malfunctioning in immune-compromised patients, followed by cytomegalovirus infection. Infections by Cryptosporidium, Mycobacterium avium complex, histoplasmosis, leishmaniasis, aspergillosis, or treponema, have been reported; however, gastric involvement of these agents is extremely rare. This review discusses the general aspects and recent reports on gastric infection in immune-compromised patients.

Toxoplasmosis of the spinal cord in an immunocompromised patient: case report and review of the literature / Toxoplasmosis medular en un paciente inmunosuprimido: Informe de un caso y revisión de la literatura

We, herein, describe an HIV-positive patient with toxoplasmosis of the spinal cord. We also carried out a comprehensive literature review of this topic, with emphasis on the diagnostic tools and therapeutic approach.

Se presenta el caso de un paciente seropositivo para VIH con diagnóstico de toxoplasmosis medular en conjunto con la revisión de la literatura de los pocos casos descritos hasta la fecha, con énfasis en las claves diagnósticas y la aproximación terapéutica.

Formulation and in vitro/in vivo Evaluation of Zidovudine Contained in Solidified Reverse Micellar Delivery System of Immune Compromised Rats.

Aim of the study was to study the in vitro and in vivo evaluation and correlation of zidovudine (AZT) loaded solidified reverse micellar microparticles (SRMMs). The SRMMs composed of goat fat and Phospholipon® 90H in various ratios (1:1, 2:1, 3:1 and 2:3) were prepared by melt dispersion method. AZT (1 %w/w, 2 %w/w, 3 %w/w and 5 %w/w) were incorporated into the SRMMs and preliminary analysis of the preparations on their stability were done visually. The 1:1 formulation was evaluated for the particle size, percentage yield and in vitro studies which was done using SGF and SIF. The in vivo study was done using Wistar albino rats and the in vitroin vivo correlation (IVIVC) was determined by plotting a graph of the fraction of drug absorbed in vivo versus the fraction of drug released in vitro. The yield of the goat fat extraction was 58 %. The particle size and yield of the solid lipid microparticle (SLM) containing 1 %w/w of AZT were 5.10 ± 0.10m and 86.3 ± 4.70% respectively. The fraction of drugs absorbed in vivo were 0.102 μg, 0.114 μg, 0.115 μg, 0.134 μg and 0.123 μg for 1 h, 3 h, 5 h, 8 h and 12 h respectively. A 1:1 ratio of goat fat and Phospholipon® 90H with a high value of correlation coefficient (r2 = 0.909) suggested good level-A correlation between the in vitro-in vivo data of the SLM obtained in the study.

Management of Paranasal Sinusitis in the Patient with Transplantation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently there has been a marked increase in the number and the success rate of organ transplantation with the development of surgical technique and the introduction of new immunosuppressants. However, clinically silent sinonasal infections in transplant recipients frequently cause problems which are sometimes fatal. As otolaryngologists, we must give attention to sinonasal infection in these immunocompromised patients who have received organ transplantation. MAERIALS AND METHODS: We reviewed 170 patients who have received organ transplantation for three years and analyzed the clinical course of patients with sinonasal infection around the transplantation period. They were managed according to the protocol of our hospital. RESULTS: There were 17 patients with sinonasal infection around transplantation. Four out of nine patients needed sinus operation before transplantation and six out of eight patients required operation after transplantation, and two of them had invasive fungal infection. Three out of four bone marrow transplant patients needed surgical management. CONCLUSION: Immune status of the transplant patients was the most important prognostic factor. Before organ transplantation, when the patient's immune status is relatively normal, thorough and aggressive physical examination including OMU-CT is mandatory. OMU-CT plays the major role in the diagnosis of sinusitis and the treatment planning. Prompt decision-making and aggressive management are also thought to improve patients' outcome, especially after transplantation. We also propose a protocol that can be used for management of sinonasal infection in transplantation patients.