Clinical characteristics and prognosis of communityacquired pneumonia in autoimmune diseaseinduced immunocompromised host: A retrospective observational study / 世界急诊医学杂志（英文）

@#BACKGROUND: Community-acquired pneumonia (CAP) in autoimmune diseases (AID)-induced immunocompromised host (ICH) had a high incidence and poor prognosis. However, only a few studies had determined the clinical characteristics of these patients. Our study was to explore the characteristics and predictors of mortality in CAP patients accompanied with AID-induced ICH. METHODS: From 2013 to 2018, a total of 94 CAP patients accompanied with AID-induced ICH, admitted to Emergency Department of Zhongshan Hospital, Fudan University, were enrolled in this study. Clinical data and the risk regression estimates of repeated predictors were evaluated by generalized estimating equations (GEEs) analysis. An open-cohort approach was used to classify patient’s outcomes into the survival or non-survival group. RESULTS: The hospital mortality of patients with CAP occurring in AID-induced ICH was 60.64%. No significant differences were found with respect to clinical symptoms and lung images between survival and non-survival groups, while renal insufficiency and dysfunction of coagulation had higher proportions in non-survival patients (P<0.05). Both noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) were performed more frequently in non-survival group (P< 0.05). By the multivariate GEEs analysis, the repeated measured longitudinal indices of neutrophilto- lymphocyte ratio (NLR) (odds ratio [OR]=1.055, 95% confidence interval [95%CI] 1.025–1.086), lactate dehydrogenase (LDH) (OR=1.004, 95%CI 1.002–1.006) and serum creatinine (sCr) (OR=1.018, 95%CI 1.008–1.028), were associated with a higher risk of mortality. CONCLUSION: The CAP patients in AID-induced ICH had a high mortality. A signifi cant relationship was demonstrated between the factors of NLR, LDH, sCr and mortality risk in these patients.

Human Cytomegalovirus Infection in Solid-Organ Transplantation

Human cytomegalovirus (CMV) continues to be a major threat against solid-organ transplant recipients despite significant advancements in its prophylaxis and therapy. Primary CMV infection or reactivation of latent CMV in the transplant recipients may cause CMV diseases such as flu-like viral syndrome and tissue-invasive CMV disease. In addition, CMV infection in the recipients is associated with graft rejection and higher risk of other opportunistic infections, which are collectively known as the "indirect effects" of CMV infection. Prevention strategies with antiviral drugs including ganciclovir remarkably decreased CMV disease and the "indirect effects". Two commonly employed strategies are universal prophylaxis and preemptive therapy. However, gangciclovir-resistant CMV has emerged due to mutations in CMV UL97 and UL54 genes, now requiring alternative therapeutic options to be developed. This review provides an overview of CMV infection and disease, "indirect effects" on hosts, prevention strategies, and drug resistance in solid-organ transplant recipients.

Reactive Cutaneous Cytophagocytosis in Nocardiosis

Cutaneous nocardiosis, which usually manifests in the form of pustules, abscesses, or subcutaneous nodules, is occasionally found in immunocompromised patients. A 59-yr-old Korean man with myasthenia gravis and thymoma developed nodular skin lesions on his trunk. Histopathologically, abscess formation with a dense infiltrate of neutrophils and many cytophagic histiocytes were observed. Numerous filamentous organisms, which turned out to be Nocardia asteroides by culture, were also found. After sulfamethoxazole-trimethoprim therapy, all of the skin lesions rapidly decreased in size, with a marked diminution of the number of cytophagic histiocytes, and cleared up within four months. On reporting a case of cutaneous nocardiosis showing unusual histopathologic findings, we considered that reactive conditions should be included in the differential diagnosis of the cutaneous cytophagocytosis, and that nocardiosis could be one of the diseases showing reactive cytophagocytosis.

Clinical Characteristics of Herpes Zoster in Immunocompromised Patients and Analysis of Pharmacokinetics of Acyclovir / 감염

BACKGROUND: We investigated this study to elucidate the clinical characteristics of herpes zoster in immunocompromised patients and to analyze the pharmacokinetics of acyclovir with the response of therapy. METHODS: A total of 51 immunocompromised patients with herpes zoster were studied prospectively over 22 months (Dec. 1997-Sep. 1999). Patients were randomized to 4 groups according to pharmaceutical company (company A or B) and method of infusion (intermittently or continuously) of acyclovir. Patients were assigned to receive acyclovir (10 mg/kg, three times daily) intermittently, or acyclovir (5 mg/kg bolus, and then 40 mg/kg/day) continuously for 7 days respectively. RESULTS: Mean age was 31.9+/-12.6 years and the ratio of male to female was 1:1.68. Dermatome involvement was most frequently on the thoracic dermatome (49%), followed by cervical, lumbar dermatome. Forty-two (82.3%) patients received hematopoietic stem cell transplantation and herpes zoster was most prevalent in average 9.2+/-7.9 months after transplantation. Thirty (58%) patients had been taken immunosuppressants at the onset of herpes zoster. Recurrence rate of herpes zoster was 7.8%. Overall adverse experience rate was 15.7%. Pharmacokinetic parameter of acyclovir from company B was close to reference as compared with those of company A. There was no difference in steady-state concentration (Css) of acyclovir between intermittent and continuous infusion. Cessation of new lesion formation occurred 4.1+/-1.3 days after initiation of therapy without statistically significant intergroup differences. Rate to loss of vesicle over 50% at the seventh day of infusion also showed no intergroup differences, but tended to highest at the continuous group of company B. CONCLUSION: Herpes zoster in immunocompromised patients were prevalent during the use of immunosuppressant, mostly within 1 year after hematopoietic stem cell transplantation. Anatomical distribution was just like that of immunocompetent patients, but recurred more frequently. Clinical response was not different according to the pharmaceutical company or method of infusion. Supplementary evaluation to the dose of acyclovir, method of infusion, duration of treatment, and alternatives may be required.