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.

Role of bronchoscopy in diagnosis of pulmonary infections in non-HIV immune compromised host

Background: The occurrence of pulmonary infections is a common life threatening complication in immunocompromised patients, necessitating timely diagnosis and specific treatment. In our study bronchoscopic diagnostic techniques that include fiber optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) were applied in non-HIV immunocompromised conditions to determine the aetiology infectious microorganisms and comparing the clinical characteristics with bronchoscopic yield and to assess the influence of these methods on therapeutic outcome in this population.Methods: This prospective observational study was conducted at Rajiv Gandhi Government General Hospital, Park Town, Chennai, for a period of 8 months from January 2016 � August 2016.After meeting the requirements of eligibility criteria, the study included 65 immunocompromised patients consecutively who presented with pulmonary diseases. The primary outcome measure was the diagnostic yield of bronchoscopy among non-HIV immunocompromised patients. The secondary outcome measures were collecting the data including etiology of different microorganisms and non-infectious causes of pulmonary diseases among non- HIV immunocompromised patients, comparing the symptoms at the time of presentation, different radiological pattern with bronchoscopic yield and comparing the different subgroups of non-HIV immunocompromised patients with regards to presenting symptoms, radiological patterns, bronchoscopic yield, treatment modification, different spectrum of infections and complications.Results: The mean age of the patients was 41.91 ranging from 15-74 years. Majority (n=36) patients showed chest symptoms alone. On bronchoscopy, 52 cases (80%) out of 65 showed positive results and negative result was noticed in 13 cases (20%). Among them bacterial infections were predominant with 24%. After BAL culture bacterial culture was positive in 23 (35%) patients and fungal culture was positive in 15 (23%) cases. After bronchoscopy, current treatment plan was changed in 37 patients and clinical improvement was seen in 26 cases i.e. yield of bronchoscopy was 71%. Minor complications were noticed in 16 cases after bronchoscopy.Conclusion: Our study concludes, in clinically stable patients FOB was the preferred technique for finding the cause of lung infiltrates in non-HIV immunocompromised patients. Because our results signifies that the yield of bronchoscopy was high (80%) despite empirical antimicrobial therapy.

Immune Responses and Vaccine Development for Cytomegalovirus Infections.

Aims: (1) To review the published literature on immune biology of host- Cytomegavovirus (CMV) interactions and to discuss the host immune responses against viral infection, providing insights into the complex interplay between the host and the virus that facilitates viral persistence. (2) To report on the status of CMV vaccines that are currently in preclinical and clinical development, outlining important questions about the nature of protective immune responses that will be required of potential CMV immunization strategies. Methodology: A Pub Med search of original articles and reviews in English language only between the years 1974-2013 was conducted using “CMV infection”, “CMV vaccines”, “CMV immune responses” and “CMV clinical trials” as keywords. Inclusion criteria were a description of the CMV disease in immune compromised patients and in individuals affected by the virus through congenital transmission, clinical observations in the course of CMV infection, the overview of the host immune responses and CMV factors in the outcome of CMV infection, the current status of therapeutic strategies and vaccine development. Results: CMV is found throughout the world in all geographic and socioeconomic groups, but, in general, it is more widespread in developing countries and in areas of lower socioeconomic conditions. CMV still remains a major human pathogen causing significant morbidity and mortality in immune suppressed or immune compromised individuals. Between 50% and 80% of adults in the United States are infected with CMV by 40 years of age. CMV is the most common congenitally transmitted virus, resulting in approximately 1 in 150 children born with congenital CMV infection, and in about 1 in 750 children developing permanent disabilities due to CMV. Thus, development of vaccines against CMV infections has been a major biomedical research priority. Conclusion: There is a need for an effective CMV vaccine that will protect immune compromised transplant patients as well as newborns, although the key requirements for protection of these two populations (and the optimal vaccine strategy to provide this protection) may differ. To date, only the Towne vaccine – a live, attenuated CMV vaccine – has undergone efficacy evaluation. Application of molecular biological techniques, coupled with an improved understanding of the CMV genome, should allow design of safer, more immunogenic, live, attenuated vaccines.

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.

Successful CT Guided Needle Aspiration of Splenic Abscess: A Case Report.

Splenic abcess is a rare clinical entity with an incidence of 0.2 to 0.7 % in autopsy based studies. Untreated, a splenic abscess is associated with nearly 100% mortality. An 44 year old male was admitted with fever and fatigue for three weeks and abdominal pain for two weeks was found to have large splenic abscesses on imaging studies. Extensive workup revealed no evidence of hematogenous spread from an endovascular source, no septic emboli in other organs and no proof of local spread from an infectious origin within the abdomen.Our case introduces an unusal presentation of splenic abscess without well described pathophysiologic mechanism to support their etiology.

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.

Guías clínicas de la enfermedad de Chagas: Parte IV. Enfermedad de Chagas en pacientes inmunocomprometidos / Guidelines for chagas disease: Part IV. Chagas disease in immune compromissed patients

A summary of different kind of immune supressed hosts and the importance of Tryponosoma cruzi infection in this group of patients is presented. Then, most relevant aspects of immune compromised host-parasite interaction are analyzed such as the moment of acquiring the infection, immune compromise level, mechanisms of acquisition the infection and geographic region. Clinical features of primary infection and reactivation of infection in chronic Chagasic patients are described making especial emphasis in solid organ transplant and BMT. Chagas disease in AIDS patients is discussed including its treatment, follow up, monitoring the immune compromise level and prophylaxis.

Se revisa someramente los diferentes tipos de inmu-osupresión y la importancia de la infección por Trypa-nosoma cruzi en este tipo de pacientes. Se analizan los aspectos más relevantes de la relación hospedero inmunocomprometido-r. cruzi, tales como el momento de la infección, grado de inmunocompromiso, mecanismos de adquisición de la infección y área geográfica. Se presenta el cuadro clínico en el caso de primoinfección, como así también en la reactivación de la infección en pacientes chagásicos crónicos, haciéndose hincapié en el trasplante de órganos sólidos y precursores hematopoyéticos. Mención especial se hace de la enfermedad de Chagas en pacientes con SIDA, destacando el cuadro clínico y enfatizando en su tratamiento, seguimiento, monitorización del nivel de su compromiso inmunológico y profilaxis.

L'aspergillose naso-sinusienne dans sa forme pseudo-tumorale: a propos d'un cas

Les rhinosinusites aspergillaires sont; actuellement; en nette augmentation. La forme invasive de la maladie est essentiellement decrite chez les sujets a immunite compromise. Cette forme peut eroder l'os et / ou mener a des complications cranio-cerebrales. La presentation clinique est peu specifique et le diagnostic est assez souvent suspecte a l'imagerie. Le traitement medico- chirurgical est dans la majorite des cas curatif. Nous rapportons les aspects cliniques; radiologiques et therapeutiques d'un patient atteint d'une rhinosinusite aspergillaire