Current status and influencing factors of vaccination in immunocompromised children / 中国生物制品学杂志

@#Objective To investigate the current status and influencing factors of vaccination in immunocompromised children and to provide a reference for vaccination strategy in these children.Methods Wenjuanxing questionnaire investigation was carried out in the parents of immunocompromised children who visited the Department of Hematology,Shanghai Children's Medical Center and the Department of Liver Transplant,Renji Hospital from December 2018 to January 2020,of which the content included the basic information of immunocompromised children as well as vaccination status and intention.Results The ages of the immunocompromised children were(6.29±4.09) years.A total of 296(48.9%) children were vaccinated after illness,while 309(51.1%) were unvaccinated.The mainly influencing factors of vaccination in immunocompromised children included low family income(χ~2=20.381,P <0.001),type of disease(solid tumor)(χ~2=29.486,P <0.001),low willingness to vaccination after treatment(χ~2=21.462,P <0.001),reduced going out of children(χ~2=9.035,P=0.003),stable condition of children and low enthusiasm of the parents to vaccination(χ~2=26.394,P <0.001).Conclusion Vaccination coverage is relatively low in immunocompromised children,of which the mainly influencing factors included low family income as well as low willingness and low enthusiasm to vaccination after treatment.Publicity and education on vaccination-related knowledge should be strengthened to improve the vaccination awareness of the parents.

Streptococcus pseudoporcinus: a rare cause of bacteraemia in an immune-compromised patient

Streptococcus pseudoporcinus, a ß-haemolytic Streptococcus is known to cause genital infections. Author report a rare case of Streptococcus pseudoporcinus bacteremia in an immune-compromised male patient diagnosed with acute myeloid leukemia eight months back. The organism was identified as a beta hemolytic bacterium which was catalase negative, oxidase positive and bacitracin resistant. Automated methods (VITEK-2) confirmed the organism to be Streptococcus pseudoporcinus.

Varicela zoster / Varicela zoster

La varicela es una enfermedad infecto-contagiosa, producida por el virus varicela-zoster (VVZ); es un virus alfaherpes que se relaciona más estrechamente con el virus del herpes simple, se presenta cuando el virus entra en contacto con la mucosa del tracto respiratorio superior o la conjuntiva de una persona susceptible, la transmisión de persona a persona se puede presentar por contacto directo con lesiones de VZV o por propagación en el aire. La reinfección con VZV es rara. El período de incubación es de 10 a 21 días; los síntomas que generalmente se presentan son fiebre, malestar general, anorexia, dolor de cabeza y posteriormente vesículas claras, pruriginosas en las primeras etapas, llenas de líquido que evolucionan a costras. La complicación más común de la varicela es la sobreinfección bacteriana de las lesiones cutáneas causadas con mayor frecuencia por Staphylococcus aureus y Streptococcus del grupo A, pero también es posible encontrar linfadenitis y abscesos subcutáneos. Cuando la varicela se presenta durante los últimos días de gestación (<5 días) o 2 días después del parto, existe un riesgo aproximado de 20% de presentar varicela neonatal.

The Varicela is an infectious-contagious disease, caused by the varicella-zoster virus (VZV); It is an alphaherpes virus that is more closely related to the herpes simplex virus, it occurs when the virus comes into contact with the mucosa of the upper respiratory tract or the conjunctiva of a suscep-tible person, transmission from person to person can occur by contact Direct with VZV or airborne injuries. Reinfection with VZV is rare. The incubation period is from 10 to 21 days; The symptoms that generally appear are fever, general malaise, anorexia, headache and later clear, itchy vesicles in the early stages, filled with fluid that evolve to crusts. The most common complication of varicela is bacterial superinfection of the cutaneous lesions most frequently caused by group A Staphylococcus aureus and Streptococcus, but it is also possible to find lymphadenitis and subcutaneous abscesses. When chickenpox occurs during the last days of gestation (<5 days) or 2 days after delivery, there is an approximate 20% risk of developing neonatal varicela

Hidden Germ of the Immunocompromised: A Case of Fungal Orbital Cellulitis

@#Orbital cellulitis is an infection of the orbital soft tissue that could possibly lead to serious complications if treatment is delayed. It is important to differentiate this condition from a less life-threatening condition like preseptal cellulitis as orbital cellulitis would require a more aggressive treatment than the former condition. The present case discusses about a patient who was diagnosed with orbital cellulitis and developed complications from the disease. The delayed administration of the appropriate antibiotic subsequently led to the patient’s death. The delay was because of the reason that the patient belonged to the immunocompromised group who harbour different causative organism than the normal population.

Clinical outcomes of immunocompromised children with acute respiratory distress syndrome / 中华急诊医学杂志

Objective To investigate the clinical outcomes of immunocompromised (IC) children with pediatric acute respiratory distress syndrome (PARDS) in pediatric intensive care unit (PICU).Methods Fifty-six PADRS children were enrolled and the data of clinical characteristics,immunological status,complications,treatments and outcomes were collected and analyzed by using univariate and multivariate regression models.Results There were 20 children in the immunocompromised group and 36 in the control group.Immunocompromised children were older and weighted greater than the control ones (P=0.003 and P＜0.01,respectively).Peripheral blood leukocyte,neutrophil and platelet counts were significantly lower in IC group compared with control group (P=0.060,P=0.006 and P=0.023,respectively).In addition,high-frequency oscillatory ventilation (HFOV) was used less frequently in the IC group (P=0.015).The PICU mortality of the IC group was significantly higher than that of control group (P=0.003).The proportion of IC patients and the incidence of ventilator-associated lung injury differed significantly between survivors and non-survivors (P=0.003 and P=0.046,respectively).After adjusting for other confounding factors by using multivariate logistic regression analysis,IC was associated with a higher mortality (OR=6.986,95％ CI:1.812-26.930,P=0.005).Survival analysis also indicated that IC children with ARDS had lower 28-day survival rate than the non-IC children (P=0.022).Conclusions IC children with PARDS have a higher PICU mortality than children with normal immune function.Immunocompromise is an important predictor of poor outcomes in children with PARDS.

Síndrome de hiperinfecção e/ou disseminação por Strongyloides stercoralis em pacientes imunodeprimidos / Hyperinfection syndrome and/or dissemination by Strongyloides stercoralis in immunosuppressed patients

A estrongiloidíase é causada principalmente pelo Strongyloides stercoralis, que afeta cerca de 30 a 100 milhões de pessoas em todo o mundo, sendo encontrada com maior frequência em países de clima tropical e subtropical. Usualmente, as infecções causadas por esse parasita são crônicas e assintomáticas, podendo persistir por décadas sem ser diagnosticada. Porém, em indivíduos imunodeprimidos, essa infecção pode se desenvolver para quadros mais graves como hiperinfecção e/ou disseminação, considerados como as formas que causam maior índice de mortalidade. Este trabalho relata, a partir de uma revisão da literatura, a associação do desenvolvimento da infecção causada pelo Strongyloides stercoralis em imunodeprimidos e a capacidade de evolução do parasita em indivíduos que fazem uso de corticosteroidoterapia, ressaltando a importância do diagnóstico precoce para evitar as formas graves da doença

The Strongyloidiasis is mainly caused by Strongyloides stercoralis which affects about 30 to 100 million people around the world, being found in greater frequency in countries with tropical and subtropical climates. Usually, the infections caused by this parasite are asymptomatic and chronic, that can persist for decades without being diagnosed. However, in immunocompromised individuals this infection can develop into more serious conditions such as hyperinfection and/or dissemination, considered the ways that cause the highest mortality rates. This paper reports the association of the development of infection caused by Strongyloides stercoralis in immunosuppressed and the development capacity of the parasite in individuals who make use of corticosteroidoterapia from a literature review, emphasizing the importance of early diagnosis to prevent severe forms of the disease

Mucormicosis cutánea en un paciente inmunocomprometido / Cutaneous mucormycosis in an immunocompromised patient

Mucormycosis is an increasingly emerging life-threatening infection and is an important cause of morbidity and mortality in patients with leukemia. We present the case of a 4-year-old boy with an acute lymphoblastic leukemia complicated by severe and prolonged neutropenia during induction chemotherapy, who developed cutaneous mucormycosis of the elbow. Direct microscopy with KOH and the histopathologic observation of the skin revealed fungal hyphae without septations. The cultures were positive for Rhizopus microsporus var oligosporus. The patient was treated succefully with amphotericin B during 40 days, surgical debridement and dermoepidermic graft. Early recognition and prompt intervention with combined medical and surgical treatment may improve the outcome. The most common management strategy in survivors involves a combination of antifungal therapy with amphotericin B and surgical debridement.

La mucormicosis es una enfermedad emergente grave, producida por hongos saprófitos del orden Mucorales, que afecta fundamentalmente a pacientes inmunocom-prometidos. La forma cutánea se origina por inoculación de esporas dentro de la dermis con el subsecuente desarrollo de una lesión tipo ectima, generalmente única y de evolución rápidamente progresiva, por las características angioinvasoras del hongo, que determina amplias zonas de infartos y necrosis en los tejidos. Presentamos el caso de un paciente con cuatro años de edad, con diagnóstico de leucemia linfoblástica aguda, en quimioterapia de inducción, que cursó con neutropenia profunda y prolongada, presentando una lesión cutánea en el codo compatible con ectima gangrenoso. Recibió tratamiento antimicrobiano y antifúngico, asociado a un aseo quirúrgico. El cultivo para hongos demostró crecimiento de Rhizopus microsporus var oligosporus, y la histología concluyó presencia de hifas no septadas. El estudio de extensión descartó compromiso óseo, sinusal y cerebral. Completó 40 días de terapia antifúngica con anfotericina B deoxicolato, evolucionando satisfactoriamente. Posteriormente requirió injerto dermo-epidérmico. Si bien esta patología es infrecuente, debemos sospecharla en pacientes con neoplasias hematológicas, para establecer un diagnóstico etiológico oportuno, ya que el tratamiento contempla el desbridamiento quirúrgico precoz asociado a antifúngicos sistémicos, siendo de elección anfotericina B.

Recurrence Rate of Herpes Zoster during the Previous Decade / 대한피부과학회지

BACKGROUND: Herpes zoster recurrence, reported to be 1~5% globally, is thought to be more frequent in immunocompromised and older individuals. Data on the recurrence rate in Korea are very rare. OBJECTIVE: This study assessed the rate and affecting factors of herpes zoster recurrence, in a Korean population. METHODS: From May, 2001 to May, 2011, 2210 patients with confirmed herpes zoster episodes were enrolled. Recurrence episodes and affecting factors of herpes zoster were confirmed using telephone question and medical record review. RESULTS: The overall recurrence rate of herpes zoster was 2.31%. Recurrences were significantly more likely in persons with zoster-associated pain of 30 days or longer, at the initial episode, and in immunocmpromised patients. Women and anyone aged between 50 and 70 years, at the index episode, had a greater likelihood of recurrence. CONCLUSION: Recurrence of herpes zoster is more common in women and is associated with pain duration and immune status.

Enfermedad fúngica invasora en pacientes de cinco hospitales de la Región de Valparaíso, Chile: 2004 a 2009 / Invasive fungal disease in patients from five hospitals in the Valparaíso Region, Chile: 2004 to 2009

Introduction: Invasive fungal disease (IFD) is a frequent cause of morbidity and mortality in immuno-compromised patients. These infections are caused mainly by Candida albicans and Aspergillus fumigatus. Objectives: To describe IFD diagnosed by culture in adults and children from five hospitals in Valparaíso, Chile and to determine the species involved and the in vitro sensitivity oí Candida spp. Material and Methods: Biodemographical data, results of cultures, antifungal treatment and mortality after 30 days, was collected. The fungi were identified by standard methods and the sensitivity of the yeasts was obtained according to the M44-A CLSI document. Results: Fifty one IFD were diagnosed, 13 in patients with haematological malignancies and 10 in immunocompetent patients from the adult ICU. The following fungal species were isolated: 34 yeasts, 15 filamentous fungi and 2 Histoplasma capsulatum. There were 33 proven and 1 probable IFD by yeasts. By filamentous fungi, there were 6 proven and 9 probable IFD, 13 out of 15 isolated species were Aspergillus {A. fumigatus being the most frequent). C. albicans was the most frequent isolated yeast, followed by C. tropicalis and C. parapsilosis. All were sensitive to fluconazol and voriconazol, excepting C. glabrata. The mortality by Candida and by filamentous fungi was 42.42 percent and 86.66 percent respectively. Con-clusions: IFD was diagnosed mainly in immunocompromised and adult ICU patients. The mortality rate in IFD by filamentous fungi was higher than Candida group. The main agents involved were Candida albicans and Aspergillus fumigatus. A high sensitivity to fluconazol and voriconazol was found in strains of Candida.

Introducción: La enfermedad fúngica invasora (EFI) es una causa frecuente de morbimortalidad en pacientes inmunocomprometidos. Es provocada principalmente por Candida albicans y Aspergillus fumigatus. Objetivos: Describir las EFI diagnosticadas con cultivos en adultos y niños de cinco hospitales de la Región de Valparaíso, Chile, conocer las especies involucradas y para Candida spp determinar su sensibilidad in vitro. Material y Métodos: En cada caso se recopilaron antecedentes demográficos, cultivos, tratamiento antifúngico y mortalidad a 30 días. La identificación de hongos se realizó por métodos estandarizados y la sensibilidad de levaduras según documento M44-A del CLSI. Resultados: se diagnosticaron 51 EFI, destacando 13 en pacientes onco-hematológicos y 10 en inmunocompetentes de UCI adultos. Se aislaron 34 levaduras, 15 hongos filamentosos y en dos casos Histoplasma capsulatum. Hubo 33 EFI probabas por levaduras y una probable. En EFI por hongos filamentosos 6 fueron probadas y 9 probables; 13 de 15 especies aisladas fueron Aspergillus, siendo A fumigatus la más frecuente. Entre las levaduras predominó C. albicans, seguida de C. tropicalis y C. parapsilosis. Todas fueron sensibles a fluconazol y voriconazol, excepto C. glabrata. La mortalidad de EFI por Candida fue de 42,4 por ciento y de EFI por hongos filamentosos de 86,6 por ciento. Conclusiones: la EFI se diagnosticó principalmente en pacientes inmunocomprometidos y en pacientes de UCI adultos. La mortalidad de EFI por hongos filamentosos fue mayor que la causada por Candida. Los principales agentes fueron C. albicans y A. fumigatus. Existe una alta sensibilidad de las cepas de Candida spp a fluconazol y voriconazol.

El test de Tzanck en pacientes inmunocomprometidos: una metodología emergente y reemergente / The Tzanck test in immunocompromised patients: an emerging and re-emerging methodology

El test de Tzanck es un método útil para verificar la infección por Herpesvirus desmostrando la presencia de células gigantes multinucleadas (80% muestras de vesículas y 20% en úlceras). Sin embargo, esto puede cambiar en los inmunocomprometidos de manera dramática, donde las lesiones ulcerosas predominan. Conocer la eficacia del test de Tzanck como herramienta diagnóstica en pacientes inmunocomprometidos con lesiones dermatológicas úlcerosas y vesiculares, intentando rescatar esta técnica como un apoyo en la esfera diagnóstica. Estudio retrospectivo y comparativo basado en informes d laboratorio de la Unidad de Microbiología Médica del Centro Ortopédico Podológico, años 2005-2009 de pacientes a quienes se les practicó el test en muestra de secreción de úlceras y decapitación de vesículas, con algún tipo de diagnóstico de inmunocompromiso. Estudiamos 40 vesículas y 94 úlceras de 134 pacientes con diagnóstico de infección VIH/SIDA (34), neoplasias sólidas (60), diabetes mellitus (22) patologías autoinmunes (12) y probables leucemias (6). Predominaron las lesiones ulcerosas genitales seguidas por cavidad oral. El test de Tzanck fue positivo en 90/134 pacientes (67,16%), con diferencia estadísticamente significativas según el tipo de muestra (úlceras 76/94 vs. vesículas 14/40) (X² P< 0,001). No se demostraron diferencias estadísticamente significativas en el análisis de los subgrupos según tipo de inmunocompromiso. El test de Tzanck sigue siendo un método diagnóstico en lesiones ulcerosas de etiología viral en pacientes inmunocomprometidos y en lesiones vesiculares; además es una técnica diagnóstica fácil, económica y rápida.

Taznck`s test is a quick diagnostic method to corroborate Herpesvirus infection following demostration of multinucleate giant cells. Positivy is near 80% in vesicle samples, but as low as 20% in ulcer samples. To know Tzanck`s test ultility as a diagnostic method in immunocompromised patients with dermatological injuries as vesicles or ulcers, in order to rescue it as an emergence & re-emergence diagnostic technique. We studied the records of the Medical Microbiology Unit of the Centro Ortopédico Podológico between 2005-2009, selecting all immunocompromised patients in who Tzanck`s test was performed. 134 patients with 94 ulcers and 40 vesicles; with immunocompromise diagnosis as HIV/AIDS (34), solid tumors (60), diabetes mellitus (22), autoimmune diseases (12) and hematologic tumors (6). Genital lesions were positive in 90/134 patients (67,16%), with extremely statistical significance diference according to type of sample (76/94 ulcers vs. 14/40 vesicles) (X² P> 0,001). No statistical significance was observed when immnocompremised subgroup was analyzed. In immunocompromised patients, Tzanck`s test is an important method for differential diagnosis in suspected viral ulcers, and confirm diagnosis; it is cheap, fast & easy to perform.

Pulmonary immune defences in the immunocompromised host / 中国实用内科杂志

The respiratory tract is constantly exposed to environmental elements so that pathogens invade the lung easily and induce infectious disease.Most microbes could be eliminated by innate immunity and adaptive immunity.In healthy host,but in immunocompromised hosts such as HIV infection,transplant recipients,cancer,collagen vascular disease and critical illness,the lungs are more susceptible to bacteria,fungal and virus. Abstract:Summ ary: The resp iratory tract is constantly exposed to environm ental elem ents so that pathogens invade the lung easily and induce infectious d isease.Mostm icrobes cou ld be elim ina-ted by innate immun ity and adaptive immun ity.In healthy host,but in immunocomprom ised hosts such as H IV infection,trans-p lant rec ip ients,cancer,collagen vascu lar d isease and critical illness,the lungs are more susceptib le to bacteria,fungal and virus.

Cytomegloviral pneumonia in immunocompromised status / 中国实用内科杂志

Cytomegalovirus is the most common pathogen resulting in pulmonary pneumonia in the immunocompromised host.The clinical manifestation of cytomegaloviral pneumonia shows acute onset of illness and rapid progress.It will develop to acute lung injury or acute respiratory distress syndrome in several days if delaying the diagnosis and proper intervention.It also shows high mortality and poor prognosis.It plays a very important role for the laboratory pathogen assay to make the confirmed diagnosis.Regarding to the therapeutic strategies,early administration of gancyclovir with intravenous immunoglobin is a recommended cocktail intervention,which could improve the prognosis and decrease the mortality.Combination of antibiotics is usually not recommended except with confirmed bacterial infection or invasive mechanical ventilation in order to refrain from making a further complicated situation.

Character of pnemocystis pneumonia complicated AIDS and non-AIDS immunocomprised host / 中国实用内科杂志

Common feactures of pnemocystis pneumonia(PCP) complicated AIDS and non-AIDS imunnocomprised host were fever,progressive dyspnea and radiographic diffuse interstitial infiltration.There are also obvious differences between them,including the former have more moderate symptoms,fewer organism load in pulmonary,more lightly neutrophil inflammatory reaction,slower response and more adverse effect of treatment with SMZco.Recognizing these characters will help to find PCP early and give timely diagnosis and treatment. Abstract:Summ ary: Common feactures of pnemocystis pneumon ia(PCP) comp licated AIDS and non-AIDS imunnocomprised host were fever,progressive dyspnea and rad iograph ic d iffuse interstitial infiltration.There are also obvious d ifferences be-tween them,inc lud ing the form er have more moderate symp-tom s,fewer organ ism load in pu lmonary,more lightly neutroph il inflamm atory reaction,slower response and more adverse effect of treatm entw ith SMZco.Recogn izing these characters w ill help to find PCP early and give tim ely d iagnosis and treatm ent.

Diagnostic procedures in pulmonary infection of the immunocompromised hosts / 中国实用内科杂志

Immunocompromised hosts(ICH)is a particular population drawing more current attention with the susceptibility to infections,especially to the opportunistic pathogens.When infections occur in ICH,the mortality increases significantly.The clinical manifestations and radiological characteristics are untypical and non-specific,so the correct diagnosis in good time is arduous.But the rapid and correct diagnosis is primary and principle to lower the mortality of the infections of ICH,so this article aims to generalize the diagnosis phronesis of pulmonary infections of ICH-to elaborate the key points of the assessment and evaluation of ICH;the principle of differential diagnosis of pulmonary infections in ICH;clinical evaluation program of the pulmonary infiltration in ICH. Abstract:Summ ary:Immunocomprom ised hosts(ICH) is a particu lar popu lation draw ing more current attention w ith the susceptib il-ity to infections,espec ially to the opportun istic pathogens.W hen infections occur in ICH,the mortality increases sign ifi-cantly.The c lin icalm an ifestations and rad iological characteristics are untyp ical and non-spec ific,so the correct d iagnosis in good tim e is arduous.But the rap id and correct d iagnosis is prim ary and princ ip le to lower the mortality of the infections of ICH,so th is artic le aim s to generalize the d iagnosis phronesis of pu lmonary infections of ICH-to elaborate the key points of the assessm ent and evaluation of ICH;the princ ip le of d ifferential d iagnosis of pu lmonary infections in ICH;c lin ical e-valuation program of the pu lmonary infiltration in ICH.