Impact of the multiplex molecular FilmArray Respiratory Panel on antibiotic prescription and clinical management of immunocompromised adults with suspected acute respiratory tract infections: A retrospective before-after study / Impacto del panel respiratorio molecular multiplex FilmArray ¿ en la prescripción de antibióticos y el manejo clínico de pacientes adultos inmunocomprometidos con sospecha de infección respiratoria aguda: un estudio retrospectivo antes/después

Abstract This study aimed to assess the impact of the implementation of a rapid multiplex molecular FilmArray Respiratory Panel (FRP) on the medical management of immunocompromised patients from a community general hospital. We conducted a single-center, retrospective, and before-after study. Two periods were evaluated: before the implementation of the FRP (pre-FRP) from April 2017 to May 2018 and after the implementation of the FRP (post-FRP) from January to July 2019. The inclusion criteria were immunocompromised patients over 18 years of age with suspected acute respiratory illness tested by conventional diagnostic meth-ods (pre-FRP) or the FilmArray™ Respiratory Panel v1.7 (post-FRP). A total of 142 patients were included, 64 patients in the pre-FRP and 78 patients in the post-FRP. The positive detec-tion rate was significantly higher in the post-FRP (63% vs. 10%, p <0.01). There were more patients receiving antimicrobial treatment in the pre-FRP compared with the post-FRP period (94% vs. 68%, p <0.01). A decrease in beta-lactam (89% vs. 61%, p <0.01) and macrolide (44% vs. 13%, p < 0.01) prescriptions were observed in the post-FRP. No differences were observed in oseltamivir use (22% vs. 13%, p = 0.14), changes in antimicrobial treatment, hospital admission rate, days-reduction in droplet isolation precautions, hospital length of stay (LOS), admission to intensive care unit (ICU), LOS in ICU, treatment failure and 30-day mortality. The implementa-tion of the FRP impacted patient care by improving diagnostic yield and optimizing antimicrobial treatment in immunocompromised adult patients.

Resumen El objetivo de este estudio fue evaluar el impacto de la implementación del panel respiratorio FilmArray® (FRP), un sistema automatizado de PCR multiplex, en el estándar de cuidado de pacientes adultos inmunocomprometidos en un hospital general. Es un estudio retrospectivo de un único centro con diseno antes/después. Los periodos evaluados fueron abril 2017-mayo 2018, previo a la implementación del FRP (pre-FRP), y enero 2019-julio 2019, luego de la implementación (post-FRP). Los criterios de inclusión fueron pacientes mayores de 18 años inmunocomprometidos con sospecha de infección respiratoria aguda a los que se les realizó, en pre-FRP, diagnóstico por métodos convencionales, y en post-FRP, el panel respiratorio FRP versión 1.7. Se incluyeron un total de 142 pacientes, 64 en pre-FRP y 78 en post-FRP. La tasa de positividad fue significativamente mayor en post-FRP frente a pre-FRP (63 vs. 10%, p<0,01). Hubo más pacientes con tratamiento antimicrobiano en pre-FRP que en post-FRP (94 vs. 68%, p <0,01). En pre-FRP hubo más pacientes tratados con betalactámicos (89 vs. 61%, p <0,01) y macrólidos (44 vs. 13%, p < 0,01). No se observaron diferencias significativas en el uso de oseltamivir (22 vs. 13%, p = 0,14), cambios en los tratamientos, número de hospitalizaciones, uso de aislamientos, duración de la estadía hospitalaria, ingreso a la unidad de cuidados intensivos, estadía en dicha unidad, falla de tratamiento y mortalidad a 30 días. El uso de FRP contribuyó a la atención del paciente mejorando el rendimiento diagnóstico y optimizando la terapia antimicrobiana en pacientes adultos inmunocomprometidos.

Utilidad del lavado broncoalveolar para la detección microbiológica, y factores asociados, en receptores de trasplante de precursores hematopoyéticos: estudio de cohorte retrospectivo

Introducción: Las opacidades pulmonares en receptores de trasplante de precursores hematopoyéticos (TPH) representan un desafío diagnóstico y son una causa de morbimortalidad. Existen grandes discrepancias con respecto a la sensibilidad diagnóstica del lavado broncoalveolar (LBA), sus complicaciones, y los factores asociados a la identificación microbiológica. Objetivo: Conocer la utilidad del estudio microbiológico del LBA en el diagnóstico, modificación de la conducta médica y estimar las complicaciones y mortalidad asociada al procedimiento, en receptores de TPH con opacidades pulmonares. Pacientes y Métodos: Estudio de cohorte, retrospectivo, en adultos receptores de TPH a los que se les realizó una broncoscopía con LBA por presentar opacidades pulmonares, en el Hospital Italiano de Buenos Aires entre el 01/01/2011 y el 31/12/2020. Resultados: De los 189 procedimientos analizados, en 79 se logró un hallazgo microbiológico (41,8%) y 122 permitieron modificar la conducta médica (64,6%). En 11 casos se observaron complicaciones graves dentro de las 12 horas (5,8%) de efectuado el LBA. La mortalidad intrahospitalaria fue de 16,8% (N = 21/125). El valor de neutrófilos en sangre previo al LBA (p = 0,037) y la presencia de nódulos pulmonares como lesión tomográfica predominante (p = 0,029) se asociaron independientemente al hallazgo microbiològico global. Conclusiones: Nuestra investigación apoya la realización del LBA como herramienta diagnóstica en pacientes que reciben un TPH y presentan opacidades pulmonares.

Background: Lung opacities are a cause of morbimortality in bone marrow transplant patients, and represent a diagnostic challenge. There are large discrepancies regarding the diagnostic sensitivity of bronchoalveolar lavage (BAL), its complications, and the factors associated with microbiological detection. Aim: To know the usefulness of the microbiological study of BAL in the diagnosis, in the modification in medical behavior and to estimate the complications and associated mortality of this diagnostic procedure in patients transplanted with hematopoietic progenitor cells with pulmonary opacities. Methods: Retrospective cohort study in bone marrow transplant adult patients who underwent bronchoscopy with BAL due to lung opacities at Hospital Italiano de Buenos Aires between 01/01/2011 and 12/31/2020. Results: Of the 189 BAL analyzed, 79 presented a microbiological detection (41.8%) and 122 allowed to modify the medical behavior (64.6%). Severe complications were observed within 12 hours after the procedure in11 cases (5.8%). In-hospital mortality was 16,8% (N = 21/125). The value of blood neutrophils prior to bronchoalveolar lavage (p = 0.037) and the presence of pulmonary nodules as the predominant tomographic lesion (p = 0.029) were independently associated with global microbiological detection. Conclusion: Our research supports the performance of BAL as a diagnostic tool in bone marrow transplant patients with lung opacities.

Nocardiosis pulmonar y del sistema nervioso central: el alcoholismo como factor de inmunocompromiso / Pulmonary and central nervous system nocardiosis: Alcoholism as an immunocompromising factor

La nocardiosis es una enfermedad de distribución mundial; de forma habitual se encuentra en zonas tropicales y afecta principalmente a pacientes inmunocomprometidos, sin embargo, también existen casos reportados de infección en personas inmunocompetentes. Esta infección es causada por actinomicetos del género Nocardia spp. que son bacterias Gram positivas, saprófitos ambientales. Aunque la exposición a Nocardia spp. es casi universal, solo una pequeña fracción de las personas expuestas desarrollan la enfermedad. Se presenta el caso de un hombre de 47 años, sin dato de inmunosupresión, procedente de un área rural de Boyacá, que consultó por un cuadro clínico de cefalea intensa e intermitente, con parestesias y, finalmente, alteración del estado de conciencia. Se practicó una resonancia magnética cerebral, en la que se evidenció una lesión que ocupaba espacio de localización córtico-subcortical en la región fronto-témporo-parietal izquierda, con efecto compresivo y desplazamiento de las cavidades del sistema ventricular. Se sospechó, inicialmente, una lesión neoplásica o un absceso cerebral. El paciente fue sometido a una resección quirúrgica, y el cultivo de la lesión documentó Nocardia africana/nova; en estudios posteriores, se evidenció un posible foco pulmonar primario. Como único factor de riesgo en el paciente, se documentó alcoholismo. Completó seis semanas de tratamiento antibiótico intrahospitalario con evolución clínica y radiológica, y egresó con plan de un año de terapia antibiótica ambulatoria. Aunque la enfermedad por Nocardia spp. afecta principalmente a pacientes inmunocomprometidos, la "evidencia" clínica demuestra que este microorganismo también puede ser una amenaza para individuos sin los factores de riesgo tradicionales para inmunosupresión.

Nocardiosis is a disease with worldwide distribution. It is usually found in tropical areas and mainly affects immunocompromised patients, however, there are also cases where its infection has been reported in immunocompetent patients. This pathology is caused by bacteria known as Nocardia spp., which are gram-positive microorganisms and environmental saprophytes, and although exposure to Nocardia spp. is almost universal, only a small fraction of exposed people develops the disease. We present the case of a 47-year-old man, with no evidence of immunosuppression, from a rural area of Boyacá, who was admitted due to intense and intermittent headache accompanied by paresthesia and, finally, a decrease in consciousness. A brain magnetic resonance was performed and evidenced a fronto-temporo- occipital space-occupying lesion in the cortico-subcortical region with a compressive effect and displacement of the ventricular system cavities. It was suspected at first a neoplastic lesion or a brain abscess. The lesion was surgically resected, and its culture showed Nocardia africana/nova. In later studies a possible primary pulmonary focus was evidenced. Alcoholism was the only risk factor documented. The patient completed 6 weeks of hospital antibiotic treatment with favorable clinical and radiological evolution and was discharged with a 1-year plan of outpatient antibiotic therapy. Although Nocardia spp. mainly affects immunocompromised patients, evidence shows that this microorganism can also be a threat to individuals without traditional immunosuppression risk factors.

An interesting case of melioidosis: a mimicry of pulmonary tuberculosis

Melioidosis is caused by Burkholderia pseudomalleiwhich is a soil-dwelling aerobic bacterium reported mostly in tropical and subtropical areas, especiallyinAsia (Southeast) andAustralia (Northern part). Melioidosis is a severe infection that can manifest as chronic debilitating pneumonia mimics pulmonary tuberculosis. Here, we reporteda case of melioidosis, in 51-year-old menwith poorly controlled type 2 diabetes mellitus. The patient recovered with appropriate intravenous antibiotics and supportive medications.

Molluscum contagiosum could become an early sign of HIV infection

HIV is a type of virus that attack the immune system, causing it unable to function normally and putting the person in a condition called immunocompromised and is vulnerable to lots of infection. People living with HIV are prone to complications if there is persisting infection and inflammation. One of the inflammation markers is theneutrophil-lymphocyte ratio(NLR). Complication on the skin is one of the frequently happened. One of it is Molluscum contagiosum. Molluscum contagiosum caused by virus infection which target the epidermal layer of the skin that result in formation of round, umbilicated, painless papule or nodule. In this case report, we present a male, 49 years old which has complained of persistent fatigue and diarrhea. There is multiple rounds, skin-colored, painless papules on his face and neck since 6 month ago which keep increasing. Laboratory result show decrease in hemoglobin and high neutrophil lymphocyte ratio. In HIV, the NLR value has a significant negative correlation with the CD4 amount. The existence of molluscum contagiosum in an adult with unknown HIV status need to be considered as a possibility of an immunocompromised especially if accompanied with other conditions. In the patient with HIV, with the existence of Molluscum contagiosum, the possibility of decreasing CD4 and increasing viral load need to be suspected. The patient抯 obedience in consuming ARV also needs a careful attention.

The Rare Imitator : Pulmonary Nocardiosis Mimics Tuberculosis Reactivation

Pulmonary Nocardiosis is a rare bacterial infection of lungs, caused by a filamentous bacterium. Immunocompromised people are known to be at danger, but there are other new emerging risk factors to consider. The presentation and clinical course in such patients differ from the previous. Here the present case is aimed to underline the presentation and diagnosis in non-risk individual.

Leucoencefalopatía multifocal progresiva: enfermedad grave en el paciente inmunosuprimido. Reporte de caso / Progressive multifocal leukoencephalopathy: severe disease in the immunosuppressed patient. Case report

RESUMEN INTRODUCCIÓN: Los pacientes con compromiso del sistema inmune pueden desarrollar una enfermedad neurológica incapacitante e incluso mortal, como lo es la leucoencefalopatía multifocal progresiva (LMP) producida por el virus de John Cunningham (JC). PRESENTACIÓN DEL CASO: Se presenta el caso de un hombre de 26 años con diagnóstico reciente de infección por virus de la inmunodeficiencia humana (VIH) que presentó síntomas constitucionales, déficit neurológico progresivo por hemiparesia espástica izquierda, disminución de la agudeza visual y cambios comportamentales. En las imágenes de resonancia magnética (IRM) cerebral contrastada se encontró afectación subcortical difusa de la sustancia blanca con compromiso de las fibras en U que, correlacionado con una prueba de reacción en cadena de la polimerasa (PCR) para virus JC en LCR, confirmó el diagnóstico de LMP. DISCUSIÓN: La LMP puede manifestarse por medio de síntomas cognitivos usualmente imperceptibles para el clínico, pero también como déficit sensorio-motor y visual que se puede corroborar en las IRM al identificar las lesiones típicas en la sustancia blanca, o bien por medio de detección del virus por PCR en líquido cefalorraquídeo. El manejo específico de la causa que desencadenó la inmunosupresión sigue siendo el pilar de tratamiento. CONCLUSIÓN: La mínima sospecha diagnóstica en aquellos pacientes con factores de riesgo y manifestaciones clínicas concordantes con la enfermedad debe llevar a que se confirme el diagnóstico y que se inicie prontamente el manejo terapéutico en búsqueda de restablecer la respuesta inmune.

ABSTRACT INTRODUCTION: Patients with immunocompromised or weakened immune system can develop a disabling and even life-threatening neurological disorder such as progressive multifocal leukoencephalopathy (PML) caused by John Cunningham (JC) virus. CASE PRESENTATION: We present the case of a 26-year-old man with a recent diagnosis of human immunodeficiency virus (HIV) infection who presented constitutional symptoms, progressive neurological deficit due to left spastic hemiparesis with decreased visual acuity and behavioral changes. The brain Magnetic Resonance Imaging (MRI) showed diffuse subcortical involvement of the white matter including the U-fibers, which, correlated with a detection of JC virus DNA by polymerase chain reaction (PCR) cerebrospinal fluid, confirmed the diagnosis of PML. DISCUSSION: PML can range from subtle cognitive impairment imperceptible to the clinician to sensory-motor deficits and visual disturbances that can be corroborated in MRI by identifying the typical lesions in the white matter or by detecting the virus by PCR in cerebrospinal fluid. The specific management of the cause that triggered the immunosuppression continues to be the mainstay of treatment. CONCLUSION: At the minimum diagnostic suspicion in patients with risk factors and clinical manifestations consistent with the disease should proceed to confirm the diagnosis and promptly immune reconstitution.

A rare case of fatal sepsis caused by Trichosporon asahii in an immunocompetent chronic obstructive pulmonary disease patient

Trichosporon asahii is a yeast-like organism that is emerging as an important cause of invasive fungal infection in immunocompromised patients, especially in patients with cancer and neutropenia. Invasive infections due to T. asahii in immunocompetent patients are rarely reported. We describe a 62-year-old chronic obstructive pulmonary disease patient who contracted severe sepsis from T. asahii without any prior history of immunosuppression. He was successfully treated with voriconazole and was discharged from the hospital.

Resistant invasive Candida auris reported in neutropenic patients treated successfully with three antifungals

Candida auris is a deadly fungal pathogen able to cause fatal symptoms in immunocompromised patients. It may be misidentified and difficult to clinically diagnose. The guidelines are to employ Echinocandin and Amphotericin B in the treatment, but the following study elucidates successful treatment of infection by a combination of three classes of antifungal drugs; never reported before. We present a patient with fulminant acute disseminated encephalomyelitis and neutropenia who developed invasive candidiasis despite appropriate antifungal therapy. We successfully treated ongoing candidemia with three antifungal drugs which lead to the resolution of fungemia after 18 days of treatment. Isolation, segregation, waste disposal, and deep cleaning technique were also followed as recommended by the Infectious Diseases Society of America guidelines. First report ofCandidemia in an immunocompromised patient was successfully treated with three classes of antifungal drugs, IV Micafungin, Amphotericin B, and Posaconazole for nearly 18 days.

Speciation of coagulase negative staphylococci (CoNS) isolated from various clinical specimens in a tertiary care hospital of southern Rajasthan

Background: Coagulase negative staphylococci (CoNS) are a group of staph bacteria, which generally exist as normal flora of human skin and the oral flora found on mucous membranes. CoNS in immunocompromised pa?ents can cause variety of infec?ons like bacteraemia, central nervous system shunt infec?on, intravascular catheter-related infec?ons, endocardi?s, surgical site infec?ons, urinary tract infec?ons, foreign body infec?on, endophthalmi?s, peritoni?s and wound, bone and joint infec?ons as well as infec?ons in neonates. These infec?ons are difficult to treat because of the risk factors and the drug resistant nature of the organisms.Objec?ve:To find out species wise distribu?on of Coagulase nega?ve Staphylococci (CoNS) in various relevant clinical samples in our ins?tute. Materials and Method:A total of 500 CoNS strains were isolated from relevant clinical specimens. CoNS strains were isolated from variety of clinical specimens. Strains were iden?fied as CoNS on the basis of colony morphology, gram stain, catalase test and coagulase test. Conven?onal methods were used for species iden?fica?on a?er confirming isolates as CoNS. Results:The most common source of CoNS isola?on was blood (34%), followed by respiratory secre?ons (24.4%), urine (16.8%), pus (13.4%), swabs (5.4%), bodily fluid (1.4%), and others (4.6%). S.epidermidis was most frequently isolated (30.6%), followed by S.hemoly?cus (25.4%), S.hominis (12.6%), S.capi?s (12%), S.lugdunensis (11.4%) and S.cohnii (08%). Conclusion : As CoNS have become major cause of nosocomial infec?ons, there is a need for rapid iden?fica?on and specia?on of CoNS with their an?bio?c suscep?bility for be?er management of these cases and to prevent emergence of drug resistance.

Infección pulmonar por Strongyloides stercoralis en paciente inmunocomprometido. Reporte de caso / Pulmonary infection caused by Strongyloides stercoralis in an immunocompromised patient. Case report

El Strongyloides stercoralis es un nemátodo intestinal capaz de completar su ciclo de vida dentro del huésped humano. Se presenta el caso clínico de una mujer de 57 años con residencia en la zona amazónica por 10 años, la que presenta antecedentes patológicos personales de hiperten-sión arterial, osteoporosis y diabetes mellitus tipo 2, lo que la cataloga como inmunocomprome-tida. Esta asiste a servicios de emergencia con cuadro agudo característico de infección de vías urinarias, recibe tratamiento en la unidad de cuidados intensivos por shock séptico de origen urinario versus pulmonar. La prueba de laboratorio clínico mediante muestra tomada a través de broncoaspiración arroja la existencia de larvas activas de Strongyloides stercoralis. La paciente mejoró sus condiciones de salud luego de un mes de evolución, respondiendo satisfactoriamente a la antibioticoterapia con carbapenémicos y el antiparasitario ivermectina. Los pacientes con factores de riesgo subyacentes tienen alta probabilidad a este tipo de infección agravada. La estrongiloidásis grave tiene una alta tasa de mortalidad, por lo que un diagnóstico temprano es indispensable para mejorar el pronóstico.

Strongyloides stercoralis is an intestinal nematode capable of completing its life cycle within the human host. The clinical case of a 57-year-old woman who has lived in the Amazon region for 10 years is presented. She has a personal pathological history of arterial hypertension, osteopo-rosis, and type 2 diabetes mellitus, which classifies her as immunocompromised. She attends emergency services with acute symptoms characteristic of urinary tract infection, receives treat-ment in the intensive care unit for septic shock of urinary versus pulmonary origin. The clinical laboratory test using a sample taken through bronchial aspiration shows the existence of active larvae of Strongyloides stercoralis. The patient's health conditions improved after a month of evolution, responding satisfactorily to antibiotic therapy with carbapenems and the antiparasitic ivermectin. Patients with underlying risk factors are at high risk for this type of aggravated infection. Severe strongyloidiasis has a high mortality rate, so early diagnosis is essential to improve prognosis

Implementación de un programa basado en IPASS en UCI / Implementation of an IPASS-based program in the ICU

Introducción: El uso de herramientas estandarizadas como estrategia de comunicación para brindar información relevante, precisa y actualizada, forma parte de las iniciativas de calidad en las instituciones que cumplen altos estándares en la atención de pacientes. Objetivo: Describir la implementación de un programa de traspaso (IPASS) en unidades de cuidados intensivos pediátricos específicos. Material y métodos: Estudio cuasi-experimental antes y después de una intervención, no controlado, utilizando como sujetos a los profesionales de la salud involucrados en traspasos de pacientes de la unidad de terapia intensiva cardiovascular (UCI 35) e inmunosuprimidos (UCI 72). La intervención consistió en la introducción de un paquete de medidas de estandarización del traspaso de pacientes que consta de: una herramienta escrita, una mnemotecnia oral, una capacitación de trabajo en equipo, observación y devolución estandarizada de los traspasos, basados en la metodología IPASS. Se realizó además una encuesta de percepción de seguridad, tanto en la etapa pre y post intervención. Se comparó el cumplimiento de cada componente del traspaso antes y después de la intervención mediante la prueba de chi2 . Resultados: Se realizaron 101 observaciones de traspaso y 56 encuestas. La mediana de pacientes por cada observación fue 6 (r: 4 a 12) y el tiempo promedio de 26± 11 min. Conclusiones: El uso de un paquete de medidas de estandarización del traspaso de pacientes posquirúrgicos cardiovasculares e inmunosuprimidos aumentó significativamente la presencia de información clave sobre criticidad de la enfermedad, acciones y situaciones de contingencia, junto con la inclusión de la síntesis por el receptor del traspaso (AU)

Introduction: The use of standardized tools as a communication strategy to provide relevant, accurate, and up-to-date information is part of quality initiatives in institutions that adhere to high standards in patient care. Objective: To describe the implementation of a handoff program (IPASS) in specific pediatric intensive care units. Methods: An uncontrolled, quasi-experimental, beforeand-after study. Subjects were healthcare providers involved in patient handoffs in the cardiovascular (ICU 35) and immunocompromised-patient (ICU 72) intensive care units. The intervention consisted of the introduction of a bundle to standardize patient handoff consisting of: a written tool, an oral mnemonic, teamwork training, observation, and standardized feedback for handoffs based on the IPASS methodology. A safety perception survey was also carried out, both in the pre- and post-intervention stage. Compliance with each handoff component before and after the intervention was compared using the Chi-squared test. Results: 101 handoff observations and 56 surveys were conducted. The median number of patients per observation was 6 (r: 4 to 12) and the mean handoff time was 26±11 min. Conclusions: The use of a standardized handoff bundle for post-surgical cardiovascular and immunocompromised patients significantly increased the availability of key information on disease severity, actions, and contingency situations, as well as a synthesis by the handoff receiver (AU)

Challenges in Diagnosis of Extrapulmonary Tuberculosis

Even in the era of twenty-first century tuberculosis is still considered as a major health burden around the globe particularly around the Indian sub-continent. Though Pulmonary system is the principal site for Mycobacterium but extra-pulmonary involvement is not so common. Extra-pulmonary involvement can be seen in isolation or even with pulmonary involvement also. Immunocompromised individuals like HIV-affected individuals carries a greater risk for disseminated tuberculosis with involvement of multiple extra-pulmonary sites but Immunocompetent persons also can develop extra-pulmonary manifestation. Among all sites, Lymph nodes are the commonest in extra-pulmonary involvement. Though conventional Sputum smear examination and culture sensitivity is still reliable in diagnosis of pulmonary tuberculosis but are less helpful in extra-pulmonary cases due to its paucibacillary nature. Modern molecular methods in background of strong clinical suspicion with or without radiological evidences forms the pathway to confirm the diagnosis. These Diagnostic difficulty makes the delay in response to treatment in these patients

Neumonía por Rothia mucilaginosa en un paciente inmunocomprometido posterior a un trasplante renal / Rothia mucilaginosa pneumonia in an immunocompromised patient after kidney transplant

Resumen Rothia mucilaginosa es una bacteria propia de la microbiota del tracto respiratorio superior, que se asocia en forma infrecuente a infecciones en pacientes inmunocomprometidos y con enfermedades pulmonares crónicas, principalmente neumonía y bacteriemia. Su tratamiento generalmente, se basa en el uso de antibacterianos β lactámicos. Se describe el caso de un paciente sometido a un trasplante renal con uso de fármacos inmunosupresores, que cursó con una infección diseminada por Cryptococcus neoformans. Tras el inicio de la terapia antifúngica, presentó un cuadro febril, con aparición de nuevos infiltrados radiológicos e insuficiencia respiratoria aguda, demostrándose en el estudio con lavado broncoalveolar, un cultivo positivo para R. mucilaginosa, descartándose otras etiologías. Evolucionó en forma favorable tras el uso de meropenem, con buena respuesta clínica y resolución de los infiltrados radiológicos.

Abstract Rothia mucilaginosa is a bacterium derived from the upper respiratory tract microbiota, which is rarely associated with infections in immunocompromised patients suffering chronic lung diseases, mainly pneumonia and bacteremia. Its treatment is generally based on the use of β-lactams. The case study of a kidney transplant patient using immunosuppressive drugs, who developed a disseminated Cryptococcus neoformans infection, is described. After starting antifungal therapy, he presented with fever, appearance of new radiological infiltrates and acute respiratory failure, demonstrating a positive culture for R. mucilaginosa in a study with bronchoalveolar lavage, ruling out other etiologies. He evolved favorably after the use of meropenem, with good clinical response and resolution of radiological infiltrates.

Tratamiento de la estomatitis aftosa recurrente en pacientes inmunocomprometidos. Revisión sistemática / Treatment of recurrent aphthous stomatitis in immunocompromised patients. Systematic review

RESUMEN Fundamento: Aunque la estomatitis aftosa recurrente no tiene una etiología bien definida porque es una enfermedad multicausal, se ha reconocido que las interacciones o el debilitamiento del sistema inmunitario, contribuyen principalmente a la magnitud del proceso patológico. Las propuestas de tratamiento en pacientes inmunocomprometidos son diversas y por lo general se centran en alteraciones inmunológicas específicas. Objetivo: Evaluar el efecto clínico de los tratamientos propuestos para la estomatitis aftosa recurrente en pacientes inmunocomprometidos. Metodología: La búsqueda se realizó en las bases de datos PubMed/Medline y Cochrane. Se incluyeron ensayos clínicos que tuviesen entre sus variables de respuesta principales: Cicatrización de la úlcera aftosa, tiempo de cicatrización, de recurrencia e intensidad del dolor y entre las variables secundarias: Los efectos adversos y los síntomas. La extracción de datos se realizó de manera independiente por los autores. Se aplicó la metodología por la colaboración Cochrane para evaluar el riesgo de sesgo en cada uno de los estudios. Resultados: Se incluyeron 11 ensayos clínicos (8 controlados) publicados entre 1995 y 2020 y que aportan resultados de la eficacia de varias intervenciones terapéuticas: talidomida (4), irsogladine (2), rebamipida (1), láser de diodo (1), cápsulas de Omega-3 (1), vitamina B 12 (1), Complejo B (1). Seis de estos estudios incluyeron pacientes con la forma menor de estomatitis aftosa recurrente. El periodo de seguimiento estuvo entre los 14 y 360 días. Conclusiones: La talidomida puede ser eficaz en el alivio de los síntomas, la cicatrización y remisión de las lesiones, el diodo de láser y vitamina B12 en la disminución de la intensidad del dolor.

ABSTRACT Background: Although recurrent aphthous stomatitis does not have a well-defined etiology due to it is a multicausal disease, it has been recognized that the interactions or the weakening of the immune system, contribute mainly to the magnitude of the process pathological. Treatment proposals in immune compromised patients are diverse and they usually focus on specific immunological alterations. Objective: To evaluate the clinical effect of the proposed treatments for recurrent aphthous stomatitis in immunocompromised patients. Methodology: The search was performed in the PubMed/Medline and Cochrane databases. Clinical trials were included that could have among their main response variables: Aphthous ulcer healing, healing time, recurrence and pain intensity and among the secondary variables: Adverse effects and symptoms. data extraction was done independently by the authors. The methodology was applied by Cochrane collaboration to assess the risk of bias in each of the studies. Results: 11 clinical trials (8 controlled) published between 1995 and 2020 and that provided the results of the efficacy of various therapeutic interventions: thalidomide (4), irsogladine (2), rebamipide (1), diode laser (1), Omega-3 capsules (1), vitamin B 12 (1), Complex B (1). Six of these studies included patients with the minor form of stomatitis recurrent aphthous. The follow-up period was between 14 and 360 days. Conclusions: Thalidomide may be effective in relieving symptoms, healing and remission of the lesions, the laser diode and vitamin B12 in the decrease of the intensity of the pain.

Radiological patterns of pulmonary fungal infection in pediatric hematology and oncology patients

Abstract Objective: To describe the radiological findings in pediatric patients with hematological or oncological diseases who also have an invasive fungal infection (IFI). Materials and Methods: This was a retrospective study of all patients with IFI admitted to a pediatric hematology and oncology hospital in Brazil between 2008 and 2014. Clinical and demographic data were collected. Chest computed tomography (CT) scans of the patients were reviewed by two independent radiologists. Results: We evaluated the chest CT scans of 40 pediatric patients diagnosed with an IFI. Twenty-seven patients (67.5%) had nodules with the halo sign, seven (17.5%) had cavities, two (5.0%) had nodules without the halo sign, and seven (17.5%) had consolidation. The patients with the halo sign and cavities were older (123 vs. 77 months of age; p = 0.03) and had less severe disease (34% vs. 73%; p = 0.04). Ten patients had a proven IFI: with Aspergillus sp. (n = 4); with Candida sp. (n = 5); or with Fusarium sp. (n = 1). Conclusion: A diagnosis of IFI should be considered in children and adolescents with risk factors and abnormal CT scans, even if the imaging findings are nonspecific.

Resumo Objetivo: O objetivo deste estudo é descrever os achados radiológicos de infecções fúngicas invasivas em crianças com doenças onco-hematológicas em um único centro, de acordo com a classificação antiga e a atual de imagens típicas e atípicas. Materiais e Métodos: Foram revisados os prontuários de todos os pacientes com infecção fúngica invasiva que foram internados em um hospital pediátrico de oncologia e hematologia de 2008 a 2014. Foram coletados dados clínicos e demográficos. As tomografias de tórax dos pacientes foram laudadas por dois radiologistas independentes. Resultados: Foram identificados 40 pacientes com infecção fúngica invasiva que realizaram tomografias de tórax. Vinte e sete pacientes apresentaram nódulos com sinal do halo (67,5%), sete tiveram cavitações (17,5%), dois tiveram nódulos sem halo (5,0%) e sete apresentaram consolidações (17,5%). Os pacientes que apresentavam achados de nódulos com sinal do halo e cavitações eram mais velhos (123 versus 77 meses; p = 0,03) e tinham menos sinais de doença grave (34% versus 73%; p = 0,04) do que os outros pacientes. Dez crianças apresentaram infecção confirmada (Aspergillus sp., n = 4; Candida sp., n = 5; Fusarium sp., n = 1). Conclusão: O diagnóstico de infecção fúngica invasiva deve ser considerado em crianças com fatores de risco e tomografias de tórax alteradas, mesmo que os achados das imagens sejam inespecíficos.

Oral mucormycosis in post-COVID-19 patients: A case series

The rise of mucormycosis in COVID-19 patients is predisposed by indiscriminate intake of corticosteroids, poorly controlled diabetes, injury, prolonged neutropenia, organ transplant, hematopoietic malignancies, prolonged stays in the intensive care unit, and due to nosocomial infection. Oral lesions seen in COVID-19 patients are more probably caused by co-infections, adverse reactions, and immunocompromised conditions instead of direct COVID-19 infection. We would like to report a case series of four patients who had oral mucormycosis after the COVID-19 recovery period.

Immunomodulatory effects of Blaps rynchopetera extract

Purpose: To explore the potential immunomodulatory effects of total extract and different polar parts from Blaps rynchopetera Fairmaire. Methods: Phagocytic activity was evaluated by neutral red assay, and the effect of the immune function was investigated by normal and immunocompromised mice models. Results: In vitro, total extract, as well as chloroform, ethyl acetate, n-butanol and water fractions could individually enhance the phagocytic ability of mouse peritoneal macrophages; in addition, chloroform and ethyl acetate fractions had an increasing tendency when combined stimulation with lipopolysaccharide (LPS). In vivo, ethyl acetate fraction (EAF) could enhance the immune organ index, increase the serum hemolysin level and peripheral blood immune cells of immunocompromised mice, while for normal mice, the effect was inconspicuous. Conclusions: Blaps rynchopetera extracts had noteworthy immunomodulatory effect, especially for individuals with immune disorders.

Rapid detection of pneumocystis carinii infection in immunocompromised patients by loop mediated isothermal amplification technique / 中国小儿急救医学

Objective:To explore the value of detecting pneumocystis carini(PC)rapidly in immunocompromised patients by loop mediated isothermal amplification(LAMP).Methods:Respiratory tract specimens of immunocompromised children suspected of pneumocystis carinii pneumonia(PCP) at Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University were collected from May 2020 to May 2021.PCR and LAMP methods were used to detect PC.Firstly, LAMP primers of PC were synthetized according to the conserved region of PC gene, and the LAMP reaction system and reaction conditions were optimized to evaluate the sensitivity and specificity.Then, the results of pathogens were compared with those of PCR detection.Results:The established LAMP detection technology for PC had high specificity and super sensitivity.The detection results could be obtained within 1 hour.In 12 clinical samples, 10 cases were positive and 2 cases were negative, the coincidence rate of LAMP and PCR technique was 100%.Conclusion:LAMP can detect PC more rapidly and sensitively than PCR, and it can provide a good support for clinical rapid diagnosis of PCP.

Rapid detection of pneumocystis carinii infection in immunocompromised patients by loop mediated isothermal amplification technique / 中国小儿急救医学

Objective:To explore the value of detecting pneumocystis carini(PC)rapidly in immunocompromised patients by loop mediated isothermal amplification(LAMP).Methods:Respiratory tract specimens of immunocompromised children suspected of pneumocystis carinii pneumonia(PCP) at Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University were collected from May 2020 to May 2021.PCR and LAMP methods were used to detect PC.Firstly, LAMP primers of PC were synthetized according to the conserved region of PC gene, and the LAMP reaction system and reaction conditions were optimized to evaluate the sensitivity and specificity.Then, the results of pathogens were compared with those of PCR detection.Results:The established LAMP detection technology for PC had high specificity and super sensitivity.The detection results could be obtained within 1 hour.In 12 clinical samples, 10 cases were positive and 2 cases were negative, the coincidence rate of LAMP and PCR technique was 100%.Conclusion:LAMP can detect PC more rapidly and sensitively than PCR, and it can provide a good support for clinical rapid diagnosis of PCP.