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1.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927853

ABSTRACT

Introduction:Immunocompromised individuals, such as those with HIV and low CD4 counts, are at increased risk for opportunistic infections. Although uncommon, these patients can be infected with multiple organisms, making diagnosis and management challenging for clinicians. Mortality remains high, as the data on initiating and adjusting antimicrobials when there is concern for co-infection is lacking. We present a case of Pneumocystis jiroveci (PCP) and cytomegalovirus (CMV) coinfection resulting in severe hypoxic respiratory failure and death. Case Report:A 38-year-old male with no past medical history presented with fever, dyspnea, and nonproductive cough. Vital signs were notable for a fever of 102.3°F, respiratory rate of 24, and oxygen saturation of 77% on room air. Physical examination revealed an ill-appearing male with bilateral rhonchi who became dyspneic with minimal conversation. Laboratory studies were significant for an elevated c-reactive protein, erythrocyte sedimentation rate, ferritin and lactate dehydrogenase. CT chest demonstrated bilateral ground glass opacities with multifocal consolidations. The patient was admitted for hypoxic respiratory failure secondary to suspected COVID pneumonia, despite negative testing. By hospital day 4, the patient had shown little improvement. Further work-up revealed that he was HIV positive with a CD4 count of 5, so he was empirically started on oral trimethoprim-sulfamethoxazole (TMPSMX) for presumed PCP pneumonia. On hospital day 9, the patient underwent endotracheal intubation for worsening hypoxia and subsequent bronchoscopy for further evaluation. PCP PCR confirmed the diagnosis, and the patient was transitioned to intravenous TMP-SMX. Still with minimal improvement, micafungin was added as potential salvage therapy. After 12 days of TMPSMX, treatment was changed to clindamycin/primaquine. CMV PCR from the bronchoalveolar lavage fluid came back positive at this time, so ganciclovir was added to the regimen. Despite multiple antimicrobials, the patient continued to decline. He was deemed not to be a candidate for ECMO given his profoundly immunocompromised status and ultimately died. Discussion:This case highlights the difficulties clinicians have in managing severely immunocompromised patients who worsen despite appropriate care. Little data exists providing guidelines on when to change to second and/or third-line agents in treating PCP pneumonia. Additionally, further studies need to be completed to delineate in whom empiric antimicrobials should be initiated early when co-infection is a possibility. ECMO may serve a purpose in this patient population given that lung rest is necessary to allow healing, but only a few cases of its use exist at this time.

2.
Digestive Endoscopy ; 34(SUPPL 1):114, 2022.
Article in English | EMBASE | ID: covidwho-1895968

ABSTRACT

AIM: The COVID-19 epidemic is still raging over the globe, and vaccination is supposed to help us overcome it. Although the vaccinations' efficacy is undeniable, their safety is still a concern. This is the first case of CMV proctitis following vaccination since the invention of the COVID-19 vaccine, suggesting that the COVID-19 vaccine may not only cause immune hyperactivity but also cause immune deficiency. We report this case to provoke new thinking about the safety of COVID-19 vaccines. METHODS: We described a case of a 58-year-old Chinese woman, without obvious cause of immunosuppression, who developed persistent constipation three days after the second COVID-19 vaccination. Electronic colonoscopy revealed new circumferential growth at the anorectal junction, with uneven surface and ulceration, which mimicked rectal carcinoma. Rectal biopsy revealed severe active chronic proctitis with CMV infection. The clinical course was favorable with ganciclovir therapy. In this case, we used laboratory biochemical examination, colonoscopy, immunohistochemistry, and other methods to detect, and finally confirmed the existence of CMV proctitis. RESULTS: Ganciclovir was used to treat the patient, and a good effect was observed. Cytomegalovirus (CMV) infection of the gastrointestinal tract occurs mainly in immunosuppressed patients. While in our case, there was no evidence of immunodeficiency, except for earlier vaccination against COVID-19. Therefore, it is plausible to doubt that COVID-19 vaccination caused the occurrence of CMV proctitis in the patient. CONCLUSIONS: It is speculated that the vaccine can cause immune dysfunction, and thus may not only lead to the occurrence of immune hyperactivity disorders but also immune deficient diseases. The clinical course of CMV proctitis was favorable with ganciclovir therapy.

3.
Future Virology ; 17(4):197-199, 2022.
Article in English | EMBASE | ID: covidwho-1887070
4.
Hematology, Transfusion and Cell Therapy ; 43:S211-S212, 2021.
Article in Portuguese | EMBASE | ID: covidwho-1859608

ABSTRACT

Introdução: O Bortezomibe (Velcade®) é um inibidor do proteassoma, especificamente do proteassoma 26S, cuja ligação irreversível leva à ativação de cascatas de sinalização que culminam com a parada do ciclo celular e apoptose. Ele foi aprovado e incluído como quimioterapia de primeira linha nas Diretrizes Diagnósticas e Terapêuticas do Mieloma Múltiplo (Portaria n.° 2017) publicadas em agosto de 2015 mas apenas em setembro de 2020 foram publicadas três Portarias do Ministério da Saúde que incorporaram este medicamento para o tratamento de pacientes com Mieloma Múltiplo no SUS (para pacientes não tratados, inelegíveis ao transplante de células-tronco;para pacientes não tratados, elegíveis ao transplante e para pacientes previamente tratados). Esta incorporação permitiu o uso mais amplo desta medicação e trouxe à tona complicações possivelmente relacionadas ao seu uso como a reativação de citomegalovírus e suas diversas formas de apresentação clínica como pneumonites, infecções gastrointestinais, hepatites, encefalites, retinites, entre outras. Série de casos: No ano de 2020, foram identificados 5 casos de infecção por citomegalovírus em pacientes em tratamento de Mieloma Múltiplo e Amiloidose em uso de esquemas quimioterápicos contendo Bortezomibe no serviço de Hematologia e Hemoterapia do Hospital das Clínicas de Ribeirão Preto/SP. Três casos foram identificados na investigação etiológica de diarréia subaguda, um foi identificado na estratificação de colite neutropênica com características enteroinvasivas e o último na investigação de pneumonite aguda com sinais de infecção viral em tomografia de tórax (neste caso, foi excluída infecção por Covid-19 após dois testes PCR-RT negativos). Em todos os casos, após identificação da infecção por CMV (por sorologia - Elisa e confirmação de carga viral por PCR-RT), foi instituída terapêutica específica com antiviral, tanto Ganciclovir endovenoso quanto Valganciclovir via oral. Apesar da alta morbimortalidade associada a esta infecção em pacientes imunossuprimidos, apenas um dos cinco pacientes faleceu de complicações associadas. Discussão: A soroprevalência elevada de infecção por citomegalovírus no Brasil está relacionada a fatores socioeconômicos e condições precárias de saneamento básico e aumenta a morbimortalidade em pacientes imunossuprimidos. O uso mais frequente do Bortezomibe como primeira linha em pacientes com Mieloma Múltiplo e Amiloidose no nosso serviço e no Brasil traz à tona este agente como diagnóstico diferencial nas suspeitas clínicas infecciosas de diversos órgãos e sistemas.

5.
Lung India ; 39(SUPPL 1):S157, 2022.
Article in English | EMBASE | ID: covidwho-1857324

ABSTRACT

Background: 70-90 % of the adult population carries latent cytomegalovirus (CMV), which may be reactivated by inflammation and immune suppression. CMV reactivation has been seen in up to one-third of critically ill patients, and is associated with worse clinical outcomes. Here, the authors present two challenging cases, wherein the management of severe COVID-19 disease was complicated by CMV pneumonia. Case Reports: Our patients presented with severe COVID-19 pneumonia with acute respiratory distress syndrome and were admitted in the intensive care unit (ICU). The patients received immunosuppressive therapy, either tocilizumab or methylprednisolone pulse therapy. Both the patients had a prolonged hospital stay, and showed an initial improvement followed by clinical deterioration, with recurrence of fever, worsening respiratory failure, and development of consolidations on CT thorax. A thorough work up for opportunistic infections revealed CMV infection. Both patients were treated with intravenous Ganciclovir and showed marked improvement. Discussion: The use of steroids and other immunomodulatory therapies in the treatment of severe COVID-19 disease, along with immune suppression caused by severe COVID-19 itself, predisposes patients to reactivation of CMV. Furthermore, CMV reactivation is associated with a longer ICU length of stay, prolonged mechanical ventilation, increased risk of secondary infections, and mortality. Conclusion: These cases highlight the importance of considering CMV disease as a differential diagnosis in critically ill patients with COVID-19 with unexplained worsening, especially in the setting of immunomodulatory therapies, as early treatment may prevent adverse clinical outcomes and mortality.

6.
Nano LIFE ; 12(1), 2022.
Article in English | EMBASE | ID: covidwho-1854417

ABSTRACT

Nanomedicine or nanotechnology exhibits outstanding features to challenge severe health issues including pathogenic viral infections, the most culpable invaders in the present situation. The perpetual mutational pattern in viruses topped with raising resistance to drug epitomizes the current situation as a trigger to explore nanotech platforms in antiviral therapies. Referring to novel physicochemical features of nanomaterials associated with effective drug delivery, it is viewed as an ideal strategy for treatment of viral infections. The coronavirus induced pathogenesis, including MERS, SARS and SARS-CoV-2 infections, has triggered alarming and highly dangerous precedents against existence of humans. Applications of nanotechnology can serve a new direction for disinfection or treatment of viruses. Presently, various types of nanomaterials, such as nanogels, nanospheres, nanocapsules, liposomes, nanoparticles and many others, that have been investigated in vivo and in vitro for successful drug delivery, vaccination, diagnostic assay and device development with anticipation to be translated in advanced clinical practices, need a collective relook. This paper intents to contribute insightful critique of current studies on the efficacy of nanoplatforms as drug transporter, diagnostic tool and vaccine candidate against pathogenic viruses counting the highly pathogenic and incurable "coronaviruses".

7.
Immun Inflamm Dis ; 10(4): e597, 2022 04.
Article in English | MEDLINE | ID: covidwho-1739166

ABSTRACT

BACKGROUND: Systemic reactivation of Epstein-Barr virus (EBV) may occur in novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, the clinical consequences of EBV reactivation remain uncertain. METHODS: In this retrospective study, we screened 1314 patients with confirmed COVID-19 who died or were discharged between January 1, 2020 and March 12, 2020, in Wuhan Infectious Disease Hospital, Wuhan, China. Patients who had complete data for EBV serology and cytomegalovirus (CMV) serology were eligible. Serum levels of viral capsid antigen (VCA)-immunoglobulin G (IgG), Epstein-Barr nuclear antigen-IgG, VCA-IgM, early antigen (EA)-IgG, CMV-IgG, and CMV-IgM were compared between survivors and nonsurvivors. Dynamic changes of laboratory tests and outcomes were compared in patients with and without ganciclovir treatment. We used 1:1 matching based on age, gender, and illness severity to balance baseline characteristics. RESULTS: EBV reactivation was present in 55 of 217 patients. EBV reactivation was associated with age (57.91 [13.19] vs. 50.28 [12.66] years, p < .001), female gender (31 [56%] vs. 60 [37%], p = .02). Patients with EBV reactivation have statistically nonsignificant higher mortality rate (12 [22%] vs. 18 [11%], p = .08). EA-IgG levels were significantly higher in nonsurvivors than in survivors (median difference: -0.00005, 95% confidence interval, CI [-3.10, 0.00], p = .05). As compared to patients with COVID-19 who did not receive ganciclovir therapy, ganciclovir-treated patients had improved survival rate (0.98, 95% CI [0.95, 1.00] vs. 0.88, 95% CI [0.81, 0.95], p = .01). Hemoglobin (p < .001) and prealbumin (p = .02) levels were significantly higher in ganciclovir-treated patients. CONCLUSION: A high proportion of COVID-19 patients had EBV reactivation that may be associated with an increased risk of death. Whether treatment with ganciclovir may decrease the mortality of COVID-19 patients complicated with EBV reactivation warrants to be addressed in a placebo-controlled randomized trial in the future.


Subject(s)
COVID-19 , Epstein-Barr Virus Infections , COVID-19/drug therapy , Epstein-Barr Virus Infections/complications , Epstein-Barr Virus Infections/drug therapy , Female , Ganciclovir/therapeutic use , Herpesvirus 4, Human/physiology , Humans , Retrospective Studies , SARS-CoV-2
8.
Kidney International Reports ; 7(2):S328, 2022.
Article in English | EMBASE | ID: covidwho-1707023

ABSTRACT

Introduction: Angioinvasive aspergillosis is a rare opportunistic infection. its occurrence increases the mortality and morbidity of organ transplant recipients. Methods: It is about a 27-year-old patient with a history of end-stage renal failure due to an apparent mineralocorticoid deficiency, hemodialysis for 10 months until he received a kidney transplant from a related living donor sharing 4 HLA identities. He received induction therapy with globulin antithymocyte and methylprednisolone followed by maintenance therapy with Mycophenolate Mofetil, prednisolone, tacrolimus. Since the recipient was not immune to cytomegalovirus (CMV), he received ganciclovir prophylaxis immediately after transplant. Post-transplant evolution was marked by the immediate resumption of diuresis, creatinine figures stagnating between 200 and 250 µmol/l. The remainder of her usual treatment consists of a proton pump inhibitor, β-blocker, cotrimoxazole. Our patient presented 2 months post transplant with febrile neutropenia. Clinically, apart from a fever of 38 °, the examination was without abnormalities. Biologically, pancytopenia, inflammatory syndrome (high CRP and procalcitonin), hypokalaemia, hypophosphatemia and hypomagnesemia, hyperferritinemia and hypertriglyceridemia were noted. A post-infectious macrophagic activation syndrome was suspected, confirmed by a sternal puncture. An etiological investigation has been launched;viral serologies (HBV, HCV, HIV, EBV, CMV, COVID 19, HSV) were negative, a cardiac ultrasound ruled out infective endocarditis, a thoracoabdominal CT scan showed multifocal sub-segmental parenchymal condensations of the right lung surrounded by a halo, an appearance suggesting angio-invasive pulmonary aspergillosis and intracortical graft hematomas. Sputum bacteriological examination did not show pneumocystis but isolated two types of candida crucei and tropicalis. A weakly positive aspergillus antigenemia (index : 0.53) was noticed. Our patient received triple antibiotic therapy (vancomycin / imipenem / levofloxacin) and an antifungal (voriconazole) after adaptation according to the antibiogram for a total duration of 15 days with daily dosage of tacrolimus. In addition, he received venoglobulins for 5 days at a dose of (0.4 mg / kg / day). The clinical and biological course was favorable with apyrexia and improvement in the blood count from the third day of treatment. Aspergillus antigenemia and a follow-up chest CT scan were scheduled after the end of treatment. Results: Initially, In view of the intensity of the induction treatment received, leuconeutropenia and in order of frequency, the 2 most evoked causes were CMV et covid19 but the CT aspect straightened the diagnosis, which was supported by aspergillary antigenemia. The emerging interest of this case report is the clinical and computed tomography discordance and the unusual rapidly favorable outcome to an aspect of angioinvasive pulmonary aspergillosis which usually show respiratory signs such as cough, hemoptysis or even respiratory distress. Conclusions: Invasive mycoses, associated with significant morbidity and mortality, are a frequent difficulty in solid organ transplantation. The clinical pictures differ and we could be faced with an atypical presentation which affects the therapeutic management. No conflict of interest

9.
Dhaka University Journal of Pharmaceutical Sciences ; 20(2):177-183, 2021.
Article in English | EMBASE | ID: covidwho-1649627

ABSTRACT

In this present world COVID-19 pandemic is one of the biggest concern. An appealing medication focus among Covids is the fundamental protease;SARS-CoV-2 protease Mpro (6Y2F) due to its fundamental role in handling the polyproteins that are interpreted from the viral RNA. The present study showed the interaction of favipiravir, ganciclovir, raltegravir and remdesivir against 6Y2F, using molecular docking were analyzed. Among those ligands’ interaction with protein structure, 6Y2F on raltegravir (-7.4 kcal/mol) and remdesivir (-6.9 kcal/mol), respectively displayed maximum binding affinity. The interactions of four ligands were contrasted with each other in that ganciclovir and raltegravir form highest number of hydrogen bond with 6Y2F. The interacting amino acids residues (Gly143, Ser144, Cys145) were studied and all selected ligands were predicted to be non-carcinogens and non-AMES toxic.

10.
Chest ; 161(1):A164, 2022.
Article in English | EMBASE | ID: covidwho-1633429

ABSTRACT

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Cytomegalovirus is an important cause of morbidity and mortality in immunocompromised patients.CMV is an important cause of pneumoina in lung transplant patients too. Pneumocytis Jiroveci (PCP) can casue a potentially life-threatening infection in immunocompromised individuals, especially HIV patients or transplant patients. In our we are presenting a rare case of an immunocompromised patient with penumonia who was infected concurrently with CMV and PCP. CASE PRESENTATION: A 53 year-old female patient with history of Rheumatoid Arthritis treated with methotrexate, prednisone and rituximab presented to the emergency room with fatigue and tiredness but no fever. She was tested for COVID-19 and influenza infections (PCR) and both were negative. At presentation, her WBC was 9900. CT with contrast of the chest showed no embolism but multi-focal ground glass opacities. Pulmonary and infectious disease teams were consulted. Blood culture was negative, MRSA screen was negative, Fungitell was positive, LDH test was elevated to 382. CMV quantitaive PCR of 10,000 copies. CMV PCR BAL is detected at 650 copies/ ml, and EBV PCR tests was negative. Pneumocystis Jiroveci pneumonia was detected on BAL DFA. Fungitell waqs more than 500. CMV retinitis has been ruled out by ophthalmology exam. Patient was diagnosed with concurrent infections. Pt was started on Bactrim, valganciclovir PO and intravenous ganciclovir with improvement in her condition. DISCUSSION: It is rare to have a concurrent pneumonia infection caused by Pneumocytis Jiroveci and CMV except in immunocompromised patients. CONCLUSIONS: A concurrent Pneumocystis Jiroveci and CMV pneumonia is a rare infection but could occur in immunocompromised patients. DISCLOSURE: Nothing to declare.

11.
IDCases ; 26: e01346, 2021.
Article in English | MEDLINE | ID: covidwho-1531342

ABSTRACT

The use of steroids and other immune modulatory therapies in the treatment of severe COVID-19 pneumonia predisposes patients to the reemergence of opportunistic infections. Cytomegalovirus (CMV) reactivation can be one of them. A 55-year-old gentleman with severe COVID-19 pneumonia and hypoxic respiratory failure who was ventilated and received steroids but no other immunomodulatory drugs; had altered sensorium and multiple episodes of seizures in the later course of his illness. Brain MRI showed leptomeningeal enhancement and encephalopathy changes, electroencephalography (EEG) was suggestive of diffuse encephalopathy and his cerebrospinal fluid (CSF) analysis revealed high Cytomegalovirus PCR DNA titers (103,614). The patient made a complete recovery after treatment with Ganciclovir. Altered sensorium in cases of COVID-19 can be multifactorial. High index of suspicion for reactivation of dormant infections is warranted. CMV meningoencephalitis is one of the differential diagnoses. We believe this is the first case reported of CMV meningoencephalitis in the setting of severe COVID-19 infection.

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