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1.
Emerg Infect Dis ; 26(3): 579-586, 2020 03.
Article in English | MEDLINE | ID: mdl-32091372

ABSTRACT

Nontuberculous mycobacteria (NTM) are an emerging cause of infections, including chronic lymphadenitis in children. To identify risk factors for NTM lymphadenitis, particularly complicated disease, we collected epidemiologic, clinical, and microbiological data on 138 cases of NTM lymphadenitis in children across 13 centers in Germany and Austria. We assessed lifestyle factors but did not identify specific risk behaviors. We noted that more cases of NTM lymphadenitis occurred during cold months than during warm months. Moreover, we noted female sex and age <5.5 years as potential risk factors. Complete extirpation of the affected lymph node appeared to be the best therapeutic measure. We integrated the study data to develop a simple risk score to predict unfavorable clinical outcomes for NTM lymphadenitis.


Subject(s)
Lymphadenitis/epidemiology , Mycobacterium Infections, Nontuberculous/epidemiology , Nontuberculous Mycobacteria/isolation & purification , Adolescent , Age Factors , Austria/epidemiology , Child , Child, Preschool , Female , Germany/epidemiology , Humans , Infant , Infant, Newborn , Lymphadenitis/microbiology , Male , Mycobacterium Infections, Nontuberculous/microbiology , Registries , Retrospective Studies , Risk Factors , Seasons , Sex Factors
2.
Pediatr Infect Dis J ; 35(1): 110-3, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26418244

ABSTRACT

We present the case of a 6-year-old, immunocompetent boy with chronic osteomyelitis of the calcaneus caused by Mycobacterium xenopi. Of note, typical histopathology was not visible on the first biopsy and developed only later over a period of 6 weeks, highlighting the difficult differential diagnosis of osteomyelitis caused by nontuberculous mycobacteria.


Subject(s)
Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium xenopi , Osteomyelitis/diagnosis , Osteomyelitis/microbiology , Anti-Bacterial Agents/therapeutic use , Biopsy , Child , Humans , Magnetic Resonance Imaging , Male , Mycobacterium Infections, Nontuberculous/therapy , Mycobacterium xenopi/classification , Mycobacterium xenopi/immunology , Osteomyelitis/drug therapy , Treatment Outcome
3.
Clin Immunol ; 141(2): 177-86, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21873117

ABSTRACT

Common variable immunodeficiency (CVID) is a heterogeneous antibody deficiency syndrome with alterations in T cell regulation and function in a subgroup of patients. We assessed phenotype and function of bulk and virus-specific CD8+ T cells of a cohort of 34 HLA-A2+ CVID patients by pentamer technology and flow cytometry in relationship to their immunological and clinical phenotypes. Bulk CD8+ T cells displayed a shift toward a more antigen experienced and activated differentiation state. The advanced differentiation pattern was mainly found in a subgroup of CVID patients with lymphadenopathy and granulomatous disease. This effect existed independently of the patients' CMV status even so CMV-associated immunosenescence was more evident in CVID patients than in CMV-positive immunocompetent controls. As the phenotype and function of virus-specific CD8+ T cells were normal in CVID the induction of antiviral immunity by prophylactic immunization appears to be a logical and desirable aim for this group of patients.


Subject(s)
CD8-Positive T-Lymphocytes/immunology , Common Variable Immunodeficiency/immunology , Cytomegalovirus/immunology , Herpesvirus 4, Human/immunology , Orthomyxoviridae/immunology , T-Cell Antigen Receptor Specificity , T-Lymphocyte Subsets/immunology , Adult , Antigens, Viral/immunology , Cell Differentiation , Common Variable Immunodeficiency/pathology , Cytomegalovirus Infections/blood , Cytomegalovirus Infections/immunology , Epstein-Barr Virus Infections/blood , Epstein-Barr Virus Infections/immunology , Female , Granuloma/etiology , Granuloma/immunology , Histocompatibility Antigens Class I/immunology , Humans , Immunodominant Epitopes/immunology , Immunophenotyping , Lymphatic Diseases/etiology , Lymphatic Diseases/immunology , Male , Middle Aged , Oligopeptides/immunology , Peptide Fragments/immunology , Phosphoproteins/immunology , Viral Matrix Proteins/immunology , Viremia/immunology , Young Adult
4.
PLoS Pathog ; 6(6): e1000947, 2010 Jun 10.
Article in English | MEDLINE | ID: mdl-20548953

ABSTRACT

Exhausted CD8+ T cell responses during chronic viral infections are defined by a complex expression pattern of inhibitory receptors. However, very little information is currently available about the coexpression patterns of these receptors on human virus-specific CD8+ T cells and their correlation with antiviral functions, T cell differentiation and antigen recognition. We addressed these important aspects in a cohort of 38 chronically HCV infected patients and found a coexpression of inhibitory receptors such as 2B4, CD160 and KLRG1 in association with PD-1 in about half of the HCV-specific CD8+ T cell responses. Importantly, this exhaustive phenotype was associated with low and intermediate levels of CD127 expression, an impaired proliferative capacity, an intermediate T cell differentiation stage and absence of sequence variations within the corresponding epitopes, indicating ongoing antigen triggering. In contrast, a low expression of inhibitory receptors by the remaining HCV-specific CD8+ T cells occurred in concert with a CD127hi phenotype, an early T cell differentiation stage and presence of viral sequence variations within the corresponding epitopes. In sum, these results suggest that T cell exhaustion contributes to the failure of about half of HCV-specific CD8+ T cell responses and that it is determined by a complex interplay of immunological (e.g. T cell differentiation) and virological (e.g. ongoing antigen triggering) factors.


Subject(s)
Antigens, CD/metabolism , Apoptosis Regulatory Proteins/metabolism , CD8-Positive T-Lymphocytes/immunology , Cell Differentiation , Hepatitis C/immunology , Lectins, C-Type/metabolism , Receptors, Immunologic/metabolism , Trans-Activators/metabolism , CD8-Positive T-Lymphocytes/metabolism , Cell Proliferation , Flow Cytometry , GPI-Linked Proteins , Hepacivirus/isolation & purification , Hepatitis C/virology , Humans , Lymphocyte Activation , Programmed Cell Death 1 Receptor , Signaling Lymphocytic Activation Molecule Family , T-Lymphocytes/immunology , T-Lymphocytes/metabolism , T-Lymphocytes/pathology , Viral Load
5.
AJR Am J Roentgenol ; 191(4): 1077-81, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18806146

ABSTRACT

OBJECTIVE: The purpose of this study was to obtain a low-dose CT scan before CT colonography to estimate the prevalence of occult colonic perforation among patients referred for same-day or next-day CT colonography after incomplete colonoscopy. MATERIALS AND METHODS: Two hundred sixty-two patients (74 men, 188 women; mean age, 64 years; range, 21-92 years) consecutively referred for same-day or next-day CT colonography after incomplete colonoscopy underwent low-dose diagnostic CT before rectal tube insertion and CO(2) insufflation. RESULTS: Perforation was found on the low-dose CT scans of two of the 262 patients (0.8%; 95% CI, 0.1-2.7%). One of these patients had no symptoms; the other had mild abdominal discomfort at the time of CT. CONCLUSION: The rate of occult colonic perforation after incomplete colonoscopy may be significant. For patients referred for CT colonography after incomplete endoscopy, use of low-dose diagnostic CT before rectal tube insertion and insufflation is indicated.


Subject(s)
Carbon Dioxide , Colonography, Computed Tomographic , Colonoscopy/adverse effects , Colonoscopy/methods , Intestinal Perforation/diagnostic imaging , Intestinal Perforation/etiology , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged
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