[Candida Infection-caused Lumbar Vertebral Osteomyelitis:Report of One Case].

Candida vertebral osteomyelitis,a rare but challenging clinical disease without specific clinical manifestations,is prone to delay in diagnosis,with potential risks of serious complications.Therefore,early diagnosis is the key to improving the cure rate of this disease.A case of invasive candida lumbar osteomyelitis after gastrointestinal surgery is reported in this paper.We analyzed the clinical characteristics of the patient and reviewed the relevant literature,aiming to improve the early diagnosis and treatment of this disease.

[Clinical Features and Risk Factors of Systemic Lupus Erythematosus Complicated with Cytomegalovirus Infection].

Objective To explore the clinical characteristics and risk factors of systemic lupus erythematosus(SLE)complicated with cytomegalovirus infection(CMV). Methods The medical records of patients diagnosed with SLE at discharge in the Department of Immunology at Peking Union Medical College Hospital between July 1,2017 and April 1,2019 were retrospectively reviewed,and the clinical and laboratory data related to CMV infection were analyzed. Results Of the 231 patients with SLE,115(49.8%)had CMV infection.Among them,78(67.8%)were asymptomatic CMV infection and 37(32.2%)were diagnosed with CMV disease.Univariate analysis showed the number of organs involved(P=0.015),presence of other infections(P=0.004),methylprednisolone pulse therapy(P=0.001),cumulative dose of prednisolone within 30 days(P=0.001),average dose of prednisolone within 30 days(P<0.001),intravenous cyclophosphamide(P=0.003),methylprednisolone pulse therapy plus immunosuppressants(P=0.001),Systemic Lupus Erythematosus Disease Activity Index 2000 at admission(P=0.018),and serum albumin(ALB)level≤30 g/L(P<0.001)were associated with CMV infection.Multivariate analysis showed presence of other infections(OR=8.003,95%CI=2.108-30.383,P=0.002),methylprednisolone pulse therapy plus immunosuppressants(OR=10.336,95%CI=2.107-50.711, P=0.004),and serum ALB≤ 30 g/L(OR=3.367,95%CI=1.157-9.796,P=0.026)were independent risk factors for CMV infection. Conclusion Presence of other infections,recent methylprednisolone pulse therapy plus immunosuppressants,and serum ALB≤30 g/L can increase the risk of CMV infection in patients with SLE.

[Clinical and Laboratory Characteristics of Disseminated Non-tuberculous Mycobacterial Disease].

Objective To explore the clinical and laboratory characteristics and the prognosis of disseminated non-tuberculous mycobacteria(NTM)diseases in human immunodeficiency virus(HIV)negative patients. Methods Cases of disseminated NTM disease were retrospectively collected in Peking Union Medical College Hospital from January 2012 to October 2018.Clinical manifestations,laboratory findings,treatment,and prognosis of these cases were retrieved from the electronic medical record system. Results Among the 23 HIV negative patients with disseminated NTM disease,21 had underlying diseases,with rheumatoid immune disease(n=7)as the most common one.The main clinical manifestation was fever(n=23).Laboratory tests showed anemia [hemoglobin(85.78±25.47)g/L],hypoalbuminemia [albumin 29(27-32)g/L],elevated erythrocyte sedimentation rate [(85.73±43.78)mm/h] and hypersensitive C-reactive protein [(112.00±70.90)mg/L],and reduction of lymphocyte count [0.69(0.29-2.10)×10 9/L].Lymphocyte subset analysis indicated reduction in CD4 + T cells [213(113-775)/µl],CD8 + T cells [267(99-457)/µl],B cells [39(4-165)/µl],and NK cells [88(32-279)/µl] and elevation of human leukocyte antigen-D related(HLA-DR),and CD38 expression in CD8 + T cells [HLA-DR +CD8 +/CD8 +,60(40-68)%;CD38 +CD8 +/CD8 +,81(65-90)%].The most common species of NTM was Mycobacterium intracellular(n=6).Lymphocyte,CD8 + T cell,B cell,and NK cell counts were significantly lower in dead patients than surviving patients(P =0.045,P=0.045,P=0.032,and P=0.010,respectively). Conclusions Disseminated NTM disease in HIV negative patients is mainly manifested as fever,anemia,hypoalbuminemia,and elevated inflammatory indicators.It is more likely to occur in immunocompromised patients.Patients with decreased lymphocytes,CD8 + T cells,B cells and NK cells tend to have a poor prognosis.

Retrospective Examination of Q Fever Endocarditis: An Underdiagnosed Disease in the Mainland of China.

BACKGROUND: Q fever endocarditis, a chronic illness caused by Coxiella burnetii, can be fatal if misdiagnosed or left untreated. Despite a relatively high positive rate of Q fever serology in healthy individuals in the mainland of China, very few cases of Q fever endocarditis have been reported. This study summarized cases of Q fever endocarditis among blood culture negative endocarditis (BCNE) patients and discussed factors attributing to the low diagnostic rate. METHODS: We identified confirmed cases of Q fever endocarditis among 637 consecutive patients with infective endocarditis (IE) in the Peking Union Medical College Hospital between 2006 and 2016. The clinical findings for each confirmed case were recorded. BCNE patients were also examined and each BCNE patient's Q fever risk factors were identified. The risk factors and presence of Q fever serologic testing between BCNE patients suspected and unsuspected of Q fever were compared using the Chi-squared or Chi-squared with Yates' correction for continuity. RESULTS: Among the IE patients examined, there were 147 BCNE patients, of whom only 11 patients (7.5%) were suspected of Q fever and undergone serological testing for C. burnetii. Six out of 11 suspected cases were diagnosed as Q fever endocarditis. For the remaining136 BCNE patients, none of them was suspected of Q fever nor underwent relevant testing. Risk factors for Q fever endocarditis were comparable between suspected and unsuspected patients, with the most common risk factors being valvulopathy in both groups. However, significantly more patients had consulted the Infectious Diseases Division and undergone comprehensive diagnostic tests in the suspected group than the unsuspected group (100% vs. 63%, P= 0.03). CONCLUSIONS: Q fever endocarditis is a serious yet treatable condition. Lacking awareness of the disease may prevent BCNE patients from being identified, despite having Q fever risk factors. Increasing awareness and guideline adherence are crucial in avoiding misdiagnosing and missed diagnosing of the disease.

Serum HBV DNA level at week 12 is superior to viral response at week 24 in predicting long-term treatment outcome of telbivudine for chronic hepatitis B patients.

BACKGROUND: Telbivudine, one of the five nucleos(t)ide antiviral drugs, was reported to be superior to lamivudine in a better biochemical, virological, and histological response for treatment-naive patients in the GLOBE trial. The aim of this study was to determine the antiviral potency, viral resistance, and the signifcance of early response for long-term telbivudine treatment. METHODS: We recruited 161 patients of chronic hepatitis B (CHB) on telbivudine between January 2009 and September 2011 in Macau, China. The serum hepatitis B virus DNA levels, hepatitis B e antigen (HBeAg) seroconversion, alanine aminotransferase (ALT) normalization, and viral resistance were analyzed. RESULTS: The median age and follow-up duration were 48 years and 16.9 months. All patients were followed up for at least 6 months, while data were collected for 132, 120, 95, and 53 patients at 12, 24, 48, and 96 weeks respectively. The cumulative HBeAg seroconversion rate was 20.8% and only three patients (1.9%) presented with telbivudine low level resistance. The ALT normalization rates were 76.9% at 48 weeks and 77.6% at 96 weeks. Undetectable HBV DNA was achieved by 1.8%, 31.6%, 60%, and 74.1% in HBeAg positive patients and 29.3%, 60.3%, 84%, and 84.6% in HBeAg negative patients at each time point. Week 12 HBV DNA level < 1000 copies/ml (< 200 IU/ml) was a better predictor of viral suppression at 2-year follow-up (P = 0.001, OR = 27.00) than undetectable HBV DNA level at week 24 (P = 0.120, OR = 4.81). CONCLUSIONS: Two-year telbivudine treatment yielded high rates of viral suppression and ALT normalization. Serum HBV DNA level at week 12 is a superior predictor for long-term viral suppression.

Major causes of fever of unknown origin at Peking Union Medical College Hospital in the past 26 years.

BACKGROUND: Despite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. To increase the knowledge of FUO, we conducted a retrospective study to investigate the causes of FUO and the change of major causes of FUO during the past 26 years. METHODS: The clinical data were retrospectively analyzed from 997 patients with FUO hospitalized at the Peking Union Medical College Hospital (PUMCH) between January 2004 and October 2010. Furthermore, the results were compared to that reported in previous studies of FUO in PUMCH since 1985. RESULTS: Of the 997 FUO cases, definite diagnosis was eventually achieved in 797 (79.9%) patients. The most common cause of FUO was infectious diseases (479 cases, 48.0%), with tuberculosis accounting for 45.3% (217/479) of the cases of infections. One hundred and sixty-eight (16.9%) patients were diagnosed with connective tissue diseases, with Still's disease and vasculitis accounted for 31.5% (53/168) and 24.4% (41/168) of this category, respectively. Neoplasms and miscellaneous causes were found in 7.9% (79/997) and 7.1% (71/997), respectively. However, no definite diagnosis had been made in the remaining 200 (20.1%) cases until they were discharged from the hospital. CONCLUSIONS: During different periods, infectious diseases, especially tuberculosis, were the leading etiology of FUO and the proportion of tuberculosis had no significant difference. While the frequency of neoplasms was descending, the proportion of lymphoma in neoplasm was ascending; the frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data.

Diagnosis and treatment of infective endocarditis in chronic hemodialysis patients.

OBJECTIVE: To analyze the clinical features of hemodialysis patients complicated by infective endo carditis. METHODS: The clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis. RESULTS: The average age of the six patients was 52.3 +/- 19.3 years old. Four were males. Vascular accesses at the onset of infective endocarditis were as follows: permanent catheters in three, temporary catheters in two, and arteriovenous fistula in one. Three were found with mitral valve involvement, two with aortic valve involvement, and one with both. Five vegetations were found by transthoracic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialysis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure after further hemodialysis for three months. One was well on maintenance hemodialysis for three months after surgery. CONCLUSIONS: Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings. With catheters removed, full course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective endocarditis.

Clinical features of initial cases of 2009 pandemic influenza A (H1N1) in Macau, China.

BACKGROUND: The first case of pandemic influenza A (H1N1) virus infection in Macau Special Administrative Region (SAR) of the People's Republic of China was documented on June 18, 2009. Subsequently, persons with suspected infection or of contact with suspected cases received screening. All the confirmed cases were hospitalized and treated with oseltamivir. Their clinical features were observed. This may help for better management for later patients and be of benefit to the government of Macau SAR to adjust its strategy to combat the pandemic influenza A (H1N1) virus infection more efficiently. METHODS: From June to July 2009, the initial 72 cases of influenza A (H1N1) in Macau were hospitalized in Common Hospital Centre S. Januario (CHCSJ). The infection was confirmed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The clinical features of the disease were closely observed and documented. Oseltamivir was given to all patients within 48 hours after the onset of disease and maintained for 5 days. RESULTS: The mean age of the 72 patients was 21 years old. Forty of them were men and 32 were women. The median incubation of the virus was 2 days (1 to 7 days). The most common symptoms were fever (97.2%) and cough (77.8%). The rate of gastrointestinal symptoms including nausea, vomiting, and diarrhea was 2.8%. Fever typically lasted for 3 days (1 to 9 days). The median time from the onset to positive results of real-time RT-PCR was 6 days (3 to 13 days). After treatment with oseltamivir, most patients became afebrile within 48 hours. Only one aged patient with a history of glaucoma and hypothyroidism was found to have lung infiltration on chest X-ray. CONCLUSIONS: The initial cases of pandemic influenza A (H1N1) virus infection in Macau SAR showed that most of the infected persons had a mild course. The virus could be detected by real-time RT-PCR within a median of 6 days from the onset. Oseltamivir was effective.

[Effectiveness of combined therapies using two types of peginterferon and ribavirin in treating chronic hepatitis C virus genotypes 1b/6a infections].

OBJECTIVE: To explore the effectiveness of a combined therapy using two types of peginterferon (PEG-IFN) and ribavirin in treating chronic hepatitis C virus (HCV) genotypes 1b/6a infections. METHODS: The clinical data of 171 patients with chronic HCV genotypes 1b/6a infection in Common Hospital Centre S. Januario, Macau SAR, China, were retrospectively analyzed. Of these patients, 145 (84.8%) were infected with HCV genotype 1b and 26 (15.2%) with HCV genotype 6a. Patients were divided into two groups based on drug therapies: PEG-IFN-2b group (n=140), in which patients were treated with PEG-IFN-2b 1.5 g/kg QW plus ribavirin 800-1 200 mg/d and PEG-IFN-2a group (n=31), in which patients were treated with PEG-IFN-2a 180g QW plus ribavirin 800-1 200 mg/d. Patients was treated for 48 weeks and then followed up for 24 weeks. RESULTS: All patients completed their therapies. The rates of early viral response (EVR) and sustained virologic response (SVR) were 78.95% and 69.59%, respectively . The two groups were not significantly different in terms of EVR P=0.091 end of treatment virological response (ETVR) (P=0.542), SVR P=0.079, relapse (P=0.497). And the two HCV genotypes patients were not significantly different in terms of EVR (P=0.268), ETVR (P=0.276), SVR (P=0.479), and relapse (P=1.000). CONCLUSIONS: PEG-IFN combined with ribavirin can achieve high viral response in treating chronic hepatitis C. PEG-IFN-2a and PEG-IFN-2b basically are similarly effective in treating HCV genotype 1b or 6a infections.

[Clinical analysis of otogenic intracranial complications].

OBJECTIVE: To analyze the clinical features and treatment protocols of otogenic intracranial complications in Peking Union Medical College Hospital. METHODS: Retrospective study of 14 patients (10 males and 4 females, aged between 12 - 62 years, mean age 32.1 years) hospitalized from 1982 - 2006. Twelve cases were otitis media (OM) with cholesteatoma, the other 2 cases were non-cholesteatomatous OM. All the otogenic intracranial complications located at the same sides as otologic disorders. Brain abscess was the most common type of otogenic complications and Proteus was the most common microorganism detected. Suppurative ear discharge, headache, high fever and nausea with vomiting were the most common clinical manifestations with very high incidences. All the patients received combined protocols of mastoid surgeries and antibiotics treatment. RESULTS: All the 14 patients recovered clinically. For patients discharged before 1987, there were 4 patients followed up for 22.5 - 24.4 years with a mean time of 23.8 without recurrence, 1 patient died of cardiovascular disease 19.2 years later after discharge, 4 patients lost follow-up. For the 5 patients discharged after 1997, brain abscess recurred in one patient with pseudo-recovery after 24 days and he fully recovered after re-hospitalization and treatment. All the five patients were followed up for 1.5 years to 10.6 years with a mean time of 6.5 years without recurrence. CONCLUSIONS: Youngsters and males seemed to be more vulnerable. Brain abscess was the most common intracranial complication and Proteus was the most common pyogenic microorganism. Combination of mastoid surgery and antibiotics were essential for effectively controlling the intracranial complications and improving the recovery. CT and MRI were essential for correct diagnosis bedtimes and MRI seemed to have a better performance.

[Changes in tumor necrosis factor-alpha mRNA expression in peripheral polymorphonuclear leukocyte and tissues during posttraumatic sepsis].

OBJECTIVE: To evaluate the changes in tumor necrosis factor-alpha (TNF-alpha) mRNA expression in peripheral polymorphonuclear leukocyte (PMNs) and tissues after cecal ligation puncture (CLP) in rats. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect TNF-alpha mRNA expression in peripheral PMNs and tissues. RESULTS: The TNF-alpha mRNA expression in peripheral PMNs rose gradually after CLP, and it began to decrease after reaching the peak at 48 hours, but it was still higher than normal. The elevation of TNF-alpha mRNA expression was first limited in the regional tissues (P<0.01 at 12 hours after CLP and peaked at 24 hours in the intestine), then it entered the blood circulation later to affect the sensitive organs--lungs and livers (P<0.01 at 24 hours after CLP and peaked at 48 hours in the lung; P<0.05 at 24 hours after CLP and peaked at 48 hours in the liver). CONCLUSION: The rise of TNF-alpha mRNA expression plays an important role in pathogenesis of sepsis.

[Apoptosis of neutrophil in peripheral blood in experimental sepsis].

OBJECTIVE: To evaluate the changes in apoptosis of neutrophil in peripheral blood in sepsis in rats. METHODS: The rat sepsis model was reproduced by cecum ligation and puncture (CLP). One hundred and forty-four rats were randomly divided into normal control group, sham operation group and 2, 6, 12, 24, 48, 72 hours after CLP groups. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) was used to identify neutrophil apoptosis. RESULTS: In early period after CLP, neutrophil apoptosis in peripheral blood was limited with a positive rate of less than 5.00%. The positive rate rose to (48.33+/-12.53)% at 48 hours, and it began to lower, approaching the normal level at 72 hours after CLP. CONCLUSION: Death is the main pathway of loss of neutrophils which are produced in the acute phase of sepsis, and apoptosis is the main pathway of loss of neutrophil in the later phase of sepsis.

[Clinical features and therapy of 106 cases of severe acute respiratory syndrome].

OBJECTIVE: To investigate the clinical characteristics of severe acute respiratory syndrome (SARS) and find out its effective treatment. METHODS: A total of 106 cases of SARS were analyzed prospectively. RESULTS: In this group, 56 were male and 50 female, aged from 15 to 81 years [average (36 +/- 10) years]. Common symptoms included fever (98.1%), chills (75.5%), cough (71.7%), headache and breathless (both 43.4%), diarrhea (24.5%) and rare rales in the lungs (11.2%). Laboratory test showed leukopenia (34.0%), lymphopenia (81.1%) and an extraordinary decrease of CD(4)(+) T cells (98.1%). Other rare abnormalities included liver injury (elevated alanine aminotransferase in 7.6%) and thrombocytopenia (3.8%). Almost all patients suffered from hypoxemia (PaO(2) less than 90 mm Hg in 90.2%, less than 70 mm Hg in 28.6%). Chest radiographs showed that unilateral focal patchy involvement in 34.0% of the patients, and unilateral multifocal or bilateral involvement were 11.3% and 46.2% respectively. Treatment regimens included small doses of steroids (methylprednisolone 40-80 mg, q12 h recommended) accompanied with broad-spectrum antibiotics such as the second generation of cephalosporins and macrolides and some other antiviral drugs. Meanwhile, emphasis was placed on oxygen support and coping with their underlying diseases. CONCLUSIONS: SARS has various presentations of clinical features and laboratory tests. Detection of CD(4)(+) T cell count is beneficial to diagnose SARS in early stage. Effective treatment includes various regimens, oxygen support and small doses of steroids.