Detection of Streptococcus pneumoniae antigen in pleural fluid: usefulness of an immunofluorescence-based lateral flow assay for the diagnosis of pneumococcal pneumonia.

The performance of an immunofluorescence-based Streptococcus pneumoniae antigen detection test in pleural fluid (IF-PF) was evaluated. For proven and possible pneumococcal pneumonias global sensitivity and specificity were 92.6 (95 CI 76.6-97.9) and 80 (95 CI 62.7-90.5), respectively, with no significant differences between children and adults. Global diagnostic accuracy of IF-PF was 86% (74.2-93.7), and a substantial k index of concordance with culture/RT-PCR of 0.716 (0.535-0.896). IF-PF might be useful as a rapid complementary test for the etiologic diagnosis of pneumococcal pneumonia.

Immune reconstitution inflammatory syndrome in HIV-infected patients with Pneumocystis jirovecii pneumonia / Síndrome inflamatorio de reconstitución inmune en pacientes con infección por VIH y neumonía por Pneumocystis jirovecii

INTRODUCTION: The incidence of immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients after an episode of Pneumocystis jirovecii pneumonia (PJP) seems to be lower than with other opportunistic infections. We conducted an observational study in order to determine the incidence, clinical characteristics and outcome of patients diagnosed with PJP-related IRIS. METHODS: We conducted an observational study of HIV patients diagnosed with PJP-related IRIS from January 2000 to November 2015. We analyzed epidemiological and clinical characteristics as well as laboratory findings. We also carried out a systematic review of published cases. RESULTS: Six cases of IRIS out of 123 (4.9%) HIV-infected patients with PJP who started ART were diagnosed. All six cases were men with a median age of 34 (IQR: 8) years. The six patients developed paradoxical IRIS. Subjects younger than 40 years old (p = 0.084) and with an HIV-RNA viral load >100000 copies/ml (p = 0.081) at diagnosis showed a tendency to develop IRIS. Thirty-seven published cases of PJP-related IRIS were identified. Although 51% of cases involved respiratory failure, no deaths were reported. CONCLUSIONS: PJP-related IRIS is rare condition compared to other opportunistic infections. It can lead to a severe respiratory failure in a significant proportion of cases, although no deaths have been reported

INTRODUCCIÓN: La incidencia del síndrome inflamatorio de reconstitución inmune (SIRI) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) después de un episodio de neumonía por Pneumocystis jirovecii (PJP) parece ser menor que con otras infecciones oportunistas. Hemos realizado un estudio observacional con el objetivo de conocer la incidencia, las características clínicas y la evolución de los pacientes diagnosticados de SIRI asociado con la PJP. MÉTODOS: Se ha realizado un estudio observacional de pacientes con VIH diagnosticados de SIRI asociado a PJP desde enero del 2000 hasta noviembre de 2015. Fueron analizadas características epidemiológicas y clínicas, así como hallazgos de laboratorio. Asimismo, se ha llevado a cabo una revisión sistemática de los casos publicados previamente. RESULTADOS: Se identificaron 6 casos de SIRI en 123 pacientes con VIH (4,9%) con PJP que comenzaron TAR. Los 6 casos eran varones con una edad media de 34 (IQR :8) años. En los 6 casos se trató de una SIRI paradójico. Los sujetos menores de 40 años (p = 0,084) y con VIH-ARN al diagnóstico mayor de 100.000 copias/ml (p = 0,081) mostraron una tendencia a desarrollar SIRI. Se identificaron 37 casos publicados de SIRI relacionado con PJP en la literatura. Aunque el 51% de los casos presentaron insuficiencia respiratoria, no se reportaron muertes. CONCLUSIONES: El SIRI asociado con PJP es una entidad infrecuente comparada con el relacionado con otras infecciones oportunistas. Puede provocar insuficiencia respiratoria grave en un porcentaje importante de casos, si bien no se han reportado muertes

Immune reconstitution inflammatory syndrome in HIV-infected patients with Pneumocystis jirovecii pneumonia.

INTRODUCTION: The incidence of immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients after an episode of Pneumocystis jirovecii pneumonia (PJP) seems to be lower than with other opportunistic infections. We conducted an observational study in order to determine the incidence, clinical characteristics and outcome of patients diagnosed with PJP-related IRIS. METHODS: We conducted an observational study of HIV patients diagnosed with PJP-related IRIS from January 2000 to November 2015. We analyzed epidemiological and clinical characteristics as well as laboratory findings. We also carried out a systematic review of published cases. RESULTS: Six cases of IRIS out of 123 (4.9%) HIV-infected patients with PJP who started ART were diagnosed. All six cases were men with a median age of 34 (IQR: 8) years. The six patients developed paradoxical IRIS. Subjects younger than 40 years old (p=0.084) and with an HIV-RNA viral load >100000 copies/ml (p=0.081) at diagnosis showed a tendency to develop IRIS. Thirty-seven published cases of PJP-related IRIS were identified. Although 51% of cases involved respiratory failure, no deaths were reported. CONCLUSIONS: PJP-related IRIS is rare condition compared to other opportunistic infections. It can lead to a severe respiratory failure in a significant proportion of cases, although no deaths have been reported.

Úlceras sobre placas psoriásicas en paciente con infección avanzada por el virus de la inmunodeficiencia humana / Ulcers on psoriatic plaques in a patient with advanced Human Immunodeficiency Virus infection

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[Fever, diarrhoea and neurological syndrome in HIV-infected immigrants]. / Síndromes febril, diarreico y neurológico en pacientes inmigrantes infectados por el VIH.

Fever, diarrhoea and neurological symptoms are relatively common in immigrants, as well as in HIV-infected patients. The main febrile diseases in HIV-positive immigrants from the tropics are tuberculosis, bacteremia due to Salmonella spp. or Streptococcus pneumoniae and community-acquired pneumonia or pneumonia due to Pneumocystis jiroveci. The presence of diarrhoea should lead to suspicion of opportunistic infections caused by parasites and protozoa of the digestive tract such as Cryptosporidium parvum, Isospora belli, Cyclospora spp. and Microsporidium spp. The main diseases to be taken into account are those of the nervous system that affect immunosuppressed patients, such as cryptococcosis, tuberculosis, toxoplasmosis, and cytomegalovirus infections. Cerebral malaria as a complication of Plasmodium falciparum should be included in the differential diagnosis.

Síndromes febril, diarreico y neurológico en pacientes inmigrantes infectados por el VIH / Fever, diarrhoea and neurological syndrome in HIV-infected immigrants

La fiebre, la diarrea y los síntomas neurológicos se observan con relativa frecuencia en la práctica diaria en pacientes inmigrantes, y también en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Las principales enfermedades que cursan con síndrome febril en pacientes inmigrantes originarios de zonas tropicales infectados por el VIH son la tuberculosis, la bacteriemia por Salmonella spp. o por Streptococcus pneumoniae, y la neumonía adquirida en la comunidad o por Pneumocystis jiroveci. En el contexto de un síndrome diarreico, hay que pensar en las infecciones oportunistas causadas por parásitos y protozoos del tubo digestivo, como Cryptosporidium parvum, Isospora belli, Cyclospora spp. y Microsporidium spp. Cabe destacar las enfermedades que afectan al sistema nervioso en estos pacientes inmunodeprimidos, fundamentalmente la criptococosis, la tuberculosis, la toxoplasmosis y la infección por citomegalovirus, sin olvidar el paludismo cerebral como complicación de Plasmodium falciparum

Fever, diarrhoea and neurological symptoms are relatively common in immigrants, as well as in HIV-infected patients. The main febrile diseases in HIV-positive immigrants from the tropics are tuberculosis, bacteremia due to Salmonella spp. or Streptococcus pneumoniae and community acquired pneumonia or pneumonia due to Pneumocystis jiroveci. The presence of diarrhoea should lead to suspicion of opportunistic infections caused by parasites and protozoa of the digestive tract such as Cryptosporidium parvum, Isospora belli, Cyclospora spp. and Microsporidium spp. The main diseases to be taken into account are those of the nervous system that affect immunosuppressed patients, such as cryptococcosis, tuberculosis, toxoplasmosis, and cytomegalovirus infections. Cerebral malaria as a complication of Plasmodium falciparum should be included in the differential diagnosis