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The Fungi
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
Broad spectrum antibiotic therapy, indwelling canulas, chemotherapy, and hyperalimentation exemplify important conditions that predispose to candida infections. In addition, defects in T cell function predispose to skin infections, while neutropenia or any defects in the function of neutrophils, such as those manifested in chronic granulomatous disease or myeloperoxidase deficiencies, predispose to systemic disease. Severely immune compromised individuals are also predisposed to disseminated disease.
Extrapulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Disseminated, or miliary TB, occurs when tubercle bacilli spread through the bloodstream resulting in small (approximately 1–2 mm) granulomatous lesions. The term “miliary” was proposed by John Jacob Manget to describe the gross appearance of pathological findings that were similar in size and appearance to millet seeds.87 Disseminated disease is defined as involvement of two or more noncontiguous sites or the presence of bacteremia. Disseminated TB has been reported to occur in approximately 1% of TB patients from Europe,9 but has been reported to account for 6%–8% of extrapulmonary TB in England and Wales88 and 11.2%–12.2% of cases in the United States.89 Historically, disseminated TB has been seen more commonly in infants and children <4 years old,90,91 however, disease also occurs in older individuals. There are now two peaks, one involving adolescents and young adults and the other among elderly individuals.90 In fact, the “cryptic” variety typically occurs in individuals older than 60 years of age.92 Males are more frequently affected in some series and females in others. Medical risk factors for disseminated TB include malnutrition, immunosuppression, alcoholism, diabetes mellitus, and chronic hemodialysis.93,94 Disease can result from early dissemination after infection or later after reactivation.95,96 Factors associated with an increased mortality include older age, lymphopenia, hypoalbuminemia, elevated transaminases, altered mental status, HIV infection, and delay in therapy.95
Viral infections
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Herpes zoster usually manifests as an eruption of grouped vesicles in a dermatomal distribution (Figure 28.2). Lesions can become pustular (Figure 28.3) or hemorrhagic. In immunosuppressed patients, disseminated disease may occur, defined as more than 20 vesicles outside the area of the primary or adjacent dermatome. Common complications of disseminated disease include pneumonia, encephalitis, and hepatitis. VZV encephalitis may occur months after an episode of herpes zoster. Patients have a subacute clinical presentation with headache, fever, mental status changes, seizures, and focal neurologic defects. Cerebrospinal fluid analysis reveals VZV DNA by PCR. Death often results, although case reports have shown that high-dose IV acyclovir therapy may be efficacious [11].
How can we assess and measure prognosis for MALT lymphoma? A review of current findings and strategies
Published in Expert Review of Hematology, 2021
Barbara Kiesewetter, Markus Raderer
Despite the development of disease specific risk stratification systems for MALT lymphoma, there is no clear concept how to measure prognosis and optimally tailor treatment in patients with MALT lymphoma. One important fact is early detection of transformation to DLBCL, as these patients face a poor prognosis and are in need of intensive therapy. In a recent evaluation, the rate of transformation in a collective of 379 patients was low at 3.2% but the prognosis was poor with 6/12 patients dying 2–33 months after histological transformation [7]. PCR-based clonality analysis disclosed that the large majority of DLBCLs detected were indeed transformations with clonal relationship to the initial MALT lymphoma. This finding also supports the notion that not only new lesions but also persistent lesions with unexpected growth should strictly be re-biopsied. Other than that, in the absence of effectively defined risk factors, patients with disseminated disease should be treated only in case of symptoms and progression with the fundamental premise to avoid unnecessary toxicity. It will be of interest to learn how the MALT-IPI performs in prospective trials and receive further data on the mutational landscape in MALT lymphoma patients, which might potentially assist treatment decisions in the near future.
Adverse health behaviours in long-term testicular cancer survivors: a Danish nationwide study
Published in Acta Oncologica, 2021
Michael Kreiberg, Mikkel Bandak, Jakob Lauritsen, Thomas Wagner, Josephine Rosenvilde, Mads Agerbaek, Lars Dysager, Cathrine Juel Lau, Klaus Kaae Andersen, Gedske Daugaard
Out of the 2572 TCS, we excluded patients with bilateral cancer (N = 81), those treated with high dose chemotherapy and stem cell transplant in first line (N = 11) and patients treated with more than one line of treatment (N = 85). These groups were excluded due to small group size and/or heterogeneous population characteristics, leaving 2395 TCS for analysis. Most patients with clinical stage I disease were treated with orchiectomy only and followed on a five-year surveillance programme (surveillance). Patients with disseminated disease were treated with orchiectomy and standard chemotherapy (BEP) or abdominal radiotherapy (RT) and these groups included both patients with disseminated disease at time of diagnosis and patients with initial clinical stage I disease and later relapse. Adjuvant RT was administered in a specific time period to patients with clinical stage I seminoma deemed high-risk (tumour size ≥ 6 cm) [17].
Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging
Published in Expert Review of Respiratory Medicine, 2019
Ana Luiza Di Mango, Gláucia Zanetti, Diana Penha, Miriam Menna Barreto, Edson Marchiori
Clinical manifestations of pulmonary coccidioidomycosis can often be mistaken with those of other causes of pneumonia. Three clinical categories are described: acute, disseminated and chronic [25]. Approximately two-thirds of infected persons remain asymptomatic or develop self-limiting respiratory symptoms. When symptomatic, pulmonary involvement is common and most patients develop a mild flu-like illness (‘valley fever’) which is self-limited, presenting with cough, fever, chills, headache and chest pain. The classical triad of desert rheumatism, characterized by fever, arthralgia and erythema nodosum, can help distinguish it from bacterial pneumonia [26,27]. Disseminated disease is characterized by the involvement of other organs, mainly the skin, joints, bones, and meninges. Risk factors for this presentation are patients with immunodeficiency syndrome (AIDS), immunosuppressed patients, pregnant women especially those in the third trimester and those with diabetes mellitus [24]. Chronic pulmonary coccidioidomycosis is defined as patients with the disease presenting symptoms that last for more than 6 weeks and/or persistent infiltrates, fibrotic or fibrocavitary disease on imaging studies [25,27].