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Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Visceral leishmaniasis – also known as kala-azar – affects only a small proportion of the many people infected with L. donovani: these are people who have not generated a sufficient specific cell-mediated immune response to suppress the infection initially. Thus, visceral leishmaniasis represents a relatively anergic state and the parasites disseminate throughout the macrophages of the lymphoreticular system. In this it has a parallel with disseminated Mycobacterium avium-intracellulare infection in immuno-suppressed patients. Clinically, there is hepatosplenomegaly, lymphadenopathy, fever, and cachexia, with anaemia and pancytopenia (Box 20.18). In infected patients, the spleen can weigh up to 3 kg; indeed, visceral leishmaniasis is one of the few causes of massive splenomegaly (Box 20.19 and see Chapter 9). As a consequence of both splenomegaly and marrow involvement, there is anaemia and cytopenia (hypersplenism).
Benign Neck Disease
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Ricard Simo, Jean-Pierre Jeannon, Enyinnaya Ofo
Mycobacterium avium and Mycobacterium avium intracellulare are the main two pathogens. The route of entry is usually through the oropharynx or the eye, from ingestion of contaminated soil leading to superficial lymphadenopathy in the neck.
The peritoneum, omentum, mesentery and retroperitoneal space
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Intra-abdominal tuberculosis (TB) is very common in resource-poor countries where all general surgeons are familiar with its presentation and management. The incidence is, however, also rising in resource-rich countries as a consequence of migration and immunosuppression where Mycobacterium avium-intracellulare is becoming increasingly prevalent with the widespread increase in human immunodeficiency virus (HIV) co-infection. The abdomen is involved in 11% of patients with extrapulmonary TB and includes intraperitoneal, GI tract and solid organ disease forms, with TB peritonitis being a common site-specific variant (ileocaecal is the most common site of involvement). Although still uncommon, TB peritonitis requires some specific mention because it is often diagnosed late in the course of the disease, resulting in undue patient morbidity and mortality.
Mycobacterium avium complex and Cryptococcus neoformans co-infection in a patient with acquired immunodeficiency syndrome: a case report
Published in Acta Clinica Belgica, 2022
Emilien Gregoire, Benoit François Pirotte, Filip Moerman, Antoine Altdorfer, Laura Gaspard, Eric Firre, Martial Moonen, Gilles Darcis
MAC disease is a non-tuberculous mycobacterial infection that also usually affects AIDS patients with CD4 + T-cell count below 100 cell/µL, and even often below 50 cells/µL. Its incidence among people living with HIV in HIC has been drastically reduced since the ART era [13]. In AIDS patients, it often presents clinically as disseminated MAC infection, with several weeks of early symptoms such as prolonged fever, fatigue, weight loss, abdominal pain, diarrhoea and hepatosplenomegaly. Lymphadenopathies are less frequent. In ART-treated AIDS patients with a good immunological response, when it has not been diagnosed and treated before, MAC infection often presents through immune reconstitution inflammatory syndrome (IRIS), whose presentation is usually lymphadenitis or soft tissue abscesses [14]. In our case, the diagnosis of disseminated MAC infection was made before IRIS occurred. The patient had nonspecific symptoms of fever and weight loss that could have been explained by HIV itself or by the cryptococcal disease. Nonetheless, a thoraco-abdominal CT scan was carried out to explore these symptoms thoroughly and exclude another OI or a neoplasm associated with AIDS. An adenomegaly was detected in the mediastinum and it was biopsied. The culture was positive for Mycobacterium avium-paratuberculosis-silvaticum. This resulted in the diagnosis of disseminated MAC infection, which was treated promptly.
Ruxolitinib for steroid-refractory graft versus host disease in pediatric HSCT: high response rate and manageable toxicity
Published in Pediatric Hematology and Oncology, 2021
Yasmina Mozo, David Bueno, Luisa Sisinni, Alba Fernández-Arroyo, Blanca Rosich, Antonio Pérez Martínez, María Isabel Benítez-Carabante, Laura Alonso, María Luz Uría, Cristina Díaz de Heredia, Carmen Mestre-Duran, Cristina Ferreras Bárbara Pascual, Juan Torres, Itsaso Losantos, Adela Escudero, Beatriz Ruz-Caracuel
The average treatment time with ruxolitinib for all patients was 152 days (IQR 244). Liver toxicity was observed in most of the cases, being grade 3 in 52% (10/19) of patients. CMV reactivation was observed in 33% (3/8) of patients with aGvHD and in 25% (3/12) of patients with cGvHD. Only one patient developed CMV disease. None of them developed EBV post-transplant lymphoproliferative disease (PTLD). Two patients (10%) experienced fungal infections, particulary patient #4 developed Aspergillus terreus azole resistant pneumonia despite of voriconazol prophylaxis. Bacterial infections were documented in 36.8% (7/19) of patients with a total of 10 episodes, (Tables 4 and 5). A total of four episodes of bacterial infections were mediated by gram-negative as Escherichia coli extended-spectrum beta-lactamases producer, Klebsiella pneumonia, Pseudomonas aeruginosa, and Salmonella enteritidis, and another four episodes mediated by Coagulase-negative Staphylococcus (three episodes) and Enterococcus. Methicillin-resistant coagulase-negative staphylococcus neither vancomycin and/or linezolid and/or tigecycline resistant strains of Staphylococcus spp. and Enterococcus spp. were found in those patients. Nontuberculosis mycobacteria, Mycobacterium avium intracellulare, was observed in one patient (patient #5). Other relevant infections are detailed in Tables 4 and 5.
MICROBIOTA INSIGHTS IN CLOSTRIDIUM DIFFICILE INFECTION AND INFLAMMATORY BOWEL DISEASE
Published in Gut Microbes, 2020
C. Rodríguez, E. Romero, L. Garrido-Sanchez, G. Alcaín-Martínez, RJ. Andrade, B. Taminiau, G. Daube, E. García-Fuentes
After fecal microbiota transplantation for CDI treatment, an increase in Bacteroidetes to the detriment of Protobacteria was found.91 The important role of Proteobacteria in IBD and CDI diseases is associated with its direct role as a disruptor of intestinal homeostasis and its direct implication in the inflammation of the intestine. The absence of differentiated B-cells and deficiency in the production of specific IgA (specifically targeting Proteobacteria) is correlated with the persistence of Proteobacteria in the inflamed gut.92 Other taxonomical alterations related to CDI and IBD are increased levels of Fusobacterium and Mycobacterium taxa.93 The Fusobacteriaceae family has also been found in high proportions in the gut microbiota of patients with CD and UC.40,75Mycobacterium avium subs. Paratuberculosis and Fusobacterium nucleatum have been recently investigated as potential aggravating factors for IBD.94