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The Fungi
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
The deep mycoses refer to diseases in which internal organs are affected. Because most of these conditions follow inhalation of the agent, respiratory distress is a common primary manifestation of such diseases. Though some of the agents do seem to have predilections for particular sites, systemic dissemination of the agent can bring about involvement of any organ system. Agents causing deep mycoses include Histoplasma capsulatum, Blastomyces dermatiditis, and Coccidioides immitis. These mycoses, characterized by an insidious onset and chronic nature, can occur in the previously healthy host. A vigorous inflammatory response to the fungal antigens accounts for a large part of the resulting pathology. The agents are all dimorphic; they exist in the environment in the mycelial phase and undergo phase transformation to become yeast forms in the host. These fungi are also associated with endemic areas, specific geographic areas where the incidence of infection is high and disease is more often seen. Opportunists such as Aspergillus, which is ubiquitous, and Candida, which is part of the normal flora, are able to cause systemic disease only in the severely compromised host.
Terminal neurological disorders
Published in Ad (Sandy) Macleod, Ian Maddocks, The Psychiatry of Palliative Medicine, 2018
Ad (Sandy) Macleod, Ian Maddocks
The clinical course of AIDS is erratic and difficult to predict, even with good medication compliance. A major clinical dilemma in the terminal phase is whether or not antiviral and prophylactic antibiotic medications are continued or not. Risking terminal opportunist infection is not necessarily wise, as uncontrolled symptoms such as diarrhoea may cause a very prolonged and uncomfortable death.25 Very assertive medical care is generally required to protect quality of life, and withdrawing this towards the expected end of life can be problematic. Orchestrating a ‘good death’ in AIDS patients may not be possible. Early in the course of the epidemic, palliative care institutions were sometimes available for these patients. In countries with access to newer therapies the illness has been transformed into a manageable chronic illness, and the supportive phase may last decades.25 The mean time from diagnosis to death has increased from 6 months to over 48 months.23 If accumulated neurocognitive deficits enforce institutional care for the long-term survivors, then palliative medicine’s role is likely to be required again. Death in AIDS is often stigmatised.26 It may be embarrassing to the family and secretive; customary bereavement rituals may not be performed. The burden of shame complicates grieving.
Microbiological contamination of manufactured products: official and unofficial limits
Published in R. M. Baird, S. F. Bloomfield, Microbial quality assurance in cosmetics, toiletries and non-sterile Pharmaceuticals, 2017
Profound changes have of course been witnessed in the past 40 years or so in hospital practice, particularly in the type of patients who are now being treated there. The widespread use of chemotherapeutic, antibiotic, immunosuppressant or cytotoxic agents on susceptible individuals, such as neonates, the elderly and others debilitated by intensive and advanced surgery, has brought about significant changes in the types and numbers of infections seen in hospitals today, and to a lesser extent in the general community. Opportunist Gram-negative pathogens have been held responsible for an increasing number of infections in such patients. Some of these infections are known to have originated from contaminated pharmaceutical, cosmetic and toiletry products. Incidents of infection associated with contamination in pharmaceuticals, cosmetics and toiletries were reviewed in detail in chapter 2 from which it can be seen that many of these incidents have been characterized by the involvement of a previously unappreciated risk in a group of susceptible and debilitated patients. Infections due to Pseudomonas spp. have been the most notorious group in the past, but other organisms such as Acinetobacter spp., Serratia spp., Aeromonas spp., Alkaligenes spp. and Enterobacter spp. have also featured increasingly often (Ramphal and Kluge 1979). At the same time, it should be remembered that reported cases represent a mere fraction of incidents occurring in practice, many of which remain undetected for a variety of reasons.
An update on the routine application of MALDI-TOF MS in clinical microbiology
Published in Expert Review of Proteomics, 2019
Martin Welker, Alex Van Belkum, Victoria Girard, Jean-Philippe Charrier, David Pincus
Another important means of infection from unusual opportunists is through zoonotic vectors: Kittang et al. [45] described the first case of zoonotic necrotizing myositis and sepsis caused by Streptococcus equi ssp. zooepidemicus, a rare zoonotic human pathogen, in a 73-year-old man, who had abrasions on his hands and then direct contact with ponies while feeding them. The invasive infection was caused by a new sequence type (ST 364) carrying multiple virulence factors in common with S. pyogenes.Bonwitt et al. [46] reported recently on a possibly new species of Wohlfartiimonas where a green bottle fly appeared to be the vector for fatal sepsis associated with myiasis in a 57-year-old man with chronic cirrhosis.
Adverse events, clinical considerations and management recommendations in rheumatoid arthritis patients treated with JAK inhibitors
Published in Expert Review of Clinical Immunology, 2018
Fabiola Atzeni, Rossella Talotta, Valeria Nucera, Francesca Marino, Elisabetta Gerratana, Donatella Sangari, Ignazio Francesco Masala, Piercarlo Sarzi-Puttini
The adverse event rate was similar in the three groups. The most frequent serious adverse events were infections, infestations, gastrointestinal disorders, and abnormal laboratory findings. Three of the seven opportunist infections in the tofacitinib groups were classified as serious (one case of pneumonia caused by Pneumocystis jiroveci, one case of cytomegalovirus sialadenitis, and one case of cytomegalovirus viremia); the four nonserious infections were cases of lymph node TB and esophageal candidiasis. Six deaths were reported: four due to acute respiratory distress syndrome, metastatic lung cancer, P. jiroveci pneumonia, and pneumonia in the tofacitinib 5 mg group; one due to cardiac arrest in the placebo group; and one considered to be unrelated to treatment in the tofacitinib 10 mg group. Three patients experienced major cardiovascular adverse events (MACEs) (angina pectoris, coronary artery disease, and carotid artery stenosis), and three cerebrovascular adverse events (cerebral infarction and two lacunar infarctions), all of whom were in the tofacitinib groups. Nine patients in the tofacitinib groups were diagnosed as having carcinomas. The altered laboratory parameters included decreased neutrophil counts, increases in LDL-C and transaminase levels, and small increases in serum creatinine (with five cases of a > 50% from baseline, none of which caused renal failure); the changes were dose-dependent and more frequent in the tofacitinib 10 mg group.
Modification of immunological features in human platelets during sepsis
Published in Immunological Investigations, 2018
Valle-Jiménez Xareni Raque, Sánchez-García Juan Carlos, Revilla-Rodríguez Eduardo, Baltierrez-Hoyos Rafael, Romero-Tlalolini María de los Ángeles, Ramírez-Cosmes Adriana, Torres-Aguilar Honorio, Bustos-Arriaga José, Aguilar-Ruiz Sergio Roberto
Pneumonia is the most common cause leading to sepsis with almost half of all cases, followed by intra-abdominal and urinary tracts infections (Ranieri et al., 2012) (Vincent et al., 2009). Although blood cultures are positive only in the third part of cases, Gram-negative bacteria are isolated in 62% of the cases, Gram-positive bacteria in 47%, and fungi in 19% (Vincent et al., 2009). The systemic inflammatory response that produces sepsis may be initiated by an infectious or sterile challenge. Pattern recognition receptors (PRRs) of the immune system detect Pathogen-associated molecular patterns (PAMPs) or Damage-associated molecular patterns (DAMPs) (Takeuchi and Akira, 2010). This recognizing leads to release of inflammatory cytokines such as TNF (tumor necrosis factor), IL (interleukin)-1 and IL-6, proteases, reactive oxygen species (ROS) and products of the complement, increasing tissue necrosis and releasing of DAMPs that exacerbate the inflammatory process, inducing injury of the venous endothelium and activating the coagulation (Seeley et al., 2012) (King et al., 2014). However, the immune system tries to compensate this over inflammatory process through the production of anti-inflammatory cytokines (Van Der Poll and Opal, 2008; Wu et al., 2017), neuroendocrine regulation (Andersson and Tracey, 2012), T and B-lymphocytes apoptosis (Hotchkiss et al., 2001), and a likely participation of epigenetic regulation (Carson et al., 2011). Nevertheless, sepsis-associated immunosuppression turn patient susceptible to infections by opportunist microorganisms (Boomer et al., 2011).