fatal infection

致命感染
  • 文章类型: Case Reports
    皮肤科假单胞菌瘤是一种罕见的侵袭性感染,涉及免疫能力和免疫功能低下的个体。自从发现遗传性免疫疾病如CARD9基因受损以来,扩展的皮肤癣菌感染主要归因于任何这些宿主因素。这项研究旨在介绍和探索致命的皮肤癣菌类假性肌瘤患者的潜在原因。我们提出了一种由常见的皮肤癣菌小孢子虫引起的慢性和深层假性细菌瘤,最终导致患者死亡。真菌学检查,进行了遗传研究和宿主对真菌的免疫反应,以探索潜在的因素。患者淋巴细胞计数减少,CD4+T细胞显著减少,尽管目前所有已知的遗传参数都被证明是正常的。通过功能研究,我们证明,患者的外周血单核细胞在真菌特异性刺激后表现出适应性细胞因子产生的严重损害,而先天免疫反应是部分缺陷。这是,根据我们的知识,首次报告了非HIVCD4淋巴细胞减少症患者的致命性皮肤真菌假性肌瘤,这突出了筛查深部皮肤癣菌病患者免疫缺陷的重要性。
    Dermatophytic pseudomycetoma is a rare invasive infection, involving both immunocompetent and immunocompromised individuals. Since the discovery of inherited immune disorders such as the impairment of CARD9 gene, extended dermatophyte infections are mostly ascribed to any of these host factors. This study is to present and explore the potential causes in a fatal dermatophytic pseudomycetoma patient. We present a chronic and deep pseudomycetoma caused by the common dermatophyte Microsporum canis which ultimately led to the death of the patient. Mycological examination, genetic studies and host immune responses against fungi were performed to explore the potential factors. The patient had decreased lymphocyte counts with significantly reduced CD4+ T cells, although all currently known genetic parameters proved to be normal. Through functional studies, we demonstrated that peripheral blood mononuclear cells from the patient showed severe impairment of adaptive cytokine production upon fungus-specific stimulation, whereas innate immune responses were partially defective. This is, to our knowledge, the first report of fatal dermatophytic pseudomycetoma in a patient with non-HIV CD4 lymphocytopenia, which highlights the importance of screening for immune deficiencies in patients with deep dermatophytosis.
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  • 文章类型: Case Reports
    一名49岁的男性发生事故,腹部计算机断层检查显示右肾乳头状肾细胞癌。住院期间,患者感染了COVID-19。在接下来的COVID-19治疗中,头部和脸部的右侧出现了一个黑点。开始抗真菌治疗和手术清创术,并观察到逐步改善。
    A 49-year-old male was involved in an accident and an abdominal computer tomographic examination revealed papillary renal cell carcinoma of the right kidney. During hospitalization, the patient was infected with COVID-19. In the following COVID-19 treatment, a black dot developed on the right side of the head and face. Antifungal therapy and surgical debridement were initiated and gradual improvement was observed.
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  • 文章类型: Case Reports
    2007年首次分离出的一种细菌,此后在大约15名患有胃肠道恶性肿瘤等疾病的患者的血液中被检测到,肠梗阻,或急性肠道感染。我们在此描述了新诊断为转移性肺癌的患者的情况,他死于致命的感染,可能与香港杆菌血症有关。通过回顾文献中报告的所有病例,我们的病例报告支持这种感染与癌症患者的高死亡率相关.
    Catabacter hongkongensis is a bacterium first isolated in 2007 and has since been detected in the blood of about fifteen patients with disease such as gastrointestinal malignancy, intestinal obstruction, or acute intestinal infection. We describe herein the case of a patient newly diagnosed with metastatic lung cancer, who died from a fatal infection possibly related to Catabacter hongkongensis bacteremia. By reviewing all cases reported in the literature, our case report supports that this infection is associated with a very high mortality in cancer patients.
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  • 文章类型: Case Reports
    BACKGROUND: Streptococcus pseudoporcinus (S. pseudoporcinus) was first identified in 2006. It cross-reacts with Lancefield group B antigen agglutination reagents and has been misidentified as S. agalactiae. Sites of S. pseudoporcinus isolation include the female genitourinary tract, urine, wounds, and dairy products. The prevalence of vaginal colonization is reportedly between 1 and 5.4%. Two uneventful cases of soft tissue infection caused by S. pseudoporcinus were reported in the past. However, since late 2019, six cases of invasive S. pseudoporcinus infections have emerged in the literature, one of which was fatal.
    METHODS: We describe a fatal case of a Caucasian male with spontaneous bacterial peritonitis associated with bacteremia due to a multidrug-resistant S. pseudoporcinus strain in a patient with decompensated liver cirrhosis. Despite the patient\'s good general condition and stable blood test results when he had visited the outpatient clinic for large-volume paracentesis a few days before admission, this time he presented to the emergency department with a rapidly worsening clinical condition and with laboratory features consistent with multiple-organ dysfunction syndrome, and succumbed within a short period.
    CONCLUSIONS: Contrary to what was thought until recently, multidrug-resistant S. pseudoporcinus may cause invasive, disseminated, fatal disease in humans. According to current limited data, vancomycin, linezolid, daptomycin, levofloxacin, clindamycin, and tetracycline seem to be the most effective antimicrobial agents against multidrug-resistant strains, and should be the empirical choice in cases of disseminated S. pseudoporcinus infection until laboratory antimicrobial susceptibility results are available. Improvements and new approaches for bacterial identification in routine clinical microbiology laboratories may reveal the real spectrum of S. pseudoporcinus infections in humans, which is currently believed to be underestimated. SS. pseudoporcinus could emerge as a serious medical problem in the near future, similar to other β-hemolytic streptococci.
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  • 文章类型: Journal Article
    腺病毒是急性上呼吸道感染的常见原因,也可能导致免疫抑制患者的播散性疾病。我们发现了一种新型腺病毒,松鼠猴腺病毒1(SqMAdV-1),作为基林比较医学和研究中心(KCCMR)的免疫功能低下的松鼠猴(Saimiriboliviensis)致命感染的原因。SqMAdV-1的测序显示,它与titi猴(Plecturocebuspupreus)腺病毒(TMAdV)最密切相关(成对核苷酸同一性为80.4%)。尽管在titi猴子中被识别,TMAdV在这些猴子中具有很高的致命性,他们不被认为是自然宿主。虽然SqMAdV-1在大小和基因组特征上与其他灵长类腺病毒相似,DNA聚合酶基因预期终止密码子处的核苷酸多态性导致羧基末端的126个氨基酸延伸,以前在其他灵长类腺病毒中没有观察到的特征。来自KCCMR的其他松鼠猴(Saimiriboliviensis和Saimirisciureus)的95个存档粪便样本的PCR测试和部分测序显示存在三种不同的情况,显然是腺病毒的特有物种。一组10个松鼠猴腺病毒变体与SqMAdV-1具有高度相似性。单个腺病毒变体(命名为SqMAdV-3),在五只猴子身上发现,与簇绒卷尾猴(Sapajusapella)腺病毒相似。检测到的最大一组腺病毒变体(命名为SqMAdV-2.0-2.16)与TMAdV具有非常高的相似性(93-99%),这表明松鼠猴可能是TMAdV的天然宿主.
    Adenoviruses are a frequent cause of acute upper respiratory tract infections that can also cause disseminated disease in immunosuppressed patients. We identified a novel adenovirus, squirrel monkey adenovirus 1 (SqMAdV-1), as the cause of fatal infection in an immunocompromised squirrel monkey (Saimiri boliviensis) at the Keeling Center for Comparative Medicine and Research (KCCMR). Sequencing of SqMAdV-1 revealed that it is most closely related (80.4 % pairwise nucleotide identity) to the titi monkey (Plecturocebus cupreus) adenovirus (TMAdV). Although identified in the titi monkey, TMAdV is highly lethal in these monkeys, and they are not thought to be the natural host. While SqMAdV-1 is similar to other primate adenoviruses in size and genomic characteristics, a nucleotide polymorphism at the expected stop codon of the DNA polymerase gene results in a 126 amino acid extension at the carboxy terminus, a feature not previously observed among other primate adenoviruses. PCR testing and partial sequencing of 95 archived faecal samples from other squirrel monkeys (Saimiri boliviensis and Saimiri sciureus) housed at the KCCMR revealed the presence of three distinct, and apparently endemic species of adenoviruses. A grouping of ten squirrel monkey adenovirus variants has high similarity to SqMAdV-1. A single adenovirus variant (designated SqMAdV-3), detected in five monkeys, has similarity to tufted capuchin (Sapajus apella) adenoviruses. The largest group of adenovirus variants detected (designated SqMAdV-2.0-2.16) has very high similarity (93-99 %) to the TMAdV, suggesting that squirrel monkeys may be the natural host of the TMAdV.
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  • 文章类型: Case Reports
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  • 文章类型: Case Reports
    Three patients with severe Clostridium difficile infection (CDI) caused by an unusual strain of C. difficile, PCR ribotype (RT) 251, were identified in New South Wales, Australia. All cases presented with severe diarrhoea, two had multiple recurrences and one died following a colectomy. C. difficile RT251 strains were isolated by toxigenic culture. Genetic characterisation was performed using techniques including toxin gene profiling, PCR ribotyping, whole genome sequencing (WGS), in-silico multi-locus-sequence-typing (MLST) and core-genome single nucleotide variant (SNV) analyses. Antimicrobial susceptibility was determined using an agar incorporation method. In vitro toxin production was confirmed by Vero cell cytotoxicity assay and pathogenicity was assessed in a murine model of CDI. All RT251 isolates contained toxin A (tcdA), toxin B (tcdB) and binary toxin (cdtA and cdtB) genes. Core-genome analyses revealed the RT251 strains were clonal, with 0-5 SNVs between isolates. WGS and MLST clustered RT251 in the same evolutionary clade (clade 2) as RT027. Despite comparatively lower levels of in vitro toxin production, in the murine model RT251 infection resembled RT027 infection. Mice showed marked weight loss, severe disease within 48 h post-infection and death. All isolates were susceptible to metronidazole and vancomycin. Our observations suggest C. difficile RT251 causes severe disease and emphasise the importance of ongoing surveillance for new and emerging strains of C. difficile with enhanced virulence.
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  • 文章类型: Journal Article
    In contrast to previous incursions of highly pathogenic avian influenza (HPAIV) H5 viruses, H5N8 clade 2.3.4.4b viruses caused numerous cases of lethal infections in white-tailed sea eagles (Haliaeetus albicilla) affecting mainly young eagles (younger than five years of age) in Germany during winter 2016/2017. Until April 2017, 17 HPAIV H5N8-positive white-tailed sea eagles had been detected (three found alive and 14 carcasses) by real-time RT-PCR and partial nucleotide sequence analyses. Severe neurological clinical signs were noticed which were corroborated by immunohistopathology revealing mild to moderate, oligo- to multifocal necrotizing virus-induced polioencephalitis. Lethal lead (Pb) concentrations, a main factor of mortality in sea eagles in previous years, could be ruled out by atomic absorption spectrometry. HPAIV H5 clade 2.3.4.4b reportedly is the first highly pathogenic influenza virus known to induce fatal disease in European white-tailed see eagles. This virus strain may become a new health threat to a highly protected species across its distribution range in Eurasia. Positive cloacal swabs suggest that eagles can spread the virus with their faeces.
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  • 文章类型: Journal Article
    Four epidemic waves of human infection with H7N9 have been recorded in China up to 1 June 2016, including in Jiangsu Province. However, few studies have investigated the differences in patients\' characteristics among the four epidemic waves, and the analyses of factors associated with fatal infection lacked statistical power in previous studies due to limited sample size.
    All laboratory-confirmed A(H7N9) patients in Jiangsu province were analysed. Patients\' characteristics were compared across four waves and between survivors and those who died. Multivariate analyses were used to identify independent predictors of death.
    Significant differences were found in the lengths of several time intervals (from onset of disease to laboratory confirmation, to onset of ARDS and respiratory failure, and to death) and in the development of heart failure. The proportions of overweight patients and rural patients increased significantly across the four waves. Administration of glucocorticoids and double-dose neuraminidase inhibitors became the norm. Predictors of death included complications such as ARDS, heart failure and septic shock, administration of glucocorticoids, and disease duration.
    Characteristics of H7N9 patients and clinical treatment options changed over time. Particular complications and the use of particular treatment, along with disease duration, could help clinicians predict the outcome of H7N9 infections.
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  • 文章类型: Case Reports
    默里谷脑炎病毒(MVEV),一种属于日本脑炎血清群的黄病毒,可引起人类严重的临床表现。我们报告了一名从澳大利亚返回加拿大的年轻女性的MVEV感染致命病例。旅行相关脑炎的鉴别诊断应包括MVEV,特别是在爆发期间。
    Murray Valley encephalitis virus (MVEV), a flavivirus belonging to the Japanese encephalitis serogroup, can cause severe clinical manifestations in humans. We report a fatal case of MVEV infection in a young woman who returned from Australia to Canada. The differential diagnosis for travel-associated encephalitis should include MVEV, particularly during outbreak years.
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