scholarly journals Pneumocystis jiroveci pneumonia in immunocompromised patients: Delayed diagnosis and poor outcomes in non-HIV-infected individuals

2014 ◽  
Vol 47 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Ming-Chi Li ◽  
Nan-Yao Lee ◽  
Ching-Chi Lee ◽  
Hsin-Chun Lee ◽  
Chia-Ming Chang ◽  
...  
Keyword(s):  
Delayed Diagnosis ◽  
Immunocompromised Patients ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Poor Outcomes

African Australians living with HIV: a case series from Victoria

Sexual Health ◽  
2010 ◽  
Vol 7 (2) ◽  
pp. 142 ◽  
Author(s):  
Chris N. Lemoh ◽  
Samia Baho ◽  
Jeffrey Grierson ◽  
Margaret Hellard ◽  
Alan Street ◽  
...  
Keyword(s):  
Delayed Diagnosis ◽  
Case Series ◽  
Cd4 Count ◽  
Horn Of Africa ◽  
Hiv Diagnosis ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Hiv Prevention Strategies ◽  
Industrialised Countries ◽  
Living With Hiv

Background: This research aimed to describe the characteristics of African-born Victorians living with HIV, identify associations with delayed HIV diagnosis and describe their response to combination antiretroviral therapy (cART). Methods: A case series of African-born adults living with HIV in Victoria was conducted. Data was collected in interviews and reviews of case notes. Associations with delayed HIV diagnosis (CD4 below 200 cells µL–1 at diagnosis and/or AIDS within 3 months of HIV diagnosis) were explored using univariate regression. AIDS-defining illnesses and response to cART were described. Results: Fourteen males and six females were included. Ten were born in the Horn of Africa (nine in Ethiopia). Sixteen had sexual exposure (12 heterosexual; four male-to-male sex). Seven reported acquiring HIV in Australia. Median CD4 count at diagnosis was 145 cells µL–1. Ten had delayed HIV diagnosis, of whom eight were born in the Horn of Africa. Delayed HIV diagnosis was associated with birth in the Horn of Africa (odds ratio: 11.56). Nine had a diagnosis of AIDS, including three cases of tuberculosis, three of Pneumocystis jiroveci pneumonia and two of cerebral toxoplasmosis. Eighteen had received cART, of which 16 achieved virological suppression and 15 achieved a CD4 count above 200 cells µL–1. Clinical failure and virological failure occurred in seven and five cases, respectively. Conclusions: HIV prevention strategies for Victoria’s African communities should address HIV exposure in Australia. Ethiopian-born Victorians with HIV appear to be at particular risk of delayed diagnosis. Response to cART in this series was comparable to that observed in other industrialised countries.

scholarly journals Gomori Methenamine Silver Stain on Bronchoalveolar Lavage Fluid Is Poorly Sensitive for Diagnosis of Pneumocystis jiroveci Pneumonia in HIV-Negative Immunocompromised Patients and May Lead to Missed or Delayed Diagnoses

2020 ◽  
Vol 144 (8) ◽  
pp. 1003-1010
Author(s):  
Marwan M. Azar ◽  
Rebecca Slotkin ◽  
Rita Abi-Raad ◽  
Yuehong Liu ◽  
Matthew H. Grant ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Bronchoalveolar Lavage Fluid ◽  
Lavage Fluid ◽  
Hiv Positive ◽  
Immunocompromised Patients ◽  
Silver Stain ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Methenamine Silver ◽  
Hiv Negative

Context.— Direct visualization of Pneumocystis jiroveci organisms, using Gomori methenamine silver (GMS) staining in bronchoalveolar lavage fluid (BAL), is a historical gold standard that has been widely used for the diagnosis of P jiroveci pneumonia (PJP). However, the stain may be less sensitive in human immunodeficiency virus (HIV)–negative immunocompromised patients owing to a lower burden of organisms. Objectives.— To assess the sensitivity of the GMS stain on BAL fluid for the diagnosis of PJP in HIV-negative immunocompromised patients as compared to HIV-positive patients. Design.— We conducted a retrospective review from 2012 to 2018 to identify immunocompromised patients (≥18 years old) who underwent bronchoscopy with BAL GMS staining for the diagnosis of PJP. To assess for sensitivity, we sought to identify BAL GMS-positive cases and BAL GMS-negative cases of PJP. The BAL GMS-negative cases were categorized into proven and probable PJP. Results.— We identified 45 adult immunocompromised patients with proven and probable PJP, including 24 HIV-negative (11 BAL GMS-positive and 13 BAL GMS-negative) and 21 HIV-positive cases (all were BAL GMS-positive). The sensitivity of BAL GMS for the diagnosis of PJP in HIV-negative immunocompromised patients was 11 of 24 (46%) versus 21 of 21 (100%) in HIV-positive patients (CD4: median, 10 cells/mL; range, 3–300 cells/mL). Delayed or missed diagnoses were seen in 3 cases of BAL GMS-negative PJP. Re-examination of BAL GMS slides showed rare P jiroveci cysts in 1 case. Conclusions.— BAL GMS has poor sensitivity for PJP in HIV-negative immunocompromised patients. Using BAL GMS as a sole method for PJP may result in missed or delayed diagnoses in this population.

scholarly journals Clinical Evaluation of a (1,3)-β-d-Glucan Assay for Presumptive Diagnosis of Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

2009 ◽  
Vol 16 (10) ◽  
pp. 1524-1526 ◽  
Author(s):  
Valerio Del Bono ◽  
Alessandra Mularoni ◽  
Elisa Furfaro ◽  
Emanuele Delfino ◽  
Lorenzo Rosasco ◽  
...  
Keyword(s):  
Cell Wall ◽  
Clinical Evaluation ◽  
Pneumocystis Pneumonia ◽  
Immunocompromised Patients ◽  
Presumptive Diagnosis ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Reliable Marker

ABSTRACT (1,3)-β-d-Glucan (BG) is a component of the Pneumocystis jiroveci cell wall. Thirty-one immunocompromised patients with pneumonia (16 with presumptive pneumocystis pneumonia [PCP] and 15 with non-PCP) were evaluated for serum BG levels. Serum from all 16 presumptive PCP patients and from 2/15 patients with non-PCP was positive for BG. Results indicate that BG is a reliable marker for diagnosing PCP.

scholarly journals Using Routine Laboratory Markers and Immunological Indicators for Predicting Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Guoxing Tang ◽  
Shutao Tong ◽  
Xu Yuan ◽  
Qun Lin ◽  
Ying Luo ◽  
...  
Keyword(s):  
T Cells ◽  
Immunosuppressive Therapy ◽  
Immunosuppressive Treatment ◽  
Control Group ◽  
Functional Markers ◽  
Immunocompromised Patients ◽  
Routine Laboratory ◽  
Pneumocystis Jiroveci ◽  
Model Based ◽  
Pneumocystis Jiroveci Pneumonia

BackgroundPneumocystis jiroveci pneumonia (PJP) is the most common opportunistic infection in immunocompromised patients. The accurate prediction of PJP development in patients undergoing immunosuppressive therapy remains challenge.MethodsPatients undergoing immunosuppressive treatment and with confirmed pneumocystis jiroveci infection were enrolled. Another group of matched patients with immunosuppressant treatment but without signs of infectious diseases were enrolled to control group.ResultsA total of 80 (40 PJP, 40 non-PJP) participants were enrolled from Tongji Hospital. None of the patients were HIV positive. The routine laboratory indicators, such as LYM, MON, RBC, TP, and ALB, were significantly lower in PJP patients than in non-PJP patients. Conversely, LDH in PJP patients was significantly higher than in non-PJP controls. For immunological indicators, the numbers of T, B, and NK cells were all remarkably lower in PJP patients than in non-PJP controls, whereas the functional markers such as HLA-DR, CD45RO and CD28 expressed on CD4+ or CD8+ T cells had no statistical difference between these two groups. Cluster analysis showing that decrease of host immunity markers including CD3+, CD4+ and CD8+ T cells, and increase of tissue damage marker LDH were the most typical characteristics of PJP patients. A further established model based on combination of CD8+ T cells and LDH showed prominent value in distinguishing PJP from non-PJP, with AUC of 0.941 (95% CI, 0.892-0.990).ConclusionsA model based on combination of routine laboratory and immunological indicators shows prominent value for predicting the development of PJP in HIV-negative patients undergoing immunosuppressive therapy.

Open Reduction for Dorsal Dislocation of Second to Fifth Carpometacarpal Joints: A Case Report

2020 ◽  
Author(s):  
Hiroo Kimura ◽  
Akira Toga ◽  
Taku Suzuki ◽  
Takuji Iwamoto
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Delayed Diagnosis ◽  
Preoperative Assessment ◽  
Radiographic Examination ◽  
Clinical Images ◽  
Left Hand ◽  
Carpometacarpal Joints ◽  
Joint Deformity ◽  
Poor Outcomes

Abstract Background Fracture-dislocations of all four ulnar (second to fifth) carpometacarpal (CMC) joints are rare hand injuries and frequently overlooked or missed. These injuries can be treated conservatively when closed reduction is successfully achieved, though they are sometimes irreducible and unstable. Case Description We report the case of a 17-year-old boy involved in a vehicular accident. Clinical images showed dorsal dislocation of all four ulnar CMC joints of the left hand associated with a fracture of the base of the fourth metacarpal. Although closed reduction was attempted immediately, the affected joints remained unstable and easily redislocated. Therefore, we performed open reduction and percutaneous fixation of all ulnar CMCs. He showed excellent recovery after 1 year postoperatively, reported no pain, and demonstrated complete grip strength and range of motion of the affected wrist and fingers. Literature Review Accurate clinical diagnosis of this lesion is difficult because of polytrauma, severe swelling masking the dislocated CMC joint deformity, and overlapping of adjacent metacarpals and carpal bones on radiographic examination. As for the treatment strategy, it has yet to obtain a consensus. Some reports value open reduction to guarantee anatomical reduction, and it is definitely needed in the patients with interposed tissues to be removed or with subacute and chronic injuries. Clinical Relevance Delayed diagnosis or treatment could lead to poor outcomes. Therefore, surgeons must be aware that precise preoperative assessment is critical, and anatomical open reduction of interposed bony fragments, like our case, may be required even in an acute phase.

scholarly journals A Historical Perspective of Cardiac Implantable Electronic Device Infection: How a Menace Can Drive Technological and Clinical Improvement

Hearts ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 202-212
Author(s):  
Giulia Massaro ◽  
Igor Diemberger ◽  
Matteo Ziacchi ◽  
Andrea Angeletti ◽  
Giovanni Statuto ◽  
...  
Keyword(s):  
Electronic Device ◽  
Positive Impact ◽  
Delayed Diagnosis ◽  
Implantation Rate ◽  
Major Complication ◽  
Lead Extraction ◽  
Cardiac Implantable Electronic Devices ◽  
Device Infection ◽  
New Perspective ◽  
Poor Outcomes

In recent decades there has been a relevant increase in the implantation rate of cardiac implantable electronic devices (CIEDs), albeit with relevant geographical inhomogeneities. Despite the positive impact on clinical outcomes, the possibility of major complications is not negligible, particularly with respect to CIED infections. CIED infections significantly affect morbidity and mortality, especially in instances of delayed diagnosis and appropriate treatment. In the present review, we will start to depict the factors underlying the development of CIED infection as well as the difficulties related to its diagnosis and treatment. We will explain the reasons underlying the need to focus on prophylaxis rather than treatment, in view of the poor outcomes despite improvements in lead extraction procedures. This will lead to the consideration of management of this complication in a hub-spoke manner, and to our analysis of the several technological and procedural improvements developed to minimize this complication. These include prolongation of CIED longevity, the development of leadless devices, and integrated prophylactic approaches. We will conclude with a discussion regarding new devices and strategies under development. This complete excursus will provide the reader with a new perspective on how a major complication can drive technological improvements.

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