AIM:To investigate the utility of the cytomegalovirus(CMV)antigenemia assay for the diagnosis of CMV gastrointestinal disease(GID). METHODS:One hundred and thirty immunocompromised patients were enrolled in this study...AIM:To investigate the utility of the cytomegalovirus(CMV)antigenemia assay for the diagnosis of CMV gastrointestinal disease(GID). METHODS:One hundred and thirty immunocompromised patients were enrolled in this study.Patients with a history of anti-CMV treatment and who had not undergone examination using the antigenemia assay were excluded.CMV-GID was defined as the detection of large cells with intranuclear inclusions alone or associated with granular cytoplasmic inclusions by biopsy.Biopsy sections were stained with hematoxylin and eosin and immunohistochemically stained with anti-CMV.We evaluated the association between CMV-GID and patient characteristics(symptoms,underlying disease,medication,leukocyte counts,and antigenemia assay).All patients were checked with an human immunodeficiency virus(HIV)antibody test before endoscopic examination.White blood cell(WBC)counts were obtained from medical records within 1 wk of endoscopy.Leukopenia was defined as a total WBC count<5000 cells/mm 3 . For HIV patients,we also checked CD4+counts from medical records. RESULTS:A total of 99 patients were retrospectively selected for analysis.Of the immunocompromised patients,19 had malignant disease,18 had autoimmune disease,19 had disorders of biochemical homeostasis, three had undergone transplantation,and 45 had HIV infection.A total of 50 patients had received immunosuppressive therapy.No patients had inflammatory bowel disease.Fifty-five patients were diagnosed as having CMV-GID.Univariate analysis indicated an association between HIV infection,leukopenia,and positive antigenemia and CMV-GID(P<0.05).Multivariate analysis using logistic regression revealed that HIV infection and positive antigenemia were the only independent factors related to CMV-GID(P<0.01).The sensitivity,specificity,positive predictive value,and negative predictive value of antigenemia for CMV-GID were 65.4%,93.6%, 91.9%,and 71.0%,respectively.In a subgroup analy-sis,patients with leukopenia displayed low sensitivity and high specificity.Minimal differences in accuracy were seen among patients with or without leukopenia. HIV-infected patients displayed low sensitivity and high specificity.Accuracy barely differed between HIV-positive and-negative patients.In HIV-infected patients, CD4 count<50 cells/μL resulted in low sensitivity and high specificity.Differences in accuracy among patients were minor,regardless of CD4 count.In patients who had undergone both quantitative real-time polymerase chain reaction(PCR)and antigenemia assay,real-time PCR was slightly more accurate in terms of sensitivity than the antigenemia assay;however,this difference was not statistically significant(P=0.312). CONCLUSION:If the antigenemia test is positive,endoscopic lesions are acceptable for the diagnosis of CMVGID without biopsy.The accuracy is not affected by HIV infection and leukopenia.Either PCR or the antigenemia assay are valid.展开更多
Plasmablastic lymphoma(PBL) is a rare aggressive B-cell lymphoproliferative disorder,which has been characterized by the World Health Organization as a new entity.Although PBL is most commonly seen in the oral cavity ...Plasmablastic lymphoma(PBL) is a rare aggressive B-cell lymphoproliferative disorder,which has been characterized by the World Health Organization as a new entity.Although PBL is most commonly seen in the oral cavity of human immunodeficiency virus(HIV)-positive patients,it can also be seen in extraoral sites in immunocompromised patients who are HIV-negative.Here we present a rare case of PBL of the small intestine in a 55-year-old HIV-negative male.Histopathological examination of the excisional lesion showed a large cell lymphoma with plasmacytic differentiation diffusely infiltrating the small intestine and involving the surrounding organs.The neoplastic cells were diffusely positive for CD79a,CD138 and CD10 and partly positive for CD38 and epithelial membrane antigen.Approximately 80% of the tumor cells were positive for Ki-67.A monoclonal rearrangement of the kappa light chain gene was demonstrated.The patient died approximately 1.5 mo after diagnosis in spite of receiving two courses of the CHOP chemotherapy regimen.In a review of the literature,this is the first case report of PBL with initial presentation in the small intestine without HIV and Epstein-Barr virus infection,and a history of hepatitis B virus infection and radiotherapy probably led to the iatrogenic immunocompromised state.展开更多
PANCREATIC tuberculosis(TB)is a rare disease and its diagnosis is difficult because of the lack of specific clinical manifestations.Computed tomography(CT)and magnetic resonance imaging(MRI)have some diagnostic values...PANCREATIC tuberculosis(TB)is a rare disease and its diagnosis is difficult because of the lack of specific clinical manifestations.Computed tomography(CT)and magnetic resonance imaging(MRI)have some diagnostic values in this disease,but it is easy to misdiagnose pancreatic TB as a pancreatic tumor.1 In this article,we present a case of non-immunocompromised patient developing an isolated pancreatic TB,report the CT and MRI findings,and the surgical procedure for it.展开更多
Squamous cell carcinoma of the anus （SCCA） is a com- mon cancer in the human immunodeficiency virus （HIV）- infected population, and its incidence continues to in- crease in male homosexuals. Combined chemoradiatio...Squamous cell carcinoma of the anus （SCCA） is a com- mon cancer in the human immunodeficiency virus （HIV）- infected population, and its incidence continues to in- crease in male homosexuals. Combined chemoradiation with mitomycin C and 5-fiuorouracil was poorly tolerated by severely immunocompromised patients in the early 1990s. In the era of highly active antiretroviral therapy （HAART）, however, recent data indicate that： （1） most HIV patients with anal cancer can tolerate standard chemotherapy regimens; and （2） this approach is associ- ated with survival rates similar to those of HIV-negative patients. However, HIV-positive patients with SCCA are much younger, more likely to develop local tumor recur- rence, and ultimately die from anal cancer than immune competent patients. Taken together, these findings suggest that anal cancer is an often fatal neoplasia in mid- dle-aged HIV-positive male homosexuals. In this popula- tion, SCCA is an opportunistic disease resulting in patients with suboptimal immune function from persistent infection and prolonged exposition to oncogenic human papillomaviruses （HPVs）. Large-scale cancer-prevention strategies （routine anuscopy and anal papanicolaou test- ing） should be implemented in this population. In addi- tion, definitive eradication of oncogenic HPVs within the anogenital mucosa of high-risk individuals might require a proactive approach with repeated vaccination.展开更多
Eighty four throat swabs were obtained from Basrah General Hospital inpatients （N = 34）： 17 were suffering from renal failure and the other 17 were diabetics; and from outpatients （N = 50）. Throat swabs were cult...Eighty four throat swabs were obtained from Basrah General Hospital inpatients （N = 34）： 17 were suffering from renal failure and the other 17 were diabetics; and from outpatients （N = 50）. Throat swabs were cultured first in the selective media Ashdown＇s broth then subcultured on Ashdown＇s agar to isolate Burkholderia pseudomallei which was recovered from seven cases （8.33%）. Four isolates were from renal failure patients （23.53%）, two from diabetic patients （11.76%） and the seventh isolate was from an outpatient with tonsillitis. All isolates were able to produce capsules, form filament chains, exhibit swarming motility and were arabinose non assimilators （Ara-） indicative of their virulence. Additionally, isolated B. pseudomallei were found to produce protease, lipase, hemolysin, and lecithinase and were able to produce biofilm, the root of many troublesome persistent infections that resist antibiotic treatment. Susceptibility of the seven isolates of B. pseudomallei toward 11 antibiotics was assessed, isolates were found multiply resistant to all antibiotics apart from ciproflaxin. This study confirms for the first time isolation of B. pseudomallei from immunocompromised patients in Basrah city of Iraq and describes their virulence potentials.展开更多
Bartonella are known to be important causes ofzooanthroponotic diseases. The range of human infection varies from mild lymphadenopathy and asymptomatic bacteremia to life-threatening systemic disease in immunocompromi...Bartonella are known to be important causes ofzooanthroponotic diseases. The range of human infection varies from mild lymphadenopathy and asymptomatic bacteremia to life-threatening systemic disease in immunocompromised patients. Microbiological improvements in isolation methods and PCR amplification of organism-specific DNA sequences have resulted in a dramatic increase in reports describing human patients with bartonellosis. Nevertheless, clearly and successful isolation ofBartonella spp. from bacteremic animals and human patients remains an ongoing challenge. Technology of experimental bartonellosis due to intraperitoneal introduction of biological material samples containing causative agents to laboratory animals is presented in the article. White nonlinear mice with the artificially cyclophosphamide formed immunodeficient state may be used as an experimental model for further investigation of the biological alterations responsible for angiomatosis. On the other hand, we believe that this new method will enhance the diagnostic sensitivity and specificity needed to achieve a diagnosis of bartonellosis.展开更多
High levels of low molecular weight (LMW) IgM in certain diseases are associated with clinical and laboratory indices which reflect the severity of the disease. These associations suggest that LMW IgM may play an impo...High levels of low molecular weight (LMW) IgM in certain diseases are associated with clinical and laboratory indices which reflect the severity of the disease. These associations suggest that LMW IgM may play an important role in the immunopathogenesis of these diseases. To further approach the question concerning the functional activity of LMW IgM in disease, a panel of LMW IgM and high molecular weight (HMW) IgM preparations with or without rheumatoid factor (RF) activity were used to investigate their antibody binding activity and their effector function. It was found that LMW IgM-RF and HMW IgM-RF had a similar binding capacity to Fc fragment as there was no significant difference in the affinity index between them. It further showed that the rate of activation and total amount of utilization of complement by LMW IgM and HMW IgM was similar, although the mean fluorescence of C3 deposition by IgM-RF and HMW IgM-RF was slightly higher than that of LMW IgM-RF and other control RF antibodies. However, the current study demonstrated that LMW IgM had strong neutrophil activating properties when compared with HMW IgM. These findings suggest that one mechanism of LMW IgM contributing to the immunopathogenesis of RA may be due to the formation of circulating immune complex ( CIC) by LMW IgM with subsequent activation of neutrophils. Whether LMW IgM has other functional activity in disease is unclear and needs further investigation.展开更多
文摘AIM:To investigate the utility of the cytomegalovirus(CMV)antigenemia assay for the diagnosis of CMV gastrointestinal disease(GID). METHODS:One hundred and thirty immunocompromised patients were enrolled in this study.Patients with a history of anti-CMV treatment and who had not undergone examination using the antigenemia assay were excluded.CMV-GID was defined as the detection of large cells with intranuclear inclusions alone or associated with granular cytoplasmic inclusions by biopsy.Biopsy sections were stained with hematoxylin and eosin and immunohistochemically stained with anti-CMV.We evaluated the association between CMV-GID and patient characteristics(symptoms,underlying disease,medication,leukocyte counts,and antigenemia assay).All patients were checked with an human immunodeficiency virus(HIV)antibody test before endoscopic examination.White blood cell(WBC)counts were obtained from medical records within 1 wk of endoscopy.Leukopenia was defined as a total WBC count<5000 cells/mm 3 . For HIV patients,we also checked CD4+counts from medical records. RESULTS:A total of 99 patients were retrospectively selected for analysis.Of the immunocompromised patients,19 had malignant disease,18 had autoimmune disease,19 had disorders of biochemical homeostasis, three had undergone transplantation,and 45 had HIV infection.A total of 50 patients had received immunosuppressive therapy.No patients had inflammatory bowel disease.Fifty-five patients were diagnosed as having CMV-GID.Univariate analysis indicated an association between HIV infection,leukopenia,and positive antigenemia and CMV-GID(P<0.05).Multivariate analysis using logistic regression revealed that HIV infection and positive antigenemia were the only independent factors related to CMV-GID(P<0.01).The sensitivity,specificity,positive predictive value,and negative predictive value of antigenemia for CMV-GID were 65.4%,93.6%, 91.9%,and 71.0%,respectively.In a subgroup analy-sis,patients with leukopenia displayed low sensitivity and high specificity.Minimal differences in accuracy were seen among patients with or without leukopenia. HIV-infected patients displayed low sensitivity and high specificity.Accuracy barely differed between HIV-positive and-negative patients.In HIV-infected patients, CD4 count<50 cells/μL resulted in low sensitivity and high specificity.Differences in accuracy among patients were minor,regardless of CD4 count.In patients who had undergone both quantitative real-time polymerase chain reaction(PCR)and antigenemia assay,real-time PCR was slightly more accurate in terms of sensitivity than the antigenemia assay;however,this difference was not statistically significant(P=0.312). CONCLUSION:If the antigenemia test is positive,endoscopic lesions are acceptable for the diagnosis of CMVGID without biopsy.The accuracy is not affected by HIV infection and leukopenia.Either PCR or the antigenemia assay are valid.
文摘Plasmablastic lymphoma(PBL) is a rare aggressive B-cell lymphoproliferative disorder,which has been characterized by the World Health Organization as a new entity.Although PBL is most commonly seen in the oral cavity of human immunodeficiency virus(HIV)-positive patients,it can also be seen in extraoral sites in immunocompromised patients who are HIV-negative.Here we present a rare case of PBL of the small intestine in a 55-year-old HIV-negative male.Histopathological examination of the excisional lesion showed a large cell lymphoma with plasmacytic differentiation diffusely infiltrating the small intestine and involving the surrounding organs.The neoplastic cells were diffusely positive for CD79a,CD138 and CD10 and partly positive for CD38 and epithelial membrane antigen.Approximately 80% of the tumor cells were positive for Ki-67.A monoclonal rearrangement of the kappa light chain gene was demonstrated.The patient died approximately 1.5 mo after diagnosis in spite of receiving two courses of the CHOP chemotherapy regimen.In a review of the literature,this is the first case report of PBL with initial presentation in the small intestine without HIV and Epstein-Barr virus infection,and a history of hepatitis B virus infection and radiotherapy probably led to the iatrogenic immunocompromised state.
文摘PANCREATIC tuberculosis(TB)is a rare disease and its diagnosis is difficult because of the lack of specific clinical manifestations.Computed tomography(CT)and magnetic resonance imaging(MRI)have some diagnostic values in this disease,but it is easy to misdiagnose pancreatic TB as a pancreatic tumor.1 In this article,we present a case of non-immunocompromised patient developing an isolated pancreatic TB,report the CT and MRI findings,and the surgical procedure for it.
文摘Squamous cell carcinoma of the anus （SCCA） is a com- mon cancer in the human immunodeficiency virus （HIV）- infected population, and its incidence continues to in- crease in male homosexuals. Combined chemoradiation with mitomycin C and 5-fiuorouracil was poorly tolerated by severely immunocompromised patients in the early 1990s. In the era of highly active antiretroviral therapy （HAART）, however, recent data indicate that： （1） most HIV patients with anal cancer can tolerate standard chemotherapy regimens; and （2） this approach is associ- ated with survival rates similar to those of HIV-negative patients. However, HIV-positive patients with SCCA are much younger, more likely to develop local tumor recur- rence, and ultimately die from anal cancer than immune competent patients. Taken together, these findings suggest that anal cancer is an often fatal neoplasia in mid- dle-aged HIV-positive male homosexuals. In this popula- tion, SCCA is an opportunistic disease resulting in patients with suboptimal immune function from persistent infection and prolonged exposition to oncogenic human papillomaviruses （HPVs）. Large-scale cancer-prevention strategies （routine anuscopy and anal papanicolaou test- ing） should be implemented in this population. In addi- tion, definitive eradication of oncogenic HPVs within the anogenital mucosa of high-risk individuals might require a proactive approach with repeated vaccination.
文摘Eighty four throat swabs were obtained from Basrah General Hospital inpatients （N = 34）： 17 were suffering from renal failure and the other 17 were diabetics; and from outpatients （N = 50）. Throat swabs were cultured first in the selective media Ashdown＇s broth then subcultured on Ashdown＇s agar to isolate Burkholderia pseudomallei which was recovered from seven cases （8.33%）. Four isolates were from renal failure patients （23.53%）, two from diabetic patients （11.76%） and the seventh isolate was from an outpatient with tonsillitis. All isolates were able to produce capsules, form filament chains, exhibit swarming motility and were arabinose non assimilators （Ara-） indicative of their virulence. Additionally, isolated B. pseudomallei were found to produce protease, lipase, hemolysin, and lecithinase and were able to produce biofilm, the root of many troublesome persistent infections that resist antibiotic treatment. Susceptibility of the seven isolates of B. pseudomallei toward 11 antibiotics was assessed, isolates were found multiply resistant to all antibiotics apart from ciproflaxin. This study confirms for the first time isolation of B. pseudomallei from immunocompromised patients in Basrah city of Iraq and describes their virulence potentials.
文摘Bartonella are known to be important causes ofzooanthroponotic diseases. The range of human infection varies from mild lymphadenopathy and asymptomatic bacteremia to life-threatening systemic disease in immunocompromised patients. Microbiological improvements in isolation methods and PCR amplification of organism-specific DNA sequences have resulted in a dramatic increase in reports describing human patients with bartonellosis. Nevertheless, clearly and successful isolation ofBartonella spp. from bacteremic animals and human patients remains an ongoing challenge. Technology of experimental bartonellosis due to intraperitoneal introduction of biological material samples containing causative agents to laboratory animals is presented in the article. White nonlinear mice with the artificially cyclophosphamide formed immunodeficient state may be used as an experimental model for further investigation of the biological alterations responsible for angiomatosis. On the other hand, we believe that this new method will enhance the diagnostic sensitivity and specificity needed to achieve a diagnosis of bartonellosis.
文摘High levels of low molecular weight (LMW) IgM in certain diseases are associated with clinical and laboratory indices which reflect the severity of the disease. These associations suggest that LMW IgM may play an important role in the immunopathogenesis of these diseases. To further approach the question concerning the functional activity of LMW IgM in disease, a panel of LMW IgM and high molecular weight (HMW) IgM preparations with or without rheumatoid factor (RF) activity were used to investigate their antibody binding activity and their effector function. It was found that LMW IgM-RF and HMW IgM-RF had a similar binding capacity to Fc fragment as there was no significant difference in the affinity index between them. It further showed that the rate of activation and total amount of utilization of complement by LMW IgM and HMW IgM was similar, although the mean fluorescence of C3 deposition by IgM-RF and HMW IgM-RF was slightly higher than that of LMW IgM-RF and other control RF antibodies. However, the current study demonstrated that LMW IgM had strong neutrophil activating properties when compared with HMW IgM. These findings suggest that one mechanism of LMW IgM contributing to the immunopathogenesis of RA may be due to the formation of circulating immune complex ( CIC) by LMW IgM with subsequent activation of neutrophils. Whether LMW IgM has other functional activity in disease is unclear and needs further investigation.
