Hydrolyzing Condition and Immunocompetence of Sheep Bone Protein Enzymatic Lysates

Utilizing collagen of sheep bone as material to get immunocompetent peptide, enzymatic hydrolysis conditions were optimized using quadratic regression general rotation design. The effect of temperature （T）, time （t）, enzyme/substrate （E/S） ratio, and substrate concentration （S） on the amount of tricarboxylix acid cycle （TCA） soluble peptides were investigated. The content of soluble peptide in the acquisition was measured by Folin-hydrozybebzebe method, and the correlation between soluble peptide content and immunocompetence was analyzed by SAS software. The best enzymatic hydrolysis condition was gotten from Design Expert 7.1.2 software. The optimal condition under which immunocompetent peptides could be prepared was 1 576 U g^-1 （E/S）, 64.05℃ （T）, 0.271 kg L^-1 （S）, and 7.22 h （t）. The correlation coefficient between TCA soluble peptides and the immuneocompetence was 0.045 〈r0.05 = 0.355, which indicated that they had no significant correlation. The result showed that the soluble peptide contained immunocompetent peptides which content was independent of immunocompetence in the hydrolasates.

Meningoencephalitis due to Listeria monocytogenes in a Young Immunocompetent Patient: Case Report with Literature Review

Meningoencephalitis secondary to Listeria monocytogenes (L. monocytogenes) mainly affects newborns, the elderly and immunocompromised people;there are extremely rare cases in which said infection occurs in immunocompetent individuals. We present the case of a young adult patient without immunocompromise, who developed meningoencephalitis due to L. monocytogenes;This case is exceptional, since it occurred in an individual outside the classic age group, in addition to not having risk factors, which is why it should be considered an atypical causal agent.

Cytomegalovirus infection in non-immunocompromised critically ill patients:A management perspective

Critically ill patients are a vulnerable group at high risk of developing secondary infections.High disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections,including cytomegalovirus(CMV).CMV seroconversion has been reported in up to 33%of ICU patients,but its impact on patient outcomes remains a matter of debate.Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/acquired immuno deficiency syndrome,the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous.Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement.Hence,a better understanding of the symptomatology,diagnostics,and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.

Disseminated tuberculosis presenting as meningitis and spondylodiscitis in an immunocompetent adult

Rationale:Disseminated tuberculosis involves the central nervous system in up to a third of cases.However,meningitis and spondylodiscitis due to miliary tuberculosis rarely occur together,particularly in the immuno-competent population.Patient concerns:A 37-year-old immunocompetent male presented with altered level of consciousness for one week and lower back pain with evening pyrexia for one month.Examination revealed spastic paraplegia and left hemiparesis.Diagnosis:Disseminated tuberculosis presenting with meningitis and spondylodiscitis.Interventions:Category I anti-tuberculous therapy with a tapering regimen of intravenous dexamethasone was administered.Outcomes:There was clinical improvement after nine months of treatment.Lessons:Tuberculosis may present with atypical clinical manifestations.Contrast enhanced computed tomography scan or magnetic resonance imaging combined with histopathological features,a high index of suspicion and clinical improvement with anti-tuberculous treatment can confirm the diagnosis in the absence of microbiological evidence,especially in extrapulmonary tuberculosis.

Coexisting cytomegalovirus colitis in an immunocompetent patient with Clostridioides difficile colitis:A case report

BACKGROUND Clostridioides difficile(C.difficile)colitis is one of the most common infections in hospitalized patients,characterized by fever and diarrhea.It usually improves after appropriate antibiotic treatment;if not,comorbidities should be considered.Cytomegalovirus(CMV)colitis is a possible co-existing diagnosis in patients with C.difficile infection with poor treatment response.However,compared with immunocompromised patients,CMV colitis in immunocompetent patients is not well studied.CASE SUMMARY We present an unusual case of co-existing CMV colitis in an immunocompetent patient with C.difficile infection.An 80-year-old female patient was referred to the infectious disease department due to diarrhea,abdominal discomfort,and fever for 1 wk during her hospitalization for surgery.C.difficile toxin B polymerase chain reaction on stool samples was positive.After C.difficile infection was diagnosed,oral vancomycin treatment was administered.Her symptoms including diarrhea,fever and abdominal discomfort improved for ten days.Unfortunately,the symptoms worsened again with bloody diarrhea and fever.Therefore,a sigmoidoscopy was performed for evaluation,showing a longitudinal ulcer on the sigmoid colon.Endoscopic biopsy confirmed CMV colitis,and the clinical symptoms improved after using ganciclovir.CONCLUSION Co-existing CMV colitis should be considered in patients with aggravated C.difficile infection on appropriate treatment,even in immunocompetent hosts.

Chronic pulmonary mucormycosis caused by rhizopus microsporus mimics lung carcinoma in an immunocompetent adult:A case report

BACKGROUND Pulmonary mucormycosis is a rare but life-threatening invasive fungal infection that mostly affects immunocompromised patients.This disease usually develops acutely and progresses rapidly,often leading to a poor clinical prognosis.Chronic pulmonary mucormycosis is highly unusual in immunocompetent patients.CASE SUMMARY A 43-year-old man,who was a house improvement worker with a long history of occupational dust exposure,presented with an irritating cough that had lasted for two months.The patient was previously in good health,without dysglycemia or any known immunodeficiencies.Chest computed tomography revealed a mass in the left lower lobe,measuring approximately 6 cm in diameter,which was suspected to be primary lung carcinoma complicated with obstructive pneumonia.Thoracoscopic-assisted left lower lobectomy was performed,and metagenomic next-generation sequencing detection,along with special pathological staining of surgical specimens,suggested Rhizopus microsporus infection.Postoperatively,the patient’s respiratory symptoms were relieved,and no signs of recurrence were found during the six-month follow-up.CONCLUSION This article reports a rare case of chronic pulmonary mucormycosis caused by Rhizopus microsporus in a middle-aged male without dysglycemia or immunodeficiency.The patient’s surgical outcome was excellent,reaffirming that surgery remains the cornerstone of pulmonary mucormycosis treatment.

Next-generation sequencing technology for the diagnosis of Pneumocystis pneumonia in an immunocompetent female:A case report

BACKGROUND Pneumocystis pneumonia(PCP)is a serious fungal infection usually seen in patients with human immunodeficiency virus,and it is more frequently found and has a high fatality rate in immunocompromised people.Surprisingly,it rarely occurs in immunocompetent patients.However,the clinical diagnosis of this pathogen is made more difficult by the difficulty of obtaining accurate microbiological evidence with routine tests.This case reports a PCP patient with normal immune function who was diagnosed through next-generation sequencing(NGS).CASE SUMMARY A 23-year-old female who had no special disease in the past was admitted to the hospital with a persistent fever and cough.Based on the initial examination results,the patient was diagnosed with bipulmonary pneumonia,and empirical broad-spectrum antibiotic therapy was administered.However,due to the undetermined etiology,the patient's condition continued to worsen.She was transferred to the intensive care unit because of acute respiratory failure.After the diagnosis of Pneumocystis jirovecii infection through NGS in bronchoalveolar lavage fluid and treatment with trimethoprim/sulfamethoxazole and caspofungin,the patient gradually recovered and had a good prognosis.CONCLUSION This case emphasizes that,for patients with normal immune function the possibility of PCP infection,although rare,cannot be ignored.NGS plays an important role in the diagnosis of refractory interstitial pneumonia and acute respiratory failure.

Esophagitis Due to Actinomycosis in an Immunocompetent Patient with a History of SARS-Cov-2 Infection: Case Report

We present an unusual case of esophageal actinomycosis that developed in a patient with normal immunity and a history of acute SARS-CoV-2 infection. We report a case of a 56-year-old female patient without chronic degenerative pathologies with a history of non-severe acute SARS-CoV-2 infection that occurred two months prior to her presentation, treated with prednisone and betamethasone orally and inhaled, respectively for 21 days. The pivotal symptom is dysphagia and definitive diagnosis requires a tissue culture of the affected organ or a biopsy that shows the classic sulfur granules. Currently, antibiotic treatment with beta-lactams, such as amoxicillin/clavulanic acid, is still effective, as it was in our patient.

Pulmonary cytomegalovirus infection:A case report and systematic review

BACKGROUND Cytomegalovirus(CMV)is a common virus that can cause the first infection in childhood or adolescence and reactivate later in life due to immunosuppression.CMV pneumonia is a rare illness in immunocompetent patients but is one of the most significant opportunistic infections in immunocompromised patients.AIM To report a case and review published cases of pulmonary CMV infection in both immunocompromised and immunocompetent patients.METHODS We conducted a systematic search on the MEDLINE(PubMed)database,without date or language restrictions,to identify relevant studies using Medical Subject Headings and Health Science Descriptors.We manually searched the reference lists of the included studies.Simple descriptive analysis was used to summarize the results.RESULTS Our search identified 445 references,and after screening,43 studies reporting 45 cases were included in the final analysis,with 29(64%)patients being immunocompromised and 16(36%)being immunocompetent.Fever(82%)and dyspnea(75%)were the most common clinical findings.Thoracic computed tomography showed bilateral ground-glass opacities,a relevant differential diagnosis for severe acute respiratory syndrome coronavirus 2 infection.The majority of patients(85%)received antiviral therapy,and 89%of patients recovered,while 9%of patients died.CONCLUSION CMV pneumonia should be considered as a differential diagnosis for coronavirus disease 2019 pneumonia,especially in immunocompromised patients.Clinicians should be aware of the clinical presentation,management,and outcomes of CMV pneumonia to guide appropriate treatment decisions.

Atypical Presentation of Ramsay Hunt Syndrome without Facial Palsy in an Immunocompetent Senegalese Adulte Patient

First described in 1907 by James Ramsay Hunt, Ramsay Hunt syndrome is a recurrence (reactivation) of varicella-zoster virus (VZV) affecting the geniculate ganglion, secondary to a decrease in cell-mediated immunity. The strict definition of Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by erythematous vesicular rash on the ear. We report a 57-year-old female immunocompetent patient complaining of otalgia, small vesicles on the Ramsey Hunt Zone. She does not complain fever, hearing loss, nausea, vomiting or dizziness. There was no peripheral facial nerve palsy, no reduction of taste sensation, no ataxia or nystagmus, Romberg sign was negative. Our patient targets two of the three criteria needed for the diagnosis of Ramsay Hunt syndrome. She began to take Acyclovir-Steroid (AS) therapy very early with good outcome. This suggests that prompt diagnosis and management improve outcome and prevent occurrence of nerve palsy in Ramsay Hunt syndrome.

Experimental Study on the Enhancement of Murine Splenic Lymphocyte Proliferation by Lycium Barbarum Glycopeptide

In order to investigate the immunoactivity of Lycium Barbarum glycopeptide (LBG), the routinely prepared murine splenic lymphocyte suspension was separately added into the samples with different concentrations (500, 100, 10, 1 μg/ml) of LBG as LBG groups. Blank control group in the absence of Lycium Barbarum glycopeptide or ConA and positive control group in the presence of 0.5 ml ConA but in the absence of LBG were created. 0.5 ml LBG samples with different concentrations in combination with 0.5 ml ConA (10 μg/ml) into each well to observe the synergic effects of LBG and ConA as LBG+ConA groups. After incubation for 72 h at 37 ℃, the samples were analyzed by CFSE-labeled cells combined with flow cytometry, and MTT. Flow cytometry revealed that both LBG could enhance the murine splenic lymphocyte proliferative reaction. Combined use of LBG and ConA had synergic effects. MTT demonstrated that sample A could obviously promote the murine splenic lymphocyte proliferative reaction as compared with control group (P<0.01), while sample B could also enhance the lymphocyte proliferation at a high dose. In combination with ConA, sample A had synergic effects at high dose, while sample B showed obviously synergic effects (P<0.05). It was concluded that both samples (A and B) had strong immunocompetence.

Mycobacterium avium subspecies paratuberculosis in the causation of Crohn's disease

Mycobacterium avium subspecies paratuberculosis(MAP),originally called Johne’s bacillus was firstdescribed from Germany in 1895 as the cause of achronic inflammatory disease of the intestine in acow.As the 20th century progressed,clinical andsub-clinical MAP infection in farm animals inWestern Europe appeared to become moreprevalent.Among the early reviews available

Total dysphagia after short course of systemic corticotherapy:Herpes simplex virus esophagitis

A 72 year-old female developed a herpetic esophagitis after 3 d of oral corticotherapy for an acute exacerbation of chronic obstructive pulmonary disease,presenting as odynophagia and total dysphagia.Biospies were taken during a first esophagogastroduodenoscopy(EGD) and the patient was referred to the thoracic surgery service with a presumptive diagnosis of esophageal cancer.A second EGD was planned for dilatation,but by that time the stenosis was completely resolved.The biopsies taken during the first EGD revealed multiple herpetic viral inclusions and ulcerations without any dysplasia or neoplasia.In front of a severe esophageal stenosis,one must still exclude the usual differential diagnosis peptic stenosis and cancer.Visualization of endoscopic lesions can suggest the diagnosis but must be promptly confirmed by biopsy,viral culture or polymerase chain reaction.Although immune systemic effects of corticotherapy are well known and herpetic esophagitis occurs most frequently in immunocompromised individuals,this case emphasizes the importance of clinical awareness concerning short courses of corticotherapy for immunocompetent individuals.This article discusses the reactivation process of herpetic infection in this context and addresses its diagnostic and therapeutic issues.

Intestinal histoplasmosis in immunocompetent adults

AIM: To present a retrospective analysis of clinical and endoscopic features of 4 cases of immunocompetent hosts with intestinal histoplasmosis(IH).METHODS: Four immunocompetent adults were diagnosed with IH between October 2005 and March 2015 at West China Hospital of Sichuan University. Clinical and endoscopic characteristics were summarized and analyzed retrospectively. GMS(Gomori methenamine silver), PAS(periodic acid-Schiff) and Giemsa staining technique were used to confirm Histoplasma capsulatum(H. capsulatum). The symptoms, signs, endoscopic presentations, radiographic imaging, pathological stain results and follow-up are presented as tables and illustrations.RESULTS: The cases were male patients, ranging from 33 to 61 years old, and primarily presented with nonspecific symptoms such as irregular fever, weight loss, abdominal pain and distention. Hepatosplenomegaly and lymphadenopathy were the most common signs. Endoscopic manifestations were localized or diffuse congestion, edema, ulcers, and polypoid nodules with central erosion involving the terminal ileum, ascendingcolon, transverse colon, descending colon, sigmoid colon and rectum, similar to intestinal tuberculosis, tumor, and inflammatory bowel disease. Numerous yeast-like pathogens testing positive for PAS and GMS stains but negative for Giemsa were detected in the cytoplasm of the histiocytes, which were highly suggestive of H. capsulatum.CONCLUSION: Immunocompetent individuals suffering from histoplasmosis are rarely reported. It is necessary that gastroenterologists and endoscopists consider histoplasmosis as a differential diagnosis, even in immunocompetent patients.

Tumour Localization of A Mitomycin C-Monoclonal Antibody MGb_2 Conjugate in Nude Mice with Human Gastric Carcinoma Xenografts

MGb2 is a monoclonal antibody againstgastric cancer.It can be well localized in thetumour tissue and has been successfully used inthe radioimmunoimaging in the patients withgastric cancer.The conjugate of MGb2 withchemotherapeutic drug mitomycin C（MMC）al-so shows highly selective cytotoxic effect uponhuman gastric cancer cells in vitro.

Within-brood body size and immunological differences in Blue Tit(Cyanistes caeruleus)nestlings relative to ectoparasitism

Several ectoparasites parasitise nestlings decreasing their body condition,growth and survival.To minimise any loss of fitness due to ectoparasites,birds have developed a wide variety of defence mechanisms,potentially including hatching asynchrony.According to the Tasty Chick Hypothesis(TCH),the cost of parasitism would be reduced if ectoparasites tend to eat on less immunocompetent nestlings,typically the last-hatched chick in asynchronously hatched broods,as they are in poor body condition.Two predictions of the TCH are that immune capacity is lower in smaller nestlings than in larger ones and that parasites should provoke a more negative effect on smaller nestlings.Here,we test these predictions in a population of Blue Tits(Cyanistes caeruleus)whose broods are parasitised by Hen Fleas(Ceratophyllus gallinae)and Blowflies(Protocalliphora azurea).We recorded the presence of both ectoparasites and analysed the immunocompetence(number of leucocytes per 10,000 erythrocytes and cutaneous immune response to phytohaemagglutinin)and body condition of smaller and larger nestlings within individual broods.The leucocyte count was higher in smaller nestlings than in larger ones,whereas the cutaneous immune response did not differ between smaller and larger nestlings.Smaller nestlings,but not larger nestlings,had lower body mass when fleas were present.Blowflies,by contrast,had no detectable negative effect on nestlings.Overall,our findings provide partial support to the TCH.Lower immune capacity in smaller nestlings than in larger ones was not supported,but Hen Fleas seemed to negatively impact on smaller nestlings more than on larger ones.

Extensively drug-resistant Salmonella typhi causing rib osteomyelitis: A case report

Rationale:Salmonella(S.)typhi is a rare cause of osteomyelitis in immunocompetent adults.Extensive drug resistance(XDR)may lead to more complicated cases of S.typhi osteomyelitis.Patient concern:A 55-year-old female presented with a persistent low-grade fever and a swelling on her lower left chest with a sinus discharging purulent fluid for the past 8 months.Her symptoms had been unresponsive to previous anti-microbial therapy.Diagnosis:Rib osteomyelitis caused by XDR S.typhi.Interventions:Surgical wound debridement,left 7th-9th rib resection and intravenous Ⅳ meropenem were done.Outcome:Fever resolved and left-sided swelling resected without recurrence.Lessons:The prevalence of XDR S.typhi is growing in South Asia and should be considered as the differential diagnosis of chronic osteomyelitis.

Enhancement of Immunological Activity of CpG ODN by Chitosan Gene Carrier

To investigate the enhancement of immunological activity of CpG ODN by chitosan gene carrier in mice, the effect of lymphocyte proliferation was detected in mice by using MTT, the levels of IgG and cytokines （IL-2 and IL-12） in serum were measured by ELISA and peripheral blood T lymphocyte subsets CD4^＋, CD8^＋ were analyzed by flow cytometry. Our results showed that spleen lymphocytes isolated from the CS-CpG ODN group of mice showed the strongest proliferation （SI =1.551）, and the levels of IgG, IL-2 and IL-12 in serum were higher than those of other groups. Compared with the immunization with CpG ODN, the immunization with CS-CpG ODN gene carrier was more efficient in up-regulating the percentage of CD4^＋T cells and the ratio of CD4^＋/CD8^＋ of mice, It was concluded that CS gene carrier of CpG ODN was much more effective in improving immunity of CpG ODN in mice.

Isolated cryptococcal osteomyelitis of the ulna in an immunocompetent patient:A case report

BACKGROUND Cryptococcal osteomyelitis is a bone infection caused by cryptococcus.As an opportunistic infection,bone cryptococcosis usually occurs in patients with immunodeficiency diseases or in those undergoing immunosuppressive therapy and often displays characteristics of disseminated disease.Isolated cryptococcal osteomyelitis is extremely unusual in immunocompetent person.The pathogenic fungus often invades vertebrae,femur,tibia,rib,clavicle,pelvis,and humerus,but the ulna is a rare target.CASE SUMMARY A 79-year-old woman complaining of chronic pain,skin ulceration and a sinus on her right forearm was admitted,and soon after was diagnosed with cryptococcal osteomyelitis in the right ulna.Unexpectedly,she was also found to have apparently normal immunity.After treatment with antifungal therapy combined with surgery debridement,the patient’s osteomyelitis healed with a satisfactory outcome.CONCLUSION Although rare,cryptococcal osteomyelitis should be considered in the differential diagnosis of osteolytic lesions even in immunocompetent patients,and good outcomes can be expected if early definitive diagnosis and etiological treatment are established.

Pulmonary nocardiosis due to Nocardia otitidiscaviarum in an immunocompetent host-A rare case report

Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients.We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever,cough with scanty sputum,hemoptysis,left sided chest pain and exertional dyspnea for two weeks.There was no past history of tuberculosis,diabetes mellitus or steroid therapy.Chest X-ray showed homogenous peripherally based opacity in the left upper zone.Bronchoscopy was done and brushing sent for culture,which showed colonies with features of Nocardia species after 48 hours.Further phenotypic characterization revealed it to be Nocardia otitidiscaviarum.Patient was treated with cotrimaxazole for six months after which complete recovery was evidenced symptomatically and radiologically.We report this case to emphasize the fact that among the Nocardia species,Nocardia otitidiscaviarum as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals.