Clinical Infection in Practice最新文献_第2页

A case of ibrutinib-associated cryptococcal meningitis with a steroid-responsive immune reconstitution syndrome 依鲁替尼相关隐球菌性脑膜炎伴类固醇反应性免疫重建综合征1例

Clinical Infection in Practice Pub Date : 2025-08-01 DOI: 10.1016/j.clinpr.2025.100505

Peter Crook , Elisabeth Grey-Davies , Faraan Khan , Tihana Bicanic

{"title":"A case of ibrutinib-associated cryptococcal meningitis with a steroid-responsive immune reconstitution syndrome","authors":"Peter Crook , Elisabeth Grey-Davies , Faraan Khan , Tihana Bicanic","doi":"10.1016/j.clinpr.2025.100505","DOIUrl":"10.1016/j.clinpr.2025.100505","url":null,"abstract":"<div><h3>Background</h3><div>Cryptococcus is an important cause of central nervous system infection in immunocompromised hosts. Although best described in those with advanced HIV infection, it is increasingly being seen in other settings, including in patients on ibrutinib (a Bruton tyrosine kinase inhibitor). In order to manage this opportunistic infection well, clinicians must understand both the pathogen and the host immune system.</div></div><div><h3>Case Report</h3><div>We present a case of cryptococcal meningitis (CM) in an HIV-negative patient on ibrutinib for chronic lymphocytic leukaemia. At presentation, he was fungaemic with <em>Cryptococcus neoformans</em> and had a lymphocytic cerebrospinal fluid (CSF) with positive cryptococcal antigen. He improved initially with liposomal amphotericin B and flucytosine. Four weeks into treatment, however, he suffered an unexpected clinical and radiological deterioration, with new confusion and hallucinations, accompanied by widespread leptomeningeal enhancement and new occipital micro-abscesses on neuroimaging. CSF cultures remained sterile and his deterioration was attributed to an inflammatory phenomenon due to immune reconstitution, following cessation of ibrutinib and fungal clearance. He was treated with steroids with a good radiological and clinical response.</div></div><div><h3>Discussion</h3><div>An immune reconstitution inflammatory syndrome is well described in HIV; there is also increasing recognition of a post-infectious inflammatory response syndrome in non-HIV-associated CM. This case highlights the challenge of managing opportunistic infections in novel risk groups of immunocompromised hosts and illustrates the dynamic interplay between pathogen and host immunity. We review here the key immune mechanisms involved in inflammatory syndromes relating to cryptococcal meningitis.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"27 ","pages":"Article 100505"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

H5N1 resurgence in Cambodia: A warning sign of global zoonotic vulnerability H5N1在柬埔寨死灰复燃：全球人畜共患易感性的警告信号

Clinical Infection in Practice Pub Date : 2025-08-01 DOI: 10.1016/j.clinpr.2025.100506

Shriyansh Srivastava , Dheeraj Sharma , G.S.N. Koteswara Rao , Sanjit Sah , Aroop Mohanty , Rachana Mehta

引用次数: 0

Resurgent COVID-19 in Southeast Asia: A critical opinion of emerging trends, public health gaps, and future preparedness 2019冠状病毒病在东南亚死灰复燃：对新趋势、公共卫生差距和未来防范的批评意见

Clinical Infection in Practice Pub Date : 2025-08-01 DOI: 10.1016/j.clinpr.2025.100507

Sudip Bhattacharya , Alok Singh , Rachana Mehta , Aroop Mohanty , Sanjit Sah , Ranjan K Mohapatra , Jaime David Acosta-España , Lysien Zambrano , Alfonso J. Rodriguez-Morales.

引用次数: 0

Corrigendum to “Carbapenemase-producing Enterobacterales Screening: Focused patient insights” [Clin. Infect. Pract. 26 (2025) 100491] “产碳青霉烯酶肠杆菌筛选：重点患者洞察”的勘误表[临床。感染。惯例26 (2025)100491]

Clinical Infection in Practice Pub Date : 2025-07-09 DOI: 10.1016/j.clinpr.2025.100501

Saba Farrukh , Jessica Martin , Caroline Chilton , Gillian Fox , Christopher Michael Rooney

引用次数: 0

Emerging Covid-19 subvariants and waning immunity: A renewed threat to India’s public health 新出现的Covid-19亚型和免疫力下降：对印度公共卫生的新威胁

Clinical Infection in Practice Pub Date : 2025-06-26 DOI: 10.1016/j.clinpr.2025.100500

Shriyansh Srivastava , Dheeraj Sharma , Malakapogu Ravindra Babu , Muhammed Fairoos A , Sachin Kumar , Aroop Mohanty , Sanjit Sah , Ranjan K. Mohapatra , Rachana Mehta

引用次数: 0

Re-emergence of KFD and the public health imperative Kyasanur Forest Disease in Karnataka – a silent storm in the tropics KFD的再次出现和卡纳塔克邦的公共卫生迫切需要的Kyasanur森林病-热带地区的无声风暴

Clinical Infection in Practice Pub Date : 2025-06-15 DOI: 10.1016/j.clinpr.2025.100499

Tarun Kumar Suvvari, Rachana Mehta, Sakshi Sharma, Aroop Mohanty, Shriyansh Srivastava, Sanjit Sah

引用次数: 0

Determinants of mortality in HIV-associated cryptococcal meningitis in Vietnam: Implications for optimizing management for resource-limited settings 越南hiv相关隐球菌脑膜炎死亡率的决定因素：资源有限环境下优化管理的意义

Clinical Infection in Practice Pub Date : 2025-05-31 DOI: 10.1016/j.clinpr.2025.100497

Tra Thu Doan , Ngan Thi Dieu Ta , Hai Ngoc Bui , Thanh Van Do , Vuong Minh Nong , Thach Ngoc Pham , Cuong Duy Do , Co Xuan Dao , Giap Van Vu

{"title":"Determinants of mortality in HIV-associated cryptococcal meningitis in Vietnam: Implications for optimizing management for resource-limited settings","authors":"Tra Thu Doan , Ngan Thi Dieu Ta , Hai Ngoc Bui , Thanh Van Do , Vuong Minh Nong , Thach Ngoc Pham , Cuong Duy Do , Co Xuan Dao , Giap Van Vu","doi":"10.1016/j.clinpr.2025.100497","DOIUrl":"10.1016/j.clinpr.2025.100497","url":null,"abstract":"<div><h3>Background</h3><div>Cryptococcal meningitis causes substantial HIV-related mortality globally.</div></div><div><h3>Aim</h3><div>This study aimed to identify determinants of mortality among HIV-infected adults with cryptococcal meningitis in Vietnam to inform targeted intervention strategies.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed medical records of 51 HIV-infected adults hospitalized for cryptococcal meningitis at two major hospitals in Hanoi, Vietnam from January 2018 to June 2023. Patients were eligible if aged ≥ 18 years, had confirmed HIV infection, and CSF testing positive for <em>Cryptococcus neoformans</em>. Demographic, clinical, treatment, and outcome data were extracted from paper and electronic records using a standardized collection form. Determinants of mortality using Kaplan-Meier survival and Cox proportional hazards regression analysis.</div></div><div><h3>Results</h3><div>Of 51 cryptococcal meningitis patients, 18 (35 %) died during hospitalization over 1319 days of follow-up. Non-survivors were older, had more comorbidities, lower CD4 counts, and higher illness severity compared to survivors. Labs showed non-survivors had more inflammation, organ injury, and severe neurological abnormalities. Despite similar initial antifungal therapy, non-survivors received shorter amphotericin B courses and had more antibiotic use, reduced fluconazole susceptibility, and complications. Using multivariate Cox regression, we found lower CD4 counts, neurological abnormalities, and delayed amphotericin B initiation were associated with higher mortality.</div></div><div><h3>Conclusion</h3><div>Out findings identify low CD4 cell counts due to late presentation and inadequate antifungal therapy duration as independent predictors of mortality. These findings support implementation of early HIV diagnosis, cryptococcal screening, and optimized antifungal protocols in comparable resource-limited settings.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"27 ","pages":"Article 100497"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Tropical diseases and climate changes: the absence of global mitigation plans 热带病和气候变化：缺乏全球缓解计划

Clinical Infection in Practice Pub Date : 2025-05-30 DOI: 10.1016/j.clinpr.2025.100498

Rajiv Gandhi Gopalsamy , Athesh Kumaraswamy , Lucas Alves da Mota Santana , Marina dos Santos Barreto , Eloia Emanuelly Dias Silva , Deise Maria Rego Rodrigues Silva , Pedro Henrique Macedo Moura , Ronaldy de Santana Santos , Adriana Gibara Guimarães , Lysandro Pinto Borges

引用次数: 0

Artificial stone silicosis presenting as suspected Tuberculosis: A series of 3 cases at a district general hospital 以疑似结核为表现的人工石质矽肺病：某区综合医院3例

Clinical Infection in Practice Pub Date : 2025-05-16 DOI: 10.1016/j.clinpr.2025.100495

Aimal Ahmad Khan , Veshalee Vernugopan , Gabriel Wallis , Johanna Feary

引用次数: 0

Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient 播散性组织胞浆菌病引起免疫功能低下患者的噬血细胞性淋巴组织细胞增多症

Clinical Infection in Practice Pub Date : 2025-04-01 DOI: 10.1016/j.clinpr.2025.100488

N.El Bardai , L.M. Vos , H.L. Leavis , M. Jak , A.H.W. Bruns , M. Limper

{"title":"Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient","authors":"N.El Bardai , L.M. Vos , H.L. Leavis , M. Jak , A.H.W. Bruns , M. Limper","doi":"10.1016/j.clinpr.2025.100488","DOIUrl":"10.1016/j.clinpr.2025.100488","url":null,"abstract":"<div><h3>Background</h3><div>The search for the trigger of hemophagocytic lymphohistiocytosis (HLH) and its management can be challenging in immunocompromised patients. In HLH triggered by infection, immunosuppressive therapy is desired to suppress hyperinflammation, but may worsen the underlying infection.</div></div><div><h3>Objectives</h3><div>To review available literature on the management and prognosis of immunocompromised patients with disseminated histoplasmosis induced HLH.</div></div><div><h3>Methods</h3><div>We describe a case and review all previously reported cases of disseminated histoplasmosis induced HLH on PubMed until June 2023.</div></div><div><h3>Results</h3><div>The literature review yielded 30 cases. Antifungal therapy was administered in all except one patient. In 18 cases, HLH was treated with immunosuppressive therapy. The most common immunosuppressive regimens were corticosteroid monotherapy and corticosteroids combined with etoposide. This case report is the first to describe the use of anakinra. The overall mortality rate was 23.3 % (n = 7).</div></div><div><h3>Conclusions</h3><div>Disseminated histoplasmosis induced HLH is a severe disorder, requiring prompt recognition and immediate intervention. Currently, no specific treatment protocol exists for this disorder. Treatment should be tailored to the patient’s condition, symptoms and individual characteristics. Careful consideration regarding immunosuppressive therapy for HLH is needed to prevent worsening of the infection. Additionally, anticipating the progression of the disease is necessary to ensure timely and appropriate interventions.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"26 ","pages":"Article 100488"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0