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Pneumocystis jirovecii colonization and infection among non HIV-infected patients.

Pneumocystis jirovecii colonization and infection among non HIV-infected patients.

Med Mal Infect. 2011 Aug 22;

Authors: Fily F, Lachkar S, Thiberville L, Favennec L, Caron F

Abstract
OBJECTIVE AND METHOD: The epidemiology of pneumocystosis has changed in the last decade with a decreased incidence in HIV infected patients, and the emerging concept of Pneumocystis colonization. The study objective was to describe Pneumocystis infection as well as colonization among non-HIV infected patients in the Rouen teaching hospital and cancer institute. A retrospective study was made of all patients with a positive respiratory sample for Pneumocystis jirovecii between January 1, 2000 and June 6, 2007. RESULTS: Fifty-four cases were reported (46 cases of pneumocystosis and eight of asymptomatic carriage) and an increasing yearly incidence over the study period was observed. Underlying diseases for pneumocystosis were haematological malignancies (n=25; 54%), organ transplantation (n=8; 17.4%), inflammatory disorders (n=6; 13%), and solid cancer (n=5; 10.8%). Sixty-five per cent of patients were under long-term steroid therapy. The overall mortality rate was 21.4%. The CD4 count for 26 patients, ranged from 18 to 1449/mm(3) (median: 107). Eight cases of asymptomatic carriage were reported with an underlying immunodepression (n=6) and pulmonary disease (n=2). DISCUSSION: The increasing incidence of pneumocystosis in immunosuppressed patients without AIDS is due to more frequent favorable conditions and progress of diagnostic tools. The clinical presentations are severe. Prophylaxis is badly codified because there is no threshold value for CD4 count. Colonization could present a warning value.

PMID: 21864998 [PubMed - as supplied by publisher]

Nasal-associated lymphoid tissue immunity and vaccine development.

Nasal vaccination is an effective therapeutic regimen for preventing upper respiratory infectious diseases. In the development of nasal vaccine, an appropriate adjuvant is required.

In the present study, we examined the efficacy of fms-like tyrosine kinase receptor-3 ligand (Flt3L) as a mucosal adjuvant. Mice were immunized intranasally with Flt3L and P6 protein of nontypeable Haemophilus influenzae (NTHi), and P6-specific immune responses were examined. In addition, NTHi challenges were performed and the level of NTHi was quantified in nasal washes. Nasal vaccination with P6 and Flt3L induced an increase in the number of dendritic cells in nasal-associated lymphoid tissue. P6-specific nasal wash immunoglobulin (Ig)A and serum IgG titers were elevated significantly after nasal immunization. Enhanced NTHi clearance from the nasopharynx was also observed.

These results indicate the potential of Flt3L as an effective mucosal adjuvant and suggest that nasal vaccination with P6 and Flt3L might be an effective regimen for the induction of NTHi-specific protective immunity.

Infection control knowledge, attitudes, and practices among cystic fibrosis patients and their families

ConclusionsThis study revealed that many CF patients and families are aware of the infection control guidelines, but that few had discussed them more than once with their CF teams. These findings underscore the importance of engaging patients and their families in regular discussions about infection control that address questions and concerns including the potential impact of infection control on health and well‐being. Further strategies are needed to overcome barriers to implementing these guidelines. Pediatr Pulmonol. © 2011 Wiley‐Liss, Inc. (Source: Pediatric Pulmonology)

Respiratory Tract Infections: Advances in Diagnosis, Management and Prevention

Respiratory tract infections are common and remain a major source of morbidity, mortality, and economic cost worldwide, despite advances in modern medicine. In fact, often as a consequence of progress in acute and chronic disease management, we have created patient populations at increased risk for immune impairment and for one specific respiratory infection, pneumonia. In 2004, pneumonia, along with influenza, was the eighth leading cause of death in the United States, the sixth leading cause of death in those over age 65, and the number one cause of death from infectious diseases. Patients at risk for pneumonia include not only previously healthy individuals, as well as the elderly with complex chronic illnesses, but also patients hospitalized for other illness, as well as those with nov...

Biomarkers to Optimize Antibiotic Therapy for Pneumonia Due To Multidrug-Resistant Pathogens

No currently available biomarker can be used as a diagnostic marker for ventilator-associated pneumonia due to multidrug-resistant pathogens. Procalcitonin can be used to customize the duration of antimicrobial treatment without excess morbidity and mortality: when its concentration is less than 0.5 ng/mL or has decreased by 80% or more compared with the peak concentration, antibiotics can be stopped. With this strategy, extreme vigilance must be maintained after terminating antimicrobial therapy to detect a recurrent infection. (Source: Clinics in Chest Medicine)

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