1/13. High frequency of cytomegalovirus-specific cytotoxic T-effector cells in HLA-A*0201-positive subjects during multiple viral coinfections.How the cellular immune response copes with diverse antigenic competition is poorly understood. Responses of virus-specific cytotoxic T lymphocytes (CTL) were examined longitudinally in an individual coinfected with human immunodeficiency virus type 1 (hiv-1), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). CTL responses to all 3 viruses were quantified by limiting dilution analysis and staining with HLA-A*0201 tetrameric complexes folded with hiv-1, EBV, and CMV peptides. A predominance of CMV-pp65-specific CTL was found, with a much lower frequency of CTL to hiv-1 Gag and Pol and to EBV-BMLF1 and LMP2. The high frequency of CMV-specific CTL, compared with hiv-1- and EBV-specific CTL, was confirmed in an additional 16 HLA-A*0201-positive virus-coinfected subjects. Therefore, the human immune system can mount CTL responses to multiple viral antigens simultaneously, albeit with different strengths.- - - - - - - - - - ranking = 1keywords = coinfection (Clic here for more details about this article) |
2/13. cytomegalovirus and cryptosporidium infections in AIDS: a necropsy study.A case of coinfection of cytomegalovirus (CMV) and cryptosporidium in an AIDS patient is reported. Chronic diarrhea was the presenting symptom. Etiologic agents were diagnosed only at postmortem evaluation. CMV intranuclear inclusions were seen in the terminal ileum, colon and vermiform appendix. cryptosporidium oocysts were also present in the intestinal brush border of the colon. Improvement of diagnostic procedures such as colonic biopsy and the use of appropriate staining procedure for AIDS patients with diarrhea can help identify the cause of illness.- - - - - - - - - - ranking = 0.25keywords = coinfection (Clic here for more details about this article) |
3/13. rhodococcus equi and cytomegalovirus pneumonia in a renal transplant patient: diagnosis by fine-needle aspiration biopsy.rhodococcus equi is a common cause of pneumonia in animals. Human infection is rare. Increasing number of cases are being reported in immunosuppressed individuals mostly associated with HIV infection, but also in solid organ transplant recipients and leukemia/lymphoma patients. We report on an adult male who developed pneumonia and gastroenteritis 4 mo after receiving a renal transplant. CT scan of the lungs showed a dominant 2.5-cm upper lobe lung mass and smaller bilateral nodules. He underwent a diagnostic bronchoscopy with fine-needle aspiration biopsy of the largest lung nodule. Smears showed histiocytic granulomatous inflammation, foamy macrophages, and acute inflammatory exudate. Scattered foamy macrophages displayed intracellular coccobacilli identifiable on Diff-Quik stain. A few cells with changes suggestive of viral inclusions were identified. cytomegalovirus (CMV) immunostain was positive in the cell block sections. lung cultures grew R. equi. To the best of our knowledge, this is the first report of coinfection with R. equi and CMV.- - - - - - - - - - ranking = 0.25keywords = coinfection (Clic here for more details about this article) |
4/13. Rapid progression of hiv-1 infection to AIDS.Homosexually acquired human immunodeficiency virus type 1 infection is usually slowly progressive, and reports of its rapid progression to acquired immunodeficiency syndrome are rare. We present a case of acute human immunodeficiency virus type 1 and cytomegalovirus coinfection that progressed to acquired immunodeficiency syndrome and death in 7 months. The factors that determine the clinical outcome of human immunodeficiency virus type 1 infection are poorly defined; however, coinfection with other agents, such as cytomegalovirus, may influence its natural history.- - - - - - - - - - ranking = 0.5keywords = coinfection (Clic here for more details about this article) |
5/13. Oral valganciclovir in children: single dose pharmacokinetics in a six-year-old girl.We report a pharmacokinetic study in a 6-year-old girl with congenital human immunodeficiency virus type 1 and cytomegalovirus coinfection maintained on iv ganciclovir for 6 years. Increasing infection and thrombosis caused by her iv device necessitated alternative therapy. Single dose pharmacokinetics of ganciclovir 4.4 mg/kg iv and valganciclovir 13.2 and 26.3 mg/kg po were studied with high performance liquid chromatography/tandem mass spectrometry. The two oral dosages yielded areas under the concentration curve of 14.3 and 28.7 microg x h/ml, equivalent to 43% bioavailability of ganciclovir from valganciclovir, which exceeded the area under the concentration curve of 11.1 microg x h/ml yielded by ganciclovir 4.4 mg/kg iv. Oral valganciclovir achieved therapeutic and dosage-proportional plasma concentrations in the child we studied.- - - - - - - - - - ranking = 0.25keywords = coinfection (Clic here for more details about this article) |
6/13. Identification of cytomegalovirus in a liquid-based gynecologic sample using morphology, immunohistochemistry, and dna real-time PCR detection.The viral cytopathic effects of cytomegalovirus (CMV) are rarely encountered in conventional cervical vaginal smears and have never been reported in a liquid-based gynecologic sample (SurePath). We present results of a liquid-based gynecologic sample (SurePath) from an asymptomatic patient with classic CMV-associated granular or dense cyanophilic intracytoplasmic and intranuclear inclusion bodies with a clear surrounding zone. These inclusions were immunohistochemically positive for CMV. The patient also had human papilloma virus (HPV)-associated koilocytes that showed a unique perinuclear immunostaining pattern suggesting coinfection with both CMV and HPV. CMV amplification using real-time polymerase chain reaction (PCR) of dna extracted from the liquid-based sample confirmed the morphologic and immunohistochemical findings of CMV infection. These observations suggest that a liquid-based preparation can be used to assess CMV infection morphologically, immunohistochemically, and by real-time PCR.- - - - - - - - - - ranking = 0.25keywords = coinfection (Clic here for more details about this article) |
7/13. Idiopathic Cd4 T-lymphocytopenia--two unusual patients with cryptococcal meningitis.Idiopathic CD4 T-lymphocytopenia (ICL) is a syndrome characterised by the depletion in the CD4 T-cells but without evidence of HIV infection. Aside from low CD4 lymphocyte counts, the immunologic findings in these patients are distinct from the abnormalities found in HIV infection. There are numerous reports of ICL associated with different diseases and clinical conditions. opportunistic infections, mostly seen in HIV patients are the most common among them. We describe two patients without risk factors for human immunodeficiency virus (HIV) infection, each of whom presented with cryptococcal meningitis and was found to have idiopathic CD4 T-lymphocytopenia. One of them also acquired EBV and CMV coinfection of the central nervous system.- - - - - - - - - - ranking = 0.25keywords = coinfection (Clic here for more details about this article) |
8/13. Fatal case of aspergillus coinfection in a renal transplant recipient suffering from cytomegalovirus pneumonitis.cytomegalovirus (CMV) disease is common in postrenal transplant recipients, and may predispose the patients to secondary bacterial or fungal infections. However, simultaneous coinfection is rare and often makes diagnosis difficult. We report a case of CMV pneumonitis in a renal transplant recipient presenting with elevated CMV pp65 antigen level and abnormal chest radiograph. Despite potent and broad-spectrum antimicrobial therapy, his condition deteriorated rapidly - he soon went into respiratory failure, septic shock and died several days later. Transbronchial biopsy and bronchoalveolar lavage obtained before the patient's death showed evidence of invasive pulmonary aspergillosis with concomitant CMV pneumonitis. High index of suspicion and early and empirical initiation of antifungal therapy may be necessary for successful management of fulminant pneumonia in solid organ transplant recipients.- - - - - - - - - - ranking = 1.25keywords = coinfection (Clic here for more details about this article) |
9/13. bartonella quintana coinfection with mycobacterium avium complex and CMV in an AIDS patient: case presentation.BACKGROUND: As a greater number of HIV-infected patients survive despite profound immunodepression due to medical progress, we face complex infection with multiple agents in AIDS-patients. CASE PRESENTATION: We report the case of an AIDS patient with a primary clinical presentation suggestive of bacillary angiomatosis. We also found in cutaneous lesions mycobacterium avium complex and cytomegalovirus. CONCLUSION: This clinical case illustrates the possibility of multiple coinfections in AIDS patients and the need to be exhaustive in evaluating infectious diseases in severely immunocompromised patients.- - - - - - - - - - ranking = 1.25keywords = coinfection (Clic here for more details about this article) |
10/13. Fetal ascites and second trimester maternal hepatitis c virus infection.OBJECTIVE: To present the first reported case of early second trimester maternal hepatitis c virus (HCV) associated with fetal ascites, which was treated with fetal paracentesis, and resulted in a successful outcome of a term liveborn infant with anti-HCV seropositivity. CASE REPORT: A 26-year-old primigravida woman was diagnosed with acute HCV infection at 17 weeks of gestation. Ultrasound (US) at 23 weeks showed significant fetal as cites and echogenic bowel, and fetal viral infection was suspected. Maternal serum was positive for high HCV-rna titers and cytomegalovirus (CMV) IgG. amniocentesis, cordocentesis and therapeutic fetal paracentesis were performed at 23 weeks. Fetal karyotype was 46, XX. Cord blood showed anti-HCV positivity and HCV-rna titer < 10. amniotic fluid was anti-HCV and CMV IgG positive. US at 27 weeks showed complete resolution of fetal ascites. A healthy 2,976 g female baby was delivered at 37 weeks, with anti-HCV seropositivity, high HCV-rna titers, CMV IgG positive, IgM negative and normal liver function tests at the 1-month follow-up. CONCLUSION: Second trimester perinatal HCV infection with possible CMV coinfection associated with fetal ascites is a rare event. Fetal therapy resulting in a successful outcome has not been reported. Prompt fetal therapy with paracentesis in this case led to the delivery of a healthy term liveborn baby with anti-HCV seropositivity.- - - - - - - - - - ranking = 0.25keywords = coinfection (Clic here for more details about this article) |
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