Sporotrichosis: An Emerging Neglected Opportunistic Infection in HIV-Infected Patients in Rio de Janeiro,Brazil

Sporotrichosis associated with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil, affecting a large at-risk population, which includes HIV-infected individuals. We assessed patients co-infected by Sporothrix spp. and HIV over time in the context of an unabated sporotrichosis epidemic.A retrospective cohort retrieved information from a National reference institute for infectious diseases regarding 48 patients with sporotrichosis-HIV co-infection (group 1) as well as 3,570 patients with sporotrichosis (group 2), from 1987 through March 2013. Most patients from group 1 were male (68.8%), whereas women were predominant in group 2 (69.1%; p<0.0001). Patients from group 1 were younger than those from group 2 (μ = 38.38±10.17 vs. 46.34±15.85; p<0.001) and differed from group 2 in terms of their race/ethnic background, with 70.8% non-white patients in group 1 vs. 38.6% from group 2 (p<0.0001). Close to half (∼44%) of the patients from group 1 were hospitalized due to sporotrichosis over time, whereas hospitalization was very unlikely in group 2, among whom approximately 1% were hospitalized over time. Dissemination of sporotrichosis was the main cause of hospitalization in both groups, although it was more common among hospitalized patients from group 1 (19/21 [90.5%] vs. 16/37 [43.2%]; p<0.001). Over the period under analysis, eight patients died due to sporotrichosis (3/48 vs. 5/3,570). The diagnosis of sporotrichosis elicited HIV testing and subsequent diagnosis in 19/48 patients, whereas 23/48 patients were simultaneously diagnosed with the two infections.HIV infection aggravates sporotrichosis, with a higher incidence of severe disseminated cases and a higher number of hospitalizations and deaths. Underserved populations, among whom sporotrichosis has been propagated, have been affected by different transmissible (e.g., HIV) and non-transmissible diseases. These populations should be targeted by community development programs and entitled to integrated management and care of their superimposed burdens.     

Opportunistic zygomycotic infections

This is a literature review of 361 opportunistic fungal infections caused by the Zygomycetes. The clinical and laboratory diagnosis, pathogenesis, management, treatment, and outcome of infection are discussed. The Zygomycetes are a group of opportunistic fungi (orders Mucorales and Entomophthorales) which cause severe infections which may be fatal. Early clinical recognition, prompt diagnostic procedures, control of underlying disease and treatment with high doses of amphotericin B and aggressive surgery increases survival in an otherwise lethal infection.     

Urine Stasis Predisposes to Urinary Tract Infection by an Opportunistic Uropathogen in the Megabladder (Mgb) Mouse

Purpose

Urinary stasis is a risk factor for recurrent urinary tract infection (UTI). Homozygous mutant Megabladder (Mgb-/-) mice exhibit incomplete bladder emptying as a consequence of congenital detrusor aplasia. We hypothesize that this predisposes Mgb-/- mice to spontaneous and experimental UTI.

Methods

Mgb-/-, Mgb+/-, and wild-type female mice underwent serial ultrasound and urine cultures at 4, 6, and 8 weeks to detect spontaneous UTI. Urine bacterial isolates were analyzed by Gram stain and speciated. Bladder stones were analyzed by x-ray diffractometry. Bladders and kidneys were subject to histologic analysis. The pathogenicity of coagulase-negative Staphylococcus (CONS) isolated from Mgb-/- urine was tested by transurethral administration to culture-negative Mgb-/- or wild-type animals. The contribution of urinary stasis to CONS susceptibility was evaluated by cutaneous vesicostomy in Mgb-/- mice.

Results

Mgb-/- mice develop spontaneous bacteriuria (42%) and struvite bladder stones (31%) by 8 weeks, findings absent in Mgb+/- and wild-type controls. CONS was cultured as a solitary isolate from Mgb-/- bladder stones. Bladders and kidneys from mice with struvite stones exhibit mucosal injury, inflammation, and fibrosis. These pathologic features of cystitis and pyelonephritis are replicated by transurethral inoculation of CONS in culture-negative Mgb-/- females, whereas wild-type animals are less susceptible to CONS colonization and organ injury. Cutaneous vesicostomy prior to CONS inoculation significantly reduces the quantity of CONS recovered from Mgb-/- urine, bladders, and kidneys.

Conclusions

CONS is an opportunistic uropathogen in the setting of urinary stasis, leading to enhanced UTI incidence and severity in Mgb-/- mice.     

Host Genetic Background Influences the Response to the Opportunistic Pseudomonas aeruginosa Infection Altering Cell-Mediated Immunity and Bacterial Replication

Pseudomonas aeruginosa is a common cause of healthcare-associated infections including pneumonia, bloodstream, urinary tract, and surgical site infections. The clinical outcome of P. aeruginosa infections may be extremely variable among individuals at risk and patients affected by cystic fibrosis. However, risk factors for P. aeruginosa infection remain largely unknown. To identify and track the host factors influencing P. aeruginosa lung infections, inbred immunocompetent mouse strains were screened in a pneumonia model system. A/J, BALB/cJ, BALB/cAnNCrl, BALB/cByJ, C3H/HeOuJ, C57BL/6J, C57BL/6NCrl, DBA/2J, and 129S2/SvPasCRL mice were infected with P. aeruginosa clinical strain and monitored for body weight and mortality up to seven days. The most deviant survival phenotypes were observed for A/J, 129S2/SvPasCRL and DBA/2J showing high susceptibility while BALB/cAnNCrl and C3H/HeOuJ showing more resistance to P. aeruginosa infection. Next, one of the most susceptible and resistant mouse strains were characterized for their deviant clinical and immunological phenotype by scoring bacterial count, cell-mediated immunity, cytokines and chemokines profile and lung pathology in an early time course. Susceptible A/J mice showed significantly higher bacterial burden, higher cytokines and chemokines levels but lower leukocyte recruitment, particularly neutrophils, when compared to C3H/HeOuJ resistant mice. Pathologic scores showed lower inflammatory severity, reduced intraluminal and interstitial inflammation extent, bronchial and parenchymal involvement and diminished alveolar damage in the lungs of A/J when compared to C3H/HeOuJ. Our findings indicate that during an early phase of infection a prompt inflammatory response in the airways set the conditions for a non-permissive environment to P. aeruginosa replication and lock the spread to other organs. Host gene(s) may have a role in the reduction of cell-mediated immunity playing a critical role in the control of P. aeruginosa infection. These results now provide a basis for mapping genomic regions underlying host susceptibility to P. aeruginosa infection.     

Opportunistic emissions of volatile isoprenoids

Isoprene, monoterpenes and sesquiterpenes are synthesized and emitted by some plant species, but not all plant species have this ability. These volatile, nonessential isoprenoid compounds share the same biochemical precursors as larger essential isoprenoids such as gibberellic acids and carotenoids. They have many protective and ecological functions for the plant species that produce them, but plant species that do not produce these compounds also grow and reproduce successfully. Here, we develop an 'opportunist hypothesis' suggesting that (i) volatile isoprenoid production takes advantage of dimethylallyl diphosphate (DMAPP) and its isomer isopentenyl diphosphate (IPP), which are synthesized primarily to produce essential isoprenoids, and (ii) conditions affecting synthesis of the higher isoprenoids will affect the production and emission of volatile isoprenoids.     

血清IL-2、IL-16水平的变化和艾滋病患者机会性感染的关系探究

目的:研究血清IL-2、IL-16水平的变化和艾滋病患者机会性感染的关系。方法:选择2016年1月至2018年10月在我院接受治疗的艾滋病患者120例作为观察组,根据美国疾病预防控制中心及世界卫生组织标准将其分为三期,A期24例,B期41例,C期55例,其中96例为机会性感染者。同期选择20例在本院进行正常体检者作为对照组。观察组采用高效抗逆转录病毒疗法(HAART)治疗。检测和比较各期艾滋病患者与对照组、机会性感染组与非机会性感染组、艾滋病各期治疗前后血清白介素-2(IL-2)、白介素-16(IL-16)、CD4~+细胞、CD8~+细胞计数的差异。结果:观察组各期艾滋病患者血清IL-2、IL-16水平明显低于对照组,且C期患者血清IL-2、IL-16水平均显著低于A、B期患者(P0.05);观察组及各期患者CD4~+细胞计数均低于对照组,CD8~+细胞计数均高于对照组,且C期患者CD4~+细胞计数均显著低于A、B期患者,CD8~+细胞计数均高于A、B期患者(P0.05);机会性感染组患者血清IL-2、IL-16水平明显低于非机会性感染组(P0.05);治疗后,观察组各期患者血清IL-2、IL-16水平较治疗前明显显著升高,且A期患者血清IL-2、IL-16显著高于B、C期患者(P0.05)。结论:艾滋病机会性感染患者血清IL-2、IL-16水平均显著降低,通过监测血清IL-2、IL-16水平可积极防治机会性感染。     

荧光假单胞菌的条件致病性

作者从血、尿标本中分离出12株荧光假单胞菌,在研究生物学性状的基础上探讨了本菌的条件致病性问题,结果显示,凡能使机体免疫力下降的各种原因均可导致本菌感染。治疗本菌感染,必须进行药敏试验,选择有效的抗生素。     

Opportunistic bacteria detected in cultivated mussels

As many as 8 Listeria monocytogenes strains, 12 Pseudomonas aeruginosa strains and 5 Staphylococcus aureus strains were isolated from mussels Mytilus edulis, grown on special installations in the Trinity Bay of the Gulf of Peter the Great, the Sea of Japan. The isolated cultures proved to be highly resistant to a number of antibiotics. Many strains displayed DNAase and haemolytic activity. The cultures of L. monocytogenes, S. aureus and P. aeruginosa also had high lipase, protease and lecithinase activity. The organism of the mussels seems to be a confinement for these bacteria under study.     

Opportunistic foraging by heteropteran mosquito predators

Tropical aquatic environments host a large number of predatory insects including heteropteran water bugs Anisops bouvieri Kirkaldy, 1704 (Heteroptera: Notonectidae), Diplonychus (=Sphaerodema) rusticus Fabricius, 1781 (Heteroptera: Belostomatidae), and Diplonychus (=Sphaerodema) annulatus Fabricius, 1781 (Heteroptera: Belostomatidae) feeding on a range of organisms. In tropical and subtropical wetlands, ponds, and temporary pools these predators play a role in regulation of dipteran populations, particularly mosquitoes and chironomids. Their relative abilities to control mosquitoes depend in part on predator preference for mosquitoes in relation to other natural prey, and the predators’ propensities to switch to mosquitoes as mosquito density increases. The prey electivity and switching dynamics of these predatory water bugs were evaluated in the laboratory under various prey densities, using two instars (II and IV) of chironomid and mosquito larvae as prey. Studies of electivity at relatively high densities (20 prey L⁻¹) in small (5 L) vessels demonstrated that all predators showed opportunistic foraging as the mosquito:chironomid ratio changed, with some evidence that mosquito larvae were positively selected over chironomids. In particular, Anisops showed strong electivity for mosquitoes when presented with any ratio of large mosquito and chironomid prey in the high density experiment, although the preference was not expressed in lower density (2.5 prey L⁻¹) treatments executed in 40 L vessels. In these lower density treatments, D. rusticus demonstrated higher electivity for mosquitoes when the mosquito:chironomid ratio was high, consistent with non-significant trends observed in the higher density experiment. The positive electivity of D. rusticus for mosquitoes was reinforced in an experiment executed over 16 days at varying prey ratios, in which D. rusticus mosquito electivity was high and consistent while D. annulatus showed slight avoidance of mosquito larvae, and Anisops remained largely opportunistic in foraging on prey in proportion with availability. Anisops and D. rusticus are potentially good biocontrol agents for mosquito larvae, in that they preferentially consume mosquitoes under many circumstances but can readily forage on other prey when mosquito density is low.     

Risk Factor Analyses for Immune Reconstitution Inflammatory Syndrome in a Randomized Study of Early vs. Deferred ART during an Opportunistic Infection

Background

Immune reconstitution inflammatory syndrome (IRIS) is reported widely in patients initiating antiretroviral therapy (ART). However, few studies are prospective, and no study has evaluated the impact of the timing of ART when allocated randomly during an acute opportunistic infection (OI).

Methodology/Principal Findings

A5164 randomized 282 subjects with AIDS-related OIs (tuberculosis excluded), to early or deferred ART. IRIS was identified prospectively using pre-defined criteria. We evaluated associations between IRIS and baseline variables in subjects with follow-up on ART using Wilcoxon and Fisher''s exact tests, logistic regression, and Cox models with time-varying covariates. Twenty of 262 (7.6%) subjects developed IRIS after a median of 33 days on ART. Subjects with fungal infections (other than pneumocystis) developed IRIS somewhat more frequently (OR = 2.7; 95% CI: 1.02, 7.2; p-value = 0.06 (using Fisher''s exact test)). In Cox models, lower baseline and higher on-treatment CD4+ T-cell counts and percentage were associated with IRIS. Additionally, higher baseline and lower on-treatment HIV RNA levels were associated with IRIS. Corticosteroids during OI management and the timing of ART were not associated with the development of IRIS.

Implications

In patients with advanced immunosuppression and non-tuberculous OIs, the presence of a fungal infection, lower CD4+ T-cell counts and higher HIV RNA levels at baseline, and higher CD4+ T-cell counts and lower HIV RNA levels on treatment are associated with IRIS. Early initiation of ART does not increase the incidence of IRIS, and concern about IRIS should not prompt deferral of ART.

Trial Registration

ClinicalTrials.gov {type:clinical-trial,attrs:{text:NCT00055120,term_id:NCT00055120}}NCT00055120     

Opportunistic infections in immunologically compromised nonhuman primates

Despite advances in the husbandry of nonhuman primates, natural and experimentally induced diseases continue to pose risks to animal health. These risks are particularly important when such disease results in immunodeficient states that provide an opportunity for the development of opportunistic infections. Because opportunistic agents may serve as significant confounders to research and hold potential for zoonotic transmission, knowledge of disease pathogenesis, surveillance, and risk reduction is particularly important to individuals who work closely with primates. Endogenous diseases of primates that result in blunted immune responses and thus allow for the development of opportunistic infection include simian type D retroviruses and measles. In addition, simian immunodeficiency virus is a frequently studied experimental cause of immunosuppression. This article focuses on clinical and pathological aspects of the most common opportunistic infections that occur in nonhuman primates maintained in research settings. The complete elimination of all infectious agents from primate colonies may be impossible and unwarranted, but microbial surveillance programs can help both to define the complement of agents present in a colony and to elucidate their potential impacts on colony health, zoonotic risk, and experimental research. We discuss risk reduction through the use of quarantine procedures, specific pathogen-free animals, and environmental controls.     

Opportunistic fungi in detroit's rats and opossum

Four Norway rats (Rattus norvegicus) and one opossum (Didelphis virginiana) were surveyed for the presence of fungi. Eighteen different fungi were isolated from rat samples and six from the opossum, includingTrichophyton mentagrophytes. Hair and skin scrapings from laboratory raised Norway rats, bedding and air from the room yielded onlyPenicillium sp.