Trichodysplasia spinulosa (TS) é uma doença proliferativa de pele observada em pacientes imunocomprometidos. Caracteriza-se pela formação de espinhas de queratina conhecidos como espículas, acantose epidérmica, dilatação do folículo piloso, queratose actínica, queda dos pelos, pápulas foliculares e, que normalmente, se manifestam na região facial do paciente e extremidades do corpo (constantemente confundida com danos por exposição prolongada ao sol). A TS resulta da infecção ativa com o poliomavírus TSassociado (TSPyV), onde observa-se alta carga viral, expressão de proteína do vírus e formação de partículas. Este estudo desenvolveu métodos moleculares de detecção e sequenciamento do genoma total e parcial de TSPyV e utilizou-se destes métodos para determinar padrões de excreção e viremia em indivíduos imunocompromentidos e imunocompetentes, bem como explorar possíveis vias de transmissão. Ainda, características genéticas e filogenéticas do TSPyV também foram determinadas. Apesar de observamos alta taxa de excreção urinaria em indivíduos imunocomprometidos (57,7%), o vírus não foi encontrado em amostras de água do meio ambiente. Ainda em termos de excreção urinária do TSPyV, apenas 1,4% dos indivíduos imunocompetentes apresentaram virúria (diferente do que se observa para os poliomavirus JCPyV e BKPyV), mas o vírus foi encontrado em leite materno, sugerindo assim a possibilidade de haver transmissão vertical do TSPyV. As análises filogenéticas revelaram a existência de 2 linhagens de vírus circulantes em nosso meio, com características distintas dos já descritos na literatura. As diferenças observadas foram suficientes para que os vírus sejam caracterizados como novos genótipos circulantes de TSPyV. / Trichodysplasia spinulosa (TS) is a proliferative skin disease seen in immunocompromised patients. It is characterized by the formation of keratin spines known as spicules, epidermal acanthosis, hair follicle dilatation, actinic keratosis, hair loss, follicular papules and, which usually manifest in the facial region and extremities of the body (constantly confounded with damage from prolonged exposure to the sun). TS results from active infection with TS-associated polyomavirus (TSPyV), where high viral load, virus protein expression and particle formation are observed. This study developed molecular methods for detection and sequencing the total and partial genome of TSPyV and, employing these methods, determined patterns of excretion and viremia in immunocompromised and immunocompetent individuals, as well as explored possible transmission pathways. Genetic and phylogenetic characteristics were also determined. Although we observed high rate of urinary shedding in immunocompromised individuals (57.7%), the virus was not found in environmental water samples. Also in terms of urinary excretion of TSPyV, only 1.4% of immunocompetent individuals presented viruria (different from what is observed for polyomaviruses JCPyV and BKPyV), but the virus was found in breast milk, thus suggesting the possibility of vertical transmission. Phylogenetic analyzes revealed the existence of 2 circulating virus strains in our country, with different characteristics from those already described in the literature. The differences seem to be sufficient to characterize the viruses as new genotypes of TSPyV.

Introduction: Pantoea agglomerans is a Gram negative ubiquitous bacteria commonly isolated from plant surfaces, seeds, fruits and animal/human feces usually introduced to human by ingestion of infected fruits/vegetables, thorn pricks and gastrointestinal translocation in lack of stomach acidity. However, the pathogen can also cause opportunistic human infection especially when the immune system is impaired. The aim of this case report is to investigate clinical features in a patient with P. agglomerans bacteremia and bring attention the opportunistic infection by this rare bacteria. Case presentation: We present a case of 57 year old caucasian lady with past medical history of Chronic Obstructive Pulmonary Disease, Atrial fibrillation, Immunoglobulin (IgG) deficiency, recurrent pneumonia, urine infection, oral/vaginal candidiasis, Gastro-esophageal reflux disease who presents with one week history of increased shortness of breath, chest tightness and productive cough without fever/chills. She also had high INR of 4.7 (target 2-3) despite taking normal dose of warfarin. She denies plant exposure. Her vitals were stable, saturation maintained with oxygen supplementation. Chest exam revealed very poor air entry bilaterally suggesting exacerbation of COPD. Oral thrush was present. Recent IgG level within last 6 months was low. Blood culture grew Pantoea agglomerans, pan-sensitive to most of the antibiotics. Chest X ray, CT scan abdomen and urine studies could not localize the source of infection. She was treated with Ceftriaxone, INR normalized to therapeutic range and she improved to baseline after 10 days of treatment. Discussion and conclusion: P. agglomerans is a rare cause of bacteremia which usually presents as fever, chills and general toxicity, however could also present as a cause of exacerbation of chronic diseases. Spontaneous infection can occur in a immunocompromised host, however the pathogen is of low virulence. The link between upper GI symptoms along with antacid receipt and spontaneous P. agglomerans infection could be possible, however needs further study. Hence, P. agglomerans should be considered one of the possible cause of spontaneous bacteremia in a immunocompromised host.

>Magister Scientiae - MSc / Insect-derived baculoviruses have been used extensively as a safe and versatile research model for transgenic protein expression. Preclinical studies have revealed the promising potential of Baculoviruses as a delivery vector for a variety of therapeutic applications, including vaccination, tissue engineering and cancer treatments. Coronaviruses are enveloped viruses containing linear, non-segmented ribonucleic acid. Human coronavirus NL63 was first discovered in the Netherlands in January 2004, where a 7-month-old girl presented with an acute respiratory tract infection that was later established to predominantly infect infants, the elderly and immunocompromised individuals. In addition to the known non-structural and structural proteins of coronaviruses, an accessory protein known as open reading frame 3 which is conserved in the Coronaviridae family has not been extensively researched. Open reading frame 3 encodes a putative membrane-bound protein. This study cloned the open reading frame 3 viral gene of 741 base pairs into the baculovirus expression construct via competent bacterial cell lines. Open reading frame 3-Baculovirus particles were generated in Spodoptera frugiperda insect cells. Recombinant cells containing the viral protein gene were used to infect healthy Spodoptera frugiperda 9 cells at varying ratios of multiplicity of infection over a fixed time-course. The open reading frame 3 viral protein was not detected by quantification methods at a molecular weight of 26 kilo Dalton, due to polyclonal antibody degradation.

It is often difficult to discern true mycobacterial infection from colonization due to Mycobacterium gordonae (. M. gordonae) since this organism is ubiquitous and is commonly an innocuous saprophyte. This study reports a rare case of caseating hilar adenopathy and pulmonary disease caused by M. gordonae in a patient with chronic obstructive pulmonary disease (COPD) and rheumatoid arthritis (RA) on maintenance steroids and methotrexate. Pathologic exam and cultures of lymph node excision biopsy and bronchoalveolar lavage (BAL) confirmed the diagnosis.Triple antimycobacterial therapy with azithromycin, ethambutol and rifabutin was administered. The patient had significant clinical and radiologic improvement and follow-up cultures confirmed microbiologic cure.Mycobacterium gordonae can be a rare cause of significant pulmonary infection, and positive sputum or BAL cultures for M. gordonae should not be automatically discarded and considered as nonpathogenic contaminants or colonizing organisms, especially in immunocompromised hosts with comorbidities. A detailed review of the case and relevant literature is provided.

Human herpesvirus 6 (HHV-6) infections occur in > 95% of humans. Primary infection, which occurs in early childhood as an asymptomatic illness or manifested clinically as roseola infantum, leads to a state of subclinical viral persistence and latency. Reactivation of latent HHV-6 is common after liver transplantation, possibly induced and facilitated by allograft rejection and immunosuppressive therapy. Since the vast majority of humans harbor the virus in a latent state, HHV-6 infections after liver transplantation are believed to be mostly due to endogenous reactivation or superinfection (reactivation in the transplanted organ). In a minority of cases, however, primary HHV-6 infection may occur when an HHV-6 negative individual receives a liver allograft from an HHV-6 positive donor. The vast majority of documented HHV-6 infections after liver transplantation are asymptomatic. In a minority of cases, HHV-6 has been implicated as a cause of febrile illness with rash and myelosuppression, hepatitis, pneumonitis, and encephalitis after liver transplantation. In addition, HHV-6 has been associated with a variety of indirect effects such as allograft rejection, and increased predisposition and severity of other infections including cytomegalovirus (CMV), hepatitis C virus, and opportunistic fungi. Because of the uncommon nature of the clinical illnesses directly attributed to HHV-6, there is currently no recommended HHV-6-specific approach to prevention. However, ganciclovir and valganciclovir, which are primarily intended for the prevention of CMV disease, are also active against HHV-6 and may prevent its reactivation after transplantation. The treatment of established HHV-6 disease is usually with intravenous ganciclovir, cidofovir, or foscarnet, complemented by reduction in the degree of immunosuppression. This article reviews the current advances in the pathogenesis, clinical diagnosis, and therapeutic modalities against HHV6 in the setting of liver transplantation.

In this report, we describe a case of a 61-year-old male patient who had the bacterium growing in a blood culture. It was susceptible to ampicillin, ceftriaxone, levofloxacin, and vancomycin but was intermediately resistant to erythromycin. The patient did not have a negative outcome as a consequence of this bacterium, which retrospectively could have been predicted based on the epidemiological data within the patient's profile.

Imunocomprometidos são pessoas susceptíveis a adquirir doenças graves a partir de alimentos contaminados, por possuírem um baixo número de células de defesa. Em consequência a este fato, apresentam alimentação extremamente restrita, evitando qualquer alimento que represente um risco microbiológico. A irradiação é uma das poucas tecnologias que permite garantir a segurança e a qualidade do alimento, controlando microrganismos patogênicos, sem afetar significativamente qualquer atributo organoléptico. Tomando-se por base a restrição alimentar em relação a produtos frescos, este trabalho destinou-se a estudar o efeito da radiação ionizante (raios gama) em saladas de frutas para pessoas imunocomprometidas. Para tanto, frutas minimamente processadas e saladas de frutas foram submetidas às doses de 0,5; 1,0; 1,5; 2,0 e 3,0 kGy e analisadas juntamente com as amostras controle (não irradiadas). Análises físico-químicas (cor, textura, acidez titulável total, pH, atividade de água, sólidos solúveis totais e açúcares solúveis), microbiológicas (estafilococos coagulase positiva, contagem de bolores e leveduras, contagem de bactérias aeróbias, coliformes totais, E. Coli e Salmonella) e sensoriais (testes de aceitação e degustação) foram realizadas, além da aplicação de questionários com chefes de nutrição de hospitais para o entendimento de práticas acerca da dieta hospitalar de imunocomprometidos. Os resultados demonstraram que a irradiação na dose de 3,0 kGy foi eficaz na eliminação de microrganismos da salada de frutas, garantindo a segurança microbiológica dentro dos níveis exigidos pela legislação. Em relação aos resultados físico-químicos, foram observadas alterações de cor e de textura com o aumento da dose de radiação. Resultados de pH, acidez, sólidos solúveis totais e atividade de água apresentaram flutuações de valores principalmente em função dos fatores intrínsecos da fruta, ao passo que saladas de frutas irradiadas com doses de 3,0 kGy, apresentaram uma tendência de ficar mais doces que as amostras controle, obtendo boa aceitação sensorial. Além disso, os resultados dos questionários realizados em hospitais reportaram uma necessidade de incorporar alimentos frescos à dieta nutricional dos imunocomprometidos, bem como a criação ou o estabelecimento de protocolos nutricionais no país para essa área. Sendo assim, com base nos resultados microbiológicos, físico-químicos e sensoriais pode-se concluir que saladas de frutas podem ser indicadas para o consumo de imunocomprometidos, desde que tratadas com a dose de 3,0 kGy e produzidas com Boas Práticas de Fabricação, respeitando os critérios de produção desde a matéria-prima até o produto final. / Immunocompromised individuals are susceptible to acquiring serious diseases from contaminated food, by having a low number of defense cells. As a result of this fact, they have an extremely restricted diet, avoiding any food that represents microbiological hazards. Irradiation is one of the few technologies that ensure the safety and quality of food, controlling pathogenic microorganisms without significantly affecting any organoleptic attribute. Based on dietary restriction in relation to fresh produce, this work was designed to study the effect of ionizing radiation (gamma rays) over fruit salad for immunocompromised individuals. For such, minimally processed fruits and fruit salad were subjected to doses of 0.5; 1.0; 1.5; 2.0 and 3.0 kGy and analyzed along with control samples (non irradiated). Analyzes were performed in the physicochemical (color, texture, titulabre total acidity, pH, water activity, total soluble solids and soluble sugars), microbiological (coagulase positive staphylococci, yeasts and molds count, count of aerobic bacteria, total coliforms, E. coli and Salmonella) and sensorial (acceptance testing and tastings) fields, besides the application of questionnaires with head of nutrition in hospitals to understand the practices of immunocompromised diet. The results showed that irradiation at the dose of 3.0 kGy was effective in eliminating microorganisms from fruit salad, ensuring the microbiological safety within the levels required by law. Regarding the physicochemical results, changes in color and texture with the increase in the dose of radiation were observed. Results of pH, acidity, total soluble solids and water activity values showed fluctuations mainly due to intrinsic factors of the fruit, while fruit salads irradiated with doses of 3.0 kGy, showed a tendency to get more sweet than the control samples, obtaining good sensorial acceptability. Furthermore, the results of questionnaires conducted in hospitals reported a need to incorporate fresh foods in the nutritional diet of immunocompromised individuals, as well as the creation or establishment of nutritional protocols in the country for that field. Thus, based on microbiological, physicochemical and sensorial results, it can be concluded that fruit salads may be indicated for the consumption of immunocompromised individuals, if treated with the dose of 3.0 kGy and produced with Good Manufacturing Practices, in compliance with the criteria of production from raw material to the end product.

Opportunistic infection is always a potentially life threatening complication in pediatric oncology patients and hematopoietic stem cell transplant recipients. With the advances in various disease treatment protocols, the overall and event-free survivals of this high risk population improve significantly. In this thesis, the author reported a number of original studies to discuss different strategies in prevention of this serious complication. Firstly, the author demonstrates that pediatric oncology patients are still vulnerable to various vaccine-preventable infectious diseases up to 18 months after stopping chemotherapy. For those vaccine-preventable infectious diseases, pediatric oncology patients can mount a significant and persistent immune response to common inactivated vaccine (namely diphtheria-tetanus-pertussis vaccine). For non-vaccine preventable infectious diseases, regular monitoring of plasma viral load and strategic use of antiviral agents as pre-emptive or prophylactic agent is an effective approach to prevent infection. In hematopoietic stem cell transplant setting, adoptive transfer of acquired immunity from donor to recipient and incorporation of this parameter in donor selection process can be considered. The findings of the studies can be applied to clinical setting. The future direction of our studies includes the immune responses of other common vaccines namely pneumococcal vaccine and pandemic influenza vaccine in high risk population. The role of transfer of donor's varicella zoster immunity in prevention of herpes zoster infection in transplant recipient can be further explored. With the advances in supportive care of our vulnerable patients, the survival rate is expected to be further improved in the future. / by Frankie Wai Tsoi, Cheng. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 193-208). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

The mental and physical benefits of pet ownership are well established; however, pets can also transmit pathogens to people, with children, elderly, pregnant and immunocompromised individuals at greatest risk of disease. Little is known about the public’s knowledge and practices related to pet-associated disease. Questionnaires were distributed at two general practice physician clinics and to parents/guardians of children diagnosed with diabetes or cancer at specialty practice clinics. Pet ownership and contact were common, with 64-66% of participants having a pet in their household. Acquisition of a new pet, including high-risk pets, was common (20%) following a diagnosis of cancer in children. Pet exposure outside the home was frequently reported for individuals in pet and non-pet owning households (25-52%). Education of respondents about diseases was poor, as only approximately one-third recalled receiving pet-associated disease information. Parents of cancer patients were more likely than parents of diabetes patients to recall receiving this information, yet proportions were low in both groups (32% and 13%, respectively). Respondents’ knowledge of pet-associated pathogens was similar between the groups, with pet owners and parents of diabetic children having higher knowledge. Pet (30-36%) and non-pet (~10%) owning households reported dog/cat bites or scratches during the preceding year. Within the general practice respondents, lower-risk households did not differ from higher-risk households regarding perceived disease risk of pets, zoonotic disease knowledge, recall of being asked by their medical provider if they owned pets, or recall of having received information regarding pet-associated disease risks and preventive measures. Pet ownership, husbandry and infection control practices were similar between low- and high-risk households. Husbandry practices that increase zoonotic disease risk were frequently identified, including feeding high-risk diets, allowing children to clean up fecal material and allowing reptiles to roam through the kitchen. With few exceptions, practices were not associated with the presence of higher-risk members in the household or recall of having previously received zoonotic disease education. There is a need for improved education on zoonotic disease prevention practices for pet- and non pet-owning households, particularly those with individuals at higher risk of infection and those with high-risk species.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 8 uppsatser.