A fatal case with disseminated Myceliophthora thermophila infection in a lymphoma patient

We report a lethal Myceliophthora thermophila infection in an immunocompromised patient. Based upon the clinical and mycological presentation, an initial diagnosis of invasive aspergillosis was made, possibly delaying optimal management in the patient. Melanized fungi are emerging pathogens that require early identification to improve their unfavorable prognosis.     

儿童Epstein—Barr病毒感染临床分析

目的探讨慢性活动性Epstein—Barr病毒（EpsteinBarrvirus,EBV）感染、急性EBV感染及正常儿童EBV—DNA及适应性体液免疫的差异。方法慢性活动性EBV感染患儿8例（慢性组）,急性EBV感染患儿13例（急性组）,正常儿童12例（对照组）外周血单个核细胞采用实时荧光定量PCR法检测,3组EBV—DNA水平,采用ELISA、抗体稀释试验评价EBV适应性体液免疫,分析其与EBV感染不同转归的关系。结果慢性组EBV—DNA载量、病毒壳蛋白抗原-IgA、-IgG及早期抗原-IgA水平明显高于急性组和对照组（P〈0．01）,病毒壳蛋白抗原-IgM水平及早期抗原-IgG滴度改变速率低于急性组（P〈O．01）;慢性组与急性组EBV核抗原-IgG抗体水平均低于对照组（P〈0．01）。结论慢性活动性EBV感染存在不同EBV核抗原-LP拷贝数及不同亲和力的抗体谱,可能与慢性活动性病程相关,对早期识别诊治有重要意义。     

Chronic active Epstein-Barr virus infection treated with PEG-aspargase: A case report

BACKGROUNDChronic active Epstein-Barr virus infection (EBV) is a systemic EBV-positive lymphoproliferative disease, which may lead to fatal illness. There is currently no standard treatment regimen for chronic active EBV (CAEBV), and hematopoietic stem cell transplantation is the only effective treatment. We here report a CAEBV patient treated with PEG-aspargase, who achieved negative EBV-DNA.CASE SUMMARYA 33-year-old female Chinese patient who had fever for approximately 3 mo was admitted to our hospital in December 2017. EBV-DNA was positive with a high copy number. She was diagnosed with chronic active EB virus infection. PEG-aspargase was administered at a dose of 1500 U/m² at a 14-d interval, resulting in eradication of EBV for more than 6 mo. The effect of PEG-aspargase in this patient was excellent.CONCLUSIONA chemotherapy regimen containing PEG-aspargase for CAEBV may be further considered.     

An adult-onset case of chronic active Epstein-Barr virus infection with fulminant clinical course

A 56-year-old Japanese male with chronic active Epstein-Barr virus (EBV) infection (CAEBV) who developed systemic gamma-delta T-cell lymphoproliferative disease (LPD) is reported. Although immune cooling therapy was effective, he died of sudden and severe hypoxia and anemia soon after the initiation of cytotoxic chemotherapy that had been previously recommended. There might remain a difficulty to control fulminant adult-onset CAEBV. Additionally, we describe three types of lymphoid cells that were observed in his peripheral blood: morphologically normal lymphocytes, large blastic cells and mature ones with rough granules. Morphological observation appeared to be useful to estimate clinical manifestations. Since CAEBV is extremely rare disease in adult population, it is important to accumulate clinical data to more understand the pathogenesis or to establish treatment strategy.     

A fatal case of Exophiala dermatitidis meningoencephalitis in an immunocompetent host: A case report and literature review

BackgroundCentral nervous system (CNS) infection due to Exophiala dermatitidis is rare and fatal, and primarily reported in immunocompromised patients or those with caspase recruitment domain-containing protein 9 deficiency. Herein, we describe a case of an otherwise healthy person (without underlying disease or gene deficiency) diagnosed with Exophiala dermatitidis meningoencephalitis. The patient achieved clinical remission under high-dose antifungal therapy in the first 14 months but died after 2 years of the therapy.Case presentationA 15-year-old student with headache and fever was admitted to our department. Lumbar puncture showed increased cerebrospinal fluid (CSF) pressure, moderately high CSF protein levels and cell counts, and a remarkable decrease in CSF glucose and chloride. Magnetic resonance imaging of the brain revealed multiple lesions and cerebral pia mater enhancement. CSF culture confirmed E. dermatitidis infection. We administered 4-week antifungal therapy of amphotericin B, but his CSF culture remained positive. After receiving the 12-week standard dose of voriconazole (200 mg q12h), the patient's CSF culture became negative, but his condition deteriorated with intracranial lesion enlargement. We administered a high-dose voriconazole therapy (600–800 mg per day) for 12 months, which led to clinical remission. The voriconazole dose was reduced due to adverse effects including hepatic dysfunction and hypokalemia, and the disease progressed with high intracranial pressure and epileptic seizures.ConclusionsCNS infection caused by E. dermatitidis is fatal and the most serious form of fungal infection. Initially, high-dose and long-term antifungal therapy could be effective. Gene defect and related antifungal immunodeficiency may be the most important pathogenic and lethal factor.     

Fatal visceral disseminated varicella-zoster virus infection in a renal transplant recipient: A case report

BACKGROUNDVisceral disseminated varicella-zoster virus (VZV) infection is a rare but life-threatening disease. In transplant recipients with VZV infection, visceral dissemination may develop without skin eruptions, which leads to the failure of early diagnosis.CASE SUMMARYThe patient was a 33-year-old male renal recipient who was referred to our hospital with severe upper abdominal pain of 3-d duration. On admission, the patient rapidly developed septic shock and multiple organ dysfunction syndrome with liver dysfunction and acute kidney injury. Next-generation sequencing of peripheral blood yielded 39224 sequence reads of VZV, and real-time polymerase chain reaction for VZV was positive, with 1.2 × 10⁷ copies/mL. The final diagnosis was visceral disseminated VZV infection. Acyclovir and supportive therapy were started, but the patient died of severe visceral organ damage 16 h after admission.CONCLUSIONVisceral disseminated VZV infection is possible in renal transplant recipients presenting abdominal pain and rapidly-evolving organ damage without skin involvement.     

Rapid diagnosis of disseminated Mycobacterium mucogenicum infection in formalin-fixed,paraffin-embedded specimen using next-generation sequencing: A case report

BACKGROUND Mycobacterium mucogenicum (M. mucogenicum) belongs to the group of rapidly growing Nontuberculous mycobacteria. This microorganism is associated with a wide spectrum of infectious diseases. Due to a low detection rate or the time required for conventional culture methodology, a rapid and broad-spectrum method is necessary to identify rare pathogens.CASE SUMMARYA 12-year-old immunocompetent girl presented with painful masses for five months. The first mass was found in the right upper quadrant of the abdomen, and was about 1 cm × 1.5 cm in size, tough but pliable in texture, with an irregular margin and tenderness. An abscess gradually formed and ulcerated with suppuration of the mass. Three new masses appeared on the back one by one. Chest computed tomography showed patchy and streaky cloudy opacities in both lungs. Needle aspiration of the abscess was performed, but the smear and conventional culture were negative, and the pathological examination showed no pathogens. We then performed next-generation sequencing using a formalin-fixed, paraffin-embedded specimen to identify the pathogen. A significantly high abundance of M. mucogenicum was detected. The patient’s abscesses gradually decreased in size, while inflammation in both lungs improved following 12-wk of treatment. No recurrence was observed four months after the end of the one-year treatment period.CONCLUSIONNext-generation sequencing is a promising tool for the rapid and accurate diagnosis of rare pathogens, even when using a formalin-fixed, paraffin-embedded specimen.     

First case of breakthrough pulmonary Aspergillus niveus infection in a patient after allogeneic hematopoietic stem cell transplantation

Aspergillus niveus is a species uncommon in clinical samples, and to date, invasive fungal infections caused by this fungal pathogen have not been described. This is the 1st report on a pulmonary breakthrough aspergillosis caused by A. niveus in a 21-year-old woman after allogeneic hematopoietic stem cell transplantation for Fanconi anemia.     

SARS‐CoV‐2 infection in hematological patients during allogenic stem cell transplantation: A double case report

Despite severe immunosuppression due to conditioning chemotherapy for acute myeloid leukemia, COVID‐19 did not lead to clinical deterioration or death, thus raising the question of the impact of immunosuppressive treatment on clinical course evolution.     

血清1,3-β-D-葡聚糖检测用于造血干细胞移植后患者侵袭性真菌感染诊断的界值初探

目的 评价血清1,3-β-D-葡聚糖(BG)浓度检测对我国造血干细胞移植(HSCT)后患者侵袭性真菌感染(IFI)早期诊断的意义并确定其界值.方法 按我国IFI的诊断标准,采用Glucatell试剂盒对HSCT后拟诊IFI的36例患者m清标本(每周采血2次)进行BG浓度的检测(G实验).根据临床回顾性诊断标准定义阳性和阴性病例,按不同G试验阳性标准计算其灵敏度、特异度,最终确定G试验在我国HSCT后患者IFI诊断的界值.结果 按试验中所得的单次结果≥80 ng/L或连续两次结果≥60ng/L作为界值,得出G试验的灵敏度、特异度、阳性和阴性预测值结果分别为81.0%、81.8%、89.5%和69.2%(P=0.002),并以此作为G试验在我国HSCT后IFI诊断的界值.结论 G试验在我国HSCT患者IFI诊断的界值与国外基本相同,是一种早期诊断IFI的快速、灵敏的检测.方法 ,值得临床推广.