Common variable immunodeficiency (CVID) is a primary immunodeficiency disorder that causes decreased immunity and increased susceptibility to infections. It affects B lymphocyte differentiation, ...resulting in predominantly bacterial and less frequently viral, fungal, and protozoal infections. The respiratory and gastrointestinal tracts where antibody defences are essential are usually affected. Individuals with CVID are also predisposed to developing lymphoid and gastrointestinal malignancies. We present two cases with rare infectious and oncological complications of CVID, including a patient with
comple
infection and ovarian cancer, and another patient with group B
empyema of the lung with acute myeloid leukaemia. The main objective of this study is to highlight how CVID-induced hypogammaglobulinaemia can lead to rare infections and malignancies. The management of these complications can vary according to severity, but an awareness of their existence is crucial to diagnose them promptly in an already immunocompromised CVID patient.
Since the beginning of the COVID-19 pandemic, great hesitancies regarding the COVID-19 immunization have existed. The most striking adverse events reported include thrombosis with thrombocytopenia ...syndrome (TTS), myocarditis, and Guillain Barre Syndrome (GBS). Post-vaccination GBS is known since the time of Influenza vaccination, but several cases of GBS have also been reported in the current COVID-19 vaccination era. As a result, our patient with a history of GBS post-Influenza vaccination, went unvaccinated for SARS-CoV-2, due to fear of GBS re-activation. Consequently, he contracted COVID-19 pneumonitis complicated with deep venous thrombosis, requiring a prolonged hospitalization. Weighing the risks and benefits of vaccination to COVID-19 is difficult, especially for people with a previous history of GBS related to Influenza vaccination. We reviewed and analyzed the reported cases of GBS temporary related to COVID-19 vaccination to determine the safety of their administration in those with a history of GBS.
The
species are gram-negative bacteria that inhabit soil and water. Infections caused by this pathogen are an uncommon clinical entity. We describe a rare case of septic shock and bacteremia caused ...by
in an immunocompetent adult female. The patient, a 59-year-old female, presented to the hospital with circulatory shock, fever, chills, and cough. Chest x-ray revealed right lower lobe lung consolidation consistent with pneumonia, and blood cultures with a positive concerning gram-negative curved rod which was later identified as
. The patient was treated in the ICU for three days with cefepime and vasoactive agents. After improvement and an additional seven days of hospitalization, the patient was discharged home with a five-day course of oral levofloxacin. Although our patient responded well to cefepime and levofloxacin, meropenem and piperacillin-tazobactam were found to be the most commonly used and the most effective antibiotics to treat
infections in other reported cases. This is amongst the few reported cases of
bacteremia in an immunocompetent individual with pneumonia.
In this article, we review a case of necrotizing cellulitis and myositis in a neutropenic leukemic patient. He underwent a series of investigations to reach the diagnosis of pyoderma gangrenosum ...(PG). The lesion improved dramatically after pertinent identification and initiation of appropriate treatment. The management of PG is exceedingly challenging due to a lack of proper clinical criteria for detection and guidelines for treatment. PG must be considered as a differential in patients with enlarging, sterile, necrotic lesions, unresponsive to prolonged broad-spectrum antibiotics. Prompt recognition can prevent deeper infections and the formation of a chronic open wound causing cosmetic disfigurement along with other catastrophic complications.
Abstract
Background
Common Variable Immunodeficiency (CVID) is a primary immunodeficiency disorder which affects B lymphocyte function and differentiation causing decreased levels of Immunoglobulin G ...(IgG), Immunoglobulin A (IgA) and Immunoglobulin M (IgM).1 The objective of this study is to highlight how hypogammaglobulinemia can lead to respiratory infections with microbes that are lesser known in the background of CVID with the help of a two-case series.
Methods
Medical records of two patients with CVID were reviewed who were found to have mycobacterium avium-complex intracellulare and streptococcus agalactiae lung infections respectively.
Results
Decreased IgG in CVID means reduced antibody production, low IgA leads to mucosal inflammation and increased susceptibility to respiratory infections2 and lower IgM memory B-cells causes infections with encapsulated microorganisms.3 Table 1 highlights the various respiratory infections and their etiologies that have been reported with CVID, the most common being encapsulated organisms like Haemophilus influenza, Streptococcus pneumonia, Neisseria meningitidis along with enterovirus. Table 2 demonstrates our findings. In the first case we have reported a patient with mycobacterium avium-complex intracellulare (MAC-I). This could be because of hypogammaglobulinemia, decreased B and T-cell interaction and reduced T-cell signaling caused by CVID.4 Although, mycobacterium tuberculosis, simiae and hominis lung infections and mycobacterium bovis systemic infections have been reported before, MAC-I is relatively rare in CVID.5 In our second case, the patient developed streptococcus agalactiae or Group-B streptococcus (GBS) empyema. Most cases of GBS have been reported in pregnant women and infants. Infections with other encapsulated organisms have been reported in CVID but GBS empyema is less frequent and can happen due to decreased bacteria-specific CD4 cells, microbial translocation and hypogammaglobulinemia.6 .
Table 1. Respiratory Infections reported in CVID along with their etiologies.
Figure 1. CT image of MAC-I infection.
Conclusion
We encountered two unique cases of CVID with rare infectious etiologies. The cases are intended to create an awareness and vigilance regarding CVID induced hypogammaglobulinemia which can cause respiratory infections with lesser known pathogens where antibodies may be important.
Disclosures
All Authors: No reported disclosures
Abstract
Background
Omadacycline (OMC), the first aminomethylcycline antibiotic, is a semisynthetic tetracycline derivative approved for community-acquired bacterial pneumonia (CABP) and acute ...bacterial soft skin infection (ABSSI), with a broad range of activity against Gram-positive and Gram-negative aerobes, anaerobes and atypical bacteria, including drug-resistant strains. It is currently under development for the treatment of cystitis and acute pyelonephritis (AP).
Methods
This systematic review of literature followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Abstracts were searched using the term: “omadacycline”. The electronic research literature databases included the Cochrane Library, MedLine, and clinicaltrials.gov from February to April 2023. Selection of studies by PRISMA flowchart is shown in figure 1. Characteristics of endpoints for each pathology are mentioned in table 1.Table 1.Endpoints for each disease. CABP (Community-acquired Pneumonia), ECR (Early clinical response), Investigator-assessed clinical response (IACR), Post treatment evaluation (PTE), ABSSI (Acute bacterial soft skin infection), EOT, (End of treatment), AP (Acute pyelonephritis).
Results
OMC was found to be noninferior to existing antibiotics in all reviewed studies. The most common side effects of OMC were nausea, vomiting and diarrhea, which were infrequent, mild and easily treatable. The only limitation of these studies was proving the efficacy of OMC by non-inferiority. Bias was assessed using the Cochrane collaboration's tool risk assessment of the clinical trials (Figure 2). Characteristics and outcomes of each study are mentioned in table 2.Table 2.Characteristics, outcomes and limitations of selected studies. CABP (Community-acquired Pneumonia), OMC (Omadacycline), IV (Intravenous), ECR (Early clinical response, IACR (Investigator-assessed clinical response), PTE (Post-treatment evaluation), AE (Adverse effect), ABSSI (Acute bacterial soft skin infection), EOT (End of treatment), AP (Acute pyelonephritis), and LEV (Levofloxacin).
References
Conclusion
Most studies showed that OMC was well tolerated, with decreased frequency of dosing, availability of both oral and intravenous options, and with equal if not better efficacy than the existing drugs. OMC has activity against common tetracycline resistance mechanisms such as efflux pumps and ribosomal protection proteins. It is excreted unchanged, having low potential for drug-drug interaction and requires no dose adjustment for age, sex, or hepatic and renal impairment. Further large scale studies are encouraged to prove OMC as an emerging antibiotic of choice for several bacterial infections. Overall, OMC appears to be a promising drug with a good safety profile. With the help of this systematic review, we aim to encourage the use of OMC for cystitis and pyelonephritis, along with continued use for CABP and ABSSI.
Disclosures
All Authors: No reported disclosures
Current pharmacological options for hypertrophic cardiomyopathy (HCM) are not disease-specific; while it treats symptoms, mavacamten targets the underlying pathology. We aim to assess the efficacy ...and safety of mavacamten, a first-in-class cardiac myosin inhibitor, in symptomatic obstructive HCM.
This systematic review of the literature followed the PRISMA guidelines. Title/abstract and topics were searched using the following term: “mavacamten”. The electronic research literature databases included the Cochrane Library, MedLine, and clinicaltrials.gov from July to August 2022. Primary efficacy endpoint was to assess clinical response at the end of treatment compared with baseline, defined as, at least one New York Heart Association (NYHA) class reduction. Two secondary endpoints from baseline were determined. The first was defined as improvement in mixed venous oxygen pressure (pVO2). The second was defined as reduction of the post-exercise left ventricular outflow tract (LVOT) gradient.
We included in our analyses data from four studies that met our review eligibility criteria. There were three randomised placebo-controlled clinical trials and one non-randomised open-label clinical trial. All four studies showed a reduction in NYHA class from mavacamten use. Three out of four studies demonstrated >1 NYHA functional class improvement ranging from 34% to 80%, while only one study showed a smaller percentage of patients remaining at class 3. Three out of four studies measured pVO2 as an outcome, and all three studies noticed an increase in peak oxygen consumption after mavacamten treatment. Additionally, three out of four studies measured post-exercise LVOT gradient reduction as an outcome and all three found significant reduction in the post-exercise LVOT gradient after treatment. The most commonly observed adverse side effects were atrial fibrillation and decreased left ventricular ejection fraction, but all participants recovered without long-term sequelae and only one patient dropped out of the trial.
Mavacamten has a greater efficacy than placebo in the treatment of HCM. It also showed promising tolerability and efficacy profiles in the treatment of HCM in adults. The three endpoints used in the evaluation of studies were reduction in NYHA class, increase in pVO2, and post-exercise LVOT gradient reduction. Mavacamten showed greater reduction in NYHA, larger effects on increase of pVO2, and significant reduction of the LVOT gradient. Mavacamten was also found to be well tolerated, like the placebo. The side effect profile was limited for the majority of individuals taking mavacamten. In the future, authors recommended dose-optimisation studies, and studies that evaluate mavacamten both in comparison to, and in conjunction with other current treatments.
Background
Nontuberculous mycobacteria (NTM) are widely distributed in natural environments and are increasing causes of disease with significant morbidity and mortality in immunocompromised ...patients. We present a 5-year experience of NTM isolates at the Moffitt Cancer Center in Tampa, Fla.
Methods
We conducted a single-center, retrospective study of NTM isolates from January 2011 to February 2016. Records were searched to identify patients with NTM. Specimens included bronchial lavage, swabs, blood/body fluids, and tissue. Basic demographics of patients, clinical attributes, sites of isolation, and concomitant neoplasia were compared.
Results
There were a total of 196 isolates of NTM; 92 of 196 isolates (47%) were
Mycobacterium avium
complex (MAC).
Mycobacterium abscessus
,
Mycobacterium gordonae
, and
Mycobacterium fortuitum
accounted for 28%, 11%, and 7% of the top 4 isolates, respectively. There was no difference in types of NTM isolated based on the type of underlying neoplasm. Eleven percent of the respiratory isolates were from patients whose biopsy was negative for malignancy on workup of lung nodule. Skin/wound isolates accounted for 13%, and blood/serologic isolates accounted for 7%. Average age of patients was 68 (SD, 11) years; 92% were US born.
Conclusions
Nontuberculous mycobacteria isolated in our study were likely to be MAC and isolated from the respiratory tract; however, we did not find significant association between types of NTM and a given neoplasm
. Mycobacterium abscessus
was the next most frequent isolate from both respiratory and nonrespiratory specimens. More than 10% of isolates were from surgically excised pulmonary nodules that were benign. Improved NTM testing and scoring algorithms could reduce the need for surgical excision of pulmonary nodules.
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