Tocilizumab has been used to treat idiopathic multicentric Castleman disease (iMCD). As tocilizumab prevents interleukin-6 from exerting pro-inflammatory effects, there is some concern about a ...delayed diagnosis of severe infections during tocilizumab treatment. Although serious infections during tocilizumab therapy have been previously described in patients with rheumatoid arthritis, they have not been reported in iMCD. We herein report a case of disseminated Staphylococcus aureus infection after a superficial skin wound followed by psoas and mediastinal abscesses with pyogenic spondylodiscitis in an iMCD patient with diabetes. Physicians should be alert for the occurrence of disseminated S. aureus infection after even minor skin injury during tocilizumab therapy.
We describe the case of a 68-year-old man who underwent ascending aortic replacement and thoracic endovascular aortic repair. Four years later, the patient developed neck pain on the right side and ...chest computed tomography showed expansion of fluid in the mediastinum which had extended to the neck. Echocardiography revealed advanced severity of aortic regurgitation and decreased ejection fraction. Given the progression of aortic regurgitation, decreased cardiac function, and rapidly expanding fluid accumulation causing neck pain, reoperation was indicated. All microbiological test including polymerase chain reaction were negative indicating absence of any infection. The patient is being followed-up without antibiotics and CT has not shown peri-graft fluid 2 years postoperatively. Since infection cannot be excluded completely, it is important to assess the condition with selective medium, extended culture periods, genetic testing, and consultations with microbiology laboratories when normal culture tests for general bacteria, and fungi are negative which can help avoid drug-resistant bacteria count, elevated medical costs, and drug side effects due to the improper use of antibiotics through proper diagnosis.
Objective Patients with hematological malignancies and solid organ tumors reportedly tend to have a more severe coronavirus disease 2019 (COVID-19) trajectory than do those with other diseases. We ...studied the clinical features and outcomes of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the seventh wave of the pandemic. Methods This study retrospectively described the characteristics of COVID-19 clusters involving patients in the hematology/respirology ward of Kochi Medical School Hospital during the seventh wave of the pandemic of SARS-CoV-2. Patients A total of 40 individuals, including 25 patients and 15 healthcare workers, were studied. The diagnosis of SARS-CoV-2 infection was based on reverse transcription polymerase chain reaction performed on nasopharyngeal samples. Results Eleven patients had hematological diseases, and 14 had respiratory diseases. Most patients presented with a fever (n=19) and/or sore throat (n=10). Lower respiratory tract symptoms and pneumonia were rather infrequent, occurring in two patients. All patients received antivirals. The maximal severities were mild in 21 patients and moderate in 2. Two asymptomatic patients with SARS-CoV-2 infection did not develop symptoms of COVID-19. Cycle threshold values in nasopharyngeal samples were significantly lower in patients with COVID-19 than in those who were asymptomatic at the time of the diagnosis with SARS-CoV-2 infection. All SARS-CoV-2-infected inpatients recovered or did not develop symptoms of COVID-19. Conclusion COVID-19 vaccination, early or preemptive treatment with antivirals, and intrinsic changes in SARS-CoV-2 may have contributed to the more favorable outcomes in our series than in previously reported nosocomial clusters.
•Invasive pneumococcal disease (IPD) patients in adults were analyzed before and during the COVID-19 pandemic.•Adult IPD incidence declined by approximately 60% during the COVID-19 ...pandemic.•Preceding influenza increased the rate of bacteremic pneumococcal pneumonia.•Preceding seasonal influenza increased the fatality rate of IPD in older adults.•Male and aging are high risk for death in IPD patients with preceding influenza.
We aimed to investigate the impact of preceding seasonal influenza on the clinical characteristics of adult patients with invasive pneumococcal disease (IPD) in Japan.
Data for 1722 adult patients with IPD were analyzed before (2017-2019) and during the COVID-19 pandemic (2020-2022).
The seasonal influenza epidemic disappeared soon after the emergence of the pandemic. Compared with that before the pandemic (66.7%), we observed a lower bacteremic pneumonia proportion in patients with IPD during the pandemic (55.6%). The clinical presentations of IPD cases significantly differed between those with and without preceding influenza. The proportion of bacteremic pneumonia was higher in IPD patients with preceding influenza than in those without in both younger (44.9% vs 84.2%) and older adults (65.5% vs 87.0%) before the pandemic. The case fatality rate was significantly higher in IPD patients with preceding influenza (28.3%) than in those without (15.3%) in older adults before the pandemic (P = 0.020).
Male and aging are high risk factors for death in older patients with IPD who had preceding influenza.
Our study reveals that preceding seasonal influenza plays a role in the development of bacteremic pneumococcal pneumonia, increasing the risk of death in older adults.
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Abstract We treated individuals for disseminated intravascular coagulation (DIC) caused by acute promyelocytic leukemia (APL) ( n = 9) using human soluble thrombomodulin (rTM) in combination with ...all- trans retinoic acid (ATRA) and chemotherapy, and compared the clinical outcomes with historical control patients ( n = 8) treated with ATRA and/or chemotherapy. Two control patients developed intracranial vascular incidents. On the other hand, no bleeding related mortality was noted in rTM-treated patients. Notably, treatment with rTM rescued patients from DIC earlier than historical controls (log rank test, p = 0.019). These results suggest that administration of rTM should be considered for the treatment of individuals with DIC associated with APL.
COVID-19 patients reveal various clinical manifestations; however, the specific mechanisms and factors contributing to rapid recovery remain unclear. We performed serum cytokine profiling using a ...bead-based immunoassay in six COVID-19 patients with mild symptoms who experienced rapid recovery. All patients had fever that resolved within 4 days. During the study, the interferon gamma-related protein 10 (IP-10) level rapidly increased initially, and then rapidly decreased in all six patients. Similarly, the interferon (IFN)-λ2/3 levels rapidly increased initially, and then decreased in five of the six patients. IP-10 and IFN-λ2/3 may play a key role in the rapid recovery of mild COVID-19.
Antibody production is one of the primary mechanisms for recovery from coronavirus disease 2019 (COVID-19). It is speculated that massive clonal expansion of B cells, which can produce clinically ...meaningful neutralizing antibodies, occurs in patients who recover on the timing of acquiring adaptive immunity.
To evaluate fluctuations in clonal B cells and the size of the clones, we chronologically assessed the B-cell receptor (BCR) repertoire in three patients with COVID-19 who recovered around 10 days after symptom onset.
We focused on the three dominant clonotypes (top 3) in each individual. The percentage frequencies of the top 3 clonotypes increased rapidly and accounted for 27.8 % on day 9 in patient 1, 10.4 % on day 12 in patient 2, and 10.8 % on day 11 in patient 3, respectively. The frequencies of these top 3 clonotypes rapidly decreased as the patients’ clinical symptoms improved. Furthermore, BCR network analysis revealed that accumulation of clusters composed of similar complementarity-determining region 3 (CDR3) sequences were rapidly formed, grew, and reached their maximum size around 10 days after symptom onset.
BCR repertoire analysis revealed that a massive surge of some unique BCRs occurs during the acquisition of adaptive immunity and recovery. The peaks were more prominent than expected. These results provide insight into the important role of BCRs in the recovery from COVID-19 and raise the possibility of developing neutralizing antibodies as COVID-19 immunotherapy.
Coronavirus disease 2019; Severe acute respiratory syndrome coronavirus 2; B-cell receptor; Repertoire assay.
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