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Yang Q, Yu C, Wu Y, Cao K, Li X, Cao W, Cao L, Zhang S, Ba Y, Zheng Y, Zhang H, Wang W. Unusual Talaromyces marneffei and Pneumocystis jirovecii coinfection in a child with a STAT1 mutation: A case report and literature review. Front Immunol 2023; 14:1103184. [PMID: 36891307 PMCID: PMC9986280 DOI: 10.3389/fimmu.2023.1103184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
Talaromyces marneffei and Pneumocystis jirovecii are the common opportunistic pathogens in immunodeficient patients. There have been no reports of T. marneffei and P. jirovecii coinfection in immunodeficient children. Signal transducer and activator of transcription 1 (STAT1) is a key transcription factor in immune responses. STAT1 mutations are predominately associated with chronic mucocutaneous candidiasis and invasive mycosis. We report a 1-year-2-month-old boy diagnosed with severe laryngitis and pneumonia caused by T. marneffei and P. jirovecii coinfection, which was confirmed by smear, culture, polymerase chain reaction and metagenome next-generation sequencing of bronchoalveolar lavage fluid. He has a known STAT1 mutation at amino acid 274 in the coiled-coil domain of STAT1 according to whole exome sequencing. Based on the pathogen results, itraconazole and trimethoprim-sulfamethoxazole were administered. This patient's condition improved, and he was discharged after two weeks of targeted therapy. In the one-year follow-up, the boy remained symptom-free without recurrence.
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Affiliation(s)
- Qin Yang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital Affiliated to Shantou University Medical College, Shenzhen, China
| | - Chendi Yu
- Department of Research and Development, Shenzhen Nuclear Gene Technology Co., Ltd., Shenzhen, China
| | - Yue Wu
- Department of Pharmacy, Shenzhen Children’s Hospital Affiliated to Shantou University Medical College, Shenzhen, China
| | - Ke Cao
- Clinical Laboratory, Shenzhen Children’s Hospital Affiliated to Shantou University Medical College, Shenzhen, China
| | - Xiaonan Li
- Department of Respiratory Diseases, Shenzhen Children’s Hospital Affiliated to Shantou University Medical College, Shenzhen, China
| | - Weiguo Cao
- Department of Radiology, Shenzhen Children’s Hospital Affiliated to Shantou University Medical College, Shenzhen, China
| | - Lichao Cao
- Department of Research and Development, Shenzhen Nuclear Gene Technology Co., Ltd., Shenzhen, China
| | - Shenrui Zhang
- Department of Research and Development, Shenzhen Nuclear Gene Technology Co., Ltd., Shenzhen, China
| | - Ying Ba
- Department of Research and Development, Shenzhen Nuclear Gene Technology Co., Ltd., Shenzhen, China
| | - Yuejie Zheng
- Department of Respiratory Diseases, Shenzhen Children’s Hospital Affiliated to Shantou University Medical College, Shenzhen, China
| | - Hezi Zhang
- Department of Research and Development, Shenzhen Nuclear Gene Technology Co., Ltd., Shenzhen, China
- *Correspondence: Wenjian Wang, ; Hezi Zhang,
| | - Wenjian Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital Affiliated to Shantou University Medical College, Shenzhen, China
- *Correspondence: Wenjian Wang, ; Hezi Zhang,
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Wu WH, Hui TC, Wu QQ, Xu CA, Zhou ZW, Wang SH, Zheng W, Yin QQ, Li X, Pan HY. Pneumocystis jirovecii and Legionella pneumophila coinfection in a patient with diffuse large B-cell lymphoma: A case report. World J Clin Cases 2021; 9:8595-8601. [PMID: 34754873 PMCID: PMC8554414 DOI: 10.12998/wjcc.v9.i28.8595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/01/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is a common non-Hodgkin's lymphoma. R-CHOP is a protocol for long-term chemotherapy for DLBCL patients. Long-term chemotherapy can lead to low immunity and increase the risk of opportunistic pathogen infections in immunocompromised patients.
CASE SUMMARY We report a case of coinfection with Pneumocystis jirovecii (P. jirovecii) and Legionella pneumophila (L. pneumophila) in a patient with DLBCL. The patient was a 40-year-old female who was diagnosed with DLBCL and was admitted due to pulmonary infection. P. jirovecii and L. pneumophila were detected in her bronchoalveolar lavage fluid by hexamine silver staining, isothermal amplification and metagenomic sequencing.
CONCLUSION To the best of our knowledge, this is the first case of P. jirovecii and L. pneumophila coinfection found in a DLBCL patient. Clinicians should be aware of the risk of complicated infection in patients undergoing long-term chemotherapy.
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Affiliation(s)
- Wen-Hao Wu
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
- Medical College, Qingdao University, Qingdao 266071, Shandong Province, China
| | - Tian-Chen Hui
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Qing-Qing Wu
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Cheng-An Xu
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Zhe-Wen Zhou
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Shou-Hao Wang
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Wei Zheng
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Qiao-Qiao Yin
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Xi Li
- Centre of Laboratory Medicine, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Hong-Ying Pan
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
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Abstract
Children are susceptible to infection with the novel coronavirus SARS-CoV-2. In this time of uncertainty, this review attempts to compile information that may be helpful to pediatric neurologists. This review consolidates current data on the disease associated with SARS-CoV-2, called COVID-19, and information from past coronavirus epidemics, to discuss diseases of pediatric neurology including Guillain-Barre syndrome (acute inflammatory demyelinating polyradiculoneuropathy); central demyelinating diseases like multiple sclerosis and acute disseminated encephalomyelitis; infantile spasms; febrile seizures; and maternal-fetal transmission of virus.
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Affiliation(s)
- Alison Christy
- Pediatric Neurology, 360139Providence Health & Services, Portland OR, USA
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Therapy and Management of Pneumocystis jirovecii Infection. J Fungi (Basel) 2018; 4:jof4040127. [PMID: 30469526 PMCID: PMC6313306 DOI: 10.3390/jof4040127] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 12/21/2022] Open
Abstract
The rates of Pneumocystis pneumonia (PcP) are increasing in the HIV-negative susceptible population. Guidance for the prophylaxis and treatment of PcP in HIV, haematology, and solid-organ transplant (SOT) recipients is available, although for many other populations (e.g., auto-immune disorders) there remains an urgent need for recommendations. The main drug for both prophylaxis and treatment of PcP is trimethoprim/sulfamethoxazole, but resistance to this therapy is emerging, placing further emphasis on the need to make a mycological diagnosis using molecular based methods. Outbreaks in SOT recipients, particularly renal transplants, are increasingly described, and likely caused by human-to-human spread, highlighting the need for efficient infection control policies and sensitive diagnostic assays. Widespread prophylaxis is the best measure to gain control of outbreak situations. This review will summarize diagnostic options, cover prophylactic and therapeutic management in the main at risk populations, while also covering aspects of managing resistant disease, outbreak situations, and paediatric PcP.
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Ma L, Cissé OH, Kovacs JA. A Molecular Window into the Biology and Epidemiology of Pneumocystis spp. Clin Microbiol Rev 2018; 31:e00009-18. [PMID: 29899010 PMCID: PMC6056843 DOI: 10.1128/cmr.00009-18] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pneumocystis, a unique atypical fungus with an elusive lifestyle, has had an important medical history. It came to prominence as an opportunistic pathogen that not only can cause life-threatening pneumonia in patients with HIV infection and other immunodeficiencies but also can colonize the lungs of healthy individuals from a very early age. The genus Pneumocystis includes a group of closely related but heterogeneous organisms that have a worldwide distribution, have been detected in multiple mammalian species, are highly host species specific, inhabit the lungs almost exclusively, and have never convincingly been cultured in vitro, making Pneumocystis a fascinating but difficult-to-study organism. Improved molecular biologic methodologies have opened a new window into the biology and epidemiology of Pneumocystis. Advances include an improved taxonomic classification, identification of an extremely reduced genome and concomitant inability to metabolize and grow independent of the host lungs, insights into its transmission mode, recognition of its widespread colonization in both immunocompetent and immunodeficient hosts, and utilization of strain variation to study drug resistance, epidemiology, and outbreaks of infection among transplant patients. This review summarizes these advances and also identifies some major questions and challenges that need to be addressed to better understand Pneumocystis biology and its relevance to clinical care.
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Affiliation(s)
- Liang Ma
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, USA
| | - Ousmane H Cissé
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, USA
| | - Joseph A Kovacs
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, USA
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Shachor-Meyouhas Y, Ravid S, Hanna S, Yaacoby-Bianu K, Kassis I. Legionella pneumophila Pneumonia in Two Infants Treated with Adrenocorticotropic Hormone. J Pediatr 2017; 186:186-188.e1. [PMID: 28336145 DOI: 10.1016/j.jpeds.2017.02.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/17/2017] [Accepted: 02/23/2017] [Indexed: 11/29/2022]
Abstract
Patients with infantile spasms, an intractable epileptic disorder, often are treated with adrenocorticotropic hormone. Legionella pneumophila is a rare cause of pneumonia in children. We describe 2 infants with Legionella pneumonia whose infection occurred within 1 month after starting adrenocorticotropic hormone.
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Affiliation(s)
- Yael Shachor-Meyouhas
- Pediatric Infectious Diseases Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
| | - Sarit Ravid
- Pediatric Neurology Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Suheir Hanna
- Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Karin Yaacoby-Bianu
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Imad Kassis
- Pediatric Infectious Diseases Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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Mizrahi H, Peretz A, Lesnik R, Aizenberg-Gershtein Y, Rodríguez-Martínez S, Sharaby Y, Pastukh N, Brettar I, Höfle MG, Halpern M. Comparison of sputum microbiome of legionellosis-associated patients and other pneumonia patients: indications for polybacterial infections. Sci Rep 2017; 7:40114. [PMID: 28059171 PMCID: PMC5216348 DOI: 10.1038/srep40114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 12/02/2016] [Indexed: 02/08/2023] Open
Abstract
Bacteria of the genus Legionella cause water-based infections resulting in severe pneumonia. Here we analyze and compare the bacterial microbiome of sputum samples from pneumonia patients in relation to the presence and abundance of the genus Legionella. The prevalence of Legionella species was determined by culture, PCR, and Next Generation Sequencing (NGS). Nine sputum samples out of the 133 analyzed were PCR-positive using Legionella genus-specific primers. Only one sample was positive by culture. Illumina MiSeq 16S rRNA gene sequencing analyses of Legionella-positive and Legionella-negative sputum samples, confirmed that indeed, Legionella was present in the PCR-positive sputum samples. This approach allowed the identification of the sputum microbiome at the genus level, and for Legionella genus at the species and sub-species level. 42% of the sputum samples were dominated by Streptococcus. Legionella was never the dominating genus and was always accompanied by other respiratory pathogens. Interestingly, sputum samples that were Legionella positive were inhabited by aquatic bacteria that have been observed in an association with amoeba, indicating that amoeba might have transferred Legionella from the drinking water together with its microbiome. This is the first study that demonstrates the sputum major bacterial commensals and pathogens profiles with regard to Legionella presence.
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Affiliation(s)
- Hila Mizrahi
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Mount Carmel, Haifa, Israel
- Microbiology Lab, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Israel
| | - Avi Peretz
- Microbiology Lab, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Israel
| | - René Lesnik
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Yana Aizenberg-Gershtein
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Mount Carmel, Haifa, Israel
| | - Sara Rodríguez-Martínez
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Mount Carmel, Haifa, Israel
| | - Yehonatan Sharaby
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Mount Carmel, Haifa, Israel
| | - Nina Pastukh
- Microbiology Lab, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Israel
| | - Ingrid Brettar
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Manfred G. Höfle
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Malka Halpern
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Mount Carmel, Haifa, Israel
- Department of Biology and Environment, Faculty of Natural Sciences, University of Haifa, Oranim, Tivon, Israel
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