53-jähriger Patient mit Fieber und Husten

Zusammenfassung: Wir beschreiben einen Patienten mit später HIV-Präsentation, Meningitis tuberculosa und offener Lungentuberkulose bei Miliartuberkulose unter schwerer HIV-assoziierter Immunsuppression. Im Verlauf tritt eine weitere opportunistische Infektion (Pneumocystis-jiroveci-Pneumonie) und im Rahmen der antiretroviralen Therapie ein Immunrekonstitutionssyndrom (IRIS) auf. Letzteres führt zu weiteren Organmanifestationen der Miliartuberkulose (urogenital, gastrointestinal). Mit der späten HIV-Präsentation assoziierte Probleme sind opportunistische Infektionen und das IRIS zu Beginn der antiretroviralen Therapie. Die Wahl des Behandlungszeitpunkts der HIV-Infektion bei gleichzeitiger opportunistischer Infektion ist entscheiden

Serial monitoring of pancreatic stone protein for the detection of sepsis in intensive care unit patients with complicated abdominal surgery: A prospective, longitudinal cohort study.

The objective of this study was to assess the performance of pancreatic stone protein (PSP) monitoring for the detection of sepsis, prediction of outcome and distinction between bacterial and fungal infections in intensive care unit (ICU) patients with complicated abdominal surgery. In this prospective multicenter cohort study, patients with complicated abdominal surgery had serial PSP measurements during their ICU stay. Infectious episodes were classified as bacterial, fungal or mixed. PSPmax (maximal PSP value within 48 h of the diagnosis of infection) and ΔPSP (difference between PSPmax and the preceding PSP value) were used for analyses. PSPmax was obtained for 118 infectious episodes (68 patients). ΔPSP was available for 73 episodes (48 patients). Both PSPmax and ΔPSP were significantly higher in patients with sepsis and in patients with a fatal outcome. A PSPmax ≥124 ng/ml and a ΔPSP ≥34 ng/ml could detect sepsis with a sensitivity/specificity of 84%/54% and 69%/76%, respectively. There was no significant difference of PSPmax or ΔPSP between patients with bacterial/mixed versus fungal infections. Serial PSP monitoring may be an additional tool for the early detection of sepsis in patients with complicated abdominal surgery who are at high risk of severe infections

Re: "Comparison of antipseudomonal betalactams for febrile neutropenia empiric therapy: systematic review and network metaanalysis" by Horita et al

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Performance of the T2Candida Panel for the Diagnosis of Intra-abdominal Candidiasis.

Performance of T2Candida for detecting intra-abdominal candidiasis (IAC) was assessed in 48 high-risk patients. T2Candida sensitivity/specificity and positive/negative predictive values were 33%/93% and 71%/74%, respectively. IAC was present in 100% of cases with concordant positive T2Candida/1,3-beta-d-glucan and absent in 90% of concordant negative results. Combination T2Candida/1,3-beta-d-glucan may help guide treatment decisions

Neutropenic Fever

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[53 year-old patient with fever and cough]

We describe a patient with late HIV presentation, opportunistic infections and an immune reconstitution syndrome (IRIS) after starting a combination antiretroviral therapy (ART)occurring in this severely immunodeficient patient. In the beginning, a miliary tuberculosis was diagnoses, followed by a second opportunistic infection, i.e. pneumocystis jiroveci pneumonia. After start of ART, further organ manifestations developed, interpreted as immune reconstitution syndrome. The decision about the optimal time point for starting ART in the presence of an opportunistic infection is essential

Severe primary cytomegalovirus infection in the immunocompetent adult patient: A case series.

Abstract Primary cytomegalovirus (CMV) infection is rare in immunocompetent adults, even rarer in elderly patients. Little is known about the severity of symptoms and the clinical course in this patient group. In children and younger adults, CMV mostly presents as an asymptomatic disease or a self-limiting mild mononucleosis-like syndrome. We describe the clinical course of an unusually severe primary CMV infection in a 69-y-old otherwise healthy man, as well as 6 other severe cases in immunocompetent adults at our institution, and compare them to adult cases from the literature. CMV primary infection and antiviral treatment should be considered in immunocompetent elderly persons presenting with a severe mononucleosis-like syndrome

Activity of antifungal combinations against Aspergillus species evaluated by isothermal microcalorimetry.

We evaluated the activity of antifungals alone or in combination against Aspergillus fumigatus and Aspergillus terreus by real-time measurement of fungal growth-related heat production. Amphotericin B, voriconazole, caspofungin, and anidulafungin were tested alone or in combination. Heat production was measured in Sabouraud dextrose broth containing 10(5)Aspergillus conidia/mL for 48 h at 37 °C. Antifungal activity was evaluated by measuring the heat detection time relative to the growth control. Against A. fumigatus, the voriconazole-echinocandin combination demonstrated longer heat detection time than each antifungal alone. Against A. terreus, the combination amphotericin B-echinocandin prolonged the heat detection time, compared to each antifungal alone. In contrast, the echinocandin-voriconazole combination did not increase the heat detection time, compared to voriconazole alone. None of the antifungal combinations decreased the heat detection time compared to the antifungals alone (e.g. antagonism was not observed). Microcalorimetry has the potential for real-time evaluation of antifungal combinations against Aspergillus spp