Fatal <it>Mycobacterium colombiense</it>/cytomegalovirus coinfection associated with acquired immunodeficiency due to autoantibodies against interferon gamma: a case report

<p>Abstract</p> <p>Background</p> <p>Reports of acquired immunodeficiency due to autoantibodies against interferon gamma in the adult population are increasing. The interleukin-12-dependent interferon-gamma axis is a major regulatory pathway of cell-mediated immunity and is critical for protection against a few intracellular organisms, including non-tuberculous mycobacteria and <it>Salmonella</it> spp. We report the first case of a fatal disseminated <it>Mycobacterium colombiense</it>/cytomegalovirus coinfection in an adult woman associated with the acquisition of autoantibodies against interferon-gamma.</p> <p>Case presentation</p> <p>A 49-year-old woman, born to nonconsanguineous parents in Laos, but who had lived in Canada for the past 30 years, presented with a 1-month history of weight loss, fatigue, cough, and intermittent low-grade fever. A thoracic computed tomography scan revealed an 8 × 7 cm irregular mass impacting the right superior lobar bronchus along with multiple mediastinal and hilar adenopathies. On the fourth day of admission, the patient developed fever with purulent expectorations. Treatment for a post-obstructive bacterial pneumonia was initiated while other investigations were being pursued. Almost every culture performed during the patient’s hospitalization was positive for <it>M. colombiense</it>. Given the late presentation of symptoms - at the age of 49 years - and the absence of significant family or personal medical history, we suspected an acquired immunodeficiency due to the presence of anti-interferon-gamma autoantibodies. This was confirmed by their detection at high levels in the plasma and a STAT1 phosphorylation assay on human monocytes. The final diagnosis was immunodeficiency secondary to the production of autoantibodies against interferon-gamma, which resulted in a post-obstructive pneumonia and disseminated infection of <it>M. colombiense</it>. The clinical course was complicated by the presence of a multiresistant <it>Pseudomonas aeruginosa</it> post-endobronchial ultrasound mediastinitis, cytomegalovirus pneumonitis with dissemination, and finally, susceptible <it>P. aeruginosa</it> ventilator-associated pneumonia with septic shock and multiple organ failure, leading to death despite appropriate antibacterial and anti-mycobacterial treatment.</p> <p>Conclusions</p> <p>Although rare, acquired immunodeficiency syndromes should be considered in the differential diagnosis of patients with severe, persistent, or recurrent infections. Specifically, severe non-tuberculous mycobacteria or <it>Salmonella</it> infections in adults without any other known risk factors may warrant examination of autoantibodies against interferon-gamma because of their increasing recognition in the literature.</p

Serdülők egészségi állapotának nemzetközi összehasonlító vizsgálata | International comparative study on health condition of young people

Bevezetés: Az egészségi állapot kapcsolata a megküzdési stratégiákkal (coping), illetve az érzelmi intelligenciával, nemzetközileg széles körben kutatott, azonban erdélyi és magyarországi serdülőkkel végzett összehasonlító vizsgálati adatok a szakirodalomban nem állnak rendelkezésre. Célkitűzés: Serdülők egészségindikátorainak, érzelmi intelligenciájának és megküzdési stratégiáinak elemzése és e tényezőknek az egészségi állapottal való összefüggéseinek vizsgálata egy nemzetközi kutatás keretében. Módszer: A szerzők 390, 13–19 éves debreceni és érmihályfalvi serdülő egészségi állapotát, megküzdési stratégiáit és érzelmi intelligenciáját vizsgálták. Eredmények: A stresszhelyzetben alkalmazott adaptív (azaz problémafókuszú) megküzdési mechanizmusok alacsonyabb depresszióértékkel, valamint jobb pszichés közérzettel jártak együtt, mint a maladaptívak (úgymint emóciókiürítés, önbüntetés, figyelemelterelés). A magasabb érzelmi intelligenciával rendelkező serdülők alacsonyabb depressziószinttel és jobb pszichés közérzettel rendelkeztek, mint társaik. Következtetések: Komoly prevenciós és intervenciós népegészségügyi program lehet a minél fiatalabb életkorban intézményileg elindított érzelmi intelligencia és coping készségfejlesztés. Ez primer prevenciós szinten megalapozza a fiataloknál az egészségtudatos szemlélet kialakulását és a személyiségfejlesztő hatást. Orv. Hetil., 2014, 155(34), 1353–1360. | Introduction: The connection between physical condition, coping strategies and emotional intelligence is widely studied in the international literature, but comparative research data collected among Transylvanian and Hungarian adolescents are not available in contemporary psychological literature. Aim: The aim of the authors was to study health indicators, emotional intelligence and coping strategies among adolescents and analyse connections between these factors and physical condition as part of an international research. Method: The physical condition, coping strategies and emotional intelligence of 390 individuals, aged between 13 and 19 years living in Debrecen (Hungary) and Érmihályfalva (Romania) were observed. Results: adaptive (i. e. problem-focused) coping strategies used in stressful situations resulted in lower depression rates, as well as better mental well-being than the maladaptive ones such as emotional clearing, self-punishment, distraction of attention. Adolescents showing higher emotional intelligence had lower depression levels and better mental well-being. Conclusions: Institutionally initiated emotional intelligence and coping strategy development for young people may prove to be an important preventive interventional public health programme. This may serve as a basis to assist health-consciousness and personality formatting. Orv. Hetil., 2014, 155(34), 1353–1360