A 19 Year Old Male With HIV Presents With Diffuse Lymphadenopathy

Background In 1872, Moritz Kaposi first described an idiopathic multiple pigmented sarcoma of the skin;\u27\u27 now identified as Kaposi\u27s sarcoma (KS).\u27 While multiple forms ofKSexist, over9S% of the cases diagnosed in the US since 1981 are of the AIDS associated variety.2 Kaposi originally described KS as skin lesions that can progress to visceral involvement. However, in a small number of cases, KS can appear in the viscera without skin involvement. These alternate presentations of KS are difficult to diagnose; therefore, it is critical to recognize them when considering differential diagnoses, particularly in patients with HIV. Case Presentation An 18-year-old African American male with a history ofHIV presented with progressive worsening of diffuse and painful lymphadenopathy fore five weeks prior to admission. The patient was diagnosed with HIV in 2010 and due to insurance issues, was never treated with highly active antiretroviral therapy (HAART). His last CD4 count (approximately two weeks prior to admission) was 411 and he had no history of opportunistic infections. He first noticed swelling in his neck, under his armpits and in his groin five weeks prior, which had become progressively more painful. The patient denied fevers, chills or weight loss, but did report significant night sweats and episodes ofhemoptysis with dots. He denied shortness ofbreath or chest pain. He also denied recent travel, history of incarceration, homelessness or exposure to active tuberculosis infection

The hidden burden of influenza: A review of the extra-pulmonary complications of influenza infection

Severe influenza infection represents a leading cause of global morbidity and mortality. Although influenza is primarily considered a viral infection that results in pathology limited to the respiratory system, clinical reports suggest that influenza infection is frequently associated with a number of clinical syndromes that involve organ systems outside the respiratory tract. A comprehensive MEDLINE literature review of articles pertaining to extra-pulmonary complications of influenza infection, using organ-specific search terms, yielded 218 articles including case reports, epidemiologic investigations, and autopsy studies that were reviewed to determine the clinical involvement of other organs. The most frequently described clinical entities were viral myocarditis and viral encephalitis. Recognition of these extra-pulmonary complications is critical to determining the true burden of influenza infection and initiating organ-specific supportive care

Burden of respiratory viral infection in persons with human immunodeficiency virus

This study was conducted to determine the prevalence of respiratory viral infections (RVI) in persons living with HIV (PLH) admitted with a respiratory complaint using real-time reverse transcription polymerase chain reaction and primer-independent next-generation sequencing (NGS). Of 82 subjects, respiratory viruses were the most common pathogen identified in 27 (33%), followed by fungus and bacteria in 8 (10%) and 4 (5%) subjects, respectively. Among subjects with RVI, 11 (41%) required ICU admission and 16 (59%) required mechanical ventilation. The proportion of respiratory viruses identified, and the associated complicated hospital course highlights the significant role that RVIs play in the lung health of PLH

Runaway Kaposi Sarcoma-associated herpesvirus replication correlates with systemic IL-10 levels

KSHV-associated inflammatory cytokine syndrome (KICS) is caused by Kaposi's sarcoma-associated herpesvirus (KSHV). KICS is associated with high-level, systemic replication of KSHV. This study characterized the clinical and virologic features of a KICS patient over time. Additionally, it compared the cytokine profiles of the KICS case to Kaposi's sarcoma (KS) (n = 11) and non-KS (n = 6) cases. This KICS case presented with elevated levels of KSHV and IL-10, as expected. Surprisingly, this case did not have elevated levels of IL-6 or human immunodeficiency virus 1 (HIV-1). Nevertheless, treatment with anti-IL6 receptor antibody (tocilizumab) reduced KSHV viral load and IL-10. The KSHV genome sequence showed no significant changes over time, except in ORF24. Phylogenetic analysis established this isolate as belonging to KSHV clade A and closely related to other US isolates. These findings suggest IL-10 as potential biomarker and therapy target for KICS

Age-associated changes in the respiratory epithelial response to influenza infection

Older adults suffer a disproportionate burden of influenza-related morbidity and mortality typically attributed to defects in the aging immune system collectively known as immunosenescence. While the age-related decline in the adaptive immune system has been well characterized, little is known about how aging affects the principal site of influenza infection—the nasal epithelium. In human nasal epithelial cell cultures (hNECs) from older adults, we found similar or increased levels of cytokines during influenza infection compared with hNECs from younger individuals. However, hNECs from older individuals demonstrated decreased mRNA expression for several key proteins that affect clearance of infected cells, including MHC-I and transporter associated with antigen presentation (TAP). These findings were confirmed at the level of protein expression. In vivo studies corroborated the in vitro differences in MHC-I and TAP gene expression and also revealed important decreases in the expression of key influenza-specific antiviral mediators MX1 and IFITM1. Furthermore, epithelial cell-cytotoxic T lymphocyte co-cultures demonstrate that CTL cytotoxic activity is dose-dependent on MHC-I antigen presentation. Taken together, these results indicate that aging is associated with important changes in the nasal epithelium, including antigen presentation and antiviral pathways, which may contribute to increased severity of disease in older adults through impaired clearance of infected cells

Highly dampened blood transcriptome response in HIV patients after influenza infection.

Respiratory viral (RV) infections represent a major threat for human health worldwide. Persons with HIV (PWH) have a compromised immune response and are thought to be at higher risk for severe RV disease. However, very little is known about the host immune response to RV infection in PWH. Here, we investigated gene expression changes in the peripheral blood of PWH co-infected with RV. Only very few differentially expressed genes could be detected between PWH with and without RV infection, suggesting that the immune response to RV in PWH is strongly dampened. Our data provides important insights into the host response to RV infections in HIV patients

Implementation of a Residency Twitter Account to Provide Curricular Enrichment

Background The Problem With the goals of improving patient safety and resident well-being, the ACGME’s 2011 revision of duty-hour requirements included a 16-hour limit on continuous duty hours for postgraduate year 1 (PGY-1) trainees, increased supervision for junior trainees, as well as mandated rest periods between duty hours.1 These rules place limitations on the ability of trainees to attend scheduled educational activities during standard work hours; a recent study showed a decrease in resident availability for teaching conferences compared with the 2003 duty hour regulations.2 Residency training programs must develop alternative avenues for education and encouraging inquiry outside of traditional methods. A Modern Solution Social networking sites, such as Twitter, represent a promising opportunity for residency programs to foster collaborative learning and educational engagement both inside and outside of the hospital. After surveying our residents’ methods of obtaining medical knowledge, the chief medical residents at Thomas Jefferson University Hospital created a shared Twitter account entitled “@JeffIMChiefs” with the goals of disseminating clinical pearls from our daily conferences and inspiring continued learning by providing links to relevant research and review articles

Optimal Lung Cancer Screening Criteria Among Persons Living With HIV

BackgroundThe US Preventive Services Task Force (USPSTF) 2021 updated recommendations on lung cancer screening with chest computed tomography to apply to individuals 50-80 years of age (previously 55-80 years), with a ≥20 pack-year history (previously ≥30), whether currently smoking or quit ≤15 years ago. Despite being at higher risk for lung cancer, persons with HIV (PWH) were not well-represented in the National Lung Screening Trial, which informed the USPSTF 2013 recommendations. It is unknown or unclear how PWH are affected by the 2021 recommendations.SettingThis study was a retrospective analysis of PWH with and without lung cancer in the Women's Interagency HIV Study and the Multicenter AIDS Cohort Study.MethodsWe identified PWH, ages 40-80 years, who currently or previously smoked, with (cases) and without lung cancer (noncases). The sensitivity and specificity of the old, new, and alternative screening criteria were evaluated in each cohort.ResultsWe identified 52 women and 19 men with lung cancer and 1950 women and 1599 men without lung cancer. Only 11 women (22%) and 6 men (32%) with lung cancer met 2013 screening criteria; however, more women (22; 44%) and men (12; 63%) met 2021 criteria. Decreased age and tobacco exposure thresholds in women further increased sensitivity of the 2021 criteria.ConclusionsThe 2021 USPSTF lung cancer screening recommendations would have resulted in more PWH with lung cancer being eligible for screening at the time of their diagnosis. Further investigation is needed to determine optimal screening criteria for PWH, particularly in women