Zhi-liang Hu, Hong-xia Wei, Wen-hu Yao and Yong-feng Yang
A 35-year-old man (body weight = 63 kg) with AIDS complaining fever and headache after having commenced anti-retroviral therapy (ART) for a week was admitted to our hospital. Five lumbar punctures performed during 38 days could not confirm a cryptococcal meningitis (CM) based on staining or culture methods for cerebrospinal fluid (CSF). The disease quickly progressed with serious hearing/vision impairment and frequent onset of seizure and coma after being treated with corticosteroids for five days, and then CM was confirmed. Subsequent lumbar puncture showed elevated intracranial pressure as high as 870 mm H2O, even though treated with standard antifungal regimens for CM. His disease was finally controlled by a new triple therapy with amphotericin B (0.7 mg•kg-1•day-1, intravenously), flucytosine (100 mg/kg perday, orally in four divided doses), and voriconazole (200 mg every 12 hours) and ART containing lamivudine (300 mg/day), stavuding (30 mg, twice a day) and efavirenz (300 mg, orally every night). Although it is rare, negative CSF stain or culture for cryptococci in AIDS patients with CM can persist for a long time. Corticosteroids should be used cautiously when an effective anti-fungal therapy is not administered. Triple therapy with amphotericin B, flucytosine and voriconazole may be selectively applied in severe CM. Voriconazole can be co-administered with efavirenz with modified dosing
Gui-lin Yang, Ying-xia Liu, Mu-tong Fang, Wei-long Liu, Xin-chun Chen, John Nunnari, Jing-jing Xie, Ming-feng Liao, Ming-xia Zhang, Guo-bao Li, Pei-ze Zhang, Yi Guan and Boping Zhou
Objective To explore whether age, disease severity, cytokines and lymphocytes in H1N1 influenza A patients correlate with viral load and clearance.
Methods Total of 70 mild and 16 severe patients infected with H1N1 influenza A virus were enrolled in this study.
Results It was found that the patients under 14 years old and severe patients displayed significantly higher viral loads and prolonged viral shedding periods compared with the patients over 14 years old and mild patients, respectively (P < 0.05). Moreover, the patients under 14 years old and severe patients displayed significantly lower Th17 cell frequency than the patients over 14 years old and mild patients (P < 0.01). The viral shedding period inversely correlated with the frequency of IL-17+IFN-γ-CD4+ T cells. Additionally, the decreased concentration of serum TGF-β correlated with the decreased frequency of IL-17+IFN-γ-CD4+ T cells.
Conclusions Both younger and severe patients are associated with higher viral loads and longer viral shedding periods, which may partially be attributed to the impaired Th17 cell response.