Bacterial infection in the acquired immunodeficiency syndrome of children

Bernstein, Larry; Krieger, Ben Zion; Novick, Brian; Sicklick, Marc; Rubinstein, Arye

doi:10.1097/00006454-198509000-00005

Cited by 162 publications

(27 citation statements)

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“…Infection with HIV typically predisposes infected individuals to cryptococcal meningitis but also to mycobacterial and bacterial meningitis (84,126,134). Several studies have shown that both children as well as adults with HIV infection have a significantly increased risk of acquiring pneumococcal infections (17,101,149). Epidemiological data suggest that individuals with untreated HIV infection have a higher risk (Ͼ40-fold) of acquiring invasive pneumococcal disease than uninfected individuals (149).…”

Section: Acquired Immunodeficienciesmentioning

confidence: 99%

Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

2008

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SUMMARY Recurrent bacterial meningitis is a rare phenomenon and generally poses a considerable diagnostic challenge to the clinician. Ultimately, a structured approach and early diagnosis of any underlying pathology are crucial to prevent further episodes and improve the overall outcome for the affected individual. In this article, we are reviewing the existing literature on this topic over the last two decades, encompassing 363 cases of recurrent bacterial meningitis described in 144 publications. Of these cases, 214 (59%) were related to anatomical problems, 132 (36%) were related to immunodeficiencies, and 17 (5%) were related to parameningeal infections. The review includes a detailed discussion of the underlying pathologies and microbiological aspects as well as recommendations for appropriate diagnostic pathways for investigating this unusual entity.

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Section: Acquired Immunodeficienciesmentioning

confidence: 99%

Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

2008

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“…These data suggested that an important function of IL-17 is to orchestrate immune responses that limit bacterial dissemination from the intestinal mucosa. SIV selectively impaired this arm of the immune response, which provides an attractive explanation as to why people with HIV are at an increased risk of developing NTS bacteremia [35][36][37] . This SIV-mediated defect in mucosal barrier function may also help explain the presence of lipopolysaccharide in the circulation of people with HIV 38 .…”

Section: Discussionmentioning

confidence: 99%

Simian immunodeficiency virus–induced mucosal interleukin-17 deficiency promotes Salmonella dissemination from the gut

Raffatellu

Santos

Verhoeven

et al. 2008

Nat Med

513

557

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Salmonella typhimurium causes a localized enteric infection in immunocompetent individuals, whereas HIV-infected individuals develop a life-threatening bacteremia. Here we show that simian immunodeficiency virus (SIV) infection results in depletion of T helper type 17 (T H 17) cells in the ileal mucosa of rhesus macaques, thereby impairing mucosal barrier functions to S. typhimurium dissemination. In SIV-negative macaques, the gene expression profile induced by S. typhimurium in ligated ileal loops was dominated by T H 17 responses, including the expression of interleukin-17 (IL-17) and IL-22. T H 17 cells were markedly depleted in SIV-infected rhesus macaques, resulting in blunted T H 17 responses to S. typhimurium infection and increased bacterial dissemination. IL-17 receptor-deficient mice showed increased systemic dissemination of S. typhimurium from the gut, suggesting that IL-17 deficiency causes defects in mucosal barrier function. We conclude that SIV infection impairs the IL-17 axis, an arm of the mucosal immune response preventing systemic microbial dissemination from the gastrointestinal tract. A.G. served as consultant for the presentation of NTS bacteremia in African subjects. J.K.K. served as collaborator on studies with Il17ra −/− mice and provided useful comments on the experimental design. S.D. designed and supervised the SIV infections of rhesus macaques, blood sample scheduling, macaque protocols, processing and cell isolations for flow cytometry and DNA microarray analyses. A.J.B. was responsible for the experimental design and supervision of mouse studies, ligated ileal loop experiments in rhesus macaques, macaque protocols and analysis of host responses to Salmonella infection. A.J.B. collected tissue during the ligated ileal loop surgery and was responsible for the final manuscript preparation. A.J.B. and S.D. provided financial support for the study and equally contributed to the experimental design, supervision and data interpretation. Although nontyphoidal Salmonella serotypes (NTS) are common agents causing acute foodborne disease worldwide, it is unusual to isolate them from the blood of adults, because in immunocompetent individuals these pathogens remain localized to the intestine and cause a self-limiting gastroenteritis 1 . However, in people with underlying immunosuppression, NTS may spread beyond the intestine and reach the bloodstream, a serious complication known as NTS bacteremia2. The rise in the number of people with AIDS in sub-Saharan Africa has led to a dramatic increase in the frequency of NTS bacteremia3. In marked contrast to the pre-AIDS era4, NTS is currently a leading cause of hospital admission of adults and among the most common bacterial blood isolates from hospitalized adults in sub-Saharan Africa5, the vast majority of whom are HIV positive 3 . NTS infection in HIV-positive African adults is associated with high acute mortality rates (47%) 6 . Although the occurrence of NTS bacteremia in HIV-positive people is well documented, there are no reports inv...

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“…Of the 9215 pregnancies initially identified, 1178 (13%) were excluded for pre-existing medical conditions with known associations with UTI (diabetes before pregnancy, 18,19 positive HIV status, 20,21 and structural abnormalities of the urinary tract), lack of prenatal care, and/or race other than black or white due to too few observations for analysis. Additional pregnancies were excluded due to missing gestational age (617 pregnancies), recorded gestational age at delivery of Ͻ20 weeks (8 pregnancies), continuous prophylactic antibiotics prescribed before 20 weeks' gestation (8 pregnancies), and unclear UTI dates (1 pregnancy).…”

Section: Methodsmentioning

confidence: 99%

Predictors of Symptomatic Urinary Tract Infection After 20 Weeks’ Gestation

et al. 1999

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OBJECTIVE:To identify predictors of symptomatic urinary tract infection (UTI) after 20 weeks' gestation. STUDY DESIGN:A retrospective cohort analysis was conducted of all deliveries at three North Carolina hospitals between 1990 and 1993. A total of 7403 deliveries remained after exclusions (pre-pregnancy diabetes, HIV-positive, structural urologic abnormalities, no prenatal care) and restrictions (black or white race, county of residence). Cystitis and pyelonephritis were identified by clinician diagnosis. Multiple logistic regression was conducted. RESULTS:Prior UTIs (both before and earlier in pregnancy), nonprivate clinics, and a history of chlamydia (white women only) doubled the risk of symptomatic UTIs after 20 weeks' gestation. The strongest predictor of pyelonephritis was prior antenatal UTIs (adjusted incidence odds ratio ϭ 5.3, 95% confidence interval of 2.6 -11.0), followed by less education (Ͻ12 years), a history of chlamydia, nonprivate clinics, illicit drug use, sickle cell hemoglobinopathy, and being unmarried. CONCLUSION:Medical history and demographic factors predict cystitis and pyelonephritis after 20 weeks' gestation. Prospective studies of pyelonephritis predictors and screening strategies are warranted.Urinary tract infections (UTIs) are common in pregnancy and have been associated with preterm delivery and low birth weight.1-3 Lower UTIs in the mother are more likely to progress to pyelonephritis during pregnancy, and pyelonephritis can result in sepsis and acute adult respiratory distress syndrome. 4,5 In 1960, Kass 6 demonstrated that detection and treatment of asymptomatic bacteriuria (ASB) in pregnancy could diminish the likelihood of progression to symptomatic UTI. This was followed by various cohort studies describing the epidemiology of UTIs during pregnancy.3,6 -16 These studies were limited by the breadth of risk factors explored and their statistical methodology. Thus, we conducted this study to identify demographic, behavioral, and medical history factors during and before pregnancy that are predictive of a symptomatic UTI in pregnancy after 20 weeks' gestation. Of particular interest was the identification of risk factors for pyelonephritis and separation of the correlated effects of black race and sickle cell hemoglobinopathies. MATERIALS AND METHODSA retrospective cohort was assembled of deliveries at three central North Carolina hospitals from 1990 to 1993: University of North Carolina Hospitals (UNCH), Duke University Medical Center (DUMC), and Durham Regional Hospital (DRH). Study details are published elsewhere. 17 Briefly, computerized obstetrics databases were analyzed and supplemented with medical chart abstracts. The original sources for all variables were routine patient questionnaires administered at the first or second prenatal visit by each clinic and medical charts maintained by the clinicians. A subset of charts was compared with the computerized data for validation.17 Approval from human subjects was received from all participating hospitals.Of the 9215 pregna...

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Bacterial infection in the acquired immunodeficiency syndrome of children

Cited by 162 publications

References 0 publications

Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

Simian immunodeficiency virus–induced mucosal interleukin-17 deficiency promotes Salmonella dissemination from the gut

Predictors of Symptomatic Urinary Tract Infection After 20 Weeks’ Gestation

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