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Travel vaccination recommendations and infection risk in HIV-positive travellers

Chang L, Lim BCW, Flaherty GT, Torresi J

J Travel Med, 2019 Sep 02;26(6).
PMID: 31066446 DOI: 10.1093/jtm/taz034

BACKGROUND: With the advent of highly active antiretroviral drugs for the treatment of human immunodeficiency virus (HIV) it has become possible for people with HIV to travel to destinations that may place them at risk of a number of infectious diseases. Prevention of infections by vaccination is therefore of paramount importance for these travellers. However, vaccine responsiveness in HIV-positive individuals is not infrequently reduced compared to HIV-negative individuals. An understanding of the expected immune responses to vaccines in HIV-positive travellers is therefore important in planning the best approach to a pretravel consultation.
METHODS: A PubMed search was performed on HIV or acquired immune deficiency syndrome together with a search for specific vaccines. Review of the literature was performed to develop recommendations on vaccinations for HIV-positive travellers to high-risk destinations.
RESULTS: The immune responses to several vaccines are reduced in HIV-positive people. In the case of vaccines for hepatitis A, hepatitis B, influenza, pneumococcus, meningococcus and yellow fever there is a good body of data in the literature showing reduced immune responsiveness and also to help guide appropriate vaccination strategies. For other vaccines like Japanese encephalitis, rabies, typhoid fever, polio and cholera the data are not as robust; however, it is still possible to gain some understanding of the reduced responses seen with these vaccines.
CONCLUSION: This review provides a summary of the immunological responses to commonly used vaccines for the HIV-positive travellers. This information will help guide travel medicine practitioners in making decisions about vaccination and boosting of travellers with HIV.

Matched MeSH terms: Immunocompetence/immunology*
Engineering of various types of tissues in immunocompetent animals and its potential for clinical application

Cao Y

Med J Malaysia, 2004 May;59 Suppl B:2.
PMID: 15468789
Matched MeSH terms: Immunocompetence/immunology*
Fulltext Gastrointestinal Cytomegalovirus infection in non-human immunodeficiency virus infected patients

Ng KL, Ho J, Ng HS, Luman W

Med J Malaysia, 2003 Aug;58(3):337-44.
PMID: 14750372

This is a retrospective study of fourteen patients who had proven Cytomegalovirus (CMV) infection of the gastrointestinal tract with no Human Immunodeficiency virus infection. The median age was 60.5 (Range 28 to 81) years. Eight patients were below (Group 1) and six above sixty five years old (Group 2). Areas of gastro-intestinal involvement were: oesophagus (2), stomach (1), colon (10) and multiple sites (1). Seven patients from Group 1 had received immunosuppressive therapy at the time of presentation and one had diabetes mellitus. We found a high prevalence of co-morbidities such as chronic renal failure and diabetes mellitus in Group 2. At median follow up of 13.9 months, there was a mortality rate of 50%. Only four patients were treated with ganciclovir. Our study concludes that the gastrointestinal CMV diseases in young patients were associated with immunosuppression whereas the older patients had chronic renal failure or diabetes.

Matched MeSH terms: Immunocompetence*
Disseminated invasive aspergillosis in an apparently immunocompetent host

Raja NS, Singh NN

J Microbiol Immunol Infect, 2006 Feb;39(1):73-7.
PMID: 16440127

Aspergillosis is a spectrum of diseases caused by members of the genus Aspergillus that continues to pose a significant threat to immunocompromised, organ transplant, neutropenic and cancer patients. In view of increasing risk factors leading to invasive aspergillosis, it is imperative for clinicians to be familiar with the clinical presentation, diagnostic methods and management of the disease. We describe a 34-year-old immunocompetent male patient receiving chemotherapy for Aspergillus fumigatus infection that had disseminated to lung, liver and spleen. A computed tomogram of thorax and abdomen showed thick-walled cavities of different sizes with air fluid levels, consolidation in both lungs and involvement of liver and spleen. His broncheoalveolar lavage and sputum specimens yielded A. fumigatus. Successful treatment of this infection was achieved with amphotericin B and itraconazole.

Matched MeSH terms: Immunocompetence*
Acute retinal necrosis by cytomegalovirus in an immunocompetent adult: case report and review of the literature

Tajunisah I, Reddy SC, Tan LH

Int Ophthalmol, 2009 Apr;29(2):85-90.
PMID: 18026692

A rare case of acute retinal necrosis caused by cytomegalovirus in an immunocompetent adult, diagnosed by polymerase chain reaction of vitreous aspirate, with good visual outcome after intravitreal and intravenous ganciclovir and oral prednisolone therapy, is reported. A 50-year-old healthy lady presented with redness and diminution of vision in her right eye of 10 days duration. She had anterior chamber inflammation, marked vitritis, and anterior retinal necrosis in the right eye. Blood and other investigations did not reveal any infectious diseases and HIV testing was negative. The retinal lesions and panuveitis resolved with treatment. Two months later she developed retinal detachment which was treated successfully. The best-corrected vision was 6/12 in the right eye. Seven cases of cytomegalovirus ocular infection in immunocompetent healthy adults, reported in the literature, were reviewed. The different presentations of this disease and the importance of suspecting this causative agent are highlighted.

Matched MeSH terms: Immunocompetence*
Molecular detection and species identification of Enterocytozoon bieneusi isolated from immunocompetent Orang Asli in Malaysia

Ashikin A, Al-Mekhlafi HM, Moktar N, Anuar TS

Parasitol Int, 2017 Apr;66(2):163-165.
PMID: 28115231 DOI: 10.1016/j.parint.2017.01.013

Most studies of opportunistic infections focus on immunocompromised patients. However, there is a lack of information on microsporidiosis in healthy people (immunocompetent) worldwide. This study aimed to detect and identify microsporidia species in immunocompetent Orang Asli living in Pahang, Malaysia. Orang Asli is a collective term for a group of indigenous people that usually reside in the interior regions of Peninsular Malaysia. They comprise about 0.7% of the total population in Malaysia and 76% of them lived below the poverty line i.e., poor housing conditions with the lack of access to safe drinking water and adequate sanitation, contaminated environment, high illiteracy rate and unhygienic practices by these people. Stool samples were collected from 209 Orang Asli and analyzed for detecting the presence of Enterocytozoon bieneusi and Encephalitozoon intestinalis by polymerase chain reaction assay targeting small subunit ribosomal RNA gene. E. bieneusi was detected in 8 individuals (3.83%). This infection was commonly found in males than females (5.2% vs. 2.7%). All infected Orang Asli were adults, with a mean age of 44years. Diarrhea and other gastrointestinal symptoms were reported in one case (12.5%) among individuals infected with this species. These findings clearly show that exposure to E. bieneusi may actually be common than reported. The accurate detection and identification of microsporidian species by molecular technique will improve therapy, clinical manifestations and prognosis of this infection, as no antiparasitic therapy has been approved for E. bieneusi. It is hoped that these findings will allow the formulation of better health management and disease prevention advisories, and improvement in the standards of health in similar communities.

Matched MeSH terms: Immunocompetence*
Fulltext Disseminated cutaneous sporotrichosis in an immunocompetent individual

Yap FB

Int J Infect Dis, 2011 Oct;15(10):e727-9.
PMID: 21719337 DOI: 10.1016/j.ijid.2011.05.005

Sporotrichosis is a subacute or chronic fungal infection caused by the ubiquitous fungus Sporothrix schenckii. Disseminated cutaneous sporotrichosis is an uncommon entity and is usually present in the immunosuppressed. Here, a case of disseminated cutaneous sporotrichosis in an immunocompetent patient is reported. This 70-year-old healthy woman presented with multiple painful ulcerated nodules on her face and upper and lower extremities of 6-month duration, associated with low-grade fever, night sweats, loss of appetite, and loss of weight. Histopathological examination of the skin biopsy revealed epidermal hyperplasia and granulomatous inflammation in the dermis, with budding yeast. Fungal culture identified S. schenckii. She had total resolution of the lesions after 2 weeks of intravenous amphotericin B and 8 months of oral itraconazole. All investigations for underlying immunosuppression and internal organ involvement were negative. This case reiterates that disseminated cutaneous sporotrichosis, although common in the immunosuppressed, can also be seen in immunocompetent patients.

Matched MeSH terms: Immunocompetence
Matrine enhances the inhibitory effect of 5-fu on sw480 cells in vitro and in vivo

Xu-hui Zhang, Lei Liang, Xiao-yan Wang, Li Zhang, Yan-xin Zheng, Hong-zhu Deng, et al.

Sains Malaysiana, 2016;45:109-113.

We investigated the antitumor effects of the combination of matrine-a purified alkaloid extracted from Sophora flavescence-and 5-fluorouracil (5-FU) on SW480 cells. This combination inhibited the growth of SW480 cells in a synergistic or additive manner by disrupting their progression through the cell cycle. Exposure of SW480 cells to matrine and 5-FU was followed by an increased rate of expression for caspase-3, caspase-9 and poly-ADP ribose polymerase (PARP) and inhibited the subcutaneous transplantation of SW480 tumors into Balb/c nude mice. Histopathological analysis showed that this effect was most pronounced in the spleens of treated animals. Typical cytotoxic effects observed in 5-FU-treated mice included fibrosis and lymphopenia, whereas in mice treated with 5-FU combined with matrine, the spleen ultrastructure remained intact. These findings indicate that matrine may enhance the therapeutic effectiveness of 5-FU in SW480 tumors by enhancing apoptosis and overcome the threat to immunocompetence associated with 5-FU.

Matched MeSH terms: Immunocompetence
Dietary astaxanthin augments disease resistance of Asian seabass, Lates calcarifer (Bloch, 1790), against Vibrio alginolyticus infection

Lim KC, Yusoff FM, Shariff M, Kamarudin MS

Fish Shellfish Immunol, 2021 Jul;114:90-101.
PMID: 33838221 DOI: 10.1016/j.fsi.2021.03.025

This investigation describes the impacts of dietary provisioning with astaxanthin on hemato-biochemistry, non-specific immunity, and disease resistance of the Asian seabass, Lates calcarifer, against the virulent Vibrio alginolyticus; with specific reference to dose-response associations and variations over different post-infection periods (0-, 7-, and 14-day). Triplicate groups of fish weighing 28 g, on average, were fed various diets (C, the control or astaxanthin-free; AXT50, 50 mg astaxanthin kg-1 diet; AXT100, 100 mg astaxanthin kg-1 diet; and AXT150, 150 mg astaxanthin kg-1 diet) for 90 days and subsequently challenged with V. alginolyticus at the end of the feeding period. Experimental infection unveiled that supplemented fish demonstrated significant improvements (P

Matched MeSH terms: Immunocompetence
Cryptococcus humicolus meningitis: first case report in Malaysia

Ramli SR, Leong MC, Khaithir TM, Aziz MN, Loons LC, Rafia MH

Southeast Asian J Trop Med Public Health, 2012 Sep;43(5):1212-7.
PMID: 23431829

We report a case of Cryptococcus humicolus meningitis complicated by communicating hydrocephalus in an apparently immunocompetent 49-year-old psychiatric patient from a nursing home. He presented with a history of poor oral intake, weight loss, headache, vomiting, blurred vision, frequent falls and unsteady gait for the previous three months. He had a history of chronic cough, productive of whitish sputum for the previous month but no hemoptysis. Cerebrospinal fluid culture was positive for Cryptococcus humicolus. He was treated with intravenous amphotericin B and oral fluconazole and had clinical and microbiological improvement after three weeks of treatment. Unfortunately, the patient acquired nosocomial methicillin-resistant Staphylococcus aureus infection and died due to overwhelming sepsis.

Matched MeSH terms: Immunocompetence
Burkholderia cepacia: a rare cause of bacterial keratitis

Ibrahim M, Yap JY

BMJ Case Rep, 2018 Apr 25;2018.
PMID: 29695396 DOI: 10.1136/bcr-2018-224552

We describe the first clinical case of Burkholderia cepacia keratitis registered in Southeast Asia. A man in his mid-70s with underlying poorly controlled diabetes mellitus came with complaints of painful red left eye for 4 days. This was accompanied with photophobia and blurring of vision after being injured by a wooden particle while cutting grass. Slit-lamp examination showed a paracentral anterior corneal stromal infiltrates with overlying epithelial defect. Culture of the corneal smear isolated B. cepacia that was sensitive to ceftazidime, meropenem and bactrim (trimethorprim and sulfomethoxazole). Topical ceftazidime was given intensively to the patient and the infection resolved after 6 weeks of treatment.

Matched MeSH terms: Immunocompetence
Inhibition of lymphocyte proliferative responses to Helicobacter pylori by plastic adherent cells

Uyub AM, Anuar AK

Southeast Asian J Trop Med Public Health, 2001 Mar;32(1):88-94.
PMID: 11485102

A study was carried out on 49 H. pylori-positive and 11 H. pylori-negative patients to determine the reactivity of peripheral blood lymphocytes (PBL) to phytohemagglutinin (PHA) and acid glycine extract (AGE) of H. pylori, and to identify cells responsible for imunosuppression. Based on response to PHA stimulation, cell-mediated immunity of all patients were competent. In some patients, however, response to AGE of H. pylori was suppressed by plastic adherent cells. This study provided evidence of the presence of plastic adherent suppressor cells which suppressed PBL response to AGE of H. pylori but not to PHA suggesting that immunosuppression is antigen specific. There is also an indication that immunosuppression may be species-specific as PBL devoid of plastic adherent cells only responded to stimulation by AGE of H. pylori but not that to AGE of C. jejuni.

Matched MeSH terms: Immunocompetence
Fulltext Intracranial bleeding (ICB) as a catastrophic complication of Streptococcus gordonii infective endocarditis (IE) in an immunocompetent patient

Pairan MS, Mohammad N, Abdul Halim S, Wan Ghazali WS

BMJ Case Rep, 2018 Sep 10;2018.
PMID: 30206067 DOI: 10.1136/bcr-2018-225265

We present an interesting case of late-onset intracranial bleeding (ICB) as a complication of Streptococcus gordonii causing infective endocarditis. A previously healthy young woman was diagnosed with infective endocarditis. While she was already on treatment for 2 weeks, she had developed seizures with a localising neurological sign. An urgent non-contrasted CT brain showed massive left frontoparietal intraparenchymal bleeding. Although CT angiogram showed no evidence of active bleeding or contrast blush, massive ICB secondary to vascular complication of infective endocarditis was very likely. An urgent decompressive craniectomy with clot evacuation was done immediately to release the mass effect. She completed total 6 weeks of antibiotics and had postoperative uneventful hospital stay despite having a permanent global aphasia as a sequel of the ICB.

Matched MeSH terms: Immunocompetence