Clinical factors associated with unfavorable outcomes in HIV-positive tuberculosis patients

The objective: to identify clinical factors with the highest sensitivity and specificity associated with an unfavorable outcome in the patient with tuberculosis and HIV infection.Subjects. 363 patients with TB/HIV co-infection. Group 1 – 59 (16.3%) patients with the unfavorable outcome, Group 2 – 304 (83.7%) patients with a favorable outcome.Methods: analysis of paired contingency tables by Pearson criterion, quantitative signs by Mann – Whitney test, simple and multiple logistic regression.Results. The following factors promoting unfavorable outcomes in the patient with TB/HIV co-infection with the highest sensitivity and specificity were identified: hemoglobin level (sensitivity – 78.0%; specificity – 73.7%), gastrointestinal candidiasis (72.9% and 84.5%), loose stool (40.7% and 97.4%), no lymphadenopathy (89.8% and 57.2%), and headache (49.2% and 88.5%). The combination of these clinical manifestations provides sensitivity of 78.0% and specificity of 94.4%.A formula is proposed for calculating the probability of an unfavorable outcome in the patient TB/HIV co-infection.

Invasive candida infection after bariatric surgery for morbid obesity presenting as late anastamotic leak

Introduction: Gastrointestinal (GI) leaks are one of the most dreaded complications following bariatric surgery because of the difficulty in diagnosing them and the associated increased morbidity and mortality. Case report: Presenting one such case of 49 yr old gentleman who was on follow-up post bariatric surgery presented lately as acute abdomen and diagnosed as GI perforation and further evaluation and procedure carried out. Discussion: GI leakage after bariatric surgery has been identified as an independent risk factor associated with perioperative death. This highlights the importance of high index of suspicion for diagnosis of this potentially lethal complication. A positive radiology should not be awaited for before exploring patients in whom the diagnosis is still unclear. Conclusion: Histopathologic examination (HPE) remains one of the major diagnostic tools in mycology because it permits rapid, presumptive identification of fungal infections, even when blood cultures are negative. There are different ways to manage leaks, depending on the magnitude of the collection and the clinical presentation. Keywords: surgical pathology; gastrointestinal candidiasis; diagnosis; mini gastric bypass; bariatric surgery; candida.

Oral Administration of Lactobacillus helveticus LA401 and Lactobacillus gasseri LA806 Combination Attenuates Oesophageal and Gastrointestinal Candidiasis and Consequent Gut Inflammation in Mice

Candida albicans is an opportunistic pathogen that causes mucosal gastrointestinal (GI) candidiasis tightly associated with gut inflammatory status. The emergence of drug resistance, the side effects of currently available antifungals and the high frequency of recurrent candidiasis indicate that new and improved therapeutics are needed. Probiotics have been suggested as a useful alternative for the management of candidiasis. We demonstrated that oral administration of Lactobacillus gasseri LA806 alone or combined with Lactobacillus helveticus LA401 in Candida albicans-infected mice decrease the Candida colonization of the oesophageal and GI tract, highlighting a protective role for these strains in C. albicans colonization. Interestingly, the probiotic combination significantly modulates the composition of gut microbiota towards a protective profile and consequently dampens inflammatory and oxidative status in the colon. Moreover, we showed that L. helveticus LA401 and/or L. gasseri LA806 orient macrophages towards a fungicidal phenotype characterized by a C-type lectin receptors signature composed of Dectin-1 and Mannose receptor. Our findings suggest that the use of the LA401 and LA806 combination might be a promising strategy to manage GI candidiasis and the inflammation it causes by inducing the intrinsic antifungal activities of macrophages. Thus, the probiotic combination is a good candidate for managing GI candidiasis by inducing fungicidal functions in macrophages while preserving the GI integrity by modulating the microbiota and inflammation.

Do Pentraxins Bind to Fungi in Invasive Human Gastrointestinal Candidiasis?

Tissue from 13 autopsy cases with invasive gastrointestinal candidiasis was studied for the binding of the pentraxins, C-reactive protein (CRP), pentraxin 3 (PTX3), and serum amyloid P component (SAP) to fungal surfaces. Invasive candidal infection was demonstrated using a hematoxylin and eosin stain and a Gomori methenamine silver stain (GMS). Immunohistochemistry was performed with CRP and PTX3 monoclonal antibodies and did not demonstrate CRP or PTX3 bound to fungi (0 of 13 cases), although CRP was extensively deposited on human tissue. A polyclonal antibody to SAP showed that SAP was bound to fungi in 12 of 13 cases. Although all three pentraxins have been reported to bind to fungi or bacteria, only SAP was bound to filamentous and yeast forms of Candida in human tissue, as detected by immunohistochemistry. SAP was abundantly present on fungi and may have affected the host innate immune response to the invading fungi.

THE ROLE OF HYPERBARIC THERAPY IN THE GROWTH OF CANDIDA ALBICANS

Background: Candida albicans is opportunistic pathogen fungi which cause many disease in human such as reccurrent apthous stomatitis, skin lesions, vulvavaginitis, candiduria and gastrointestinal candidiasis. Aim: Infection mechanism of C. albicans is very complex including adhesion and invasion, morphology alteration from khamir form cell to filamen form (hifa), biofilm forming and the avoidance of host immunity. Method: The ability of C. albicans to adhere to the host cell which is act as important factor in the early colonization and infection. Result: The phenotype alteration to be filament form let the C. albicans to penetrate to the epithelium and play important role in infection and separation C. Albicans to the host cell. Hyperbaric oxygen is the inhalation of 100 percent oxygen inside hyperbaric chamber that is pressurized to greater than 1 atmosphere (atm). Conclusion: The organism was found to be inhibited within a pressure/time range well tolerated by human subjects, suggesting that hyperbaric oxygen might be used successfully in treating human candidiasis.