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Levothyroxine sodium in treatment of severe pulmonary tuberculosis with euthyroid sick syndrome

Yuecui LI ; Shenjie TANG ; Weiyue HU ; Jin LI ; Hongxia LUO ; Jin ZHOU ; Chenghang LI

Chinese Journal of Clinical Infectious Diseases.2010;03(5):267-270. doi:10.3760/cma.j.issn.1674-2397.2010.05.004

Objective To evaluate the efficacy of low-dose levothyroxine sodium in treatment of severe pulmonary tuberculosis with euthyroid sick syndrome(ESS). Methods One hundred and twenty inpatients with severe pulmonary tuberculosis and ESS were randomly divided into treatment group and control group by gender, age, disease duration and severity. Both groups were given anti- tuberculosis, antiinfection treatment and nutritional support for 2 weeks; patients in treatment group were given low-dose levothyroxine sodium additionally. Thyroid function, clinical improvements, increase of albumin, reduction of acid-fast bacilli, improvements on images and the mortality rates were compared between the groups.Results After 2 weeks of treatment, symptoms including fever, cough and night sweats were improved in both groups. Marked improvements were observed in 19 patients(31.7%)of treatment group and 8 patients (13.3%)of control group(χ2 = 5. 73, P ＜ 0.05). Clearance rate of acid-fast bacilli in treatment group was 25.0%(15/60), but that in the control was only 6.7%(4/60)(χ2 = 7. 50, P ＜ 0.01). Serum albumin in the treatment group was increased to(34.2 ±0.4)g/L after the treatment, and that in the control group was(29.1 ±0.6)g/L(t =2.42, P＜0.05). T3 and FT3 were significantly increased in both groups, but more significant difference was observed in the treatment group(t = 59. 42 and 50. 66, P ＜ 0. 01). No empty closed after treatment in both groups, but the effective rate in treatment group was significantly higher than that in the control group(93.3% vs. 76.7%, χ2 =6. 54, P＜0.05). Two patients in control group died(2/60, 3. 3%), while no death was reported in treatment group. Conclusions Low-dose levothyroxine sodium treatment is effective for ESS in patients with severe pulmonary tuberculosis.Improvement on low T3 syndrome may be an important indicator for the overall improvement or recovery.

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Association of polymorphisms of -139 and -336 nucleotides in DC-SIGN promoter region with HIV infection

Qinguang LI ; Lijun XU ; Qiyun ZHANG ; Fan HUANG ; Huicong CHEN ; Ronghua CHEN

Chinese Journal of Clinical Infectious Diseases.2010;03(4):204-208. doi:10.3760/cma.j.issn.1674-2397.2010.04.004

Objective To investigate the polymorphisms of-139 and -336 nucleotides in dendritic cells specific intercellular adhesion molecule-3-grabbing nonintegrin (DC-SIGN) promoter region in context of HIV susceptibility, infection routines and HIV/AIDS progress. Methods Polymorphisms of -139 and -336 nucleotides in DC-SIGN were examined in 160 HIV-positive subjects and 178 healthy controls;the Spearman test was performed to analyze their associations with HIV infection status. Results In 160 HIV-positive subjects, there were 92 (57.5%) with-139C, 68 (42.5%) with-139T, 29 (18.1%) with-336C and 131 (81.9%) with -336T. The frequencies of -139T/C and -336T/C in HIV-positive subjects were similar to those in the healthy controls (χ2 =0. 121 and 1. 754, P ＞0.05 ). No differences were found in the distribution of -139T/C or -336T/C in HIV-positive subjects infected via sex intercourse or intravenous drug (χ2 =0. 435 and 0. 103, P ＞ 0. 05 ). -139C was usually companied with -336C ( r = 0. 359, P ＜ 0.01 ).-139T (27.9%) were more frequently presented in patients with CD4 +T cells ≤50 cells/μL than -139C( 23.0%, χ2 = 4.055, P ＜ 0.05 ). -139T/C and -336T/C were not related to HIV RNA levels ( t = - 0. 643and - 1. 637, P ＞ 0.05). Conclusions Genotype -139C in DC-SIGN promoter region usually coexist with -336C. Polymorphisms of -139 and -336 are not related to HIV susceptibilities or HIV infection routes.-139T genotype may be related to serious depletion on CD4 + T cells.

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Relationship between bacterial biofilm and bacterial culture in patients with chronic rhinosinusitis

Ruilong XU ; Huayong YING ; Pan ZHUGE ; Lihong BO ; Huihua YOU

Chinese Journal of Clinical Infectious Diseases.2010;03(4):217-221. doi:10.3760/cma.j.issn.1674-2397.2010.04.007

Objective To investigate the relationship between bacteria biofilm and bacterial culture in patients with chronic rhinosinusitis (CRS). Methods Ninety patients with CRS were enrolled in the study. Five patients with deviation of nasal septum and 10 healthy subjects served as controls. Mucosa of uncinate process or near the ostium of the maxillary sinus was obtained during endoscopic sinus surgery. All specimens were processed for bacterial culture and scanned by electron microscopy. Pearson test was performed to analyze the relationship between the presence of bacterial biofilm and the results of bacteria culture. Results The scanning electron microscopy showed bacterial biofilms in 64 (71.1%) out of 90patients with CRS, while the positive rate of bacteria culture in the study group was 66.7% (60/90). No bacterial biofilm and bacterium was detected in the control group and 26 culture-negative individuals in study group. Pearson correlation analysis showed a statistically association between bacterial biofilm and bacterial culture in CRS ( r = 0. 901, P = 0. 000). Conclusion Positive results of bacteria culture are highly correlated with the presence of bacterial biofilm in CRS patients.

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Expression of CD127 and its association with apoptosis of CD8 + T lymphocytes in patients with chronic HIV-1 infection

Lei JIN ; Jiyun Lü ; Xiangsheng XU ; Shuye ZHANG ; Yanmei JIAO ; Hao WU ; Xicheng WANG ; Zheng ZHANG ; Fusheng WANG

Chinese Journal of Clinical Infectious Diseases.2010;03(4):195-199. doi:10.3760/cma.j.issn.1674-2397.2010.04.002

Objective To investigate the expression of CD127 (interleukin-7 receptor α, IL-7Rα)and its association with apoptosis of CD8 + T lymphocytes in patients with chronic HIV-1 infection. Methods The expression of CD127 on T lymphocytes and spontaneous apoptosis of CD8+ T lymphocytes were measured by flow cytometry in peripheral blood from 24 patients with chronic HIV-1 infections and 12 healthy subjects. The associations of CD127 expression with CD4 +T lymphocytes counts, HIV RNA loads and cell apoptosis were analyzed. Mann-Whitney U test was performed to compare between the groups, and Spearman test was used for correlation analysis. Results The expression of CD127 on CD8 + T lymphocytes was significantly down-regulated in HIV-1 infected subjects (Z = -4.796, P ＜ 0. 01 ), which was positively correlated with CD4 + T lymphocytes (r = 0.817, P ＜ 0.01 ) and negatively correlated with HIV RNA load and CD8+T lymphocytes apoptosis (r= -0.442 and -0.688,P＜0.05 and ＜0.01). Conclusion CD127 down-regulation may play an important role in the descended ability of receiving survival signals and ascended apoptosis of CD8 + T lymphocytes during chronic HIV-1 infection, which indicates that IL-7 might be a novel strategy in treatment of HIV infection.

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Immune reconstitution inflammatory syndrome and its risk factors in highly active antiretroviral therapy

Guoqiang ZHOU ; Min WANG ; Yuhuang ZHENG ; Meng LIU ; Gang XIAO

Chinese Journal of Clinical Infectious Diseases.2010;03(4):213-216. doi:10.3760/cma.j.issn.1674-2397.2010.04.006

Objective To determine the incidence, clinical manifestation and risk factors of immune reconstitution inflammatory syndromes (IRIS) in highly active antirctroviral therapy (HAART) for HIV/AIDS patients. Methods Two hundred and twelve HIV/AIDS patients received HAART, and were followed up for 6 months. The incidence time and disease spectrum of IRIS were observed. Multiple logistic regression analysis was performed to identify the risk factors for IRIS. Results Among 212 patients, there were 59 (27.8%) experienced an IRIS event during the first 6 months of HAART, 2 of which died (2/59,3.39% ). Median time of IRIS onset was 21 days form HAART initiation. The disease spectrum included tuberculosis, herpes virus infections, pneumocystis jirovecii pneumonia, cryptococcal meningitis and penicillium marneffei infection. Risk factors of IRIS included baseline infections ( OR = 1. 655, P =0.010),fever during HAART ( OR = 2. 344, P= 0.006), and baseline CD4 + count ( OR = 1. 556, P = 0. 034).Conclusions IRIS usually occurred within the first month from HAART initiation, and tuberculosis and herpes virus infection are most common. The occurrence of IRIS is associated with the antigens burden and the decreased baseline CD4 + count.

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Effect of highly active antiretroviral therapy on HIV-1 specific CTL immune responses

Wen ZHAO ; Yangbo TANG ; Xiaoping TANG ; Fuchun ZHANG ; Weiping CAI ; Hanlin ZHAN

Chinese Journal of Clinical Infectious Diseases.2010;03(4):209-212. doi:10.3760/cma.j.issn.1674-2397.2010.04.005

Objective To investigate the effect of highly active antiretroviral therapy (HAART) on human immunodeficiency virus type-1 ( HIV-1 ) antigen specific cytotoxic T lymphocyte (CTL) immune responses. Methods Peripheral blood mononuclear cells (PBMCs) were collected from 38 HIV-1 infected individuals receiving HAART ( HAART group) and 31 HIV-1 infected individuals not receiving HAART (non-HAART group), and stimulated with a peptide pool containing 12 overlapping peptides in HIV-1 P24;then the frequency of interferon γ ( IFNγ ) secreting cells were assessed by enzyme-linked immunospot (ELISPOT) method. Difference in HIV-1 antigen specific CTL immune response between non-HAART group and HAART group was analyzed by χ2 and Mann-Whitney U tests. Results Positive response rate of HIV-1 antigen specific CTL immune responses in HAART group ( 65.8%, 24/38 ) was higher than that of non-HAART group (32.3%, 10/31, χ2 = 6. 522, P ＜ 0.05 ). For HIV-1 infected individuals with blood CD4 +T cells ＞ 350/μL, the frequency of HIV-1 antigen specific CTL responses in HAART group was higher than that in non-HAART group (Z = -2. 819, P ＜0.05 ). In the HAART group, those receiving HAART more than 12 months were of higher frequency of HIV-1 antigen specific CTL responses ( Z =-2. 195, P ＜ 0. 05 ). Conclusion HAART especially long-term treatment may enhance HIV-1 specific CTL responses in HIV-1 infected individuals.

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Immune reconstitution in HIV-1 infected individuals with long-term highly active antiretroviral therapy

Lei FENG ; Chunhui SHOU ; Changzhong JIN ; Mingqing DONG ; Yuanhao JIN ; Brockmeyer NORBERT ; Nanping WU ; Jie YAN

Chinese Journal of Clinical Infectious Diseases.2010;03(4):200-203. doi:10.3760/cma.j.issn.1674-2397.2010.04.003

Objective To evaluate the immune reconstitution of HIV-1 infected individuals after long-term highly antiretroviral therapy (HAART). Methods Twenty-five HIV-1 infected individuals receiving HAART, 17 without HAART and 15 healthy controls were included in the study. CD4 +T, CD8 +T,CD8/human leukocyte antigen DR (HLADR) + T, CD8/CD38 +T cells, and the expression of CD127 on CD3 +T cells from peripheral blood samples were measured by flow cytometry. IL-7 in peripheral blood was measured by enzyme-linked immunosorbort assay (ELISA) in HAART group. t test was performed to compare the measurement data among the groups. Results Before HAART, the count of CD4 + T cells in HIV-1 infected group was lower than that of the healthy control (t =9. 12, P ＜0. 01 ), while the counts of CD8 + T,CD8/HLADR+T, and CD8/CD38 +T cells were higher than those of the healthy control (t = 4.48, 4.89 and 3.88, P＜0. 01 ). Ater 7 years' antiviral therapy, CD4 +T cells increased, CD8 +T cells decreased, but both of them didn' t reach to the normal levels ( t = 2.66 and 2.43, P ＜ 0.05 ). While the counts of CD8/HLADR+T cells and CD8/CD38 +T cells almost reached to the normal levels (t = 0. 86 and 1.39, P ＞0.05). Before HAART, the concentration of IL-7 in HIV-1 infected group was higher than that in healthy controls (t =5.31, P ＜0.01 ). It decreased with HAART, but was still higher than the normal level (t =2. 81, P ＜ 0. 05 ). The expression of CD127 on CD3 + CD8 + T cells in non-HAART group was significantly lower than that in healthy control ( t =- 6.01, P ＜ 0.01 ), while that in HAART group was higher ( t = 2.32,P ＜0.05), but still not reached to the normal level ( t = 4.49, P ＜ 0. 05 ). CD127 expression on ( CD45RA + ) CD3 + CD8 + T cells almost increased to the normal level ( t= 0. 28, P ＞ 0. 05 ), while that on ( CD45RO + ) CD3 + CD8 + T cells was still remarkably lower than the normal ( t = 4. 86, P ＜ 0. 05 ). Conclusion Long-term HAART can partially restore the count and function of lymphocyte subsets in HIV-1 infected individuals, and the abnormal immune activation can be inhibited.

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Clinical and laboratory features of severe cases of hand, foot and mouth diseases in Wenzhou

Suhua LI ; Jie CHEN ; Hongjiao WANG ; Junya CHEN ; Zhiwei XU ; Yiping CHEN

Chinese Journal of Clinical Infectious Diseases.2010;03(6):337-339. doi:10.3760/cma.j.issn.1674-2397.2010.06.005

Objective To investigate the clinical and laboratory features of severe cases of hand,foot and mouth disease (HFMD) in Wenzhou, Zhejiang Province. Methods Clinical data of 107 children with HFMD, including 97 severe and 10 critical cases treated in Children' s Hospital Affiliated to Wenzhou Medical College during January and May 2010 were retrospectively analyzed. One hundred and fifty children with mild HFMD were also selected as the controls. Clinical features and laboratory results were compared between the two groups. Results Fever, rash and infection in central nervous system were observed in all patients with severe HFMD, and symptoms on respiratory, digestive and cardiovascular systems were more serious than those of mild HFMD cases. White blood cell counts (WBC) were higher in severe group than those in controls (t = 12.72, P ＜0.01). Hyperglycemia (9. 2 mmol/L) and abnormal troponin (0. 3 -9. 0 ng/mL) were presented in all the critical patients. Cerebrospinal fluid WBC counts were raised in 97 severe HFMD patients (98.5 × 106/L for average) with predominance of lymphocytes. Among 107 severe patients, EV71 was positive in 70, including all 10 critical cases. Conclusion Involvement of nervous,respiratory and digestive symptoms is common in severe cases of HFMD, and EV71 is the predominant pathogen.

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Drug-resistance and genotyping of methicillin-resistant Staphylococcus aureus isolated from intensive care unit

Zhijun ZHAO ; Wei JIA ; Zhiyun SHI ; Gang LI ; Nan ZHANG ; Shuai ZONG ; Jun WEI

Chinese Journal of Clinical Infectious Diseases.2010;03(6):321-324. doi:10.3760/cma.j.issn.1674-2397.2010.06.001

Objective To investigate drug resistance and genotypes of methicillin-resistant Staphylococcus aureus (MRSA) isolated from intensive care unit (ICU). Methods MRSA strains were isolated from patients, medical staff and environment of hospital ICUs. Disk diffusion (K-B method) was used for drug resistance testing; Staphylococcal cassette chromosome mec (SCCmec) and Staphylococcal protein A (spa) typing methods were used for genotyping and identifying the homology. Results There were 78 strains of Staphylococcus aureus isolated including 62 isolates of MRSA, which were mainly from the burn ICU (22, 35.48%). Among 62 MRSA strains, 50 were hospital acquired strains, in which 43 isolates were of SCCmec Ⅲ, 4 of SCCmec Ⅰ and 3 of SCCmec Ⅱ. Twelve isolates could not be typed. Twenty-eight out of 37 hospital acquired isolates were typed by spa typing as SCCmec Ⅲ-t030, which belonged to the same clone. Conclusion MRSA in ICU is multi-drug resistant and SCCmec Ⅲ-t030 is the most prevalent genotype, which indicates that clinical MRSA strains and environmental MRSA strains may be homologous.

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Correlation of T-lymphocytes expressing HLA-DR antigen with serum HBV DNA and HBeAg levels in chronic hepatitis B

Songping ZHANG ; Yongle ZHANG ; Mingli ZHU ; Yijian PAN ; Ying WANG ; Gongying CHENG

Chinese Journal of Clinical Infectious Diseases.2010;03(6):333-336. doi:10.3760/cma.j.issn.1674-2397.2010.06.004

Objective To investigate the correlation of T-lymphocyte expressing HLA-DR with serum HBV DNA and HBeAg contents in chronic hepatitis B. Methods Totally 134 chronic hepatitis B patients and 36 healthy blood donors were enrolled in the study. The T-lymphocytes (CD3 + HLA-DR + ,CD4 + HLA-DR+ and CD8 + HLA-DR+ T) expressing HLA-DR were detected by flow cytometry, the serum HBV viral loads were detected by the real-time quantitative PCR and HBeAg was detected by chemiluminescence method. According to serum HBV DNA viral loads patients were defined as HBV DNA negative (≤ 103 copies/mL), low (＞ 103 - 105 copies/mL), medium (＞ 105 - 107 copies/mL) and high groups (＞ 107 - 109 copies/mL) ; according to serum HBeAg levels, patients were defined as HBeAg negative (≤1 PEIU/mL), low (＞ 1 - 100 PEIU/mL), medium (＞ 100-1 000 PEIU/mL) and high groups (＞ 1 000-10 000 PEIU/mL). T test and one-way ANOVA were performed. Results With HBV DNA loads, HBeAg levels increased, the percentage of CD3 + HLA-DR + , CD4 + HLA-DR + and CD8 + HLA-DR +decreased, especially CD8 + HLA-DR +. Compared with HBV DNA negative group, the percentages of CD3 +HLA-DR + , CD4 + HLA-DR + and CD8 + HLA-DR + were significantly reduced in high group (t = 3. 686,4. 592 and 3. 216, P ＜ 0. 0l); the percentages of CD4 + HLA-DR + and CD8 + HLA-DR + were also reduced in medium group (t = 3. 761 and 2.862, P ＜ 0.01); while in low group, only the percentage of CD8 + HLA-DR + was reduced (t = 2.215, P ＜ 0.05). Compared with HBeAg negative group, the percentages of CD3 +HLA-DR+, CD4 + HLA-DR+ and CD8 + HLA-DR+ were significantly reduced in medium and high groups (thigher =3. 144, 2.222 and 4.035; tmiddle =3.311, 2.362 and 3.374, P ＜0.05), while in the low group,only the percentage of CD8+HLA-DR+ was reduced (t=2.029, P＜0. 05). Conclusion The combined measurement of HBV DNA, HBeAg and T-lymphocytes expressing HLA-DR in chronic hepatitis B patients may not only help to evaluate the immune status of patients, but also can predict the disease progression and clinical outcomes.

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