Age-associated changes in immune cells have been linked to an increased risk for infection. However, a global and detailed characterization of the changes that human circulating immune cells undergo with age is lacking. Here, we combined scRNA-seq, mass cytometry and scATAC-seq to compare immune cell types in peripheral blood collected from young and old subjects and patients with COVID-19. We found that the immune cell landscape was reprogrammed with age and was characterized by T cell polarization from naive and memory cells to effector, cytotoxic, exhausted and regulatory cells, along with increased late natural killer cells, age-associated B cells, inflammatory monocytes and age-associated dendritic cells. In addition, the expression of genes, which were implicated in coronavirus susceptibility, was upregulated in a cell subtype-specific manner with age. Notably, COVID-19 promoted age-induced immune cell polarization and gene expression related to inflammation and cellular senescence. Therefore, these findings suggest that a dysregulated immune system and increased gene expression associated with SARS-CoV-2 susceptibility may at least partially account for COVID-19 vulnerability in the elderly.
Adult ; Aged ; Aged, 80 and over ; Aging ; genetics ; immunology ; Betacoronavirus ; CD4-Positive T-Lymphocytes ; metabolism ; Cell Lineage ; Chromatin Assembly and Disassembly ; Coronavirus Infections ; immunology ; Cytokine Release Syndrome ; etiology ; immunology ; Cytokines ; biosynthesis ; genetics ; Disease Susceptibility ; Flow Cytometry ; methods ; Gene Expression Profiling ; Gene Expression Regulation, Developmental ; Gene Rearrangement ; Humans ; Immune System ; cytology ; growth & development ; immunology ; Immunocompetence ; genetics ; Inflammation ; genetics ; immunology ; Mass Spectrometry ; methods ; Middle Aged ; Pandemics ; Pneumonia, Viral ; immunology ; Sequence Analysis, RNA ; Single-Cell Analysis ; Transcriptome ; Young Adult

Adult ; Aged ; Aqueous Humor ; virology ; Female ; Humans ; Immunocompetence ; immunology ; Inflammation ; virology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Pyogenic liver abscess (PLA) can be caused by bacteria entering the liver via the portal vein or primary bacteremia, or it can be cryptogenic. Recently, Klebsiella pneumoniae has been increasingly found as a PLA pathogen. PLA due to this bacterium often leads to formation of extrahepatic abscesses. The treatment of choice is dual therapy with insertion of percutaneous catheter drainage and antibiotic therapy. We report 2 cases of PLA due to K. pneumoniae in immunocompetent children. We successfully treated patient 1 with percutaneous catheter drainage for 18 days and 6-week course of antibiotic therapy. Patient 2 was treated with percutaneous needle aspiration and antibiotic therapy for the same period. In both patients, the PLAs showed the ultrasound-confirmed resolutions after the dual therapy.
Abscess ; Anti-Bacterial Agents ; Bacteremia ; Bacteria ; Catheters ; Child ; Drainage ; Humans ; Immunocompetence ; Klebsiella pneumoniae ; Klebsiella ; Liver ; Liver Abscess, Pyogenic ; Needles ; Pneumonia ; Portal Vein

Septic arthritis of acromioclavicular (AC) joint is a rare entity. It is generally seen in patients who are immunocompromised. Only 15 cases have been reported till now, with only one case series of 6 patients. We report a case of septic arthritis of AC joint in an immunocompetent child. A 9 years old girl presented with history of pain in left shoulder for 4 days associated with fever. No history suggestive of any immunocompromised state was complained. On local examination, a swelling of around 3 cm in diameter was found over left AC joint region with raised local temperature, tenderness on palpation and positive response in fluctuation test. Total leukocyte count was 18.7 × 10/L with 80% of neutrophils. Erythrocyte sedimentation rate (ESR) was 28 mm/1 h. C-reactive protein (CRP) was 12 mg/L. X-ray showed enlarged left AC joint space. Ultrasound revealed hypoechoic collection in the AC joint and the surrounding area. The aspirate was thick and purulent in nature, revealing Gram positive cocci at staining. Arthrotomy and thorough lavage of AC joint was done. Culture of the aspirate showed Methicillin Resistant Staphylococcus Aureus (MRSA) after 48 hours that was sensitive to amikacin, gentamicin, erythromycin and teicoplanin. Patient was symptom-free at 2 months of follow-up with no signs of osteomyelitis on the radiographs. Thus this is the first case of AC joint septic arthritis in healthy individual. Being proximal to the shoulder joint, AC joint septic arthritis can be confused with the shoulder joint septic arthritis. Thus, high index of suspicion is required for accurate diagnosis.
Acromioclavicular Joint ; Anti-Bacterial Agents ; therapeutic use ; Arthritis, Infectious ; diagnosis ; therapy ; Child ; Female ; Humans ; Immunocompetence

Disseminated herpes zoster commonly occurs in patients with decreased immunity, but rarely in patients without any evidence of immunosuppression. We reported a case of disseminated herpes zoster with visceral organ involvement in a non-immunocompromised patient. An 83-year-old man visited our pain center, with chief complaints of painful rashes on the L3–L4 and S2–S4 due to acute herpes zoster. Even though intravenous antiviral therapy was initiated immediately upon hospitalization, his lesion deteriorated and systemic cluster formed. Urinary retention and hyponatremia occurred, and he was diagnosed with zoster cystitis and severe inappropriate antidiuretic hormone syndrome. Conservative treatment, including Foley catheter insertion and correction of hyponatremia with antiviral therapy, was initiated, and he was discharged without any complications at the 33rd day of hospitalization. Old age can be a risk factor of disseminated herpes zoster, and visceral organ involvement should also be considered.
Aged ; Aged, 80 and over ; Catheters ; Cystitis ; Exanthema ; Herpes Zoster ; Hospitalization ; Humans ; Hyponatremia ; Immunocompetence ; Immunosuppression ; Inappropriate ADH Syndrome ; Pain Clinics ; Risk Factors ; Urinary Bladder ; Urinary Retention

In many countries, vaccines are used for the prevention of foot-and-mouth disease (FMD). However, because there is no protection against FMD immediately after vaccination, research and development on antiviral agents is being conducted to induce protection until immunological competence is produced. This study tested whether well-known chemicals used as RNA virus treatment agents had inhibitory effects on FMD viruses (FMDVs) and demonstrated that ribavirin showed antiviral effects against FMDV in vitro/in vivo. In addition, it was observed that combining the administration of the antiviral agents orally and complementary therapy with vaccines synergistically enhanced antiviral activity and preserved the survival rate and body weight in the experimental animals. Antiviral agents mixed with an adjuvant were inoculated intramuscularly along with the vaccines, thereby inhibiting virus replication after injection and verifying that it was possible to induce early protection against viral infection prior to immunity being achieved through the vaccine. Finally, pigs treated with antiviral agents and vaccines showed no clinical signs and had low virus excretion. Based on these results, it is expected that this combined approach could be a therapeutic and preventive treatment for early protection against FMD.
Animals ; Antiviral Agents ; Body Weight ; Foot-and-Mouth Disease ; Immunocompetence ; Ribavirin ; RNA Viruses ; Survival Rate ; Swine ; Vaccination ; Vaccines ; Virus Replication

Intestinal tuberculosis is an infection of the gastrointestinal tract by the Mycobacterium tuberculosis complex. To the best of our knowledge, solitary intestinal tuberculosis accompanied by intestinal obstruction, particularly in the middle of the small intestine, is extremely rare. We report a case of solitary jejunal tuberculosis in a 49-year-old man with no underlying disease. He was admitted a few days after the onset of diffuse abdominal discomfort. Upon evaluation, we initially considered a malignancy of the distal jejunum with ileus due to the presence of a mass. Therefore, he underwent laparoscopic resection of the small bowel. Unexpectedly, the histologic specimen showed a chronic caseating granulomatous lesion with acid-fast bacilli. Ultimately, he was diagnosed with solitary jejunal tuberculosis. He was successfully treated with anti-tuberculosis drugs without any complications.
Gastrointestinal Tract ; Humans ; Ileus ; Immunocompetence ; Intestinal Obstruction* ; Intestine, Small ; Jejunum ; Middle Aged ; Mycobacterium tuberculosis ; Tuberculosis* ; Tuberculosis, Gastrointestinal

Neuralgic amyotrophy (NA) is a peripheral neuropathy, primarily involving the brachial plexus. There is a relation between antecedent infection and NA. A few cases of NA after infections such as Epstein-Barr virus, herpes zoster virus, parvovirus, human immunodeficiency virus, Borrelia, and other infections have been reported. This case report describes a 26-year-old man with motor impairment after neuropathic pain with preceding mild flu-like symptoms whose laboratory studies revealed evidence of cytomegalovirus (CMV) infection. He was diagnosed with NA associated with CMV infection. In conclusion, CMV is a rare but possible pathogen of NA.
Adult ; Borrelia ; Brachial Plexus ; Brachial Plexus Neuritis ; Cytomegalovirus Infections ; Cytomegalovirus ; Herpesvirus 3, Human ; Herpesvirus 4, Human ; HIV ; Humans ; Immunocompetence ; Neuralgia ; Parvovirus ; Peripheral Nervous System Diseases

OBJECTIVE: To investigate the etiological and clinical characteristics of immunocompetent patients with candidemia. METHODS: The clinical and microbiological data of patients diagnosed as candidemia admitted in Peking University Third Hospital from January 2010 to June 2016 were retrospectively analyzed. Underlying diseases, Candida spp. colonization, clinical manifestations, microbiological data, treatment and the outcome were compared between the HIV-negative immunocompromised (IC) and nonimmunocompromised (NIC) patients. RESULTS: A total of 62 cases diagnosed as candidemia were analyzed including 36 men and 26 women, with 16 to 100 years of age [(66.02±17.65) years]. There were 30 NIC and 32 HIV-negative IC patients respectively. In the NIC patients, there were 19 cases (19/30, 63.33%) with admission in intensive care unit (ICU), 21 (21/30, 70.00%) associated diabetes mellitus or uncontrolled hyperglycemia and 22 (22/30,73.33%) receiving invasive mechanical ventilation, while in the HIV-negative IC patients, there were 8 (8/32, 25.00%), 13 (13/32, 40.63%) and 7 (7/32, 21.88%) respectively (P<0.05). The NIC patients had higher acute physiology and chronic health evaluation (APACHE II) scores and sequential organ failure assessment (SOFA) scores both at admission (19.98±5.81, 6.04±6.14) and candidemia onset (25.61±6.52, 12.75±8.42) than the HIV-negative IC patients (APACHEII 15.09±5.82, 22.15±5.98) and SOFA 2.87±2.73, 7.66±5.64 respectively (P<0.05). In the NIC patients, twenty-one cases (21/30, 70.00%) died in hospital, while 14 cases (14/32, 43.75%) in HIV-negative IC. The crude mortality was significantly different between the two groups (P<0.05). By blood culture, Canidia albicans remained the the most prevalent isolates in all the patients. Clinical manifestation, Candida spp. colonization, etiology and drug susceptibility were also similar between NIC and HIV-negative IC patients (P>0.05). CONCLUSION Candidemia in NIC patients tends to occur in those who are much more critically ill, more often admitted in ICU, and more frequently have diabetes mellitus or uncontrolled hyperglycemia and receive invasive mechanical ventilation than HIV-negative IC patients. NIC patients also have poorer prognosis than HIV-negative IC patients. Clinical manifestations, and microbiological characteristics are similar between HIV-negative IC and NIC patients.
APACHE ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Candida ; Candidemia/therapy* ; Candidiasis/therapy* ; Female ; Humans ; Immunocompetence ; Intensive Care Units ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Young Adult

BACKGROUND: Herpes zoster meningitis and meningoencephalitis, rare complications of herpes zoster, may follow the onset of rash, precede it, or even occur without rash. There have been few studies describing the order of occurrence of neurological symptoms and zoster. OBJECTIVE: We compared the clinical and laboratory features, treatments, and progress of the conditions among patients with herpes zoster meningitis and meningoencephalitis according to the timing of zoster onset in relation to neurological symptoms and also according to the immune status. METHODS: We performed a retrospective review of 21 patients with meningitis and 3 patients with meningoencephalitis who showed the characteristic rash of herpes zoster at National Health Insurance Service Ilsan Hospital between March 2000 and June 2015. RESULTS: The 11 patients in whom zoster preceded neurological symptoms had a shorter duration of neurological symptoms (median 3 days; range 1~10) than did the 13 patients who experienced neurological symptoms first (median 10 days; range 4~27) (p<0.05). The intervals between the onset of neurological symptoms and a) presentation to the hospital, b) cerebrospinal fluid tests, and c) intravenous acyclovir treatment were all shorter in the patients with zoster preceding neurological symptoms (p<0.05). No significant differences in age or immune status were observed between the two groups. In the 9 immunocompromised patients, higher incidence of meningoencephalitis and neurologic complications was noted in comparison to the 15 immunocompetent patients (p<0.05). CONCLUSION: Antecedent zoster rash in varicella zoster virus-induced meningitis and meningoencephalitis appears to lead to more rapid initiation of diagnostic tests and antiviral treatment. The possibility of central nervous system complications should not be overlooked even in patients with herpes zoster.
Acyclovir ; Central Nervous System ; Cerebrospinal Fluid ; Chickenpox* ; Diagnostic Tests, Routine ; Exanthema ; Herpes Zoster ; Herpesvirus 3, Human* ; Humans ; Immunocompetence ; Immunocompromised Host ; Incidence ; Meningitis* ; Meningoencephalitis* ; National Health Programs ; Retrospective Studies