Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
Introduction: Purpureocillium lilacinum (formerly Paecilomyces lilacinus) is an emerging, saprophytic fungus known to cause severe, treatment-refractory ocular infections. It is notoriously clinically resistant to several common antifungal agents, including amphotericin B. Risk factors for Purpureocillium lilacinum (P. lilacinum) keratitis include contact lens wear, ocular trauma, and local or systemic immunosuppression. Case Presentation: We describe the clinical course of a 70-year-old male with type 2 diabetes mellitus and a history of long-term soft contact lens use who presented with a right corneal ulcer. Despite initial treatment with topical voriconazole, the infection progressed over two months to involve the entire globe, resulting in intractable endophthalmitis. Microbiological analysis of corneal scrapings identified P. lilacinum, confirmed by MALDI-TOF mass spectrometry and ITS sequencing. Despite the addition of systemic voriconazole, the patient’s condition deteriorated, leading to a painful blind right eye which ultimately needed enucleation. Conclusions: This case highlights the aggressive potential of P. lilacinum in a host with multiple risk factors. It underscores the critical need for a high index of suspicion, rapid and accurate mycological diagnosis, and immediate, aggressive management. The therapeutic challenges, including intrinsic and emerging antifungal resistance, often necessitate early surgical intervention to prevent catastrophic outcomes....
Background and Objectives: Surfactant protein-D (SP-D) enters the circulation when the alveolo-capillary barrier is injured. We synthesised evidence on the diagnostic and prognostic performance of circulating SP-D in children with acute infectious lung disease. Methods: We searched MEDLINE, Embase and Scopus (inception–1 June 2025) for human studies reporting serum/plasma SP-D in patients <18 years with community-acquired pneumonia (CAP), viral pneumonitis or paediatric ARDS (PARDS). Two reviewers independently screened, extracted data and assessed risk of bias (ROBINS-I). Primary outcomes were discrimination of severe versus non-severe disease and prediction of hard outcomes (mechanical ventilation, PARDS and mortality). Heterogeneity in assays and outcome definitions precluded meta-analysis; a narrative synthesis was undertaken. Results: Five studies (n = 723) from emergency and PICU settings met inclusion criteria. Admission SP-D was consistently higher in severe versus mild CAP; reported AUCs ranged 0.699–0.802. Thresholds of 110–180 ng/mL yielded sensitivities of 67–85% and specificities of 45–70%. In influenza-associated respiratory failure, SP-D correlated with ventilator days (r ≈ 0.45) and ICU length of stay (r ≈ 0.44). In multicentre PARDS cohorts, each 10 ng/mL increase in SP-D was associated with higher odds of severe PARDS and death (adjusted OR 1.02 per 10 ng/mL). Overall risk of bias across studies was low-to-moderate, with one study rated serious due to sampling and adjustment limitations. Conclusions: Across pathogens and care settings, elevated circulating SP-D correlates with radiographic consolidation, evolving PARDS and worse short-term outcomes. Although assay standardisation and external validation are needed, current evidence supports incorporating SP-D into multiparametric, age-aware risk-stratification algorithms for childhood pneumonia and viral lung injury....
Background: Fever of unknown origin (FUO) in children remains a diagnostic challenge due to heterogeneous etiologies. This study investigated the etiological distribution, long-term outcomes of undefined cases, and laboratory predictors that differentiate infectious from non-infectious etiologies. Methods: We retrospectively evaluated 87 children (1 month–18 years) hospitalized with fever > 38.3 ◦C for ≥7 days with no detectable source (2018–2024). Patients were categorized into five groups: infectious, inflammatory, neoplastic, miscellaneous, and undefined. Comparisons between these groups were performed in terms of age, laboratory values, and duration of fever using the Kruskal–Wallis test and oneway ANOVA. Demographic, clinical, laboratory, and follow-up data were compared. ROC analysis and binary logistic regression identified predictors of non-infectious etiologies. Results: Infectious diseases (42.5%) and inflammatory disorders (19.5%) were the most common causes, while 17.2% of cases remained undefined. The median age was 60 months. Rash (31%) and fatigue (27.5%) were the most common complaints on admission. The undefined group showed complete spontaneous resolution during a median 63-month follow-up, with no recurrence or new diagnoses, except for one patient. Miscellaneous etiologies accounted for 14.9% of cases, and more than half of these were newly diagnosed primary immunodeficiencies. C-reactive protein and ferritin levels were significantly higher in the inflammatory disease group compared to the groups with unknown and infectious etiologies. In the binary logistic regression analysis, longer fever duration combined with elevated ferritin level was a combined predictor of non-infectious causes (AUC = 0.718). Conclusions: Infectious and inflammatory conditions predominate in pediatric FUO, yet a subset of cases resolve spontaneously and follow a benign course. The combination of fever duration and ferritin count may aid early differentiation of non-infectious etiologies, supporting more focused diagnostic approaches. Given the notable proportion of primary immune deficiencies, especially in populations with high consanguinity, early immunologic screening should be incorporated into FUO evaluation protocols....
Background Hepatitis C virus (HCV) invades the host’s immune system and induces various metabolic changes. Therefore, we aimed to investigate the relative gene expression of the chemokine ligand CXCL10, along with some targeted metabolites, in chronic hepatitis C (CHC) patients receiving direct-acting antiviral drugs (DAAs), to identify potential biomarkers for viral eradication and therapeutic follow-up. Subjects and methods This prospective study included 50 patients with CHC who were evaluated before and 3 months after treatment with oral sofosbuvir/daclatasvir (SOF/DAC), as well as 50 healthy controls. All participants underwent history taking, full clinical examination, abdominal ultrasound and assessment of liver fibrosis. Laboratory investigations included liver function tests, alpha-fetoprotein (AFP), anti-HCV antibodies, HCV-RNA quantification and lipid profile. Relative expression levels of the CXCL10 gene were measured using real-time qPCR. Extended metabolic profiling of amino acids and acylcarnitines was performed using high Performance Liquid Chromatography Tandem Mass Spectrometry) HPLC–MS/MS). Results The relative quantity (RQ) of CXCL10 gene expression levels was significantly elevated in treatment-naïve CHC patients and showed a marked decline following therapy (p < 0.001). Receiver operating characteristic (ROC) curve analysis revealed that CXCL10 RQ demonstrated excellent discrimination between pre-treatment CHC cases and controls (AUC = 0.980), with 98.0% sensitivity and 100% specificity. In post-treatment cases, CXCL10 RQ showed good discriminatory performance (AUC = 0.820), with 82% sensitivity and 80% specificity. Significant metabolic improvements were observed following DAA’s treatment. The amino acid profile demonstrated a significant decrease in the levels of nearly all amino acids while acylcarnitines increased across most short-, medium-, and long-chain species, with only C8 showing a significant decrease. Conclusion CXCL10 might play a role in hepatitis C pathogenesis, and its expression levels could serve as a marker of therapeutic response reflecting potent anti-inflammatory effects of DAAs. Differential metabolites may also provide non-invasive indicators of liver status and treatment prognosis....
Background Spontaneous bacterial peritonitis (SBP) is a common complication in cirrhotic patients with ascites, whereas spontaneous fungal peritonitis (SFP) is a less recognized but serious entity. Data on the frequency and predisposing factors of SFP in cirrhosis remain limited. We aimed to evaluate the prevalence, risk factors, and clinical features of SFP in patients with cirrhotic ascites. Methods This multicenter cross-sectional study enrolled 267 Egyptian adults with cirrhotic ascites. All patients underwent history taking, clinical examination, and routine laboratory testing. Ascitic fluid analysis included direct microscopic examination and bacterial and fungal cultures. Results The prevalence of SFP was 2.62%, whereas 56.55% of patients were diagnosed with SBP. Among SFP cases, the most frequent presentations were abdominal distension (42.85%), abdominal pain (42.85%), and abdominal pain with fever (14.28%). Hepatorenal syndrome was present in 28.57% and hepatocellular carcinoma in 14.28% of SFP cases. Most SFP patients (85.71%) had received antibiotics during hospitalization. According to the Child–Pugh classification, 57.1% of patients were class C, and the remainder were class B (42.9%). The mean Model for End-Stage Liver Disease (MELD) score among SFP patients was 18.3 ± 8.99. Conclusion A high index of suspicion for SFP is required in cirrhotic patients with ascites, particularly in those presenting with a higher MELD score and Child–Pugh class C who fail to improve after antibiotic treatment....
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