Microbiology / Infectious Disease

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/32552

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    Navigating an Acute presentation of HIV/AIDS on a Young Adult
    (2024-03-21) Meza, Sebastian; Truong, David
    BACKGROUND: The initial stage of human immunodeficiency virus (HIV) infection can resemble mononucleosis, showcasing various nonspecific symptoms. Due to its elusive nature, clinicians may overlook the diagnosis without a heightened level of suspicion. Common clinical symptoms: fever, sore throat, skin rash, lymphadenopathy, myalgia/arthralgia, diarrhea, weight loss, night sweats, headaches. Opportunistic infections occur with CD4 counts < 200 cells/microL. We will be discussing Cryptococcus. CASE INFORMATION: HPI: A 27 y.o. Male with no past medical history comes to the emergency department with a chief complaint of headache and abdominal pain. Pt states that the pain and headache began about 3 weeks ago and has been worsening. The headache is diffuse but worse in the back of the head. Pt admits to feeling worse at night, having night sweats, subjective fevers, N/V, weight loss and decreased appetite. Pt denies photosensitivity, chest pain, dyspnea, and body aches. Social: Pt denies IVDU, endorses heavy drinking, THC use, currently engaged in MSM. PE: Ill-appearing, occipital tenderness to palpation, no nuchal rigidity, diffuse maculopapular rash across the forehead. Labs: WBC 3.7-5.1; AST 38; ALT 65; UA neg; UDS THC and Opioids; HCVAB +; HIV screening +; HIV RNA PCR = 108k copies; CD4 = 33. CSF: Cryptococcal anti-gen+ (1:2560) titer; Clear, Colorless; WBC 239/cc (ref 0-5); Lymphocytes 97% (ref 20-50%); RBC 3653/cc (ref 0-5); Glucose: 42 (ref 40-70); Protein: 42.9 (15-45); OP: 57 cm H20 (very high) Imaging: CT Chest showing a single LUL Cavitary lung lesion Assessment: Cryptococcal Meningitis Opportunistic Infection 2/2 HIV/AIDS Treatment: Amphotecirin B (3 to 4 mg/kg IV per day); Flucytosine (100mg/kg q6h). Regimen recommended for minimum of 2 wks – may extend to 4-6 wks RESULTS: After nine days of hospitalization, the patient disclosed a history of engaging in HIV high-risk behaviors and activities. This revelation prompted medical attention towards HIV testing and further evaluation. However, challenges arose during attempts to perform bedside lumbar puncture, leading to the decision to obtain the procedure through Interventional Radiology (IR). Following the diagnostic procedures, including HIV testing and assessment of CD4 counts, opportunistic bacterial tests were ordered to address potential complications. Subsequently, appropriate treatment was administered based on the test results, ensuring comprehensive care for the patient's condition. CONCLUSIONS: Physicians should have a low threshold for suspicion for HIV. Give priority to early detection and proactive management to enhance patient outcomes. The absence of a history of risky behavior or activities should not deter a physician from pursuing an HIV diagnosis. An effective way to gather HIV-related risk factors is by obtaining the patient's history in a one-on-one setting. The lack of HIV testing resulted in complications and prolonged hospitalization, ultimately leading to the patient's death secondary to seizures and respiratory failure.
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    Assessing Changes to the Lower GI Tract Microbiome in Response to Neglect-related Early Life Stress Exposure
    (2024-03-21) Choe, Jamie; Donkor, Michael; Zhang, Yan; Gorham, Isabelle; Allen, Michael; Phillips, Nicole; Jones, Harlan
    Growing evidence supports exposure to early life stress (ELS) is associated with alterations in the developing immune system and increases the risk for chronic health conditions. It is widely understood that alterations to the gut microbiome can occur from exposure to various environmental factors, including diet and stress. Early life malnutrition is a form of neglect-related ELS that refers to states of both under- and over-nutrition in which a child may have insufficient intake of one or more nutrients due to an imbalanced diet. Malnutrition during childhood is a public health concern with significant health ramifications. Recent research shows the gut microbiome is intimately involved with immune system development—especially during early life when the immune system is being trained. In the present study, we use a modified version of the maternal separation with early weaning (MSEW) model to study the impact of physical neglect and malnutrition on the gut microbiome in mice. Conditions of neglect-related stress were simulated based on scheduled dam-pup separation (physical neglect) and a high carbohydrate early-wean diet (malnutrition). C57BL/6J mice were bred in-house and ELS pups were subjected to: (1) daily dam-pup separation on postnatal days (PD) 2-13 and/or (2) early weaning (EW) to a high carbohydrate diet on PD14-21. All tissues and stool samples were collected on PD21 for analysis. Pups exposed to MSEW or EW alone were assessed separately. 16S rRNA gene sequencing revealed the neglect-related ELS condition, as described under the present model, led to significant shifts in the predominate species in the lower GI tract microbial community. ELS-mediated shifts included increased Bacteroides and Enterococcus and were accompanied by decreased Lachnospiraceae. RTqPCR of bilateral adrenal glands revealed gene expression changes in key enzymes for stress response pathways, namely those implicated in the synthesis of adrenal glucocorticoids. These results demonstrate ELS-mediated dysbiosis can be observed at PD21 under the present model. Our findings at the PD21 timepoint reveal acute changes to the gut microbiome in the context of ELS and characterizes the baseline microbial community in the lower GI tract.