Mediterranean Journal of Hematology and Infectious Diseases最新文献

Iron is required for several vital biological processes in all human cells. In mammals, a considerable number of proteins are involved in iron metabolism and utilize iron in many essential cellular processes, such as oxygen transport, mitochondrial respiration, gene regulation, and DNA synthesis or repair. Iron metabolism is a complex system finely regulated at both systemic and cellular levels. It involves the development of specialized mechanisms for iron absorption, transport, recycling, storage, and export, and protection against toxic compounds that can be generated during iron redox cycling in the presence of oxygen. The erythropoietic compartment consumes the majority of iron to support the high demand for hemoglobin synthesis. A tightly regulated system enables efficient iron uptake by erythroid cells and its subsequent processing for the synthesis of large amounts of heme, which is then incorporated into hemoglobin. A bidirectional regulatory system between erythropoiesis and iron metabolism ensures precise coordination between the two processes. This regulation is often disrupted in various anemic conditions.

Pidotimod, a synthetic dipeptide, has been utilized for over three decades as an immunomodulatory agent to prevent recurrent respiratory infections, particularly in immunocompromised populations such as children and the elderly. Originally developed for its ability to enhance innate and adaptive immune responses, pidotimod is now being revisited in light of new clinical insights and emerging therapeutic needs. Recent studies have expanded its potential beyond traditional indications, with evidence supporting its role in patients with chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD), allergic rhinitis, and even viral infections, including SARS-CoV-2. Pidotimod exerts its effects by stimulating dendritic cells, enhancing toll-like receptor (TLR) expression, and promoting cytokine production, including IL-2 and IFN-γ, thereby supporting both cellular and humoral immunity. This broad-spectrum immune modulation makes pidotimod a promising adjunct in managing immune-mediated diseases and infections in both immunocompetent and immunocompromised individuals. In this review, we examine pidotimod's pharmacodynamics, summarize clinical evidence from recent studies, and explore its evolving role in modern therapeutic strategies for infectious diseases. Given its safety profile and oral administration, pidotimod holds significant promise not only for preventing infections but also as part of a broader immunomodulatory approach in complex disease management.

Background: Efficient management of sepsis requires precise antibiotic therapy. This study examines the efficacy of guiding such therapy using Procalcitonin (PCT), C-Reactive Protein (CRP), and albumin levels.

Methods: A total of 127 adult sepsis patients were assigned to either standard care or a biomarker-guided group where antibiotic use was adjusted based on biomarker levels.

Results: The biomarker-guided approach significantly reduced the duration of antibiotic therapy (9.0 vs. 10.5 days, P=0.04) and expedited antibiotic de-escalation. Hospital costs were lower in the biomarker-guided group (20,000 vs. 24,000 CNY, P=0.04), though reductions in secondary infections did not reach statistical significance. There was no significant difference in 28-day mortality rates.

Conclusion: Biomarker-guided antibiotic therapy can enhance the efficiency of treatment in sepsis, reducing both duration and cost without impacting patient safety. These findings suggest the potential benefits of incorporating biomarkers into standard sepsis management protocols.

Sickle cell disease (SCD) is a genetic disease of public health concern. Adult patients face various disease-related complications, which affect their quality of life (QoL). Few studies have examined relationships between these events and health-related (HR) QoL. We conducted a study of 240 adults with SCD seen in steady state at a routine clinic visit over one year. Two self-administered questionnaires were used to determine patients' HRQoL: the sickle cell self-efficacy scale (SCSES) comprising 9 specific items and the unspecific SF-36 scoring system comprising 8 subscales, which construct the physical component summary (PCS) and the mental component summary (MCS). Factors impacting HRQoL were established using univariate and multivariate regression analyses. Participants had a median age of 28 years (Sex ratio male/female 0.61; 68% SS genotype). Most of them had experienced more than one SCD-related complication and more than one affected organ system. A good correlation was established between the SCD-specific and the unspecific scoring systems (p < 0.0001). Using the SF-36 scoring system, energy/fatigue, general health, and pain subscales showed the lowest median scores (50, 45, and 56.5, respectively), while physical functioning had the highest median score (75). In univariate and multivariate analyses, hospitalization for SCD complications occurring during the last year preceding QoL evaluation was the main feature impacting HRQoL (p < 0.001). Good compliance to hydroxyurea (HU) therapy was associated with higher SCSES (p = 0.04) and higher emotional role functioning (p = 0.03) scores. The recent occurrence of severe SCD complications mainly influenced HRQoL. Our study suggests that a more effective treatment through better compliance with HU therapy would provide benefit in terms of QoL.

Syphilis, a sexually transmitted infection caused by Treponema pallidum (T. pallidum), is re-emerging globally. Recent epidemiological data show a rising incidence, particularly among men who have sex with men (MSM). Known as 'the great mimic' for its broad clinical spectrum, secondary syphilis classically presents with a maculopapular rash involving the trunk and extremities. However, it can also present with atypical cutaneous manifestations, especially in immunocompromised patients. This aspect may contribute to delayed diagnosis and treatment. Starting from a clinical case, we will conduct a literature review on syphilis/HIV coinfection, with a particular focus on the broad spectrum of cutaneous manifestations and the key differential diagnoses involved. We report the case of a 60-year-old male living with HIV who presented with non-pruritic, polymorphic skin lesions sparing the palms and soles. The patient had a prior history of treated latent syphilis. Initial diagnostic workup excluded common differentials, including monkeypox and fungal infections. Serologic testing confirmed active syphilis with a reactive Rapid Plasma Reagin (RPR) titer of 1:32, skin biopsy showed dense plasma cell-rich infiltrate, and immunohistochemistry was positive for T. pallidum. Despite negative cerebrospinal fluid findings, neurological symptoms prompted treatment with intravenous penicillin G, and the symptoms resolved with treatment. This case underscores the importance of considering syphilis in the differential diagnosis of atypical dermatologic presentations, given its increasing prevalence and potential for severe systemic involvement.

Background: Thalassemia is an inherited blood disorder characterized by abnormal hemoglobin production, leading to chronic anemia. Patients, particularly those who are transfusion-dependent, face a heightened risk of infections due to disease-related factors like anemia and treatment-related complications such as iron overload and splenectomy. This study explores the factors contributing to infections in thalassemia patients to improve management strategies.

Methods: A retrospective analysis was conducted on 303 patients with thalassemia at a tertiary care center from 2007 to 2022. Data were collected on demographics, transfusion dependency, splenectomy status, ferritin levels, vaccination history, and culture results. Logistic regression analysis was used to identify infection risk factors, with significance set at p-value < 0.05.

Results: Out of 303 patients, 72 (23.8%) experienced culture-positive infections, with Escherichia coli being the most isolated pathogen. Patients with infections had significantly higher ferritin levels and were less likely to be on chelation therapy. Chelation therapy was significantly associated with a reduced risk of infection (OR 0.18, p < 0.001). Higher serum albumin levels were also associated with lower odds of infection (OR 0.92, p < 0.001). Mortality was significantly higher among patients with positive cultures compared to those without (22% vs. 3%, p < 0.001).

Conclusion: This study highlights the strong link between iron overload, chelation, and risk of infection in thalassemia patients. Effective management, including proper chelation therapy and monitoring ferritin levels, is critical for reducing infections and improving outcomes. Further studies are needed to confirm these findings and guide future management strategies.