[Show abstract][Hide abstract] ABSTRACT: Increasing evidence suggests that human cytomegalovirus (HCMV), a beta-herpes virus that chronically infects human beings, is associated with colorectal cancer (CRC). The viral nucleic acids specifically localized to the neoplastic mucosal epithelium of CRC, while tumoral presence of HCMV independently predicted a poor outcome in elderly patients. In the past decade, the concept of "oncomodulation" of HCMV in human cancers has been formulated. In CRC, changes in the tumor microenvironment are closely related to cancer behavior and prognosis, while the underlying mechanism driving these changes remains unclear. As HCMV affects multiple cellular functions, including signal pathways that regulate angiogenesis, apoptosis, cell invasiveness, and anti-cancer immunity, the virus potentially exerts oncomodulatory effects in the tumor microenvironment of CRC. Here, we summarize the current knowledge about the association between HCMV and CRC and suggest future perspectives on both research and anti-cancer therapy of CRC.
[Show abstract][Hide abstract] ABSTRACT: Infectious diseases are closely related to cancer. Human cytomegalovirus (HCMV) has been implicated to promote tumor growth and is present in the tumor specimens of colorectal cancer (CRC). This study aimed to investigate whether tumoral presence of HCMV is associated with a different clinical outcome in elderly patients with CRC. We analyzed archived tumor specimens from 95 CRC patients who aged 65 years or older. HCMV was detected by PCR. Clinical, pathological, disease-free and overall survival data were compared between patients with HCMV-positive and HCMV-negative tumors. Quantitative reverse-transcription PCR (qRT-PCR) array was used to evaluate the expression levels cytokine genes of T helper subpopulations in tumors. In the Kaplan-Meier analysis of the 81 patients who underwent curative surgery, 39 patients with HCMV-positive tumors had a lower disease-free survival rate (P = 0.024). For patients with stage II or III diseases, tumoral HCMV status correlated with disease-free survival more closely than the traditional histopathological staging methods. In a multivariate Cox proportional-hazards model, tumoral presence of HCMV independently predicted tumor recurrence in 5 years (hazard ratio 4.42; 95% confidence interval: 1.54-12.69, P = 0.006). The qRT-PCR analysis of 10 stage II tumors showed that the gene expression levels of interleukin-17-the signature cytokine of T-helper 17 cells-and its receptor, IL17RC, were higher in the 5 HCMV-positive tumors. Our results suggested that presence of HCMV in CRC is associated with poorer outcome in elderly patients. How the virus interacts with the tumor microenvironment should be further investigated. This article is protected by copyright. All rights reserved.
Clinical Microbiology and Infection 10/2013; · 4.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It has long been suggested that human cytomegalovirus (HCMV) might be involved in human oncogenesis. However, whether HCMV was associated with colorectal cancer (CRC) was still controversial.
To clarify whether HCMV specifically infects the tumorous tissue of CRC.
Paired tumor and adjacent non-neoplastic CRC specimens were collected from 163 patients. HCMV DNA was detected and quantified through PCR and quantitative real-time PCR. Virus location was determined by in situ hybridization (ISH) of formalin-fixed paraffin-embedded tissue sections with an HCMV-specific probe.
By PCR, HCMV DNA was detected in 42.3% (69/163) of the tumor specimens, while only 5.6%(14/163) samples of adjacent non-neoplastic tissue were positive for HCMV (p<0.0001). Quantitative real-time PCR in 54 sample pairs revealed significantly higher viral copies in the tumor specimens than the adjacent non-neoplastic tissue specimens (p<0.001). By ISH, the nucleic acids of HCMV were detected in the cytoplasm of neoplastic epithelium. No hybridization was detected in the inflammatory infiltrates, submucosa, or other stromal tissues.
HCMV preferentially infects the tumor epithelium of CRC. How the virus subsists in and interacts with the microenvironment of tumor epithelium of CRC should be studied.
Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 05/2012; 54(3):240-4. · 3.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We propose a pathogen-classification system using the Surface-Enhanced Raman Scattering (SERS) platform. The system differentiates the pathogens based on their SERS spectra, which are believed to be related to the surface chemical components. The specialty of the system is to not only consider the usual classification accuracy, but also pay attention to the different types of costs during misclassification. For instance, due to the effectiveness of treatments, the cost of classifying a Gram-positive bacterium as another Gram-positive one should be lower than the cost of classifying a Gram-positive bacterium as a Gram-negative one. We express the task as the cost-sensitiveclassification problem, and take state-of-the-art cost-sensitiveclassification algorithms from the machine learning community to conquer the task. Our experimental study validates the usefulness of those algorithms on building the system.
IEEE International Conference on Bioinformatics and Biomedicine, BIBM 2011, Atlanta, GA, USA, 12-15 November, 2011; 01/2011
[Show abstract][Hide abstract] ABSTRACT: Acinetobacter baumannii is an increasingly common nosocomial infection with a high mortality rate. Identification of predictor factors of mortality from A. baumannii infection is important for the implementation of therapeutic management for patients with higher risk. However, many studies have reported data for Acinetobacter calcoaceticus-A. baumannii complex, which might lead to an uncertainty of results. In this study, we aimed to identify the predictive factors for mortality of patients infected with true A. baumannii that had been precisely identified by genotypic methodology.
Sixty seven patients with documented A. baumannii bacteremia were identified from a medical center in northern Taiwan during the period between February 1998 and February 2001. The patients' medical records were retrospectively reviewed.
The risk factors associated with mortality in patients with A. baumannii bacteremia were underlying disease with malignancy, end-stage renal disease, and inappropriate antibiotic therapy. Laboratory variables, such as creatinine level, were also associated with poor prognosis by multivariate analysis.
Increased serum creatinine level, malignancy and inappropriate therapy within 3 days were related to increased mortality in patients with A. baumannii bloodstream infection. Physicians should be aware of patients with poor prognostic factors and initiate prompt strategies, including appropriate antimicrobial therapy, in order to reduce mortality.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 11/2008; 41(5):397-402. · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Studies of the human cytomegalovirus (HCMV) glycoprotein N (gpUL73-gN) showed that genotypic variations exist in different geographic areas, with gN-2 unidentified in Chinese population. The purpose of this study was to determine the HCMV gN variants in the Chinese population of Taiwan. Primers were designed and a polymerase chain reaction (PCR) was carried out on the UL73 gene. The PCR products were subjected to restriction fragment length polymorphism (RFLP) analysis. The same PCR-RFLP assay was repeated using primers published previously to demonstrate the influence of primer design. Of the 48 clinical HCMV isolates, 33 were positive for PCR products by both primer sets. Fifteen were positive only by the "in-house" PCR. The distribution of gN-1, gN-2, gN-3, and gN-4 by RFLP analysis was 14:11:7:17, with one isolate positive for both gN-1 and gN-2. The published primers detected the four genotypes with the number of 14:0:2:17. The under-representation of gN-2 and gN-3 by the method published previously may be due to inappropriate primer design when re-examining the sequences. On the basis of the results of this study, gN-2 is not the rarest gN genotype in the Chinese population of Taiwan. The design of primers used for PCR-RFLP genotyping may have a great influence on the frequency distribution of HCMV genomic variants.
Journal of Virological Methods 08/2008; 151(1):161-4. · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aeromonas peritonitis remains a rare condition. In this study we describe the clinical features of primary and secondary Aeromonas peritonitis, and compare the differences between these two diseases entities. Patients with Aeromonas peritonitis were identified from microbiological and medical records during the period between March 1994 and March 2003. Clinical characteristics, laboratory data, microbiological results, treatment and outcome of patients were obtained by retrospective chart review. 22 and 27 patients with primary or secondary peritonitis caused by Aeromonas species were identified. All except two of these patients were adults, with a median age of 62.4 (31-76) vs 65.8 (8-85) years, respectively. Males were predominant (82 vs 78%). Peritonitis was community acquired in 73% and 56% of patients in these two groups, respectively. Significantly higher prevalence of underlying liver cirrhosis (96 vs 7%, p<0.001), which was Child-Pugh class C in 91% of cases, in primary peritonitis was noted. Primary peritonitis was more likely to be monomicrobial (100 vs 15%, p<0.001) and complicated by bacteremia (50 vs 7%, p=0.011). A source of intraabdominal infection should be sought when Aeromonas peritonitis occurs in a patient who has no history of liver cirrhosis or who has a polymicrobial result of ascites culture.
[Show abstract][Hide abstract] ABSTRACT: Adult typhoidal acute acalculous cholecystitis is rare with only 2 cases having been reported in the English literature. We present the case of a previously healthy 36-y-old female who suffered fever, chills, epigastralgia and progressive jaundice for 3 d, with acute acalculous cholecystitis subsequently diagnosed. In addition to antibiotic therapy with ceftriaxone, open cholecystectomy was performed. However, bile and blood culture both showed Salmonella typhi growth unexpectedly, and ileocolitis was revealed by colonoscopy. Careful tracing of the history of the patient recalled a history of travel to Indonesia. In adults without common risk factors for acalculous cholecystitis, a detailed history including travel to endemic areas and high index of suspicion for typhoidal acute acalculous cholecystitis are important, and appropriate antimicrobial therapy for covering Salmonella typhi should be considered.
[Show abstract][Hide abstract] ABSTRACT: Severe acute respiratory syndrome (SARS) is an emerging viral infectious disease. We report our experience in treating SARS patients.
From April 27 to May 24, 2003, a total of 36 patients with probable SARS were admitted and treated in a hospital rearranged as a special center for the management of SARS patients. Medical records for the patients were retrospectively reviewed. Univariate and multivariate analyses were performed to determine factors associated with respiratory failure and intubation.
Of the 36 patients with probable SARS (median age, 37 years; range, 22-66 years), 9 were male and 27 were female. Thirty-two patients (88.9%) were infected in the hospital setting. All patients presented with fever, and 33 eventually developed lymphopenia during hospitalization. Chest radiography showed no unique pattern, but pleural effusion was not seen. All patients initially received empiric antibacterial therapy against common causative pathogens of atypical pneumonia. Ribavirin was given to all except 1 patient. Twenty-two patients received immunoglobulin therapy, and 32 were given corticosteroids. A total of 20 patients (55.6%) required supplemental oxygen, and 8 (22.2%) were intubated with mechanical ventilatory support. Two of these patients died. A higher body temperature at presentation (median 39.5 vs 38.6 degrees C), and higher peak values of lactate dehydrogenase (410 vs 282 U/L) and C-reactive protein (10.2 vs 2.5 mg/dL), were associated with subsequent respiratory failure. Multivariate analysis showed that peak level of C-reactive protein was the only independent predictor of respiratory failure and intubation (odds ratio for every increment of 1 mg/dL = 1.45; 95% confidence interval = 1.003, 2.097; p = 0.048).
All patients with probable SARS who were admitted to hospital presented with fever and lymphopenia. While the efficacy of different treatments could not be evaluated from this retrospective study, a higher value of C-reactive protein was associated with the development of respiratory failure and subsequent intubation.
Journal of the Chinese Medical Association 04/2005; 68(3):110-7. · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case, the proposed entry route of infection is ascending retrograde from the biliary tract. Bile and aspirated pus culture repeatedly tested positive, and blood negative, for Candida albicans and Candida glabrata. Cholecystitis was cured by percutaneous gallbladder drainage and amphotericin B therapy. The liver abscesses were successfully treated by a cumulative dosage of 750 mg amphotericin B. We conclude that in cases involving less immunocompromised patients and those without candidemia, a lower dosage of amphotericin B may be adequate in treating candidal liver abscesses.
World Journal of Gastroenterology 04/2005; 11(11):1725-7. · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Medical records of 54 patients whose cerebrospinal fluid (CSF) cultures were positive for Acinetobacter were retrospectively reviewed. In 34 (63.0%) patients, the Acinetobacter isolates were clinically insignificant. In the other 20 (37.0%) patients, presence of the organism was regarded as clinically significant and specific antimicrobial therapy was administered. Patients with clinically significant Acinetobacter in CSF more frequently resided in intensive care units (p = 0.011), had intracerebral hemorrhage (p = 0.012) or previous CNS infection (p = 0.003), had prior antibiotic exposure (p = 0.011), and had undergone neurosurgical procedures (p = 0.003). Their CSF was characteristic of neutrophilic pleocytosis, an elevated protein level, and a low CSF-to-serum glucose ratio. Apart from fever, no significant statistical differences existed in individual clinical symptoms and signs between the 2 groups of patients, while a combination of symptoms efficiently differentiated clinically significant and insignificant Acinetobacter. The finding of multiple CSF specimens positive for Acinetobacter was highly suggestive of an active CNS infection (p<0.001). The high ratio of clinically insignificant Acinetobacter CSF isolates highlights the importance of careful judgment when the organism is cultured from CSF. Antimicrobial therapy must be initiated promptly in patients with identified risk factors, while unnecessary treatment should be avoided in those without them.
[Show abstract][Hide abstract] ABSTRACT: Stenotrophomonas maltophilia is an important nosocomial pathogen with intrinsic multi-drug resistance. This retrospective study reviewed 84 episodes of S. maltophilia bacteremia over a 4-year period from July 1999 to September 2003. Stenotrophomonas maltophilia bacteremia was hospital-acquired in 64 patients (76%), and developed after prolonged hospitalization in 48 (57%). Seventy patients (83%) had a central venous catheter (CVC), 64 (76%) had prior antibiotic therapy, 55 (65%) had underlying malignancy, and 43 (51%) were receiving immunosuppressive therapy. Twenty seven percent of the episodes of bacteremia had polymicrobial isolates. The overall and bacteremia-related mortality rates were 44% and 33%, respectively. Forty six percent of the bacteremia-related mortality occurred within 3 days after onset of symptoms. The most common sources of bacteremia were respiratory tract (33%) and CVC (31%), while the source of the bacteremia was unknown in 26% of episodes. The most effective antibiotics in vitro were trimethoprim-sulfamethoxazole, ciprofloxacin, chloramphenicol, and ceftazidime; however, a trend of increasing drug resistance in these agents was identified over the study period. On univariate analysis, nosocomial bacteremia, long-lasting neutropnenia (>10 days), bacteremia originating from the respiratory tract, shock, low serum albumin level (<3 g/dL), and thrombocytopenia (platelet count <100,000/mm3) were significantly related to mortality (p<0.05). Among these variables, shock and thrombocytopenia were independent factors associated with mortality. In contrast, patients with CVC-related bacteremia had a lower mortality rate (odds ratio, 0.04; p<0.001). Patients treated with appropriate antibiotics had a lower mortality rate, but this difference was not significant (p=0.477). In S. maltophilia bacteremia, careful evaluation of CVC was important for identifying the source of bacteremia and predicting prognosis. The source of bacteremia and condition of patients at presentation were the major factors influencing prognosis.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 12/2004; 37(6):350-8. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prognostic factors of candidal meningitis had rarely been studied owing to the rarity of this disease. We identified 17 patients with candidal meningitis at a teaching hospital in Taiwan over a 14-y period and give details of the clinical features, treatment, outcome and prognostic factors of this disease. 10 patients were children (1 was neonate) and 7 were adults. The clinical features and cerebrospinal fluid (CSF) findings were non-specific. The disease was diagnosed > 72 h after hospitalization in 14 (82%) patients. The most frequently isolated species was Candida albicans (65%). Regimens of therapy included intravenous amphotericin B deoxycholate (AmB) or fluconazole alone, or a combination of intravenous AmB with intrathecal AmB, flucytosine or fluconazole. All indwelling central nervous system devices were externalized or removed. Four adults died of the disease. Three of them had malignancy and had received < 48 h of antifungal therapy. For adult patients with malignancy, early diagnosis and alternative treatment modalities with newer antifungal agents may be needed.
[Show abstract][Hide abstract] ABSTRACT: Central venous catheter-associated Nocardia bacteremia is rarely reported. We present the case of a 48-y-old male with a history of advanced T-cell lymphoma who suffered from recurrent fever and persistent Gram-positive bacillus bacteremia. Port-A catheter-associated Nocardia bacteremia was diagnosed on the basis of the clinical response to removal of the catheter and the finding of increased gallium uptake, along with the Port-A catheter presented in the gallium inflammation scan.
[Show abstract][Hide abstract] ABSTRACT: Ninety-nine individuals with stools positive for Blastocystis hominis but negative for other parasites were identified from medical records of healthy adults who had received a physical examination at Taipei Veterans General Hospital from November 2000 to October 2002. The medical records of these 99 positive cases and 193 randomly selected controls, matched for age, sex, and date of examination, were retrospectively reviewed. The pathogenicity of B. hominis could not be demonstrated due to a lack of association with the development of gastrointestinal symptoms or pathologic findings on endoscopic examination. Multivariate analyses revealed that chronic hepatitis B infection was a predisposing condition to the acquisition of B. hominis (odd ratio = 2.848, 95% confidence interval = 1.299-6.242, P = 0.009), and concentration of urate was significantly lower in B. hominis-positive individuals (mean +/- SD = 361.64 +/- 87.44 versus 392.57 +/- 93.38 micromol/L; P = 0.009). Among the 64 individuals who underwent gastric biopsy, Helicobacter pylori was found more frequently in the individuals harboring B. hominis (19 of 26 versus 15 of 38; P = 0.017).
The American journal of tropical medicine and hygiene 09/2003; 69(2):213-6. · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The clinical spectrum of severe acute respiratory syndrome (SARS) varies widely in the way that asymptomatic carriers are believed to exist in the community. Still there are severe forms of illness in which the patients deteriorate unexpectedly within hours. This study delineates clinical characteristics of such fatal cases of SARS for the purpose of identifying patients with poor outcome.
Patients with the diagnosis of probable or suspected SARS admitted to the Taipei Veterans General Hospital during the period from March 26, 2003 to May 25, 2003 were included. The medical records of fatal cases were retrospectively reviewed.
During the study period, thirty-six probable cases and 17 suspected cases of SARS were identified. Eight probable but none of the suspected cases died from acute respiratory distress syndrome (ARDS) with multiple organ dysfunction after a median of 6-day hospital stay (range, 1-30 days). All but 2 patients acquired the infection nosocomially. Of the fatal cases, four were males and 4 females, with the median age of 65 years (range, 29-76 yrs). All except 3 had co-morbid conditions, such as hypertension, diabetes mellitus, coronary artery disease or chronic obstructive pulmonary disease. The lactate dehydrogenase (LDH) values were abnormal (> 200 U/L) in all patients. The chest radiograph of these fatal cases consistently showed multifocal infiltration over the unilateral or bilateral lobe of the lung.
Patients of SARS who had advanced age, co-morbid conditions, highly elevated LDH and multifocal infiltration over chest radiograph should be closely monitored and actively treated.
Journal of the Chinese Medical Association 06/2003; 66(6):323-7. · 0.89 Impact Factor