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Objective: To analyze the clinical characteristics of AIDS-related non-Hodgkin lymphoma (ARL) and review relative literature for the diagnosis and treatment of ARL., Method: The clinical data of ARL patients admitted to Peking Union Medical College Hospital from April 2009 to April 2011 were retrospectively analyzed., Results: Five male ARL patients aged 32 to 65 years old were included in this retrospective study. Among them, two patients were found to be HIV-positive for the first time, three were on regular highly active anti-retroviral therapy (HAART) for 7 - 8 months before the emergence of lymphoma-related symptoms. CD(4)(+) T cell count was (69 - 232) × 10(6)/L at presentation. Two patients firstly presented with sore throat and throat ulcer, one with cervical nodules, one with pelvic mass, one with fever and edema in right thigh. Through pathological analysis, four patients had B cell-originated lymphoma, with one Burkitt lymphoma and three diffuse large B cell lymphomas; one patient had T-cell lymphoma. Four patients were treated with chemotherapy, with one complete remission, one relapse, one non-response, and one death. One patient had radiotherapy only and had progressed disease. Bone marrow suppression and gastrointestinal disturbance were the main adverse effects of chemotherapy., Conclusions: Lymphoma should be considered in any HIV-infected patients presented with unexplainable adenopathy, recurrent sore throat or throat ulcer, or fever of unknown origin. Biopsy should be rigorously carried out. Appropriate chemotherapy, together with HAART, may improve the prognosis greatly.

Objective: To report the clinical characteristics of prosthetic valve endocarditis (PVE)., Methods: All 25 cases of definite PVE (Duke criteria) diagnosed at our hospital between January 1992 to December 2008 were retrospectively analyzed. Among them, 7 cases were pathologically confirmed and the others were clinically confirmed with either 2 major criteria or 1 major and ≥ 3 minor criteria. Their clinical characteristics, underlying heart diseases, previous heart operations, presenting manifestations, causative microbes, echocardiographic findings and prognosis, were studied., Results: (1) Although most cases underwent valve transplantations for underlying heart diseases of rheumatic heart diseases and congenital heart diseases, 10 patients were complicated with infectious endocarditis (IE) prior to the operations, 4 of them were PVE. (2) Eleven of them developed PVE within 2 months postoperatively. Fever (100%), major vessel embolism (48%), and anemia (36%) were the most frequently manifestations. Fourteen cases (56%) had positive culture results with 15 causative pathogens, including 5 coagulase-negative Staphylococcus (CNS, 3 were methicillin-resistant coagulase-negative Staphylococcus, MRSCoN), 4 fungi, 2 Enterococcus faecalis, 2 Burkholderia cepacia, 1 Stenotrophomonas maltophilia, and 1 Streptococcus. (3) Prosthetic valve vegetations, periannular leakage, regurgitation, were the main echocardiographic findings. Transesophageal echocardiography (TEE) revealed 13 PVE who had no positive findings on previous transthoracic echocardiography (TTE). (4) Eighteen PVE (72%) developed peri-annular complications (12 leakage, 3 dehiscence, 2 abscesses, 1 fistula), major vessel embolism, congestive heart failure (16%) were frequently observed, 9 of the 17 patients died in hospital, in spite of intensive managements., Conclusions: PVE has a high mortality and is a severe complication for patients who underwent heart surgery. Its causative pathogen spectrum is quite different from that of native valve endocarditis. TTE is not sensitive for some PVE cases.

Objective: To improve the diagnosis and treatment of infective endocarditis (IE) by exploring its causes, pathogenic microorganism and clinical characteristics., Methods: The clinical data of 120 IE patients treated in Peking Union Medical College Hospital from October 1997 to September 2007 were analyzed retrospectively., Results: Of the 120 consecutive cases diagnosed as IE according to the Duke's new criteria, 79 were male and 41 female with a average age of (43.2 +/- 16.7) years old. Twelve cases were prosthetic valve endocarditis (PVE) and 108 cases native valve endocarditis (NVE) and there were no previously known heart diseases in 29 of the cases. Seventy-nine of the 108 (73.1%) NVE patients had basic cardiac abnormalities before IE diagnosis, such as congenital cardiovascular disease (30 cases), idiopathic mitral valve prolapse (23 cases) and rheumatic heart disease (11 cases). Fever (100.0%), anemia (54.2%) and embolism (48.3%) were the most common clinical manifestations in the IE development. Of the 83 patients who had a positive blood culture result, Streptococcus viridans (51.8%) was the most common isolated microorganism., Conclusions: Congenital cardiovascular diseases and idiopathic mitral valve prolapse are the two most commonly heart diseases in IE. Blood culture and echocardiogram should always be done to exclude IE, especially presenting with fever of unknown reasons.

Objective: To investigate the clinical features, cerebrospinal fluid (CSF) changes, imaging characteristics, diagnostic methods, treatment regimens and outcomes of Chinese adult patients with tuberculous meningitis (TBM)., Methods: Clinical data of 100 cases of TBM admitted to Peking Union Medical College Hospital from January 1982 to December 2003 were investigated retrospectively. Data were collected with regard to the clinical, laboratory and demographic characteristics of the patients as well as the results of radiological investigations and data of clinical outcome., Results: One hundred TBM cases were included in this study; there were 49 males and 51 females. The mean age was (31 +/- 11) years. Seventy percent of the patients was of chronic duration (11.1 +/- 9.2) weeks. Thirteen cases were definitely diagnosed through positive CSF culture and smear or brain biopsy, the remaining 87 cases were diagnosed clinically. Fever (97%), headache (92%), decreased level of consciousness (71%), meningeal irritation (77%) and impairment of cranial nerve function were the most frequent symptoms and signs. Thirty-five cases were accompanied with active pulmonary tuberculosis and 12 cases with extrapulmonary tuberculosis. Raised intracranial pressure was present in 86%. CSF was non-purulent with lymphocytic pleocytosis, marked elevation of protein concentration and significant decrease of glucose. Sixty-seven cases had imaging data; abnormalities were found in 52 with ventricular enlargement, hydrocephalus and infarction the most frequent findings. All the patients received anti-tuberculosis therapy, nine underwent neurosurgical drain due to hydrocephalus, eighty-one improved and seven died., Conclusions: TBM should be suspected when chronic meningitis was accompanied with active pulmonary or extrapulmonary tuberculosis. Differential diagnosis and trial anti-tuberculosis therapy may be of help for the diagnosis. Positive CSF smear and culture and biopsy of brain or meninges are the golden standards for the diagnosis of TBM. Early diagnosis and treatment are very important for improving the outcome.

Objective: To investigate the clinical characteristics, therapeutical approaches and outcome of Pneumocystis pneumonia (PCP) in patients with AIDS., Methods: The clinical data of 22 PCP patients with AIDS who were treated in Peking Union Medical College Hospital from January 1992 to October 2004 were analyzed, including the routes of HIV infection, clinical profiles, immunological status, chest radiological characteristics, therapeutic managements and outcome., Results: (1) Of the 22 PCP patients, 16 were male and 6 female. The average age was (35.0 +/- 9.4) years old. The majority of patients got HIV infection through blood transfusion (54.5%) and sexual transmission (27.3%). (2) The common clinical presentations were fever (21/22), progressive exertional dyspnea (20/22), cough (16/22), sputum (12/22) and weight loss (18/22). 68.2% (15/22) of the patients had normal or mild coarse breath sounds on auscultation. 14 patients had an PaO(2) less than 60 mm Hg (1 mm Hg = 0.133 kPa). (3) All the 22 PCP cases were in their late stage of AIDS. For the 20 patients who had an immunological test, the peripheral CD(4)(+) T lymphocyte count was ranging from 3 x 10(6)/L to 148 x 10(6)/L and 90% of the cases had a CD(4)(+) T cell count less than 100 x 10(6)/L, 95% of the cases had a CD(4)(+)/CD(8)(+) ratio less than 0.20; (4) The most common abnormal chest radiological findings were bilateral diffuse interstitial infiltrations (19/22) and patchy shadows (14/22); (5) All patients were given trimethoprim-sulfamethoxazole (SMZco) and 86.4% of the patients were treated with corticosteroids concomitantly. Of the 22 PCP patients, 13 recovered, 5 gave up after knowing their definite diagnosis, 4 died. Comparing with the recovery patients, the 4 patients who died of PCP had much lesser CD(4)(+) T cell count (P = 0.07)., Conclusions: Most PCP occurred in patients who were in their late stage of AIDS and with a CD(4)(+) T cell count below 100 x 10(6)/L. For these reasons, we suggest that whenever encountering a young patient presenting with fever, dyspnea, hypoxia, loss of weight, the possibility of PCP complicating AIDS should be considered, especially when chest radiological study revealed interstitial infiltration or patchy shadows. If HIV was confirmed to be positive, the combined therapy of SMZco and corticosteroids should be started immediately.

Objectives: To investigate the clinical features, diagnostic methods, therapeutic approaches, outcomes and the alterations of peripheral lymphocyte subsets in cytomegalovirus (CMV) diseases., Methods: From August 2000 to October 2002, 50 cases of CMV diseases were treated in Peking Union Medical College Hospital. The diagnosis were made by their symptoms and positive CMV pp65 antigen or/and CMV specific IgM. Of the 50 patients, 15 were male, and 35 female. Their age was (35.5 +/- 16.2) years. Their clinical data were collected, and their peripheral lymphocyte subsets were measured at the time when they were first diagnosed as CMV disease. The lymphocyte subsets of 51 healthy blood donors were tested as normal controls. The lymphocyte subsets were compared between those who had an immunocompromising underlying disease and those who had not., Results: (1) CMV disease occurred in 39 patients who had immunocompromising underlying diseases, and in 11 patients who had not; (2) CMV disease caused various symptoms, most of them were nonspecific. Fever (100%), hematological abnormalities (96%) and abnormal liver function test (30%) were the most common manifestations. 3 cases of CMV retinitis were acquired immune deficiency syndrome patients with CD4+ T cell count less than 50/ microl; 2 patients developed multiple organ failure; (3) The positive rates of CMV pp65 antigen and specific IgM assays were 85.3% and 68.3%, respectively; (4) Comparing with normal controls, all patients with CMV disease had decreased B cell and nature killer cells, increased CD8+ T cell percentage and a reversed CD4+/CD8+ ratio; further more, the patients with underlying diseases had lower CD4+ T-cell and CD8+ T-cell counts than those without underlying diseases., Conclusions: CMV disease occurred in patients with or without underlying diseases. Their clinical manifestations were heterogeneous and non-specific, therefore, special laboratory tests were necessary to confirm the diagnosis. pp65 antigen assay had more diagnostic value than IgM assay. The dramatic changes in lymphocyte subsets suggest CMV disease has a immunological pathogenesis.

Objective: To investigate the clinical characteristics, therapeutical approaches and outcome of infective endocarditis (IE)., Methods: The clinical features, diagnosis, treatment and outcome of 70 IE patients who were treated in Peking Union Medical College Hospital from January 1988 to May 2000 were analyzed., Results: Of the 70 consecutive cases who were diagnosed as IE according to the Duke's new criteria. 38 patients were male and 32 patients female. The average age was (36.1 +/- 16.6) years old. 8 cases were prosthetic valve endocarditis (PVE) and 62 cases native valve endocarditis (NVE). 57 of the 62 (91.9%) NVE patients had pre-existing cardiac abnormalities predisposing to IE, such as congenital cardiovascular disease (22 cases), idiopathic mitral valve prolapse (18 cases), rheumatic heart disease (12 cases), senile degenerative heart disease (3 cases), and permanent pacemaker (PM) implantation 2 cases. Fever (100%), anemia (57.1%) and embolism (47.1%) were the three most common clinical manifestations. Of the 42 cases who had a positive blood culture result, Streptococcus vividans (54.8%) was the most common isolated microorganism. 39 out of the 51 cases receiving antimicrobial therapy and 17 of the 19 cases being treated with combination of antibiotics and surgery were cured. 14 cases including 5 PVE and 2 IE after PM implantation died with a mortality rate of 20%. Intractable congestive heart failure was the leading cause of death., Conclusions: Congenital cardiovascular diseases and idiopathic mitral valve prolapse were the two most commonly found underlying heart diseases. Blood culture and echocardiogram should always be done to evaluate the possibility of IE while a patient presents with fever of unknown origin, especially when he or she has anemia or embolism. PVE, IE after PM implantation and intractable congestive heart failure were associated with a poor prognosis.

Objective: To elucidate the mechanism of strong inflammatory response in severe acute respiratory syndrome (SARS) patients., Methods: 24 patients managed with a standard corticosteroid protocol developed by Peking Union Medical College Hospital were followed up for 2 months and their clinical outcomes were documented. Plasma levels of interleukin (IL)-1 beta, IL-2, IL-4, IL-8, IL-10, IL-12 p70, interferon gamma (IFN gamma), and tumor necrosis factor alpha (TNF alpha) were determined by quantitative ELISA during the course of disease respectively. 12 healthy blood donors were used as normal controls., Results: All SARS patients had remarkably increased plasma IL-8 concentrations (median 31.23 ng/L) at the onset of disease compared with those of normal controls (6.28 ng/L, P < 0.01). Along with the course of disease IL-8 concentration kept going up and 75% (18/24) patients reached a peak median concentration of 149.65 ng/L (P < 0.01) at the third and fourth weeks. IL-8 came back to normal control levels one month after discharged from hospital. Meanwhile, SARS patients also showed high a TNF alpha level (median 23.12 ng/L) (P < 0.01) at the second week and reached a peak median of 136.35 ng/L (P < 0.05) at the third an fourth weeks. One month after discharged from hospital the plasma TNF alpha concentration fell down to a median of 94.88 ng/L, but it was still much higher than normal controls (3.77 ng/L, P < 0.01)., Conclusion: The SARS-associated coronovirus infection may cause complex cytokine cascade. IL-8 and TNF alpha probably play important roles in mediating strong inflammatory response, which are thought to be responsible for lung injury in SARS patients.

Objective: To investigate the clinical characteristics of severe acute respiratory syndrome (SARS) and find out its effective treatment., Methods: A total of 106 cases of SARS were analyzed prospectively., Results: In this group, 56 were male and 50 female, aged from 15 to 81 years [average (36 +/- 10) years]. Common symptoms included fever (98.1%), chills (75.5%), cough (71.7%), headache and breathless (both 43.4%), diarrhea (24.5%) and rare rales in the lungs (11.2%). Laboratory test showed leukopenia (34.0%), lymphopenia (81.1%) and an extraordinary decrease of CD(4)(+) T cells (98.1%). Other rare abnormalities included liver injury (elevated alanine aminotransferase in 7.6%) and thrombocytopenia (3.8%). Almost all patients suffered from hypoxemia (PaO(2) less than 90 mm Hg in 90.2%, less than 70 mm Hg in 28.6%). Chest radiographs showed that unilateral focal patchy involvement in 34.0% of the patients, and unilateral multifocal or bilateral involvement were 11.3% and 46.2% respectively. Treatment regimens included small doses of steroids (methylprednisolone 40-80 mg, q12 h recommended) accompanied with broad-spectrum antibiotics such as the second generation of cephalosporins and macrolides and some other antiviral drugs. Meanwhile, emphasis was placed on oxygen support and coping with their underlying diseases., Conclusions: SARS has various presentations of clinical features and laboratory tests. Detection of CD(4)(+) T cell count is beneficial to diagnose SARS in early stage. Effective treatment includes various regimens, oxygen support and small doses of steroids.

Objective: To study the alterations and the clinical significance of peripheral lymphocyte subsets in patients with active cytomegalovirus (CMV) infection during the early stage of allogeneic peripheral blood stem cell transplantation (PBSCT) and to investigate the influence of active CMV infection on immunity., Methods: K(3)-EDTA anticoagulated peripheral blood samples were collected weekly from 27 allogeneic PBSCT recipients in the first 3 months after PBSCT. CMV pp65 antigen in peripheral white blood cells were tested by indirect immunofluorescence assay, and lymphocyte subsets were detected by flow cytometry with specific fluorescent monoclonal antibodies. In the meantime lymphocyte subsets of 51 samples from healthy blood donors were tested as normal control values., Results: CD(4)(+) T cell count for all recipients was significantly low throughout the first 3 months after PBSCT as compared with normal donors (P < 0.01). Of the 27 allogeneic PBSCT recipients, 5 had no active CMV infection, 10 had asymptomatic CMV active infection, 12 had symptomatic CMV infection. The average CD(4)(+) T cell counts (x 10(6)/L) for the different groups of patients were 328 +/- 203, 239 +/- 218 and 199 +/- 92; The average CD(8)(+) T cell counts (x 10(6)/L) were 400 +/- 380, 267 +/- 206 and 603 +/- 461, respectively. The average percentage of CD(4)(+) CD(28)(+) T cell subsets were (89.2 +/- 8.9)%, (84.2 +/- 10.1)% and (63.5 +/- 11.4)%, respectively. The recipients with asymptomatic CMV active infection were likely to have more natural killer (NK) cells as compared with those without active CMV infection (P < 0.01). The patients with symptomatic CMV infection had significantly lower CD(4)(+) cell count and higher CD(8)(+) cell count than those with asymptomatic CMV infection (P < 0.01). The percentage of CD(4)(+) CD(28)(+) cells was decreased significantly in the CMV active infection group (P < 0.01)., Conclusions: CMV active infection could induce dramatic alterations in lymphocyte subsets lymphocyte subsets and host immunity for allogeneic PBSCT recipients. Therefore, the changes of lymphocyte subsets might serve as auxiliary parameters to predict active CMV infections in this kind of immunocompromised patients.