RESUMO
Biomarkers could be useful in evaluating immune reconstitution inflammatory syndrome (IRIS). A cohort of 45 HIV-1-infected, antiretroviral treatment (ART)-naive patients with baseline CD4 T cell counts Assuntos
Antirretrovirais/uso terapêutico
, Proteína C-Reativa/metabolismo
, Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo
, Infecções por HIV/sangue
, Infecções por HIV/tratamento farmacológico
, Síndrome Inflamatória da Reconstituição Imune/sangue
, Síndrome Inflamatória da Reconstituição Imune/epidemiologia
, Infecções Oportunistas Relacionadas com a AIDS/complicações
, Infecções Oportunistas Relacionadas com a AIDS/imunologia
, Adulto
, Autoanticorpos/sangue
, Autoanticorpos/imunologia
, Biomarcadores/sangue
, Contagem de Linfócito CD4
, Feminino
, HIV-1/isolamento & purificação
, Antígenos HLA-A/genética
, Humanos
, Síndrome Inflamatória da Reconstituição Imune/diagnóstico
, Síndrome Inflamatória da Reconstituição Imune/etiologia
, Contagem de Leucócitos
, Masculino
, Pessoa de Meia-Idade
, Estudos Retrospectivos
, Fatores de Risco
RESUMO
There are few case reports of infections caused by Brevibacterium species, and there have been no previously reported cases of endocarditis caused by any of the 6 known species of Brevibacterium. We report the first case of Brevibacterium endocarditis (caused by Brevibacterium otitidis) in a patient with prosthetic heart valves. The patient responded to 6 weeks of treatment with vancomycin and 2 weeks with gentamicin, and she has been receiving long-term maintenance therapy with oral azithromycin.
Assuntos
Infecções por Actinomycetales/diagnóstico , Brevibacterium/patogenicidade , Endocardite Bacteriana/diagnóstico , Infecções por Actinomycetales/tratamento farmacológico , Administração Oral , Idoso , Brevibacterium/isolamento & purificação , Esquema de Medicação , Endocardite Bacteriana/tratamento farmacológico , Feminino , Próteses Valvulares Cardíacas/microbiologia , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologiaRESUMO
Strongyloides hyperinfection syndrome may be complicated by paralytic ileus that interferes with the absorption of oral anti-helminthics. We report on the administration of ivermectin as a rectal enema preparation to a renal transplant recipient with Strongyloides hyperinfection syndrome and progressive ileus. Attempts at treatment using nasogastric albendazole and ivermectin were unsuccessful despite clamping the nasogastric tube after drug administration. Ivermectin tablets were ground to a powder, resuspended in a commercially available suspending agent, and administered per rectum. The suspending agent was chosen for its near-physiologic osmolality to allow longer retention, in contrast to many enema preparations that have a laxative effect. The patient improved markedly within 72 hours of initiation of the therapy per rectum and recovered fully. Ivermectin administered as an enema may be beneficial in patients with severe strongyloidiasis who are unable to absorb or tolerate oral therapy.
Assuntos
Antinematódeos/administração & dosagem , Pseudo-Obstrução Intestinal/etiologia , Ivermectina/administração & dosagem , Estrongiloidíase/tratamento farmacológico , Administração Retal , Enema , Feminino , Humanos , Hospedeiro Imunocomprometido , Pseudo-Obstrução Intestinal/fisiopatologia , Pessoa de Meia-Idade , Estrongiloidíase/complicações , Resultado do TratamentoRESUMO
Enterococci are a major cause of bacteraemia and endocarditis and are increasingly being implicated in bone and joint infections. Hematogenous enterococcal vertebral osteomyelitis, however, has been only rarely reported. Here we present the first 2 patients from the United States and review the literature on 10 additional cases that have been published since 1967. The clinical presentation of enterococcal vertebral osteomyelitis was similar to cases due to other bacteria. Enterococcus faecalis caused most cases, consistent with its presumably increased virulence. All enterococcal cases in the literature were reported from Europe, which may be due to epidemiological differences related to antibiotic utilization and infection control practices between the US and Europe. Nine of all 12 cases were reported since 1995, which may be consistent with the increase in occurrence of enterococcal infections in general, in association with increasing patient co-morbidities, invasive procedures, and indwelling vascular devices.
Assuntos
Enterococcus faecalis/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Osteomielite/microbiologia , Vértebras Torácicas/microbiologia , Antibacterianos/uso terapêutico , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológicoRESUMO
OBJECTIVE: HIV and type 2 diabetes are known risk factors for albuminuria, but no previous reports have characterized albuminuria in HIV-infected patients with diabetes. RESEARCH DESIGN AND METHODS: We performed a cross-sectional study including 73 HIV-infected adults with type 2 diabetes, 82 HIV-infected non-diabetics, and 61 diabetic control subjects without HIV. Serum creatinine >1.5 mg/dL was exclusionary. Albuminuria was defined as urinary albumin/creatinine ratio >30 mg/g. RESULTS: The prevalence of albuminuria was significantly increased among HIV-infected diabetics (34% vs. 13% of HIV non-diabetic vs. 16% diabetic control, pâ=â0.005). HIV status and diabetes remained significant predictors of albuminuria after adjusting for age, race, BMI, and blood pressure. Albumin/creatinine ratio correlated significantly with HIV viral load (râ=â0.28, pâ=â0.0005) and HIV-infected subjects with albuminuria had significantly greater cumulative exposure to abacavir (pâ=â0.01). In an adjusted multivariate regression analysis of HIV-infected subjects, the diagnosis of diabetes (pâ=â0.003), higher HIV viral load (pâ=â0.03) and cumulative exposure to abacavir (pâ=â0.0009) were significant independent predictors of albuminuria. CONCLUSIONS: HIV and diabetes appear to have additive effects on albuminuria which is also independently associated with increased exposure to abacavir and HIV viral load. Future research on the persistence, progression and management of albuminuria in this unique at-risk population is needed.
Assuntos
Albuminúria/etiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Adulto , Albuminúria/epidemiologia , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Linfócitos T CD4-Positivos/imunologia , Estudos Transversais , Didesoxinucleosídeos/efeitos adversos , Didesoxinucleosídeos/uso terapêutico , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise MultivariadaRESUMO
Cutaneous fungal infections in solid-organ transplant patients present in a variety of nonspecific ways, requiring a high index of suspicion to diagnose correctly. In the present series of four transplant recipients, subsequent primary cutaneous fungal infections presented as papules, plaques, ulcers and subcutaneous nodules. Transplantations included one cardiac, two renal and one renal-pancreatic transplant. Fungal infections were limited to the skin; there was no evidence of disseminated disease in any case. The pathogens isolated were Scedosporium apiospermum (Pseudallescheria boydii), Alternaria species, Aspergillus fumigatus, and a coelomycete in the Coniothyrium-Microsphaeropsis complex of dark molds. Individuals were successfully treated with surgical debridement, antifungal agents, and reduction of immunosuppressive therapy. All patients and allografts survived. Accurate diagnosis, aggressive surgery and appropriate antifungal therapy, combined with close outpatient follow-up, optimize the likelihood of a cure in a transplant population.