Assuntos
Insuficiência Respiratória , Telangiectasia Hemorrágica Hereditária , Humanos , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/diagnóstico , Telangiectasia Hemorrágica Hereditária/genética , Mutação , Insuficiência Respiratória/etiologia , Endoglina/genéticaAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Febre/induzido quimicamente , Mesalamina/efeitos adversos , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Doença de Crohn/tratamento farmacológico , Feminino , Febre/terapia , Hidratação , Humanos , Mesalamina/uso terapêutico , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Sacroileíte/tratamento farmacológicoRESUMO
We present the case of a recurrent hyperammonaemic encephalopathy due to a portosystemic shunt that was successfully treated by embolization.
Assuntos
Embolização Terapêutica/métodos , Encefalopatia Hepática/diagnóstico por imagem , Encefalopatia Hepática/terapia , Hiperamonemia/diagnóstico por imagem , Hiperamonemia/terapia , Idoso , Cirurgia Bariátrica/efeitos adversos , Feminino , Humanos , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Derivação Portossistêmica Cirúrgica , Tomografia Computadorizada por Raios XAssuntos
Tumores Fibrosos Solitários/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Doenças Assintomáticas , Humanos , Achados Incidentais , Laparoscopia , Masculino , Tumores Fibrosos Solitários/patologia , Tumores Fibrosos Solitários/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaAssuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Doenças das Valvas Cardíacas/tratamento farmacológico , Doenças das Valvas Cardíacas/microbiologia , Valva Mitral , Infecções por Salmonella/tratamento farmacológico , Salmonella enteritidis , Idoso de 80 Anos ou mais , Humanos , Masculino , Indução de RemissãoAssuntos
Gânglios da Base/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Epilepsia Generalizada/diagnóstico por imagem , Hipoparatireoidismo/complicações , Tomografia Computadorizada por Raios X , Adulto , Calcinose/tratamento farmacológico , Calcinose/etiologia , Calcitriol/uso terapêutico , Carbonato de Cálcio/uso terapêutico , Quimioterapia Combinada , Epilepsia Generalizada/etiologia , Humanos , Hipocalcemia/tratamento farmacológico , Hipocalcemia/etiologia , MasculinoRESUMO
BACKGROUND: The objective of this study is to analyze the factors that are associated with the adequacy of empirical antibiotic therapy and its impact in mortality in a large cohort of patients with extended-spectrum ß-lactamase (ESBL)--producing Escherichia coli and Klebsiella spp. bacteremia. METHODS: Cases of ESBL producing Enterobacteriaceae (ESBL-E) bacteremia collected from 2003 through 2008 in 19 hospitals in Spain. Statistical analysis was performed using multivariate logistic regression. RESULTS: We analyzed 387 cases ESBL-E bloodstream infections. The main sources of bacteremia were urinary tract (55.3%), biliary tract (12.7%), intra-abdominal (8.8%) and unknown origin (9.6%). Among all the 387 episodes, E. coli was isolated from blood cultures in 343 and in 45.71% the ESBL-E was multidrug resistant. Empirical antibiotic treatment was adequate in 48.8% of the cases and the in hospital mortality was 20.9%. In a multivariate analysis adequacy was a risk factor for death [adjusted OR (95% CI): 0.39 (0.31-0.97); P = 0.04], but not in patients without severe sepsis or shock. The class of antibiotic used empirically was not associated with prognosis in adequately treated patients. CONCLUSION: ESBL-E bacteremia has a relatively high mortality that is partly related with a low adequacy of empirical antibiotic treatment. In selected subgroups the relevance of the adequacy of empirical therapy is limited.
Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/enzimologia , Infecções por Klebsiella/tratamento farmacológico , Klebsiella/enzimologia , beta-Lactamases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Criança , Pré-Escolar , Estudos de Coortes , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido , Klebsiella/isolamento & purificação , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/mortalidade , Masculino , Pessoa de Meia-Idade , Espanha , Análise de Sobrevida , Resultado do Tratamento , Adulto JovemAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Dor nas Costas/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Hepatite Autoimune/diagnóstico , Tiazinas/efeitos adversos , Tiazóis/efeitos adversos , Citoesqueleto de Actina/imunologia , Alanina Transaminase/sangue , Anti-Inflamatórios/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspartato Aminotransferases/sangue , Azatioprina/uso terapêutico , Bilirrubina/sangue , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Quimioterapia Combinada , Hepatite Autoimune/tratamento farmacológico , Humanos , Imunoglobulina G/sangue , Imunossupressores/uso terapêutico , Masculino , Meloxicam , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Tiazinas/uso terapêutico , Tiazóis/uso terapêuticoRESUMO
INTRODUCTION: Enterococcal bloodstream infections have acquired considerable importance in recent years, mainly because of the increasing number of cases that occur during hospital admission. METHODS: Retrospective study of the clinical records of patients diagnosed with enterococcal bacteremia and hospitalized over a 12-year period (January 1994-April 2006), analyzing epidemiological, clinical and microbiological characteristics, outcome and prognostic factors. RESULTS: A total of 182 episodes of bacteremia were recorded; 68% of them were nosocomial infections, accounting for 5% of the in-hospital bacteremia episodes in this period. The most frequent sources of infection were urinary tract (29%), cardiovascular (25%), intra-abdominal (21%) and primary bacteremia (12%). Associated comorbid conditions were present in 85% of patients, mainly neoplasms (33%). Enterococcus faecalis was responsible for 70% of cases, E. faecium 22%, and other species of enterococci 8%. Twenty percent were polymicrobial bacteremia. Antibiotic resistance was documented in 23% of the strains: 14% ampicillin, 8% gentamicin, 3% ampicillin and gentamicin, and 0.5% vancomycin. Overall mortality was 31%. Polymicrobial bacteremia and comorbidity were associated with a poor prognosis. CONCLUSION: In our hospital, Enterococcus is the fifth most frequent cause of nosocomial bacteremia. E. faecium is characterized by a high incidence (more than 50% of cases) of ampicillin resistance.
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Bacteriemia/epidemiologia , Doenças Transmissíveis Emergentes/epidemiologia , Infecção Hospitalar/epidemiologia , Enterococcus/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Criança , Pré-Escolar , Doenças Transmissíveis Emergentes/microbiologia , Comorbidade , Infecção Hospitalar/microbiologia , Surtos de Doenças , Farmacorresistência Bacteriana , Enterococcus/patogenicidade , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais Urbanos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
We present a case of tuberculous peritonitis in a 71-year-old woman with long-standing rheumatoid arthritis treated with adalimumab, and we review the association between antitumor necrosis factor therapy and tuberculosis. Our case illustrates that the index of suspicion of tuberculosis in these patients, even with atypical clinical features, must be very high, and underscores the need of tuberculosis screening before therapy is started.
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Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Peritonite/microbiologia , Tuberculose/induzido quimicamente , Adalimumab , Idoso , Anticorpos Monoclonais Humanizados , Artrite Reumatoide/tratamento farmacológico , Feminino , Humanos , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
Although pericardial involvement is very frequent in systemic lupus erythematosus, cardiac tamponade is extremely rare as the first manifestation of the disease. On the other hand, systemic lupus erythematosus is a disease that predominantly affects young women, and it is a very uncommon condition in the elderly. We report a 91-year-old woman diagnosed with cardiac tamponade, which was the presenting clinical feature of a previously undiagnosed case of systemic lupus erythematosus.
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Tamponamento Cardíaco/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Idade de Início , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/imunologia , Diagnóstico Diferencial , Feminino , HumanosRESUMO
BACKGROUND AND OBJECTIVE: Clinical suspicion of bacteremia lacks of sensitivity, specificity or predictive values enough to be clinically useful. The aim of this study was to develop a clinical prediction rule of bacteremia for patients hospitalized in an internal medicine department, with community-acquired symptoms, who had blood cultures obtained. PATIENTS AND METHOD: A prospective study, including all patients who had blood cultures in the first 48 h after admission, was performed. A clinical prediction rule of bacteremia was derived from a random sample of two thirds of the patients (derivation cohort) and validated in the remaining (validation cohort). After bivariate analysis, significant variables were included in a stepwise logistic regression analysis. In every patient out of the derivation and validation cohorts a score, derived from the addition of points for each of the significant predictor variables of logistic regression, was obtained; according to this score, 4 groups were formed, and the prevalence of bacteremia in each of them was calculated. Calibration and discrimination were evaluated by the Hosmer-Lemeshow test and area under the ROC curve respectively. RESULTS: Four hundred and forty-eight blood cultures were obtained; the prevalence of bacteremia was 25.2%. Independent predictors of bacteremia in the bivariate analysis were urinary focus of infection, body temperature >= 38.3 degrees C, presence of band forms, ESR >= 70 mm, platelets < 200 * 103/microl, blood glucose >= 140 mg/dl, urea >= 50 mg/dl, C-reactive protein >= 12 mg/dl, and albumin < 3 g/dl. According to the score, in the derivation cohort, four groups with increasing prevalence of bacteremia were identified; in the group with a score between 0 and 3, the prevalence was 2.4%; between 4 and 5: 15.7%; between 6 and 7: 42.9%; and score >= 8: 65%. In the validation cohort, the prevalence was 4.1%, 22.6%, 29.3%, and 80%, respectively. The model showed good calibration (Hosmer-Lemeshow *2 = 4.91; p = 0.77). Area under the ROC curve was 0.81 (95% confidence interval, 0.76-0.86) in the derivation cohort, and 0.77 (95% confidence interval, 0.69-0.85) in validation cohort. CONCLUSIONS: Our model, constructed with 9 variables and a simple additive point system, had good calibration and discrimination, which points at its usefulness to estimate the probability of bacteremia in patients admitted in an Internal Medicine department. Used in conjunction with clinical judgement, the model can be useful in the decision-making process, concerning blood cultures obtention, clinical monitoring, and empirical antimicrobial therapy. Before application, additional prospective validation in other settings is warranted.