Assuntos
Endoftalmite/etiologia , Corpos Estranhos no Olho/etiologia , Ferimentos Oculares Penetrantes/complicações , Antibioticoprofilaxia , Clindamicina/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Corpos Estranhos no Olho/tratamento farmacológico , Corpos Estranhos no Olho/microbiologia , Infecções Oculares Bacterianas/prevenção & controle , Ferimentos Oculares Penetrantes/tratamento farmacológico , Ferimentos Oculares Penetrantes/microbiologia , Gentamicinas/uso terapêutico , Humanos , Infecção da Ferida Cirúrgica/prevenção & controle , VitrectomiaRESUMO
INTRODUCTION: Nocardia brasiliensis is a very rarely reported cause of chronic phagedenic ulcerations. We report the case of an elderly woman who developed such an infection after falling on her right leg on the road in the Bresse country (an essentially agricultural and bovine-cattle breading region) and developed a chronic phagedenic ulcer secondarily complicated by nodular lymphangitis of the thigh. CASE REPORT: A 75 year-old woman fell on her right leg on the side of the main road outside her hamlet in the Bresse country and secondarily developed a chronique phagedenic ulceration. We first considered her as suffering from pyoderma gangrenosum. A complete scanning only revealed an autoimmune thyroiditis and a rapidly healing gastric ulceration, and none of the treatments, either local or systemic, helped the skin condition to heal. After 3 weeks of application of a local corticoid ointment, the patient developed fever, general malaise, an exacerbation of her wound and an infiltration of the skin round her knee, together with nodular lymphangitic dissemination. A supplementary bacterial swab disclosed massive proliferation of a slow-growing Gram-positive bacillus, which proved to be Nocardia brasiliensis, together with a methicillino-sensitive Staphylococcus aureus. The treatment with sulfamethoxazole-trimetoprim gave a rash after 12 hours and was changed to amoxicillin and clavulanic acid, which rapidly proved to be permanently effective. DISCUSSION: The revelation of this particular slow-growing bacteria is difficult and requires bacterial swabs. Nocardia brasiliensis is relatively rare in primary skin ulcerations and we discuss the reasons why an elderly women should find this bacteria on the road outside her hamlet in the French countryside. This particular infectious condition requires general scanning, to make sure that the primary skin condition does not extend to other organs. We review the therapeutical options for patients who exhibit allergic reactions to the classically effective antibiotic drugs.
Assuntos
Úlcera da Perna/etiologia , Úlcera da Perna/microbiologia , Nocardiose/complicações , Acidentes por Quedas , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Doença Crônica , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Linfangite/etiologia , Nocardia/patogenicidade , Nocardiose/tratamento farmacológicoRESUMO
We describe clinical and pathological features of kidney and skin involvement in a patient with hypersensitivity vasculitis associated with dapsone. Although visceral damage occurs rarely, similar skin and kidney histopathologic and immunohistochemical findings indicate that this organ is a target for type IV cell-mediated dapsone reaction. To our knowledge, this is the first reported case of renal hypersensitivity vasculitis associated with dapsone.
Assuntos
Dapsona/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Nefropatias/induzido quimicamente , Hansenostáticos/efeitos adversos , Vasculite Leucocitoclástica Cutânea/induzido quimicamente , Adulto , Antibacterianos , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Clofazimina/administração & dosagem , Clofazimina/uso terapêutico , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Dapsona/administração & dosagem , Dapsona/uso terapêutico , Hipersensibilidade a Drogas/tratamento farmacológico , Quimioterapia Combinada/administração & dosagem , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Nefropatias/tratamento farmacológico , Hansenostáticos/administração & dosagem , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Vasculite Leucocitoclástica Cutânea/tratamento farmacológicoRESUMO
PURPOSE: To report successful treatment of exogenous Fusarium and Aspergillus endophthalmitis with new antifungal agents. DESIGN: Interventional case report. METHODS: Treatment of two cases is reviewed. RESULTS: A 64-year-old man developed post-cataract Fusarium moniliforme endophthalmitis. Infection persisted despite removal of the intraocular lens, three vitrectomies, and five intravitreal injections of amphotericin. Inflammation resolved and vision improved from 20/80 to 20/40 on 6 months of oral voriconazole. A 55-year-old man developed post-cataract intraocular inflammation. After three vitrectomies and removal of the intraocular lens, Aspergillus fumigatus endophthalmitis was diagnosed. Intravitreal amphotericin and systemic voriconazole were given, but one week later there were early signs of recurrence. Intravenous caspofungin was added and the eye improved. Caspofungin was continued for 6 weeks and voriconazole for 6 months. Vision improved from counting fingers to 20/80 at 6 months and 20/25 at 23 months. CONCLUSION: Voriconazole is a promising new therapy for Fusarium and Aspergillus endophthalmitis. Caspofungin may act synergistically with voriconazole in treating Aspergillus endophthalmitis.
Assuntos
Antibacterianos , Antifúngicos/uso terapêutico , Aspergillus fumigatus/isolamento & purificação , Quimioterapia Combinada/uso terapêutico , Endoftalmite/tratamento farmacológico , Fusarium/isolamento & purificação , Micoses/tratamento farmacológico , Peptídeos Cíclicos/uso terapêutico , Pirimidinas/uso terapêutico , Triazóis/uso terapêutico , Caspofungina , Extração de Catarata , Equinocandinas , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Humanos , Implante de Lente Intraocular , Lipopeptídeos , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Complicações Pós-Operatórias , Vitrectomia , VoriconazolRESUMO
PURPOSE: To report a method of treatment for through-the-flap multibacterial ulcerative keratitis after laser in situ keratomileusis (LASIK). METHODS: Bacterial ulcerative keratitis after LASIK was treated with topical and systemic antibiotics followed by flap lifting, cleaning, and phototherapeutic keratectomy (PTK). Follow-up examinations included in vivo confocal microscopy, corneal topography, and wavefront analysis. RESULTS: Rapid recovery of the ulcerative keratitis was observed after flap lifting and cleaning of the interface and PTK combined with topical and systemic antibiotics. Two years postoperatively, corneal topography showed a slight depression of the ulcer area and decentration of the photoablation. Wavefront analysis revealed an irregular scan with a pronounced coma-like aberration, which with a wavefront-guided custom test lens correction provided 20/16 visual acuity. CONCLUSIONS: Ulcerative bacterial keratitis is a possible sight-threatening complication of LASIK refractive surgery. Lifting and rinsing the flap combined with cleaning of the flap interface with PTK may be helpful in these conditions when regression of the ulcer does not occur with topical and oral antibiotic treatment.
Assuntos
Infecções por Acinetobacter/terapia , Antibacterianos , Úlcera da Córnea/terapia , Quimioterapia Combinada/uso terapêutico , Infecções Oculares Bacterianas/terapia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Ceratectomia Fotorrefrativa/métodos , Infecções Estafilocócicas/terapia , Acinetobacter/isolamento & purificação , Infecções por Acinetobacter/diagnóstico , Infecções por Acinetobacter/microbiologia , Adulto , Terapia Combinada , Topografia da Córnea , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/microbiologia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Humanos , Lasers de Excimer , Masculino , Microscopia Confocal , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Retalhos Cirúrgicos/microbiologiaRESUMO
PURPOSE: To evaluate the causative organisms of and predisposing medical conditions in endogenous endophthalmitis and review visual acuity after pars plana vitrectomy. METHODS: Records of 23 patients (32 eyes) who were diagnosed with endogenous endophthalmitis and treated at Shanghai Eye, Ear, Nose & Throat Hospital from January 2000 to December 2003 were retrospectively reviewed. Final visual acuity was followed up. RESULTS: Of these 23 patients, 19 (86%) had endogenous endophthalmitis confirmed with a positive smear or culture; 12 cases (63%) were due to fungi, 6 (32%) were due to bacteria, and 1 (5%) was a mixed infection (fungus and bacteria). Culture specimens from four patients, which were obtained by vitrectomy, were all positive, while their initial vitreous needle biopsy specimens were negative. Of the 20 eyes that underwent pars plana vitrectomy, 17 (85%) had anatomical success, and 16 (80%) gained visual acuity of counting fingers or better; of these eyes, 8 (40%) had visual acuity of 20/200 or better. CONCLUSION: Fungi, especially Candida albicans, were the most common causative organisms. The most common predisposing medical conditions were recent tumor surgery and intravenous administration in rural settings. Most patients with endogenous endophthalmitis who undergo pars plana vitrectomy will have useful vision (counting fingers). Vitreous specimens for culture that were obtained by vitrectomy were more sensitive in detecting the causative organism.
Assuntos
Endoftalmite/cirurgia , Infecções Oculares Bacterianas/cirurgia , Infecções Oculares Fúngicas/cirurgia , Vitrectomia/métodos , Adolescente , Adulto , Idoso , Antibacterianos , Bactérias/isolamento & purificação , Criança , Terapia Combinada , Quimioterapia Combinada/uso terapêutico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Fungos/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Acuidade Visual , Corpo Vítreo/microbiologiaRESUMO
PURPOSE: To determine if the treatment outcomes for endophthalmitis are influenced by subconjunctival antibiotics. METHODS: A retrospective, nonrandomized consecutive series of patients with clinically diagnosed bacterial endophthalmitis confirmed with positive cultures who presented between December 1, 1995, and February 28, 2002, was studied. Patients with cataract surgery, glaucoma filtering blebs, or trauma who presented with visual acuity of hand motions or better were included. All patients received intravitreal and topical antibiotics. Management by pars plana vitrectomy or vitreous tap and use or nonuse of subconjunctival antibiotics were at the discretion of the treating physician. RESULTS: There were 59 patients identified; 54 met the follow-up criteria. These patients were divided into two groups based on whether subconjunctival antibiotics were used (group ABX; n = 21) or not used (group noABX; n = 33). The median pretreatment visual acuity was hand motions in both groups. The median age in both groups was 74 years. Etiology, duration of symptoms, vitreous culture organisms, percentage of cases with wound complications such as leaks or vitreous incarceration, and intraocular lens type were similar in the two study groups. Intravitreal and topical antibiotics and corticosteroids used were not significantly different in the two groups, except that topical ceftazidime was used less frequently in group ABX than in group noABX (43% vs. 82%, respectively; P = 0.007). The median follow-up was 13 months in both groups (range: 3-87 months for group ABX and 3-63 months for group noABX). Final visual acuity in groups ABX and noABX was at least 20/50 (33% vs. 39%, respectively), 20/60 to 5/200 (29% vs. 39%, respectively), 4/200 to better than hand motions (0 vs. 3%, respectively), or hand motions or worse (38% vs. 18%, respectively). These differences were not significant (P = 0.37). Reinjection rates (14% vs. 15%, respectively) were also similar in groups ABX and noABX. The additional procedures rate was significantly higher in group ABX than in group noABX (P = 0.024), with cumulative rates of 33% and 3%, respectively, at the 12-month follow-up. CONCLUSIONS: These data suggest that subconjunctival antibiotics may not be necessary to treat infectious endophthalmitis managed with otherwise standard tap and injection techniques and topical antibiotics.
Assuntos
Antibacterianos , Túnica Conjuntiva/efeitos dos fármacos , Quimioterapia Combinada/uso terapêutico , Endoftalmite/tratamento farmacológico , Infecções Oculares Bacterianas/tratamento farmacológico , Administração Tópica , Idoso , Vias de Administração de Medicamentos , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Feminino , Humanos , Injeções , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Vitrectomia , Corpo Vítreo/efeitos dos fármacosAssuntos
Lesões Encefálicas/diagnóstico , Lesões Encefálicas/cirurgia , Gatos , Alimentos , Órbita/lesões , Órbita/cirurgia , Assunção de Riscos , Ferimentos Penetrantes , Ferimentos Perfurantes , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Animais , Antifúngicos/uso terapêutico , Lesões Encefálicas/tratamento farmacológico , Ciprofloxacina/uso terapêutico , Terapia Combinada , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Imageamento por Ressonância Magnética , Metronidazol/uso terapêutico , Microcirurgia/métodos , Procedimentos Neurocirúrgicos , Cuidados Pós-Operatórios , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XAssuntos
Quimioterapia Combinada/uso terapêutico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Facoemulsificação , Complicações Pós-Operatórias , Infecções por Serratia/microbiologia , Serratia marcescens/isolamento & purificação , Endoftalmite/tratamento farmacológico , Infecções Oculares Bacterianas/tratamento farmacológico , Gentamicinas/uso terapêutico , Humanos , Infecções por Serratia/tratamento farmacológico , Irrigação Terapêutica , Vancomicina/uso terapêuticoAssuntos
Injúria Renal Aguda/epidemiologia , Leptospirose/epidemiologia , Injúria Renal Aguda/diagnóstico , Animais , Antibacterianos , Estudos de Coortes , Comorbidade , Quimioterapia Combinada/uso terapêutico , Feminino , Seguimentos , Humanos , Incidência , Leptospirose/diagnóstico , Leptospirose/tratamento farmacológico , Masculino , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Turquia/epidemiologiaRESUMO
AIM: To characterize infectious complications arising within 30 days after transplantation of autologous hemopoietic blood cells in 42 patients with hematological malignancy (HM); to compare the course of early posttransplantation period with reference to a kind of high-dose conditioning and dose of transplanted CD34+ cells. MATERIAL AND METHODS: Autotransplantation (AT) was conducted as consolidation of a complete or partial remission in 20 patients with multiple myeloma, 14 patients with lymphogranulomatosis and lymphosarcoma, 7 patients with acute leukemia and 1 patient with rabdomyosarcoma. The program of pretransplantation conditioning corresponded to the disease form and included: melphalan, BEAM, busulphane-cyclophosphamide. The number of transplanted CD34+ cells was 1.7-20.1 (median 5.3) x l0(6) cell/kg. The transplantation was followed by selective intestinal decontamination and mycosis prophylaxis. Fever was managed with antibiotics. RESULTS: An early period after AT ran without febrile episodes in 7 (17%) patients. This allowed physicians to avoid systemic antibiotic therapy. The infectious focus was not definitely localized in 35 patients with febrile fever in 77% cases. Clinically and bacteriologically verified infections were detected in 8 (19%) patients: 7 cases of pneumonia and 1 of bacteriemia. None of the patients died of infection early after AT. Not a single case of invasive aspergillesis was registered. CONCLUSION: Incidence and features of infections did not vary with the above diseases and did not depend on the dose of transplanted CD34+ cells. The kind of high-dose conditioning had a significant influence on the time of granulocyte recovery, duration of agranulocytosis, duration of one febrile episode and of antibiotic therapy. The dose of transplanted CD34+ cells also influenced the time of granulocyte recovery and duration of antibiotic therapy.
Assuntos
Bacteriemia/etiologia , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pneumonia por Pneumocystis/etiologia , Infecções Estafilocócicas/etiologia , Adulto , Antibacterianos , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Quimioterapia Combinada/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/microbiologia , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus/isolamento & purificação , Fatores de Tempo , Condicionamento Pré-Transplante , Transplante AutólogoAssuntos
Mordeduras Humanas/cirurgia , Lábio/lesões , Língua/lesões , Adulto , Antibacterianos , Anti-Infecciosos Locais/uso terapêutico , Mordeduras Humanas/fisiopatologia , Desbridamento , Quimioterapia Combinada/uso terapêutico , Humanos , Hialuronoglucosaminidase/uso terapêutico , Lacerações/cirurgia , Lábio/cirurgia , Masculino , Pessoa de Meia-Idade , Supuração , Deiscência da Ferida Operatória/cirurgia , Irrigação Terapêutica , Língua/cirurgia , Cicatrização/fisiologia , Infecção dos Ferimentos/cirurgiaRESUMO
We describe a case of endophthalmitis following strabismus surgery. Drainage of the suprachoroidal effusion with injection of antibiotics was unsuccessful in salvaging vision. Endophthalmitis following strabismus surgery may present with findings simulating a choroidal effusion or hemorrhage. Treating physicians should be alert to signs and symptoms of this severe complication of strabismus surgery in preverbal children.
Assuntos
Bacteriemia/etiologia , Doenças da Coroide/etiologia , Esotropia/cirurgia , Infecções Oculares Bacterianas/etiologia , Panoftalmite/etiologia , Infecções Pneumocócicas/etiologia , Complicações Pós-Operatórias , Antibacterianos , Bacteriemia/diagnóstico , Bacteriemia/terapia , Doenças da Coroide/diagnóstico , Doenças da Coroide/terapia , Terapia Combinada , Quimioterapia Combinada/uso terapêutico , Esotropia/congênito , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/terapia , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Músculos Oculomotores/cirurgia , Panoftalmite/diagnóstico , Panoftalmite/terapia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/terapia , Streptococcus pneumoniae/isolamento & purificação , VitrectomiaRESUMO
Tropical pyomyositis is a primary pyogenic infection of skeletal muscle, often caused by Staphylococcus aureus. The most common presentation of tropical pyomyositis is that of multiple acute abscesses with fever. Hepatitis is a rare manifestation of this disease. We report a case of tropical pyomyositis who presented with hepatic encephalopathy leading to initial diagnostic dilemma.
Assuntos
Abscesso/diagnóstico , Polimiosite/diagnóstico , Abscesso/complicações , Abscesso/terapia , Antibacterianos , Braço , Biópsia , Diagnóstico Diferencial , Drenagem , Quimioterapia Combinada/uso terapêutico , Seguimentos , Encefalopatia Hepática/complicações , Encefalopatia Hepática/diagnóstico , Humanos , Perna (Membro) , Fígado/diagnóstico por imagem , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Polimiosite/complicações , Polimiosite/terapia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Supuração , UltrassonografiaAssuntos
Antibacterianos/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Antibacterianos/efeitos adversos , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Dose Máxima Tolerável , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Antibacterianos , Fibrose Cística/microbiologia , Farmacorresistência Bacteriana Múltipla , Quimioterapia Combinada/uso terapêutico , Testes de Sensibilidade Microbiana , Infecções Respiratórias/microbiologia , Doença Aguda , Doença Crônica , Fibrose Cística/complicações , Humanos , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/prevenção & controle , Pseudomonas aeruginosa/efeitos dos fármacos , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/prevenção & controleAssuntos
Prótese Vascular/efeitos adversos , Confusão/etiologia , Infecções Relacionadas à Prótese/complicações , Doença Aguda , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Celulite (Flegmão)/complicações , Celulite (Flegmão)/tratamento farmacológico , Cloxacilina/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/complicações , Quimioterapia Combinada/uso terapêutico , Artéria Femoral/cirurgia , Alucinações/etiologia , Humanos , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Masculino , Artéria Poplítea/cirurgia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/tratamento farmacológico , Radiografia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Deficiência de Vitamina B 12/complicaçõesRESUMO
Inflammatory pseudotumor (IPL) of the liver is a rare benign clinicopathologic entity, which has been associated with infectious conditions, including alimentary, digestive tract and mouth infections. We report a new case, where a patient developed hepatic IPL that revealed endometritis related to Corynebacterium infection; the patient had a favorable outcome of hepatic IPL after appropriate antibiotic therapy initiation. Our findings therefore confirm that antibiotic therapy may be effective in patients with hepatic IPL associated with underlying infections, avoiding unnecessary surgery. Our data also indicate that when hepatic IPL is observed, a complete clinical evaluation, including gynecological evaluation, should be systematically performed.
Assuntos
Infecções por Corynebacterium/diagnóstico , Endometrite/diagnóstico , Granuloma de Células Plasmáticas/diagnóstico , Dispositivos Intrauterinos/efeitos adversos , Hepatopatias/diagnóstico , Adulto , Antibacterianos , Infecções por Corynebacterium/tratamento farmacológico , Diagnóstico Diferencial , Quimioterapia Combinada/uso terapêutico , Endometrite/tratamento farmacológico , Endometrite/etiologia , Feminino , Seguimentos , Granuloma de Células Plasmáticas/terapia , Humanos , Hepatopatias/terapia , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Primary cutaneous mucormycosis is an unusual mycotic infection associated to immunosupression. We present a 34 year-old woman with HIV infection with a necrotic primary mucormycosis of the skin associated to a venous catheter. She was treated with amphotericin B and surgical debridement.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Mucormicose/etiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Infecções Oportunistas Relacionadas com a AIDS/cirurgia , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Cateterismo/efeitos adversos , Terapia Combinada , Desbridamento , Quimioterapia Combinada/uso terapêutico , Fasciite Necrosante/complicações , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/microbiologia , Feminino , Antebraço , Humanos , Infecções por Klebsiella/complicações , Infecções por Klebsiella/tratamento farmacológico , Mucormicose/tratamento farmacológico , Mucormicose/patologia , Mucormicose/cirurgia , Curativos Oclusivos/efeitos adversos , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/tratamento farmacológico , Úlcera Cutânea/etiologia , Úlcera Cutânea/microbiologiaRESUMO
BACKGROUND: We previously showed that a positive impact of peritoneal defense response on the outcome of peritoneal dialysis (PD)-related peritonitis is characterized by an increased pattern of peritoneal CD4/CD8 T-cell ratio with a predominant CD4(+)-T helper subtype 1 phenotype. To further explore longitudinal changes in peritoneal immunity during PD-related peritonitis, we examined the production of interleukin 12 (IL-12), IL-18, and interferon gamma (IFN-gamma) in peritoneal dialysate effluent (PDE) and kinetic expression of the transcription factors T box expressed in T cells (T-bet) and guanine adenine thymine adenine (GATA) binding protein 3 (GATA-3) in peritoneal T cells during peritonitis. Correlations between these observations and responses to antibiotics were analyzed. METHODS: IL-12, IL-18, and IFN-gamma protein and IFN-gamma, T-bet, and GATA-3 messenger RNA (mRNA) were measured in PDE during various phases of peritonitis in 40 patients undergoing PD. Patients were divided into 2 groups according to whether they had a rapid versus delayed response to antibiotic treatment. RESULTS: In the early phase of peritonitis, IL-12, IL-18, and IFN-gamma levels in PDE were significantly greater in the rapid-response group (P < 0.05). Changes in peritoneal IL-12 and IL-18 levels preceded changes in IFN-gamma levels. The kinetics of IFN-gamma, T-bet, and GATA-3 mRNA expression in peritoneal T cells, measured by means of real-time polymerase chain reaction, differed between the 2 groups. In the rapid-response group, IFN-gamma and T-bet mRNA expression increased, whereas that of GATA-3 decreased over time. Results were opposite in the delayed-response group, with IFN-gamma and T-bet levels decreasing and GATA-3 levels increasing over time. CONCLUSION: These data suggest that local IL-12 and IL-18 production is part of a protective early immune response to PD-related peritonitis. High IL-12 and IL-18 levels in PDE during the early phase of peritonitis correlated with a predominant type 1 immune response and favorable outcome.