Assuntos
Antibacterianos/uso terapêutico , Clindamicina/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus/isolamento & purificação , Antibacterianos/farmacologia , Austrália/epidemiologia , Clindamicina/farmacologia , Feminino , Humanos , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/epidemiologiaRESUMO
Prototheca species are achlorophyllus algae. Prototheca wickerhamii and Prototheca zopfii cause human disease. In immunocompetent individuals, they cause soft tissue infections and olecranon bursitis, but in transplant recipients, these organisms can cause disseminated disease. We report a fatal case of disseminated P. zopfii infection in an hematopoietic stem cell transplant (HSCT) recipient with bloodstream infection and involvement of multiple soft tissue sites. We review all previous cases of protothecosis in HSCT reported in the literature. Protothecosis is uncommon after HSCT, but has a disseminated presentation that is frequently fatal. It is commonly misidentified as a yeast. Tumor necrosis factor-alpha inhibitors and contamination of central venous catheters may contribute to development of protothecosis. Optimal treatment approaches are yet to be defined. New agents such as miltefosine may be possible future therapies.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções/etiologia , Prototheca/classificação , Evolução Fatal , HumanosAssuntos
Antibacterianos/uso terapêutico , Penicilina G/uso terapêutico , Reação em Cadeia da Polimerase/métodos , Sífilis Cardiovascular/diagnóstico , Treponema pallidum/isolamento & purificação , Adulto , Austrália , Proteínas de Bactérias/genética , DNA Bacteriano/genética , Diagnóstico Diferencial , Humanos , Masculino , Especificidade da Espécie , Sífilis Cardiovascular/tratamento farmacológico , Sífilis Cardiovascular/microbiologia , Treponema pallidum/genéticaRESUMO
Public providers have no financial incentive to respect their legal obligation to exempt the poor from user fees. Health Equity Funds (HEFs) aim to make exemptions effective by giving NGOs responsibility for assessing eligibility and compensating providers for lost revenue. We use the geographic spread of HEFs over time in Cambodia to identify their impact on out-of-pocket (OOP) payments. Among households with some OOP payment, HEFs reduce the amount paid by 35%, on average. The effect is larger for households that are poorer and mainly use public health care. Reimbursement of providers through a government operated scheme also reduces household OOP payments but the effect is not as well targeted on the poor. Both compensation models raise household non-medical consumption but have no impact on health-related debt. HEFs reduce the probability of primarily seeking care in the private sector.
Assuntos
Financiamento Governamental , Financiamento Pessoal , Acessibilidade aos Serviços de Saúde/economia , Idoso , Camboja , Feminino , Humanos , Masculino , PobrezaRESUMO
The etiology of culture-negative septic arthritis is poorly characterised in persons infected with human immunodeficiency virus (HIV). New molecular methods may assist in the investigation of culture-negative infections of sterile sites, including septic arthritis. We describe the first case of septic arthritis due to the cause of rat bite fever (RBF), Streptobacillus moniliformis, confirmed by 16S rRNA sequence analysis, in a patient with newly diagnosed HIV infection.