RESUMO
OBJECTIVE: This study aimed at providing original data on fungemia in the Centre Hospitalier de Mayotte in terms of prevalence, epidemiological characteristics of infected patients, yeast species distribution and profile of in vitro antifungals susceptibility. METHODS: A total of 223 positive blood cultures for yeasts were retrospectively reported during the period April 2010-April 2020. RESULTS: Ninety-five episodes were identified corresponding to an incidence rate of 3.7 cases/100,000 inhabitants. The average age of patients was 33.5 years, and 63.3% patients were hospitalized in intensive care unit. The main co-morbidities were surgery in the 30 days prior to fungemia (27.8%), neoplasia (22.8%), parenteral nutrition (17.7%), diabetes (16.5%) and immunosuppressive medications (31.6%). Candida spp accounted for the majority of isolates (92.4%) with a predominance of non-albicans species (55.8% vs 33.7%), including C. albicans (33.7%), C. tropicalis (30.5%) and C. parapsilosis (20%). The antifungal susceptibility profiles did not differ from expected results for each species and did not change significantly over time. DISCUSSION: Fungemia remain frequent hospital infections associated with high mortality in Mayotte. The vast majority of fungemia was due to Candida spp. Non-albicansCandida species reach half of the Candida isolates with a high percentage of C. tropicalis. Surprisingly, no case of candidemia due to C. glabrata were identified. The management of candidemia remains satisfactory and the treatment was adapted according to the international recommendations. However, the high susceptibility of Candida spp. isolates to fluconazole may invite to reconsider the use of this molecule as empirical and first-line treatment of candidemia in Mayotte.
Assuntos
Antifúngicos/farmacologia , Candida/classificação , Candida/efeitos dos fármacos , Infecção Hospitalar/epidemiologia , Fungemia/epidemiologia , Fungemia/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Criança , Pré-Escolar , Comores/epidemiologia , Farmacorresistência Fúngica , Feminino , França , Fungemia/tratamento farmacológico , Humanos , Incidência , Oceano Índico , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemAssuntos
Nódulo da Irmã Maria José/diagnóstico , Umbigo/patologia , Neoplasias Abdominais/diagnóstico , Neoplasias Abdominais/secundário , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Adulto , Idoso de 80 Anos ou mais , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Primárias Desconhecidas/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Nódulo da Irmã Maria José/patologiaRESUMO
Mycobacterium kansasii most commonly causes a slowly progressive pulmonary disease. Skin and disseminated infections are seen less frequently and only in immunocompromised hosts. To our knowledge, no case of Mycobacterium kansasii infection or skin infection associated with additional organ involvement in an immunocompetent patient has been reported.
Assuntos
Linfadenite/diagnóstico , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium kansasii/isolamento & purificação , Dermatopatias Infecciosas/diagnóstico , Idoso , Biópsia , Feminino , Humanos , Imunocompetência , Linfadenite/microbiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Pele/microbiologia , Pele/patologia , Dermatopatias Infecciosas/microbiologiaRESUMO
INTRODUCTION: Eccrine sweat gland carcinoma, which belongs to the eccrine sweat gland carcinoma family, is a rare malignancy of the skin with a potential aggressive growth and metastatic spread. EXEGESIS: We report here a case of malignant eccrine poroma arising on the upper leg, with widespread pulmonary metastases. CONCLUSION: A brief synopsis of the pathological and clinical aspects of eccrine sweat gland carcinoma is presented with the currently available therapies.
Assuntos
Acrospiroma/patologia , Carcinoma de Células Escamosas/secundário , Glândulas Écrinas/patologia , Neoplasias Pulmonares/secundário , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , PrognósticoRESUMO
We report the first case of recurrent hepatitis secondary to a pituitary macroadenoma in a 55-year old man. Liver ischemia is thought to be the main consequence of episodes of acute adrenal insufficiency. Sudden acute adrenal insufficiency was due to enlargement of the sella content secondary to several microhemorrhages in the macroadenoma.
Assuntos
Adenoma/complicações , Hepatite/etiologia , Isquemia/etiologia , Fígado/irrigação sanguínea , Neoplasias Hipofisárias/complicações , Doença Aguda , Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Transaminases/sangueRESUMO
INTRODUCTION: The authors report the case of a patient who presented for 4 years recurrent anterior uveitis accompanied by asymptomatic tuberculous mediastinal lymphadenitis. EXEGESIS: CT scan of the chest showed the existence of mediastinal lymphadenopathy (< 1 cm). Mediastinoscopy with biopsy of the right laterotracheal lymph node was performed. The culture was positive for Mycobacterium tuberculosis, thus permitting the diagnosis of tuberculosis. CONCLUSION: This case report stresses the advantage of extensive etiological assessment when faced with unexplained uveitis; particularly it emphasizes the importance of investigating potential tuberculosis. The existence of granulomatous uveitis, a positive skin test, the ethnic origin, and mostly results of chest CT scan, were the rationale for the use of mediastinoscopy with lymph node biopsy to help guide diagnosis.
Assuntos
Doenças do Mediastino/diagnóstico , Mediastinoscopia , Tuberculose dos Linfonodos/diagnóstico , Uveíte/microbiologia , Adulto , Feminino , Humanos , Doenças do Mediastino/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Recidiva , Tuberculose dos Linfonodos/microbiologia , Uveíte/etiologiaAssuntos
Adenoma/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Adenoma/enzimologia , Adenoma/patologia , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Diagnóstico Diferencial , Hepatite Viral Humana/sangue , Hepatite Viral Humana/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/enzimologia , Neoplasias Hipofisárias/patologia , RecidivaRESUMO
Turner's syndrome is an ovarian dysgenesis (karyotype 45 X0) characterized by sexual infantilism and multiple malformations. Liver enzyme anomalies are often observed, but the underlying pathogenic mechanism remains unknown. Nodular regenerative hyperplasia of the liver is associated with another disease in about 80% of cases. However, these two diseases have only been reported together in one woman. We describe here a second case of this association "Turner's syndrome and nodular regenerative hyperplasia". We think that women with Turner's syndrome should benefit from screening for nodular regenerative hyperplasia by searching for elevated liver enzymes. This easily applicable screening protocol would provide early diagnostic of nodular regenerative hyperplasia and allow early and effective treatment of portal hypertension. Moreover, this approach would improve our knowledge of this association.
Assuntos
Nefropatias/genética , Regeneração Hepática/genética , Síndrome de Turner/genética , Adulto , Feminino , Testes Genéticos , Humanos , Hiperplasia , Nefropatias/diagnóstico , Fígado/patologia , Testes de Função Hepática , Síndrome de Turner/diagnósticoRESUMO
We report the case of a 26 year-old woman who developed acquired hemophilia secondary to factor VIII inhibitors, two months after a normal pregnancy. The initial hemorrhagic event was a spontaneous deep muscular hematoma mimicking a deep venous thrombosis. This observation was marqued by the apparition of antibodies against porcin factor VIII under treatment by porcin factor VIII. Intravenous immunoglobulin was ineffective, then cyclophosphamide was necessary to control the disease.
Assuntos
Acenocumarol/efeitos adversos , Anticoagulantes/efeitos adversos , Fator VIII/antagonistas & inibidores , Hemofilia A/induzido quimicamente , Heparina/efeitos adversos , Transtornos Puerperais/induzido quimicamente , Acenocumarol/administração & dosagem , Adulto , Anticoagulantes/administração & dosagem , Testes de Coagulação Sanguínea , Diagnóstico Diferencial , Feminino , Hemofilia A/sangue , Heparina/administração & dosagem , Humanos , Gravidez , Transtornos Puerperais/sangue , RecidivaAssuntos
Neoplasias da Mama/complicações , Transtornos da Motilidade Esofágica/etiologia , Fasciite/etiologia , Síndromes Paraneoplásicas/fisiopatologia , Idoso , Antineoplásicos/uso terapêutico , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Diagnóstico Diferencial , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/tratamento farmacológico , Acalasia Esofágica/etiologia , Transtornos da Motilidade Esofágica/diagnóstico , Transtornos da Motilidade Esofágica/tratamento farmacológico , Fasciite/diagnóstico , Feminino , Mãos , Humanos , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/tratamento farmacológicoRESUMO
In most cases, the treatment of adult's Still disease presents difficulties, in view of its undesirable side-effects. For this reason, we made an open trial of the effects of high-dose intravenous immunoglobulins (IVIg), a therapy with low iatrogen risk, and whose effectiveness in the treatment of other multisystemic diseases has been acknowledged. Seven patients suffering from adult Still's disease were given between one and eight IVIg infusions with a dose of 1 g/kg/day for two consecutive days. All seven responded positively, with clinical improvement. It lasted between 1 and 90 days in three patients, who subsequently relapsed; it has been continuing for an average of 13 months (2 to 24 months) in the other four patients. There were no clinical features making it possible to distinguish, after the trial, the patients who responded positively to intravenous immunoglobulins. This data, which needs to be confirmed with a controlled trial, provides hope of improved therapy for the one half of patients suffering from adult Still's disease who respond positively to intravenous immunoglobulins.