RESUMO
In vitro susceptibility of 933 Candida isolates, from 16 French hospitals, to micafungin was determined using the Etest in each center. All isolates were then sent to a single center for determination of MICs by the EUCAST reference method. Overall essential agreement between the two tests was 98.5% at ±2 log2 dilutions and 90.2% at ±1 log2 dilutions. Categorical agreement was 98.2%. The Etest is a valuable alternative to EUCAST for the routine determination of micafungin MICs in medical mycology laboratories.
Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Equinocandinas/farmacologia , Lipopeptídeos/farmacologia , Candida/genética , Farmacorresistência Fúngica/genética , Micafungina , Testes de Sensibilidade MicrobianaRESUMO
The purpose of this investigation was to characterize the management and prognosis of severe Pneumocystis jirovecii pneumonia (PJP) in human immunodeficiency virus (HIV)-negative patients. An observational cohort study of HIV-negative adults with PJP documented by bronchoalveolar lavage (BAL) through Gomori-Grocott staining or immunofluorescence, admitted to one intensive care unit (ICU) for acute respiratory failure, was undertaken. From 1990 to 2010, 70 patients (24 females, 46 males) were included, with a mean age of 58.6 ± 18.3 years. The mean Simplified Acute Physiology Score (SAPS)-II was 36.9 ± 20.4. Underlying conditions included hematologic malignancies (n = 21), vasculitis (n = 13), and solid tumors (n = 13). Most patients were receiving systemic corticosteroids (n = 63) and cytotoxic drugs (n = 51). Not a single patient received trimethoprim-sulfamethoxazole as PJP prophylaxis. Endotracheal intubation (ETI) was required in 42 patients (60.0 %), including 38 with acute respiratory distress syndrome (ARDS). In-ICU mortality was 52.9 % overall, reaching 80.9 % and 86.8 %, respectively, for patients who required ETI and for patients with ARDS. In the univariate analysis, in-ICU mortality was associated with SAPS-II (p = 0.0131), ARDS (p < 0.0001), shock (p < 0.0001), and herpes simplex virus (HSV) or cytomegalovirus (CMV) on BAL (p = 0.0031). In the multivariate analysis, only ARDS was associated with in-ICU mortality (odds ratio [OR] 23.4 [4.5-121.9], p < 0.0001). PJP in non-HIV patients remains a serious disease with high in-hospital mortality. Pulmonary co-infection with HSV or CMV may contribute to fatal outcome.
Assuntos
Coinfecção/mortalidade , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/mortalidade , Herpes Simples/complicações , Herpes Simples/mortalidade , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/mortalidade , Idoso , Líquido da Lavagem Broncoalveolar/virologia , Estudos de Coortes , Citomegalovirus/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Simplexvirus/isolamento & purificaçãoRESUMO
Merkel cell carcinoma (MCC) are rare neuroendocrine malignant tumor of the skin, occurring in elderly patients. It affects primarily the sun-exposed areas of the skin, with approximately 50% of all tumors occurring in the face and neck and 40% in the extremities. Immunohistochemical markers (CK20+, CK7- and TTF1-) are used to distinguish between MCC and other tumors. MCC have a tendency to rapid local progression, frequent spread to regional lymph nodes and distant metastases. Due to the rarity of the disease, the optimal treatment has not been fully defined. Localized stages (stages I and II) are treated by surgical excision of the primary tumor (with 2 to 3 cm margin) and lymphadenectomy in case of node-positive disease, followed by external beam radiotherapy (EBRT) to a total dose of 50 to 60Gy in the tumor bed. Adjuvant EBRT has been shown to decrease markedly locoregional recurrences and to increase survival in recent studies. Treatment of lymph nodes area is more controversial. Chemotherapy is recommended only for metastatic disease.
Assuntos
Carcinoma de Célula de Merkel/radioterapia , Neoplasias Cutâneas/radioterapia , Carcinoma de Célula de Merkel/patologia , Carcinoma de Célula de Merkel/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Resultado do TratamentoRESUMO
In Senegal, tick-borne relapsing fever caused by the spirochetes Borrelia crucidurae is the most common cause of fever after malaria in rural areas. However, this is only rarely diagnosed in France, probably because: i) the diagnosis relies on investigations that are not routinely done; ii) even undiagnosed, borreliosis may be cured with empirical antibiotic treatment. We report four observations of tick-borne relapsing fever in patients returning from Senegal: In two patients, the diagnosis relied on the observation of spirochetes in blood smears; in the other two, the diagnosis relied on typical clinico-biological signs, borreliosis serology and exposure. These four cases diagnosed over a four year period in one institution suggest that relapsing fever is not rare in patients returning from West Africa. Patients who return form Senegal with unexplained fever should be investigated with careful examination of blood smears and PCR on blood samples.
Assuntos
Infecções por Borrelia/microbiologia , Doenças Transmitidas por Carrapatos/microbiologia , Adulto , Amoxicilina/administração & dosagem , Amoxicilina/uso terapêutico , Animais , Antibacterianos/uso terapêutico , Infecções por Borrelia/patologia , Feminino , Humanos , Injeções Intravenosas , Plasmodium/isolamento & purificação , Recidiva , Senegal , Doenças Transmitidas por Carrapatos/patologia , Carrapatos/microbiologia , Viagem , Resultado do TratamentoRESUMO
BACKGROUND: Invasive aspergillosis is an opportunistic infection that occurs mainly among patients with prolonged neutropenia. Few data are available on invasive aspergillosis in nonneutropenic patients. METHODS: The aim of this survey was to compare neutropenic and nonneutropenic patients who had received a diagnosis of invasive aspergillosis at our institution during a 6-year period. RESULTS: Among the 88 cases of invasive aspergillosis analyzed here, 12 were histologically proven, 52 were probable, and 24 were possible. Forty-seven percent of cases were diagnosed in the intensive care unit, and 40% were diagnosed in hematology units. Neutropenia was a risk factor for 52 patients (59%), most of whom had hematological or solid malignancies. Among the 36 nonneutropenic patients (41%), the main underlying conditions were steroid-treated chronic obstructive pulmonary disease, asthma, rheumatoid arthritis, giant-cell arteritis, and microvascular disorders; 10 patients were recipients of solid-organ transplants, and 1 patient was seropositive for human immunodeficiency virus. The distribution of proven and probable invasive aspergillosis was similar for neutropenic and nonneutropenic patients. The mortality rate was 71.5% overall and was significantly higher among nonneutropenic patients than among neutropenic patients (89% vs. 60%; P<.05). Compared with neutropenic patients, nonneutropenic patients were significantly less likely to have symptoms of invasive aspergillosis and more likely to have frequent intercurrent pneumonia due to another microorganism. The sensitivity of mycological examination of bronchoalveolar lavage fluid specimens was higher for nonneutropenic patients than for neutropenic patients (85% vs. 58%; P<.05), whereas the sensitivity of antigenemia was the same for the 2 populations (65% vs. 64%). Findings on thoracic computed tomographs were similar, except that segmental areas of consolidation occurred more frequently among neutropenic patients. CONCLUSION: This survey at a whole institution underlines the high number of cases of invasive aspergillosis among nonneutropenic patients, with an overall mortality rate that was significantly higher than that for neutropenic patients.
Assuntos
Aspergilose/epidemiologia , Aspergilose/patologia , Neutropenia/complicações , Adolescente , Adulto , Idoso , Anticorpos Antifúngicos/sangue , Antifúngicos/uso terapêutico , Antígenos de Fungos/sangue , Aspergilose/complicações , Aspergilose/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Cryptococcal infections are frequent in HIV-infected patients and are regularly looked after. This infection may occur in others immunosuppressives situations and, in those cases, diagnosis is often delayed. METHODS: We report four cases of cryptococcal infections in patients whose immunosuppression isn't related with HIV infection but due to chronic lymphocytic leukemia, giant cell temporal arteritis, gastric neoplasm and lupus. Diagnosis, prognostic and treatment are detailed. RESULTS: Four patients aged from 25 to 76 presented a cryptococcal infection (three meningitis). A woman died at the admission. Another died seven years later. The two others are still alive under treatment. When infected, all patients were immunodeficiency. CONCLUSION: Cryptococcal infection may occur in patients non-HIV-infected patients. Early detection is needed to improve prognostic.
Assuntos
Soronegatividade para HIV , Hospedeiro Imunocomprometido , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/etiologia , Adulto , Idoso , Feminino , Arterite de Células Gigantes/complicações , Humanos , Leucemia Linfocítica Crônica de Células B/complicações , Lúpus Vulgar/complicações , Masculino , Meningite Criptocócica/mortalidade , Meningite Criptocócica/terapia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/complicaçõesRESUMO
The sources of exposure during diseases due to Aspergillus fungi in cystic fibrosis patients are still poorly explored. We assessed home fungal exposure in patients suffering from cystic fibrosis and analysed its impact on the presence of Aspergillus biological markers, the colonisation of airways, as well as the sensitization and Aspergillus serology. Between March 2012 and August 2012, 34 patients benefited from a visit performed by a home environment medical adviser including sampling for mycological analysis. The number of colonies of Aspergillus was not significantly different in the various sampling sites (P=0.251), but the number of non-Aspergillus colonies was much higher in the kitchen (P=0.0045). Subsequently, home fungal exposure was compared between the groups "absence of Aspergillus-related markers" and "presence of Aspergillus-related markers". Home exposure to Aspergillus (P=0.453) and non-Aspergillus (P=0.972) flora was not significant between the 2 groups. Within this series of 34 patients that should be expanded, we note an absence of clear relationship between home exposure and the Aspergillus-linked markers in patients suffering from cystic fibrosis. This result should be taken into account regarding too restrictive hygiene advices provided to families, given the fact that fungal exposure can also results from activities performed away from home.
Assuntos
Poluição do Ar em Ambientes Fechados/análise , Aspergillus/isolamento & purificação , Fibrose Cística/microbiologia , Fungos/isolamento & purificação , Adolescente , Adulto , Microbiologia do Ar , Criança , Pré-Escolar , Fibrose Cística/complicações , Fibrose Cística/epidemiologia , Feminino , França/epidemiologia , Fungos/classificação , Humanos , Masculino , Exposição Ocupacional/análise , Aspergilose Pulmonar/epidemiologia , Aspergilose Pulmonar/microbiologia , Características de Residência , Adulto JovemRESUMO
During a 15-day period, 7 premature infants hospitalized in a neonatal intensive care unit presented with sepsis caused by Candida albicans. The local environment and hands of all 54 persons involved in the intensive care unit were examined for the presence of this organism. Five techniques were used in the analysis of the isolates recovered from blood cultures of the children, the hands of personnel and 10 control isolates. The methods used were serotype determination, genetic fingerprinting, morphotyping, resistotyping and killer yeast typing. Morphotyping and genetic fingerprinting proved to be the most discriminatory techniques, and only combined analysis of the results obtained with these various methods allowed the source of the outbreak to be identified. An isolate from the hands of a healthy staff member and isolates from infected children all belonged to the same strain.
Assuntos
Candida albicans/classificação , Candidíase/transmissão , Infecção Hospitalar/microbiologia , Impressões Digitais de DNA , Doenças do Prematuro/microbiologia , Adulto , Candida albicans/isolamento & purificação , Candidíase/epidemiologia , Infecção Hospitalar/epidemiologia , Feminino , França , Pessoal de Saúde , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Unidades de Terapia Intensiva Neonatal , Masculino , Técnicas de Tipagem Micológica , SorotipagemRESUMO
Invasive pulmonary aspergillosis (IPA) is an increasing cause of morbidity and mortality in patients with hematologic malignancies. A major program of construction work close to our unit prompted us to evaluate the efficacy of itraconazole prophylaxis in preventing IPA in these patients. During September 1994 to December 1995, 77 patients undergoing 96 neutropenic episodes (mean duration, 19.3 days +/- 9.1) received itraconazole as antifungal prophylaxis. All patients were treated in laminar air flow rooms. Itraconazole was administered at a loading dose of 600mg/d, (day 1 to day 3) and 400mg/d on the following days, in 87 instances. In the remaining episodes, the daily dose was 200 or 400mg. Oral doses were adjusted to reach a plasma itraconazole level (PIL) above 1000ng/l. In cases of inadequate PIL or poor oral intake, IV AmphoB was started at a 20 mg daily dose. Five cases of IPA (proven n = 2, probable n = 3) were observed. This represents an incidence of 5.2% of the total number of episodes. One out of 67 (2%) treatment episodes with adequate PIL were associated with IPA as compared to 4 of 29 (14%) episodes with inadequate PIL, (p < 0.02). AmphoB was added in 28 cases because of low PIL (n = 25), and/or antibiotic-resistant fever persistent pulmonary infiltrate (n = 8). These results need to be interpreted with caution, because of the absence of randomization or a control group. The efficacy of Itraconazole in neutropenic patients with high risk IPA has to be confirmed on larger and prospective studies.
Assuntos
Antifúngicos/uso terapêutico , Aspergilose Broncopulmonar Alérgica/prevenção & controle , Itraconazol/uso terapêutico , Neutropenia/complicações , Adulto , Aspergilose Broncopulmonar Alérgica/complicações , Aspergilose Broncopulmonar Alérgica/epidemiologia , Monitoramento de Medicamentos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
UNLABELLED: Reduction mammaplasty (RM) can be performed during adolescence if the functional capacity of the breast is preserved. Future breast feeding must be carefully considered in the therapeutic decision making process. PURPOSE OF THE STUDY: Breast feeding after reduction mammaplasty performed during adolescence was assessed to determine surgical factors influencing outcome and patient reception of information concerning breast feeding. METHODS: A questionnaire was sent to 109 women who had undergone reduction mammaplasty between 1981 and 1997 when they were 15-17 years old to ascertain their reasons for having surgery, their satisfaction, and their attitude towards breast feeding. RESULTS: Sixty-five questionnaires (60%) could be analyzed. Mean delay since surgery was 8.1 years. Seventeen women (26%) had delivered 25 infants (mean 1.5). Mean delay after surgery to first delivery was 7.68 years. Five women (29%) nursed their first infant for a mean 11.3 days. None of the women interrupted breast feeding for a reason related to a nipple anomaly or difficult sucking. Twelve women (71%) did not nurse their first infant, because of the prior breast surgery for six of them. Among the 48 nulliparous women, 24 (50%) stated they would nurse their future infant. Although information on breast feeding was systematically delivered, 41 women (63%) stated they had not been informed. There was no statistical relationship between breast feeding and degree of satisfaction, patient-assessed scar quality, or nipple disorders. CONCLUSION: Adolescents who undergo reduction mammaplasty can nurse their future infants with a complication rate similar to that in the general population. Special attention must be given to delivery of information on breast feeding.
Assuntos
Aleitamento Materno , Mamoplastia , Adulto , Feminino , Humanos , Educação de Pacientes como Assunto , Satisfação do Paciente , Inquéritos e QuestionáriosRESUMO
To estimate the rate of infectious diseases and the efficiency of medical care in our hospital, we conducted a prevalence survey of both infections and antibiotic use on 588 inpatients. Results showed that 125 patients (21% of the total) had infections; of these, 56 had nosocomial infections. A third of the patients had been receiving antimicrobial drugs; among them, 30% were receiving the drugs for prophylactic reasons. A misuse in the prophylaxis of infections was determined, particularly in the duration of treatment. The study demonstrated that an effective infection-control program and an antibiotic policy are required in our hospital.
Assuntos
Antibacterianos/uso terapêutico , Infecções/epidemiologia , Técnicas Bacteriológicas , Infecção Hospitalar/prevenção & controle , Uso de Medicamentos , França , Hospitais Gerais , Humanos , Controle de Infecções , Infecções/tratamento farmacológicoAssuntos
Criptococose/diagnóstico , Cryptococcus neoformans , Otopatias/microbiologia , Fluconazol/uso terapêutico , Úlcera Cutânea/microbiologia , Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Criptococose/patologia , Criptococose/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/patologia , Úlcera Cutânea/terapiaAssuntos
Criptococose , Dermatomicoses , Transplante de Rim , Transplante de Fígado , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Dermatomicoses/diagnóstico , Dermatomicoses/tratamento farmacológico , Fluconazol/administração & dosagem , Fluconazol/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Expression of survivin, a member of the inhibitor of apoptosis protein family, is elevated in human cancers and considered as a new therapeutic target. Mechanism upregulating survivin expression in tumour cells is poorly understood. In this study, we show that breast cancer patients harbouring a polymorphism G235A in the survivin promoter present a higher level of survivin expression. This polymorphism creates a binding site for the transcription factor GATA-1 inducing a second GATA-1-binding site in survivin promoter. At the mRNA level, GATA-1 was present in breast carcinomas and adjacent normal tissues, whereas the protein was only detected in carcinomas by western blot and immunohistochemistry. Transfection of wild-type and different constitutively active GATA-1 mutants (serine 26, 178 or 310) showed that only phospho-serine 26 GATA-1 was able to increase survivin expression. This increase was higher in G235A than in G235G cell lines. Phospho-serine 26 GATA-1 bound directly survivin promoter, with a stronger interaction in G235A than in G235G polymorphism indicating that both GATA-1-binding sites are functional. These data identify GATA-1 as a key feature in tumour aggressiveness by enhancing survivin expression and delineate its targeting as a possible new therapeutic strategy in breast carcinomas.
Assuntos
Neoplasias da Mama/genética , Fator de Transcrição GATA1/fisiologia , Proteínas Associadas aos Microtúbulos/genética , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas , Sítios de Ligação , Neoplasias da Mama/química , Linhagem Celular Tumoral , Feminino , Humanos , Proteínas Inibidoras de Apoptose , Fosforilação , Survivina , Regulação para CimaRESUMO
In the field of ophthalmology, indications for high-dose corticotherapy are various. This paper reports the case of a Caledonian man who presented with intestinal strongyloidiasis, discovered 25 years after he had left the endemic area. A checkup before corticotherapy for traumatic retina edema provided the diagnosis of the infection. The authors emphasize the importance of searching for Strongyloidiasis stercoralis larva before initiating corticotherapy, as it is the main treatment responsible for parasitic dissemination. The most severe form of strongyloidiasis, the disseminated form, has a high mortality rate: 70%-90%. The definitive diagnostic test is enhanced larva recovery, which should be proposed to every patient returning from endemic area, people with precarious hygiene or with high eosinophilia or intestinal symptoms of chronic infection. Delay in diagnosing strongyloidiasis frequently results in death, despite vigorous treatment.
Assuntos
Corticosteroides/efeitos adversos , Papiledema/tratamento farmacológico , Strongyloides stercoralis , Estrongiloidíase/diagnóstico , Adulto , Animais , Humanos , Enteropatias/parasitologia , Masculino , RecidivaRESUMO
The problem of the human Simuliidosis (caused by black flies) is reviewed for the France: important and, perhaps, relatively recent increase from the known human attacks by black flies. Countries and anthropophilic species are cited.
Assuntos
Doenças Parasitárias/história , Simuliidae , Animais , França/epidemiologia , História do Século XIX , História do Século XX , Humanos , Doenças Parasitárias/epidemiologia , Simuliidae/classificaçãoRESUMO
Second observation of this black-fly in human simuliidosis. The country is the department of Vaucluse.
Assuntos
Simuliidae/patogenicidade , Animais , França , HumanosRESUMO
Melanoma treatment is based on surgery. In metastatic cases, vaccine therapy has been recently developed to overcome T cell or dendritic cell dysfunction. HLA tetramerbased assays are useful for immunologic monitoring of this trial and to quantitate CD8+ specific lymphocytes. In the present work, we used tetrameric technology to detect expanded populations of tumor specific CD8+ Tcells specific of Melan-A/Mart-1 Antigen have been quantified using flow cytometry. The feasibility of routinely detection of 0,1% +/- 0,03 of CD8 T cells has been demonstrated, without any difference the levels observed before and after (day 30) surgery. The value of experimentation of these cells should be determined in clinic and particularly to analyze surgical practice.
Assuntos
Antígenos CD8/imunologia , Antígeno HLA-A2/imunologia , Melanoma , Proteínas de Neoplasias/metabolismo , Neoplasias Cutâneas , Adulto , Idoso , Antígenos de Neoplasias , Feminino , Humanos , Antígeno MART-1 , Masculino , Melanoma/imunologia , Melanoma/metabolismo , Melanoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/cirurgiaRESUMO
UNLABELLED: Reduction mammaplasty has now become routine surgery with good results in middle-aged women. However the scars it leaves, its psychological and functional (breastfeeding) impact could limited its indications in teenage girls. AIM: The purpose of our study was to report the long-term results of reduction mammaplasty in teenage girls and to assess their consequences. MATERIAL AND METHODS: We conducted a retrospective study of 65 reduction mammaplasty carried out between 1981 and 1997 in 15 to 17 years old girls. The study was based on data in their medical records and answers to a questionnaire which was sent to each patient. RESULTS: Average followup was 8.1 years. The reduction technique with superior pedicle were mainly used. Average breast tissue excised was 1050 g. Minor complications occurred in three cases. Eleven revisions had to be carried out with 1.6 years on average after primary surgery. The psychological and functional complaints observed preoperatively disappeared in more than 90% of the cases. In over 80% of the cases the patients were pleased or very pleased with the shape, the volume kept and the symmetry. Scars were well accepted in 83% of the cases. Seventeen women were given birth to 25 children. Five of whom breast-fed their babies, while six refused because of their breast surgery history. Although information about breast-feeding after such surgery is systematically given, 41 women claimed they had not received it. CONCLUSION: Reduction mammaplasty is reliable in teenage girls. Patients are generally satisfied and the remaining scar is well accepted. Breast-feeding is possible after this surgery and information on that point ought to be better developed.
Assuntos
Mama/patologia , Mama/cirurgia , Mamoplastia , Adolescente , Humanos , Hipertrofia/cirurgia , Estudos Retrospectivos , Fatores de TempoRESUMO
Cutis laxa (CL) is a rare disorder in which the skin hangs in loose fields, so that affected individuals appear to be prematurely aged. The changes are more evident when effect the face with a prematurely-aged appearance. The acute form follows an inflammatory skin lesions. Its aetiology is not well known. We report a case of a head acute CL of a 17 years patient, secondary to a generalized skin eruption. The prematurely-aged appearance concern especially forehead, ear lobes and nasolabial folds. A two stages surgical treatment has associated: a forehead lifting associated to a Coleman lipofilling and an ear lobe reduction, a secondary Coleman lipofilling of the nasolabial folds. The skin biopsy confirm the diagnosis. The correction is stable and satisfactory after one year. The confrontation of our findings to those previously described confirm complexity of diagnosis and histological observations of this rare disorder.