RESUMO
Scedosporium apiospermum is an ubiquitous fungus responsible for various infections in immunocompromised and immunocompetent patients. Ear infections are infrequent. We report an exceptional case of S. apiospermum external otitis complicated by temporomandibular joint arthritis. After 6 months of antibiotherapy, diagnosis was established by mycological analysis of external auditory canal and infratemporal fossae needle sampling. A satisfactory outcome was obtained after 2 months of voriconazole alone. We have reviewed 15 cases of S. apiospermum otitis. Seven of these patients were immunocompromised. Most common clinical presentation included a chronic external otitis lasting months or years before complication stage. Most common clinical features included recurrent unilateral otalgia (11/15) and purulent otorrhea (13/15). Diagnosis was often made at later stage (12/15) with local extension to bones and/or soft tissues (9/15) or cerebral lethal dissemination (3/15).The extremely low incidence of S. apiospermum otomycosis and its non-specific presentation results in a frequent diagnosis delay. A mycological investigation should be performed in case of persistent external otitis and/or osteolysis despite prolonged antibiotic treatment to prevent further extension of the disease.
Assuntos
Artrite/etiologia , Micoses/diagnóstico , Otite Externa/diagnóstico , Scedosporium/isolamento & purificação , Transtornos da Articulação Temporomandibular/diagnóstico , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Artrite/microbiologia , Artrite/patologia , Cabeça/diagnóstico por imagem , Humanos , Masculino , Micoses/microbiologia , Micoses/patologia , Otite Externa/complicações , Otite Externa/microbiologia , Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/microbiologia , Transtornos da Articulação Temporomandibular/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Voriconazol/uso terapêuticoRESUMO
Due to large outbreaks observed worldwide, Candida auris has emerged as a major threat to healthcare facilities. To prevent these phenomena, a systematic screening should be performed in patients transferred from regions where the pathogen is highly endemic. In this study, we recorded and analyzed French mycologists' current knowledge and practice regarding C. auris screening and diagnosis. Thirty-six centers answered an online questionnaire. Only 11 (30.6 %) participants were aware of any systematic screening for C. auris for patients admitted to their hospital. In the case of post-admission screening, axillae/groins (n = 21), nares (n = 7), rectum (n = 9), and mouth (n = 6) alone or various combinations were the body sites the most frequently sampled. Only six centers (8.3 %) reported using a commercially available plate allowing the differentiation of C. auris colonies from that of other Candida species, while five laboratories (13.8 %) had implemented a C. auris-specific qPCR. Considering the potential impact on infected patients and the risk of disorganization in the care of patients, it is crucial to remember to biologists and clinicians the utmost importance of systematic screening on admission.
RESUMO
A survey of mycology laboratories for antifungal susceptibility testing (AFST) was undertaken in France in 2018, to better understand the difference in practices between the participating centers and to identify the difficulties they may encounter as well as eventual gaps with published standards and guidelines. The survey captured information from 45 mycology laboratories in France on how they perform AFST (number of strains tested, preferred method, technical and quality aspects, interpretation of the MIC values, reading and interpretation difficulties). Results indicated that 86% of respondents used Etest as AFST method, with a combination of one to seven antifungal agents tested. Most of the participating laboratories used similar technical parameters to perform their AFST method and a large majority used, as recommended, internal and external quality assessments. Almost all the participating mycology laboratories (98%) reported difficulties to interpret the MIC values, especially when no clinical breakpoints are available. The survey highlighted that the current AFST practices in France need homogenization, particularly for MIC reading and interpretation.
Assuntos
Antifúngicos/uso terapêutico , Laboratórios , Testes de Sensibilidade Microbiana , Micologia , Prática Profissional/estatística & dados numéricos , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão/métodos , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão/normas , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão/estatística & dados numéricos , Farmacorresistência Fúngica , França , História do Século XXI , Humanos , Laboratórios/normas , Laboratórios/estatística & dados numéricos , Ensaio de Proficiência Laboratorial/métodos , Ensaio de Proficiência Laboratorial/estatística & dados numéricos , Testes de Sensibilidade Microbiana/métodos , Testes de Sensibilidade Microbiana/normas , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Micologia/história , Micologia/métodos , Micologia/normas , Micologia/estatística & dados numéricos , Prática Profissional/normas , Controle de Qualidade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Twenty-five patients, of whom 22 were renal transplant recipients, developed Pneumocystis jirovecii infections at the nephrology department of Reims University Hospital (France) from September 2008 to October 2009, whereas only four sporadic cases had been diagnosed in this department over the 14 previous years. AIM: This outbreak was investigated by analysing patient encounters and P. jirovecii types. METHODS: A transmission map was drawn up. P. jirovecii typing at DHPS, ITS and mtLSU rRNA sequences was performed in the patients of the cluster (18 patients with Pneumocystis pneumonia (PCP) and seven colonized patients), 10 unlinked control patients (six PCP patients and four colonized patients), as well as 23 other patients diagnosed with P. jirovecii (nine PCP patients and 14 colonized patients) in the same department over a three-year post-epidemic period. FINDINGS: Eleven encounters between patients harbouring the same types were observed. Three PCP patients and one colonized patient were considered as possible index cases. The most frequent types in the cluster group and the control group were identical. However, their frequency was significantly higher in the first than in the second group (P < 0.01). Identical types were also identified in the post-epidemic group, suggesting a second outbreak due to the same strain, contemporary to a disruption in prevention measures. CONCLUSIONS: These results provide additional data on the role of both PCP and colonized patients as infectious sources. Longitudinal screening of P. jirovecii types in infected patients, including colonized patients, is required in the investigation of the fungus's circulation within hospitals.
Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Genótipo , Infecções por Pneumocystis/epidemiologia , Pneumocystis carinii/classificação , Pneumocystis carinii/isolamento & purificação , Idoso , Análise por Conglomerados , Infecção Hospitalar/transmissão , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Transmissão de Doença Infecciosa , Feminino , França/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Epidemiologia Molecular , Filogenia , Infecções por Pneumocystis/transmissão , Pneumocystis carinii/genética , Análise de Sequência de DNA , Adulto JovemRESUMO
We report on a case of loiasis revealed during an assisted reproductive technology (ART) cycle. Loa loa could limit implantation outcome. We propose to focus on an ART strategy with frozen embryos to treat the patient before any transfer.
RESUMO
Frog photoreceptor membranes contain 54,000 g of protein per mole of visual pigment chromophore, virtually all of it insoluble membrane protein. Acrylamide gel electrophoresis indicates one major polypeptide class, most likely the visual pigment apoprotein. Suspensions of these photoreceptor membranes accumulate calcium ions when ATP is present, a characteristic that may play a part in visual excitation.
Assuntos
Membranas/análise , Células Fotorreceptoras/análise , Adenosina Trifosfatases/análise , Aminoácidos/análise , Animais , Anuros , Cálcio/análise , Cálcio/metabolismo , Isótopos de Cálcio , Eletroforese Descontínua , Membranas/enzimologia , Membranas/metabolismo , Células Fotorreceptoras/enzimologia , Células Fotorreceptoras/metabolismo , Rana catesbeiana , Pigmentos da Retina/análise , EspectrofotometriaRESUMO
INTRODUCTION: Surgical resection of cardial and subcardial cancers is often associated with pathological involvement of esophageal section margin, resulting in early anastomotic recurrences. Total gastrectomy associated with partial esophagectomy through combined abdominal and right thoracic approach allows esophageal section under azygos vein. PATIENTS AND METHODS: We studied, in 17 patients operated on using this procedure, post-operative morbidity, mortality and anastomotic relapse. RESULTS: No post-operative death, fistula or anastomotic relapse have been observed. Two patients exhibited benign infectious post-operative complication. CONCLUSION: Total gastrectomy with partial esophagectomy through combined abdominal and right thoracic approach seems therefore to be considered as a good alternative in the surgical management of cardial and subcardial carcinomas.
Assuntos
Adenocarcinoma/cirurgia , Cárdia , Esofagectomia , Gastrectomia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/mortalidade , Feminino , Humanos , Laparotomia , Excisão de Linfonodo , Masculino , Neoplasias Gástricas/mortalidade , Análise de Sobrevida , Toracotomia , Fatores de TempoRESUMO
Acquired jejuno-ileal diverticulosis are rare (0.1 to 1.4%) but their complications are non exceptional (6 to 13%) with a death rate which can reach 40% in older patients. From a histological view, acquired diverticulosis differ from congenital ones by an absent muscular tunic. Complications consist in, by descending order: diverticulitis, perforation (7%), acute bowel obstruction (3%), intestinal hemorrhage (2.7%) mostly massive, malabsorption of fat, protein, macrocytic anaemia, intestinal tumors same as found in small, bowel. The treatment of small bowel diverticulosis becomes surgical only when complicated. It consists in the strict resection of the complicated diverticulosis area, respecting the asymptomatic diverticulosis. Prophylaxis of the complications is based on healthy diet habits against stasis, bowel pressure using antispasmodics, intestinal disinfectants, residue free diet, and against infection (oral tetracyclines).
Assuntos
Divertículo , Doenças do Íleo , Doenças do Jejuno , Adulto , Idoso , Autopsia , Divertículo/diagnóstico por imagem , Divertículo/patologia , Divertículo/cirurgia , Feminino , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/patologia , Doenças do Íleo/cirurgia , Íleo/patologia , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/patologia , Doenças do Jejuno/cirurgia , Jejuno/patologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
The authors report two cases of the Shulman's syndrome. Twenty one cases of this new entity are found in the literature. The main signs are the acute painful onset after an unusual physical exertion, the development of fasciitis, and (or) myositis, and (or) scleroderma of limbs, the absence of Raynaud's phenomenon, visceral involvement, constant eosinophilia and hypergammaglobulinemia; the prognosis is good with an improvement sometimes spontaneous or coincident with prednisone therapy. One of the observations is interesting by the association with Gougerot-Sjogren's syndrome, and a familial case of morphea. The prognosis in this case is mediocre: failure of corticotherapy, and incomplete remission with cyclophosphamide.
Assuntos
Eosinofilia/complicações , Fáscia , Hipergamaglobulinemia/complicações , Miosite/complicações , Escleroderma Sistêmico , Humanos , Masculino , Pessoa de Meia-Idade , Músculos/patologia , Escleroderma Sistêmico/classificação , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/patologia , Pele/patologia , SíndromeRESUMO
The authors report an unusual case of chronic sarcoidosis with skin ulcerations and atrophic lesions simulating Pick-Herxheimer's disease. Other severe manifestations are found: cardiac involvement with conduction disturbances and myocardial failure, and muscular involvement which responded well to corticosteroid therapy.
Assuntos
Arritmias Cardíacas/patologia , Atrofia Muscular/patologia , Sarcoidose/patologia , Manifestações Cutâneas , Arritmias Cardíacas/etiologia , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Atrofia Muscular/etiologia , Miocárdio/patologia , Sarcoidose/complicaçõesRESUMO
We report 3 cases of post-traumatic cutaneous mucormycosis caused by Lichtheimia corymbifera, two of them occurring after a farm working accident. Management of post-traumatic mucormycoses consists of a wide excision of the infected tissue, combined with immediate antifungal therapy. Liposomal amphotericin B is the recommended first line treatment. Few studies have evaluated the efficacy of posaconazole. All 3 patients received a surgical debridement and liposomal amphotericin B, which was followed by posaconazole in 2 cases. The duration of the antifungal treatment is not yet well defined. All three patients received a treatment of five weeks with a favorable outcome.
Assuntos
Absidia/isolamento & purificação , Dermatomicoses/microbiologia , Mucormicose/microbiologia , Ferimentos e Lesões/microbiologia , Adolescente , Adulto , Antifúngicos/uso terapêutico , Desbridamento , Dermatomicoses/tratamento farmacológico , Dermatomicoses/cirurgia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Mucormicose/cirurgia , Ferimentos e Lesões/tratamento farmacológico , Ferimentos e Lesões/cirurgiaAssuntos
Dermatomicoses/diagnóstico , Infecções Oportunistas/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Scedosporium/isolamento & purificação , Idoso , Biomarcadores , Biópsia , Dermatomicoses/sangue , Dermatomicoses/microbiologia , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/microbiologia , Transplante de Pulmão , Masculino , Infecções Oportunistas/sangue , Infecções Oportunistas/microbiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/microbiologia , Pioderma Gangrenoso/diagnóstico , Scedosporium/crescimento & desenvolvimento , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , beta-Glucanas/sangueAssuntos
Terapia Baseada em Transplante de Células e Tecidos , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Células-Tronco Neoplásicas/patologia , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Linfócitos T Citotóxicos/transplante , Transferência Adotiva , Animais , Apoptose , Proliferação de Células , Células Cultivadas , Leucemia Mielogênica Crônica BCR-ABL Positiva/imunologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/mortalidade , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Camundongos , Camundongos Endogâmicos C57BLAssuntos
Adenoma/complicações , Neoplasias das Glândulas Suprarrenais/complicações , Síndrome de Cushing/complicações , Neoplasias Primárias Múltiplas/complicações , 17-Hidroxicorticosteroides/urina , 17-Cetosteroides/urina , Adenoma/patologia , Neoplasias das Glândulas Suprarrenais/patologia , Adrenalectomia , Adulto , Síndrome de Cushing/sangue , Síndrome de Cushing/tratamento farmacológico , Síndrome de Cushing/patologia , Síndrome de Cushing/terapia , Síndrome de Cushing/urina , Feminino , Humanos , Hidrocortisona/sangue , Hidrocortisona/uso terapêutico , Hiperglicemia , Hiperplasia/complicações , Infecções Respiratórias/complicaçõesAssuntos
Hiperparatireoidismo Secundário , Adulto , Fosfatase Alcalina/sangue , Vasos Sanguíneos/patologia , Osso e Ossos/patologia , Calcinose/complicações , Cálcio/urina , Humanos , Hiperparatireoidismo Secundário/diagnóstico , Hiperparatireoidismo Secundário/diagnóstico por imagem , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/patologia , Hiperplasia/complicações , Rim/patologia , Falência Renal Crônica/complicações , Masculino , Nefrite/complicações , Osteomalacia/complicações , Osteosclerose/complicações , Glândulas Paratireoides/patologia , Fósforo/sangue , Radiografia , Raquitismo/complicaçõesRESUMO
Since october 1986, we have performed 92 wirsungo-sphincteroclasias (W-SC) in patients with severe chronic pancreatitis who did not have dominant cavity formation (which can be managed by simple cyst-duodenostomy) and presented dilatation (even moderate) of the Wirsung's duct. This novel technique involves identification of the biliopancreatic outlet by biliary spincteroclasia followed by short cephalic wirsungotomy. This method allows desobstruction of the duct both upstream and downstream followed by drilling and calibration of the duct and the ampula to 9 to 11 mm. The wirsungotomy is then sutured and a temporary naso-wirsung drain is installed instead of a wirsungojejunal Y anastomosis. Biliodigestive anastomosis was also required in 64 cases using a Vankemmel cholecystoplasty in all cases except 2 (prior cholecystectomy). Duodenoplasty and gastrojejunostomy were also required in 4 and 3 cases respectively. There were no post-operative deaths and pancreatic fistulization was never observed. The mean hospital stay after surgery was 12.2 days. Long-term follow-up at 3 to 33 months showed 6 reoperations (W-SC) and 5 more cases of biliodigestive anastomosis. Actuarial survival at 5 years was 81.5% with 90.7% good and excellent results with weight gain in 50% of the cases. The rate of diabetes degradation was better than with other treatment modalities. These very encouraging results have led us to abandon the more classical techniques of exeresis or pancreatojejunal drainage into an excluded loop in favor of W-SC for chronic parenchymatous pancreatitis or cyst-duodenostomy for chronic cavitary pancreatitis. The procedure is associated with a biliodigestive anastomosis using the Vankemmel plasty in about two-thirds of the cases.