RESUMO
TREATMENT OF THE INITIAL INFECTION OR FIRST CLINICAL EPISODE OF GENITAL HERPES: An initial infection or first clinical episode of genital herpes is treated with oral aciclovir 200mg×5/d for 5 to 10 days depending on clinical status. The recommended dosage for valaciclovir is 1g×2/d and treatment duration is identical to that for aciclovir. TREATMENT OF HERPES RECURRING DURING PREGNANCY: There are no studies of the efficacy of antiviral therapy on the symptoms of genital recurring during pregnancy. However, initial anti-viral treatment using aciclovir or valaciclovir may be given where warranted by symptoms (i.e. duration and severity of symptoms). Valaciclovir may be used instead (equivalent efficacy but better safety data for aciclovir). Valaciclovir may be given at a dosage of 1×500mg b.i.d. p.o. for 5 days. PROPHYLACTIC ANTI-VIRAL TREATMENT DURING PREGNANCY: In female patients presenting an initial infection or infection recurring during pregnancy, although there is no demonstrated benefit for prophylactic treatment in reducing the risk of neonatal herpes, anti-viral prophylaxis is recommended after 36 WA (weeks' amenorrhoea) to limit the need for Caesarean section due to herpetic lesions. The recommended antivirals are aciclovir at a dosage of 400mg t.i.d p.o. or valaciclovir at a dosage of 500mg b.i.d. p.o. until delivery.
Assuntos
Aciclovir/administração & dosagem , Antivirais/administração & dosagem , Herpes Genital/tratamento farmacológico , Valaciclovir/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Herpes Genital/transmissão , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologiaRESUMO
BACKGROUND: Patients with suspected Middle East respiratory syndrome coronavirus (MERS-CoV) infection should be hospitalized in isolation wards to avoid transmission. This suspicion can also lead to medical confusion and inappropriate management of acute respiratory syndrome due to causes other than MERS-CoV. METHODS: We studied the characteristics and outcome of patients hospitalized for suspected MERS-CoV infection in the isolation wards of two referral infectious disease departments in the Paris area between January 2013 and December 2016. RESULTS: Of 93 adult patients (49 male (52.6%), median age 63.4 years) hospitalized, 82 out of 93 adult patients had returned from Saudi Arabia, and 74 of them were pilgrims (Hajj). Chest X-ray findings were abnormal in 72 (77%) patients. The 93 patients were negative for MERS-CoV RT-PCR, and 70 (75.2%) patients had documented infection, 47 (50.5%) viral, 22 (23.6%) bacterial and one Plasmodium falciparum malaria. Microbiological analysis identified Rhinovirus (27.9%), Influenza virus (26.8%), Legionella pneumophila (7.5%), Streptococcus pneumoniae (7.5%), and non-MERS-coronavirus (6.4%). Antibiotics were initiated in 81 (87%) cases, with two antibiotics in 63 patients (67.7%). The median duration of hospitalization and isolation was 3 days (1-33) and 24 h (8-92), respectively. Time of isolation decreased over time (P < 0.01). Two patients (2%) died. CONCLUSION: The management of patients with possible MERS-CoV infection requires medical facilities with trained personnel, and rapid access to virological results. Empirical treatment with neuraminidase inhibitors and an association of antibiotics effective against S. pneumoniae and L. pneumophila are the cornerstones of the management of patients hospitalized for suspected MERS-CoV infection.
Assuntos
Infecções por Coronavirus/terapia , Hospitalização , Coronavírus da Síndrome Respiratória do Oriente Médio , Idoso , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Coronavírus da Síndrome Respiratória do Oriente Médio/isolamento & purificação , Oseltamivir/uso terapêutico , Oxigenoterapia , Paris , Isolamento de Pacientes , Estudos Retrospectivos , Arábia Saudita , Streptococcus pneumoniae , Viagem , Resultado do TratamentoRESUMO
BACKGROUND: Creeping eruption is a migratory linear cutaneous trail. In addition to hookworm-related cutaneous larva migrans (HrCLM), other diseases can also be revealed by this sign. OBJECTIVES: To report the different aetiologies of creeping eruption. METHODS: All consecutive patients with creeping eruption presenting to our unit in Pitié Salpêtrière Hospital in Paris between 1 March 2008 and 31 January 2013 were included. The diagnoses were based on microscopic data when available (hookworm folliculitis, strongyloidiasis) or the association of epidemiological, clinical, biological features and good outcome after specific treatment (HrCLM, loiasis, gnathostomiasis). RESULTS: Seventy-four patients (95%) presented with HrCLM. All but one had been travelling in a tropical country; seven (9%) also presented with folliculitis. Skin scraping of hookworm folliculitis lesions was performed in five cases and revealed living nematode larvae in three cases. Two patients (3%) with cutaneous gnathostomiasis after returning from Bali and Japan presented with intermittent creeping dermatitis on the foot and thigh, respectively. One patient (1%), native to Cameroon, was diagnosed with loiasis and one patient (1%), with no travel history, presented with 'creeping hair'. CONCLUSION: Hookworm-related cutaneous larva migrans explains 95% of the cases of creeping eruption; gnathostomiasis, loiasis and cutaneous pili migrans may also be diagnosed.
Assuntos
Dermatopatias Parasitárias/etiologia , Adulto , Feminino , Gnatostomíase/diagnóstico , Cabelo , Humanos , Larva Migrans/diagnóstico , Loíase/diagnóstico , Masculino , ViagemRESUMO
Since their introduction in the 2000s, echinocandin drugs have become widely used for the treatment and prophylaxis of invasive fungal infections and, notably, invasive candidiasis. Although cases of breakthrough candidiasis in patients receiving echinocandins have been reported, clinical failure during echinocandin treatment due to the acquisition of resistance by a normally susceptible Candida spp. isolate is considered rare. To date, no publications have been published correlating the use of echinocandins and the emergence of echinocandin resistance among Candida species. So, our goal is to report an initial analysis of echinocandin use in relation to the emergence of resistant Candida isolates. We report here a single-centre experience of the emergence of eight resistant isolates belonging to normally susceptible Candida species in six patients receiving echinocandins. We describe the context and analyse the use of echinocandins over the previous decade. For seven of these isolates, we identified FKS gene mutations involved in decreased susceptibility. Seven isolates were obtained in 2011, on the heels of a ten-fold increase in caspofungin use over the preceding decade. In contrast, in 2012, the use of echinocandins decreased in our institution by 19.5 % and, in that year, only one Candida-resistant isolate was detected, despite the stable global epidemiology of invasive candidaemia. This work underlines the necessity of improving the prescription of antifungal drugs. Improvement in the monitoring of strain susceptibility should also be considered in order to better detect the emergence of resistant or non-susceptible yeast strains.
Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidíase/microbiologia , Farmacorresistência Fúngica , Uso de Medicamentos , Equinocandinas/farmacologia , Idoso , Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candidíase/epidemiologia , Equinocandinas/uso terapêutico , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , PrevalênciaRESUMO
BACKGROUND: Treatment of hookworm-related cutaneous larva migrans (HrCLM) with a single dose of oral ivermectin has not been adequately evaluated to date. Response rates reported in three large studies varied from 77% to more than 95%. OBJECTIVES: We evaluated the efficacy of ivermectin in the treatment of HrCLM. METHODS: We retrospectively studied all returning travellers with HrCLM who consulted in our institution. Patients were then treated with a single, 200 µg/kg dose of ivermectin, orally. RESULTS: Sixty-two travellers (35 female, 27 male, mean age 35.6 years) with HrCLM and creeping dermatitis were included. Six patients (10%) also had associated hookworm folliculitis. Fifty-nine patients (95%) completely responded with one ivermectin dose. The response rate was 98% in the 56 patients presenting with only creeping dermatitis and 66% in the six patients presenting with additional hookworm folliculitis (P = 0.02). CONCLUSION: The efficacy of a single dose of oral ivermectin is higher in patients with only creeping dermatitis than in those with associated hookworm folliculitis.
Assuntos
Anti-Helmínticos/uso terapêutico , Infecções por Uncinaria/tratamento farmacológico , Ivermectina/uso terapêutico , Dermatopatias Parasitárias/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
A solitary tuberculous brain lesion (STBL) can be difficult to distinguish from a glioma, metastasis or other infectious disease, especially from a pyogenic brain abscess. We analyzed the clinical characteristics, diagnostic procedures and outcomes of 24 patients with STBL diagnosed in three centers from France, India and Mexico. We also reviewed 92 STBL cases previously reported in the literature. General symptoms were found in 54% of our patients, including enlarged lymph nodes in 20%. Cerebrospinal fluid was typically abnormal, with lymphocytic pleocytosis and a high protein level. The lung CT scan was abnormal in 56% of patients, showing lymphadenopathy or pachipleuritis. Brain MRI or CT was always abnormal, showing contrast-enhanced lesions. Typically, MRI abnormalities were hypointense on T1-weighted sequences, while T2-weighted sequences showed both a peripheral hypersignal and a central hyposignal. The diagnosis was documented microbiologically or supported histologically in 71% of cases. Clinical outcome was good in 83% of cases.
Assuntos
Tuberculoma Intracraniano/epidemiologia , Adolescente , Adulto , Idoso , Antituberculosos/uso terapêutico , Abscesso Encefálico/diagnóstico , Neoplasias Encefálicas/diagnóstico , Comorbidade , Diagnóstico Diferencial , Feminino , Febre/etiologia , França/epidemiologia , Glioma/diagnóstico , Cefaleia/etiologia , Humanos , Índia/epidemiologia , Imageamento por Ressonância Magnética , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Marrocos/etnologia , Mycobacterium tuberculosis/isolamento & purificação , Avaliação de Sintomas , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma Intracraniano/patologia , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Cutaneous leishmaniasis (CL) is a disfiguring but not life-threatening disease. Because antileishmanial drugs are potentially toxic, the World Health Organization (WHO) recommends simple wound care or local therapy as first-line treatment, followed or replaced by systemic therapy if local therapy fails or cannot be performed. METHODS: To determine the feasibility and impact of the recommended approach, we analyzed the results of a centralized referral treatment program in 135 patients with parasitologically proven CL. RESULTS: Infections involved 10 Leishmania species and were contracted in 29 different countries. Eighty-four of 135 patients (62%) were initially treated without systemic therapy. Of 109 patients with evaluable charts, 23 of 25 (92%) treated with simple wound care and 37 of 47 (79%) treated with local antileishmanial therapy were cured by days 42-60. In 37 patients with large or complex lesions, or preexisting morbidities, or who had not been cured with local therapy, the cure rate with systemic antileishmanial agents was 60%. Systemic adverse events were observed in 15 patients, all receiving systemic therapy. CONCLUSIONS: In this population of CL patients displaying variable degrees of complexity and severity, almost two-thirds of patients could be initially managed without systemic therapy. Of these, 60 were cured before day 60. The WHO-recommended stepwise approach favoring initial local therapy therefore resulted in at least 44% of all patients being cured without exposure to the risk of systemic adverse events. Efforts are needed to further simplify local therapy of CL and to improve the management of patients with complex lesions and/or preexisting comorbidities.
Assuntos
Antiprotozoários/uso terapêutico , Bandagens , Leishmaniose Cutânea/terapia , Viagem , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
The emergence of multi-resistant bacteria (MRB) in developing countries (DCs) is a worrying phenomenon at regional and international levels with a risk of international spread through travelers. The French guidelines recommend a systematic screening in case of hospitalization, for the travelers who have been repatriated and for those with a history of hospitalization in a foreign country during the past year. A simple travel in DCs is not considered as a risk factor for colonization or infection with a MRB. We report the case of a 56-year-old man with acute prostatitis and epididymitis due to Extended-spectrum ß-lactamase-producing Escherichia coli. He was returning from Southeast Asia with no history of hospitalization or recent use of antibiotics. However, he had unprotected sex during his travel. This case report leads us to discuss the different ways of acquiring this resistant bacterium during travel as well as the usefulness of expanding the screening of carriage for MRB in all travelers in case of hospitalization.
Assuntos
Farmacorresistência Bacteriana Múltipla , Infecções por Escherichia coli/diagnóstico , Escherichia coli/isolamento & purificação , Viagem , Infecções Urinárias/diagnóstico , Sudeste Asiático , Farmacorresistência Bacteriana Múltipla/genética , Epididimite/diagnóstico , Epididimite/microbiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prostatite/diagnóstico , Prostatite/microbiologia , Doenças Bacterianas Sexualmente Transmissíveis/complicações , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Doenças Bacterianas Sexualmente Transmissíveis/microbiologia , Tailândia , Medicina de Viagem , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia , beta-Lactamases/genética , beta-Lactamases/metabolismoRESUMO
OBJECTIVE: Among patients attending a multidisciplinary day-hospital program for persistent symptoms after COVID-19, we aimed i) to describe their characteristics ii) to present the medical conclusions (diagnoses and recommendations) and iii) to assess the patients' satisfaction and its correlates. METHODS: For this retrospective chart review study, frequent symptoms were systematically assessed. Standardized questionnaires explored fatigue (Pichot scale), physical activity (Ricci & Gagnon scale), health-related quality of life (Short-Form Health Survey), anxiety and depressive symptoms (Hospital Anxiety and Depression scale) and associated psychological burden (Somatic-Symptom-Disorder B criteria Scale). Medical record conclusions were collected and a satisfaction survey was performed at 3-months follow-up. RESULTS: Among 286 consecutive patients (median age: 44 years; 70% women), the most frequent symptoms were fatigue (86%), breathlessness (65%), joint/muscular pain (61%) and cognitive dysfunction (58%), with a median duration of 429 days (Inter-quartile range (IqR): 216-624). Questionnaires revealed low levels of physical activity and quality of life, and high levels of fatigue, anxiety, depression, and psychological burden, with 32% and 23% meeting the diagnostic criteria for a depressive or anxiety disorder, respectively. Positive arguments for a functional somatic disorder were found in 76% of patients, including 96% with no abnormal clinical or test findings that may explain the symptoms. Physical activity rehabilitation was recommended for 91% of patients. Patients' median satisfaction was 8/10 (IqR: 6-9). CONCLUSION: Most patients attending this program presented with long-lasting symptoms and severe quality of life impairment, received a diagnosis of functional somatic disorder, and reported high levels of satisfaction regarding the program.
RESUMO
To investigate trends in travel-associated morbidity with particular emphasis on emerging infections with the potential for introduction into Europe, diagnoses of 7,408 returning travellers presenting to 16 EuroTravNet sites in 2010 were compared with 2008 and 2009. A significant increase in reported Plasmodium falciparum malaria (n=361 (6% of all travel-related morbidity) vs. n=254 (4%) and 260 (5%); p<0.001), P. vivax malaria (n=51 (1%) vs. n=31 (0.5%) and 38 (1%); p=0.027) and dengue fever (n=299 (5%) vs. n=127 (2%) and 127 (2%); p<0.001) was observed. Giardia lamblia was identified in 16% of patients with acute diarrhoea, with no significant annual variation. The proportion of acute diarrhoea due to Campylobacter increased from 7% in 2008 to 12% in 2010 (p=0.001). We recorded 121 patients with pulmonary tuberculosis in 2010, a threefold increase in the proportionate morbidity from 2008 to 2010. In 2010, 60 (0.8%) cases of chronic Chagas disease, 151 (2%) cases of schistosomiasis and 112 (2%) cases of cutaneous larva migrans were reported. Illness patterns in sentinel travellers, captured by EuroTravnet, continue to highlight the potential role of travellers in the emergence of infectious diseases of public health concern in Europe and the relevance of offering medical travel advice and enforcing specific and adequate prophylaxis.
Assuntos
Doenças Transmissíveis/epidemiologia , Migrantes/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adulto , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/etiologia , Dengue/epidemiologia , Diarreia/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Gastroenteropatias/epidemiologia , Humanos , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade , Vigilância da População , Infecções Respiratórias/epidemiologia , Dermatopatias/epidemiologiaRESUMO
INTRODUCTION: Persistent symptoms have recently emerged as a clinical issue in COVID-19. We aimed to assess the prevalence and risk factors in symptomatic non-hospitalized individuals with mild COVID-19. METHODS: We performed a prospective cohort study of symptomatic COVID-19 outpatients, from March to May 2020, with weekly phone calls from clinical onset until day 30 and up to day 60 in case of persistent symptoms. The main outcomes were the proportion of patients with complete recovery at day 30 and day 60 and factors associated with persistent symptoms. RESULTS: We enrolled 429 individuals mostly women (72.5%) and healthcare workers (72.5%), with a median age of 41.6 years [IQR 30-51.5]. Symptoms included: cough (69.7%), asthenia (68.8%), anosmia (64.8%), headaches (64.6%), myalgia (62.7%), gastrointestinal symptoms (61.8%), fever (61.5%), and ageusia (60.8%). Mean duration of disease was 27 days (95%CI: 25-29). The rate of persistent symptoms was 46.8% at day 30 and 6.5% at day 60 consisting in asthenia (32.6%), anosmia (32.6%), and ageusia (30.4%). The probability of complete recovery was 56.3% (95%CI: 51.7-61.1) at day 30 and 85.6% (95%CI: 81.2-89.4) at day 60. Factors associated with persistent symptoms were age>40 (HR 0.61), female sex (HR 0.70), low cycle threshold (HR 0.78), and ageusia (HR 0.59). CONCLUSIONS: COVID-19 - even in its mild presentation - led to persistent symptoms (up to one month) in nearly half of individuals. Identification of risk factors such as age, gender, ageusia and viral load is crucial for clinical management and argues for the development of antiviral agents.