Assuntos
Antibacterianos/administração & dosagem , Monitoramento de Medicamentos , Linezolida/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacocinética , Relação Dose-Resposta a Droga , Feminino , Humanos , Linezolida/farmacocinética , Masculino , Estudos RetrospectivosRESUMO
A 42-year-old woman, living in a nursing home for the mentally disabled, with congenital ventricular septal defect and multiple comorbidities, developed endocarditis with vegetations of the interventricular septum and the right coronary aortic leaflet. The main feature of this case was the metastatic embolism leading to multiple and muscular abscesses. Methicillin-sensitive S. aureus, spa type 253 and ST30, producing toxin shock syndrome toxin-1 was isolated from blood cultures. The patient was initially treated with beta-lactam antibiotics without showing clinical response and subsequently with daptomycin and linezolid that improved the patient's clinical symptoms. The effectiveness of treatment with daptomycin and linezolid was partly due to the ability of linezolid to reduce TSST-1 secretion. The portal of entry of the infection was not recognized. TSST-1 production by the strain might have favoured the formation of large cardiac vegetations and the subsequent metastatic dissemination to the muscles.
Assuntos
Abscesso/microbiologia , Toxinas Bacterianas/metabolismo , Endocardite Bacteriana/microbiologia , Enterotoxinas/metabolismo , Doenças Musculares/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Superantígenos/metabolismo , Abscesso/tratamento farmacológico , Acetamidas/uso terapêutico , Adulto , Antibacterianos/uso terapêutico , Daptomicina/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Linezolida , Doenças Musculares/tratamento farmacológico , Oxazolidinonas/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/metabolismoAssuntos
Doenças Cardiovasculares/etiologia , Infecções por HIV/complicações , Síndrome Metabólica/etiologia , Adulto , Glicemia/metabolismo , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Infecções por HIV/sangue , Humanos , Insulina/sangue , Resistência à Insulina , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: The standard of care for HCV Hepatitis is the combination of interferon (IFN) plus Ribavirin. In HIV patients the use of this combination therapy may induce drug interactions, and reduces the adherence to HAART. The aim of this study is to evaluate safety and efficacy of a 48 weeks daily dose IFN schedule. METHODS: We evaluated 50 coinfected patients; alpha IFN 2a was administered at a dose of 3 MU daily. The baseline values were the following : CD4+ 515 cells/mmc (mean); HIV-RNA <50 copies/ml in all patients; HCV-RNA 28, 3 x 106 copies/ml. RESULTS: At 48 weeks, 10 patients (20%) achieved a biochemical and virological response according to an intention to treat analysis.Twenty four patients (48%) underwent a drop-out mainly by side effects related to overlapping toxicity of interferon and antiretroviral therapy. All the patients, who responded to the treatment, showed a fast relapse one month after the end of treatment. CONCLUSION: Although our results demonstrated a very poor outcome and a bad tolerance to interferon monotherapy, this approach should not be dropped out, mainly in patients at high risk for side effects and in those with cirrhosis who do not tolerate or are at increased risk for the use of ribavirin.