RESUMO
Onychomycosis, or fungal infection of the nails, is one of the most prevalent fungal diseases in the general population. Treatment is of limited effectiveness, tedious, and must be administered for long periods. Furthermore, systemic antifungal agents are associated with adverse effects. Photodynamic therapy (PDT) may prove to be a viable alternative in the treatment of superficial skin infections, including onychomycosis. We review articles relating to the usefulness of PDT in onychomycosis in both in vitro and in vivo settings and discuss the potential and limitations of various photosensitizing agents. In vivo, methylene blue and 5-aminolevulinic acid have led to cure rates in 80% and 43% of cases, respectively, at 12 months. Finally, based on data in the literature and our own experience, we propose a protocol of 3 PDT sessions, separated by an interval of 1 or 2 weeks, using methyl aminolevulinate 16% as a photosensitizing agent and red light (λ=630 nm, 37 J.cm(-2)). Each session is preceded by the topical application of urea 40% over several days. Clinical trials are needed to optimize PDT protocols and to identify those patients who will benefit most from this treatment.
Assuntos
Onicomicose/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Ácido Aminolevulínico/administração & dosagem , Ácido Aminolevulínico/análogos & derivados , Ácido Aminolevulínico/uso terapêutico , Antifúngicos/uso terapêutico , Protocolos Clínicos , Ensaios Clínicos como Assunto , Esquema de Medicação , Medicina Baseada em Evidências , Fungos/efeitos dos fármacos , Fungos/efeitos da radiação , Humanos , Azul de Metileno/administração & dosagem , Azul de Metileno/uso terapêutico , Fármacos Fotossensibilizantes/administração & dosagem , Resultado do Tratamento , Ureia/administração & dosagem , Ureia/uso terapêuticoAssuntos
Fezes/parasitologia , Himenolepíase/parasitologia , Hymenolepis/isolamento & purificação , Enteropatias Parasitárias/parasitologia , África do Norte/etnologia , Animais , Anticestoides/uso terapêutico , Antiprotozoários/uso terapêutico , Criança , Feminino , Giardíase/complicações , Giardíase/diagnóstico , Giardíase/tratamento farmacológico , Transtornos do Crescimento/etiologia , Humanos , Himenolepíase/complicações , Himenolepíase/diagnóstico , Himenolepíase/tratamento farmacológico , Himenolepíase/epidemiologia , Enteropatias Parasitárias/diagnóstico , Enteropatias Parasitárias/tratamento farmacológico , Enteropatias Parasitárias/epidemiologia , Metronidazol/uso terapêutico , Niclosamida/uso terapêutico , Espanha/epidemiologiaAssuntos
Meningites Bacterianas , Infecções por Salmonella , Salmonella enteritidis/isolamento & purificação , Idoso , Humanos , Masculino , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/epidemiologia , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/epidemiologiaRESUMO
BACKGROUND: The aim of this study was to know the frequency and the clinical characteristics of urinary infection by non typhi Salmonella in our area in Spain. PATIENTS AND METHODS: The clinical histories of patients with urinary infection by non typhi Salmonella diagnosed in the Hospital General del Guadalajara from January 1990 to July 1999 were reviewed. RESULTS: During the period studied nine patients with urinary infection by non typhi Salmonella were diagnosed, representing 0.056% of the urinary infection diagnosed in our hospital over the same period. All the patients presented underlying disease and five were undergoing immunosuppressor treatment. Four patients presented urological disease. The most frequent serogroup was Salmonella enteritidis (7 cases). All the episodes were symptomatic. The same microorganism was isolated in stools in four patients. The evolution was favorable in five of the nine cases. Recurrence was observed in two patients and secondary bacteremia in one. Six patients required antibiotic treatment over two or more weeks. The mean length of treatment was of 2.5 weeks. CONCLUSIONS: Urinary infection by non typhi Salmonella is predominantly observed in patients undergoing immunosuppression or with urological disease. Prolonged antibiotic treatment is recommended due to its bad evolution.