RESUMO
Paragonimus kellicotti is an emerging pathogen in the United States with 19 previously reported cases, most in Missouri. Pulmonary symptoms with eosinophilia are most common, though 1 case did involve the central nervous system with few symptoms. We describe the first 2 cases of eosinophilic meningitis due to Paragonimus kellicotti.
Assuntos
Eosinofilia/patologia , Eosinofilia/parasitologia , Meningite/patologia , Meningite/parasitologia , Paragonimíase/diagnóstico , Paragonimíase/patologia , Paragonimus/isolamento & purificação , Adolescente , Adulto , Animais , Eosinofilia/etiologia , Humanos , Masculino , Meningite/etiologia , Estados UnidosRESUMO
BACKGROUND: Despite the proven efficacy of acyclovir (ACV) therapy, herpes simplex encephalitis (HSE) continues to cause substantial morbidity and mortality. Among patients with HSE treated with ACV, the mortality rate is approximately 14%-19%. Among survivors, 45%-60% have neuropsychological sequelae at 1 year. Thus, improving therapeutic approaches to HSE remains a high priority. METHODS: Following completion of a standard course of intravenous ACV, 87 adult patients with HSE (confirmed by positive polymerase chain reaction [PCR] for herpes simplex virus DNA in cerebrospinal fluid) were randomized to receive either valacyclovir (VACV) 2 g thrice daily (n = 40) or placebo tablets (n = 47) for 90 days (12 tablets of study medication daily). The primary endpoint was survival with no or mild neuropsychological impairment at 12 months, as measured by the Mattis Dementia Rating Scale (MDRS). Logistic regression was utilized to assess factors related to the primary endpoint. RESULTS: The demographic characteristics of the 2 randomization groups were statistically similar with no significant differences in age, sex, or race. At 12 months, there was no significant difference in the MDRS scoring for VACV-treated vs placebo recipients, with 85.7% and 90.2%, respectively, of patients demonstrating no or mild neuropsychological impairment (P = .72). No significant study-related adverse events were encountered in either treatment group. CONCLUSIONS: Following standard treatment with intravenous ACV for PCR-confirmed HSE, an additional 3-month course of oral VACV therapy did not provide added benefit as measured by neuropsychological testing 12 months later in a population of relatively high-functioning survivors. CLINICAL TRIALS REGISTRATION: NCT00031486.
Assuntos
Aciclovir/análogos & derivados , Antivirais/uso terapêutico , Encefalite por Herpes Simples/tratamento farmacológico , Encefalite por Herpes Simples/epidemiologia , Valina/análogos & derivados , Aciclovir/administração & dosagem , Aciclovir/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/administração & dosagem , Transtornos Cognitivos , Encefalite por Herpes Simples/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Valaciclovir , Valina/administração & dosagem , Valina/uso terapêutico , Adulto JovemRESUMO
Syphilis is commonly known as "the great imitator" owing to its varied clinical manifestations. Secondary syphilis has a variety of presentations, with the most common manifesting as a diffuse papulosquamous eruption on the palms and soles. Lues maligna praecox is a rare form of secondary syphilis, with severe constitutional symptoms, seen primarily in HIV-positive individuals. We report an atypical case of suspected lues maligna in a 45-year-old male. The patient was HIV-positive with a CD4 count of 441. He presented to our clinic with large painful gummatous ulcers in the groin and lower back. He also reported daily fevers, night sweats, and weight loss consistent with secondary syphilis. Prior to this episode the patient had a history of acute active syphilis (RPR 1:128) in 2012 treated at that time with a single dose of 2.4 million units intramuscular benzathine penicillin; he had no reported exposures since that time. The patient was treated with three weekly doses of benzathine penicillin, 2.4 million units, given intramuscularly. This case demonstrates the importance of recognizing the varied clinical presentation of secondary syphilis and keeping lues maligna in consideration for ulceronodular skin lesions in patients who are HIV-positive.
Assuntos
Soropositividade para HIV , Sífilis/diagnóstico , Antibacterianos/uso terapêutico , Dorso/patologia , Contagem de Linfócito CD4 , Virilha/patologia , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Penicilina G Benzatina/uso terapêutico , Úlcera Cutânea/microbiologia , Úlcera Cutânea/patologia , Sífilis/tratamento farmacológico , Sífilis/patologiaRESUMO
We report a rare complication of nontyphoidal Salmonella infection in a 12-month-old girl with a retropharyngeal abscess. The patient presented with a four-day history of nasal congestion, cough, decreased oral intake, and increased irritability. She was admitted for a suspected deep neck infection. Computed tomography confirmed a retropharyngeal abscess with airway narrowing. Incision and drainage was performed, and intraoperative cultures grew nontyphoidal Salmonella. Epidemiologic investigation revealed exposure to a backyard flock of chickens. The patient had little direct contact with chickens but did go with family to collect eggs, riding on a vehicle that likely became contaminated. This case highlights the risks to infants and young children in contact with live poultry or contaminated environments.
Assuntos
Bacteriemia/diagnóstico , Transplante de Medula Óssea , Infecções por Fusobacteriaceae/diagnóstico , Hospedeiro Imunocomprometido , Leptotrichia/efeitos dos fármacos , Bacteriemia/tratamento farmacológico , Bacteriemia/imunologia , Feminino , Infecções por Fusobacteriaceae/tratamento farmacológico , Infecções por Fusobacteriaceae/imunologia , Humanos , Leptotrichia/genética , Leucemia Mieloide Aguda/imunologia , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/imunologia , Mieloma Múltiplo/terapiaRESUMO
BACKGROUND: Antiretroviral therapy is recommended for human immunodeficiency virus (HIV)-infected patients during pregnancy to reduce the vertical transmission to the newborn. Complications from this therapy are uncommon. CASE: A 38-year-old HIV-positive pregnant woman was treated with lamivudine and zidovudine. At 28 weeks of gestation, her hemoglobin had fallen to 4.6 g/dL with an mean corpuscular volume (MCV) of 126 microm. At 36 weeks the fetal biophysical profile was abnormal. A pale hydropic infant was delivered via emergency cesarean, with a hemoglobin of 2.1 gm and MCV of 131 microm. The newborn hemoglobin normalized after withdrawal of the neonatal retroviral therapy. CONCLUSION: Maternal-fetal macrocytic anemia may complicate antiretroviral therapy.
Assuntos
Anemia Macrocítica/induzido quimicamente , Fármacos Anti-HIV/efeitos adversos , Doenças Fetais/induzido quimicamente , Infecções por HIV/tratamento farmacológico , Complicações Hematológicas na Gravidez/induzido quimicamente , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Anemia Macrocítica/embriologia , Fármacos Anti-HIV/uso terapêutico , Cesárea , Quimioterapia Combinada , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Lamivudina/efeitos adversos , Lamivudina/uso terapêutico , Gravidez , Resultado da Gravidez , Carga Viral , Zidovudina/efeitos adversos , Zidovudina/uso terapêuticoRESUMO
Respiratory viruses cause significant morbidity and mortality in immunocompromised populations such as stem cell transplant and solid organ transplant patients. Few viruses causing respiratory tract infection have an approved therapy, and many of the viruses have no therapeutic options at all. In this article, we describe novel agents under development for treatment options against several respiratory viruses.
RESUMO
Candidemia is the fourth most frequent nosocomial bloodstream infection in the US. The clinical characteristics and outcome of candidemia in adult patients with diabetes mellitus (DM) have not been reported in the literature. The objective of the study was to determine the epidemiology and determinants of mortality in diabetic patients with candidemia. A retrospective cohort study among diabetic patients with candidemia was carried out at 2 medical centers. The primary outcome was death from any cause after the onset of candidemia until discharge from the hospital. A stepwise logistic regression analysis was performed to determine the predictors of mortality. From June 1995 to June 2003, 87 patients with both DM and candidemia were studied. Candida albicans was the most common (48/87, 55%) and Candida glabrata the second most common isolate of candidemia (18/87, 21%). Overall hospital mortality was 39% (34/87). Logistic regression analysis identified 3 independent determinants of death; Apache II score > or =23 (OR 8.3, 95% CI{2.7, 25.4}, p =0.0002), nosocomial candidemia (OR 10.2, 95% CI{1.1, 97.9}, p = 0.04), and mechanical ventilation (OR 3.6, 95% CI{1.1, 11.2}, p = 0.03). The study demonstrates the emergence of non-albicans species of Candida as major causes of candidemia among diabetic patients. The severity of illness reflected by Apache II was the most significant predictor of mortality among diabetic patients with candidemia.