RESUMO
Background: Antiviral-resistant herpes simplex virus type 1 (HSV-1) has been recognized as an emerging clinical problem among patients undergoing hematopoietic stem cell transplantation (HSCT). Methods: A prospective observational study was conducted at a hematological center over a 2-year period. Oropharyngeal swab samples were serially collected each week from 1 week before and up to 100 days after HSCT and were tested for virus isolation. The HSV-1 isolates were tested for sensitivity to acyclovir (ACV). The prognosis of patients with ACV-resistant (ACVr) HSV-1 and the genetic background of the ACVr HSV-1 isolates were assessed. Results: Herpes simplex virus type 1 was isolated in 39 of 268 (15%) HSCT patients within 100 days after transplantation. Acyclovir-resistant HSV-1 emerged in 11 of these 39 patients (28%). The 100-day death rates of HSCT patients without HSV-1 shedding, those with only ACV-sensitive HSV-1 shedding, and those with ACVr HSV-1 shedding were 31%, 39%, and 64%, respectively. Patients with HSV-1, including ACVr HSV-1, shedding showed a significantly higher mortality rate. Relapsed malignancies were a significant risk factor for the emergence of ACVr HSV-1. Acyclovir resistance was attributable to viral thymidine kinase and DNA polymerase mutations in 6 and 5 patients, respectively. Conclusions: Herpes simplex virus type 1, including ACVr HSV-1, shedding was associated with poorer outcome in HSCT patients, even if HSV disease did not always occur. Patients with relapsed malignancies were at especially high risk for the emergence of ACVr HSV-1.
Assuntos
Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Farmacorresistência Viral , Transplante de Células-Tronco Hematopoéticas/mortalidade , Herpes Simples/tratamento farmacológico , Herpesvirus Humano 1/efeitos dos fármacos , Adolescente , Adulto , Idoso , DNA Polimerase Dirigida por DNA/genética , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Herpes Simples/virologia , Herpesvirus Humano 1/isolamento & purificação , Humanos , Japão , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/virologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Recidiva , Taxa de Sobrevida , Timidina Quinase/genética , Adulto JovemAssuntos
Neoplasias Induzidas por Radiação/prevenção & controle , Centrais Nucleares , Doenças Profissionais/prevenção & controle , Lesões por Radiação/prevenção & controle , Liberação Nociva de Radioativos , Bancos de Sangue , Transfusão de Sangue Autóloga , Humanos , Japão , Doenças Profissionais/etiologiaRESUMO
Metallo-beta-lactamase-producing multidrug-resistant Pseudomonas aeruginosa (MDR P. aeruginosa) is a cause of life-threatening infections. With parenteral colistin not available in Japan, we treated MDR P. aeruginosa sepsis with monobactam and aminoglycoside combination therapy, with screening using a 'break-point checkerboard plate'.
Assuntos
Aminoglicosídeos/uso terapêutico , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Monobactamas/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , beta-Lactamases/biossíntese , Quimioterapia Combinada/métodos , Feminino , Humanos , Japão , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Sepse/tratamento farmacológico , Sepse/microbiologia , Resultado do TratamentoRESUMO
Vitamin D insufficiency is a reemerging and common health problem for skeletal system. Pharmacological application of glucocorticoid inhibits intestinal calcium absorption and stimulates tubular calcium excretion, thus induces severely negative calcium balance. We report a patient presenting symptomatic hypocalcemia following high dose glucocorticoid administration. After a pulse-therapy with methylprednisolone, hypocalcemia with muscle cramp developed in association with hypercalciuria and secondary hyperparathyroidism in the absence of hypomagnesemia. Circulating level of 1,25-dihydroxyvitamin D was in a reference range, while that of 25-hydroxyvitamin D was insufficient. Treatment with alfacalcidol of 1 mug/day promptly improved serum calcium level within a couple of weeks. Vitamin D insufficiency could be a serious problem in patients with high dose glucocorticoid therapy.