RESUMO
INTRODUCTION: Rapid antigen detection (RAD) tests are convenient tools for detecting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in clinics, and testing using saliva samples could decrease the risk of infection during sample collection. This study aimed to assess the accuracy of the SARS-CoV-2 RAD for testing of nasopharyngeal swab specimens and saliva samples in comparison with the RT-PCR tests and viral culture for detecting viable virus. METHODS: One hundred seventeen nasopharyngeal swab specimens and 73 saliva samples with positive results on RT-PCR were used. Residual samples were assayed using a commercially available RAD test immediately, and its positivity was determined at various time points during the clinical course. The concordance between 54 nasopharyngeal swab samples and saliva samples that were collected simultaneously was determined. Viral culture was performed on 117 samples and compared with the results of the RAD test. RESULTS: The positive rate of RAD test using saliva samples was low throughout the clinical course. Poor concordance was observed between nasopharyngeal swab specimens and saliva samples (75.9%, kappa coefficient 0.310). However, a substantially high concordance between the RAD test and viral culture was observed in both nasopharyngeal swab specimens (86.8%, kappa coefficient 0.680) and saliva samples (95.1%, kappa coefficient 0.643). CONCLUSIONS: The sensitivity of the SARS-CoV-2 RAD test was insufficient, particularly for saliva samples. However, a substantially high concordance with viral culture suggests its potential utility as an auxiliary test for estimating SARS-CoV-2 viability.
Assuntos
COVID-19 , SARS-CoV-2 , Humanos , Nasofaringe , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SalivaRESUMO
Rationale: Improved therapeutic options are needed for patients with treatment-refractory nontuberculous mycobacterial lung disease caused by Mycobacterium avium complex (MAC). Objectives: To evaluate the efficacy and safety of daily amikacin liposome inhalation suspension (ALIS) added to standard guideline-based therapy (GBT) in patients with refractory MAC lung disease. Methods: Adults with amikacin-susceptible MAC lung disease and MAC-positive sputum cultures despite at least 6 months of stable GBT were randomly assigned (2:1) to receive ALIS with GBT (ALIS + GBT) or GBT alone. Once-daily ALIS was supplied in single-use vials delivering 590 mg amikacin to the nebulizer. The primary endpoint was culture conversion, defined as three consecutive monthly MAC-negative sputum cultures by Month 6. Measurements and Main Results: Enrolled patients (ALIS + GBT, n = 224; GBT-alone, n = 112) were a mean 64.7 years old and 69.3% female. Most had underlying bronchiectasis (62.5%), chronic obstructive pulmonary disease (14.3%), or both (11.9%). Culture conversion was achieved by 65 of 224 patients (29.0%) with ALIS + GBT and 10 of 112 (8.9%) with GBT alone (odds ratio, 4.22; 95% confidence interval, 2.08-8.57; P < 0.001). Patients in the ALIS + GBT arm versus GBT alone were more likely to achieve conversion (hazard ratio, 3.90; 95% confidence interval, 2.00-7.60). Respiratory adverse events (primarily dysphonia, cough, and dyspnea) were reported in 87.4% of patients receiving ALIS + GBT and 50.0% receiving GBT alone; serious treatment-emergent adverse events occurred in 20.2% and 17.9% of patients, respectively. Conclusions: Addition of ALIS to GBT for treatment-refractory MAC lung disease achieved significantly greater culture conversion by Month 6 than GBT alone, with comparable rates of serious adverse events. Clinical trial registered with www.clinicaltrials.gov (NCT02344004).
Assuntos
Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Pneumopatias/tratamento farmacológico , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Administração por Inalação , Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Feminino , Humanos , Lipossomos , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Complexo Mycobacterium avium , Estudos Prospectivos , Resultado do TratamentoRESUMO
Some infectious diseases, such as infective endocarditis, osteomyelitis, and abscesses, require treatment with long-term intravenous antimicrobial treatment. Therefore, the patient is required to stay in the hospital to receive therapy, which lowers their quality of life. Establishing an outpatient parenteral antimicrobial therapy (OPAT) by continuous infusion pump is desired in Japan to overcome these issues. However, the 24-h stability of antimicrobial agents dissolved in infusion solutions is unclear. Thus, we investigated the stability of antimicrobial agents in five different infusion solutions in a clinical setting. Benzylpenicillin potassium (PCG) and ampicillin (ABPC) were dissolved separately in five different infusion solutions and kept at 25 or 31.1 °C for 24 h. The residual ratios were determined by high-performance liquid chromatography (HPLC). Dissolved PCG in acetate ringer solution remained stable for 24 h at temperatures of 25 and 31.1 °C (101.7 ± 1.4% and 92.9 ± 1.3%, respectively). In addition, the PCG solution did not adsorb onto the elastomeric infusion pump after 24 h at 31.1 °C. PCG dissolved in acetate ringer solution was also stable for 10 days after being kept in an elastomeric infusion pump at 4 °C (99.7 ± 0.5%). ABPC was unstable in all of the tested infusion solutions and temperatures. Based on our results, PCG in acetate ringer solution can be used in OPAT with continuous infusion pumps.
Assuntos
Ampicilina/administração & dosagem , Ampicilina/química , Antibacterianos/administração & dosagem , Antibacterianos/química , Bombas de Infusão , Penicilina G/administração & dosagem , Penicilina G/química , Estabilidade de Medicamentos , Elastômeros , Humanos , Concentração de Íons de Hidrogênio , Infusões Intravenosas , Soluções Isotônicas/administração & dosagem , Soluções Isotônicas/química , Japão , Temperatura , Fatores de TempoRESUMO
Aggregatibacter actinomycetemcomitans is well-known as the pathogen of gingivitis or periodontitis, and discitis or vertebral osteomyelitis cases caused by this organism have rarely been reported. Ampicillin or amoxicillin has been used in the previously reported discitis cases; however, no cases have been reported that is treated with levofloxacin. We report the first published case we chose levofloxacin to treat. We failed to perform the susceptibility testing because of the poor growth and fastidious nature of the organism, and the result of susceptibility of amoxicillin was unclear. Levofloxacin, which A. actinomycetemcomitans is usually susceptible to, can be an effective alternative oral antimicrobial agent in such cases.
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Aggregatibacter actinomycetemcomitans/efeitos dos fármacos , Antibacterianos/uso terapêutico , Discite/tratamento farmacológico , Levofloxacino/uso terapêutico , Infecções por Pasteurellaceae/tratamento farmacológico , Administração Oral , Sedimentação Sanguínea/efeitos dos fármacos , Nitrogênio da Ureia Sanguínea , Proteína C-Reativa/análise , Discite/sangue , Discite/diagnóstico , Feminino , Febre , Humanos , Dor Lombar , Pessoa de Meia-Idade , Infecções por Pasteurellaceae/sangue , Infecções por Pasteurellaceae/diagnósticoRESUMO
OBJECTIVE: We studied the relationships between plasma and saliva concentrations of antiretroviral drugs to explore whether saliva can be used for therapeutic drug monitoring (TDM). METHODS: Abacavir (ABC), tenofovir (TFV), darunavir (DRV), and raltegravir (RAL) in plasma and saliva from 30 HIV-1-infected patients were quantified using liquid chromatography-tandem mass spectrometry. RESULTS: Mean saliva-to-plasma concentration ratios were 0.623 (ABC), 0.024 (TFV), 0.065 (DRV), and 0.0135 (RAL), which agree with the plasma protein binding rates except TFV. Significant correlations were evident between saliva and plasma concentrations of ABC, DRV, and RAL. CONCLUSIONS: This study suggests that plasma concentrations of ABC, DRV, and RAL can be estimated from their saliva concentrations and that the saliva concentration of some antiretroviral drugs reflects the unbound drug concentration in plasma.â©.
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Fármacos Anti-HIV/sangue , Darunavir/sangue , Didesoxinucleosídeos/sangue , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Raltegravir Potássico/sangue , Saliva/metabolismo , Tenofovir/sangue , Adulto , Idoso , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/farmacocinética , Cromatografia Líquida , Darunavir/administração & dosagem , Darunavir/farmacocinética , Didesoxinucleosídeos/administração & dosagem , Didesoxinucleosídeos/farmacocinética , Monitoramento de Medicamentos/métodos , Quimioterapia Combinada , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , HIV-1/patogenicidade , Humanos , Masculino , Pessoa de Meia-Idade , Ligação Proteica , Raltegravir Potássico/administração & dosagem , Raltegravir Potássico/farmacocinética , Espectrometria de Massas em Tandem , Tenofovir/administração & dosagem , Tenofovir/farmacocinéticaRESUMO
The number of reported cases of bacteremia due to Rothia mucilaginosa (R. mucilaginosa), a component of the normal flora of human gastrointestinal tract mucosa, is limited. We encountered three cases of bacteremia due to R. mucilaginosa during neutropenia after chemotherapy for myeloid malignancies. Although all three patients were successfully treated with antimicrobial agents, one patient developed disseminated lesions in the lungs and soft tissue. The portal of R. mucilaginosa bacteremia is reportedly mucositis or dental disorders; however, no such complications were identified in our patients. Even in the absence of a preexisting portal, R. mucilaginosa should be recognized as a potential causative pathogen of bacteremia during neutropenic periods. Accumulations of cases and isolates are required to further elucidate the risk factors for developing R. mucilaginosa bacteremia, its clinical course, and the optimal antimicrobial treatment.
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Antibacterianos/uso terapêutico , Antineoplásicos/uso terapêutico , Bacteriemia/tratamento farmacológico , Neoplasias da Medula Óssea/tratamento farmacológico , Leucemia Mieloide Aguda/tratamento farmacológico , Micrococcaceae/isolamento & purificação , Sarcoma/tratamento farmacológico , Adulto , Bacteriemia/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: CONVERT, a randomized, active-controlled, global, Phase 3 trial demonstrated that patients with treatment-refractory Mycobacterium avium complex (MAC) pulmonary disease were more likely to achieve culture conversion with amikacin liposome inhalation suspension (ALIS) plus guideline-based therapy (GBT) versus those continuing on GBT alone. This subgroup analysis reports the efficacy and safety of ALIS in Japanese patients enrolled in CONVERT. METHODS: Japanese patients aged ≥20 years with treatment-refractory MAC pulmonary disease from Japanese sites were included. Patients were randomized to receive once-daily 590 mg ALIS + GBT or GBT alone; patients converting by Month 6 remained in the study to complete 12-month treatment followed by a 12-month off-treatment period. Nonconverters exited the study at Month 8. The primary endpoint was the proportion of patients achieving culture conversion by Month 6. RESULTS: Of the 59 Japanese patients screened, 48 were randomized to receive ALIS + GBT (n = 34) or GBT alone (n = 14), and 41/48 (85.4 %) were women. The mean (standard deviation) age of patients was 64.5 (8.6) years, and 83.3 % of patients had bronchiectasis at baseline. By Month 6, sputum culture conversion was cumulatively achieved in 9/34 (26.5 %) patients receiving ALIS + GBT versus none receiving GBT alone. Treatment-emergent adverse events were reported in 94.1 % and 100.0 % of patients receiving ALIS + GBT and GBT alone, respectively. No deaths were reported. CONCLUSIONS: The efficacy observed in the Japanese subpopulation was largely consistent with that in the overall CONVERT study population, with more patients achieving culture conversion with ALIS + GBT versus GBT alone. Safety profiles were similar between the overall population and the Japanese subpopulation. CLINICAL TRIAL REGISTRATION: NCT02344004.
Assuntos
Pneumopatias , Infecção por Mycobacterium avium-intracellulare , Feminino , Humanos , Masculino , Amicacina/efeitos adversos , Antibacterianos/efeitos adversos , Japão , Lipossomos/uso terapêutico , Pneumopatias/induzido quimicamente , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Pessoa de Meia-Idade , IdosoRESUMO
A 72-year-old man was admitted to our hospital with complaints of dry mouth, muscle weakness of the lower limbs and gait disturbance. The patient had dry mouth, dry eyes, positive anti-SS-B antibody and salivary gland inflammation. Sjögren's syndrome was diagnosed. Since muscle weakness of the lower limbs and gait disturbance were not compatible with Sjögren's syndrome, we considered the possibility of paraneoplastic syndrome. Serum levels of CEA, NSE and ProGRP were elevated. Chest roentgenogram and CT showed a nodular lesion in the right upper lobe of the lung and swollen lymph nodes in the hilum and mediastinum. Small cell lung cancer was diagnosed by bronchoscopy. Anti-P/Q-type Ca2+ channel antibody was positive. Electromyogram showed a reduction in the amplitude of the evoked muscle action potential response after slow repetitive stimulation and did not show a reduction after rapid repetitive stimulation. Based on these findings, we made a diagnosis of Lambert-Eaton myasthenic syndrome (LEMS). Concurrent chemoradiotherapy induced an improvement of muscle weakness of the lower limbs. LEMS is frequently associated with a malignant tumor and an autoimmune disorder. We thought that in this patient, the presentation of LEMS was apparent because he had both Sjögren's syndrome and small cell lung cancer.
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Carcinoma de Células Pequenas/complicações , Síndrome Miastênica de Lambert-Eaton/etiologia , Neoplasias Pulmonares/complicações , Síndrome de Sjogren/complicações , Idoso , Carcinoma de Células Pequenas/diagnóstico , Carcinoma de Células Pequenas/terapia , Terapia Combinada , Humanos , Síndrome Miastênica de Lambert-Eaton/diagnóstico , Síndrome Miastênica de Lambert-Eaton/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Masculino , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/terapiaRESUMO
Photocrosslinked polyacrylic acid (PAA-HEMA) hydrogels are a promising candidate for use in dermatological patch adhesives. To gain further knowledge about the properties of this gel, we investigated the T1 relaxation time and the diffusion coefficient (D) of water in the hydrogels using magnetic resonance (MR) imaging. Hydrogels with different formulations and process factors were prepared and tested. The observed data were analyzed by ANOVA, which clarified the mode of action of the formulation and process factors based on these MR parameters. Various gel properties (i.e., gel fraction, swelling capacity, gel strength, and water-retention ability) were also measured, followed by a Bayesian network (BN) analysis. The BN allowed us to summarize well the relationships between the formulation and process factors, MR parameters, and gel properties. T1 was associated with the swelling and water-retention properties of the hydrogel, whereas D was associated with gel formation and gel strength. Furthermore, this study clarified that T1 and D mostly represented the hydration and water-compartmentalization effects of the hydrogel, respectively. In conclusion, the state of water seems to play an important role in the properties of the PAA-HEMA hydrogel.