RESUMEN
A 5-year-old patient treated for acute lymphoblastic leukaemia (ALL) developed proven pulmonary invasive fungal disease (IFD) due to Actinomucor elegans. While completing ALL treatment according to AIEOP ALL protocol 2009 for further 15 months, antifungal treatment with liposomal amphotericin B and intermittent additional posaconazole was continued until immune reconstitution 7 months after the end of ALL treatment. Repeated imaging guided treatment decisions. Twenty-six and 19 months after the end of ALL treatment and antifungal treatment, respectively, the patient is still in the first complete remission and shows no signs of active invasive fungal disease (IFD).
Asunto(s)
Anfotericina B/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Mucormicosis/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Antifúngicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Asparaginasa/administración & dosificación , Preescolar , Ciclofosfamida/administración & dosificación , Citarabina/administración & dosificación , Daunorrubicina/administración & dosificación , Humanos , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Mercaptopurina/administración & dosificación , Metotrexato/administración & dosificación , Mucorales/aislamiento & purificación , Leucemia-Linfoma Linfoblástico de Células Precursoras/microbiología , Prednisona/administración & dosificación , Inducción de Remisión , Triazoles/uso terapéutico , Vincristina/administración & dosificaciónRESUMEN
PURPOSE: Increased gut permeability causes the trespass of antigens into the blood stream which leads to inflammation. Gut permeability reflected by serum zonulin and diversity of the gut microbiome were investigated in this cross-sectional study involving female study participants with different activity and BMI levels. METHODS: 102 women were included (BMI range 13.24-46.89 kg m-2): Anorexia nervosa patients (n = 17), athletes (n = 20), normal weight (n = 25), overweight (n = 21) and obese women (n = 19). DNA was extracted from stool samples and subjected to 16S rRNA gene analysis (V1-V2). Quantitative Insights Into Microbial Ecology (QIIME) was used to analyze data. Zonulin was measured with ELISA. Nutrient intake was assessed by repeated 24-h dietary recalls. We used the median of serum zonulin concentration to divide our participants into a "high-zonulin" (> 53.64 ng/ml) and "low-zonulin" (< 53.64 ng/ml) group. RESULTS: The alpha-diversity (Shannon Index, Simpson Index, equitability) and beta-diversity (unweighted and weighted UniFrac distances) of the gut microbiome were not significantly different between the groups. Zonulin concentrations correlated significantly with total calorie-, protein-, carbohydrate-, sodium- and vitamin B12 intake. Linear discriminant analysis effect size (LEfSe) identified Ruminococcaceae (LDA = 4.163, p = 0.003) and Faecalibacterium (LDA = 4.151, p = 0.0002) as significantly more abundant in the low zonulin group. CONCLUSION: Butyrate-producing gut bacteria such as Faecalibacteria could decrease gut permeability and lower inflammation. The diversity of the gut microbiota in women does not seem to be correlated with the serum zonulin concentration. Further interventional studies are needed to investigate gut mucosal permeability and the gut microbiome in the context of dietary factors.
Asunto(s)
Toxina del Cólera/sangre , Dieta , Microbioma Gastrointestinal , Intestinos/microbiología , Adolescente , Adulto , Biomarcadores/sangre , Índice de Masa Corporal , Colesterol/sangre , Carbohidratos de la Dieta , Grasas de la Dieta/administración & dosificación , Proteínas en la Dieta/administración & dosificación , Impedancia Eléctrica , Femenino , Haptoglobinas , Humanos , Evaluación Nutricional , Obesidad/sangre , Obesidad/microbiología , Sobrepeso/sangre , Sobrepeso/microbiología , Permeabilidad , Precursores de Proteínas , Triglicéridos/sangre , Adulto JovenRESUMEN
Spontaneous rupture of the ascending aorta is a life-threatening condition requiring immediate intervention. The rupture usually leads to sudden death as a result of hemopericardium or hemothorax. The underlying histopathological condition in the cases described so far was mostly an atheromatous plaque. Some other rare underlying conditions were also described. We report a case of cystic medial necrosis Erdheim Gsell as a reason for fatal spontaneous rupture of the ascending aorta.
Asunto(s)
Rotura de la Aorta/etiología , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/patología , Rotura de la Aorta/patología , Autopsia , Quistes/complicaciones , Quistes/patología , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Rotura EspontáneaRESUMEN
BACKGROUND: This study evaluated the consequences in Europe of the COVID-19 outbreak on pathology laboratories orientated toward the diagnosis of thoracic diseases. MATERIALS AND METHODS: A survey was sent to 71 pathology laboratories from 21 European countries. The questionnaire requested information concerning the organization of biosafety, the clinical and molecular pathology, the biobanking, the workload, the associated research into COVID-19, and the organization of education and training during the COVID-19 crisis, from 15 March to 31 May 2020, compared with the same period in 2019. RESULTS: Questionnaires were returned from 53/71 (75%) laboratories from 18 European countries. The biosafety procedures were heterogeneous. The workload in clinical and molecular pathology decreased dramatically by 31% (range, 3%-55%) and 26% (range, 7%-62%), respectively. According to the professional category, between 28% and 41% of the staff members were not present in the laboratories but did teleworking. A total of 70% of the laboratories developed virtual meetings for the training of residents and junior pathologists. During the period of study, none of the staff members with confirmed COVID-19 became infected as a result of handling samples. CONCLUSIONS: The COVID-19 pandemic has had a strong impact on most of the European pathology laboratories included in this study. Urgent implementation of several changes to the organization of most of these laboratories, notably to better harmonize biosafety procedures, was noted at the onset of the pandemic and maintained in the event of a new wave of infection occurring in Europe.
Asunto(s)
COVID-19/prevención & control , Servicios de Laboratorio Clínico/estadística & datos numéricos , Patología Clínica/estadística & datos numéricos , Patología Molecular/estadística & datos numéricos , Encuestas y Cuestionarios , Enfermedades Torácicas/diagnóstico , Bancos de Muestras Biológicas/organización & administración , Bancos de Muestras Biológicas/estadística & datos numéricos , COVID-19/epidemiología , COVID-19/virología , Servicios de Laboratorio Clínico/tendencias , Contención de Riesgos Biológicos/estadística & datos numéricos , Brotes de Enfermedades , Europa (Continente)/epidemiología , Predicción , Humanos , Pandemias , Patología Clínica/métodos , Patología Clínica/tendencias , Patología Molecular/métodos , Patología Molecular/tendencias , SARS-CoV-2/aislamiento & purificación , SARS-CoV-2/fisiología , Manejo de Especímenes/métodos , Manejo de Especímenes/estadística & datos numéricos , Enfermedades Torácicas/terapiaRESUMEN
BACKGROUND: Faecal microbiota transplantation is an experimental approach for the treatment of patients with ulcerative colitis. Although there is growing evidence that faecal microbiota transplantation is effective in this disease, factors affecting its response are unknown. AIMS: To establish a faecal microbiota transplantation treatment protocol in ulcerative colitis patients, and to investigate which patient or donor factors are responsible for the treatment success. METHODS: This is an open controlled trial of repeated faecal microbiota transplantation after antibiotic pre-treatment (FMT-group, n = 17) vs antibiotic pre-treatment only (AB-group, n = 10) in 27 therapy refractory ulcerative colitis patients over 90 days. Faecal samples of donors and patients were analysed by 16SrRNA gene-based microbiota analysis. RESULTS: In the FMT-group, 10/17 (59%) of patients showed a response and 4/17 (24%) a remission to faecal microbiota transplantation. Response to faecal microbiota transplantation was mainly influenced by the taxonomic composition of the donor's microbiota. Stool of donors with a high bacterial richness (observed species remission 946 ± 93 vs no response 797 ± 181 at 15367 rps) and a high relative abundance of Akkermansia muciniphila (3.3 ± 3.1% vs 0.1 ± 0.2%), unclassified Ruminococcaceae (13.8 ± 5.0% vs 7.5 ± 3.7%), and Ruminococcus spp. (4.9 ± 3.5% vs 1.0 ± 0.7%) were more likely to induce remission. In contrast antibiotic treatment alone (AB-group) was poorly tolerated, probably because of a sustained decrease of intestinal microbial richness. CONCLUSIONS: The taxonomic composition of the donor's intestinal microbiota is a major factor influencing the efficacy of faecal microbiota transplantation in ulcerative colitis patients. The design of specific microbial preparation might lead to new treatments for ulcerative colitis.
Asunto(s)
Colitis Ulcerosa/terapia , Trasplante de Microbiota Fecal/métodos , Microbioma Gastrointestinal , Adulto , Antibacterianos/administración & dosificación , Heces/microbiología , Humanos , Masculino , Microbiota , Persona de Mediana Edad , Estudios Prospectivos , Inducción de Remisión , Ruminococcus , Resultado del Tratamiento , Adulto JovenAsunto(s)
Enfermedades del Esófago/virología , Herpes Zóster/complicaciones , Herpesvirus Humano 3/aislamiento & purificación , Úlcera/virología , Aciclovir/uso terapéutico , Anciano de 80 o más Años , Antivirales/uso terapéutico , ADN Viral/aislamiento & purificación , Úlcera Duodenal/patología , Úlcera Duodenal/virología , Enfermedades del Esófago/patología , Herpes Zóster/tratamiento farmacológico , Herpesvirus Humano 3/genética , Humanos , Masculino , Úlcera Gástrica/patología , Úlcera Gástrica/virología , Úlcera/patologíaRESUMEN
Campylobacter fetus comprises two subspecies, C. fetus subsp. fetus and C. fetus subsp. venerealis, which are considered emerging pathogens in humans and animals. Comparisons at the genome level have revealed modest subspecies-specific variation; nevertheless, these two subspecies show distinct host and niche preferences. C. fetus subsp. fetus is a commensal and pathogen of domesticated animals that can be transmitted to humans via contaminated food. The clinical features of human infection can be severe, especially in impaired hosts. In contrast, C. fetus subsp. venerealis is a sexually transmitted pathogen essentially restricted to cattle. Infections leading to bovine venereal campylobacteriosis cause substantial economic losses due to abortion and infertility. Recent genome sequencing of the two subspecies has advanced our understanding of C. fetus adaptations through comparative genomics and the identification of subspecies-specific gene regions predicted to be involved in pathogenesis. The most striking difference between the subspecies is the highly subspecies-specific association of a pathogenicity island in the C. fetus subsp. venerealis chromosome. The inserted region encodes a Type 4 secretion system, which contributes to virulence properties of this organism in vitro. This review describes the main differences in epidemiological, phenotypic, and molecular characteristics of the two subspecies and summarizes recent advances towards understanding the molecular mechanisms of C. fetus pathogenesis.
RESUMEN
We describe a severe and recurrent septicemia due to Campylobacter in a 75-year-old immunocompetent patient. Two Campylobacter strains were detected in several blood cultures. Campylobacter fetus and Campylobacter lari were identified with PCR tests based on species-specific nucleotide sequences for the 16S rRNA gene.
Asunto(s)
Bacteriemia/diagnóstico , Infecciones por Campylobacter/diagnóstico , Campylobacter fetus/aislamiento & purificación , Inmunocompetencia , Anciano , Antibacterianos , Bacteriemia/tratamiento farmacológico , Bacteriemia/inmunología , Campylobacter/clasificación , Infecciones por Campylobacter/tratamiento farmacológico , Infecciones por Campylobacter/inmunología , Quimioterapia Combinada/administración & dosificación , Estudios de Seguimiento , Humanos , Masculino , Reacción en Cadena de la Polimerasa/métodos , ARN Bacteriano/análisis , Recurrencia , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
For febrile neutropenic patients who received hematopoietic stem cell transplantation, the Gram stain-acridine orange leukocyte cytospin (AOLC) test and the differential-time-to-positivity method (DTP) were performed. As a diagnostic tool for catheter-related bloodstream infections in these patients, the Gram stain-AOLC test has a lower sensitivity than does the DTP method but acceptable positive and negative predictive values.