RESUMEN
BACKGROUND: The Asia Pacific Society of Infection Control launched the APSIC guide for prevention of catheter associated urinary tract infections in July 2022. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities in the Asia Pacific region to achieve high standards in infection prevention and control practices during the management and care of patients with a urinary catheter. METHODS: The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. RESULTS: It recommends that healthcare institutions have a catheter associated urinary tract infection prevention program that includes surveillance and the use of the insertion and maintenance bundles. Implementation of the bundles is best done using a quality improvement approach with a multidisciplinary team. CONCLUSIONS: Healthcare facilities should aim for excellence in care of patients with urinary catheters. It is recommended that healthcare facilities have a catheter associated urinary tract infection prevention program as part of their Infection Prevention and Control program.
Asunto(s)
Infecciones Relacionadas con Catéteres , Infecciones Urinarias , Humanos , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Control de Infecciones , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/prevención & control , Infecciones Urinarias/epidemiología , Catéteres Urinarios/efectos adversosRESUMEN
HIV/AIDS remains one of the most serious public health problems in Thailand. This study aimed to assess the health-related quality of life (HRQOL) and its related factors among people living with HIV/AIDS (PLWHA) in Thailand. A cross-sectional study was conducted with 259 patients at a tertiary care hospital. HRQOL was assessed using the Thai version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. Socio-demographics and clinical status were measured using a self-administered questionnaire. Multiple linear regression models were used to explore associations between socio-demographic status, clinical status, and HRQL. Multiple linear regression analyses showed that employment status was strongly related to better overall physical and mental health summary scores (PHS, MHS). In addition, patients with disclosure of HIV status, aged over 50 years, and having at least a rating of good health in the nurses' opinion were the independent positive predictive factors for overall PHS. While being on antiretroviral therapy (ART) and good compliance with ART were positive predictive factors for overall MHS. Improving and strengthening quality of life among PLWHAs are important goals for HIV/AIDS services. Regular assessment of HRQL can provide potential information for intervention to improve quality of life.
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Infecciones por VIH/psicología , Estado de Salud , Salud Mental , Calidad de Vida , Centros de Atención Terciaria , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/psicología , Adulto , Factores de Edad , Antirretrovirales/uso terapéutico , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Modelos Lineales , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Factores Socioeconómicos , TailandiaRESUMEN
The performance of the settle plate method (SPM) compared with the microbiological air sampler method (MAS) for post-flood fungal bio-aerosol (FB) measurement was evaluated in a Thai hospital. Compared with closed-ventilation units, open-ventilation units had significantly higher median FB level by SPM on days 3 and 5 of incubation (270 vs 90 colony-forming units (cfu)/m(3) and 420 vs 180 cfu/m(3), respectively). Strong correlations between SPM and MAS results on day 3 (r = 1.60, P < 0.001) and day 5 (r = 1.49, P = 0.002) of incubation suggested the utility of SPM for post-flood FB measurement in open-ventilation units in resource-limited situations.
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Aerosoles , Microbiología del Aire , Hongos/aislamiento & purificación , Recuento de Colonia Microbiana/métodos , Hospitales , Humanos , Tailandia , Ventilación/métodosRESUMEN
SETTING: Human immunodeficiency virus (HIV) clinics at two Thai tertiary care medical centres. OBJECTIVES: To evaluate the efficacy of tuberculin skin test (TST) guided isoniazid preventive therapy (IPT) in combination with antiretroviral therapy (ART) in the prevention of tuberculosis (TB). DESIGN: A 4-year prospective comparative study of patients at two HIV clinics: one performed TST at enrolment and, if positive, prescribed IPT (IPT group), while the other did not perform TST (non-IPT group). RESULTS: There were 200 patients included in each group. Baseline characteristics and drop-out rates were similar in both groups. The incidence of pulmonary TB over 4 years was not significantly different between the IPT and non-IPT groups (0.80 cases vs. 1.76 per 100 person-years [py], P = 0.13). However, the incidence of pulmonary TB in the non-IPT group was significantly higher during the first 6 months (8.60 vs. 0 cases/100 py, P = 0.01) and among patients with initial CD4 < 200 cells/l (9.41 vs. 0 cases/100 py, P = 0.02). The survival analyses demonstrated a protective effect of IPT (x(2) = 3.66, P = 0.04) for early TB. CONCLUSIONS: Benefit of IPT plus ART was evident only in the first 6 months of care. These findings suggest that TST-guided IPT should be routinely provided for HIV-infected patients after initial entry into medical care.
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Antituberculosos/uso terapéutico , Infecciones por VIH/complicaciones , Isoniazida/uso terapéutico , Tuberculosis Pulmonar/prevención & control , Adulto , Fármacos Anti-VIH/uso terapéutico , Femenino , Estudios de Seguimiento , Infecciones por VIH/tratamiento farmacológico , Humanos , Incidencia , Masculino , Estudios Prospectivos , Tailandia/epidemiología , Factores de Tiempo , Prueba de Tuberculina , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiologíaRESUMEN
PURPOSE: To evaluate the impact of country socioeconomic status and hospital type on device-associated healthcare-associated infections (DA-HAIs) in neonatal intensive care units (NICUs). METHODS: Data were collected on DA-HAIs from September 2003 to February 2010 on 13,251 patients in 30 NICUs in 15 countries. DA-HAIs were defined using criteria formulated by the Centers for Disease Control and Prevention. Country socioeconomic status was defined using World Bank criteria. RESULTS: Central-line-associated bloodstream infection (CLA-BSI) rates in NICU patients were significantly lower in private than academic hospitals (10.8 vs. 14.3 CLA-BSI per 1,000 catheter-days; p < 0.03), but not different in public and academic hospitals (14.6 vs. 14.3 CLA-BSI per 1,000 catheter-days; p = 0.86). NICU patient CLA-BSI rates were significantly higher in low-income countries than in lower-middle-income countries or upper-middle-income countries [37.0 vs. 11.9 (p < 0.02) vs. 17.6 (p < 0.05) CLA-BSIs per 1,000 catheter-days, respectively]. Ventilator-associated-pneumonia (VAP) rates in NICU patients were significantly higher in academic hospitals than in private or public hospitals [13.2 vs. 2.4 (p < 0.001) vs. 4.9 (p < 0.001) VAPs per 1,000 ventilator days, respectively]. Lower-middle-income countries had significantly higher VAP rates than low-income countries (11.8 vs. 3.8 per 1,000 ventilator-days; p < 0.001), but VAP rates were not different in low-income countries and upper-middle-income countries (3.8 vs. 6.7 per 1,000 ventilator-days; p = 0.57). When examined by hospital type, overall crude mortality for NICU patients without DA-HAIs was significantly higher in academic and public hospitals than in private hospitals (5.8 vs. 12.5%; p < 0.001). In contrast, NICU patient mortality among those with DA-HAIs was not different regardless of hospital type or country socioeconomic level. CONCLUSIONS: Hospital type and country socioeconomic level influence DA-HAI rates and overall mortality in developing countries.
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Infecciones Relacionadas con Catéteres/mortalidad , Infección Hospitalaria/epidemiología , Países en Desarrollo , Unidades de Cuidado Intensivo Neonatal , Neumonía Asociada al Ventilador/mortalidad , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/microbiología , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Cateterismo Venoso Central/mortalidad , Infección Hospitalaria/sangre , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Contaminación de Equipos , Hospitales Privados/clasificación , Hospitales Públicos/clasificación , Hospitales de Enseñanza/clasificación , Humanos , Recién Nacido , Neumonía Asociada al Ventilador/epidemiología , Estudios Prospectivos , Factores Socioeconómicos , Ventiladores Mecánicos/efectos adversos , Ventiladores Mecánicos/microbiologíaRESUMEN
The tuberculin skin test (TST) is an important tool for the detection of latent tuberculosis (TB) and the identification of health care workers (HCWs) who require chemoprophylaxis. Although TST is inexpensive, easily available and the preferred test in most TB-prevalent settings, it has recognised limitations, including subjective interpretation, false positivity, cross reactivity with non-tuberculous mycobacteria, administration errors and the requirement for two visits. Given these limitations and the unavailability of better screening tests in resource-limited settings, the acceptance rate for chemoprophylaxis among HCWs has remained low. Furthermore, chemoprophylaxis in these settings is complicated by the high rate of drug-resistant TB, potential adverse reactions, prescription of chemoprophylaxis in undiagnosed active TB patients and the unavailability of follow-up systems provided by occupational health programmes. In the present article, we provide our viewpoint and a practical approach along with existing evidence supporting or discouraging the use of TST and isoniazid chemoprophylaxis for TB screening and management among HCWs in TB-prevalent settings.
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Antituberculosos/administración & dosificación , Personal de Salud , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Isoniazida/administración & dosificación , Tuberculosis Latente/prevención & control , Enfermedades Profesionales/prevención & control , Exposición Profesional , Salud Laboral , Prueba de Tuberculina , Actitud del Personal de Salud , Esquema de Medicación , Medicina Basada en la Evidencia , Conocimientos, Actitudes y Práctica en Salud , Humanos , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/epidemiología , Tuberculosis Latente/transmisión , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/epidemiología , Aceptación de la Atención de Salud , Valor Predictivo de las Pruebas , PrevalenciaRESUMEN
Detection by microneutralization of low-titre antibodies (anti-H5 micro-NT titre ≤ 1:80) against avian influenza virus (H5N1) is usually taken to be a false-positive result. In this prospective study of 242 intensive-care unit patients admitted for severe community-acquired pneumonia, the prevalence of low-titre anti-H5 micro-NT was 2.4%. Prior exposure to poultry was the sole independent risk factor for these low-titre antibodies (adjusted OR 42.41; 95% CI 22.45-64.51; p <0.001). We suggest that low anti-H5 micro-NT titres be interpreted in conjunction with plausible poultry, environmental and human exposure to H5N1.
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Infecciones Comunitarias Adquiridas/terapia , Glicoproteínas Hemaglutininas del Virus de la Influenza/sangre , Gripe Humana/diagnóstico , Neumonía/terapia , Virología/métodos , Adulto , Animales , Infecciones Comunitarias Adquiridas/diagnóstico , Enfermedad Crítica , Femenino , Humanos , Gripe Humana/epidemiología , Unidades de Cuidados Intensivos , Masculino , Pruebas de Neutralización/métodos , Neumonía/diagnóstico , PrevalenciaRESUMEN
Treatment limitations exist for drug-resistant Acinetobacter baumannii central nervous system (CNS) infection. We conducted a retrospective study and systematic literature review to identify patients with drug-resistant A. baumannii CNS infection who received primary or adjunct intrathecal or intraventricular (IT/IVT) colistin. In a case series of seven Thai patients and 17 patients identified in the literature, clinical and microbiological cure rates with IT/IVT colistin therapy were 83% and 92%, respectively. Three patients (13%) developed chemical ventriculitis and one (4%) experienced treatment-associated seizures. Death was associated with delayed IT/IVT colistin therapy compared to survival (mean time from diagnosis to IT/IVT colistin, 7 vs. 2 days; p 0.01). The only independent predictor of mortality was the severity of illness (APACHE II score > 19, adjusted odds ratio 49.5; 95% CI 1.7-1428.6; p 0.02). This case series suggests that administration of primary or adjunctive IT/IVT colistin therapy was effective for drug-resistant A. baumannii CNS infection.
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Infecciones por Acinetobacter/tratamiento farmacológico , Acinetobacter baumannii/efectos de los fármacos , Antibacterianos/administración & dosificación , Infecciones Bacterianas del Sistema Nervioso Central/tratamiento farmacológico , Infecciones del Sistema Nervioso Central/tratamiento farmacológico , Colistina/administración & dosificación , APACHE , Infecciones por Acinetobacter/microbiología , Adolescente , Adulto , Anciano , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Infecciones Bacterianas del Sistema Nervioso Central/microbiología , Niño , Preescolar , Colistina/efectos adversos , Colistina/farmacología , Colistina/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana Múltiple , Femenino , Humanos , Inyecciones Intraventriculares , Inyecciones Espinales , Masculino , Persona de Mediana Edad , Factores de Riesgo , Tailandia , Resultado del TratamientoAsunto(s)
Infecciones por VIH/terapia , Adolescente , Adulto , Recuento de Linfocito CD4 , Estudios de Factibilidad , Femenino , Infecciones por VIH/diagnóstico por imagen , Infecciones por VIH/inmunología , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Radiografía Torácica , TailandiaRESUMEN
SUMMARY: A cross-sectional study of 350 patients with HIV-1 infection was conducted to identify risks for pulmonary Mycobacterium tuberculosis (TB) after non-reactive two-step tuberculin skin tests (TST). Among 219 patients (62.6%) with non-reactive TST, independent risks for active pulmonary TB were prior known TB exposure (adjusted odds ratio [aOR] = 16.00, 95% confidence interval [CI] = 2.00-26.36, P = 0.008), CD4 <100 cells/microL (aOR = 2.50, 95% CI = 1.30-6.50, P = 0.04) and less than secondary-school education (aOR = 2.60, 95% CI = 1.50-6.90, P = 0.02). Our findings suggest that further diagnostic work-up for pulmonary TB is warranted among patients with HIV infection, non-reactive TSTs and either prior known TB exposure, CD4 counts <100 cells/microL or limited formal education.
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Infecciones por VIH/complicaciones , Prueba de Tuberculina , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis , Pobreza , Medición de Riesgo , Factores de Riesgo , Tuberculosis Pulmonar/microbiología , Adulto JovenRESUMEN
BACKGROUND: We report the design and analysis of a streamlined approach to the delivery of antiretroviral therapy (ART) that minimized risk for emergence of ART drug resistance (ART-DR) in a resource-limited setting. METHODS: The algorithm of care for persons with HIV comprised generic, fixed-dose, twice-daily stavudine, lamivudine and nevirapine (GPO-VIR), scheduled and unannounced pill counts and measurement of viral load at months 6 and 18 after initiation of ART. We evaluated adherence as measured by pill counts, HIV suppression and programmatic costs. RESULTS: Over a 4-year period, 214 of 330 patients (64.8%) were enrolled; baseline median CD4 count was 84 cells/microL. At month 1, nine patients (4.2%) discontinued GPO-VIR because of skin rash. At month 6, 199 patients (93%) achieved viral load < or =400 HIV-1 RNA copies/mL, with current alcohol use the sole predictor of treatment failure [adjusted Relative Risk (aRR)=1.67; 95% confidence interval=1.05-2.48; P<0.001]. Most patients (97%) with HIV suppression at month 6 had viral loads < or =50 copies/mL at month 18; all had > or =75% visit compliance and 192 (98%) had > or =75% adherence measured by pill counts. The estimated annual costs were $111.92 per patient for the pill counts, home visits and viral load measurement. CONCLUSIONS: Secure ART delivery, while minimizing risk for non-adherence and ART-DR, is clinically and economically feasible in this resource-limited setting.
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Antirretrovirales/uso terapéutico , Países en Desarrollo , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/economía , Lamivudine/uso terapéutico , Nevirapina/uso terapéutico , Estavudina/uso terapéutico , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4/economía , Costos de los Medicamentos , Farmacorresistencia Viral , Femenino , Infecciones por VIH/inmunología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Tailandia , Insuficiencia del Tratamiento , Carga Viral/economía , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the prevalence and patterns of antiretroviral (ARV) drug resistance (ARV-DR) among ARV drug-naïve, recently infected persons with HIV in the 4-year interval (2003-2006) after the inception of the National Access to ARV Programme for People who have AIDS in Thailand. METHODS: Cross-sectional study of patients with recent HIV infection for HIV risks, ARV-DR risks and baseline ARV-DR. RESULTS: Seven of the 305 patients (2%) had baseline ARV-DR. Via contract tracing, all seven patients with transmitted ARV-DR identified sexual partners with prior ARV treatment failure and had documented low (<75%) ARV adherence. Annual ARV-DR increased from 0 to 5.2% (P=0.06) between 2003 and 2006. CONCLUSIONS: Report of sexual partners with potential HIV and ARV drug exposures can prompt baseline ARV-DR testing of at-risk individuals, while behavioural interventions for adherence and safer sex are refined to minimize the emergence of resistance to generic, fixed-dose combination stavudine, lamivudine and nevirapine (GPO-VIR) therapy.
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Antirretrovirales/uso terapéutico , Farmacorresistencia Viral/efectos de los fármacos , Infecciones por VIH/tratamiento farmacológico , Adolescente , Adulto , Condones , Estudios Transversales , Farmacorresistencia Viral/genética , Femenino , Infecciones por VIH/genética , Infecciones por VIH/transmisión , VIH-1/efectos de los fármacos , VIH-1/genética , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Estudios Prospectivos , ARN Viral/genética , Conducta Sexual/psicología , Tailandia , Carga ViralAsunto(s)
Aeromonas hydrophila/aislamiento & purificación , Epiglotitis , Fascitis Necrotizante , Infecciones por Bacterias Gramnegativas , Infecciones de los Tejidos Blandos , Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Epiglotitis/diagnóstico , Epiglotitis/tratamiento farmacológico , Epiglotitis/microbiología , Epiglotitis/cirugía , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/tratamiento farmacológico , Fascitis Necrotizante/microbiología , Fascitis Necrotizante/cirugía , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones de los Tejidos Blandos/microbiología , Infecciones de los Tejidos Blandos/cirugíaRESUMEN
Clostridium difficile is a well-known cause of sporadic and healthcare-associated diarrhea. Multihospital outbreaks due to a single strain and outbreaks associated with antibiotic selective pressure, especially clindamycin, have been well documented. Severe cases and fatalities from C. difficile are uncommon. The recent global emergence of a hypervirulent strain containing binary toxin (Toxinotype III ribotype 027), with or without deletion in a regulatory gene (tcdC gene), together with high-level resistance to third generation fluoroquinolones, has been associated with increased morbidity and mortality. Although the defective regulatory gene locus is associated with increased toxin production in vitro, the in vivo significance of this mutation and of the binary toxin remains undefined. To date, treatment strategies have not evolved in response to the emergence of this hypervirulaent strain. We provide a critical, quantitative summary of the evolving clinical and molecular epidemiology of C. difficile along with implications relevant to future treatment strategies.
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Antibacterianos/farmacología , Clostridioides difficile/efectos de los fármacos , Clostridioides difficile/patogenicidad , Diarrea/microbiología , Farmacorresistencia Bacteriana , Fluoroquinolonas/farmacología , Adulto , Anciano de 80 o más Años , Proteínas Bacterianas/biosíntesis , Proteínas Bacterianas/genética , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/mortalidad , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Diarrea/epidemiología , Diarrea/mortalidad , Humanos , Epidemiología Molecular , Regiones Promotoras Genéticas , Proteínas Represoras/biosíntesis , Proteínas Represoras/genética , VirulenciaRESUMEN
OBJECTIVES: The aim of the study was to determine the incidence of, and risk factors for, nevirapine (NVP)-associated hepatotoxicity and rash in HIV-infected Thai men and women, including pregnant women, receiving NVP-containing highly active antiretroviral therapy (HAART). METHODS: NVP-containing HAART was prescribed to eligible men and women enrolled in the Prevention of Mother-To-Child Transmission of HIV (PMTCT) and MTCT-Plus programmes. All pregnant women received zidovudine (ZDV)/lamivudine (3TC)/NVP from >14 weeks of gestational age if their CD4 cell count was
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Terapia Antirretroviral Altamente Activa/efectos adversos , Erupciones por Medicamentos/etiología , Infecciones por VIH/tratamiento farmacológico , Nevirapina/efectos adversos , Piel/efectos de los fármacos , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Non-neoformans cryptococci have been generally regarded as saprophytes and rarely reported as human pathogens. However, the incidence of infection due to these organisms has increased over the past 40 years, with Cryptococcus laurentii and Cryptococcus albidus, together, responsible for 80% of reported cases. Conditions associated with impaired cell-mediated immunity are important risks for non-neoformans cryptococcal infections and prior azole prophylaxis has been associated with antifungal resistance. The presence of invasive devices was a significant risk factor for Cryptococcus laurentii infection (adjusted OR = 8.7; 95% CI = 1.48-82.9; p = 0.003), while predictors for mortality included age > or =45 years (aOR = 8.4; 95% CI = 1.18-78.82; p = 0.004) and meningeal presentation (aOR = 7.0; 95% CI = 1.85-60.5; p= 0.04). Because clinical manifestations of non-neoformans cryptococcal infections are most often indistinguishable from Cryptococcus neoformans, a high index of suspicion remains important to facilitate early diagnosis and prompt treatment for such infections.
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Criptococosis/tratamiento farmacológico , Anfotericina B/uso terapéutico , Criptococosis/etiología , Criptococosis/prevención & control , Farmacorresistencia Fúngica , Humanos , Factores de RiesgoRESUMEN
Chylous ascites (CA) is a rare manifestation of tuberculosis. We report a case of CA due to tuberculosis in an HIV-infected patient and review the literature on CA in HIV disease. This patient was successfully treated with large volume abdominal paracentesis, antituberculous drugs, and parenteral medium chain triglycerides.
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Ascitis Quilosa/etiología , Ascitis Quilosa/terapia , Infecciones por VIH/complicaciones , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis/complicaciones , Adulto , Antituberculosos/uso terapéutico , Humanos , Masculino , Paracentesis , Triglicéridos/uso terapéutico , Tuberculosis/tratamiento farmacológicoRESUMEN
Disseminated nocardiosis has never been described before in a patient with Waldenstrom macroglobulinemia. We report an unusual case of disseminated nocardiosis in a patient with Waldenstrom macroglobulinemia who presented with pulmonary non-caseating granulomas. The patient was successfully treated with trimethoprim-sulfamethoxazole (TMP-SMX) for 1 year.
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Nocardiosis/complicaciones , Nocardia asteroides , Granuloma de Células Plasmáticas del Pulmón/microbiología , Macroglobulinemia de Waldenström/complicaciones , Absceso , Discitis/microbiología , Humanos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Nocardiosis/diagnóstico por imagen , Osteomielitis/microbiología , Granuloma de Células Plasmáticas del Pulmón/diagnóstico por imagen , Absceso del Psoas/microbiología , RadiografíaRESUMEN
Successful treatment outcome for cryptococcal disease has been available since the introduction of the polyene antifungal, amphotericin B. Over the past 15-20 years, treatment of acute cryptococcal disease has dramatically improved. Several therapeutic strategies have been introduced which improve overall outcome of therapy and help decrease the duration of treatment. Not surprisingly, most data now exists on the treatment of AIDS-associated cryptococcal disease, especially cryptococcal meningitis. Currently, amphotericin B with or without flucytosine is regarded as the best initial therapy for patients with meningitis or more severe illness, although, the azoles and other formulations of amphotericin B can considered in other situations. The choice of treatment for cryptococcal disease depends on both the anatomic sites of involvement and the host's immune status, all of which will be addressed in this article.
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Antifúngicos/uso terapéutico , Meningitis Criptocócica/tratamiento farmacológico , Enfermedad Aguda , Animales , Antifúngicos/farmacología , Cryptococcus neoformans/efectos de los fármacos , Cryptococcus neoformans/inmunología , Humanos , Meningitis Criptocócica/inmunologíaRESUMEN
Neisseria elongata subsp. elongata, previously considered nonpathogenic, is a potential agent of human endocarditis. We report the second case of human endocarditis caused by this organism. The patient was successfully treated with Ceftriaxone alone for a total of six weeks.