RESUMO
Antifungal treatment in the hematological patient has reached a high complexity with the advent of new antifungals and diagnostic tests, which have resulted in different therapeutic strategies. The use of the most appropriate treatment in each case is essential in infections with such a high mortality. The availability of recommendations as those here reported based on the best evidence and developed by a large panel of 48 specialists aimed to answer when is indicated to treat and which agents should be used, considering different aspects of the patient (risk of fungal infection, clinical manifestations, galactomanann test, chest CT scan and previous prophylaxis) may help clinicians to improve the results.
Assuntos
Antifúngicos/uso terapêutico , Doenças Hematológicas/complicações , Micoses/complicações , Micoses/tratamento farmacológico , Humanos , Leucemia/complicações , Micoses/microbiologia , Síndromes Mielodisplásicas/complicações , RiscoRESUMO
Diseases of the gastrointestinal system frequently complicate immunosuppressed patients. Endogenous flora is the principal source of infection in humans, especially in patients with dysfunction of the digestive epithelial barrier due to various factors. Bacterial translocation, traumatisms, ischemia and surgery are frequent events in the general population. In addition, important risk factors for abdominal infections in specific patients include tumoral infiltration, mucositis complicating chemotherapy and/or radiotherapy, hypoproteinemia, neutropenia and lymphocyte deficiency. Clinical pictures vary according to patients' baseline condition and the environmental setting, including nosocomial infections. The differential clinical characteristics of abdominal infections observed in distinct types of immunosuppressed patients are reviewed.
Assuntos
Abdome , Hospedeiro Imunocomprometido , Infecções dos Tecidos Moles/etiologia , Antibioticoprofilaxia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/imunologia , Infecções Bacterianas/prevenção & controle , Translocação Bacteriana , Diarreia/complicações , Doenças do Sistema Digestório/complicações , Suscetibilidade a Doenças , Humanos , Incidência , Intestinos/microbiologia , Micoses/epidemiologia , Micoses/etiologia , Micoses/imunologia , Micoses/prevenção & controle , Neoplasias/complicações , Neoplasias/imunologia , Neutropenia/complicações , Peritonite/etiologia , Peritonite/imunologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Risco , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/imunologia , Infecções dos Tecidos Moles/prevenção & controle , Viroses/epidemiologia , Viroses/etiologia , Viroses/imunologiaRESUMO
AIM: To investigate the responses of TT virus (TTV) and hepatitis B virus (HBV) to a long-term lamivudine therapy. METHODS: Sixteen patients infected with both TTV and HBV were treated with lamivudine 100 mg daily for 30 months. Blood samples were drawn at the beginning of the therapy and subsequently at month 3, 6, 9, 12 and 30. Serum TTV was quantified by real time PCR and serum HBV was detected by hybridization assay and nested polymerase chain reaction. RESULTS: TTV infection was detected in 100 % of HBV-infected patients. Loss of serum TTV DNA after one year of treatment occurred in 1/16 (6 %) patients. At the end of therapy, TTV DNA was positive in 94 % of them. The decline of HBV viremia was evident at 3 months after therapy and the response rate was 31 %, 44 %, 63 %, 50 % and 50 % at month 3, 6, 9, 12 and 30, respectively. CONCLUSION: TTV replication is not sensitive to lamivudine and is highly prevalent in HBV-infected patients.