Assuntos
Genótipo , Hepacivirus/genética , Adulto , Feminino , Hepatite C/virologia , Humanos , Masculino , EspanhaRESUMO
In this prospective study we analyzed pretransplant interferon-γ secretion by cytomegalovirus (CMV)-specific CD8+ T cells to assess its possible utility in determining the risk of CMV replication after solid organ transplantation. A total of 113 lung and kidney transplant patients were enrolled in the study but only 55 were evaluable. All CMV-seronegative recipients were pretransplant "nonreactive" (IFNγ <0.2 IU/mL) (11/11), whereas 30/44 (68.2%) CMV-seropositive (R+) recipients were "reactive" (IFNγ ≥0.2 IU/mL) and 14/44 (31.8%) were "nonreactive". In the R(+) "nonreactive" group, 7/14 (50%) developed posttransplant CMV replication, whereas the virus replicated only in 4/30 (13.3%) of the R(+) "reactive" patients (p = 0.021). According to the best multivariate model, pretransplant "nonreactive" recipients receiving an organ from a CMV-seropositive donor had a 10-fold increased risk of CMV replication compared to pretransplant "reactive" recipients (adjusted OR 10.49, 95% CI 1.88-58.46). This model displayed good discrimination ability (AUC 0.80) and calibration (Hosmer-Lemeshow test, p = 0.92). Negative and positive predictive values were 83.7% and 75%, respectively. The accuracy of the model was 82%. Therefore, assessment of interferon-γ secretion by cytomegalovirus (CMV)-specific CD8+ T cells prior to transplantation is useful in informing the risk of posttransplant CMV replication in solid organ transplant patients.
Assuntos
Linfócitos T CD8-Positivos/metabolismo , Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/patogenicidade , Rejeição de Enxerto/diagnóstico , Interferon gama/metabolismo , Transplante de Rim/efeitos adversos , Transplante de Pulmão/efeitos adversos , Adulto , Idoso , Antivirais/uso terapêutico , Biomarcadores/sangue , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/etiologia , Feminino , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/etiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Adulto JovemRESUMO
Objetivos: Investigar el fenómeno de la multirresistencia a la tuberculosis, y posibles alternativas terapéuticas. Procedimientos básicos empleados: Se realiza mediante un estudio prospectivo. Toda cepa de M. tuberculosis identificada es estudiada in vitro, en cuanto a la resistencia a drogas esenciales, segunda línea y tercera línea, así como nuevos fármacos. Se lleva acabo un estudio epidemiológico de los factores de riesgo presentes en los pacientes con tuberculosis multirresistente. Hallazgos principales: Los factores relacionados con la MDRTB, en nuestro estudio, han sido: edad, contactos previos con TB, enfermedad tuberculosa anterior, uso de drogas intravenoso y situación laboral/ingresos. Con relación a la resistencia a fármacos de primera línea, un 87,5 por ciento de las cepas han sido sensibles a estos antimicrobianos, y resistentes el 12,5 por ciento restante. El porcentaje de multirresistencia ha sido del 5,8 por ciento. De los fármacos de segunda y tercera línea empleados en tuberculosis han mostrado mayor resistencia la rifabutina, la rifapentina, ciprofloxacina y ofloxacina. Los nuevos fármacos ensayados, moxifloxacina y linezolid, han mostrado excelentes resultados. Las asociaciones con mayor actividad in vitro han sido: isoniacida, rifapentina, ofloxacina e isoniacida, rifapentina, clofacimina (AU)
Assuntos
Adolescente , Adulto , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Humanos , Tuberculose/tratamento farmacológico , Resistência a Múltiplos Medicamentos/fisiologia , Antituberculosos/análise , Fatores de Risco , Estudos Prospectivos , Infecções Oportunistas Relacionadas com a AIDS/epidemiologiaRESUMO
The routine use of isoniazid prophylaxis after liver transplantation is a controversial issue because the benefits must be weighed against the risk of hepatotoxicity. We decided not to institute isoniazid prophylaxis but to study the efficacy of a surveillance mycobacterial program. One hundred patients were included in the protocol. Sputum and urine samples were processed before transplantation and on days 15, 30, 60, 90, 12, 150, and 180 for acid-fast stain and culture. One case of tuberculosis was promptly identified and successfully treated. Cases of tuberculosis with negative surveillance cultures were not identified. Our approach indicates that surveillance mycobacterial cultures can permit rapid identification of tuberculosis after liver transplantation and it is an alternative for groups who questioned isoniazid prophylaxis.
Assuntos
Antituberculosos/uso terapêutico , Isoniazida/uso terapêutico , Transplante de Fígado , Infecções por Mycobacterium/prevenção & controle , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose/prevenção & controle , Adulto , Antituberculosos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas , Quimioterapia Combinada , Etambutol/uso terapêutico , Seguimentos , Humanos , Isoniazida/efeitos adversos , Fígado/efeitos dos fármacos , Transplante de Fígado/patologia , Masculino , Estreptomicina/uso terapêutico , Fatores de Tempo , Tuberculose/epidemiologiaRESUMO
A simple new test to differentiate Prototheca wickerhamii and P. zopfii from P. stagnora by determining susceptibility to neomycin is described. Susceptibility determined using a 30 micrograms neomycin disk provides a rapid and reliable means of distinguishing P. wickerhamii and P. zopfii from P. stagnora.
Assuntos
Micologia/métodos , Prototheca/classificação , Estudos de Avaliação como Assunto , Humanos , Testes de Sensibilidade Microbiana , Neomicina/farmacologia , Prototheca/efeitos dos fármacos , Prototheca/isolamento & purificação , Especificidade da EspécieRESUMO
The in vitro activity of ribostamycin against algae of the genus Prototheca was evaluated by minimum inhibitory concentration (MIC) studies on solid media. Concentrations of 4 mcg/ml were required to inhibit 100% of the P. zopfii strains; 16 mcg/ml inhibited 100% of the P. stagnora strains and 95% of the P. wickerhamii strains. These values are inferior to plasma concentrations obtained after injection of ribostamycin. It is likely that this antibiotic could be effective in the treatment of protothecosis in man.
