RESUMO
We describe the case of an immunosuppressed transplant recipient with disseminated blastomycosis (cutaneous, central nervous system, and pulmonary infection) complicated by septic shock and severe, refractory acute respiratory distress syndrome that improved markedly and rapidly after the addition of corticosteroids to the antifungal regimen.
Assuntos
Corticosteroides/uso terapêutico , Blastomicose/complicações , Blastomicose/tratamento farmacológico , Hospedeiro Imunocomprometido , Transplante de Rim/imunologia , Infecções Oportunistas/tratamento farmacológico , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/microbiologia , Antifúngicos/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/microbiologia , Índice de Gravidade de Doença , Choque Séptico/tratamento farmacológico , Choque Séptico/etiologia , Resultado do TratamentoRESUMO
BACKGROUND: An increased incidence of urinary tract infections (UTIs) caused by ciprofloxacin-gentamicin-resistant Escherichia coli (CiGREC) has been observed in a tertiary care centre in Sherbrooke, Quebec. The risk factors for such infections remained unclear. METHODS: To determine risk factors for, and outcomes of, CiGREC UTIs, a case control study was conducted. Between 2000 and 2007, 93 cases and 186 controls were identified using laboratory records of patients with greater than 10(7) colony-forming units/L of E coli in a urinary specimen. Cases had E coli with minimum inhibitory concentration to ciprofloxacin of 4 mg/L or greater and minimum inhibitory concentration to gentamicin of 8 mg/L or greater (CiGREC), and controls had E coli with any other susceptibility pattern to ciprofloxacin and gentamicin. Clinical and laboratory data were collected. Adjusted odds ratios (AOR) and their 95% CIs were calculated by logistic regression. RESULTS: The prevalence of CiGREC increased sixfold during the study period. Risk factors associated with CiGREC UTI were advanced age, male sex, urological abnormality, domicile outside Sherbrooke, living in a nursing home (AOR 11.73; 95% CI 3.70 to 37.15), use of fluoroquinolones (AOR 15.24; 95% CI 5.42 to 42.83) or aminoglycosides (AOR 6.59; 95% CI 1.22 to 35.61) within the previous month, and use of fluoroquinolones during the preceding one to 12 months (AOR 2.45; 95% CI 1.06 to 5.62). Compared with controls, cases were more likely not to receive an active antibiotic as empirical or definitive treatment, and were more likely to relapse. INTERPRETATION: In the future, it may become necessary to avoid selecting as empirical therapy of urinary tract infection an antibiotic to which the patient has been recently exposed.
RESUMO
BACKGROUND: Sub-Saharan Africa is the continent with the highest prevalence of Hepatitis C virus (HCV) infection. Genotype 2 HCV is thought to have originated from West Africa several hundred years ago. Mechanisms of transmission remain poorly understood. METHODOLOGY/PRINCIPAL FINDINGS: To delineate mechanisms for HCV transmission in West Africa, we conducted a cross-sectional survey of individuals aged >or=50 years in Bissau, Guinea-Bissau. Dried blood spots were obtained for HCV serology and PCR amplification. Prevalence of HCV was 4.4% (47/1066) among women and 5.0% (27/544) among men. In multivariate analysis, the independent risk factors for HCV infection were age (baseline: 50-59 y; 60-69 y, adjusted odds ratio [AOR]: 1.67, 95% CI: 0.91-3.06; >or=70 y, AOR: 3.47, 95% CI: 1.89-6.39), belonging to the Papel, Mancanha, Balanta or Mandjako ethnic groups (AOR: 2.45, 95% CI:1.32-4.53), originating from the Biombo, Cacheu or Oio regions north of Bissau (AOR: 4.16, 95% CI: 1.18-14.73) and having bought or sold sexual services (AOR: 3.60, 95% CI: 1.88-6.89). Of 57 isolates that could be genotyped, 56 were genotype 2. CONCLUSIONS: Our results suggest that transmission of HCV genotype 2 in West Africa occurs through sexual intercourse. In specific locations and subpopulations, medical interventions may have amplified transmission parenterally.
Assuntos
Hepacivirus/genética , Hepatite C/epidemiologia , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Idoso , Sequência de Bases , Primers do DNA , Feminino , Genótipo , Guiné-Bissau/epidemiologia , Hepatite C/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de RiscoRESUMO
BACKGROUND AND OBJECTIVE: The factors that led to the simultaneous emergence, decades ago, of HIV-1 in central Africa and HIV-2 in West Africa remain unclear. The low HIV-2-associated mortality enables epidemiological assessment of risk factors potentially relevant in the early stages of the epidemic. In Guinea-Bissau, its epicentre, HIV-2 became highly prevalent (approximately 15%) in cohorts of individuals born before 1962, but is now disappearing whereas HIV-1 prevalence is increasing. We sought to verify the hypothesis that parenteral transmission was the key factor in the building-up of the HIV-2 epidemic. DESIGN: Cross-sectional community survey of 1608 individuals aged > or = 50 years in Bissau. METHODS: Capillary blood was obtained for HIV serology. Associations between HIV-2 (alone or in dual HIV-1/HIV-2 infections) and exposures were measured with crude and adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS: Prevalence of HIV-2 was higher in women (160/1063; 15.1%) than men (45/545; 8.3%, P < 0.001). Among women, excision (AOR, 1.54; 95% CI, 1.08-2.18) was independently associated with HIV-2, as were age and being widowed (AOR, 1.88; 95% CI, 1.29-2.74). Among men, HIV-2 was not associated with sexually transmitted infections or transactional sex. In an analysis comprising men and women that was adjusted for age, sex, ethnic group and marital status, HIV-2 was associated with having received injections for the treatment of tuberculosis (AOR, 2.12; 95% CI, 1.11-4.05) or trypanosomiasis (AOR, 1.75; 95% CI, 1.03-2.97). CONCLUSIONS: Parenteral transmission through ritual excision and multiple injections during treatment of tuberculosis and trypanosomiasis contributed to the emergence of HIV-2 in Guinea-Bissau.