RESUMO
O objetivo deste estudo é relatar a experiência do ambulatório de assistência ao pré-natal do Centro de Referência e Treinamento DST/Aids-SP no acolhimento a homens transgêneros gestantes, descrevendo como foram organizadas as ações e o aprendizado que extraímos dessa vivência. A finalidade é ampliar o debate sobre o tema e fomentar ações no cuidado a essa população e ampliar seu acesso aos serviços de saúde.
RESUMO
Paracoccidioides brasiliensis rarely shows bone marrow involvement and its response to treatment with itraconazole in children needs further assessment. We describe here a child with a juvenile disseminated form of paracoccidioidomycosis, which showed reticuloendothelial system involvement and the presence of Paracoccidioides brasiliensis in the bone marrow. The patient showed an effective and rapid response to itraconazole therapy.
Assuntos
Medula Óssea/microbiologia , Osteomielite/diagnóstico , Osteomielite/microbiologia , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/complicações , Antifúngicos/uso terapêutico , Biópsia , Medula Óssea/patologia , Criança , Feminino , Histocitoquímica , Humanos , Itraconazol/uso terapêutico , Linfonodos/patologia , Microscopia , Osteomielite/tratamento farmacológico , Osteomielite/patologia , Paracoccidioidomicose/tratamento farmacológico , Resultado do TratamentoRESUMO
This is a retrospective observational study of clinical and epidemiologic data from bloodstream yeast infections over 5 years (2004-2008) in a tertiary-care hospital. During this period, there were 52 such infections, at a rate of 2.4 per 1,000 hospital admissions. Non-C. albicans Candida species and other genera were responsible for 82% of infections, with C. tropicalis and C. parapsilosis being the most common. In 2008 no C. albicans infections occurred. Several uncommon fungal pathogens were observed, including Trichosporon asahii, Rhodotorula spp. and Candida zeylanoides. Of 16 isolates tested, 3 (19%) were resistant to fluconazole, including one C. zeylanoides (MIC 8 microg/ml) and one C. tropicalis (MIC 16 microg/ml) isolate, as well as intrinsically resistant C. krusei. All isolates tested were susceptible to itraconazole (n = 7) and amphotericin B (n = 8). Yeast infections were associated with severe underlying diseases, mainly hematological/solid cancers (71%), hospitalization in the ICU (41%), central venous catheters (80%), and use of antimicrobials (94%). The overall mortality rate was 50%. Our finding of a predominance of non-C. albicans Candida species infection with uncommon yeasts, and fluconazole resistance, suggests the need for continuous surveillance of fungemia and of antibiotic susceptibility trends, in order to adopt treatment strategies applicable to particular healthcare institutions.
