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1.
Ann Maxillofac Surg ; 9(1): 10-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31293924

RESUMO

Aim: The objective was to do a comparative study and to evaluate the outcome in overall acceptance for correction of residual facial deformity with autogenous graft versus porous polyethylene implants. Materials and Methods: A total of 16 patients in the age group of ≥15 years irrespective of sex, caste, religion, and socioeconomic status presenting with signs and symptoms of residual facial deformities and who were declared fit for surgery were included in the study. The study patients were further divided into two groups, of eight each. Deformity correction using autogenous grafts was performed in Group A and using high-density polyethylene (HDPE) alloplastic implants was performed in Group B. During the follow-up period, patients' and doctor rating of overall acceptance between autogenous and alloplastic (HDPE) bone grafts was recorded on 100-mm visual analog scale (VAS) on the 2nd day and 7th day and at 3, 6, and 12 weeks. Results: The unpaired t-test is used for evaluation. VAS score at all the follow-up periods above stated was significantly higher in alloplastic group than in the autogenous group for both in patients and doctor evaluation. Conclusion: From the present study, it can be concluded that porous HDPE implants are an effective alternative to autogenous grafts in accordance of overall acceptance for correction of residual facial deformity when proper case selection, exclusion of negative prognostic factors, and meticulous surgical procedure are followed.

2.
J Biomech Eng ; 140(4)2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29238816

RESUMO

Methods that effectively assess and train dynamic seated balance are critical for enhancing functional independence and reducing risk of secondary health complications in the elderly and individuals with neuromuscular impairments. The objective of this research was to devise and validate a portable tool for assessing and training dynamic seated balance. An instrumented wobble board was designed and constructed that (1) elicits multidirectional perturbations in seated individuals, (2) quantifies seated balance proficiency, and (3) provides real-time, kinematics-based vibrotactile feedback. After performing a technical validation study to compare kinematic wobble board measurements against a gold-standard motion capture system, 15 nondisabled participants performed a dynamic sitting task using the wobble board. Our results demonstrate that the tilt angle measurements were highly accurate throughout the range of wobble board dynamics. Furthermore, the posturographic analyses for the dynamic sitting task revealed that the wobble board can effectively discriminate between the different conditions of perturbed balance, demonstrating its potential to serve as a clinical tool for the assessment and training of seated balance. Vibrotactile feedback decreased the variance of wobble board tilt, demonstrating its potential for use as a balance training tool. Unlike similar instrumented tools, the wobble board is portable, requires no laboratory equipment, and can be adjusted to meet the user's balance abilities. While future work is warranted, obtained findings will aid in effective translation of assessment and training techniques to a clinical setting, which has the potential to enhance the diagnosis and prognosis for individuals with seated balance impairments.


Assuntos
Desenho de Equipamento , Fenômenos Mecânicos , Equilíbrio Postural , Fenômenos Biomecânicos , Estudos de Viabilidade , Retroalimentação Sensorial , Feminino , Humanos , Masculino , Postura Sentada , Software , Adulto Jovem
3.
J Clin Diagn Res ; 11(4): TM01-TM02, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28571233

RESUMO

In modern era, with tremendous competition, long working hours and more demanding workstyle, nearly every profession is associated with some or the other health hazards. These may develop and progress rapidly or in a gradual way but ultimately add up unwanted morbidities and in long run affects the production and work output. Unfortunately, doctors and other health professionals who look after the health of society, are not the exceptions to this rule and depending upon their specialty, they have to face some or the other health issues. This article highlights some important though underestimated health issues among radiologists and some remedies. It aims to sensitize radiologists about such health issues so that they can take timely remedial measures before it is really late.

4.
J Clin Diagn Res ; 11(3): TE01-TE05, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28511478

RESUMO

The small airways, once regarded as the silent zone in the air conducting system of the lungs are now known to be one of the initial sites of involvement in diseases like asthma and Chronic Obstructive Pulmonary Disease (COPD). Identification of the involvement of distal airways in these diseases is often difficult to assess, clinically as well as by conventional pulmonary function tests and therefore, usually remains undiscovered in early stages. Early recognition of their involvement in asthma and COPD and timely management may reduce long term morbidity in these conditions. This article aims to highlight the relatively lesser recognized facts about small airways involvement in asthma and COPD and role of imaging and newer modalities for detection.

5.
J Clin Microbiol ; 54(9): 2354-64, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27413188

RESUMO

Aspergillus species cause a wide spectrum of clinical infections. Although Aspergillus fumigatus and Aspergillus flavus remain the most commonly isolated species in aspergillosis, in the last decade, rare and cryptic Aspergillus species have emerged in diverse clinical settings. The present study analyzed the distribution and in vitro antifungal susceptibility profiles of rare Aspergillus species in clinical samples from patients with suspected aspergillosis in 8 medical centers in India. Further, a matrix-assisted laser desorption ionization-time of flight mass spectrometry in-house database was developed to identify these clinically relevant Aspergillus species. ß-Tubulin and calmodulin gene sequencing identified 45 rare Aspergillus isolates to the species level, except for a solitary isolate. They included 23 less common Aspergillus species belonging to 12 sections, mainly in Circumdati, Nidulantes, Flavi, Terrei, Versicolores, Aspergillus, and Nigri Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identified only 8 (38%) of the 23 rare Aspergillus isolates to the species level. Following the creation of an in-house database with the remaining 14 species not available in the Bruker database, the MALDI-TOF MS identification rate increased to 95%. Overall, high MICs of ≥2 µg/ml were noted for amphotericin B in 29% of the rare Aspergillus species, followed by voriconazole in 20% and isavuconazole in 7%, whereas MICs of >0.5 µg/ml for posaconazole were observed in 15% of the isolates. Regarding the clinical diagnoses in 45 patients with positive rare Aspergillus species cultures, 19 (42%) were regarded to represent colonization. In the remaining 26 patients, rare Aspergillus species were the etiologic agent of invasive, chronic, and allergic bronchopulmonary aspergillosis, allergic fungal rhinosinusitis, keratitis, and mycetoma.


Assuntos
Aspergillus/classificação , Aspergillus/isolamento & purificação , Técnicas de Diagnóstico Molecular/métodos , Aspergilose Pulmonar/diagnóstico , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Antifúngicos/farmacologia , Aspergillus/efeitos dos fármacos , Calmodulina/genética , Hospitais , Humanos , Índia , Testes de Sensibilidade Microbiana , Aspergilose Pulmonar/microbiologia , Análise de Sequência de DNA , Tubulina (Proteína)/genética
6.
J Clin Diagn Res ; 10(4): TE01-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27190919

RESUMO

Aspergillus is a large genus of saprophytic fungi which are present everywhere in the environment. However, in persons with underlying weakened immune response this innocent bystander can cause fatal illness if timely diagnosis and management is not done. Chest infection is the most common infection caused by Aspergillus in human beings. Radiological investigations particularly Computed Tomography (CT) provides the easiest, rapid and decision making information where tissue diagnosis and culture may be difficult and time-consuming. This article explores the crucial role of CT and offers a bird's eye view of all the radiological patterns encountered in pulmonary aspergillosis viewed in the context of the immune derangement associated with it.

8.
Yonsei Med J ; 57(1): 88-96, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26632387

RESUMO

PURPOSE: Diagnosis of extrapulmonary tuberculosis (EPTB) poses serious challenges. A careful selection of appropriate gene targets is essential for designing a multiplex-polymerase chain reaction (M-PCR) assay. MATERIALS AND METHODS: We compared several gene targets of Mycobacterium tuberculosis, including IS6110, devR, and genes encoding MPB-64 (mpb64), 38kDa (pstS1), 65kDa (hsp65), 30kDa (fbpB), ESAT-6 (esat6), and CFP-10 (cfp10) proteins, using PCR assays on 105 EPTB specimens. From these data, we chose the two best gene targets to design an M-PCR. RESULTS: Among all gene targets tested, mpb64 showed the highest sensitivity (84% in confirmed cases and 77.5% in clinically suspected cases), followed by IS6110, hsp65, 38kDa, 30kDa, esat6, cfp10, and devR. We used mpb64+IS6110 for designing an M-PCR assay. Our M-PCR assay demonstrated a high sensitivity of 96% in confirmed EPTB cases and 88.75% in clinically suspected EPTB cases with a high specificity of 100%, taking clinical diagnosis as the gold standard. CONCLUSION: These M-PCR results along with the clinical findings may facilitate an early diagnosis of EPTB patients and clinical management of disease.


Assuntos
Reação em Cadeia da Polimerase Multiplex/métodos , Mycobacterium tuberculosis/isolamento & purificação , Reação em Cadeia da Polimerase/métodos , Tuberculose/diagnóstico , Técnicas Bacteriológicas/métodos , Elementos de DNA Transponíveis/genética , DNA Bacteriano/análise , DNA Bacteriano/genética , Diagnóstico Precoce , Feminino , Amplificação de Genes , Humanos , Masculino , Mycobacterium tuberculosis/genética , Reação em Cadeia da Polimerase/normas , Sensibilidade e Especificidade
9.
Mycoses ; 58(9): 531-5, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26201384

RESUMO

Atopic patients with chronic obstructive pulmonary disease (COPD) demonstrate more severe symptoms than their non-atopic counterparts. Also, Aspergillus hypersensitivity is known in COPD. However, allergic sensitisation to non-Aspergillus fungi has never been studied in COPD patients. To evaluate the prevalence of fungal sensitisation and its impact on the clinical presentation and outcome of COPD patients. Sensitisation to 17 fungi was studied in 55 COPD patients through skin prick tests, fungus-specific IgE, precipitating antibodies, total IgE and eosinophil counts. The clinical symptoms of patients were monitored thorough a patient-administered questionnaire. Overall, 5.4% (n = 3) of COPD patients were fungus sensitive. The sensitisation was noted to Alternaria alternata and Schizophyllum commune in two patients each, whereas another was sensitive to A. tamarii, Rhizopus spp. and Aspergillus fumigatus. Eosinophils were higher in fungus-sensitised patients (P = 0.001 vs. 0.003). No differences were noted in the clinical presentation of patients sensitised to fungi compared to those not sensitised to fungi or non-atopic. Although low, fungal sensitisation occurs in COPD but it is not limited to Aspergilli alone. Fungus-sensitised patients exhibit greater eosinophilia, implying more severe inflammation. Thus, such patients should be followed up regularly to recognise clinical worsening or development of ABPM.


Assuntos
Alérgenos/imunologia , Aspergillus fumigatus/imunologia , Fungos/imunologia , Hipersensibilidade , Doença Pulmonar Obstrutiva Crônica/imunologia , Alternaria/imunologia , Aspergillus fumigatus/patogenicidade , Eosinófilos/imunologia , Feminino , Humanos , Imunoglobulina E/imunologia , Masculino , Eosinofilia Pulmonar/imunologia , Eosinofilia Pulmonar/microbiologia , Rhizopus/imunologia , Schizophyllum/imunologia , Testes Cutâneos
10.
PLoS One ; 10(3): e0118997, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25781896

RESUMO

Aspergillus terreus is emerging as an etiologic agent of invasive aspergillosis in immunocompromised individuals in several medical centers in the world. Infections due to A. terreus are of concern due to its resistance to amphotericin B, in vivo and in vitro, resulting in poor response to antifungal therapy and high mortality. Herein we examined a large collection of molecularly characterized, geographically diverse A. terreus isolates (n = 140) from clinical and environmental sources in India for the occurrence of cryptic A. terreus species. The population structure of the Indian A. terreus isolates and their association with those outside India was determined using microsatellite based typing (STR) technique and Amplified Fragment Length Polymorphism analysis (AFLP). Additionally, in vitro antifungal susceptibility of A. terreus isolates was determined against 7 antifungals. Sequence analyses of the calmodulin locus identified the recently described cryptic species A. hortai, comprising 1.4% of Aspergillus section Terrei isolates cultured from cases of aspergilloma and probable invasive aspergillosis not reported previously. All the nine markers used for STR typing of A. terreus species complex proved to be highly polymorphic. The presence of high genetic diversity revealing 75 distinct genotypes among 101 Indian A. terreus isolates was similar to the marked heterogeneity noticed in the 47 global A. terreus population exhibiting 38 unique genotypes mainly among isolates from North America and Europe. Also, AFLP analysis showed distinct banding patterns for genotypically diverse A. terreus isolates. Furthermore, no correlation between a particular genotype and amphotericin B susceptibility was observed. Overall, 8% of the A. terreus isolates exhibited low MICs of amphotericin B. All the echinocandins and azoles (voriconazole, posaconazole and isavuconazole) demonstrated high potency against all the isolates. The study emphasizes the need of molecular characterization of A. terreus species complex isolates to better understand the ecology, acquisition and transmission of this species.


Assuntos
Aspergillus/efeitos dos fármacos , Farmacorresistência Fúngica/genética , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados , Aspergilose/microbiologia , Aspergillus/isolamento & purificação , Ensaio de Imunoadsorção Enzimática , Proteínas Fúngicas/química , Proteínas Fúngicas/genética , Genes Fúngicos , Variação Genética , Genótipo , Humanos , Índia , Testes de Sensibilidade Microbiana , Repetições de Microssatélites , Dados de Sequência Molecular , Filogenia , Análise de Sequência de DNA
11.
Med Mycol ; 52(8): 782-97, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25202126

RESUMO

Filamentous basidiomycetes (BM) are common environmental fungi that have recently emerged as important human pathogens, inciting a wide array of clinical manifestations that include allergic and invasive diseases. We reviewed 218 reported global cases of BM fungi. The most common etiologic agent was Schizophyllum commune in 52.3% (114/218) of the cases followed by Hormographiella aspergillata (n = 13; 5.9%), Ceriporia lacerata (n = 11; 5%), and, rarely, Volvariella volvacea, Inonotus tropicalis, Irpex lacteus, Phellinus undulates, Perenniporia species, Bjerkandera adusta, Sporotrichum pruinosum, Phanerochaete steroids, and Cyclomyces tabacinus. These fungi are present in the environment as gilled mushrooms, shelf fungi, and bracket fungi. However, in clinical settings, they usually present as nonsporulating white moulds that are difficult to identify. Moreover, the GenBank database of these fungi is limited. Regarding the country-wise distribution of cases, Japan topped the list with about 43% (n = 94) of globally reported cases, followed by India (57; 26%), the United States (4%), Austria (3.2%), Iran (3.2%), France (2.8%), and the remaining one-third from 16 other countries. The respiratory tract was the most commonly afflicted site (n = 71), with the majority of the cases (42; 59.1%) being allergic in etiology and comprising 34 cases of allergic bronchopulmonary mycosis. Also, B. adusta has been implicated in a recently described clinical entity, that is, fungus associated chronic cough, reported exclusively from Japan. BM fungi-incited diseases are currently underdiagnosed due to lack of awareness and expertise, warranting comprehensive epidemiological and susceptibility studies to determine their prevalence and to predict a more appropriate therapy.


Assuntos
Basidiomycota , Micoses , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Humanos , Testes de Sensibilidade Microbiana , Micoses/tratamento farmacológico , Micoses/microbiologia
12.
Open Forum Infect Dis ; 1(2): ofu029, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25734109

RESUMO

Penicillium species are rarely reported agents of infections in immunocompromised patients. We report 3 cases of invasive mycosis caused by voriconazole-resistant Penicillium oxalicum in patients with acute myeloid leukemia, diabetes mellitus, and chronic obstructive pulmonary disease, while on voriconazole therapy. Penicillium oxalicum has not been previously recognized as a cause of invasive mycoses.

13.
Crit Rev Microbiol ; 40(1): 30-48, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23383677

RESUMO

Allergic bronchopulmonary mycosis (ABPM) is a hypersensitivity-mediated disease of worldwide distribution. We reviewed 143 reported global cases of ABPM due to fungi other than aspergilli. The commonest etiologic agent was Candida albicans, reported in 60% of the cases, followed by Bipolaris species (13%), Schizophyllum commune (11%), Curvularia species (8%), Pseudallescheria boydii species complex (3%) and rarely, Alternaria alternata, Fusarium vasinfectum, Penicillium species, Cladosporium cladosporioides, Stemphylium languinosum, Rhizopus oryzae, C. glabrata, Saccharomyces cerevisiae and Trichosporon beigelii. India accounted for about 47% of the globally reported cases of ABPM, attributed predominantly to C. albicans, followed by Japan (16%) where S. commune predominates, and the remaining one-third from the USA, Australia and Europe. Notably, bronchial asthma was present in only 32% of ABPM cases whereas its association with development of allergic bronchopulmonary aspergillosis (ABPA) is known to be much more frequent. The cases reviewed herein revealed a median IgE value threefold higher than that of ABPA, suggesting that the etiologic agents of ABPM incite a stronger immunological response than that by aspergilli in ABPA. ABPM is currently underdiagnosed, warranting comprehensive basic and clinical studies in order to elucidate its epidemiology and to devise a more effective therapy.


Assuntos
Fungos/isolamento & purificação , Aspergilose Pulmonar Invasiva/epidemiologia , Aspergilose Pulmonar Invasiva/microbiologia , Austrália/epidemiologia , Europa (Continente)/epidemiologia , Fungos/classificação , Imunoglobulina E/sangue , Índia/epidemiologia , Aspergilose Pulmonar Invasiva/imunologia , Japão/epidemiologia , Estados Unidos/epidemiologia
14.
Mycoses ; 57(1): 64-8, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23834440

RESUMO

The Ustilaginomycetous basidiomycete yeast, Pseudozyma aphidis has recently been implicated in potentially fatal disorders ranging from subcutaneous mycoses to disseminated infections. Till date a solitary case of P. aphidis fungaemia in a paediatric patient has been reported. We present a case of fungaemia due to P. aphidis in a rhesus factor-isoimmunised, low-birth-weight neonate. The isolate was identified by sequencing the D1/D2 domain of the LSU region. Antifungal susceptibility of the isolate revealed susceptibility to amphotericin B, voriconazole, itraconazole, isavuconazole and posaconazole. It had high minimum inhibitory concentrations of fluconazole and was resistant to flucytosine and echinocandins. Consequently, the patient was successfully treated with intravenous amphotericin B. Although the source of infection could not be traced, as the neonate developed fungaemia on the first day of life, it could possibly be from the maternal urogenital tract or intrahospital transmission. A review of previously published cases revealed that risk factors for invasive Pseudozyma spp. infections were similar to those previously reported for non-albicans Candida spp. Pseudozyma species are underreported due to the difficulty of identifying this rare yeast pathogen by commercial identification systems. Considering that Pseudozyma spp. cause invasive fungal infections globally and are resistant to flucytosine, fluconazole and echinocandins, this pathogen assumes a greater clinical significance.


Assuntos
Fungemia/microbiologia , Doenças do Recém-Nascido/microbiologia , Ustilaginales/isolamento & purificação , Antifúngicos/farmacologia , Farmacorresistência Fúngica , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/tratamento farmacológico , Masculino , Testes de Sensibilidade Microbiana , Ustilaginales/efeitos dos fármacos
15.
Diagn Microbiol Infect Dis ; 78(2): 196-8, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24315117

RESUMO

Ceratocystis adiposa known as phytopathogen of conifers has not been recognized so far as a human pathogen. Herein, we report for the first time a case of allergic fungal rhinosinusitis due to C. adiposa. The fungus was identified by sequencing internal transcribed spacer of rDNA and D1/D2 of larger subunit region.


Assuntos
Ascomicetos/imunologia , Rinite Alérgica Perene/imunologia , Sinusite/imunologia , Ascomicetos/isolamento & purificação , Ascomicetos/ultraestrutura , Biópsia , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Rinite Alérgica , Rinite Alérgica Perene/diagnóstico , Sinusite/diagnóstico , Tomografia Computadorizada por Raios X
18.
J Clin Microbiol ; 51(10): 3331-7, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23903552

RESUMO

Nonsporulating molds (NSMs), especially basidiomycetes, have predominantly been reported as human pathogens responsible for allergic and invasive disease. Their conventional identification is problematic, as many isolates remain sterile in culture. Thus, inconclusive culture reports might adversely affect treatment decisions. The clinical significance of NSMs in pulmonary mycoses is poorly understood. We sequenced the internal transcribed spacer (ITS) region and D1/D2 domain of the larger subunit (LSU) of 52 NSMs isolated from respiratory specimens. The basidiomycetes were the predominant NSMs, of which Schizophyllum commune was the most common agent in allergic bronchopulmonary mycosis (ABPM), followed by Ceriporia lacerata in invasive fungal disease. Porostereum spadiceum, Phanaerochaete stereoides, Neosartorya fischeri, and Marasmiellus palmivorus were the other molds observed. Application of ITS and LSU region sequencing identified 92% of the isolates. The antifungal susceptibility data revealed that all basidiomycetes tested were susceptible to amphotericin B and resistant to caspofungin, fluconazole, and flucytosine. Except for 3 isolates of S. commune and a solitary isolate of M. palmivorus, all basidiomycetes had low MICs for itraconazole, posaconazole, and voriconazole. Basidiomycetes were isolated from patients with ABPM, invasive pulmonary mycosis/pneumonia, or fungal balls. In addition, the majority of the basidiomycetes were isolated from patients with chronic respiratory disorders who were sensitized to one of the basidiomycetous fungi and demonstrated precipitating antibodies against the incriminating fungi, indicating an indolent tissue reaction. Thus, isolation of basidiomycetes from the lower respiratory tract could be significant, and it is important to monitor these patients in order to prevent subsequent lung damage.


Assuntos
Broncopneumonia/microbiologia , Fungos/isolamento & purificação , Micoses/microbiologia , Antifúngicos/farmacologia , DNA Fúngico/química , DNA Fúngico/classificação , DNA Fúngico/genética , DNA Fúngico/isolamento & purificação , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Farmacorresistência Fúngica , Fungos/classificação , Fungos/efeitos dos fármacos , Fungos/genética , Humanos , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Análise de Sequência de DNA
19.
Antimicrob Agents Chemother ; 57(6): 2845-8, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23507274

RESUMO

Schizophyllum commune (n = 30) showed lowest geometric mean MICs of isavuconazole (0.19 µg/ml), itraconazole (0.2 µg/ml), voriconazole (0.24 µg/ml), and amphotericin B (0.29 µg/ml) and high geometric mean MICs of fluconazole (19.39 µg/ml) and flucytosine (17.28 µg/ml). Five cases (of 8) of allergic bronchopulmonary mycosis that were treated with itraconazole had no recrudescence after 6 to 24 months of follow-up. One case each of invasive pulmonary mycosis and fungal ball were treated successfully with voriconazole and itraconazole.


Assuntos
Antifúngicos , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Micoses/tratamento farmacológico , Schizophyllum/efeitos dos fármacos , Anfotericina B/farmacologia , Anfotericina B/uso terapêutico , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Humanos , Aspergilose Pulmonar Invasiva/microbiologia , Itraconazol/farmacologia , Itraconazol/uso terapêutico , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Micoses/microbiologia , Pirimidinas/farmacologia , Pirimidinas/uso terapêutico , Schizophyllum/classificação , Schizophyllum/genética , Análise de Sequência de DNA , Resultado do Tratamento , Triazóis/farmacologia , Triazóis/uso terapêutico , Voriconazol
20.
J Clin Microbiol ; 51(2): 585-90, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23241374

RESUMO

The filamentous basidiomycete Ceriporia lacerata, an agent of white rot on wood, has never been reported in human disease and its clinical significance is not yet known. We describe 4 patients with respiratory diseases where C. lacerata was implicated in a wide spectrum of clinical manifestations ranging from saprobic colonization to fungal pneumonia. The isolates did not show the morphological characteristics that facilitate recognition of filamentous basidiomycetes, such as the presence of clamp connections, spicules along hyphae, or fruiting bodies. The identity of the mold was confirmed by sequencing the internal transcribed spacer 1 and 4 (ITS-1 and ITS-4) and D1/D2 regions of the rRNA gene. All of the isolates exhibited the lowest MICs of posaconazole and isavuconazole (MIC range, 0.06 to 0.125 µg/ml), followed by itraconazole (MIC range, 0.06 to 0.5 µg/ml), voriconazole (MIC range, 0.125 to 0.5 µg/ml), and amphotericin B (MIC range, 0.25 to 1 µg/ml). The infections reported here occurred in patients with preexisting lung damage induced by tuberculosis or chronic obstructive pulmonary disease. Chronic, sometimes fatal infections by the ascomycete Aspergillus fumigatus and the basidiomycete Schizophyllum commune are well established in the presence of an anatomical pulmonary defect or in the background of immunodeficiency. It is postulated that C. lacerata, a novel opportunist basidiomycete, may be involved in similar pathological processes.


Assuntos
Basidiomycota , Pneumopatias Fúngicas/microbiologia , Sistema Respiratório/microbiologia , Adulto , Antifúngicos/farmacologia , Basidiomycota/citologia , Basidiomycota/efeitos dos fármacos , Basidiomycota/genética , Líquido da Lavagem Broncoalveolar/microbiologia , DNA Espaçador Ribossômico/genética , Feminino , Humanos , Pneumopatias Fúngicas/diagnóstico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Dados de Sequência Molecular , Escarro/microbiologia
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