RESUMO
BACKGROUND: The clinical and laboratory characteristics of AIDS-associated Talaromyces marneffei infection, a rare but a fatal mycosis disease of the central nervous system, remain unclear. CASE PRESENTATION: Herein, we conducted a retrospective study of ten AIDS patients with cerebrospinal fluid culture-confirmed central nervous system infection caused by Talaromyces marneffei. All 10 patients were promptly treated with antifungal treatment for a prolonged duration and early antiviral therapy (ART). Among them, seven patients were farmers. Nine patients were discharged after full recovery, while one patient died during hospitalization, resulting in a mortality rate of 10%. All patients initially presented symptoms and signs of an increase in intracranial pressure, mainly manifesting as headache, dizziness, vomiting, fever, decreased muscle strength, diplopia or even altered consciousness with seizures in severe patients. Nine patients (90%) showed lateral ventricle dilatation or intracranial infectious lesions on brain CT. Cerebrospinal fluid findings included elevated intracranial pressure, increased leukocyte count, low glucose, low chloride and high cerebrospinal fluid protein. The median CD4+ T count of patients was 104 cells/µL (IQR, 36-224 cells/µL) at the onset of the disease. The CD4+ T cell counts of three patients who eventually died were significantly lower (W = 6.00, p = 0.020) than those of the patients who survived. CONCLUSIONS: The common clinical symptoms of T. marneffei central nervous system infection are associated with high intracranial pressure and intracranial infectious lesions. Earlier recognition and diagnosis and a prolonged course of amphotericin B treatment followed by itraconazole combined with early ART might reduce the mortality rate.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Infecções do Sistema Nervoso Central/microbiologia , Infecções por HIV/complicações , Micoses/líquido cefalorraquidiano , Micoses/virologia , Talaromyces/patogenicidade , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Antifúngicos/uso terapêutico , Infecções do Sistema Nervoso Central/etiologia , China/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/epidemiologia , Estudos RetrospectivosRESUMO
To evaluate the infectious etiologies, clinical features, and outcomes of patients with CNS infections at a tertiary care center. Patients that present with a pleocytosis in the cerebral spinal fluid (CSF), defined as a CSF WBC count > 5 cells/mm3, from July 2015 to June 2016 at a tertiary care hospital were analyzed for this report. Data from patients with confirmed (n = 43) and presumed (n = 51) CNS infections were analyzed. CNS infection was the leading known cause of CSF pleocytosis (n = 43, 18% of all patients with a pleocytosis in the CSF), and HSV-2 was identified as the leading causative pathogen (n = 10) followed by varicella zoster virus (n = 5). Fifty-three percent of patients with a pleocytosis in the CSF did not receive a diagnosis. In the patients that did not receive a diagnosis, CNS infection was presumed to be the cause in 51 patients (21% of patients with CSF pleocytosis). The mean time to diagnosis for patients with confirmed CNS infection was 16 days, but time to diagnosis was highly variable depending on the causative pathogen. There was a significant overlap in CSF parameters and peripheral white blood cell counts in patients diagnosed with a viral, bacterial, or fungal infection. Neuroimaging changes were present in only 44% of CNS infections. The overall mortality was 7% for CNS infections, and 17% of patients with a CNS infection had a severe neurologic deficit at presentation while only 3% had a severe deficit at the last neurologic assessment. This study provides new insights into the infectious causes of disease in a cohort of patients with pleocytosis in the CSF. The study provides new insights into the time to diagnosis and outcomes in patients that present with pleocytosis in the CSF.
Assuntos
Infecções Bacterianas/diagnóstico por imagem , Herpes Simples/diagnóstico por imagem , Herpes Zoster/diagnóstico por imagem , Leucocitose/diagnóstico por imagem , Micoses/diagnóstico por imagem , Adulto , Idoso , Infecções Bacterianas/líquido cefalorraquidiano , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Sistema Nervoso Central/diagnóstico por imagem , Sistema Nervoso Central/microbiologia , Sistema Nervoso Central/patologia , Sistema Nervoso Central/virologia , Diagnóstico Tardio , Feminino , Herpes Simples/líquido cefalorraquidiano , Herpes Simples/mortalidade , Herpes Simples/virologia , Herpes Zoster/líquido cefalorraquidiano , Herpes Zoster/mortalidade , Herpes Zoster/virologia , Herpesvirus Humano 2/genética , Herpesvirus Humano 2/isolamento & purificação , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/isolamento & purificação , Humanos , Contagem de Leucócitos , Leucocitose/microbiologia , Leucocitose/mortalidade , Leucocitose/virologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Micoses/líquido cefalorraquidiano , Micoses/microbiologia , Micoses/mortalidade , Neuroimagem , Estudos Retrospectivos , Análise de Sobrevida , Centros de Atenção TerciáriaRESUMO
Cerebral Scedosporium infections usually occur in lung transplant recipients as well as in immunocompetent patients in the context of near drowning. Voriconazole is the first-line treatment. The diffusion of voriconazole through the blood-brain barrier in the context of cerebral infection and cyclosporine administration is crucial and remains a matter of debate. To address this issue, the pharmacokinetics of voriconazole was assessed in the plasma, cerebrospinal fluid (CSF), and brain in an experimental model of cerebral scedosporiosis in rats receiving or not receiving cyclosporine. A single dose of voriconazole (30 mg/kg, i.v.) was administered to six groups of rats randomized according to the infection status and the cyclosporine dosing regimen (no cyclosporine, a single dose, or three doses; 15 mg/kg each). Voriconazole concentrations in plasma, CSF, and brain samples were quantified using ultra-performance liquid chromatography-tandem mass spectrometry and high-performance liquid chromatography UV methods and were documented up to 48 hours after administration. Pharmacokinetic parameters were estimated using a noncompartmental approach. Voriconazole pharmacokinetic profiles were similar for plasma, CSF, and brain in all groups studied. The voriconazole Cmax and area under the curve (AUC) (AUC0 ≥ 48 hours) values were significantly higher in plasma than in CSF [CSF/plasma ratio, median (range) = 0.5 (0.39-0.55) for AUC0 ≥ 48 hours and 0.47 (0.35 and 0.75) for Cmax]. Cyclosporine administration was significantly associated with an increase in voriconazole exposure in the plasma, CSF, and brain. In the plasma, but not in the brain, an interaction between the infection and cyclosporine administration reduced the positive impact of cyclosporine on voriconazole exposure. Together, these results emphasize the impact of cyclosporine on brain voriconazole exposure.
Assuntos
Ciclosporina/farmacologia , Micoses/tratamento farmacológico , Voriconazol/farmacocinética , Animais , Barreira Hematoencefálica/efeitos dos fármacos , Barreira Hematoencefálica/metabolismo , Modelos Animais de Doenças , Masculino , Micoses/sangue , Micoses/líquido cefalorraquidiano , Micoses/metabolismo , Ratos , Ratos Sprague-Dawley , Scedosporium/fisiologia , Voriconazol/sangue , Voriconazol/líquido cefalorraquidiano , Voriconazol/uso terapêuticoRESUMO
Rapid and accurate laboratory tests are important for the timely diagnosis and treatment of central nervous system infections. The FilmArray meningitis/encephalitis (ME) panel (BioFire Diagnostics, Salt Lake City, UT) is an FDA-cleared, multiplex molecular panel that allows the detection of 14 pathogens (bacterial [n = 6], viral [n = 7], and fungal [n = 1] pathogens) from cerebrospinal fluid (CSF). In this study, we evaluated the performance characteristics of the FilmArray ME panel using clinical, residual CSF samples (n = 291) that tested positive by a routine method(s) (e.g., bacterial culture, individual real-time PCR assay) for a pathogen represented on the ME panel. Of note, a subset (n = 76) of the CSF specimens was collected during the prevaccine era and had been characterized as positive for a bacterial pathogen. The FilmArray ME panel demonstrated an overall percent positive agreement (PPA) of 97.5% (78/80) for bacterial pathogens, 90.1% (145/161) for viruses, and 52% (26/50) for Cryptococcusneoformans/C. gattii Despite the low overall agreement (52%) between the ME panel and antigen testing for detection of C. neoformans/C. gattii, the percent positive agreement of the FilmArray assay for C. neoformans/C. gattii was 92.3% (12/13) when the results were compared directly to the results of routine fungal smear or culture. The FilmArray ME panel offers a rapid (â¼60-min), syndrome-based approach for the detection of select meningitis and encephalitis pathogens.
Assuntos
Encefalite/diagnóstico , Meningite/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase Multiplex/métodos , Antígenos de Fungos/isolamento & purificação , Bactérias/isolamento & purificação , Infecções Bacterianas/líquido cefalorraquidiano , Infecções Bacterianas/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Encefalite/líquido cefalorraquidiano , Fungos/isolamento & purificação , Humanos , Meningite/líquido cefalorraquidiano , Micoses/líquido cefalorraquidiano , Micoses/diagnóstico , Kit de Reagentes para Diagnóstico , Viroses/líquido cefalorraquidiano , Viroses/diagnóstico , Vírus/isolamento & purificaçãoRESUMO
BACKGROUND: Encephalitis is parenchymal brain inflammation due to infectious or immune-mediated processes. However, in 15-60% the cause remains unknown. This study aimed to determine if the cytokine/chemokine-mediated host response can distinguish infectious from immune-mediated cases, and whether this may give a clue to aetiology in those of unknown cause. METHODS: We measured 38 mediators in serum and cerebrospinal fluid (CSF) of patients from the Health Protection Agency Encephalitis Study. Of serum from 78 patients, 38 had infectious, 20 immune-mediated, and 20 unknown aetiology. Of CSF from 37 patients, 20 had infectious, nine immune-mediated and eight unknown aetiology. RESULTS: Heat-map analysis of CSF mediator interactions was different for infectious and immune-mediated cases, and that of the unknown aetiology group was similar to the infectious pattern. Higher myeloperoxidase (MPO) concentrations were found in infectious than immune-mediated cases, in serum and CSF (p = 0.01 and p = 0.006). Serum MPO was also higher in unknown than immune-mediated cases (p = 0.03). Multivariate analysis selected serum MPO; classifying 31 (91%) as infectious (p = 0.008) and 17 (85%) as unknown (p = 0.009) as opposed to immune-mediated. CSF data also selected MPO classifying 11 (85%) as infectious as opposed to immune-mediated (p = 0.036). CSF neutrophils were detected in eight (62%) infective and one (14%) immune-mediated cases (p = 0.004); CSF MPO correlated with neutrophils (p<0.0001). CONCLUSIONS: Mediator profiles of infectious aetiology differed from immune-mediated encephalitis; and those of unknown cause were similar to infectious cases, raising the hypothesis of a possible undiagnosed infectious cause. Particularly, neutrophils and MPO merit further investigation.
Assuntos
Citocinas/sangue , Citocinas/líquido cefalorraquidiano , Encefalite/sangue , Encefalite/líquido cefalorraquidiano , Adulto , Infecções Bacterianas/sangue , Infecções Bacterianas/líquido cefalorraquidiano , Biomarcadores , Moléculas de Adesão Celular/sangue , Moléculas de Adesão Celular/líquido cefalorraquidiano , Quimiocinas/líquido cefalorraquidiano , Quimiocinas/classificação , Diagnóstico Diferencial , Encefalite/etiologia , Encefalite/imunologia , Encefalite Viral/sangue , Encefalite Viral/líquido cefalorraquidiano , Encefalite Viral/diagnóstico , Inglaterra/epidemiologia , Feminino , Humanos , Encefalite Infecciosa/sangue , Encefalite Infecciosa/líquido cefalorraquidiano , Encefalite Infecciosa/diagnóstico , Contagem de Leucócitos , Masculino , Estudos Multicêntricos como Assunto , Micoses/sangue , Micoses/líquido cefalorraquidiano , Micoses/diagnóstico , Síndromes Paraneoplásicas do Sistema Nervoso/sangue , Síndromes Paraneoplásicas do Sistema Nervoso/líquido cefalorraquidiano , Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico , Peroxidase/sangue , Peroxidase/líquido cefalorraquidiano , Estudos Retrospectivos , Toxoplasmose Cerebral/sangue , Toxoplasmose Cerebral/líquido cefalorraquidiano , Toxoplasmose Cerebral/diagnósticoRESUMO
Invasive fungal infections are a major cause of morbidity and mortality in immunocompromised patients. Because the etiologic agents of these infections are abundant in nature, their isolation from biopsy material or sterile body fluids is needed to document infection. This review evaluates and discusses different human body fluids used to diagnose fungal infections.
Assuntos
Líquidos Corporais/metabolismo , Micoses/diagnóstico , Animais , Humanos , Micoses/sangue , Micoses/líquido cefalorraquidiano , Micoses/urinaRESUMO
Multiple sclerosis (MS) is the prototypical inflammatory disease of the central nervous system and spinal cord, leading to axonal demyelination of neurons. Recently, we have found a correlation between fungal infection and MS in peripheral blood of patients. The present work provides evidence of fungal infection in the cerebrospinal fluid (CSF) of some MS patients. Thus, fungal antigens can be demonstrated in CSF, as well as antibodies reacting against several Candida species. Comparison was made between CSF and blood serum for the presence of fungal antigens (proteins) and antibodies against different Candida spp. Analyses of both CSF and serum are complementary and serve to better evaluate for the presence of disseminated fungal infection. In addition, PCR analyses indicate the presence of DNA from different fungal species in CSF, depending on the patient analyzed. Overall, these findings support the notion that fungal infection can be demonstrated in CSF from some MS patients. This may constitute a risk factor in this disease and could also help in understanding the pathogenesis of MS.
Assuntos
Esclerose Múltipla/líquido cefalorraquidiano , Esclerose Múltipla/microbiologia , Micoses/líquido cefalorraquidiano , Micoses/microbiologia , Adulto , Anticorpos Antifúngicos/sangue , Anticorpos Antifúngicos/líquido cefalorraquidiano , Antígenos de Fungos/sangue , Antígenos de Fungos/líquido cefalorraquidiano , Candida/classificação , Candida/genética , Candida/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/sangue , Micoses/sangue , Adulto JovemRESUMO
During bacterial infections of the central nervous system the number of microorganisms in the cerebrospinal fluid is often ranging from few up to hundreds of cells per milliliter. The electrophoretic techniques with the UV-detection reach a detection limit for whole cells of approximately 10(7)cells per milliliter. The coupling of the filtration cartridge with capillary isoelectric focusing can improve the detection limit by four orders of magnitude. In order to improve the detection limit the red non-ionogenic surfactant 1-[[4-(phenylazo)phenyl]azo]-2-hydroxy-3-naphthoic acid polyethylene glycol ester, PAPAN 1000, has been prepared and used for the dynamic labeling of analytes before filtration of the sample with a concentration modulation in the analysis of proteins or microorganisms. Values of isoelectric points of labeled analytes have been calculated using pI markers detectable at 515 nm and have been found comparable with pI of the native compounds. Minimum detectable amounts of proteins and microorganisms were lower than nanograms and a hundred labeled cells, respectively. The introduced method, coupling of the filtration cerebrospinal fluid spiked with microorganisms and labeled by PAPAN, facilitates their rapid CIEF separation in the pH gradient pH range of 2-5 at their clinically important level 10(1) to 10(2) cells per milliliter.
Assuntos
Infecções Bacterianas/líquido cefalorraquidiano , Candida/isolamento & purificação , Eletroforese Capilar/métodos , Escherichia coli/isolamento & purificação , Micoses/líquido cefalorraquidiano , Saccharomyces cerevisiae/isolamento & purificação , Staphylococcus/isolamento & purificação , Infecções Bacterianas/diagnóstico , Humanos , Focalização Isoelétrica/métodos , Limite de Detecção , Micoses/diagnóstico , Naftóis/química , Polietilenoglicóis/química , Tensoativos/químicaRESUMO
As culture-based methods for the diagnosis of invasive fungal diseases (IFD) in leukemia and hematopoietic SCT patients have limited performance, non-culture methods are increasingly being used. The third European Conference on Infections in Leukemia (ECIL-3) meeting aimed at establishing evidence-based recommendations for the use of biological tests in adult patients, based on the grading system of the Infectious Diseases Society of America. The following biomarkers were investigated as screening tests: galactomannan (GM) for invasive aspergillosis (IA); ß-glucan (BG) for invasive candidiasis (IC) and IA; Cryptococcus Ag for cryptococcosis; mannan (Mn) Ag/anti-mannan (A-Mn) Ab for IC, and PCR for IA. Testing for GM, Cryptococcus Ag and BG are included in the revised EORTC/MSG (European Organization for Research and Treatment of Cancer/Mycoses Study Group) consensus definitions for IFD. Strong evidence supports the use of GM in serum (A II), and Cryptococcus Ag in serum and cerebrospinal fluid (CSF) (A II). Evidence is moderate for BG detection in serum (B II), and the combined Mn/A-Mn testing in serum for hepatosplenic candidiasis (B III) and candidemia (C II). No recommendations were formulated for the use of PCR owing to a lack of standardization and clinical validation. Clinical utility of these markers for the early management of IFD should be further assessed in prospective randomized interventional studies.
Assuntos
Antígenos de Fungos , Transplante de Células-Tronco Hematopoéticas , Leucemia/sangue , Leucemia/líquido cefalorraquidiano , Mananas , Micoses , beta-Glucanas , Antígenos de Fungos/sangue , Antígenos de Fungos/líquido cefalorraquidiano , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Congressos como Assunto , União Europeia , Galactose/análogos & derivados , Leucemia/microbiologia , Mananas/sangue , Mananas/líquido cefalorraquidiano , Micoses/sangue , Micoses/líquido cefalorraquidiano , Micoses/diagnóstico , Micoses/terapia , Transplante Homólogo , beta-Glucanas/sangue , beta-Glucanas/líquido cefalorraquidianoRESUMO
Representatives of the genus Pseudallescheria (anamorph: Scedosporium) are saprobes and the aetiologic agent of invasive mycosis in humans. After dissemination, the central nervous system (CNS) is one of the most affected organs. Prerequisites for the survival of Pseudallescheria/Scedosporium in the host are the ability to acquire nutrients and to evade the immune attack. The cleavage of complement compounds via the secretion of fungal proteases might meet both challenges since proteolytic degradation of proteins can provide nutrients and destroy the complement factors, a fast and effective immune weapon in the CNS. Therefore, we studied the capacity of different Pseudallescheria/Scedosporium species to degrade key elements of the complement cascade in the cerebrospinal fluid and investigated a correlation with the phylogenetic background. The majority of the Pseudallescheria apiosperma isolates tested were demonstrated to efficiently eliminate proteins like complement factors C3 and C1q, thus affecting two main components of a functional complement cascade, presumably by proteolytic degradation, and using them as nutrient source. In contrast, the tested strains of Pseudallescheria boydii have no or only weak capacity to eliminate these complement proteins. We hypothesise that the ability of Pseudallescheria/Scedosporium strains to acquire nutrients and to undermine the complement attack is at least partly phylogenetically determined.
Assuntos
Proteínas do Sistema Complemento/líquido cefalorraquidiano , Evasão da Resposta Imune , Pseudallescheria/classificação , Pseudallescheria/patogenicidade , Scedosporium/classificação , Scedosporium/patogenicidade , Encefalopatias/imunologia , Encefalopatias/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/imunologia , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Complemento C1q/líquido cefalorraquidiano , Complemento C1q/imunologia , Complemento C3/líquido cefalorraquidiano , Complemento C3/imunologia , Humanos , Micoses/líquido cefalorraquidiano , Micoses/imunologia , Micoses/microbiologia , Filogenia , Pseudallescheria/genética , Scedosporium/genéticaRESUMO
Posaconazole (POS) and caspofungin (CAS) are new therapeutic options for treating fungal infection. This study establishes the activity of POS and CAS against yeast causing invasive fungal infections. In addition, the utility of the E-test system for estimating the minimum inhibitory concentrations (MICs) related to these antifungal drugs has been assessed. The study includes 53 yeast isolates causing invasive fungal infection. MIC50 and MIC90 values were determined by the M27-A2 reference method. MIC values obtained with the reference method were then compared with those obtained with E-testing. The results were MIC50/90 (microg/mL) POS: 0.25/1, CAS: 0.06/4. Overall agreement with E-test: POS: 63.9%, CAS: 80.2%. None of the yeast isolates studied showed high MIC values for POS and CAS. Although it has some limitations, the E-test is a simple and fairly reliable system for determining the MICs of POS and CAS for yeast.
Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Equinocandinas/farmacologia , Testes de Sensibilidade Microbiana , Triazóis/farmacologia , Candida/isolamento & purificação , Caspofungina , Cryptococcus/efeitos dos fármacos , Cryptococcus/isolamento & purificação , Humanos , Lipopeptídeos , Micoses/sangue , Micoses/líquido cefalorraquidiano , Micoses/microbiologia , Rhodotorula/efeitos dos fármacos , Rhodotorula/isolamento & purificação , Sensibilidade e Especificidade , Especificidade da EspécieAssuntos
Infecções do Sistema Nervoso Central/líquido cefalorraquidiano , Infecções do Sistema Nervoso Central/diagnóstico , Ácido Láctico/líquido cefalorraquidiano , Infecções Bacterianas/líquido cefalorraquidiano , Glucose/líquido cefalorraquidiano , Humanos , Micoses/líquido cefalorraquidiano , Viroses/líquido cefalorraquidiano , Viroses/diagnósticoRESUMO
A quick and accurate diagnosis of maladies affecting the central nervous system (CNS) is imperative. Procurement and analysis of cerebrospinal fluid (CSF) are paramount in helping the clinician determine a patient's clinical condition. Various staining methods, measurement of white blood cell counts, glucose and protein levels, recognition of xanthochromia, and microbiologic studies are CSF parameters that are collectively important in the ultimate determination by a clinician of the presence or absence of a catastrophic CNS condition. Many of these CNS parameters have significant limitations that should be recognized to minimize under treating patients with catastrophic illness.
Assuntos
Líquido Cefalorraquidiano/fisiologia , Medicina de Emergência , Laboratórios Hospitalares , Infecções Bacterianas/líquido cefalorraquidiano , Glucose/líquido cefalorraquidiano , Humanos , Laboratórios Hospitalares/economia , Laboratórios Hospitalares/organização & administração , Micoses/líquido cefalorraquidiano , Reação em Cadeia da Polimerase , Fatores de TempoRESUMO
We report a case of cerebral phaeohyphomycosis due to Wangiella dermaitidis in an immunocompetent adult man. His cerebrospinal fluid (CSF) showed pleocytosis with a high eosinophil count but without peripheral blood eosinophilia. The present case suggested that this black yeast-like fungus should be included when the causes of CSF eosinophilia are considered, even though it is an extremely rare pathogen.
Assuntos
Encefalopatias/microbiologia , Eosinofilia/líquido cefalorraquidiano , Eosinófilos/microbiologia , Exophiala , Micoses/complicações , Adulto , Encefalopatias/complicações , Eosinofilia/complicações , Exophiala/isolamento & purificação , Humanos , Masculino , Micoses/sangue , Micoses/líquido cefalorraquidianoRESUMO
Enriched broth medium is routinely used as a supplement for agar plate culture of cerebrospinal fluid (CSF). To assess the clinical utility of broth cultures, 151 consecutive CSF bacterial and fungal isolates obtained from 91 patients were retrospectively reviewed for the effect of results on treatment. Treatment decisions associated with individual CSF specimens for which isolates were recovered from thioglycollate broth only were compared with the treatment decisions associated with CSF specimens for which isolates were recovered by agar plate culture. Treatment was defined as initiation of or change in antimicrobial therapy based on the reporting of CSF culture isolates. Thirty-six (24%) of the 151 isolates were recovered in broth only. Three (8%) of these 36 isolates (from 34 patients) resulted in treatment with antimicrobial agents; however, 2 of the 3 treated isolates (Candida tropicalis, Proteus mirabilis) were recovered from a second CSF specimen in agar plate culture within 24 hours. Thus, only a single isolate (3%; Staphylococcus epidermidis) was treated based solely on a positive broth culture result. In contrast, 60 (52%) of the 115 isolates recovered in agar plate culture from 23 (40%) of 57 patients were treated (staphylococci, 28; gram-negative bacilli, 14; Cryptococcus neoformans, 10; Streptococcus pneumoniae, 3; Streptococcus sanguis, 1; other, 4). We conclude that treatment with antimicrobial agents based on isolates recovered from CSF specimens in broth culture alone is infrequent and infer from the data that the use of CSF broth cultures contributes little to treatment decisions.
Assuntos
Anti-Infecciosos/uso terapêutico , Bactérias/isolamento & purificação , Líquido Cefalorraquidiano/microbiologia , Fungos/isolamento & purificação , Técnicas Microbiológicas , Adolescente , Adulto , Ágar , Idoso , Idoso de 80 Anos ou mais , Antibacterianos , Infecções Bacterianas/líquido cefalorraquidiano , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Meios de Cultura , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Micoses/líquido cefalorraquidiano , Micoses/tratamento farmacológico , Micoses/microbiologia , Estudos RetrospectivosRESUMO
We present a case of cerebral phaeohyphomycosis caused by Cladophialophora bantiana in an apparently immunocompetent patient with a history of intravenous drug use. The diagnosis was achieved in specimens obtained at necropsy by histological and mycological examination, with subsequent identification of the isolate in culture.
Assuntos
Encefalopatias/microbiologia , Encéfalo/patologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Fungos Mitospóricos/fisiologia , Micoses/microbiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/microbiologia , Encefalopatias/líquido cefalorraquidiano , Encefalopatias/patologia , Líquido Cefalorraquidiano/microbiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Fungos Mitospóricos/efeitos dos fármacos , Fungos Mitospóricos/isolamento & purificação , Micoses/líquido cefalorraquidiano , Micoses/patologia , Punção Espinal , Tomografia Computadorizada por Raios XAssuntos
Líquido Cefalorraquidiano/química , Doença Aguda , Infecções Bacterianas/líquido cefalorraquidiano , Líquido Cefalorraquidiano/citologia , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/normas , Contraindicações , Análise Custo-Benefício , Humanos , Meningite/líquido cefalorraquidiano , Meningite Viral/líquido cefalorraquidiano , Micoses/líquido cefalorraquidiano , Fatores de Risco , Punção Espinal/efeitos adversos , Tuberculose Meníngea/líquido cefalorraquidianoRESUMO
Trichosporon beigelii (Trichosporon cutaneum) was identified as the causative agent of chronic meningitis in a 15-year-old boy with acute lymphocytic leukaemia. After a neutropenic episode following cytostatic treatment and itraconazole therapy as prophylaxis, cerebrospinal fluid (CSF) samples yielded growth of Trichosporon beigelii. Treatment with amphotericin B, flucytosine and high doses of fluconazole was followed by clinical improvement, although CSF pleocytosis remained. The cross-reactivity between Cryptococcus neoformans and Trichosporon beigelii in a cryptococcal antigen latex test was used as a means of diagnosis in CSF and serum samples.
Assuntos
Meningite/complicações , Micoses/complicações , Infecções Oportunistas/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adolescente , Anfotericina B/administração & dosagem , Doença Crônica , Quimioterapia Combinada , Fluconazol/administração & dosagem , Flucitosina/administração & dosagem , Humanos , Masculino , Meningite/líquido cefalorraquidiano , Meningite/tratamento farmacológico , Micoses/líquido cefalorraquidiano , Micoses/tratamento farmacológico , Infecções Oportunistas/líquido cefalorraquidiano , Infecções Oportunistas/tratamento farmacológico , Trichosporon/patogenicidadeRESUMO
Clinical evaluation of fluconazole was performed on 12 cases of mycotic infections (7 cases of Candida esophagitis; one each case of cryptococcal meningitis with AIDS, Candida tropicalis fungemia and disseminated cryptococcosis in kidney transplant patient; 2 cases of Candida pneumonia). Satisfactory responses were obtained except 1 case of Candida pneumonia in which clinical efficacy could not be evaluated. Hiccup was noted in 1 case during the fluconazole treatment. No other adverse reaction was observed. When 150 mg and 200 mg of fluconazole were administered orally to a patient with hemodialysis (HD) after HD on separate occasions, concentrations of the drug in serum at 20 hours after ingestion were 5.9 micrograms/ml and 11.6 micrograms/ml, respectively, and in cerebrospinal fluid (CSF) were 3.5 micrograms/ml and 9.2 micrograms/ml, respectively. Two clinical benefits were obtained in our studies. First, it was possible to treat the AIDS-patient as an outpatient with Candida esophagitis using orally administered fluconazole. Second, it was possible to treat the case of cryptococcal meningitis, in which relapse often occurs, to complete the therapy when the cryptococcal antigen in serum and CSF diminished to an undetectable level and to maintain the therapy preventing relapse without severe adverse effects. Ongoing and future clinical trials will define the specific roles of fluconazole more clearly in the treatment of systemic mycosis.