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1.
Artigo em Inglês | MEDLINE | ID: mdl-32876295

RESUMO

Sporotrichosis is an implantation mycosis highly prevalent in Brazil, associated with soil activities and contact with infected animals. It has numerous clinical manifestations and its disseminated cutaneous form is uncommon, found in approximately 4% of cases and usually related to immunosuppressive conditions. We report an alcoholic 56-year-old male patient with no other comorbidities, presenting with multiple cutaneous nodules and ulcers. The patient was diagnosed with disseminated cutaneous sporotrichosis based on the isolation and identification of Sporothrix spp. The patient was initially treated with amphotericin B with satisfactory results and then with itraconazole.


Assuntos
Alcoolismo/complicações , Sporothrix/isolamento & purificação , Esporotricose/diagnóstico , Anfotericina B/uso terapêutico , Animais , Antifúngicos/uso terapêutico , Brasil , Humanos , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Esporotricose/tratamento farmacológico , Resultado do Tratamento , Úlcera/etiologia
2.
BMC Infect Dis ; 20(1): 717, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993529

RESUMO

BACKGROUND: Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). CASE PRESENTATION: An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable. CONCLUSION: H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.


Assuntos
Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/etiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/diagnóstico , Peritonite/etiologia , Administração Intravenosa , Administração Oral , Idoso de 80 Anos ou mais , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Ásia , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Feminino , Histoplasmose/tratamento farmacológico , Histoplasmose/microbiologia , Humanos , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Falência Renal Crônica/terapia , Peritonite/tratamento farmacológico , Peritonite/microbiologia , Resultado do Tratamento
3.
BMC Infect Dis ; 20(1): 681, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943003

RESUMO

BACKGROUND: The purpose of this case report was to report a case of Cryptococcus laurentii infection in the left knee of a previously healthy 29 year old male patient. CASE PRESENTATION: After an initial misdiagnosis and 7 months of failed treatment, the patient received nearly a month of treatment with voriconazole (200 mg IV q12 h) and knee irrigation with amphotericin B until the infection was controlled. The treatment continued with fluconazole for nearly 7 months and approximately 5 weeks of antibiotic treatment for a skin bacterial coinfection. In the end, the patient's symptoms disappeared completely, the left knee recovered well, and there was no recurrence of infection. CONCLUSION: The key points of successful treatment in this case were the thorough debridement, the adequate course of knee irrigation with antifungal drugs and more than 6 months of oral antifungal drugs that were able to eradicate the infection.


Assuntos
Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Joelho/microbiologia , Administração Oral , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Artrite Infecciosa/microbiologia , Criptococose/cirurgia , Cryptococcus/isolamento & purificação , Desbridamento , Erros de Diagnóstico , Fluconazol/uso terapêutico , Infecção Focal/tratamento farmacológico , Infecção Focal/microbiologia , Infecção Focal/cirurgia , Humanos , Joelho/diagnóstico por imagem , Joelho/cirurgia , Masculino , Dermatopatias Bacterianas/tratamento farmacológico , Voriconazol/uso terapêutico
4.
Medicine (Baltimore) ; 99(31): e21431, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756151

RESUMO

RATIONALE: The use of autologous hematopoietic stem cell transplantation (AHSCT) for autoimmune diseases has become the first indication for transplant in nonmalignant disease. Mucormycosis is a rare invasive infection with increasing incidence in patients treated with AHSCT. We report the first case of pulmonary mucormycosis following AHSCT for systemic sclerosis (SSc). PATIENT CONCERNS: A 24-year-old woman with rapidly progressive diffuse cutaneous SSc presented with an acute respiratory distress syndrome 6 days after AHSCT. DIAGNOSES: The results of clinical and computed tomography scan were consistent with pulmonary mucormycosis and the diagnosis was confirmed by a positive Mucorales Polymerase Chain Reaction on a peripheral blood sample. INTERVENTIONS AND OUTCOMES: Early antifungal therapy by intravenous amphotericin B provided rapid improvement within 4 days and sustained recovery after 2 years of follow-up. LESSONS: With the progressively increasing use of AHSCT and other stem cell therapy for treatment of severe SSc and other autoimmune diseases, the potential onset of rare post-transplant fungal infections, such as mucormycosis, requires careful patient monitoring and better awareness of early initiation of adequate therapy.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Mucormicose/etiologia , Esclerodermia Difusa/etiologia , Escleroderma Sistêmico/terapia , Transplante Autólogo/efeitos adversos , Doença Aguda , Administração Intravenosa , Assistência ao Convalescente , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Feminino , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/patologia , Mucorales/genética , Síndrome do Desconforto Respiratório do Adulto/etiologia , Esclerodermia Difusa/patologia , Transplante Autólogo/métodos , Resultado do Tratamento , Adulto Jovem
5.
BMC Infect Dis ; 20(1): 614, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32811466

RESUMO

BACKGROUND: The most common aetiological agents of mucormycosis are Rhizopus, Mucor, Apophysomyces and Lichtheimia. Apophysomyces is comparatively rare, as it has been reported in less than 3% of mucormycosis cases. The genus Apophysomyces includes six species, and only A. elegans, A. mexicanus, A. variabilis and A. ossiformis have been reported to cause infections in both immunocompetent and immunocompromised patients. CASE PRESENTATION: We present a case of a 46-year-old male patient with bilateral blepharoedema, corneal opacity in the left eye and poorly controlled diabetes mellitus. The patient was subjected to total maxillectomy, exenteration of the left orbit and treatment with liposomal amphotericin B. Direct mycological analysis with KOH 10% revealed hyaline, coenocytic, long and wide hyphae. Apophysomyces ossiformis was identified from maxillary biopsy using 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. The patient requested to be transferred to another hospital to continue treatment, where he died on the ninth day after admittance. CONCLUSION: To the best of our knowledge, this is the first case of rhino-orbital mucormycosis due to A. ossiformis with a fatal outcome. This case reveals the need to identify the fungus causing mucormycosis with molecular methods to identify adequate treatment therapies for patients with this infection.


Assuntos
Complicações do Diabetes/microbiologia , Mucorales/genética , Mucormicose/complicações , Doenças Orbitárias/complicações , Rinite/complicações , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Biópsia , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/cirurgia , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Masculino , Maxila/microbiologia , Maxila/patologia , Maxila/cirurgia , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Mucormicose/cirurgia , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/microbiologia , Doenças Orbitárias/cirurgia , RNA Ribossômico 28S/genética , Rinite/tratamento farmacológico , Rinite/microbiologia , Rinite/cirurgia
7.
BMC Infect Dis ; 20(1): 506, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-32660641

RESUMO

BACKGROUND: We evaluated the epidemiology, clinical characteristics, microbiology, outcomes, and risk factors for mortality of candidemia in adult surgical patients in Shenyang from 2012 to 2018. METHODS: We designed a retrospective observational study of adult patients with candidemia in a teaching hospital including three hospital campuses. Data regarding clinical and demographic characteristics were collected from the patient's medical records. RESULTS: Of the 236 cases of candidemia, 172 (72.9%) were identified in surgical patients, including 146 (84.9%) general surgeries, 11 (6.4%) urologic surgeries, 6 (3.5%) thoracic surgeries, and others. Higher proportions of solid tumors, total parenteral nutrition, the presence of a urinary catheter, and the presence of a gastric tube were observed in surgical patients with candidemia versus non-surgical ones, whereas the percentages of hematological malignancy, diabetes mellitus, and renal replacement therapy were relatively lower in surgical patients. Renal failure, leukopenia, and thrombocytopenia were less common laboratory findings in surgical patients with candidemia than compared to non-surgical ones. Among surgical patients with candidemia, Candida parapsilosis was the predominant species (43%), followed by C. albicans (33.7%), C. glabrata (11%), C. tropicalis (8.1%), and others (4.1%). Overall susceptibility, susceptible dose dependent or intermediate susceptibility, and resistance to fluconazole were detected in 73.3, 19.8, and 3.5% Candida isolates from surgical patients, respectively, but no resistance to amphotericin B was observed. Overall, the 30-day mortality in surgical patients was 19.2%. At multivariable analysis, independent risk factors for death in surgical patients with candidemia were ICU stay, thrombocytopenia, and C. albicans infection. CONCLUSIONS: Surgical patients account for the majority of candidemia cases. Among patients with recent surgery, risk factors for species distribution, antifungal sensitivity patterns of Candida isolates causing candidemia, and independent risk factors for mortality should be evaluated and considered for a better outcome in the antifungal treatment.


Assuntos
Candida albicans/isolamento & purificação , Candida parapsilosis/isolamento & purificação , Candidemia/epidemiologia , Candidemia/mortalidade , Complicações Pós-Operatórias/microbiologia , Adulto , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Candidemia/microbiologia , China/epidemiologia , Feminino , Fluconazol/uso terapêutico , Hospitais de Ensino , Humanos , Incidência , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
8.
Mikrobiyol Bul ; 54(2): 334-338, 2020 Apr.
Artigo em Turco | MEDLINE | ID: mdl-32723288

RESUMO

In this study, a case of candidemia caused by Candida hellenica as the first report in our country was presented. Fluconazole and liposomal amphotericin B treatment was initiated in a 20-year-old male patient in October 2018 due to the diagnosis of candidemia following esophageal surgery. The patient had a history of multiple esophageal operations. The patient was discharged during the last 24 hours due to the lack of fever, improvement in general condition and lack of growth in blood cultures. Germination tube test of the Candida isolate grown in blood culture was negative and the colony morphology in corn meal tween 80 agar was not defining. It was identified as C.hellenica according to the profile obtained from the ID32C® (bioMérieux, France) method based on carbohydrate assimilation. The target ITS regions of the rRNA genes were amplified by polymerase chain reaction and sequenced using suitable primers for the confirmation of the identification on species level. The DNA sequences obtained were searched by using the "National Center for Biotechnology Information (BLAST)" (http://www.ncbi.nlm.nih.gov/ BLAST/) database and the isolate was identified as C.hellenica with a 99% homology with GenBank sequences. MALDI-TOF (Vitek MS, bioMerieux) could not identify the yeast isolate. The reference microdilution method was performed according to the recommendations of the Clinical and Laboratory Standards Institute in order to test the antifungal susceptibility. The minimal inhibitory concentrations for the isolate, determined after 24-hour incubation were 0.25 µg/ml for amphotericin B, 8 µg/ml for fluconazole, 0.25 µg/ml for voriconazole, and 0.25 µg/ml for itraconazole. As our case had a previous history of gastrointestinal tract surgery it was thought that gastrointestinal tract was the endogenous source of candidemia by leading to mucosal disruption and this mucosal disruption might facilitate the translocation of Candida. The carbohydrate assimilation test ID32C®, was able identify the causative agent of candidaemia at the species level in this case. However, uncommon or previously unrecognized organisms may be misidentified by commercial systems. While the phenotypic definition is sufficient in routine laboratories, it is mandatory to confirm the microorganism species definition by DNA sequence analysis, as done in this case. We have presented a correctly identifed and successfully treated candidemia case. Although the candidemia was not mortal in our patient, the mortality rate of candidemia which is 50%, should be remembered. A total of two C.hellenica infections have been reported in the literature, including one candidaemia and one respiratory tract colonization. Our successfully treated case was presented to draw attention to this rare infectious agent.


Assuntos
Candidemia , Esôfago , Complicações Pós-Operatórias , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candidemia/tratamento farmacológico , Candidemia/etiologia , Esôfago/cirurgia , Fluconazol/uso terapêutico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Complicações Pós-Operatórias/microbiologia , Adulto Jovem
9.
J Mycol Med ; 30(3): 101007, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32718789

RESUMO

Mucormycosis are life-threatening fungal infections especially affecting immunocompromised or diabetic patients. Despite treatment, mortality remains high (from 32 to 70% according to organ involvement). This review provides an update on mucormycosis management. The latest recommendations strongly recommend as first-line therapy the use of liposomal amphotericin B (≥5mg/kg) combined with surgery whenever possible. Isavuconazole and intravenous or delayed-release tablet forms of posaconazole have remained second-line. Many molecules are currently in development to fight against invasive fungal diseases but few have demonstrated efficacy against Mucorales. Despite in vitro efficacy, combinations of treatment have failed to demonstrate superiority versus monotherapy. Adjuvant therapies are particularly complex to evaluate without prospective randomized controlled studies, which are complex to perform due to low incidence rate and high mortality of mucormycosis. Perspectives are nonetheless encouraging. New approaches assessing relationships between host, fungi, and antifungal drugs, and new routes of administration such as aerosols could improve mucormycosis treatment.


Assuntos
Infectologia/normas , Infectologia/tendências , Mucormicose/terapia , Guias de Prática Clínica como Assunto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Terapia Combinada/métodos , Terapia Combinada/normas , Terapia Combinada/tendências , Complicações do Diabetes/microbiologia , Humanos , Hospedeiro Imunocomprometido , Infectologia/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas , Procedimentos Cirúrgicos Operatórios/tendências , Terapias em Estudo/métodos , Terapias em Estudo/tendências
10.
BMC Infect Dis ; 20(1): 438, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571233

RESUMO

BACKGROUND: Candida sp. osteoarticular infection is rare and most often due to hematogenous seeding during an episode of candidemia in immunocompromised patients. However, the diagnosis can be delayed in patients with subtle symptoms and signs of joint infection without a concurrent episode of candidemia. CASE PRESENTATION: A 75-year-old woman presented with a three-year history of pain and swelling of the left knee. Candida pelliculosa was detected from the intraoperative tissue when the patient had undergone left total knee arthroplasty 32 months ago, but no antifungal treatment was performed. One year after the total knee arthroplasty, C. pelliculosa was repeatedly isolated from the left knee synovial fluid and antifungal treatment comprising amphotericin B deoxycholate and fluconazole was administered. However, joint infection had extended to the adjacent bone and led to progressive joint destruction. The patient underwent surgery for prosthesis removal and received prolonged antifungal treatment with micafungin and fluconazole. CONCLUSIONS: This case shows that C. pelliculosa, an extremely rare non-Candida albicans sp., can cause fungal arthritis and lead to irreversible joint destruction owing to delayed diagnosis and treatment.


Assuntos
Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Candida/patogenicidade , Candidíase/microbiologia , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Candida/isolamento & purificação , Candidemia/tratamento farmacológico , Candidemia/etiologia , Candidíase/tratamento farmacológico , Ácido Desoxicólico/uso terapêutico , Remoção de Dispositivo , Combinação de Medicamentos , Feminino , Fluconazol/uso terapêutico , Humanos , Cuidados Intraoperatórios , Prótese Articular , Joelho/microbiologia , Joelho/cirurgia , Micafungina/uso terapêutico , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia
11.
J Med Microbiol ; 69(6): 844-849, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32459615

RESUMO

Introduction. Signal transducer and activator of transcription 3 (STAT3) deficiency is a rare primary immunodeficiency associated with increased susceptibility to bacterial and fungal infections, notably pulmonary aspergillosis.Aim. We describe the emergence of azole-resistant Aspergillus fumigatus infections in STAT3-deficient patients.Methodology. During a retrospective study of 13 pulmonary aspergillosis cases in STAT3-deficient patients conducted in France, we identified patients infected with azole-resistant A. fumigatus isolates.Results. Two out of the 13 STAT3-deficient patients with aspergillosis had azole-resistant A. fumigatus infection, indicating an unexpectedly high prevalence of resistance. The first patient with STAT3 deficiency presented several flares of allergic bronchopulmonary aspergillosis-like episodes. He was chronically infected with two azole-resistant A. fumigatus isolates (TR34/L98). Despite prolonged antifungal treatment, including caspofungin and amphotericin B, the patient was not able to clear the azole-resistant A. fumigatus. The second patient had chronic cavitary pulmonary aspergillosis (CCPA). The A. fumigatus isolate was initially azole susceptible but harboured three F46Y, M172V and E427K point mutations. Despite prolonged antifungal therapies, lesions worsened and the isolate became resistant to all azoles. Surgery and caspofungin treatments were then required to cure CCPA. Resistance was probably acquired from the environment (TR34/L98) in the first case whereas resistance developed under antifungal treatments in the second case. These infections required long-term antifungal treatments and surgery.Conclusions. The emergence of azole-resistant A. fumigatus infections in STAT3-deficiency dramatically impacts both curative and prophylactic antifungal strategies. Physicians following patients with primary immune-deficiencies should be aware of this emerging problem as it complicates management of the patient.


Assuntos
Antifúngicos/uso terapêutico , Aspergillus fumigatus/efeitos dos fármacos , Azóis/uso terapêutico , Farmacorresistência Fúngica/efeitos dos fármacos , Aspergilose Pulmonar/tratamento farmacológico , Aspergilose Pulmonar/genética , Fator de Transcrição STAT3/deficiência , Adulto , Anfotericina B/uso terapêutico , Caspofungina/uso terapêutico , Criança , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/genética , Doenças Transmissíveis/microbiologia , Farmacorresistência Fúngica/genética , França , Proteínas Fúngicas/genética , Genótipo , Humanos , Masculino , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Adulto Jovem
12.
Intern Med ; 59(9): 1227-1230, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32378656

RESUMO

Liposomal-amphotericin B (L-AmB) is used for cutaneous leishmaniasis (CL); however, its treatment failure has not yet been described in detail. A 58-year-old man returned from the Republic of Venezuela with a cutaneous ulcer on his left lower leg. The causative pathogen was Leishmania braziliensis. We started L-AmB 3 mg/kg/day for 6 days; however, the ulcer did not resolve. The patient was successfully retreated with a higher dose L-AmB 4 mg/kg/day 9 times (total, 36 mg/kg). If L-AmB fails to treat CL and other therapeutics cannot be used, increasing the L-AmB dose is a viable option.


Assuntos
Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmania braziliensis/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Anfotericina B/administração & dosagem , Antiprotozoários/administração & dosagem , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Humanos , Leishmaniose Cutânea/complicações , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Retratamento , Falha de Tratamento
13.
Am J Trop Med Hyg ; 103(1): 308-314, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32394874

RESUMO

Visceral leishmaniasis (VL) is endemic in Asia, East and North Africa, South America, and Southern Europe, and is a major public health problem in the Indian subcontinent. Miltefosine received approval in 2002 to treat VL in India, and the Indian National Vector Borne Disease Control Programme later adopted a single dose (10 mg/kg) of liposomal amphotericin B. We report results of a randomized trial comparing the efficacy of combination therapy with an Indian preparation of liposomal amphotericin B (single dose of 7.5 mg/kg) and short-course miltefosine (2.5 mg/kg/day for 14 days; n = 66) in comparison to miltefosine monotherapy (2.5 mg/kg/day for 28 days; n = 78). Nine patients in the miltefosine group and three in the combination therapy group had to discontinue therapy because of serious adverse events. At the end of the therapy, the clinical and parasitological cure rate was 100% in both groups. By per-protocol analysis, by 6 months after completion of treatment, 12 of 69 patients in the miltefosine monotherapy arm (17.4%, 95% CI: 10.24-28%) and none in the combination therapy arm had relapse. Over 5 years of follow-up, 10 patients in the miltefosine monotherapy arm (all within 0.5-2 years after completing therapy) and none in the combination therapy arm experienced post-kala-azar dermal leishmaniasis. Combination therapy offered benefits over miltefosine monotherapy for VL in India.


Assuntos
Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmaniose Visceral/tratamento farmacológico , Fosforilcolina/análogos & derivados , Adolescente , Adulto , Idoso , Anfotericina B/administração & dosagem , Antiprotozoários/administração & dosagem , Criança , Quimioterapia Combinada , Feminino , Humanos , Índia , Leishmania donovani , Masculino , Pessoa de Meia-Idade , Fosforilcolina/administração & dosagem , Fosforilcolina/uso terapêutico , Adulto Jovem
14.
Int J Infect Dis ; 97: 27-29, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32425641

RESUMO

BACKGROUND: Visceral leishmaniasis-related hemophagocytic lymphohistiocytosis (VL-HLH) is a secondary hemophagocytic syndrome, which can be life-threatening, caused by leishmania and transmitted by infected sandflies. Rapid and accurate identification of leishmania is crucial for clinical strategies. CASE REPORT: Here, we report an infantile infection in a non-epidemic area of China. The infant was a 9.5-month-old girl with fever, pancytopenia and hepatosplenomegaly, which meet the HLH-2004 standard, and the negative gene results exclude congenital HLH. However, chemotherapy is ineffective and is accompanied by severe infection. Fortunately, she is diagnosed with VL-HLH (visceral leishmaniasis-related hemophagocytic lymphohistiocytosis), as leishmania is detected by next-generation meta-genome sequencing (mNGS) and quickly relieved after treatment with libosomal amphotericin B (L-AMB). CONCLUSION: mNGS can detect leishmania in pediatric HLH, and should be performed as a new detection for VL-HLH, particularly for infants, who may not respond to HLH-2004 regimen.


Assuntos
Leishmaniose Visceral/diagnóstico , Linfo-Histiocitose Hemofagocítica/diagnóstico , Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Lactente , Leishmania/isolamento & purificação , Leishmaniose Visceral/tratamento farmacológico , Leishmaniose Visceral/parasitologia , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Linfo-Histiocitose Hemofagocítica/parasitologia
16.
Am J Trop Med Hyg ; 102(6): 1319-1322, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32228792

RESUMO

The six previously reported civilian cases of mucosal leishmaniasis (ML) diagnosed in the United States have all represented imported New World ML. We describe two new patients with ML diagnosed in New York City-a Syrian immigrant with a nasal mass (Leishmania tropica), the first report of Old World ML in the United States, and an American ecologist who worked in Bolivia and had been treated for cutaneous infection 23 years before developing lesions (L. (Viannia) braziliensis) initially of the uvula, soft palate, and posterior pharynx and subsequently the larynx.


Assuntos
Leishmaniose Mucocutânea/epidemiologia , Leishmaniose Mucocutânea/patologia , Idoso , Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Humanos , Leishmania braziliensis/isolamento & purificação , Leishmaniose Mucocutânea/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Fosforilcolina/análogos & derivados , Fosforilcolina/uso terapêutico
17.
Cochrane Database Syst Rev ; 4: CD013594, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32343003

RESUMO

BACKGROUND: Progressive disseminated histoplasmosis (PDH) is a serious fungal infection that affects people living with HIV. The best way to treat the condition is unclear. OBJECTIVES: We assessed evidence in three areas of equipoise. 1. Induction. To compare efficacy and safety of initial therapy with liposomal amphotericin B versus initial therapy with alternative antifungals. 2. Maintenance. To compare efficacy and safety of maintenance therapy with 12 months of oral antifungal treatment with shorter durations of maintenance therapy. 3. Antiretroviral therapy (ART). To compare the outcomes of early initiation versus delayed initiation of ART. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane CENTRAL; MEDLINE (PubMed); Embase (Ovid); Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and BIOSIS Previews (all three in the Web of Science); the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry, all up to 20 March 2020. SELECTION CRITERIA: We evaluated studies assessing the use of liposomal amphotericin B and alternative antifungals for induction therapy; studies assessing the duration of antifungals for maintenance therapy; and studies assessing the timing of ART. We included randomized controlled trials (RCT), single-arm trials, prospective cohort studies, and single-arm cohort studies. DATA COLLECTION AND ANALYSIS: Two review authors assessed eligibility and risk of bias, extracted data, and assessed certainty of evidence. We used the Cochrane 'Risk of bias' tool to assess risk of bias in randomized studies, and ROBINS-I tool to assess risk of bias in non-randomized studies. We summarized dichotomous outcomes using risk ratios (RRs), with 95% confidence intervals (CI). MAIN RESULTS: We identified 17 individual studies. We judged eight studies to be at critical risk of bias, and removed these from the analysis. 1. Induction We found one RCT which compared liposomal amphotericin B to deoxycholate amphotericin B. Compared to deoxycholate amphotericin B, liposomal amphotericin B may have higher clinical success rates (RR 1.46, 95% CI 1.01 to 2.11; 1 study, 80 participants; low-certainty evidence). Compared to deoxycholate amphotericin B, liposomal amphotericin B has lower rates of nephrotoxicity (RR 0.25, 95% CI 0.09 to 0.67; 1 study, 77 participants; high-certainty evidence). We found very low-certainty evidence to inform comparisons between amphotericin B formulations and azoles for induction therapy. 2. Maintenance We found no eligible study that compared less than 12 months of oral antifungal treatment to 12 months or greater for maintenance therapy. For both induction and maintenance, fluconazole performed poorly in comparison to other azoles. 3. ART We found one study, in which one out of seven participants in the 'early' arm and none of the three participants in the 'late' arm died. AUTHORS' CONCLUSIONS: Liposomal amphotericin B appears to be a better choice compared to deoxycholate amphotericin B for treating PDH in people with HIV; and fluconazole performed poorly compared to other azoles. Other treatment choices for induction, maintenance, and when to start ART have no evidence, or very low certainty evidence. PDH needs prospective comparative trials to help inform clinical decisions.


Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Infecções por HIV/complicações , Histoplasmose/tratamento farmacológico , Anfotericina B/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Antifúngicos/efeitos adversos , Estudos de Coortes , Ácido Desoxicólico , Esquema de Medicação , Fluconazol/uso terapêutico , Infecções por HIV/tratamento farmacológico , Histoplasmose/mortalidade , Humanos , Quimioterapia de Indução , Itraconazol/uso terapêutico , Rim/efeitos dos fármacos , Lipossomos , Quimioterapia de Manutenção , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Int J Infect Dis ; 96: 151-153, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32339725

RESUMO

Eye damage during invasive aspergillosis is rarely described and biological diagnosis remains challenging. Here we report the case of a heart transplant recipient with ocular aspergillosis complicating disseminated aspergillosis. Although voriconazole was rapidly given, a decrease in visual acuity of the right eye was consistent with endophthalmitis, resulting in an emergency vitrectomy. The diagnosis was rapidly confirmed: laboratory results showed the presence of Aspergillus fumigatus in a vitreous sample. A series of systemic antifungal medications (liposomal amphotericin B, caspofungin, and voriconazole), several liposomal amphotericin B ocular injections, and pars plana vitrectomy resulted in a limited positive clinical outcome. Interestingly although standard mycological follow-up procedures were negative, Aspergillus antigen testing gave an index of 5.92 on vitreous humour, thus a new intraocular injection of liposomal amphotericin B was performed and voriconazole reinitiated. Ten other vitreous samples from patients without fungal infections were also tested, all showing indexes below 0.25. Although larger studies are needed, this case illustrates that galactomannan testing of vitreous humour could be useful for the diagnosis of fungal endophthalmitis if these data are confirmed in other patients, in particular, if standard mycology is negative and PCR is not available.


Assuntos
Aspergilose/diagnóstico , Aspergillus fumigatus , Endoftalmite/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Mananas/metabolismo , Corpo Vítreo/metabolismo , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/metabolismo , Endoftalmite/tratamento farmacológico , Endoftalmite/metabolismo , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/metabolismo , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acuidade Visual , Vitrectomia , Voriconazol/uso terapêutico
20.
Rev. iberoam. micol ; 37(1): 34-36, ene.-mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193844

RESUMO

ANTECEDENTES: La histoplasmosis es una micosis sistémica endémica en América con pocos casos reportados en pediatría. OBJETIVOS: Describir la epidemiología, formas clínicas y evolución de la histoplasmosis en niños de un hospital pediátrico en Argentina. MÉTODOS: El estudio, retrospectivo y descriptivo, se llevó a cabo entre enero de 2008 y diciembre de 2016 en el Hospital de Pediatría «Prof. Dr. Juan Pedro Garrahan», e incluyó pacientes menores de 18 años con cuadro clínico, serología, cultivos y/o hallazgos histológicos compatibles con histoplasmosis. Se estudiaron 13 pacientes (siete niños y seis niñas, con una mediana de edad de 9 años y rango intercuartílico de 3,4 a 13 años), de los cuales tres niños (23%) provenían de la provincia de Buenos Aires, tres de la provincia de Santa Fe (23%) y siete (54%) de otras provincias. RESULTADOS: Diez pacientes (77%) presentaron la forma diseminada de la enfermedad y tres (23%) la forma pulmonar (23%); ocho niños (62%) tenían otras comorbilidades. La serología fue positiva en siete casos (54%), los cultivos fueron positivos en nueve pacientes (69%) y en diez casos (77%) se identificaron hallazgos histológicos compatibles con histoplasmosis. Todos los pacientes recibieron anfotericina B (liposomal en siete casos y desoxicolato en seis). Diez pacientes (77%) continuaron el tratamiento con itraconazol y tres pacientes (23%) fallecieron por causas no relacionadas con la histoplasmosis. CONCLUSIONES: En la serie analizada predominaron los pacientes con histoplasmosis diseminada asociada a otra enfermedad. La mortalidad no estuvo directamente relacionada con la infección


BACKGROUND: Histoplasmosis is a fungal disease, endemic in South America, and seldom reported in paediatrics. AIMS: To report the epidemiology, clinical features and outcome of children diagnosed with histoplasmosis in an Argentinian Children's Hospital. METHODS: A retrospective and descriptive study was performed from January 2008 to December 2016 in Hospital de Pediatría 'Prof. Dr. Juan Pedro Garrahan'. Patients under 18 years with clinical features, serological tests, cultures and/or histological findings compatible with histoplasmosis were included. Thirteen patients were selected (seven male and six female; mean age was 9 years with interquartile range 3.4-13); three children (23%) were from Buenos Aires province, three (23%) from Santa Fe province, and seven (54%) from other provinces. RESULTS: In ten cases (77%) the clinical form was disseminated, and it was pulmonary in three (23%). Eight cases (62%) suffered other comorbidities. Serological tests were positive in seven patients (54%), with positive cultures obtained in nine patients (69%). Histological findings compatible with histoplasmosis were found in 10 cases (77%). All patients received treatment with amphotericin B (liposomal formulation in seven cases, deoxycholate in six), with 10 patients continuing with oral itraconazole. Three patients (23%) died from causes unrelated to histoplasmosis. CONCLUSIONS: The majority of children in the series had comorbidities and disseminated histoplasmosis. Mortality was not directly associated with histoplasmosis


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Itraconazol/uso terapêutico , Estudos Retrospectivos , Histoplasmose/mortalidade , Argentina
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