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1.
Medicine (Baltimore) ; 99(2): e18692, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914069

RESUMO

RATIONALE: Allergic bronchopulmonary aspergillosis (ABPA) complicated with pulmonary thromboembolism (PTE) is rare. This report describes a patient who was diagnosed with ABPA and soon developed PTE. PATIENT CONCERNS: A 64-year-old man was diagnosed with ABPA in hospital for recurrent fever with cough. Two months later, the patient was readmitted to the hospital because of PTE. DIAGNOSES: ABPA was diagnosed during the first hospitalization, and laboratory tests showed an increase in serum IgE and Aspergillus fumigatus-specific IgG. Sputum culture suggested A. fumigatus and high-resolution computed tomography (HRCT) showed inflammation of both lungs and central bronchiectasis. During the second hospitalization, the patient's chest angiography showed PTE. INTERVENTIONS: The patient began treatment with antifungal drugs and corticosteroids, and was discharged from the hospital when his condition improved. Two months after discharge, the patient was treated with anticoagulant drugs due to PTE. OUTCOMES: The patient got better after taking anticoagulant drugs and was discharged from the hospital. The patient appears for regular follow-up visits in our outpatient clinic every 2 months and is currently in good condition. LESSONS: Patients with ABPA may be concurred with PTE. The risk of PTE in ABPA should be assessed in advance and preventive strategies also need to be taken beforehand. Pulmonary artery examination is necessary once it happened.


Assuntos
Aspergilose Broncopulmonar Alérgica/complicações , Embolia Pulmonar/etiologia , Anticoagulantes/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/tratamento farmacológico
2.
J Zoo Wildl Med ; 50(4): 1008-1011, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926538

RESUMO

Curvularia spp. are globally distributed saprophytic fungi, classified in the literature as dematiaceous, or darkly pigmented fungi. These fungi have been increasingly recognized as causing cutaneous, ocular, respiratory, and central nervous system infections in humans, but have been infrequently documented as pathogens in the veterinary literature. A 5-yr-old male Chinese goral (Naemorhedus griseus) presented with bilateral fungal dermatitis of the pinnae, and subsequent pyogranulomatous rhinosinusitis. Clinical signs included epistaxis, mucosanguineous nasal discharge, and dyspnea. Sequential histologic examinations of cutaneous and nasal lesions revealed pyogranulomatous inflammation with extracellular and phagocytized nonpigmented yeasts. Fungal culture and polymerase chain reaction identified Curvularia sp. The absence of pigmentation in tissue in this case suggests that pigmentation may not be a consistent histologic finding for this fungus, emphasizing the importance of molecular identification to prevent misidentification. Despite intensive interventions in this goral, the disease progressed, and was ultimately fatal.


Assuntos
Dermatomiosite/veterinária , Rinite/veterinária , Sinusite/veterinária , Animais , Animais de Zoológico , Antifúngicos/uso terapêutico , Clotrimazol/uso terapêutico , Dermatomiosite/tratamento farmacológico , Dermatomiosite/microbiologia , Griseofulvina/uso terapêutico , Masculino , Rinite/tratamento farmacológico , Rinite/microbiologia , Ruminantes , Sinusite/tratamento farmacológico , Sinusite/microbiologia
3.
Zhonghua Nei Ke Za Zhi ; 59(1): 5-17, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31887830

RESUMO

In this consensus we mainly present the etiology, epidemiology, risk factors, microbiology, clinical diagnosis and general principles of treatment, as well as the detailed diagnosis and treatment of common candidiasis. Though mucocutaneous candidiasis such as oral, esophageal and vulvovaginal infections are known as non-invasive diseases, they are included in this consensus, considering their high prevalence and the potential to be the source of systematic infections.In order to be accordant with the practical situation in China, new technologies and drugs that have not been well developed or routinely applied are not recommended in this consensus. As to the differences from foreign guidelines, we address the explanations. Individualized treatment and management should be administrated based on the specific underlying conditions, organism distribution and drug resistance profile of Candida species.


Assuntos
Antifúngicos/uso terapêutico , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Adulto , Antifúngicos/administração & dosagem , Candida/efeitos dos fármacos , China , Consenso , Humanos , Prevalência , Fatores de Risco
4.
An Bras Dermatol ; 94(6): 744-746, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789256

RESUMO

This report describes a case of unusual deep skin ulcers with tortuous sinus tract formation in an immunocompetent woman. She was initially diagnosed with a Staphylococcus aureus skin infection and histopathologically diagnosed with pyoderma gangrenosum. However, culture from the deep end of ribbon gauze inserted into the subcutaneous sinus tract revealed shiny, light-yellow mucoid colonies, which were identified as Cryptococcus neoformans var. grubii. She was treated with fluconazole for nine months and completely healed. Cryptococcosis is an opportunistic infection caused by variants of C. neoformans species. Cutaneous manifestations of cryptococcosis are quite divergent, rarely occurring as deep skin ulcers with sinus formation.


Assuntos
Criptococose/patologia , Cryptococcus neoformans/isolamento & purificação , Dermatomicoses/patologia , Imunocompetência , Úlcera Cutânea/microbiologia , Úlcera Cutânea/patologia , Adulto , Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Dermatomicoses/tratamento farmacológico , Dermatomicoses/microbiologia , Feminino , Fluconazol/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Úlcera Cutânea/tratamento farmacológico
5.
Chem Commun (Camb) ; 55(100): 15145-15148, 2019 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-31790115

RESUMO

A lipase-triggered drug release nanoplatform (PGL-DPP-FLU NPs) for multi-modal antifungal therapy is developed. The lipases secreted by C. albicans can accelerate FLU release. The ROS and heat produced by PGL-DPP-FLU NPs make C. albicans more vulnerable to FLU, thereby PGL-DPP-FLU NPs exhibit high performance for combating azole-resistant C. albicans biofilms and wound infection.


Assuntos
Antifúngicos/farmacologia , Azóis/química , Candida albicans/efeitos dos fármacos , Lipase/metabolismo , Nanopartículas/química , Animais , Antifúngicos/química , Antifúngicos/uso terapêutico , Azóis/farmacologia , Candidíase/tratamento farmacológico , Candidíase/patologia , Candidíase/veterinária , Farmacorresistência Fúngica/efeitos dos fármacos , Etilenoglicóis/química , Fluconazol/química , Cetonas/química , Lasers , Camundongos , Fotoquimioterapia , Fototerapia , Poliésteres/química , Pirróis/química
7.
An Bras Dermatol ; 94(5): 574-577, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31780436

RESUMO

The authors report a case of 40-year-old male patient with a five-year history of chromoblastomycosis on his right leg. Diagnosis was performed by direct 40% KOH exam of skin scales, culture with micro- and macromorphologic analysis, and genotypic characterization (sequencing of a fragment of the ITS region and phylogenetic analysis) of the isolated fungus. Rhinocladiella aquaspersa was identified as the etiological agent. Initially, the treatment was with oral itraconazole 200mg/day for one year. However, the presence of "sclerotic cells" with filaments ("Borelli spiders") resulted in a change of medical treatment: a higher dose of itraconazole (400mg/day) and surgery, achieving clinical and mycological cure in one year. This is the first report of chromoblastomycosis caused by R. aquaspersa in Guatemala.


Assuntos
Ascomicetos/isolamento & purificação , Cromoblastomicose/microbiologia , Adulto , Antifúngicos/uso terapêutico , Ascomicetos/ultraestrutura , Cromoblastomicose/tratamento farmacológico , Cromoblastomicose/patologia , Guatemala , Humanos , Itraconazol/uso terapêutico , Masculino , Resultado do Tratamento
8.
Zhonghua Nei Ke Za Zhi ; 58(11): 861-864, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31665870

RESUMO

Mucor infection is rarely reported in non-immunocompromised population, especially in isolated gastrointestinal tracts. IgG(4)-related diseases (IgG(4)-RD) have been recognized in recent years, but secondary causes of IgG(4) elevation should be differentiated. We reported a young man with duodenal mass and ulcer and high serum IgG(4) level. Histological biopsy of the mass revealed positive mucor mycelium and infiltration of IgG(4) positive plasma cells. Serum IgG(4) decreased to normal range after surgical resection and systemic antifungal treatment. This case suggests that isolated mucor mycosis infection can develop in the digestive tract and mimics as IgG(4)-related disease.


Assuntos
Antifúngicos/uso terapêutico , Úlcera Duodenal/patologia , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Imunoglobulina G/sangue , Mucor/isolamento & purificação , Mucormicose/tratamento farmacológico , Biópsia , Úlcera Duodenal/cirurgia , Humanos , Hospedeiro Imunocomprometido , Imunoglobulina G/efeitos dos fármacos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/microbiologia , Masculino , Mucor/efeitos dos fármacos , Mucormicose/microbiologia , Resultado do Tratamento
9.
J Med Microbiol ; 68(12): 1766-1770, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31746725

RESUMO

Introduction. Evidence for the clinical utility of bronchoalveolar lavage (BAL) galactomannan in the management of fungal disease outside of haemato-oncology patients is limited.Aim. To determine how the introduction of BAL galactomannan testing impacted on the diagnosis and management of invasive aspergillosis and other fungal diseases in non-haemato-oncology patients.Methodology. Retrospective review of all adult patients (age ≥16 years) without a diagnosis of haematological malignancy who had a positive BAL galactomannan from 1 November 2014 to 30 April 2018. Using electronic patient records we obtained demographic data, clinical details, laboratory investigations, relevant radiology and antimicrobial history for each case.Results. In total, 121 episodes with a galactomannan OD index of ≥0.500 were included in the study; 29 cases (24 %) were felt to reflect fungal disease. Antifungal therapy was commenced as a direct consequence of a positive BAL galactomannan result in 13 patients where the ultimate diagnosis was subsequently considered to be non-mycological: associated medication-related side-effects in this group included deranged liver function tests (n=3), rash (n=1) and fever (n=1), related to amphotericin B (n=1) and voriconazole (n=4).Conclusion. We show that vigilance is required when interpreting galactomannan results in non-haematology patients to avoid potentially harmful overtreatment.


Assuntos
Antifúngicos/uso terapêutico , Líquido da Lavagem Broncoalveolar/química , Mananas/análise , Sobremedicalização , Micoses/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Estudos Retrospectivos , Adulto Jovem
10.
JAMA ; 322(17): 1673-1681, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31688884

RESUMO

Importance: Children, adolescents, and young adults with acute myeloid leukemia are at high risk of life-threatening invasive fungal disease with both yeasts and molds. Objective: To compare the efficacy of caspofungin vs fluconazole prophylaxis against proven or probable invasive fungal disease and invasive aspergillosis during neutropenia following acute myeloid leukemia chemotherapy. Design, Setting, and Participants: This multicenter, randomized, open-label, clinical trial enrolled patients aged 3 months to 30 years with newly diagnosed de novo, relapsed, or secondary acute myeloid leukemia being treated at 115 US and Canadian institutions (April 2011-November 2016; last follow-up June 30, 2018). Interventions: Participants were randomly assigned during the first chemotherapy cycle to prophylaxis with caspofungin (n = 257) or fluconazole (n = 260). Prophylaxis was administered during the neutropenic period following each chemotherapy cycle. Main Outcomes and Measures: The primary outcome was proven or probable invasive fungal disease as adjudicated by blinded central review. Secondary outcomes were invasive aspergillosis, empirical antifungal therapy, and overall survival. Results: The second interim efficacy analysis and an unplanned futility analysis based on 394 patients appeared to have suggested futility, so the study was closed to accrual. Among the 517 participants who were randomized (median age, 9 years [range, 0-26 years]; 44% female), 508 (98%) completed the trial. The 23 proven or probable invasive fungal disease events (6 caspofungin vs 17 fluconazole) included 14 molds, 7 yeasts, and 2 fungi not further categorized. The 5-month cumulative incidence of proven or probable invasive fungal disease was 3.1% (95% CI, 1.3%-7.0%) in the caspofungin group vs 7.2% (95% CI, 4.4%-11.8%) in the fluconazole group (overall P = .03 by log-rank test) and for cumulative incidence of proven or probable invasive aspergillosis was 0.5% (95% CI, 0.1%-3.5%) with caspofungin vs 3.1% (95% CI, 1.4%-6.9%) with fluconazole (overall P = .046 by log-rank test). No statistically significant differences in empirical antifungal therapy (71.9% caspofungin vs 69.5% fluconazole, overall P = .78 by log-rank test) or 2-year overall survival (68.8% caspofungin vs 70.8% fluconazole, overall P = .66 by log-rank test) were observed. The most common toxicities were hypokalemia (22 caspofungin vs 13 fluconazole), respiratory failure (6 caspofungin vs 9 fluconazole), and elevated alanine transaminase (4 caspofungin vs 8 fluconazole). Conclusions and Relevance: Among children, adolescents, and young adults with acute myeloid leukemia, prophylaxis with caspofungin compared with fluconazole resulted in significantly lower incidence of invasive fungal disease. The findings suggest that caspofungin may be considered for prophylaxis against invasive fungal disease, although study interpretation is limited by early termination due to an unplanned interim analysis that appeared to have suggested futility. Trial Registration: ClinicalTrials.gov Identifier: NCT01307579.


Assuntos
Antifúngicos/uso terapêutico , Caspofungina/uso terapêutico , Fluconazol/uso terapêutico , Leucemia Mieloide Aguda/tratamento farmacológico , Micoses/prevenção & controle , Adolescente , Adulto , Antifúngicos/efeitos adversos , Aspergilose/epidemiologia , Aspergilose/prevenção & controle , Caspofungina/efeitos adversos , Criança , Pré-Escolar , Término Precoce de Ensaios Clínicos , Feminino , Fluconazol/efeitos adversos , Humanos , Lactente , Estimativa de Kaplan-Meier , Leucemia Mieloide Aguda/complicações , Masculino , Neutropenia/complicações , Adulto Jovem
11.
BMC Infect Dis ; 19(1): 846, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615425

RESUMO

BACKGROUND: Cryptococcal meningitis is most commonly found in HIV-infected patients. In HIV-negative patients, its low incidence can lead to prolonged time to diagnosis. Detailed case reports of chronic cryptococcal meningitis are scarce, but could provide clues for earlier diagnosis in this patient category. CASE PRESENTATION: A 60-year old man presented June 2015 with intermittent headaches for several months without any fever. Initial work-up showed a leukocytosis, raised CSF opening pressure and raised leukocytes and protein in the CSF. An MRI revealed leptomeningeal contrast enhancement and cerebellar oedema. While malignancy and various infectious causes were excluded, the patient had a spontaneous clinical and radiological recovery. One year later, the patient returned with complaints of headaches. Also, cerebellar oedema and leptomeningeal contrast enhancement had recurred. Eventually in March 2017, the novel cryptococcal antigen lateral flow assay (CrAg LFA) was positive on CSF, and one colony of Cryptococcus neoformans was cultured from CSF. The patient was treated with the standard antifungal regimen which resulted in resolution of his headaches. In retrospect, the cryptococcal antigen test was already positive on a serum sample from June 2015. Interestingly, post-treatment immunological analysis revealed both a low mannose-binding lectin (MBL) concentration and low naïve CD4 counts. CONCLUSIONS: We present a patient with cryptococcal meningitis in an HIV-negative patient with low MBL and low naïve CD4 count suffering a chronic relapsing meningo-encephalitis with relatively mild symptoms for around 2 years. In patients with an unexplained meningo-encephalitis such as this case, early performance of CrAg LFA on serum and/or CSF is an inexpensive and rapid method to reduce time-to diagnosis.


Assuntos
Linfócitos T CD4-Positivos/citologia , Lectina de Ligação a Manose/metabolismo , Meningite Criptocócica/diagnóstico , Antifúngicos/uso terapêutico , Antígenos de Fungos/líquido cefalorraquidiano , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/metabolismo , Cryptococcus neoformans/isolamento & purificação , Humanos , Imagem por Ressonância Magnética , Masculino , Meningite Criptocócica/imunologia , Meningite Criptocócica/metabolismo , Pessoa de Meia-Idade , Recidiva
12.
BMC Infect Dis ; 19(1): 843, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615438

RESUMO

BACKGROUND: In recent years, some rare fungi have been increasingly recognized as new human pathogens. Here we reported the first fatal case of human severe pneumonia complicated by multiple organ dysfunction caused by Acrophialophora levis infection. However, its pathogenic mechanism and risk factors are unknown. Acrophialophora genus has only reported in six cases of human infection worldwide, but it has not been reported previously in China. CASE PRESENTATION: A 71-year-old male patient with severe pneumonia complicated with multiple organ dysfunction caused by A. levis infection. The fungal identification was based on micromorphology and sequence analysis of the internal transcriptional spacer (ITS) of ribosomal RNA genes recovered from lower respiratory tract secretions. The microbial characteristics, sensitivity to antifungal drugs of this isolated A. levis were studied. Anti-infective regimen, liposomal amphotericin B combined with tegacycline, was used to prevent infection. The next day, the fever decreased, body temperature fluctuated between 36.5 and 37.8 degree, cough and sputum decreased, and sputum volume decreased, with oxygen uptake for 5 L/min, blood oxygen saturation over 95%. After 17 days of treatment, CT reexamination showed that the lesions in the right lung and left upper lung were absorbed and pleural effusion was reduced. The next 8 days, the patient asked to return to the local hospital for treatment. The local hospital stopped using liposomal amphotericin B because of the absence of liposomal amphotericin B, and died of respiratory failure 2 days later. CONCLUSIONS: This study is the first to report the occurrence, risk factors, molecular determinants, microbial characteristics and susceptibility to antifungal agents of A. levis infection in China. In addition, six published cases of human infection with Acrophialophora were reviewed.


Assuntos
Ascomicetos/isolamento & purificação , Pneumonia/diagnóstico , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Humanos , Masculino , Derrame Pleural/etiologia , Pneumonia/complicações , Pneumonia/tratamento farmacológico , Pneumonia/patologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
13.
An Bras Dermatol ; 94(4): 470-472, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644624

RESUMO

Paracoccidioidomycosis is a fungal infection that occurs in immunocompetent patients and are classified into two forms: the acute-subacute form, predominantly in young patients, and the chronic adult form that may present classic ulcerated lesions to rare sarcoid ones. We present the case of a boy whose infection began with sarcoid lesions but, after being mistakenly diagnosed with cutaneous sarcoidosis and treated (for three years) with prednisone, developed painful ulcerations throughout the body. After the correct diagnosis, with evidence of the fungus in histopathological and mycological examinations, the patient was properly treated with itraconazole for eight months and evolved with total remission of the disease.


Assuntos
Glucocorticoides/efeitos adversos , Paracoccidioidomicose/etiologia , Paracoccidioidomicose/patologia , Prednisona/efeitos adversos , Adolescente , Antifúngicos/uso terapêutico , Humanos , Itraconazol/uso terapêutico , Masculino , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/tratamento farmacológico , Sarcoidose/diagnóstico , Sarcoidose/patologia , Resultado do Tratamento
14.
Turk J Ophthalmol ; 49(5): 294-296, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650813

RESUMO

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.


Assuntos
Antifúngicos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase/terapia , Endoftalmite/terapia , Infecções Oculares Fúngicas/terapia , Litotripsia/efeitos adversos , Vitrectomia/métodos , Adulto , Candida albicans/genética , Candidíase/etiologia , Candidíase/microbiologia , DNA Fúngico/análise , Endoftalmite/etiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Tomografia por Emissão de Pósitrons , Cálculos Ureterais/terapia , Acuidade Visual
15.
BMC Infect Dis ; 19(1): 911, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664917

RESUMO

BACKGROUND: Cyst infection is a prevalent complication in autosomal dominant polycystic kidney disease (ADPKD) patients, however therapeutic and diagnostic approaches towards this condition remain unclear. The confirmation of a likely episode of cyst infection by isolating the pathogenic microorganism in a clinical scenario is possible only in the minority of cases. The available antimicrobial treatment guidelines, therefore, might not be appropriate to some patients. CASE PRESENTATION: We describe two unique cases of kidney cyst infection by Candida albicans, a condition that has not been previously described in literature. Both cases presented clear risk factors for Candida spp. infection. However, since there was no initial indication of cyst aspiration and culture, antifungal therapy was not immediately started and empirical treatment was initiated as recommended by the current guidelines. Antifungal treatment was instituted in both cases along the clinical course, according to their specificities. CONCLUSION: Our report highlights the possibility of Candida spp. cyst infection. Failure of clinical improvement with antibiotics should raise the suspicion of a fungal infection. Identification of infected cysts should be pursued in such cases, particularly with PET-CT, and when technically possible followed by cyst aspiration and culture to guide treatment. Risk factors for this condition, such as Candida spp. colonization, previous antimicrobial therapy, hemodialysis, necrotizing pancreatitis, gastrointestinal/hepatobiliary surgical procedure, central venous catheter, total parenteral nutrition, diabetes mellitus and immunodeficiency (neutropenia < 500 neutrophils/mL, hematologic malignancy, chemotherapy, immunosuppressant drugs), should be also considered accepted criteria for empirical antifungal therapy.


Assuntos
Candida albicans , Candidíase/diagnóstico por imagem , Candidíase/etiologia , Rim Policístico Autossômico Dominante/complicações , Adulto , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Cistos/diagnóstico por imagem , Cistos/microbiologia , Cistos/terapia , Drenagem , Evolução Fatal , Feminino , Fluconazol/uso terapêutico , Humanos , Masculino , Nefrectomia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Diálise Renal , Insuficiência Renal/terapia , Resultado do Tratamento
17.
BMC Infect Dis ; 19(1): 862, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623573

RESUMO

BACKGROUND: Idiopathic CD4 lymphocytopenia (ICL) is a rare clinical disease with relative CD4 deficiency in the absence of HIV infection. The pathogenicity of ICL is poorly understood with an unclear incidence rate in the general population. Sequelae of ICL includes AIDS-defining infections, which most commonly includes Cryptococcus neoformans. Typically, C. neoformans infections present with CNS involvement but rarely with extra-CNS manifestations. Here, we present a rare case of ICL with exclusively primary pulmonary cryptococcus and a review of the literature. CASE PRESENTATION: A 56-year-old female presented to our tertiary care hospital requiring a right hip open reduction intervention. The patient became febrile during admission, prompting a work-up that included a chest X-ray showing a peripheral pulmonary solitary nodule. Transthoracic biopsy revealed encapsulated yeast forms in keeping with C. neoformans. CD4 counts, repeated at least one month apart, were < 200 cells/mm3, with negative HIV testing. Flow cytometry and genetic testing were completed to elucidate the etiology of the immune deficiency, both of which were unremarkable. She was subsequently treated with 12 months of posaconazole with clinical resolution. CONCLUSIONS: Our patient highlights a rare clinical disease, which a review of literature revealed only five cases in the literature with exclusive pulmonary Cryptococcus in ICL/ This case demonstrates the strong clinical acumen required to properly diagnose and ultimately manage the patient.


Assuntos
Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Linfopenia/diagnóstico , Infecções Respiratórias/diagnóstico , Antifúngicos/uso terapêutico , Contagem de Linfócito CD4 , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Feminino , Humanos , Pulmão/microbiologia , Pulmão/patologia , Linfopenia/etiologia , Pessoa de Meia-Idade , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triazóis/uso terapêutico
18.
Hosp Pract (1995) ; 47(4): 171-176, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31585520

RESUMO

A high prevalence of invasive candidiasis has been reported in recent years. Patients admitted to an intensive care unit are at the highest risk for invasive candidiasis, mostly due to the severity of their disease, immune-suppressive states, prolonged length of stay, broad-spectrum antibiotics, septic shock, and Candida colonization. Intraabdominal candidiasis comprises a range of clinical manifestations, from just the suspicion based on clinical scenario to fever, leukocytosis, increase in biomarkers to the isolation of the responsible microorganism. In critically ill patients with IAC prompt treatment and adequate source control remains the ultimate goal.


Assuntos
Antifúngicos/uso terapêutico , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/fisiopatologia , Unidades de Terapia Intensiva , Infecções Intra-Abdominais/tratamento farmacológico , Infecções Intra-Abdominais/fisiopatologia , Antifúngicos/administração & dosagem , Biomarcadores , Candidíase Invasiva/mortalidade , Candidíase Invasiva/prevenção & controle , Estado Terminal , Humanos , Infecções Intra-Abdominais/mortalidade , Infecções Intra-Abdominais/prevenção & controle , Mananas/imunologia , Pró-Calcitonina/metabolismo , Fatores de Risco , Índice de Gravidade de Doença , beta-Glucanas/metabolismo
20.
Artigo em Inglês | MEDLINE | ID: mdl-31618378

RESUMO

The largest endemic areas of paracoccidioidomycosis (PCM) in Brazil comprise the humid agricultural regions of the Southeast, South, and, recently, the Midwest and North regions. The Ceara State, located in the Brazilian Northeast region, presents semi-arid climate in most of its territory, characterized by high temperatures, scarce vegetation and low humidity. The objective of the present study was to describe a new autochthonous case of paracoccidioidomycosis from a distinct area of Ceara and review the characteristics of PCM occurrence in Northeastern Brazil. The patient was a 65-year-old male farmer who denied traveling outside the Ceara State or living in other locations. He was born and lived in the rural area known as Camara, bordering the municipalities of Itapaje and Itapipoca. Camara is one of the highest areas (around 720 m of altitude) of the Uruburetama mountains that exhibits tropical forests and is located in Northern Ceara, distant 139 km from the capital, Fortaleza. The patient sought for care, complaining of an oral lesion that appeared over the past three years. The hard palate lesion biopsy revealed multinucleated cells with cytoplasmic inclusions, compatible with PCM. After culture, P. brasiliensis was identified by polymerase chain reaction. Serological testing for PCM was reagent. The patient was treated with itraconazole for approximately 17 months, persisting free of symptoms after 15 months of follow-up. Regarding this new autochthonous case in the Ceara State, PCM should be considered in the differential diagnosis of patients with suggestive clinical manifestations, proceeding from the mountainous areas of Ceara.


Assuntos
Antifúngicos/uso terapêutico , Itraconazol/uso terapêutico , Paracoccidioidomicose/diagnóstico , Idoso , Humanos , Masculino , Paracoccidioidomicose/tratamento farmacológico
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