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1.
Ann Otol Rhinol Laryngol ; 130(1): 108-111, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32597680

RESUMO

OBJECTIVES: We report a case of acutely worsening allergic fungal sinusitis in a patient receiving immunotherapy with pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor. METHODS: A 53-year-old man with a history of metastatic melanoma and recent initiation of pembrolizumab therapy presented with acutely worsening headaches, left abducens nerve palsy, and neuroimaging demonstrating an erosive skull base lesion with bilateral cavernous sinus involvement. RESULTS: Intraoperative findings were consistent with non-invasive allergic fungal sinus disease. Microbiology and histopathologic data ruled out malignancy and demonstrated Aspergillus fumigatus without concern for angioinvasion. After treatment with antifungal therapy, the patient's symptoms and abducens nerve palsy resolved. Symptoms were well-controlled 7 months after his initial presentation. CONCLUSIONS: Inflammatory sinusitis in patients receiving anti-PD-1 therapy may be secondary to T-cell infiltration, a similar pathophysiology as immune-related adverse events, and warrants appreciation by otolaryngologists given our increasing exposure to immunotherapy and its head and neck manifestations.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Aspergilose/diagnóstico , Sinusite/microbiologia , Doenças do Nervo Abducente/etiologia , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergillus fumigatus/isolamento & purificação , Diagnóstico Diferencial , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Melanoma/tratamento farmacológico , Pessoa de Meia-Idade , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias da Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Voriconazol/uso terapêutico
3.
Int J Dermatol ; 60(1): 99-106, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33166092

RESUMO

BACKGROUND: Cutaneous sporotrichosis, a subcutaneous mycosis because of Sporothrix schenckii, is sporadic worldwide with local hyperendemic pockets. OBJECTIVES: To study clinico-epidemiological and therapeutic aspects of sporotrichosis in our clinic. METHODS: We retrospectively analyzed medical records of 152 (M:F 52:100) patients with cutaneous sporotrichosis managed during 2010-2019. RESULTS: All patients were involved in agricultural activities, and 63.2% were aged 21-60 years. Women outnumbered men by nearly two times. Fixed and lymphocutaneous sporotrichosis occurred in 54.6% and 43.4% patients, respectively. Only 2% of patients had multifocal sporotrichosis. Only 48% of patients imputed their disease to prior injuries. Extremities, upper in 53.9% and lower in 21% of patients, were mostly involved. Scrotum involvement in one patient was unusual. A mixed inflammatory infiltrate in 38.7%, chronic granuloma formation in 35%, and presence of spores in 48.9% biopsies was noted. S. schenckii grew on Sabouraud's dextrose agar in 40.2% of cases. Treatment with saturated solution of potassium iodide was curative in 76.8% patients, and lesions healed in 2-9 months (average 5.2 months). Metallic taste was experienced by 42.9% of patients. Itraconazole therapy was safe and effective in seven patients, and the response was better when combined with SSKI compared to either drug used alone. CONCLUSION: Cutaneous sporotrichosis mostly affects persons during active years of life. The injuries predisposing to infection are mostly forgotten. Both fixed and lymphocutaneous sporotrichosis involving extremities remain common forms. SSKI alone or in combination with itraconazole is safe and effective treatment. Itraconazole is preferable in patients having preexisting hypothyroidism or intolerance to SSKI.


Assuntos
Agricultura , Antifúngicos/uso terapêutico , Granuloma/microbiologia , Doenças Profissionais/tratamento farmacológico , Iodeto de Potássio/uso terapêutico , Esporotricose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/efeitos adversos , Criança , Tratamento Farmacológico , Extremidades , Feminino , Humanos , Índia/epidemiologia , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Doenças Profissionais/patologia , Iodeto de Potássio/efeitos adversos , Estudos Retrospectivos , Esporos Fúngicos , Esporotricose/epidemiologia , Esporotricose/etiologia , Esporotricose/patologia , Ferimentos e Lesões/complicações , Adulto Jovem
6.
Medicine (Baltimore) ; 99(50): e23213, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327239

RESUMO

Cryptococcosis caused by Cryptococcus gattii, is a life threatening fungal infection with recently increasing prevalence. C. gattii is a species complex comprising multiple independent species. However, many biological characteristics and clinical features of cryptococcosis due to C. gattii are relatively less well defined. In this paper, we identify two cases of C. gattii infection, and laboratory findings of genotype VGI and VGII in two groups of apparently immunocompetent Chinese individuals respectively. Upon detailed review of all 35 cases of C. gattii infections, it was observed that C. gattii can cause debilitating illness in both immunocompetent and immunocompromised individuals. Cryptococcosis due to C. gattii is a serious systemic fungal infection, with pulmonary central nervous system tropism. Epidemiologically, C. gattii infection is not only restricted in tropical and subtropical regions, but also in other geographical settings.


Assuntos
Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Criptococose/diagnóstico , Criptococose/microbiologia , Cryptococcus gattii/genética , Administração Intravenosa , Adolescente , Adulto , Idoso , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Grupo com Ancestrais do Continente Asiático/genética , Infecções Fúngicas do Sistema Nervoso Central/líquido cefalorraquidiano , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Criptococose/líquido cefalorraquidiano , Criptococose/tratamento farmacológico , Quimioterapia Combinada , Feminino , Flucitosina/administração & dosagem , Flucitosina/uso terapêutico , Genótipo , Geografia , Humanos , Hospedeiro Imunocomprometido/imunologia , Masculino , Pessoa de Meia-Idade , Prevalência , Recidiva , Punção Espinal/métodos , Resultado do Tratamento , Recusa do Paciente ao Tratamento , Adulto Jovem
7.
Ann Agric Environ Med ; 27(4): 540-543, 2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33356058

RESUMO

INTRODUCTION: The role of fungi in infections in immunocompromised patients is a growing problem in both diagnosis and treatment. Candida species are the most common cause of fungal, endogenous endophthalmitis and infections of the cornea. CASE STUDY: A patient was admitted to hospital due to acute inflammation of the tissue of the left orbit, 1.5 years after the corneal penetrating transplantation of the left eye with intracapsular extraction of lens and simultaneous anterior vitrectomy. The microbiological system identified: Streptococcus pyogenes, Staphylococcus aureus, and Candida glabrata in the patient. CONCLUSIONS: The factors conducive to fungal infections are: patient's old age, immune disorders and diabetes, as well as the presence of a necrotic tissue or a foreign body. All these parameters were met in this case. Only antibiotic therapy and long-term antifungal therapy, together with surgical debridement of the site of the ongoing infection produces clinical effects in such severe cases.


Assuntos
Antifúngicos/uso terapêutico , Candida glabrata/isolamento & purificação , Candidíase/diagnóstico , Desbridamento , Infecções Oculares Fúngicas/diagnóstico , Panoftalmite/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Candidíase/microbiologia , Candidíase/fisiopatologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Panoftalmite/microbiologia , Polônia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus/isolamento & purificação , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia , Streptococcus pyogenes/isolamento & purificação , Resultado do Tratamento
8.
J Investig Med High Impact Case Rep ; 8: 2324709620972244, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33167717

RESUMO

The ongoing coronavirus disease-2019 (COVID-19) pandemic has been the focus of health care workers as it has affected millions of people and cost hundreds of thousands of lives around the world. As hospitals struggle to identify and care for those afflicted with COVID-19, it is easy to overlook endemic diseases that potentially worsen or mimic the pulmonary manifestations or may coinfect those with COVID-19. In this case report, we present the case of a 48-year-old Hispanic female who was admitted with respiratory distress from an acute COVID-19 infection but was also found to have acute pulmonary coccidioidomycosis infection and was treated successfully.


Assuntos
Técnicas de Laboratório Clínico , Coccidioidomicose/diagnóstico , Infecções por Coronavirus/diagnóstico , Progressão da Doença , Pneumonia Viral/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Antifúngicos/uso terapêutico , Coccidioidomicose/complicações , Coccidioidomicose/tratamento farmacológico , Coinfecção , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Radiografia Torácica/métodos , Síndrome Respiratória Aguda Grave/complicações , Resultado do Tratamento
10.
BMC Infect Dis ; 20(1): 844, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198666

RESUMO

BACKGROUND: Raised intracranial pressure (ICP) and insufficient antifungal regimens are the two main factors result to unsatisfactory outcomes in non-HIV cryptococcal meningitis (CM) patients. In this study, we try to discuss that whether triple therapy of amphotericin B (AmB), fluconazole, 5-flucytosine (5-FC) plus ventriculoperitoneal shunts (VPS) is superior to AmB, 5-FC, fluconazole plus intermittent lumbar puncture in induction therapy in non-HIV CM patients with increased ICP. METHODS: We reviewed 66 clinical records from non-HIV CM patients with increased ICP. The demographic and clinical characteristics, BMRC staging, cerebrospinal fluid profiles (CSF), brain magnetic resonance imaging, treatment, and outcomes of these individuals were retrospectively analyzed. All non-HIV CM patients with increased ICP (≥ 25 cmH2O) were divided into two groups, including 27 patients treated with triple antifungal agents and 39 patients treated with the same triple therapy plus VPS. RESULTS: Triple therapy plus VPS group had more satisfactory outcomes, more CSF sterilization at 10 weeks follow-up, lower CSF opening pressure, lower BMRC staging scores one week after VPS, less CSF C. neoformans counts and CSF culture positive. Besides, these patients had shorter hospital stay than triple therapy group. CONCLUSIONS: Triple antifungal agents combined with VPS could effectively reduce ICP, had faster rate of clearance of C. neoformans counts, more improved neurological function, shorten hospitalization time and better outcomes in non-HIV CM patients with increased ICP. Our study indicated that triple therapy plus early VPS may be an optimal treatment for non-HIV CM patients with increased ICP.


Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Cryptococcus neoformans/efeitos dos fármacos , Fluconazol/uso terapêutico , Flucitosina/uso terapêutico , Hipertensão Intracraniana/tratamento farmacológico , Hipertensão Intracraniana/cirurgia , Tempo de Internação/tendências , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/cirurgia , Derivação Ventriculoperitoneal/métodos , Adulto , Cryptococcus neoformans/isolamento & purificação , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Hipertensão Intracraniana/complicações , Masculino , Meningite Criptocócica/complicações , Pessoa de Meia-Idade , Estudos Retrospectivos , Punção Espinal , Resultado do Tratamento
11.
BMC Infect Dis ; 20(1): 817, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33167878

RESUMO

BACKGROUND: Gastrointestinal (GI) mucormycosis is a rare and often deadly form of mucormycosis. Delayed diagnosis can lead to an increased risk of death. Here, we report a case of GI mucormycosis following streptococcal toxic shock syndrome in a virologically suppressed HIV-infected patient. CASE PRESENTATION: A 25-year-old Thai woman with a well-controlled HIV infection and Grave's disease was admitted to a private hospital with a high-grade fever, vomiting, abdominal pain, and multiple episodes of mucous diarrhea for 3 days. On day 3 of that admission, the patient developed multiorgan failure and multiple hemorrhagic blebs were observed on all extremities. A diagnosis of streptococcal toxic shock was made before referral to Siriraj Hospital - Thailand's largest national tertiary referral center. On day 10 of her admission at our center, she developed feeding intolerance and bloody diarrhea due to bowel ischemia and perforation. Bowel resection was performed, and histopathologic analysis of the resected bowel revealed acute suppurative transmural necrosis and vascular invasion with numerous broad irregular branching non-septate hyphae, both of which are consistent with GI mucormycosis. Peritoneal fluid fungal culture grew a grayish cottony colony of large non-septate hyphae and spherical sporangia containing ovoidal sporangiospores. A complete ITS1-5.8S-ITS2 region DNA sequence analysis revealed 100% homology with Rhizopus microsporus strains in GenBank (GenBank accession numbers KU729104 and AY803934). As a result, she was treated with liposomal amphotericin B. However and in spite of receiving appropriate treatment, our patient developed recurrent massive upper GI bleeding from Dieulafoy's lesion and succumbed to her disease on day 33 of her admission. CONCLUSION: Diagnosis of gastrointestinal mucormycosis can be delayed due to a lack of well-established predisposing factors and non-specific presenting symptoms. Further studies in risk factors for abdominal mucormycosis are needed.


Assuntos
Trato Gastrointestinal/microbiologia , Doença de Graves/complicações , Infecções por HIV/complicações , Mucormicose/complicações , Rhizopus/genética , Choque Séptico/complicações , Infecções Estreptocócicas/complicações , Streptococcus pyogenes/isolamento & purificação , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , DNA Fúngico/genética , Evolução Fatal , Feminino , Infecções por HIV/virologia , Humanos , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Choque Séptico/diagnóstico , Choque Séptico/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Síndrome , Tailândia
12.
BMC Infect Dis ; 20(1): 827, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176724

RESUMO

BACKGROUND: Candida auris is a new pathogen called "superbug fungus" which caused panic worldwide. There are no large-scale epidemiology studies by now, therefore a systematic review and meta-analysis was undertaken to determine the epidemic situation, drug resistance patterns and mortality of C. auris. METHODS: We systematically searched studies on the clinical report of Candida auris in Pubmed, Embase and Cochrane databases until October 6, 2019. A standardized form was used for data collection, and then statics was performed with STATA11.0. RESULTS: It showed that more than 4733 cases of C. auris were reported in over 33 countries, with more cases in South Africa, United States of America, India, Spain, United Kingdom, South Korea, Colombia and Pakistan. C. auirs exhibited a decrease in case count after 2016. Clade I and III were the most prevalent clades with more cases reported and wider geographical distribution. Blood stream infection was observed in 32% of the cases, which varied depending on the clades. Resistance to fluconazole, amphotericin B, caspofungin, micafungin and anidulafungin in C. auris were 91, 12, 12.1, 0.8 and 1.1%. The overall mortality of C. auris infection was 39%. Furthermore, subgroup analyses showed that mortality was higher in bloodstream infections (45%), and lower in Europe (20%). CONCLUSIONS: Over 4000 cases of C. auris were reported in at least 33 countries, which showed high resistance to fluconazole, moderate resistance to amphotericin B and caspofungin, high sensitivity to micafungin and anidulafungin. The crude mortality for BSI of C. auris was 45% which was similar to some drug-resistant bacteria previously reported. In conclusion, C. auris displayed similar characteristics to some drug resistance organisms. This study depicts several issues of C. auris that are most concerned, and is of great significance for the clinical management.


Assuntos
Candida/efeitos dos fármacos , Candidíase/epidemiologia , Candidíase/mortalidade , Anfotericina B/uso terapêutico , Anidulafungina/uso terapêutico , Antifúngicos/uso terapêutico , Candida/classificação , Candida/genética , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Caspofungina/uso terapêutico , Farmacorresistência Fúngica Múltipla/efeitos dos fármacos , Fluconazol/uso terapêutico , Humanos , Micafungina/uso terapêutico , Prevalência
13.
Medicine (Baltimore) ; 99(48): e22487, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235057

RESUMO

RATIONALE: Fungal endocarditis (FE) is a rare disease, in which antifungal treatment is necessary. When FE is complicated with prosthetic heart valve and/or atrial fibrillation, the coadministration of antifungal agents and warfarin is inevitable. We report a case of rheumatic heart disease with atrial fibrillation who developed FE following prosthetic heart valve replacement. The international normalized ratio (INR) increased significantly during the antifungal treatment with fluconazole. A discussion of the antifungal strategy in FE patients with prosthetic heart valves and/or atrial fibrillation and the interaction between antifungal agents and warfarin was performed. PATIENT CONCERNS: A 54-year-old Chinese woman experienced intermittent fevers, aphemia, and weakness in her right extremities. Her temperature was 38.7°C, and there was atrial fibrillation with heart rate 110 times/min. Neurological examination revealed that she had drowsiness, Broca aphasia, right central facial paralysis, and hemiplegia (Medical Research Council scale, upper limb grade 0, lower limb grade II). DIAGNOSES: Multiple infarction on magnetic resonance imaging and the occlusion of left middle cerebral artery suggested the occurrence of cerebral embolism. The presence of Candida parapsilosis in the results of 4 blood cultures and the existence of valve vegetation in the reexamination of echocardiogram supported the diagnosis of FE. INTERVENTIONS: The patient was given antifungal therapy with fluconazol. The INR increased dramatically on the 9th day of antifungal treatment, and subcutaneous bruising occurred at the intravenous infusion site. The antagonist of vitamin K1 was used and warfarin was reduced to a smaller dosage. The antifungal agent was replaced with caspofungin. OUTCOMES: Her speech improved significantly, and the muscle strength of her paralyzed side reached the Medical Research Council scale of grade IV. She continued to receive caspofungin for antifungal treatment with relatively stable INR and waited for heart valve surgery. LESSONS: The choice of antifungal agents is often a big challenge for FE patients, especially when they need warfarin for anticoagulation. It is better to administer a low dose of warfarin while carefully monitoring the INR or choose the antifungal drugs with little or no effect on warfarin.


Assuntos
Antifúngicos/uso terapêutico , Fibrilação Atrial/diagnóstico , Candidíase/diagnóstico , Endocardite não Infecciosa/diagnóstico , Valva Mitral , Infecções Relacionadas à Prótese/diagnóstico , Varfarina/uso terapêutico , Antifúngicos/administração & dosagem , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Candida parapsilosis/isolamento & purificação , Candidíase/complicações , Candidíase/tratamento farmacológico , Caspofungina/administração & dosagem , Caspofungina/uso terapêutico , Terapia Combinada , Diagnóstico Diferencial , Endocardite não Infecciosa/complicações , Endocardite não Infecciosa/tratamento farmacológico , Feminino , Fluconazol/administração & dosagem , Fluconazol/uso terapêutico , Hemiplegia/etiologia , Humanos , Infarto da Artéria Cerebral Média/etiologia , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/tratamento farmacológico , Varfarina/administração & dosagem
14.
Medicine (Baltimore) ; 99(47): e23189, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33217827

RESUMO

This retrospective study assessed the efficacy and safety of 1% topical clotrimazole cream for the treatment of patients with tinea cruris (TC).We included 86 patients with confirmed TC for the presence of fungal hyphae. Of those, 43 patients received 1% topical clotrimazole cream for a total of 4 consecutive weeks, and were assigned to an experimental group. The other 43 patients underwent 1% topical butenafine cream for a total of 2 consecutive weeks, and were allocated to a control group. The efficacy and safety were measured and analyzed after 4 weeks treatment.After treatment, patients in both groups achieved better improvements in erythema (P < .01), scaling (P < .01), itching (P < .01), and KOH-negative results (P < .01), compared with those in patients before the treatment. However, there were not significant differences in erythema (P = .61), scaling (P = .57), itching (P = .47), and KOH-negative results (P = .67) between 2 groups. In addition, no treatment-related adverse events were recorded in both groups.Both 1% topical clotrimazole and butenafine cream are found to be effective and safe for patients with TC. However, there is not significant difference in efficacy and safety between two groups.


Assuntos
Antifúngicos/uso terapêutico , Benzilaminas/uso terapêutico , Clotrimazol/uso terapêutico , Naftalenos/uso terapêutico , /tratamento farmacológico , Administração Cutânea , Adulto , Antifúngicos/efeitos adversos , Benzilaminas/efeitos adversos , Clotrimazol/efeitos adversos , Eritema/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Naftalenos/efeitos adversos , Prurido/microbiologia , Estudos Retrospectivos , Creme para a Pele/uso terapêutico , Adulto Jovem
15.
Int J Nanomedicine ; 15: 7825-7840, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33116503

RESUMO

Background: Voriconazole (VRC) is a triazole broad spectrum antifungal drug, used in the management of versatile fungal infections, particularly fungal keratitis. The obligatory use of niosomal delivery of VRC may reduce the frequency of dosing intervals resulting from its short biological half time and consequently improve patient compliance. Methods: VRC loaded proniosomes (VRC-PNs) were set by the coacervation technique and completely characterized. The developed formula was comprehensively assessed concerning in- vitro release behavior, kinetic investigation, and its conflict against refrigerated and room temperature conditions. A selected noisomal formula was incorporated into ocusert (VRC-PNs Ocu) formulated by 1% w/w hydroxypropyl methyl cellulose HPMC and 0.1% w/w carbopol 940. Eventually, in vitro antifungal activity against Candida albicans and Aspergillus nidulans was assessed by the cup diffusion method. Results: The optimized VRC-PNs (Pluronic F127: cholesterol weight ratio 1:1 w/w) exhibited the highest entrapment efficiency (87.4±2.55%) with a spherical shape, proper size in nano range and a suitable Zeta potential of 209.7±8.13 nm and -33.5±1.85 mV, respectively. Assurance of drug encapsulation in nanovesicles was accomplished by several means such as attenuated total reflection Fourier-transform infrared spectroscopy, differential scanning calorimetry in addition to powder X-ray diffraction investigations. It displayed a biphasic in vitro release pattern and after 6 months of storage at a refrigerated temperature, the optimized formula preserved its stability. VRC-PNs Ocu proved a very highly significant antifungal activity matched with the free drug or nanosuspension which was extra assured by comparing its mean inhibition zone with that of 5% natamycin market eye drops. Conclusion: In conclusion, VRC-PNs Ocu could be considered as a promising stable sustained release topical ocular nanoparticulate system for the management of fungal infections.


Assuntos
Antifúngicos/química , Antifúngicos/farmacologia , Portadores de Fármacos/química , Composição de Medicamentos , Olho/efeitos dos fármacos , Voriconazol/química , Voriconazol/farmacologia , Animais , Antifúngicos/uso terapêutico , Candida albicans/efeitos dos fármacos , Candida albicans/fisiologia , Olho/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Géis , Humanos , Tamanho da Partícula , Tensoativos/química , Voriconazol/uso terapêutico , Água/química
16.
Zhonghua Fu Chan Ke Za Zhi ; 55(10): 697-702, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33120482

RESUMO

Objective: Using clotrimazole vaginal tablet as a positive control, to evaluate the results of clotrimazole vaginal expansion suppository in the treatment of mild and moderate vulvovaginal candidiasis in terms of efficacy, patient satisfaction, side effects, and recurrence rate. Methods: This study was jointly conducted by 5 hospitals from August 2017 to October 2018, patients with mild and moderate vulvovaginal candidiasis confirmed by fungal culture and symptoms scores were selected. They were randomized to experimental group and control group as 1∶1 ratio. In the experimental group (n=105), the subjects applied clotrimazole vaginal expansion suppository (150 mg) daily at night for 7 days. In the control group (n=106), the subjects used a single dose of clotrimazole vaginal tablet (500 mg). Follow-ups were performed at (8±3) and (30±5) days after the discontinuation of the drugs, respectively. The difference in clinical symptoms and signs scores was used to evaluate the improvement of clinical symptoms, and the patient's satisfaction and side effects were recorded. Results: At the first follow-up, the experimental group and control group were followed up by fungal culture on the cure rate [66.7% (70/105) versus 63.2% (67/106), P>0.05] and total effective rate [98.1% (103/105) versus 99.1% (105/106), P>0.05], the differences were not statistically significant. At the second follow-up, the recurrence rates of the experimental group and the control group were 5.7% (4/70) and 14.9% (10/67), respectively, with no significant difference (P>0.05). In the evaluation of patient satisfaction, the leakage of the drug in the experimental group was significantly better than that in the control group (P<0.01). The side effects mainly included vaginal stimulation, itching and burning sensation, and there was no statistical difference between the two groups (χ2=1.070, P=0.586). Conclusions: In the treatment of mild and moderate vulvovaginal candidiasis, clotrimazole vaginal expansion suppository is no less effective than clotrimazole vaginal tablet, and there is no significant difference in the recurrence rate between the two. In terms of patient satisfaction, clotrimazole vaginal expansion suppository is superior to clotrimazole vaginal tablet.


Assuntos
Antifúngicos/administração & dosagem , Candidíase Vulvovaginal/tratamento farmacológico , Clotrimazol/administração & dosagem , Adulto , Antifúngicos/uso terapêutico , Clotrimazol/uso terapêutico , Feminino , Humanos , Supositórios , Resultado do Tratamento , Vagina/microbiologia , Cremes, Espumas e Géis Vaginais
18.
Eye Contact Lens ; 46(6): e66-e68, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33044373

RESUMO

We report a rare case of dematiaceous fungus colonization in the therapeutic bandage contact lens (BCL), in an eye with peripheral ulcerative keratitis. Bandage contact lens removal and appropriate treatment resulted in improvement of the visual acuity and prevented the spread of fungus to the underlying ocular structures. Microbiological evaluation of the BCL showed dematiaceous fungal filaments, and the fungus was identified as Bipolaris species. In patients with pigmented plaque-like lesions, with BCL in situ, dematiaceous fungus on the undersurface of the BCL should be kept in mind. Patient education regarding the importance of frequent BCL replacement, proper ocular hygiene, and timely follow-up should be emphasized.


Assuntos
Ascomicetos/isolamento & purificação , Betacoronavirus , Lentes de Contato/microbiologia , Úlcera da Córnea/microbiologia , Infecções por Coronavirus/epidemiologia , Infecções Oculares Fúngicas/microbiologia , Micoses/microbiologia , Pneumonia Viral/epidemiologia , Idoso , Antifúngicos/uso terapêutico , Bandagens , Carboximetilcelulose Sódica/uso terapêutico , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/tratamento farmacológico , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Humanos , Perda de Seguimento , Masculino , Micoses/diagnóstico , Micoses/tratamento farmacológico , Natamicina/uso terapêutico , Pandemias , Tomografia de Coerência Óptica , Acuidade Visual
19.
J Investig Med High Impact Case Rep ; 8: 2324709620966475, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33054445

RESUMO

Severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2), commonly known as COVID-19 (coronavirus disease-2019), began in the Wuhan District of Hubei Province, China. It is regarded as one of the worst pandemics, which has consumed both human lives and the world economy. COVID-19 infection mainly affects the lungs triggering severe hypoxemic respiratory failure, also providing a nidus for superimposed bacterial and fungal infections. We report the case of a 73-year-old male who presented with progressive dyspnea; diagnosed with SARS-CoV-2-related severe acute respiratory distress syndrome and complicated with lung cavitations growing Aspergillus sp. COVID-19, to our knowledge, has rarely been associated with subacute invasive pulmonary aspergillosis with aspergillomas. Subacute invasive pulmonary aspergillosis as a superimposed infection in patients with SARS-CoV-2 is a rare entity. By reporting this case, we would like to make the readers aware of this association.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Aspergilose Pulmonar Invasiva/etiologia , Pneumonia Viral/complicações , Doença Aguda , Idoso , Antifúngicos/uso terapêutico , Aspergillus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Diagnóstico Diferencial , Humanos , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Radiografia Torácica , Tomografia Computadorizada por Raios X
20.
AAPS PharmSciTech ; 21(7): 283, 2020 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-33051708

RESUMO

Ciclopirox olamine (CPO) is a topical wide-spectrum antimycotic agent that possesses antifungal, antibacterial and anti-inflammatory activities. Loading CPO into a hybridized vesicular system is expected to enhance its buccal permeation and hence, therapeutic activity, whereas the frequent administration and side effects are reduced. Vesicular systems with high penetration ability were prepared based on cholesterol, Lipoid S45 or Phospholipon 90H, with span 60 while incorporating a penetration enhancer (Labrafac or labrasol) followed by full assessment of their size, entrapment efficiency, and drug release profiles. The optimum formulation, composed of Lipoid S45 and Labrafac, possessed the smallest vesicle size (346.1 nm), highest entrapment efficiency (94.4%), and sustained CPO release pattern, and was characterized for its morphology and thermal properties. This powerful mixture of the penetration enhancers (Lipoid S45 and Labrafac) in the designed hybridized vesicles was thoroughly investigated for their characteristics after being incorporated in bioadhesive gel. Moreover, enhanced antifungal activity was demonstrated either upon testing the designed formulation on agar plates or in vivo upon treating infected rabbits with the proposed formulation. Results suggest that the presented bioadhesive gel incorporating the CPO-loaded vesicles can be a promising delivery system that can offer a prolonged localized antifungal treatment with enhanced therapeutic effect.


Assuntos
Antifúngicos/administração & dosagem , Ciclopirox/administração & dosagem , Adesivos , Administração Bucal , Ágar , Animais , Antifúngicos/uso terapêutico , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/microbiologia , Colesterol/química , Ciclopirox/uso terapêutico , Composição de Medicamentos , Liberação Controlada de Fármacos , Excipientes , Nanopartículas , Tamanho da Partícula , Coelhos , Reologia
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