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1.
BMC Infect Dis ; 20(1): 669, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928130

RESUMO

BACKGROUND: The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues. CASE PRESENTATION: We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death. CONCLUSIONS: The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.


Assuntos
Abscesso Encefálico/diagnóstico , Abscesso Encefálico/parasitologia , Infecções Parasitárias do Sistema Nervoso Central/diagnóstico , Entamebíase/diagnóstico , Idoso , Animais , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Ceftriaxona/administração & dosagem , Infecções Parasitárias do Sistema Nervoso Central/tratamento farmacológico , Infecções Parasitárias do Sistema Nervoso Central/patologia , Infecções Parasitárias do Sistema Nervoso Central/cirurgia , Terapia Combinada , DNA de Protozoário/análise , Dexametasona/administração & dosagem , Quimioterapia Combinada , Entamoeba histolytica/genética , Entamoeba histolytica/imunologia , Entamoeba histolytica/isolamento & purificação , Entamebíase/tratamento farmacológico , Entamebíase/patologia , Entamebíase/cirurgia , Evolução Fatal , Feminino , Humanos , Metronidazol/administração & dosagem , Procedimentos Neurocirúrgicos , Testes Sorológicos
3.
J Med Life ; 13(2): 151-155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32742506

RESUMO

Thalassemia represents a heterogeneous group of inherited diseases characterized by the lack or reduced production of hemoglobin ß-chains. Many patients with thalassemia require splenectomy. What should be considered in the evaluation and management of candidates for splenectomy is to cover vaccination against infections such as pneumococci and the implementation of antibiotic prophylaxis. This study aimed to investigate the effect of the antibiotic type on the outcome of acute post-splenectomy infection in patients with thalassemia. This investigation is a retrospective cohort study. One hundred fifty medical records of hemoglobinopathy patients who underwent splenectomy were collected from the Ali-Asghar Hospital, Tehran, Iran. SPSS v. 20 and SAS v. 1.9 were used to analyze the data. A total of 150 patients that were vaccinated against post-splenectomy infections and were under antibiotic prophylaxis underwent splenectomy. The most commonly prescribed drugs were ceftriaxone or cefotaxime (132 cases, 88%), followed by ceftriaxone plus clindamycin (5.3%), ceftriaxone plus amikacin (3.3%), clindamycin (1.3%), vancomycin plus amikacin (0.7%), and others (1.3%). In terms of treatment outcomes, 143 cases (95.3%) were treated with the same antibiotics, and 4 (2.7%) experienced a changed antibiotic regimen with vancomycin. The results show that perceptions of treatment for fever in splenectomized children need to be changed, and most of them do not require hospitalization and initiation of broad-spectrum antibiotics such as vancomycin for initially refractory cases, and can only be treated with daily intravenous ceftriaxone.


Assuntos
Antibacterianos/uso terapêutico , Febre/tratamento farmacológico , Esplenectomia , Adolescente , Adulto , Amicacina/administração & dosagem , Amicacina/uso terapêutico , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Irã (Geográfico) , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Medicine (Baltimore) ; 99(32): e21570, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769902

RESUMO

RATIONALE: Macrophage activation syndrome (MAS) is a rare life-threatening condition characterized by cytokine-mediated tissue injury and multiorgan dysfunction. PATIENT CONCERNS: We describe the unique case of young man who developed MAS as the sole manifestation of an otherwise paucisymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DIAGNOSES: Clinical and biological criteria led to the diagnosis of MAS; cytokine profile was highly suggestive reverse transcription polymerase chain reaction for SARS-CoV-2 in nasopharyngeal swabs was negative, but serum anti-SARS-CoV-2 immunoglobulin A and immunoglobulin G resulted positive leading to the diagnosis of SARS-CoV-2 infection. INTERVENTIONS: The patient was treated with empiric antibiotic and hydroxychloroquine. OUTCOMES: Clinical improvement ensued. At follow-up, the patient is well. LESSON: SARS-CoV-2 infection may trigger develop life-threatening complications, like MAS. This can be independent from coronavirus disease 2019 gravity.


Assuntos
Ceftriaxona/administração & dosagem , Infecções por Coronavirus/diagnóstico , Hospitalização , Hidroxicloroquina/administração & dosagem , Síndrome de Ativação Macrofágica/diagnóstico , Pneumonia Viral/diagnóstico , Adolescente , Análise Química do Sangue , China , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/tratamento farmacológico , DNA Viral/análise , Diagnóstico Diferencial , Progressão da Doença , Quimioterapia Combinada , Eletrocardiografia/métodos , Seguimentos , Humanos , Síndrome de Ativação Macrofágica/terapia , Masculino , Pandemias , Alta do Paciente , Pneumonia Viral/tratamento farmacológico , Radiografia Torácica/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
6.
BMC Infect Dis ; 20(1): 505, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-32660552

RESUMO

BACKGROUND: Meningococcal meningitis (MM) is a life-threatening disease associated with approximately 10% case fatality rates and neurological sequelae in 10-20% of the cases. Recently, we have shown that the matrix metalloproteinase (MMP) inhibitor BB-94 reduced brain injury in a mouse model of MM. The present study aimed to assess whether doxycycline (DOX), a tetracycline that showed a neuroprotective effect as adjuvant therapy in experimental pneumococcal meningitis (PM), would also exert a beneficial effect when given as adjunctive therapy to ceftriaxone (CRO) in experimental MM. METHODS: BALB/c mice were infected by the intracisternal route with a group C Neisseria meningitidis strain. Eighteen h post infection (hpi), animals were randomised for treatment with CRO [100 mg/kg subcutaneously (s.c.)], CRO plus DOX (30 mg/kg s.c.) or saline (control s.c.). Antibiotic treatment was repeated 24 and 40 hpi. Mouse survival and clinical signs, bacterial counts in cerebella, brain damage, MMP-9 and cyto/chemokine levels were assessed 48 hpi. RESULTS: Analysis of bacterial load in cerebella indicated that CRO and CRO + DOX were equally effective at controlling meningococcal replication. No differences in survival were observed between mice treated with CRO (94.4%) or CRO + DOX (95.5%), (p > 0.05). Treatment with CRO + DOX significantly diminished both the number of cerebral hemorrhages (p = 0.029) and the amount of MMP-9 in the brain (p = 0.046) compared to untreated controls, but not to CRO-treated animals (p > 0.05). Levels of inflammatory markers in the brain of mice that received CRO or CRO + DOX were not significantly different (p > 0.05). Overall, there were no significant differences in the parameters assessed between the groups treated with CRO alone or CRO + DOX. CONCLUSIONS: Treatment with CRO + DOX showed similar bactericidal activity to CRO in vivo, suggesting no antagonist effect of DOX on CRO. Combined therapy significantly improved mouse survival and disease severity compared to untreated animals, but addition of DOX to CRO did not offer significant benefits over CRO monotherapy. In contrast to experimental PM, DOX has no adjunctive activity in experimental MM.


Assuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Doxiciclina/uso terapêutico , Meningite Meningocócica/tratamento farmacológico , Neisseria meningitidis Sorogrupo C , Animais , Antibacterianos/administração & dosagem , Carga Bacteriana/efeitos dos fármacos , Ceftriaxona/administração & dosagem , Hemorragia Cerebral/tratamento farmacológico , Quimiocinas/análise , Quimiocinas/metabolismo , Modelos Animais de Doenças , Doxiciclina/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Metaloproteinase 9 da Matriz/análise , Metaloproteinase 9 da Matriz/metabolismo , Meningite Meningocócica/mortalidade , Camundongos , Camundongos Endogâmicos BALB C , Distribuição Aleatória , Resultado do Tratamento
7.
Rev. esp. patol. torac ; 32(2): 154-158, mayo 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193910

RESUMO

La proteinosis alveolar pulmonar es una enfermedad rara que se produce por un acúmulo anormal de lipoproteínas a nivel alveolar, siendo la broncoscopia una herramienta importante para su diagnóstico y tratamiento. Se presenta el caso de una mujer de 44 años, fumadora, con tos escasamente productiva blanquecina y disnea de tres meses de evolución, tratada de forma previa con antibioterapia por sospecha de neumonía adquirida en la comunidad, con escasa mejoría. La tomografía torácica mostró un patrón intersticial bilateral, compuesto por zonas en vidrio deslustrado, áreas geográficas y crazy paving. A nivel analítico, se observaron niveles aumentados de LDH e IgE junto a hipoxemia moderada, siendo la serología de VIH negativa. Las muestras de la broncoscopia fueron positivas para tinciones con ácido peryódico de Schiff, hallazgo compatible con el diagnóstico de proteinosis alveolar pulmonar. La paciente fue tratada con lavado broncoalveolar total, con buena respuesta y sin presentar recaídas hasta la fecha


Pulmonary alveolar proteinosis is a rare disease caused by an abnormal accumulation of lipoproteins at the alveolar level in which bronchoscopy is an important tool for diagnosis and treatment. We present the case of a 44-year-old woman, smoker, with a slightly productive cough producing milky sputum and dyspnea progressing over three months, previously treated with antibiotics for suspected community-acquired pneumonia with little improve-ment. The thoracic CT showed a bilateral interstitial pattern composed of areas of ground glass opacity, geographic areas and crazy paving. At the analytical level, increased levels of LDH and IgE along with moderate hypoxemia were observed, with negative HIV serology. Bronchoscopy samples were positive for Periodic Acid-Schiff staining, a finding compatible with the diagnosis of pulmonary alveolar proteinosis. The patient was treated with a full bronchoal-veolar lavage with a good response and she has not suffered a relapse to date


Assuntos
Humanos , Feminino , Adulto , Proteinose Alveolar Pulmonar/diagnóstico , Broncoscopia/métodos , Doenças Raras/diagnóstico por imagem , Proteinose Alveolar Pulmonar/patologia , Doenças Raras/patologia , Lavagem Broncoalveolar , Radiografia Torácica , Ceftriaxona/administração & dosagem , Levofloxacino/administração & dosagem , Prednisona/administração & dosagem , Tomografia Computadorizada por Raios X , Biópsia
8.
Braz. J. Vet. Res. Anim. Sci. (Online) ; 57(2): e166204, mai. 2020. ilus, graf
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1122176

RESUMO

Medical management of abdominal abscesses in horses requires prolonged antibiotic therapy and presents varied success rates. A 6-year-old male horse with a history of colic and multiple abdominal punctures to relieve gas was attended. At admission, tachycardia, tachypnea, hyperthermia, mucosal congestion, dehydration, and rigid gait were observed. The association of physical examination, laboratory and ultrasonographic findings allowed the diagnoses of peritonitis and abdominal abscess. Supporting treatment plus broad spectrum antibiotic therapy was performed: daily intraperitoneal ceftriaxone (25 mg/kg, 7 days); daily intravenous gentamicin (6.6 mg/kg, 7 days); per os metronidazole three times a day (15 mg/kg 12 days), followed by the same dose twice a day (15 mg/kg 33 days), totaling 45 days of treatment. Plasma fibrinogen and ultrasonographic examination were the most effective tools to evaluate abscess evolution. There was normalization of the physical examination 24 h after beginning the treatment, consecutive regression of the nucleated cell count in the peritoneal fluid, and regression of plasma fibrinogen and size of the abscess. On the 10th treatment day, the animal was discharged from the hospital, maintaining oral therapy with metronidazole every 12 h (15 mg / kg). When the animal returned on the 30th day, an abscess size regression was observed. However, there was no resolution, and therapy with metronidazole was maintained. On the 45th day of treatment, a new hospital evaluation was performed, where the abscess resolved, and metronidazole was suspended. It is highlighted that the therapeutic association used in the treatment of abdominal infection and abscess resulted in a rapid clinical response.(AU)


O tratamento conservativo dos abscessos abdominais em equinos requer antibioticoterapia prolongada e apresenta variadas taxas de sucesso. Foi atendido um cavalo de seis anos de idade, com histórico de cólica e múltiplas punções abdominais por agulha para esvaziamento de gás. Na admissão, foram observados taquicardia, taquipnéia, hipertermia, congestão mucosa, desidratação e marcha rígida. A associação do exame físico, achados laboratoriais e ultrassonográficos permitiu o diagnóstico de peritonite e abscesso abdominal. Foi realizado tratamento suporte e antibioticoterapia de amplo espectro: ceftriaxona intraperitoneal diária (25 mg/kg, 7 dias); gentamicina intravenosa diária (6,6 mg/kg, 7 dias); metronidazol oral três vezes ao dia (15 mg/kg, 12 dias), seguido de mesma dose duas vezes ao dia, por mais 33 dias, totalizando 45 dias de tratamento. O fibrinogênio plasmático e o exame ultrassonográfico foram os recursos mais eficazes para a avaliação da evolução do abscesso. Após 24 horas do início do tratamento foi constatada a normalização do exame fisico, regressão progressiva da contagem de células nucleadas no líquido peritoneal, do fibrinogênio plasmático e do tamanho do abscesso. No 10° dia de tratamento o animal recebeu alta hospitalar, mantendo-se a terapia oral com metronidazol a cada 12 horas (15 mg/Kg). Em retorno, ao 30° dia, observou-se regressão do tamanho do abscesso, entretanto, não houve resolução, tendo sido mantida a terapia com metronidazol. No 45º dia de tratamento, realizou-se nova avaliação hospitalar, onde foi observada a resolução do abscesso e a admnistração do metronidazol foi suspensa. Destaca-se, que a associação terapêutica utilizada no tratamento de infecção abdominal e abscesso resultou em rápida resposta clínica.(AU)


Assuntos
Animais , Peritonite/veterinária , Ceftriaxona/administração & dosagem , Gentamicinas/administração & dosagem , Abscesso Abdominal/veterinária , Cavalos , Metronidazol/administração & dosagem , Ultrassom , Fibrinogênio , Injeções Intraperitoneais/veterinária
9.
Psychopharmacology (Berl) ; 237(7): 2007-2018, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32382781

RESUMO

RATIONALE: The beta-lactam antibiotic ceftriaxone reliably attenuates the reinstatement of cocaine seeking. While the restoration of nucleus accumbens core (NA core) GLT-1 expression is necessary for ceftriaxone to attenuate reinstatement, AAV-mediated GLT-1 overexpression is not sufficient to attenuate reinstatement and does not prevent glutamate efflux during reinstatement. AIMS: Here, we test the hypothesis that ceftriaxone attenuates reinstatement through interactions with glutamate autoreceptors mGlu2 and mGlu3 in the NA core. METHODS: Male and female rats self-administered cocaine for 12 days followed by 2-3 weeks of extinction training. During the last 6-10 days of extinction, rats received ceftriaxone (200 mg/kg IP) or vehicle. In experiment 1, rats were killed, and NA core tissue was biotinylated for assessment of total and surface expression of mGlu2 and mGlu3 via western blotting. In experiment 2, we tested the hypothesis that mGlu2/3 signaling is necessary for ceftriaxone to attenuate cue- and cocaine-primed reinstatement by administering bilateral intra-NA core infusion of mGlu2/3 antagonist LY341495 or vehicle immediately prior to reinstatement testing. RESULTS: mGlu2 expression was reduced by cocaine and restored by ceftriaxone. There were no effects of cocaine or ceftriaxone on mGlu3 expression. We observed no effects of estrus on expression of either protein. The antagonism of mGlu2/3 in the NA core during both cue- and cocaine-primed reinstatement tests prevented ceftriaxone from attenuating reinstatement. CONCLUSIONS: These results indicate that ceftriaxone's effects depend on mGlu2/3 function and possibly mGlu2 receptor expression. Future work will test this hypothesis by manipulating mGlu2 expression in pathways that project to the NA core.


Assuntos
Comportamento Aditivo/metabolismo , Ceftriaxona/administração & dosagem , Cocaína/administração & dosagem , Núcleo Accumbens/metabolismo , Receptores de Glutamato Metabotrópico/metabolismo , Animais , Comportamento Aditivo/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/metabolismo , Inibidores da Captação de Dopamina/administração & dosagem , Extinção Psicológica/efeitos dos fármacos , Extinção Psicológica/fisiologia , Feminino , Masculino , Núcleo Accumbens/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Receptores de Glutamato Metabotrópico/antagonistas & inibidores , Autoadministração
10.
Am J Transplant ; 20(7): 1882-1884, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32243672

RESUMO

The clinical manifestation of COVID-19 can vary from an asymptomatic course to ARDS requiring invasive mechanical ventilation and extracorporeal membrane oxygenation. A kidney transplanted patient infected with SARS CoV-2 infection showed a mild disease despite immune suppression. It is possible that Immunosuppression can "be protective" as the cytokine storm is an important factor in the disease story. Despite the good outcome reported in the present case report, is remains of vital importance the solid organ transplant patients use precautions in order to avoid the infection.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Glomerulonefrite por IGA/complicações , Falência Renal Crônica/complicações , Transplante de Rim , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Betacoronavirus , Ceftriaxona/administração & dosagem , Citocinas/metabolismo , Glomerulonefrite por IGA/cirurgia , Humanos , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Pandemias , Tacrolimo/administração & dosagem , Resultado do Tratamento
11.
Wei Sheng Yan Jiu ; 49(1): 92-97, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-32290921

RESUMO

OBJECTIVE: This study aimed to explore whether exposure to ceftriaxone during early life could influences glucose and lipid metabolism of high fat diet-induced mice. METHODS: Total 48 of female BALB/c aged 2 week old were randomly divided into control group(treated with saline), antibiotic group(treated with100 mg/kg ceftriaxone), high-fat diet group(treated with saline) and combined action group(treated with 100 mg/kg ceftriaxone)(n=12), respectively to stop gavage 2 weeks later. Then high-fat diet group and combined action group were fed with high-fat diet for 12 weeks. Fasting blood glucose(FBG) and oral glucose tolerance test were conducted in the last week. Serum total cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), fasting insulin, leptin and TG, TC in liver were also measured. Furthermore, homeostasis model assessment of insulin resistance(HOMA-IR) was calculated from FBG and insulin. RESULTS: Compared with normal chow diet, high-fat diet impaired oral glucose tolerance and increased the levels of abdominal adipose tissue, FBG, HOMA-IR, lips in serum and liver and leptin(P<0. 05). The oral administration of ceftriaxone in early life impaired oral glucose tolerance and increased the levels of abdominal adipose tissue, FBG and TG in liver(P<0. 05). In addition, early ceftriaxone intervention could enhance the impaired glucose tolerance, the increasing FBG, insulin resistance and liver lipids associated with high-fat diet(P<0. 05). CONCLUSION: Early ceftriaxone intervention not only significantly increases the level of abdominal adipose tissue, FBG, insulin resistance and liver lipids, but also enhances glycolipid metabolic disorders induced by high-fat diet. These result suggest that the exposure to antibiotics in the early life might increase the sensitivity of host animal to high fat diet induced abnormal glycolipid metabolism late.


Assuntos
Ceftriaxona/efeitos adversos , Dieta Hiperlipídica/efeitos adversos , Glicolipídeos/metabolismo , Resistência à Insulina , Metabolismo dos Lipídeos , Administração Oral , Animais , Glicemia , Ceftriaxona/administração & dosagem , Feminino , Insulina/sangue , Camundongos , Camundongos Endogâmicos BALB C , Distribuição Aleatória
12.
Medicine (Baltimore) ; 99(10): e18954, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150046

RESUMO

RATIONALE: In patients receiving biological therapies, serious infections are a major concern. Infections associated with anti-tumor necrosis factor antibody therapy include tuberculosis, viral, fungal, and bacterial infections. Likewise, severe infections of the upper and lower respiratory tract, lung, skin and soft tissue, urinary tract, gastrointestinal tract, joint, and bone have also been reported previously. However, infections involving the central nervous system are rare, especially an intracranial infection caused by odontogenic infection. To date, only few cases have been reported of this infection. This is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. PATIENT CONCERNS: A 39-year-old male with psoriatic arthritis receiving adalimumab treatment came to the emergency department with initial presentation of sudden onset convulsions. He had been receiving adalimumab treatment for 1 month. Two days after the third injection, the patient had an episode of sudden-onset general convulsion for nearly 5 min with the upgazing and general tonic presentation. Magnetic resonance imaging (MRI) showed left frontal lobe brain abscess. Pus culture from the brain abscess detected Streptococcus sanguinis (S. sanguinis), Fusobacterium nucleatum (F. nucleatum), and Parvimonas micra (P. micra). DIAGNOSIS: Brain abscess with odontogenic infection. INTERVENTIONS: The patient received left frontal craniotomy, abscess drainage and systemic empiric antibiotics treatment with vancomycin, cefepime, and metronidazole. Due to drug rash with eosinophilia and systemic symptoms during the treatment, vancomycin and metronidazole were discontinued, and systemic antibiotics were switched to teicoplanin and ceftriaxone. OUTCOMES: A brain MRI follow-up performed after 1 month of initial treatment revealed the reduced size of the abscess lesion and minimal oedema. The patient was discharged with stable condition. LESSONS: To the best of our knowledge, this is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. Such a rare diagnosis must be kept in mind when patients treated with adalimumab present with sudden-onset convulsions. Careful dental examination should be performed before administration of adalimumab.


Assuntos
Adalimumab/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Psoriásica/tratamento farmacológico , Abscesso Encefálico/diagnóstico , Cérebro , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Abscesso Encefálico/microbiologia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Terapia Combinada , Craniotomia , Diagnóstico Diferencial , Firmicutes/isolamento & purificação , Fusobacterium nucleatum/isolamento & purificação , Humanos , Imagem por Ressonância Magnética , Masculino , Periodontite/complicações , Streptococcus/isolamento & purificação , Teicoplanina/administração & dosagem , Teicoplanina/uso terapêutico
14.
Gastroenterology ; 158(6): 1546-1547, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32017908

Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Coinfecção/diagnóstico , Granuloma/diagnóstico , Proctite/diagnóstico , Doenças Sexualmente Transmissíveis/diagnóstico , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/imunologia , Antibacterianos/administração & dosagem , Antivirais/administração & dosagem , Ceftriaxona/administração & dosagem , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Coinfecção/tratamento farmacológico , Coinfecção/imunologia , Coinfecção/microbiologia , Colonoscopia , Citomegalovirus/isolamento & purificação , DNA Bacteriano/isolamento & purificação , Doxiciclina/administração & dosagem , Quimioterapia Combinada/métodos , Granuloma/tratamento farmacológico , Granuloma/imunologia , Granuloma/microbiologia , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Proctite/tratamento farmacológico , Proctite/imunologia , Proctite/microbiologia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/imunologia , Doenças Sexualmente Transmissíveis/microbiologia , Resultado do Tratamento , Valganciclovir/administração & dosagem
15.
Int J Antimicrob Agents ; 55(3): 105888, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31923571

RESUMO

Teicoplanin possesses several convenient properties for use in the delivery of outpatient parenteral antimicrobial therapy (OPAT) services. However, its use is not widespread and data on its efficacy in the OPAT setting are limited. Here we present a case series of patients undergoing OPAT care being treated by either teicoplanin-based (n = 107) or ceftriaxone-based (n = 191) antibiotic regimens. Clinical failure with teicoplanin occurred in five episodes of care (4.7%) compared with only two episodes of ceftriaxone-based OPAT care (1.0%). Teicoplanin-associated clinical failure was observed in 2 (33.3%) of 6 patients with Enterococcus infections compared with 3 (3.0%) of 101 patients with non-Enterococcus infections. Overall, there were four (2.9%) drug-related adverse events for teicoplanin and four (1.8%) for ceftriaxone, prompting a switch to teicoplanin in three patients. These findings support the continued use of teicoplanin in OPAT as well as its consideration in centres where it is not currently being offered.


Assuntos
Antibacterianos/administração & dosagem , Teicoplanina/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Ceftriaxona/administração & dosagem , Ceftriaxona/efeitos adversos , Humanos , Infusões Parenterais , Pacientes Ambulatoriais , Teicoplanina/efeitos adversos
17.
BMC Infect Dis ; 19(1): 1079, 2019 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-31878894

RESUMO

BACKGROUND: Community-onset pneumonia (COP) is a combined concept of community acquired pneumonia and the previous classification of healthcare-associated pneumonia. Although ceftriaxone (CRO) is one of the treatment choices for COP, it is unclear whether 1 or 2 g CRO daily has better efficacy. We compared the effectiveness of 1 g with 2 g of CRO for COP treatment. We hypothesized that 1 g CRO would show non-inferiority over 2 g CRO. METHODS: This study was an analysis of prospectively registered data of the patients with COP from four Japanese hospitals (the Adult Pneumonia Study Group-Japan: APSG-J). We included subjects who were initially treated solely with 1 or 2 g of CRO. The propensity score was estimated from the 33 pre-treatment variables, including age, sex, weight, pre-existing comorbidities, prescribed drugs, risk factors for aspiration pneumonia, vital signs, laboratory data, and a finding from chest xrays. The primary endpoint was the cure rate, for which a non-inferiority analysis was performed with a margin of 0.05. In addition, we performed three sensitivity analyses; using data limited to the group in which CRO solely was used until the completion of treatment, using data limited to inpatient cases, and performing a generalized linear mixed-effect logistic regression analysis to assess the primary outcome after adjusting for random hospital effects. RESULTS: Of the 3817 adult subjects with pneumonia who were registered in the APSG-J study, 290 and 216 were initially treated solely with 1 or 2 g of CRO, respectively. Propensity score matching was used to extract 175 subjects in each group. The cure rate was 94.6 and 93.1% in the 1 and 2 g CRO groups, respectively (risk difference 1.5%; 95% confidence interval - 3.1 to 6.0; p = 0.009 for non-inferiority). The results of the sensitivity analyses were consistent with the primary result. CONCLUSIONS: The propensity score-matched analysis of multicenter cohort data from Japan revealed that the cure rate for COP patients treated with 1 g daily CRO was non-inferior to that of patients treated with 2 g daily CRO.


Assuntos
Antibacterianos/administração & dosagem , Ceftriaxona/administração & dosagem , Pneumonia/tratamento farmacológico , Sistema de Registros , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pneumonia/epidemiologia , Pneumonia/mortalidade , Pontuação de Propensão
18.
Rev Chilena Infectol ; 36(3): 253-264, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859743

RESUMO

BACKGROUND: Nowadays about half of antibiotic prescriptions are inadequate, increasing bacterial resistance. Both cephalosporins and fluoroquinolones are associated with this phenomenon: increase of ß-lactamase producing bacteria and Clostridioides difficile infections, which is why regulatory agencies seek to rationalize their use. AIM: To evaluate the effect of use recommendations on the proportion of inadequate prescriptions of ceftriaxone and fluoroquinolones. METHODS: A prospective and interventional study was developed, comparing the quality and quantity of use of ceftriaxone and fluoroquinolones before and after the implementation of use recommendations for treatments of infectious diseases acquired at the community. The outcomes were: proportion of inadequate prescriptions and defined daily dose (DDD). Data were analyzed using the Chi-square test, Fisher's correction and Student's test. RESULTS: A total of 206 patients were evaluated, a 35% decrease in inadequate prescriptions, a decline in the consumption of ceftriaxone and levofloxacin, and a significant increase in the use of ampicillin/ sulbactam was observed. CONCLUSIONS: The implementation of use recommendations based on scientific evidence and local susceptibility allowed to reduce the proportion of inadequate prescriptions and to reduce de consumption of ceftriaxone and fluoroquinolones.


Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos/normas , Ceftriaxona/administração & dosagem , Prescrições de Medicamentos/normas , Fluoroquinolonas/administração & dosagem , Hospitais Universitários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Uso de Medicamentos/normas , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Prescrição Inadequada/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
19.
BMJ Case Rep ; 12(11)2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31748364

RESUMO

Parvimonas micra (P. micra) is a Gram-positive anaerobic cocci, normally found in the oral cavity and rarely causes severe infections. We describe a rare clinical presentation of P. micra as spondylodiscitis and psoas abscess with haematogenous spread in an adult patient. MRI lumbar spine detected L2 and L3 spondylodiscitis. Blood cultures were positive at 48 hours of incubation and P. micra was identified on anaerobic culture after 72 hours. Isolates from bone biopsy confirms P. micra She was successfully treated with ceftriaxone, followed by oral metronidzole for a total of 8 weeks. The suspected origin of her P. micra was a dental cavity. Anaerobic bacteria tend to be underestimated in spondylodiscitis. In cases of slow growing organisms, we emphasise the importance of performing accurate identification including anaerobic bacteria to guide management. P. micra should be considered in patients with spondylodiscitis who had recent dental intervention or perioral infection.


Assuntos
Discite/complicações , Discite/microbiologia , Firmicutes/isolamento & purificação , Abscesso do Psoas/complicações , Abscesso do Psoas/microbiologia , Administração Intravenosa , Administração Oral , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Biópsia , Osso e Ossos/patologia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Discite/diagnóstico por imagem , Discite/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Abscesso do Psoas/tratamento farmacológico , Resultado do Tratamento
20.
BMJ Case Rep ; 12(11)2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31678926

RESUMO

A 65-year-old male patient presented with fever, fast atrial fibrillation and frank haematuria on return to Ireland from travel in East Africa. He had a systolic murmur leading to a clinical suspicion of endocarditis. He had no specific clinical features of diphtheria. Blood cultures were taken and empiric therapy commenced with benzylpenicillin, vancomycin and gentamicin. Corynebacterium diphtheriae was detected on blood culture. The isolate was submitted to a reference laboratory for evaluation of toxigenicity. While initially there was concern regarding the possibility of myocarditis, a clinical decision was made not to administer diphtheria antitoxin in the absence of clinical features of respiratory diphtheria, in the presence of invasive infection and with presumptive previous immunisation. There is no specific guidance on the role of antitoxin in this setting. The issue is not generally addressed in previous reports of C. diphtheriae blood stream infection.


Assuntos
Infecções por Corynebacterium/sangue , Corynebacterium diphtheriae/isolamento & purificação , Administração Intravenosa , Idoso , Antibacterianos/administração & dosagem , Ceftriaxona/administração & dosagem , Infecções por Corynebacterium/tratamento farmacológico , Infecções por Corynebacterium/microbiologia , Antitoxina Diftérica/uso terapêutico , Úlcera do Pé/complicações , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/microbiologia , Insuficiência da Valva Mitral/cirurgia
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