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2.
J R Soc Interface ; 17(172): 20200393, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33143594

RESUMO

The basic reproductive number, R0, is one of the most common and most commonly misapplied numbers in public health. Often used to compare outbreaks and forecast pandemic risk, this single number belies the complexity that different epidemics can exhibit, even when they have the same R0. Here, we reformulate and extend a classic result from random network theory to forecast the size of an epidemic using estimates of the distribution of secondary infections, leveraging both its average R0 and the underlying heterogeneity. Importantly, epidemics with lower R0 can be larger if they spread more homogeneously (and are therefore more robust to stochastic fluctuations). We illustrate the potential of this approach using different real epidemics with known estimates for R0, heterogeneity and epidemic size in the absence of significant intervention. Further, we discuss the different ways in which this framework can be implemented in the data-scarce reality of emerging pathogens. Lastly, we demonstrate that without data on the heterogeneity in secondary infections for emerging infectious diseases like COVID-19 the uncertainty in outbreak size ranges dramatically. Taken together, our work highlights the critical need for contact tracing during emerging infectious disease outbreaks and the need to look beyond R0.


Assuntos
Betacoronavirus , Coinfecção/complicações , Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Modelos Biológicos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Busca de Comunicante , Infecções por Coronavirus/transmissão , Humanos , Pandemias , Pneumonia Viral/transmissão , Fatores de Risco
4.
Gastroenterol. hepatol. (Ed. impr.) ; 43(8): 418-425, oct. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-196892

RESUMO

INTRODUCTION: Many patients with hepatitis C virus (HCV) have associated comorbidities that require complex treatments. We sought to determine the impact of treatment with direct-acting antiviral agents (DAAs) for HCV on adherence to prescribed concomitant medications for associated comorbidities and to identify predictors of non-adherence to comedications. PATIENTS AND METHODS: HCV-infected patients treated with DAAs in a Spanish hospital between January 2015 and December 2016 and followed-up by the pharmacy unit were included in the study. Adherence to concomitant comedication prescribed before and during HCV therapy with DAAs was compared to adherence during the same number of weeks before DAA initiation. Demographic, clinical and pharmacotherapy variables were analyzed to determine factors associated with non-adherence. A multivariate regression model was created for prediction of non-adherence to concomitant medication. RESULTS: Data from 214 patients using prescribed concomitant therapies were analyzed. Significant reduction on adherence to comedications was observed after initiation of DAA treatment compared with a similar period before therapy initiation (29.9% vs. 36.9%, p = 0.032). The univariate analysis showed that polypharmacy and presence of vascular disease were associated negatively with adherence to concomitant medications (87.8%, p = 0.006 and 84.7%, p < 0.001, respectively). Multivariate analysis indicated that HIV/HBV coinfection was associated with adherence (OR 0.19; 95% CI 0.09-0.39), while polypharmacy was a predictor for non-adherence (OR 4.54; 95% CI 1.48-13.92). DISCUSSION: Adherence to concomitant medications decreases in HCV-infected patients when DAA therapy is initiated. Polypharmacy is a predictor for non-adherence, while HIV/HBV coinfection reduce non-adherence rates. Polymedicated patients on DAAs might benefit from close follow-up and educational programmes to improve their adherence


INTRODUCCIÓN: Muchos pacientes con virus de la hepatitis C (VHC) presentan comorbilidades que requieren tratamientos complejos. Queremos determinar el impacto del tratamiento con antivirales de acción directa (AAD) para el VHC en la adherencia a medicaciones concomitantes e identificar factores predictivos de no adherencia a comedicaciones. PACIENTES Y MÉTODOS: Pacientes tratados con AAD entre 2015 y 2016 se incluyeron en el estudio y se comparó su adherencia a medicaciones concomitantes antes y durante la terapia con AAD en un periodo de tiempo similar. Múltiples variables fueron analizadas para identificar factores asociados a la no-adherencia. Se creó un modelo de regresión multivariable para predecir la no adherencia a medicaciones concomitantes. RESULTADOS: Se analizaron datos de 214 pacientes en tratamientos concomitantes. Tras iniciar la terapia con AAD, la adherencia a las comedicaciones disminuyó respecto a la adherencia en ausencia de AAD (29,9% respecto al 36,9%; p = 0,032). El análisis univariante demostró que la polifarmacia y la enfermedad vascular estaban asociadas negativamente con la adherencia a las medicaciones concomitantes (87,8%, p = 0,006 y 84,7%, p < 0,001, respectivamente). El análisis multivariante indicó que la coinfección con VIH/VHB estaba asociada con la adherencia (OR: 0,19; IC 95%: 0,09-0,39), mientras que la polifarmacia era un predictor de no adherencia (OR: 4,54; IC 95%: 1,48-13,92). DISCUSIÓN: El inicio del tratamiento con AAD disminuye la adherencia a la comedicación en pacientes con VHC. La polifarmacia es predictor de no adherencia mientras que la coinfección con VIH/VHB la reduce. Aquellos pacientes polimedicados y en tratamiento con AAD podrían beneficiarse de un seguimiento estrecho para aumentar su adherencia


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Antivirais/uso terapêutico , Hepatite C/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Coinfecção/complicações , Coinfecção/tratamento farmacológico , Polimedicação , Fatores de Tempo
5.
BMC Infect Dis ; 20(1): 642, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873233

RESUMO

BACKGROUND: Evidence suggested that vaginal microbiome played a functional role in the progression of cervical lesions in female infected by HPV. This study aimed at evaluating the influence of common vaginal infection on the carcinogenicity of high risk HPV (hr-HPV). METHODS: From January 15, 2017 to December 31, 2017, 310,545 female aged at least 30 years old had been recruited for cervical cancer screening from 9 clinical research centers in Central China. All the recruited participants received hr-HPV genotyping for cervical cancer screening and vaginal microenvironment test by a high vaginal swab. Colposcopy-directed biopsy was recommended for female who were infected with HPV 16 and HPV 18, and other positive hr-HPV types through test had undertaken triage using liquid-based cytology, cases with the results ≥ ASCUS among them were referred to colposcopy directly, and cervical tissues were taken for pathology examination to make clear the presence or absence of other cervical lesions. RESULTS: Among 310,545 female, 6067 (1.95%) were tested with positive HPV 16 and HPV 18, 18,297 (5.89%) were tested with other positive hr-HPV genotypes, cervical intraepithelial neoplasia (CIN) 1, CIN 2, CIN 3 and invasive cervical cancer (ICC) were detected in 861 cases, 377 cases, 423 cases, and 77 cases, respectively. Candida albicans and Gardnerella were not associated with the detection of cervical lesions. Positive trichomonas vaginitis (TV) was correlated with hr-HPV infection (p < 0.0001). Co-infection with TV increased the risk of CIN 1 among female infected with hr-HPV (OR 1.18, 95% CI: 1.42-2.31). Co-infection with TV increased the risk of CIN 2-3 among female infected with HPV 16 (OR 1.71, 95% CI: 1.16-2.53). CONCLUSIONS: Co-infection of TV and HPV 16 is a significant factor for the detection of cervical lesions.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Coinfecção/complicações , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Infecções por Papillomavirus/complicações , Vaginite por Trichomonas/complicações , Trichomonas vaginalis/isolamento & purificação , Neoplasias do Colo do Útero/epidemiologia , Adulto , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/virologia , China/epidemiologia , Coinfecção/diagnóstico , Colposcopia , Estudos Transversais , Citodiagnóstico , Detecção Precoce de Câncer/métodos , Feminino , Genótipo , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Fatores de Risco , Vaginite por Trichomonas/diagnóstico , Vaginite por Trichomonas/parasitologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia
6.
PLoS Pathog ; 16(9): e1008744, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32898182

RESUMO

In HIV-hepatitis B virus (HBV) co-infection, adverse liver outcomes including liver fibrosis occur at higher frequency than in HBV-mono-infection, even following antiretroviral therapy (ART) that suppresses both HIV and HBV replication. To determine whether liver disease was associated with intrahepatic or circulating markers of inflammation or burden of HIV or HBV, liver biopsies and blood were collected from HIV-HBV co-infected individuals (n = 39) living in Bangkok, Thailand and naïve to ART. Transient elastography (TE) was performed. Intrahepatic and circulating markers of inflammation and microbial translocation were quantified by ELISA and bead arrays and HIV and HBV infection quantified by PCR. Liver fibrosis (measured by both transient elastography and liver biopsy) was statistically significantly associated with intrahepatic mRNA for CXCL10 and CXCR3 using linear and logistic regression analyses adjusted for CD4 T-cell count. There was no evidence of a relationship between liver fibrosis and circulating HBV DNA, qHBsAg, plasma HIV RNA or circulating cell-associated HIV RNA or DNA. Using immunohistochemistry of liver biopsies from this cohort, intrahepatic CXCL10 was detected in hepatocytes associated with inflammatory liver infiltrates in the portal tracts. In an in vitro model, we infected an HBV-infected hepatocyte cell line with HIV, followed by interferon-γ stimulation. HBV-infected cells lines produced significantly more CXCL10 than uninfected cells lines and this significantly increased in the presence of an increasing multiplicity of HIV infection. Conclusion: Enhanced production of CXCL10 following co-infection of hepatocytes with both HIV and HBV may contribute to accelerated liver disease in the setting of HIV-HBV co-infection.


Assuntos
Quimiocina CXCL10/metabolismo , Coinfecção/complicações , Infecções por HIV/complicações , HIV/isolamento & purificação , Vírus da Hepatite B/isolamento & purificação , Hepatite B/complicações , Cirrose Hepática/epidemiologia , Adulto , Austrália/epidemiologia , Estudos de Coortes , Coinfecção/virologia , Feminino , Infecções por HIV/virologia , Hepatite B/virologia , Humanos , Incidência , Cirrose Hepática/metabolismo , Cirrose Hepática/virologia , Masculino , Países Baixos/epidemiologia , Prognóstico , Tailândia/epidemiologia
7.
PLoS One ; 15(9): e0239258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32961548

RESUMO

BACKGROUND: Viral infections in children and adolescents with malignancy are commonly encountered and have a significant impact on morbidity and mortality. Studies and epidemiological data regarding viral infections in children with cancer in developing countries are lacking. This retrospective cohort study aims to assess the burden of viral infections in children and adolescents with cancer, by assessing prevalence, risk factors, as well as morbidity and mortality of common viruses over a period of 8 years. METHODS AND FINDINGS: Medical records of cancer patients treated at the Children Cancer Center of Lebanon were reviewed and 155 participants under the age of 21 were identified with at least one documented viral infection during the period from July 2009 to November 2017. This subset included 136 participants with active malignancy and 19 participants with a history of cancer who underwent hematopoietic stem cell transplantation [HSCT] and were in remission; the latter group was analyzed separately. Information regarding participant characteristics, hospital course, and complications were obtained. Associations between viral infections and certain factors were assessed. In the cohort, 64% were male, 81% were Lebanese. In participants with active malignancy, 90% received chemotherapy in the 6 months preceding the viral infection episode, 11% received radiotherapy. 51% of participants were neutropenic at the time of viral detection, and 77% were lymphopenic. 17% experienced a bacterial co-infection, and 3 experienced a viral co-infection. Among 162 viral infection episodes, clinically diagnosed skin infections, mainly herpes simplex virus type 1 and varicella-zoster virus, were the most common [44% of cases]. These were followed by laboratory-proven systemic herpes infections: cytomegalovirus [14%] and Epstein-Barr virus [6%]. Respiratory viruses: influenza and respiratory syncytial virus, accounted for 9% and 4%, respectively, whereas rotavirus represented 11% and BK virus represented 3% of cases. Acute lymphocytic leukemia was the most prevalent neoplasia [57%]. Fever was the most common presenting symptom [55%] and febrile neutropenia was the reason for admission in 24% of cases. The mean length of stay was significantly longer in participants with cytomegalovirus infections and significantly lower in rotavirus infection. Admission to the ICU occurred in 9%, complications in 8%, and mortality in 5%. Participants with viral infections post-HSCT were noted to have a significantly longer length of hospital stay compared to non-HSCT participants, with no other significant differences in clinical course and outcome. The study was limited by its retrospective nature and by the late introduction and underuse of multiplex PCR panels, which may have led to underdiagnosis of viral infections. CONCLUSIONS: Viral infections were prevalent in our sample of cancer patients and may have contributed to morbidity and mortality. Newly available viral diagnostics are likely to vastly increase the number and scope of detectable viral infections in this population. Prospective studies using multiplex PCR technology with systematic testing of patients will be more helpful in defining the burden of viral infections. Furthermore, efforts at antimicrobial stewardship would benefit from the identification of viral causes of infection and limit the unnecessary use of antibiotics in the pediatric cancer population.


Assuntos
Infecções por Citomegalovirus/epidemiologia , Influenza Humana/epidemiologia , Neoplasias/epidemiologia , Infecções Respiratórias/epidemiologia , Adolescente , Criança , Criança Hospitalizada , Pré-Escolar , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/virologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/virologia , Feminino , Transplante de Células-Tronco Hematopoéticas , Hospitais , Humanos , Lactente , Influenza Humana/complicações , Influenza Humana/diagnóstico , Influenza Humana/virologia , Líbano/epidemiologia , Reação em Cadeia da Polimerase Multiplex/métodos , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/virologia , Pediatria , Vírus Sincicial Respiratório Humano/genética , Vírus Sincicial Respiratório Humano/isolamento & purificação , Vírus Sincicial Respiratório Humano/patogenicidade , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/virologia , Estudos Retrospectivos , Infecções por Rotavirus/complicações , Infecções por Rotavirus/diagnóstico , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/patologia
8.
Mol Immunol ; 127: 124-135, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32971399

RESUMO

The aim of this study was to determine the interaction of peripheral immunity vs. the CNS in the setting of AD pathogenesis at the transcriptomic level in a data driven manner. For this purpose, publicly available gene expression data from the GEO Datasets repository. We performed differential gene expression and functional enrichment analyses were performed on the five retrieved studies: (a) three hippocampal cortex (HC) studies (b) one study of peripheral blood mononuclear cells (PBMC) and (c) one involving neurofibrillary tangle - containing neurons of the entorhinal cortex (NFT EC). Subsequently, BLAST was used to determine protein conservation between human proteins vs. microbial, whereas putative protein / oligopeptide antigenicity were determined via RANKPep. Gene ontology and pathway analyses revealed significantly enriched viral parasitism pathways in both PBMC and NFT - EC datasets, mediated by ribosomal protein families and epigenetic regulators. Among these, a salient viral pathway referred to Influenza A infection. NFT - EC annotations included leukocyte chemotaxis and immune response pathways. All datasets were significantly enriched for infectious pathways, as well as pathways involved in impaired proteostasis and non - phagocytic cell phagosomal cascades. In conclusion, our in silico analysis outlined an ad hoc model of AD pathophysiology in which double hit (PBMC and NFT-EC) viral parasitism is mediated by eukaryotic translational hijacking, and may be further implicated by impaired immune responses. Overall, our results overlap with the antimicrobial protection hypothesis of AD pathogenesis and support the notion of a pathogen - driven etiology.


Assuntos
Doença de Alzheimer/genética , Doença de Alzheimer/virologia , Sistema Nervoso Central/virologia , Coinfecção/complicações , Simulação por Computador , Regulação da Expressão Gênica , Parasitos/fisiologia , Proteostase/genética , Doença de Alzheimer/microbiologia , Animais , Sistema Nervoso Central/imunologia , Córtex Entorrinal/patologia , Perfilação da Expressão Gênica , Ontologia Genética , Humanos , Proteínas do Tecido Nervoso/metabolismo , Emaranhados Neurofibrilares/patologia , Oligopeptídeos/metabolismo , Mapas de Interação de Proteínas , Software
9.
J Parkinsons Dis ; 10(4): 1343-1353, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986683

RESUMO

Since the initial reports of COVID-19 in December 2019, the world has been gripped by the disastrous acute respiratory disease caused by the SARS-CoV-2 virus. There are an ever-increasing number of reports of neurological symptoms in patients, from severe (encephalitis), to mild (hyposmia), suggesting the potential for neurotropism of SARS-CoV-2. This Perspective investigates the hypothesis that the reliance on self-reporting of hyposmia has resulted in an underestimation of neurological symptoms in COVID-19 patients. While the acute effect of the virus on the nervous system function is vastly overshadowed by the respiratory effects, we propose that it will be important to monitor convalescent individuals for potential long-term implications that may include neurodegenerative sequelae such as viral-associated parkinsonism. As it is possible to identify premorbid harbingers of Parkinson's disease, we propose long-term screening of SARS-CoV-2 cases post-recovery for these expressions of neurodegenerative disease. An accurate understanding of the incidence of neurological complications in COVID-19 requires long-term monitoring for sequelae after remission and a strategized health policy to ensure healthcare systems all over the world are prepared for a third wave of the virus in the form of parkinsonism.


Assuntos
Infecções por Coronavirus/complicações , Transtornos Parkinsonianos/psicologia , Transtornos Parkinsonianos/virologia , Pneumonia Viral/complicações , Agnosia/virologia , Coinfecção/complicações , Infecções por Coronavirus/psicologia , Humanos , Pandemias , Pneumonia Viral/psicologia
10.
BMC Infect Dis ; 20(1): 554, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736608

RESUMO

BACKGROUND: In this study, we aimed to describe the prevalence, clinical presentation and risk factors of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) cases in China. METHODS: We performed a descriptive analysis of demographic and clinical data of HIV/TB coinfected patients receiving ART at Beijing Ditan Hospital between January 2014 and October 2018. RESULTS: Of 199 patients included, 45 (22.6%) developed paradoxical TB-IRIS, and 19 (9.5%) TB-IRIS cases presented miliary TB. The pre-ART CD4 count lower than 50 cells/mm3 was found to be significantly associated with development of TB-IRIS. Similarly, patients with higher than 4-fold increase in CD4 cell count after antiretroviral therapy (ART) had significantly higher odds of having TB-IRIS. When patients aged 25-44 years were utilized as the control group, youths (< 25 years old) were more likely to have miliary TB. No significant difference was observed in the intervals from initiation of ART to IRIS presentation between miliary and non-miliary group. CONCLUSIONS: In conclusion, our data demonstrate that approximate one quarter of patients coinfected with TB and HIV develop paradoxical TB-IRIS after initial of ART therapy in China. Lower baseline CD4 count and rapid increase in CD4 count are the major risk factors associated with the occurrence of paradoxical TB-IRIS.


Assuntos
Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/epidemiologia , Tuberculose Miliar/etiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Pequim/epidemiologia , Contagem de Linfócito CD4 , Coinfecção/complicações , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Tuberculose Miliar/epidemiologia , Tuberculose Miliar/imunologia , Adulto Jovem
11.
Ann Afr Med ; 19(3): 176-181, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32820729

RESUMO

Objectives: The study sought to determine the prevalence and risk factors associated with Hepatitis B surface antigenemia (HBsAg) positivity among pregnant women in Jos, Nigeria. Methodology: This was a cross-sectional study carried out among the pregnant population in five healthcare facilities in Jos, between November 1, 2017 and April 30, 2018. Informed consent was obtained, and data on sociodemographic and risk factors for hepatitis B virus (HBV) infection were collected. Hepatitis B viral infection was assessed using the in vitro HBsAg diagnostic rapid kit (Acon Laboratories, USA). Descriptive statistics, Chi-square test, and logistic regression were performed to identify predictors of HBV infection in the study population. All statistical analyses were carried out on STATA version 15. Results: Of the 3,238 women enrolled, 7.4% (241/3238) (95% confidence interval [CI] = 6.6% to 8.4%) were HBsAg positive. The absence of HBV vaccination (adjusted odds ratio [AOR] = 2.49; 95% CI = 1.49-4.09; P < 0.001), co-infection with HIV (AOR = 1.90; 95% CI = 1.18-3.08; P = 0.009), and higher parity (AOR = 1.37; 95% CI = 1.04-1.79; P = 0.024) were independently associated with HBV infection in pregnancy. Conclusions: The prevalence of HBV infection among pregnant women was high, especially among those without prior vaccination for HBV, those with HIV co-infection and higher parity.


Assuntos
Antígenos de Superfície da Hepatite B/sangue , Hepatite B/epidemiologia , Adulto , Coinfecção/complicações , Coinfecção/epidemiologia , Coinfecção/virologia , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Hepatite B/diagnóstico , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/sangue , Vírus da Hepatite B/isolamento & purificação , Humanos , Nigéria/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Prevalência , Fatores de Risco , Adulto Jovem
12.
Int J Infect Dis ; 100: 141-148, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32829051

RESUMO

OBJECTIVES: We aimed to explore the effect of antiretroviral treatment (ART) history on clinical characteristics of patients with co-infection of SARS-CoV-2 and HIV. METHODS: We retrospectively reviewed 20 patients with laboratory-confirmed co-infection of SARS-CoV-2 and HIV in a designated hospital. Patients were divided into medicine group (n = 12) and non-medicine group (n = 8) according to previous ART history before SARS-CoV-2 infection. RESULTS: The median age was 46.5 years and 15 (75%) were female. Ten patients had initial negative RT-PCR on admission, 5 of which had normal CT appearance and 4 were asymptomatic. Lymphocytes were low in 9 patients (45%), CD4 cell count and CD4/CD8 were low in all patients. The predominant CT features in 19 patients were multiple (42%) ground-glass opacities (58%) and consolidations (32%). Erythrocyte sedimentation rate (ESR) in the medicine group was significantly lower than that in the non-medicine group [median (interquartile range, IQR):14.0 (10.0-34.0) vs. 51.0 (35.8-62.0), P = 0.005]. Nineteen patients (95%) were discharged with a median hospital stay of 30 days (IQR, 26-30). CONCLUSIONS: Most patients with SARS-CoV-2 and HIV co-infection exhibited mild to moderate symptoms. The milder extent of inflammatory response to SARS-CoV-2 infection might be associated with a previous history of ART in HIV-infected patients.


Assuntos
Antirretrovirais/uso terapêutico , Betacoronavirus , Coinfecção/complicações , Infecções por Coronavirus/complicações , Infecções por HIV/tratamento farmacológico , Pneumonia Viral/complicações , Adulto , Coinfecção/tratamento farmacológico , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
15.
Infez Med ; 28(2): 263-267, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487793

RESUMO

Invasive pulmonary aspergillosis (IPA) is a life-threatening condition that usually occurs in immunocompromised hosts. However, according to recent reports it can affect immunocompetent hosts with severe influenza infection due to viral-dependent disruption of respiratory immune defenses. We present the case of a 61-year-old Caucasian man admitted to the Emergency Department with respiratory failure and fever, who was diagnosed with H1N1 influenza and IPA. Because of his poor general conditions, he was treated with a double antifungal scheme, although this lies outside the suggested treatment guidelines. This choice turned out to be extremely effective. He was discharged after one month and his clinical conditions showed rapid improvement, with nearly complete normalization of the radiological pattern in three months. IPA remains a life-threatening condition, even in immunocompetent hosts, and should therefore always be suspected; if necessary, a combined treatment should rapidly be started. We report this case as the interest in influenza-associated IPA is high, both due to the clinical severity of this condition, which is treatable if identified early, and the emerging importance of respiratory infections caused by viruses belonging to the SARS family, such as SARS-CoV-2.


Assuntos
Antifúngicos/uso terapêutico , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Aspergilose Pulmonar Invasiva/complicações , Insuficiência Respiratória/etiologia , Coinfecção/complicações , Coinfecção/tratamento farmacológico , Quimioterapia Combinada , Humanos , Imunocompetência , Influenza Humana/tratamento farmacológico , Aspergilose Pulmonar Invasiva/diagnóstico por imagem , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
16.
Trop Doct ; 50(3): 261-263, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32476601

RESUMO

We report the case of an eight-year-old boy who presented with an acute encephalitis and was confirmed to have Japanese encephalitis (JE). In addition, we found the vesicular stage of neurocysticercosis (NCC). The co-occurrence of JE and NCC was thought to be synergistic as there is some evidence that in presence of NCC, the neuroinvasiveness and virulence of JE is greater and associated with poor outcome.


Assuntos
Coinfecção/complicações , Encefalite Japonesa/complicações , Neurocisticercose/complicações , Criança , Coinfecção/parasitologia , Coinfecção/terapia , Coinfecção/virologia , Encefalite Japonesa/diagnóstico , Encefalite Japonesa/terapia , Humanos , Masculino , Neurocisticercose/diagnóstico , Neurocisticercose/terapia , Resultado do Tratamento
17.
Surg Today ; 50(10): 1314-1317, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32572584

RESUMO

We herein report an effective procedure for liver transplantation (LT) for severe cirrhotic patients with hemophilia. Three hemophilic patients suffering from liver cirrhosis due to human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection underwent deceased donor LT in our institute. Basic clotting parameters were measured and evaluated during LT to determine the optimal packing procedure. All patients were treated with a gauze packing procedure to ensure stable hemostasis in relation to hemophilia during the peri-transplant period. The graft function of all patients recovered well upon gauze removal (depacking) procedure and the patients were finally discharged to home. The administration of clotting factor was discontinued on day 3 after deceased donor LT. No infectious complications occurred in any of the 3 patients. This technique could be an option for achieving successful LT in these patients. Cooperation between transplant surgeons and anesthesiologists can make this challenging operation possible.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Coinfecção/complicações , Infecções por HIV/complicações , Hemofilia A/complicações , Hemostasia Cirúrgica/métodos , Hepatite C/complicações , Cirrose Hepática/etiologia , Cirrose Hepática/cirurgia , Transplante de Fígado/métodos , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento
18.
J Fr Ophtalmol ; 43(7): e245-e246, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32564980
19.
Am J Trop Med Hyg ; 103(2): 672-674, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32431277

RESUMO

We report a patient with risk factors for both microbial keratitis and endophthalmitis, which were initially challenging to distinguish. Cultures of corneal scrapings yielded several organisms, including an uncultivable Gram-negative rod, eventually identified as Kingella negevensis. Kingella negevensis is so named because most strains have been isolated in the Negev, a desert region of southern Israel. The epidemiology of K. negevensis remains incompletely understood. We found no other reports in the literature of this organism causing microbial keratitis.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/administração & dosagem , Inibidores da Captação de Dopamina/administração & dosagem , Endoftalmite/complicações , Ceratite/complicações , Infecções por Neisseriaceae/complicações , Infecções Estreptocócicas/complicações , Abuso de Substâncias por Via Intravenosa/complicações , Administração Oftálmica , Adulto , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Ceftazidima/uso terapêutico , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Doxiciclina/uso terapêutico , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Kingella/genética , Kingella/isolamento & purificação , Linezolida/uso terapêutico , Moxifloxacina/uso terapêutico , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/tratamento farmacológico , Infecções por Neisseriaceae/microbiologia , Soluções Oftálmicas , Prednisona/uso terapêutico , Propionibacterium acnes/isolamento & purificação , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Tobramicina/uso terapêutico , Vancomicina/uso terapêutico , Voriconazol/uso terapêutico
20.
BMC Infect Dis ; 20(1): 372, 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32450844

RESUMO

BACKGROUND: After successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibrosis assessment that determine the duration of therapy. We aimed to assess the diagnostic performance of APRI and FIB-4 for diagnosing cirrhosis in HIV/HCV co-infected patients using hepatic transient elastography (TE) as gold standard. METHOD: This is a retrospective study on HIV/HCV co-infected patients who concomitantly performed hepatic TE measurement, APRI, and FIB-4 evaluation before HCV treatment initiation at a tertiary hospital in Jakarta from 2014 to 2019. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) ≥ 12.5 kPa was determined by receiver operator characteristics curves. RESULTS: 223 HIV/HCV co-infected patients on stable antiretroviral therapy were included, of whom 91.5% were male with mean age of 37 (SD 5) years. Only 28.7% of patients were classified as cirrhosis (F4). Using TE as gold standard (≥12.5 kPa), the low threshold of APRI (1) had specificity 95%, sensitivity 48.4%, correctly classified 81.6% of patients, with moderate performance, AUC at 0.72 (95% CI 0.63-0.80). The optimal cut-off of FIB-4 was 1.66 [specificity 92.5%, sensitivity 53.1%, AUC at 0.73 (95% CI 0.65-0.81)] and correctly classified 81.1% of the patients. CONCLUSION: APRI score ≥ 1 and FIB-4 score ≥ 1.66 had moderate performance with high specificity in diagnosing cirrhosis. These biochemical markers could be used while TE is not available.


Assuntos
Aspartato Aminotransferases/sangue , Infecções por HIV/complicações , Hepatite C/complicações , Cirrose Hepática/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Adulto , Antivirais/uso terapêutico , Biomarcadores/sangue , Coinfecção/complicações , Coinfecção/tratamento farmacológico , Técnicas de Imagem por Elasticidade , Feminino , Infecções por HIV/tratamento farmacológico , Hepatite C/tratamento farmacológico , Humanos , Indonésia , Cirrose Hepática/tratamento farmacológico , Masculino , Contagem de Plaquetas , Estudos Retrospectivos
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