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1.
Undersea Hyperb Med ; 46(5): 719-722, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683373

RESUMO

Introduction: Stingray spine injuries are among the most common marine animal injuries in humans. While most resolve with immersion in warm water, a few become infected and require antibiotics. We present a case report of a presumptive stingray injury that evolved to a major slough and which required prolonged healing in a patient with diabetes mellitus. Our literature review was unable to find a similarly reported case. Materials: A co-author was asked to evaluate and manage an ominous-appearing wound on the right foot of a diabetic. The problem developed after the individual had been wading in shallow ocean beach water. The patient's diabetic sensory neuropathy obscured the immediate association of the problem with a stingray injury, but this became the presumptive diagnosis when pain developed and necessitated that he seek medical care. Findings/Clinical Course: After an initial urgent care visit, increasing pain and worsening appearance of the patient's foot necessitated a visit to our emergency department. The patient was admitted the next day due to symptoms of systemic sepsis. On the fourth hospital day, a large bulla on the lateral side of the right foot was excised. This unroofed a full-thickness slough to the periosteum level of the underlying bones. Not until the 16th hospital day had enough improvement occurred to discharge the patient. Over the next 16 weeks, the wound improved, developed a vascular base and epithelialized. Conclusion: With a dearth of literature about stingray injuries in patients with diabetes mellitus reported, our case is unique: The patient's wound course more closely resembled a toxic inoculation than the typical puncture wound-cellulitis presentations associated with stingray injuries.


Assuntos
Mordeduras e Picadas/complicações , Traumatismos do Pé/terapia , Ferimentos Penetrantes/terapia , Adulto , Animais , Antibacterianos/uso terapêutico , Mordeduras e Picadas/terapia , Vesícula/etiologia , Vesícula/terapia , Complicações do Diabetes/terapia , Diabetes Mellitus , Traumatismos do Pé/etiologia , Humanos , Masculino , Necrose , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Cicatrização , Ferimentos Penetrantes/etiologia
2.
Exp Parasitol ; 207: 107772, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31610183

RESUMO

Cyclosporiasis is an emerging worldwide infection caused by an obligate intracellular protozoan parasite, Cyclospora cayetanensis. In immunocompetent patients, it is mainly manifested by self-limited diarrhea, which is persistent and may be fatal in immunocompromised patients. The standard treatment for cyclosporiasis is a combination of two antibiotics, trimethoprim and sulfamethoxazole. Gastrointestinal, haematologic and renal side effects were reported with this combination. Moreover, sulfa allergy, foetal anomalies and recurrence were recorded with no alternative drug treatment option. In this study, silver nanoparticles were chemically synthesized to be evaluated for the first time for their anti-cyclospora effects in both immunocompetent and immunosuppressed experimental mice in comparison to the standard treatment. The effect of silver nanoparticles was assessed through studying stool oocyst load, oocyst viability, ultrastructural changes in oocysts, and estimation of serum gamma interferon. Toxic effect of the therapeutic agents was evaluated by measuring liver enzymes, urea and creatinine in mouse sera. Results showed that silver nanoparticles had promising anti-cyclospora potentials. The animals that received these nanoparticles showed a statistically significant decrease in the oocyst burden and number of viable oocysts in stool and a statistically significant increase in serum gamma interferon in comparison to the corresponding group receiving the standard treatment and to the infected non-treated control group. Scanning electron microscopic examination revealed mutilated oocysts with irregularities, poring and perforations. Biochemical results showed no evidence of toxicity of silver nanoparticles, as the sera of the mice showed a statistically non-significant decrease in liver enzymes in immunocompetent subgroups, and a statistically significant decrease in immunosuppressed subgroups. Furthermore, a statistically non-significant decrease in urea and creatinine was recorded in all subgroups. Thus, silver nanoparticles proved their effectiveness against Cyclospora infection, and this will draw the attention to its use as an alternative to the standard therapy.


Assuntos
Coccidiostáticos/uso terapêutico , Cyclospora/efeitos dos fármacos , Ciclosporíase/tratamento farmacológico , Nanopartículas Metálicas/uso terapêutico , Alanina Transaminase/análise , Animais , Aspartato Aminotransferases/análise , Coccidiostáticos/farmacologia , Coccidiostáticos/toxicidade , Creatinina/sangue , Ciclofosfamida/imunologia , Cyclospora/isolamento & purificação , Cyclospora/ultraestrutura , Diarreia/tratamento farmacológico , Diarreia/parasitologia , Fezes/parasitologia , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Imunossupressores/imunologia , Interferon gama/sangue , Fígado/efeitos dos fármacos , Fígado/enzimologia , Masculino , Nanopartículas Metálicas/toxicidade , Camundongos , Microscopia Eletrônica de Varredura , Microscopia Eletrônica de Transmissão , Oocistos/isolamento & purificação , Oocistos/ultraestrutura , Prata , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Ureia/sangue
3.
Rev Med Chil ; 147(3): 390-394, 2019 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-31344179

RESUMO

Goodpasture Syndrome is described as a single episode disease entity. It is diagnosed with the demonstration of antiglomerular basement (anti-GBM) antibodies in plasma or renal tissue. Although the recurrence of anti-GBM disease is rare, it has been reported in up to 3% of cases. Recurrence with negative anti-GBM antibodies in plasma is even less frequent We report a 63 years old male in whom anti-GBM disease recurred without detectable anti-GBM antibodies in plasma, despite having positive antibodies at the onset.


Assuntos
Doença Antimembrana Basal Glomerular/patologia , Autoanticorpos/análise , Antibacterianos/uso terapêutico , Doença Antimembrana Basal Glomerular/diagnóstico por imagem , Doença Antimembrana Basal Glomerular/tratamento farmacológico , Biópsia , Ciclofosfamida/uso terapêutico , Imunofluorescência , Humanos , Nefropatias/patologia , Glomérulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Recidiva , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
4.
Medicina (B Aires) ; 79(3): 167-173, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31284250

RESUMO

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Pé Diabético/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Pé Diabético/microbiologia , Quimioterapia Combinada , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia
5.
J Med Microbiol ; 68(8): 1167-1172, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31199227

RESUMO

OBJECTIVES: Elizabethkingia meningoseptica is a multi-drug-resistant organism that is associated with high mortality and morbidity in newborn and immunocompromised patients. This study aimed to identify the best antimicrobial therapy for treating this infection. METHODS: A retrospective descriptive study was conducted from 2010 to 2017 in a tertiary paediatric hospital in Singapore. Paediatric patients aged 0 to 18 years old with a positive culture for E. meningoseptica from any sterile site were identified from the hospital laboratory database. The data collected included clinical characteristics, antimicrobial susceptibility and treatment, and clinical outcomes. RESULTS: Thirteen cases were identified in this study. Combination therapy with piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluoroquinolone resulted in a cure rate of 81.8  %. The mortality rate was 15.4  % and neurological morbidity in patients with bacteraemia and meningitis remained high (75 %). CONCLUSIONS: Treatment with combination therapy of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluroquinolone was effective in this study, with low mortality rates being observed.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Flavobacteriaceae/tratamento farmacológico , Fluoroquinolonas/uso terapêutico , Combinação Piperacilina e Tazobactam/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Antibacterianos/farmacologia , Criança , Pré-Escolar , Feminino , Flavobacteriaceae/efeitos dos fármacos , Flavobacteriaceae/isolamento & purificação , Infecções por Flavobacteriaceae/epidemiologia , Infecções por Flavobacteriaceae/microbiologia , Fluoroquinolonas/farmacologia , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Combinação Piperacilina e Tazobactam/farmacologia , Estudos Retrospectivos , Fatores de Risco , Singapura/epidemiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/farmacologia
6.
Rinsho Ketsueki ; 60(5): 365-371, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31167996

RESUMO

Although Pneumocystis pneumonia (PCP), a life-threatening infection, has been reported in patients with non-Hodgkin B-cell lymphoma (BNHL) who were treated with rituximab-containing chemotherapies (R-CTX), the PCP prophylaxis regimen awaits establishment to date. This study reports a retrospective analysis of the efficacy and safety of a low-dose trimethoprim/sulfamethoxazole (TMP/SMX) in patients with BNHL receiving R-CTX. We retrospectively analyzed 156 patients newly diagnosed with BNHL who received R-CTX at our institute from 2010 to 2015. We collected patients' clinical and laboratory data, including lymphocytes count, IgG level, PCP prophylaxis regimens, and adverse events (AEs). Patients were categorized into the following two groups based on the TMP/SMX regimen: group A (33 patients; 80 mg/400 mg×3/week) or group B (65 patients; 160 mg/800 mg×2/week). Both lymphocytes count and IgG level declined during R-CTX. No patient developed PCP. Patients in group B exhibited a significantly higher incidence of AEs (18.2% vs. 63.1%; p<0.05) and increased AST (6.1% vs. 26.6%; p<0.05), compared with those in group A. Thus, TMP/SMX (80 mg/400 mg×3/week) effectively prevents PCP and is preferable because of the lower rates of AEs.


Assuntos
Linfoma não Hodgkin/tratamento farmacológico , Pneumonia por Pneumocystis/prevenção & controle , Rituximab/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Humanos , Estudos Retrospectivos
7.
BMC Infect Dis ; 19(1): 420, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088380

RESUMO

BACKGROUND: Urinary tract infection is an infection affecting infants and children. The aim of this study was to determine the etiology of urinary tract infection along with their antimicrobial resistance. METHODS: This cross-sectional study was conducted from June 2015 to January 2016 at Siddhi Memorial Hospital, Bhaktapur, Nepal. Urine samples were first cultured on cystine lactose electrolyte deficient agar and blood agar by semi-quantitative technique, and then incubated aerobically for 18-24 h at 37 °C. The identified bacterial isolates were tested for antimicrobial susceptibility by Kirby Bauer disc diffusion technique. RESULTS: Of 1599 urine samples, 12.3% samples showed significant bacterial growth. E. coli (58.7%) was the most common pathogen, followed by Klebsiella pneumoniae (22.5%). Most of the isolates were resistant to ampicillin and co-trimoxazole, while least were resistant to amikacin and nitrofurantoin. Higher multi-drug resistance (61.9%) was observed among isolates. CONCLUSIONS: E. coli and Klebsiella spp. were predominant cause of pediatric urinary tract infection in children. Higher susceptibility observed against aminoglycosides and nitrofurans make these drugs suitable in emergency.


Assuntos
Farmacorresistência Bacteriana , Infecções Urinárias/diagnóstico , Adolescente , Ampicilina/farmacologia , Ampicilina/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Farmacorresistência Bacteriana/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Nepal/epidemiologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia
8.
Internist (Berl) ; 60(7): 669-677, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31089770

RESUMO

Pneumocystis jirovecii pneumonia (PcP) has for many years been reported mostly in human immunodeficiency virus-infected patients. Increasingly, it also affects other immunocompromised patients, e.g. after organ or allogeneic stem cell/bone marrow transplantation, patients with hematologic malignancies or autoimmune diseases. The diagnosis of PcP relies on a critical evaluation of clinical symptoms, risk factors, radiologic features and microbiological tests. High dose cotrimoxazole is the most effective therapeutic option. Rapid initiation is essential, since mortality is especially high in patients admitted to intensive care with respiratory failure. This article reviews the current epidemiology of PcP and highlights the diagnostic and therapeutic options. Recommendations for primary and secondary prophylaxis are summarized.


Assuntos
Infecções por HIV/complicações , Hospedeiro Imunocomprometido , Infecções Oportunistas , Infecções por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/diagnóstico , Antibacterianos/uso terapêutico , Humanos , Infecções por Pneumocystis/complicações , Infecções por Pneumocystis/tratamento farmacológico , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
9.
J Korean Med Sci ; 34(21): e156, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31144480

RESUMO

BACKGROUND: Few studies have reported on breakthrough urinary tract infection (UTI) associated with the susceptibility of index UTI to prophylactic antibiotics in children with primary vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). We assessed the impact of the susceptibility of index UTI to prophylactic antibiotics in breakthrough UTIs in children with primary VUR receiving CAP. METHODS: We retrospectively reviewed the medical records of 81 children with primary VUR who were diagnosed after febrile or symptomatic UTI and subsequently received trimethoprim-sulfamethoxazole (TMP-SMX) as CAP between January 2010 and December 2013. We allocated children to a susceptible group or a resistant group based on the susceptibility of index UTI to TMP-SMX. We evaluated patient demographics and clinical outcomes after CAP according to the susceptibility of index UTI to TMP-SMX. Multivariate analysis was used to identify the predictive factors for breakthrough UTI. RESULTS: Of the 81 children, 42 were classified into the susceptible group and 39 into the resistant group. The proportion of breakthrough UTI was 31.0% (13/42) in the susceptible group and 53.8% (21/39) in the resistant group (P = 0.037). Progression of renal scarring was observed in 0% of children in the susceptible group and 15% in the resistant group (P = 0.053). Multivariate analysis showed that TMP-SMX resistance and initial renal scarring were significant predictors of breakthrough UTI. CONCLUSION: Susceptibility of index UTI to prophylactic antibiotics is a risk factor of breakthrough UTI and is associated with poor clinical outcomes in children with primary VUR receiving CAP.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Antibioticoprofilaxia/métodos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/tratamento farmacológico , Antibacterianos/uso terapêutico , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Combinação de Medicamentos , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Infecções Urinárias/microbiologia
10.
BMC Infect Dis ; 19(1): 311, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953458

RESUMO

BACKGROUND: Trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for anti-Pneumocystis jirovecii pneumonia (PcP) prophylaxis in kidney transplant recipients (KTR). Post-transplant management balances preventing PcP with managing TMP-SMX-related adverse effects. TMP-SMX dose reduction addresses adverse effects but its implications to incident PcP are unclear. METHODS: We performed a retrospective review of all patients transplanted between 2011 and 2015 prescribed daily single strength TMP-SMX for twelve months post-transplantation as PcP prophylaxis. Actual TMP-SMX dose and duration, adverse effects, number of dose reductions and reasons, and PcP events were captured. Multivariate logistic regression analyses for risk factors associated with dose reduction were performed. RESULTS: Of 438 KTR, 233 (53%) maintained daily TMP-SMX and 205 (47%) sustained ≥1 dose reduction, with the point prevalence of a reduced dose regimen being between 18 and 25%. Median duration for daily TMP-SMX was 8.45/12 months, contributing 4137 patient-months daily TMP-SMX and 1110 patient-months with a reduced dose. PcP did not occur in any patients. There were 84 documented dose reductions for hyperkalemia and 102 for leukopenia, with 12 and 7 patients requiring TMP-SMX cessation. In multivariate analysis, a living donor transplant protected against hyperkalemia (Odds Ratio 0.46, 95% CI 0.26-0.83, p < 0.01) while acute rejection risked leukopenia (Odds Ratio 3.31, 95% CI 1.39-7.90, p = 0.006). CONCLUSIONS: TMP-SMX dose reduction is frequent in the first post-transplant year but PcP does not occur. To limit the need for TMP-SMX dose reduction due to adverse effects, a clinical trial comparing daily to thrice weekly single strength TMP-SMX in de-novo KTR is justified.


Assuntos
Antibioticoprofilaxia/efeitos adversos , Transplante de Rim/métodos , Pneumonia por Pneumocystis/prevenção & controle , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii/patogenicidade , Pneumonia por Pneumocystis/tratamento farmacológico , Estudos Retrospectivos , Transplantados , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
11.
BMJ Case Rep ; 12(4)2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31023740

RESUMO

Gingival pathology is a daily presentation, however a small number of systemic conditions can manifest similar to a common gingival condition and have fatal results. Dentist referred 56-year-old woman to Oral and Maxillofacial Surgery department with a 2-week medical history of gingival bleeding not responding to local measures. Biopsy showed eosinophilic infiltrate and vasculitis, and blood tests showed positive markers including cytoplasmic antineutrophil cytoplasmatic antibodies. Granulomatosis with polyangiitis is a rare disease affecting the respiratory tract, blood vessels and kidneys. Oral lesions are rarely the primary presenting feature. When left untreated, most cases are fatal within a year of diagnosis. The diagnosis can only be made when certain criteria are found, including granular oral lesions exhibiting an eosinophilic inflammatory infiltrate on biopsy. With 5% of cases showing intraoral lesions as the primary feature, it is essential that dentists have the knowledge of this rare disease to refer and not to treat as a common gingival condition.


Assuntos
Odontólogos/educação , Doenças da Gengiva/diagnóstico , Granulomatose com Poliangiite/patologia , Úlceras Orais/etiologia , Assistência ao Convalescente , Antibacterianos/uso terapêutico , Anticorpos Anticitoplasma de Neutrófilos/metabolismo , Biópsia , Diagnóstico Diferencial , Eosinófilos/patologia , Feminino , Células Gigantes de Corpo Estranho/patologia , Doenças da Gengiva/patologia , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/sangue , Granulomatose com Poliangiite/tratamento farmacológico , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Pessoa de Meia-Idade , Úlceras Orais/diagnóstico , Úlceras Orais/tratamento farmacológico , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Doenças Raras , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
14.
Acta Med Okayama ; 73(1): 85-89, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30820060

RESUMO

Pneumocystis pneumonia (PCP) due to Pneumocystis jirovecii infection is the leading cause of fatal opportunistic infections in immunocompromised patients. We will determine whether a daily sulfamethoxazole-trimethoprim (SMX/TMP) dose of 200/40 mg was non-inferior to 400/80 mg for PCP prevention in patients with systemic rheumatic disease under immunosuppressive therapy. This is a randomized, open-label, multicenter controlled trial. The primary outcome is the rate of PCP prevention at 52 weeks. The secondary outcome is the discontinuation rate of SMX/TMP. The trial will evaluate the optimal dose of SMX/TMP for PCP prevention in patients with systemic rheumatic disease under immunosuppressive therapy.


Assuntos
Antibacterianos/uso terapêutico , Pneumonia por Pneumocystis/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto , Antibacterianos/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem
15.
BMC Pulm Med ; 19(1): 65, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885173

RESUMO

BACKGROUND: Fibrosing interstitial lung disease is the poor prognostic non-infectious lung disease by unknown etiology. Here, we present one case developing interstitial pneumonia with fibrosis after treatment of pneumocystis pneumonia (PCP) in newly diagnosed HIV-1 infected case. CASE PRESENTATION: A previously healthy 63-year old male was referred to our institute because of protracted dyspnea on effort in 2 weeks after pneumocystis pneumonia treatment. At referral, arterial blood oxygen pressure was within normal range (93.5 mmHg) at rest, but decreased rapidly 30 s after a slow walk (44.5 mmHg). Respiratory function tests showed severe restrictive ventilator impairment (vital capacity = 36.5%; forced expiratory volume in 1 s = 107.4%). Chest computed tomography showed severe fibrotic changes at bilateral basal parts and diffuse fibrotic changes in which PCP lesions were seen initially in previous images although ß-D glucan was not elevated and P. jirovecii was not detected in saliva at referral. Other etiologies of fibrotic IP including infectious and/or autoimmune diseases were excluded by serology. Fibrotic lesion did not expand thereafter although it had not responded to the high-dose corticosteroid therapy. CONCLUSION: We report the first case of fibrosing interstitial lung disease triggered by HIV-related PCP.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções por HIV/complicações , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Pneumonia por Pneumocystis/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Volume Expiratório Forçado , Humanos , Hospedeiro Imunocomprometido , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/complicações , Tomografia Computadorizada por Raios X , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , beta-Glucanas/sangue
16.
Medicine (Baltimore) ; 98(11): e14879, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882696

RESUMO

RATIONALE: Nocardia species are not commonly referred as primary infectious entities but rather as opportunistic pathogens. Infectious cases of Nocardia spp. in immunocompetent individuals are rare. PATIENT CONCERNS: An immunocompetent 58-year-old patient presented with recurrent headaches. DIAGNOSIS: A brain abscess was found and surgically drained. Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry and heat shock protein 65/16S-23S rRNA gene intergenic spacer genotyping from the sample revealed the etiological agent as Nocardia beijingensis. INTERVENTIONS: Meropenem/amikacin/Trimethoprim-sulfamethoxazole were administered. OUTCOMES: The infection persisted leading to the patient's death. LESSONS: Here we present the first case of N. beijingensis infection of the central nervous system in an immunocompetent patient from Latin America. Further inquiry is needed to establish whether this species is more virulent than other Nocardia isolates.


Assuntos
Abscesso Encefálico/diagnóstico , Nocardiose/complicações , Antibacterianos/uso terapêutico , Abscesso Encefálico/etiologia , Humanos , América Latina , Masculino , Meropeném/uso terapêutico , Pessoa de Meia-Idade , Nocardia/patogenicidade , Nocardiose/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
17.
PLoS One ; 14(3): e0212848, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30865646

RESUMO

BACKGROUND: Despite high antiretroviral (ARV) treatment coverage among pregnant women for prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in Zimbabwe, the MTCT rate is still high. Therefore in 2016, the country adopted World Health Organization recommendations of stratifying pregnant women into "High" or"Low" MTCT risk for subsequent provision of HIV exposed infant (HEI) with appropriate follow-up care according to risk status. OBJECTIVE: The study sought to ascertain, among pregnant women who delivered in clinics of Harare in August 2017: the extent to which high risk MTCT pregnancies were identified at time of delivery; and whether their newborns were initiated on appropriate ARV prophylaxis, cotrimoxazole prophylaxis, subjected to early HIV diagnostic testing and initiated on ARV treatment. METHODS: Cross-sectional study using review of records of routinely collected program data. RESULTS: Of the 1,786 pregnant women who delivered in the selected clinics, HIV status at the time of delivery was known for 1,756 (98%) of whom 197 (11%) were HIV seropositive. Only 19 (10%) could be classified as "high risk" for MTCT and the remaining 90% lacked adequate information to classify them into high or low risk for MTCT due to missing data. Of the 197 live births, only two (1%) infants had a nucleic-acid test (NAT) at birth and 32 (16%) infants had NAT at 6 weeks. Of all 197 infants, 183 (93%) were initiated on single ARV prophylaxis (Nevirapine), 15 (7%) infants' ARV prophylaxis status was not documented and one infant got dual ARV prophylaxis (Nevirapine+Zidovudine). CONCLUSION: There was paucity of data requisite for MTCT risk stratification due to poor recording of data; "high risk" women were missed in the few circumstances where sufficient data were available. Thus "high risk" HEI are deprived of dual ARV prophylaxis and priority HIV NAT at birth and onwards which they require for PMTCT. Health workers need urgent training, mentorship and supportive supervision to master data management and perform MTCT risk stratification satisfactorily.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adolescente , Adulto , Antibioticoprofilaxia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Programas de Rastreamento/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto Jovem , Zimbábue/epidemiologia
18.
J Infect Chemother ; 25(6): 477-479, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30797688

RESUMO

Detecting Pneumocystis jirovecii by bronchoalveolar lavage or lung biopsy is the gold standard for diagnosis of P. jirovecii pneumonia (PJP); however, these techniques are not always applicable in children because of their high invasiveness. We report two pediatric cases of PJP diagnosed by polymerase chain reaction (PCR) of gastric lavage that were successfully treated. To date, there are no reported cases of using PCR of gastric lavage to diagnose PJP. On the day of PJP onset, both the infants required respiratory support and infiltrative shadows were observed in both lung fields on chest radiography. Furthermore, their (1 â†’ 3)-ß-D glucan levels were elevated. P. jirovecii was detected by PCR of gastric lavage and trimethoprim-sulfamethoxazole was administered for 3 weeks, following which their condition improved. They were long-term steroid users, but without any prophylaxis. PCR of gastric lavage in cases of suspected PJP may help in confirming the diagnosis in children who have mild to moderate airway symptoms, or have difficulty with invasive examination like bronchoscopy.


Assuntos
Lavagem Gástrica , Hospedeiro Imunocomprometido , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , DNA Bacteriano/isolamento & purificação , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer/imunologia , Recém-Nascido , Recém-Nascido Prematuro/imunologia , Masculino , Pneumocystis carinii/genética , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/imunologia , Pneumonia por Pneumocystis/microbiologia , Reação em Cadeia da Polimerase , Resultado do Tratamento
19.
Transplant Proc ; 51(1): 220-222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30736974

RESUMO

BACKGROUND: Persistent hyperparathyroidism is one of the main causes of hypercalcemia following kidney transplantation; differential diagnosis is required. CASE PRESENTATION: We report the case of a 61-year-old kidney transplant recipient who underwent transplant in September 2016. She was admitted in March 2017 presenting with a 3-week history of asthenia, hypotension, and cough. Laboratory analysis showed acute kidney injury with hypercalcemia and elevation of inflammatory markers. She was initially treated with hydration therapy. A few days after admission she developed respiratory failure: chest computed tomography showed a ground-glass pattern. A diagnosis of Pneumocystis jirovecii was made on bronchoalveolar lavage. A subsequent graft biopsy was performed that revealed intratubular calcium deposition without signs of rejection. The patient was given trimethoprim/sulfamethoxazole, with improvement in pulmonary and renal function as well as improvement in hypercalcemia. CONCLUSIONS: P jirovecii infection can trigger activation of intra-alveolar macrophages that leads to extrarenal vitamin D production with subsequent hypercalcemia. This rare event should be considered in renal transplant patients with pulmonary infection accompanied by hypercalcemia. In our case, hypercalcemia also provoked acute kidney injury.


Assuntos
Lesão Renal Aguda/etiologia , Hipercalcemia/etiologia , Transplante de Rim , Pneumonia por Pneumocystis/complicações , Feminino , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Pneumocystis carinii , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/imunologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
20.
BMC Infect Dis ; 19(1): 143, 2019 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-30755178

RESUMO

BACKGROUND: Melioidosis is an infection caused by Burkholderia pseudomallei, which is more prevalent in the tropics and leads to significant morbidity and mortality. It characteristically produces widespread caseous lesions and abscesses, and can present with varied clinical manifestations. Melioidosis involving the central nervous system is uncommon. CASE PRESENTATION: A 42-year-old Sri Lankan male with type 2 diabetes presented with a febrile illness of 6 days with headache and constitutional symptoms. Clinical examination was unremarkable. Four days later, he developed focal seizures involving the left leg and numbness of the left side. Initial laboratory investigations were suggestive of a bacterial infection. Blood culture was reported as positive for a Pseudomonas species, which was resistant to gentamicin. Contrast enhanced CT and MRI scans of the brain showed a subdural collection in the right fronto-temporo-parietal region with possible abscess formation. Melioidosis antibody testing using indirect hemagglutination method was reactive with a titre more than 1/10,240. He was treated with intravenous meropenem and oral co-trimoxazole for 8 weeks (Intensive phase). The subdural collection was managed conservatively, and seizures were treated with oral antiepileptics. At 7 weeks, follow-up contrast enhanced MRI showed improvement of the subdural collection, and inflammatory markers had normalized. He was discharged after 8 weeks, and treated with oral co-trimoxazole and doxycycline for 6 months (eradication phase). At 6 months follow-up, the patient is asymptomatic. CONCLUSIONS: Cerebral melioidosis is an unusual presentation of melioidosis where the diagnosis can be easily missed. Knowledge of the protean manifestations of melioidosis is of paramount importance in order to detect and treat this potentially fatal infection appropriately, especially in tropical countries where the disease is endemic.


Assuntos
Encefalopatias/microbiologia , Burkholderia pseudomallei , Melioidose/complicações , Adulto , Antibacterianos/uso terapêutico , Encéfalo/patologia , Encefalopatias/complicações , Complicações do Diabetes/microbiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Doxiciclina/uso terapêutico , Gentamicinas/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Masculino , Melioidose/diagnóstico , Melioidose/microbiologia , Meropeném , Espaço Subdural/patologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
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