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1.
Pulm Pharmacol Ther ; 67: 102008, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33727066

RESUMO

Coronavirus virus disease 2019 (COVID-19) is a viral infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), actually considered as a global pandemic. The entry-point for SARS-CoV-2 is angiotensin converting enzyme 2 (ACE2) and dipeptidyl peptidase 4 (DPP4), which are highly expressed in the lung. Among other complications, COVID-19leads to fatal pneumonia, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) due to development of cytokine storm (CS). The pathogenesis of SARS-CoV-2 infection depends on the viral load and human innate/adaptive immune response that are required for viral elimination in the first phase of COVID-19. However, an exaggerated immune response in the second phase of COVID-19 results in immune overreaction and CS-induced ALI and ARDS. Thus, in view of these considerations, we report here a series of five patients with COVID-19 pneumonia who developed ALI. In addition to the supportive therapy, the patients received doxycycline in the first week and doxycycline plus colchicine in the second week. Following sequential therapy with doxycycline and/or colchicine in patients with COVID-19 pneumonia, the patients had reduction of disease severity and symptoms with better clinical and radiological outcomes. However, it is tough to confirm the link between this therapeutic combination and recovery from COVID-19 pneumonia, as it is a small case-series report. Nevertheless, this study gives a rational for large-scale prospective studies to evaluate the dual sequential effect of doxycycline and colchicine on the COVID-19 severity. This case-series illustrated that use of colchicine: doxycycline combination is linked with marked improvements in the clinical, laboratory and radiological outcomes in patients with COVID-19 pneumonia. However, we cannot sketch any definitive conclusion from our observation, despite we hypothesize that this combination therapeutic regimen may attenuate and treat COVID-19. Further, namely prospective, randomized, and controlled clinical studies are recommended in this regard.


Assuntos
/tratamento farmacológico , Colchicina/uso terapêutico , Doxiciclina/uso terapêutico , Adulto , Idoso , /virologia , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , /isolamento & purificação
2.
Drug Discov Ther ; 15(1): 39-41, 2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33612572

RESUMO

An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which began in Wuhan, China in December 2019, has rapidly spread all over the world. The World Health Organization characterized the disease caused by SARS-CoV-2 (COVID-19) as a pandemic in March 2020. In the absence of specific treatments for the virus, treatment options are being examined. Drug repurposing is a process of identifying new therapeutic uses for approved drugs. It is an effective strategy to discover drug molecules with new therapeutic indications. This strategy is time-saving, low-cost, and has a minimal risk of failure. Several existing approved drugs such as chloroquine, hydroxychloroquine, doxycycline, azithromycin, and ivermectin are currently in use because of their efficacy in inhibiting COVID-19. Multidrug therapy, such as a combination of hydroxychloroquine and azithromycin, a combination of doxycycline and ivermectin, or a combination of ivermectin, doxycycline, and azithromycin, has been successfully administered. Multidrug therapy is efficacious because the mechanisms of action of these drugs differ. Moreover, multidrug therapy may prevent the emergence of drug-resistant SARS-CoV-2.


Assuntos
/tratamento farmacológico , Quimioterapia Combinada/métodos , Azitromicina/uso terapêutico , Doxiciclina/uso terapêutico , Reposicionamento de Medicamentos , Humanos , Hidroxicloroquina/uso terapêutico , Ivermectina/uso terapêutico , Resultado do Tratamento
4.
BMC Oral Health ; 21(1): 80, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607998

RESUMO

BACKGROUND: Periodontitis is a chronic inflammatory disease characterized by progressive damage on the structure of tooth-supporting tissues. The aim of the study is determining the combination photodynamic effect of diode laser 405 nm treatments and the administration of doxycycline 0.1% within 1, 3, 5, and 7 days on a Wistar rat model of periodontitis. METHODS: Samples were induced with Porphyromonas gingivalis ATCC33277 to allow periodontitis development and were treated with combination of doxycycline and laser diode, then statistical analysis was carried out (One-Way ANOVA test and the post-hoc Duncan test; Kruskal-Wallis test and Mann-Whitney follow-up test for non-parametric data). Samples were divided into five groups, laser exposure used was 405-nm diode laser with energy density of 8 J/cm2. The expression level of histomorphometric was calculated by measuring the number of macrophages, lymphocytes, fibroblasts and the distance between the CEJ-AV. RESULTS: The results showed that the combination treatment of doxycycline and laser exposure yielded immunomodulatory effects. The expression level of fibroblast and the distance between CEJ-AV bone showed that the combination of doxycycline and laser therapy exerted healing effect in rat models of periodontitis on day 5 and 7. CONCLUSION: The combination of doxycycline 0.1% and diode laser therapy provides a healing effect in rats models of periodontitis.


Assuntos
Periodontite , Fotoquimioterapia , Animais , Doxiciclina/uso terapêutico , Lasers Semicondutores/uso terapêutico , Periodontite/tratamento farmacológico , Ratos , Ratos Wistar
7.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542018

RESUMO

We report a case of chronic Q fever presenting with catastrophic bleeding from an infected abdominal aortic aneurysm causing a primary aortoduodenal fistula in an 80-year-old retired farmer. This presentation is rarely reported in literature and only through case reports. Early diagnosis and definitive surgery were critical to a successful outcome. Serological diagnosis of Q fever was initiated on the patient's past exposure to animal reservoirs. Complicating the case was ongoing gastrointestinal bleeding postsurgery, with multiple endoscopies undertaken before a culprit remnant fistula was found. This case highlights the value in considering Coxiella burnetii as an underlying cause in patients with known risk factors presenting with primary aortoduodenal fistulas. Though rare, it represents a readily treatable cause.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Hemorragia Gastrointestinal/etiologia , Fístula Intestinal/cirurgia , Febre Q/diagnóstico , Fístula Vascular/cirurgia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antimaláricos/uso terapêutico , Coxiella burnetii/isolamento & purificação , Doxiciclina/uso terapêutico , Duodenopatias/cirurgia , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Febre Q/tratamento farmacológico , Tomografia Computadorizada por Raios X
8.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542012

RESUMO

A 40-year-old woman was referred to infectious disease specialists for a Mycobacterium mageritense skin infection following mastectomy and bilateral reconstruction with deep inferior epigastric perforator flap. Her case demonstrates the difficulty in treating non-tuberculosis mycobacterial infections, especially the rarely seen species. She failed to respond to dual antibiotic therapy containing imipenem-cilastin despite reported sensitivity. Additionally, her course was complicated by intolerance to various regimens, including gastrointestinal distress, a drug rash with eosinophilia and systemic symptoms, and tendinopathy. With few published data, no treatment guidelines, and limited medications from which to choose for M. mageritense, her treatment posed a challenge. She ultimately required aggressive surgical intervention and a triple therapy antibiotic regimen. The duration of our patient's treatment and the extent of her complications suggest a potential need for early surgical intervention in postsurgical wounds infected with M. mageritense that do not respond to conventional treatment.


Assuntos
Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Desbridamento/efeitos adversos , Doxiciclina/uso terapêutico , Mamoplastia , Mastectomia , Mycobacteriaceae/isolamento & purificação , Complicações Pós-Operatórias/tratamento farmacológico , Adulto , Neoplasias da Mama/cirurgia , Feminino , Humanos , Retalho Perfurante
10.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563686

RESUMO

Methicillin-resistant Staphylococcus aureus (MRSA) can cause a wide range of skin infections, however MRSA panniculitis without bacteremia is a rare manifestation. Here, we report a woman in her 20s with relapsed Hodgkin lymphoma undergoing stem cell mobilisation who presented with bilateral subcutaneous nodules over her shins. Ultrasound scan of one nodule showed non-specific inflammatory changes. Punch biopsy of a nodule showed lobular panniculitis with Gram-positive cocci. Blood cultures were negative but a culture from the biopsy grew MRSA. She was started on doxycycline with improvement in her symptoms. This case serves as a reminder to consider infections as a cause of panniculitis in immunocompromised patients.


Assuntos
Mobilização de Células-Tronco Hematopoéticas , Paniculite/microbiologia , Infecções Estafilocócicas/microbiologia , Adulto , Antibacterianos/uso terapêutico , Biópsia , Doxiciclina/uso terapêutico , Feminino , Doença de Hodgkin/terapia , Humanos , Hospedeiro Imunocomprometido , Staphylococcus aureus Resistente à Meticilina , Paniculite/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico
11.
Hosp Pediatr ; 11(4): e61-e65, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33431429

RESUMO

Multisystem inflammatory syndrome in children (MIS-C) is an emerging disease described in children in association with infection or epidemiological link to severe acute respiratory syndrome coronavirus 2. Signs and symptoms include fever, rash, and cardiac dysfunction; US Centers for Disease Control and Prevention have put forth broad criteria for diagnosis. The illness is serious and can progress rapidly to heart failure and death. However, findings in MIS-C are nonspecific, and there is significant overlap with other systemic illnesses, including Kawasaki disease and several viral and bacterial infections. We present 5 children admitted to a teaching hospital within an 11-day period in May 2020 for MIS-C evaluation who were later diagnosed with murine typhus. Typhus is a rickettsial infection that presents with fever and rash, and, although usually self-limited, responds well to treatment with doxycycline to shorten the course of illness. Clinical and laboratory characteristics of these children are presented to illustrate similarities to MIS-C, which can also be shared with viral, bacterial, or other regional endemic infections, as well as noninfectious inflammatory diseases. This case series serves to remind pediatric hospitalists to be vigilant to avoid premature closure on MIS-C for children admitted with fever and systemic inflammation. Maintaining a wide differential diagnosis in approaching such patients is of utmost importance as community exposure to severe acute respiratory syndrome coronavirus 2 is likely and evidence of past infection becomes commonplace.


Assuntos
/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Tifo Endêmico Transmitido por Pulgas/diagnóstico , Adolescente , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Criança , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Feminino , Humanos , Masculino , Tifo Endêmico Transmitido por Pulgas/tratamento farmacológico
13.
BMC Infect Dis ; 21(1): 103, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482743

RESUMO

BACKGROUND: Scalp Eschar and Neck LymphAdenopathy after Tick bite is a zoonotic non-pathogen-specific disease most commonly due to Rickettsia slovaca and Rickettsia raoultii. Diagnosis is mostly based only on epidemiological and clinical findings, without serological or molecular corroboration. We presented a clinical case in which diagnosis was supported by entomological identification and by R. slovaca DNA amplifications from the tick vector. CASE PRESENTATION: A 6-year-old child presented with asthenia, scalp eschar and supraclavicular and lateral-cervical lymphadenopathy. Scalp Eschar and Neck LymphAdenopathy After Tick bite syndrome following a Dermacentor marginatus bite was diagnosed. Serological test on serum revealed an IgG titer of 1:1024 against spotted fever group rickettsiae, polymerase chain reaction assays on tick identified Rickettsia slovaca. Patient was successfully treated with doxycycline for 10 days. CONCLUSIONS: A multidisciplinary approach including epidemiological information, clinical evaluations, entomological identification and molecular investigations on tick, enabled proper diagnosis and therapy.


Assuntos
Dermacentor/microbiologia , Linfadenopatia/diagnóstico , Infecções por Rickettsia/diagnóstico , Rickettsia/isolamento & purificação , Dermatoses do Couro Cabeludo/diagnóstico , Picadas de Carrapatos/complicações , Animais , Criança , Dermacentor/classificação , Doxiciclina/uso terapêutico , Feminino , Humanos , Linfadenopatia/tratamento farmacológico , Linfadenopatia/microbiologia , Pescoço/microbiologia , Rickettsia/genética , Rickettsia/imunologia , Infecções por Rickettsia/tratamento farmacológico , Infecções por Rickettsia/microbiologia , Dermatoses do Couro Cabeludo/tratamento farmacológico , Dermatoses do Couro Cabeludo/microbiologia , Picadas de Carrapatos/microbiologia , Picadas de Carrapatos/parasitologia , Doenças Transmitidas por Carrapatos/diagnóstico , Doenças Transmitidas por Carrapatos/tratamento farmacológico , Doenças Transmitidas por Carrapatos/microbiologia , Resultado do Tratamento
15.
BMJ Case Rep ; 14(1)2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33452066

RESUMO

A 53-year-old man with diabetes came to the emergency department with fever and dry cough for 5 days, swelling of the left leg for 2 days, shortness of breath and chest pain for 1 hour. He had raised temperature, tachycardia, tachypnoea, reduced oxygen saturation and swollen tender left leg on examination. The frontal chest radiograph showed bilateral ground-glass opacities; he tested positive for COVID-19 with elevated D-dimer. The colour Doppler examination of the left leg revealed acute deep vein thrombosis (DVT) of the common femoral and the popliteal veins. The chest CT showed bilateral diffuse ground-glass opacities predominantly involving peripheral zones and the lower lobes. The CTPA revealed left pulmonary thromboembolism (PTE), treated with low-molecular-weight heparin. COVID-19 predominantly affects the respiratory system. DVT and PTE are common in COVID-19 but lethal. They should be diagnosed early by clinical and radiological examinations and treated promptly with anticoagulants.


Assuntos
/complicações , Embolia Pulmonar/etiologia , Trombose Venosa/etiologia , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Antiparasitários/uso terapêutico , Antivirais/uso terapêutico , /diagnóstico , /terapia , Angiografia por Tomografia Computadorizada , Diabetes Mellitus Tipo 2/complicações , Doxiciclina/uso terapêutico , Veia Femoral , Produtos de Degradação da Fibrina e do Fibrinogênio , Glucocorticoides/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Ivermectina/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Oxigenoterapia , Veia Poplítea , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/terapia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
18.
Respiration ; 99(12): 1145-1153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33316806

RESUMO

Treatment with immunomodulators, such as intravenous immunoglobulin (IVIG), may attenuate inflammatory responses observed in the severe stages of acute respiratory distress syndrome (ARDS) caused by coronavirus disease 19 (COVID-19). We retrospectively evaluated the clinical courses of 12 COVID-19 patients who received IVIG at various stages of their illness, including within the first 72 h of clinical presentation, after initiation of mechanical ventilation, and after prolonged ventilation and ICU stay. The patients included 9 men and 3 women with a median age of 50 years (range 23-74), median Charlson Comorbidity Score of 2 (range 0-7), and median Acute Physiology and Chronic Health Evaluation Score of 13 (range 5-33) at the time of IVIG. The IVIG total dose ranged from 0.5 to 2.0 g/kg (median 1.25 g/kg) distributed over 1-4 daily doses. The most common regimen received was 0.5 g/kg daily for 3 days. The median time to IVIG administration was 9 days (range 0-48 days) after admission. The median time from first IVIG dose administration to hospital discharge was 14 days (range 3-48). The 5 patients who received IVIG ≤4 days of admission demonstrated a significantly shorter length of hospital stay after treatment (median 7 days, range 3-14 days) than the 7 patients who received it >7 days after admission (median 33 days, range 8-48 days, p = 0.03, Mann-Whitney U test). These cases demonstrate that IVIG may improve the clinical state of patients with moderate to severe COVID-19 infection. Despite very high illness severity scores, all patients survived hospital discharge. No thrombotic events occurred and IVIG was well tolerated, despite most cases demonstrating very elevated D-dimer suggestive of active intravascular fibrinolysis. We believe that IVIG warrants immediate clinical trial evaluation in COVID-19 to confirm its role as a mainstay treatment of moderate to severe COVID-19 infection as a means to reduce hospital stay and utilization of ICU resources, including mechanical ventilation, and potentially reduce mortality.


Assuntos
/terapia , Oxigenação por Membrana Extracorpórea , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Unidades de Terapia Intensiva , Tempo de Internação , Respiração Artificial , APACHE , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Corticosteroides/uso terapêutico , Adulto , Idoso , Alanina/análogos & derivados , Alanina/uso terapêutico , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , Doxiciclina/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Lopinavir/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Adulto Jovem
20.
BMC Infect Dis ; 20(1): 826, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176719

RESUMO

BACKGROUND: Human granulocytic anaplasmosis (HGA) is a tick-borne infectious disease caused by Anaplasma phagocytophilum. To date, there have been no reported cases of A. phagocytophilum infection found in both the biting tick and the patient following a tick bite. CASE PRESENTATION: An 81-year-old woman presented with fever following a tick bite, with the tick still intact on her body. The patient was diagnosed with HGA. The tick was identified as Ixodes nipponensis by morphological and molecular biological detection methods targeting the 16S rRNA gene. The patient's blood was cultured after inoculation into the human promyelocytic leukemia cell line HL-60. A. phagocytophilum growth was confirmed via culture and isolation. A. phagocytophilum was identified in both the tick and the patient's blood by Anaplasma-specific groEL- and ankA-based nested polymerase chain reaction followed by sequencing. Moreover, a four-fold elevation in antibodies was observed in the patient's blood. CONCLUSION: We report a case of a patient diagnosed with HGA following admission for fever due to a tick bite. A. phagocytophilum was identified in both the tick and the patient, and A. phagocytophilum was successfully cultured. The present study suggests the need to investigate the possible incrimination of I. nipponensis as a vector for HGA in Korea.


Assuntos
Anaplasma phagocytophilum/genética , Anaplasmose/diagnóstico , Ixodes/microbiologia , Picadas de Carrapatos/microbiologia , Doenças Transmitidas por Carrapatos/diagnóstico , Idoso de 80 Anos ou mais , Anaplasma phagocytophilum/isolamento & purificação , Anaplasmose/tratamento farmacológico , Anaplasmose/microbiologia , Animais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Feminino , Febre , Células HL-60 , Humanos , Reação em Cadeia da Polimerase , RNA Ribossômico 16S/genética , República da Coreia , Doenças Transmitidas por Carrapatos/tratamento farmacológico , Doenças Transmitidas por Carrapatos/microbiologia , Resultado do Tratamento
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