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1.
BMC Infect Dis ; 20(1): 202, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143583

RESUMO

BACKGROUND: Brucellosis is a zoonotic infection transmitted from infected animals to humans, osteonecrosis of the femoral head (ONFH) is a devastating disease that affects patients' life with pain, dysfunction of walking and always lead to total hip arthroplasty (THA). We presented a case of ONFH which was very likely due to the infection of Brucella spp. CASE PRESENTATION: The patient was a 49 years-old male who was a herder living in Inner Mongolia, the northern part of China. He first showed recurrent fever then presented bilateral hip pain, which was confirmed to be brucellosis and ONFH on the right side of the hip. He was admitted to our center showed bilateral ONFH with the restrictive movement of both hips. We performed THA after it was confirmed that the infection has been cured. The patient can walk with the help of the walker the second day after surgery. CONCLUSION: Brucellosis is still a common epidemic disease worldwide, which can lead to many complications, brucellosis arthritis is the most common complication of Brucellosis. Osteonecrosis of the femoral head can also present in the patients with brucellosis. All the patients presented with recurrent fever and hip pain, who is from the epidemic region, should be taken both septic arthritis and ONFH into consideration.


Assuntos
Brucelose/diagnóstico , Necrose da Cabeça do Fêmur/diagnóstico , Antibacterianos/uso terapêutico , Artroplastia de Quadril , Brucelose/complicações , Brucelose/tratamento farmacológico , China , Doxiciclina/uso terapêutico , Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rifampina/uso terapêutico
2.
BMC Infect Dis ; 20(1): 199, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143636

RESUMO

BACKGROUND: Campylobacter jejuni is a motile, gram-negative rod known for causing self-limiting enterocolitis while rarely causing extraintestinal infections. We report the first case of a patient with Campylobacter jejuni osteomyelitis in both femora. CASE PRESENTATION: A 54-year-old female presented with progressive pain in both upper extremities. Her past medical history mentioned a lymphoplasmacytic lymphoma (LPL) for which she had received dexamethasone, cyclophosphamide and fludarabine and was still receiving maintenance therapy with intravenous rituximab. Two months prior to presentation, she received oral fluoroquinolone for a recurrent enterocolitis with stool cultures positive for Campylobacter jejuni. Palpation of the left quadriceps femoris muscle was remarkably painful during physical examination. Laboratory testing showed elevated C-reactive protein and recent low gamma globulin levels. The presumptive diagnosis at this point was a transformation of LPL to a large B cell lymphoma. In order to determine the preferred site for biopsy, a fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography combined with computed tomography was done. However, blood cultures taken on admission showed growth of Campylobacter jejuni in both aerobic bottles, with a strain resistant to fluoroquinolones. Diagnosis of Campylobacter jejuni osteomyelitis was confirmed with 16S ribosomal RNA gene polymerase chain reaction performed on femoral bone obtained through biopsy. Treatment with intravenous imipenem/cilastatin followed by intravenous and oral doxycycline proved insufficient. Subsequently, the patient was treated successfully with intravenous meropenem for six weeks and concurrent intravenous immunoglobulin. CONCLUSION: We report the first case of Campylobacter jejuni osteomyelitis in both femora in a patient with acquired hypogammaglobulinemia. Diagnosis was confirmed by blood cultures and positive 16S ribosomal RNA gene polymerase chain reaction for Campylobacter spp. on bone biopsy. Treatment was successful with intravenous meropenem and immunoglobulin. Our report showcases an unusual manifestation in a patient with immunodeficiency and discusses failure of initial antibiotic therapy.


Assuntos
Infecções por Campylobacter/diagnóstico , Imunodeficiência de Variável Comum/diagnóstico , Osteomielite/diagnóstico , Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Infecções por Campylobacter/complicações , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/microbiologia , Campylobacter jejuni/genética , Campylobacter jejuni/isolamento & purificação , Imunodeficiência de Variável Comum/complicações , Doxiciclina/uso terapêutico , Feminino , Fêmur/efeitos dos fármacos , Humanos , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/metabolismo
3.
BMC Infect Dis ; 20(1): 47, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941460

RESUMO

BACKGROUND: Ureaplasma urealyticum is a fastidious bacteria which lacks a cell wall. Extragenital infections are rare in immunocompetent adults. There are few literature reports of perinephric abscess. We present a case of non-resolving multifocal "culture-negative" abscesses in a hypogammaglobulinemic adult female due to U. urealyticum. CASE PRESENTATION: 66-year-old female with a one-week history of fever, malaise and new right hip and leg pain. Past medical history was notable for chronic pancytopenia secondary to in remission B cell follicular lymphoma, ESRD on intermittent hemodialysis with bilateral nephrostomy tubes and Crohn's. CT abdomen/pelvis revealed a small left perinephric hematoma and proximal right femur fluid collection. Persistent right thigh pain led to additional ultrasound with anterior thigh collection and CT revealed an irregular rim-enhancing fluid collection in the left posterior pararenal space. Antimicrobial therapy included ertapenem and vancomycin followed by meropenem, trimethoprim-sulfamethoxazole, daptomycin and metronidazole in setting of persistent culture-negative results and clinical deterioration. Following detection of U. urealyticum by 16S rDNA PCR in both left pararenal and right trochanteric bursa abscesses doxycycline was started. Despite this, the patient died four days later. CONCLUSIONS: Disseminated infection by U. urealyticum has been documented in immunocompromised adult patients with few reports of perinephric abscess. We propose that ascending genitourinary route led to perinephric abscess. The multiple disseminated fluid collections make it highly suspicious for hematogenous spread given the lack of radiographic enhancement to suggest contiguous spread. Diagnosis and treatment of U. urealyticum-disseminated infection is extremely challenging as culture is laborious and not routinely performed. Furthermore, the lack of cell wall renders beta-lactams and vancomycin ineffective and therefore requirement for "atypical" coverage. Early diagnosis and treatment are key to prevent further complications and death.


Assuntos
Hospedeiro Imunocomprometido , Infecções por Ureaplasma/diagnóstico , Ureaplasma urealyticum/genética , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Idoso , Antibacterianos/uso terapêutico , DNA Bacteriano/análise , DNA Ribossômico/análise , Suscetibilidade a Doenças/imunologia , Doxiciclina/uso terapêutico , Evolução Fatal , Feminino , Humanos , Reação em Cadeia da Polimerase , Infecções por Ureaplasma/tratamento farmacológico , Infecções por Ureaplasma/microbiologia
4.
Dtsch Med Wochenschr ; 145(1): 19-28, 2020 01.
Artigo em Alemão | MEDLINE | ID: mdl-31914465

RESUMO

Lyme borreliosis is the most common zoonosis in Germany with an incidence of up to 138/100 000. More than 90 % of all cases show dermatological manifestations. Early manifestations are erythema migrans, multiple erythemata migrantia, and (less frequently) borrelial lymphocytoma. A typical late manifestation is acrodermatitis chronica atrophicans. Lyme neuroborreliosis is much less common with an incidence of about 0.8/100 000 inhabitants in Germany. Bannwarth's syndrome (painful radiculoneuritis) is the most common manifestation of Lyme neuroborreliosis in adults followed by meningitis. International case definitions exist regarding the likelihood of Lyme neuroborreliosis on the basis of diagnostic test results. A CSF analysis should be performed in patients with suspected Lyme neuroborreliosis. The first line treatment for dermatological manifestations of Lyme borreliosis is doxycycline, in children and pregnant women amoxicillin. Doxycycline and beta-lactam antibiotics show similar efficacy regarding neurological symptoms and adverse effects for treatment of neurological manifestations. Treatment duration for early manifestations is 10 to 14 days, in Lyme neuroborreliosis it should not exceed 21 days. All manifestations, also Lyme neuroborreliosis, usually show a favourable prognosis after antibiotic treatment. Antibiotic treatment does not show any efficacy in patients with unspecific symptoms and concurrent positive anti-borrelial serology.


Assuntos
Doença de Lyme , Antibacterianos/uso terapêutico , Criança , Doxiciclina/uso terapêutico , Eritema Migrans Crônico , Feminino , Dedos/patologia , Alemanha/epidemiologia , Humanos , Incidência , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Doença de Lyme/epidemiologia , Doença de Lyme/fisiopatologia , Masculino , Gravidez , Pele/patologia
5.
Braz Oral Res ; 33: e112, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939496

RESUMO

This clinical trial compared the efficacy of doxycycline (DOX) in ß-cyclodextrin (DOX)/ßCD) with DOX- alone in gel on thirty-three subjects with periodontitis. Patients were randomized to group 1 GI; 10% DOX + scaling and root planning (SRP); group 2 (GII (10% DOX /ß-CD + SRP), and group 3 (GIII; SRP). Gels were applied in GI and GII at baseline (T0) and 30 days later (T1). Periodontal Probing Depth (PPD), Clinical Attachment Level (CAL), Bleeding on Probing (BOP) and Visible Plaque Index (VPI) were evaluated at (T0), 30 days (T1) and 60 days after T0 (T2). Bone density was analyzed after 18 months (T3). GII showed the most significant reduction of PPD (2.62 mm; p <0.003), and greatest gain in CAL (2.54 mm p <0.003) at T2. BOP and the VPI had a strong reduction in all groups at T2 (p <0.05), both decreased by ≥5 times and 2 times, respectively, in all groups at T1. Bone density increased in all groups in radiographs (T3). The use of DOX encapsulated in ß-CD gel with SRP resulted in significant improvements in clinical periodontal parameters; such molecular inclusion of doxycycline into ß-CD in gel for local application is relatively simple and useful in dentistry.


Assuntos
Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Periodontite/tratamento farmacológico , beta-Ciclodextrinas/uso terapêutico , Adulto , Índice de Placa Dentária , Raspagem Dentária/métodos , Método Duplo-Cego , Composição de Medicamentos , Feminino , Géis , Humanos , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal , Índice Periodontal , Aplainamento Radicular/métodos , Resultado do Tratamento , Adulto Jovem
6.
APMIS ; 128(1): 61-64, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31691353

RESUMO

Francisella tularensis is a zoonotic bacterium which causes the infection tularemia. It colonizes invertebrates and vertebrates, counting wildlife animals and rodents. Humans can become infected through several pathways including contaminated food, water, and handling animals and due to bites from vectors. Ticks are known to cause tularemia in humans, though their role as a disease transferring vector is not well understood. We describe two case reports of tularemia transferred by ticks on Southern Zealand, Denmark. Case 1: A 49-year-old woman presented with lymphadenopathy and an unhealed sifting wound after a tick bite. Serology tests for F. tularensis were initially negative but turned positive five weeks after symptom onset, when abscess drainage was performed. Gentamicin and ciprofloxacin treatment improved the patient's clinical condition, and she completely recovered. Case 2: A 74-year-old man presented with malaise, fever, and an abdominal ulcer allegedly caused after a vector bite. CRP and leukocytes were increased, while serology tests for F. tularensis were negative. Doxycycline treatment improved the patient's clinical condition, and he completely recovered. Three weeks after symptom onset, renewed serology tests for F. tularensis were positive.


Assuntos
Antibacterianos/uso terapêutico , Carrapatos/microbiologia , Tularemia/diagnóstico , Tularemia/transmissão , Idoso , Animais , Ciprofloxacino/uso terapêutico , Dinamarca , Doxiciclina/uso terapêutico , Feminino , Francisella tularensis , Humanos , Linfadenopatia/microbiologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Int J Infect Dis ; 92: 78-80, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887457

RESUMO

We report the case of an 18-year-old immunocompetent man who presented to the hospital with fever, headaches, and arthromyalgia, which progressed to include an erythematous rash. He had a history of a tick bite 72 h earlier. The diagnosis of rickettsial infection was suspected and a course of doxycycline was initiated for a total of 5 days. His evolution was rapidly favorable under treatment, with resolution of the symptoms within 24 h. Blood cultures came back positive for Neisseria meningitidis serotype B, indicating an authentic purpura fulminans. Purpura fulminans is a medical emergency, a syndrome of intravascular thrombosis characterized by a very rapid evolution that requires early recognition and specific treatment. It is commonly described in the young and healthy patient and has high mortality and morbidity. Common bacteria mainly associated with purpura fulminans are Meningococcus spp., Pneumococcus spp., and Staphylococcus spp.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Doxiciclina/uso terapêutico , Infecções Meningocócicas/tratamento farmacológico , Púrpura Fulminante/tratamento farmacológico , Adolescente , Febre/microbiologia , Humanos , Masculino , Neisseria meningitidis , Púrpura Fulminante/microbiologia , Resultado do Tratamento
9.
Eklem Hastalik Cerrahisi ; 30(3): 333-7, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650935

RESUMO

Brucellosis is a zoonosis seen all over the world and is still endemic in certain parts of the world. Brucellosis is a systemic infection which involves multiple organs and tissues. Although musculoskeletal system involvement is frequent in brucellosis, bursal involvement is seen rarely. In this article, we present a case of subacromial and subdeltoid brucellar bursitis with positive serology and aspiration culture. Patient achieved complete recovery with rifampicin and doxycycline treatment, without any evidence of relapse. A high clinical suspicion is required for the diagnosis of brucellar bursitis.


Assuntos
Brucelose/diagnóstico , Bursite/diagnóstico , Articulação do Ombro , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Brucelose/tratamento farmacológico , Brucelose/microbiologia , Bursite/tratamento farmacológico , Bursite/microbiologia , Diagnóstico Diferencial , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Rifampina/administração & dosagem , Rifampina/uso terapêutico
10.
Int J Mol Sci ; 20(18)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31546787

RESUMO

The pathological aggregation of amyloidogenic proteins is a hallmark of many neurological diseases, including Alzheimer's disease and prion diseases. We have shown both in vitro and in vivo that doxycycline can inhibit the aggregation of Aß42 amyloid fibrils and disassemble mature amyloid fibrils. However, the molecular mechanisms of the drug's anti-amyloidogenic property are not understood. In this study, a series of molecular dynamics simulations were performed to explain the molecular mechanism of the destabilization of Aß42 fibrils by doxycycline and to compare the action of doxycycline with those of iododoxorubicin (a toxic structural homolog of tetracyclines), curcumin (known to have anti-amyloidogenic activity) and gentamicin (an antibiotic with no experimental evidence of anti-amyloidogenic properties). We found that doxycycline tightly binds the exposed hydrophobic amino acids of the Aß42 amyloid fibrils, partly leading to destabilization of the fibrillar structure. Clarifying the molecular determinants of doxycycline binding to Aß42 may help devise further strategies for structure-based drug design for Alzheimer's disease.


Assuntos
Peptídeos beta-Amiloides/antagonistas & inibidores , Peptídeos beta-Amiloides/química , Doxiciclina/química , Simulação de Dinâmica Molecular , Fragmentos de Peptídeos/antagonistas & inibidores , Fragmentos de Peptídeos/química , Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/metabolismo , Peptídeos beta-Amiloides/metabolismo , Doxiciclina/uso terapêutico , Humanos , Interações Hidrofóbicas e Hidrofílicas , Fragmentos de Peptídeos/metabolismo
11.
BMC Infect Dis ; 19(1): 824, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533663

RESUMO

BACKGROUND: To reduce acquisition and relapse of bacterial vaginosis (BV), lactobacilli must be maintained in the vaginal microbiome. Probiotic lactobacilli may aid this purpose. We investigated whether vaginal probiotics (containing Lactobacillus rhamnosus DSM 14870 and Lactobacillus gasseri DSM 14869) would result in vaginal colonisation with lactobacilli in women with and without BV. METHODS: This prospective, partially randomised, exploratory pilot study was conducted in Soweto, South Africa. Thirty-nine sexually-active, HIV negative women were enrolled from October 2014 to May 2016 into three arms. Women who did not have BV (Group 1, n = 13) self-administered probiotic capsules vaginally once daily for 30 days, then once a week until Day 190. Women diagnosed with BV were randomized into Group 2 (n = 12) or Group 3 (n = 14) and treated with the triple oral antibiotic combination for vaginal discharge syndrome per South African guidelines (cefixime 400 mg stat, doxycycline 100 mg BD for 7 days and metronidazole 2 g stat). Immediately after antibiotic treatment, women in Group 2 self-administered probiotic capsules vaginally once daily for 30 days then vaginally once a week until Day 190. Women in Group 3 were not given lactobacilli. RESULTS: During the study, L. rhamnosus DSM 14870 or L. gasseri DSM 14869, were isolated in 5/13 (38.5%) women in Group 1 compared to 10/12 (83.3%) women in Group 2 (p = 0.041). The 1-month and 6-month BV cure rates were similar (P >  0.05) between Group 2 (42 and 25%) compared to Group 3 (36 and 25%). In Group 2, no correlation was observed between the frequency of isolation of the two Lactobacillus strains and the 1-month or 6-month cure rate. CONCLUSIONS: Supplementation with vaginal probiotic capsules resulted in colonisation of the vagina by the Lactobacillus strains (L. rhamnosus DSM 14870 and L. gasseri DSM 14869) contained in the capsules. We observed low initial cure rates of BV after a stat dose of metronidazole and that the probiotic did not improve BV cure rates or alleviate recurrence which could be due to treatment failure or very limited power of the study. TRIAL REGISTRATION: Registered at the Pan African Clinical Trial Registry ( www.pactr.org ) on April 13, 2018 (retrospectively registered). Trial identification number: PACTR201804003327269.


Assuntos
Antibacterianos/uso terapêutico , Lactobacillus/fisiologia , Probióticos/uso terapêutico , Vaginose Bacteriana/tratamento farmacológico , Adolescente , Adulto , Cefixima/uso terapêutico , Doxiciclina/uso terapêutico , Feminino , Humanos , Lactobacillus/isolamento & purificação , Metronidazol/uso terapêutico , Projetos Piloto , Estudos Prospectivos , África do Sul , Resultado do Tratamento , Vagina/microbiologia , Vaginose Bacteriana/microbiologia , Adulto Jovem
12.
BMC Infect Dis ; 19(1): 796, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31510926

RESUMO

BACKGROUND: The number of new rickettsial species are rapidly increasing, and increasing numbers of Rickettsia raoultii (R. raoultii) infection cases have been detected in humans. However, neurological abnormalities caused by R. raoultii are rarely reported, especially in northwestern China. CASE PRESENTATION: A 36-year-old Kazakh shepherd with an attached tick on part temporalis, presented with right eyelid droop, lethargy, fever, headache, fever (38.0-41.0 °C) and erythematous rash. The examination of cerebrospinal fluid (CSF) showed cerebrospinal pressure of 200 mm H2O, leukocyte count of 300.0 × 106/L, adenosine deaminase of 2.15 U/L, and total protein concentration of 0.93 g/L. The diagnosis of R. raoultii infection was confirmed by six genetic markers, and semi-quantified by enzyme-linked immunosorbent assay for rickettsial antigen. The patient gradually recovered after treatment with doxycycline and ceftriaxone. R. raoultii DNA was found both in a tick detached from this patient and in 0.18% (2/1107) of blood samples collected from local shepherds. CONCLUSIONS: This is the first reported case with neurological abnormalities caused by R. raoultii in northwestern China. It is vital to detect rickettsial agents both in blood and CSF for tick bite patients with neurological abnormalities. Public health workers and physicians should pay attention to neurological abnormalities caused by Rickettsia.


Assuntos
Doenças do Sistema Nervoso/diagnóstico , Infecções por Rickettsia/diagnóstico , Rickettsia/metabolismo , Picadas de Carrapatos/diagnóstico , Adenosina Desaminase/líquido cefalorraquidiano , Adulto , Animais , Antígenos de Bactérias/análise , Antígenos de Bactérias/imunologia , Ceftriaxona/uso terapêutico , China , DNA Bacteriano/sangue , Doxiciclina/uso terapêutico , Humanos , Contagem de Leucócitos , Masculino , Doenças do Sistema Nervoso/etiologia , Filogenia , RNA Ribossômico 16S/metabolismo , Rickettsia/classificação , Rickettsia/genética , Infecções por Rickettsia/complicações , Infecções por Rickettsia/tratamento farmacológico , Picadas de Carrapatos/complicações , Carrapatos/genética
13.
BMJ Case Rep ; 12(9)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31494582

RESUMO

Acalculous cholecystitis etiologies while numerous, some of them are less-known such as brucellosis. In this report, we elaborate the clinical findings, investigations and management of two female patients presenting acalculous cholecystitis in whom diagnosis of acute brucellosis was retained. Both patients had fever, asthenia and abdominal tenderness. Laboratory results showed evidence of inflammation as well as hepatic cytolysis while cholestasis was noted in one patient. In both cases, ultrasound study and CT confirmed the presence of acalculous cholecystitis. Serology (tube agglutination test) led to the diagnosis of brucellosis. Diagnosis of brucellosis-related acute cholecystitis was established in both cases based on imaging findings as well as serology without resorting to cholecystectomy. Favourable clinical response to specific antibiotic therapy further supported our diagnosis as well as our decision to avoid surgery. Although few cases have been reported, brucellosis must be considered as a cause of acalculous cholecystitis, especially in endemic countries.


Assuntos
Colecistite Acalculosa/microbiologia , Antibacterianos/uso terapêutico , Brucelose/complicações , Doxiciclina/uso terapêutico , Leite/microbiologia , Alimentos Crus/efeitos adversos , Rifampina/uso terapêutico , Dor Abdominal/microbiologia , Colecistite Acalculosa/diagnóstico por imagem , Colecistite Acalculosa/tratamento farmacológico , Doença Aguda , Animais , Brucelose/diagnóstico por imagem , Brucelose/tratamento farmacológico , Brucelose/fisiopatologia , Proteína C-Reativa/metabolismo , Feminino , Contaminação de Alimentos , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Ultrassonografia , Vômito , Adulto Jovem
14.
BMC Oral Health ; 19(1): 209, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488125

RESUMO

BACKGROUND: To compare the effectiveness of systemic doxycycline as an adjunct to scaling and root planing (SRP) with SRP alone in improving periodontal clinical attachment level and glycemic control in diabetic patients with periodontitis. METHODS: Two independent reviewers (KY and SJ) screened two electronic databases, PubMed and Scopus, for randomized clinical trials on the use of systemic doxycycline as an adjunct to scaling and root planing in improving periodontal status and glycemic control in diabetic patients with periodontitis using predetermined selection criteria within a 3-month period. The reviewers independently did data screening, data selection, data extraction and risk of bias. Quality of studies involved was analysed using the revised Cochrane Risk of Bias 2.0. Weighted standard mean differences (SMD) and 95% confidence intervals were calculated using a random effects meta-analysis model. Publication bias was evaluated using funnel plot. Quality of evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Electronic searches provided 1358 records and six studies were selected. The meta-analyses indicated that there was no statistically significant difference in the improvement of periodontal status with the use of systemic doxycycline as an adjunct for scaling and root planing (SRP). SMD of clinical attachment levels (- 0.22 [- 0.52, 0.08]) and HbA1c levels (- 0.13 [- 0.41, 0.15]) were calculated. Overall risk of bias is high in 2 out of 6 studies involved. CONCLUSION: Systemic doxycycline when used in addition to scaling and root planing yields no significant improvement of clinical attachment levels for periodontal status and reduction of HbA1c levels in treatment of diabetic patients with periodontitis when comparing the test group to the control group.


Assuntos
Antibacterianos/uso terapêutico , Raspagem Dentária/métodos , Doxiciclina/uso terapêutico , Periodontite/tratamento farmacológico , Aplainamento Radicular/métodos , Antibacterianos/administração & dosagem , Complicações do Diabetes , Diabetes Mellitus , Doxiciclina/administração & dosagem , Hemoglobina A Glicada , Humanos , Perda da Inserção Periodontal/tratamento farmacológico , Perda da Inserção Periodontal/terapia , Periodontite/terapia
15.
Indian J Med Res ; 149(6): 706-714, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31496523

RESUMO

Onchocerciasis and lymphatic filariasis (LF) are human filarial diseases belonging to the group of neglected tropical diseases, leading to permanent and long-term disability in infected individuals in the endemic countries such as Africa and India. Microfilaricidal drugs such as ivermectin and albendazole have been used as the standard therapy in filariasis, although their efficacy in eliminating the diseases is not fully established. Anti-Wolbachia therapy employs antibiotics and is a promising approach showing potent macrofilaricidal activity and also prevents embryogenesis. This has translated to clinical benefits resulting in successful eradication of microfilarial burden, thus averting the risk of adverse events from target species as well as those due to co-infection with loiasis. Doxycycline shows potential as an anti-Wolbachia treatment, leading to the death of adult parasitic worms. It is readily available, cheap and safe to use in adult non-pregnant patients. Besides doxycycline, several other potential antibiotics are also being investigated for the treatment of LF and onchocerciasis. This review aims to discuss and summarise recent developments in the use of anti-Wolbachia drugs to treat onchocerciasis and LF.


Assuntos
Filariose Linfática/tratamento farmacológico , Doenças Negligenciadas/tratamento farmacológico , Oncocercose/tratamento farmacológico , Wolbachia/patogenicidade , Adulto , Albendazol/uso terapêutico , Animais , Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Filariose Linfática/epidemiologia , Filariose Linfática/microbiologia , Humanos , Índia/epidemiologia , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/microbiologia , Oncocercose/epidemiologia , Oncocercose/microbiologia , Medicina Tropical , Wolbachia/efeitos dos fármacos
17.
Int J Infect Dis ; 88: 21-26, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31382048

RESUMO

BACKGROUND: Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. METHODS: We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. RESULTS: Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. CONCLUSION: This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. KEY POINTS: We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Cardiopatias/cirurgia , Febre Q/complicações , Adolescente , Adulto , Criança , Doxiciclina/uso terapêutico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/microbiologia , Feminino , Cardiopatias/congênito , Humanos , Hidroxicloroquina/uso terapêutico , Veias Jugulares/cirurgia , Masculino , Registros Médicos , Pessoa de Meia-Idade , Febre Q/diagnóstico , Febre Q/epidemiologia , Febre Q/microbiologia , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Centros de Atenção Terciária , Adulto Jovem
18.
Georgian Med News ; (291): 122-125, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31418744

RESUMO

In this study, we studied the activity of the antibacterial drugDoxycycline (Russia), and the control was the drug of pentavalent antimony - Glucantim (France), which for a long time was the "gold standard" in the treatment of any form of leishmaniasis. In the course of the experiment, the leading positions of doxycycline established in vitro. Its minimum doses lead to absolute suppression of the mobility of the pathogen L. major. Increasing the therapeutic dose of the drug is not justified. Comparison of this drug with the gold standard of therapy with meglumine antimonate (glucantim) showed its superiority in all indicators.


Assuntos
Doxiciclina/uso terapêutico , Leishmaniose/tratamento farmacológico , Antimoniato de Meglumina/uso terapêutico , Humanos , Técnicas In Vitro
19.
BMC Oral Health ; 19(1): 176, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387569

RESUMO

BACKGROUND: Glycemic control is vital in the care of type 2 diabetes mellitus (T2DM) and is significantly associated with the incidence of clinical complications. This Bayesian network analysis was conducted with an aim of evaluating the efficacy of scaling and root planning (SRP) and SRP + adjuvant treatments in improving glycemic control in chronic periodontitis (CP) and T2DM patients, and to guide clinical practice. METHODS: We searched the Pubmed, Embase, Cochrane Library and Web of Science databases up to 4 May 2018 for randomized controlled trials (RCTs). This was at least three months of the duration of study that involved patients with periodontitis and T2DM without other systemic diseases given SRP. Patients in the control group did not receive treatment or SRP combination with adjuvant therapy. Outcomes were given as HbA1c% and levels fasting plasma glucose (FPG). Random-effects meta-analysis and Bayesian network meta-analysis were conducted to pool RCT data. Cochrane's risk of bias tool was used to assess the risk of bias. RESULTS: Fourteen RCTs were included. Most were unclear or with high risk of bias. Compared to patients who did not receive treatment, patients who received periodontal treatments showed improved HbA1c% level, including SRP (the mean difference (MD) -0.399 95% CrI 0.088 to 0.79), SRP + antibiotic (MD 0.62, 95% CrI 0.18 to 1.11), SRP + photodynamic therapy (aPDT) + doxycycline (Doxy) (MD 1.082 95% CrI 0.13 to 2.077) and SRP + laser (MD 0.66 95% CrI 0.1037, 1.33). Among the different treatments, SRP + aPDT + Doxy ranked best. Regarding fasting plasma glucose (FPG), SRP did not show advantage over no treatment (MD 4.91 95% CI - 1.95 to 11.78) and SRP with adjuvant treatments were not better than SRP alone (MD -0.28 95% CI -8.66, 8.11). CONCLUSION: The results of this meta-analysis seem to support that periodontal treatment with aPDT + Doxy possesses the best efficacy in lowering HbA1c% of non-smoking CP without severe T2DM complications. However, longer-term well-executed, multi-center trails are required to corroborate the results.


Assuntos
Antibacterianos/uso terapêutico , Periodontite Crônica/terapia , Raspagem Dentária/métodos , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Fotoquimioterapia , Aplainamento Radicular/métodos , Antibacterianos/administração & dosagem , Teorema de Bayes , Glicemia , Periodontite Crônica/sangue , Terapia Combinada , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Feminino , Humanos , Masculino , Metanálise em Rede , Bolsa Periodontal/sangue , Bolsa Periodontal/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
20.
PLoS One ; 14(8): e0220905, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31408484

RESUMO

BACKGROUND: Scrub typhus, an important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to report on the clinical profile and complications of scrub typhus and its outcome in Nepalese children. METHODS: A prospective observational study was carried out in children aged 1-16 years, admitted to a tertiary care hospital of central Nepal in between July 2016- Aug 2017. Scrub typhus was diagnosed with IgM ELISA. RESULTS: All cases of scrub typhus (n = 76) presented with fever and commonly had other symptoms such as headache (75%), myalgia (68.4%), vomiting (64.5%), nausea (59.2%), abdominal pain (57.9%), cough (35.5%), shortness of breath (22.4%), altered sensorium (14.5%), rashes (13.2%) and seizures (11.8%). Important clinical signs noticed were lymphadenopathy (60.5%), hepatomegaly (47.4%), edema (26.3%), jaundice (26.3%), and splenomegaly (15.8%). About 12% (n = 9) had necrotic eschar. Similarly, thrombocytopenia, raised liver enzymes and raised creatinine values were seen in 36.9%, 34.2% and 65.8% respectively. The most common complications were myocarditis (72.4%), hypoalbuminemia (71.1%), severe thrombocytopenia (22.4%), renal impairment (65.8%), hyponatremia (48.7%) and hepatitis (34.2%). Over two-thirds (69.70%) of the cases were treated with doxycycline followed by combination with azithromycin in the remaining 18.4%. Overall, mortality rate in this group was 3.9%. CONCLUSIONS: Scrub typhus should be considered as a differential in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Myocarditis and acute kidney injury are important complications which when addressed early can prevent mortality. Use of doxycycline showed a favorable outcome.


Assuntos
Tifo por Ácaros/parasitologia , Adolescente , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Azitromicina/administração & dosagem , Azitromicina/uso terapêutico , Criança , Pré-Escolar , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Lactente , Masculino , Nepal/epidemiologia , Estudos Prospectivos , Tifo por Ácaros/complicações , Tifo por Ácaros/tratamento farmacológico , Centros de Atenção Terciária , Resultado do Tratamento
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