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4.
Artigo em Chinês | MEDLINE | ID: mdl-31245947

RESUMO

OBJECTIVE: To investigate the therapeutic effects and mechanisms of Bianyanning on acute pharyngitis in rats, and to provide evidence and experimental data for its clinical application. METHODS: The acute pharyngitis of rats was induced by spraying ammonia directly to their throat. The model rats were randomly divided into model control group, the high-, medium- and low-dose group of Bianyanning, while normal rats were used as control group, 10 in each group. After the corresponding drug treatment, the symptoms and manifestations of each group were observed and recorded; 24 hours after last gavaging, blood samples of each group were collected from the abdominal aorta. The serum contents of interleukin 1-beta (IL-1ß) and tumor necrosis factor alpha (TNF-α) were detected by ELISA. HE method was used to observe the characteristic of the lung tissues and the transmission electron microscopy method was used to observe the trachea cilia. RESULTS: After the treatment, compared with the model control group, the high-, medium- and low-dose group of Bianyanning, the symptoms of acute pharyngitis such as inflamed and congestive throat were relieved obviously. The morphological changes of lung and bronchus tissues were apparently improved. The contents of IL-1ß and TNF-α in serum were decreased significantly. CONCLUSION: Compound Bianyanning can promote the recovering process of acute pharyngitis, improve the morphology of lungs and bronchus, which may be related to inhibiting the releasing of the IL-1ß and TNF-α in serum.


Assuntos
Medicamentos de Ervas Chinesas , Faringite , Animais , Medicamentos de Ervas Chinesas/farmacologia , Interleucina-1beta/metabolismo , Faringite/tratamento farmacológico , Faringite/imunologia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/metabolismo
5.
Planta Med ; 85(9-10): 745-754, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31167299

RESUMO

ELOM-080, also known as Myrtol, represents a distillate of a mixture of 4 rectified essential oils: eucalyptus oil, sweet orange oil, myrtle oil, and lemon oil. ELOM-080 is an approved herbal medicinal product for the secretolytic therapy and facilitation of expectoration in acute and chronic bronchitis and for the secretolytic therapy of sinusitis. Its clinical efficacy has been reported by several randomized control trials. Interestingly, in the recent past, a considerable number of clinical studies on the use of ELOM-080 as add-on treatment of different respiratory tract diseases has been conducted and published in China. As these publications were only available in Chinese, the international attention in the literature was limited. Based on the translation of these studies into English, this review aims to provide a brief overview of the studies' major results, which contribute to the knowledge on the efficacy of ELOM-080 in the treatment of respiratory tract diseases: ELOM-080 was shown to be of great value as add-on treatment not only for the well-established indications bronchitis and sinusitis, but also for pharyngitis, asthma, chronic obstructive pulmonary disease, and, most importantly, otitis media. Besides this clinical evidence, this review also summarizes the great progress in deciphering the mode of action of ELOM-080 that has been made by Chinese publications.


Assuntos
Monoterpenos/uso terapêutico , Doenças Respiratórias/tratamento farmacológico , Asma/tratamento farmacológico , Bronquite/tratamento farmacológico , China , Combinação de Medicamentos , Humanos , Monoterpenos/farmacologia , Otite Média/tratamento farmacológico , Faringite/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Sinusite/tratamento farmacológico
6.
Turk J Ophthalmol ; 49(3): 164-167, 2019 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-31245979

RESUMO

Tularemia is a zoonotic disease caused by Francisella tularensis, a highly virulent gram-negative coccobacillus. Oropharyngeal tularemia, one of the clinical subtypes, is the most common clinical form of the disease in Eastern Europe, including Turkey. This clinical form affects mostly the head and neck region and the most common complaints of patients are mass in the neck, sore throat, and fever. This form of tularemia may be confused with tonsillitis, pharyngitis, or cervical lymphadenitis caused by other microbial agents due to the nonspecific clinical and laboratory features. In this study, we present a patient with nasolacrimal duct obstruction and dacryocystitis caused by oropharyngeal tularemia.


Assuntos
Dacriocistite/etiologia , Infecções Oculares Bacterianas/etiologia , Francisella tularensis/isolamento & purificação , Obstrução dos Ductos Lacrimais/etiologia , Orofaringe/microbiologia , Faringite/complicações , Tularemia/complicações , Adulto , Dacriocistite/diagnóstico , Dacriocistite/microbiologia , Diagnóstico Diferencial , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/microbiologia , Imagem por Ressonância Magnética , Masculino , Ducto Nasolacrimal/microbiologia , Ducto Nasolacrimal/patologia , Orofaringe/diagnóstico por imagem , Faringite/diagnóstico , Faringite/microbiologia , Doenças Raras , Tularemia/diagnóstico
7.
J Med Microbiol ; 68(7): 1053-1058, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169483

RESUMO

BACKGROUND: Streptococcus pyogenes is the most common cause of bacterial pharyngitis. Genotyping of emm is useful for molecular epidemiological survey of S. pyogenes. Antibiotic resistance data are needed for empirical treatments. METHODS: In total, 358 children in Changwon, Korea who had pharyngitis symptoms were subjected to throat cultures to isolate S. pyogenes in 2017. emm genotyping was performed by direct sequencing. An antibiotic susceptibility test was performed using the disk diffusion method for erythromycin (ERY), clindamycin (CLI), tetracycline (TET) and ofloxacin (OFX). Screening for macrolide resistance phenotype and its determinants was performed for the ERY-resistant strains. RESULTS: A total of 190 strains (53.1 %) of S. pyogenes were isolated from 358 children. The most frequent emm genotype was emm4 (53.2 %), followed by emm89 (12.6 %), emm28 (11.6 %) and emm1 (10 %). Antibiotic resistance rates to ERY, CLI, TET and OFX were 3.2 %, 2.6 %, 1.1 % and 2.6%, respectively. There were five isolates of the cMLSB phenotype having the ermB gene and one M phenotype harbouring the mefA gene. CONCLUSIONS: The distribution of emm genotypes was quite different from those previously reported in Korea. emm4 accounted for more than 50  % of the genotypes. Macrolide resistance rates remained very low, but five of six ERY-resistant strains displayed the cMLSB phenotype.


Assuntos
Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Proteínas de Transporte/genética , Farmacorresistência Bacteriana/genética , Faringite/epidemiologia , Faringite/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/genética , Adolescente , Antibacterianos/farmacologia , Criança , Pré-Escolar , Genótipo , Humanos , República da Coreia/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/efeitos dos fármacos
8.
Medicine (Baltimore) ; 98(25): e16022, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232934

RESUMO

BACKGROUND: Laryngeal mask airway (LMA) insertion provokes fewer stress responses than endotracheal intubation. This study aimed to evaluate the LMA Protector for assessing improvements in intraoperative hemodynamic stability and to reduce postoperative discomfort compared with endotracheal intubation in laparoscopic cholecystectomy. METHODS: Fifty-six patients who underwent laparoscopic cholecystectomy while under sevoflurane-based general anesthesia were randomly allocated to airway management using LMA (LMA group) or endotracheal tube (ETT group). Heart rate, blood pressure, and peak airway pressure were recorded before and after carboperitoneum. Postoperative pain and analgesic requirements were assessed, in addition to nausea, hoarseness, dysphonia, and sore throat during the first 1 hour postoperatively and until postoperative day 1. RESULTS: All patients underwent successful LMA or ETT placement within 2 attempts. There was no difference in highest mean (SD) peak airway pressure during carboperitoneum between the LMA and ETT groups (17.7 [2.8] mm Hg vs 19.1 [3.8] mm Hg, P = .159, respectively). The incidence of high systolic blood pressure and bradycardia was higher in the LMA group. The highest pain scores 1 hour postoperatively and on postoperative day 1 were lower in the LMA group than in the ETT group (3.9 [2.0] vs 5.4 [2.3], P = .017 and 5.6 [1.9] vs 6.7 [1.7], P = .042, respectively); requirements for analgesics were similar in the 2 groups. The incidence of nausea was lower in the LMA group than in the ETT group until postoperative day 1 (4/28 [14%] vs 12/28 [43%], P = .031, respectively). CONCLUSION: The LMA Protector was an effective ventilator device associated with fewer intraoperative hemodynamic stress responses and improved the quality of early recovery after laparoscopic cholecystectomy.


Assuntos
Colecistectomia Laparoscópica , Intubação Intratraqueal/efeitos adversos , Máscaras Laríngeas/efeitos adversos , Dor Pós-Operatória/etiologia , Faringite/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento , Adulto Jovem
9.
J Korean Acad Nurs ; 49(2): 215-224, 2019 Apr.
Artigo em Coreano | MEDLINE | ID: mdl-31064974

RESUMO

PURPOSE: To investigate the differences in postoperative sore throat and hoarseness by adjustment of endotracheal tube cuff pressure (CP) during nitrous oxide (N2O) and air anesthesia. METHODS: A one-equivalent control group pretest-posttest design was used. Data were collected from August 8 to October 19, 2017 and analyzed using the independent t-test and repeated measures ANOVA. Eighty-four participants were enrolled and divided into three groups: 28 in the Control Group (CP adjusted every 30 minutes using N2O), 28 in Experimental Group 1 (CP adjusted every 10 minutes using N2O), and 28 in Experimental Group 2 (non-adjusted CP using air), all of whom underwent urologic, gynecologic, and orthopedic surgeries at the G University hospital. Sore throat was assessed using a numeric rating scale; hoarseness was evaluate using the Stout classification at 1, 6, and 24 hours after surgery. RESULTS: Scores for sore throat and hoarseness were significantly different between the groups at each measurement time, and scores were consistently higher in the control group. During subsequent measurements, sore throat and hoarseness scores were significantly lower at 6 hours. Cuff pressure changed significantly using air anesthesia (χ²=10.41, p=.015) up to 2 hours after induction. Severe sore throat and hoarseness was observed for up to 6 hours after surgery. CONCLUSION: Cuff pressure adjustment at short time intervals would be helpful in reducing postoperative sore throat and hoarseness. Nursing intervention focused on prevention of sore throat and hoarseness should be required up to 6 hours postoperatively in patients undergoing endotracheal intubation.


Assuntos
Anestesia Geral/métodos , Rouquidão/etiologia , Óxido Nitroso/química , Faringite/etiologia , Idoso , Anestesia Geral/efeitos adversos , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Pressão
10.
MBio ; 10(2)2019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-31040243

RESUMO

Group A Streptococcus (GAS) infections account for an estimated 500,000 deaths every year. This bacterial pathogen is responsible for a variety of mild and life-threatening infections and the triggering of chronic autoimmune sequelae. Pharyngitis caused by group A Streptococcus (GAS), but not asymptomatic GAS carriage, is a prerequisite for acute rheumatic fever (ARF). Repeated bouts of ARF may trigger rheumatic heart disease (RHD), a major cause of heart failure and stroke accounting for 275,000 deaths annually. A vaccine that prevents pharyngitis would markedly reduce morbidity and mortality from ARF and RHD. Nonhuman primates (NHPs) have been utilized to model GAS diseases, and experimentally infected rhesus macaques develop pharyngitis. Here we use an NHP model of GAS pharyngitis to evaluate the efficacy of an experimental vaccine, Combo5 (arginine deiminase [ADI], C5a peptidase [SCPA], streptolysin O [SLO], interleukin-8 [IL-8] protease [SpyCEP], and trigger factor [TF]), specifically designed to exclude GAS components potentially linked to autoimmune complications. Antibody responses against all Combo5 antigens were detected in NHP serum, and immunized NHPs showed a reduction in pharyngitis and tonsillitis compared to controls. Our work establishes the NHP model as a gold standard for the assessment of GAS vaccines.IMPORTANCE GAS-related diseases disproportionally affect disadvantaged populations (e.g., indigenous populations), and development of a vaccine has been neglected. A recent strong advocacy campaign driven by the World Health Organization and the International Vaccine Institute has highlighted the urgent need for a GAS vaccine. One significant obstacle in GAS vaccine development is the lack of a widely used animal model to assess vaccine efficacy. Researchers in the field use a wide range of murine models of infection and in vitro assays, sometimes yielding conflicting results. Here we present the nonhuman primate pharyngeal infection model as a tool to assess vaccine-induced protection against colonization and clinical symptoms of pharyngitis and tonsillitis. We have tested the efficacy of an experimental vaccine candidate with promising results. We believe that the utilization of this valuable tool by the GAS vaccine research community could significantly accelerate the realization of a safe and effective GAS vaccine for humans.


Assuntos
Faringite/prevenção & controle , Infecções Estreptocócicas/prevenção & controle , Vacinas Estreptocócicas/imunologia , Streptococcus pyogenes/imunologia , Tonsilite/prevenção & controle , Animais , Anticorpos Antibacterianos/sangue , Modelos Animais de Doenças , Feminino , Macaca mulatta , Masculino , Vacinas Estreptocócicas/administração & dosagem , Resultado do Tratamento
11.
Nat Commun ; 10(1): 2297, 2019 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-31127085

RESUMO

Candida albicans is a fungal pathobiont, able to cause epithelial cell damage and immune activation. These functions have been attributed to its secreted toxin, candidalysin, though the molecular mechanisms are poorly understood. Here, we identify epidermal growth factor receptor (EGFR) as a critical component of candidalysin-triggered immune responses. We find that both C. albicans and candidalysin activate human epithelial EGFR receptors and candidalysin-deficient fungal mutants poorly induce EGFR phosphorylation during murine oropharyngeal candidiasis. Furthermore, inhibition of EGFR impairs candidalysin-triggered MAPK signalling and release of neutrophil activating chemokines in vitro, and diminishes neutrophil recruitment, causing significant mortality in an EGFR-inhibited zebrafish swimbladder model of infection. Investigation into the mechanism of EGFR activation revealed the requirement of matrix metalloproteinases (MMPs), EGFR ligands and calcium. We thus identify a PAMP-independent mechanism of immune stimulation and highlight candidalysin and EGFR signalling components as potential targets for prophylactic and therapeutic intervention of mucosal candidiasis.


Assuntos
Candida albicans/imunologia , Proteínas Fúngicas/imunologia , Interações Hospedeiro-Patógeno/imunologia , Sacos Aéreos/microbiologia , Animais , Candida albicans/genética , Candida albicans/metabolismo , Candidíase/imunologia , Candidíase/microbiologia , Linhagem Celular Tumoral , Modelos Animais de Doenças , Células Epiteliais/imunologia , Células Epiteliais/metabolismo , Células Epiteliais/microbiologia , Receptores ErbB/genética , Receptores ErbB/imunologia , Receptores ErbB/metabolismo , Feminino , Proteínas Fúngicas/genética , Proteínas Fúngicas/metabolismo , Humanos , Sistema de Sinalização das MAP Quinases/imunologia , Metaloproteinases da Matriz/imunologia , Metaloproteinases da Matriz/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Membrana Mucosa/imunologia , Membrana Mucosa/microbiologia , Faringite/imunologia , Faringite/microbiologia , Fosforilação , Peixe-Zebra
12.
Microbiol Spectr ; 7(2)2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30977463

RESUMO

Streptococci carrying serogroup C and G antigens, and in particular, Streptococcus dysgalactiae subsp. equisimilis (SDSE), are emerging human pathogens that are increasingly isolated from patients with a myriad of infections that range from mundane to life-threatening. SDSE is microbiologically similar to Streptococcus pyogenes. These streptococci frequently cause infections of the throat and skin and soft tissues. Moreover, they may invade the bloodstream and disseminate widely to many deep tissue sites, including the endocardium. Life-threatening invasive infections due to SDSE, including the streptococcal toxic shock syndrome, occur most frequently in patients with severe underlying medical diseases. Treatment with penicillin is adequate under most circumstances, but treatment failure occurs. SDSE may also be resistant to other antibiotic classes including tetracyclines, macrolides, and clindamycin. Most human infections caused by groups C and G streptococci are transmitted from person to person, but infections due to Streptococcus equi subsp. zooepidemicus (and, rarely, to S. equi subsp. equi) are zoonoses. Transmission of these latter species occurs by animal contact or by contamination of food products and has been associated with the development of poststreptococcal glomerulonephritis. Members of the Streptococcus anginosus group, usually classified with the viridans group of streptococci, are associated with a variety of pyogenic infections.


Assuntos
Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Glomerulonefrite/microbiologia , Humanos , Faringite/epidemiologia , Faringite/microbiologia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/transmissão , Streptococcus/classificação , Streptococcus/patogenicidade , Zoonoses/epidemiologia , Zoonoses/microbiologia
13.
Eur J Clin Microbiol Infect Dis ; 38(6): 1179-1185, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30852698

RESUMO

We compared the performance of two rapid antigen tests-QuikRead go® Strep A test (Orion Diagnostica, Espoo, Finland) and BD Veritor™ system (Becton, Dickinson and Company, Sparks, MD) with throat culture. Our aim was to evaluate each assay's performance and agreement compared to throat culture in order to choose one of the assays as a point-of-care test in the emergency room. One hundred throat samples were collected in triplicates from patients with suspected pharyngitis admitted to the emergency room. One throat swab was seeded for a throat culture. The other two throat swabs from each patient were analyzed at the emergency room by the QuikRead go® Strep A test, and by the BD Veritor™ system, according to each manufacturer's instructions. Agreement level between BD Veritor™ test and throat culture was 79%; sensitivity and specificity of this test were 80% and 78.7%, respectively. QuikRead go® Strep A test had an agreement level of 75% with throat culture; sensitivity and specificity of this test were 80% and 73.3%, respectively. Both tests have a good diagnostic performance. Other characteristics such as costs, size of instrument, and ease of implementation should be taken into consideration when choosing a point-of-care test.


Assuntos
Testes Diagnósticos de Rotina/normas , Faringite/diagnóstico , Kit de Reagentes para Diagnóstico/normas , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes , Serviço Hospitalar de Emergência , Finlândia , Humanos , Faringite/microbiologia , Faringe/microbiologia , Testes Imediatos , Sensibilidade e Especificidade , Infecções Estreptocócicas/microbiologia
15.
Indian Pediatr ; 56(1): 49-52, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30806362

RESUMO

OBJECTIVE: To assess the validity of modified Centor Score in predicting streptococcal pharyngitis, and describe the antibiotic sensitivity of streptococcal strains. METHODS: A cross-sectional study of 120 children (age 1-18 y) with signs and symptoms of pharyngitis was undertaken in the pediatric department of a tertiary care teaching hospital in Chennai from July 2015 to April 2016. Modified Centor score was calculated for all children, and streptococcal sore throat was confirmed by throat swab culture. Predictive validity of Centor score was assessed by Receiver Operating Curve (ROC) analysis. RESULTS: Streptococcal culture positivity was 35%. The Area Under the Curve (AUC) value for modified Centor score was 0.589 (95% CI 0.481 to 0.697, P=0.11) in predicting streptococcal pharyngitis. Cough had the highest sensitivity (63.4%), but poor specificity (36.7%) for streptococcal pharyngitis confirmed by culture. The specificity was 100% for palatine petechiae, followed by palatine exudates (97.5%) and tender anterior cervical nodes (88.6%) to diagnose streptococcal pharyngitis. The proportion of antibiotic resistance was highest for cotrimoxazole (16.7%). CONCLUSION: Predictive validity of modified Centor score was not satisfactory, and resistance to cotrimoxazole, fluoroquinolones and macrolides was high among S. pyogenes strains.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Faringite , Infecções Estreptocócicas , Streptococcus pyogenes/efeitos dos fármacos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Índia/epidemiologia , Lactente , Masculino , Testes de Sensibilidade Microbiana , Faringite/diagnóstico , Faringite/epidemiologia , Faringite/microbiologia , Sensibilidade e Especificidade , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia
16.
Eur Arch Otorhinolaryngol ; 276(3): 775-783, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30739176

RESUMO

PURPOSE: Acute pharyngitis is an uncomfortable disorder mostly caused by viruses and for which antibiotics are unwarranted. This study compared lozenges containing ectoine, a natural extremolyte, with hyaluronic acid lozenges and hypertonic saline gargle for symptomatic treatment of acute viral pharyngitis. METHODS: This prospective, controlled clinical study, recruited 90 patients with moderate-to-severe pharyngitis symptoms who chose to use either ectoine (n = 35), hyaluronic acid (n = 35), or saline gargle (n = 20). Patients applied their 7-day treatment from the inclusion visit (V1) until the end-of-study visit (V2). Patients' pharyngitis symptoms, general health, general treatment effectiveness and tolerability, and patient compliance were assessed by investigators and patients. RESULTS: The sum score for three primary symptoms (pain on swallowing, urge to cough, and hoarseness) decreased by 79.5% (ectoine), 72.2% (hyaluronic acid), and 44.8% (saline gargle). Both lozenges were significantly superior to saline gargle (P < 0.05). Regarding general health improvement, ectoine was significantly superior to saline gargle (72.5% vs. 45.2%, P < 0.05), but hyaluronic acid (63.3%) was not. At V2, 65.7% of patients receiving ectoine reported "very good" general health vs. 48.6% of those receiving hyaluronic acid and 20.0% using saline gargle. Ectoine was significantly superior (P < 0.05) to both hyaluronic acid and saline gargle in terms of tolerability and patient compliance. No patients taking ectoine reported unpleasant sensations while applying their treatment, whereas almost half of patients using hyaluronic acid lozenges and saline gargle did. CONCLUSION: Treatment with ectoine lozenges significantly relieves moderate-to-severe symptoms of acute viral pharyngitis and is more effective and tolerable than treatments with hyaluronic acid lozenges and hypertonic saline gargle.


Assuntos
Diamino Aminoácidos/uso terapêutico , Ácido Hialurônico/uso terapêutico , Faringite/tratamento farmacológico , Solução Salina Hipertônica/uso terapêutico , Doença Aguda , Administração Oral , Adulto , Idoso , Tosse/tratamento farmacológico , Deglutição , Método Duplo-Cego , Feminino , Rouquidão/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Dor/etiologia , Medição da Dor , Cooperação do Paciente , Faringite/complicações , Faringite/virologia , Estudos Prospectivos , Resultado do Tratamento
17.
Eur Arch Otorhinolaryngol ; 276(3): 879-887, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30767047

RESUMO

PURPOSE: Group A beta-hemolytic Streptococcus (GABHS) causes a recurrent acute pharyngotonsillitis (RAPT) in children. Moreover, the repeated use of antibiotics contributes to its resistance. However, S. Salivarius 24SMB and S. oralis 89a were effective probiotics in other infections. Thus, we decided to evaluate this combination efficacy compared to placebo in RAPT. METHODS: Patients with microbiologically confirmed GABHS were enrolled in this randomized, placebo-controlled trial. They received the aforementioned combination or placebo as an oral spray. We investigated episodes of frequency and duration, need for antibiotics, school days lost, the treatment impact on life quality, treatment compliance and side effects during a 90-day treatment and a 6-month follow-up. RESULTS: We included 41 patients in each group. The mean number of GABHS infection was significantly lower during both study periods for the two groups. However, our treatment group showed a lower rate. Moreover, the probiotic group had a lower mean number and a shorter median duration of GABHS episodes during both study periods than controls. Furthermore, the mean duration of antibiotic treatment was lower in the probiotic group during the 90-day and 6-month follow-up periods. Similarly, patients in the probiotic group showed a significantly lower mean number of absence days from school but higher EQ-VAS score. Indeed, all patients included were compliant to treatment. CONCLUSIONS: We identified potential probiotics, possessing desirable features against GABHS pharyngotonsillitis. Our findings represent the first evidence which throws the light on using these probiotics that can reduce antibiotics use which did not have efficient results regarding recurrence.


Assuntos
Terapia Biológica/métodos , Probióticos/uso terapêutico , Infecções Estreptocócicas/terapia , Streptococcus agalactiae , Streptococcus oralis , Streptococcus salivarius , Tonsilite/terapia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino , Sprays Orais , Faringite/microbiologia , Faringite/terapia , Probióticos/administração & dosagem , Recidiva , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes , Tonsilite/microbiologia
18.
Rev. bras. med. fam. comunidade ; 14(41): e1815, 02/2019. ilus, tab
Artigo em Português | LILACS, Coleciona SUS | ID: biblio-986445

RESUMO

Objetivo: Apresentar informações sobre o diagnóstico e tratamento da síndrome PFAPA na Atenção Primária à Saúde. Métodos: Revisão sistemática de literatura baseada na recomendação PRISMA e realizada nas bases de dados Scielo, Lilacs, Medline, IBECS e PubMed, incluindo estudos publicados no período de 2004 a 2018, além da consulta a outros documentos específicos da síndrome PFAPA. Resultados: Após busca e seleção, foram incluídos 31 artigos. Avaliação e Diagnóstico: A síndrome PFAPA acomete principalmente crianças, sendo caracterizada por febre periódica acompanhada por faringite, estomatite aftosa e/ou adenite cervical. Seu diagnóstico é clínico e por exclusão, baseado em critérios estabelecidos. Recomendações: Os episódios costumam responder a prednisona e, em graus variáveis, a cimetidina e colchicina. Casos refratários e acompanhados de hipertrofia tonsilar são candidatos a tonsilectomia, devendo ser encaminhados à avaliação otorrinolaringológica.


Objective: To present information about the diagnosis and treatment of PFAPA syndrome in Primary Health Care. Methods: Systematic review of literature based on the PRISMA recommendation and carried out in the Scielo, Lilacs, Medline, IBECS and PubMed databases, including studies published from 2004 to 2018, in addition to consulting other PFAPA syndrome specific documents. Results: After search and selection, 31 articles were included. Assessment and Diagnosis: PFAPA syndrome affects mainly children and is characterized by periodic fever accompanied by pharyngitis, aphthous stomatitis and/or cervical adenitis. Its diagnosis is clinical and by exclusion, based on established criteria. Recommendations: The episodes usually respond to prednisone and, in varying levels, cimetidine and colchicine. Refractory cases and accompanied by tonsillar hypertrophy are candidates for tonsillectomy, and should be referred to otorhinolaryngological evaluation.


Objetivo: Presentar informaciones sobre el diagnóstico y tratamiento del síndrome PFAPA en la Atención Primaria a la Salud. Métodos: Revisión sistemática de literatura basada en la recomendación PRISMA y realizada en las bases de datos Scielo, Lilacs, Medline, IBECS y PubMed, incluyendo estudios publicados en el período 2004 a 2018, además de la consulta a otros documentos específicos del síndrome PFAPA. Resultados: Después de la búsqueda y selección, se incluyeron 31 artículos. Evaluación y Diagnóstico: El síndrome PFAPA acomete principalmente niños, siendo caracterizada por fiebre periódica acompañada por faringitis, estomatitis aftosa y/o adenitis cervical. Su diagnóstico es clínico y por exclusión, basado en criterios establecidos. Recomendaciones: Los episodios suelen responder a la prednisona y, en grados variables, a la cimetidina y colchicina. Los casos refractarios y acompañados de hipertrofia tonsilar son candidatos a tonsilectomía, debiendo ser encaminados a la evaluación otorrinolaringológica.


Assuntos
Atenção Primária à Saúde , Febre Recorrente , Estomatite Aftosa , Faringite , Linfadenite
19.
BMC Infect Dis ; 19(1): 193, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808305

RESUMO

BACKGROUND: Clinical guidelines for the diagnosis of group A streptococcal (GAS) pharyngitis recommend the use of a rapid antigen detection test (RADT) and/or bacterial culture. This study evaluated the overall diagnosis and treatment of acute pharyngitis in the United States, including predictors of test type and antibiotic prescription. METHODS: A retrospective analysis of pharyngitis events from 2011 through 2015 was conducted using the MarketScan commercial/Medicare databases. A pharyngitis event was defined as occurring within 2 weeks from the index visit. Patient and provider characteristics were examined across 5 testing categories: RADT, RADT plus culture, other tests, nucleic acid amplification testing (NAAT), and no test. Multivariate models were used to identify significant predictors of NAAT use and antibiotic prescription. RESULTS: A total of 18.8 million acute pharyngitis events were identified in 11.6 million patients. Roughly two-thirds of events (68.2%) occurred once, and roughly a third of patients (29.1%) required additional follow-up, but hospitalization was rare (0.3%). Across all events, 43% were diagnosed by RADT, while 20% were diagnosed by RADT plus culture. The proportion of events diagnosed by NAAT increased 3.5-fold from 2011 to 2015 (0.06% vs 0.27%). Antibiotic use was frequent (49.3%), less often in combination with RADT plus culture (31.2%) or NAAT alone (34.5%) but significantly more often with RADT alone (53.4%) or no test (57.1%). Pediatricians were significantly less likely than other providers to prescribe antibiotics in their patients, regardless of patient age (p < 0.0001). CONCLUSIONS: Antibiotic use for sore throat remains common, with many clinicians not following current guidelines for diagnosis of GAS pharyngitis. Diagnosis of GAS pharyngitis using RADT plus culture or NAAT alone was associated with lower use of antibiotics. Diagnostic testing can help lower the incidence of inappropriate antibiotic use, and inclusion of NAAT in the clinical guidelines for GAS pharyngitis warrants consideration.


Assuntos
Faringite/diagnóstico , Faringite/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Testes Imunológicos , Masculino , Técnicas de Amplificação de Ácido Nucleico , Faringite/tratamento farmacológico , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/genética , Streptococcus pyogenes/imunologia , Streptococcus pyogenes/patogenicidade , Estados Unidos
20.
BMJ Case Rep ; 12(1)2019 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-30700448

RESUMO

Fusobacterium necrophorum is a rare infection most notable for causing Lemierre's syndrome. This consists of a primary oropharyngeal infection and septic thrombophlebitis, and one or more metastatic focus. Prior to the widespread use of antibiotics, Lemierre's syndrome commonly followed a rapidly progressing course, with a high mortality. We describe a case of a previously well 18-month-old boy who presented to the emergency department with a 3-week history of progressive, right-sided, painful neck swelling and systemic sepsis. He was initially treated conservatively with intravenous antibiotics, but ultimately required surgical drainage. Lemierre's syndrome is a rare condition with increasing incidence which can have significant adverse outcomes including death. Early recognition and treatment are essential, but identifying Lemierre's disease is challenging.


Assuntos
Fusobacterium necrophorum/isolamento & purificação , Síndrome de Lemierre/complicações , Síndrome de Lemierre/diagnóstico , Faringite/complicações , Faringite/tratamento farmacológico , Sepse/complicações , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/microbiologia , Diagnóstico Diferencial , Drenagem , Humanos , Lactente , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/microbiologia , Síndrome de Lemierre/tratamento farmacológico , Masculino , Pescoço/diagnóstico por imagem , Pescoço/microbiologia , Radiografia Intervencionista , Sepse/diagnóstico , Sepse/tratamento farmacológico , Tomografia Computadorizada por Raios X , Tonsilite/complicações , Tonsilite/tratamento farmacológico , Resultado do Tratamento , Ultrassonografia
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