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2.
Medicine (Baltimore) ; 98(41): e17535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593129

RESUMO

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.


Assuntos
Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/cirurgia , Scedosporium/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Farmacorresistência Fúngica/fisiologia , Feminino , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Micoses/mortalidade , Estudos Observacionais como Assunto , Cuidados Pós-Operatórios , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Scedosporium/isolamento & purificação , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
3.
Expert Opin Pharmacother ; 20(12): 1429-1438, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31282759

RESUMO

Introduction: Human cytomegalovirus (HCMV) or human herpesvirus 5 (HHV-5) is a ß-herpesvirus that causes widespread infection in nearly all members of the human population worldwide. Its persistence in humans after primary infection in a latent phase as well as a partial non-protective immune response is the basis for repeated re-activation/re-infection episodes occurring both in immunocompetent and immunocompromised subjects. In the latter patient populations, which include hematopoietic stem cell transplant (HSCT) recipients, HCMV reactivation episodes may be particularly severe, leading to both systemic and end-organ diseases. Since the 90s, at least four antiviral drugs targeting the DNA polymerase complex have been developed for the prevention and treatment of HCMV infections in transplant recipients, used as first-line (ganciclovir and valganciclovir) and second-line therapy (foscarnet and cidofovir). However, due to their toxicity and drug-resistance induction, new drugs with different targets were needed. Areas covered: In 2017, a new drug named letermovir (LTV), which targets the HCMV DNA terminase complex, was licensed for prophylaxis of HCMV infections in HSCT recipients. This is the focus of this review. Expert opinion: LTV safety and efficacy are promising. However, long-term adverse events and the emergence of drug-resistant HCMV strains must be investigated in extended clinical trials prior to drawing final conclusions.


Assuntos
Acetatos/uso terapêutico , Quimioprevenção/métodos , Infecções por Citomegalovirus/prevenção & controle , Citomegalovirus/efeitos dos fármacos , Quinazolinas/uso terapêutico , Antivirais/uso terapêutico , Quimioprevenção/estatística & dados numéricos , Cidofovir/uso terapêutico , Citomegalovirus/genética , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/epidemiologia , Farmacorresistência Viral/efeitos dos fármacos , Ganciclovir/uso terapêutico , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Transplantados/estatística & dados numéricos , Condicionamento Pré-Transplante/métodos , Condicionamento Pré-Transplante/estatística & dados numéricos , Valganciclovir/uso terapêutico
4.
Rev Chilena Infectol ; 36(2): 167-178, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344153

RESUMO

This manuscript includes the antiinfective therapeutic resources for immunocompromised patients under chemotherapy by cancer or hematopoietic stem cells transplant (HSCT) receptors. The document presents the antimicrobial therapy indicated in the most prevalent clinical situations in this population and the primary and alternative therapy for some specific microorganisms. The clinical situations included in the analysis are: febrile neutropenia without focus, sepsis, infections of the central nervous system, pneumonia, skin and soft tissue infections, neutropenic enterocolitis and urinary tract infection. The therapeutic resources, recommended doses and special precautions for the use of antimicrobial recommended in bacterial, viral, fungal and parasitic infections in this population are described, including the measurement of plasma concentrations of certain drugs in specific situations.


Assuntos
Anti-Infecciosos/administração & dosagem , Neutropenia Febril/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Neoplasias/complicações , Neoplasias/terapia , Relação Dose-Resposta a Droga , Humanos , Imunocompetência/efeitos dos fármacos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Guias de Prática Clínica como Assunto , Fatores de Risco , Resultado do Tratamento
5.
Biomed Res Int ; 2019: 6076571, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080825

RESUMO

Cerebral involvement especially brain abscess is life-threatening complication and major cause of death during Scedosporium apiospermum infection. However, little is known about pathogenesis of brain oedema associated with abscess in scedosporiosis. Experimental scedosporiosis was conducted in BALB/cMlac mice to characterize the presence of brain oedema, its type, and its related mechanisms focusing on aquaporin (AQP)-4, nuclear factor erythroid-2 related factor (Nrf-2), and tumor necrotic factor (TNF)-α. The results revealed that S. apiospermum infection induced severe inflammatory environment relevant to TNF-α expression and cytogenic oedema-associated brain abscess predominately in cerebrum of immunocompromised mice without voriconazole treatment reflecting to downregulation of AQP-4 in neighboring abscess areas and oedematous blood vessels. Downregulation of Nrf-2 in neuronal cells and myelin degeneration were significantly observed in nontreated mice. In summary, oxidative stress, severe inflammatory response, and space-occupying mass from abscess formation inducing tissue hypoxia might be the postulate causes of oedema induced by scedosporiosis.


Assuntos
Aquaporina 4/metabolismo , Abscesso Encefálico/imunologia , Abscesso Encefálico/metabolismo , Edema Encefálico/metabolismo , Micoses/imunologia , Fator 2 Relacionado a NF-E2/metabolismo , Scedosporium/patogenicidade , Animais , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Abscesso Encefálico/patologia , Regulação para Baixo , Feminino , Hipóxia , Hospedeiro Imunocomprometido/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Micoses/patologia , Bainha de Mielina , Estresse Oxidativo , Fator de Necrose Tumoral alfa/metabolismo , Voriconazol/farmacologia
6.
Transplant Proc ; 51(2): 512-516, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30879579

RESUMO

BACKGROUND: A significant gap exists between demand and supply of organs for patients with end-stage renal disease. To increase the donor pool, kidney transplantation is performed across ABO- and HLA-incompatible barriers. ABO-incompatible kidney transplant (ABOi-KT) recipients are at increased risk of antibody-mediated rejection, infection, and mortality. Hypogammaglobulinemia secondary to immunosuppression is highly prevalent after solid organ transplantation, and intravenous immunoglobulin (IVIG) has been reported to reduce the risks of infections in various settings. We use high-dose IVIG in ABOi-KT recipients perioperatively. We aimed to determine the rate of infectious complications along with graft and patient survival in our ABOi-KT recipients. METHODS: We included all adult patients who underwent ABOi-KT from the year 2007 to 2016. Patients received rituximab, plasma exchange, and IVIG (2 g/kg body weight). Thymoglobulin and intravenous methylprednisolone were used as induction treatment. Oral prednisone, mycophenolate mofetil, and tacrolimus were used as maintenance therapy. RESULTS: A total of 77 ABOi-KTs were performed, and the recipients were followed up for a median of 1557 days. Two patients were diagnosed as having BK nephropathy. No patients were diagnosed as having pneumocystis infection, cytomegalovirus disease, herpes simplex, varicella zoster, or fungal infection. One-year graft and patient survival was 94.8% and 100%, respectively. CONCLUSIONS: In our series of ABOi-KTs, we observed a low risk of infectious complications and excellent patient survival. High-dose IVIG might have reduced infections.


Assuntos
Sistema do Grupo Sanguíneo ABO , Incompatibilidade de Grupos Sanguíneos , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/imunologia , Transplante de Rim/métodos , Adulto , Feminino , Rejeição de Enxerto , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/uso terapêutico , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade
7.
Acta Gastroenterol Belg ; 82(1): 27-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30888750

RESUMO

AIM: This study evaluates hepatitis B virus (HBV) vaccination response in children with celiac disease (CD). Response in initial non-responders after a single booster vaccination as well as factors influencing HBV vaccination response were evaluated. METHODOLOGY: Anti-hepatitis B surface antibodies (a-HBsAB) were checked in all children with CD and a documented complete HBV vaccination. An a-HBsAB <10 U/L was considered as non-response. A single intramuscular HBV-vaccine booster was advised to all non-responders. Response was checked at the next appointment. RESULTS: 133 children with CD were included, median age of 7.3 years (range 1.7-17.3) and 46 (35%) were male. The age at CD diagnosis was 6.0 years (range 1.1-15.7). HBV non-response was documented in 55% (n=73/133). No other factors were influencing the response. A booster was documented in 34/73 (47 %) initial non-responders (3 refused (4%), 36 (49%) had no follow up). Response after booster vaccination resulted in immunity in 22/34 (65%) and persisting non-response in 12/34 (35%). A single booster is able to reduce non-response from 55% (73/133) to 23% (22/94). CONCLUSION: A significantly lower immune response following HBV vaccination in children with CD was confirmed. A single intramuscular booster vaccination is able to induce a serologic response in two thirds of the initial non-responders. Control of HBV vaccination response has to become part of the follow-up in CD patients.


Assuntos
Doença Celíaca , Vacinas contra Hepatite B/administração & dosagem , Hepatite B/prevenção & controle , Vacinação/estatística & dados numéricos , Adolescente , Doença Celíaca/sangue , Doença Celíaca/complicações , Doença Celíaca/imunologia , Criança , Pré-Escolar , Hepatite B/complicações , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/análise , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/metabolismo , Antígenos de Superfície da Hepatite B/uso terapêutico , Vacinas contra Hepatite B/metabolismo , Vacinas contra Hepatite B/uso terapêutico , Vírus da Hepatite B , Humanos , Imunidade Ativa/efeitos dos fármacos , Imunização Secundária , Hospedeiro Imunocomprometido/efeitos dos fármacos , Lactente , Masculino , Estudos Prospectivos
8.
Int J Med Mushrooms ; 21(1): 13-27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30806252

RESUMO

Agaricus bisporus is a very important edible and medicinal mushroom. In this study, we systematically investigated the monosaccharide composition, methylation, and immunomodulatory activities of polysaccharides from A. bisporus fruiting bodies (FPS), cultured mycelia (IPS), and fermentation broth (EPS). The results indicated that FPS was mainly composed of mannose; IPS, of glucose; and EPS, of galactose. However, the methylation results indicated that FPS, IPS, and EPS possessed different polysaccharide structures. Furthermore, FPS, IPS, and EPS caused remarkable increases in the thymus and spleen indexes; in the amounts of serum cytokines containing interleukin (IL)-2, IL-4, tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ); in the counts of CD3+CD4+ lymphocytes and the ratio of CD4+ to CD8+ T lymphocytes; however, they decreased the counts of CD3+CD8+ lymphocytes in normal mice. Finally, in cyclophosphamide-treated mice, the FPS, IPS, and EPS were able to significantly restore the thymus and spleen indexes, lymphocyte proliferation, phagocytotic activity of peritoneal macrophages, and levels of IL-2, IL-6, IL-10, IL-17, TNF-α, and immunoglobin G. These findings suggest that FPS, IPS, and EPS could all be exploited as immunomodulatory agents and potential immunotherapeutic medicines for patients with inadequate immune function.


Assuntos
Agaricus/química , Carpóforos/química , Hospedeiro Imunocomprometido/efeitos dos fármacos , Fatores Imunológicos/farmacologia , Micélio/química , Polissacarídeos/farmacologia , Animais , Células Cultivadas , Citocinas/genética , Citocinas/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Fatores Imunológicos/administração & dosagem , Macrófagos Peritoneais/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos ICR , Fagocitose/efeitos dos fármacos , Fagocitose/fisiologia , Polissacarídeos/química , Baço/citologia
9.
Biomed Res Int ; 2019: 9461960, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30723745

RESUMO

In this study, we evaluated the immunity-enhancing effects of Orostachys japonicus A. Berger (OJ). To examine the immune protective effect in vitro, primary mouse splenocytes were treated with water or ethanol extracts of OJ in the absence or presence of cyclophosphamide (CY), which is a cytotoxic, immunosuppressive agent. The extracts increased the propagation of splenocytes and inhibited CY-induced cytotoxicity. Further, to examine the immunostimulatory effects in vivo, adult Wistar rats were orally administered OJ extracts with or without CY treatment. With the administration of OJ extracts, CY-treated immunosuppressed rats showed improved physical endurance, as assessed by the forced swim test. In addition, extract administration increased not only the number of immunity-related cells but also the levels of plasma cytokines. OJ extracts also recovered splenic histology in CY-treated rats. These findings suggest that an OJ regimen can enhance immunity by increasing immune cell propagation and specific plasma cytokine levels.


Assuntos
Crassulaceae/química , Imunidade Inata/efeitos dos fármacos , Extratos Vegetais/administração & dosagem , Baço/efeitos dos fármacos , Animais , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/imunologia , Ciclofosfamida/administração & dosagem , Citocinas/imunologia , Hospedeiro Imunocomprometido/efeitos dos fármacos , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/administração & dosagem , Imunossupressores/química , Extratos Vegetais/química , Ratos , Baço/citologia , Baço/imunologia
10.
J Infect Chemother ; 25(5): 379-384, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30797689

RESUMO

A 76-year-old Japanese woman was admitted due to uncontrolled cellulitis of the right lower leg. She had deep vein thrombosis on the right limb. Moreover, she had a long history of rheumatoid arthritis treated with corticosteroids. Skin biopsy and lumbar puncture were performed to diagnose disseminated cryptococcosis. She was administered antifungal agents (liposomal amphotericin B and 5-fluorocytosine). On treatment day 14, debridement was performed, and cryptococcosis was controlled. However, she developed toxic megacolon due to Clostridioides difficile infection (CDI). On day 32, she was transferred to the intensive care unit due to severe acidosis and acute kidney injury secondary to CDI-related toxic megacolon. Vancomycin, metronidazole, and tigecycline were administered for treatment of CDI. After several weeks of intensive care, toxic megacolon was improved, but renal replacement therapy was discontinued according to the patient's will. On day 73, she died of renal failure. We experienced a complex of rare diseases, Cryptococcus neoformans cellulitis and Clostridioides difficile-related toxic megacolon. Both diseases were presumed to be the result of corticosteroid and methotrexate use. Hence, careful monitoring is required when treating immunocompromised hosts to reduce the risk of developing complications.


Assuntos
Lesão Renal Aguda/terapia , Celulite (Flegmão)/microbiologia , Clostridiales/patogenicidade , Coinfecção/microbiologia , Criptococose/microbiologia , Cryptococcus neoformans/patogenicidade , Megacolo Tóxico/microbiologia , Lesão Renal Aguda/etiologia , Idoso , Anti-Infecciosos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Celulite (Flegmão)/imunologia , Celulite (Flegmão)/terapia , Clostridiales/isolamento & purificação , Coinfecção/imunologia , Coinfecção/terapia , Criptococose/imunologia , Criptococose/terapia , Cryptococcus neoformans/isolamento & purificação , Desbridamento , Diagnóstico Diferencial , Quimioterapia Combinada/métodos , Evolução Fatal , Feminino , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/efeitos adversos , Megacolo Tóxico/complicações , Megacolo Tóxico/imunologia , Megacolo Tóxico/terapia , Terapia de Substituição Renal
12.
Transpl Infect Dis ; 21(2): e13048, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30636363

RESUMO

Invasive fungal infections are a common complication in immunocompromised patients, such as organ transplant recipients. Isavuconazole is a broad-spectrum azole antifungal for the treatment of aspergillosis and mucormycosis. The package insert for isavuconazole recommends against opening the capsule for administration through enteral feeding tubes. We describe the case of a 68-year-old man with a complex post-lung transplant course receiving isavuconazole for presumed invasive aspergillosis (bronchial alveolar lavage galactomannan index of >3.75) therapy administered through a gastrostomy-jejunostomy tube (G-J tube). Therapeutic drug monitoring was performed to ensure appropriate absorption. Peak and trough concentrations were measured in the early and late phases of the treatment course and resulted in trough levels of 2.7 mcg/mL and 4.0 mcg/mL, which is consistent with previously published trough concentrations of isavuconazole when the capsule was administered intact. This case report suggests that opening isavuconazole capsules and administration through a G-J tube results in appropriate absorption and serum drug levels comparable to intact capsules.


Assuntos
Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Infecções Fúngicas Invasivas/tratamento farmacológico , Nitrilos/administração & dosagem , Nitrilos/uso terapêutico , Piridinas/administração & dosagem , Piridinas/uso terapêutico , Triazóis/administração & dosagem , Triazóis/uso terapêutico , Idoso , Cápsulas/administração & dosagem , Monitoramento de Medicamentos , Nutrição Enteral/métodos , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Jejuno/efeitos dos fármacos , Transplante de Pulmão/efeitos adversos , Masculino
14.
J Oncol Pharm Pract ; 25(1): 214-216, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29933728

RESUMO

Cases of Merkel cell carcinoma have become increasingly more common in the last two decades, and its incidence has been predicted to climb further. Immunosenescence might explain in part the higher Merkel cell carcinoma prevalence in seniors aged 70 and older. This cancer might also be more aggressive in immunocompromised patients. In a subset of immunocompromised Merkel cell carcinoma patients, we identified significant lymphopenia and a more advanced disease stage compared with their immunocompetent counterparts. Time to death in this cohort was much shorter than in immunocompetent subjects, and their likelihood of death from Merkel cell carcinoma was five times higher. Avelumab approval in 2017 represents an important step forward in the therapy of Merkel cell carcinoma. Hopefully, PD1/PDL1 inhibitors will improve survival in immunocompromised Merkel cell carcinoma hosts, traditionally linked with inferior clinical outcomes.


Assuntos
Antineoplásicos/uso terapêutico , Antígeno B7-H1/antagonistas & inibidores , Carcinoma de Célula de Merkel/tratamento farmacológico , Hospedeiro Imunocomprometido/efeitos dos fármacos , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/farmacologia , Azatioprina/farmacologia , Azatioprina/uso terapêutico , Carcinoma de Célula de Merkel/imunologia , Feminino , Humanos , Hospedeiro Imunocomprometido/imunologia , Fatores Imunológicos/farmacologia , Fatores Imunológicos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Cutâneas/imunologia , Resultado do Tratamento
15.
Am J Clin Dermatol ; 20(1): 55-73, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30298481

RESUMO

Hematopoietic stem cell transplants (HSCTs) are used to treat a variety of conditions, including hematologic malignancies, bone marrow failure syndromes, and immunodeficiencies. Over 60,000 HSCTs are performed annually worldwide, and the numbers continue to increase. Indeed, as new conditioning regimens develop, more and more individuals, including those of older age, will be eligible for transplants. Nevertheless, although HSCTs are clearly a life-saving and necessary treatment for thousands of patients per year, there is still substantial morbidity and mortality associated with the procedure. Of note, skin eruptions in the post-HSCT period are frequent and often significantly reduce quality of life in recipients. Moreover, these cutaneous findings sometimes herald an underlying systemic condition, presenting possible opportunities for timelier intervention. Dermatologists therefore play a vital role in distinguishing life-threatening conditions from benign issues and prompting recognition of critical complications earlier in their course. This article aims to review the major dermatologic conditions occurring in the early post-HSCT period.


Assuntos
Erupção por Droga/etiologia , Doença Enxerto-Hospedeiro/imunologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Dermatopatias Infecciosas/etiologia , Antineoplásicos/efeitos adversos , Doença Enxerto-Hospedeiro/prevenção & controle , Neoplasias Hematológicas/cirurgia , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Hospedeiro Imunocomprometido/imunologia , Qualidade de Vida , Pele/efeitos dos fármacos , Pele/imunologia , Pele/microbiologia , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/métodos , Resultado do Tratamento
16.
Rev Chilena Infectol ; 35(4): 351-357, 2018 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-30534920

RESUMO

BACKGROUND: The increase of invasive fungal disease (IFD) in immunocompromised patients has led to the frequent prescription of highly active antifungal drugs but with a high economic cost. AIM: To characterize the use of antifungals drugs, evaluate its prescription and determine consumption and associated costs. METHODS: Retrospective descriptive study from January 2015 to April 2016. Audit of prescriptions and review of clinical files. Each prescription was classified according to whether it corresponded to a possible, probable or proven invasive fungal disease (IFD). Consumptions and treatment costs were calculated. RESULTS: 152 antifungal prescriptions were audited in 79 patients. The total cost of antifungal medications was US $ 714,413. 52.1% of the expenditure (US $ 372,319) corresponded to indications in proven IFD, 10.7% (US $ 76,377) probable IFD, 0.8% (US $ 5,638) non-IFI, 12.2% (US $ 87,459) IFD possible and 1.5% (US $ 10,896) non-IFD and 22.6% (US $ 161,723) was prophylaxis. The highest consumption was in indications related to IFD tested with a proven DOT of 10.54 days, with liposomal amphotericin B and iv voriconazole the drugs with the highest consumption with a DOT probable_AnBL of 3.15 and DOT proven voriconazole iv of 3.01. CONCLUSIONS: The consumption of antifungal drug medications generates high costs at 12% of the total pharmacy budget of our institution. The expense was associated mainly with the indications in IFI tested the voriconazole and amphotericin B liposomal with the highest consumption which added to its high cost and prolonged days of general therapy a big impact in the budget.


Assuntos
Antifúngicos/economia , Antifúngicos/uso terapêutico , Custos de Medicamentos , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/economia , Adolescente , Antifúngicos/classificação , Criança , Pré-Escolar , Chile , Feminino , Hospitais Pediátricos , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Lactente , Infecções Fúngicas Invasivas/classificação , Masculino , Estudos Retrospectivos , Adulto Jovem
17.
Am J Case Rep ; 19: 1162-1167, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30270342

RESUMO

BACKGROUND Herpes zoster is caused by the reactivation of the varicella zoster virus (VZV) and usually presents with vesicular skin lesions with a dermatomal distribution. Disseminated herpes zoster (DHZ) infection is characterized by non-dermatomal skin eruptions, often with involvement of other organs, and occurs in immunocompromised patients. CASE REPORT A 69-year-old man who was treated with prednisolone for amiodarone-associated interstitial lung disease, presented with seizures and altered consciousness. He had an erythematous rash with raised vesicles involving the skin of the genital region, left thigh, and abdomen. Following a diagnosis of DHZ with herpes zoster meningoencephalitis, he was treated with intravenous acyclovir. However, his level of consciousness did not improve, and he died of respiratory failure due to aspiration pneumonia. CONCLUSIONS A diagnosis of DHZ should be considered in immunosuppressed patients treated with steroids who present with seizures. A detailed search for skin eruptions should be conducted to enable early diagnosis and treatment.


Assuntos
Glucocorticoides/efeitos adversos , Herpes Zoster/etiologia , Hospedeiro Imunocomprometido/imunologia , Meningoencefalite/etiologia , Prednisolona/efeitos adversos , Convulsões/etiologia , Idoso , Antivirais/administração & dosagem , Evolução Fatal , Glucocorticoides/imunologia , Glucocorticoides/uso terapêutico , Herpes Zoster/tratamento farmacológico , Herpes Zoster/imunologia , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Doenças Pulmonares Intersticiais/induzido quimicamente , Doenças Pulmonares Intersticiais/tratamento farmacológico , Masculino , Meningoencefalite/tratamento farmacológico , Prednisolona/imunologia , Prednisolona/uso terapêutico , Convulsões/tratamento farmacológico
18.
Int J Infect Dis ; 77: 23-25, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30273649

RESUMO

Histoplasma capsulatum variety capsulatum (H. capsulatum) is a thermally dimorphic fungus that is endemic to the Mississippi River and Ohio River valley regions. Of the hundreds of thousands of patients exposed to this fungus, less than 1% develop a severe illness most commonly manifesting as pulmonary disease. Septic arthritis from hematogenous seeding with H. capsulatum or from direct inoculation has been reported only rarely in the literature. The first case of septic arthritis of the shoulder due to H. capsulatum occurring in an immunocompromised patient, treated successfully with irrigation and debridement, systemic antifungals, and local delivery of amphotericin B with cement beads, is reported here. Importantly, the addition of local amphotericin B delivery by cement beads to conventional treatment likely led to clinical cure in this patient.


Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Artrite Infecciosa/terapia , Histoplasmose/terapia , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/microbiologia , Feminino , Histoplasma/efeitos dos fármacos , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico por imagem , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Metotrexato/uso terapêutico , Ohio , Resultado do Tratamento
19.
J Natl Compr Canc Netw ; 16(10): 1216-1247, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30323092

RESUMO

The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period. This portion of the guidelines describes recommendations regarding the management of anthracycline-induced cardiotoxicity and lymphedema. In addition, recommendations regarding immunizations and the prevention of infections in cancer survivors are included.


Assuntos
Sobreviventes de Câncer , Oncologia/normas , Neoplasias/terapia , Sobrevivência , Antraciclinas/efeitos adversos , Antibióticos Antineoplásicos/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Infecções Bacterianas/imunologia , Infecções Bacterianas/prevenção & controle , Cardiotoxicidade/diagnóstico , Cardiotoxicidade/etiologia , Cardiotoxicidade/terapia , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Hospedeiro Imunocomprometido/imunologia , Hospedeiro Imunocomprometido/efeitos da radiação , Linfedema/induzido quimicamente , Linfedema/diagnóstico , Linfedema/terapia , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Oncologia/métodos , Neoplasias/complicações , Neoplasias/imunologia , Neoplasias/psicologia , Medição de Risco/métodos , Medição de Risco/normas , Sociedades Médicas/normas , Estados Unidos , Vacinação/métodos , Vacinação/normas , Viroses/imunologia , Viroses/prevenção & controle
20.
PLoS One ; 13(10): e0204152, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30296293

RESUMO

Lonicera japonica is a typical Chinese herbal medicine. We previously reported a method to isolate polysaccharides from Lonicera japonica (LJP). In this study, we first performed a qualitative analysis of LJP using the Fourier Transform Infrared Spectrometer (FT-IR) and explored the monosaccharide composition of LJP using the pre-column derivatization high performance liquid chromatography (HPLC) method. We then investigated the immunomodulatory function of LJP in cyclophosphamide (CTX)-induced immunosuppressed mouse models. The results showed that LJP had the characteristic absorption of typical polysaccharides consisting of 6 types of monosaccharides. In addition, LJP can increase significantly the organ index, splenic lymphocyte proliferation, macrophage phagocytosis, and natural killer (NK) cell activity in CTX-treated mice. LJP could also restore the levels of serum cytokines interleukin (IL-2), tumor necrosis factor (TNF-α) and Interferon-γ (IFN-γ) in the CTX-treated mice. Finally, the results on measuring the T-lymphocytes subsets of spleen also confirmed LJP-induced immunomodulatory activity in immunosuppressed mice from another perspective. Therefore, LJP could be used as a potential immunomodulatory agent.


Assuntos
Ciclofosfamida/efeitos adversos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Fatores Imunológicos/administração & dosagem , Lonicera/química , Polissacarídeos/administração & dosagem , Baço/imunologia , Animais , Proliferação de Células/efeitos dos fármacos , Cromatografia Líquida de Alta Pressão , Citocinas/sangue , Fatores Imunológicos/química , Fatores Imunológicos/farmacologia , Linfócitos/citologia , Linfócitos/efeitos dos fármacos , Masculino , Camundongos , Extratos Vegetais/administração & dosagem , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Polissacarídeos/química , Polissacarídeos/farmacologia , Pesquisa Qualitativa , Distribuição Aleatória , Espectroscopia de Infravermelho com Transformada de Fourier , Baço/efeitos dos fármacos
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