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1.
Exp Parasitol ; 208: 107788, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31647916

RESUMO

Acanthamoeba is a free-living amoeba that is widely distributed in the environment. It is an opportunist protist, which is known to cause rare yet fatal infection of the central nervous system (CNS), granulomatous amebic encephalitis (GAE) in humans. GAE cases are increasingly been reported among immunocompromised patients, with few cases in immunocompetent hosts. Diagnosis of GAE primarily includes neuroimaging, microscopy, cerebrospinal fluid (CSF) culture, histopathology, serology and molecular techniques. Early diagnosis is vital for proper management of infected patients. Combination therapeutic approach has been tried in various GAE cases reported worldwide. We tried to present a comprehensive review, which summarizes on the epidemiology of GAE caused by Acanthamoeba along with the associated clinical symptoms, risk factors, diagnosis and treatment of GAE among infected patients.


Assuntos
Acanthamoeba/patogenicidade , Infecções Protozoárias do Sistema Nervoso Central/parasitologia , Encefalite Infecciosa/parasitologia , Acanthamoeba/classificação , Acanthamoeba/genética , Infecções Protozoárias do Sistema Nervoso Central/diagnóstico , Infecções Protozoárias do Sistema Nervoso Central/epidemiologia , Infecções Protozoárias do Sistema Nervoso Central/terapia , Genótipo , Granuloma/parasitologia , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Encefalite Infecciosa/diagnóstico , Encefalite Infecciosa/epidemiologia , Encefalite Infecciosa/terapia
2.
Radiol Med ; 125(1): 31-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31587180

RESUMO

RATIONAL AND OBJECTIVES: To compare thin-section computed tomography (CT) features of pulmonary cryptococcosis (PC) in immunocompetent and non-AIDS immunocompromised patients. MATERIALS AND METHODS: We retrospectively reviewed CT findings of 18 immunocompetent and 24 non-AIDS immunocompromised patients with clinically proven PC. Different patterns of pulmonary abnormalities between the two groups of patients were compared by Fisher's exact test. RESULTS: Pulmonary nodules were present in 37 of the 42 patients. Masses were detected in 16 patients and consolidation in 9. There were 12 patients with a solitary nodule or mass. Masses were associated with nodules in 12 patients. Consolidation was associated with nodules/masses in nine patients. The nodules/masses were associated with cavitations in 13 patients. Margination of nodules/masses was well defined in nine patients and ill-defined in 33. The abnormalities were predominantly distributed in the peripheral region of the lung (n = 29, 69.0%). The presence of cavitations in nodules/masses was significantly more frequent in non-AIDS immunocompromised than in immunocompetent patients (P = 0.001). CONCLUSIONS: The most common thin-section CT feature of PC was pulmonary nodules/masses, which were ill-defined and located peripherally. Cavitations within nodules/masses were more commonly found in non-AIDS immunocompromised patients. PC should be considered in the differential diagnosis of pulmonary nodules/masses.


Assuntos
Criptococose/diagnóstico por imagem , Imunocompetência , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Criptococose/patologia , Criptococose/cirurgia , Feminino , Humanos , Pneumopatias Fúngicas/patologia , Pneumopatias Fúngicas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
An Bras Dermatol ; 94(6): 744-746, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789256

RESUMO

This report describes a case of unusual deep skin ulcers with tortuous sinus tract formation in an immunocompetent woman. She was initially diagnosed with a Staphylococcus aureus skin infection and histopathologically diagnosed with pyoderma gangrenosum. However, culture from the deep end of ribbon gauze inserted into the subcutaneous sinus tract revealed shiny, light-yellow mucoid colonies, which were identified as Cryptococcus neoformans var. grubii. She was treated with fluconazole for nine months and completely healed. Cryptococcosis is an opportunistic infection caused by variants of C. neoformans species. Cutaneous manifestations of cryptococcosis are quite divergent, rarely occurring as deep skin ulcers with sinus formation.


Assuntos
Criptococose/patologia , Cryptococcus neoformans/isolamento & purificação , Dermatomicoses/patologia , Imunocompetência , Úlcera Cutânea/microbiologia , Úlcera Cutânea/patologia , Adulto , Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Dermatomicoses/tratamento farmacológico , Dermatomicoses/microbiologia , Feminino , Fluconazol/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Úlcera Cutânea/tratamento farmacológico
6.
Mikrobiyol Bul ; 53(4): 464-471, 2019 Oct.
Artigo em Turco | MEDLINE | ID: mdl-31709944

RESUMO

Cryptosporidium spp. is one of the leading causes of parasitic diarrhea. It is the most common parasite in humans all over the world with Giardia. Cryptosporidium is an important cause of chronic diarrhea in Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) patients. Patients with normal immune system may have an asymptomatic course or clinical presentation such as acute watery diarrhea without blood and persistent diarrhea. The severity and duration of the disease may be a reflection of the immune deficiency. Children under two years of age and children with malnutrition may have a risk of prolonged Cryptosporidium spp. infection, even if immunodeficiency work-up is normal, as they may have defects in the natural immune system and lymphocyte functions. Cryptosporidium spp. oocysts contaminate water sources, swimming pools, vegetables and fruits because oocysts are partially resistant to chlorination. So it may be problem for public health. Pets, livestock and humans can be carriers of Cryptosporidium spp. Factors such as developmental level of the countries, immune system, nutritional status, living in crowded environments, contact with contaminated water, close contact with animals, working at a hospital and hot and humid climate affect the incidence of Cryptosporidiosis. Cryptosporidium spp. may cause asymptomatic infection, mild diarrheal disease or severe diarrhea with high volume, which may be accompanied by nausea, vomiting, abdominal pain and fever, following a 1-7 day incubation period. Diarrhea may be acute or chronic, transient, intermittent, or continuous; loss of fluid can be up to 25 L/day in severe diarrhea. Cryptosporidium spp. are mainly located in intestines, but non-intestinal (bile ducts, pancreas, stomach, respiratory system, kidney) involvement may occur in immunocompromised patients. Hepatobiliary system involvement occurs in 10-30% of patients with AIDS; stone-free cholecystitis can lead to sclerosing cholangitis and pancreatitis. Hepatobiliary involvement is not expected in patients without immunodeficiency. In this article, we present a case of Cryptosporodiosis with hepatobiliary system involvement who were admitted to the pediatric emergency clinic with the complaints of severe diarrhea and Cryptosporidium spp. oocysts were detected in parasitological examination of the stool specimen. Immunodeficiency was not considered with her resume and laboratuary examinations. We would like to emphasize that Cryptosporodium spp. may be the cause of severe acute diarrhea in non-immunocompromised patients and may also involve hepatobiliary system involvement.


Assuntos
Doenças Biliares , Criptosporidiose , Cryptosporidium , Diarreia , Hepatopatias , Doenças Biliares/etiologia , Doenças Biliares/parasitologia , Criptosporidiose/complicações , Diarreia/etiologia , Feminino , Humanos , Imunocompetência , Hepatopatias/etiologia , Hepatopatias/parasitologia
7.
Medicine (Baltimore) ; 98(45): e17913, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702669

RESUMO

Nocardia is an opportunistic pathogen from environment, which is generally thought to infect immunosuppressed patients (ISPs), but recent studies showed it could also cause infections in immunocompetent patients (ICPs).The aim of this study was to compare the clinical characteristics, patients' outcome, Nocardia species' identification, and antibiotic susceptibility profiles of nocardiosis between ICPs and ISPs.The detailed clinical data were collected from all the nonrepetitive nocardiosis patients during 2011 and 2018, from a tertiary general hospital in Beijing, China. Then each Nocardia isolate was identified to species level by DNA sequencing. The antibiotic susceptibility testing was performed by E test method, and interpreted following CLSI M24 document. The clinical and microbiological characteristics between ICPs and ISPs were compared statistically.A total of 23 nonrepetitive nocardiosis patients with detailed clinical data were enrolled in this study. Among them, 9 were ICPs and 14 were ISPs. All the skin and soft tissue infections occurred in ICPs (33.3% vs 0%, P < .05). Bronchiectasis occurred more frequently in ICPs (44.4% vs 21.4%), whereas chronic kidney diseases and coinfection with aspergillosis occurred more frequently in ISPs (35.7% vs 0%, 35.7% vs 0%, respectively), although they did not reach the statistical significance. There were no significant differences in other clinical characteristics, Nocardia species' identification, and antibiotic susceptibility between ISPs and ICPs (P > .05).Nocardiosis could occur in both ISPs and ICPs. Skin and soft tissue infection and bronchiectasis occurred more frequently in ICPs. Chronic kidney diseases and co-infection with aspergillosis occurred more frequently in ISPs. These characteristics should be noticed by physicians in diagnosis of nocardiosis.


Assuntos
Imunocompetência , Nocardiose/microbiologia , Nocardia/isolamento & purificação , Adulto , Idoso , Antibacterianos/uso terapêutico , China/epidemiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Pessoa de Meia-Idade , Nocardia/efeitos dos fármacos , Nocardiose/classificação , Nocardiose/diagnóstico , Nocardiose/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
8.
Rev Med Suisse ; 15(666): 1795-1801, 2019 Oct 09.
Artigo em Francês | MEDLINE | ID: mdl-31599520

RESUMO

Aspergillus is a group of molds which is found everywhere worldwide, exposition of human being is common. Most of immunocompetent people do not develop disease caused by Aspergillus. However, diseases in different forms may occur in certain conditions in immunocompetent patient. These diseases include hypersensitivity reactions, like allergic broncho-pulmonary aspergillosis, or infectious process like chronic pulmonary aspergillosis or invasive pulmonary aspergillosis. This article reviewed the clinical features of these diseases and the current available diagnostic techniques.


Assuntos
Imunocompetência/imunologia , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/imunologia , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/imunologia , Humanos , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/imunologia
9.
Exp Parasitol ; 207: 107772, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31610183

RESUMO

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


Assuntos
Coccidiostáticos/uso terapêutico , Cyclospora/efeitos dos fármacos , Ciclosporíase/tratamento farmacológico , Nanopartículas Metálicas/uso terapêutico , Alanina Transaminase/análise , Animais , Aspartato Aminotransferases/análise , Coccidiostáticos/farmacologia , Coccidiostáticos/toxicidade , Creatinina/sangue , Ciclofosfamida/imunologia , Cyclospora/isolamento & purificação , Cyclospora/ultraestrutura , Diarreia/tratamento farmacológico , Diarreia/parasitologia , Fezes/parasitologia , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Imunossupressores/imunologia , Interferon gama/sangue , Fígado/efeitos dos fármacos , Fígado/enzimologia , Masculino , Nanopartículas Metálicas/toxicidade , Camundongos , Microscopia Eletrônica de Varredura , Microscopia Eletrônica de Transmissão , Oocistos/isolamento & purificação , Oocistos/ultraestrutura , Prata , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Ureia/sangue
10.
Med. clín (Ed. impr.) ; 153(7): 290-292, oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185339

RESUMO

Introducción: Streptococcus agalactiae es un microorganismo causal infrecuente en el absceso epidural espinal (AEE) que generalmente afecta a pacientes con comorbilidades predisponentes y/o alguna potencial fuente de infección. Caso clínico: Presentamos el caso de un paciente de 53años, inmunocompetente y sin antecedentes médicos de interés, que desarrolló un cuadro de dolor lumbar, paraparesia y disfunción de esfínteres en el contexto de un síndrome febril sin foco conocido de una semana de evolución. La exploración neurológica mostró paraparesia flácida proximal, nivel sensitivo T10, esfínter anal atónico y reflejos osteotendinosos normales. La RM medular mostró un extenso AEE dorsal. Se realizó una laminectomía urgente con drenaje del absceso en menos de 24h y se inició antibioterapia empírica. El resultado del cultivo mostró Streptococcus agalactiae. Tras un estudio exhaustivo, no se encontró ninguna enfermedad predisponente ni fuente de la infección. Conclusiones: Describimos un caso infrecuente de AEE causado por Streptococcus agalactiae en un paciente sano sin factores predisponentes. Este caso subraya la importancia del diagnóstico precoz de esta entidad, dado que se puede asociar potencialmente con un mejor pronóstico


Background: Streptococcus agalactiae is an uncommon microorganism that causes spinal epidural abscess (SEA) and usually affects individuals with a predisposing condition or potential source of infection. Case description: We present the case of an immunocompetent 53-year-old patient with an unremarkable past medical history who developed progressive low extremity weakness, bowel and bladder dysfunction and genital sensory impairment. A neurological exam on admission revealed flaccid proximal paraparesis, T10 sensory level, atonic anal sphincter and normal myotatic reflexes. Urgent neuroimaging showed a large thoracic epidural spinal abscess. Laminectomy and abscess drainage were immediately performed and systemic antibiotic treatment was initiated. Abscess cultures revealed Streptococcus agalactiae. After an exhaustive workup no predisposing factors or local or systemic source for the infection were found. Conclusions: We report a singular case of spinal epidural abscess caused by Streptococcus agalactiae in a healthy patient with no predisposing factors. This case also highlights the importance of an early diagnosis and treatment to obtain a better neurological outcome


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Epidural/complicações , Streptococcus agalactiae/isolamento & purificação , Imunocompetência , Laminectomia , Medula Espinal/diagnóstico por imagem , Abscesso Epidural/imunologia , Dor Lombar/etiologia , Paraparesia/complicações , Transtornos da Excreção/complicações , Biomarcadores Tumorais , Medula Espinal/patologia
11.
Artigo em Inglês | MEDLINE | ID: mdl-31505743

RESUMO

Hepatitis B Virus (HBV) is a significant public health challenge. Around 250 million people live with chronic HBV infection. With a global approach to this issue, we focus on new perspective in diagnosis, management and prevention of HBV chronic infection. Precise diagnosis of HBV status is crucial to guide patient management. Although available drugs reduce the risk of liver disease progression, they are not able to definitely eradicate HBV, and new therapeutic options are urgently needed. Thus, prevention of HBV infection is still the most effective strategy to achieve the control of the disease. Key aspects of prevention programs include surveillance of viral hepatitis, screening programs and immunization strategies. In spite of the high success rate of licensed HBV vaccines, a need for improved vaccine persists, especially in order to provide coverage of current non-responders.


Assuntos
Hepatite B Crônica , Antivirais/uso terapêutico , Vacinas contra Hepatite B/administração & dosagem , Vírus da Hepatite B/imunologia , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/prevenção & controle , Humanos , Imunização , Imunocompetência
13.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31471448

RESUMO

CONTEXT: Live vaccines usually provide robust immunity but can transmit the vaccine virus. OBJECTIVE: To assess the characteristics of secondary transmission of the vaccine-strain varicella-zoster virus (Oka strain; vOka) on the basis of the published experience with use of live varicella and zoster vaccines. DATA SOURCES: Systematic review of Medline, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases for articles published through 2018. STUDY SELECTION: Articles that reported original data on vOka transmission from persons who received vaccines containing the live attenuated varicella-zoster virus. DATA EXTRACTION: We abstracted data to describe vOka transmission by index patient's immune status, type (varicella or herpes zoster) and severity of illness, and whether transmission was laboratory confirmed. RESULTS: Twenty articles were included. We identified 13 patients with vOka varicella after transmission from 11 immunocompetent varicella vaccine recipients. In all instances, the vaccine recipient had a rash: 6 varicella-like and 5 herpes zoster. Transmission occurred mostly to household contacts. One additional case was not considered direct transmission from a vaccine recipient, but the mechanism was uncertain. Transmission from vaccinated immunocompromised children also occurred only if the vaccine recipient developed a rash postvaccination. Secondary cases of varicella caused by vOka were mild. LIMITATIONS: It is likely that other vOka transmission cases remain unpublished. CONCLUSIONS: Healthy, vaccinated persons have minimal risk for transmitting vOka to contacts and only if a rash is present. Our findings support the existing recommendations for routine varicella vaccination and the guidance that persons with vaccine-related rash avoid contact with susceptible persons at high risk for severe varicella complications.


Assuntos
Vacina contra Varicela/imunologia , Vacina contra Herpes Zoster/imunologia , Infecção pelo Vírus da Varicela-Zoster/transmissão , Vacina contra Varicela/efeitos adversos , Exantema/virologia , Vacina contra Herpes Zoster/efeitos adversos , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Fatores de Risco , Soroconversão , Índice de Gravidade de Doença , Vacinas Atenuadas
14.
Medicina (B Aires) ; 79(4): 287-290, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487250

RESUMO

Histoplasmosis and leishmaniasis are neglected and endemic diseases in Argentina, and generally are found associated with immunosuppression. We report the case of an immunocompetent 16-years-old man with simultaneous occurrence of central nervous system histoplasmosis and cutaneous leishmaniasis. Upon admission, the patient showed a one-month old skin lesion in a leg and mild paraparesis. Imaging studies detected thickening and edema in the spinal cord and the cerebrospinal fluid analysis was within normal range. The case was diagnosed as a demyelinating disorder and treated with high-dose short-term steroids. Seventy-two hours later the patient showed severe paraparesis and nuclear magnetic resonance imaging revealed nodular lesions in the spinal cord. Histoplasma capsulatum belonging to the phylogenetic species LamB was isolated from cerebrospinal fluid samples. The patient received intravenous antifungal therapy with amphotericin B for 30 days, followed by oral fluconazole and itraconazole for one year. Three months after initiation of antifungal treatment, the cutaneous lesion recrudesced and Leishmania amastigotes were observed on microscopic examination. The cutaneous leishmaniasis was treated with intramuscular meglumine antimoniate. The patient's outcome was favorable after treatment for both diseases.


Assuntos
Infecções Fúngicas do Sistema Nervoso Central/complicações , Histoplasmose/complicações , Leishmaniose Cutânea/complicações , Adolescente , Antibacterianos/administração & dosagem , Antifúngicos/administração & dosagem , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Imunocompetência , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Masculino
15.
Rev Port Cir Cardiotorac Vasc ; 26(2): 151-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476818

RESUMO

Mucormycosis is a life-threatening fungal infection that occurs mainly in immunocompromised patients. Its occurrence isolated in the lung rare and carries a high mortality risk if untreated. We report the case of a 76-year old male immunocompetent patient, under treatment for pulmonary tuberculosis, admitted to the emergency department with hemoptysis. Bronchoscopy was performed and active bleeding from the middle lobe bronchus was found. Chest CT scan identified a solitary cavitary lesion in the middle lobe. The patient was proposed for urgent open middle lobectomy. Postoperative period was uneventful. Pulmonary mucormycosis was confirmed and adjuvant therapy with Amphotericin B was performed for 30 days. Despite its rarity, mucormycosis prevalence is expected to raise together with increasing number of immunocompromised patients. A high level of suspicion is recommended as early diagnosis can be determinant.


Assuntos
Pneumopatias Fúngicas/terapia , Mucormicose/terapia , Tuberculose Pulmonar/terapia , Idoso , Anti-Infecciosos/uso terapêutico , Humanos , Imunocompetência , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/imunologia , Masculino , Mucormicose/complicações , Mucormicose/diagnóstico , Mucormicose/imunologia , Pneumonectomia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/imunologia
16.
Immunity ; 51(2): 214-224, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31433969

RESUMO

In ecological terms, the microbiome is defined as the microbiota and its environment, a definition that encompasses the human host. The size, species composition, and biogeography of microbial communities is shaped by host interactions, and, in turn, the microbiota influences many aspects of human health. Here we discuss the concept of microbiota-nourishing immunity, a host-microbe chimera composed of the microbiota and host factors that shape the microbial ecosystem, which functions in conferring colonization resistance against pathogens. We propose that dysbiosis is a biomarker of a weakening in microbiota-nourishing immunity and that homeostasis can be defined as a state of immune competence. Microbiota-nourishing immunity thus provides a conceptual framework to further examine the mechanisms that preserve a healthy microbiome and the drivers and consequences of dysbiosis.


Assuntos
Disbiose/imunologia , Interações Hospedeiro-Patógeno , Microbiota/imunologia , Animais , Autoantígenos/imunologia , Homeostase , Humanos , Imunidade , Imunocompetência , Tolerância a Antígenos Próprios
17.
BMC Infect Dis ; 19(1): 722, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420023

RESUMO

BACKGROUND: Coccidioides spp. are dimorphic fungi endemic to Central America, regions of South America and southwestern USA. Two species cause most human disease: Coccidioides immitis (primarily California isolates) and Coccidioides posadasii. Coccidioidomycosis is typically acquired through inhalation of soil or dust containing spores. Coccidioidal meningitis (CM), most common in the immunocompromised host, can also affect immunocompetent hosts. CASE PRESENTATION: We report a case of C. posadasii meningoencephalitis in a previously healthy 42-year-old Caucasian male who returned to Canada after spending time working in New Mexico. He presented with a 3-week history of headache, malaise and low-grade fevers. He developed progressive confusion and decreasing level of consciousness following hospitalization. Evidence of hydrocephalus and leptomeningeal enhancement was demonstrated on magnetic resonance imaging (MRI) of his brain. Serologic and PCR testing of the patient's CSF confirmed Coccidioides posadasii. Despite appropriate antifungal therapy he continues to have significant short-term memory deficits and has not returned to his full baseline functional status. CONCLUSIONS: Travel to endemic regions can result in disease secondary to Coccidioides spp. and requires physicians in non-endemic areas to have a high index of suspicion. Effective therapeutic options have reduced the mortality rate of CM, however, it is still associated with significant morbidity and requires life-long therapy.


Assuntos
Antifúngicos/uso terapêutico , Coccidioidomicose/microbiologia , Meningite Fúngica/microbiologia , Meningoencefalite/microbiologia , Adulto , Antituberculosos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/microbiologia , Encéfalo/patologia , Canadá , Coccidioides/genética , Coccidioides/patogenicidade , Coccidioidomicose/tratamento farmacológico , Humanos , Imunocompetência , Imunoglobulina M/líquido cefalorraquidiano , Imagem por Ressonância Magnética , Masculino , Meningite Fúngica/diagnóstico por imagem , Meningite Fúngica/tratamento farmacológico , Meningoencefalite/tratamento farmacológico , New Mexico , Viagem
18.
Rev Med Liege ; 74(7-8): 410-413, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31373456

RESUMO

The occurrence of non-viral meningitis remains a heavy diagnosis carrying undeniable pejorative aspects that may vary according to several factors such as the age and the presence or absence of an immunodeficiency. In some cases, uncommon germs can also lead to a bad prognosis such as Listeria monocytogenes that can be responsible of an extremely severe septic state. We report the case of a girl with Listeria meningitis, whose evolution was unfortunately quickly negative.


Assuntos
Listeria monocytogenes , Listeriose , Meningite por Listeria , Sepse , Antibacterianos/uso terapêutico , Criança , Evolução Fatal , Feminino , Humanos , Imunocompetência , Listeria monocytogenes/patogenicidade , Listeriose/diagnóstico , Listeriose/tratamento farmacológico , Listeriose/microbiologia , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/microbiologia
19.
Parasit Vectors ; 12(1): 359, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340851

RESUMO

BACKGROUND: An outbreak of leishmaniasis caused by Leishmania infantum was declared in the southwest of the Madrid region (Spain) in June 2009. This provided a unique opportunity to compare the management of visceral leishmaniasis (VL) in immunocompetent adults (IC-VL), patients with HIV (HIV-VL) and patients receiving immunosuppressants (IS-VL). METHODS: A cohort of adults with VL, all admitted to the Hospital Universitario de Fuenlabrada between June 2009 and June 2018, were monitored in this observational study, recording their personal, epidemiological, analytical, diagnostic, treatment and outcome variables. RESULTS: The study population was made up of 111 patients with VL (10% HIV-VL, 14% IS-VL, 76% IC-VL). Seventy-one percent of the patients were male; the mean age was 45 years (55 years for the IS-VL patients, P = 0.017). Fifty-four percent of the IC-VL patients were of sub-Saharan origin (P = 0.001). Fever was experienced by 98% of the IC-VL patients vs 73% of the LV-HIV patients (P = 0.003). Plasma ferritin was > 1000 ng/ml in 77% of the IC-VL patients vs 17% of the LV-HIV patients (P = 0.007). Forty-two percent of patients fulfilled the criteria for haemophagocytic lymphohistiocytosis. RDT (rK39-ICT) serological analysis returned sensitivity and specificity values of 45% and 99%, respectively, and ELISA/iIFAT returned 96% and 89%, respectively, with no differences in this respect between patient groups. Fourteen (13.0%) patients with VL experienced treatment failure, eight of whom were in the IC-VL group. Treatment with < 21 mg/kg (total) liposomal amphotericin B (LAB) was associated with treatment failure in the IC-VL patients [P = 0.002 (OR: 14.7; 95% CI: 2.6-83.3)]. CONCLUSIONS: IS-VL was more common than HIV-VL; the lack of experience in dealing with IS-VL is a challenge that needs to be met. The clinical features of the patients in all groups were similar, although the HIV-VL patients experienced less fever and had lower plasma ferritin concentrations. RDT (rK39-ICT) analysis returned a good specificity value but a much poorer sensitivity value than reported in other scenarios. The patients with HIV-VL, IS-VL and IC-VL returned similar serological results. Current guidelines for treatment seem appropriate, but the doses of LAB required to treat patients with HIV-VL and IS-VL are poorly defined.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Infecções por HIV/parasitologia , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/epidemiologia , Adulto , Idoso , Antígenos de Protozoários/imunologia , Coinfecção/tratamento farmacológico , Coinfecção/epidemiologia , Coinfecção/parasitologia , Coinfecção/virologia , Diagnóstico Tardio , Surtos de Doenças/prevenção & controle , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Imunocompetência , Imunossupressores/uso terapêutico , Leishmania infantum , Leishmaniose Visceral/tratamento farmacológico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Minorias Sexuais e de Gênero , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Pan Afr Med J ; 32: 170, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303939

RESUMO

Tuberculosis is a disease caused by tubercle bacillus infection. It can affect all of the body's organs. Pulmonary tuberculosis accounts for a little more than 50% of its occurrences. It is a public health problem worldwide, and developing countries in particular. Pseudotumoral bronchopulmonary tuberculosis is a particular form of tuberculosis in immunocompetent subject. It can manifests as a bronchial or pulmonary lesion, suggesting a neoplasia visible on chest CT scan or bronchoscopy. This similarity can confuse clinicians, making diagnosis challenging and requiring the use of invasive diagnostic techniques, since traditional means are often lacking. This increases burden of care and causes delayed treatment. This study aims to educate clinicians about this particular and uncommon form of tuberculosis, which should be suspected in patient with radiological findings compatible with the disease, especially since they live in a highly endemic country. Therapy and treatment duration are the same as for common forms of tuberculosis.


Assuntos
Neoplasias Brônquicas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Tuberculose Pulmonar/diagnóstico , Adulto , Broncoscopia/métodos , Diagnóstico Diferencial , Humanos , Imunocompetência , Masculino , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/patologia
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