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1.
BMC Cancer ; 20(1): 15, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906982

RESUMO

BACKGROUND: Patients with lymphoma are at risk for developing pulmonary opportunistic infections due to immunocompromise. However, clinical reports of concurrent lymphoma and opportunistic infection at presentation are rare and often confined to single cases. A delayed diagnosis of either opportunistic infection or lymphoma usually occurs in this complex situation. Here, we report such a case and analyse 18 similar cases searched in the PubMed database to deepen clinicians' understanding. CASE PRESENTATION: A 48-year-old man presented with a 3-month history of fever, cough and emaciation. High-resolution computed tomography revealed bilateral cavitating lesions of different sizes. Aspergillus fumigatus complex was identified from a bronchoalveolar lavage fluid culture. However, antifungal treatment combined with multiple rounds of antibacterial therapy was unsuccessful, and the patient's lung lesions continued to deteriorate. Multiple puncture biopsies finally confirmed the coexistence of diffuse large B-cell lymphoma. Despite the initiation of combination chemotherapy, the patient died of progressive respiratory failure. CONCLUSIONS: Synchronous pulmonary lymphoma and simultaneous opportunistic infection is rare and usually lacks specific clinical and imaging manifestations. Lymphoma should be considered as part of the differential diagnosis of patients with an opportunistic infection when treatment fails or other symptoms are present that could be considered "atypical" for the condition. Tissue biopsy is the gold standard, and multiple biopsies are essential for making the final diagnosis and should be performed upon early suspicion.


Assuntos
Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico , Aspergillus fumigatus/patogenicidade , Biópsia , Diagnóstico Diferencial , Humanos , Aspergilose Pulmonar Invasiva/diagnóstico por imagem , Aspergilose Pulmonar Invasiva/microbiologia , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pulmão/patologia , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/complicações , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/patologia , Tomografia Computadorizada por Raios X
2.
Infect Dis Clin North Am ; 33(4): 1143-1157, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31668195

RESUMO

Transplants have become common with excellent patient and graft outcomes owing to advances in surgical technique, immunosuppression, and antimicrobial prophylaxis. In 2017, 34,770 solid organ transplants were performed in the United States. For solid organ transplant recipients, infection remains a common complication owing to the regimens required to prevent rejection. Opportunistic infections, which are infections that are generally of lower virulence within a healthy host but cause more severe and frequent disease in immunosuppressed individuals, typically occur in the period 1 month to 1 year after transplantation. This article focuses on opportunistic infections in the solid organ transplant recipient.


Assuntos
Infecções Oportunistas/etiologia , Transplantados , Anti-Infecciosos/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Infecções Oportunistas/patologia , Transplante de Órgãos/efeitos adversos
4.
Ann Hematol ; 98(8): 1919-1925, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31168652

RESUMO

The outcome of high-risk myelodysplastic syndrome (MDS) patients treated with 5-azacitidine (5-AZA) in the real-life setting remains largely unknown. We evaluated 110 MDS patients (IPSS intermediate 2/high) treated outside of clinical trials at a single institution between September 2003 and January 2017. Median duration of therapy was 9.5 cycles. The overall survival (OS) of the whole cohort was 66.1% at 1 year and 38.3% at 2 years. No differences in terms of OS were observed with regard to gender (p = 0.622) and age at baseline (< 65 years, 65-75, and > 75 years, p = 0.075). According to the IPSS-R, the very high-risk group had an inferior 2-year OS (17%) compared with intermediate-group patients (64%, p < 0.001). Transfusion independency at baseline was identified as a favorable prognostic factor on 1-year (66.8%) and 2-year OS (43.4%) (p < 0.001). After four cycles, the persistence of bone marrow blasts > 10% identified patients with a worse outcome, with a 2-year OS of 9.4% (p = 0.002). The occurrence of an infection during the first four cycles impacted on the 2-year OS (31.6% vs 58.3% in patients without infections, p = 0.032). Patients receiving at least 24 cycles of the drug have a 5-year OS of 38.2%. This analysis allowed to identify features at baseline or during treatment with 5-AZA associated with a different 2-year OS.


Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Azacitidina/uso terapêutico , Síndromes Mielodisplásicas/tratamento farmacológico , Infecções Oportunistas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/mortalidade , Síndromes Mielodisplásicas/patologia , Infecções Oportunistas/mortalidade , Infecções Oportunistas/patologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
6.
Clin Microbiol Infect ; 25(10): 1186-1194, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30986554

RESUMO

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are serious complications in transplant patients. The aim of this review is to summarize the evidence regarding nosocomial pneumonia in transplant recipients, including HAP in non-ventilated patients and VAP, and to identify future directions for improvement.A comprehensive literature search in the PubMed/MEDLINE database was performed. Articles written in English and published between 1990 and November 2018 were included. HAP/VAP in transplant patients usually occurs early post-transplant, particularly during neutropenia in haematopoietic stem cell transplant recipients. Bacteria are the leading cause of nosocomial pneumonia for both immunocompetent and transplant recipients, being Gram negative organisms, and especially Pseudomonas aeruginosa, highly prevalent. Multidrug-resistant bacteria are of special concern. Pneumonia in the transplant setting may be caused by opportunistic pathogens, and the differential diagnosis needs to be extended to other non-infectious complications. The most relevant opportunistic pathogens are Aspergillus fumigatus, Pneumocystis jirovecii and cytomegalovirus. Nevertheless, they are an exceptional cause of nosocomial pneumonia, and usually occur in severely immunosuppressed patients not receiving antimicrobial prophylaxis. Performing bronchoalveolar lavage may improve the rate of aetiological diagnosis, leading to a change in therapeutic management and improved outcomes. The optimal length of antibiotic therapy for bacterial HAP/VAP has not been well defined, but it should perhaps be longer than in the general population. Mortality associated with HAP/VAP is high. HAP/VAP in transplant patients is frequent and is associated with increased mortality. There is room for improvement in gaining knowledge about the management of HAP/VAP in this population.


Assuntos
Pneumonia Associada a Assistência à Saúde/epidemiologia , Pneumonia Associada a Assistência à Saúde/patologia , Hospedeiro Imunocomprometido , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/patologia , Transplantados , Anti-Infecciosos/uso terapêutico , Bactérias/classificação , Bactérias/isolamento & purificação , Testes Diagnósticos de Rotina , Gerenciamento Clínico , Fungos/classificação , Fungos/isolamento & purificação , Pneumonia Associada a Assistência à Saúde/etiologia , Pneumonia Associada a Assistência à Saúde/mortalidade , Humanos , Infecções Oportunistas/etiologia , Infecções Oportunistas/mortalidade , Análise de Sobrevida , Resultado do Tratamento , Vírus/classificação , Vírus/isolamento & purificação
8.
Acta Parasitol ; 64(1): 103-111, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30644064

RESUMO

BACKGROUND : Microsporidia may cause infection in both immunocompromised and immunocompetent populations. The best strategy to control microsporidiosis is obtaining thorough knowledge of its outbreak and pathogenicity. PURPOSE : Because of the lack of precise estimation of microsporidia prevalence among Iranian children with cancer, the current study aimed at evaluating the rate of intestinal microsporidia in children undergoing chemotherapy. METHODS:  Patients with cancer undergoing chemotherapy in a children's hospital in Northwestern Iran were studied; 132 stool samples were collected and stained by the Weber and Ryan-blue modified trichrome staining techniques. The extracted DNA samples were evaluated by the nested polymerase chain reaction (PCR) method. All positive isolates were sequenced for genotyping and phylogenetic analysis. RESULTS: A total of 17 (12.8%) samples were microscopically positive for microsporidia infection, whereas only 14 (10.6%) cases were positive based on nested PCR results. In the positive samples detected with nested PCR, the frequency of Enterocytozoon bieneusi and Encephalitozoon intestinalis infections was 71.4% (n = 10) and 28.6% (n = 4), respectively. After sequencing and phylogenetic analysis, the genotype of E. bieneusi was type D and the sequences of the isolated species were similar to those of the registered ones. CONCLUSION: E. bieneusi is a major contributor to microsporidiosis in young immunocompromised patients in Iran. Microsporidia species are well-detected when confirmatory techniques such as molecular methods are in agreement with staining. So, to ensure this, a suggestion has been made to introduce a certain diagnostic test for microsporidiosis.


Assuntos
Encephalitozoon/classificação , Encephalitozoon/isolamento & purificação , Encefalitozoonose/epidemiologia , Encefalitozoonose/microbiologia , Neoplasias/complicações , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/microbiologia , Criança , DNA Fúngico/química , DNA Fúngico/isolamento & purificação , Encephalitozoon/genética , Encefalitozoonose/patologia , Fezes/microbiologia , Genótipo , Humanos , Irã (Geográfico) , Infecções Oportunistas/patologia , Filogenia , Reação em Cadeia da Polimerase , Prevalência , Análise de Sequência de DNA
9.
Int J Rheum Dis ; 22(4): 742-745, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25996353

RESUMO

Primary aspergillosis of the kidney is a rare complication of immunosuppression in systemic lupus erythematosus. Symptoms can be insidious and can mimic malignancies, such as lymphomas. Herein, we report a case of a woman with systemic lupus erythematosus with recent history of lymphoma, who presented with a history of prolonged pyrexia without localizing symptoms. Repeat biopsy of the kidneys was crucial in obtaining histological diagnosis, and this was aided by findings on positron emission tomography - computed tomography.


Assuntos
Aspergilose/diagnóstico por imagem , Imunossupressores/efeitos adversos , Rim/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Infecções Oportunistas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Infecções Urinárias/diagnóstico por imagem , Aspergilose/imunologia , Aspergilose/microbiologia , Aspergilose/patologia , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Hospedeiro Imunocomprometido , Rim/imunologia , Rim/microbiologia , Rim/patologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/imunologia , Pessoa de Meia-Idade , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia , Valor Preditivo dos Testes , Infecções Urinárias/imunologia , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia
10.
Transpl Infect Dis ; 21(1): e13025, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30414295

RESUMO

Nocardia species represent a well-recognized yet uncommon cause of opportunistic infections in humans. It most frequently presents as a pulmonary infection with or without central nervous system involvement. It is a very rare cause of spinal abscesses, with only 26 cases reported in the literature. Here we report a 49-year-old man with a history of renal transplantation who presented with low back pain and was diagnosed with epidural and paraspinal abscesses due to Nocardia cyriacigeorgica that was successfully treated with antimicrobial therapy alone. In addition to the case reported here, we also conducted a systematic review of the existing literature regarding spinal abscesses due to Nocardia species and examined the success of the various treatments utilized.


Assuntos
Abscesso Epidural/diagnóstico , Transplante de Rim/efeitos adversos , Vértebras Lombares/microbiologia , Nocardiose/diagnóstico , Infecções Oportunistas/diagnóstico , Administração Intravenosa , Antibacterianos/uso terapêutico , Abscesso Epidural/complicações , Abscesso Epidural/microbiologia , Abscesso Epidural/patologia , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nocardia/isolamento & purificação , Nocardiose/microbiologia , Nocardiose/patologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia , Resultado do Tratamento
11.
J Am Acad Dermatol ; 80(4): 883-898.e2, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30102950

RESUMO

As discussed in the first article in this continuing medical education series, angioinvasive fungal infections pose a significant risk to immunocompromised and immunocompetent patients alike, with a potential for severe morbidity and high mortality. The first article in this series focused on the epidemiology and clinical presentation of these infections; this article discusses the diagnosis, management, and potential complications of these infections. The mainstay diagnostic tests (positive tissue culture with histologic confirmation) are often supplemented with serum biomarker assays and molecular testing (eg, quantitative polymerase chain reaction analysis and matrix-assisted laser desorption ionization time-of-flight mass spectrometry) to ensure proper speciation. When an angioinvasive fungal infection is suspected or diagnosed, further workup for visceral involvement also is essential and may partially depend on the organism. Different fungal organisms have varied susceptibilities to antifungal agents, and knowledge on optimal treatment regimens is important to avoid the potential complications associated with undertreated or untreated fungal infections.


Assuntos
Antifúngicos/uso terapêutico , Dermatomicoses/diagnóstico , Dermatomicoses/tratamento farmacológico , Biomarcadores/sangue , Biópsia por Agulha , Vasos Sanguíneos/patologia , Terapia Combinada , Dermatomicoses/complicações , Dermatomicoses/patologia , Farmacorresistência Fúngica , Humanos , Técnicas de Tipagem Micológica , Infecções Oportunistas/complicações , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/patologia , Reação em Cadeia da Polimerase , Pele/irrigação sanguínea , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
12.
J Am Acad Dermatol ; 80(4): 869-880.e5, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30102951

RESUMO

Angioinvasive fungal infections cause significant morbidity and mortality because of their propensity to invade blood vessel walls, resulting in catastrophic tissue ischemia, infarct, and necrosis. While occasionally seen in immunocompetent hosts, opportunistic fungi are emerging in immunosuppressed hosts, including patients with hematologic malignancy, AIDS, organ transplant, and poorly controlled diabetes mellitus. The widespread use of antifungal prophylaxis has led to an "arms race" of emerging fungal resistance patterns. As the at-risk population expands and new antifungal resistance patterns develop, it is critical for dermatologists to understand and recognize angioinvasive fungal pathogens, because they are often the first to encounter the cutaneous manifestations of these diseases. Rapid clinical recognition, histopathologic, and culture confirmation can help render a timely, accurate diagnosis to ensure immediate medical and surgical intervention. Superficial dermatophyte infections and deep fungal infections, such as blastomycosis and histoplasmosis, have been well characterized within the dermatologic literature, and therefore this article will focus on the severe infections acquired by angioinvasive fungal species, including an update on new and emerging pathogens. In the first article in this continuing medical education series, we review the epidemiology and cutaneous manifestations. The second article in the series focuses on diagnosis, treatment, and complications of these infections.


Assuntos
Dermatomicoses/patologia , Pele/irrigação sanguínea , Aspergilose/complicações , Aspergilose/diagnóstico , Aspergilose/epidemiologia , Aspergilose/patologia , Vasos Sanguíneos/patologia , Candidíase Cutânea/complicações , Candidíase Cutânea/diagnóstico , Candidíase Cutânea/epidemiologia , Candidíase Cutânea/patologia , Dermatomicoses/complicações , Dermatomicoses/diagnóstico , Dermatomicoses/epidemiologia , Farmacorresistência Fúngica , Humanos , Mucormicose/complicações , Mucormicose/diagnóstico , Mucormicose/epidemiologia , Mucormicose/patologia , Infecções Oportunistas/complicações , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/patologia , Feoifomicose/complicações , Feoifomicose/diagnóstico , Feoifomicose/epidemiologia , Feoifomicose/patologia
13.
Pract Neurol ; 19(1): 62-63, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30242096

RESUMO

This case report is of a septuagenarian man on chronic low-dose prednisone who presented with disseminated nocardiosis (Nocardia cyriacigeorgica) that was initially mistaken for metastatic brain cancer. Neurologists should be aware of the potential for opportunistic infections with steroid use and to consider a definite tissue diagnosis with culture and histopathology prior to treatment.


Assuntos
Anti-Inflamatórios/efeitos adversos , Hospedeiro Imunocomprometido , Nocardiose/imunologia , Nocardiose/patologia , Prednisona/efeitos adversos , Idoso , Encéfalo/microbiologia , Encéfalo/patologia , Humanos , Masculino , Nocardiose/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/patologia , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Tela Subcutânea/microbiologia , Tela Subcutânea/patologia
14.
Virchows Arch ; 474(1): 117-123, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30194489

RESUMO

Primary classic Hodgkin lymphoma of the gastrointestinal tract represents a rare occurrence. A full patient's work-up is essential in order to exclude a secondary intestinal involvement. Histologically Epstein-Barr virus mucocutaneous ulcer closely resembles Hodgkin lymphoma. The differential diagnosis between these two entities is relevant, since both the therapeutic approach and the clinical behavior are different. Herein, we describe a case of primary classic Hodgkin lymphoma arising in the ileum and a case of Epstein-Barr virus mucocutaneous ulcer of the colon, focusing on the main clinicopathological differences.


Assuntos
Doenças do Colo/patologia , Infecções por Vírus Epstein-Barr/patologia , Doença de Hodgkin/patologia , Neoplasias do Íleo/patologia , Infecções Oportunistas/patologia , Úlcera/patologia , Adulto , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Biópsia , Doenças do Colo/imunologia , Doenças do Colo/virologia , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/imunologia , Infecções por Vírus Epstein-Barr/virologia , Feminino , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/metabolismo , Humanos , Neoplasias do Íleo/química , Neoplasias do Íleo/tratamento farmacológico , Hospedeiro Imunocomprometido , Imuno-Histoquímica , Imunossupressores/efeitos adversos , Masculino , Metotrexato/efeitos adversos , Infecções Oportunistas/imunologia , Infecções Oportunistas/virologia , Valor Preditivo dos Testes , Úlcera/imunologia , Úlcera/virologia
15.
Inflamm Bowel Dis ; 24(11): 2431-2441, 2018 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-30312414

RESUMO

Background: Vedolizumab (ENTYVIO) is a humanized α4ß7 integrin antagonist approved for the treatment of inflammatory bowel disease, which selectively blocks gut-specific lymphocyte trafficking. We evaluated the risk of opportunistic infections of interest in patients treated with vedolizumab. Methods: We determined the frequency of opportunistic infections and tuberculosis in patients receiving vedolizumab in phase 3 clinical trials and post-marketing settings. We also evaluated adverse events reported in the post-marketing setting in patients with a history of or concurrent hepatitis B/C virus infection. Results: The incidence of opportunistic infections in patients receiving vedolizumab was 0.7 (GEMINI 1 and 2 clinical trials) and 1.0 (long-term safety study) per 100 patient-years, with 217 events reported in approximately 114,071 patient-years of exposure (post-marketing setting). Most opportunistic infections were nonserious and the majority of patients continued treatment with vedolizumab. Clostridium difficile was the most commonly reported infection, with an incidence rate of 0.5 per 100 patient-years (clinical trials). Tuberculosis was reported at 0.1 per 100 patient-years (clinical trials), with 7 events in the post-marketing setting. No tuberculosis-related deaths were reported in either setting. No cases of progressive multifocal leukoencephalopathy were reported. In 29 patients with a history of or concurrent hepatitis B/C infection in the post-marketing setting, no viral reactivation was observed. Conclusions: Clinical trials and post-marketing data showed that the rate of serious opportunistic infections in patients receiving vedolizumab was low and most patients could continue vedolizumab treatment. The frequency of tuberculosis infection was also low and no hepatitis B/C viral reactivation was reported.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Fármacos Gastrointestinais/efeitos adversos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Marketing , Infecções Oportunistas/microbiologia , Tuberculose/microbiologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/induzido quimicamente , Infecções Oportunistas/patologia , Prognóstico , Tuberculose/induzido quimicamente , Tuberculose/patologia , Adulto Jovem
16.
PLoS One ; 13(9): e0204167, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30212579

RESUMO

BACKGROUND/OBJECTIVES: Different adapted Pseudomonas aeruginosa morphotypes are found during chronic infections. Relevant biological determinants in P. aeruginosa successively isolated from a cystic fibrosis (CF) patient were analyzed in this work to gain insight into P. aeruginosa heterogeneity during chronic infection. METHODS: Seventeen P. aeruginosa isolates collected from a patient over a 3 year period were included, 5 small colony variants (SCV) and 12 mucoids. The following analyses were performed: Pulsed-Field-Gel-Electrophoresis (PFGE)/Multilocus- sequence-typing (MLST)/serotype, antimicrobial susceptibility, growth curves, capacity to form biofilm, pigment production, elastase activity, motility; presence/expression of virulence/quorum sensing genes, and identification of resistance mechanisms. RESULTS: All isolates had closely related PFGE patterns and belonged to ST412. Important phenotypic and genotypic differences were found. SCVs were more resistant to antimicrobials than mucoid isolates. AmpC hyperproduction and efflux pump activity were detected. Seven isolates contained two integrons and nine isolates only one integron. All SCVs showed the same OprD profile, while three different profiles were identified among mucoids. No amino acid changes were found in MutL and MutS. All isolates were slow-growing, generally produced high biofilm, had reduced their toxin expression and their quorum sensing, and showed low motility. Nevertheless, statistically significant differences were found among SCV and mucoid isolates. SCVs grew faster, presented higher biofilm formation and flicA expression; but produced less pyorubin and pyocyanin, showed lower elastase activity and rhlR, algD, and lasB expression than mucoid isolates. CONCLUSION: These results help to understand the molecular behavior of chronic P. aeruginosa isolates in CF patients.


Assuntos
Fibrose Cística/microbiologia , Regulação Bacteriana da Expressão Gênica , Genótipo , Infecções Oportunistas/microbiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/genética , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Doença Crônica , Células Clonais , Fibrose Cística/complicações , Fibrose Cística/tratamento farmacológico , Fibrose Cística/patologia , Farmacorresistência Bacteriana/genética , Eletroforese em Gel de Campo Pulsado , Genes Bacterianos , Variação Genética , Humanos , Integrons , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Infecções Oportunistas/complicações , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/patologia , Porinas/genética , Porinas/metabolismo , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/patologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/patogenicidade , Percepção de Quorum , Sorogrupo , beta-Lactamases/genética , beta-Lactamases/metabolismo
17.
Clin Transplant ; 32(10): e13382, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30129986

RESUMO

The aim of the present study was to determine the clinical characteristics, frequency of opportunistic infections (OI) in HCV-positive kidney recipients, and to evaluate HCV replication as a risk factor for developing an OI. We conducted a retrospective study of all kidney recipients from 2003 to 2014. A total of 1203 kidney transplants were performed during the study period. Opportunistic infections were recorded in 251 patients (21%) and nucleic acid amplification testing (NAAT) positivity in 75 (6%). Patients who are HCV NAAT positive were more likely to present an OI than those who are HCV NAAT negative (45% vs 20%, P < 0.001). Multivariate analysis showed the factors that were independently associated with the development of OI to be acute rejection, graft loss, post-transplantation hemodialysis, and HCV replication. Liver cirrhosis after transplantation could not be considered a risk factor to develop OI. To conclude, a high index of suspicion of OI must be maintained in the case of kidney recipients with HCV replication. Active surveillance of cytomegalovirus infection and other prophylactic strategies against OI should be considered after 6 month post-transplantation. Prompt initiation of DAA therapies may be a useful option aiming to decrease the incidence of OI after transplantation.


Assuntos
Rejeição de Enxerto/etiologia , Hepatite C Crônica/complicações , Transplante de Rim/efeitos adversos , Infecções Oportunistas/etiologia , Viremia/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto , Hepacivirus/isolamento & purificação , Hepatite C Crônica/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/patologia , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Transplantados , Viremia/virologia , Adulto Jovem
19.
Biomed Res Int ; 2018: 1923606, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29607315

RESUMO

An evaluation of studies of biologically active nanoparticles provides guidance for the synthesis of nanoparticles with the goal of developing new antibiotics/antifungals to combat microbial resistance. This review article focuses on the physicochemical properties of cerium oxide nanoparticles (CeNPs) with antimicrobial activity. Method. This systematic review followed the Guidelines for Transparent Reporting of Systematic Reviews and Meta-Analyses. Results. Studies have confirmed the antimicrobial activity of CeNPs (synthesized by different routes) using nitrate or chloride salt precursors and having sizes less than 54 nm. Conclusion. Due to the lack of standardization in studies with respect to the bacteria and CeNP concentrations assayed, comparisons between studies to determine more effective routes of synthesis are difficult. The mechanism of CeNP action likely occurs through oxidative stress of components in the cell membrane of the microorganism. During this process, a valence change occurs on the CeNP surface in which an electron is gained and Ce4+ is converted to Ce3+.


Assuntos
Anti-Infecciosos , Cério , Nanopartículas , Infecções Oportunistas/tratamento farmacológico , Animais , Anti-Infecciosos/síntese química , Anti-Infecciosos/química , Anti-Infecciosos/uso terapêutico , Cério/química , Cério/uso terapêutico , Humanos , Nanopartículas/química , Nanopartículas/uso terapêutico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia
20.
Exp Clin Transplant ; 16(5): 522-527, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29534657

RESUMO

OBJECTIVES: We investigated the incidence of gastrointestinal disorders requiring endoscopic and histopathologic diagnoses in renal transplant recipients. MATERIALS AND METHODS: In this retrospective analysis, we examined records of patients seen at the Department of Hepato-Gastroenterology and Transplantation Sciences, Sindh Institute of Urology and Trans?lantation (Karachi, Pakistan) from January 2010 to December 2014. Renal transplant recipients with gastrointestinal disorders who required endoscopy, including proctoscopy and upper and lower gastrointestinal endoscopy as per indication, were included. RESULTS: Of 1770 patients included in this study, most were male patients (n = 1517; 85.7%). In this patient group, 1957 endoscopies, including proctoscopies, were performed, which included 1033 esophagogastroduodenoscopies (52.8%), 571 sigmoidoscopies (29.2%), and 107 colonoscopies (5.5%). The most common indications were diarrhea (n = 697; 31.2%) and weight loss (n = 690; 31%). Findings showed esophageal candidiasis in 127 patients (12%); however, biopsy revealed Candida species in 33 patients (34%). Cytomegalovirus and herpes esophagitis were observed in 8 (8.3%) and 5 patients (5.2%). Helicobacter pylori gastritis was seen in 119 patients (15.4%), cytomegalovirus gastritis in 9 patients (1.2%), and gastric lymphoma in 1 patient (0.1%). Duodenal fissuring was the most common pathology observed during endoscopy (396 patients; 33.9%), followed by decreased height of duodenal folds in 157 patients (13.4%), with biopsy showing sprue in 325 patients (37.6%) and giardiasis in 118 patients (13.7%). Lower gastrointestinal endoscopy showed ulcers in 198 patients (24.6%) and polyps in 31 patients (3.9%). Histopathologic examination showed cytomegalovirus colitis in 89 patients (15.5%), amebic colitis in 21 (3.7%), and tuberculosis in 11 (1.9%). CONCLUSIONS: We observed a wide spectrum of pathologic lesions, including opportunistic infections, in endoscopic biopsies from our renal transplant patients. Cytomegalovirus colitis was the most common infection in the lower gastrointestinal tract, whereas giardiasis was the most common in the duodenum.


Assuntos
Endoscopia Gastrointestinal , Gastroenteropatias/diagnóstico , Trato Gastrointestinal/patologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Infecções Oportunistas/diagnóstico por imagem , Centros de Atenção Terciária , Adulto , Biópsia , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/patologia , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Masculino , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/patologia , Paquistão/epidemiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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