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1.
Indian J Ophthalmol ; 69(4): 987-989, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33727474

RESUMO

A 42-year-old male patient presented with profound impairment of vision in both eyes, just as he was recovering from COVID-19. A known diabetic and hypertensive, he suffered from COVID-19 pneumonia further complicated by ARDS, septicaemia and acute kidney injury. His vision on presentation was finger counting close to face bilaterally with multiple, yellowish lesions at the posterior pole. Based on the clinical findings and previous blood culture report, it was diagnosed as candida retinitis and treated with oral and intravitreal anti-fungals. The lesions were regressing at follow-up. This is a post COVID-19 presumed candida retinitis case report.


Assuntos
/diagnóstico , Candidíase/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Infecções Oportunistas/diagnóstico , Retinite/diagnóstico , Administração Oral , Adulto , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Fluconazol/uso terapêutico , Humanos , Injeções Intravítreas , Masculino , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Retinite/tratamento farmacológico , Retinite/microbiologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Voriconazol/uso terapêutico
2.
BMC Infect Dis ; 21(1): 8, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407179

RESUMO

BACKGROUND: Nocardiosis is an uncommon opportunistic infection seen in immunocompromised patients or those with a dysfunctional immune system. Nocardia asteroides infection in patients with Pemphigus foliaceus (PF) has never been reported. CASE PRESENTATION: We report an interesting case of nocardiosis-characterized by pulmonary intra-cavitary infection, in a 54-year-old man with PF and diabetes mellitus. The man finally recovered from the infection. CONCLUSIONS: This is the first case reporting pulmonary nocardiosis in a patient with PF. We recommend that physicians be aware of nocardiosis in patients with pemphigus as a possible cause of underlying infectious disease to avoid misdiagnoses and mismanagement.


Assuntos
Nocardiose/complicações , Nocardiose/diagnóstico , Nocardia/isolamento & purificação , Infecções Oportunistas/diagnóstico , Pênfigo/complicações , Antibacterianos/administração & dosagem , Líquido da Lavagem Broncoalveolar/microbiologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Nocardiose/tratamento farmacológico , Nocardiose/microbiologia , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Pênfigo/tratamento farmacológico , Prednisona/administração & dosagem , Escarro/microbiologia , Resultado do Tratamento
3.
Ann Hematol ; 100(3): 653-659, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33495923

RESUMO

The primary aim of this study was to describe the use of primary anti-infective prophylaxis (AP) in common clinical practice in patients affected by immune thrombocytopenia (ITP) and treated with RTX. Population studied consisted of patients affected by ITP (age ≥ 18 years) who had received at least one dose of RTX from January 2008 to June 2018. Five Italian haematology centres participated in the current study. Data were retrospectively collected: demographic data (age, gender), concomitant comorbidities and previous therapies for ITP, characteristics of AP, the occurrence of infections and their management. The ITP cohort consisted of 67 patients sub-grouped into two categories according to the administration of AP: (1) treated with AP (N= 34; 51%) and (2) not treated with AP (N=33, 49%). AP consisted of combined trimethoprim/sulfamethoxazole (TMP/SMX) and acyclovir (AC) in half of patients. TPM/SMX as a single agent was adopted in 32% patients and one patient received only AC. Overall, infections were experienced in 15% of patients during follow-up with a similar proportion in the 2 groups (treated and not treated) of patients (14.7% vs 15%). Clinical course of infections was however, less severe in patients treated with AP, where all infections were grade 2 and did not require hospitalization. In neither group of patients was reported Pneumocystis pneumonia. In conclusion, despite the absence of clear evidence, our analysis shows that AP in patients with ITP receiving RTX is frequently adopted, even if in the absence of well-defined criteria. Prophylaxis administration is quite consistent within the same haematological Center; thus, it seems related to clinicians' experience.


Assuntos
Antibioticoprofilaxia , Infecções Oportunistas/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Rituximab/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/métodos , Antibioticoprofilaxia/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/etiologia , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/epidemiologia , Estudos Retrospectivos , Adulto Jovem
4.
BMC Infect Dis ; 21(1): 27, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413168

RESUMO

BACKGROUND: Ruxolitinib is a novel oral Janus kinase inhibitor that is used for treatment of myeloproliferative diseases. It exhibits potent anti-inflammatory and immunosuppressive effects, and may increase the risk of opportunistic infections. Here, we report a rare case of Cryptococcus neoformans and Mycobacterium haemophilum coinfection in a myelofibrosis patient who was receiving ruxolitinib. CASE PRESENTATION: A 70-year-old Thai man who was diagnosed with JAK2V617F-mutation-positive primary myelofibrosis had been treated with ruxolitinib for 4 years. He presented with cellulitis at his left leg for 1 week. Physical examination revealed fever, dyspnea, desaturation, and sign of inflammation on the left leg and ulcers on the right foot. Blood cultures showed positive for C. neoformans. He was prescribed intravenous amphotericin B deoxycholate with a subsequent switch to liposomal amphotericin B due to the development of acute kidney injury. He developed new onset of fever after 1 month of antifungal treatment, and the lesion on his left leg had worsened. Biopsy of that skin lesion was sent for mycobacterial culture, and the result showed M. haemophilum. He was treated with levofloxacin, ethambutol, and rifampicin; however, the patient eventually developed septic shock and expired. CONCLUSIONS: This is the first case of C. neoformans and M. haemophilum coinfection in a patient receiving ruxolitinib treatment. Although uncommon, clinicians should be aware of the potential for multiple opportunistic infections that may be caused by atypical pathogens in patients receiving ruxolitinib.


Assuntos
Celulite (Flegmão)/microbiologia , Criptococose/microbiologia , Fungemia/microbiologia , Infecções por Mycobacterium/tratamento farmacológico , Pirazóis/efeitos adversos , Idoso , Anfotericina B/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Antifúngicos/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Coinfecção/tratamento farmacológico , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Cryptococcus neoformans/patogenicidade , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Fungemia/tratamento farmacológico , Humanos , Masculino , Infecções por Mycobacterium/microbiologia , Mycobacterium haemophilum/patogenicidade , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Mielofibrose Primária/complicações , Mielofibrose Primária/tratamento farmacológico , Pirazóis/uso terapêutico
5.
Top Antivir Med ; 28(2): 455-458, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32886465

RESUMO

Due to COVID-19, this year marked the first virtual Conference on Retroviruses and Opportunistic Infections (CROI) in the conference's 27-year history. There were important studies presented that provided new insights into the prevention, diagnosis, and treatment of tuberculosis (TB) and other HIV coinfections. Highlights related to TB and HIV coinfections from this year's meeting are reviewed below.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Infecções Oportunistas/epidemiologia , Saúde Pública , Tuberculose/epidemiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Controle de Doenças Transmissíveis/organização & administração , Congressos como Assunto , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Masculino , Micoses/diagnóstico , Micoses/tratamento farmacológico , Micoses/epidemiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Gravidez , Prevalência , Prevenção Primária/métodos , Medição de Risco , Análise de Sobrevida , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Interface Usuário-Computador , Adulto Jovem
6.
Nat Med ; 26(6): 941-951, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32514171

RESUMO

Although disinfection is key to infection control, the colonization patterns and resistomes of hospital-environment microbes remain underexplored. We report the first extensive genomic characterization of microbiomes, pathogens and antibiotic resistance cassettes in a tertiary-care hospital, from repeated sampling (up to 1.5 years apart) of 179 sites associated with 45 beds. Deep shotgun metagenomics unveiled distinct ecological niches of microbes and antibiotic resistance genes characterized by biofilm-forming and human-microbiome-influenced environments with corresponding patterns of spatiotemporal divergence. Quasi-metagenomics with nanopore sequencing provided thousands of high-contiguity genomes, phage and plasmid sequences (>60% novel), enabling characterization of resistome and mobilome diversity and dynamic architectures in hospital environments. Phylogenetics identified multidrug-resistant strains as being widely distributed and stably colonizing across sites. Comparisons with clinical isolates indicated that such microbes can persist in hospitals for extended periods (>8 years), to opportunistically infect patients. These findings highlight the importance of characterizing antibiotic resistance reservoirs in hospitals and establish the feasibility of systematic surveys to target resources for preventing infections.


Assuntos
Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana/genética , Equipamentos e Provisões Hospitalares/microbiologia , Controle de Infecções , Microbiota/genética , Leitos/microbiologia , Biofilmes , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/transmissão , Desinfecção , Farmacorresistência Bacteriana Múltipla/genética , Contaminação de Equipamentos , Mapeamento Geográfico , Humanos , Metagenômica , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/transmissão , Quartos de Pacientes , Singapura , Análise Espaço-Temporal , Centros de Atenção Terciária
8.
Eur Urol ; 77(6): 748-754, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32317180

RESUMO

BACKGROUND: Previous studies on coronavirus disease 2019 (COVID-19) have focused on populations with normal immunity, but lack data on immunocompromised populations. OBJECTIVE: To evaluate the clinical features and outcomes of COVID-19 pneumonia in kidney transplant recipients. DESIGN, SETTING, AND PARTICIPANTS: A total of 10 renal transplant recipients with laboratory-confirmed COVID-19 pneumonia were enrolled in this retrospective study. In addition, 10 of their family members diagnosed with COVID-19 pneumonia were included in the control group. INTERVENTION: Immunosuppressant reduction and low-dose methylprednisolone therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The clinical outcomes (the severity of pneumonia, recovery rate, time of virus shedding, and length of illness) were compared with the control group by statistical analysis. RESULTS AND LIMITATIONS: The clinical symptomatic, laboratory, and radiological characteristics of COVID-19 pneumonia in the renal transplant recipients were similar to those of severe COVID-19 pneumonia in the general population. The severity of COVID-19 pneumonia was greater in the transplant recipients than in the control group (five severe/three critical cases vs one severe case). Five patients developed transient renal allograft damage. After a longer time of virus shedding (28.4 ± 9.3 vs 12.2 ± 4.6 d in the control group) and a longer course of illness (35.3 ± 8.3 vs 18.8 ± 10.5 d in the control group), nine of the 10 transplant patients recovered successfully after treatment. One patient developed acute renal graft failure and died of progressive respiratory failure. CONCLUSIONS: Kidney transplant recipients had more severe COVID-19 pneumonia than the general population, but most of them recovered after a prolonged clinical course and virus shedding. Findings from this small group of cases may have important implications for the treatment of COVID-19 pneumonia in immunosuppressed populations. PATIENT SUMMARY: Immunosuppressed transplant recipients with coronavirus disease 2019 infection had more severe pneumonia, but most of them still achieved a good prognosis after appropriate treatment.


Assuntos
Antivirais/administração & dosagem , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Glucocorticoides/administração & dosagem , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Metilprednisolona/administração & dosagem , Infecções Oportunistas/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Transplantados , Adulto , Idoso , Antivirais/efeitos adversos , Betacoronavirus/imunologia , Betacoronavirus/isolamento & purificação , China , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Feminino , Glucocorticoides/efeitos adversos , Humanos , Imunossupressores/administração & dosagem , Transplante de Rim/mortalidade , Masculino , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Ventilação não Invasiva , Infecções Oportunistas/mortalidade , Infecções Oportunistas/terapia , Infecções Oportunistas/virologia , Oxigenoterapia , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Eliminação de Partículas Virais , Adulto Jovem
9.
Zhonghua Nei Ke Za Zhi ; 59(3): 213-217, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32146748

RESUMO

Objective: To investigate the breakthrough incidence of invasive fungal disease(IFD) and side effects of posaconazole as primary prophylaxis during induction chemotherapy for acute myeloid leukemia(AML). Methods: A total of 206 newly diagnosed AML patients admitted to our department during January 2016 and December 2018 were enrolled in the study. Exclusive criteria were as followings including patients diagnosed as acute promyelocytic leukemia; those who received intravenous antifungal therapy after admission or had history of IFD one month before induction chemotherapy, or those with functional insufficiency of vital organs and those older than 65. Forty-seven patients received posaconazole (posaconazole group), 61 cases received voriconazole (voriconazole group) and 98 cases did not receive any prophylaxis (control group) during induction chemotherapy. Prophylactic efficacy and safety between posaconazole and voriconazole were compared. Results: During induction chemotherapy, five possible cases of IFD occurred in posaconazole group (10.6%); while 11 cases (18.0%) were in voriconazole group including 7 possible, 3 probable and 1 proven. Thirty-five cases (35.7%) in control group were diagnosed as IFD including 19 possible, 11 probable and 5 proven ones. The incidences of IFD in posaconazole and voriconazole group were significantly lower than that in control group (P<0.05). The difference of posaconazole group and voriconazole group was not significant (P>0.05). The reported adverse events in posaconazole group were significantly lower than those in voriconazole group [12.8%(6/47) vs. 32.8%(20/61), P<0.05]. Conclusions: Posaconazole and voriconazole decrease IFD as primary prophylaxis during induction chemotherapy in patients with AML. The prophylactic effect of IFD with posaconazole is similar as voriconazole, but posaconazole shows better safety.


Assuntos
Antifúngicos/uso terapêutico , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/prevenção & controle , Leucemia Mieloide Aguda/microbiologia , Triazóis/uso terapêutico , Antibioticoprofilaxia , Humanos , Quimioterapia de Indução , Leucemia Mieloide Aguda/tratamento farmacológico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/prevenção & controle , Estudos Retrospectivos , Voriconazol
10.
J Mycol Med ; 30(2): 100932, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32008965

RESUMO

Acrophialophora fusispora is a soil-borne fungus rarely implicated in human infections. Here, we report a case of pulmonary infection due to A. fusispora in a 59-year-old male who presented with productive cough and gradually progressive dyspnoea for 20 days. He had a past history of pulmonary tuberculosis and was a known case of chronic obstructive pulmonary disease for past five years. He was diagnosed with mixed connective tissue disease and had been receiving oral azathioprine and prednisolone for three months. CECT thorax revealed an aspergilloma and serum Aspergillus fumigatus-specific IgG levels were raised, suggestive of chronic pulmonary aspergillosis. He was also tested positive for influenza A (H1N1) and received treatment with oral oseltamivir without any clinical benefit. Culture of sputum and bronchoalveolar lavage fluid showed growth of a fungus which was identified as Acrophialophora fusispora based on characteristic microscopic morphology and internal transcribed spacer sequencing of the ribosomal DNA. Antifungal susceptibility testing for six antifungal drugs showed itraconazole to have the most potent in vitro activity (MIC=0.25µg/mL) against A. fusispora in comparison to the other drugs tested. Treatment with itraconazole capsule 200mg twice daily was initiated and favourable clinical response was observed after 10 days of therapy. Follow-up visit after three months showed marked clinical and radiological improvement. A. fusispora is an emerging opportunistic fungus capable of causing invasive infections in immunocompromised hosts. Lack of knowledge about this fungus and confusion with morphologically similar opportunistic fungi have led to its misidentification and hence its prevalence remains largely underestimated. Accurate identification is crucial as it can help initiate early effective antifungal therapy and improve patient outcomes. To our knowledge, this is the first case of pulmonary infection due to A. fusispora reported from India.


Assuntos
Ascomicetos/isolamento & purificação , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/microbiologia , Doença Mista do Tecido Conjuntivo/complicações , Infecções Oportunistas/diagnóstico , Aspergilose Pulmonar/complicações , Antifúngicos/uso terapêutico , Ascomicetos/patogenicidade , Doença Crônica , Coinfecção , Humanos , Hospedeiro Imunocomprometido , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/complicações , Influenza Humana/imunologia , Influenza Humana/microbiologia , Itraconazol/uso terapêutico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/imunologia , Masculino , Pessoa de Meia-Idade , Doença Mista do Tecido Conjuntivo/tratamento farmacológico , Doença Mista do Tecido Conjuntivo/imunologia , Doença Mista do Tecido Conjuntivo/microbiologia , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Aspergilose Pulmonar/tratamento farmacológico , Aspergilose Pulmonar/imunologia , Aspergilose Pulmonar/microbiologia
11.
Intern Med ; 59(2): 261-266, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31941872

RESUMO

Mucormycosis has emerged as the third-most common fungal mycosis and is one of the most fatal molds. We herein report a case study of a 30-year-old woman who was a veterinarian, specializing in livestock, who developed disseminated mucormycosis during induction therapy for acute lymphoblastic leukemia. We successfully used a radical approach for treatment, including a surgical procedure and allogeneic transplantation, with continuous administration of antifungal agents. Reports of successful treatments are extremely rare, and our case has had the longest documented remission from disseminated disease. We speculate that our case's occupational environment may represent a risk factor for development of mucormycosis.


Assuntos
Doenças dos Trabalhadores Agrícolas/tratamento farmacológico , Antifúngicos/uso terapêutico , Transplante de Células-Tronco Hematopoéticas/métodos , Mucormicose/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Médicos Veterinários , Doença Aguda , Adulto , Animais , Humanos , Hospedeiro Imunocomprometido , Gado , Masculino , Infecções Oportunistas/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Transplante Homólogo/métodos , Resultado do Tratamento
12.
J Ethnopharmacol ; 246: 112205, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476442

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Currently, more than two thirds of the world's 36.9 million people living with HIV/AIDS reside in Sub-Saharan Africa. Opportunistic infections (OI) associated with HIV are the single most important cause of mortality and morbidity among HIV/AIDS patients in poor countries. There is widespread use of medicinal plant species to manage the HIV infection and it's associated OI in Uganda, even by patients already on antiretroviral drugs (ARV). However, much of this information remains undocumented and unverified. AIM OF STUDY: The aim of this study was to systematically and comprehensively document the traditional indigenous knowledge and practices associated with the management of HIV/AIDS infections by herbalists in Uganda. METHODS: Ethnobotanical data were collected using semi-structured interviews and questionnaires. Ninety traditional medicine practitioners (TMP) or herbalists were interviewed in Arua, Dokolo, Mbale, Bushenyi, Iganga, Rakai, Luwero and Kaabong districts to gather information on the plant species used. Data were analysed and presented using descriptive statistics and the Informant Consensus Factor. RESULTS: We documented 236 medicinal plant species from 70 families and 201 genera. Acacia was the most widely represented genus with five species. The most frequently used medicinal plant species for treating various OI were Erythrina abyssinica (45), Warburgia ugandensis (43), Zanthoxylum chalybeum (38), Acacia hockii (37), Mangifera indica (36), Aloe vera (35), Albizia coriaria (34), Azadirachta indica (32), Psorospermum febrifugum (27) Vernonia amygdalina (22) and Gymnosporia senegalensis (21). Some of the plant species were used for treating all the OI mentioned. There is a high degree of consensus among the TMP on which plant species they use for the different OI, even though they are geographically separated. Herbalists contribute to the widespread practice of simultaneously using herbal medicines and ARV. Some TMP are also engaged in dangerous practices like injecting patients with herbs and encouraging simultaneous use of herbs and ARV. Although the TMP relied on biomedical laboratory diagnoses for confirming the patients' HIV sero status, they were familiar with the signs and symptoms of HIV/AIDS. CONCLUSION: There is wide spread use of a rich diversity of medicinal plants species and practices by TMP to manage OI in HIV/AIDS patients in Uganda.


Assuntos
Infecções por HIV/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Medicina Tradicional Africana , Infecções Oportunistas/tratamento farmacológico , Fitoterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Etnobotânica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preparações de Plantas/uso terapêutico , Plantas Medicinais , Uganda , Adulto Jovem
13.
Turk Patoloji Derg ; 36(1): 68-72, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-29630083

RESUMO

Microsporidiosis is a rare, but emerging opportunistic infection in solid organ transplant and stem cell transplant recipients. Renal involvement in microsporidiosis is very rarely seen in these recipients. We describe two cases of pediatric renal microsporidiosis, diagnosed on renal biopsies, following bone marrow transplantation presenting as severe acute kidney injury. The first patient died, whereas the second survived due to early diagnosis based on high index of suspicion and prompt treatment with Albendazole. We believe these are the first such reported cases of renal microsporidiosis in pediatric bone marrow transplant recipients.


Assuntos
Lesão Renal Aguda/microbiologia , Transplante de Medula Óssea/efeitos adversos , Microsporídios/patogenicidade , Microsporidiose/microbiologia , Infecções Oportunistas/microbiologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/tratamento farmacológico , Lesão Renal Aguda/imunologia , Adolescente , Albendazol/uso terapêutico , Antiparasitários/uso terapêutico , Evolução Fatal , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Lactente , Masculino , Microsporídios/imunologia , Microsporidiose/diagnóstico , Microsporidiose/tratamento farmacológico , Microsporidiose/imunologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Resultado do Tratamento
14.
J Pediatric Infect Dis Soc ; 9(1): 100-105, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-31183496

RESUMO

Cryptococcus albidus, synonymous with Naganishia albida, rarely causes opportunistic infection in immunocompromised individuals. Its clinical features, particularly in children, are not well defined. Here, we report a case of C albidus fungemia in an immunosuppressed child; we also present results of a systematic review, for which we searched PubMed, Embase, and Web of Science using the keywords "cryptococcus" and "albidus." Our goal was to describe the spectrum of disease, diagnostic approaches, therapies, and outcomes. We identified 20 cases of invasive infection, only 2 of which involved children, and 7 cases of noninvasive infection. The reports originated in the Americas, Europe, and Asia. Of those with invasive infection, 16 (80%) patients had an underlying chronic disorder or had received immunosuppressive therapy, 8 (40%) had fungemia, and 6 (30%) had a central nervous system infection. The attributable case fatality rate was 40%. C albidus is an opportunistic yeast that can rarely cause life-threatening fungemia and central nervous system infection in individuals of any age, especially those who are immunocompromised.


Assuntos
Antifúngicos/uso terapêutico , Criptococose , Cryptococcus , Fluconazol/uso terapêutico , Hospedeiro Imunocomprometido , Arterite de Takayasu/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anfotericina B/uso terapêutico , Pré-Escolar , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/etiologia , Criptococose/imunologia , Feminino , Humanos , Recém-Nascido , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/tratamento farmacológico , Transplante Autólogo
15.
J Pediatric Infect Dis Soc ; 9(1): 96-99, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-31183500

RESUMO

Little information on the efficacy and pharmacokinetics of letermovir among immunocompromised children is currently available. We describe here the use of letermovir in a 2-year-old immunocompromised child with ganciclovir-resistant cytomegalovirus disease who required extracorporeal membrane oxygenation. Detailed information on therapeutic-drug-monitoring measures and dosage adjustments for letermovir is provided.


Assuntos
Acetatos/administração & dosagem , Antivirais/administração & dosagem , Infecções por Citomegalovirus/tratamento farmacológico , Citomegalovirus , Monitoramento de Medicamentos/métodos , Hospedeiro Imunocomprometido , Pneumonia Viral/tratamento farmacológico , Quinazolinas/administração & dosagem , Acetatos/farmacocinética , Acetatos/uso terapêutico , Antivirais/farmacocinética , Antivirais/uso terapêutico , Pré-Escolar , Ensaios de Uso Compassivo , Citomegalovirus/genética , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/virologia , DNA Viral/sangue , Relação Dose-Resposta a Droga , Oxigenação por Membrana Extracorpórea/efeitos adversos , Evolução Fatal , Feminino , Ganciclovir/uso terapêutico , Hepatite Viral Humana/tratamento farmacológico , Hepatite Viral Humana/imunologia , Humanos , Infecções Oportunistas/tratamento farmacológico , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase , Quinazolinas/farmacocinética , Quinazolinas/uso terapêutico , Falha de Tratamento , Carga Viral
16.
BMC Infect Dis ; 19(1): 1024, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31795955

RESUMO

BACKGROUND: In 2018 in Ethiopia, magnitude of human immunodeficiency virus Acquired Immunodeficiency Syndrome treatment failure was 15.9% and currently the number of patient receiving second line antiretroviral therapy (ART) is more increasing than those taking first line ART. Little is known about the predictors of treatment failure in the study area. Therefore; more factors that can be risk for first line ART failure have to identified to make the patients stay on first line ART for long times. Consequently, the aim of this study was to identify determinants of first line ART treatment failure among patients on ART at St. Luke referral hospital and Tulubolo General Hospital, 2019. METHODS: A 1:2 un-matched case-control study was conducted among adult patients on active follow up. One new group variables was formed as group 1 for cases and group 0 for controls and then data was entered in to Epi data version 3 and exported to STATA SE version 14 for analysis. From binary logistic regression variables with p value ≤0.25 were a candidate for multiple logistic regression. At the end variables with a p-value ≤0.05 were considered as statistically significant. RESULT: A total of 350 (117 cases and 233 controls) patients were participated in the study. Starting ART after 2 years of being confirmed HIV positive (AOR = 3.82 95% CI 1.37,10.6), nevirapine (NVP) based initial ART (AOR = 2.77,95%CI 1.22,6.28) having history of lost to follow up (AOR 3.66,95%CI 1.44,9.27) and base line opportunistic infection (AOR = 1.97,95%CI 1.06,3.63), staying on first line ART for greater than 5 years (AOR = 3.42,95%CI 1.63,7.19) and CD4 less than100cell/ul (AOR = 2.72,95%CI 1.46,5.07) were independent determinants of first line ART treatment failure. CONCLUSION: Lost to follow up, staying on first line ART for greater than 5 years, presence of opportunistic infections, NVP based NNRT, late initiation of ART are determinant factors for first line ART treatment failure. The concerned bodies have to focus and act on those identified factors to maintain the patient on first line ART.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Antirretrovirais/uso terapêutico , Nevirapina/uso terapêutico , Adulto , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Etiópia , Feminino , Seguimentos , Soropositividade para HIV/tratamento farmacológico , Hospitais Gerais , Humanos , Modelos Logísticos , Perda de Seguimento , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infecções Oportunistas/tratamento farmacológico , Centros de Cuidados de Saúde Secundários , Falha de Tratamento , Adulto Jovem
17.
BMJ Case Rep ; 12(12)2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31801778

RESUMO

We report a case of a catheter-related bloodstream infection due to oxacillin-susceptible Staphylococcus pseudintermedius in a patient receiving haemodialysis who possibly acquired the organism from her pets. Because of persistent bacteremia and the organism's ability to form biofilm, catheter removal and antimicrobial therapy were indicated to attain source control. Both clinical and microbiological cure were confirmed. Catheter care education should include information about pet exposure and the possibility of zoonotic infections.


Assuntos
Infecções Relacionadas a Cateter/transmissão , Infecções Estafilocócicas/transmissão , Infecções Cutâneas Estafilocócicas/transmissão , Zoonoses/transmissão , Adulto , Animais , Animais Domésticos , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Gatos , Cães , Feminino , Humanos , Falência Renal Crônica/terapia , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/transmissão , Diálise Renal/efeitos adversos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Staphylococcus , Resultado do Tratamento , Zoonoses/tratamento farmacológico
18.
J BUON ; 24(5): 1768-1775, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31786836

RESUMO

Infections in immunocompromised-neoplastic patients represent a severe complication. Among bacteria, Enterococcus species constitute a common causative pathogen of urinary tract infections (UTIs), especially among hospitalized patients with or without urinary tract carcinoma, related commonly to urinary tract abnormalities, urinary catheters or prolonged antibiotic treatment. Although enterococci have been considered more commonly as colonization bacteria in the intestine than virulent agents, they are frequently implicated in UTIs. The high incidence of enterococcal UTIs is associated with several risk factors including age, female gender, previous UTI, diabetes, pregnancy, immunosuppression due to cancer development and progression, renal transplantation and spinal cord injury. Clinical manifestations are usually absent or mild in enterococcal UTIs, which may also become an important source for both bacteremia and endocarditis. Over the last years, the prevalence of multidrug resistant enterococci, particularly vancomycin-resistant E. faecium and E. faecalis has significantly risen worldwide, associated with increased morbidity, limited treatment options and increased health-care costs. In this review, the current knowledge on enterococcal UTIs epidemiology and influence in the corresponding immunocompromised patients is highlighted.


Assuntos
Enterococcus/patogenicidade , Infecções por Bactérias Gram-Positivas/microbiologia , Hospedeiro Imunocomprometido , Neoplasias/imunologia , Infecções Oportunistas/microbiologia , Infecções Urinárias/microbiologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Enterococcus/efeitos dos fármacos , Enterococcus/imunologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/imunologia , Interações Hospedeiro-Patógeno , Humanos , Incidência , Neoplasias/epidemiologia , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/imunologia , Prevalência , Medição de Risco , Fatores de Risco , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Urinárias/imunologia
19.
BMC Infect Dis ; 19(1): 1003, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775716

RESUMO

BACKGROUND: Although antiretroviral therapy (ART) has greatly improved the prognosis of acquired immunodeficiency syndrome (AIDS) patients globally, opportunistic infections (OIs) are still common in Chinese AIDS patients, especially cryptococcosis. CASE PRESENTATION: We described here two Chinese AIDS patients with cryptococcal infections. Case one was a fifty-year-old male. At admission, he was conscious and oriented, with papulonodular and umbilicated skin lesions, some with ulceration and central necrosis resembling molluscum contagiosum. The overall impression reminded us of talaromycosis: we therefore initiated empirical treatment with amphotericin B, even though the case history of this patient did not support such a diagnosis. On the second day of infusion, the patient complained of intermittent headache, but the brain CT revealed no abnormalities. On the third day, a lumbar puncture was performed. The cerebral spinal fluid (CSF) was turbid, with slightly increased pressure. India ink staining was positive, but the cryptococcus antigen latex agglutination test (CrAgLAT: IMMY, USA) was negative. Two days later, the blood culture showed a growth of Cryptococcus neoformans, and the same result came from the skin culture. We added fluconazole to the patient's treatment, but unfortunately, he died three days later. Case two was a sixty-four-year-old female patient with mild fever, productive cough, dyspnea upon movement, and swelling in both lower limbs. The patient was empirically put on cotrimoxazole per os and moxifloxacin by infusion. A bronchofibroscopy was conducted with a fungal culture, showing growth of Cryptococcus laurentii colonies. Amphotericin B was started thereafter but discontinued three days later in favor of fluconazole 400 mg/d due to worsening renal function. The patient became afebrile after 72 h of treatment with considerable improvement of other comorbidities and was finally discharged with continuing oral antifungal therapy. CONCLUSIONS: Our cases illustrate that cryptococcal disease is an important consideration when treating immunocompromised individuals such as AIDS patients. Life threatening meningitis or meningoencephalitis caused by C. neoformansmay still common in these populations and can vary greatly in clinical presentations, especially with regard to skin lesions. Pulmonary cryptococcosis caused by C. laurentii is rare, but should also be considered in certain contexts. Guidelines for its earlier diagnosis, treatment and prophylaxis are needed.


Assuntos
Síndrome de Imunodeficiência Adquirida/microbiologia , Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Infecções Oportunistas/microbiologia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Administração Oral , Anfotericina B/efeitos adversos , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Antígenos de Fungos/imunologia , China , Criptococose/microbiologia , Feminino , Fluconazol/administração & dosagem , Fluconazol/uso terapêutico , Humanos , Masculino , Meningite/microbiologia , Pessoa de Meia-Idade , Infecções Oportunistas/tratamento farmacológico , Resultado do Tratamento
20.
BMJ Case Rep ; 12(11)2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31732540

RESUMO

This report describes a 79-year-old Caucasian man with a history of syringomyelia, paraplegia and a long-term urethral catheter, presenting with recurrent catheter-related or catheter-associated urinary tract infections (CAUTIs) and persistent delirium. On one occasion, urine cultured bacteria from the Burkholderia cepacia complex (BCC). This organism is recognised as being a coloniser of fluid or aquatic settings. However, in certain circumstances (eg, immunosuppression, immunocompromise, multimorbidity), BCC has been recognised to cause infection, that is, rather than merely contamination or colonisation. In this unwell older patient, treatment of the BCC CAUTI was guided by antibiotic sensitivities and microbiology advice. The report incorporates a brief discussion of some relevant microbiological terminology, and refers to associations and commoner sites of BCC-related infection. The report concludes by exploring how three philosophical concepts (Occam's razor, Hickam's dictum and Crabtree's bludgeon) proved relevant in supporting clinical decision-making in this case.


Assuntos
Infecções por Burkholderia/diagnóstico , Cateteres de Demora/efeitos adversos , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Cateterismo Urinário/efeitos adversos , Cateteres Urinários/efeitos adversos , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Idoso , Antibacterianos/uso terapêutico , Infecções por Burkholderia/tratamento farmacológico , Tomada de Decisão Clínica , Diagnóstico Diferencial , Humanos , Masculino , Infecções Oportunistas/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico
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