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1.
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
2.
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
3.
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
4.
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
5.
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
7.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570344

RESUMO

A 37-year-old woman with a history of inflammatory bowel disease on mercaptopurine presented with a week of recurrent fever, headache, myalgias and mildly elevated serum transaminases and leucopenia. Her workup revealed primary cytomegalovirus (CMV) infection with atypical lymphocytosis, elevated viral load, positive IgM and negative IgG. Two weeks after her initial presentation, she developed odynophagia and diarrhoea prompting endoscopic evaluation with biopsies, which demonstrated CMV disease of the gastrointestinal tract. Her fever and systemic symptoms improved rapidly with initiation of intravenous ganciclovir. She was transitioned to and maintained on oral valganciclovir until two and half months after discharge when her symptoms and lab abnormalities had fully subsided.


Assuntos
Antivirais/uso terapêutico , Infecções por Citomegalovirus/diagnóstico , Ganciclovir/uso terapêutico , Gastroenteropatias/virologia , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infecções Oportunistas/virologia , Adulto , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/imunologia , Feminino , Febre , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/imunologia , Cefaleia , Humanos , Doenças Inflamatórias Intestinais/imunologia , Mialgia , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Resultado do Tratamento , Carga Viral
8.
Monaldi Arch Chest Dis ; 89(3)2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31505923

RESUMO

We present the case of a 46-year-old Caucasian male, affected by ulcerative colitis, who developed tuberculous pleurisy during immunosuppressive therapy; despite proper therapy, worsening of the radiological findings was observed. The case was discussed among an online group of Italian physicians and diagnosis of immune reconstitution inflammatory syndrome (IRIS) tuberculosis was established. Therapy was continued and full recovery was obtained. IRIS is a syndrome initially described during opportunistic infections in HIV infected after being placed in anti-retroviral therapy. It reveals itself through a wide variety of manifestations, including fever, lymphadenopathies, worsening of lung infiltrates, pleural or pericardial effusion, central nervous system involvement. Few data are available regarding the best therapeutic options. IRIS is an insidious and potentially serious complication of opportunistic infections in immunocompromised patients. The always wider diffusion of immunosuppressive therapies increases the number of patients at risk, therefore physicians need to be aware of the issue.


Assuntos
Colite Ulcerativa/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Imunossupressores/efeitos adversos , Infecções Oportunistas/etiologia , Tuberculose Pleural/etiologia , Antituberculosos/uso terapêutico , Colite Ulcerativa/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/tratamento farmacológico , Tuberculose Pleural/tratamento farmacológico
9.
Gastroenterology ; 157(4): e8-e9, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476298
10.
Drug Resist Updat ; 44: 100640, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31492517

RESUMO

Antibiotics are powerful drugs used in the treatment of bacterial infections. The inappropriate use of these medicines has driven the dissemination of antibiotic resistance (AR) in most bacteria. Pseudomonas aeruginosa is an opportunistic pathogen commonly involved in environmental- and difficult-to-treat hospital-acquired infections. This species is frequently resistant to several antibiotics, being in the "critical" category of the WHO's priority pathogens list for research and development of new antibiotics. In addition to a remarkable intrinsic resistance to several antibiotics, P. aeruginosa can acquire resistance through chromosomal mutations and acquisition of AR genes. P. aeruginosa has one of the largest bacterial genomes and possesses a significant assortment of genes acquired by horizontal gene transfer (HGT), which are frequently localized within integrons and mobile genetic elements (MGEs), such as transposons, insertion sequences, genomic islands, phages, plasmids and integrative and conjugative elements (ICEs). This genomic diversity results in a non-clonal population structure, punctuated by specific clones that are associated with significant morbidity and mortality worldwide, the so-called high-risk clones. Acquisition of MGEs produces a fitness cost in the host, that can be eased over time by compensatory mutations during MGE-host coevolution. Even though plasmids and ICEs are important drivers of AR, the underlying evolutionary traits that promote this dissemination are poorly understood. In this review, we provide a comprehensive description of the main strategies involved in AR in P. aeruginosa and the leading drivers of HGT in this species. The most recently developed genomic tools that allowed a better understanding of the features contributing for the success of P. aeruginosa are discussed.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/genética , Genoma Bacteriano , Infecções Oportunistas/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/genética , Células Clonais , Transferência Genética Horizontal , Aptidão Genética , Ilhas Genômicas , Interações Hospedeiro-Patógeno/genética , Humanos , Sequências Repetitivas Dispersas , Epidemiologia Molecular , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/microbiologia , Plasmídeos/química , Plasmídeos/metabolismo , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/crescimento & desenvolvimento , Pseudomonas aeruginosa/patogenicidade , beta-Lactamases/genética , beta-Lactamases/metabolismo
11.
Am J Case Rep ; 20: 1210-1215, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31417073

RESUMO

BACKGROUND Mucormycosis is a serious, potentially fatal fungal infection caused by species in the Mucorales order. Together with candidiasis and aspergillosis, it is one of the most significant fungal infection that carries a high rate of mortality. Early detection and initiation of antifungal therapy with adequate surgical debridement improves the clinical outcome. CASE REPORT We describe a case of mucormycosis in a patient with acute myeloid leukemia who developed disseminated lung disease with muscular involvement without any cutaneous manifestation. Successful treatment was achieved with surgical debridement, amphotericin B lipid-complex and posaconazole step-down therapy. CONCLUSIONS Mucormycosis can present in various clinical scenarios. Key to diagnosis depends on tissues diagnosis from the affected system, as was done with lung and muscle biopsy in our patient. Clinicians should maintain high suspicion for early diagnosis and prompt treatment.


Assuntos
Leucemia Mieloide Aguda/complicações , Pneumopatias Fúngicas/microbiologia , Mucormicose/diagnóstico , Doenças Musculares/microbiologia , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Feminino , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Doenças Musculares/tratamento farmacológico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia
12.
Int J Med Sci ; 16(6): 838-844, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31337957

RESUMO

The increased use of novel and powerful immunosuppressive drugs in kidney diseases may concomitantly expose the patients to higher risk of opportunistic infections, some of which still remain underdiagnosed thus mishandled. As such, we recently had a less prepared encounter of pulmonary nocardial infection in an ANCA-associated renal vasculitis patient under steroid therapy. Despite the use of broad-spectrum antimicrobials including micafungin, the infection was still unbridled and eventually culminated in lethal brain abscess. We thus chose to renew the knowledge of the clinical features, imaging manifestations, differential diagnosis, specific laboratory tests and unique treatment about this rare infection in kidney diseases patients under immunosuppressive therapy. In addition, CT images of easily confused pulmonary lesions superimposed on kidney diseases were also retrieved from our depository. Moreover, impaired renal function as a risk factor for infection and pharmacological options for the treatment were also focused. By sharing our hard-learnt experience and reviewing the literatures, our report may contribute to the awareness among the clinicians in general and nephrologists in particular of this rare disease in susceptible patients and facilitate a swift thus life-saving treatment.


Assuntos
Antibacterianos/uso terapêutico , Imunossupressores/efeitos adversos , Nocardiose/diagnóstico , Infecções Oportunistas/diagnóstico , Pneumonia Bacteriana/diagnóstico , Lesão Renal Aguda/complicações , Lesão Renal Aguda/imunologia , Lesão Renal Aguda/terapia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia , Encéfalo/diagnóstico por imagem , Encéfalo/microbiologia , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Hospedeiro Imunocomprometido , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Nocardiose/tratamento farmacológico , Nocardiose/etiologia , Nocardia asteroides/isolamento & purificação , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/etiologia , Plasmaferese , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/etiologia , Tomografia Computadorizada por Raios X
13.
Mycoses ; 62(9): 847-853, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31166627

RESUMO

Fungal cholecystitis is an uncommon entity, and no cases of cholecystitis associated with mould infection have been reported. We present a case of acute Fusarium cholecystitis in a cytopenic patient with leukaemia who had disseminated fusariosis. We also review the published cases of fungal cholecystitis, which is most often caused by Candida species. Although it is rare, fungal cholecystitis should be part of the differential diagnosis of acute cholecystitis in high-risk patients with predisposing factors for opportunistic fungal infections.


Assuntos
Colecistite Acalculosa/diagnóstico , Colecistite Acalculosa/microbiologia , Colecistite Aguda/microbiologia , Infecções Oportunistas/diagnóstico , Abdome/diagnóstico por imagem , Colecistite Acalculosa/tratamento farmacológico , Adulto , Antifúngicos/uso terapêutico , Biópsia , Diagnóstico Diferencial , Feminino , Fusariose/tratamento farmacológico , Fusariose/microbiologia , Fusarium/patogenicidade , Humanos , Pulmão/diagnóstico por imagem , Neutropenia/complicações , Neutropenia/microbiologia , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Pele/microbiologia , Pele/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
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
15.
Saudi J Kidney Dis Transpl ; 30(3): 606-614, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249224

RESUMO

Cytomegalovirus (CMV) is one of opportunistic infections post solid organ transplant and remains a cause of morbidity and mortality. Mammalian target of rapamycin inhibitors has a theoretical antiviral advantage compared to conventional immunosuppression. The primary outcome was to assess the viremic response and kidney function in a cohort of kidney transplant recipients (KTRs) with difficult to manage CMV infection when converted to sirolimus. We retrospectively analyzed the outcome of substituting sirolimus for mycophenolate mofetil (MMF) or tacrolimus in 18 KTR with difficult to manage, resistant/recurrent CMV viremia unresponsive or intolerant of standard anti-CMV treatment, or immunosuppression reduction. Safety and feasibility of sirolimus conversion were assessed through studying CMV viral loads, creatinine levels, immunosuppression, antiviral therapy, kidney function, and acute rejection episodes before and after starting sirolimus as well as the sirolimus side effects. Data were collected from the hospital filing system. The Wilcoxon matched-pairs signed-rank test and Friedman test were used for statistical analysis. The area under the curve for Log10 CMV viral load (log10 copies/ml) was significantly higher before than after the sirolimus switch (P = 0.0156). The median number of days on antiviral treatment was reduced after conversion to sirolimus [48 days (0-95); vs. 68 days (21-146)]. Acute rejection occurred more commonly before than after starting sirolimus [n =5 (27.7%) vs. n = 2 (11.1%)]. Median serum creatinine before conversion to sirolimus was 175.5 µmol/L (79-243), and showed no deterioration three months and one year after conversion [148 (69-271) and 162.5 (69-287) µmol/L, respectively, P = 0.002]. The use of sirolimus, often alongside tacrolimus and after discontinuation of MMF, is a useful strategy in treating recurrent CMV viremia without provoking rejection.


Assuntos
Antivirais/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Infecções Oportunistas/tratamento farmacológico , Sirolimo/uso terapêutico , Adulto , Idoso , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/virologia , Substituição de Medicamentos , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/efeitos adversos , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/virologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Sirolimo/efeitos adversos , Tacrolimo/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
Saudi J Kidney Dis Transpl ; 30(3): 732-737, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249243
17.
Acta Derm Venereol ; 99(10): 889-893, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31141157

RESUMO

Mycobacterium chelonae is a rapidly growing non-tuberculous mycobacterium, which causes infections of the human skin and soft tissue. Despite an increasing incidence of such infections, patients are often misdiagnosed. We report here 5 patients with cutaneous and/or soft tissue infection due to M. chelonae who were diagnosed and treated at our centre. Two of the 5 patients were on immunosuppressive treatment. While clinical presentations differed in each patient, all had a long history of skin lesions. In addition to careful history-taking, tissue biopsies were obtained for mycobacterial culture and histopathological examination. Culture-directed antibiotic therapy was initiated, which resulted in a slow, but continuous, healing of the lesions. In summary, M. chelonae infections are still relatively rare, but should be considered in both immunocompromised and immunocompetent patients with prolonged skin lesions resistant to standard antibiotic treatment. For diagnosis, tissue analysis for mycobacterial culture and histopathological examination, and once diagnosed, adequate antibiotic treatment, is needed.


Assuntos
Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium chelonae/isolamento & purificação , Infecções Oportunistas/microbiologia , Dermatopatias Bacterianas/microbiologia , Infecções dos Tecidos Moles/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Masculino , Testes de Sensibilidade Microbiana , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/imunologia , Mycobacterium chelonae/efeitos dos fármacos , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/imunologia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/imunologia , Resultado do Tratamento
18.
Internist (Berl) ; 60(7): 678-683, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31089769

RESUMO

Infections in immunosuppressed patients represent a particular challenge in the diagnostics and treatment. They often present with atypical and particularly severe courses, for which rapid diagnostics and treatment are decisive for treatment success. Opportunistic infections with human herpes viruses occur not only more frequently in immunocompromised patients compared to healthy people but also represent a special challenge. In the treatment of immunosuppressed patients, e.g. with human immunodeficiency virus infections and patients with solid organ transplantations, infections with herpes simplex virus, varicella zoster virus, Epstein-Barr virus and cytomegalovirus are particularly important. The symtoms are very variable, ranging from asymptomatic detection of viremia to vital life-threatening organ manifestations. This review article describes the most important clinical presentations of these opportunistic infections. Furthermore, the diagnostic, therapeutic and prophylactic strategies for human herpes viruses are summarized.


Assuntos
Herpes Zoster/diagnóstico , Infecções por Herpesviridae/diagnóstico , Hospedeiro Imunocomprometido/imunologia , Infecções Oportunistas/diagnóstico , Transplante de Órgãos , Transplante/efeitos adversos , Antivirais/uso terapêutico , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Herpes Zoster/tratamento farmacológico , Infecções por Herpesviridae/tratamento farmacológico , Herpesvirus Humano 3 , Herpesvirus Humano 4 , Humanos , Imunossupressão , Infecções Oportunistas/tratamento farmacológico
19.
Int J Rheum Dis ; 22(7): 1331-1334, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31117158

RESUMO

We present a case of an elderly, immunosuppressed patient with rheumatoid arthritis who was not appropriately vaccinated, and subsequently developed herpes zoster ophthalmicus, which initially presented similar to giant cell arteritis. Evidence-based vaccinations are integral in decreasing the incidence of preventable diseases and promoting optimal health at the individual and population level. Although the patient ultimately did not suffer any long-term adverse sequelae, this case highlights the importance of vaccination in the rheumatology setting, and to consider both inflammatory and infectious causes of headache and vision changes in the elderly.


Assuntos
Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Cefaleia/virologia , Herpes Zoster Oftálmico/virologia , Herpesvirus Humano 3/patogenicidade , Infecções Oportunistas/virologia , Transtornos da Visão/virologia , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/imunologia , Cefaleia/diagnóstico , Cefaleia/tratamento farmacológico , Cefaleia/imunologia , Herpes Zoster Oftálmico/diagnóstico , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/imunologia , Herpesvirus Humano 3/efeitos dos fármacos , Herpesvirus Humano 3/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/imunologia
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