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2.
Emerg Infect Dis ; 25(3): 559-563, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30789131

RESUMO

A surgical heater-cooler unit has been implicated as the source for Mycobacterium chimaera infections among cardiac surgery patients in several countries. We isolated M. chimaera from heater-cooler units and patient infections in the United States. Whole-genome sequencing corroborated a risk for these units acting as a reservoir for this pathogen.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Genoma Bacteriano , Genômica , Infecções por Mycobacterium/epidemiologia , Infecções por Mycobacterium/etiologia , Mycobacterium/genética , Infecção da Ferida Cirúrgica/epidemiologia , Genômica/métodos , Genótipo , Humanos , Mycobacterium/classificação , Infecções por Mycobacterium/microbiologia , Polimorfismo de Nucleotídeo Único , Estados Unidos/epidemiologia
5.
Int J Infect Dis ; 70: 69-71, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29550450

RESUMO

OBJECTIVES: This study investigated the prevalence and factors associated with mycobacteremia and mortality among febrile HIV infected patients in developing countries. METHODS: A hospital based cross-sectional study was conducted among febrile HIV patients admitted at Bugando Medical centre and Sekou Toure hospital between November 2016 and March 2017. Blood culture was done on BACTEC Myco/F Lytic bottles. Clinical and demographic data were collected using a pre-tested data collection tool. RESULTS: A total of 154 patients with the mean age of 41.5±12.2 were enrolled. Females formed the majority, 93 (60%) of the study participants. The prevalence of Mycobacteremia was 3.3% while that of other bacteria was 8.4%. Age (p=0.03), recent HIV diagnosis (p=0.005), not taking HAART (p=0.031) and low CD4+ count (p=0.002) were significantly associated with Mycobacteremia. Factors significantly associated with 14-day in-hospital mortality were advanced HIV infection (p<0.001), poor ART adherence (p<0.001), low CD4+ (p=0.0002) and Mycobacteremia (p=0.007). CONCLUSION: The prevalence of Mycobacteremia was low; however, it was significantly associated with mortality. Mycobacteremia should be suspected in high risk febrile HIV infected individuals followed by early appropriate treatment in order to reduce associated morbidity and mortality.


Assuntos
Bacteriemia/epidemiologia , Febre/mortalidade , Infecções por HIV/mortalidade , Infecções por Mycobacterium/epidemiologia , Adolescente , Adulto , Idoso , Bacteriemia/etiologia , Bacteriemia/mortalidade , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium/etiologia , Infecções por Mycobacterium/mortalidade , Prevalência , Tanzânia/epidemiologia , Adulto Jovem
6.
BMC Infect Dis ; 18(1): 70, 2018 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-29415658

RESUMO

BACKGROUND: Although atypical mycobacteria had been increasingly found in various ocular infections in the past decades, a slow-growing Mycobacterium haemophilum (M. haemophilum) was scarcely reported. Similar to tuberculous infection, the presentation can masquerade as low-grade granulomatous intraocular inflammation with partial response to corticosteroids. Besides, the special requirements for culture make this pathogen difficult to diagnose. The study aims to report the clinical presentation and notify the awareness of NTM endophthalmitis among clinicians. This is the first case report of late-onset, postoperative M. haemophilum endophthalmitis in the literature. CASE PRESENTATION: A 66-year-old man with non-insulin-dependent diabetes mellitus (NIDDM) manifested chronic granulomatous inflammation in the left eye after multiple glaucoma surgeries. With a diagnosis of noninfectious panuveitis, he was treated with systemic corticosteroids. The inflammation initially responded to therapy although it subsequently worsened and became purulent endophthalmitis. The vitreous cultures grew M. haemophilum. Intraocular and systemic antimicrobial treatments were administered early, but the patient eventually turned blind. CONCLUSIONS: M. haemophilum endophthalmitis is a rare but serious intraocular complication leading to loss of vision or eyeball. Awareness of atypical mycobacterial infections is necessary especially in patients with impaired immune function, previous intraocular surgery, and corticosteroid resistance. Proper laboratory investigations and treatments should be performed. However, due to the rarity of the disease, the development of guidelines for its investigation and therapy is still challenging.


Assuntos
Endoftalmite/etiologia , Infecções por Mycobacterium/etiologia , Mycobacterium haemophilum/patogenicidade , Complicações Pós-Operatórias/microbiologia , Idoso , Antibacterianos/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Glaucoma/cirurgia , Humanos , Masculino , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/microbiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Uveíte/etiologia
7.
Perfusion ; 33(4): 264-269, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29108485

RESUMO

INTRODUCTION: Mycobacterium chimaera ( M. chimaera) is a recently characterised bacterium that can cause life-threatening infections in small numbers of patients who undergo cardiopulmonary bypass during cardiac surgery. The likely mode of transmission is thought to occur through aerosolisation from contaminated water reservoirs. The airborne bacteria then contaminate the surgical field, leading to an infection months or even years later. The preferred practical solution to disrupt the transmission of these airborne bacteria to the patient is to remove the heater-cooler units (HCUs) from the operating room (OR). We describe a process of achieving this in order to provide information to guide other institutions who wish to do a similar thing. METHODS: A multidisciplinary team was assembled to work on the project. The planning phase involved trialling different OR layouts and simulating the alterations in the HCU circuit function. The changes to the OR were made over a weekend to minimise disruption to the operating schedule. RESULTS: The HCU was moved to the dirty utility room adjacent to the OR. Standard operating procedures (SOP) and risk assessments were made to enable this to be used for a dual purpose. One of the ORs was reconfigured to allow the cardiopulmonary bypass machine to be located close to the HCU in the dirty utility room. The total cost of the alterations was £6,158. Although we have provided a physical barrier to interrupt patient exposure to aerosolised M. chimaera from HCUs, we continue to perform cultures and decontamination as per the national recommendations. The SOP was designed to be auditable to ensure compliance with the protocols. CONCLUSIONS: We show a method by which the HCU can be removed from the OR in a relatively low-cost, straightforward and practical manner.


Assuntos
Ar Condicionado , Ponte Cardiopulmonar/efeitos adversos , Calefação , Infecções por Mycobacterium/etiologia , Mycobacterium/isolamento & purificação , Salas Cirúrgicas , Ar Condicionado/economia , Ar Condicionado/instrumentação , Calefação/economia , Calefação/instrumentação , Humanos , Infecções por Mycobacterium/prevenção & controle , Salas Cirúrgicas/economia , Medição de Risco
8.
Intern Med ; 57(3): 423-427, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29093379

RESUMO

Mycobacterium colombiense (M. colombiense) is a member of the Mycobacterium avium complex (MAC). To our knowledge, this is the third case report of an M. colombiense infection. An 80-year-old man, immunocompromised by myelodysplastic syndrome (MDS), developed a skin rash with exfoliation and eruption on his face and scalp. Mycobacteria were detected in pus samples. Broad-range polymerase chain reaction (PCR) revealed the mycobacteria to be M. colombiense. The lesions resolved after daily administration of rifampicin, ethambutol, and clarithromycin. In conclusion, broad-range PCR identified this rare mycobacterium, allowing for the administration of appropriate combination antibiotic therapy.


Assuntos
Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Etambutol/uso terapêutico , Infecções por Mycobacterium/tratamento farmacológico , Síndromes Mielodisplásicas/tratamento farmacológico , Síndromes Mielodisplásicas/microbiologia , Rifampina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Mycobacterium/efeitos dos fármacos , Infecções por Mycobacterium/etiologia , Resultado do Tratamento
9.
Intern Med ; 57(3): 429-435, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29093394

RESUMO

Mycobacterium bovis infection after intravesical Bacillus Calmette-Guérin (BCG) therapy is rare. A 65-year-old Japanese man with history of bladder cancer and intravesical BCG therapy, presented with low-grade fever. An aneurysm with perianeurysmal fluid was suspected and endovascular aortic repair was performed. After 160 days, he developed blood-streaked sputum and computed tomography images revealed that the perianeurysmal fluid area was increasing in size. A multiplex polymerase chain reaction using sputum identified M. bovis. Treatment with anti-tuberculosis drugs reduced the size of the perianeurysmal fluid area. After intravesical BCG therapy, the possibility of M. bovis infection should be considered, thus further investigations are required.


Assuntos
Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/etiologia , Aneurisma da Aorta Abdominal/cirurgia , Vacina BCG/uso terapêutico , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/etiologia , Tuberculose Cardiovascular/tratamento farmacológico , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Administração Intravesical , Idoso , Aneurisma da Aorta Abdominal/microbiologia , Grupo com Ancestrais do Continente Asiático , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tretoquinol , Tuberculose Cardiovascular/diagnóstico , Tuberculose Cardiovascular/microbiologia , Tuberculose Cardiovascular/cirurgia
10.
Front Immunol ; 9: 3148, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30761159

RESUMO

Background: NF-κB1 is a master regulator of both acquired and innate responses. NFKB1 loss-of-function mutations elicit a wide clinical phenotype with asymptomatic individuals at one end of the spectrum and patients with common variable immunodeficiency, combined immunodeficiency or autoinflammation at the other. Impairment of acquired and innate immunity and disseminated Mycobacterium genavense infection expands the clinical and immunological phenotype of NF-κB1 deficiency. Objective: Functional and molecular characterization of a patient with a novel phenotype of NF-κB1 deficiency. Methods: Circulating T, B, dendritic cell subsets and innate or unconventional T-cells were quantified. The cytokine production in stimulated whole blood samples was assessed and molecular characterization by next generation sequencing and gene expression assays were also performed. Results: We report a patient presenting with features of combined immunodeficiency (CID) and disseminated Mycobacterium genavense infection. Sequencing of genomic DNA identified a novel synonymous mutation (c.705G > A) in NFKB1 gene which resulted in exon 8 skipping and haploinsufficiency of the NF-κB1 subunit p50. The susceptibility to atypical mycobacterial infection has not been previously reported and may be the result of a dendritic cell deficiency. A selective deficiency of circulating follicular helper T (cTFH) cells responsible for mediating the differentiation of naive B cells into memory and plasma cells was also present in the patient. It could affect the maturation of innate or unconventional T cells where NF-κB1 could also be involved. Conclusion: These findings showed that the role of NF-κB1 in humans could be critical for the development of acquired and innate immunity and further highlights the role of human T cells in anti-mycobacterial immunity.


Assuntos
Imunidade Adaptativa , Imunidade Inata , Síndromes de Imunodeficiência/complicações , Síndromes de Imunodeficiência/genética , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/etiologia , Mycobacterium/imunologia , Subunidade p50 de NF-kappa B/deficiência , Biópsia , Medula Óssea/metabolismo , Criança , Citocinas/metabolismo , Humanos , Imunofenotipagem , Masculino , Mutação , Linhagem , Fenótipo , Pele/patologia
12.
Int J Infect Dis ; 63: 1-6, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28780185

RESUMO

BACKGROUND: Medical tourism is increasingly popular for elective cosmetic surgical procedures. However, medical tourism has been accompanied by reports of post-surgical infections due to rapidly growing mycobacteria (RGM). The authors' experience working with patients with RGM infections who have returned to the USA after traveling abroad for cosmetic surgical procedures is described here. METHODS: Patients who developed RGM infections after undergoing cosmetic surgeries abroad and who presented at the Montefiore Medical Center (Bronx, New York, USA) between August 2015 and June 2016 were identified. A review of patient medical records was performed. RESULTS: Four patients who presented with culture-proven RGM infections at the sites of recent cosmetic procedures were identified. All patients were treated with a combination of antibiotics and aggressive surgical treatment. CONCLUSIONS: This case series of RGM infections following recent cosmetic surgeries abroad highlights the risks of medical tourism. Close monitoring of affected patients by surgical and infectious disease specialties is necessary, as aggressive surgical debridement combined with appropriate antibiotic regimens is needed to achieve cure. Given the increasing reports of post-surgical RGM infections, consultants should have a low threshold for suspecting RGM, as rapid diagnosis may accelerate the initiation of targeted treatment and minimize morbidity.


Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Turismo Médico , Infecções por Mycobacterium/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adulto , Antibacterianos/uso terapêutico , Desbridamento/efeitos adversos , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/etiologia , Micobactérias não Tuberculosas/isolamento & purificação , Fatores de Risco
13.
J Cardiothorac Vasc Anesth ; 31(5): 1831-1835, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28838729

RESUMO

A SERIES of reports in the United States and Europe have linked Mycobacterium chimaera infections to contaminated heater-cooler devices used during cardiac surgery. Heater-cooler devices commonly are used for cardiopulmonary bypass during cardiac surgery. M. chimaera is a slow-growing nontuberculous mycobacterium that has been shown to cause cardiac complications that can lead to fatal disease following cardiac surgery. Given that more than 250,000 cardiothoracic surgical procedures requiring cardiopulmonary bypass take place each year in the United States, the estimated number of patient exposures to M. chimaera has prompted a public health crisis. The goal of this review is to summarize the present status of the M. chimaera outbreak and provide cardiothoracic surgeons, cardiac anesthesiologists, and other clinicians with current approaches to patient management and to discuss risk mitigation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Infecção Hospitalar/etiologia , Contaminação de Equipamentos , Complicações Intraoperatórias/etiologia , Infecções por Mycobacterium/etiologia , Mycobacterium/isolamento & purificação , Temperatura Baixa/efeitos adversos , Infecção Hospitalar/diagnóstico , Temperatura Alta/efeitos adversos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/microbiologia , Infecções por Mycobacterium/diagnóstico
14.
J Card Surg ; 32(6): 402-404, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28508409

RESUMO

A global outbreak of invasive Mycobacterium chimaera infections after cardiac surgery has recently been linked to bioaerosols from contaminated heater-cooler units. The majority of cases have occurred after valvular surgery or aortic graft surgery and nearly half have resulted in death. To date, infections in patients with left ventricular assist devices (LVADs) have not been characterized in the literature. We report two cases of device-associated M. chimaera infection in patients with continuous-flow LVADs and describe challenges related to diagnosis and management in this population.


Assuntos
Ventrículos do Coração , Coração Auxiliar/efeitos adversos , Coração Auxiliar/microbiologia , Infecções por Mycobacterium/etiologia , Mycobacterium/isolamento & purificação , Infecções Relacionadas à Prótese/etiologia , Idoso , Antibacterianos/administração & dosagem , Desbridamento , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/microbiologia , Infecções por Mycobacterium/terapia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/terapia
15.
Clin Infect Dis ; 65(4): 669-674, 2017 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-28430899

RESUMO

The global outbreak of Mycobacterium chimaera infections associated with heater-cooler devices (HCDs) presents several important, unique challenges for the infection prevention community. The primary focus of this article is to assist hospitals in establishing a rapid response for identification, notification, and evaluation of exposed patients, and management of HCDs with regard to placement and containment, environmental culturing, and disinfection.


Assuntos
Procedimentos Cirúrgicos Cardíacos/instrumentação , Surtos de Doenças/prevenção & controle , Contaminação de Equipamentos/prevenção & controle , Infecções por Mycobacterium , Mycobacterium , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Desinfecção , Feminino , Humanos , Lactente , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium/etiologia , Infecções por Mycobacterium/microbiologia , Infecções por Mycobacterium/prevenção & controle , Gestão de Riscos , Adulto Jovem
16.
Rev Med Interne ; 38(5): 320-327, 2017 May.
Artigo em Francês | MEDLINE | ID: mdl-27639910

RESUMO

Opportunistic infections (OI) are uncommon in sarcoidosis (1 to 10%) and mostly occur in patients with previously diagnosed disease or can rarely be the presenting manifestation. The most common OIs are, in descending order: aspergillosis, cryptococcosis, and mycobacterial infections. Treatment with corticosteroids is the most frequent risk factor for OI occurrence during sarcoidosis but immunosuppressive drugs and therapy with anti-TNFα are also risk factors. Overall, clinical presentation, treatment, and outcome are identical to that occur in other conditions complicated with the occurrence of OIs. However, some atypical presentations of OIs can mimic sarcoidosis exacerbation and misdiagnosis may lead clinicians to increase immunosuppression, causing worsening of the OI. The meticulous collection of patient's history along with factors differentiating OI from sarcoidosis exacerbation is key factor to optimally manage these patients.


Assuntos
Infecções Oportunistas/etiologia , Sarcoidose/complicações , Aspergilose/etiologia , Criptococose/etiologia , Humanos , Hospedeiro Imunocomprometido , Infecções por Mycobacterium/etiologia , Micoses/etiologia , Infecções Oportunistas/imunologia , Infecções Oportunistas/terapia , Doenças Raras/etiologia , Fatores de Risco , Sarcoidose/imunologia , Sarcoidose/terapia , Viroses/etiologia
17.
Can J Anaesth ; 64(5): 513-516, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28035639

RESUMO

PURPOSE: To present a case of mycobacterium infection transmitted through a heater-cooler unit during cardiac bypass surgery. CLINICAL FEATURES: A 63-yr-old woman with a past medical history of aortic coarctation repair in 1963 and a mechanical aortic valve replacement in 2010 was prescribed antibiotics and steroids at an outpatient care facility in September 2015 for symptoms of an upper respiratory tract infection. Four months later, she developed malaise and intermittent fever with anemia and acute kidney dysfunction. Extensive evaluation revealed negative blood cultures but was suggestive of amyloidosis. The patient was therefore started on systemic steroids prior to being referred to us.At our institution, transesophageal echocardiography and cardiac magnetic resonance imaging revealed a normal mechanical aortic prosthesis with an aortic root abscess. The patient was started on empiric antibiotics for endocarditis. Renal biopsy revealed interstitial nephritis with one granuloma for which she was again started on high-dose steroids. The patient continued to deteriorate, with worsening renal function and pancytopenia that required daily red blood cell and platelet transfusions.Three weeks into this hospitalization, her blood cultures were reported to be positive for Mycobacterium chimera, and she was started on a four-drug regimen of rifampin, rifabutin, ethambutol, and clarithromycin, with dramatic clinical improvement. CONCLUSION: Heater-cooler units manufactured by LivaNova prior to September 2014 and used during cardiopulmonary bypass have been linked to M. chimera, which causes a latent infection that may be activated and become disseminated in cases of immunosuppression related to steroid use.


Assuntos
Antibacterianos/administração & dosagem , Ponte Cardiopulmonar/efeitos adversos , Infecções por Mycobacterium/etiologia , Esteroides/administração & dosagem , Ponte Cardiopulmonar/instrumentação , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Contaminação de Equipamentos , Feminino , Humanos , Pessoa de Meia-Idade , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/microbiologia
18.
Ophthalmology ; 124(2): 178-188, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27871762

RESUMO

PURPOSE: To investigate and characterize clinical and histopathologic ocular findings in patients with disseminated infection with Mycobacterium chimaera, a slow-growing nontuberculous mycobacterium (NTM), subsequent to cardiothoracic surgery. DESIGN: Observational case series. PARTICIPANTS: Five white patients (10 eyes). METHODS: Analysis of clinical ocular findings, including visual acuity, slit-lamp biomicroscopy, spectral-domain optical coherence tomography (SD OCT), fundus autofluorescence (FAF), and fluorescein angiography/indocyanine green (ICG) angiography findings, of patients with a disseminated M. chimaera infection. Biomicroscopic and multimodal imaging findings were compared with the histopathology of 1 patient. MAIN OUTCOME MEASURES: Clinical and histopathologic ocular findings of M. chimaera. RESULTS: The mean age of the 5 male patients, diagnosed with endocarditis or aortic graft infection, was 57.8 years. Clinical ocular findings included anterior and intermediate uveitis, optic disc swelling, and white-yellowish choroidal lesions. Multifocal choroidal lesions were observed bilaterally in all patients and were hyperfluorescent on fluorescein angiography, hypofluorescent on ICG angiography, and correlated with choroidal lesions on SD OCT. The extent of choroidal lesions varied from few in 2 patients to widespread miliary lesions in 3 patients leading to localized choroidal thickening with elevation of the overlying retinal layers. Spectral-domain optical coherence tomography through regressing lesions revealed altered outer retinal layers and choroidal hypertransmission. The ocular findings were correlated with the course of the systemic disease. Patients with few choroidal lesions had a favorable outcome, whereas all patients with widespread chorioretinitis died of systemic complications of M. chimaera infection despite long-term targeted antimicrobial therapy. Ocular tissue was obtained from 1 patient at autopsy. Necropsy of 2 eyes of 1 patient revealed prominent granulomatous lymphohistiocytic choroiditis with giant cells. CONCLUSIONS: M. chimaera infection subsequent to cardiothoracic surgery is a novel entity that has been recently described. It involves multiple organ systems and can cause life-threatening disseminated disease. The ocular manifestations documented using multimodal imaging allow us to use the eye as a window to the systemic infection.


Assuntos
Ponte Cardiopulmonar , Oftalmopatias/etiologia , Infecções Oculares Bacterianas/etiologia , Infecções por Mycobacterium/complicações , Mycobacterium/isolamento & purificação , Complicações Pós-Operatórias , Idoso , Quimera , Endocardite Bacteriana/complicações , Olho/microbiologia , Oftalmopatias/microbiologia , Oftalmopatias/patologia , Oftalmopatias/fisiopatologia , Infecções Oculares Bacterianas/microbiologia , Feminino , Angiofluoresceinografia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium/etiologia , Tomografia de Coerência Óptica , Acuidade Visual
19.
Microbiol Immunol ; 60(10): 678-686, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27686649

RESUMO

An association between a hypercoagulable state and Mendelian susceptibility to mycobacterial disease (MSMD) has been established in a few studies; resultant thrombosis is considered rare. In a case-control study, the prevalence of factor V Leiden, prothrombin G20210A and methylenetetrahydrofolate reductase (MTHFR) C677T, A1298C mutations were investigated in mycobacterium-infected patients. The study comprised 30 patients with mycobacterial infections (invasive, disseminated and/or recurrent infections with Bacille Calmette-Guerin or non-tuberculosis mycobacteria and Mycobacterium Tuberculosis with positive results for acid-fast bacilli and tuberculin skin tests) and 30 normal healthy controls. Forty female (66.7%) and 20 male subjects (33.3%) aged from 3 to 70 years were recruited into this study. Genotyping of targeted genes was performed by RT-PCR and cytokine TNF-α concentrations were quantified using a commercially available ELISA kit. Significant associations between mycobacterial infection and TNF-α production after stimulating peripheral blood mononuclear cells with LPS alone and with IFN-γ plus LPS were identified. Moreover, genotyping analysis in the studied population revealed a significant association between MTHFR c.677C>T (OR, 3.28; 95% CI, 1.35-7.92; P < 0.05), MTHFR c.1298A>C (OR, 2.33; 95% CI, 1.10-4.93; P < 0.05) and mycobacterial infection in affected patients, indicating susceptibility to venous thromboembolism according to previous studies. Additionally, mycobacterium-infected patients had a significantly greater prevalence of MTHFR C677T and A1298C mutations than controls.


Assuntos
Estudos de Associação Genética , Predisposição Genética para Doença , Infecções por Mycobacterium/etiologia , Tromboembolia Venosa/complicações , Tromboembolia Venosa/genética , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Pré-Escolar , Citocinas/sangue , Citocinas/metabolismo , Fator V/genética , Feminino , Frequência do Gene , Genótipo , Humanos , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/metabolismo , Masculino , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Pessoa de Meia-Idade , Mutação , Infecções por Mycobacterium/epidemiologia , Razão de Chances , Fenótipo , Polimorfismo de Nucleotídeo Único , Prevalência , Recidiva , Tromboembolia Venosa/imunologia , Adulto Jovem
20.
J Immunol Res ; 2016: 7515687, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27725944

RESUMO

Human tuberculosis remains a huge global public health problem with an estimated 1/3rd of the population being infected. Defensins are antibacterial cationic peptides produced by a number of cell types, most notably neutrophil granulocytes and epithelial cells. All three defensin types (α-, ß-, and θ-defensins) have antibacterial activities, mainly through bacterial membrane permeabilization. Defensins are effective against Gram-negative and Gram-positive bacteria including mycobacteria and are active both intra- and extracellularly. Mycobacterial resistance has never been demonstrated although the mprF gene encoding resistance in Staphylococcus aureus is present in the Mycobacterium tuberculosis genome. In addition to their antibacterial effect, defensins are chemoattractants for macrophages and neutrophils. There are many cases for their use for therapy or prophylaxis in tuberculosis as well. In conclusion, we propose that there is considerable scope and potential for exploring their use as therapeutic/prophylactic agents and more comprehensive survey of defensins from different species and their bioactivity is timely.


Assuntos
Defensinas/metabolismo , Infecções por Mycobacterium/etiologia , Infecções por Mycobacterium/metabolismo , Mycobacterium/imunologia , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Defensinas/química , Defensinas/genética , Defensinas/farmacologia , Interações Hospedeiro-Patógeno/genética , Interações Hospedeiro-Patógeno/imunologia , Humanos , Imunidade , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/microbiologia
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