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1.
Praxis (Bern 1994) ; 110(2): 108-110, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33530778

RESUMO

An Itching Pleasure Abstract. A 50-year-old female patient presents in the emergency department with an itchy, acneiform exanthema on the trunk and malaise for two days. Laboratory testing showed no abnormalities. After further questioning, the patient reported frequent use of her new whirlpool. Based on the medical history and the clinic we suspected a pseudomonas folliculitis. A bacterial culture of the pustules showed growth of Pseudomonas aeruginosa, which confirmed the diagnosis. Systemic antibiotics were not necessary in the absence of risk factors for severe progress or immunosuppression. The exanthema healed within a few days without any complications by using external disinfectants.


Assuntos
Foliculite , Infecções por Pseudomonas , Feminino , Humanos , Pessoa de Meia-Idade , Prazer , Prurido/etiologia , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa
2.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472807

RESUMO

Infectious scleritis is a rare but important cause of scleral inflammation. It is usually associated with an underlying ocular (prior ocular surgery or trauma) or systemic risk factor. A 53-year-old apparently systemically healthy woman presenting with spontaneous-onset pain, redness and watering in the left eye for 10 days was diagnosed with culture-proven Pseudomonas aeruginosa anterior scleritis. However, she was non-responsive to organism-sensitive antibiotics and scleral graft was performed twice, which showed graft re-infection. On repeated extensive systemic evaluations, the patient was diagnosed with biopsy-proven granulomatosis with polyangiitis (GPA). The patient was started on mycophenolate mofetil for both induction and maintenance phases and showed dramatic improvement with no recurrence till 1 year follow-up. High index of suspicion for autoimmune disorders, especially GPA, must be maintained for unilateral relentless infective scleritis masquerading as autoimmune necrotising scleritis. Mycophenolate mofetil holds a promising role for inducing as well as maintaining disease remission in ocular GPA.


Assuntos
Doenças Autoimunes/diagnóstico , Diagnóstico Diferencial , Granulomatose com Poliangiite/diagnóstico , Infecções por Pseudomonas/diagnóstico , Esclerite/diagnóstico , Antibacterianos , Cefazolina/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Humanos , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Ácido Micofenólico , Polimixina B/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/etiologia , Infecções por Pseudomonas/patologia , Pseudomonas aeruginosa , Esclerite/tratamento farmacológico , Esclerite/etiologia , Esclerite/patologia , Tropanos/uso terapêutico
4.
BMJ Case Rep ; 14(1)2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468501

RESUMO

Herein, we report a case of a 68-year-old woman receiving ibrutinib for chronic lymphocytic leukaemia, who presented with septic shock and a progressive necrotic lesion on her nose. Surgical pathology of the nasal lesion revealed evidence of tissue necrosis, and both tissue and blood culture grew Pseudomonas aeruginosa A diagnosis of ecthyma gangrenosum was made. Additional investigations also led to the discovery of invasive pulmonary aspergillosis. To our knowledge, this is the first case of ecthyma gangrenosum secondary to Pseudomonas sepsis and concurrent invasive pulmonary aspergillosis associated with ibrutinib use.


Assuntos
Adenina/análogos & derivados , Ectima/diagnóstico , Ectima/etiologia , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Piperidinas/efeitos adversos , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa , Adenina/efeitos adversos , Idoso , Feminino , Humanos , Necrose , Infecções por Pseudomonas/etiologia , Sepse/diagnóstico , Sepse/etiologia
5.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370978

RESUMO

A 57-year-old male chronic smoker with underlying diabetes mellitus presented with dysphonia associated with cough, dysphagia and reduced effort tolerance of 3 months' duration. Videoendoscope finding revealed bilateral polypoidal and erythematous true and false vocal fold with small glottic airway. The patient was initially treated as having tuberculous laryngitis and started on antituberculous drug. However, no improvement was observed. CT of the neck showed erosion of thyroid cartilage, which points to laryngeal carcinoma as a differential diagnosis. However, the erosion was more diffuse and appeared systemic in origin. The diagnosis of laryngeal perichondritis was made when the histopathological examination revealed features of inflammation, and the tracheal aspirate isolated Pseudomonas aeruginosa The patient made a good recovery following treatment with oral ciprofloxacin.


Assuntos
Doenças da Laringe/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Tosse/microbiologia , Transtornos de Deglutição/microbiologia , Diagnóstico Diferencial , Disfonia/microbiologia , Humanos , Doenças da Laringe/complicações , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/microbiologia , Neoplasias Laríngeas/diagnóstico , Laringoscopia , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Cartilagem Tireóidea/diagnóstico por imagem , Cartilagem Tireóidea/microbiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Laríngea/diagnóstico , Prega Vocal/diagnóstico por imagem , Prega Vocal/microbiologia
6.
BMC Infect Dis ; 20(1): 729, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028225

RESUMO

BACKGROUND: This study describes the disease burden, clinical characteristics, antibiotic management, impact of multidrug resistance and outcome of Pseudomonas aeruginosa bloodstream infection (PABSI) among children admitted to a tertiary referral hospital for children in Cape Town, South Africa. METHODS: A retrospective descriptive study was conducted at a paediatric referral hospital in Cape Town, South Africa. Demographic and clinical details, antibiotic management and patient outcome information were extracted from medical and laboratory records. Antibiotic susceptibility results of identified organisms were obtained from the National Health Laboratory Service database. RESULTS: The incidence risk of PABSI was 5.4 (95% CI: 4.34-6.54) PABSI episodes / 10,000 hospital admissions and the most common presenting feature was respiratory distress, 34/91 (37.4%). Overall, 69/91 (75.8%) of the PA isolates were susceptible to all antipseudomonal antibiotic classes evaluated. Fifty (54.9%) of the PABSI episodes were treated with appropriate empiric antibiotic therapy. The mortality rate was 24.2% and in multivariable analysis, empiric antibiotic therapy to which PA isolates were not susceptible, infections present on admission, and not being in the intensive care unit at the time that PABSI was diagnosed were significantly associated with 14-day mortality. CONCLUSIONS: PABSI caused appreciable mortality, however, appropriate empiric antibiotic therapy was associated with reduced 14-day mortality.


Assuntos
Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Hospitais Pediátricos , Humanos , Lactente , Unidades de Terapia Intensiva , Masculino , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/mortalidade , Pseudomonas aeruginosa/efeitos dos fármacos , Estudos Retrospectivos , África do Sul/epidemiologia , Taxa de Sobrevida , Centros de Atenção Terciária
7.
BMC Infect Dis ; 20(1): 665, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907533

RESUMO

BACKGROUND: Pseudomonas aeruginosa (P. aeruginosa) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia. METHODS: From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500-bed tertiary teaching hospital in Chongqing, China retrospectively. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and septic shock. RESULTS: Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 h. Early TTP (≤18 h) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P = 0.014), higher incidence of septic shock (52.4% vs12.9%, P = 0.06), higher Pitt bacteremia scores [3.00 (1.00-5.00) vs 1.00 (1.00-4.00), P = 0.046] and more intensive care unit admission (61.9% vs 22.6%, P = 0.008) when compared with late TTP (> 18 h) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for in-hospital mortality (OR 5.88, 95%CI 1.21-21.96, P = 0.035; OR 4.95, 95%CI 1.26-27.50, P = 0.024; respectively). The independent risk factors for septic shock were as follows: TTP ≤18 h, Pitt bacteremia scores ≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18-33.77, P = 0.032; OR 8.15, 95%CI 1.15-42.43, P = 0.014; OR 6.46, 95% CI 1.19-33.19 P = 0.031; respectively). CONCLUSIONS: Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children.


Assuntos
Bacteriemia/diagnóstico , Hemocultura , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Bacteriemia/mortalidade , Criança , Pré-Escolar , China , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Lactente , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Prognóstico , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/mortalidade , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Choque Séptico/mortalidade , Centros de Atenção Terciária , Fatores de Tempo
8.
Am J Respir Crit Care Med ; 202(8): 1133-1145, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32569477

RESUMO

Rationale: In cystic fibrosis the major cause of morbidity and mortality is lung disease characterized by inflammation and infection. The influence of sphingolipid metabolism is poorly understood with a lack of studies using human airway model systems.Objectives: To investigate sphingolipid metabolism in cystic fibrosis and the effects of treatment with recombinant human acid ceramidase on inflammation and infection.Methods: Sphingolipids were measured using mass spectrometry in fully differentiated cultures of primary human airway epithelial cells and cocultures with Pseudomonas aeruginosa. In situ activity assays, Western blotting, and quantitative PCR were used to investigate function and expression of ceramidase and sphingomyelinase. Effects of treatment with recombinant human acid ceramidase on sphingolipid profile and inflammatory mediator production were assessed in cell cultures and murine models.Measurements and Main Results: Ceramide is increased in cystic fibrosis airway epithelium owing to differential function of enzymes regulating sphingolipid metabolism. Sphingosine, a metabolite of ceramide with antimicrobial properties, is not upregulated in response to P. aeruginosa by cystic fibrosis airway epithelia. Tumor necrosis factor receptor 1 is increased in cystic fibrosis epithelia and activates NF-κB signaling, generating inflammation. Treatment with recombinant human acid ceramidase, to decrease ceramide, reduced both inflammatory mediator production and susceptibility to infection.Conclusions: Sphingolipid metabolism is altered in airway epithelial cells cultured from people with cystic fibrosis. Treatment with recombinant acid ceramidase ameliorates the two pivotal features of cystic fibrosis lung disease, inflammation and infection, and thus represents a therapeutic approach worthy of further exploration.


Assuntos
Ceramidase Ácida/metabolismo , Ceramidase Ácida/farmacologia , Fibrose Cística/tratamento farmacológico , Pneumonia/diagnóstico , Infecções por Pseudomonas/diagnóstico , Esfingolipídeos/metabolismo , Adolescente , Células Epiteliais Alveolares/efeitos dos fármacos , Animais , Western Blotting/métodos , Células Cultivadas , Criança , Fibrose Cística/diagnóstico , Humanos , Inflamação/diagnóstico , Inflamação/tratamento farmacológico , Espectrometria de Massas/métodos , Camundongos , Pneumonia/tratamento farmacológico , Reação em Cadeia da Polimerase/métodos , Infecções por Pseudomonas/tratamento farmacológico , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Adulto Jovem
9.
J Laryngol Otol ; 134(5): 404-408, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32498734

RESUMO

OBJECTIVE: To predict skull base osteomyelitis in patients with necrotising otitis externa using diffusion-weighted imaging. METHODS: A retrospective analysis was conducted of 25 necrotising otitis externa patients with skull base osteomyelitis (n = 10) or without skull base involvement (n = 14) who underwent a single-shot diffusion-weighted imaging of the skull base. RESULTS: The respective mean apparent diffusion coefficient values of the skull base, as determined by two reviewers, were 0.851 ± 0.15 and 0.841 ± 0.14 ×10-3mm2/s for the skull base osteomyelitis patients, and 1.065 ± 0.19 and 1.045 ± 0.20 ×10-3mm2/s for the necrotising otitis externa patients without skull base involvement. The difference in apparent diffusion coefficients between the groups was significant, for both reviewers (p = 0.008 and 0.012). The optimal threshold apparent diffusion coefficient for predicting skull base osteomyelitis in necrotising otitis externa patients was 0.945 ×10-3mm2/s and 0.915 ×10-3mm2/s, with an area under the curve of 0.825 and 0.800, accuracy of 87.5 and 83.3 per cent, sensitivity of 85.7 and 90.0 per cent, and specificity of 90.0 and 78.6 per cent, for each reviewer respectively. CONCLUSION: Apparent diffusion coefficient is a non-invasive imaging parameter useful for predicting skull base osteomyelitis in necrotising otitis externa patients.


Assuntos
Osteomielite/patologia , Otite Externa/complicações , Base do Crânio , Adulto , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Necrose/patologia , Osteomielite/complicações , Osso Petroso , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus
12.
Infection ; 48(2): 303-307, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31981091

RESUMO

INTRODUCTION: Pseudomonas aeruginosa (PA) is a known cause of skin and soft tissue infections (SSTIs). Therapeutic options against multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of PA are limited, especially in patients with impaired renal function. Ceftolozane/tazobactam (C/T) is a novel beta-lactam/beta-lactamase inhibitor with powerful anti-PA activity. Thanks to its characteristics, it appears to be the best available anti-pseudomonal drug in many clinical scenarios. A case series of four adult patients followed between January 2018 and May 2019 is reported. All subjects presented complicated SSTIs by MDR- or XDR-PA and were affected by chronic kidney disease. RESULTS: C/T was used as a monotherapy in three cases and in combination regimen in the remaining case. In two cases, C/T was the first-line option, in the remaining ones was the salvage treatment. All patients were successfully treated without worsening of renal function and without any other adverse events. CONCLUSIONS: C/T may represent a useful option against MDR- and XDR-PA strains responsible of complicated SSTIs in patients affected by impaired renal function.


Assuntos
Cefalosporinas/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Dermatopatias Bacterianas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Tazobactam/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Humanos , Pessoa de Meia-Idade , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/microbiologia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/microbiologia , Resultado do Tratamento
13.
J Dermatol ; 47(2): 121-127, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31803963

RESUMO

Papulopustular rash, an acneiform rash, appears on the seborrheic region during the first to second week of treatment with an epidermal growth factor receptor inhibitor (EGFRi). The rash gradually disappears after the fourth week; however, it persists or newly develops in other regions during EGFRi treatment. Because Staphylococcus aureus is frequently isolated from late-phase papulopustular rash, we assessed the incidence of bacterial infection and treatment outcomes of patients with late-phase papulopustular rash. Sixty-four cases treated with an EGFRi over 4 weeks who presented with papulopustular rash were assessed retrospectively. The median duration of EGFR inhibitor treatment was 5 months. Grade 2 and 3 papulopustular rash was observed in 47 and eight cases, respectively. Bacterial culture was performed in 51 cases, 50 of which yielded positive results: methicillin-sensitive S. aureus in 29, methicillin-resistant S. aureus in 14, Staphylococcus species in five, Pseudomonas aeruginosa in three, and other in four cases. Of the S. aureus isolates, 42% were resistant to minocycline and 40% to levofloxacin. After treatment with topical and/or oral antibiotics without topical corticosteroids, the papulopustular rash rapidly improved by an average of 2.9 ± 3.4 weeks. However, use of a combination of antibiotics and a topical corticosteroid prolonged the recovery period to an average of 18.9 ± 11.4 weeks. In conclusion, folliculitis that develops over 4 weeks after the initiation of EGFRi treatment is typically caused by staphylococcal infection. Bacterial culture is necessary due to the high rate of antibiotic resistance. It is important to distinguish late- from early-phase papulopustular rash and to treat using different approaches.


Assuntos
Antibacterianos/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Exantema/diagnóstico , Foliculite/diagnóstico , Infecções por Pseudomonas/diagnóstico , Infecções Estafilocócicas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Cetuximab/efeitos adversos , Farmacorresistência Bacteriana , Receptores ErbB/antagonistas & inibidores , Exantema/tratamento farmacológico , Exantema/imunologia , Exantema/microbiologia , Feminino , Foliculite/tratamento farmacológico , Foliculite/imunologia , Foliculite/microbiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Panitumumabe/efeitos adversos , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/imunologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/imunologia , Pseudomonas aeruginosa/isolamento & purificação , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/imunologia , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo
14.
Indian J Ophthalmol ; 68(1): 232-233, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31856535

RESUMO

We report a rare case of Pseudomonas stutzeri endophthalmitis in an immunocompetent individual along with the review of the literature. A 39-year-old healthy lady presented with sudden painful loss of vision in her right eye. She was diagnosed with postcataract surgery acute endophthalmitis and underwent vitrectomy, intraocular lens explantation and intravitreal antibiotics. P. stutzeri was isolated from vitreous. Though the infection was controlled, the anatomy of the eye could not be salvaged and the right eye became phthisical. P. stutzeri is a rare cause of endophthalmitis with usually poor outcomes.


Assuntos
Extração de Catarata/efeitos adversos , Endoftalmite/etiologia , Infecções por Pseudomonas/etiologia , Pseudomonas stutzeri/isolamento & purificação , Adulto , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas , Feminino , Humanos , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/microbiologia
15.
Burns ; 46(1): 182-189, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31859083

RESUMO

BACKGROUND: Many studies have suggested that procalcitonin can predict bloodstream infection and also distinguish between Gram-negative, Gram-positive and fungal infections after burn. However, up to now, there is no literature on serum procalcitonin level of multidrug-resistant pathogens and non-multidrug-resistant pathogens among Gram-negative bloodstream infections after burn. The purpose of this study is to explore the value of serum procalcitonin in identifying Gram-negative bloodstream infection in patients with febrile critical burn and then to investigate the difference of serum procalcitonin level between multidrug-resistant pathogens and non-multidrug-resistant pathogens among Gram-negative bloodstream infections after burn. METHODS: Patients with febrile critical burn admitted to the burn department of our hospital from 1 January 2014 to 1 August 2018 were retrospectively analysed. Patients with positive blood culture whose blood samples were collected for simultaneous blood culture and procalcitonin testing were enrolled. All strains were identified by an automatic microorganism analyser, and procalcitonin was analysed by an automatic electrochemiluminescence immunoassay. RESULTS: Overall, a total of 119 patients with positive blood culture met the inclusion criteria. There were 64 Gram-negative bacilli, 38 Gram-positive bacteria, 8 C. albicans and 9 polymicrobial bloodstream infections. The median procalcitonin value in Gram-negative bloodstream infections (2.67 ng/mL, interquartile range (IQR) 1.58-6.08) was significantly higher than that in Gram-positive bloodstream infections (1.04 ng/mL, IQR 0.35-1.60, P < 0.01), or C. albicans bloodstream infections (1.09 ng/mL, IQR 0.82-2.30, P < 0.05). Receiver operating characteristic curve (ROC) analysis showed that in addition to polymicrobial bloodstream infections, the area of procalcitonin under the curve distinguishing Gram-negative bloodstream infections from all other blood culture-positive bloodstream infections was 0.761, the best critical value was 1.73 ng/mL, the sensitivity was 73%, the specificity was 74%, the positive predictive value was 80%, the negative predictive value was 67%, The level of procalcitonin was significantly higher in multidrug-resistant Gram-negative bacilli (A. baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) (2.76 ng/mL, IQR 2.01-7.76) than in non-multidrug-resistant bacilli (1.01 ng/mL, IQR 0.58-1.56, P < 0.01). CONCLUSION: Elevated serum procalcitonin can identify Gram-negative bloodstream infections in patients with febrile critical burn. In Gram-negative bloodstream infections, high procalcitonin levels may be associated with multidrug-resistant Gram-negative bacilli (A. baumannii, K. pneumoniae and P. aeruginosa).


Assuntos
Bacteriemia/diagnóstico , Queimaduras/sangue , Febre/sangue , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Pró-Calcitonina/sangue , Infecções por Acinetobacter/sangue , Infecções por Acinetobacter/complicações , Infecções por Acinetobacter/diagnóstico , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/fisiologia , Adulto , Bacteriemia/sangue , Bacteriemia/complicações , Bacteriemia/microbiologia , Hemocultura , Queimaduras/complicações , Candida albicans , Candidemia/sangue , Candidemia/diagnóstico , Coinfecção/sangue , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/microbiologia , Farmacorresistência Bacteriana Múltipla/fisiologia , Feminino , Febre/etiologia , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Infecções por Klebsiella/sangue , Infecções por Klebsiella/complicações , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/fisiologia , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/sangue , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/fisiologia , Estudos Retrospectivos , Adulto Jovem
16.
Clin Immunol ; 210: 108269, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31683054

RESUMO

Genetic studies have led to identification of an increasing number of monogenic primary immunodeficiency disorders. Monoallelic pathogenic gain-of-function (GOF) variants in NFKBIA, the gene encoding IκBα, result in an immunodeficiency disorder, typically accompanied by anhidrotic ectodermal dysplasia (EDA). So far, 14 patients with immunodeficiency due to NFKBIA GOF mutations have been reported. In this study we report three patients from the same family with immunodeficiency, presenting with recurrent respiratory tract infections, bronchiectasis and viral skin conditions due to a novel pathogenic NFKBIA variant (c.106 T > G, p.Ser36Ala), which results in reduced IκBα degradation. Immunological investigations revealed inadequate antibody responses against vaccine antigens, despite hypergammaglobulinemia. Interestingly, none of the studied patients displayed features of EDA. Therefore, missense NFKBIA variants substituting serine 36 of IκBα, differ from the rest of pathogenic GOF NFKBIA variants in that they cause combined immunodeficiency, even in the absence of EDA.


Assuntos
Mutação com Ganho de Função/genética , Síndromes de Imunodeficiência/diagnóstico , Leucócitos Mononucleares/imunologia , Meningites Bacterianas/diagnóstico , Inibidor de NF-kappaB alfa/genética , Neisseria meningitidis/fisiologia , Papillomaviridae/fisiologia , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/fisiologia , Viroses/imunologia , Adulto , Artrite Juvenil , Azitromicina/uso terapêutico , Bronquiectasia , Proliferação de Células , Células Cultivadas , Criança , Displasia Ectodérmica , Gentamicinas/uso terapêutico , Humanos , Síndromes de Imunodeficiência/genética , Masculino , Meningites Bacterianas/tratamento farmacológico , Linhagem , Infecções por Pseudomonas/tratamento farmacológico , Viroses/diagnóstico , Verrugas , Adulto Jovem
17.
Gene ; 722: 144127, 2020 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-31525397

RESUMO

Complement factor H (CFH) serves as a major down-regulator in the complement system, often utilized by bacterial pathogens to evade complement attack. Yet, little is currently known about the genetic correlation of CFH polymorphisms with sepsis due to various microbial infections. A case-control method (488 septic patients and 527 healthy individuals) was carried out in this study to investigate the genetic relationship between CFH polymorphisms (rs3753394 C/T, rs1065489 G/T and rs1061170 C/T) and susceptibility to sepsis caused by bacterial infections in Chinese Han populations. Our findings indicated that the frequency of rs3753394 CT/TT genotype in the septic patients with P. aeruginosa was significantly higher than that in the control individuals (P = 0.033, OR = 2.668, 95%CI = 1.072-6.334). The rs3753394 T allele frequency in the P. aeruginosa-infected patients was significantly increased, compared to that in the healthy controls (P = 0.014, OR = 1.68, 95%CI = 1.118-2.538). Moreover, these significant differences of rs3753394 genotype and allele frequencies remained after multiple testing corrections [P (corr.) = 0.033 for genotype; P (corr.) = 0.033 for allele]. The current study highlighted the significance of CFH polymorphism rs3753394 as a potential biomarker for targeting P. aeruginosa infection in critically ill patients.


Assuntos
Predisposição Genética para Doença , Infecções por Pseudomonas/genética , Pseudomonas aeruginosa , Sepse/genética , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , China/etnologia , Fator H do Complemento/genética , Frequência do Gene , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/etnologia , Sepse/diagnóstico , Sepse/etnologia , Sepse/microbiologia
18.
Infect Disord Drug Targets ; 20(1): 56-64, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30659550

RESUMO

BACKGROUND: Resistance to antimicrobial agents in Pseudomonas aeruginosa (P. aeruginosa) including carbapenems is a prominent problem in patients. The aim of this study is surveying Metallo-beta-lactamase (MBL)-producing P. aeruginosa isolated from patient specimens with nosocomial and non-nosocomial infections in Kurdistan province, Iran. METHODS: In total, 146 Pseudomonas spp. were collected (December 2015 to August 2017). P. aeruginosa isolates were detected by phenotypic and polymerase chain reactions (PCR) of gyrB gene. Combination disk (CD) phenotypic test was used for the identification of MBL-producing strains and PCR was applied for identification of blaIMP and blaVIM genes in P. aeruginosa. Sensitivity and specificity of phenotypic tests were calculated as well. Fisher's exact test and logistic regression were used for data analysis (p≤0.05). RESULTS: A total of 134 (91.78%) and 133 (91.09%) P. aeruginosa were detected using PCR and the phenotypic test, respectively. Fifty-six (41.79%) clinical isolates were isolated from patients with nosocomial infection. CD test proved that 67 out of 134 (50%) P. aeruginosa isolates were positive for MBL, of which 11 (8.20%) carried blaIMP gene. No significant relationship was found between MBL-producing P. aeruginosa and blaIMP genes; as well as between MBL-producing P. aeruginosa and blaIMP genes with age, sex, city of residence, inpatient/outpatient and specimen's type (p≥0.05). CONCLUSION: Presence of MBL-producing P. aeruginosa strains and blaIMP genes were proved in this study; thus more precaution should be taken in the administration of carbapenem antibiotics to patients.


Assuntos
Infecção Hospitalar/microbiologia , DNA Girase/genética , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , beta-Lactamases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Criança , Pré-Escolar , Contagem de Colônia Microbiana , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Masculino , Testes de Sensibilidade Microbiana , Técnicas Microbiológicas , Pessoa de Meia-Idade , Fenótipo , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/metabolismo , Adulto Jovem
19.
Clin Microbiol Infect ; 26(3): 345-350, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31295551

RESUMO

OBJECTIVES: To assess risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infection in neutropenic patients. METHODS: Single-centre retrospective analysis of consecutive bloodstream infection (BSI) episodes (2004-2017, Barcelona). Two multivariate regression models were used at BSI diagnosis and P. aeruginosa detection. Significant predictors were used to establish rules for stratifying patients according to MDR-PA BSI risk. RESULTS: Of 661 Gram-negative BSI episodes, 190 (28.7%) were caused by P. aeruginosa (70 MDR-PA). Independent factors associated with MDR-PA among Gram-negative organisms were haematological malignancy (OR 3.30; 95% CI 1.15-9.50), pulmonary source of infection (OR 7.85; 95% CI 3.32-18.56), nosocomial-acquired BSI (OR 3.52; 95% CI 1.74-7.09), previous antipseudomonal cephalosporin (OR 13.66; 95% CI 6.64-28.10) and piperacillin/tazobactam (OR 2.42; 95% CI 1.04-5.63), and BSI occurring during ceftriaxone (OR 4.27; 95% CI 1.15-15.83). Once P. aeruginosa was identified as the BSI aetiological pathogen, nosocomial acquisition (OR 7.13; 95% CI 2.87-17.67), haematological malignancy (OR 3.44; 95% CI 1.07-10.98), previous antipseudomonal cephalosporin (OR 3.82; 95% CI 1.42-10.22) and quinolones (OR 3.97; 95% CI 1.37-11.48), corticosteroids (OR 2.92; 95% CI 1.15-7.40), and BSI occurring during quinolone (OR 4.88; 95% CI 1.58-15.05) and ß-lactam other than ertapenem (OR 4.51; 95% CI 1.45-14.04) were independently associated with MDR-PA. Per regression coefficients, 1 point was assigned to each parameter, except for nosocomial-acquired BSI (3 points). In the second analysis, a score >3 points identified 60 (86.3%) out of 70 individuals with MDR-PA BSI and discarded 100 (84.2%) out of 120 with non-MDR-PA BSI. CONCLUSIONS: A simple score based on demographic and clinical factors allows stratification of individuals with bacteraemia according to their risk of MDR-PA BSI, and may help facilitate the use of rapid MDR-detection tools and improve early antibiotic appropriateness.


Assuntos
Farmacorresistência Bacteriana Múltipla , Neutropenia/complicações , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/etiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Adulto , Idoso , Área Sob a Curva , Biomarcadores , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neutropenia/diagnóstico , Neutropenia/epidemiologia , Razão de Chances , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/epidemiologia , Fatores de Risco , Sensibilidade e Especificidade , Espanha/epidemiologia
20.
Clin Microbiol Infect ; 26(3): 313-318, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31306794

RESUMO

BACKGROUND: Pseudomonas aeruginosa is one of the most common pathogens isolated from respiratory tract specimen in patients with bronchiectasis. It is considered highly responsible for pathogenicity, progression and clinical outcomes of bronchiectasis. AIMS: To summarize existing evidence on how different factors of Pseudomonas aeruginosa affect the pathogenicity, progression and clinical outcomes of bronchiectasis, so as to provide possible insights for clinical practice and related research in the future. SOURCES: PubMed was searched for studies pertaining to bronchiectasis and P. aeruginosa published to date, with no specific inclusion or exclusion criteria. Reference lists of retrieved reviews were searched for additional articles. CONTENT: This review focused on non-cystic fibrosis bronchiectasis and also provided some data on cystic fibrosis when studies in bronchiectasis were limited. We discussed various factors in relation to P. aeruginosa: virulence factors, drug resistance, regulatory systems, genomic diversity and transmission of P. aeruginosa, as well as treatment for P. aeruginosa. Their impacts on bronchiectasis and its management were discussed. IMPLICATIONS: The impact of P. aeruginosa on bronchiectasis is definite, although conclusions in some aspects are still vague. Faced with the worrying drug-resistance status and treatment bottleneck, individualized management and novel therapies beyond the classic pathway are most likely to be a future trend. To confirm the independent or integrated impact of various factors of P. aeruginosa on bronchiectasis and to figure out all the problems mentioned, larger randomized control trials are truly needed in the future.


Assuntos
Bronquiectasia/etiologia , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bronquiectasia/diagnóstico , Bronquiectasia/terapia , Tomada de Decisão Clínica , Gerenciamento Clínico , Progressão da Doença , Suscetibilidade a Doenças , Farmacorresistência Bacteriana , Variação Genética , Genoma Bacteriano , Humanos , Avaliação de Resultados da Assistência ao Paciente , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/patogenicidade , Fatores de Virulência
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