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1.
Medicine (Baltimore) ; 98(38): e17315, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568018

RESUMO

Early differential diagnosis of bloodstream infections (BSIs) caused by different sources and species of bacteria in hospitalized patients is crucial for the timely targeted interventions including appropriate use of antibiotics. The aim of this study was to identify 9 biomarkers for the early differentiation of gram-negative-bloodstream infection (GN-BSI), gram-positive (GP)-BSI, and fungal-BSI.A prospective study was conducted for a total of 390 inpatients who underwent blood culture in the Chinese PLA General Hospital from September 2015 to March 2018. Patients with positive culture of a single pathogen were divided into GN-BSI, GP-BSI, and Fungal-BSI groups, and a culture-negative disease control group was also established. The serum levels of macrophage inflammatory protein 1ß (MIP-1ß), tumor necrosis factor α (TNF-α), interleukin (IL)-3, interferon (IFN)-γ, IL-17A, IL-4, IL-12p70, and P-selectin were detected and the NLR was calculated from routine blood test. Receiver-operating characteristic analysis was used to determine the efficacy of various indicators in the differential diagnosis of BSIs. Prediction and validation experiments on clinical patient samples (263 cases) were also performed.The level of IL-3 in the GP-BSI group was significantly higher than those in the other 3 groups. The level of IFN-γ in the fungal-BSI group was significantly higher than those in the other 3 groups. NLR, MIP-1ß, TNF-α, IL-17A, and IL3 exhibited some efficacy when distinguishing between GN-BSI and GP-BSI and NLR had the largest area under curve (AUC) (0.728), followed by MIP-1ß with an AUC of 0.679. IFN-γ and IL-3 exhibited some value in differential diagnosis between GN-BSI and Fungal-BSI. IL-3, MIP-1ß, TNF-α, IFN-γ, NLR, IL-17A, and IL-4 exhibited some value in distinguishing fungal-BSI and GP-BSI, with IL-3 had the largest AUC (0.722), followed by MIP-1ß with an AUC of 0.703.NLR and MIP-1ß may be valuable in differentiating GN-BSI from GP-BSI in hospitalized patients. IFN-γ and IL-3 may be helpful in differential diagnosis GN-BSI and fungal-BSI. IL-3 and MIP-1ß exhibited some diagnostic efficacy in distinguishing fungal-BSI and GP-BSI. Additionally, IL-3 with high serum level may be a marker for GP-BSI and IFN-γ with high serum level may be a valuable marker for the prediction of Fungal-BSI. The utility of these biomarkers to predict BSIs owing to different pathogens in hospitalized patients needs to be assessed in further studies.


Assuntos
Bacteriemia/diagnóstico , Quimiocina CCL4/sangue , Infecção Hospitalar/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Interferon gama/sangue , Interleucina-12/sangue , Interleucina-17/sangue , Interleucina-3/sangue , Interleucina-4/sangue , Micoses/diagnóstico , Proteínas NLR/sangue , Selectina-P/sangue , Fator de Necrose Tumoral alfa/sangue , Bacteriemia/sangue , Bacteriemia/microbiologia , Biomarcadores/sangue , Infecção Hospitalar/sangue , Infecção Hospitalar/microbiologia , Diagnóstico Diferencial , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/sangue , Micoses/microbiologia , Estudos Prospectivos
2.
Internist (Berl) ; 60(10): 1111-1117, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31444523

RESUMO

Despite many novel diagnostic strategies and advances in treatment, infective endocarditis (IE) remains a severe disease. The epidemiology of IE has shifted and staphylococci have replaced streptococci as the most common cause and nosocomially acquired infections, invasive procedures, indwelling cardiac devices and acquired infections due to intravenous drug abuse are more frequent. The incidence of IE has steadily increased in recent years and the patients affected are older and have more comorbidities. The modern treatment of IE is interdisciplinary. The pharmacotherapy of IE depends on the pathogen and its sensitivity. The presence of a bioprosthetic valve and implantable cardiac devices plays a significant role in selection of antibiotics and duration of treatment. This article provides an update and overview of the current clinical practice in diagnostics and pharmacotherapy of IE in adults with a special focus on partial oral therapy and the role of aminoglycosides.


Assuntos
Antibacterianos/uso terapêutico , Endocardite/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Micoses/tratamento farmacológico , Adulto , Comorbidade , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Incidência , Micoses/diagnóstico , Micoses/epidemiologia
4.
BMC Infect Dis ; 19(1): 707, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399065

RESUMO

BACKGROUND: Talaromyces marneffei is a thermally dimorphic fungus endemic in south-east Asia. It predominantly occurs in both immunocompromised and immunosuppressed patients and can be fatal if diagnosis and treatment are delayed. The clinical manifestations of T. marneffei infection are nonspecific and rapid diagnosis of T. marneffei infection remains challenging. CASE PRESENTATION: A 24-year-old man came to our outpatient department with the sign of common skin lesions. The lesions were cuticolor follicular papules with or without central umbilication, nodules and acne-like lesions, which are common in syringoma, steatocystoma multiplex and trichoepithelioma. A dermatoscopy examination was performed to differentiate these skin lesions. The dermatoscopic images revealed circular or quasi-circular whitish amorphous structure with a central brownish keratin plug, providing the diagnostic clues of T. marneffei infection. Therefore, a skin scrapings culture, skin biopsy and serological detection for human immunodeficiency virus (HIV) were performed. The final diagnosis of this patient was T. marneffei and HIV co-infection. CONCLUSION: Rapid diagnosis of T. marneffei infection is clinically challenging since presenting clinical manifestations are nonspecific with significant overlap with other common conditions. This case highlights that dermatoscopy is a promising tool for the rapid diagnosis of T. marneffei infection in patients with nonspecific skin lesions, assisting clinicians to avoid delayed diagnosis or misdiagnosis.


Assuntos
Dermoscopia/métodos , Micoses/diagnóstico , Talaromyces/patogenicidade , Anfotericina B/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , China , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Masculino , Micologia/métodos , Micoses/tratamento farmacológico , Adulto Jovem
5.
Ther Umsch ; 76(2): 98-104, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31429394

RESUMO

An erythematous macule is not always a fungal infection Abstract. In this article we show ten cases of erythematic macules and plaques which we think are most important in the differential diagnosis to a fungal infection of the skin. The macules are mostly solitary. A few of them can be also exanthematous. It is important to know about the differential diagnosis because clinic is often doubtful and can be challenging, especially if the evolution is not clear.


Assuntos
Exantema , Micoses , Diagnóstico Diferencial , Exantema/diagnóstico , Humanos , Micoses/diagnóstico , Placa Amiloide , Pele
6.
Med Mycol ; 57(Supplement_3): S267-S273, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292660

RESUMO

Patients receiving intensive anti-leukemic treatment or recipients of allogeneic hematopoietic stem cell transplantation (HSCT) are prone to develop invasive fungal disease caused by both Aspergillus and non-Aspergillus moulds. Overall mortality following invasive mould disease (IMD) is high; adequate and timely antifungal treatment seems to ameliorate the outcome, yet early diagnosis in the haematological patient remains a challenge for most clinicians. Prophylaxis and the empiric addition of antifungal therapy to neutropaenic patients with fever persisting or recurring during broad-spectrum antibiotic treatment is therefore standard of care in many institutions. However, aside from the potential for overtreatment and important side effects, the emergence of resistance to medical triazoles in Aspergillus fumigatus poses a risk for inadequate initial treatment. Initial voriconazole therapy in patients with azole-resistant invasive aspergillosis was recently shown to be associated with a 23% increased mortality rate compared to the patients with azole-susceptible infection, despite changing to appropriate antifungal therapy once resistance was detected. Moreover, fever is not always present with IMD; therefore, cases may be missed when relying solely on this symptom for starting diagnostic procedures and antifungal treatment. At our institution, a diagnostic-driven treatment approach for IMD was implemented relying on clinical but also laboratory markers to start antifungal treatment. We describe the basis and clinical implementation of our diagnostic-driven approach in this review.


Assuntos
Hematologia/tendências , Micoses/diagnóstico , Micoses/prevenção & controle , Farmacorresistência Fúngica , Humanos , Micoses/sangue
7.
Med Mycol ; 57(Supplement_3): S259-S266, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292661

RESUMO

The field of diagnostic mycology represents much more than culture and microscopy and is rapidly embracing novel techniques and strategies to help overcome the limitations of conventional approaches. Commercial molecular assays increase the applicability of PCR testing and may identify markers of antifungal resistance, which are of great clinical concern. Lateral flow assays simplify testing and turn-around time, with potential for point of care testing, while proximity ligation assays embrace the sensitivity of molecular testing with the specificity of antibody detection. The first evidence of patient risk stratification is being described and together with the era of next generation sequencing represents an exciting time in mycology.


Assuntos
Micologia/tendências , Micoses/diagnóstico , Técnicas de Laboratório Clínico/tendências , Humanos
8.
Vestn Otorinolaringol ; 84(2): 78-83, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31198221

RESUMO

The purpose of the work is to study the current state of the problem of diagnosing and treating fungal adenoiditis and tonsillomycosis in children. This article summarizes the literature data on the predisposing factors and characteristics of the occurrence of fungal infections of adenoid vegetations and tonsils in children. The works present modern approaches to the diagnosis and treatment of children with fungal adenoiditis and tonsillomycosis, depending on the selected genus and the type of fungus. Based on the conducted research, performed on the basis of "The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute", we found that the incidence of fungal adenoiditis in children is 16.4%, and the incidence of tonsillomicosis in children with chronic tonsillitis is 21.5%. The most frequently detected strain in this pathology is C. albicans. In the presented study, a justification of the chosen treatment regimen was made on the basis of the data obtained during microbiological (bacteriological and mycological) studies.


Assuntos
Micoses , Nasofaringite , Tonsilite , Antifúngicos , Criança , Doença Crônica , Fungos , Humanos , Hiperplasia , Micoses/diagnóstico , Micoses/terapia , Nasofaringite/diagnóstico , Nasofaringite/terapia , Tonsilite/diagnóstico , Tonsilite/terapia
10.
BMC Infect Dis ; 19(1): 506, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182059

RESUMO

BACKGROUND: Scalp mycosis is often caused by dermatophytes and was so called tinea capitis. There is no published report caused by Aspergillus protuberus. We report a rare case of kerion-type scalp mycosis caused by A. protuberus. CASE PRESENTATION: A 5-year-old girl developed pyogenic mass with pain for 8 days and got a fever for 2 days prior to admission. Surgical incision and drainage of the mass, intravenous cefuroxime and metronidazole in the local hospital aggravated the skin lesions. Species identification was performed by observation of morphologic and biochemical characteristicsand sequencing of the internal transcribed spacer (ITS) and ß-tubulin (BT2). Treatment with oral and topical antifungal agents was effective with no relapse during the six months of clinical follow-up. CONCLUSIONS: Aspergillusis a opportunistic pathogenic fungus and its infection occurs mostly in patients with underlying conditions and immunocompromised statuses. So far no report of kerion-type scalp infection has been reported. The first case of kerion-type scalp mycosis caused by A. protuberus was described to highlight the importance of mycological examination that helps to recognize rare pathogenic fungi. Any boggy lesion with hair loss over the scalp and non-responsive to antibiotics should be suspected as resulting from fungal infection, and mycological examination should be performed, especially in children.


Assuntos
Aspergillus/isolamento & purificação , Micoses/diagnóstico , Couro Cabeludo/patologia , Antifúngicos/uso terapêutico , Aspergillus/classificação , Pré-Escolar , Feminino , Humanos , Hospedeiro Imunocomprometido , Micoses/tratamento farmacológico , Micoses/microbiologia , Filogenia , Couro Cabeludo/microbiologia
11.
Indian J Ophthalmol ; 67(7): 1048-1053, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238406

RESUMO

Purpose: The aim of the study is to identify risk factors, clinical characteristics, causative fungi, and treatment outcome of dematiaceous fungal keratitis in North India. Methods: Consecutive cases of culture-proven dematiaceous fungal keratitis between January 2012 and June 2017 were retrieved from the medical record department. Risk factors, clinical signs, and outcome were registered. Results: Eighty-three patients were included. Identified dematiaceous fungal organism were Curvularia sp. (n = 55/83; 66.3%), Alternaria sp. (n = 12/83; 14.5%), Ulocladium sp. (n = 5/83; 6%), Bipolaris sp. (n = 5/83; 6.1%), Scedosporium sp. (n = 3/83; 3.6%), Acremonium sp. (n = 2/83; 2.4%), and Epicoccum sp. (n = 1/83; 1.2%). Male preponderance was reported. The most common predisposing factor was corneal trauma (67.4%). In cases associated with corneal trauma due to vegetative matter, sugarcane was the most common cause. In all, 89% of the patients were more than 30 years of age. The median infiltrate size was 8 mm2. The median time of antifungal therapy was 4.2 weeks (interquartile range [IQR]: 1-25 weeks). Complications were seen in 14 (n = 14/65; 21.5%) patients. Complete resolution of dematiaceous fungal keratitis was present in 27 (n = 27/65; 41.5%) eyes. Conclusion: Curvularia sp. and Alternaria sp. were the predominant pathogenic genera causing dematiaceous fungal keratitis. Among the causative fungi, infections due to Scedosporium sp. were associated with the worst outcomes. Ulocladium sp. and Epicoccum sp. were also identified. Both the species are not reported previously as a causal organism of dematiaceous fungal keratitis from North India.


Assuntos
Infecções Oculares Fúngicas/microbiologia , Ceratite/microbiologia , Fungos Mitospóricos/isolamento & purificação , Micoses/microbiologia , Adulto , Córnea/microbiologia , Córnea/patologia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Índia/epidemiologia , Ceratite/diagnóstico , Ceratite/epidemiologia , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Lâmpada de Fenda
12.
Int J Infect Dis ; 86: 15-17, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31229614

RESUMO

Talaromyces marneffei is a fungal opportunistic infection usually seen in immunocompromised patients from eastern countries. In the US when examining HIV-patients for suspected fungal infections, laboratory serological tests guide therapy until cultures are available. We present the case of a 35-year-old HIV patient originally from Thailand in which urine lab results were positive for Blastomyces and Histoplasma antigen, but biopsy showed T. marneffei. Concomitantly the patient presented with hyponatremia which was deemed to be from SIADH. We present the first case of a patient with T. marneffei cross reactivity with Blastomyces, Histoplasma and SIADH due to pulmonary disease.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Antígenos de Fungos/urina , Blastomyces/imunologia , Histoplasma/imunologia , Micoses/diagnóstico , Talaromyces/imunologia , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/urina , Adulto , Blastomyces/isolamento & purificação , Reações Cruzadas , Histoplasma/isolamento & purificação , Humanos , Masculino , Micoses/imunologia , Micoses/microbiologia , Micoses/urina , Testes Sorológicos , Talaromyces/isolamento & purificação , Tailândia
13.
Vet Clin Pathol ; 48(2): 250-254, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31175684

RESUMO

Histoplasmosis is one of the most common systemic fungal diseases in cats from the United States. It commonly causes respiratory or disseminated disease and is often associated with one or more cytopenias. Here, we describe 32 cats in which a Histoplasma-like fungal infection was associated with concurrent hemophagia in at least one sample site, commonly spleen, bone marrow, liver, and/or lymph node. The degree of hemophagia was characterized as moderate or marked in the majority of cases, and in all cases, there was a predominance of phagocytized mature erythrocytes. A few cases also had macrophages with phagocytized erythroid precursors, platelets, and/or neutrophils. Complete blood count results were available for 25 cats, and cytopenias were common (20/25), including solitary anemia (10), anemia and thrombocytopenia (5), solitary neutropenia (2), pancytopenia (2), and anemia and neutropenia (1). Bone marrow samples were only available in a small subset of cases, preventing the further assessment of the causes of the cytopenias. Hemophagocytosis has been previously reported in cats with neoplastic diseases and a cat with calicivirus infection, and likely occurs with other conditions as well, such as hemorrhage or hemolysis. Results of this report suggest that systemic fungal disease is an additional differential to consider when there is hemophagia in a feline cytology sample.


Assuntos
Doenças do Gato/diagnóstico , Histoplasmose/veterinária , Micoses/veterinária , Animais , Biópsia por Agulha Fina/veterinária , Contagem de Células Sanguíneas/veterinária , Medula Óssea/patologia , Doenças do Gato/microbiologia , Doenças do Gato/patologia , Gatos , Eritrócitos/patologia , Feminino , Histoplasmose/diagnóstico , Histoplasmose/microbiologia , Histoplasmose/patologia , Fígado/patologia , Linfonodos/patologia , Macrófagos/patologia , Masculino , Micoses/diagnóstico , Micoses/microbiologia , Micoses/patologia , Fagocitose , Baço/patologia
14.
Internist (Berl) ; 60(7): 684-689, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31119309

RESUMO

BACKGROUND: Invasive aspergillosis, mucormycosis, and cryptococcosis are severe opportunistic infections in patients with long phases of neutropenia and also after allogeneic stem cell and organ transplantation. Due to the late appearance of clinical signs and the often poor outcome, these diseases require special attention and proactive interventions. MATERIAL AND METHODS: Published guidelines and selected current literature were reviewed for this article. RESULTS: Invasive aspergillosis and mucormycosis are typically observed in the upper and lower airways of severely immunocompromized patients. When invasive fungal diseases are suspected, sectional imaging and, if possible, serological testing should be performed as soon as possible. If imaging or serological tests confirm the suspected diagnosis, pre-emptive antimycotic treatment should be started and further confirmation of the diagnosis sought via microbiological and/or histological investigations. Treatment depends on comedication, comorbidity and risk factors, primarily with voriconazole, isavuconazole and liposomal amphotericin B. With the advent of antiretroviral treatment, a decrease of cryptococcosis cases in people with human immunodeficiency virus was observed; however, increasing cases have been reported in patients with new forms of immunosuppression. Cryptococcus spp. predominantly cause central nervous system infections but also pneumonia and bloodstream infections. Diagnostics include blood and cerebrospinal fluid cultures and antigen tests. First line treatment consists of a combination therapy with amphotericin B and flucytosine. CONCLUSION: An interdisciplinary approach with microbiologists, infectious diseases specialists and radiologists is needed for diagnostics and treatment of invasive fungal diseases.


Assuntos
Antifúngicos/uso terapêutico , Aspergilose , Mucormicose , Micoses/tratamento farmacológico , Infecções Oportunistas , Aspergilose/diagnóstico , Aspergilose/tratamento farmacológico , Humanos , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Micoses/diagnóstico , Neutropenia
15.
J Zoo Wildl Med ; 50(1): 225-230, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31120682

RESUMO

Nannizziopsis crocodili, a contagious, keratinophilic fungus, was identified from biopsied tissue in a captive juvenile freshwater crocodile during an outbreak of severe multifocal dermatitis affecting four of five crocodiles. Lesions progressed from superficial, well-demarcated ulceration of scales, to black pigmentation, localized edema, erythema, and flattening of the scales. Treatment with topical enilconazole provided clinical improvement in three of four crocodiles but all developed terminal gout. One crocodile did not develop clinical disease despite long-term exposure. This is the first report of N. crocodili in freshwater crocodiles and in a location remote to the index Australian case.


Assuntos
Jacarés e Crocodilos , Dermatite/veterinária , Fungicidas Industriais/uso terapêutico , Imidazóis/uso terapêutico , Micoses/veterinária , Onygenales/isolamento & purificação , Animais , Animais de Zoológico , Dermatite/diagnóstico , Dermatite/tratamento farmacológico , Dermatite/microbiologia , Micoses/diagnóstico , Micoses/tratamento farmacológico , Micoses/microbiologia
16.
J Mycol Med ; 29(2): 180-184, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056403

RESUMO

Emergence of saprophytic fungi thriving in dead plant material and soil as opportunistic human pathogens is of great concern. Cladosporium species are environmental saprophytes reported to cause various superficial and invasive fungal infections worldwide. C. sphaerospermum, a predominantly indoor fungus has been reported from cases of meningitis, subcutaneous and pulmonary fungal infections in the past. Herein we report the first case of cerebral abscess due to C. sphaerospermum in an immunocompetent host who was successfully managed by combined medical and surgical therapy.


Assuntos
Abscesso Encefálico/microbiologia , Cladosporium/isolamento & purificação , Cladosporium/patogenicidade , Micoses/diagnóstico , Adulto , Antifúngicos/farmacologia , Encéfalo/diagnóstico por imagem , Abscesso Encefálico/cirurgia , Humanos , Imunocompetência , Imagem por Ressonância Magnética , Masculino , Micoses/tratamento farmacológico , Resultado do Tratamento
17.
Top Antivir Med ; 27(1): 34-40, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31137001

RESUMO

The 2019 Conference on Retroviruses and Opportunistic Infections provided a considerable amount of new information on the progress in implementation of strategies to reduce morbidity and mortality from complications and coinfections that occur in people with HIV infection, and on the clinical management of these important problems. This review will address new insights into the prevention and treatment of tuberculosis, fungal infections, sexually transmitted infections, malignancies, and a range of metabolic complications and noncommunicable diseases.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Coinfecção/epidemiologia , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Coinfecção/prevenção & controle , Humanos , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/tratamento farmacológico , Doenças Metabólicas/prevenção & controle , Micoses/diagnóstico , Micoses/tratamento farmacológico , Micoses/prevenção & controle , Neoplasias/diagnóstico , Neoplasias/tratamento farmacológico , Neoplasias/prevenção & controle , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/prevenção & controle
18.
BMC Cancer ; 19(1): 358, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991992

RESUMO

BACKGROUND: Micafungin is a well-tolerated and effective prophylactic antifungal agent used in hematologic diseases. In this prospective trial, we evaluated the efficacy and safety of prophylactic micafungin during first induction chemotherapy in patients with acute leukemia. We also compared outcomes of prophylactic micafungin with those of prophylactic posaconazole in acute myeloid leukemia (AML). METHODS: Medically fit patients with newly diagnosed acute leukemia received 50 mg micafungin intravenously once daily from the initiation of first induction chemotherapy to recovery of neutrophil count, suspected fungal infection, or unacceptable drug-related toxicity ( Clinicaltrials.gov number, NCT02440178). The primary end point was incidence of invasive fungal infection, and the secondary end points were adverse events of prophylactic micafungin and mortality during induction therapy. RESULTS: The 65 patients (median age = 51 years, male:female = 34:31) enrolled in this study had diagnoses of AML (33, 50.8%), acute lymphoblastic leukemia (31, 47.7%), and acute biphenotypic leukemia (1, 1.5%). Median duration of micafungin treatment was 24 days (range 1-68), with proven invasive fungal disease in one patient (1.5%) and possible fungal infection in two patients (3.1%). Three of the patients (4.6%) experienced the following adverse events, but all events were tolerable: liver function abnormality (Grade 2, n = 1; Grade 3, n = 1) and allergic reaction (Grade 2, n = 1). Three patients died during induction therapy, and invasive aspergillosis pneumonia was the cause of death for one of those patients. Overall, 19 patients (29.2%) discontinued prophylactic micafungin, and 18 (27.7%) patients switched to another antifungal agent. We observed no fungal infections caused by amphotericin B-resistant organisms. In AML patients, outcomes of prophylactic micafungin during induction chemotherapy did not differ significantly with those of prophylactic posaconazole with regard to incidence of fungal infections, rate of discontinuation, or safety. CONCLUSIONS: Our study demonstrates that prophylactic micafungin is safe and effective in patients with acute leukemia undergoing induction chemotherapy. Outcomes in patients with AML were similar to those of prophylactic posaconazole, indicating the usefulness of micafungin as a prophylactic antifungal agent during induction chemotherapy for AML. TRIAL REGISTRATION: Clinicaltrials.gov NCT02440178, registered May 12th 2015.


Assuntos
Antifúngicos/uso terapêutico , Quimioterapia de Indução/efeitos adversos , Leucemia Mieloide Aguda/complicações , Micafungina/uso terapêutico , Micoses/etiologia , Micoses/prevenção & controle , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Quimioterapia de Indução/métodos , Estimativa de Kaplan-Meier , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/mortalidade , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Prognóstico , Resultado do Tratamento , Adulto Jovem
19.
BMJ Case Rep ; 12(4)2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30967452

RESUMO

A 33-year-old man presented to the emergency department with a right-sided facial paralysis and maxillary division (V2, trigeminal nerve) paraesthesia. He had been suffering with upper respiratory tract symptoms in the preceding 2 months, including rhinorrhoea, fever and headache. The patient was otherwise fit and immunocompetent. Urgent radiological investigation revealed extensive fungal sinusitis with sphenoid sinus dehiscence and skull base osteitis. The patient underwent emergency endoscopic sinus surgery revealing concretions and debris in the ethmoid and sphenoid sinuses. He was commenced on systemic antifungal therapy and made a full recovery with resolution of his cranial neuropathies. The fungus Schizophyllum commune was isolated and is a rare cause of fungal sinusitis, but with the potential for invasive disease in immunosuppressed individuals.


Assuntos
Doenças Ósseas Infecciosas/etiologia , Doenças dos Nervos Cranianos/etiologia , Micoses/complicações , Osteíte/etiologia , Sinusite/complicações , Adulto , Antifúngicos/uso terapêutico , Doenças Ósseas Infecciosas/complicações , Doenças Ósseas Infecciosas/microbiologia , Fluconazol/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Masculino , Micoses/diagnóstico , Micoses/microbiologia , Micoses/terapia , Osteíte/microbiologia , Schizophyllum/isolamento & purificação , Sinusite/diagnóstico , Sinusite/microbiologia , Sinusite/terapia , Base do Crânio/diagnóstico por imagem , Base do Crânio/microbiologia , Base do Crânio/patologia , Tomografia Computadorizada por Raios X
20.
BMJ Case Rep ; 12(4)2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31023737

RESUMO

A 54-year-old Caucasian woman presented with corneal ulcer of the right eye of 4 weeks duration after scratching her cornea while removing her contact lens and artificial eye lashes. Her visual acuity was 20/32 (left eye) and finger counting (right eye). She had a 3x3 mm epithelial defect with underlying corneal oedema and hypopyon. Right eye cultures grew Paecilomyces species. Topical and systemic antifungal agents were initiated. Due to the sight-threatening disease, the patient underwent surgical intervention with intrastromal injection of amphotericin B and a large conjunctival flap covering 75% of the right eye corneal ulcer. After 3 months of therapy, she had near-complete resolution of the corneal ulcer. Unfortunately, recurrence of the corneal ulcer occurred within 3 weeks of cessation of therapy, prompting reinitiation of ophthalmic and systemic antifungal agents. The patient was advised to continue therapy for 6 months with regular follow-up.


Assuntos
Anfotericina B/administração & dosagem , Úlcera da Córnea/tratamento farmacológico , Ceratite/patologia , Micoses/microbiologia , Paecilomyces/isolamento & purificação , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Edema da Córnea/patologia , Úlcera da Córnea/microbiologia , Úlcera da Córnea/patologia , Infecções Oculares Fúngicas/complicações , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Fúngicas/cirurgia , Feminino , Humanos , Injeções Intraoculares , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Ceratite/cirurgia , Pessoa de Meia-Idade , Micoses/complicações , Micoses/diagnóstico , Recidiva , Retalhos Cirúrgicos , Resultado do Tratamento , Acuidade Visual
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