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1.
Medicine (Baltimore) ; 98(41): e17535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593129

RESUMO

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.


Assuntos
Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/cirurgia , Scedosporium/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Farmacorresistência Fúngica/fisiologia , Feminino , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Micoses/mortalidade , Estudos Observacionais como Assunto , Cuidados Pós-Operatórios , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Scedosporium/isolamento & purificação , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
2.
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
3.
BMC Infect Dis ; 19(1): 745, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455239

RESUMO

BACKGROUND: Due to the similar clinical, lung imaging, and pathological characteristics, talaromycosis is most commonly misdiagnosed as tuberculosis. This study aimed to identify the characteristics of talaromycosis pleural effusion (TMPE) and to distinguish TMPE from tuberculosis pleural effusion (TPE). METHODS: We enrolled 19 cases each of TMPE and TPE from Guangxi, China. Patients' clinical records, pleural effusion tests, biomarker test results, and receiver operating characteristic curves were analyzed. RESULTS: In total, 39.8% (65/163) of patients exhibited serous effusion, of whom 61 were non-human immunodeficiency virus (HIV)-infected patients; 68.85% of the non-HIV-infected patients (42/61) had TMPE. Thoracentesis was performed only in 19 patients, all of whom were misdiagnosed with tuberculosis and received long-term anti-tuberculosis treatment. In four of these patients, interleukin (IL)-23, IL-27, and interferon-gamma (IFN-γ) measurements were not performed since pleural effusion samples could not be collected because the effusion had been drained prior to the study. In the remaining 15 patients, pleural effusion samples were collected. Talaromyces marneffei was isolated from the pleural effusion and pleural nodules. Most TMPEs were characterized by yellowish fluid, with marked elevation of protein content and nucleated cell counts. However, neutrophils were predominantly found in TMPEs, and lymphocytes were predominantly found in TPEs (both p < 0.05). Adenosine deaminase (ADA) and IFN-γ levels in TMPEs were significantly lower than those in TPEs (all p < 0.05) and provided similar accuracies for distinguishing TMPEs from TPEs. IL-23 concentration in TMPEs was significantly higher than that in TPEs (p < 0.05), and it provided similar accuracy for diagnosing TMPEs. IL-27 concentrations in TMPEs were significantly lower than those in TPEs (all p < 0.05) but was not useful for distinguishing TMPE from TPE. CONCLUSIONS: Talaromycosis can infringe on the pleural cavity via the translocation of T. marneffei into the pleural space. Nonetheless, this phenomenon is still commonly neglected by clinicians. TMPE is a yellowish fluid with exudative PEs and predominant neutrophils. Higher neutrophil counts and IL-23 may suggest talaromycosis. Higher lymphocyte counts, ADA activity, and IFN-γ concentration may suggest tuberculosis.


Assuntos
Micoses/etiologia , Derrame Pleural/microbiologia , Tuberculose Pleural/diagnóstico , Adenosina Desaminase/metabolismo , Adolescente , Adulto , Idoso , Biomarcadores/metabolismo , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Interferon gama/metabolismo , Subunidade p19 da Interleucina-23/metabolismo , Interleucinas/metabolismo , Linfócitos/microbiologia , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/microbiologia , Neutrófilos/microbiologia , Neutrófilos/patologia , Derrame Pleural/diagnóstico , Derrame Pleural/tratamento farmacológico , Curva ROC , Talaromyces/patogenicidade , Tuberculose Pleural/tratamento farmacológico , Tuberculose Pleural/etiologia
4.
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
5.
Med Mycol ; 57(Supplement_3): S328-S343, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292663

RESUMO

The high burden and growing prevalence of invasive fungal infections (IFIs), the toxicity and interactions associated with current antifungal drugs, as well as the increasing resistance, ask for the development of new antifungal drugs, preferably with a novel mode of action. Also, the availability of oral or once-weekly alternatives would enable ambulatory treatment resulting in an improved patient's comfort and therapy adherence. However, only one new azole and two new posaconazole-formulations were marketed over the last decade. This review focuses on the antifungal drugs in the pipeline undergoing clinical evaluation. First, the newest azole, isavuconazole, with its improved safety profile and reduction in DDIs, will be discussed. Moreover, there are two glucan synthase inhibitors (GSIs) in the antifungal pipeline: rezafungin (CD101), a long-acting echinocandin with an improved stability that enables once weekly administration, and SCY-078, an orally available GSI with efficacy against azole- and echinocandin resistant isolates. A new oral formulation of amphotericin B will also be presented. Moreover, the first representative of a new antifungal class, the orotomides, with a broad spectrum and no cross-resistance with current antifungal classes, will be discussed. Finally, an overview of other antifungals that are still in earlier clinical development phases, is provided.


Assuntos
Antifúngicos , Desenvolvimento de Medicamentos/tendências , Micoses/tratamento farmacológico , Antifúngicos/uso terapêutico , Humanos , Micoses/patologia
6.
AAPS PharmSciTech ; 20(7): 253, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31309346

RESUMO

Drug delivery systems (DDS) can be designed to enrich the pharmacological and therapeutic properties of several drugs. Many of the initial obstacles that impeded the clinical applications of conventional DDS have been overcome with nanotechnology-based DDS, especially those formed by chitosan (CS). CS is a linear polysaccharide obtained by the deacetylation of chitin, which has potential properties such as biocompatibility, hydrophilicity, biodegradability, non-toxicity, high bioavailability, simplicity of modification, aqueous solubility, and excellent chemical resistance. Furthermore, CS can prepare several DDS as films, gels, nanoparticles, and microparticles to improve delivery of drugs, such as photosensitizers (PS). Thus, CS-based DDS are broadly investigated for photodynamic therapy (PDT) of cancer and fungal and bacterial diseases. In PDT, a PS is activated by light of a specific wavelength, which provokes selective damage to the target tissue and its surrounding vasculature, but most PS have low water solubility and cutaneous photosensitivity impairing the clinical use of PDT. Based on this, the application of nanotechnology using chitosan-based DDS in PDT may offer great possibilities in the treatment of diseases. Therefore, this review presents numerous applications of chitosan-based DDS in order to improve the PDT for cancer and fungal and bacterial diseases.


Assuntos
Quitosana/química , Sistemas de Liberação de Medicamentos , Fotoquimioterapia , Fármacos Fotossensibilizantes/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Humanos , Micoses/tratamento farmacológico , Nanopartículas/química , Neoplasias/tratamento farmacológico , Fármacos Fotossensibilizantes/química , Polissacarídeos
8.
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
9.
Prog. obstet. ginecol. (Ed. impr.) ; 62(3): 221-229, mayo-jun. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-ET1-3618

RESUMO

Objective: To demonstrate that vaginal application of boric acid and probiotics is effective for the treatment of vulvovaginitis and can be considered not only an alternative option, but also a first-line treatment.Material and methods: We performed a multicenter, open-label, pilot trial with random allocation to the study treatment (150 mg boric acid + Lactobacillus gasseri and Lactobacillus rhamnosus) or active control treatment (clotrimazole in candida vulvovaginitis and clindamycin in bacterial vulvovaginitis). All treatments were administered vaginally. The study population comprised 48 women aged >18 years with a suspected diagnosis of vulvovaginitis. We excluded patients who were menstruating or breastfeeding and patients who were pregnant (or planning to become pregnant) at baseline. We also excluded patients who had taken antibiotic treatment or probiotic prophylaxis in the previous 2 weeks and treatments that could interfere with the study. Similarly, we excluded patients infected by Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, or Herpes simplex. Follow-up lasted 12 weeks and included 3 face-to-face contacts and 2 telephone calls. Results: Almost all patients (97.9%) were of childbearing age, 100% were sexually active, 77.1% had a history of vulvovaginitis, and 41.7% had recurrent vulvovaginitis. After treatment, the cure rate was 60.9% in the study treatment group and 62.5% in the control group. Vulvovaginitis improved in 39.1% and 33.3%, respectively, and no response was observed in 0% and 4.2% respectively, with no significant differences between the treatments. The Sobel score improved significantly (p<0.05) after 2 weeks of follow-up (study treatment, baseline=5.83±1.6 and 2 weeks=1.00±1.90; control treatment, baseline=6.13±3.03 and 2 weeks=1.30±2.72), although there were no significant differences between the groups. Conclusions: Administration of boric acid and probiotics for treatment of vulvovaginitis proved to be as effective as the standard treatment for candida and bacterial vulvovaginitis. Larger studies are needed to confirm our findings


Objetivo: Demostrar que la administración vaginal de ácido bórico y probióticos en vulvovaginitis oportunistas es un tratamiento eficaz, no solo como opción alternativa, sino también como primera opción terapéutica. Material y métodos: Ensayo piloto multicéntrico, abierto, con asignación aleatoria al tratamiento en estudio (150mg ácido bórico + L.gasseri y L.rhamnosus, AB+P) o al control (C) activo (clotrimazol en vulvovaginitis candidiásica y clindamicina en vulvovaginitis bacteriana), todos vía vaginal. Se incluyó 48 mujeres > 18 años, con diagnóstico de sospecha de vulvovaginitis. Se excluyó pacientes con menstruación, con lactancia, embarazadas (o susceptibles de embarazo) al inicio del estudio, con tratamiento antibiótico o profilaxis con probióticos en las 2 semanas previas y tratamientos que pudieran interferir. Se excluyó pacientes con infección por Chlamydia trachomatis, Trichomona vaginalis, Neisseria gonorrhoeae o Herpes simplex. Se siguieron 12 semanas con 3 controles presenciales y 2 telefónicos. Resultados: 97,9% estaban en edad fértil, 100% eran sexualmente activas, 77,1% tenía antecedentes de vulvovaginitis y 41,7% sufría vulvovaginitis recurrentes. Tras el tratamiento, se logró resolución en un 60,9% con AB+P y un 62,5% con C, mejoría en 39,1% y 33,3% y ausencia de respuesta en 0% y 4,2% respectivamente, sin diferencias significativas entre tratamientos. Sobel score mostró mejoría significativa (p<0,05) tras 2 semanas de seguimiento (AB+P: basal=5,83±1,6 y 2sems=1,00±1,90, C: basal=6,13±3,03 y 2sems=1,30±2,72) sin diferencias entre grupos. Conclusiones: El tratamiento de vulvovaginitis con ácido bórico y probióticos resultó un recurso terapéutico igual de eficaz que los tratamientos estándar para vulvovaginitis candidiásica y bacteriana. Estudios más amplios podrían confirmarlo


Assuntos
Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Ácidos Bóricos/uso terapêutico , Probióticos/uso terapêutico , Vulvovaginite/tratamento farmacológico , Micoses/tratamento farmacológico , Infecções Bacterianas/tratamento farmacológico , Candidíase Vulvovaginal/tratamento farmacológico , Resultado do Tratamento
10.
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
11.
Clin Nephrol ; 92(1): 44-51, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31131821

RESUMO

BACKGROUND: Peritoneal dialysis-associated peritonitis (PDAP) is one of the major causes of peritoneal dialysis (PD) failure and death. Therefore, it is important to determine how to effectively treat patients with PDAP. MATERIALS AND METHODS: We analyzed the pathogen spectrum and bacterial resistance in 203 PDAP cases that were enrolled in this study from January 1, 2015 to December 31, 2017. All patients were infected with peritonitis and had been treated with antibiotics while at our center. Bacterial culture results of PD fluid and pathogen drug resistance were collected and analyzed. A total of 159 cases (78.3%) had a positive bacterial culture of PD fluid. RESULTS: A total of 47 pathogens were identified, including 19 (40.4%) Gram-positive cocci strains (the most common was Staphylococcus spp.), 15 (31.9%) Gram-negative bacilli strains (the most common was Escherichia coli, 4 fungal strains, and 9 other strains. The drug sensitivity test showed that Gram-positive cocci were sensitive to vancomycin (94.9%), but had a high resistance to cefazolin (67.7%). Gram-negative bacilli were sensitive to imipenem (96.2%), but had a high resistance to ceftriaxone (60.0%). Voriconazole and itraconazole were sensitive in fungal infections. A total of 162 cases were cured, 37 cases were unresponsive to antibiotic treatment and converted to hemodialysis after Tenckhoff catheter removal, and 4 cases resulted in death. CONCLUSION: Gram-positive cocci are still the primary pathogen of PDAP cases in our center, but demonstrate a high resistance to first-generation cephalosporin, which is the suggested treatment per International Society for Peritoneal Dialysis 2016 Peritonitis Recommendations. Therefore, an individualized treatment based on the distribution of pathogens and drug resistance in different centers is more conducive to improve the cure rate of PDAP.


Assuntos
Antibacterianos/uso terapêutico , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cocos Gram-Positivos/efeitos dos fármacos , Diálise Peritoneal/efeitos adversos , Peritonite/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antifúngicos/uso terapêutico , Infecções Bacterianas , Cefazolina/uso terapêutico , Ceftriaxona/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Humanos , Imipenem/uso terapêutico , Itraconazol/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Peritonite/etiologia , Vancomicina/farmacologia , Voriconazol/uso terapêutico , Adulto Jovem
12.
Zhonghua Wai Ke Za Zhi ; 57(5): 348-352, 2019 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-31091589

RESUMO

Objective: To investigate the clinical effect of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection. Methods: A retrospective analysis of 11 patients(4 hips, 7 knees) admitted with chronic periprosthetic fungal infection at Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from January 2004 to April 2016.There were males and females with an age of 67 years (range:47-77 years). Each patient underwent single-stage revision including aggressive soft-tissue debridement. Liquid samples and tissue samples were immediately sent to the microbiology laboratory for drug sensitivity testing and histological analysis. Removed the infected components and cement thoroughly, pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungussensitive antibiotics. The patients with infected hips received an uncemented prosthesis and 0.5 g of gentamicin loaded commercial cement was received by the patients with infected knee.After that, a new prosthesis was implanted.Long-term combination therapy of antibacterial agents and antifungal agents were given after operation. Recurrence of infection and clinical outcomes were evaluated. The follow-up period was 5 years (range: 2-12 years). Results: One patient died of acute heart failure on the eighth postoperative day.Three infection cases were recurred.Eight cases had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection. The Harris hip score assessed preoperatively and at latest follow-up was increased from 39.25±5.12 to 79.50±4.79, the difference was statistically significant (t=-11.356, P=0.001).The Hospital for Special Surgery knee score was improved from preoperative 46.25±5.61 to final follow-up 80.50±5.06, and the difference was statistically significant (t=-9.930, P=0.002). Conclusion: Treatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes.


Assuntos
Antifúngicos/administração & dosagem , Artroplastia de Substituição/efeitos adversos , Micoses/tratamento farmacológico , Infecções Relacionadas à Prótese/tratamento farmacológico , Idoso , Antibacterianos/administração & dosagem , Doença Crônica , Terapia Combinada , Feminino , Gentamicinas/administração & dosagem , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Vancomicina/administração & dosagem
13.
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
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 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
16.
BMC Infect Dis ; 19(1): 336, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014277

RESUMO

BACKGROUND: Talaromyces marneffei is an invasive, and thermal dimorphic pathogenic fungus, whose infection is life threatening in human. Although immunocompromised patients, such as patients with human immunodeficiency virus infection and recipients of organ transplant, are susceptible hosts, infections have been recently reported in people with normal immune function. Patients with cancer may also be susceptible hosts but no case of T. marneffei infection has been reported in patients with lung cancer. In this case, we describe T. marneffei infection coexisting with primary pulmonary lymphoepithelioma-like carcinoma (LELC) in an HIV-negative patient. CASE PRESENTATION: A 50-year-old, previously healthy female presented with a 1-month history of cough and fever. CT scans showed a mass in the left lower lung, left pleural thickening, pleural effusion, and multiple swollen lymph nodes throughout the body. Based on the pathology of the left lung lesion, she was diagnosed with left primary pulmonary LELC complicated with T. marneffei. She received both anti-tumor and anti-fungal treatments. A subsequent CT re-examination demonstrated that the mass was absorbed remarkably after treatment. Follow up showed no tumor progression and no relapse of T. marneffei infection. CONCLUSION: This case suggested that clinicians should pay more attention to the potential hosts of T. marneffei infection, especially those with lung cancer. Early diagnosis and treatment can improve the prognosis of T. marneffei infection coexisting with lung cancer.


Assuntos
Neoplasias Pulmonares , Micoses , Talaromyces , Antifúngicos/uso terapêutico , Antineoplásicos/uso terapêutico , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Pessoa de Meia-Idade , Micoses/complicações , Micoses/diagnóstico , Micoses/tratamento farmacológico , Tomografia Computadorizada por Raios X
17.
Transpl Infect Dis ; 21(3): e13066, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30859662

RESUMO

BACKGROUND: Invasive fungal disease (IFD) has a poor prognosis in children with hematological disorders after hematopoietic stem cell transplantation (HSCT). We assessed if drug combinations with different targets may improve the outcome. METHODS: Retrospective study to assess the outcome of combination antifungal therapy (CAT) for proven-probable IFD (PP-IFD) in children with hematological disorders after HSCT from January 2008 to June 2018. RESULTS: Over the 10-year period, 95 PP-IFD were diagnosed in pediatric recipients, median age of 5.6 years. Twenty-seven patients received combinations of caspofungin and voriconazole, 28 patients received combinations of caspofungin and amphotericin B, and 40 patients received combinations of voriconazole and amphotericin B. The overall response rate of PP-IFD was 77.9%, while the 100-day overall survival rates were 66.8%. Univariate analysis showed that factors that significantly affected the response to combination treatments were type of combination (P = 0.02), the stem cell source (P = 0.04), the donor type (P = 0.03), HLA-match (P = 0.03), aGVHD (P = 0.02), period of treatment (P = 0.044), use of corticosteroids (0.036), CD4:CD8 ratio (P = 0.014), and CMV viremia (P = 0.033). In addition, multivariate analysis demonstrated that only the type of combination remained a significant factor (odds ratio = 0.335, 95% confidence interval: 0.071-0.812, P = 0.042). Forty-three children suffered from mild and reversible adverse reactions, no serious side effects during treatment. CONCLUSION: A variety of factors can affect the outcome of CAT. Combination of caspofungin with voriconazole is a safe and helpful treatment option for HSCT recipients with IFD.


Assuntos
Antifúngicos/uso terapêutico , Doenças Hematológicas/complicações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções Fúngicas Invasivas/tratamento farmacológico , Micoses/tratamento farmacológico , Adolescente , Anfotericina B/uso terapêutico , Caspofungina/uso terapêutico , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Doenças Hematológicas/microbiologia , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/microbiologia , Humanos , Lactente , Masculino , Micoses/etiologia , Estudos Retrospectivos , Análise de Sobrevida , Transplante Homólogo/efeitos adversos , Resultado do Tratamento , Voriconazol/uso terapêutico
18.
Mycoses ; 62(6): 526-533, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30864238

RESUMO

BACKGROUND: Posaconazole (PCZ) is used mainly for the prevention of invasive fungal infection (IFI). METHODS: A multicentre retrospective, investigational study using a non-randomized, single-arm design carried out in six tertiary hospitals in Spain to evaluate the use of PCZ in different forms of administration in the (non-prophylactic) treatment of IFI. RESULTS: Over an eight-year-period, 67 patients were included in this study. PCZ was administered as salvage therapy (intolerant or refractory to a previous antifungal agent) in 65/67 (97%); of these, it was used against Aspergillosis (68.6%), Zygomycosis (13.4%), other moulds (8.9%) and yeast (10.5%). The median duration of PCZ therapy was 75 days. The oral solution was associated with low serum levels (<0.7 mg/L) in 63% of available patients. Clinical response at 3 and 12 months of PCZ therapy were for aspergillosis: 47.8% and 41.3%; for zygomycosis: 55.5% and 55.5%; and for other mycoses: 69.2% and 69.2%, respectively. Suspension by toxicity was only observed in 6% and 7.5% of patients at 3 and 12 months, respectively, mainly with grade III/IV elevations of liver function test (LFTs). CONCLUSIONS: Posaconazole salvage therapy, especially oral tablets, can be an effective alternative option for patients with IFI who cannot tolerate or do not respond to other antifungal therapies.


Assuntos
Antifúngicos/administração & dosagem , Micoses/tratamento farmacológico , Terapia de Salvação/métodos , Triazóis/administração & dosagem , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/efeitos adversos , Antifúngicos/farmacocinética , Análise Química do Sangue , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Centros de Atenção Terciária , Resultado do Tratamento , Triazóis/efeitos adversos , Triazóis/farmacocinética , Suspensão de Tratamento/estatística & dados numéricos
19.
Int J Antimicrob Agents ; 53(6): 716-723, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30825504

RESUMO

Resveratrol is a naturally occurring polyphenolic antioxidant that has received massive attention for its potential health benefits, including anticarcinogenesis, anti-aging and antimicrobial properties. The compound is well tolerated by humans and in recent years has been widely used as a nutraceutical. Its common use makes it interesting to investigate with respect to antimicrobial properties both as a single agent and in combination with conventional antibiotics. Resveratrol displays antimicrobial activity against a surprisingly wide range of bacterial, viral and fungal species. At subinhibitory concentrations, resveratrol can alter bacterial expression of virulence traits leading to reduced toxin production, inhibition of biofilm formation, reduced motility and interference with quorum sensing. In combination with conventional antibiotics, resveratrol enhances the activity of aminoglycosides against Staphylococcus aureus, whereas it antagonises the lethal activity of fluoroquinolones against S. aureus and Escherichia coli. Whilst the antimicrobial properties of the compound have been extensively studied in vitro, little is known about its efficacy in vivo. Nonetheless, following topical application resveratrol has alleviated acne lesions caused by the bacterium Propionibacterium acnes. There are currently no in vivo studies addressing its effect in combination with antibiotics, but recent research suggests that there may be a potential for enhancing the antimicrobial efficacy of certain existing antibiotic classes in combination with resveratrol. Given the difficulties associated with introducing new antimicrobial agents to the market, nutraceuticals such as resveratrol may prove to be interesting candidates when searching for solutions for the growing problem of antimicrobial resistance.


Assuntos
Antibacterianos/farmacologia , Antifúngicos/farmacologia , Antioxidantes/farmacologia , Bactérias/efeitos dos fármacos , Reposicionamento de Medicamentos , Fungos/efeitos dos fármacos , Resveratrol/farmacologia , Animais , Infecções Bacterianas/tratamento farmacológico , Humanos , Micoses/tratamento farmacológico
20.
Mycoses ; 62(6): 542-550, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30887582

RESUMO

BACKGROUND: Reports on the consumption of systemic antifungal drugs on a national level are scarce although of high interest to compare trends and the associated epidemiology in other countries and to assess the need for antifungal stewardship programmes. OBJECTIVES: To estimate patterns of Belgian inpatient and outpatient antifungal use and provide reference data for other countries. METHODS: Consumption records of antifungals were collected in Belgian hospitals between 2003 and 2016. Primary healthcare data were available for the azoles for the period 2010-2016. RESULTS: The majority of the antifungal consumption resulted from prescriptions of fluconazole and itraconazole in the ambulatory care while hospitals were responsible for only 6.4% of the total national consumption and echinocandin use was limited. The annual average antifungal consumption in hospitals decreased significantly by nearly 25% between 2003 and 2016, due to a decrease solely in non-university hospitals. With the exception of specialised burn centres, antifungals are mostly consumed at ICUs and internal medicine wards. A significant decline was also observed in the consumption of azoles in primary health care, attributed to itraconazole. The major part of azoles was prescribed by generalists followed by dermatologists. CONCLUSIONS: In spite of the downward trend in annual use of systemic antifungal drugs, Belgium remains one of the biggest consumers in Europe.


Assuntos
Antifúngicos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Micoses/tratamento farmacológico , Bélgica , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino
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