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1.
J Assoc Physicians India ; 67(3): 75-80, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31304712

RESUMO

Antimicrobial resistance is a global problem and is definitely a cause of concern in India too, in the context of typhoid fever. It is becoming clearer that monotherapy is not effective for typhoid fever and the option to be considered is combination therapy. There are very few antibiotic combinations that are approved and backed by clinical evidence, available in India for the treatment of typhoid fever. Cefixime-ofloxacin combination is approved by Indian Regulatory Authority and has a good body of clinical evidence in the current Indian context. In-silico studies have demonstrated positive rationale of combining these two drugs, while in-vitro studies have substantiated the same by showing a strain specific synergistic and or additive activity between the two drugs against S. typhi. Clinical studies in Indian patients have shown multiple benefits of using this combination in typhoid fever such as a quick time to defervescence (~3 days), complete clinical cure in ~7 days, effective symptomatic relief, efficacy in relapse cases and a reduced need for hospitalization. The drug combination also demonstrates a very good tolerability profile. Recommendations of the Association of physicians of India also back this combination in typhoid fever. Thus, in the current era of emerging antibiotic resistance, cefixime-ofloxacin is a safe, effective and reliable treatment option for clinicians to treat uncomplicated typhoid in the Indian community setting.


Assuntos
Antibacterianos/uso terapêutico , Cefixima/uso terapêutico , Ofloxacino/uso terapêutico , Febre Tifoide/tratamento farmacológico , Combinação de Medicamentos , Humanos , Índia , Salmonella typhi
2.
BMC Infect Dis ; 19(1): 460, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118048

RESUMO

BACKGROUND: The multidrug therapy (MDT) for leprosy treatment adopted by Brazil in the 1990s was important for reducing leprosy in the country; however, recurrent cases remained problematic. Mechanisms involved in leprosy recurrence are heterogeneous and can be sorted into three groups: insufficient therapy, bacillary persistence and new infections. This study aimed to analyse the time interval of leprosy recurrence in relation to the therapeutic scheme in the state of Acre. The hypotheses were as follows: 1) treatments (a) rifampicin, ofloxacin and minocycline (ROM) and (b) dapsone (DDS) have a short leprosy recurrence time, 2) treatments based on MDT have a long leprosy recurrence time, 3) there is a dose-response relationship between MDT and the time interval between leprosy episodes. METHODS: This retrospective cohort study included 201 patients with a second episode of clinical leprosy at the reference centers for leprosy control in the state of Acre. Exposure was the type of therapeutic scheme as follows: 1) ROM, 2) DDS, 3) MDT0-9 doses, 4) MDT10-19 doses, 5) MDT20-29 doses, and 6) MDT30+ doses. Outcome was the time interval between release from treatment and a diagnosis of a recurrent leprosy case. Incidence rate ratios and relative risk Poisson regressions adjusted by age and sex were calculated with 95% confidence intervals. RESULTS: The 201 patients studied during this retrospective follow-up resulted in a total of 224 cases of recurrent leprosy. Incidence rate ratios within this therapeutic scheme were as follows: 3.3 (2.39, 4.2; ROM/MDT30+), 1.12 (0.33, 1.92; DDS/MDT30+), 2.17 (1.39, 2.94; MDT0-9/MDT30+), 1.94 (1.13, 2.75; MDT10-19/MDT30+) and 1.26 (0.47, 2.05; MDT20-29/MDT30+). Relative risk Poisson regressions showed a protective effect of MDT30+ in comparison with ROM (0.22; 0.07, 0.72), MDT0-9 (0.42; 0.21, 0.85), and MDT10-19 (0.44; 0.21, 0.92). No differences among MDT30+ and DDS (0.71; 0.36, 1.41) and MDT20-29 (0.76; 0.38, 1.49) were observed. CONCLUSIONS: New infection is an important-yet neglected-mechanism in leprosy recurrence in the state of Acre and can challenge the leprosy elimination plan in Brazil. MDT with few doses might be associated with leprosy recurrence due to insufficient therapy or bacillary persistence.


Assuntos
Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/etiologia , Adulto , Brasil/epidemiologia , Estudos de Coortes , Dapsona/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Minociclina/uso terapêutico , Ofloxacino/uso terapêutico , Recidiva , Estudos Retrospectivos , Rifampina/uso terapêutico , Fatores de Tempo , Resultado do Tratamento
3.
Cornea ; 38(8): 948-950, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31045959

RESUMO

PURPOSE: To report the clinical features and outcomes of toxic keratitis after application of powdered custard apple seeds for hair washing for head lice infestation. METHODS: Retrospective review of all patients with toxic keratitis after application of powdered custard apple seed for head lice infestation during the time period from January 2015 to December 2017. Demographic details, clinical features, and visual outcomes were documented. RESULTS: Thirty-one eyes of 19 patients with toxic keratitis after application of crushed custard apple seeds for head lice infestation were included in the study. Eighteen females and 1 male with a median age of 14 years [interquartile range (IQR) 12-34 years] presented with severe epiphora, congestion, photophobia, and defective vision (median logMar visual acuity 0.4, IQR 0.2-0.8) after application of custard apple seed powder for hair washing. Ten eyes (32.2%) had an epithelial defect (median size 9 mm, IQR 5-12 mm), and 21 (67.7%) eyes had punctate epithelial erosions. All the patients were treated with topical antibiotics, and at 3 days follow-up, all of them had resolution of symptoms and signs with a median logarithm of the minimum angle of resolution (logMAR) visual acuity of 0 (IQR 0-0.2). CONCLUSIONS: Health education about the harmful effect of this traditional practice for head lice infestation will prevent further similar events.


Assuntos
Annona/toxicidade , Ceratite/induzido quimicamente , Infestações por Piolhos/tratamento farmacológico , Pediculus/efeitos dos fármacos , Administração Oftálmica , Adolescente , Adulto , Animais , Antibacterianos/uso terapêutico , Criança , Dor Ocular/induzido quimicamente , Dor Ocular/diagnóstico , Dor Ocular/tratamento farmacológico , Feminino , Humanos , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Doenças do Aparelho Lacrimal/induzido quimicamente , Doenças do Aparelho Lacrimal/diagnóstico , Doenças do Aparelho Lacrimal/tratamento farmacológico , Masculino , Ofloxacino/uso terapêutico , Fotofobia/induzido quimicamente , Fotofobia/diagnóstico , Fotofobia/tratamento farmacológico , Estudos Retrospectivos , Transtornos da Visão/induzido quimicamente , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Adulto Jovem
5.
Cochrane Database Syst Rev ; 1: CD010871, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30682211

RESUMO

BACKGROUND: The genital infection caused by Chlamydia trachomatis (CT) is a common sexually transmitted infection (STI) globally. The infection is mainly asymptomatic in women, thus it can produce infertility and chronic pelvic pain. In men infection is mainly symptomatic, but can evolve to prostatitis. Clinical practice guidelines for CT urogenital infections do not give any specific recommendation about which antibiotic use as first option OBJECTIVES: To assess the efficacy and safety of antibiotic treatment for CT genital infection in men and non-pregnant women. SEARCH METHODS: The Cochrane Sexually Transmitted Infections' (STI) Information Specialist developed the electronic searches in electronic databases (CENTRAL, MEDLINE, Embase and LILACS), and trials registers. We searched studies published from inception to June 2018. SELECTION CRITERIA: We included parallel, randomised controlled trials (RCTs) of men, and sexually-active, non-pregnant women with CT infection (urethritis or uterine cervicitis or asymptomatic), diagnosed by cell culture for CT, nucleic acid amplification tests (NAAT) or antigen-based detection methods, who had been treated with any of the antibiotic regimens recommended by any of the updated to 2013 CT Guidelines. DATA COLLECTION AND ANALYSIS: Four review authors screened evidence according to selection criteria and independently extracted data and assessed risk of bias. Two authors developed the 'Summary of findings' tables. We used a fixed-effect meta-analysis model for combining data where it was reasonable to assume that studies were estimating the same underlying treatment effect. We estimated the pooled risk ratio in order to establish the effects of the comparisons. Our primary outcomes were microbiological failure and adverse events, and our secondary outcomes were clinical failure, antimicrobial resistance and reinfection. MAIN RESULTS: We selected 14 studies ( 2715 participants: 2147 (79.08%) men and 568 (20.92%) women). The studies were conducted mainly at STD clinics. Sample sizes ranged from 71 to 606 participants; follow-up was 29.7 days on average.For the comparison: azithromycin single dose versus doxycycline once or twice daily for 7 days, in men treated for CT, the risk of microbiological failure was higher in the azithromycin group (RR 2.45, 95% CI 1.36 to 4.41; participants = 821; studies = 9; moderate-quality evidence), but regarding clinical failure, the results showed that the effect is uncertain (RR 0.94, 95% CI 0.43 to 2,05; I² = 55%; participants = 525; studies = 3; low-quality evidence). Regarding adverse events (AE) in men there could be little or no difference between the antibiotics (RR 0.83, 95% CI 0.67 to 1.02; participants = 1424; studies = 6; low-quality evidence). About women treated for CT, the effect on microbiological failure was uncertain (RR = 1.71, 95% CI 0.48 to 6.16; participants = 338; studies = 5; very low-quality evidence). There were no studies assessing clinical failure or adverse events in women, however, we found that azithromycin probably has fewer adverse events in both genders (RR 0.83, 95% CI 0.71 to 0.98; I² = 0%; participants = 2261; studies = 9; moderate-quality evidence).For the second comparison: doxycycline compared to ofloxacin, for men treated for CT the effect on microbiological failure was uncertain (RR 8.53, 95% CI 0.43 to 167.38, I² not applicable; participants = 80; studies = 2; very low-quality evidence), as also it was on clinical failure (RR 0.85, 95% CI 0.28 to 2.62; participants = 36; studies = 1; very low-quality evidence). The effect of in women on clinical failure was uncertain (RR 0.94, 95% CI 0.39 to 2.25; I² = 39%; participants = 127; studies = 2; very low-quality evidence).Regarding adverse events, the effect in both men and women was uncertain (RR 1.02 95% CI 0.66 to 1.55; participants = 339 studies = 3; very low-quality evidence). The effect on microbiological failure in women and in men and women together, the effect on microbiological failure was not estimable. The most frequently AE reported were not serious and of gastrointestinal origin.No studies assessed antimicrobial resistance or reinfection in either comparison. AUTHORS' CONCLUSIONS: In men, regimens with azithromycin are probably less effective than doxycycline for microbiological failure, however, there might be little or no difference for clinical failure. For women, we are uncertain whether azithromycin compared to doxycycline increases the risk of microbiological failure. Azithromycin probably slightly reduces adverse events compared to doxycycline in men and women together but may have little difference in men alone. We are uncertain whether doxycycline compared to ofloxacin reduces microbiological failure in men or women alone, or men and women together, nor if it reduces clinical failure or adverse events in men or women.Based on the fact that women suffer mainly asymptomatic infections, and in order to test the effectiveness and safety of the current recommendations (azithromycin, doxycycline and ofloxacin), for CT infection, especially in low and middle income countries, future RCTs should be designed and conducted to include a large enough sample size of women, and with low risk of bias. It is also important that future RCTs include adherence, CT resistance to antibiotic regimens, and risk of reinfection as outcomes to be measured. In addition, it is important to conduct a network meta-analysis in order to evaluate all those studies that included in one arm only the current antibiotic treatments for CT infection that are recommended by the updated clinical practice guidelines.


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis , Doxiciclina/uso terapêutico , Antibacterianos/efeitos adversos , Infecções Assintomáticas/terapia , Azitromicina/efeitos adversos , Doxiciclina/efeitos adversos , Feminino , Humanos , Masculino , Ofloxacino/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores Sexuais , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológico
6.
Am J Otolaryngol ; 40(1): 46-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30266529

RESUMO

OBJECTIVE: We investigated the medical costs and effects of ofloxacin drops (OFLX), gelatin sponge patches, spontaneous healing, and endoscopic myringoplasty on healing in large tympanic membrane perforations (TMPs). METHODS: In total, 100 patients with large traumatic TMPs involving >50% of the eardrum were randomly assigned to OFLX, gelatin sponge, spontaneous healing, or endoscopic myringoplasty treatment groups. Medical costs, closure times, and closure rates were compared among groups at 6 months. RESULTS: The closure rates in the OFLX, gelatin sponge, spontaneous healing, and endoscopic myringoplasty groups were 95.7%, 82.6%, 58.3%, and 91.7%, respectively (P = 0.05). The mean closure time was 13.73 ±â€¯6.14 days in the OFLX group, 15.89 ±â€¯4.95 days in the gelatin sponge group, 48.36 ±â€¯10.37 days in the spontaneous healing group, and 12 days in the endoscopic myringoplasty group (P < 0.001). The mean medical costs in US dollars were $15.53 ±â€¯3.15, $103.64 ±â€¯111.58, $11.17 ±â€¯1.33, and $715.90 in the OFLX, gelatin sponge, spontaneous healing, and endoscopic myringoplasty groups, respectively (P < 0.001). CONCLUSION: Although the gelatin sponge and myringoplasty treatments significantly shortened the closure time compared with spontaneous healing, the gelatin sponge patch did not significantly improve the closure rate, and the medical cost of myringoplasty was significantly higher than that of the other treatments. In contrast, OFLX significantly shortened closure time and had a higher closure rate than spontaneous healing, and the medical costs were lower than those of the gelatin sponge and myringoplasty procedures.


Assuntos
Endoscopia/economia , Esponja de Gelatina Absorvível/economia , Custos de Cuidados de Saúde , Miringoplastia/economia , Ofloxacino/economia , Perfuração da Membrana Timpânica/terapia , Adulto , Antibacterianos/economia , Antibacterianos/uso terapêutico , Feminino , Esponja de Gelatina Absorvível/uso terapêutico , Hemostáticos/economia , Hemostáticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Ofloxacino/uso terapêutico , Perfuração da Membrana Timpânica/economia , Cicatrização , Adulto Jovem
7.
J Med Case Rep ; 12(1): 388, 2018 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-30579358

RESUMO

BACKGROUND: Mucosal melanoma of the head and neck is a rare malignant tumor associated with a poor prognosis. Surgery, chemotherapy, radiotherapy, and biotherapy are common strategies for treating mucosal melanoma of the head and neck. Episcleritis is an idiopathic, immune-mediated disease, and is classified into two types: simple episcleritis and nodular episcleritis. CASE PRESENTATION: In this case report we describe ocular changes involving simple episcleritis in a 65-year-old Chinese man with mucosal melanoma of the head and neck after treatment with interferon alfa-2b and radiotherapy. On the third day of interferon alfa-2b treatment, he began to develop simple episcleritis in his left eye. Moreover, the percentage of CD3+ T cells in lymphocytes from blood was increased after interferon alfa-2b treatment. After approximately 6 days, the symptoms of eye pain, hyperemia, and edema disappeared gradually. Then, after radiotherapy was performed three times, he again developed episcleritis in his left eye. The same symptoms of hyperemia and edema occurred again; CD3+ T cell frequency was also at a higher level. After approximately a week, all the symptoms disappeared completely. Simple treatment involving topical ofloxacin and phenylephrine was administered during the two periods of episcleritis. CONCLUSION: Episcleritis in this patient might have been due to the treatment with interferon alfa-2b and radiotherapy, leading to an increase in the level of CD3+ T cells and activation of immune system cells, which provides the guide for clinical clinicians.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias de Cabeça e Pescoço/terapia , Interferon alfa-2/uso terapêutico , Melanoma/terapia , Radioterapia , Idoso , Antibacterianos/uso terapêutico , Antineoplásicos/efeitos adversos , Quimioterapia Adjuvante , Terapia Combinada , Neoplasias de Cabeça e Pescoço/fisiopatologia , Humanos , Interferon alfa-2/efeitos adversos , Masculino , Melanoma/fisiopatologia , Ofloxacino/uso terapêutico , Soluções Oftálmicas/uso terapêutico , Fenilefrina/uso terapêutico , Radioterapia/efeitos adversos , Resultado do Tratamento
8.
Braz J Infect Dis ; 22(4): 305-310, 2018 Jul - Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30086258

RESUMO

OBJECTIVES: To determine the main predictors of death in multidrug-resistant (MDRTB) patients from Brazil. DESIGN: Retrospective cohort study, a survival analysis of patients treated between 2005 and 2012. RESULTS: Of 3802 individuals included in study, 64.7% were men, mean age was 39 (1-93) years, and 70.3% had bilateral pulmonary disease. Prevalence of human immunodeficiency virus (HIV) was 8.3%. There were 479 (12.6%) deaths. Median survival time was 1452 days (4 years). Factors associated with increased risk of death were age greater than or equal to 60 years (hazard rate [HR] = 1.6, confidence interval [CI] = 1.15-2.2), HIV co-infection (HR = 1.46; CI = 1.05-1.96), XDR resistance pattern (HR = 1.74, CI = 1.05-2.9), beginning of treatment after failure (HR = 1.72, CI = 1.27-2.32), drug abuse (HR = 1.64, CI = 1.22-2.2), resistance to ethambutol (HR = 1.30, CI = 1.06-1.6) or streptomycin (HR = 1.24, CI = 1.01-1.51). Mainly protective factors were presence of only pulmonary disease (HR = 0.57, CI = 0.35-0.92), moxifloxacin use (HR = 0.44, CI = 0.25-0.80), and levofloxacin use (HR = 0.75; CI = 0.60-0.94). CONCLUSION: A more comprehensive approach is needed to manage MDRTB, addressing early diagnostic, improving adhesion, and comorbidities, mainly HIV infection and drug abuse. The latest generation quinolones have an important effect in improving survival in MDRTB.


Assuntos
Infecções por HIV , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Brasil/epidemiologia , Causas de Morte , Criança , Pré-Escolar , Estudos de Coortes , Coinfecção/etiologia , Escolaridade , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Ofloxacino/uso terapêutico , Quinolonas/uso terapêutico , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida/tendências , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Adulto Jovem
9.
BMC Infect Dis ; 18(1): 98, 2018 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-29486710

RESUMO

BACKGROUND: The emergence of extensively drug-resistant tuberculosis (XDR-TB) has raised public health concern for global TB control. Although multi drug-resistant tuberculosis (MDR- TB) prevalence and associated genetic mutations in Morocco are well documented, scarce information on XDR TB is available. Hence, the evaluation of pre-XDR and XDR prevalence, as well as the mutation status of gyrA, gyrB, rrs, tlyA genes and eis promoter region, associated with resistance to second line drugs, is of great value for better management of M/XDR TB in Morocco. OBJECTIVES: To evaluate pre-XDR and XDR prevalence, as well as the mutation status of gyrA, gyrB, rrs, tlyA genes and eis promoter region, associated with resistance to second line drug resistance, in 703 clinical isolates from TB patients recruited in Casablanca, and to assess the usefulness of molecular tools in clinical laboratories for better management of M/XDR TB in Morocco. METHODS: Drug susceptibility testing (DST) was performed by the proportional method for first line drugs, and then the selected MDR isolates were tested for second line drugs (Ofloxacin, Kanamycin, Amikacin and Capreomycin). Along with DST, all samples were subjected to rpoB, katG and p-inhA mutation analysis by PCR and DNA sequencing. MDR isolates as well as 30 pan-susceptible strains were subjected to PCR and DNA sequencing of gyrA, gyrB, rrs, tlyA genes and eis promoter, associated with resistance to fluoroquinolones and injectable drugs. RESULTS: Among the 703 analysed strains, 12.8% were MDR; Ser531Leu and Ser315Thr being the most common recorded mutations within rpoB and katG genes associated with RIF and INH resistance respectively. Drug susceptibility testing for second line drugs showed that among the 90 MDR strains, 22.2% (20/90) were resistant to OFX, 2.22% (2/90) to KAN, 3.33% (3/90) to AMK and 1.11% (1/90) to CAP. Genotypic analysis revealed that 19 MDR strains harbored mutations in the gyrA gene; the most recorded mutation being Asp91Ala accounting for 47.6% (10/21), and 2 isolates harbored mutations in the promoter region of eis gene. No mutation was found in gyrB, rrs and tlyA genes. Moreover, none of the pan-susceptible isolates displayed mutations in targeted genes. CONCLUSION: Most of mutations associated with SLD resistance occurred in gyrA gene (codons 90-94) and eis promoter region. These findings highlight the impact of mutations in gyrA on the development of fluroquinolones resistance and provide the first estimates of the proportion of pre-XDR-TB among MDR-TB cases in Morocco.


Assuntos
Análise Mutacional de DNA , Farmacorresistência Bacteriana Múltipla/genética , Mutação , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Amicacina/uso terapêutico , Antituberculosos/uso terapêutico , Sequência de Bases , Capreomicina/uso terapêutico , Análise Mutacional de DNA/métodos , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Tuberculose Extensivamente Resistente a Medicamentos/epidemiologia , Tuberculose Extensivamente Resistente a Medicamentos/microbiologia , Frequência do Gene , Humanos , Canamicina/uso terapêutico , Testes de Sensibilidade Microbiana , Marrocos/epidemiologia , Mycobacterium tuberculosis/isolamento & purificação , Ofloxacino/uso terapêutico , Prevalência , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia
11.
Emerg Infect Dis ; 24(1): 165-166, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29260666

RESUMO

In Canada, Hansen disease (leprosy) is rare and not considered in diagnoses for nonimmigrant patients. We report Mycobacterium leprae infection in a Canadian man whose sole travel was to Florida, USA. The M. leprae isolate was identified as armadillo-associated genotype 3I-2-v1. Travelers to the southern United States should avoid contact with armadillos.


Assuntos
Hanseníase/diagnóstico , Hanseníase/epidemiologia , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Canadá , Dapsona/administração & dosagem , Dapsona/uso terapêutico , Quimioterapia Combinada , Florida , Humanos , Hansenostáticos/administração & dosagem , Hansenostáticos/uso terapêutico , Hanseníase/microbiologia , Masculino , Mycobacterium leprae , Ofloxacino/administração & dosagem , Ofloxacino/uso terapêutico , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Viagem
12.
Ocul Immunol Inflamm ; 26(2): 269-272, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-27494457

RESUMO

A 28-year-old male farmer presented to our emergency service with bilateral painful visual loss for the past 7 days that occurred suddenly after alcohol consumption. Examination showed bilateral central corneal epithelial defects, 3+ stromal edema, and cortical cataracts. After treatment with oral and topical corticosteroids for 4 weeks the corneal edema had subsided completely with mild anterior stromal scarring. Rapid progression of cataract to intumescent stage warranted sequential cataract surgeries 1 and 2 months after first presentation. Postoperatively, visual acuity recovered to 20/20 and 20/30 in the right and left eye respectively. This case highlights the extremely rare presentation of bilateral alcohol-induced toxic endothelitis, which recovered after intensive corticosteroid therapy.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Catarata/induzido quimicamente , Edema da Córnea/induzido quimicamente , Epitélio Posterior/efeitos dos fármacos , Etanol/toxicidade , Ceratite/induzido quimicamente , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Catarata/diagnóstico , Extração de Catarata , Edema da Córnea/diagnóstico , Edema da Córnea/tratamento farmacológico , Combinação de Medicamentos , Epitélio Posterior/patologia , Glucocorticoides/uso terapêutico , Humanos , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Masculino , Metilprednisolona/uso terapêutico , Ofloxacino/uso terapêutico , Parassimpatolíticos/uso terapêutico , Prednisolona/análogos & derivados , Prednisolona/uso terapêutico , Tropanos/uso terapêutico
13.
J Microbiol Immunol Infect ; 51(1): 88-93, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28698044

RESUMO

BACKGROUND: Multidrug-resistant and extensively drug-resistant tuberculosis infections cause public health concerns worldwide. Local epidemiologic data about the drug resistance of Mycobacterium tuberculosis isolate (Mtb) is critical to guide appropriate empirical therapy to cure patients and restrain the spread of tuberculosis. METHODS: Antituberculosis susceptibility testing was performed for 287 Mtbs, including 63 MDR-Mtbs collected in southern Taiwan from 2011 to 2015. Tuberculosis patients were classified into newly diagnosed cases and previously treated cases based on patients' medical history. RESULTS: Almost no resistance was found to the tested second-line antituberculosis drugs in non-MDR-Mtbs. Higher resistance rates to ethambutol, ofloxacin, and streptomycin were observed in MDR-Mtbs compared to non-MDR-Mtbs. Among 63 MDR-Mtbs, 61.9% of patients were newly diagnosed and 38.1% were previously treated cases. For MDR-Mtb, the drug-resistance rates in previously treated cases were significantly higher for ethambutol, pyrazinamide, ofloxacin, moxifloxacin, streptomycin, and p-aminosalicylic acid. When MDR-Mtbs are identified in previously treated cases, empirical administration of ethambutol, pyrazinamide, ofloxacin, or moxifloxacin may not provide effective treatment. The resistance rates to these drugs were all more than 50%. Furthermore, 25% of MDR-Mtbs from previously treated patients were resistant to p-aminosalicylic acid. CONCLUSION: We observed almost no resistance to the tested second-line antituberculosis drugs among non-MDR-Mtbs. Anti-tuberculosis regimen with pyrazinamide, ethambutol, fluoroquinolone, kanamycin, cycloserine and p-aminosalicylic acid can be empirically used for newly diagnosed MDR-TB cases. For previously treated MDR-TB patients, empirical ethambutol, pyrazinamide, ofloxacin, or moxifloxacin may not provide effective treatment because the resistance rates to these drugs were all >50%.


Assuntos
Antituberculosos/farmacologia , Tuberculose Extensivamente Resistente a Medicamentos/diagnóstico , Tuberculose Extensivamente Resistente a Medicamentos/epidemiologia , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Ácido Aminossalicílico/uso terapêutico , Antituberculosos/classificação , Etambutol/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/microbiologia , Fluoroquinolonas/uso terapêutico , Humanos , Testes de Sensibilidade Microbiana , Moxifloxacina , Ofloxacino/uso terapêutico , Pirazinamida/uso terapêutico , Estreptomicina/uso terapêutico , Taiwan/epidemiologia
14.
Chemotherapy ; 63(6): 321-323, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30844788

RESUMO

Drugs that have a good intracellular passage are used in the treatment of brucellosis. According to our knowledge, there is no report in English about rifabutin usage in brucellosis. We present a case that developed intolerance to many anti-brucella drugs, who was then successfully treated with a combination of rifabutin, ofloxacin, and ceftriaxone.


Assuntos
Antibióticos Antituberculose/uso terapêutico , Brucelose/tratamento farmacológico , Rifabutina/uso terapêutico , Adulto , Brucelose/complicações , Brucelose/diagnóstico , Ceftriaxona/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Ofloxacino/uso terapêutico , Sacroileíte/diagnóstico , Sacroileíte/etiologia , Tomografia Computadorizada por Raios X
15.
Indian J Med Res ; 146(Supplement): S23-S29, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29205192

RESUMO

BACKGROUND & OBJECTIVES: The prevalence of multidrug-resistant (MDR) Escherichia coli isolates producing ß-lactamase enzyme is a growing problem across the globe. Strain typing is an epidemiologically important tool not only for detecting the cross transmission of nosocomial pathogens but also for determining the source of infection. The present study was conducted to understand the clonal relationship among various ß-lactamase-producing MDR E. coli isolates using enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR). METHODS: A total of 41 MDR E. coli isolates were randomly collected from various clinical samples and processed. Isolated organisms were tested for antibiotics resistance pattern. Phenotypic detection of metallo ß-lactamases (MBL) was carried out by the imipenem-ethylenediaminetetraacetic acid disc diffusion/double-disc synergy test. AmpC enzyme production was tested by a modified three-dimensional extract test. RESULTS: Almost all isolates were found sensitive to colistin. A high percentage of drug resistance was observed in these isolates against ceftazidime (100%), cefotaxime (100%), cefepime (100%), ofloxacin (97.56%), amoxicillin/clavulanic acid (97.56%) and norfloxacin (85.36%). Of the 41 isolates, ESBL producers were found to be predominant, i.e., 22 (53.65%), followed by AmpC (6, 14.63%) and MBL (5, 12.19%). INTERPRETATION & CONCLUSIONS: At 60 per cent similarity cut-off value, the dendrogram analysis showed that there were a total of 14 unique clusters of ERIC (CL-1 - CL-14) within the 41 E. coli isolates, which revealed the genetic diversity existing between them.


Assuntos
Farmacorresistência Bacteriana Múltipla/genética , Escherichia coli/genética , Variação Genética/genética , Resistência beta-Lactâmica/genética , Cefotaxima/uso terapêutico , Colistina/uso terapêutico , DNA Intergênico/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/patogenicidade , Variação Genética/efeitos dos fármacos , Humanos , Imipenem/uso terapêutico , Testes de Sensibilidade Microbiana/métodos , Ofloxacino/uso terapêutico , Reação em Cadeia da Polimerase/métodos , Centros de Atenção Terciária , beta-Lactamases/genética
16.
Infez Med ; 25(4): 366-370, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29286018

RESUMO

Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy decreases the progression risk of non-muscle-invasive bladder cancer, but potentially yields a broad spectrum of side effects. We report the case of a 73-year-old man affected by miliary pulmonary BCG infection, whose microbiological diagnosis was probably hindered by empiric fluoroquinolones, focusing on imaging and clinical work-up.


Assuntos
Vacina BCG/efeitos adversos , Imunoterapia/efeitos adversos , Mycobacterium bovis/patogenicidade , Tuberculose Miliar/etiologia , Tuberculose Pulmonar/etiologia , Idoso , Antituberculosos/uso terapêutico , Líquido da Lavagem Broncoalveolar/microbiologia , Carcinoma de Células de Transição/terapia , Diagnóstico Tardio , Febre de Causa Desconhecida/microbiologia , Humanos , Masculino , Mycobacterium bovis/isolamento & purificação , Ofloxacino/uso terapêutico , Escarro/microbiologia , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Neoplasias da Bexiga Urinária/terapia
18.
Tuberculosis (Edinb) ; 107: 1-4, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29050755

RESUMO

Rapid detection of resistance to the second-line drugs is essential for early initiation of appropriate anti-tubercular treatment regimen among multi-drug tuberculosis (MDR-TB). In this study, we applied a multiplex allele-specific PCR (MAS-PCR) to identify the mutations on codons 90 and 94 of gyrA and nucleotide 1401 of rrs for detecting ofloxacin (OFX) and kanamycin (KAN) resistance in 139 MDR-TB isolates from China. Using the traditional phenotypic method as the reference, MAS-PCR detected resistance to OFX and KAN with sensitivities of 67.3% and 76.5%, respectively, and specificities of 100.0%. Therefore, MAS-PCR assays can be used for rapid detection of second-line drug resistance among MDR-TB in China, enabling early administration of appropriate treatment regimens to the affected MDR-TB patients.


Assuntos
Técnicas Bacteriológicas , Análise Mutacional de DNA/métodos , Farmacorresistência Bacteriana Múltipla/genética , Reação em Cadeia da Polimerase Multiplex , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Antituberculosos/uso terapêutico , China , DNA Girase/genética , Genótipo , Humanos , Canamicina/uso terapêutico , Resistência a Canamicina/genética , Testes de Sensibilidade Microbiana , Mutação , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/patogenicidade , Ofloxacino/uso terapêutico , Valor Preditivo dos Testes , Proteínas Ribossômicas/genética , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico
19.
BMC Infect Dis ; 17(1): 655, 2017 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-28962599

RESUMO

BACKGROUND: Interim treatment outcomes at 6-months for multidrug-resistant tuberculosis (MDR-TB) treatment are among the most basic performance monitoring and key evaluation indicators in the Stop and End TB strategy of the World Health Organization (WHO). Therefore, this study was conducted to evaluate the interim treatment outcomes of MDR-TB patients in Pakistan. METHODS: This study was conducted at the Programmatic Management Unit for Drug-resistance TB (PMDT) site of the National Tuberculosis Program (NTP), Pakistan. It is located in the Chest Disease Unit (CDU) of the Bahawal Victoria Hospital (BVH), Bahawalpur, Punjab, Pakistan. Data was collected between April 1, 2014 and December 31, 2015. The medical records, Electronic Nominal Recording Reporting System (ENRS) data and MRD-TB notification forms of the MDR-TB patients registered at the PMDT site were reviewed to obtain data. For reporting and calculation of interim treatment outcomes, standardized WHO methodology was adopted. Simple logistic regression analysis was used to examine the possible association between the dependent variable (i.e. unsuccessful interim treatment outcome) and selected socio-demographic and clinical variables. RESULTS: A total of 100 drug-resistant TB (DR-TB) patients (all types) were registered during the study period. Out of these, 80 were MDR-TB patients for whom interim results were available. Out of the 80 MDR-TB cases, 48 (60%) were classified under the successful interim treatment outcome category. The remaining 40% had unsuccessful 6-month treatment outcomes and 12 (15%) patients died, while nine (11.3%) were lost to follow-up by six months. The final predictors of unsuccessful interim treatment outcomes were; being resistant to ofloxacin (AOR 3.23, 95% CI 0.96-10.89; p-value = 0.04), having above normal baseline serum creatinine levels (AOR 6.49, 95% CI 1.39-30.27; p-value = 0.02), and being culture positive at the second month of treatment (AOR 6.94, 95% CI 2-24.12; p-value = 0.01). CONCLUSIONS: Despite free treatment and programmatic efforts to ensure patient adherence, the high rate of unsuccessful interim treatment outcomes is concerning. The identified risk factors for unsuccessful interim treatment outcomes in the current study provides clinicians an opportunity to identify high-risk patients and ensure enhanced clinical management and greater treatment success rates.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Adulto , Antituberculosos/efeitos adversos , Estudos de Coortes , Creatinina/sangue , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Humanos , Perda de Seguimento , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Ofloxacino/uso terapêutico , Paquistão , Cooperação do Paciente , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 35(8): 487-492, oct. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-167835

RESUMO

Introducción: En los últimos años se ha observado un incremento de la resistencia a fluoroquinolonas en enterobacterias, estando asociado significativamente a la resistencia a betalactámicos. Nuestro objetivo fue conocer la prevalencia de mecanismos cromosómicos y plasmídicos de resistencia a quinolonas en aislados productores de betalactamasas de claseC adquiridas y/o carbapenemasas. Métodos: Se evaluó la presencia de mecanismos cromosómicos y plasmídicos de resistencia a quinolonas [mutaciones en la región determinante de resistencia a quinolonas de gyrA y parCy genes qnr, aac(6')-Ib-cr y qepA] en 289 aislados de enterobacterias productoras de betalactamasas de claseC adquiridas y/o carbapenemasas recogidos entre febrero y julio de 2009 en 35 hospitales españoles. Resultados: Se detectaron determinantes plasmídicos en 92 aislados (31,8%); en 83 aislados (28,7%) se detectó algún gen qnr, y en 20 (7%), la variante aac(6')-Ib-cr. El gen qnr más prevalente fue qnrB4 (20%), asociado en la mayoría de los casos a DHA-1. El 14,6% de los aislados con una CMI de ciprofloxacino superior a 0,25mg/l no presentaban mutaciones en gyrA ni parC, detectándose en el 90% de los mismos algún determinante plasmídico de resistencia a quinolonas. Conclusión: qnrB4 fue el determinante plasmídico más prevalente, claramente asociado a DHA-1. Los mecanismos plasmídicos en asociación con mecanismos cromosómicos diferentes a las mutaciones en los genes de las topoisomerasas (sobreexpresión de bombas de expulsión, alteración del lipopolisacárido o disminución de porinas) pueden dar lugar a valores de CMI de ciprofloxacino que superan los puntos de corte establecidos por los principales comités internacionales de definición de puntos de corte para interpretación de datos de sensibilidad (AU)


Background: Quinolone resistance in Enterobacteriaceae species has increased over the past few years, and is significantly associated to beta-lactam resistance. The aim of this study was to evaluate the prevalence of chromosomal- and plasmid-mediated quinolone resistance in acquired AmpC Beta-lactamase and/or carbapenemase-producing Enterobacteriaceae isolates. Methods: The presence of chromosomal- and plasmid-mediated quinolone resistance mechanisms [mutations in the quinolone resistance determining region (QRDR) of gyrA and parC and qnr, aac(6')-Ib-cr and qepA genes] was evaluated in 289 isolates of acquired AmpC Beta -lactamase- and/or carbapenemase-producing Enterobacteriaceae collected between February and July 2009 in 35 Spanish hospitals. Results: Plasmid mediated quinolone resistance (PMQR) genes were detected in 92 isolates (31.8%), qnr genes were detected in 83 isolates (28.7%), and the aac(6')-Ib-cr gene was detected in 20 isolates (7%). qnrB4 gene was the most prevalent qnr gene detected (20%), associated, in most cases, with DHA-1. Only 14.6% of isolates showed no mutations in gyrA or parC with a ciprofloxacin MIC of 0.5mg/L or higher, whereas PMQR genes were detected in 90% of such isolates. Conclusion: qnrB4 gene was the most prevalent PMQR gene detected, and was significantly associated with acquired AmpC Beta -lactamase DHA-1. PMQR determinants in association with other chromosomal-mediated quinolone resistance mechanisms, different to mutations in gyrA and parC (increased energy-dependent efflux, altered lipopolysaccharide or porin loss), could lead to ciprofloxacin MIC values that exceed breakpoints established by the main international committees to define clinical antimicrobial susceptibility breakpoints (AU)


Assuntos
Humanos , Quinolonas/farmacologia , beta-Lactamases/uso terapêutico , Fluoroquinolonas/farmacologia , Enterobacteriaceae/enzimologia , Proteínas de Bactérias/classificação , Carbapenêmicos/metabolismo , Espanha/epidemiologia , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Proteínas de Bactérias/uso terapêutico , Proteínas de Bactérias/análise , Plasmídeos/uso terapêutico , Testes de Sensibilidade Microbiana/métodos , Ofloxacino/uso terapêutico
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