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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): 710, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31405376

RESUMO

BACKGROUND: Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy. CASE PRESENTATION: A 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates. CONCLUSION: PC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed.


Assuntos
Criptococose/diagnóstico por imagem , Criptococose/microbiologia , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/microbiologia , Derrame Pleural/microbiologia , Administração Oral , Idoso , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Criptococose/tratamento farmacológico , Cryptococcus neoformans/patogenicidade , Fluconazol/administração & dosagem , Fluconazol/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/tratamento farmacológico , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/radioterapia , Masculino , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Tomografia por Emissão de Pósitrons
3.
Emerg Infect Dis ; 25(9): 1776-1777, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31441756

RESUMO

Chronic pulmonary blastomycosis is often misdiagnosed and treated as tuberculosis in disease-endemic and non-disease-endemic areas. We report the case of a 32-year-old man who after visiting Chicago, Illinois, USA, returned to India and received treatment for tuberculosis for 12 months before receiving the correct diagnosis of blastomycosis.


Assuntos
Blastomyces/isolamento & purificação , Blastomicose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Adulto , Antifúngicos/uso terapêutico , Blastomicose/tratamento farmacológico , Blastomicose/microbiologia , Chicago , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Índia , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , Masculino , Viagem , Tuberculose Pulmonar/diagnóstico
5.
Mycoses ; 62(10): 893-907, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31173415

RESUMO

BACKGROUND: Mucormycosis portends a poor prognosis with mortality rates ranging from 50% to 70% in pulmonary mucormycosis (PM) and up to 95% in disseminated disease. However, detailed outcomes data have been lacking. It remains unknown how to identify patients who would benefit from surgical resection. OBJECTIVES: We present our experience with patients undergoing surgical resection for PM, including an analysis of factors affecting postoperative survival. We also describe a thoracic surgeon's approach through illustrative cases. PATIENTS/METHODS: We conducted a single-centre retrospective study of all adult patients with PM who received antifungal therapy and underwent surgical resection or who received antifungal therapy alone at Stanford between January 2004 and June 2018. RESULTS: Twelve patients received antifungal therapy and underwent surgical resection and 13 patients received antifungal therapy alone. From infection onset to death (or right-censoring if still alive), patients who underwent surgical resection had a median survival of 406 days (mean, 561.3; range, 22-2510), and patients who received antifungal therapy alone had a median survival of 28 days (mean, 66.7; range, 8-447). In patients who underwent surgical resection, median postoperative survival time was 154 days (range, 11-2495), in-hospital mortality was 16.7%, and 1-year mortality was 50.0%. Age, primary disease, ASA status, extrapulmonary dissemination, laterality, multilobar involvement, number of lesions, largest lesion size, platelet count, surgical approach, type of resection or extent of resection were not significantly associated with postoperative survival. CONCLUSIONS: Surgical resection significantly increases survival and should be strongly considered for selected patients with PM.


Assuntos
Pneumopatias Fúngicas/cirurgia , Mucormicose/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodos , Adulto , Idoso , Antifúngicos/uso terapêutico , Terapia Combinada/métodos , Feminino , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
7.
Med Mycol ; 57(Supplement_2): S110-S117, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30816974

RESUMO

Fungal asthma broadly encompasses the presence of fungal sensitization or fungal allergy in patients with asthma. The clinical presentation of fungal asthma can vary from fungal-sensitized asthma at one end to allergic bronchopulmonary mycosis at the other end of the spectrum. Here we present five cases that illustrate some of the most challenging aspects of the diagnosis and management of fungal asthma. The cases are aimed at elucidating complex clinical presentations in fungal asthma such as allergic bronchopulmonary mycosis presenting with normal immunoglobulin E (IgE) values, the role of several different fungi in causing allergic mycosis, newer treatments like omalizumab (and mepolizumab), and a complication of long-standing allergic bronchopulmonary aspergillosis, namely, chronic pulmonary aspergillosis.


Assuntos
Asma/etiologia , Gerenciamento Clínico , Pneumopatias Fúngicas/complicações , Antifúngicos/uso terapêutico , Asma/diagnóstico , Testes Diagnósticos de Rotina/métodos , Humanos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico
8.
Med Mycol ; 57(2): 133-150, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30329097

RESUMO

Pulmonary cryptococcosis is an important opportunistic invasive mycosis in immunocompromised patients, but it is also increasingly seen in immunocompetent patients. The main human pathogens are Cryptococcus neoformans and C. gattii, which have a worldwide distribution. In contrast to cryptococcal meningitis, pulmonary cryptococcosis is still underdiagnosed because of limitations in diagnostic tools. It can mimic lung cancer, pulmonary tuberculosis, bacterial pneumonia, and other pulmonary mycoses both clinically and radiologically. Pulmonary nodules are the most common radiological feature, but these are not specific to pulmonary cryptococcosis. The sensitivity of culture of respiratory samples for Cryptococcus is poor and a positive result may also reflect colonisation. Cryptococcal antigen (CrAg) with lateral flow device is a fast and sensitive test and widely used on serum and cerebrospinal fluid, but sera from patients with pulmonary cryptococcosis are rarely positive in the absence of disseminated disease. Detection of CrAg from respiratory specimens might assist the diagnosis of pulmonary cryptococcosis but there are very few data. Molecular detection techniques such as multiplex reverse transcription polymerase chain reaction (RT-PCR) could also provide better sensitivity but these still require validation for respiratory specimens. The first line of treatment for pulmonary cryptococcosis is fluconazole, or amphotericin B and flucytosine for those with central nervous system involvement. Pulmonary cryptococcosis worsens the prognosis of cryptococcal meningitis. In this review, we summarize the biological aspects of Cryptococcus and provide an update on the diagnosis and management of pulmonary cryptococcosis.


Assuntos
Criptococose/diagnóstico , Criptococose/patologia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/patologia , Pulmão/patologia , Animais , Antifúngicos/uso terapêutico , Técnicas de Laboratório Clínico , Criptococose/tratamento farmacológico , Criptococose/prevenção & controle , Cryptococcus/isolamento & purificação , Cryptococcus/patogenicidade , Cryptococcus/fisiologia , Humanos , Pulmão/microbiologia , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/prevenção & controle , Prognóstico , Fatores de Risco
9.
Am J Ophthalmol ; 198: 88-96, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30308204

RESUMO

PURPOSE: Histoplasmosis is a known complication of systemic immunosuppressive therapy, particularly among patients who are receiving tumor necrosis factor α inhibitors. There are limited data on the development of disseminated or pulmonary histoplasmosis among patients who are receiving systemic immunosuppressive medication for noninfectious ocular inflammation. DESIGN: Retrospective case series. METHODS: We reviewed all patients with uveitis or scleritis who subsequently developed pulmonary or disseminated histoplasmosis at the Mayo Clinic in Rochester, Minnesota between September 1, 1994 and July 1, 2017, with a 3:1 age- and sex-matched control cohort who did not develop histoplasmosis. This was a single institutional study examining patients that developed histoplasmosis after the initiation of systemic immunomodulatory therapy (IMT). Patients had to develop either disseminated or pulmonary histoplasmosis while receiving systemic immunosuppressive therapy and have an ophthalmic examination at Mayo Clinic Rochester. The control group was comprised of patients who received systemic IMT for ocular inflammation but did not develop histoplasmosis. RESULTS: Nine cases of histoplasmosis were identified: 2 disseminated and 7 pulmonary. Both patients with disseminated histoplasmosis were taking tumor necrosis factor α inhibitors. Seven of the 9 patients received systemic antifungal medication, including both disseminated cases. Over a median follow-up of 4.4 years, none of the patients died, and there were no recurrences of histoplasmosis. When compared to the control cohort, there was no correlation between length of time on IMT and the risk of histoplasmosis. CONCLUSIONS: Ocular inflammation patients on systemic immunomodulatory therapy may develop pulmonary or disseminated histoplasmosis. Most cases require treatment with systemic antifungal medication, but it might not be necessary to stop systemic immunomodulatory medication for ocular inflammation. Ophthalmologists should be aware that patients receiving systemic immunomodulatory therapy have a higher risk of developing Histoplasma infections. Prompt diagnosis and treatment using the expertise of an infectious diseases specialist may ensure low mortality for these patients.


Assuntos
Adalimumab/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Histoplasmose/induzido quimicamente , Infliximab/efeitos adversos , Pneumopatias Fúngicas/induzido quimicamente , Esclerite/tratamento farmacológico , Uveíte/tratamento farmacológico , Adulto , Antifúngicos/uso terapêutico , Feminino , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Imunomodulação , Infecções Fúngicas Invasivas/induzido quimicamente , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/tratamento farmacológico , Itraconazol/uso terapêutico , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fator de Necrose Tumoral alfa/antagonistas & inibidores
11.
J Mycol Med ; 29(1): 80-83, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30553628

RESUMO

Pulmonary mucormycosis is a rare opportunistic infection caused by Mucormycosis. This fungal infection is uncommon in immunocompetent individuals. Because of its various clinical and imaging manifestations, it is a diagnostic challenge to distinguish pulmonary mucormycosis from other pulmonary diseases, such as carcinoma. Herein, we report a case of pulmonary mucormycosis presenting as Pancoast syndrome and bone destruction of ribs. A 46-year-old Chinese woman was admitted due to pain in chest, right neck and arm for four months and hoarseness for one week. The pre-admission diagnosis via chest CT was pulmonary carcinoma. The subsequent bronchoalveolar lavage fluid analysis and bronchoscopic biopsy were negative for malignant cells, except chronic inflammation. Imaging-guided percutaneous biopsies were carried out after admission and the final pathological diagnosis was pulmonary mucormycosis. Although the patient was started on oral posaconazole of 400mg bid, the disease condition continued to deteriorate. She finally died of respiratory failure.


Assuntos
Osso e Ossos/patologia , Pneumopatias Fúngicas/diagnóstico , Mucormicose/diagnóstico , Síndrome de Pancoast/diagnóstico , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Imunocompetência , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pneumopatias Fúngicas/tratamento farmacológico , Neoplasias Pulmonares/diagnóstico , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Infecções Oportunistas/diagnóstico , Síndrome de Pancoast/tratamento farmacológico , Tomografia Computadorizada por Raios X
12.
J Med Case Rep ; 12(1): 327, 2018 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-30384858

RESUMO

BACKGROUND: Pulmonary cryptococcosis is a common fungal infection frequently seen in immunocompromised patients. Owing to its nonspecific clinical and radiographic features, the differential diagnosis with secondary tuberculosis, malignant tumor, and bacterial pneumonia is sometimes difficult. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as a malignant tumor. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis and malignant tumor is rarely presented. CASE PRESENTATION: A 52-year-old immunocompetent Han Chinese woman was presented to our emergency department complaining of headache and vomiting accompanied by postural changes. She was diagnosed with pulmonary cryptococcosis according to results of laboratory tests, computed tomography, and percutaneous lung biopsy. Owing to the poor therapeutic effects of 6-month fluconazole treatment, she underwent a second percutaneous lung biopsy and was diagnosed with pulmonary cryptococcosis coexisting with adenocarcinoma. Delayed treatment of malignant tumor resulted in lymph node metastasis, higher pathologic stage, and probably poorer prognosis. CONCLUSIONS: Our patient's case serves as a reminder not to misdiagnose pulmonary cryptococcosis coexisting with adenocarcinoma.


Assuntos
Adenocarcinoma/microbiologia , Adenocarcinoma/fisiopatologia , Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Fluconazol/uso terapêutico , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/tratamento farmacológico , Grupo com Ancestrais do Continente Asiático , Comorbidade , Feminino , Humanos , Pessoa de Meia-Idade
13.
J Mycol Med ; 28(4): 659-662, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30477694

RESUMO

Trichoderma species are saprophytic filamentous fungi that can be found all over the word. These fungi show increasing medical importance as opportunistic human pathogens, particularly in immunocompromised patients. Invasive infections due to Trichoderma are rare and definitive diagnosis is complex to achieve because of the lack of specific diagnosis tools. We report in this work the first proven case of invasive pulmonary infection due to T. longibrachiatum in a 69-year-old white male with hematologic malignancy. The patient was successfully treated initially with voriconazole alone followed by a combination of voriconazole and caspofungine.


Assuntos
Hospedeiro Imunocomprometido , Infecções Fúngicas Invasivas/complicações , Infecções Fúngicas Invasivas/microbiologia , Leucemia Mieloide Aguda/complicações , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/microbiologia , Idoso , Antifúngicos/uso terapêutico , Caspofungina/uso terapêutico , Quimioterapia Combinada , Humanos , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/tratamento farmacológico , Leucemia Mieloide Aguda/imunologia , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Resultado do Tratamento , Trichoderma/isolamento & purificação , Voriconazol/uso terapêutico
14.
Rev Inst Med Trop Sao Paulo ; 60: e75, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30462798

RESUMO

Coccidioidomycosis is a fungal infection caused by Coccidioides immitis or Coccidioides posadasii. These fungi are known to thrive in desert climate. Fungi produce infectious arthroconidia in soil, they are aerosolized in the air and when inhaled by humans, usually cause infections such as pneumonia. The first cases of coccidioidomycosis in Brazil were reported in 1978. Since then, there have been other reports mainly from desert regions of Northeastern Brazil. The present report describes three cases of coccidioidomycosis on male farmers from Serra Talhada county, Pernambuco State, who developed pneumonia and were subsequently diagnosed with pulmonary coccidioidomycosis. These three farmers were successfully treated with oral fluconazole. They reported having hunted armadillos in a rural and arid area of Pernambuco State. Armadillos are known to be carriers of Coccidioides. This is the first report of infection caused by Coccidioides in Pernambuco State, Brazil.


Assuntos
Coccidioidomicose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Adulto , Idoso , Animais , Antifúngicos/uso terapêutico , Tatus/microbiologia , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/transmissão , Fluconazol/uso terapêutico , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/transmissão , Masculino
15.
BMJ Case Rep ; 20182018 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-30061139

RESUMO

Coccidioides is a fungus endemic to Southwestern USA and Northern Mexico which can be asymptomatic or result in a well-defined clinical syndrome of community-acquired pneumonia. On rare occasion, coccidioidomycosis may have atypical presentations as in our patient, a 25-year-old man admitted with a 2-month history of progressive dyspnoea and cough. He was found to have a large right-sided pneumothorax with exudative pleural effusion which did not resolve following thoracentesis. Decortication was performed which revealed a dense rind of inflammatory tissue covering all lobes of his right lung. Histopathology demonstrated hyphae resembling Aspergillus, but culture and serology confirmed Coccidioides immitis Following several months of antifungal therapy, he achieved complete clinical recovery with near-complete resolution of radiographic findings.


Assuntos
Antifúngicos/uso terapêutico , Coccidioides/isolamento & purificação , Coccidioidomicose/diagnóstico , Tosse/microbiologia , Pneumopatias Fúngicas/diagnóstico , Pneumotórax/microbiologia , Adulto , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/fisiopatologia , Dispneia/microbiologia , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/fisiopatologia , Masculino , Pneumotórax/tratamento farmacológico , Pneumotórax/fisiopatologia , Resultado do Tratamento
16.
Respiration ; 96(3): 283-301, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29953992

RESUMO

Systemic endemic mycoses cause high rates of morbidity and mortality in certain regions of the world and the real impact on global health is not well understood. Diagnosis and management remain challenging, especially in low-prevalence settings, where disease awareness is lacking. The main challenges include the variability of clinical presentation, the fastidious and slow-growing nature of the fungal pathogens, the paucity of diagnostic tests, and the lack of options and toxicity of antifungal drugs. Coccidioidomycosis and paracoccidioidomycosis are restricted to the Americas only, and while histoplasmosis and blastomycosis also occur predominantly in the Americas, these mycoses have also been reported on other continents, especially in sub-Saharan Africa. Talaromycosis is endemic in tropical and subtropical regions in South-East Asia and southern China. Systemic endemic mycoses causing pulmonary disease are usually acquired via the airborne route by inhalation of fungal spores. Infections can range from asymptomatic or mild with flu-like illnesses to severe pulmonary or disseminated diseases. Skin involvement is frequent in patients with paracoccidioidomycosis, blastomycosis, sporotrichosis, and talaromycosis and manifests as localized lesions or diffuse nodules in disseminated disease, but can also occur with other endemic mycoses. Culture and/or characteristic histopathology from clinical samples is the diagnostic standard for endemic mycoses. Immunological assays are often not available for the diagnosis of most endemic mycoses and molecular amplification methods for the detection of fungal nucleic acids are not standardized at present. The first-line treatment for mild to moderate histoplasmosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, and talaromycosis is itraconazole. Severe illness is treated with amphotericin B. Patients with severe coccidioidomycosis should receive fluconazole. Treatment duration depends on the specific endemic mycosis, the severity of disease, and the immune status of the patient, ranging between 6 weeks and lifelong treatment.


Assuntos
Doenças Endêmicas , Pneumopatias Fúngicas/diagnóstico por imagem , Adulto , Antifúngicos/administração & dosagem , Feminino , Humanos , Itraconazol/administração & dosagem , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/microbiologia , Masculino , Pessoa de Meia-Idade , Radiografia Torácica
18.
Am J Health Syst Pharm ; 75(13): 958-961, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29941535

RESUMO

PURPOSE: A pediatric patient with cystic fibrosis (CF) was successfully treated for Aspergillus fumigatus infection with posaconazole delayed-release tablets. SUMMARY: A 13-year-old, 29-kg, Caucasian boy with CF was admitted to the hospital for a pulmonary exacerbation. The patient had a history of multiple hospital admissions and was colonized with methicillin-sensitive Staphylococcus aureus, Stenotrophomonas maltophilia, and A. fumigatus. The patient was started on piperacillin-tazobactam 2.8 g (piperacillin 2 g and tazobactam 0.8 g) i.v. every 6 hours (400 mg/kg/day) and tobramycin 400 mg i.v. every 24 hours (13.7 mg/kg/day). After 2 weeks of therapy and therapeutic tobramycin concentrations, doxycycline 75 mg given orally twice daily was continued due to lack of clinical improvement. After 2 additional weeks of therapy, the patient was started on posaconazole delayed-release tablets 300 mg given orally daily with the evening meal due to concern about A. fumigatus colonization and a further decline in forced expiratory volume in 1 second to 37%. The posaconazole trough concentration was 1,500 ng/mL after 5 days of therapy. As this level was within the goal range, posaconazole was continued, with a plan to periodically check the trough level, pulmonary function, and liver function. The patient's liver function values remained stable throughout therapy. The patient's appetite improved and weight increased. Once the patient's weight exceeded 35 kg, his dosage of posaconazole delayed-release tablets was increased to 400 mg daily. His pulmonary function improved during posaconazole therapy, and A. fumigatus was eradicated. Posaconazole was discontinued after 9 months of therapy. CONCLUSION: A 13-year old patient with CF was successfully treated for an A. fumigatus infection with posaconazole delayed-release tablets.


Assuntos
Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergillus fumigatus , Pneumopatias Fúngicas/tratamento farmacológico , Triazóis/uso terapêutico , Adolescente , Antifúngicos/administração & dosagem , Aspergilose/complicações , Aspergilose/microbiologia , Criança , Fibrose Cística/complicações , Preparações de Ação Retardada , Humanos , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/microbiologia , Masculino , Triazóis/administração & dosagem
20.
BMC Res Notes ; 11(1): 331, 2018 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-29784014

RESUMO

BACKGROUND: Sulfonylureas are widely used for type 2 diabetes mellitus, but these medications carry a risk of hypoglycemia. Drug-drug interactions that inhibit sulfonylurea metabolism and thus increase systemic exposure can cause unintentional sulfonylurea toxicity. CASE PRESENTATION: A 56-year-old man presented with severe, recurrent hypoglycemia. He had a history of type 2 diabetes mellitus and was taking the sulfonylurea gliclazide with no prior episodes of hypoglycemia. The onset of his hypoglycemia occurred within days after starting voriconazole and subsequently fluconazole for a fungal pneumonia. Unintentional sulfonylurea toxicity developed due to an adverse drug-drug interaction between gliclazide and these antifungals. Azole antifungals inhibit the metabolism of sulfonylureas resulting in increased systemic exposure and consequent toxicity. After the diagnosis of sulfonylurea toxicity was recognized, the patient was treated initially with dextrose and then administered octreotide to prevent recurrent hypoglycemia. He was successfully managed, his hypoglycemic episodes resolved, and his medications were adjusted to avoid any further adverse interactions. CONCLUSIONS: Adverse drug-drug interactions continue to pose challenges to clinicians. Both individual vigilance and system wide strategies are needed to prevent and mitigate consequences. This case highlights an important drug-drug interaction and reviews the presentation, management and antidotal therapy of sulfonylurea toxicity.


Assuntos
Antifúngicos/farmacologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Interações de Medicamentos , Gliclazida/toxicidade , Hipoglicemiantes/toxicidade , Pneumopatias Fúngicas/tratamento farmacológico , Pneumonia/tratamento farmacológico , Compostos de Sulfonilureia/toxicidade , Fluconazol/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Voriconazol/farmacologia
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