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1.
BMC Infect Dis ; 20(1): 739, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032533

RESUMO

BACKGROUND: Invasive infections with Candida krusei are uncommon and rarely complicated by spondylitis. Previous described cases were solely treated with antimycotic therapy, despite guidelines recommending surgical interventions. CASE PRESENTATION: We describe a case of C. krusei spondylitis in a patient treated with chemotherapy for acute myeloid leukemia. After induction chemotherapy, the patient developed a candidemia, which was treated with micafungin. One month after the candidemia, the patient was admitted with severe lumbar pain. Spondylitis of the L4 and L5 vertebra was diagnosed on MR-imaging, with signs suggesting an atypical infection. The patient was treated with anidulafungin combined with voriconazole. Despite maximal conservative management symptoms gradually worsened eventually requiring surgical intervention. CONCLUSIONS: In contrast to previous case reports, antimycotic treatment alone could be insufficient in treating C. krusei spondylitis.


Assuntos
Candida/efeitos dos fármacos , Candidíase/imunologia , Hospedeiro Imunocomprometido , Espondilite/tratamento farmacológico , Espondilite/imunologia , Idoso , Anidulafungina/uso terapêutico , Antifúngicos/uso terapêutico , Candidemia/induzido quimicamente , Candidemia/tratamento farmacológico , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Candidíase/cirurgia , Humanos , Quimioterapia de Indução/efeitos adversos , Masculino , Micafungina/uso terapêutico , Espondilite/microbiologia , Espondilite/cirurgia , Resultado do Tratamento , Voriconazol/uso terapêutico
2.
Int J Nanomedicine ; 15: 7825-7840, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33116503

RESUMO

Background: Voriconazole (VRC) is a triazole broad spectrum antifungal drug, used in the management of versatile fungal infections, particularly fungal keratitis. The obligatory use of niosomal delivery of VRC may reduce the frequency of dosing intervals resulting from its short biological half time and consequently improve patient compliance. Methods: VRC loaded proniosomes (VRC-PNs) were set by the coacervation technique and completely characterized. The developed formula was comprehensively assessed concerning in- vitro release behavior, kinetic investigation, and its conflict against refrigerated and room temperature conditions. A selected noisomal formula was incorporated into ocusert (VRC-PNs Ocu) formulated by 1% w/w hydroxypropyl methyl cellulose HPMC and 0.1% w/w carbopol 940. Eventually, in vitro antifungal activity against Candida albicans and Aspergillus nidulans was assessed by the cup diffusion method. Results: The optimized VRC-PNs (Pluronic F127: cholesterol weight ratio 1:1 w/w) exhibited the highest entrapment efficiency (87.4±2.55%) with a spherical shape, proper size in nano range and a suitable Zeta potential of 209.7±8.13 nm and -33.5±1.85 mV, respectively. Assurance of drug encapsulation in nanovesicles was accomplished by several means such as attenuated total reflection Fourier-transform infrared spectroscopy, differential scanning calorimetry in addition to powder X-ray diffraction investigations. It displayed a biphasic in vitro release pattern and after 6 months of storage at a refrigerated temperature, the optimized formula preserved its stability. VRC-PNs Ocu proved a very highly significant antifungal activity matched with the free drug or nanosuspension which was extra assured by comparing its mean inhibition zone with that of 5% natamycin market eye drops. Conclusion: In conclusion, VRC-PNs Ocu could be considered as a promising stable sustained release topical ocular nanoparticulate system for the management of fungal infections.


Assuntos
Antifúngicos/química , Antifúngicos/farmacologia , Portadores de Fármacos/química , Composição de Medicamentos , Olho/efeitos dos fármacos , Voriconazol/química , Voriconazol/farmacologia , Animais , Antifúngicos/uso terapêutico , Candida albicans/efeitos dos fármacos , Candida albicans/fisiologia , Olho/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Géis , Humanos , Tamanho da Partícula , Tensoativos/química , Voriconazol/uso terapêutico , Água/química
3.
Medicine (Baltimore) ; 99(44): e22911, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126348

RESUMO

The aim of this study was to investigate the clinical characteristics of central nervous system (CNS) aspergillosis in immunocompetent patients.This study enrolled six immunocompetent patients diagnosed with CNS aspergillosis. Additionally, we reviewed the clinical profiles for 28 cases reported in the literature. The age, gender, etiology of Aspergillus infection, clinical manifestations, location of the lesion, treatment, and prognosis were analyzed.There were 19 men (average age, 54.6 ±â€Š14.3 years) and 15 women (average age, 47.0 ±â€Š19.4 years). The clinical manifestations included headache (55.9%; n = 19), visual impairment (32.4%; n = 11), diplopia (32.4%; n = 11), hemiplegia (20.6%; n = 7), fever (17.6%; n = 6), and epilepsy (8.8%; n = 3). According to the radiological features, CNS aspergillosis lesions were divided into two subtypes: parenchymal lesions in the cerebral lobes (n = 11), and meningeal lesions in the meninges (n = 23). The patients with meningeal lesions are easy to be complicated with more serious cerebrovascular diseases, such as subarachnoid hemorrhage and massive infarction. Most of the lesions in brain parenchyma were abscess formation, and magnetic resonance imaging showed ring enhancement. The clinical diagnosis of Aspergillus infection was mainly based on brain biopsy (n = 14), autopsy (n = 8), pathological examination of adjacent brain tissues (n = 7), cerebrospinal fluid (CSF) or tissue culture (n = 3), and second-generation sequencing analysis of the CSF (n = 3). Clinical improvement was achieved in 23 cases, and 11 patients succumbed to the disease. Voriconazole treatment was effective in 24 (70.6%) cases.Immunocompetent subjects are also at risk for Aspergillus infections. Concomitant cerebrovascular diseases are common in patients with CNS aspergillosis, especially in patients with meningeal aspergillosis. Parenchymal aspergillosis lesions are usually localized and manifest as brain abscesses with annular enhancement on magnetic resonance imaging. Biopsy, CSF culture, and next-generation sequencing are mainstream diagnostic modalities. Voriconazole is an effective treatment for Aspergillus infection, and early diagnosis and treatment should be highlighted.


Assuntos
Abscesso Encefálico , Encéfalo , Imunocompetência , Meningite Fúngica , Neuroaspergilose , Hemorragia Subaracnóidea , Voriconazol/uso terapêutico , Adulto , Antifúngicos/uso terapêutico , Biópsia/métodos , Encéfalo/diagnóstico por imagem , Encéfalo/microbiologia , Encéfalo/patologia , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/etiologia , Diagnóstico , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Meningite Fúngica/diagnóstico , Meningite Fúngica/etiologia , Pessoa de Meia-Idade , Neuroaspergilose/líquido cefalorraquidiano , Neuroaspergilose/diagnóstico , Neuroaspergilose/tratamento farmacológico , Neuroaspergilose/fisiopatologia , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
BMC Infect Dis ; 20(1): 681, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943003

RESUMO

BACKGROUND: The purpose of this case report was to report a case of Cryptococcus laurentii infection in the left knee of a previously healthy 29 year old male patient. CASE PRESENTATION: After an initial misdiagnosis and 7 months of failed treatment, the patient received nearly a month of treatment with voriconazole (200 mg IV q12 h) and knee irrigation with amphotericin B until the infection was controlled. The treatment continued with fluconazole for nearly 7 months and approximately 5 weeks of antibiotic treatment for a skin bacterial coinfection. In the end, the patient's symptoms disappeared completely, the left knee recovered well, and there was no recurrence of infection. CONCLUSION: The key points of successful treatment in this case were the thorough debridement, the adequate course of knee irrigation with antifungal drugs and more than 6 months of oral antifungal drugs that were able to eradicate the infection.


Assuntos
Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Joelho/microbiologia , Administração Oral , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Artrite Infecciosa/microbiologia , Criptococose/cirurgia , Cryptococcus/isolamento & purificação , Desbridamento , Erros de Diagnóstico , Fluconazol/uso terapêutico , Infecção Focal/tratamento farmacológico , Infecção Focal/microbiologia , Infecção Focal/cirurgia , Humanos , Joelho/diagnóstico por imagem , Joelho/cirurgia , Masculino , Dermatopatias Bacterianas/tratamento farmacológico , Voriconazol/uso terapêutico
5.
BMC Infect Dis ; 20(1): 562, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32738901

RESUMO

BACKGROUND: Morbidity and mortality in transplant patients is increased by infection caused mainly by rare opportunistic pathogens. The present study reports a case where Hongkongmyces snookiorum caused subcutaneous phaeohyphomycosis in a kidney transplant patient. CASE PRESENTATION: A 47-year old Chinese woman with chronic kidney disease 5 underwent kidney transplantation 3 years ago. Her regular medications included Tacrolimus (1 mg, two times daily), Mycophenolate Mofetil (two times 250 mg, twice daily) and Prednisone acetate tablets (5 mg daily). Eighteen months ago, her proximal right index finger was red, painful and swollen. After admission, a hard and fluctuating 1 cm × 1 cm abscess was found on the dorsal side of the right index finger. Gram and fluorescence staining of a direct smear of a syringe extraction from the abscess revealed presence of filamentous fungi. White velvet colonies (2-3 mm) were found on blood plate and Sabouraud glucose agar (SGA) after 1 week, and grey aerial hyphae were observed. After 15 days, a 26 mm gray colony was also observed on SGA. The homology between this filamentous fungus and Hongkongmyces snookiorum ILLS00125755 (Genbank Sequence ID: MH161189.1) was 99.66%. An in vitro antifungal susceptibility test showed that this filamentous fungus was sensitive to azoles such as itraconazole and voriconazole. CONCLUSIONS: We report an opportunistic fungus infection caused by Hongkongmyces snookiorum in a transplant patient. Our finding shows that prevention of subcutaneous fungal infection is necessary for kidney transplantation patients.


Assuntos
Ascomicetos/isolamento & purificação , Transplante de Rim/efeitos adversos , Feoifomicose/etiologia , Antifúngicos/uso terapêutico , Feminino , Humanos , Itraconazol/uso terapêutico , Pessoa de Meia-Idade , Feoifomicose/tratamento farmacológico , Feoifomicose/microbiologia , Insuficiência Renal Crônica/terapia , Voriconazol/uso terapêutico
6.
BMC Infect Dis ; 20(1): 566, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746887

RESUMO

BACKGROUND: Subtenon injection of triamcinolone acetonide (STTA) has been widely adopted in the clinical setting of ophthalmology and its infectious complications are rare. However, orbital abscess following STTA has been reported in seven cases. Furthermore, although eye infections due to Exophiala species are uncommon, there have been 19 cases to date. E. jeanselmei, E. phaeomuriformis, E. werneckii, and E. dermatitidis have been reported to cause human eye infections; however, to the best of our knowledge, orbital abscess caused by E. dermatitidis has not yet been reported. We describe the first documented case of fungal orbital abscess caused by E. dermatitidis following STTA. We also review the related literature of orbital abscess following STTA, as well as eye infections caused by the four Exophiala species. CASE PRESENTATION: The patient was a 69-year-old Japanese woman with diabetic mellitus. She had a macular oedema in her right eye, which occurred secondary to branch retinal vein occlusion. An orbital abscess caused by E. dermatitidis occurred 4 months after the second STTA for the macular oedema, which was successfully treated by a surgical debridement and systemic administration of voriconazole. CONCLUSIONS: Our findings in the patient and from our literature survey caution ophthalmologists to the fact that STTA can cause fungal orbital infections, especially in diabetic patients. Furthermore, surgical treatment is one of the most important risk factors.


Assuntos
Anti-Inflamatórios/efeitos adversos , Dermatite/diagnóstico , Exophiala/isolamento & purificação , Infecções Oculares/diagnóstico , Triancinolona Acetonida/efeitos adversos , Abscesso/microbiologia , Idoso , Anti-Inflamatórios/uso terapêutico , Antifúngicos/uso terapêutico , Dermatite/tratamento farmacológico , Dermatite/microbiologia , Infecções Oculares/tratamento farmacológico , Infecções Oculares/microbiologia , Feminino , Humanos , Edema Macular/diagnóstico , Edema Macular/etiologia , Triancinolona Acetonida/uso terapêutico , Voriconazol/uso terapêutico
8.
An Bras Dermatol ; 95(5): 645-648, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32773280

RESUMO

This report presents the case of a 13-year-old female patient with history of acute myeloid leukemia, who, after a bone marrow transplant, began to vomit and experienced rapidly progressive deterioration of consciousness, in addition to disseminated erythematous-violaceous macules, and some blisters with hemorrhagic content inside. Skin biopsy evidenced intravascular filamentous structures. A blood culture confirmed the presence of Fusarium oxysporum. Intravenous treatment with voriconazole was initiated. The patient evolved unfavorably with multiple necrotic skin lesions, ischemic brain lesions, and death.


Assuntos
Fusariose , Fusarium , Adolescente , Antifúngicos/uso terapêutico , Transplante de Medula Óssea , Feminino , Fusariose/diagnóstico , Fusariose/tratamento farmacológico , Humanos , Voriconazol/uso terapêutico
9.
An Bras Dermatol ; 95(5): 609-614, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32723611

RESUMO

Fusariosis is a superficial or systemic infection, which occurs mainly in immunocompromised hosts, especially in patients with hematological neoplasia; 70%-75% of the cases present cutaneous manifestations. The disseminated form is rare and difficult to diagnose; even with specific treatment, the evolution is usually fatal. Currently, it is considered an emerging disease; in some centers, it is the second most common cause of invasive mycosis, after aspergillosis. The authors describe a case of a female patient with idiopathic bone marrow aplasia and disseminated fusariosis, who initially appeared to benefit from voriconazole and amphotericin B; however, due to persistent neutropenia, her clinical condition deteriorated with fatal evolution.


Assuntos
Fusariose , Fusarium , Antifúngicos/uso terapêutico , Medula Óssea , Feminino , Humanos , Hospedeiro Imunocomprometido , Voriconazol/uso terapêutico
10.
J Mycol Med ; 30(3): 101002, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32507472

RESUMO

INTRODUCTION: Rhino-orbital-aspergillosis (ROA) is a rare but serious disease in immunocompetent patients. Diagnosis is often delayed due to the absence of specific clinical symptoms. We describe the case of a patient who presented initially with ROA which spread progressively to the right ethmoid-sphenoid sinuses and then to the brain. OBSERVATION: A 61-year-old patient with a history of well-controlled diabetes presented with a sudden severe decrease in right visual acuity. Cerebral MRI showed the presence of an infiltrate in the right orbital apex extending to the homolateral cavernous sinus without any cerebral involvement. A diagnosis of right orbital myositis was made and corticosteroid therapy was started. His symptoms worsened progressively leading to quasi-blindness. A new MRI showed the development of right sphenoid-ethmoid osteolytic lesions. A fungal aetiology was suspected and tests for fungal biomarkers found a ß-(1-3)-D-glucan level of 99pg/ml but negative galactomannan. An ethmoid biopsy was performed for histological and mycological investigations, including the detection of Aspergillus DNA by qPCR. qPCR was positive and culture resulted in the isolation of multi-sensitive Aspergillus fumigatus. Treatment was initiated with voriconazole. Due to persistence of blindness and the appearance of a lesion extending to the right frontal lobe, surgical excision was performed followed by antifungal treatment for a total duration of 1year. The patient is currently stable, but has persistence of blindness in the right eye. CONCLUSION: Invasive ROA is a rare but serious disease in immunocompetent patients which should be evoked in the differential diagnosis of a tumour or vasculitis. Early diagnosis is essential for optimal management.


Assuntos
Aspergilose/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Infecções Oculares Fúngicas/microbiologia , Imunocompetência , Infecções Fúngicas Invasivas/diagnóstico , Rinite/microbiologia , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/microbiologia , Aspergillus fumigatus/isolamento & purificação , Cegueira/diagnóstico , Cegueira/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/complicações , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/microbiologia , Infecções Oculares Fúngicas/complicações , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/microbiologia , Masculino , Pessoa de Meia-Idade , Neuroaspergilose/complicações , Neuroaspergilose/diagnóstico , Neuroaspergilose/tratamento farmacológico , Neuroaspergilose/microbiologia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/microbiologia , Rinite/complicações , Rinite/diagnóstico , Rinite/tratamento farmacológico , Voriconazol/uso terapêutico
11.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(3): 342-345, 2020 Mar 30.
Artigo em Chinês | MEDLINE | ID: covidwho-210236

RESUMO

OBJECTIVE: To investigate the effect of heat inactivation (56℃for 30 min) of SARS-CoV-2 on the results of therapeuticdrug monitoring (TDM) of voriconazole by liquid chromatography tandem mass spectrometry (LC-MS/MS). METHODS: We collected clinical blood samples from voriconazole-treated patients in heparinized tubes and sterilized the surface of the tubes with 75% ethanol. The whole blood samples were centrifuged to separate the plasma with or without prior heat inactivation, or only the separated plasma was heat inactivated. Heat inactivation of the samples was carried out at 56 ℃ for 30 min followed by protein precipitation with acetonitrile or ethanol. The plasma standard and quality control samples were inactivated in an identical manner and tested with LC-MS/MS along with the treated samples. RESULTS: The optimized method showed a high imprecision (with mean intra- and inter-day imprecisions of 3.59% and 2.81%, respectively) and a high accuracy (mean 97.37%) for detecting voriconazole in the inactivated samples at different concentration levels. Sample preparation with acetonitrile or ethanol resulted in a high mean recovery (100.56% or 95.90%) with minimal mean matrix effect (102.85% or 93.62%). The measured voriconazole concentrations in inactivated whole blood, inactivated plasma and the samples without inactivation all showed good linear correlations with correlation coefficients all greater than 0.99. CONCLUSIONS: Heat inactivation at 56 ℃ for 30 min combined with ethanol sample preparation only has limited effects to affect LC-MS-based voriconazole concentration measurement in whole blood samples collected in heparinized tubes, and can be used for therapeutic drug monitoring of voriconazole during the ongoing COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Monitoramento de Medicamentos , Pandemias , Pneumonia Viral , Espectrometria de Massas em Tandem , Voriconazol/uso terapêutico , Cromatografia Líquida de Alta Pressão , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Temperatura Alta , Humanos , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Reprodutibilidade dos Testes
12.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(3): 342-345, 2020 Mar 30.
Artigo em Chinês | MEDLINE | ID: mdl-32376593

RESUMO

OBJECTIVE: To investigate the effect of heat inactivation (56℃for 30 min) of SARS-CoV-2 on the results of therapeuticdrug monitoring (TDM) of voriconazole by liquid chromatography tandem mass spectrometry (LC-MS/MS). METHODS: We collected clinical blood samples from voriconazole-treated patients in heparinized tubes and sterilized the surface of the tubes with 75% ethanol. The whole blood samples were centrifuged to separate the plasma with or without prior heat inactivation, or only the separated plasma was heat inactivated. Heat inactivation of the samples was carried out at 56 ℃ for 30 min followed by protein precipitation with acetonitrile or ethanol. The plasma standard and quality control samples were inactivated in an identical manner and tested with LC-MS/MS along with the treated samples. RESULTS: The optimized method showed a high imprecision (with mean intra- and inter-day imprecisions of 3.59% and 2.81%, respectively) and a high accuracy (mean 97.37%) for detecting voriconazole in the inactivated samples at different concentration levels. Sample preparation with acetonitrile or ethanol resulted in a high mean recovery (100.56% or 95.90%) with minimal mean matrix effect (102.85% or 93.62%). The measured voriconazole concentrations in inactivated whole blood, inactivated plasma and the samples without inactivation all showed good linear correlations with correlation coefficients all greater than 0.99. CONCLUSIONS: Heat inactivation at 56 ℃ for 30 min combined with ethanol sample preparation only has limited effects to affect LC-MS-based voriconazole concentration measurement in whole blood samples collected in heparinized tubes, and can be used for therapeutic drug monitoring of voriconazole during the ongoing COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Monitoramento de Medicamentos , Pandemias , Pneumonia Viral , Espectrometria de Massas em Tandem , Voriconazol/uso terapêutico , Cromatografia Líquida de Alta Pressão , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Temperatura Alta , Humanos , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Reprodutibilidade dos Testes
13.
J Mycol Med ; 30(2): 100953, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32362445

RESUMO

OBJECTIVE: The present study was designed to discover novel biomarkers involved in voriconazole resistance in clinical isolates of Aspergillus flavus. MATERIALS AND METHODS: Two voriconazole non-wild-type and two voriconazole-wild-type A. flavus clinical isolates were selected to evaluate possible molecular mechanism involved in A. flavus resistance to voriconazole using the mutation assessment, Quantitative real- time PCR of cyp51A and cyp51C genes and complementary DNA- amplified fragment length polymorphism technique. RESULTS: No mutations were seen in the cyp51A and cyp51C genes in voriconazole non-wild-type isolates compared to wild- type and reference strains. Regarding to mRNA expression results, no changes were observed in expression fold of cyp51A and cyp51C mRNA expression level in first non- wild- type isolate compared to wild-type isolate. For second isolate cyp51C mRNA expression level was down regulated (5.6 fold). The set of genes including ABC fatty acid transporter XM- 002375835 and aldehydereductase XM- 002376518 and three unknown functional genes were identified. Based on results, the over-expression of AKR1 and ABC fatty acid transporter in the voriconazole non- wild- type isolates suggests these genes could represent a novel molecular marker linked to the voriconazole resistance in A. flavus. CONCLUSION: The results obtained in this study showed a novel finding as the authors identified AKR1 and ABC fatty acid transporter genes as possible voriconazole target genes in Iranian clinical isolates of A. flavus.


Assuntos
Aspergilose/microbiologia , Aspergillus flavus/genética , Farmacorresistência Fúngica/genética , Proteínas Fúngicas/genética , Voriconazol/uso terapêutico , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/genética , Aspergillus flavus/efeitos dos fármacos , Aspergillus flavus/isolamento & purificação , Biomarcadores/análise , Sistema Enzimático do Citocromo P-450/genética , Análise Mutacional de DNA/métodos , Regulação Fúngica da Expressão Gênica , Humanos , Testes de Sensibilidade Microbiana , Técnicas de Tipagem Micológica , Mutação Puntual , Esterol 14-Desmetilase/genética
15.
Am J Trop Med Hyg ; 103(2): 672-674, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32431277

RESUMO

We report a patient with risk factors for both microbial keratitis and endophthalmitis, which were initially challenging to distinguish. Cultures of corneal scrapings yielded several organisms, including an uncultivable Gram-negative rod, eventually identified as Kingella negevensis. Kingella negevensis is so named because most strains have been isolated in the Negev, a desert region of southern Israel. The epidemiology of K. negevensis remains incompletely understood. We found no other reports in the literature of this organism causing microbial keratitis.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/administração & dosagem , Inibidores da Captação de Dopamina/administração & dosagem , Endoftalmite/complicações , Ceratite/complicações , Infecções por Neisseriaceae/complicações , Infecções Estreptocócicas/complicações , Abuso de Substâncias por Via Intravenosa/complicações , Administração Oftálmica , Adulto , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Ceftazidima/uso terapêutico , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Doxiciclina/uso terapêutico , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Kingella/genética , Kingella/isolamento & purificação , Linezolida/uso terapêutico , Moxifloxacina/uso terapêutico , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/tratamento farmacológico , Infecções por Neisseriaceae/microbiologia , Soluções Oftálmicas , Prednisona/uso terapêutico , Propionibacterium acnes/isolamento & purificação , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Tobramicina/uso terapêutico , Vancomicina/uso terapêutico , Voriconazol/uso terapêutico
16.
Mycoses ; 63(6): 528-534, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-547397

RESUMO

OBJECTIVES: Patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications like invasive aspergillosis. Our study evaluates coronavirus disease 19 (COVID-19) associated invasive aspergillosis at a single centre in Cologne, Germany. METHODS: A retrospective chart review of all patients with COVID-19 associated ARDS admitted to the medical or surgical intensive care unit at the University Hospital of Cologne, Cologne, Germany. RESULTS: COVID-19 associated invasive pulmonary aspergillosis was found in five of 19 consecutive critically ill patients with moderate to severe ARDS. CONCLUSION: Clinicians caring for patients with ARDS due to COVID-19 should consider invasive pulmonary aspergillosis and subject respiratory samples to comprehensive analysis to detect co-infection.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Aspergilose Pulmonar/complicações , Síndrome do Desconforto Respiratório do Adulto/complicações , Idoso , Antifúngicos/uso terapêutico , Líquido da Lavagem Broncoalveolar/química , Líquido da Lavagem Broncoalveolar/virologia , Infecções por Coronavirus/diagnóstico por imagem , Feminino , Alemanha , Hemorragia/etiologia , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva , Pneumopatias/etiologia , Masculino , Mananas/análise , Metapneumovirus/isolamento & purificação , Pessoa de Meia-Idade , Nitrilos/uso terapêutico , Pandemias , Infecções por Paramyxoviridae/etiologia , Pneumonia Viral/diagnóstico por imagem , Aspergilose Pulmonar/diagnóstico por imagem , Piridinas/uso terapêutico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Estudos Retrospectivos , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triazóis/uso terapêutico , Voriconazol/uso terapêutico
17.
Mycoses ; 63(6): 528-534, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-125102

RESUMO

OBJECTIVES: Patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications like invasive aspergillosis. Our study evaluates coronavirus disease 19 (COVID-19) associated invasive aspergillosis at a single centre in Cologne, Germany. METHODS: A retrospective chart review of all patients with COVID-19 associated ARDS admitted to the medical or surgical intensive care unit at the University Hospital of Cologne, Cologne, Germany. RESULTS: COVID-19 associated invasive pulmonary aspergillosis was found in five of 19 consecutive critically ill patients with moderate to severe ARDS. CONCLUSION: Clinicians caring for patients with ARDS due to COVID-19 should consider invasive pulmonary aspergillosis and subject respiratory samples to comprehensive analysis to detect co-infection.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Aspergilose Pulmonar/complicações , Síndrome do Desconforto Respiratório do Adulto/complicações , Idoso , Antifúngicos/uso terapêutico , Líquido da Lavagem Broncoalveolar/química , Líquido da Lavagem Broncoalveolar/virologia , Infecções por Coronavirus/diagnóstico por imagem , Feminino , Alemanha , Hemorragia/etiologia , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva , Pneumopatias/etiologia , Masculino , Mananas/análise , Metapneumovirus/isolamento & purificação , Pessoa de Meia-Idade , Nitrilos/uso terapêutico , Pandemias , Infecções por Paramyxoviridae/etiologia , Pneumonia Viral/diagnóstico por imagem , Aspergilose Pulmonar/diagnóstico por imagem , Piridinas/uso terapêutico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Estudos Retrospectivos , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triazóis/uso terapêutico , Voriconazol/uso terapêutico
18.
Mycoses ; 63(6): 528-534, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32339350

RESUMO

OBJECTIVES: Patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications like invasive aspergillosis. Our study evaluates coronavirus disease 19 (COVID-19) associated invasive aspergillosis at a single centre in Cologne, Germany. METHODS: A retrospective chart review of all patients with COVID-19 associated ARDS admitted to the medical or surgical intensive care unit at the University Hospital of Cologne, Cologne, Germany. RESULTS: COVID-19 associated invasive pulmonary aspergillosis was found in five of 19 consecutive critically ill patients with moderate to severe ARDS. CONCLUSION: Clinicians caring for patients with ARDS due to COVID-19 should consider invasive pulmonary aspergillosis and subject respiratory samples to comprehensive analysis to detect co-infection.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Aspergilose Pulmonar/complicações , Síndrome do Desconforto Respiratório do Adulto/complicações , Idoso , Antifúngicos/uso terapêutico , Líquido da Lavagem Broncoalveolar/química , Líquido da Lavagem Broncoalveolar/virologia , Infecções por Coronavirus/diagnóstico por imagem , Feminino , Alemanha , Hemorragia/etiologia , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva , Pneumopatias/etiologia , Masculino , Mananas/análise , Metapneumovirus/isolamento & purificação , Pessoa de Meia-Idade , Nitrilos/uso terapêutico , Pandemias , Infecções por Paramyxoviridae/etiologia , Pneumonia Viral/diagnóstico por imagem , Aspergilose Pulmonar/diagnóstico por imagem , Piridinas/uso terapêutico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Estudos Retrospectivos , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triazóis/uso terapêutico , Voriconazol/uso terapêutico
19.
Int J Infect Dis ; 96: 151-153, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32339725

RESUMO

Eye damage during invasive aspergillosis is rarely described and biological diagnosis remains challenging. Here we report the case of a heart transplant recipient with ocular aspergillosis complicating disseminated aspergillosis. Although voriconazole was rapidly given, a decrease in visual acuity of the right eye was consistent with endophthalmitis, resulting in an emergency vitrectomy. The diagnosis was rapidly confirmed: laboratory results showed the presence of Aspergillus fumigatus in a vitreous sample. A series of systemic antifungal medications (liposomal amphotericin B, caspofungin, and voriconazole), several liposomal amphotericin B ocular injections, and pars plana vitrectomy resulted in a limited positive clinical outcome. Interestingly although standard mycological follow-up procedures were negative, Aspergillus antigen testing gave an index of 5.92 on vitreous humour, thus a new intraocular injection of liposomal amphotericin B was performed and voriconazole reinitiated. Ten other vitreous samples from patients without fungal infections were also tested, all showing indexes below 0.25. Although larger studies are needed, this case illustrates that galactomannan testing of vitreous humour could be useful for the diagnosis of fungal endophthalmitis if these data are confirmed in other patients, in particular, if standard mycology is negative and PCR is not available.


Assuntos
Aspergilose/diagnóstico , Aspergillus fumigatus , Endoftalmite/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Mananas/metabolismo , Corpo Vítreo/metabolismo , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/metabolismo , Endoftalmite/tratamento farmacológico , Endoftalmite/metabolismo , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/metabolismo , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acuidade Visual , Vitrectomia , Voriconazol/uso terapêutico
20.
Int J Infect Dis ; 95: 262-264, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32339721

RESUMO

Phaeohyphomycosis is a set of fungal infections caused by various dematiaceous fungi such as coelomycetes. These infections can occur either in immunocompetent or immunocompromised patients like solid organ transplants. Here we describe a nodular lesion of the right hallux that occurred in a kidney transplant patient. Microscopic examination of the biopsy revealed fungal hyphae and culture was positive to a grey to black mould that lacked characteristic elements to be identified. Nucleic acid sequencing targeting the internal transcribed spacer of the ribosomal DNA identified this mould as Medicopsis romeroi. The patient benefited of an antifungal therapy with voriconazole associated with surgical excision of the lesion. No relapse of the lesion was observed during a six-month follow-up. In solid organ transplants, phaeohyphomycosis caused by Medicopsis romeroi are very rare with only 12 cases reported. The clinical history should be well assessed since the lesion can appear several years after a cutaneous trauma that happened in a tropical region. Therapy generally combines antifungals with surgical excision of the lesion in order to avoid any relapse or dissemination of the infection.


Assuntos
Transplante de Rim , Feoifomicose/diagnóstico , Adulto , Antifúngicos/uso terapêutico , Ascomicetos/classificação , Ascomicetos/genética , Ascomicetos/isolamento & purificação , DNA Fúngico , DNA Ribossômico , Humanos , Masculino , Microscopia , Feoifomicose/microbiologia , Feoifomicose/patologia , Voriconazol/uso terapêutico
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