RESUMO
Mannose-binding lectin (MBL) is a serum protein that activates the complement and mediates phagocytosis. MBL levels and MBL2 genotype may impact upon host susceptibility to tuberculosis (TB) disease but evidence to date has been conflicting. MBL2 exon 1 and promoter genotyping and serum MBL concentrations were determined in 79 patients with active tuberculosis (58 pulmonary TB and 21 extrapulmonary or miliary TB) and 120 household healthy contacts (HHC) from a Mediterranean area (Majorca Island, Spain). Significantly higher serum MBL levels were found in patients with active tuberculosis than in HHC [median MBL concentrations 3430 ng mL(-1) (10-28 415) and 2600 ng mL(-1) (5-20 000) respectively, P = 0.002]. These higher MBL levels were mainly related to the most prevalent YA/YA wild-type diplotype. There was a strong correlation between MBL2 exon 1 and promoter genotype and MBL levels. The diplotype LYQA/HYPA was present in 12 out of 57 of the pulmonary TB cases but in none of the extrapulmonary TB patients. Diplotype LXPA/HYPA, producer of high levels of MBL, was significantly more frequent in HHC than in patients (16.8% vs. 6.4%, P = 0.031) suggesting a protective role against the development of TB disease that has not been previously found.
Assuntos
Éxons/genética , Predisposição Genética para Doença/genética , Lectina de Ligação a Manose/genética , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas/genética , Tuberculose/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Frequência do Gene , Genótipo , Haplótipos , Humanos , Masculino , Lectina de Ligação a Manose/sangue , Ilhas do Mediterrâneo , Pessoa de Meia-Idade , Espanha , Tuberculose/sangue , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/genética , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVE: Tuberculosis is an important health care problem, even in our setting. The objective of this study is to describe clinic and epidemiological features of cutaneous tuberculosis in our area. PATIENTS AND METHODS: A retrospective study was performed of all patients diagnosed of cutaneous tuberculosis in a hospital in Mallorca (Spain) from January 2003 to July 2011. The clinical forms, diagnostic methods used, treatment used and clinical course were recorded. RESULTS: Twenty-eight cases of cutaneous tuberculosis were diagnosed (5.9% of the tuberculosis cases diagnosed in this period), 15 with classic cutaneous tuberculosis (14 scrofuloderma, 1 empyema necessitatis) and 13 patients with tuberculids (8 erythema induratum of Bazin disease and 5 erythema nodosum). Scrofulodermas came from lymph nodes in 10 of the patients, infected bone in 4 and pleural in one case; 13/28 patients came from other continents. Most of the patients were treatment with 3-4 tuberculostatic drugs, with favorable course. CONCLUSIONS: Cutaneous tuberculosis is not uncommon in our setting. In classic cutaneous tuberculosis culture is the gold standard diagnostic method while tuberculids are most commonly diagnosed by histology.
Assuntos
Tuberculose Cutânea/epidemiologia , Adulto , Idoso , Antituberculosos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Resultado do Tratamento , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológicoRESUMO
Peripheral venous catheter-associated bloodstream infections (PVC-BSIs) lead to prolonged hospitalization, morbidity and increased costs. The impact of infection-prevention measures on the rate of PVC-BSIs in a university hospital in Spain was assessed. An active surveillance programme was initiated in 2015, which revealed a high PVC-BSI incidence ratio (0.48/1000 patient-days). A bundle aimed at nurses, medical staff and patients was implemented, and a Catheter Infection Team (CIT) was set up. The intervention achieved a decrease in PVC-BSI rate: 0.34 in 2016, 0.29 in 2017, and 0.17 in 2018. The decline was greatest for Gram-negative PVC-BSIs (67.6% in 2015, 35.3% in 2018).
Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Controle de Infecções/métodos , Sepse/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/epidemiologia , Feminino , Humanos , Incidência , Controle de Infecções/organização & administração , Masculino , Pessoa de Meia-Idade , Sepse/epidemiologia , Espanha/epidemiologia , Adulto JovemRESUMO
We describe two new cases of Peptostreptococcus endocarditis, one case of Peptostreptococcus micros prosthetic valve endocarditis and the other of Peptostreptococcus assaccharolyticus tricuspid native valve endocarditis in an intravenous drug user (IDU) patient and review nine cases previously reported.
Assuntos
Endocardite Bacteriana/microbiologia , Infecções por Bactérias Gram-Positivas , Peptostreptococcus , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Patients with chronic inflammatory diseases being treated with immunosuppressive drugs, and with tumor necrosis factor inhibitors in particular, have an increased risk of infection by Mycobacterium tuberculosis. Screening for latent tuberculosis infection and preventive therapy to reduce the risk of progression to active tuberculosis are mandatory in this group of patients. This updated multidisciplinary consensus document presents the latest expert opinions on the treatment and prevention of tuberculosis in candidates for biologic therapy and establishes recommendations based on current knowledge relating to the use of biologic agents.
Assuntos
Antituberculosos/uso terapêutico , Terapia Biológica/efeitos adversos , Tuberculose Latente/tratamento farmacológico , Tuberculose/prevenção & controle , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Antituberculosos/administração & dosagem , Monitoramento de Medicamentos , Hidradenite Supurativa/tratamento farmacológico , Humanos , Imunidade Celular , Tuberculose Latente/diagnóstico , Seleção de Pacientes , Psoríase/tratamento farmacológico , Risco , Subpopulações de Linfócitos T/imunologia , Tuberculose/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidoresAssuntos
Infecções por Actinomycetales/etiologia , Infecções por HIV/complicações , Pneumonia Bacteriana/etiologia , Rhodococcus equi , Infecções por Actinomycetales/diagnóstico por imagem , Infecções por Actinomycetales/tratamento farmacológico , Adulto , Antibacterianos/efeitos adversos , Antivirais/efeitos adversos , Progressão da Doença , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/tratamento farmacológico , RadiografiaAssuntos
Listeria monocytogenes/isolamento & purificação , Listeriose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Listeriose/tratamento farmacológico , Listeriose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
El riesgo de infección por Mycobacterium tuberculosis se halla aumentado en los pacientes con enfermedades inflamatorias crónicas y en tratamiento inmunosupresor, en particular con terapia antifactor de necrosis tumoral α. La detección de la infección tuberculosa latente y el tratamiento preventivo dirigido a reducir el riesgo de progresión a tuberculosis activa es obligatoria en este grupo de pacientes. Este documento de consenso multidisciplinar actualiza la opinión de expertos y establece recomendaciones para el diagnóstico y tratamiento de la infección tuberculosa latente en estos pacientes, según los conocimientos actuales en terapias biológicas
Patients with chronic inflammatory diseases being treated with immunosuppressive drugs, and with tumor necrosis factor inhibitors in particular, have an increased risk of infection by Mycobacterium tuberculosis. Screening for latent tuberculosis infection and preventive therapy to reduce the risk of progression to active tuberculosis are mandatory in this group of patients. This updated multidisciplinary consensus document presents the latest expert opinions on the treatment and prevention of tuberculosis in candidates for biologic therapy and establishes recommendations based on current knowledge relating to the use of biologic agents
Assuntos
Humanos , Antituberculosos/uso terapêutico , Tuberculose/prevenção & controle , Terapia Biológica/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Antituberculosos/administração & dosagem , Hidradenite Supurativa/tratamento farmacológico , Seleção de Pacientes , Psoríase/tratamento farmacológico , Tuberculose/tratamento farmacológico , Monitoramento de Medicamentos , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
No disponible
Assuntos
Humanos , Listeriose/diagnóstico , Listeria monocytogenes/isolamento & purificaçãoRESUMO
Three patients are reported who had systemic lupus erythematosus and membrane-proliferative glomerulonephritis. These patients failed to respond to intravenous cyclophosphamide and steroids and were then changed to receive oral cyclosporine A, at a dose of 5 mg/kg/day. The three patients showed remission of disease, symptoms, and renal and immunological parameters, with minimal secondary effects. The medical literature was reviewed and cyclosporine A is suggested to be a therapeutical choice for patients with lupus nephropathy even when they do not respond to other immunosuppressive regimes, such as pulse cyclophosphamide.
Assuntos
Ciclosporina/uso terapêutico , Glomerulonefrite Membranoproliferativa/tratamento farmacológico , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Adulto , Feminino , Glomerulonefrite Membranoproliferativa/complicações , Humanos , Lúpus Eritematoso Sistêmico/complicaçõesRESUMO
No disponible
No disponible
Assuntos
Humanos , Masculino , Adulto , Pneumonia/complicações , Pneumonia/diagnóstico , Rhodococcus equi/isolamento & purificação , Rhodococcus equi/patogenicidade , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Radiografia Torácica/métodos , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antirretrovirais/uso terapêutico , Testes de Sensibilidade Microbiana/métodos , Infecções por HIV/fisiopatologia , Infecções por HIV , Broncoscopia/métodos , Hemoptise/complicações , Hemoptise/diagnóstico , Tomografia Computadorizada de Emissão/métodos , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/patogenicidade , Estudos RetrospectivosRESUMO
Antecedentes y objetivo. La tuberculosis constituye un importante problema sanitario, también en nuestro medio. Este estudio sepropone describir las características clínicas y epidemiológicas de la tuberculosis cutánea en nuestro medio. Pacientes y métodos. Estudio retrospectivo de los casos de tuberculosis cutánea diagnosticados de enero de 2003 a julio de 2011 en un hospital de Mallorca. Se registraron las formas clínicas, la metodología diagnóstica empleada, el tratamiento utilizado y la evolución clínica. Resultados. Se diagnosticaron 28 casos de tuberculosis con afectación cutánea (5,9% del total de tuberculosis), tuberculosis verdadera en 15 casos (14 escrofulodermas, un empiema necessitatis) y tubercúlides en el resto (8 casos de eritema indurado de Bazin y 5 de eritema nodoso). El foco de origen de los escrofulodermas fue ganglionar (10), óseo (4) y pleural (1); 13/28 pacientes eran originarios de otros continentes. La mayoría de los pacientes fueron tratados con 3-4 fármacos tuberculostáticos, evolucionando favorablemente. Conclusión. La tuberculosis cutánea no es infrecuente en nuestro medio. En las tuberculosis cutáneas verdaderas el cultivo es el método diagnóstico más rentable, mientras que en las tubercúlides generalmente la histología es la que proporciona el diagnóstico(AU)
Background and objective. Tuberculosis is an important health care problem, even in our setting. The objective of this study is to describe clinic and epidemiological features of cutaneous tuberculosis in our area. Patients and methods. A retrospective study was performed of all patients diagnosed of cutaneous tuberculosis in a hospital in Mallorca (Spain) from January 2003 to July 2011. The clinical forms, diagnostic methods used, treatment used and clinical course were recorded. Results. Twenty-eight cases of cutaneous tuberculosis were diagnosed (5.9% of the tuberculosis cases diagnosed in this period), 15 with classic cutaneous tuberculosis (14 scrofuloderma, 1 empyema necessitatis) and 13 patients with tuberculids (8 erythema induratum of Bazin disease and 5 erythema nodosum). Scrofulodermas came from lymph nodes in 10 of the patients, infected bone in 4 and pleural in one case; 13/28 patients came from other continents. Most of the patients were treatment with 3-4 tuberculostatic drugs, with favorable course. Conclusions. Cutaneous tuberculosis is not uncommon in our setting. In classic cutaneous tuberculosis culture is the gold standard diagnostic method while tuberculids are most commonly diagnosed by histology(AU)