RESUMO
Sexual life is an important dimension of quality of life, which may be affected by the fear of transmission in people living with HIV/AIDS (PLWHA), despite the fact that antiretroviral therapy prevents person-to-person transmission. We, therefore, aimed to explore the sexual life satisfaction of PLWHA and its correlation with their fear of HIV transmission and self-esteem. Consecutive adult PLWHA from seven HIV care facilities in the Rhone-Alpes region, France, were asked to complete a self-administered, anonymous questionnaire concerning sociological and medical data, satisfaction with sexual life (18 questions), and self-esteem (Rosenberg score). Overall, 690 PLWHA answered the questionnaire (mean age 49.2 ± 11 years); 74.9% were men, of which 75.1% had sex with men. Overall, 68.0% of respondents feared transmitting HIV (a lot/a bit). A lower satisfaction with sexual life was significantly associated with being female, not having a stable sexual partner, being unemployed, having a low income, experiencing a fear of HIV transmission, having lower self-esteem, and not reporting an excellent/very good health status. These results strongly suggest that the information concerning the antiretroviral-induced suppression of infectivity should be widely diffused, as this may enhance the quality of sexual life in PLWHA.
Assuntos
Medo , Infecções por HIV/psicologia , Satisfação Pessoal , Qualidade de Vida/psicologia , Autoimagem , Adolescente , Adulto , Antirretrovirais/uso terapêutico , Feminino , França , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Inquéritos e Questionários , Adulto JovemAssuntos
Antibacterianos/administração & dosagem , Clindamicina/administração & dosagem , Hidradenite Supurativa/tratamento farmacológico , Ofloxacino/administração & dosagem , Administração Oral , Adolescente , Adulto , Criança , Relação Dose-Resposta a Droga , Esquema de Medicação , Substituição de Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rifampina/administração & dosagem , Resultado do Tratamento , Adulto JovemRESUMO
Transient elastography (TE) is a noninvasive technique to evaluate liver fibrosis. We compared the performance of TE with liver biopsy (LB) in patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfection. Patients prospectively underwent TE and LB. The diagnosis accuracy of TE was calculated using receiver operating characteristic (ROC) curves for different stages of fibrosis, and optimal cut-off values were defined. A sequential algorithm combining TE with biochemical score (Fibrotest) is proposed. Fifty-seven patients had both TE and LB (median time: 3 days) and two with proven cirrhosis, only TE. Forty-six (78%) were under antiretroviral therapy with anti-HBV drugs in 98%, and 19 (32%) had elevated alanine aminotransferase (ALT). A significant correlation was observed between liver stiffness measurement (LSM) and METAVIR fibrosis stages (P < 0.0001). Patients with elevated ALT tended to have higher LSM than those with normal ALT. The areas under the ROC curves were 0.85 for significant fibrosis (≥ F2), 0.92 for advanced fibrosis (≥ F3) and 0.96 for cirrhosis. Using a cut-off of 5.9 kPa for F ≥ 2 and 7.6 kPa for F ≥ 3, the diagnosis accuracy was 83% and 86%, respectively. With an algorithm combining TE and Fibrotest, 97% of patients were well classified for significant fibrosis. Using this algorithm, the need for LB can be reduced by 67%. In HIV/HBV-coinfected patients, most of them with normal ALT under antiretroviral treatment including HBV active drugs, TE was proficient in discriminating moderate to severe fibrosis from minimal liver disease.
Assuntos
Técnicas de Imagem por Elasticidade/métodos , Infecções por HIV/complicações , Cirrose Hepática/diagnóstico , Fígado/patologia , Adulto , Algoritmos , Biópsia/métodos , Feminino , Infecções por HIV/virologia , HIV-1 , Hepatite B/complicações , Hepatite B/patologia , Hepatite B/virologia , Vírus da Hepatite B , Humanos , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Clostridium sordellii is usually associated with skin and soft tissue infections. We describe the first case to our knowledge of a Clostridium sordellii-associated brain abscess, diagnosed by 16S rRNA gene sequencing, expanding the microbiological spectrum of brain abscesses, with emphasis on the role of 16S rRNA gene PCR in their etiologic diagnosis.
Assuntos
Abscesso Encefálico/diagnóstico , Infecções por Clostridium/diagnóstico , Clostridium sordellii/isolamento & purificação , Adulto , Encéfalo/diagnóstico por imagem , Abscesso Encefálico/microbiologia , Infecções por Clostridium/microbiologia , Clostridium sordellii/classificação , Clostridium sordellii/genética , Análise por Conglomerados , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Humanos , Imageamento por Ressonância Magnética , Masculino , Dados de Sequência Molecular , Filogenia , Reação em Cadeia da Polimerase , RNA Ribossômico 16S/genética , Radiografia , Análise de Sequência de DNARESUMO
Mucormycosis are infrequent filamentous fungal infections, but severe and with high mortality (20 to 50%). Symptoms are very common, like necrosis, and burn/polytrauma patients have a higher risk of mucormycosis than the general population. We report here the history of a 38-year-old man, polytraumatized and burned because of a tractor incident. During the first two weeks two haemorrhagic shock episodes occurred because of necrosis of the humeral artery. Analysis of vascular fragment identified Lichteimia spp. The diagnosis of invasive infection was established after identifying Lichteimia spp. in blood cultures also. We treated the patient with intravenous liposomal amphotericin, oral posaconazole and surgical debridement according to the gold standard. The wound mucormycosis was also treated with a humeral bypass with vascular allograft and a latissimus dorsi pedicled flap. Furthermore, mucormycosis was treated with local instillations of amphotericin B in the dressings twice a day with 1% (1 mg/100mL) solution of non-liposomal amphotericin. Early diagnosis and treatment is very important for mucormycosis healing and to minimize morbimortality. With burn and polytrauma patients necrosis and bad local evolution have to be carefully screened and analyzed.
RESUMO
We report the case of an atypical localization of a spinal cord "toxoplasmic abscess". The 46-year-old patient, HIV-1 positive, was admitted for acute urine retention and gait disorders. MRI revealed a T12-L1 medullary lesion suggesting a tumoral, inflammatory and infectious pathology. The radiological aspect and immunosuppression lead to the initiation of a treatment against Toxoplasma gondii, following the same treatment principles as for cerebral toxoplasmosis. The diagnosis can only be proved by data from autopsy or surgical biopsy, but toxoplasmosis PCR on CSF seems to be an interesting alternative to confirm the diagnosis. According to the literature, PCR is not sensitive enough as a diagnostic tool. Improvement after treatment supported the diagnosis confirmed by PCR.
Assuntos
Infecções por HIV/complicações , Toxoplasma/isolamento & purificação , Animais , Antiprotozoários/uso terapêutico , Líquido Cefalorraquidiano/parasitologia , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/métodos , Radiografia , Sensibilidade e Especificidade , Doenças da Medula Espinal/parasitologia , Doenças da Medula Espinal/patologia , Toxoplasma/genética , Toxoplasmose/diagnóstico , Toxoplasmose/diagnóstico por imagem , Toxoplasmose/tratamento farmacológico , Toxoplasmose/patologiaRESUMO
OBJECTIVE: The long-term impact of treatment strategies proposed by the IDSA guidelines for patients presenting with methicillin-susceptible S. aureus (MSSA) prosthetic joint infection (PJI) is not well-known. PATIENTS AND METHODS: Retrospective (2000-2010) cohort study including patients presenting with MSSA hip or knee PJI. A univariate Cox analysis was performed to determine if the non-compliance with IDSA surgical guidelines was a risk factor for treatment failure. RESULTS: Eighty-nine patients with a mean follow-up of 2.8 years were included. Non-compliance with IDSA surgical guidelines was associated with treatment failure (hazard ratio 2.157; 95% CI [1.022-4.7]). The American Society of Anesthesiologists score, inadequate antimicrobial therapy, and a rifampicin-based regimen did not significantly influence patient outcome. CONCLUSION: Based on the IDSA guidelines, if a patient presenting with MSSA PJI is not eligible for implant retention, complete implant removal is needed to limit treatment failure.
Assuntos
Antibacterianos/uso terapêutico , Desbridamento , Fidelidade a Diretrizes , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Guias de Prática Clínica como Assunto , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Artrite Infecciosa , Biofilmes , Terapia Combinada , Tratamento Conservador , Remoção de Dispositivo , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Masculino , Meticilina/farmacologia , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Recidiva , Estudos Retrospectivos , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Staphylococcus aureus/efeitos dos fármacos , Falha de TratamentoRESUMO
Brain aspergillosis is a rare pathology, occurring mainly in immunocompromised patients, responsible for multiple cerebral septic infarctions. Some researchers have described magnetic resonance (MR) findings in cerebral invasive aspergillosis, but diffusion-weighted imaging (DWI) has rarely been reported, especially in typical non-enhancing lesions, while it may be helpful for early differential diagnosis and may allow earlier antifungal treatment. We describe three cases of patients presenting brain aspergillosis, with MR imaging including diffusion-weighted sequences and apparent diffusion coefficient (ADC) cartography. The three patients described in this study presented a total of 23 circular lesions, and one patient presented an infarction area in the territory of the right middle cerebral artery. Lesions were ring-enhancing for one patient, and presented no enhancement for the other two. Eleven lesions were very bright on DWI, with reduced ADC values. Twelve lesions, either enhancing or not enhancing, presented a 'target-like' aspect with central and peripheral hypointense areas on DWI, corresponding to higher ADC value areas, and intermediate marked hypersignal on DWI. This typical aspect of aspergillosis lesions on DWI may allow early diagnosis and treatment of cerebral aspergillosis, and is helpful for differentiating aspergillosis lesions from other infectious or malignant lesions affecting immunocompromised patients.
Assuntos
Encéfalo/microbiologia , Encéfalo/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Neuroaspergilose/patologia , Encéfalo/fisiopatologia , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Hospedeiro Imunocomprometido/imunologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas Mielinizadas/microbiologia , Fibras Nervosas Mielinizadas/patologia , Neuroaspergilose/imunologia , Neuroaspergilose/fisiopatologia , Infecções Oportunistas/imunologia , Infecções Oportunistas/patologia , Infecções Oportunistas/fisiopatologia , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
INTRODUCTION: The aim of this study was to evaluate the vaccinal status among Croix-Rousse Hospital workers, attitude towards this vaccination, and the information delivered in order to promote this vaccination. METHODS: Questionnaires were delivered by electronic mailing. RESULTS: Six hundred (and) twenty-nine questionnaires were analyzed (26.7% of hospital workers); 30.7% of responders were vaccinated against influenza, 89.2% of responders were aware of influenza and vaccine. Vaccine coverage was lower in younger workers, non health-care workers, non physician health-care workers, and surgeons who responded. Motivation and reserve varied according to the status, position, and age, with some discrepancies. CONCLUSION: These results suggest implementing a better targeted vaccination campaign, according to the various categories of personnel.
Assuntos
Hospitais Filantrópicos/estatística & dados numéricos , Vacinas contra Influenza , Recursos Humanos em Hospital/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Feminino , França , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Medicina/estatística & dados numéricos , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Recursos Humanos em Hospital/classificação , Recursos Humanos em Hospital/psicologia , Médicos/estatística & dados numéricos , Cruz Vermelha/organização & administração , Especialização , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Like Fusobacterium necrophorum, Fusobacterium nucleatum is capable causing Lemierre's syndrome. Various locations of venous thrombosis have been described associated with Fusobacterium sp. septicemia. EXEGESIS: We describe a 43-year old alcoholic patient with F.nucleatum septicemia complicated with hepatic abscesses, middle hepatic venous thrombosis, osteomyelitis and infiltrative pneumonia. A pancreatic prosthesis was the only potentially identified infectious entrance. CONCLUSION: Our patient showed an alternative presentation of Lemierre's syndrome, a "digestive variant". To the best of our knowledge, this is the first report of Fusobacterium septicemia associated with hepatic venous thrombosis. This report is close to the cases of portal thrombosis and opens the clinical sphere of the lemierre's syndrome, whose incidence is increasing.
Assuntos
Síndrome de Budd-Chiari/microbiologia , Infecções por Fusobacterium/complicações , Fusobacterium nucleatum/isolamento & purificação , Abscesso Hepático/microbiologia , Sepse/microbiologia , Adulto , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Síndrome de Budd-Chiari/diagnóstico , Síndrome de Budd-Chiari/terapia , Infecções por Fusobacterium/diagnóstico , Infecções por Fusobacterium/terapia , Humanos , Abscesso Hepático/diagnóstico , Abscesso Hepático/terapia , Masculino , Pâncreas/cirurgia , Próteses e Implantes/efeitos adversos , Sepse/diagnóstico , Sepse/terapia , Síndrome , Resultado do TratamentoRESUMO
INTRODUCTION: Neuromeningeal tuberculosis of deleterious, paradoxical, progression despite appropriate antibiotic therapy is rare. OBSERVATION: An immunocompetent woman exhibited an immediately disseminated form of tuberculosis with progressive neurological involvement associating expanding intracranial tuberculomas and meningeal-radiculitis despite adapted anti-tuberculosis quadritherapy. DISCUSSION: During anti-tuberculosis therapy clinical worsening is rare, particularly when 2 different manifestations are associated and the worsening occurs in an immunocompetent patient. This possibility should be systematically evoked in such cases. The explanation of this phenomenon is still unclear.
Assuntos
Antituberculosos/uso terapêutico , Radiculopatia/tratamento farmacológico , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma/tratamento farmacológico , Tuberculose Meníngea/tratamento farmacológico , Idoso , Anti-Inflamatórios/uso terapêutico , Confusão/microbiologia , Progressão da Doença , Quimioterapia Combinada , Feminino , Febre/microbiologia , Humanos , Imunocompetência , Isoniazida/uso terapêutico , Imageamento por Ressonância Magnética , Ofloxacino/uso terapêutico , Prednisona/uso terapêutico , Radiculopatia/complicações , Radiculopatia/diagnóstico , Rifampina/uso terapêutico , Punção Espinal , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculoma/complicações , Tuberculoma/diagnóstico , Tuberculoma Intracraniano/complicações , Tuberculoma Intracraniano/diagnóstico , Tuberculose Meníngea/complicações , Tuberculose Meníngea/diagnósticoRESUMO
OBJECTIVE: The authors had for aim to evaluate the clinical and biological evolution in HIV-infected patients with viraemia lower than 30,000 copies/mL having decided to interrupt their treatment. PATIENTS AND METHODS: Patients with highly active antiretroviral therapy (HAART) for more than 3 months followed by treatment interruption longer than 1 month were included in a retrospective analysis. RESULTS: Forty-six patients having stopped treatment between November 1999 and July 2003 were included. The median duration of treatment interruption was 9.5 months. During the study, no clinical event occurred for 21 patients, and at least 1 clinical event occurred for the 25 others. The median CD4(+) cell counts (CD4) before and at the end of treatment interruption were 597/mm(3) and 437/mm(3), respectively (P<0.001). The median values of viral load before and at the end of treatment interruption were <50 and 23749 copies/mL, respectively (P<0.001). Among the 26 patients having started a new HAART, pre-treatment interruption and post-new HAART median CD4 (with a median delay after HAART of 9.7 months) were 548 and 432.5/mm(3) (P=0.02). Pre-treatment interruption and post-new HAART median viral load were 131.5 and 94.5 copies/mL (NS). CONCLUSIONS: Treatment interruption must be used with caution in spite of the absence of virological impact, because CD4 cell count after new HAART is lower than CD4 preceding treatment interruption. Treatment interruption is contraindicated for patients with AIDS. Physicians must carefully follow other patients who decide on a treatment interruption.
Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Recusa do Paciente ao Tratamento , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: To describe and evaluate a polymerase chain reaction (PCR) method for early diagnosis and prompt management of cytomegalovirus (CMV) retinitis in HIV-infected patients. METHODS: A total of 110 HIV-infected patients (Centers for Disease Control and Prevention stages II to IV) were sampled sequentially for isolation of CMV from peripheral blood leukocytes (PBL; n = 560) and for amplification of CMV DNA in PBL. Semiquantitative analysis of the PCR product was performed and each PCR-positive specimen was assigned a score between 1+ and 4+ (corresponding to four points on a standard curve of dilutions: 80, 800, 8000 and 80,000 CMV genome copies). RESULTS: Levels of CMV DNA in blood increased with HIV infection stage. We focused on eight patients who developed one or more episodes of retinitis during longitudinal follow-up, in whom we found a strong correlation between viraemia, high PCR signal (3+ or 4+) (P < 0.0001) and clinical symptoms. Relapse was preceded by an increase in CMV DNA and resolution correlated with clearance of CMV DNA from blood. CONCLUSIONS: Persistent high PCR levels always preceded virus isolation and may be the first indication of organ involvement and thus early treatment. PCR scores were consistently useful as indicators of drug efficacy and for monitoring of treatment.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções por Citomegalovirus/diagnóstico , DNA Viral/sangue , Infecções por HIV/complicações , Retinite/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Citomegalovirus/genética , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/complicações , DNA Viral/genética , Estudos de Avaliação como Assunto , Humanos , Leucócitos/microbiologia , Reação em Cadeia da Polimerase/métodos , Retinite/complicaçõesRESUMO
The incidence of severe falciparum malaria is increasing in the developed countries and mortality remains high despite progress in intensive care management and schizonticide treatment. Many authors emphasize the importance of exchange transfusion (EXT) in the most severe cases. We studied 21 cases (34 +/- 12 years, 6 females; SAPS: 8.4 +/- 3.7) of severe malaria (according to WHO criteria) consecutively admitted to ICU between 1985 and 1990: 3 patients underwent EXT. Twenty were febrile above 39 degrees C, 10 had cerebral malaria, 14 hepatic impairment, 8 acute renal failure, 5 pulmonary oedema. Nine patients required mechanical ventilation, 1 haemodialysis, 1 intracranial pressure monitoring. Mean parasitemia was 13%, 16 patients had thrombocytopenia less than 50 x 10(9)/l, 3 anemia less than 7 g/dl and 3 leucopenia less than 2.8 x 10(9)/l. Nineteen received quinine i.v., 1 mefloquine, 1 chloroquine. Sixteen patients received blood products transfusion, 3 were treated by EXT in addition. Twenty were cured and discharged from hospital without sequelae (mean stay: 14 days); 4 had nosocomial infection, 1 a splenic infarction. One patient (17-years-old; SAPS: 17; parasitemia: 7.8%) died 12 h after admission from non-cardiogenic pulmonary oedema with multi-organ failure. The literature and this study lead us to propose EXT in patients with unfavourable evolution after conventional treatment rather than in all the patients with a parasitemia above 10% at admission. A randomized study to compare conventional treatment in ICU with or without EXT is necessary.
Assuntos
Malária Falciparum/terapia , Adolescente , Adulto , Pré-Escolar , Cloroquina/uso terapêutico , Transfusão Total , Feminino , Humanos , Infusões Intravenosas , Unidades de Terapia Intensiva , Malária Cerebral/complicações , Malária Cerebral/fisiopatologia , Malária Cerebral/terapia , Malária Falciparum/complicações , Malária Falciparum/fisiopatologia , Masculino , Mefloquina/uso terapêutico , Pessoa de Meia-Idade , Quinina/uso terapêutico , Respiração Artificial , Estudos RetrospectivosRESUMO
The authors report the case of a 51-year-old woman who was hospitalized for severe acute colitis. Sub-total colectomy was performed, due to clinical deterioration and resistance to treatment. The examination of the surgery specimen revealed a herpes-virus type 2 as the responsible pathogen agent. Complementary aciclovir treatment cured the patient.
Assuntos
Colite/microbiologia , Herpes Genital/microbiologia , Herpesvirus Humano 2/isolamento & purificação , Ileíte/microbiologia , Doença Aguda , Colectomia , Colite/patologia , Colite/cirurgia , Feminino , Herpes Genital/patologia , Herpes Genital/cirurgia , Humanos , Ileíte/patologia , Ileíte/cirurgia , Pessoa de Meia-IdadeRESUMO
The role of drugs inhibiting viral replication in patients infected with HIV has been confirmed. Until now only dideoxynucleosides, which are reverse transcriptase inhibitors, have demonstrated antiviral activity in humans. A number of compounds acting on other steps of the viral cycle are currently being evaluated and clinical trials are being performed. Some investigators are attempting to inhibit the binding of viral particles to target cells and their penetration into these by acting on the interaction between HIV ant the CD4 molecule. Another approach consists in the characterization of enzymatic activities which are specific of HIV, other than reverse transcriptase, such as ribonuclease H, integrase or protease, in order to prepare specific inhibitors. Attempts are made to inhibit retroviral gene expression and production of viral particles in infected cells. The development of new nucleoside analogues and drugs with mechanisms of action and toxicities different from those of zidovudine should allow in the near future combination chemotherapy of HIV infection.
Assuntos
Didesoxinucleosídeos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Didesoxinucleosídeos/classificação , Didesoxinucleosídeos/farmacologia , Infecções por HIV/microbiologia , Humanos , Transcrição Gênica/efeitos dos fármacos , Integração Viral/efeitos dos fármacos , Replicação Viral/efeitos dos fármacosRESUMO
INTRODUCTION: Pubic osteomyelitis has been described in three situations: children in whom Staphylococcus aureus is the preeminent pathogen; elderly patients who have undergone genitourinary procedures, and parenteral drug abusers. In contrast, pubic osteomyelitis in athletes has been described less often. We report three cases of acute staphylococcal pubic osteomyelitis in young athletic men and present a review of the literature. EXEGESIS: The clinical presentation in each case was acute groin, hip, or perineal pain; fever; inability to bear weight; and pubic symphysis tenderness. The diagnosis was established by blood culture and radiologic changes. CONCLUSIONS: Staphylococcus aureus pubic osteomyelitis should be suspected in athletes who have febrile hip or groin pain. The pathogenesis of this disease is thought to involve preexisting trauma or athletic injury and subsequent seeding of this area during transient bacteremia. Prolonged antimicrobial therapy is required for the cure, and debridement with curettage may be necessary if patients have persistent infection or sequestra.
Assuntos
Osteomielite/patologia , Osso Púbico/microbiologia , Esportes , Infecções Estafilocócicas/complicações , Adolescente , Adulto , Traumatismos em Atletas/complicações , Bacteriemia , Desbridamento , Humanos , Masculino , Osteomielite/etiologia , Osteomielite/terapia , Dor/etiologia , Osso Púbico/patologia , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidadeRESUMO
The diagnosis of severe actinomycosis parallel to that of neoplasia leads to speculation of a possible fortuitous association. Because underlying conditions such as immuno-suppression are suspected in such disease, and to strengthen this hypothesis, we report one more case of disseminated actinomycosis associated with a malignant disease, namely an epidermoid pulmonary carcinoma. The diagnosis was made by thoracotomy a few months after the infectious episode. Two years later the patient recovered. The analysis of the literature data is in favor of a fortuitous association between both diagnoses.
Assuntos
Actinomicose/complicações , Carcinoma de Células Escamosas/complicações , Neoplasias Pulmonares/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We present one case of acquired Toxoplasma gondii retinochoroiditis after livrer transplantation. Three weeks after receiving liver transplant from a seropositive donor for Toxoplasma gondii, the fundus examination showed a vitreal haze and an edematous retinal lesion with retinal hemorrhages. Routine screening tests for uveitis were performed. The serum toxoplasmosis titers revealed a seroconversion for toxoplasmosis (pre-transplantation tests were negative). The PCR assay on aqueous humor resulted in an amplified product identical to toxoplasmosis. This immunocompromised patient likely received an infected hepatic transplant. The patient's ocular inflammation cleared on 1-month pyrimethamine-sulfadiazine medication. Four months later, the patient developed a retinal detachment with massive proliferative vitreoretinopathy.