RESUMO
BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is a severe drug eruption. We report herein the first case of AGEP induced by phloroglucinol (Spasfon®). PATIENTS AND METHODS: A 27-year-old pregnant woman developed a febrile exanthematous pustulosis eruption three days after treatment with intravenous phloroglucinol and paracetamol for nephritic colic. She had no previous history of psoriasis. The laboratory workup showed hyperleukocytosis with neutrophilia. A cytobacteriological sample of the pustules was negative. Skin biopsy revealed marked neutrophilic and leukocytoclastic vasculitis. Reintroduction of phloroglucinol after delivery resulted in the same clinical symptoms within a few hours of intake. A diagnosis of phloroglucinol-induced AGEP was made on the basis of intrinsic imputability of I4 (S3 C3) using the imputability criteria of Begaud et al. The outcome was favorable after withdrawal of the drug. DISCUSSION: To the best of our knowledge, this is the first case of phloroglucinol-induced AGEP confirmed by reintroduction of the drug.
Assuntos
Pustulose Exantematosa Aguda Generalizada/diagnóstico , Pustulose Exantematosa Aguda Generalizada/etiologia , Indicadores e Reagentes/efeitos adversos , Floroglucinol/efeitos adversos , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Acetaminofen/administração & dosagem , Antipiréticos/administração & dosagem , Biópsia , Feminino , Humanos , Gravidez , Cólica Renal/tratamento farmacológico , Pele/patologiaAssuntos
Assistência ao Convalescente/métodos , Dermoscopia , Detecção Precoce de Câncer , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adulto , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Melanoma/patologia , Melanoma/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fotografação , Estudos Retrospectivos , Pele/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
Deoxyguanosine kinase (dGK) deficiency is a frequent cause of mitochondrial DNA depletion associated with a hepatocerebral phenotype. In this study, we describe a new splice site mutation in the DGUOK gene and the clinical, radiologic, and genetic features of these DGUOK patients. This new DGUOK homozygous mutation (c.444-62C>A) was identified in three patients from two North-African consanguineous families with combined respiratory chain deficiencies and mitochondrial DNA depletion in the liver. Brain MRIs are normal in DGUOK patients in the literature. Interestingly, we found subtentorial abnormal myelination and moderate hyperintensity in the bilateral pallidi in our patients. This new mutation creates a cryptic splice site in intron 3 (in position -62) and is predicted to result in a larger protein with an in-frame insertion of 20 amino acids. In silico analysis of the putative impact of the insertion shows serious clashes in protein conformation: this insertion disrupts the alpha5 helix of the dGK kinase domain, rendering the protein unable to bind purine deoxyribonucleosides. In addition, a common haplotype that segregated with the disease in both families was detected by haplotype reconstruction with 10 markers (microsatellites and SNPs), which span 4.6 Mb of DNA covering the DGUOK locus. In conclusion, we report a new DGUOK splice site mutation that provide insight into a critical protein domain (dGK kinase domain) and the first founder mutation in a North-African population.
Assuntos
DNA Mitocondrial/genética , Efeito Fundador , Predisposição Genética para Doença , Encefalopatia Hepática/enzimologia , Encefalopatia Hepática/genética , Mutação/genética , Fosfotransferases (Aceptor do Grupo Álcool)/genética , Análise Mutacional de DNA , Evolução Fatal , Regulação Enzimológica da Expressão Gênica , Genótipo , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Linhagem , Fosfotransferases (Aceptor do Grupo Álcool)/química , Fosfotransferases (Aceptor do Grupo Álcool)/metabolismo , Estrutura Secundária de Proteína , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SíndromeRESUMO
BACKGROUND: Pyoderma gangrenosum is a neutrophilic dermatosis in which systemic involvement is rare. It may be associated with systemic disease. We report a case of pyoderma gangrenosum in the spleen. CASE REPORT: A 68-year-old man presenting pyoderma gangrenosum with pustules and stage I multiple myeloma was admitted for asthenia and abdominal pain. There were no skin lesions. Laboratory tests showed inflammatory syndrome with polynuclear leucocytes of 25,000/mm(3). CAT scans and abdominal ultrasound revealed a splenic abscess. A spleen biopsy was performed and histological examination showed polynuclear leukocyte infiltration, while cultures were negatives. Diagnosis of pyoderma gangrenosum with splenic involvement was made. Increased systemic corticosteroid therapy produced a successful outcome. Haematological findings remained unchanged. DISCUSSION: Spleen involvement in pyoderma gangrenosum is very rare and can mimic an infectious process. In such cases, routine screening is essential for associated diseases, particularly haematological malignancies.
Assuntos
Abscesso/complicações , Pioderma Gangrenoso/complicações , Esplenopatias/complicações , Idoso , Mãos/patologia , Humanos , Contagem de Leucócitos , MasculinoRESUMO
In a prospective randomized multicenter study, 308 children, ages 2 to 15 years, were randomized to receive either cefuroxime axetil suspension (N = 152; 20 mg/kg/day twice daily) for 4 days, penicillin suspension (N = 156; 45 mg/kg/day divided three times daily) for 10 days, of whom 97 and 103, respectively, had culture-proved group A beta-hemolytic Streptococcus infection. Two to 4 days after completion of the treatment, group A beta-hemolytic Streptococcus were eradicated from 85 of 97 (87.6%) children taking cefuroxime and from 90 of 103 (87.4%) taking penicillin; respective clinical cure rates were 94.8% and 96.1%. Clinical signs and symptoms resolved significantly more rapidly with cefuroxime (P < 0.05). At 28 to 32 days posttreatment the eradication of the primary isolate was confirmed in 94.4 and 91.9% of cefuroxime axetil and penicillin-treated patients, respectively. Drug-related adverse events (mainly gastrointestinal and cutaneous reactions) were reported in 2.1 and 2.7% of the cefuroxime- and penicillin-treated patients, respectively. Results indicated that a 4-day treatment with cefuroxime axetil was as effective and well-tolerated as the conventional 10-day treatment with penicillin in children with acute group A beta-hemolytic Streptococcus pharyngitis.
Assuntos
Cefuroxima/análogos & derivados , Penicilinas/uso terapêutico , Faringite/tratamento farmacológico , Pró-Fármacos/uso terapêutico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes , Adolescente , Cefuroxima/administração & dosagem , Cefuroxima/efeitos adversos , Cefuroxima/uso terapêutico , Criança , Pré-Escolar , Intervalos de Confiança , Esquema de Medicação , Feminino , Humanos , Masculino , Penicilinas/administração & dosagem , Penicilinas/efeitos adversos , Faringite/microbiologia , Faringite/fisiopatologia , Pró-Fármacos/administração & dosagem , Pró-Fármacos/efeitos adversos , Estudos Prospectivos , Infecções Estreptocócicas/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: Acute otitis media is the leading reason for antibiotic prescriptions in childhood. The increase in antibiotic resistance of Streptococcus pneumoniae is generally attributed to the extensive use of antibiotics and the selective pressure on the bacterial strains of the nasopharyngeal flora. OBJECTIVE: To evaluate the change in nasopharyngeal carriage of S. pneumoniae during antibiotic therapy prescribed for acute otitis media. METHODS: Between October, 1993, and March, 1994, we conducted a clinical trial comparing cefpodoxime-proxetil and amoxicillin-clavulanate in acute otitis media. From 364 children, 4 months to 4.5 years old, a nasopharyngeal sample was obtained before and after treatment. Antibiotic susceptibility was established by determining minimal inhibitory concentrations by the agar dilution method. Serotype and randomly amplified polymorphic DNA analysis were used to compare pre- and posttreatment S. pneumoniae strains. RESULTS: The risk for a child to carry penicillin-resistant S. pneumoniae (MIC > or = 0.125 mg/l) did not increase after antibiotic treatment: 84 of 364 (23.1%) before, 70 of 364 (19.2%) after. There was a significant decrease of penicillin-susceptible S. pneumoniae carriage, 117 of 364 (32.1%) before treatment compared with 24 of 364 (6.6%) (P = 0.0001) after treatment. However, among the children carrying S. pneumoniae at the end of the treatment there was an increase in the percentage of penicillin-resistant pneumococci: 84 of 201 (41.8%) before treatment and 70 of 94 (74.5%) after treatment. Among the 94 children carrying S. pneumoniae at the end of the treatment, 22 did not harbor pneumococcus before, 16 carried another genotypically different serotype and 56 harbored the same serotype. Among these 56 children 2 patients harbored strains that had increased MICs for the tested beta-lactam antibiotics. The randomly amplified polymorphic DNA analysis showed that in one case, the strains were genetically different. CONCLUSIONS: These data illustrate that antibiotic therapy did not increase the rate at which children carried penicillin-resistant S. pneumoniae, but there was an increase in the rate of resistance among the children carrying pneumococci at the end of the treatment, mainly as a result of reduction of susceptible strains.
Assuntos
Antibacterianos/uso terapêutico , Ceftizoxima/análogos & derivados , Nasofaringe/microbiologia , Otite Média/tratamento farmacológico , Streptococcus pneumoniae/efeitos dos fármacos , Doença Aguda , Amoxicilina/uso terapêutico , Combinação Amoxicilina e Clavulanato de Potássio , Ceftizoxima/uso terapêutico , Pré-Escolar , Ácidos Clavulânicos/uso terapêutico , Feminino , Humanos , Lactente , Masculino , Otite Média/microbiologia , Resistência às Penicilinas , Estudos Prospectivos , Cefpodoxima ProxetilRESUMO
OBJECTIVE: To study the spread of extended-spectrum beta-lactamase-producing, but aminoglycoside-susceptible, Klebsiella pneumoniae strains in our hospital over an 8-month period, by using two genotypic markers. DESIGN: Ribotyping (using two endonucleases) and randomly amplified polymorphic DNA analysis (RAPD; using two different 10-mer primers) were applied to the epidemiological typing of clinical K pneumoniae isolates from stools, ileal fluid, or urine of hospitalized children. SETTING AND PATIENTS: The surgical intensive-care ward (S1: 9 patients, 17 isolates), surgical unit (S2: 2 patients, 2 isolates), and gastroenterology ward (GE: 1 patient, 1 isolate) of the Robert Debré Hospital of Paris, France. RESULTS: Ribotyping of the 20 clinical isolates, the type strain of the species, and two epidemiologically unrelated isolates with EcoRI and HindIII revealed 6 and 5 different patterns, respectively. Six ribotypes were identified by using these two enzymes. RAPD generated 6 distinct patterns, in complete agreement with ribotyping. Our genotypic results showed that 11 patients from wards S1, S2, and GE harbored genotypically related strains, suggesting nosocomial transmission and cross-colonization between and within the three wards. CONCLUSIONS: Ribotyping and RAPD appear to be reliable methods for distinguishing K pneumoniae strains. The spread of one strain of K pneumoniae in different units of our hospital was demonstrated by both methods. However, RAPD has the advantage of simplicity and rapidity conferred by polymerase chain reaction.
Assuntos
Infecção Hospitalar/microbiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/classificação , Técnica de Amplificação ao Acaso de DNA Polimórfico , Infecção Hospitalar/transmissão , Impressões Digitais de DNA , Resistência a Múltiplos Medicamentos , Feminino , Genótipo , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva , Infecções por Klebsiella/transmissão , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , MasculinoRESUMO
Restriction fragment length polymorphism analysis (RFLP) of total DNA and rDNA regions was used for the epidemiological evaluation of 10 Enterobacter cloacae nosocomial isolates obtained from nine patients in our hospital. Five of these patients were hospitalized during overlapping periods, thus raising the question of cross-contamination. A single biochemical pattern and antibiotic susceptibility profile was observed for all isolates but one. In contrast, based on the results of total DNA and rDNA RFLP patterns, the genetic unrelatedness of the isolates was clearly shown, thus excluding a common source of contamination or patient-to-patient transfer.
Assuntos
Infecção Hospitalar/microbiologia , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/microbiologia , Adulto , Bacteriemia/microbiologia , Feminino , França , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Polimorfismo de Fragmento de Restrição , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Especificidade da EspécieRESUMO
Chronic infection by Pseudomonas aeruginosa (PA) in patients with cystic fibrosis (CF) is preceded by a period of colonization and acute infection. Early aggressive antibiotic treatment of initial colonisation may prevent or at least delay chronic pulmonary infection. We initiated treatment with a combination of IV beta-lactam tobramycin, followed by nebulized colistin when PA was first isolated from patients with CF. Subsequent serial PA isolates obtained from these colonized CF patients were characterized by means of molecular methods to determine whether they were genetically related to the initial strain. Initial colonization was eradicated in all 19 patients. All patients reacquired PA within 3-25 months during the 3 years of follow-up. Fourteen patients acquired a new PA strain with a distinct genotypic profile, suggesting a new source of contamination. Five patients had two PA isolates with identical genotypes, suggesting either previous undetected respiratory tract colonization or a persistent environmental source of contamination.
Assuntos
Fibrose Cística/tratamento farmacológico , DNA Bacteriano/análise , Quimioterapia Combinada/administração & dosagem , Pneumonia Bacteriana/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/genética , Administração por Inalação , Administração Oral , Ceftazidima/administração & dosagem , Criança , Pré-Escolar , Doença Crônica , Colistina/administração & dosagem , Contagem de Colônia Microbiana , Fibrose Cística/microbiologia , Eletroforese em Gel de Campo Pulsado , Feminino , Genótipo , Humanos , Imipenem/administração & dosagem , Lactente , Masculino , Pneumonia Bacteriana/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/efeitos dos fármacos , Medição de Risco , Tobramicina/administração & dosagemRESUMO
We describe a case of candidaemia in a paediatric cystic fibrosis (CF) patient with a totally implantable vascular access (TIVA). Serial quantitative blood cultures during therapy with amphotericin B delivered via the catheter suggested that the patient was responding to therapy. The TIVA was finally removed because of persistent fever, but its culture remained sterile. Randomly amplified polymorphic DNA (RAPD) analysis of Candida albicans from various anatomical sites showed that the patient's sputum was the most likely source of TIVA contamination. Investigation of TIVA-related candidaemia by molecular analysis could guide rational antifungal chemoprophylaxis of TIVA-related candidaemia.
Assuntos
Candidíase/tratamento farmacológico , Cateteres de Demora/efeitos adversos , Fibrose Cística/complicações , Fungemia/tratamento farmacológico , Anfotericina B/uso terapêutico , Candidíase/diagnóstico , Criança , DNA Fúngico/análise , Feminino , Fungemia/diagnóstico , HumanosRESUMO
BACKGROUND: Careful epidemiological studies and sophisticated diagnostic procedures are necessary to prove that bacterial infection is nosocomial in origin. DNA finger printing method can be useful with this aim in view. CASE REPORTS: A 11 month-old girl suffered from a febrile pneumonia. She developed acute meningitis 15 days later; culture of CSF grew Streptococcus pneumoniae, serotype 23 F, resistant to beta-lactamines, erythromycin and cotrimoxazole. She died 24 hours later. Five days after this death, a 5 month-old infant hospitalized in the next bed developed an acute pulmonary infection due to the same strain with the same bacterial characteristics; this patient was cured with cefotaxime plus vancomycin and gentamicin. Randomly amplified polymorphic DNA analysis showed an identical profile of both strains. CONCLUSION: This is the first case of meningitis due to penicillin-resistant Streptococcus pneumoniae (PRSP) associated with nosocomial spread between two children in adjacent beds. This case suggests that it is necessary to isolate patients with PRSP infection during hospitalization.
Assuntos
Hospitais Pediátricos , Meningite Pneumocócica/transmissão , Técnica de Amplificação ao Acaso de DNA Polimórfico , Infecção Hospitalar , Feminino , Humanos , Lactente , Meningite Pneumocócica/genética , Testes de Sensibilidade Microbiana , Resistência às Penicilinas , SorotipagemRESUMO
OBJECTIVES: Passive smoking has been demonstrated in many situations. We designed an experimental protocol to measure passive smoking in the coaches of the French high-speed train (TGV) and to attempt to identify interindividual variability in sensitivity. METHODS: Ten healthy non-smokers (5 males, 5 females) volunteered to avoid exposure to tobacco smoke for the duration of the study. On three separate occasion they were subjected to a 5-hour trip in the smoking coaches of the French TGV (south-east line). Twelve-hour urine samples were collected before each trip and over the following 72 hours. Urinary cotinine was measured in each fraction. RESULTS: Significant levels of urinary cotinine were found for a prolonged period in these passive smokers. Elimination of the tobacco by-product was similar to the level observed in subjects smoking 2 to 5 cigarettes per day. The kinetics of cotinine elimination was reproducible from one trip to another for any given individual, however significant interindividual variability was observed despite normal liver function in all. CONCLUSION: Measurement of urinary cotinine is potentially useful in non-smokers who are involuntarily exposed to tobacco smoke and who wish to know the extent of their exposure.
Assuntos
Cotinina/urina , Ferrovias , Poluição por Fumaça de Tabaco , Adulto , Monóxido de Carbono/análise , Cotinina/metabolismo , Feminino , França , Humanos , Masculino , Testes de Função Respiratória , Fatores de TempoRESUMO
OBJECTIVE: Current guidelines recommend that only tonsillopharyngitis due to group A beta-haemolytic streptococcus (GABHS) diagnosed by rapid diagnostic test should be treated with antibiotics. Empirical antibiotic therapy must be based on epidemiological surveillance of resistance of GABHS to antibiotics. The aim of our study was to assess the activity of antimicrobial agents currently recommended for the treatment of GABHS tonsillopharyngitis. Method The activity of penicillin G, amoxicillin, cefaclor, cefpodoxime, cefuroxime, erythromycin, clarithromycin and clindamycin was determined against 93 consecutive GABHS isolates collected in 2002. MIC50 and MIC90 of antibiotics tested were determined by agar dilution method according to CA-SFM guidelines. Macrolide resistance genes (ermA, ermB, mef) were detected by PCR. Genetic diversity of erythromycin-resistant isolates was analysed by pulsotypic method after digestion by SmaI (Finger-printing II, Biorad). RESULTS: The activity of beta-lactam agents tested was similar and no resistant strain was detected (0%). Nevertheless, this study shows an increasing emergence of erythromycin-resistant GABHS strains reaching 14% in 2002 (vs. 6.2% in a previous study carried out in 1996-1999). CONCLUSION: The empirical antibiotic therapy of tonsillopharyngitis must consider, on the one hand, the high risk of GABHS eradication failure associated with in vitro resistance to erythromycin and clarithromycin, and on the other hand, the sustained susceptibility of GABHS to beta-lactam agents. These results reinforce the recommendations to use beta-lactam agents as first line treatment of GABHS tonsillopharyngitis.
Assuntos
Faringite/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes , Tonsilite/microbiologia , Doença Aguda , Tonsila Faríngea , Proteínas de Bactérias/genética , Contagem de Colônia Microbiana , Impressões Digitais de DNA , DNA Bacteriano/análise , DNA Bacteriano/genética , Farmacorresistência Bacteriana , Eletroforese em Gel de Campo Pulsado , Pesquisa Empírica , Variação Genética , Humanos , Proteínas de Membrana/genética , Metiltransferases/genética , Testes de Sensibilidade Microbiana , Paris/epidemiologia , Seleção de Pacientes , Faringite/tratamento farmacológico , Faringite/epidemiologia , Reação em Cadeia da Polimerase , Vigilância da População , Guias de Prática Clínica como Assunto , Prevalência , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/genética , Streptococcus pyogenes/fisiologia , Tonsilite/tratamento farmacológico , Tonsilite/epidemiologiaRESUMO
AIM: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The aim of this study was to evaluate subclinical atherosclerosis and to determine the prevalence of risk factors for CVD in SLE patients. METHODS: One hundred fifty-three patients (149 women and 4 men), aged (37±11.6) years with a definite diagnosis of SLE according to the revised criteria of the American College of Rheumatology (ACR), underwent physical examination, carotid and leg arteries B-mode ultrasound with a measure of ankle-brachial pressure index (ABPI); 94 patients had myocardial tomoscintigraphy. The laboratory check-up was: total cholesterol (TC), HDLc, LDLc, homocystein, glycemia, vascular cell adhesion molecules (VCAM-I). All patients had a normal renal function at the time of the study. RESULTS: The mean age is 37 years. Cardiovascular events were noticed in 15 patients (6 angina, 2 myocardial infarction and 7 strokes). Cardiovascular risk factors (CVRF) were: dyslipidemia (62.8%), moderate homocysteinemia (55%), BMI>25 (39%) and hypertension (35%) which is associated with a stroke (P<0.0006). The cumulative prednisone dose per patient was 45.5g. V.C.A.M-I level was high in 86.2 % of cases.95% of our patients had at least two CVRF. Myocardial perfusion stress scanning showed abnormalities in 21 patients (22.3%). Perfusion defects were linked with a stroke (P<0.01) and coronary events (P<0.02). Carotid atheroma was present in 32 patients (20.9%). Carotid plaques were associated with age (P<0.01), total cholesterol (TC)(P<0.05), and steroid dose (P<0.01). Intima-media-thickness was correlated with age (P<0.0003), TC (P<0.0007), LDLc (P<0.002), and homocysteine (P<0.03). 70% patients had a mediacalcinosis in femoral and popliteal arteries. The ABPI was correlated with V.C.A.M-I (P<0.0005). CONCLUSION: In Algeria, as elsewhere, young women with SLE have subclinical atherosclerosis which must be detected and they are at high risk of a vascular event.
Assuntos
Doenças Cardiovasculares/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Adulto , Fatores Etários , Argélia/epidemiologia , Aterosclerose/epidemiologia , Biomarcadores/sangue , Pressão Sanguínea , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Distribuição de Qui-Quadrado , Dislipidemias/epidemiologia , Feminino , Humanos , Hiper-Homocisteinemia/epidemiologia , Hipertensão/epidemiologia , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores SexuaisRESUMO
Cryptosporidium has emerged as an important cause of diarrheal illness worldwide, especially amongst young children and patients with infectious or iatrogenic immune deficiencies. The authors describe a case of mild cryptosporidiosis in a well-nourished, immunocompetent, one-year-old child. Rapid clinical and parasitological improvement was observed after a 3-day course of nitazoxanide.
RESUMO
BACKGROUND: We explored the addition of rituximab to high-dose cytarabine (ara-C), oxaliplatin (L-OHP), and dexamethasone [R-DHAOx], in resistant and relapsed patients with CD20-positive follicular non-Hodgkin's lymphoma. METHODS: Twenty-two patients were included; they were treated previously with one to five chemotherapy regimens, including 13 patients who had also received rituximab. R-DHAOx consisted of rituximab, 375mg/m(2), day 1; dexamethasone, 40mg/d, days one to four; L-OHP, 130mg/m(2), day 1; and ara-C, 2000mg/m(2) every 12 h, day 2. Courses were repeated every 21 days for eight courses. RESULTS: Twenty-one patients (95%) achieved a complete response and one had a partial response. Responses were obtained in patients with and without resistance to prior treatment, either alone or combined with rituximab. The median follow-up time was 58.3 months (range, 8.7-92.6 months). Progression-free survival reached a plateau at 84% at 38.2 months. Only two of the 21 complete responders have relapsed. Tumor molecular markers disappeared in all 10 complete responders whose markers were found before treatment. Peripheral neuropathy related to the cumulative dose of L-OHP, and myelosuppression were the most prominent toxic effects. CONCLUSIONS: R-DHAOx is highly active for salvage treatment of patients with follicular non-Hodgkin's lymphoma, and it produces long-term antitumor efficacy.
Assuntos
Anticorpos Monoclonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Linfoma Folicular/tratamento farmacológico , Adulto , Idoso , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Murinos , Biomarcadores Tumorais/metabolismo , Citarabina/administração & dosagem , Dexametasona/administração & dosagem , Intervalo Livre de Doença , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Compostos Organoplatínicos/administração & dosagem , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Rituximab , Resultado do TratamentoAssuntos
Alcaligenes/isolamento & purificação , Colesteatoma/complicações , Infecção Hospitalar/complicações , Infecções por Bactérias Gram-Negativas/complicações , Otite Média Supurativa/complicações , Alcaligenes/efeitos dos fármacos , Antibacterianos/uso terapêutico , Criança , Colesteatoma/diagnóstico , Colesteatoma/terapia , Doença Crônica , Terapia Combinada , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/terapia , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/terapia , Humanos , Otite Média Supurativa/diagnóstico , Otite Média Supurativa/terapiaRESUMO
Escherichia coli K1 is the most common cause of gram-negative neonatal bacterial meningitis and septicemia. In an attempt to identify genetic markers in E. coli K1 that are associated with the capacity of the organism to cause neonatal meningitis, we used rRNA gene restriction patterns. E. coli strains isolated from the CSF of neonates with meningitis (n = 43) on two continents were compared to strains isolated from the blood of neonates with bacteremia who did not have meningitis (n = 29) and to isolates from the vaginas of asymptomatic pregnant women whose neonates remained without infection (n = 39). E. coli strains from CSF are genetically less heterogeneous than isolates from blood and the vagina: 44.2% of the CSF isolates belonged to only two types, whereas no more than two blood vaginal strains were of the same type. After HindIII digestion, a 14.9-kb rDNA-containing fragment was found in 81.3% of the strains from CSF vs. 28.0% of the isolates from blood and only 12.8% of the vaginal isolates (P = .001). Thus, genotyping might provide markers to identify organisms in the maternal vaginal flora that are highly likely to cause neonatal meningitis. This observation may have very practical implications for the early identification of these organisms in pregnant women and thus for the selective establishment of preventive measures per partum or for the early treatment of colonized neonates.
Assuntos
Infecções por Escherichia coli/microbiologia , Escherichia coli/genética , Meningites Bacterianas/microbiologia , Antígenos de Bactérias/sangue , Antígenos de Bactérias/líquido cefalorraquidiano , Técnicas de Tipagem Bacteriana , DNA Bacteriano/genética , DNA Ribossômico/genética , Escherichia coli/classificação , Escherichia coli/imunologia , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/sangue , Infecções por Escherichia coli/líquido cefalorraquidiano , Feminino , Genótipo , Humanos , Recém-Nascido , Gravidez , Vagina/microbiologiaRESUMO
We describe one case of late-onset neonatal Escherichia coli meningitis associated with urinary tract infection. Two genotypic methods revealed that the E. coli isolates obtained from blood, feces, and cerebrospinal fluid shared the same pattern, which was different from the unique pattern obtained for the isolates recovered from the urine and the tracheal aspirate. Our study supports passage of bacteria through the gastrointestinal mucosa to the bloodstream as the initial event, with subsequent meningeal localization.