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1.
Mo Med ; 117(2): 89-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32308221

RESUMO

BACKGROUND: There is lack of specific data on imported infections in the mid-west United States (U.S.). METHODS: Retrospective data on demographic and geographic data of imported infections seen by the infectious diseases clinics and consultation service from 2001-2018 was collected. RESULTS: Of the 64 infections, tuberculosis(TB) was most common [20(31.3%); pulmonary(11,55%), lymphadenopathy(8,40%), gastrointestinal(4,20%), disseminated(2,10%), and 1(5%) each of genitourinary and vertebral spine infection, 4 Human immune-deficiency virus infection and 1 echinococcosis)] followed by malaria(11,17.2%). Other infections: Cysticercosis [7,10.9%], giardiasis (4,6.3%), 3 each (4.7%) Human T-lymphotrophic Virus infection and schistosomiasis, 2 each (3.1%) leprosy, strongyloidiasis, and typhoid fever, one each (1.6%) of ascariasis, brucellosis, Chagas disease, Chikungunya virus, hepatitis A virus, echinococcosis, Japanese encephalitis virus, loiasis, paratyphoid fever, Q fever, and unspecified parasitosis. Geographic origins: Africa(26,40.6%), Asia(16,25%), Central America(11,17.2%), Europe(2,3.1%), Oceania(2,3.1%), South America(2,3.1%), and Unknown(5). More cases were seen after 2015. CONCLUSIONS: With increasing tourism, it is important to educate rural mid-west healthcare professionals on travel medicine. The current COVID-19 pandemic illustrates the importance of this type of education and data accumulation now and in the future.


Assuntos
Doenças Transmissíveis Importadas/epidemiologia , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Meio-Oeste dos Estados Unidos/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Vigilância da População , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Centros de Atenção Terciária , Viagem , Febre Tifoide , Estados Unidos
2.
Transpl Infect Dis ; 19(2)2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28036138

RESUMO

Ehrlichiosis in lung transplant (LT) recipients is associated with severe outcomes. Ehrlichia ewingii is a less frequent cause of symptomatic ehrlichiosis, characterized by cytoplasmic inclusions (morulae) within circulating neutrophils. We report a case of E. ewingii infection in an LT recipient diagnosed promptly by blood smear exam and confirmed with molecular studies.


Assuntos
Antibacterianos/uso terapêutico , Ehrlichia/isolamento & purificação , Ehrlichiose/diagnóstico , Febre/diagnóstico , Rejeição de Enxerto/tratamento farmacológico , Terapia de Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Transplante de Pulmão/efeitos adversos , Neutrófilos/microbiologia , Idoso , Animais , Citodiagnóstico/métodos , DNA Bacteriano/isolamento & purificação , Transmissão de Doença Infecciosa , Doxiciclina/uso terapêutico , Diagnóstico Precoce , Ehrlichiose/sangue , Ehrlichiose/tratamento farmacológico , Ehrlichiose/microbiologia , Feminino , Febre/sangue , Febre/tratamento farmacológico , Febre/microbiologia , Humanos , Terapia de Imunossupressão/métodos , Imunossupressores/uso terapêutico , Ixodidae/microbiologia , Leucopenia/sangue , Ácido Micofenólico/efeitos adversos , Ácido Micofenólico/uso terapêutico , Reação em Cadeia da Polimerase , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Tacrolimo/efeitos adversos , Tacrolimo/uso terapêutico , Toracentese , Trombocitopenia/sangue , Tomografia Computadorizada por Raios X
4.
Int J Nephrol Renovasc Dis ; 11: 173-186, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29928142

RESUMO

Peritoneal dialysis is an effective treatment modality for patients with end-stage renal disease. The relative use of peritoneal dialysis versus hemodialysis varies widely by country. Data from a 2004 survey reports the percentage of patients with end-stage renal disease treated with peritoneal dialysis to be 5%-10% in economically developed regions like the US and Western Europe to as much as 75% in Mexico. This disparity is probably related to the availability and access to hemodialysis, or in some cases patient preference for peritoneal over hemodialysis. Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis. Fifty years ago, with the advent of the Tenckhoff catheter, patients averaged six episodes of peritonitis per year on peritoneal dialysis. In 2016, the International Society for Peritoneal Dialysis proposed a benchmark of 0.5 episodes of peritonitis per year or one episode every 2 years. Despite the marked reduction in peritonitis over time, peritonitis for the individual patient is problematic. The mortality for an episode of peritonitis is 5% and is a cofactor for mortality in another 16% of affected patients. Prevention of peritonitis and prompt and appropriate management of peritonitis is essential for the long-term success of peritoneal dialysis in all patients. In this review, challenges and solutions are addressed regarding the pathogenesis, clinical features, diagnosis, treatment, and prevention of peritoneal dialysis-related peritonitis from the viewpoint of an infectious disease physician.

5.
BMJ Case Rep ; 20182018 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-29804087

RESUMO

We present a 23-year-old female patient with a chief complaint of progressively worsening dyspnoea of 2 days duration. Her medical history was significant for end stage renal disease secondary to membranoproliferative glomerulonephritis. A peritoneal dialysis (PD) catheter was placed 8 weeks prior to admission. She did not miss any of the PD sessions prior to this admission. Vital signs were significant for hypoxemia. Physical examination was remarkable for right-sided basilar crackles with no other signs of fluid overload. A chest X-ray demonstrated the presence of a large right-sided pleural effusion. Right-sided thoracentesis was performed, with subsequent pleural fluid analysis concerning for a pleuroperitoneal leak. CT peritoneography performed confirming the diagnosis as contrast material leaked through the inferior vena cava (IVC) diaphragmatic foramen into the right pleural space. Surgical intervention was deferred in light of the close proximity of the defect to the IVC. The patient was transitioned to haemodialysis for temporary cessation of PD.


Assuntos
Hidrotórax/etiologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Derrame Pleural/etiologia , Feminino , Humanos , Derrame Pleural/diagnóstico por imagem , Adulto Jovem
6.
IDCases ; 10: 105-107, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29085780

RESUMO

BACKGROUND: In endemic regions, histoplasmosis is often seen in hosts with defective cell mediated immunity. We report a case of disseminated histoplasmosis in a patient with common variable immunodeficiency (CVID), a disorder mainly characterized by B cell defects. CASE: A 35 year old male with CVID developed fever, headache, dyspnea and pancytopenia within few weeks of swimming in the Tennessee River. After a non-revealing initial evaluation he was transferred to a tertiary facility for fever of unknown origin, where massive splenomegaly was noted. Clinical course was complicated by hypoxia from extensive bilateral lung infiltrates requiring non-invasive ventilation. Urine and serum Histoplasma antigens were positive. He was treated with liposomal amphotericin B followed by itraconazole after clinical improvement within 48 h and discharged home by day 6. Fungal blood cultures sent on day 1 grew Histoplasma capsulatum on day 19. After 5 months splenomegaly completely resolved and he successfully completed one year of treatment with itraconazole. CONCLUSIONS: Our case highlights the significance of T cell defects in CVID. More research focusing on T cell defects in CVID is required to understand the extent of vulnerability to such intracellular pathogens in CVID.

7.
IDCases ; 10: 123-126, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29159070

RESUMO

Primary Cytomegalovirus (CMV) infection is often not suspected as a cause of fever of unknown origin (FUO) in immune-competent adults. We present a case-series of symptomatic primary CMV infection in immunocompetent adults presenting as fever of unknown origin (FUO). All patients with CMV serology tested between November 2008 and June 2016 underwent chart review. Cases were defined as those between 18 and 65 years of age with documented fever and elevated serum anti-CMV IgM. Exclusion criteria were organ specific CMV disease, positive serum anti-EBV IgM, or presence of any immunocompromising condition. Sixteen patients (69% male, mean age 42.2 ± 11.7 years) met criteria. Mean duration of illness was 4.6 ± 3.3 weeks. Common symptoms other than fever included fatigue (94%), night sweats (81%), malaise (75%), myalgias (63%), and headache (56%). Eleven patients (68.8%) had contact with young children; six (35.3%) patients had children in daycare. Twelve (75%) patients had extensive testing and multiple visits or hospitalizations prior to consulting with an infectious disease specialist. Peripheral smear was done in twelve (75%) patients and all had atypical lymphocytes. Five patients (31.3%) had a leukocytosis. Peak serum transaminases were: AST 115.25 ± 50.5 IU/L and ALT 168.38 ± 92.0 IU/L. One patient had splenic infarcts. In addition, two cases of hydrops fetalis were attributed to primary CMV infection. In summary, primary CMV infection can present as FUO in immunocompetent adults. Contact with young children in daycare may be a risk factor. Heightened clinical suspicion will promote earlier diagnosis and avoid unnecessary testing.

8.
Am J Trop Med Hyg ; 94(6): 1376-9, 2016 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-27001756

RESUMO

Human rabies is a fatal disease, transmitted by saliva of infected animals, and the diagnosis requires a high index of suspicion. Very few cases are reported annually in the United States. We present a case of human rabies without a clear exposure history that masqueraded as serotonin syndrome.


Assuntos
Vírus da Raiva/classificação , Raiva/virologia , Síndrome da Serotonina/etiologia , Animais , Diagnóstico Diferencial , Evolução Fatal , Genoma Viral , Humanos , Masculino , Pessoa de Meia-Idade , Raiva/patologia , Vírus da Raiva/genética , Síndrome da Serotonina/patologia
9.
Clin Infect Dis ; 41(8): 1159-66, 2005 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-16163635

RESUMO

Continuous renal replacement therapy (CRRT) is now commonly used as a means of support for critically ill patients with renal failure. No recent comprehensive guidelines exist that provide antibiotic dosing recommendations for adult patients receiving CRRT. Doses used in intermittent hemodialysis cannot be directly applied to these patients, and antibiotic pharmacokinetics are different than those in patients with normal renal function. We reviewed the literature for studies involving the following antibiotics frequently used to treat critically ill adult patients receiving CRRT: vancomycin, linezolid, daptomycin, meropenem, imipenem-cilastatin, nafcillin, ampicillin-sulbactam, piperacillin-tazobactam, ticarcillin-clavulanic acid, cefazolin, cefotaxime, ceftriaxone, ceftazidime, cefepime, aztreonam, ciprofloxacin, levofloxacin, moxifloxacin, clindamycin, colistin, amikacin, gentamicin, tobramycin, fluconazole, itraconazole, voriconazole, amphotericin B (deoxycholate and lipid formulations), and acyclovir. We used these data, as well as clinical experience, to make recommendations for antibiotic dosing in critically ill patients receiving CRRT.


Assuntos
Antibacterianos/administração & dosagem , Antifúngicos/administração & dosagem , Estado Terminal/terapia , Insuficiência Renal/terapia , Terapia de Substituição Renal , Humanos
10.
Perit Dial Int ; 25(4): 313-9, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16022084

RESUMO

The incidence of resistant gram-positive bacteria in nosocomial and, more recently, community-acquired infections is increasing. Staphylococci, because of their natural habitat on the skin, have always been the leading cause of peritonitis in patients receiving peritoneal dialysis (PD). These organisms have demonstrated a remarkable ability to develop resistance to antibiotics, first with penicillin, then antistaphylococcal penicillins (methicillin-resistant Staphylococcus aureus), and more recently, strains expressing resistance to vancomycin (vancomycin-intermediate and vancomycin-resistant S. aureus) have emerged. Enterococci are normal inhabitants of the gastrointestinal tract and occasionally cause PD peritonitis. In the past 15 years, vancomycin-resistant enterococci have emerged as significant pathogens in many areas. In the past 5 years, novel antibiotics that have activity on gram-positive bacteria, including vancomycin-resistant strains, have become available. The problem of resistant gram-positive bacteria in PD peritonitis, their therapy, and the role of these newer agents, quinupristin/dalfopristin, linezolid, and daptomycin, are reviewed.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Bactérias Gram-Positivas , Infecções por Bactérias Gram-Positivas/microbiologia , Diálise Peritoneal/efeitos adversos , Peritonite/microbiologia , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Peritonite/tratamento farmacológico , Resultado do Tratamento
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