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1.
Mycoses ; 54(4): e168-74, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21672037

RESUMEN

Coincident with an increased use of cardiac rhythm management devices (CRMD) has been an increase in the number of pacemaker and cardioverter-defibrillator infections. CRMD endocarditis accounts for about 10% of all device-related infections, and cardiac infection caused by Candida sp. is a rare event. To date, only sporadic reports of this unusual and life-threatening event have been reported. By describing a case of CRMD-related Candida endocarditis and conducting a literature review, we provide a detailed characterisation of this unusual clinical entity with an emphasis on diagnosis, management and treatment. A case of CRMD-related Candida endocarditis is presented and a computer search for confirmed cases of CRMD-Candida endocarditis was conducted. Current recommendations for management and treatment were documented. From 1969 to 2009, 15 patients with CRMD-Candida endocarditis (12 pacemaker and three implanted cardioverter-defibrillator) were documented. All were males, non-albicans Candida sp. were frequently recovered, a major fungal embolus occurred in 27% of patients and two of 10 patients who received defined antifungal therapy and device explantation expired. CRMD Candida endocarditis is a rare and serious clinical event; isolates can include Candida albicans and other Candida sp., and treatment involves both targeted antifungal therapy and device removal.


Asunto(s)
Candida/aislamiento & purificación , Candidiasis/diagnóstico , Endocarditis/diagnóstico , Endocarditis/microbiología , Marcapaso Artificial/microbiología , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/administración & dosificación , Candida/clasificación , Candidiasis/tratamiento farmacológico , Candidiasis/microbiología , Endocarditis/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Análisis de Supervivencia , Resultado del Tratamiento
2.
Chemotherapy ; 56(5): 411-6, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20948212

RESUMEN

BACKGROUND: Increasingly frequent reports of vancomycin treatment failures for serious methicillin-resistant Staphylococcus aureus (MRSA) infections provide impetus for comparative in vitro studies to assess the activity of newer antimicrobial agents against a range of MRSA isolates. METHODS: A sample of 168 MRSA derived from a long-term MRSA collection was subjected to susceptibility testing to telavancin, daptomycin, linezolid, tigecycline and vancomycin by broth micro-dilution. Data were reviewed for sporadic occurrence of isolates with reduced susceptibility. Analyses were performed to test for temporal trends toward decreasing susceptibility and to compare susceptibility of isolates from different infection sites. RESULTS: No MRSA isolate from any time period was resistant to test antibiotics. For daptomycin, linezolid and tigecycline, there were no susceptibility differences between the pre- and postclinical availability periods. All newer agents were active against MRSA isolates with minimum inhibitory concentrations (MICs) of vancomycin >1 mg/l, but there were significant correlations in susceptibility among several pairs of antibiotics. CONCLUSIONS: Telavancin and other newer antistaphylococcal agents were fully active against MRSA from various infection sites including isolates with vancomycin MIC >1 mg/l.


Asunto(s)
Aminoglicósidos/farmacología , Antiinfecciosos/farmacología , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Acetamidas/farmacología , Daptomicina/farmacología , Linezolid , Lipoglucopéptidos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Minociclina/análogos & derivados , Minociclina/farmacología , Oxazolidinonas/farmacología , Tigeciclina , Vancomicina/farmacología
3.
Chest ; 135(4): 1019-1023, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19017881

RESUMEN

BACKGROUND: In the United States, cases of human blastomycosis are largely described in defined geographic areas, with Mississippi reporting the highest prevalence of disease in the southeast region. The infection is uncommonly recognized in mountainous areas, and our previous report of blastomycosis in the southern Appalachian mountains of northeast Tennessee appeared to be an exception to the usual disease distribution. METHODS: Our current retrospective study was undertaken to determine whether blastomycosis has persisted as an endemic fungal infection in our northeast Tennessee geographic area and whether epidemiologic features have changed over a 25-year time period. RESULTS: Results show that clinical aspects of the disease have remained fairly constant with few exceptions; mass-type pulmonary lesions have become more common, and itraconazole has emerged as the therapy of choice. Most notably, however, are the observations that blastomycosis persists as a major endemic fungal infection in our mountain region, more than half of all cases occurring during the period from 1996 to 2005 were found in a core area centered on two counties, Washington and Unicoi; three of five counties surrounding the core counties experienced rate increases compared to our previous study. CONCLUSIONS: These findings suggest a further expansion of this endemic fungal disease beyond the core region.


Asunto(s)
Blastomicosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Enfermedades Endémicas , Femenino , Humanos , Itraconazol/uso terapéutico , Enfermedades Pulmonares Fúngicas/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tennessee/epidemiología
5.
Tenn Med ; 100(12): 44-6, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18183856

RESUMEN

Opportunistic infections are well documented in states of steroid excess. To our knowledge, histoplasmosis has not been previously reported in Cushing's disease, and has rarely been reported in patients with exogenous glucocorticoid use. We report a novel presentation of Histoplasmosis as pulmonary nodules in a patient with Cushing's disease. A 45-year-old man with a pituitary macroadenoma and Cushing's disease was treated with transsphenoidal hypophysectomy and radiation therapy. He was receiving Ketoconazole and basal steroid replacement, when he presented with dyspnea. Chest radiograph showed nodular lesions and subsequent biopsy revealed Histoplasma capsulatum. Itraconazole was administered and the patient recovered. The case not only demonstrates the protean manifestations of Histoplasmosis in patients with glucocorticoid excess but it also emphasizes the importance of intensive control of the hypercortisolemia in achieving a favorable outcome.


Asunto(s)
Adenoma/complicaciones , Histoplasmosis/etiología , Enfermedades Pulmonares/etiología , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/complicaciones , Neoplasias Hipofisarias/complicaciones , Adenoma/patología , Aminoglutetimida/uso terapéutico , Dexametasona/uso terapéutico , Humanos , Itraconazol/uso terapéutico , Cetoconazol/uso terapéutico , Masculino , Persona de Mediana Edad , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/tratamiento farmacológico , Neoplasias Hipofisarias/patología
6.
South Med J ; 98(11): 1139-41, 2005 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-16351037

RESUMEN

Rupture of a coccidioidal pulmonary cavity with subsequent pyopneumothorax is a rare clinical event, even in areas endemic for coccidioidomycosis. Our encounter with a patient diagnosed with this condition in northeast Tennessee serves notice to clinicians that coccidioidomycosis is indeed a traveling fungal disease, and practitioners must be alert to common and uncommon manifestations of infection associated with this fungus. A literature review pertaining to coccidioidal pyopneumothorax revealed that patients usually present with a recent onset of chest pain. Serologic testing and pleural fluid culture are highly useful, and management includes surgical intervention with or without antifungal therapy.


Asunto(s)
Coccidioidomicosis/diagnóstico , Empiema Pleural/diagnóstico , Enfermedades Pulmonares Fúngicas/diagnóstico , Neumotórax/diagnóstico , Anciano , Coccidioidomicosis/epidemiología , Empiema Pleural/microbiología , Humanos , Hidroneumotórax/diagnóstico , Hidroneumotórax/epidemiología , Hidroneumotórax/microbiología , Enfermedades Pulmonares Fúngicas/epidemiología , Masculino , Neumotórax/epidemiología , Neumotórax/microbiología , Sudoeste de Estados Unidos/epidemiología , Tennessee/epidemiología , Viaje
8.
J Infect ; 50(4): 338-43, 2005 May.
Artículo en Inglés | MEDLINE | ID: mdl-15845432

RESUMEN

Corynebacterium striatum (CS) is an underappreciated human pathogen that has been associated with serious infections in both immunocompetent and immunocompromised hosts. CS infections tend to be more frequent in males and major infection sites have included blood stream, lung, and central nervous system. Most are nosocomially acquired and there is a significant association with medical devices ranging from intravascular catheters to central nervous system drainage devices. Empiric therapy with vancomycin is advisable as susceptibility to other agents is variable. Treatment may also include removal of foreign material such as an intravascular catheter. The present review describes the wide spectrum of infections associated with CS and we add a unique case of CS pancreatic abscess where treatment included linezolid.


Asunto(s)
Corynebacterium/patogenicidad , Infección Hospitalaria/microbiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Corynebacterium/efectos de los fármacos , Corynebacterium/aislamiento & purificación , Infecciones por Corynebacterium/tratamiento farmacológico , Infecciones por Corynebacterium/etiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad
9.
J Clin Microbiol ; 42(6): 2792-5, 2004 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15184473

RESUMEN

Susceptibility to mupirocin was assessed in methicillin-resistant Staphylococcus aureus isolates selected from eras corresponding to differences in usage rate and prescription policies at a Veterans Affairs medical center. The eras studied encompassed from the time of introduction of the drug to its widespread use, through recommended judicious use, and finally to subsequent stringent administrative control. Prescriptions declined from 3.0 to 0.1 per 1,000 patient days. Precipitous declines first in the numbers of isolates with high-level resistance (from 31% to 4%) and then in those with low-level resistance (from 26% to 10%) accompanied prescription control.


Asunto(s)
Resistencia a la Meticilina , Mupirocina/farmacología , Staphylococcus aureus/efectos de los fármacos , Proteínas Bacterianas/genética , Prescripciones de Medicamentos , Farmacorresistencia Bacteriana Múltiple , Humanos , Proteínas Nucleares/genética , Reacción en Cadena de la Polimerasa
13.
South Med J ; 96(9): 888-90, 2003 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-14513986

RESUMEN

More than 150 years ago, Thomas Addison first described the clinical features and pathogenesis of adrenal insufficiency. At that time, tuberculosis was the most common cause of this disease. The pathway to diagnosis and treatment of Addison's disease has been well described. However, determining the cause of the disorder remains a challenge. It is important to consider recently described infectious agents in the pathogenesis of Addison's disease. Mycobacterial, bacterial, viral, and fungal infections may lead to the development of adrenal insufficiency. Skin, pulmonary, and imaging findings can aid the clinician in making a prompt diagnosis of specific infections, which is crucial because early identification of infectious causes of Addison's disease may enable recovery of adrenal function. This review describes the clinical presentations of the multiple infectious causes of adrenal insufficiency.


Asunto(s)
Insuficiencia Suprarrenal/etiología , Insuficiencia Suprarrenal/microbiología , Enfermedades Transmisibles/complicaciones , Enfermedades Transmisibles/microbiología , Insuficiencia Suprarrenal/virología , Enfermedades Transmisibles/virología , Humanos
14.
Infect Control Hosp Epidemiol ; 24(5): 342-6, 2003 May.
Artículo en Inglés | MEDLINE | ID: mdl-12785407

RESUMEN

OBJECTIVE: To determine the efficacy of mupirocin ointment in reducing nasal colonization with mupirocin-susceptible, methicillin-resistant Staphylococcus aureus (MS MRSA) as well as mupirocin-resistant MRSA (MR MRSA). DESIGN: Prospective evaluation in which patients colonized with MRSA were treated twice daily with 2% topical mupirocin ointment for 5 days. SETTING: James H. Quillen Veterans' Affairs Medical Center. PATIENTS: Forty hospitalized patients with two anterior nares cultures positive for MRSA within a 7-day period. METHODS: Treated patients had post-treatment cultures at day 3 and weeks 1, 2, and 4. Isolates underwent mupirocin-susceptibility testing and DNA typing. MRSA clearance and type turnover were assessed for isolates that were mupirocin-susceptible, low-level (LL) MR MRSA and high-level (HL) MR MRSA. RESULTS: Post-treatment nares cultures on day 3 were negative for 78.5%, 80%, and 27.7% of patients with MS MRSA, LL-MR MRSA, and HLMR MRSA, respectively. Sustained culture negativity at 1 to 4 weeks was more common in the MS MRSA group (91%) than in the LL-MR MRSA group (25%) or the HL-MR MRSA group (25%). Positive post-treatment cultures usually showed the same DNA pattern relative to baseline. Plasmid curing of 18 HL-MR MRSA resulted in 15 MS MRSA and 3 LL-MR MRSA. CONCLUSIONS: Mupirocin was effective in eradicating MS MRSA, but strains of MR MRSA often persisted after treatment. This appeared to reflect treatment failure rather than exogenous recolonization. MR MRSA is now more prevalent and it is appropriate to sample MRSA populations for mupirocin susceptibility prior to incorporating mupirocin into infection control programs.


Asunto(s)
Antibacterianos/administración & dosificación , Resistencia a la Meticilina , Mupirocina/administración & dosificación , Cavidad Nasal/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/efectos de los fármacos , Administración Tópica , Antibacterianos/farmacología , Resistencia a Medicamentos , Hospitales de Veteranos , Humanos , Pruebas de Sensibilidad Microbiana , Mupirocina/farmacología , Tennessee
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