RESUMEN
The diagnosis of strongyloidiasis relies upon the identification of the parasite in stool samples. In 1981, a serologic assay was developed, which was useful in the diagnosis of strongyloidiasis in the immunocompetent host. In the present study, we evaluated the enzyme-linked immunosorbent assay (ELISA) in patients with hematologic malignancies. Between April 1995 and December 1998, sera from 164 consecutive patients were tested for the presence of IgG antibody to Strongyloides stercoralis. Patient was considered uninfected after at least three negative stool examinations. The prevalence of strongyloidiasis was 13%. The underlying diseases were acute leukemia in 21% and lymphoma in 52% of the patients. The majority of the patients were receiving chemotherapy (93%) and steroids (76%). The sensitivity, specificity, and positive and negative predictive values were 68%, 89%, 48%, and 95%, respectively. The ELISA may be an excellent assay to rule out the diagnosis of strongyloidiasis in patients with hematologic malignancies.
Asunto(s)
Neoplasias Hematológicas/complicaciones , Huésped Inmunocomprometido , Inmunoglobulina G/sangre , Strongyloides stercoralis/inmunología , Estrongiloidiasis/diagnóstico , Adulto , Animales , Anticuerpos Antihelmínticos/sangre , Antígenos Helmínticos/inmunología , Ensayo de Inmunoadsorción Enzimática/métodos , Heces/parasitología , Femenino , Neoplasias Hematológicas/inmunología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Sensibilidad y Especificidad , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/epidemiología , Estrongiloidiasis/etiología , Estrongiloidiasis/inmunologíaRESUMEN
A total of 21 patients with hematologic malignancies were given thiabendazole for treatment of strongyloidiasis. Fifteen patients were cured. Since there were no relapses, it is unlikely that maintenance therapy has a role in the management of strongyloidiasis in this population of patients.
Asunto(s)
Antinematodos/uso terapéutico , Neoplasias Hematológicas/complicaciones , Estrongiloidiasis/tratamiento farmacológico , Tiabendazol/uso terapéutico , Adolescente , Adulto , Anciano , Antinematodos/efectos adversos , Niño , Mareo/inducido químicamente , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Estrongiloidiasis/complicaciones , Tiabendazol/efectos adversos , Resultado del TratamientoRESUMEN
A prospective randomized trial was performed to compare teicoplanin to vancomycin as part of the empirical antibiotic therapy of febrile neutropenic cancer patients. Fifty-three patients were randomized to receive ceftazidime (100 mg/kg daily every 8 h), amikacin (15 mg/kg daily every 8 h) and teicoplanin (6 mg/kg once a day) and 53 other patients received ceftazidime, amikacin (same dosages) and vancomycin (30 mg/kg/day every 6 h). In 99 evaluable episodes, the success rates were 54% for patients receiving teicoplanin and 52% for patients receiving vancomycin (p=0.76, 95% CI-18-23). The response rates were similar for patients with unexplained fever and for patients with documented infections. There were no differences in renal toxicity or cutaneous side effects between the two groups. The overall death rate was 18.9%, with 10 deaths in each group. The most important factor associated with death was the diagnosis of a fungal infection (p=0.001). Teicoplanin seems to be well tolerated and as effective as vancomycin in the empirical antibiotic therapy of fever in neutropenic cancer patients.
Asunto(s)
Amicacina/uso terapéutico , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Ceftazidima/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Fiebre , Leucemia/complicaciones , Linfoma/complicaciones , Neutropenia , Teicoplanina/uso terapéutico , Vancomicina/uso terapéutico , Adolescente , Adulto , Anciano , Infecciones Bacterianas/complicaciones , Trasplante de Médula Ósea , Niño , Femenino , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Leucemia/terapia , Linfoma/terapia , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
The action of a kinin-potentiating peptide (KPP) obtained from tryptic digestion of human serum proteins was compared with that of bradykinin-potentiating peptide 9a (BPP9a; obtained from snake venom) and enalaprilat (a synthetic inhibitor of angiotensin-converting enzyme; ACE) as a means of understanding the mechanism of action of KPP on smooth muscle. KPP potentiated bradykinin-induced contractile effects in guinea-pig ileum and rat uterus, but not the bradykinin-induced relaxation of pre-contracted ileum, whereas BPP9a and enalaprilat potentiated both bradykinin effects. The receptor mediating both the contraction and the relaxation elicited by bradykinin in the ileum was found to be of the B2 type. KPP retained its potentiating effect in the presence of enalaprilat in the guinea-pig ileum and rat uterus, whereas the potentiation evoked by BPP9a was abolished. Enalaprilat inhibited the activity of purified ACE, whereas KPP was completely devoid of such an effect. The potentiating effect of KPP, but not that of BPP9a or enalaprilat, was blocked by compounds that inhibit phospholipase A2 and lipoxygenase activity but not by inhibitors of cyclo-oxygenase or phosphodiesterases. The results suggest that the potentiating effect of KPP (i) does not involve inhibition of ACE; (ii) is not due to an increased affinity of the receptor for bradykinin, and (iii) probably involves post-receptor events linked to phospholipase A2 and to the lipoxygenase pathway.