RESUMEN
An 88-year-old man with mutilating mucosal leishmaniasis (ML) involving septal perforation, with granulomas in the pharynx and larynx, was treated with oral miltefosine, 50 mg three times/day for 28 days. Miltefosine, an antineoplastic agent, is considered an alternative option for the treatment of ML, showing efficacies of 75-92% in Bolivia, Brazil, and Argentina. The patient denied having previous cutaneous (CL) leishmaniasis, and no CL lesions were recognized by physical examination. Parasites obtained from mucosal lesions were identified by cytochrome b gene sequencing as Leishmania guyanensis. Clinical cure was observed 2 months posttreatment, and no evidence of reactivation was observed in the 3-year follow-up. Adverse effects such as nausea, loss of appetite, and epigastric pain were experienced during treatment with miltefosine. There is a need for improved access to miltefosine in leishmaniasis-endemic areas of Latin America and a greater awareness of ML and its treatment among physicians working in endemic countries.
Asunto(s)
Antiprotozoarios/uso terapéutico , Leishmaniasis Mucocutánea/tratamiento farmacológico , Enfermedades Nasales/tratamiento farmacológico , Enfermedades Faríngeas/tratamiento farmacológico , Fosforilcolina/análogos & derivados , Anciano de 80 o más Años , Citocromos b/genética , Disfonía/etiología , Humanos , Leishmania guyanensis/genética , Leishmania guyanensis/aislamiento & purificación , Masculino , Perforación del Tabique Nasal/etiología , Enfermedades Nasales/complicaciones , Enfermedades Nasales/patología , Enfermedades Faríngeas/complicaciones , Enfermedades Faríngeas/patología , Fosforilcolina/uso terapéutico , Índice de Severidad de la EnfermedadRESUMEN
RESUMEN Introducción: Los abscesos profundos de cuello son colecciones de pus alojadas en los espacios profundos cervicales. En la población pediátrica son poco frecuentes, sin embargo, pueden presentar complicaciones potencialmente mortales. Objetivo: Caracterizar a los pacientes que consultan por abscesos profundos del cuello en el Servicio de Urgencia Pediátrico del Hospital Dr. Sótero del Rio. Material y método: Estudio de tipo descriptivo retrospectivo con datos obtenidos de fichas clínicas de pacientes. Se realizó una revisión de fichas clínicas de los pacientes diagnosticados con abscesos profundos de cuello en el Servicio de Urgencia Pediátrica del Hospital Sótero del Río entre los años 2011 y 2018. Se analizaron variables clínicas (anamnesis, examen físico, exámenes de laboratorio generales y específicos y su manejo) y demográficas. Los resultados se analizaron mediante estadística descriptiva con medidas de tendencia central y rango, utilizando Statistical Package for the Social Science (SPSS). Resultados: Se incluyeron 41 pacientes entre 0 y 15 años, con un promedio de edad de 7,2 años. Sesenta y tres por ciento de los pacientes fueron de sexo masculino. Se presentaron 23 (56%) pacientes con abscesos periamigdalinos (PA), 12 (29,2%) con abscesos retrofaríngeos (RF), 5 (12,1%) con abscesos parafaríngeos (PF) y 1 (2,4%) con absceso de tipo mixto (RF- PF). El 60% de los pacientes recibió algún tratamiento médico previo. Se realizó estudio imagenológico en 83% de los pacientes. Todos los pacientes presentaron parámetros inflamatorios elevados. En el 80% de los pacientes se realizó tratamiento médico y algún tipo de drenaje. Conclusiones: Los abscesos profundos del cuello son una entidad relativamente poco frecuente en pediatría, pero potencialmente peligrosa si no se detecta a tiempo, por lo que debemos tener un alto índice de sospecha para evitar las complicaciones.
ABSTRACT Introduction: Deep neck abscesses are pus collections lodged in the deep cervical spaces. They are rare in the pediatric population, however, they can present life-threatening complications. Objective: To characterize the patients who consult for deep neck abscesses in the pediatric emergency department of Dr. Sótero del Rio Hospital. Material and method: Descriptive retrospective study. A review of clinical records of patients diagnosed with deep neck abscesses in the pediatric emergency department of Dr. Sótero del Rio Hospital between 2011 and 2018 was made. The clinical (anamnesis, physical exam, general and specific laboratory exams and management) and demographic characteristics were evaluated. The results were analyzed by descriptive statistics with measures of central tendency and range, using Statistical Package for the Social Science (SPSS). Results: Forty-one patients between 0 and 15 years of age were included, with an average age of 7.2 years. 63% of the patients were male. There were 23 (56%) patients with peritonsillar abscesses (PA), 12 (29.2%) with retropharyngeal abscesses (RF), 5 (12.1%) with parapharyngeal abscesses (PF) and 1 (2.4%) with abscess of mixed type (RF-PF). 60% of the patients received some previous medical treatment. An imaging study was performed in 83% of the patients. All the patients presented high inflammatory parameters. In 80% of patients, medical treatment and some type of drainage were performed. Conclusions: Deep abscesses of the neck are a relatively rare entity in pediatrics, but potentially dangerous if not detected in time, so we must have a high index of suspicion to avoid complications.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Absceso/cirugía , Absceso/tratamiento farmacológico , Cuello , Enfermedades Faríngeas/cirugía , Enfermedades Faríngeas/tratamiento farmacológico , Chile , Drenaje , Epidemiología Descriptiva , Absceso Retrofaríngeo/cirugía , Absceso Retrofaríngeo/tratamiento farmacológico , Absceso/diagnóstico , Absceso/microbiologíaRESUMEN
INTRODUCTION: Histoplasmosis is a systemic mycosis endemic in Brazil, especially in the State of Rio Grande do Sul, where Histoplasma capsulatum was isolated from the soil. H. capsulatum may compromise unusual areas, including the oropharynx, particularly in patients presenting disseminated histoplasmosis; which is associated with a state of immunosuppression, such as AIDS. METHODS: During database analysis of a total of 265 cases of histoplasmosis, the medical records of 11 patients with histological or microbiological diagnoses of oral histoplasmosis (OH) between 1987 and 2008 were retrospectively reviewed. RESULTS: This work reports 11 cases of OH, the majority presenting histopathological or microbiological evidence of disseminated histoplasmosis (DH). In the patients with DH, OH was the first manifestation of histoplasmosis. Five of the 11 patients discussed were HIV-seropositive with clinical and laboratory findings of AIDS. Four patients presented active pulmonary tuberculosis concomitant with histoplasmosis. Treatment was based on the use of itraconazole and amphotericin B deoxycholate. Eight patients responded successfully to therapy after one year, two did not come back for reevaluation and one died despite adequate therapy. CONCLUSIONS: Oral histoplasmosis is closely associated with immunosuppression status, especially in patients presenting AIDS; moreover, in many cases, OH is the first sign of disseminated histoplasmosis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Histoplasmosis/microbiología , Orofaringe/microbiología , Enfermedades Faríngeas/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adulto , Anciano , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Ácido Desoxicólico/uso terapéutico , Combinación de Medicamentos , Femenino , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Humanos , Itraconazol/uso terapéutico , Cetoconazol/uso terapéutico , Masculino , Persona de Mediana Edad , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/tratamiento farmacológico , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: Histoplasmosis is a systemic mycosis endemic in Brazil, especially in the State of Rio Grande do Sul, where Histoplasma capsulatum was isolated from the soil. H. capsulatum may compromise unusual areas, including the oropharynx, particularly in patients presenting disseminated histoplasmosis; which is associated with a state of immunosuppression, such as AIDS. METHODS: During database analysis of a total of 265 cases of histoplasmosis, the medical records of 11 patients with histological or microbiological diagnoses of oral histoplasmosis (OH) between 1987 and 2008 were retrospectively reviewed. RESULTS: This work reports 11 cases of OH, the majority presenting histopathological or microbiological evidence of disseminated histoplasmosis (DH). In the patients with DH, OH was the first manifestation of histoplasmosis. Five of the 11 patients discussed were HIV-seropositive with clinical and laboratory findings of AIDS. Four patients presented active pulmonary tuberculosis concomitant with histoplasmosis. Treatment was based on the use of itraconazole and amphotericin B deoxycholate. Eight patients responded successfully to therapy after one year, two did not come back for reevaluation and one died despite adequate therapy. CONCLUSIONS: Oral histoplasmosis is closely associated with immunosuppression status, especially in patients presenting AIDS; moreover, in many cases, OH is the first sign of disseminated histoplasmosis.
INTRODUÇÃO: Histoplasmose é uma micose sistêmica, endêmica no Brasil, especialmente no Estado do Rio Grande do Sul, onde Histoplasma capsulatum foi isolado do solo. H. capsulatum pode acometer áreas não-usuais, como cavidade orofaríngea, particularmente em pacientes com histoplasmose disseminada, por sua vez, associada com estado de imunossupressão, como na AIDS. MÉTODOS: A partir de 265 casos de histoplasmose em um banco de dados de um laboratório de micologia, foram analisados retrospectivamente 11 prontuários de pacientes com diagnóstico histológico ou microbiológico de histoplasmose oral (HO) entre 1987 e 2008. RESULTADOS: Reportamos neste trabalho onze casos de HO, a grande maioria com evidências histopatológicas e microbiológicas de histoplasmose disseminada (HD). Nos pacientes com HD, HO foi a primeira manifestação de histoplasmose. Cinco dos onze casos relatados eram portadores do vírus do HIV, todos com diagnóstico clínico e laboratorial de AIDS. Quatro pacientes do total tinham concomitantemente tuberculose pulmonar e histoplasmose. Tratamento foi baseado no uso de itraconazol e anfotericina B principalmente. Oito pacientes tiveram sucesso terapêutico após um ano, dois não retornaram para reavaliação e um faleceu apesar da adequada terapia antifúngica. CONCLUSÕES: Histoplasmose oral está associada muitas vezes com estado de imunossupressão, especialmente em pacientes com AIDS. Em muitos casos pode representar o primeiro sinal indicativo de histoplasmose disseminada.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Histoplasmosis/microbiología , Orofaringe/microbiología , Enfermedades Faríngeas/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Combinación de Medicamentos , Ácido Desoxicólico/uso terapéutico , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Itraconazol/uso terapéutico , Cetoconazol/uso terapéutico , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/tratamiento farmacológico , Estudios RetrospectivosRESUMEN
Os abcessos laterofaríngeos e retrofaríngeos são infecções potencialmente fatais, designadamente na criança. Objetivo: Revisão de agentes etiológicos, achados clínicos e de exames de imagem de abcessos laterofaríngeos e retrofaríngeos em crianças, assim como de resultados e complicações do tratamento através de uma abordagem cirúrgica trans-oral. Material e método: Estudo retrospectivo abrangendo 11 crianças, internadas nos últimos 5 anos num hospital universitário terciário, com o diagnósticos de abcesso laterofaríngeo (n = 8) e retrofaríngeo (n = 3), com idades variando entre 0 e 12 anos. Os processos clínicos e exames de imagem foram revistos. Resultado: A idade média de apresentação foi de 3.3 anos de idade. Alterações da mobilidade cervical(64 por cento) e odinofagia(55 por cento) foram os sintomas mais frequentes. Febre(64 por cento), rigidez cervical(64 por cento), abaulamento da parede faríngea(55 por cento),massa cervical(55 por cento) e linfadenopatias(36 por cento) foram os achados clínicos mais frequentes. Todos os doentes foram submetidos a drenagem cirurgia por via trans-oral nas primeiras 48 horas após a admissão hospitalar. Cerca de 82 por cento dos doente apresentaram melhoria do quadro clinico após 48 horas e todos após 72 horas, sem quaisquer complicações. Conclusão: Considerando os bons resultados e a baixa taxa de complicações, o presente estudo sugere que uma antibioterapia sistémica associada a uma intervenção cirúrgica atempada parece ser uma opção válida no tratamento destes abcessos.
Lateropharyngeal and retropharyngeal abscesses are potentially life threatening infections in children AIM: To review the etiologic, clinical, and imaging signs of lateropharyngeal and retropharyngeal abscesses in children as well as treatment-outcomes and complications using a surgical trans-oral approach. Method: Retrospective analysis of 11 children, hospitalized in the last 5 years, with a diagnosis of lateropharyngeal (n = 8) and retropharyngeal (n = 3) abscesses, ages ranging from 0 to 12 years old. Charts and CT scans were reviewed. Result: The average age of presentation was 3.3 years. Neck stiffness (64 percent) and odynophagia (55 percent) were the most common symptoms. Fever (64 percent), stiff neck (64 percent), bulging of the oropharyngeal wall (55 percent), mass in the neck (55 percent) and lymphadenopathy (36 percent) were the most prevalent physical findings. All these patients were submitted to surgical drainage using a trans-oral approach in the first 48 hours after admission. About 82 percent of the patients showed improvement after 48 hours, and 100 percent after 72 hours, without any complications. Conclusion: Based on the good clinical outcomes and low incidence of complications, the present study suggests that antibiotic therapy complemented with a timely surgical treatment, is a valid treatment option in refractory parapharyngeal abscesses.
Asunto(s)
Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Enfermedades Faríngeas/cirugía , Absceso/diagnóstico , Absceso/tratamiento farmacológico , Absceso/cirugía , Antibacterianos/uso terapéutico , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/tratamiento farmacológico , Estudios Retrospectivos , Absceso Retrofaríngeo/diagnóstico , Absceso Retrofaríngeo/tratamiento farmacológico , Absceso Retrofaríngeo/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
UNLABELLED: Lateropharyngeal and retropharyngeal abscesses are potentially life threatening infections in children AIM: To review the etiologic, clinical, and imaging signs of lateropharyngeal and retropharyngeal abscesses in children as well as treatment-outcomes and complications using a surgical trans-oral approach. METHOD: Retrospective analysis of 11 children, hospitalized in the last 5 years, with a diagnosis of lateropharyngeal (n = 8) and retropharyngeal (n = 3) abscesses, ages ranging from 0 to 12 years old. Charts and CT scans were reviewed. RESULT: The average age of presentation was 3.3 years. Neck stiffness (64%) and odynophagia (55%) were the most common symptoms. Fever (64%), stiff neck (64%), bulging of the oropharyngeal wall (55%), mass in the neck (55%) and lymphadenopathy (36%) were the most prevalent physical findings. All these patients were submitted to surgical drainage using a trans-oral approach in the first 48 hours after admission. About 82% of the patients showed improvement after 48 hours, and 100% after 72 hours, without any complications. CONCLUSION: Based on the good clinical outcomes and low incidence of complications, the present study suggests that antibiotic therapy complemented with a timely surgical treatment, is a valid treatment option in refractory parapharyngeal abscesses.
Asunto(s)
Enfermedades Faríngeas/cirugía , Absceso/diagnóstico , Absceso/tratamiento farmacológico , Absceso/cirugía , Antibacterianos/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/tratamiento farmacológico , Absceso Retrofaríngeo/diagnóstico , Absceso Retrofaríngeo/tratamiento farmacológico , Absceso Retrofaríngeo/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
A apresentação faringolaríngea da tuberculose como forma isolada da doença é rara, entretanto, nos últimos anos, com o aumento progressivo do número de casos de tuberculose em geral, a possibilidade dessas localizações aumentou. OBJETIVO: Descrever caso de tuberculose faringolaríngea primária em paciente grávida e imunocompetente. RELATORIO DE CASO: Paciente do sexo feminino, 30 anos, com história de odinofagia há 10 meses, sem qualquer sintoma sistêmico ou outras queixas referentes às vias aéreas superiores. Apresentava lesão granulomatosa em orofaringe e laringe, e o resultado da biópsia revelou bacilos álcool-ácido resistentes. Exames clínico e radiológico do aparelho respiratório sem alterações. Realizado tratamento anti-tuberculose por nove meses com resolução completa do quadro. CONCLUSÃO: Autores realçam a importância epidemiológica da tuberculose e a necessidade de um alto grau de suspeição de lesões das vias aéreas superiores para o diagnóstico precoce da doença.
Tuberculosis of the Larynx and pharynx only is rare. However, in the last few years, the number of tuberculosis cases in general have had a dramatic increase, thus increasing the possibility of isolated laryngo-pharyngeal lesions. AIM: To report a case of isolated laryngo-pharyngeal tuberculosis in a pregnant, immunocompetent host. CASE REPORT: A 30- year-old pregnant female had complained of odynophagia for the last ten months. There were no other respiratory or systemic symptoms. An oro-pharyngeal granulomatous lesion was found, and the biopsy revealed acid-fast bacilli. There were no clinical or radiologic pulmonary findings. She was submitted successfully to an tuberculosis treatment protocol for nine months. CONCLUSIONS: The authors point out the epidemiological importance of tuberculosis and the need for a higher degree of suspicion when dealing with uncommon upper airway lesions to make an early diagnosis.
Asunto(s)
Adulto , Femenino , Humanos , Embarazo , Antituberculosos/uso terapéutico , Enfermedades Faríngeas/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Tuberculosis Laríngea/diagnóstico , Tuberculosis/diagnóstico , Quimioterapia Combinada , Isoniazida/uso terapéutico , Enfermedades Faríngeas/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Tuberculosis Laríngea/tratamiento farmacológico , Tuberculosis/tratamiento farmacológicoRESUMEN
UNLABELLED: Tuberculosis of the Larynx and pharynx only is rare. However, in the last few years, the number of tuberculosis cases in general have had a dramatic increase, thus increasing the possibility of isolated laryngo-pharyngeal lesions. AIM: To report a case of isolated laryngo-pharyngeal tuberculosis in a pregnant, immunocompetent host. CASE REPORT: A 30- year-old pregnant female had complained of odynophagia for the last ten months. There were no other respiratory or systemic symptoms. An oro-pharyngeal granulomatous lesion was found, and the biopsy revealed acid-fast bacilli. There were no clinical or radiologic pulmonary findings. She was submitted successfully to an tuberculosis treatment protocol for nine months. CONCLUSIONS: The authors point out the epidemiological importance of tuberculosis and the need for a higher degree of suspicion when dealing with uncommon upper airway lesions to make an early diagnosis.
Asunto(s)
Antituberculosos/uso terapéutico , Enfermedades Faríngeas/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Tuberculosis Laríngea/diagnóstico , Tuberculosis/diagnóstico , Adulto , Quimioterapia Combinada , Femenino , Humanos , Isoniazida/uso terapéutico , Enfermedades Faríngeas/tratamiento farmacológico , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Tuberculosis/tratamiento farmacológico , Tuberculosis Laríngea/tratamiento farmacológicoRESUMEN
Histoplasmosis is a deep mycosis caused by Histoplasma capsulatum, which has been found in soil with accumulated excreta of bats and birds. This disease has variable clinical findings with only pulmonary or systemic involvement. Upper aerodigestive lesions are found mainly associated with systemic disease, affecting particularly patients with immunosuppression conditions mainly caused by HIV. However, it is uncommon in immunocompetent patients. This report describes a case of oro-laryngeal-esophageal histoplasmosis in a HIV-seronegative patient without detectable systemic involvement.
Asunto(s)
Histoplasmosis/patología , Enfermedades de la Boca/patología , Antifúngicos/uso terapéutico , Enfermedades del Esófago/tratamiento farmacológico , Enfermedades del Esófago/patología , Seronegatividad para VIH , Histoplasmosis/tratamiento farmacológico , Humanos , Itraconazol/uso terapéutico , Masculino , Persona de Mediana Edad , Enfermedades de la Boca/tratamiento farmacológico , Mucosa Bucal/patología , Orofaringe/patología , Enfermedades Faríngeas/tratamiento farmacológico , Enfermedades Faríngeas/patologíaRESUMEN
BACKGROUND: Oropharyngeal candidiasis (OPC) and esophageal candidiasis (EPC) are frequent complications in AIDS patients. The use of Fluconazole, an effective and a low toxicity drug, has been associated to the emergency of secondary resistant strains. For this reason, in vitro antifungal susceptibility tests are necessary to predict a therapeutic failure. Etest is an easy to perform alternative test, that has showed a good agreement with the broth microdilution reference method (NCCLS, document M27-A). AIM: To measure the susceptibility of C. albicans isolates from AIDS patients complicated with OPC and EPC to Amphotericin B (AmB) and Fluconazole (Flu) using Etest. MATERIAL AND METHODS: Twenty strains from 20 AIDS patients were studied. AmB was tested in RPMI 1640 agar and Flu in Casitone agar. RESULTS: All studied strains showed minimal inhibitory concentrations (MICs) < 1 mg/mL for AmB. A highly resistant strain to Flu (> 256 mg/mL) was isolated from a patient previously treated with Flu. CONCLUSIONS: In AIDS patients with OPC and EPC, the susceptibility to Flu of the isolates should be screened, to detect resistant strains. Etest is a reliable alternative in these cases, for laboratories that cannot use the reference method.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antifúngicos/farmacología , Candida albicans/efectos de los fármacos , Candidiasis/tratamiento farmacológico , Enfermedades del Esófago/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Anfotericina B/farmacología , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Recuento de Linfocito CD4 , Candida albicans/aislamiento & purificación , Candidiasis Bucal/tratamiento farmacológico , Farmacorresistencia Fúngica , Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/tratamiento farmacológico , Femenino , Fluconazol/farmacología , Fluconazol/uso terapéutico , Humanos , Masculino , Pruebas de Sensibilidad Microbiana/métodos , Enfermedades Faríngeas/tratamiento farmacológicoRESUMEN
BACKGROUND: Oropharyngeal candidiasis (OPC) and esophageal candidiasis (EPC) are frequent complications in AIDS patients. The use of Fluconazole, an effective and a low toxicity drug, has been associated to the emergency of secondary resistant strains. For this reason, in vitro antifungal susceptibility tests are necessary to predict a therapeutic failure. Etest is an easy to perform alternative test, that has showed a good agreement with the broth microdilution reference method (NCCLS, document M27-A). AIM: To measure the susceptibility of C. albicans isolates from AIDS patients complicated with OPC and EPC to Amphotericin B (AmB) and Fluconazole (Flu) using Etest. MATERIAL AND METHODS: Twenty strains from 20 AIDS patients were studied. AmB was tested in RPMI 1640 agar and Flu in Casitone agar. RESULTS: All studied strains showed minimal inhibitory concentrations (MICs) < 1 mg/mL for AmB. A highly resistant strain to Flu (> 256 mg/mL) was isolated from a patient previously treated with Flu. CONCLUSIONS: In AIDS patients with OPC and EPC, the susceptibility to Flu of the isolates should be screened, to detect resistant strains. Etest is a reliable alternative in these cases, for laboratories that cannot use the reference method.
Asunto(s)
Humanos , Masculino , Femenino , Antifúngicos , Candida albicans/efectos de los fármacos , Candidiasis/tratamiento farmacológico , Enfermedades del Esófago/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antifúngicos , Anfotericina B/farmacología , Anfotericina B/uso terapéutico , Candida albicans/aislamiento & purificación , Candidiasis Bucal/tratamiento farmacológico , Enfermedades Faríngeas/tratamiento farmacológico , Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/tratamiento farmacológico , Fluconazol/farmacología , Fluconazol/uso terapéutico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Farmacorresistencia Fúngica , Pruebas de Sensibilidad Microbiana/métodosRESUMEN
Caspofungin is an antifungal agent of the novel echinocandin class. We investigated its efficacy, safety, and tolerability as therapy for oropharyngeal and/or esophageal candidiasis in a phase II dose-ranging study. Patients were randomized in a double-blind manner to receive either caspofungin acetate (35, 50, or 70 mg) or amphotericin B (0.5 mg/kg of body weight) intravenously once daily for 7 to 14 days. A favorable response required both complete resolution of symptoms and quantifiable improvement of mucosal lesions 3 to 4 days after discontinuation of study drug. Efficacy was assessed using a modified intent-to-treat analysis. No hypothesis testing of efficacy was planned or performed. Of 140 enrolled patients, 63% had esophageal involvement and 98% were infected with the human immunodeficiency virus (HIV) (median CD4 count, 30/mm(3)). A modestly higher proportion of patients in each of the caspofungin groups (74 to 91%) achieved favorable responses compared to amphotericin B recipients (63%), but there was considerable overlap in the 95% confidence intervals surrounding these point estimates. Similar trends were found in the subgroups with esophageal involvement, a history of fluconazole failure, and CD4 counts of < or =50/mm(3). A smaller proportion of patients receiving any dose of caspofungin experienced drug-related adverse events compared to patients given standard doses of conventional amphotericin B (P < 0.01). Caspofungin provided a generally well-tolerated parenteral therapeutic option for HIV-infected patients with oropharyngeal and/or esophageal candidiasis in this study.
Asunto(s)
Anfotericina B/uso terapéutico , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Candidiasis/tratamiento farmacológico , Enfermedades del Esófago/tratamiento farmacológico , Péptidos Cíclicos , Péptidos , Adolescente , Adulto , Anciano , Anfotericina B/efectos adversos , Antibacterianos/efectos adversos , Antifúngicos/efectos adversos , Caspofungina , Método Doble Ciego , Tolerancia a Medicamentos , Equinocandinas , Enfermedades del Esófago/microbiología , Femenino , Humanos , Lipopéptidos , Masculino , Persona de Mediana Edad , Enfermedades Faríngeas/tratamiento farmacológico , Enfermedades Faríngeas/microbiología , Resultado del TratamientoRESUMEN
Objetivo: comparar a eficácia e a tolerabilidade de dois esquemas posológicos de amoxicilina: 45 mg/kg/dia divididos em três doses (tid) no tratamento de crianças com faringotonsilite bacteriana aguda...
Asunto(s)
Niño , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/tratamiento farmacológico , Enfermedad Aguda , Amoxicilina/administración & dosificación , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus pyogenes/patogenicidadRESUMEN
Se presenta un grupo compuesto por 70 pacientes portadores de síntomas atribuibles a reflujo faringolaríngeo y 20 pacientes controles. Se describen y proponen 3 estadios clínocos nasofibroscópicos de la enfermedad y se correlacionan con los síntomas digestivos, broncopulmonares y faringolaríngeos en los pacientes y controles. En los 70 pacientes se analizan los resultados del tratamiento médico propuesto, siendo bueno en el 88,4 por ciento de los casos y regular en 11,6 por ciento
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Hipofaringe/fisiopatología , Enfermedades Faríngeas/diagnóstico , Reflujo Gastroesofágico/complicaciones , Omeprazol/uso terapéutico , Estudios de Casos y Controles , Famotidina/uso terapéutico , Trastornos de la Voz/etiología , Cisaprida/uso terapéutico , Tos/etiología , Hipofaringe/efectos de los fármacos , Enfermedades Faríngeas/tratamiento farmacológicoRESUMEN
Las fístulas faríngeas y faringostomas son las complicaciones más frecuentes de la laringectomía radical por cáncer, reportándose en la literatura médica una incidencia entre el 4 y el 65 porciento. En el Instituto Nacional de Oncología y Radiobiología se reporta el 20 porciento. No constituye una complicación grave pero si molesta pues prolonga la estadía hospitalaria, la recuperación de la vía oral, y sobre todo la reincorporación del paciente a la sociedad. Alrededor del 50 porciento curan espontáneamente en un promedio de 7 semanas; las que no curan requieren de una o más reintervenciones quirúrgicas. Teniendo en cuenta la capacidad reparadora del factor de crecimiento epidérmico (EGF) que favorece el proceso de cicatrización al acelerar la regeneración epidérmica, se realiza este estudio piloto con 12 pacientes que fueron sometidos a la aplicación tópica de este producto 2 veces al día hasta la curación o mejoría local que permitiera la reintervención quirúrgica exitosa. Se obtuvo un 100 porciento de respuestas objetivas: 8 respuestas completas y 4 respuestas parciales. Las respuestas completas se obtuvieron en un promedio de 34 días. Se concluye que el tratamiento de elección de las fístulas faríngeas y faringostomas es la cirugía, pero el EGF local es una opción terapéutica efectiva para los pacientes que no pueden ser sometidos a faringoplastias y en aquellos donde ésta no ha sido efectiva, mejorando el estado local de los tejidos que permiten el éxito posterior de la reconstrucción. No se reportan complicaciones en este estudio(AU)
Asunto(s)
Humanos , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/tratamiento farmacológico , Fístula/etiología , Fístula/tratamiento farmacológico , Factor de Crecimiento Epidérmico/uso terapéutico , Laringectomía/métodos , Complicaciones Intraoperatorias , Laringe/cirugíaRESUMEN
Realizamos uma revisäo sobre as principais doenças granulomatosas que podem acometer a laringe, devido à grande ocorrência dessas afecçöes no Brasil e em outros países de clima tropical e subtropical. Ressaltamos os aspectos histopatológicos para o seu diagnóstico, assim como o seu tratamento.
Asunto(s)
Humanos , Actinomicosis/fisiopatología , Amiloidosis/fisiopatología , Blastomicosis/fisiopatología , Enfermedades Faríngeas/fisiopatología , Granulomatosis con Poliangitis/fisiopatología , Lepra/fisiopatología , Histoplasmosis/fisiopatología , Leishmaniasis/fisiopatología , Rinoscleroma/fisiopatología , Sarcoidosis/fisiopatología , Sífilis/fisiopatología , Tuberculosis/fisiopatología , Actinomicosis/diagnóstico , Actinomicosis/tratamiento farmacológico , Amiloidosis/diagnóstico , Amiloidosis/terapia , Blastomicosis/diagnóstico , Blastomicosis/tratamiento farmacológico , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/tratamiento farmacológico , Enfermedades Faríngeas/terapia , Granulomatosis con Poliangitis/diagnóstico , Granulomatosis con Poliangitis/tratamiento farmacológico , Lepra/diagnóstico , Lepra/tratamiento farmacológico , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Leishmaniasis/diagnóstico , Leishmaniasis/tratamiento farmacológico , Rinoscleroma/diagnóstico , Rinoscleroma/tratamiento farmacológico , Sarcoidosis/diagnóstico , Sarcoidosis/tratamiento farmacológico , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológicoAsunto(s)
Actinomicosis/diagnóstico , Actinomicosis/fisiopatología , Actinomicosis/tratamiento farmacológico , Amiloidosis/diagnóstico , Amiloidosis/fisiopatología , Amiloidosis/tratamiento farmacológico , Blastomicosis/diagnóstico , Blastomicosis/fisiopatología , Blastomicosis/tratamiento farmacológico , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/fisiopatología , Enfermedades Faríngeas/terapia , Enfermedades Faríngeas/tratamiento farmacológico , Granulomatosis con Poliangitis/diagnóstico , Granulomatosis con Poliangitis/fisiopatología , Granulomatosis con Poliangitis/tratamiento farmacológico , Lepra/diagnóstico , Lepra/fisiopatología , Lepra/tratamiento farmacológico , Histoplasmosis/diagnóstico , Histoplasmosis/fisiopatología , Histoplasmosis/tratamiento farmacológico , Leishmaniasis/diagnóstico , Leishmaniasis/fisiopatología , Leishmaniasis/tratamiento farmacológico , Rinoscleroma/diagnóstico , Rinoscleroma/fisiopatología , Rinoscleroma/tratamiento farmacológico , Sarcoidosis/diagnóstico , Sarcoidosis/fisiopatología , Sarcoidosis/tratamiento farmacológico , Sífilis/diagnóstico , Sífilis/fisiopatología , Sífilis/tratamiento farmacológico , Tuberculosis/diagnóstico , Tuberculosis/fisiopatología , Tuberculosis/tratamiento farmacológicoRESUMEN
In a previous study we observed that 6% of adult and 18% of children contacts of H. influenzae infected patients became carriers of the bacillus. We studied 1296 adults involved in children care, 398 from day care centers and 898 from hospitals in Santiago. A pharyngeal sample was cultured in chocolate agar plus bacitracin (300 mg/ml) and incubated at 37 degrees C in a 5-10% CO2 atmosphere for 18-24 h. Isolates of H influenzae were biotypified and serogrouped according to international recommendations. We observed that 2.4% of subjects were H influenzae carriers. Thirty carriers were treated with 2 doses of enoxacin, 440 mg. All became free of H influenzae at a 30-day follow-up.
Asunto(s)
Portador Sano/epidemiología , Guarderías Infantiles , Enoxacino/uso terapéutico , Infecciones por Haemophilus/epidemiología , Haemophilus influenzae , Hospitales Pediátricos , Enfermedades Faríngeas/epidemiología , Adulto , Portador Sano/tratamiento farmacológico , Portador Sano/microbiología , Niño , Guarderías Infantiles/estadística & datos numéricos , Preescolar , Chile/epidemiología , Evaluación de Medicamentos , Tolerancia a Medicamentos , Femenino , Infecciones por Haemophilus/tratamiento farmacológico , Infecciones por Haemophilus/microbiología , Haemophilus influenzae/aislamiento & purificación , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Masculino , Enfermedades Faríngeas/tratamiento farmacológico , Enfermedades Faríngeas/microbiología , Prevalencia , Recursos HumanosAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Antiinfecciosos/uso terapéutico , Enfermedades Gastrointestinales/tratamiento farmacológico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/tratamiento farmacológico , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/tratamiento farmacológico , Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/tratamiento farmacológico , Enfermedades Gastrointestinales/complicaciones , Humanos , Infecciones Oportunistas/complicaciones , Enfermedades Faríngeas/complicaciones , Enfermedades Faríngeas/tratamiento farmacológico , Infecciones por Protozoos/complicaciones , Infecciones por Protozoos/tratamiento farmacológicoRESUMEN
Bajo diseño doble ciego se realizó la evaluación de la eficacia terapéutica del diclofenaco potásico más trimetoprim sulfametoxazol en comparación con placebo más trimetoprim sulfametoxazol, en pacientes que cursaban con faringoamigdalitis bacteriana aguda, con temperatura mayor de 38.5 a 40-C y que requirieron terapéutica antimicrobiana. Este estudio demostró la bondad terapéutica del diclofenaco potásico, ya que es el único antiinflamatorio no esteroideo que se puede asociar al trimetoprim sulfametoxazol. Se evaluaron los parámetros de exudado faríngeo, inflamación, temperatura, analgesia, así como la opinión global de la eficacia del investigador y del paciente. En la evaluación comparativa de los resultados durante y al final del tratamiento en relación con la evaluación al inicio del mismo, se obtuvo una diferencia altamente significativa en los parámetros evaluados para el diclofenaco potásico más trimetoprim sulfametoxazol en comparación con el grupo tratado con placebo más trimetoprim sulfametoxazol. La tolerancia fue buena en ambos grupos