RESUMEN
Mucormycosis, a group of opportunistic mycoses caused by Mucorales, present a significant threat to immunocompromised patients. In this report, we present the case of a 57-year-old male patient who underwent liver transplant for secondary biliary cirrhosis following inadvertent bile duct injury. Despite initial satisfactory postoperative evolution, the patient developed fever, and imaging revealed a suspicious lesion. Preliminary culture growth suggested a filamentous fungus, leading to initiation of liposomal amphotericin B. However, the lesion progressed, and a surgical debridement was necessary. During surgery, involvement of the liver dome and diaphragm was observed, and a nonanatomical hepatectomy was performed. Despite efforts, the patient's condition deteriorated, ultimately resulting in multiple organ failure and mortality. This case emphasizes the challenging nature of mucormycosis in livertransplant recipients.
Asunto(s)
Antifúngicos , Huésped Inmunocomprometido , Cirrosis Hepática Biliar , Trasplante de Hígado , Mucormicosis , Humanos , Masculino , Mucormicosis/diagnóstico , Mucormicosis/microbiología , Mucormicosis/inmunología , Mucormicosis/tratamiento farmacológico , Mucormicosis/etiología , Persona de Mediana Edad , Trasplante de Hígado/efectos adversos , Antifúngicos/uso terapéutico , Resultado Fatal , Cirrosis Hepática Biliar/cirugía , Cirrosis Hepática Biliar/microbiología , Cirrosis Hepática Biliar/diagnóstico , Resultado del Tratamiento , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Desbridamiento , Aloinjertos , Hepatectomía , Anfotericina B/uso terapéutico , Anfotericina B/administración & dosificación , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/microbiologíaRESUMEN
COVID-19 disease is associated with a significant number of opportunistic infections, including invasive fungal infections such as mucormycosis. The prevalence of the latter is rare, estimated to be between 0.005 and 1.7 per million inhabitants. Risk factors include hematological diseases, Diabetes Mellitus with poor metabolic control, solid organ transplantation, neutropenia, and prolonged administration of systemic corticosteroids. We report two males aged 60 and 75 years with pulmonary and tracheobronchial invasive mucormycosis, respectively. Both patients had a deficient metabolic control of their diabetes as a predisposing risk factor added to severe COVID-19 infection. High suspicion and early diagnosis are essential for prompt treatment, especially considering the associated high morbidity and mortality of this fungal infection.
Asunto(s)
COVID-19 , Diabetes Mellitus , Mucormicosis , Infecciones Oportunistas , Humanos , Masculino , COVID-19/complicaciones , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/complicaciones , Factores de Riesgo , Persona de Mediana Edad , AncianoRESUMEN
COVID-19 disease is associated with a significant number of opportunistic infections, including invasive fungal infections such as mucormycosis. The prevalence of the latter is rare, estimated to be between 0.005 and 1.7 per million inhabitants. Risk factors include hematological diseases, Diabetes Mellitus with poor metabolic control, solid organ transplantation, neutropenia, and prolonged administration of systemic corticosteroids. We report two males aged 60 and 75 years with pulmonary and tracheobronchial invasive mucormycosis, respectively. Both patients had a deficient metabolic control of their diabetes as a predisposing risk factor added to severe COVID-19 infection. High suspicion and early diagnosis are essential for prompt treatment, especially considering the associated high morbidity and mortality of this fungal infection.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Anciano , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/diagnóstico , COVID-19/complicaciones , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Diabetes MellitusRESUMEN
Chronic diarrhea is a common reason for consultation in renal transplant patients. Cytomegalovirus infection is the cause of chronic diarrhea of infectious origin in 50% of cases, but coinfection with tuberculosis is rare. We present the case of a renal transplant patient with chronic diarrhea, with a finding of left colon colitis and positive microbiological studies in biopsy for tuberculosis and cytomegalovirus. The patient received valganciclovir and anti-tubercular treatment with adequate evolution. Immunosuppressed patients may have diarrhea secondary to opportunistic infections; therefore, an algorithm for early diagnosis and treatment is recommended.
Asunto(s)
Colitis , Infecciones por Citomegalovirus , Trasplante de Riñón , Mycobacterium tuberculosis , Infecciones Oportunistas , Humanos , Citomegalovirus , Trasplante de Riñón/efectos adversos , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/tratamiento farmacológico , Colitis/diagnóstico , Colitis/tratamiento farmacológico , Diarrea/etiologíaRESUMEN
BACKGROUND/OBJECTIVES: Cutaneous mucormycosis is an emerging opportunistic mycosis caused by Mucorales. It can be divided into primary caused by trauma and secondary by extension of rhino-cerebral and disseminated cases. The objective is to present a retrospective study of cases of mucormycosis with cutaneous involvement. METHODS: A retrospective and descriptive study was carried out. Mucormycosis patients were included and divided into two groups: a) Primary Cutaneous and b) Secondary Cutaneous. Mycological tests were performed; the agents were identified by morphology and molecular studies (PCR and sequencing); some cases underwent histopathology. Clinical data and response to treatment were collected. RESULTS: 115 cases were included, 18 of primary, and 97 of secondary cutaneous mucormycosis. Primary cutaneous mucormycosis was most associated with adhesive bands (44.4%) and trauma from traffic accidents (33.3%). The principal clinical form was extensive and deep necrotic ulcers. Secondary cutaneous mucormycosis cases were rhino-cerebral with uncontrolled diabetes (81.4%) The most frequent clinical presentation was necrosis of the eyelid and the nose (65.9%). In both groups, the principal agent was Rhizopus arrhizus, 38.8% and 74.2% respectively. The most effective treatment was the combination of amphotericin B with surgical debridement. The clinical and mycological cure was achieved in 31.0% of primary cases, and 44.4% for secondary cases. CONCLUSION: Primary cutaneous mucormycosis is caused by implantation of the Mucorales due to trauma or rupture of the cutaneous barrier-breach, and secondary cutaneous mucormycosis develops as part of the rhino-cerebral process. The response to treatment depends on the extension and depth, as well as the predisposing factors.
Asunto(s)
Dermatomicosis/diagnóstico , Mucormicosis/diagnóstico , Adhesivos/efectos adversos , Adulto , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Desbridamiento , Dermatomicosis/terapia , Complicaciones de la Diabetes , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Mucormicosis/terapia , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/terapia , Estudios Retrospectivos , Rhizopus oryzae , Centros de Atención Terciaria , Heridas y Lesiones/complicacionesRESUMEN
INTRODUCTION: Acute pulmonary histoplasmosis (APH) is rare in an immunocompetent patient. We report a case of APH diagnosed by culture of broncho-alveolar lavage (BAL) in a patient presenting a pseudo-tumoral form with nodules progressing to cavitation. OBSERVATION: A 41 year-old male smoker was hospitalized with a persistent fever, dry cough and dyspnoea on exertion. The first CT scan showed a reticulo-nodular interstitial infiltrate with lymphadenopathy that progressed rapidly to multiple pulmonary nodules with central cavitation. Bronchial endoscopy, with BAL culture, provided the diagnosis of Histoplasma capsulatum, variety capsulatum. The infection may have occurred during work in a hangar in Guadeloupe that was scattered with bats' guano. After two months of treatment by itraconazole, the patient's condition improved clinically and radiologically with reduction of the nodules and their cavitation. CONCLUSION: This case presents an immunocompetent patient with pulmonary histoplasmosis and multiple, radiologically atypical, nodules. The diagnosis was established by BAL culture.
Asunto(s)
Histoplasmosis/diagnóstico , Inmunocompetencia , Enfermedades Pulmonares Fúngicas/diagnóstico , Adulto , Lavado Broncoalveolar , Broncoscopía , Guadalupe , Histoplasma/aislamiento & purificación , Histoplasmosis/microbiología , Humanos , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/microbiología , Fumar/efectos adversos , Fumar/inmunología , Tomografía Computarizada por Rayos XRESUMEN
In Colombia, especially in intensive care units, candidemia is a frequent cause of infection, accounting for 88% of fungal infections in hospitalized patients, with mortality ranging from 36% to 78%. Its incidence in Colombia is higher than that reported in developed countries and even higher than in other Latin American countries. First, the patient's risk factors should be considered, and then clinical characteristics should be assessed. Finally, microbiological studies are recommended and if the evidence supports its use, molecular testing. In general, American, Latin American, and European guides place the echinocandins as the first-line treatment for candidemia and differ in the use of fluconazole based on evidence, disease severity, previous exposure to azoles, and prevalence of Candida non-albicans. Taking into account the high incidence of this disease in our setting, it should be looked for in patients with risk factors to start a prompt empirical anti-fungal treatment.
En Colombia, especialmente en las unidades de cuidados intensivos, la candidemia es una causa frecuente de infección del torrente sanguíneo y representa el 88 % de las infecciones fúngicas en pacientes hospitalizados, con una mortalidad entre 36 y 78 %. Su incidencia en Colombia es mayor a la reportada en los países desarrollados e, incluso, en otros países de Latinoamérica. Para su manejo deben considerarse los factores de riesgo del paciente, luego valorar las características clínicas y, finalmente, hacer los estudios microbiológicos y, si es necesario, pruebas moleculares. En general, las guías estadounidenses, latinoamericanas y europeas recomiendan las equinocandinas como el tratamiento de primera línea de la candidemia y difieren en el uso de fluconazol dependiendo de la 'evidencia', la gravedad de la enfermedad, la exposición previa a los azoles y la prevalencia de Candida no albicans. Dada su gran incidencia en nuestro país, asociada con una elevada mortalidad, esta infección debe buscarse sistemáticamente en pacientes con factores de riesgo, con el fin de iniciar oportunamente el tratamiento antifúngico.
Asunto(s)
Candidemia/epidemiología , APACHE , Antifúngicos/efectos adversos , Antifúngicos/farmacología , Candida/clasificación , Candida/aislamiento & purificación , Candidemia/diagnóstico , Candidemia/tratamiento farmacológico , Candidemia/microbiología , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/microbiología , Colombia/epidemiología , Comorbilidad , Farmacorresistencia Fúngica , Humanos , Huésped Inmunocomprometido , Recien Nacido Prematuro , Enfermedades del Prematuro/epidemiología , Neoplasias/epidemiología , Neutropenia/epidemiología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/epidemiología , Infecciones Oportunistas/microbiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/microbiología , Pronóstico , Diálisis Renal/efectos adversos , Respiración Artificial/efectos adversos , Factores de Riesgo , Especificidad de la EspecieRESUMEN
Abstract Objectives To describe the characteristics of opportunistic infections in pediatrics regarding their clinical aspects, as well as the diagnostic strategy and treatment. Source of data Non-systematic review of literature studies in the PubMed database. Synthesis of data Opportunistic infections caused by non-tuberculous mycobacteria, fungi, Herpesvirae, and infections affecting individuals using immunobiological agents are analyzed. Because these are severe diseases with a rapid evolution, diagnostic suspicion should be early, associated with the patient's clinical assessment and history pointing to opportunistic infections. Whenever possible, samples of secretions, blood, and other fluids and tissues should be collected, with early therapy implementation. Conclusions Despite the improved diagnosis of opportunistic infections in recent years, they remain a challenge for pediatricians who are not used to these infections. They should raise the suspicion and start treating the case, but should also resort to specialists in the management of these infections to provide a better outcome for these patients, who still have high mortality.
Resumo Objetivos Descrever as características das infecções oportunistas em pediatria em seus aspectos clínicos, bem como a estratégia diagnóstica e o tratamento. Fonte dos dados Revisão de trabalhos de literatura de forma não sistemática na base de dados Pubmed. Síntese dos dados São apresentadas as infecções oportunistas causadas por micobactérias não tuberculosas, fungos, herpervírus e as infecções que acometem indivíduos em uso de imunobiológicos. Por se tratar de doenças graves e de evolução rápida, a suspeita diagnóstica deve ser precoce, associada à clínica do paciente e aos dados de história que apontam para infecções oportunistas. Sempre que possível, amostras de secreções, sangue e outros fluidos e de tecidos devem ser coletadas, com instituição precoce de terapia. Conclusões Apesar da melhoria do diagnóstico de infecções oportunistas nos últimos anos, elas ainda são um desafio para o pediatra pouco habituado a essas infecções. Ele deve fazer a suspeita e iniciar a condução do caso, mas recorrer a especialistas com prática no manejo dessas infecções de modo a propiciar um melhor desfecho para esses pacientes que ainda apresentam alta mortalidade.
Asunto(s)
Humanos , Niño , Infecciones Oportunistas/diagnóstico , PediatríaRESUMEN
Cryptococcosis is an opportunistic infection caused by the Basidiomycota Cryptococcus neoformans (Cryptococcus gattii), which affects immunosuppressed patients and less frequently immunocompetent patients. Solid-organ transplant recipients are a particularly high-risk group, depending on the net state of immunosuppression. In these patients, the infection usually appears after the first year after transplant, although it may occur earlier in liver transplant recipients. In most cases, the infection is secondary to the reactivation of a latent infection, although it may be due to an unidentified pretransplant infection by primary infection. Less frequently, it may be transmitted by the graft. The lung and central nervous system are most frequently involved. Extrapulmonary involvement is seen in 75% of the cases, and disseminated disease occurs in 61%, with mortality ranging from 17% to 50% when the central nervous system is involved. Here, we report a case of disseminated cryptococcosis (lymphadenitis, meningitis, pulmonary nodules, and possibly sacroiliitis) in a patient after liver transplant, with good clinical and microbiological outcomes and without relapse.
Asunto(s)
Criptococosis/microbiología , Trasplante de Hígado/efectos adversos , Enfermedades Pulmonares Fúngicas/microbiología , Linfadenitis/microbiología , Infecciones Oportunistas/microbiología , Sacroileítis/microbiología , Adulto , Antifúngicos/uso terapéutico , Criptococosis/diagnóstico , Criptococosis/tratamiento farmacológico , Criptococosis/inmunología , Femenino , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/inmunología , Linfadenitis/diagnóstico , Linfadenitis/tratamiento farmacológico , Linfadenitis/inmunología , Meningitis Criptocócica/tratamiento farmacológico , Meningitis Criptocócica/inmunología , Meningitis Criptocócica/microbiología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/inmunología , Sacroileítis/diagnóstico , Sacroileítis/tratamiento farmacológico , Sacroileítis/inmunología , Resultado del TratamientoRESUMEN
OBJECTIVES: To describe the characteristics of opportunistic infections in pediatrics regarding their clinical aspects, as well as the diagnostic strategy and treatment. SOURCE OF DATA: Non-systematic review of literature studies in the PubMed database. SYNTHESIS OF DATA: Opportunistic infections caused by non-tuberculous mycobacteria, fungi, Herpesvirae, and infections affecting individuals using immunobiological agents are analyzed. Because these are severe diseases with a rapid evolution, diagnostic suspicion should be early, associated with the patient's clinical assessment and history pointing to opportunistic infections. Whenever possible, samples of secretions, blood, and other fluids and tissues should be collected, with early therapy implementation. CONCLUSIONS: Despite the improved diagnosis of opportunistic infections in recent years, they remain a challenge for pediatricians who are not used to these infections. They should raise the suspicion and start treating the case, but should also resort to specialists in the management of these infections to provide a better outcome for these patients, who still have high mortality.
Asunto(s)
Infecciones Oportunistas , Niño , Humanos , Infecciones Oportunistas/diagnóstico , PediatríaAsunto(s)
Hialohifomicosis/microbiología , Trasplante de Riñón/efectos adversos , Infecciones Oportunistas/microbiología , Trasplante de Páncreas/efectos adversos , Sinusitis/microbiología , Diagnóstico Diferencial , Humanos , Hialohifomicosis/diagnóstico , Hialohifomicosis/inmunología , Hialohifomicosis/terapia , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/terapia , Valor Predictivo de las Pruebas , Sinusitis/diagnóstico , Sinusitis/inmunología , Sinusitis/terapia , Resultado del TratamientoRESUMEN
Progressive multifocal leukoencephalopathy (PML) is a debilitating and often fatal viral disease of the central nervous system. A 39-year-old male kidney transplant recipient presented to our hospital with weakness of the left arm and leg, his immunosuppressive regimen consisted of tacrolimus, mycophenolate sodium, and meprednisone. Magnetic resonance imaging of the brain revealed hypercellularity in neural tissue and a lesion affecting the right ventral and lateral areas of the thalamus and the posterior limb of the internal capsule. The cerebrospinal fluid tested negative for bacteria, fungi, and acid-fast bacilli; cytology revealed no malignant cells. The clinical presentation, brain imaging, biopsy results showing a demyelinating process, and absence of atypical proliferation all suggested that the first diagnosis to be ruled out was PML. The weakness resolved after withdrawal of tacrolimus and mycophenolate sodium. On day 250 after presentation, no further neurologic deterioration was evident, and renal function was stable. The diagnosis of PML may not always be straightforward. Polymerase chain reaction for detecting John Cunningham virus was not available at our center or in the region. However, a negative result using polymerase chain reaction does not rule out PML.
Asunto(s)
Inmunosupresores/efectos adversos , Virus JC/patogenicidad , Trasplante de Riñón/efectos adversos , Leucoencefalopatía Multifocal Progresiva/virología , Infecciones Oportunistas/virología , Adulto , Biopsia , Quimioterapia Combinada , Humanos , Huésped Inmunocomprometido , Inmunosupresores/administración & dosificación , Virus JC/inmunología , Leucoencefalopatía Multifocal Progresiva/diagnóstico , Leucoencefalopatía Multifocal Progresiva/inmunología , Imagen por Resonancia Magnética , Masculino , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/inmunología , Valor Predictivo de las Pruebas , Resultado del TratamientoRESUMEN
The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis. A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed. A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma. Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a "watch and wait" basis. Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.
Asunto(s)
Histoplasmosis/complicaciones , Leucemia Linfocítica Crónica de Células B/diagnóstico , Infecciones Oportunistas/complicaciones , Anciano de 80 o más Años , Enfermedad de Alzheimer/complicaciones , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Histoplasma/aislamiento & purificación , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Humanos , Hipertensión/complicaciones , Itraconazol/uso terapéutico , Leucemia Linfocítica Crónica de Células B/complicaciones , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/microbiología , Ganglios Linfáticos/patología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Espera VigilanteRESUMEN
RESUMEN El linfoma linfocítico de células pequeñas es una neoplasia de células B maduras con un amplio espectro de presentaciones clínicas. Las infecciones por gérmenes oportunistas no asociadas con el tratamiento, incluso en estadios avanzados de la enfermedad, tienen baja incidencia. Se han reportado muy pocos casos de pacientes con linfoma linfocítico de células pequeñas asociado a histoplasmosis diseminada que no habían recibido quimioterapia en el momento del diagnóstico. Se presenta el caso de una paciente de 82 años que fue hospitalizada por presentar tos seca intermitente, astenia y adinamia de un mes de evolución. Se le practicaron múltiples estudios para detectar infecciones o compromiso inmunológico o reumático, y se diagnosticó un síndrome adenopático extenso con compromiso cervical, torácico y retroperitoneal. En la citometría de flujo y en la biopsia de ganglio linfático cervical, se reportaron los fenotipos CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg y CD10neg, con restricción de la cadena ligera kappa, lo cual confirmó un linfoma linfocítico de células pequeñas. En la histopatología del ganglio, se observaron granulomas epitelioides sin necrosis, pero las coloraciones especiales no mostraron la presencia de microorganismos, en tanto que el cultivo del ganglio fue positivo para Histoplasma capsulatum. Se inició el tratamiento antifúngico con anfotericina B e itraconazol, y la paciente tuvo una adecuada evolución. Dado que no se cumplían los criterios para el tratamiento oncológico, se continuó con su observación mediante controles periódicos. Las infecciones oportunistas pueden ser la manifestación clínica inicial en pacientes con síndromes linfoproliferativos de bajo grado. Este caso demuestra que pueden desarrollarse, incluso, en ausencia de quimioterapia.
ABSTRACT The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis. A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed. A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma. Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a "watch and wait" basis. Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.
Asunto(s)
Anciano de 80 o más Años , Femenino , Humanos , Infecciones Oportunistas/complicaciones , Leucemia Linfocítica Crónica de Células B/diagnóstico , Histoplasmosis/complicaciones , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Leucemia Linfocítica Crónica de Células B/complicaciones , Anfotericina B/uso terapéutico , Itraconazol/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Espera Vigilante , Enfermedad de Alzheimer/complicaciones , Histoplasma/aislamiento & purificación , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Hipertensión/complicaciones , Ganglios Linfáticos/microbiología , Ganglios Linfáticos/patología , Ganglios Linfáticos/diagnóstico por imagen , Antifúngicos/uso terapéuticoRESUMEN
Invasive aspergillosis and mucormycosis are life-threatening infections in solid organ and hematopoietic cell transplant recipients. Despite medical advancements in the care of these patients and the availability of new mold-active drugs, the outcomes remain suboptimal. Therefore, there has been increased interest in the use of combination antifungal therapy, in hopes that leveraging the possible in vitro synergy of these agents will improve the prognosis of invasive mold disease. However, there has been a large disconnect between the results of experimental and clinical investigations, as clinical studies have not unequivocally demonstrated the superiority of combination therapy over monotherapy. This is particularly true for mucormycosis, where the rarity of the condition has made it nearly impossible to prospectively study novel therapeutic strategies. We review the current standard of antifungal therapy and the preclinical and clinical data addressing the merit of combination therapy, and we provide guidance to optimize the management of these mycoses.
Asunto(s)
Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Mucormicosis/tratamiento farmacológico , Infecciones Oportunistas/tratamiento farmacológico , Trasplante de Órganos/efectos adversos , Animales , Antifúngicos/efectos adversos , Aspergilosis/diagnóstico , Aspergilosis/inmunología , Aspergilosis/microbiología , Quimioterapia Combinada , Humanos , Infecciones Fúngicas Invasoras/diagnóstico , Infecciones Fúngicas Invasoras/inmunología , Infecciones Fúngicas Invasoras/microbiología , Mucormicosis/diagnóstico , Mucormicosis/inmunología , Mucormicosis/microbiología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/microbiología , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: As for all tests, the diagnostic performances of Xpert MTB/RIF might be different in settings with different tuberculosis prevalence. Aim of the study is to evaluate the performances of Xpert MTB/RIF to diagnose tuberculosis in Brazil, where 407 culture-confirmed tuberculosis patients were retrospectively enrolled in Rio Grande do Sul, between 2015 and 2016. METHODS: Sensitivity, specificity, positive and negative predictive values of the test were calculated and a logistic regression analysis was performed to assess the role played by explanatory variables in the occurrence of true positive and negative diagnostic results. RESULTS: Sensitivity of Xpert MTB/RIF was 100.0%, specificity 92.8%; positive and negative predictive values were 71.4% and 100.0%, respectively. In the HIV- infected sub-group specificity was 59.3%. In the multivariate logistic regression analysis, true positivity was associated with increasing age (1.0; p-value: 0.02) while true positivity and negativity were negatively associated with alcohol abuse. CONCLUSIONS: Xpert is sensitive and specific in the Brasilian settings.
Asunto(s)
Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Tuberculosis/diagnóstico , Adulto , Antibióticos Antituberculosos/farmacología , Brasil , Coinfección , Farmacorresistencia Bacteriana , Femenino , Infecciones por VIH/complicaciones , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/aislamiento & purificación , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/diagnóstico , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Rifampin/farmacología , Sensibilidad y Especificidad , Tuberculosis/complicacionesAsunto(s)
Virus de la Hepatitis E/patogenicidad , Hepatitis E/epidemiología , Trasplante de Riñón , Infecciones Oportunistas/epidemiología , Anticuerpos Antihepatitis/sangre , Hepatitis E/diagnóstico , Hepatitis E/inmunología , Hepatitis E/virología , Virus de la Hepatitis E/genética , Virus de la Hepatitis E/inmunología , Interacciones Huésped-Patógeno , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Trasplante de Riñón/efectos adversos , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/virología , Prevalencia , Estudios Prospectivos , ARN Viral/genética , Estudios Seroepidemiológicos , Resultado del Tratamiento , Estados Unidos/epidemiología , Carga ViralRESUMEN
We assessed the diagnostic ability of an enzyme-linked immunosorbent assay test for measurement of specific secretory IgA (sIgA) in saliva to identify cystic fibrosis (CF) patients with Pseudomonas aeruginosa chronic lung infection and intermittent lung colonization. A total of 102 Brazilian CF patients and 53 healthy controls were included. Specific serum IgG response was used as a surrogate to distinguish CF patients according to their P. aeruginosa colonization/infection status. The rate of sIgA positivity was 87.1% in CF chronically infected patients (median value = 181.5 U/mL), 48.7% in intermittently colonized patients (median value = 45.8 U/mL) and 21.8% in free of infection patients (median value = 22.1 U/mL). sIgA levels in saliva were significantly associated with serum P. aeruginosa IgG and microbiological culture results. The sensitivity, specificity, PPV and NPV for differentiation between presence and absence of chronic lung infection were 87%, 63%, 51% and 92%, respectively. Measurement of sIgA in saliva may be used for screening patients in risk of developing P. aeruginosa chronic lung infection in CF and possibly also for paranasal sinusitis, and, most importantly, to efficiently rule out chronic P. aeruginosa lung infection.
Asunto(s)
Anticuerpos Antibacterianos/análisis , Fibrosis Quística/diagnóstico , Inmunoglobulina A Secretora/análisis , Inmunoglobulina G/análisis , Infecciones Oportunistas/diagnóstico , Infecciones por Pseudomonas/diagnóstico , Saliva/química , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Estudios Transversales , Fibrosis Quística/complicaciones , Fibrosis Quística/inmunología , Fibrosis Quística/microbiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Pulmón/inmunología , Pulmón/microbiología , Pulmón/patología , Masculino , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/microbiología , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/inmunología , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa , Saliva/inmunología , Saliva/microbiología , Sensibilidad y EspecificidadRESUMEN
Opportunistic infections can cause manifestations that resemble neuropsychiatric systemic lupus erythematosus and they can also trigger lupus flares. Therefore, central nervous system infections as differential diagnosis in neuropsychiatric systemic lupus erythematosus may be difficult, leading to delayed diagnosis and specific treatment. Central nervous system infection in systemic lupus erythematosus is not common but, if left misdiagnosed and not treated promptly, can be fatal. Complementary diagnosis tests are generally non-specific and disappointing. Caution with immunosuppressive drug treatment should be emphasized while an opportunistic infection cannot be ruled out. In this review, we discuss the various types of central nervous system infections reported in systemic lupus erythematosus patients, highlighting the importance of their early recognition in order to improve morbidity and mortality. Prevention with vaccination is a recommended approach.
Asunto(s)
Enfermedades del Sistema Nervioso Central/microbiología , Lupus Eritematoso Sistémico/tratamiento farmacológico , Vasculitis por Lupus del Sistema Nervioso Central/diagnóstico , Infecciones Oportunistas/diagnóstico , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Lupus Eritematoso Sistémico/complicaciones , Masculino , Infecciones Oportunistas/complicaciones , Brote de los SíntomasRESUMEN
Corynebacterium pseudodiphtheriticum forma parte de la microbiota normal de orofaringe y de piel. Sin embargo, en las últimas décadas está emergiendo como oportunista causante de infecciones clínicamente significativas en pacientes con algún compromiso previo. Se refiere el caso clínico de una paciente de 76 años con antecedentes de hipertensión arterial, hipotiroidismo, diabetes tipo 2 e insuficiencia renal crónica, que presentó neumonía durante su estadía en terapia intensiva. El examen directo del esputo inducido (coloración de Gram) reveló una muestra representativa con abundante microbiota monomicrobiana constituida por bacilos gram positivos pleomórficos corineformes y el cultivo presencia de C. pseudodiphtheriticum. La paciente recibió medicación empírica con cefalosporina de tercera generación con evolución favorable.
Microorganisms of the genera Corynebacterium, specie pseudodiphtheriticum are a part of the indigenous microbiota of human skin and oropharinx. Nevertheless in recent decades these bacilli are emerging as opportunistic pathogens causing clinically significant infections in patients with previous compromise. We report the case of a 76 years old female patient, with a history of hypertension, hypothyroidism, type 2 diabetes and chronic renal failure, who presented pneumonia during their stay at the intensive care unit. The induced sputum revealed a representative sample with monomicrobial gram positive pleomorphic coryneform rods (Gram stain) and cultures demonstrated the presence of C. pseudodiphtheriticum as the only bacteria recovered. The pacient received an empirical third generation cephalosporin medication with a succesfull recovery.