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
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
Opportunistic infections are widely described in patients with novel coronavirus disease 2019 (COVID-19); however, very few studies have addressed those affecting the oral cavity. Given the lack of information on the clinical presentations and the available treatment options, the present study aimed to show a case in which a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) was used for the management of two concomitant COVID-19-associated opportunistic oral infections (oral pseudomembranous candidiasis and recurrent herpes labialis). Within 7 days and without any systemic drug administration, all the lesions resolved completely, and the patient no longer reported oral pain or discomfort. According to the current case report and taking into consideration the significant gaps in the knowledge and understanding of COVID-19, this combination of phototherapy modalities seems to be a promising tool for managing viral and fungal opportunistic oral infections.
Asunto(s)
COVID-19 , Infecciones Oportunistas , Fotoquimioterapia , Humanos , Infecciones Oportunistas/tratamiento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , SARS-CoV-2RESUMEN
RESUMEN La toxoplasmosis cerebral o neurotoxoplasmosis es una de las infecciones oportunistas más frecuentes en los pacientes positivos al VIH. Se produce aproximadamente en el 10 % de los pacientes con sida no tratados. La localización de la infección, causada por el parásito Toxoplasma gondii, indica inmunodeficiencia severa, con linfocitos T CD4+ menor a 100 cel/mm3. El objetivo de este trabajo fue describir la evolución clínica e imagenológica de un paciente con diagnóstico de neurotoxoplasmosis, atendido en el Hospital Militar Dr. Carlos J. Finlay: hombre de 33 años, con síntomas neurológicos focales, sin factor de riesgo vascular, con estudios de imagen sugestiva de proceso expansivo intracraneal. Durante su ingreso se recibe el resultado de positivo al VIH y se interpreta como una neurotoxoplasmosis. Se empleó tratamiento antiparasitario con mejoría del trastorno neurológico y de las neuroimágenes. Ante un paciente con VIH y síntomas neurológicos focales se debe pensar en una neurotoxoplasmosis. La respuesta al tratamiento en el caso estudiado confirmó el diagnóstico (AU).
ABSTRACT Cerebral toxoplasmosis or neurotoxoplasmosis is one of the most common opportunistic infections in HIV-positive patients. It occurs in approximately 10 % of untreated AIDS patients. The location of the infection, caused by the parasite Toxoplasma gondii, indicates severe immunodeficiency, with CD4+ T lymphocytes less than 100 cell/mm3. The objective of this work was to describe the clinical and imaging evolution of a patient with diagnosis of neurotoxoplasmosis, attended at the Military Hospital Dr. Carlos J. Finlay: 33-year-old man, with focal neurological symptoms, without vascular risk factor, with studies of suggestive imaging of intracranial expansive process. During admission, the HIV positive result is received and interpreted as a neurotoxoplasmosis. Antiparasitic treatment was used with improvement of neurological disorder and neuroimagens. In the case of a patient with HIV and focal neurological symptoms doctors should think about neurotoxoplasmosis. The response to treatment in the case studied confirmed the diagnosis (AU).
Asunto(s)
Humanos , Masculino , Toxoplasmosis Cerebral/diagnóstico , Medicina General , Infecciones Oportunistas/tratamiento farmacológico , VIH , Resultado del Tratamiento , Toxoplasmosis Cerebral/rehabilitación , Toxoplasmosis Cerebral/epidemiologíaRESUMEN
As neutropenic patients with haematological cancer are not typically included in randomized controlled trials (RCTs) of candidaemia, there is low quality of evidence regarding the management of this common opportunistic mycosis in this patient population, which is at high risk for poor outcomes. Herein we identify the gaps in knowledge that are not addressed by the modern RCTs and candidaemia guidelines, and outline some considerations for the future clinical research agenda in candidaemia/invasive candidiasis in haematological patients.
Asunto(s)
Candidemia , Candidiasis Invasiva , Neoplasias Hematológicas , Infecciones Oportunistas , Antifúngicos/uso terapéutico , Candidemia/tratamiento farmacológico , Candidiasis Invasiva/diagnóstico , Candidiasis Invasiva/tratamiento farmacológico , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/tratamiento farmacológico , Humanos , Infecciones Oportunistas/tratamiento farmacológicoRESUMEN
INTRODUCTION: Acute invasive fungal rhinosinusitis (AIFRS) is rare but has high mortality. It is more frequent in immunocompromised patients with multiple comorbidities, which make their management more difficult. The aim of this study is to describe a cohort of patients operated due to AIFRS, their clinical characteristics, mortality, aetiological agent and efficacy of diagnostic tests. MATERIAL AND METHOD: Non-concurrent prospective study of patients with AIFRS who were operated between 2005 and 2015 in our centre. RESULTS: Thirty-two patients were included, 62.5% (20/32) men, with an average age of 39.4 years (16-65 years). Overall mortality was 71.9%; acute mortality 46.9% and late mortality 25%. Haematological malignancies were the most common underlying disease, present in 84.4% (27/32) of cases, followed by diabetes mellitus in 9.4% (3/32). On diagnosis, 62.5% (20/32) of patients were neutropenic, 80% (16/20) of them with febrile neutropenia. Fever was the most frequent symptom, present in 65.6% (21/32) of patients, followed by facial pain or headache in 53.1% (17/32). Aspergillus was identified in 37.5% (12/32) of cases and Rhizopus in 31.3% (10/32). There was no association between the analysed variables and increased risk of mortality. CONCLUSIONS: AIFRS is an aggressive disease with a high mortality rate, therefore a timely diagnosis is fundamental. It is necessary to optimise suspicion criteria for an early diagnosis in order to improve the prognosis.
Asunto(s)
Infecciones Fúngicas Invasoras/cirugía , Rinitis/cirugía , Sinusitis/cirugía , Enfermedad Aguda , Adolescente , Adulto , Anciano , Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Aspergilosis/cirugía , Aspergillus/aislamiento & purificación , Terapia Combinada , Complicaciones de la Diabetes/epidemiología , Diagnóstico Precoz , Neutropenia Febril/inducido químicamente , Neutropenia Febril/complicaciones , Femenino , Neoplasias Hematológicas/complicaciones , Humanos , Huésped Inmunocomprometido , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Infecciones Fúngicas Invasoras/microbiología , Leucemia/complicaciones , Linfoma/complicaciones , Masculino , Persona de Mediana Edad , Mucormicosis/tratamiento farmacológico , Mucormicosis/cirugía , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/cirugía , Pronóstico , Estudios Prospectivos , Rinitis/tratamiento farmacológico , Rinitis/microbiología , Rhizopus/aislamiento & purificación , Factores de Riesgo , Sinusitis/tratamiento farmacológico , Sinusitis/microbiología , Adulto JovenRESUMEN
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
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
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
Cryptococcus spp. are common opportunistic fungal pathogens, particularly in HIV patients. The approved drug miltefosine (MFS) has potential as an alternative antifungal against cryptococcosis; however, the mechanism of action of MFS in Cryptococcus is poorly understood. Here, we examined the effects of MFS on C. neoformans and C. gattii yeasts (planktonic and biofilm lifestyles) to clarify its mechanism of action. MFS presented inhibitory and fungicidal effects against planktonic Cryptococcus cells, with similar activities against dispersion biofilm cells, while sessile biofilm cells were less sensitive to MFS. Interestingly, MFS had postantifungal effect on Cryptococcus, with a proliferation delay of up to 8.15 h after a short exposure to fungicidal doses. MFS at fungicidal concentrations increased the plasma membrane permeability, likely due to a direct interaction with ergosterol, as suggested by competition assays with exogenous ergosterol. Moreover, MFS reduced the mitochondrial membrane potential, increased reactive oxygen species (ROS) production, and induced DNA fragmentation and condensation, all of which are hallmarks of apoptosis. Transmission electron microscopy analysis showed that MFS-treated yeasts had a reduced mucopolysaccharide capsule (confirmed by morphometry with light microscopy), plasma membrane irregularities, mitochondrial swelling, and a less conspicuous cell wall. Our results suggest that MFS increases the plasma membrane permeability in Cryptococcus via an interaction with ergosterol and also affects the mitochondrial membrane, eventually leading to apoptosis, in line with its fungicidal activity. These findings confirm the potential of MFS as an antifungal against C. neoformans and C. gattii and warrant further studies to establish clinical protocols for MFS use against cryptococcosis.
Asunto(s)
Antifúngicos/farmacología , Apoptosis/efectos de los fármacos , Cryptococcus gattii/efectos de los fármacos , Cryptococcus neoformans/efectos de los fármacos , Fosforilcolina/análogos & derivados , Anfotericina B/farmacología , Biopelículas/efectos de los fármacos , Biopelículas/crecimiento & desarrollo , Membrana Celular/química , Membrana Celular/efectos de los fármacos , Membrana Celular/metabolismo , Permeabilidad de la Membrana Celular/efectos de los fármacos , Criptococosis/tratamiento farmacológico , Criptococosis/microbiología , Cryptococcus gattii/metabolismo , Cryptococcus gattii/ultraestructura , Cryptococcus neoformans/metabolismo , Cryptococcus neoformans/ultraestructura , Fragmentación del ADN/efectos de los fármacos , Ergosterol/metabolismo , Cápsulas Fúngicas/efectos de los fármacos , Cápsulas Fúngicas/metabolismo , Cápsulas Fúngicas/ultraestructura , Humanos , Potencial de la Membrana Mitocondrial/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Fosforilcolina/farmacología , Plancton/efectos de los fármacos , Plancton/crecimiento & desarrollo , Especies Reactivas de Oxígeno/agonistas , Especies Reactivas de Oxígeno/metabolismoRESUMEN
An evaluation of studies of biologically active nanoparticles provides guidance for the synthesis of nanoparticles with the goal of developing new antibiotics/antifungals to combat microbial resistance. This review article focuses on the physicochemical properties of cerium oxide nanoparticles (CeNPs) with antimicrobial activity. Method. This systematic review followed the Guidelines for Transparent Reporting of Systematic Reviews and Meta-Analyses. Results. Studies have confirmed the antimicrobial activity of CeNPs (synthesized by different routes) using nitrate or chloride salt precursors and having sizes less than 54 nm. Conclusion. Due to the lack of standardization in studies with respect to the bacteria and CeNP concentrations assayed, comparisons between studies to determine more effective routes of synthesis are difficult. The mechanism of CeNP action likely occurs through oxidative stress of components in the cell membrane of the microorganism. During this process, a valence change occurs on the CeNP surface in which an electron is gained and Ce4+ is converted to Ce3+.
Asunto(s)
Antiinfecciosos , Cerio , Nanopartículas , Infecciones Oportunistas/tratamiento farmacológico , Animales , Antiinfecciosos/síntesis química , Antiinfecciosos/química , Antiinfecciosos/uso terapéutico , Cerio/química , Cerio/uso terapéutico , Humanos , Nanopartículas/química , Nanopartículas/uso terapéutico , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/patologíaAsunto(s)
Antifúngicos/farmacología , Candida/efectos de los fármacos , Candida/aislamiento & purificación , Enfermedades Transmisibles Emergentes/tratamiento farmacológico , Adolescente , Alelos , Candida/clasificación , Candida/genética , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/microbiología , Femenino , Variación Genética , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/epidemiología , Infecciones Oportunistas/microbiologíaRESUMEN
SETTING: Tuberculosis (TB) in solid-organ transplants (SOTs) is an important opportunistic infection associated with mortality and graft loss. SOT recipients carry a higher risk of contracting active TB than the general population. Clinical and radiographic presentations are non-specific, and sputum smear and culture have low yields. TB patients with SOTs require standard anti-tuberculosis treatment. However, rifampicin (RMP) use is associated with a 30% rate of acute graft rejection (AGR) and a 20% rate of transplant loss. OBJECTIVE: To determine treatment outcomes in SOT recipients with active TB. DESIGN: A retrospective study of clinical and microbiological data and TB treatment outcomes. RESULTS: Among the 2349 transplants assessed, active TB was detected in 31 recipients; 55% had pulmonary TB and 40% were sputum smear-positive. In 32% of the patients, TB was diagnosed 30 days after symptom onset, 77% of the patients were cured and 10% died. AGR occurred in 13%. CONCLUSION: TB was diagnosed in <30 days. Anti-tuberculosis treatment without RMP (80% vs. 67%; P = 0.48, OR 0.5, 95%CI 0.07-3.55) and with moxifloxacin yielded higher treatment success rates and a lower risk of AGR.
Asunto(s)
Antituberculosos/uso terapéutico , Infecciones Oportunistas/epidemiología , Receptores de Trasplantes , Tuberculosis/epidemiología , Adolescente , Adulto , Colombia/epidemiología , Femenino , Fluoroquinolonas/uso terapéutico , Rechazo de Injerto/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Moxifloxacino , Infecciones Oportunistas/tratamiento farmacológico , Trasplante de Órganos , Estudios Retrospectivos , Rifampin/uso terapéutico , Factores de Riesgo , Esputo/microbiología , Resultado del Tratamiento , Tuberculosis/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Adulto JovenRESUMEN
This study presents a systematic review of the literature on the etiology of superficial and invasive candidiasis in Mexico reported from 2005 to 2015. The data have shown that Candida albicans is the most prevalent species with an increasing tendency of the non-C. albicans Candida species, as reported in other countries. The use of phenotypical methods in the identification of the yeasts limits the identification at the species level, particularly in species that are part of complexes, this is important because the identification only at the genus level leads to inadequate treatment due to the different susceptibility to the antifungals among species. In addition, this finding reveals the need to implement in clinical laboratories the molecular methods for the correct identification of the species involved, and the antifungal susceptibility tests to prevent the etiological changes associated with a poor therapeutic management.
Asunto(s)
Candida/aislamiento & purificación , Candidiasis/epidemiología , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Candida/clasificación , Candida/patogenicidad , Candidiasis/tratamiento farmacológico , Candidiasis/microbiología , Candidiasis Invasiva/epidemiología , Candidiasis Invasiva/microbiología , Comorbilidad , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Manejo de la Enfermedad , Susceptibilidad a Enfermedades , Farmacorresistencia Fúngica Múltiple , Humanos , México/epidemiología , Técnicas de Tipificación Micológica , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/epidemiología , Infecciones Oportunistas/microbiología , Especificidad de la EspecieRESUMEN
Histoplasmosis is a systemic mycosis that is considered an important public health problem. In this work, we performed a descriptive, observational, cross-sectional and retrospective study with a secondary data analysis of medical records from 2000 to 2012 at a tertiary hospital. The study sample consisted of 275 patients with laboratory-confirmed Disseminated Histoplasmosis (DH)/AIDS. The results showed that the prevalence of DH associated with AIDS was 4.4%. The majority of patients were young adult men with fever in 84.2%, cough in 63.4%, weight loss in 63.1%, diarrhoea in 44.8% and skin manifestations in 27.6% of patients. In the overall cohort, the CD4 counts were low, but not significantly different in survivors and non-survivors. Higher levels of urea and lower levels of haemoglobin and platelets were observed in non-survivor patients (<.05). The global lethality was 71.3% (196/275). The results with high prevalence and lethality highlight the need to adopt measures to facilitate early diagnosis, proper treatment and improved prognosis.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Histoplasmosis/epidemiología , Infecciones Oportunistas/epidemiología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adolescente , Adulto , Anciano , Antifúngicos/uso terapéutico , Brasil/epidemiología , Recuento de Linfocito CD4 , Niño , Estudios de Cohortes , Estudios Transversales , Femenino , Hemoglobinas/análisis , Histoplasmosis/tratamiento farmacológico , Histoplasmosis/mortalidad , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/mortalidad , Recuento de Plaquetas , Prevalencia , Estudios Retrospectivos , Centros de Atención Terciaria/estadística & datos numéricos , Urea/análisis , Adulto JovenAsunto(s)
Lesión Renal Aguda/virología , Infecciones por Adenovirus Humanos/virología , Fiebre/virología , Trasplante de Riñón/efectos adversos , Nefritis Intersticial/virología , Infecciones Oportunistas/virología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/tratamiento farmacológico , Lesión Renal Aguda/inmunología , Infecciones por Adenovirus Humanos/diagnóstico , Infecciones por Adenovirus Humanos/tratamiento farmacológico , Infecciones por Adenovirus Humanos/inmunología , Adulto , Antivirales/uso terapéutico , Biopsia , Fiebre/diagnóstico , Fiebre/tratamiento farmacológico , Fiebre/inmunología , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Masculino , Nefritis Intersticial/diagnóstico , Nefritis Intersticial/tratamiento farmacológico , Nefritis Intersticial/inmunología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/inmunologíaRESUMEN
Necrotizing fasciitis is a rapidly progressive destructive soft tissue infection with high mortality. Streptococcus pneumoniae as etiologic agent of necrotizing fasciitis is extremely unusual. The increased susceptibility to Streptococcus pneumoniae infection in patients with systemic lupus erythematosus is probably a multifactorial phenomenon. We report a case of a patient, a 36-year-old Caucasian female with 8-year history of systemic lupus erythematosus who presented a fatal Streptococcus pneumoniae necrotizing fasciitis. The role of computed tomography and the high performance of blood cultures for isolation of the causative microorganism are emphasized. Once diagnosis is suspected, empiric antibiotic treatment must be prescribed and prompt surgical exploration is mandatory.