RESUMO
Relatamos a ocorrência da Síndrome Inflamatória da RecuperaçãoImune (IRIS), após reversão de agranulocitose, induzida por poliquimioterapia,em paciente do sexo feminino acometida por hanseníasedimorfa-virchowiana. Propomos que em todos os pacientes submetidosà poliquimioterapia para hanseníase sejam efetuados periodicamenteexames laboratoriais que possam identificar precocementedistúrbios hematológicos graves
We report the occurrence of Immune Reconstitution InflammatorySyndrome (IRIS) after reversal of agranulocytosis provoked by drugor drugs used in the treatment of leprosy. After suspension of thedrugs under suspicion and the recovery of the hematologic disturbanceand as consequence the restoration of the immune conditionwe started an alternate treatment for Hansens disease. Takingthis case as an example, we propose that all patients with leprosyand under treatment with drugs such as dapsone and/ or rifampicinshould have a periodical hemogram to identify premature hematologicanomalies.
Assuntos
Feminino , Humanos , Adulto , Agranulocitose , Hanseníase Multibacilar , Síndrome Inflamatória da Reconstituição Imune , Clofazimina , Dapsona , Quimioterapia Combinada , Relatos de Casos , RifampinaRESUMO
PURPOSE: The vascular function in HIV-infected persons under HAART and non-HIV-infected persons was investigated. METHOD: 18 HIV-positive patients and 23 HIV-negative subjects (14 younger group and 9 older group) were evaluated for microvascular vasodilatation during postocclusive reactive hyperemia (PORH) and during prolonged local thermal hyperemia; overall microvascular flux increase induced by iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) and large artery stiffness (SI(DVP)). RESULTS: Cutaneous vascular conductance (CVC) responses to ACh were lower in HIV patients compared to both HIV-negative groups (mean [SEM]) (HIV positive: 878.2 [99.5]; older HIV negative: 1129.3 [231.6]; younger HIV negative: 1366.5 [172.6] % baseline). Regarding SNP iontophoresis, HIV-positive and older HIV-negative groups showed lower CVC responses than younger HIV-negative group (HIV positive: 1043.0 [164.6]; older HIV-negative: 980.8 [108.3]; younger HIV-negative: 1757.3 [245.1] % baseline). Vasodilatation induced by thermal hyperemia (HIV positive: 1.63 [0.11]; older HIV negative: 1.48 [0.08]; younger HIV negative: 1.85 [0.27] perfusion units/mm Hg) and PORH (HIV positive: 0.374 [0.025]; older HIV negative: 0.326 [0.025]; younger HIV negative: 0.326 [0.037] PU/mm Hg) were similar between all groups. SIDVP was greater in HIV and older healthy groups than younger healthy group (HIV positive: 9.17 [0.42]; older HIV negative: 8.19 [0.43]; younger HIV negative: 6.42 [0.22] m/s). CONCLUSION: HIV-infected patients under HAART exhibited slight but nonsignificant lower microvascular reactivity to pharmacological stimuli and increased arterial stiffness compared to age-matched HIV-negative subjects. Comparison of both HIV-positive and older HIV-negative groups with younger HIV-negative subjects suggests that age plays a major role in microvascular reactivity regardless the HIV-infection.
Assuntos
Artérias/fisiopatologia , Infecções por HIV/fisiopatologia , Microcirculação/fisiologia , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Fluxometria por Laser-Doppler , Masculino , Pessoa de Meia-Idade , Pele/irrigação sanguínea , VasodilataçãoRESUMO
Multidrug therapy (WHO/MDT) in multibacillary leprosy consists of treatment with rifampicin, dapsone andclofazimine. However, adverse effects can cause the patient to abandon treatment. We report on a patient whopresented agranulocytosis and hemolytic anemia associated with this treatment regime. We also examined theimportance of laboratory exams for diagnosis and follow-up of the patient, and for early detection of adverse effects, with a view to improving adhesion to treatment and contributing to the eradication of Hansens disease as a public health issue.
Assuntos
Adulto , Feminino , Humanos , Agranulocitose/induzido quimicamente , Anemia Hemolítica/induzido quimicamente , Hansenostáticos/efeitos adversos , Clofazimina/efeitos adversos , Dapsona/efeitos adversos , Quimioterapia Combinada/efeitos adversos , Hanseníase/tratamento farmacológico , Rifampina/efeitos adversosRESUMO
Multidrug therapy (WHO/MDT) in multibacillary leprosy consists of treatment with rifampicin, dapsone and clofazimine. However, adverse effects can cause the patient to abandon treatment. We report on a patient who presented agranulocytosis and hemolytic anemia associated with this treatment regime. We also examined the importance of laboratory exams for diagnosis and follow-up of the patient, and for early detection of adverse effects,with a view to improving adhesion to treatment and contributing to the eradication of Hansen's disease as a public health issue.
Assuntos
Agranulocitose/induzido quimicamente , Anemia Hemolítica/induzido quimicamente , Hansenostáticos/efeitos adversos , Adulto , Clofazimina/efeitos adversos , Dapsona/efeitos adversos , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Hanseníase/tratamento farmacológico , Rifampina/efeitos adversosRESUMO
Os autores apresentam uma série clínica de vinte e dois pacientes adultos infectados pelo Stafilococcus Aureus meticilino resistente (MRSA), de 1997 a 1999, observados do Hospital Universitário Lauro Wanderley (HULW) em João Pessoa - Paraíba - Brasil. Além disso, enfatizam o intervalo médio entre a admissão do paciente e o diagnóstico da infecção por MRSA, quantificam a incidência de casos, a distribuição por sexo e por faixa etária, determinam o índice de mortalidade e abordam sobre a dificuldade atual no manuseio destas cepas meticilino-resistente
Assuntos
Humanos , Masculino , Feminino , Adulto , Infecção Hospitalar/diagnóstico , Resistência a Meticilina , TerapêuticaAssuntos
Humanos , Feminino , Adulto , Aracnoidite , Meningoencefalite , Tuberculoma Intracraniano , Tuberculose MeníngeaRESUMO
Relata-se um caso de ofidismo em uma vítima de 53 anos de idade, procedente de Mamanguape-PB, picada por jararaca (Bothrops erythromelas) no pé e que se estendeu com lesöes externas equimóticas comprometendo todo o membros inferiores e regiäo dorsal. Tratada com soro antiofídico e antibióticos, teve alta após 14 dias de hospitalizaçäo