RESUMO
Toxoplasmosis is an infrequent infection in solid organ transplantation, except in heart transplantation, where the grafting of a positive organ in a negative recipient transmits the infection in a high percentage of cases, in the absence of prophylaxis. We report a case of pneumonia by Toxoplasma gondii in a woman who received a liver transplant and had pre-transplant positive serology. Diagnosis was made by cytologic examination of bronchoalveolar lavage fluid, where the parasite was observed with hematoxylin-eosin and Giemsa staining. That finding was confirmed by direct immunofluorescence and positive polymerase chain reaction. The patient had a favorable outcome, although she had not initially received first-choice drugs. This was a case of severe illness secondary to reactivation of Toxoplasma infection, diagnosed pre-mortem and with a favorable outcome. Duration of treatment and need for secondary prophylaxis in these patients are discussed in the literature. Although infrequent, toxoplasmosis must be considered among the differential diagnoses of pulmonary infiltrates in solid organ transplantation.
Assuntos
Transplante de Fígado/efeitos adversos , Pneumonia/parasitologia , Toxoplasma/fisiologia , Toxoplasmose/parasitologia , Animais , Anti-Infecciosos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Pneumonia/tratamento farmacológico , Recidiva , Sobrevida , Toxoplasma/isolamento & purificação , Toxoplasmose/tratamento farmacológicoRESUMO
Trovafloxacin, once administrated by oral route, is rapidly absorbed and reaches its maximum seric concentration in about one hour. Alatrofloxacin is the prodrug, that is rapidly hydrolyzed to its original state when administered intravenously. Its bioavailability is equivalent when administered either oral or intravenously. It is a fluoroquinolone of extensive in vitro spectrum, with a higher activity for Gram positive coccus, anaerobic and atypical pneumonia-producing bacteria. The average half-life is around eleven hours, with an enhanced protein bound that allows to administrate it only once a day. The renal excretion is under 8%; it doesn't require any doses adjustment in renal insufficiency. Trovafloxacin reaches higher tissue and intracelular concentrations than classic fluoroquinolones. All these pharmacokinetic and pharmacodynamic characteristics allow to consider trovafloxacin as an interesting drug for the treatment of mixed infections or those resistant to the first line drugs.
Assuntos
Anti-Infecciosos/farmacocinética , Bactérias Anaeróbias/efeitos dos fármacos , Fluoroquinolonas , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Naftiridinas/farmacocinética , Humanos , Testes de Sensibilidade MicrobianaRESUMO
Trovafloxacin, once administrated by oral route, is rapidly absorbed and reaches its maximum seric concentration in about one hour. Alatrofloxacin is the prodrug, that is rapidly hydrolyzed to its original state when administered intravenously. Its bioavailability is equivalent when administered either oral or intravenously. It is a fluoroquinolone of extensive in vitro spectrum, with a higher activity for Gram positive coccus, anaerobic and atypical pneumonia-producing bacteria. The average half-life is around eleven hours, with an enhanced protein bound that allows to administrate it only once a day. The renal excretion is under 8
; it doesnt require any doses adjustment in renal insufficiency. Trovafloxacin reaches higher tissue and intracelular concentrations than classic fluoroquinolones. All these pharmacokinetic and pharmacodynamic characteristics allow to consider trovafloxacin as an interesting drug for the treatment of mixed infections or those resistant to the first line drugs.
Assuntos
Humanos , Endocardite Bacteriana/prevenção & controle , Endocardite Bacteriana/etiologia , Endocardite Bacteriana Subaguda/etiologia , Endocardite Bacteriana Subaguda/prevenção & controle , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/normas , Próteses Valvulares Cardíacas/normas , Antibacterianos/normas , Assistência Médica/normas , Extração Dentária/efeitos adversosAssuntos
Humanos , Endocardite Bacteriana/prevenção & controle , Antibacterianos/normas , Endocardite Bacteriana/etiologia , Endocardite Bacteriana Subaguda/etiologia , Endocardite Bacteriana Subaguda/prevenção & controle , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/normas , Extração Dentária/efeitos adversos , Assistência Médica/normas , Próteses Valvulares Cardíacas/normasRESUMO
Pseudomonas mendocina has been isolated from soil and water samples. Although it has been recovered from some human clinical samples, its pathogenic role has not yet been documented. We report the first known case of endocarditis in humans due to P. mendocina.