RESUMO
We report a case of cerebral phaeohyphomycosis, a fungal brain infection due to a dark (dematiaceous) fungi in a 6-year-old French Guyanese boy. The child presented fever and drowsiness due to several paraventricular brain abscesses. Neurological surgeries were performed to reduce intracranial hypertension and to obtain abscess biopsies. Mycological cultures of intraoperative samples led to the diagnosis of cerebral phaeohyphomycosis due to Cladophialophora bantiana. The patient neurological status deteriorated and remained critical after several weeks of combination antifungal therapy with voriconazole 8mg/kg/day, liposomal amphotericin B 10mg/kg/day and flucytosine 200mg/kg/day. A complete surgical resection was not possible because of multiple small abscesses. A multidisciplinary ethical staff decided on home medical care with palliative ventriculoperitoneal shunt, nasogastric feeding and analgesics. One year later, the patient's neurological condition had improved and cerebral lesions had regressed, while he had not received any antifungal treatment but only traditional medicines. Cerebral phaeohyphomycosis are rare diseases affecting immunocompromised but also apparently non-immunocompromised patients, as in this case. A complete surgical resection is not always possible and mortality rates are high in spite of treatments with a combination of antifungals. The diagnosis may be difficult because of these dematiaceous fungi's slowly growing and their potential pathogenicity for laboratory staff.
Assuntos
Ascomicetos/isolamento & purificação , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Feoifomicose Cerebral/diagnóstico , Antifúngicos/uso terapêutico , Ascomicetos/fisiologia , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/microbiologia , Abscesso Encefálico/terapia , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/terapia , Feoifomicose Cerebral/microbiologia , Feoifomicose Cerebral/terapia , Criança , Terapia Combinada , Nutrição Enteral , Guiana Francesa , Humanos , Imunocompetência , Intubação Gastrointestinal , Masculino , Procedimentos Neurocirúrgicos , Derivação VentriculoperitonealRESUMO
OBJECTIVE: To study the frequency and types of suboptimal care in initial management of children suffering from a severe bacterial infection (SBI), in a French region where little is known about pediatric SBI epidemiology. METHOD: Retrospective single-center study over a 6-year period. Children between 3 months and 15 years of age, deceased or surviving and admitted to the pediatric intensive care unit of the university-affiliated hospital of Martinique for a community-onset SBI were included in this study. The optimality of the medical care before admission to the pediatric intensive care unit was assessed in a blinded fashion by two independent experts. RESULTS: Twenty-nine of the 30 children suffering from SBI could be analyzed. The median age was 3.7 years (IQR: 1.7-10.4); the mortality rate was 14 % (95 % CI: 1-27 %). Most frequently infections were pulmonary infections (48 %; 95 % CI: 29-67 %), followed by septic shock (44 %; 95 % CI: 25-63 %). Microbiological cultures were positive in 55 % (95 % CI, 36-74 %) (n=16) of the cases, with five pneumococcus and four Streptococcus pyogenes. Of the 29 children included in the study, 72 % (95 % CI: 55-89 %) (n=21) had received at least one episode of suboptimal care. Suboptimal care comprised delay in diagnosis (identification of serious symptoms) in 65 % (95 % CI: 47-83 %), a delay in seeking care in 41 % (95 % CI: 22-60 %), and a delay in the initiation of antibiotics or hemodynamic support in 45 % (95 % CI: 26-64 %) and 38 % (95 % CI: 20-56 %) of the cases, respectively. CONCLUSION: Suboptimal care was frequent in the initial management of SBI, particularly because of a delay in seeking care and the failure of physicians to recognize early signs of SBI. A large public information campaign, focusing on healthcare accessibility and better education of physicians in the early recognition of SBIs are means of improvement that need to be explored.
Assuntos
Infecções Bacterianas/diagnóstico , Infecções Comunitárias Adquiridas/diagnóstico , Adolescente , Antibacterianos/uso terapêutico , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Competência Clínica , Infecções Comunitárias Adquiridas/microbiologia , Diagnóstico Tardio , Feminino , Hospitais Universitários , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Martinica/epidemiologia , Estudos Retrospectivos , Tempo para o TratamentoRESUMO
OBJECTIVES: The aim of this study is to evaluate the screening for trisomy 21 (T21) between 2011 and 2013 on Martinique French West Indies after the decree of 23 June 2009. MATERIALS AND METHODS: Were used the prenatal data provided by accredited laboratories and the data from the Registry of Congenital French West Indies (REMALAN). RESULTS: A total of 85.9 % of patients underwent screening: 60.5 % on a combined calculation of risk (CRC), 14.6 % on a sequential calculation of risk (CRS) and 10.8 % on serum markers 2nd trimester (MST2). Overall 5.4 % of the patients were placed in a risk group. During this period, 47 trisomy 21 were identified by the REMALAN which 38 (80.1 %) were detected prenatally: 24 of CRC, 3 on MST2 and 11 on signs of ultrasound at the 1st and 2nd trimester. The sensitivity of the CRC was 88 % for a false positive rate of 3.87 %. The overall sensitivity of screening (CRC, CRS and MST2) was 87 % for a false positive rate of 5.21 %. CONCLUSION: These data show that the coverage rate in Martinique is satisfactory and the screening fir Down syndrome meet expectations.
Assuntos
Atenção à Saúde/normas , Síndrome de Down/diagnóstico , Diagnóstico Pré-Natal/normas , Sistema de Registros , Adulto , Atenção à Saúde/estatística & dados numéricos , Feminino , Humanos , Martinica , Gravidez , Diagnóstico Pré-Natal/estatística & dados numéricosRESUMO
Fungal colonization is a common occurrence in preterm neonates. Our objective was to describe the profile and characteristics of fungal colonization in preterm infants admitted to the Martinique NICU. From March 2012 to January 2013, an epidemiological prospective cohort study was conducted with 57 very low-birth-weight infants. Cutaneous, rectal, gastric, respiratory, and urinary swabs were collected on admission, then every week for 4 weeks. The prevalence of fungal colonization was 68% (39/57): 46% by Malassezia species, 28% by Candida parapsilosis, 19% by C. albicans, 5% by C. glabrata, and 2% by C. guilliermondii. The colonized patients had a duration of parenteral nutrition and antibiotic therapy longer than the others (P<0.05). Nosocomial colonization (after 2 days of life) occurred in 52% of cases: Malassezia species and C. parapsilosis were the commensal skin yeasts most frequently implicated. Forty-nine percent (28/57) had suspected invasive fungal infections that received probabilistic treatment. Only one case of invasive fungal infection with C. glabrata was diagnosed. This study highlights the important role played by nosocomial transmission in the colonization of preterm newborns. Mycological surveillance cultures in the NICU are very useful for monitoring fungal ecology and can improve the prevention of fungal colonization in preterm infants at risk of invasive fungal infection.