ABSTRACT
ABSTRACT Herein we report a fatal case of donor-derived transmission of XDR-resistant carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) in cardiac transplantation. A 59-year-old male patient with non-obstructive hypertrophic cardiomyopathy underwent heart transplantation. On day 5 post-operation, blood cultures from the donor were positive for colistin-resistant carbapenemase-producing K. pneumoniae (ColR KPC-Kp) susceptible only to amikacin. Recipient blood cultures were also positive for ColR KPC-Kp with the same sensitivity profile as the donor isolate with an identical PFGE pattern. The patient was treated with double-carbapenems and amikacin. The patient evolved to pericarditis, osteomyelitis, and pulmonary necrosis, all fragment cultures positive for the same agent. The patient developed septic shock, multiple organ failure and died on day 50 post-transplantation. Based on current microbiological scenario worldwide the possibility of transmitting multidrug resistant (MDR) organisms should be considered.
Subject(s)
Humans , Male , Middle Aged , Tissue Donors , Klebsiella Infections/transmission , Heart Transplantation/adverse effects , Transplant Recipients , Carbapenem-Resistant Enterobacteriaceae/isolation & purification , Klebsiella pneumoniae/isolation & purification , Klebsiella Infections/drug therapy , Risk Factors , Colistin/pharmacology , Fatal Outcome , Drug Resistance, Multiple, Bacterial , Anti-Bacterial Agents/pharmacologyABSTRACT
Objective: To evaluate the incidence and spectrum of abdominal computed tomography imaging findings in patients with paracoccidioidomycosis. Materials and Methods: Retrospective analysis of abdominal computed tomography images of 26 patients with disseminated paracoccidioidomycosis. Results: Abnormal abdominal tomographic findings were observed in 18 patients (69.2%), while no significant finding was observed in the other 8 (30.8%) patients. Conclusion: Computed tomography has demonstrated to play a relevant role in the screening and detection of abdominal abnormalities in patients with disseminated paracoccidioidomycosis. .
Objetivo: Avaliar a frequência e variedade de achados de imagem por exames de tomografia computadorizada de abdome em indivíduos com paracoccidioidomicose disseminada. Materiais e Métodos: Estudo retrospectivo dos exames de tomografia computadorizada de abdome de 26 pacientes com paracoccidioidomicose disseminada. Resultados: Foram encontradas alterações tomográficas abdominais em 18 pacientes (69,2%) dos casos analisados e 8 pacientes (30,8%) apresentaram exames normais. Conclusão: A tomografia computadorizada de abdome mostrou grande importância no rastreamento e identificação de alterações abdominais nos pacientes com paracoccidioidomicose disseminada. .
Subject(s)
Adult , Female , Humans , Infant, Newborn , Pregnancy , Abortifacient Agents, Nonsteroidal , Fetal Death , Misoprostol , Oxytocics , Infusions, Intravenous , Labor, Induced/methods , Pregnancy Outcome , Randomized Controlled Trials as Topic , UgandaABSTRACT
A tuberculose é uma doença infecciosa de grande impacto social causada pelo Mycobacterium tuberculosis. O relatório da Organização Mundial da Saúde (OMS) 2010 estima em 14 milhões o número de pessoas com tuberculose no mundo, com concentração crescente nos países com baixo desenvolvimento social. Em 1993, a OMS lançou o Tratamento Diretamente Supervisionado de Curto Prazo (DOTS), considerado a estratégia mais efetiva no controle da tuberculose em grandes proporções. O DOTS foi introduzido no Brasil em 1998, priorizando cidades com altos índices de casos. Estudos afirmam que houve progresso em diagnóstico, tratamento e rastreamento da tuberculose. O objetivo deste estudo foi revisar a literaturasobre as políticas de controle da tuberculose no mundo e no Brasil, enfatizando a estratégia DOTS. Foram selecionados documentos técnicos da OMS e do Ministério da Saúde do Brasil e artigos científicos nas bases Pubmed e Scielo, estes últimos publicados entre janeiro de 1993 e janeiro de 2010, utilizando-se os descritores: DOTS-plus, treatment, HIV, tuberculosis e DOTS. Foram selecionados 21 artigos científicos de 178 publicações em periódicos e 11 documentos técnicos. Esta literatura enfatiza as políticas de controle da tuberculose no Brasil, no mundo e suatrajetória. Conclui-se que estratégias como o DOTS demandam longo período de adaptação dos profissionais da saúde e dos governos locais, mas já se observa melhora dos indicadores de controle da tuberculose com essas políticas.
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis that has a huge social impact. According to the World Health Organization (WHO) report published in 2010, an estimated 14 million people worldwide are infected with active tuberculosis (TB) with an increasing concentration in countries with low social development. In 1993, WHO published Directly Observed Treatment Short Course (DOTS) Guidelines, that are considered the most effective strategy on tuberculosis control in large scale. DOTS was implemented in Brazil in 1998, prioritizingcities with high tuberculosis incidence rates. Studies sustain that a very significant progress has been made regarding diagnosis, treatment and screening of tuberculosis. The objective of this study was to review literature on tuberculosis control policies around the world and in Brazil, emphasizing the DOTS strategy. Technical documents from WHO and Brazilian Health Ministry as well as scientific articles from Pubmed and Scielo databases from January 1993 to January 2010 were screened using as keywords: DOTSplus, treatment, HIV, tuberculosis and DOTS. Twenty one articleswere selected from 178 publications and 11 technical documents. The literature emphasized tuberculosis control policies in Brazil and around the world, characterizing the development until today. It is concluded that strategies such as DOTS require a long period of adjustments by health professionals and local governments. Improvements have already been shown in tuberculosis rates with those policies.