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1.
Med. U.P.B ; 39(2): 31-41, 21/10/2020.
Article in Spanish | LILACS, COLNAL | ID: biblio-1123578

ABSTRACT

Cavitation is a common finding in lung images, secondary to infectious, inflammatory, tumor, and autoimmune conditions, the former being the most common cause in all levels of care and geography. The diagnostic approach must be judicious, integrating the image, with the patient's medical history, personal history, and exposures, as well as the time of evolution of the symptoms; which are key elements for the approach. It is always essential to integrate the clinical findings with the laboratory and the pathology in order to reach an accurate diagnosis and timely treatment, since the isolated image is not enough, given the multiple etiologies described and variety of presentation that make this radiological sign only a premise to the confirmation of an underlying disease.


Una cavitación es un hallazgo común en imágenes pulmonares, secundaria a condiciones infecciosas, inflamatorias, tumorales y autoinmunes, siendo las primeras la causa más común en todos los niveles de atención y geográficos. El abordaje diagnóstico debe ser riguroso, integrando la imagen con la historia clínica del paciente, sus antecedentes personales y exposiciones, así como el tiempo de evolución de los síntomas; estos son elementos clave para el enfoque. Siempre es fundamental integrar los hallazgos clínicos con el laboratorio y la patología para llegar a un diagnóstico preciso y a un tratamiento oportuno, pues la imagen aislada no es suficiente, dadas las múltiples etiologías descritas y la variedad de presentación que hacen de este signo radiológico solo una premisa a la confirmación de una enfermedad subyacente.


Uma cavitação é uma descoberta comum em imagens pulmonares, secundária a condições infecciosas, inflamatórias, tumorais e autoimunes, sendo as primeiras a causa mais comum em todos os níveis de atenção e geográficos. A abordagem diagnóstica deve ser rigorosa, integrando a imagem com a história clínica do paciente, seus antecedentes pessoais e exposições, assim como o tempo de evolução dos sintomas; estes são elementos chave para o enfoque. Sempre é fundamental integrar as descobertas clínicas com o laboratório e a patologia para chegar a um diagnóstico preciso e a um tratamento oportuno, pois a imagem isolada não é suficiente, dadas as múltiplas etiologias descritas e a variedade de apresentação que fazem deste signo radiológico só uma premissa à confirmação de uma doença subjacente.


Subject(s)
Humans , Lung Diseases , Aspergillosis , Tuberculosis , Cavitation , Pulmonary Infarction
2.
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1363-1368, July-Aug. 2020. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1131490

ABSTRACT

In this study we describe the epidemiology, clinical signs, and pathology of an outbreak of avian aspergillosis in alternative breeding in the southern region of Rio Grande do Sul, Brazil. Between the fifth and tenth day of life, 360 chicks from a flock of 4000 developed unspecific clinical signs and died. The birds were housed in a reused aviary litter, without previous treatment. In 11 six-day-old female ISA Brown chicks (Gallus gallus domesticus), necropsy revealed firm, yellowish-white, multinodular lesions extending from the pleura to the lung parenchyma. Histologically, a granulomatous, multifocal to coalescent pneumonia was observed. Granulomas were characterized by central necrosis, with heterophil and epithelioid macrophage infiltration and presence of countless Y-shaped intralesional septate hyphae morphologically compatible with Aspergillus spp. The diagnosis through isolation confirmed Aspergillus fumigatus. We highlight the importance of aspergillosis as a primary cause of diseases in the respiratory tract of young birds in alternative breeding. Measures to prevent aspergillosis mainly regarding the reuse of aviary litter are essential in poultry husbandry to prevent economic losses, reduce environmental contamination and mitigate the potential risk to public health.(AU)


Descrevem-se os aspectos epidemiológicos e patológicos de um surto de aspergilose aviária em criação alternativa na região sul do Rio Grande do Sul, Brasil. De um lote de 4000 pintainhas, entre o quinto e o 10º dia de vida, 360 aves apresentaram sinais clínicos inespecíficos e morreram. As aves foram alojadas em cama reutilizada do aviário, sem tratamento prévio. Na necropsia de 11 pintainhas (Gallus gallus domesticus), fêmeas, seis dias de idade da linhagem Isa Brown, foram observadas no pulmão lesões multinodulares, branco-amareladas e firmes, que se estendiam da pleura ao parênquima. Histologicamente foi observada pneumonia granulomatosa, multifocal a coalescente. Os granulomas eram caracterizados por necrose central, com infiltrado inflamatório de heterófilos, macrófagos, células epitelioides com presença de inúmeras hifas septadas intralesionais, semelhantes à letra "Y", morfologicamente compatíveis com Aspergillus spp. O diagnóstico foi confirmado pelo isolamento de Aspergillus fumigatus. Alerta-se para a importância da aspergilose como causa primária de afecções no trato respiratório de aves jovens em criações alternativas. Medidas preventivas relacionadas ao manejo dessas aves são indispensáveis principalmente quanto à reutilização da cama dos aviários, a fim de evitar perdas econômicas, reduzir a contaminação ambiental e o potencial risco à saúde pública.(AU)


Subject(s)
Animals , Poultry/microbiology , Aspergillosis/epidemiology , Aspergillus fumigatus/isolation & purification , Chickens/microbiology , Brazil
3.
Medicina (B.Aires) ; 80(4): 397-400, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1154836

ABSTRACT

Resumen La traqueobronquitis aspergilar es una forma poco frecuente de aspergilosis invasiva reportada excepcionalmente en el paciente inmunocompetente. Su diagnóstico es difícil, y los tratamientos propuestos hasta ahora son de escasa efectividad, todo lo cual constituye un verdadero problema para el equipo de salud. Presentamos el caso de una paciente de 28 años, inmunocompetente y sin antecedentes epidemiológicos, que desarrolló traqueobronquitis necrotizante por aspergilosis invasiva y recibió tratamiento con voriconazol con instilación local por broncoscopia con buena respuesta.


Abstract Aspergillus tracheobronchitis is a rare form of invasive aspergillosis reported exceptionally in the immunocompetent patient. Its diagnosis is difficult, and the treatments proposed so far are of little effectiveness, all of which constitute a real problem for the health team. We present the case of an immunocompetent 28 yearsold woman, with no epidemiological background, who developed necrotizing tracheobronchitis due to invasive aspergillosis and received voriconazole with local instillation by bronchoscopy with a good response.


Subject(s)
Humans , Female , Adult , Aspergillosis , Respiratory Tract Infections , Tracheitis , Bronchitis , Bronchoscopy , Antifungal Agents
4.
Pesqui. vet. bras ; 40(2): 102-106, Feb. 2020. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1098449

ABSTRACT

Susceptibility testing is essential to inform the correct management of Aspergillus infections. In this study we present antifungal susceptibility profile of A. fumigatus isolates recovered from lungs of birds with and without aspergillosis. Fifty three isolates were tested for their antifungal susceptibility to voriconazole (VRC), itraconazole (ITZ), amphotericin (AMB) and caspofungin (CSP) using the M38-A2 broth microdilution reference method. Five isolates were resistant to more than one antifungal drug (CSP + AMB, VRC + ITZ and AMB + ITZ). Fifteen (28%) isolates with susceptible increased exposure (I) to ITZ were sensible to VRC. Resistance to AMB (>2µg/mL) was observed in only four isolates. Eleven (21%) A. fumigatus present resistance to ITZ (13%) and VRC (8%). Fungal isolation from respiratory samples has been regarded as being of limited usefulness in the ante mortem diagnosis of aspergillosis in birds. However, the results suggest that the detection and antifungal susceptibility profile may be helpful for monitoring of therapy for avian species and where antifungal resistance might be emerging and what conditions are associated to the event.(AU)


Os testes de suscetibilidade são essenciais para informar o correto manejo das infecções por Aspergillus. Neste estudo apresentamos o perfil antifúngico de isolados de A. fumigatus provenientes de pulmões de aves com e sem aspergilose. Cinqüenta e três isolados foram testados quanto à susceptibilidade antifúngica ao voriconazol (VRC), itraconazol (ITZ), anfotericina B (AMB) e caspofungina (CSP) pelo método de referência de microdiluição do caldo M38-A2. Cinco isolados foram resistentes a mais de um antifúngico (CSP + AMB, VRC + ITZ e AMB + ITZ). Quinze (28%) isolados suscetíveis - com exposição aumentada (I) ao ITZ foram sensíveis ao VRC. A resistência ao AMB (>2µg/mL) foi observada em apenas quatro isolados. Onze (21%) A. fumigatus apresentaram resistência a ITZ (13%) e VRC (8%). O isolamento de fungos de amostras respiratórias tem sido considerado de utilidade limitada no diagnóstico ante mortem de aspergilose em aves. No entanto, os resultados sugerem que a detecção e o perfil de suscetibilidade a antifúngicos podem ser úteis para o monitoramento da terapia de espécies aviárias, assim como a emergência da resistência antifúngica e quais condições podem estar associadas ao evento.(AU)


Subject(s)
Animals , Poultry Diseases , Aspergillosis/drug therapy , Aspergillosis/veterinary , Aspergillus fumigatus/isolation & purification , Aspergillus fumigatus/drug effects , Chickens , Drug Resistance, Fungal/drug effects , Antifungal Agents/therapeutic use
5.
Arq. bras. med. vet. zootec. (Online) ; 72(1): 65-70, Jan.-Feb. 2020. ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1088922

ABSTRACT

O presente trabalho relata o caso de aspergilose sistêmica em um cavalo da raça Quarto de Milha. O animal apresentava quadro de emagrecimento progressivo e alopecia. Os parâmetros avaliados durante o exame clínico encontravam-se de acordo com os valores normais para a espécie. No hemograma verificou-se leucocitose por neutrofilia, sem desvio à esquerda, proteínas plasmáticas totais elevadas e aumento do fibrinogênio, indicando um processo inflamatório acompanhado de desidratação. Os exames bioquímicos séricos demonstraram aumento no valor da ureia. Apesar dos exames realizados e da terapia instituída com antibióticos de amplo espectro e suporte nutricional, após 51 dias de internamento o quadro clínico evoluiu para caquexia e decúbito permanente do paciente, o qual foi submetido à eutanásia seguida de necropsia. Com base nos achados nos exames necroscópico e histopatológico, diagnosticou-se infecção sistêmica por Aspergillus sp., acometendo pulmões, fígado, rins, peritônio parietal e encéfalo. Dentre os fatores predisponentes à relatada infecção fúngica sistêmica, destaca-se o status imunológico debilitado do paciente, possivelmente proporcionado por tratamentos prolongados com antibióticos e anti-inflamatórios esteroidais. O presente trabalho relata o primeiro caso descrito de arpergilose sistêmica no Brasil. O diagnóstico definitivo só foi possível após necropsia e histopatologia, visto que os sinais clínicos inespecíficos não foram determinantes para o diagnóstico em vida.(AU)


This paper reports the case of systemic aspergillosis on a Quarter Horse. The animal had progressive weight loss and alopecia. The parameters evaluated during the clinical examination were in agreement with the normal values for the species. The hemogram showed neutrophilic leukocytosis, without left-sided, elevated total plasma proteins and an increase in fibrinogen, indicating an inflammatory process accompanied by dehydration. Serum biochemical tests showed an increase in the value of urea. Despite the performed tests and established therapy with broad spectrum antibiotics and nutritional support, after 51 days of hospitalization the clinical condition evolved into cachexia and permanent decubitus of the patient which underwent to euthanasia and necropsy. From the findings of necropsy and histopathology, systemic infection was diagnosed by Aspergillus sp., affecting the lungs, liver, kidneys, parietal peritoneum and encephalon. Among the factors predisposing to the reported systemic fungal infection, the patient's weakened immune status is highlighted, possibly due to prolonged antibiotic and steroidal anti-inflammatory treatments. This paper reports the first case described of systemic aspergillosis in Brazil. Definitive diagnosis was only possible after necropsy and histopathology, since nonspecific clinical signs were not determinant for the diagnosis in life.(AU)


Subject(s)
Animals , Aspergillosis/veterinary , Immunosuppression/veterinary , Horses , Autopsy/veterinary
7.
Rev. fac. cienc. méd. (Impr.) ; 16(2): 23-30, jul.- dic. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1140248

ABSTRACT

La aspergilosis es una infección o respuesta alérgica debida al hongo Aspergillus spp. El hongo comúnmente crece en hojas muertas, granos almacenados, pilas de estiércol o abono u otra vegetación en descomposición. Implica un amplio espectro de entidades que requieren de alto grado de sospecha por mantener altas tasas de mortalidad, especialmente en el paciente inmunosupreso, estas pueden ser modificadas con el tratamiento temprano. Objetivo: actualizar las características clínicas y epidemiológicas de la aspergilosis incluyendo el diagnóstico y manejo, así como los factores presentes en general y en particular en los inmunosupresos. Material y Métodos: se realiza selección bibliográfica de revisiones y guías de manejo en las bases de datos bibliográficas PUBMED (últimos 5 años), SciELO y Revistas Hondureñas (BVS); se incluyen 21 referencias sobre diferentes aspectos de diagnóstico, manejo y tratamiento de aspergilosis. Conclusión: la sospecha de aspergilosis en cualquier cuadro respiratorio atípico con manifestaciones similares a tuberculosis o asma, debe ser mandatorio en los protocolos hospitalarios de manejo, especialmente en individuos con factores de riesgo conocidos, que implican riesgo ocupacional de contacto con conidias de Aspergillus spp...(AU)


Subject(s)
Humans , Aspergillosis/diagnosis , Mycoses/complications , Databases, Bibliographic , Review
8.
Rev. chil. infectol ; 36(6): 732-741, dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058105

ABSTRACT

Resumen Introducción: La enfermedad fúngica invasora (EFI) por hongos filamentosos es cada vez más frecuente. Objetivo: Estudiar la epidemiología de la EFI en adultos hospitalizados en nuestro centro. Metodología: Estudio retrospectivo de pacientes adultos de un hospital universitario en Santiago, Chile, con EFI por hongos filamentosos entre enero de 2005 y diciembre de 2015. Resultados: Se identificaron 125 episodios, siendo 48% categoria probada, 40% probable y 11% posible según criterios EORTC/MSG, incidencia global 0,47 x 1.000 egresos, 57% pacientes masculinos y edad de 50 ± 16 años. El 66,4% tenía patología hematológica, 11,2% trasplante de órgano sólido, 11,2% enfermedad reumatológica, 11,2% otra condición. Los factores de riesgo fueron neutropenia 44%, corticoterapia 21%, inmunosupresores 13%. Los hongos más frecuentemente identificados fueron Aspergillus spp (53,6%), Mucorales (16%), Fusarium spp (8,8%), Alternaria spp (5,6%), otros filamentosos (3,2%). Todos recibieron antifúngicos, 82% monoterapia, 18% terapia combinada, hubo defocación quirúrgica en 90% de mucormicosis. La mortalidad global fue 42%. Al comparar 2005-2009 vs 2010-2015, hubo un aumento significativo de la incidencia y una tendencia a menor mortalidad en el segundo período. Conclusiones: Durante un período de 10 años, observamos un aumento de la incidencia de EFI por filamentosos, aspergilosis fue la etiología más frecuente y la mortalidad global fue 42%.


Background: Invasive fungal disease (IFD) due to filamentous fungi is increasingly common. Aim: To study the epidemiology of EFI in hospitalized adults in our center. Methods: Retrospective study of adult patients of a university hospital in Santiago, Chile, with EFI due to filamentous fungi between January 2005 and December 2015. Results: 125 episodes were identified, being 48% proven, 40% probable and 11% possible according to EORTC/MSG criteria, overall incidence was 0.47/1,000 admissions, 57% male patients and age 50 ± 16 years. 66.4% had hematological pathology, 11.2% solid organ transplant, 11.2% rheumatology diseases, 11.2% other conditions. The risk factors were neutropenia 44%, corticosteroid therapy 21%, immunosuppressants 13%. The most frequent mould identified were Aspergillus spp (53.6%), Mucorales (16%), Fusarium spp (8.8%), Alternaria spp (5.6%) and other filamentous (3.2%). All received antifungals, 82% monotherapy, 18% combined therapy, there was surgical defocation in 90% of mucormycosis. The overall mortality was 42%. When comparing 2005-2009 vs 2010-2015, there was a significant increase in incidence and a tendency to lower mortality in the second period. Conclusions: Over a period of 10 years, we observed an increase in the incidence of EFI by filamentous, aspergillosis was the most frequent etiology and the overall mortality was 42%.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aspergillosis/drug therapy , Invasive Fungal Infections/drug therapy , Invasive Fungal Infections/epidemiology , Chile/epidemiology , Retrospective Studies , Fungi , Antifungal Agents/therapeutic use
9.
Int. j. med. surg. sci. (Print) ; 6(2): 50-54, jun. 2019. ilus
Article in English | LILACS | ID: biblio-1247431

ABSTRACT

Introduction: Aspergillosis is the second most frequent opportunistic fungal infection of the pa-ranasal sinuses. It primarily affects the maxillary sinus and occurs mainly in immunocompromi-sed individuals. Infection is caused by inhalation of spores or by an oro-sinusal communication. Aspergillosis is classified into an invasive and non-invasive form or Aspergilloma, which usually affects immunocompetent patients. Violaceous lesions, ulcers, necrosis and tissue destruction can be manifested clinically. Patients may experience pain, paresthesias, increases in the vo-lume of purulent or bloody nasal discharge and congestion. Case report: A 62-year-old female patient, immunocompetent, with a condition evolving for about six years. Condition began after a dental extraction, and consisted of absence of scarring and recurrent episodes of symptoma-tology suggestive of maxillary sinusitis with poor response to antibiotics. The patient was referred to the maxillofacial care unit, presenting an increase of volume in the right genial region, pain and paraesthesia of infraorbital region. The CT scan showed the presence of a radiopaque foreign body in the right maxillary sinus. A surgical procedure was carried out using the Caldwe-ll-Luc technique and biopsy; the case was diagnosed with Aspergillosis. The patient was treated without antifungal therapy because she had a good immune status. Conclusion: Aspergilloma is the most common form of Aspergillosis in immunocompetent individuals. It is usually diagnosed late, as its clinical picture is similar to bacterial sinusitis. In most cases, patients respond well to surgical treatment, and systemic antifungal therapy is not necessary.


Subject(s)
Humans , Female , Middle Aged , Aspergillosis/surgery , Aspergillosis/diagnostic imaging , Tomography, X-Ray Computed/methods , Maxillary Sinusitis/surgery , Immunocompromised Host
10.
Braz. j. biol ; 79(2): 169-173, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-989440

ABSTRACT

Abstract Even today, an effective diagnostic test for aspergillosis in penguins is unknown, being the gold standard post-mortem examinations. The fungal antigen galactomannan (GM) has been used as a biomarker of disease in humans and is detected by the Platelia Aspergillus EIA (BioRad)®, a commercial kit based on the sandwich ELISA technique. It is standardized for use in neutropenic patients, however studies have demonstrated its usefulness also possible for birds. The aim of our study was to evaluate the effectiveness of Platelia Aspergillus EIA® test (BioRad-US) in the diagnosis of aspergillosis in Magellanic penguins, determining sensitivity, specificity, and positive and negative predictive values for different cut-off points. Were included in the study, blood serum samples (n = 29) Magellanic penguins in captivity that died by aspergillosis. Detection of GM was performed following manufacturer's instructions and the GM index was obtained by dividing the average value of OD of the duplicate of the clinical sample by duplicate OD of the average value of the cut-off sample provided by the kit. Through information database results were obtained for the presence of anti-Aspergillus fumigatus antibodies detected by agar gel immunodiffusion (AGID) for all serum samples. Results were analyzed using chi-square test and Kruskal-Wallis from SPSS 20.0, IBM®. ROC curve was obtained and from this, rates of sensitivity, specificity, positive and negative predictive values were also calculated based on four different cutoff points (0.5, 1.0, 1.5 and 2.0). The serum GM index did not differ between animals of the case and control group (pkw =0.097). In determining the ROC curve for serum GM detection the value of area under the curve was 0.635. From the values ​​determined by the coordinate of the curve, four different cut points (0.5, 1.0, 1.5 and 2.0) were analyzed, resulting in sensitivity rates ranging from 86.2 to 34.5% % and specificity between 87% and 26.1%. By comparing the serum GM index in group case as the presence or absence of antibodies detected by AGID was found p=0.503. The detection of GM the Platelia Aspergillus EIA® test seems is not be useful for the diagnosis of aspergillosis in naturally infected penguins.


Resumo Ainda hoje, um teste diagnóstico eficaz para aspergilose em pinguins não é conhecido, sendo o padrão-ouro os exames post-mortem. O antígeno fúngico galactomanana (GM) tem sido utilizado como biomarcador da doença em humanos, sendo detectado pelo Platelia Aspergillus EIA (BioRad)®, um kit comercial que se baseia na técnica ELISA sanduíche. É padronizado para utilização em pacientes neutropênicos, no entanto estudos tem demonstrado sua possível utilidade também para aves.O objetivo de nosso estudo foi avaliar a eficácia do teste Platelia Aspergillus EIA® (BioRad-US) no diagnóstico da aspergilose em pinguins-de-Magalhães, determinando sensibilidade, especificidade e valores preditivos positivos e negativos em diferentes pontos de corte. Foram incluídas no estudo, amostras de soro sanguíneo (n=29) de pinguins-de-Magalhães em cativeiro que vieram a óbito por aspergilose. A detecção de GM foi realizada seguindo instruções do fabricante e o índice de GM foi obtido dividindo o valor da média da DO da duplicata da amostra clínica pelo valor da média da DO da duplicata da amostra de cut-off fornecida pelo kit. Através de informações em banco de dados foram obtidos resultados sobre a presença de anticorpos anti-Aspergillus fumigatus, detectada por Imunodifusão em gel de ágar (IDGA) em todas as amostras séricas. Os resultados foram analisados utilizando-se teste de qui-quadrado e Kruskal-Wallis a partir do programa estatístico SPSS 20.0, IBM®. Curva ROC foi obtida e a partir desta, taxas de sensibilidade, especificidade, valores preditivo positivo e negativo foram igualmente calculados considerando quatro diferentes pontos de corte (0.5, 1.0, 1.5 e 2.0). O índice de GM sérica não diferiu entre os animais do grupo caso e controle (pKW = 0.097). Na determinação da curva ROC para detecção de GM sérica o valor da área sobre a curva foi de 0.635. A partir dos valores determinados pelas coordenadas da curva, quatro diferentes pontos de corte (0.5, 1.0, 1.5 e 2.0) foram analisados, resultando em taxas de sensibilidade variando de 86.2% a 34.5%, e de especificidade entre 87% e 26.1%. Ao comparar o índice de GM sérica nos animais do grupo caso quanto a presença ou não de anticorpos detectados pela IDGA foi encontrado p=0.503. A detecção de GM pelo teste Platelia Aspergillus EIA® não parece ser útil para o diagnóstico da aspergilose em pinguins naturalmente infectados.


Subject(s)
Animals , Aspergillosis/diagnosis , Aspergillosis/veterinary , Aspergillus/isolation & purification , Enzyme-Linked Immunosorbent Assay/methods , Spheniscidae/microbiology , Biomarkers/analysis , Mannans/analysis
11.
Article in Korean | WPRIM | ID: wpr-759618

ABSTRACT

BACKGROUND: Invasive aspergillosis (IA) is associated with high morbidity and mortality, particularly among immunocompromised patients, such as lung transplant recipients. Voriconazole, the first-line therapy for IA, shows a non-linear pharmacokinetic profile and has a narrow therapeutic range. Careful and appropriate administration is necessary, primarily because it is used for critically ill patients; however, the clinical usefulness of therapeutic drug monitoring (TDM) has not been sufficiently verified. Therefore, in this study, we validated the safety and efficacy of voriconazole TDM in lung transplant recipients receiving only voriconazole for IA treatment. METHODS: The electronic medical records of lung transplant recipients (≥19 years of age) administered only voriconazole for > 7 days for treatment of IA from June 1, 2013 to May 31, 2018 were analyzed retrospectively. RESULTS: Among the 54 patients, 27 each were allocated to TDM and non-TDM groups, respectively. There were no significant differences in patient characteristics between the two groups except for ICU-hospitalization status. Of the TDM group patients, 81.5% needed adjustment of voriconazole dosage because the levels were out of target range. Comparison of two groups showed that treatment response was higher throughout treatment and switching rates of second-line agents were significantly lower in the TDM group, but it was insufficient to confirm safety improvements through voriconazole TDM. CONCLUSION: Considering that the treatment response tended to be higher and the rates of switching to second-line antifungal agents were lower in the TDM group, voriconazole TDM may increase the therapeutic effect on IA in lung transplant patients.


Subject(s)
Antifungal Agents , Aspergillosis , Critical Illness , Drug Monitoring , Electronic Health Records , Humans , Immunocompromised Host , Lung Transplantation , Lung , Mortality , Retrospective Studies , Transplant Recipients , Voriconazole
12.
Article in Korean | WPRIM | ID: wpr-786609

ABSTRACT

The gastrointestinal tract is a vast reservoir for internal microbiota; it is exposed directly to various externally introduced microbes, including bacteria, viruses, parasites and others. In immune-compromised conditions, the gastrointestinal tract is frequently affected by infectious diseases that seldom manifest clinically in immune-competent hosts. Immune-compromised conditions result from a variety of reasons, including human immunodeficiency virus infection, anti-cancer chemo-radiotherapy, immune suppressive therapy for autoimmune diseases, and organ transplantations. The stomach is a relatively rare site for opportunistic infections in immune-compromised patients compared to the esophagus and colon, where esophagitis and colitis develop frequently and cause significant clinical consequences. Helicobacter pylori infection is majorly involved in gastric malfunctioning in immune-compromised patients, followed by cytomegalovirus infection. Infections by Cryptosporidium, Mycobacterium avium complex, histoplasmosis, leishmaniasis, aspergillosis, or treponema, have been reported; however, gastric involvement of these agents is extremely rare. This review discusses the general aspects and recent reports on gastric infection in immune-compromised patients.


Subject(s)
Aspergillosis , Autoimmune Diseases , Bacteria , Colitis , Colon , Communicable Diseases , Cryptosporidium , Cytomegalovirus Infections , Esophagitis , Esophagus , Gastrointestinal Tract , Helicobacter pylori , Histoplasmosis , HIV , Humans , Leishmaniasis , Microbiota , Mycobacterium avium Complex , Opportunistic Infections , Organ Transplantation , Parasites , Stomach , Transplants , Treponema
14.
Rev. Soc. Bras. Med. Trop ; 51(6): 725-730, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-977100

ABSTRACT

Abstract Invasive aspergillosis is a common fungal infection in immunocompromised individuals. Some studies have shown that toll-like receptor and dectin-1 genetic polymorphisms may alter signaling pathways, thus increasing an individual's susceptibility to invasive aspergillosis. We investigated the pertinent literature to determine whether polymorphisms in the genes encoding toll-like receptors and dectin-1 increase the susceptibility to invasive aspergillosis. This study systematically reviewed the literature using the databases PubMed/PMC, Scopus, and Web of Science using the keywords invasive aspergillosis, polymorphism, Toll-like, and Dectin-1. From the initial search, 415 studies were found and according to our inclusion and exclusion criteria, eight studies were selected. Several studies described single-nucleotide polymorphisms (SNPs) that are associated with a greater susceptibility to invasive aspergillosis. These SNPs were found in the genes that encode toll-like receptors 1, 3, 4, and 5 and the gene that encodes dectin-1; upon activation, both cellular receptors initiate a signaling cascade that can result in the production of cytokines and chemokines. Thus, our literature review uncovered a significant association between polymorphisms in the genes that encode toll-like receptors and dectin-1 and invasive aspergillosis. More studies should be performed to better understand the relationship between toll-like receptor and dectin-1 genetic polymorphisms and invasive aspergillosis susceptibility.


Subject(s)
Humans , Aspergillosis/genetics , Genetic Predisposition to Disease/genetics , Polymorphism, Single Nucleotide/genetics , Lectins, C-Type/genetics , Toll-Like Receptors/genetics
15.
Braz. j. microbiol ; 49(3): 675-682, July-Sept. 2018. graf
Article in English | LILACS | ID: biblio-951801

ABSTRACT

Abstract Aspergillus fumigatus is an opportunistic saprobe fungus that accounts for 90% of cases of pulmonary aspergillosis in immunosuppressed patients and is known for its angiotropism. When it reaches the respiratory tract, A. fumigatus interacts with structural components and blood vessels of the lungs, such as elastin. To understand the effect of this structural component, we examined the effect of elastin on the production and development of the biofilm of A. fumigatus. In RPMI containing 10 mg/mL of elastin, a significant increase (absorbance p < 0.0001; dry weight p < 0.0001) in the production of biofilm was observed in comparison to when RPMI was used alone, reaching a maximum growth of 18.8 mg (dry weight) of biofilm in 72 h. In addition, elastin stimulates the production (p = 0.0042) of extracellular matrix (ECM) and decreases (p = 0.005) the hydrophobicity during the development of the biofilm. These results suggest that elastin plays an important role in the growth of A. fumigatus and that it participates in the formation of thick biofilm.


Subject(s)
Humans , Aspergillosis/metabolism , Aspergillosis/microbiology , Aspergillus fumigatus/physiology , Elastin/metabolism , Biofilms , Extracellular Matrix/metabolism , Aspergillus fumigatus/genetics , Host-Pathogen Interactions
16.
Braz. j. microbiol ; 49(3): 668-674, July-Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-951814

ABSTRACT

Abstract The virulence genes in invasive aspergillosis (IA) have not been analyzed adequately. The present study was designed to evaluate the expression of gpaB and sidA genes, which are important virulence genes in Aspergillus spp. from bronchoalveolar lavage (BAL) samples. Direct examination and culture on Czapek Agar and Sabouraud Dextrose Agar media were performed for 600 BAL specimens isolated from patients with possible aspergillosis. A Galactomannan ELISA assay was also carried out. The expression levels of the gpaB and sidA genes in isolates were analyzed using quantitative real-time PCR (qRT-PCR). We identified 2 species, including Aspergillus flavus (A. flavus) and Aspergillus fumigatus (A. fumigatus) in 25 positive samples for invasive aspergillosis as validated using GM-ELISA. A. flavus is the main pathogen threatening transplant recipients and cancer patients worldwide. In this study, A. flavus had low levels of the gpaB gene expression compared to A. fumigatus (p = 0.006). The highest sidA expression was detected in transplant recipients (p = 0.05). There was no significant correlation between sidA expression and underlying disease (p = 0.15). The sidA and gpaB gene expression patterns may provide evidence that these virulence genes play important roles in the pathogenicity of Aspergillus isolates; however, there are several regulatory genes responsible for the unexpressed sidA and gpaB genes in the isolates.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Aspergillosis/microbiology , Aspergillus flavus/metabolism , Aspergillus flavus/pathogenicity , Aspergillus fumigatus/metabolism , Aspergillus fumigatus/pathogenicity , Bacterial Proteins/metabolism , Aspergillus flavus/isolation & purification , Aspergillus flavus/genetics , Aspergillus fumigatus/isolation & purification , Aspergillus fumigatus/genetics , Bacterial Proteins/genetics , Virulence
17.
Rev. ABENO ; 18(3): 84-92, jul.-set. 2018. tab, graf
Article in Portuguese | LILACS, BBO | ID: biblio-964815

ABSTRACT

Agentes infecciosos podem ser transmitidos via partículas microscópicas suspensas no ar e secreções presentes em superfícies contaminadas de instrumentos e equipamentos. Entre os contaminantes veiculados pelo ar em ambiente interno estão os fungos, bactérias e vírus, que são provenientes do ar externo, do sistema de climatização, da construção, mobiliário, carpete e de seus ocupantes. A maioria dos procedimentos realizados na clínica odontológica libera grande quantidade de aerossóis, partículas diminutas que ficam durante várias horas no ar e podem conter diversos micro-organismos, dentre eles, os fungos. Em clínicas de ensino, esta contaminação é maior devido ao alto número de ocupantes e de procedimentos realizados ao mesmo tempo. Ao conhecer os gêneros fúngicos aos quais seus pacientes estão expostos, o profissional pode minimizar os riscos de infecção, adotando práticas de higienização do ambiente e do ar que possam auxiliar na prevenção de doenças. A verificação de fungos foi realizada pelo método de sedimentação em placa, que se mostra útil para a análise da quantidade e da qualidade de fungos presentes em ambientes internos e externos. Foram identificadas espécies pertencentes aos gêneros Aspergillus, Fusarium, Cladosporium, Nigrospora e Penicillium, encontrados com maior frequência os gêneros Penicillium e Aspergillus provenientes de ambiente externo e interno (AU).


Infectious agents can be transmitted via microscopic particles suspended in the air and secretions present on contaminated surfaces of instruments and equipment. Indoor airborne contaminants include fungi, bacteria and viruses, which come from outside air, the air conditioning system, the building, furniture, carpet and their occupants. Most procedures performed at the dental clinic release large amounts of aerosols, minute particles that remain for several hours in the air and may contain several microorganisms, among them fungi. In teaching clinics, this contamination is greater due to the high number of occupants and procedures performed at the same time. By knowing the fungal genera to which their patients are exposed, the professional can minimize the risks of infection, adopting practices of hygiene of the environment and air that can aid in the prevention of diseases. The fungi check was performed by the plate sedimentation method, which is useful for the analysis of the quantity and quality of fungi present in internal and external environments. Species belonging to the genus Aspergillus, Fusarium, Cladosporium, Nigrospora and Penicillium were identified, most frequently found Penicillium and Aspergillus genera from external and internal environment (AU).


Subject(s)
Bacterial Infections and Mycoses/etiology , Air Samples , Infection Control , Dental Clinics , Dentists , Education, Dental/methods , Aspergillosis , Brazil , Accelerated Sedimentation/methods , Data Interpretation, Statistical , Noxae/immunology
18.
Braz. j. infect. dis ; 22(1): 37-40, Jan.-feb. 2018. tab
Article in English | LILACS | ID: biblio-951618

ABSTRACT

ABSTRACT Introduction: Invasive aspergillosis is a condition associated with a high mortality rate mostly due to difficulties in performing an early diagnosis. In recent years, galactomannan detection has markedly improved the diagnosis of invasive aspergillosis, but very little is known on how physicians deal with this test in clinical practice. Methods: This cross-sectional study aimed to analyze the indications for the use of serum galactomannan in a large Brazilian hospital, between 2015 and 2016. No specific protocol was in place for GM request. We reviewed the medical records of adult (>18 years-old) patients who were tested for galactomannan due to one the following indications: screening, diagnosis, or treatment follow-up. Additional variables included demographic data, underlying diseases, presence of neutropenia, and use of previous antifungal (anti-Aspergillus) drugs. Results: The mean age of the patients was 51 years-old (sd ± 15.8), and 63.3% of patients were male. Patients with hematological malignancies accounted for 60.1% of the cases, mostly acute myeloid leukemia (19.6%). Galactomannan testing was positive in 12.2% of patients, including 1.6% of occasions in which the test was used for screening purposes, 13.2% for diagnosis, and 32.4% during follow-up. Median time for chest imaging request was two days before GM testing. Previous antifungal therapy was reported for 35.1% of patients, mostly amphotericin B (57.1%). Conclusion: The correct use of galactomannan testing is essential for an early diagnosis of invasive aspergillosis, which may improve the prognosis of the disease. We demonstrated that clinicians usually ask for galactomannan tests to confirm imaging findings in patients who frequently were on antifungal drugs, something that could be improved by medical education. We observed a low frequency of galactomannan use for preemptive antifungal therapy (25.7%), which is worrying considering the well-known beneficial use of GM testing in this scenario.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aspergillosis/diagnosis , Aspergillosis/blood , Mannans/blood , Aspergillosis/drug therapy , Reference Values , Cross-Sectional Studies , Predictive Value of Tests , Reproducibility of Results , Statistics, Nonparametric , Early Diagnosis , Antifungal Agents/therapeutic use
19.
Article in English | WPRIM | ID: wpr-741184

ABSTRACT

BACKGROUND: Pulmonary nodular lymphoid hyperplasia (PNLH) is a non-neoplastic pulmonary lymphoid disorder that can be mistaken for malignancy on radiography. Herein, we present nine cases of PNLH, emphasizing clinicoradiological findings and histological features. METHODS: We analyzed radiological and clinicopathological features from the electronic medical records of nine patients (eight females and one male) diagnosed with PNLH. IgG and IgG4 immunohistochemical staining was performed in three patients. RESULTS: Two of the nine patients had experienced tuberculosis 40 and 30 years prior, respectively. Interestingly, none were current smokers, although two were ex-smokers. Three patients complaining of persistent cough underwent computed tomography of the chest. PNLH was incidentally discovered in five patients during examination for other reasons. The remaining patient was diagnosed with the disease following treatment for pneumonia. Imaging studies revealed consolidation or a mass-like lesion in eight patients. First impressions included invasive adenocarcinoma and mucosal-associated lymphoid tissue‒type lymphoma. Aspergillosis was suspected in the remaining patient based on radiological images. Resection was performed in all patients. Microscopically, the lesions consisted of nodular proliferation of reactive germinal centers accompanied by infiltration of neutrophils and macrophages in various degrees and surrounding fibrosis. Ultimately, all nine patients were diagnosed with PNLH and showed no evidence of recurrence on follow-up. CONCLUSIONS: PNLH is an uncommon but distinct entity with a benign nature, and understanding the radiological and clinicopathological characteristics of PNLH is important.


Subject(s)
Adenocarcinoma , Aspergillosis , Cough , Electronic Health Records , Female , Fibrosis , Follow-Up Studies , Germinal Center , Humans , Hyperplasia , Immunoglobulin G , Lymphoma , Macrophages , Neutrophils , Pneumonia , Pseudolymphoma , Radiography , Recurrence , Thorax , Tuberculosis
20.
Article in English | WPRIM | ID: wpr-741149

ABSTRACT

Lymphomas arising in the central nervous system (CNS) of immunocompromised hosts are most commonly non-Hodgkin’s lymphomas and are highly associated with Epstein-Barr virus (EBV). Here we report an autopsy case of EBV-associated CNS diffuse large B-cell lymphoma (DLBCL) in a host suffering from systemic lupus erythematosus who underwent immunosuppressive therapy. After autopsy, EBV-associated CNS DLBCL as well as pulmonary mixed aspergillosis and Pneumocystis jirovecii pneumonia were added to the cause of clinical manifestations of complicated pneumonia and cerebral hemorrhage in this immunocompromised patient. In conclusion, complex disease processes were revealed by autopsy in this case, indicating that the clinicopathological correlations observed through autopsy can improve our understanding of disease progression and contribute to the management of similar patients in the future.


Subject(s)
Aspergillosis , Autopsy , B-Lymphocytes , Central Nervous System , Cerebral Hemorrhage , Disease Progression , Herpesvirus 4, Human , Humans , Immunocompromised Host , Lupus Erythematosus, Systemic , Lymphoma , Lymphoma, B-Cell , Pneumocystis carinii , Pneumonia
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