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1.
Rev. eletrônica enferm ; 23: 1-12, 2021.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1248185

ABSTRACT

Objetivou-se analisar o conceito de "Proteção" em pacientes submetidos ao transplante de células tronco hematopoiéticas e cor-relacionar com os elementos do diagnóstico de enfermagem "Proteção Ineficaz" proposto pela NANDA-I.Revisão integrativa da literatura, fundamentada no modelo de Análise de Conceito proposto por Walker e Avant. Realizada na Biblioteca Virtual em Saúde e as seguintes bases de dados: CINAHL, SCOPUS, PUBMED/MEDLINE, LILACS e Web of Science com recorte temporal de cinco anos. A amostra final foi composta por 16 artigos e pela identificação de três atributos definidores, 15 antecedentes e 11 consequentes.Conclusão:a análise de conceito pode contribuir para o refinamento e o aprimoramento do diagnóstico de en-fermagem "Proteção Ineficaz". Foi possível identificar uma outra definição, 10 antecedentes e 10 consequentes que não constam na NANDA-I, bem como a necessidade de revisar a definição e demais componentes do diagnóstico propostos pela taxonomia.


The objective was to analyze the "Protection" concept in patients undergoing hematopoietic stem cell transplantation and correlate it with elements of the "Ineffective Protection" nursing diagnosis proposed by NANDA-I. Integrative literature review based on the Concept Analysis model proposed by Walker and Avant and performed at the Virtual Health Library and CINAHL, SCOPUS, PUBMED/MEDLINE, LILACS and Web of Science databases within a five-year time frame . The final sample consisted of 16 articles and the identification of three defining attributes, 15 antecedents and 11 consequences. Conclusion: concept analysis can contribute to refine and improve the nursing diagnosis "Ineffective Protection". It was possible to identify another definition, 10 antecedents and 10 consequences that are not included in NANDA-I, as well as the need to revise the definition and other components of the diagnosis proposed by the taxonomy.


Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Immunocompetence , Nursing Process
2.
Rev. epidemiol. controle infecç ; 10(3): 1-11, jul.-set. 2020. ilus
Article in Portuguese | LILACS | ID: biblio-1247662

ABSTRACT

Justificativa e Objetivos: Neurocriptococose é uma doença fúngica que acomete principalmente pacientes imunocomprometidos. Casos em pacientes imunocompetentes têm sido descritos em alguns relatos de casos; no entanto, por não ser uma doença de notificação compulsória no Brasil até 2020, ainda pouco se sabe sobre sua epidemiologia no sul do país. O presente estudo teve como objetivo descrever aspectos epidemiológicos relacionados à doença em pacientes supostamente imunocompetentes. Métodos: Estudo retrospectivo, observacional, baseado em uma série de casos atendidos entre 2018 e 2019, em um hospital público de Joinville, Santa Catarina, Brasil. Pacientes com diagnóstico clínico confirmado pela presença do fungo do gênero Cryptococcus spp. no líquido cefalorraquidiano pelo método tinta da China foram avaliados quanto aos aspectos clínicos, tratamento e complicações durante o período de internação. Resultados: Houve dois pacientes em 2018 e seis pacientes em 2019 com diagnóstico confirmado. Todos sem fatores aparentes para imunocomprometimento e sem fator de risco ambiental evidente. A maioria eram homens com média de idade de 39 anos. Febre e confusão mental foram os achados mais comuns na apresentação. A variante C. neoformans foi encontrada em 75% dos casos. Todos receberam Anfotericina B, no mínimo, durante 13 dias, associado ou não a Fluconazol. Seis pacientes apresentaram nefrotoxicidade pela Anfotericina B, dois evoluíram para óbito intra-hospitalar e dois permaneceram com sequelas neurológicas. Conclusão: A mortalidade e as complicações relacionadas ao tratamento da neurocriptococose em pessoas imunocompetentes foram altas na amostra estudada. A recente inclusão da doença como uma patologia de notificação compulsória poderá aprimorar dados epidemiológicos para o melhor entendimento e a prevenção dessa doença.(AU)


Background and Objectives: Neurocryptococcosis is a fungal disease that affects mainly immunocompromised patients. Cases in immunocompetent patients have been described in some case reports. However, as its reporting was not mandatory in Brazil until 2020, little is known about its epidemiology in the South Region of the country. The present study had the objective of describing epidemiological aspects related to the disease in presumably immunocompetent patients. Methods: A retrospective and observational study was developed, based on cases of patients who received care in a public hospital in Joinville, Santa Catarina, Brazil, between 2018 and 2019. Patients with a clinical diagnosis confirmed by the presence of the fungus Cryptococcus spp. in cerebrospinal fluid by means of the Chinese ink staining were evaluated regarding clinical aspects, treatment, and complications during hospitalization. Results: The diagnosis of the disease was confirmed for two patients in 2018 and six patients in 2019. All of them showed no apparent factors for immunodeficiency and no evident environmental risk factors. Most were men with an average age of 39 years. Fever and mental confusion were the most common symptoms at admission. The variant C. neoformans was found in 75% of the cases. All patients received amphotericin B for at least 13 days with or without combined fluconazole. Six patients had nephrotoxicity due to amphotericin B, two evolved to in-hospital death, and two had neurological sequelae. Conclusion: Mortality and complications related to the treatment of neurocryptococcosis in immunocompetent people showed high rates in the studied sample. The recent inclusion of this disease as a mandatory reporting pathology can improve epidemiological data, which will be used to achieve better understanding and prevention of this problem.(AU)


Justificación y Objetivos: La neurocriptococosis es una enfermedad fúngica que afecta especialmente a pacientes inmunocomprometidos. Fueron citados casos en pacientes inmunocompetentes en algunos relatos. Por no considerársela de notificación obligatoria en Brasil hasta 2020, poco se sabe aún sobre su epidemiología en el sur del país. El estudio objetivó describir aspectos epidemiológicos relativos a la enfermedad en pacientes supuestamente inmunocompetentes. Métodos: Estudio retrospectivo, observacional, en base a una serie de casos atendidos entre 2018 y 2019 en un hospital público de Joinville, Santa Catarina. Pacientes con diagnóstico clínico confirmado por presencia de Cryptococcus spp., utilizándose el método de tinta china en líquido cefalorraquídeo fueron evaluados respecto de aspectos clínicos, tratamiento y complicaciones durante su internación. Resultados: Hubo 2 pacientes en 2018 y 6 en 2019 con diagnóstico confirmado, todos sin factores aparentes de inmunocompromiso y sin factor de riesgo ambiental evidente. Mayoría de hombre, media etaria de 39 años. Fueron hallazgos comunes en su presentación la fiebre y confusión mental. La variante C. neoformans fue hallada en 75% de los casos. Todos recibieron anfotericina B como mínimo durante 13 días, en asociación o no con fluconazol. Seis pacientes presentaron nefrotoxicidad por anfotericina B, dos sufrieron fallecimiento intrahospitalario, y dos resultaron con secuelas neurológicas. Conclusión: La mortalidad y las complicaciones relativas al tratamiento de la neurocriptococosis en inmunocompetentes fueron altas en la muestra estudiada. La inclusión de la enfermedad como patología de notificación obligatoria podrá mejorar los datos epidemiológicos para entender mejor y prevenir la enfermedad.(AU)


Subject(s)
Humans , Meningitis, Cryptococcal/epidemiology , Immunocompetence
3.
Rev. Hosp. Ital. B. Aires (2004) ; 40(1): 25-28, mar. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1102210

ABSTRACT

Introducción: la zigomicosis es una infección fúngica poco frecuente, con alta tasa de mortalidad y de mal pronóstico. Afecta principalmente a pacientes inmunocomprometidos. La asociación con el síndrome hemofagocítico es extremadamente inusual, más aún en pacientes inmunocompetentes, con pocos ejemplos registrados en la literatura. Caso clínico: se presenta el caso de un paciente masculino inmunocompetente de 40 años con diagnóstico de mucormicosis y síndrome hemofagocítico que evoluciona desfavorablemente, con fallo multiorgánico, a pesar de los esfuerzos médicos. Conclusión: la asociación de mucormicosis con síndrome hemofagocítico en un paciente inmunocompetente es extremadamente rara; existen pocos casos informados en Latinoamérica. Debemos tener presente esta asociación, ya que requiere un tratamiento agresivo y soporte vital avanzado. (AU)


Introduction: zygomycosis is a rare fungal infection that carries with high mortality rates. This poor prognosis, rapidly progressive infection mainly affects immunocompromised patients. The association with hemophagocytic lymphohistiocytosis is extremely unusual, even more in immunocompetent patients, with few cases reported. Case: we present the case of an immunocompetent male patient who was diagnosed with zygomycosis and hemophagocytic lymphohistiocytosis. Despite medical efforts he developed multiorganic failure. Conclusion: the association of mucormycosis with hemophagocytic lymphohistiocytosis in an immunocompetent patient is exceptional with few cases reported in Latin America. We must always suspect this association considering they require aggressive treatment and advanced life support. (AU)


Subject(s)
Humans , Male , Adult , Zygomycosis/diagnosis , Lymphohistiocytosis, Hemophagocytic/diagnosis , Pancytopenia/blood , Psychomotor Agitation , Vancomycin/therapeutic use , Norepinephrine/administration & dosage , Norepinephrine/therapeutic use , Amphotericin B/therapeutic use , Exophthalmos/diagnostic imaging , Immunocompromised Host/immunology , Colistin/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Zygomycosis/etiology , Zygomycosis/mortality , Zygomycosis/epidemiology , Delirium , Lymphohistiocytosis, Hemophagocytic/etiology , Lymphohistiocytosis, Hemophagocytic/mortality , Fever , Meropenem/therapeutic use , Immunocompetence/immunology , Jaundice , Mucormycosis/complications , Multiple Organ Failure/diagnosis
5.
Protein & Cell ; (12): 740-770, 2020.
Article in English | WPRIM | ID: wpr-827016

ABSTRACT

Age-associated changes in immune cells have been linked to an increased risk for infection. However, a global and detailed characterization of the changes that human circulating immune cells undergo with age is lacking. Here, we combined scRNA-seq, mass cytometry and scATAC-seq to compare immune cell types in peripheral blood collected from young and old subjects and patients with COVID-19. We found that the immune cell landscape was reprogrammed with age and was characterized by T cell polarization from naive and memory cells to effector, cytotoxic, exhausted and regulatory cells, along with increased late natural killer cells, age-associated B cells, inflammatory monocytes and age-associated dendritic cells. In addition, the expression of genes, which were implicated in coronavirus susceptibility, was upregulated in a cell subtype-specific manner with age. Notably, COVID-19 promoted age-induced immune cell polarization and gene expression related to inflammation and cellular senescence. Therefore, these findings suggest that a dysregulated immune system and increased gene expression associated with SARS-CoV-2 susceptibility may at least partially account for COVID-19 vulnerability in the elderly.


Subject(s)
Adult , Aged , Aged, 80 and over , Aging , Genetics , Allergy and Immunology , Betacoronavirus , CD4-Positive T-Lymphocytes , Metabolism , Cell Lineage , Chromatin Assembly and Disassembly , Coronavirus Infections , Allergy and Immunology , Cytokine Release Syndrome , Allergy and Immunology , Cytokines , Genetics , Disease Susceptibility , Flow Cytometry , Methods , Gene Expression Profiling , Gene Expression Regulation, Developmental , Gene Rearrangement , Humans , Immune System , Cell Biology , Allergy and Immunology , Immunocompetence , Genetics , Inflammation , Genetics , Allergy and Immunology , Mass Spectrometry , Methods , Middle Aged , Pandemics , Pneumonia, Viral , Allergy and Immunology , Sequence Analysis, RNA , Single-Cell Analysis , Transcriptome , Young Adult
6.
Clinics ; 75: e1498, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055886

ABSTRACT

OBJECTIVE: To evaluate the role of intraocular fluid analysis as a diagnostic aid for uveitis. METHODS: Twenty-eight samples (27 patients including 3 HIV-infected patients) with active (n=24) or non-active (n=4) uveitis were submitted to aqueous (AH; n=12) or vitreous humor (VH) analysis (n=16). All samples were analyzed by quantitative PCR for herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Toxoplasma gondii. RESULTS: The positivity of the PCR in AH was 41.7% (5/12), with 50% (2/4) in immunocompetent and 67% (2/3) in HIV+ patients. The positivity of the PCR in VH was 31.2% (5/16), with 13% (1/8) in immunocompetent and 50% (4/8) in immunosuppressed HIV negative patients. The analysis was a determinant in the diagnostic definition in 58% of HA and 50% of VH. CONCLUSION: Even in posterior uveitis, initial AH analysis may be helpful. A careful formulation of possible clinical diagnosis seems to increase the chance of intraocular sample analysis being meaningful.


Subject(s)
Humans , Aqueous Humor/microbiology , Aqueous Humor/parasitology , Aqueous Humor/virology , Uveitis/diagnosis , Vitreous Body/microbiology , Vitreous Body/parasitology , Toxoplasma , Uveitis/microbiology , Uveitis/parasitology , Uveitis/virology , Vitreous Body/virology , DNA, Viral/analysis , Polymerase Chain Reaction , HIV-1 , Immunocompromised Host , Simplexvirus/genetics , Simplexvirus/immunology , Herpesvirus 4, Human , Herpesvirus 3, Human/genetics , Herpesvirus 3, Human/immunology , Cytomegalovirus/genetics , Cytomegalovirus/immunology , Immunocompetence
7.
Protein & Cell ; (12): 740-770, 2020.
Article in English | WPRIM | ID: wpr-828746

ABSTRACT

Age-associated changes in immune cells have been linked to an increased risk for infection. However, a global and detailed characterization of the changes that human circulating immune cells undergo with age is lacking. Here, we combined scRNA-seq, mass cytometry and scATAC-seq to compare immune cell types in peripheral blood collected from young and old subjects and patients with COVID-19. We found that the immune cell landscape was reprogrammed with age and was characterized by T cell polarization from naive and memory cells to effector, cytotoxic, exhausted and regulatory cells, along with increased late natural killer cells, age-associated B cells, inflammatory monocytes and age-associated dendritic cells. In addition, the expression of genes, which were implicated in coronavirus susceptibility, was upregulated in a cell subtype-specific manner with age. Notably, COVID-19 promoted age-induced immune cell polarization and gene expression related to inflammation and cellular senescence. Therefore, these findings suggest that a dysregulated immune system and increased gene expression associated with SARS-CoV-2 susceptibility may at least partially account for COVID-19 vulnerability in the elderly.


Subject(s)
Adult , Aged , Aged, 80 and over , Aging , Genetics , Allergy and Immunology , Betacoronavirus , CD4-Positive T-Lymphocytes , Metabolism , Cell Lineage , Chromatin Assembly and Disassembly , Coronavirus Infections , Allergy and Immunology , Cytokine Release Syndrome , Allergy and Immunology , Cytokines , Genetics , Disease Susceptibility , Flow Cytometry , Methods , Gene Expression Profiling , Gene Expression Regulation, Developmental , Gene Rearrangement , Humans , Immune System , Cell Biology , Allergy and Immunology , Immunocompetence , Genetics , Inflammation , Genetics , Allergy and Immunology , Mass Spectrometry , Methods , Middle Aged , Pandemics , Pneumonia, Viral , Allergy and Immunology , Sequence Analysis, RNA , Single-Cell Analysis , Transcriptome , Young Adult
8.
Protein & Cell ; (12): 740-770, 2020.
Article in English | WPRIM | ID: wpr-828582

ABSTRACT

Age-associated changes in immune cells have been linked to an increased risk for infection. However, a global and detailed characterization of the changes that human circulating immune cells undergo with age is lacking. Here, we combined scRNA-seq, mass cytometry and scATAC-seq to compare immune cell types in peripheral blood collected from young and old subjects and patients with COVID-19. We found that the immune cell landscape was reprogrammed with age and was characterized by T cell polarization from naive and memory cells to effector, cytotoxic, exhausted and regulatory cells, along with increased late natural killer cells, age-associated B cells, inflammatory monocytes and age-associated dendritic cells. In addition, the expression of genes, which were implicated in coronavirus susceptibility, was upregulated in a cell subtype-specific manner with age. Notably, COVID-19 promoted age-induced immune cell polarization and gene expression related to inflammation and cellular senescence. Therefore, these findings suggest that a dysregulated immune system and increased gene expression associated with SARS-CoV-2 susceptibility may at least partially account for COVID-19 vulnerability in the elderly.


Subject(s)
Adult , Aged , Aged, 80 and over , Aging , Genetics , Allergy and Immunology , Betacoronavirus , CD4-Positive T-Lymphocytes , Metabolism , Cell Lineage , Chromatin Assembly and Disassembly , Coronavirus Infections , Allergy and Immunology , Cytokine Release Syndrome , Allergy and Immunology , Cytokines , Genetics , Disease Susceptibility , Flow Cytometry , Methods , Gene Expression Profiling , Gene Expression Regulation, Developmental , Gene Rearrangement , Humans , Immune System , Cell Biology , Allergy and Immunology , Immunocompetence , Genetics , Inflammation , Genetics , Allergy and Immunology , Mass Spectrometry , Methods , Middle Aged , Pandemics , Pneumonia, Viral , Allergy and Immunology , Sequence Analysis, RNA , Single-Cell Analysis , Transcriptome , Young Adult
9.
Infectio ; 23(4): 402-404, Dec. 2019. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1040010

ABSTRACT

Resumen En humanos las infecciones producidas por Streptococcus equi son de rara ocurrencia, tienen una amplia variedad de formas de presentación, incluyendo compromiso articular, el cual ha sido pocas veces descrito en humanos y aún menos en pacientes inmunocompetentes. En este artículo se presenta un caso de artritis séptica por S. equi que ocurrió por una exposición ocupacional en un paciente inmunocompetente y la revisión de la literatura relacionada.


Abstract Human infections caused by Streptococcus equi are rare, have a wide variety of forms of presentation, including joint involvement, which has been rarely described in humans and even less in immunocompetent patients. In this article we present a septic arthritis case due to S. equi that occurred due to an occupational exposure in an immunocompetent patient, and a review of the related literature as well. The publication of this case report was accepted by the institutional ethics committee and the consent signed by the patient was obtained.


Subject(s)
Humans , Male , Middle Aged , Arthritis, Infectious , Streptococcus equi , Occupational Exposure , Colombia , Sepsis , Immunocompetence
10.
Infectio ; 23(4): 369-371, Dec. 2019. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1019867

ABSTRACT

Resumen Los miembros del género Kocuria corresponden a cocos Gram positivos ubicuos, generalmente inocuos y que hacen parte de la flora saprófita de un porcentaje importante de la población; ocasionalmente han sido descritos como los agentes responsables de patologías infecciosas, principalmente dentro del contexto de pacientes que concomitantemente cursan con enfermedades crónicas y estados de inmunosupresión. Son escasos los casos reportados como causa de endocarditis en pacientes inmunocompetentes a nivel global por especies de este género. Se expone el caso de una mujer inmunocompetente de 44 años, sin antecedentes de importancia, en quien solo el diagnóstico microbiológico permitió confirmar la presencia de Kocuria kristinae como agente causal de su endocarditis infecciosa; la literatura señala la dificultad existente al momento de diferenciar la endocarditis producida por Staphylococcus spp. versus Kocuria kristinae por su evolución clínica similar, indicando la importancia de la microbiología al momento de identificar y diagnosticar apropiadamente.


Summary Members of the genus Kocuria correspond to ubiquitous, generally harmless, Gram-positive cocci that are part of the saprophytic flora of a significant percentage of the population; occasionally they have been described as the agents responsible for infectious pathologies, mainly in the context of patients who concomitantly have chronic diseases and are under an immunosuppression state. There are few cases reported as a cause of endocarditis in immunocompetent patients globally by species of this genus. We present the case of a 44-year-old immunocompetent woman, with no relevant history, in whom only the microbiological diagnosis confirmed the presence of Kocuria kristinae as the causative agent of her infectious endocarditis; Literature points out the difficulty existing when differentiating endocarditis produced by Staphylococcus spp. versus Kocuria kristinae because of their similar clinical evolution, indicating the importance of microbiology when identifying and diagnosing accurately.


Subject(s)
Humans , Male , Adult , Gram-Positive Cocci , Endocarditis, Bacterial , Immunocompetence , Actinomycetales , Actinobacteria , Endocarditis , Infections , Micrococcaceae
13.
An. bras. dermatol ; 94(6): 744-746, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1054899

ABSTRACT

Abstract This report describes a case of unusual deep skin ulcers with tortuous sinus tract formation in an immunocompetent woman. She was initially diagnosed with a Staphylococcus aureus skin infection and histopathologically diagnosed with pyoderma gangrenosum. However, culture from the deep end of ribbon gauze inserted into the subcutaneous sinus tract revealed shiny, light-yellow mucoid colonies, which were identified as Cryptococcus neoformans var. grubii. She was treated with fluconazole for nine months and completely healed. Cryptococcosis is an opportunistic infection caused by variants of C. neoformans species. Cutaneous manifestations of cryptococcosis are quite divergent, rarely occurring as deep skin ulcers with sinus formation.


Subject(s)
Humans , Female , Adult , Skin Ulcer/microbiology , Skin Ulcer/pathology , Cryptococcosis/pathology , Cryptococcus neoformans/isolation & purification , Dermatomycoses/pathology , Immunocompetence , Skin Ulcer/drug therapy , Fluconazole/therapeutic use , Immunocompromised Host , Cryptococcosis/microbiology , Cryptococcosis/drug therapy , Dermatomycoses/microbiology , Dermatomycoses/drug therapy , Antifungal Agents/therapeutic use
14.
Rev. méd. Chile ; 147(8): 983-992, ago. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058633

ABSTRACT

Background: C-reactive protein (CRP) is used to monitor patients' response during treatment of infectious diseases. Morbidity and mortality associated with community-acquired pneumonia (CAP) is high, particularly in hospitalized patients. Better risk prediction during hospitalization could improve management and ultimately reduce mortality rates. Aim: To evaluate CRP measured at admission and the third day of hospitalization as a predictor for adverse events in CAP. Material and Methods: A prospective cohort study of adult patients hospitalized with CAP at an academic hospital. Major adverse outcomes were admission to ICU, mechanical ventilation, prolonged hospital length of stay, hospital complications and 30-day mortality. Predictive associations between CRP (as absolute levels and relative decline at third day) and adverse events were analyzed. Results: Eight hundred and twenty-three patients were assessed, 19% were admitted to ICU and 10.6% required mechanical ventilation. The average hospital stay was 8.8 ± 8.2 days, 42% had nosocomial complications and 8.1% died within 30 days. Ninety eight percent of patients had elevated serum CRP on admission to the hospital (18.1 ± 14.1 mg/dL). C-reactive protein measured at admission was associated with the risk of bacterial pneumonia, bacteremic pneumonia, septic shock and use of mechanical ventilation. Lack of CRP decline within three days of hospitalization was associated with high risk of complications, septic shock, mechanical ventilation and prolonged hospital stay. Conclusions: CRP responses at third day of hospital admission was a valuable predictor of adverse events in hospitalized CAP adult patients.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumonia/blood , C-Reactive Protein/analysis , Community-Acquired Infections/blood , Immunocompetence , Pneumonia/immunology , Pneumonia/mortality , Prognosis , Shock, Septic/mortality , Shock, Septic/blood , Time Factors , Biomarkers/blood , Predictive Value of Tests , Prospective Studies , Risk Factors , Community-Acquired Infections/immunology , Community-Acquired Infections/mortality , Area Under Curve
15.
Rev. pediatr. electrón ; 16(2): 22-26, ago. 2019.
Article in Spanish | LILACS | ID: biblio-1021347

ABSTRACT

La tuberculosis es una enfermedad infecciosa por Mycobacterium tuberculosis conocida desde la antigüedad y con gran importancia en la actualidad ubicándose como una de las principales causas de morbimortalidad, puede tener presentación pulmonar y extrapulmonar. Se presenta el caso clínico de una adolescente inmunocompetente con tuberculosis con descripción de la historia natural, a raíz del cual se realiza y presenta una revisión de literatura actual confrontando con artículos de revisiones de temas en búsqueda electrónica en bases de datos de RIMA, MEDLINE, PUBMED, MEDSCAPE, de 2013 a 2018. CONCLUSIONES: Es primordial conocer la presentación extrapulmonar corresponde al 21% de los casos de tuberculosis puede ser asintomático o sintomático con fiebre, tos y dolor pleurítico.


Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis that has been known since antiquity and with great importance at present, being one of the main causes of morbidity and mortality, it can have pulmonary and extrapulmonary presentation. METHOD: review of current literature comparing articles with reviews of subjects in electronic search in databases of RIMA, MEDLINE, PUB-MED, MEDSCAPE, from 2013 to 2018 Clinical case: the clinical case of an immunocompetent adolescent with tuberculosis is represented. description of the natural history CONCLUSIONS: It is essential to know the extrapulmonary presentation corresponds to 21% of cases of tuberculosis can be asymptomatic or symptomatic with fever, cough and pleuritic pain.


Subject(s)
Humans , Female , Adolescent , Tuberculosis, Pleural/diagnosis , Immunocompetence
16.
Medicina (B.Aires) ; 79(4): 287-290, ago. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1040524

ABSTRACT

La histoplasmosis y la leishmaniasis son enfermedades olvidadas, endémicas en Argentina, y generalmente se asocian a inmunocompromiso. Presentamos el caso de un varón de 16 años, inmunocompetente, con histoplasmosis del sistema nervioso central y leishmaniasis cutánea. Inicialmente, el paciente presentó una lesión en la pierna de un mes de evolución seguida de paraparesia leve, diagnosticada como un proceso de desmielinización mediante estudios de imágenes. El cuadro fue tratado con altas dosis de corticoides y en 72 horas evolucionó a paraparesia grave con lesiones nodulares en las vértebras cervicales, observadas en las imágenes de resonancia magnética nuclear. Se aisló Histoplasma capsulatum de líquido cefalorraquídeo, genotípicamente identificado como perteneciente a la especie filogenética LamB. El paciente recibió tratamiento intravenoso con anfotericina B deoxicolato durante 30 días y posteriormente fluconazol e itraconazol oral durante un año. A los tres meses de iniciado el tratamiento con antifúngicos se reactivó la lesión de la pierna y en el examen directo se observaron amastigotes de Leishmania. La leishmaniasis cutánea fue tratada con antimoniato de meglumina intramuscular. La respuesta clínica al tratamiento de ambas enfermedades fue favorable.


Histoplasmosis and leishmaniasis are neglected and endemic diseases in Argentina, and generally are found associated with immunosuppression. We report the case of an immunocompetent 16-years-old man with simultaneous occurrence of central nervous system histoplasmosis and cutaneous leishmaniasis. Upon admission, the patient showed a one-month old skin lesion in a leg and mild paraparesis. Imaging studies detected thickening and edema in the spinal cord and the cerebrospinal fluid analysis was within normal range. The case was diagnosed as a demyelinating disorder and treated with high-dose short-term steroids. Seventy-two hours later the patient showed severe paraparesis and nuclear magnetic resonance imaging revealed nodular lesions in the spinal cord. Histoplasma capsulatum belonging to the phylogenetic species LamB was isolated from cerebrospinal fluid samples. The patient received intravenous antifungal therapy with amphotericin B for 30 days, followed by oral fluconazole and itraconazole for one year. Three months after initiation of antifungal treatment, the cutaneous lesion recrudesced and Leishmania amastigotes were observed on microscopic examination. The cutaneous leishmaniasis was treated with intramuscular meglumine antimoniate. The patient´s outcome was favorable after treatment for both diseases.


Subject(s)
Humans , Male , Adolescent , Leishmaniasis, Cutaneous/complications , Central Nervous System Fungal Infections/complications , Histoplasmosis/complications , Leishmaniasis, Cutaneous/diagnosis , Leishmaniasis, Cutaneous/drug therapy , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/drug therapy , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Immunocompetence , Anti-Bacterial Agents/administration & dosage , Antifungal Agents/administration & dosage
17.
Arq. neuropsiquiatr ; 77(5): 357-365, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011344

ABSTRACT

ABSTRACT Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). Objective: To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients. Methods: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection. Results: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients. Conclusion: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.


RESUMO Las infecciones causadas por el virus de inmunodeficiencia humana (VIH) y la larva de la Tenia solium siguen estando diseminadas en países en vías de desarrollo. Ambas patologías modifican el estado inmune y es posible que la infección por el VIH module la frecuencia y la patología de la neurocisticercosis (NCC). Objetivo: Describir los casos publicados de NCC en los pacientes VIH positivos y evaluar si las características de la NCC, incluyendo frecuencia, síntomas, presentación radiológica, respuesta a tratamiento, difieren entre los sujetos VIH positivos y VIH negativos. Métodos: Cuarenta casos con coinfección NCC/VIH fueron identificados en la literatura. Se compararon sus características clínico-radiológicas, así como su respuesta al tratamiento con diferentes series de casos históricos no pareados. Resultados: La mayoría de los pacientes NCC/VIH tenían epilepsia y múltiples parásitos vesiculares en el parénquima. Las características clínico-radiológicas de la NCC así como la evolución de los pacientes fueron similares entre pacientes VIH positivos y negativos, así como entre pacientes VIH inmunocomprometidos y no inmunocomprometidos. Conclusión: No encontramos interacciones claras entre VIH y NCC. Este resultado puede haber sido influenciado por el pequeño número de casos y la parcialidad de la información publicada. Un esfuerzo multiinstitucional, sistemático encaminado a reportar todos los casos de esta patología dual es necesario para confirmar estos resultados y esclarecer la relación entre patógenos.


Subject(s)
Humans , Male , Female , HIV Infections/complications , Neurocysticercosis/etiology , Coinfection/immunology , Coinfection/therapy , HIV Infections/immunology , HIV Infections/therapy , Treatment Outcome , AIDS-Related Opportunistic Infections/immunology , CD4 Lymphocyte Count , Neurocysticercosis/immunology , Neurocysticercosis/therapy , Immunocompetence
18.
Rev. chil. infectol ; 36(2): 167-178, abr. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1003665

ABSTRACT

Resumen Este documento incluye los recursos terapéuticos antiinfecciosos necesarios para pacientes inmunocomprometidos por terapia de cáncer o receptores de trasplante de precursores hematopoyéticos (TPH). Se aborda la terapia indicada para pacientes con las situaciones clínicas prevalentes en esta población y la terapia indicada para algunos microorganismos específicos. Según presentación clínica, se aborda el manejo de pacientes con: neutropenia febril sin foco, sepsis, infecciones del sistema nervioso central, neumonía, infecciones de piel y tejidos blandos, enterocolitis neutropénica e infección del tracto urinario. Se describe el arsenal terapéutico necesario, las dosis recomendadas y las precauciones especiales para el uso de antibacterianos, antivirales, antifúngicos y antiparasitarios en esta población, incluida la medición de concentraciones plasmáticas de ciertos fármacos en situaciones específicas.


This manuscript includes the antiinfective therapeutic resources for immunocompromised patients under chemotherapy by cancer or hematopoietic stem cells transplant (HSCT) receptors. The document presents the antimicrobial therapy indicated in the most prevalent clinical situations in this population and the primary and alternative therapy for some specific microorganisms. The clinical situations included in the analysis are: febrile neutropenia without focus, sepsis, infections of the central nervous system, pneumonia, skin and soft tissue infections, neutropenic enterocolitis and urinary tract infection. The therapeutic resources, recommended doses and special precautions for the use of antimicrobial recommended in bacterial, viral, fungal and parasitic infections in this population are described, including the measurement of plasma concentrations of certain drugs in specific situations.


Subject(s)
Humans , Hematopoietic Stem Cell Transplantation/adverse effects , Febrile Neutropenia/drug therapy , Infections/drug therapy , Anti-Infective Agents/administration & dosage , Neoplasms/complications , Neoplasms/therapy , Risk Factors , Treatment Outcome , Immunocompromised Host/drug effects , Practice Guidelines as Topic , Dose-Response Relationship, Drug , Immunocompetence/drug effects
19.
Rev. chil. infectol ; 36(2): 145-166, abr. 2019. tab
Article in Spanish | LILACS | ID: biblio-1003664

ABSTRACT

Resumen El enfrentamiento del diagnóstico diferencial y etiológico de las enfermedades infecciosas de los pacientes con cáncer, incluyendo los receptores de trasplante de precursores hematopoyéticos (TPH), debe corresponder a una decisión informada, oportuna y que repercuta directamente en una conducta médica que determine una mejor sobrevida y calidad de vida de los pacientes. El objetivo de este trabajo fue aportar en el manejo de estos pacientes desarrollando una herramienta útil al médico clínico para tomar estas decisiones. Para ello se agruparon las infecciones por sistemas comprometidos diferenciando los posibles agentes etiológicos en bacterias, virus, hongos y parásitos, explicitando los exámenes diagnósticos más relevantes, mencionando la o las técnicas recomendadas, junto con el tipo de muestra óptima para su adecuado procesamiento. De manera adicional, se incorporó el ítem "nivel de requerimiento" para sugerir lo que, a juicio de los autores y la evidencia existente, debe estar presente obligatoriamente en el centro o puede ser derivable a otro laboratorio.


The confrontation of the differential and etiological diagnosis of the infectious diseases of cancer patients, including hematopoietic stem cells transplant (HSCT) recipients, must correspond to an informed, timely decision that directly affects medical behavior that determines a better survival and quality of life for patients. The main goal of this work was to contribute to the management of these patients developing a useful tool for the clinician to make these decisions. For that, infections were grouped by compromised systems, differentiating the possible etiological agents in bacteria, viruses, fungi and parasites, highlighting the relevant diagnostic tests, mentioning the recommended techniques together with the optimal sample type for proper processing. In addition, under each group of techniques we added the item "level of requirement" to suggest what, in the opinion of the authors and the existing evidence, must be mandatory to have at local level or can be derivable to another laboratory.


Subject(s)
Humans , Laboratories, Hospital/standards , Cross Infection/diagnosis , Cross Infection/microbiology , Hematopoietic Stem Cell Transplantation/adverse effects , Neoplasms/complications , Biopsy/standards , Cross Infection/therapy , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/standards , Environmental Exposure/adverse effects , Immunocompetence , Neoplasms/therapy
20.
Rev. chil. infectol ; 36(2): 126-138, abr. 2019. graf
Article in Spanish | LILACS | ID: biblio-1003663

ABSTRACT

Resumen El ambiente hospitalario es una fuente potencial de exposición a patógenos como bacterias, hongos y parásitos, que pueden provocar infecciones en pacientes con cáncer incluyendo receptores de trasplante de precursores hematopoyéticos. Para aminorar este riesgo, se deben tener en cuenta los elementos de diseño, construcción y emplazamiento del área de atención de pacientes. Se entregan recomendaciones para proveer ambientes seguros, incluyendo características y uso de ambiente protegido, la definición de procesos críticos, equipos clínicos destinados a la atención de pacientes, sugerencias de ámbitos a supervisar y aspectos relativos a la calidad microbiológica del aire y agua.


The hospital environment is a potential source of exposure to pathogens such as bacteria, fungi and parasites that can cause infections in patients with cancer including transplanted hematopoietic precursors. To mitigate this risk, the design, construction and location elements of the patient care area must be taken into account. Recommendations are given to provide safe environments, including aspects related to characteristics and use of a protected environment, the definition of critical processes, clinical teams dedicated to the care of patients, suggestions of areas to be monitored, the microbiological quality of air and water.


Subject(s)
Humans , Cross Infection/microbiology , Cross Infection/prevention & control , Hematopoietic Stem Cell Transplantation/adverse effects , Equipment and Supplies, Hospital/microbiology , Hospital Design and Construction/methods , Neoplasms/complications , Water Microbiology , Risk Factors , Infection Control/methods , Risk Assessment , Air Microbiology , Environmental Exposure/adverse effects , Immunocompetence , Neoplasms/therapy
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