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1.
An. bras. dermatol ; 96(2): 196-199, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1248739

ABSTRACT

Abstract The authors present seven cases of rhinocerebral mucormycosis associated to diabetes mellitus, which is a disease with epidemic proportions affecting individuals worldwide, particularly in developing countries, and which poses significant morbidity and mortality. Mucormycosis is an opportunistic fungal infection with high mortality and requires an invasive therapeutic approach to save the patient's life with significant morbidity and sequelae, thus prevention is crucial.


Subject(s)
Humans , Opportunistic Infections/epidemiology , Diabetes Mellitus/epidemiology , Epidemics , Mucormycosis/diagnosis , Mucormycosis/epidemiology
3.
Biomédica (Bogotá) ; 35(4): 522-530, oct.-dic. 2015. graf, tab
Article in Spanish | LILACS | ID: lil-768082

ABSTRACT

Introducción. Acinetobacter baumannii es una bacteria oportunista que infecta a pacientes gravemente enfermos, principalmente con neumonía asociada al uso del respirador y bacteriemia. La aparición de resistencia a los carbapenémicos limita las opciones terapéuticas para el manejo de las infecciones ocasionadas por esta bacteria. Objetivo. Describir las características clínicas y moleculares de las infecciones ocasionadas por A. baumannii resistente a carbapenémicos en hospitales de Medellín. Materiales y métodos. Durante dos años se llevó a cabo un estudio descriptivo de corte transversal en cinco hospitales de Medellín. La información clínica provenía de las historias clínicas. La presencia de carbapenemasas se evaluó mediante el test tridimensional y la técnica de reacción en cadena de la polimerasa. La tipificación molecular se hizo con electroforesis en gel de campo pulsado y tipificación de secuencias de múltiples locus. Resultados. Se incluyeron 32 pacientes, 13 de los cuales presentaban infecciones de la piel y los tejidos blandos (n=7, 21,9 %), y osteomielitis (n=6, 18,7 %). Los porcentajes de resistencia fueron superiores a 80 % para todos los antibióticos evaluados, excepto para la colistina y la tigecilina. Las carbapenemasas OXA-23 y OXA-51, así como la secuencia de inserción IS Aba1 , se detectaron en todos los aislamientos. La electroforesis en gel de campo pulsado reveló una gran diversidad genética en los aislamientos, y la tipificación de secuencias de múltiples locus evidenció la circulación de los clones ST229 y ST758 en la ciudad. Conclusión. Contrario a lo reportado previamente, los resultados del estudio revelaron que la osteomielitis y las infecciones de la piel y los tejidos blandos eran los principales cuadros clínicos causados por A. baumannii resistente a carbapenémicos en instituciones de Medellín, y resaltan su importancia como agente etiológico de este tipo de infecciones.


Introduction: Acinetobacter baumannii is an opportunistic bacterium which infects seriously ill patients, particularly those with ventilator-associated pneumonia and bacteremia. The emergence of resistance to carbapenem limits the options for the treatment of infections caused by this bacterium. Objective: To describe the clinical and molecular characteristics of infections caused by carbapenem-resistant A. baumannii in Medellín hospitals. Materials and methods: A cross-sectional descriptive study was carried out in five Medellín hospitals over a 2-year period. Clinical information was obtained from medical histories of patients. The presence of carbapenemases was evaluated by three-dimensional test and PCR. Molecular typing was performed using PFGE and MLST. Results: The study included 32 patients, 13 of whom presented skin and soft tissue infections (n=7, 21.9%) or osteomyelitis (n=6, 18.7%). Resistance rates of the isolates exceeded 80% for all the antibiotics evaluated except colistin and tigecycline. Carbapenemases OXA-23 and OXA-51, as well as the insertion sequence IS Aba1 , were detected in all the isolates. PFGE revealed high genetic diversity in the isolates and MLST showed clones ST229 and ST758 are circulating in the city. Conclusion: In contrast to previous reports, the results of the present study showed osteomyelitis and infections of skin and soft tissues to be the main infections caused by carbapenem-resistant A. baumannii in Medellín hospitals and revealed its importance as an etiological agent for this type of infections.


Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Osteomyelitis/epidemiology , Acinetobacter Infections/epidemiology , Cross Infection/epidemiology , Skin Diseases, Bacterial/epidemiology , Soft Tissue Infections/epidemiology , beta-Lactam Resistance , Acinetobacter baumannii/isolation & purification , Osteomyelitis/microbiology , beta-Lactamases/genetics , Hospitals, Urban , Opportunistic Infections/microbiology , Opportunistic Infections/epidemiology , Acinetobacter Infections/microbiology , Cross Infection/microbiology , Cross-Sectional Studies , Electrophoresis, Gel, Pulsed-Field , Skin Diseases, Bacterial/microbiology , Colombia/epidemiology , Soft Tissue Infections/microbiology , beta-Lactam Resistance/genetics , Drug Resistance, Multiple, Bacterial , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/enzymology , Acinetobacter baumannii/genetics
4.
An. bras. dermatol ; 90(3): 334-337, May-Jun/2015. tab, graf
Article in English | LILACS | ID: lil-749656

ABSTRACT

Abstract BACKGROUND: Onychomycosis are caused by dermatophytes and Candida, but rarely by non- dermatophyte molds. These opportunistic agents are filamentous fungi found as soil and plant pathogens. OBJECTIVES: To determine the frequency of opportunistic molds in onychomycosis. METHODS: A retrospective analysis of 4,220 cases with onychomycosis, diagnosed in a 39-month period at the Institute of Dermatology and Skin surgery "Prof. Dr. Fernando A. Cordero C." in Guatemala City, and confirmed with a positive KOH test and culture. RESULTS: 32 cases (0.76%) of onychomycosis caused by opportunistic molds were confirmed. The most affected age group ranged from 41 to 65 years (15 patients, 46.9%) and females were more commonly affected (21 cases, 65.6%) than males. Lateral and distal subungual onychomycosis (OSD-L) was detected in 20 cases (62.5%). The microscopic examination with KOH showed filaments in 19 cases (59.4%), dermatophytoma in 9 cases (28.1%), spores in 2 cases (6.25%), and filaments and spores in 2 cases (6.25%). Etiologic agents: Aspergillus sp., 11 cases (34.4%); Scopulariopsis brevicaulis, 8 cases (25.0%); Cladosporium sp., 3 cases (9.4%); Acremonium sp., 2 cases (6.25%); Paecilomyces sp., 2 cases (6.25%); Tritirachium oryzae, 2 cases (6.25%); Fusarium sp., Phialophora sp., Rhizopus sp. and Alternaria alternate, 1 case (3.1%) each. CONCLUSIONS: We found onychomycosis by opportunistic molds in 0.76% of the cases and DLSO was present in 62.5%. The most frequent isolated etiological agents were: Aspergillus sp. and Scopulariopsis brevicaulis. .


Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Fungi , Onychomycosis/microbiology , Opportunistic Infections/microbiology , Age Distribution , Brazil/epidemiology , Fungi/isolation & purification , Onychomycosis/epidemiology , Opportunistic Infections/epidemiology , Retrospective Studies , Sex Distribution
5.
Article in English | IMSEAR | ID: sea-157606

ABSTRACT

In India, an opportunistic infection with HIV and associated complications accounts for considerable proportion of mortality. There exists definite CD4 cell count correlation with opportunistic infection in HIV patients. Objectives: To document the prevalence of HIV with correlation of different opportunistic infection with CD4 cell count. Material and Method: A total of 174 HIV positive patients either hospitalised or ART POD were studied for finding the spectrum of opportunistic infection and for HIV prevalence. Various samples were collected as per symptoms and clinical presentation. Result: Among opportunistic infection, most common were bacterial infection with 72.5%, followed by fungal infection 42.1% and parasitic infection with 25.8%. TB in 21 patients and candidacies in 5 patients were found in CD4 cell count <500 cell/μl followed by chronic diarrhoea with CD4 cell count <200 cell / μl. Conclusion: Prevalence of HIV infection in persons attending ICTC is 11.3%. TB is the most common opportunistic infection followed by candidacies and diarrhoea.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , CD4 Lymphocyte Count , Female , HIV , HIV Infections/complications , HIV Infections/epidemiology , HIV Infections/immunology , Humans , Male , Middle Aged , Opportunistic Infections/epidemiology , Opportunistic Infections/etiology , Opportunistic Infections/immunology , Prevalence , Young Adult
6.
Actual. SIDA. infectol ; 21(81): 84-94, sep.2013. tab
Article in Spanish | LILACS | ID: lil-777930

ABSTRACT

El virus linfotrópicos-T humanos tipo 1 (HTLV-1) es el agente etiológico de una enfermedad hematológica de mal pronóstico, la leucemia de células T del adulto (ATL) y de una enfermedad neurológica invalidante, la mielopatía asociada al HTLV-1/paraparesia espástica tropical (HAM/TSP) para las cuales no existe un tratamiento eficaz. El virus linfotrópico-T humano tipo 2 (HTLV-2) ha sido relacionado a síndromes neurológicos, aumento de infecciones y mortalidad. En Argentina, existe una restricción étnica/geográfica con una región endémica para el HTLV-1 en el Noroeste (Aymarás) y otra para el HTLV-2 en la Región Chaqueña (Tobas y Wichis). El aumento de corrientes migratorias a partir de áreas endémicas ha contribuido a la mayor circulación de estos virus en el país, hecho que plantea el desafío de poder brindar un diagnóstico final y una atención integral a los individuos. Este manuscrito comprende una revisión actualizada y la experiencia de nuestro grupo sobre estas infecciones...


HTLV-1 is the ethiologic agent of an hematologic disease with bad prognosis, Adult T-cell Leukemia (ATL) lethal in short time and a chronic and progressively invalidant neurological disease, HTLV-1 Associated Mielopathy/Tropical Spastic Paraparesis (HAM/TSP), for which no effective treatment is available. HTLV-2 has been related to neurologic syndromes, an increase in infections and mortality. In Argentina, the infection shows an ethnic/geographic restriction with an endemic regions for HTLV-1 in the Northeast (Aymaras) and for HTLV-2 in the Chaqueña Region (Tobas y Wichis). The increasing migrations from endemic areas have contributed to a major circulatin of these viruses and detection of HAM/TSP and ATL cases countrywide. This situation poses the challenge of giving a complete and final diagnosis and an integral care to infected individuals. This manuscript describes general aspects of HTLV-1/2 and the situation and experience of our group on these infections in the country...


Subject(s)
Humans , Blotting, Western , Enzyme-Linked Immunosorbent Assay , Endemic Diseases/prevention & control , Hematologic Diseases/etiology , Spinal Cord Diseases/immunology , Opportunistic Infections/epidemiology , Paraparesis, Tropical Spastic/pathology , Serologic Tests , Human T-lymphotropic virus 1/immunology , /immunology
7.
Braz. j. oral sci ; 12(3): 216-222, July-Sept. 2013. graf, tab
Article in English | LILACS | ID: lil-701309

ABSTRACT

AIM: To report the frequency of oral lesions in HIV-positive patients on Highly Active Antiretroviral Therapy (HAART), comparing with a non-HIV infected control group, and to correlate the presence of lesions with demographic and clinical features of HIV-seropositive patients. METHODS: A quantitative case-control study was conducted by a dental professional, using a questionnaire, analysis of medical records of patients and clinical examinations. RESULTS: According to the results, oral lesions were found in 23% of HIV-positive patients versus 5% in controls. Candidiasis (29%) and periodontal changes (25%) were the most frequent oral lesions found in these patients. Gender and viral load values were statistically significant when HIV-positive patients with and without oral lesions were compared. CONCLUSIONS: The results showed a change in lesion pattern of HIV patients on HAART, highlighting a high frequency of these new lesions and reinforcing the need for periodic dental evaluation of HIV-positive patients.


Subject(s)
Humans , Male , Female , Antiretroviral Therapy, Highly Active , Candidiasis, Oral/diagnosis , Periodontal Diseases/diagnosis , Wounds and Injuries/diagnosis , HIV , Bacterial Infections/diagnosis , Bacterial Infections/epidemiology , Opportunistic Infections/diagnosis , Opportunistic Infections/epidemiology
8.
Actual. SIDA. infectol ; 21(80): 37-41, jul. 2013.
Article in Spanish | LILACS | ID: lil-781696

ABSTRACT

Introducción: la histoplasmosis constituye la segunda micosis sistémica en orden de frecuencia en Argentina, después de criptococosis, en pacientes HIV positivos. En éstos, la forma clínica diseminada progresiva es marcadora de sida. La coinfección HIV-Histoplasmosis diseminada (HD) en nuestro país ha sido reportada entre 5,3 y 6 %. Métodos: estudio descriptivo, retrospectivo, realizado en un hospital de agudos de CABA, que incluyó pacientes HIV positivos con HD, en el período 2000-2011. Resultados: n:80. Edad, media (desvío estándar, DE): 37 años (8,1). Varones: 81,2%. CD4, mediana (rango intercuartil, RIC): 19,5 cél/µL (7-54). HD como primera marcadora de sida: 70%; serología HIV previa desconocida: 38,7 %. El 11,8% recibía terapia antirretroviral (TARV) al diagnóstico de HD. Otra infección oportunista concomitante al diagnóstico: 29,4%. Clínica 84,7% fiebre, 75% síndrome de impregnación, 72,2% síntomas respiratorios, 56,9% lesiones cutáneo-mucosas, 30,5% hepatosplenomegalia. Laboratorio: 76,2% anemia, 60,3% leucopenia, 42,1% plaquetopenia. Aislamientos: hemocultivos: 81,8%; muestras positivas: piel y mucosas: 39 pacientes, respiratorias: 16 pacientes, médula ósea: 6 pacientes. Radiografía de tórax patológica: 77,6%. Tratamiento: anfotericina B: 58,5%; itraconazol: 91%. Recaída: 21,2%. Mortalidad global: 20,2%, atribuible a HD: 5,9%. Conclusión: HD fue la primera marcadora en el 70% de los pacientes, alrededor de un 40% desconocían su serología y sólo 1 de cada 10 recibía TARV, lo que refleja un retraso en el diagnóstico de HIV en nuestra población. Las principales manifestaciones clínicas semejan otras infecciones oportunistas siendo importante la sospecha diagnóstica para el tratamiento temprano.


Introduction: Histoplasmosis is the second most frequente fungal infection in Argentina, after cryptococcosis in HIV positive patients. In these patients the disseminated clinical presentation is an AIDS-defining condition. Disseminated histoplasmosis (DH) and HIV coinfection has been reported between 5.3 and 6 % in Argentina. Methods: Retrospective, descriptive study, performed in an acute care hospital of Buenos Aires city, including HIV positive patients with DH, between 2000-2011. Results: n: 80. Mean age (standard deviation, SD): 37 years (8.1). Male: 81.2%. Median CD4 (interquartile range, IQR): 19.5 cells/uL (7-54). DH as the first AIDS defining condition: 70%; unknown prior HIV test: 38.7%. ONly 11.8% were receiving antiretroviral treatment at the time of diagnosis of DH. Other concomitant oportunistic infections: 29.4 %. Clinical manifestations: fever 84.7%, constitutinal symptoms 75%, respiratory symptoms 72.2 %, mucocutaneous lesions 56.9%, liver and/or spleen enlargement 30.5%. Laboratory abnormalities: anemia 76.2 %, leucopenia 60.3%, thrombocytopenia 42.1% Microbiological isolates: blood culture 81.8%; others positive samples: 39 of skin and mucosa, 16 of respiratory specimens, 6 of bone marrow. X-ray chest abnormalities: 77.6%. Treatment: amphotericin B: 58.5%; itraconazole: 91%. Relapse: 21.2%. Global mortality: 20.2%, DH atributable mortality: 5.9%. Conclusion: DH was the first AIDS defining condition in 70% of our patients, about 40% were unaware of their serostatus and only one in ten received antiretroviral treatment, reflecting a delay in diagnosis of HIV in our population. The main clinical manifestations resemble other oportunistic infections, so diagnostic of DH should be for considered in order to provide timely treatment.


Subject(s)
Humans , Male , Adult , Young Adult , Amphotericin B/therapeutic use , Epidemiologic Factors , Epidemiology, Descriptive , Histoplasmosis/diagnosis , Opportunistic Infections/epidemiology , Itraconazole/therapeutic use , Retrospective Studies , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/immunology , Acquired Immunodeficiency Syndrome/microbiology
9.
Rev. panam. salud pública ; 31(1): 48-53, ene. 2012. tab
Article in Spanish | LILACS | ID: lil-618467

ABSTRACT

OBJETIVO: Determinar la frecuencia de Candida en cavidad bucal de niños con riesgo de desarrollar infecciones oportunistas y establecer si existe asociación entre la frecuencia de esta colonización bucal y tres tipos de población en riesgo. MÉTODOS: Se estudiaron cuatro grupos de población infantil de México: grupo VIH/sida bajo terapia antirretroviral altamente activa (TAAA) (35 niñas y 25 niños); grupo desnutrición (26 niñas y 29 niños); grupo tarahumara (37 niñas y 20 niños), una de las poblaciones étnicas más pobres del país, y grupo control (8 niñas y 21 niños aparentemente sanos). Los niños con VIH/sida fueron inmunológica y virológicamente clasificados según los criterios de EC-Clearinghouse, mientras que la desnutrición fue determinada a través del índice peso/talla de la Organización Mundial de la Salud. Se tomó una muestra de la mucosa bucal con hisopo estéril, que fue incubada en agar dextrosa Sabouraud y en CHROMagar-Candida®. Las especies de Candida se confirmaron con la prueba API ID32C. RESULTADOS: Los grupos VIH/sida y desnutrición mostraron la frecuencia más alta de Candida spp. (51,7 por ciento y 38,2 por ciento, respectivamente) mientras que el grupo tarahumara presenta una frecuencia semejante a la del grupo control (17,5 por ciento vs 10,3 por ciento). Respecto a las especies de Candida, el grupo desnutrición mostró la mayor diversidad: C. albicans, C. tropicalis, C. krusei y C. glabrata. CONCLUSIONES: Los infantes con inmunodeficiencia y con desnutrición requieren de estrategias diseñadas para disminuir la colonización bucal candidal y disminuir el riesgo de infecciones oportunistas.


OBJECTIVE: Determine the frequency of candida in the oral cavity of children with a risk of developing opportunistic infections, and establish if there is an association between the frequency of this oral colonization and three categories of at-risk populations. METHODS: Four infant population groups in Mexico were studied: an HIV/AIDS group undergoing highly active antiretroviral therapy (35 girls and 25 boys); a malnourished group (26 girls and 29 boys); a group from the Tarahumara indigenous people, one of the poorest ethnic populations in the country (37 girls and 20 boys); and a control group (8 girls and 21 boys in apparently good health). The children with HIV/AIDS were immunologically and virologically classified according to the EC Clearinghouse criteria, while malnutrition was determined through the World Health Organization's weight/height index. A sample of oral mucosa was taken with a sterile swab, which was incubated in Sabouraud dextrose agar and in Candida CHROMagar®. The species of candida were confirmed through the API ID32C test. RESULTS: The HIV/AIDS and malnutrition groups showed the higher frequency of Candida spps (51.7 percent and 38.2 percent, respectively), while the frequency level in the Tarahumara group was similar to that of the control group (17.5 percent versus 10.3 percent). With regard to the species of candida, the malnutrition group had the greatest diversity: C. albicans, C. tropical, C. krusei, and C. glabrata. CONCLUSIONS: The children with HIV/AIDS and malnutrition require strategies designed to reduce oral candidal colonization and reduce the risk of opportunistic infections.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Candidiasis, Oral/epidemiology , HIV Infections/epidemiology , Indians, North American/statistics & numerical data , Malnutrition/epidemiology , Comorbidity , Cross-Sectional Studies , Candida/isolation & purification , Carrier State/epidemiology , Immunocompromised Host , Mexico , Mouth Mucosa/microbiology , Opportunistic Infections/epidemiology , Vulnerable Populations/statistics & numerical data
10.
Article in English | WPRIM | ID: wpr-223075

ABSTRACT

A total of 450 stool samples were collected from inpatient and outpatient clinics of Pediatric Department, Minia University Hospital, Minia District, Egypt. Two groups of patients were studied, including 200 immunosuppressed and 250 immunocompetent children. Stool samples were subjected to wet saline and iodine mounts. A concentration technique (formol-ether sedimentation method) was carried out for stool samples diagnosed negative by wet saline and iodine mounts. Samples were stained by 2 different methods; acid fast stain (modified Ziehl-Neelsen stain) and Giemsa stain. Total 188 cases (94%) were diagnosed positive for parasitic infections among immunosuppressed children, whereas 150 cases (60%) were positive in immunocompetent children (P<0.0001). The most common protozoan infection in immunosuppressed group was Cryptosporidium parvum (60.2%), followed by Blastocystis hominis (12.1%), Isospora belli (9.7%), and Cyclospora caytenensis (7.8%). On the other hand, Entamoeba histolytica (24.6%) and Giardia lamblia (17.6%) were more common than other protozoans in immunocompetent children.


Subject(s)
Animals , Child , Child, Preschool , Cross-Sectional Studies , Egypt/epidemiology , Feces/parasitology , Female , Helminthiasis/epidemiology , Helminths/classification , Humans , Immunocompromised Host , Male , Opportunistic Infections/epidemiology , Parasites/classification , Protozoan Infections/epidemiology
11.
Article in English | IMSEAR | ID: sea-33719

ABSTRACT

Southeast Asia is a region where the number of people infected with HIV/AIDS is one of the fastest growing in the world. Tuberculosis (TB) has grown along with the HIV epidemic. TB is not only the most common AIDS-defining illness but is also the leading cause of morbidity and mortality in AIDS patients. Cryptococcosis (meningitis or disseminated) is one of the most common opportunistic infections in AIDS patients. Cryptococcal meningitis is the first in the differential diagnosis considered with meningeal irritation. Penicillosis, a unique systemic mycosis, is an important emerging public health problem and has been classified as an AIDS defining illness in endemic areas like Thailand. Pneumocystis carinii (jiroveci) pneumonia has been one of the most important opportunistic infections in AIDS patients. Among parasitic infections, cryptosporidiosis is the most common intestinal protozoan infection relating to diarrhea in AIDS patients and toxoplasmosis is the only parasitic infection of the nervous system with a substantial incidence, up to 14.8%. Cytomegalovirus (CMV) retinitis has a lower prevalence compared to other opportunistic infections. In the era of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections has significantly reduced in the past few years. Subsequently, the phenomena of immune restoration inflammatory syndrome (IRIS) in AIDS patients has been reported in this region as a result of HAART.


Subject(s)
Asia, Southeastern/epidemiology , Cause of Death , Cytomegalovirus Retinitis/epidemiology , HIV Infections/drug therapy , Humans , Meningitis, Cryptococcal/epidemiology , Opportunistic Infections/epidemiology , Pneumonia, Pneumocystis/epidemiology , Tuberculosis/microbiology
12.
Indian J Pathol Microbiol ; 2007 Apr; 50(2): 453-7
Article in English | IMSEAR | ID: sea-75363

ABSTRACT

Renal transplant is usually performed at the end stage of renal disease. Most of the transplant recipients become susceptible to infections due to chronic uremia, protein depletion, anemia and administration of immunosuppressive drugs. It is a retrospective study of 510 post renal transplant recipients. 378 (74%) renal transplant recipients suffered from the infections. Most common site of infection was urinary tract infection (53%). Out of 26% of wound infections, the deep wound infection (23%) was six times higher than superficial wound infection (3.5%). Chest infection and bacteraemia were noticed to be 18% and 8%, respectively. The common isolate was Escherichia coli (160) followed by Staphylococcus aureus (140), Enterococcus (86) and Pseudomonas (69).


Subject(s)
Bacteremia/epidemiology , Central Nervous System Infections/epidemiology , Humans , India/epidemiology , Kidney Transplantation/adverse effects , Opportunistic Infections/epidemiology , Pneumonia/epidemiology , Retrospective Studies , Surgical Wound Infection/epidemiology , Urinary Tract Infections/epidemiology
13.
Rev. invest. clín ; 57(2): 368-380, mar.-abr. 2005. tab
Article in Spanish | LILACS | ID: lil-632494

ABSTRACT

The main problems in solid organ transplant recipients are rejection and infections. The new immunosuppressive regimens have lowered the risk of rejection, however, infections continue to be one of the most important determinants for morbidity and mortality in these patients. The survival of the transplanted organ is also impacted by the different infectious diseases that occur in the post-transplant period. These infections are of viral, bacterial, fungal and parasitic origin, and their presentation occurs characteristically within well defined risk periods after the transplant. The clinical presentation is commonly atypical; therefore for optimal management, it is necessary to have a through knowledge of the epidemiology and clinical manifestations of these problems, but most importantly, the experience of the clinician in the clinical approach and early detection will result in better outcomes. We review recent information regarding the infectious diseases that affect solid organ recipients according to the type of transplant, the post-transplant, risk factors before the transplant and the type of immunosuppressive therapy used, which are the main determinants for these complications and their prognosis.


Los problemas principales en el paciente sometido a trasplante de órgano sólido (TOS) son el rechazo del órgano y las infecciones. Los nuevos esquemas inmunosupresores han disminuido el riesgo de rechazo, sin embargo, las infecciones siguen siendo uno de los determinantes más importantes de morbilidad y mortalidad en estos pacientes. La sobrevida del órgano trasplantado es impactada también por los diversos procesos infecciosos que ocurren en el periodo postrasplante. Las infecciones que afectan a estos pacientes son de origen viral, bacteriano, fúngico y parasitario y su presentación ocurre característicamente dentro de periodos bien definidos de riesgo posterior al trasplante. La presentación clínica frecuentemente es atípica, por lo que para el manejo óptimo es necesario conocer la epidemiología y las manifestaciones clínicas de estos problemas, pero sobre todo la experiencia del clínico en el abordaje y en la detección temprana resulta en un mejor desenlace. En este artículo se revisa la información reciente sobre las enfermedades infecciosas que afectan a pacientes sometidos a TOS de acuerdo con el tipo de trasplante, al periodo postrasplante, a los factores de riesgo previo al trasplante y al tipo de terapia inmunosupresora utilizada, los cuales son los principales determinantes de estas complicaciones y de su pronóstico.


Subject(s)
Humans , Infections/etiology , Organ Transplantation , Postoperative Complications/etiology , Bacterial Infections/epidemiology , Bacterial Infections/etiology , Disease Susceptibility , Infection Control , Immunosuppression Therapy/adverse effects , Infections/epidemiology , Mycoses/epidemiology , Mycoses/etiology , Organ Specificity , Opportunistic Infections/epidemiology , Opportunistic Infections/etiology , Organ Transplantation/adverse effects , Parasitic Diseases/epidemiology , Parasitic Diseases/etiology , Postoperative Complications/epidemiology , Risk , Surgical Wound Infection/epidemiology , Surgical Wound Infection/etiology , Virus Activation , Virus Diseases/epidemiology , Virus Diseases/etiology
14.
Rev. argent. microbiol ; 37(1): 46-56, ene.-mar. 2005. ilus, tab
Article in Spanish | LILACS | ID: lil-634488

ABSTRACT

Se comunica el primer aislamiento de Histoplasma capsulatum var. capsulatum de un murciélago macho de la especie Eumops bonariensis, capturado en la ciudad de Buenos Aires en 2003. Los aislamientos fueron recuperados de bazo e hígado e identificados fenotípicamente. Se los comparó por PCR, con 17 aislamientos clínicos, 12 de pacientes residentes en la ciudad de Buenos Aires y cinco de otros países de América, usando los iniciadores 1283, (GTG)5, (GACA)4 y M13. Con los cuatro iniciadores, los perfiles de los aislamientos de murciélago resultaron idénticos entre sí y más relacionados a los de pacientes de Buenos Aires que a los de otros países (porcentaje de similitud: 91-100% y 55-87%, respectivamente). La alta relación genética entre los aislamientos obtenidos del murciélago y de los humanos residentes en Buenos Aires sugiere una fuente común de infección. Este es el primer registro de E. bonariensis infectado con H. capsulatum en el mundo, y el primer aislamiento del hongo en la población de quirópteros de la Argentina. Así como estos mamíferos actúan como reservorio y dispersan el hongo en la naturaleza, la infección en murciélagos urbanos podría asociarse al elevado número de casos de histoplasmosis entre pacientes inmunodeprimidos en la ciudad de Buenos Aires.


We report the first isolation of Histoplasma capsulatum var. capsulatum from a male bat Eumops bonariensis captured in Buenos Aires city in 2003. The pathogen was recovered from spleen and liver specimens, and was identified by its phenotypic characteristics. PCR with primers 1283, (GTG)5, (GACA)4 and M13 was used to compare both bat isolates with 17 human isolates, 12 from patients residing in Buenos Aires city, and 5 from other countries of the Americas. The profiles obtained with the four primers showed that both bat isolates were identical to each other and closer to Buenos Aires patients than to the other isolates (similarity percentage: 91-100% and 55-97%, respectively). The high genetic relationship between bat isolates and those from patients living in Buenos Aires suggests a common source of infection. This is the first record of E. bonariensis infected with H. capsulatum in the world, and the first isolation of the fungus in the Argentinean Chiroptera population. In the same way as these wild mammals act as reservoir and spread the fungus in the natural environment, infection in urban bats could well be associated with the increase in histoplasmosis clinical cases among immunosuppressed hosts in Buenos Aires city.


Subject(s)
Animals , Humans , Male , Chiroptera/microbiology , Histoplasma/isolation & purification , Americas , Argentina/epidemiology , Chiroptera/classification , Disease Reservoirs , DNA, Fungal/genetics , Histoplasma/genetics , Histoplasmosis/epidemiology , Histoplasmosis/microbiology , Histoplasmosis/transmission , Immunocompromised Host , Liver/microbiology , Opportunistic Infections/epidemiology , Opportunistic Infections/microbiology , Opportunistic Infections/transmission , Species Specificity , Spleen/microbiology , Urban Health
15.
EMJ-Emirates Medical Journal. 2005; 23 (1): 35-9
in English | IMEMR | ID: emr-70663

ABSTRACT

A total of 620 consenting patients were tested for HIV by rapid Elisa method in three government hospital in Wukari Local government area Taraba State, Nigeria between April 2001 and March 2002. Seropositive subjects were followed up on their subsequent visits to the hospital and using their hospital records to obtain information on their HIV status, other associated and opportunistic infections. A total of 124 [20%] subjects subdivided into males 58 [9.4%] and females 66 [10.6%] of those tested were positive for HIV. While 10 [1.6%] males and 14 [2.3%] females had developed AIDS. Six different infections were identified among the infected subjects including 39 cases of diarrhoea. 31 cases of pulmonary tuberculosis [PTB] 21, cases of oral candidiasis and 19 cases of skin/ soft tissue infections. There were 3 cases of urethral track infection and 24 cases of bronchopneumonia. The productive age group 15-50 years remains mainly the most affected group with the HIV scourge. The negative impact of polygamy, extramarital affairs and lack of women sex right. Empowerment and low level human development on the spread of HIV/AIDS is discussed


Subject(s)
Humans , Male , Female , Acquired Immunodeficiency Syndrome , AIDS-Related Opportunistic Infections/epidemiology , HIV/isolation & purification , Opportunistic Infections/epidemiology , Seroepidemiologic Studies
16.
Rev. argent. microbiol ; 36(3): 118-124, jul.-sep. 2004. ilus, tab
Article in Spanish | LILACS | ID: lil-634468

ABSTRACT

El síndrome del desmedro multisistémico postdestete (PMWS) fue descrito por primera vez en Canadá en el año 1991 y desde entonces un número creciente de casos han sido diagnosticados en todo el mundo. En la Argentina, el PMWS fue reportado por primera vez recientemente. Se estudiaron 48 cerdos de 5 a 12 semanas de edad con signos característicos de PMWS procedentes de 19 granjas. Si bien se desconoce la distribución real del virus en nuestro país se observó desde el año 2001 un número creciente de granjas con PMWS y distribuidas en las principales provincias productoras. La histopatología fue una herramienta diagnóstica importante en casos sospechosos de PMWS con la observación de diferentes grados de lesión. En los animales estudiados las infecciones secundarias pudieron ser importantes, ya sea por patógenos oportunistas o por complicaciones bacterianas.


Postweaning multisystemic wasting syndrome was first described in Canada in 1991 and at present an increasing number of cases has been diagnosed worldwide. In Argentina the first cases of PMWS were reported recently. Forty eight 5 to 12 week old pigs with signs characteristic of PMWS from 19 farms were studied. Although the real distribution of the virus in our country is not known it was observed an increasing number of farms with PMWS distributed in the major producing provinces. The histopathology was an important tool in diagnosis of suspicious cases of PMWS with the observation of different degrees of lesion. In the studied animals, the secondary infections, either by opportunistic pathogens or secondary bacteria could be important.


Subject(s)
Animals , Circoviridae Infections/veterinary , Swine Diseases/pathology , Wasting Syndrome/pathology , Argentina/epidemiology , Bacterial Infections/epidemiology , Bacterial Infections/microbiology , Bacterial Infections/pathology , Bacterial Infections/veterinary , Central Nervous System/pathology , Central Nervous System/virology , Circoviridae Infections/epidemiology , Circoviridae Infections/pathology , Circoviridae Infections/virology , Circovirus/isolation & purification , Giant Cells/virology , Inclusion Bodies, Viral/ultrastructure , Lymph Nodes/pathology , Lymph Nodes/virology , Macrophages/virology , Opportunistic Infections/epidemiology , Opportunistic Infections/microbiology , Opportunistic Infections/pathology , Opportunistic Infections/veterinary , Superinfection , Sus scrofa , Swine Diseases/epidemiology , Swine Diseases/virology , Viscera/pathology , Viscera/virology , Wasting Syndrome/epidemiology , Wasting Syndrome/virology
17.
Rev. invest. clín ; 56(2): 169-180, abr. 2004. ilus, tab
Article in Spanish | LILACS | ID: lil-632318

ABSTRACT

Las infecciones oportunistas (IO's) complican la evolución de los pacientes VIH-positivos. Se han observado diferencias regionales en la incidencia y en la prevalencia de las IO's en los pacientes con SIDA en relación con deficiencias inmunológicas, factores ambientales y a las condiciones socioeconómicas y sanitarias en el entorno de estos pacientes. Al inicio de la epidemia, la incidencia global de IO's alcanzó entre 60 y 100% de los pacientes VIH-positivos. Posteriormente, la incidencia de tuberculosis, de enteropatógenos, de Pneumocystis jiroveci y de Mycobacterium avium ha disminuido en el hemisferio occidental debido a la profilaxis farmacológica, a la mejoría en la atención médica y a la introducción de la terapia antirretroviral. Este fenómeno ha sido más obvio en Estados Unidos, en Europa occidental y en la mayoría de los países de América Latina. Al inicio de la epidemia de VIH, la frecuencia de las diferentes IO's en México fue similar en todos los reportes clínicos, la mayoría de los casos mostraban candidiasis mucocutánea o esofágica seguida por neumonía por P. jiroveci y enteritis por Cryptosporidium sp. Recientemente, se ha observado un incremento en el número de episodios de retinitis por CMV y de infección diseminada por M. avium como consecuencia de la sobrevida más prolongada de los pacientes VIH-positivos. En conclusión, las tasas de morbilidad y de mortalidad en los pacientes VIH-positivos han disminuido como resultado de la mejoría de la atención en el cuidado de estos pacientes, la aplicación de medidas de prevención específicas para IO's y más recientemente por la introducción de terapia antirretroviral muy activa.


Opportunistic infections (OI's) complicate the outcome of HIV-positive patients. There have been observed regional differences in the incidence and the prevalence of OI's in AIDS patients secondary to immunological deficiencies, environmental factors and socioeconomic and sanitary conditions. At the beginning of the epidemic, the global incidence of OI's in HIV-positive patients was between 60 and 100%. Later, the incidence of tuberculosis, intestinal pathogens, Pneumocystis jiroveci and Mycobacterium avium has decreased in the western hemisphere, because of the pharmacological prophylaxis, the improvement in the medical care and the introduction of the antiretroviral therapy. This phenomenon has been more evident in the United States, in Western Europe, and most Latin American countries. At the beginning of the HIV epidemic, the frequency of the different OI's in Mexico was similar among all the clinical reports; the majority of the cases showed mucocutaneous or esofagic candidiasis, followed by P. jiroveci pneumonia, and Cryptosporidium sp. enteritis. Recently, we have seen an increased in the number of episodes of CMV retinitis and M. avium disseminated infection as evidence of a prolonged survival of the HIV-positive patients. In conclusion, the morbidity and mortality rates in the HIV-positive patients have diminished as a result of the improvement of the medical care, the application of specific IO's prevention measures and more recently to the introduction of HAART. KEY WORDS. AIDS. HAART. Pneumocystis jiroveci. Mycobacterium avium. Toxoplasma gondii. Opportunistic infections.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , HIV Infections/complications , HIV Infections/epidemiology , Opportunistic Infections/complications , Opportunistic Infections/epidemiology , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , HIV Infections/transmission , Mexico/epidemiology , Opportunistic Infections/transmission , Time Factors
18.
Gac. méd. Méx ; 140(1): 59-69, ene.-feb. 2004. ilus, tab
Article in Spanish | LILACS | ID: lil-632143

ABSTRACT

La introducción de nuevos agentes antirretrovirales y el desarrollo de nuevos esquemas de profilaxis antimicrobiana contra agentes oportunistas, ha conducido a una mejor calidad de vida en los pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Estos nuevos esquemas de tratamiento han cambiado la epidemiología de las infecciones oportunistas que, previo al uso de terapia antirretroviral (AR V) altamente activa, se presentaban con una elevada frecuencia en los niños infectados por el VIH. Específicamente, la neumonía por Pneumocystis carinii (PCP) ocurría en 12 al 40% de estos pacientes y estaba asociada con una elevada mortalidad. Actualmente, el uso de la terapia antirretroviral combinada y la administración de esquemas de profilaxis han resultado en una disminución importante en los casos de PCP. Sin embargo, en países en vías de desarrollo como el nuestro, la terapia altamente activa y la administración de estas profilaxis no están al alcance de todos los pacientes, por lo se encuentran en alto riesgo de presentar infecciones oportunistas, sobre todo producidas por Pneumocystis carinii, las cuales pueden acortar y afectar notablemente su supervivencia. El propósito de este articulo es hacer una revisión de la neumonía debida al Pneumocystis carinii, con especial énfasis, en las características epidemiológicas, clínicas y terapéuticas de la enfermedad en niños con VIH/SIDA.


Introduction of new antiretroviral agents and development of new prophylaxis schedules against opportunistic microorganisms have allowed increase in survival as well as better quality of life in HIV-infected patients. These new treatment schedules have changed the epidemiology of opportunistic infections that previous to use of highly active antiretroviral therapy (HAART), fomerly occurred with high frequency in HIV-infected children. Specifically, pneumonia due to Pneumocystis carinii formerly occurred in 12 to 80% of these patients and was associated with high mortality. Currently, with use of combined antiretroviral therapy (ART) and prophylactic treatments important reduction of PCP has been observed. However, despite these benefits ART is not yet available for many patients from several developing countries who are at risk for opportunistic infections, mainly due to Pneumocystis carinii. which can affect life expectancy. Therefore, the purpose of this paper was a review of epidemiologic, clinical, and therapeutic characteristics of P. carinii pneumonia in HIV-infected children.


Subject(s)
Child , Humans , HIV Infections/complications , Opportunistic Infections/complications , Pneumocystis carinii , Pneumonia, Pneumocystis/complications , Algorithms , Opportunistic Infections/diagnosis , Opportunistic Infections/epidemiology , Opportunistic Infections/microbiology , Opportunistic Infections/therapy , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/epidemiology , Pneumonia, Pneumocystis/microbiology , Pneumonia, Pneumocystis/therapy , Survival Rate
19.
Indian J Med Sci ; 2000 Nov; 54(11): 491-4
Article in English | IMSEAR | ID: sea-67373

ABSTRACT

One hundred patients with chronic chest infection suffering for more than three months admitted into a tertiary referral Hospital, northeast India were examined for pulmonary mycoses. The morning sputum samples in 3 consecutive days with a throat swab of each patient were examined for detection, isolation and identification of the fungus. Study showed Pulmonary candidiasis in 50% of the patients where Candida albicans were having highest incidence of association followed by 5 other species of Candida. Pre-existing conditions like pulmonary tuberculosis, bronchogenic carcinoma, lung abscess, bronchial asthma make the lungs prone to be invaded by the candida species. Long term antibiotics and steroids therapy was found to be associated with pulmonary candidiasis. Other conditions like irradiation treatment, malignancy, diabetes mellitus and malnutrition were also found to be the predisposing factors which influence bronchopulmonary candidiasis.


Subject(s)
Candida/isolation & purification , Candidiasis/epidemiology , Chronic Disease , Hospitals/statistics & numerical data , Humans , India/epidemiology , Inpatients/statistics & numerical data , Lung Diseases, Fungal/epidemiology , Opportunistic Infections/epidemiology , Pharynx/microbiology , Population Surveillance , Prospective Studies , Respiratory Tract Infections/epidemiology
20.
Rev. Inst. Med. Trop. Säo Paulo ; 42(4): 225-30, July-Aug. 2000. tab
Article in English | LILACS | ID: lil-266056

ABSTRACT

Tuberculosis is one of the most frequent opportunistic infections after renal transplantation and occurred in 30 of 1264 patients transplanted between 1976 and 1996 at Hospital São Paulo - UNIFESP and Hospital Dom Silvério, Brazil. The incidence of 2.4 per cent is five times higher than the Brazilian general population. The disease occurred between 50 days to 18 years after the transplant, and had an earlier and worse development in patients receiving azathioprine, prednisone and cyclosporine, with 35 per cent presenting as a disseminated disease, while all patients receiving azathioprine and prednisone had exclusively pulmonary disease. Ninety percent of those patients had fever as the major initial clinical manifestation. Diagnosis was made by biopsy of the lesion (50 per cent), positivity to M. tuberculosis in the sputum (30 per cent) and spinal cerebral fluid analysis (7 per cent). Duration of treatment ranged from 6 to 13 months and hepatotoxicity occurred in 3 patients. The patients who died had a significant greater number of rejection episodes and received higher doses of corticosteroid. In conclusion, the administration of cyclosporine changed the clinical and histopathological pattern of tuberculosis occurring after renal transplantation.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Cyclosporine/pharmacology , Immunosuppressive Agents/pharmacology , Kidney Transplantation , Tuberculosis/immunology , Brazil/epidemiology , Cyclosporine/administration & dosage , Immunosuppressive Agents/administration & dosage , Incidence , Kidney Transplantation/immunology , Opportunistic Infections/epidemiology , Opportunistic Infections/immunology , Opportunistic Infections/pathology , Postoperative Period , Retrospective Studies , Tuberculosis/epidemiology , Tuberculosis/pathology
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